ABSTRACT
Objective To evaluate the effects of baseline and changes of peritoneal transport characteristics on the prognosis of maintaining peritoneal dialysis (PD) patients.Methods Five hundred and eight-six PD patients who started PD from September 11,2006 to October 30,2014 in a single center were included and followed up until March 30,2016.According to their baseline D/Pcr value in peritoneal equilibrium test (PET),the patients were divided into high transport (H) group (D/ Pcr 0.82-1.03),high average transport (HA) group (D/Pcr 0.65-0.81),low average transport (LA) group (D/Pcr 0.50-0.64) and low transport (L) group (D/Pcr 0.34-0.49).According to the changes of follow-up D/Pcr comparing with baseline D/Pcr,the patients were also divided into ascending group,descending group and no-change group.The patient and technical survival rates were estimated by Kaplan-Meier analysis.Cox proportional hazards analyses were used to analyze the risk factors for PD patient death and technical failure.Results There were 67 patients in L group,229 patients in LA group,252 patients in HA group,and 38 patients in H group.The patient survival rate in H group was significantly lower than those of L group (P=0.036),LA group (P=0.008) and HA group (P=0.041).There was no significant difference on technical survival rate among these 4 groups.According to the tendency of follow-up D/Pcr changes,there were 127 patients in ascending group,101 patients in descending group and 179 patients in no-change group.There was no significant difference on patient survival among these 3 groups (P=0.064).However in patients with a high transport rate (D/Pcr≥0.65),the patient survival was lower in descending group than those in ascending group (P=0.033) and nochange group (P=0.049).Age over 65 years old (HR=2.499),malnutrition during follow-up (HR=3.144),ultrafiltration less than 400 ml/d during follow-up (HR=1.863) and high sensitive C reactive protein≥ 10 mg/L (HR=4.526) were the independent risk factors for patient death (all P ＜ 0.05).Gender (HR=1.609),age over 65 years old (HR=1.929),ultrafiltration less than 400 ml/d during follow-up (HR=1.708),high sensitive C reactive protein ≥10 mg/L (HR=1.829),malnutrition (HR=1.876) and change of peritoneal transport function (HR=0.579) affect technical failure (all P ＜ 0.05).Conclusions The survival rate of PD patients with basal high peritoneal transit is relatively low,especially for patients with descending transport rate during follow-up.The concern on the peritoneal transport status is constructive for the prognosis of PD patients.
ABSTRACT
Objective To explore the clinical curative effect of combination of Tripterygium glycosides and Valsartan on chronic Glomerulonephritis complication with hypertension and the influence on inflammatory cytokines.Methods 90 cases of patients with chronic glomerulonephritis complication with hypertension in our hospital were selected from January 2015 to January 2016,To adopt randomized single blind controlled design methods,were divided into the treatment group Tripterygium glycosides combined with Valsartan,and the control group Tripterygium glycosides,each group were 45 cases,continuous medication for 24 weeks.Before and after treatment respectively observe the changes in blood pressure,24h urinary protein,endogenous creatinine clearance rate(Ccr),blood urea nitrogen(BUN),serum creatinine(Scr),glomerular filtration rate(GFR),inflammatory cytokines such as tumor necrosis factor-α,hypersensitive C-reactive protein,interleukin-6 as reference indicators.Results All the patients were observed for 24 weeks,no adverse effects were found.The effective rate of the treatment group was 95.55%,significantly higher than 75.55%of the control group(P<0.05).After treatment,systolic blood pressure(SBP),diastole blood pressure(DBP),24h urinary protein,SCr and BUN were all decrease,while Ccr and GFR were improved,and inflammatory cytokines such as tumor necrosis factor-α,hypersensitive C-reactive protein,interleukin-6 were reduced in the treatment group and the control group,the difference was statistically significant(P<0.05).Compared with the control group,blood pressure,24h urinary protein,Ccr, Scr,GFR,TNF-α、hs-CRP were improved in the treatment group(P<0.05).Conclusion Tripterygium glycosides combined with Valsartan treatment has good clinical curative effect,It can effectively relieve the symptom of chronic Glomerulonephritis complication with hypertension.