UCSF researchers say societal control of sugar needed, similar to alcohol, tobacco.

Sugar should be controlled like alcohol and tobacco to protect public health, according to a team of UCSF researchers, who maintain in a new report that sugar is fueling a global obesity pandemic, contributing to 35 million deaths annually worldwide from non-communicable diseases like diabetes, heart disease and cancer.

Non-communicable diseases now pose a greater health burden worldwide than infectious diseases, according to the United Nations. In the United States, 75 percent of health care dollars are spent treating these diseases and their associated disabilities.

In the Feb. 2 issue of Nature, Robert Lustig, M.D., Laura Schmidt, Ph.D., M.S.W., M.P.H., and Claire Brindis, D.P.H., colleagues at the University of California, San Francisco, argue that sugar’s potential for abuse, coupled with its toxicity and pervasiveness in the Western diet, make it a primary culprit of this worldwide health crisis.

This partnership of scientists trained in endocrinology, sociology and public health took a new look at the accumulating scientific evidence on sugar. Such interdisciplinary liaisons underscore the power of academic health sciences institutions like UCSF.

Sugar, they argue, is far from just “empty calories” that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones and causes significant damage to the liver — the least understood of sugar’s damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.

Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, Lustig, Schmidt and Brindis argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40 percent of people with metabolic syndrome — the key metabolic changes that lead to diabetes, heart disease and cancer — are not clinically obese.

“As long as the public thinks that sugar is just ‘empty calories,’ we have no chance in solving this,” said Lustig, a professor of pediatrics in the division of endocrinology at the UCSF Benioff Children’s Hospital and director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.

“There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates,” Lustig said. “But sugar is toxic beyond its calories.”

Limiting the consumption of sugar has challenges beyond educating people about its potential toxicity. “We recognize that there are cultural and celebratory aspects of sugar,” said Brindis, director of UCSF’s Philip R. Lee Institute for Health Policy Studies (IHPS). “Changing these patterns is very complicated.”

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UCSF professor emeritus was 84.

John Hutchinson

John Corrin Hutchinson, M.D., or “Hutch” to many, UC San Francisco professor emeritus and Distinguished Fellow of the American College of Cardiology, passed away peacefully on Jan. 14, 2012. He was 84.

Hutchinson was born in Minneapolis, the son of a physician and naval officer. He attended the Blake School in Minnesota, and went on to receive both his undergraduate degree in Physics and M.D. degree from Harvard University in 1954. He completed his internship and residency at the University of Minnesota. Hutchinson served as the assistant medical director of the Cardiopulmonary Lab, U.S. Naval Hospital in Chelsea Massachusetts from 1959 to 1961.

Hutchinson came to UCSF in 1961 as a USPHS trainee in cardiology at the Cardiovascular Research Institute (CVRI), and was a research fellow at the CVRI from 1964 to 1965. He was an assistant clinical professor of medicine and surgery at UCSF from 1964 to 1975, and a clinical professor of medicine and surgery at UCSF, from 1975 until his retirement.

His promotion to associate clinical professor stemmed from his serving as the liaison cardiologist to the Division of Cardiac Surgery. As the cardiologist associated with the cardiac surgery team, he operated the bypass pump during open heart surgery, was responsible for pre- and post-operative care, and taught not only the medical students and medical house staff, but the surgical house staff as well.

Uniformly over the years, students, residents, nurses and peers evaluated Hutchinson’s teaching and his professional competence in the highest possible terms. Because of his contributions to the Cardiac Surgery Division, he ultimately received a joint appointment with medicine and surgery.

Hutchinson published numerous articles in the Journal of Thoracic and Cardiovascular Surgery, Lancet, American Journal of Surgery, Circulation, and contributed a chapter in “The Handbook of Surgery.”

Hutchinson wrote, in part, for the Harvard 50^th Anniversary Report:

“I’m semi-retired from my activities at University of California, San Francisco, where I have been a clinical professor of medicine and surgery. Five years ago we moved from San Francisco to Sausalito, where we have a grand view of sky, water and maritime traffic. Our four children are all nearby, so we see them often.

