MedicalResearch.com - Medical Research Interviews

MedicalResearch.com

Hemodialysis research, author interviews, dialysis updates and information on chronic kidney disease and end stage renal failure.

Editor: Marie Benz, [email protected]

July 9 2013

For Informational Purposes Only: Not for Specific Medical Advice.

mailto:[email protected]

mailto:[email protected]

Read more interviews on Hemodialysis.com

Medical Disclaimer | Terms and Conditions

• The contents of the MedicalResearch.com Site, such as text, graphics, images, and other material contained on the MedicalResearch.comm Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the MedicalResearch.com Site!

• If you think you may have a medical emergency, call your doctor or 911 immediately. MedicalResearch.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by MedicalResearch.comm or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of MedicalResearch.com or EDI, or other visitors to the Site is solely at your own risk.

• The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis.

Asthma: Genetic Risks of Development and CourseMedicalResearch.com Interview with:Daniel Belsky, PhDCenter for the Study of Aging and Human Development Duke University

• MedicalResearch.com: What are the main findings of the study?• Dr. Belsky : We looked to the largest-ever genome-wide association study of asthma (that study by the GABRIEL Consortium

included more than 26,000 individuals) to identify genetic variants that could be used to construct a genetic profile of asthma risk. We then turned to The Dunedin Multidisciplinary Health and Development Study, a unique cohort of 1,000 individuals who have been followed from birth through their fourth decade of life with extensive measurements of asthma and related traits. We computed a “genetic risk score” for each person based on the variants identified in GWAS. Then, we looked at who developed asthma, when they developed asthma, and what that asthma looked like in terms of allergic response and impaired lung function.

• What we found:• (1) People with higher genetic risk scores were more likely to develop asthma and they developed asthma earlier in life.• (2) Among children who developed asthma, the ones at higher genetic risk were more likely to have persistent asthma

through midlife.• (3) Genetic risk was specifically associated with allergic asthma that resulted in chronic symptoms of impaired lung function.• (4) People with higher genetic risk score developed more severe cases of asthma. As compared to people with a lower

genetic risk, they were more often absent from school and work because of asthma and they were more likely to be hospitalized for asthma.

• (5) The genetic risk score provided new information about asthma risk that could not be obtained from a family history.

Read the rest of the interview on MedicalResearch.com

mailto:http://medicalresearch.com/asthma/asthma-genetic-risks-of-development-and-course/1043/






http://www.nejm.org/doi/pdf/10.1056/NEJMoa0906312

http://www.cng.fr/gabriel/

http://dunedinstudy.otago.ac.nz/




• MedicalResearch.com: Were any of the findings unexpected?• Dr. Belsky : We were a little surprised to find that people with higher genetic risk scores did not necessarily have strong

family histories of asthma, and vice versa–people who had many relatives with asthma often had very low genetic risk scores. We have seen this same pattern of results now in other studies we’ve done on smoking and obesity, and other investigators have found similar results for type-2 diabetes and some cancers. So this lack of overlap between genotypic and family history risk looks like a real thing. One possible explanation for this observation is that family histories capture information about environmental risks and about interactions between genetic and environmental risk factors.

• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Belsky : Genetic tests to determine whether children will develop asthma or whether their asthma will remit or persist

are not yet possible. Our work suggests that genetic information may, in the future, be able to improve clinical risk assessments. In the mean time, the genetic risk score we studied will be a useful tool for research.











• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Belsky : Future research should focus on the question of how genetic risks interact with environmental exposures

including pollution and other factors that affect air quality. Research is also needed to test how well our findings generalize to non-European populations and to investigate how the genetic risks we studied affect asthma in later life.

