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1.
Background
Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction.Methods
Using Cox Proportional Hazard Models on data (N?=?669) from the EchoCardiography and Heart Outcome Study (ECHOS) study we evaluated whether estimated glomerular filtration rate (eGFR) was associated with mortality risk before and after adjustment for severe diastolic dysfunction. Severe diastolic dysfunction was defined by a restrictive left ventricular filling pattern (RF) (=deceleration time?<?140 ms) by Doppler echocardiography.Results
Median eGFR was 58 ml/min/1.73 m2, left ventricular ejection fraction was 33% and RF was observed in 48%. During the 7 year follow up period 432 patients died. Multivariable adjusted eGFR was associated with similar mortality risk before (Hazard Ratio(HR)eGFR 10 ml increase: 0.94 (95% CI: 0.89-0.99, P?=?0.024) and after (HReGFR 10 ml increase: 0.93 (0.89-0.99), P?=?0.012) adjustment for RF (HR: 1.57 (1.28-1.93), P?<?0.001).Conclusions
In patients admitted with HF RF does not contribute to the increased mortality risk observed in patients with a decreased eGFR. Factors other than severe diastolic dysfunction may explain the association between renal function and mortality risk in HF patients.2.
Daisuke Takada Keiichi Sumida Akinari Sekine Ryo Hazue Masayuki Yamanouchi Tatsuya Suwabe Noriko Hayami Junichi Hoshino Naoki Sawa Kenmei Takaichi Takeshi Fujii Kenichi Ohashi Yoshifumi Ubara 《BMC nephrology》2017,18(1):362
Background
Various renal manifestations are known to develop in patients with liver disease, including chronic hepatitis and cirrhosis.Case presentation
We evaluated renal disease in two 47-year-old Japanese men with liver cirrhosis and chronic alcoholism for 34 years and 27 years, respectively. Renal biopsy demonstrated massive wire loop-like deposits in the subendothelial space of the glomerular basement membrane and in the mesangium. However, immunofluorescence was only positive for IgA and C3, and electron microscopy did not reveal any organized structures in the electron-dense deposits. IgA nephropathy was diagnosed, although the features were different from primary IgA nephropathy. Both patients had portosystemic shunts associated with liver cirrhosis. Their renal deposits and proteinuria resolved completely after 1 year of steroid therapy.Conclusion
Alcohol abuse may have contributed to development of secondary IgA nephropathy in these two patients, probably via their portosystemic shunts.3.
Background
Renal impairment and atrial fibrillation (AF) often coexist. Catheter ablation is an effective way to reduce the burden of AF and improve symptoms; however, little is known about the relationship between renal function and AF and its role in the progression of AF for patients undergoing repeat catheter ablation.Methods
In all, 171 patients with long-standing persistent AF ablation were enrolled in the study. The patients were divided into two groups according to their delta estimated glomerular filtration rate (eGFR) values, which was defined as the eGFR before the repeat procedure minus the eGFR before the initial procedure. Patients with decreasing eGFR (delta eGFR <?0) were categorized as group I, while individuals with no change or increasing eGFR (delta eGFR≥?0) were categorized as group II. eGFR was estimated at baseline and at the 12-month and 24-month follow-up visits.Results
After a mean follow-up of 31.4?±?13.2 months, group I had a significantly higher arrhythmia recurrence rate than group II (71.2 vs. 49.2?%, p?<?0.001). On multivariable analyses, eGFR changes after the repeat procedure were associated with arrhythmia recurrence, hypertrophic cardiomyopathy, and CHA2DS2-VASc score. Patients with arrhythmia recurrence and those with a CHA2DS2-VASc score of ≥?3 were more likely to show an eGFR decline at follow-up.Conclusion
Patients with long-standing persistent AF, with a failed initial ablation procedure and undergoing a repeat ablation procedure, appear to have a higher risk of arrhythmia recurrence. During the follow-up period, patients without arrhythmia recurrence and those with a CHA2DS2-VASc score of <?3 show improved renal function.4.
