Physical, mental, and emotional wellness are just some avenues to maintain a person’s overall wel... more Physical, mental, and emotional wellness are just some avenues to maintain a person’s overall well-being. These components of wellness influence each other; mental wellness is known to be affected by physical wellness. Physical wellness in the form of regular exercise stands as a method to mitigate the high rates of depression and burnout among medical students. This study examines the levels of physical activity among preclinical and clinical medical students. This is an observational, non-randomized study with data collection over one month. Fifty-nine percent of students surveyed met the CDC recommendation for exercise. The major reason to exercise was to improve mental health, with 37% of respondents citing this as a motivator. For those who did not meet the physical activity recommendation, lack of time was cited in 75% of respondents. Greater knowledge of prevention methods, risk factors, and outcomes of chronic health conditions may contribute to higher physical activity leve...
Interventions such as thrombolytic therapy, designed to preserve jeopardized myocardium after cor... more Interventions such as thrombolytic therapy, designed to preserve jeopardized myocardium after coronary thrombosis, suffer from inadequate scientific validation because of present limitations in the ability to measure the cardiac volume at risk initially, or to predict the eventual volume of unperfused tissue in the absence of intervention. To determine whether the unimpeded change in perfused myocardial volume over time could be predicted accurately in vivo, Tl-201 quantitative scintigraphy was performed in 10 dogs at 5 minutes and at 1 week after closed-chest coronary artery occlusion (CAO). Initial and final ischemic cardiac volumes (ICV) were measured at necropsy by autoradiography: Initial ICV from Ce-141 microspheres injected into the left ventricle 5 minutes after CAO and final ICV from autoradiography of Tl-201 given 1 week after CAO. Planar scintigrams were computer-analyzed with a quantitative anatomically-referenced technique. Early scintigraphic perfusion defect (SPD) size was closely related to initial ICV measured at necropsy, r=.93. SPD size decreased predictably by 50% during 1 week. Late SPD size correlated with final ICV at necropsy, r=.92. Size of the SPD 5 minutes after CAO predicted both size of the SPD 1 week later, r=.87, and also final ICV, r=.92. These data demonstrate that: 1) after acute caninemore » CAO without therapeutic intervention, SPD size becomes predictably smaller with time; 2) this change reflects a change in the volume of ischemic myocardium; 3) quantitative scintigraphy accurately predicts both early and late ischemic cardiac volume as confirmed at autopsy.« less
Pacing and Clinical Electrophysiology, Aug 1, 1997
Head upright tilt table testing has emerged as a standard technique for the evaluation of patient... more Head upright tilt table testing has emerged as a standard technique for the evaluation of patients with recurrent unexplained syncope. To determine the specificity of head upright tilt table testing with and without a low dose isoproterenol infusion, the following study wns undertaken. A total of 34 normal volunteers (21 men, 13 women, mean age 32.9 ± 1.7 years) with no history of syncope, presyncope, or vertigo underwent head upright tilt table testing for 45 minutes. A positive test was defined as the production of syncope or presyncope associated with hypotension and bradycardia. If the test wns negative the patient was lowered to the supine position and a low dose isoproterenol infusion started (sufficient to raise the heart rate 20–25% above baseline) and the patient retilted for 20 minutes. Three subjects (8.8%; 95% CI 2, 26; P = 0.23) developed syncope during the test, two during the baseline tilt, and one during isoproterenol infusion. Interestingly, one of these subjects later bad a clinical syncopal episode. We conclude that head up tilt table testing at 80° with or without low level isoproterenol infusion provides an adequate specificity.
The phenomenon of apparently normal angiographic left ventricular wall motion in the presence of ... more The phenomenon of apparently normal angiographic left ventricular wall motion in the presence of greater than or equal to 1 completely obstructed coronary artery was investigated in 16 patients with coronary artery disease (CAD) by quantitative phasic biplane cineangiography. Angiographic contours were digitized at quarterly intervals throughout ejection and 9 areas of motion were measured in both right and left anterior oblique planes. Normal values were derived from 18 other patients who had normal coronary arteries and normal left ventricular function. Areas of asynergy undetected when quantitative analysis was applied only at end-systole in the right anterior oblique plane were found in 12 of the 16 patients with CAD: in 2 patients by end-systolic analysis in the left anterior oblique plane and in 10 patients by phasic analysis of both planes. Of 19 asynergic areas 18 corresponded to sites of high-grade CAD. All patients had angina pectoris, but only 5 had clinical or electrocardiographic evidence of prior infarction.
