scholarly journals Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Masanori Abe ◽  
Ikuto Masakane ◽  
Atsushi Wada ◽  
Shigeru Nakai ◽  
Kosaku Nitta ◽  
...  

Background: Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality.Methods: This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis.Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03–1.22), P = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92–0.98), P = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02–1.19), P = 0.015] and II [1.10 (1.02–1.39), P = 0.014] but significantly lower for type V [0.91 (0.88–0.94), P < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications.Conclusions: Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Masanori Abe ◽  
Ikuto Masakane ◽  
Atsushi Wada ◽  
Shigeru Nakai ◽  
Eiichiro Kanda ◽  
...  

AbstractFew data are available regarding the association of dialyzer type with prognosis. In Japan, dialyzers are classified as types I, II, III, IV, and V based on β2-microglobulin clearance rates of < 10, < 30, < 50, < 70, and ≥ 70 mL/min, respectively. We investigated the relationship of the 5 dialyzer types with 1-year mortality. This nationwide cohort study used data collected at the end of 2008 and 2009 by the Japanese Society for Dialysis Therapy Renal Data Registry. We enrolled 203,008 patients on maintenance hemodialysis who underwent hemodialysis for at least 1 year and were managed with any of the 5 dialyzer types. To evaluate the association of dialyzer type with 1-year all-cause mortality, Cox proportional hazards models and propensity score-matched analyses were performed. After adjustment of the data with clinicodemographic factors, the type I, II, and III groups showed significantly higher hazard ratios (HRs) than the type IV dialyzers (reference). After adjustment for Kt/V and β2-microglobulin levels, the HRs were significantly higher in the type I and II groups. After further adjustment for nutrition- and inflammation-related factors, the HRs were not significantly different between the type IV and type I and II groups. However, type V dialyzers consistently showed a significantly lower HR. With propensity score matching, the HR for the type V dialyzer group was significantly lower than that for the type IV dialyzer group. Additional long-term trials are required to determine whether type V dialyzers, which are high-performance dialyzers, can improve prognosis.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Masanori Abe ◽  
Ikuto Masakane ◽  
Atsushi Wada ◽  
Shigeru Nakai ◽  
Kosaku Nitta ◽  
...  

AbstractA target Kt/V of > 1.4 and use of a high-flux dialyzer are recommended for patients on hemodialysis. However, there is little information on the relationship between the dialyzer surface area and mortality in these patients. In this nationwide cohort study, we aimed to clarify this relationship by analyzing data from the Japanese Society for Dialysis Therapy for 2010–2013. We enrolled 234,638 patients on hemodialysis who were divided according to quartile for dialyzer surface area into the S group (small, < 1.5 m2), M group (medium, 1.5 m2), L group (large, 1.6 to < 2.0 m2), or XL group (extra-large, ≥ 2.0 m2). We assessed the association of each group with 3-year mortality using Cox proportional hazards models and performed propensity score matching analysis. By the end of 2013, a total of 53,836 patients on dialysis (22.9%) had died. There was a significant decrease in mortality with larger dialyzer surface areas. The hazard ratio (95% confidence interval) was significantly higher in the S group (1.15 [1.12–1.19], P < 0.0001) and significantly lower in the L group (0.89 [0.87–0.92] P < 0.0001) and XL group (0.75 [0.72–0.78], P < 0.0001) than in the M group as a reference after adjustment for all confounders. Findings were robust in several sensitivity analyses. Furthermore, the findings remained significant after propensity score matching. Hemodialysis using dialyzers, especially super high-flux dialyzers with a larger surface area might reduce mortality rates, and a surface area of ≥ 2.0 m2 is superior, even with the same Kt/V.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Deepshikha Bhowmik ◽  
Shiela Chetri ◽  
Bhaskar Jyoti Das ◽  
Debadatta Dhar Chanda ◽  
Amitabha Bhattacharjee

Abstract Objective This study was designed to discover the dissemination of virulence genes in Methicillin-resistant Staphylococcus aureus from clinical, community and environmental settings. Results This study includes 1165 isolates collected from hospital, community and environmental settings. Among them sixty three were confirmed as MRSA with varied SCCmec types viz; type I, type II, type III, type IV, type V, type VI, type VII, type VIII and type XII. The virulence gene such as sea (n = 54), seb (n = 21), eta (n = 27), etb (n = 2), cna (n = 24), ica (n = 2) and tst (n = 30) was also revealed from this study. The study underscores coexistence of resistance cassette and virulence genes among clinical and environment isolates which is first of its kind from this part of the world.


2016 ◽  
Vol 3 (5) ◽  
pp. 814
Author(s):  
Suhag Patel ◽  
Sunita Garg ◽  
Sumit Sabharwal ◽  
Neetika Jain ◽  
Shadabul Islam ◽  
...  

