Browsing by Author "Friedman, Allon N."
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Item A Systematic Review and Qualitative Analysis of Existing Dietary Mobile Applications for People With Chronic Kidney Disease(Elsevier, 2022) Russell, Carl R., III; Zigan, Clarisse; Wozniak, Kirsten; Soni, Kshaunish; Hill Gallant, Kathleen M.; Friedman, Allon N.; Medicine, School of MedicineObjective: The goal of this study was to systematically evaluate the quality of electronic applications (apps) available for chronic kidney disease (CKD) dietary management. Methods: The review consisted of (1) a systematic search for all mobile CKD diet apps available on the App Store and Google Play Store, (2) an evaluation to determine how well existing apps met criteria for an ideal app, and (3) a systematic literature review of publications found through Google Scholar, Mendeley, and PubMed that reviewed specific CKD diet apps and the broader field. Results: After applying systematic search criteria, 10 unique apps were identified. Ten of 14 criteria considered necessary in an ideal CKD diet app were applied to the 13 apps. Important criteria such as tailoring recommendations to CKD stage or individual dietary needs, tracking nutrient intake, allowing data to be accessible to clinicians, availability on different app platforms, and including CKD-friendly recipes were not consistently available in the apps. None of the apps used the most contemporary nutrition guidelines on which to base their recommendations. While the literature suggests there is demand for CKD diet apps, common shortcomings of available apps including barriers to usability, inclusion of erroneous information, the requirement of a high e-literacy level, user costs, lack of privacy, security, and interactive features, and the inability of caregivers or family members to use apps to assist in patient care. Conclusions: The few CKD dietary apps currently on the market for people with CKD have notable limitations in terms of content and software design. Opportunities therefore exist for improving on available CKD diet apps and thereby fulfilling an important unmet need for patients with CKD.Item AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19(Wolters Kluwer, 2021) Gupta, Shruti; Coca, Steven G.; Chan, Lili; Melamed, Michal L.; Brenner, Samantha K.; Hayek, Salim S.; Sutherland, Anne; Puri, Sonika; Srivastava, Anand; Leonberg-Yoo, Amanda; Shehata, Alexandre M.; Flythe, Jennifer E.; Rashidi, Arash; Schenck, Edward J.; Goyal, Nitender; Hedayati, S. Susan; Dy, Rajany; Bansal, Anip; Athavale, Ambarish; Nguyen, H. Bryant; Vijayan, Anitha; Charytan, David M.; Schulze, Carl E.; Joo, Min J.; Friedman, Allon N.; Zhang, Jingjing; Sosa, Marie Anne; Judd, Eric; Velez, Juan Carlos Q.; Mallappallil, Mary; Redfern, Roberta E.; Bansal, Amar D.; Neyra, Javier A.; Liu, Kathleen D.; Renaghan, Amanda D.; Christov, Marta; Molnar, Miklos Z.; Sharma, Shreyak; Kamal, Omer; Boateng, Jeffery Owusu; Short, Samuel A.P.; Admon, Andrew J.; Sise, Meghan E.; Wang, Wei; Parikh, Chirag R.; Leaf, David E.; STOP-COVID Investigators; Medicine, School of MedicineBackground: AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). Methods: We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients. Results: A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission. Conclusions: AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.Item Assessing Global Kidney Nutrition Care(Wolters Kluwer, 2022) Wang, Angela Yee-Moon; Okpechi, Ikechi G.; Ye, Feng; Kovesdy, Csaba P.; Brunori, Giuliano; Burrowes, Jerrilynn D.; Campbell, Katrina; Damster, Sandrine; Fouque, Denis; Friedman, Allon N.; Garibotto, Giacomo; Guebre-Egziabher, Fitsum; Harris, David; Iseki, Kunitoshi; Jha, Vivekanand; Jindal, Kailash; Kalantar-Zadeh, Kamyar; Kistler, Brandon; Kopple, Joel D.; Kuhlmann, Martin; Lunney, Meaghan; Mafra, Denise; Malik, Charu; Moore, Linda