Renin-angiotensin system inhibitor is associated with the reduced risk of all-cause mortality in COVID-19 among patients with/without hypertension / 医学前沿

Consecutively hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) in Wuhan, China were retrospectively enrolled from January 2020 to March 2020 to investigate the association between the use of renin-angiotensin system inhibitor (RAS-I) and the outcome of this disease. Associations between the use of RAS-I (angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)), ACEI, and ARB and in-hospital mortality were analyzed using multivariate Cox proportional hazards regression models in overall and subgroup of hypertension status. A total of 2771 patients with COVID-19 were included, with moderate and severe cases accounting for 45.0% and 36.5%, respectively. A total of 195 (7.0%) patients died. RAS-I (hazard ratio (HR)= 0.499, 95% confidence interval (CI) 0.325-0.767) and ARB (HR = 0.410, 95% CI 0.240-0.700) use was associated with a reduced risk of all-cause mortality among patients with COVID-19. For patients with hypertension, RAS-I and ARB applications were also associated with a reduced risk of mortality with HR of 0.352 (95% CI 0.162-0.764) and 0.279 (95% CI 0.115-0.677), respectively. RAS-I exhibited protective effects on the survival outcome of COVID-19. ARB use was associated with a reduced risk of all-cause mortality among patients with COVID-19.

Systematic review of clinical practice guidelines for kidney disease in China: application of the Appraisal of Guidelines Research and Evaluation-China / 中华肾脏病杂志

Objective@#To evaluate the quality of clinical practice guidelines for kidney diseases in China and provide reference for selecting suitable high-quality guidelines for primary care and developing standardized guidelines.@*Methods@#The China Guideline Clearinghouse, China Biology Medicine disc, VIP Database, Wanfang Database and CNKI, and other resources were searched from January 2013 to July 2018. In accordance with the criteria for inclusion and exclusion, the published guidelines for kidney diseases were screened. The Appraisal of Guidelines Research and Evaluation-China (AGREE-China) was used to systematically assess the current status of domestic guidelines for kidney diseases.@*Results@#A total of 18 guidelines for kidney diseases were included, covering different types of kidney disease such as glomerulonephritis, nephrotic syndrome, end-stage renal disease and other diseases. The overall score ranged from 30 to 68, with an average score of 47.3. The average scores of these guidelines were 20.1, 12.8, 0.5, 9.9 and 3.9 in five review fields including scientificity/rigorism, effectiveness/safety, economy, availability/feasibility, and conflicts of interest, respectively. Of these 18 guidelines, 8(44.4%) guidelines were strongly recommended, and 10(55.6%) guidelines were weakly recommended.@*Conclusions@#There are still deficiencies in scientificity/rigorism and economy in current guidelines for kidney diseases in China. The AGREE-China can be used as an evaluation tool for guidelines for kidney diseases in accordance with China's situation, while its practicability and feasibility still need further verification and improvement.

The prevalence and risk factors of anemia in a general population from Kailuan in north China / 中华内科杂志

Objective To analyze the prevalence and risk factors of anemia in a general population in Kailuan.Methods Working and retired employees m Kailuan Company who had participated in biennial physical examination from 2006-2014 were investigated by questionnaire and blood test.Hemoglobin levels＜ 120 g/L in male and＜ 110 g/L in female are defined as anemia.The trend of prevalence of anemia was analyzed by chi square test.Multivariable logistic regression was used to analyze the factors associated with anemia.Results (1) The biennial prevalence of anemia in Kailuan during 2006-2014 were 3.7％,3.1％,2.4％,1.3％,1.5％.The corresponding proportion were 3.3％,2.3％,1.9％,0.8％,1.0％ in males and 5.3％,5.9％,4.2％,3.1％ and 3.3％ in females,respectively.The differences between males and females were statistically significant (all P＜0.05).The prevalence of anemia declined over time (P for trend＜0.05).(2) The results of multivariable logistic regression showed that aging and elevated hs-CRP were positively associated with anemia,with OR=1.01 (95％CI 1.01-1.02)and 1.03 (95％CI 1.02-1.03),respectively.While male,BMI,physical exercise,smoking,hyperlipidemia were negatively associated with anemia with OR=0.60(95％CI 0.55-0.65),0.99 (95％CI 0.98-0.99),0.91 (95％CI 0.82-0.98),0.87 (95％CI 0.81-0.95)and 0.87(95％CI0.81-0.94),respectively.Conclusions The prevalence of anemia in a large general population in Kailuan has been analyzed.Prevalence of anemia is higher in males than females and declines over time.Several demographic and clinical characteristics are associated with anemia.