AIM: The purpose of this study was to describe the external and internal anatomy of the mandibular premolars. MATERIAL AND METHODS: 100 extracted human permanent mandibular first and second premolars teeth were collected. The length of the tooth from the cusp tip to root apex was measured with the help of Vernier calliper. In case of curved roots, ligature wire was adapted to the root and then straightened and measured. Each tooth was examined for the number of roots, curvature of root, presence of root canal invagination. India ink was injected into the pulp chamber through the access opening with a no.27 gauge needle mounted on a disposable syringe. The ink was then drawn through the root canal system by applying negative pressure to the apical end of tooth with the use of central suction system. RESULTS: The average (mean) length of mandibular first premolar was 22.25 mm. Average (mean) length of mandibular second premolar was 21.90 mm. Mandibular first premolar had a ribbon shaped root canal orifice in 35% of teeth. Mandibular second premolar had a ribbon shaped of root canal orifice in 44% teeth. Mesial invagination of the root was found in 18% of first and 8% second mandibular premolar teeth. 78% had a Type I canal pattern with Type II, Type IV, Type V, Type VI and Type VII canals being identified in 1%, 2%, 13%, 2% and 1% of the teeth respectively. CONCLUSIONS: Complex root canal anatomy frequently found with mandibular premolars among which more common with mandibular first premolars in Indian population.


reportaendo ◽  
2018 ◽  
Vol 1 (4) ◽  
Author(s):  
JENNY GUERRERO FERRECCIO ◽  
CAMILA ADRIANA PERALTA MIER

Introducción: El tratamiento endodontico representa en la actualidad una gran rama en el área de la odontología de importancia para la preservación de piezas dentales, que se verían afectadas por el ataque de agentes externos y que comprometen su funcionabilidad y estética, pero la complejidad de la anatomía de los conductos de todos los dientes en general aún sigue siendo un problema, más aun en los premolares, ya que estos a diferencia de las demás piezas dentarias, tienen diferentes formas y cantidad de conductos radiculares. (6) Propósito: El propósito de este estudio es demostrar la importancia del conocimiento sobre la anatomía radicular y sus variaciones anatómicas, para minimizar el fracaso al realizar una terapia endodontica. Objetivo: El objetivo directo de este estudio es determinar las variaciones anatómicas de premolares superiores e inferiores y su relación con estructuras anatómicas de pacientes atendidos endodónticamente, el año 2016, en la clínica Nexodent de la ciudad de Guayaquil, mediante el uso de sus tomografías previas a  su tratamiento.Materiales y métodos: Se analizaron 70 tomografías de 41 pacientes atendidos en el año 2016 en la clínica Nexodent de la ciudad de Guayaquil. Al momento de analizar cada tomografía se tomaron tres fotografías de cortes tomografcos: coronal, axial y sagital para obtener una información variada de su anatomía. Resultados: De las tomografías revisadas, el 71% fue de género femenino. El 29% de género masculino. Los resultados encontrados del número de conductos en las piezas dentales registradas señalan que el 56% de los casos presenta 1 sólo conducto. En cuanto a la variación anatómica de las piezas dentales estudiadas, se utilizó la clasifcación de Vertucci. El 56% de las piezas dentales es de Tipo I, el 26% es de Tipo IV, el 11% es de Tipo II, y el restante son de Tipo V. Se analizó la distancia entre cada premolar maxilar hasta el seno maxilar y en promedio la distancia fue de 5,3 mm. La distancia promedio de los premolares mandibulares hasta el foramen mentoniano fue de 6,21 mm. La principal localización encontrada para el orifcio del foramen apical fue el centro con el 58% de los casos.Discusión: Se obtuvo mayoría de aciertos sobre los estudios realizados con los estudios de las referencias bibliográfcas excepto en; La incidencia de los conductos en los segundos premolares superiores en que se obtuvo mayoria de un conducto en lugar de dos. En la distancia promedio del apice de los primeros premolares mandibulares con el agujero mentoniano en donde las distancias promedios fueron mayores. En la localizacion del foramen apical en la pieza #35, en que hubo mayor localizacion del foramen en el centro y no hacia distal.Conclusión: Se puede concluir que el mejor examen complementario para analizar la anatomía de conductos es la tomografía y que los resultados obtenidos en esta investigación no fueron muy distintos en comparación a investigaciones realizadas por otros autores.    AbstractIntroduction: Endodontic treatment currently represents a large branch in the area of dentistry of importance for the preservation of dental pieces, which would be afected by the attack of external agents and compromise its functionality and aesthetics, but the complexity of the root Canals anatomy of all teeth in general still remains a problem, even more so in the premolars as these unlike other teeth, have diferent forms and quantity of root Canals. 6 Purpose: The purpose of this study is to demonstrate the importance of knowledge about the root canal anatomy and its anatomical variations, in order to minimize the failure in an endodontic therapy.Objective: The direct objective of this study is to determine the anatomical variations of upper and lower premolars and their relationship with anatomical structures of endodontically treated patients, in 2016, at the Nexodent Clinic of the city of Guayaquil, using their tomography prior to its treatment. Materials and methods: We analyzed 70 CT scans of 41 patients seen in 2016 at the Nexodent clinic in the city of Guayaquil. At the moment of analyzing each tomography three photographs were taken: coronal, axial and sagittal to obtain al the information of its anatomy. Results: Of the CT scans reviewed, 71% were female, 29% male. The results found of the number of root canals in the registered dental pieces indicate that 56% of the cases present 1 only conduit. Regarding the anatomical variation of the studied dental pieces, the Vertucci classifcation was used 56% of the teeth are Type I, 26% are Type IV, 11% are Type II, and the rest are Type V. The average distance between the maxillary premolars to the maxillary sinus was 5.3 mm. The mean distance from the mandibular premolars to the mental foramen was 6.21 mm. The main location found for the apical foramen was the center with 58% of the cases. Discussion: the mayority of the studies carried out with the studies of the bibliographical references where equal except in; The incidence of root canals in the upper second premolars where the mayority of one root was obtained instead of two. In the average distance of the apex of the frst mandibular premolars with the mental foramen where the average distances were greater. In the location of the apical foramen in # 35, in which there was greater location of foramen in the center and not distal. Conclusion: It can be concluded that the best complementary exam to analyze the anatomy of root Canals is the tomography and that the results obtained in this investigation were not very diferent  in comparison to investigations realized by other authors. 