W.; Price, S. Russ; Steiber, Alison; Wanner, Christoph; Wee, Pieter Ter; Levin, Adeera; Johnson, David W.; Bello, Aminu K.; Medicine, School of MedicineBackground and objectives: Nutrition intervention is an essential component of kidney disease management. This study aimed to understand current global availability and capacity of kidney nutrition care services, interdisciplinary communication, and availability of oral nutrition supplements. Design, setting, participants, & measurements: The International Society of Renal Nutrition and Metabolism (ISRNM), working in partnership with the International Society of Nephrology (ISN) Global Kidney Health Atlas Committee, developed this Global Kidney Nutrition Care Atlas. An electronic survey was administered among key kidney care stakeholders through 182 ISN-affiliated countries between July and September 2018. Results: Overall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care. Only 48% of the 155 countries have dietitians/renal dietitians to provide this specialized service. Dietary counseling, provided by a person trained in nutrition, was generally not available in 65% of low-/lower middle-income countries and "never" available in 23% of low-income countries. Forty-one percent of the countries did not provide formal assessment of nutrition status for kidney nutrition care. The availability of oral nutrition supplements varied globally and, mostly, were not freely available in low-/lower middle-income countries for both inpatient and outpatient settings. Dietitians and nephrologists only communicated "sometimes" on kidney nutrition care in ≥60% of countries globally. Conclusions: This survey reveals significant gaps in global kidney nutrition care service capacity, availability, cost coverage, and deficiencies in interdisciplinary communication on kidney nutrition care delivery, especially in lower-income countries.Item Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19(American Medical Association, 2020-10-20) Gupta, Shruti; Wang, Wei; Hayek, Salim S.; Chan, Lili; Mathews, Kusum S.; Melamed, Michal L.; Brenner, Samantha K.; Leonberg-Yoo, Amanda; Schenck, Edward J.; Radbel, Jared; Reiser, Jochen; Bansal, Anip; Srivastava, Anand; Zhou, Yan; Finkel, Diana; Green, Adam; Mallappallil, Mary; Faugno, Anthony J.; Zhang, Jingjing; Velez, Juan Carlos Q.; Shaefi, Shahzad; Parikh, Chirag R.; Charytan, David M.; Athavale, Ambarish M.; Friedman, Allon N.; Redfern, Roberta E.; Short, Samuel A. P.; Correa, Simon; Pokharel, Kapil K.; Admon, Andrew J.; Donnelly, John P.; Gershengorn, Hayley B.; Douin, David J.; Semler, Matthew W.; Hernán, Miguel A.; Leaf, David E.; STOP-COVID Investigators; Medicine, School of MedicineImportance: Therapies that improve survival in critically ill patients with coronavirus disease 2019 (COVID-19) are needed. Tocilizumab, a monoclonal antibody against the interleukin 6 receptor, may counteract the inflammatory cytokine release syndrome in patients with severe COVID-19 illness. Objective: To test whether tocilizumab decreases mortality in this population. Design, Setting, and Participants: The data for this study were derived from a multicenter cohort study of 4485 adults with COVID-19 admitted to participating intensive care units (ICUs) at 68 hospitals across the US from March 4 to May 10, 2020. Critically ill adults with COVID-19 were categorized according to whether they received or did not receive tocilizumab in the first 2 days of admission to the ICU. Data were collected retrospectively until June 12, 2020. A Cox regression model with inverse probability weighting was used to adjust for confounding. Exposures: Treatment with tocilizumab in the first 2 days of ICU admission. Main Outcomes and Measures: Time to death, compared via hazard ratios (HRs), and 30-day mortality, compared via risk differences. Results: Among the 3924 patients included in the analysis (2464 male [62.8%]; median