PURPOSE:We examined central sensitization in patients with urinary urgency, with or without urgency urinary incontinence. MATERIALS AND METHODS:Adult male and female patients who presented with urinary urgency, with or without urgency incontinence, and seeking treatment for their overactive bladder (OAB) were enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) II Study. A control group without urgency or incontinence was also enrolled. Symptoms associated with central sensitization were assessed using the validated self-reported questionnaire Central Sensitization Inventory (CSI). CSI ≥ 40 is associated with a higher likelihood of having central sensitization. RESULTS:Six hundred seventeen cases with urinary urgency and 125 controls without urinary symptoms were included. Cases had higher CSI part A scores compared with controls (median 28.0 vs 15.0). The percentage of participants likely to have central sensitization (CSI ≥40) was significantly higher in cases vs controls (21% vs 3.2%, P < .001). About one-fourth of OAB cases had symptoms consistent with central sensitization with CSI ≥ 40. CSI ≥ 40 was associated with roughly 9 times the odds of being an urgency case compared with CSI < 40 (odds ratio 9.17, P < .001). Higher central sensitization scores correlated with more severe OAB-q Questionnaire (OAB-q symptom severity, ρ = 0.30, P < .001), urgency symptoms (LURN SI-29 subscale, ρ = 0.25, P < .001), incontinence symptoms (LURN SI-29 subscale, ρ = 0.24, P < .001), and worse quality of life (OAB-q health-related quality of life, ρ = -0.40, P < .001). CONCLUSIONS:Patients with OAB with urinary urgency had more central sensitization symptoms compared with controls. Our data suggested that central sensitization may play a role in at least a subset of patients with urinary urgency, with or without urgency urinary incontinence.
Background: Diabetes is the leading cause of kidney failure globally affecting 40% of people receiving peritoneal dialysis (PD). High quality data on the potential impact of improving glycemic control is needed to inform the current recommendations to individualise HbA 1C targets. Methods: Data from eight countries in the prospective cohort Peritoneal Dialysis Outcomes and Practice Patterns Study (2014-2022) was used to assess the association between baseline HbA 1C and all-cause mortality in people with Type 2 diabetes on PD for at least 90 days. Cox proportional hazards model adjusted for potential confounders assessed the relationship in the whole cohort and subgroups. Using inverse probability weighting, an average treatment effect in the treated analysis further investigated potential implications of improved glycemic control. Results: HbA 1C was measured at least once in 8,436 patients during a mean follow-up of 16 months. Compared with HbA 1C ≤8%, HbA 1C >8% was associated with higher risk of all-cause mortality in the cohort as a whole (HR 1.18 p=0.02 95%CI 1.03-1.35) and within subgroups; aged <65years (HR 1.28 p=0.01 95% CI1.05-1.56), average albumin >3.0g/dL (HR 1.25 p=0.004 95% CI 1.07-1.46), no pre-existing coronary artery disease (HR 1.24 p=0.008 95% CI 1.06-1.46), haemoglobin <10g/L (HR 1.50 p=0.01 95% CI 1.09-2.07) and PD vintage <1year (HR 1.22 p=0.02 95% CI 1.03-1.45). The projected survival advantage at 3 years for those with HbA 1C ≤8% compared with >8% was 7% overall, increasing to 12% in younger cohorts (aged <65years). The largest predicted absolute survival advantage of 16% (78% versus 61%) was seen in those aged <65, with a normal serum albumin and no history of coronary artery disease. Conclusions: Associations between HbA 1C and mortality argue for tighter individualised targets for patient subgroups (younger, non-inflamed, without established CAD). Our weighted analysis suggests improved glycemic control (reducing HbA 1C to <8%) may result in an absolute reduction in mortality at three years of up to 12% in younger cohorts.
