Chien-Liang Chen

Secondary hyperparathyroidism (SHPT) contributes to mineral-bone disorders, chronic inflammation, and adverse cardiometabolic outcomes in patients undergoing dialysis. Radiomics of epicardial adipose tissue (EAT) derived from computed tomography (CT) may serve as an imaging biomarker of cardiometabolic risk; however, the effect of parathyroidectomy (PTX) on EAT remodeling remains unclear. This cohort study enrolled dialysis patients with severe SHPT who underwent PTX and controls who received standard medical therapy. At baseline and 6 months, the participants underwent CT-based EAT radiomics assessment, coronary artery calcification (CAC) scoring, dual-energy X-ray absorptiometry (DEXA) for body composition and bone mineral density (BMD), and biochemical evaluation. PTX significantly decreased EAT attenuation (-69.99 ± 8.07 to -72.64 ± 5.68 HU; p = 0.04) and increased EAT volume (p = 0.04), indicating a shift toward less inflamed, lipid-rich adipose tissue. Fat mass and BMD increased (p < 0.01), whereas lean mass and resting metabolic rate decreased (p < 0.01). Controls exhibited stable EAT parameters but showed significant BMD decline (p = 0.02) and CAC progression (p = 0.005). PTX was associated with significantly lower CAC progression according to both the Hokanson and Modified Raggi criteria (p < 0.05). Changes in EAT volume were negatively correlated with changes in attenuation (r = -0.444, p = 0.006). These findings suggest that PTX in dialysis patients with SHPT might modulate cardiometabolic profiles by increasing EAT volume, reducing EAT attenuation, improving bone density, and attenuating CAC progression. Furthermore, CT-derived EAT radiomics may provide complementary biomarkers for cardiometabolic remodeling following PTX.

Background: Liquid biopsy may complement tissue profiling in upper tract urothelial carcinoma (UTUC), but cross-specimen findings require cautious interpretation when assays differ. The objective was to describe genes detected in matched tumor, urine, and blood specimens and use The Cancer Genome Atlas bladder urothelial carcinoma (TCGA-BLCA) dataset only as a bladder-centered, hypothesis-generating reference. Materials and Methods: Nine patients with urothelial carcinoma arising predominantly from the renal pelvis or ureter were enrolled from 25 March 2024, through 4 March 2026. Tumor samples were snap-frozen and underwent tumor-normal paired whole-exome sequencing; urine analyses used cellular genomic DNA from urine pellets, and blood analyses used plasma cell-free DNA. Genes reported in all three specimen reports were tabulated. Variant counts were summarized descriptively because the assays used different analytical strategies. Results: Urine, plasma cell-free DNA, and tumor specimens contained 32–38, 30–36, and 296–3103 reported variants per patient, respectively. One to 10 genes per patient were reported in all three specimen types. With-No-Lysine Kinase 1 (WNK1) was identified post hoc in all three specimen reports for 2 patients; both institutional WNK1 findings were synonymous. TCGA-BLCA analyses were exploratory and were not considered UTUC validation. Conclusions: Matched multi-biospecimen sequencing identified genes in tumor, urine, and plasma cell-free DNA from this small UTUC cohort. These findings support the feasibility of exploratory genomic tracking, but assay asymmetry prevents attribution of count differences to specimen biology. WNK1 is a preliminary post hoc observation, not a validated biomarker.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is characterized by small vessel inflammation, which can lead to renal hemorrhage. Some forms of ANCA-associated vasculitis, such as microscopic polyangiitis, may lead to aneurysm formation, particularly renal aneurysm, which may resolve with appropriate immunosuppressive therapy. However, maintenance treatment should be administered cautiously to patients with ANCA-associated vasculitis and end-stage renal disease (ESRD) owing to the lower relapse rate and increased risk of infectious complications associated with immunosuppressive therapy. Herein, we describe a case involving a woman with ANCA-associated vasculitis and ESRD who did not receive maintenance immunosuppressive therapy and subsequently experienced right and left renal hemorrhages 8 and 14 years after the initiation of dialysis, respectively. Treatment choices for ANCA-associated vasculitis are based on individual factors such as disease severity and level of vasculitis activity. This case report highlights ANCA-associated vasculitis with two episodes of aneurysm-related bleeding, emphasizing that maintenance immunosuppressive therapy may be critical for patients having ANCA-associated vasculitis with ESRD, particularly those with persistently high ANCA titers.

Although stent grafts have demonstrated significant benefits over bare metal stents and conventional venoplasty at maintaining patency of dialysis vascular access, they are far from perfect and are prone to edge stenosis. A new strategy of placing stent graft to reduce the possible occurrence of edge stenosis is therefore proposed in this study. A retrospective review between 2015 and 2023 identified 21 arteriovenous grafts (AVG) hemodialysis patients who underwent stent graft placement with the medial stent end in an outflow venous valve. The indications for stent graft placement were either due to frequent recoil venous anastomotic stenoses recalcitrant to venoplasty or vascular ruptures after balloon dilation. Stent grafts of 6-7 mm in diameter were deployed crossing the venous anastomosis onto a venous valve. The primary stent-end patency, primary and secondary access patency were calculated with Kaplan-Meier analysis. Technical success was achieved in 100% of the 21 patients. The median primary stent-end patency was 24 months with the patency rates at 12- and 24-month of 65.3% and 43.5% respectively. Six patients had in-stent stenosis and three patients had stent graft downward migration, resulting in edge stenosis. The secondary access patency rates at 1- and 2-year were 100% and 94.7%, respectively. No major complications were encountered in this study. Placing the stent graft end in an outflow venous valve seems to reduce occurrence of the edge stenosis, and therefore prolong the stent graft patency.

