Immunogenicity of COVID-19 Vaccination in Patients With End-Stage Renal Disease Undergoing Maintenance Hemodialysis: The Efficacy of a Mix-and-Match Strategy.

BACKGROUND: The objective of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19) vaccination in patients with end-stage renal disease (ESRD) on hemodialysis. METHODS: ESRD patients at the hemodialysis center of a tertiary-care university-affiliated hospital and healthy employees at the clinical laboratory center were prospectively recruited between March and June 2021. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody analysis, blood samples were collected serially on days 0, 14, 28, and 56 after the first vaccine dose, and on days 7 and 50 after the second dose. Antibodies against the SARS-CoV-2 spike protein were quantified, and SARS-CoV-2 neutralizing antibodies were measured in the serum and plasma. RESULTS: Thirty-one ESRD patients and 55 healthy employees were regularly monitored. Twenty-five (80.6%) ESRD patients on hemodialysis received a mix-and-match strategy with ChAdOx1-BNT162b2 (AZ-Pf group) and six (19.4%) received two doses of ChAdOx1 (AZ-AZ group). ESRD patients on hemodialysis showed lower binding antibody titers and neutralizing antibody activities compared to healthy participants following the first vaccination with ChAdOx1. After the second dose, AZ-Pf group had higher immunogenicity than healthy people on days 7 and 50. The binding antibody titer and neutralizing antibody activities on days 7 and 50 were significantly higher in the AZ-Pf group than in the AZ-AZ group. CONCLUSION: ESRD patients on hemodialysis receiving the mix-and-match strategy (ChAdOx1-BNT162b2) have COVID-19 vaccine immunogenicity comparable to healthy individuals receiving two doses of ChAdOx1. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04871945.

Occipitocervical inclination: new radiographic parameter of neutral occipitocervical position.

PURPOSE: To describe occipitocervical inclination (OCI), a new parameter that could compensate for defects in existing radiographic parameters, and to define occipitocervical neutral position. METHODS: Neutral, flexion, and extension lateral cervical spine radiographs of 200 patients (100 male and 100 female patients) judged to be normal were analyzed. The mean age was 45.19 years (range 11-74; 42.84 for male and 47.53 for female patients). For OCI, the angle formed by the line connecting the posterior border of the C4 vertebral body and McGregor's line was measured. Occipitocervical angle (OCA) and occipitocervical distance (OCD) were measured and compared with OCI. RESULTS: OCI on standard, neutral lateral cervical radiographs was 102.51° ± 8.87°. There was no significant gender difference in neutral OCI 102.81° ± 7.93° for male and 102.21° ± 9.74° for female patients (P = 0.631). The mean neutral OCA was 38.69° ± 9.23°, and the mean neutral OCD was 22.98 ± 5.10 mm. Pearson's correlation coefficient for the value of the cervical lordosis angle and that of neutral OCI was r = 0.274 (P < 0.001). Intraclass correlation coefficient values for inter- and intraobserver reliability for OCI were significantly higher than those for OCA (P < 0.001) and tended to be higher than those for OCD (P = 0.087). CONCLUSIONS: OCI is a very useful parameter for the determination of neutral position during occipitocervical fusion for patients with altered C0-C2 anatomy.

Estimating Negative Effect of Abdominal Obesity on Mildly Decreased Kidney Function Using a Novel Index of Body-Fat Distribution.

