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Article ; Online: Sodium-glucose cotransporter 2 inhibitors: are they ready for prime time in the management of lupus nephritis?

Wagner, Benjamin R / Rao, Panduranga S

2024 Volume 36, Issue 3, Page(s) 163–168

Abstract: Purpose of review: Lupus nephritis is a common complication of systemic lupus erythematosus and is associated with significant morbidity and mortality. The utility of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of lupus nephritis ...

Abstract	Purpose of review: Lupus nephritis is a common complication of systemic lupus erythematosus and is associated with significant morbidity and mortality. The utility of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of lupus nephritis is currently uncertain. Here, we summarize the rationale for their use among patient with lupus nephritis. Recent findings: SGLT2 inhibitors were initially developed as antihyperglycemic agents. They have since been shown to have additional, profound effects to slow the progression of chronic kidney disease and lessen the long-term risks of cardiovascular disease in large clinic trials of patients with chronic kidney disease, with and without diabetes, as well as in patients with and without proteinuria. Patients with recent exposure to immunosuppression were excluded from these trials due to concern for risk of infection. In the few, small trials of patients with lupus nephritis, SGLT2 inhibitors were found to be well tolerated. They have been shown to reduce proteinuria and to have modest beneficial effects on blood pressure and BMI among patients with lupus nephritis. They have not been shown to influence disease activity. Summary: SGLT2 inhibitors may have a role in mitigating the chronic renal and cardiovascular effects of lupus nephritis. They should be introduced after kidney function has been stabilized with appropriate immunosuppression, in conjunction with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. They currently have no role in active disease.
MeSH term(s)	Humans ; Glucose/metabolism ; Lupus Nephritis/drug therapy ; Lupus Nephritis/complications ; Proteinuria/drug therapy ; Proteinuria/etiology ; Renal Insufficiency, Chronic/complications ; Sodium/metabolism ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
Chemical Substances	Glucose (IY9XDZ35W2) ; Sodium (9NEZ333N27) ; Sodium-Glucose Transporter 2 Inhibitors
Language	English
Publishing date	2024-01-31
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1045317-9
ISSN	1531-6963 ; 1040-8711
ISSN (online)	1531-6963
ISSN	1040-8711
DOI	10.1097/BOR.0000000000001002
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Zs.A 3028: Show issues

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Article: Clinical Utility in Adopting Race-free Kidney Donor Risk Index.

Doshi, Mona D / Schaubel, Douglas E / Xu, Yuwen / Rao, Panduranga S / Sung, Randall S

Transplantation direct

2022 Volume 8, Issue 7, Page(s) e1343

Abstract: Recent events of racial injustice prompted us to study potential impact of removing race from kidney donor risk index (KDRI) calculator.: Methods: We used Scientific Registry for Transplant Recipients data to analyze outcomes of 66 987 deceased-donor ... ...

Abstract	Recent events of racial injustice prompted us to study potential impact of removing race from kidney donor risk index (KDRI) calculator. Methods: We used Scientific Registry for Transplant Recipients data to analyze outcomes of 66 987 deceased-donor kidney transplants performed in the United States between 2010 and 2016. Graft failure (GF) was defined as death or return to dialysis or requiring repeat transplant. We compared original KDRI and a race-free KDRI (Black donor coefficient zeroed out in the KDRI formula) with respect to recategorization of perceived GF risk (based on KDPI categories: ≤20, 21-34, 35-85, ≥86)' risk discrimination (using the C statistic) and predictive accuracy (using Brier score), and GF risk prediction (using Cox regression on time-to-GF). We used logistic regression to study the impact of donor race on discard probability. Results: There were 10 949 (16.3% of recipients) GF, and 1893 (17% of GFs) were among recipients of kidneys from Black donors. The use of race-free KDRI resulted in reclassification of 49% of kidneys from Black donors into lower GF risk categories. The impact on GF risk discrimination was minimal, with a relative decrease in C statistic of 0.16% and a change in GF predictive accuracy of 0.07%. For a given recipient/donor combination, transplants from Black (compared with non-Black) donors are estimated to decrease predicted graft survival at 1-y by 0.3%-3%, and 5-y by 1%-6%. Kidneys from Black donors are significantly more likely to be discarded (odds ratio adjusted for KDRI except race = 1.24). We estimate that an equal discard probability for Black and non-Black donors would yield 70 additional kidney transplants annually from Black donors. Conclusions: Use of race-free KDRI did not impact GF risk discrimination or predictive accuracy and may lower discard of kidneys from Black donors. We recommend use of race-free KDRI calculator acknowledging the possibility of miscalculation of GF risk in small proportion of kidneys from Black donors.
Language	English
Publishing date	2022-06-17
Publishing country	United States
Document type	Journal Article
ISSN	2373-8731
ISSN	2373-8731
DOI	10.1097/TXD.0000000000001343
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Article ; Online: Molecular epidemiology of norovirus variants detected in children under five years of age in Hyderabad, India.

