Relationship between Permanent Catheter Patency and Nutrient Score in Patients Aged >75 Years Requiring Renal Replacement Therapy.

Background: Malnutrition is common in patients undergoing hemodialysis and is a powerful predictor of morbidity and mortality. This study aimed to investigate the effect of nutritional status on permanent catheter patency in elderly patients aged >75 years of age undergoing dialysis using tunneled dialysis catheters; Methods: Records of 383 patients whose nutritional factors and body cell mass (BCM) were measured simultaneously at the start of dialysis between 14 January 2020 and 30 September 2023, at Chungnam National University Hospital, were retrospectively reviewed. The relationships between permanent catheter patency at 180 days and BCM parameters and clinical parameters were studied using Kaplan-Meier survival curves and multivariate Cox proportional hazards analysis. Results: Age and sexual differences were significant (p ≤ 0.05), and most of the BCM parameters and BCM were not significant (p ≤ 0.05), except for intracellular water. Permanent catheter patency was superior at low controlling nutritional status (CONUT) scores (p < 0.05). After adjustment for covariates, the CONUT score remained an independent factor associated with permanent catheter-patency survival; Conclusions: CONUT scores measured before the start of dialysis are expected to play an important role in predicting the prognosis of permanent catheter-patency survival in patients aged >75 years.

Association between Serum GDF-15 and Cognitive Dysfunction in Hemodialysis Patients.

Cognitive dysfunction is more frequent in end-stage renal disease (ESRD) patients undergoing hemodialysis compared with the healthy population, emphasizing the need for early detection. Interest in serum markers that reflect cognitive function has recently increased. Elevated serum growth differentiation factor 15 (GDF-15) levels are known to be associated with an increased risk of decreased renal function and cognitive dysfunction. This study investigated the relationship between GDF-15 and cognitive dysfunction in hemodialysis patients using a retrospective analysis of 92 individuals aged ≥ 18 years. Cognitive function was assessed using the Korean version of the Mini-Mental Status Examination (K-MMSE), categorizing patients into normal (≥24 points) and cognitive dysfunction (<24 points). As a result, serum GDF-15 concentrations were at significantly higher levels in the cognitive dysfunction group (7500.42 pg/mL, p = 0.001). Logistic regression indicated an increased risk of K-MMSE scores < 24 points when serum GDF-15 exceeded 5408.33 pg/mL. After indoxyl sulfate exposure in HT22 cells, HT22 cells survival was decreased and GDF-15 expression in HT22 cells was increased. Similarly, exposure to indoxyl sulfate in mouse brain tissue resulted in an increased expression of GDF-15. This study highlights the potential of serum GDF-15 as a marker for cognitive dysfunction in hemodialysis patients, offering a valuable screening tool. Serum GDF-15 is related to cognitive dysfunction in hemodialysis patients and may be helpful in screening for cognitive dysfunction in hemodialysis patients.

Effect of cilostazol on arteriovenous fistula in hemodialysis patients / Efecto del cilostazol en una fístula arteriovenosa en pacientes en hemodiálisis

Background: The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve permanently patent vascular access, little have been noticeable. Cilostazol, a phosphodiesterase-3 inhibitor, has been shown to be effective in peripheral arterial disease including vascular injury-induced intimal hyperplasia. We therefore aimed to determine the effect of cilostazol on the patency and maturation of permanent vascular access. Methods: This single-center, retrospective study included 194 patients who underwent arteriovenous fistula surgery to compare vascular complications between the cilostazol (n=107) and control (n=87) groups. Results: The rate of vascular complications was lower in the cilostazol group than in the control group (36.4% vs. 51.7%; p=0.033), including maturation failure (2.8% vs. 11.5%; p=0.016). The rate of reoperation due to vascular injury after hemodialysis initiation following fistula maturation was also significantly lower in the cilostazol group than in the control group (7.5% vs. 28.7%; p<0.001). However, there were no significant differences in the requirement for percutaneous transluminal angioplasty (PTA), rate of PTA, and the interval from arteriovenous fistula surgery to PTA between the cilostazol and control groups. Conclusion: Cilostazol might be beneficial for the maturation of permanent vascular access in patients requiring hemodialysis. (AU)

