Browsing by Author "Kao T.-W."

Background: Dyslipidemia and residual renal function (RRF) have a significant impact on the cardiovascular mortality in dialysis patients, but their association in patients on chronic peritoneal dialysis (PD) has not been completely studied. Methods: 170 PD patients were divided into 2 groups based on the RRF (Group I had no RRF and Group II had RRF > 0 ml/min/1.73 m2 BSA). An observational, longitudinal study was performed to elucidate the dyslipidemic state in PD patients with different levels of RRF and the associafion of dyslipidemia and deterioration of RRF during 3 years. Results: Patients' basic characteristics and lipid profiles at the initiation of study were similar between the groups. At the end of study, Group I patients had a lower T-CHO (p = 0.001), LDL-C (p = 0.018), HDL-C (p = 0.05) and non-HDL-C (p = 0.003) than Group II. There was a significant correlation between a change in HDL-C and the decline of RRF (r = 0.177, p = 0.048) and it was independent of PD duration and levels of highly sensitive C-reactive protein (r = 0.233, p = 0.04). Conclusion: Our results clearly demonstrate the different longitudinal changes of lipid profiles in PD patients with different RRF and an association between decline of HDL-C and deterioration of RRF. ?2008 Dustri-Verlag Dr. K. Feistle.

Background: Frailty is a geriatric syndrome that is generally represented as a universal issue in the aging population and may lead to adverse health-related events. The most widely used definition of frailty was proposed by Fried et al., wherein frailty is characterized by low physical activity, involuntary weight loss, exhaustion, poor muscle strength, and slow gait speed. The concept of “cognitive frailty” (simultaneous occurrence of both cognitive impairment and physical frailty) has recently been proposed. The Alzheimer’s Disease 8 (AD8) is a brief questionnaire used to differentiate normal aging from dementia. We hypothesized a positive correlation between frailty and AD8 scores in community-dwelling older adults. Methods: Individuals over 65?years who visited a medical center in Taipei city during May, 2012 to April, 2013 for an annual check-up were eligible. The final sample comprised 205 older adults (average age?=?75.5?±?7.6?years). Frailty status was determined according to the Fried frailty criteria. Multiple logistic regression analyses were used to estimate the odds of frailty among individuals with AD8 scores of 2 or more. Results: After adjusting for age, gender and health-related behaviors, the odds ratio of frailty for individuals with AD8 scores???2 was 5.3 (p?=?0.008). This positive relationship remained even after adjustment for additional correlates. Conclusion: The findings have important implications for the early identification of frailty risk, provided that longitudinal studies can identify the directionality of the relationship between AD8 scores and frailty. ? 2017, European Geriatric Medicine Society.

Background: Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage. The influence of a mild decrease in kidney function on residual hypertension after adrenalectomy is unexplored. Study Design: Nonconcurrent prospective study. Setting & Participants: The study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 150 patients (61 men; overall mean age, 47.2 ± 11.6 years) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007. Predictor: Presurgery estimated glomerular filtration rate (eGFR). Outcomes & Measurements: Residual hypertension after adrenalectomy, defined either as less than 75% of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery. Results: Before surgery, 27 (18%), 72 (48%), and 51 (34%) patients had moderately to severely decreased (<60 mL/min/1.73 m2), mildly decreased (60 ? eGFR < 90 mL/min/1.73 m2), or nondecreased eGFR (?90 mL/min/1.73 m2), respectively. After surgery, 16 (59.3%), 29 (40.3%), and 10 (19.3%) patients in each category had postsurgery residual hypertension. Compared with patients without decreased eGFR before surgery, adjusted odds ratios for postsurgery residual hypertension were 2.7 (95% confidence interval, 1.03 to 7.0; P = 0.04) and 2.8 (95% confidence interval, 1.05 to 9.3) for mildly and moderately to severely decreased eGFR, respectively. Limitations: Arbitrary definition for residual hypertension. Conclusions: Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy. Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension. ? 2009 National Kidney Foundation, Inc.

