Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients.

OBJECTIVES: Systemic inflammation has been reported to be associated with uremic pruritus (UP). Although a vegetarian diet can reduce systemic inflammation in hemodialysis patients, the effect of vegetarian diet on UP is not clear. The purpose of the study was to know the possible effects of vegetarian diet on UP. METHODS: A cross-sectional study was done to compare the severity of UP and blood levels of systemic inflammatory markers between vegetarian and non-vegetarian hemodialysis patients. Six non-vegetarian patients with uremic pruritus changed their non-vegetarian diet to vegetarian diet for 2 months. Visual Analogue Scale (VAS) and pruritus score (PS) were used to measure the UP severity. The serum high-sensitivity C-reactive protein (hs-CRP), and interleukin-2 (IL-2) were used as markers of inflammation. RESULTS: Both the median VAS scores (p = .043) and the median PS scores (p < .001) were lower in the Vegetarian than in the non-vegetarian group. The median values of hs-CRP in Vegetarian were lower than that for the non-vegetarian (p = .020). The median value of IL-2 was also lower in Vegetarian than that of the non-vegetarian (p = .016). There were 6 non-vegetarian patients shift to vegetarian for 2 months. The pruritus score improved and IL-2 level decreased after change to vegetarian diet. CONCLUSION: We concluded that vegetarian diet might be associated with the amelioration of the uremic pruritus severity in hemodialysis patients.

Longer dialysis times are associated with a lower chance of dementia among chronic hemodialysis patients.

Dementia is common in chronic hemodialysis (HD) patients and is associated with a higher mortality. Factors associated with dementia in HD patients are not clear. We investigated factors associated with early dementia in HD patients. Chronic HD patients of 27 hemodialysis centers were enrolled in 2013. Early dementia was identified using the AD8 assessment. Factors associated with early dementia were analyzed using logistic regression. A total of 1617 chronic HD patients including 820 males and 797 females, aged 63.3 ± 13 years, dialyzed for 4 (1.8-8.4) years were analyzed. Early dementia was identified in 414 (25.6%) of the patients. Longer HD times were associated with a lower chance of dementia (P = 0.032), with an adjusted odds ratio (OR) of 0.522 (95% confidence interval [CI]: 0.270-0.969) for every one more hour of HD. Patient's age (OR: 1.587, 95% CI: 1.406-1.791, P < 0.001), body mass index (OR: 0.958, 95% CI: 0.921-0.996, P = 0.031), cerebrovascular accident (OR: 1.480, 95% CI: 1.000-2.188), diabetes (OR: 1.894, 95% CI: 1.390-2.581, P < 0.001), and serum albumin (OR: 0.376, 95 % CI: 0.256-0.553, P < 0.001) were independently linked to early dementia. Short hemodialysis times are associated with early dementia in a chronic hemodialysis population with a quarter of patients having early dementia. Patients' age, nutrition status and comorbidity are independently linked to early dementia.

Nutritional status of vegetarians on maintenance haemodialysis.

AIM: Vegetarian diets have long been thought of as beneficial to health. However, vegetarian diets are often low in protein, which is contradictory to the high protein diet guideline for uraemia patients. The purpose of the study was to investigate the impact of a vegetarian diet on the nutritional status of haemodialysis (HD) patients. METHODS: Patients on chronic HD for over 6 months were included in the study. The normalized protein catabolic rate (nPCR) was used to reflect daily protein intake. Biochemical markers of nutrition, anthropometric parameters, subjective global assessment (SGA) and functional activity of daily living were assessed to evaluate the nutritional status of vegetarians on chronic HD. RESULTS: Nineteen out of 318 HD patients were vegetarians. The nPCR was lower in the vegetarian group (1.20 ± 0.24 vs 1.10 ± 0.29 g/kg per day, non-Veg vs Veg, P < 0.05). The serum albumin and prealbumin were similar in vegetarian and non-vegetarian HD patients. The body mass index (BMI) and mid-arm muscular circumference (MAMC) were lower in vegetarian patients (P < 0.05). The haematocrit of vegetarians can be maintained at a level similar to that of non-vegetarian patients but erythropoietin doses needed were higher in vegetarian patients (P < 0.05). The muscle strength evaluated by the hand-grip test, SGA and activities of daily living were similar in vegetarians and non-vegetarians. CONCLUSION: The present study revealed that HD patients on vegetarian diets might have a smaller BMI, but SGA and function of daily activities were similar to those of the non-vegetarians. The haematocrit of vegetarians can be maintained with a higher erythropoietin dose.

HIV vaccine candidates.

Amino acid sequences of the HIV-1 surface protein gp120 show extensive variations. Some of the peptide or DNA vaccines using the V3-loop of gp120 can trigger antibody production against some isolates of HIV, but these antibodies are not protective against other isolates. Thus, more conserved peptides from other HIV proteins have also been tried as vaccines. However, antibodies specific for these peptides cannot prevent the normal entry of HIV into the host cells, followed by integration of viral genomes into host chromosomes. Therefore, we decided to make a careful analysis of the aligned amino acid sequences of gp120 stored at Los Alamos National Laboratory. Unexpectedly, we found that there are several, not just one or two, segments of seven or more consecutive and nearly invariant amino acid residues present in the C1, C2 and C5 regions of this protein. Furthermore, four of these segments are physically close to each other in the known three-dimensional structure of the core portion of gp120. The remaining segments are not in that crystallized region; however, two of these are covalently linked with a disulfide bond. Therefore, we propose that these segments may be combined to form the basis of possible HIV vaccine candidates. In addition, it is necessary to incorporate the processed peptide from gp120 or other proteins and to understand the time-dependent effects of the highly variable loops of gp120 on triggering antibody production in human patients.