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Ababneh H, Tóth A, Lente G, Balogh E, Csiki DM, Nagy B, Szöőr Á, Jeney V. High phosphate and calcium induce osteoblastic phenotype switching and calcification of corneal epithelial cells in a Runx2-dependent and synergistic manner; a possible mechanism of chronic kidney disease-associated corneal calcification. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167171. [PMID: 38631411 DOI: 10.1016/j.bbadis.2024.167171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
Patients with advanced chronic kidney disease (CKD) have elevated circulating calcium × phosphate product levels and exhibit soft tissue calcification. Besides the cardiovascular system, calcification is commonly observed in the cornea in CKD patients on hemodialysis. Cardiovascular calcification is a cell-mediated, highly regulated process, and we hypothesized that a similar regulatory mechanism is implicated in corneal calcification with the involvement of corneal epithelial cells (CECs). We established a mouse model of CKD-associated corneal calcification by inducing CKD in DBA/2J mice with an adenine and high phosphate diet. CKD was associated with aorta and corneal calcification as detected by OsteoSense staining and corneal Ca measurement (1.67-fold elevation, p < 0.001). In vitro, excess phosphate and Ca induced human CEC calcification in a dose-dependent and synergistic manner, without any influence on cell viability. High phosphate and Ca-containing osteogenic medium (OM; 2.5 mmol/L excess phosphate and 0.6 mmol/L excess Ca over control) increased the protein expression of Runx2 and induced its nuclear translocation. OM increased the expression of the bone-specific Ca-binding protein osteocalcin (130-fold increase, p < 0.001). Silencing of Runx2 attenuated OM-induced CEC calcification. Immunohistology revealed upregulation of Runx2 and overlapping between the Runx2 and the Alizarin red positive areas of calcification in the cornea of CKD mice. This work sheds light on the mechanism of CKD-induced corneal calcification and provides tools to test calcification inhibitors for the prevention of this detrimental process.
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Affiliation(s)
- Haneen Ababneh
- MTA-DE Lendület Vascular Pathophysiology Research Group, Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Doctoral School of Molecular Cell and Immune Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Tóth
- MTA-DE Lendület Vascular Pathophysiology Research Group, Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gréta Lente
- MTA-DE Lendület Vascular Pathophysiology Research Group, Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Doctoral School of Molecular Cell and Immune Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enikő Balogh
- MTA-DE Lendület Vascular Pathophysiology Research Group, Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dávid Máté Csiki
- MTA-DE Lendület Vascular Pathophysiology Research Group, Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Doctoral School of Molecular Cell and Immune Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Árpád Szöőr
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Viktória Jeney
- MTA-DE Lendület Vascular Pathophysiology Research Group, Research Centre for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Pessoa MBCN, Santo RM, de Deus AA, Duque EJ, Crispilho SF, Jorgetti V, Dalboni MA, Rochitte CE, Moyses RMA, Elias RM. Corneal and Coronary Calcification in Maintenance Hemodialysis: The Face Is No Index to the Heart. JBMR Plus 2023; 7:e10823. [PMID: 38130747 PMCID: PMC10731104 DOI: 10.1002/jbm4.10823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 12/23/2023] Open
Abstract
