Association of blood pressure after peritoneal dialysis initiation with the decline rate of residual kidney function in newly-initiated peritoneal dialysis patients.

BACKGROUND: Lower blood pressure (BP) levels are linked to a slower decline of kidney function in patients with chronic kidney disease (CKD) without kidney replacement therapy. However, there are limited data on this relation in peritoneal dialysis (PD) patients. Here we evaluated the association of BP levels with the decline of residual kidney function (RKF) in a retrospective cohort study. METHODS: We enrolled 228 patients whose PD was initiated between 1998 and 2014. RKF was measured as the average of creatinine and urea clearance in 24-hr urine collections. We calculated the annual decline rate of RKF by determining the regression line for individual patients. RKF is thought to decline exponentially, and thus we also calculated the annual decline rate of logarithmic scale of RKF (log RKF). We categorized the patients' BP levels at 3 months after PD initiation (BP3M) into four groups (Optimal, Normal & High normal, Grade 1 hypertension, Grade 2 & 3 hypertension) according to the 2018 European Society of Cardiology and European Society of Hypertension Guidelines for the management of arterial hypertension. RESULTS: The unadjusted, age- and sex-adjusted, and multivariable-adjusted decline rate of RKF and log RKF decreased significantly with higher BP3M levels (P for trend <0.01). Compared to those of the Optimal group, the multivariable-adjusted odds ratios (95% confidence interval) for the faster side of the median decline rate of RKF and log RKF were 4.04 (1.24-13.2) and 5.50 (1.58-19.2) in the Grade 2 and 3 hypertension group, respectively (p<0.05). CONCLUSIONS: Higher BP levels after PD initiation are associated with a faster decline in RKF among PD patients.

Differences in Electromyographic Activities and Spatiotemporal Gait Parameters between General and Developed Insoles with a Toe-Grip Bar.

The present study was aimed at comparing the muscle activities and gait parameters between the toe-grip bar insoles and general insoles during walking using randomized crossover design. Twelve healthy men participated in this study. Temporal and spatial gait parameters and electromyography (EMG) results were concurrently collected while the subjects walked along an 8 m walkway with the developed and general insoles. Developed insoles provide a three-dimensional mesh structure at the toe portion and a convex bulging structure (toe-grip bar) near the center of the proximal phalanx of the first to fifth toe. The linear mixed model was used to estimate the toe-grip bar insole effect. The results showed that there were no sequence or period effects for any of the examined parameters. During the stance phase, those wearing the developed insoles had significantly higher %IEMG for the TA, GM, and GL than those wearing the general insoles (TA: 5.03%IEMG, p = 0.005; GM: 4.65%IEMG, p = 0.046; and GL: 6.50%IEMG, p = 0.008). During the swing phase, those wearing the developed insoles had significantly higher activity for only the TA compared to those wearing the general insoles (5.54%IEMG, p = 0.011). With respect to gait parameters, those wearing the developed insoles had greater step length (2.81 cm, p = 0.038), longer stance time (0.03 s, p = 0.001), and shorter swing time (-0.02 s, p = 0.003) compared to those wearing the general insoles. The results suggest that walking with toe-grip bar insoles contributes to increased crural muscle activity and step length.

The effect of wearing insoles with a toe-grip bar on occupational leg swelling and lower limb muscle activity: A randomized cross-over study.

OBJECTIVE: Sitting or standing for hours decreases the blood flow in the legs and results in increased pressure on the veins, leading to the development of chronic venous disease. This study aimed to investigate the effects of insoles with a toe-grip bar on occupational leg swelling and lower limb muscle activity. METHODS: This randomized cross-over study enrolled 12 healthy men who work in a sitting or standing position. They were randomly divided into groups A (wore shoes with insoles with a toe-grip bar for 8 hours each) and B (wore shoes with regular insoles for 8 hours each). After 1 week, groups A and B wore shoes with regular insoles and shoes with insoles with a toe-grip bar, respectively, for 8 hours each. Lower leg volume was measured before and after each intervention, and lower limb muscle activity was measured at the start of each intervention. RESULTS: Occupational leg swelling was significantly smaller in men wearing insoles with a toe-grip bar (P < .05). Moreover, the integrated electromyogram value of the tibialis anterior muscle and medial and lateral gastrocnemius muscles during the stance phase of walking, and tibialis anterior muscle during the swing phase of walking was significantly greater in men wearing insoles with a toe-grip bar (all P < .05). CONCLUSION: Insoles with a toe-grip bar contribute to increased lower limb muscle activity, attenuating occupational leg swelling.

