New research shows clear association between ACE inhibitors and acute kidney injury

Contact: Genevieve Maul gm349@admin.cam.ac.uk 44-012-237-65542 University of Cambridge

These and similar drugs are the second most prescribed on the NHS

Cambridge scientists have found an association between ACE inhibitors (and similar drugs) and acute kidney injury – a sudden deterioration in kidney function. The research is published today, 06 November, in the journal PLOS ONE.

ACE inhibitors and related drugs known as angiotensin receptor antagonists (ARAs or ‘sartans’) are the second most frequently prescribed medicines in UK clinical practice, and are used to treat common conditions such as high blood pressure, heart disease and kidney problems, especially in people with diabetes. Although concerns about a link between these drugs and kidney function have been raised in the past, the size of the problem had previously been unknown.

The researchers therefore examined the issue using data from the whole of England. They compared the admission rates for acute kidney injury to English hospitals with the prescribing rates of ACE inhibitors and ARAs. From 2007/8 to 2010/11, there was a 52 per cent increase in acute kidney injury admissions. During this same period of time, there was an increase in the number of prescriptions for ACE inhibitors and ARAs issued by GP surgeries by 16 per cent.

The results show a clear association between the increase in prescriptions and the increase in hospital admissions. The researchers estimate that 1636 hospital admissions with acute kidney injury – which has a mortality rate in the UK of around 25-30 per cent of patients – could potentially have been avoided if the prescribing rate had remained at the 2007/8 levels. They estimate that one in seven cases of acute kidney injury could be due to increased prescriptions for these drugs.

This is the first time that a study has been able to assess the extent to which these medications are linked to acute kidney injury. However, the researchers emphasise that we cannot assume that the medication was a direct cause of the acute kidney injury in this study, and no one should stop taking these medications unless advised by their doctor to do so.

Dr Rupert Payne, senior author of the study from the University of Cambridge’s Institute of Public Health, said: “There has been lots of anecdotal evidence suggesting these drugs may be a contributory factor in patients developing acute kidney injury, and this work gives us an opportunity to estimate the size of the problem, as well as making clinicians and patients more aware of the importance of using these drugs in accordance with current clinical guidelines.

“As both a GP and clinical pharmacologist, it also highlights to me the importance of improving our understanding of the risks and benefits of drugs more generally in the real world of clinical practice, away from the artificial setting of clinical trials.”

Dr Laurie Tomlinson, co-author of the study, added: “As a kidney doctor I have looked after many patients with acute kidney injury who were taking these medications prior to becoming unwell and have often worried that the drugs were doing more harm than good. These results are the first to estimate to what extent these drugs may be contributing to the growing incidence of acute kidney injury. Therefore, they represent the first step of research needed to better define when they can be prescribed safely, which should reduce the growing burden of acute kidney injury and save NHS costs and ultimately lives.”

The researchers will next use large primary care databases to examine the association between the drugs and acute kidney injury for individual patients and, in particular, the role of other medication, patient factors (such as the existence of chronic kidney disease) and infections in causing acute kidney injury.

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For additional information please contact:

Genevieve Maul, Office of Communications, University of Cambridge Tel: direct, +44 (0) 1223 765542, +44 (0) 1223 332300 Mob: +44 (0) 7774 017464 Email: Genevieve.maul@admin.cam.ac.uk

Notes to editors:

The paper ‘ACE Inhibitor and Angiotensin Receptor-II Antagonist prescribing and hospital admissions with acute kidney injury: A longitudinal ecological study’ will be published in the 06 November edition of PLOS ONE.

The live article will be available at http://dx.plos.org/10.1371/journal.pone.0078465

Get richer, die younger: study

08   Oct  2013
Paris (AFP)

We all live longer when times are good, right?

Not so, according to a new study which says that in developed countries, the elderly have a higher mortality rate when the economy goes into higher gear.

Even its authors are baffled by the outcome.

The finding was “highly unexpected”, Herbert Rolden from the Leyden Academy on Vitality and Ageing in the Netherlands, told AFP.

In the long term, economic prosperity is credited with lower mortality rates across all age groups — largely due to a drop in old-age mortality.

But the picture changes when you look at short-term economic fluctuations, according to the study which appears in the Journal of Epidemiology and Community Health.

For every rise of one percentage point in a country’s gross domestic product, mortality among 70-74-year-old men rose by 0.36 percent and for women of the same age by 0.18 percent, it found.

Among 40-45-year-olds, the corresponding rise was 0.38 percent for men and 0.16 for women.

The study analysed mortality and economic growth figures from 1950 to 2008 in 19 developed countries — Australia, Japan, New Zealand, the United States and several in Europe.

“Since many developed countries are currently in a recession, one could expect that this has a dampening effect on old age survival,” says the study.

“However, it has been found that annual increases in unemployment, or decreases in gross domestic product (GDP) are associated with LOWER mortality rates.”

A similar, seemingly counterintuitive trend had already been found in younger people.

That had been ascribed to more work stress and traffic accidents due to higher employment in economic boom times.

But such factors are unlikely to hold true for older, retired people, said Rolden.

“We are still in the dark on what really explains the association,” he admitted.

