The use of cooled dialysate temperatures first came about in the early 1980 s as a way to curb the incidence of intradialytic hypotension(IDH). IDH was then, and it remains today, the most common complication affectin...The use of cooled dialysate temperatures first came about in the early 1980 s as a way to curb the incidence of intradialytic hypotension(IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst incenter hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and efficacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37 ℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confirm the encouraging outcomes mentioned here.展开更多
BACKGROUND Research exploring the influence of healthier lifestyle modification(LSM)on the risk of hepatocellular carcinoma(HCC)in patients with chronic hepatitis B(CHB)is limited.AIM To emulate a target trial to dete...BACKGROUND Research exploring the influence of healthier lifestyle modification(LSM)on the risk of hepatocellular carcinoma(HCC)in patients with chronic hepatitis B(CHB)is limited.AIM To emulate a target trial to determine the effect of LSM on HCC incidence and mortality among patients with CHB by large-scale population-based observational data.METHODS Among the patients with CHB enrolled in the Korean National Health Insurance Service between January 1,2009,and December 31,2017,those aged≥20 years who drank alcohol,smoked cigarettes,and were sedentary were analyzed.Exposure included at least one LSM,including alcohol abstinence,smoking cessation,and regular exercise.The primary outcome was HCC development,and the secondary outcome was liver-related mortality.We used 2:1 propensity score matching to account for covariates.RESULTS With 48766 patients in the LSM group and 103560 in the control group,the adjusted hazard ratio(HR)for incident HCC and liver-related mortality was 0.92[95%confidence interval(CI):0.87-0.96]and 0.92(95%CI:0.86-0.99)in the LSM group,respectively,compared with the control group.Among the LSM group,the adjusted HR(95%CI)for incident HCC was 0.84(0.76-0.94),0.87(0.81-0.94),and 1.08(1.00-1.16)for alcohol abstinence,smoking cessation,and regular exercise,respectively.The adjusted HR(95%CI)for liver-related mortality was 0.92(0.80-1.06),0.81(0.72-0.91),and 1.15(1.04-1.27)for alcohol abstinence,smoking cessation,and regular exercise,respectively.CONCLUSION LSM lowered the risk of HCC and mortality in patients with CHB.Thus,active LSM,particularly alcohol abstinence and smoking cessation,should be encouraged in patients with CHB.展开更多
Background: Kidney failure causes anemia and is associated with a very high risk of coronary heart disease(CHD). Mildly to moderately decreased kidney function is far more common and also is associated with an elevate...Background: Kidney failure causes anemia and is associated with a very high risk of coronary heart disease(CHD). Mildly to moderately decreased kidney function is far more common and also is associated with an elevated prevalence of anemia and CHD risk. Recent data suggest an even higher risk of CHD when both conditions are present. Methods: We investigated the association of kidney dysfunction and anemia with CHD events(fatal or nonfatal CHD or coronary revascularization procedures) and CHD and all- cause mortality over 12 years of follow- up in 14 971 adults aged 45 to 64 years in the ARIC Study. Glomerular filtration rate(GFR) was estimated from calibrated serum creatinine using the MDRD Study equation(< 30 mL/min per 1.73 m2 excluded, n=32). Anemia was defined as hemoglobin level<13.5 g/dL in men(648/6746, 9.6% ) and< 12 g/dL in women(1049/8225, 12.8% ). Results: The prevalence of anemia was progressively higher at lower estimated GFR< 75 mL/min per 1.73 m2(both P< .001) for both men and women. A total of 1635(10.9% ) participants had a CHD event, 360(2.4% ) died of CHD, and 1722(11.5% ) died of any cause during follow- up. After adjustment for known risk factors, including diabetes, lipid levels, blood pressure, and use of antihypertensive medication, decreased kidney function was associated with a higher risk of recurrent CHD events and mortality from CHD and all causes. These associations were significantly stronger among participants with anemia. The adjusted relative hazards of all- cause mortality associated with moderately decreased versus normal kidney function(GFR 30- 59 vs ≥ 90 mL/min per 1.73 m2) were 1.7(95% CI 1.3- 2.2) in the absence of anemia and 3.5(95% CI 2.4- 5.1) in the presence of anemia(P interaction=.001) . Conclusions: The combination of moderately decreased kidney function and anemia is associated with an increased risk of CHD events and mortality, emphasizing the need to identify individuals with these conditions and evaluate interventions to treat anemia and slow the progression of chronic kidney disease.展开更多
文摘The use of cooled dialysate temperatures first came about in the early 1980 s as a way to curb the incidence of intradialytic hypotension(IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst incenter hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and efficacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37 ℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confirm the encouraging outcomes mentioned here.