Retirement invites new personal developments. Here in Sausalito we have a great place to sail, which I enjoy with its beauty and simplicity. I sing with the wonderful San Francisco Choral Society and enjoy the perpetual search for artistic excellence. After sixty years of singing, I am taking voice lessons and am still getting better.

Many of us in medicine see health care going down the tubes. Someone needs to step us to the plate and lead us out of the mess. Monetarization is draining the ethical blood out of the historically charitable profession.”

Hutchinson is survived by his wife, four children and four grandchildren.

Donations in his memory can be made to the UCSF Department of Cardiology.

UC Davis’ new arrhythmia technology heals young hearts with minimal downtime.

Teenager Jordan Marshall is back on the football field after specialized treatment at UC Davis Medical Center for an irregular heart beat.

When friends describe 14-year-old Jordan Marshall, one word almost certainly leaves their lips: football. The high school freshman, who lives in Sacramento, is drawn to the game the same way that his more sedentary peers are drawn to YouTube or “Angry Birds.” Whether he’s playing tight end, running back or safety, football is a fixation that stokes his soul.

But a shocking incident in August 2010 meant that Jordan had to rethink his goal of playing college football. His mother, Kim Marshall, knew something was dreadfully wrong when she noticed a thicket of parents and players on the sidelines as she was making her way to her son’s game, minutes after it had started.

“Someone said, ‘Who’s here for Jordan?’ and I saw my son sitting with his face in his hands complaining that he couldn’t breathe. His heart was beating so fast, you could see the palpitations in his chest,” she recalled.

Putting football on hold

Marshall, who works as a medical claims analyst, shook off the terror that she realized could immobilize her and morphed into what she calls “capable mom mode.” Someone suggested calling 9-1-1, but she knew it would be quicker to take him herself to the hospital, a five-minute drive away.

At the ER, Marshall felt like a character in a TV hospital drama. Doctors and nurses surrounded them, gloved hands touched and probed, an IV was hooked up and monitors beeped. Jordan’s heartbeat remained high, until a heart-slowing medication entered his system via his IV. Almost immediately his heartbeat plunged from 210 beats per minute to a healthy 89.

Jordan was discharged and, after an appointment with a pediatric cardiologist and a few more tests, it was confirmed that he had a condition known as arrhythmia, which can cause his heart to beat too fast. Untreated, arrhythmia can be life-threatening. Football, Jordan was told, had to be put on hold.

Two weeks later, Jordan was referred to UC Davis Medical Center, where he met Jeanny Park, a pediatric cardiologist who specializes in diagnosing and treating irregular heartbeats. Park cleared Jordan to play football after prescribing a beta blocker, which relaxes blood vessels and slows heart rate to improve blood flow.

The latest technology for treating arrhythmia

Park also had a suggestion. UC Davis had recently installed a system called Stereotaxis that helps identify and resolve problems with electrical pathways in the heart. After inserting ultra-thin catheters into blood vessels in the groin, physicians use a computer system to navigate the catheters to the heart. Small cameras then project images of the heart’s delicate architecture on a large-scale monitor, allowing easier visualization of the sources of arrhythmia. Stereotaxis is more precise and, because the catheters are magnet driven, involves less X-ray exposure than traditional systems.

Jordan, Park said, could be a good candidate for the procedure.

“Beta blockers work well for most adults but are not ideal for adolescents,” said Park. “Young people do not like to take pills every day for the rest of their lives, and some patients unintentionally skip a dose. Side effects can include tiredness and depression. In patients like Jordan, they can take the edge off their competitiveness, which is not desirable for a football player.”

Jordan and his mother agreed to the procedure at UC Davis, the only medical center in California currently using this technology for pediatric arrhythmia patients. During Jordan’s procedure, Park was able to identify the specific area of abnormal electrical activity in Jordan’s heart – a “Eureka” moment.

“It was located along a portion of one of the heart valves that can be very difficult to map and that would have been extremely challenging to find and fix without this technology,” said Park.

Using radiofrequency energy, she eliminated the tissue causing the faulty electrical pathway.

“Jordan had the procedure on a Wednesday morning,” said Marshall, who is also the mother of 9-year-old Jayden. “He was discharged on Thursday, and on Saturday he was playing football again.”

