scholarly journals MO699PERITONITIS RISK OF PD MODALITIES AND TECHNICAL SURVIVAL ACCORDING TO BASELINE PERITONEAL TRANSPORT STATUS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hasan Haci Yeter ◽  
Omer Faruk Akcay ◽  
Galip Güz
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Significant Risk ◽  
Technical Failure ◽  
Peritoneal Transport ◽  
The Mean ◽  
The Impact

Abstract Background and Aims The PD modality is usually modulated according to the PET and dialysis adequacy during follow-up but, initial modality choice generally depends on patient preferences and lifestyle regardless of patients’ baseline transport status. However, the relationship between baseline transport status, the PD modality chosen, and technical survival is not well established. Peritonitis is one of the leading causes of technical failure, hospitalization, and death in PD. While obesity, low albumin levels, exit-site infections, and nasal staphylococcus carriage are well-defined risk factors for peritonitis, some suggest CAPD could be another risk factor due to increased daily connection to PD. Many studies indicated that CAPD and APD have similar technical survival rates. In this study, we aimed to identify the impact of the baseline transport status on technical survival of CAPD and APD. We also investigated peritonitis risk of modalities considering all defined risk factors. Method This is a retrospective, single-center, cohort study of incident adult PD patients followed-up between January 2010 and January 2020. One hundred and thirty-six patients, followed-up for at least three years, were included. Patients with malignancy and who had less than 1.7 Kt/V per week were excluded. Peritonitis is defined according to the "International Society Peritoneal Dialysis" guideline. According to the baseline PET, patients were divided into two groups as follows; 1) high or high average transporters and 2) low or low average transporters. Risk factors for peritonitis, five years, and overall technical survival of both modalities according to baseline transport status were determined. Results The mean age was 35.5±12 years, and the median follow-up time was 47 (36-178) months. Sixty-six (48%) of the patients were female. Patients' first-year Kt/V per week was 2.18±0.4, and the mean ultrafiltration was 0.9±0.4 liters. 26 (19%) of the patients had diabetes mellitus, 57(42%) patients had hypertension, and 27 (20%) of the patients had a history of hemodialysis of more than three months. 89 (65%) of the patients were performing CAPD, 59 (66%) of whom were low or low-average transporters. 47(35%) of patients were performing APD and 28(60%) of whom were high or high-average transporters. During the follow-up, a total of 71 peritonitis episodes were observed, and the incidence of peritonitis was 0.13 episodes/year. Univariate logistic regression analysis showed that CAPD, low education level (being primary school graduate or illiterate), HD treatment before PD, and bathing less than once per week were associated with peritonitis risk. However, multivariate analysis of associated factors demonstrated that only CAPD was a significant risk factor for peritonitis [odds ratio:2.360 (95% confidence interval:1.075-5.180), p=0.03]. Kaplan-Meier survival analysis showed that low or low-average transporters and high or high-average transporters had similar technical survival rates in both CAPD or APD at the end of three years (figure 1). Similar rates were found in overall survival. Conclusion In our study, APD and CAPD patients had similar technical survival regardless of the peritoneal transport characteristics. However, CAPD was found to be a factor for peritonitis. Thus, it may be appropriate to initiate the PD treatment with APD modality and evaluate patients to switch modalities with PET only in case of peritoneal dialysis inadequacy.

scholarly journals Differences in Risk Factors for Retinopathy of Prematurity Development in Paired Twins: A Chinese Population Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Gordon S. K. Yau ◽  
Jacky W. Y. Lee ◽  
Victor T. Y. Tam ◽  
Stan Yip ◽  
Edith Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retinopathy Of Prematurity ◽  
Very Low Birth Weight ◽  
Significant Risk ◽  
The Mean ◽  
Record Review ◽  
Chinese Twins ◽  
Retrospective Medical Record Review

