| 1. |
- Su, Guobin, et al.
(author)
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Dietary Phosphorus, Its Sources, and Mortality in Adults on Haemodialysis : The DIET-HD Study
- 2022
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In: Nutrients. - : MDPI AG. - 2072-6643. ; 14:19
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Journal article (peer-reviewed)abstract
- Dietary phosphorus restrictions are usually recommended for people on haemodialysis, although its impact on patient-relevant outcomes is uncertain. We aimed to evaluate the association between total phosphorus intake and its sources with mortality in haemodialysis. Phosphorus intake was ascertained within the DIET-HD study in 8110 adults on haemodialysis. Adjusted Cox regression analyses were conducted to evaluate the association between the total and source-specific phosphorus (plant-, animal-, or processed and other sources) with mortality. During a median 3.8 years of follow-up, there were 2953 deaths, 1160 cardiovascular-related. The median phosphorus intake was 1388 mg/day. Every standard deviation (SD) (896 mg/day) increase in total phosphorus was associated with higher all-cause mortality [hazard ratio (HR), 1.16; 95% confidence intervals (CI), 1.06–1.26] and cardiovascular mortality (HR, 1.18; 95% CI, 1.03–1.36). Every SD (17%) increase in the proportion of phosphorus from plant sources was associated with lower all-cause mortality (HR, 0.95; 95% CI, 0.90–0.99). Every SD (9%) increase in the proportion of phosphorus from the processed and other sources was associated with higher all-cause mortality (HR, 1.06; 95% CI, 1.02–1.10). A higher total phosphorus intake was associated with increased all-cause and cardiovascular death. This association is driven largely by the phosphorus intake from processed food. Plant based phosphorus was associated with lower all-cause mortality.
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| 2. |
- Su, Guobin, et al.
(author)
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Healthy Lifestyle and Mortality Among Adults Receiving Hemodialysis : The DIET-HD Study
- 2022
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In: American Journal of Kidney Diseases. - : Elsevier BV. - 0272-6386. ; 79:5, s. 688-698
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Journal article (peer-reviewed)abstract
- Rationale & Objective: A healthy lifestyle promotes cardiovascular health and reduces cardiac-related mortality in the general population, but its benefits for people receiving maintenance hemodialysis are uncertain. Study Design: Prospective cohort study. Setting & Participants: 5,483 of 9,757 consecutive adults receiving maintenance hemodialysis (January 2014 to June 2017, median dialysis vintage: 3.6 years) in a multinational private dialysis network and with complete lifestyle data. Exposure: Based on the American Heart Association's recommendations for cardiovascular prevention, a modified healthy lifestyle score was the sum of 4 components addressing use of smoking tobacco, physical activity, diet, and control of systolic blood pressure. Outcome: Cardiovascular and all-cause mortality. Analytical Approach: Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between lifestyle score (low [0-2 points] as the referent, medium [3-5], and high [6-8]) and mortality. Associations were expressed as adjusted hazard ratio (AHR) with 95% CI. Results: During a median of 3.8 years (17,451 person-years in total), there were 2,163 deaths, of which 826 were related to cardiovascular disease. Compared with patients who had a low lifestyle score, the AHRs for all-cause mortality among those with medium and high lifestyle scores were 0.75 (95% CI, 0.65-0.85) and 0.64 (95% CI, 0.54-0.76), respectively. Compared with patients who had a low lifestyle score, the AHRs for cardiovascular mortality among those with medium and high lifestyle scores were 0.73 (95% CI, 0.59-0.91) and 0.65 (95% CI, 0.49-0.85), respectively. Limitations: Self-reported lifestyle, data-driven approach. Conclusions: A healthier lifestyle is associated with lower all-cause and cardiovascular mortality among patients receiving maintenance hemodialysis.
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| 3. |
- Su, Guobin
(author)
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Infections in patients with chronic kidney disease : patterns, outcomes and the role of vitamin D for future prevention
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background: Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. Patients with CKD are at high risk of infections. Frequent episodes of infections with greater use of antibiotics might put this population at risk of infections caused by resistant organisms. Thus, infection issues in patients with CKD could be related to another public health problem - antibiotic resistance. Aim: To investigate the antibiotic resistant patterns of pathogens responsible for infections, ascertain short-term and long-term patient outcomes during and after hospitalizations with infections and explore the role of vitamin D for infection prevention in patients with CKD. Methods: The thesis consists of two observational studies (Paper I & II), one cohort study (Paper III) and one systematic review and meta-analysis (Paper IV). Paper I, II & III explored the association between kidney function (defined as estimated glomerular filtration rate, eGFR) and various outcomes. These outcomes included microbial pattern (Paper I), prevalence of infections with multi-drug resistant organisms (MDROs) in the first positive microbial cultures (Paper I), intensive care unit admission (Paper II), length of hospital stay (Paper II), medical expense (Paper II), and mortality (Paper II & III). These were assessed in patients hospitalized with infections, using electronic medical records from four hospitals from 2012 to 2015 in China. Paper IV obtained data from existing literature to explore the association of infections with vitamin D status or use of vitamin D in patients treated with long-term dialysis. Results: In adult patients hospitalized with infections, the proportion of Gram-negative bacteria decreased while the proportion of Gram-positive bacteria increased across eGFR strata. Compared with the reference eGFR, lower eGFR was associated with: higher odds of infections by MDROs (19% and 41% higher in those with eGFR between 30-59 ml/min/1.73 m2 and eGFR <30 ml/min/1.73 m2, respectively) (Paper I); more than twofold higher adjusted odds of ICU admission, longer median length of hospital stay (P< 0.001), inferred 20.0% higher costs in those with eGFR< 60 ml/min/1.73 m2 (P< 0.001) (Paper II); progressively increased risks of cardiovascular mortality (subdistribution hazard ratio [SHR] 2.15 for eGFR 30-59 mL/min/1.73m2; SHR 3.19 for eGFR<30 mL/min/1.73m2) (Paper III). In the systematic review of vitamin D and infections in patients treated with long-term dialysis, the risk of composite infections was 39% lower in those with high/normal levels of 25-hydroxy vitamin D than that in those with low levels. Compared to those who did not use vitamin D, the pooled adjusted risk of composite infection was 41% lower in those who used vitamin D (Paper IV). Conclusions: CKD patients hospitalized with infections have a higher risk of infections by MDROs, poorer in-hospital outcomes resulting in higher medical costs and increased risk of cardiovascular mortality in the long-run. Use of vitamin D to achieve high/normal serum levels of 25(OH)-vitamin D might help lowering the risk of infections in maintenance dialysis patients. Further research is needed to investigate the potential role of vitamin D therapy in infection prevention among non-dialysis dependent CKD patients.