Park was at medical school when children with Jordan’s diagnosis sometimes had to undergo open-heart surgery. She has since witnessed the metamorphosis to a host of less-invasive interventions that have greatly expanded treatment options for cardiac patients. She was not surprised that Jordan was back on the football field so quickly.

“It can be unsettling for parents to see their children running around so soon, but this is a relatively safe procedure with a low risk for complications,” she said.

As for Jordan, his focus is not on his heart but on his game.

“When I learned I might not ever play football again, I was mad and scared,” he said. “There is no other activity that is more meaningful to me. Football is me and it cannot be replaced.”

UC Irvine center explores, extols health benefits of exercise in childhood.

Dan Cooper, UC Irvine

Dr. Dan Cooper believes that exercise can be the best medicine — so much so that he’s studying how specifically designed exercise programs for at-risk kids can help curb excessive weight gain, fight diseases and foster long-term fitness.

With childhood obesity and asthma emerging as national health crises, Cooper in 2006 founded UC Irvine’s Pediatric Exercise Research Center, and over the past six years, it has shed light on the full benefits of physical activity.

At any one time, PERC hosts 15 to 20 studies of how — and how much — exercise works to avert type 2 diabetes, limit asthma attacks, thwart arthritis, prevent cancer, encourage mineralization in growing bones, and improve the quality of life for kids with chronic diseases and congenital disorders.

“Our purpose is to recognize the importance of exercise for health and growth in children,” says Cooper, professor and chair of pediatrics at UCI and director of the Institute for Clinical & Translational Science, which supports PERC efforts. “We’re one of the few centers in the country to focus on this crucial issue.”

He and PERC’s associate director, gymnast Shlomit Aizik, maintain that exercise is necessary not only for good childhood health but also to prevent later-in-life maladies such as heart disease and stroke.

Cooper was one of the principal investigators for the nationwide Healthy study, which involved healthier cafeteria choices, longer and more intense periods of physical activity, and robust in-school education programs to lower rates of obesity and other risk factors for type 2 diabetes.

Besides its role in overall fitness, exercise also triggers biochemical mechanisms that activate anti-inflammatory cells and important growth factors, Aizik says.

PERC-supported research on these biochemical mechanisms opened the door to understanding the positive influence of physical activity on immune diseases — most commonly asthma and, to a lesser extent, arthritis, which is increasingly seen in obese children — while addressing a pressing question.

“How much exercise is too much?” Cooper says. “Too much can actually worsen these conditions. The challenge is determining the right ‘dose’ of exercise to achieve anti-inflammatory benefits without causing future harm. PE teachers are not trained for this, so we’re establishing programs to help schools properly integrate the correct amount of exercise.”

PERC researchers are also probing the impact of physical activity during key stages of child development. For example, studies show that diet and exercise are linked to proper mineralization in growing bones, which can stave off osteoporosis in middle and old age.

A PERC group is currently looking at the effects of exercise on infants born two to three months early, missing out on a phase of fetal life marked by lots of body-conditioning physical movement. “This is lost when babies are born prematurely, interfering with a critical growth period,” Cooper says.

His team has created an activity program to offset this deficit. It starts, he says, with passive manipulation of a newborn’s arms and legs and progresses over 12 months to include such motions as head lifting and crawling. After a year, researchers will assess the influence of the exercise on body composition, bone mineralization and additional developmental markers.

Another PERC effort — led by Aizik — seeks to increase physical activity among kids with congenital conditions. College students are being trained to engage spina bifida patients at Miller Children’s Hospital Long Beach in exercise.

“Youngsters with disabilities rarely get enough physical activity,” Aizik says. “And studies show that it improves and extends the quality of life for these children. We want to measure the psychological and physiological results of this mentor-based program to see how we can incorporate an appropriate amount of exercise into their lives.”

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By curbing consumption, funding treatment, tens of thousands of lives could be saved.

Kirsten Bibbins-Domingo, UC San Francisco

Every year, Americans drink 13.8 billion gallons of soda, fruit punch, sweet tea, sports drinks, and other sweetened beverages — a mass consumption of sugar that is fueling soaring obesity and diabetes rates in the United States.

