2 Minute Medicine Rewind August 7, 2023
1. Despite returning to a normal eGFR at the time of discharge, hospitalized patients with an acute kidney injury (AKI) had increased mortality and morbidity, as well as a greater risk of developing chronic kidney disease, compared to hospitalized patients without an AKI.
Evidence Rating Level: 2 (Good)
Although acute kidney injury (AKI) is common among hospitalized patients, the long-term effects on morbidity and mortality are poorly understood. This retrospective cohort study aimed to investigate the chronic outcomes associated with a previous AKI. 40,558 patients hospitalized in Israel between 2008 and 2022 were included in this study. Eligible patients had at least three serial creatinine measurements during their hospital admission, never received dialysis, and were discharged with an estimated glomerular filtration rate (eGFR) above 60 mL/min/1.73 m2. This study did not include any patients with a prior diagnosis of chronic kidney disease (CKD). 15% of participants were admitted with a low eGFR, while 85% were admitted with a normal eGFR. The cohort admitted with a diagnosed AKI had an increase in mortality risk during the subsequent year after their discharge (adjusted hazard ratio [AHR], 1.18; 95% CI, 1.11-1.24), in addition to an increased risk of developing end-stage renal disease in the subsequent 10 years (AHR, 3.67; 95% CI, 2.43-5.54). This finding persisted after adjusting for possible confounding variables, including age, sex, underlying disease, and treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. One limitation of this study is that the researchers did not have access to the participant’s pre-admission eGFRs, and as such, it is not possible to determine whether participants had returned to their baseline renal function at the time of discharge. This study demonstrates that despite returning to a normal eGFR, patients hospitalized with an AKI have an increased mortality and morbidity risk, and may benefit from additional follow-up and monitoring.
1. A 6-month aerobic exercise program reduced the perceived severity of chemotherapy-induced peripheral neuropathy (CIPN) for patients undergoing ovarian cancer treatment.
Evidence Rating Level: 3 (Average)
Many patients undergoing chemotherapy suffer from chemotherapy-induced peripheral neuropathy (CIPN). Unfortunately, there are no effective treatments for CIPN. In this secondary analysis of a randomized controlled trial, researchers assessed the effectiveness of a home-based 6-month aerobic exercise program for reducing the severity of CIPN. Researchers conducted a secondary analysis of the Women’s Activity and Lifestyle Study in Connecticut (WALC). Study participants had all received chemotherapy for ovarian cancer. Of the 134 participants, 69 were randomized to a 6-month aerobic exercise intervention group, and 65 were randomized to the attention control group, which participated in weekly health education phone calls. The main outcome was self-assessed CIPN severity at baseline compared to 6 months, with scores ranging from 0 to 44. There was no statistically significant difference in CIPN severity between the two groups at baseline. At 6 months, the exercise group reported a 1.3-point decrease in symptom severity (95% CI, −2.3 to −0.2), while the attention control group reported a 0.4-point increase in symptom severity (95% CI, −0.8 to 1.5). This study suggests that aerobic exercise programs may be beneficial for patients suffering from CIPN. Future research may aim to replicate this finding with a larger cohort. As well, future studies may examine whether the benefits of aerobic exercise for reducing CIPN severity persist beyond 6 months.
1. Anxiety and depression were more prevalent among individuals with eczema or psoriasis, and those with these inflammatory conditions were more likely to report poor sleep.
