Wogonin Ameliorates ER Stress-Associated Inflammatory Response, Apoptotic Death and Renal Fibrosis in a Unilateral Ureteral Obstruction Mouse Model.

Wogonin, a vital bioactive compound extracted from the medicinal plant, Scutellaria baicalensis, has been wildly used for its potential in mitigating the progression of chronic diseases. Chronic kidney disease (CKD) represents a significant global health challenge due to its high prevalence, morbidity and mortality rates, and associated complications. This study aimed to assess the potential of wogonin in attenuating renal fibrosis and to elucidate the underlying molecular mechanisms using a unilateral ureteral obstruction (UUO) mouse model as a CKD mimic. Male mice, 8 weeks old, underwent orally administrated of either 50 mg/kg/day of wogonin or positive control of 5 mg/kg/day candesartan following UUO surgery. NRK52E cells were exposed to tumor growth factors-beta (TGF-ß) to evaluate the anti-fibrotic effects of wogonin. The results demonstrated that wogonin treatment effectively attenuated TGF-ß-induced fibrosis markers in NRK-52E cells. Additionally, administration of wogonin significantly improved histopathological alterations and downregulated the expression of pro-fibrotic factors (Fibronectin, α-smooth muscle actin, Collagen IV, E-cadherin, and TGF-ß), oxidative stress markers (Catalase, superoxide dismutase 2, NADPH oxidase 4, and thioredoxin reductase 1), inflammatory molecules (Cyclooxygenase-2 and TNF-α), and the infiltration of neutrophils and macrophages in UUO mice. Furthermore, wogonin treatment mitigated endoplasmic reticulum (ER) stress-associated molecular markers (GRP78, GRP94, ATF4, CHOP, and the caspase cascade) and suppressed apoptosis. The findings indicate that wogonin treatment ameliorates key fibrotic aspects of CKD by attenuating ER stress-related apoptosis, inflammation, and oxidative stress, suggesting its potential as a future therapeutic target.

s-Ethyl cysteine, an amino acid derivative, attenuated cisplatin induced nephrotoxicity.

Renal protection from s-ethyl cysteine (SEC) against cisplatin (CP)-induced inflammatory and oxidative injury was examined. Mice were divided into five groups: normal group, 0.25% SEC group, CP group, 0.125% SEC + CP group, 0.25% SEC + CP group. After 2 weeks supplementation, mice of CP and SEC + CP groups received CP treatment. H&E stain showed that CP caused infiltration of inflammatory cells and necrosis of tubular cells. SEC pre-treatments attenuated CP-induced inflammatory injury and degeneration. SEC pre-treatments limited CP-stimulated release of interleukin (IL)-1beta, IL-6, tumor necrosis factor-alpha and prostaglandin E2 in kidney. CP raised the renal activity and mRNA expression of cyclooxygenase-2 and nuclear factor kappa B. SEC pre-treatments reversed these alterations. CP increased the production of reactive oxygen species and nitric oxide, and lowered glutathione content, glutathione peroxidase and glutathione reductase activities in kidney. SEC pre-treatments reversed these changes. CP up-regulated renal inducible nitric oxide synthase (iNOS) mRNA expression, and down-regulated nuclear factor E2-related factor (Nrf)-2 and heme oxygenase (HO)-1 mRNA expression. SEC pre-treatments suppressed iNOS mRNA expression; and enhanced renal Nrf2 and HO-1 mRNA expression. These novel findings suggest that dietary SEC via exerting its multiple bio-functions could be considered as a protective agent for kidney against CP.

Genetic risk score for risk prediction of diabetic nephropathy in Han Chinese type 2 diabetes patients.

