Paik Seong Lim - Academia.edu (original) (raw)

Papers by Paik Seong Lim

Acta Nephrologica, Sep 1, 2018

許多透析病人為年長、罹患多重共病且營養狀況不良。透析醫護人員經由水分及營養規則性評估是改善病人水分及營養狀態的重要方法。經由人體及身體組成的量測方式，可以提供透析病人的重要營養訊息。然而，由於此... more 許多透析病人為年長、罹患多重共病且營養狀況不良。透析醫護人員經由水分及營養規則性評估是改善病人水分及營養狀態的重要方法。經由人體及身體組成的量測方式，可以提供透析病人的重要營養訊息。然而，由於此些檢驗方式的預先假設，以及透析改變了體內水分的狀態，限制了此些測量於透析病人的應用性。另一方面，身體組成測量方式，是經由單一或多個電生物阻抗在健康民眾推估實驗而設立。此外，大多數電生物阻抗法推估出的預後模組，於透析病人存在其根本問題。近幾年，根據生物阻抗頻譜分析水分及生理改變的型態，設計出監測透析病人體內是否水分過多組成的儀器。由於具有非侵襲性、使用方便等特性，全世界越來越多的透析機構及醫療人員運用此儀器於床邊評估透析病人水分。此外，生物阻抗頻譜分析儀對於評估營養狀況及透析病人的透析是否充足也有臨床重要性。我們回顧及整理近幾年此議題的文獻並提供重要相關性。

thought to lead to accelerated atherogenesis but the underlying mechanisms are still poorly under... more thought to lead to accelerated atherogenesis but the underlying mechanisms are still poorly understood.Background. Several studies have demonstrated that Moreover, the risk factors of atherosclerosis identifiedatherosclerotic complications are the major cause of in the Framingham study [1–2] in non-uraemic popula-morbidity and mortality in end-stage renal disease tions such as arterial hypertension, lipid dyslipidaemia,(ESRD) patients on dialysis. The allele e4 of apolipo-and haemostatic abnormalities are very common inprotein E (ApoE) gene has been associated with an these dialysis patients.increased risk for ischaemic cerebrovascular disease Apolipoprotein E is a 299-amino acid protein found(ICVD) in general populations in recent preliminary in chylomicrons, VLDL, intermediate-density lipopro-cross-sectional studies. tein, and HDL [3]. It plays an important role in theMethods. The aim of our study was to prospectively metabolism of these lipoproteins by binding to theinvestigate t...

Tuberculous peritonitis (TbP) is an uncommon peritoneal infection but remains a major clinical pr... more Tuberculous peritonitis (TbP) is an uncommon peritoneal infection but remains a major clinical problem in many developing countries, where the incidence of tuberculosis (Tb) is high. The clinical presentation may be insidious and variable. Because of the indolent nature of the infection, combined with limited diagnostic strategies, most often the diagnosis is delayed resulting in a high morbidity and mortality. We hereby report a case of non-caseating TbP in a hemodialysis (HD) patient with liver disease.

Nephrology Dialysis Transplantation, 2020

Background and Aims Muscle strength is a solid predictor of outcome for hemodialysis (HD) patient... more Background and Aims Muscle strength is a solid predictor of outcome for hemodialysis (HD) patients. In this study, our aim is to investigate the relationship between muscle strength and six potential muscle biomarkers including irisin, myostatin, myonectin, antichymotrypsin, urotensin II and insulin-like growth factor 1 (IGF-1). Method The cohort of prevalent HD patients in Tungs’ Taichung MetroHarbor Hospital were participated in our cross-sectional clinical study. The serum muscle markers were determined using standardized enzyme-linked immunosorbent assay methods. The muscle strength was accessed by handgrip strength (HGS) on arm without vascular access before dialysis session. Results A total of 175 patients were enrolled in this study with an average age of 59.2 and among them 84 were males (48.0%). Among the six potentially associated with muscle strength viz HGS, we found that only IGF-1 level (r=0.180, p=0.017) correlated positively with HGS. In the multivariate regression a...

