Uremic Patients Research Articles

Effect of dialyzer membranes on mortality in uremic patients undergoing long-term hemodialysis: A Nationwide population-based study using the Taiwan Dialysis Registry Data System 2005-2012.

The characteristics in dialyzer are associated with mortality in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD). This study is to investigate the effects of dialyzer membranes on 3-year mortality in ESRD patients. From the long-term nationwide population database. Prevalent HD patients during 2005-2012 were enrolled. Our main analysis to calculate the effect was cox regression multivariate model. Overall, the mean age of all population (N= 73 565) was 61.0± 13.6 years, the observation period is 2.46 years ±0.98 within 3 years and 64.6% used polysulfone (PS), polymethyl methacrylate (PMMA) (11.6%), polyethersulfone (11.4%), and cellulose triacetate (CTA) (10.7%), ethylene vinyl alcohol (EVAL) (hazard ratio [HR] 2.72, 95% confidence interval [CI] 1.71-4.33) and CTA (HR 1.35, 95% CI 1.12-1.64) were associated with higher mortality than PS, but PMMA was not. EVAL and CTA adversely affected mortality and PMMA had no protective role. Further investigations on membrane characters on HD patients are warranted. Taipei Medical University (TMU) (TMU-JIRB (No. N201804051).

Volume Resuscitation and Progression to Organ Failure in Shiga Toxin-Producing Escherichia coli Infection in Adults.

OBJECTIVES:Shiga toxin-producing Escherichia coli infection is associated with dysentery and the hemolytic uremic syndrome, marked by the triad of microangiopathic hemolytic anemia, acute kidney failure, and thrombocytopenia. Descriptions of Shiga toxin-producing Escherichia coli outbreaks causing hemolytic uremic syndrome in adults are sparse, and management strategies are largely adapted from pediatric literature where aggressive fluid administration is recommended. However, these may not be ideal for adults.DESIGN:We present a case series of an Shiga toxin-producing Escherichia coli outbreak in U.S. Marine Corps recruits.SETTING:We review the clinical course, laboratory data, and fluid resuscitation used in hospitalized patients during the 2017 Shiga toxin-producing Escherichia coli outbreak at Marine Corps Recruit Depot, San Diego.PATIENTS:Patients admitted to the hospital for complications from Shiga toxin-producing Escherichia coli infection. All were previously healthy men between the ages of 17 and 20 years.INTERVENTIONS:Isotonic crystalloid fluid resuscitation during the first 72 hours.MEASUREMENTS AND MAIN RESULTS:Of 244 identified cases of Shiga toxin-producing Escherichia coli infection, 30 required hospitalization, 15 progressed to hemolytic uremic syndrome, and five required hemodialysis. Patients were admitted and given aggressive IV fluid hydration. Those who progressed to hemolytic uremic syndrome received on average 8.4 L of isotonic crystalloid over the initial 72 hours, with up to 18% of body weight delivered. The six critically ill patients received a mean 12.2 L in the first 72 hours. Those who did not progress to hemolytic uremic syndrome received a mean 3.0 L of crystalloid. If oligoanuria developed, a net-even fluid balance was maintained. The amount of volume infused was not associated with improved outcomes. The patients with the highest fluid balance totals more often required dialysis than those who received less fluid. One hemolytic uremic syndrome patient developed flash pulmonary edema.CONCLUSIONS:The aggressive IV hydration protocols (as a percentage of body weight) in the pediatric literature may not be applicable to adults diagnosed with hemolytic uremic syndrome. A more conservative fluid strategy in adults with hemolytic uremic syndrome merits further investigation.

Effects of high-flux hemodialysis combined with levocarnitine on blood lipid metabolism, calcium and phosphorus metabolism, iPTH, cardiac function and inflammation of uremic patients.

article: Effects of high-flux hemodialysis combined with levocarnitine on blood lipid metabolism, calcium and phosphorus metabolism, IPTH, cardiac function and inflammation of uremic patients - Minerva Medica 2021 May 31 - Minerva Medica - Journals

Local NF-κB Activation Promotes Parathyroid Hormone Synthesis and Secretion in Uremic Patients.

