Cut-off values of haemoglobin and clinical outcomes in incident peritoneal dialysis: the PDTAP study.

BACKGROUND: To explore the cut-off values of haemoglobin (Hb) on adverse clinical outcomes in incident peritoneal dialysis (PD) patients based on a national-level database. METHODS: The observational cohort study was from the Peritoneal Dialysis Telemedicine-assisted Platform (PDTAP) dataset. The primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and modified MACE (MACE+). The secondary outcomes were the occurrences of hospitalization, first-episode peritonitis and permanent transfer to haemodialysis (HD). RESULTS: A total of 2591 PD patients were enrolled between June 2016 and April 2019 and followed up until December 2020. Baseline and time-averaged Hb <100 g/l were associated with all-cause mortality, MACE, MACE+ and hospitalizations. After multivariable adjustments, only time-averaged Hb <100 g/l significantly predicted a higher risk for all-cause mortality {hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.19-281], P = .006}, MACE [HR 1.99 (95% CI 1.16-3.40), P = .012] and MACE+ [HR 1.77 (95% CI 1.15-2.73), P = .010] in the total cohort. No associations between Hb and hospitalizations, transfer to HD and first-episode peritonitis were observed. Among patients with Hb ≥100 g/l at baseline, younger age, female, use of iron supplementation, lower values of serum albumin and renal Kt/V independently predicted the incidence of Hb <100 g/l during the follow-up. CONCLUSION: This study provided real-world evidence on the cut-off value of Hb for predicting poorer outcomes through a nation-level prospective PD cohort.

Quantitatively Evaluating the Relationships between Insulin Resistance and Retinal Neurodegeneration with Optical Coherence Tomography in Early Type 2 Diabetes Mellitus.

INTRODUCTION: The aim of this study was to quantitatively assess retinal neurodegenerative changes with optical coherence tomography (Cirrus HD-OCT) in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR) and evaluate their relationships with insulin resistance (IR) and associated systemic indicators. METHODS: 102 T2DM patients without DR and 48 healthy controls were included in this observational cross-sectional study. The OCT parameters of macular retinal thickness (MRT) and ganglion cell-inner plexiform layer (GCIPL) thicknesses were evaluated between diabetic and normal eyes. The receiver operating characteristics (ROC) curve was generated to evaluate the discrimination power of early diabetes. Correlation and multiple regression analysis were performed between ophthalmological parameters and T2DM-related demographic and anthropometric variables, and serum biomarkers and homeostasis model assessment of insulin resistance (HOMA-IR) scores. RESULTS: MRT and GCIPL thicknesses showed significant thinning in patients, especially in inferotemporal area. High body mass index (BMI) correlated with decreased GCIPL thicknesses and elevated intraocular pressure (IOP). A negative correlation between waist-to-hip circumference ratio (WHR) and GCIPL thicknesses was also found. High-density lipoprotein (HDL) and fasting C-peptide (CP0) were associated with GCIPL thickness but only in inferotemporal region (r = 0.20, p = 0.04; r = -0.20, p = 0.05, respectively). Multiple regression analysis showed that increased HOMA-IR scores independently predicted both average (ß = -0.30, p = 0.05) and inferotemporal (ß = -0.34, p = 0.03) GCIPL thinning. CONCLUSION: Retinal thinning in early T2DM was associated with obesity-related metabolic disorders. IR as an independent risk factor for retinal neurodegeneration may increase the risk of developing glaucoma.

The influence of smoking on retinal ganglion cell-inner plexiform layer complex in male diabetes.

