Tso-Hsiao Chen

• Professor at Taipei Medical University

In hospitalized patients, acute kidney injury (AKI) is an important adverse event associated with high mortality and medical costs. Accurate diagnosis and timely management of AKI are essential for improving the outcomes of in-hospital AKI, and delayed diagnosis or misdiagnosis hinders advancements in AKI care. To ameliorate this problem, several e...

Background Digital Health Literacy (DHL) is crucial in navigating digital health environments, yet few studies focus on older adults. Objective Explore the associations of digital health information and resource utilization, IT-related social support, and barriers/enhancers to digital health service usage with DHL among older adults. Methods A cr...

Background: Acute kidney injury (AKI) is an important adverse event of hospitalized patients that associates high mortality and high medical cost. While accurate diagnosis and timely management of AKI is essential for improving the outcomes of in-hospital AKI, delayed diagnosis or misdiagnosis by clinicians hinders the advance in the care of AKI. T...

Background Computerized diagnostic algorithms could achieve early detection of acute kidney injury (AKI) only with available baseline serum creatinine (SCr). To tackle with this weakness, we tried to construct a machine learning model for AKI diagnosis based on point-of-care clinical features regardless of baseline SCr. Methods Patients with SCr >...

The intimate correlation of chronic kidney disease (CKD) with structural alteration in gut microbiota or metabolite profile has been documented in a growing body of studies. Nevertheless, a paucity of demonstrated knowledge regarding the impact and underlying mechanism of gut microbiota or metabolite on occurrence or progression of CKD is unclarifi...

Background Arteriovenous fistula (AVF) is the most important vascular access for hemodialysis; however, preventive treatment to maintain the patency of AVFs has not been developed. In endothelium, β-catenin functions in both the intercellular adherens complex and signaling pathways that induce the transition of endothelial cells to myofibroblasts i...

Background: Hemodialysis patients are at high risk of muscle loss as a result of aging and disease, and combined with inadequate dietary intake. The Healthy Eating Index for HemoDialysis patients (HEI-HD) was developed to assess the dietary quality of hemodialysis patients. The purposes of this study were to examine the effects of different nutrit...

While arteriovenous fistula (AVF) nonmaturation is a major issue of hemodialysis care, an effective treatment to improve AVF maturation remains lacking. AVF introduces pulsatile arterial blood flow into its venous limb and produces high luminal pressure gradient, which may have adverse effect on vascular remodeling. As such, the aim of the present...

Cardiovascular disease (CVD) is the most common complication in hemodialysis patients. Nutritional education provided by dietitians could improve overall dietary quality and dietary fat quality to reduce the risk of CVD. However, no studies have investigated the relationship between dietary fat quality (using the hypocholesterolemic/hypercholestero...

Background: Chronic kidney disease (CKD) patients tend to have a reduced immune response to infection and vaccination. The efficacy of current available COVID-19 vaccines in CKD patients has not been widely evaluated. Methods: In the present study, three hundred and eight chronic dialysis patients received ChAdOx1 nCoV-19 (Oxford-AstraZeneca, AZ...

Acute kidney injury (AKI) is a sudden episode of kidney damage that commonly occurs in patients admitted to hospitals. To date, no ideal treatment has been developed to reduce AKI severity. Oligo-fucoidan (FC) interferes with renal tubular cell surface protein cluster of differentiation 44 (CD44) to prevent renal interstitial fibrosis; however, the...

The clinical characteristics and surgical prognosis of glucocorticoid-remediable aldosteronism (GRA, also known as familial hyperaldosteronism type 1, FH-I) have not been widely studied. Using data from the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry retrospectively, we describe the associated clinical factors for GRA and clinical...

Chronic kidney disease (CKD) is a common global progressive disease, but there are no ideal drugs for the treatment. Fucoidan and fucoxanthin, and L-carnitine are one of the very few natural products that have a therapeutic effect on CKD in animal experiments. However, the combined effects of these compounds on CKD are unknown. We established a mou...

Background: Energy requirements must be estimated before nutritional care can be provided for patients undergoing hemodialysis (HD). However, the recommended caloric intake for patients has not been conclusively determined because of insufficiently large sample sizes. Method: This cross-sectional observational study recruited patients undergoing...

A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis...

