PubMed Health⌕ Search

Biomedical subjects

Kai Ming Chow

Publications and source records attributed to Kai Ming Chow.

13 recordsLinked to original sources
PubMed2002

Plasminogen activator inhibitor-1 polymorphism is associated with progressive renal dysfunction after acute rejection in renal transplant recipients.

BACKGROUND: Plasma level of plasminogen activator inhibitor (PAI)-1 is genetically determined by a polymorphism in the promoter region, involving two alleles, 4G and 5G. Plasma PAI-1 concentrations are higher in subjects homozygous for the 4G allele than other genotypes (5G/5G and 4G/5G). Such genetic variation in fibrinolytic system may affect the long-term renal transplant outcome. METHODS: We determined PAI-1 4G/5G-promoter genotype polymorphism among our renal transplant recipients between 1985 and 2001. Primary event was defined as doubling of baseline serum-creatinine level. RESULTS: Over a median period of 79 months, 130 patients with 132 kidney grafts were assessed. Baseline clinical variables were comparable among three genotype groups. There was no association between primary event and PAI-1 genotype among the entire cohort. However, among subjects with prior acute rejection episodes, those homozygous for 4G had significantly higher risk of serum creatinine doubling than the other two genotypes (relative risk 2.45, 95% confidence interval 1.19-5.04). PAI-1 genotype does not predict primary events in patients without rejection (relative risk 0.57, 95% confidence interval 0.07-4.17). CONCLUSIONS: PAI-1 4G/5G-promoter polymorphism modulates the risk of renal transplant outcomes after acute rejection(s). Recipients homozygous for PAI-1 4G allele have a higher risk of progressive renal damage after acute rejection episode(s). PAI-1 promoter polymorphisms are potentially important determinants of renal response to rejection.

Acute Disease↗
PubMed2002

Calcifications.

Explore the source record for details and available documents.

Calcinosis↗
PubMed2002

Tuberculous peritonitis-associated mortality is high among patients waiting for the results of mycobacterial cultures of ascitic fluid samples.

We identified 60 cases of tuberculous peritonitis during the past 12 years at our health care center. Most of the patients had severe underlying medical conditions, such as cirrhosis, renal failure, diabetes mellitus, and malignancy. Abnormal chest radiograph findings, ascitic fluid lymphocytosis, and biochemical findings for exudates could only identify 33%, 37%, and 53% of the cases, respectively. On the other hand, peritoneal biopsy allowed early definitive diagnosis for 9 patients. Thirty-one patients died, 26 of whom died < or =6 weeks after their initial presentation, often before the result of mycobacterial culture was available. Only 8 patients died of advanced disease after antituberculous therapy was started. Univariate analysis showed that advanced age, underlying diagnosis, and delayed initiation of therapy were associated with higher mortality rates. Standard antituberculous chemotherapy is highly effective. However, conventional microbiologic diagnostic methods are slow and not sensitive enough for establishing a diagnosis of tuberculous peritonitis.

Adolescent↗
PubMed2002

Good metabolic control using tacrolimus-based immunosuppressants in primary cadaveric renal transplantation in Chinese--a preliminary report.

Metabolic complications are common with tacrolimus therapy. Recent evidence suggests that there is ethnical variability in the side-effect profile of tacrolimus. We performed an open-label study to examine the metabolic profile of tacrolimus-based immunosuppressive therapy in 10 consecutive adult Chinese patients after cadaveric renal transplantation. One case withdrew because of parvovirus infection. The mean age of the remaining nine cases was 33 +/- 2.9 yr. Mean tacrolimus whole blood trough level at 0 and 12 months were 11.4 +/- 1.8 and 7.0 +/- 0.7 ng/mL, respectively. The dosage at corresponding time points were 0.31 +/- 0.001 and 0.10 +/- 0.003 mg/kg, respectively. We found no difference in lipid profile, blood pressure control, and most importantly, fasting glucose level, before and I yr after tacrolimus therapy. Standard 75-g oral glucose tolerance test and whole blood HbAlc level were normal in all patients. Our preliminary data suggest good short-term safety among Chinese renal transplantation recipients after tacrolimus-based immunosuppressants, with a very low incidence of hyperglycemia, hypertension and dyslipidemia. The long-term implications and the underlying explanation for this ethnical difference require further investigations.

