The Synergistic Value of Time-Averaged Serum Albumin and Globulin in Predicting the First Peritonitis in Incident Peritoneal Dialysis Patients.

BACKGROUND: The prognostic value of serum time-averaged albumin (TA-Alb) and time-averaged globulin (TA-Glo) combination on the peritonitis in peritoneal dialysis (PD) patients is unknown. METHODS: The patients who started PD treatment between July 2013 and 2018 were included. Serum Alb and globulin (Glo) were tested at baseline and monthly during follow-up. TA-Alb and TA-Glo were calculated until first peritonitis occurred or the end of the study. PD patients were divided into 4 groups based on the medians of TA-Alb and TA-Glo separately. Cox regression was conducted to identify the hazard ratios (HRs) of peritonitis among categorical groups. RESULTS: Three hundred and sixty-three patients were included and among them 109 patients experienced first peritonitis. Peritonitis patients had lower baseline Alb, TA-Alb, and TA-Glo levels and ultrafiltration volume. Multivariate cox regression analysis revealed that TA-Alb, TA-Glo, and baseline Alb were significantly associated with first peritonitis. The highest HR existed in Group 1 with lower Alb and lower Glo (HR 4.57, 95% CI 2.36-8.87, p < 0.001) compared with Group 4 with higher Alb and higher Glo. CONCLUSION: Lower TA-Glo is an independent risk factor for the first peritonitis in PD patients. Combined with lower TA-Alb will increase the predictive effect than separate factor alone.

The Association of Longitudinal Serum Uric Acid and All-Cause Mortality in Incident Peritoneal Dialysis Patients.

BACKGROUND: Time-averaged uric acid (TA-UA) value was calculated to investigate the association of longitudinal UA and all-cause mortality in incident peritoneal dialysis (PD) patients. METHODS: Three hundred PD patients were divided into 3 groups based on the serum TA-UA level (Group 1: < 6 mg/dL; Group 2: 6-8 mg/dL; Group 3: ≥8 mg/dL). Hazards ratio (HR) of all-cause mortality was calculated. Logistic regression was conducted to identify the associated clinical factors of lower and higher TA-UA level. RESULTS: Increased HRs for death existed in Group 1 and Group 3 compared with Group 2 (HR 3.24, 95% CI 1.25-8.39, p = 0.016; HR 4.69, 95% CI 1.24-17.72, p = 0.023). Lower residual renal function, lower albumin, and higher high-density lipoprotein cholesterol were related to the lower serum TA-UA. Higher body mass index and higher C-reactive protein were associated with higher serum TA-UA in PD patients. CONCLUSION: Both TA-UA < 6 and ≥8 mg/dL increased the all-cause mortality in incident PD patients.

Effects of Peritoneal Dialysis on Clinical Factors and Functional Performance.

BACKGROUND: We investigated the longitudinal trend of functional performance in peritoneal dialysis (PD) patients over 1 year after PD commencement and its related clinical parameters. METHODS: One hundred and ninety-six PD patients were enrolled in this study. Karnofsky Performance Status Scale(KPSS) scores were used to assess functional performance. Patients were stratified into 3 groups according to the changes in KPSS from baseline to 1 year. A logistic regression analysis was performed to examine the associations of clinical parameters with KPSS changes. RESULTS: Patients with KPSS declined showed older age and higher serum albumin concentration reduction within 1 year than those in KPSS improved and stable changes. Age was the significant risk factor for KPSS decline, while male and diabetes were significantly associated with non-declined KPSS by multivariable logistic regression analysis. CONCLUSION: The main determinants of KPSS trend were age, sex, and diabetes in new PD patients.

The green tea polyphenol (-)-epigallocatechin-3-gallate ameliorates experimental immune-mediated glomerulonephritis.

