SILVIA MARIA DE OLIVEIRA TITAN
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- Bisphosphonate utilization across the spectrum of eGFR(2020) TITAN, Silvia M.; LAUREATI, Paola; SANG, Yingying; CHANG, Alex R.; EVANS, Marie; TREVISAN, Marco; LEVEY, Andrew S.; GRAMS, Morgan E.; INKER, Lesley A.; CARRERO, Juan-JesusBisphosphonates are the most common treatment for osteoporosis but there are concerns regarding its use in CKD. We evaluated the frequency of BSP by eGFR categories among patients with osteoporosis from two healthcare systems. Our results show that 56% of patients were treated, with reduced odds in those with lower eGFR. Introduction Osteoporosis is common in patients with chronic kidney disease (CKD). Bisphosphonates (BSP) are the most common treatment but there are concerns regarding its efficacy and toxicity in CKD. We evaluated the frequency of BSP use by level of estimated glomerular filtration rate (eGFR) in patients with osteoporosis. Methods We assessed BSP use in patients with incident osteoporosis from the SCREAM-Cohort, Stockholm-Sweden, and Geisinger Healthcare, PA, USA. Osteoporosis was defined as the first encountered ICD diagnosis, and BSP use was defined as the dispensation or prescription of any BSP from 6 months prior to 3 years after the diagnosis. Multinomial logistic regression was used to account for the competing risk of death. Results A total of 15,719 women and 3011 men in SCREAM and 17,325 women and 3568 men in Geisinger with incident osteoporosis were included. Overall, 56% of individuals used BSP in both studies, with a higher proportion in women. After adjustments, the odds of BSP was lower across lower eGFR in SCREAM, ranging from 0.90 (0.81-0.99) for eGFR 75-89 mL/min/1.73m(2) to 0.56 (0.46-0.68) for eGFR 30-44 mL/min/1.73m(2) in women and from 0.72 (0.54-0.97) for eGFR of 60-74 to 0.42 (0.25-0.70) for eGFR 30-44 mL/min/1.73m(2) in men. In Geisinger, odds were lower for eGFR < 30 mL/min/1.73m(2) in both sexes and the frequency of BSP use dropped over time. Conclusion In the two healthcare systems, approximately half of the people diagnosed with osteoporosis received BSP. Practices of prescription in relation to eGFR varied, but those with lower eGFR were less likely to receive BSP.
- Potential Biomarkers of the Turnover, Mineralization, and Volume Classification: Results Using NMR Metabolomics in Hemodialysis Patients(2020) BAPTISTA, A.L.; PADILHA, K.; MALAGRINO, P.A.; VENTURINI, G.; ZERI, A.C.M.; REIS, L.M. dos; MARTINS, J.S.; JORGETTI, V.; PEREIRA, A.C.; TITAN, S.M.; MOYSES, R.M.A.Bone biopsy is still the gold standard to assess bone turnover (T), mineralization (M), and volume (V) in CKD patients, and serum biomarkers are not able to replace histomorphometry. Recently, metabolomics has emerged as a new technique that could allow for the identification of new biomarkers useful for disease diagnosis or for the understanding of pathophysiologic mechanisms, but it has never been assessed in the chronic kidney disease–mineral and bone disorder (CKD–MBD) scenario. In this study, we investigated the association between serum metabolites and the bone TMV classification in patients with end-stage renal disease by using serum NMR spectroscopy and bone biopsy of 49 hemodialysis patients from a single center in Brazil. High T was identified in 21 patients and was associated with higher levels of dimethylsulfone, glycine, citrate, and N-acetylornithine. The receiver-operating characteristic curve for the combination of PTH and these metabolites provided an area under the receiver-operating characteristic curve (AUC) of 0.86 (0.76 to 0.97). Abnormal M was identified in 30 patients and was associated with lower ethanol. The AUC for age, diabetes mellitus, and ethanol was 0.83 (0.71 to 0.96). Low V was identified in 17 patients and was associated with lower carnitine. The association of age, phosphate, and carnitine provided an AUC of 0.83 (0.70 to 0.96). Although differences among the curves by adding selected metabolites to traditional models were not statistically significant, the accuracy of the diagnosis according to the TMV classification seemed to be improved. This is the first study to evaluate the TMV classification system in relation to the serum metabolome assessed by NMR spectroscopy, showing that selected metabolites may help in the evaluation of bone phenotypes in CKD–MBD. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
- Performance of Indexed and Nonindexed Estimated GFR(2020) TITAN, Silvia; MIAO, Shiyuan; TIGHIOUART, Hocine; CHEN, Nan; SHI, Hao; ZHANG, Luxia; LI, Zuo; FROISSART, Marc; ROSSING, Peter; GRUBB, Anders; FAN, Li; MAUER, Michael; BAKOUSH, Omran; WYATT, Christina; SHLIPAK, Michael G.; SHAFI, Tariq; INKER, Lesley A.; LEVEY, Andrew S.
