Nephrology

BERLIN – Ankylosing spondylitis patients are at sharply increased risk of various forms of acute and chronic renal comorbidity, according to the first population-based study to examine the issue.

The explanation for this elevated renal risk is likely twofold: the well-documented nephrotoxic effects of long-term therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), the first-line treatment mainstay in ankylosing spondylitis (AS); and extra-articular manifestations of the disease process itself, according to Adrian R. Levy, Ph.D., of the research firm Oxford Outcomes in Vancouver, B.C.

He presented a retrospective cohort study utilizing Quebec’s administrative physician-billing database. He identified 8,616 individuals with AS in the Canadian province during 1996-2006, and determined their rate of diagnosed renal comorbidities. Then he compared the AS group to a randomly generated sample of 1% of the general Quebec population without AS.

Overall, diagnosed renal complications were present in 3.4% of men and 2.1% of women with AS, compared with 2% and 1.6%, respectively, in the general population. Age- and gender-adjusted prevalence ratios demonstrated significantly excess risks of various forms of renal disease in the AS population, Dr. Levy said at the annual European Congress of Rheumatology.

The magnitude of the increased risk was greatest in younger patients with AS. For example, the prevalence ratio for any of the renal conditions under study was 2.4-fold greater among 20- to 39-year-old men with AS than controls, but only 1.5-fold greater in AS patients over age 60.

The clinical implications are clear, Dr. Levy emphasized: Close and careful monitoring for renal complications is de rigueur in individuals with AS, especially if they are on long-term, full-dose, continuous NSAID therapy.

The study was funded by Abbott.

BERLIN – Ankylosing spondylitis patients are at sharply increased risk of various forms of acute and chronic renal comorbidity, according to the first population-based study to examine the issue.

The explanation for this elevated renal risk is likely twofold: the well-documented nephrotoxic effects of long-term therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), the first-line treatment mainstay in ankylosing spondylitis (AS); and extra-articular manifestations of the disease process itself, according to Adrian R. Levy, Ph.D., of the research firm Oxford Outcomes in Vancouver, B.C.

He presented a retrospective cohort study utilizing Quebec’s administrative physician-billing database. He identified 8,616 individuals with AS in the Canadian province during 1996-2006, and determined their rate of diagnosed renal comorbidities. Then he compared the AS group to a randomly generated sample of 1% of the general Quebec population without AS.

Overall, diagnosed renal complications were present in 3.4% of men and 2.1% of women with AS, compared with 2% and 1.6%, respectively, in the general population. Age- and gender-adjusted prevalence ratios demonstrated significantly excess risks of various forms of renal disease in the AS population, Dr. Levy said at the annual European Congress of Rheumatology.

The magnitude of the increased risk was greatest in younger patients with AS. For example, the prevalence ratio for any of the renal conditions under study was 2.4-fold greater among 20- to 39-year-old men with AS than controls, but only 1.5-fold greater in AS patients over age 60.

The clinical implications are clear, Dr. Levy emphasized: Close and careful monitoring for renal complications is de rigueur in individuals with AS, especially if they are on long-term, full-dose, continuous NSAID therapy.

The study was funded by Abbott.

BERLIN – Ankylosing spondylitis patients are at sharply increased risk of various forms of acute and chronic renal comorbidity, according to the first population-based study to examine the issue.

The explanation for this elevated renal risk is likely twofold: the well-documented nephrotoxic effects of long-term therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), the first-line treatment mainstay in ankylosing spondylitis (AS); and extra-articular manifestations of the disease process itself, according to Adrian R. Levy, Ph.D., of the research firm Oxford Outcomes in Vancouver, B.C.

He presented a retrospective cohort study utilizing Quebec’s administrative physician-billing database. He identified 8,616 individuals with AS in the Canadian province during 1996-2006, and determined their rate of diagnosed renal comorbidities. Then he compared the AS group to a randomly generated sample of 1% of the general Quebec population without AS.

Overall, diagnosed renal complications were present in 3.4% of men and 2.1% of women with AS, compared with 2% and 1.6%, respectively, in the general population. Age- and gender-adjusted prevalence ratios demonstrated significantly excess risks of various forms of renal disease in the AS population, Dr. Levy said at the annual European Congress of Rheumatology.

The magnitude of the increased risk was greatest in younger patients with AS. For example, the prevalence ratio for any of the renal conditions under study was 2.4-fold greater among 20- to 39-year-old men with AS than controls, but only 1.5-fold greater in AS patients over age 60.

The clinical implications are clear, Dr. Levy emphasized: Close and careful monitoring for renal complications is de rigueur in individuals with AS, especially if they are on long-term, full-dose, continuous NSAID therapy.

The study was funded by Abbott.

CHICAGO – An experimental therapy is closing in on a new target in metastatic castration-resistant prostate cancer: heat shock protein 27.

OGX-427 is a second-generation antisense oligonucleotide that is designed to reduce production of heat shock protein 27 (Hsp27), a cell-survival protein that is highly expressed in many cancers including prostate and associated with poorer prognosis. Hsp27 increases after castration therapy as a stress survival response and has been shown to be highly overexpressed in castration-resistant prostate cancer tissues, Dr. Kim N. Chi explained at the annual meeting of the American Society of Clinical Oncology.

In phase I studies, OGX-427 decreased tumor markers in patients with prostate and ovarian cancer and measurable disease by more than 15% in roughly one-third of patients. The drug has a prolonged half-life of about 10 days, but no dose-limiting toxicities were identified. Mostly the adverse events were dose-dependent, grade 1-2 infusion reactions, said Dr. Chi, chair of the genitourinary group and medical director of clinical trials at the Vancouver (British Columbia) Prostate Centre–BC Cancer Agency.

The goal of the current phase II trial was to improve the 12-week progression-free rate in chemotherapy naive men with metastatic castration-resistant prostate cancer. Patients were randomized to twice-daily prednisone 5 mg alone or with OGX-427 600 mg IV in three loading doses in the first week followed by 1,000 mg weekly for up to 24 weeks for patients with a best response of stable disease or continuously for responders.

The current analysis includes 42 of the 72 planned patients. Because of the frequent use of corticosteroids to manage infusion reactions, the control arm was added to isolate out the effect of OGX-427, he said.

The 22 patients in the OGX-427 arm were slightly younger than the 20 controls were (median 66 years vs. 72 years), but the OGX-427 arm had more patients with lung metastases (14% vs. 0%), elevated lactate dehydrogenase (36% vs. 15), elevated alkaline phosphatase (32% vs. 10%), prior prednisone therapy (23% vs. 15%) and 5 or more circulating tumor cells/7.5 mL of blood (96% vs. 90%), Dr. Chi pointed out.

Median treatment duration was 24 weeks with OGX-427 and 14 weeks with prednisone alone. In all, 93% of controls came off treatment because of disease progression vs. only 31% on OGX-427, although 25% also did so because of adverse events.

At 12 weeks, 71% of patients on OGX-427 were progression free, compared with 40% on prednisone alone, he said.

A prostate-specific antigen decline of 50% or more occurred in 50% and 20%, respectively.

The objective response rate was 44%, including one complete response and three partial responses, among nine evaluable OGX-427 patients vs. 0% among 12 evaluable controls.

Sixty percent of OGX-427 patients have had either a decrease of more than 5 circulating tumor cells/7.5 mL or maintained a less 5 cell/7.5 mL count, compared with 41% of controls having a similar decline.

Treatment-related events have been predominantly infusion related and were described as a flulike illness that occurs mainly in the first couple of infusions and includes grade 1/2 chills (55%), diarrhea (41%), nausea (32%), flushing (23%), vomiting (23%) and pyrexia (18%).

"Patients tend to build tolerance and they [events] are brief and self-limited," Dr. Chi said.

Grade 3/4 lymphopenia was more common with OGX-427 at 18% vs. 10% among controls but did not result in any infectious sequelae.

"These preliminary data identify Hsp27 as a novel therapeutic target and supports continued evaluation of OGX-427 for patients with castration-resistant prostate cancer," he concluded.

Discussant Dr. Karim Fizazi, with Institut Gustave Roussy, Villejuif, France, said he was surprised by the "quite-high" adverse event rates for chills, nausea, and diarrhea, but that fortunately they were mostly grade 1 and 2. He said the biological background for targeting Hsp27 is very strong and called the preliminary evidence of clinical activity exciting.

"If these data are confirmed, which I don’t really doubt they will, what will be the phase III development path for such IV [intravenous] weekly drug infusions in the context of all the drugs we now have in prostate cancer?" he asked.

The current trial is ongoing, with a phase II trial of OGX-427 plus abiraterone (Zytiga) in castration-resistant prostate cancer to be initiated later this year, according to OncoGenex Pharmaceuticals. The company is also developing the targeted anticlusterin molecule OGX-001 to be evaluated later this year in two phase III trials in castration-resistant disease.

Dr. Chi reports research funding from OncoGenex Pharmaceuticals, which is developing OGX-427. Dr. Fizazi reports a consultant or advisory role with OncoGenex and Exelixis.

CHICAGO – An experimental therapy is closing in on a new target in metastatic castration-resistant prostate cancer: heat shock protein 27.

OGX-427 is a second-generation antisense oligonucleotide that is designed to reduce production of heat shock protein 27 (Hsp27), a cell-survival protein that is highly expressed in many cancers including prostate and associated with poorer prognosis. Hsp27 increases after castration therapy as a stress survival response and has been shown to be highly overexpressed in castration-resistant prostate cancer tissues, Dr. Kim N. Chi explained at the annual meeting of the American Society of Clinical Oncology.

In phase I studies, OGX-427 decreased tumor markers in patients with prostate and ovarian cancer and measurable disease by more than 15% in roughly one-third of patients. The drug has a prolonged half-life of about 10 days, but no dose-limiting toxicities were identified. Mostly the adverse events were dose-dependent, grade 1-2 infusion reactions, said Dr. Chi, chair of the genitourinary group and medical director of clinical trials at the Vancouver (British Columbia) Prostate Centre–BC Cancer Agency.