Journal of the Formosan Medical Association = Taiwan yi zhi, 2001

Renal oncocytoma is a rare benign tumor of the kidney that accounts for about 5% of renal tumors.... more Renal oncocytoma is a rare benign tumor of the kidney that accounts for about 5% of renal tumors. Acquired renal cystic disease (ARCD) is commonly seen in dialyzed patients. However, the occurrence of renal oncocytoma in ARCD has rarely been reported. We report such a case in a 67-year-old man who had hypertension-associated end-stage renal disease and had received regular hemodialysis for 5 years. Radiologic diagnostic studies demonstrated a renal mass in the left atrophic cystic kidney that increased in size from 2 cm to 4 cm during 2 years of follow-up. Under the diagnosis of renal cell carcinoma, he received left radical nephrectomy. The pathologic examination revealed renal oncocytoma with a well-cirumscribed, homogenous, mahogany-brown tumor on a background of ARCD. Although patients with ARCD have a higher incidence of renal malignancies, renal oncocytoma may occur in these patients and may be managed conservatively.

Background: Compelling evidence has demonstrated a link between oxidative stress and the pathogen... more Background: Compelling evidence has demonstrated a link between oxidative stress and the pathogenesis and progression of atherosclerosis It has been conjectured that oxidative stress may be a mechanism by which the accelerated rate of cardiovascular disease observed in maintenance hemodialysis (HD) patients, be explained. The purpose of this study was to examine the discriminative potential of plasma protein carbonyl (PC), a marker of oxidative stress, in age-, sex-, and smoking-matched HD patients with and without ischemic cardiomyopathy (ICM). Methods: Plasma protein carbonyls levels were determined using spectrophotometry in eighty-two HD patients (30 men and 52 women, mean age 62.3±11.8 years) immediately prior to one midweek HD treatment. Forty two patients, including 16 men and 26 women, had clinically significant ischemic cardiomyopathy. Traditional cardiovascular risk factors, including serum lipids, lipoproteins, apolipoproteins, and fibrinogen, were also measured, as were serum chemistry and dialysis adequacy. Results: Mean plasma protein levels were significantly elevated in HD patients when compared to normal controls. We also found that HD patients with 1CM have significantly elevated plasma protein carbonyls levels when compared to patients without 1CM. Serum lipoprotein and plasma fibrinogen levels did not differ between the two groups, therefore elevated PC levels appeared to be the single strongest predictor of prevalent ICM in this patient population. Conclusions: The results of our study suggest that ischemic cardiomyopathy is more prevalent among hemodialysis patients with higher plasma PC levels. Elevated plasma level of protein carbonyl was an important predictor of ischemic cardiomyopathy in our HD patients. The increased plasma proteins oxidation seen in HD patients may be the consequence of multiple brief episodes of ischemia-reperfusion. These findings provide further evidence for the role of oxidative stress as a risk factor for the occurrence and development of ICM.