We evaluated whether genetic information could offer improvement on risk prediction of diabetic nephropathy (DN) while adding susceptibility variants into a risk prediction model with conventional risk factors in Han Chinese type 2 diabetes patients. A total of 995 (including 246 DN cases) and 519 (including 179 DN cases) type 2 diabetes patients were included in derivation and validation sets, respectively. A genetic risk score (GRS) was constructed with DN susceptibility variants based on findings of our previous genome-wide association study. In derivation set, areas under the receiver operating characteristics (AUROC) curve (95% CI) for model with clinical risk factors only, model with GRS only, and model with clinical risk factors and GRS were 0.75 (0.72-0.78), 0.64 (0.60-0.68), and 0.78 (0.75-0.81), respectively. In external validation sample, AUROC for model combining conventional risk factors and GRS was 0.70 (0.65-0.74). Additionally, the net reclassification improvement was 9.98% (P = 0.001) when the GRS was added to the prediction model of a set of clinical risk factors. This prediction model enabled us to confirm the importance of GRS combined with clinical factors in predicting the risk of DN and enhanced identification of high-risk individuals for appropriate management of DN for intervention.

IL-17 and CD40 ligand synergistically stimulate the chronicity of diabetic nephropathy.

Background: Early stages of diabetic nephropathy (DN) are characterized by an influx of inflammatory cells. Interactions between infiltrating T cells and podocytes may play an important role in the ongoing inflammatory response and remodelling. The aim of this study was to explore the role of IL-17 and CD40 ligand (CD40L) in DN. Methods: The study design involved a case series. Kidney biopsy samples of 69 patients with type 2 diabetes were assessed for the presence of CD4+ IL-17+ T cells. The number of CD4+ IL-17+ T cells were counted and correlated with clinical and laboratory findings. Additionally, advanced glycation end-products (AGEs) were added to cultured podocytes to imitate diabetic conditions and thus to elucidate the role of CD4+ IL-17+ T cells in renal sclerosis. Results: CD80 expression was detected in early phases of DN but was absent during diffused glomerurosclerosis in DN kidney specimens. In DN samples, CD40 expression was not only observed in most of the infiltrating cells, but also increased in podocytes and tubular epithelial cells. CD40L is locally expressed on infiltrating cells. CD4+ IL-17+ T cells were found in DN, and the number of CD4+ IL-17+ T cells was positively correlated with the deterioration in glomerular filtration rate (GFR). IL-17A was the key cytokine produced by CD4+ IL-17+ T cells. IL-17A levels were elevated in DN renal tissue and were correlated with declining GFR. IL-17 and CD40L synergistically enhanced IL-6, monocyte chemoattractant protein-1 (MCP-1), regulated on activation, normal T cell expressed and secreted (RANTES), transforming growth factor beta 1 (TGF-ß1) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) production in vitro. AGEs induced podocyte activation with increasing expression of IL-17A, CD40 and TGF-ß1 in vitro. Blockade with an anti-IL-17 monoclonal antibody reduced the expression of CD40 and TGF-ß1, but increased the viability of cultured podocytes. Conclusions: IL-17 and CD40L synergistically mediate the inflammatory response and remodelling associated with tissue injury and glomerular sclerosis in DN.

Prolonged QT interval is linked to all-cause and cardiac mortality in chronic peritoneal dialysis patients.

AIM: Prolonged QT interval is related to changes of electrolytes in haemodialysis (HD) and is associated with all-cause mortality in HD patients. It is unknown if prolonged QT interval is associated with all-cause mortality in peritoneal dialysis (PD) patients as the electrolytes were relatively stable in PD. We therefore investigated the association of prolonged QT interval and all-cause mortality in chronic PD patients. METHODS: The QT intervals were measured in 2003 and all patients were followed to December 2012. A prolonged QT interval was defined as a QT interval > 450 ms. The association of prolonged QT interval with all-cause and cardiac-specific mortality was analyzed using Cox regression and Kaplan-Meier analysis. RESULTS: Of 306 patients, 196 (64%) patients had prolonged QT interval. The incidence density rate was 9.7 per 100 persons-years for all-cause mortality and 5.6 for cardiac specific mortality in patients with prolonged QT interval. Prolonged QT interval was associated with all-cause mortality with a hazard ratio (HR) of 1.59 (95% confidence interval (CI): 1.06-2.39, P = 0.03] and cardiac mortality (HR: 1.66, 95% CI: 1.00-2.78, P = 0.05) with adjustments for age, gender, diabetes, and vintage of dialysis. Longer QT interval (>500 ms, 450-500 ms, and < 450 ms) was significantly associated with a worse overall survival (P = 0.03, log-rank test) and cardiac mortality free survival (P = 0.05, log-rank test). CONCLUSIONS: Prolonged QT interval was associated with all-cause and cardiac mortality in patients on peritoneal dialysis. The association is independent of patient's age and diabetes.