Background: Fetuin A, a predictor of cardio-vascular (CV) mortality in dialysis patients has been associated with dyslipidemia in non-diabetic coronary artery disease. Truncal obesity is linked to dyslipidemia and also predicts CV mortality. This study had aimed to investigate the associations among fetuin A, truncal obesity, and dyslipidemia in hemodialysis (HD) patients. Methods: One hundred and nine non-diabetic HD patients were evaluated. Waist circumference, highly sensitive C-reactive protein (hs-CRP), fetuin A, and lipoprotein levels (i.e. total cholesterol (T-CHO), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), non-HDL-C, and triglyceride (TG)) were measured for analysis of correlations. The patients were divided into tertiles by fetuin A concentrations. Results: Data from 63 women and 46 men aged 60±13 years were analyzed. Patients in the highest tertile of fetuin A (0.33-0.51 g/l) had higher serum creatinine, albumin, T-CHO, LDL-C, non-HDL-C, and TG, more truncal obesity and lower hs-CRP than patients in the lowest tertile (all P<0.05). In multi-variable linear regression analysis, fetuin Awas independently associated with TG level and total iron binding capacity after adjustments for age, hemoglobin, albumin, calcium, body mass index, and hs-CRP. Patients in the highest fetuin A tertile had 3.2- and 4.4-fold higher incidence of truncal obesity (P=0.038) and hyper-triglyceridemia (P=0.015) independent of nutritional status and inflammation. Conclusion: Fetuin A is positively associated with truncal obesity and dyslipidemia, which are independent of malnutrition and inflammation. It may predict visceral adiposity and dyslipidemia, especially TG and TG-rich lipoproteins, in HD patients. ? 2009 European Society of Endocrinology.

Background/Purpose: Sevelamer hydrochloride is a recently developed phosphate binder, which is a quaternary amine anion exchanger without calcium or aluminum. Sevelamer is effective in controlling hyperphosphatemia without increasing the calcium load in chronic hemodialysis (HD) patients. We investigated whether sevelamer restored bone metabolism in chronic HD patients. Methods: An 8-week, prospective, open-label, randomized study was conducted after a 2-week washout period in chronic hyperphosphatemic HD patients. This study compared the effect of sevelamer on markers of bone turnover with that of calcium acetate, as stratified by baseline serum intact parathyroid hormone (iPTH) level. Results: There was no difference in the changes of serum phosphorus, calcium-phosphorus product and serum iPTH between the sevelamer and the calcium acetate groups. However, more hypercalcemic events (12%) were documented under calcium acetate treatment. In patients with hypoparathyroidism, calcium acetate treatment decreased serum iPTH at the end of the study, while sevelamer did not. Increased serum alkaline phosphatase levels were found among patients receiving sevelamer treatment compared with those who received calcium acetate treatment. In those patients receiving sevelamer, the serum alkaline phosphatase level was also positively correlated to the sevelamer dosage (r = 0.246, p = 0.013). Conclusion: Sevelamer effectively reduces serum phosphorus with a lower incidence of hypercalcemic effects in HD patients. Sevelamer is an effective means of treatment for chronic hyperphosphatemic HD patients, especially those with hypoparathyroidism. ? 2010 Formosan Medical Association & Elsevier.

A 75-year-old woman was admitted for dyspnea and fever. She underwent emergent dialysis smoothly under F6-HPS polysulfone hemodialyzer. With two subsequent hemodialysis sessions, severe anaphylactic reaction with cardiopulmonary resuscitation occurred under FX60 polysulfone dialyzer. Further dialysis sessions by F6-HPS polysulfone dialyzer were uneventful. This rare case demonstrated that dialyzer reaction may be markedly different even with the same material and the same manufacturer. ? 2014 International Society for Hemodialysis.

Polycystic kidney disease (PCKD) is the most common hereditary cause of end-stage renal disease, the complications of which may prevent the choice of peritoneal dialysis (PD). The aim of this study was to explore the effects of dialysis modality on outcomes in patients with PCKD. We extracted a cohort of 1417 adult patients with PCKD initiating long-term dialysis therapy in 1999-2010 from the Taiwan National Health Insurance Research Database, among which 125 patients chose PD. The patients on HD were older and had a higher comorbidity index compared to those on PD. We compared the risks for death, hospitalization and medical expenditures between the patients on PD and propensity-score matched patients on hemodialysis (HD). The overall survival did not differ between the patients on PD and HD. The patients on PD tended to have higher hazard ratios (HR) for the first episode of hospitalization (adjusted HR 1.34 [95% CI, 1.04-1.79]). The annual medical expenses were 10% lower for the patients on PD. PD is an equivalent choice of renal replacement therapy to HD for patients with PCKD in terms of survival. Although the patients on PD had a higher risk for hospitalization, the medical expenditure for PD was 10% lower.