• Citation:• Polygenic risk and the development and course of asthma: an analysis of data from a four-decade longitudinal study

Dr Daniel W Belsky PhD,Prof Malcolm R Sears MB,Robert J Hancox MD,HonaLee Harrington BS,Renate Houts PhD,Prof Terrie E Moffitt PhD,Karen Sugden PhD,Benjamin Williams BSc,Prof Richie Poulton PhD,Prof Avshalom Caspi PhDThe Lancet Respiratory Medicine – 28 June 2013DOI: 10.1016/S2213-2600(13)70101-2










Prostate Cancer: Soy Supplementation Did Not Reduce RecurrenceMedicalResearch.com Interview with:Maarten C. Bosland, DVSc, PhD

Professor of Pathology Department of Pathology University of Illinois at ChicagoCollege of Medicine Chicago, IL 60612

• MedicalResearch.com: What are the main findings of the study?• Dr. Bosland: Daily consumption of a supplement containing soy protein isolate for two years following radical prostatectomy

did not reduce recurrence of prostate cancer in men at high risk for this (radical prostatectomy is surgical removal of the prostate to treat prostate cancer). The study showed that this soy supplementation was safe. It is not clear whether this result indicates that soy does not prevent the development of prostate cancer, but men that have the disease probably do not benefit from soy supplementation.

• MedicalResearch.com: Were any of the findings unexpected?• Dr. Bosland:: The hypothesis was that soy supplementation reduces prostate cancer recurrence, based on epidemiologic

findings and data from animal studies. Thus, the finding of a lack of treatment effect was unexpected.

• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Bosland: Men should not expect benefit from consuming soy after initial surgical treatment for prostate cancer. Men

who have received radiation treatment may also not benefit from soy. Men who consume soy for their entire life may have a reduced risk of developing detectable prostate cancer (but this cannot be studied in a clinical trial). The study results indicate that long-term soy consumption does appear to be safe. It is not clear whether soy is of benefit to men who have advanced prostate cancer and are receiving hormonal treatment or chemotherapy and whether it is safe for these men.


mailto:http://medicalresearch.com/cancer-_-oncology/prostate-cancer-soy-supplementation-did-not-reduce-recurrence/1040/










Prostate Cancer: Soy Supplementation Did Not Reduce RecurrenceMedicalResearch.com Interview with:Maarten C. Bosland, DVSc, PhD

Professor of Pathology Department of Pathology University of Illinois at ChicagoCollege of Medicine Chicago, IL 60612

• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Bosland: It would be useful to determine the benefit and safety of soy supplements in men who have advanced prostate

cancer and are receiving hormonal treatment or chemotherapy in rigorous randomized clinical trials. It is important to also rigorously test other dietary supplements commonly used by men with prostate cancer for benefit and safety randomized clinical trials.

• Citation:• Effect of Soy Protein Isolate Supplementation on Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy

A Randomized Trial• Bosland MC, Kato I, Zeleniuch-Jacquotte A, et al. Effect of Soy Protein Isolate Supplementation on Biochemical Recurrence of

Prostate Cancer After Radical Prostatectomy: A Randomized Trial. JAMA. 2013;310(2):170-178. doi:10.1001/jama.2013.7842.











Insulin Resistance and Cardiorespiratory Fitness : Ethnic DifferencesMedicalResearch.com Interview with:Dr Nazim Ghouri MBChB, MRCP UK

Specialty Registrar (Diabetes/Endocrinology/GIM) and Honorary Clinical LecturerInstitute of Cardiovascular and Medical Sciences

BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow G12 8TA

• MedicalResearch.com: What are the main findings of the study?• Answer: In this study we aimed to determine the extent to which increased insulin resistance and blood sugar levels in

South Asian men, compared to white European men, living in the UK, was due to lower fitness and physical activity levels.• We studied 100 South Asian and 100 European men aged 40-70 years living in Scotland without diagnosed diabetes and

measured their blood sugar levels, insulin resistance and other risk factors.• The men also undertook a treadmill exercise test to determine how much oxygen their bodies were able to use during

intense exercise – a key measure of physical fitness, wore accelerometers for a week to assess their physical activity levels, and had a detailed assessment of their body size and composition. Statistical modeling was then used to determine the extent to which body size and composition, fitness and physical activity variables explained differences in insulin resistance and blood sugar between South Asians and Europeans.