Loss of Residual Renal Function is Associated With Vascular Calcification in Hemodialysis Patients.

Vascular calcification is common in chronic hemodialysis (HD) patients and can be measured using abdominal aortic calcification (AAC). Loss of residual renal function (RRF) is associated with increased mortality in HD patients. However, the association between loss of RRF and vascular calcification is unknown. The aim of the study was to analyze the association between loss of RRF and VC in HD patients. All chronic HD (HD for more than 3 months) patients of China Medical University Hospital in 2014 were included. AAC scores were measured semi-quantitatively based on later lumbar radiographs. Loss of RRF was defined as urine output less than 200 mL per day. The association between loss of RRF and AAC was analyzed using logistic regression. Four hundred and thirty-eight chronic HD patients with a mean age of 63 ± 12 years were analyzed. The median (interquartile range) AAC score of all patients was 7 (2-13). The AAC score of patients with loss of RRF was 9 (3-22), significantly higher than that of patients with RRF 5 (0-17) (P = 0.004). Loss of RRF, independent of patients' age, diabetes, C-reactive protein, calcium-phosphorus product and vintage of dialysis was associated with higher AAC scores. Loss of RRF was associated with vascular calcification in HD patients.

Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis.

BACKGROUND: Multidisciplinary care (MDC) was widely used in multiple chronic illnesses but the effectiveness of MDC in patients with chronic kidney disease (CKD) was inconclusive. The aim of this meta-analysis is to estimate the effectiveness of MDC for CKD. METHODS: We searched PubMed, Web of Science, Google Scholar, Cochrane Library, and China Journal Full-text Database for relevant articles published in English or Chinese. Studies investigating MDC and non-MDC in patients with CKD were included. Random effect model was used to compare all-cause mortality, dialysis, risk of temporal catheterization, and hospitalization in the two treatment entities. RESULTS: We analyzed 8853 patients of 18 studies in patients with CKD stages 3-5, aged 63±12 years. MDC was associated with lower risk of all-cause mortality with an odds ratio (OR) of 0.52 [95% confidence interval (CI): 0.44-0.88, p=0.01], mainly in cohort studies. MDC was associated with a lower risk of starting dialysis (p=0.02) and lower risk of temporal catheterization for dialysis (p<0.01). MDC was not associated with a higher chance of choosing peritoneal dialysis (p=0.18) or a lower chance of hospitalization for dialysis (p=0.13). CONCLUSIONS: Limited evidence from randomized controlled trials is currently available to support the benefit of MDC in patients with CKD. MDC is associated with lower all-cause mortality, lower risk of starting dialysis, and lower risk of temporal catheterization for dialysis in cohort studies. MDC is not associated with a higher chance of choosing peritoneal dialysis or a lower chance of hospitalization for dialysis. More studies are needed to determine the optimal professional that should be included in MDC.

Patients with diabetes as the primary kidney disease have a worse survival than patients with comorbid diabetes in chronic haemodialysis patients.

