Christian Temml

Elevated Uric Acid Increases the Risk for Kidney Disease

Recent epidemiologic studies suggest that uric acid predicts the development of new-onset kidney disease, but it is unclear whether uric acid is an independent risk factor. In this study, data from 21,475 healthy volunteers who were followed prospectively for a median of 7 yr were analyzed to examine the association between uric acid level and incident kidney disease (estimated GFR [eGFR] <60 ml/min per 1.73 m(2)). After adjustment for baseline eGFR, a slightly elevated uric acid level (7.0 to 8.9 mg/dl) was associated with a nearly doubled risk for incident kidney disease (odds ratio 1.74; 95% confidence interval 1.45 to 2.09), and an elevated uric acid (> or =9.0 mg/dl) was associated with a tripled risk (odds ratio 3.12; 95% confidence interval 2.29 to 4.25). These increases in risk remained significant even after adjustment for baseline eGFR, gender, age, antihypertensive drugs, and components of the metabolic syndrome (waist circumference, HDL cholesterol, blood glucose, triglycerides, and BP). In a fully adjusted spline model, the risk for incident kidney disease increased roughly linearly with uric acid level to a level of approximately 6 to 7 mg/dl in women and 7 to 8 mg/dl in men; above these levels, the associated risk increased rapidly. In conclusion, elevated levels of uric acid independently increase the risk for new-onset kidney disease.

Prevalence of lower urinary tract symptoms in Austria as assessed by an open survey of 2,096 men

Objective: The lack of knowledge on the prevalence of lower urinary tract symptoms (LUTS) in German-speaking countries prompted us to assess this issue in Austria by means of a large open-scale study. Methods: A community sample of 2,096 men equal to or older than 20 years, who participated in a health survey in Vienna, completed the recently validated German translation of the International Prostate Symptom Score (IPSS). In addition, a detailed urological history and a physical evaluation (including digital rectal examination) were obtained. Results: The mean age in the study population was 47 ± 14 (range 20–96) years. The mean IPSS increased from 2.1 (20–29 years, n = 128) to 2.6 (30–39, n = 322), 3.0 (40–49, n = 902), 5.8 (50–59, n = 325), 5.7 (60–69, n = 219), 6.4 (70–79, n = 158), and 6.1 (≥80 years, n = 42). The proportion of patients with moderate/severe LUTS defined by an IPSS >7 increased from 6.3% (20–29 years) to 8.4 (30–39), 11.1 (40–49), 27.1 (50–59), 28.3 (60–69), 36 (70–79), and 35.7% (≥80 years). Overall, 7.8% of the men aged ≥50 years previously underwent transurethral resection of the prostate. In men aged 50–59 years, this proportion was 1.3%, and it increased to 4.2, 20.9, and 27.5% in those aged 60–69, 70–79, and ≥80 years, respectively. 7% of the men had previously consulted an urologist for micturition problems. In all life decades, these patients had higher IPSS levels than those with no previous urological visit. Conclusions: Based on the data generated, it is estimated that at present in Austria 26.9% (n = 291,761) of the men aged ≥50 years have moderate and further 2.8% (n = 30,815) severe LUTS. 7.8% of the men aged ≥50 years (n = 84,256) had a previous transurethral resection of the prostate. These data confirm the high prevalence of this condition in Austria.

Serum androgen levels in men: impact of health status and age

OBJECTIVES To investigate the impact of health status on androgen levels in men and to assess the age-related changes in androgen levels. METHODS Sera were obtained from 526 men (age 20 to 89 years) participating in a health screening project and 35 men selected according to the SENIEUR protocol, which excludes those with underlying disease. The health screening project participants were divided into two groups: healthy men (n = 133; group 1) and the remainder (n = 393; group 2). The total testosterone and sex hormone-binding globulin levels were quantified, and the amount of free testosterone (cfT) was calculated. RESULTS The lowest annual declines in androgen level were observed in group 3 (testosterone 0.2%; cfT 0.4%), followed by group 1 (testosterone 0.4%; cfT 0.8%) and group 2 (testosterone 0.8%; cfT 0.9%). Body mass index and levels of cholesterol, triglycerides, and glucose correlated negatively (P <0.01) with testosterone and cfT. Decade-adjusted reference values (mean +/- 2 standard deviations) for testosterone and cfT were defined. The proposed lower testosterone reference value declined gradually from 3.1 ng/mL (20 to 29 years) to 1.7 ng/mL (70 years or older). CONCLUSIONS In this cross-sectional study, serum androgens declined in aging men, and the extent of this decrease correlated with health status. A fixed, non-age-adjusted reference value does not adequately reflect this and might lead to a false diagnosis of androgen deficiency, particularly in elderly men. The clinical value of age-related reference values, however, needs to be determined in prospective studies.

