Author Correction: Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker monotherapy retard deterioration of renal function in Taiwanese chronic kidney disease population.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Author Correction: Relationship between body mass index and renal function deterioration among the Taiwanese chronic kidney disease population.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker monotherapy retard deterioration of renal function in Taiwanese chronic kidney disease population.

It remains unclear how different uses of angiotensin-converting inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) influence the progression of chronic kidney disease (CKD). This study explored CKD progression in a multicentre, longitudinal cohort study that included 2639 patients with CKD stage 1-5 and hypertension. Patients treated with ACEI or ARB for ≥90 days during a 6-mo period comprised the study group, or no treatment, comprised the control group. The study group was subdivided on the basis of treatment: ACEI monotherapy or ARB monotherapy. Progression of renal deterioration was defined by an average eGFR decline of more than 5 mL/min/1.73 m2/yr or the commencement of dialysis. With at least 1-year follow up, a progression of renal deterioration was demonstrated in 29.70% of the control group and 25.09% of the study group. Patients in the study group had significantly reduced progression of CKD with adjusted odds ratio 0.79 (95% confidence interval: 0.63-0.99). However, when ACEI monotherapy and ARB monotherapy were analyzed separately, none of their associations with CKD progression was statistically significant. In conclusion, ACEI or ARB monotherapy may retard the deterioration of renal function among patients with CKD and hypertension.

Effects of Hemodialysis on the Symptom Burden of Terminally Ill and Nonterminally Ill End-Stage Renal Disease Patients.

BACKGROUND: No study has compared the effects of hemodialysis on the symptom burden of terminally ill and nonterminally ill end-stage renal disease (ESRD) patients. OBJECTIVES: This study aimed to examine the effects of hemodialysis on the symptom burden of ESRD patients and compare the terminally ill and nonterminally ill groups. DESIGN: This was a quantitative survey; for patients on hemodialysis, the survey was conducted at the beginning and end of the weekly cycle of hemodialysis sessions. SETTING/SUBJECTS: A total of 211 ESRD patients were recruited in Taiwan, 47 of which were terminally ill (38 on hemodialysis) and 164 nonterminally ill (110 on hemodialysis). MEASUREMENTS: Symptom burden was assessed using the Taiwanese version of the MD Anderson Symptom Inventory for kidney disease. RESULTS: Being terminally ill predicted higher symptom severity (B = 0.604, p = 0.017), whereas hemodialysis predicted lower symptom severity (B = -0.614, p = 0.014) in ESRD patients. Nonterminally ill patients who were married or on hemodialysis experienced lower symptom severity (B = -0.604, p = 0.013 and B = -0.665, p = 0.017, respectively). Among terminally ill patients, neither hemodialysis nor other background characteristics predicted symptom severity. When hemodialysis was initiated, no change in symptom severity was observed in terminally ill and nonterminally ill patients. CONCLUSIONS: The effects of hemodialysis on symptom burden were different between ESRD patients with different disease states. Hemodialysis predicted lower symptom severity only in nonterminally ill ESRD patients. Apart from dialysis, care providers should revisit the palliative approach for treating terminally ill ESRD patients to improve their quality of life.

Relationship between body mass index and renal function deterioration among the Taiwanese chronic kidney disease population.

This study investigated the characteristics of patients with different chronic kidney disease (CKD) stages according to various body mass index (BMI) categories and determined the influence of BMI in renal function deterioration. We conducted a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of CKD project (2008-2013) and National Health Insurance Research Database (2001-2013). A total of 7357 patients with CKD aged 20-85 years from 14 hospitals were included in the study. A higher male sex, diabetes mellitus (DM) and hypertension were noted among overweight and obese CKD patients, while more cancer prevalence was noted among underweight CKD patients. Charlson comorbidity index was significantly higher and correlated with BMI among late CKD patients. Patients with BMI < 18.5 kg/m2 exhibited non-significantly higher events of eGFR decline events in both early and late CKD stages than other BMI groups. BMI alone is not a determinant of CKD progression among our Taiwanese CKD patients. Obesity should be re-defined and body weight manipulation should be individualized in CKD patients.

Risks of nocturia in patients with chronic kidney disease--do the metabolic syndrome and its components matter?

PURPOSE: We evaluate the risk factors for nocturia in patients with chronic kidney disease, and determine whether the metabolic syndrome and its components aggravate nocturia in these patients. MATERIALS AND METHODS: We enrolled patients with chronic kidney disease who had regular followup at nephrology clinics, and excluded from study those patients undergoing dialysis, and those with neurogenic bladder or active urinary tract infection. Patients were asked to complete a questionnaire including medical history, clinical parameters and times of nocturnal voids in the last month. Laboratory parameters were checked when the questionnaire was completed. Clinically significant nocturia was defined as voiding 2 or more times per night. The metabolic syndrome was defined according to the ATP III (National Cholesterol Education Program Adult Treatment Panel III) guidelines. Chronic kidney disease was divided into 5 stages (based on National Kidney Foundation guidelines). Multivariate logistic regression was used to evaluate the risk factors for clinically significant nocturia. RESULTS: A total of 202 men and 234 women were eligible for analysis (mean age 68.4 years). The prevalence rate of clinically significant nocturia in patients with chronic kidney disease was 64.0%. Statistically significant risk factors for clinically significant nocturia were patient age (OR 1.02, 95% CI 1.003-1.04) and chronic kidney disease stage (OR 1.47, 95% CI 1.19-1.81) but not gender. Although 53.9% of our patients with chronic kidney disease had the metabolic syndrome, the metabolic syndrome (adjusted OR 0.96, 95% CI 0.64-1.44) and its components had no significant correlations with clinically significant nocturia. CONCLUSIONS: Clinically significant nocturia is prevalent in patients with chronic kidney disease, and the severity increased with chronic kidney disease stage and patient age. Contrary to previous reports, the metabolic syndrome did not increase the risk of clinically significant nocturia in patients with chronic kidney disease.