tbuckley/cabot-search huggingface dataset:
Abstract P2-01-04: Use of axillary ultrasound impacts outcome of node positive breast cancer patients
Authors: NC Verheuvel, AC Voogd, VCG Tjan-Heijnen, RMH Roumen
Journal: Cancer Research (2017)

Abstract Background The Z0011 trial initiated a paradigm shift in the treatment of axillary node positive breast cancer patients. Treatment strategy, however, starts with the information gathered by the diagnostic axillary work up. This can either be done by sentinel lymph node biopsy (SLNB) or ultrasound guided lymph node biopsy (UGLNB). We examined whether there are relevant clinical and prognostic differences between patients found node positive by these two diagnostic selection processes. Methods Patients diagnosed with invasive breast cancer in the Netherlands between January 2000 and December 2013 were studied. Patients with no clinically palpable lymphadenopathy (cN0) and node-positive disease after an axillary lymph node dissection (ALND) were included. Patients with stage IV breast cancer, with clinical stage T3-T4 breast tumor according to the TNM-classification, those treated within the neo-adjuvant setting, patients with palpable axillary nodes (cN≥1) and patients who did not undergo an ALND were excluded. Results A total of 14,730 patients fulfilled the inclusion criteria, of whom 9,448 were included in the SLNB group and 5,282 in the UGLNB group. Patients in the UGLNB group were older at diagnosis (p&amp;lt;0.001), had larger tumors (p&amp;lt;0.001), a higher tumor grade (p=0.001), and were more likely to have a negative hormonal receptor status (p&amp;lt;0.001) and to undergo a mastectomy (p&amp;lt;0.001). Patients in the UGLNB group were also more likely to have ≥3 positive axillary lymph nodes (p&amp;lt;0.001) and, after adjustment for these differences, had a worseoverall survival (HR=1.64; 95% CI=1.53-1.75) compared to the node-positive patients in the SLNB group. Conclusion Our multicenter study shows that patients with a positive UGLNB have less favorable disease characteristics and a worse prognosis compared to patients with a positive SLNB. The diagnostic selection process plays an important role when axillary treatment strategies are considered. Therefore, we conclude that the conclusions of the Z0011 trial cannot (yet) be applied to patients with a positive UGLNB. Citation Format: Verheuvel NC, Voogd AC, Tjan-Heijnen VCG, Roumen RMH. Use of axillary ultrasound impacts outcome of node positive breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-04.
Sequential salvage chemotherapy for CDDP-refractory advanced testicular cancer: Japanese high-volume center experience.
Authors: Terukazu Nakamura, Yasunori Kimura, Takashi Ueda, Yoshio Naya, Fumiya Hongo, Tsuneharu Miki
Journal: Journal of Clinical Oncology (2013)

e15526 Background: Chemotherapy- refractory or resistant GCTs, so called ‘difficult-to-treat’ GCTs would remain continuously disease-free with salvage chemotherapy or surgery. The optimal salvage chemotherapy remains unclear. The aim of this study was to assess the efficacy of ‘sequential’ chemotherapy for advanced testicular cancer. Methods: Salvage chemotherapy was required in 129 patients out of 233 advanced GCTs treated at Kyoto Prefectural University of Medicine from June, 1998 to December, 2011. Clinical outcomes were retrospectively assessed. Results: Median age was 31 year-old (range:17-65y.o.). Non-seminoma was in 111 cases (86.0%). IGCCC showed good in 37 cases (28.9%), intermediate 33 (25.6%), poor 47 (36.4%), and unknown 12 (9.1%). As the 2 nd line therapy, VIP/VeIP and TIP/N therapy were done in 43 (33.3%) and 49 cases (38.0%), respectively. With regard to the patients requiring 3 rd line or more chemotherapy, 95, 67, 40, 26 cases had 3 rd , 4 th , 5 th and 6 th line or more chemotherapy, respectively. TIN therapy was performed in 48 patients as 3 rd line and in 24 patients as 4 th line. Irinotecan-containing chemotherapy was done in 24 and 36 cased as 2 nd +3 rd line therapy and 4 th line or more, respectively. Gemcitabine-containing therapy was done in 33 cases with 3 rd line or more chemotherapy. Overall survival rate at median follow-up period was 71.0%at median follow-up of 48m. Overall survival stratified by IGCCC was shown in the figure. There was no significant difference between any two groups. Clinical outcomes showed no evidence of disease (NED) was obtained in 86.1% with second line therapy. Noteworthy mentioned, about 40% patients had NED even in the 4 th line or more chemotherapy group. Conclusions: Relatively good prognosis was obtained in the patients with salvage chemotherapy at Japanese high volume center. Sequential continuous chemotherapy would be very important to manage ‘difficult-to-treat’ advanced germ cell tumors.
Retraction: PM02734 (Elisidepsin) Induces Caspase-Independent Cell Death Associated with Features of Autophagy, Inhibition of the Akt/mTOR Signaling Pathway, and Activation of Death-Associated Protein Kinase
Authors: Yi-He Ling, Miguel Aracil, Yiyu Zou, Ziqiang Yuan, Bo Lu, José Jimeno, Ana Maria Cuervo, Roman Perez-Soler
Journal: Clinical Cancer Research (2013)

