Light Chain Deposition Disease Recurrence in Renal Allograft after Long-Term Remission.

Light chain deposition disease (LCDD) is a rare manifestation of monoclonal gammopathy, which can lead to renal failure. We previously reported a detailed recurrence process in a case of LCDD after renal transplantation. To the best of our knowledge, no report has described the long-term clinical course and renal pathology findings of recurrent LCDD in patients after renal transplantation. In this case report, we describe the long-term clinical presentation and changes in renal pathology of the same patient after early LCDD relapse in a renal allograft. A 54-year-old woman with recurrent immunoglobulin A λ-type LCDD in an allograft was admitted 1 year post-transplant for bortezomib and dexamethasone therapy. At 2 years post-transplantation, a graft biopsy performed after complete remission was achieved, showing some glomeruli with residual nodular lesions similar to the pre-treatment renal biopsy findings. However, the enlarged subendothelial space disappeared. She remained in complete remission serologically for 6 years. Subsequently, the ratio of serum κ/λ-free light chains decreased gradually. She underwent a transplant biopsy approximately 12 years after renal transplantation due to increased proteinuria and decreased renal function. Compared with the previous graft biopsy, almost all glomeruli showed advanced nodule formation and subendothelial expansion. Because the LCDD case relapsed after long-term remission following renal transplantation, protocol biopsy monitoring might be necessary.

Urinary Metabolome Analyses of Patients with Acute Kidney Injury Using Capillary Electrophoresis-Mass Spectrometry.

Acute kidney injury (AKI) is defined as a rapid decline in kidney function. The associated syndromes may lead to increased morbidity and mortality, but its early detection remains difficult. Using capillary electrophoresis time-of-flight mass spectrometry (CE-TOFMS), we analyzed the urinary metabolomic profile of patients admitted to the intensive care unit (ICU) after invasive surgery. Urine samples were collected at six time points: before surgery, at ICU admission and 6, 12, 24 and 48 h after. First, urine samples from 61 initial patients (non-AKI: 23, mild AKI: 24, severe AKI: 14) were measured, followed by the measurement of urine samples from 60 additional patients (non-AKI: 40, mild AKI: 20). Glycine and ethanolamine were decreased in patients with AKI compared with non-AKI patients at 6-24 h in the two groups. The linear statistical model constructed at each time point by machine learning achieved the best performance at 24 h (median AUC, area under the curve: 89%, cross-validated) for the 1st group. When cross-validated between the two groups, the AUC showed the best value of 70% at 12 h. These results identified metabolites and time points that show patterns specific to subjects who develop AKI, paving the way for the development of better biomarkers.

Study of Glomerulopathy in Donors after Kidney Transplantation.

INTRODUCTION: Living kidney donation improves the lives of individuals with kidney failure; however, recent studies have suggested that living kidney donors may be at a relatively higher risk of reduced renal function than healthy non-donors. We therefore aimed to evaluate the clinical and pathological findings in living kidney donors who developed kidney disease. METHODS: From January 1991 to May 2019, 1,625 live kidney donations were performed at our hospital. Among the donors, 7 developed kidney disease after donation and underwent open renal biopsy. We studied the clinical and pathological findings of these patients from their clinical records. RESULTS: There were 3 patients with immunoglobulin A (IgA) nephropathy, 2 with membranous nephropathy, 1 with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis, and 1 with secondary focal segmental glomerulosclerosis (FSGS). All patients with IgA nephropathy had latent IgA deposition on their baseline biopsy. One patient with membranous nephropathy demonstrated findings of membranous nephropathy on the baseline biopsy, despite being asymptomatic. All patients, except for those with ANCA-associated nephropathy and secondary FSGS, recovered from the nephritis or maintained an adequate renal function after treatment. DISCUSSION/CONCLUSION: Baseline biopsy is necessary for assessing the renal condition of kidney donors, and these donors require long-term follow-up based on their baseline biopsy findings. If donors develop kidney disease, appropriate diagnosis and treatment are essential.