AIM: Diabetes is the leading cause of chronic kidney disease (CKD) that requires dialysis. It is not clear if survival of patients with diabetes as primary kidney disease (DKD) is different from the survival of patients with diabetes as comorbidity (DCM). We investigated the survival of patients with DKD and patients with DCM in patients on maintenance haemodialysis (HD) using propensity score matching approach. METHODS: All patients on maintenance HD in Taiwan Renal Registry Database from 1997 to 2005 were analyzed and were prospectively followed to 31 December 2008. Patients' survival was determined using Cox proportional-hazards regression. RESULTS: We analyzed the survival of 2632 patients with DCM and 13,160 matched patients with DKD. The first year mortality rate was 11.9% in patients with DCM and 13.9% in patients with DKD. The incidence density rate of overall mortality was 11.2 per 100 patient-years in patients with DCM and 12.9 in patients with DKD. Patients with DKD had a worse survival than patients with DCM (P < 0.01). Compared to patients with DCM, the odds ratio (95% confidence interval [CI]) for first year mortality was 1.27 (1.10-1.47) and the hazard ratio for overall mortality was 1.18 (1.12-1.25) in patients with DKD. Patients' age, male gender, comorbid liver cirrhosis, higher fasting blood glucose, lower haematocrit, and lower serum phosphorus were independently associated with higher mortality. CONCLUSIONS: Patients with diabetes as primary kidney disease are associated with higher first year and overall mortality, compared to patients with diabetes as comorbidity in patients on maintenance haemodialysis.

Upper gastrointestinal bleeding in patients with CKD.

BACKGROUND AND OBJECTIVES: Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. RESULTS: In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (P<0.001) and lower serum albumin (P=0.004) were independently associated with higher upper gastrointestinal bleeding risk. CONCLUSIONS: In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin.

Association of walking with survival and RRT among patients with CKD stages 3-5.

BACKGROUND AND OBJECTIVES: Patients with CKD can benefit from an increase in physical activity. Walking is one of the most common exercises in patients with CKD; however, the association of walking with outcomes in patients with CKD is not clear. This study investigated the association of walking with overall mortality and RRT in patients with CKD stages 3-5. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients with CKD stages 3-5 in the CKD program of China Medical University Hospital from June 2003 to May 2013 were enrolled. The risks of overall mortality and RRT were analyzed using competing-risks regressions. RESULTS: A total of 6363 patients (average age, 70 years) during a median of 1.3 (range=0.6-2.5) years of follow-up were analyzed. There were 1341 (21.1%) patients who reported walking as their most common form of exercise. The incidence density rate of overall mortality was 2.7 per 100 person-years for walking patients and 5.4 for nonwalking ones. The incidence density rate of RRT was 22 per 100 person-years for walking patients and 32.9 for nonwalking ones. Walking, independent of patients' age, renal function, and comorbidity, was linked to lower overall mortality and lower RRT risk in the multivariate competing-risks regression. The adjusted subdistribution hazard ratio (SHR) of walking was 0.67 (95% confidence interval [95% CI], 0.53 to 0.84; P<0.001) for overall mortality and 0.79 (95% CI, 0.73 to 0.85; P<0.001) for the risk of RRT. The SHRs of overall mortality were 0.83, 0.72, 0.42, and 0.41 for patients walking 1-2, 3-4, 5-6, and ≥7 times per week, and the SHRs of RRT were 0.81, 0.73, 0.57, and 0.56, respectively. CONCLUSIONS: Walking is the most popular form of exercise in patients with CKD and is associated with lower risks of overall mortality and RRT. The benefit of walking is independent of patients' age, renal function, and comorbidity.

Comparing risk of new onset diabetes mellitus in chronic kidney disease patients receiving peritoneal dialysis and hemodialysis using propensity score matching.

