Association of uteroglobin G38A polymorphism with IgA nephropathy: a meta-analysis

Venous distensibility may be an indicator of early arteriovenous fistula failure, a retrospective single-centre cohort study

BACKGROUND

Arteriovenous-fistula (AVF) are crucial for hemodialysis access, yet they frequently experience early failure. While studies have identified potential patient and clinical risk factors, these findings remain inconsistent. This inconsistency might be attributed to the varying definitions of "early failure". Our retrospective cohort study aimed to evaluate how common risk factors predict four frequently early-failure criteria: thrombosis/stenosis, <500 ml/min blood flow, <5 mm vein diameter, and ≥6 mm deep vein. We also assessed how well these risk factors predict early failure defined as meeting at least one of these criteria. Additionally, we examined the predictive ability of vein-distensibility, a previously overlooked factor in AVF failure.

METHODS

Consecutive patients with first-time AVF employing standard minimum preoperative artery- and vein-diameters (1.8-2.0 mm) who underwent first Doppler-ultrasound (DUS) at ≤4 months in 2016-2022 were identified. Early AVF failure was defined as the presence of at least one of the following conditions on the first DUS: poor blood flow (Qa), poor vein diameter, poor vein depth, and thrombosis/stenosis. Factors associated with early AVF failure were explored with multivariate analyses.

RESULTS

105 patients were eligible and 63 (60%) had an early AVF failure. The only strong predictor of early failure was low vein-distensibility (Odds ratio = 0.57, 95% confidence intervals [CIs] = 0.38-0.83, p = 0.005). Female sex only predicted too-deep veins (Odds ratio = 14.29, 95% CIs = 2.00-100, p = 0.024).

CONCLUSIONS

venous distensibility may be a useful early-failure determinant when minimum preoperative vessel-diameter limits are met. Moreover, the female sex is associated with too-deep AVF veins.

HD, Sarma P, Srikanth L, V. SK. Thrombophilic risk factors and ABO blood group profile for arteriovenous access failure in end stage kidney disease patients: a single-center experience

INTRODUCTION

Thrombosis of fistula occurs most frequently in end-stage kidney disease (ESKD) patients receiving hemodialysis. However, the role of thrombophilia in arteriovenous fistula (AVF) failure has not been well established. Hence, this study was aimed at assessing the roles of hereditary and acquired thrombophilic factors in association with AVF failure among patients with ESKD undergoing hemodialysis.

METHODS

A cross-sectional study was conducted on 100 ESKD patients, of whom 50 patients with well-functioning AVFs with no fistula failures earlier were enrolled as Group 1, and 50 patients who have had AVF failure were enrolled as Group 2. The hereditary factors as factor V Leiden, factor XIII, prothrombin, and methylene tetrahydrofolate reductase and the acquired factors as lipoprotein (a), fibrinogen, homocysteine, and anticardiolipin antibodies IgG and IgM were studied.

RESULTS

Among the hereditary factors, no statistically significant difference was observed in relation to factor V Leiden and Prothrombin (p > 0.05). However, for factor XIII and methylene tetrahydrofolate reductase, a statistically significant difference was observed between patients with well-functioning AVFs and patients who have had AVF failure (p < 0.05). We found a statistically significant increase in all the acquired factors in patients who have had AVF failure in comparison with patients with well-functioning AVFs (p < 0.001). Association between ABO blood groups and thrombophilic factors showed significant association between factor V Leiden, anticardiolipin antibody IgG and IgM and ABO blood groups (p < 0.05), whereas none of the other thrombophilic factors showed significant association (p > 0.05).

CONCLUSION

Thus, our study suggests significant role of acquired factors in causing AVF failure.

Is health-related quality of life associated with adequacy of hemodialysis in chronic kidney disease patients?

INTRODUCTION

Monitoring Health Related Quality of Life (HRQoL) in different stages of chronic kidney disease is advised by all nephrology societies. We aimed to study the relation between quality of life and dialysis adequacy.

METHODS

One hundred patients (51% males), on regular hemodialysis 3/week for > 6 months in two hospitals were included. Single pool Kt/V was used to assess dialysis adequacy. Patients were grouped into 3 divisions according to Kt/v: Group A > 1.5 (n = 24), group B 1.2-1.5 (n = 54) and group C < 1.2 (n = 22). KDQOL-SF™ questionnaire was used to study quality of life in our groups. Group C was reassessed after 3 months of improving Kt/v.

RESULTS

Mean values were: Kt/V (1.48 ± 0.41), Cognitive Function (84.27 ± 9.96), Work status (30.00 ± 33.33), Energy (45.70 ± 13.89), Physical Function and Role limitations due to physical function (45.30 ± 12.39 and 31.25 ± 19.26, respectively). Group A had significantly higher scores of KDQOL-SF except Role limitations due to Physical Function. All subscales improved in group C after Kt/v improvement except 3 subscales, namely, work status, patient satisfaction and role limitation due to physical and emotional functions.

CONCLUSION

Inadequate HD badly affects quality of life and improving adequacy refines many components of quality of life.