Effect of Low-Density Lipoprotein Apheresis for Nephrotic Idiopathic Membranous Nephropathy as Initial Induction Therapy.

Low-density lipoprotein apheresis (LDL-A) has been used for nephrotic syndrome (NS) caused by focal segmental glomerulosclerosis in Japan. Idiopathic membranous nephropathy (iMN) can also cause treatment-resistant NS. Therefore, we investigated the effect of LDL-A during initial induction for it. This retrospective, observational, and single-center study enrolled consecutive iMN patients who received steroids from March 2000 to May 2015. We compared data between 11 patients treated with LDL-A (LDL-A group) and 27 patients without (non-LDL-A group) at baseline and 4 and 8 weeks later. Reduction rate of proteinuria and increase rate of serum albumin in LDL-A group were significantly higher than the other after 4 weeks (P = 0.036 and 0.030) and 8 weeks (P = 0.030 and <0.001), respectively. There was no adverse event caused by LDL-A and immunosuppressant dose was not significantly different. In conclusion, LDL-A may be an effective choice for initial induction of nephrotic iMN.

Successful treatment of peritoneal dialysis-related peritonitis caused by Dermacoccus nishinomiyaensis.

A 53-year-old man receiving peritoneal dialysis (PD) for 4 months presented with PD-related peritonitis (abdominal pain, turbid peritoneal dialysate effluent, white blood cell in peritoneal dialysate effluent 5350/µL, C-reactive protein 25.56 mg/dL) caused by Dermacoccus (D.) nishinomiyaensis. He was first treated empirically with cefazolin and ceftazidime. After detection of D. nishinomiyaensis in the peritoneal effluent culture collected on the first day of hospitalization, the antibiotics were changed to amoxicillin and vancomycin. After confirming negative-conversion of peritoneal effluent culture, treatment was continued for more than 6 weeks. The peritonitis resolved; he continues peritoneal dialysis without withdrawal from PD or catheter removal. D. nishinomiyaensis is part of resident microbiota of the skin, and its pathogenicity is rarely reported. To date, there is no report of PD-related peritonitis caused by D. nishinomiyaensis. Because it is a slow grower, it may be missed and the peritonitis categorized as culture-negative. Long-term culture is important to detect it. It is difficult to determine the antibiotics that can be used because susceptibility to antibiotics is unknown due to the organism's rarity. Furthermore, the appropriate treatment period is also unknown. Long-term treatment may be useful in PD-related peritonitis caused by D. nishinomiyaensis because it is a slow grower.

Incidence rate of atrial fibrillation after dialysis initiation and its relationship with cardiovascular events.

Aim: This study aimed to investigate the incidence of atrial fibrillation (AF) and its prognosis in the patients after dialysis initiation.Methods: A total of 1524 patients with chronic kidney disease who were initiated on dialysis were included. Dialysis was initiated between October 2011 and September 2013. Electrocardiogram was obtained at dialysis initiation, in March 2015, and September 2016. The mortality and cardiovascular disease (CVD) event rates of 1520 patients (1028 men and 492 women; mean age, 67.5 ± 13.1 years) who were followed up were compared, and they were divided into 2 groups: the AF group (with AF at least once) and N group (without AF).Results: The prevalence of AF was 6.2, 7.9, and 6.5% at dialysis initiation, in March 2015, and September 2016, respectively, and the incidence of new AF onset was 4.8% in March 2015 and 2.3% in September 2016. In total, 45 (28.0%) and 347 (25.5%) patients died in the AF and N groups, (p = .508), respectively. The incidence rates of CVD event were 91 (56.5%) and 413 (30.4%) in the AF and N groups (p < .001), respectively. In the multivariate analysis, mortality was not significant, but the incidence of CVD event was significantly higher in the AF group. Albumin level was associated with new-onset AF.Conclusions: After dialysis initiation, a high incidence of new-onset AF was observed. The lower albumin value at the time of dialysis initiation is more likely to be associated with AF development. Attention should be paid to the CVD events in the AF group.

