Ehlersblackwell5766

The impact of chronic kidney disease (CKD) on inpatient health care use is unknown. This study aimed to describe the prevalence of pediatric CKD among children hospitalized in the United States and examine the association of CKD with hospital outcomes.

Cross-sectional national survey of pediatric discharges.

Hospital discharges of children (aged>28 days to 19 years) with a chronic medical diagnosis included in the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2006, 2009, 2012, and2016.

Presence of primary or coexisting CKD as identified by diagnosis codes.

Length of stay (LOS), cost, and mortality.

Multivariable analysis using Poisson, gamma, and logistic regressions were performed for LOS, cost, and mortality, respectively.

A chronic medical condition was present in 6,524,745 estimated discharges during the study period and CKD was present among 3.9% of discharges (96.1% without CKD). Those with CKD had a longer LOS (median of 2.8 [IQR, 1.4-6.0] days compared with 1.8 llnesses. Further studies are needed to better understand the health care needs and delivery of care to hospitalized children with CKD.The clinical significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients undergoing left ventricular assist device (LVAD) implantation is not fully explored. NT-proBNP concentrations are influenced by body composition, renal function and intracardiac pressures; dynamic measures pre- and post-LVAD implantation. We sought to identify the individual contribution of cardiac and extracardiac factors to NT-proBNP concentrations in advanced heart failure patients before and after LVAD implantation. We retrospectively collected data from 63 patients implanted with a LVAD with NT -proBNP measurements (2006-2019). Hemodynamic measurements were obtained through right heart catheterization (RHC). Univariable linear regression and multivariable stepwise regression models were used to analyze variables associated with NT-proBNP concentrations in the pre- and post-LVAD setting. Paired t-test was performed on a subpopulation of 13 patients with complete data. We found significant differences in all extracardiac (BMI, creatinine, eGFR) and all invasive hemodynamic measurements pre-LVAD compared to post-LVAD. NT-proBNP decreased by 83 %, in the subpopulation of 13 patients 736 pmol/L [IQR 498-1330] to 126 pmol/L [IQR 74.8-241.7]. In multivariable analysis, only creatinine remained significantly associated with NT-proBNP before LVAD implant (p = 0.016), whereas pulmonary capillary wedge pressure (PCWP) was the only independent variable associated with NT-proBNP after LVAD implant (p less then 0.0001). Creatinine and PCWP were the only independent factors associated with NT-proBNP concentrations before and after LVAD implantation, respectively. Invasive hemodynamic measurements were more closely associated with NT-proBNP concentration after LVAD than extracardiac factors and reversely pre-LVAD, suggesting that NT-proBNP serves as a useful biomarker of cardiac conditions post-LVAD implantation.We aimed to investigate whether circulating leptin and body mass index (BMI) associate independently with cognitive function (decline) and brain volumes using magnetic resonance imaging (MRI) in older individuals at risk of cardiovascular disease. We studied the cross-sectional and longitudinal associations in participants enrolled in the PROSPER study (Prospective Study of Pravastatin in the Elderly at Risk). Cognitive function was tested at baseline and repeated during a mean follow-up time of 3.2 years. Analyses were performed with multivariable (repeated) linear regression models and adjusted for demographics, cardiovascular risk-factors, and stratified by sex. We included 5623 dementia-free participants (52 % female, mean age 75 years) with a mean BMI of 26.9 (SD = 4.1). In a sub-study, 527 participants underwent brain MRI. selleckchem At baseline, individuals with a BMI > 30 had a worse performance on the Stroop test (β 5.0 s, 95 %CI 2.6;7.5) and larger volumes of the amygdala (β 234 mm3, 95 %CI 3;464) and hippocampus (β 590 mm3, 95 %CI 181;999), independent of intracranial volume and serum leptin levels, compared with individuals with the reference BMI (BMI 18-25 kg/m2). Per log ng/mL higher serum leptin, independent of BMI, a 135 mm3 (95 %CI 2;268) higher volume of the amygdala was found, but no association was observed with cognitive tests nor with other brain volumes. Stratification for sex did not materially change the results. Whereas higher BMI associated with worse cognitive function independent of leptin levels, our study provided evidence that leptin and BMI independently associate with amygdala volume suggesting potential distinct biological associations.Malondialdehyde-modified low-density lipoprotein (MDA-LDL) is recognized as a surrogate marker of lipid oxidation and is associated with arteriosclerosis. However, there are limited reports on the relationship between heart failure and MDA-LDL. Therefore, we aimed to determine whether MDA-LDL is activated in patients with left ventricular (LV) dysfunction and examine our hypothesis that the B-type natriuretic peptide (BNP) masks the enhancement of MDA-LDL in patients with LV dysfunction by its strong antioxidative action. The study population comprised 2,976 patients with various cardiovascular diseases. Patients were divided into four groups depending on the LV ejection fraction (LVEF) or plasma BNP level. A nonparametric analysis with the Kruskal-Wallis test was used to perform an interquartile comparison. In addition, structural equation modeling and Bayesian estimation were used to compare the effects of LVEF and BNP on MDA-LDL. MDA-LDL levels did not significantly change (P > 0.05) with respect to the degree of LVEF among the four groups. In contrast, MDA-LDL levels were significantly decreased (P less then 0.001) with respect to the degree of BNP among the four groups. A path model based on structural equation modeling clearly showed a significant effect of LVEF (standardized regression coefficient; β -0.107, P less then 0.001) and BNP (β -0.114, P less then 0.001) on MDA-LDL, with a significant inverse association between LVEF and BNP (correlation coefficient -0.436, P less then 0.001). MDA-LDL should be activated in patients with LV dysfunction; however, BNP is thought to exert a strong compensatory suppression on lipid oxidation, masking the relationship between heart failure and lipid oxidation.