Nagamani, K / Rani, Manisha / Reddy, Vishnuvardhan / Rao, Panduranga / Rajyalakshmi, Sushma / Pakalapaty, Sunitha

Indian journal of medical microbiology

2021 Volume 40, Issue 1, Page(s) 12–17

Abstract: Purpose: Noroviruses are common viral agents in acute diarrhea in all age groups worldwide. Norovirus has been classified into 10 genogroups, GI to GX with over 48 genotypes among them the GII.4 genotype has evolved over time with a clear pattern of ... ...

Abstract	Purpose: Noroviruses are common viral agents in acute diarrhea in all age groups worldwide. Norovirus has been classified into 10 genogroups, GI to GX with over 48 genotypes among them the GII.4 genotype has evolved over time with a clear pattern of periodic variant replacement. Immunity is strain or genotype specific with little or no protection conferred across genogroups. The present study was aimed to determine the epidemiology, prevalent genotypes of norovirus in children below five years of age in the Hyderabad region, India. Methods: The stool samples and clinical data were collected from 458 children below 5 years of age comprising of cases with acute gastroenteritis (n = 366) and a control group (n = 92) admitted to the pediatric ward. All the samples were tested for Norovirus by ELISA and RT-PCR. Sequencing was done for predominant strains. Results: 10.3% (n = 38) of cases and 3.2% (n = 3) of the control group were found to be Norovirus positive. Predominant genotypes were GII-82.5% followed by GI-12.5%. Conclusion: Sequencing and Phylogenetic analyses of 20 GII.4 strains was done. All of the isolates are clustered away from published the GII.4 variants thus suggesting the appearance of a new variant.
MeSH term(s)	Caliciviridae Infections/epidemiology ; Child ; Child, Preschool ; Feces ; Genotype ; Humans ; Infant ; Molecular Epidemiology ; Norovirus/genetics ; Phylogeny ; Prevalence
Language	English
Publishing date	2021-12-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1038798-5
ISSN	1998-3646 ; 0255-0857
ISSN (online)	1998-3646
ISSN	0255-0857
DOI	10.1016/j.ijmmb.2021.11.012
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Zs.A 2639: Show issues

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Article ; Online: Renal transplant failure has a devastating impact requiring greater recognition and support.

Rao, Panduranga S / Nunes, Julie Wright

Evidence-based nursing

2015 Volume 18, Issue 3, Page(s) 78

MeSH term(s)	Female ; Graft Rejection/psychology ; Grief ; Humans ; Kidney Transplantation ; Male
Language	English
Publishing date	2015-07
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	1425988-6
ISSN	1468-9618 ; 1367-6539
ISSN (online)	1468-9618
ISSN	1367-6539
DOI	10.1136/eb-2014-102008
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Zs.A 5184: Show issues

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Article ; Online: Prognostic utility of rhythmic components in 24-h ambulatory blood pressure monitoring for the risk stratification of chronic kidney disease patients with cardiovascular co-morbidity.