Background
IgA nephropathy is the most common primary glomerular disease worldwide and also the most frequent cause of kidney failure. Mycophenolate mofetil (MMF) is a selective immunosuppressant widely used in many autoimmune diseases. However, the benefits and risks of MMF for the treatment of IgA nephropathy remain uncertain.Methods
A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to assess the efficacy and safety of MMF in IgA nephropathy patients, using the statistical software Review Manager 5.1.Results
Eight RCTs involving 357 patients were identified and included in this review. Overall, no statistical difference was found in the therapeutic effect of MMF treatment compared with other therapies. MMF had no significant effects on reducing proteinuria or protecting renal function. However, subgroup analysis indicated that relatively short-term therapy (<18 months) might be beneficial in IgA nephropathy patients while longer term MMF use conferred no advantage. There was also no statistical difference between MMF and control groups in the incidence of side effects. When compared with other immunosuppressants, MMF was considered superior to cyclophosphamide in terms of better therapeutic effects and fewer adverse reactions, but no difference was found between MMF and leflunomide.Conclusions
Our current evidence indicates that a relatively short course of MMF may be beneficial in treating IgA nephropathy. However, high-quality RCTs with large sample size as well as a well-designed study to evaluate the long-term effects of MMF are needed to further evaluate the efficacy and safety of MMF in this disease.5.
Zachary A. Marcum Christopher W. Forsberg Kathryn P. Moore Ian H. de Boer Nicholas L. Smith James S. Floyd 《Journal of general internal medicine》2018,33(2):155-165
Background
For patients with type 2 diabetes and chronic kidney disease (CKD), high-quality evidence about the relative benefits and harms of oral glucose-lowering drugs is limited.Objective
To evaluate whether mortality risk differs after the initiation of monotherapy with either metformin or a sulfonylurea in Veterans with type 2 diabetes and CKD.Design
Observational, national cohort study in the Veterans Health Administration (VHA).Participants
Veterans who received care from the VHA for at least 1 year prior to initiating monotherapy treatment for type 2 diabetes with either metformin or a sulfonylurea between 2004 and 2009.Main Measures
Metformin and sulfonylurea use was assessed from VHA electronic pharmacy records. The CKD-EPI equation was used to estimate glomerular filtration rate (eGFR). The outcome of death from January 1, 2004, through December 31, 2009, was assessed from VHA Vital Status files.Key Results
Among 175,296 new users of metformin or a sulfonylurea monotherapy, 5121 deaths were observed. In primary analyses adjusted for all measured potential confounding factors, metformin monotherapy was associated with a lower mortality hazard ratio (HR) compared with sulfonylurea monotherapy across all ranges of eGFR evaluated (HR ranging from 0.59 to 0.80). A secondary analysis of mortality risk differences favored metformin across all eGFR ranges; the greatest risk difference was observed in the eGFR category 30–44 mL/min/1.73m2 (12.1 fewer deaths/1000 person-years, 95% CI 5.2–19.0).Conclusions
Initiation of metformin versus a sulfonylurea among individuals with type 2 diabetes and CKD was associated with a substantial reduction in mortality, in terms of both relative and absolute risk reduction. The largest absolute risk reduction was observed among individuals with moderately–severely reduced eGFR (30–44 mL/min/1.73m2).6.
