Risk factors for mortality in diabetic peritoneal dialysis patients

Objective To investigate the risk factors of all-cause mortality in diabetic patients on peritoneal dialysis (PD). Methods As a single-center retrospective cohort study, all incident PD patients who were catheterized at the First Affiliated Hospital of Nanchang University between November 1, 2005 and February 28, 2017 were included. Patients were divided into diabetes mellitus group (DM group) and non-diabetes mellitus group (NDM group). Outcomes were analyzed by Kaplan-Meier method. Multivariate Cox proportional hazards models were utilized to assess the risk factors of all-cause mortality. Results A total of 977 patients were enrolled. Compared with NDM group, patients in DM group were older (47.5±14.4 vs 59.3±11.3, P＜0.01), had more cardiovascular disease (CVD) (7.5% vs 20.3%, P＜0.01), higher levels of serum hemoglobin (78.2±17.2 vs 82.3±14.6 g/L, P＜0.01) , and lower levels of serum albumin (36.1±5.0 vs 32.7±5.6 g/L, P＜0.01). The one-, three- and five-year patient survival rates of DM and NDM group were 89.7%, 56.0%, 31.9% and 94.7%, 81.3%, 67.4%, respectively.Survival rate was significantly lower in DM group than in NDM group ( χ2=63.51, P＜0.01). Stratified analysis showed that DM group had significant lower survival rate than NDM group in patients younger than 70 years old ( χ2= 73.35, P＜0.01), while survival rate was similar between the two groups patients older than 70 years old ( χ2= 0.003, P=0.96). Multivariate Cox proportional hazards model analysis showed that DM (HR: 1.74, 95%CI: 1.27-2.38, P＜0.01), age (HR: 1.05, 95%CI: 1.04-1.06, P＜0.01), leukocyte (HR: 1.06, 95%CI: 1.00-1.12, P=0.04) and triglyceride (HR: 1.19, 95%CI: 1.07-1.32, P＜0.01) were all independent risk factors for all-cause mortality of PD patients. However, age (HR: 1.05, 95%CI: 1.04-1.07, P＜0.01) and alkaline phosphatase (HR: 1.01, 95%CI: 1.00-1.01, P=0.02) were independent risk factors for all-cause mortality of diabetic patients. Conclusions Long-term survival rate was lower in diabetic PD patients than in non-diabetic PD patients. DM, age, leukocyte and triglyceride were independent risk factors of mortality in PD patients. Age and alkaline phosphatase were independent risk factors of mortality in diabetic patients.     

Impact of left ventricular hypertrophy on survival in end-stage renal disease

We examined the prognostic significance of left ventricular hypertrophy determined by echocardiography in a cohort beginning renal replacement therapy. No patient had hemodynamically significant valvular disease or echocardiographic signs of obstructive cardiomyopathy. Using the Cox proportional hazards model, left ventricular hypertrophy was significantly associated with survival. The relative risk, based on comparison of upper and lower quintiles of left ventricular mass index, was 3.7 (95% confidence intervals, 1.6 to 8.3) for all-cause mortality and 3.7 (95% confidence intervals, 1.2 to 11.1) for cardiac mortality. The independent risk, adjusted for age, known coronary artery disease, diabetes, level of systolic blood pressure, and treatment (dialysis or transplantation), was 2.9 (95% confidence intervals, 1.3 to 6.9) for all-cause mortality and 2.7 (95% confidence intervals, 0.9 to 8.2) for cardiac mortality. Therefore, left ventricular hypertrophy appears to be an important, independent, determinant of survival in patients receiving therapy for end-stage renal failure.     