Nephron, 2000

Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/journals/nef/nef_bk.htm

Nephrology Dialysis Transplantation, 1999

Conclusion. We demonstrated that increased oxidative stress in the blood circulation of the uraem... more Conclusion. We demonstrated that increased oxidative stress in the blood circulation of the uraemic patients Background. Iron balance is critical for adequate erythropoiesis and there remains much debate con-on haemodialysis is exacerbated by the elevated baseline serum ferritin levels and intravenous iron infusion. cerning the optimal timing and dosage of iron therapy for haemodialysis patients receiving recombinant The resultant oxidative damage may contribute to the increased incidence of atherosclerosis in the human erythropoietin therapy. Methods. In this study, we examined the influence of patients with end-stage renal disease on long-term haemodialysis. baseline ferritin level and intravenous infusion of 100 mg ferric saccharate on the oxidative status of the Key words: Key words: erythropoiesis; erythropoietin patients on maintenance haemodialysis. The levels of therapy; haemodialysis; intravenous iron therapy; oxidantioxidant enzymes and lipid peroxides were deterative stress; reactive oxygen species; uraemia mined in erythrocytes and plasma of 50 uraemic patients on haemodialysis. These patients were divided into groups 1, 2, and 3, based on their baseline serum ferritin levels of <300, 301-600, and >601 mg/l, Introduction respectively. Results. We found that the mean superoxide dismutase Several lines of evidence have indicated that reactive (SOD) activities in the erythrocytes were similar in the oxygen species (ROS) may be involved in the uraemic three groups of patients and did not differ from those toxicity of patients with end-stage renal disease of the age-matched controls. On the other hand, all (ESRD). In addition, these patients are also chronicthe haemodialysis patients showed significantly higher ally exposed to the oxidative stress of ROS as a result plasma SOD activity as compared to controls. After of activation of neutrophils induced by their interaction intravenous iron infusion, group 3 patients showed the with the dialysis membranes [1,2]. Increased concentralargest decrease in plasma SOD activity. The plasma tion of malondialdehyde (MDA), one of the end glutathione peroxidase (GSHPx) activities of the products of the peroxidation of polyunsaturated fatty patients in all three groups and the erythrocyte GSHPx acids, has been reported in plasma and erythrocytes activities of the patients in the groups 2 and 3 were [3-5] of haemodialysis patients. It has been observed lower than those of the healthy controls. In all three that plasma levels of glutathione (GSH) [6 ], GSH groups of patients, no difference in GSHPx activity peroxidase (GSHPx) [4], vitamins C [4] and E [5] are was found before and after intravenous iron infusion. decreased in the ESRD patients. Erythrocyte superox-On the other hand, we found that the average baseline ide dismutase (SOD) activity was reported to be levels of plasma lipid peroxides of all three groups of increased [7] or decreased [8] by different investigators. patients were significantly higher than that of the These studies clearly suggest that oxidative stress is controls. The patients in group 3 with the highest enhanced, as indicated by decreased antioxidant levels serum ferritin levels showed the highest levels of plasma and increased lipid peroxidation, exists in the haemolipid peroxides. More importantly, we found that after dialysis patients. iron infusion, the patients in all three groups, particu-The use of recombinant human erythropoietin larly those in group 3, showed significantly elevated (rHuEpo) to treat the anaemia of patients on maintenlevels of plasma lipid peroxides. ance dialysis has been a major advance in the care of these patients. However, this treatment is frequently Correspondence and offprint requests to: Professor Yau-Huei Wei, blunted by the induction of iron depletion [10,11].

Symmetrical peripheral gangrene (SPG) is an uncommon but devastating complication in critically i... more Symmetrical peripheral gangrene (SPG) is an uncommon but devastating complication in critically ill patients with a high mortality. It is seen in a wide variety of medical conditions, presenting as symmetrical gangrene of two or more extremities without large vessel obstruction. We hereby report a 65-year-old woman diagnosed of having E. coli bacteremia with urosepsis, who presented with acute abdomen, consciousness disturbance and multiple organ failure. Owing to low blood pressure and unstable hemodynamic status, inotropic agents with maximum dose of dopamine at 12.7 μg/kg/min and levophed of 2.6 μg/min were used. On the 4th day of admission, patient developed cyanosis and gangrene of fingers and toes. However, even with the dose of inotropic agents tapered, the cyanosis and gangrene did not resolve. Autoamputation developed and the patient underwent multiple surgical amputations of her fingers and toes. Patient also developed acute kidney injury with anuria and pulmonary edema, t...

Journal of Renal Nutrition, 2020

OBJECTIVES This study was performed to determine the effects of probiotic supplementation on chol... more OBJECTIVES This study was performed to determine the effects of probiotic supplementation on cholesterol-triglyceride ratio, an indirect marker of insulin resistance, protein-bound uremic toxins, biomarkers of inflammation, and microbial translocation in end-stage renal disease patients on hemodialysis. METHODS Fifty-six patients aged 39-75 years were assigned into two groups to receive either probiotic sachets (n = 28) or a placebo (n = 28) in a randomized double-blinded placebo-controlled clinical trial. The patients in the probiotic group received twice daily sachets that contained a mixture of three viable and freeze-dried strains: Lactococcus lactis subsp. Lactis LL358, Lactobaccillus salivarius LS159, and Lactobaccillus pentosus LPE588 at high dose (100 billion; 1 × 1011 cfu/day) for 6 months. RESULTS A total of 50 patients were available for final analysis. Probiotic supplementation did not have a significant influence on cholesterol-triglyceride ratio. Probiotic supplementation for 6 months caused a significant decrease in serum levels of indoxyl sulfate. Compared with the placebo, probiotic supplementation did not result in significant changes in hemoglobin levels, blood urea nitrogen, blood glucose, serum p-cresyl sulfate, inflammatory, and microbial translocation markers. No clinically significant changes in body composition were observed between the two groups during the study period. The probiotic supplementation was well tolerated by all subjects with minimal adverse effects during the 6-month-long study. CONCLUSION Our results suggest that high-dose multistrain lactobaccillus probiotic supplementation over 6 months as a monotherapy did not significantly decrease markers of insulin resistance, cholesterol-triglyceride ratio, and most of the studied markers, with the exception of levels of indoxyl sulfate in patients on HD.