The unchecked overproduction of reactive oxygen and nitrogen species by inflammatory cells can cause tissue damage, intensify inflammation, promote apoptosis, and accelerate the progression of immune-mediated glomerulonephritis (GN). Here we tested whether the anti-inflammatory and antioxidant properties of the green tea polyphenol (-)-epigallocatechin-3-gallate (EGCG) favorably affect the development of immune-mediated GN. Pretreatment of 129/svJ mice with EGCG from 2 days before to 2 weeks after the induction of GN led to reduced proteinuria and serum creatinine, and marked improvement in renal histology when compared with vehicle-pretreated diseased mice. This pretreatment reduced oxidative stress, and normalized osteopontin, p65/nuclear factor-κB, inducible nitric oxide synthase, nitric oxide metabolites, p-Akt, phosphorylated extracellular signal-regulated kinases 1 and 2, p47phox, and myeloperoxidase, all of which were elevated in vehicle-pretreated diseased mice. Levels of glutathione peroxidase and peroxisome proliferator-activated receptor-γ (PPARγ), both reduced in the vehicle-pretreated diseased mice, were normalized. This renoprotective effect was reversed by concomitant administration of the PPARγ antagonist GW9662 throughout the EGCG pretreatment period. Importantly, mortality and renal dysfunction were significantly attenuated even when the polyphenol treatment was initiated 1 week after the onset of GN. Thus, EGCG reversed the progression of immune-mediated GN in mice by targeting redox and inflammatory pathways.

The effects of depression and age on sleep disturbances in patients with non-dialysis stage 3-5 chronic kidney disease: a single-center study.

PURPOSE: Sleep disturbances have a negative impact on the prognosis of chronic kidney disease (CKD). However, information on the prevalence and predictors is limited. This study aimed to evaluate the prevalence and explore clinical factors affecting the quality of sleep in patients with non-dialysis CKD. METHODS: Participants included 152 adult non-dialysis patients with stage 3-5 CKD. Demographic and clinical data were collected. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), respectively. Sleep disturbances were defined as a PSQI score ≥ 5. Logistic regression was conducted to explore the independent factors of sleep disturbances. Clinical parameters were correlated with BDI scores using linear regression models. RESULTS: The total prevalence of patients with sleep disturbances was 66.4%. Older age, higher BDI scores, lower estimated glomerular filtration rate (eGFR) changes per month (△eGFR/m) before the study, and lower serum magnesium levels were found in patients with sleep disturbances. BDI scores (odds ratio [OR] 1.224, 95% confidence interval [CI] 1.091-1.373, p = 0.001) and age (OR 1.041, 95% CI 1.013-1.069, p = 0.003) were independent predictors of sleep disturbances. Serum uric acid levels (ß - 0.629, 95% CI - 1.244 to - 0.013, p = 0.046), △eGFR/m before the study (ß - 0.454, 95% CI - 0.885 to - 0.024, p = 0.039), and daily protein intake (ß - 0.052, 95% CI - 0.102 to - 0.002, p = 0.043) were negatively associated with BDI scores. CONCLUSION: A high overall prevalence of sleep disturbances was found in patients with non-dialysis stage 3-5 CKD. Depression, as a manageable predictor, should be managed, especially in elderly patients.

Treatment of membranous nephropathy with mizoribine: A control trial.

AIM: Membranous nephropathy remains the most common form of the nephrotic syndrome in adults. The combination therapy of steroid and cyclophosphamide has routinely been used. Although satisfactory therapeutic efficacy can be achieved, its side effect on reproductive system has been a concern. Mizoribine is an imidazole nucleoside and a novel immunosuppressant that has been used to treat other immune-related diseases. In this study we examine if the combined regimen of mizoribine and steroid would be advantageous over the use of cyclophosphamide and steroid in treating adult membranous nephropathy. METHODS: There were total of fifty-five patients completed the study. These patients had membranous nephropathy with presentation of proteinuria. They were treated with combined regimen of mizoribine and steroid or cyclophosphamide and steroid, and were followed up for one year to monitor safety and efficacy. RESULTS: We found the condition of proteinuria was significantly improved in the mizoribine group and the improvement was comparable to the patients treated with cyclophosphamide. These patients also exhibited an increase of serum albumin. There was no significant increase of adverse events with the use of mizoribine-based therapy, suggesting the tolerability of mizoribine in adult patients with membranous nephropathy. CONCLUSION: In conclusion, the results indicated the satisfactory safety and efficacy of the combination regiment of mizoribine and steroid in treating adult patients with membranous nephropathy.