Lin Kou Medical Center

Taoyuan, Taiwan

Lin Kou Medical Center

Taoyuan, Taiwan

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Hsu C.-W.,Chang Gung Memorial Hospital | Hsu C.-W.,Lin Kou Medical Center | Hsu C.-W.,Chang Gung University | Lin J.-L.,Chang Gung Memorial Hospital | And 18 more authors.
Nephrology | Year: 2010

Aim: Chronic inflammation, which is common in dialysis patients, often causes malnutrition and even protein-energy wasting. However, the association of high-calcium dialysate with malnutrition and/or inflammation in non-diabetic maintenance haemodialysis patients remains unclear. This study investigated the possible adverse effects of high-calcium dialysate and mortality in this population. Methods: A total of 717 non-diabetic haemodialysis patients participated in this 2 year prospective study. The subjects were categorized into three subgroups based on whether dialysate calcium concentrations were high (3.5 mEq/L), standard (3.0 mEq/L) or low (2.5 mEq/L). Demographic, haematological, nutritional and inflammatory markers, biochemical and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup. Results: Patients with high-calcium dialysate (n = 82) had a higher incidence of malnutrition and inflammation (61.0% vs 44.1% and 43.9%, respectively) than those with standard- and low-calcium dialysate (n = 528 and 107). Backward stepwise multiple regression analysis revealed that high-calcium dialysate was negatively correlated with nutritional index, serum albumin levels, but positively associated with the inflammatory marker of serum ferritin levels. At the end of the 2 year follow up, 45 patients had died. Cox multivariate analysis demonstrated that high-calcium dialysate was a significant associated factor (relative risk 2.765; 95% confidence interval 1.429-5.352) for 2 year all-cause mortality in these patients. Conclusion: The analytical results indicate that high-calcium dialysate is associated with malnutrition and inflammation as well as 2 year mortality in non-diabetic maintenance haemodialysis patients and the findings suggest that this population, even those with optimal mineral balance, should avoid high-calcium dialysate. © 2010 Asian Pacific Society of Nephrology.


Hsu C.-W.,Chang Gung Memorial Hospital | Hsu C.-W.,Lin Kou Medical Center | Hsu C.-W.,Chang Gung University | Lin J.-L.,Chang Gung Memorial Hospital | And 14 more authors.
BMC Nephrology | Year: 2014

Background: Malnutrition is associated with an increased risk of cardiovascular death and may cause protein-energy wasting in individuals with chronic kidney disease. A previous study demonstrated that blood cadmium levels (BCLs) were associated with malnutrition in maintenance hemodialysis (MHD) patients. However, the correlation between cadmium exposure and malnutrition remains unclear in chronic peritoneal dialysis (CPD) patients. This study examined the possible adverse effects of environmental cadmium exposure in CPD patients. Methods. A total of 301 CPD patients were enrolled and divided into 3 study groups based on the following BCL tertiles: low (<0.19 μg/L), middle (0.19-0.39 μg/L), and high (>0.39 μg/L). Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis. The analysis also included values of nutritional and inflammatory markers. Results: The BCLs of CPD patients were lower than those of MHD patients. At baseline, patients in the high BCL group were older and had a higher prevalence of diabetes mellitus but lower serum albumin, creatinine, and phosphate levels than the patients in the other 2 groups. After adjusting for potential variables, stepwise backward multiple linear regression analysis revealed that age and alanine aminotransferase levels were positively associated with logarithmic transformation of BCLs (log BCLs), while serum albumin levels were negatively associated with log BCLs in CPD patients. The log BCLs were a significant determinant (beta coefficient ± standard error = -0.185 ± 0.074; P = 0.013) of nutritional status and significantly associated with the presence of malnutrition (odds ratio = 2.64; 95% confidence interval: 1.07-6.48; P = 0.035) in CPD patients after adjustment for related variables. Conclusions: BCL is significantly associated with nutritional status and malnutrition in CPD patients. Therefore, it is important for CPD patients to avoid environmental exposure to cadmium such as through smoking and consumption of cadmium-rich foods. © 2014 Hsu et al.; licensee BioMed Central Ltd.


