Association between metabolic parameters and risks of anemia and electrolyte disturbances among stages 3-5 chronic kidney disease patients in Taiwan.

BACKGROUND: Anemia and electrolyte disturbances are adverse outcomes of chronic kidney disease (CKD). This study explored the association between metabolic parameters with anemia and electrolyte and mineral disorders among CKD patients in Taiwan. METHODS: This cross-sectional study with a total of 2176 CKD stages 3-5 patients were collected from the Department of Nephrology at Shuang Ho Hospital, Taipei Medical University through the "Chronic Kidney Disease Common Care Network" database from December 2008 to April 2019. A multivariable-adjusted logistic regression expressed as odd ratios (OR) was performed to assess the association of metabolic parameters with anemia and electrolyte and mineral disorders. RESULTS: Elevated diastolic blood pressure, fasting blood glucose, and glycated hemoglobin A1c (HbA1c) were associated with presence of anemia. Similarly, elevated fasting blood glucose and HbA1c were associated with hyponatremia (OR = 1.59 and 1.58, P for both < 0.01) and hypercalcemia (OR = 1.38 and 1.33, P for both < 0.05). There was no significant association in serum lipid levels with presence of anemia. However, total triglycerides, total cholesterol and low-density lipoprotein-cholesterol were only associated with presence of hypercalcemia (OR = 1.43, 1.95 and 3.08, respectively, P for all < 0.05). CONCLUSIONS: Elevated diastolic blood pressure, fasting blood glucose, HbA1c and blood lipids are associated with anemia or electrolyte and mineral disorders in CKD patients.

Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan.

We evaluated the interactive effects of nutrition education (NE) and lifestyle factors on kidney function parameters and cardiovascular risk factors among chronic kidney disease (CKD) patients. This cross-sectional cohort study recruited 2176 CKD stages 3-5 patients aged > 20 years from Integrated Chronic Kidney Disease Care Network, Shuang Ho Hospital, Taiwan between December 2008 and April 2019. The multivariable regression analysis was performed to investigate the interactive effects of NE with lifestyle factors on kidney function parameters and cardiovascular risk factors. Relative excess risk due to interaction (RERI) and attributable proportion (AP) were applied to assess additive interaction. Patients who were smoking or physically inactive but received NE had better estimated glomerular filtration rate (eGFR) (ß: 3.83, 95% CI: 1.17-6.49 or ß: 3.67, 95% CI: 2.04-5.29) compared to those without NE. Patients with smoking and NE significantly reduced risks for having high glycated hemoglobin A1c (HbA1c) by 47%, high low-density lipoprotein cholesterol (LDL-C) by 38%, and high corrected calcium (C-Ca) by 50% compared to those without NE. Moreover, NE and smoking or inactive physical activity exhibited an excess risk of high C-Ca (RERI: 0.47, 95% CI: 0.09-0.85 for smoking or RERI: 0.46, 95% CI: 0.01-0.90 and AP: 0.51, 95% CI: 0.03-0.99 for physical activity). Our study suggests that CKD patients who were enrolled in the NE program had better kidney function. Thus, NE could be associated with slowing kidney function decline and improving cardiovascular risk factors.

Effects of glucose and alpha-tocopherol on low-density lipoprotein oxidation and glycation.

Glycation of blood proteins is considered to be a major contributor to hyperglycemic complications in diabetes mellitus patients. In this study, we demonstrate the efficacy of alpha-tocopherol in reducing low-density lipoprotein (LDL) oxidation and glycation in vitro. Native LDL isolated from healthy subjects was exposed to various concentrations of glucose and malondialdehyde (MDA) with or without alpha-tocopherol enrichment for 7 days in sealed vacuum ampoules. The degree of glycation, copper-induced lag time, content of thiobarbituric acid-reactive substances (TBARS), and alpha-tocopherol levels in LDL were then assessed. LDL lag time was significantly reduced with high levels of glucose and MDA. Alpha-tocopherol enrichment dramatically inhibited the oxidation of LDL in the lag-time assay. However, the length of incubation time was inversely related to the LDL lag time. Longer incubation time resulted in shorter LDL lag time, with or without alpha-tocopherol enrichment. The level of TBARS associated with LDL oxidation was highest in native, MDA-supplemented, and high-glucose samples. The alpha-tocopherol levels were inversely related to glucose levels and incubation times. In conclusion, high-glucose concentrations heightened the oxidative susceptibility of LDL. Alpha-tocopherol enrichment reduced this trend and prevented LDL from undergoing architectural modification.