UNLABELLED: Chronic kidney disease (CKD) patients are at risk for developing new-onset diabetes mellitus (NODM) even after hemodialysis (HD) and peritoneal dialysis (PD) treatment. It is not clear if the incidence for NODM is different in CKD patients receiving HD and PD. This study compared the risk of NODM in PD patients and HD patients. METHODS: All HD and PD patients in Taiwan Renal Registry Database from 1997 to 2005 were included and all patients were followed to December 31, 2008. The risk of NODM was analyzed in PD patients and propensity score matched HD patients using logistic regression for early type NODM (< = 6 months after dialysis) and Cox regression for late type NODM (>6 months after dialysis). RESULTS: A total of 2548 PD patients and 10192 HD patients who had no diabetes on the initiation of dialysis were analyzed. The incidence for NODM was 3.7 per 100 patient/year for HD and 2.4 for PD patients. HD patients are more at risk for developing early type NODM (p<0.001) with an adjusted odds ratio of 1.41 [95% confidence interval (CI) 1.12-1.78)]. HD patients are more at risk for late type NODM (p<0.001) with an adjusted hazard ratio of 2.01 (95% CI: 1.77-2.29). Patient's age was negatively associated with risk of early type of NODM (p<0.001) but positively associated with risk of late type NODM (p<0.001). CONCLUSIONS: Chronic kidney disease patients receiving hemodialysis are more at risk for developing new-onset diabetes mellitus compared to those receiving peritoneal dialysis.

Comparing Survival between peritoneal dialysis and hemodialysis patients with subclinical peripheral artery disease: a 6-year follow-up.

Peripheral artery disease (PAD) is known to be an increased mortality risk in patients with end-stage renal disease (ESRD). The aim of this study was to compare patient survival between patients with subclinical PAD undergoing peritoneal dialysis (PD) and hemodialysis (HD). Subclinical peripheral artery was defined as an ankle-brachial index of less than 0.9. This study was conducted from April 2005, and the observation period ended on 30 June 2011. At the end of the follow-up, the status of all patients was assessed and data on mortality were obtained for the entire cohort. A total of 91 patients (61 HD and 30 PD) were included for analyses in this study. Mortality rate was 60.0% (18/30) for PD and 52.5% (32/61) for HD. Kaplan-Meier estimate demonstrate that PD patients had a higher mortality rate than those underwent HD (log-rank p = 0.0039). Cox regression model demonstrated that PD was an independent predictor for further mortality in ESRD patients with subclinical peripheral artery disease.(p = 0.012, HR: 1.776, 95% CI: 1.136-2.775). In multivariate analysis, the HD group still had a greater survival than PD group (p = 0.005, HR:1.916, 95% CI: 1.218-3.015). In patients with subclinical peripheral artery disease, the patient survival is better in HD patients as compared with PD patients.

Pericardial effusion as a crucial presentation of Erdheim-Chester disease in a hemodialysis patient: an overlooked diagnosis.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis whose hallmark is tissue infiltration by CD68-positive, CD1a-negative and usually S-100 protein-positive foamy non-Langerhans histiocytes and mononuclear cells. Here, we report a hemodialysis (HD) patient who presented with fever and pericardial effusion. We performed pericardiocentesis with pericardial biopsy and the histological findings indicated ECD. We administered intravenous methylprednisolone pulse therapy (250 mg/d) followed by oral prednisolone (50 mg/d). The patient's fever gradually subsided and there was no recurrence of pericardial effusion. This is the first report of an HD patient with ECD. We suggest that ECD be considered in the differential diagnosis of new HD patients who present with pericardial effusion, especially when this did not improve following increased dose of HD.

Hypertensive disorders in pregnancy and subsequent diabetes mellitus: a retrospective cohort study.

BACKGROUND: Cohort study on the association between hypertensive disorders in pregnancy (HDP) and postpartum diabetes is limited. This retrospective cohort study investigated the incidence of diabetes mellitus after delivery among women with HDP using claims data of a universal insurance system. METHODS: We defined the HDP group as women aged 19-40 years with their first HDP in 2003, excluding those with a history of gestational diabetes mellitus, diabetes mellitus, or hypertension before the date of diagnosis with HDP. Women who had normal pregnancy without HDP were randomly chosen as our comparison group, frequency matched with age and index year of the HDP group. Both groups were followed until December 31, 2008 to evaluate the occurrence of diabetes. RESULTS: This study consisted of 1139 women with HDP cases and 4527 non-HDP pregnant women. Overall, the subsequent incidence of diabetes mellitus was 5.08-fold higher in the HDP group than in the non-HDP group, with an adjusted hazard ratio of 3.42 (95% confidence interval [CI], 2.07-5.64) after controlling for age, occupation, income, and comorbidity. The hazard ratio of developing diabetes increased to 39.5 (95% CI, 13.0-120.6) for women having HDP, hyperlipidemia, and obesity simultaneously. CONCLUSIONS: Women with HDP have a high risk of subsequent diabetes. HDP women with obesity and hyperlipidemia are at an extremely high risk of diabetes mellitus. Early identification of women with HDP is needed for prevention, particularly those with other comorbidities.