Efficacy of Long-Term Treatment With Tolvaptan to Prolong the Time Until Dialysis Initiation in Patients With Chronic Kidney Disease and Heart Failure.

The short-term effectiveness of tolvaptan (TLV) against heart failure has been established. TLV is known to decrease the worsening of renal function more than loop diuretics. Long-term TLV administration decreases the rate of re-hospitalization in heart failure and prevents deterioration of kidney function. If repeated hospitalization for heart failure can be prevented in patients having concurrent chronic kidney disease (CKD), the period until dialysis initiation may be prolonged. We investigated whether long-term TLV management can extend the period until dialysis initiation in patients with CKD and heart failure. A retrospective, observational study was conducted among patients with CKD stage G4 and G5 admitted because of heart failure between April 2013 and July 2018. They were divided into those with TLV and those without TLV. They were followed up until August 2018 and relevant data was collected. Data from 115 patients (68 men and 47 women), with a mean age of 73.4 ± 11.9 (median 76.0 and IQR 66.5-82.0) years and a mean eGFR of 11.8 ± 5.7 (median 9.9 and IQR 7.5-14.8) mL/min/1.73m2 were included in the analysis. Twenty-five patients had received long-term TLV treatment, and 90 had not. Multivariate analysis after adjustment showed that long-term use of TLV significantly lowered the hazard ratio (HR) for time taken to reach dialysis initiation (HR: 0.3286, 95%CI: 0.1282-0.8423, P = 0.0205). Propensity score-matched analysis showed similar results (HR: 0.3220, 95%CI: 0.1107-0.9369, P = 0.0376). In patients with CKD G4 and G5 and heart failure, long-term treatment with TLV can prolong the time until dialysis initiation.

Hepatitis B Virus Infection Among Patients With Chronic Kidney Disease Who Attended an Educational Program in Japan.

The rate of hepatitis B infection among hemodialysis patients is high. However, it is not clear if this rate reflects the infection rate among patients with chronic kidney disease (CKD). Therefore, we evaluated the rate of hepatitis B infection among patients with CKD. This is an important clinical issue when considering the risk of infection to medical staff when performing invasive procedures in this clinical population. A retrospective, observational study was conducted among stable, non-dialysis patients with CKD who attended a CKD educational program at our hospital, between August 2012 and October 2017. We collected patients' background and markers of hepatitis infection (HBsAg, HBcAb and HBsAb, as well as HBV-DNA when available) from medical records. The data from 496 patients (373 men and 123 women, with a mean age of 69.3 ± 13.0 years and mean level of creatinine of 3.15 ± 1.72 mg/dL, AST of 21.6 ± 10.5 IU/L, and ALT of 17.3 ± 12.5 IU/L), were included in the analysis. The rate of positive testing for hepatitis B virus infection was as follows: HBsAg, 1.6%; HBsAb, 16.5%; and HBcAb, 21.4%. Of the patients with a negative HBsAg test, 20.1% tested positive for HBcAb. Of the 66 patients in whom HBV-DNA testing was performed, 10.6% tested positive. The rate of hepatitis B virus infection was specifically higher among patients ≥71-years-old. In patients with CKD, the rate of HBsAg positivity is high. Rate of HBcAb positivity is higher particularly in older individuals.

Relationship Between Mortality and Cancer-Bearing Status in Patients With Chronic Kidney Disease Who Attended an Educational Program.

Patients with malignancy have a poorer prognosis than others do, which must be taken into consideration when treating them for chronic kidney disease (CKD). However, there are few studies investigating their prognosis. This was an observational study of 515 (394 men and 121 women) stable non-dialysis patients with CKD who attended a CKD educational program. Mean age was 68.8 ± 13.0 years. Median follow-up was 968.5 days. Mean creatinine was 3.4 ± 1.6 mg/dL. Of these, 63 had malignancy and 452 did not; 20.6% of the former and 11.9% of the latter group died by the end of the study period (P = 0.0548). Malignancy was not associated with all-cause mortality (HR: 1.3475, 95% CI: 0.7202-2.5214, P = 0.3507) but with malignancy-associated mortality (HR: 3.9477, 95% CI: 1.6348-9.5331, P = 0.0023). Renal replacement therapy was not associated with mortality. Since malignancy greatly affects the prognosis, it must be taken into consideration when treating these patients.