Introduction: Among patients with acute pulmonary embolism (PE), elevated levels of brain natriur... more Introduction: Among patients with acute pulmonary embolism (PE), elevated levels of brain natriuretic peptide (BNP) correlate with right ventricular dysfunction and increased morbidity and mortality. Suggested BNP cut-offs for PE risk stratification in the general population range from 90-100 pg/mL. It is unclear whether this BNP cut-off should be used for PE risk stratification among patients with heart failure (HF), who may have elevated BNP at baseline. Methods: Patients diagnosed with acute PE between 2010 and 2015 at the University of Toledo Medical Center were identified. Patients were categorized as: no HF, heart failure with reduced ejection fraction (HFrEF), or heart failure with preserved ejection fraction (HFpEF). No HF was defined as having no prior history of HF and an ejection fraction (EF) ≥ 50%. HFrEF was defined as history of HF and an EF < 50%. HFpEF was defined as history of HF and an EF ≥ 50%. HF was defined as subjects with HFrEF or HFpEF. Results: One hundred and eighty-three patients with acute PE were identified for this study. One hundred and forty-two patients were classified as no HF (median BNP 112 [interquartile range (IQR) 49-355] pg/mL), while 41 were classified as HF (median BNP 422 [IQR 179-940] pg/mL) (p<0.0001). When HF was further sub-categorized, we found significant differences in BNP levels between subjects with HFrEF (median BNP 923 [IQR 464-2296] pg/mL) vs. subjects with HFpEF (median BNP 247 [IQR 88-726] pg/mL) (p=0.002). Median BNP among patients with HFrEF was significantly higher compared to patients with no HF (p<0.0001). Median BNP among patients with HFpEF was not significantly different compared to patients with no HF (p=0.416). Conclusions: Patients with HFrEF who present to the hospital with acute PE have significantly higher median BNP compared to patients with HFpEF or no HF. These results suggest that risk stratification for PE using current BNP cut-off guidelines may not be optimal for patients with HFrEF.
Introduction: Among patients with acute pulmonary embolism (PE), an elevated right ventricular to... more Introduction: Among patients with acute pulmonary embolism (PE), an elevated right ventricular to left ventricular diameter (RV:LV) ratio is associated with increased morbidity and mortality. RV:LV cut-offs used to identify PE patients at elevated risk for adverse events range from 0.9-1.0. It is unclear whether this cut-off should be used for PE risk stratification among patients with heart failure (HF), who may have abnormal cardiac chamber dimensions. Methods: Patients diagnosed with acute PE between 2010 and 2015 at the University of Toledo Medical Center were identified. Patients were categorized as: no HF, heart failure with reduced ejection fraction (HFrEF), and heart failure with preserved ejection fraction (HFpEF). No HF was defined as having no prior history of HF and an ejection fraction (EF) ≥ 50%. HFrEF was defined as history of HF and an EF < 50%. HFpEF was defined as history of HF and an EF ≥ 50%. Results: One hundred and eighty-three patients were identified for this study. Twelve patients were excluded due to missing EF records. Among the remaining 171 patients, 142 were categorized as no HF, 13 were categorized as HFrEF, and 16 were categorized as HFpEF. There were no significant differences in mean RV diameter between HFrEF [39.1 mm, standard deviation (SD) ± 5.9], no HF [36.9 mm, SD ± 7.5], or HFpEF [38.5 mm, SD ± 6.6] (p=0.575). However, mean LV diameter among patients with HFrEF was significantly higher [52.2 mm, SD ± 7.2] compared to no HF [38.1 mm, SD ± 8.3] and HFpEF [42.1 mm, SD ± 6.6] (p<0.001). Median RV:LV ratio was 0.77 [interquartile range (IQR) 0.65-0.89] for HFrEF, 0.91 [IQR 0.79-1.17] for no HF, and 0.89 [IQR 0.80-1.04] for HFpEF (p=0.024). Conclusions: Patients with HFrEF who presented to the hospital with acute PE had significantly higher mean LV diameter and lower RV:LV ratio compared to patients with HFpEF or no HF. These results suggest that risk stratification using current RV:LV ratio guidelines may underestimate PE risk among patients with HFrEF.