Marian Goicoechea Soledad García de Vinuesa Borja Quiroga Eduardo Verde Carmen Bernis Enrique Morales Gema Fernández-Juárez Patricia de Sequera Ursula Verdalles Ramón Delgado Alberto Torres David Arroyo Soraya Abad Alberto Ortiz José Luño 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2018,32(3):255-263
Background
Patients with chronic kidney disease (CKD) are at high risk for developing cardiovascular events. However, limited evidence is available regarding the use of aspirin in CKD patients to decrease cardiovascular risk and to slow renal disease progression.Study Design
Prospective, multicenter, open-label randomized controlled trial.Setting and Participants
One hundred eleven patients with estimated glomerular filtration rate (eGFR) 15–60 ml/min/1.73 m2 without previous cardiovascular events.Intervention
Aspirin treatment (100 mg/day) (n?=?50) or usual therapy (n?=?61). Mean follow-up time was 64.8?±?16.4 months.Outcomes
The primary endpoint was composed of cardiovascular death, acute coronary syndrome (nonfatal MI, coronary revascularization, or unstable angina pectoris), cerebrovascular disease, heart failure, or nonfatal peripheral arterial disease. Secondary endpoints were fatal and nonfatal coronary events, renal events (defined as doubling of serum creatinine, ≥?50% decrease in eGFR, or renal replacement therapy), and bleeding episodes.Results
During follow-up, 17 and 5 participants suffered from a primary endpoint in the control and aspirin groups, respectively. Aspirin did not significantly reduce primary composite endpoint (HR, 0.396 (0.146–1.076), p?=?0.069. Eight patients suffered from a fatal or nonfatal coronary event in the control group compared to no patients in the aspirin group. Aspirin significantly reduced the risk of coronary events (log-rank, 5.997; p?=?0.014). Seventeen patients in the control group reached the renal outcome in comparison with 3 patients in the aspirin group. Aspirin treatment decreased renal disease progression in a model adjusted for age, baseline kidney function, and diabetes mellitus (HR, 0.272; 95% CI, 0.077–0.955; p?=?0.043) but did not when adjusted for albuminuria. No differences were found in minor bleeding episodes between groups and no major bleeding was registered.Limitations
Small sample size and open-label trial.Conclusions
Long-term treatment with low-dose aspirin did not reduce the composite primary endpoint; however, there were reductions in secondary endpoints with fewer coronary events and renal outcomes. ClinicalTrials.gov Identifier: NCT01709994.7.
Background
Klotho is a single-pass transmembrane protein, which appears to be implicated in aging. The purpose of the present study was to characterize the relationship between the soluble Klotho level and renal function in patients with various degrees of chronic kidney disease (CKD).Methods
The levels of soluble Klotho in the serum and urine obtained from one hundred thirty-one CKD patients were determined by a sandwich enzyme-linked immunosorbent assay system.Results
The amount of urinary excreted Klotho during the 24 hr period ranged from 1.6 to 5178 ng/day (median 427 ng/day; interquartile range [IR] 56.8-1293.1), and the serum Klotho concentration ranged from 163.9 to 2123.7 pg/ml (median 759.7 pg/ml; IR 579.5-1069.1). The estimated glomerular filtration rate (eGFR) was significantly correlated with the log-transformed values of the amount of 24 hr urinary excreted Klotho (r?=?0.407, p?<?0.01) and the serum Klotho levels (r?=?0.232, p?<?0.01). However, a stepwise multiple regression analysis identified eGFR to be a variable independently associated only with the log-transformed value of the amount of 24-hr urinary excreted Klotho but not with the log-transformed serum Klotho concentration. Despite the strong correlation between random urine protein-to-creatinine ratio and the 24 hr urinary protein excretion (r?=?0.834, p?<?0.01), a moderate linear association was observed between the log-transformed value of the amount of 24 hr urinary excreted Klotho and that of the urinary Klotho-to-creatinine ratio (Klotho/Cr) in random urine specimens (r?=?0.726, p?<?0.01).Conclusions
The amount of urinary Klotho, rather than the serum Klotho levels, should be linked to the magnitude of the functioning nephrons in CKD patients. The use of random urine Klotho/Cr as a surrogate for the amount of 24-hr urinary excreted Klotho needs to be evaluated more carefully.8.
