Sequence of progression of albuminuria and decreased GFR in persons with type 1 diabetes: a cohort study.

Background: The sensitivity of albuminuria in predicting loss of kidney function has been questioned. We determined the sequence of kidney disease stages (microalbuminuria, macroalbuminuria, low estimated glomerular filtration rate [eGFR], and end-stage renal disease [ESRD]) and characterized those without albuminuria before a low eGFR.

Study Design: The Pittsburgh Epidemiology of Diabetes Complications Study is a prospective cohort investigation of childhood-onset type 1 diabetes.

Depressive symptoms, inflammation, and ischemic stroke in older adults: a prospective analysis in the cardiovascular health study.

Objectives: To investigate the mediator role of inflammation in any relationship between depressive symptoms and ischemic stroke.

Design: Longitudinal prospective study.

Setting: Review of medical records, death certificates, and the Medicare healthcare utilization database for hospitalizations.

Kidney function as a predictor of loss of lean mass in older adults: health, aging and body composition study.

Objectives: To assess the association between kidney function and change in body composition in older individuals.

Design: Prospective cohort study.

Setting: Two sites, Pittsburgh, Pennsylvania, and Memphis, Tennessee.

Life-space constriction, development of frailty, and the competing risk of mortality: the Women's Health And Aging Study I.

Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes. Little is known about the behavioral antecedents of frailty. In this study, the authors hypothesized that constriction of life space identifies older adults at risk for frailty, potentially a marker of already-decreased physiologic reserve.

Compensatory strategies used by older adults facing mobility disability.

Preclinical disability in mobility tasks can be recognized by asking people without overt mobility disability whether they have changed the way, either the manner or the frequency, of doing a mobility task because of a health or physical condition. Like other compensatory strategies, preclinical mobility disability has a dual nature as both a risk marker associated with impairment or limitation and a mediating factor affecting the natural history of disability. The method of ascertaining preclinical disability through self-report has been shown to have construct validity, to be reliable, and to identify people at an elevated risk of developing overt mobility disability over 1 to 2 years.

Low serum selenium is associated with anemia among older adults in the United States.

Objective: We hypothesized that low serum selenium was associated with anemia in humans.

Subjects: A total of 2092 adults aged 65 and older, in the third National Nutrition Examination Survey, Phase 2 (1991-1994) (NHANES III).

Methods: Examination of the relationship between serum selenium and hematological indices in NHANES III.

Chronic peritoneal dialysis in the United States: declining utilization despite improving outcomes.

In the United States, chronic peritoneal dialysis take-on has declined among incident ESRD patients. Although increasing age, co-morbidity, and body size may explain part of this decline, other factors likely contribute. Among incident ESRD patients in the United States, we found that peritoneal dialysis take-on significantly decreased from 11% in 1996 to 1997 to 7% in 2002 to 2003 (P < 0.

Oxidative stress is associated with greater mortality in older women living in the community.

Objectives: To determine whether oxidative stress, as implied by oxidative damage to proteins, is associated with greater mortality in older women living in the community.

Design: Longitudinal.

Setting: Women's Health and Aging Study I, Baltimore, Maryland.

Types of anemia and mortality among older disabled women living in the community: the Women's Health and Aging Study I.

Aims: To classify the different types of anemia among moderately to severely disabled women living in the community and examine the relationship between types of anemia and mortality.

Methods: We studied anemia in 688 women, >or=65 years, in the Women's Health and Aging Study I, a population based study of moderately to severely disabled older women living in the community in Baltimore, Maryland. Anemia was defined by World Health Organization criteria.

Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women.

Polypharmacy, common in older people, confers both risk of adverse outcomes and benefits. We assessed the relationship of commonly prescribed medications with anticholinergic and sedative effects to physical and cognitive performance in older individuals. The study population comprised 932 moderately to severely disabled community-resident women aged 65 years or older who were participants in the Women's Health and Aging Study I.

Comparison of infectious complications between incident hemodialysis and peritoneal dialysis patients.

The impact of dialysis modality on infection, especially early in the course of dialysis, has not been well studied. This study compared infection between hemodialysis (HD) and peritoneal dialysis (PD) from the start of dialysis and evaluated factors that have an impact on infection risk. In this observational cohort study, all incident dialysis patients (n = 181; HD 119 and PD 62) at a single center from 1999 to 2005 had data collected prospectively beginning day 1 of dialysis.

Renal provider recognition of symptoms in patients on maintenance hemodialysis.

Background And Objectives: Although several studies have found that the burden of symptoms in patients who are on maintenance hemodialysis is substantial, little is known about renal providers' awareness of these symptoms. The aim of this study was to assess renal provider recognition of symptoms and their severity in hemodialysis patients.

Design, Setting, Participants, & Measurements: The Dialysis Symptom Index, a 30-item measure of symptoms and their severity, was administered to patients during a routine hemodialysis session.

Kidney function, electrocardiographic findings, and cardiovascular events among older adults.