Pneumonia is a leading cause of mortality. Severity-assessment scores in pneumonia guide treatment crucially, but the ones currently in existence are limited in their use. Community-based studies demonstrated the association between pre-existing low estimated glomerular filtration rate (eGFR) and outcomes in pneumonia. However, whether a single eme...

Background: To investigate the association between insulin resistance (IR) and cardiovascular disease (CVD) risks among hemodialysis patients. Methods: We conducted a cross-sectional study between 2013 and 2017, on 384 hemodialysis patients from seven hospital-based-dialysis centers. HOMA-IR is classified according to median value. The CVD risks...

The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2)...

Background: The hyperhomocysteinemia was with high prevalence and has been considered as a risk factor for cardiovascular disease in hemodialysis patients. These patients also experienced a high risk of muscle wasting caused by the comorbidity, malnutrition, and low physical activity. We investigated the associations of homocysteinemia with muscle...

Background Patients with renal impairment have altered immunity, which might cause vulnerability to specific pathogens and worsen pneumonia-related outcomes. Nonetheless, the microbiological features of pneumonia in patients with decreased renal function remain unknown. Methods Therefore, we conducted a retrospective cohort study enrolling adult p...

Objectives: The total medical (economic) costs of haemodialysis (HD) and peritoneal dialysis (PD), including direct medical costs, out-of-pocket (OOP) costs and productivity losses, have become an important issue. This study aims to compare the direct non-medical costs and indirect medical costs of both modalities in Taiwan. Design and setting:...

Hemodialysis patients are at the high risk for morbidity and mortality. Evaluation and management of body composition and biochemical values are important to improve dialysis outcomes. We aimed to examine the effects of the mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, and dialysis adequacy on the mortalit...

Introduction: Muscle wasting (cachexia) is common in hemodialysis patients and links to several adverse outcomes. We examined the association between cachexia indicators and metabolic syndrome (MetS) and its components. Methods: A cross-sectional study was conducted between September 2013 and April 2017 on 391 hemodialysis patients from seven hospi...

Rationale: Severe hypertriglyceridemia is the 3rd-leading cause of acute pancreatitis. Current treatment option for hypertriglyceridemia associated with acute pancreatitis is mainly supportive measures, including adequate fluid supply, pain management, and broad-spectrum antibiotics if necessary. Extracorporeal method by mean of plasmapheresis is...

Abstract Background Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. Method...

Objective: To modify the hemodialysis eating index (m-HDEI) aligning with the Healthy Eating Index released by the US Department of Agriculture (USDA); and to investigate the associations of the m-HDEI with cardiovascular disease (CVD) risks in hemodialysis (HD) patients. Methods: In a clinical cross-sectional study, we recruited 492 HD patients,...

Ethnopharmacological relevance: Brown seaweed is a common food for Asians, and the bioactive ingredient fucoxanthin exerts anti-apoptotic activities in several cell types. Renal tubular cell apoptosis is one of the common cellular events leading to renal fibrosis and chronic kidney disease (CKD). However, the influence of fucoxanthin-containing br...

The current study was to examine the association of adequate intake of macronutrients and micronutrients with traditional and nontraditional cardiovascular risk factors in hemodialysis patients. A clinical cross-sectional study was conducted between September 2013 and April 2017 on 492 hemodialysis patients aged 20 years and above, received thrice-...

Dietary energy intake strongly linked to dialysis outcomes. We aimed to explore the optimal cut-off point of energy intake (EI) for identification of metabolic syndrome (MetS) in hemodialysis patients. The cross-sectional data of 243 hemodialysis patients from multi-dialysis centers in Taiwan was used. The dietary intake was assessed by using the t...

Ethical approvals. (DOCX)

Background: Insulin resistance (IR) is an independent predictor of cardiovascular morbidity and mortality in end-stage renal disease (ESRD) patients. This study was to investigate the association between IR and cardiovascular disease (CVD) risk factors among ESRD patients undergoing hemodialysis. Methods: A clinical cross-sectional study was conduc...

Platelet hyperactivity plays a critical role for initiating several vascular diseases such as atherothrombosis. Therefore, development of effective antiplatelet agents is necessary for ameliorating platelet-related diseases. In this study, we investigated the effects of the new synthesized compound, MP407 on platelet aggregation and further elucida...

Rapidly progressive glomerulonephritis (RPGN) is usually accompanied by microscopic glomerular crescent formation with progression to renal failure within weeks to months. RPGN is relative rare and affecting 10% to 15% of patients with glomerulonephritis (GN). The antineutrophlil cytoplasmic antibody (ANCA)-associated RPGN are responsible for more...

