Abstract
Aims
Heart failure increases the risk of kidney disease progression. However, whether cardiac function and structure are associated with the risk of incident chronic kidney disease (CKD) is ...not well characterized in a community setting.
Methods and results
Among 4188 participants (mean age 75 years and 22% blacks) of the Atherosclerosis Risk in Communities Study without prevalent CKD in 2011–13, we examined the association of echocardiographic measures of left ventricular (LV) mass index, ejection fraction, left atrial volume index (LAVi), right ventricular (RV) fractional area change, and peak RV-right atrium (RA) gradient, with the subsequent risk of incident CKD, as defined by >25% decline to estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, hospitalization with CKD diagnosis, or incident end-stage kidney disease. Multivariable Cox regression models were used to estimate hazard ratios (HRs). The risk of incident CKD was monotonically increased with each of higher LV mass index adjusted HR 2.61 (1.92–3.55) for highest quartile (Q4) vs. lowest (Q1), lower ejection fraction 1.54 (1.17–2.04) for Q1 vs. Q4, higher LAVi 2.12 (1.56–2.89) for Q4 vs. Q1, and higher peak RV-RA gradient 2.17 (1.45–3.25) for Q4 vs. Q1 but not with RV function. The associations were consistent between subgroups by sex and race.
Conclusion
Among community-dwelling older individuals, LV mass index, ejection fraction, LAVi, and peak RV-RA gradient were independently associated with the risk of incident CKD. Our results further support that heart disease is associated with the risk of kidney disease progression and suggest the value of echocardiography for assessing cardiac and kidney health in older populations.
Abstract Background and hypothesis Extended-hours haemodialysis (HD) is associated with better clinical outcomes than conventional HD. We investigated whether extended-hours HD and conventional HD ...have varying effects on blood levels of calciprotein particles (CPP) and phosphorus, which have been identified as major pathogenic molecules for vascular calcification. Methods Patients who underwent conventional or extended in-centre daytime HD between January and March 2020 were included. Plasma CPP levels, representing only secondary CPP (CPP-Ⅱ), were measured in pre-dialysis samples. Linear and non-linear associations between CPP and serum phosphorus levels were examined across dialysis modalities. Results A total of 382 participants (185 undergoing extended-hours HD and 197 undergoing conventional HD) were included in the analysis. The median age of participants was 71 years, 65% of the patients were men, and the mean phosphorus level was 5.4 mg/dL. Plasma CPP (CPP-Ⅱ) levels were lower in the extended-hours HD group than in the conventional HD group (40 018 AU vs. 75 728 AU, p < 0.01). Multivariable linear regression analysis showed that extended-hours HD was associated with lower natural logarithmic plasma CPP (CPP-Ⅱ) levels: -0.64 (95% CI: -0.74 to -0.55). Restricted cubic spline function indicated that extended-hours HD was associated with lower plasma CPP (CPP-Ⅱ) levels across levels of serum phosphorus, with significant differences observed between groups, especially in hyperphosphatemic conditions (P for interaction < 0.01). Conclusions The extended-hours HD group had lower CPP levels than the conventional HD group despite no significant differences in serum phosphorus levels, which may contribute to better clinical outcomes in patients on extended-hours HD.
CD34.sup.+ cells maintain vascular homeostasis and predict cardiovascular outcomes. We previously evaluated the association of CD34.sup.+ cells with cardiovascular disease (CVD) events over 23 ...months, but long-term CVD outcomes in relation to levels of CD34.sup.+ cells in patients on maintenance hemodialysis are unclear. Herein, we analyzed the long-term predictive potential levels of CD34.sup.+ cells for CVD outcomes and all-cause mortality. Between March 2005 and May 2005, we enrolled 215 patients on maintenance hemodialysis at Nagoya Kyoritsu Hospital and followed them up to 12.8 years. According to the CD34.sup.+ cell counts, patients were classified into the lowest, medium, and highest tertiles. Levels of CD34.sup.+ cells were analyzed in association with four-point major adverse CV events (MACEs), CVD death, and all-cause mortality. In univariate analysis age, smoking habit, lower geriatric nutrition risk index, lower calcium x phosphate product, and lower intact parathyroid hormone were significantly associated with the lowest tertile. Whereas, in multivariate analysis, age and smoking habit were significantly associated with the lowest tertile. Among 139 (64.7%) patients who died during a mean follow-up period of 8.0 years, 39 (28.1%) patients died from CVD. Patients in the lowest tertile had a significantly lower survival rate than those in the medium and highest tertiles (p less than or equal to 0.001). Using multivariable analyses, the lowest tertile was significantly associated with four-point MACEs (hazard ratio 1.80, p = 0.023) and CVD death (hazard ratio 2.50, p = 0.011). In conclusion, our long-term observational study revealed that a low level of CD34.sup.+ cells in the circulation predicts CVD outcomes among patients on maintenance hemodialysis.
