The aim of this study was to investigate clinical significance of impaired fasting glucose (IFG) in nondiabetic patients on maintenance peritoneal dialysis (PD).
In total, 362 maintenance PD patients ...were enrolled and followed up for 2-years. According to 1997 definitions, patients were divided into 3 groups: diabetic (n = 85), nondiabetic with IFG (n = 62) and nondiabetic with normal fasting glucose levels (n = 215). After basal data were collected for cross-sectional analyses, mortality and cause of death were recorded for longitudinal analyses.
After adjusting for related variables by multivariate logistic regression analysis, IFG was found to be positively associated with age but negatively associated with normalized protein nitrogen appearance and transferrin saturation in nondiabetic maintenance PD patients. Thirty nondiabetic patients had died after the 2-year follow-up. Cox multivariate analysis showed that age (hazard ratio: 1.037; 95% confidence interval: 1.002-1.073; P = 0.036) and presence of IFG (hazard ratio: 2.719; 95% confidence interval: 1.082-6.833; P = 0.033) were significant risk factors for all-cause 2-year mortality in nondiabetic maintenance PD patients.
IFG, a preventable and treatable condition, was associated with all-cause 2-year mortality in nondiabetic maintenance PD patients.
Abstract Introduction This is an observational study that examines the clinical features, the degrees of esophageal injury, physiological markers, and clinical outcomes after paraquat ingestion and ...seeks to determine what association, if any, may exist between these findings. Methods The study included 16 of 1410 paraquat subjects who underwent endoscopies at Chang Gung Memorial Hospital between 1980 and 2007. Results Corrosive esophageal injuries were classified as grade 1 in 8, 2a in 5, and 2b in 3 patients. No patients had grade 0, 3a, or 3b esophageal injuries. After paraquat ingestion, systemic toxicity occurred, with rapid development of hypoxia, hepatitis, and renal failure in many cases. Hypoxia occurred in 1 (12.5%), 5 (100%), and 3 (100%) patients with grades 1, 2a, and 2b esophageal injury, respectively. There were more hypoxic patients with grades 2a and 2b than those with grade 1 esophageal injury ( P < .05). The nadir Pao 2 was lower in patients with grades 2a and 2b than those with grade 1 esophageal injury ( P < .05). However, there were no significant differences in terms of acute hepatitis, peak serum alanine aminotransferase, acute renal failure, and peak serum creatinine between the 3 groups ( P > .05). Kaplan-Meier analysis did not find any difference in survival between the groups ( P > .05). Conclusion Paraquat, a mild caustic agent, produces only grades 1, 2a, and 2b esophageal injury. Our findings showed a potential relationship between the degree of hypoxia, mortality, and degree of esophageal injury, although such a low number of study subjects limits the conclusions that can be made by this study.
Background A previous study in type 2 diabetic patients with high-normal body lead burdens showed that EDTA chelation therapy for 3 months slows progressive diabetic nephropathy during a 12-month ...follow-up. The effect of a longer course of therapy on kidney function decrease over a longer follow-up is not known. Study Design A 12-month run-in phase, then a randomized single-blind study with a 27-month intervention. Setting & Participants University medical center; 50 patients (serum creatinine, 1.5-3.9 mg/dL) with high-normal body lead burden (≥80-<600 μg) were randomly assigned to the treatment and control groups. Intervention The treatment group received weekly chelation therapy for 3 months to reduce their body lead burden to <60 μg and then as needed for 24 months to maintain this level. The control group received placebo for 3 months and then weekly for 5 weeks at 6-month intervals for 24 months. Outcomes The primary end point was change in estimated glomerular filtration rate (eGFR) over time. A secondary end point was a 2-fold increase in baseline serum creatinine level or the requirement for renal replacement therapy. Measurements Body lead burdens were assessed by EDTA mobilization tests and eGFR was calculated using the equation for Chinese patients with type 2 diabetes. Results Mean baseline eGFRs in the treatment and control groups were similar. After 3 months of chelation therapy, the change in eGFR in the treatment group (+1.0 ± 4.8 mL/min/1.73 m2 ) differed significantly from that in the control group (−1.5 ± 4.8 mL/min/1.73 m2 ; P = 0.04). In the subsequent 24-month intervention, the yearly rate of decrease in eGFR (5.6 ± 5.0 mL/min/1.73 m2 per year) in the treatment group was slower than that (9.2 ± 3.6 mL/min/1.73 m2 per year; P = 0.04) in the control group. 17 (68%) control-group patients and 9 (36%) treatment-group patients achieved the secondary end point. Limitations Small sample size, not double blind. Conclusions A 27-month course of EDTA chelation therapy retards the progression of diabetic nephropathy in type 2 diabetic patients with high-normal body lead burdens.
