Declining kidney function is linked to a higher risk of heart failure, heart attack, peripheral arterial disease, and early death in individuals with or without kidney disease, according to a pair of studies appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The findings indicate that poor kidney function may raise an individual’s risk for cardiovascular complications. To evaluate heart health, clinicians should factor in not only their patients’ current level of kidney function, but also changes in kidney function over time.

Chronic kidney disease (CKD) patients have an increased risk of developing and dying from cardiovascular disease, but the links between kidney function and heart health are not well understood. Michael Shlipak, MD (San Francisco VA Medical Center and University of California, San Francisco), Mark Sarnak, MD (Tufts-New England Medical Center), and their colleagues studied clinical information from individuals who were enrolled in the Cardiovascular Health Study, a community-based study of elderly people. Using a new blood test of kidney function, called cystatin C, the researchers looked for links between changes in kidney function during a period of seven years with the incidence of heart failure, heart attack, stroke, and peripheral arterial disease (obstruction of large arteries in the arms and legs) during the subsequent eight years. Among 4,378 eligible participants in the study, those with rapid kidney decline (1,083 patients) demonstrated a 32% increased risk of experiencing heart failure, a 48% increased risk of having a heart attack, and a 67% increased risk of developing peripheral arterial disease. (They did not have an increased risk of suffering a stroke.)

Importantly, researchers identified an association between rapid kidney function decline and heart complications in patients with and without CKD. Treatments that slow the decline of kidney function and stabilize it in the normal range, before kidney disease develops, could have substantial health benefits.

In the second study, Kunihiro Matsushita, MD, PhD, Josef Coresh, MD, PhD (Johns Hopkins University), and their colleagues examined the effects of changes in kidney function in 13,029 participants of the Atherosclerosis Risk in Communities (ARIC) Study, a population-based sample of individuals aged 45 to 64 years. The researchers followed patients from 1987 to 2006, and monitored participants’ kidney function at the start of the study, three years into the study, and nine years into the study. Investigators found that a large drop in kidney function over time – regardless of the initial level of function – increased one’s risk of developing heart disease and of dying early. Patients whose kidney function dropped by more than 5.6% per year demonstrated a 30% increased risk of developing heart disease and a 22% increased risk of dying prematurely compared to patients with stable kidney function.

Physicians regularly monitor kidney function in elderly patients and patients with diabetes and hypertension to optimize the dose of prescription drugs excreted by the kidneys. This study indicates that physicians who detect a decline in patients’ kidney function over time should view this as a sign of increased risk of heart disease and premature death.

“Our results suggest there may be clinical value in sequential kidney function data, often measured in routine care, even among individuals with mildly reduced kidney function,” the authors wrote.

The authors in both studies report no financial disclosures. Dr. Shlipak’s and Dr. Sarnak’s co-authors include Ronit Katz, DPhil, Bryan Kestenbaum, MD, David Siscovick, MD (University of Washington); Linda Fried, MD (VA Pittsburgh Healthcare System); Anne Newman, MD (University of Pittsburgh); and Dena Rifkin, MD (Tufts-New England Medical Center). Dr. Matsushita’s and Dr. Coresh’s co-authors include Elizabeth Selvin, PhD, Lori Bash, PhD, Brad Astor, PhD (Johns Hopkins University), and Nora Franceschini, MD (University of North Carolina).

The articles, entitled “Rapid Decline of Kidney Function Increases Cardiovascular Risk in the Elderly” (doi 10.1681/ASN.2009050546) and “Change in Estimated GFR Associates with Coronary Heart Disease and Mortality” (doi 10.1681/ASN.2009010025) appeared online at jasn.asnjournals/ on November 5, 2009.

Source: Shari Leventhal

American Society of Nephrology

UC Irvine neurobiologist Hans Keirstead and his research team has launched a project to develop stem cell lines that genetically match human patients. These lines would allow scientists to better study conditions ranging from diabetes to Parkinson’s disease, and they would provide the basis for potential patient-specific stem cell treatments.

