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Lin C.-H.,National Taiwan University Hospital | Wu V.-C.,National Taiwan University Hospital | Li W.-Y.,National Taiwan University Hospital | Sy H.-N.,Changhua Christian Hospital | And 10 more authors.
European Journal of Neurology | Year: 2013

Background and purpose: Restless legs syndrome (RLS) is an underestimated movement disorder in patients with end-stage renal disease (ESRD). Several clinical and laboratory factors were inconsistently reported to associate with RLS. We aim to perform a large-scale multicenter study to investigate the possible associated risk factors of RLS in patients with ESRD in Taiwan, a country with the highest incidence of uremia in the world. Methods: From October 2009 to October 2011, we constitutively recruited 1130 patients with ESRD from 17 hemodialysis centers. Demographic, laboratory data, presence and severity of RLS were collected. Odds ratios (ORs) were estimated by logistic regression models. Results: We found the prevalence of RLS to be 25.3% in patients with ESRD. Having type 2 diabetes [OR=3.61 (2.27-5.77), P<0.01], low serum transferrin saturation [OR=1.42 (1.01-2.03), P<0.05] and duration of dialysis [OR=1.09 (1.03-1.14), P<0.01] were associated with RLS. In contrast, high serum hemoglobin level was inversely associated with RLS [OR=0.61 (0.40-0.89), P<0.05]. RLS has a significant impact on sleep quality in dialysis patients. Among patients with RLS, history of type 2 diabetes [OR=4.04 (1.65-10.79), P<0.05], low serum hemoglobin level [OR=5.41 (2.43-13.12), P<0.01] and duration of dialysis [OR=1.01 (1.01-1.02), P<0.01] were associated with increased severity of RLS. Conclusions: Our findings demonstrated that RLS is common in Taiwanese dialysis patients. Clinicians should have a high suspicion for the presence of RLS symptoms in patients with ESRD, especially those with type 2 diabetes, anemia, low serum iron status and long duration of dialysis. © 2013 EFNS.


Hsieh J.-C.,Buddhist Tzu Chi General Hospital | Wang J.-H.,Buddhist Tzu Chi General Hospital | Wang J.-H.,Tzu Chi University | Chen Y.-C.,Buddhist Tzu Chi General Hospital | And 3 more authors.
Archives of Medical Research | Year: 2013

Background and Aims: Long-acting natriuretic peptide (LANP) is one of the peptide hormones in atrial natriuretic peptide (ANP) prohormone. Its biological properties are blood pressure regulation, maintenance of plasma volume and anticancer effects. The aim of this study was to evaluate the relationship between metabolic syndrome (MetS) and fasting serum LANP concentration in hypertensive patients. Methods: Fasting blood samples were obtained from 224 patients with or without hypertension. MetS and its components were defined using diagnostic criteria from the International Diabetes Federation. Results: Eighty-eight hypertensive patients (59.5 %) had MetS. Hypertensive patients with MetS had higher body weight (p = 0.003), waist circumference (p = 0.003), body mass index (p = 0.002), triglyceride concentrations (p = 0.029), insulin levels (p = 0.001), HOMA-IR (p <0.003) and HOMA-β (p = 0.049) and lower HDL-C concentrations (p = 0.001), LANP levels (p = 0.012) than those without MetS. The univariable linear regression analysis showed that age (p = 0.038) and the BUN concentration (p = 0.022) were positively correlated with the serum LANP levels, whereas the insulin level (p = 0.001), HOMA-IR (p = 0.004), and HOMA-β (p = 0.001) were negatively correlated with the fasting serum LANP levels among the hypertensive patients. Multivariable forward stepwise linear regression analysis of the significant variables showed that the HOMA-β (β = -0.387, R2 = 0.141, p <0.001) was an independent predictor of fasting serum LANP levels in hypertensive patients. Conclusions: LANP level is significantly reduced in hypertensive patients affected by MetS and is negatively related to pancreatic beta cell function in hypertensive patients. © 2013 IMSS.