- Metabolites related to eGFR: Evaluation of candidate molecules for GFR estimation using untargeted metabolomics(2019) TITAN, S. M.; VENTURINI, G.; PADILHA, K.; TAVARES, G.; ZATZ, R.; BENSENOR, I; LOTUFO, P. A.; RHEE, E. P.; I, R. Thadhani; PEREIRA, A. C.Background: Metabolomics can be used to identify novel metabolites related to renal function and that could therefore be used for estimating GFR. We evaluated metabolites replicated and related to eGFR in 3 studies (CKD) and general population). Methods: Metabolomics was performed by GC-MS. The Progredir Cohort (n = 454, class 3 and 4 CKD) was used as the derivation study and adjusted linear regression models on eGFR-CKDEPI were built. Bonferroni correction was applied for selecting metabolites to be independently validated in the Diabetic Nephropathy Study (n = 56 macroalbuminuric DN) and in the Baependi Heart Study (BHS, n = 1145, general population). Results: In the Progredir Cohort, 72 metabolites where associated with eGFR. Of those, 11 were also significantly associated to eGFR in the DN Study and 8 in the BHS. Four metabolites were replicated and significantly associated to eGFR in all 3 studies: D-threitol, myo-inositol, 4-deoxierythronic acid and galacturonic acid. In addition, pseudouridine was strongly correlated to eGFR only in the 2 CKD populations. Conclusions: Our results demonstrate metabolites that are potential biomarkers of renal function: D-threitol, myo-inositol, 4-deoxierythronic acid, galacturonic acid and pseudouridine. Further investigation is needed to determine their performance against otherwise gold-standard methods, most notably among those with normal eGFR.
- 1,5-Anhydroglucitol predicts CKD progression in macroalbuminuric diabetic kidney disease: results from non-targeted metabolomics(2018) TAVARES, Gesiane; VENTURINI, Gabriela; PADILHA, Kallyandra; ZATZ, Roberto; PEREIRA, Alexandre C.; THADHANI, Ravi I.; RHEE, Eugene P.; TITAN, Silvia M. O.Introduction Metabolomics allows exploration of novel biomarkers and provides insights on metabolic pathways associated with disease. To date, metabolomics studies on CKD have been largely limited to Caucasian populations and have mostly examined surrogate end points. Objective In this study, we evaluated the role of metabolites in predicting a primary outcome defined as dialysis need, doubling of serum creatinine or death in Brazilian macroalbuminuric DKD patients. Methods Non-targeted metabolomics was performed on plasma from 56 DKD patients. Technical triplicates were done. Metabolites were identified using Agilent Fiehn GC/MS Metabolomics and NIST libraries (Agilent MassHunter Work-station Quantitative Analysis, version B. 06.00). After data cleaning, 186 metabolites were left for analyses. Results During a median follow-up time of 2.5 years, the PO occurred in 17 patients (30.3%). In non-parametric testing, 13 metabolites were associated with the PO. In univariate Cox regression, only 1,5-anhydroglucitol (HR 0.10; 95% CI 0.01-0.63, p =.01), norvaline and l-aspartic acid were associated with the PO. After adjustment for baseline renal function, 1,5-anhydroglucitol (HR 0.10; 95% CI 0.02-0.63, p =.01), norvaline (HR 0.01; 95% CI 0.001-0.4, p =.01) and aspartic acid (HR 0.12; 95% CI 0.02-0.64, p =.01) remained significantly and inversely associated with the PO. Conclusion Our results show that lower levels of 1,5-anhydroglucitol, norvaline and l-aspartic acid are associated with progression of macroalbuminuric DKD. While norvaline and l-aspartic acid point to interesting metabolic pathways, 1,5-anhydroglucitol is of particular interest since it has been previously shown to be associated with incident CKD. This inverse biomarker of hyperglycemia should be further explored as a new tool in DKD.