Clinical Kidney Journal, 2012

Background. Maintenance of the optimal fluid status in hemodialysis patients is still a challengi... more Background. Maintenance of the optimal fluid status in hemodialysis patients is still a challenging task in daily clinical practice. A bioelectric impedance technique has been applied for evaluation of hydration status in the dialysis population in recent years, but serial observations of its role in clinical dry weight determination are lacking. In this study, serial follow-up data of a body composition monitor based on bioimpedance spectroscopy (BCM-BIS) applied in dialysis patients were analyzed to define the technique's feasibility, precision and possible role in dry weight determination. Methods. BCM-BIS was applied monthly to 194 hemodialysis patients for 6 months. Intra-patient precision was analyzed. Bland-Altman analysis and repeated-measures analysis of variance (ANOVA) were used to define the relationship between the dry weights determined by BCM-BIS and by clinical judgment. Results. The coefficients of variation (CVs) of fluid parameters were <5%. Serial changes in dry weight differences were compared in groups with different post-dialysis hydration status and dry weight differences decreased gradually. Bland-Altman analysis revealed that the range of these differences was significantly narrower towards the latter part of the study. The upper limit of agreement with 95% confidence interval (CI) was 1.47 L and the lower limit was −3.02 L. Conclusions. BCM-BIS is precise and can be easily applied in the clinical setting. Discrepancy between the dry weights determined by BCM-BIS and by clinical judgment significantly decreased during the study. It is sensitive in dry weight determination, especially for those patients with obvious over-hydration (OH) by BCM-BIS. Patients with post-dialysis OH results beyond some critical values (>1.5 L or <−3 L) should be closely monitored.

Journal of human hypertension, 1994

The association of excessive lead burden and essential hypertension has been a subject of much di... more The association of excessive lead burden and essential hypertension has been a subject of much dispute. In particular, the potential detrimental effect of low level environmental exposure on BP has caused considerable concern. We studied the urinary excretion of lead following the infusion of EDTA (1 g of calcium disodium edetate) in 12 healthy controls (group I), 10 subjects with essential hypertension alone (Group II) and in 36 subjects with chronic renal insufficiency. Those subjects with renal insufficiency were further divided into three groups: group III, 12 patients with a history of 7-19 years of essential hypertension who subsequently developed into renal failure; group IV, patients with chronic renal failure alone; and group V, patients with chronic renal failure due to causes other than hypertensive nephropathy and associated with secondary hypertension. In comparison with other groups, subjects with hypertensive nephropathy (group III) had significantly elevated lead bod...

Acta …, 2011

Sclerosing encapsulating peritonitis (SEP) is a rare but serious and devastating complication wit... more Sclerosing encapsulating peritonitis (SEP) is a rare but serious and devastating complication with a very high mortality rate in patients undergoing peritoneal dialysis. We hereby report a 63-year-old female patient diagnosed to have end-stage renal disease ( ...

American Journal of Nephrology, 1995

The present study examines the serum aluminum (Al) and daily urine Al excretion in 50 patients wi... more The present study examines the serum aluminum (Al) and daily urine Al excretion in 50 patients with chronic renal insufficiency (CRI) who are not taking any Al-containing agents. The influence of body iron stores and hematological indexes on the above parameters were also studied. Data on a group of 20 healthy subjects not taking any drugs were included for comparisons. The basal Al levels in CRI patients (10.5 +/- 9.7 micrograms/l) were significantly higher than those (3.8 +/- 2.4 micrograms/l) of the normal subjects. In addition, the renal Al clearance (2.98 +/- 0.35 ml/min) in CRI patients was significantly lower than that (4.93 +/- 0.21 ml/min) in normal subjects. Although all serum Al levels of our patients were within the nontoxic range (&amp;lt; 50 micrograms/l), the results of our study showed a negative correlation between serum Al and serum transferrin saturation (r = -0.40, p &amp;lt; 0.005) as well as serum iron (r = -0.406, p &amp;lt; 0.005). There was a negative correlation between daily urine Al excretion and serum ferritin levels (r = -0.305, p = 0.031). The study group is further divided into 2 subgroups, i.e. group A (ferritin &amp;lt; 100 micrograms/l) and group B (ferritin &amp;gt; 300 micrograms/l). The daily urine Al excretion in group A was higher than that in group B. In conclusion, our study first demonstrates that Al tends to be accumulated in patients with CRI, similar to Al in patients with hemodialysis, and the chronic low-level Al exposure in CRI patients may affect body iron status and metabolism, or iron status may play a role in Al absorption and excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

