Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have... more Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have been performed only in field--based team sports. The aim of this study was to compare generic (light--based) and sport--specific (live opponent) reactive agility tests in court--based team sport athletes.
The primary aim of this study was to determine the prevalence of current strength-based exercise ... more The primary aim of this study was to determine the prevalence of current strength-based exercise in rural and regional populations of Central Queensland. The secondary aim was to examine the proportion of residents from various demographic groups who currently partake in strength-based exercise to allow for targeted strength training campaigns. A cross-sectional, survey-based experimental design was followed. Rural and regional Australia. Rural and regional community-dwelling individuals living in Central Queensland and aged 18 years and older. Survey data was collected in October and November 2010 as part of the Central Queensland University Social Survey. Strength-based exercise participation, gender, age, income, years of education, self-reported physical activity and perception of health. Participation in strength-based exercise was 13.2%. Women were less likely to partake in strength-based exercise than male, and ≥55 year old adults were less likely to partake in strength-based exercise than 18-34 year old adults. Participation in strength-based exercise was found to increase with years of education, self-reported physical activity and self-rated health. The prevalence of adults in rural and regional Central Queensland engaging in strength-based exercise is low. Exercise physiologists, clinicians and government officials must work together to ensure that this form of exercise is acknowledged as a vital component of health in rural and regional areas.
The majority of CKD-related complications stem from cardiovascular pathologies such as hypertensi... more The majority of CKD-related complications stem from cardiovascular pathologies such as hypertension. To help reduce cardiovascular complications, aerobic exercise is often prescribed. Emerging evidence suggests high intensity interval training (HIIT) may be more beneficial than traditional aerobic exercise. However, appraisals of varying forms of aerobic exercise, along with descriptions of mechanisms responsible for health-related improvements, are lacking. This study examined the effects of 8 weeks of HIIT (85% VO2max), versus low intensity aerobic exercise (LIT; 45-50% VO2max) and sedentary behaviour (SED), in an animal model of early-stage CKD. Tissue-specific mRNA expression of RAAS-related genes and CKD-related clinical markers were examined. Compared to SED, HIIT resulted in increased plasma albumin (p = 0.001), reduced remnant kidney weight (p = 0.028), and reduced kidney weight-body weight ratios (p = 0.045). Compared to LIT, HIIT resulted in reduced Agt mRNA expression (p = 0.035), reduced plasma LDL (p = 0.001), triglycerides (p = 0.029), and total cholesterol (p = 0.002), increased plasma albumin (p = 0.047), reduced remnant kidney weight (p = 0.005), and reduced kidney weight-body weight ratios (p = 0.048). These results suggest HIIT is a more potent regulator of several markers that describe and influence health in CKD.
Chronic kidney disease (CKD) is characterized by increased levels of oxidative stress and inflamm... more Chronic kidney disease (CKD) is characterized by increased levels of oxidative stress and inflammation. Oxidative stress and inflammation promote renal injury via damage to molecular components of the kidney. Unfortunately, relationships between inflammation and oxidative stress are cyclical in that the inflammatory processes that exist to repair radical-mediated damage may be a source of additional free radicals, resulting in further damage to renal tissue. Oxidative stress and inflammation also have the ability to become systemic, serving to injure tissues distal to the site of original insult. This review describes select mediators in the exacerbatory relationship between oxidative stress, inflammation, and CKD. This review also discusses oxidative stress, inflammation, and CKD as they pertain to the development and progression of common CKD-associated comorbidities. Lastly, the utility of several widely accessible and cost-effective lifestyle interventions and their ability to r...
The Journal of sports medicine and physical fitness, Jan 12, 2014
Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have... more Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have been performed only in field--based team sports. The aim of this study was to compare generic (light--based) and sport--specific (live opponent) reactive agility tests in court--based team sport athletes. Twelve semi--professional male basketball players (age: 25.9 ± 6.7 yr; stature: 188.9 ± 7.9 cm; body mass: 97.4 ± 16.1 kg; predicted maximal oxygen uptake: 49.5 ± 5.3 mL∙kg--1∙min--1) completed multiple trials of a Reactive Agility Test containing light--based (RAT--Light) and opponent--based stimuli (RAT--Opponent). Multiple outcome measures were collected during the RAT--Light (agility time and total time) and RAT--Opponent (decision time and total time). Mean performance times during the RAT--Light (2.233 ± 0.224 s) were significantly (P < 0.001) slower than during the RAT--Opponent (1.726 ± 0.178 s). Further, a small relationship was observed between RAT--Light agility time and ...
