Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis?

Background: Advanced glycosylated end-products (AGEs) have been shown to cause cardiovascular disease, and tissue AGE accumulation can be measured by skin autofluorescence (SAF). AGEs are cleared by the kidney, and thus accumulate in dialysis patients. However, as the results of SAF measurements in peritoneal dialysis patients (PD) have been ambiguous, we examined the association between mortality and SAF. Methods: We reviewed SAF measurements in PD patients attending a university associated PD program, along with standard measurements of dialysis adequacy and peritoneal membrane function. Results: We studied 341 prevalent PD patients, 61.9% male, mean age 61.2 ± 16 years, and 31.4% of all patients died during a median follow-up of 27.2 (23.3–36.3) months. Patients who died were older, mean age 72 ± 10.5 years, were more often diabetic (60.7%), and had higher median SAF 3.8 (3.2–4.5) AU. On logistic regression, mortality was independently associated with age (odds ratio (OR) 1.1 (95% confidence limits 1.06–1.16), diabetes OR 10.1 (3.1–33.4), SAF OR 3.3 (1.8–6.2), all p < 0.001, and male gender OR 5.2 (1.6–17.4), p = 0.007; and negatively associated with weight OR 0.91 (0.86–0.95), p < 0.001, normalised nitrogen appearance rate (nPNA) OR 0.05 (0.01–0.4), p = 0.005 and mean arterial blood pressure (MAP) OR 0.96 (0.93–0.96), p = 0.03. Conclusions: In this observational study, SAF was independently associated with mortality. However, other factors were also associated with mortality, including age, diabetes and malnutrition which have all been reported to affect SAF measurements. Thus, the additional predictive value of measuring SAF compared to standard risk factors for mortality remains to be determined. Graphical abstract: [Figure not available: see fulltext.]

Insulin resistance in adult polycystic kidney disease

Insulin resistance in adult polycystic kidney disease. Adult polycystic kidney disease (APKD) is a common hereditary disease with renal and extra-renal manifestations. There are at least three genes responsible for this disease. The polycystic kidney disease 1 (PKD1) gene product is a membrane protein involved in cell-cell and cell-matrix interactions and has a widespread tissue distribution. Abnormal membrane fluidity in erythrocytes from APKD patients is due to altered membrane proteins. Membrane fluidity of mononuclear cells is related to whole body insulin sensitivity. Insulin sensitivity might therefore be disturbed in APKD if the erythrocyte membrane abnormality is also present in other cells. Therefore, we investigated insulin sensitivity in 15 APKD patients and 20 normal subjects matched for age and sex. Insulin sensitivity was assessed by a short insulin tolerance test to derive the first-order rate constant for the disappearance of glucose (Kitt) and mononuclear leukocyte membrane fluidity was measured by fluorescence anisotropy. The Kitt value (% mmol·liter−1·min−1) was lower in APKD patients than in normal subjects [median (range) 2.2 (1.5 to 6.3) vs. 4.1 (2.0 to 5.4), P < 0.001]. Fasting plasma insulin concentrations were negatively correlated with the Kitt values (r = −0.66, P < 0.001). Core region anisotropy was significantly lower (higher fluidity) in leukocytes from APKD patients [mean (SEM) 0.164 (0.003) vs. 0.174 (0.001), P < 0.001]. Insulin sensitivity was positively correlated with the fluorescence anisotropy of the core region of leukocyte membranes (r = 0.81, P = 0.0001). In conclusion, APKD patients were insulin resistant and some patients were hyperinsulinemic, which may indicate increased cardiovascular risk. The cellular basis of the insulin resistance may be directly related to the proteins causing the disease or to the general change in membrane properties

Prevalence of chronic kidney disease in Thai adults: a national health survey

<p>Abstract</p> <p>Background</p> <p>The prevalence of patients with end stage renal disease (ESRD) who need dialysis and/or transplantation has more than doubled in Thailand during the past two decades. It has been suggested that therapeutic strategies to reduce the risk of ESRD and other complications in CKD are now available, thus the early recognition and the institution of proven therapeutic strategies are important and beneficial. We, therefore, aimed to determine the prevalence of CKD in Thai adults from the National Health Examination Survey of 2004.</p> <p>Methods</p> <p>Data from a nationally representative sample of 3,117 individuals aged 15 years and older was collected using questionnaires, physical examination and blood samples. Serum creatinine was measured by Jaffé method. GFR was estimated using the Chinese modified Modification of Diet in Renal Disease Study equation. Chronic kidney Disease (CKD) stages were classified based on Kidney Disease Outcome Quality Initiative (K/DOQI).</p> <p>Results</p> <p>The prevalence of CKD in Thai adults weighted to the 2004 Thai population by stage was 8.1% for stage 3, 0.2% and 0.15% for stage 4 and 5 respectively. Compared to non-CKD, individuals with CKD were older, had a higher level of cholesterol, and higher blood pressure. Those with cardiovascular risk factors were more likely to have CKD (stage 3-5) than those without, including hypertension (OR 1.6, 95%CI 1.1, 3.4), diabetes (OR 1.87, 95%CI 1.0, 3.4). CKD was more common in northeast (OR 2.1, 95%CI 1.3, 3.3) compared to central region. Urinalysis was not performed, therefore, we could not have data on CKD stage 1 and 2. We have no specific GFR formula for Thai population.</p> <p>Conclusion</p> <p>The identification of CKD patients should be evaluated and monitored for appropriate intervention for progression to kidney disease from this screening.</p