Now a group of scientists at the University of California, San Francisco, San Francisco General Hospital and Trauma Center (SFGH) and Columbia University have analyzed the effect of a nationwide tax on these sugary drinks.

They estimate slapping a penny-per-ounce tax on sweetened beverages would prevent nearly 100,000 cases of heart disease, 8,000 strokes, and 26,000 deaths over the next decade.

“You would also prevent 240,000 cases of diabetes per year,” said Kirsten Bibbins-Domingo, M.D., Ph.D., an associate professor of medicine and of epidemiology and biostatistics at UCSF and acting director of the Center for Vulnerable Populations at the UCSF-affiliated SFGH.

In addition to $13 billion per year in direct tax revenue, Bibbins-Domingo and her colleagues estimated that such a tax would save the public $17 billion over the next decade in health care-related expenses due to the decline of obesity-related diseases.

“Our hope is that these types of numbers are useful for policy makers to weigh decisions,” she said.

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Toxicity levels obscured, increasing risks of heart disease, cancer.

A new UC San Francisco analysis of tobacco industry documents shows that Philip Morris USA manipulated data on the effects of additives in cigarettes, including menthol, obscuring actual toxicity levels and increasing the risk of heart, cancer and other diseases for smokers.

Tobacco industry information can’t be taken at face value, the researchers conclude. They say their work provides evidence that hundreds of additives, including menthol, should be eliminated from cigarettes on public health grounds.

The article is published in PLoS Medicine.

In the new, independent study, the scientists reassessed data from Philip Morris’ “Project MIX,” which detailed chemical analyses of smoke and animal toxicology studies of 333 cigarette additives. Philip Morris, the nation’s largest tobacco company, published its findings in 2002.

By investigating the origins and design of Project MIX, the UCSF researchers conducted their own inquiry into the Philip Morris results. They stressed that many of the toxins in cigarette smoke substantially increased after additives were added to cigarettes.

They also found, after obtaining evidence that additives increased toxicity, that tobacco scientists adjusted the protocol for presenting their results in a way that obscured these increases.

“We discovered these post-hoc changes in analytical protocols after the industry scientists found that the additives increased cigarette toxicity by increasing the number of fine particles in the cigarette smoke that cause heart and other diseases,” said senior author Stanton A. Glantz, Ph.D., UCSF professor of medicine and director of the Center for Tobacco Control Research and Education at UCSF.

“When we conducted our own analysis by studying additives per cigarette — following Philip Morris’ original protocol — we found that 15 carcinogenic chemicals increased by 20 percent or more,” he said.

Additionally, in the independent study, the researchers discovered the reason behind Philip Morris’ failure to identify many toxic effects in animal studies: its studies were too small.

“The experiment was too small in terms of the number of rats analyzed to statistically detect important changes in biological effects,” Glantz said. “Philip Morris underpowered its own studies.”

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Devices to track heart-ventricle and pulmonary artery pressure may be particularly promising.

Gregg Fonarow, UCLA

FINDINGS:
Heart failure affects 5.8 million people in the U.S. alone and is responsible for nearly 1 million hospitalizations each year, most resulting from a build-up of body fluid in the lungs and other organs due to the heart’s inability to pump effectively. The disease needs to be closely tracked in order to avoid such hospitalizations, and home-monitoring interventions may be especially useful, UCLA researchers say.

UC Davis’ Vascular and Heart Program is a hub for research, teaching and patient care.

Darlene Hamilton

When Darlene Hamilton of Sacramento developed shortness of breath in the middle of the night at the age of 59, the possibility of a heart problem did not occur to her. Thinking she might be having a bad asthma attack, her husband insisted they go right away to UC Davis Medical Center’s emergency department.

Hamilton doesn’t remember much else until she woke up three days later, after undergoing repair of a severely leaking heart valve.

“Dr. Young saved my life,” she says of J. Nilas Young, chief of cardiothoracic surgery, who performed her surgery. “I love UC Davis!”

Heart disease, strokes and related cardiovascular problems remain the leading causes of death and illness in the United States. For this reason, UC Davis Health System’s 2011– 2016 Strategic Plan identifies cardiovascular care as one of four focus areas for which improvements would greatly benefit individual and population health.