Systolic blood pressure and progression of renal dysfunction in the elderly patients with moderate to severe chronic kidney disease: a cohort study from a tertiary hospital / 中华内科杂志

Objective To study the effect of blood pressure (BP) control on the progression of renal function in elderly patients with chronic kidney disease (CKD) stages 3 and 4.Methods Patients aged 65 years or older in our CKD clinic with baseline CKD stages 3 and 4 and with more than one-year followup until February 2014 were included in this study.Those who had an annual loss of epidermal growth factor receptor(eGFR) for more than 5 ml · min-1 · 1.73 m-2,or reached CKD stage 5,and/or initiated renal replacement therapy were regarded as progression of CKD.Cox regression was used to analyze the effect of BP control on the progression of CKD.Results A total of 118 patients [57 men,mean age (73.8 ± 5.1) years] were enrolled in the final analysis with median baseline eGFR of 37.9 (29.3,46.7) ml ·min-1· 1.73m-2.The baseline BP was (137.0±18.0)/(72.5±10.3)mmHg(1 mmHg=0.133 kPa).During the median 26 months (12-94 m) follow-up period,the average treated BP was (136.2 ± 12.1)/ (70.5 ±6.9)mmHg.Among all the subjects,64.4％ of them reached the BP target (＜ 140/90 mmHg) and 23.7％ had progression of CKD.Treated systolic BP (HR =1.504,95％ CI 1.023-2.212) and baseline eGFR (HR =0.923,95％ CI 0.872-0.977) were independent risk factors for renal function progression in multivariate Cox analysis.Patients with treated systolic BP over 140 mmHg had higher risk to develop progression of CKD compared with those with systolic BP ≤ 140 mmHg (HR =2.505,95％ CI 1.090-5.756).Conclusions Tight blood pressure control is important in the routine care of elderly patients with CKD stage 3 and stage 4.

Clinical characteristics of the chronic kidney disease in the elderly: a cross-sectional study / 中华肾脏病杂志

Objective To analyze the baseline clinical characteristics of the chronic kidney disease (CKD) in aged people in the clinic.Methods Patients aged 18 years or older in our CKD clinic from October 2003 to December 2012 were included in this study.According to their age patients were divided into 2 groups:aged CKD group:aged 65 or older and non-aged CKD group:younger than 65.A group of the elderly without CKD from health screening program were selected as aged non-CKD control group.Causes,distributions of stages and complications of CKD in three groups were analyzed.Results The major cause of the elderly CKD was hypertension,different from that of younger CKD.The distribution of CKD stage in the elderly was mainly in the G3b stage,different from that in the younger.Anemia and mineral bone disease presented in earlier CKD stage in the aged CKD patients and the prevalence was higher than in the aged non-CKD group.The prevalence of hypertension had no statistical difference between the two CKD groups,but hypertension control rate was lower in aged CKD patients.Conclusions The clinical characteristics including causes and renal stage are different between the young and aged CKD patients.Complications such as anemia and mineral bone disease presents in earlier renal stage in aged CKD patients which means we should monitor and interfere earlier.

Chinese cohort study of chronic kidney disease: design and methods / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chronic kidney disease (CKD) is a common disorder associated with multiple adverse clinical consequences, especially cardiovascular risk and end-stage renal disease. A recent national survey demonstrated that CKD has become a leading health problem in China. There is an urgent need to implement an in-depth investigation of the CKD burden and also to explore underlying mechanisms of CKD progression and it association with adverse consequences.</p><p><b>METHODS</b>The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is the first national CKD cohort in China. It will enroll approximately 3 000 pre-dialysis CKD patients aged between 18 and 74 years and follow-up for at least 5 years. Questionnaires, anthropometric measures, laboratory tests, and biomaterials will be collected at baseline and annually. The principal clinical outcomes of the C-STRIDE consist of renal disease events, cardiovascular events, and death. Based on the longitudinal clinical data and biomaterials, the risk factors with CKD progression and other outcomes will be analyzed, and candidate markers and predicted models will be established.</p><p><b>CONCLUSION</b>The C-STRIDE would provide important evidence for underlying mechanisms of CKD progression, valuable information for clinical guidelines, and healthcare policies in China.</p>

Current status of chronic kidney disease in China and the challenge to laboratory medicine / 中华检验医学杂志

Chronic kidney disease (CKD) has become a public health issue worldwide.A recent cross-sectional survey revealed that the prevalence of CKD in residents aged 18 years or older was 10.8％,indicating the challenge of CKD in China.The major indicators of kidney damage include estimated glomerular filtration rate (eGFR),proteinuria and hematuria.It is recommended that laboratory should report eGFR when reporting results of blood creatinine.Both of Chinese equation and Chronic Kidney Disease Epidemiology Collaboration equation could be used.The process of creatinine measurement should be standardized.For evaluation of proteinuria,urinary creatinine should also be measured when using spot urine sample.Considering the high false positive rate and low false negative rate of urine routine test for hematuria,it is recommended that microscopic examination on urinary sediment should be done for those with positive hematuria by urine routine test.(Chin J Lab Med,2012,35:769-772)