Keirstead will use a technique called somatic cell nuclear transfer (SCNT) in which a patient’s DNA is transplanted into a donated unfertilized egg cell in order to generate stem cell lines with the same genetic makeup of the patient. These lines have tremendous therapy potential because the human immune system is less likely to attack genetically identical cells. Only a few laboratories in the world are attempting this technique in human stem cell research and, thus far, no human stem cell lines have been derived using this method.

“This technique holds tremendous promise to advance our knowledge of stem cells and their potential to cure disease,” said Keirstead, associate professor of anatomy and neurobiology and co-director of UCI’s Sue and Bill Gross Stem Cell Research Center. “I am excited to embark on this line of research and look forward to the day when patient-specific stem cells are utilized to treat people suffering from debilitating injuries and health conditions.”

This project has received approval from UCI’s Institutional Review Board, which under federal regulation reviews all proposed studies involving human tissue. The Embryonic Stem Cell Research Oversight Committee at UCI also has reviewed the project and will ensure that experiments involving embryonic stem cells serve important research goals and are conducted according to the highest ethical standards.

UCI has built a cutting-edge workstation that is custom-designed for SCNT experiments. Designed by Gabriel Nistor, a scientist in Keirstead’s laboratory, the quarter-million dollar system housed at the Sue and Bill Gross Stem Cell Research Center will allow scientists to dissect single cells using lasers, manipulate cells using robotic instruments, and control the climate in the work area. Nistor collaborated with scientists at West Coast Fertility Centers’ Embryology Laboratory to design the system. From this Orange County medical practice, Keirstead plans to obtain donated egg cells for his SCNT research.

Stem cells are the “master” cells that give rise to each of the specialized cells within the human body. During organ and tissue development, these cells transform into a particular specialized cell, such as a heart cell or a liver cell, when prompted by their environment or by their internal genetic programming. If researchers can control the processes directing stem cell transformation, they may one day be able to use these cells as a source of healthy replacement cells for diseased or injured tissues.

Keirstead is a pioneer in the use of human embryonic stem cells in the study of spinal cord injuries. Keirstead’s laboratory was the first in the world to develop a method to restrict human embryonic stem cells so they generate large amounts of only one cell type in high purity. That type of cell, an oligodendrocyte, insulates connections in the spinal cord, allowing them to conduct electricity.

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About the University of California, Irvine: The University of California, Irvine is a top-ranked university dedicated to research, scholarship and community service. Founded in 1965, UCI is among the fastest-growing University of California campuses, with more than 25,000 undergraduate and graduate students and about 1,800 faculty members. The second-largest employer in dynamic Orange County, UCI contributes an annual economic impact of $3.7 billion. For more UCI news, visit today.uci.edu/.

Contact: Jennifer Fitzenberger

University of California – Irvine

The Glenn Foundation for Medical Research, founded by philanthropist Paul F. Glenn, has announced a $5 million commitment to the American Federation for Aging Research (AFAR) to provide grants to scientists studying the biology of aging and age-related diseases. This grant provides timely support as current cutbacks in federal funding jeopardize the careers of hundreds of promising investigators who are working to understand how aging influences disease.

The Glenn Foundation funds will go toward the AFAR Research Grant Program and the Glenn/AFAR Breakthroughs in Gerontology (BIG) Awards. AFAR Research Grants provide start-up funding to scientists in the early phases of their careers, enabling them to study the basic mechanisms of aging, age-related diseases and processes underlying common geriatric functional disorders. The Glenn/AFAR Breakthroughs in Gerontology Awards support innovative higher-risk research that may offer significant promise of yielding transforming discoveries in the fundamental biology of aging that could lead to major new insights into the factors that regulate aging.

