Association between regional economic status and renal recovery of dialysis-requiring acute kidney injury among critically ill patients.

The association between regional economic status and the probability of renal recovery among patients with dialysis-requiring AKI (AKI-D) is unknown. The nationwide prospective multicenter study enrolled critically ill adult patients with AKI-D in four sampled months (October 2014, along with January, April, and July 2015) in Taiwan. The regional economic status was defined by annual disposable income per capita (ADIPC) of the cities the hospitals located. Among the 1,322 enrolled patients (67.1 ± 15.5 years, 36.2% female), 833 patients (63.1%) died, and 306 (23.1%) experienced renal recovery within 90 days following discharge. We categorized all patients into high (n = 992) and low economic status groups (n = 330) by the best cut-point of ADIPC determined by the generalized additive model plot. By using the Fine and Gray competing risk regression model with mortality as a competing risk factor, we found that the independent association between regional economic status and renal recovery persisted from model 1 (no adjustment), model 2 (adjustment to basic variables), to model 3 (adjustment to basic and clinical variables; subdistribution hazard ratio, 1.422; 95% confidence interval, 1.022-1.977; p = 0.037). In conclusion, high regional economic status was an independent factor for renal recovery among critically ill patients with AKI-D.

Comparisons of the peritoneal equilibration test and ultrafiltration in patients with and without diabetes mellitus on continuous ambulatory peritoneal dialysis.

BACKGROUND/AIMS: To compare dialysance and ultrafiltration (UF) of peritoneum in diabetes mellitus (DM) and non-DM patients on continuous ambulatory peritoneal dialysis. METHODS: A total of 162 adult patients on continuous ambulatory peritoneal dialysis (40 DM and 122 non-DM patients) were studied with the peritoneal equilibration test (PET) using 2.5% glucose dialysis solution retained for 4 h. Patients using 2,000 or 1,500 ml of infusion volume were classified into groups A (23 DM and 63 non-DM patients) and B (16 DM and 41 non-DM patients), respectively. PET results were compared between DM and non-DM patients by unpaired t test. Using Pearson's correlation and least-square multiple regression, the most powerful predictors of UF rate were also evaluated in DM and non-DM patients. RESULTS: There were no differences between PET parameters and UF rate between DM and non-DM patients in the whole group (WG) and group A. The only significant difference (p < 0.05) was an increased D4/D0 value in DM patients in group B. The most simple but powerful method to predict UF rate was (100 - GAP)/(D4/D0), where GAP corresponds to the glucose absorption percentage and D4/D0 is the PET 4-hour dialysate glucose level/PET 0-hour dialysate glucose level. GAP and D4/D0 were two major determinants of UF rate in the DM group, non-DM group and WG. CONCLUSIONS: Peritoneal permeability did not differ between DM and non-DM patients, and GAP and D4/D0 were two major factors predicting UF rate.

A comparison of responsiveness to hepatitis B vaccination in patients on hemodialysis and peritoneal dialysis.

The doses of hepatitis B vaccine given to peritoneal dialysis (PD) patients are currently based on responsiveness data from hemodialysis (HD) patients. To determine whether the doses are also appropriate from PD patients, we did a head-to-head comparison of short-term and 2-year responses to hepatitis B vaccination of HD patients and PD patients. We evaluated serum titers of the antibody to hepatitis B surface antigen (anti-HBs) after the patients had completed a course of four consecutive intramuscular vaccinations (40 microg of Engerix-B administered into the deltoid muscle at 0, 1, 2, and 6 months) in 69 dialysis patients (47 HD and 22 PD patients) who were both hepatitis B surface antigen (HBsAg) and anti-HBs negative. No patients had received a hepatitis B vaccination prior to the study. There was no significant difference in response to hepatitis B vaccination between the HD and PD groups (78.7% versus 77.3%, p=0.33). The seroconversion rate defined as anti-HBs > or = 10IU/L was influenced only by age (p=0.011). There was also no significant difference in responsiveness between the HD and PD groups (60% versus 50%, p=0.41) at a 2-year follow-up. We conclude that doses of HBV vaccine being used for HD patients are also appropriate for PD patients and a booster dose of vaccine is required to maintain seroprotection for those who lost protecting anti-HBs.

Glutathione S-transferase T1 deletion is a risk factor for developing end-stage renal disease in diabetic patients.

Reactive oxygen metabolites may contribute to the development of end-stage renal disease (ESRD) in diabetic and hypertensive patients. In this study, we used multiplex polymerase chain reaction (PCR) to analyze polymorphisms of two endogenous antioxidant genes, glutathione S-transferase M1 (GSTM1) and glutathione S-transferase T1 (GSTT1), and to determine their role in the development of ESRD in diabetic and hypertensive patients. Our results showed that homozygous deletion of the GSTT1 gene is a risk factor for developing ESRD in diabetic patients (p=0.004, OR=2.18, 95% confidence interval (CI) =1.29-3.70), but not in hypertensive patients. No association between homozygous deletion of GSTM1 and the development of ESRD was found in either diabetic patients or hypertensive patients. These results indicate that genetic variations in enzymes involved in free radical metabolism are associated with the development of ESRD in diabetes mellitus (DM) patients, and may permit the targeting of preventive and early intervention strategies to high-risk individuals.

Evaluation of gallbladder function in patients with non-diabetic chronic renal failure by quantitative radionuclide cholescintigraphy.

BACKGROUND/AIMS: We investigated quantitatively the motor function of the gallbladder in patients with non-diabetic chronic renal failure by the Tc-99m DISIDA cholescintigraphy. METHODOLOGY: Twenty-four patients (13 males, 11 females; aged 62.0 +/- 16.2 years) with non-diabetic chronic renal failure were included in this study. All cases had normal gallbladder diagnosed by ultrasonography and normal liver function without symptoms or signs of cholecystitis. Fifteen normal controls (12 males, 3 females; aged 60.7 +/- 6.3 years) were also included for comparison. Gallbladder function was represented as the filling fraction and the ejection fraction calculated using quantitative Tc-99m DISIDA cholescintigraphy and was compared in the groups. RESULTS: The results showed no significant difference (P > 0.05) between non-diabetic chronic renal failure and controls in filling fraction (64.3 +/- 31.0 vs. 74.9 +/- 9.5) and in ejection fraction (54.4 +/- 26.5 vs. 49.9 +/- 4.2) by the independent Student's t test. CONCLUSIONS: Non-diabetic chronic renal failure seems not to impair gallbladder function although non-diabetic chronic renal failure patients had a tendency toward a decreased filling fraction. The high variability of filling fraction and ejection fraction observed in our patients implies that the determinants of gallbladder functions in non-diabetic chronic renal failure patients may be multiple in nature.