Caspase-Independent Cell Death Associated with Features of Autophagy, Inhibition of the Akt/
Comparison of [<sup>99m</sup>Tc] tilmanocept and [<sup>99m</sup>Tc] sulfur colloid for identification of sentinel lymph nodes in clinically node-negative breast cancer patients.
Authors: Jennifer L. Baker, Minya Pu, Christopher A. Tokin, Karen Messer, Carl Hoh, David R. Vera, Anne M. Wallace
Journal: Journal of Clinical Oncology (2013)

11098 Background: Receptor-targeted (CD206) [ 99m Tc] tilmanocept is a radiopharmaceutical specifically engineered for sentinel lymph node (SLN) identification that has recently completed phase III clinical trials. The agent has been compared to vital blue dye in prior studies, but has not yet been compared to radio-labeled sulfur colloid. We compared the performance of [ 99m Tc]tilmanocept vs. filtered [ 99m Tc]sulfur colloid (fTcSC) in two cohorts of clinically node-negative breast cancer patients (BCP) who underwent SLN mapping at a single institution. Outcomes were degree of SLN localization and % positive nodes among those removed. Methods: The [ 99m Tc]tilmanocept cohort was composed of UCSD-specific patients pooled from two phase III clinical trials (Jun 2008-Jun 2009, Jul 2010-Apr 2011); the fTcSC cohort was composed of consecutive BCP undergoing SLN mapping at UCSD (Mar 2011-Feb 2012). Demographic, lymph node-specific, and cancer characteristics were compared between groups. A zero-inflated binomial model compared %-positive nodes among nodes removed. Results: There were 85 vs.120 patients in the [ 99m Tc]tilmanocept and fTcSC cohorts, respectively. The groups did not differ in demographic or clinicopathologic factors predictive of axillary metastatic disease (age, race, cancer stage, histologic subtype and grade, hormone and HER2-Neu status or presence of lymphovascular invasion). The [ 99m Tc]tilmanocept group had significantly fewer SLNs removed (mean 1.9 vs. 3.9, p&lt;0.001), achieved higher gamma counts/node (28 vs. 1.6 kcps, p&lt;0.001), and detected a significantly higher percent of tumor-positive SLNs (73% vs. 49%, p=0.016) while identifying the same rate of node-positive patients (24% vs. 18%, p=0.4). Conclusions: [ 99m Tc]Tilmanocept identified the same rate of node positive patients and removed fewer SLNs compared to fTcSC among BCP with similar risk of axillary metastatic disease. These data suggest that [ 99m Tc]tilmanocept more precisely targets true SLNs and may minimize morbidity while maintaining or improving the accuracy of axillary staging in clinically node-negative breast cancer patients.
FLT3 Splice Variant (FLT3Va) As a Potential Immunotherapeutic Target in Patients with Acute Myeloid Leukemia (AML)
Authors: Sophia Adamia, Jeffrey Nemeth, Shruti Bhatt, Sarah R Walker, Natalie I Voeks, William Lento, Ricardo M. Attar, Ilene Galinsky, David A Frank, Martha Wadleigh, Anthony Letai, David P. Steensma, David M. Weinstock, Daniel J. DeAngelo, David M. Dorfman, Richard M. Stone, James D Griffin
Journal: Blood (2016)
COMPARISON OF VERY LATE VASCULAR RESPONSE BEYOND 2 YEARS AFTER STENT IMPLANTATION BETWEEN EES AND BES: AN OCT SUB-STUDY OF THE NEXT
Authors: Yosuke Katayama, Takashi Kubo, Takashi Akasaka, Akira Taruya, Tsuyoshi Nishiguchi, Yuichi Ozaki, Akio Kuroi, Ikuko Teraguchi, Takashi Yamano, Tomoyuki Yamaguchi, Yasushi Ino, Hironori Kitabata, Yoshiki Matsuo, Takeshi Hozumi, Atsushi Tanaka, Takeshi Kimura
Journal: Journal of the American College of Cardiology (2017)
ESTUDIO PROSPECTIVO DE LAS GASTROSCOPIAS URGENTES REALIZADAS POR INGESTA DE CUERPO EXTRAÑO E IMPACTACIÓN ALIMENTARIA EN EL HOSPITAL “12 DE OCTUBRE” DE MADRID
Authors: F Garrido Gallego, M Algara San Nicolas, L Santos Santamaría, M Ortiz Durán, M Pérez Carreras, S Rodríguez Muñoz, G Castellano Tortajada
Journal: Endoscopy (2015)