Effect of radial artery calcification on survival of arteriovenous fistula and the patients in end-stage renal disease patients

Objective To investigate the effect of radial artery calcification (RAC) on survival of arteriovenous fistula (AVF) and the patients in end-stage renal disease. Methods Adult ESRD patients undergoing AVF surgery between January 2013 and January 2016 at the Eighth Affiliated Hospital of Sun Yat-sen University were enrolled in this study. The clinical and biochemical data were collected. Segment of radial artery were obtained from the operation of AVF. RAC at the site of anastomotic were observed by alizarin red S and hematoxylin and eosin staining. According to RAC, the patients were divided into calcification group and non-calcification group. Kaplan-Meier analysis was performed to analyze the survival rates of the two groups, and Cox proportional hazards regression model was used to estimate the risk factors of AVF dysfunction and all-cause mortality in ESRD patients. Results Among 180 cases of ESRD patients, 38 cases (21.1%) were developed RAC at the site of anastomotic in different degrees. Compared with the non-calcification groups, the calcification groups had a longer dialysis vintage, a higher proportion of diabetes and higher level of HbAlc (all P﹤0.05). Binary logistic regression analysis showed that dialysis vintage＞5 years and diabetics were two independent risk factors of RAC at the site of anastomotic. Kaplan-Meier survival analysis demonstrated that there were no statistical differences between two groups in AVF survival ( χ2=0.009, P=0.926). Calcification group had higher all-cause mortality than non-calcification groups ( χ2=9.809, P=0.002). Multivariate Cox regression analysis demonstrated that homocysteine was independent risk factor for AVF dysfunction (HR=1.027, 95%CI: 1.003-1.051, P=0.027). Age was independent risk factor for all-cause mortality (HR=1.078, 95%CI: 1.035-1.122, P=0.000). Conclusions Dialysis vintage＞5 years and diabetes were two independent risk factors of RAC at the site of anastomotic in ESRD patients. RAC at the site of anastomotic had no effect on AVF survival, but increased all-cause mortality.     

Outcome and selection of revascularization strategy in left main coronary artery stenosis

Objectives. To investigate clinical outcome in unselected real-life patients with unprotected left main coronary artery (ULMCA) stenosis and determine factors associated with selection of revascularization strategy. Design. Consecutive patients with ULMCA stenosis at our institution in 2009–2013 (n?=?308) were retrospectively analyzed with propensity score adjusted Cox proportional hazards models for outcome. Baseline characteristics in relation to selection of revascularization strategy were analyzed with multivariate logistic regression. Results. Patients that underwent PCI (n?=?94) had a higher risk of major adverse cardiac and cerebrovascular events (MACCE; adjusted HR 2.13 [95% CI 1.08–4.19]) than patients that had CABG surgery but there was no difference in the combination of death and MI (adjusted HR 1.17 [95% CI 0.50–2.75]). Later year of index angiography, age, Euroscore II and angiographer favoring PCI was associated with PCI as revascularization strategy. Higher SYNTAX score, higher systolic blood pressure and angiographer favoring CABG was associated with CABG. Conclusions. In consecutive patients with ULMCA stenosis PCI is associated with higher MACCE rates than CABG but there is no difference in death and MI. Later year of index angiography, higher age, lower systolic blood pressure, higher predicted per-procedural surgical risk, less complex coronary anatomy and angiographer favoring PCI increased the probability of revascularization with PCI instead of CABG.     

Survival analysis of pediatric dialysis patients in Taiwan

Aim: The long‐term survival of Taiwanese children with end‐stage renal disease (ESRD) has not been reported before. This study aimed to determine the long‐term survival, mortality hazards and causes of death in paediatric patients receiving dialysis. Methods: Paediatric patients (aged 19 years and younger) with incident ESRD who were reported to the Taiwan Renal Registry from 1995 to 2004 were included. A total of 319 haemodialysis (HD) and 156 peritoneal dialysis (PD) patients formed the database. After stratification by dialysis modality, multivariate Cox proportional‐hazards model was constructed with age, sex and co‐morbidity as predictive variables. Results: The annual paediatric ESRD incidence rate was 8.12 per million of age‐related populations. The overall 1‐, 5‐, and 10‐year survival rates for PD patients were 98.1%, 88.0% and 68.4%, respectively, and were 96.9%, 87.3% and 78.5% for HD patients. The survival analysis showed no significant difference between HD and PD (P = 0.4878). Using ‘15–19 years’ as a reference group, the relative risk (RR) of the youngest group (0–4 years) was 6.60 (95% CI: 2.50–17.38) for HD, and 5.03 (95% CI: 1.23–20.67) for PD. The death rate was 24.66 per 1000 dialysis patient‐years. The three major causes of death were infection (23.4%), cardiovascular disease (13.0%) and cerebrovascular disease (10.4%). Hemorrhagic stroke (87.5%) was the main type of foetal cerebrovascular accident. Conclusion: We conclude that there was no significant difference of paediatric ESRD patient survival between HD and PD treatment in Taiwan. The older paediatric ESRD patients had better survival than younger patients.     