Purpose.To determine the differences in risk factors for retinopathy of prematurity (ROP) in paired twins.Methods.A retrospective medical record review was performed for all paired twins screened for ROP between 2007 and 2012. Screening was offered to very low birth weight (≤1500 grams) and preterm (≤32 weeks) neonates. Twins 1 and 2 were categorized based on the order of delivery. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP.Results.In 34 pairs of Chinese twins, the mean gestational age (GA) was 30.2 ± 2.0 weeks. In Twin 1, smaller GA (OR = 0.44,P=0.02), higher mean oxygen concentration (OR = 1.34,P=0.03), presence of thrombocytopenia (OR = 1429.60,P<0.0001), and intraventricular hemorrhage (OR = 18.67,P=0.03) were significant risk factors for ROP. For Twin 2, a smaller GA (OR = 0.45,P=0.03) was the only risk factor. There were no significant risk factors for ROP in Twin 1 or Twin 2 on multivariate analysis.Conclusion.In Chinese twin pairs, smaller GA was the only common risk factor for ROP while Twin 1 was more susceptible to the postnatal risks for ROP.

Abstract 141: Impact of an Aggressive Medical Management Protocol on Early Risk Factor Measures in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) Trial

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tanya N Turan ◽  
Azhar Nizam ◽  
Michael J Lynn ◽  
Colin P Derdeyn ◽  
David Fiorella ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Medical Management ◽  
Intracranial Stenosis ◽  
Patient Specific ◽  
Early Risk ◽  
Aggressive Medical Management ◽  
The Impact ◽  
Early Risk Factor

Purpose: SAMMPRIS is the first stroke prevention trial to include protocol-driven aggressive management of multiple vascular risk factors. We sought to determine the impact of this protocol on early risk factor control in the trial. Materials and Methods: SAMMPRIS randomized 451 patients with symptomatic 70%-99% intracranial stenosis to aggressive medical management or stenting plus aggressive medical management at 50 USA sites. For the primary risk factor targets (SBP < 140 mm/Hg (<130 if diabetic) and LDL < 70 mg/dL), the study neurologists follow medication titration algorithms and risk factor medications are provided to the patients. Secondary risk factors (diabetes, non-HDL, weight, exercise, and smoking cessation) are managed with assistance from the patient’s primary care physician and a lifestyle modification program (provided). Sites receive patient-specific recommendations and feedback to improve performance. Follow-up continues, but the 30-day data are final. We compared baseline to 30-day risk factor measures using paired t-tests for means and McNemar tests for percentages. Results: The differences in risk factor measures between baseline and 30 days are shown in Table 1. Conclusions: The SAMMPRIS protocol resulted in major improvements in controlling most risk factors within 30 days of enrollment, which may have contributed to the lower than expected 30 day stroke rate in the medical group (5.8%). However, the durability of this approach over time will be determined by additional follow-up.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 600-606 ◽  
Author(s):  
Christine Moore ◽  
Jastej Dhaliwal ◽  
Agnes Tong ◽  
Sarah Eden ◽  
Cindi Wigston ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Skin Lesions ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
The Impact

Objective.To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.Design.Retrospective cohort study.Setting.A 472-bed acute-care teaching hospital in Toronto, Canada.Patients.Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.Methods.Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.Results.Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.Conclusions.Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

scholarly journals Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Justin W. Arner ◽  
Sachidhanand Jayakumar ◽  
Dharmesh Vyas ◽  
James P. Bradley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Revision Surgery ◽  
Significant Risk ◽  
Return To Sport ◽  
Significant Risk Factor ◽  
Return To Play ◽  
Bone Width ◽  
Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

P3850Impact of sex and risk factors for venous thromboembolism on the clinical course of first acute venous thromboembolism. Insights from the PREFER in VTE

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Giustozzi ◽  
S Barco ◽  
L Valerio ◽  
F A Klok ◽  
M C Vedovati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Baseline Risk ◽  
Major Surgery ◽  
First Episode ◽  
Risk Of Recurrence ◽  
Recurrent Vte ◽  
The Impact