Nocturia is an age-independent risk factor for hip-fractures in men.

Nocturia is a highly prevalent symptom in the elderly and a common reason for interrupted sleep resulting in dizziness, worse daytime functioning and higher risk of falls. The aim of this study was to determine the role of nocturia as a risk factor for hip‐fractures in men.

Are Lower Urinary Tract Symptoms Influenced by Metabolic Syndrome

OBJECTIVES To determine the role of the metabolic syndrome (MS) in the genesis of lower urinary tract symptoms (LUTS) in both sexes. The MS and LUTS are highly prevalent disorders, both increasing with increasing age. METHODS Participants in a health-screening project underwent a detailed health examination, including all factors associated with the MS, and were assessed regarding LUTS. The MS was defined according to the International Diabetes Federation consensus definition of 2005, and LUTS were quantified using the International Prostate Symptom Score (IPSS). RESULTS A total of 2371 men (mean age 46.1 years) and 731 women (mean age 53.9 years) were analyzed. In the men, moderate-to-severe LUTS (IPSS >7) were present in 13.1%; in the women, the corresponding value was 23.5%. The proportion of the MS diagnosed during the health investigation was 33.8% in the men and 30.2% in the women. On multiple linear regression analysis, the MS was not associated with the IPSS, IPSS obstructive or irritative subscore, or LUTS. The proportion of LUTS and mean IPSS did not significantly differ regarding the presence or absence of the MS in either sex. CONCLUSIONS According to our results, the MS did not turn out to be significantly and independently involved in the genesis of LUTS in men or women.

Chronic Pelvic Pain and Lower Urinary Tract Symptoms in Both Sexes: Analysis of 2749 Participants of an Urban Health Screening Project

BACKGROUND Recent studies question the role of the prostate as the key factor in the pathogenesis of chronic pelvic pain syndrome (CPPS). OBJECTIVE To compare symptoms related to CPPS and lower urinary tract symptoms (LUTS) in both sexes. DESIGN, SETTING, AND PARTICIPANTS Participants of a voluntary health examination in Vienna. INTERVENTION AND MEASUREMENTS All participants completed a detailed questionnaire containing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), with the female homolog of each male anatomical term use on questionnaires for female participants, the International Prostate Symptom Score (IPSS), and additional questions on pelvic pain. Furthermore, all participants underwent a detailed health investigation performed by a general practitioner. RESULTS AND LIMITATIONS The study cohort comprised 1768 men and 981 women. The mean NIH-CPSI was 7.2+/-0.1 in women and 3.8+/-0.2 in men (p<0.001). In subject up to the age of 70 yr, the NIH-CPSI was higher in women (p<0.001). The NIH-CPSI increased with age in men (p<0.001), yet not in women (p=0.4). The prevalence of symptoms suggestive of CPPS in this selected population was 5.7% in women and 2.7% in men, and was higher in premenopausal women (p=0.03). Until the age of 50 yr, NIH-CPSI pain score in women exceeded that of men (p<0.001). The mean IPSS was higher in women (p<0.001). Storage symptoms were higher in women up to 60 yr, and voiding symptoms were higher in men above 60 yr. In men and women with symptoms suggestive of CPPS, the mean IPSS was significantly higher compared with those without CPPS symptoms (p<0.001). Limitations of our study are (1) that a urological evaluation was not performed and (2) that the questionnaire was not formerly validated for females. CONCLUSION The preponderance of CPPS in females raises questions about the etiological role of the prostate in all cases with chronic pelvic pain and suggests that other pathomechanisms are likely to be involved.

Is there an association between lower urinary tract symptoms and cardiovascular risk in men? A cross sectional and longitudinal analysis.

OBJECTIVE To investigate the association between lower urinary tract symptoms (LUTS) and both coronary vascular disease (CVD) and stroke in men in a cross-sectional and longitudinal setting. MATERIAL AND METHODS Men aged 30-92 years underwent a free health investigation and completed the International Prostate Symptom Score questionnaire. In the cross-sectional part, the 10-year CVD and stroke risks were estimated according to the Framingham risk score. In the follow-up period (mean 6.1 years) the CVD and stroke events were recorded. RESULTS Two-thousand ninety-two men aged 47.8 years (SD 11.5) were analyzed. No to mild LUTS were present in 1,738 men, 337 men had moderate LUTS, and 17 had severe LUTS. The 10-year risk (cross-sectional design) for CVD or stroke in men with no to mild, moderate, and severe LUTS was 8.8%, 10.6%, and 15.9% (P <.01) and 6.9%, 7.5%, and 11.7% (P <.01), respectively. Adjusted for age, diabetes, total and low-density lipoprotein cholesterol, the odds ratios for CVD and stroke risk were 0.98 (P = .58) and 0.99 (P = .72) for moderate and 1.28 (P = .03) and 1.66 (P <.01) for severe LUTS. During follow-up, 96 events (CVD or stroke) were recorded: Men with no to mild, moderate, and severe LUTS had 76 (4.4%), 15 (4.5%), and 5 (29.4%) events, respectively. The adjusted (see above) hazard ratios were 0.63 (P = .16) for moderate and 3.82 (P = .01) for severe LUTS. CONCLUSION Although moderate LUTS do not seem to be a risk factor for CVD and stroke, men with severe LUTS were at increased risk for both according to a cross-sectional and longitudinal analysis. Studies with a larger group of men with severe LUTS are warranted to further substantiate these observations.

