Abnormal serum potassium is associated with an increased risk of mortality in dialysis patients. However, the impacts of serum potassium levels on short- and long-term mortality and association of ...potassium variability with death in peritoneal dialysis (PD) patients are uncertain.
We examined mortality-predictability of serum potassium at baseline and its variability in PD patients treated in our center January 2006 through December 2010 with follow-up through December 2012. The hazard ratios (HRs) were used to assess the relationship between baseline potassium levels and short-term (≤1 year) as well as long-term (>1 year) survival. Variability of serum potassium was defined as the coefficient of variation of serum potassium (CVSP) during the first year of PD.
A total of 886 incident PD patients were enrolled, with 248 patients (27.9%) presented hypokalemia (serum potassium <3.5 mEq/L). During a median follow-up of 31 months (range: 0.5-81.0 months), adjusted all-cause mortality hazard ratio (HR) and 95% confidence interval (CI) for baseline serum potassium of <3.0, 3.0 to <3.5, 3.5 to <4.0, 4.5 to <5.0, and ≥5.0 mEq/L, compared with 4.0 to <4.5 (reference), were 1.79 (1.02-3.14), 1.15 (0.72-1.86), 1.31 (0.82-2.08), 1.33 (0.71-2.48), 1.28 (0.53-3.10), respectively. The increased risk of lower potassium with mortality was evident during the first year of follow-up, but vanished thereafter. Adjusted all-cause mortality HR for CVSP increments of 7.5% to <12.0%; 12.0% to <16.7% and ≥16.7%, compared with <7.5% (reference), were 1.35 (0.67-2.71), 2.00 (1.05-3.83) and 2.18 (1.18-4.05), respectively. Similar association was found between serum potassium levels and its variability and cardiovascular mortality.
A lower serum potassium level was associated with all-cause and cardiovascular mortality during the first year of follow-up in incident PD patients. In addition, higher variability of serum potassium levels conferred an increased risk of death in this population.
Peritoneal dialysis (PD) is developing rapidly in China, but because there are not enough well-trained PD doctors and nurses in more rural areas, this expansion is occurring mainly in larger cities. ...To address this imbalance, our center established a PD satellite center program across Guangdong Province, with the aim of extending the use and improving the quality of PD.
Sun Yat-sen University PD center is responsible for running the satellite program. The PD satellite centers are selected using specific criteria. The full-time PD physicians and nurses in the satellite centers accept a unified training program and treatment practices, and their clinical outcomes are carefully followed by our center.
The program began in January 2008, and there are now 12 PD centers from which 26 doctors and 32 nurses received PD training. Several hundred patients are now receiving PD through this program. The total number of PD patients treated by our center and the satellites increased to 1860 from 1010. The number treated in the satellite units increased to 1165 from 601. The annual dropout rate fell to 17.6% from 28.2%, and the average peritonitis incidence fell from 1 episode in 39.4 patient-months to 1 episode in 46.2 patient-months. The 1-year patient and technique survival rates increased to 84.2% from 82.0% and to 93% from 88.7% respectively.
Our PD satellite center program is a good model for increasing the use and improving the quality of PD in rural areas. We plan to expand this program to other parts of southern China.
The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated ...with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients.
This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis.
In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months) of 1117 CAPD patients, 309(27.7%) patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years) hazard ratio (HR) = 1.427, 95% confidence interval (CI) = 1.051 to 1.938, P = 0.023, male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030), lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004) and albumin <38g/L (HR = 1.425, 95% CI: 1.112 to 1.825, P = 0.005).
Older age, male, lower educational level and hypoalbuminemia at the commencement of PD were the risk factors associated with the first episode of peritonitis in Southern Chinese CAPD patients.