Abstract Introduction The interaction between sex and specific provoking risk factors for venous thromboembolism (VTE) may influence initial presentation and prognosis. Purpose We investigated the impact of sex on the risk of recurrence across subgroups of patients with first VTE classified according to baseline risk factors. Methods PREFER in VTE was an international, non-interventional registry (2013–2015) including patients with a first episode of acute symptomatic objectively diagnosed VTE. We studied the risk of recurrence in patients classified according to baseline provoking risk factors for VTE consisted of i) major transient (major surgery/trauma, >5 days in bed), ii) minor transient (pregnancy or puerperium, estroprogestinic therapy, prolonged immobilization, current infection or bone fracture/soft tissue trauma); iii) unprovoked events, iv) active cancer-associated VTE. Results A total of 3,455 patients diagnosed with first acute VTE were identified, of whom 1,623 (47%) were women. The percentage of patients with a major transient risk factor was 22.2% among women and 19.7% among men. Minor transient risk factors were present in 21.3% and 12.4%, unprovoked VTE in 51.6% and 61.6%, cancer-associated VTE in 4.9% of women and 6.3% of men, respectively. The proportions of cases treated with Vitamin-K antagonists (VKAs) and direct oral anticoagulants (DOACs) were similar between sexes. Median length of treatment of VKAs was 181.5 and 182.0 days and of DOACs was 113.0 and 155.0 days in women and men, respectively. At 12-months of follow-up, VTE recurrence was reported in 74 (4.8%) women and 80 (4.5%) men. Table 1 shows the sex-specific proportion of recurrences by VTE risk factor categories. Table 1 Major Transient (n=722) Minor transient (n=573) Cancer-associated (n=195) Unprovoked (1965) Women (361) Men (361) OR (95% CI) Women (346) Men (227) OR (95% CI) Women (79) Men (116) OR (95% CI) Women (837) Men (1128) OR (95% CI) One-year follow-up, n (N%)   Recurrent VTE, 21 (6.2) 10 (2.9) 0.46 (0.2; 0.9) 9 (2.7) 12 (5.4) 2.09 (0.9; 5.0) 6 (8.0) 5 (4.5) 0.54 (0.2; 1.9) 38 (4.7) 53 (4.7) 1.03 (0.7; 1.6)   Major bleeding, 6 (1.8) 5 (1.5) 0.83 (0.3; 2.7) 5 (1.5) 1 (0.5) 0.30 (0.1; 2.6) 1 (1.3) 3 (2.7) 2.07 (0.2; 20) 10 (1.2) 15 (1.4) 1.11 (0.6; 2.4)   All-cause death, 37 (10.2) 31 (8.5) 0.82 (0.5; 1.4) 10 (2.9) 14 (6.2) 2.21 (0.9; 5.1) 26 (32.9) 49 (42.2) 1.49 (0.8; 2.7) 33 (3.9) 30 (2.7) 0.66 (0.4; 1.1) Conclusions The proportion of patients with recurrent VTE events after first acute symptomatic VTE provoked by transient risk factors was not negligible during the first year of follow-up during in both women and men. These results may have implications on the decision whether to consider extended anticoagulant therapy in selected patients with provoked events. Acknowledgement/Funding This study was funded by Daiichi Sankyo.

Long Term Follow-Up of Pediatric Sickle Cell Disease Patients with Conditional Velocities on Transcranial Doppler (TCD).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2338-2338
Author(s):  
Lena Coïc ◽  
Suzanne Verlhac ◽  
Emmanuelle Lesprit ◽  
Emmanuelle Fleurence ◽  
Francoise Bernaudin
Keyword(s):  
Risk Factors ◽  
Color Doppler ◽  
Significant Risk ◽  
Biological Data ◽  
Treatment Intensification ◽  
Significant Difference ◽  
History Of ◽  
The Mean