This study was designed to test whether an exercise program is additive to diet counseling in low... more This study was designed to test whether an exercise program is additive to diet counseling in lowering elevated blood cholesterol levels. From a screened population of 1024 subjects, we randomized 66 predominantly female subjects to two intervention groups: diet counseling and diet counseling with exercise. Subjects were selected who had elevated levels of serum low-density lipoprotein cholesterol, an average or low fitness level, and a diet high in saturated fat and cholesterol. After 26 weeks of intervention, 51 subjects exhibited significant decreases in serum levels of cholesterol, high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. The addition of exercise to diet counseling resulted in improved aerobic capacity, losses of body fat and weight, and further nonsignificant decreases in serum cholesterol and low-density lipoprotein cholesterol levels. Since these results differ from data acquired in individuals with normal to borderline serum cholesterol levels, further studies appear indicated in hypercholesterolemic subjects, especially in women.
American Journal of Clinical Pathology, Aug 1, 1988
The fluorogenic synthetic substrate and radial immunodiffusion assays of plasma plasminogen were ... more The fluorogenic synthetic substrate and radial immunodiffusion assays of plasma plasminogen were compared before and after administration of intravenous streptokinase in differing doses to 57 patients being treated for acute myocardial infarction. There was a moderate correlation (r = 0.73, slope = 0.221, intercept = 1.005, n = 57 pairs) in the two assays of plasma plasminogen before the administration of streptokinase. After streptokinase, however, the correlation of the two assays was poor (r = 0.28, slope = 0.03, y-intercept = 0.003, n = 57 pairs). The decrease in plasma plasminogen by the fluorogenic synthetic substrate assay after streptokinase averaged 95 +/- 5%, with little variation between doses. In contrast, the percentage decrease in plasma plasminogen after streptokinase by the radial immunodiffusion assay averaged only 30 +/- 11%. The percentage change in plasma plasminogen by the two assays is significantly different (P = 0.001). The discrepancy in the percentage change in plasma plasminogen after streptokinase as measured by the fluorogenic synthetic substrate assay and the radial immunodiffusion assay can be explained by a lack of specificity for the antibody to plasminogen in the radial immunodiffusion kit. Antigen-antibody precipitin rings were observed after incubation of antibody with a mixture presumed to contain plasmin, plasmin-alpha 2 antiplasmin complexes, and plasmin-fibrin/fibrinogen degradation products. Based on these data, the fluorogenic synthetic substrate assay for plasma plasminogen is a superior means of following plasminogen depletion in response to thrombolytic therapy after streptokinase treatment for acute myocardial infarction.
ObjectivesDetermine the baseline clinical, laboratory, and echocardiographic values that predict ... more ObjectivesDetermine the baseline clinical, laboratory, and echocardiographic values that predict reduced cardiac index (CI) among subjects with acute submassive pulmonary embolism (PE).BackgroundSubmassive PE represents a large portion of acute PE population and there is controversy regarding optimal treatment strategies for these patients. There is significant heterogeneity within the submassive PE population and further refinement of risk stratification may aid clinical decision‐making.MethodsWe identified subjects with normotensive acute PE who underwent echocardiogram and right heart catheterization (RHC) prior to catheter‐directed thrombolysis (CDT). We sought to determine the predictors of reduced CI, defined as CI < 2.2 L min‐1m‐2.ResultsThirty‐two subjects met the inclusion criteria and 41% had reduced CI. Baseline variables did not distinguish subjects with reduced versus normal CI. Brain natriuretic peptide (BNP) was significantly different between the reduced versus no...
Accurate assessment of glomerular filtration rate (GFR) is important in ascertaining health statu... more Accurate assessment of glomerular filtration rate (GFR) is important in ascertaining health status, especially in older individuals and in populations at risk of chronic kidney disease. Recently we observed that smokers with renal artery stenosis and renovascular hypertension had lower GFR when estimated by cystatin-C, than with creatinine-based estimates. We sought to resolve this issue. Data from the Diabetes Control and Complications Trial (DCCT) were used to estimate GFR in individuals with diabetes. Iohexol clearance was used as the standard, and was compared to GFR estimates using creatinine and cystatin-C. Creatinine and cystatin-C estimates were calculated with the 24-hour urine creatinine clearance and the CKD-EPI cystatin-C. formula, and compared to iohexol based estimates using the Bland-Altman method. There were 441 patients with iohexol, creatinine and cystatin-C values. The average age was 27.6 ± 6.6 years. The mean iohexol GFR for the population was 127.5 ± 19.2 ml/mi...
