ABSTRACT
Objective To analyze the relationship between the level of 25 (OH )D and mortality in maintenance hemodialysis (M HD) patients .Methods This study was a prospective cohort study .We enrolled 156 M HD patients of Sichuan people′s hospital dialysis center in July of 2010 .The patients were divided into three groups according to the level of 25(OH)D .The three groups were normal(25(OH)D>30 ng/mL) ,insufficient(15 ng/mL<25(OH)D≤30 ng/mL) and deficient(25(OH)D≤15 ng/mL) re‐spectively .All the patients were follow‐up 40 months ;the end point was all‐cause and cardiovascular death .Results After follow‐up 40 months ,there were 26 deaths (16 .7% ) and 13 cardiovascular deaths among the 156 cases .There were 15 deaths (30 .6% ) in in‐sufficient group ,among which there were nine cardiovascular deaths ;there were eight deaths (11 .6% ) in deficient group ,among which there were three cardiovascular deaths ;there were three deaths (7 .9% ) in normal group ,among which there was one cardio‐vascular death .There was statistically significance either between all‐cause and cardiovascular mortality of deficient and normal group or between deficient and insufficient group (P<0 .05) .The Kaplan‐Meier curve analysis showed 25(OH)D≤15 ng/mL was the independent risk factor of the all‐cause and cardiovascular mortality(P<0 .05) .Cox regression showed 25(OH)D≤15 ng/mL was the independent risk factor of the all‐cause mortality in crude analysis (RR=4 .43 ,95% CI:1 .28-15 .32 ,P<0 .05) and adjus‐ted analysis (RR=4 .92 ,95% CI 1 .23-19 .66 ,P<0 .05) .Cox regression showed 25(OH)D≤15 ng/mL was the risk factor of the cardiovascular mortality in crude analysis(RR=8 .12 ,95% CI:1 .04 -64 .15 ,P=0 .047) .Conclusion 25(OH)D≤15 ng/mL was the risk factor and predictor of the all‐cause and cardiovascular mortality in M HD patients .
ABSTRACT
Objective To study the association of serum L-kynurenine changes with nutritional status and vascular stiffness in maintenance hemodialysis (MHD) patients. Methods Twenty gender- and age-matched healthy volunteers (healthy group) and 40 MHD patients,including 20 cases with α-keto aicd(α-keto acid group)and 20 cases without α-keto aicd(non-α-keto acid group)were enrolled in the study.Serum L-kynurenine was measured by high performance liquid chromatography.C-reactive protein (CRP)and interleukin 6 (IL-6)were detected.Subjective global assessment(SGA)and malnutrition inflammation score(MIS)were applied to evaluate the nutritional status.Pulse wave velocity(PWV)was used to evaluate arterial stiffness for both groups of MHD patients. Results Serum L-kynurenine was significantly higher in MHD patients than that in healthy subjects[(3.20±1.12)μmol/L vs (1.74±0.27)μmol/L,P0.05].IL-6 was significantly higher in MHD patients as compared to healthy subjects[(6.45±3.78)ng/L vs(1.38±1.59)ng/L,P<0.01],while such difference was found between α-keto aicd group and non-α-keto aicd group[(3.37±0.82)ng/L vs (9.62±2.48)ng/L,P<0.051.There was no difference of CRP concentration between two MHD groups.As compared to non-α-keto acid group,higher SGA score(26.00±1.75 vs 22.67±2.61,P=0.001),lower MIS score(5.82±2.27 vs 10.00±2.62,P=0.002),lower left side PWV[(21.11±8.21)m/s vs(24.57±5.45)m/s,P=0.244]and lower right side PWV[(19.27±3.22)m/s vs (24.19±5.41)m/s,P=0.015]were observed in α-keto aicd group.Pearson analysis showed positive correlation between serum L-kynurenine and IL-6(r=0.352,P=0.011)and negative correlation between L-kynurenine and pre-dialysis Scr(r=-0.412,P=0.019). Conclusions Inflammation is common in MHD patients.Tryptophan degeneration product L-kynurenine may indicate inflammation status.α-keto acid improves nutritional status,anemia and arterial stiffness maybe through the alleviation of inflammation in MHD patients.