Abstract Abnormal TCD defined as high mean maximum velocities &gt; 200 cm/sec are highly predictive of stroke risk and justify long term transfusion program. Outcome and risk factors of conditional TCD defined as velocities 170–200 cm/sec remains to be described. Patients and methods Since 1992, 371 pediatric SCD patients (303 SS, 44 SC, 18 Sß+, 6 Sß0) were systematically explored once a year by TCD. The newborn screened cohort (n=174) had the first TCD exploration between 12 and 18 months of age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. Biological data were assessed at baseline, after the age of 1.5 years and remotely of transfusion or VOC. We report the characteristics and the outcome in patients (n=43) with an history of conditional TCD defined by mean maximum velocities ranging between 170 and 200 cm/s in the ACM, the ACA or the ICA. Results: The mean follow-up of TCD monitoring was 5,5 years (0 – 11,8 y). All patients with an history of conditional doppler were SS/Sb0 (n=43). Mean (SD) age of patients at the time of their first conditional TCD was 4.3 years (2.2) whereas in our series the mean age at abnormal TCD (&gt; 200 cm/sec) occurrence was 6.6 years (3.2). Comparison of basal parameters showed highly significant differences between patients with conditional TCD and those with normal TCD: Hb 7g4 vs 8g5 (p&lt;0.001), MCV 82.8 vs 79 (p=0.047). We also had found such differences between patients with normal and those with abnormal TCD (Hb and MCV p&lt; 0.001). Two patients were lost of follow-up. Two patients died during a trip to Africa. Conditional TCD became abnormal in 11/43 patients and justified transfusion program. Mean (SD) conversion delay was 1.8 (2.0) years (range 0.5–7y). No stroke occurred. 16 patients required a treatment intensification for other indications (frequent VOC/ACS, splenic sequestrations): 6 were transplanted and 10 received HU or TP. Significant risk factors (Pearson) of conversion to abnormal were the age at time of conditional TCD occurrence &lt; 3 y (p&lt;0.001), baseline Hb &lt; 7g/dl (p=0.02) and MCV &gt; 80 (p=0.04). MRI/MRA was performed in 31/43 patients and showed ischemic lesions in 5 of them at the mean (SD) age of 7.1 y (1.8) (range 4.5–8.9): no significant difference was observed in the occurrence of lesions between the 2 groups. Conclusions This study confirms the importance of age as predictive factor of conditional to abnormal TCD conversion with a risk of 64% when first conditional TCD occured before the age of 3 years. TCD has to be frequently controled during the 5 first years of life.

scholarly journals Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Alyssa Denton ◽  
Lilian Thorpe ◽  
Alexandra Carter ◽  
Adriana Angarita-Fonseca ◽  
Karen Waterhouse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Drug Resistant ◽  
Age Group ◽  
Drug Resistant Epilepsy ◽  
New Diagnosis

Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

scholarly journals MON-662 Diabetes Risk for Non-Obese Subjects in a Japanese Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yoshimi Tatsukawa ◽  
Hiroko Kitamura ◽  
Michiko Yamada ◽  
Waka Ohishi ◽  
Ayumi Hida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Risk Factor ◽  
Blood Glucose ◽  
Fatty Liver ◽  
Handgrip Strength ◽  
Fasting Blood Glucose ◽  
Significant Risk ◽  
Metabolic Abnormality

