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1.
Eur J Clin Nutr ; 69(7): 786-90, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25293433

ABSTRACT

BACKGROUND/OBJECTIVES: An increased risk of mortality and cardiovascular disease (CVD) is observed in people with chronic kidney disease (CKD) even in early stages. Dietary sodium intake has been associated with important CVD and CKD progression risk factors such as hypertension and proteinuria in this population. We aimed to investigate the relationship between sodium intake and CVD or CKD progression risk factors in a large cohort of patients with CKD stage 3 recruited from primary care. SUBJECTS/METHODS: A total of 1733 patients with previous estimated glomerular filtration rate (eGFR) of 30-59 ml/min/1.73m(2), with a mean age 72.9±9.0 years, were recruited from 32 general practices in primary care in England. Medical history was obtained and participants underwent clinical assessment, urine and serum biochemistry testing. Sodium intake was estimated from three early-morning urine specimens using an equation validated for this study population. RESULTS: Sixty percent of participants who had estimated sodium intake above recommendation (>100 mmol/day or 6 g salt/day) also had higher diastolic blood pressure, mean arterial pressure (MAP), urinary albumin-to-creatinine ratio, high-sensitive C-reactive protein and uric acid and used a greater number of anti-hypertensive drugs. In multivariable regression analysis, excessive sodium intake was an independent predictor of MAP (B=1.57, 95% confidence interval (CI) 0.41-2.72; P=0.008) and albuminuria (B=1.35, 95% CI 1.02-1.79; P=0.03). CONCLUSIONS: High sodium intake was associated with CVD and CKD progression risk factors in patients with predominantly early stages of CKD followed up in primary care. This suggests that dietary sodium intake could afffect CVD risk even in early or mild CKD. Intervention studies are warranted to investigate the potential benefit of dietary advice to reduce sodium intake in this population.


Subject(s)
Cardiovascular Diseases/etiology , Kidney Failure, Chronic/etiology , Sodium, Dietary/poisoning , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Cardiovascular Diseases/epidemiology , Cohort Studies , Cross-Sectional Studies , Disease Progression , England/epidemiology , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Hypertension/etiology , Incidence , Inflammation Mediators/blood , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/urine , Male , Primary Health Care , Prospective Studies , Proteinuria/epidemiology , Proteinuria/etiology , Risk Factors , Severity of Illness Index , Sodium/urine
2.
J Am Geriatr Soc ; 40(9): 922-35, 1992 Sep.
Article in English | MEDLINE | ID: mdl-1512391

ABSTRACT

OBJECTIVE: The purpose of this paper is to provide a comprehensive review of information accumulated over the past 26 years regarding the psychometric properties and utility of the Mini-Mental State Examination (MMSE). PARTICIPANTS: The reviewed studies assessed a wide variety of subjects, ranging from cognitively intact community residents to those with severe cognitive impairment associated with various types of dementing illnesses. MAIN OUTCOME MEASURES: The validity of the MMSE was compared against a variety of gold standards, including DSM-III-R and NINCDS-ADRDA criteria, clinical diagnoses, Activities of Daily Living measures, and other tests that putatively identify and measure cognitive impairment. RESULTS: Reliability and construct validity were judged to be satisfactory. Measures of criterion validity showed high levels of sensitivity for moderate-to-severe cognitive impairment and lower levels for mild degrees of impairment. Content analyses revealed the MMSE was highly verbal, and not all items were equally sensitive to cognitive impairment. Items measuring language were judged to be relatively easy and lacked utility for identifying mild language deficits. Overall, MMSE scores were affected by age, education, and cultural background, but not gender. CONCLUSIONS: In general, the MMSE fulfilled its original goal of providing a brief screening test that quantitatively assesses the severity of cognitive impairment and documents cognitive changes occurring over time. The MMSE should not, by itself, be used as a diagnostic tool to identify dementia. Suggestions for the clinical use of the MMSE are made.


Subject(s)
Cognition Disorders/diagnosis , Psychiatric Status Rating Scales/statistics & numerical data , Activities of Daily Living , Age Factors , Aged , Cognition Disorders/psychology , Dementia/diagnosis , Dementia/psychology , Female , Humans , Probability , Psychiatric Status Rating Scales/standards , Psychological Tests/standards , Psychological Tests/statistics & numerical data , Psychometrics , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , Sex Factors
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