Antecedentes: La maduración y la permeabilidad del acceso vascular permanente son fundamentales en los pacientes que requieren hemodiálisis. Aunque se han realizado numerosos ensayos para conseguir un acceso vascular permanentemente permeable, pocos han conseguido resultados destacables. El cilostazol, un inhibidor de la fosfodiesterasa 3, ha demostrado ser eficaz en la enfermedad arterial periférica, incluida la hiperplasia intimal inducida por lesiones vasculares. Por lo tanto, nuestro objetivo era determinar el efecto del cilostazol en la permeabilidad y la maduración del acceso vascular permanente. Métodos: Este estudio unicéntrico y retrospectivo incluyó 194 pacientes sometidos a una cirugía de fístula arteriovenosa para comparar las complicaciones vasculares entre los grupos de cilostazol (n=107) y de control (n=87). Resultados: La tasa de complicaciones vasculares fue menor en el grupo de cilostazol que en el grupo de control (36,4% frente a 51,7%; p=0,033), incluido el fracaso de la maduración (2,8% frente a 11,5%; p=0,016). La tasa de reintervención por lesión vascular tras el inicio de la hemodiálisis después de la maduración de la fístula también fue significativamente menor en el grupo de cilostazol que en el grupo de control (7,5% frente a 28,7%; p<0,001). Sin embargo, no hubo diferencias significativas en la necesidad de angioplastia transluminal percutánea (ATP), la tasa de ATP y el intervalo desde la cirugía de la fístula arteriovenosa hasta la ATP entre los grupos de cilostazol y de control. Conclusión: El cilostazol podría ser beneficioso para la maduración del acceso vascular permanente en pacientes que necesitan hemodiálisis. (AU)

Progression to chronic kidney disease according to albumin uria in diabetic nephropathy patients with preserved renal function / Progresión a enfermedad renal crónica según albuminuria en pacientes con nefropatía diabética con función renal preservada

ABSTRACT Background : Albuminuria predicts progression of diabetic nephropathy (DN) but lacks specificity and sensitivity for the diagnosis of chronic kidney disease (CKD) and progressive decline in estimated glomerular filtration rate (eGFR). We evaluated the decline in renal function in patients with DN and analyzed the prognosis of renal function according to the level of albuminuria and the incidence of cardiovascular disease (CVD), cerebrovascular diseases, and peripheral artery disease (PAD) according to the level of albuminuria. Methods: This retrospective study included 331 patients with eGFR >60 mL/min/1.73 m2 and urinary albumin/creatinine (Cr) ratio (ACR) >30 mg/g Cr who were treated at the Chungnam National University Hospital between January 2012 and December 2018. Patients were divided into mildly increased albuminuria, moderately increased albuminuria, and severely increased albuminuria groups according to their urine ACRs of 30-300, 300 900, and >900 mg/g Cr, respectively. Renal outcomes and incidence of CVD, cerebrovascular disease, and PAD were compared among the three groups. Results: More severe albuminuria was associated with higher rates of progression to CKD (p< 0.001) and >50% reduction in eGFR from baseline (p< 0.001). There was a statistically significant difference in the rate of PCI with angina or myocardial infarction (p=0.030). However, cerebrovascular disease and PAD did not significantly differ among the three groups. Conclusión: Among patients with DN who maintained a relatively preserved renal function with an eGFR >60 mL/min/1.73 m2, the rates of renal deterioration and progression to CKD were significantly more frequent in those with more severe albuminuria.

RESUMEN Antecedentes: La albuminuria predice la progresión de la nefropatía diabética (ND) pero carece de especificidad y sensibilidad para el diagnóstico de la enfermedad renal crónica (ERC) y la disminución progresiva en la tasa de filtración glomerular estimada (eGFR). Evaluamos la disminución de la función renal en pacientes con ND y analizamos el pronóstico de la función renal de acuerdo con el nivel de albuminuria y la incidencia de enfermedad cardiovascular (ECV), enfermedades cerebrovasculares y enfermedad de las arterias periféricas (EAP) de acuerdo con el nivel de albuminuria. Material y métodos: Este estudio retrospectivo incluyó a 331 pacientes con eGFR >60 ml/min/1,73 m2 y de albúmina urinaria/creatinina (CR) (ACR) >30 mg/g CR que fueron tratados en el Hospital Universitario Nacional de Chungnam entre enero de 2012 y diciembre de 2018. Los pacientes se dividieron en tres grupos: albuminuria ligeramente aumentada, aumento moderado de albuminuria y aumento severo de albuminuria de acuerdo con sus ACRs de orina de 30-300, 300-900 y >900 mg/g Cr, respectivamente. Los resultados renales e incidencia de ECV, enfermedad cerebrovascular y EAP se compararon entre los tres grupos. Resultados: La albuminuria más severa se asoció con tasas más altas de progresión a ERC (P <0,001) y una reducción >50% en eGFR desde la línea de base (P <0,001). Hubo una diferencia estadísticamente significativa en la tasa de PCI con la angina o el infarto de miocardio (P =0,030). Sin embargo, la enfermedad cerebrovascular y la EAP no difirieron significativamente entre los tres grupos. Conclusión: entre los pacientes con ND que mantuvieron una función renal relativamente conservada con un eGFR >60 ml/ min/1,73 m2, las tasas de deterioro renal y la progresión a la ERC fueron significativamente más frecuentes en aquellos con albuminuria más severa.