The goal of the current phase II trial was to improve the 12-week progression-free rate in chemotherapy naive men with metastatic castration-resistant prostate cancer. Patients were randomized to twice-daily prednisone 5 mg alone or with OGX-427 600 mg IV in three loading doses in the first week followed by 1,000 mg weekly for up to 24 weeks for patients with a best response of stable disease or continuously for responders.

The current analysis includes 42 of the 72 planned patients. Because of the frequent use of corticosteroids to manage infusion reactions, the control arm was added to isolate out the effect of OGX-427, he said.

The 22 patients in the OGX-427 arm were slightly younger than the 20 controls were (median 66 years vs. 72 years), but the OGX-427 arm had more patients with lung metastases (14% vs. 0%), elevated lactate dehydrogenase (36% vs. 15), elevated alkaline phosphatase (32% vs. 10%), prior prednisone therapy (23% vs. 15%) and 5 or more circulating tumor cells/7.5 mL of blood (96% vs. 90%), Dr. Chi pointed out.

Median treatment duration was 24 weeks with OGX-427 and 14 weeks with prednisone alone. In all, 93% of controls came off treatment because of disease progression vs. only 31% on OGX-427, although 25% also did so because of adverse events.

At 12 weeks, 71% of patients on OGX-427 were progression free, compared with 40% on prednisone alone, he said.

A prostate-specific antigen decline of 50% or more occurred in 50% and 20%, respectively.

The objective response rate was 44%, including one complete response and three partial responses, among nine evaluable OGX-427 patients vs. 0% among 12 evaluable controls.

Sixty percent of OGX-427 patients have had either a decrease of more than 5 circulating tumor cells/7.5 mL or maintained a less 5 cell/7.5 mL count, compared with 41% of controls having a similar decline.

Treatment-related events have been predominantly infusion related and were described as a flulike illness that occurs mainly in the first couple of infusions and includes grade 1/2 chills (55%), diarrhea (41%), nausea (32%), flushing (23%), vomiting (23%) and pyrexia (18%).

"Patients tend to build tolerance and they [events] are brief and self-limited," Dr. Chi said.

Grade 3/4 lymphopenia was more common with OGX-427 at 18% vs. 10% among controls but did not result in any infectious sequelae.

"These preliminary data identify Hsp27 as a novel therapeutic target and supports continued evaluation of OGX-427 for patients with castration-resistant prostate cancer," he concluded.

Discussant Dr. Karim Fizazi, with Institut Gustave Roussy, Villejuif, France, said he was surprised by the "quite-high" adverse event rates for chills, nausea, and diarrhea, but that fortunately they were mostly grade 1 and 2. He said the biological background for targeting Hsp27 is very strong and called the preliminary evidence of clinical activity exciting.

"If these data are confirmed, which I don’t really doubt they will, what will be the phase III development path for such IV [intravenous] weekly drug infusions in the context of all the drugs we now have in prostate cancer?" he asked.

The current trial is ongoing, with a phase II trial of OGX-427 plus abiraterone (Zytiga) in castration-resistant prostate cancer to be initiated later this year, according to OncoGenex Pharmaceuticals. The company is also developing the targeted anticlusterin molecule OGX-001 to be evaluated later this year in two phase III trials in castration-resistant disease.

Dr. Chi reports research funding from OncoGenex Pharmaceuticals, which is developing OGX-427. Dr. Fizazi reports a consultant or advisory role with OncoGenex and Exelixis.

CHICAGO – An experimental therapy is closing in on a new target in metastatic castration-resistant prostate cancer: heat shock protein 27.

OGX-427 is a second-generation antisense oligonucleotide that is designed to reduce production of heat shock protein 27 (Hsp27), a cell-survival protein that is highly expressed in many cancers including prostate and associated with poorer prognosis. Hsp27 increases after castration therapy as a stress survival response and has been shown to be highly overexpressed in castration-resistant prostate cancer tissues, Dr. Kim N. Chi explained at the annual meeting of the American Society of Clinical Oncology.

In phase I studies, OGX-427 decreased tumor markers in patients with prostate and ovarian cancer and measurable disease by more than 15% in roughly one-third of patients. The drug has a prolonged half-life of about 10 days, but no dose-limiting toxicities were identified. Mostly the adverse events were dose-dependent, grade 1-2 infusion reactions, said Dr. Chi, chair of the genitourinary group and medical director of clinical trials at the Vancouver (British Columbia) Prostate Centre–BC Cancer Agency.

The goal of the current phase II trial was to improve the 12-week progression-free rate in chemotherapy naive men with metastatic castration-resistant prostate cancer. Patients were randomized to twice-daily prednisone 5 mg alone or with OGX-427 600 mg IV in three loading doses in the first week followed by 1,000 mg weekly for up to 24 weeks for patients with a best response of stable disease or continuously for responders.

The current analysis includes 42 of the 72 planned patients. Because of the frequent use of corticosteroids to manage infusion reactions, the control arm was added to isolate out the effect of OGX-427, he said.

The 22 patients in the OGX-427 arm were slightly younger than the 20 controls were (median 66 years vs. 72 years), but the OGX-427 arm had more patients with lung metastases (14% vs. 0%), elevated lactate dehydrogenase (36% vs. 15), elevated alkaline phosphatase (32% vs. 10%), prior prednisone therapy (23% vs. 15%) and 5 or more circulating tumor cells/7.5 mL of blood (96% vs. 90%), Dr. Chi pointed out.

Median treatment duration was 24 weeks with OGX-427 and 14 weeks with prednisone alone. In all, 93% of controls came off treatment because of disease progression vs. only 31% on OGX-427, although 25% also did so because of adverse events.

At 12 weeks, 71% of patients on OGX-427 were progression free, compared with 40% on prednisone alone, he said.

A prostate-specific antigen decline of 50% or more occurred in 50% and 20%, respectively.

The objective response rate was 44%, including one complete response and three partial responses, among nine evaluable OGX-427 patients vs. 0% among 12 evaluable controls.

Sixty percent of OGX-427 patients have had either a decrease of more than 5 circulating tumor cells/7.5 mL or maintained a less 5 cell/7.5 mL count, compared with 41% of controls having a similar decline.

Treatment-related events have been predominantly infusion related and were described as a flulike illness that occurs mainly in the first couple of infusions and includes grade 1/2 chills (55%), diarrhea (41%), nausea (32%), flushing (23%), vomiting (23%) and pyrexia (18%).

"Patients tend to build tolerance and they [events] are brief and self-limited," Dr. Chi said.

Grade 3/4 lymphopenia was more common with OGX-427 at 18% vs. 10% among controls but did not result in any infectious sequelae.

"These preliminary data identify Hsp27 as a novel therapeutic target and supports continued evaluation of OGX-427 for patients with castration-resistant prostate cancer," he concluded.

Discussant Dr. Karim Fizazi, with Institut Gustave Roussy, Villejuif, France, said he was surprised by the "quite-high" adverse event rates for chills, nausea, and diarrhea, but that fortunately they were mostly grade 1 and 2. He said the biological background for targeting Hsp27 is very strong and called the preliminary evidence of clinical activity exciting.

"If these data are confirmed, which I don’t really doubt they will, what will be the phase III development path for such IV [intravenous] weekly drug infusions in the context of all the drugs we now have in prostate cancer?" he asked.

The current trial is ongoing, with a phase II trial of OGX-427 plus abiraterone (Zytiga) in castration-resistant prostate cancer to be initiated later this year, according to OncoGenex Pharmaceuticals. The company is also developing the targeted anticlusterin molecule OGX-001 to be evaluated later this year in two phase III trials in castration-resistant disease.

Dr. Chi reports research funding from OncoGenex Pharmaceuticals, which is developing OGX-427. Dr. Fizazi reports a consultant or advisory role with OncoGenex and Exelixis.

The risk of myocardial infarction is just as high in patients who have chronic kidney disease as in those who have diabetes, and their subsequent mortality is even higher, according to a report published online June 19 in the Lancet.

"Our research suggests that there is a strong case for considering CKD to be a coronary heart disease risk equivalent," as is the case with diabetes. This means that people with CKD, like diabetes patients, "are at a comparable risk of coronary events to those who have previously had a heart attack," Dr. Marcello Tonelli of the departments of medicine and public health sciences at the University of Alberta, Edmonton, said in a press statement accompanying the release of the report.

Dr. Tonelli and his associates used information from two large, population-based cohorts – the Alberta Kidney Disease Network and the National Health and Nutrition Examination Survey (NHANES) 2003-2006 – to compare the risks of hospitalization for MI among adults with previous MI, adults with diabetes mellitus but no kidney disease, and adults with CKD but no diabetes. The 1,268,029 study subjects were followed for a median of 4 years, during which time 1% (11,340) were admitted for MI.

Compared with healthy adults, the unadjusted rate of MI during follow-up was highest in people with a history of MI (18.5 per 1,000 person-years) but was also significantly elevated in those with diabetes (5.4 per 1,000 person-years) or CKD (6.9 per 1,000 person-years).

In addition, the proportion of patients who died within 30 days of admission for MI was highest for patients with CKD (14%) but also was significantly elevated for patients with diabetes (8%) and those with a history of MI (10%).

These findings suggest that "arguments supporting inclusion of diabetes in the highest risk category for CHD seem also to apply to people with CKD," the investigators said (Lancet 2012 June 19 [doi:10.1016/S0140-6736(12)60572-8]).

In exploratory analyses in which the data were adjusted to account for patient age, socioeconomic status, and comorbidities, the MI rate decreased in those with CKD but not in those with diabetes. This suggests that demographic and clinical characteristics – most notably, old age – are responsible for much of the cardiovascular risk associated with CKD, they noted.

The study findings also imply that patients with CKD, like those with diabetes, would benefit from lipid-lowering treatment.

This study was supported by the Alberta Heritage Foundation for Medical Research, Alberta Health and Wellness, the University of Alberta, and the University of Calgary. Dr. Tonelli reported ties to Pfizer and Merck, and one of his associates reported ties to Amgen.