Mid-term survival after cardiac surgery in elderly patients: analysis of predictors for increased mortality

This study examines and quantifies the potential risk factors for increased mid-term mortality in elderly patients (> or = 75 years old) undergoing cardiac surgery. We undertook a retrospective analysis of 840 consecutive elderly patients who underwent cardiac surgery (CABG and/or Valve) between April 1997 and March 2002. Deaths occurring as a function of time were described using the product limit methodology of Kaplan and Meier. Cox proportional hazards analysis was used to identify preoperative risk factors for mortality with hazard ratios (HR). One hundred and sixty-two (19.3%) deaths occurred during the study period, with a total follow-up of 1866 patient years (mean 2.2 years, SD 1.5 years). Observed freedom from death in the elderly patients at 5 years was 71.7%, compared to 70.9% for the age- and sex-matched general population (P=0.252). Multivariate analysis for independent predictors of increased mortality found that renal dysfunction (HR 3.2; P<0.001), valves(s) surgery (HR 1.8; P<0.001), cerebrovascular disease (HR 1.8; P=0.003), and catastrophic state (HR 2.2; P=0.011) were the major risk factors. We have identified and quantified several risk factors, which need to be considered when assessing patients for cardiac surgery.     

Relationship between Serum Magnesium Levels and Cardiovascular Events in Chronic Kidney Disease Patients

Background: Magnesium is an essential ion for all living cells because over 300 enzymes require the presence of magnesium for their catalytic action. To date, no group has evaluated magnesium as a cardiovascular risk factor in chronic kidney disease (CKD) subjects, in which closely interrelated factors and potential confounders such as endothelial dysfunction, insulin resistance (the homeostasis model assessment (HOMA) index) and inflammation (expressed as serum C-reactive protein (CRP) levels) were also considered. Methods: Between March 2006 and December 2010, 283 CKD patients were followed up for time-to-event analysis until the occurrence of fatal or nonfatal cardiovascular events. Endothelium-dependent vasodilatation (flow-mediated dilatation; FMD) and endothelium-independent vasodilatation (nitroglycerin-mediated dilatation) of the brachial artery were assessed noninvasively using high-resolution ultrasound. Results: From the univariate analysis of FMD, it appears that a higher magnesium level is associated with less endothelial dysfunction. When a multivariate analysis was performed, magnesium and estimated glomerular filtration rates (eGFR) maintained a strong positive correlation with FMD, supporting the hypothesis that higher levels of magnesium may protect against endothelial damage. In univariate Cox proportional hazards models, FMD, magnesium, high sensitivity CRP, the HOMA index, eGFR, comorbid diabetes, hypertension, smoking status, systolic blood pressure, serum phosphate and intact parathormone emerged as significant predictors for cardiovascular outcomes. Kaplan-Meier curves showed significantly higher cardiovascular mortality rates in CKD patients whose serum magnesium levels were below 2.05 mg/dl. Conclusions: This observational cohort study showed that magnesium may be an independent predictor of future cardiovascular outcomes and is the first study demonstrating such a role in etiologically diagnosed CKD patients, across different stages.     

肿瘤大小对T3期胃癌患者预后的影响

目的探讨肿瘤大小对T3期胃癌患者预后的影响。方法对408例L期胃癌患者施行胃癌D2根治术,应用Cox比例风险模型对肿瘤大小进行最佳截点的筛选。对全组T3期胃癌患者的预后因素进行单因素及多因素分析：并对大直径组及小直径组胃癌患者的预后因素进行多因素分析。结果本组408例T3期胃癌患者通过Cox比例风险模型筛选出肿瘤大小的最佳截点为8cm。肿瘤大于或等于8cm的胃癌患者（大直径组）85例．小于8cm的胃癌患者（小直径组）323例：大直径组和小直径组术后5年生存率分别为33．8％和52．2％,差异有统计学意义（P〈0．05）。通过Cox比例风险模型分析显示,肿瘤大小、淋巴结转移、Boi Tmann分型和肿瘤部位是影响全组患者预后的独立因素（均P〈0．01）：进一步按肿瘤大小进行分层预后分析显示,Borrmann分型和淋巴结转移是影响大直径组患者预后的独立因素（均P〈0．05）;淋巴结转移是影响小直径组患者预后的独立因素（P〈0．01）。结论以8cm为界值进行B期胃癌患者的预后判断准确性最高。肿瘤大小是影响B期胃癌患者预后的独立因素。     