PURPOSE: This study aims to evaluate the influence of smoking on ganglion cell-inner plexiform layer complex (GC-IPL) thickness and central macular thickness (CMT) measured by spectral domain optical coherence tomography (OCT) in male diabetes. METHODS: 90 smoking and 90 never-smoking male subjects were included in this study. They were divided into six groups based on the diagnostic criteria for diabetes and the Early Treatment Diabetic Retinopathy Study (ETDRS) classification: smoking healthy subjects (SH, n = 20), non-smoking healthy subjects (NSH, n = 20), smoking diabetic patients without diabetic retinopathy (SNDR, n = 40), non-smoking diabetic patients without diabetic retinopathy (NSNDR, n = 40), smoking diabetic patients with diabetic retinopathy (SDR, n = 30), and non-smoking diabetic patients with diabetic retinopathy (NSDR, n = 30). After a full ophthalmologic examination, GC-IPL thickness and central macular thickness (CMT) were measured by OCT. Statistical analysis was performed to compare GC-IPL thickness and CMT between groups. Multiple linear regression equations were constructed to explore the potential risk factors of mean GC-IPL thickness. RESULTS: There were no significant differences in GC-IPL thickness and CMT between SH and NSH (all p > 0.05). Mean, superonasal, superior, superotemporal, inferonasal, inferior GC-IPL (p＜0.001, p＜0.001, p＜0.001, p = 0.003, p = 0.001, and p = 0.005, respectively) were thinner in the SNDR than NSNDR except for inferotemporal GC-IPL thickness and CMT (p = 0.066, p = 0.605, respectively). Mean, superonasal, superior, and inferonasal GC-IPL were thinner in the SDR than NSDR (p = 0.019, p = 0.045, p = 0.037, and p = 0.049, respectively). Multiple regression analysis demonstrated that age (ß [SE], -0.141 [0.060]; p = 0.020) and smoking (ß [SE], -4.470 [1.015]; p＜0.001) were the most important determinants for mean GC-IPL thickness. CONCLUSION: Smoking is associated with reduced retinal GC-IPL thickness in male diabetes. Smoking behavior and age are important determinants of mean GC-IPL thickness.

Analysis of ganglion cell-inner plexiform layer thickness in retinal vein occlusion with resolved macular edema.

PURPOSE: To analyze the retinal ganglion cell-inner plexiform layer (GCIPL) changes in retinal vein occlusion (RVO) eyes with resolved macular edema using optical coherence tomography. METHODS: We compared the average and minimum GCIPL thickness in RVO eyes with fellow eyes and healthy controls including 40 unilateral RVO patients and 48 healthy subjects. The average GCIPL thickness in BRVO eyes was segmented into the affected and opposite area according to the site of lesion, comparing them with corresponding areas in fellow eyes. Furthermore, maximum central macular thickness (CMT), visual acuity (VA), and intravitreal injection times were recorded to investigate their relationship with the GCIPL thickness. RESULTS: Despite no significant difference in CMT (P = 0.96), the average (P = 0.02 and P < 0.001, respectively) and minimum (both P < 0.001) GCIPL thicknesses were decreased in RVO eyes with resolved macular edema after treatment in comparison to fellow eyes and healthy eyes. Maximum CMT thickness was negatively correlated with the minimum GCIPL thickness (r = - 0.47, P = 0.003). VA and average GCIPL thickness were associated (rs = - 0.49, P = 0.002). In a subgroup analysis that only included BRVO patients, the opposite area revealed no significant difference between two eyes (P = 0.91) although the affected area in BRVO eyes was decreased (P < 0.001). CONCLUSIONS: A decrease of GCIPL thickness in RVO was observed even after anatomic restoration and associated with VA prognosis. These GCIPL defects could be attributable to systemic risks and RVO itself, not anti-VEGF effects.

Telemedicine and Clinical Outcomes in Peritoneal Dialysis: A Propensity-Matched Study.

