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1.
Chinese Journal of Nephrology ; (12): 688-696, 2023.
Article in Chinese | WPRIM | ID: wpr-1029224

ABSTRACT

Objective:To explore the association between increasing ultrafiltration rate before a long interdialytic interval and hospitalization risk in maintenance hemodialysis (MHD) patients.Methods:A retrospective study was conducted to collect and analyze the demographic characteristics, disease-related, and laboratory indicators of MHD patients in the hemodialysis center of the Third Affiliated Hospital of Guangzhou Medical University from August to November 2020. The actual ultrafiltration rate higher than the planned ultrafiltration rate was defined as increased ultrafiltration rate. The patients were divided into increased ultrafiltration rate group and control group, and the differences of clinical data between the two groups were compared. The actual ultrafiltration rate >13 ml·kg -1·h -1 was defined as high filtration rate. Multivariate logistic regression analysis was used to assess the association between high ultrafiltration rate, increased ultrafiltration rate in MHD patients and occurrence of hospitalization (all cause, cardiovascular, and heart failure events). The receiver-operating characteristic curve was performed to evaluate the best cut point value of actual ultrafiltration rate and percentage of additional ultrafiltration rate for predicting intradialytic hypotension. Results:A total of 126 MHD patients were included in the study, with age of (57.48±13.81) years old, including 67 males (53.2%) and 59 females (46.8%). There were 69 patients (54.8%) in the increased ultrafiltration rate group, and 57 patients (45.2%) in the control group. During 2-year follow-up period, there were 69 patients (54.8%) of all cause hospitalization, 37 patients (29.4%) of cardiovascular hospitalization, 25 patients (19.8%) of heart failure hospitalization, and 43 patients (34.1%) of intradialytic hypotension. The body mass index ( t=4.343, P<0.001) and actual ultrafiltration rate ( t=4.694, P<0.001) in the increased ultrafiltration rate group were higher than those in the control group. Multivariate logistic regression analysis results showed that high ultrafiltration rate was an independent related factor of cardiovascular hospitalization after adjusting for age, gender and cardiovascular disease ( OR=2.871, 95% CI 1.202-6.854, P=0.018), and increasing ultrafiltration rate was an independent related factor of heart failure hospitalization after adjusting for age and serum albumin in the MHD patients ( OR=0.302, 95% CI 0.112-0.812, P=0.018). When the actual ultrafiltration rate was ≤13 ml·kg -1·h -1, increasing ultrafiltration rate was correlated with the reduced risk of heart failure hospitalization (after adjusting for serum albumin, OR=0.044, 95% CI 0.005-0.360, P=0.004) and cardiovascular hospitalization (after adjusting for age, OR=0.052, 95% CI 0.010-0.259, P<0.001) in the MHD patients. Receiver-operating characteristic curve analysis results showed that the area under the curve of actual ultrafiltration rate for predicting the risk of intradialytic hypotension in MHD patients was 0.734 (95% CI 0.633-0.835, P<0.001) with the best cut point of 13.8 ml·kg -1·h -1, and the sensitivity and specificity of 0.488 and 0.951, respectively. When the actual ultrafiltration rate was ≤13 ml·kg -1·h -1, the area under the curve of percentage of additional ultrafiltration rate for predicting the risk of intradialytic hypotension in MHD patients was 0.746 (95% CI 0.603-0.889, P=0.001), with the best cut point of 26.0%, and the sensitivity and specificity of 0.579 and 0.914, respectively. Conclusions:Increasing ultrafiltration rate before a long interdialytic interval and reduced risk of heart failure and cardiovascular hospitalization in MHD patients with the ultrafiltration rate ≤13 ml·kg -1·h -1 during 2-year follow-up period.