Abstract Background The association between blood lead levels and mortality in patients on maintenance hemodialysis remains unclear. Methods A cross-sectional and 18-month prospective study included ...927 patients on maintenance hemodialysis. Baseline variables and blood lead levels were measured before hemodialysis and categorized as 3 equal groups: high (>12.64 μg/dL), middle (8.51-12.64 μg/dL), and low (<8.51 μg/dL). Mortality and cause of death were recoded for longitudinal analyses. Results At baseline, after related variables were adjusted, logarithmic transformation of blood lead level was negatively related to log ferritin and positively related to the vintage of hemodialysis and the percentage of urban area patients. By the end of the follow-up, 59 patients had died. Kaplan–Meier survival analysis showed that the high blood lead level group had greater mortality than the low blood lead level group (log-rank test, P < .001). After adjustment for potential variables, Cox multivariate analysis demonstrated that by using the low blood lead level as the reference, high blood lead levels were associated with increased hazard ratios (HRs) for all-cause (HR 4.70; 95% confidence interval CI, 1.92-11.49; P =. 003), cardiovascular-cause (HR 9.71; 95% CI, 2.11-23.26; P =. 005), and infection-cause (HR 5.35; 95% CI, 1.38-20.83; P =. 046) 18-month mortality in patients on maintenance hemodialysis. Moreover, there was a significant trend ( P = .032) of HRs for all-cause mortality among the 3 study groups. Conclusion High blood lead level is associated with increased HRs for all-cause, cardiovascular-cause, and infection-cause 18-month mortality in patients on maintenance hemodialysis.
Background Blood lead levels (BLLs) are associated with mortality in the general population. The clinical significance of BLLs in long-term hemodialysis (HD) patients with diabetes is unknown. Study ...Design A cross-sectional and 1-year prospective study. Settings & Participants 211 patients with diabetes on long-term HD therapy at 3 centers. Predictor BLLs measured before HD at baseline, categorized as abnormal (>20 μg/dL), high normal (10 to 20 μg/dL), and low normal (<10 μg/dL). Outcomes & Measurements Malnutrition, defined as serum albumin level less than 3.6 g/dL, and inflammation, defined as high-sensitivity C-reactive protein level greater than 3 mg/dL, for cross-sectional analyses. Mortality and cause of death for longitudinal analyses. Results 34, 112, and 65 patients had abnormal, high-normal, and low-normal BLLs at baseline. At baseline, patients with abnormal BLLs had a greater proportion of malnutrition (14.7% versus 1.5% and 11.6%; P = 0.01) and inflammation (76.5% versus 52.3% and 50.9%; P = 0.01) than those with low- and high-normal BLLs. Backward stepwise regression analysis found that high-sensitivity C-reactive protein level correlated positively and albumin level correlated negatively with BLLs after other confounders were adjusted. At the end of follow-up, 16 patients had died. Kaplan-Meier analysis showed that patients with an abnormal BLL had greater mortality than those with low and low-normal BLLs ( P = 0.004). Limitations Small sample size, sparse outcomes, and limited follow-up. Conclusions BLL may contribute to inflammation and nutritional status in long-term HD patients with diabetes on long-term HD therapy and may relate to 1-year mortality in these patients.
To measure the anisotropic diffusion in kidney and to demonstrate the feasibility of renal tractography.
Diffusion tensor imaging was acquired in kidney from 10 healthy volunteers and 5 patients with ...chronic kidney disease. Diffusion indices were calculated from the tensor, including fractional anisotropy, intervoxel diffusion coherence, and mean/axial/radial diffusivity.
Acquisitions with respiratory triggering could provide improved image quality in all diffusion indices, as compared to that by breathhold. It is sufficient to use five to seven scan averages when the measured diffusion indices converge to a steady state in medulla, which reduced the acquisition time in a triggered measurement down to a clinically tolerable limit. Second, the measured diffusion indices can be affected by the diffusion weighting. An increased diffusion weighting will lead to an underestimation in all diffusion indices. Finally the direction of water diffusion is consistent in the kidney cortex, which was properly reflected in intervoxel diffusion coherence. In a feasibility study in healthy volunteers and patients, renal tractography was performed that visualized the organized renal structure and as it declined with the progress of chronic kidney disease.
When compared to conventional breath hold technique, the significant improvement in image quality compensated for the prolonged acquisition time. Therefore, triggered acquisition is preferred in a clinical setting because it required less from patient cooperation.