Abdominal obesity is a major risk factor of chronic kidney disease (CKD). Conventional obesity-related indicators, included body mass index (BMI), waist circumference (WC), and conicity index (C-index), have some limitations. We examined the usefulness of trunk/body fat mass ratio (T/Br) to predict negative effect of abnormal fat distribution on excretory kidney function. We analyzed anthropometric, biochemical and densitometric data from a nation-wide, population-based, case-control study (the Korean National Health and Nutrition Examination Survey [KNHANES] IV and V). A total of 11,319 participants were divided into 2 groups according to estimated glomerular filtration rate (eGFR, mL·min⁻¹·1.73 m⁻²) as follows: Group I (n = 7,980), eGFR ≥ 90 and ≤ 120; and group II (n = 3,339), eGFR ≥ 60 and < 90. Linear regression analysis revealed that T/Br was closely related to eGFR (ß = -0.3173, P < 0.001), and the correlation remained significant after adjustment for age, gender, BMI, WC, C-index, systolic blood pressure (BP), hemoglobin, and smoking amount (ß = -0.0987, P < 0.001). Logistic regression analysis showed that T/Br (odds ratio [OR] = 1.046; 95% confidence interval [CI] = 1.039-1.054) was significantly associated with early decline of kidney function, and adjustment for age, gender, BMI, C-index, systolic BP, hemoglobin, serum glucose level, high-density lipoprotein (HDL)-cholesterol, and smoking amount did not reduce the association (OR = 1.020; 95% CI = 1.007-1.033). T/Br is useful in estimating the negative impact of abdominal obesity on the kidney function.

Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings.

The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m² or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

Evaluation of Urinary Indices for Albuminuria and Proteinuria in Patients with Chronic Kidney Disease.

BACKGROUND/AIMS: Either protein-to-creatinine ratio (PCR) or albumin-to-creatinine ratio (ACR) can be adopted for estimation of proteinuria in patients with chronic kidney disease (CKD). Estimated protein excretion rate (ePER) and estimated albumin excretion rate (eAER) may be superior to ACR and PCR. Reports show that urine albumin-to-protein ratio (APR) may be useful in detecting tubular proteinuria, but should be compared with urine protein electrophoresis (PEP). METHODS: Both 24-h urine and spot urine were collected from 77 stable CKD patients for measurement of albumin, protein, and creatinine, and PEP. Based on MDRD and CKD-EPI equations, ePERMDRD, ePERCKD-EPI, eAERMDRD and eAERCKD-EPI were calculated to estimate daily proteinuria and albuminuria. Glomerular CKD was defined by clinical and/or pathological evidence. RESULTS: ACR correlated significantly with PCR. However, microalbuminuria was present in patients without pathologic proteinuria. Twenty-four-hour urine albumin correlated better with eAERMDRD and eAERCKD-EPI than ACR, and 24-h urine protein correlated better with ePERMDRD and ePERCKD-EPI than PCR. APR significantly but not well correlated with the albumin fraction in urine PEP. The albumin fraction obtained from urine PEP was significantly higher in patients with glomerulopathy than those with non-glomerular CKD, whereas there were no differences in APR between groups. In contrast with APR, the albumin fraction in urine PEP was independently associated with glomerular CKD. CONCLUSIONS: Both PCR and ACR are useful in evaluation of proteinuria. In quantifying daily proteinuria and albuminuria, ePER and eAER are superior to PCR and ACR, respectively. Compared with APR, urine PEP is more useful in diagnosing glomerular proteinuria.

Overhydration Negatively Affects Quality of Life in Peritoneal Dialysis Patients: Evidence from a Prospective Observational Study.

