ABSTRACT
<p><b>BACKGROUND</b>Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death.</p><p><b>METHODS</b>Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients' data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality.</p><p><b>RESULTS</b>In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094-1.886), age (OR: 1.046, 95% CI: 1.036-1.057), and presence of DN (OR: 1.837, 95% CI: 1.322-2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346-0.989), hemoglobin (OR: 0.974, 95% CI: 0.967-0.981), albumin (OR: 0.939, 95% CI: 0.915-0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070-0.386) were protective factors based on a multivariate analysis.</p><p><b>CONCLUSIONS</b>Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , China , Multivariate Analysis , Renal Dialysis , Mortality , Retrospective Studies , Risk FactorsABSTRACT
Objective To investigate whether apoptosis of renal tubular epithelial cells induced by endoplasmic reticulum stress (ERS) takes a role in the traumatic rhabdomyolysis-induced acute kidney injury (AKI). Methods The model of rhabdomyolysis-induced AKI was reproduced by intramuscular injection of hypertonic glycerol into the hind limbs in male Wistar rats. There were 11 animal groups (each n=3) including control, 1h, 3h, 6h, 12h, 24h, 48h, 72h, 96h, 120h and 168h groups. Serum and renal tissue were collected at various time points. Parameters of renal function and renal pathology were used to evaluate renal injury at various time points. The renal tubular epithelial cell apoptosis was revealed by TUNEL staining at each time point. The expressions of factors, caspase-8, cytochrome C and caspase-9 activity fragments, involved in apoptosis as induced by Fas ligand/ receptor interaction and mitochondria were determined by Western blotting at each time point. Furthermore, the expressions of endoplasmic reticulum chaperone protein GRP78 and apoptosis factor caspase-12 activity fragment were also assayed by Western blotting. Results Pathological changes of tubular epithelial cells were detected at 1h, presenting a large area of necrosis at 24h, with the highest number of apoptotic renal tubular epithelial cells. Tubular-interstitial injury reached the peak at 72h. The expression of apoptotic factors (caspase-8, cytochrome C and caspase-9) was elevated reaching the peak at 12h. The change in endoplasmic reticulum stress protein expressions of GRP-78 showed a similar trend as that of caspase-12 (increased at 1h, and reached the peak at 12h). Conclusions Apoptosis of renal tubular epithelial cell is the main pathogenesis of rhabdomyolysis-induced renal injury. In addition to the activation of the death-receptor and the mitochondrial death pathway, endoplasmic reticulum stress also plays an important role in this process.
ABSTRACT
<p><b>BACKGROUND</b>Sustained hypotension during hemodialysis (HD) is an important clinical issue. Plasma adrenomedullin (AM) is increased in HD patients with sustained hypotension, but little is known about whether removing AM can improve hypotension. The objective of this study was to investigate the beneficial effects of hemodialysis using a high-flux dialyzer on removal of increased plasma AM levels and improving low blood pressure in elderly HD patients with sustained hypotension.</p><p><b>METHODS</b>Forty-eight elderly patients (age 65 or older) who had undergone maintenance HD for more than one year were recruited and studied. We evaluated plasma levels of AM in sustained hypotension (SH; n = 28) and normotensive (NT; n = 20) patients. The patients with hypotension were further divided into two subgroups and treated with either high-flux dialyzer or low-flux dialyzer for 3 months. Plasma adrenomedullin levels and blood pressure were analyzed at days 0 and 181.</p><p><b>RESULTS</b>Plasma levels of AM were significantly higher in SH than in NT patients ((24.92 ± 3.7) ng/L vs. (15.52 ± 6.01) ng/L, P < 0.05), and were inversely correlated with mean arterial blood pressure (MAP) at pre-HD. After 3 months, the level of plasma AM in high-flux group was decreased ((24.58 ± 4.36) ng/L vs. (16.18 ± 5.08) ng/L, P < 0.05), but MAP was increased ((67.37 ± 4.31) mmHg vs. (74.79 ± 3.59) mmHg, P < 0.05). There was no obvious change in low-flux group.</p><p><b>CONCLUSIONS</b>Plasma AM levels were significantly elevated in elderly HD patients with SH. High-flux dialyzer therapy can decrease plasma AM level and improve hypotension.</p>