In this study, we investigated the association of time-varying serum albumin levels with mortality over a 5-year period in one cohort of patients undergoing long-term peritoneal dialysis (PD) therapy. The participants in this study enrolled 302 patients who underwent long-term PD at a single PD center in Taiwan. We reviewed medical records from 2011 to 2015 retrospectively. Time-averaged albumin level and serum albumin reach rate (defined as the percentage of serum albumin measurements that reached ≥3.5 g/dL) were applied as the predictor variables in the first 2 years (2011–2012). All-cause mortality was used as the outcome variable in the subsequent 3 years (2013–2015). Hazard function of all-cause mortality in the study participants was examined by using Cox proportional hazard regression models . Patients with different albumin reach rates (75–< 100%, 50–< 75%, 1–< 50%) did not exhibit a significantly increased risk for all-cause mortality. Patients with a 0% albumin reach rate exhibited a significantly increased risk for all-cause mortality (hazard ratio [HR] 7.59, 95% confidence interval [CI], 2.38–24.21) by fully adjusted analysis. Patients with time-averaged albumin levels of < 3.5 g/dL (HR 15.49, 95% CI 1.74–137.72) exhibited a higher risk for all-cause mortality than those with serum albumin levels ≥4.0 g/dL. This study demonstrated that higher serum albumin reach rates and higher time-averaged serum albumin levels are associated with a lower mortality rate over a 5-year period among patients undergoing long-term PD.

An ethnicity-based reference range for normal renal size is fundamental for ultrasonographic assessment. Herein, we aimed to establish a Chinese renal reference by a large sample size, as well as to elucidate the relationship of renal dimension to age and body indices, with the aid of a comprehensive literature review. Records of 3707 healthy cases were obtained from health evaluation centers of Kaohsiung and Linkuo Chang Gung Memorial Hospitals. As a result, the mean right renal length was 10.62±0.69 cm, left renal length 10.76±0.70 cm, right renal width 4.78±0.75 cm, and left renal width 5.10±0.64 cm. Renal size was well-correlated curvilinearly to age, while linearly to body height, body weight, and body mass index. Renal size increases and then decreases with aging, and significant variations of renal size exist among different ethnicities. Our work provides a reliable reference range for renal size in the Chinese population, and valid relationships between renal dimensions and other parameters.

Background: Hemodialysis (HD) vascular access failure is one of the most important causes of morbidity and contributes to the cost of dialysis care. There is paucity of data evaluating long‐term monitoring of C‐reactive protein (CRP) on outcome of HD vascular access.Methods: We conducted a retrospective study to investigate whether variability of serum CRP level was associated with vascular access failure rate over a 7‐year period. A total of 318 HD patients were included. Their demographic data, co‐morbidities and biochemical data were reviewed and collected. Serum high‐sensitivity CRP (hs‐CRP) level was measured every 6 months. Patients were divided into three groups according to their serial hs‐CRP levels. Patients with their hs‐CRP below 2 mg/L were defined as low group (n=65, 20.4%) and those with higher than 4 mg/L were defined as high (n=39, 12.3%). The rest were classified as fluctuated hs‐CRP group (n=214, 67.3%). Treatment of vascular access failure includes angioplasty and access re‐creation.Results: Their body mass index, indicators of dialysis adequacy and serum albumin and hs‐CRP levels differed significantly among three groups. The annual vascular access failure rate was significantly higher in fluctuated hs‐CRP group than in high hs‐CRP group (0.41 vs 0.36, P=.037). Serum albumin was a significant associate of vascular access failure. Kaplan‐Meier survival analysis indicated patients with high or fluctuated hs‐CRP had shorter free interval of vascular access failure than low hs‐CRP group.Conclusions: HD patients with fluctuated hs‐CRP levels were associated with increased vascular access failure.

Background: The pleiotropic effects of 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), which are independent from their cholesterol-lowering action, have been widely recognized in various biological systems. Statins can affect endothelial homeostasis, which is partly modulated by the production of nitric oxide (NO). However, it is unclear how statin/NO-mediated posttranslational S-nitrosylation of endothelial proteins and changes in translational profiles may benefit endothelial integrity. Therefore, it is important to understand the statin/NO-mediated S-nitrosylation in endothelial cells. Results: Rosuvastatin treatment of human umbilical vein endothelial cells (ECs) enhanced the enzymatic activity of endothelial nitric oxide synthase (eNOS) and the expression of 78 S-nitrosoproteins. Among these S-nitrosoproteins, we identified 17 proteins, including protein disulfide bond isomerase, phospholipase C, transaldolase and heat shock proteins. Furthermore, a hydrophobic Cys66 was determined as the S-nitrosylation site of the mitochondrial HSP70. In addition to the statin-modulated posttranslational S-nitrosylation, changes in the NO-mediated translational proteome were also observed. Seventeen major proteins were significantly upregulated after rosuvastatin treatment. However, 12 of these proteins were downregulated after pretreating ECs with an eNOS inhibitor (L-NAME), which indicated that their expression was modulated by NO. Conclusions: ECs treated with rosuvastatin increase eNOS activation. The increased NO production is involved in modulating S-nitrosylation and translation of proteins. We provide further evidence of the pleiotropic effect of rosuvastatin on endothelial physiology.

We examined the association between catheter use for maintenance hemodialysis (HD) and mortality/hospitalization in a cohort of patients with prevalent HD. In this study, 70 HD patients with tunneled cuffed central venous catheters (TCVCs) from a Taiwanese HD center during 2014-2016 were enrolled and compared with 70 matched HD patients with native arteriovenous fistulae (AVF). The compared variables included demographic parameters and laboratory and dialysis-related indices. Cox regression analysis was used to assess the risk of mortality/hospitalization within a year. Low baseline serum albumin levels were found in patients with TCVCs (3.64 g/dL vs 3.79 g/dL, p = 0.030). The mortality rates of patients with AVF and TCVCs were 14 per 1000 patients and 171 per 1000 patients, respectively. Infection was the leading cause of mortality/hospitalization in patients with TCVCs. Using multivariate analyses, the risk of death was found to be significantly higher in patients with TCVCs than in those with AVF (Hazard ratio [HR] 12.15, 95% CI 1.16-127.17; p = 0.037). Patients with TCVC also had a higher hospitalization rate (HR 1.33, 95% CI 0.71-2.49; p = 0.369) (not statistically significant). Catheter use for maintenance HD was associated with increased all-cause mortality.