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Taipei, Taiwan

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. Source


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 2 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. Source


Wu C.-C.,Chi Mei Medical Center | Liou H.-H.,Hsin Jen Hospital | Su P.-F.,Vanderbilt University | Chang M.-Y.,I - Shou University | And 3 more authors.
Nephrology Dialysis Transplantation | Year: 2011

Background. Five components of metabolic syndrome (MetS) have been identified as predictive of cardiovascular events (CVEs) in the general population: impaired fasting glucose, abdominal obesity, hypertriglyceridemia, hypertension and low high-density lipoprotein cholesterol. Whether MetS and its components are also predictive of CVEs in chronic hemodialysis (HD) patients remains unclear. We therefore investigated the role of MetS and its components in patients on chronic HD.Methods. MetS at baseline was diagnosed in 91 HD patients based on the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF) definitions. During a 3-year period, all hospitalizations, CVEs and deaths were recorded and analyzed using Kaplan-Meier survival analysis and Cox regression.Results. There were no differences in the number of CVEs, hospitalizations or deaths between patients with and without AHA/NHLBI-defined MetS; however, patients with IDF-defined MetS were found to be at a higher risk for CVEs (P = 0.006). Cox regression analysis showed that, of the MetS components, abdominal obesity was the single most significant predictor of CVEs (hazard ratio 6.25; 95% confidence interval: 1.65-23.6; P = 0.007).Conclusions. IDF-defined MetS was more predictive of CVEs than AHA/NHLBI-defined MetS. Of the MetS components, abdominal obesity was the single most significant predictor of CVEs in chronic HD patients. © The Author 2011. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. Source


Wang C.-H.,Tzu Chi University | Wang J.-H.,Buddhist Tzu Chi General Hospital | Fang T.-C.,Tzu Chi University | Liou H.-H.,Hsin Jen Hospital | Hsu B.-G.,Tzu Chi University
Blood Purification | Year: 2010

Background:Metabolic syndrome is a significant risk factor for cardiovascular disease and predicts hospitalization in peritoneal dialysis (PD) patients. An inverse association between circulating adiponectin and metabolic syndrome has been observed in humans. However, no data are available on the relationship between metabolic syndrome and serum adiponectin levels in PD patients. Method: Fasting blood samples were obtained from 47 PD patients and 47 subjects in an outpatient department were enrolled as a control group. Metabolic syndrome and its components were defined using diagnostic criteria from the International Diabetes Federation. Adiponectin levels were measured using a commercial enzyme immunoassay kit. Results: Twenty-seven of 47 PD patients (57.5%) had metabolic syndrome. PD patients had lower serum albumin (p < 0.001) and higher serum adiponectin levels (p = 0.016), high-sensitivity C-reactive protein (p = 0.008), creatinine (p < 0.001) and metabolic syndrome (p < 0.001) than controls. The fasting adiponectin level inversely correlated with the metabolic syndrome in these PD patients (p = 0.006). Univariate linear regression analysis showed that the waist circumference (r = -0.304; p = 0.038), body mass index (r = -0.347; p = 0.017), body fat mass (r = -0.305; p = 0.037), white blood count (r = -0.631; p < 0.001), triglyceride (TG; r = -0.526; p < 0.001), and fasting glucose (r = -0.394; p = 0.006) were negatively correlated with the fasting serum adiponectin levels, while high-density lipoprotein-cholesterol (r = 0.443; p = 0.002) was positively correlated with the fasting serum adiponectin levels among the PD patients. Multivariate forward stepwise linear regression analysis of the significant variables showed that white blood count (R2 change = 0.398, p < 0.001), and TG (R2 change = 0.118, p = 0.002) were the independent predictors of fasting serum adiponectin levels and explained 51.6% of variance. Conclusions: We observed that PD patients had higher metabolic syndrome than the general population and an inverse association was found between the circulating fasting adiponectin level and metabolic syndrome in PD patients. White blood count and TG were independent predictors of the serum adiponectin level among PD patients. Copyright © 2010 S. Karger AG. Source


Fang T.-C.,Tzu Chi University | Wang C.-H.,Tzu Chi University | Liou H.-H.,Hsin Jen Hospital | Hsu B.-G.,Tzu Chi University
Therapeutic Apheresis and Dialysis | Year: 2010

Leptin correlates with body fat content and plays a pivotal role in inflammatory response. This study aimed to investigate the relationships of fasting serum leptin levels and the anthropometric fat components among peritoneal dialysis (PD) patients. Fasting blood samples were obtained from 40 PD patients. Leptin levels were measured using a commercial enzyme-linked immunosorbent assay kit. Body weight (r = 0.424; P = 0.006), waist circumference (r = 0.352; P = 0.026), body mass index (BMI; r = 0.483; P = 0.002), body fat mass (r = 0.352; P = 0.026), high sensitivity C-reactive protein (hs-CRP; r = 0.494; P = 0.001), triceps skinfold thickness (TSF; r = 0.505; P = 0.001), mid-arm circumference (MAC; r = 0.471; P = 0.002), and mid-arm fat area (MAFA; r = 0.564; P < 0.001) were positively correlated, while high density lipoprotein (HDL)-cholesterol (r = -0.345; P = 0.028) was negatively correlated with fasting serum leptin levels among the PD patients. Multivariate forward stepwise linear regression analysis showed that MAFA (R2 = 0.318, P = 0.011) was the independent predictor of fasting serum leptin levels among the PD patients. In conclusion, fasting leptin level was positively associated with body fat composition (body weight, waist circumference, BMI, body fat mass, TSF, MAC, and MAFA) and hs-CRP among PD patients, and MAFA was the independent predictor of fasting serum leptin levels among the PD patients. © 2010 The Authors. Journal compilation © 2010 International Society for Apheresis. Source

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