• The results suggested that lower fitness, together with greater body fat in South Asians, explained over 80 per cent of their increased insulin resistance compared to white men with Low fitness being the single most important factor associated with the increased insulin resistance and blood sugar levels in middle-aged South Asian compared to European men living in the UK.


mailto:http://medicalresearch.com/diabetes/insulin-resistance-and-cardiorespiratory-fitness-ethnic-differences/1036/


http://www.angina.com/genetic-associations/the-relationship-between-metabolic-risk-factors-and-incident-cardiovascular-disease-in-europeans-south-asians-and-african-caribbeans/1151/

http://medicalresearch.com/stroke/effect-of-aerobic-exercise-walking-training-on-functional-status-and-health-related-quality-of-life-in-chronic-stroke-survivors/484/

http://medicalresearch.com/diabetes/insulin-resistance-and-cardiorespiratory-fitness-ethnic-differences/1036/


Insulin Resistance and Cardiorespiratory Fitness : Ethnic DifferencesMedicalResearch.com Interview with:Dr Nazim Ghouri MBChB, MRCP UK

Specialty Registrar (Diabetes/Endocrinology/GIM) and Honorary Clinical LecturerInstitute of Cardiovascular and Medical Sciences

BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow G12 8TA

• MedicalResearch.com: Were any of the findings unexpected?• Answer: The data also showed that while fitness improves with increasing physical activity, South Asians’ lower fitness values could

not be explained simply by their lower activity levels. South Asians had lower fitness levels than Europeans at all levels of physical activity, suggesting inherent differences in body make-up.

• MedicalResearch.com: What should clinicians and patients take away from your report?• Answer: The fact that South Asians’ increased insulin resistance and blood sugar levels are strongly associated with their lower

fitness levels, and that increasing physical activity is the only way to increase fitness, suggests that South Asians may need to engage in greater levels of physical activity than Europeans to achieve the same levels of fitness and minimize their diabetes risk.

• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Answer: These findings have potential implications for physical activity guidance, which, at present, do not take ethnicity into

account. A number of leading doctors and scientists have already recommended that the BMI threshold for obesity in South Asian populations should be lowered from 30 kg/m2 to 25 kg/m2, in recognition of the fact that substantially lower BMIs are needed in South Asians to confer equivalent diabetes risk to those observed in populations of white European origin. The present data suggest that differential physical activity guidance for South Asians may also be needed.

• Citation:• Lower cardiorespiratory fitness contributes to increased insulin resistance and fasting glycaemia in middle-aged South Asian

compared with European men living in the UK.• Ghouri N, Purves D, McConnachie A, Wilson J, Gill JM, Sattar N.• BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and

Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK,Diabetologia. 2013 Jun 29.[Epub ahead of print]






Diabetes in the Elderly: Indivualized Treatment with Vildagliptin (Glavus)MedicalResearch.com Interview with: Dr David Strain, MRCP MDClinical senior lecturer and honorary consultant

University of Exeter Medical SchoolInstitute of Biomedical and Clinical Science Department of Diabetes and Vascular Research

Royal Devon & Exeter Hospital Exeter EX2 5AX

• MedicalResearch.com: What is the Background of the study?• In early 2010 recent diabetes outcome trials such as ACCORD and ADVANCE had put into question the benefit of aggressive

HbA1c reduction for all patients particularly in elderly population. After that there were several guidelines that suggested individualizing treatment targets for elderly patients according to their age, co-morbidities, frailty and baseline HbA1c. This featured in the Finnish guidelines and the European Working Party for the management of Diabetes in the Older Person. However this was also completely without any evidence base. I worked with Paivi Paldanius (the final author of the paper and a medical advisor for Novartis) to establish a pragmatic study. We both acknowledged the importance of having a patient-centric, pragmatic and ‘real-life’ approach and as there was already evidence that DPP-4 inhibitors, in this case vildagliptin (due to Päivi’s affiliation), had demonstrated it’s efficacious and had no tolerability issues in the elderly population we decided to go ahead with the study.

