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Objective:To explore the relationship between metabolic acidosis and cardiac valve calcification in maintenance hemodialysis (MHD) patients in the Pearl River Delta Region.Methods:Patients on MHD greater than 3 months who were treated in 10 blood purification centers in the Pearl River Delta Region from July 1 to September 30, 2019 were selected for this multicenter cross-sectional study. Based on a Doppler ultrasound, MHD patients were further divided into non-valve calcification group and valve calcification group. The demographics data, frequency of dialysis, blood pressure, single pool Kt/V(spKt/V), dialysis medications and laboratory data were collected and compared. Spearman correlation analysis was used to analyze the correlation between serum carbon dioxide combining power (CO 2CP) and cardiac valve calcification. Multivariate logistic regression model was used to analyze the influencing factors of cardiac valve calcification. Results:A total of 664 MHD patients were included in this study, with age of (57.0±14.2) years old and dialysis age of 43.0 (22.3, 71.7) months, including 395 males (59.5%) and 269 females (40.5%). Among them, there were 119 patients (17.9%) with diabetes and 186 patients (28.0%) with dialysis 2 times per week. There were 329 patients (49.5%) in the valve calcification group, and 335 patients (50.5%) in the non-valve calcification group. Compared to those in non-valve calcification group, valve calcification group had longer duration of dialysis, higher proportion of patients with dialysis 2 times per week, higher levels of diastolic blood pressure, fasting blood glucose, intact parathyroid hormone and ferritin, higher proportion of patients with blood CO 2CP<19 mmol/L (median CO 2CP), higher proportion of patients on usage of calcium channel blocker, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, α-receptor blocker, β-receptor blocker, calcitriol and lanthanum carbonate (all P<0.05), while the levels of spKt/V, hemoglobin, serum CO 2CP, corrected calcium, blood phosphorus, blood alkaline phosphatase, albumin, total cholesterol, triacylglycerol, low-density lipoprotein, high-density lipoprotein, transferrin saturation, and the proportion of patients on usage of sevelamer and cinacalcet were lower (all P<0.05). Spearman analysis showed significant negative correlation between serum CO 2CP and valve calcification ( rs=-0.697, P<0.001). Multivariate logistic regression analysis showed that dialysis performed twice a week ( OR=2.789, 95% CI 1.232-6.305, P=0.014), blood total cholesterol ( OR=1.449, 95% CI 1.014-2.071, P=0.042), CO 2CP<19 mmol/L ( OR=22.412, 95% CI 10.640-47.210, P<0.001) were the influencing factor of valve calcification in MHD patients. Conclusions:MHD patients with cardiac valve calcification have significant acid loading. Metabolic acidosis is an independent influencing factor for cardiac valve calcification in MHD patients.
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Objective To explore the impact of intermittent androgen deprivation therapy on prostate volume and lower urinary tract symptoms (LUTS) in patients with prostate cancer combined with prostatic hyperplasia (BPH),and to evaluate the clinical effect of intermittent androgen deprivation therapy as compared with conventional drug in patients with BPH.Methods Patients with prostate cancer (n=57) and BPH (n=83) were respectively treated with intermittent androgen deprivation therapy and finasteride combined with alpha-receptor antagonist.Prostate volume,international prostate symptom score (IPSS),quality of life index (QOL) and maximum urinary flow rate (Qmax) in patients were observed before and 1,3,6 and 12 months after treatment.Results The improvements in prostate volume,IPSS,QOL and Qmax were higher in prostate cancer patients treated with intermittent androgen deprivation therapy than in BPH patients treated with finasteride combined with alpha-receptor antagonist (P ＜ 0.05).Conclusions Intermittent androgen deprivation therapy can significantly reduce prostate volume and improve LUTS in patients with prostate cancer,and has a better clinical effect than finasteride combined with alpha-receptor antagonist treatment.
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Objective To investigate the compliance with medical therapy in elderly patients with benign prostatic hyperplasia (BPH).Methods The BPH patients aged 66 to 93 treated with 5α-reductase inhibitor (finasteride) and/or α-blockers (tamsulosin,doxazosin or terazosin) were followed up for 6 months.The retrospective data,including international prostatic symptom score (IPSS),quality of life (QOL),maximum flow rate (Qmax),prostate volume (PV),the information of medical types,total number of days of medication supplied,discontinuation and switching of therapy,and adverse effects were collected and analyzed.Results In all 103 subjects,30 patients (29.1％) received α-blockers,25 patients (24.3％) received finasteride,and 48 patients (46.6％)received combination therapy.After a follow-up of 6 months,the medication possession ratio (MPR)was 0.89±0.23 with a good-compliance rate (MPR≥0.8),discontinuation rate and switching rate were 79.6％ (82 cases),5.8％ (6 cases) and 6.8％ (7 cases),respectively,while the efficacy rate,the adverse reaction rate,incidence of acute urinary retention (AUR) and incidence of BPH related operations were 73.8％ (76 cases),12.6％ (13 cases),15.5％ (16 cases) and 4.9％ (5 cases),separately.The MPR (0.90±0.24) and good-compliance rate (84.0％) in patients treated with finasteride were both greater than those with α-blockers (0.87 ± 0.25,76.7％) and combination therapy (0.89 ±0.22,79.2％),but with no significant difference.Compared with patients with badcompliance,the efficacy ratio of medical therapy was significant higher in patients with goodcompliance (81.7％ vs.42.9％),while the incidence of adverse effects and AUR were significant fewer (7.3％ vs.33.3％ and 9.8％ vs.38.1％).Conclusions Elderly patients received either monotherapy or combination therapy with finasteride and α-blockers have good-compliance,which might be associated with the good effect of medical therapy and fewer adverse effects.