Risk Factors for COVID-19 Infection in Adult Patients: A Retrospective Observational Study in Japan.

Purpose: The aim of the study was to identify the characteristics of patients infected with coronavirus disease 2019 (COVID-19) and to determine risk factors for COVID-19 infection in Japanese patients. Patients and Methods: We conducted a single-center retrospective observational study in Japanese adult patients (≥20 years) who visited Kenwakai Hospital (Nagano Japan). We analyzed data of 378 patients (mean age, 75 ± 14 years; men, 54%) from the hospital's electronic information system. COVID-19 was diagnosed by polymerase-chain reaction. Patients were divided into 2 groups based on diagnosis of COVID-19. Results: Patients infected with COVID-19 showed significantly higher rates of men (69.8 vs 51.6%, P = 0.025) than uninfected control patients. After adjustment for possible confounding factors, COVID-19 infection was significantly associated with BUN (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.03) and serum creatinine (Scr) (OR, 1.14; 95% CI, 1.05-1.24). This association was observed in men (BUN, P = 0.012; Scr, P = 0.012), but not in women (BUN, P = 0.43; Scr, P = 0.54). Conclusion: BUN and Scr are potential risk factors for infection of COVID-19 in Japanese patients, particularly in men. Our results suggest that renal parameters might be important in Japanese male patients for the early detection of COVID-19 infection.

Zinc Acetate Hydrate Supplementation versus Polaprezinc Supplementation for Improving Hypozincemia in Hemodialysis Patients: A Randomized Clinical Trial.

Zinc supplementation may ameliorate zinc deficiency in maintenance hemodialysis patients; however, no standard protocol has been established. This study aimed to investigate the effects of zinc acetate hydrate (ZAH) and polaprezinc (PPZ) as zinc supplements in hemodialysis patients. We enrolled 75 hemodialysis patients with serum zinc levels <60 µg/dL for this study and randomly assigned Zinc supplementation to these 75 patients: 37 received ZAH (50 mg/day), and 38 received PPZ (34 mg/day). Serum zinc levels of both groups were compared every 4 weeks for 1 year. In both groups, serum zinc levels significantly increased at 4-52 weeks. Serum zinc levels were significantly higher in the ZAH group at 4-12 weeks; however, no significant differences were observed between the groups at 16-52 weeks. Adverse events requiring a reduction in the zinc dose, including copper deficiency, occurred significantly more frequently in the ZAH group. In conclusion, PPZ can safely maintain serum zinc levels for 1 year. ZAH provides rapid zinc supplementation but can cause adverse events.

Range of serum transthyretin levels in hemodialysis patients at a high risk of 1-year mortality: A retrospective cohort study.

INTRODUCTION: Transthyretin (TTR) is a sensitive marker of nutritional status and independent risk factor for mortality in hemodialysis patients. However, its range associated with prognosis in Japanese hemodialysis patients is unknown. METHODS: Maintenance hemodialysis Patients (n = 664) were enrolled, and their TTR levels were measured to assess 1-year mortality. Patients were assigned to four groups based on TTR levels: <20, 20 to <30 (control), 30 to <40, and ≥40 mg/dl. One-year mortality at each TTR range was analyzed using a Cox proportional hazards model after adjustment for prognostic factors. RESULTS: Seventy-seven (11.6%) deaths were recorded during follow-up. The hazard ratio (HR) of TTR <20 mg/dl was significantly higher compared with the control group in terms of all-causes (HR: 3.14) and non-cardiovascular mortality (HR: 6.986). CONCLUSION: TTR levels were independent and sensitive predictors of mortality in hemodialysis patients. TTR <20 mg/dl is a risk factor for 1-year mortality in Japanese hemodialysis patients.

Association of urinary vanin-1 with kidney function decline in hypertensive patients.

Previously, the authors reported the utility of urinary vanin-1 as an early biomarker of kidney injury in spontaneously hypertensive rats and in humans. However, little is known about whether urinary vanin-1 can be used to predict the clinical outcome. This study aimed to evaluate the predictive power of urinary vanin-1 based on kidney function decline in hypertensive patients. The authors measured urinary vanin-1 in 147 patients at the baseline and examined its association with the incidence of ≥20% decline in the estimated glomerular filtration rate (eGFR) using the Cox regression analysis. The mean age of the patients averaged 72.9 ± 8.2 years, and 39% were women. Median (interquartile range) urinary vanin-1 was 0.33 (0-2.6) ng/mg Cr During a median follow-up of 12 months, 14 patients showed kidney function decline. A higher urinary vanin-1 level was associated with an increased risk of kidney function decline (hazard ratio, 9.87; 95% CI, 1.11-87.5) (p = .04) in the fully adjusted model. In conclusion, urinary vanin-1 is an independent risk factor for kidney function decline in hypertensive patients and it could be useful in clinical settings. The underlying pathophysiologic mechanisms warrant additional investigation.

