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Objective:To explore the relationship between end-dialysis over-weight (edOW) in initial stage of hemodialysis and long-term prognosis in maintenance hemodialysis patients.Methods:The data of initial uremia patients receiving hemodialysis in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017 were retrospectively analyzed. The end point of follow-up was death or until April 30, 2018. The general data including age, gender, body mass index, primary disease, complications and laboratory indicators of the patients and the related parameters of dialysis from four to twelve months were collected. Kaplan-Meier method was used to analyze survival rate. Cox multivariate regression was used to analyze the relationship between edOW and all-cause mortality and cardiovascular disease (CVD) mortality.Results:A total of 469 patients (300 males, 64.0%) were enrolled, with age of (56.9±17.1)years old. During the follow-up period of (4.1±2.4) years (1.0-10.3 years), 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.1% (45/102). The value of edOW was (0.28±0.02) kg. The patients were divided into edOW<0.28 kg group ( n=292) and edOW≥0.28 kg group ( n=177) according to the mean value of edOW. Kaplan-Meier survival analysis showed that the long-term survival rate in edOW<0.28 kg group was higher than that in edOW≥0.28 kg group (Log-rank χ2=4.134, P=0.043), and the CVD mortality in edOW≥0.28 kg group was significantly higher than that in edOW<0.28 kg group (Log-rank χ2=11.136, P=0.001). Cox multivariate regression analysis showed that high edOW was an independent influencing factor for all-cause death and CVD death in hemodialysis patients ( HR=1.541, 95% CI 1.057-2.249, P=0.025; HR=1.930, 95% CI 1.198-3.107, P=0.007). Conclusion:High edOW in early phase is an independent influencing factor of all-cause and CVD death in hemodialysis patients.
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Objective:To retrospectively analyze the early mortality and related risk factors in adult patients with maintenance hemodialysis (MHD).Methods:Adult MHD patients from 2008 to 2018 were enrolled and divided into training data group and validation data group. In training data group, multivariate logistic regression was used to analyze the risk factors of early death within 120 days after hemodialysis and establish a prediction model. The receiver operating characteristic (ROC) curve was applied to evaluate the prediction ability of the model.Results:A total of 4 885 patients were included. The cumulative mortality within 120 days was 20.97/100 person years, and that within 365 days was 12.25/100 person years. A total of 3 603 patients in the training data group were analyzed. The following risk factors were correlated with early mortality (all P<0.05), including age at start of dialysis over 60 years old ( OR=1.792), non-chronic glomerulonephritis ( OR=2.214), cardio-cerebrovascular disease ( OR=2.695), plasma albumin less than 35 g/L ( OR=1.358), platelet count less than 120×10 9/L ( OR=2.194), serum creatinine less than 600 μmol/L ( OR=1.652), blood urea nitrogen over 30 mmol/L ( OR=1.887), blood phosphorus less than 1.13 mmol/L ( OR=1.783), pulse pressure over 55 mmHg(1 mmHg=0.133 kPa) ( OR=1.656), low density lipoprotein less than 1.5 mmol/L ( OR=1.873), and blood calcium over 2.5 mmol/L ( OR=1.876). Risk prediction model was established. The other 1 282 cases in the validation data group were verified. The area under ROC curve was 0.810, with sensitivity 85.7%, and specificity 62.5%. Conclusion:The mortality rate of adult MHD patients within 120 days after dialysis is high. The established prediction model can effectively predict the risk of early death.
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Objective To analyze and summarize the cases of pregnancy on maintenance hemodialysis (MHD),and review the literature.Methods Seven cases of pregnancy and childbirth in patients on MHD in the First Affiliated Hospital of Zhejiang University from Jan 2009 to Dec 2017 were analyzed,and the literature about pregnancy in patients on MHD reported in Pubmed and Web of Science database was retrieved.Both maternal and fetal outcome were studied.Results There are seven pregnant MHD patients in this center,among whom six patients went through a smooth pregnancy and one patient had intra-uterine fetal death at 14 weeks of pregnancy.The six patients had preterm labor.Among six fetuses,four grew in good health and developed well,one had physical development retardation and one had heart malformation at born.In the literature,169 cases reported pregnant patients and 182 fetuses were evaluated,of which 145 live infants were delivered,79.67％ overall fetal survival rate,with gestational age of (32.94±3.34) weeks.In 164 delivered fetuses,147 were preterm labor (89.63％).The weight of live births was (1824±609) g.There were no maternal deaths.Fetal survival rate was zero in ＜ 20 weeks of gestational age,20-24 weeks was 14.29％,25-27 weeks was 45.45％,≥28 weeks was 94.44％.The fetal survival rate was higher in pregnant woman receiving hemodialysis≥28 hours weekly compared to women receiving ＜ 16 hours weekly (92.31％ vs 52.94％,P=0.02).Conclusions There are still a very high matemal and fetal complication rate in hemodialysis patients,especially in fetus.Gestational age≥28 weeks has a high fetal survival rate.Intensive dialysis during pregnancy may benefit higher fetal survival rate.