Secondary hyperparathyroidism (SHPT) in uremic patients is characterized by parathyroid gland (PTG) hyperplasia and parathyroid hormone (PTH) elevation. Previously, we demonstrated that NF-κB activation contributed to parathyroid cell proliferation in rats with chronic kidney disease. Although vitamin D inhibits inflammation and ameliorates SHPT, the contribution of vitamin D deficiency to SHPT via local NF-κB activation remains to be clarified. PTGs collected from 10 uremic patients with advanced SHPT were used to test the expressions of vitamin D receptor (VDR), NF-κB, and proliferating cell nuclear antigen (PCNA). Freshly excised PTG tissues were incubated for 24 hours in vitro with VDR activator (VDRA) calcitriol or NF-κB inhibitor pyrrolidine thiocarbamate (PDTC). Chromatin immunoprecipitation (ChIP) and luciferase reporter assays were performed to investigate the regulation of PTH transcription by NF-κB. We found higher levels of activated NF-κB and lower expression of VDR in nodular hyperplastic PTGs than in diffuse hyperplasia. In cultured PTG tissues, treatment with VDRA or PDTC inhibited NF-κB activation and PCNA expression, and downregulated preproPTH mRNA and intact PTH levels. ChIP assays demonstrated the presence of NF-κB binding sites in PTH promoter. Furthermore, in luciferase reporter assays, addition of exogenous p65 significantly increased PTH luciferase activity by 2.4-fold (P < 0.01), while mutation of NF-κB binding site at position -908 of the PTH promoter suppressed p65-induced PTH reporter activity (P < 0.01). In summary, local NF-κB activation contributes to SHPT and mediates the transcriptional activation of PTH directly in uremic patients. Vitamin D deficiency may be involved in SHPT via the activation of NF-κB pathway.

Peripheral Neuropathy Burden in Hemodialysis and Liver Cirrhosis in a Sample of Egyptian Patients

Background: Chronic kidney disease [CKD] and liver cirrhosis [LC] are significant public health challenges in both developed and developing countries, resulting in an impairment in quality of life worldwide. Patients' morbidity and mortality are primarily due to neurological problems that occur as a result of these conditions. Peripheral neuropathy [PN] is a common neurological complication that has been related to the severity of the disability. The aim of the work: To evaluate the prevalence and patterns of PN in cirrhotic and uremic patients on hemodialysis [HD] at Al-Azhar University Hospitals in Cairo, Egypt. Patients and Methods: A cross-sectional study was performed on patients recruited from nephrology unit, tropical and internal medicine departments at Al-Azhar University Hospitals in Cairo. Sixty HD patients and sixty cirrhotic patients were investigated. All patients were submitted to clinical evaluation as well as electrophysiological studies and laboratory investigations. Results: Neuropathy was diagnosed in 76.7% and 73.3% of HD and LC groups respectively. Patients with neuropathy showed significantly higher duration of dialysis and cirrhosis in both groups, higher urea and potassium levels and autonomic presentation [39.1%] in HD group and higher grades “B” & “C” in Child-Pugh classification and motor [18.2%] and asymptomatic [29.5%] presentations in LC group. Sensory symptoms were present in 45.7% and 34.1% in HD and LC groups respectively with no significant difference. Both axonal and mixed types were insignificantly more prevalent than pure demyelinating neuropathy in both groups. Conclusion: The present study emphasized the high prevalence of PN in patients with CKD on HD and patients with LC with different patterns of presentation denoting wide variety of pathological mechanisms.