Chronic kidney disease (CKD) is associated with cardiovascular (CV) disease and mortality. It is not known whether cardiac rhythm disturbances are more prevalent among individuals with CKD or whether resting electrocardiogram findings predict future CV events in the CKD setting. Data were obtained from the Cardiovascular Health Study, a community-based study of adults aged >/=65 yr.

Relationship of uric acid with progression of kidney disease.

Background: Uric acid levels are increased in patients with kidney dysfunction. We tested the hypothesis that uric acid may be associated with kidney disease progression.

Study Design: Cohort study.

Low serum selenium concentrations are associated with poor grip strength among older women living in the community.

Aging is associated with a loss of muscle strength, and, in turn, loss of muscle strength has been associated with increased risk of frailty, disability and mortality. The factors that contribute to loss of muscle strength with aging have not been well characterized. Selenium is important in normal muscle function because of its role in selenoenzymes that protect muscle against oxidative damage.

Inflammation and frailty in older women.

Objectives: To evaluate relationships between white blood cell (WBC) count and interleukin-6 (IL-6) and prevalent frailty.

Design: Cross-sectional study.

Setting: Two population-based studies, the Women's Health and Aging Studies (WHAS) I and II, Baltimore, Maryland.

Individual and neighborhood socioeconomic status and progressive chronic kidney disease in an elderly population: The Cardiovascular Health Study.

Few studies have focused on the association between socioeconomic status (SES) and progressive chronic kidney disease (pCKD) in an elderly population. We conducted a cohort study of 4735 Cardiovascular Health Study participants, ages 65 and older and living in 4 US communities, to examine the independent risk of pCKD associated with income, education and living in a low SES area. pCKD was defined as creatinine elevation 0.

Can older adult volunteers serve effectively to improve asthma management for children? Experience Corps Baltimore.

The present study was conducted to determine whether older adults can learn and retain information on asthma and play a role as community health workers to teach children about asthma. A total of 36 older adults and 28 students in grades K-6 participated. Pre-tests and post-tests were administered to participants.

X-ray scattering intensities of water at extreme pressure and temperature.

We have calculated the coherent x-ray scattering intensity of several phases of water under high pressure using the ab initio density functional theory (DFT). Our calculations span the molecular liquid, ice VII, and superionic solid phases, including the recently predicted symmetrically hydrogen bonded region. We compute simulated spectra for ice VII and superionic water.

Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study.

Background: Our research group has previously shown that the geriatric syndrome of frailty is associated with features of the metabolic syndrome (MetS) on cross-sectional analysis.

Methods: To test whether MetS and its physiologic determinants-insulin resistance as measured by homeostasis model assessment score (IR-HOMA), increased inflammation and coagulation factor levels, and elevated blood pressure-are associated with incident frailty, we studied a subcohort of participants from the Cardiovascular Health Study observed from 1989/1990 through 1998/1999: 3141 community-dwelling adults, aged 69 to 74 years, without frailty and illnesses that increase inflammation markers or mimic frailty. The association of baseline MetS, IR-HOMA, levels of inflammation and coagulation factors, and systolic blood pressure (SBP) with time to onset of frailty was adjusted for demographic and psychosocial factors and incident events.

Framework for evaluating disease severity measures in older adults with comorbidity.

Background: Accounting for the influence of concurrent conditions on health and functional status for both research and clinical decision-making purposes is especially important in older adults. Although approaches to classifying severity of individual diseases and conditions have been developed, the utility of these classification systems has not been evaluated in the presence of multiple conditions.

Methods: We present a framework for evaluating severity classification systems for common chronic diseases.

Oxidative protein damage is associated with poor grip strength among older women living in the community.

Grip strength, an indicator of muscle strength, has been shown to be a predictor of poor outcomes among older adults. Protein carbonylation, an indicator of oxidative damage to proteins, leads to cellular dysfunction and a decline in tissue function. Oxidative stress has been implicated in the pathogenesis of sarcopenia.

Exploring the hierarchy of mobility performance in high-functioning older women.

Background: Preventing mobility disability depends on matching interventions to individual needs. The purpose of this study is to improve targeting by determining whether mobility performance is associated with, and predicts, mobility disability hierarchically. The hypothesis is that poorer performance tested by more demanding tasks is more strongly associated with current and future mobility "limitation" (self-reported task modification or difficulty) than is that tested by less demanding tasks, in a graded manner.

Ventricular structure and function in hypertensive participants with heart failure and a normal ejection fraction: the Cardiovascular Health Study.

Objectives: The purpose of this study was to evaluate left ventricular (LV) size and structure in elderly subjects with hypertension (HTN) and heart failure who have a normal ejection fraction (HFNEF) in a large population-based sample.

Background: The pathophysiology of HFNEF is incompletely understood but is generally attributed to LV diastolic dysfunction with normal or reduced LV diastolic chamber size despite greater than normal filling pressures.

Methods: In the Cardiovascular Health Study (n = 5,888), demographic and clinical characteristics and ventricular structure and function were compared in healthy normal subjects (healthy; n = 499), subjects with HTN but not heart failure (HTN; n = 2,184), and subjects with HTN and HFNEF (HFNEF; n = 167).