Ismail?Kocyigit Mahmut?Ilker?Yilmaz Ozkan?Gungor Eray?Eroglu Aydin?Unal Ozcan?Orscelik Bulent?Tokgoz Murat?Sipahioglu Ahmet?Sen Juan?Jesús?Carrero Oktay?Oymak Jonas?Axelsson
Background
In this study, we examined the relative usefulness of serum copeptin levels as a surrogate marker of vasopressin (AVP) in adult polycystic kidney disease (ADPKD) by correlating it with baseline and longitudinal changes in markers of both renal function and common CVD manifestations (hypertensive vascular disease, atherosclerosis and endothelial dysfunction) that accompany the progression of this disease.Methods
We studied a cohort of young and otherwise healthy ADPKD patients (n?=?235) and measured cardiovascular function using flow-mediation dilatation (FMD), carotid intima media thickness (cIMT) and pulse wave velocity (PWV), as well as serum copeptin (commercial ELISA, a stable marker of AVP activity). The same analyses were carried out at baseline and after 3 years of follow-up.Results
At baseline, median eGFR was 69 mL/min./1.73 m2, mean FMD 6.9?±?0.9%, cIMT 0.7?±?0.1 mm, and PWV 8.1?±?1.2 m/s. At follow-up, equivalent values were 65 (44–75) mL/min./1.73 m2, 5.8?±?0.9%, 0.8?±?0.1 mm. and 8.2?±?1.3 m/s. with all changes statistically significant. Plasma copeptin also rose from 0.62?±?0.12 to 0.94?±?0.19 ng/mL and this change correlated with ΔeGFR (-0.33, p?<?0.001), ΔFMD (0.599, p?<?0.001), ΔcIMT (0.562, p?<?0.001) and ΔPWV (0.27, p?<?0.001) also after linear regression modeling to correct for confounders. Finally, ROC analysis was done for a high baseline copeptin with ΔeGFR [cut-off:≤59], ΔFMD [cut-off: ≤7.08], ΔcIMT [cut-off:>0.76], and ΔPWV [cut-off:≤7.80].Conclusions
Vascular dysfunction as reflected by FMD and cIMT, but not PWV or an altered cardiac geometry, precede most other signs of disease in ADPKD but is predicted by elevated levels of the circulating AVP-marker copeptin.9.
Background
The current treatment options for idiopathic membranous nephropathy (IMN) carry significant toxicity. In this prospective, observational pilot study, we used single time infusion of bone marrow derived autologous mononuclear cells (MNCs) in adult patients with treatment refractory IMN.Methods
Twelve patients of biopsy proven IMN who had failed a cyclical 6-month regimen of steroid and cyclophosphamide were enrolled in the study. Bone-marrow was harvested from the iliac crest and underwent processing to isolate MNCs. Cells were counted and subjected to viability testing before being infused through a peripheral vein on the same day. After the infusion, subjects were followed up monthly for the next six months. Supportive treatment including angiotensin antagonists and statins was continued throughout the study period.Result
The proteinuria, serum albumin and creatinine values at entry were 2.97?±?0.6 gm/1.73 m2/d, 2.27?±?1.1 gm/l and 0.9?±?0.8 mg/dl respectively. There was a reduction in proteinuria (p?<?0.0001), and increase in serum albumin (p?=?0.001) at 1 month, with 64% of the subjects showing?>50% reduction in proteinuria. However, the response was ill sustained. At 6 months, only 2 patients had >50% reduction. Serum creatinine remained stable throughout the study period. No infusion related side effects were noted.Conclusion
Autologous mononuclear cell infusion leads to transitory reduction in proteinuria and improvement in serum albumin in treatment refractory IMN. This effect, however, is transient. Whether this can be overcome by repeated infusion of cultured mesenchymal cells needs to be investigated.10.
Background
This study aimed to investigate the prognostic factors of patients with stage IIA (T3N0M0) colon cancer in terms of macroscopic serosal invasion and small tumor size.Methods
We enrolled 375 stage IIA colon cancer patients who underwent curative resection between January 2004 and December 2011. Macroscopic serosal invasion was defined as tumor nodules or colloid changes protruding the surface of the serosa. The clinicopathologic characteristics were analyzed to identify independent prognostic factors.Results
The median follow-up was 47 months (range, 1–90 months). On multivariate survival analysis, macroscopic serosal invasion (adjusted hazard ratio [HR]?=?4.750; p?=?0.013), tumor size <?5 cm (adjusted HR?=?3.112, p?=?0.009), perineural invasion (adjusted HR?=?3.528; p?=?0.002), <?12 retrieved lymph nodes (adjusted HR?=?4.257; p?=?0.002), and localized perforation (adjusted HR?=?7.666; p?=?0.008) were independent risk factors for recurrence.Conclusion
We found novel prognostic factors of stage IIA colon cancer, including macroscopic serosal invasion and small tumor size (<?5 cm). Further studies are needed to evaluate the benefit of adjuvant chemotherapy in patients with these prognostic factors.11.