Risk factors for progression of advanced chronic kidney disease——A monocentric cohort study from a specific CKD outpatient management clinic / 中华肾脏病杂志

Objective To identify the risk factors for progression of advanced chronic kidney disease(CKD) patients who were cared by nephrologists in a specific CKD outpatient management clinic.Methods A prospective monocentric cohort study was performed.CKD patients of stage 3, 4 and 5 without renal replacement treatment were followed up regularly by nephrologists in this specific CKD management clinic.Patients with established atherosclerotic renal artery stenosis(ARAS) and chronic tubulointerstitial nephritis, and those who had not been followed-up for at least 12 months before Jun.30, 2010 were excluded.Clinical and laboratory data including blood pressure (BP), proteinuria, hemoglobulin (Hb), calcium phosphate product (Ca×P) and serum creatinine were consecutively collected.The treatment regimen was also recorded.Estimated glomerular filtration rate(eGFR) was calculated with the formula modified for Chinese to evaluate the change of renal function.The progression of kidney disease was defined as initiation of renal replacement therapy, the annual decrease of eGFR＞4 ml·min-1·(1.73 m2)-1, and/or death associated with renal disease.Results A total of 138 patients were enrolled in the final analysis with 84 patients of CKD stage 3, 36 of CKD stage 4 and 18 of CKD stage 5, respectively.At the time of enrollment, patients had an average age of (56.5:±:16.7) years old with an average eGFR of (32.3±13.4) ml·min-1·(1.73 m2)-1.During a mean follow-up interval of (27.1±12.1) months, the patients were well-controlled with an average blood pressure of (126.5±12.4)/(76.4±7.9) mm Hg in 50.7％(70/138), less than or equal to 130/80 mm Hg, an average Hb of(123.8±17.1) g/L in 73.9％(102/138), above or equal to 110 g/L and an average Ca×P of (45.2±7.7) mg2/dl2 in 89.1％(123/138), less than or equal to 55 mg2/dl2.Sixty-two patients (44.9％) had progression of kidney disease. On univariate analysis, factors predicting progression were low eGFR at referral, high systolic pressure, low Hb level, high Ca×P and proteinuria during follow-up, and renin-angiotensin system inhibitors treatment did not affect the progression.After the adjustment, multivariate analysis revealed proteinuria and low Hb level were independent factors for the progression of kidney disease.Conclusions The co-morbidities of advanced CKD patients can be managed efficiently in specific CKD outpatient management clinic.Control of proteinuria and correction of anemia may be beneficial to prevent the progression of advanced CKD.

Evaluation measurement of urinary albumin in population survey / 中华检验医学杂志

Objective To evaluate the spot urine sample collection method and value of urinary albumin measurement in population survey. Methods Six hundred and fifty-nine Beijing residents were requested to collect 24 h urine for detection of UAER, as well as random spot urine samples and morning urine samples in the next day. Rapid semi-quantitative urinary albumin-specific dipstick and ACR were measured in each spot urine specimen. The 24 h UAER was measured as golden standard to generate ROC curves and evaluate the sensitivity, specificity and AUC of each method. Results The value of ACR in the morning spot urine samples and random spot urine samples were 9. 36(5. 12-33.29) mg/g and 11.29(6. 34-41.29) mg/g respectively and there was no significant difference between these two groups (t = - 1. 382,P＞0.05). The correlation was significant in the two groups (r = 0.932, P ＜ 0.01). The correlation coefficient between ACR in the morning spot urine samples and UAER was 0. 853 (P ＜ 0. 01). The correlation coefficient between ACR in the random spot urine samples and UAER was 0. 874 (P ＜0. 01).The sensitivity and specificity of ACR for diagnosis of albuminuria in the random urine samples were 77. 9% and 91.0%. The sensitivity and specificity of ACR for diagnosis of albuminuria in the morning urine samples were 78. 4% and 95.7%. Concerning the semi-quantitative urinary albumin-specific dipstick, sensitivity and specificity were 90. 3% and 41.1% , respectively. The specificity was much lower than that of ACR. The area under the ROC curves of ACR in the random urine specimens and the morning urine specimens was 0. 918 ±0. 012, 0. 929 ± 0. 015, respectively. There was no statistical difference between these two groups (χ2 =2. 13, P＞0. 05). The area under the ROC curves of semi-quantitative urinary albumin-specific dipstick in the random urine specimens was 0.661 ±0.021, lower than that of ACR (χ2 = 248.41, P＜0.01).Conclusion Measurement of ACR in random urine samples is a reasonable method with simplicity and accuracy for the detection of albuminuria in general population screening program.