Paraoxonase 1 concerning dyslipidaemia, cardiovascular diseases, and mortality in haemodialysis patients

Paraoxonase 1 (PON1) is known for preventing atherosclerosis through lipid-modifying features, antioxidant activity, anti-inflammatory, anti-apoptosis, anti-thrombosis, and anti-adhesion properties. Uremic patients requiring haemodialysis (HD) are especially prone to atherosclerosis and its complications. We analysed the PON1 gene (PON1) polymorphisms and serum PON1 (paraoxonase) activity concerning dyslipidaemia and related cardiovascular diseases and mortality to show how they associate under uremic conditions modified by maintenance HD treatment. The rs662 AA + AG (OR 1.76, 95%CI 1.10–2.80, P = 0.018), rs854560 TT (OR 1.48, 95%CI 1.04–2.11, P = 0.031), and rs854560 AT + TT (OR 1.28, 95%CI 1.01–1.63, P = 0.040) contributed to the prevalence of atherogenic dyslipidaemia diagnosed by the triglyceride (TG)/HDL-cholesterol ratio ≥ 3.8. The normalized serum PON1 activity positively correlated with atherogenic dyslipidaemia (ẞ 0.67 ± 0.25, P = 0.008). The PON1 rs854560 allele T was involved in the higher prevalence of ischemic cerebral stroke (OR 1.38, 1.02–1.85, P = 0.034). The PON1 rs705379 TT genotype contributed to cardiovascular (HR 1.27, 95% CI 1.03–1.57, P = 0.025) and cardiac (HR 1.34, 95% CI 1.05–1.71, P = 0.018) mortality. All P-values were obtained in multiple regression analyses, including clinical variables. Multifaceted associations of PON1 with dyslipidaemia, ischemic cerebral stroke, and cardiovascular mortality in HD patients provide arguments for the consideration of PON1 and its protein product as therapeutic targets in the prevention of atherosclerosis and its complications in uremic patients.

Predialysis and Dialysis Therapies Differently Affect Nitric Oxide Synthetic Pathway in Red Blood Cells from Uremic Patients: Focus on Peritoneal Dialysis.

Red blood cells (RBCs) have been found to synthesize and release both nitric oxide (NO) and cyclic guanosine monophosphate (cGMP), contributing to systemic NO bioavailability. These RBC functions resulted impaired in chronic kidney disease (CKD). This study aimed to evaluate whether predialysis (conservative therapy, CT) and dialysis (peritoneal dialysis, PD; hemodialysis, HD) therapies used during CKD progression may differently affect NO-synthetic pathway in RBCs. Our data demonstrated that compared to PD, although endothelial-NO-synthase activation was similarly increased, HD and CT were associated to cGMP RBCs accumulation, caused by reduced activity of cGMP membrane transporter (MRP4). In parallel, plasma cGMP levels were increased by both CT and HD and they significantly decreased after hemodialysis, suggesting that this might be caused by reduced cGMP renal clearance. As conceivable, compared to healthy subjects, plasma nitrite levels were significantly reduced by HD and CT but not in patients on PD. Additionally, the increased carotid intima-media thickness (IMT) values did not reach the significance exclusively in patients on PD. Therefore, our results show that PD might better preserve the synthetic NO-pathway in CKD-erythrocytes. Whether this translates into a reduced development of uremic vascular complications requires further investigation.

Chitinase-3-like protein 1 is an independent risk factor for the early failure of forearm autologous arteriovenous fistulas in uremic patients.

Chitinase-3-like protein 1 (CHI3L1) has been introduced as a marker of inflammation in different diseases, which can promote cell proliferation and differentiation. It has also been demonstrated that elevated serum CHI3L1 concentration can independently predict all-cause mortality in uremic patients. However, the impact of CHI3L1 on the early failure of autologous arteriovenous fistulas (AVFs) in uremic patients remains unknown. We conducted a prospective observational cohort study of 109 uremic patients (mean age 53.2 ± 14.7 years, 67.9% males), who received forearm AVF surgery, and were consecutively enrolled with a median follow-up time of 15 months. The early failure was defined as a fistula that never developed adequately for dialysis or that failed within the first 3months of use. Serum CHI3L1 concentration was determined by the ELISA method. Among 109 uremic patients, 24 patients had AVF failure. The optimal cutoff value based on the receiver operating characteristics analysis of CHI3L1 was 122.6ng/mL, with the area under the curve of 0.73 (P=0.001). The Kaplan-Meier survival analysis demonstrated that patients with CHI3L1 < 122.6ng/mL had better AVF patency than patients with CHI3L1 ≥ 122.6ng/mL (Log-rank test, P=0.001). Multivariable Cox proportional hazards regression analysis showed that baseline CHI3L1 level (≥ 122.6ng/mL vs. < 122.6ng/mL) was significantly associated with AVF failure after adjustment for confounders (adjusted hazard ratio [HR], 3.67; 95% CI, 1.44-9.36). The study demonstrated that Increased baseline serum level of CHI3L1 is independently associated with higher risk of the early failure of forearm AVFs.

