High-Sensitivity C-Reactive Protein: An Independent Risk Factor for Left Ventricular Hypertrophy in Patients with Lupus Nephritis

Objective. To determine the prevalence of left ventricular hypertrophy (LVH) and its associated risk factors in lupus nephritis (LN) patients. Methods. 287 LN patients (age: 38.54 ± 13.31, 262 female) were recruited. Echocardiography and serum high-sensitivity C-reactive protein (hs-CRP) were measured. Their relationship was evaluated by univariate correlation analysis and multivariate regression analysis. Results. The prevalence of LVH in this cohort was 21.25% (n = 61). Serum hs-CRP level was significantly elevated in patients with LVH compared to those without (8.03 (3.22–30.95) versus 3.93 (1.48–9.48) mg/L, P < .01), and correlated with left ventricular mass index (LVMI) (r = 0.314, P = .001). Multivariate regression analysis further confirmed that hs-CRP was an independent risk factor (β = 0.338, P = .002) for LVH in patients with LN. Conclusions. Our findings demonstrated that serum hs-CRP level is independently correlated with LVMI and suggested that measurement of hs-CRP may provide important clinical information to investigate LVH in LN patients

Clinical Outcome of Twice-Weekly Hemodialysis Patients with Long-Term Dialysis Vintage

Background/Aims: Twice-weekly hemodialysis(HD) is prevalent in the developing countries, scarce data are available for this treatment in patients with long-term dialysis vintage. Methods: 106 patients with more than 5 years HD vintage undergoing twice-weekly HD or thrice-weekly HD in a hemodialysis center in Shanghai between December 1, 2013 and December 31, 2013 were enrolled into the cohort study with 3 years follow-up. Kaplan–Meier analysis and Cox proportional hazards models were used to compare patient survival between the two groups. Subgroup analysis of 62 patients more than 10 years HD vintage was also performed according to their different dialysis frequency. Results: Compared with patients on thrice-weekly HD, twice-weekly HD patients had significantly longer HD session time and higher single-pool Kt/V (spKt/V) (session time, 4.59±0.45 vs 4.14±0.31 hours/per session, P&#x3c; 0.001; spKt/V, 2.12±0.31 vs 1.83±0.30, P&#x3c; 0.001). Kaplan–Meier survival analysis indicated that the two groups had similar survival (P=0.983). Multivariate Cox regression analysis showed that age and time-dependent serum albumin were predictors of patient mortality. Subgroup analysis of 62 patients more than 10 years HD vintage also indicated that the two groups had similar survival. During the follow-up, 4 patients dropped out from the twice-weekly HD group and transferred to thrice-weekly HD. Conclusion: The similar survival between twice-weekly HD and thrice-weekly HD in patients with long-term dialysis vintage is likely relating to patient selection, individualized treatment for dialysis patients based on clinical features and socioeconomic factors remains a tough task for the clinicians

An observational study on the effect of seasonal variation on peritoneal dialysis patients

Background: Seasonal variation has an impact on plants, wild animals, and also human beings. Data have shown seasonal variation has a significant impact on patients’ fluid status, biochemistry results, and outcomes in hemodialysis populations. The relevant data on peritoneal dialysis is scant.Methods: This was a cross sectional study. All patients followed up in our center had a peritoneal equilibration test and PD adequacy test every 6 months. All the peritoneal equilibration test and PD adequacy test data were collected during December 2019 to November 2020. The monthly delivery information of the whole center was collected from 2015 to 2019.Results: There were 366 patients and 604 sets of peritoneal equilibration test and PD adequacy test results in the study. Plasma albumin and phosphate levels were higher in summer. The monthly average outdoor temperature was positively correlated with plasma albumin. There was no seasonal difference in peritoneal dialysis ultrafiltration or urine volume. The percentage of low glucose concentration (1.5%) usage was higher in summer and lower in winter.Conclusion: Plasma albumin and phosphate levels were higher in summer in PD patients. Weaker glucose peritoneal dialysis dialysate was more widely used in summer. Understanding the seasonal variation of peritoneal dialysis is helpful in individualized treatment

Association between sarcopenic obesity and mortality in patients on peritoneal dialysis: a prospective cohort study