• It was obvious that we needed to implement a holistic approach and take into account as many clinically relevant parameters as possible, such as age, baseline HbA1c, duration of the disease, co-morbidities and frailty, for implementation of the individualized care. Our primary goal was to request that the physicians acting as investigators would still apply their clinical judgment based on these clinical features of each individual patient but also, follow their local guidelines as in their daily clinical practice. This would later provide us with invaluable information and perspective when interpreting the data and recommending implementation of the results. For assessment of frailty we screened for many different methodologies but Prof Timo Strandberg (known expert of the field and mentioned in the acknowledgements section of our paper) suggested to apply modified Linda Fried’s method for assessment of phenotype of frailty as this method is validated, very pragmatic, reproducible and also feasible to be used for the first time also by a non-geriatric investigator. All investigators were trained to follow these parameters by the protocol. We also wished to evaluate in parallel the conventional HbA1c drop assessment in order to be able to put the potential success of our new endpoint, meeting the individualized target, into perspective and for comparison against other standard data from other studies with DPP-4 inhibitors with elderly. We also wished to simulate a clinical, real-world setting as much as possible and included patients who would seem representative of most elderly T2DM patients.


mailto:http://medicalresearch.com/diabetes/diabetes-in-the-elderly-indivualized-treatment-with-vildagliptin-glavus/1032/











http://medicalresearch.com/author-interviews/fraility-as-a-predictor-of-surgical-complications/1029/

http://medicalresearch.com/diabetes/diabetes-in-the-elderly-indivualized-treatment-with-vildagliptin-glavus/1032/





• MedicalResearch.com: What are the main findings of the study?

Dr. Strain: The primary objectives were to determine whether the DPP-4 inhibitor, vildagliptin could achieve the individualized targets in these elderly adults. This it did with an odds ratio of success of 3.16 after adjustment for baseline variables.

• The secondary objectives included assessing the safety of the agent, and more importantly exploring the individualized targets that were set. Vildagliptin appeared safe in this elderly population and was just as potent across the all age-ranges with no new safety signals.

• MedicalResearch.com: Were any of the findings unexpected?• Dr. Strain: There were many findings additional to the primary objectives which were significant; we observed that basic

patient education, communication about and focus on individualized target setting induced a clinically meaningful response even in the placebo group; Indeed 27% of the patients responded to nothing more than a simple educational approach that was individualized to their need rather than the generic “one size fits all” approach of many international guidelines.

• The overall the discontinuation rate was also much lower than anticipated in this type of population in other studies with conventional approach. It was also somewhat surprising that the physicians were considerably influenced by stringent HbA1c targets possibly as a result of the local recommendations and the average HbA1c target was 7.0% (53mmol/mol) much lower than we anticipated. This is now an area of further analysis in order to determine what drove the targets that were set. We believe this analysis will provide invaluable information for those trying to implement the recently published guidance for the management of the older person with diabetes. The results of this study support global guidelines’ recommending individualized care, and demonstrate the feasibility of the study design, and the setting of individualized targets.


















• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Strain: This study supports guidelines’ recommendations and demonstrated that the local guidelines need to be

synchronized with the international guidelines which recommend individualization of the target setting based on the clinical features of each individual patient. The inclusion of frail elderly patients in our study will open the door for their inclusion in future studies. The study also demonstrates that individualized targets can be used as an endpoint in a clinical study and we trust that many studies will adapt this approach when evaluating the safety and efficacy of treatment modalities, thus follow our lead in providing an evidence-base for global treatment guidelines for patients with T2DM.

• What was most also very interesting, however was that by individualizing the goals and setting realistic targets, then spending time talking to patients rather than aggressively chasing targets resulted in nearly a quarter of patients achieving better glycemic control.


















• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Strain: The physicians in our study seemed to be influenced by their local guidelines which might not yet have been

updated and there seems to be a gap in the application of the global guidelines. Our short term next goal is to gain a better understand of which factors impacted target setting and if these potential barriers to more optimal treatment can be overcome by communicating our further, secondary findings in peer reviewed journals and by educating colleagues of our findings.

