Browsing by Author "Smith, Abigail R."

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    Association of COVID-19 Versus COVID-19 Vaccination With Kidney Function and Disease Activity in Primary Glomerular Disease: A Report of the Cure Glomerulonephropathy Study
    (Elsevier, 2024) Wang, Chia-shi; Glenn, Dorey A.; Helmuth, Margaret; Smith, Abigail R.; Bomback, Andrew S.; Canetta, Pietro A.; Coppock, Gaia M.; Khalid, Myda; Tuttle, Katherine R.; Bou-Matar, Raed; Greenbaum, Larry A.; Robinson, Bruce M.; Holzman, Lawrence B.; Smoyer, William E.; Rheault, Michelle N.; Gipson, Debbie; Mariani, Laura H.; Cure Glomerulonephropathy (CureGN) Study Consortium; Pediatrics, School of Medicine
    Rationale & objective: Patients with glomerular disease (GN) may be at increased risk of severe COVID-19, yet concerns over vaccines causing disease relapse may lead to vaccine hesitancy. We examined the associations of COVID-19 with longitudinal kidney function and proteinuria and compared these with similar associations with COVID-19 vaccination. Study design: Observational cohort study from July 1, 2021, to January 1, 2023. Setting & participants: A prospective observational study network of 71 centers from North America and Europe (CureGN) with children and adults with primary minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy. Exposure: COVID-19 and COVID-19 vaccination. Outcome: Repeated measure of estimated glomerular filtration rate (eGFR); recurrent time-to-event outcome of GN disease worsening as defined by doubling of the urinary protein-creatinine ratio (UPCR) to at least 1.5g/g or increase in dipstick urine protein by 2 ordinal levels to 3+(300mg/dL) or above. Analytical approach: Interrupted time series analysis for eGFR. Prognostic matched sequential stratification recurrent event analysis for GN disease worsening. Results: Among 2,055 participants, 722 (35%) reported COVID-19 infection; of these, 92 (13%) were hospitalized, and 3 died (<1%). The eGFR slope before COVID-19 infection was-1.40mL/min/1.73m2 (± 0.29 SD); within 6 months after COVID-19 infection, the eGFR slope was-4.26mL/min/1.73m2 (± 3.02 SD), which was not significantly different (P=0.34). COVID-19 was associated with increased risk of worsening GN disease activity (HR, 1.35 [95% CI, 1.01-1.80]). Vaccination was not associated with a change in eGFR (-1.34mL/min/1.73m2±0.15 SD vs-2.16mL/min/1.73m2±1.74 SD; P=0.6) or subsequent GN disease worsening (HR 1.02 [95% CI, 0.79-1.33]) in this cohort. Limitations: Infrequent or short follow-up. Conclusions: Among patients with primary GN, COVID-19 infection was severe for 1 in 8 cases and was associated with subsequent worsening of GN disease activity, as defined by proteinuria. By contrast, vaccination against COVID-19 was not associated with change in disease activity or kidney function decline. These results support COVID-19 vaccination for patients with GN. Plain-language summary: In this cohort study of 2,055 patients with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy, COVID-19 resulted in hospitalization or death for 1 in 8 cases and was associated with a 35% increase in risk for worsening proteinuria. By contrast, vaccination did not appear to adversely affect kidney function or proteinuria. Our data support vaccination for COVID-19 in patients with glomerular disease.
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    Cardiovascular and Thromboembolic Events in Children and Adults With Glomerular Disease: Findings From the Cure GlomeruloNephropathy (CureGN) Network
    (Elsevier, 2024-07-20) Wadhwani, Shikha; Mansfield, Sarah A.; Smith, Abigail R.; Robinson, Bruce M.; Abdelghani, Eman; Al-Uzri, Amira; Ashoor, Isa F.; Bartosh, Sharon M.; Chishti, Aftab S.; Hayek, Salim S.; Hladunewich, Michelle A.; Kerlin, Bryce A.; Madapoosi, Siddharth S.; Mariani, Laura H.; Mottl, Amy K.; Rheault, Michelle N.; O'Shaughnessy, Michelle M.; Sperati, Christopher John; Srivastava, Tarak; Selewski, David T.; Wang, Chia-Shi; Wong, Craig S.; Weaver, Donald J., Jr.; Khalid, Myda; GlomeruloNephropathy (CureGN) Study Consortium; Pediatrics, School of Medicine
    Rationale & objective: Cardiovascular (CV) and thromboembolic (TE) events are known complications of glomerular disease (GD), but their incidence and risk factors are poorly characterized. This analysis describes CV and TE outcomes in the Cure GlomeruloNephropathy (CureGN) Network. Study design: Prospective cohort study. Setting & participants: CureGN is a prospective cohort study of children and adults with biopsy-proven minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), or IgA nephropathy (IgAN)/vasculitis (IgAV). Data from 2,545 children and adults (23% MCD, 23% MN, 25% FSGS, 29% IgAN/IgAV) was analyzed. Exposure: Estimated glomerular filtration rate (eGFR), proteinuria, serum albumin, tobacco use, body mass index, hypertension, renin-angiotensin-aldosterone system. Outcomes: CV and TE events. Analytic approach: Kaplan-Meier curves were used to estimate cumulative incidence, and multivariable Cox proportional hazards models were fitted to estimate associations of histologic diagnosis, age, biological sex, and race. Laboratory and other clinical data were evaluated separately in models adjusted for base model covariates. Results: Median follow-up time was 4.6 years (IQR 2.7-6.1). The cumulative incidence of first CV and TE event postbiopsy was 3% and 2% in children and 10% and 5% in adults, respectively. No association between GD subtype and risk of CV or TE event was detected. Older age and Black race were associated with higher risk of first CV and TE event {hazard ratio (HR) (95% confidence interval {CI}) per 5 years, CV = 1.17 (1.12-1.23); TE = 1.11 (1.05-1.18); for Black race, CV = 1.62 (1.03-2.56), TE = 2.25 (1.27-4.01)}. Lower eGFR, higher urinary protein-creatinine ratio (UPCR), and lower serum albumin levels at enrollment were associated with higher risk of first CV and TE event (eGFR per 10 mL/min/1.73 m2, CV = 0.87 [0.81-0.93], TE = 0.80 [0.73-0.88]; UPCR per mg/mg, CV = 1.04 [1.02-1.07], TE = 1.03 [1.00-1.07]; serum albumin per g/dL, CV = 0.75 [0.59-0.95], TE = 0.71 [0.53-0.96]). Limitations: Age of cohort, duration of follow-up. Conclusions: In the CureGN cohort, elevated risk of incident CV and TE events is associated with severity of kidney disease rather than GD subtype.