The clinical trial on the Development of a treatment strategy for chronic kidney disease‒mineral and bone disorder by a mUltilateral mechanism of ETelcalcetide hydrochloride, or the DUET trial, was ...designed to determine the efficacy of etelcalcetide, an intravenous calcimimetic, for control of secondary hyperparathyroidism (SHPT).
Eligible SHPT maintenance hemodialysis patients (n = 124) were randomized (1:1:1) for inclusion in the DUET trial, a 12-week, multicenter, open-label, parallel-group study (jRCTs041180108), and assigned to either an etelcalcetide + active vitamin D group (group E+D), an etelcalcetide + oral calcium preparation group (group E+Ca), or a control group (group C). The primary endpoint was number of patients with a 50% reduction from baseline of intact parathyroid hormone (iPTH) levels, and iPTH levels ≤ 240 pg/mL at 12 weeks after start of the trial.
The proportion of patients reaching the primary endpoint (95% confidence interval CI) was 90.0% (76.3%–97.2%) in group E+D, 56.8% (39.5%–72.9%) in group E+Ca, and 19.5% (8.8%–34.9%) in group C. Etelcalcetide treatment led to a significant increase in the number of patients achieving the endpoint (odds ratio, 13.4; 95% CI, 5.10–35.3) on logistic regression analysis, with iPTH, corrected serum calcium, and phosphate at baseline as covariates. Significantly more patients achieved the endpoint in group E+D compared with group E+Ca (odds ratio, 6.35; 95% CI, 1.79–22.48). There were fewer hypocalcemic visits in group E+D compared with group E+Ca (P = 0.018), yet the former group was prone to hyperphosphatemia.
Etelcalcetide showed good control of iPTH for maintenance hemodialysis patients with SHPT. Active vitamin D was useful in correcting hypocalcemia, but the oral calcium preparation was superior for suppression of hyperphosphatemia.
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Preventing cycle-by-cycle variations of combustion in gasoline engine is necessary for further improvements in thermal efficiency. In this paper, Large-Eddy Simulation (LES) of combustion in a ...gasoline engine was conducted with compressible fluid engine CFD code HINOCA, which is based on Cartesian grid and immersed boundary method. Prediction accuracy was verified, and influence factors of cycle-by-cycle combustion variations were analyzed with the obtained results.
Collagenofibrotic glomerulopathy is a rare glomerular disease characterized by extensive accumulation of atypical type III collagen fibers within the mesangial matrix and subendothelial space. ...Laboratory evaluation of this disease shows a marked increase in serum procollagen III peptide (P III P) levels. Here, we report the case of two brothers with collagenofibrotic glomerulopathy confirmed by histology. Patient 1 presented with proteinuria and hypertension and patient 2 presented with nephrotic-range proteinuria. Immunohistochemistry revealed strong staining for antibodies to type III collagen in the widened subendothelial spaces in both patients. Electron microscopy revealed numerous collagenous fibers in the mesangium and subendothelial space. P III P levels were elevated in both patients. Most reported cases of collagenofibrotic glomerulopathy, including the adult-onset type, have been sporadic. Within the limits of our literature search, this is only the third report of adult siblings with collagenofibrotic glomerulopathy confirmed by histology. This report indicates that it may be beneficial to measure serum P III P levels in the siblings of patients diagnosed with adult-onset collagenofibrotic glomerulopathy.
Development of Fast Unstructured-Grid Flow Solver FaSTAR HASHIMOTO, Atsushi; MURAKAMI, Keiichi; AOYAMA, Takashi ...
JOURNAL OF THE JAPAN SOCIETY FOR AERONAUTICAL AND SPACE SCIENCES,
2015, Letnik:
63, Številka:
3
Journal Article
Although CFD tools are necessary for aerodynamic design, it is still time consuming and this is one of the big problems. In order to shorten the computational time, a fast CFD code “FaSTAR” has been ...developed. We combined two acceleration techniques. One is a convergence acceleration technique such as the multigrid method. A coarse-grid generation method using octree data of the Cartesian grid is proposed. This method is simple and it can generate high-quality coarse grids. The other is a programing technique such as data structure improvement and performance tuning. We demonstrate the high-speed performance of the code for aerodynamic computation of a standard aircraft model, NASA-CRM. The computational time is less than one hour using 10 million cells and 100 CPU cores. It is found that the multigrid method is beneficial for large-scale problems.
The flow and optical fields of a Q-switched supersonic flow chemical oxygen-iodine laser are simulated by solving simultaneously the gas flow model coupled with the precise chemical kinetic model and ...the geometric optical model. The effects of hyperfine relaxation and velocity cross relaxation for iodine atoms and nonuniformity of the three-dimensional flow field on power extraction are investigated. The results show that the peak power under the influence of hyperfine relaxation and velocity cross relaxation, which is normalized by the corresponding continuous wave value, is 15. This value agrees fairly well with previously reported experimental results of Q-switched chemical oxygen-iodine laser operations. The peak power of pulse in the three-dimensional flow field is considerably small compared to that in the equivalent one-dimensional flow field and the pulse is widened roughly twice due to insufficient mixing, shock waves, expansion waves and wakes.
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