Although the eyes are the main site of metastatic calcification in patients with chronic kidney disease (CKD), corneal and conjunctival calcification (CCC) is poorly evaluated in this population. Whether CCC correlates with coronary artery calcification remains unknown since studies so far have relied on methods with low sensitivity. Our objective was to test the relationship between CCC and coronary calcification based on tomography. This was a cross-sectional study that included patients on maintenance dialysis. Clinical, demographic, and biochemical data (calcium, phosphorus, parathormone, alkaline phosphatase, and 25(OH)-vitamin D) were recorded. Hyperparathyroidism was defined as parathyroid hormone (PTH) > 300 pg/mL. CCC was evaluated by anterior segment optical coherence tomography (AS-OCT), and coronary calcium scores (Agatston method) were assessed by computed tomography. We compared no/mild with moderate/severe CCC. Twenty-nine patients were included (49.6 ± 15.0 years, 62.1% female, on hemodialysis for 5.7 [2.7-9.4] years, 17.2% with diabetes mellitus, 75.9% with hyperparathyroidism). CCC was found in 82.7% of patients, with median scores of 9 (3, 14.5), ranging from 0 to 16. CCC was classified as absent/mild, moderate, and severe in 27.6%, 20.7%, and 51.7%, respectively. Coronary calcification was found in 44.8% of patients, with median scores of 11 (0, 464), varying from 0 and 6456. We found no significant correlation between coronary calcium scores and CCC (r = 0.203, p = 0.282). Hyperphosphatemia was more frequent in patients with moderate/severe CCC than in those with absent/mild CCC. We concluded that CCC was frequent in patients with CKD on dialysis and did not correlate with coronary calcium scores. Hyperphosphatemia appears to contribute to CCC. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Ruth Miyuki Santo
- Department of OphtalmologyUniversidade de Sao Paulo, Hospital das Clinicas HCFMUSPSao PauloBrazil
| | - Aline A. de Deus
- Department of Internal MedicineService of Nephrology, Universidade de Sao Paulo, Hospital das Clinicas HCFMUSPSao PauloBrazil
| | - Eduardo J Duque
- Department of Internal MedicineService of Nephrology, Universidade de Sao Paulo, Hospital das Clinicas HCFMUSPSao PauloBrazil
| | - Shirley F. Crispilho
- Department of Post GraduationUniversidade Nove de Julho (UNINOVE)Sao PauloBrazil
| | - Vanda Jorgetti
- Department of Internal MedicineService of Nephrology, Universidade de Sao Paulo, Hospital das Clinicas HCFMUSPSao PauloBrazil
| | | | - Carlos Eduardo Rochitte
- Department of RadiologyUniversidade de Sao Paulo, Hospital das Clinicas HCFMUSPSao PauloBrazil
| | - Rosa M. A. Moyses
- Department of Internal MedicineService of Nephrology, Universidade de Sao Paulo, Hospital das Clinicas HCFMUSPSao PauloBrazil
| | - Rosilene M. Elias
- Department of Post GraduationUniversidade Nove de Julho (UNINOVE)Sao PauloBrazil
- Department of Internal MedicineService of Nephrology, Universidade de Sao Paulo, Hospital das Clinicas HCFMUSPSao PauloBrazil
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Babenko B, Mitani A, Traynis I, Kitade N, Singh P, Maa AY, Cuadros J, Corrado GS, Peng L, Webster DR, Varadarajan A, Hammel N, Liu Y. Detection of signs of disease in external photographs of the eyes via deep learning. Nat Biomed Eng 2022; 6:1370-1383. [PMID: 35352000 PMCID: PMC8963675 DOI: 10.1038/s41551-022-00867-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/15/2022] [Indexed: 01/14/2023]
Abstract
Retinal fundus photographs can be used to detect a range of retinal conditions. Here we show that deep-learning models trained instead on external photographs of the eyes can be used to detect diabetic retinopathy (DR), diabetic macular oedema and poor blood glucose control. We developed the models using eye photographs from 145,832 patients with diabetes from 301 DR screening sites and evaluated the models on four tasks and four validation datasets with a total of 48,644 patients from 198 additional screening sites. For all four tasks, the predictive performance of the deep-learning models was significantly higher than the performance of logistic regression models using self-reported demographic and medical history data, and the predictions generalized to patients with dilated pupils, to patients from a different DR screening programme and to a general eye care programme that included diabetics and non-diabetics. We also explored the use of the deep-learning models for the detection of elevated lipid levels. The utility of external eye photographs for the diagnosis and management of diseases should be further validated with images from different cameras and patient populations.