BackgroundWhether sarcopenic obesity had unfavorable effect on survival of peritoneal dialysis (PD) patients is unknown. We aimed to investigate the association between sarcopenic obesity and survival in PD patients.MethodsThis was a prospective observational study. Eligible PD patients from November 2016 to December 2017 were enrolled and followed until August 31, 2023. Sarcopenia was defined following the recommendations of the Asian Working Group for Sarcopenia (AWGS) as low appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS). Obesity was defined using the percentage of body fat (PBF). Survival analysis was conducted using the Kaplan–Meier and log-rank test. The Cox regression and the cumulative incidence competing risk (CICR) analyzes were used to investigate the association between sarcopenic obesity and all-cause mortality.ResultsA total of 223 patients were enrolled with 133 (59.6%) males, a median age of 57.5 (44.6, 65.7) years, a median dialysis vintage of 20.3 (6.4, 57.7) months and 48 (21.5%) who had comorbid diabetes mellitus. Among them, 46 (20.6%) patients were sarcopenic, and 25 (11.2%) patients were diagnosed with sarcopenic obesity. After followed up for 51.6 (25.6, 73.9) months, the Kaplan–Meier curve showed the sarcopenic obesity (log-rank = 13.527, p &lt; 0.001) group had significant lower survival rate compared to the nonsarcopenic non-obesity group. For multivariate analysis, the CICR method showed patients with sarcopenic obesity had significantly higher mortality rate (HR: 2.190, 95% CI: 1.011–4.743, p = 0.047) compared to those with nonsarcopenic non-obesity.ConclusionSarcopenia is not uncommon in PD patients, with a considerable proportion having sarcopenic obesity. There is a significant association between sarcopenic obesity and an increased risk of mortality in PD patients

Peritoneal Protein Clearance Is a Function of Local Inflammation and Membrane Area Whereas Systemic Inflammation and Comorbidity Predict Survival of Incident Peritoneal Dialysis Patients

It is not clear whether the association of increased peritoneal protein clearance (PPCl) with worse survival on peritoneal dialysis (PD) is a consequence of either local or systemic inflammation or indicative of generalized endothelial dysfunction associated with comorbidity. To investigate this we determined the relationship of PPCl to comorbidity, membrane area (equivalent to low molecular weight peritoneal solute transport rate), local and systemic inflammation and hypoalbuminaemia, and for each of these with patient survival. 257 incident patients from three GLOBAL Fluid Study centers were included in this analysis. Clinical profiles were collected at baseline along with a peritoneal equilibration test, 24-h dialysate protein and paired plasma and dialysate cytokine measurements. Although peritoneal protein clearance was associated with increased age and severe comorbidity on univariate analysis, only dialysate IL-6, peritoneal solute transport rate, plasma albumin and cardiac comorbidities (ischaemic heart disease and left ventricular dysfunction) were independent explanatory variables on multivariate analysis. While peritoneal protein clearance and daily peritoneal protein loss were associated with survival in univariate analysis, on multivariate analysis only plasma IL-6, age, residual kidney function, comorbidity, and plasma albumin were independent predictors. Peritoneal protein clearance is primarily a function of peritoneal membrane area and local membrane inflammation. The association with comorbidity and survival is predominantly explained by its inverse relationship to hypoalbuminaemia, especially in diabetics

Local and systemic endothelial injury in renal failure treated with peritoneal dialysis

Excess fluid and waste products of metabolism, as well as protein, are removed from the peritoneal cavity in Peritoneal Dialysis (PD). Increased peritoneal protein clearance (Pcl) is associated with a greater risk of mortality. It is not clear whether this association reflects systemic endothelial injury or local peritoneal capillary damage and inflammation, or both. To investigate this problem a series of analyses were undertaken in different incident, prevalent and longitudinal patient cohorts. Transcapillary escape rate of albumin (TERalb) was measured to determine systemic capillary permeability. Luminex assays combined with principle component analysis were applied to measure endothelial biomarker patterns. It was demonstrated that: (1) Pcl is a function of both local peritoneal inflammation, membrane area (PSTR) and comorbidity (especially cardiovascular) but only its association with the latter predicted survival. (2) There is a progressive uncoupling of the Pcl, (indicative of large pore pathway) and PSTR (effectively the small pore area) with time on PD. (3) Isolated small pore ultrafiltration (due to icodextrin) decreases with prolonged time on PD and is also uncoupled from the increase in peritoneal membrane area. (4) The systemic endothelial barrier function is decreased in PD patients, especially diabetics, but not associated with hypoalbuminaemia which is linked to systemic inflammation. (5) Hydration status is related to plasma albumin concentration but not endothelial dysfunction as measured by soluble biomarkers. Pcl is a function of both local peritoneal factors, e.g. inflammation and progressive fibrosis, and systemic patient characteristics, e.g. age and comorbidity. The influence of comorbidity is complex depending on type, associated patterns of endothelial injury and causes of associated hypoalbuminaemia. The importance of plasma colloidal pressure in determining fluid status was emphasized. Strategies to improve fluid distribution should focus on reducing peritoneal protein loss and increasing albumin synthesis rather than blocking systemic vascular leak

Longitudinal Study of Small Solute Transport and Peritoneal Protein Clearance in Peritoneal Dialysis Patients