Ferrokinetics is associated with the left ventricular mass index in patients with chronic kidney disease.

Background Patients with chronic kidney disease (CKD) often have the complication of anaemia. Usage of an erythropoietin-stimulating agent accelerates iron deficiency because it promotes iron utilization. Recently, iron administration was reported to be effective for patients with cardiac failure. We examined the association between ferrokinetics and cardiac function in patients with CKD. Methods In this cross-sectional study, we examined 558 patients (424 men and 134 women; mean age, 68.9 ± 13.1 years) with CKD who were admitted to our hospital. We assessed cardiac function by ultrasonography and ferrokinetics through transferrin saturation (TSAT) and ferritin levels. Results The primary diseases of CKD were nephrosclerosis (n = 247), diabetic nephropathy (n = 154), chronic glomerulonephritis (n = 73), and others. The mean estimated glomerular filtration rate was 16.9 ± 9.3 mL/min/1.7 m2, and the haemoglobin (Hb) level was 11.0 ± 1.7 g/dL. The median of TSAT was 28.05%, and patients were divided into two groups: below (L-Ts) and above (H-Ts) the median. The median of ferritin was 122 ng/mL, and patients were divided into two groups: below (L-f) and above (H-f) the median. We categorized four groups as H-Ts + H-F, H-Ts + L-F, L-Ts + H-F, and L-Ts + L-F. The Hb levels were 11.1 ± 1.8, 11.3 ± 1.4, 10.9 ± 1.6, and 10.8 ± 1.5 g/dL, respectively, and there was no difference between groups. However, the left ventricular mass indices (LVMIs) were 122.6 ± 46.6, 110.8 ± 32.0, 118.3 ± 36.0, 126.7 ± 46.9, respectively (P = 0.0291). This tendency was stronger in patients without cardiovascular events. Conclusion In patients with CKD, there is an association between ferrokinetics and LVMI. We have to be mindful not only of anaemia but also of ferrokinetics.

Factors associated with severity of sleep apnoea syndrome in patients with chronic kidney disease.

Background In patients with chronic kidney disease (CKD), prevalence of sleep apnoea syndrome (SAS) is reported to be markedly high. However, the factors associated with severity of SAS in such patients rarely have been reported. Methods This was a cross-sectional study of 100 stable non-dialysis patients with CKD who attended a CKD educational programme from April 2014 to August 2015. Diagnosis of SAS and its severity were assessed using a type-3 portable monitor. Results Eighty-six men and 14 women with a mean age of 71.6 ± 9.7 years were included. Mean apnoea-hypopnoea index (AHI) was 26.0 ± 13.8. Severe SAS was seen in 39 patients. Significant differences in brain natriuretic peptide (BNP) level (213.6 ± 329.6 pg/mL vs 107.8 ± 141.3 pg/mL, P < 0.05) and cardiothoracic ratio (CTR, 52.4% ± 6.3% vs 49.6% ± 5.7%, P < 0.05) were seen between patients with and without severe SAS. After adjusting for various parameters, BNP level, CTR, and diameter of the inferior vena cava at the end of inhalation were found to correlate with AHI. Conclusions In patients with CKD, prevalence of severe SAS is extremely high. In these patients, fluid retention, rather than systolic or diastolic function, correlates with severity of SAS.

Two Patients with Familial Hypercholesterolemia Who Were Successfully Weaned from Low-density Lipoprotein Apheresis after Treatment with Evolocumab.