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Affiliation(s)
- Boris Babenko
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Akinori Mitani
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA ,Artera, Mountain View, CA, USA
| | - Ilana Traynis
- Google Health via Advanced Clinical, Deerfield, IL USA
| | - Naho Kitade
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Preeti Singh
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - April Y. Maa
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA USA ,grid.484324.d0000 0004 0420 9995Regional Telehealth Services, Technology-based Eye Care Services (TECS) Division, Veterans Integrated Service Network (VISN) 7, Decatur, GA USA
| | | | - Greg S. Corrado
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Lily Peng
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Dale R. Webster
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | | | - Naama Hammel
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
| | - Yun Liu
- grid.420451.60000 0004 0635 6729Google Health, Palo Alto, CA USA
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Le Trung N, Quoc Toan P, Thang LV, Ngan ND, Chien Thang N, Van Cuong N, Van Dam N, Tuan Anh H, Thi Hang V, Kien Trung N, Nhu Binh D, Anh Tuan V. The Relationship Between Dry Eye in Adults with Indications for Kidney Transplantation and Influence Factors. Clin Ophthalmol 2021; 15:4327-4332. [PMID: 34737547 PMCID: PMC8560330 DOI: 10.2147/opth.s335989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Patients with end-stage renal failure are susceptible to dry eye disease. This study explores the relationship between dry eye disease and influence factors. Patients and Methods The control group consisted of 57 healthy subjects who were kidney donors. They were of the same age and sex as the kidney transplant recipients. The outcome variable was the dry eye condition of the participants. The Schirmer test confirmed dry eye disease, TBUT (breakup time test), and the Eye Surface Disease Index (OSDI) questionnaire, using linear regression to evaluate the association. Results The total number of subjects was 146 (89 kidney recipients and 57 kidney donors). When univariate analysis found the level of visual acuity, the age group involved was statistically significant, while the other factors were not statistically significant. In multivariable logistic regression analysis, age (odds ratio: 2.8, p<0.05), smoking history (odd ratio: 0.1, p<0.05), corneal conjunctival calcification (odd ratio: 0.2, p<0.05); central corneal thickness (odd ratio: 1.02, p<0.05) is considered to be an influence factor for disease progression. Conclusion Age group, smoking history, corneal central thickness, and conjunctival calcification are factors for dry eye disease in patients preparing to receive a kidney. These results reinforce the evidence for multifactorial dry eye disease in patients with renal impairment.
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Affiliation(s)
- Nguyen Le Trung
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Opthalmology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Pham Quoc Toan
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Nephrology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Le Viet Thang
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Nephrology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Nguyen Dinh Ngan
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Opthalmology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Nguyen Chien Thang
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Opthalmology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Nguyen Van Cuong
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Opthalmology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Nguyen Van Dam
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Opthalmology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Hoang Tuan Anh
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Opthalmology, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Vo Thi Hang
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Opthalmology, Military Hospital 103, Hanoi, 12108, Vietnam
| | | | - Do Nhu Binh
- Vietnam Military Medical University, Hanoi, 12108, Vietnam.,Vietnam Department of Infectious Diseases, Military Hospital 103, Hanoi, 12108, Vietnam
| | - Vu Anh Tuan
- Vietnam Hanoi Medical University, Hanoi, 11601, Vietnam
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Pessoa MBCN, Santo RM, De Deus AA, Duque EJ, Rochitte CE, Moyses RMA, Elias RM. Corneal and Conjunctival Calcification in a Dialysis Patient Reversed by Parathyroidectomy. Blood Purif 2020; 50:254-256. [PMID: 33302281 DOI: 10.1159/000508804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
Mineral and bone metabolism disorders are relatively common among patients with end-stage renal disease on maintenance hemodialysis. Corneal and conjunctival calcification is the main extravascular site for calcification. Recently, this form of calcification has been linked to vascular calcification. Secondary hyperparathyroidism can lead to high levels of calcium and phosphorus and increase the risk of calcification. Here, we report a case of a 38-year-old female with severe hyperparathyroidism who underwent eye examination before and after parathyroidectomy. Anterior segment optical coherence tomography showed an improvement in the number and size of ocular calcifications 6 months after surgery. This case calls attention to the importance of eye examination in patients on dialysis and brings the possibility of recovery of calcification in a short-term follow-up.
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Affiliation(s)
- Maria Beatriz C N Pessoa
- Department of Post Graduation, Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil.,Hospital de Força Aérea de São Paulo, São Paulo, Brazil
| | - Ruth Miyuki Santo
- Ophthalmology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aline A De Deus
- Nephrology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo Jorge Duque
- Nephrology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Rosa M A Moyses
- Nephrology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosilene M Elias
- Department of Post Graduation, Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil, .,Nephrology, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil,
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Kal Ö, Ulusoy MO, Kal A, Tanriaşki G, Cezairlioğlu Ş. Evaluation of Dry Eye Using Anterior Segment Optical Coherence Tomography in Patients With End-Stage Renal Disease Undergoing Hemodialysis. Ther Apher Dial 2017; 22:104-108. [PMID: 29205873 DOI: 10.1111/1744-9987.12612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/08/2017] [Accepted: 08/16/2017] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to evaluate dry eye parameters with conventional tests and tear meniscus with Anterior Segment Optical Coherence Tomography (AS-OCT) in patients with end-stage renal disease (ESRD). Thirty-eight ESRD patients undergoing hemodialysis, and 40 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered. Before conventional dry eye tests, tear meniscus were evaluated using AS-OCT. After a complete ocular examination, Schirmer and break-up time (BUT) tests were performed and probable corneal staining was investigated. Schirmer test and BUT values were significantly lower in ESRD patients (P < 0.05). OSDI scores and corneal staining scores were significantly higher in ESRD patients (P < 0.05). Tear meniscus height, tear meniscus depth, and tear meniscus area, which were obtained by AS-OCT were significantly lower in patients with ESRD (P < 0.05). Tear meniscus evaluation using AS-OCT is an effective and non-invasive method to assess tear meniscus in patients with ESRD. Patients with ESRD undergoing hemodialysis should obtain regular ophthalmic examination, especially for dry eye.