• At the University of Exeter Medical School, our longer-term aims are to carry this work forward to a longer term study using clinically meaningful outcomes for an elderly population, such as frailty progression, hospitalizations for any cause and quality of life, using the more conventional outcomes for secondary analyses – we believe that at the age of 75 patients are far more interested in the quality of their remaining years rather than the quantity and this should be the principle focus of studies

• Citation:• Individualised treatment targets for elderly patients with type 2 diabetes using vildagliptin add-on or lone therapy

(INTERVAL): a 24 week, randomised, double-blind, placebo-controlled studyDr W David Strain MD,Valentina Lukashevich MD,Wolfgang Kothny MD,Marie-José Hoellinger MD,Päivi Maria Paldánius MMedSciThe Lancet – 23 May 2013DOI: 10.1016/S0140-6736(13)60995-2






Fraility as a Predictor of Surgical ComplicationsMedicalResearch.com Interview with Kenneth Ogan MDDepartment of Urology

Emory University School of Medicine1365 Clifton Rd. NE, Building B, Suite 1400 Atlanta, Georgia 30322

• MedicalResearch.com: What are the main findings of the study?

Dr. Ogan: Surgical risk assessment is traditionally a very subjective process, and an evaluation that more accurately measures a patient’s physiologic reserve would greatly aid in surgical decision making. In this study we sought to further characterize frailty as an objective risk assessment tool in surgical patients. We prospectively measured the five component frailty criteria described by Fried et al.1 (weight loss, exhaustion, low activity, grip strength, and gait speed). Patients deemed “intermediately frail” and “frail” had twice the likelihood of experiencing any complication in the 30-day post-operative period.

•MedicalResearch.com: Were any of the findings unexpected?

• Dr. Ogan: We hypothesized that frailty would not be of use in minimally invasive surgery, however a subset analysis showed frailty conferred an even greater risk of post-operative complications in patients undergoing laparoscopic and robotic procedures.










Fraility as a Predictor of Surgical ComplicationsMedicalResearch.com Interview with Kenneth Ogan MDDepartment of Urology

Emory University School of Medicine1365 Clifton Rd. NE, Building B, Suite 1400 Atlanta, Georgia 30322

• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Ogan: We only included major intra-abdominal operations in our study, so future research should be focused on

confirming these findings in more heterogeneous surgical populations. Additionally, a valuable study would be to determine the impact of preoperative interventions on postoperative outcomes in frail patients.

• References• 1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Geront A Biol Sci Med Sci. 2001;

56:146-156.• Citation:• Too Frail for Surgery?: Initial Results of a Large Multidisciplinary Prospective Study Examining Pre-operative Variables

Predictive of Poor Surgical Outcomes• Louis M. Revenig, Daniel J. Canter, Maxwell D. Taylor, Caroline Tai, John F. Sweeney, Juan M. Sarmiento, David A. Kooby,

Shishir K. Maithel, Viraj A. Master, Kenneth Ogan










Lung Cancer Screening CT Scans Can Predict Future Cardiovascular EventsDr. Pim A. de Jong,Department of Radiology University Medical Center Utrecht,

Heidelberglaan 100, E.01.132, 3508GAUtrecht, the Netherlands.

• MedicalResearch.com: What are the main findings of the study?• Dr. de Jong: The main findings of the study is that lung cancer screening CT scans can predict future cardiovascular events.• MedicalResearch.com: Where any of the findings unexpected?• Dr. de Jong: The unexpected aspect is that the CT scans were not-ECG gated, but even these non-gated scans were good

enough to quantify arterial calcifications and predict risk.• MedicalResearch.com: What should patients and providers take home from this study?• Dr. de Jong: The implication is that cardiovascular prediction is possible based on CT scans obtained for another indication

even when no ECG gating isapplied.

• MedicalResearch.com: What further research do you recommend as a result of your report?• Dr. de Jong: Future research should aim to test whether events can be prevented

with medication and whether quality of life and survival can beimproved at reasonable costs. After that has been proven one couldthink of implementation studies.