Introduction:Automated peritoneal dialysis (APD) is the predominant peritoneal dialysis (PD) modality in many high-income countries and is increasingly adopted in low- and middle-income settings. Outcome differences between APD and continuous ambulatory PD (CAPD) remain unclear. A clearer understanding could inform clinical and policy decisions. Methods:Patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS; N = 9463 patients across 6 countries/regions) who were enrolled within 3 months of starting PD were analyzed in intent-to-treat Cox regression models examining associations between PD modality (CAPD vs. APD) and patient survival, permanent transfer to hemodialysis (HD, HDT), and time to first peritonitis, adjusting for patient and facility-level factors and stratified by country. Results:Of the patients, 87% were prescribed APD (range: 37% in South Korea to 91% in USA). APD patients were younger, had lower urine output, more often used hypertonic solutions, and less often used icodextrin. Overall, there was no evident difference between APD and CAPD in survival (adjusted hazard ratio [AHR]: 0.82, 95% confidence interval [CI]: 0.66-1.03) or HDT (AHR: 0.96, 95% CI: 0.83-1.11), though results varied by country and subgroups (APD had lower death risk in those having assisted PD). APD patients had a lower risk of peritonitis overall (AHR: 0.83, 95% CI: 0.72-0.97), and specifically of gram-positive (AHR: 0.67, 95% CI: 0.52-0.87) and culture-negative (AHR: 0.64, 95% CI: 0.44-0.95) peritonitis. Conclusion:APD and CAPD showed comparable patient and technique survival. APD's lower peritonitis rate highlights the importance of aseptic technique; its benefits in assisted PD patients suggest that it may be suited for those requiring support.
Abstract Background Renin-angiotensin system (RAS) inhibitors are a cornerstone of cardiovascular and kidney risk modification in chronic kidney disease (CKD). Yet, they are often discontinued in advanced CKD to limit adverse effects or to delay kidney replacement therapy (KRT). Methods From the CKD-Renal Epidemiology and Information Network prospective cohort study, we selected participants with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 and treated with RAS inhibitors. We performed a target trial emulation with parametric g-formula to compare two strategies: to discontinue or to continue RAS inhibitors. Models were adjusted for sociodemographics, clinical and laboratory characteristics, and drug prescriptions. Outcomes were the composite of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure, i.e. major cardiovascular events (MACE), and KRT initiation. Results Among the 1 434 patients included (median age 68 years, median eGFR 25 mL/min/1.73m2, 35% women), 386 (27%) discontinued RAS inhibitors over a median follow-up of 35 months. Very few events related to adverse drug reactions were reported in the 3 months preceding RAS inhibitor discontinuation (n = 23), but their incidence over this period was ∼13-fold higher than that during the entire follow-up. The 3-year adjusted relative risk of MACE associated to discontinuing RAS inhibitors, compared to continuing, was 2.02 (95% CI, 1.62 to 2.47), and that of KRT initiation, 1.34 (95% CI, 1.14 to 1.60). Discussion RAS inhibitor discontinuation was strongly associated with MACE and KRT risks, major causes of morbidity and mortality in advanced CKD. Our findings, consistent with prior data, suggest the risk-benefit balance favors continued use with close monitoring.
Introduction The ULTra study was designed to better understand the relationship of lifestyle factors with urinary urgency, specifically by assessing physical activity and sleep quality using a wearable tracker. Our objectives here are to describe study design and enrollment, adherence, and data evaluability results. Methods The Urinary Urgency and Lifestyle Wearable Tracker (ULTra) study of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is a 3-month, prospective study performed within the larger 1-year Urinary Urgency Phenotyping (UUP) study. The UUP and ULTra studies enrolled adults with bothersome urinary urgency without (URG) or with urgency urinary incontinence (UUI) and a sex- and age-matched control group (no urinary symptoms). Data collection using the wearable tracker, including steps, heart rate, logged physical activities, and sleep episode information, occurred over two weeks at baseline and again 3-months after enrollment. Adherence and data validity criteria were developed for physical activity and sleep data obtained via the wearable tracker. Results We enrolled 270 participants (64 URG, 143 UUI, 63 controls), and 205 (76%) had evaluable data (at least 5 valid days) for either physical activity or sleep. In cases, data evaluability differed by sex, but not by age or case-control status. Female participants (versus male) and those with higher comorbidity and incontinence scores were less likely to contribute evaluable data. Conclusion This manuscript describes the design of the LURN ULTra study and discusses feasibility and challenges encountered in conducting a multicenter study employing wearable technology in an adult population seeking care for urinary symptoms.
