Supplement Use by US Adults With CKD: A Population-Based Study.
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ABSTRACT:
SUBMITTER: Kurani S
PROVIDER: S-EPMC6875608 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
Publications
Supplement Use by US Adults With CKD: A Population-Based Study.
Kurani Shaheen S Hickson LaTonya J LJ Thorsteinsdottir Bjorg B Barreto Erin F EF Haag Jordan D JD Shah Nilay D ND McCoy Rozalina G RG
American journal of kidney diseases : the official journal of the National Kidney Foundation 20190718 6
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| S-EPMC8683945 | biostudies-literature
Project description:Background and objectivesAlthough prior studies have observed high resource use among patients with CKD, there is limited exploration of emergency department use in this population and the proportion of encounters related to CKD care specifically.Design, setting, participants, & measurementsWe identified all adults (≥18 years old) with eGFR<60 ml/min per 1.73 m2 (including dialysis-dependent patients) in Alberta, Canada between April 1, 2010 and March 31, 2011. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of emergency department encounters and followed until death or end of study (March 31, 2013). Within each CKD category, we calculated adjusted rates of overall emergency department use as well as rates of potentially preventable emergency department encounters (defined by four CKD-specific ambulatory care-sensitive conditions: heart failure, hyperkalemia, volume overload, and malignant hypertension).ResultsDuring mean follow-up of 2.4 years, 111,087 patients had 294,113 emergency department encounters; 64.2% of patients had category G3A CKD, and 1.6% were dialysis dependent. Adjusted rates of overall emergency department use were highest among patients with more advanced CKD; 5.8% of all emergency department encounters were for CKD-specific ambulatory care-sensitive conditions, with approximately one third resulting in hospital admission. Heart failure accounted for over 80% of all potentially preventable emergency department events among patients with categories G3A, G3B, and G4 CKD, whereas hyperkalemia accounted for almost one half (48%) of all ambulatory care-sensitive conditions among patients on dialysis. Adjusted rates of emergency department events for heart failure showed a U-shaped relationship, with the highest rates among patients with category G4 CKD. In contrast, there was a graded association between rates of emergency department use for hyperkalemia and CKD category.ConclusionsEmergency department use is high among patients with CKD, although only a small proportion of these encounters is for potentially preventable CKD-related care. Strategies to reduce emergency department use among patients with CKD will, therefore, need to target conditions other than CKD-specific ambulatory care-sensitive conditions.
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Project description:BackgroundThe risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear.ObjectivesWe set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old).DesignPopulation-based, retrospective cohort study.SettingsOntario, Canada.Participants905 167 individuals (≥66 years old) from 2008 to 2015.MeasurementsSerum potassium values.MethodsIndividuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m2) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models.ResultsAmong a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event.LimitationsLimited to individuals aged 66 years and above.ConclusionsPatients with low eGFR are at a high risk of initial and recurrent hyperkalemia.Trial registrationN/A.
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Project description:Some herbal supplements may contain lead.To examine whether use of specific herbal dietary supplements during the last 30 days is associated with blood lead levels in US men and women.Cross-sectional analysis.NHANES participants from 1999-2004, a representative sample of the civilian non-institutionalized US population.Lead was measured in blood. Associations between lead and self-reported supplement use were estimated using multivariable regression weighted to account for NHANES sampling. Herbal supplements investigated were those previously reported to contain high heavy metal content: Ayurvedic or traditional Chinese medicine herbs, echinacea, ginkgo, ginseng, St. John's wort, and "other" herbs (specifically, kava, valerian, black cohosh, bee pollen, and nettle).Among 6,712 women > or =20 years, those using herbal supplements had lead levels that were 10% higher than non-users (95% CI 3%-17%, p = 0.005). Women using Ayurvedic or traditional Chinese medicine herbs, St. John's wort, and "other" herbs had lead levels 24% (95% CI 5%-45%, p = 0.01), 23% (95% CI 4%-46%), p = 0.02), and 21% (95% CI 2%-44%, p = 0.03) higher, respectively, than non-users. No significant associations were observed between herb use and lead levels among men (n = 6,095). Among reproductive-aged women (16-45 years), herbal supplement users had lead levels 20% higher than non-users (95% CI 5%-34%, p = 0.008). In contrast, garlic and other dietary supplements were not associated with higher lead levels.Use of specific herbal supplements is associated with higher blood lead levels among women. Our data suggest testing guidelines for herbal supplements and regulations limiting lead in supplements are needed.
