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1.
Yu Bao Yi-An Wang Hua Xiao Ying Wang Yan Wu Yue Yan Zhu Zhu Mei Ni Cheng-Xian Pi Ming-Yue Liu Jun-Hua Yang Yan-Ting Li Xin-Kui Tian Tao Wang Xing-Wei Zhe 《International urology and nephrology》2018,50(11):2061-2066
Background
Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that elevated heart rate (HR) is a risk factor for cardiovascular mortality. We investigated the link between serum endocan and circadian heart rate variability in non-dialysis stage 5 CKD patients.Methods
In a cross-sectional study, we enrolled 54 prevalent n non-dialysis stage 5 CKD patients (32 males, aged 48.2?±?14.92 years). HR was measured with an automatic system. Serum endocan level was analyzed by ELISA.Results
Night/day HR ratio was independently predicted by serum endocan level (P?<?0.01) and hypertension history (P?<?0.05). Adjusted R2 of the model was 0.222.Conclusion
Increased serum endocan is significantly associated with circadian heart rate variability in non-dialysis stage 5 CKD patients. Further investigation is needed to explore the potential benefits of serum endocan lowering therapy in this patient group.2.
Ping-Min Chen Takashi Wada Chih-Kang Chiang 《Clinical and experimental nephrology》2017,21(2):307-315
Background
Several risk factors were associated with poor outcomes in diabetic patients with chronic kidney disease (CKD). However, few studies addressed the prognostic implications of these factors in advanced CKD. Our study aimed to provide more evidence for risk factor stratification of diabetic patients with advanced CKD.Method
A total of 447 diabetic patients with advanced CKD, age of 18–80, who visited the nephrology out-patient clinic were enrolled. All patients were in stage 3B-5 CKD. The primary outcomes included long-term renal replacement therapy and mortality. The occurrence of cardiovascular events was also analyzed as secondary outcome. Multivariate Cox regression models were used to address each risk factor in this cohort. We also used this cohort to evaluate the validity of the modified diabetic nephropathy score.Results
Patients with lower estimated glomerular filtration rate (eGFR) were associated with higher degree of proteinuria. In the multivariate Cox regression model, eGFR and the degree of proteinuria were both strong outcome predictors. The effects of glycosylated hemoglobin and blood pressure in this advanced CKD cohort were minimal. Elder patients with advanced CKD had a higher mortality rate, but commenced less renal replacement therapy. Applying these indicator analyses, we proposed a modified diabetic nephropathy score for outcome prediction.Conclusions
Our analysis demonstrated the impact of eGFR and proteinuria in the advanced CKD group. Indicators in early CKD possessed a different prognostic profile in this advanced CKD cohort, therefore, necessitating a modified scoring system.3.
Ladan Golestaneh Joel Neugarten Frederick Kaskel Aileen P. McGinn 《Clinical and experimental nephrology》2018,22(4):889-897
Background
Hyponatremia is a common electrolyte disorder and a prognostic marker for mortality. We hypothesize that in advanced chronic or acute kidney disease, hyponatremia is not independently associated with mortality because of the contribution of kidney failure to its pathophysiology.Methods
Clinical Looking Glass, Montefiore’s clinical database, was used to build a cohort of all patients hospitalized between January of 2009 and December of 2011. A chronic kidney disease (CKD) group and an acute kidney injury (AKI) group were defined based on GFR measurements during and before index hospitalization. Cox regression models assessed the hazard for death for those with community acquired hyponatremia as compared to those without hyponatremia, stratified by stage of kidney disease within each cohort.Results
Forty-four thousand four hundred and seventy-six patients were studied. Forty six percent (46.2%) of subjects were in the CKD cohort and 53.8% were in the AKI cohort. Hyponatremic patients were older, and had a higher prevalence of CKD and AKI. A total of 7,934 subjects died (17.8%) during 22 months of follow-up. In CKD and AKI cohorts, hyponatremia, age, race, illness severity and Charlson score were associated with mortality. Hyponatremia had similar hazard ratios (HR) across kidney disease stages despite loss of statistical significance in later stages due to smaller sample size.Conclusions
The association between community acquired hyponatremia and mortality showed consistent HRs across progressive stages of CKD and AKI suggesting that the contribution of tubular dysfunction to hyponatremia in advanced kidney disease does not alter this association.4.
