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Dietary fiber is an essential nutrient for human health,known as the seventh nutrient after carbohydrate,fat,protein,vitamins,water and minerals.Recent studies have shown that dietaty fiber intake can delay progress of chronic kidney disease.This review focuses on the definition and classification of dietary fiber and its preventive and therapeutic effect in chronic kidney disease.
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Objective To measure the renal cortex blood flow leVel in Patients with stage 3-4 chronic kidney disease, and to obserVe the effect of Probucol on renal cortex blood flow and renal function. Methods Twenty Patients with stage 3-4 chronic kidney disease in our hosPital were randomly diVided into treatment grouP ( 10 Patients ) and obserVation grouP ( 10 Patients). Ten healthy subjects were chosen as the control grouP. Dynamic sonograPhic tissue Perfusion measurement (DTPM) was used to eValuate the mean flow intensity (Imix),mean flow Velocity (Vmix) and tissue resistance index (TRI) in the three grouPs. Patients in the obserVation grouP were treated with standard theraPy;the treatment grouP was giVen Probucol 500 mg,twice daily in addition to standard theraPy for 6 months. The renal cortex blood flow leVel after treatment was measured in the treatment grouP and obserVation grouP. The serum BUN,SCr,TC,TG,LDL,HDL,hs_CRP,ox_LDL,PA,ALB before and after treatment were measured and comPared between the treatment grouP and obserVation grouP. Results Imix and Vmix were significantly lower,and TRI was significantly higher in the treatment grouP and obserVation grouP than in the control grouP (P<0. 01). After 6 months of treatment,Imix and Vmix in the treatment grouP were significantly increased and TRI significantly decreased as comPared with the baseline and the control grouP (P<0. 01). After treatment,Imix and Vmix were significantly decreased and TRI was significantly increased in the obserVation grouP (P<0. 05). In the treatment grouP,the serum BUN,SCr,TC,TG,LDL,hs_CRP and ox_LDL decreased and PA,ALB and HDL increased after treatment as comPared with the baseline and the obserVation grouP (P<0. 05 or P<0. 01). Conclusion The renal cortex blood flow leVel is significantly lower in Patients with stage 3-4 chronic kidney disease than in the healthy PeoPle. Probucol can imProVe the renal cortex blood flow leVel significantly,Protect the renal function, and imProVe microinflammatory state,nutrition status and dysliPidemia.
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Objective To investigate clinical characteristics and risk factors in elderly patients with type 2 diabetes mellitus (T2DM) complicated with chronic kidney disease (CKD).Methods Two hundred and two T2DM patients aged ≥60 y admitted in Tongren Hospital from August 2009 to February 2012 were enrolled in the study,including 64 cases complicated with CKD (CKD group)and 138 cases without CKD (non-CKD group).Hemoglobin (Hgb),albumin (ALB),glycated hemoglobin A1C (HbA1 c),fasting plasma glucose(FBG),postprandial glucose (PBG),serum creatinine (Scr),blood urea nitrogen (BUN),uric acid (UA),total cholesterol (TC),triglyceride (TG),high densitylipoprotein (HDL-C),low density lipoprotein (LDL-C) were measured and ratio of urinary albumin to creatinine (UAER/CR) were calculated,ankle brachial index (ABI) and ambulatory blood pressure was examined.Results The duration of diabetes in CKD group was longer than that in non-CKD group [(13 ± 11) vs.(10 ± 7) y,t =2.35,P ＜ 0.05].Hgb and ALB in CKD group were lower than those in non-CKD group [(12.1 ± 1.7) vs.(13.3 ±1.3) g/L,(34.4±2.6) vs.(36.8 ±3.4) g/L,t=-5.73,-4.75,allP＜0.01]; UA,TG,24 h systolic blood pressure (SBP),24 h pulse pressure (PP)in CKD group were higher than those in non-CKD group [(367 ± 81) vs.(323 ± 74) μmol/L,(1.6 ± 0.9) vs.(1.3 ± 0.7) mmol/L,(133 ± 14) vs.(127±16)mmHg,(65 ±12) vs.(58 ±12)mmHg,t =3.82,2.50,2.47,3.68,all P＜0.1].The UAER/CR in CKD group and non-CKD group was 86.2 mg/g (24.6-374.8 mg/g) and 6.0 mg/g (3.6-17.8 mg/g),respectively (P ＜ 0.01) and ABI in CKD group and non-CKD group was 0.94 ± 0.18 and 1.03 ±0.18 (-2.78,P ＜0.05).There were no significant differences in FBG,PBG,HbA1c,TC,HDL-C andLDL-C between two groups(t =-2.02,1.47,1.48,-0.53,-1.20,-0.76,all P＞0.05).Logistic regression analysis showed that ALB,TG and UAER/CR were the independent risk factors of CKD in T2DM patients(OR:0.79,3.63 and 1.04,95％ CI:0.62-1.01,1.45-9.01 and 1.00-1.08).Spearman correlation analysis demonstrated that eGFR was positively associated with Hgb,ALB,ABI (r =0.38,0.33 and 0.28,all P ＜ 0.01),negatively associated with age,BUN,Cr,UA,TG,UAER/CR,24 hSBP and PP in all diabetes patients(r =-0.32,-0.63,-0.89,-0.34,-0.18,-0.65,-0.16 and -0.248,all P ＜0.01).Conclusions ALB,TG,UAER/CR are the independent risk factors of chronic kidney disease in elderly patients with type 2 diabetes mellitus.