UNLABELLED: Backgound: This study evaluated whether the hydration status affected health-related quality of life (HRQOL) during 12 months in peritoneal dialysis (PD) patients. METHODS: The hydration status and the HRQOL were examined at baseline and after 12 months using a bioimpedance spectroscopy and Kidney Disease Quality of Life-Short Form, respectively in PD patients. Four hundred eighty-one patients were included and divided according to the baseline overhydration (OH) value; normohydration group (NH group, -2L≤ OH ≤+2L, n=266) and overhydration group (OH group, OH >+2L, n=215). Baseline HRQOL scores were compared between the two groups. The subjects were re-stratified into quartiles according to the OH difference (OH value at baseline - OH value at 12 months; <-1, -1 - -0.1, -0.1 - +1, and ≥+1L). The relations of OH difference with HRQOL scores at 12 months and the association of OH difference with the HRQOL score difference (HRQOL score at baseline - HRQOL score at 12 months) were assessed. RESULTS: The OH group showed significantly lower baseline physical and mental health scores (PCS and MCS), and kidney disease component scores (KDCS) compared with the NH group (all, P<0.01). At 12 months, the adjusted PCS, MCS, and KDCS significantly increased as the OH difference quartiles increased (P<0.001, P=0.002, P<0.001, respectively). In multivariate analysis, the OH difference was independently associated with higher PCS (ß = 2.04, P< .001), MCS (ß=1.02, P=0.002), and KDCS (ß=1.06, P<0.001) at 12 months. The OH difference was independently associated with the PCS difference (ß = -1.81, P<0.001), MCS difference (ß=-0.92, P=0.01), and KDCS difference (ß=-0.90, P=0.001). CONCLUSION: The hydration status was associated with HRQOL and increased hydration status negatively affected HRQOL after 12 months in PD patients.

A J-Shaped Association Between Serum Uric Acid Level and Allograft Outcomes After Living Donor Kidney Transplantation.

Hyperuricemia following kidney transplantation (KT) may contribute to a decline in allograft renal function, but be affected by KT-related confounding factors. Some studies have even suggested that a reduction in serum uric acid (UA) is associated with poor patient outcomes. Thus, we retrospectively analyzed the impact of serum UA on allograft outcomes in 281 KT recipients. KT recipients were divided into five groups according to serum UA level (mg/dL): Group I (n = 46), ≤ 5; Group II (n = 62), > 5 and ≤ 6; Group III (n = 70), > 6 and ≤ 7; Group IV (n = 53), > 7 and ≤ 8; Group V (n = 50), > 8. Regression analysis showed that serum UA level was significantly associated with future allograft function. In a Kaplan-Meier analysis, the dialysis-free survival of Group II recipients was better than that of the other groups (Group I, 140 ± 5 months; Group II, 208 ± 7 months; Group III, 148 ± 4 months; Group IV, 185 ± 12 months; Group V, 164 ± 11 months; P = 0.0164). In Cox proportional hazard models adjusting for estimated glomerular filtration rate, the relative risk of allograft loss still tended to be elevated in Group I (HR=3.417, 95% CI 1.138-10.258) and Group V (HR=2.793, 95% CI 1.108-7.041), using Group II as the reference. Our results suggest that there is a J-shaped association between serum UA levels and allograft outcomes in living donor KT recipients.

Cervical subtotal en-bloc spondylectomy of C6 mesenchymal chondrosarcoma.

INTRODUCTION: We present a case of C6 mesenchymal chondrosarcoma and discuss safe posterior to anterior approach subtotal en-bloc spondylectomy. MATERIALS AND METHODS: A 29-year-old male consulted for our department with severe posterior neck pain doing exercise. CT scan demonstrated a primary osteolytic lesion on C6 left transverse foramen and MRI demonstrated the tumor involved C6 vertebra from layers B, C and F sectors 4-6 encasing left vertebral artery. Preoperatively neurointerventional radiology service occluded the left vertebral artery and tumor feeding artery using coil embolization. Posterior approach consist of C5-C7 laminectomy, left sided C6 and C7 nerve root sacrifice, posterior disc removal and release of C5-6-7 and posterior reconstruction. Then, position was changed to supine, and the anterior approach was followed as C5-6, C6-7 discectomy, left vertebral artery ligation and cut, longus coli resection and C6 subtotal spondylectomy with en-bloc resection of mass, mesh cage insertion and C5-C7 anterior plate fixation. During operation, frozen biopsy was performed on 8 areas (longus coli, lateral margin, anteroinferior margin, posterior margin, posterosuperior margin, C5 transverse foramen, posteroinferior margin, inferior margin) after wide resection. Tumor free margin was confirmed. RESULTS: After operation, he complained of tingling sensation of left thumb and forearm medial side, and elbow extensor motor grade was checked to 4/5 postoperatively. In the followed-up radiograph, the tumor was completely removed, and the instability of joint was not seen. As a result of observing follow-up CT at a year after the surgery, recurrence findings have not been shown up to now, and the progression of neurologic symptoms has not been shown either. CONCLUSION: Based on the Grand Round case and relevant literature, we discuss the case of mesenchymal chondrosarcoma occurring from the C6 cervical spine treated with cervical subtotal en-bloc spondylectomy. Successful en-bloc resection of the tumor was achieved using posterior to anterior approach.