La ingesta de cuerpos extraños e impactación alimentaria (CE-IA) son motivos frecuentes de consulta en los Servicios de Urgencias.
USE OF DABIGATRAN ETEXILATE TO PREVENT STROKE AND THROMBOEMBOLISM IN PATIENTS UNDERGOING LEFT ATRIAL CATHETER ABLATION PROCEDURES FOR PAROXYSMAL OR PERSISTENT (NON-PERMANENT) ATRIAL FIBRILLATION AND LEFT ATRIAL FLUTTER
Authors: Christopher R. Ellis, Moore Shoemaker, Arvindh Kanagasundram, George Crossley, Juan Estrada, Sharon Shen, Pablo Saavedra, Sherry Bowman, Sean Whalen
Journal: Journal of the American College of Cardiology (2017)
PATIENT CHARACTERISTICS AS PREDICTORS OF TRANSRADIAL APPROACH FAILURE DURING CORONARY ANGIOGRAPHY PROCEDURES
Authors: Amornpol Anuwatworn, Alexander Pham, Jimmy Yee, Shenjing Li, Vishesh Kumar, James Higgins, Terezia Petraskova, Julia Stys, Paul Thompson, Adam Stys, Tomasz Stys
Journal: Journal of the American College of Cardiology (2017)
A subgroup analysis of small lymphocytic and marginal zone lymphomas in the Eastern Cooperative Oncology Group protocol E4402 (RESORT): A randomized phase III study comparing two different rituximab dosing strategies for low tumor burden indolent non-Hodgkin lymphoma.
Authors: Michael E. Williams, Fangxin Hong, Brad S. Kahl, Randy D. Gascoyne, Lynne I. Wagner, John C. Krauss, Sandra J. Horning
Journal: Journal of Clinical Oncology (2012)