The risk of myocardial infarction is just as high in patients who have chronic kidney disease as in those who have diabetes, and their subsequent mortality is even higher, according to a report published online June 19 in the Lancet.

"Our research suggests that there is a strong case for considering CKD to be a coronary heart disease risk equivalent," as is the case with diabetes. This means that people with CKD, like diabetes patients, "are at a comparable risk of coronary events to those who have previously had a heart attack," Dr. Marcello Tonelli of the departments of medicine and public health sciences at the University of Alberta, Edmonton, said in a press statement accompanying the release of the report.

Dr. Tonelli and his associates used information from two large, population-based cohorts – the Alberta Kidney Disease Network and the National Health and Nutrition Examination Survey (NHANES) 2003-2006 – to compare the risks of hospitalization for MI among adults with previous MI, adults with diabetes mellitus but no kidney disease, and adults with CKD but no diabetes. The 1,268,029 study subjects were followed for a median of 4 years, during which time 1% (11,340) were admitted for MI.

Compared with healthy adults, the unadjusted rate of MI during follow-up was highest in people with a history of MI (18.5 per 1,000 person-years) but was also significantly elevated in those with diabetes (5.4 per 1,000 person-years) or CKD (6.9 per 1,000 person-years).

In addition, the proportion of patients who died within 30 days of admission for MI was highest for patients with CKD (14%) but also was significantly elevated for patients with diabetes (8%) and those with a history of MI (10%).

These findings suggest that "arguments supporting inclusion of diabetes in the highest risk category for CHD seem also to apply to people with CKD," the investigators said (Lancet 2012 June 19 [doi:10.1016/S0140-6736(12)60572-8]).

In exploratory analyses in which the data were adjusted to account for patient age, socioeconomic status, and comorbidities, the MI rate decreased in those with CKD but not in those with diabetes. This suggests that demographic and clinical characteristics – most notably, old age – are responsible for much of the cardiovascular risk associated with CKD, they noted.

The study findings also imply that patients with CKD, like those with diabetes, would benefit from lipid-lowering treatment.

This study was supported by the Alberta Heritage Foundation for Medical Research, Alberta Health and Wellness, the University of Alberta, and the University of Calgary. Dr. Tonelli reported ties to Pfizer and Merck, and one of his associates reported ties to Amgen.

The risk of myocardial infarction is just as high in patients who have chronic kidney disease as in those who have diabetes, and their subsequent mortality is even higher, according to a report published online June 19 in the Lancet.

"Our research suggests that there is a strong case for considering CKD to be a coronary heart disease risk equivalent," as is the case with diabetes. This means that people with CKD, like diabetes patients, "are at a comparable risk of coronary events to those who have previously had a heart attack," Dr. Marcello Tonelli of the departments of medicine and public health sciences at the University of Alberta, Edmonton, said in a press statement accompanying the release of the report.

Dr. Tonelli and his associates used information from two large, population-based cohorts – the Alberta Kidney Disease Network and the National Health and Nutrition Examination Survey (NHANES) 2003-2006 – to compare the risks of hospitalization for MI among adults with previous MI, adults with diabetes mellitus but no kidney disease, and adults with CKD but no diabetes. The 1,268,029 study subjects were followed for a median of 4 years, during which time 1% (11,340) were admitted for MI.

Compared with healthy adults, the unadjusted rate of MI during follow-up was highest in people with a history of MI (18.5 per 1,000 person-years) but was also significantly elevated in those with diabetes (5.4 per 1,000 person-years) or CKD (6.9 per 1,000 person-years).

In addition, the proportion of patients who died within 30 days of admission for MI was highest for patients with CKD (14%) but also was significantly elevated for patients with diabetes (8%) and those with a history of MI (10%).

These findings suggest that "arguments supporting inclusion of diabetes in the highest risk category for CHD seem also to apply to people with CKD," the investigators said (Lancet 2012 June 19 [doi:10.1016/S0140-6736(12)60572-8]).

In exploratory analyses in which the data were adjusted to account for patient age, socioeconomic status, and comorbidities, the MI rate decreased in those with CKD but not in those with diabetes. This suggests that demographic and clinical characteristics – most notably, old age – are responsible for much of the cardiovascular risk associated with CKD, they noted.

The study findings also imply that patients with CKD, like those with diabetes, would benefit from lipid-lowering treatment.

This study was supported by the Alberta Heritage Foundation for Medical Research, Alberta Health and Wellness, the University of Alberta, and the University of Calgary. Dr. Tonelli reported ties to Pfizer and Merck, and one of his associates reported ties to Amgen.

Approximately one in eight Alzheimer’s disease patients who develop delirium while hospitalized will suffer at least one adverse outcome, based on data from 771 adults. The findings were published in Annals of Internal Medicine on June 18.

Previous studies have shown that delirium can increase the rate of cognitive decline in AD patients, but the impact of hospitalization and delirium has not been well studied, said Dr. Tamara G. Fong of the Aging Brain Center, Boston, and her colleagues. Adults with Alzheimer’s disease (AD) are three times more likely to be hospitalized than are those without AD, the researchers noted.

To assess the adverse outcomes of death, institutionalization, and cognitive decline associated with hospitalization and delirium, Dr. Fong and her colleagues followed 771 community-dwelling adults aged 65 years and older with a clinical diagnosis of AD. The mean follow-up was 2 years, and outcomes were assessed at 1 year after an initial hospitalization. A total of 367 individuals (48%) were hospitalized, and 194 of these patients (25%) developed delirium while hospitalized (Ann. Intern. Med. 2012;156:848-56).

At least one adverse outcome occurred in 32% of nonhospitalized patients, 55% of hospitalized patients without delirium, and 79% of hospitalized patients with delirium.

In the hospitalized patients, 6% of deaths, 15% of institutionalizations, and 21% of cases of cognitive decline were associated with delirium, the researchers said.

Death occurred in 15% of hospitalized patients with delirium, compared with 9% of hospitalized patients without delirium and 2% of nonhospitalized patients.

The hospitalized patients with delirium had an increased risk for death, institutionalization, and cognitive decline, compared with the other groups, with adjusted risk ratios of 5.4, 9.3, and 1.6, respectively. Hospitalized patients with no delirium had a slightly smaller increase in the risk of death (adjusted risk ratio 4.7) and institutionalization (adjusted risk ratio 6.9).

The mean age of the patients was 77 years, 57% were women, and 95% were white.

The results were limited by several factors, including the observational nature of the study and the incomplete data on the cognitive outcome and functional status of some patients, the researchers wrote. But the findings show "the important and incremental associations of hospitalization and delirium with 1-year outcomes," they said.

Additional research is needed to determine whether preventing hospitalization and delirium in AD patients can reduce their risk for death, institutionalization, and cognitive decline, they noted.

Dr. Fong had no financial conflicts to disclose. The study was funded by the National Institute on Aging and the Massachusetts Alzheimer’s Disease Research Center.

Approximately one in eight Alzheimer’s disease patients who develop delirium while hospitalized will suffer at least one adverse outcome, based on data from 771 adults. The findings were published in Annals of Internal Medicine on June 18.

Previous studies have shown that delirium can increase the rate of cognitive decline in AD patients, but the impact of hospitalization and delirium has not been well studied, said Dr. Tamara G. Fong of the Aging Brain Center, Boston, and her colleagues. Adults with Alzheimer’s disease (AD) are three times more likely to be hospitalized than are those without AD, the researchers noted.

To assess the adverse outcomes of death, institutionalization, and cognitive decline associated with hospitalization and delirium, Dr. Fong and her colleagues followed 771 community-dwelling adults aged 65 years and older with a clinical diagnosis of AD. The mean follow-up was 2 years, and outcomes were assessed at 1 year after an initial hospitalization. A total of 367 individuals (48%) were hospitalized, and 194 of these patients (25%) developed delirium while hospitalized (Ann. Intern. Med. 2012;156:848-56).

At least one adverse outcome occurred in 32% of nonhospitalized patients, 55% of hospitalized patients without delirium, and 79% of hospitalized patients with delirium.

In the hospitalized patients, 6% of deaths, 15% of institutionalizations, and 21% of cases of cognitive decline were associated with delirium, the researchers said.

Death occurred in 15% of hospitalized patients with delirium, compared with 9% of hospitalized patients without delirium and 2% of nonhospitalized patients.

The hospitalized patients with delirium had an increased risk for death, institutionalization, and cognitive decline, compared with the other groups, with adjusted risk ratios of 5.4, 9.3, and 1.6, respectively. Hospitalized patients with no delirium had a slightly smaller increase in the risk of death (adjusted risk ratio 4.7) and institutionalization (adjusted risk ratio 6.9).

The mean age of the patients was 77 years, 57% were women, and 95% were white.

The results were limited by several factors, including the observational nature of the study and the incomplete data on the cognitive outcome and functional status of some patients, the researchers wrote. But the findings show "the important and incremental associations of hospitalization and delirium with 1-year outcomes," they said.

Additional research is needed to determine whether preventing hospitalization and delirium in AD patients can reduce their risk for death, institutionalization, and cognitive decline, they noted.

Dr. Fong had no financial conflicts to disclose. The study was funded by the National Institute on Aging and the Massachusetts Alzheimer’s Disease Research Center.

Approximately one in eight Alzheimer’s disease patients who develop delirium while hospitalized will suffer at least one adverse outcome, based on data from 771 adults. The findings were published in Annals of Internal Medicine on June 18.

Previous studies have shown that delirium can increase the rate of cognitive decline in AD patients, but the impact of hospitalization and delirium has not been well studied, said Dr. Tamara G. Fong of the Aging Brain Center, Boston, and her colleagues. Adults with Alzheimer’s disease (AD) are three times more likely to be hospitalized than are those without AD, the researchers noted.

To assess the adverse outcomes of death, institutionalization, and cognitive decline associated with hospitalization and delirium, Dr. Fong and her colleagues followed 771 community-dwelling adults aged 65 years and older with a clinical diagnosis of AD. The mean follow-up was 2 years, and outcomes were assessed at 1 year after an initial hospitalization. A total of 367 individuals (48%) were hospitalized, and 194 of these patients (25%) developed delirium while hospitalized (Ann. Intern. Med. 2012;156:848-56).

