Comparison of tunneled central venous catheters and native arteriovenous fistulae by evaluating the mortality and morbidity of patients with prevalent hemodialysis.

PURPOSE: We examined the association between catheter use for maintenance hemodialysis (HD) and mortality/hospitalization in a cohort of patients with prevalent HD. METHODS: In this study, 70 HD patients with tunneled cuffed central venous catheters (TCVCs) from a Taiwanese HD center during 2014-2016 were enrolled and compared with 70 matched HD patients with native arteriovenous fistulae (AVF). The compared variables included demographic parameters and laboratory and dialysis-related indices. Cox regression analysis was used to assess the risk of mortality/hospitalization within a year. RESULTS: Low baseline serum albumin levels were found in patients with TCVCs (3.64 g/dL vs 3.79 g/dL, p = 0.030). The mortality rates of patients with AVF and TCVCs were 14 per 1000 patients and 171 per 1000 patients, respectively. Infection was the leading cause of mortality/hospitalization in patients with TCVCs. Using multivariate analyses, the risk of death was found to be significantly higher in patients with TCVCs than in those with AVF (Hazard ratio [HR] 12.15, 95% CI 1.16-127.17; p = 0.037). Patients with TCVC also had a higher hospitalization rate (HR 1.33, 95% CI 0.71-2.49; p = 0.369) (not statistically significant). CONCLUSION: Catheter use for maintenance HD was associated with increased all-cause mortality.

Factors Associated with Functional Performance among Patients on Hemodialysis in Taiwan.

BACKGROUND/AIMS: We investigated factors associated with functional performance in hemodialysis (HD) patients as well as their relationships with mortality. METHODS: We enrolled 790 HD patients who were followed up from 2009 to 2013. Functional performance was evaluated by Karnofsky Performance Status Scale (KPSS) scores. We examined the associations of clinical variables and all-cause mortality with KPSS scores. RESULTS: Of the participants, 460 had high KPSS scores (range 90-100) and 330 had low KPSS scores (below 80). On multivariate analysis, age and weekly HD sessions were associated with significantly increased odds of a lower KPSS score (age: OR 1.05, 95% CI 1.04-1.07, p < 0.001; weekly HD: OR 2.10, 95% CI 1.37-3.21, p = 0.001). A low KPSS score was a significant predictor of increased all-cause mortality (hazard ratio 1.49; 95% CI 1.02-2.16, p = 0.037), as determined using Cox regression analysis. CONCLUSION: Functional performance was associated with clinical variables and all-cause mortality in HD patients.

C-reactive protein variability is associated with vascular access outcome in hemodialysis patients.

BACKGROUND: Hemodialysis (HD) vascular access failure is one of the most important causes of morbidity and contributes to the cost of dialysis care. There is paucity of data evaluating long-term monitoring of C-reactive protein (CRP) on outcome of HD vascular access. METHODS: We conducted a retrospective study to investigate whether variability of serum CRP level was associated with vascular access failure rate over a 7-year period. A total of 318 HD patients were included. Their demographic data, co-morbidities and biochemical data were reviewed and collected. Serum high-sensitivity CRP (hs-CRP) level was measured every 6 months. Patients were divided into three groups according to their serial hs-CRP levels. Patients with their hs-CRP below 2 mg/L were defined as low group (n=65, 20.4%) and those with higher than 4 mg/L were defined as high (n=39, 12.3%). The rest were classified as fluctuated hs-CRP group (n=214, 67.3%). Treatment of vascular access failure includes angioplasty and access re-creation. RESULTS: Their body mass index, indicators of dialysis adequacy and serum albumin and hs-CRP levels differed significantly among three groups. The annual vascular access failure rate was significantly higher in fluctuated hs-CRP group than in high hs-CRP group (0.41 vs 0.36, P=.037). Serum albumin was a significant associate of vascular access failure. Kaplan-Meier survival analysis indicated patients with high or fluctuated hs-CRP had shorter free interval of vascular access failure than low hs-CRP group. CONCLUSIONS: HD patients with fluctuated hs-CRP levels were associated with increased vascular access failure.

Differential gene expression by 1,25(OH)2D3 in an endometriosis stromal cell line.

Endometriosis is a common female reproductive disease characterized by invasion of endometrial cells into other organs, frequently causing pelvic pain and infertility. Alterations of the vitamin D system have been linked to endometriosis incidence and severity. To shed light on the potential mechanism for these associations, we examined the effects of 1,25(OH)2D3 on gene expression in endometriosis cells. Stromal cell lines derived from endometriosis tissue were treated with 1,25(OH)2D3, and RNA-seq was used to identify genes differentially expressed between treated and untreated cells. Gene ontology and pathway analyses were carried out using Partek Flow and Ingenuity software suites, respectively. We identified 1627 genes that were differentially expressed (886 down-regulated and 741 up-regulated) by 1,25(OH)2D3. Only one gene, CYP24A1, was strongly up-regulated (369-fold). Many genes were strongly down-regulated. 1,25(OH)2D3 treatment down-regulated several genetic pathways related to neuroangiogenesis, cellular motility, and invasion, including pathways for axonal guidance, Rho GDP signaling, and matrix metalloprotease inhibition. These findings support a role for vitamin D in the pathophysiology of endometriosis, and provide new targets for investigation into possible causes and treatments.

Free p-cresol sulfate is associated with survival and function of vascular access in chronic hemodialysis patients.

BACKGROUND: Protein-bound uremic toxins indoxyl sulfate (IS) and p-cresol sulfate (p-CS) have been implicated as an important factor in uremic syndrome. Recent evidence indicates that both IS and p-CS are predictors of cardiovascular as well as all-cause mortality among chronic dialysis patients. We conducted a study to analyze the relationship between IS and p-CS and vascular access (VA) outcome in chronic hemodialysis (HD) patients. METHODS: A total of 91 chronic stable HD patients were divided into groups according to survival of VA and frequency of VA dysfunction. Demographic and biochemical data were reviewed and recorded. Serum levels of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1, and the total and free forms of IS and p-CS were determined. RESULTS: Patients with a history of frequent VA failure and dysfunction had lower albumin and higher levels of ICAM-1, free IS, free and total p-CS. Diabetes was associated with higher IS and p-CS. Logistic regression revealed that diabetes and free p-CS were independent factors associated with poor outcome of VA. CONCLUSION: Endothelial dysfunction and uremic toxins were associated with survival and function of VA. Diabetes and free p-CS were significantly related to the outcome of VA among chronic HD patients.