8007 Background: Management of low tumor burden (LTB) indolent lymphoma in the rituximab (R) era is uncertain. We hypothesized that R could delay the need for chemotherapy and that maintenance R (MR) would be superior to R retreatment (RR) at progression. E4402 is a randomized phase III study comparing MR and RR for previously untreated, LTB (by GELF criteria) small lymphocytic lymphoma (SLL), marginal zone lymphoma (MZL) and FL. Results for the FL subset was previously presented (Kahl, et al. Blood 2011; 118(21): LBA 6); we now report outcomes for the non-FL patients (pt). Methods: Pt received R 375 mg/m 2 weekly x 4, with responders randomized to MR (1 dose R q 3 mo) or RR (R q wk x 4 at progression), each continued until treatment failure. The primary endpoint, time to treatment failure (TTTF), was defined as progression within 6 mo of last R, no response to RR, initiation of alternative therapy, or inability to complete protocol therapy. Pt were evaluated q 3 mo, with CT scans q 6 mo. Secondary endpoints: time to first cytotoxic therapy (TTCT), quality of life (QOL) and safety. Results: From 11/03 to 9/08,137 non-FL pt were enrolled. Complete or partial response was achieved in 57 (41%), who were randomized to MR (n=32) or RR (n=25). 136 pt were stage III-IV (1 IE), and all had PS 0-1; for MR vs RR, median age 66 vs 64, and M:F 47:53% vs. 28:72%, respectively. The mean no. of R doses/pt (incl. 4 induction doses) was 17.9 (range 5- 30) for MR and 5.8 (range 4-12) for RR. With a median follow-up of 4.3 yr, TTTF was 3.74 yr for MR vs. 1.07 yr for RR (p=.0002; HR 4.95). At 3 yr, 100% of MR vs. 70% of RR pt (p=.0002) remained free of cytotoxic therapy. Grade 3-4 toxicities occurred in 2 MR pt, 1 neutropenia and 1 encephalopathy. Conclusions: A planned subgroup analysis of non-FL pt showed significant benefit in TTTF and TTTC for MR but with 2 grade 4 toxicities. This differs from the FL pt in this trial, for whom response to induction was higher (70 vs. 41%; p&lt;.0001) and where no TTTF benefit was observed with MR. LTB non-follicular indolent lymphoma pt who achieve a CR or PR to induction R benefit from MR therapy.
Prospective-retrospective analysis of a novel blood-based combinatorial biomarker assay (liquid biopsy) in 859 patients to demonstrate the benefit of combining biomarker data with imaging to differentiate benign breast lesions from invasive breast cancer in women.
Authors: David Emery Reese, Kasey Benson, Michael Silver, Sherri Borman, Meredith C. Henderson, Rao Mulpuri, Christa Corn
Journal: Journal of Clinical Oncology (2015)

e22260 Background: Radiologists often experience difficulty in differentiating benign lesions from invasive breast cancers in patients assessed as BIRADS 3 or 4. Thus, a diagnostic test that would provide biochemical evidence to increase confidence in the patient’s clinical course is needed. Here, we present the a combinatorial biomarker panel for use in conjunction with imaging that increases the precise distinction between benign lesions and breast cancer. Methods: We have conducted two independent, multi-center, prospective clinical trials to establish the clinical validity of a breast cancer biomarker assay that uses a combination of Serum Protein Biomarkers (SPB), Tumor-Associated Autoantibodies (TAAb) with patient specific data to differentiate patients with benign breast disease from those with invasive breast cancer (IBC). Panels of biomarkers and associated algorithms were developed using prospectively collected samples from women under age 50 (n = 351) and from women ages 25-75 (n = 508). Results: The combination of the 001 and 002 trial data sets followed by multiple rounds of cross-validation resulted in a more sensitive and specific breast biomarker assay. Importantly, the ability to distinguish between benign and IBC/DCIS was not affected by breast density in either patient population. Conclusions: We note that breast biopsy decision making would benefit from the addition of blood-based biomarker testing. Given the high negative-predictive value of the biomarker test, a negative biomarker test can be interpreted as the patient being likely to have a benign condition. While the use of blood-based biomarker testing can never supersede breast imaging as a screening modality, it can provide additional biological information for patients with questionable lesions discovered on imaging. The combination of blood-based biomarker testing with traditional imaging can help improve diagnostic accuracy and patient follow-up, and likely reduce the number of biopsies performed. Clinical trial information: NCT02078570.
HEART-FEMORAL PULSE WAVE VELOCITY IS A STRONGER MARKER OF ARTERIAL AGING THAN CAROTID-FEMORAL PULSE WAVE VELOCITY
Authors: Timothy S. Phan, Amer Ahmed Syed, Harry Garrett Oldland, Nicolas Sanchez, Zeba Hashmath, Scott R. Akers, Julio A. Chirinos
Journal: Journal of the American College of Cardiology (2017)
Phase I/Ib clinical and immunologic assessment of immunotherapeutic vaccine, DPX-Survivac in women with ovarian, Fallopian tube, or peritoneal cancer (OC).
Authors: Michelle Wilson, Jeannine A. Villella, Neil Lorne Berinstein, Jennifer Brown, Stephanie Lheureux, Anna Haley, Kunle Odunsi, Mohan Karkada, John J. Nemunaitis, Michael Morse, Tanja Pejovic, James Bentley, Genevieve Weir, Lisa MacDonald, Leeladhar Sammatur, Marianne Stanford, Tomasz Burzykowski, Rita Nigam, Marc Mansour, Amit M. Oza
Journal: Journal of Clinical Oncology (2014)