Association between a low dose of proton pump inhibitors and kidney function decline in elderly hypertensive patients: a retrospective observational study.

OBJECTIVES: Proton pump inhibitors (PPIs) are widely used for acid suppression therapy. Recently, PPI use was reported to be associated with chronic kidney disease (CKD); however, whether a low dose of PPIs is associated with CKD remains unknown. METHODS: This retrospective observational study included hypertensive patients who visited Kenwakai Hospital between 2017 and 2019. Renal parameters, such as the estimated glomerular filtration rate (eGFR) and serum creatinine (Scr), were extracted from medical records and compared between three years before treatment and the baseline. PPI use was assessed as cumulative exposure for three years. RESULTS: The study population included 152 patients (57.9% men; mean age, 74.5 years). Of those, 35.5% were PPI users (low dose, 17.1%; high dose, 18.4%). A significant decrease in eGFR and an increase in Scr were observed between three years before treatment and the baseline in the high-dose PPI group but not the non-use or low-dose PPI groups. CONCLUSIONS: Our results suggest that a low dose of PPIs may be safe in clinical settings, but further prospective studies are needed to clarify our findings.

Effectiveness of monitoring free carnitine levels for L-carnitine supplementation in hemodialysis patients to maintain carnitine sufficiency and nutritional factors.

We investigated the effectiveness of monitoring serum carnitine levels in hemodialysis patients receiving L-carnitine supplementation. One-hundred forty-five hemodialysis patients were divided into three groups. Group 1 consisted of patients (n = 30) who had been receiving supplementation before this study and then discontinued at the beginning. The remaining patients were divided into Group 2 (n = 13) and Group 3 (n = 102) based on their baseline free carnitine (FC) level, <20 or ≥ 20 µmol/L. Group 2 was started on supplementation, and Groups 1 and 3 were observed without any intervention for the first 6 months. FC was measured every 6 months in all three groups up to 18 months. All patients in whom FC was less than 20 µmol/L at 6 and 12 months were prescribed supplementation. After the first 6 months, the mean ± SD of FC changed from 262.5 ± 87.5 µmol/L at baseline to 70.8 ± 33.6 µmol/L (P < 0.001) in Group 1, from 17.4 ± 1.9 to 193.9 ± 43.3 µmol/L (P < 0.001) in Group 2, and from 49.2 ± 24.6 to 44.2 ± 19.8 µmol/L (P < 0.05) in Group 3. The acyl/free carnitine changed from 0.62 to 0.59 in Group 1 (P = 0.287), from 0.76 to 0.66 in Group 2 (P = 0.054) and from 0.57 to 0.60 in Group 3 (P < 0.05). Of the 145 patients, 126 continued follow-up for the full 18 months. FC remained in the normal range (36-74 µmol/L) within the 95% CI. FC was considered a strong predictor of carnitine deficiency after 6 months (AUC: 0.9146, cut-off value: 33.8 µmol/L). FC monitoring is essential for appropriate carnitine supplementation in hemodialysis patients.

Urinary vanin-1 associated with chronic kidney disease in hypertensive patients: A pilot study.