Brief overview of surgical aspect of autologous arterio-venous fistula for dialysis access

Patients with the end-stage renal disease require renal replacement therapy in renal transplant, peritoneal dialysis, and intermittent hemodialysis. Hemodialysis remains the primary modality for renal replacement therapy. Excellent vascular access is a mainstay for performing hemodialysis. Here we present a brief review of the various surgical aspects of AV fistula creation. Preoperative physical examination and judicious use of the imaging modalities to define the artery and venous mapping provide a good outcome of the fistula formation. Surgical creation of RC-AVF is preferred for the end-stage renal disease patient. The end-to-side anastomosis between the radial artery and cephalic vein has shown very good results.

Serum β2-microglobulin as a predictor of residual kidney function in peritoneal dialysis patients

BACKGROUND

While clinical guidelines recommend that residual kidney function (RKF) is measured in peritoneal dialysis (PD) patients, 24-h urine collection is cumbersome and prone to errors. We wished to determine whether an equation using serum β2-microglobulin (β2M) could prove of clinical benefit in estimating RKF and identifying patients who could start PD with incremental prescriptions.

METHODS

We measured serum β2M in consecutive PD outpatients recently starting dialysis with continuous ambulatory PD (CAPD) or automated PD (APD), attending a single tertiary hospital for their routine clinical visit. RKF was defined as the mean of 24-h urine clearances of creatinine and urea. An equation estimating RKF (eRKF) was generated based on serum β2M levels on a randomly selected modelling group.

RESULTS

We included 511 patients, of whom 351 in the modelling group and 150 in the validation group. Mean age was 58.7 ± 15.8, 307 (60.0%) were men and median RKF value was 4.5 (2.4-6.5) mL/min/1.73 m2. In the validation group, an equation based on β2M, creatinine, urea, age and gender showed minimal bias of - 0.1 mL/min/1.73 m2 to estimate RKF. Area under the receiving operator characteristic curve was 0.915 to detect RKF ≥ 2 mL/min/1.73 m2.

CONCLUSION

An equation based on serum β2M concentration would not be able to replace 24-h urine collection as the standard of care when an exact measurement of RKF is required. However, it could prove useful in identifying patients suitable for an incremental PD prescription and for monitoring RKF in individuals unable to reliably collect urine.

Influence of dialysate temperature on creatinine peritoneal clearance in peritoneal dialysis patients: a randomized trial

BACKGROUND

Patients on continuous ambulatory peritoneal dialysis (PD) are encouraged to warm dialysate to 37 °C before peritoneal infusion; main international PD guidelines do not provide specific recommendation, and patients generally warm dialysate batches partially or do not warm them at all. Warming of dialysate is a time-consuming procedure, not free from potential risks (i.e. degradation of glucose), and should be justified by a clear clinical benefit.

METHODS

We designed a single blind randomized controlled trial where 18 stable PD patients were randomized to receive a peritoneal equilibration test either with dialysate at a controlled temperature of 37 °C (intervention group) or with dialysate warmed with conventional methods (control group). Primary end-point was a higher peritoneal creatinine clearance in patients in the intervention group.

RESULTS

Patients in the intervention group did not show a significantly higher peritoneal creatinine clearance when compared to the control group (6.38 ± 0.52 ml/min vs 5.65 ± 0.37 ml/min, p = 0.2682). Similar results were obtained for urea peritoneal clearance, mass transfer area coefficient of creatinine and urea. There were no significant differences in total abdominal discomfort questionnaire score, blood pressure and body temperature between the two groups.

CONCLUSIONS

Using peritoneal dialysate at different temperatures without causing significant side effects to patients appears feasible. We report a lack of benefit of warming peritoneal dialysate to 37 °C on peritoneal clearances; future PD guidelines should not reinforce this recommendation.

TRIAL REGISTRATION

NCT04302649, ClinicalTrials.gov ; date of registration 10/3/2020 (retrospectively registered).

Association of obesity with bone mineral density and osteoporosis in adults: a systematic review and meta-analysis

OBJECTIVES

Results from previous studies investigating the association of obesity with bone mineral density (BMD) and osteoporosis (OP) are inconsistent. The purpose of the present study was to examine whether obesity is associated with BMD and the risk of OP.

STUDY DESIGN

This is a meta-analysis.

METHODS

A computerised literature search was conducted using the PubMed, Web of Science, China National Knowledge Internet (CNKI) (Chinese) and Wanfang (Chinese) databases for relevant articles published in English or Chinese before the end of December 2017. Means with standard deviations and odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs) were computed to estimate the association between obesity and BMD and the risk of OP by using a random-effects model. In addition, a heterogeneity test and sensitivity analysis were conducted.

RESULTS

Adults with obesity had higher BMD than healthy-weight subjects in both the lumbar spine and femoral neck measurement sites. Obesity was positively related to BMD in the two sites, with merged weighted mean difference (WMD) of 0.07 g/cm² in the lumbar spine (95% CI: 0.045, 0.095; P < 0.001; P_{heterogeneity} <0.001; I² = 89.1%) and WMD of 0.087 g/cm² in the femoral neck (95% CI: 0.063, 0.112; P < 0.001; P_{heterogeneity} <0.001; I² = 92.8%). General obesity was negatively related to femoral neck OP, indicating that obesity is a protective factor for OP, with a merged OR of 0.169 (95% CI: 0.132, 0.216; P < 0.001; P_{heterogeneity} = 0.716; I² = 0.0%).

