Associations Between Lifestyle Factors and Reduced Kidney Function in US Older Adults: NHANES 1999-2016.

Objective: This study aimed to evaluate the associations between lifestyle factors and the estimated glomerular filtration rate (eGFR) levels in older adults by analyzing the United States National Health and Nutrition Examination Survey data (1999-2016). Methods: A total of 10,052 eligible participants were divided into two groups: reduced eGFR group (eGFR < 60 ml/min/1.73 m2) and normal group (eGFR ≥ 60 ml/min/1.73 m2). The primary factors were physical activity, alcohol consumption, smoking, and comorbidities. Results: Multivariable analysis revealed that older age, proteinuria, cardiovascular disease, diabetes, hyperuricemia, and hypertension were significantly associated with higher odds of reduced kidney function. Sufficient physical activity, current alcohol consumption, and being a current smoker were significantly associated with lower odds of reduced kidney function. However, subgroup analysis by sex revealed that the effects of proteinuria, current alcohol consumption, and sufficient physical activity were sex-specific. Conclusion: Several risk and beneficial factors for reduced kidney function in adults aged 65 and above in the United States were identified, but some of them might be sex-specific. Further studies are warranted to confirm these findings in other populations and countries.

Risk Factors for Chronic Kidney Disease in Older Adults with Hyperlipidemia and/or Cardiovascular Diseases in Taipei City, Taiwan: A Community-Based Cross-Sectional Analysis.

This cross-sectional study aimed to compare risk factors for chronic kidney disease (CKD) in older adults with or without dyslipidemia and/or cardiovascular diseases (CVD) in Taipei City, Taiwan. The data on 2912 participants with hyperlipidemia and/or CVD and 14,002 healthy control participants derived from the Taipei City Elderly Health Examination Database (2010 to 2011) were analyzed. The associations between conventional CKD risk factors and CKD were comparable between participants with and without hyperlipidemia. Participants with high uric acid and BUN had a higher risk of CKD if they also had hyperlipidemia and CVD [odds ratio (OR) in uric acid = 1.572, 95% CI 1.186-2.120, p < 0.05; OR in BUN = 1.271, 95% CI 1.181-1.379, p < 0.05]. The effect was smaller in participants with hyperlipidemia only (OR in uric acid = 1.291, 95% CI 1.110-1.507, p < 0.05; OR in BUN = 1.169, 95% CI 1.122-1.221, p < 0.05). The association between uric acid/BUN and CKD was also observed in the healthy population and participants with CVD only. In conclusion, older adults with hyperlipidemia and CVD are at high of CKD. Physicians should be alert to the potential for CKD in older patients with hyperlipidemia and CVD.

Association between lifestyle factors and decreased kidney function in older adults: a community-based cross-sectional analysis of the Taipei City elderly health examination database.

BACKGROUND: Impaired kidney function is the hallmark of chronic kidney disease (CKD), and is associated with increased risk of all-cause mortality in the elderly. In the present cross-sectional population-based study, we aimed to evaluate the associations between lifestyle factors (exercise habit, alcohol consumption, smoking history, and betel nut chewing) and decreased kidney function. METHODS: The data from the Taipei City Elderly Health Examination Database (2006 to 2012) were extracted. Associations between risk factors and reduced estimated Glomerular filtration rate (eGFR) were evaluated by regression and stratification analyses. RESULTS: A total of 297,603 participants were included in the final analysis, and 29.7% of them had reduced eGFR. Smoking was significantly associated with an elevated risk of reduced eGFR. While, physical exercise conferred to a significantly decreased adjusted odds ratio (aOR) in reduced eGFR (regular exercise, aOR = 0.79; occasional exercise, aOR = 0.87). Furthermore, the protective effect of exercise habit against reduced eGFR was not affected by comorbid conditions, such as hypertension, diabetes, obesity, and cardiovascular disease. CONCLUSIONS: Engaging in physical exercise was beneficially associated with reduced eGFR in older individuals. Longitudinal or prospective studies are warranted for confirmation and extrapolation of the current findings.

Changes of immunogenic profiles between a single dose and one booster influenza vaccination in hemodialysis patients - an 18-week, open-label trial.