BACKGROUND AND OBJECTIVES: Peritoneal protein clearance (Pcl) is determined by both effective (small pores) membrane area and relative capillary leakiness (large pores). It is not known how these two components change with duration of peritoneal dialysis (PD) in the context of progressive membrane injury and differential attrition of patients with higher Pcl, which has been associated with increased mortality risk in several studies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients treated continuously from 2000 to 2011 for a minimum of 4 years were selected from the longitudinal prospective Stoke PD Study. Pcl, membrane area (peritoneal solute transport rate [PSTR]), dialysis prescription, and residual renal function were measured every 6 months, along with comorbidity and peritonitis events. Multilevel multivariate analysis was used to determine associations with Pcl over time, taking into account within-subject correlations. RESULTS: From 280 incident patients, 335 datasets were analyzed from 49 patients receiving treatment for 4 years. Pcl correlated with PSTR at baseline (R=0.61; P<0.01), but over time there was progressive uncoupling of this relationship (year 4, R=0.28; P=0.05) with increasing PSTR (0.66–0.74; P<0.01) and stable Pcl (78.4–81.9 ml/d; P=0.7). Multivariate analysis found that age, PSTR, daily ultrafiltration, and sodium removal were significant predictors of Pcl when adjusted for sex, comorbidity, glucose exposure, and residual renal function. Peritonitis was associated with increased PSTR but a similar pattern of uncoupling. CONCLUSION: There is a progressive dissociation of the small- and large-pore pathways with time on PD, which would be in keeping with a switch from local inflammation early on to progressive fibrosis, combined with increased vascular surface area. Measuring longitudinal changes in Pcl may complement membrane function tests used to monitor progressive injury

Adiponectin,leptin: focus on low-protein diet supplemented with keto acids in chronic glomerulonephritis with hbv patients

Leptin and adiponectin come from adipose tissue, which can reflect patients' inflammation and status of lipid metabolism. Our study is aim to evaluate the effects of short-term restriction of dietary protein intake (DPI) supplemented with keto acids on nutrition and lipid metabolic disturbance in chronic glomeruloneph-ritis with HBV patients. 17 patients were randomized to either low DPI with keto acid-supplemented (sLP) or low DPI (LP) group for 12 weeks. Low-protein diet (LPD) wasindividualized with protein intake of 0.6–0.8 g/kg/day and keto acids were supplied in 0.1 g/kg/day. Nutritional index other clinical index were measured to evaluate the effect and safey respectively. Serum levels of adiponectin, leptin were determined by ELISA assay.The urine protein excretion level was significantly decreased after 12 weeks in the sLP group compared to the basal value and the LP group (baseline:4.52±1.74,4 weeks:3.19±1.52 g,8 weeks: 2.19±1.1 g,12 weeks:1.64±0.77 g, P<0.05).No difference was observed in serume creatinine, eGFR. Nutritional index was significantly improved at week 12 in the sLP group. 4 week later, Serum leptin of sLP decreased signficangly compared with baseline.[baseline: 4.99 (1.66, 11.44) ng/ml, 4 weeks: 2.29 (1.22,10.2) ng/ml;8 weeks: 1.8(1.18,5.07) ng/ml; 12 weeks: 1.38(0.88,2.55) ng/ml, P<0.05]. The level of serum adiponectin in sLP raised after 8 week compared with the baseline and LP (baselin: 21.60±4.78 pg/ml, 4 weeks: 22.30±4.98 pg/ml, 8 weeks: 24.44±4.43 pg/ml, 12 weeks: 25.11±4.25 pg/ml, P<0.05). In conclusion: Short-term restriction of DPI 0.6–0.8 g of protein/ kg IBW/day is safe, when combined with keto acids, is associated with decreased of urinary protein and improvement of lipid metabolis

Association of serum angiopoietin-2 with malnutrition, inflammation, atherosclerosis and valvular calcification syndrome and outcome in peritoneal dialysis patients: a prospective cohort study

Abstract Background To examine serum angiopoietin-2 (Angpt-2) in relation to malnutrition, inflammation, atherosclerosis and cardiac valvular calcification, so-called MIAC syndrome and its predictive role in outcomes of peritoneal dialysis (PD) patients. Methods A prospective observational study was conducted in 324 chronic PD patients. Biochemical analysis was performed at baseline for serum angiopoietins, albumin and high sensitive C-reactive protein (hs-CRP) and echocardiography was done to detect cardiac valvular calcification. Primary study end points were fatal or nonfatal cardiovascular events and mortality. Results The median of serum Angpt-2 levels was 5.44 ng/mL (interquartile range, 3.41–7.85). Across the three tertiles of serum Angpt-2, a significant trend effect was observed for body mass index, normalized protein catabolic rate, calcium × phosphorus product, hs-CRP, brain natriuretic peptide, lower-density lipoprotein cholesterol, left ventricular ejection fraction, total weekly urea clearance and residual renal function (all p < 0.05). Serum Angpt-2 showed a significant increase across the four groups of patients with increasing components of MIAC syndrome (p < 0.001). There were 77 deaths and 57 cardiovascular events. High serum Angpt-2 was an independent predictor of fatal and nonfatal cardiovascular events in PD patients (p = 0.02), however serum Angpt-2 was not an independent predictor of all-cause mortality (p = 0.3). Conclusions Serum Angpt-2 showed close association with valvular calcification, atherosclerosis, inflammation and malnutrition, having significant independent prognostic value and is useful for cardiovascular event stratification in chronic PD patients. Angpt-2 might be a potential mediator of increased cardiovascular risk in patients undergoing PD treatment