Acute Coronary Syndrome Does Not Have a Negative Impact on Outcomes after Coronary Artery Bypass Grafting in Patients with Left Main Disease

Purpose: Early and long-term outcomes of coronary artery bypass grafting (CABG) in patients with left main disease (LMD) with acute coronary syndrome (ACS) have never been assessed.Methods: Between September 2004 and April 2012, 459 patients with LMD underwent first-time isolated CABG. Of those, 191 patients had ACS and 268 did not. Early and late postoperative outcomes were compared between two groups.Results: Patients in the LMD+ACS group were older and more likely to be female. Left ventricular ejection fraction was lower in the LMD+ACS group. In both groups, bilateral internal thoracic artery grafts were used in over 90% of patients and off-pump technique in over 95%. Operative death rate was not significantly different between the groups (LMD+ACS: 2.1% vs. LMD–ACS: 0.4%). Log-rank test revealed that the actuarial survival rate (79.2 ± 3.7% vs. 81.5 ± 3.5%) and freedom from major adverse cardiac and cerebrovascular events (MACCE) (69.2 ± 4.2% vs. 67.0 ± 4.1%) were similar between groups at 7 years. Multivariate analyses demonstrated that ACS was not identified as an independent predictor of operative death, late mortality, and late MACCE.Conclusion: ACS did not have a negative impact on early and late outcomes of CABG in patients with LMD.     

Effects of serum magnesium level on mortality in maintenance hemodialysis patients

Objective To investigate the effects of serum magnesium level on all-cause mortality and cardiovascular and cerebrovascular diseases mortality in maintenance hemodialysis (MHD) patients. Methods Clinical data of MHD patients in Shaoxing People's Hospital from June 1, 2016 to June 30, 2018 were collected retrospectively. The patients were divided into low magnesium group (serum magnesium≤0.96 mmol/L), medium magnesium group (serum magnesium 0.97-1.07 mmol/L) and high magnesium group (serum magnesium≥1.08 mmol/L) according to the tertile of mean serum magnesium level. The differences of clinical data and laboratory results were compared among the three groups. Kaplan-Meier method was used to draw the survival curves, and log-rank test was used to compare the survival rate differences. Multivariate Cox regression was used to analyze the relationship between serum magnesium and all-cause mortality and cardiovascular and cerebrovascular diseases mortality in MHD patients. Results A total of 332 patients [194 males (58.4%)] were included in this study, with a median age of 63(51, 72) years and a median follow-up time of 36(20, 45) months. Kaplan-Meier survival analysis showed that the all-cause survival rate and cardiovascular and cerebrovascular diseases survival rate in the low magnesium group were lower than those in the medium magnesium group and the high magnesium group (Log-rank χ2=36.286, P＜0.001; Log-rank χ2=20.145, P＜0.001; respectively). After adjusting for multiple confounding factors, the results of multivariate Cox regression analysis suggested that low serum magnesium was an independent risk factor for all-cause death and cardiovascular and cerebrovascular diseases death in MHD patients. The risk of all-cause death and cardiovascular and cerebrovascular diseases death in the low magnesium group were significantly higher than those in the high magnesium group (HR=2.925, 95%CI 1.352-6.330, P=0.006; HR=3.821, 95% CI 1.394-10.473, P=0.009; respectively). Conclusions Hypomagnesemia may be an independent risk factor for all-cause death and cardiovascular and cerebrovascular diseases death in MHD patients. Low serum magnesium level increases the risk of all-cause death and cardiovascular and cerebrovascular diseases in MHD patients.     