Annual influenza vaccination is recommended, but its efficacy in dialysis population is still controversial. Here we aimed to compare the dynamic changes of immune response between various influenza vaccination protocols in hemodialysis patients. A 18-week open label, non-randomized, controlled trial was conducted during 2011-2012. The efficacy between unvaccinated, one- and two-dose regimens were evaluated in 175 hemodialysis patients. Immunogenic profiles were assessed by hemagglutination-inhibition assays. At 3-9 weeks post-vaccination, antibody responses were similar between the one- and two-dose regimens, while the seroprotection rates (antibody titer ≥1:40) for influenza A were 55.6-82.5% in the adult (18-60 years) and 33.3-66.7% in the elderly (>60 years). Meanwhile, the seroprotection rates for influenza B were low (4.0-25.0%). By 18 weeks post-vaccination, the seroprotection rates for influenza A and B declined (0.0-33.3%) in both the adult and elderly receiving one- or two-dose regimens. Of dialysis patients, at most 2.4% developed moderate to severe adverse effects(myalgia and headache) after vaccination. In conclusion, the two-dose regimen could not improve immune responses than the one-dose regimen in hemodialysis patients; meanwhile the induced protective antibodies of both regimens could not be maintained for more than 4 months. Modification of current influenza vaccination strategy in dialysis population should be re-considered.

Myeloperoxidase in chronic kidney disease: role of visceral fat.

AIM: Visceral fat is more significantly correlated with inflammation markers and oxidative stress than is subcutaneous fat. Myeloperoxidase is one inflammatory signal secreted after polymorphonuclear leukocytes are stimulated. However, few studies discuss the correlation between visceral fat and the inflammatory response in patients with chronic kidney disease (CKD). METHODS: Sixty-six patients with CKD were enrolled and 60 healthy participants. Visceral fat levels were obtained using bioelectrical impedance analysis. Traditional risk factors for myeloperoxidase were analyzed. RESULTS: Baseline myeloperoxidase levels were significantly different between patients and controls, and were correlated with visceral fat after they had been adjusted for residual renal function. A multivariate linear regression model revealed that the neutrophil count and visceral fat and serum albumin levels were significant predictors of plasma myeloperoxidase in patients with CKD, but not in controls. The neutrophil count was correlated with myeloperoxidase only in the CKD group. CONCLUSION: Visceral fat predicted plasma myeloperoxidase in patients with CKD, but not in healthy controls. Myeloperoxidase was probably contributed by primed and activated neutrophils that had been irritated by visceral fat in patients with CKD.

Poor immune response to a standard single dose non-adjuvanted vaccination against 2009 pandemic H1N1 influenza virus A in the adult and elder hemodialysis patients.

BACKGROUND: Hemodialysis patients have higher risk of mortality and morbidity when infected with 2009 pandemic H1N1 (pH1N1/09) virus. Depending on different methodologies and criteria, previous studies reported variable response rates to adjuvanted vaccines against pH1N1/09 virus in hemodialysis patients, however, the efficacy of non-adjuvanted vaccines, which are currently used in many countries such as the USA and Asian areas, has not been comprehensively evaluated in hemodialysis population before. METHODS: We evaluated the efficacy of a standard single 15 µg-dose of non-adjuvanted monovalent pH1N1/09 vaccine (AdimFlu-S) in vaccine-naïve 110 hemodialysis and 173 healthy participants. When enrolling, all participants had not any clinical symptom or sign suggesting pH1N1/09 infection since the index case was identified in Taiwan. Sera from all participants were tested by hemagglutination inhibition (HI) and micro-neutralization-ELISA (microNT-ELISA) tests before and 21 days after vaccination. The outcome parameters were seroconversion rate (≥ 4-fold in HI titer with titer ≥ 1:40), seroprotection rate (HI titers ≥ 1:40), seroresponse rate (≥ 4-fold increase in HI or microNT-ELISA titer), fold of increase in geometric mean (GM) titers, and adverse effects. RESULTS: In method A analyses, we included all participants' data in final analyses, and the seroconversion rates and the fold increase of GM titer after vaccination were 25.4% and 1.8 in adult (18-60-year olds) hemodialysis subgroup, and 23.4% and 1.8 in elder (>60-year olds) hemodialysis subgroup based on HI titers, which were all significantly lower than those of the corresponding healthy control subgroups. Similar trends were observed based on microNT-ELISA titers, further validating the results. Multivariable analysis revealed hemoglobin and cholesterol levels were significant predictors for seroresponse in hemodialysis patients, suggesting the possible impacts of nutrition status and anemia. In method B analyses, we excluded participants with pre-vaccination seroprotection (based on HI or microNT-ELISA criteria) in final analyses. The response rates in various subgroups from method B analyses were also similar as those from method A analyses. No severe adverse effect was noted. CONCLUSIONS: According to the European and U.S. criteria, a single 15 µg-dose of non-adjuvanted pH1N1/09 vaccination is safe but ineffective in both adult and elder hemodialysis patients. Further studies using multiple doses or higher antigen amount are warrant to define the most appropriate regimen.