At least one adverse outcome occurred in 32% of nonhospitalized patients, 55% of hospitalized patients without delirium, and 79% of hospitalized patients with delirium.

In the hospitalized patients, 6% of deaths, 15% of institutionalizations, and 21% of cases of cognitive decline were associated with delirium, the researchers said.

Death occurred in 15% of hospitalized patients with delirium, compared with 9% of hospitalized patients without delirium and 2% of nonhospitalized patients.

The hospitalized patients with delirium had an increased risk for death, institutionalization, and cognitive decline, compared with the other groups, with adjusted risk ratios of 5.4, 9.3, and 1.6, respectively. Hospitalized patients with no delirium had a slightly smaller increase in the risk of death (adjusted risk ratio 4.7) and institutionalization (adjusted risk ratio 6.9).

The mean age of the patients was 77 years, 57% were women, and 95% were white.

The results were limited by several factors, including the observational nature of the study and the incomplete data on the cognitive outcome and functional status of some patients, the researchers wrote. But the findings show "the important and incremental associations of hospitalization and delirium with 1-year outcomes," they said.

Additional research is needed to determine whether preventing hospitalization and delirium in AD patients can reduce their risk for death, institutionalization, and cognitive decline, they noted.

Dr. Fong had no financial conflicts to disclose. The study was funded by the National Institute on Aging and the Massachusetts Alzheimer’s Disease Research Center.

NEW ORLEANS – Suspect a problem with the hemoglobin A_1c whenever it’s discordant with blood sugar–monitoring data.

This happens surprisingly often. The HbA_1c level is a measure of glycolated hemoglobin, so any condition that affects hemoglobin, either qualitatively or quantitatively, can seriously distort the HbA_1c value, Dr. Thomas L. O’Connell explained at the annual meeting of the American College of Physicians.

Examples include patients on hemodialysis, or who have recently been transfused, are anemic, or who have a hemoglobinopathy, noted Dr. O’Connell, an endocrinologist at Duke University, Durham, N.C.

"Don’t even bother measuring [HbA_1c] in a patient who has recently been transfused. This happens all the time in the hospital: a transfused patient’s blood sugar level on finger-stick testing is 300 mg/dL, but the [HbA_1c] is 5.5%," he observed.

Hemoglobinopathies can result in either a false-high or false-low HbA_1c value. More than 700 hemoglobinopathies or abnormal hemoglobin variants have been described and many of these are asymptomatic. The most common hemoglobinopathy in the United States is sickle cell trait, affecting 2 million people.

"There are a lot of people out there with hemoglobinopathies," the endocrinologist stressed.

When the HbA_1c results seem sketchy, an excellent alternative is the fructosamine test. Not nearly as well known as the HbA_1c, the fructosamine test measures glycolated protein in the blood rather than glycolated hemoglobin, so it is unaffected by hemoglobinopathies.

If blood glucose measurement by fingerstick provides a snapshot of a patient’s diabetic control and the HbA_1c is more like a feature-length movie reflecting metabolic control over the past 3 months, then the fructosamine test is akin to a short film providing a view of a patient’s average blood glucose concentration during the previous 2-3 weeks.

Dr. O’Connell reported that he serves as a consultant to Sanofi-Aventis and Amylin.

NEW ORLEANS – Suspect a problem with the hemoglobin A_1c whenever it’s discordant with blood sugar–monitoring data.

This happens surprisingly often. The HbA_1c level is a measure of glycolated hemoglobin, so any condition that affects hemoglobin, either qualitatively or quantitatively, can seriously distort the HbA_1c value, Dr. Thomas L. O’Connell explained at the annual meeting of the American College of Physicians.

Examples include patients on hemodialysis, or who have recently been transfused, are anemic, or who have a hemoglobinopathy, noted Dr. O’Connell, an endocrinologist at Duke University, Durham, N.C.

"Don’t even bother measuring [HbA_1c] in a patient who has recently been transfused. This happens all the time in the hospital: a transfused patient’s blood sugar level on finger-stick testing is 300 mg/dL, but the [HbA_1c] is 5.5%," he observed.

Hemoglobinopathies can result in either a false-high or false-low HbA_1c value. More than 700 hemoglobinopathies or abnormal hemoglobin variants have been described and many of these are asymptomatic. The most common hemoglobinopathy in the United States is sickle cell trait, affecting 2 million people.

"There are a lot of people out there with hemoglobinopathies," the endocrinologist stressed.

When the HbA_1c results seem sketchy, an excellent alternative is the fructosamine test. Not nearly as well known as the HbA_1c, the fructosamine test measures glycolated protein in the blood rather than glycolated hemoglobin, so it is unaffected by hemoglobinopathies.

If blood glucose measurement by fingerstick provides a snapshot of a patient’s diabetic control and the HbA_1c is more like a feature-length movie reflecting metabolic control over the past 3 months, then the fructosamine test is akin to a short film providing a view of a patient’s average blood glucose concentration during the previous 2-3 weeks.

Dr. O’Connell reported that he serves as a consultant to Sanofi-Aventis and Amylin.

NEW ORLEANS – Suspect a problem with the hemoglobin A_1c whenever it’s discordant with blood sugar–monitoring data.

This happens surprisingly often. The HbA_1c level is a measure of glycolated hemoglobin, so any condition that affects hemoglobin, either qualitatively or quantitatively, can seriously distort the HbA_1c value, Dr. Thomas L. O’Connell explained at the annual meeting of the American College of Physicians.

Examples include patients on hemodialysis, or who have recently been transfused, are anemic, or who have a hemoglobinopathy, noted Dr. O’Connell, an endocrinologist at Duke University, Durham, N.C.

"Don’t even bother measuring [HbA_1c] in a patient who has recently been transfused. This happens all the time in the hospital: a transfused patient’s blood sugar level on finger-stick testing is 300 mg/dL, but the [HbA_1c] is 5.5%," he observed.

Hemoglobinopathies can result in either a false-high or false-low HbA_1c value. More than 700 hemoglobinopathies or abnormal hemoglobin variants have been described and many of these are asymptomatic. The most common hemoglobinopathy in the United States is sickle cell trait, affecting 2 million people.

"There are a lot of people out there with hemoglobinopathies," the endocrinologist stressed.

When the HbA_1c results seem sketchy, an excellent alternative is the fructosamine test. Not nearly as well known as the HbA_1c, the fructosamine test measures glycolated protein in the blood rather than glycolated hemoglobin, so it is unaffected by hemoglobinopathies.

If blood glucose measurement by fingerstick provides a snapshot of a patient’s diabetic control and the HbA_1c is more like a feature-length movie reflecting metabolic control over the past 3 months, then the fructosamine test is akin to a short film providing a view of a patient’s average blood glucose concentration during the previous 2-3 weeks.

Dr. O’Connell reported that he serves as a consultant to Sanofi-Aventis and Amylin.

SAN FRANCISCO – Perioperative infusions of sodium bicarbonate failed to reduce the risk of kidney injury in patients undergoing cardiac surgery in a multicenter randomized, double-blind, placebo-controlled trial in 427 patients.

The bicarbonate infusion increased the pH of both blood and urine in the 215-patient treatment group compared with 213 patients in a control group who got sodium chloride (saline) infusions, but 45% of the bicarbonate group and 44% of the placebo group developed kidney injury, a nonsignificant difference, Dr. Shay McGuinness and his associates reported at an international conference of the American Thoracic Society.

The study excluded patients with end-stage renal disease; patients having emergency cardiac surgery or planned off-pump cardiac surgery; and patients with known blood-borne infectious disease, chronic inflammatory disease, immunosuppression, or chronic moderate- to high-dose corticosteroid use.

"We cannot recommend the use of perioperative infusions of sodium bicarbonate to reduce cardiac surgery–associated kidney injury in these patients, and we do not believe further investigation of this therapy is justified," said Dr. McGuinness, an intensive care specialist at Auckland City Hospital, New Zealand.

The study defined kidney injury as an increase in creatinine of at least 25% from baseline or at least 0.5 mg/dL within the first 5 postoperative days.

The bicarbonate group and placebo group did not differ significantly in mean time on ventilation (21 and 25 hours, respectively), length of stay in the ICU (2 days each), length of stay in the hospital (13 days each), mortality in the ICU (3% and 2%, respectively), or 90-day mortality (4% and 2%).

The infusion strategy had started to catch on in New Zealand and Australia, but it’s unclear if anyone in the United States has pursued it, he said.

The study identified a high-risk group, got a plausible physiological treatment effect, and had good compliance and follow-up rates, but the clinical results were "absolutely negative," Dr. McGuinness said.

The investigators still are analyzing subgroups in the study, but "my gut feeling is that this is a completely negative study. There’s not even a hint of benefit. Walk away from it and find something else to study," he said.

To be in the study, patients having cardiac surgery at three centers in New Zealand and Australia had to have one or more risk factors for associated kidney injury. The rates of risk factors were similar between groups, including age over 70 (a mean of 58% of patients), preexisting renal impairment (14%), left ventricular ejection fraction below 35% (6%), valvular surgery with or without coronary artery surgery (72%), previous cardiac surgery involving sternotomy (16%), or insulin-dependent diabetes mellitus (6%). Measures of baseline renal function were similar between groups.

"What you see is standard cardiosurgical higher-risk patients" in the cohort, Dr. McGuinness said.

Infusions commenced at the start of anesthesia with a 1-mmol/mL solution, followed by 0.5 mmol/kg for 1 hour and 0.2 mmol/kg per hour for 23 hours.

Acid-base status and plasma levels of bicarbonate were similar between groups at baseline, but statistically and clinically significant differences emerged between groups at several time points after the infusion started.

Mean plasma bicarbonate levels in the bicarbonate and placebo groups were 25.72 mmol/L and 25.91 mmol/L at baseline, respectively, 27.03 and 24.35 mmol/L at 6 hours, 29.74 and 23.7 mmol/L at 24 hours, and 29.14 and 25.35 mmol/L at 48 hours.

