BACKGROUND: Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.METHODS: Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.RESULTS: After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.CONCLUSION: Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.
Blood Cell Count ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Kidney Diseases ; Kidney Failure, Chronic ; Longitudinal Studies ; Magnesium ; Parathyroid Hormone ; Parathyroidectomy ; Phosphorus ; Quality of Life ; Renal Dialysis ; Weight Gain ; Weights and Measures

This study examined the sociodemographic factors, health-related habits, chronic diseases, dietary habits, and nutrient intake according to the self-rated health status in a group aged over 65 years by analyzing the nationally representative Korean survey data. A total of 1,510 subjects were analyzed among the participants of the 2016 Korean National Health and Examination Survey (KNHANES). Statistical analyses for complex samples were performed using the SPSS software package (version 19.0) The study subjects were divided into two groups (healthy group vs. unhealthy group) based on their self-rated health status. The percentage of the healthy group was 66.5%. Gender, age, education level, household income, job (P < 0.001, respectively), marital status, and basic living allowance (P < 0.05, respectively) were significant sociodemographic variables of the self-rated health status. Alcohol consumption (P < 0.01), aerobic physical activity, stress, quality of life, not feeling very well, depression and activity restriction (P < 0.001, respectively) were also significant health-related variables of the self-rated health status. Blood glucose, anemia (P < 0.05, respectively), and chewing problems (P < 0.001) were significant chronic disease-related variables of the self-rated health status. Adequate intakes of protein, dietary fiber, phosphorus, thiamin, niacin, vitamin C (P < 0.001, respectively), calcium, sodium, potassium (P < 0.01, respectively), iron, vitamin A, and riboflavin (P < 0.05, respectively) were also significant variables of the self-rated health status. In complex samples multiple logistic regression analysis, the self-rated health status was influenced significantly by the aerobic physical activity (P < 0.01), stress level (P < 0.05), depression (P < 0.001), quality of life (P < 0.001), not feeling very well (P < 0.001), activity restriction (P < 0.001), chewing problem (P < 0.05), and adequate intake of iron (P < 0.05). These results suggest that activity restriction, mental health, adequate iron intake, and physical activity may be associated with the self-rated health status in the elderly.
Aged ; Alcohol Drinking ; Anemia ; Ascorbic Acid ; Blood Glucose ; Calcium ; Chronic Disease ; Depression ; Dietary Proteins ; Education ; Family Characteristics ; Food Habits ; Humans ; Iron ; Logistic Models ; Marital Status ; Mastication ; Mental Health ; Motor Activity ; Niacin ; Nutrition Surveys ; Phosphorus ; Potassium ; Quality of Life ; Riboflavin ; Sodium ; Vitamin A

OBJECTIVE: To observe the effect of Ronghuang granule on serum fibroblast growth factor 23 (FGF23), fibroblast growth factor receptor (FGFRs) and Klotho protein levels in non-dialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and kidney deficiency and damp heat syndrome. METHODS: Seventy non-dialysis CKD-MBD patients with kidney deficiency and dampness-heat syndrome were randomized into control group (=35) and treatment group (=35). All the patients were given routine treatment combined with traditional Chinese medicine retention enema, and the patients in the treatment group received additional Ronghuang granule treatment (3 times a day). After the 12-week treatments, the patients were examined for changes of TCM syndromes. Serum levels of Ca, P, parathyroid hormone (iPTH), FGF23, FGFRs and Klotho proteins were detected before and after treatment. These parameters were also examined in 20 healthy volunteers. RESULTS: Sixty-five patients completed the study, including 33 in the control group and 32 in the treatment group. The patients in the treatment group showed significantly better treatment responses than those in the control group ( < 0.05 or 0.01). At 4, 8, and 12 weeks of treatment, the patients in the treatment group had significantly lowered scores of TCM syndromes compared with the score before treatment ( < 0.05 or 0.01), while in the control group, significant reduction of the scores occurred only at 12 weeks ( < 0.05); at each of the time points, the treatment group had significantly greater reductions in the score than the control group ( < 0.01). Significant improvements in serum Ca, P and iPTH levels were observed at 4, 8, and 12 weeks in the treatment group ( < 0.05) but only at 12 weeks in the control group ( < 0.05). The patients in the control and treatment groups all showed elevated serum levels of FGF23, FGFRs and Klotho protein compared with the normal subjects ( < 0.01); FGF23, FGFRs and Klotho levels were significantly reduced in the treatment group ( < 0.05) but remained unchanged in the control group (>0.05), showing significant differences between the two groups. CONCLUSIONS Ronghuang granule improves the clinical symptoms of non-dialysis CKD-MBD patients with kidney deficiency and dampness heat syndrome by reducing serum levels of FGF23, FGFRs and Klotho, improving calcium and phosphorus metabolism disorder, and inhibiting secondary hyperparathyroidism.
Calcium ; blood ; Chronic Kidney Disease-Mineral and Bone Disorder ; blood ; therapy ; Drugs, Chinese Herbal ; pharmacology ; Enema ; Fibroblast Growth Factors ; blood ; Glucuronidase ; blood ; Humans ; Parathyroid Hormone ; blood ; Phosphorus ; blood ; Receptors, Fibroblast Growth Factor ; blood ; Renal Insufficiency, Chronic ; blood ; therapy ; Sweating Sickness ; blood ; therapy ; Syndrome