El Jamal, Nadim / Brooks, Thomas G / Cohen, Jordana / Townsend, Raymond R / Sosa, Giselle Rodriguez de / Shah, Vallabh / Nelson, Robert G / Drawz, Paul E / Rao, Panduranga / Bhat, Zeenat / Chang, Alexander / Yang, Wei / FitzGerald, Garret A / Skarke, Carsten

Journal of human hypertension

2024

Abstract: Chronic kidney disease (CKD) represents a significant global burden. Hypertension is a modifiable risk factor for rapid progression of CKD. We extend the risk stratification by introducing the non-parametric determination of rhythmic components in 24-h ... ...

Abstract	Chronic kidney disease (CKD) represents a significant global burden. Hypertension is a modifiable risk factor for rapid progression of CKD. We extend the risk stratification by introducing the non-parametric determination of rhythmic components in 24-h profiles of ambulatory blood pressure monitoring (ABPM) in the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study for Kidney Disease and Hypertension (AASK) cohort using Cox proportional hazards models. We find that rhythmic profiling of BP through JTK_CYCLE analysis identifies subgroups of CRIC participants that were more likely to die due to cardiovascular causes. While our fully adjusted model shows a trend towards a significant association between absent cyclic components and cardiovascular death in the full CRIC cohort (HR: 1.71,95% CI: 0.99-2.97, p = 0.056), CRIC participants with a history of cardiovascular disease (CVD) and absent cyclic components in their BP profile had at any time a 3.4-times higher risk of cardiovascular death than CVD patients with cyclic components present in their BP profile (HR: 3.37, 95% CI: 1.45-7.87, p = 0.005). This increased risk was not explained by the dipping or non-dipping pattern in ABPM. Due to the large differences in patient characteristics, the results do not replicate in the AASK cohort. This study suggests rhythmic blood pressure components as a potential novel biomarker to unmask excess risk among CKD patients with prior cardiovascular disease.
Language	English
Publishing date	2024-01-11
Publishing country	England
Document type	Journal Article
ZDB-ID	639472-3
ISSN	1476-5527 ; 0950-9240
ISSN (online)	1476-5527
ISSN	0950-9240
DOI	10.1038/s41371-023-00884-0
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Zs.A 2380: Show issues

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Article ; Online: Quality of life of older patients undergoing renal transplantation: finding the right immunosuppressive treatment.

Perlman, Rachel L / Rao, Panduranga S

Drugs & aging

2014 Volume 31, Issue 2, Page(s) 103–109

Abstract: Kidney transplantation is currently the best treatment for end-stage renal disease, both in terms of mortality benefit and quality of life (QOL). Elderly patients are a rapidly growing subset of the kidney transplant waiting list. While it is clear that ... ...

Abstract	Kidney transplantation is currently the best treatment for end-stage renal disease, both in terms of mortality benefit and quality of life (QOL). Elderly patients are a rapidly growing subset of the kidney transplant waiting list. While it is clear that elderly individuals have a mortality benefit from kidney transplant, it is less clear how to make sure these individuals benefit from optimal QOL following transplant. Several studies demonstrate superiority of some immunosuppressive regimens over others in the QOL domain. Tacrolimus has been shown to be associated with better QOL than cyclosporine (ciclosporin), as has corticosteroid-free immunosuppressive regimens. Similarly, patients on drug regimens, which tend to lessen the side effects, report better QOL. However, these studies are observational or cross-sectional and not focused exclusively on the elderly patient. More studies are needed to determine optimal immunosuppression regimens for elderly individuals. Additionally, further studies on determinants of QOL in elderly kidney transplant recipients are also needed.
MeSH term(s)	Aged ; Cyclosporine/therapeutic use ; Female ; Humans ; Immunosuppression/methods ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/psychology ; Male ; Middle Aged ; Quality of Life ; Renal Insufficiency/psychology ; Renal Insufficiency/therapy ; Research Design ; Tacrolimus/therapeutic use
Chemical Substances	Immunosuppressive Agents ; Cyclosporine (83HN0GTJ6D) ; Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2014-01-08
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	1075770-3
ISSN	1179-1969 ; 1170-229X
ISSN (online)	1179-1969
ISSN	1170-229X
DOI	10.1007/s40266-013-0149-x
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Zs.A 3481: Show issues

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Article ; Online: Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study.