Physical, mental, and emotional wellness are just some avenues to maintain a person’s overall wel... more Physical, mental, and emotional wellness are just some avenues to maintain a person’s overall well-being. These components of wellness influence each other; mental wellness is known to be affected by physical wellness. Physical wellness in the form of regular exercise stands as a method to mitigate the high rates of depression and burnout among medical students. This study examines the levels of physical activity among preclinical and clinical medical students. This is an observational, non-randomized study with data collection over one month. Fifty-nine percent of students surveyed met the CDC recommendation for exercise. The major reason to exercise was to improve mental health, with 37% of respondents citing this as a motivator. For those who did not meet the physical activity recommendation, lack of time was cited in 75% of respondents. Greater knowledge of prevention methods, risk factors, and outcomes of chronic health conditions may contribute to higher physical activity leve...
Interventions such as thrombolytic therapy, designed to preserve jeopardized myocardium after cor... more Interventions such as thrombolytic therapy, designed to preserve jeopardized myocardium after coronary thrombosis, suffer from inadequate scientific validation because of present limitations in the ability to measure the cardiac volume at risk initially, or to predict the eventual volume of unperfused tissue in the absence of intervention. To determine whether the unimpeded change in perfused myocardial volume over time could be predicted accurately in vivo, Tl-201 quantitative scintigraphy was performed in 10 dogs at 5 minutes and at 1 week after closed-chest coronary artery occlusion (CAO). Initial and final ischemic cardiac volumes (ICV) were measured at necropsy by autoradiography: Initial ICV from Ce-141 microspheres injected into the left ventricle 5 minutes after CAO and final ICV from autoradiography of Tl-201 given 1 week after CAO. Planar scintigrams were computer-analyzed with a quantitative anatomically-referenced technique. Early scintigraphic perfusion defect (SPD) size was closely related to initial ICV measured at necropsy, r=.93. SPD size decreased predictably by 50% during 1 week. Late SPD size correlated with final ICV at necropsy, r=.92. Size of the SPD 5 minutes after CAO predicted both size of the SPD 1 week later, r=.87, and also final ICV, r=.92. These data demonstrate that: 1) after acute caninemore » CAO without therapeutic intervention, SPD size becomes predictably smaller with time; 2) this change reflects a change in the volume of ischemic myocardium; 3) quantitative scintigraphy accurately predicts both early and late ischemic cardiac volume as confirmed at autopsy.« less
Pacing and Clinical Electrophysiology, Aug 1, 1997
Head upright tilt table testing has emerged as a standard technique for the evaluation of patient... more Head upright tilt table testing has emerged as a standard technique for the evaluation of patients with recurrent unexplained syncope. To determine the specificity of head upright tilt table testing with and without a low dose isoproterenol infusion, the following study wns undertaken. A total of 34 normal volunteers (21 men, 13 women, mean age 32.9 ± 1.7 years) with no history of syncope, presyncope, or vertigo underwent head upright tilt table testing for 45 minutes. A positive test was defined as the production of syncope or presyncope associated with hypotension and bradycardia. If the test wns negative the patient was lowered to the supine position and a low dose isoproterenol infusion started (sufficient to raise the heart rate 20–25% above baseline) and the patient retilted for 20 minutes. Three subjects (8.8%; 95% CI 2, 26; P = 0.23) developed syncope during the test, two during the baseline tilt, and one during isoproterenol infusion. Interestingly, one of these subjects later bad a clinical syncopal episode. We conclude that head up tilt table testing at 80° with or without low level isoproterenol infusion provides an adequate specificity.
The phenomenon of apparently normal angiographic left ventricular wall motion in the presence of ... more The phenomenon of apparently normal angiographic left ventricular wall motion in the presence of greater than or equal to 1 completely obstructed coronary artery was investigated in 16 patients with coronary artery disease (CAD) by quantitative phasic biplane cineangiography. Angiographic contours were digitized at quarterly intervals throughout ejection and 9 areas of motion were measured in both right and left anterior oblique planes. Normal values were derived from 18 other patients who had normal coronary arteries and normal left ventricular function. Areas of asynergy undetected when quantitative analysis was applied only at end-systole in the right anterior oblique plane were found in 12 of the 16 patients with CAD: in 2 patients by end-systolic analysis in the left anterior oblique plane and in 10 patients by phasic analysis of both planes. Of 19 asynergic areas 18 corresponded to sites of high-grade CAD. All patients had angina pectoris, but only 5 had clinical or electrocardiographic evidence of prior infarction.