Lin H.-H.,China Medical University at Taichung | Liou H.-H.,Hsin Jen Hospital | Wu M.-S.,National Taiwan University Hospital | Huang C.-C.,China Medical University at Taichung
BMC Nephrology | Year: 2016

Background: Fetuin-A is known as a circulating inhibitor of vascular calcification. Factors associated with serum fetuin-A concentrations after long-term use of different phosphate binders in hemodialysis patients is still uncertain. Methods: In the post-hoc study, we analyzed serum fetuin-A and biochemical factors (Ca, P, i-PTH, hsCRP, TG, LDL-C) in 50 hemodialysis patients, who completed a 48-week, open-Label, controlled randomized parallel-group study. 23 patients received sevelamer and 27 patients received calcium carbonate. Results: After the 48-week treatment, the sevelamer group had less serum calcium increment, less iPTH decrement, more ALK-P increment, more hsCRP decrement and more LDL-C decrement. There was no significant difference in the serum fetuin-A decrement between two groups. Decreased serum fetuin-A levels were found after 48-week treatment in both groups: from 210.61 (104.73) to 153.85 (38.64) ug/dl, P = 0.003 in sevelamer group, from 203.95 (107.87) to 170.90 (58.02) ug/mL, P =0.002 in calcium group. The decrement in serum fetuin-A (Δfetuin-A) levels was associated with ΔCa (ρ = - 0.230, P = 0.040), ΔiPTH (ρ = 0.306, P = 0.031) and Δalbumin (ρ = 0.408, P = 0.003), not associated with sevelamer use, ΔP and ΔhsCRP. Conclusion: After long-term sevelamer or calcium carbonate treatment, both groups of maintenance HD patients had lower serum fetuin-A levels. Serum levels of increased calcium, decreased iPTH and decreased albumin were associated with the serum fetuin-A decrement. © 2016 Lin et al.


Lin H.-H.,China Medical University at Taichung | Liou H.-H.,Hsin Jen Hospital | Wu M.-S.,National Taiwan University Hospital | Lin C.-Y.,China Medical University at Taichung | Huang C.-C.,China Medical University at Taichung
Nephrology | Year: 2014

Aims: Fibroblast growth factor 23 (FGF23) and Klotho are associated with vascular calcification and cardiovascular disease in dialysis patients. Sevelamer has been shown to reduce progression of vascular calcification. This study aimed to determine the long-term effect of sevelamer treatment on serum FGF23 and Klotho levels in chronic haemodialysis (HD) patients. Methods: In the post-hoc analysis, we measured serum FGF23, Klotho and other biochemical factors (Ca, P, i-PTH, hsCRP, LDL-C) in 50 haemodialysis patients, who completed a 48-week, open-Label, controlled randomized parallel-group study. Twenty-three patients received sevelamer and 27 patients received calcium carbonate. Results: After 48-week sevelamer treatment, there were significant changes with lower LDL-C (from 2.82 ± 0.78 to 1.65 ± 0.53 mmol/L, P = 0.000), lower FGF23 (from 2465.97 (2568.88) to 795.61 (1098.39), P = 0.000) and higher s-Klotho levels (from 189.35 (161.88) to 252.94 (517.80) pg/mL, P = 0.000). In calcium carbonate group, there were no significant changes of LDL-C and FGF23, but with a borderline significant increase of s-Klotho level (from 142.34 (265.24) to 188.57 (252.38) pg/mL, P = 0.054). Multivariate analysis showed that FGF23 decrement was associated with sevelamer treatment (β = -0.277, P = 0.005), change of serum phosphate (β = 0.609, P = 0.000) and calcium levels (β = 0.635, P = 0.000). The increase of serum Klotho was associated with the decrease of serum phosphate (β = 0.490, P = 0.019). Conclusion: Maintenance HD patients had lower serum FGF23 levels, accompanied with significantly increased serum Klotho levels, after 48-week sevelamer treatment. The FGF23 decrement was associated with sevelamer use, the change of serum phosphate and calcium levels. The serum Klotho increment was proportional to the phosphate-lowering power of the binders. © 2014 Asian Pacific Society of Nephrology.