Lee C.-C.,Chang Gung Memorial Hospital | Lee C.-C.,Lin Kou Medical Center | Lee C.-C.,Chang Gung University | Weng C.-H.,Chang Gung Memorial Hospital | And 20 more authors.
Medicine (United States) | Year: 2016

The negative impact of environmental exposure of cadmium has been well established in the general population. However, the effect of cadmium exposure in chronic peritoneal dialysis (PD) patients remains uncertain. A total of 306 chronic PD patients were included in this 36-month observational study. Patients were stratified into 3 groups by the tertile of baseline blood cadmium levels (BCLs): high (>0.244mg/L, n=101), middle (0.130-0.244mg/L, n=102), and low (<0.130mg/L, n=103) for cross-sectional analyses. Mortality rates and cause of death were recorded for longitudinal analyses. Patients in the high-BCL group were older, more likely to have diabetes mellitus, had lower levels of serum albumin and lower percentage of lean body mass than patients in the low-BCL group. A multivariate logistic regression analysis revealed that logarithmic transformed BCL was independently associated with a higher risk of low turnover bone disease (odds ratio=3.8, P=0.005). At the end of the 36-month follow-up, 66 (21.6%) patients died. Mortality rates increased with higher BCLs (P for trend=0.005). A Cox multivariate analysis showed that, using the low-BCL group as the reference, the high-BCL group had increased hazard ratios (HR) for all-cause mortality in chronic PD patients after adjusting for related variables (HR=2.469, 95% confidence interval=1.078-5.650, P=0.043). In conclusion, BCL showed significant association with malnutrition and low turnover bone disease in chronic PD patients. Furthermore, BCL is an important determinant of mortality. Our findings suggest that avoiding environmental exposure to cadmium as much as possible is warranted in chronic PD patients. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Hsu C.-W.,Chang Gung Memorial Hospital | Hsu C.-W.,Lin Kou Medical Center | Hsu C.-W.,Chang Gung University | Lin J.-L.,Chang Gung Memorial Hospital | And 11 more authors.
Therapeutic Apheresis and Dialysis | Year: 2010

Elevated white blood cell (WBC) counts predict coronary heart disease and all-cause mortality in the general population. Chronic inflammation and malnutrition are associated with increased risk of cardiovascular death in individuals with chronic kidney disease. In this study, we investigated the association between WBC count with inflammation, malnutrition, and mortality in maintenance hemodialysis (MHD) patients. A total of 959 MHD patients were stratified into four equal sized groups based on WBC count. Demographic, hematological, nutritional and inflammatory markers, and biochemical and dialysisrelated data were obtained for cross-sectional analysis. All patients were followed for one year to investigate the risks for mortality. The mean WBC count was 6.4 ± 1.8 ¥ 10 3/μL (range: 2.3-16.3 ¥ 10 3/μL). Stepwise multiple linear regression analysis indicated a positive correlation betweenWBC count and inflammation (high-sensitivity C-reactive protein > 3 mg/L). Forty-five patients (4.7%) died within the 1-year study period. Cox multivariate regression analysis demonstrated that total WBC count significantly predicts 1-year mortality due to all-cause (hazard ratio (HR): 1.228, 95% confidence interval (CI): 1.095-1.378; P < 0.001), due to cardiovascular disease (HR: 1.242, 95% CI: 1.046-1.475; P = 0.013) and due to infection (HR: 1.252, 95% CI: 1.066-1.470;P = 0.006).These findings suggest that total WBC count should be measured in future studies that evaluate the clinical outcome of MHD patients and that dialysis patients with elevated WBC counts require further medical attention to reduce risks of mortality. © 2010 The Authors. Journal compilation © 2010 International Society for Apheresis.


Hsu C.-W.,Chang Gung Memorial Hospital | Hsu C.-W.,Lin Kou Medical Center | Hsu C.-W.,Chang Gung University | Weng C.-H.,Chang Gung Memorial Hospital | And 19 more authors.
PLoS ONE | Year: 2016

Background: Determine the effect of the day 1 urinary excretion of cadmium (D1-UE-Cd) on mortality of patients admitted to a coronary care unit (CCU). Methods: A total of 323 patients were enrolled in this 6-month study. Urine and blood samples were taken within 24 h after CCU admission. Demographic data, clinical diagnoses, and hospital mortality were recorded. The scores of established systems for prediction of mortality in critically ill patients were calculated. Results: Compared with survivors (n = 289), non-survivors (n = 34) had higher levels of D1-UE-Cd. Stepwise multiple linear regression analysis indicated that D1-UE-Cd was positively associated with pulse rate and level of aspartate aminotransferase, but negatively associated with serum albumin level. Multivariate Cox analysis, with adjustment for other significant variables and measurements from mortality scoring systems, indicated that respiratory rate and D1-UE-Cd were independent and significant predictors of mortality. For each 1 μg/day increase of D1-UE-Cd, the hazard ratio for CCU mortality was 3.160 (95% confidence interval: 1.944-5.136, p < 0.001). The chi-square value of Hosmer-Lemeshow goodness-of-fit test for D1-UE-Cd was 10.869 (p = 0.213). The area under the receiver operating characteristic curve for D1-UE-Cd was 0.87 (95% confidence interval: 0.81-0.93). Conclusions: The D1-UE-Cd, an objective variable with no inter-observer variability, accurately predicted hospital mortality of CCU patients and outperformed other established scoring systems. Further studies are needed to determine the physiological mechanism of the effect of cadmium on mortality in CCU patients. © 2016 Hsu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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