Real-time PCR analysis of the intestinal microbiotas in peritoneal dialysis patients.

Bifidobacterium and Lactobacillus can beneficially affect the host by producing acetic acid and lactic acid, which lower pH and thereby inhibit the growth of pathogens or allow the probiotic bacteria to compete with pathogens for epithelial adhesion sites and nutrients. The transmural migration of enteric organisms into the peritoneal cavity can cause peritonitis in peritoneal dialysis (PD) patients. We hypothesized that the composition of the intestinal microbiota with regard to Lactobacillus species and Bifidobacterium species differed between PD patients and healthy controls. The aim of the study was to investigate these differences by real-time PCR analysis of fecal samples. From 1 August 2009 to 31 March 2010, a total of 29 nondiabetic PD patients and 41 healthy controls from China Medical University Hospital were recruited after giving their informed consent. Fecal samples were collected from the PD patients and their age-matched counterparts in the morning using a standardized procedure. DNA extracted from these samples was analyzed by real-time PCR. All bifidobacteria, Bifidobacterium catenulatum, B. longum, B. bifidum, Lactobacillus plantarum, L. paracasei, and Klebsiella pneumoniae were less frequently detected in the patient samples. Dysbiosis (microbial imbalance) may impair intestinal barrier function and increase host vulnerability to pathogen invasion. Further studies are necessary to confirm our findings before clinical trials with probiotic supplementation in PD patients.

Long-term use of fenofibrate is associated with increased prevalence of gallstone disease among patients undergoing maintenance hemodialysis.

BACKGROUND: In spite of insufficient evidence to guide the use of lipid-lowering drugs (LLDs) among the dialysis population, these drugs are frequently used to treat dyslipidemia. Several studies have found that long-term use of LLDs is associated with an increased risk of gallstone disease (GSD) in the general population. However, the lithogenic risk of LLDs in patients undergoing hemodialysis (HD) has not been studied. AIM: It is to assess the influence of long-term use of LLDs on the prevalence of GSD among patients undergoing HD. METHODS: This cross-sectional study included 108 eligible patients receiving maintenance HD: 35 receiving lovastatin; 34 fenofibrate; and 39 no LLD. GSD was defined as the presence of gallstones or the performance of cholecystectomy while taking LLD. Abdominal ultrasonography, demographic parameters, and laboratory data were obtained for all enrolled subjects. ANOVA with Bonferroni's test and chi-square test were used to compare differences among the three groups. RESULTS: The three groups had similar clinical characteristics with regard to age, gender, duration of HD, body mass index, and total cholesterol values. However, a significantly higher prevalence of GSD and higher triglyceride levels were found in patients receiving fenofibrate, compared with those in other groups (p < 0.05). Among dialysis patients on fenofibrate, increased age, female gender, larger daily dose, and longer duration of treatment were associated with increased risks for GSD. CONCLUSIONS: Our study shows that long-term use of fenofibrate is related to increased risk of GSD among HD patients. Further large-scale studies are needed to confirm our findings.

Comparison of hepatitis B surface antibody decay rates after vaccination between hemodialysis and peritoneal dialysis patients.