Scope: Several beneficial biological functions of fucoidan (FO) isolated from brown algae have been demonstrated. The purpose of this study was to investigate whether FO derived from Sargassum hemiphyllum ameliorates pancreatic β-cell damage and impaired insulin synthesis under diabetic condition. Methods and results: The effects of FO were stud...

Objectives Taiwan succeeded in raising the proportion of peritoneal dialysis (PD) usage after the National Health Insurance (NHI) payment scheme introduced financial incentives in 2005. This study aims to compare the economic costs between automated PD (APD) and continuous ambulatory PD (CAPD) modalities from a societal perspective. Design and set...

Tubulointerstitial fibrosis is recognized as a key determinant of progressive chronic kidney disease (CKD). Fucoidan, a sulphated polysaccharide extracted from brown seaweed, exerts beneficial effects in some nephropathy models. The present study evaluated the inhibitory effect of oligo-fucoidan (800 Da) on renal tubulointerstitial fibrosis. We est...

The accumulation of advanced glycation end products (AGEs) in diabetic patients induces vascular endothelial injury. Promyelocytic leukemia zinc finger protein (PLZF) is a transcription factor that can be activated by low-temperature far-infrared (FIR) irradiation to exert beneficial effects on the vascular endothelium. In the present study, we inv...

Objectives To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes. Design and setting Systematic review and meta-analysis of randomised, controlled trials. Data sources Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966...

The authors regret that the original Affiliations of authors does not meet the request of College of Medicine in Taipei Medical University, and revise the Author labels and the Affiliations of authors as below. Yung-Ho Hsua,b, Chung-Yi Chengc, Yen-Cheng Chenc, Tso-Hsiao Chenb,c, Yuh-Mou Sueb,c, Wei-Lun Tsaic, Cheng-Hsien Chena,b,c*a Division of Nep...

Recent studies have indicated that the ratio of C-reactive protein to albumin (CRP–Alb ratio) is associated with clinical outcomes in patients with disease. We examined the predictive value of this ratio in patients undergoing hemodialysis (HD). In this cross-sectional study, 91 eligible adult HD patients were analyzed, and the correlation between...

The certification of Taipei Medical University Joint Institutional Review Board. (PDF)

This paper reports a comprehensive comparison for mortality and technique failure rates between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Taiwan. A propensity-score matched cohort study was conducted by retrieving APD and CAPD patients identified from the Taiwan National Health Insurance Research Da...

Objective: n-3 and n-6 polyunsaturated fatty acids (PUFAs) are essential nutrients in the human diet and possibly affect muscle mass. We evaluated the association between the dietary ratios of n-3 and n-6 PUFAs and muscle mass, indicated as skeletal muscle mass (SMM) and appendicular skeletal muscle mass (ASM), in patients with diabetes undergoing...

Background Heart failure is a highly prevalent cardiovascular complication among patients receiving long‐term hemodialysis, but the benefits of carvedilol, bisoprolol, and metoprolol controlled release/extended release on the outcomes of these patients remain unclear. In this study, we address the use of these 3 β‐blockers and their associations wi...

Table S1. Logistic Regression Model Used to Calculate the Propensity Score Table S2. Distribution of Propensity Score Among the Treat and Control Groups of the Full and Matched Cohorts Table S3. Baseline Characteristics of the Excluded and Included Patients in the Study Group Table S4. Incident Rate Ratios of All‐Cause Mortality for the Study Gr...

Peroxisome proliferator-activated receptor alpha (PPARα) is a transcription factor which has been reported to inhibit gentamicin-induced apoptosis in renal tubular cells. However, the antiapoptotic mechanism of PPARα is still unknown. In this study, we found that PPARα overexpression induced Na(+)/H(+) exchanger NHE1 expression in the rat renal tub...

In this cross-sectional study, we hypothesized that hemodialysis patients consuming greater processed meat is associated with hypertension risk, which can be partly explained by the high sodium content in processed meat. From September 2013 to May 2014, one hundred and four patients requiring chronic hemodialysis treatment were recruited from hemod...

Background n-3 polyunsaturated fatty acids (PUFAs) might be useful nutritional strategy for treating patients with sarcopenia. We evaluated the effect of the intake of dietary n-3 PUFAs on the skeletal muscle mass (SMM), appendicular skeletal muscle mass (ASM), and its determinants in patients receiving standard hemodialysis (HD) treatment for the...

