SummaryBackground and objectives The significance of renal parenchymal volume and the factors that influence it are poorly understood.Design, setting, participants, & measurements Renal parenchymal volume (RPV) was measured on contrastenhanced CT scans after exclusion of sinus fat and vessels in 224 healthy subjects evaluated as kidney donors and in a separate cohort of 22 severely obese individuals before and after 6 months of weight loss. GFR was measured by iohexol clearance in 76 of the transplant donors. RPV was correlated with age, GFR, and various anthropometric parameters. ResultsIn potential transplant donors, RPV correlated with body surface area (BSA; r ϭ 0.68) and was 7% larger in men but did not vary with age or race. Gender and body size were independent determinants of RPV. RPV correlated well with GFR (r ϭ 0.62) and accounted for almost all of the variability in a model of GFR that included age, race, gender, and body surface area. GFR correlated more strongly with RPV than with creatinine-based equations. The same relationship between RPV and BSA was observed in obesity, and RPV decreased with weight loss. ConclusionsIn healthy adults younger than 65 years, renal parenchymal volume is governed by body size and gender but not age or race and is strongly correlated with GFR. This indicates that renal parenchymal volume varies to meet metabolic demand and is closely linked to renal function.
Background: Asians and Pacific Islanders in the Hemochromatosis and Iron Overload Screening (HEIRS) Study had the highest prevalence of elevated serum ferritin (SF) and transferrin saturation (TS) levels, but to our knowledge, the reasons for this have not been investigated. Methods: Using multiple linear regression, we compared TS and SF distributions for 42 720 Asian, Pacific Islander, and white HEIRS Study participants recruited through 5 field centers in North America who did not have HFE C282Y or H63D alleles. Results: Compared with their white counterparts, Asian men had a 69-ng/mL (155-pmol/L) higher adjusted mean SF level and a 3% higher TS level (PϽ.001); Asian women had 23-ng/mL (52-pmol/L) higher adjusted mean SF level and a 3% higher TS level (PϽ.001). The mean TS level of Asian women was higher than that of Pacific Islander women, and the mean SF level of Pacific Islander men was significantly higher than that of white men. These differences remained significant after adjusting for self-reported history of diabetes or liver disease. Additional information for selected participants suggested that these differences are largely unrelated to mean corpuscular volume less than 80 fL, body mass index, or self-reported alcohol intake. Available liver biopsy and phlebotomy data indicated that iron overload is probably uncommon in Asian participants. Conclusion: Higher TS and SF levels in persons of Asian or Pacific Island heritage may need to be interpreted differently than for whites, although the biological basis and clinical significance of higher levels among Asians and Pacific Islanders are unclear.
Background Intermittent claudication, defined as fatigue or pain in the legs while walking, is a common symptom in peripheral arterial disease. Although exercise effectively improves function and manages symptoms, adherence rates are not ideal. The high levels of pain experienced in traditional exercise programmes may explain the suboptimal adherence. Alternative modalities of exercise can elicit similar benefits to traditional walking exercise. The purpose of this systematic review was to compare completion and adherence rates of exercise programmes in traditional exercise interventions versus alternative exercise interventions among patients with intermittent claudication. Design Systematic review. Methods The electronic databases of Medline, SPORTDiscus and CINAHL were searched from the earliest records to March 2018. Search terms were based on ‘peripheral artery disease’ and ‘exercise’. Studies were included if they involved structured exercise and explicitly reported the number of participants that commenced and completed the programme. Results The search identified 6814 records based on inclusion criteria. Eighty-four full-text records were reviewed in further detail. Out of the 84 studies, there was a total of 122 separate exercise groups, with 64 groups of ‘traditional walking exercise’ and 58 groups of ‘alternative exercise’. Completion and adherence rates for traditional exercise were 80.8% and 77.6%, respectively. Completion and adherence rates for alternative exercise were 86.6% and 85.5%, respectively. Conclusions The use of alternative modalities of exercise, which have been proved to be as effective as traditional exercise, may offer a solution to the poor participation and adherence rates to exercise in this population.
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