Abstract [Background] Obesity is a major risk factor of developing diabetes and cardiovascular diseases, though not all obese people develop these conditions and diseases. Because Asian populations have a lower frequency of obesity in comparison with populations in the United States and Europe, it is important to detect risk factors for developing diabetes in non-obese Japanese populations. [Objectives] To examine risk factors for diabetes, and to consider countermeasures against diabetes development in Japanese populations, especially non-obese individuals. [Methods] This study examined 1,794 individuals (514 males and 1,280 females) who participated in both Adult Health Study health examinations on A-bomb survivors and their controls in Hiroshima and Nagasaki between 1994–1996 (baseline) and 2008–2011. They were aged 48–79 years and had not been diagnosed with diabetes at baseline or cancer. Obesity was defined as a BMI of 23 kg/m2 or greater based on the WHO recommendation for Asians. In accordance with AHA/NHLBI criteria for diagnosis of metabolic syndrome, we defined a diagnosis of metabolic abnormality as having at least two of the criteria other than abdominal obesity. The diagnostic criteria for diabetes were a fasting blood glucose ≥126 mg/dL, a non-fasting blood glucose ≥200mg/dL, a self-report of a diabetes diagnosis, or the initiation of medical treatment for diabetes during the follow-up period. We compared presences of fatty liver and metabolic abnormality, BMI at baseline, and changes of body weight from baseline between the group that developed diabetes and the group did not over a 15-year follow-up. [Results] During the follow-up period until 2001, 66 (7.0%) individuals and 127 individuals (14.8%) from the non-obese and obese groups, respectively, developed diabetes. BMI at baseline and presences of fatty liver and metabolic abnormality were associated with developing diabetes in both non-obese and obese groups. Changes in body weight from baseline were not a significant risk factor of diabetes in this study. Furthermore, we analyzed the association between diabetes risk and appendicular lean mass/height2 (ALM/H2) and handgrip strength based on the diagnostic criteria for sarcopenia among 676 subjects with information of these measurements at baseline. Occurrences of low ALM/H2 were associated with developing diabetes, but an association between low handgrip strength and developing diabetes was not observed. [Conclusion] Regardless of whether obesity was observed or not, presences of metabolic abnormality and fatty liver were significant risk factors. Increased risk of developing diabetes was observed among non-obese individuals with suspected sarcopenia. This study suggests that maintenance of muscle mass may be an effective countermeasure to reduce the risk of developing diabetes.

Patient-Doctor Contact Interval and Clinical Outcomes in Continuous Ambulatory Peritoneal Dialysis Patients

2017 ◽  
Vol 45 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Chunyan Yi ◽  
Qunying Guo ◽  
Jianxiong Lin ◽  
Jianying Li ◽  
Xueqing Yu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Operating Characteristic ◽  
Patient Survival ◽  
Characteristic Curve ◽  
Survival Rates ◽  
Guangzhou City ◽  
Clinical Events ◽  
The Mean

Background: The optimal patient-doctor contact (PDC) interval remains unknown in peritoneal dialysis (PD) patients. The aim was to investigate the association between PDC interval and clinical outcomes in continuous ambulatory PD (CAPD) patients. Methods: In this retrospective cohort study, CAPD patients who resided in Guangzhou city between January 2006 and December 2012 were included. According to receiver operating characteristic curve analysis, all patients were classified as high (PDC interval ≤2 months) and low (PDC interval >2 months) PDC frequency groups. Biochemical data, clinical events, and clinical outcomes during the follow-up period were compared. Results: Of 433 CAPD patients, the mean age was 51.3 ± 15.7 years, 54.3% of patients were male, and 29.1% with diabetes. The median vintage of PD was 45.8 (26.3-69.1) months. Patients with high PDC frequency (n = 233) had better patient-survival rates (99.6, 87.7, and 76.5% vs. 92.7, 76.5, and 58.7% at 1, 3, and 5 years; p < 0.001), lower peritonitis rate (0.17 vs. 0.23 episodes per patient-year; p < 0.001), and hospitalization rate (0.49 vs. 0.67 episodes per patient-year; p < 0.001) than those in the low PDC frequency group (n = 200). After adjustment for confounders, PDC interval of no more than 2 months was independently associated with better patient survival (hazard ratio 0.60, 95% CI 0.42-0.86, p = 0.006). Conclusion: A PDC interval of 2 months or less was associated with better clinical outcomes in CAPD patients. This indicates that a shorter PDC interval should be encouraged for them to achieve better clinical outcomes.

Sign in / Sign up

Export Citation Format

Share Document