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BackgroundFew investigations have evaluated the influences on peripheral arterial disease (PAD) risk of statin treatment in hemodialysis (HD) subjects with hyperlipidemia (HL).MethodsFrom the National Health Insurance Research Dataset, we identified 3658 HD patients with statin therapy for HL as the statin cohort, and then selected, by 1:1 propensity score matching, 3658 HD patients with HL but without statin use as the nonstatin cohort in 2000–07. The cohorts were followed through until the end of 2011. We used Cox proportional hazards regression analysis to assess the hazard ratio (HR) of PAD development.ResultsThe average follow-up period was 4.18 years; the incident PAD risk was 1.35-fold greater in statin users than in nonusers (16.87 versus 12.46/1000 person-years), with an adjusted HR (aHR) of 1.34 for PAD [95% confidence interval (CI) 1.12–1.62]. The PAD risk increases were significant for patients receiving fluvastatin (aHR 1.88; 95% CI 1.12–3.14) and atorvastatin (aHR 1.60; 95% CI 1.24–2.08). The risk increased with higher annual average statin dosage (P for trend ConclusionsHD patients with HL on statin medication were at increased PAD risk, which increased with cumulative statin dosage. Thorough considerations are needed before prescribing statins to HD patients.

Background This study compared the risk of developing new-onset diabetes between hemodialysis (HD) and peritoneal dialysis (PD) patients. We further investigated the effectiveness of icodextrin in reducing the risk of new-onset diabetes in PD patients. Methods From the Taiwan health insurance database, 36 879 incident HD patients and 6382 incident PD patients from 2000 to 2010 were identified as study cohorts. We further selected an additional HD cohort matched by propensity scores (PSs) of PD patients. Incidence rates and hazard ratios (HRs) of new-onset diabetes were assessed among cohorts and between icodextrin users and nonusers by the end of 2011. Results For the unmatched cohorts, the incidence of new-onset diabetes was higher in PD patients than in HD patients (9.16 versus 8.18 per 1000 person-years), with an adjusted HR of 1.51 (95% CI 1.30-1.75) for PD patients. For the PS-matched cohorts, the corresponding incidence rates were 9.43 and 5.90 per 1000 person-years, respectively, with an adjusted HR of 1.61 (95% CI 1.32-1.97). Among PD patients, the incidence was lower in icodextrin users than in nonusers (6.22 versus 12.1 per 1000 person-years), with an adjusted HR of 0.66 (95% CI 0.50-0.88) for users. Conclusions Our study suggests that PD patients are at a higher risk of developing new-onset diabetes than HD patients. Icodextrin is recommended for PD patients to reduce the risk of new-onset diabetes.

BACKGROUND Studies investigating the risk of cardiac dysrhythmia warranting permanent pacemaker therapy for end-stage renal disease (ESRD) patients are limited. This study investigated the incidence rate of permanent cardiac pacing in dialysis patients. METHODS Using the Taiwan National Health Insurance Database, we identified 28 471 newly diagnosed ESRD patients in 2000-2010 [9700 on peritoneal dialysis (PD) and 18 771 on hemodialysis (HD)] and 113 769 randomly selected controls without kidney disease, frequency-matched by sex, age and diagnosis date. We also established propensity score-matched HD and PD cohorts with 9700 patients each. Incidence rates and hazard ratios (HRs) of implantation were evaluated by the end of 2011. Complications were also evaluated among patients with implantation. RESULTS The incidence rates of permanent pacemaker implantation were 5.93- and 3.50-fold greater in HD and PD patients than in controls (1.44 and 0.85 versus 0.24 per 1000 person-years, respectively). The adjusted HRs (aHRs) of implantation were 3.26 [95% confidence interval (CI) = 2.41-4.42] and 2.36 (95% CI = 1.56-3.58) for HD and PD patients, respectively, compared with controls. The pacemaker implantation rate was 0.33 per 1000 person-years greater in the propensity score-matched HD cohort than in the PD cohort, with an aHR of 1.30 (95% CI = 0.82-2.05) for the HD cohort compared with the PD cohort. CONCLUSIONS Dialysis patients are at an increased risk of dysrhythmia requiring pacemaker implantation compared with the general population. The risks are not significantly different between HD and PD patients.

Background. Renal vascular resistance [resistive index (RI)] has been associated with albuminuria in patients with type 2 diabetes. We studied the correlations between renal artery RI and urinary albumin excretion in adolescents and young adults. Methods. From May 2006 through September 2008, we established a cohort of adolescents and young adults based on previous history of elevated blood pressure (EBP) or normal blood pressure in childhood. This cohort was selected from the 1992–2000 nationwide mass urine screening of school children aged 6–18 years in Taiwan. From October through December 2008, we called back these adolescents and young adults living in Taipei to participate in a renal vascular stiffness study. Linear mixed regression models were applied to study the correlation between renal artery RI and urinary albumin excretion after controlling for cardiovascular (CV) risk factors. Results. Of the 147 subjects enrolled in this study, 67 had macroalbuminuria, 36 had microalbuminuria and 44 had normoalbuminuria. Except for high-density lipoprotein cholesterol, most CV risk factors did not differ significantly among these three groups. Mean RI were similar for the three groups. Neither log (urinary albumin concentration) nor log (urinary albumin:creatinine ratio) correlated with RI. Step-wise linear mixed regression models showed that RI was significantly associated only with male gender and diastolic blood pressure, but not with urinary albumin excretion or EBP in childhood. Conclusion. Renal artery RI is not associated with urinary albumin excretion in nondiabetic adolescents and young adults.

Background Studies on the effectiveness of seasonal influenza vaccination in peritoneal dialysis (PD) patients are limited. The aim of the present study is to evaluate the effectiveness of seasonal influenza vaccination in reducing morbidity and mortality in incident end-stage renal disease patients on PD. Methods From Taiwan's National Health Insurance Research Database, we identified 2089 incident PD patients with seasonal influenza vaccination and 2089 propensity score matched incident PD patients without the vaccination during 1998-2010. Each study subject was followed up to measure the 12-month incident cardiovascular and infectious diseases, and deaths. The effects of multi-year vaccinations were also estimated. Results Compared with the non-vaccinated cohort, the vaccinated cohort had a lower hospitalization rate (68.5 versus 80.2 per 100 person-years) with an adjusted hazard ratio (aHR) of 0.85 [95% confidence interval (CI) = 0.78-0.92]. Hazards of hospitalization were significantly reduced for sepsis (aHR = 0.79, 95% CI = 0.65-0.96), heart disease (aHR = 0.74, 95% CI = 0.63-0.89) and intensive care (aHR = 0.85, 95% CI = 0.73-0.99). In addition, hazards of peritonitis (aHR = 0.84, 95% CI = 0.73-0.97) and overall mortality (aHR = 0.66, 95% CI = 0.55-0.78) were also reduced. The aHR of mortality was reduced much further to 0.28 (95% CI = 0.22-0.35) for those with multiple-year vaccinations. Conclusions Seasonal influenza vaccination for PD patients is associated with significant reduction in morbidities and a 34% reduction in mortality. Multi-year vaccinations could reduce the death hazard further to 72%.