CONCLUSIONS

Adults with obesity had significantly higher BMD than healthy-weight adults. Obesity was positively associated with BMD and negatively correlated with OP.

Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers

BACKGROUND

In hemodialysis patients Hepatitis B virus (HBV) infection is one of the problems. Because of HBV vaccine response is lower than in the general population, in this study it is aimed to determine the factors that may cause inadequate HBV vaccine response in hemodialysis patients.

METHODS

In study, HBsAg, anti-HBs, anti-HBc IgG data belonging to 278 patients were obtained from file and computer records. It was seen that seronegative cases had been given recombinant HBV vaccine. Anti-HBs titers were monitored 1 month after vaccination was completed. According to this, the patients are divided into two groups. Those with anti-HBs < 10 IU/mL were identified as non-responders and with anti-HBs ≥ 10 IU/mL as responders. Factors such as age, serum albumin and urea reduction rate which may affect inadequate response to HBV vaccine were evaluated. As statistical examination, Chi-square test was used for the analysis of the data determined by counting, and logistic regression was used for statistically significant independent variables in chi-square test. p value of < 0.05 was considered statistically significant (Confidence interval: 95%).

RESULTS

Out of 278 patients, according to exclusion criteria 81 patients were excluded. 13.2%(26/197) of HBV vaccinated patients had insufficient response. The inadequate response rate to HBV vaccination was found to be higher in patients with age ≥ 65 (p = 0.039), serum albumin < 3.5 g/dL (p = 0.024) and urea reduction rate ≤ 65 (p = 0.028). No statistically significant relationship was found between inadequate response to HBV vaccine and anti-HCV positivity, presence of diabetes mellitus, anemia status, vitamin D therapy and vascular access pathway variability.

CONCLUSION

We conclude that relatively high patient age, low albumin level and insufficient urea reduction rate may cause inadequate HBV vaccine response. Taking these factors into consideration may provide a useful insight for an adequate response to vaccination.

Systemic Endotoxin in Peritoneal Dialysis Patients

Previous reports linked systemic endotoxemia in dialysis patients to increased markers of inflammation, cardiovascular disease, and mortality. Many peritoneal dialysis (PD) patients use acidic, hypertonic dialysates, which could potentially increase gut permeability, resulting in systemic endotoxemia. However, the results from studies measuring endotoxin in PD patients are discordant. We therefore measured systemic endotoxin in 55 PD outpatients attending for routine assessment of peritoneal membrane function; mean age 58.7 ± 16.4 years, 32 (58.2%) male, 21 (38.2%) diabetic, median duration of PD treatment 19.5 (13 - 31) months, 32 (58.2%) using 22.7 g/L dextrose dialysates, and 47 (85.5%) icodextrin. The median systemic endotoxin concentration was 0.0485 (0.0043 - 0.103) Eu/mL. We found no association between endotoxin levels and patient demographics, markers of inflammation, serum albumin, N-terminal pro-brain natriuretic peptide, extracellular volume measured by bioimpedance, blood pressure, PD prescriptions or peritoneal membrane transporter status, or medications. The measurement of endotoxin can be lowered by failure to effectively release protein-bound endotoxin prior to analysis and increased by contamination when taking blood samples and processing and storing the samples. Additionally, contamination with β-glucan from fungal cell walls and the use of different assays to analyze endotoxin can also give differing results. These factors may help to explain the disparate results reported in different studies. Our study would suggest that exposure to standard peritoneal dialysates does not substantially increase systemic endotoxin. However, until endotoxin assays can measure free and bound endotoxin separately, the role of endotoxin causing inflammation in PD patients remains to be determined.

Uteroglobin gene polymorphism (G38A) may be a risk factor in childhood idiopathic nephrotic syndrome

BACKGROUND

Uteroglobin (UG) is a multifunctional protein with anti-inflammatory properties. The aim of this study was to first evaluate the role of UG gene G38A polymorphism in childhood idiopathic nephrotic syndrome (INS), and determine whether this variation may be related to the occurrence of INS or a steroid response.

METHODS

One hundred and thirty-six children diagnosed with INS in Gaziantep University, Department of Pediatric Nephrology, and 70 healthy volunteers were included. Children with INS were divided into two groups: steroid-sensitive (n = 84), and steroid-resistant (n = 52). Samples were examined using the polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) enzyme method.

RESULTS

The distributions of AA, GG, and AG genotypes of UG gene G38A (G/A) were 16.9%, 44.9%, and 38.2% in the all-INS group, whereas they were 14.3%, 48.8%, and 36.9% in the steroid-sensitive INS (SSINS) group compared with 21.1%, 38.5%, and 40.4% in steroid-resistant INS (SRINS), and 5.7%, 41.4%, and 52.9% in controls. The risk of INS was increased almost 4-fold in children with the AA genotype (p = 0.016). The risk of having SSINS was increased 3.5-fold (p = 0.042) whereas the risk of SRINS was increased 4.8-fold in the same genotype (p = 0.014).