Derrick Antoniak Chandrakanth Are Chad Vokoun Kaeli Samson Lynette Smith Jason Shiffermiller 《Journal of gastrointestinal surgery》2018,22(8):1376-1384
Background
Severe chronic kidney disease (CKD) predicts adverse outcomes in patients undergoing pancreatectomy, but the impact of milder CKD is unknown. Additionally, some authors have suggested that, due to physiologic changes of aging, CKD is over-diagnosed in patients above age 65.Methods
Patients undergoing pancreatectomy for malignancy from 2005 to 2014 were identified from the National Surgical Quality Improvement Program. Primary outcomes were all-cause mortality and major complication, defined as myocardial infarction, cardiac arrest, stroke, venous thromboembolism, respiratory failure, deep surgical site infection, pneumonia, acute kidney injury, coma >?24 h, or re-operation occurring within 30 days of surgery.Results
The mean age of 16,173 participants was 66 (range 18–90). Median preoperative creatinine was 0.80 mg/dL (0.10–11.0), and median preoperative eGFR was 86.36 mL/min/1.73m2 (2.98–182.2). Mortality and major complication occurred in 3 and 23% of patients, respectively. In adjusted analyses, CKD stages 2 (adjusted odds ratio (aOR) 1.24, 95% confidence interval (CI) 1.10–1.40), 3a (aOR 1.50, 95% CI 1.24–1.82), 3b (aOR 1.56, 95% CI 1.19–2.06), and 4 (aOR 2.17, 95% CI 1.25–3.76) were associated with increased major complication, and CKD stage 4 was associated with increased mortality (aOR 2.68, 95% CI 1.10–6.56). Age did not influence the relationship between CKD and either outcome.Conclusion
CKD of any stage was associated with an increased risk of postoperative major complication, and severe CKD was associated with increased mortality among patients undergoing pancreatectomy for malignancy. These associations were not diminished in elderly patients. Our findings could inform preoperative counseling and decision-making.5.
Genjiro Kimura Masato Kasahara Kenji Ueshima Sachiko Tanaka Shinji Yasuno Akira Fujimoto Toshiya Sato Miyuki Imamoto Shinji Kosugi Kazuwa Nakao 《Clinical and experimental nephrology》2017,21(3):417-424
Background
Dyslipidemia is a risk factor for the progression of chronic kidney disease (CKD). While conventional lipid lowering therapy provides a benefit to CKD management, the effect of statins on eGFR remains unclear.Methods
A prospective, multi-center, open-labeled, randomized trial. Total of 349 CKD patients with hyperlipidemia were randomized into 2 groups, and followed for 2 years. Group A included patients who were treated with atorvastatin. Group C were treated with conventional lipid lowering drugs other than statin. Primary endpoint was changes in eGFR. Secondary endpoints included changes in urinary albumin excretion, serum LDL-C, serum triglyceride, cardio-vascular events and all-cause mortality.Results
As the primary endpoint, eGFR decreased by 2.3 ml/min/1.73 m2 in Group A and by 2.6 ml/min/1.73 m2 in Group C, indicating that there was no difference in change of eGFR between the two groups. As secondary endpoints, atorvastatin succeeded to reduce serum LDL-C level significantly and rapidly, but conventional therapy did not. In fact, mean LDL-C level did not reach the target level of 100 mg/dl in Group C. Serum triglyceride was lowered only by atorvastatin, but not conventional drugs. The number of cardiovascular events and all-cause mortality did not differ between in two groups.Conclusion
The ASUCA (Assessment of Clinical Usefulness in CKD Patients with Atorvastatin) trial demonstrated that atorvastatin failed to exhibit reno-protections compared to conventional therapy in Japanese patients with dyslipidemia and CKD. It would be due in part to the ability of atorvastatin to more potently reduce serum LDL and triglycerides compared to conventional therapy.6.