Decreased skeletal muscle has been identified as a relevant factor for arterial stiffness but has not been thoroughly investigated in peritoneal dialysis (PD) patients. The aim of this study was to ...investigate the relationship between skeletal muscle and arterial stiffness in PD patients. A cross-sectional study of 658 prevalent PD patients with a mean brachial-ankle pulse wave velocity (baPWV) of 1714 (±501) cm/s and mean skeletal muscle mass of 26.6 (±5.4) kg was performed. Skeletal muscle mass level was significantly higher in males than in females. When examining skeletal muscle mass as a continuous variable, skeletal muscle mass was significantly associated with baPWV in fully adjusted linear regression models in total patients standardized coefficients (β), -0.181; 95% confidence interval (95% CI), -0.276 to -0.056; P = 0.003 or female patients (β, -0.119; 95% CI, -0.350 to -0.015; P = 0.03) but not in male patients (β, -0.117; 95% CI, -0.300 to 0.011; P = 0.07). Furthermore, in females, a significant association between the middle or highest tertile of skeletal muscle mass and baPWV was found in fully adjusted models (β, -0.123; 95% CI, -0.204 to -0.008; P = 0.03; β, -0.140; 95% CI, -0.228 to -0.016; P = 0.02, respectively). In conclusion, decreased skeletal muscle mass was independently associated with increased baPWV in PD patients, and this association was significant in females but not in males.
Community-acquired pneumonia, especially severe community-acquired pneumonia (SCAP), remains the leading cause of death in the world. Despite advances in antimicrobial therapy, the mortality rates ...due to SCAP have not decreased significantly since antibiotics became routinely available. Traditional Chinese medicine (TCM) has been used for treating pneumonia for thousands of years. It is popular and widely practiced in Asia. In recent decades, evidence from both clinicians and patients suggests that TCM has some beneficial effect on SCAP. Thus, this study aims to compare the efficacy of a combination of a conventional drug and TCM to the conventional drug alone, to provide a scientific basis for clinical decisions.
A prospective, multi-center, single-blinded, double-dummy, and randomized controlled clinical trial is being conducted to test the therapeutic effects of a combination of conventional medicine and TCM versus conventional medicine in the treatment of SCAP. A total of 198 patients will be enrolled in this study, with 99 in each treatment group (combination group or conventional medicine group). The TCM will be administered twice daily for 28 days. All patients will be followed for 3 months. The primary outcome measure is treatment failure, which is defined as clinical deterioration. Secondary outcome measures are time to clinical stability, length of hospital stay, in-hospital mortality, SOFA questionnaire, quality of life and cost of treatment.
It is hypothesized that the combination of a conventional drug and TCM will reduce treatment failure, time to clinical stability, length hospital of stays, and in-hospital mortality, and improve the quality of life of SCAP patients.
ClinicalTrials.gov, NCT03185923 . Registered on 20 June 2017.
The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed ...to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration.
This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities.
A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found ( P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation.
Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.
Highlights • TCM plus conventional medical treatment therapy might be associated with reduction risk of exacerbation, improvement of lung function. • TCM plus conventional medical treatment therapy ...might be associated with better quality of life and higher exercise capacity. • High quality studies are needed to provide clear evidence for the future use of TCM.
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•Microneedle patch allows the drug to penetrate the biofilm and be released inside.•Enzymatic disruption of biofilm structure makes bacteria more sensitive.•Antibiotics combined with ...mild photothermal therapy to kill exposed bacteria.
The biofilms present in wounds are difficult to eliminate due to the compact barrier formed by extracellular polymeric substances (EPS). Herein, we have designed a dissolvable microneedle patch that destroys the structure of EPS matrix by enzymolysis and kills the exposed bacteria by the combination of photothermal- and chemo- therapy. The microneedles can destroy the physical barrier of biofilms and release α-amylase to degrade the extracellular polysaccharide of EPS, making the bacteria susceptible to antimicrobial therapies. Furthermore, the levofloxacin-loaded polydopamine nanoparticles (PDA@Levo) encapsulated in microneedles can achieve both antibiotic and mild photothermal therapy (PTT, 50 °C) under 808 nm laser irradiation to synergistically eradicate bacteria. The combined use of enzymolysis, antibiotics and PTT therapy effectively removed the biofilms. The in vitro experiments showed the biomass of biofilms formed by Staphylococcus aureus and Pseudomonas aeruginosa was reduced to 12.6% and 31.3%, respectively. In vivo, the α-amylase-PDA@Levo microneedle (MN) could remove biofilms from infected wounds and kill exposed bacteria, thereby reducing inflammation and further facilitating the wound healing process, while the mild PTT did not cause damage to normal tissues. We believe that this new multimodal therapy microneedle patch holds great potential in combating bacterial biofilms that are associated with wound infections.
