Syed Tahir Shah

Alcohol consumption and blood pressure in the adult US population: assessment of gender-related effects.

Objective Our objective was to assess the gender-related effects of alcohol consumption on blood pressure (BP) in a representative sample of the adult US population. Methods We examined data from the National Health and Nutrition Examination Survey 1999–2000. The effects of various risk factors for hypertension on BP were examined with analysis of covariance statistics. Results Of the 5448 adults over 20 years of age, 2650 (48.7%) reported the intake of one or more drinks per day over the past year. In this population, the mean ± SEM age was 46.9 ± 0.34 years, the body mass index was 24.8 kg/m2, 1257 (47.4%) were women, systolic BP was 124.3 ± 0.44 mmHg and diastolic BP was 72.7 ± 0.27 mmHg. Hypertension was reported in 21.1%, diabetes in 5.1% and cigarette smoking in 39.7%. A significant effect on systolic BP was shown with age (P < 0.01), body mass index (P < 0.01), race (P = 0.01), gender (P < 0.01) and diabetes (P < 0.01). The interaction with gender and alcohol drinking level was significant (P = 0.02). Post-hoc analysis localized the source of this effect. There was a significant increase in systolic BP between one and three and between one and four, but not between one and two, drinks per day in men. This effect was not observed in women. Conclusion Consistent with previous reports, our study suggests that alcohol intake up to two drinks per day has no effect on BP. There was a gender-related effect of alcohol intake in excess of two drinks per day on BP, with increased BP observed only in men but not in women.

New-Onset Diabetes after Hemodialysis Initiation: Impact on Survival

Background: The incidence of new-onset diabetes after initiation of hemodialysis (NODAD) and its impact on survival is not known. Methods: We used data from the United States Renal Data System (USRDS) from January 2000 to December 2001, with at least 3 years of follow-up for this study. Patients aged 18–80 years were included. NODAD was defined as two Medicare institutional claims for diabetes in patients with no history of diabetes prior to starting hemodialysis (HD). Incidence (per 1,000 patient-years), prevalence (%) and hazard ratios for mortality in patients with NODAD were calculated. Results: There were 59,340 incident patients with no history of diabetes prior to starting HD, of which 3,853 met criteria for NODAD. The overall incidence and prevalence of NODAD were 20 per 1,000 patient-years and 7.6%, respectively. In a cohort of 444 patients without diabetes and documented glycosylated hemoglobin A1c, <6% prior to starting HD (from January 2005 and March 2006), at a mean follow-up of 4.7 ± 2.6 months, 6.8% developed NODAD defined by two Medicare claims for diabetes after initiation of HD. NODAD was associated with a significantly increased risk of death as compared to non-diabetes patients (hazard ratio 1.20, 95% confidence interval 1.14–1.25). Conclusion: The USRDS showed a high incidence of NODAD, associated with significantly higher mortality compared to those who did not develop NODAD. The mechanism of NODAD needs to be explored further in experimental and clinical studies.

Long-term kidney transplant outcome in obese patients in a predominantly African American population.

Karabicak I, Aytug S, Lewis S, Shah S, Sumrani N, Hayat A, Distant DA, Salifu MO. Long‐term kidney transplant outcome in obese patients in a predominantly African American population.
Clin Transplant 2011: 25: E264–E270.

Effect of ethnicity on the progression of diabetic kidney disease independent of glycemic control.

Background/Aims: The prevalence of diabetic kidney disease (DKD) and risk of progression to end-stage renal disease is higher in African-Americans as compared to Caucasians. Whether the higher rate of estimated glomerular filtration rate (eGFR) decline in African-Americans is mediated by poor glycemic control is unclear. Methods: We conducted a prospective study of 183 (African-American, n = 95; Caucasian, n = 88, mean age 66 ± 10 vs. 70 ± 11 years) patients with a diagnosis of DKD followed over a period of 12 months. eGFR (ml/min/1.73 m2) was calculated by MDRD formula and grouped into stage 1–2 (≥60 ml/min), stage 3 (30–60 ml/min) and stage 4 (<30 ml/min). In addition, glycosylated hemoglobin A1C (HbA1c) was categorized into tertiles (<7, 7–8 and >8%) at each time point. Results:There were no significant differences in eGFR at any time point between African-American and Caucasian in any stage of CKD during this period. There were also no significant differences in eGFR at any time point in each category of HbA1c. Conclusions: Our data indicate that there were no ethnic differences in the rate of progression of DKD under equivalent glycemic control. Further research is needed to explore the mechanisms associated with higher prevalence and rapid progression of CKD in African-Americans compared to Caucasians.