Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 7 Articles
Background. This study evaluated the association between achieving target chronic kidney disease-mineral and bone disorder\n(CKD-MBD) marker levels andmortality in Taiwanese hemodialysis (HD) patients. Target levelswere based on the Kidney Disease:\nImproving Global Outcomes (KDIGO) guidelines. Methods. We performed a retrospective medical record review of 1126 HD\npatients between 2009 and 2013. A logistic regressionmodel was used to evaluate the relationship between achieving target marker\nlevels and the risk for all-cause and cardiovascular (CV)mortality. Reference target ranges were 7.9 � calcium (Ca) � 9.9mg/dL, 2.4\n� phosphate (P) � 4.7mg/dL, and 144 � intact parathyroid hormone (iPTH) � 648 pg/mL. Results. Achievement of target P levels\nwas associated with a lower risk for all-cause mortality compared to achievement of either target Ca or iPTH levels. Achieving\ntarget P + iPTH levels (OR 1.32) was associated with a lower odds ratio for all-cause mortality compared to achieving target Ca +\nP (OR 1.66) and Ca + iPTH (OR 1.43) levels. Similar trends were observed for CV mortality risk. Conclusions. The present study\ndemonstrated that achieving serum P levels within the KDIGO target range is the most important factor for lowering mortality in\nHD patients....
Therenal functions of 215 patients (24with benign renal mass, the rest with RCC staged T1-T2)who underwent partial nephrectomy\n(PN) between 2003 and 2014 were evaluated to identify predictors of short- and long-term deterioration in renal function after PN\namong renal cell carcinoma (RCC) patients with or without preoperative predisposition to chronic kidney disease (CKD) and\namong patients with benign renal mass. The 1- and 5-year predictive factors for de novo CKD were statistically analyzed. The\nincidence of de novo CKD differed significantly (...
Background: Drug-induced acute kidney injury is a common situation in clinical\npractice. Many treatments are involved and they are even more aggressive when associated\nwith a predisposing factor such as diabetes. We aimed to investigate clinical\nfeatures of acute drug-induced kidney injury in diabetics in order to clarify renal\nprognosis. Methods: This was a descriptive and analytical retrospective study including\ndiabetics who presented drug-induced acute kidney injury, conducted in our\ndepartment during the period from 1986 to 2015. Acute kidney injury was classified\naccording to Kidney Disease Improving Global Outcomes criteria. We analyzed medical\nrecords of patients. Results: 31 patients were included with mean age of 65.41\nyears and gender ratio M/F at 0.93. Diabetes was type 2 in 97% of cases. Mean previous\ncreatinine clearance was 39.33 ml/min/1.73 m2. Drugs involved were blockers\nof renin-angiotensin system (35%), aminoglycosides (16%), non-steroidal anti-inflammatory\n(16%), diuretics (13%), lipid-lowering agents (10%), rifampicin (6%) and\nifosfamide (3%). Extracellular dehydration was present in nine cases (29%). Main\ndrug combinations were with diuretics in 16 cases (52%) and with ACE inhibitor or\nARB in eight cases (26%). Oligo anuria was observed in 5 cases (16%). Proteinuria\nwith urine strips was objectified in 25 cases (81%). Acute kidney injury was grade 3\nin 24 cases (77%), grade 2 in three cases (10%) and grade 1 in four cases (13%). Renal\nsurvival at 102 months was 57%. Identified renal prognosis factors were serum phosphorus\n>1.47 mmol/l (p = 0.01), proteinuria at urine strips (p = 0.042), dehydration\n(p = 0.013), oral antidiabetic treatment (p = 0.038), intravenous rehydration (p =\n0.021) and insulin (p = 0.006). Conclusion: Drug-induced acute kidney injury is potentially\nserious in diabetics. Prevention is essential to improve the prognosis of this\nrenal damage....
