Jung-ho Shin

Role of IL-1α in Cisplatin-Induced Acute Renal Failure in Mice

Background/Aims For unknown reasons, caspase-1 -/- mice, protected against cisplatin-induced acute renal failure (ARF), are deficient in interleukin (IL)-1α. We thus asked whether IL-1α deficiency underlies the mechanism of protection against cisplatin-induced ARF in these mice. Methods Cisplatin (30 mg/kg) was injected intraperitoneally into wild-type C57BL/6 mice to produce a cisplatin-induced model of ARF. IL-1α was measured in control vehicle- and cisplatin-treated wild-type animals. We also examined whether IL-1α -/- mice were similarly protected against cisplatin-induced ARF. Additionally, infiltration of CD11b- and CD49b-positive cells, as markers of macrophages, natural killer, and natural killer T cells (pan-NK cells), was investigated in wild-type and IL-1α -/- mice. Results Compared with vehicle-treated mice, renal IL-1α increased in cisplatin-treated wild-type mice beginning on day 1. IL-1α -/- mice were shown to be protected against cisplatin-induced ARF. No significant difference in the infiltration of neutrophils or CD11b- and CD49b-positive cells were observed between wild-type and IL-1α -/- mice. Conclusions Mice deficient in IL-1α are protected against cisplatin-induced ARF. The lack of IL-1α may explain, at least in part, the protection against cisplatin-induced ARF observed in caspase-1 -/- mice. Investigation of the protective mechanism (s) in IL-1α -/- mice in cisplatin-induced ARF merits further study.

Metabolic syndrome and chronic kidney disease as risk factors of osteoporosis.

AIMSnOsteoporosis is a significant cause of morbidity and mortality, and is often accompanied by metabolic syndrome (MetS) and chronic kidney disease (CKD). We demonstrated the relationship among MetS, CKD and osteoporosis, and investigated the roles of MetS and CKD in the occurrence of osteoporosis in a healthy Korean population.nnnMETHODSnThe estimated glomerular filtration rate (eGFR) was calculated using the modification of diet in renal disease study equation. The diagnosis of MetS was made according to the updated guidelines from the American Heart Association/ National Heart, Lung, and Blood Institute. Bone mineral density (BMD) values were measured. A decreased BMD level was defined as either osteopenia or osteoporosis.nnnRESULTSnThe subjects comprised 38.9% men and 61.1% women; 6.6% had CKD, 19.4% had MetS, and 12.2% had osteoporosis. In females, the prevalence of MetS and CKD was higher in those with decreased BMD (p = 0.034 and p = 0.114, respectively). The risks for decreased BMD increased with fewer MetS components and lower eGFR in a simple logistic analysis. However, the correlation disappeared when adjusted for age. In males, the prevalence of MetS and CKD was lower in decreased BMD (p = 0.034 and p = 0.157, respectively). Both the presence of MetS components and lower eGFR had protective effects on BMD values in simple and multiple logistic analyses.nnnCONCLUSIONSnIn females, decreased BMD was positively related with both MetS and CKD. But, this relationship was not seen by adjustment for age. In males, lower BMD was negatively related to both MetS and CKD in unadjusted and adjusted models.

Predicting clinical outcomes using phase angle as assessed by bioelectrical impedance analysis in maintenance hemodialysis patients