Two elderly patients (a 76-year-old man and a 75-year-old woman), who had been previously diagnosed with familial hypercholesterolemia (at 58 and 48 years of age, respectively) underwent long-term treatment with oral therapy and low-density lipoprotein (LDL) apheresis. As their LDL cholesterol levels remained high (>150 mg/dL and >120 mg/dL, respectively) and their familial hypercholesterolemia was complicated with angina pectoris, we added evolocumab to their prescription. Thereafter, their LDL cholesterol levels decreased rapidly, and the patients were successfully weaned from LDL apheresis. Evolocumab therapy should thus be considered when LDL apheresis cannot achieve the target LDL cholesterol levels, though the prognosis of such treatment remains unclear.

Relationship Between Mortality and Cancer-Bearing Status at Time of Dialysis Initiation.

Patients with malignancy are reported to have poorer prognosis than those without malignancy. When patients with malignancy develop end-stage kidney disease, clinicians must determine treatment with consideration of prognosis. Furthermore, malignancy is sometimes found at time of dialysis initiation. However, prognosis of patients with malignancy at time of dialysis initiation has not been investigated. A total of 1524 patients with chronic kidney disease who initiated dialysis at 17 centers participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis were included. Patients initiated dialysis between October 2011 and September 2013. Mortality rates were compared between patients with and without malignancy. Types of malignancy and respective prognoses also were assessed. The study included 1030 men and 492 women with a mean age of 67.5 ± 13.1 years. Of these, 92 had malignancy and 1430 did not; 45.7% of the former group and 16.0% of the latter group died by March 2015 (P < 0.01). Even after adjusting for various factors, presence of malignancy remained an independent risk factor for mortality (P < 0.01). Patients with performance status (PS) of 0 had significantly lower mortality (P < 0.01). Patients with malignancy at time of dialysis initiation had poor prognosis. Therefore, presence of malignancy should be taken into consideration when patients initiate dialysis. In patients with malignancy, better PS was associated with better prognosis.

Evaluation of the Relationship between the Serum Alkaline Phosphatase Level at Dialysis Initiation and All-Cause Mortality: A Multicenter, Prospective Study.

BACKGROUND/AIM: High serum alkaline phosphatase (ALP) levels predict mortality independent of bone metabolism parameters and liver function test results in patients on hemodialysis. The relationship between serum ALP at dialysis initiation and mortality during maintenance dialysis is unknown; therefore, we aimed to identify an association. METHODS: This multicenter, prospective cohort study analyzed 1,213 patients registered in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis from October 2011 to September 2013. Patients were divided into 2 groups based on serum ALP levels. All-cause mortality and incidences of cardiovascular events after dialysis initiation were compared using the log-rank test and multivariate Cox proportional hazard regression analysis. We performed stratified analysis based on parathyroid hormone (PTH) levels. RESULTS: During the follow-up, 109 (18.0%) and 86 (14.1%) patients died in the high ALP group (232 ≥IU/L; High ALP group) and low ALP group (232

Physical function at the time of dialysis initiation is associated with subsequent mortality.

BACKGROUND: In dialysis patients, physical function is associated with mortality. However, the association between physical function at the time of dialysis initiation and subsequent mortality remains unknown. METHODS: A total of 1496 patients with chronic kidney disease who initiated dialysis at 17 centers participating in the Aichi Cohort Study of the Prognosis in Patients Newly Initiated into Dialysis, a multicenter prospective cohort study, were included. The patients were divided into the high (H)-, middle (M)-, and low (L)-score groups according to Barthel index (BI) at the time of dialysis initiation, and the all-cause, cardiovascular disease (CVD)-related, and infection-related mortality rates were compared. Moreover, factors affecting all-cause mortality were investigated. The effects of BI on mortality were assessed in the patients stratified by age, sex, and history of CVD or cerebral infarction. RESULTS: A log-rank test for the Kaplan-Meier survival curve showed significant differences between the three groups in all-cause, CVD-related, and infection-related mortality rates (p < 0.001). Cox proportional hazard regression analysis with the step-wise method showed a significantly higher risk of all-cause mortality in the M and L groups than in the H group (M group: HR 1.612, 95 % CI 1.075-2.417; L group: HR 1.994, 95 % CI 1.468-2.709). Regardless of the age categories and the history of CVD, the risk of all-cause mortality was significantly higher in the L group than in the H group. CONCLUSION: Physical function assessed by BI at the time of dialysis initiation was found to be associated with subsequent mortality.

