Vaughan, Lisa E.

Background: Total kidney volume (TKV), a prognostic biomarker in ADPKD, is used to stratify high risk individuals. eGFR measures may carry significant error in ADPKD compared to measured GFR(mGFR). This retrospective study investigates the association between height adjusted TKV (htTKV) and eGFR derived from race-free CKD-EPI equations utilizing creatinine and cystatin C. Methods: eGFR was calculated using 3 race-free CKD-EPI formulas: creatinine-based (CKD-EPI creatinine), cystatin C (CKD-EPI cys), and creatinine-cystatin C (CKD-EPI creatinine-cystatin C) equations on 697 Mayo Clinic ADPKD patients. Correlations between eGFR and TKV measures were estimated and stratified by MIC class risk groups and CKD. Linear regression models were computed to predict ln(htTKV) from the 3 eGFR data sets. The eGFR measures were compared to iothalamate-based mGFR in a subset of patients (n=50). Results: A correlation between eGFR measures and htTKV (Pearson correlation r of -0.53 to -0.54), varied by MIC stratification. Pearson correlation was -0.47 to -0.48 for MIC 1A and 1B, -0.67 to -0.71 for MIC 1C, and -0.67 to -0.68 for MIC 1D and 1E. All equations were significantly associated with htTKV levels, with similar adjusted beta values (95% CI) of -0.15 (-0.17 to -0.13), -0.14 (-0.16 to -0.12), -0.15 (-0.16 to -0.13), for CKD-EPI creatinine, CKD-EPI cystatin C, and CKD-EPI creatinine-cystatin C, respectively. Compared to mGFR, the CKD-EPI creatinine-cystatin C equation was the least biased (mean -0.86 (95% CI: -3.09 to 1.37)) versus CKD-EPI creatinine (2.31 (-0.73 to 5.34)) or CKD-EPI cystatin C (-3.54 (-5.86 to -1.21)), and most precise, with 1-P30 of 16% (95% CI 7.2% to 29.1%), compared to 18% (8.6% to 31.4%) for CKD-EPI creatinine, or 20% (10.0% to 33.7%) for CKD-EPI cystatin C. Conclusion: A moderate correlation between eGFR and htTKV associated with MIC stratification. Associations between htTKV and all 3 CKD-EPI equations were similar. CKDEPIcrcys tended to be the least biased and most precise equation when compared to mGFR and may be a reasonable alternative.

Background: Contemporary data on trends in survival after incident atrial fibrillation (AF) are limited. Methods: Residents of a 27-county area in southern Minnesota and western Wisconsin with new-onset atrial fibrillation or atrial flutter between 2013 and 2023 were identified. An electronic algorithm requiring 1 inpatient code or 2 outpatient codes separated by >7 days but within 1 year was used to define AF. Patients were followed for all-cause mortality through March 31, 2025. Standardized mortality ratios of observed versus expected survival were calculated, and time trends in survival were examined using Cox regression adjusting for demographics, cardiovascular risk factors, comorbid conditions, and area-level measures of socioeconomic status and rurality. Results: There were 44,930 individuals identified with incident AF from 2013-2023 (56.4% male; mean (SD) age 72.8 (13.5) years; 95.8% were non-Hispanic white). Within the first 90 days, the risk of all-cause mortality was greatly elevated compared with individuals of a similar age and sex distribution in the general population (standardized mortality ratios 12.6, 95% CI, 12.1-13.0 and 3.8, 95% CI, 3.6-4.0 for the first 30 days and 31 to 90 days after diagnosis, respectively). This excess risk was observed for all age groups but was greatest in the youngest age group (standardized mortality ratios among 18-64 year olds for the first 30 days: 49.9, 95% CI, 44.6-55.7 and 31 to 90 days: 11.1, 95% CI: 9.4-13.1; Figure ). In the youngest age group, the excess risk persists through 5 years post AF, however, in the oldest age group the excess risk only persisted through 1 year. Survival within the first 90 days improved over the study period (adjusted hazard ratio [aHR], 0.88; 95% CI, 0.79-0.99 for 2023 vs 2013); likewise, among 90-day survivors, survival improved between 2013 and 2023 (aHR,0.82; 95% CI, 0.76-0.88). These trends were driven by improvements in the younger age groups, particularly for death among 90-day survivors (aHR for 18-64 years, 0.66, 95% CI, 0.52-0.83; 65-74 years: 0.77, 95% CI: 0.65-0.90; 75-84 years, 0.84, 95% CI: 0.75-0.95; 85+ years, 0.99, 95% CI: 0.98-1.01). Conclusion: In a Midwestern community, the excess risk of death is high within the first 90 days after incident AF. Furthermore, survival after AF has improved between 2013 and 2023, with the improvement greatest in younger age groups.

Circulating extracellular vesicles, proinflammatory/pro-oxidant metabolites, and history of preeclampsia may be used as biomarkers for diagnosis of early CAC in postmenopausal women.