CONCLUSIONS

The uteroglobin gene may play an important role in the development of INS, and the AA genotype of UG gene G38A polymorphism was found more frequently in those children. Further studies evaluating all polymorphisms in larger patient groups are needed to exactly determine the effect of UG gene on the development of INS and steroid response in children.

Endovascular Creation of an Arteriovenous Fistula (endoAVF) for Hemodialysis Access: First Results

INTRODUCTION

Surgical creation of a radiocephalic fistula is the gold standard of vascular access for hemodialysis. Recently, an endovascular approach for upper arm fistula creation (endoAVF) has been developed, which may be an alternative to open surgery. We describe a case series of eight cases showing feasibility, early complications and outcome of this novel treatment option.

MATERIALS AND METHODS

Between July 2015 and February 2016, we created an endoAVF in eight patients. Indications for endoAVF were confirmed by a multidisciplinary vascular board upon the exclusion for Cimino fistula candidates. Patients were suitable for the procedure after a pre-therapeutic ultrasound showed adequate brachial and ulnar vessels and no ipsilateral central venous stenosis. Patient characteristics, technical success, total patient radiation dose, complication rates, time to maturation of endoAVF and clinical effectiveness at six months were assessed retrospectively.

RESULTS

Creation of endoAVF using the everlinQ endoAVF system (TVA Medical Inc., Austin, TX, USA) was successful in all eight cases. There were one minor intraprocedural complication and no postoperative complications. Median time to endoAVF maturation was 63 days (range 26-137 days). One patient was lost to follow-up after the first monitoring visit. In the remaining seven patients, hemodialysis was started without problems. Patency after 6 months was 100%.

DISCUSSION

The endoAVF demonstrated to be feasible and safe for the creation of arteriovenous fistula suitable for hemodialysis access. Further studies with more patients and longer follow-up periods are needed to assess long-term outcomes and comparability to surgical dialysis access creation.

Risk Factors for Decline of Residual Renal Function in Children Treated With Peritoneal Dialysis

♦ BACKGROUND: The aim of the study was to assess risk factors for residual renal function (RRF) decline in children during the first/second year of chronic peritoneal dialysis (PD). ♦ METHODS: The study group included 56 children with end-stage renal disease (ESRD) (age 10.13 ± 4.86 years), including 18 on continuous ambulatory PD (CAPD) and 38 on automated PD (APD), in whom we evaluated RRF (daily diuresis [mL/m2/24 h], residual glomerular filtration rate (rGFR) [mL/min/1.73 m2]), etiology of ESRD, PD fluid volume (mL/m2/24 h), glucose load (g/m2/24 h), ultrafiltration (mL/m2/24 h), peritoneal permeability (D/PCrea 4h, D/D0 Glu 4h), dialysis adequacy (twKt/V, twCCr [L/week/1.73 m2]), blood pressure (BP), biochemical parameters, and medications used. Duration of follow-up was 24 months. ♦ RESULTS: Mean diuresis before initiation of PD was 1,394.93 ± 698.37 (mL/m2/24 h), and mean rGFR was 7.41 ± 3.96 (mL/min/1.73 m2). The rate of daily diuresis decline was -529.34 ± 546.28 in the first year and -107.10 ± 291.54 (mL/m2/24 h) in the second year (p = 0.005), and the rate of rGFR decline was -3.35 ± 3.73 in the first year and -1.63 ± 1.85 (mL/min/1.73 m2) in the second year (p = 0.118). Eleven (19.64%) patients became anuric. In univariate analysis, the rate of daily diuresis decline in the first year was related to baseline diuresis (r = -0.29, p = 0.031), proteinuria (r = -0.43, p = 0.001), and systolic BP (r = -0.31, p = 0.020); 12-month changes (Δ0 - 12) in PD fluid volume (r = -0.37, p = 0.004), glucose load (r = -0.28, p = 0.035), and ultrafiltration (r = -0.38, p = 0.004); serum calcium-phosphorus product (r = -0.41, p = 0.002); and Δ0 - 12 body mass index (BMI) Z-score (r = 0.30, p = 0.024); while the rate of rGFR decline in the first year was related only to baseline rGFR (r = -0.57, p < 0.001). In multivariate analysis, significant predictors of the rate of daily diuresis decline in the first year were baseline diuresis (β = -0.386, p < 0.001) and proteinuria (β = -0.278, p = 0.017), mean systolic BP Z-score (β = -0.237, p = 0.027), and age at the onset of PD (β = -0.224, p = 0.037), while predictors of the rate of rGFR decline were baseline rGFR (β = -0.607, p < 0.001) and baseline proteinuria (β = -0.225, p = 0.046). In the second year, the only predictors of the rate of rGFR decline were D/D0 Glu 4h (r = 0.44, p = 0.033, univariate analysis) and rGFR at 12 months (β = -0.499, p = 0.044). ♦ CONCLUSION: The most important risk factors for rapid RRF decline in children during the first year of chronic PD include higher baseline daily diuresis and proteinuria, and additional factors are systolic BP and age at the onset of PD; while high baseline GFR and low peritoneal transport status may be the only important factors during the second year.