Impact of low calcium dialysate on survival in continuous ambulatory peritoneal dialysis patients

Objective To investigate the impact of low calcium dialysate on survival in continuous ambulatory peritoneal dialysis（CAPD）patients. Methods CAPD patients at our PD center between January 1,2006 and December 31,2010 were retrospectively studied. The patients were divided into standard - calcium dialysate (SCD) group and low - calcium dialysate (LCD) group. Cox regression analysis was used to compare patient survival and determine the related risk factors Results A total of 982 eligible PD patients were included in this study, of whom 634 patients treated with standard-calcium dialysate, and 348 with low-calcium dialysate. During a median follow-up of 24.2 - month, 162(16.5% ) died, 71(43.8% ) of them due to cardiovascular and cerebrovascular diseases. The overall 1-, 3-, and 5-year patient survival rates were 90.9%, 74.2% and 58.9% in SCD group and 98.6%, 94.0% and 76.4% in LCD group. Cox regression analysis demonstrated that low calcium dialysate treatment reduced 59% risk of all-cause death, as compared with standard calcium dialysate exposure. Old age, diabetes status and lower hematoglobin were independent risk factors of all - cause death in CAPD patients. Conclusion The survival rate of CAPD patients using LCD is obviously higer than that using SCD. Old age, diabetes status and lower haematoglobin are independent risk factors of all-cause death in CAPD patients.     

Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement

In this study, we investigated the early and long-term results of conventional aortic valve replacement (AVR) in very old patients.Methods: Seventy-five patients with aortic stenosis underwent conventional AVR for patients aged 80 years.We examined early death and major adverse cardiovascular and cerebrovascular event (MACCE).Results: The operative mortality was 0% for isolated AVR and 19.2% for concomitant surgery. The postoperative survival rate and MACCE free-rate were no significant differences between the isolated AVR and the concomitant surgery. Univariate analysis confirmed that cardiac dysfunction, severe chronic kidney disease (CKD), hemodialysis, + coronary artery bypass grafting, and norepinephrine use were risk factor of early death. Univariate analysis confirmed that severe CKD, BNP >1000 pg/ml, aortic cross clamping time (ACCT) >180 min, and non-use carperitide and multivariate analysis confirmed that ACCT >180 min, and non-use carperitide were risk factor of MACCE.Conclusions: This study showed that the results of conventional AVR in very old patients were not satisfactory. However, the results obtained with isolated AVR were favorable with no operative deaths. The present study demonstrated that preoperative cardiac function, preoperative renal function, and operative factors have an important impact on early mortality and MACCE.     

Silent cerebral infarction predicts vascular events in hemodialysis patients

BACKGROUND: Cardiovascular disease is the leading cause of death in hemodialysis (HD) patients. We have previously reported a higher incidence of silent cerebral infarction (SCI) in HD patients compared with the control group using MRI studies. In the present study, we examined whether or not SCI could predict vascular events in HD patients. METHODS: Cranial magnetic resonance imaging (MRI) was performed on 119 HD patients without symptomatic cerebrovascular disease. SCI was detected by MRI, and the patients were prospectively followed up. The end points of the study were the incidence of major events related to vascular events (cerebral events, cardiac events, and sudden deaths). We investigated the prognostic role of SCI in cerebral, cardiac, and vascular events by using the Kaplan-Meier method and Cox proportional hazards analysis. RESULTS: The prevalence of SCI was 49.6% in HD patients. During a follow-up period of maximum 60 months, vascular events, which included 13 cerebral events, 5 cardiac events, and 3 sudden deaths, occurred in 21 patients. The presence of SCI was predictive for a higher cerebral and vascular morbidity compared to the absence of SCI [18.6% (N= 11) vs. 3.3% (N= 2), P= 0.0169, and 30.5% (N= 18) vs. 5.0% (N= 3), P= 0.0006, respectively]. By multivariate Cox proportional hazards analysis, SCI remained a powerful independent predictor of cerebral and vascular events (hazard ratio for cerebral events 7.33, 95% CI 1.27-42.25: for vascular events 4.48, 95% CI 1.09-18.41). CONCLUSION: The findings of the present study indicate that the presence of SCI is a new risk factor for vascular events in HD patients.     