“As the number of older adults in the United States continues to grow, there is a greater need not only to provide high-quality medical care but also to develop new scientific knowledge about aging processes and age-related diseases and disorders that will allow more people to live healthier longer, free of disability. Aging research is about studying the young, before the body breaks down. Scientists search for clues about why we develop diseases later in life,” said Stephanie Lederman, executive director, AFAR. “The forward-thinking vision of Paul Glenn and the Glenn Foundation will allow greater distribution of resources to novel research that will benefit all of us as we age,” she added.

“We are proud to support the work of AFAR,” said Mark R. Collins, president of the Glenn Foundation for Medical Research. “Longer life brings with it vulnerability to diseases such as Alzheimer’s, Parkinson’s, osteoporosis, diabetes and others. Funding of aging research is an important path to the alleviation of suffering and reduced healthcare costs. This research forms the backbone of scientific advances in our understanding of aging. AFAR is a key organization in assuring that the best research remains supported.”

Nearly 2,500 researchers have been recipients of AFAR-supported grant awards, many of whom have gone on to distinguish themselves as leaders in the field of aging research, chairing departments and running laboratories at major academic institutions. Many of the nation’s leaders in biogerontology have been beneficiaries of AFAR grant programs.

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The Glenn Foundation for Medical Research was founded in 1965 to extend the healthy productive years of life through research on the mechanisms of biological aging. For more information, visit glennfoundation/.

The American Federation for Aging Research is a nonprofit organization whose mission is to support biomedical research on aging. It is devoted to creating the knowledge that all of us need to live healthy, productive, and independent lives. Since 1981, AFAR has awarded more than $100 million to nearly 2,500 talented scientists as part of its broad-based series of grant programs. Its work has led to significant advances in our understanding of the aging process, age-related diseases, and healthy aging practices. AFAR communicates news of these innovations through its organizational web site afar/ and educational web sites Infoaging (wwwaging) and Health Compass (healthcompass/).

Source: Stacey Harris

American Federation for Aging Research

A set of molecular biomarkers might better predict the recurrence of bladder cancer than conventional prognostic features such as the stage or grade of the malignancy at the time it is discovered, UT Southwestern Medical Center researchers have found.

Once a patient undergoes surgery for the removal of their bladder and lymph nodes — the standard treatment for muscle-invasive bladder cancer — researchers say a routine tissue analysis could easily test for the presence of mutated proteins, or biomarkers, that they found to help ascertain the chances that the cancer will return.

The findings, which researchers say could one day alter the postoperative treatment offered to patients who test positive for the mutated biomarkers, are available online and in an upcoming issue of The Lancet Oncology.

“Our goal is to identify patients who have a higher chance of cancer recurrence,” said Dr. Jose Karam, the study’s lead author and a medical resident at UT Southwestern. “If we can identify key biomarker alterations in these patients, we might be able to predict who will benefit from treatments such as chemotherapy.”

In the study, UT Southwestern scientists investigated the association of the proteins Bcl-2, caspase-3, P53 and survivin with the recurrence of cancer after surgery. The proteins are known to regulate apoptosis, or programmed cell death.

Apoptosis is a way for the body to safely dispose of dead cells, and it plays a role in preventing cancer. If cells don’t die when they are supposed to, they can continue dividing and change into a tumor.

“We are trying to identify tumors that are more aggressive and more likely to spread,” said Dr. Yair Lotan, assistant professor of urology at UT Southwestern and an author of the study. “Even after we’ve removed a diseased bladder and lymph nodes from a patient, more than 20 percent of patients have disease elsewhere in their body.”

Researchers collected archival tissue from 226 patients who underwent surgery for bladder cancer — the fourth most common cancer in men and the ninth most common cancer in women — between January 1987 and December 2002. They tested the tissue for the protein biomarkers and found that patients who showed mutations in all four biomarkers had a significantly increased rate of mortality from cancer after surgery. Patients who showed no mutations in the four biomarkers had a 90 percent chance of survival at five years compared to less than 20 percent if they had four mutated markers.

Dr. Shahrokh Shariat, the study’s senior author and a urology resident at UT Southwestern, said the findings suggest that mutations in the biomarkers indicate a malfunction in programmed cell death, leading to increased chances of cancer recurrence and mortality.

