Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease

Posted on January 15, 2016 by Maurice Preter MD

Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease

http://archinte.jamanetwork.com/article.aspx?articleid=2481157

Benjamin Lazarus, MBBS1,2; Yuan Chen, MS1; Francis P. Wilson, MD, MS3; Yingying Sang, MS1; Alex R. Chang, MD, MS4; Josef Coresh, MD, PhD1,5; Morgan E. Grams, MD, PhD1,5
JAMA Intern Med. Published online January 11, 2016. doi:10.1001/jamainternmed.2015.7193
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Importance  Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide and have been linked to acute interstitial nephritis. Less is known about the association between PPI use and chronic kidney disease (CKD).

Objective  To quantify the association between PPI use and incident CKD in a population-based cohort.

Design, Setting, and Participants  In total, 10 482 participants in the Atherosclerosis Risk in Communities study with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2 were followed from a baseline visit between February 1, 1996, and January 30, 1999, to December 31, 2011. The data was analyzed from May 2015 to October 2015. The findings were replicated in an administrative cohort of 248 751 patients with an estimated glomerular filtration rate of at least 60 mL/min/1.73 m2 from the Geisinger Health System.

Exposures  Self-reported PPI use in the Atherosclerosis Risk in Communities study or an outpatient PPI prescription in the Geisinger Health System replication cohort. Histamine2 (H2) receptor antagonist use was considered a negative control and active comparator.

Main Outcomes and Measures  Incident CKD was defined using diagnostic codes at hospital discharge or death in the Atherosclerosis Risk in Communities Study, and by a sustained outpatient estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 in the Geisinger Health System replication cohort.

Results  Among 10 482 participants in the Atherosclerosis Risk in Communities study, the mean (SD) age was 63.0 (5.6) years, and 43.9% were male. Compared with nonusers, PPI users were more often of white race, obese, and taking antihypertensive medication. Proton pump inhibitor use was associated with incident CKD in unadjusted analysis (hazard ratio [HR], 1.45; 95% CI, 1.11-1.90); in analysis adjusted for demographic, socioeconomic, and clinical variables (HR, 1.50; 95% CI, 1.14-1.96); and in analysis with PPI ever use modeled as a time-varying variable (adjusted HR, 1.35; 95% CI, 1.17-1.55). The association persisted when baseline PPI users were compared directly with H2 receptor antagonist users (adjusted HR, 1.39; 95% CI, 1.01-1.91) and with propensity score–matched nonusers (HR, 1.76; 95% CI, 1.13-2.74). In the Geisinger Health System replication cohort, PPI use was associated with CKD in all analyses, including a time-varying new-user design (adjusted HR, 1.24; 95% CI, 1.20-1.28). Twice-daily PPI dosing (adjusted HR, 1.46; 95% CI, 1.28-1.67) was associated with a higher risk than once-daily dosing (adjusted HR, 1.15; 95% CI, 1.09-1.21).

Conclusions and Relevance  Proton pump inhibitor use is associated with a higher risk of incident CKD. Future research should evaluate whether limiting PPI use reduces the incidence of CKD.

 

Posted in Aging, dietary, epigenetics, Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, News, Psychiatry/Neurology | Tagged , |

Erectile dysfunction? – Eat berries!

Posted on January 15, 2016 by Maurice Preter MD

http://ajcn.nutrition.org/content/early/2016/01/06/ajcn.115.122010.abstract

Dietary flavonoid intake and incidence of erectile dysfunction1

  1. Aedín Cassidy2,
  2. Mary Franz3, and
  3. Eric B Rimm3–6*

+Author Affiliations


  1. 2Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, United Kingdom;

  2. 3Departments of Nutrition and

  3. 4Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and

  4. 5Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital; and

  5. 6Harvard Medical School, Boston, MA

+Author Notes

  • ↵1 Supported by research grants CA55075, HL35464, and UM1 CA167552 from the NIH and the Biotechnology and Biological Sciences Research Council, United Kingdom (reference BB/J004545/1); AC is a Royal Society Wolfson Research Merit Award Holder. This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).

  1. ↵*To whom correspondence should be addressed. E-mail: erimm@hsph.harvard.edu.

Abstract

Background: The predominant etiology for erectile dysfunction (ED) is vascular, but limited data are available on the role of diet. A higher intake of several flavonoids reduces diabetes and cardiovascular disease risk, but no studies have examined associations between flavonoids and erectile function.

Objective: This study examined the relation between habitual flavonoid subclass intakes and incidence of ED.