Tae Yamamoto Mariko Miyazaki Masaaki Nakayama Gen Yamada Masato Matsushima Mistuhiro Sato Toshinobu Sato Yoshio Taguma Hiroshi Sato Sadayoshi Ito 《Clinical and experimental nephrology》2016,20(4):595-602
Background
Anemia greatly affects the development of renal and cardiovascular outcomes in chronic kidney disease (CKD) patients. However, the impact based on CKD stage remains unclear.Methods
We prospectively followed 2,602 Japanese CKD patients under the care of nephrologists. CKD was defined according to cause, estimated glomerular filtration rate <60 mL/min, and/or proteinuria. Patient outcomes [primary end-points: cardiovascular events (CVEs), all-cause mortality, and end-stage kidney disease (ESKD) requiring renal replacement therapy] were assessed in association with basal hemoglobin (Hb) levels (<10, 10–12 and ≥12 g/dL), stratified by CKD stages.Results
During follow-up, 123 patients developed CVEs, 41 died, and 220 progressed to ESKD. For stages G3, G4 and G5, ESKD frequencies were 2.8, 64.4, and 544.8 person-years, while CVEs and death were 25.6, 45.6, and 76.3 person-years, respectively. The combined endpoint rate was significantly higher in patients with Hb <10 versus Hb 10–12 g/dL, but a higher risk for CVEs and death with Hb <10 g/dL was found only in G3 [hazard ratio (HR) 4.49, (95 % confidence interval (95 % CI) 2.06–9.80)]. In contrast, risk for ESKD with Hb <10 g/dL was found only in G4 [HR 3.08 (95 % CI 1.40–6.79)] and G5 [HR 1.43 (95 % CI 1.01–2.05)]. No increased risks with higher Hb levels were found.Conclusion
The impact of renal anemia of Hb <10 g/dL on clinical outcomes differed by CKD stage, with a significantly high risk for CVEs and all-cause mortality in G3 and progression to ESKD in G4 and G5.7.
Tetsuo Shoji Kakuya Niihata Shingo Fukuma Shunichi Fukuhara Tadao Akizawa Masaaki Inaba 《Clinical and experimental nephrology》2017,21(4):685-693
Background
Serum ferritin concentration >100 ng/mL was associated with a higher risk of death in hemodialysis patients in Japan, whereas such an association was less clear in hemodialysis patients in Western countries. Since Japanese dialysis patients are generally less inflamed than those in Western countries, inflammation may modify the association between serum ferritin and the adverse outcomes.Methods
We performed an observational cohort study using data from 2606 Japanese hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study (DOPPS) III (2005–2008) or DOPPS IV (2009–2012). The predictor was serum ferritin category (<50, 50–99.9, 100–199.9, and ≥200 ng/mL), and the primary and secondary outcomes were all-cause mortality and cardiovascular hospitalization, respectively. C-reactive protein (CRP, cut-off by 0.3 mg/dL) and serum albumin (cut-off by 3.8 g/dL) were stratification factors related to systemic inflammation.Results
After adjustment for relevant confounding factors, a U-shaped association was observed between serum ferritin and all-cause mortality in the group with low CRP levels, whereas such relationship was not significant in the high CRP counterparts. In contrast, we found a linear association between serum ferritin and cardiovascular hospitalization in the low CRP and high CRP groups commonly. Similar results were obtained when the total cohort was stratified by serum albumin.Conclusions
Serum ferritin showed different patterns of association with all-cause mortality in hemodialysis patients with versus without inflammation, whereas its association with cardiovascular hospitalization was similar regardless of inflammatory conditions.8.