| S-EPMC2771230 | biostudies-other
Project description:STUDY OBJECTIVES:Outdoor artificial nighttime light is increasingly recognized as a form of environmental pollution. Excessive nighttime light exposure, whether from indoor or outdoor sources, has been associated with a number of deleterious effects on human health. We performed a population-based cohort study in South Korea to assess the possible association between outdoor nocturnal lighting and insomnia in older adults, as measured by prescriptions for hypnotic drugs. METHODS:This study used data from the 2002-2013 National Health Insurance Service-National Sample Cohort (NHIS-NSC), and a total of 52,027 adults who were age 60 years or older were included in the study. Light data were based on satellite mapping of artificial light. The usage data of two hypnotic drugs, zolpidem (N05CF02) and triazolam (N05CD05), were extracted from the NHIS-NSC records. RESULTS:Of the 52,027 patients in this cohort, 11,738 (22%) had prescriptions for hypnotic drugs. Increasing outdoor artificial nighttime light exposure (stratified by quartile) was associated with an increased prevalence of hypnotic prescriptions and daily dose intake. Compared with individuals in the lowest quartile 1, the regression coefficients for prescription days and daily defined doses of all hypnotic drugs and certain hypotonic drugs were significantly higher among those living in areas with higher outdoor artificial nighttime light (quartiles 2 through 4). CONCLUSIONS:Outdoor artificial nighttime light exposure was significantly associated with prescription of hypnotic drugs in older adults. These findings are consistent with the hypothesis that outdoor artificial nighttime light may cause sleep disturbances.
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Project description:BackgroundHealth supplement (HS) products that are available in the Emirate of Dubai (United Arab Emirates; UAE) contain chemicals that may adversely affect human health. This study aimed to investigate the prevalence of, and factors associated with HS consumption, knowledge, related adverse events, and reporting practices of adverse events amongst the general population in Dubai, UAE.MethodsA cross-sectional household telephone survey using a computer-assisted questionnaire was conducted amongst a random representative sample (n = 1203) of the Dubai population that assessed HS use and knowledge. Dependent variables were supplement use and reports of adverse events while independent variables included socio-demographic factors, knowledge, attitudes, and practice. Logistic regression analysis was performed to identify factors independently associated with HS use.ResultsAmong the 1203 participants in this study, 455 (37.8%) reported ever using HS. Amongst ever-users, reasons for use were to improve health (66.1%), for bodybuilding (9.9%), disease prevention (6.8%), and weight management (5.3%). The majority of users purchased their HS from pharmacies (88.4%) or were prescribed HS (46.6%). Vitamins were the most commonly used HS (87.9%) followed by minerals (10.5%) and sports nutrition products (10.5%). Only 2.9% of users experienced an adverse event associated with HS use which all resolved when the HS was discontinued. Only three of those affected reported the incident. Multivariate logistic regression analysis revealed that HS use was independently associated with female gender (adjusted odds ratio [AOR]; 3.26, 95% confidence interval [CI]: 2.26-4.70), higher income (AOR 2.41, 95% CI: 1.20-4.83), being a past-smoker (AOR 2.39, 95% CI: 1.27-4.48), having an allergy (AOR 1.75, 95% CI: 1.14-2.66), more frequent doctor visits (AOR 1.86, 95% CI: 1.02-3.39), taking prescribed medications (AOR 1.47, 95% CI: 1.04-2.06), and knowledge about HS (AOR 3.91, 95% CI: 2.26-6.76).ConclusionsOur study provides the first population-based estimates of HS use and HS-related adverse events in the Gulf region. Adverse events associated with HS are infrequent and this may be due to the well-developed regulatory framework in Dubai and the high level of knowledge amongst consumers who mainly consume vitamins and minerals on the advice of pharmacists or healthcare professionals.
