Youssef MK Farag, MD, PhD, MPH

BackgroundWhether iron deficiency contributes to incident heart failure (HF) and cardiac dysfunction has important implications given the prevalence of iron deficiency and the availability of several therapeutics for iron repletion.ObjectivesThe aim of this study was to estimate the associations of plasma ferritin level with incident HF overall, HF phenotypes, and cardiac structure and function measures in older adults.MethodsParticipants in the ongoing, longitudinal ARIC (Atherosclerosis Risk In Communities) study who were free of prevalent HF and anemia were studied. The associations of plasma ferritin levels with incident HF overall and heart failure with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) were estimated using Cox proportional hazards regression models. Linear regression models estimated the cross-sectional associations of plasma ferritin with echocardiographic …

Objective To assess if a combination of clinical, cerebrospinal fluid (CSF), and quantitative vessel-wall magnetic resonance imaging (VWMRI) markers can predict Primary Angiitis of the Central Nervous System (PACNS) with and without brain biopsy. Background Without brain biopsy, there are limited diagnostic predictors to differentiate PACNS from non-inflammatory cerebral vasculopathy. Design/Methods In this cross-sectional study, we reviewed electronic medical records to identify patients (≥ 18 years old) who presented to our medical center between 01/2015 and 12/2021 with ischemic stroke due to biopsy-proven PACNS and probable PACNS (not-biopsy proven). For the comparison group, we identified patients with non-inflammatory vasculopathy with intracranial atherosclerotic disease (ICAD). Patients with no CSF or VWMRI data were excluded. Using logistic regression models in primary and sensitivity …

Background:Hypervolemia is thought to be a major contributor to higher left ventricular mass (LVM), a potent predictor for cardiovascular mortality among patients on maintenance hemodialysis. We hypothesized that a decrease in vector length (a bioimpedance proxy of hypervolemia) would be associated with an increase in LVM.Methods:Using data from the Frequent Hemodialysis Network Daily Trial (n= 160) we used linear regression to assess the association of changes in vector length from baseline to month 12 with changes in magnetic resonance imaging (MRI) measures of LVM and other cardiac parameters. We adjusted models for the randomized group, baseline vector length, age, sex, race, body mass index, vascular access, dialysis vintage, history of hypertension, heart failure, and diabetes, residual kidney function, pre-dialysis systolic blood pressure (BP), ultrafiltration rate, serum-dialysate sodium …

Albuminuria, an established biomarker of the progression of chronic kidney disease, is also recognized as a biomarker for the risk of cardiovascular disease. Elevated urinary albumin excretion indicates kidney damage and systemic vascular disease, including myocardial capillary disease and arterial stiffness. Albuminuria is associated with an increased risk of coronary artery disease, stroke, heart failure, arrhythmias, and microvascular disease. There are now several therapeutic agents that can lead to albuminuria lowering and a reduction in cardiovascular risk. However, screening for albuminuria is still low. Considering the importance of multidisciplinary management of patients with cardiovascular disease, it is crucial that health care professionals managing such patients are aware of the benefits of albuminuria surveillance and management.

Introduction Anaemia is a common complication affecting ∼42% patients with chronic kidney disease (CKD) stages 3–5 at 1 year after diagnosis and ∼67% at 5 years, with prevalence increasing as estimated glomerular filtration rate (eGFR) decreases. Despite the fact that anaemia is associated with CKD progression, adverse cardiovascular (CV) events and premature mortality in patients with CKD, management of these patients remains suboptimal. The nonsteroidal mineralocorticoid receptor antagonist finerenone demonstrated significant cardiorenal benefits in patients with CKD and type 2 diabetes (T2D) in FIDELITY (a prespecified pooled analysis of the phase III FIDELIO-DKD and FIGARO-DKD trials). However, the effect of anaemia on CV and kidney outcomes in patients receiving finerenone has not been established. Purpose This post hoc analysis investigated …

Aim To study the association between periodontitis, tooth loss, and rheumatoid arthritis (RA) by using a large national dataset. Materials and Methods An observational cross‐sectional study was performed using the National Health and Nutrition Examination Survey cycles (2009–2014). RA status was detected using a questionnaire. Periodontal status was assigned on the basis of the clinical attachment level and periodontal pocket depth. Dentition status was assessed by the number of permanent teeth observed. We examined the association between RA as exposure and moderate/severe periodontitis and non‐functional dentition as outcomes. We progressively adjusted our models for different sets of potential confounders. Results Moderate/severe periodontitis was more prevalent in participants reporting RA (53% vs. 41.5%, p = .0003). Non‐functional dentition was more prevalent in participants with RA (41 …