Is 30-day mortality an adequate outcome statistic for patients considering heart valve replacement?

BACKGROUND: In-hospital mortality is widely used by clinicians as a benchmark measure of outcome for determining risks/benefits of cardiac surgery. Patients, however, may wish to have information on estimated longer-term outcomes. Mortality risk by 1 year after the operation may be a more meaningful outcome statistic. We therefore undertook to determine 30-day and 365-day postoperative mortality rates in a large series of consecutive patients who have undergone heart valve replacement (HVR) surgery in the United Kingdom since 1986. METHODS: Data on 80,757 patients registered on the UK Heart Valve Registry were analyzed. Kaplan-Meier actuarial survival analysis was calculated to determine 30-day (group 1) and 365-day (group 2) mortality. Cox proportional hazards were calculated for each group to identify significant risk factors for mortality less than 1 year. RESULTS: Thirty-day mortality represents around half (56%) of the 365-day mortality. This ratio was robust for most subdivisions of the total population. Cox proportional hazards demonstrated female sex, age older than 70 years, single tricuspid valve replacement, multiple valve replacement regardless of type of valve, and subsequent valve operation as significant risk factors of early mortality (group 1). However, men were at significantly greater risk of late mortality (group 2). All other factors remained significant with the exception of subsequent valve operation, which was dropped from the model (group 2). CONCLUSIONS: The robustness of these data would allow cardiologists and cardiac surgeons to provide preoperative patients with a reasonably accurate estimate of survival rates at 1 year after valve replacement surgery in addition to the customary short-term 30-day outcome.     

Association of incomplete revascularization with long-term survival after off-pump coronary artery bypass grafting

Background

We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting.

Materials and methods

Of 1553 patients with triple-vessel disease who had undergone consecutive off-pump coronary artery bypass grafting, 1351 (87.0%) had complete revascularization (CR) and 202 had IR (13.0%). After propensity score patient matching, we had 200 patients in each group. Cardiac survival and major adverse cardiac and cerebrovascular events (MACCE) were assessed before and after patient matching. Subgroup analysis was performed to evaluate the interaction between the left ventricular ejection fraction (LVEF) and the completeness of revascularization. The follow-up duration was 60 mo.

Results

In the all-patient analysis, the CR group had a lower incidence of in-hospital mortality, cardiac mortality, and MACCE (P = 0.033, P < 0.001, and P = 0.003, respectively). The 5-year cardiac survival was 96.5% ± 0.6% in the CR group and 88.9% ± 2.5% in the IR group (P < 0.001), with a freedom from MACCE rate of 85.4% ± 1.2% and 78.8% ± 3.4%, respectively (P = 0.015). After patient matching, the CR group showed superior 5-year cardiac survival compared with the IR group (96.2% ± 1.4% versus 88.8% ± 2.5%, P = 0.022), with a similar freedom from MACCE rate. IR was identified as an independent predictor of cardiac death (hazard ratio 2.76, 95% confidence interval 1.62–4.70; P < 0.001). IR predicted cardiac death more distinctly in patients with a low LVEF (hazard ratio 5.29, 95% confidence interval 1.71–16.39; P = 0.004) than in those with a preserved LVEF (hazard ratio 2.04, 95% confidence interval 1.02–4.08; P = 0.045).

Conclusions

CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.     

Low levels of high-density lipoprotein cholesterol are associated with vascular remodeling in cardiac transplant recipients

BACKGROUND: Early atherosclerosis may be associated with compensatory vessel enlargement, termed positive remodeling. Enlarged brachial artery diameter has been reported in patients with risk factors for atherosclerosis and in individuals with coronary atherosclerosis, indicating that brachial artery enlargement is a marker for the presence of atherosclerotic changes. Cardiac transplant recipients often have abnormal lipid levels, but the effect of specific lipid abnormalities on vascular remodeling in this population has not been evaluated. This study examined the relationship between lipid levels and brachial artery diameter in cardiac transplant recipients. METHODS: Thirty-five stable cardiac transplant recipients underwent high-resolution brachial artery ultrasound to evaluate resting brachial artery diameter. Levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were determined and the presence of other cardiac risk factors was assessed. RESULTS: Brachial artery diameter was larger (4.3 +/- 0.1 mm) in subjects with low levels of HDL-C (< 40 mg/dL, n = 11) compared to subjects with high HDL-C (> or = 40 mg/dL, n = 24), who had a mean brachial artery diameter of 3.7 +/- 0.1 mm (P = .006). Neither high LDL-C (> or = 100 mg/dL) nor high triglycerides (> or = 200 mg/dL) were associated with differences in brachial artery diameter. Multivariate analysis demonstrated that the relationship between low HDL-C and increased brachial artery diameter was independent of body surface area or statin use. CONCLUSIONS: Low levels of HDL-C are an independent predictor of brachial artery enlargement in stable cardiac transplant recipients. These findings suggest that suboptimal HDL-C levels may be associated with the development of vascular remodeling and atherosclerosis in this population.     