PubMed | China Medical University at Taichung, Hsin Jen Hospital and National Taiwan University Hospital
Type: | Journal: BMC nephrology | Year: 2016

Fetuin-A is known as a circulating inhibitor of vascular calcification. Factors associated with serum fetuin-A concentrations after long-term use of different phosphate binders in hemodialysis patients is still uncertain.In the post-hoc study, we analyzed serum fetuin-A and biochemical factors (Ca, P, i-PTH, hsCRP, TG, LDL-C) in 50 hemodialysis patients, who completed a 48-week, open-Label, controlled randomized parallel-group study. 23 patients received sevelamer and 27 patients received calcium carbonate.After the 48-week treatment, the sevelamer group had less serum calcium increment, less iPTH decrement, more ALK-P increment, more hsCRP decrement and more LDL-C decrement. There was no significant difference in the serum fetuin-A decrement between two groups. Decreased serum fetuin-A levels were found after 48-week treatment in both groups: from 210.61 (104.73) to 153.85 (38.64) ug/dl, P=0.003 in sevelamer group, from 203.95 (107.87) to 170.90 (58.02) ug/mL, P =0.002 in calcium group. The decrement in serum fetuin-A (fetuin-A) levels was associated with Ca (=- 0.230, P=0.040), iPTH (=0.306, P=0.031) and albumin (=0.408, P=0.003), not associated with sevelamer use, P and hsCRP.After long-term sevelamer or calcium carbonate treatment, both groups of maintenance HD patients had lower serum fetuin-A levels. Serum levels of increased calcium, decreased iPTH and decreased albumin were associated with the serum fetuin-A decrement.


PubMed | Hsin Jen Hospital, Tseng Han Chi Hospital, An Hsin Chushan Clinic, Saint Pauls Hospital and 7 more.
Type: Journal Article | Journal: International urology and nephrology | Year: 2016

Fluid management with body composition monitor based on bioimpedance spectroscopy (BCM-BIS) has been found to be beneficial for dialysis patients. We conducted a study to provide an algorithm for the determination of post-dialysis target weight (PDTW) and to evaluate whether this approach could improve clinical outcomes compared to patients who had PDTW decided clinically.Two hundred and ninety-eight dialysis patients participated in this 1-year randomized controlled trial. The outcomes were all-cause hospitalization rate, AFO or CV-related events, hypertension and intra-dialysis morbidities.80% of post-dialysis weight reached the target set with current algorithm. All-cause hospitalization rate was not different. Incidence of acute fluid overload (AFO) or CV-related events was lower in study group. Longitudinal data showed decreased incidence of hypertension, intra-dialysis morbidities and intra-dialysis hypotension.Assessment of PDTW by BCM-BIS with an explicit algorithm decreased AFO or CV-related events, hypertension and intra-dialysis morbidities. Further studies were required to demonstrate possible benefits of hospitalization rate.


Lee Y.-C.,I - Shou University | Lee Y.-C.,National Cheng Kung University | Hung S.-Y.,I - Shou University | Wang H.-K.,I - Shou University | And 14 more authors.
Sleep | Year: 2015

Study Objectives: Sleep apnea (SA) is characterized by apnea during sleep and is associated with cardiovascular diseases and an increase in allcause mortality. Chronic kidney disease (CKD) is a global health problem that has placed a substantial burden on healthcare resources. However, the relationship between SA and the incidence of CKD is not clear. This study aimed to determine whether SA is an independent risk factor for the development of CKD. Design: Retrospective cohort study. Setting: National Health Insurance Research Database (NHIRD) of Taiwan. Patients or Participants: A total of 4,674 adult patients (age ≥ 30 y) in whom SA was newly diagnosed from 2000 to 2010 were included, together with 23,370 non-SA patients as the comparison group. The two groups were frequency-matched for sex, age, and year of receiving medical service. Each individual was followed until 2011. Interventions: N/A. Measurements and Results: These two groups were monitored and observed for the occurrence of CKD. Patients with SA experienced a 1.94 fold increase (95% confidence interval [CI], 1.52-2.46; P < 0.001) in the incidence of CKD, which was independent of sex, age, and comorbid medical conditions. Additionally, they showed a 2.2-fold increase (95% CI, 1.31-3.69; P < 0.01) in the incidence of end-stage renal disease (ESRD). Conclusions: Patients with sleep apnea are at increased risk for chronic kidney disease and end-stage renal disease compared with the general population. As such, screening renal function and treatment of chronic kidney disease is an important issue in patients with sleep apnea.