Effect of High-Density Lipoprotein from Healthy Subjects and Chronic Kidney Disease Patients on the CD14 Expression on Polymorphonuclear Leukocytes.

In uremic patients, high-density lipoprotein (HDL) loses its anti-inflammatory features and can even become pro-inflammatory due to an altered protein composition. In chronic kidney disease (CKD), impaired functions of polymorphonuclear leukocytes (PMNLs) contribute to inflammation and an increased risk of cardiovascular disease. This study investigated the effect of HDL from CKD and hemodialysis (HD) patients on the CD14 expression on PMNLs. HDL was isolated using a one-step density gradient centrifugation. Isolation of PMNLs was carried out by discontinuous Ficoll-Hypaque density gradient centrifugation. CD14 surface expression was quantified by flow cytometry. The activity of the small GTPase Rac1 was determined by means of an activation pull-down assay. HDL increased the CD14 surface expression on PMNLs. This effect was more pronounced for HDL isolated from uremic patients. The acute phase protein serum amyloid A (SAA) caused higher CD14 expression, while SAA as part of an HDL particle did not. Lipid raft disruption with methyl-β-cyclodextrin led to a reduced CD14 expression in the absence and presence of HDL. HDL from healthy subjects but not from HD patients decreased the activity of Rac1. Considering the known anti-inflammatory effects of HDL, the finding that even HDL from healthy subjects increased the CD14 expression was unexpected. The pathophysiological relevance of this result needs further investigation.

Evolutionary seroepidemiology of viral hepatitis and the gap in hepatitis C care cascades among uraemic patients receiving haemodialysis in Taiwan-the Formosa-Like Group.

Uraemic patients undergoing haemodialysis are at high risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. We aimed to evaluate the evolutionary seroprevalence of viral hepatitis and the gap in HCV care cascades in this special population by a large-scale surveillance study in Taiwan. Uraemic patients on maintenance haemodialysis from 22 sites (FORMOSA-LIKE group) in 2012 (n=1,680) and 2019 (n=2,326) were recruited for this study. The distributions and sequential changes of viral hepatitis markers were analysed. The prevalence of anti-HCV antibody and hepatitis B surface antigen (HBsAg) seropositivity was 13.6% (316/2326) and 11.5% (267/2326), respectively, in 2019 compared with 17.3% (290/1680, P=.002) and 13.6% (229/1680, P=.046), respectively, in 2012. The HCV-viremic rate among anti-HCV-seropositive patients was significantly lower in 2019 than in 2012 (56.3% [178/316] vs. 73.8% [214/290], P<.001). The HCV treatment rate increased from 2.3% (5/217) in 2012 to 21.7% (49/226) in 2019 (P<.001). In the sequential analysis of the 490 patients who participated in both screens, 17 of the 55 HCV-viremic patients became HCV RNA seronegative, including 13 by antivirals and four spontaneously. By contrast, one anti-HCV-seropositive but nonviremic patient became viremic, and six anti-HCV-seronegative patients became anti-HCV-seropositive in 2019. The annual incidence of new HCV was 0.2%/year. Seven HBsAg-seropositive patients experienced HBsAg loss (1.25%/year). Two patients had new anti-HBc seropositivity (new HBV exposure: 0.57%/year). The seroprevalence of viral hepatitis decreased in an 8-year follow-up but remained prevalent, and the treatment of HCV infection was underutilized in uraemic patients. Additional efforts are needed to enhance the HCV treatment uptake of uraemic patients. Clinical Trial IDs: NCT03803410, NCT01766895.

