This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/diagnosis/*mortality ; Comorbidity ; Coronary Angiography/*statistics & numerical data ; Coronary Stenosis/mortality/radiography ; Female ; Humans ; Incidence ; Kidney Diseases/*diagnosis/*mortality ; Kidney Function Tests/*statistics & numerical data ; Male ; Middle Aged ; Prognosis ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Sensitivity and Specificity ; Survival Rate ; Tomography, X-Ray Computed/*statistics & numerical data

The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis.
Blood Vessel Prosthesis/*statistics & numerical data ; Female ; Graft Occlusion, Vascular/*diagnosis/*epidemiology ; *Graft Survival ; Humans ; Indicator Dilution Techniques/statistics & numerical data ; Kidney Function Tests/*statistics & numerical data ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Prognosis ; Renal Dialysis/*statistics & numerical data ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Treatment Outcome ; *Vascular Patency

OBJECTIVES: ACKD has been described mainly in patients treated with hemodialysis(HD), and there are only a few reports about the prevalence of ACKD in continuous ambulatory peritoneal dialysis (CAPD) patients. Therefore, we compared the prevalence of ACKD in patients receiving HD and CAPD, and evaluated the possible factors which may affect the development of ACKD. METHODS: Forty nine HD and 49 CAPD patients who had received dialysis therapy for at least 12 months were enrolled in this cross-sectional study. Patients who had a past history of polycystic kidney disease and had acquired cystic kidney disease on predialysis sonographic exam were excluded. Detection of ACKD was made by ultrasonography and ACKD was defined as 3 or more cysts in each kidney. RESULTS: The prevalence of ACKD was about 31+ACU- (30/98) and there was no significant difference between HD and CAPD patients(27+ACU- vs. 34+ACU-, p +AD4- 0.05). The prevalence of ACKD was not associated with age, sex, primary renal disease, the levels of hemoglobin, BUN, and serum creatinine. However, the duration of dialysis was significantly related to the development of ACKD (presence of ACKD, 74.4 42.4 months vs. absence of ACKD, 37.8 24.1 months, p +ADw- 0.05). CONCLUSION: The prevalence of ACKD is not different according to the mode of dialysis, and the major determinant of acquired cyst formation is duration of dialysis.
Adolescence ; Adult ; Age Distribution ; Aged ; Chi-Square Distribution ; Comparative Study ; Cross-Sectional Studies ; Female ; Human ; Kidney Failure, Chronic/therapy ; Kidney Function Tests ; Kidney, Cystic/etiology+ACo- ; Kidney, Cystic/epidemiology+ACo- ; Male ; Middle Age ; Peritoneal Dialysis, Continuous Ambulatory/methods ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects+ACo- ; Prevalence ; Renal Dialysis/methods ; Renal Dialysis/adverse effects+ACo- ; Retrospective Studies ; Risk Factors ; Sex Distribution ; Statistics, Nonparametric

This study analyzes the clinical effects of parenterally administered Shenqi Fuzheng on renal function. 20 national, general hospitals were selected. Their hospital information system (HIS) data on 51 898 cases of parenterally administered Shenqi Fuzheng were mined for data. Patients ranged from 18 to 80 years old. 27 718 cases were selected for analysis. Serum creatinine (Scr) and blood urea nitrogen (BUN) levels were taken before and after treatment for outcome evaluation. According to instructions, we divided 197 cases into the treatment group (doses > 250 mL) and 5 728 cases acted as the control group (dose < or = 250 mL). Stratified analysis adjusted for age, sex, hospital illness, treatment, etc. According to the four variables, the case group compared with the control group did not show abnormal renal function changes; 57 confounding factors were balanced using propensity score method resulting in the treatment group showing no abnormal changes in renal function. This HIS b data analysis found that parenterally administered Shenqi Fuzheng above the recommended dosage did not significantly impact on renal function was no significant difference. Prospective studies should be carried out to validate this data.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Drug Hypersensitivity ; etiology ; physiopathology ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; Female ; Hospital Information Systems ; statistics & numerical data ; Humans ; Kidney ; drug effects ; physiopathology ; Kidney Function Tests ; Male ; Middle Aged ; Pragmatic Clinical Trials as Topic ; Young Adult

BACKGROUND: It has not been clear whether immunosuppressive therapy favorably influences renal function and proteinuria in IgA nephropathy (IgAN). Angiotensin converting enzyme inhibitor (ACEi) has an anti-proteinuric effect in IgAN. A retrospective study was done to see whether the addition of immunosuppressive therapy to ACEi produces a more excellent anti-proteinuric effect and preserves better renal function than ACEi alone. METHODS: A total of 49 patients with proteinuria>1.0 g/day and serum creatinine concentrations<1.5 mg/dL were followed-up from at least 1 year to 9 years. Among them, 25 patients were treated with the combination of cyclophosphamide, prednisolone and ACEi while the other 24 were treated with ACEi alone. RESULTS: The combination therapy or ACEi alone both reduced proteinuria with significant value (the combination group: from 5.74+/-5.08 to 2.29+/-2.77 g/day, ACEi group: from 3.85+/-2.54 to 1.68+/-1.91 g/day), while no significant differences in reduction of proteinuria were noticed between the two groups. There was no significant elevation of serum creatinine in both groups during follow-up (the combination group: from 0.91+/-0.20 to 1.03+/-0.38 mg/dL, ACEi group: from 0.93+/-0.27 to 0.99+/-0.37 mg/dL). This study showed no significant differences in the change in slope of 1/serum creatinine levels during the follow-up period between the two groups. CONCLUSION: We conclude that immunosuppressive therapy may not be beneficial in patients with proteinuric IgAN. ACEi may be a valuable therapeutic agent avoiding serious side effects of immunosuppressive agents.
Adolescent ; Adult ; Aged ; Angiotensin-Converting Enzyme Inhibitors/*administration & dosage ; Comparative Study ; Cyclophosphamide/*administration & dosage ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Glomerulonephritis, IGA/diagnosis/*drug therapy ; Human ; Immunosuppressive Agents/*administration & dosage ; Kidney Function Tests ; Male ; Middle Age ; Prednisolone/*administration & dosage ; Probability ; Retrospective Studies ; Severity of Illness Index ; Statistics, Nonparametric ; Treatment Outcome