Nephrology nursing journal : journal of the American Nephrology Nurses' Association
This is the second in a series of three articles about the risk factors and complications related... more This is the second in a series of three articles about the risk factors and complications related to chronic kidney disease and their impact on cardiovascular disease. This article focuses on identifying pathophysiologic mechanisms by which two traditional risk factors of cardiovascular disease (hypertension and dyslipidemia), and two nontraditional risk factors associated with chronic kidney disease (anemia and abnormalities in bone and mineral metabolism) contribute to the markedly increased cardiovascular morbidity and mortality seen in individuals with chronic kidney disease.
International Journal of Sports Physiology and Performance, 2015
To evaluate anthropometric measures and serum markers of myostatin-pathway activity after differe... more To evaluate anthropometric measures and serum markers of myostatin-pathway activity after different weight-reduction protocols in wrestlers. Subjects were randomly assigned to a gradual-weight-reduction (GWR) or rapid-weight-reduction (RWR) group. Food logs were collected for the duration of the study. Anthropometric measurements and serum samples were collected after an 8-h fast at baseline and after the weight-reduction intervention. Subjects reduced body mass by 4%. The GWR group restricted calories over 12 d, while the RWR group restricted calories over 2 d. A series of 2×5 repeated-measures (RM) ANOVAs was conducted to examine differences in nutrient consumption, while separate 2×2 RM ANOVAs were conducted to examine differences in anthropometric measures and serum markers. When applicable, Tukey post hoc comparisons were conducted. Significance for all tests was set at P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05. There were no between-groups differences for any anthropometric measure (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05). Subjects in both groups experienced a significant reduction in body mass, fat mass, lean mass, and percent body fat (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). There were no between-groups differences in serum markers of myostatin-pathway activity (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05), but subjects in the RWR condition experienced a significant increase in serum myostatin (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01), a decrease in follistatin (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01), and an increase in myostatin-to-follistatin ratio (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Although there were no between-groups differences for any outcome variables, the serum myostatin-to-follistatin ratio was significantly increased in the RWR group, possibly signaling the early stages of skeletal-muscle catabolism.
International Journal of Sports Physiology and Performance, 2014
To compare perceptual and physiological training-load responses during various basketball trainin... more To compare perceptual and physiological training-load responses during various basketball training modes. Eight semiprofessional male basketball players (age 26.3 ± 6.7 y, height 188.1 ± 6.2 cm, body mass 92.0 ± 13.8 kg) were monitored across a 10-wk period in the preparatory phase of their training plan. Player session ratings of perceived exertion (sRPE) and heart-rate (HR) responses were gathered across base, specific, and tactical/game-play training modes. Pearson correlations were used to determine the relationships between the sRPE model and 2 HR-based models: the training impulse (TRIMP) and summated HR zones (SHRZ). One-way ANOVAs were used to compare training loads between training modes for each model. Stronger relationships between perceptual and physiological models were evident during base (sRPE-TRIMP r = .53, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05; sRPE-SHRZ r = .75, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) and tactical/game-play conditioning (sRPE-TRIMP r = .60, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05; sRPE-SHRZ r = .63; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) than during specific conditioning (sRPE-TRIMP r = .38, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05; sRPE-SHRZ r = .52; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Furthermore, the sRPE model detected greater increases (126-429 AU) in training load than the TRIMP (15-65 AU) and SHRZ models (27-170 AU) transitioning between training modes. While the training-load models were significantly correlated during each training mode, weaker relationships were observed during specific conditioning. Comparisons suggest that the HR-based models were less effective in detecting periodized increases in training load, particularly during court-based, intermittent, multidirectional drills. The practical benefits and sensitivity of the sRPE model support its use across different basketball training modes.