The cause may lie in a change in social structure, with younger relatives and friends working longer and having less time to care for the elderly, according to one, untested, theory.

Another idea pins the blame on air pollution, which increases during economic expansion and is likelier to have more of an effect on frail people.

The team call for more research. Unravelling the mystery could have many benefits, they say.

 

http://www.afp.com/en/news/topstories/get-richer-die-younger-study

Thousands of unexplained and unexpected deaths among elderly revealed in leaked Government analysis

Labour calls for “urgent investigation” amid fears more old people are dying because of cuts to public funding

Adam Withnall, Charlie Cooper

Thursday, 25 July 2013

A leaked report has revealed that thousands more elderly people died in the past year than the Government had expected, particularly in poorer areas of the country.

Labour called for an “urgent investigation” into the findings, and said the Coalition needs to “be honest” about whether cuts to social care budgets over the past three years have contributed to the spike in mortality rates.

The increase in deaths has been most striking amongst women aged 85 and over, and that rise is the driving force behind alarming statistics which suggest around 600 more people than expected are dying every week, the analysis revealed.

The document, made public by the Health Service Journal, reveals that number-crunchers at Public Health England have been “tracking the mortality summaries to determine if last year’s unwelcome increase in mortality in older age may be continuing.”

The report found that there has been, “if anything, a further deterioration in mortality”.

In a letter to the health secretary Jeremy Hunt, seen by The Independent, Mr Burnham has called for an “urgent” investigation into the figures.

Official projections estimated there would be around 455,000 deaths in England between the summers of 2012 and 2013. The actual number was almost 25,000 greater than that, an increase of around 5 per cent on top of Office of National Statistics expectations.

The research also broke down the numbers to look specifically at the so-called “Spearhead authorities” – the areas of the country which fare poorest for life expectancy and mortality rates.

It noted that: “Worryingly, female 75-and-over mortality trends appear to have been worse in the Spearhead areas.” There was even a clearly-observable tailing-off of life expectancy in these areas.

Although the reason for the increase remains unknown, some experts have already suggested that cuts to local government social care budgets may be to blame.

Mr Burnham writes: “As you will be aware, the Government has made significant cuts to local authority budgets that pay for social care, which have seen £1.8 billion taken on out of adult social care since 2010, and it is clear that families need immediate action to improve the care system. Are you satisfied that all social care departments have sufficient funding to prevent older people being placed at serious risk?”

Public Health England acknowledged it had carried out the analysis, and in a recent report, which it did publish, it noted the severity of influenza and other viruses over the most recent winter, and observed: “The number of deaths during 2012/13 was high.”

But it could not yet offer a definitive explanation as to why mortality rates rose across the board. A spokesperson for Public Health England said: “We are currently undertaking further work to understand why there was a rise in mortality rates during the earlier months of this year and the causes behind this.”

They added that weekly rates are currently down to within levels expected for this time of year.

Speaking to the Health Service Journal, professor of human geography Danny Dorling said he believed the recent cuts could be to blame for the increase in deaths among the elderly.

He said: “Elevated mortality amongst the elderly is often about people dying two or five years earlier than would be expected given recent rates.

“It is possible that cuts or freezes to services have a particular bad effect on this group – even cuts and freezes that might appear very minor – because the group is so vulnerable.

“Increased anxiety resulting from knowing you might have to move home or even have no home has long been known to be very damaging for the health of very elderly people. The timing of this recent rise in mortality coincides with the crisis in the funding of a large number of care homes.

“It is worth thinking… who gets left a little longer in A&E than they were left when there was funding growing year on year. Who is most neglected when the carer visiting them has only 15 minutes when they used to have 30?”

http://www.independent.co.uk/news/uk/home-news/thousands-of-unexplained-and-unexpected-deaths-among-elderly-revealed-in-leaked-government-analysis-8731985.html#

 

Alcohol provides protective effect, reduces mortality substantial

Contact: Sherri McGinnis González
smcginn@uic.edu
312-996-8277
University of Illinois at Chicago

Injured patients were less likely to die in the hospital if they had alcohol in their blood, according to a study from the University of Illinois at Chicago School of Public Health — and the more alcohol, the more likely they were to survive.

“This study is not encouraging people to drink,” cautions UIC injury epidemiologist Lee Friedman, author of the study, which will be published in the December issue of the journal Alcohol and is now online.

That’s because alcohol intoxication — even minor inebriation — is associated with an increased risk of being injured, he says.

“However, after an injury, if you are intoxicated there seems to be a pretty substantial protective effect,” said Friedman, who is assistant professor of environmental and occupational health sciences at UIC.

“The more alcohol you have in your system, the more the protective effect.”

Friedman analyzed Illinois Trauma Registry data for 190,612 patients treated at trauma centers between 1995 and 2009 who were tested for blood alcohol content, which ranged from zero to 0.5 percent at the time they were admitted to the trauma unit.

Of that group, 6,733 died in the hospital.

The study examined the relationship of alcohol dosage to in-hospital mortality following traumatic injuries such as fractures, internal injuries and open wounds. Alcohol benefited patients across the range of injuries, with burns as the only exception.