Sullivan, Valerie K / Appel, Lawrence J / Anderson, Cheryl A M / Kim, Hyunju / Unruh, Mark L / Lash, James P / Trego, Marsha / Sondheimer, James / Dobre, Mirela / Pradhan, Nishigandha / Rao, Panduranga S / Chen, Jing / He, Jiang / Rebholz, Casey M

American journal of kidney diseases : the official journal of the National Kidney Foundation

2023 Volume 82, Issue 2, Page(s) 202–212

Abstract: Rationale & objective: Ultraprocessed foods are widely consumed in the United States and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the general population. We investigated associations between ... ...

Abstract	Rationale & objective: Ultraprocessed foods are widely consumed in the United States and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the general population. We investigated associations between ultraprocessed food intake and chronic kidney disease (CKD) progression, all-cause mortality, and incident CVD in adults with chronic kidney disease (CKD). Study design: Prospective cohort study. Setting & participants: Chronic Renal Insufficiency Cohort Study participants who completed baseline dietary questionnaires. Exposure: Ultraprocessed food intake (in servings per day) classified according to the NOVA system. Outcomes: CKD progression (≥50% decrease in estimated glomerular filtration rate [eGFR] or initiation of kidney replacement therapy), all-cause mortality, and incident CVD (myocardial infarction, congestive heart failure, or stroke). Analytical approach: Cox proportional hazards models adjusted for demographic, lifestyle, and health covariates. Results: There were 1,047 CKD progression events observed during a median follow-up of 7 years. Greater ultraprocessed food intake was associated with higher risk of CKD progression (tertile 3 vs tertile 1, HR, 1.22; 95% CI, 1.04-1.42; P=0.01 for trend). The association differed by baseline kidney function, such that greater intake was associated with higher risk among people with CKD stages 1/2 (eGFR≥60mL/min/1.73m Limitations: Self-reported diet. Conclusions: Greater ultraprocessed food intake may be associated with CKD progression in earlier stages of CKD and is associated with higher risk of all-cause mortality in adults with CKD. Plain language summary: Ultraprocessed foods are industrial formulations produced using ingredients and processes that are not commonly used in culinary preparations and contain few, if any, intact unprocessed foods. Ultraprocessed foods are widely consumed in the United States, and high intakes of such foods have been linked to cardiovascular disease, kidney disease, and mortality in the general population. In this study, we found that greater intake of ultraprocessed foods was associated with higher risk of kidney disease progression and mortality in adults with chronic kidney disease. Our findings suggest that patients with kidney disease may benefit from greater consumption of fresh, whole, and homemade or hand-prepared foods and fewer highly processed foods.
MeSH term(s)	Adult ; Humans ; United States/epidemiology ; Cohort Studies ; Prospective Studies ; Cardiovascular Diseases ; Risk Factors ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/therapy ; Renal Insufficiency, Chronic/complications ; Glomerular Filtration Rate ; Kidney ; Disease Progression
Language	English
Publishing date	2023-04-06
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2023.01.452
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Zs.A 1669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 468: Show issues

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Article ; Online: Quantifying lung ultrasound comets with a convolutional neural network: Initial clinical results.

Wang, Xianglong / Burzynski, Joseph S / Hamilton, James / Rao, Panduranga S / Weitzel, William F / Bull, Joseph L

Computers in biology and medicine

2019 Volume 107, Page(s) 39–46

Abstract: Lung ultrasound comets are "comet-tail" artifacts appearing in lung ultrasound images. They are particularly useful in detecting several lung pathologies and may indicate the amount of extravascular lung water. However, the comets are not always well ... ...

