Residual Daily Urine Volume Association with Inflammation and Nutrition Status in Maintenance Hemodialysis Patients

Background. This study determines the clinical significance of residual renal function (RRF), defined as residual daily urine volume (RDUV), in maintenance hemodialysis (MHD) patients. Methods. This multi-center study enrolled 704 MHD patients. Geographic, hematological, biochemical, and dialysis-related data were obtained. Values for nutritional and inflammatory markers were analyzed together with RDUV. Results. In total, 670 of 704 patients (95.2%) with HD duration greater than 1 year had abnormal RDUV (<500 ml). Patients with higher RRF were younger, had shorter HD duration, higher prevalence of hypertension and levels of serum albumin, high density lipoprotein (HDL), and lower mid-week inter-dialysis body weight increase (MIBWI), cardio-thoracic ratio, levels of intact parathyroid hormone, high sensitivity C-reactive protein (Hs CRP), and KT/V (Daugirdes) values than those with low RRF. Stepwise multiple regression analysis demonstrated that RRF was positively correlated with serum albumin, HDL levels, and presence of hypertension, and negatively correlated with age, HD duration, and MIBWI in MHD patients. Moreover, after adjusting factors that were significantly related to serum albumin or Hs CRP, RRF was still positively correlated with serum albumin (0.000137 ± 0.000585, p?=?0.0197) and negatively correlated with log Hs CRP (?0.000184 ± 0.000952, p = 0.0533). A one-liter increase in RDUV was associated with a 1.4 g/L increase in serum albumin level in MHD patients. Conclusion. This clinical study first demonstrated that RRF affects nutritional and inflammatory status in MHD patients. Because malnutrition and inflammation can cause high mortality in MHD patients, preserving RRF is important for these patients.     

Cardiothoracic Ratio,Inflammation, Malnutrition,and Mortality in Diabetes Patients on Maintenance Hemodialysis

BackgroundThis study investigates diabetic patients on maintenance hemodialysis (HD), and examines whether cardiothoracic ratio (CTR), malnutrition, and inflammation are closely interrelated, and whether CTR predicts short-term mortality in this population.MethodsA 2-year longitudinal study that enrolls 179 patients—73 without cardiomegaly (CTR < 50%), 81 with mild cardiomegaly (CTR 50%–60%), and 25 with moderate-to-severe cardiomegaly (CTR > 60%).ResultsSpearman analysis established that CTR was positively correlated with age (P < 0.001) and high sensitivity C reactive protein (HsCRP) (P < 0.05), but negatively correlated with albumin (P < 0.05) and creatinine (P < 0.001). Multivariate logistic analyses identified age (P = 0.0027), creatinine (P = 0.0484), intact-PTH (P = 0.0197) and HsCRP (P = 0.0247) were independent determinants of cardiomegaly. After 2 years, 31 of 179 (17.32%) patients died including 9 of 25 (36%) with CTR > 60%, 14 of 81 (17.28%) with CTR 50%–60%, and 8 of 73 (10.96%) with CTR < 50%. The primary causes of death were infection (61.29%) and cardiovascular disease (CVD) (32.26%). Cox multivariable regression analysis revealed CTR > 50% was the only independent variable for the development of all-cause and infection-cause mortality in 2 years. Kaplan-Meier analysis confirmed that patients with CTR > 60% suffered higher cumulative mortality than patients with CTR < 50% (P = 0.0003).ConclusionsCTR does not only correlate with inflammation and nutritional status in diabetic patients on maintenance HD, but also predict the all-cause and infection-cause 2-year mortality.     

Food safety involving ingestion of foods and beverages prepared with phthalate-plasticizer-containing clouding agents