Fabienne Langlois Dawn Shao Ting Lim Chris G. Yedinak Isabelle Cetas Shirley McCartney Justin Cetas Aclan Dogan Maria Fleseriu 《Pituitary》2018,21(1):32-40
Purpose
Silent corticotroph adenomas (SCAs) are clinically silent and non-secreting, but exhibit positive adrenocorticotropic hormone (ACTH) immunostaining. We characterized a single center cohort of SCA patients, compared the SCAs to silent gonadotroph adenomas (SGAs), identified predictors of recurrence, and reviewed and compared the cohort to previously published SCAs cases.Methods
Retrospective review of SCA and SGA surgically resected patients over 10 years and 6 years, respectively. Definitions; SCA—no clinical or biochemical evidence of Cushing’s syndrome and ACTH positive immunostaining, and SGA—steroidogenic factor (SF-1) positive immunostaining. A systematic literature search was undertaken using Pubmed and Scopus.Results
Review revealed 814 pituitary surgeries, 39 (4.8%) were SCAs. Mean follow-up was 6.4 years (range 0.5–23.8 years). Pre-operative magnetic resonance imaging demonstrated sphenoid and/or cavernous sinus invasion in 44%, 33% were >?50% cystic, and 28% had high ACTH levels pre-operatively. Compared to SGAs (n?=?70), SCAs were of similar size and invasiveness (2.5 vs. 2.9 cm, p?=?0.2; 44 vs. 41%, p?=?0.8, respectively), but recurrence rate was higher (36 vs. 10%, p?=?0.001) and more patients received radiation therapy (18 vs. 3%, p?=?0.006). Less cystic tumors (0 vs. 50%, p?<?0.001) and higher pre-operative ACTH levels (54 vs. 28 pg/ml, p?=?0.04) were predictors of recurrence for SCAs.Conclusion
This review is unique; a strict definition of SCA was used, and single center SCAs were compared with SGAs and with SCAs literature reviewed cases. We show that SCAs are aggressive and identify predictors of recurrence. Accurate initial diagnosis, close imaging and biochemical follow up are warranted.12.
Eugene Z. Oddone Jennifer M. Gierisch Linda L. Sanders Angela Fagerlin Jordan Sparks Felicia McCant Carrie May Maren K. Olsen Laura J. Damschroder 《Journal of general internal medicine》2018,33(9):1487-1494
Background
A large proportion of deaths and chronic illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity.Objective
To test whether telephone-based health coaching after completion of a comprehensive health risk assessment (HRA) increases patient activation and enrollment in a prevention program compared to HRA completion alone.Design
Two-arm randomized trial at three sites.Setting
Primary care clinics at Veterans Affairs facilities.Participants
Four hundred seventeen veterans with at least one modifiable risk factor (BMI?≥?30, <?150 min of at least moderate physically activity per week, or current smoker).Intervention
Participants completed an online HRA. Intervention participants received two telephone-delivered health coaching calls at 1 and 4 weeks to collaboratively set goals to enroll in, and attend structured prevention programs designed to reduce modifiable risk factors.Measurements
Primary outcome was enrollment in a structured prevention program by 6 months. Secondary outcomes were Patient Activation Measure (PAM) and Framingham Risk Score (FRS).Results
Most participants were male (85%), white (50%), with a mean age of 56. Participants were eligible, because their BMI was ≥?30 (80%), they were physically inactive (50%), and/or they were current smokers (39%). When compared to HLA only at 6 months, health coaching intervention participants reported higher rates of enrollment in a prevention program, 51 vs 29% (OR?=?2.5; 95% CI: 1.7, 3.9; p?<?0.0001), higher rates of program participation, 40 vs 23% (OR?=?2.3; 95% CI: 1.5, 3.6; p?=?0.0004), and greater improvement in PAM scores, mean difference 2.5 (95% CI: 0.2, 4.7; p?=?0.03), but no change in FRS scores, mean difference 0.7 (95% CI ??0.7, 2.2; p?=?0.33).Conclusions
Brief telephone health coaching after completing an online HRA increased patient activation and increased enrollment in structured prevention programs to improve health behaviors.ClinicalTrials.gov Identifier
NCT0182856713.