Macrophage and adipocyte interaction as a source of inflammation in kidney disease

In obesity, adipose tissue derived inflammation is associated with unfavorable metabolic consequences. Uremic inflammation is prevalent and contributes to detrimental outcomes. However, the contribution of adipose tissue inflammation in uremia has not been characterized. We studied the contribution of adipose tissue to uremic inflammation in-vitro, in-vivo and in human samples. Exposure to uremic serum resulted in activation of inflammatory pathways including NFκB and HIF1, upregulation of inflammatory cytokines/chemokines and catabolism with lipolysis, and lactate production. Also, co-culture of adipocytes with macrophages primed by uremic serum resulted in higher inflammatory cytokine expression than adipocytes exposed only to uremic serum. Adipose tissue of end stage renal disease subjects revealed increased macrophage infiltration compared to controls after BMI stratification. Similarly, mice with kidney disease recapitulated the inflammatory state observed in uremic patients and additionally demonstrated increased peripheral monocytes and inflammatory polarization of adipose tissue macrophages (ATMS). In contrast, adipose tissue in uremic IL-6 knock out mice showed reduced ATMS density compared to uremic wild-type controls. Differences in ATMS density highlight the necessary role of IL-6 in macrophage infiltration in uremia. Uremia promotes changes in adipocytes and macrophages enhancing production of inflammatory cytokines. We demonstrate an interaction between uremic activated macrophages and adipose tissue that augments inflammation in uremia.

Impact of the Living Donor Age and the Hormonal Profile of Algerian Renal Transplant Recipients

Kidney transplantation is the best treatment received by an uremic patient. One of the major advantages of transplantation is restoring a hormonal profile as before the chronic kidney disease. However, the posttransplant state depends on several factors including the quality of the graft. In this study, we assessed the donor age in living donors-recipients as well as the exploration of their hormonal profile. This is a single-center follow-up study over a period of 3 years, including 90 kidney recipients transplanted by living donors. We performed blood measurements of parathyroid hormone, prolactin, follicle stimulating hormone, luteinizing hormone, testosterone, estradiol, blood glucose, urea, creatinine, total cholesterol, triglycerides, high density lipoprotein-cholesterol, uric acid, albumin, and 24-h proteinuria. Glomerular filtration rate, body mass index, and low-density cholesterol were calculated. To analyze the donor age effect on recipients, the patients were divided into two groups according to donors age (<40 years and ≥40 years). The hormonal profile was normal for almost the majority of patients. In addition, we noted a return to dialysis associated with certain metabolic abnormalities and a donor age >40 years. Exploring the hormonal profile of the recipient is recommended. The donor age significantly influences the recipient fate but not their hormonal profile.

Acute Guillain Barre Syndrome in A Hemodialysis Patient with Diabetic Nephropathy: A Case Report

Acute Guillain Barre syndrome is a common type of autoimmune mediated acute peripheral neuropathy. Its initial symptoms are symmetrical limb weakness, sensory disturbance, pain or other symptoms. This paper reports a case of acute Guillain Barre syndrome in a uremic patient with diabetic nephropathy and long-term regular hemodialysis, in order to further explore the clinical manifestations and differential characteristics of uremic patients with acute Guillain Barre syndrome, improve the early diagnosis rate of uremic patients with acute Guillain Barre syndrome, make the patients get timely treatment, so as to reduce the disability of such patients To improve the prognosis of the disease.

The Effect of Virgin Coconut Oil (VCO) with Lotion on the Skin Moisture among Uremic Patients Undergoing Hemodialysis

Objects: to examine the effect of Virgin Coconut Oil on the skin moisture among uremic patients undergoinghemodialysis.Methods: the study was a quasi-experiment with a pre-test and post-test equivalent control group. The studypopulation was 80 persons.Results: The results showed that there was a significant effect of skin moisture on the intervention groupbefore and after being given Virgin Coconut Oil. Data were analyzed by pair t-test and independent test.Conclusion: There is no need for special emulsions such as Virgin Coconut Oil to moisturize the skin inuremic patients undergoing hemodialysis because of using ordinary lotions can moisturize the skin, but itmust be used regularly, twice a day after bathing, the lotion used must also be a lotion that does not containmercury as well as chemicals that can harm the skin.