Abstract	Lung ultrasound comets are "comet-tail" artifacts appearing in lung ultrasound images. They are particularly useful in detecting several lung pathologies and may indicate the amount of extravascular lung water. However, the comets are not always well defined and large variations in the counting results exist between observers. This study uses a convolutional neural network to quantify these lung ultrasound comets on a 4864-image clinical lung ultrasound dataset labeled by the authors. The neural network counted the number of comets correctly on 43.4% of the images and has an intraclass correlation (ICC) of 0.791 with respect to human counting on the test set. The ICC level indicates a higher correlation level than previously reported ICC between human observers. The neural network was then deployed and applied to a clinical 6272-image dataset. The correlation between the automated comet counts and the clinical parameters was examined. The comet counts correlate positively with the diastolic blood pressure (p = 0.047, r = 0.448), negatively with ejection fraction (p = 0.061, r = -0.513), and negatively with BMI (p = 0.009, r = -0.566). The neural network can be alternatively formulated as a diagnostic test for comet-positive images with 80.8% accuracy. The results could potentially be improved with a larger dataset and a refined approach to the neural networks used.
MeSH term(s)	Adult ; Aged ; Artifacts ; Blood Pressure/physiology ; Extravascular Lung Water/diagnostic imaging ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Lung/diagnostic imaging ; Male ; Middle Aged ; Neural Networks, Computer ; Ultrasonography/methods
Language	English
Publishing date	2019-02-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	127557-4
ISSN	1879-0534 ; 0010-4825
ISSN (online)	1879-0534
ISSN	0010-4825
DOI	10.1016/j.compbiomed.2019.02.002
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Zs.A 653: Show issues

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Article ; Online: Prognostic score matching methods for estimating the average effect of a non-reversible binary time-dependent treatment on the survival function.

He, Kevin / Li, Yun / Rao, Panduranga S / Sung, Randall S / Schaubel, Douglas E

Lifetime data analysis

2019 Volume 26, Issue 3, Page(s) 451–470

Abstract: In evaluating the benefit of a treatment on survival, it is often of interest to compare post-treatment survival with the survival function that would have been observed in the absence of treatment. In many practical settings, treatment is time-dependent ...

Abstract	In evaluating the benefit of a treatment on survival, it is often of interest to compare post-treatment survival with the survival function that would have been observed in the absence of treatment. In many practical settings, treatment is time-dependent in the sense that subjects typically begin follow-up untreated, with some going on to receive treatment at some later time point. In observational studies, treatment is not assigned at random and, therefore, may depend on various patient characteristics. We have developed semi-parametric matching methods to estimate the average treatment effect on the treated (ATT) with respect to survival probability and restricted mean survival time. Matching is based on a prognostic score which reflects each patient's death hazard in the absence of treatment. Specifically, each treated patient is matched with multiple as-yet-untreated patients with similar prognostic scores. The matched sets do not need to be of equal size, since each matched control is weighted in order to preserve risk score balancing across treated and untreated groups. After matching, we estimate the ATT non-parametrically by contrasting pre- and post-treatment weighted Nelson-Aalen survival curves. A closed-form variance is proposed and shown to work well in simulation studies. The proposed methods are applied to national organ transplant registry data.
MeSH term(s)	Computer Simulation ; Humans ; Prognosis ; Statistics, Nonparametric ; Survival Analysis ; Treatment Outcome
Language	English
Publishing date	2019-10-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1479719-7
ISSN	1572-9249 ; 1380-7870
ISSN (online)	1572-9249
ISSN	1380-7870
DOI	10.1007/s10985-019-09485-x
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Article ; Online: Association between Depressive Symptom Trajectory and Chronic Kidney Disease Progression: Findings from the Chronic Renal Insufficiency Cohort Study.

Missikpode, Celestin / Ricardo, Ana C / Brown, Julia / Durazo-Arvizi, Ramon A / Fischer, Michael J / Hernandez, Rosalba / Porter, Anna C / Cook, Judith A / Anderson, Amanda / Dolata, Jacquie / Feldman, Harold I / Horwitz, Edward / Lora, Claudia / Wright Nunes, Julie / Rao, Panduranga S / Lash, James P

Kidney360

2023 Volume 4, Issue 5, Page(s) 606–614

MeSH term(s)	Humans ; Cohort Studies ; Depression/epidemiology ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/epidemiology ; Kidney Failure, Chronic/epidemiology
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	2641-7650
ISSN (online)	2641-7650
DOI	10.34067/KID.0000000000000087
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