Background
Few studies have focused on investigating hypoalbuminemia in patients during earlier stages of chronic kidney disease (CKD). In particular, little is known about the role of gastrointestinal (GI) symptoms. Our goal in this paper is to study how GI symptoms relate to serum albumin levels in CKD, especially in the context of and compared with inflammation.Methods
We performed a cross-sectional study of 3599 patients with chronic kidney disease enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. All subjects were asked to complete the Modification of Diet in Renal Disease (MDRD) study patient symptom form. Our main predictor is GI symptom score. Serum level of C-reactive protein (CRP) was measured as well. Main outcome measures are serum albumin levels and prevalence of hypoalbuminemia.Results
Of the participants assessed, mean serum albumin was 3.95?±?0.46 g/dL; 12.7 % had hypoalbuminemia. Patients with lower estimated glomerular filtration rate (eGFR) were likely to have more GI symptoms (apparent at an eGFR <45 ml/min/1.73 m2). Patients with worse GI symptoms had lower dietary protein intake. GI symptoms, like inflammation, were risk factors for lower serum albumin levels. However, adding GI symptom score or CRP into the multivariable regression analysis, did not attenuate the association between lower eGFR and lower albumin or hypoalbuminemia.Conclusions
Increased prevalence of GI symptoms become apparent among CKD patients at relatively high eGFR levels (45 ml/min/1.73 m2), long before ESRD. Patients with more severe GI symptoms scores are more likely to have hypoalbuminemia. But our data do not support GI symptoms/decreased protein intake or inflammation as being the main determinants of serum albumin level in CKD patients.14.
Zhongping WEI Bonnie Ching-Ha KWAN Kai Ming CHOW Phyllis Mei-Shan CHENG Cathy Choi-Wan LUK Ka-Bik LAI Philip Kam-Tao LI Cheuk Chun SZETO 《BMC nephrology》2018,19(1):367
Background
Urinary mitochondrial DNA (mtDNA) fragment level has been proposed as a biomarker of chronic kidney disease (CKD). In this study, we determine the relation between urinary mtDNA level and rate of renal function deterioration in non-diabetic CKD.Methods
We recruited 102 non-diabetic CKD patients (43 with kidney biopsy that showed non-specific nephrosclerosis). Urinary mtDNA level was measured and compared to baseline clinical and pathological parameters. The patients were followed 48.3?±?31.8?months for renal events (need of dialysis or over 30% reduction in estimated glomerular filtration rate [eGFR]).Results
The median urinary mtDNA level was 1519.42 (inter-quartile range 511.81–3073.03) million copy/mmol creatinine. There were significant correlations between urinary mtDNA level and baseline eGFR (r?=?0.429, p?<?0.001), proteinuria (r?=?0.368, p?<?0.001), severity of glomerulosclerosis (r?=???0.537, p?<?0.001), and tubulointerstitial fibrosis (r?=???0.374, p?=?0.014). The overall rate of eGFR decline was ??2.18?±?5.94?ml/min/1.73m2 per year. There was no significant correlation between the rate of eGFR decline and urinary mtDNA level. By univariate analysis, urinary mtDNA level predicts dialysis-free survival, but the result became insignificant after adjusting for clinical and histological confounding factors.Conclusion
Urinary mtDNA levels have no significant association with the rate of renal function decline in non-diabetic CKD, although the levels correlate with baseline renal function, proteinuria, and the severity of histological damage. Urinary mtDNA level may be a surrogate marker of permanent renal damage in non-diabetic CKD.15.