Central to carrying out the goals of the strategic plan is UC Davis’ Vascular and Heart Program, a hub for research, teaching and patient care. The multidisciplinary center — staffed by physicians with expertise in every specialty and subspecialty in cardiology and vascular care — offers personalized, comprehensive treatment services.

Reginald Low, chief of cardiology, takes pride that UC Davis is a recognized national leader in advancing catheter-based innovations.

“New developments in techniques, devices and medications have revolutionized treatment options,” Low says.

Less-invasive technologies are now used to perform a wide variety of procedures, including viewing the interior chambers of the heart and treating leaking valves, irregular heartbeats, coronary artery disease and other conditions.

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Grants will support research on cell mechanics and the genetics of common diseases.

David Segal, UC Davis

The W.M. Keck Foundation has awarded $2 million in grants to the University of California, Davis, for research on cell mechanics and the genetics of common diseases.

Professors Gang-Yu Liu, Department of Chemistry, and Ian Kennedy, Department of Mechanical and Aerospace Engineering, received $1 million to develop a new instrument for measuring the mechanics of single cells and using it to study the toxicity of nanoparticles. Associate professor David Segal, Department of Pharmacology, was awarded $1 million to take a novel approach to identifying genetic changes associated with heart disease.

UC Davis is one of only three institutions to receive grants from the foundation’s medical research program this year, and one of only six institutions to receive grants from the foundation’s science and engineering research program.

Liu and Kennedy will use their grant to develop a microscope that can measure the stiffness and other mechanical properties of individual cells, as well as see activity inside them. The new instrument will combine a confocal microscope, which can focus on layers within a living cell, with an atomic force microscope, which can study surfaces in exquisite detail as well as press a tiny bead against a cell and measure its resistance.

Gang-Yu Liu, UC Davis

“We are very excited to accept this grant and extremely grateful to the Keck Foundation for this and past support,” said Winston Ko, dean of the Division of Mathematical and Physical Sciences in the College of Letters and Science.

The foundation’s total philanthropic support to UC Davis exceeds $7.9 million, including previous major grants to faculty to support work on the Large Synoptic Survey Telescope in Chile and the Keck Center for Active Visualization in Earth Sciences, housed at UC Davis.

“I have every reason to believe that professor Liu’s research will lead to the same level of discovery and innovation,” Ko said.

Liu’s laboratory has already demonstrated the potential of the microscope concept in experiments with nerve cells, which become stiffer when they are affected by the prion proteins related to Alzheimer’s disease. The new instrument will be able to test a wider range of cell types and incorporate other features that make it easier to use with live cells, Liu said.

Liu and Kennedy now plan to use the microscope to test whether early signs of damage to endothelial cells — which line the blood vessels and airways, for example — show up as changes in the cells’ mechanical properties. The experiments will use novel nanoparticles made by Kennedy’s lab, which combine tiny particles of metal oxides — similar to particles that are widespread in the environment, and that are also becoming common in products such as sunscreens — with gold or other elements that allow the particles to be tracked within cells.

The new microscope will help to answer questions that are difficult to address with current technology. Zinc oxides, for example, are used in some sunscreens and also occur naturally in the environment. There is some evidence that they can cause damage to cells, but no clear scientific consensus about how serious the problem is, Kennedy said.

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People tend to delay care this time of year, even if they have symptoms, UCSF doctor says.

People tend to delay care around the holidays, says Dr. Steven Polevoi of UCSF.

Steven Polevoi, M.D., has seen it all.

During his 23-year career, the medical director of the UCSF Emergency Department has done everything from treat traumatic injuries to deliver babies. While medical emergencies occur throughout the year, Polevoi sees the winter season and its related overindulgence as a pivotal time for preventing emergencies by listening to our bodies.

“People tend to delay care around the holidays,” said Polevoi, whose emergency medicine team treats about 3,000 patients every month. “They may have symptoms of cardiovascular disease such as abdominal or chest discomfort which they interpret as indigestion or overeating, but in fact it could be cardiac ischemia.”