Application of serum and urinary endothelin-1, interleukin-6 assay in screening atherosclerotic renal artery stenosis / 中华肾脏病杂志

Objective To investigate the possibility of using serum and urinary endothelin-1 (ET-1), interleukin-6 (IL-6) assay as screening tools for atherosclerotic renal artery stenosis (ARAS). Methods Serum and urinary samples from 49 patients with ARAS, 32 cases with≥2 risk factors for atherosclerosis and 30 normal controls were detected for ET-1 and IL-6 by RIA. The receiver operating characteristic (ROC) curves were then generated to assess their accuracy in screening ARAS by using selective renal angiography as golden standard. Results Urinary ET-1, urinary IL-6 and urinary-serum ratio of ET-1 in ARAS cases were higher than those in two control groups, and were all correlated with degree of renal artery stenosis. The area under the ROC curve of urinary ET-1, urinary IL-6 and urinary-serum ratio of ET-1 was 0.792, 0.756 and 0.779, respectively. The sensitivity and specificity of urinary ET-1 to distinguish ARAS(≥50%) was 80.0% and 72.8% respectively using 6.72 ng/mmol creatinine as the cut-off point. The cut-off value of ET-1 urinary-serum ratio was 12.59 with a sensitivity of 66.7% and a specificity of 61.7%. The sensitivity and specificity of urinary IL-6 were 73.3% and 70.4% respectively using 23.85 ng/mmol creatinine as the cut-off point. The sensitivity and specificity were improved to 80.0% and 77.8% respectively when using 12.60 ng/mmol creatinine as the cut-off point and combined with hypertension to perform series test. Conclusion Urinary ET-1 and urinary IL-6 could be used as screening tools for ARAS.

The influence of using continuous quality improvement program in the follow-up survey to atherosclerotic renal artery stenosis patients / 中国实用护理杂志

Objective To improve the compliance and prognosis of patients with atherosclerotic renal artery stenosis(ARAS) by using continuous quality improvement program(CQI).Methods Survey patients by the way of using the four-step problem-solving framework referred as the PDCA cycle,i.e.plan,do,check and act.Compare the results of patients which have obtained before and after CQI.Results The follow-up rate of patients was improved from 46.9% to 83.3%, and most of the patients are willing to enter the follow-up program.The patients are more likely to receive examinations of ARAS,such as blood pressure,renal function,renal artery color duplex sonography and renal scintigraphy.The control rate of blood pressure was also improved from 45.6% to 93.1% Conclusion CQI is a useful method to improve the compliance and prognosis for ARAS patients,and nurses have played an important role during the whole process.

Clinical characteristics of renal artery stenosis complicated with malignant hypertension / 中华肾脏病杂志

Objective To investigate the incidence, clinical characteristics and prognosis of malignant hypertension (MHT) resulted from renal artery stenosis (RAS).Methods Among those diagnosed as RAS by arteriography over a 23 year period (From January 1980 to April 2003), 23 patients complicated with malignant hypertension(MHT) were included. Their etiology, clinical characteristics,treatment and prognosis were analyzed, and compared with those of 46 renal parenchymal MHT and 23 primary MHT cases during in the same period.Results Twenty three patients accounted for 25 8%of MHT cases and 19 5%of RAS cases during the same period.Among 23 patients, atherosclerotic renal artery stenosis (ARAS) and Takayasu arteritis were most commonly seen, and ARAS became the leading cause after 1990.The distinct characteristics of RAS included unilateral small kidney(52 2%), abdominal or flank bruit(17 4%)and azotemia induced by treatment with angiotensin converting enzyme inhibitor(8.7%).Besides, compared with renal parenchymal MHT group, the level of urine protein in RAS with MHT group was less and all decreased to less than 1 g/d after blood pressure was controlled.Furthermore, hematuria was seldom in RAS with MHT group. As for basal renal function, serum creatinine level in the majority in RAS with MHT group was normal, while most patients of the other two groups had elevated or remarkably elevated serum creatinine level.Hypertension was cured in 54 5%of those receiving interventional therapy in RAS with MHT group. During the follow up 3～12 months, only 2 cases in RAS with MHT group were dialysis dependent, who were less than those in other groups.Conclusions RAS is a common cause of secondary MHT, and the percentage of ARAS is increasing. For MHT patients without hematuria and massive proteinuria, screening for renal artery stenosis is strongly recommended. Although prognosis of RAS is comparatively good, early diagnosis and treatment are crucial.