age, 62 [interquartile range {IQR}, 52-71] years), 433 (11.0%) received tocilizumab in the first 2 days of ICU admission. Patients treated with tocilizumab were younger (median age, 58 [IQR, 48-65] vs 63 [IQR, 52-72] years) and had a higher prevalence of hypoxemia on ICU admission (205 of 433 [47.3%] vs 1322 of 3491 [37.9%] with mechanical ventilation and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of <200 mm Hg) than patients not treated with tocilizumab. After applying inverse probability weighting, baseline and severity-of-illness characteristics were well balanced between groups. A total of 1544 patients (39.3%) died, including 125 (28.9%) treated with tocilizumab and 1419 (40.6%) not treated with tocilizumab. In the primary analysis, during a median follow-up of 27 (IQR, 14-37) days, patients treated with tocilizumab had a lower risk of death compared with those not treated with tocilizumab (HR, 0.71; 95% CI, 0.56-0.92). The estimated 30-day mortality was 27.5% (95% CI, 21.2%-33.8%) in the tocilizumab-treated patients and 37.1% (95% CI, 35.5%-38.7%) in the non-tocilizumab–treated patients (risk difference, 9.6%; 95% CI, 3.1%-16.0%). Conclusions and Relevance: Among critically ill patients with COVID-19 in this cohort study, the risk of in-hospital mortality in this study was lower in patients treated with tocilizumab in the first 2 days of ICU admission compared with patients whose treatment did not include early use of tocilizumab. However, the findings may be susceptible to unmeasured confounding, and further research from randomized clinical trials is needed.Item The Association Between Kidney Disease and Diabetes Remission in Bariatric Surgery Patients With Type 2 Diabetes(Elsevier, 2019-12) Friedman, Allon N.; Wang, Junyao; Wahed, Abdus S.; Docherty, Neil G.; Fennern, Erin; Pomp, Alfons; Purnell, Jonathan Q.; le Roux, Carel W.; Wolfe, Bruce; Medicine, School of MedicineRationale & objective: The association between bariatric surgery, type 2 diabetes, and chronic kidney disease (CKD) is poorly understood. We studied whether remission of type 2 diabetes induced by bariatric surgery influences markers of kidney disease, if CKD is associated with remission of diabetes after bariatric surgery, and if baseline levels of gut hormones and peptides modify these associations. Study design: Prospective observational study. Study participants: 737 bariatric surgery patients with type 2 diabetes who participated in a multicenter cohort study for up to 5 years. Predictors: Demographics, blood pressure, medications, type of bariatric surgery, anthropometrics, markers of kidney disease, and circulating levels of gut hormones and peptides. Outcomes: Estimated glomerular filtration rate (eGFR), urinary albumin excretion, prognostic risk for CKD, and remission of diabetes. Analytical approach: Linear mixed models for eGFR; generalized linear mixed models with logit link for albuminuria, prognostic risk for CKD, and diabetes remission. Results: Remission of diabetes at 5 years post-bariatric surgery was not independently associated with eGFR but was associated with lower risk for moderate/severe increase in albuminuria (risk ratio, 0.66; 95% CI, 0.48-0.90) and stabilization in prognostic risk for CKD. These findings were modified by baseline ghrelin level. Lower preoperative eGFR and greater prognostic risk for CKD were independently associated with reduced likelihood of diabetes remission. The association with preoperative GFR was modified by C-peptide level. Higher baseline circulating ghrelin level was independently associated with a lower prognostic risk for CKD. Limitations: A minority of participants had baseline CKD; lack of comparison group; no information on duration of diabetes, other clinical end points, or kidney biopsy results. Conclusions: Remission of type 2 diabetes 5 years after bariatric surgery was associated with improvements in