BioMed Research International, 2018

Background. There is accumulating evidence pointing to uremia-induced impairment of the intestina... more Background. There is accumulating evidence pointing to uremia-induced impairment of the intestinal epithelial barrier structure in advanced chronic kidney disease (CKD) and hemodialysis (HD) patients. In this study, the impact of intradialytic hypotension on intestinal barrier integrity is being explored. Methods. Immunohistochemical staining was used to detect the expression of 4 types of tight junction (TJ) proteins such as occludin, zonula occludens-1 (ZO-1), claudin-1, and claudin-4, in colonic samples of a group of patients receiving segmental colectomy. Five patients with nondialysis CKD (group 2), 5 HD patients with intradialytic hypotension (group 3), and 5 non-CKD subjects (group 1) were examined. Results. Both patients’ groups 2 and 3 demonstrated significantly reduced expression of occludin as compared to group 1 (p<0.05 and p<0.01, resp.). Except for claudin-4, expression of all markers of TJ proteins was significantly reduced in patients’ group 3 as compared to co...

It is well documented that cardiovascular morbidity as well as mortality are increased in patient... more It is well documented that cardiovascular morbidity as well as mortality are increased in patients along with the development of chronic kidney disease (CKD)[1-5]. Traditional risk factors per se are not able to give a satisfactory explanation for this burden in these patients[6-9]. Recently, other non-traditional risk factors, including oxidative stress, have been proposed to participate in the cardiovascular mortality in uremia [10, 11].There is a body of evidence indicating that oxidative stress occurs in patient with CKD. Oxidative stress is defined as the imbalance between prooxidant and antioxidant mechanisms in favor of the former that ultimately leads to oxidation of all basic cell components, i.e. proteins, lipids, DNA, and carbohydrates. This article (1) reviews the evidence and causes for oxidative stress in CKD, (2) briefly discuss the current strategies for ameliorating oxidative stress in these patients.

BACKGROUND: Accumulating evidence suggested that oxidative stress and inflammation are important ... more BACKGROUND: Accumulating evidence suggested that oxidative stress and inflammation are important risk factors for cardiovascular events in hemodialysis patients. The effects of an oral spherical adsorptive carbon preparntion, AST-120, on markers of microinflammation and oxidative stress remain unclear. The aim of this study was to evaluate the depurative effect of AST-120 on sever a l protein-bound uremic toxins such as p-cresol sulfate and indoxyl sulfate in patients receiving post-dilution on-line hemodiafiltration (OLHDF). Moreover, the effects of AST-120 on both inflammatory and oxidative stress markers were also studied. METHODS: A total of 30 stable chronic kidney disease (CKD) patients receiving post-dilution OLHDF were enrolled and randomly assigned to either the control group or the experimental group. Patients in the experimental group received AST-120 at a daily do se of 6 g for 3 months. Serum levels of protein-bound toxins, oxidative stress and inflammatory biomarkers b...

International Journal of Molecular Sciences, 2020

Indoxyl sulfate (IS), a uremic toxin derived from dietary tryptophan metabolism by the gut microb... more Indoxyl sulfate (IS), a uremic toxin derived from dietary tryptophan metabolism by the gut microbiota, is an endogenous aryl hydrocarbon receptor (AhR) agonist and a key player in bone remodeling. Resveratrol (RSV), an AhR antagonist, plays a protective role in shielding against AhR ligands. Our study explored the impact of IS on osteoblast differentiation and examined the possible mechanism of IS in controlling the expression of osteoblastogenesis markers through an in-depth investigation of AhR signaling. In vivo, we found histological architectural disruption of the femoral bones in 5/6 nephrectomies of young adult IS exposed mice, including reduced Runx2 antigen expression. RSV improved the diaphysis architecture, Runx2 expression, and trabecular quality. In vitro data suggest that IS at 500 and 1000 μM disturbed osteoblastogenesis through suppression of the ERK and p38 mitogen-activated protein kinase (MAPK) pathways, which were found to be downstream of AhR. RSV proved to amel...