Background: Vitamin D receptor (VDR) polymorphisms are associated with osteoporosis, diabetes, immunological diseases, and cancers. However, the association of obesity with VDR polymorphisms has shown inconsistent results, and perhaps it depends upon the characteristics of a population. Therefore, we evaluated the association between BsmI (rs1544410) and ApaI (rs7975232) polymorphisms of VDR and obesity in Korean patients with type 2 diabetes mellitus (T2DM). Methods: A total of 506 patients with T2DM participated in the study. Polymerase chain reaction-restriction fragment length polymorphism was used to analyze BsmI and ApaI polymorphisms; the genotypes were presented as BB, Bb, or bb for BsmI and AA, Aa, or aa for ApaI. Obesity was defined using the body mass index (BMI) with a cutoff level of 25 kg/m 2. Results: The prevalence of obesity was higher in patients with the bb genotype than in those with BB or Bb genotypes (48.4% vs 33.9%, P = 0.031). The mean BMI was 25.2 ± 3.5 kg/m 2 in patients with bb genotype and 24.1 ± 3.1 kg/m 2 in patients with BB or Bb genotypes. Patients with Aa or aa genotypes showed a higher prevalence of obesity than patients with AA genotype (47.6% vs 26.1%, P = 0.043). Glycemic control parameters and lipid profiles did not show significant differences with either polymorphism. Conclusion: To our knowledge, this is the first study to assess the association between VDR polymorphisms and obesity in Korean patients with T2DM. Further studies in larger populations and multiethnic cohorts are needed to validate our findings.
End-stage renal disease (ESRD) patients on hemodialysis have poor nutritional status and associated problems such as inflammation and sarcopenia. Blood urea nitrogen (BUN) is an important measure of uremic toxins, and urea reduction is a marker of hemodialysis efficacy. However, a low protein diet for lower BUN could aggravate malnutrition in patients, and optimal pre-dialysis BUN is not defined. We investigated the association of pre-dialysis BUN with patients’ comorbidities and the relationship between pre-dialysis BUN and serum albumin as a nutrient marker. Among the 67 patients, the average pre- and post-dialysis BUN were 59.2 and 15.0 mg/dL, respectively, serum creatinine was 10.1 mg/dL, and the average serum albumin was 4.0 g/dL. Patients’ age was negatively correlated with serum creatinine (r=−0.277, p<0.05) and albumin (r=−0.453, p<0.001). Predialysis BUN showed a significant positive correlation with serum albumin (r=0.287, p<0.05) and creatinine (r=0.454, p<0.001). However, the predialysis BUN was not significantly related to diabetes, coronary artery disease, congestive heart failure, or cerebrovascular disease. Hemodialysis patients with high pre-dialysis BUN and high serum creatinine could be regarded as having good nutritional status. The significance of this study lies in the potential utility of pre-dialysis blood urea nitrogen as an indicator of the nutritional status of patients. Liberal protein intake might be recommended to adequately dialyzed patients.
Background and Aims Elderly population is increasing and the age starting dialysis treatment is also increasing. It could be an ethical issue that we should do or not do start dialysis treatment in the oldest old people such as 10th decade. We investigated duration of dialysis therapy via patients age using National Health Insurance calim data to know dialysis survival of patients via their age. Method Korean National Health Insurance Database was used and excerpted data from the insurance claim of ICD code of dialysis. We included all new patients starting dialysis more than 3 months between 2004 and 2013 and compared dialysis duration among the age group. Patients on dialysis before 2003 were excluded, and patients on kidney transplantation were also excluded. Results Total 208,202 dialysis patients were included via dialysis insurance calim code from about 50,000,000 South Korean population during the year 2003 to 2015. 126,448 patients were excluded due to dialysis before 2003, < 3 months of dialysis duration, kidney transplatation, and to have missing data. Among the final 81,754 patients, 73,969 were hemodialysis and 7,785 were peritoneal dialysis. 47,798 were men and 33,956 were wemen. Observed median dialysis duration of each aged group of 20-40, 41-50, 51-60, 61-70, 71-80, 81-90, and >90 were 5.4 (2.2 - 18.3), 5.0 (1.8 - 17.7), 4.2 (1.5 - 15.1), 3.5 (1.2 - 12.6), 2.7 (0.9 - 10.1), 1.8 (0.5 - 7.1), 1.3 (0.3 - 4.9) years, respectively (p < 0.0001). Comparing with age under 40, dialysis survival hazard ratio of > 40, > 50, > 60, > 70, > 80, and > 90 were 1.493, 2.452, 3.762, 6.113, 9.787, and 15.326, respectively (p < 0.0001). Survival probability of the patients by the age was demonstrated in the figure 1. Lowest socio-econonic status and highest Charson-Comorbidity group showed highest hazard ratio of dialysis mortality, and peritoneal dialysis showed longer dialysis duration (HR 0.704, 95% CI of 0.69 - 0.74, p < 0.0001). Conclusion We concluded that dialysis durability by the age was rapidly decreased after 70 years old. As the longest patients survival of > 90 years were less than 5 years, we should consider patients’ general performance when starting dialysis of oldest old patients.
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