Introduction: Among patients with acute pulmonary embolism (PE), elevated levels of brain natriur... more Introduction: Among patients with acute pulmonary embolism (PE), elevated levels of brain natriuretic peptide (BNP) correlate with right ventricular dysfunction and increased morbidity and mortality. Suggested BNP cut-offs for PE risk stratification in the general population range from 90-100 pg/mL. It is unclear whether this BNP cut-off should be used for PE risk stratification among patients with heart failure (HF), who may have elevated BNP at baseline. Methods: Patients diagnosed with acute PE between 2010 and 2015 at the University of Toledo Medical Center were identified. Patients were categorized as: no HF, heart failure with reduced ejection fraction (HFrEF), or heart failure with preserved ejection fraction (HFpEF). No HF was defined as having no prior history of HF and an ejection fraction (EF) ≥ 50%. HFrEF was defined as history of HF and an EF &amp;amp;lt; 50%. HFpEF was defined as history of HF and an EF ≥ 50%. HF was defined as subjects with HFrEF or HFpEF. Results: One hundred and eighty-three patients with acute PE were identified for this study. One hundred and forty-two patients were classified as no HF (median BNP 112 [interquartile range (IQR) 49-355] pg/mL), while 41 were classified as HF (median BNP 422 [IQR 179-940] pg/mL) (p&amp;amp;lt;0.0001). When HF was further sub-categorized, we found significant differences in BNP levels between subjects with HFrEF (median BNP 923 [IQR 464-2296] pg/mL) vs. subjects with HFpEF (median BNP 247 [IQR 88-726] pg/mL) (p=0.002). Median BNP among patients with HFrEF was significantly higher compared to patients with no HF (p&amp;amp;lt;0.0001). Median BNP among patients with HFpEF was not significantly different compared to patients with no HF (p=0.416). Conclusions: Patients with HFrEF who present to the hospital with acute PE have significantly higher median BNP compared to patients with HFpEF or no HF. These results suggest that risk stratification for PE using current BNP cut-off guidelines may not be optimal for patients with HFrEF.
Introduction: Among patients with acute pulmonary embolism (PE), an elevated right ventricular to... more Introduction: Among patients with acute pulmonary embolism (PE), an elevated right ventricular to left ventricular diameter (RV:LV) ratio is associated with increased morbidity and mortality. RV:LV cut-offs used to identify PE patients at elevated risk for adverse events range from 0.9-1.0. It is unclear whether this cut-off should be used for PE risk stratification among patients with heart failure (HF), who may have abnormal cardiac chamber dimensions. Methods: Patients diagnosed with acute PE between 2010 and 2015 at the University of Toledo Medical Center were identified. Patients were categorized as: no HF, heart failure with reduced ejection fraction (HFrEF), and heart failure with preserved ejection fraction (HFpEF). No HF was defined as having no prior history of HF and an ejection fraction (EF) ≥ 50%. HFrEF was defined as history of HF and an EF &amp;lt; 50%. HFpEF was defined as history of HF and an EF ≥ 50%. Results: One hundred and eighty-three patients were identified for this study. Twelve patients were excluded due to missing EF records. Among the remaining 171 patients, 142 were categorized as no HF, 13 were categorized as HFrEF, and 16 were categorized as HFpEF. There were no significant differences in mean RV diameter between HFrEF [39.1 mm, standard deviation (SD) ± 5.9], no HF [36.9 mm, SD ± 7.5], or HFpEF [38.5 mm, SD ± 6.6] (p=0.575). However, mean LV diameter among patients with HFrEF was significantly higher [52.2 mm, SD ± 7.2] compared to no HF [38.1 mm, SD ± 8.3] and HFpEF [42.1 mm, SD ± 6.6] (p&amp;lt;0.001). Median RV:LV ratio was 0.77 [interquartile range (IQR) 0.65-0.89] for HFrEF, 0.91 [IQR 0.79-1.17] for no HF, and 0.89 [IQR 0.80-1.04] for HFpEF (p=0.024). Conclusions: Patients with HFrEF who presented to the hospital with acute PE had significantly higher mean LV diameter and lower RV:LV ratio compared to patients with HFpEF or no HF. These results suggest that risk stratification using current RV:LV ratio guidelines may underestimate PE risk among patients with HFrEF.