albuminuria and stabilized prognostic risk for CKD, but not with eGFR. Lower kidney function and greater prognostic risk at the time of bariatric surgery was linked to a lower likelihood of diabetes remission. These results highlight the need to identify the mechanisms through which bariatric surgery may delay the long-term progression of CKD in type 2 diabetes. Keywords: C-peptide; CKD risk; Obesity; Roux-en-Y gastric bypass (RYGB); albuminuria; bariatric surgery; chronic kidney disease (CKD); diabetes remission; estimated glomerular filtration rate (eGFR); ghrelin; gut peptides; insulin; laparoscopic adjustable gastric banding (LAGB); modifiable risk factor; type 2 diabetes mellitus (T2DM); urinary albumin-creatinine ratio (UACR); weight loss.Item Association between plasma endocannabinoids and appetite in hemodialysis patients: A pilot study(Elsevier, 2016-07) Friedman, Allon N.; Kim, Jeffrey; Kaiser, Shaun; Pedersen, Theresa L.; Newman, John W.; Watkins, Bruce A.; Medicine, School of MedicineUremia-associated anorexia may be related to altered levels of long chain n-6 and n-3 polyunsaturated fatty acid (PUFA) derived circulating endocannabinoids (EC) and EC-like compounds that are known to mediate appetite. Our study's hypothesis was that such molecules are associated with appetite in patients with end-stage renal disease. A cross-sectional observational study was performed in 20 chronic hemodialysis patients (9 females, 11 males) and 10 healthy female controls in whom appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) and blood drawn in the fasting (and when applicable) pre-dialysis state. Blood levels of PUFA and EC were also measured. Higher blood levels of the long chain n-6 fatty acid 20:4n6 (arachidonic acid) and lower levels of the long chain n-3 fatty acid 20:5n3 (eicosapentaenoic acid) were observed in female hemodialysis patients compared to controls. No differences were observed between male and female patients. In female study participants strong correlations between specific EC-like compounds and total SNAQ scores were noted, including with the n-6 PUFA derived linoleoyl ethanolamide (L-EA; ρ=-0.60, P<.01) and the n-3 PUFA derived docosahexaenoyl ethanolamide (DH-EA; ρ=0.63, P<.01). The L-EA:DH-EA ratio was most strongly associated with the SNAQ score (ρ=-0.74, P≤.001), and its questions associated with appetite (ρ=-0.69, P≤.01) and satiety (ρ=-0.81, P≤.001). These findings support a link between circulating EC and appetite in hemodialysis patients.Item Bariatric Surgery and Risk of Death in Persons With Chronic Kidney Disease(Wolters Kluwer, 2022) Coleman, Karen J.; Shu, Yu-Hsiang; Fischer, Heidi; Johnson, Eric; Yoon, Tae K.; Taylor, Brianna; Imam, Talha; DeRose, Stephen; Haneuse, Sebastien; Herrinton, Lisa J.; Fisher, David; Li, Robert A.; Theis, Mary Kay; Liu, Liyan; Courcoulas, Anita P.; Smith, David H.; Arterburn, David E.; Friedman, Allon N.; Medicine, School of MedicineObjective: A retrospective cohort study investigated the association between having surgery and risk of mortality for up to 5 years and if this association was modified by incident ESRD during the follow-up period. Summary of Background Data: Mortality risk in individuals with pre-dialysis CKD is high and few effective treatment options are available. Whether bariatric surgery can improve survival in people with CKD is unclear. Methods: Patients with class II and III obesity and pre-dialysis CKD stages 3-5 who underwent bariatric surgery between January 1, 2006 and September 30, 2015 (n = 802) were matched to patients who did not have surgery (n = 4933). Mortality was obtained from state death records and ESRD was identified through state-based or healthcare system-based registries. Cox regression models were used to investigate the association between bariatric surgery and risk of mortality and if this was moderated by incident ESRD during the follow-up period. Results: Patients were primarily women (79%), non-Hispanic White (72%), under 65 years old (64%), who had a body mass index > 40kg/m 2 (59%), diabetes (67%), and hypertension (89%). After adjusting for incident ESRD, bariatric surgery was associated with a 79% lower 5-year risk of mortality compared to matched controls (hazard ratio = 0.21; 95% confidence interval: 0.14-0.32; P < 0.001). Incident ESRD did not moderate the observed association between surgery and mortality (hazard ratio = 1.59; 95% confidence interval: 0.31-8.23; P =0.58). Conclusions: Bariatric surgery is associated with a reduction in mortality in pre-dialysis patients regardless of developing ESRD. These findings are significant because patients with CKD are at relatively high risk for death with few efficacious interventions available to improve survival.Item Bariatric Surgery and Risk of Death in Persons with Chronic Kidney Disease(Wolters Kluwer, 2022-12-01) Coleman, Karen J.; Shu , Yu-Hsiang; Fischer , Heidi; Johnson , Eric; Yoon , Tae K.; Taylor , Brianna; Imam, Talha; DeRose , Stephen; Haneuse , Sebastien; Herrinton , Lisa J.; Fisher, David; Li , Robert A.; Theis, Mary Kay; Liu , Liyan; Courcoulas, Anita P.; Smith, David H.; Arterburn, David E.; Friedman, Allon N.; Medicine, School of MedicineObjective: A retrospective cohort study investigated the association between having surgery and risk of mortality for up to five years and if this association was modified by incident End Stage Renal Disease (ESRD) during the follow-up period. Summary Background Data: Mortality risk in individuals with pre-dialysis chronic kidney disease (CKD) is high and few effective treatment options are available. Whether bariatric surgery can improve survival in people with CKD is unclear. Methods: Patients with class II and III obesity and pre-dialysis CKD stages 3 – 5 who underwent bariatric surgery between 1/1/2006 and 9/30/2015 (n = 802) were matched to patients who did not have surgery (n = 4,933). Mortality was obtained from state death records and ESRD was identified through state-based or healthcare system-based registries. Cox regression models were used to investigate the association between bariatric surgery and risk of mortality and if this was moderated by incident ESRD during the follow-up period. Results: Patients were primarily women (79%), non-Hispanic White (72%), under 65 years old (64%), who had a BMI ≥ 40 kg/m2 (59%), diabetes (67%) and hypertension (89%). After adjusting for incident ESRD, bariatric surgery was associated with a 79% lower 5-year risk of mortality compared to matched controls (HR = 0.21; 95% CI: 0.14-0.32; p < .001). Incident ESRD did not moderate the observed association between surgery and mortality (HR = 1.59; 95% CI 0.31-8.23; p = .58). Conclusions: Bariatric surgery is associated with a reduction in mortality in pre-dialysis patients regardless of developing ESRD. These findings are significant because patients with CKD are at relatively high risk for death with few efficacious interventions available to improve survival.Item Benefits of Icosapent Ethyl Across the Range of Kidney Function in Patients With Established Cardiovascular Disease or Diabetes: REDUCE-IT RENAL(Wolters Kluwer, 2021-11-30) Majithia, Arjun; Bhatt, Deepak L.; Friedman, Allon N.; Miller, Michael; Steg, Ph. Gabriel; Brinton, Eliot A.; Jacobson, Terry A.; Ketchum, Steven B.; Juliano, Rebecca A.; Jiao, Lixia; Doyle, Ralph T., Jr.; Granowitz, Craig; Budoff, Matthew; Mason, R. Preston; Tardif, Jean-Claude; Boden, William E.; Ballantyne, Christie M.; Medicine, School of MedicineBackground: Chronic kidney disease is associated with adverse outcomes among patients with established cardiovascular disease (CVD) or diabetes. Commonly used medications to treat CVD are less effective among patients with reduced kidney function. Methods: REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) was a