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Affiliation(s)
- Öznur Kal
- Nephrology Department, Konya Research Hospital, Başkent University, School of Medicine, Konya, Turkey
| | - Mahmut Oğuz Ulusoy
- Ophthalmology Department, Konya Research Hospital, Başkent University, School of Medicine, Konya, Turkey
| | - Ali Kal
- Ophthalmology Department, Konya Research Hospital, Başkent University, School of Medicine, Konya, Turkey
| | - Gülşah Tanriaşki
- Ophthalmology Department, Başkent University, School of Medicine, Ankara, Turkey
| | - Şefik Cezairlioğlu
- Ophthalmology Department, Başkent University, School of Medicine, Ankara, Turkey
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Association Between Conjunctival and Corneal Calcification and Atherosclerotic Changes in the Carotid Artery in Maintenance Hemodialysis Patients. Cornea 2016; 36:68-73. [PMID: 27684460 DOI: 10.1097/ico.0000000000001034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to investigate the association between atherosclerotic changes in the common carotid artery (CA) and conjunctival and corneal calcification (CCC) in maintenance hemodialysis (MHD) patients. METHODS Fifty eyes of MHD patients with the highest CCC scores were enrolled. CCCs were scored according to the method described by Tokuyama et al. The eyes with the highest CCC scores were selected for further analysis. According to their CCC scores, the patients were classified into 3 groups: mild (0-2 score), moderate (3-5), and severe (6-10 score). Atherosclerosis of the common CA was evaluated by determination of intima-media thickness (IMT), peak systolic (PSV) and end diastolic (EDV) flow velocities, pulsatility index, and resistive index values by using Doppler ultrasonography. RESULTS The mean IMT of the CA was 0.61 ± 0.09 mm in the mild group, 0.82 ± 0.16 mm in the moderate group, and 1.21 ± 0.32 mm in the severe group (P < 0.001). The PSV and EDV were significantly higher in the severe group than in the mild and moderate groups (all, P < 0.001). The CCC score was positively correlated with the duration of hemodialysis, ocular surface disease index score, IMT, PSV, EDV, lymphocyte, calcium, and sedimentation rate. In multiple stepwise linear regression analysis, IMT was the best predictive factor for the CCC score (R = 0.812, β = 9.526 ± 1.05, and P < 0.001). CONCLUSIONS Our results suggest that chronic ocular ischemia due to atherosclerotic changes may have a role in the formation or progression of CCC in MHD patients.
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Aktaş S, Sağdık HM, Aktaş H, Gülcan E, Tetikoğlu M, Coşgun S, Çalışkan S, Özcura F. Tear function in patients with chronic renal failure undergoing hemodialysis. Ren Fail 2014; 37:245-8. [PMID: 25394531 DOI: 10.3109/0886022x.2014.982487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate dry eye symptoms and clinical tear film alterations in patients with chronic renal failure (CRF). MATERIALS AND METHODS Thirty-five non-diabetic CRF patients undergoing hemodialysis, and 31 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered, and after a complete ocular examination, Schirmer and tear break-up time (TBUT) tests were performed. RESULTS OSDI scores were significantly higher (p<0.01) and TBUT tests were significantly lower (p=0.01) in CRF patients than in the control group. Schirmer test results were also lower in the CRF patients group, but lacked statistical significance (p=0.20). CONCLUSION Patients with CRF should be advised to obtain an ophthalmic examination, especially for dry eye.