Prognostic Significance of 1-Year Serum Albumin Levels Within the Normal Range After Kidney Transplantation.

Hypoalbuminemia is associated with poor outcomes in kidney transplantation (KT). However, what level is optimal in serum albumin is not clear for the long-term prognosis. To determine whether the long-term outcomes are different even between the normal ranges of serum albumin after KT, we analyzed data from 404 renal allograft recipients whose 1-year post-transplant serum albumin levels were within the normal limits (3.5-5.5 g/dL). During a follow-up of 122 ± 56 months, 97 graft losses, 20 patient deaths, and 50 cardiovascular (CV) events occurred. Based on 1-year serum albumin levels, the patients were divided into high normal (≥4.6 g/dL, n = 209) and low normal (<4.6 g/dL, n = 195) groups. Kaplan-Meier analyses revealed that the low normal group had poorer allograft survival (P = 0.01), patient survival (P < 0.001), and CV event-free survival (P < 0.001) than the high normal group. Cox regression analysis confirmed that 1-year serum albumin was inversely associated with the risk of graft loss (hazard ratio [HR] 0.414, 95% confidence interval [CI] 0.200-0.856), patient death (HR 0.097, 95% CI 0.019-0.484), and CV events (HR 0.228, 95% CI 0.074-0.702). In conclusion, a relatively low 1-year post-transplant serum albumin level within the normal limits (<4.6 g/dL) significantly predicts poor long-term outcomes.

Association between a change in donor kidney function and long-term allograft outcomes in kidney transplant recipients.

Reserve capacity of donated kidney may be an important determinant of allograft survival in kidney transplantation (KT). Here, we investigate change in estimated glomerular filtration rate of donor kidney (ΔeGFR(Donor)) over 30 days after KT as a predictor of the allograft function. A total of 222 recipients were divided into two groups according to ΔeGFR(Donor) as follows: Group I (n = 110), ΔeGFR(Donor) ≥ -25%; Group II (n = 112), ΔeGFR(Donor) < -25%. Three years after KT, Group I had a higher eGFR(Recipient) than Group II (55 ± 21 vs. 47 ± 22 mL/min/1.73 m2, P < 0.05). However, no differences in eGFR(Recipient) were detected between the two groups after 10 years. Linear regression analysis showed that ΔeGFR(Donor) was significantly associated with the eGFR(Recipient) at 3 years post-transplantation, but not at 10 years post-transplantation. In Kaplan-Meier analysis, Group I had a greater dialysis-free survival rate than Group II at the 10-year follow-up (84% vs. 76%, P < 0.05). However, no difference in overall survival rate between groups was detected. In the multivariate-adjusted Cox proportional-hazard model, ΔeGFR(Donor) was independently associated with future allograft loss (hazard ratio 0.973; 95% confidence interval 0.949-0.999). These results suggest that larger recovery of donor kidney function after KT donation is associated with better short/intermediate-term allograft outcomes. Follow-up assessment of donor kidney function may be useful to monitor KT recipients at risk for allograft loss.

Optoelectronic oscillator for a measurement of acoustic velocity in acousto-optic device.