International Journal of Sports Physiology and Performance, 2015
To compare game activity demands between female and male semi-professional basketball players. Fe... more To compare game activity demands between female and male semi-professional basketball players. Female (n = 12) and male (n = 12) semi-professional basketball players were monitored across three competitive games. Time-motion analysis procedures quantified player activity into pre-defined movement categories across backcourt (BC) and frontcourt (FC) positions. Activity frequencies, durations, and distances were calculated relative to live playing time (·min-1). Work:rest ratios were also calculated using the video data. Game activity was compared between genders for each playing position and all players. Female players performed at greater running work-rates than males (45.7 ± 1.4 vs. 42.1 ± 1.7 m·min-1, P = 0.05), while male players performed more dribbling than females (2.5 ± 0.3 vs. 3.0 ± 0.2 s·min-1; 8.4 ± 0.3 vs. 9.7 ± 0.7 m·min-1, P = 0.05). Positional analyses revealed female BC players performed more low-intensity shuffling (P = 0.04) and jumping (P = 0.05), as well as longer (P = 0.04) jogging durations than male BC players. Female FC players executed more upper-body activity (P = 0.03) and larger work:rest ratios (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than male FC players. No significant gender differences were observed in the overall intermittent demands, distance traveled, high-intensity shuffling activity, and sprinting requirements during game-play. These findings highlight that gender-specific running and dribbling differences might exist in semi-professional basketball. Further, position-specific variations between female and male basketball players should be considered. These data may prove useful in the development of gender-specific conditioning plans relative to playing position in basketball.
The extent of diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) in the Med... more The extent of diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) in the Medicare population is relatively unknown. Also unknown is the effect of these diseases on patient survival before end-stage renal disease (ESRD). Prevalent cohorts of Medicare enrollees from 1996 to 2000 were assessed for diabetes and CKD, presence of CVD, and probability of death versus ESRD in the follow-up period. Hospitalization rates and, in diabetics, lipid testing and glycemic control monitoring were also assessed. The prevalence of diabetes in the Medicare population increased at 4.4% per year, reaching 18.9% in the 1999-2000 cohort. Approximately 726,000 elderly Medicare enrollees carry a diagnosis code for CKD. Those with CKD are 5 to 10 times more likely to die before reaching ESRD than the non-CKD group. In CKD patients, CVD is twice as common and advances at twice the rate. Cardiovascular disease advances at a similarly higher rate in CKD patients who die and those who survive to ESRD. Heart failure hospitalizations are 5 times greater in CKD patients and only 30% less than those in dialysis patients. Only half of the CKD patients with diabetes who advance to ESRD had a lipid or glycosylated hemoglobin test done in the year before or after dialysis initiation. Diabetes, the leading cause of ESRD, is increasing in the general Medicare population at 4.4% per year. Cardiovascular disease is common, progresses at twice the rate, is associated with death before ESRD, and patients receive suboptimal risk factor monitoring. Active identification and treatment of CKD patients is needed.
Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have... more Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have been performed only in field--based team sports. The aim of this study was to compare generic (light--based) and sport--specific (live opponent) reactive agility tests in court--based team sport athletes.
The primary aim of this study was to determine the prevalence of current strength-based exercise ... more The primary aim of this study was to determine the prevalence of current strength-based exercise in rural and regional populations of Central Queensland. The secondary aim was to examine the proportion of residents from various demographic groups who currently partake in strength-based exercise to allow for targeted strength training campaigns. A cross-sectional, survey-based experimental design was followed. Rural and regional Australia. Rural and regional community-dwelling individuals living in Central Queensland and aged 18 years and older. Survey data was collected in October and November 2010 as part of the Central Queensland University Social Survey. Strength-based exercise participation, gender, age, income, years of education, self-reported physical activity and perception of health. Participation in strength-based exercise was 13.2%. Women were less likely to partake in strength-based exercise than male, and ≥55 year old adults were less likely to partake in strength-based exercise than 18-34 year old adults. Participation in strength-based exercise was found to increase with years of education, self-reported physical activity and self-rated health. The prevalence of adults in rural and regional Central Queensland engaging in strength-based exercise is low. Exercise physiologists, clinicians and government officials must work together to ensure that this form of exercise is acknowledged as a vital component of health in rural and regional areas.
The majority of CKD-related complications stem from cardiovascular pathologies such as hypertensi... more The majority of CKD-related complications stem from cardiovascular pathologies such as hypertension. To help reduce cardiovascular complications, aerobic exercise is often prescribed. Emerging evidence suggests high intensity interval training (HIIT) may be more beneficial than traditional aerobic exercise. However, appraisals of varying forms of aerobic exercise, along with descriptions of mechanisms responsible for health-related improvements, are lacking. This study examined the effects of 8 weeks of HIIT (85% VO2max), versus low intensity aerobic exercise (LIT; 45-50% VO2max) and sedentary behaviour (SED), in an animal model of early-stage CKD. Tissue-specific mRNA expression of RAAS-related genes and CKD-related clinical markers were examined. Compared to SED, HIIT resulted in increased plasma albumin (p = 0.001), reduced remnant kidney weight (p = 0.028), and reduced kidney weight-body weight ratios (p = 0.045). Compared to LIT, HIIT resulted in reduced Agt mRNA expression (p = 0.035), reduced plasma LDL (p = 0.001), triglycerides (p = 0.029), and total cholesterol (p = 0.002), increased plasma albumin (p = 0.047), reduced remnant kidney weight (p = 0.005), and reduced kidney weight-body weight ratios (p = 0.048). These results suggest HIIT is a more potent regulator of several markers that describe and influence health in CKD.