Clinical analysis of peritoneal dialysis in the treatment of rapidly progressive glomerulonephritis

Objective To observe the clinical characteristics and prognosis of patients with rapidly progressive glomerulonephritis (RPGN) caused by lupus nephritis, antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, or primary glomerulonephritis who were treated with peritoneal dialysis (PD) and then withdrew PD because of renal recovery. Methods Data of the above patients were retrospectively analyzed. The patients were diagnosed as RPGN and received PD therapy in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from February 2009 to August 2018. The patients were divided into early withdrawal group (PD time≤183 days, n=24) and late withdrawal group (PD time＞183 day, n=24). The differences of clinical characteristics between the two groups were compared. The cumulative incidence of adverse events in both groups was analyzed using Kaplan-Meier curves. Cox proportional hazards model was used to analyze the risk factors influencing the prognosis of patients. Results Forty-eight RPGN patients were included. The median time of maintaining PD was 178(76, 378) days. Compared with the late withdrawal group, the patients in early withdrawal group had lower levels of urine volume, serum albumin and parathyroid hormone, and lower rates of gross hematuria and hypertension at the beginning of PD, and received higher rates of methylprednisolone impulse, combined immunosuppressive agents, and hemodialysis or continuous renal replacement therapy (all P＜0.05). At the time of PD withdrawal, the levels of serum creatinine, serum calcium, serum albumin and parathyroid hormone in the early withdrawal group were significantly lower than those in the late withdrawal group (all P＜0.05). The Kaplan-Meier curves showed that there was no significant difference in the cumulative survival of patients in both groups (log-rank test χ2=3.485, P=0.062). Cox regression analysis revealed serum creatinine≥209 μmol/L at the time of PD withdrawal was an independent risk factor for poor prognosis (HR=5.253，95%CI 1.757-15.702, P=0.003). Conclusions PD can be used for RPGN patients caused by lupus nephritis, ANCA-associated vasculitis and primary nephritis. Serum creatinine≥209 μmol/L at the time of PD withdrawal is an independent risk factor for poor prognosis.     

The Geriatric Nutritional Risk Index predicts amputation after infrapopliteal angioplasty in critical limb ischemia patients

ObjectiveTo validate the Critical Limb Ischemia Frailty Index (CLIFI), and to identify independent predictors of 2-year amputation-free survival after infrapopliteal endovascular treatment for chronic limb-threatening ischemia (CLTI) in Thai patients.MethodsThis retrospective study was conducted during the June 2014 to February 2017 study period. CLTI patients treated with infrapopliteal angioplasty were enrolled and analyzed. A patient was defined as CLIFI positive if two or more of the following criteria were present: Geriatric Nutritional Risk Index (GNRI) < 89.8, low skeletal muscle mass index (<6.87 kg/m² in males, and <5.46 kg/m² in females), and/or non-ambulatory status. Kaplan–Meier survival analysis was used to assess 2-year amputation-free survival (AFS), and comparisons were performed using log-rank test. Univariate and multivariate Cox proportional hazards models were used to analyze for significant and independent association, respectively, between preoperative characteristics and AFS.ResultsA total of 266 patients and 286 limbs were included. Forty (15.0%) patients were CLIFI positive, and 226 (85.0%) patients were CLIFI negative. The 2-year amputation-free survival rate was 90.3% in the CLIFI positive group, and 86.6% in the CLIFI negative group (p = 0.59). Multivariate analysis revealed the GNRI to be an independent risk factor for amputation within two years after infrapopliteal revascularization (adjusted hazard ratio: 4.87, 95% confidence interval: 1.20–19.70; p = 0.02).ConclusionsThe GNRI was found to independently predict 2-year amputation after infrapopliteal angioplasty in Thai CLTI patients; however, the CLIFI was not found to significantly predict 2-year amputation in this patient population.     