The purpose of this study was to investigate the difference of nutritional status according to metabolic syndrome in colorectal cancer patients. The subjects were divided into 2 groups (metabolic syndrome group and normal group) according to the presence or absence of metabolic syndrome in 143 patients diagnosed with colorectal cancer, and their lifestyle and nutritional status were analyzed. Recall method was used for the dietary survey, and metabolic syndrome was defined as the presence of 3 or more of waist circumference, fasting blood glucose, triglyceride, high-density lipoprotein (HDL)-cholesterol, and blood pressure. This study showed that the metabolic syndrome group had a low age, a high body mass index (BMI), and a high drinking rate. The intake of energy, protein, fat, calcium, and phosphorus was significantly higher in the metabolic syndrome group than in the normal group, and the intake of β-carotene, vitamin C, and folic acid was significantly low. The intake of cholesterol, fatty acid, saturated fatty acid, and polyunsaturated fatty acid was also higher in the metabolic syndrome group. Higher BMI, alcohol consumption, intake of fat, total fatty acid or saturated fatty acid increased the risk of metabolic syndrome, but fiber, vitamin C, or folic acid intake lowered the risk.Weight management and balanced nutritional intake should be emphasized to prevent metabolic syndrome and to improve the condition in patients with colorectal cancer.
Alcohol Drinking ; Ascorbic Acid ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Calcium ; Cholesterol ; Colorectal Neoplasms* ; Diet ; Drinking ; Fasting ; Folic Acid ; Humans ; Life Style ; Lipoproteins ; Methods ; Nutritional Status ; Phosphorus ; Triglycerides ; Waist Circumference

BACKGROUND: Endothelial adhesion molecule expression induced by pro-inflammatory cytokine plays an important role in vascular endothelial cell injury, leading to vascular disease. Allium tuberosum (AT), which is used as a functional food, has a thrombolytic effect. It contains vitamin A, vitamin C, carbohydrate, calcium, iron, and phosphorus. There are many carotenes that turn into vitamin A in the body. Also, it helps blood circulation and stimulates metabolism. The purpose of the this study was to estimate the anti-inflammatory effects of the AT extract. METHODS: Human vascular endothelial cells were pre-treated with 100 μg/mL AT extract for 30 minutes and subsequently co-treated with TNF-α (10 ng/mL) and AT extract (100 μg/mL) for 1, 4, and 6 hours. After treatment, the cells were lysed and used for quantitative reverse transcription PCR, Western blot analysis, and monocyte adhesion assay. RESULTS: We examined the effect of the AT extract on inflammatory gene expression in TNF-α-induced human umbilical vein endothelial cells (HUVECs). The extract reduced the expression levels of mRNA and protein of intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 in TNF-α-stimulated HUVECs. It also inhibited the TNF-α-induced phosphorylation of the NF-κB p65 subunit and degradation of IκBα. Furthermore, the AT extract prevented the increased adhesion capacity of monocyte to TNF-α-stimulated vascular endothelial cells by reducing ICAM-1 and VCAM-1 expression. CONCLUSIONS: The AT extract has preventive and anti-inflammatory effect against vascular disease and has potential for supporting prevention against the early process of atherosclerosis.
Allium* ; Ascorbic Acid ; Atherosclerosis ; Blood Circulation ; Blotting, Western ; Calcium ; Carotenoids ; Chive* ; Endothelial Cells* ; Functional Food ; Gene Expression ; Human Umbilical Vein Endothelial Cells ; Humans* ; Inflammation* ; Intercellular Adhesion Molecule-1 ; Iron ; Metabolism ; Monocytes ; Necrosis* ; NF-kappa B ; Phosphorus ; Phosphorylation ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; Vascular Cell Adhesion Molecule-1 ; Vascular Diseases ; Vitamin A