INTRODUCTION: Telemedicine (TM) has shown to provide potential benefits on clinical outcomes in patients with chronic kidney disease but limited evidences published in the peritoneal dialysis (PD) population. This study aimed to explore the long-term effects of TM on the mortality and technique failure. METHODS: The Peritoneal Dialysis Telemedicine-assisted Platform Cohort Study (PDTAP Study) was conducted prospectively in 27 hospitals in China since 2016. Patient and practice data were collected through the doctor-end of the TM app (Manburs) for all participants. TM including self-monitoring records, on-line education materials, and real-time physician-patient contact was only performed for the patient-end users of the Manburs. The primary outcome was all-cause mortality. The secondary outcomes were cause-specific mortality and all-cause and cause-specific permanent transfer to hemodialysis. RESULTS: A total of 7,539 PD patients were enrolled between June 2016 and April 2019, with follow-up till December 2020. Patients were divided into two cohorts: TM group (39.1%) and non-TM group (60.9%). A propensity score was used to create 2,160 matched pairs in which the baseline covariates were well-balanced. There were significantly lower risks of all-cause mortality (HR 0.59 [0.51, 0.67], p < 0.001), CVD mortality (HR 0.59 [0.49, 0.70], p < 0.001), all-cause transfer to hemodialysis (0.57 [0.48, 0.67], p < 0.001), transfer to hemodialysis from PD-related infection (0.67 [0.51, 0.88], p = 0.003), severe fluid overload (0.40 [0.30, 0.55], p < 0.001), inadequate solute clearance (0.49 [0.26, 0.92], p = 0.026), and catheter-related noninfectious complications (0.41 [0.17, 0.97], p = 0.041) in the TM group compared with the non-TM group. CONCLUSION: This study indicated real-world associations between TM usage and reduction in patient survival and technique survival through a multicenter prospective cohort.

Design and Analysis of Area and Energy Efficient Reconfigurable Cryptographic Accelerator for Securing IoT Devices.

Achieving low-cost and high-performance network security communication is necessary for Internet of Things (IoT) devices, including intelligent sensors and mobile robots. Designing hardware accelerators to accelerate multiple computationally intensive cryptographic primitives in various network security protocols is challenging. Different from existing unified reconfigurable cryptographic accelerators with relatively low efficiency and high latency, this paper presents design and analysis of a reconfigurable cryptographic accelerator consisting of a reconfigurable cipher unit and a reconfigurable hash unit to support widely used cryptographic algorithms for IoT Devices, which require block ciphers and hash functions simultaneously. Based on a detailed and comprehensive algorithmic analysis of both the block ciphers and hash functions in terms of basic algorithm structures and common cryptographic operators, the proposed reconfigurable cryptographic accelerator is designed by reusing key register files and operators to build unified data paths. Both the reconfigurable cipher unit and the reconfigurable hash unit contain a unified data path to implement Data Encryption Standard (DES)/Advanced Encryption Standard (AES)/ShangMi 4 (SM4) and Secure Hash Algorithm-1 (SHA-1)/SHA-256/SM3 algorithms, respectively. A reconfigurable S-Box for AES and SM4 is designed based on the composite field Galois field (GF) GF(((22)2)2), which significantly reduces hardware overhead and power consumption compared with the conventional implementation by look-up tables. The experimental results based on 65-nm application-specific integrated circuit (ASIC) implementation show that the achieved energy efficiency and area efficiency of the proposed design is 441 Gbps/W and 37.55 Gbps/mm2, respectively, which is suitable for IoT devices with limited battery and form factor. The result of delay analysis also shows that the number of delay cycles of our design can be reduced by 83% compared with the state-of-the-art design, which shows that the proposed design is more suitable for applications including 5G/Wi-Fi/ZigBee/Ethernet network standards to accelerate block ciphers and hash functions simultaneously.

Sleep Disorders and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Prospective Cohort Study.

