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Articles by T Greene
Total Records ( 3 ) for T Greene
  J. M Weinberg , L. J Appel , G Bakris , J. J Gassman , T Greene , C. A Kendrick , X Wang , J Lash , J. A Lewis , V Pogue , D Thornley Brown , R. A Phillips and for the African American Study of Hypertension and Kidney Disease Collaborative Research Group

Background  The incidence and factors associated with hyperkalemia in patients with chronic kidney disease (CKD) treated with angiotensin converting enzyme inhibitors (ACEIs) and other antihypertensive drugs was investigated using the African American Study of Kidney Disease and Hypertension (AASK) database.

Methods  A total of 1094 nondiabetic adults with hypertensive CKD (glomerular filtration rate [GFR], 20-65 mL/min/1.73 m2) were followed for 3.0 to 6.4 years in the AASK trial. Participants were randomly assigned to ACEI, β-blocker (BB), or dihydropyridine calcium channel blocker (CCB). The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L (to convert to millimoles per liter, multiply by 1.0), or a clinical center initiated hyperkalemia stop point.

Results  A total of 6497 potassium measurements were obtained, and 80 events in 51 subjects were identified (76 events driven by a central laboratory result and 4 driven by a clinical center–initiated hyperkalemia stop point). Compared with a GFR higher than 50 mL/min/1.73 m2, after multivariable adjustment, the hazard ratio (HR) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m2 and a GFR lower than 30 mL/min/1.73 m2 was 3.61 (95% confidence interval [CI], 1.42-9.18 [P = .007]) and 6.81 (95% CI, 2.67-17.35 [P < .001]), respectively; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m2. Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use (HR, 7.00; 95% CI, 2.29-21.39 [P < .001]) and BB group (HR, 2.85; 95% CI, 1.50-5.42 [P = .001]). Diuretic use was associated with a 59% decreased risk of hyperkalemia.

Conclusions  In nondiabetic patients with hypertensive CKD treated with ACEIs, the risk of hyperkalemia is small, particularly if baseline and follow-up GFR is higher than 40 mL/min/1.73 m2. Including a diuretic in the regimen may markedly reduce risk of hyperkalemia.

  J. M Young , N Terrin , X Wang , T Greene , G. J Beck , J. W Kusek , A. J Collins , M. J Sarnak and V. Menon

Background and objectives: Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, reduces bioavailability of nitric oxide and induces endothelial dysfunction. This dimethylated amino acid accumulates in chronic kidney disease and may be involved in the pathophysiology of cardiovascular disease (CVD) in this population.

Design, settings, participants, & methods: The Modification of Diet in Renal Disease Study was a randomized, controlled trial conducted between 1989 and 1993. We measured ADMA in frozen samples collected at baseline (n = 820) and obtained survival status, up to December 31, 2000, from the National Death Index. We examined the relationship of ADMA with prevalent CVD and performed multivariable Cox models to examine the relationship of ADMA with all-cause and CVD mortality.

Results: Mean (SD) age was 52 (12) yr, GFR was 32 ± 12 ml/min per 1.73 m2, and ADMA was 0.70 ± 0.25 µmol/L. A 1-SD increase in ADMA was associated with a 31% increased odds of prevalent CVD in an adjusted logistic regression model. During the 10-yr follow-up period, 202 (25%) participants died of any cause, 122 (15%) from CVD, and 545 (66%) reached kidney failure. In multivariable Cox models, a 1-SD increase in ADMA was associated with a 9% increased risk for all-cause and 19% increased risk for CVD mortality.

Conclusions: In this cohort of patients with predominantly nondiabetic, stages 3 to 4 chronic kidney disease, there was a strong association of ADMA with prevalent CVD and a modest association with all-cause and CVD mortality.

  J. T Daugirdas , K Meyer , T Greene , R. S Butler and E. D. Poggio

Background and objectives: GFR is scaled to body surface area (S), whereas hemodialysis dosage is scaled to total body water (V). Scaling to metabolic rate (M) or liver size (L) has also been proposed.

Design, setting, participants, & measurements: In 1551 potential kidney donors (662 men and 889 women) for whom GFR had been estimated from 125I-iothalamate clearance (iGFR) between the years 1973 and 2005, iGFR scaling was examined. Scaling was to estimates of S, V, M, or L. The study looked at the variation of iGFR by gender, age, S, V, M, and L within the study population.

Results: In multiple regression analysis, neither gender nor race was significantly associated with iGFR after controlling for height, weight, and age. Raw iGFR averaged 122 ± 23 ml/min in men and 106 ± 21 ml/min in women (P < 0.001). In an adjusted analysis, iGFR scaled to S or L was similar for men and women (NS), whereas iGFR scaled to either V or M was substantially different between the genders (P < 0.001). When the patients by gender were divided into five quintiles of V or S, the iGFR-V ratio varied more with body size than iGFR scaled to the other measures.

Conclusions: iGFR scaled to S or L was similar in men and women. Scaling to either M or V resulted in a sizeable gender difference, whereas scaling to V led to markedly different values of iGFR across body size.

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