• Citation:• Lung Cancer Screening CT-Based Prediction of Cardiovascular Events.• Mets OM, Vliegenthart R, Gondrie MJ, Viergever MA, Oudkerk M, de Koning HJ, Mali WP, Prokop M, van Klaveren RJ, van der

Graaf Y, Buckens CF, Zanen P, Lammers JW, Groen HJ, Isgum I, de Jong PA.• JACC Cardiovasc Imaging. 2013 Jun 8. pii: S1936-878X(13)00332-X. doi: 10.1016/j.jcmg.2013.02.008. [Epub ahead of print]


http://medicalresearch.com/cancer-_-oncology/lung-cancer-screening-ct-scans-can-predict-future-cardiovascular-events/1024/






PAD: Home-Based Walking Exercise InterventionMedicalResearch.com Interview with: Mary McGrae McDermott, MDProfessor of Medicine

Northwestern University Feinberg School of MedicineContributing Editor, JAMA

Home-Based Walking Exercise Intervention in Peripheral Artery DiseaseA Randomized Clinical Trial• MedicalResearch.com: What are the main findings of the study? • Answer: The goals trial found that a group-mediated cognitive behavioral intervention significantly improved six-minute

walk performance, physical activity levels, and patient-perceived walking performance compared to a control group. The gains in six-minute walk in the intervention group were consistent with a large meaningful change in walking performance.were any of the findings unexpected?the magnitude of the gain in six-minute walk was greater than that observed in supervised treadmill exercise interventions in people with pad. In addition, our prior work shows that a supervised treadmill exercise intervention does not significantly increase physical activity levels in daily life. However, the current home-based intervention significantly improved physical activity levels in daily life.

• MedicalResearch.com: What should clinicians and patients take away from your report?• Answer: That home-based exercise can be effective in people with peripheral artery disease.• MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Our intervention required meetings at the medical center once weekly. Future research should focus on home-

based exercise interventions for people with peripheral artery disease that do not require any regular visits to the medical center.

• Citation:• McDermott MM, Liu K, Guralnik JM, et al. Home-Based Walking Exercise Intervention in Peripheral Artery Disease: A

Randomized Clinical Trial. JAMA. 2013;310(1):57-65. doi:10.1001/jama.2013.7231.


http://medicalresearch.com/author-interviews/pad-home-based-walking-exercise-intervention/1021/







Is Dairy intake Protective against Uterine Fibroid Risk?MedicalResearch.com Interview with:Dr. Lauren A. WiseSlone Epidemiology Center1010 Commonwealth Avenue Boston, MA

• MedicalResearch.com: What are the main findings of the study?• Dr. Wise: We found that the strong inverse association between dairy and uterine fibroids in black women in the Black

Women’s Health Study is not explained by percent European ancestry.

MedicalResearch.com: Were any of the findings unexpected?• Dr. Wise: Yes, we expected genetic ancestry to explain the entire association because there is evidence that percent

European ancestry is both positively associated with dairy intake and inversely associated with fibroid risk.• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Wise: Dairy intake may be protective against fibroid risk.• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Dr. Wise: Given this is the first study showing an inverse association between dairy and fibroids, future studies in different

populations are needed to confirm our findings.• • Citation:• Is the Observed Association Between Dairy Intake and Fibroids in African Americans Explained by Genetic Ancestry?• Lauren A. Wise, Julie R. Palmer, Edward Ruiz-Narvaez, David E. Reich, and Lynn Rosenberg• Am. J. Epidemiol. f

irst published online July 3, 2013 doi:10.1093/aje/kwt091


http://medicalresearch.com/author-interviews/is-dairy-intake-protective-against-uterine-fibroid-risk/1018/









Type 2 Diabetes: Validating a Renal Risk ScoreMedicalResearch.com Interview with: C Raina ElleyAssociate Professor and General Practitioner,

Acting Head, Dept General Practice & Primary Health Care,Faculty Medical and Health Sciences, University of Auckland, Private Bag 92019,