BACKGROUND: Patients with chronic kidney disease experience a high burden of sleep disorders, and there are associations between sleep disorders and cognitive impairment. OBJECTIVES: Based on our previous cross-sectional survey on cognitive impairment in peritoneal dialysis, we further explored the relationship between sleep disorders and cognitive impairment, and predictors for declining cognitive function. METHOD: We conducted a multicenter prospective cohort study enrolling 458 clinically stable patients on peritoneal dialysis who were then followed up for 2 years.Demographic data, comorbidities, depression, and biochemistry data were collected at baseline. Sleep disorders including insomnia, restless legs syndrome, sleep apnea syndrome, excessive daytime sleepiness, possible narcolepsy, sleep walking and nightmares, and possible rapid eye movement behavior disorders were assessed using a panel of specific sleep questionnaires at baseline and in a second survey. Global cognitive function was measured at baseline and in a second survey, using the Modified Mini-Mental State Examination. Specific cognitive domains were evaluated using Trail-Making Test Forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status were used to asses immediate and delayed memory, visuospatial skills, and language ability. RESULTS: Sleep disorders were common among peritoneal dialysis patients. The prevalence of cognitive impairment evaluated by the Modified Mini-Mental State Examination (3MS) increased from 19.8 to 23.9%. Possible narcolepsy was associated with decreased Modified Mini-Mental State Examination scores at baseline. During follow-up, sleepwalking and nightmares were associated with higher risks of declined delayed memory in the longitudinal study. CONCLUSIONS: Possible narcolepsy was associated with general cognitive dysfunction, and sleep walking and nightmares were risk factors for impaired delayed memory.

Cognitive Changes in Peritoneal Dialysis Patients: A Multicenter Prospective Cohort Study.

RATIONALE & OBJECTIVE: Cognitive impairment is an independent predictor of technique failure and mortality in patients on peritoneal dialysis (PD) therapy. We investigated changes in cognitive function and factors associated with it in this population. STUDY DESIGN: Multicenter prospective cohort study. SETTING & PARTICIPANTS: 458 PD patients were enrolled and followed up for 2 years. PREDICTORS: Global and specific domains of cognitive function were measured at baseline and after 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function; Trail-Making Tests A and B, for executive function; and subtests of the Battery for the Assessment of Neuropsychological Status, for immediate and delayed memory, visuospatial skill, and language ability. OUTCOMES: The primary outcome was change in cognitive function. Secondary outcomes included all-cause mortality, cardiovascular mortality, hospitalization, and transition to hemodialysis therapy. ANALYTICAL APPROACH: Multivariable linear regression models. RESULTS: The prevalence of cognitive impairment increased from 19.8% to 23.9%. 3MS scores significantly decreased (84.8 to 83.1), although executive function, immediate memory, and visuospatial skill improved over time. Delayed memory capacity and language ability were unchanged. Lower serum albumin level was associated with deteriorated delayed memory, visuospatial skill, and language ability, as well as with the decline in general cognitive function (ß values of 0.64, 0.90, 0.80, and 0.44, respectively). Advanced age, lower education, and depression were also correlated with deterioration in general and specific cognitive function. After multivariable adjustment, both global and specific cognitive impairment at baseline were associated with a greater rate of hospitalization, and memory dysfunction was associated with a lower dialysis modality survival rate. LIMITATIONS: A relatively short observation period, small number of deaths, and potential selection bias due to patients unavailable for the second assessment. CONCLUSIONS: In a PD population, global cognitive function declined over 2 years, though some specific cognitive domains improved. Besides well-recognized factors, hypoalbuminemia and depression were also risk factors for cognitive impairment.

Low Power Near Field Communication Methods for RFID Applications of SIM Cards.

Power consumption and communication distance have become crucial challenges for SIM card RFID (radio frequency identification) applications. The combination of long distance 2.45 GHz radio frequency (RF) technology and low power 2 kHz near distance communication is a workable scheme. In this paper, an ultra-low frequency 2 kHz near field communication (NFC) method suitable for SIM cards is proposed and verified in silicon. The low frequency transmission model based on electromagnetic induction is discussed. Different transmission modes are introduced and compared, which show that the baseband transmit mode has a better performance. The low-pass filter circuit and programmable gain amplifiers are applied for noise reduction and signal amplitude amplification. Digital-to-analog converters and comparators are used to judge the card approach and departure. A novel differential Manchester decoder is proposed to deal with the internal clock drift in range-controlled communication applications. The chip has been fully implemented in 0.18 µm complementary metal-oxide-semiconductor (CMOS) technology, with a 330 µA work current and a 45 µA idle current. The low frequency chip can be integrated into a radio frequency SIM card for near field RFID applications.