We report a novel means of measuring the acoustic velocity based on a well-known acousto-optic interaction. With an acousto-optic modulator (AOM), we construct an optoelectronic oscillator (OEO) that can measure the acoustic velocity in the AOM directly. The free spectral range between the modes is a function of the total loop length of the OEO, which is mainly dependent on the propagation time of the acoustic wave through the AOM. By changing the propagation time, we measured the acoustic velocity from the variation of the free spectral range. The results are reported and compared with earlier results. This method is insensitive to the variation of the optical phase shift. In addition, the high frequency-stability and microwave spectral purity of the OEO allow reliable and precise measurements.

Highly transparent privacy filter film with image distortion.

We present a novel privacy filter film with transparent micro-cuboid arrays. The privacy filter film, which does not include any opaque materials, rarely affects the normal transparency, whereas it obscures personal information by distorting paths of oblique light rays. The effects of the cuboid size and a gap between the privacy filter and a display are analyzed using a ray-tracing program. The analysis is consistent with the experimental results carried out using the poly-dimethylsiloxane (PDMS) micro-cuboid (100 µm × 100 µm × 200 µm) arrays, which are fabricated by lithography and transfer molding.

Human CLOCK gene-associated attention deficit hyperactivity disorder-related features in healthy adults: quantitative association study using Wender Utah Rating Scale.

Circadian rhythm disturbance is highly prevalent in attention deficit hyperactivity disorder (ADHD). Recently, the association between the CLOCK gene and ADHD has been demonstrated in clinical samples, and the CLOCK gene's role was thought to be mediated by rhythm dysregulation. Meanwhile, ADHD has been suggested as the extreme end of a continuously distributed trait that can be found in the general population. Therefore, we examined two possibilities: (1) an ADHD-related continuous trait may be associated with the CLOCK gene, and (2) this association may be mediated by the degree of individuals' evening preference. To explore these possibilities, we performed a quantitative trait locus association study with a sample of 1,289 healthy adults. The Wender Utah Rating Scale (WURS) and the Composite Scale of Morningness (CSM) were utilized to measure the quantitative traits. Quantitative association analysis was performed using PLINK software. We found that rs1801260 (=T3111C) was associated with WURS scores in both allele-wise (p = 0.018) and haplotype-wise analyses (range of p values: 0.0155-0.0171) in male participants only. After controlling for the CSM total score as a covariate, the strength of the association did not change at all, suggesting that the association was not mediated by evening preference. Despite the very weak association signal, our results provide evidence that the CLOCK gene's association with ADHD in clinical samples may be generalizable to traits measured in the normal population. However, as our results failed to show a mediating role of evening preference, ongoing efforts are needed to identify the mechanisms by which the CLOCK gene determines ADHD-related traits.

Association of heart rate and left ventricular structure in a rural population in Korea.

Abstract We investigated the association of heart rate (HR) and estimated glomerular filtration rate (eGFR) with left ventricular (LV) structure in a multi-rural cohort project in Korea. A total of 3215 subjects were analyzed for factors related to Echo-LV mass index (LVMI). eGFR was positively associated with both types of LVMI whereas HR was negatively associated with both. Odd ratios (ORs) (highest versus lowest quartiles) for LVMI by height(2.7) were significant for HR (OR: 0.441, p = 0.0035 in males; OR: 0.638, p = 0.0226 in females), and for eGFR (OR:1.643, p = 0.0145) in females. In conclusion, in addition to age, systolic blood pressure and body mass index, eGFR is positively associated with echocardiographic LVMI and HR is negatively associated with echocardiographic LVMI.

Comparison and correlation of pelvic parameters between low-grade and high-grade spondylolisthesis.