Mean plasma pH levels in the bicarbonate and placebo groups were 7.40 and 7.41 at baseline, 7.40 and 7.37 at 6 hours, and 7.44 and 7.36 at 24 hours, respectively.

Mean urinary pH measures were 5.8 and 5.5 at baseline, 6.5 and 5.8 at 6 hours, and 7.3 and 5.2 at 24 hours, respectively.

Up to half of the 1 million patients who undergo open heart surgery each year will develop associated kidney injury with increased risk for further morbidity or death. The overall incidence of cardiac surgery–related kidney injury is approximately 5%-10% and probably is increasing, he said.

A previous pilot study by Dr. McGuinness and his associates of 100 patients at a single site had suggested that prophylactic perioperative infusions of sodium bicarbonate might reduce the risk of kidney injury. The investigators conducted the phase II trial before deciding whether or not to pursue a large phase III trial, which will not be happening based on these results.

The study was funded by Fisher & Paykel Healthcare and New Zealand medical organizations. Dr. McGuinness reported having no disclosures.

SAN FRANCISCO – Perioperative infusions of sodium bicarbonate failed to reduce the risk of kidney injury in patients undergoing cardiac surgery in a multicenter randomized, double-blind, placebo-controlled trial in 427 patients.

The bicarbonate infusion increased the pH of both blood and urine in the 215-patient treatment group compared with 213 patients in a control group who got sodium chloride (saline) infusions, but 45% of the bicarbonate group and 44% of the placebo group developed kidney injury, a nonsignificant difference, Dr. Shay McGuinness and his associates reported at an international conference of the American Thoracic Society.

The study excluded patients with end-stage renal disease; patients having emergency cardiac surgery or planned off-pump cardiac surgery; and patients with known blood-borne infectious disease, chronic inflammatory disease, immunosuppression, or chronic moderate- to high-dose corticosteroid use.

"We cannot recommend the use of perioperative infusions of sodium bicarbonate to reduce cardiac surgery–associated kidney injury in these patients, and we do not believe further investigation of this therapy is justified," said Dr. McGuinness, an intensive care specialist at Auckland City Hospital, New Zealand.

The study defined kidney injury as an increase in creatinine of at least 25% from baseline or at least 0.5 mg/dL within the first 5 postoperative days.

The bicarbonate group and placebo group did not differ significantly in mean time on ventilation (21 and 25 hours, respectively), length of stay in the ICU (2 days each), length of stay in the hospital (13 days each), mortality in the ICU (3% and 2%, respectively), or 90-day mortality (4% and 2%).

The infusion strategy had started to catch on in New Zealand and Australia, but it’s unclear if anyone in the United States has pursued it, he said.

The study identified a high-risk group, got a plausible physiological treatment effect, and had good compliance and follow-up rates, but the clinical results were "absolutely negative," Dr. McGuinness said.

The investigators still are analyzing subgroups in the study, but "my gut feeling is that this is a completely negative study. There’s not even a hint of benefit. Walk away from it and find something else to study," he said.

To be in the study, patients having cardiac surgery at three centers in New Zealand and Australia had to have one or more risk factors for associated kidney injury. The rates of risk factors were similar between groups, including age over 70 (a mean of 58% of patients), preexisting renal impairment (14%), left ventricular ejection fraction below 35% (6%), valvular surgery with or without coronary artery surgery (72%), previous cardiac surgery involving sternotomy (16%), or insulin-dependent diabetes mellitus (6%). Measures of baseline renal function were similar between groups.

"What you see is standard cardiosurgical higher-risk patients" in the cohort, Dr. McGuinness said.

Infusions commenced at the start of anesthesia with a 1-mmol/mL solution, followed by 0.5 mmol/kg for 1 hour and 0.2 mmol/kg per hour for 23 hours.

Acid-base status and plasma levels of bicarbonate were similar between groups at baseline, but statistically and clinically significant differences emerged between groups at several time points after the infusion started.

Mean plasma bicarbonate levels in the bicarbonate and placebo groups were 25.72 mmol/L and 25.91 mmol/L at baseline, respectively, 27.03 and 24.35 mmol/L at 6 hours, 29.74 and 23.7 mmol/L at 24 hours, and 29.14 and 25.35 mmol/L at 48 hours.

Mean plasma pH levels in the bicarbonate and placebo groups were 7.40 and 7.41 at baseline, 7.40 and 7.37 at 6 hours, and 7.44 and 7.36 at 24 hours, respectively.

Mean urinary pH measures were 5.8 and 5.5 at baseline, 6.5 and 5.8 at 6 hours, and 7.3 and 5.2 at 24 hours, respectively.

Up to half of the 1 million patients who undergo open heart surgery each year will develop associated kidney injury with increased risk for further morbidity or death. The overall incidence of cardiac surgery–related kidney injury is approximately 5%-10% and probably is increasing, he said.

A previous pilot study by Dr. McGuinness and his associates of 100 patients at a single site had suggested that prophylactic perioperative infusions of sodium bicarbonate might reduce the risk of kidney injury. The investigators conducted the phase II trial before deciding whether or not to pursue a large phase III trial, which will not be happening based on these results.

The study was funded by Fisher & Paykel Healthcare and New Zealand medical organizations. Dr. McGuinness reported having no disclosures.

SAN FRANCISCO – Perioperative infusions of sodium bicarbonate failed to reduce the risk of kidney injury in patients undergoing cardiac surgery in a multicenter randomized, double-blind, placebo-controlled trial in 427 patients.

The bicarbonate infusion increased the pH of both blood and urine in the 215-patient treatment group compared with 213 patients in a control group who got sodium chloride (saline) infusions, but 45% of the bicarbonate group and 44% of the placebo group developed kidney injury, a nonsignificant difference, Dr. Shay McGuinness and his associates reported at an international conference of the American Thoracic Society.

The study excluded patients with end-stage renal disease; patients having emergency cardiac surgery or planned off-pump cardiac surgery; and patients with known blood-borne infectious disease, chronic inflammatory disease, immunosuppression, or chronic moderate- to high-dose corticosteroid use.

"We cannot recommend the use of perioperative infusions of sodium bicarbonate to reduce cardiac surgery–associated kidney injury in these patients, and we do not believe further investigation of this therapy is justified," said Dr. McGuinness, an intensive care specialist at Auckland City Hospital, New Zealand.

The study defined kidney injury as an increase in creatinine of at least 25% from baseline or at least 0.5 mg/dL within the first 5 postoperative days.

The bicarbonate group and placebo group did not differ significantly in mean time on ventilation (21 and 25 hours, respectively), length of stay in the ICU (2 days each), length of stay in the hospital (13 days each), mortality in the ICU (3% and 2%, respectively), or 90-day mortality (4% and 2%).

The infusion strategy had started to catch on in New Zealand and Australia, but it’s unclear if anyone in the United States has pursued it, he said.

The study identified a high-risk group, got a plausible physiological treatment effect, and had good compliance and follow-up rates, but the clinical results were "absolutely negative," Dr. McGuinness said.

The investigators still are analyzing subgroups in the study, but "my gut feeling is that this is a completely negative study. There’s not even a hint of benefit. Walk away from it and find something else to study," he said.

To be in the study, patients having cardiac surgery at three centers in New Zealand and Australia had to have one or more risk factors for associated kidney injury. The rates of risk factors were similar between groups, including age over 70 (a mean of 58% of patients), preexisting renal impairment (14%), left ventricular ejection fraction below 35% (6%), valvular surgery with or without coronary artery surgery (72%), previous cardiac surgery involving sternotomy (16%), or insulin-dependent diabetes mellitus (6%). Measures of baseline renal function were similar between groups.

"What you see is standard cardiosurgical higher-risk patients" in the cohort, Dr. McGuinness said.

Infusions commenced at the start of anesthesia with a 1-mmol/mL solution, followed by 0.5 mmol/kg for 1 hour and 0.2 mmol/kg per hour for 23 hours.

Acid-base status and plasma levels of bicarbonate were similar between groups at baseline, but statistically and clinically significant differences emerged between groups at several time points after the infusion started.

Mean plasma bicarbonate levels in the bicarbonate and placebo groups were 25.72 mmol/L and 25.91 mmol/L at baseline, respectively, 27.03 and 24.35 mmol/L at 6 hours, 29.74 and 23.7 mmol/L at 24 hours, and 29.14 and 25.35 mmol/L at 48 hours.

Mean plasma pH levels in the bicarbonate and placebo groups were 7.40 and 7.41 at baseline, 7.40 and 7.37 at 6 hours, and 7.44 and 7.36 at 24 hours, respectively.

Mean urinary pH measures were 5.8 and 5.5 at baseline, 6.5 and 5.8 at 6 hours, and 7.3 and 5.2 at 24 hours, respectively.

Up to half of the 1 million patients who undergo open heart surgery each year will develop associated kidney injury with increased risk for further morbidity or death. The overall incidence of cardiac surgery–related kidney injury is approximately 5%-10% and probably is increasing, he said.

A previous pilot study by Dr. McGuinness and his associates of 100 patients at a single site had suggested that prophylactic perioperative infusions of sodium bicarbonate might reduce the risk of kidney injury. The investigators conducted the phase II trial before deciding whether or not to pursue a large phase III trial, which will not be happening based on these results.

The study was funded by Fisher & Paykel Healthcare and New Zealand medical organizations. Dr. McGuinness reported having no disclosures.

ATLANTA – Interstitial cystitis and chronic pelvic pain may be more common in males than assumed.

A national telephone survey shows that about 2 million U.S. men may suffer from either of the disorders, Dr. Anne Suskind said during a poster session at the annual meeting of the American Urological Association.