Evidence Rating Level: 2 (Good)
Anxiety and depression are known to be more prevalent among those with inflammatory skin diseases, such as eczema and psoriasis. In this population-based match cohort study, researchers aimed to establish whether known risk factors for mental illness, such as poor sleep quality, disproportionately impact people with eczema or psoriasis. Data was gathered from the UK Clinical Practice Research Datalink on adults registered with a primary care practice between 1997 and 2019. Individuals with eczema or psoriasis were matched by age, sex, and clinical practice with up to 5 individuals without these skin conditions. 1,032,782 participants were in the eczema group, compared to 4,990,125 in the matched control group. 336,884 participants were in the psoriasis group, compared to 1,834,330 in the matched control group. After adjusting for several confounding variables, eczema and psoriasis were associated with increased anxiety (adjusted HR [95% CI]: eczema 1.14 [1.13–1.16], psoriasis 1.17 [1.15–1.19]) and depression (eczema 1.11 [1.1–1.12], psoriasis 1.21 [1.19–1.22]). For those with eczema, 11% of the depression and 13% of the anxiety cohort reported poor sleep, compared to 5.9% and 6.8% of matched controls. The researchers of this study suggest that improving sleep quality may be helpful for reducing the mental illness burden among those with inflammatory skin conditions. Future research should examine whether improved sleep hygiene reduces the prevalence of anxiety and depression among those with inflammatory skin conditions.
1. Compared to healthy controls, participants with a first episode of schizophrenia had reduced expression of a microglia-associated protein, CSF1R.
2. CSF1R inhibition worsened anxiety behaviors in mice exposed to chronic unpredictable stress.
Evidence-rating level: 3 (Average)
Psychosocial stress is thought to contribute to the development of schizophrenia, mainly for those with underlying genetic susceptibility. Though microglia are important regulators of stress in the brain, the role of microglia in the development of schizophrenia has not previously been thoroughly investigated. Colony stimulating factor 1 receptor (CSF1R) is a protein expressed by microglia. In this study, 51 participants with a first episode of schizophrenia (FES) were paired with 46 healthy age and sex-matched controls (HC) with elevated perceived stress. Researchers measured CSF1R RNA and protein levels in the participant’s blood. In addition, participants underwent brain MRIs to compare anatomy between FES and HC groups. Finally, the researchers studied a mouse model of chronic unpredictable stress, combined with a CSF1R inhibitor, and examined the rodent’s anxiety behaviors. The FES group had lower levels of CSF1R mRNA and protein compared to the HC group (p < 0.05). Additionally, their superior frontal and parahippocampal gyrus volumes were significantly smaller compared to the HC group. In mice, the CSF1R inhibitors enhanced anxiety behaviors during chronic unpredictable stress. As well, CSF1R inhibition reduced the expression of genes involved in brain angiogenesis (p < 0.001) in mice. This study demonstrates that CSF1R may be an important regulator of stress responses and the development of schizophrenia. Limitations of this study include the small sample size and cross-sectional study design. Future research may examine the CSF1R expression in a larger sample size or via a longitudinal study. As well, this study included exclusively male rodents in the creation of their mouse model. Future work should aim to better encapsulate human populations by incorporating both male and female mice. Overall, this study suggests that CSF1R could be a novel therapeutic target for schizophrenia treatments in the future.
1. Among those treated for Hepatitis C Virus (HCV) infection, leading causes of death included drug abuse, liver failure, and liver cancer, and all-cause mortality was higher for those treated for HCV compared to the general population.
Evidence rating level: 2 (Good)
Interferon-free antiviral agents have changed the landscape of hepatitis C virus (HCV) infection since 2014. Compared to previous management options, current treatments are shorter in duration and more effective, leading to HCV cure in >95% of patients. In this population-based cohort study, researchers aimed to determine the mortality rates for patients successfully treated for HCV since 2014. The study included 21,790 participants who were treated for HCV between 2014 and 2019. Participants were classified into three groups: those without cirrhosis, those with compensated cirrhosis, and those with end-stage liver disease. The cohort was followed from 12 weeks after initiating antiviral treatment until December 31, 2019, or their death. 7% of participants died during the study period. The majority of deaths were due to drug-related causes (24%), liver failure (18%), and liver cancer (16%). All-cause mortality, in deaths per 1000 person-years, was 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively, which is much higher than the general population. Higher mortality rates were associated with age, substance abuse, and comorbidities. Although treatments for HCV infection have improved greatly in the past decade, this study emphasizes the need for follow-up care for infected individuals after completing antiviral therapy. Future research could examine whether coupling addiction counseling with antiviral treatment improves mortality rates associated with HCV infection.
Image: PD
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