Background Multimorbidity is common in patients with atrial fibrillation (AF); however, the impact of the number and type of comorbid conditions on outcomes remains uncertain. Methods This cohort study included patients with new‐onset AF from a Midwest region between 2013 and 2017. Eighteen chronic conditions at the time of AF were classified into groups: cardiometabolic, other somatic, and mental health. Cox regression determined associations between the number of each condition type with death, ischemic stroke/transient ischemic attack, and congestive heart failure, stratified by age. Results Among 16 509 patients with AF (mean age, 74 years; 43% women), the mean number of cardiometabolic, other somatic, and mental health conditions was 2.7, 1.4, and 0.5, respectively. The number and type of conditions had a varying impact on outcomes and differed by age. A higher number of cardiometabolic conditions were associated with increased risk of death within 90 days only in people aged ≥85 years (≥4 conditions versus 0: hazard ratio [HR], 1.74 [95% CI, 1.05–2.87]), whereas for death after 90 days, associations were strongest in the youngest age group (<65 years: HR, 1.83 [95% CI, 1.35–2.46]; 65–74 years: HR, 1.34 [95% CI, 1.04–1.73]; 75–84 years: HR, 1.32 [95% CI, 1.09–1.60]; ≥85 years: HR, 1.14 [95% CI, 0.96–1.35]). Associations with outcomes were generally strongest in the youngest age group and attenuated with older age for higher number of other somatic conditions, whereas the pattern was less consistent for mental health conditions. Conclusions Along with cardiometabolic‐related conditions, other somatic and mental health conditions are important predictors of outcomes in AF, with effects differing by age, and should be considered when caring for these patients.

Abstract Background Women with advanced chronic kidney disease (CKD) encounter reproductive health challenges, including reduced fertility, menstrual irregularity, and sexual dysfunction. This study examined changes in sex hormones in patients with CKD, their correlation with sexual function, and changes after transplant. Methods This study recruited women aged 18–51 years with CKD stages 3b-5 from outpatient clinics and dialysis units. Exclusion criteria included active pregnancy, menopause, prior hysterectomy/bilateral oophorectomy, or use of hormonal contraceptives/therapy. Data were collected at enrollment and at 6 months post-transplant. Results Thirty-eight subjects met eligibility criteria and enrolled in the trial (8 in CKD stage 3b, 10 in CKD stage 4, and 20 in CKD stage 5/5D). Sexual dysfunction (25/38, 65.8%), defined as total female sexual function index score &lt; 26.55, and menstrual irregularities (17/38, 44.7%) were common, with abnormal elevation of luteinizing hormone present in the follicular phase in the majority of patients. There was a significant negative association between total female sexual function index score and prolactin (β = -0.26, P = 0.03) and dehydroepiandrosterone sulfate (β = -0.07, P = 0.01) after adjusting for age. After transplant, there was also a significant improvement in both prolactin and dehydroepiandrosterone sulfate levels, although sexual dysfunction persisted. Conclusions This study highlights the complex interplay between advanced CKD, reproductive endocrinology, and sexual health. Significant hormonal dysregulation and associated reproductive challenges were observed. The prominent role of dehydroepiandrosterone sulfate in sexual dysfunction among women with CKD requires further study.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia with prevalence increasing over the last decade. However, data on recent temporal trends in incidence of AF have been inconsistent, with some reports of increasing trends over time and others indicating no change in incidence over time. Therefore, we aimed to determine how the incidence of AF has changed over the last decade in a community in the Midwest USA. Methods: Between 2013 and 2023, adults (aged 18 and older) with incident AF were identified in a 27-county region in the Midwest. AF was identified using diagnostic codes by employing an electronic algorithm requiring 1 inpatient code or 2 outpatient codes separated by >7 days but within 1 year. For total rates, age - and sex-adjusted incidence rates were standardized to the 2010 US total population. Poisson regression was used to calculate the incidence rate ratio of AF for 2023 vs 2013. Results: We identified 44,930 individuals with incident AF from 2013 to 2023. Of these, 56.4% were male, the mean (SD) age was 72.8 (13.5) years, and 95.8% were non-Hispanic white. The age-and sex-adjusted incidence rates (per 1,000) and 95% confidence intervals standardized to the 2010 US total population were 5.24 (5.07-5.41) in 2013, 5.73 (5.56-5.91) in 2018, and 5.44 (5.28-5.61) in 2023. Although a drop in incidence was observed corresponding to the COVID-19 pandemic, a small increase in the overall incidence of AF was observed over time. The overall incidence rate ratio (95% CI) for 2023 vs 2013 was 1.07 (1.02-1.11), P=0.003. The incidence rates were higher in men compared to women and increased with older age ( Figure 1 ). However, differences in AF incidence by sex were greatest in the youngest age group and attenuated with older age (incidence rate ratio (95% CI): 2.18 (2.10-2.28) for ages 18-64 years, 1.76 (1.70-1.83) for ages 65-74 years, 1.38 (1.33-1.42) for ages 75-84 years, and 1.23 (1.18-1.28) for ages 85 years and older). Conclusion: In this 27-county region in the Midwest, although small in magnitude, a statistically significant increase in AF incidence was observed over time from 2013 to 2023. Furthermore, the incidence of AF was higher in men compared with women, especially in younger age groups.