Background and Objectives Dual renin-angiotensin-aldosterone system (RAAS) blockade involves dual therapy with a combination of angiotensin-converting enzyme inhibitors (ACEis), angiotensin-receptor blockers (ARBs), direct renin inhibitors (DRIs), or mineralocorticoid receptor antagonists (MRAs). It is hypothesized that dual RAAS blockade would result in a more complete inhibition of the RAAS cascade. However, large clinical trials on dual RAAS inhibition have shown increased risk of acute kidney injury (AKI) and hyperkalemia without additional benefit on mortality, cardiovascular events, or chronic kidney disease (CKD) progression compared to RAAS inhibitor monotherapy in patients with diabetic kidney disease (DKD). The development of newer, more selective non-steroidal MRAs as cardiorenal protective therapies has created a new opportunity for dual RAAS inhibition. We conducted …

Background:Intra-dialytic hypertension, defined as an increase in blood pressure (BP) from pre-to post-hemodialysis (HD), affects 5-15% of patients receiving maintenance HD and is associated with cardiovascular and all-cause mortality. Hypervolemia is thought to be a major etiological factor, yet the association of more objective biomarkers of volume status with intra-dialytic hypertension is not well described.Methods:In a post hoc analysis of the Frequent Hemodialysis Network Daily Trial (n= 234), using data from baseline, 1, 4, and 12-month visits (n= 800), we used random effects regression to assess the association of bioimpedance estimates of volume (vector length) with post-HD systolic BP (continuous) and any increase in systolic BP (categorical) from pre-to post-HD. We adjusted models for randomized group, age, sex, self-reported race, Quételet (body mass) index, vascular access, HD vintage …

ObjectivesTo detect the association between psoriasis as an exposure and oral health conditions as outcomes represented by periodontal and dentition status. This was addressed by analysis of a large number of adults in the United States. MethodsBy using The National Health and Nutrition Examination Survey datasets from 2009 to 2014, we performed a cross-sectional analysis of 11,726 participants included in our study population. For participants aged ≥ 30 years, the psoriasis status was assessed from the medical questionnaire. We used data from periodontal and oral examinations to assess the oral conditions of our participants. We examined the association between psoriasis as exposure and moderate/severe periodontitis and non-functional dentition as outcomes. ResultsThe weighted prevalence of psoriasis was 3%, 44% for moderate/severe periodontitis, and 20.5% for non-functional dentition. The …

Background In patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces cardiovascular and kidney failure outcomes. Finerenone also lowers the urine albumin-to-creatinine ratio (UACR). Whether finerenone-induced change in UACR mediates cardiovascular and kidney failure outcomes is unknown. Objective To quantify the proportion of kidney and cardiovascular risk reductions seen over a 4-year period mediated by a change in kidney injury, as measured by the change in log UACR between baseline and month 4. Design Post hoc mediation analysis using pooled data from 2 phase 3, double-blind trials of finerenone. (ClinicalTrials.gov: NCT02540993 and NCT02545049) Setting …

BackgroundCKD is a major public health problem worldwide. Anemia, a frequent and treatable complication of CKD, is associated with decreased physical functioning and physical activity. The objective of this study was to evaluate the joint association of CKD and anemia with physical functioning and physical activity in a representative sample of the US population.MethodsCross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 1999–2016 for physical functioning outcomes (N= 33,300) and NHANES 2007–2016 for physical activity (N= 22,933). The NHANES physical functioning questionnaire included 19 items. The NHANES physical activity questionnaire captured work-related, leisure-time, and sedentary activities. Higher physical functioning scores represent worse function. CKD was classified using Kidney Disease Outcomes Quality Initiative 2002 criteria, and anemia was …

Introduction Edema is a common manifestation of proteinuric kidney diseases, but there is no consensus approach for reliably evaluating edema. The objective of this study was to develop an edema clinician-reported outcome measure for use in patients with nephrotic syndrome. Methods A literature review was conducted to assess existing clinician-rated measures of edema. Clinical experts were recruited from internal medicine, nephrology, and pediatric nephrology practices to participate in concept elicitation using semi-structured interviews and cognitive debriefing. Qualitative analysis methods were used to collate expert input and inform measurement development. In addition, training and assessment modules were developed using an iterative process that also utilized expert input and cognitive debriefing to ensure interrater reliability. Results While several clinician-rated measures of edema have been …

Continuing in the tradition of award-winning educator and epidemiologist Dr. Leon Gordis, Gordis Epidemiology, 7th Edition, provides a solid introduction to basic epidemiologic principles as well as practical applications in public health and clinical practice, highlighted by real-world examples throughout. Written by Drs. David D Celentano, Moyses Szklo, and Youssef Farag of Johns Hopkins University, this bestselling text is known for its reader-friendly, accessible writing style and practical approach to a complex and challenging subject, making it a favorite text of students as well as an ideal resource for health care providers, health policy makers, and epidemiologists at all levels of training and practice. Covers the basic principles and concepts of epidemiology in a clear, uniquely memorable way, using a wealth of full-color figures, graphs, charts, and cartoons to help you understand and retain key information. Includes new examples and cases reflecting modern epidemiology, including lessons from the COVID-19 pandemic and other current topics of interest. Reflects how epidemiology is practiced today, with chapters progressing from observation and developing hypotheses to data collection and analyses. Features end-of-chapter questions for quick self-assessment, and a glossary of genetic terminology. Provides more than 200 additional multiple-choice self-assessment questions online. Provides a strong basis for understanding the role and importance of epidemiology in today’s data-driven society. Evolve Instructor site with an image/table collection, test bank, and more is available to instructors through their Elsevier sales rep or via …

