The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 37
Slide Session
OS-NEP-10 Nephrology
The Association Between the Bacterial Colonization in Tunneled Cuffed Dialysis Catheter and Residual Renal Function
Jin Suk KANG1, Byeong Yun YOUNG1, Dong Won LEE1, Sang Heon SONG2, Eun Young SEONG2, Soo Bong LEE2, Ihm Soo KWAK2
Internal Medicine, Pusan National University Hospital, Korea1, Biomedical Reserch Institute, Pusan Na- tional University Hospital, Korea2
Background: Hemodialysis (HD) patients have compromised immunity that permits bacterial colonization and chronic low grade infection. There are few reports about the bacterial colonization of dialysis access which is one of the main passages of infection.
We studied the association between bacterial colonization in tunneled cuffed dialysis catheter (TCC) and clinical factors, especially residual renal function and mortality.
Methods: In this Retrospective study, we found the clinical data of 155 patients who received TCC removal from Jan. 2005 to Dec. 2012. Baseline data were collected from medical records. The follow-up data including urine output (UO), time of anuria and death were acquired from the patients or their family members by telephone.
Results: In the analysis of biochemical parameters, there was no signifi cant difference between colonization group (26 patients, 16.8%) and non-colonization group (129 patients, 83.2%). Eighty six patients were followed up by telephone questionnaire and 21 (24%) of them belonged to the colonization group. The monthly rate of decrease in UO was signifi cantly more rapid in the colonization group (68.1 ± 75.2 vs. 32.9 ± 42.6 mL/min/month, p=0.012) and the time to anuria was also shorter in the colonization group (19.3 ± 18.9 vs. 48.6 ± 46.1 months, p=0.011). The survival analysis showed that the colonization group had significantly worse estimated anuria-free survival than non-colonization group (log rank p=0.001). The all-cause mortality, however, did not signifi cantly differ between the groups (log rank p=0.185).
Conclusions: Bacterial colonization in TCC was associated with rapid loss of residual renal function.
OS-NEP-11 Nephrology
Insulin Resistance is Associated with New Onset Cardi- ovascular Events in Non-Diabetic, Prevalent Peritoneal Dialysis Patients
Chang-Yun YOON1, Youn Kyung KEE1, Eunyoung LEE1, Young Su JOO1, In Mee HAN1, Seung Gyu HAN1, Mi Jung LEE1, Hyung Jung OH1, Jung Tak PARK1, Seung Hyeok HAN1, Shin-Wook KANG1, Tae-Hyun YOO1
Severance Hospital, Korea1
Background: Chronic exposure of high glucose and consequent abdominal obesity might be a potential source of insulin resistance (IR) in prevalent peritoneal dialysis (PD) patients. Even though a small sample-sized study reported that IR was associated with cardiovascular morbidity and mortality, further clarifi cation about the clinical signifi cance of IR in this population is needed. The aim of this study was to elucidate the prognostic values of IR on new-onset cardiovascular events in non-diabetic, prevalent PD patients.
Methods: Non-diabetic ESRD patients maintained PD more than 3 months were recruited and prospectively followed up. IR was assessed by homeostatic model as- sessment of insulin resistance (HOMA-IR) using fasting insulin and glucose levels. The primary outcomes were new cardiovascular events or death during follow-up period.
Results: Among 201 subjects, male was 49.3% (n=99) and mean age was 53.1 years.
Mean HOMA-IR was 2.58. HOMA-IR was positively associated with body mass index (BMI), serum calcium and triglyceride, and was negatively associated with HDL-cho- lesterol. In addition, previous cardiovascular diseases (CVD) were signifi cantly related with high HOMA-IR. In multivariate linear regression for the association of HOMA-IR with clinical and biochemical variables, BMI, systolic blood pressure, triglyceride and previous CVD were remained for association with HOM-IR. During a mean follow up of 40.2 months, thirty-six (17.9%) patients were developed new cardiovascular events.
When divided into three groups according to HOMA-IR, highest tertile HOMA-IR group showed significantly higher cardiovascular outcomes compared to lower two-third group (p=0.014). Cox regression analysis revealed that HOMA-IR was an independent predictor after adjusting for demographic, biochemical and PD related parameters (OR=1.17, 95% confi dence interval: 1.04-1.33, p=0.011).
Conclusions: IR measured by HOMA-IR is an independent risk factor for cardiovascular morbidity and mortality in non-diabetic and prevalent ESRD patients undergoing PD.