Relationship between mortality and speed of eGFR decline in the 3 months prior to dialysis initiation.

BACKGROUND: The timing for initiating dialysis in chronic kidney disease is often determined by the clinical symptoms and estimated glomerular filtration rate (eGFR). However, very few studies have examined how the speed of kidney function decline before initiating dialysis relates to mortality after dialysis initiation. Here, we report our examination of the relationship between the speed of eGFR decline in the 3 months prior to dialysis initiation and mortality. METHODS: The study included 1292 new dialysis patients who were registered in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis. The subjects were placed in 4 groups based on the speed of eGFR decline in the 3 months before initiating dialysis (eGFR at 3 months before initiation-eGFR at initiation) <2: ≥2, <4: ≥4, <6: ≥6 mL/min/1.73 m2. All-cause, cardiovascular, and infection-related mortality rates were compared using Kaplan-Meier curves. A multivariate analysis using the Cox proportional hazard model was used to extract the factors that contributed to all-cause mortality. RESULTS: The group with faster eGFR decline exhibited significantly more heart failure symptoms when dialysis was initiated. Rapid eGFR decline correlated with prognosis (log-rank test: all-cause mortality p < 0.001, cardiovascular mortality p < 0.001). The speed of eGFR decline was related to elevated all-cause mortality rates [eGFR decline 10 mL/min/1.73 m2, HR (95 % CI) = 1.53 (1.12-2.08)]. CONCLUSIONS: This study showed that patients with rapid eGFR decline in the 3 months before initiating dialysis more often presented with heart failure symptoms when dialysis was initiated and had poorer survival prognoses.

Association between 1,25-dihydroxyvitamin D and left atrial diameter in pre-dialysis chronic kidney disease patients
.

OBJECTIVE: To investigate the correlation between serum 1,25-dihydroxyvitamin D (1,25D) levels and left atrial diameter (LAD) using echocardiography in pre-dialysis chronic kidney disease (CKD). SUBJECTS AND METHODS: From an initial population of 487 patients (109 met the exclusion criteria), a total of 378 patients with CKD stage 3a - 5 who had not undergone dialysis or kidney transplantation were included in the study. The relationship between serum 1,25D levels and LAD was examined. Moreover, factors that impacted LAD were extracted through stepwise multiple regression analyses. RESULTS: Serum 1,25D levels correlated negatively with LAD, left ventricular end-diastolic diameter, interventricular septum thickness, end-diastolic volume, stroke volume, left ventricular mass index (LVMI), and E/e'. Stepwise multiple regression analyses revealed there was a significant relationship between serum 1,25D levels and LAD (regression coefficient = -0.070, p = 0.001). In the stratified analysis, serum 1,25D levels were associated with LAD in the LVMI < 125 g/m2 (regression coefficient = -0.067, p = 0.038) and ejection fraction (EF) ≥ 60% groups (regression coefficient = -0.080, p = 0.004). CONCLUSION: Serum 1,25D levels were independently associated with LAD in CKD patients; however, the association was not significant in patients with an EF < 60% and LVMI > 125 g/m2.

Predialysis Vitamin D Receptor Activator Treatment and Cardiovascular Events after Dialysis Initiation: A Multicenter Observational Study.