Background: Metabolic syndrome (MetS) and insulin resistance (IR) strongly promote macrovascular complications and endothelial dysfunction. They accelerate the progression of renal dysfunction in chronic kidney disease patients. However, their correlation with residual renal function (RRF) and peritoneal characteristics have never been investigated. Methods: The inter-relationships of IR (homeostatic model assessment, HOMAIR), serum adiponectin level, body mass index (BMI), highly sensitive C-reactive protein (hs-CRP), RRF, peritoneal solute clearance (Kt/Vurea) and solute transport rate of 104 chronic peritoneal dialysis (PD) patients were examined. Results: Patients with (n = 57) and without (n = 47) clinically diagnosed MetS had the same degree of RRF, peritoneal Kt/Vurea, and solute transport rate. Higher HOMAIR (p = 0.011), BMI (p = 0.01) and hs-CRP (p = 0.032), as well as lower adiponectin (p = 0.019), were associated with lower peritoneal Kt/V urea. Serum adiponectin was negatively associated with solute transport rate (p = 0.02). In multiple regression analysis, higher HOMA IR (p = 0.005), BMI (p = 0.021) and hs-CRP (p < 0.001) correlated with lower peritoneal Kt/Vurea. Conclusions: MetS plays an important role in both macrovascular complications and endothelial dysfunction in chronic PD patients, which correlates with changes in peritoneal solute clearance and solute transport rate but not RRF. Copyright ? 2008 S. Karger AG.

This study evaluated the correlations between spiritual beliefs and health-related quality of life (HRQOL) of hemodialysis (HD) patients in Taiwan. Participants had to complete two questionnaires: the 36-item Short Form Health Survey Questionnaire and the Royal Free Interview for Spiritual and Religious Beliefs. They were then divided into three groups according to their strength of spiritual beliefs - having no, weak, or strong beliefs. Demographic, clinical, and laboratory data among groups were compared. Correlations between spiritual beliefs and HRQOL were then determined by the analysis of covariance and the post hoc Scheffe tests. Six hundred thirty-three patients completed the study. There were more women in the group of patients with strong beliefs (P = 0.005) and more less-educated patients in the group of patients with weak beliefs (P = 0.005). Patients with no or with strong spiritual beliefs had higher role physical (P = 0.01) and social functioning (SF) (P = 0.001) scores than patients with weak beliefs. After adjustment for gender, age, marital status, education, comorbidities, and time on dialysis, patients with no or with strong spiritual beliefs were found to have higher SF scores (P = 0.02) than patients with weak beliefs. HD patients with no or strong spiritual beliefs had higher SF HRQOL than those with weak spiritual beliefs. ? 2009, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Background: Acute kidney injury (AKI) is gaining worldwide attention recently, emerging as a major public health threat. However, the association between the development of AKI and subsequent malignancy has not been studied before. Methods: We conducted a population study based on the Taiwan National Health Insurance database, using 1,000,000 representative database during 2000-2008. All patients' survival to discharge from index hospitalization with recovery from dialysis-requiring AKI were identified (recovery group), and matched with those without recovery and those without AKI, at a 1:1:1 ratio. Results: We identified 625 individuals more than 18 years old [352 male (56.5 %); mean age, 63.3 years] in recovery group and matched 625 individuals in each group. During a mean followed-up of 3.7 years, the incidences of new-onset malignancy were 4.2, 2.9, and 2.6 per 100 person-year among the non-recovery, the recovery, and the non-AKI group, respectively. After adjustment, the recovery group was more likely to develop long-term de novo malignancy than those without AKI [hazard ratio (HR) 1.44, 95 % confidence interval (CI) 1.02-2.03; p = 0.04], while less likely than those who did not recover (HR 0.66, 95 % CI 0.45-0.98; p = 0.04). Conclusions: Dialysis-requiring AKI can post a long-term risk of de novo malignancy for those who survive from the initial insult. Even patients who have recovered from dialysis still carry a significantly higher possibility of developing malignancy than those without AKI episode. ? 2014 Springer-Verlag.

This study evaluated the associations between economic, social, psychological factors, and health-related quality of life of hemodialysis patients. Cross-sectional study design was used. End-stage renal disease patients who had received maintenance hemodialysis for more than 2 months at 14 centers in northern Taiwan were invited to participate. Demographic, economic, and psychosocial data of patients were collected. Depression was assessed by the Beck Depression Inventory. Health-related quality of life was measured by the Medical Outcomes Study Short-Form 36. Multivariable linear regression analyses were performed. Eight hundred sixty-one patients (373 males, mean age 59.4 ± 13.2 years) completed the study. Higher monthly income was positively associated with role emotional and mental health (P < 0.05), and so was increased frequency of social activities with social functioning (P < 0.05). The more worries, the stronger the inverse associations with social functioning (P < 0.05) and mental health (P < 0.01). Higher depression scores were associated with lower scores of all Short-Form 36 dimensions (P < 0.01). Higher monthly income and increased social activities are associated with better health-related quality of life, whereas more worries and higher depression scores are associated with worse health-related quality of life of hemodialysis patients. ? 2009, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.