5555 Background: Survivin plays a key role in apoptosis, proliferation and angiogenesis. It is overexpressed in 90% of epithelial OC making it an attractive target. Increases in expression have been correlated with progression and drug resistance. DPX-Survivac is a vaccine containing a mix of survivin HLA class I peptides designed to evoke a cytotoxic T cell response against survivin. This Phase I/Ib de-escalation study reports the safety and immune potency of DPX-Survivac in combination with metronomic low dose oral cyclophosphamide (CPA) in OC. Methods: 30 Stage IIc-IV advanced or recurrent OC patients (pts) with no evidence of disease progression post chemotherapy were enrolled. Dose limiting toxicities (DLT) were defined as ≥gd3 AEs, ≥gd2 allergic or autoimmune reactions by CTCAE v4.03. Immune correlates (MDSCs; T regs; B cells) and vaccine induced T cell immunity (ELISpot; tetramer analysis; multi-parametric intracellular cytokine staining) were assessed in purified PBMC and blood. Clinical response was evaluated by RECIST and CA125. Results: No significant systemic AEs were seen. The most severe local injection site reactions were gd 3 skin ulcerations with 2 in cohort C. Phase Ib cohorts were de-escalated to 2 priming doses (0.25ml) 3 wks apart followed by boosters (0.1ml) every 8 wks with CPA. Immune response increased with dose (B vs. C p=0.013) and with use of CPA (A vs. C p=0.015). Despite de-escalation 6/6 pts in cohort 1 mounted a significant immune response by d77 with 1 gd 3 skin ulceration seen. In this cohort a PR by RECIST1.1 and GCIG CA125 criteria was confirmed in 1 pt with residual disease post platinum therapy and persisted on stopping vaccine and CPA. The PR correlated with a robust immune response verified by IFN-γ ELISpot and MHC tetramer assay. Conclusions: DPX-Survivac is well tolerated with proven immunogenicity. Early evidence of clinical activity is promising. A randomized phase II trial to assess vaccine efficacy in OC will commence in 2014. Clinical trial information: NCT01416038. Ph Cohort Pts (n) CPA Priming DPX Boost DPX (0.1mL) Skin ulceration Dose (ml) n Freq wks n Freq wks Gd n I A 6 N 0.5 3 3 0 0 2 1 B 6 Y 0.1 3 3 0 0 3 1 C 6 Y 0.5 3 3 0 0 3, 2 2, 1 Ib 1 6 Y 0.25 2 3 4 8 3 1 2* 6 Y 0.25 2 3 4 8 n/a n/a *recruited.
Prescriptions for adrenaline devices in children are rising faster than anaphylaxis
Authors: Zosia Kmietowicz
Journal: BMJ (2017)

Researchers have called for clarity on when adrenaline auto injectors (AAIs) should be prescribed for children with allergies and how many devices they should be given after finding that prescriptions have been rising faster than the incidence of anaphylaxis.

The doctors and health economists from the University of Birmingham identified 23 837 children in a general practice database as being at high risk of anaphylaxis and scrutinised the prescriptions they were given between 2000 and 2012. They reported the results in the British …
TIMELY DETECTION OF PULMONARY ARTERIAL HYPERTENSION IN PATIENTS WITH REPAIRED CONGENITAL HEART DISEASE: INTERIM RESULTS FROM THE ACHD-QUERI REGISTRY
Authors: Michael Landzberg, Curtis Daniels, Paul Forfia, Anatoly Langer, Vallerie McLaughlin, Mona Selej, Marjan Sepassi, Mary Tan, Gary Webb
Journal: Journal of the American College of Cardiology (2017)
TEL/PDGFβR Tyrosine Kinase Fusion Specifically Activates Myeloid Differentiation Programs, and Converts Lymphoid Progenitors into the Myeloid Lineage.
Authors: Hirokazu Shigematsu, Hiromi Iwasaki, Shin-ichi Mizuno, David W. Sternberg, Brian J.P. Huntly, D. Gary Gilliland, Koichi Akashi
Journal: Blood (2004)
TRENDS IN PREVALENCE AND IN-HOSPITAL MORTALITY OF NSTEMI PATIENTS WITH SOLID TUMOR CANCER: THE NATIONWIDE ANALYSIS FROM 1998-2013
Authors: Parshva Patel, Subir Bhatia, Shilpkumar Arora, Kanishk Agnihotri, Abhishek Deshmukh
Journal: Journal of the American College of Cardiology (2017)
Evaluation of the role of confirming responses in clinical trials in oncology
Authors: J. L. Perez-Gracia, M. Muñoz, J. Wu, E. Carrasco, I. Garcia-Ribas, A. Peiro, J. Blatter
Journal: Journal of Clinical Oncology (2004)