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ESKD-Free Survival Time in Patients with CKD and Type 2 Diabetes (TD2) in FIDELITY — The Capital Region of Denmark's Research Portal Skip to main navigation Skip to search Skip to main content The Capital Region of Denmark's Research Portal Home The Capital Region of Denmark's Research Portal Logo Help & FAQ Dansk English Home Hospitals/departments Researchers Research output Activities Prizes Search by expertise, name or affiliation ESKD-Free Survival Time in Patients with CKD and Type 2 Diabetes (TD2) in FIDELITY Ajay K Singh, Stefan D Anker, Gerasimos Filippatos, Bertram Pitt, Peter Rossing, Luis M Ruilope, Christiane Ahlers, Youssef M Farag, Katja Rohwedder, Luke Roberts, George L Bakris Steno Diabetes Center Copenhagen Overview Original language English Article number SA-PO476 Journal Journal of the American Society of Nephrology Volume 34 ISSN 1046-6673 …

Introduction: The impact of change in albuminuria measured by UACR on key clinical outcomes (overall survival [OS], a composite cardiovascular [CV] outcome, and kidney disease progression) in patients (pts) with CKD associated with T2D is understudied. Hypothesis: A decreased UACR is associated with a lower risk of clinical outcomes, while an increased UACR is associated with a higher risk of clinical outcomes. Methods: Adult pts with an elevated UACR ≥30 mg/g (initial test) after T2D and CKD diagnosis were identified from the Optum EHR database (1/2007-9/2021). UACR change was categorized as increased (>30% change), stable (-30% to 30%), or decreased (<-30%) based on the percentage change between the initial test and the last test (between 6 to 24 months after the initial test). Clinical outcomes, including OS, a composite CV outcome (CV death, myocardial infarction, stroke, or heart failure …

Background and Aims Chronic kidney disease (CKD) is often underrecognised until later stages when most of the kidney function is lost and the therapeutic window for disease-modifying therapy is narrow . We previously developed a lab-based risk prediction model to accurately predict CKD progression in adults at all stages of CKD . Here, we describe a validation of our model in the clinical trial population of FIDELITY, a prespecified pooled analysis of the phase III FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049) trials for the nonsteroidal mineralocorticoid receptor antagonist finerenone . Method We performed a post hoc analysis of all participants from the FIDELITY database, irrespective of estimated glomerular filtration rate (eGFR) or albuminuria stage. Baseline values for the underlying laboratory tests required for the model, Klinrisk, were extracted from …

Patients with chronic kidney disease (CKD) develop anemia largely because of inappropriately low erythropoietin (EPO) production and insufficient iron available to erythroid precursors. In four phase 3, randomized, open‐label, clinical trials in dialysis‐dependent and non–dialysis‐dependent patients with CKD and anemia, the hypoxia‐inducible factor prolyl hydroxylase inhibitor, vadadustat, was noninferior to the erythropoiesis‐stimulating agent, darbepoetin alfa, in increasing and maintaining target hemoglobin concentrations. In these trials, vadadustat increased the concentrations of serum EPO, the numbers of circulating erythrocytes, and the numbers of circulating reticulocytes. Achieved hemoglobin concentrations were similar in patients treated with either vadadustat or darbepoetin alfa, but compared with patients receiving darbepoetin alfa, those receiving vadadustat had erythrocytes with increased mean …

The end-stage kidney disease (ESKD) Data Standards Project was launched by the Kidney Health Initiative (KHI) with the goal of standardizing dialysis-related measurements for research use. KHI is a public-private partnership between the American Society of Nephrology, US Food and Drug Administration, and organizations with an interest in kidney disease. KHI promotes safe and effective patient-centered therapies for people with kidney disease. In 2018, KHI established a workgroup with expertise in nephrology, nursing, quality management, ESKD data, organizational management, and clinical research. The workgroup identified 5 topic areas and 8 specific measures for the development of standards on the basis of the existing ESKD Measurement Specification Manual published by the Centers for Medicare & Medicaid Services. The topic areas were ultrafiltration rate, vascular access, dialysis small solute …

BackgroundEgypt is the most populous country across the Middle East and North Africa (MENA), with more than 102.3 million residents and a gross domestic product of US $303 billion. Approximately 43% of the population is urbanized, living in major cities such as Cairo, Alexandria, and Mansoura (1). This transcontinental country is located at the northeast corner of Africa, split by the great Nile River Valley at its center, and borders the Red and Mediterranean Seas (2). The World Bank classifies Egypt in the lower-to middle-income economies, relying on tourism, agriculture, and manufacturing (2).