Dr. Karam noted that while the findings are still preliminary and need to be scientifically validated before being applied in the clinic, the results could change the treatment patients receive.

“Patients who have alterations on all four biomarkers might benefit from adjuvant chemotherapy even if the cancer appears to be confined to their bladder.

Otherwise, their chances for survival are likely to be poor,” said Dr. Karam. “Likewise, those who show none of the biomarkers might not need unnecessary chemotherapy.”

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Other UT Southwestern researchers involved in the study were Dr. Arthur Sagalowsky, professor of urology and surgery; Dr. Claus G. Roehrborn, chairman of urology; Dr. Shahrokh F. Shariat, medical resident; and Dr. Raheela Ashfaq, professor of pathology. Researchers from the University of Montreal also participated.

The study was supported by the National Institutes of Health and the Austrian Programme for Advanced Research and Technology.

About UT Southwestern Medical Center

UT Southwestern Medical Center, one of the premier medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. Its more than 1,400 full-time faculty members — including four active Nobel Prize winners, more than any other medical school in the world — are responsible for groundbreaking medical advances and are committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 89,000 hospitalized patients and oversee 2.1 million outpatient visits a year.

The UT Southwestern Harold C. Simmons Comprehensive Cancer Center combines the highest standards of individual care with innovative programs for cancer diagnosis, treatment and prevention based on UT Southwestern’s internationally recognized research coupled with the most sophisticated equipment and advanced technologies available. The expertise of the physicians in the Simmons Cancer Center extends to virtually every cancer in every age group, from breast, urologic, gynecologic, lung, gastrointestinal, head and neck, brain, and skin to lymphomas, leukemia, and marrow transplantation.

Dr. Yair Lotan – utsouthwestern.edu/utsw/cda/dept37389/files/341426.html

Contact: Connie Piloto

UT Southwestern Medical Center

Responding to research published in the Lancet about climate change and health, Professor Vivienne Nathanson, Head of Science and Ethics at the British Medical Association, said:

“The BMA is pleased to welcome this important work. It clearly shows that taking action to reduce greenhouse gas emissions can have positive impacts for health.

“Climate change not only contributes to disease and premature death but exacerbates existing health inequalities in the UK and globally. Today’s research shows that a reduction in emissions will have a positive effect on health in both high and low-income settings, and that lifestyle changes made by all us will have direct health benefits.

“The BMA is disappointed that, so far, health has not figured significantly on the agenda for the Copenhagen summit. We call on world leaders to move towards solutions that benefit both the environment and individuals.”

Source
British Medical Association

The chairs of the House and Senate Veterans’ Affairs committees are pushing for legislation that would allow Congress to approve funding for veterans’ health care programs one year in advance, the New York Times reports. According to the Times, the so-called advance appropriation would separate VA health care funding from “the crush of appropriations and political horse-trading that take place at year’s end.”

Senate committee Chair Daniel Akaka (D-Hawaii) and House committee Chair Bob Filner (D-Calif.) said delays in funding are unacceptable during a time of war. Akaka said, “The Department of Veterans Affairs operates the largest health care system in the nation, but its funding is untimely and unpredictable.” He said, “Unlike Medicare and Medicaid, VA never knows what its level of funding will be for the next year. VA health care providers are tied down by uncertainty,” adding, “This situation is bad for taxpayers, bad for VA and bad for veterans.” The Partnership for Veterans Health Care Budget Reform, a coalition of major veterans groups, and Akaka say that funding delays affect veterans’ care and can lead to wait times for appointments and make hiring personnel and purchasing equipment more difficult.

Filner said the legislation is a compromise that does not require mandatory funding for any veterans’ programs. “You can’t run an agency if you can’t get timely funding,” Filner said (Alvarez, New York Times, 9/19).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Men who regularly take part in moderate-to-heavy intensity exercise such as jogging, tennis or swimming may be less likely to have a stroke than people who get no exercise or only light exercise, such as walking, golfing, or bowling, according to a study published in the November 24, 2009, print issue of Neurology? ®, the medical journal of the American Academy of Neurology.

