Arteriovenous graft patency outcomes and prognostic factors.

OBJECTIVES: Arteriovenous graft for hemodialysis shows poorer outcomes than arteriovenous fistula, due to frequent stenosis and thrombosis. We investigated arteriovenous graft patency outcomes and prognostic factors for these outcomes. METHODS: We included a single-center cohort of patients receiving arteriovenous graft for hemodialysis access from 2010 to 2014. Demographics, laboratory data, comorbidities, and medications were collected from medical records. Surgical factors related to graft operation including the type and diameter of connected vessels, graft location, and type of operation (elective or emergency) were also recorded. Outcomes included primary and secondary patency. Survival analysis was conducted using the Kaplan-Meier method; univariate and multivariate analyses were used to evaluate the prognostic factors. RESULTS: Data from 225 grafts were analyzed. During the follow-up period (mean: 583 days, range: 1-1717 days), 138 (61%) grafts required intervention and 46 (20%) permanently failed. Primary patency at one, two, and three years was 42%, 20%, and 16%, respectively. Secondary patency at one, two, and three years was 85%, 72%, and 64%, respectively. Multivariate analysis showed that primary patency was negatively associated with increasing age and location of vessel anastomosis (reference-brachiobrachial anastomosis; brachiobasilic - HR, 0.569; 95% CI, 0.376-0.860; p = 0.007; brachioaxillary anastomosis - HR 0.407; 95% CI, 0.263-0.631; p < 0.0001); secondary patency was positively associated with diastolic blood pressure, serum albumin level, and hemoglobin over 10 g/dL. Adverse events other than stenosis or thrombosis, such as infection/inflammation or pseudoaneurysm were observed in approximately 20% of grafts. CONCLUSIONS: Factors associated with diminished primary arteriovenous graft patency included increased patient age and location of vessel anastomosis (brachiobrachial type compared to brachiobasilic or brachioaxillary type); diminished secondary patency was associated with low diastolic blood pressure, low serum albumin, and hemoglobin level under 10 g/dL. Among these factors, diastolic blood pressure, serum albumin, and hemoglobin level may be modifiable and could improve arteriovenous graft patency outcomes.

Two cases of idiopathic membranous nephropathy treated with rituximab.

Idiopathic membranous nephropathy is a common cause of nephrotic syndrome, and has been reported as a cause of idiopathic primary glomerulonephropathy in up to 90% of patients. However, the treatment options remain controversial. We report two cases of idiopathic membranous nephropathy that were treated with rituximab. A 54-year-old man and a 64-year old man were admitted for rituximab therapy. They had previously been treated with combinations of immunosuppressive agents including cyclophosphamide, cyclosporine, mycophenolate, and steroids. However, the patients' heavy proteinuria was not resolved. Both patients received rituximab therapy, 2 weeks apart. After several months of follow-up and a second round of rituximab treatment for each patient, their proteinuria decreased and partial remission of disease was achieved in both patients.

Erratum: Asymptomatic renal pseudoaneurysm after percutaneous renal biopsy [Volume 32, Issue 2, June 2013, pp. 87-89].

[This corrects the article DOI: 10.1016/j.krcp.2013.04.006.].

Korean red ginseng (Panax ginseng) ameliorates type 1 diabetes and restores immune cell compartments.

ETHNOPHARMACOLOGICAL RELEVANCE: Historical records reveal that in traditional medicine, a disease similar to diabetes was treated with ginseng. Korean red ginseng has been considered beneficial as a dietary supplement for its anti-diabetic potential. AIM: This study was designed to investigate the prophylactic potential of Korean red ginseng (KRG) extract (Panax ginseng C.A. Meyer Radix Rubra) in a well-established mouse model of Type 1 diabetes (T1D). MATERIALS AND METHODS: The prophylactic effect of KRG extract was evaluated in mice fed with KRG extract for two weeks prior to induction of diabetes by streptozotocin (STZ) administration. Glucose levels and glucose challenge test results of KRG-treated diabetic mice were compared to those of untreated diabetic mice and healthy control mice. Examination of the immune compartments in lymphoid organs and immunohistochemical staining of pancreas for islet cell morphology and insulin producing beta cells were performed. RESULTS: KRG extract significantly lowered blood glucose levels to an average of 250mg/dl from 350mg/dl and improved glucose challenge testing when applied as prophylaxis. Histological findings indicated that KRG extract protected against STZ-induced destruction of pancreatic tissue and restored insulin secretion. Strikingly, this effect was accompanied by restoration of lymphocytes in secondary lymphoid organs, suggesting that KRG extract facilitated immune homeostasis. CONCLUSION: This is the first report to demonstrate the prophylactic function of KRG extract in ameliorating the hyperglycemia of T1D. Immune compartments of diabetic mice were found to be preserved in KRG-treated mice suggesting that Korean red ginseng may benefit T1D patients, not only for its hypoglycemic but also for its immunomodulatory effects.

Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting.

BACKGROUND: Acute kidney injury (AKI) is a serious complication after coronary artery bypass grafting and is closely associated with high mortality. The objective of the present study was to identify the incidence and risk factors for AKI after off-pump coronary artery bypass grafting (OPCAB) and to construct a risk model for prediction of AKI after OPCAB. METHODS: We retrospectively studied 448 adult patients who underwent isolated OPCAB between April 2006 and July 2007. AKI was defined as an increase in serum creatinine of 0.3 mg/dL or 50% within 48 h after surgery. Multivariate analysis was used to evaluate risk factors for AKI after OPCAB and a risk model was developed with a weighted score based on the odds ratio. RESULTS: The incidence of AKI was 7.6% (n = 34). Most patients (97%) had mild AKI. Independent preoperative risk factors of postoperative AKI were identified as high systolic blood pressure, decreased glomerular filtration rate, and coronary angiography (CAG) less than 7 days prior to OPCAB. The incidence of AKI across each increasing score level increased from 2.2% to 60%. CONCLUSION: AKI after OPCAB was common. High systolic blood pressure, renal dysfunction, and CAG less than 7 days prior to cardiac surgery were associated with AKI after OPCAB. Our risk model may provide information to clinicians and patients about the risk of postoperative AKI.