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| 4. |
- Xu, Hong, et al.
(author)
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eGFR and the risk of community-acquired infections
- 2017
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In: American Society of Nephrology. Clinical Journal. - 1555-9041 .- 1555-905X. ; 12:9, s. 1399-1408
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Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVES: Community-acquired infections are common, contributing to adverse outcomes and increased health care costs. We hypothesized that, with lower eGFR, the incidence of community-acquired infections increases, whereas the pattern of site-specific infections varies.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 1,139,470 health care users (mean age =52±18 years old, 53% women) from the Stockholm CREAtinine Measurements Project, we quantified the associations of eGFR with the risk of infections, overall and major types, over 12 months.RESULTS: A total of 106,807 counts of infections were recorded throughout 1,128,313 person-years. The incidence rate of all infections increased with lower eGFR from 74/1000 person-years for individuals with eGFR=90-104 ml/min per 1.73 m(2) to 419/1000 person-years for individuals with eGFR<30 ml/min per 1.73 m(2). Compared with eGFR of 90-104 ml/min per 1.73 m(2), the adjusted incidence rate ratios of community-acquired infections were 1.08 (95% confidence interval, 1.01 to 1.14) for eGFR of 30-59 ml/min per 1.73 m(2) and 1.53 (95% confidence interval, 1.39 to 1.69) for eGFR<30 ml/min per 1.73 m(2). The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis became increasingly higher along with lower eGFR strata (e.g., low respiratory tract infection accounting for 25% versus 15% of community-acquired infections in eGFR<30 versus 90-104 ml/min per 1.73 m(2), respectively). Differences in incidence associated with eGFR were in general consistent for most infection types, except for nervous system and upper respiratory tract infections, for which no association was observed.CONCLUSIONS: This region-representative health care study finds an excess community-acquired infections incidence in individuals with mild to severe CKD. Lower respiratory tract infection, urinary tract infection, and sepsis are major infections in CKD.
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| 5. |
- Xu, Hong, et al.
(author)
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Estimated glomerular filtration rate and the risk of cancer
- 2019
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In: American Society of Nephrology. Clinical Journal. - 1555-9041 .- 1555-905X. ; 14:4, s. 530-539
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Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVES: Community-based reports regarding eGFR and the risk of cancer are conflicting. We here explore plausible links between kidney function and cancer incidence in a large Scandinavian population-based cohort.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In the Stockholm Creatinine Measurements project, we quantified the associations of baseline eGFR with the incidence of cancer among 719,033 Swedes ages ≥40 years old with no prior history of cancer. Study outcomes were any type and site-specific cancer incidence rates on the basis of International Classification of Diseases-10 codes over a median follow-up of 5 years. To explore the possibility of detection bias and reverse causation, we divided the follow-up time into different time periods (≤12 and >12 months) and estimated risks for each of these intervals.RESULTS: In total, 64,319 cases of cancer (affecting 9% of participants) were detected throughout 3,338,226 person-years. The relationship between eGFR and cancer incidence was U shaped. Compared with eGFR of 90-104 ml/min, lower eGFR strata associated with higher cancer risk (adjusted hazard ratio, 1.08; 95% confidence interval, 1.05 to 1.11 for eGFR=30-59 ml/min and adjusted hazard ratio, 1.24; 95% confidence interval, 1.15 to 1.35 for eGFR<30 ml/min). Lower eGFR strata were significantly associated with higher risk of skin, urogenital, prostate, and hematologic cancers. Any cancer risk as well as skin (nonmelanoma) and urogenital cancer risks were significantly elevated throughout follow-up time, but they were higher in the first 12 months postregistration. Associations with hematologic and prostate cancers abrogated after the first 12 months of observation, suggesting the presence of detection bias and/or reverse causation.CONCLUSIONS: There is a modestly higher cancer risk in individuals with mild to severe CKD driven primarily by skin and urogenital cancers, and this is only partially explained by bias.
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