The prognostic effect of gender on immunoglobulin A nephropathy (IgAN) is not clear. We explored gender-related differences in clinicopathological features and renal outcomes in IgAN.
This was a ...single-centre retrospective study. Patients were divided into two groups according to gender. The clinicopathological features at biopsy and renal outcomes during the follow-up were collected and analysed. Renal outcomes were defined as the doubling of baseline serum creatinine and end-stage renal disease (ESRD) (estimated glomerular filtration rate < 15 mL/min/1.73 m
, dialysis, or renal transplantation). The prognostic effects of gender were evaluated by Cox regression models.
A total of 988 eligible IgAN patients were enrolled, and the ratio of males to females was 1:1.4. Compared with female patients, male patients had worse renal function, greater proteinuria, a higher prevalence of hypertension, hypertriglyceridaemia and hyperuricaemia, and more severe segmental sclerosis and tubular atrophy/interstitial fibrosis. However, haematuria occurred more frequently in female patients. During a median follow-up time of 48.6 (34.7, 62.7) months, no differences in renal survival rates were noted between the male and female groups. Multivariable Cox regression analyses revealed that gender was not a significant risk factor for renal outcomes after frequency matching of baseline eGFR and serum uric acid (SUA) levels. In addition, male and female patients shared similar risk factors, including a low eGFR and increased proteinuria and segmental sclerosis. In males, however, an elevated proportion of global glomerulosclerosis was also a poor prognostic factor for renal survival.
Male IgAN patients presented with worse clinicopathologic features than female patients, but no significant differences were observed in long-term renal survival between male and female patients by eGFR- and SUA level-matching.
Peritoneal dialysis–related peritonitis causes the denudation of mesothelial cells and, ultimately, membrane integrity alterations and peritoneal dysfunction. Because heat shock protein 72 (HSP72) ...confers protection against apoptosis and because autophagy mediates survival in response to cellular stresses, we examined whether autophagy contributes to HSP72-mediated cytoprotection in lipopolysaccharide (LPS)-induced peritonitis. Exposure of cultured peritoneal mesothelial cells to LPS resulted first in autophagy and later, apoptosis. Inhibition of autophagy by 3-methyladenine or Beclin-1 small-interfering RNA sensitized cells to apoptosis and abolished the antiapoptotic effect of HSP72, suggesting that autophagy activation acts as a prosurvival mechanism. Overexpression of HSP72 augmented autophagy through c-Jun N-terminal kinase (JNK) phosphorylation and Beclin-1 up-regulation. Suppression of JNK activity reversed HSP72-mediated Beclin-1 up-regulation and autophagy, indicating that HSP72-mediated autophagy is JNK dependent. In a rat model of LPS-associated peritonitis, autophagy occurred before apoptosis in peritoneum. Up-regulation of HSP72 by geranylgeranylacetone increased autophagy, inhibited apoptosis, and attenuated peritoneal injury, and these effects were blunted by down-regulation of HSP72 with quercetin. Additionally, blocking autophagy by chloroquine promoted apoptosis and aggravated LPS-associated peritoneal dysfunction. Thus, HSP72 protects peritoneum from LPS-induced mesothelial cells injury, at least in part by enhancing JNK activation–dependent autophagy and inhibiting apoptosis. These findings imply that HSP72 induction might be a potential therapy for peritonitis.
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