Chronic kidney disease (CKD) is characterized by increased levels of oxidative stress and inflamm... more Chronic kidney disease (CKD) is characterized by increased levels of oxidative stress and inflammation. Oxidative stress and inflammation promote renal injury via damage to molecular components of the kidney. Unfortunately, relationships between inflammation and oxidative stress are cyclical in that the inflammatory processes that exist to repair radical-mediated damage may be a source of additional free radicals, resulting in further damage to renal tissue. Oxidative stress and inflammation also have the ability to become systemic, serving to injure tissues distal to the site of original insult. This review describes select mediators in the exacerbatory relationship between oxidative stress, inflammation, and CKD. This review also discusses oxidative stress, inflammation, and CKD as they pertain to the development and progression of common CKD-associated comorbidities. Lastly, the utility of several widely accessible and cost-effective lifestyle interventions and their ability to r...
The Journal of sports medicine and physical fitness, Jan 12, 2014
Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have... more Comparisons between reactive agility tests incorporating generic and sport--specific stimuli have been performed only in field--based team sports. The aim of this study was to compare generic (light--based) and sport--specific (live opponent) reactive agility tests in court--based team sport athletes. Twelve semi--professional male basketball players (age: 25.9 ± 6.7 yr; stature: 188.9 ± 7.9 cm; body mass: 97.4 ± 16.1 kg; predicted maximal oxygen uptake: 49.5 ± 5.3 mL∙kg--1∙min--1) completed multiple trials of a Reactive Agility Test containing light--based (RAT--Light) and opponent--based stimuli (RAT--Opponent). Multiple outcome measures were collected during the RAT--Light (agility time and total time) and RAT--Opponent (decision time and total time). Mean performance times during the RAT--Light (2.233 ± 0.224 s) were significantly (P < 0.001) slower than during the RAT--Opponent (1.726 ± 0.178 s). Further, a small relationship was observed between RAT--Light agility time and ...
Nephrology nursing journal : journal of the American Nephrology Nurses' Association
This is the second in a series of three articles about the risk factors and complications related... more This is the second in a series of three articles about the risk factors and complications related to chronic kidney disease and their impact on cardiovascular disease. This article focuses on identifying pathophysiologic mechanisms by which two traditional risk factors of cardiovascular disease (hypertension and dyslipidemia), and two nontraditional risk factors associated with chronic kidney disease (anemia and abnormalities in bone and mineral metabolism) contribute to the markedly increased cardiovascular morbidity and mortality seen in individuals with chronic kidney disease.
International Journal of Sports Physiology and Performance, 2015
To evaluate anthropometric measures and serum markers of myostatin-pathway activity after differe... more To evaluate anthropometric measures and serum markers of myostatin-pathway activity after different weight-reduction protocols in wrestlers. Subjects were randomly assigned to a gradual-weight-reduction (GWR) or rapid-weight-reduction (RWR) group. Food logs were collected for the duration of the study. Anthropometric measurements and serum samples were collected after an 8-h fast at baseline and after the weight-reduction intervention. Subjects reduced body mass by 4%. The GWR group restricted calories over 12 d, while the RWR group restricted calories over 2 d. A series of 2×5 repeated-measures (RM) ANOVAs was conducted to examine differences in nutrient consumption, while separate 2×2 RM ANOVAs were conducted to examine differences in anthropometric measures and serum markers. When applicable, Tukey post hoc comparisons were conducted. Significance for all tests was set at P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05. There were no between-groups differences for any anthropometric measure (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05). Subjects in both groups experienced a significant reduction in body mass, fat mass, lean mass, and percent body fat (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). There were no between-groups differences in serum markers of myostatin-pathway activity (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05), but subjects in the RWR condition experienced a significant increase in serum myostatin (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01), a decrease in follistatin (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01), and an increase in myostatin-to-follistatin ratio (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Although there were no between-groups differences for any outcome variables, the serum myostatin-to-follistatin ratio was significantly increased in the RWR group, possibly signaling the early stages of skeletal-muscle catabolism.