OS-NEP-12 Nephrology
Circulating Irisin Levels are Associated with Sarcopenia and Carotid Atherosclerosis in Peritoneal Dialysis Patients
Mi Jung LEE1, Young Eun KWON1, Yung Ly KIM1, Kyoung Sook PARK1, Han Jak RYU1, Youn Kyung KEE1, Chang-Yun YOON1, Eunyoung LEE1, Young Su JOO1, In Mee HAN1, Sung Gyu HAN1, Hyung Jung OH1, Jung Tak PARK1, Seung Hyeok HAN1, Shin-Wook KANG1, Tae-Hyun YOO1
Yonsei University, Korea1
Background: Sarcopenia is an important cardiovascular risk factor in patients with end-stage renal disease. Recent studies have indicated that skeletal muscles mediate their protective effect by secreting myokines. However, to date, the pathophysiologic role of irisin, a novel myokine, has not been evaluated in peritoneal dialysis (PD) pa- tients. In this study, therefore, we investigated the association of irisin with sarcopenia and carotid atherosclerosis in these patients.
Methods: Serum irisin levels were assessed by enzyme-linked immunosorbent assay in 102 prevalent PD patients. To determine sarcopenia and carotid atherosclerosis, anthropometric indices including mid-arm muscle circumference (MAMC) and carotid intima-media thickness (cIMT) were measured. Linear and logistic regression analyses were performed to ascertain the independent association of irisin with sarcopenia and carotid atherosclerosis.
Results: The mean serum irisin levels were 184.2 ± 88.0 ng/mL. Thirty-seven patients (36.3%) had carotid atherosclerosis. In univariate linear regression analysis, serum irisin concentrations were positively correlated with MAMC, thigh circumference, and serum creatinine levels, whereas negatively correlated with residual renal function and cIMT. Multivariate analysis revealed that MAMC [ß = 0.31, 95% confi dence interval (CI)
= 1.89 to 17.85, P = 0.02] and cIMT (ß = -0.29, 95% CI = -92.53 to -17.11, P = 0.005) had independent association with serum irisin levels. In addition, serum irisin con- centration was a signifi cant independent risk factor for carotid atherosclerosis after adjustment for confouding variables (per 1 ng/mL increase, odds ratio = 0.987, 95% CI
= 0.979 to 0.996, P = 0.004).
Conclusions: This study demonstrated for the fi rst time that circulating irisin levels were signifi cantly associated with sarcopenia and carotid atherosclerosis in PD pa- tients, suggesting that irisin could mediate the detrimental effect of sarcopenia on cardiovascular disease.
OS-ONC-03 Oncology
Association Between Circulating Vitamin D, Vitamin D Receptor Gene Polymorphisms and Colorectal Cancer Risk
Fayiz Manar ATOUM1, Meylia TCHOPERIAN2 Hashemite University, Jordan1, Hashemite University, Jordan2
Background: Vitamin D may have anticancer effect in colorectal cancer mediated by binding of the active form 1,25(OH)2D to vitamin D receptor (VDR). Taq1 VDR gene polymorphism, a C-to-T base substitution (rs731236) in exon 9 may infl uence its ex- pression and function. The aim of this study is to determine 25(OH)D vitamin D level and to investigate the association between circulating vitamin D level and Taq1VDR gene polymorphism among Jordanian colorectal cancer patients.
Methods: this case control study enrolled ninety-three Jordanian colorectal cancer patients and one hundred and two healthy Jordanian volunteers from AL-Basheer Hospital/Amman (2012-2013). Ethical approval and signed consent forms were signed by all participants before sample collection. 25(OH)D level was determined by compet- itive immunoassay Elecsys (Roche Diagnostic, France). DNA was extracted (Promega, USA) and amplifi ed by PCR followed by VDR Taq1 restriction enzyme digestion. Geno- type distribution was evaluated by paired t-test and chi-square. Comparison between vitamin D levels among CRC and control were expressed by odd ratio with 95% confi - dence interval.
Results: Vitamin D serum level was significantly lower among colorectal cancer patients (8.34 ng/ml) compared to the healthy control group (21.02 ng/ml). Patients defi cient in vitamin D level (less than 10.0 ng/ml) have increased colorectal cancer risk 19.17 fold compared to control. Only 2.2% of CRC patients have optimal vitamin D compared to 23.5% among healthy control. TT, Tt and tt Taq1 genotype frequency among CRC was 35.5%, 50.5% and 14% compared to 43.1%, 41.2% and 15.7.7%
among healthy control; respectively. CRC patients had lower mean vitamin D level among TT (8.91±4.31) and Tt (9.15±5.25) genotypes compared to control ((21.32±8.31) and (19.31±7.68); respectively.
Conclusions: This study provided an evidence that there is signifi cant association be- tween low 25(OH)D serum level and colorectal cancer risk.