Outcome of permanent vascular access for haemodialysis in patients with end-stage renal disease in Cameroon: results from the pilot experience of the Douala general hospital

Background Chronic Kidney disease is a major health problem in the world. Native arteriovenous Fistula (AVF) is well established as the best vascular access for haemodialysis. Little is known about the outcome of AVF in sub-Saharan Africa. We aim to analyze the outcome of patients undergoing AVF creation during the pilot program established at the Douala general hospital (DGH). Method This was hospital-based, longitudinal study with a retrospective phase (April 2010-January 2014) and a prospective phase (January 2014-April 2014). All consecutive patients operated for AVF creation were included in this study. Socio-demographics data, functionality, and complications were analyzed. Results Eighty-one patients including 52 men were enrolled in this study (49 prospectively and 32 retrospectively). The mean age was 52, 3 years (range 18-81 years). Hypertension (66, 7%), diabetes (17, 3%), and HIV (8, 6%) were the most observed co-morbidities. About 96.3% of AVF were native and 3.7% were prosthetic graft. Radiocephalic AVF was performed at a rate of 77.8%. The primary function rate was 97.7% and the mean follow-up period 43.4 weeks. The overall rate of complications was 44.4% of whom 30.5% were early, 30.5% secondary, and 39% lasted. The treatment of these complications was conservative in 48.7% of cases. Conclusions The results of the pilot program of AVF creation at the DGH are encouraging. However, the sustainability of this project requires human capacity building.

Anesthesia for Vascular access Surgery

The type of anesthesia chosen is an integral part of the decision-making process for arteriovenous access construction. We discuss the different types of anesthesia used, with emphasis on brachial plexus block, which is potentially safer than general anesthesia in this fragile patient population with end-stage renal disease. Brachial plexus block is superior to local anesthesia and enables the use of a tourniquet to minimize potential damage to the blood vessels during anastomosis using microsurgery techniques, and does not lead to the vasospasm that may be seen with local anesthesia. Regional anesthesia has a beneficial sympathectomy-like effect that causes vasodilation with increased blood flow during surgery and in the fistula postoperatively that may prevent early thrombosis and potentially improve outcome.

Association of uteroglobin G38A gene polymorphism with IgA nephropathy risk: an updated meta-analysis

Association of uteroglobin G38A gene polymorphism and IgA nephropathy (IgAN) risk is still not clear. This investigation was conducted to assess if there was an association between the uteroglobin G38A gene polymorphism and IgAN risk using meta-analysis. The relevant literatures were identified from PubMed, and Cochrane Library on 10 October 2013, and eligible studies were included and synthesized. Seven reports were recruited into this meta-analysis for the association of the uteroglobin G38A gene polymorphism with IgAN risk. In overall population, the A allele and AA genotype were not associated with IgAN risk. Furthermore, the GG genotype was also not associated with IgAN risk in overall population. Interestingly, the association of uteroglobin G38A gene polymorphism with IgAN risk was also not found in Asians and in Caucasians. In the sensitivity analysis, according to Hardy-Weinberg equilibrium test, according to the control source from healthy, the genotyping methods using PCR-RFLP, PCR-SSCP, no association of the uteroglobin G38A gene polymorphism with IgAN risk was found and the results were similar to those in non-sensitivity analysis. In conclusion, the uteroglobin G38A gene polymorphism was not associated with IgAN risk. However, additional studies are required to firmly establish a correlation between the uteroglobin G38A gene polymorphism and IgAN risk.

Residual renal function in children treated with chronic peritoneal dialysis

Residual renal function (RRF) in patients with end-stage renal disease (ESRD) receiving renal replacement therapy is defined as the ability of native kidneys to eliminate water and uremic toxins. Preserved RRF improves survival and quality of life in adult ESRD patients treated with peritoneal dialysis. In children, RRF was shown not only to help preserve adequacy of renal replacement therapy but also to accelerate growth rate, improve nutrition and blood pressure control, reduce the risk of adverse myocardial changes, facilitate treatment of anemia and calcium-phosphorus balance abnormalities, and result in reduced serum and dialysate fluid levels of advanced glycation end-products. Factors contributing to RRF loss in children treated with peritoneal dialysis include the underlying renal disease such as hemolytic-uremic syndrome and hereditary nephropathy, small urine volume, severe proteinuria at the initiation of renal replacement therapy, and hypertension. Several approaches can be suggested to decrease the rate of RRF loss in pediatric patients treated with chronic peritoneal dialysis: potentially nephrotoxic drugs (e.g., aminoglycosides), episodes of hypotension, and uncontrolled hypertension should be avoided, urinary tract infections should be treated promptly, and loop diuretics may be used to increase salt and water excretion.