"We found that anywhere from 1% to 2.5% of men report symptoms suggestive of interstitial cystitis and a similar number report symptoms suggestive of chronic prostatitis or chronic pelvic pain," said Dr. Suskind, a fellow at the University of Michigan, Ann Arbor. "The degree of overlap is less than 20%"

Dr. Suskind and her colleagues conducted a telephone survey similar to the RAND IC Epidemiology Study (RICE) survey of women. That study – the largest interstitial cystitis epidemiology study ever undertaken – found that up to 6.5% of U.S. women may have the disorder.

The male-targeted survey used versions of the RICE validated definitions to assess problems in men. Chronic prostatitis was considered a value of greater than 5 on the National Institute of Health Chronic Prostatitis Symptom Index, plus ejaculatory or perineal pain.

Researchers contacted 6,072 households, asking if the male resident would be willing to answer a survey about President Obama’s performance. If the answer was yes, the survey ensued, with questions about any urinary tract pain attached at the end of the political questions.

Initially, 296 men screened positive for the bladder symptoms; 149 of these men met inclusionary diagnostic criteria for interstitial cystitis or prostatitis. Of these, 52 were excluded from the final analysis.

Based on the remaining sample of 97 subjects, 23% met the high specificity definition of interstitial cystitis/ bladder pain syndrome, 16% met the case definition of chronic prostatitis/chronic pelvic pain syndrome, and 8% met both definitions.

By extrapolating the numbers to the entire U.S. adult male population, Dr. Suskind concluded that up to 2 million men would meet the diagnostic definition for either of the disorders. A further analysis showed that the overlap between the two conditions was small – about 17% – indicating that they could be easily diagnostically differentiated.

"These conditions appear to be more widespread in men than many of us have believed," she concluded.

Dr. Suskind reported having no financial disclosures.

ATLANTA – Interstitial cystitis and chronic pelvic pain may be more common in males than assumed.

A national telephone survey shows that about 2 million U.S. men may suffer from either of the disorders, Dr. Anne Suskind said during a poster session at the annual meeting of the American Urological Association.

"We found that anywhere from 1% to 2.5% of men report symptoms suggestive of interstitial cystitis and a similar number report symptoms suggestive of chronic prostatitis or chronic pelvic pain," said Dr. Suskind, a fellow at the University of Michigan, Ann Arbor. "The degree of overlap is less than 20%"

Dr. Suskind and her colleagues conducted a telephone survey similar to the RAND IC Epidemiology Study (RICE) survey of women. That study – the largest interstitial cystitis epidemiology study ever undertaken – found that up to 6.5% of U.S. women may have the disorder.

The male-targeted survey used versions of the RICE validated definitions to assess problems in men. Chronic prostatitis was considered a value of greater than 5 on the National Institute of Health Chronic Prostatitis Symptom Index, plus ejaculatory or perineal pain.

Researchers contacted 6,072 households, asking if the male resident would be willing to answer a survey about President Obama’s performance. If the answer was yes, the survey ensued, with questions about any urinary tract pain attached at the end of the political questions.

Initially, 296 men screened positive for the bladder symptoms; 149 of these men met inclusionary diagnostic criteria for interstitial cystitis or prostatitis. Of these, 52 were excluded from the final analysis.

Based on the remaining sample of 97 subjects, 23% met the high specificity definition of interstitial cystitis/ bladder pain syndrome, 16% met the case definition of chronic prostatitis/chronic pelvic pain syndrome, and 8% met both definitions.

By extrapolating the numbers to the entire U.S. adult male population, Dr. Suskind concluded that up to 2 million men would meet the diagnostic definition for either of the disorders. A further analysis showed that the overlap between the two conditions was small – about 17% – indicating that they could be easily diagnostically differentiated.

"These conditions appear to be more widespread in men than many of us have believed," she concluded.

Dr. Suskind reported having no financial disclosures.

ATLANTA – Interstitial cystitis and chronic pelvic pain may be more common in males than assumed.

A national telephone survey shows that about 2 million U.S. men may suffer from either of the disorders, Dr. Anne Suskind said during a poster session at the annual meeting of the American Urological Association.

"We found that anywhere from 1% to 2.5% of men report symptoms suggestive of interstitial cystitis and a similar number report symptoms suggestive of chronic prostatitis or chronic pelvic pain," said Dr. Suskind, a fellow at the University of Michigan, Ann Arbor. "The degree of overlap is less than 20%"

Dr. Suskind and her colleagues conducted a telephone survey similar to the RAND IC Epidemiology Study (RICE) survey of women. That study – the largest interstitial cystitis epidemiology study ever undertaken – found that up to 6.5% of U.S. women may have the disorder.

The male-targeted survey used versions of the RICE validated definitions to assess problems in men. Chronic prostatitis was considered a value of greater than 5 on the National Institute of Health Chronic Prostatitis Symptom Index, plus ejaculatory or perineal pain.

Researchers contacted 6,072 households, asking if the male resident would be willing to answer a survey about President Obama’s performance. If the answer was yes, the survey ensued, with questions about any urinary tract pain attached at the end of the political questions.

Initially, 296 men screened positive for the bladder symptoms; 149 of these men met inclusionary diagnostic criteria for interstitial cystitis or prostatitis. Of these, 52 were excluded from the final analysis.

Based on the remaining sample of 97 subjects, 23% met the high specificity definition of interstitial cystitis/ bladder pain syndrome, 16% met the case definition of chronic prostatitis/chronic pelvic pain syndrome, and 8% met both definitions.

By extrapolating the numbers to the entire U.S. adult male population, Dr. Suskind concluded that up to 2 million men would meet the diagnostic definition for either of the disorders. A further analysis showed that the overlap between the two conditions was small – about 17% – indicating that they could be easily diagnostically differentiated.

"These conditions appear to be more widespread in men than many of us have believed," she concluded.

Dr. Suskind reported having no financial disclosures.

ATLANTA – Men younger than age 55 who have served in the U.S. armed forces are almost three times as likely to report urinary incontinence as are their nonmilitary peers.

The association between military service and incontinence remained statistically significant even after investigators controlled for age, medications, and medical comorbidities – including prostate problems, Dr. Alayne Markland said at the annual meeting of the American Urological Society. Additionally, in the youngest group of men, the presence of posttraumatic stress disorder was associated with a threefold increase of any lower urinary tract symptom.

"One implication of this finding is the need for additional screening for men who are members of the armed forces, especially those who are returning from the current wars," said Dr. Markland, an internist at the Birmingham (Ala.) VA Medical Center. "This is something we need to ask about."

Dr. Markland reviewed data from the 2005-2006 and 2007-2008 cycles of the NHANES (National Health and Nutritional Examination Survey). Those cycles included queries about lower urinary tract symptoms, and provided an opportunity for respondents to rate any problems as mild, moderate, or severe.

The survey population included 5,287 men who were older than age 20. Military exposure was assessed by asking whether the respondent had ever served in any branch of the U.S. armed forces.

The investigators divided respondents into three age groups, correlated with the timing of military conflicts in which they might have served: 70 years or older (World War II or the Korean War); 55-59 (Vietnam War); and younger than 55 (Gulf War, Iraq, or Afghanistan). The groupings also allowed some comparison based on health concerns that are known to be associated with each conflict. For example, Vietnam-era vets could have been exposed to the defoliant Agent Orange and have a higher prevalence of diabetes and cancer than exists in the general population. Middle-aged veterans sometimes report Gulf War syndrome, and younger veterans report posttraumatic stress disorder and traumatic brain injury.

Among the entire survey population, the rate of any incontinence was 10%. About a quarter of the respondents reported having some military exposure. The rate of incontinence among these men was 19%, a significant difference.

Urgency was the most common problem, reported by 15% of veterans and 8% of civilians. The rates of stress and mixed incontinence were 4% and 2%, respectively.

Moderate to severe symptoms also were more common among the veterans (19% vs. 3%), whereas 1% of each group reported severe incontinence.

However, Dr. Markland said, when the group was broken down by age, the youngest group was driving the difference. Men aged 55 years and younger were three times more likely to report any urinary incontinence than were the nonmilitary population. The difference remained significant even after investigators controlled for ethnicity, socioeconomic level, body mass index, diabetes, and heart disease.

In another model that included prostate enlargement and cancer, the youngest veterans still had a threefold increase in the risk of incontinence.

Dr. Markland then examined the youngest group more carefully. Their average age was 26 years. Posttraumatic stress disorder was common, affecting 28% of them; 16% of this population reported some form of lower urinary tract problem. In fact, the presence of PTSD was associated with a threefold increase of any lower urinary tract symptom.

The association might be related to adrenergic or anticholinergic medication used to treat PTSD, Dr. Markland said. But even after investigators controlled for this, the youngest veterans had a 20% higher risk of any lower urinary tract symptom.

Because NHANES doesn’t collect any detailed information about military experience, there’s no way to tease out any cause and effect information, she said. But Dr. Christopher Amling, a moderator at the session, suggested that modern war injuries could be playing a part.

"Normally, you would expect to see much higher rates of this among an older population," said Dr. Amling, chief of urology at the Oregon Health and Science University, Portland. "What’s remarkable to me is that this is occurring in this younger population. To me, this suggests something about the recent conflicts – perhaps there is a greater risk of spinal cord or limb injuries."

Or, he said, the difference could be as simple as reluctance among older men to discuss their urinary problems. "Maybe they’re just more embarrassed to say anything about it."

However, Dr. Markland said, younger veterans are returning from the Middle East conflicts with different kinds of injuries than have been seen in past wars.

"Traumatic brain injury is a big issue, and we are still trying to recognize the more subtle presentations of blast injuries."

And, she said, the very armor that protects soldiers may contribute to problems when they survive an injury. "The Kevlar protection shields the thorax and abdomen, so although more people are surviving, we’re seeing many more limbs blown off, as well as TBI. We can keep soldiers from being killed, but anything that injures the brain can cause dysfunctional voiding."

Dr. Markland and Dr. Amling said they had no financial disclosures.

ATLANTA – Men younger than age 55 who have served in the U.S. armed forces are almost three times as likely to report urinary incontinence as are their nonmilitary peers.