2.
Chinese Journal of Nephrology ; (12): 344-351, 2022.
Article in Chinese | WPRIM | ID: wpr-933866

ABSTRACT

Objective:To investigate the level of endogenous hydrogen sulfide (H 2S) in contrast-induced acute kidney injury (CIAKI), as well as the potential role of H 2S against CIAKI by down-regulating NLRP3 inflammasome. Methods:Twenty-four healthy male Sprague-Dawley rats, weighing 180-220 g, were randomly divided into three groups according to the random number table method: control group, CIAKI group (iopromide 2.9 g/kg) and CIAKI+NaHS group (NaHS 4 mg/kg for three days before 2.9 g/kg iopromide injection). Kidneys were collected for whole-genome sequencing and bioinformatic analysis. HE and PAS staining were used for kidney histological examination. TUNEL assays were applied to detect renal tubular epithelial injury. Expressions of NLRP3 inflammasome (NLRP3, ASC and caspase-1) were evaluated by immunofluorescence staining. The role of H 2S in contrast (iopromide 200 mgI/kg)-induced injury on human renal tubular epithelium (HK-2 cells) was investigated, and CCK-8 assay was used to detect cellular viability. Results:Compared with the control group, the expression of endogenous H 2S synthetases-related genes [cystathionine β-synthase ( CBS), cystathionine-γ-lyase ( CSE) and 3-mercaptopyruvate sulfurtransferase ( 3- MST)] was lower in CIAKI group (all P<0.05). The gene expression levels of CBS, CSE and 3- MST were negatively correlated with renal function biomarkers serum creatinine, blood urea nitrogen and cystatin-C (all P<0.05). Compared with the CIAKI group, CIAKI+NaHS group showed alleviated creatinine, blood urea nitrogen and cystatin-C, improved histological changes, reduced apoptosis. Moreover, the expression levels of NLRP3, ASC and caspase-1 in CIAKI+NaHS group were lower than those in CIAKI group (all P<0.05). In HK-2 cells, compared with the contrast group, the cellular viability was higher in the contrast+NaHS group; reducing endogenous H 2S by CBS inhibitor could enhance contrast-induced cell viability ( P<0.05). Conclusions:Injury of endogenous H 2S system is pivotal to CIAKI pathogenesis. Up-regulation of H 2S ameliorates renal injury of CIAKI rats, which may be related to regulation of NLRP3 inflammasome.

3.
Clinical Medicine of China ; (12): 622-625, 2016.
Article in Chinese | WPRIM | ID: wpr-492631

ABSTRACT

Objective To investigate the changes and clinical significance of platelet parameters and the hemorheological parameters in patients with diabetic kidney disease(DKD). Methods One hundred and eight patients with diabetics were divided into simplicity diabetes mellitus ( SDM ) group with 41 cases, early diabetic nephropathy( EDN) group with 36 cases and clinical diabetic nephropathy( CDN) group with 31 cases according to 24 hours urine albumin excretion rate( UAER) ,and 26 healthy persons were included into this study as control group. The platelet parameters(including mean platelet volume(MPV),platelet volume distribution width(PDW),platelet volume(PCT),and PLT) and hemorrheology were measured in all groups. Results Levels of MPV,PDW,PCT and PLT in diabetics group were (9.80±1.14) fl,(18.00±0.99) fl,(0.21 ±0. 05)% and (186±47)×109/L respectively,in control group were(7. 70±1. 11) fl,(13. 90±1. 02) fl,(0. 16 ±0.05)% and (234±51)×109/L respectively,the differences were significant(P=0.043,0.039,0.040, 0. 035). Levels of MPV,PDW,PCT and PLT in SDM group were (8. 40±1. 07) fl,(16. 40±0. 79) fl,(0. 19 ±0. 04)% and (195±49)×109/L respectively,in EDN group were (10. 20±1. 23) fl,(18. 30±1. 02) fl,(0. 20 ±0. 06) % and (188±52)×109/L respectively,in CDN group were (11. 40±1. 14) fl,(19. 60±1. 21) fl,(0. 25 ±0. 05)% and (172±40)×109/L respectively,the differences were significant between the groups( P=0. 032, 0. 039,0. 041,0. 008). The levels of erythrocyte aggregation index,capillary plasma viscosity,low/medium/high shear viscosity of whole blood, low/medium/high shear reduced viscosity of whole blood and erythrocyte deformation index in diabetics group were 1. 86±0. 13,1. 40±0. 14,(13. 83±1. 62) mPa·s,(7. 79±0. 84) mPa·s,(6. 46±0. 77) mPa·s,7. 54±1. 03,4. 73±0. 74,4. 16±0. 69 and 0. 55±0. 03 respectively,in control group were 1. 38±0. 05,1. 21±0. 08,(9. 35±1. 22) mPa·s,(5. 88±0. 87) mPa·s,(5. 02±0. 86) mPa·s, 4. 00 ±0. 75,3. 12±0. 65,2. 76±0. 56 and 0. 68±0. 06 respectively,the differences were significant between the two groups( P=0. 034,0. 020,0. 018,0. 044,0. 016,0. 014) . Furthermore,the results of erythrocyte aggregation index, capillary plasma viscosity, low /medium/high shear viscosity of whole blood, low/medium/high shear reduced viscosity of whole blood and erythrocyte deformation index were significantly different in sub group of diabetes( P=0. 004,0. 002,0. 001,0. 004,0. 003,0. 041,0. 025,0. 009,0. 042) . Conclusion It is important to measure the platelet parameters and hemorrheology in diabetes kidney disease patients. The platelet parameters and hemorrheology may be the early indicators to diagnosis the diabetic nephropathy.