STUDY DESIGN: This study was retrospectively conducted on 51 patients with L5-S1 spondylolisthesis. OBJECTIVE: This study was conducted to compare a total of 11 pelvic parameters, such as the level of displacement by Meyerding method, lumbar lordosis, sacral inclination, lumbosacral angle, slip angle, S2 inclination, pelvic incidence (PI), L5 inclination, L5 slope, pelvic tilt (PT), and sacral slope (SS) between low-grade and high-grade spondylolisthesis, and to investigate a correlation of the level of displacement by Meyerding method with other pelvic parameters. METHODS: Pelvic parameters were measured using preoperational erect lateral spinal simple radiographs. The patients were divided into 39 patients with low-grade spondylolisthesis and 12 patients with high-grade spondylolisthesis before analysis. In all patients of both groups, 11 radiographic measurements including the level of displacement by Meyerding method, lumbar lordosis, sacral inclination, lumbosacral angle, slip angle, S2 inclination, PI, L5 inclination, L5 slope, PT, and SS were performed. T test and Pearson correlation analysis were conducted to compare and analyze each measurement. RESULTS: As for the comparison between the 2 groups, a statistically great significance in the level of displacement by Meyerding method, lumbosacral angle, slip angle, L5 incidence, PI, and L5 slope (P≤0.001) was shown. Meanwhile, a statistical significance in the sacral inclination and PT (P<0.05) was also shown. However, no statistical significance in the S2 incidence and SS was shown. A correlation of the level of displacement by Meyerding method with each parameter was analyzed in the both the groups. A high correlation was observed in the lumbar lordosis, lumbosacral angle, slip angle, L5 incidence, and L5 slope (Pearson correlation coefficient, P=0.01), as well as the sacral inclination, PI, and PT (Pearson correlation coefficient, P=0.05). Meanwhile, no correlation was shown in the S2 incidence and SS. CONCLUSIONS: A significant difference in the lumbosacral angle, slip angle, L5 incidence, PI, L5 slope, sacral inclination, and PT was shown between the patients with high-grade spondylolisthesis and patients with low-grade spondylolisthesis. Among the aforementioned measurements, the PI showed a significant difference between the 2 groups and also had a significant correlation with the dislocation level in all the patients.

Association between Relative Thrombocytosis and Microalbuminuria in Adults with Mild Fasting Hyperglycemia.

An elevated platelet count may contribute to significant thrombotic events and pose a risk for diabetic microvascular complications. Albuminuria, one of the hallmarks of diabetes, is thought to be a risk factor for endothelial dysfunction. In this study, we investigated the association between relative thrombocytosis and an increased urine albumin-to-creatinine ratio in healthy adult participants. Using multivariate analyses on data from the Korea National Health and Nutrition Examination Survey V-VI, 12,525 eligible native Koreans aged ≥ 20 were categorized into platelet count quintiles by sex. The highest platelet count quintile included younger, more obese participants with elevated white blood cell counts, poor lipid profiles, and a better estimated glomerular filtration rate. Restricted cubic spline regression analysis revealed significant associations between platelet count and fasting blood glucose, glycated hemoglobin, and urine albumin-to-creatinine ratio. Adjusted logistic regression models indicated that heightened fasting blood glucose and platelet count were linked to risk of microalbuminuria (fasting blood glucose, odds ratio = 1.026, 95%CI = 1.011-1.042; platelet count, odds ratio = 1.004, 95%CI = 1.002-1.006). Particularly, an increased platelet count was notably associated with microalbuminuria progression in subjects with impaired fasting glucose. These findings suggest that an elevated platelet count, even below diagnostic thrombocytosis levels, independently correlates with an increased risk of vascular endothelial dysfunction in patients with impaired fasting glucose.

Vertically aligned carbon nanopillars with size and spacing control for a transparent field emission display.

A top-down fabrication method is presented for vertically aligned carbon nanopillars (CNPs) using photolithography and pyrolysis. The modified backside exposure method of photolithography fabricates vertically aligned polymer (SU-8) nanopillars. The pyrolysis process, which transforms the polymer to amorphous carbon, reliably produces vertically aligned CNPs with widths ranging from 100 to 400 nm. The CNPs can be used as a transparent field emission cathode for a transparent display and light emission is observed.

Effect of mycophenolic acid on cyclosporin A-induced fibronectin expression in rat mesangial cells.