multicenter, double-blind, placebo-controlled trial that randomly assigned statin-treated patients with elevated triglycerides (135-499 mg/dL) who had CVD or diabetes and 1 additional risk factor to treatment with icosapent ethyl (4 g daily) or placebo. Patients from REDUCE-IT were categorized by prespecified estimated glomerular filtration rate (eGFR) categories to analyze the effect of icosapent ethyl on the primary end point (composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina) and key secondary end point (a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke). Results: Among the 8179 REDUCE-IT patients, median baseline eGFR was 75 mL·min-1·1.73 m-2 (range, 17-123 mL·min-1·1.73 m-2). There were no meaningful changes in median eGFR for icosapent ethyl versus placebo across study visits. Treatment with icosapent ethyl led to consistent reduction in both the primary and key secondary composite end points across baseline eGFR categories. Patients with eGFR <60 mL·min-1·1.73 m-2 treated with icosapent ethyl had the largest absolute and similar relative risk reduction for the primary composite end point (icosapent ethyl versus placebo, 21.8% versus 28.9%; hazard ratio [HR], 0.71 [95% CI, 0.59-0.85]; P=0.0002) and key secondary composite end point (16.8% versus 22.5%; HR 0.71 [95% CI, 0.57-0.88]; P=0.001). The numeric reduction in cardiovascular death was greatest in the eGFR <60 mL·min-1·1.73 m-2 group (icosapent ethyl: 7.6%; placebo: 10.6%; HR, 0.70 [95% CI, 0.51-0.95]; P=0.02). Although patients with eGFR <60 mL·min-1·1.73 m-2 treated with icosapent ethyl had the highest numeric rates of atrial fibrillation/flutter (icosapent ethyl: 4.2%; placebo 3.0%; HR 1.42 [95% CI, 0.86-2.32]; P=0.17) and serious bleeding (icosapent ethyl: 5.4%; placebo 3.6%; HR, 1.40 [95% CI, 0.90-2.18]; P=0.13), HRs for atrial fibrillation/flutter and serious bleeding were similar across eGFR categories (P-interaction for atrial fibrillation/flutter=0.92; P-interaction for serious bleeding=0.76). Conclusions: In REDUCE-IT, icosapent ethyl reduced fatal and nonfatal ischemic events across the broad range of baseline eGFR categories.Item Blood Levels of Endocannabinoids, Oxylipins, and Metabolites Are Altered in Hemodialysis Patients(MDPI, 2022-08-29) Watkins, Bruce A.; Friedman, Allon N.; Kim, Jeffrey; Borkowski, Kamil; Kaiser, Shaun; Fiehn, Oliver; Newman, John W.; Medicine, School of MedicineHemodialysis patients (HDPs) have higher blood pressure, higher levels of inflammation, a higher risk of cardiovascular disease, and unusually low plasma n-3 polyunsaturated fatty acid (PUFA) levels compared to healthy subjects. The objective of our investigation was to examine the levels of endocannabinoids (eCBs) and oxylipins (OxLs) in female HDPs compared to healthy matched female controls, with the underlying hypothesis that differences in specific PUFA levels in hemodialysis patients would result in changes in eCBs and OxLs. Plasma phospholipid fatty acids were analyzed by gas chromatography. Plasma was extracted and analyzed using ultra-performance liquid chromatography followed by electrospray ionization and tandem MS for eCBs and OxLs. The global untargeted metabolite profiling of plasma was performed by GCTOF MS. Compared to the controls, HDPs showed lower levels of plasma EPA and the associated OxL metabolites 5- and 12-HEPE, 14,15-DiHETE, as well as DHA derived 19(20)-EpDPE. Meanwhile, no changes in arachidonylethanolamide or 2-arachidonylglycerol in the open circulation were detected. Higher levels of multiple N-acylethanolamides, monoacylglycerols, biomarkers of progressive kidney disease, the nitric oxide metabolism-linked citrulline, and the uremic toxins kynurenine and creatine were observed in HDP. These metabolic differences in cCBs and OxLs help explain the severe inflammatory and cardiovascular disease manifested by HDPs, and they should be explored in future studies.