Auckland, New Zealand

• MedicalResearch.com: What are the main findings of the study?• Answer: Type 2 Diabetes is the leading cause of end-stage renal failure and dialysis in many countries. Early identification of

those who are at risk within primary care could prompt more intensive intervention to control glycaemia and blood pressure and use of ACE inhibitors or angiotensin receptor blockers to slow progression. Traditionally estimated glomerular filtration rate and/or urine albumin creatinine ratio have been used to alert clinicians of deteriorating renal function in people with diabetes. However, a far more accurate renal risk score has been developed that combines serum creatinine, demographic characteristics, albuminuria, glycaemia, blood pressure, cardiovascular co-morbidity and duration of diabetes.

• The 5-year renal risk score was developed by following more than 25,000 people with type 2 diabetes in New Zealand for a median of 7.3 years (equivalent to 180,497 person-years). The study identified those who commenced dialysis for end-stage renal disease, received a renal transplant or died from renal failure to derive the risk score.

• MedicalResearch.com: Were any of the findings unexpected?• Answer: The accuracy with which the risk score predicted renal events in a separate validation cohort was unexpected, with

areas under the ROC of 0.91-0.92, compared with eGFR (0.77). People with the same eGFR (e.g. a 55 year old man with an eGFR of 58ml/min/1.73m2) could have a 5 year risk of an end stage renal event of anywhere between 0.4% and 28%.

• The significant contribution of ethnicity to risk (after controlling for other known risk factors) was also surprising. There are possibly genetic components contributing to risk, but ethnicity may also be a marker of other risk factors, such as long-term exposure to poverty, smoke or other differences in lifestyle risk factors.


http://medicalresearch.com/diabetes/type-2-diabetes-validating-a-renal-risk-score/1011/






http://medicalresearch.com/uncategorized/diabetes-elevated-transferrin-saturation-associated-with-mortality/948/

http://hemodialysis.com/


Type 2 Diabetes: Validating a Renal Risk ScoreMedicalResearch.com Interview with: C Raina ElleyAssociate Professor and General Practitioner,

Acting Head, Dept General Practice & Primary Health Care,Faculty Medical and Health Sciences, University of Auckland, Private Bag 92019,

Auckland, New Zealand

• MedicalResearch.com: What should clinicians and patients take away from your report?• Answer: With electronic medical records, routinely entered measures can be combined to produce risk profiles and

prompting early preventive therapy of those at greater risk. Our new renal risk score is being added to the online cardiovascular risk calculator for people with type 2 diabetes http://www.nzssd.org.nz/cvd/ so cardiovascular and renal risk can be assessed together. Risk scores can also be used as an educational tool for patients. Their assessment of 5-year risk or pictorial depiction of risk can highlight an issue and help motivate change or adherence with interventions.

• MedicalResearch.com: What recommendations do you have for future research as a result of this study?• Answer: Future research could assess the effectiveness of use of risk prediction and early intervention in randomized

controlled trials. Furthermore, with the paucity of interventions to slow progression to renal failure, partly due to the time it takes to reach hard endpoints like dialysis or doubling of serum creatinine in efficacy trials, using significant change in a risk profile that at least combines eGFR and albuminuria could allow more timely assessment of effectiveness of new interventions. Lastly, as the racial or ethnicity profiles vary from country to country, similar studies carried out within national or regional contexts may produce locally valid risk calculators.

• Citation:• “Derivation and Validation of a Renal Risk Score for People with Type 2 Diabetes” in Diabetes Care, 2013,

doi:10.2337/dc13-0190 by C. Raina Elley, Tom Robinson, Simon A Moyes, Tim Kenealy, John Collins, Elizabeth Robinson, Brandon Orr-Walker, Paul L Drury








http://www.nzssd.org.nz/cvd/


Date post:	07-May-2015
Category:	Health & Medicine
Upload:	marie-benz-md-faad
View:	139 times
Download:	2 times

MedicalResearch.com - Medical Research Interviews

Health & Medicine