This study was undertaken to determine if mycophenolic acid (MPA) inhibits the profibrotic action of cyclosporin A (CsA) and, if so, to determine the molecular mechanisms involved. The effect of MPA treatment on CsA-induced signaling through the transforming growth factor-ß (TGF-ß)/Smad pathway was evaluated by immunoblot analysis in cultured primary rat mesangial cells. Treatment of cells with 1 µmol/l MPA did not significantly decrease the CsA-induced expression of TGF-ß(1), but partially reversed the increases in Smad3 phosphorylation and fibronectin (FBN) production, and increased Smad7 expression. These results suggest that MPA may ameliorate CsA-induced FBN production by modulating the Smad signaling pathway. This study provides evidence that MPA can attenuate CsA-induced renal injury after kidney transplantation.

Evaluating the Safety and effectivenesS in adult KorEaN patients treated with Tolvaptan for management of autosomal domInAnt poLycystic kidney disease (ESSENTIAL): short-term outcomes during the titration period.

BACKGROUND: Tolvaptan reduces height-adjusted total kidney volume (htTKV) and renal function decline in autosomal dominant polycystic kidney disease (ADPKD). This study was aimed at investigating the efficacy and safety of tolvaptan in Korean patients with ADPKD during the titration period. METHODS: This study is a multicenter, single-arm, open-label phase 4 study. We enrolled 108 patients with ADPKD (age, 19-50 years) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 and factors defined as indicative of rapid disease progression. After tolvaptan titration, we evaluated efficacy and side effects and assessed factors associated with the effects. RESULTS: After titration for 4 weeks, eGFR and htTKV decreased by 6.4 ± 7.9 mL/min/1.73 m2 and 16 ± 45 mL/m, respectively. No serious adverse drug reactions were observed during the titration period. The greatest eGFR decline was observed in the first week, with a starting tolvaptan dose of 45 mg. Multivariate linear regression for htTKV decline showed that the greater the change in urine osmolality (Uosm), the greater the decrease in htTKV (ß, 0.436; p = 0.009) in the 1D group stratified by the Mayo Clinic image classification. Higher baseline eGFR was related to a higher htTKV reduction rate in the 1E group (ß, -0.642; p = 0.009). CONCLUSION: We observed short-term effects and safety during the tolvaptan titration period. The decline of htTKV can be predicted as a short-term effect of tolvaptan by observing Uosm changes from baseline to end of titration in 1D and baseline eGFR in 1E groups.

Fractional excretion of uric acid as a predictor for saline responsiveness in long-term kidney transplant patients.

BACKGROUND/AIMS: Subclinical hypovolemia may contribute to allograft dysfunction in long-term kidney transplant (KT) patients. In order to predict responsiveness to saline hydration, indices for tubular transport were investigated. METHODS: Fifty-four clinically euvolemic long-term KT patients with recently aggravated azotemia were given intravenous hydration as follows: 0.9% saline 5 ml/kg over 1 h, followed by 0.9% saline 1 ml/kg/h over 12 h and 1 liter of 0.45% saline over the next 24 h. Serum and urine data were collected and analyzed to assess responses. RESULTS: In all patients, saline hydration relieved azotemia, as shown by blood urea nitrogen (46.9 ± 17.2 vs. 39.3 ± 15.4 mg/dl; p < 0.01) and serum creatinine levels (2.9 ± 1.1 vs. 2.5 ± 1.1 mg/dl; p < 0.01) on day 0 versus day 2. In 38 patients, serum creatinine did not increase in the following month (70% responders). Compared with the nonresponders, the responders had a higher urine-to-plasma creatinine ratio and lower fractional excretion of sodium, uric acid and urea at admission. Multivariate logistic regression analysis revealed that responsiveness to saline hydration was independently associated with lower fractional excretion of uric acid. CONCLUSION: Subclinical hypovolemia should be considered in long-term KT patients with azotemia of unexplainable causes. Fractional excretion of uric acid may predict responsiveness to saline hydration.