Background: Anxiety disorders (ADs) are common with a high rate of medical comorbidities. Although the\nassociation between ADs and the overall cancer risk remains controversial, patients with ADs were found to\nbe more likely to develop specific cancer types. Herein, we estimated the risk of developing urological cancers\namong patients with ADs in a 5-year follow-up period using a population-based database.\nMethods: Two study cohorts were identified from the Taiwan Longitudinal Health Insurance Database 2005:\npatients with ADs, and comparison subjects selected by one-to-one matching for sex, age, and the year of\nrecruitment. Follow-up was undertaken to determine whether sampled patients and comparison subjects had\ndeveloped urological cancers in the subsequent 5 years.\nResults: We found that urological cancers occurred among 0.54% of patients with ADs and 0.13% of comparison\nsubjects. After adjusting for sociodemographic characteristics, medical comorbidities, and alcohol and tobacco use\ndisorder, the stratified Cox proportional hazard regression suggested that patients with ADs were more likely to\ndevelop urological cancers relative to comparison subjects (adjusted hazard ratio, 3.67; 95% confidence interval, 2.\n85 ~ 4.72). The adjusted HR for males with ADs was 3.82 (95% CI: 2.79 ~ 5.23) in comparison to males without ADs.\nIn addition, the adjusted HR for females with ADs was 3.47 (95% CI: 2.26 ~ 5.31) than those females without ADs.\nConclusions: We concluded that during the 5-year follow-up period, there was a significantly increased risk of\nurological cancers among patients with ADs....
Background: Patients with chronic kidney disease have a markedly increased cardiovascular mortality compared\nwith the general population. Long chain n-3 polyunsaturated fatty acids have been suggested to possess cardioprotective\nproperties. This cross-sectional and comparative study evaluated correlations between hemodynamic measurements,\nresistance artery function and fish consumption to the content of long chain n-3 polyunsaturated fatty acids in adipose\ntissue, a long-term marker of seafood intake.\nMethods: Seventeen patients with chronic kidney disease stage 5 + 5d and 27 healthy kidney donors were evaluated\nwith hemodynamic measurements before surgery; from these subjects, 11 patients and 11 healthy subjects had\nvasodilator properties of subcutaneous resistance arteries examined. The measurements were correlated to\nadipose tissue n-3 polyunsaturated fatty acids. Information on fish intake was obtained from a dietary questionnaire\nand compared with adipose tissue n-3 polyunsaturated fatty acids.\nResults: Fish intake and the content of n-3 polyunsaturated fatty acids in adipose tissue did not differ between\npatients and controls. n-3 polyunsaturated fatty acid levels in adipose tissue were positively correlated to systemic\nvascular resistance index; (r = 0.44; p = 0.07 and r = 0.62; p < 0.05, chronic kidney disease and healthy subjects\nrespectively) and negatively correlated to cardiac output index (r = âË?â??0.69; p < 0.01 and r = âË?â??0.50; p < 0.05, chronic\nkidney disease and healthy subjects respectively). No correlation was observed between n-3 polyunsaturated fatty\nacid levels in adipose tissue and vasodilator properties in resistance arteries. n-3 PUFA content in adipose tissue\nincreased with increasing self-reported fish intake.\nConclusions: The correlations found, suggest a role for n-3 polyunsaturated fatty acids in hemodynamic\nproperties. However, this is apparently not due to changes in intrinsic properties of the resistance arteries\nas no correlation was found to n-3 polyunsaturated fatty acids....
Previous studies have reached diverse conclusions about the influence of tumor size on the oncologic outcomes in patients with\nupper tract urothelial carcinoma (UTUC). In this study, we retrospectively analyzed the records of 687 patients and evaluated how\ntumor size affected the prognosis of patients with UTUC after surgery. Clinicopathologic characteristics and oncological outcomes\nwere compared according to tumor size (ââ?°Â¤3 cm versus >3 cm). During a median follow-up period of 65 months (range 3ââ?¬â??144\nmonths), 225 patients (32.8%) died from UTUC and 228 patients (33.2%) experienced intravesical recurrence (IVR). Patients with\na larger tumor size tended to have a significantly higher percentage of being male (...
Pharmacologic toxicities are common and range from mild to life-threatening. The aim of this study is to review and update the\ndata on the role of renal replacement therapy (RRT) in the management of various pharmacologic poisonings.We aim to provide\na focused review on the role of RRT in the management of pharmacological toxicities. Relevant publications were searched in\nMEDLINE with the following search terms alone or in combination: pharmacologic toxicity, hemodialysis, hemofiltration, renal\nreplacement therapy, toxicology, poisonings, critical illness, and intensive care.The studies showed that a pharmacologic substance\nshould meet several prerequisites to be deemed dialyzable. These variables include having a low molecular weight (<500 Da)\nand low degree of protein binding (<80%), being water-soluble, and having a low volume of distribution (<1 L/kg). RRT should\nbe strongly considered in critically ill patients presenting with toxic alcohol ingestion, salicylate overdose, severe valproic acid\ntoxicity, metformin overdose, and lithium poisoning. The role of RRT in other pharmacologic toxicities is less certain and should\nbe considered on a case-by-case basis....
Loading....