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Heart failure (HF) is the end stage of a variety of heart diseases,with poor clinical outcome, high mortality, and an increasing incidence year by year. It is one of the most important cardiovascular diseases. Almost half of patients with heart failure have normal ejection fraction (EF),which we call heart failure with preserved ejection fraction ( HFpEF) . The incidence of HFpEF in developed countries continues to rise, which is considered to be a common danger factor,including the elder,female,and patients with hypertension, metabolic syndrome,renal dysfunction and obesity. A large number of clinical studies from home and abroad show that chronic kidney disease (CKD) will aggravate or promote the occurrence and development of HFpEF through the reaction of microvascular and vascular inflammation,nerve system activity,cardiac structure change,calcium and phosphorus metabolism disorder and so on,and the glomerular filtration rate ( eGFR) and proteinuria are closely related to the prognosis of HFpEF in CKD. To clarify the influence of CKD on HFpEF and its related mechanisms,it is of certain value to assess the condition of HFpEF and to further treat it.
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Hypophosphatemic rickets is a disorder of renal tublular reabsorption of phosphorus,which resulting in bone dysplasia.It is characterized by hypophosphatemia,rickets and limb deformity.Hypophosphatemic rickets may be mainly due to congenital / genetic or secondary to the tumor and other renal tubular disease.Phosphorus is an important element in cell metabolism.Extracellular phosphorus ions maintain the phosphorus concentration at a low level by dietary absorption,kidney regulation and various phosphorus-regulating factors.With the development of molecular biological technologies,forms of renal phosphate wasting diseases have been identified in past years,and FGF23 plays an important role in the disease mechanism.This review aims to overview the studies of the treatment and physiopathology of hypophosphatemic rickets and to enhance the recognition of hypophosphatemic rickets.
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Objective To investigate the effect of α-keto acid combined with low protein diet on kidney function, calcium-phosphorus metabolism and adenosine deaminase activity in malnourished patients with long term peritoneal dialysis.Methods Forty-six cases malnourished patients with long term peritoneal dialysis were selected from May 2013 to August 2014 in the hospital and divided into two groups.The control group (n=23) were treated by conventional therapy, acceptable daily intake of protein 1.2 g/(kg? d).The experiment group (n=23) were treated by α-keto acid combined with low protein diet, acceptable daily intake of protein 0.8 g/(kg? d).Two groups were treated for three months.Serum calcium, phosphorus, nutritional status assessment, adenosine deaminase activity and renal function were observed and compared after treatment.ResuIts After twelve months ’ treatment, compared with control group, serum creatinine, blood urea nitrogen, serum uric acid of experiment group were lower ( P0.05).ConcIusion α-keto acid combined with low protein diet could effectively increase serum calcium level, reduce serum phosphorus level, ADA activity and WBC count, and improve nutritional status in long-term peritoneal dialysis patients, which has important significance.
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Objective To explore the blood pressure variability (BPV) in pediatric patients undergoing maintenance hemodialysis (MHD) and to assess the factors associated with pre-dialysis BPV (pre-HD BPV).Methods The pediatric patients who undergone regular dialysis for more than twelve months from Oct 2005 to Oct 2011 in hemo dialysis center of Guizhou Provincial People's Hospital were divided into high pre-HD BPV group and low pre-HD BPV group.Baseline characteristics,biochemical indexes and cardiac function parameters measured by echocardiography were collected in both groups and multiple linear regression analysis was performed.Results Pediatric patients in high pre-HD BPV group demonstrated significantly higher inter-dialytic weight growth rate (IDWG),pre-dialysis systolic blood pressure and average amount of dehydration than those in low pre-HD BPV group (P ＜ 0.05),while significantly lower hemoglobin and albumin levels than those in low pre-HD BPV group (P ＜ 0.05).Comparison among laboratory indicators,serum phosphorus and parathyroid hormone demonstrated significant difference between groups (P ＜ 0.05).For all pediatric patients,pre-HD BPV was positively correlated with IDWG (β=0.165),pre-dialysis systolicblood pressure (β=0.259),and iPTH (β=0.187),while negatively correlated with hemoglobin level (β=-0.199).Conclusions Increasing IDWG,higher pre-dialysis systolic blood pressure,anemia and secondary hyperparathyroidism influence BPV in pediatric patients on MHD.
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Objective To analyze the disorder status of calcium-phosphorus metablism in maintenance hemodialysis patients. Methods Serum calcium, serum phosphorus, calcium-phosphorus product and PTH were detected in 70 patients with maintenance hemodialysis ,and compared with the indicators of K/DOQI guidelines. Results There were 36 cases over 50 years age and 34 cases less than 50 years age in 70 cases, and there were no significant differences in serum calcium, serum phosphorus, calcium-phosphorus product and PTH between two groups (P ＞0.05). The longer the dialysis, the more obvious changes of serum phosphorus and PTH levels, and there were significant differences(P ＜0.05). In 70 cases ,46 cases(65. 7%) serum calcium,34 cases(48.6%) serum phosphorus ,40 cases(57. 1%) calcium and phosphorus product,28 cases(40%) PTH met the requirement of K/DOQI guidelines,only 18 cases (25.7%) of all indicators reached the K/DOQI requirements. Conclusion The calcium-phosphorus metablism in most hemodialytic patients still cannot reach the K/DOQI guidelines.