The role of glycated albumin as a marker of glycemic state in type 2 diabetic patients under hemodialysis

Background: Glycated albumin (GA) and glycated hemoglobin (HbA1c) levels are affected not only by plasma glucose levels but also by albumin metabolism and hemoglobin metabolism, respectively. Our study is aiming to evaluate the role of (GA) as an indicator of the glycemic state and its correlation with HbA1c in hemodialysis patients with diabetes mellitus. Research Design and Methods: Our study is a cohort prospective study done on 50 chronic uremic diabetic patients 23 males and 27 females at Al-Azhar Assuit University Hospital, from August 2016 to February 2017. All the studied patients were on regular HD 3 times/week, 4 hours session. Multiple regression analysis was done to assess the correlation between glycated albumin and HbA1c as indicators of glycemic state. Patients with pregnancy, nephrotic syndrome, neoplastic disorders, and anemia due to causes other than chronic renal disease as hemolytic anemia, chronic liver diseases, thyroid disorders, and those under immunosuppressive therapy were excluded. Results: GA had had a highly significant predictor for PG (p-value = 0.001) VS HbA1c%, which was had a significant predictor (p-value = 0.021). Conclusion: Our study suggested that while HbAlc is considered the gold standard test in estimating the glycemic state in diabetic patients, GA can be used as an indicator of the glycemic state in uremic patients on regular HD.

PREVALENCE OF DYSLIPIDEMIA IN CHRONIC KIDNEY DISEASE

BACKGROUND: Chronic kidney disease (CKD) is a worldwide health problem with increasing incidence and prevalence. The annual mortality rate of patients undergoing dialysis is more than 20%. The leading causes of morbidity and mortality in CKD are cardiovascular diseases, primarily atherosclerotic coronary artery disease. Dyslipidemia is a common complication of CKD. It is a signicant risk factor for the development of cardiovascular disease. Alteration in lipid prole correlates with declining glomerular ltration rate (GFR) and degree of proteinuria. AIM: Ÿ To identify the altered lipid prole in patients with chronic kidney disease. Ÿ To note the alterations in different lipoprotein fractions in chronic kidney disease patients. Ÿ To note the difference in lipid prole in CKD patients on conservative management and maintenance hemodialysis. MATERIALS AND METHODS: A Hospital-based observational Prospective study was conducted in the Department of Medicine, Santhiram medical college, and general hospital for six months. Chronic kidney disease patients who are non-diabetic were taken for the study with informed and written consent taken from the patient. RESULTS: Plasma triglycerides(153.14±54.37mg/dl) were elevated, and plasma HDL (36±43.5mg/dl) was decreased in CKD patients. There is no signicant elevation of total cholesterol levels. On comparing lipid proles of CKD patients on conservative management and hemodialysis, there was a signicant increase in triglycerides in the hemodialysis group. CONCLUSION: Signicant elevation of triglycerides and VLDL was observed in patients of CKD on hemodialysis. Further, a reduced HDL cholesterol level was also observed in both conservative and hemodialysis groups of CKD patients. Dyslipidemia observed in Uremic patients may contribute to accelerated atherosclerosis and further progression of chronic renal failure.

Effect of Teaching Guidelines on Uremic Patients Regarding Arteriovenous Fistula Occlusion

Background: ArterioVenous Fistula (AVF) is the preferred hemodialysis access type because ithas better rates and fewer complications than other types. The aim of this study was to evaluate theeffect of teaching guidelines on uremic patients regarding arteriovenous fistula occlusion. Researchdesign: A quasi experimental design was utilized to meet the aim of study. Setting: This study wasconducted in dialysis unit at Benha University Hospital and Benha Teaching Hospital. The sample: Allavailable patients (purposive sample) at dialysis unit, the total sample included100 patients. Tools:Two tools were used for data collection. I: questionnaire sheet for patients was used and consist ofthree parts. Socio demographic data for patient, medical history for patient and knowledge assessment.II: Patients' self-care practices regarding AVF prevention. Results: 31% of the studied patients wereaged from50-60years, while 41% of them diploma education and more than half (58%) of them weremales and not working. Regarding studied patients their knowledge about AV fistula pre and postguidelines of studied patients had in correct answers pre implementing guidelines. While postguidelines implementation of them were having correct answers .Conclusion: Less than third of thestudied patients had good level of total knowledge during pre-guideline and more than three quarters ofthe patients had good level of total knowledge during post guideline. There was statistically significantrelation between total knowledge and total self-practices scores about arteriovenous fistula.Recommendation: Develop and implement health education program for uremic patients to increasetheir knowledge about arteriovenous fistula and practices should be followed before and after dialysissession. Further researches are needed to study barriers and motivators' factors to encourage patientsfor maintain about fistula.