OBJECTIVEnProtein-energy wasting is common in patients on hemodialysis and is an independent risk factor for adverse events. The aim of this study was to retrospectively investigate whether phase angle (PA), known as a nutritional marker, can predict various clinical outcomes in patients with end-stage renal disease (ESRD) who are receiving hemodialysis.nnnMETHODSnUsing bioelectrical impedance analysis (BIA), PA was obtained every 6xa0mo, and patients were divided into two groups according to baseline PA: group A included patients with PA ≥4.5°, and group B included patients with PA <4.5°.nnnRESULTSnWe followed 142 patients for a median of 29xa0mo (12-42xa0mo). We found that a decrease in PA was associated with an increased risk for death that persisted after adjusting for age, sex, and comorbidities (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.33-0.97). Cardiovascular events were not associated with PA (Pxa0=xa00.685). We found that PA predicted the occurrence of infection, independent of age, sex, and comorbidities (HR, 0.65; 95% CI, 0.45-0.94). Although levels of hemoglobin did not differ between groups during the study period, patients in group B received higher doses of erythropoiesis-stimulating agents and intravenous iron than those in group A (Pxa0=xa00.004 and 0.044, respectively). In longitudinal analyses, we did not find increases in PA over time in patients who had a mean dialysis adequacy ≥1.4, daily protein catabolic rate ≥1.2xa0g/kg, or total carbon dioxide level ≥22xa0mmol/L.nnnCONCLUSIONSnPA assessed in a simple manner using BIA provides practical information to predict clinical outcomes in ESRD patients on maintenance hemodialysis.

Impact of intradialytic blood pressure changes on cardiovascular outcomes is independent of the volume status of maintenance hemodialysis patients

Intradialytic systolic blood pressure (SBP) changes are related to the volume status; however, whether SBP change impacts on adverse outcomes depends on the volume status remains uncertain. We retrospectively investigated the relationship among intradialytic changes in SBP, cardiovascular outcomes, and volume status in maintenance hemodialysis patients. We determined SBP changes (ΔSBP) as postdialysis SBP minus predialysis SBP and volume status as the ratio of extracellular water to total body water (ECW/TBW) using bioelectrical impedance analysis. There were 82 (60.3%) with ΔSBP -20 to 10xa0mm Hg, 21 (15.4%) with ΔSBP ≤ -20xa0mm Hg, and 33 (24.3%) with ΔSBP ≥ 10xa0mm Hg, and they were followed up for a median of 34xa0months. Cardiovascular events more frequently occurred in the patients with ΔSBP ≤ -20xa0mm Hg and ≥xa010xa0mm Hg (hazard ratio: 2.3 and 3.0; Pxa0=xa0.062 and .006); these associations persisted even after adjusting for postdialysis ECW/TBW (Pxa0=xa0.056 and .028). Moreover, ΔSBP ≥ 10xa0mm Hg was associated with increased cardiovascular mortalities independent of postdialysis ECW/TBW (Pxa0=xa0.043). There was an independent association of volume status between considerable SBP decrease or increase during hemodialysis and adverse cardiovascular outcomes. Besides appropriate volume control, other factors related to BP changes during hemodialysis must be investigated.

Influence of Major Coping Strategies on Treatment Non-adherence and Severity of Comorbid Conditions in Hemodialysis Patients

Background Non-adherence and comorbidities are prevalent among hemodialysis patients and are associated with increased mortality and financial burden. We aimed to investigate the influence of major coping strategies (CSs) on non-adherence and comorbidities in hemodialysis patients. Methods A total of 49 patients were enrolled. We collected participant data including CS measured by a Korean version of the ways of coping questionnaire (K-WCQ), comorbidities measured by age-adjusted Charlson comorbidity index (CCI), and adherence measured by the 8-item Morisky medication adherence scale (MMAS-8). Results Regarding major CS, 61.2% of participants reported use of support-seeking CS (SUP group), 14.3% reported use of problem-focused CS (PRO group), and 24.5% reported use of hopeful-thinking CS (HOP group). The mean MMAS-8 score was higher in the PRO group than in the HOP group (P = 0.024). The mean CCI score was lower in the PRO group than in the HOP group (P = 0.017). In the HOP group, the severity of somatic symptoms was positively correlated with the scores for the emotion-focused CS subscale (r = 0.39, P = 0.029) and the hopeful-thinking CS subscale (r = 0.38, P = 0.036) of the K-WCQ. The level of life satisfaction positively correlated with the score for the problem-focused CS subscale in the HOP group (r = 0.40, P = 0.027). Conclusion We should pay more attention to the CSs of hemodialysis patients and provide interventions that promote problem-focused CSs, especially for nonadherent patients with high comorbidity rates who mainly use a hopeful-thinking CS.

Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study

Background Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. Methods A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. Results A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). Conclusions Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.