Background
Hepatocyte growth factor (HGF) counteracts peritoneal fibrosis in animal models and in-vitro studies, but no study explored effluent HGF in peritoneal dialysis (PD) patients with ultrafiltration failure (UFF). Our aim was to assess the relationship between effluent HGF with UF profile, free water transport (FWT) and small-solute transport.Methods
We performed 4-hour, 3.86% PET with additional UF measurement at 60 minutes in 68 PD patients. MTACcreatinine, FWT, small-pore ultrafiltration, and effluent HGF were quantified.Results
Effluent HGF negatively correlated with UF (r?=??0.80, p?=?0.009) and FWT (r?=??0.69, p?=?0.04). Patients with UFF had higher dialysate HGF (103 pg/mL vs 77 pg/mL, p?=?0.018) and, although not statistically significant, those with FWT compromise had also higher dialysate HGF compared with subgroup of UFF without FWT compromise (104 pg/mL vs 88 pg/mL, p?=?0.08). FWT?≤?45% without clinical UFF was documented in some patients who also had increased effluent HGF.Conclusions
Dialysate HGF concentration is significantly higher among patients with UFF, specially, if FWT is impaired, being a sign of peritoneal membrane deterioration.16.
Steven K. Dobscha Lauren M. Denneson Anne E. Kovas Alan Teo Christopher W. Forsberg Mark S. Kaplan Robert Bossarte Bentson H. McFarland 《Journal of general internal medicine》2014,29(4):853-860
BACKGROUND
Veterans receiving Veterans Affairs (VA) healthcare have increased suicide risk compared to the general population. Many patients see primary care clinicians prior to suicide. Yet little is known about the correlates of suicide among patients who receive primary care treatment prior to death.OBJECTIVE
Our aim was to describe characteristics of veterans who received VA primary care in the 6 months prior to suicide; and to compare these to characteristics of control patients who also received VA primary care.DESIGN
This was a retrospective case–control study.SUBJECTS
The investigators partnered with VA operations leaders to obtain death certificate data from 11 states for veterans who died by suicide in 2009. Cases were matched 1:2 to controls based on age, sex, and clinician.MAIN MEASURES
Demographic, diagnosis, and utilization data were obtained from VA’s Corporate Data Warehouse. Additional clinical and psychosocial context data were collected using manual medical record review. Multivariate conditional logistic regression was used to examine associations between potential predictor variables and suicide.KEY RESULTS
Two hundred and sixty-nine veteran cases were matched to 538 controls. Average subject age was 63 years; 97 % were male. Rates of mental health conditions, functional decline, sleep disturbance, suicidal ideation, and psychosocial stressors were all significantly greater in cases compared to controls. In the final model describing men in the sample, non-white race (OR?=?0.51; 95 % CI?=?0.27–0.98) and VA service-connected disability (OR?=?0.54; 95 % CI?=?0.36–0.80) were associated with decreased odds of suicide, while anxiety disorder (OR?=?3.52; 95 % CI?=?1.79–6.92), functional decline (OR?=?2.52; 95 % CI?=?1.55–4.10), depression (OR?=?1.82; 95 % CI?=?1.07–3.10), and endorsement of suicidal ideation (OR?=?2.27; 95 % CI?=?1.07–4.83) were associated with greater odds of suicide.CONCLUSIONS
Assessment for anxiety disorders and functional decline in addition to suicidal ideation and depression may be especially important for determining suicide risk in this population. Continued development of interventions that support identifying and addressing these conditions in primary care is indicated.17.
Purpose
Remission from Cushing disease (CD) after pituitary adenoma resection may be predicted by a postoperative reduction in serum cortisol level. A 2008 consensus statement recommends assessing morning cortisol levels during the first postoperative week, and replacing glucocorticoid (GC) if cortisol nadir of <?2 or <?5 µg/dL is achieved. We sought to evaluate adherence to consensus recommendations following adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma resection at our tertiary medical center, and assess time to cortisol nadir to better define the window for assessment and intervention.Methods
We retrospectively analyzed data extracted from in-hospital electronic medical records for CD surgeries between January 1991 and September 2015. We compared cortisol levels and collection times, ACTH measurement, and postoperative and discharge GC treatment before and after consensus statement publication in July 2008.Results
107 surgeries were performed in 92 patients with CD. After 2008, more surgeries had at least one cortisol value assessed (67.9% before vs. 91.3% after, p?=?0.033), with median initial cortisol measurement at 14 h post-surgery. However, ACTH measurement remained unchanged (42.9% vs. 43.5%; p?>?0.99). Cortisol collection during GC treatment tended to increase (32.7% vs. 57.1%; p?=?0.068). Of surgeries performed without prior GC treatment, 31.7 and 55.0% had a cortisol nadir of <?2 and <?5 µg/dL, respectively, within 72 h postoperative.Conclusions
Our physicians were more diligent in measuring in-hospital postoperative cortisol levels consistent with 2008 consensus recommendations. Better management of cortisol measurements and their timing is an opportunity for improvement.18.