Design: We conducted a prospective study among 25,096 men from the Health Professionals Follow-Up Study. Total flavonoid and subclass intakes were calculated from food-frequency questionnaires collected every 4 y. Participants rated their erectile function in 2000 (with historical reporting from 1986) and again in 2004 and 2008.

Results: During 10 y of follow-up, 35.6% reported incident ED. After multivariate adjustment, including classic cardiovascular disease risk factors, several subclasses were associated with reduced ED incidence, specifically flavones (RR = 0.91; 95% CI: 0.85, 0.97; P-trend = 0.006), flavanones (RR = 0.89; 95% CI: 0.83, 0.95; P-trend = 0.0009), and anthocyanins (RR = 0.91; 95% CI: 0.85, 0.98; P-trend = 0.002) comparing extreme intakes. The results remained statistically significant after additional adjustment for a composite dietary intake score. In analyses stratified by age, a higher intake of flavanones, anthocyanins, and flavones was significantly associated with a reduction in risk of ED only in men <70 y old and not older men (11–16% reduction in risk; P-interaction = 0.002, 0.03, and 0.007 for flavones, flavanones, and anthocyanins, respectively). In food-based analysis, higher total intake of fruit, a major source of anthocyanins and flavanones, was associated with a 14% reduction in risk of ED (RR = 0.86; 95% CI: 0.79, 0.92; P = 0.002).

Conclusions: These data suggest that a higher habitual intake of specific flavonoid-rich foods is associated with reduced ED incidence. Intervention trials are needed to further examine the impact of increasing intakes of commonly consumed flavonoid-rich foods on men’s health.

 

Posted in Aging, dietary, Events, Fifth Avenue Concierge Medicine, Health, keto, News, Psychiatry/Neurology | Tagged |

Meta-analyses with industry involvement are massively published and report no caveats for antidepressants.

Posted on November 26, 2015 by Maurice Preter MD
J Clin Epidemiol. 2015 Sep 21. pii: S0895-4356(15)00429-1. doi: 10.1016/j.jclinepi.2015.08.021. [Epub ahead of print]

Meta-analyses with industry involvement are massively published and report no caveats for antidepressants.

Abstract

OBJECTIVES:

To identify the impact of industry involvement in the publication and interpretation of meta-analyses of antidepressant trials in depression.

STUDY DESIGN AND SETTING:

Using MEDLINE, we identified all meta-analyses evaluating antidepressants for depression published in January 2007-March 2014. We extracted data pertaining to author affiliations, conflicts of interest, and whether the conclusion of the abstract included negative statements on whether the antidepressant(s) were effective or safe.

RESULTS:

We identified 185 eligible meta-analyses. Fifty-four meta-analyses (29%) had authors who were employees of the assessed drug manufacturer, and 147 (79%) had some industry link (sponsorship or authors who were industry employees and/or had conflicts of interest). Only 58 meta-analyses (31%) had negative statements in the concluding statement of the abstract. Meta-analyses including an author who were employees of the manufacturer of the assessed drug were 22-fold less likely to have negative statements about the drug than other meta-analyses [1/54 (2%) vs. 57/131 (44%); P < 0.001].

CONCLUSION:

There is a massive production of meta-analyses of antidepressants for depression authored by or linked to the industry, and they almost never report any caveats about antidepressants in their abstracts. Our findings add a note of caution for meta-analyses with ties to the manufacturers of the assessed products.

Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS:

Antidepressants; Competing interests; Conflicts of interest; Depression; Industry sponsor; Meta-analyses

Posted in Aging, Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, News, Psychiatry/Neurology | Tagged , , , , , |

Smartphone apps in epilepsy care

Posted on November 26, 2015 by Maurice Preter MD

Abstract

Objectives

To evaluate the applications of mobile phones in the day to day care of epileptic patients as a diagnostic, prognostic and therapeutic tool.

Methods

Detailed search of various mobile applications in the field of epileptology was made in MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, LILACS and corresponding developer websites of mobile applications were also looked into regarding their technical specifications and user friendliness.

Results

A plethora of apps are available across various mobile platforms especially Android, iOS and Windows. Careful selection and application of such apps by both the healthcare providers, the epileptic patients and their caregivers with proper understanding of their potential benefits as well as limitations will result in better diagnosis, prognosis and treatment of epilepsy.

Conclusion

The field of medicine is rapidly inculcating advanced cutting edge technologies for better diagnosis of diseases and better targeted therapy to such diseases. Hi tech electronic gadgets, in particular, are now becoming part and parcel of patient care in many specialties. The advent of the modern portable computers has revolutionised almost every specialty. The field of mobile technology is advancing with a break neck pace, with increase in mobile subscribers, advanced handsets practically like digital personal assistants with advanced capabilities. The possibilities of using such rapidly evolving mobile technology in the field of medicine are endless. This article explores such possibilities in the field of epileptology after analysing the current and existing applications of mobile phones in care of the epileptic patients worldwide.