BACKGROUND: Vitamin D receptor activator (VDRA) administration has been linked with a reduced incidence of cardiovascular disease (CVD). However, it is unclear whether VDRA administration during the predialysis stage is associated with CVD incidence after dialysis initiation in patients with chronic kidney disease. Therefore, we examined the association between VDRA use and CVD events. METHODS: This multicenter observational study included 1,516 patients; they were divided into 2 groups: those who did and did not receive oral VDRA for at least 3 months before dialysis initiation. The CVD incidence was compared between these groups. Factors that impacted CVD incidence were extracted through a multivariate analysis. Subgroups were created based on prior CVD history and serum CRP levels. RESULTS: The incidence of CVD was significantly lower in the VDRA group (log-rank test, p = 0.014). Stepwise multivariate analyses identified age, gender, diabetes, CVD history, calcium-channel blockers, beta-blockers, loop diuretics, anti-platelet agents, phosphate binders, VDRA, erythropoiesis stimulating agents, and cardiothoracic ratio as factors affecting CVD incidence. In the group with no CVD history, VDRA use was associated with a low incidence of CVD (HR 0.35). In the group with serum CRP levels <1.0 mg/dl, VDRA use was associated with a low incidence of CVD (HR 0.47). CONCLUSION: Administration of VDRA during predialysis was associated with a low incidence of CVD onset after dialysis initiation.

Association between Plaque Score of the Carotid Artery and the Severity of Sleep Apnea Syndrome in Patients with Chronic Kidney Disease.

BACKGROUND: Recently, sleep apnea syndrome (SAS) has been associated with hypertension, cardiovascular disease and death. Patients with chronic kidney disease (CKD) have higher rates of SAS, atherosclerotic complications and death than do patients without CKD. Although the relationship between SAS and atherosclerosis is well known, few papers have described this relationship in humans, especially in CKD patients. PATIENTS AND METHODS: This was a cross-sectional study of 110 clinically stable, non-dialysis patients with CKD who attended a CKD educational program from April 2014 to September 2015. The diagnosis of SAS and its severity were assessed using a type 3 portable monitor. Other atherosclerosis-related data were obtained from the patients' medical records in order to determine the factors associated with the severity of SAS. RESULTS: 95 men and 15 women with a mean age of 71.4 ± 9.9 years were included in the study. The patients' mean body mass index was 24.0 ± 3.9, their mean blood pressure 134.3 ± 21.2/73.6 ± 13.4 mm Hg and their mean estimated glomerular filtration rate 19.8 ± 9.5 ml/min/1.7 m(2). Adjusted plaque score was a significant predictor of severe SAS (odds ratio = 1.13, p = 0.0182). Mixed plaque was significantly associated with severe SAS (correlation ratio = 0.48, p < 0.0001). CONCLUSIONS: Many patients with CKD also have SAS. Our findings demonstrate the relationship between plaque score and the severity of SAS.

Presence of Atrial Fibrillation at the Time of Dialysis Initiation Is Associated with Mortality and Cardiovascular Events.

BACKGROUND: Death in dialysis patients results mainly from cardiovascular and cerebrovascular diseases. To our knowledge, no prospective study has compared the rates of mortality or cardiovascular events between patients with and without atrial fibrillation (AF) at the time of dialysis initiation. METHODS: This study included 1,516 patients who were initiated into dialysis between October 2011 and August 2013. Rates of mortality and cardiovascular events were compared between patients with and without AF, and between AF patients with and without warfarin (WF) treatment. RESULTS: The study comprised 1,025 men and 491 women with a mean age of 67.5 ± 13.1. Of these patients, 93 had AF, while 1,423 did not; 22.6% of the former group and 9.7% of the latter group died by March 2014 (p < 0.01). Cardiovascular events occurred in 34.4% of patients with AF and 15.1% of patients without (p < 0.01). Even after adjustments for various factors, AF remained an independent risk factor for mortality (hazard ratio (HR) 1.873, 95% CI 1.168-3.002, p < 0.01). It was also an independent risk factor for cardiovascular events (HR 1.872, 95% CI 1.262-2.778, p < 0.01). No difference in any parameter was noted between the groups that did and did not receive WF treatment. CONCLUSION: Patients with AF at the time of dialysis initiation show a poor prognosis and are at high risk of cardiovascular events. Therefore, AF should be taken into consideration in dialysis patients.