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Al-Aly Z.,Saint Louis Veterans Affairs Medical Center | Al-Aly Z.,Saint Louis Veterans Affairs Clinical Research and Epidemiology Center | Zeringue A.,Saint Louis Veterans Affairs Clinical Research and Epidemiology Center | Fu J.,Saint Louis Veterans Affairs Clinical Research and Epidemiology Center | And 11 more authors.
Journal of the American Society of Nephrology | Year: 2010

The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the definition of CKD may transform a static definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual. Copyright © 2010 by the American Society of Nephrology.

Ricardo A.C.,University of Illinois at Chicago | Yang W.,University of Pennsylvania | Anderson C.,Johns Hopkins Medical Institution | Menezes M.,University of Illinois at Chicago | And 5 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2013

Background and objective Among general populations, a healthy lifestyle has been associated with lower risk of death. This study evaluated this association in individuals with CKD. Design, setting, participants,&measurementsAtotal of 2288 participantswithCKD(estimatedGFR<60 ml/min per 1.73m2 ormicroalbuminuria) in the ThirdNationalHealth andNutrition Examination Surveywere included. A weighted healthy lifestyle score was calculated (range, 24 to 15, with 15 indicating healthiest lifestyle) on the basis of the multivariable Cox proportional hazards model regression coefficients of the following lifestyle factors: smoking habit, bodymass index (BMI), physical activity, and diet.Main outcomewas all-causemortality, ascertained through December 31, 2006. Results Aftermedian follow-up of 13 years, 1319 participants had died. Compared with individuals in the lowest quartile of weighted healthy lifestyle score, adjusted hazard ratios (95% confidence intervals) of all-cause mortality were 0.53 (0.41-0.68), 0.52 (0.42-0.63), and 0.47 (0.38-0.60) for individuals in the second, third, and fourth quartiles, respectively. Mortality increased 30% among individuals with a BMI of 18.5 to <22 kg/m2 versus 22 to <25 kg/m2 (P<0.05); decreased mortality was associated with never-smoking versus current smoking (0.54 [0.41-0.70]) and regular versus no physical activity (0.80 [0.65-0.99]). Diet was not significantly associated with mortality. Conclusions Compared with nonadherence, adherence to a healthy lifestyle was associated with lower all-cause mortality risk in CKD. Examination of individual components of the healthy lifestyle score, with adjustment for other components, suggested that the greatest reduction in all-cause mortality was related to nonsmoking. © 2013 by the American Society of Nephrology.

Prasad B.,University of Illinois at Chicago | Carley D.W.,University of Illinois at Chicago | Krishnan J.A.,University of Illinois at Chicago | Weaver T.E.,University of Illinois at Chicago | Weaver F.M.,Center for Management of Complex Chronic Care
Journal of Clinical Sleep Medicine | Year: 2012

Purpose: Mechanistic and observational studies support an independent increase in risk of hypertension and abnormal glucose metabolism associated with obstructive sleep apnea (OSA). However, the specifi c populations and outcomes that improve with treatment of OSA in clinical practice are not established. We examined the effectiveness of OSA treatment on clinical blood pressure and diabetes control measures in men with preexisting systemic hypertension or type 2 diabetes. Methods: A retrospective cohort of veterans (n = 221) with a new diagnosis of OSA and initiation of positive airway pressure treatment was identifi ed using administrative databases and clinical records. Measurements and Results: Outcomes were changes in blood pressure (BP; mean of 3 highest recordings; systolic and diastolic) and glycemic control (mean of 3 highest fasting glucose and hemoglobinA1C values) at 3-6 months (T1) and 9-12 months (T2) following treatment compared to pretreatment. A generalized estimating equation model was used with adjustment for potential confounders: demographics, body mass index (BMI), OSA severity, Charlson comorbidity index, and pharmacologic treatment for hypertension and diabetes. Sustained independent effects of OSA treatment (mean change [95% CI]) were noted in both systolic BP (T1; -7.44 [-10.41 to -4.47] and T2; -6.81 [-9.94 to -3.67]) and diastolic BP (T1; -3.14, [-4.99 to -1.29] and T2; -3.69, [-5.53 to -1.85]). Diabetes control measures did not change with OSA treatment. Conclusions: Treatment of OSA improves offi ce blood pressure in hypertensive men. Prospective studies are necessary to better characterize specifi c populations with OSA that benefi t from treatment with respect to progression of hypertension and type 2 diabetes.