文摘BACKGROUND Research exploring the influence of healthier lifestyle modification(LSM)on the risk of hepatocellular carcinoma(HCC)in patients with chronic hepatitis B(CHB)is limited.AIM To emulate a target trial to determine the effect of LSM on HCC incidence and mortality among patients with CHB by large-scale population-based observational data.METHODS Among the patients with CHB enrolled in the Korean National Health Insurance Service between January 1,2009,and December 31,2017,those aged≥20 years who drank alcohol,smoked cigarettes,and were sedentary were analyzed.Exposure included at least one LSM,including alcohol abstinence,smoking cessation,and regular exercise.The primary outcome was HCC development,and the secondary outcome was liver-related mortality.We used 2:1 propensity score matching to account for covariates.RESULTS With 48766 patients in the LSM group and 103560 in the control group,the adjusted hazard ratio(HR)for incident HCC and liver-related mortality was 0.92[95%confidence interval(CI):0.87-0.96]and 0.92(95%CI:0.86-0.99)in the LSM group,respectively,compared with the control group.Among the LSM group,the adjusted HR(95%CI)for incident HCC was 0.84(0.76-0.94),0.87(0.81-0.94),and 1.08(1.00-1.16)for alcohol abstinence,smoking cessation,and regular exercise,respectively.The adjusted HR(95%CI)for liver-related mortality was 0.92(0.80-1.06),0.81(0.72-0.91),and 1.15(1.04-1.27)for alcohol abstinence,smoking cessation,and regular exercise,respectively.CONCLUSION LSM lowered the risk of HCC and mortality in patients with CHB.Thus,active LSM,particularly alcohol abstinence and smoking cessation,should be encouraged in patients with CHB.
文摘Background: Kidney failure causes anemia and is associated with a very high risk of coronary heart disease(CHD). Mildly to moderately decreased kidney function is far more common and also is associated with an elevated prevalence of anemia and CHD risk. Recent data suggest an even higher risk of CHD when both conditions are present. Methods: We investigated the association of kidney dysfunction and anemia with CHD events(fatal or nonfatal CHD or coronary revascularization procedures) and CHD and all- cause mortality over 12 years of follow- up in 14 971 adults aged 45 to 64 years in the ARIC Study. Glomerular filtration rate(GFR) was estimated from calibrated serum creatinine using the MDRD Study equation(< 30 mL/min per 1.73 m2 excluded, n=32). Anemia was defined as hemoglobin level<13.5 g/dL in men(648/6746, 9.6% ) and< 12 g/dL in women(1049/8225, 12.8% ). Results: The prevalence of anemia was progressively higher at lower estimated GFR< 75 mL/min per 1.73 m2(both P< .001) for both men and women. A total of 1635(10.9% ) participants had a CHD event, 360(2.4% ) died of CHD, and 1722(11.5% ) died of any cause during follow- up. After adjustment for known risk factors, including diabetes, lipid levels, blood pressure, and use of antihypertensive medication, decreased kidney function was associated with a higher risk of recurrent CHD events and mortality from CHD and all causes. These associations were significantly stronger among participants with anemia. The adjusted relative hazards of all- cause mortality associated with moderately decreased versus normal kidney function(GFR 30- 59 vs ≥ 90 mL/min per 1.73 m2) were 1.7(95% CI 1.3- 2.2) in the absence of anemia and 3.5(95% CI 2.4- 5.1) in the presence of anemia(P interaction=.001) . Conclusions: The combination of moderately decreased kidney function and anemia is associated with an increased risk of CHD events and mortality, emphasizing the need to identify individuals with these conditions and evaluate interventions to treat anemia and slow the progression of chronic kidney disease.