International Journal of Sports Physiology and Performance, 2014
To compare perceptual and physiological training-load responses during various basketball trainin... more To compare perceptual and physiological training-load responses during various basketball training modes. Eight semiprofessional male basketball players (age 26.3 ± 6.7 y, height 188.1 ± 6.2 cm, body mass 92.0 ± 13.8 kg) were monitored across a 10-wk period in the preparatory phase of their training plan. Player session ratings of perceived exertion (sRPE) and heart-rate (HR) responses were gathered across base, specific, and tactical/game-play training modes. Pearson correlations were used to determine the relationships between the sRPE model and 2 HR-based models: the training impulse (TRIMP) and summated HR zones (SHRZ). One-way ANOVAs were used to compare training loads between training modes for each model. Stronger relationships between perceptual and physiological models were evident during base (sRPE-TRIMP r = .53, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05; sRPE-SHRZ r = .75, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) and tactical/game-play conditioning (sRPE-TRIMP r = .60, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05; sRPE-SHRZ r = .63; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05) than during specific conditioning (sRPE-TRIMP r = .38, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05; sRPE-SHRZ r = .52; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Furthermore, the sRPE model detected greater increases (126-429 AU) in training load than the TRIMP (15-65 AU) and SHRZ models (27-170 AU) transitioning between training modes. While the training-load models were significantly correlated during each training mode, weaker relationships were observed during specific conditioning. Comparisons suggest that the HR-based models were less effective in detecting periodized increases in training load, particularly during court-based, intermittent, multidirectional drills. The practical benefits and sensitivity of the sRPE model support its use across different basketball training modes.
International Journal of Sports Physiology and Performance, 2015
To compare game activity demands between female and male semi-professional basketball players. Fe... more To compare game activity demands between female and male semi-professional basketball players. Female (n = 12) and male (n = 12) semi-professional basketball players were monitored across three competitive games. Time-motion analysis procedures quantified player activity into pre-defined movement categories across backcourt (BC) and frontcourt (FC) positions. Activity frequencies, durations, and distances were calculated relative to live playing time (·min-1). Work:rest ratios were also calculated using the video data. Game activity was compared between genders for each playing position and all players. Female players performed at greater running work-rates than males (45.7 ± 1.4 vs. 42.1 ± 1.7 m·min-1, P = 0.05), while male players performed more dribbling than females (2.5 ± 0.3 vs. 3.0 ± 0.2 s·min-1; 8.4 ± 0.3 vs. 9.7 ± 0.7 m·min-1, P = 0.05). Positional analyses revealed female BC players performed more low-intensity shuffling (P = 0.04) and jumping (P = 0.05), as well as longer (P = 0.04) jogging durations than male BC players. Female FC players executed more upper-body activity (P = 0.03) and larger work:rest ratios (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than male FC players. No significant gender differences were observed in the overall intermittent demands, distance traveled, high-intensity shuffling activity, and sprinting requirements during game-play. These findings highlight that gender-specific running and dribbling differences might exist in semi-professional basketball. Further, position-specific variations between female and male basketball players should be considered. These data may prove useful in the development of gender-specific conditioning plans relative to playing position in basketball.
The extent of diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) in the Med... more The extent of diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) in the Medicare population is relatively unknown. Also unknown is the effect of these diseases on patient survival before end-stage renal disease (ESRD). Prevalent cohorts of Medicare enrollees from 1996 to 2000 were assessed for diabetes and CKD, presence of CVD, and probability of death versus ESRD in the follow-up period. Hospitalization rates and, in diabetics, lipid testing and glycemic control monitoring were also assessed. The prevalence of diabetes in the Medicare population increased at 4.4% per year, reaching 18.9% in the 1999-2000 cohort. Approximately 726,000 elderly Medicare enrollees carry a diagnosis code for CKD. Those with CKD are 5 to 10 times more likely to die before reaching ESRD than the non-CKD group. In CKD patients, CVD is twice as common and advances at twice the rate. Cardiovascular disease advances at a similarly higher rate in CKD patients who die and those who survive to ESRD. Heart failure hospitalizations are 5 times greater in CKD patients and only 30% less than those in dialysis patients. Only half of the CKD patients with diabetes who advance to ESRD had a lipid or glycosylated hemoglobin test done in the year before or after dialysis initiation. Diabetes, the leading cause of ESRD, is increasing in the general Medicare population at 4.4% per year. Cardiovascular disease is common, progresses at twice the rate, is associated with death before ESRD, and patients receive suboptimal risk factor monitoring. Active identification and treatment of CKD patients is needed.
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