End-stage renal disease(ESRD)significantly impacts patients’quality of life and poses substantial socioeconomic burdens.Dietary interventions are crucial for managing ESRD,yet high-quality evidence and analysis speci...End-stage renal disease(ESRD)significantly impacts patients’quality of life and poses substantial socioeconomic burdens.Dietary interventions are crucial for managing ESRD,yet high-quality evidence and analysis specifically linking diet to mortality outcomes is scarce.Methods:We conducted a comprehensive study involving 656 peritoneal dialysis(PD)patients over 12 years,with an average follow-up every 3 months.Dietary intake was meticulously recorded using a 3-day dietary record method,integrated with detailed health records and outcomes.We employed a 2-stage model to evaluate nonlinear relationships between dietary nutrients and mortality risk,accounting for various confounding factors.Findings:Our analysis revealed that 14 out of 26 nutritional elements lack guidelines for ESRD and PD patients,with 13 showing significant associations with mortality.For example,while guidelines suggest a dietary protein intake of 1.0 to 1.2 g/kg/d,our findings indicate an optimal range of 0.88 to 1.13 g/kg/d.Similarly,the recommended dietary energy intake of 25 to 35 kcal/kg/d was refined to 26 to 42 kcal/kg/d.We identified that 69% of dietary intake-outcome relationships are nonlinear,especially in patients with poor health status.Interpretations:Our study provides detailed dietary intake thresholds that correlate with improved prognosis in ESRD patients,enhancing current guidelines.The findings highlight the importance of personalized nutritional management and underscore the nonlinear nature of nutrient–disease relationships,particularly in severely ill patients.This approach can refine dietary recommendations and improve patient care in ESRD.展开更多
Aim:Eligibility for liver transplantation for hepatocellular carcinoma(HCC)is currently based on singledimension,diameter measurements on cross-sectional imaging,as specified by various selection criteria.This does no...Aim:Eligibility for liver transplantation for hepatocellular carcinoma(HCC)is currently based on singledimension,diameter measurements on cross-sectional imaging,as specified by various selection criteria.This does not account for significant differences in shape,and therefore tumour volume,between patients.This study investigated whether one-dimensional selection criteria disadvantages patients by not considering volume.Methods:Patient data were collected retrospectively from a prospectively maintained database.Tumours were measured on both computer tomography(CT)and magnetic resonance imaging(MRI).Tumour volume was measured using two methods;semi-automated planimetry and the ellipsoid volume formula.Statistical analysis was performed using SPSS.Results:A total of 313 patients with HCC were assessed for liver transplantation.For this study,patients who underwent transplantation(n=89)and those who did not based on tumour size(n=33)were included.In total,213 tumours were measured,showing excellent correlation between CT and MRI(R^(2)=0.83).The majority of tumour nodules(94%)were ellipsoid not spherical.Volumetric measurements of the 84 tumours that did not meet diameter-based Milan criteria confirmed that 76%would have been within a theoretical volume allowance based on Milan criteria diameters.Conclusion:This study shows that a significant number of patients deemed outside conventional diameter-based Milan criteria have smaller tumour volumes than those considered within criteria.It appears that those with ellipsoid rather than spherical tumours may be disadvantaged by current size-based criteria.Further research using a contemporary patient cohort who have had the benefit of advancements in non-surgical treatments for HCC is required.展开更多
基金supported by the National Natural Science Foundation of China(62402017 and 82470774)Xuzhou Scientific Technological Projects(KC23143)+2 种基金the Clinical Cohort Construction Program of Peking University Third Hospital(No.BYSYDL2023004)Peking University Medicine plus X Pilot Program-Key Technologies R&D Project(2024YXXLHGG007)the receipt of studentship awards from the Health Data Research UK-The Alan Turing Institute Wellcome PhD Programme in Health Data Science(Grant Ref:218529/Z/19/Z).
文摘End-stage renal disease(ESRD)significantly impacts patients’quality of life and poses substantial socioeconomic burdens.Dietary interventions are crucial for managing ESRD,yet high-quality evidence and analysis specifically linking diet to mortality outcomes is scarce.Methods:We conducted a comprehensive study involving 656 peritoneal dialysis(PD)patients over 12 years,with an average follow-up every 3 months.Dietary intake was meticulously recorded using a 3-day dietary record method,integrated with detailed health records and outcomes.We employed a 2-stage model to evaluate nonlinear relationships between dietary nutrients and mortality risk,accounting for various confounding factors.Findings:Our analysis revealed that 14 out of 26 nutritional elements lack guidelines for ESRD and PD patients,with 13 showing significant associations with mortality.For example,while guidelines suggest a dietary protein intake of 1.0 to 1.2 g/kg/d,our findings indicate an optimal range of 0.88 to 1.13 g/kg/d.Similarly,the recommended dietary energy intake of 25 to 35 kcal/kg/d was refined to 26 to 42 kcal/kg/d.We identified that 69% of dietary intake-outcome relationships are nonlinear,especially in patients with poor health status.Interpretations:Our study provides detailed dietary intake thresholds that correlate with improved prognosis in ESRD patients,enhancing current guidelines.The findings highlight the importance of personalized nutritional management and underscore the nonlinear nature of nutrient–disease relationships,particularly in severely ill patients.This approach can refine dietary recommendations and improve patient care in ESRD.
文摘Aim:Eligibility for liver transplantation for hepatocellular carcinoma(HCC)is currently based on singledimension,diameter measurements on cross-sectional imaging,as specified by various selection criteria.This does not account for significant differences in shape,and therefore tumour volume,between patients.This study investigated whether one-dimensional selection criteria disadvantages patients by not considering volume.Methods:Patient data were collected retrospectively from a prospectively maintained database.Tumours were measured on both computer tomography(CT)and magnetic resonance imaging(MRI).Tumour volume was measured using two methods;semi-automated planimetry and the ellipsoid volume formula.Statistical analysis was performed using SPSS.Results:A total of 313 patients with HCC were assessed for liver transplantation.For this study,patients who underwent transplantation(n=89)and those who did not based on tumour size(n=33)were included.In total,213 tumours were measured,showing excellent correlation between CT and MRI(R^(2)=0.83).The majority of tumour nodules(94%)were ellipsoid not spherical.Volumetric measurements of the 84 tumours that did not meet diameter-based Milan criteria confirmed that 76%would have been within a theoretical volume allowance based on Milan criteria diameters.Conclusion:This study shows that a significant number of patients deemed outside conventional diameter-based Milan criteria have smaller tumour volumes than those considered within criteria.It appears that those with ellipsoid rather than spherical tumours may be disadvantaged by current size-based criteria.Further research using a contemporary patient cohort who have had the benefit of advancements in non-surgical treatments for HCC is required.