4.
Clinical Medicine of China ; (12): 346-350, 2016.
Article in Chinese | WPRIM | ID: wpr-494170

ABSTRACT

Objective To study the association of carotid atherosclerosis with high-sensitivity creative protein(hs-CRP),lipoprotein-a(Lp-a) and superoxide dismutase(SOD) in patients with chronic renal failure (CRF).Methods Seventy-one CRF patients were divided into Group A of 45 patients under maintenance hemodialysis and Group B of 26 patients without hemodialysis,and 20 healthy donor was Group C in this study.And 71 CRF patients were divided into carotid atherosclerosis group (43 cases) and non carotid atherpsclerosis group(28 cases) according to whether the carotid atherosclerosis plaque was detected out.Fortythree CRF patients presented carotid atherosclerosis including 17 patients with soft plaque,10 patients with hard plaque and the other 16 with mixed plaque.Color ultra-sound was used to measure the carotid intimal medial thickness(IMT) and define the type of plaque.Levels of hs-CRP,Lp (a) and SOD were detected and analyzed in this study.Results (1) Levels of hs-CRP,Lp-a,SOD and IMT were significantly different in group A ((7.39±2.25) ag/L,(428.43±102.25) mmol/L,(71.35±21.52) KU/L and (1.23±0.31) mm,respectively),group B((7.41±1.67) mg/L,(432.12±96.43) mmol/L,(68.14±15.25) KU/L and (1.18±0.26) mm,respectively),and group C ((2.11 ± 0.86) mg/L,(193.32 ± 62.31) mmol/L,(94.23 ± 21.13)KU/L and (0.61 ±0.22) mm,respectively),the differences were significant (F =2.998,2.783,2.032,2.802;P<0.05).Plaque incidence was increased in group A(68.9%) and group B(69.2%) compared with group C (12.5%) with statistical significance (x2=17.863,17.989;P<0.001).(2) Furthermore,for CRF patients,hsCRP and Lp-a were positively related to IMT in group A (r =O.436,0.279;P<0.05) and group B (r =0.652,0322;P < 0.05),SOD presenting negative relationship with IMT (r =-0.283,P < 0.01 for group A,and r =-0.164,P<0.05 for group B).(3) Level of hs-CRP and Lp-a in carotid atherosclerosis group were higher than those in non carotid atherosclerosis group((7.58±2.47) mg/L vs.(3.41±1.26) mg/L,(437.31±115.38) mmol/L vs.(256.24± 101.22) mmol/L),the differences were significant (t =2.917,2.583;P <0.05).Level of SOD in carotid atherosclerosis group was lower than that in non carotid atherosclerosis group ((68.43±13.36) KU/L vs.(76.22±17.12) KU/L),the difference was signifiant(t=2.156,P<0.05).(4)Level of hs-CRP and SOD in patients with soft plaque and mixed plaque were statistically different from those in patients with hard plaque(F=4.210,2.056;P<0.05).Conclusion The micro-inflammatory status,oxidative stress and disturbance of Lp-a metabolism are extensively existed in CRF patients and closely connect to each other.Therefore,they might correlate with the formation of plaques in carotidartery.

5.
Chinese Journal of Geriatrics ; (12): 495-497, 2012.
Article in Chinese | WPRIM | ID: wpr-426465

ABSTRACT

Objective To study the clinical significances of serum lipoprotein (LP),high sensitivity C- reactive protein (hs CRP),cystatin (Cys-C),apolipoprotein (Apo) in type 2 diabetic mellitus (T2DM) patients with early renal impairment.Methods Totally 96 patients were divided into two groups:50 cases in simple diabetic group (DM) aged 60-73 years,46 cases in diabetic nephropathy group (DN) aged 61-72 years,and 50 healthy persons as normal control group aged 61-68 years.Serum levels of LP(a),hs-CRP,Cys-C,ApoA1 and ApoB were detected.Results Serum levels of LP (a) [(214.8±182.3) mg/L vs.(113.1±76.2) mg/L],Cys-C[(0.95±0.16)mg/L vs.(0.46±0.17) mg/L],hs-CRP (2.57± 1.84) mg/L vs.(1.07±0.38)mg/L] and ApoB [(1.12±0.18) g/L vs.(0.81 ±0.15) g/L ]were higher in T2DM patients than in normal control group(all P<0.01),while ApoA1 level was lower than in control[(1.02±0.17)g/L vs.(1.27±0.14)g/L,P< 0.01].The levels of LP (a) (455.6 ± 263.5 ) mg/L,Cys-C (2.14 ± 0.68 ) mg/L,hs-CRP (7.24±4.55)mg/L and ApoB(1.22±0.17)g/L in DN group were increased compared with DM group (all P<0.01).Serum levels of ApoA1 were decreased in DN group compared with DM group [(0.88±0.17) g/L vs.(1.02±0.17) g/L,P<0.01].The serum levels of LP (a) (r=0.487,P<0.05),Cys-C(r=0.55,P<0.05),hs-CRP(r=0.478,P<0.01) and ApoB(r=0.505,P<0.05) were positively correlated with urinary mAlb in T2DM patients,while ApoA1 was negtively related with mAIb(r=-0.52,P<0.05).Conclusions The serum LP (a),Cys C,Apo and hsCRP could be sensitive markers of early renal impairment,and their combinatorial measurement offers more value in patients with T2DM.

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