PURPOSE: The purpose of this study was to determine the time and content of dietary education by analyzing the physiological indicators of hemodialysis patients during their first year and to present baseline data related to dietary education for patients on hemodialysis. METHODS: For this retrospective study physiological indicators for 73 patients on hemodialysis were analyzed. Data included levels of potassium, phosphorus, albumin and the IDWG rate, and Kt/V during the first year after starting hemodialysis. Repeated-measure ANOVA was used for statistical analysis. RESULTS: Serum levels of phosphorus (p < .006), albumin (p < .001) and the IDWG rate (p < .001) increased significantly in the 7 months fromthe start of hemodialysis. CONCLUSION: The results indicate that the period in which diet related educational intervention is necessary is before physiological changes, that is, after 6 months of dialysis. The contents for effective education should include phosphorus-limited and weight control dietary restrictions at 6 months.
Blood Chemical Analysis ; Dialysis ; Diet ; Education ; Humans ; Phosphorus ; Potassium ; Renal Dialysis ; Retrospective Studies

BACKGROUNDThe incidence of diabetic nephropathy (DN) increases year by year. However, clinical characteristics of DN patients on maintenance hemodialysis (MHD) were rarely reported in China. The purpose of this study was to examine the clinical characteristics of the DN patients on MHD in Anhui Province, Eastern China.

METHODSThe clinical data of MHD patients in the hemodialysis centers of 26 hospitals in Anhui Province from January 1, 2014, to March 31, 2014, were examined. The differences between DN patients and non-DN patients were compared regarding vascular access, nutritional status, mineral and bone disorder, and other indexes.

RESULTSAmong the selected 2768 adult MHD patients, 427 had DN. The incidence of hypertension, coronary heart disease, and cerebral thrombus in DN patients was 94.1%, 21.5%, and 15.0%, respectively, which were higher than those in non-DN patients (P < 0.001). Category of vascular access for hemodialysis in DN patients was arteriovenous fistula (AVF) (87.4% [373/427]) and tunneled cuffed catheter (TCC) (11.2% [48/427]). The percentage of AVF was significantly lower than that of non-DN patients (P < 0.001), and percentage of TCC was significantly higher than that of non-DN patients (P < 0.001). Hemoglobin achievement rate in DN patients was 32.0%. The incidence of hypoalbuminemia was 24.7%, significantly higher than that in non-DN patients (P < 0.001). The achievement rate of the target range in mineral values was 55.9% in corrected serum calcium level, 30.1% in serum phosphorus level, and 49.3% in intact parathyroid hormone (iPTH) level in DN patients. Compared with non-DN patients, the achievement rate of serum phosphorus was significantly higher in DN patients.

CONCLUSIONSDN patients on MHD in Anhui province exhibited different clinical characteristics compared to non-DN hemodialysis patients. They presented higher percentage in TCC use and cardiovascular complication, lower serum albumin and iPTH levels than those in non-DN patients.

Aged ; Calcium ; blood ; China ; Coronary Disease ; blood ; epidemiology ; physiopathology ; Cross-Sectional Studies ; Diabetic Nephropathies ; blood ; epidemiology ; physiopathology ; Female ; Humans ; Hypertension ; blood ; epidemiology ; physiopathology ; Intracranial Thrombosis ; blood ; epidemiology ; physiopathology ; Male ; Middle Aged ; Parathyroid Hormone ; blood ; Phosphorus ; blood ; Renal Dialysis

BACKGROUNDMineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.

METHODSChinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China. Markers of MBD, including serum phosphorus, calcium, and intact parathyroid hormone, were measured in baseline samples at the patients' entry. The association between serum phosphorus and abdominal aortic calcification (AAC), left ventricular hypertrophy (LVH) were examined by logistic regression models.

RESULTSAltogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml.min-1.1.73 m-2 were included. The proportion of patients with hyperphosphatemia were 2.6%, 2.9%, 6.8%, and 27.1% in CKD Stages 3a, 3b, 4, and 5, respectively. Moreover, 71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder (PB). Lateral abdominal X-rays were obtained in 2280 patients, 9.8% of the patients were diagnosed as having AAC. Altogether 2219 patients had data of echocardiography, and 13.2% of them were diagnosed with LVH. Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.