- Metabolomics biomarkers and the risk of overall mortality and ESRD in CKD: Results from the Progredir Cohort(2019) TITAN, Silvia M.; VENTURINI, Gabriela; PADILHA, Kallyandra; GOULART, Alessandra C.; LOTUFO, Paulo A.; BENSENOR, Isabela J.; KRIEGER, Jose E.; THADHANI, Ravi I.; RHEE, Eugene P.; PEREIRA, Alexandre C.Introduction Studies on metabolomics and CKD have primarily addressed CKD incidence defined as a decline on eGFR or appearance of albuminuria in the general population, with very few evaluating hard outcomes. In the present study, we investigated the association between metabolites and mortality and ESRD in a CKD cohort. Setting and methods Data on 454 participants of the Progredir Cohort Study, Sao Paulo, Brazil were used. Metabolomics was performed by GC-MS (Agilent MassHunter) and metabolites were identified using Agilent Fiehn GC/MS and NIST libraries. After excluding metabolites present in <50% of participants, 293 metabolites were analyzed. An FDR q value <0.05 criteria was applied in Cox models on the composite outcome (mortality or incident renal replacement therapy) adjusted for batch effect, resulting in 34 metabolites associated with the outcome. Multivariable- adjusted Cox models were then built for the composite outcome, death, and ESRD incident events. Competing risk analysis was also performed for ESRD. Results Mean age was 68 +/- 12y, mean eGFR-CKDEPI was 38.4 +/- 14.6 ml/min/1.73m(2) and 57% were diabetic. After adjustments (GC-MS batch, sex, age, DM and eGFR), 18 metabolites remained significantly associated with the composite outcome. Nine metabolites were independently associated with death: D-malic acid (HR 1.84, 95% CI 1.32-2.56, p = 0.0003), acetohydroxamic acid (HR 1.90, 95% CI 1.30-2.78, p = 0.0008), butanoic acid (HR 1.59, 95% CI 1.17-2.15, p = 0.003), and docosahexaenoic acid (HR 0.58, 95% CI 0.39-0.88, p = 0.009), among the top associations. Lactose (SHR 1.49, 95% CI 1.04-2.12, p = 0.03), 2-O-glycerol-alpha-D-galactopyranoside (SHR 1.76, 95% CI 1.06-2.92, p = 0.03), and tyrosine (SHR 0.52, 95% CI 0.31-0.88, p = 0.02) were associated to ESRD risk, while D-threitol, mannitol and myo-inositol presented strong borderline associations. Conclusion Our results identify specific metabolites related to hard outcomes in a CKD population. These findings point to the need of further exploration of these metabolites as biomarkers in CKD and the understanding of the underlying biological mechanisms related to the observed associations.
- Estimation of Glomerular Filtration Rate With vs Without Including Patient Race(2020) LEVEY, Andrew S.; TIGHIOUART, Hocine; TITAN, Silvia M.; INKER, Lesley A.This cross-sectional study evaluates the use of race in estimating glomerular filtration rate and whether height and weight could substitute for race using pooled data from 10 studies of people with and without chronic kidney disease.