Terumasa Hayashi Tomonori Kimura Keiko Yasuda Koichi Sasaki Yoshitsugu Obi Hiromi Rakugi Yoshitaka Isaka 《Clinical and experimental nephrology》2017,21(2):333-341
Background
It is not known whether asymptomatic cardiac troponin T (cTnT) elevation is associated with all-cause or cardiovascular mortality in non-diabetic and advanced chronic kidney disease (CKD) patients.Methods
We measured cTnT in 248 consecutive patients at 1–2 weeks before dialysis initiation between March 2005 and August 2010 and followed them prospectively. A Cox proportional hazard model was used to investigate the relationship between cTnT and all-cause and cardiovascular mortality on dialysis.Results
The median age of the patients was 67 years (male 59.3 %), and the prevalence of diabetic nephropathy (DN) was 38.3 %. Asymptomatic cTnT elevation (>0.01 ng/mL) was observed in 196 (79 %) and 111 (73 %) patients among the overall patients and among patients without DN, respectively. A total of 51 patients died during a median follow-up period of 31.6 months. The cTnT level was associated with all-cause [hazard ratio (HR) 1.453; 95 % confidence interval (CI) 1.093–1.931; P = 0.010] and cardiovascular mortality [HR 1.973; 95 % CI 1.127–3.454; P = 0.017] on dialysis after extensive adjustment in the overall patient population. Patients without DN showed similar associations as those for the overall patient population (all-cause mortality: HR 1.566; 95 % CI 1.048–2.339; P = 0.029 and cardiovascular mortality: HR 2.657; 95 % CI 1.115–6.328; P = 0.027).Conclusion
Asymptomatic cTnT elevation might be strongly associated with all-cause and cardiovascular mortality in patients without DN, as well as in the overall advanced CKD patients. We suggest that cardiovascular risk in patients with pre-dialysis CKD should be stratified according to cTnT levels.9.
Shinichi Hikasa Megumi Yasuda Kyoko Hideta Mai Kawakami Satoshi Higasa Akihiro Sawada Tazuko Tokugawa Takeshi Kimura 《Clinical and experimental nephrology》2017,21(6):971-977
Background
Renal dysfunction is recognized with increasing frequency among the noninfectious comorbidities associated with human immunodeficiency virus (HIV) infection. Urinary liver-type fatty acid-binding protein (L-FABP) has been shown to be a new biomarker to screen for not only tubulointerstitial damage but also kidney dysfunction.Methods
We performed a cross-sectional study to determine the association between the urinary L-FABP and chronic kidney disease (CKD) among 77 HIV-infected Japanese patients by backward-stepwise multivariable logistic regression.Results
The prevalence of individuals in the low risk was 80 %. Urinary L-FABP level was not associated with antiretroviral therapy and tenofovir disoproxil fumarate. On the other hand, urinary L-FABP level was independently associated with the CKD classification.Conclusion
Urinary L-FABP may be used as an adjunct to diagnose the CKD stage.10.
Sinee Disthabanchong Kotcharat Vipattawat Bunyong Phakdeekitcharoen Chagriya Kitiyakara Vasant Sumethkul 《International urology and nephrology》2018,50(2):355-364
Purpose
Vascular calcification is common in chronic kidney disease (CKD) and predicts poor patient outcomes. While computed tomography is the gold standard for evaluation of vascular calcification, plain radiograph offers a simpler and less costly alternative. The calcification of abdominal aorta, iliac and femoral arteries has been evaluated by plain radiograph, but the data on their outcome predictabilities are still limited. The present study investigated the role of abdominal aortic calcification (AAC) and pelvic arterial calcification (PAC) in predicting overall morality in non-dialysis CKD stages 2–5 (CKD 2–5), maintenance hemodialysis (HD) and long-term kidney transplant (KT) patients.Methods
Four hundred and nineteen patients were included. Lateral abdominal and pelvic radiographs were obtained. The degree of AAC and PAC was evaluated according to the methods described previously by Kaupplia et al. and Adragao et al. Patients were followed prospectively for 5 years.Results
AAC and PAC scores correlated well with the correlation coefficients of 0.442 for CKD 2–5, 0.438 for HD and 0.586 for KT (p < 0.001). Patients with AAC score > 6 or PAC score > 1 were older, showed higher prevalence of DM and had higher serum phosphate and PTH but lower serum albumin and eGFR. A more severe degree of AAC was associated with an increase in KT duration, whereas a more severe degree of PAC was associated with worsening kidney function and prolonged dialysis vintage. Kaplan–Meier survival curves revealed AAC score > 6 as a significant predictor of all-cause mortality in CKD 2–5 but not in HD or KT, whereas PAC score > 1 was a significant predictor of all-cause mortality in all three populations. After adjusting for age, the predictability of AAC was lost, whereas PAC remained an independent predictor of mortality in all three populations. Adjustments for cardiovascular and CKD risk factors including age, gender, BMI, DM, serum albumin, calcium and phosphate attenuated the predictability of PAC in HD but not in CKD 2–5 or KT patients.Conclusion
PAC was better than AAC in predicting mortality in CKD, HD and KT patients.11.