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Project description:BackgroundThe health benefits and risks of dietary supplement use are controversial.ObjectiveTo evaluate the association among dietary supplement use, levels of nutrient intake from foods and supplements, and mortality among U.S. adults.DesignProspective cohort study.SettingNHANES (National Health and Nutrition Examination Survey) data from 1999 to 2010, linked to National Death Index mortality data.Participants30 899 U.S. adults aged 20 years or older who answered questions on dietary supplement use.MeasurementsDietary supplement use in the previous 30 days and nutrient intake from foods and supplements. Outcomes included mortality from all causes, cardiovascular disease (CVD), and cancer.ResultsDuring a median follow-up of 6.1 years, 3613 deaths occurred, including 945 CVD deaths and 805 cancer deaths. Ever-use of dietary supplements was not associated with mortality outcomes. Adequate intake (at or above the Estimated Average Requirement or the Adequate Intake level) of vitamin A, vitamin K, magnesium, zinc, and copper was associated with reduced all-cause or CVD mortality, but the associations were restricted to nutrient intake from foods. Excess intake of calcium was associated with increased risk for cancer death (above vs. at or below the Tolerable Upper Intake Level: multivariable-adjusted rate ratio, 1.62 [95% CI, 1.07 to 2.45]; multivariable-adjusted rate difference, 1.7 [CI, -0.1 to 3.5] deaths per 1000 person-years), and the association seemed to be related to calcium intake from supplements (≥1000 mg/d vs. no use: multivariable-adjusted rate ratio, 1.53 [CI, 1.04 to 2.25]; multivariable-adjusted rate difference, 1.5 [CI, -0.1 to 3.1] deaths per 1000 person-years) rather than foods.LimitationsResults from observational data may be affected by residual confounding. Reporting of dietary supplement use is subject to recall bias.ConclusionUse of dietary supplements is not associated with mortality benefits among U.S. adults.Primary funding sourceNational Institutes of Health.
| S-EPMC6736694 | biostudies-literature
Project description:Nearly 70% of older adults in the U.S. report using ≥1 dietary supplements (DSs) daily. While DSs may have health benefits, there is risk for toxicity or harmful drug-supplement interactions if not taken correctly. Older adults with chronic wounds who use DSs are at increased risk of adverse drug-supplement interactions because they usually have comorbidities requiring polypharmacy management. However, no studies have evaluated DS use in this population. The aim of this retrospective pilot study was to describe DS use by a sample of older adults (n = 40) with chronic venous leg ulcers (CVLUs) who participated in a clinical trial testing the effects of fish oil supplementation on wound healing. At baseline, study personnel assisted all participants in completing an electronic questionnaire about DS use. Descriptive statistics were used to characterize the data. Twenty-five of the 40 participants (62.5%) reported taking ≥1 DS daily. On average, DS users were 65.16 years (SD = 8.51) and the majority were men (64.0%), white (68.0%), and had at least some college education (72.0%). Fifteen (60.0%) reported taking 1-2 DSs/day, and 10 (40.0%) reported taking ≥3/day. The most frequently reported DSs used were multivitamin/mineral complex (60.0%), vitamin D (36.0%), vitamin B complex (28.0%) and calcium (28.0%). Reasons for using DSs were to maintain or improve health (44.0%), improve bone density (12%), and boost the immune system (12%). Supplement users reported consuming an average of 9.12 (SD = 6.46) prescription drugs daily and 21 (84.0%) reported ≥3 chronic health conditions. In summary, DS use in this sample of chronic wound patients was high. Moreover, DS users reported using multiple prescription drugs (2-23/day) concomitantly with DSs. While older adults with CVLUs may benefit from targeted DS therapy, monitoring their DS use to reduce risk for adverse drug-supplement interactions is best practice.