Depression and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Cross-sectional Study.

BACKGROUND: Depression and cognitive impairment have been identified as independent risk factors for mortality in peritoneal dialysis (PD) patients. The relationship between depression and global and specific cognitive functions in PD patients was investigated in this study. STUDY DESIGN: Multicenter cross-sectional study. SETTING & PARTICIPANTS: 458 clinically stable patients, drawn from 5 PD units, who performed PD for at least 3 months were enrolled. PREDICTOR: Depression, defined as depression severity index score > 0.5 using the Zung Self-rating Depression Scale. OUTCOMES: Global and specific cognitive impairment. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), Trail-Making Test forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skills, and language ability. RESULTS: Prevalences of depression and cognitive impairment evaluated by the 3MS were 52% and 28.4%, respectively. Patients with mild or moderate/severe depression had higher prevalences of general cognitive impairment, executive dysfunction, and impaired immediate and delayed memory. After adjusting for demographics, comorbid conditions, and clinical parameters, depression scores were independently associated with lower 3MS scores, lower immediate and delayed memory and language ability scores, and longer completion times of Trails A and B. Even mild depression was independently associated with higher risk for cognitive impairment, executive dysfunction, and impaired immediate and delayed memory after multivariable adjustments. LIMITATIONS: The causal relationship between depression and cognitive impairment could not be determined, and the potential copathogenesis behind depression and cognitive impairment was not fully investigated. CONCLUSIONS: Even mild depression is closely associated with global and specific cognitive impairment in PD patients.

Insulin resistance in the retina: possible implications for certain ocular diseases.

Insulin resistance (IR) is becoming a worldwide medical and public health challenge as an increasing prevalence of obesity and metabolic disorders. Accumulated evidence has demonstrated a strong relationship between IR and a higher incidence of several dramatically vision-threatening retinal diseases, including diabetic retinopathy, age-related macular degeneration, and glaucoma. In this review, we provide a schematic overview of the associations between IR and certain ocular diseases and further explore the possible mechanisms. Although the exact causes explaining these associations have not been fully elucidated, underlying mechanisms of oxidative stress, chronic low-grade inflammation, endothelial dysfunction and vasoconstriction, and neurodegenerative impairments may be involved. Given that IR is a modifiable risk factor, it may be important to identify patients at a high IR level with prompt treatment, which may decrease the risk of developing certain ocular diseases. Additionally, improving IR through the activation of insulin signaling pathways could become a potential therapeutic target.

Tracing the contribution and fate of synthetic nitrogen fertilizer in young apple orchard agrosystems.

Excessive synthetic nitrogen (N) inputs in intensive orchard agrosystems of developing countries are a growing concern regarding their adverse impacts on fruit production and the environment. Quantifying the distribution and contribution of fertilizer N is essential for increasing N use efficiency and minimizing N loss in orchards. A 15N tracer experiment was performed in a young dwarf apple orchard over two growing seasons to determine the fertilizer N transformation and fate. Fertilizer N primarily contributed to 25 % to 75 % of soil nitrate in the top 60 cm, but the contribution to soil microbial biomass N and fixed ammonium was <8 %, with the contribution to plant N ranging from 9 % to 19 %. In most growth periods, soil nitrate and fixed ammonium contents derived from native soil with N fertilization were higher than those not receiving N fertilizer. The N use efficiency of plants was only 2.6 % and 4.9 % in the first and second seasons, respectively, in contrast to 56.6 % and 54.0 % of N recovered in soil. Meanwhile, N assimilated into microbial biomass accounted for 0.8 %, and the proportion fixed by clay minerals was 3.5 %-5.2 %. One season after N fertilization, the nitrate below the 1 m soil layers accounted for 4.6 % of the applied N fertilizer, and the proportion increased to 22.5 % after two seasons. The N loss rate via N2O emission was 0.4 % over two years. The application of N fertilizer facilitated indigenous soil N mineralization, and abiotic ammonium fixation more efficiently retained synthetic N than microbial immobilization. These findings provide new insight into orchard N cycling, and attention should be given to the improvement of soil N retention and turnover capacity regulated by soil microbial and abiotic processes, as well as the potential environmental impacts of additional soil N mineralization resulting from prolonged chemical N fertilization.