Hypertension and chronic kidney disease (CKD) are serious interrelated public health problems. Despite the monitoring and control of high blood pressure, symptoms of CKD are not usually apparent in its early stages. Previously, we reported the utility of urinary vanin-1 as an early biomarker of kidney injury in spontaneously hypertensive rats, but it remains unknown whether urinary vanin-1 is associated with CKD in humans. In this study, we estimated associations between urinary vanin-1 and parameters of kidney function in a cross-sectional study of hypertensive patients. We measured concentrations of vanin-1 using spot urine from 147 adult hypertensive patients (mean age, 72.8 years; 39.5% women). Patients were divided into 2 groups based on the median of the estimated glomerular filtration rate (eGFR). The group with eGFR < 60 mL/min per 1.73 m2 showed significantly higher levels of urinary vanin-1 than those with eGFR ≥ 60 mL/min per 1.73 m2. On univariate analysis, urinary vanin-1 as well as neutrophil gelatinase-associated lipocalin (NGAL) showed significant negative correlations with eGFR; however, multivariate analysis revealed that urinary vanin-1, but not NGAL, significantly correlated with eGFR. In addition, urinary vanin-1 had a significant positive correlation with the urinary protein-to-creatinine ratio (UPCR) (r = 0.21; P = .021) and albumin-to-creatinine ratio (UACR) (r = 0.61; P < .01). In conclusion, urinary vanin-1 is associated with lower eGFR and higher UPCR and UACR, and might be a potential marker of decreased kidney function in hypertensive patients. Further studies are needed to confirm these findings.

Sensitivity to electrical stimulation of human immunodeficiency virus type 1 and MAGIC-5 cells.

To determine the sensitivities to low electrical potential of human immunodeficiency virus type 1 (HIV-1) and its target cells, HIV-1 and MAGIC-5 cells were directly stimulated with a constant direct current potential of 1.0 V (vs. Ag/AgCl). HIV-1 was incubated for 3 h at 37°C on a poly-L-lysine-coated indium-tin oxide electrode, and then stimulated by an electrical potential. MAGIC-5 cells were seeded onto the electrically stimulated HIV-1 and cultured for 3 days at 37°C. HIV-1-infected cells were measured by multinuclear activation via a galactosidase indicator assay. MAGIC-5 cells were also stimulated by an electrical potential of 1.0 V; cell damage, proliferation and apoptosis were evaluated by trypan blue staining, cell counting and in situ apoptosis detection, respectively. HIV-1 was found to be damaged to a greater extent by electrical stimulation than the cells. In particular, after application of a 1.0-V potential for 3 min, HIV-1LAI and HIV-1KMT infection were inhibited by about 90%, but changes in cell damage, proliferation and apoptosis were virtually undetectable. These results suggested that HIV-1 is significantly more susceptible to low electrical potential than cells. This finding could form the basis of a novel therapeutic strategy against HIV-1 infection.

Effect of electrical stimulation on human immunodeficiency virus type-1 infectivity.

We examined the effects of electrical stimulation on HIV-1-adsorbed MAGIC-5 (MAGIC-5/HIV-1) cells and unadsorbed MAGIC-5 (MAGIC-5) cells. When MAGIC-5 cells were stimulated by a constant d.c. potential of 1.0 V (vs Ag/Agcl) immediately after HIV-1(LAI) infection, infectivity was more affected by electrical stimulation than by cell membrane damage. In particular, after application of potential at 1.0 V for 5 min, about 1% of the membranes of the MAGIC-5/HIV-1(LAI) cells were damaged, but the infectivities of both HIV-1(LAI) and HIV-1(NL43-luc) cells decreased about 37 and 44%, respectively (p < 0.05). After application of potential at 1.0 V for 5 min, the mean fluorescence intensities (MFIs) of highly reactive oxygen species (hROS) and nitric oxide (NO) in MAGIC-5/HIV-1(NL43-Luc) cells were significantly increased compared with that of unstimulated MAGIC-5/HIV-1(NL43-Luc) cells (p < 0.01). However, the MFIs of hROS and NO in MAGIC-5 cells were also increased, to the same level, by electrical stimulation for 5 min. These results suggest that HIV-1 adsorbed onto or invading cells is damaged by direct or indirect effects of electrical stimulation, resulting in a decrease in HIV-1 infectivity. It is also suggested that hROS and NO induced by electrical stimulation are important factors for inhibiting HIV-1 infection.

Frequency change-induced alternative potential waveform dependence of membrane damage to cells cultured on an electrode surface.

In the present study, alternative potential stimulation with rectangular pulse, sine and triangular waveforms at 10 and 100Hz was applied to cells cultured on an ITO electrode. As a result, we found that the alternating potential waveform dependence induced by the frequency on membrane damage of cells cultured on an electrode surface. The cell membrane damage was promoted by a rectangular pulse wave in comparison with sine and triangular waves, when alternating electrical potentials of 0 to +1.0V at 100Hz were loaded. In contrast, this waveform dependence was not observed when the frequency was 10Hz. Furthermore, it was found that cell membrane damage was induced at positive potentials more than +0.8V under the present experimental conditions.