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    • "Various studies carried out in different regions around the world have found that the incidence of malignancy is generally higher in patients suffering from end-stage renal disease (ESRD) [1] [2] [3] [4]. Compared with other countries, Taiwan has a remarkably high incidence and prevalence of patients with ESRD [5] [6]. In Taiwan, bladder, liver, and kidney cancers are leading malignancies in patients with chronic dialysis in a 12-year cross-sectional study between 1997 and 2008. "
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    ABSTRACT: Background: Urothelial cancer (UC) is the leading cancer of patients with end-stage renal disease (ESRD) in Taiwan. The aims of this study were to explore the time trends of UC incidences and propose possible etiologic factors. Methods: Abstracting from the National Health Insurance Research Database (NHIRD), there were 90,477 newly diagnosed cases of ESRD between 1997 and 2008 covering the patients aged 40-85. Among them, 2,708 had developed UC after diagnosis of ESRD. The CIR40-85 (cumulative incidence rate) of upper tract UC (UTUC) and lower tract UC (LTUC) were calculated for ESRD patients and general population, as well as SIR40-85 (standardized incidence ratio) for comparison. Results: Female ESRD patients were found to have 9-18 times of elevated risks of UC, while those of males were increased up to 4-14 times. The time trends of CIR40-84 and SIR40-84 of UTUC in females appear to decline after calendar year 2000. These trends may be related to AA associated herbal products after 1998. Conclusions: Patients with ESRD are at increased risks for both LTUC and UTUC in Taiwan. We hypothesize that the time trends associate with the consumption of aristolochic acid in Chinese herbal products (female predominant).
    Full-text · Article · Jun 2014 · BioMed Research International
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    • "Cardiovascular mortality is up to 20 times higher in chronic kidney disease (CKD) than in the general population [1] accounting for approximately 50% of all deaths [2]. Although a plethora of traditional and nontraditional risk factors have been associated with a high incidence and prevalence of cardiovascular diseases in CKD patients [3], it is noteworthy that the most frequent cardiometabolic risk factors (e.g. "
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    ABSTRACT: Background and aim: Cardiovascular disease is the leading cause of death among patients with chronic kidney disease (CKD). Although there is emerging evidence that excess visceral fat is associated with a cluster of cardiometabolic abnormalities in these patients, the impact of visceral obesity evaluated by a gold-standard method on future outcomes has not been studied. We aimed to investigate whether visceral obesity assessed by computed tomography was able to predict cardiovascular events in CKD patients. Methods and results: We studied 113 nondialyzed CKD patients [60% men; 31% diabetics; age 55.3 ± 11.3 years; body mass index (BMI) 27.2 ± 5.3 kg/m(2); estimated glomerular filtration rate (GFR) 33.7 ± 13.6 ml/min/1.73 m(2)]. Visceral and subcutaneous abdominal fat were assessed by computed tomography at L4-L5. Visceral to subcutaneous fat ratio >0.55 (highest tertile cut-off) was defined as visceral obesity. Cardiovascular events including acute myocardial infarction, angina, arrhythmia, uncontrolled blood pressure, stroke and cardiac failure were recorded during 24 months. Cardiovascular events were 3-fold higher in patients with visceral obesity than in those without visceral obesity. The Kaplan-Meier analysis indicated that patients with visceral obesity had shorter cardiovascular event-free time than those without visceral obesity (P = 0.021). In the univariate Cox analysis, visceral obesity was associated with higher risk of cardiovascular events (hazard ratio = 3.4; 95% confidence interval = 1.1-10.5; P = 0.03). The prognostic power of visceral obesity for cardiovascular events remained significant after adjustments for sex, age, diabetes, previous cardiovascular disease, smoking, sedentary lifestyle, BMI, GFR, hypertension, dyslipidemia and inflammation. Conclusion: Visceral obesity assessed by computed tomography was a predictor of cardiovascular events in CKD patients.
    Full-text · Article · Jul 2012 · Nutrition, metabolism, and cardiovascular diseases: NMCD
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    • "Active malignancy in end-stage renal disease (ESRD) patients is an absolute contraindication to kidney transplantation (KT) for several reasons (1). First, immune suppression contributes to the progression of cancer, which can significantly increase patient mortality (2). Indeed, the incidence of malignancy in KT recipients is 2-20-fold higher than that in the general population, depending on malignancy type (3). "
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    ABSTRACT: In general, a 2-yr disease-free duration is recommended before kidney transplantation (KT) in end-stage renal disease (ESRD) patients who also have acute leukemia. However, the optimal disease-free interval has not been specified for all subtypes of acute leukemia. Among these subtypes, acute promyelocytic leukemia (APL) shows a favorable prognosis and low relapse rate compared to other types of leukemia. We here report KT after complete remission (CR) of APL in an ESRD patient. Irreversible kidney injury developed in a 23-yr-old man with APL. First, we induced CR and subsequently performed KT 7 months after the achievement of CR. The patient's clinical course after KT was favorable, without allograft rejection or relapse of APL up to 1 yr after KT. On the basis of our clinical experience, it is suggested that a long wait may not be necessary before KT in patients with ESRD and APL.
    Full-text · Article · Jul 2012 · Journal of Korean medical science
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