Surgical Treatment of Cephalic Arch Stenosis by Central Transposition of the Cephalic Vein

Purpose

After creation of a brachiocephalic (BC) arteriovenous fistula (AVF), stenosis of the cephalic vein close to its junction with the axillary vein (cephalic arch stenosis, CAS) can develop. Flow impairment and access thrombosis are the consequences, sometimes complicated by prestenotic aneurysm of the cephalic vein. We here report our experience with cephalic vein transposition (CVT) for CAS.

Methods

From March 2007 through February 2012, symptomatic CAS was detected in 25 patients (13 female) with either dysfunction (n=14) or thrombosis (n=11) of their BC AVF. All were treated by CVT: the vein was ligated and cut distally to the stenotic segment, then tunneled subcutaneously to the medial aspect of the upper arm and anastomosed to the proximal brachial or basilic vein in an end-to-side fashion. Simultaneous thrombectomy of the cephalic vein was performed in 11 patients and aneurysmorrhaphy in 9. In addition, one patient had a proximal new AV anastomosis, another angioplasty of an in-stent restenosis of the access-draining subclavian vein.

Results

After CVT, two acute complications (8%) occurred: access thrombosis (one) and bleeding (one). During follow-up (1 to 54 months, median 13 months, 34.5 patient-years), six patients died with functioning AVF, three were successfully transplanted. Primary (secondary) 1-year patency was 79% (90%), with a reintervention rate of 0.1/patient/year.

Conclusions

Primary 1-year access patency rates after CVT compare favorably with those after interventional treatment, and reintervention rates are lower. Frequently occurring prestenotic aneurysms could be repaired simultaneously. CVT should therefore be regarded as the treatment of choice for CAS.

1790 G/A polymorphism, but not 1772 C/T polymorphism, is significantly associated with cancers: an update study

This study aimed to investigate the association between PASD8 gene and cancers. For 1772 C/T polymorphism (rs11549465), it included 5552 cases and 8044 controls, and for 1790 G/A (rs11549467), 3381 cases and 5830 controls. The allele-analysis results showed that 1772 C/T (rs11549465) was significantly associated with cancers (OR: 1.177, 95% CI: 1.011-1.369, p=0.035). And results of genotype-analysis indicated that 1790 G/A (rs11549467) had a significant relationship with cancers. (OR: 0.736, 95% CI: 0.595-0.910, p=0.005). For 1790 G/A (rs11549467), the association was significant when subdivided by different kinds of cancers. And no association existed when subdivided into population-type subgroups. In conclusion, PASD8 gene played an important role in the development of cancers.

Assessment of Effects of Upper Extremity Exercise with Arm Tourniquet on Maturity of Arteriovenous Fistula in Hemodialysis Patients

Objective

This study was designed to investigate the effects of hand exercise using a tourniquet on arteriovenous fistula (AVF) maturity in patients with end stage renal disease.

Methods

Fifty patients were randomly allocated to 2 groups with 25 patients. After creating an AVF, in the control group, patients were asked to start doing simple hand exercise- opening and closing the fingers. In the second groups, patients underwent a structured isometric exercise program. The pre exercise and post exercise ultrasound examination were performed in the first 24 hours and 2 weeks after the operation respectively. Patients were also clinically evaluated at the end of the study.

Results

Post exercise ultrasound showed significant difference in the draining vein diameter, vein wall thickness, vein area and blood flow rate (BFR) (p-value: 0.009, 0.04, 0.02 and 0.02 respectively). The number of patients who had clinically mature AVFs in the case group was significantly more than the control group (13 vs. 5; p-value: 0.008).

Conclusion

We conclude that hand exercise using arm tourniquet affects most sonographic parameters which are associated with AVF maturity, and could be beneficial for acceleration of AVF clinical maturation.

Association between SHBG Asp327Asn (rs6259) polymorphism and breast cancer risk: a meta-analysis of 10,454 cases and 13,111 controls

Sex hormone-binding globulin (SHBG) is a plasma glycoprotein that plays an important role in breast cancer pathophysiology and risk definition, since it regulates the bioavailable fraction of circulating estradiol. Epidemiological studies have evaluated the association between SHBG Asp327Asn polymorphism and breast cancer risk in diverse populations. However, the results remain conflicting rather than conclusive. This meta-analysis of literatures was performed to derive a more precise estimation of the relationship. A total of 10 studies were identified for the meta-analysis, including 10,454 cases and 13,111 controls for SHBG Asp327Asn polymorphism. When all studies were pooled into the meta-analysis, there was no evidence for significant association between SHBG Asp327Asn polymorphism and breast cancer risk (for Asn/Asn vs. Asp/Asp: OR = 1.20, 95 % CI = 0.94-1.55; for Asp/Asn vs. Asp/Asp: OR = 0.94, 95 % CI = 0.87-1.01; for dominant model: OR = 0.95, 95 % CI = 0.90-1.02; for recessive model: OR = 1.22, 95 % CI = 0.95-1.57). In the subgroup analyses by ethnicity, menopausal status, and source of controls, no significant associations were found in all genetic models. Interestingly, further analyses stratified by menopausal status in different ethnicities revealed that this polymorphism might provide protective effects against breast cancer risk in postmenopausal Asian women (for dominant model: OR = 0.83, 95 % CI = 0.70-0.97). Sensitivity analyses were performed by sequential removal of individual studies and cumulative statistics have showed combined ORs were not materially altered by any individual study under all comparisons. In summary, this meta-analysis suggests that SHBG Asp327Asn polymorphism is not associated with breast cancer risk overall, while it might be an important genetic susceptibility factor in postmenopausal Asian women for developing breast cancer. Larger and well-designed studies are warranted to confirm our findings in the future.