急性肾损伤是影响心脏手术后患者长期生存的危险因素

目的 了解心脏术后急性肾损害（AKI）患者的长期预后情况及探讨有关危险因素。 方法 选择2004年1月1日至2007年6月30日本院所有行心脏手术,且存活出院的患者,门诊或电话随访患者的生存情况至2010年2月28日。回顾性收集患者术前、术中、术后的临床及实验室资料,观察患者术后长期生存率及肾功能情况。应用Cox回归方程分析与患者长期生存相关的危险因素。 结果 共941例心脏手术患者,术后发生过AKI患者275例（29.2%）,非AKI患者666例（70.8%）。在总共46.5个月（34.5,59.2）的随访过程中,术后发生过AKI的患者生存率显著低于非AKI患者（67.8%比85.6%,P < 0.01）,且随着AKI严重程度的增加,生存率逐渐下降（AKIN 1、2和3期患者的生存率分别为70.7%、62.3%和58.6%, P < 0.01）。AKI组中90.5%的患者出院时肾功能完全恢复至基线水平,但随访期间生存率仍显著低于非AKI组患者（69.6%比85.6%,P < 0.01）。Cox回归分析显示年龄增加（年龄每增加20 岁,HR=2.238）、术前贫血（HR=1.625）、手术时间延长（每增加1 h,HR=1.153）、AKI的发生及分期增加（每增加1期,HR=1.473）是患者长期预后不良的独立危险因素。随访结束时,AKI组患者的Scr显著高于非AKI组（107.6 μmol/L比83.0 μmol/L,P = 0.014）;AKI组中34.0%患者进入了CKD 3~5期。出院后5年34.8%的AKI患者发生Scr翻倍。 结论 心脏手术后AKI是影响患者长期生存的独立危险因素,即使AKI后Scr值恢复到基线水平,长期的患者预后和肾脏预后仍然较差。     

Association between body-mass index and survival in peritoneal dialysis patients

Objective To evaluate the association between body-mass index and prognosis in peritoneal dialysis (PD) patients. Methods In this observational study of a single nephrology unit in Shanghai East Hospital, 81 incident continuous ambulatory peritoneal dialysis(CAPD) patients were included from Jan 2008 to Dec 2013, whom were followed-up by 36 months or until death. The patients were classified as underweight (BMI＜18.5kg/m2); normal weight (18.5～23.9kg/m2); overweight (24～27.9kg/m2) and obese (BMI≥28kg/m2). The patients and technique survival rates were estimated by Kaplan-Meier analysis. Cox proportional hazards analyses were used to elucidate relationship between BMI and all-cause mortality and technique failure in PD patients. Results The overall survival rate was similar between normal and overweight groups (P=0.96), but significantly lower in underweight group and obese group (P＜0.01 respectively). The overall technical survival rate of obese group was lower compare with normal group (P＜0.01). The main cause of technical failure was peritonitis (81.3%). BMI was positively correlated with albumin (r=0.24, P＜0.05), hemoglobin (r=0.56, P＜0.01), glucose(r=0.23, P＜0.05) and cholesterol (r=0.41, P＜0.01), but negatively correlated with Kt/V (r=-0.36, P＜0.01) and Ccr(r=-0.34, P＜0.01). In adjusted Cox proportional hazard mode 3, obese was independently associated with all-cause mortality (HR: 5.93, 95%CI: 1.10～31.79). Obese and peritonitis were independently associated with technical failure (HR: 10.33, 95%CI: 1.04～78.02 and HR: 2.74, 95%CI: 1.17～6.40 respectively). Conclusions Underweight and obese CAPD patients have poorer outcome. Obese CAPD patients also have lower technical survival rate. Obesity was an independent risk factor for all-cause mortality in CAPD patients.