Association between Albumin-Globulin Ratio and Mortality in Patients with Chronic Kidney Disease.

BACKGROUND: Malnutrition and inflammation are highly prevalent and tightly regulated with each other in chronic kidney disease (CKD) patients. Inflammation can lead to malnutrition in patients with sufficient nourishment, while malnutrition may also induce an inflammatory response. This study investigated whether the albumin-globulin ratio (AGR) can predict the mortality risk in CKD patients. METHODS: We enrolled 956 stage 3-5 CKD patients retrospectively at a medical center. Patients' baseline characteristics including demographics, laboratory data, pharmacotherapy, and comorbidities were collected for statistical adjustments. The study patients were stratified into three AGR groups according to similar magnitudes of hazards for mortality as follows: low AGR group, AGR ≤ 1.0; moderate AGR group, 1.1 ≤ AGR < 1.3; high AGR group, AGR ≥1.3. Multivariate Cox proportional hazard analysis was performed to evaluate the association of the AGR with the study outcomes, including overall and cardiovascular disease (CVD) mortality. RESULTS: During a median follow-up duration of 2.44 years, 108 (11.3%) deaths were recorded and 50 patients died from CVD. In adjusted model 1, the moderate AGR group was associated with hazard ratios (HR) of 0.57 (95% CI = 0.36-0.90, p = 0.016) and 0.52 (95% CI = 0.28-0.98, p = 0.043) for all-cause and CVD mortality compared with the low AGR group, respectively. The high AGR group was associated with HRs of 0.49 (95% CI = 0.27-0.90, p = 0.021) and 0.27 (95% CI = 0.1-0.74, p = 0.01) for all-cause and CVD mortality compared with the low AGR group, respectively. Similar results were obtained in the adjusted model 2 (inverse probability of the group weighted Cox model). In addition, the association between the AGR and mortality risk remained significant when the AGR was treated as a continuous variable. CONCLUSION: AGR is a significant biomarker predicting overall and cardiovascular mortality risk independent of various important factors amongst stage 3-5 CKD patients. We suggest that the AGR may be a simple and inexpensive measurement for detecting CKD patients at risk of mortality.

Association between End-Stage Renal Disease and Incident Diabetes Mellitus-A Nationwide Population-Based Cohort Study.

BACKGROUND: Glucose is one of the constituents in hemodialysates and peritoneal dialysates. How the dialysis associates with the incident diabetes mellitus (DM) remains to be assessed. METHODS: The claim data of end-stage renal disease (ESRD) patients who initiated dialysis from and a cohort of matched non-dialysis individuals from 2000 to 2013 were retrieved from the Taiwan National Health Insurance Research Database to examine the risk of incident DM among patients on hemodialysis (HD) and peritoneal dialysis (PD). Predictors of incident DM were determined for HD and PD patients using Fine and Gray models to treat death as a competing event, respectively. RESULTS: A total of 2228 patients on dialysis (2092 HD and 136 PD) and 8912 non-dialysis individuals were the study population. The PD and HD patients had 12 and 97 new-onset of DM (incidence rates of 15.98 and 8.69 per 1000 patient-years, respectively), while the comparison cohort had 869 DM events with the incidence rate of 15.88 per 1000 patient-years. The multivariable-adjusted Cox models of Fine and Gray method showed that the dialysis cohort was associated with an adjusted hazard ratio (HR) of 0.49 (95% CI 0.39⁻0.61, p value < 0.0001) for incident DM compared with the comparison cohort. The adjusted HR of incident DM was 0.46 (95% CI 0.37⁻0.58, p value < 0.0001) for HD and 0.84 (95% CI 0.47⁻1.51, p value = 0.56) for PD. CONCLUSIONS: ESRD patients were associated with a lower risk of incident DM. HD was associated with a lower risk of incident DM, whereas PD was not.

Decreasing catheter-related bloodstream infections in the intensive care unit: interventions in a medical center in central Taiwan.

BACKGROUND: A high catheter-related bloodstream infection (CRBSI) rate, in comparison with that in the National Healthcare Safety Network report, is an important concern in our hospital. Therefore, evidence-based interventions have been introduced to reduce the rate of CRBSI. METHODS: A surveillance study conducted from March 2008 to May 2010 to observe the reduction of infection rate after interventions in two intensive care units (ICUs). The major intervention, introduced in November 2009, was the standardization of the process of central venous catheter (CVC) implantation, including hand hygiene and maximal sterile barrier precautions. RESULTS: The utilization ratios of CVC changed little during the study. The median CRBSI infection rates decreased from 1.95 (mean 1.58) infections per 1000 catheter-days at baseline to 0 (mean 1.06) after interventions (p = 0.310 by the Wilcoxon signed ranks test). The rate of CRBSI in one ICU showed 0 infections per 1000 catheter-days, which was sustained for 6 months after interventions. CONCLUSION: The reduction of infection rates could be possible by standardizing the CVC implantation procedure. However, more interventions, such as cleaning the skin with chlorhexidine, avoiding the femoral site when possible, and removing unnecessary catheters, should also be considered to reduce the rate of CRBSI.