Background: Several epidemiologic studies have revealed a higher risk of cancer in patients with diabetes mellitus (DM) relative to the general population. To investigate whether the use of acarbose was associated with higher/lower risk of new‐onset cancers.Method: We conducted a retrospective cohort study, using a population‐based National Health Insurance Research Database of Taiwan. Both inpatients and outpatients with newly onset DM diagnosed between 2000 and 2012 were collected. The Adapted Diabetes Complications Severity Index (aDCSI) was used to adjust the severity of DM. The Cox proportional hazards regression model was used to estimate the hazard ratio (HR) of disease.Results: A total of 22 502 patients with newly diagnosed DM were enrolled. The Cox proportional hazards regression model indicating acarbose was neutral for risk for gastroenterological malignancies, when compared to the acarbose non‐acarbose users group. However, when gastric cancer was focused, acarbose‐user group had significantly lowered HR than non‐acarbose users group (p = 0.003). After adjusted for age, sex, cancer‐related comorbidity, severity of DM, and co‐administered drugs, the HR of gastric cancer risk was 0.43 (95% CI = 0.25–0.74) for acarbose‐user patients.Conclusion: This long‐term population‐based study demonstrated that acarbose might be associated with lowered risk of new‐onset gastric cancer in diabetic patients after adjusting the severity of DM.

Background: Conflicting evidence exists regarding the relationship between socioeconomic status and access to or outcomes after kidney transplantation. This study analyzed the effects of individual and neighborhood socioeconomic status on kidney transplant access and outcomes in Taiwan. Methods: We used a retrospective cohort study design and performed comparisons using the Cox proportional hazards model after adjusting for risk factors. Data were collected from the National Health Insurance Bureau of Taiwan data (2003–2012). Results: Patients with high individual and neighborhood socioeconomic status had higher chances of receiving kidney transplants than those with low individual and neighborhood socioeconomic status [adjusted hazard ratio (aHR) = 2.04; 95% CI: (1.81–2.31), p < 0.001]. However, there were no significant differences in post-transplant graft failure or patient mortality in Taiwan between individuals of varying socioeconomic status after five years. When we stratified kidney transplants by domestic and overseas transplantation, there were no significant differences in post-transplant mortality and graft failure, but individuals who received a kidney graft in Taiwan with high individual and neighborhood socioeconomic status experienced lower risks of graft failure (aHR = 0.55; [95% CI 0.33–0.89], p = 0.017). Conclusion: A relevant disparity exists in accessing kidney transplantation in Taiwan, depending on individual and neighborhood socioeconomic status. However, results post transplantation were not different after five years. Improved access to waitlisting, education, and welfare support may reduce disparities. Graphical

Introduction: Denosumab preceding elective surgery is an alternative option when parathyroidectomy is not immediately possible. Denosumab (an osteoprotegerin mimic) may play a role in the cardiovascular system, which is reflected in the features of epicardial adipose tissue (EAT) and coronary artery calcification (CAC). Methods: We investigated the effects of denosumab on EAT attenuation (EATAT) and CAC in dialysis patients with secondary hyperparathyroidism (SHPT). This cohort study included patients on dialysis with SHPT. The baseline characteristics of dialysis patients and propensity score–matched non-dialysis patients were compared. Computed tomography scans of the dialysis patients (dialysis group with denosumab, n = 24; dialysis group without denosumab, n = 21) were obtained at baseline and at 6 months follow-up. Results: At baseline, the dialysis group patients had a higher EATAT-median (-71.00H ± 10.38 vs. -81.60H ± 6.03; P < 0.001) and CAC (1223A [248.50–3315] vs. 7A [0–182.5]; P < 0.001) than the non-dialysis group. At follow-up, the dialysis group without denosumab showed an increase in Agatston score (1319.50A (238.00–2587.50) to 1552.00A (335.50–2952.50); P = 0.001) without changes in EATAT-median (-71.33H ± 11.72 to -70.86H ± 12.67; P = 0.15). The dialysis group with denosumab showed no change in Agatston score (1132.2A (252.25–3260.5) to 1199.50A (324.25–2995); P = 0.19), but a significant decrease of EATAT-median (-70.71H ± 9.30 to -74.33H ± 10.28; P = 0.01). Conclusions: Denosumab may reverse EATat and retard CAC progression in dialysis patients with SHPT.

Adverse renal effects of systemic vascular endothelial growth factor (VEGF) inhibitor treatment are well documented. We aimed to identify associations between intravitreal VEGF inhibitor use and renal function decline in patients with diabetic retinopathy. We included 625 patients with diabetic retinopathy for regular renal function follow-ups and grouped them according to intravitreal therapy (67 with and 558 without treatment). We used a generalized estimating equation model to identify renal function decline risk factors. Increased age (p = 0.02), insulin use (p = 0.01), hypertension (p < 0.01), and ischemic heart disease (p < 0.01) were associated with significantly decreased estimated glomerular filtration rates (eGFRs) in patients with diabetic retinopathy after 1-year follow-up. Compared to the control group, patients who received intravitreal VEGF inhibitor injections showed a declining eGFR trend in the repeated measurement model without statistical significance (p = 0.06). In subgroup analysis, patients with initial eGFR ≤ 30 mL/min/1.73 m² who received intravitreal VEGF inhibitors had significantly decreased renal function (p < 0.01) compared to those without treatment. Intravitreal VEGF inhibitor injection was associated with renal function deterioration among patients with diabetic retinopathy and advanced chronic kidney disease. Strategies to monitor renal function after treatment should be considered in these high-risk populations.

Aluminum accumulation is a well-described complication in dialysis patients. Improvements in hemodialysis technology have possibly eliminated the occurrence of aluminum overload. Limited evidence s...