Medical Bulletin 24/June/2023

Here are the top medical news for the day:

Even a slight decrease in kidney function raises health risks in young adults.

A study of more than 8 million adults in Ontario, Canada suggests that even a modest loss of kidney function is associated with increased health risks. The study could lead to better approaches to preventing chronic kidney disease and related conditions, particularly in younger adults.

The research team examined ICES health record data from 2008 to 2021 for every Ontario adult aged 18-65 who had at least one blood test for kidney function, but no history of kidney disease. They found that 18% of those in the 18-39 age group had kidney function that was modestly below normal levels, but not low enough to be diagnosed with chronic kidney disease. Individuals in this “grey zone” faced a modestly increased risk of kidney failure, death, and cardiovascular events such as heart attack.

For example, in young adults (age 18-39), a 20-30% loss in kidney function was associated with a 1.4-fold increase in death, a 1.3-fold increase in a cardiac event, and a 6-fold increase in the risk of kidney failure. However, the absolute risk of any of these events was still low at less than 2 per 1000.

Reference: Associations between modest reductions in kidney function and adverse outcomes in young adults: retrospective, population-based cohort study. Junayd Hussain, Nicholas Grubic, Ayub Akbari, Mark Canney, Meghan J Elliott, Pietro Ravani, Peter Tanuseputro, Edward G Clark, Gregory L Hundemer, Tim Ramsay, Navdeep Tangri, Greg A Knoll, Manish M Sood. BMJ 2023;381:e075062

Women with heart rhythm disorder experience faster cognitive decline compared to men

Women with atrial fibrillation progress more rapidly to cognitive impairment and dementia than men with the heart rhythm condition, according to research presented at the scientific congress of the European Society of Cardiology (ESC).

The researchers analyzed the associations between 1) atrial fibrillation and baseline cognitive diagnosis; and 2) atrial fibrillation and time to progression in cognitive diagnosis. Men and women with atrial fibrillation were compared to those without the condition and differences by gender were examined.

Women with atrial fibrillation were three times more likely to have mild cognitive impairment or MCI and dementia at baseline compared to women without atrial fibrillation. During a median follow-up of four years, 30% of participants progressed to a worse stage of cognitive impairment and 21% developed dementia. Women with atrial fibrillation had a higher risk of progressing to a worse stage of cognitive impairment compared to women without atrial fibrillation. Regarding progression to each stage, compared to women without atrial fibrillation, women with the condition were more likely to transition from normal cognition to MCI and from MCI to vascular dementia. The associations between atrial fibrillation and more rapid cognition decline were not statistically significant in men.

Reference: Dr. Kathryn Wood et al, EUROPEAN SOCIETY OF CARDIOLOGY, JOURNAL Alzheimer & Dementia

The Impact of Widely Used Steroids on Cancer Treatments

Sometimes, immunotherapy patients experience side effects that steroids called glucocorticoids (GCs) can treat. GCs are often used to regulate the immune response in conditions such as asthma, Crohn’s disease, and even COVID-19. Yet just how they work is also a mystery.

Now, Cold Spring Harbor Laboratory (CSHL) researchers may be closer to answering both questions. Their new research indicates GCs may indirectly lead to some immunotherapy treatment failures by driving the production of a protein called Cystatin C (CyC). Higher levels of CyC are linked to poorer outcomes of this type of therapy.

For this study, the researchers analyzed a massive genetic dataset from the UK Biobank. How massive? Almost 500,000 volunteers, including patients with cancer and they also reached out to researchers overseas to gather even more patient data.

Reference: Cystatin C is glucocorticoid-responsive, directs the recruitment of Trem2+ macrophages, and predicts failure of cancer immunotherapy, Cell Genomics, DOI 10.1016/j.xgen.2023.100347