This study was designed to test whether an exercise program is additive to diet counseling in low... more This study was designed to test whether an exercise program is additive to diet counseling in lowering elevated blood cholesterol levels. From a screened population of 1024 subjects, we randomized 66 predominantly female subjects to two intervention groups: diet counseling and diet counseling with exercise. Subjects were selected who had elevated levels of serum low-density lipoprotein cholesterol, an average or low fitness level, and a diet high in saturated fat and cholesterol. After 26 weeks of intervention, 51 subjects exhibited significant decreases in serum levels of cholesterol, high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. The addition of exercise to diet counseling resulted in improved aerobic capacity, losses of body fat and weight, and further nonsignificant decreases in serum cholesterol and low-density lipoprotein cholesterol levels. Since these results differ from data acquired in individuals with normal to borderline serum cholesterol levels, further studies appear indicated in hypercholesterolemic subjects, especially in women.
American Journal of Clinical Pathology, Aug 1, 1988
The fluorogenic synthetic substrate and radial immunodiffusion assays of plasma plasminogen were ... more The fluorogenic synthetic substrate and radial immunodiffusion assays of plasma plasminogen were compared before and after administration of intravenous streptokinase in differing doses to 57 patients being treated for acute myocardial infarction. There was a moderate correlation (r = 0.73, slope = 0.221, intercept = 1.005, n = 57 pairs) in the two assays of plasma plasminogen before the administration of streptokinase. After streptokinase, however, the correlation of the two assays was poor (r = 0.28, slope = 0.03, y-intercept = 0.003, n = 57 pairs). The decrease in plasma plasminogen by the fluorogenic synthetic substrate assay after streptokinase averaged 95 +/- 5%, with little variation between doses. In contrast, the percentage decrease in plasma plasminogen after streptokinase by the radial immunodiffusion assay averaged only 30 +/- 11%. The percentage change in plasma plasminogen by the two assays is significantly different (P = 0.001). The discrepancy in the percentage change in plasma plasminogen after streptokinase as measured by the fluorogenic synthetic substrate assay and the radial immunodiffusion assay can be explained by a lack of specificity for the antibody to plasminogen in the radial immunodiffusion kit. Antigen-antibody precipitin rings were observed after incubation of antibody with a mixture presumed to contain plasmin, plasmin-alpha 2 antiplasmin complexes, and plasmin-fibrin/fibrinogen degradation products. Based on these data, the fluorogenic synthetic substrate assay for plasma plasminogen is a superior means of following plasminogen depletion in response to thrombolytic therapy after streptokinase treatment for acute myocardial infarction.
ObjectivesDetermine the baseline clinical, laboratory, and echocardiographic values that predict ... more ObjectivesDetermine the baseline clinical, laboratory, and echocardiographic values that predict reduced cardiac index (CI) among subjects with acute submassive pulmonary embolism (PE).BackgroundSubmassive PE represents a large portion of acute PE population and there is controversy regarding optimal treatment strategies for these patients. There is significant heterogeneity within the submassive PE population and further refinement of risk stratification may aid clinical decision‐making.MethodsWe identified subjects with normotensive acute PE who underwent echocardiogram and right heart catheterization (RHC) prior to catheter‐directed thrombolysis (CDT). We sought to determine the predictors of reduced CI, defined as CI < 2.2 L min‐1m‐2.ResultsThirty‐two subjects met the inclusion criteria and 41% had reduced CI. Baseline variables did not distinguish subjects with reduced versus normal CI. Brain natriuretic peptide (BNP) was significantly different between the reduced versus no...
Accurate assessment of glomerular filtration rate (GFR) is important in ascertaining health statu... more Accurate assessment of glomerular filtration rate (GFR) is important in ascertaining health status, especially in older individuals and in populations at risk of chronic kidney disease. Recently we observed that smokers with renal artery stenosis and renovascular hypertension had lower GFR when estimated by cystatin-C, than with creatinine-based estimates. We sought to resolve this issue. Data from the Diabetes Control and Complications Trial (DCCT) were used to estimate GFR in individuals with diabetes. Iohexol clearance was used as the standard, and was compared to GFR estimates using creatinine and cystatin-C. Creatinine and cystatin-C estimates were calculated with the 24-hour urine creatinine clearance and the CKD-EPI cystatin-C. formula, and compared to iohexol based estimates using the Bland-Altman method. There were 441 patients with iohexol, creatinine and cystatin-C values. The average age was 27.6 ± 6.6 years. The mean iohexol GFR for the population was 127.5 ± 19.2 ml/mi...
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