Long-term survival of patients receiving home hemodialysis with self-punctured arteriovenous access.

OBJECTIVE: To determine the long-term survival of patients receiving home hemodialysis (HHD) through self-punctured arteriovenous access. METHODS: We conducted an observational study of all patients receiving HHD at our facility between 2001 and 2020. The primary outcome was treatment survival, and it was defined as the duration from HHD initiation to the first event of death or technique failure. The secondary outcomes were the cumulative incidence of technique failure and mortality. Cox proportional hazard models were used to identify the predictive factors for treatment survival. RESULTS: A total of 77 patients (mean age, 50.7 years; 84.4% male; 23.4% with diabetes) were included. The median dialysis duration was 18 hours per week, and all patients self-punctured their arteriovenous fistula. During a median follow-up of 116 months, 30 treatment failures (11 deaths and 19 technique failures) were observed. The treatment survival was 100% at 1 year, 83.5% at 5 years, 67.2% at 10 years, and 34.6% at 15 years. Age (adjusted hazard ratio [aHR], 1.07) and diabetes (aHR, 2.45) were significantly associated with treatment survival. Cardiovascular disease was the leading cause of death, and vascular access-related issues were the primary causes of technique failure, which occurred predominantly after 100 months from HHD initiation. CONCLUSION: This study showed a favorable long-term prognosis of patients receiving HHD. HHD can be a sustainable form of long-term kidney replacement therapy. However, access-related technique failures occur more frequently in patients receiving it over the long term. Therefore, careful management of vascular access is crucial to enhance technique survival.

Molecular characterization of low-temperature-inducible NTR-C in Chlorella vulgaris.

We isolated a cDNA corresponding to a chloroplast NADPH-dependent thioredoxin reductase gene (NTR-C), in Chlorella that is low-temperature-inducible. The obtained cDNA was 1,838 bp in length and coded for 529 amino acids. The deduced amino acid sequence showed higher homology to those of Arabidopsis and rice NTR-C, containing a thioredoxin (Trx) and a thioredoxin reductase (TR), than those of NTR-A (mitochondrial) and NTR-B (cytosolic) from various organisms, which contain only a TR domain and differ in subcellular localization. The results of enzyme assays of partially-purified mature NTR-C protein (mNTR-C), expressed in Escherichia coli with a pET-29b(+) expression vector, provided evidence that the gene included both regions. Northern blot analysis showed a remarkable increase in transcripts under low temperature, while the protein level did not significantly change when examined by using Western blotting with anti-mNTR-C antibodies. The TR activity dependent on NADPH was not enhanced by low temperature despite the substantial increase in transcripts. Based on the results of measurement of peroxiredoxin (Prx) activity and Western blotting using both an extract of Chlorella and purified mNTR-C, the Chlorella was suggested to possess a Prx that interacts with NTR-C.