Key Points Significant heterogeneity in patient characteristics, urine metabolic studies, and kidney outcomes exist among enteric hyperoxaluria patients from diverse etiologies. Structurally induced malabsorption and exocrine pancreatic insufficiency have the highest kidney stone event rates. Patients with structurally induced malabsorption have up to 18% ESKD incidence at 5 years. Background Enteric hyperoxaluria (EH) is a risk factor for calcium oxalate nephrolithiasis and kidney disease. The study compares patient characteristics and urine metabolic profiles at the time of EH diagnosis and kidney stones and ESKD events during follow-up in a cohort with diverse causes of EH. Methods Adult patients with newly documented elevated urinary oxalate excretion >40 mg/24 h between January 1, 2010, and October 10, 2023, and a known enteric diagnosis including inflammatory bowel disease, exocrine pancreatic insufficiency (EPI), celiac disease, structural intestinal malabsorption (SIM), or malabsorptive bariatric surgery (Bariatric) were identified. Event rates and cumulative incidence of kidney stones and ESKD were assessed. Results Among 814 identified patients, the most common enteric etiology was Bariatric ( n =524, 64%). Patients with ulcerative colitis had the highest prevalence of kidney stones at EH diagnosis (93.6%) compared with other enteric etiologies ( P = 0.002). Patients with SIM had the highest urinary oxalate, lower urinary citrate, and volume, compared with other enteric etiologies ( P < 0.05). Calcium oxalate supersaturation was similar among the enteric groups ( P = 0.67). Median stone event rate for the overall cohort was 0.70 stone events/year during a mean (SD) follow-up of 5.0 (3.9) years. The SIM and EPI groups experienced the highest stone events (median [IQR] 1.24 [0.28–2.40] and 1.20 [0.41–1.99] events/year, respectively) while the Bariatric group had the lowest event rates (median [IQR] 0.45 [0.00–1.66 events/year]; P < 0.001). The SIM group had the highest ESKD incidence (17.8% 5 years postdiagnosis; log-rank test P < 0.001). Conclusions We describe a large EH cohort from diverse enteric etiologies. Significant heterogeneity exists in patient characteristics, urine metabolic risk factors, and adverse kidney outcomes. Patients with SIM and EPI experienced the highest kidney stone events and patients with SIM had the highest ESKD incidence. This study highlights the urgent need for more granular information regarding the natural history and risk factors for kidney complications for patients with EH to support interventional trials to improve outcomes.

ABSTRACT Background This medical center migrated from alcohol to sotradecol foam sclerotherapy (SFS) because of perceived improved efficacy in managing symptomatic kidney and liver cysts. We report technical aspects, change in short- and long-term cyst volumes, patient-reported outcomes, safety and applications of the technique. Methods In this retrospective observational study, cases from January 2017 to December 2021 had TKCV/TLCV (per Targeted Kidney or Liver or Cyst analysis) segmented using a deep-learning algorithm and cyst segmentation software (pre-, post-procedure and longitudinally). TKCV/TLCV % change were evaluated using the one-sample Wilcoxon signed rank test. For analyses involving changes in cyst volumes, the median % change in cyst volume per patient was assessed. Longitudinal changes in cyst volumes were assessed using linear mixed models. Changes in quality of life (QOL) [Linear Analog Self-Assessment (LASA), Polycystic Liver Disease Quality of life Questionnaire (PLD-Q) and 12-item short-form (SF12)] were also assessed. Results There were 102 SFS sessions (38 kidney, 58 liver, 6 combined liver/kidney cysts) performed on 77 unique individuals included for analysis. Median [interquartile range (IQR)] % reductions in TKCV were –92.0% (IQR –98.2%, –82.7%, P &lt; .001) and for TLCV were –83.1% (IQR –93.5%, –52.9%, P &lt; .001). Among patients with multiple kidney procedures (n = 7), median % reduction in TKCV was –94.3% (IQR –96.6%, –92.4%, P = .023). For patients with multiple liver procedures (n = 11), median % reduction in TLCV was –63.3% (IQR –85.2%, –28.3%, P = .004). Results were similar among the four patients undergoing multi-stage procedures (n = 1 kidney, n = 3 liver). When measured longitudinally, both liver and kidney cyst volumes declined to levels near 0 mL by 1 year follow-up and remained stable several years later. LASA physical domain and PLD-Q QOL scores improved post-SFS procedure. Conclusion SFS led to substantial long-term reductions in TKCV/TLCV and improved QOL. SFS can augment cyst volume reduction in addition to tolvaptan (kidney cysts) and octreotide (liver cysts). In some individuals with large symptomatic cysts, multiple SFS procedures were safe and effective in reducing TLCV/TKCV and improving symptoms.