ABSTRACT
ObjectiveCardiovascular calcification is a highly common complication in patients with end stage renal disease. The aim of this study was to explore the effect of cardiac valve calcification (VC) on left ventricular function and morphology in patients with end stage renal disease by echocardiography. Methods Echocardiography results of 137 patients with end stage renal disease who underwent hemodialysis in the general hospital of the eastern theater of war from June 2013 to August 2013 were retrospectively analyzed. The morphological structure and function parameters of the left ventricle were measured by echocardiography and tissue doppler imaging to assess cardiovascular calcification. Logistic regression analysis was used to investigate the independent risk factors of cardiac valve calcification.Results VC was found in 55 patients (40.1%) in this study. The age [(52.7±11.1) vs (42.6±12.3)], low density lipoprotein [(2.7±0.8)mg/dL vs (2.2±0.6)mg/dL], cholesterol [(5.2±1.1)mg/dL vs (4.5±0.9)mg/dL] levels were higher, while serum creatinine [(10.7±2.7)mg/dL vs (13.2±8.5)mg/dL] was lower in patients with VC than patients without VC (P<0.05). Logistic regression analysis showed that the older age, longer dialysis time and higher mean value of mitral annular systolic values were the independent risk factors for VC. The morphological and structural parameters of the left ventricle of the group with VC were higher than those of the group without VC (P<0.05), while the parameters of left ventricular diastolic function of the group with VC were lower than those of the group without VC (P<0.05).ConclusionVC diagnosed by echocardiography in patients with end stage renal disease may indicate significantly higher incidence of left ventricular hypertrophy and reduction of left ventricular diastolic function in comparison to those without VC.
ABSTRACT
Objective To observe the clinical efficacy and safety of low-dose tacrolimus (TAC) combined with tripterygium(TW) in treatment of steroid-resistant nephrotic syndrome (SRNS). Methods The patients, who were diagnosed with mesangial proliferative glomerulonephritis (MesPGN) and focal segmental glomerulosclerosis (FSGS) by biopsy and failed to respond to a 3 month treatment with prednisone (1 mg/[kg • d], maximum 60 mg/d, were randomly divided into 2 groups (TAC+TW group and TW group). Initially TAC+TW group took TAC 0. 05 mg/(kg • d) 2 h after meal at a 12 h interval; the plasma TAC level was examined after 3 days and was kept at 1. 5-4 ng/ml; meanwhile, TW was given at 60 mg/d before meal. TW group only took TW(60 mg/d before meal). The efficacy, adverse reactions and plasma TAC levels were observed in each group. Results (1) Totally 20 patients met the recruitment criteria, including 11 in the TAC+TW group and 9 in the TW group. The age, sex, time of onset, blood pressure, 24 h urine protein, serum albumin, creatinine, cholesterol, triglyceride, fasting blood glucose, renal pathology types and period of prednisone use were similar between the two groups. (2) In TAC+ TW group the urine protein began to decrease one month later; 12 months later,8 cases had complete remission (72. 7%), 2 had partial remission (18. 2%),and 1 was ineffective (9. 1%), with a total effective rate of 90. 9%. I n TW group the urine protein also began to decrease one month later; 12 months later only 2 cases had complete remission (22. 2%), 4 had partial remission (44. 5%), and 3 were ineffective (33. 3%), with a total effective rate of 66. 7%. (3)In TAC + TW group the plasma protein was significantly higher than that before treatment; the plasma protein recovered to normal level after 6 month treatment. However, there was no significant increase in TW group. The pre- and post-treatment serum creatinine levels were similar between the two groups. (4) The incidence rates of adverse reactions were not significantly different between the two groups. Conclusion Low dose TAC combined with TW can effectively decrease proteinuria in patients with SRNS, generating a higher rate of clinical remission; meanwhile, the patients have a good tolerance and less adverse reactions.
ABSTRACT
BACKGROUND: Carotid intima media thickness (CIMT) and stiffness are taken as useful surrogate markers of atherosclerosis. In China, the number of elderly patients undergoing hemodialysis has increased year by year, with the increase of dialysis-related cardiovascular events. This study was undertaken to examine carotid stiffness in elderly hemodialysis patients by the ultrasound techniques in order to find out the possible risk factors. METHODS: From January 2006 to February 2010, a total of 87 patients (41 males and 46 females) treated with routine hemodialysis at the 97th Hospital of People's Liberation Army were enrolled in this study. The distensibility coefficient (DC) of the carotid artery was detected by Doppler ultrasonic diagnosis apparatus (Philips HBI5000, frequency 12 MHz) for evaluation of arterial stiffness. Serum albumin, total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), glucose, creatinine, calcium, phosphorus, and intact parathyroid hormone (iPTH) were examined with standard methods. The liner correlation and multiple stepwise regression analysis were used to find correlations between them. RESULTS: In this study, the systolic blood pressure was 153.33±25.98 mmHg, DBP 84.22± 10.39 mmHg, TC 4.39±1.05 mmol/L, TG 1.36±0.72 mmol/L, LDL 2.47±0.77 mmol/L, Cr 889.82± 207.38 mol/L, Glu 5.36±1.87 mmol/L, Ca I 2.00±2.19±0.21 mmol/L, and DC 13.39±5.32×10-3/kPa. DC was associated with age (r =-0.459, P<0.001), SBP (r =-0.527, P<0.001), and serum calcium (r =-0.273, P=0.011). The multiple stepwise regression analysis showed that SBP, age, increased serum calcium level, and diabetes were independent risk factors for decreasing DC. CONCLUSION: Systolic blood pressure, age, increased serum calcium level and diabetes in elderly hemodialysis patients are independent risk factors for increased carotid arterial stiffness.