Chang Seong Kim Eun Hui Bae Seong Kwon Ma Sue K. Park Ju Yeon Lee Wookyung Chung Kyubeck Lee Yeong Hoon Kim Kook-Hwan Oh Curie Ahn Soo Wan Kim Representing KNOW-CKD Study Group 《Clinical and experimental nephrology》2017,21(4):608-616
Background
High serum adiponectin levels predict all-cause and cardiovascular mortality in chronic kidney disease (CKD). However, the relationship between serum adiponectin concentration and arterial stiffness in CKD is not well established. The aim of this study was to assess this relationship by measuring pulse wave velocity (PWV) in CKD patients.Methods
Serum adiponectin concentration was measured in 716 CKD patients in the prospective KoreaN cohort study for Outcome in patients With Chronic Kidney Disease. The study group consisted of 415 men and 301 women; mean age was 53.1 years, and baseline estimated glomerular filtration rate (eGFR) was 51 ± 29 ml/min per 1.73 m2. Heart to femoral PWV (hfPWV) and mean brachial to ankle PWV (baPWV) served as indicators of aortic artery stiffness and arterial stiffness, respectively.Results
Increasing quartiles of serum adiponectin levels were associated with women, lower eGFRs and body mass indices, and higher urinary albumin-creatinine ratios. Serum adiponectin concentration also correlated with hfPWV and mean baPWV, even after adjusting for age and sex. It independently associated with hfPWV (B 0.028; 95 % confidence interval, 0.004–0.051; P = 0.020) but not mean baPWV in a multivariable linear regression analysis. In a multivariable logistic regression analysis, it correlated significantly with the highest quartile of hfPWVs but not mean baPWVs.Conclusion
The independent and significant correlation of serum adiponectin concentration with hfPWV in CKD patients implicates adiponectin in CKD-associated aortic stiffness.12.
Ewelina Lukaszyk Mateusz Lukaszyk Ewa Koc-Zorawska Anna Bodzenta-Lukaszyk Jolanta Malyszko 《International urology and nephrology》2018,50(1):121-125
Background/aims
Zonulin is the only known regulator of intestinal permeability. It is also considered as a potential inflammatory marker in several conditions such as diabetes and inflammatory bowel syndrome. The aim of the study was to investigate zonulin levels in patients with early stages of CKD and its possible correlation with inflammation, anemia and iron status parameters.Methods
Eighty-eight patients with early stages of CKD and 23 healthy volunteers were enrolled in the study. Zonulin, hepcidin-25, soluble transferrin receptor, interleukin-6 and high-sensitivity C-reactive protein were measured using commercially available assays.Results
Zonulin was significantly lower among patients with CKD in comparison with healthy volunteers. There were no statistically significant differences in zonulin concentration between patients with and without inflammation. Zonulin was significantly correlated with hepcidin only in patients with inflammation. Zonulin was neither related to iron nor related to ferritin.Conclusions
Zonulin cannot be considered as an inflammatory marker in CKD. It does not play a role in the disturbances of iron metabolism in CKD. Its physiological role remains to be elucidated.13.
Background
Although there were studies to investigate the risk factors for acute kidney injury (AKI) after surgery, most of them focused on one specific type of surgeries. The risk factors for postoperative AKI in patients undergoing all surgeries in intensive care units (ICU) have not been reported.Methods
Data from 1731 patients undergoing surgery in 30 ICUs of 28 tertiary hospitals in Beijing from March to August 2012 were prospectively collected. AKI was defined and staged by the KDIGO criteria. Multivariate logistic regression analysis was performed to assess independent risk factors for postoperative AKI.Results
Postoperative AKI occurred in 44.8% of patients (stage 1 54.8%; stage 2 21.9%, stage 3 23.3%). Cardiovascular surgery was identified as an independent factor for postoperative AKI as well as emergency surgery [odds ratio (OR) 1.403], nephrotoxic drugs (OR 1.303), APACHE II score (OR 1.055), SOFA score (OR 1.115), duration for positive fluid balance (OR 1.165), use of diuretics (OR 2.293), sepsis (OR 1.501), and CKD (OR 4.517). AKI stage 3 versus stages 1–2 was associated with higher mortality in ICU, hospital, and 28-day follow-up after cardiovascular, abdominal, limb, and chest surgeries, while this was not observed after neurosurgery or other surgeries.Conclusion
Risk factors for AKI in ICU patients after different types of surgery were identified. This might be the first step to reduce the high incidence of AKI after surgery. The presence of AKI in ICU patients was associated with higher mortality after most types of surgery, but not after neurosurgery.Trial registration
ChiCTR-ONC-11001875.14.