BACKGROUND AND OBJECTIVES: The available information about maintaining effective immunity after hepatitis B virus (HBV) vaccination in dialysis patients is limited. The aim of this study was to determine whether a difference exists in the persistence of immunity between hemodialysis (HD) and peritoneal dialysis (PD) patients. We compared the decay rate of hepatitis B surface antibody (anti-HBs) titers after HBV vaccination between HD and PD patients. DESIGN, SETTING, PARTICIPANTS, AND MEASURES: A total of 103 HD and 53 PD patients who were completely vaccinated were enrolled. We examined their anti-HBs titers at the 1st month after vaccination then annually thereafter. Changes in the anti-HBs titers were assessed by comparing annual geometric mean titers (GMTs). RESULTS: The slopes of the anti-HBs titer decay rates plotted on a logarithmic scale for the HD and PD groups were -23.41 and -31.48, respectively. The decay rate of the PD group was significantly faster than that of the HD group (P=0.0053). CONCLUSION: The decay rate of anti-HBs titers in the PD group was faster than that in the HD group. Hepatitis B vaccination could not offer long-term protection in HD or PD patients. Post-vaccination testing every 6-12 months is necessary and revaccination may be protective in dialysis patients, especially in hyper-endemic areas of hepatitis B infection.

Prophylactic use of omeprazole associated with a reduced risk of peptic ulcer disease among maintenance hemodialysis patients.

BACKGROUND: Patients undergoing maintenance hemodialysis (MHD) have a high prevalence of peptic ulcer disease (PUD). Omeprazole is a proton pump inhibitor with proven efficacy in the prevention and treatment of PUD. However, there is little data on the prophylactic use of omeprazole in reducing the risk of PUD among MHD patients. METHODS: This prospective study included 93 patients undergoing MHD at Zen-Ho Dialysis Center between July 2008 and December 2009. Fifty-three patients were assigned to receive 20 mg of omeprazole daily for 18 months and 40 patients served as control. The Kaplan-Meier method was applied to calculate the cumulative incidence of PUD. RESULTS: The per-protocol population comprised 85 patients (omeprazole group, 49; control group, 36). Both groups had similar baseline characteristics. The need for endoscopy was found to be significantly less (10.2 vs. 44.4%, p = 0.001) in the omeprazole group than in the control group. Dialysis patients in the omeprazole group required fewer blood transfusions and erythropoietin doses than did the control group patients. Kaplan-Meier analysis revealed a higher cumulative ulcer rate in the control group (log-rank test, p = 0.04). However, omeprazole did not reduce the risk of PUD in MHD patients on regular aspirin or warfarin. CONCLUSIONS: We conclude that prophylactic use of omeprazole might be effective to lower the incidence of PUD among MHD patients without regular aspirin or warfarin use. Further large-scale controlled trials should be carried out to confirm our findings.

Atrial fibrillation linked to vascular access thrombosis in chronic hemodialysis patients.

AIM: Atrial fibrillation (AF) is characterized by the development of thromboembolic events and is more prevalent among end-stage renal disease patients than in the general population. Vascular access thrombosis (VAT) is a major morbidity in chronic hemodialysis (HD) patients; however, the association between AF and VAT is unknown. METHODS: We retrospectively reviewed chronic HD patients with functional vascular access between 1997 and 2006. The association between AF and the development of VAT was analyzed using Kaplan-Meier analysis and multivariate Cox proportional hazards regression. RESULTS: A total of 568 chronic HD patients, including 55 (9.7%) patients with AF, were reviewed and 154 (27.1%) patients developed at least one episode of VAT. Patients with AF had worse VAT-free survival than patients without AF (p< 0.001). In Cox regression, age, type of vascular access, atrial fibrillation, diabetes, hypertension, and C-reactive protein were independently linked to the development of VAT ( p= 0.049, < 0.001, < 0.001, 0.001, 0.028 and 0.045). The hazard ratios were 2.1 (95% CI: 1.00-1.03) for arteriovenous graft, 2.47 (95% CI: 1.66-3.69) for AF, 1.72 (95% CI: 1.25-2.39) for diabetes and 1.09 (95% CI: 1.00-1.18) for serum C-reactive protein (every 1 mg/dL increase), respectively. CONCLUSION: Atrial fibrillaiton is linked to the development of vascular access thrombosis in chronic hemodialysis patients and is independent of traditional VAT risk factors.