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Affiliation(s)
- Serdar Aktaş
- Department of Ophthalmology, Dumlupinar University School of Medicine , Kutahya , Turkey
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Sun W, Sun M, Zhang M, Liu Y, Lin X, Zhao S, Ma L. Correlation between conjunctival and corneal calcification and cardiovascular calcification in patients undergoing maintenance hemodialysis. Hemodial Int 2014; 19:270-8. [PMID: 25377787 DOI: 10.1111/hdi.12236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Wenxue Sun
- Department of Nephrology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou China
| | - Mei Sun
- Department of Nephrology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou China
| | - Minghui Zhang
- Department of Nephrology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou China
| | - Yi Liu
- Department of Nephrology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou China
| | - Xiaomin Lin
- Department of Nephrology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou China
| | - Sisi Zhao
- Department of Nephrology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou China
| | - Lulu Ma
- Department of Nephrology; The First Affiliated Hospital; Wenzhou Medical University; Wenzhou China
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Hussein SE, Hassan OA, Granat MH. Assessment of the potential iridology for diagnosing kidney disease using wavelet analysis and neural networks. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Impact of living environment on 2-year mortality in elderly maintenance hemodialysis patients. PLoS One 2013; 8:e74358. [PMID: 24058552 PMCID: PMC3776842 DOI: 10.1371/journal.pone.0074358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/31/2013] [Indexed: 12/02/2022] Open
Abstract
Background Studies on risk factors of mortality in elderly patients with hemodialysis usually focus on comorbidities, nutrition, and inflammation. Discussion on the correlation between living environment and mortality of these patients is limited. Methods A total of 256 elderly hemodialysis patients participated in this 2-year prospective observational study. The subjects were divided into 2 subgroups based on whether they were living in Taipei Basin (n = 63) or not (n = 193). Demographic, hematological, nutritional, inflammatory, 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 in the basin group had a higher incidence of combined protein-energy wasting and inflammation than those in the around basin group. At the end of the 2-year follow-up, 68 patients had died. Univariate binary logistic regression analysis revealed that a very advanced age, basin group, serum albumin levels, serum creatinine levels, non-anuria, and the complications of stroke and CAD were associated with 2-year mortality. Meanwhile, log high-sensitivity C-reactive protein (hs-CRP) levels were not associated with 2-year mortality. Multivariate Cox regression analysis revealed that basin group, serum albumin levels, and the complications of stroke and CAD were significant risk factors for 2-year mortality in these patients. Conclusion The results of this study indicate that factors such as living in the Taipei Basin with higher air pollutant levels in elderly hemodialysis patients is associated with protein-energy wasting and inflammation, as well as 2-year mortality. These findings suggest that among this population, living environment is as important as comorbidities and nutrition. Furthermore, air pollution should be getting more attention especially in the overcrowding Basin topography.
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Natoli JL, Boer R, Nathanson BH, Miller RM, Chiroli S, Goodman WG, Belozeroff V. Is there an association between elevated or low serum levels of phosphorus, parathyroid hormone, and calcium and mortality in patients with end stage renal disease? A meta-analysis. BMC Nephrol 2013; 14:88. [PMID: 23594621 PMCID: PMC3658973 DOI: 10.1186/1471-2369-14-88] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/25/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Biochemical markers of altered mineral metabolism have been associated with increased mortality in end stage renal disease patients. Several studies have demonstrated non-linear (U-shaped or J-shaped) associations between these minerals and mortality, though many researchers have assumed linear relationships in their statistical modeling. This analysis synthesizes the non-linear relationships across studies. METHODS We updated a prior systematic review through 2010. Studies included adults receiving dialysis and reported categorical data for calcium, phosphorus, and/or parathyroid hormone (PTH) together with all-cause mortality. We performed 2 separate meta-analyses to compare higher-than-referent levels vs referent and lower-than-referent levels vs referent levels. RESULTS A literature review showed that when a linear relationship between the minerals and mortality was assumed, the estimated associations were more likely to be smaller or non-significant compared to non-linear models. In the meta-analyses, higher-than-referent levels of phosphorus (4 studies, RR = 1.20, 95% CI = 1.15-1.25), calcium (3 studies, RR = 1.10, 95% CI = 1.05-1.14), and PTH (5 studies, RR = 1.11, 95% CI = 1.07-1.16) were significantly associated with increased mortality. Although no significant associations between relatively low phosphorus or PTH and mortality were observed, a protective effect was observed for lower-than-referent calcium (RR = 0.86, 95% CI = 0.83-0.89). CONCLUSIONS Higher-than-referent levels of PTH, calcium, and phosphorus in dialysis patients were associated with increased mortality risk in a selection of observational studies suitable for meta-analysis of non-linear relationships. Findings were less consistent for lower-than-referent values. Future analyses should incorporate the non-linear relationships between the minerals and mortality to obtain accurate effect estimates.
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