Higher cardiothoracic ratio is associated with higher risk for both all-cause mortality and CVD events in patients undergoing HD.

No abstract

Our results suggest that low hemoglobin concentrations are associated with a high risk of hemorrhagic stroke, but not of ischemic stroke, in patients undergoing hemodialysis.

-Urinary protein (UP) is widely used as a clinical marker for podocyte injury; however, not all proteinuric nephropathies fit this model. We previously described the elevation of urinary angiotensinogen (AGT) accompanied by AGT expression by injured podocytes in a nitric oxide inhibition rat model (Eriguchi M, Tsuruya K, Haruyama N, Yamada S, Tanaka S, Suehiro T, Noguchi H, Masutani K, Torisu K, Kitazono T. Kidney Int 87: 116 -127, 2015). In this report, we performed the human and animal studies to examine the significance and origin of urinary AGT. In the human study, focal segmental glomerulosclerosis (FSGS) patients presented with higher levels of urinary AGT, corrected by UP, than minimal-change disease (MCD) patients. Furthermore, AGT was evident in podocin-negative glomerular segmental lesions. We also tested two different nephrotic models induced by puromycin aminonucleoside in Wistar rats. The urinary AGT/UP ratio and AGT protein and mRNA expression in sieved glomeruli from FSGS rats were significantly higher than in MCD rats. The presence of AGT at injured podocytes in FSGS rats was detected by immunohistochemistry and immunoelectron microscopy. Finally, we observed the renal tissue and urinary metabolism of exogenous injected human recombinant AGT (which is not cleaved by rodent renin) in FSGS and control rats. Significant amounts of human AGT were detected in the urine of FSGS rats, but not of control rats. Immunostaining for rat and human AGT identified that only rat AGT was detected in injured podocytes, and filtered human AGT was seen in superficial proximal tubules, but not in injured podocytes, suggesting AGT generation by injured podocytes. In conclusion, the urinary AGT/UP ratio represents a novel specific marker of podocyte injury.angiotensinogen; focal segmental glomerulosclerosis; minimalchange disease; podocyte; proteinuric nephropathy THE LOCAL RENIN-ANGIOTENSIN system (RAS) plays a crucial role in organ homeostasis, independently of the circulating RAS (15,26). The physiological function of the local RAS in the kidney includes the regulation of the glomerular filtration rate, blood pressure, and reabsorption at proximal tubules (3,19). In contrast, pathological long-term elevation of the intrarenal RAS leads to hypertension and renal injury (17,28,34). In pathological conditions, there is a vicious cycle of local RAS activation and organ dysfunction in the kidney, with local RAS activation augmenting organ dysfunction and vice versa. Therefore, local RAS elevation predicts not only disease prognosis but also the activity of organ injury.Several reports have demonstrated that urinary angiotensinogen (AGT) is a good marker of intrarenal RAS (13, 15, 16). Urinary AGT is elevated and associated with renal prognosis in both patients with various kidney diseases (18, 34) and experimental models (4, 22). However, the origin of AGT in the urine and the kidney is a matter of debate (25), specifically whether it is derived from circulating AGT (liver derived) (23) or from intrarenal generation (24)...

The prevalence of atherosclerotic diseases is higher in hemodialysis patients. The aim of the current study was to investigate associations between cholesterol level and the incidences of cardiovascular disease (CVD) and mortality in hemodialysis patients. A total of 3517 participants undergoing maintenance hemodialysis were followed up for 10 years. Total cholesterol (TC) level was divided into quartile in baseline data. The multivariate analyses were calculated by a Cox proportional hazards model. The incidences of ischemic heart disease (IHD), peripheral artery disease (PAD), and CVD were significantly positively associated with higher cholesterol levels after adjustment for confounding factors (P < 0.01, P = 0.04, and P < 0.01, respectively). Furthermore, the incidences of cancer‐associated mortality and all‐cause mortality were significantly positively associated with lower cholesterol levels after adjustment for confounding factors (both P < 0.01). The lowest TC level at all‐cause mortality risk was 179 mg/dL. From these results, higher TC predicts IHD, PAD, and CVD events, and lower TC predicts cancer‐associated mortality and all‐cause mortality in patients undergoing maintenance hemodialysis.