Additional file 2: of Dysnatremia, its correction, and mortality in patients undergoing continuous renal replacement therapy: a prospective observational study

Subject number according to the change of serum sodium during 24 or 72 hours. (DOC 38 kb

Additional file 1: of Urinothorax after ultrasonography-guided renal biopsy: a case report

Figure S1. Retrograde pyelography (RGP) showing urine leakage from lower pole of kidney. (TIF 110 kb

Glycemic Control and Mortality in Diabetic Patients Undergoing Dialysis Focusing on the Effects of Age and Dialysis Type: A Prospective Cohort Study in Korea

<div><p>Background</p><p>Active glycemic control has been proven to delay the onset and slow the progression of diabetic retinopathy, nephropathy, and neuropathy in diabetic patients, but the optimal level is obscure in end-stage renal disease. In this study, we evaluated the effect of hemoglobin A1c (HbA1c) on mortality of diabetic patients on dialysis, focusing on age and dialysis type.</p><p>Methods</p><p>Of 3,302 patients enrolled in the prospective cohort for end-stage renal disease in Korea between August 2008 and October 2013, 1,239 diabetic patients who had been diagnosed with diabetes or having HbA1c≥6.5% at the time of enrollment were analyzed. Age was categorized as <55, 55–64 and ≥65 years old. Age, sex, modified Charlson comorbidity index, hemoglobin, primary renal disease, body mass index, and dialysis duration were adjusted.</p><p>Results</p><p>A total of 873 patients received hemodialysis (HD) and 366 underwent peritoneal dialysis (PD). During the mean follow-up of 19.1 months, 141 patients died. Patients with poor glucose control (HbA1c≥8%) showed worse survival than patients with HbA1c<8% (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.48–3.29; <i>P</i><0.001). Subgroup analysis divided by age revealed that HbA1c≥8% was a predictor of mortality in age <55 (HR, 4.3; 95% CI, 1.78–10.41; <i>P</i> = 0.001) and age 55–64 groups (HR, 3.3; 95% CI, 1.56–7.05; <i>P</i> = 0.002), but not in age ≥65 group. Combining dialysis type and age, poor glucose control negatively affected survival only in age < 55 group among HD patients, but it was significant in age < 55 and age 55–64 groups in PD patients. Deaths from infection were more prevalent in the PD group, and poor glucose control tended to correlate with more deaths from infection in PD patients (<i>P</i> = 0.050).</p><p>Conclusions</p><p>In this study, the effect of glycemic control differed according to age and dialysis type in diabetic patients. Thus, the target of glycemic control should be customized; further observational studies may strengthen the clinical relevance.</p></div

Pre-Transplant Cardiovascular Risk Factors Affect Kidney Allograft Survival: A Multi-Center Study in Korea

<div><p>Background</p><p>Pre-transplant cardiovascular (CV) risk factors affect the development of CV events even after successful kidney transplantation (KT). However, the impact of pre-transplant CV risk factors on allograft failure (GF) has not been reported.</p><p>Methods and Findings</p><p>We analyzed the graft outcomes of 2,902 KT recipients who were enrolled in a multi-center cohort from 1997 to 2012. We calculated the pre-transplant CV risk scores based on the Framingham risk model using age, gender, total cholesterol level, smoking status, and history of hypertension. Vascular disease (a composite of ischemic heart disease, peripheral vascular disease, and cerebrovascular disease) was noted in 6.5% of the patients. During the median follow-up of 6.4 years, 286 (9.9%) patients had developed GF. In the multivariable-adjusted Cox proportional hazard model, pre-transplant vascular disease was associated with an increased risk of GF (HR 2.51; 95% CI 1.66–3.80). The HR for GF (comparing the highest with the lowest tertile regarding the pre-transplant CV risk scores) was 1.65 (95% CI 1.22–2.23). In the competing risk model, both pre-transplant vascular disease and CV risk score were independent risk factors for GF. Moreover, the addition of the CV risk score, the pre-transplant vascular disease, or both had a better predictability for GF compared to the traditional GF risk factors.</p><p>Conclusions</p><p>In conclusion, both vascular disease and pre-transplant CV risk score were independently associated with GF in this multi-center study. Pre-transplant CV risk assessments could be useful in predicting GF in KT recipients.</p></div

Kaplan-Meier survival curve for all-cause mortality according to HbA1c levels (%).

<p>Kaplan-Meier survival curve for all-cause mortality according to HbA1c levels (%).</p

Incremental value of pre-transplant CV risk score or vascular disease over traditional risk factors for predicting allograft failure.

<p>Incremental value of pre-transplant CV risk score or vascular disease over traditional risk factors for predicting allograft failure.</p

Allograft failure according to the pre-transplant CV risk score before and after adjustment for competing risks.

<p>(A) Kaplan-Meier curves for the probability of graft failure in the KT recipients classified by the pre-transplant CV risk score tertiles. (B) Cumulative incidence function for graft failure and competing risk by the pre-transplant CV risk score tertiles. Cardiac death and unknown death were considered competing risk events. T1, the 1^st tertile; T2, the 2^nd tertile; T3, the 3^rd tertile.</p

Patient characteristics according to age.

<p>HD, hemodialysis; PD, peritoneal dialysis; ESRD, end-stage renal disease; BMI, Body mass index; MCCI, Modified Charlson co-morbidity index; RAS; renin-angiotensin system</p><p>Patient characteristics according to age.</p

Multivariate analysis in subgroups according to dialysis modality and age

<p>Adjusted for age, sex, modified Charlson comorbidity index, hemoglobin, primary renal disease, body mass index, and dialysis duration. Reference groups are patients with HbA1c<8% in each population.</p

Kaplan-Meier survival curves for cause-specific death according to HbA1c level

<p>(A) Death from cardiovascular disease in hemodialysis patients, (B) Death from cardiovascular disease in peritoneal dialysis patients, (C) Death from infection in hemodialysis patients, and (D) Death from infection in peritoneal dialysis patients.</p