In May 2011, the illegal use of the phthalate plasticizer di(2-ethylhexyl) phthalate in clouding agents for use in foods and beverages was reported in Taiwan. This food scandal has caused shock and panic among the majority of Taiwanese people and has attracted international attention. Phthalate exposure is assessed by ambient monitoring or human biomonitoring. Ambient monitoring relies on measuring chemicals in environmental media, foodstuff and consumer products. Human biomonitoring determines body burden by measuring the chemicals, their metabolites or specific reaction products in human specimens. In mammalian development, the fetus is set to develop into a female. Because the female phenotype is the default, impairment of testosterone production or action before the late phase may lead to feminizing characteristics. Phthalates disrupt the development of androgen-dependent structures by inhibiting fetal testicular testosterone biosynthesis. The spectrum of effects obtained following perinatal exposure of male rats to phthalates has remarkable similarities with the human testicular dysgenesis syndrome. Epidemiological studies have suggested associations between phthalate exposure and shorter gestational age, shorter anogenital distance, shorter penis, incomplete testicular descent, sex hormone alteration, precocious puberty, pubertal gynecomastia, premature thelarche, rhinitis, eczema, asthma, low birth weight, attention deficit hyperactivity disorder, low intelligence quotient, thyroid hormone alteration, and hypospadias in infants and children. Furthermore, many studies have suggested associations between phthalate exposure and increased sperm DNA damage, decreased proportion of sperm with normal morphology, decreased sperm concentration, decreased sperm morphology, sex hormone alteration, decreased pulmonary function, endometriosis, uterine leiomyomas, breast cancer, obesity, hyperprolactinemia, and thyroid hormone alteration in adults. Finally, the number of phthalate-related scientific publications from Taiwan has increased greatly over the past 5 years, which may reflect the health effects from the illegal addition of phthalate plasticizer to clouding agent in foodstuff over the past two decades.     

Human poisoning with spinosad and flonicamid insecticides

This report describes the first known case in the literature of acute exposure to a mixture of spinosad and flonicamid that resulted in a substantial clinical toxicities. An 80-year-old depressed female attempted suicide by drinking a mixture of 80-mL Conserve (Dow AgroSciences, Taipei, Taiwan) and 2-3 gram powder of flonicamid (Ishihara Sangyo Kaisha, Taipei, Taiwan). Spinosad was the main compound ingested. The clinical manifestations were mostly neurological, i.e. consciousness disturbance, shock, respiratory failure, pneumonitis and urinary retention. Endoscopic examination found grade 2a corrosive esophageal injury. After resuscitation, detoxification procedures and intensive care, the patient recovered fully without leaving any chronic sequels. An emerging question arising from this report is, why are the clinical symptoms so severe, given that both compounds were claimed safe in laboratory animals? The answer is unclear. One possible explanation is, the amount of spinosad ingested was far beyond the physiological safety dose that can be handled by human body. Other potential contributors to the clinical toxicities in this patient are the solvent compositions that were found in the Conserve insecticide formulation.     

Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis

Previous studies of general populations indicated environmental exposure to low-level cadmium increases mortality. However, the effect of cadmium exposure on maintenance hemodialysis (MHD) patients is unclear.A total of 937 MHD patients from 3 centers in Taiwan were enrolled in this 36-month observational study. Patients were stratified by baseline blood cadmium level (BCL) into 3 groups: high BCL (>0.521 μg/L; n = 312), intermediate BCL (0.286−0.521 μg/L; n = 313), and low BCL (<0.286 μg/L; n = 312). The mortality rates and causes of death were analyzed.The analytic results demonstrated patients in the high BCL group had a significantly higher prevalence of malnutrition and inflammation than patients in the low and intermediate BCL groups. After 3 years of follow-up, 164 (17.5%) patients died and the major cause of death was cardiovascular disease. A Cox multivariate analysis indicated the high BCL group had increased hazard ratios (HRs) for all-cause mortality (HR = 1.72; 95% confidence interval [CI]: 1.14–2.63; P = 0.018), cardiovascular-related mortality (HR = 1.85; 95% CI: 1.09–3.23; P = 0.032), and infection-related mortality (HR = 2.27; 95% CI: 1.12–4.55; P = 0.035). A Cox multivariate analysis of MHD patients who never smoked (n = 767) indicated the high BCL group had increased HRs for all-cause mortality (HR = 1.67; 95% CI: 1.04–2.63; P = 0.048) and cardiovascular-related mortality (HR = 2.08; 95% CI: 1.08–4.00; P = 0.044).In conclusion, BCL is an important determinant of mortality in MHD patients. Therefore, MHD patients should avoid cadmium exposure as much as possible, such as tobacco smoking and eating cadmium-containing foods.