Effects of Long-Term Use of Insoles with a Toe-Grip Bar on the Balance, Walking, and Running of Preschool Children: A Randomized Controlled Trial.

This randomized controlled study is aimed at investigating the effects of long-term use of insoles with a toe-grip bar on the balance, walking, and running of preschool children. Fifty-two preschool children were randomly assigned to an intervention group or control group. Children included in the intervention group wore shoes with insoles that had a toe-grip bar, and those in the control group wore shoes with regular insoles without a toe-grip bar for 4 weeks while they were at school. The center of gravity sway (total trajectory length and envelope area), walking parameters (walking speed, cadence, stride length, step length, stance time, and swing time), and time to run 25 m were measured before and after the intervention. The 25 m running time of the intervention group was significantly improved after the intervention (F = 5.66; p < 0.05). This study suggests that insoles with a toe-grip bar may contribute to improvements in the running of preschool children.

Effect of Insoles with a Toe-Grip Bar on Toe Function and Standing Balance in Healthy Young Women: A Randomized Controlled Trial.

OBJECTIVE: The aim of this randomized controlled study was to investigate the effects of insoles with a toe-grip bar on toe function and standing balance in healthy young women. METHODS: Thirty female subjects were randomly assigned to an intervention group or a control group. The intervention group wore shoes with insoles with a toe-grip bar. The control group wore shoes with general insoles. Both groups wore the shoes for 4 weeks, 5 times per week, 9 hours per day. Toe-grip strength, toe flexibility, static balance (total trajectory length and envelope area of the center of pressure), and dynamic balance (functional reach test) were measured before and after the intervention. RESULTS: Significant interactions were observed for toe-grip strength and toe flexibility (F = 12.53, p < 0.01; F = 5.84, p < 0.05, resp.), with significant improvement in the intervention group compared with that in the control group. Post hoc comparisons revealed that both groups showed significant improvement in toe-grip strength (p < 0.01 and p < 0.05, resp.), with higher benefits observed for the intervention group (p < 0.01). Conversely, no significant interaction was observed in the total trajectory length, envelope area, and functional reach test. CONCLUSIONS: This study suggests that insoles with a toe-grip bar contribute to improvements in toe-grip strength and toe flexibility in healthy young women.

Fever associated with severe dialysis-related amyloidosis.

Dialysis-related amyloidosis (DRA) is one of the most important complications in patients on long-term hemodialysis (HD). DRA often affects the osteoarticular system; however, little is known about the role of ß2-microglobulin in the induction of fever in HD patients. We report a 64-year-old woman on long-term (24 years) HD who developed polyarthralgia and intermittent fever. Infectious diseases, connective tissue diseases, and malignant neoplasm were ruled out. Computed tomography and magnetic resonance imaging showed swelling of the soft tissues around bilateral shoulder and hip joints, suggestive of amyloid deposits. Gallium scintigraphy showed abnormal uptake in the vicinity of several large joints. It was presumed that the fever was related to the amyloid joint deposits, and the patient was treated with prednisolone and ß2-microglobulin adsorption therapy. The treatment resulted in the resolution of fever, relief of arthralgia, and normalization of several inflammatory cytokines and C-reactive protein. The findings suggest that massive DRA could cause systemic inflammatory response in patients on long-term HD.

Parathyroid cell growth in patients with advanced secondary hyperparathyroidism: vitamin D receptor, calcium sensing receptor, and cell cycle regulating factors.

