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It is crucial to understand the impact of DPP-4 inhibitors on the immune system, particularly T cell differentiation, maturation, and proliferation, in patients with type 2 diabetes and CKD. This prospective observational study aimed to investigate the distribution of immune cells (particularly regulatory T cells), following the administration of gemigliptin, a DPP-4 inhibitor, in patients with type 2 diabetes mellitus and chronic kidney disease. We enrolled 28 patients with type 2 diabetes, aged 20 to 69, who had been taking a daily dose of 50mg gemigliptin for <3 months and had chronic kidney disease stages 3, 4, or 5, including that undergoing dialysis. T regulatory cells were defined as CD4 + CD25 high CD127 low/- FoxP3 + phenotype, and flow cytometry was used to examine the distribution of T regulatory cells. In the patient group, blood samples were collected at baseline, as well as at 3 and 6 months after initiating medication. Of the 28 patients, 17 (60.7%) were male and the mean age was 61.82 ± 8.03 years. Serum Cr ≥ 1.5 mg/dL was 16 (57%), and Cr < 1.5 mg/dL was 12 (43%). The number of CD4(+)/CD25(+) cells did not significantly increase or decrease in baseline, 3 months, and 6 months time changes, and the number of CD127(-/FoxP3(+) cells did not change significantly. Treatment with gemigliptin for 3 and 6 months did not significantly alter the number, percentage, or ratio of circulating Treg cells in patients with type 2 diabetes and CKD. Therefore, the administration of gemigliptin may help maintain regulatory T cells or have no significant impact.

The development of immunosuppressants has enabled remarkable progress in kidney transplantation (KT). However, current immunosuppressants cannot induce immune tolerance, and their nonspecific immunosuppressive effects result in many adverse effects. Regulatory T cells (Tregs) play crucial roles in controlling all specific immune responses. This study evaluated the distribution of Tregs and their effects on kidney allograft function in Korean KT recipients. We enrolled 113 KT recipients with stable graft function. The differentiation and expansion of Tregs were examined by flow cytometry to compare the Tregs subpopulations. Among the 113 patients, 73 (64.6%) were males, and the mean follow-up period from KT to Tregs collection was 147.5 + 111.3 months. Patients receiving lower doses of cyclosporine had higher proportions of Tregs than those with higher doses of cyclosporine (36.3 + 21.6 vs 17.0 + 12.7, P= .010, respectively). Patients taking cyclosporine tended to have higher Tregs numbers than those taking tacrolimus (94.7 + 158.1 vs 49.3 + 69.4, P= .095, respectively). However, no significant association was observed between Tregs and allograft dysfunction in the cox proportional hazard model. Tregs counts may be associated with the type and dose of immunosuppressants. However, no significant relationship was found between Tregs and kidney allograft function in stable KT recipients.

AbstractBackground/Aims:Aldosterone antagonists have been proven to be efficient in the management of hypertension and the reduction of proteinuria; however, they are not widely used because of the risk of hyperkalemia. We assessed the predictors of hyperkalemia risk following hypertension control using aldosterone blockade in the presence or absence of chronic kidney disease (CKD). Methods:A total of 6,575 patients with hypertension treated between January 1, 2000, and November 30, 2012, were evaluated for the safety of an aldosterone-blocking agent (spironolactone) added to preexisting blood pressure-lowering regimens. Hyperkalemia was defined as a serum potassium level ≥5.0 mEq/l. All patients used 3 mechanistically complementary antihypertensive agents, including a diuretic and a RAAS blocker. Patients were evaluated after 4 and 8 weeks of treatment. The incidence of hyperkalemia, significant renal dysfunction [a reduction of the estimated glomerular filtration rate (eGFR) ≥30], and adverse effects was assessed. Results:The incidence of hyperkalemia in the presence or absence of CKD was 50.4 and 42.6 after 4 weeks (p = 0.001) and 3.8 and 3.0 after 8 weeks, respectively (p = 0.371). A logistic regression analysis revealed that medication, CKD, basal hyperkalemia, reduction in eGFR, and diabetes were all predictive of a hyperkalemia risk following spironolactone use. Conclusion:Spironolactone was well tolerated by selected CKD patients. The risk of serious hyperkalemia or a significant reduction of eGFR appears to be low. Strict monitoring over the first month of treatment followed by standard surveillance for angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers is suggested.© 2015 S. Karger AG, Basel

The objective of this study was to examine the correlation between arterial blood gas (ABG) and peripheral venous blood gas (VBG) samples for all commonly used parameters in patients admitted to a medical intensive care unit (ICU).

No standard method for assessing the nutritional status in dialysis patients. In the present study, we undertook an evaluation to determine whether estimation of geriatric nutritional risk index (GNRI) and lymphocyte subset counts can be helpful in diagnosis of malnutrition in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients.

Background: Our objective was to examine the association between the Geriatric Nutritional Risk Index (GNRI) and Total lymphocytes count (TLC) with mortality in Korean Hemodialysis Patients. Methods:We examined the GNRI and TLC of 120 maintenance hemodialysis patients and followed these patients for 120 months. Predictors for all-cause death were examined using life table analysis and the Cox proportional hazards model. Results: Life table analysis revealed that subjects with a GNRI < 90 (n = 19) had a lower survival rate than did those with a GNRI ≥ 90 (n = 101) (Wilcoxon test, P= 0.048), but subjects with a TLC < 1500/mm3(n = 76)had a similar survival rate compared those with a TLC ≥ 1500/mm3(n = 44) (Wilcoxon test, P= 0.500). Multivariate Cox proportional hazards analyses demonstrated that the GNRI was a significant predictor of mortality [hazard ratio (HR) 9.315, 95% confidence interval (CI) 1.161–74.753, P= 0.036], after adjusting for age, sex, presence of type 2 diabetes mellitus, Kt/V, nPCR and TLC. The association of a GNRI ≥ 90 with a TLC ≥ 1500/mm3seemed to exclude the occurring of complications with moderate reliability.