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Objective To explore the effect of total parathyroidectomy (PTX) with forearm autograft on the anemia and cardiac function in uremic patients with secondary hyperparathyroidism (SHPT).Methods The clinical data of 130 uremic patients who received PTX with forearm autograft in the First Affiliated Hospital of Zhejiang University from October 2010 to December 2015 were retrospectively analyzed.The changes of anemia and echocardiogram before and after operation were compared.According to the presence of left ventricular hypertrophy (LVH) before operation,the patients were divided into LVH group and non-LVH group.Echocardiographic indexes before and one year after operation of the two groups were compared.Results (1) Three months and one year after operation,hemoglobin and hematocrit increased while erythropoietin average usage decreased significantly (P＜0.01).(2) Compared with preoperative period,the dry weight was significantly increased one year after operation,and the cardiac function indexes including left ventricular end diastolic diameter (LVDd),interventricular septum end diastolic thickness (IVSd),left ventricular posterior wall end diastolic thickness (LVPWd),interventricular septum systolic thickness (IVSs),left ventricular systolic diameter (LVDs),left ventricular myocardial mass (LVM),and left ventricular myocardial mass index (LVMI) decreased significantly (P ＜ 0.05).(3) In the non-LVH group,only IVSs decreased one year after operation (P ＜ 0.05).In the LVH group,LVDs,LVDd,LVPWd,LVM,LVMI and IVSs were decreased significantly one year after operation than those in preoperative period (P ＜ 0.05).Conclusions PTX with forearm autograft is an effective treatment for uremic patients with SHPT significantly improving anemia and left ventricular structure and function,especially for patients with ventricular hypertrophy in preoperative.
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Objective To evaluate the prophylactic efficacy of compound sulfamethoxazole (SMZco)combined with ganciclovir on severe pulmonary infection in the early stage of renal transplantation. Methods Between January 2005 and January 2006,two hundred and forty renal allograft patients in our hospital were enrolled in this study.All the patients were divided into two groups.Group A(n=84)received oral SMZco combined with intravenous ganciclovir.Group B(n=156)received intravenous ganciclovir only as control.According to the time of SMZco administration,group A was divided into two subgroups:group A1(within 2weeks after transplantation,n=43)and group A2(more than 2 weeks after transplantation,n=41).All the patients were followed up for 9 months.Incidence of pulmonary infection and effects on graft function by SMZco at different time point were investigated. Results The incidence of severe pulmonary infection and mortality of infection were significantly lower in group A than those in group B (2/84 vs 16/156,P=0.027;0/2 vs 2/16,P＜0.01).There were no significant differences between two groups in terms of age,gender,warm or cold ischemia,complement dependent cytotoxieity test results,incidence of urinary infection and Scr.The incidence of elevatedScr was significantly lower in group A2 than that in group A1(15/43 vs 2/41,P＜0.01),however,all the elevated Scr returned to basal level within 1 week after SMZco was discontinued.Conclusions Oral SMZco combined with ganciclovir administration after renal transplantation is effective on preventing severe pulmonary infection and thus improves graft and recipient survival.The administration of oral SMZco initiated more than 2 weeks after transplantation is better for graft function.
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Objective To investigate the effect of intracerebroventricular injection of morphine and orphanin FQ (OFQ) on somatosensory evoked potential (SEP) and Na+-K+ATPase activity in cerebral cortex of rat. MethodsTo study the SEP with the BL-420 biological signal collecting system. The cerebral cortex tissues were extracted, homogenized and centrifuged. Na+-K+ATPase activity was measured with ATPase analytical kit. Results After intracerebroventricular injection with OFQ 0.9 ?g, the amplitude of P1-N1 and N1-P2 increased significantly(P
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Objective To investigate the occurrence,types and therapeutic effect of malignancies in renal allograft recipients. Methods A retrospective study of 1200 renal allograft transplantations in 1189 patients performed between July 1977 and September 2001 was carried out. Results After transplantation among the 1189 recipients,19 cases (an incidence rate of 1.6%) were diagnosed with malignancies,including hepatocarcinoma in 4 cases,breast cancer in 3,Kaposi sarcoma in 2,lung cancer in 2,and squamous carcinoma of bladder,non-Hodgkin lymphoma,stomach carcinoma,carcinoma of head of pancreas,carcinoma of gingival,colon carcinoma,gallbladder carcinoma each in 1,and 1 intensive metastasis case without concerned source.The mean postoperative duration of immunosuppressive treatment before the diagnosis of malignancies was (36.7?24.2)months (range,2 to 112 months).Surgical operations were performed in 12 cases,all of whom survived with normal renal function.A mean follow-up of 15.4 months (range,1 to 73 months) showed that no recurrent malignancy developed and no rejection of transplanted kidneys occurred.Five of the 7 cases who had malignancies at advanced stage and lost surgical treatment opportunity died within 1 year after the diagnosis. Conclusions The incidence of malignancy in renal allograft recipients is much higher than normal population,closely related to the long term use of immunosuppressants.Radical surgery of the malignancies is preferred option and use of immunosuppressants can be reduced or discontinued;meanwhile the function of the transplanted kidney should be maintained as much as possible.