Adult↗
PubMed2002

Primary IgA nephropathy with low histologic grade and disease progression: is there a "point of no return"?

Histologic low-grade chronic renal lesions in 144 adults with primary immunoglobulin A (IgA) nephropathy were correlated with clinical parameters of disease progression over a median follow-up of 93 months. Using chronicity-based histologic grading, 50, 59, and 35 patients were glomerular grade (GG) 1a, GG1b, and GG2; 83 and 61 patients were tubulointerstitial grade (TIG) 1 and TIG2; and 25 patients had hyaline arteriolosclerosis. On follow-up, GG and TIG were predictive of disease progression by impairment of renal function, development of hypertension, and significant proteinuria (>1 g/d). Hyaline arteriolosclerosis correlated only with the development of hypertension. Histologic lesions GG1a or TIG1 predicted a significant low risk for disease progression compared with other renal lesions, regardless of the renal manifestation at the time of biopsy. Combined GG1a, TIG1, and isolated hematuria at the time of biopsy enhanced the sensitivity to determine early IgA nephropathy and to define a nonearly cohort with a higher risk of disease progression appropriate for recruitment into clinical therapeutic trials within realistic time frames. The significant risk of progression in other low-grade lesions, such as GG1b or TIG2, suggests that the point of no return in IgA nephropathy may occur much earlier than perceived and that delayed biopsy in these patients no longer may be justified.

Adolescent↗
PubMed2002

Prognostic role of serum ACE activity on outcome of type 2 diabetic patients on chronic ambulatory peritoneal dialysis.

Overexpression of the renin-angiotensin system is important in the pathogenesis of macroangiopathy (MA). Patients with diabetes with end-stage renal failure have elevated serum angiotensin-converting enzyme (ACE) activity compared with their nonuremic counterparts. Because their major cause of death is MA, the significance of serum ACE activity on outcome of this group of patients is studied. We performed a prospective cohort study of 49 patients with type 2 diabetes on continuous ambulatory peritoneal dialysis (CAPD) therapy. Baseline serum ACE activity was determined by a modified spectrophotometric method and followed up at a median of 34 months. The prevalence of MA (defined as ischemic heart disease, sudden cardiac arrest, stroke, or peripheral vascular disease) and all-cause mortality rates were studied. Risk for MA is associated with serum ACE activity (median with MA, 69.0 U/L [range, 46.0 to 100.1 U/L] versus without MA, 57.2 U/L [range, 36.3 to 81.0 U/L]; P = 0.02). At the end of follow-up, 48% of patients (24 of 49 patients) died, 70% of MA. The group that died had increased baseline serum ACE activity (nonsurvivors, 65.0 U/L [range, 33.5 to 100.0 U/L] versus survivors, 49.4 U/L [range, 36.4 to 86.5 U/L]; P < 0.05) and MA rates (nonsurvivors, 77% versus survivors, 36%; P < 0.01). Cox regression analysis performed with age, sex, mean blood pressure, body mass index, metabolic control, Kt/V, residual renal function, serum albumin level, and ACE activity showed that baseline serum ACE activity (P = 0.033) is an independent predictor for mortality in patients with type 2 diabetes on CAPD therapy. Among patients with type 2 diabetes on CAPD therapy, serum ACE activity is associated with risk for MA and is an independent predictor for mortality. Whether ACE inhibition will have a beneficial effect on the outcome of these patients needs further investigation.