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Objective To explore the predicting value of plasma asymmetric dimethylarginine (ADMA) in cardiac structure and function of patients with chronic kidney diseases (CKD).Methods A total of 100 CKD patients were enrolled in this cross-sectional study.According to staging of the K-DOQI guideline,CKD patients were divided into five groups.Twenty healthy people were enrolled as control.Plasma level of ADMA was determined by reversed-phase high performance liquid chromatography.Cardiac structure and function were detected by color echocardiography.Results Plasma levels (μmol/L) of ADMA in CKD stage 3 to 5 patients (1.3318±0.4684,1.5712±0.4210,2.1093±0.7714) were significantly higher than those in CKD stage 1,2 patients (0.4387±0.2575,0.4809±0.2846) and healthy control (0.4611±0.1615) (all P＜ 0.01).Meanwhile,ADMA level of CKD stage 5 was significantly higher as compared to CKD stage 3-4.The left ventricular mass index (LVMI) was significantly higher in stage 4-5 patients than that in stage 1-3 and healthy control.Plasma ADMA was positively correlated with LVMI (r=0.476,P=0.028) and negatively correlated with left ventricular ejection fraction (EF) (r=-0.327,P=0.041).Multivariate stepwise Logistic regression analysis revealed plasma ADMA level was an independent predictors for EF (OR=0.984,P＜0.01).Conclusions Plasma level of ADMA begins to increase in CKD patients of stage 3 and rises proportionally to the decline of renal function.Plasma ADMA level is useful in predicting the cardiovascular complications of CKD patients.
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Objective Todeterminethecorrelationbetweenthrombomodulinand atherosclerosis in chronic kidney diseases (CKD) patients.Methods A total of 96 CKD patients in our hospital were enrolled in the study, including 32 maintenance hemodialysis(MHD) patients and 64 non-hemodialysis CKD patients with stage 2 to 5(non-HD) and 30 age- and gendermatched healthy volunteers were used as control.Intima-media thickness(IMT) and atherosclerotic plaquesof theextracranialcommoncarotidarteryweredetectedbyhigh-resolutionB-mode ultrasonography. Bloodlevelof thrombomodulinwasmeasuredusingELISA,andcreatinine,triglycerides, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol were measured routinely as well.Correlation analysis of thrombomodulin with other parameters was performed.Results The thrombomodulin level was significantly higher in CKD patients as compared to healthy controls[(12.15±3.04) mg/L vs(3.12±0.23) mg/L, P＜0.05], and also significantly higher in MHD patients as compared to non-HD patients [(16.89±3.35) mg/L vs (9.78±2.49) mg/L, P＜0.05].The atherosclerotic plaques incidence and IMT value of carotid artery increased significantly in CKD patients compared with healthy volunteers.Thrombomodulin was positively correlated with IMT in CKD patients(r=0.335, P＜0.01).Multiple stepwise regression analysis showed that thrombomodulin, Tm (OR=1.13, 95％CI 1.010-1.121), SBP (OR=1.09, 95％GI 1.009-1.114), CRP(OR=1.22, 95％CI 1.216-2.007), and Scr were independent risk factors of IMT.ConclusionThrombomodulin is correlated with carotid atherosclerosis in CKD patients and may be used as a marker to evaluate the endothelial damage.
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Objective To investigate the incidence and clinicopathological characteristics of acute-on-chronic renal failure (A/C) . Methods Clinical data from all patients diagnosed as A/C by clinical materials and renal biopsy for a 12-year period (Jan, 1990 to Dec, 2001) were collected, and the cause of acute renal failure (ARF), relationship between cause and underlying renal diseases and factors affecting prognosis were analyzed. Results One hundred and four A/C patients accounted for 35. 5% of biopsied ARF cases during the same period. Acute interstitial Aubulointerstitial disease, increased activity of lupus nephritis (LN) and idiopathic ARF in nephrotic syndrome (NS) were the most common causes of ARF in A/C. And 39 A/C cases (35.6% ) were drug-related. Offending drugs were mostly antibiotics, non-steroid anti- inflammatory drugs or combination of them. Idiopathic ARF was commonly seen in minimal change diseases with ARF. Flare-up of underlying diseases was mostly occurred in LN patients. The causes of 9 malignant hypertension cases were IgA nephropathy, sclerotic nephritis and so on. The mortality of this group was 1. 9% (2 cases): one patient died of multiple organ failure resulted from basal disease; the other suffered from sudden death of unknown reason. Thirty-nine cases needed renal replacement therapy, and after 28. 5 days' treatment on the average, 23 of them did not need dialysis any more. Serum creatinine (Scr) returned to normal level in 48 patients (46. 2% ) when discharged. Twenty-one cases had been diagnosed before consulting to our department. Among them, 15 cases (71. 4% ) were diagnosed as "chronic renal failure . Multivariate Logistic regressive analysis showed that hypertension, dialysis therapy and high Scr level indicated poor renal prognosis. Conclusions A/C is an common part of ARF. Being aware of adverse effects of drugs (especially for elders), decreasing the activity of connective tissue diseases, controlling the blood pressure and keeping proper circulating volume are very important for patients with chronic renal diseases. After reasonable therapy, most patients' renal function can be improved. Early correct diagnosis and treatment are important.