The association between military service and incontinence remained statistically significant even after investigators controlled for age, medications, and medical comorbidities – including prostate problems, Dr. Alayne Markland said at the annual meeting of the American Urological Society. Additionally, in the youngest group of men, the presence of posttraumatic stress disorder was associated with a threefold increase of any lower urinary tract symptom.

"One implication of this finding is the need for additional screening for men who are members of the armed forces, especially those who are returning from the current wars," said Dr. Markland, an internist at the Birmingham (Ala.) VA Medical Center. "This is something we need to ask about."

Dr. Markland reviewed data from the 2005-2006 and 2007-2008 cycles of the NHANES (National Health and Nutritional Examination Survey). Those cycles included queries about lower urinary tract symptoms, and provided an opportunity for respondents to rate any problems as mild, moderate, or severe.

The survey population included 5,287 men who were older than age 20. Military exposure was assessed by asking whether the respondent had ever served in any branch of the U.S. armed forces.

The investigators divided respondents into three age groups, correlated with the timing of military conflicts in which they might have served: 70 years or older (World War II or the Korean War); 55-59 (Vietnam War); and younger than 55 (Gulf War, Iraq, or Afghanistan). The groupings also allowed some comparison based on health concerns that are known to be associated with each conflict. For example, Vietnam-era vets could have been exposed to the defoliant Agent Orange and have a higher prevalence of diabetes and cancer than exists in the general population. Middle-aged veterans sometimes report Gulf War syndrome, and younger veterans report posttraumatic stress disorder and traumatic brain injury.

Among the entire survey population, the rate of any incontinence was 10%. About a quarter of the respondents reported having some military exposure. The rate of incontinence among these men was 19%, a significant difference.

Urgency was the most common problem, reported by 15% of veterans and 8% of civilians. The rates of stress and mixed incontinence were 4% and 2%, respectively.

Moderate to severe symptoms also were more common among the veterans (19% vs. 3%), whereas 1% of each group reported severe incontinence.

However, Dr. Markland said, when the group was broken down by age, the youngest group was driving the difference. Men aged 55 years and younger were three times more likely to report any urinary incontinence than were the nonmilitary population. The difference remained significant even after investigators controlled for ethnicity, socioeconomic level, body mass index, diabetes, and heart disease.

In another model that included prostate enlargement and cancer, the youngest veterans still had a threefold increase in the risk of incontinence.

Dr. Markland then examined the youngest group more carefully. Their average age was 26 years. Posttraumatic stress disorder was common, affecting 28% of them; 16% of this population reported some form of lower urinary tract problem. In fact, the presence of PTSD was associated with a threefold increase of any lower urinary tract symptom.

The association might be related to adrenergic or anticholinergic medication used to treat PTSD, Dr. Markland said. But even after investigators controlled for this, the youngest veterans had a 20% higher risk of any lower urinary tract symptom.

Because NHANES doesn’t collect any detailed information about military experience, there’s no way to tease out any cause and effect information, she said. But Dr. Christopher Amling, a moderator at the session, suggested that modern war injuries could be playing a part.

"Normally, you would expect to see much higher rates of this among an older population," said Dr. Amling, chief of urology at the Oregon Health and Science University, Portland. "What’s remarkable to me is that this is occurring in this younger population. To me, this suggests something about the recent conflicts – perhaps there is a greater risk of spinal cord or limb injuries."

Or, he said, the difference could be as simple as reluctance among older men to discuss their urinary problems. "Maybe they’re just more embarrassed to say anything about it."

However, Dr. Markland said, younger veterans are returning from the Middle East conflicts with different kinds of injuries than have been seen in past wars.

"Traumatic brain injury is a big issue, and we are still trying to recognize the more subtle presentations of blast injuries."

And, she said, the very armor that protects soldiers may contribute to problems when they survive an injury. "The Kevlar protection shields the thorax and abdomen, so although more people are surviving, we’re seeing many more limbs blown off, as well as TBI. We can keep soldiers from being killed, but anything that injures the brain can cause dysfunctional voiding."

Dr. Markland and Dr. Amling said they had no financial disclosures.

ATLANTA – Men younger than age 55 who have served in the U.S. armed forces are almost three times as likely to report urinary incontinence as are their nonmilitary peers.

The association between military service and incontinence remained statistically significant even after investigators controlled for age, medications, and medical comorbidities – including prostate problems, Dr. Alayne Markland said at the annual meeting of the American Urological Society. Additionally, in the youngest group of men, the presence of posttraumatic stress disorder was associated with a threefold increase of any lower urinary tract symptom.

"One implication of this finding is the need for additional screening for men who are members of the armed forces, especially those who are returning from the current wars," said Dr. Markland, an internist at the Birmingham (Ala.) VA Medical Center. "This is something we need to ask about."

Dr. Markland reviewed data from the 2005-2006 and 2007-2008 cycles of the NHANES (National Health and Nutritional Examination Survey). Those cycles included queries about lower urinary tract symptoms, and provided an opportunity for respondents to rate any problems as mild, moderate, or severe.

The survey population included 5,287 men who were older than age 20. Military exposure was assessed by asking whether the respondent had ever served in any branch of the U.S. armed forces.

The investigators divided respondents into three age groups, correlated with the timing of military conflicts in which they might have served: 70 years or older (World War II or the Korean War); 55-59 (Vietnam War); and younger than 55 (Gulf War, Iraq, or Afghanistan). The groupings also allowed some comparison based on health concerns that are known to be associated with each conflict. For example, Vietnam-era vets could have been exposed to the defoliant Agent Orange and have a higher prevalence of diabetes and cancer than exists in the general population. Middle-aged veterans sometimes report Gulf War syndrome, and younger veterans report posttraumatic stress disorder and traumatic brain injury.

Among the entire survey population, the rate of any incontinence was 10%. About a quarter of the respondents reported having some military exposure. The rate of incontinence among these men was 19%, a significant difference.

Urgency was the most common problem, reported by 15% of veterans and 8% of civilians. The rates of stress and mixed incontinence were 4% and 2%, respectively.

Moderate to severe symptoms also were more common among the veterans (19% vs. 3%), whereas 1% of each group reported severe incontinence.

However, Dr. Markland said, when the group was broken down by age, the youngest group was driving the difference. Men aged 55 years and younger were three times more likely to report any urinary incontinence than were the nonmilitary population. The difference remained significant even after investigators controlled for ethnicity, socioeconomic level, body mass index, diabetes, and heart disease.

In another model that included prostate enlargement and cancer, the youngest veterans still had a threefold increase in the risk of incontinence.

Dr. Markland then examined the youngest group more carefully. Their average age was 26 years. Posttraumatic stress disorder was common, affecting 28% of them; 16% of this population reported some form of lower urinary tract problem. In fact, the presence of PTSD was associated with a threefold increase of any lower urinary tract symptom.

The association might be related to adrenergic or anticholinergic medication used to treat PTSD, Dr. Markland said. But even after investigators controlled for this, the youngest veterans had a 20% higher risk of any lower urinary tract symptom.

Because NHANES doesn’t collect any detailed information about military experience, there’s no way to tease out any cause and effect information, she said. But Dr. Christopher Amling, a moderator at the session, suggested that modern war injuries could be playing a part.

"Normally, you would expect to see much higher rates of this among an older population," said Dr. Amling, chief of urology at the Oregon Health and Science University, Portland. "What’s remarkable to me is that this is occurring in this younger population. To me, this suggests something about the recent conflicts – perhaps there is a greater risk of spinal cord or limb injuries."

Or, he said, the difference could be as simple as reluctance among older men to discuss their urinary problems. "Maybe they’re just more embarrassed to say anything about it."

However, Dr. Markland said, younger veterans are returning from the Middle East conflicts with different kinds of injuries than have been seen in past wars.

"Traumatic brain injury is a big issue, and we are still trying to recognize the more subtle presentations of blast injuries."

And, she said, the very armor that protects soldiers may contribute to problems when they survive an injury. "The Kevlar protection shields the thorax and abdomen, so although more people are surviving, we’re seeing many more limbs blown off, as well as TBI. We can keep soldiers from being killed, but anything that injures the brain can cause dysfunctional voiding."

Dr. Markland and Dr. Amling said they had no financial disclosures.

NATIONAL HARBOR, MD. – The National Kidney Foundation recommends the preferential creation of radiocephalic fistulas over that of brachiocephalic fistulas for hemodialysis access, but in patients older than 68 years, radiocephalic fistulas are associated with more postoperative complications, according to a retrospective analysis of 287 patients.

Dr. Steven Abramowitz and his colleagues at the Mount Sinai Medical Center, New York, studied patients older than 68 years of age who had preoperative vein mapping and regular follow-up after creation of arteriovenous fistulas. Within this group of 287 patients, 164 underwent radiocephalic fistula (RCF) creation and 123 underwent brachiocephalic fistula (BCF) creation. Dr. Abramowitz presented their findings at the Vascular Annual Meeting.

The researchers analyzed medical records to determine the number of central venous catheter days, the number of fistula-related procedures recorded, and the number of access-related hospitalizations for each patient. Bivariate analysis using linear modeling and one-way analysis of variance was used to assess cohort differences.

Among those patients who had a BCF, the average number of central venous catheter days was 53.3 days per patient, the average number of fistula-related procedures recorded was 0.6 per patient, and the number of hemodialysis-related hospitalizations was 0.3 per patient.

In comparison, among those patients who had an RCF, the average number of central venous catheter days was 83.4 days per patient, the average number of fistula-related procedures recorded was 1.8 per patient, and the average number of hemodialysis-related hospitalizations was 0.8 per patient.

These results indicated a significant difference in postoperative course between those patients who underwent BCF vs. RCF creation.

Patients older than 68 years of age who undergo RCF creation "may have a greater likelihood of increased central venous catheter days, a greater number of hospitalizations related to hemodialysis access, and a greater number of postoperative procedures than those who undergo BCF creation," said Dr. Abramowitz.

He reported that he had no disclosures.

NATIONAL HARBOR, MD. – The National Kidney Foundation recommends the preferential creation of radiocephalic fistulas over that of brachiocephalic fistulas for hemodialysis access, but in patients older than 68 years, radiocephalic fistulas are associated with more postoperative complications, according to a retrospective analysis of 287 patients.