2021 ◽  
Author(s):  
Dicken Kong ◽  
Jiandong Zhou ◽  
Sharen Lee ◽  
Keith Sai Kit Leung ◽  
Tong Liu ◽  
...  

AbstractBackgroundIn this territory-wide, observational, propensity score-matched cohort study, we evaluate the development of transient ischaemic attack and ischaemic stroke (TIA/Ischaemic stroke) in patients with AF treated with edoxaban or warfarin.MethodsThis was an observational, territory-wide cohort study of patients between January 1st, 2016 and December 31st, 2019, in Hong Kong. The inclusion were patients with i) atrial fibrillation, and ii) edoxaban or warfarin prescription. 1:2 propensity score matching was performed between edoxaban and warfarin users. Univariate Cox regression identifies significant risk predictors of the primary, secondary and safety outcomes. Hazard ratios (HRs) with corresponding 95% confidence interval [CI] and p values were reported.ResultsThis cohort included 3464 patients (54.18% males, median baseline age: 72 years old, IQR: 63-80, max: 100 years old), 664 (19.17%) with edoxaban use and 2800 (80.83%) with warfarin use. After a median follow-up of 606 days (IQR: 306-1044, max: 1520 days), 91(incidence rate: 2.62%) developed TIA/ischaemic stroke: 1.51% (10/664) in the edoxaban group and 2.89% (81/2800) in the warfarin group. Edoxaban was associated with a lower risk of TIA or ischemic stroke when compared to warfarin.ConclusionsEdoxaban use was associated with a lower risk of TIA or ischemic stroke after propensity score matching for demographics, comorbidities and medication use.


2020 ◽  
Author(s):  
Deepshikha Bhowmik ◽  
Shiela Chetri ◽  
Bhaskar Jyoti Das ◽  
Debadatta Dhar Chanda ◽  
Amitabha Bhattacharjee

Abstract Objective: This study was designed to discover the dissemination of virulence genes in Methicillin-resistant Staphylococcus aureus from clinical and environmental settings. Results: The virulence gene such as sea (n=54), seb (n=21), eta (n=27), etb (n=2), cna (n=24), ica (n=2) and tst (n=30) was revealed from this study. Different SCCmec types such as type I, type II, type III, type IV, type V, type VI, type VII, type VIII and type XII were detected among sixty three MRSA isolates where SCCmec type II having ST1551 and type V with ST2416 were found to be associated with multidrug resistance and were highly prevalent in the study area.


PEDIATRICS ◽  
1977 ◽  
Vol 59 (4) ◽  
pp. 513-525
Author(s):  
Peter O. Kwiterovich ◽  
J. Ramsay Farah ◽  
W. Virgil Brown ◽  
Paul S. Bachorik ◽  
Stephen B. Baylin ◽  
...  