| S-EPMC9036647 | biostudies-literature
Project description:Aims and objectivesTo describe and explore characteristics associated with oral dietary supplement use and identify potential interactions with prescription medications in a sample of rural community-dwelling older adults.BackgroundOlder adults use polypharmacy to help manage chronic diseases. Due to healthcare access disparities, rural older adults may consider dietary supplement use as an alternative approach to maintain health and manage disease. Oral dietary supplement use is expected to increase among ageing adults; placing them at risk for potential interactions and adverse events.DesignA secondary analysis was conducted on oral dietary supplement, medication and health characteristic data collected on N = 138 participants. The original study was adherent to STROBE guidelines.ResultsResearchers found that 83% of the rural older adults used oral dietary supplements in addition to their prescribed medications. Participants took additional single-dose vitamins along with their multivitamin; 57% took vitamin D, 52% took calcium, 15% took vitamin C and 13% took additional potassium and vitamin E. Participants also used oral dietary supplements with medications that had a potential for interaction.ConclusionsCompared with national samples of older adults, a high percentage of rural older adults used oral dietary supplements in addition to their prescribed medications. In the rural setting, older adults are at risk for potential drug-oral dietary supplement interactions.Relevance to clinical practiceNurses can conduct vigilant medication reconciliation that includes documenting characteristics of oral dietary supplement use. Nurses can assist with providing appropriate dietary supplements education that promotes patient knowledge and prevent inappropriate use; particularly when caring for older adults from rural settings.
| S-EPMC6453705 | biostudies-literature
Project description:Background: We seek to understand correlates of chronic stress and their influence on the development of substance use in a population-based cohort of young adults (OYSUP). Methodology: We evaluated clinical features, salivary RNA metrics and differential expression of candidate genes in unfractionated saliva samples from 48 individuals (31% female, 55% ever-smoking) randomly selected from two groups stratified by high versus low severe negative life events and difficulties within the last year as as measured by the Life Events and Difficulties Schedule (LEDS, Brown & Harris, 1978). We used multiple analytical platforms, multiple reference genes and 18 replicates of all gene expression assays (assays). We chose 38 candidate genes previously identified as differentially expressed in a genome-wide scan of monocyte RNA in 11 familial caregivers of glioblastoma multiforme patients and 10 control subjects matched on age (middle-aged), gender (57% female), ethnicity and marital status and free of major stressors during the previous year. Principal Findings: We observed significant differences in smoking prevalence (Pearson’s χ22d.f.=4.5, P=0.035) and RNA integrity score (t=2.12, P=0.039) between stress strata. We analyzed quantitative PCR data using both the comparative standard curve (CSC) and relative standard curve (RSC) methods because 34% of assays had efficiency estimates <90%. Assay data exhibited excellent linearity and low variability. We observed significant under expression of five assays in the high stress stratum using both methods, four of which interrogate glucocorticoid receptor regulated genes. Post-hoc analyses identified significant associations of RNA yield, integrity score, gender, ever-smoking and/or stress with results of normalized gene expression in 22/37 assays. IL8 expression remained significantly associated with chronic stress after adjustment for clinical and salivary RNA variables. Salivary IL8 expression has been previously associated with oropharyngeal squamous cell cancer. Conclusions: A gene expression signature of chronic stress previously observed in adult hematopoietic samples is observed in the unfractionated saliva of young adults. Future investigation will need to analyze associated clinical, metabolic, meta-genomic, and proteomic components of unfractionated saliva to elucidate factors influencing the salivary transcriptome.
2012-06-15 | GSE27144 | GEO