Magnolol isolated from Magnolia officinalis, a Chinese medical herb, exhibits an anti-inflammatory activity and a protective effect against periodontitis. The inflammation caused by lipopolysaccharide (LPS) from Porphyromonas gingivalis (P. gingivalis) has been considered a key inducer in the development of periodontitis. In this study, we investig...

Acute lung injury (ALI) has a high morbidity and mortality rate due to the serious inflammation and edema occurred in lung. Magnolol extracted from Magnolia officinalis, has been reported to exhibit anti-inflammatory, and antioxidant activities. Peroxisome proliferator-activated receptors (PPARs) are known to exert a cytoprotective effect against c...

The platelet-derived soluble CD40L (sCD40L) release plays a critical role in the development of atherosclerosis. Nifedipine, a dihydropyridine-based L-type calcium channel blocker (CCB), has been reported to have an anti-atherosclerotic effect beyond its blood pressure-lowering effect, but the molecular mechanisms remain unclear. The present study...

: The intervention also yielded improved quality-of-life measures. Depression is common in patients with chronic kidney disease who are on hemodialysis. Available behavioral modalities for treating depression may not be feasible for patients who receive hemodialysis two or three times per week. The purpose of this randomized controlled trial was to...

Magnolol (1) isolated from Magnolia officinalis exhibits many beneficial effects such as anti-inflammatory and antioxidant activity. The aim of this study was to evaluate the effects of magnolol (1) on RANKL-induced osteoclast differentiation and investigate the underlying molecular mechanisms. Treatment with magnolol (1) significantly inhibited os...

Heat stroke is a life-threatening condition characterized by an increased core body temperature (over 40°C) and a systemic inflammatory response, which may lead to a syndrome of multiple organ dysfunction. Heat stroke may be due to either strenuous exercise or non-exercise-induced exposure to a high environmental temperature. Current management of...

Epithelial-mesenchymal transition (EMT) occurs in stressed tubular epithelial cells, contributing to renal fibrosis. Initial mechanisms promoting EMT are unknown. Pressure force is an important mechanism contributing to the induction and progression of renal fibrogenesis in ureteric obstruction. In our study of cultured rat renal tubular cells (NRK...

Objective In this study, a Hemodialysis Eating Index (HDEI) suitable for hemodialysis (HD) patients in Taiwan was developed based on the dietary recommendations of the U.S. National Kidney Foundation for HD patients and the Taiwanese 2011 Daily Food Guide. The HDEI was used to explore HD-associated cardiovascular disease (CVD) risk factors. Method...

Urotensin II (U-II), an 11-amino acid peptide, exerts a wide range of actions in cardiovascular systems. Interleukin-8 (IL-8) is secreted by endothelial cells, thereby enhancing endothelial cell survival, proliferation, and angiogenesis. However, the interrelationship between U-II and IL-8 as well as the detailed intracellular mechanism of U-II in...

We report two patients with drug-induced liver injury (DILI)-related acute liver failure (ALF) who were successfully treated with high-volume plasma exchange without liver transplantation. The first patient was a 66-year-old man admitted because of a perforated duodenal ulcer complicated with peritonitis and septic shock. After treatment with multi...

Kidney International aims to inform the renal researcher and practicing nephrologists on all aspects of renal research. Clinical and basic renal research, commentaries, The Renal Consult, Nephrology sans Frontieres, minireviews, reviews, Nephrology Images, Journal Club. Published weekly online and twice a month in print.

An 85-year-old female presented with fever and consciousness disturbance for 3 days. The patient's blood culture subsequently revealed persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia despite the administration of vancomycin or teicoplanin monotherapy. Gallium inflammation scan and magnetic resonance image of the spine discl...

Zhibai Dihuang Wan (ZDW) is an ancient traditional Chinese medicine composed of eight herbal ingredients and has been used to treat chronic kidney inflammation and diabetes for thousands of years. Nonetheless, the influence of ZDW on acute kidney injury is still unknown. We intended to identify the influence of ZDW on cell growth and gentamicin-ind...

Urotensin II (UII) is a cyclic vasoactive peptide which is mainly expressed in kidneys. Although elevated plasma UII levels are associated with renal impairment, the influence of UII on renal injury is unclear. In this study, we monitored the influence of UII on gentamicin-induced apoptosis in rat tubular cells (NRK-52E). We found that UII signific...