Methionine synthase reductase A66G polymorphism contributes to tumor susceptibility: evidence from 35 case-control studies

Methionine synthase reductase (MTRR) gene is involved in tumorigenesis by regulating DNA methylation through activation of methionine synthase (MTR). MTRR is polymorphic at nucleotide 66 (A-to-G) and the resulting variant enzyme has a lower affinity for MTR. The reported associations of MTRR A66G polymorphism with cancer risk are contradictory. Therefore, we performed a meta-analysis to better assess the associations, including 18,661 cases and 27,678 controls from 35 studies. Crude ORs with 95% CIs were used to assess the strength of association between the MTRR A66G polymorphism and cancer risk. The pooled ORs were performed for homozygote model (GG vs. AA), heterozygote model (GG vs. GA), recessive genetic model (GG vs. GA + AA), and dominant genetic model (GG + GA vs. AA), respectively. Overall, results indicated that the G allele and GG variant genotypes were associated with a significantly increased cancer risk (G vs. A: OR, 1.039; 95% CI, 1.009-1.078; homozygote model: OR, 1.094; 95% CI, 1.006-1.191). In subgroup analysis by ethnicity, significant increased risks were found among Asians with G allele (G vs. A: OR, 1.063; 95% CI, 1.011-1.119; homozygote model: OR, 1.189; 95% CI, 1.055-1.341; recessive model: OR, 1.197; 95% CI, 1.068-1.341). For stratification analysis, the cancer types with fewer than three studies were categorized into "other cancers", and the results indicated that there was a significant elevated cancer risk in "other cancers" in all genetic models, not in colorectal cancer, lymphoid leukemia or breast cancer. In summary, our study suggests that the MTRR A66G polymorphism is a potential biomarker for cancer risk.

Role of acupressure in symptom management in patients with end-stage renal disease: a systematic review

BACKGROUND

Acupressure is a widely used adjunct for various symptoms in patients with nonchronic kidney disease. However, its role for symptom management in end-stage renal disease (ESRD) populations is not clear.

OBJECTIVE

To summarize and critically evaluate the evidence available from randomized clinical trials (RCTs) of acupressure for patients with ESRD.

DESIGN

Systematic review of RCTs.

METHODS

Thirteen databases were searched from their inceptions through December 2009, irrespective of publication status or language.

RESULTS

In total, 7 RCTs out of 86 screened studies were included and analyzed. Most studies lacked sufficient description to gauge the quality of the RCT. Acupressure was not superior to sham acupressure (n = 2) or to transcutaneous electrical stimulation (n = 1), while studies suggested benefits of acupressure compared to usual care (n = 3), sleep medication (n = 1), and undefined control intervention (n = 1). None of these studies reported any adverse events.

CONCLUSION

No definitive conclusion is available. Future trials should adhere to standards of trial methodology and explicitly report relevant information for evaluation of efficacy and safety of acupressure in patients with ESRD.

Association between the -634C/G polymorphisms of the vascular endothelial growth factor and retinopathy in type 2 diabetes: a meta-analysis

AIMS

To investigate the association of vascular endothelial growth factor (VEGF) -634C/G polymorphism with retinopathy in type 2 diabetes.

METHODS

8 studies with 1183 cases and 1057 controls were included. Allelic and genotypic comparisons between cases and controls were evaluated.

RESULTS

Our meta-analysis did not suggest a significant association of the -634C/G polymorphism with diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) (P>0.05). The pooled odds ratios (ORs) for allelic frequency comparison, recessive model comparison, dominant model comparison, and additive model showed that the -634C/G polymorphism is significantly associated with nonproliferative diabetic retinopathy (NPDR): OR=1.61 [95% confidence interval (CI, 1.23, 2.10)], P=0.0005, P(heterogeneity)=0.38, OR=2.24 [95% CI (1.15, 4.39)], P=0.02, P(heterogeneity)=0.24, OR=1.87 [95% CI (1.01, 3.48)], P=0.05, P(heterogeneity)=0.16, and OR=2.91 [95% CI (1.33, 6.39)], P=0.008, P(heterogeneity)=0.26, respectively. However, in sensitivity analyses, we only detected a marginally significant association of the C allele with NPDR: OR=1.54 [95% CI (1.00, 2.39)], P=0.05, P(heterogeneity)=0.17.

CONCLUSIONS

Our meta-analysis does not support the association of the VEGF -634C/G polymorphism with DR and PDR. Significant association between this polymorphism and NPDR was detected in this meta-analysis. However, this association is not robust and could be due to chance.