Posted in Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, keto, News, Psychiatry/Neurology | Tagged |

Coconut Oil for Alzheimer’s Disease

Posted on October 29, 2015 by Maurice Preter MD 
















Coconut Oil for Alzheimer’s Disease:


Overall Status:




Recruiting








Brief Description:




The goal of this randomized study is to determine the efficacy of coconut oil as a possible treatment for older adults with mild to moderate Alzheimer’s disease.










Patient Qualifications:
























Min Age
Max Age
Gender
Healthy Volunteers












60 Years












85 Years












Both












No






















Inclusion Criteria:






    

  • Diagnosis of mild to moderate Alzheimer’s disease
    • 

  • Study partner who spends at least 10 hours/week with the participant and can attend clinic visits and provide information about the participant
    • 

  • Mini-Mental State Examination score of 16-26; Rosen Modified Hachinski Ischemic score of ≤4
    • 

  • Must undergo ApoE genetic laboratory testing at the baseline visit
    • 

  • If taking Alzheimer’s disease medications such as cholinesterase inhibitors (donepezil, rivastigmine, or galantamine) and/or memantine, must be on stable dose for at least 3 months prior to screening and agree not to change these medications during the course of the study, unless medically necessary
    • 

  • If taking memory-enhancing nonprescription supplements (for example, gingko biloba, huperzine, resveratrol, or docosahexaenoic acid), must be on stable dose for at least 3 months prior to screening and agree not to change these medications during the course of the study
    • 

  • Fluent in English
    • 











Exclusion Criteria:






    

  • Significant neurological or medical disease, other than Alzheimer’s, that may affect cognition
    • 

  • Current major psychiatric disorder or symptoms that could affect the participant’s ability to complete the study
    • 

  • Geriatric Depression Scale score of more than 6 or suicidal ideation
    • 

  • Current, clinically significant chronic illness, such as uncontrolled diabetes or diabetic ketoacidosis, that is likely to result in deterioration of the participant’s condition or safety during the study
    • 

  • History of clinically evident stroke, history of clinically significant carotid or vertebrobasilar stenosis, plaque or other risk factors for thromboembolic stroke
    • 

  • History of seizures
    • 

  • Myocardial infarction within the last 2 years; abnormal electrocardiogram at screening visit; uncontrolled hypertension within 6 months prior to screening
    • 

  • Cancer within the last 3 years, with the exception some carcinomas of the skin
    • 

  • Clinically significant infection within 30 days prior to screening.
    • 

  • Use of experimental or other investigational medications/devices for treatment within 90 days prior to screening
    • 

  • Laboratory findings of fasting total cholesterol greater than or equal to 240 mg/dL, fasting triglycerides greater than or equal to 200 mg/dL, or fasting glucose greater than or equal to 126 mg/dL
    • 

  • Other clinically significant abnormality seen on physical, neurological, laboratory, vital signs, or ECG examination (for example, changes consistent with recent infarction, ischemia, clinically significant arrhythmias, and clinically significant conduction defects)
    • 

  • Have taken coconut oil as a supplement or Axona™ (a medical food) within the last 30 days
    • 











Detailed Description:




This randomized, double-blind, placebo-controlled trial is designed to determine the effect of taking coconut oil on the cognition, functioning, and behavior of older adults with mild to moderate Alzheimer’s. Participants will take a proprietary blend of coconut and medium-chain triglyceride oils, administered as a 1-ounce drink three times daily, for either Months 1-3 or Months 4-6 of the study; a placebo will be taken during the other 3-month period. The study medication formula is Cognate Nutritionals’ Fuel for Thought™.










Locations:



































Lead Sponsor:





















Agency












University of South Florida
























Collaborator Sponsor:












Facility Investigators:























Name
Role
Affiliation












Amanda G. Smith, MD












Principal Investigator












USF Health Byrd Alzheimer’s Institute
























Study Contact:























Name
Phone
Email












Jill Smith












813-974-4355































ClinicalTrials.gov ID




NCT01883648 (follow link to view full record on ct.gov in new window)








Official Title:




A Randomized, Double-Blind, Placebo-Controlled, 6 Month Cross-Over Study to Evaluate the Efficacy of Coconut Oil (Fuel for Thought™) Treatment for Subjects With Mild to Moderate Alzheimer’s Disease








Study Start Date:




June 2013








Study End Date:




December 2015








Disease Stage:




Early


Middle








Enrollment:




65 

















								
					


				
			

							
													
					
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