Cardiac ischemia — which could lead to a heart attack — occurs when blood flow and oxygen to the heart are dramatically reduced by narrowing of the coronary arteries. Symptoms include discomfort in the upper abdomen or chest that is often described as a heavy sensation or pressure, like “an elephant sitting on my chest.”

“You meet the patient and they tell you their story,” Polevoi said. “You say, ‘Why didn’t you come sooner?’ and they say, ‘Well, I was traveling or I was having a party.’ These can be subtle symptoms patients interpret as something other than a serious condition.”

People can sometimes confuse a serious heart condition with acid reflux or heartburn – especially around the time of holiday feasting — because the symptoms are similar.

Heart-related deaths increase by 5 percent during the holiday season. Fatal heart attacks peak on Christmas, the day after Christmas, and New Year’s Day, according to a national Circulation study published in 2004.

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Procedure may stop “flight-or-fight” stress response impacting heart.

Kalyanam Shivkumar, UCLA

What do sweaty palms and abnormal heart rhythms have in common? Both can be initiated by the nervous system during an adrenaline-driven “flight-or-fight” stress reaction, when the body senses danger.

Hyperhidrosis, an abnormal flight-or-fight response of the sympathetic nervous system that causes excessively sweaty palms may also contribute to problems like dangerous irregular rhythms from the lower chambers of the heart, known as ventricular arrhythmias.

UCLA cardiologists have now found that surgery to snip nerves associated with the sympathetic nervous system on both the left and right sides of the chest may be helpful in stopping dangerous, incessant ventricular arrhythmias — known as an “electrical storm” — when other treatment methods have failed. This same type of surgery has been used for years to alleviate hyperhidrosis.

The UCLA team’s findings are reported in the Dec. 27–Jan. 3 issue of the Journal of the American College of Cardiology. The study is one of the first to assess the impact of bilateral cardiac sympathetic denervation (BCSD), surgery on both sides of the heart, to control arrhythmias. The research builds on previous work at UCLA in which a similar procedure was performed only on the left side. But for some patients to obtain relief, the researchers said, it must be done bilaterally.

Many people suffer from ventricular arrhythmias, one of the leading causes of death in the U.S. (400,000 deaths per year). These arrhythmias can usually be controlled by using medications, an implantable cardioverter defibrillator that automatically shocks the heart back into normal rhythm, or a procedure called catheter ablation, which involves a targeted burn to the tiny area of the heart causing the irregular heart beat.

“When these treatment options fail, especially for a patient experiencing a life-threatening electrical storm, the situation becomes critical,” said the study’s senior author, Dr. Kalyanam Shivkumar, director of the UCLA Cardiac Arrhythmia Center and co-director of the Oppenheimer Family Center for Neurobiology of Stress at UCLA. “We are always seeking additional options to help patients.”

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Finding by UC Irvine team could help prevent cardiovascular complications.

N.D. Vaziri, UC Irvine

UC Irvine researchers have uncovered an important source of inflammation seen in people with chronic kidney disease, which is increasingly common due to the epidemic of obesity-related diabetes and hypertension.

Dr. N.D. Vaziri, professor emeritus of medicine and physiology & biophysics, found that CKD causes massive depletion of the key adhesive proteins, called the tight junction, that normally seal the space between the cells lining the intestines. This breakdown in the colon allows the leakage of microbial products and other noxious material into the body’s internal environment, accounting for the persistent systemic inflammation that frequently occurs in CKD patients.

“In fact, low levels of bacterial endotoxins are often noted in the blood of individuals with advanced chronic kidney disease,” Vaziri said. “However, the source and place of entry of these toxins were previously unknown.”

Understanding the connection between CKD and tight junction disintegration, he added, could lead to novel treatments to curb this inflammation and its many adverse consequences. Study results appear online in the journal Nephrology Dialysis Transplantation.

It’s estimated that nearly 25 million people in the U.S. have CKD, and more than 400,000 have end-stage kidney disease requiring dialysis. Many CKD patients develop accelerated cardiovascular disease — the primary cause of premature death in this population — linked to persistent inflammation.

“The relentless inflammation seen in chronic kidney disease has devastating effects on the cardiovascular system and other parts of the body,” Vaziri said.

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