The parathyroid gland (PTG) is a unique endocrine organ in which the quiescent glandular cells begin to proliferate in response to the demand for maintaining calcium (Ca) homeostasis in the progressive course of renal failure, leading to secondary hypereparathyroidism (SHPT). SHPT is characterized with continuous over-secretion of parathyroid hormone (PTH) and high turn-over bone disease, osteitis fibrosa, and the major factors include a deficiency of active vitamin D, hypocalcemia, and phosphate retention. With long-term end-stage renal failure, SHPT becomes resistant to conventional medical treatment such as phosphate binders and active vitamin D supplementation, and the growth of the PTG accelerates with the pattern of hyperplasia changing from diffuse to nodular type. In this process, the sigmoid curve between extracellular Ca concentration (exCa) and the plasma level of PTH shifts to the upper-rightward, indicating both an absolute increase in PTH secretion and the resistance of PT cells to exCa. Many experimental and human studies have revealed down-regulation of vitamin D receptor (VDR), calcium-sensing receptor (CaSR), and retinoid X receptor (RXR) in PT cells. The sustained proliferation of PT cells after obtaining autonomicity is another characteristic feature of SHPT. In this context, it has been demonstrated that the cell cycle is markedly progressed, where the expression of cyclin-dependent kinase inhibitor (CDKI), p21 and p27, is depressed in a VDR-dependent manner. These pathological features are most evident in nodular hyperplasia, in which monoclonal proliferation is obvious, indicating the phenotypic changes have occured in PT cells. It has been observed by Fukagawa and colleagues that pharmacologically high dose of active vitamin D administered orally can cause small-size PTG hyperplasia to regress in patients with advanced SHPT. Successful renal transplantation may also restore VDR and CaSR expressions in the diffuse type, in association with increasing TUNEL-positive cells. Thus, it is important to vigorously treat SHPT when the PT cell proliferation is in the reversible stage of diffuse hyperplasia.

Infusion of radiocontrast agents induces exaggerated release of urinary endothelin in patients with impaired renal function.

BACKGROUND: The aim of the study was to examine the role of endothelin in radiocontrast-induced nephropathy (RCN) in patients with chronic renal failure. METHODS: We measured plasma endothelin-1 (ET) and the urinary excretion of endothelin-like immunoreactivity before and after infusion of radio contrast medium (CM) in patients with normal renal function (group N; n = 6; mean serum creatinine concentration, 0.8 +/- 0.1 (SEM) mg/dl), and in another group, with renal dysfunction (group R; n = 6; 2.7 +/- 0.5 mg/dl). Half-normal saline (0.45% NaCl solution) was continuously infused in all patients for 25 h, at a rate of 100 ml/h; starting from 5 h before the infusion of CM. RESULTS: Plasma ET in group R (5.2 +/- 1.4 pg/ml) was significantly higher than in group N (0.9 +/- 0.3; P << 0.01). Urinary endothelin excretion corrected by creatinine concentration (uET/Cr) in group R (7.9 +/- 2.4 mg/g Cr) was significantly higher than in group N (1.5 +/- 0.4 mg/g Cr; P << 0.05). Urinary excretion levels of N-acetyl-Beta- d-glucosaminidase (NAG) and Beta2-microglobulin (Beta2M) were also significantly higher in group R (0.8 +/- 0.2 mU/g Cr and 670 +/- 400 mg/g Cr, respectively) than in group N (0.3 +/- 0.1 and 7.5 +/- 2.2, respectively). After CM infusion, uET/Cr in group R significantly increased, to 10.7 +/- 2.6 mg/g Cr on the next day and returned to baseline level on the third day. NAG and Beta2M showed a similar pattern, but a significant change in NAG was observed on the second day in group R. In group N, uET/Cr, NAG, and Beta2M did not change after CM infusion. Plasma ET remained unchanged throughout the observation period of 4 days in both groups. No patient developed pulmonary edema or a significant rise in serum creatinine (more than 0.5 mg/dl), caused by infusion of the amount of half-normal saline used. CONCLUSIONS: In the present study, uET/Cr increased after the administration of CM only in the patients with renal impairment. This difference in endothelin reaction may be a causal one, in that patients with renal insufficiency readily develop RCN. The infusion of half-normal saline starting before CM infusion causes no side effects and is safe for the prevention of CM-induced acute renal failure. The aim of the study was to examine the role of endothelin in radiocontrast-induced nephropathy (RCN) in patients with chronic renal failure.