Unravelling the genetic basis of renal diseases; from single gene to multifactorial disorders

Chronic kidney disease is common with up to 5% of the adult population reported to have an estimated glomerular filtration rate of < 60 ml/min/1.73 m(2). A large number of pathogenic mutations have been identified that are responsible for 'single gene' renal disorders, such as autosomal dominant polycystic kidney disease and X-linked Alport syndrome. These single gene disorders account for < 15% of the burden of end-stage renal disease that requires dialysis or kidney transplantation. It has proved more difficult to identify the genetic susceptibility underlying common, complex, multifactorial kidney conditions, such as diabetic nephropathy and hypertensive nephrosclerosis. This review describes success to date and explores strategies currently employed in defining the genetic basis for a number of renal disorders. The complementary use of linkage studies, candidate gene and genome-wide association analyses are described and a collation of renal genetic resources highlighted.

Hypoxia-inducible factor-1alpha gene polymorphisms and cancer risk: a meta-analysis

BACKGROUND

The results from the published studies on the association between hypoxia-inducible factor -1alpha (HIF-1alpha) polymorphisms and cancer risk are conflicting. In this meta-analysis, we aimed to investigate the association between HIF-1alpha 1772 C/T and 1790 G/A polymorphisms and cancer.

METHODS

The meta-analysis for 1772 C/T polymorphism included 4131 cancer cases and 5387 controls, and for 1790 G/A polymorphism included 2058 cancer cases and 3026 controls. Allelic and genotypic comparisons between cases and controls were evaluated. Subgroup analyses by cancer types, ethnicity, and gender were also performed. We included prostate cancer in male subgroup, and female specific cancers in female subgroup.

RESULTS

For the 1772 C/T polymorphism, the analysis showed that the T allele and genotype TT were significantly associated with higher cancer risk: odds ratio (OR) = 1.29 [95% confidence interval (CI, 1.01, 1.65)], P = 0.04, P(heterogeneity) < 0.00001, and OR = 2.18 [95% CI (1.32, 3.62)], P = 0.003, P(heterogeneity) = 0.02, respectively. The effect of the genotype TT on cancer especially exists in Caucasians and female subjects: OR = 2.40 [95% CI (1.26, 4.59)], P = 0.008, P(heterogeneity) = 0.02, and OR = 3.60 [95% CI (1.17, 11.11)], P = 0.03, P(heterogeneity) = 0.02, respectively. For the 1790 G/A polymorphism, the pooled ORs for allelic frequency comparison and dominant model comparison suggested a significant association of 1790 G/A polymorphism with a decreased breast cancer risk: OR = 0.28 [95% CI (0.08, 0.90)], P = 0.03, P(heterogeneity) = 0.45, and OR = 0.29 [95% CI (0.09, 0.97)], P = 0.04, P(heterogeneity) = 0.41, respectively. The frequency of the HIF-1alpha 1790 A allele was very low and only two studies were included in the breast cancer subgroup.

CONCLUSIONS

Our meta-analysis suggests that the HIF-1alpha 1772 C/T polymorphism is significantly associated with higher cancer risk, and 1790 G/A polymorphism is significantly associated with decreased breast cancer risk. The effect of the 1772 C/T polymorphism on cancer especially exists in Caucasians and female subjects. Only female specific cancers were included in female subgroup, which indicates that the 1772 C/T polymorphism is significantly associated with an increased risk for female specific cancers. The association between the 1790 G/A polymorphism and lower breast cancer risk could be due to chance.

Uteroglobin: a steroid-inducible immunomodulatory protein that founded the Secretoglobin superfamily

Blastokinin or uteroglobin (UG) is a steroid-inducible, evolutionarily conserved, secreted protein that has been extensively studied from the standpoint of its structure and molecular biology. However, the physiological function(s) of UG still remains elusive. Isolated from the uterus of rabbits during early pregnancy, UG is the founding member of a growing superfamily of proteins called Secretoglobin (Scgb). Numerous studies demonstrated that UG is a multifunctional protein with antiinflammatory/ immunomodulatory properties. It inhibits soluble phospholipase A(2) activity and binds and perhaps sequesters hydrophobic ligands such as progesterone, retinols, polychlorinated biphenyls, phospholipids, and prostaglandins. In addition to its antiinflammatory activities, UG manifests antichemotactic, antiallergic, antitumorigenic, and embryonic growth-stimulatory activities. The tissue-specific expression of the UG gene is regulated by several steroid hormones, although a nonsteroid hormone, prolactin, further augments its expression in the uterus. The mucosal epithelia of virtually all organs that communicate with the external environment express UG, and it is present in the blood, urine, and other body fluids. Although the physiological functions of this protein are still under investigation, a single nucleotide polymorphism in the UG gene appears to be associated with several inflammatory/autoimmune diseases. Investigations with UG-knockout mice revealed that the absence of this protein leads to phenotypes that suggest its critical homeostatic role(s) against oxidative damage, inflammation, autoimmunity, and cancer. Recent studies on UG-binding proteins (receptors) provide further insight into the multifunctional nature of this protein. Based on its antiinflammatory and antiallergic properties, UG is a potential drug target.