Diabetes Mellitus, Type 2↗
PubMed2002

Comparison of clinical outcome and ease of handling in two double-bag systems in continuous ambulatory peritoneal dialysis: a prospective, randomized, controlled, multicenter study.

BACKGROUND: We performed a prospective, randomized, controlled, multicenter study on the use of two double-bag disconnect systems: Stay-Safe (SS; Fresenius Deutschland GmbH2) and Ultrabag (UB; Baxter Healthcare, Deerfield, IL) to assess the ease of handling, peritonitis rate, exit-site infection rate, and clinical outcome. METHODS: We enrolled 110 new continuous ambulatory peritoneal dialysis (CAPD) patients; 55 patients were randomized to SS treatment, and 55 patients, to UB treatment. RESULTS: Patients using the UB and SS systems were followed up for 946 and 846 patient-months, respectively. There were 21 episodes of peritonitis in 18 patients in the UB group and 23 episodes in 18 patients in the SS group. No significant difference was observed in peritonitis rates between the two systems, which were 45 and 36.8 patient-months per episode for the UB and SS groups, respectively. At 12 months, 82.1% of patients in the UB group and 72.1% in the SS group were free of peritonitis; at 18 months, 71.1% and 62.2% were free of peritonitis for the UB and SS groups, respectively (P = 0.559). Gram-positive organisms accounted for 28.6% of infections in the UB group and 39.1% in the SS group. Exit-site infection rates were one episode per 21 patient-months versus 19.2 patient-months in the UB and SS groups, respectively (P = 0.743). Patients perceived SS as easier to handle in 4 of the 13 steps immediately post-CAPD training. However, there was no significant difference in rankings between the two systems after 1 month of adaptation. Median training periods were 4 and 5 days for the SS and UB groups, respectively (P = 0.640). CONCLUSION: The two double-bag systems (UB and SS) have similar incidences of peritonitis and exit-site infection. Both systems showed comparably good clinical outcome. The SS system is easier to learn during the initial training period, but the difference is not significant after 1 month's adaptation.

Catheters, Indwelling↗
PubMed2002

Independent effects of residual renal function and dialysis adequacy on dietary micronutrient intakes in patients receiving continuous ambulatory peritoneal dialysis.

BACKGROUND: Dialysis patients are at risk of vitamin and mineral deficiencies, not only because of losses during chronic hemodialysis or peritoneal dialysis but also because of low intakes. OBJECTIVE: The objective was to determine the importance of urea clearance (calculated as K(t)/V) and residual renal function (RRF) in predicting micronutrient intakes in a large cohort of patients receiving continuous ambulatory peritoneal dialysis (CAPD). DESIGN: We conducted a survey of dietary intakes in 242 CAPD patients and divided them into 3 groups according to their weekly urea clearance and RRF: WD group (n = 84), a urea clearance >/= 1.7 and a glomerular filtration rate (GFR) >/= 1 mL x min(-1) x 1.73 m(-2); DD group (n = 71), a urea clearance >/= 1.7 and a GFR < 1 mL x min(-1) x 1.73 m(-2); and ID group (n = 87), a urea clearance < 1.7. RESULTS: Most of the patients had intakes of water-soluble vitamins and minerals that were lower than the recommended dietary allowance; most intakes were significantly higher in the WD group than in the DD and ID groups, except those of niacin and calcium. After age, sex, body weight, and the presence of diabetes were controlled for, total weekly urea clearance and the GFR (but not peritoneal dialysis urea clearance) were significantly associated with intakes of vitamins A and C, the B vitamins, and minerals (calcium, phosphate, iron, and zinc). Low intakes of vitamins and minerals with low RRF and urea clearance were the result of reduced overall food intakes, except for thiamine, vitamin B-6, and folic acid, which were deficient in the diet. CONCLUSIONS: Supplementation with most water-soluble vitamins and minerals, including iron and zinc, should be considered in CAPD patients, especially those with low RRF and low urea clearance. The optimal dose needs to be determined.

Adult↗