PubMed | National Cheng Kung University, I - Shou University and Hsin Jen Hospital
Type: | Journal: BioMed research international | Year: 2015

Peritoneal dialysis (PD) can induce fibrosis and functional alterations in PD patients peritoneal membranes, due to long-term unphysiological dialysate exposure, partially occurring via triggering of epithelial-to-mesenchymal transition (EMT) in peritoneal mesothelial cells (MCs). Vitamin D can ameliorate these negative effects; however, the mechanism remains unexplored. Therefore, we investigated its possible links to MCs EMT inhibition.Peritoneal fibrosis was established in Sprague-Dawley rats by chlorhexidine gluconate (CG) intraperitoneal injection for 21 days, with and without 1,25(OH)2D3 treatment. Morphological and functional evaluation and western blot analysis of EMT marker were performed upon peritoneum tissue. In vitro study was also performed in a primary human peritoneal MC culture system; MCs were incubated with transforming growth factor-1 (TGF-1) in the absence or presence of 1,25(OH)2D3. EMT marker expression, migration activities, and cytoskeleton redistribution of MCs were determined.1,25(OH)2D3 ameliorated CG-induced morphological and functional deterioration in animal model, along with CG-induced upregulation of -SMA and downregulation of E-cadherin expression. Meanwhile, 1,25(OH)2D3 also ameliorated TGF-1-induced decrease in E-cadherin expression, increase in Snai1 and -SMA expression, intracellular F-actin redistribution, and migration activity in vitro.1,25(OH)2D3 can ameliorate CG-induced peritoneal fibrosis and attenuate functional deterioration through inhibiting MC EMT.


Shen T.-W.,Tzu Chi University | Wang C.-H.,Buddhist Tzu Chi General Hospital | Wang C.-H.,Tzu Chi University | Lai Y.-H.,Buddhist Tzu Chi General Hospital | And 5 more authors.
European Journal of Clinical Investigation | Year: 2011

Background: Arterial stiffness is an independent predictor of all-cause and cardiovascular mortality, particularly in patients with chronic kidney disease and end-stage renal disease (ESRD). The objective of this study was to determine the risk factors for de novo arterial stiffness in long-term dialysis patients.Materials and methods: A total of 59 dialysis patients without initial arterial stiffness were studied for 1 year. Cardio-ankle vascular index (CAVI) was measured and a CAVI value ≥ 9 at the end of 1 year was defined as de novo arterial stiffness. The initial baseline characteristics and laboratory parameters and final laboratory parameters after 1 year were analysed.Results: Dialysis patients with de novo arterial stiffness were significantly older than dialysis patients without de novo arterial stiffness. Initial serum phosphorus and calcium × phosphorus product of dialysis patients with de novo arterial stiffness were significantly greater than those of dialysis patients without de novo arterial stiffness. The haematocrit of dialysis patients with de novo arterial stiffness was significantly lower than that of dialysis patients without de novo arterial stiffness. Multivariate logistic regression analysis showed that age and initial serum phosphorus were independent risk factors for de novo arterial stiffness in dialysis patients.Conclusion: After 1-year follow-up, de novo arterial stiffness in dialysis patients as determined by CAVI was significantly associated with age and initial serum phosphorus. © 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation.


PubMed | Hsin Jen Hospital and Buddhist Tzu Chi General Hospital
Type: | Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy | Year: 2016

Anthropometric measurements, including body mass index (BMI), body weight and total fat mass are associated with the bone mineral density (BMD) in the general population. Compared to that in the general population, BMD was lower in dialysis patients. However, the association between anthropometric measurements and BMD is not well-established among peritoneal dialysis (PD) patients. To study this, we conducted a cross-sectional study in 48 chronic PD patients. Anthropometric parameters, biochemical data, and BMD measured by dual energy X-ray absorptiometry in lumbar vertebrae (L2-L4) were collected. Among these PD patients, eight patients (16.7%) had osteoporosis and 22 patients (45.8%) osteopenia, while 18 patients were normal. Older age, decreased height, lower body weight, BMI, triceps skinfold thickness (TSF), mid-arm fat area (MAFA), and higher adiponectin levels were observed in our patients with lower lumbar T-scores. Height, body weight, waist circumference, BMI, body fat mass, TSF, mid-arm circumference, MAFA, and serum phosphorus levels were positively, while age, adiponectin levels were negatively correlated with lumbar BMD levels. According to our multivariate forward stepwise linear regression analysis, TSF (R

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