[Effects of Long-term Combined Application of Organic and Inorganic Fertilizers on Soil Carbon Pool and Greenhouse Gas Emissions in Orchards].

Applying organic fertilizer can increase the contents of soil organic carbon (SOC) and active organic carbon, which are crucial for strengthening soil quality and fertility. Four treatments were established:no fertilization (CK), single application of organic fertilizer (M), single application of chemical fertilizer (NPK), and combined application of organic and inorganic fertilizers (MNPK). The changes in SOC and active components under long-term combined application of organic and inorganic fertilizers were investigated, as were the effects of various fertilization measures on greenhouse gas emissions. Moreover, we evaluated the variation in the soil carbon pool management index (CPMI). Total organic carbon (TOC), microbial biomass carbon (MBC), dissolved organic carbon (DOC), easily oxidized organic carbon (EOC), and particulate organic carbon (POC) increased by 82.84%, 66.30%, 21.12%, 93.28%, and 145.80%, respectively, when compared to those in the CK treatment. The NPK treatment had no discernible effect on SOC and organic carbon components. The combined application of organic and inorganic materials could enhance LI, CPI, and the soil carbon pool management index, with the increase in LI and CPI being the primary reason for the increase in CPMI. Correlation analyses revealed that soil organic carbon components and CPMI were significantly positively correlated with greenhouse gas emissions. The combined application of organic and inorganic materials enhanced cumulative CO2 emissions and warming potential (GWP) but decreased GHGI and yielded a maximum of 56365 kg·hm-2. Compared with that in the CK treatment (29073 kg·hm-2), apple yield in MNPK increased by 93.87%. Therefore, applying organic and inorganic fertilizers in dryland apple orchards can improve the accumulation of organic carbon and stabilize the soil carbon pool, which is more beneficial to the sustainable development of orchards.

[Seasonal Regulation of Soil Microbial Carbon and Phosphorus Metabolisms in an Apple Orchard: Evidence from the Enzymatic Stoichiometry Method].