Background
Contrast-induced acute kidney injury (CI-AKI) particularly in high risk patients with chronic kidney disease (CKD), increases morbidity and mortality. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein excreted by the kidney during AKI. There are no urine (u) NGAL data as an early CI-AKI marker in CKD patients undergoing coronary procedures.Methods
This prospective study enrolled 130 patients with estimated glomerular filtration rate (eGFR) <?60 ml/min/1.73 m2 undergoing elective coronary procedures. Serial urine samples, obtained at baseline and 3, 6, 12, 18, and 24 h post contrast administration were analyzed by NGAL ELISA kit. AKI was defined as an increase in serum creatinine (SCr) of?≥?0.3 mg/dl or?≥?1.5 times baseline SCr within 48 h per 2012 KDIGO guidelines. Receiver operator characteristic curve analyses identified optimal uNGAL and delta of uNGAL values for diagnosing CI-AKI.Results
The uNGAL was significantly and inverse correlated with eGFR (R =?0.25, P <?0.005). CI-AKI developed in 16/130 (12.31%) patients: 13 and 3 in CI-AKI stages I and II, respectively. uNGAL and delta of uNGAL were significantly higher in the CI-AKI group when compared with the No CI-AKI group (P <?0.05). The best uNGAL cut-off for optimal sensitivity 94%, specificity 78%, and area under the curve 0.84 for predicting CI-AKI was 117 ng/mL at 6 h, respectively. Corresponding values for predicting CI-AKI stage II were 100%, 87% and 0.9 when using an uNGAL of 264 ng/mL at 6 h.Conclusions
Monitoring of uNGAL levels not only provide the early detecting CI-AKI but also predict the severity of CI-AKI in CKD patients undergoing elective coronary procedures.19.
Altuntas YE Kement M Oncel M Sahip Y Kaptanoglu L 《Diseases of the colon and rectum》2008,51(10):1562-1565
Purpose
This study was designed to evaluate the effect of Seprafilm® use in the presence of different severity of adhesions encountered in relaparotomies.Methods
A total of 110 male Balb/c mice were randomized into two experiment groups: Sepra and Control. All animals underwent cecal and small-bowel abrasions during the first operation. The severity of adhesions were evaluated as “slight” or”dense” at the time of relaparotomy performed 14days after the initial operation, and Seprafilm® was applied to the animals in Group Sepra. Accordingly, the groups were documented as Sepra-slight, Sepra-dense, Control-slight, and Control-dense. All subjects were killed 14days later, the adhesion severity was evaluated with a scale scoring 0 to 5, and the results were compared between the groups.Results
The death of 21 animals (19.1 percent) before (n?=?10) and after (n?=?11) the second operation left 22, 24, 26, and 17 animals in groups Sepra-slight, Sepra-dense, Control-slight, and Control-dense, respectively. Seprafilm® significantly reduced the adhesion severity score (1.1?±?1.1 vs. 2.1?±?1.5 in Groups Sepra and Control, respectively; P?0.05). Seprafilm® did not significantly decrease the severity of adhesions in the presence of slight adhesions at the time of relaparotomy (P?>?0.05). However, the analysis of groups revealed that Seprafilm® was more effective when used during the observation of severe adhesions at the time of relaparotomy (1.7?±?1.4 vs. 2.7?±?1.5 in Groups Sepra-dense vs. Control-dense, respectively; P?0.05).Conclusions
Seprafilm® is effective in preventing adhesions even if it is used at the time of relaparotomy, but the antiadhesive effect of product peaks when it is used during the observation of dense adhesions at the time of relaparotomy.20.
I. C. M. Volschan L. Kasuki C. M. S. Silva M. L. Alcantara R. M. Saraiva S. S. Xavier M. R. Gadelha 《Pituitary》2017,20(3):349-357