However, exercise did not have a protective effect against stroke for women. Women who took part in moderate-to-heavy intensity exercise did not have a reduced risk of stroke.

The study involved 3,298 people living in northern Manhattan, NY, with an average age of 69 who were followed for about nine years. During that time, there were 238 strokes. A total of 41 percent of the participants reported that they participated in no physical activity. Twenty percent regularly participated in moderate-to-heavy intensity activities.

Men who participated in moderate-to-heavy intensity activities were 63 percent less likely to have a stroke than people with no physical activity. The baseline risk of ischemic stroke over five years in the entire group was 4.3 percent; among those with moderate-to-heavy intensity activities the risk was 2.7 percent, and among those with no activity it was 4.6 percent.

“Taking part in moderate-to-heavy intensity physical activity may be an important factor in preventing stroke,” said study author Joshua Z. Willey, MD, of Columbia University Medical Center and New York Presbyterian Hospital at Columbia. Willey is also a member of the American Academy of Neurology. “A large percentage of the participants were not taking part in any physical activities. This may be true of many elderly people who live in cities. Identifying ways to improve physical activity among these people may be a key goal for public health.”

These results are contrary to some other studies that found that even light intensity physical activity reduced the risk of stroke. Willey said the number of participants may not have been large enough to detect subtle differences in the group that took part in only light physical activity.

Stroke is the leading cause of disability and the third-leading cause of death in the United States.

The study was supported by the National Institutes of Health.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as multiple sclerosis, restless legs syndrome, Alzheimer’s disease, narcolepsy, and stroke.

Source: American Academy of Neurology (AAN)

BioTime, Inc. (NYSE Amex:BTX), a biotechnology company that develops and markets products in the field of regenerative medicine, today announced that two human embryonic stem (hES) cell lines, ESI-014 and ESI-017, developed by a BioTime subsidiary have been approved by the National Institutes of Health (NIH) for inclusion in the NIH Human Embryonic Stem Cell Registry. This approval opens the door to the use of these cell lines in Federally funded research. To BioTime’s knowledge, these are the first such cell lines approved for Federal funding that were derived under conditions designed to be compliant with current Good Manufacturing Practices (cGMP) for human clinical use.

“This approval is key to our strategy of making our bank of GMP-compliant hES cell lines the industry standard for the development of a wide array of new human therapeutic products,” said Michael D. West, Ph.D., President and CEO of BioTime. “We believe our ESI hES cell lines are the best characterized and documented lines available today. Our clinical grade hES cell lines were derived using procedures and documentation that are in compliance with current Good Tissue Practices (cGTP) and cGMP, which we believe will facilitate the transition of therapeutic products derived by researchers from these cell lines from laboratory to clinical use. We’re grateful the NIH has approved the use of ESI-014 and ESI-017 and we look forward to working with researchers to translate the science into commercially successful therapeutic products.”

The NIH created the Human Embryonic Stem Cell Registry in 2001 in order to facilitate research using human embryonic stem cells. The registry now includes hES cell lines that meet certain eligibility criteria including ethical derivation and informed consent. Only research projects using hES cell lines listed in the Registry are eligible for Federal funding.

ESI-014 and ESI-017 were developed by ES Cell International Pte. Ltd. (ESI), a wholly owned subsidiary of BioTime. ESI is one of the earliest pioneers of human embryonic stem cell technology. The ESI hES cell lines were produced free of animal feeder cells, are fully characterized, and have been assessed for pluripotency and karyotypic stability. As part of a collaboration with the California Institute of Regenerative Medicine (CIRM), BioTime has supplied research grade versions of the cells to dozens of researchers throughout California, including researchers at universities that are part of the University of California system. BioTime has agreed to provide a complete genome sequence to these collaborators by the Fall of 2011 to facilitate future human use of products derived from these cell lines. BioTime expects to seek NIH approval of ESI’s other GMP-compliant hES cell lines, which have also been provided to CIRM-funded researchers. Another ESI cell line is being evaluated by a large pharmaceutical company for potential use in its product development program.