Primary type V hyperlipoproteinemia was identified in two preadolescent children. The propositus (kindred N) was a 10-year-old girl with severely creamy plasma, lipemia retinalis, hypertriglyceridemia (triglyceride level, 6,800 mg/100 ml), and hypercholesterolemia (cholesterol level, 490 mg/100 ml). Her parents and an 8-year-old sister all had endogenous hypertriglyceridemia (type IV hyperlipoproteinemia). In kindred A, an 11-year-old boy had triglyceride levels as high as 1,100 mg/100 ml and recurrent abdominal pain. His father had type V hyperlipoproteinemia; his mother was normal. All three of his older teenage siblings had type IV hyperlipoproteinemia. The enzymatic activities of lipoprotein lipase (LPL), hepatic triglyceride lipase (HTL), and histaminase (H) were studied in postheparin plasma. The LPL level was low in the children and both parents in kindred N. LPL level in kindred A was normal, except for one child with type IV hyperlipoproteinemia. HTL level was normal to above normal in both kindreds. Most patients had a normal H level, but one parent (kindred N) had no preheparin H and very low levels of postheparin H. There was a strong correlation (r = 0.58, significant at &lt; 1% level) between the release of LPL and H but not between HTL and H (r = 0.22). The mean (± 1 S.D.) levels of the enzymes were as follows: LPL, 2.8 ± 0.7 µmol/ml/hr in kindred N and 5.4 ± 2.2 µmol/ml/hr in kindred A; H, 13.4 ± 6.8 units/ml in kindred N and 22.0 ± 11.9 units/ml in kindred A; and HTL, 18.0 ± 7.1 µmol/ml/hr in kindred N and 14.9 ± 6.3 µmol/ml/hr in kindred A. The enzymatic activities of kindreds N and A were significantly different for LPL (P &lt; .001) and H (.025 &lt; P &lt; .05) but not for HTL. All but one child had at least one high insulin level, which was accompanied by hyperglycemia in two children. The hypertriglyceridemia in all but one child was ameliorated on therapeutic diets. These data suggest that the genetic basis of the hypertriglyceridemia in these two families is different and that hyperchylomicronemia in childhood is not confined to the rare type I hyperlipoproteinemia.


2020 ◽  
Author(s):  
Yang Wu ◽  
Haofei Hu ◽  
Jinlin Cai ◽  
Runtian Chen ◽  
Xin Zuo ◽  
...  

Abstract Background Previous studies have revealed that hypertension is one of major risk factors of incident diabetes. However, reliable quantification of the relationship between hypertension and diabetes risk is limited, especially in Chinese people. We aimed to investigate the association between hypertension and risk of incident diabetes in a large cohort of Chinese population. Methods This was a retrospective propensity score-matched cohort study. We enrolled 211809 Chinese adults without diabetes at baseline between 2010 and 2016. The target independent and dependent variable were hypertension at baseline and incident diabetes during follow-up respectively. The one to one propensity score matching using a non-parsimonious multivariable logistic regression was conducted to balance the confounders between 28,946 hypertensive patients and 28,946 non-hypertensive participants. The doubly robust estimation method was used to investigate the association between hypertension and incident diabetes. Result After propensity-score matching, the cumulative incidence of diabetes among hypertensive and non-hypertensive participants were 1627.690 per 100,000 person-years and 1414.422 per 100,000 person-years, respectively. In the propensity-score matching cohort, compared to the non-hypertensive participants, the risk of incident diabetes increased by 14.0% among hypertensive subjects (HR = 1.140, 95% confidence interval (CI): 1.058–1.229, P = 0.00063). After adjusting for the demographic and clinical covariates, diabetes risk increased by 13.1% in the hypertensive group (HR = 1.131, 95%CI: 1.049–1.220, P = 0.00143). And diabetes risk increased by 15.4% among hypertensive subjects after adjusting for the propensity score (HR = 1.154, 95%CI:1.070–1.244, P = 0.00019).In the subgroup analysis, compared to non-hypertensive participants with low propensity score, the risk of incident diabetes increased by 2.6 times among hypertensive patients with high propensity score (HR = 3.610,95%CI: 2.604–5.005,P < 0.00001). In the sensitivity analysis, the risk of diabetes in the hypertensive group increased by 11.7% in the original cohort (HR = 1.117༌95%CI: 1.044–1.196,P = 0.00134) and 19.9% in the weighted cohort(HR = 1.199༌95%CI: 1.149–1.250,P < 0.00001), respectively. Conclusion Hypertension was associated with a 13.1% increase in the risk of developing diabetes in Chinese adults. Additionally, compared to non-hypertensive participants with low propensity score, the risk of incident diabetes increased by 2.6 times among hypertensive patients with high propensity score.


Sign in / Sign up

Export Citation Format

Share Document