Soil microbial carbon (C), nitrogen (N), and phosphorus (P) nutrient requirements and metabolic limitations are closely related to the availability of environmental nutrients. However, it is unclear how manure and chemical fertilization shift nutrient limitations for microbes in terms of the soil enzymatic stoichiometry in an apple orchard. Therefore, based on the long-term experiment located in an apple orchard established in 2008, this study applied the theory and method of soil enzyme stoichiometry to systematically investigate the effects of the combined application of manure and chemical fertilizers on soil C, N, and P turnover-related enzyme activities (ß-1,4-glucosidase, BG; leucine aminopeptidase, NAG; ß-1,4-N-acetylglucosaminidase, LAP; and acid or alkaline phosphatase, PHOS) and their stoichiometric characteristics and analyzed their relationships with environmental factors and microbial carbon use efficiency. The experiment was designed with four treatments, such as, no fertilization input as the control (CK), single application of chemical fertilizer (NPK), combined application of manure and chemical fertilizer (MNPK), and single application of manure (M). The results revealed that:① at different growth stages of fruit trees, the soil microbial biomass C (microC) content of manure fertilizer treatments (MNPK and M) was significantly higher than that of no manure fertilizer treatments (CK and NPK). The content of microbial biomass N (microN) in the NPK, MNPK, and M treatments increased by 89%, 269%, and 213%, respectively, compared with that in CK (P<0.05). ② Compared with those in the fertilization treatments, CK had higher leaf N and P contents (29.8 g·kg-1 and 2.17 g·kg-1) at the germination stage, and the leaf P content at the germination stage alone was significantly negatively correlated with soil available phosphorus (AP) content. ③ Soil enzyme stoichiometry analysis demonstrated that all data points in this study were above the 1:1 line, indicating that microbial communities had a strong phosphorus limitation. The range of vector length and angle was 0.56-0.79 and 59.3°-67.7°, respectively, in the growth period of fruit trees, and the vector angle was >45° in this study, which also reflected the strong phosphorus limitation of microorganisms. ④ RDA and random forest model analysis showed that organic carbon and available nitrogen (AN) were the main physical and chemical factors affecting vector length; AP, AN, and soil water content were the main physical and chemical factors affecting vector angle. Combined with SEM analysis, AN and dissolved organic carbon (DOC) directly affected microC and microN, AP directly affected microP and microN, DOC and AP directly affected vector length, and AP and microN directly affected vector angle. In addition, microbial carbon utilization was positively correlated with vector length and negatively correlated with vector angle. In summary, the combined application of manure and chemical fertilizers regulated microbial carbon and phosphorus metabolism by affecting soil carbon and phosphorus content at different growth stages of fruit trees, thereby affecting microbial carbon utilization. This study provides a scientific basis for manure and chemical fertilizers to improve soil quality and maintain soil health.

The Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study: Design and methods.

OBJECTIVES: The primary objective of the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study is to explore potential predictors and their effects on patient survival, technique survival, and the occurrence of infectious and noninfectious complications. DESIGN: The PDTAP study is a national-level cohort study in China. A newly developed PD telemedicine application provided a unique and convenient way to collect multicenter, structured data across units. SETTING: The PDTAP study was underway in 27 hospitals from 14 provinces located at 7 geographical regions (northwest, northeast, north, central, southwest, southeast, and south) in China. PARTICIPANTS: Our study aims to enroll at least 7000 adult patients with end-stage renal disease receiving PD. METHODS: Approval has been obtained through the ethics committees of all hospitals. All participants signed the informed consent form after the center had received ethics board approval in accordance with the Declaration of Helsinki. MAIN OUTCOME MEASURES: Patient survival, technique survival, hospitalization, and the occurrence of infectious and noninfectious complications. CONCLUSIONS: The PDTAP study aims to explore potential predictors and their effects on patient survival, technique survival, and infectious and noninfectious complications using a newly developed PD telemedicine system to collect multicenter, structured data in real-world practice. Substantial and transformable findings in relation to PD practices were expected. This study also developed a national-level infrastructure for further collaboration and ancillary investigation.

Depression at Baseline Is an Independent Risk Factor for Cognitive Decline in Patients on Peritoneal Dialysis: A Multicenter Prospective Cohort Study.

Background:Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients.Methods:This multicenter prospective cohort study included 458 PD patients who were followed up for 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function, Trail-Making Tests A and B for executive function, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale.Results:During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill.Conclusion:Depression was a significant risk factor for worsening of CI in PD patients.

The Association of Cognitive Impairment with Peritoneal Dialysis-Related Peritonitis.

