Efficacy of low-dose daytime ambulatory peritoneal dialysis in diabetic end-stage renal disease patients with better residual renal function / 中华肾脏病杂志

Objective To study the efficacy of low-dose daytime ambulatory peritoneal dialysis (DAPD) and low-dose CAPD in diabetic end-stage renal disease (ESRD) patients with better residual renal function (RRF). Methods Forty stable diabetic ESRD patients with better RRF (rGFR ≥ 5 ml/min and urine volume ≥ 750 ml/d) were enrolled. They were randomly divided into two groups: low-dose DAPD group (n=20) and low-dose CAPD group (n=20). DAPD group received three 1.5 L to 2 L daily exchanges with a nocturnal empty belly, dwelling for 3 to 4 hours. CAPD group received three 1.5 L to 2 L daily exchange or four 1.5 L daily exchange regimens and dwelled during the night. At the beginning of the study and 6 months later, total weekly Kt/V and Ccr (peritoneal+renal), rGFR were calculated. Meanwhile 24-hour urinary protein,serum albumin (Alb), hemoglobin (Hb), fasting plasma glucose, glycosylated hemoglobin and insulin dosage were measured. Nutritional status was assessed by SGA. Results Thirty-five patients fulfilled the study. There were no significant differences between two groups in age, gender, BMI,PD time, D/Pcr, etc. At the end of the 6th month, the insulin dose[(33.6±10.9) U/d] and 24-hour dialysate protein [(11.13t4.95) g] in CAPD group were significantly higher as compared to DAPD group [(20.6±6.2) U/d, P＜0.05 and (5.66±2.88) g, P＜0.01 respectively]. Alb in CAPD group [(29.7±4.2) g/L] was significantly lower than that in DAPD group [(36.5 ±3.9) g/L, P＜0.05].While the net ultrafiltration [(554±187) ml vs (309±177) ml], 24-hour urine volume [(1090±361)ml vs (750±258) ml] and rGFR [(8.21±2.40) ml/min vs (4.88±2.11) ml/min] in DAPD group were all significantly higher than those in CAPD group (all P＜0.05). Conclusion For the diabetic ESRD patients with better RRF, the low-dose DAPD regimen is more effective to control plasma glucose, improve nutritional status and protect RRF than the low-dose CAPD.

Gastrodine represses expression of IL-1 beta, IL-6 induced by hyperglycemia in gitter cells / 中国中药杂志

<p><b>OBJECTIVE</b>Inflammatory factors have been known to induce nerve cells apoptosis and decrease learning capacity of diabetics. The aim of this study is to evaluate the inhibitory effect of Gastrodine on the expression of interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) in culturing for gitter cells (BV-2 cells) induced by high concentration of glucose.</p><p><b>METHOD</b>The BV-2 cells incubated in vitro with different concentrations of glucose and gastrodine were divided into five groups: control group (glucose: 25 mmol x L(-1)), high concetration of glucose (glucose: 45 mmol x L(-1) HCG) group and Gastrodine groups (glucose 45 mmol x L(-1) with gastrodine 25 mg x L(-1) (LG), 50 mg x L(-1) (MG), 100 mg x L(-1) (HG). After culturing for 24 h, morphological changes of cells were observed by inverted phase contrast microscope. The supernatant protein of IL-1 beta and IL-6 was detected by ELISA. The mRNA expression of IL-1 beta and IL-6 was assessed by Reverse transcription polymerase chain reaction (RT-PCR).</p><p><b>RESULT</b>The cells were proned to aggregate, some of them with hypertrophy, distinct nucleoli and branch-shaped hyperplasy in HCG group, while less change in Gastrodine groups. The supernatant protein of IL-1 beta is higher in HCG group than control group (119.53 +/- 15.91) ng x L(-1) vs (25.74 +/- 15.72) ng x L(-1) (P < 0.01), but lower in the gastrodine groups than HCG LG (99.32 +/- 19.66) ng x L(-1), MG (76.94 +/- 17.16) ng x L(-1), HG (88.35 +/- 18.72) ng x L(-1) vs (119.53 +/-15.91) ng x L(-1) (P < 0.05). The supernatant protein of IL-6 protein also higher in HCG than control group (393.7 +/- 17.51) ng x L(-1) vs (125.85 +/- 36.62) ng x L(-1) (P < 0.01), and lower in the gastrodine groups than HCG (LG 327.06 +/- 23.53) ng x L(-1), MG (217.36 +/- 28.81) ng x L(-1), HG (263.17 +/- 22.32) ng x L(-1) vs (393.7 +/- 17.51) ng x L(-1), P < 0.05). The mRNA expression of IL-1 beta was increased significantly higher in HCG than control group (2.77 +/- 0.29) vs (1.13 +/- 0.27) (P < 0.05), but decreased significantly in gastrodine groups than HCG LGA (2.66 +/- 0.31), MGA (2.1 +/- 0.41), HGA (2.4 +/- 0.28) vs (2.77 +/- 0.29) (P < 0.05). The mRNA Expression of IL-6 was higher in HCG than control group (3.97 +/- 0.33) vs (1.05 +/- 0.13) (P < 0.05, but lower in gastrodine groups than HCG LG (3.28 +/- 0.3), MG (2.65 +/- 0.33), HG (3.04 +/- 0.26), vs (3.97 +/- 0.33) (P < 0.05).</p><p><b>CONCLUSION</b>Gastrodine can inhibit the expression of IL-1 beta, IL-6 in cultured BV-2 cells induced by high concentration of glucose.</p>

Theoretical evaluation of the use of KT/Vurea and Ccr as indexes of peritoneal dialysis adequacy / 生物医学工程学杂志

Urea clearance index (KT/Vurea) and creatinine clearance weekly (Ccr) are main indexes to evaluate dialysis adequacy. In order to discuss whether they are suitable to evaluate peritoneal dialysis adequacy, we applied trans-peritoneum transport kinetic model and explored the transport characteristics of fluid and various solutes. We found that: (1) There was no specific relationship among the removal of solutes with different molecular weights; (2) There was significant difference between urea removal and fluid and sodium removal. Our results suggest that urea and creatinine removal do not represent other solutes and fluid removal. KT/Vurea and Ccr may thus not suit to be used alone to evaluate peritoneal dialysis adequacy.

Trans-membrane transport kinetic models in peritoneal dialysis / 生物医学工程学杂志

The peritoneum is a biologic semi-permeable membrane. This article presents some kinetic models of fluid and solute trans-peritoneal transport in peritoneal dialysis including the membrane model, the three-pore model, the extended three-pore model and the distributed model. In these models different trans-peritoneal transport mechanisms were revealed. The three-pore model is emphasized.