Source:

BioTime, Inc.

Recognizing that IV use is not always optimal to provide patients with fluids and medications, the American Association of Critical-Care Nurses (AACN) recently endorsed a consensus paper that recommends intraosseous (IO) vascular access in a variety of healthcare settings.

AACN participated in the Consortium on Intraosseous Vascular Access in Healthcare Practice – a group convened in October 2009 by the Infusion Nurses Society, Norwood, Mass. Other members of the consortium include Society of Pediatric Nurses, Air & Transport Nurses Association and Emergency Nurses Association.

The consortium explored evidence that supports use of IO access beyond its well-established benefits in resuscitative settings to wherever vascular access is medically necessary or difficult to achieve. A consensus paper recommending use of IO vascular access in a number of healthcare settings will be published in the November/December Journal of Infusion Nursing and December issue of AACN’s Critical Care Nurse.

“Recommendations for the Use of Intraosseous Access for Emergent and Nonemergent Situations in Various Healthcare Settings: A Consensus Paper” proposes, among other things, that providers in various healthcare settings consider IO vascular access as an alternative to peripheral or central IV access. Settings include the intensive care unit; high acuity/progressive care floors; general medical floor; pre-procedure surgical settings where lack of vascular access may delay surgery; and chronic and long-term care settings where patient morbidity or mortality can occur.

IO access to the bone marrow space is achieved by manually inserted, impact-driven or drill-powered needles. Recently developed IO devices make the procedure relatively easy to perform with appropriate education and training.

AACN Clinical Practice Manager Robi Hellman, RN, MSN, CNS, notes the relevance of the recommendations to critical care nurses and other healthcare providers.

“The significant time savings that IO access provides could benefit patients in emergent situations, decreasing the time required to achieve access and administer necessary fluids and medications.” She adds, “This practice change could be an appropriate solution for a growing patient population with difficult vascular access.”

Source:

American Association of Critical-Care Nurses

Adults aged 50 and older comprise 51.5 percent of all emergency department visits each year related to adverse reactions to medications, according to a study by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report says 61.5 percent were made by people aged 65 or older and 60.9 percent involved women.

Nearly 8 in 10 of the hospital visits by older patients involved adverse reactions to just one medication they had taken, the report said. Central nervous system drugs such as narcotic and non-narcotic pain relievers accounted for the largest share of these visits (24.3 percent). But cases included a broad range of medications, including central nervous system drugs, blood modifiers, cardiovascular system medications, metabolic disorder treatments, and psychotherapeutic drugs.

The study showed 32.9 percent of these visits to hospital emergency departments by those aged 50 and older resulted in hospitalizations for further treatment. However, the level of hospitalization differed considerably between those aged 50 to 64 (25.5 percent) and those aged 65 and older (37.6 percent).

These findings highlight the greater potential risk older Americans face from adverse reactions to medicines because of physiological changes, the concurrent use of multiple medications, and other factors. These risks may pose an even greater public health challenge as the number of older Americans continues to grow in decades to come.

“Individuals taking medications need to take personal responsibility and not assume that just because the medications are legally prescribed that they are without risk,” said SAMHSA Administrator Pamela S. Hyde. “People should monitor how they feel when on medication, ask their doctor about what signs to look out for, and not hesitate to contact a doctor if they feel the medication is having adverse effects on their health.”

Emergency Department Visits Involving Adverse Reactions to Medications among Older Adults, was developed as part of the agency’s strategic initiative on data, quality and outcomes. It is based on data from SAMHSA’s 2008 Drug Abuse Warning Network (DAWN). DAWN is a public health surveillance system that monitors drug-related hospital emergency department visits reported throughout the nation.

Source:
Substance Abuse and Mental Health Administration (SAMHSA)