Background:Research on the association between cognitive impairment (CI) and peritoneal dialysis (PD)-related peritonitis is limited. Therefore, we investigated whether CI contributed to the risk of PD-related peritonitis.Methods:This prospective cohort study enrolled 458 patients from 5 PD centers between 1 March 2013, and 30 November 2013, and continued until 31 May 2016. We used the Modified Mini-Mental State Examination (3MS) to assess general cognition, the Trail-Making Test to assess executive function, and subtests of the Battery for the Assessment of Neuropsychological Status to assess immediate and delayed memory, visuospatial skills, and language ability. Patients were assigned to CI and non-CI groups based on their 3MS scores. The first episode of peritonitis was the primary endpoint event. Treatment failure of peritonitis was defined as peritonitis-associated death or transfer to hemodialysis. We used competing risk models to analyze the association between CI and the risk of peritonitis. The association of CI with treatment failure after peritonitis was analyzed using logistic regression models.Results:Ninety-four first episodes of peritonitis were recorded during a median follow-up of 31.4 months, 18.1% of which led to treatment failure. No significant group differences were observed for the occurrence, distribution of pathogenic bacteria, or outcomes of first-episode peritonitis. Immediate memory dysfunction was independently associated with a higher risk of PD-related peritonitis (hazard ratio [HR] 1.736, 95% confidence interval [CI] 1.064 - 2.834, p < 0.05), adjusting for confounders.Conclusions:Immediate memory dysfunction was a significant, independent predictor of PD-related peritonitis. Neither general nor specific domains of CI predicted treatment failure of peritonitis.

An association of cognitive impairment with diabetes and retinopathy in end stage renal disease patients under peritoneal dialysis.

BACKGROUND: Diabetes and retinopathy have been considered as risk factors of cognitive impairment (CI) in previous studies. We investigated both of these two factors and their relationship with global and specific cognitive functions in end stage renal disease patients under peritoneal dialysis (PD). METHODS: In this multicenter cross-sectional study, 424 clinically stable patients were enrolled from 5 PD units, who performed PD for at least three months and completed fundoscopy examination if they had diabetes. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), Trail-Making Test forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skills, and language ability. RESULTS: PD Patients with DM and Retinopathy had significantly higher prevalence of CI, executive dysfunction, impaired immediate memory and visuospatial skill, compared with patients in non-DM group. By multivariate logistic regression analyses, DM and retinopathy rather than DM only were significantly associated with increased risk for CI, executive dysfunction, impaired immediate memory and visuospatial skill, odds ratios(ORs) and 95% confidence intervals were 2.09[1.11,3.92], 2.89[1.55,5.37], 2.16 [1.15,4.06] and 2.37[1.32,4.22], respectively (all P < 0.05). CONCLUSIONS: Diabetic PD patients with retinopathy were at two times risk for overall cognitive impairment, executive dysfunction, impaired immediate memory and visuospatial skill as compared to non-diabetic PD patients.

Performance of the Modified Mini-Mental State Examination (3MS) in Assessing Specific Cognitive Function in Patients Undergoing Peritoneal Dialysis.

PURPOSE: While Cognitive impairment (CI) has been identified as an independent risk factors for mortality in patients undergoing peritoneal dialysis (PD), it is inadequately assessed. We evaluated the applicability of the Modified Mini-Mental State Examination (3MS) in assessing specific cognitive function and compared it to a detailed neuropsychological test battery as the reference standard. METHODS: In this multicentric cross-sectional study, we enrolled 445 clinically stable patients from five PD units, who were undergoing PD for at least 3 months. The 3MS was evaluated for general cognitive function. A detailed neuropsychological battery including domains of immediate memory, delayed memory, executive function, language, and visuospatial ability were evaluated as reference standards. Sensitivity and specificity of the 3MS was determined by using receiver operating characteristic (ROC) analysis. RESULTS: The CI prevalence evaluated by 3MS was 23.6%. PD patients with CI performed worse in all cognitive domains. The 3MS correlated well with specific cognitive domains. However, 18.5%, 57.4%, 12.6%, 8.8%, and 41.2% of patients whom were idendified as normal by 3MS still showed executive dysfunction, immediate memory impairment, delayed memory impairment, and language-ability and visuospatial-ability impairment, respectively. The 3MS identified patients having specific cognitive dysfunction with varied extent of diagnostic value, with 0.50, 0.42, 0.35, 0.34, and 0.26 of Youden index in executive function, delayed memory, language ability, immediate memory, and visuospatial ability, respectively. CONCLUSIONS: The 3MS is not a comprehensive instrument for major cognitive domains in PD patients. It could, however, be used for executive dysfunction and delayed memory impairment screening.