Rimmer J.H.,University of Alabama at Birmingham | Wang E.,University of Illinois at Chicago | Pellegrini C.A.,Northwestern University | Lullo C.,University of Illinois at Chicago | Gerber B.S.,Center for Management of Complex Chronic Care
American Journal of Physical Medicine and Rehabilitation | Year: 2013

Objective: Weight reduction programs are not generally designed or adapted for people with physical disabilities. This study examined the effect of a 9-months remote, telephone-based weight management program for people with physical disabilities using a Web-based system (Personalized Online Weight and Exercise Response System [POWERS]). Design: A total of 102 participants (mean ± SD age, 46.5 ± 12.7 yrs; body mass index, 32.0 ± 5.8 kg/m) with a physical disability (spinal cord injury, multiple sclerosis, spina bifida, cerebral palsy, stroke, or lupus) were randomized to one of three conditions: physical activity only (POWERS), physical activity plus nutrition (POWERSplus), and control. The POWERS group received a physical activity tool kit and regular coaching telephone calls. The POWERS plus group received an intervention identical to that of the POWERS group plus nutritional information. The control group received the physical activity tool kit and self-guided health promotion resources at the completion of the trial but no coaching. Results: Postintervention differences in body weight were found between the groups. There was a significant group × time interaction (P < 0.01) in postintervention body weight, with both the POWERS and POWERSplus groups demonstrating greater reduction in body weight compared with the control group (POWERS: -2.1 ± 5.5 kg, -2.4 ± -5.9%; POWERSplus: -0.5 ± 5.0 kg, -0.6 ± 4.3%; control: +2.6 ± 5.3 kg, 3.1 ± 7.4%). Conclusions: A low-cost telephone intervention supported with a Web-based remote coaching tool (POWERS) can be an effective strategy for assisting overweight adults with physical disabilities in maintaining or reducing their body weight. Copyright © 2013 Lippincott Williams & Wilkins.

Gerber B.S.,Center for Management of Complex Chronic Care | Gerber B.S.,University of Illinois at Chicago | Cho Y.I.,University of Illinois at Chicago | Arozullah A.M.,University of Illinois at Chicago | Lee S.-Y.D.,University of North Carolina at Chapel Hill
American Journal Geriatric Pharmacotherapy | Year: 2010

Background: Racial differences in adherence to prescribed medication regimens have been reported among the elderly. It remains unclear, however, whether these differences persist after controlling for confounding variables. Objective: The objective of this study was to determine whether racial differences in medication adherence between African American and white seniors persist after adjusting for demographic characteristics, health literacy, depression, and social support. We hypothesized that differences in adherence between the 2 races would be eliminated after adjusting for confounding variables. Methods: A survey on medication adherence was conducted using face-to-face interviews with Medicare recipients ≥65 years of age living in Chicago. Participants had to have good hearing and vision and be able to speak English to enable them to respond to questions in the survey and sign the informed-consent form. Medication adherence measures included questions about: (1) running out of medications before refilling the prescriptions; (2) following physician instructions on how to take medications; and (3) forgetting to take medications. Individual crude odds ratios (CORs) were calculated for the association between race and medication adherence. Adjusted odds ratios (AORs) were calculated using the following covariates in multivariate logistic regression analyses: race; age; sex; living with a spouse, partner, or significant other; income; Medicaid benefits; prescription drug coverage; having a primary care physician; history of hypertension or diabetes; health status; health literacy; depression; and social support. Results: Six hundred thirty-three eligible cases were identified. Of the 489 patients who responded to the survey, 450 (266 African American [59%; mean age, 78.2 years] and 184 white [41%; mean age, 76.8 years]; predominantly women) were included in the sample. The overall response rate for the survey was 77.3%. African Americans were more likely than whites to report running out of medications before refilling them (COR = 3.01; 95% CI, 1.72-5.28) and not always following physician instructions on how to take medications (COR = 2.64; 95% CI, 1.50-4.64). However, no significant difference between the races was observed in forgetting to take medications (COR = 0.90; 95% CI, 0.61-1.31). In adjusted analyses, race was no longer associated with low adherence due to refilling (AOR = 1.60; 95% CI, 0.74-3.42). However, race remained associated with not following physician instructions on how to take medications after adjusting for confounding variables (AOR = 2.49; 95% CI, 1.07-5.80). Conclusion: Elderly African Americans reported that they followed physician instructions on how to take medications less frequently than did elderly whites, even after adjusting for differences in demographic characteristics, health literacy, depression, and social support. © 2010 Excerpta Medica Inc.

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