Maddalena Gaeta Emanuele Rausa Alexis E. Malavazos Luigi Bonavina Cornelius M. Smuts Cristian Ricci 《Obesity surgery》2018,28(4):900-906
Background
Type II obesity represents a major pandemic and public health threat in high-income countries. Type II obesity increases the risk of all-cause and specific-cause mortality, and it is widely acknowledged that bariatric surgery represents the only effective therapeutic option in these patients. The aim of the present study was to estimate US population attributable risk for all-cause and cause-specific mortality in type II obese subjects undergoing weight loss as resulting from bariatric surgery alone and supplemented with behavioral intervention.Methods
The American National Health and Nutrition Examination Survey linked to the US death registry updated to 2011 was used to estimate type II obesity prevalence and all-cause and specific cause of death for type II obese adults undergoing weight loss. Multivariate adjusted proportional hazard Cox models were used to estimate mortality risks. Statistical analyses were performed on the most updated version of the database (June 2017).Results
A monotone positive trend for type II obesity was observed during the period 1999–2014 (p < 0.001). According to trend analysis, the rate of type II obesity in US adults is expected to rise up to 8.5%. Two- to sevenfold increased risk of all-cause and specific-cause mortality was observed for type II obese participants when compared to type I obese and overweight participants. Population attributable risk for all-cause and specific-cause mortality for type II obese subjects undergoing weight loss was ranging between 6 and 34%.Conclusions
Bariatric surgery supplemented with behavioral intervention can result in a relevant reduction of mortality if extensively applied to the US population.15.
Marenao Tanaka Tomohisa Yamashita Masayuki Koyama Norihito Moniwa Kohei Ohno Kaneto Mitsumata Takahito Itoh Masato Furuhashi Hirofumi Ohnishi Hideaki Yoshida Kazufumi Tsuchihashi Tetsuji Miura BOREAS HD study Investigators 《Clinical and experimental nephrology》2016,20(3):469-478
Background
It is controversial whether treatment with an angiotensin II receptor blocker (ARB) or a calcium channel blocker (CCB) improves prognosis of hemodialysis (HD) patients.Methods
This study was designed as a multicenter prospective cohort study. HD patients (n = 1071) were enrolled from 22 institutes in January 2009 and followed up for 3 years. Patients with missing data, kidney transplantation or retraction of consent during the follow-up period (n = 204) were excluded, and 867 patients contributed to analysis of mortality. Propensity score (PS) for use of ARB and that for CCB was calculated using a multiple logistic regression model.Results
ARB and CCB were prescribed in 45.6 and 54.7 % of patients at enrollment. During the 3-year follow-up period, all-cause mortality and cardiovascular mortality rates were 18.8 and 5.1 %, respectively. Kaplan–Meier curves showed that all-cause and cardiovascular mortality rates were lower in the ARB group than in the non-ARB group, though the mortality rates were similar in the CCB group and non-CCB group. In PS-stratified Cox regression analysis, ARB treatment was associated with 34 and 45 % reduction of all-cause death and cardiovascular death, respectively. In PS matching analysis, ARB treatment was associated with a significant reduction (46 % reduction) in the risk of all-cause death. A significant impact of CCB treatment on all-cause or cardiovascular mortality was not detected in PS analysis.Conclusions
The use of an ARB, but not a CCB, is associated with reduced all-cause and cardiovascular mortalities in patients on HD.16.