Body mass index modifies the risk of cardiovascular death in proteinuric chronic kidney disease

BACKGROUND In subjects with end-stage renal disease, a high body mass index (BMI) is inversely related to overall mortality, which has been coined reverse epidemiology phenomenon. This study sought to investigate this paradox as well as a possible risk modification by proteinuria on the relationship of BMI with earlier stages of chronic kidney disease (CKD) concerning cardiovascular mortality. METHODS We used the Vienna Health Screening Initiative, a longitudinal cohort study from 1990 to 2006, including 49 398 volunteers (49.9% women, age 20-89 years): n = 2487 showed mild CKD (proteinuria and GFR >60 ml/min/1.73 m(2)) and n = 392 showed moderate CKD (GFR = 30-59 ml/min/1.73 m(2)). The follow-up period was 5.5 +/- 4.2 years; n = 148 cardiovascular deaths occurred. Exposure variables were BMI, glomerular filtration rate (GFR) and proteinuria. Cox regression models on cardiovascular mortality with adjustment for age, sex, log(cholesterol/HDL), uric acid, smoking, glucose, diabetes, mean blood pressure, hypertension and antihypertensive drug use were fitted. RESULTS The risk factor paradox is shown in moderate CKD (GFR = 45 ml/min/1.73 m(2)): hazard ratios (HR) of BMI contrasts decreased consistently from 1.28 (95% CI 0.33-5.82) at BMI 20 kg/m(2) versus 25 kg/m(2) to 0.76 (95% CI 0.38-1.50) at BMI 30 kg/m(2) versus 25 kg/m(2) and to 0.58 (95% CI 0.13-2.64) at BMI 35 kg/m(2) versus 25 kg/m(2), thus showing an inverse relationship compared to mild CKD/healthy participants. Examining proteinuria as an effect modifier in this context showed that in moderate CKD (contrast: proteinuria versus no proteinuria) HR decreased more profoundly from 9.43 (95% CI 2.66-27.40) at BMI 25 kg/m(2) to 3.74 (95% CI 0.93-15.70) at BMI 30 kg/m(2) and to 1.95 (95% CI 0.37-22.30) at BMI 35 kg/m(2), and conversely in non-proteinuric subjects, hazards for cardiovascular mortality increased in underweight as well as in overweight/obese subjects in a U-shaped manner. CONCLUSIONS Our results suggest that obese subjects with proteinuric CKD may not be counselled for weight reduction since a higher BMI was associated with a remarkably reduced risk of death.

The natural history of the overactive bladder syndrome in females: a long-term analysis of a health screening project.

To analyze the natural history of the overactive bladder (OAB) syndrome in women over a period of 6.5 years.

Impact of Overactive Bladder Symptoms on Sexuality in Both Sexes

Objectives: To define the epidemiological impact of the overactive bladder syndrome (OAB) on sexual life. We therefore analyzed this issue in a large cohort of individuals participating in a health screening project. Patients and Methods: A total of 2,365 men and women completed the Bristol Female Lower Urinary Tract Symptoms Questionnaire (BFLUTS). OAB was defined according to the International Continence Society (ICS). The impact of OAB on sexual life was assessed by a single question: ‘In general, how do your micturition problems affect your sexual life’. Results: A total of 1.199 men and 1.166 women with were analyzed. The overall prevalence of OAB was 13.9% (n = 329): 9.7% had OABdry and 4.2% OABwet. A total of 17.6% (n = 58) of individuals with OAB reported a negative impact of OAB on sexual life as compared to 4.7% of those without OAB (p < 0.001). One of 4 with OABwet reported a negative impact on sexual life (25%) as compared to 14.4% in those with OABdry (p < 0.005). Conclusion: Sexual dysfunction is frequently reported in individuals with OAB. Individuals with OABwet are experiencing a more profound impact on sexuality. Therefore, patients with OAB should be assessed regarding sexual dysfunction by the urologist.