6070 Background: Response confirmation is required by all guidelines for response assessment in clinical trials in oncology, even though its rationale is not based on any experimental data and has not even been tested. Since confirmation requires to repeat imaging techniques and is associated with practical inconveniences, we conducted this study to determine if confirmation of response adds any value over assessing response based on the first evaluation of best response. Methods: To avoid selection bias, all the trials performed to assess the efficacy of one novel chemotherapeutic agent in different tumor types, used as single agent or in combination, were selected. Nine trials including 416 patients were identified. Response rates determined only by the first assessment of the best response observed in each patient were compared with response rates determined after response was confirmed. An estimate of the agreement between both methods was obtained using the Kappa coefficient. Results: 81 responses (19.5%) were observed when confirmation was required, as compared with 97 responses (23.3%) when only the first assessment was used. The increase in response rate when confirmation was not done was 3.9% (2.1%–6.6%). Global agreement between both methods for all trials according to the Kappa coefficient was 0.89, reflecting an almost perfect agreement (Landis, Biometrics 1977). Confidence intervals of response rates obtained by both methods overlapped widely. In 16 patients responding at the first assessment, response was not subsequently confirmed. Only 1 of those patients progressed in the very next cycle, making it possible that response could have been confirmed in the other 15 if imaging techniques had been performed in the minimum interval allowed. Conclusions: Confirmation of clinical responses does not seem to add any value to determination of response rates by assessing the first best response observed. Pending results of confirmatory studies, we suggest that response confirmation seems unnecessary, since it is an expensive and time consuming procedure, and it may potentially increase heterogeneity in results. No significant financial relationships to disclose.
Abstract MP016: Glycated Albumin and Fructosamine May Not Overcome Limitations of HbA1c in the Setting of Chronic Kidney Disease
Authors: Molly Jung, Bethany Warren, Morgan Grams, Diana Kwong, Tariq Shafi, Josef Coresh, Casey Rebholz, Elizabeth Selvin
Journal: Circulation (2017)

Introduction: Alterations in red blood cell turnover in the setting of chronic kidney disease (CKD) may limit the interpretability of hemoglobin A1c (HbA1c) as a measure of diabetic glucose control. Where HbA1c is problematic, glycated albumin and fructosamine have been proposed as better markers of hyperglycemia. We investigated whether the associations of HbA1c, glycated albumin, and fructosamine with fasting glucose and HbA1c varied by CKD stage. Methods: We performed a cross-sectional analysis of 1,678 persons with diagnosed diabetes aged 65 years or older from the Atherosclerosis Risk in Communities Studies (list 5, 2011-2013). We compared Spearman’s rank correlation coefficients and root mean square error (RMSEs) for HbA1c, glycated albumin, and fructosamine with fasting glucose and HbA1c across CKD stages. CKD stages were defined using estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR). Results: Mean age was 76 years, 54% (910 of 1,678) were female, and 29% (479 of 1,678) were black. The associations of HbA1c, glycated albumin, and fructosamine with fasting glucose were weaker (lower correlations and higher RMSEs) in persons with worse kidney function compared to those with preserved kidney function (Table). Both glycated albumin and fructosamine had stronger associations with HbA1c compared to fasting glucose and their associations with HbA1c were relatively similar across CKD stages. Conclusions: In persons with worse kidney function, HbA1c, glycated albumin, and fructosamine were all poorly correlated with fasting glucose. Yet the associations between glycated albumin and fructosamine with HbA1c were similar across CKD stages. Our data suggest that glycated albumin and fructosamine might not overcome limitations of HbA1c as a marker of hyperglycemia in older adults with CKD.