The benefit extended from the lowest blood alcohol concentration (below 0.1 percent) through the highest levels (up to 0.5 percent).

“At the higher levels of blood alcohol concentration, there was a reduction of almost 50 percent in hospital mortality rates,” Friedman said. “This protective benefit persists even after taking into account injury severity and other factors known to be strongly associated with mortality following an injury.”

Very few studies have looked at the physiological mechanisms related to alcohol and injury in humans. Some animal studies have shown a neuro-protective effect from alcohol, but the findings of most animal and previous human studies often contradict one another because of different study criteria.

Friedman says it’s important for clinicians to recognize intoxicated patients but also to understand how alcohol might affect the course of treatment. Further research into the biomechanism of the protective phenomenon is needed, he said.

If the mechanism behind the protective effect were understood, “we could then treat patients post-injury, either in the field or when they arrive at the hospital, with drugs that mimic alcohol,” he said.

 

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[Photos available for download: http://newsphoto.lib.uic.edu/v/friedman].

UIC ranks among the nation’s leading research universities and is Chicago’s largest university with 27,500 students, 12,000 faculty and staff, 15 colleges and the state’s major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world. For more information about UIC, please visit www.uic.edu.

Suicide, Not Car Crashes, #1 Cause of Injury Death

By
WebMD Health News

Sept. 20, 2012 — Suicide has overtaken car crashes as the leading cause of injury-related deaths in the U.S.

While public health efforts have curbed the number of car fatalities by 25% over the last decade, a new study shows suicide deaths rose by 15% during the same period.

In addition, deaths from unintentional poisoning and falls have also increased dramatically in recent years.

Researchers found deaths caused by accidental poisoning and falls increased by 128% and 71%, respectively.

“Comprehensive and sustained traffic safety measures have apparently substantially diminished the motor vehicle traffic mortality rate, and similar attention and resources are needed to reduce the burden of other injury,” researcher Ian Rockett, PhD, MPH of West Virginia University and colleagues write in the American Journal of Public Health.

Causes of Death Evolving

In the study, researchers looked at cause of death data from the National Center for Health Statistics from 2000 to 2009.

“Contrasting with disease mortality, the injury mortality rate trended upward during most of that decade,” write the researchers.

The top five leading causes of injury-related deaths were:

  1. Suicide
  2. Motor vehicle crashes
  3. Poisoning
  4. Falls
  5. Homicide

Researchers say the findings demonstrate that suicide is now a global public health issue.

“Our finding that suicide now accounts for more deaths than do traffic crashes echoes similar findings for the European Union, Canada, and China,” they write.

Researchers say deaths from unintentional poisoning rose, in part, because of a sharp rise in prescription drug overdoses.

For example, drug overdoses accounted for 75% of unintentional poisoning deaths in 2008, with prescription drugs accounting for 74% of those overdoses.

The study also showed that women had a lower injury-related death rate than men. Blacks and Hispanics had a lower rate of car fatalities and suicides, and a higher rate of homicides than whites.

http://www.webmd.com/mental-health/news/20120920/suicide-top-cause-of-injury-death

Study shows no evidence of a mortality benefit to PSA screening

Men enrolled in the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial had no evidence of a mortality benefit compared to a control group of men undergoing usual care, according to a study published online Jan. 6 in the Journal of the National Cancer Institute.

The Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) Trial is a multi-center, two-arm trial, which began enrollment in November 1993 with follow-up through December 2009, and was designed to evaluate the effect of screening on these specific cancers. The enrollees were aged 55-74 and had no previous personal history of these cancers. Men in the intervention arm underwent annual PSA testing for six years and annual digital rectal examination for four years, while those in the control arm received their usual medical care, which for some men included screening. A previous report of PLCO results through ten years was criticized for being too short of a follow-up period.

To determine longer-range outcomes among the men enrolled in PLCO, Gerald L. Andriole, M.D., of Washington University School of Medicine in St. Louis, and colleagues, examined outcomes of the men through 13 years. The researchers found a statistically significant 12% relative increase in the incidence rate of prostate cancer, and a non-statistically significant decrease in the incidence of high-grade prostate cancer in the intervention arm compared to the control arm, but no difference in mortality between the two arms.  In addition, there was no apparent differential effect of screening by age category, pre-trial PSA testing, or co-morbidity. 

The authors write, “Improvements in prostate cancer treatment are probably at least in part responsible for declining prostate cancer mortality rates. Even if life is only prolonged by therapy, the opportunities for competing causes of death increase, especially among older men.”

The authors also point out that of the 4250 prostate cancer case patients diagnosed in the intervention arm, 455 (10.7%) died of causes other than the cancer types studied; in the control arm, 3815 men were diagnosed with prostate cancer of whom 377 (9.9%) died, also of other causes. “Thus, a higher percentage of deaths from other causes rather than a deficit occurred among the prostate cancer patients diagnosed in the intervention arm, an indication of the over-diagnosis associated with PSA detection,” the authors write.

The researchers plan to again update the mortality findings from the prostate component of the PLCO after follow-up data through 15 years becomes available.

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Contact: Philip C. Prorok, prorokp@mail.nih.gov