Dialysis Care and Dialysis Funding in Asia

Tang, Sydney C.W.; Yu, Xueqing; Chen, Hung Chun; Kashihara, Naoki; Park, Hyeong Cheon; Liew, Adrian; Goh, Bak Leong; Nazareth, Maria Gina C.; Bunnag, Sakarn; Tan, Jackson; Lun, Virithy; Lydia, Aida; Sharma, Sanjib Kumar; Hoque, Ehteshamul; Togtokh, Ariunaa; Ghnaimet, Mohammad; Jha, Vivekanand

doi:10.1053/j.ajkd.2019.08.005

Cited by 51 publications

(54 citation statements)

References 21 publications

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“…We believe our cohort is a good representation of a Chinese PD cohort as our centre is one of the largest tertiary-care and university-affiliated medical centres. It is also part of the public healthcare system which takes care of 94% of dialysis patients in Hong Kong [ 53 ]. We also included both incident and prevalent PD patients, which can lead to a few concerns.…”

Section: Discussionmentioning

confidence: 99%

Interaction between central obesity and frailty on the clinical outcome of peritoneal dialysis patients

et al. 2020

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Background Frailty and obesity contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients, but the interaction between frailty and obesity remains uncertain. Objective To examine the interaction between frailty and obesity on the clinical outcome of PD patients. Design Single centre prospective observational cohort study. Patients 267 prevalent Chinese PD patients were recruited. Measurements Frailty was identified by a standard score. General and central obesity were determined by body mass index (BMI) and waist-hip ratio (WHR), respectively. Body composition was assessed by bioimpedance spectroscopy. All patients were followed for two years. Outcome measures included all-cause as well as cardiovascular mortality and hospitalization. Results Of the 267 patients, 120 (44.9%) were frail. Frail individuals were more likely to have central obesity (p < 0.001) but not general obesity. Although WHR did not predict patient survival, there was a significant interaction between WHR and frailty on patient survival and cardiovascular survival (p = 0.002 and p = 0.038, respectively). For patients without frailty, the two-year cardiovascular survival was 91.3% and 74.4% for those with and without central obesity, respectively (p = 0.002). For patients with frailty, however, the two-year cardiovascular survival was 64.6% and 66.7% for those with and without central obesity, respectively (p = 0.6). For patients without frailty, the number of hospital admission for cardiovascular disease over 2 years were 0.12 ± 0.37 and 0.34 ± 0.72 for those with and without central obesity, respectively (p = 0.03). For frail patients, however, the number of hospital admission was similar between those with and without central obesity. Conclusion There is a significant interaction between frailty and central obesity on the outcome of PD patients. The protective role of central obesity is only apparent in PD patients without frailty but not the frail ones, and there is a little prognostic value of general (non-central) obesity.

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Section: Discussionmentioning

confidence: 99%

Interaction between central obesity and frailty on the clinical outcome of peritoneal dialysis patients

et al. 2020

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“…In the 2018 iteration of the United States Renal Data System (USRDS) report, 6 out of the top 10 countries in the world with diabetic kidney disease (DKD) as the cause of end-stage kidney disease (ESKD) were from the Asia-Pacific region, with Malaysia and Singapore topping the charts consistently over the previous years (1). It is, therefore, unsurprising that DKD is a significant healthcare burden for the Asia-Pacific countries, with a considerable amount of the countries' medical expenditure being spent on kidney replacement therapy (KRT) (2). Specifically, the differences in healthcare infrastructure, resources and cultural beliefs among the Asia-Pacific countries have resulted in the heterogeneity of care and outcomes DOI: 10.1111/nep.13763 for people with DKD in the region.…”

Section: Executive Summary Of Asian Pacific Society Of Nephrology CLImentioning

confidence: 99%

Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease – Executive Summary

et al. 2020

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“…Renal fibrosis is a common feature in most forms of chronic kidney disease (CKD), and is characterized by the accumulation of collagen, fibronectin, and other related fibrotic molecules in the kidney [1]. More importantly, tubulointerstitial fibrosis is a critical and irreversible process that heralds end-stage renal disease in diabetic [2][3][4] and non-diabetic kidney disease [4][5][6], which mandates a substantial healthcare budget as renal replacement therapy becomes necessary [7]. Currently, there is no effective treatment to halt disease progression.…”

Section: Introductionmentioning

confidence: 99%

The PAR-1 antagonist vorapaxar ameliorates kidney injury and tubulointerstitial fibrosis

Lok

Yiu

et al. 2020

Clinical Science

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Protease-activated receptor (PAR)-1 has emerged as a key profibrotic player in various organs including kidney. PAR-1 activation leads to deposition of extracellular matrix (ECM) proteins in the tubulointerstitium and induction of epithelial-mesenchymal transition (EMT) during renal fibrosis. We tested the anti-fibrotic potential of vorapaxar, a clinically approved PAR-1 antagonist for cardiovascular protection, in an experimental kidney fibrosis model of unilateral ureteral obstruction (UUO) and an AKI-to-CKD transition model of unilateral ischemia-reperfusion injury (UIRI), and dissected the underlying renoprotective mechanisms using rat tubular epithelial cells. PAR-1 is activated mostly in the renal tubules in both the UUO and UIRI models of renal fibrosis. Vorapaxar significantly reduced kidney injury and ameliorated morphologic changes in both models. Amelioration of kidney fibrosis was evident from downregulation of fibronectin, collagen and α-smooth muscle actin in the injured kidney. Mechanistically, inhibition of PAR-1 inhibited MAPK ERK1/2 and TGF-β–mediated Smad signaling, and suppressed oxidative stress, overexpression of pro-inflammatory cytokines and macrophage infiltration into the kidney. These beneficial effects were recapitulated in cultured tubular epithelial cells in which vorapaxar ameliorated thrombin- and hypoxia-induced TGF-β expression and ECM accumulation. In addition, vorapaxar mitigated capillary loss and the expression of adhesion molecules on the vascular endothelium during AKI-to-CKD transition. The PAR-1 antagonist vorapaxar protects against kidney fibrosis during UUO and UIRI. Its efficacy in human CKD in addition to CV protection warrants further investigation.

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Dialysis Care and Dialysis Funding in Asia

Cited by 51 publications

References 21 publications

Interaction between central obesity and frailty on the clinical outcome of peritoneal dialysis patients

Interaction between central obesity and frailty on the clinical outcome of peritoneal dialysis patients

Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease – Executive Summary

The PAR-1 antagonist vorapaxar ameliorates kidney injury and tubulointerstitial fibrosis

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