Dr. Steven Abramowitz and his colleagues at the Mount Sinai Medical Center, New York, studied patients older than 68 years of age who had preoperative vein mapping and regular follow-up after creation of arteriovenous fistulas. Within this group of 287 patients, 164 underwent radiocephalic fistula (RCF) creation and 123 underwent brachiocephalic fistula (BCF) creation. Dr. Abramowitz presented their findings at the Vascular Annual Meeting.

The researchers analyzed medical records to determine the number of central venous catheter days, the number of fistula-related procedures recorded, and the number of access-related hospitalizations for each patient. Bivariate analysis using linear modeling and one-way analysis of variance was used to assess cohort differences.

Among those patients who had a BCF, the average number of central venous catheter days was 53.3 days per patient, the average number of fistula-related procedures recorded was 0.6 per patient, and the number of hemodialysis-related hospitalizations was 0.3 per patient.

In comparison, among those patients who had an RCF, the average number of central venous catheter days was 83.4 days per patient, the average number of fistula-related procedures recorded was 1.8 per patient, and the average number of hemodialysis-related hospitalizations was 0.8 per patient.

These results indicated a significant difference in postoperative course between those patients who underwent BCF vs. RCF creation.

Patients older than 68 years of age who undergo RCF creation "may have a greater likelihood of increased central venous catheter days, a greater number of hospitalizations related to hemodialysis access, and a greater number of postoperative procedures than those who undergo BCF creation," said Dr. Abramowitz.

He reported that he had no disclosures.

NATIONAL HARBOR, MD. – The National Kidney Foundation recommends the preferential creation of radiocephalic fistulas over that of brachiocephalic fistulas for hemodialysis access, but in patients older than 68 years, radiocephalic fistulas are associated with more postoperative complications, according to a retrospective analysis of 287 patients.

Dr. Steven Abramowitz and his colleagues at the Mount Sinai Medical Center, New York, studied patients older than 68 years of age who had preoperative vein mapping and regular follow-up after creation of arteriovenous fistulas. Within this group of 287 patients, 164 underwent radiocephalic fistula (RCF) creation and 123 underwent brachiocephalic fistula (BCF) creation. Dr. Abramowitz presented their findings at the Vascular Annual Meeting.

The researchers analyzed medical records to determine the number of central venous catheter days, the number of fistula-related procedures recorded, and the number of access-related hospitalizations for each patient. Bivariate analysis using linear modeling and one-way analysis of variance was used to assess cohort differences.

Among those patients who had a BCF, the average number of central venous catheter days was 53.3 days per patient, the average number of fistula-related procedures recorded was 0.6 per patient, and the number of hemodialysis-related hospitalizations was 0.3 per patient.

In comparison, among those patients who had an RCF, the average number of central venous catheter days was 83.4 days per patient, the average number of fistula-related procedures recorded was 1.8 per patient, and the average number of hemodialysis-related hospitalizations was 0.8 per patient.

These results indicated a significant difference in postoperative course between those patients who underwent BCF vs. RCF creation.

Patients older than 68 years of age who undergo RCF creation "may have a greater likelihood of increased central venous catheter days, a greater number of hospitalizations related to hemodialysis access, and a greater number of postoperative procedures than those who undergo BCF creation," said Dr. Abramowitz.

He reported that he had no disclosures.

ATLANTA – Children who are exposed to secondhand tobacco smoke have an increased risk of urinary urgency, frequency, and incontinence, prospective data from a small study have shown.

Among children with these bladder symptoms, 28% were exposed to tobacco smoke on a daily basis – 13% higher than the overall child exposure rate in New Jersey, Dr. Kelly Johnson said at the annual meeting of the American Urological Association.

In addition to irritating a child’s bladder, childhood exposure to tobacco smoke is directly linked to the development of bladder cancer as an adult, she said in a press briefing.

Dr. Johnson, chief urology resident at the Robert Wood Johnson University Hospital, New Brunswick, N.J., presented prospective data on 45 children, aged 4-17 years, who presented with irritative bladder symptoms – frequency, urgency, and incontinence.

She used the Harvard Children’s Health and the Children’s Neurotoxicant Exposure studies to classify tobacco smoke exposure. The patients’ symptom severity was scored with the Dysfunctional Voiding Scoring System and classified as very mild, mild, Drmoderate, or severe.

About half of the group (21) had very mild or mild symptoms, while the remainder had symptoms scored as moderate or severe.

None of the children with mild scores were exposed to secondhand smoke on a daily basis, and none had mothers who smoked. However, 23% of those with moderate to severe scores had mothers who smoked, and 50% were exposed to smoke in a car on a regular basis.

"On our measures of environmental tobacco smoke exposure, children with greater exposure had significantly higher symptom severity scores than children who weren’t exposed," Dr. Johnson said. "This relationship was particularly striking for the younger children aged 4-10 years old."

Physicians who see children with bladder dysfunction should ask parents about smoke exposure, she advised – not only because of its effect on the current problems, but because of its proven dangers as the child grows up.

"Tobacco smoke contains chemicals that are known bladder irritants in both children and adults, and European studies have shown a strong relationship between adult bladder cancer and childhood tobacco smoke exposure.

The discussion of a child’s urinary symptoms provides a very good opportunity to speak to parents about smoking cessation, she added.

"It’s a teachable moment," that can have a long-lasting positive impact on both the child and the parent. "Unlike other risky behaviors, which affect only the person who engages in them, smoking poses substantial health risks to those not involved in the process," she said.

Dr. Johnson said she had had no relevant financial disclosures.

ATLANTA – Children who are exposed to secondhand tobacco smoke have an increased risk of urinary urgency, frequency, and incontinence, prospective data from a small study have shown.

Among children with these bladder symptoms, 28% were exposed to tobacco smoke on a daily basis – 13% higher than the overall child exposure rate in New Jersey, Dr. Kelly Johnson said at the annual meeting of the American Urological Association.

In addition to irritating a child’s bladder, childhood exposure to tobacco smoke is directly linked to the development of bladder cancer as an adult, she said in a press briefing.

Dr. Johnson, chief urology resident at the Robert Wood Johnson University Hospital, New Brunswick, N.J., presented prospective data on 45 children, aged 4-17 years, who presented with irritative bladder symptoms – frequency, urgency, and incontinence.

She used the Harvard Children’s Health and the Children’s Neurotoxicant Exposure studies to classify tobacco smoke exposure. The patients’ symptom severity was scored with the Dysfunctional Voiding Scoring System and classified as very mild, mild, Drmoderate, or severe.

About half of the group (21) had very mild or mild symptoms, while the remainder had symptoms scored as moderate or severe.

None of the children with mild scores were exposed to secondhand smoke on a daily basis, and none had mothers who smoked. However, 23% of those with moderate to severe scores had mothers who smoked, and 50% were exposed to smoke in a car on a regular basis.

"On our measures of environmental tobacco smoke exposure, children with greater exposure had significantly higher symptom severity scores than children who weren’t exposed," Dr. Johnson said. "This relationship was particularly striking for the younger children aged 4-10 years old."

Physicians who see children with bladder dysfunction should ask parents about smoke exposure, she advised – not only because of its effect on the current problems, but because of its proven dangers as the child grows up.

"Tobacco smoke contains chemicals that are known bladder irritants in both children and adults, and European studies have shown a strong relationship between adult bladder cancer and childhood tobacco smoke exposure.

The discussion of a child’s urinary symptoms provides a very good opportunity to speak to parents about smoking cessation, she added.

"It’s a teachable moment," that can have a long-lasting positive impact on both the child and the parent. "Unlike other risky behaviors, which affect only the person who engages in them, smoking poses substantial health risks to those not involved in the process," she said.

Dr. Johnson said she had had no relevant financial disclosures.

ATLANTA – Children who are exposed to secondhand tobacco smoke have an increased risk of urinary urgency, frequency, and incontinence, prospective data from a small study have shown.

Among children with these bladder symptoms, 28% were exposed to tobacco smoke on a daily basis – 13% higher than the overall child exposure rate in New Jersey, Dr. Kelly Johnson said at the annual meeting of the American Urological Association.

In addition to irritating a child’s bladder, childhood exposure to tobacco smoke is directly linked to the development of bladder cancer as an adult, she said in a press briefing.

Dr. Johnson, chief urology resident at the Robert Wood Johnson University Hospital, New Brunswick, N.J., presented prospective data on 45 children, aged 4-17 years, who presented with irritative bladder symptoms – frequency, urgency, and incontinence.

She used the Harvard Children’s Health and the Children’s Neurotoxicant Exposure studies to classify tobacco smoke exposure. The patients’ symptom severity was scored with the Dysfunctional Voiding Scoring System and classified as very mild, mild, Drmoderate, or severe.

About half of the group (21) had very mild or mild symptoms, while the remainder had symptoms scored as moderate or severe.

None of the children with mild scores were exposed to secondhand smoke on a daily basis, and none had mothers who smoked. However, 23% of those with moderate to severe scores had mothers who smoked, and 50% were exposed to smoke in a car on a regular basis.

"On our measures of environmental tobacco smoke exposure, children with greater exposure had significantly higher symptom severity scores than children who weren’t exposed," Dr. Johnson said. "This relationship was particularly striking for the younger children aged 4-10 years old."

Physicians who see children with bladder dysfunction should ask parents about smoke exposure, she advised – not only because of its effect on the current problems, but because of its proven dangers as the child grows up.

"Tobacco smoke contains chemicals that are known bladder irritants in both children and adults, and European studies have shown a strong relationship between adult bladder cancer and childhood tobacco smoke exposure.

The discussion of a child’s urinary symptoms provides a very good opportunity to speak to parents about smoking cessation, she added.

"It’s a teachable moment," that can have a long-lasting positive impact on both the child and the parent. "Unlike other risky behaviors, which affect only the person who engages in them, smoking poses substantial health risks to those not involved in the process," she said.

Dr. Johnson said she had had no relevant financial disclosures.