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    Experimental pain and auditory sensitivity in overactive bladder syndrome: a Symptoms of the Lower Urinary Tract Dysfunction Research Network (LURN) Study
    (Wolters Kluwer, 2022) Harte, Steven E.; Wiseman, Jon; Wang, Ying; Smith, Abigail R.; Yang, Claire C.; Helmuth, Margaret; Kreder, Karl; Kruger, Grant H.; Gillespie, Brenda W.; Amundsen, Cindy; Kirkali, Ziya; Lai, H. Henry; LURN Study Group; Anesthesia, School of Medicine
    Purpose: The objective of this study was to investigate the presence of nonbladder sensory abnormalities in participants with overactive bladder syndrome (OAB). Materials and methods: Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study participants with OAB symptoms and controls were recruited from 6 U.S. tertiary referral centers. Quantitative sensory testing (QST) was performed to determine pressure pain sensitivity at the thumbnail bed and auditory sensitivity. Fixed and mixed effect multivariable linear regressions and Weibull models were used to compare QST responses between groups. Pearson correlations were used to assess the relationship between QST measures. Associations between QST and self-reported symptoms were explored with linear regression. Results: A total of 297 participants were analyzed (191 OAB, 106 controls; 76% white, 51% male). OAB cases were older than controls (57.4 vs 52.2 years, p=0.015). No significant differences in experimental thumbnail (nonbladder) pain or auditory sensitivity were detected between OAB cases and controls. Correlations between pressure and auditory derived metrics were weak to moderate overall for both groups, with some significantly stronger correlations for cases. Exploratory analyses indicated increased pressure pain and auditory sensitivity were modestly associated with greater self-reported bladder pain and pain interference with physical function. Conclusions: As a group, no significant differences between OAB cases and controls were observed in experimental nonbladder pain or auditory sensitivity during QST. Associations between QST outcomes and clinical pain raise the possibility of centrally mediated sensory amplification in some individuals with OAB.
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    Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease
    (Elsevier, 2023) Krissberg, Jill R.; O’Shaughnessy, Michelle M.; Smith, Abigail R.; Helmuth, Margaret E.; Almaani, Salem; Aviles, Diego H.; Brathwaite, Kaye E.; Cai, Yi; Cattran, Daniel; Gbadegesin, Rasheed; Glenn, Dorey A.; Greenbaum, Larry A.; Iragorri, Sandra; Jain, Koyal; Khalid, Myda; Kidd, Jason; Kopp, Jeffrey; Lafayette, Richard; Lane, Jerome C.; Lugani, Francesca; Nestor, Jordan G.; Parekh, Rulan S.; Reidy, Kimberly; Selewski, David T.; Sethna, Christine B.; Sperati, C. John; Tuttle, Katherine; Twombley, Katherine; Vasylyeva, Tetyana L.; Weaver, Donald J., Jr.; Wenderfer, Scott E.; Gibson, Keisha; CureGN Consortium; Pediatrics, School of Medicine
    Rationale & objective: The effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown. Study design: Prospective cohort study. Setting & participants: 1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort. Exposure: Race and ethnicity as a participant-reported social factor. Outcome: Acute care utilization defined as hospitalizations or emergency department visits. Analytical approach: Multivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and acute care utilization. Results: Black or Hispanic participants had lower SES and more severe glomerular disease than White or Asian participants. Acute care utilization rates were 45.6, 29.5, 25.8, and 19.2 per 100 person-years in Black, Hispanic, White, and Asian adults, respectively, and 55.8, 42.5, 40.8, and 13.0, respectively, for children. Compared with the White race (reference group), Black race was significantly associated with acute care utilization in adults (rate ratio [RR], 1.76 [95% CI, 1.37-2.27]), although this finding was attenuated after multivariable adjustment (RR, 1.31 [95% CI, 1.03-1.68]). Black race was not significantly associated with acute care utilization in children; Asian race was significantly associated with lower acute care utilization in children (RR, 0.32 [95% CI 0.14-0.70]); no significant associations between Hispanic ethnicity and acute care utilization were identified. Limitations: We used proxies for SES and lacked direct information on income, household unemployment, or disability. Conclusions: Significant differences in acute care utilization rates were observed across racial and ethnic groups in persons with prevalent glomerular disease, although many of these difference were explained by differences in SES and disease severity. Measures to combat socioeconomic disadvantage in Black patients and to more effectively prevent and treat glomerular disease are needed to reduce disparities in acute care utilization, improve patient wellbeing, and reduce health care costs.