Objectives
Patients with psoriasis may have a higher risk of developing chronic kidney (CKD) and end-stage renal disease (ESRD) compared with general population. This systematic review and meta-analysis aimed to comprehensively investigate this association by reviewing all available evidence.Methods
A systematic review was performed using MEDLINE and EMBASE database from inception to January 2018 to identify all cohort studies that compared the risk of incident CKD and/or ESRD in patients with psoriasis versus individuals without psoriasis. Pooled risk ratio and 95% confidence interval were calculated using random-effect, generic inverse variance method.Results
A total of four retrospective cohort studies with 199,808 patients with psoriasis were included. The risk of incident CKD and ESRD was significantly increased among patients with psoriasis with the pooled risk ratio of 1.34 (95% CI, 1.14–1.57) and 1.29 (95% CI, 1.05–1.60), respectively.Conclusion
A significantly increased risk of incident CKD and ESRD among patients with psoriasis compared with individuals without psoriasis was demonstrated in this study.17.
Carla Vanti Silvano Ferrari Jorge Hugo Villafañe Pedro Berjano Marco Monticone 《Journal of orthopaedics and traumatology》2017,18(2):145-150
Background
This study aims to investigate the responsiveness and the minimum important change of the Italian version of the Oswestry Disability Index (ODI-I) in subjects with symptomatic specific low back pain associated with lumbar spondylolisthesis (SPL).Materials and methods
One hundred and fifty-one patients with symptomatic SPL completed the ODI-I, a 0–100 numerical rating scale (NRS), and performed the prone and supine bridge tests. The global perception of effectiveness was measured with a 7-point Likert scale. Responsiveness was assessed by distribution methods (minimum detectable change [MDC], effect size [ES], standardized response mean [SRM]) and anchor-based methods (ROC curves).Results
The MDC was 4.23, the ES was 0.95 and the SRM was 1.25. ROC analysis revealed an area under the curve of 0.76 indicating moderate discriminating capacity. The best cut-off point for the dichotomous outcome was 7.5 (sensitivity 90.3%, specificity 56.7%). .Conclusions
The ODI-I proved to be responsive in detecting changes after conservative treatment in subjects with lumbar SPL.Level of evidence
II.18.
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.19.
Han Jie Lee Alvin Lee Hong Hong Huang Weber Kam On Lau 《International urology and nephrology》2018,50(4):665-673
Purpose
Primary ADT (pADT) monotherapy is used significantly for patients with clinically localised disease in Asia and is acceptable even by guidelines, especially in intermediate- and high-risk disease. This occurs despite controversy in the West and data suggesting association with adverse effects, notably cardiovascular events. We therefore sought to assess the impact of pADT on all-cause mortality and prostate cancer-specific mortality (PCSM) in Asian men with high-risk and unfavourable intermediate-risk PCa.Methods
With cancer registry data, men from a single centre in Singapore with clinically localised high-risk/unfavourable intermediate-risk PCa diagnosed between 2004 and 2014 and either treated conservatively with no therapy or started on pADT within 1 year of diagnosis were followed up through January 2017. Patients with non-localised PCa (clinical stage T4, regional/distant lymph node involvement, metastases), or receipt of local therapy (radical prostatectomy/radiotherapy) were excluded. The primary outcomes of all-cause mortality and PCSM were analysed with Cox proportional hazards regression models.Results
Three hundred and forty Asian men were analysed, and 177 (52.1%) were started on pADT, with mean age of 77 (49–98) years. There were 119 deaths in the cohort, and 68 (38.4%) occurred in patients treated with pADT (median follow-up, 4.4 years). After adjusting for comorbidities and clinical characteristics, pADT did not provide benefit to all-cause mortality, PCSM or cardiovascular mortality.Conclusion
For clinically localised unfavourable intermediate-risk and high-risk PCa, starting pADT within 12 months of diagnosis is not associated with improved 5-year all-cause mortality or PCSM compared to patients treated conservatively with no therapy and should be discouraged due to lack of mortality benefit.20.
Manouchehr Aghajanzadeh Amir Hassankhani Alireza Amir Maafi Yasman Safarpoor 《Indian Journal of Thoracic and Cardiovascular Surgery》2016,32(3):189-193