Analysis of vortex ring formation in the heart chamber by instantaneous vortex deviation based on convolutional neural network

The formation of vortex rings during the left ventricle (LV) filling is an optimized mechanism for blood transport, and the vorticity is an important measure of a healthy heart and LV. There is a relationship between abnormal diastolic vortex structure and impaired LV, and hence vortex identification is vital for understanding the underlying physical mechanism of blood flow. However, due to lack of quantitative methods, defining, computing and mapping the left ventricular vortices has not been rigorously studied previously. In this paper, a novel method of vortex detection based on the convolutional neural network (CNN) is created, which enables determination of the boundary of vortex and integrates the local and global flow fields. We have used the CNN-based vortex identification and vector flow mapping (VFM) to quantify left ventricular vorticity. In the clinical application of our methodology to healthy subjects and uremic patients, we find differences in the strength and position of the vortices between healthy and patients with uremia cardiomyopathy. Our results can accurately indicate the role of vortex formation in intracardiac flow, and provide new insights into the blood flow within the heart structure.

Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study

Background Incremental peritoneal dialysis (iPD) can be useful in patients with residual renal function (RRF). RRF was well preserved and similar survival was shown in iPD compared to conventional PD (cPD) in previous study. However, the long-term survival of iPD remains unclear compared to cPD in diabetic patients. This study evaluated whether patient survival, hospitalization and peritonitis, and PD survival in iPD were lower than cPD or not. Methods We conducted a 12-year retrospective observational study of 303 PD patients (232 cPD and 71 iPD) using propensity score matching by age, gender, and diabetes mellitus (DM). Finally, 78 cPD patients and 39 iPD patients were included and 44 patients had DM. Incremental PD was defined as starting PD with two or three manual exchanges per day. Results The median duration of iPD was 24.1 months and iPD had higher RRF than cPD. Compared to cPD, the patient survival, PD survival and hospitalization benefits were not found in iPD but diabetic iPD patients had significantly longer survival and less hospitalization. Cumulative risk for peritonitis was lower iPD and PD duration of iPD was longer than those of cPD. The iPD was an independent factor associated with survival in patients with DM. Conclusions Incremental PD may be a safe PD modality to initiate and maintain PD in less uremic patients with tolerable RRF. Incremental PD would be a benefit for survival in diabetic patients. Further prospective studies are necessary to confirm the effectiveness of iPD in PD patients with similar RRF.

High peak of carbamylated hemoglobin discordant with urea level: a case report

ABSTRACT Hemoglobin A1c (HbA1c) measurement is commonly performed in diabetes mellitus patients to monitor glycemic control over the last three to four months. Carbamylated hemoglobin, which is the hemoglobin that binds to isocyanic acid derived from urea, is one of the possible analytical interference in the uremic patient. When measured by ion-exchange high-performance liquid chromatography (HPLC), carbamylated hemoglobin forms a peak that overlaps the peak of HbA1c, causing a falsely elevated HbA1c result. We report a case of a 60-years-old man who had a spurious increase in HbA1c, with a high carbamylated hemoglobin peak disproportionate to the urea value. Subsequent hemoglobin analysis using hemoglobin electrophoresis and HPLC hemoglobin testing system suggested hemoglobin J (Hb J) variant. Our case highlighted the possibility of misleading HbA1c interpretation in the presence of a high carbamylated hemoglobin peak, but not proportionate to urea value. In this study, Hb J was detected. A method free from hemoglobin variant interference should be used ideally, and monitoring glycemic control should be performed using alternative methods, such as serum fructosamine or continuous glucose monitoring.