CONCLUSIONSIn Chinese patients with CKD, the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal. The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.

Adolescent ; Adult ; Aged ; China ; Chronic Kidney Disease-Mineral and Bone Disorder ; blood ; metabolism ; physiopathology ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Hyperphosphatemia ; blood ; metabolism ; physiopathology ; Hypertrophy, Left Ventricular ; blood ; metabolism ; physiopathology ; Logistic Models ; Male ; Middle Aged ; Phosphorus ; blood ; Prospective Studies ; Renal Insufficiency, Chronic ; blood ; metabolism ; physiopathology ; Vascular Calcification ; blood ; metabolism ; physiopathology ; Young Adult

OBJECTIVE: To assess the risk factors for delirium in patients admitted to a rehabilitation unit for acute or subacute neurological or musculoskeletal disorders. METHODS: We reviewed the medical records of 537 patients admitted to a rehabilitation unit and selected 398 patients in the acute or subacute stage of various neurological or musculoskeletal disorders. Among them, patients who had suffered from delirium were categorized into the delirium group (n=65), and the other patients were categorized into the non-delirium group (n=333). As potential risk factors for delirium, the patients' diagnosis, underlying disease, demographic data, hospital stay duration, surgery, and laboratory findings were reviewed, and the differences between the two groups with respect to independent risk factors were analyzed. RESULTS: The average age in the delirium group was higher; the hospital stay and pre-transfer periods were longer. A large proportion of the patients were admitted for musculoskeletal disorders, and many patients had diabetes mellitus, dementia, and depression as underlying diseases. Laboratory tests revealed increases in the white blood cells (WBC), glucose, blood urea nitrogen (BUN), total bilirubin, aspartate transaminase (AST), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels in the delirium group, while the hemoglobin, calcium, phosphorus, protein, albumin, and potassium levels were decreased. Depression, musculoskeletal disorders, traumatic brain injury, elevated WBC, BUN, AST, and CRP levels, and decreased potassium and phosphorus levels were identified as independent risk factors for delirium. CONCLUSION: Risk factors treatable before delirium onset were identified in rehabilitation patients in acute and subacute stages of various disorders. Early diagnosis and prevention of these risk factors could decrease delirium occurrence and increase rehabilitation effectiveness.
Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Sedimentation ; Brain Injuries ; C-Reactive Protein ; Calcium ; Delirium* ; Dementia ; Depression ; Diabetes Mellitus ; Diagnosis ; Early Diagnosis ; Humans ; Length of Stay ; Leukocytes ; Medical Records ; Nitrogen ; Phosphorus ; Potassium ; Rehabilitation* ; Risk Factors* ; Urea

The Clinical Chemistry Subcommittee of the Korean Association for External Quality Assessment Service conducted external quality assessments in 2015. This included general chemistry and blood gas measurements as part of a scheme of six trials, comprising three samples each. All control materials were included at the same time. The overall response rates were 94.4% for general chemistry and 92.2% for blood gas. The parameters tested included sodium, potassium, chloride, blood urea nitrogen, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase, lactate dehydrogenase, gamma glutamyl transferase, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol for general chemistry, and pH, partial pressure of carbon dioxide (pCO₂), and partial pressure of oxygen (pO₂) for blood gas assessments. Two types of reports were generated: a method summary, including mean, standard deviation, and coefficient of variation for each test method; and a result summary of each participating laboratory, including mean, standard deviation, number of peer groups, and standard deviation index and variance index scores of each laboratory. The overall quality performance in 2015 was similar to that of previous years, and showed lower interlaboratory variation than that in 2014. The requisite continual improvement in clinical chemistry testing quality can be achieved through participation in similar proficiency testing programs.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Bilirubin ; Blood Urea Nitrogen ; Calcium ; Carbon Dioxide ; Chemistry ; Chemistry, Clinical* ; Cholesterol ; Clinical Chemistry Tests ; Creatinine ; Glucose ; Hydrogen-Ion Concentration ; Korea* ; L-Lactate Dehydrogenase ; Lipoproteins ; Methods ; Oxygen ; Partial Pressure ; Peer Group ; Phosphorus ; Potassium ; Sodium ; Transferases ; Triglycerides ; Uric Acid