Aims: Heart failure is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin-angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined. Methods and results: We conducted a nationwide observational study using data from the Taiwan National Health Insurance claims da...

OBJECTIVE: The aim of the study was to investigate the association between dialysis shift and subjective sleep quality in chronic haemodialyzed patients. DESIGN: A cross-sectional observational study. PARTICIPANTS AND METHODS: A total of 206 haemodialyzed patients aged from 22 to 71 participated in this study. Participants were grouped into the mor...

End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. Taiwan's National Health Insurance Research Datab...

Statins are reported to alleviate renal fibrosis in animal models with ureteral obstruction. However, the molecular mechanism of this antifibrotic effect is still unclear. Pressure force is an important mechanism contributing to induction and progression of tubulointerstitial fibrogenesis in ureteric obstruction. In this study, we investigated the...

A 94-year-old female with end-stage renal disease presents with fever, fatigue, and hematochezia. She had previously resided in Hunan Province, China, and Myanmar, and she immigrated to Taiwan 30 years ago. Colonoscopy revealed a colonic ulcer. Biopsy of the colonic ulcer showed ulceration of the colonic mucosa, and many Paragonimus westermani-like...

Background Sitagliptin, a dipeptidyl peptidase-IV inhibitor, is widely used as an oral hypoglycemic agent. It may induce hemodynamic effects when interacting with angiotensin II receptor blockers. Methods The study was conducted in an outpatient setting at Taipei Medical University Hospital. Diabetic patients who had already received angiotensin I...

Klotho was identified as the responsible gene in a mutant mouse line whose disruption results in a variety of premature aging-related phenotypes. Nonetheless, the related mechanisms were still unknown. Many studies report that dietary phosphate restriction and genetic ablation of vitamin D pathways indirectly reverse premature aging processes in th...

Kinesin motor proteins can hydrolyze ATP and unidirectionally transport specific cargo molecules along microtubule tracks (MTs). Engineering scientists interested in nanotechnology have used kinesin and MTs to build shuttles of 2 geometries. In the bead geometry, the kinesin shuttles transport cargos along the MTs. In the gliding geometry, cargos a...

Adipokine leptin reportedly acts on the kidney in pathophysiological states. However, the influence of leptin on renal tubular epithelial cells is still unclear. Gentamicin, a widely used antibiotic for the treatment of bacterial infection, can cause nephrotoxicity. This study aims to investigate the influence of long-term leptin treatment on genta...

Necrotizing fasciitis is a lethal soft tissue infection for its rapid progression to septic shock. We present a 59-year-old male on chronic hemodialysis (HD). We made the diagnosis of necrotizing fasciitis of the right thigh due to the crepitus from physical examination and subcutaneous emphysema from an X film. He was successfully treated with ant...

Many studies suggest that far-infrared (FIR) therapy can reduce the frequency of some vascular-related diseases. The non-thermal effect of FIR was recently found to play a role in the long-term protective effect on vascular function, but its molecular mechanism is still unknown. In the present study, we evaluated the biological effect of FIR on vas...

The Chinese herbal formula, Pien Tze Huang, is popular in Asian countries and the United States for its hepato-protective effects. This report concerns two patients who took Pien Tze Huang, and who initially exhibited polyuria, followed by weight loss and an acute kidney injury. When the patients stopped taking Pien Tze Huang, and was given with in...

To examine the psychometric properties of the Chinese version of the Sleep-Associated Monitoring Index (SAMI) in Taiwanese haemodialysis patients. An instrument translation and validation study. A haemodialysis (HD) unit in a university-affiliated medical centre in northern Taiwan. 206 patients who were 18 or above, diagnosed with end-stage renal d...

Vancomycin and teicoplanin are the two most used glycopeptides for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is suspected to have more nephrotoxicity but this has not been clearly established. The aim of this study was to assess its nephrotoxicity by a consensus definition of acute kidney injury (AKI): the risk...

Leptin, a circulating hormone secreted mainly from adipose tissues, possesses protective effects on many cell types. Serum leptin concentration increases in patients with chronic renal failure and those undergoing maintenance dialysis. Gentamicin, a widely used antibiotic for the treatment of bacterial infection, can cause nephrotoxicity. In the pr...