Effect of Ultrafiltration Rate in Long Interdialytic Interval Hemodialysis Session versus Average Weekly Ultrafiltration Rate on Mortality Rate and Adverse Cardiovascular Outcomes in Maintenance Hemodialysis Patients

Objective: Cardiovascular events are more commonly observed during hemodialysis sessions after a long interdialytic interval compared to average weekly hemodialysis sessions, and ultrafiltration rate (UFR) was reported to be associated with cardiovascular outcomes. Whether the UFR during hemodialysis sessions after a long interdialytic interval is a better predictor of cardiovascular outcome than the average weekly UFR is unknown. Methods: The charts of patients aged >18 years with end-stage renal disease that received hemodialysis treatment Siriraj Hospital during January 2008 to December 2017 were retrospectively reviewed. Results: Two hundred and forty-one patients (52.8% females) were included. During the median time follow-up of 54 months, the rate of adverse cardiovascular outcomes was 7.26 events/100-patient-years, and the mortality rate was 8.40 deaths/100-patient-years. Mean UFR was significantly higher in the long interdialytic interval hemodialysis sessions than in the average weekly UFR sessions (14.07±5.29 vs.13.13±5.14 ml/h/kg, p13 ml/hour/kg subgroup was 1.29 (95% CI: 0.65-2.56) and 1.05 (95% CI: 0.55-2.03) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. The adjusted HR for adverse cardiovascular outcome in the UFR >13 ml/h/kg subgroup was 1.32 (95% CI: 0.64-2.80) and 0.72 (95% CI: 0.36-1.35) in the long interdialytic interval hemodialysis sessions and the average weekly UFR, respectively. Conclusion: This study revealed the UFR in long interdialytic hemodialysis sessions to be more strongly associated with adverse cardiovascular outcomes and all-cause mortality than the average weekly UFR

Aspects of cell membrane function in adult polycystic kidney disease

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN012986 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Kidney Transplantation Outcomes across Autosomal Dominant Polycystic Kidney Disease at Siriraj Hospital

Background: Thailand has a population of 65 million. The estimated incidence of chronic kidney disease (CKD) patients is approximately 17%. Siriraj Hospital has performed kidney transplantations since 1973. With 43 years of experience, a total of 1,150 kidney transplantations (65.5% were deceased donors and 34.5% were living donors) were performed at Siriraj Hospital. Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent, potentially lethal, monogenetic disorder with the prevalence of 1:500-1:1000 worldwide. It is the fourth leading cause of end-stage renal disease (ESRD). The characteristic of ADPKD is the enlargement of kidney from numerous cysts present on the renal tubules which gradually grow resulting in the decline of glomerular filtration rate (GFR) and eventually turning into ESRD. Objective: We aimed to study the outcome of kidney transplantation in ADPKD recipients at Siriraj Hospital. Methods: Thirty-one ESRD-ADPKD patients (male 22, female 9) received kidney transplantation at Siriraj Hospital. Twenty-eight patients (90.3%) were deceased donors and 3 patients (9.7%) were living donors. All living donors were performed genetic tests, including linkage study and mutation test, to exclude ADPKD relatives who carried abnormal PKD genes. Results: The kidney allograft survival at 1-, 5- and 10-years were 81%, 81% and 54%, respectively. The results of patient survival at 1-, 5- and 10-years were 94%, 90% and 75%, respectively. Conclusion: Kidney transplantation provides excellent patient and graft survival rates and is the preferred treatment option for patients with ADPKD and ESRD

Assessment of Volume Status in Chronic Hemodialysis: Comparison of Lung Ultrasound to Clinical Practice and Bioimpedance

Objective: To compare LUS with other volume assessment methods, and to verify the prognostic value of LUS in Thai chronic HD patients. Materials and Methods: We conducted a prospective cohort study in 36 chronic HD patients. Volume status before the HD session was evaluated by physical examinations, bioimpedance analysis (BIA), and ultrasound lung comets (ULCs). Mortality and morbidities were recorded during a 1-year follow-up period. Results: The degree of lung fluid accumulation was assessed by summation of the number of ULCs, and was classified into 3 groups: mild-to-moderate (ULC60) in 11.1%, 77.8%, and 11.1% of the patients, respectively. Either clinical edema or lung crackle had low sensitivity (20-32%) to detect extravascular lung water excess in patient with mild-to-moderate ULC and severe ULC. Overhydration assessed by BIA was found in 75% and 64.3% of patients with mild-to-moderate and severe ULC, respecively.  In patients with very severe ULC, the admission rate due to volume overload was significantly higher, there was also a trend of increased mortality, as well as intradialytic complications. Conclusion: Clinical assessment and BIA have limited value in determining extravascular fluid excess in the lung. Lung ultrasound is a useful tool to detect subclinical pulmonary congestion. The long-term outcome by using LUS-guided fluid management needs larger population studies