Consistency between multifrequency bioelectrical impedance analysis and dual-energy x-ray absorptiometry for muscle mass assessment in elderly patients with advanced chronic kidney disease / 中华老年医学杂志

Objective:To compare the consistency between bioelectrical impedance analysis(BIA)and dual-energy X-ray absorptiometry(DXA)in skeletal muscle mass assessment in elderly patients with advanced chronic kidney disease(CKD), and to provide a basis for accurate clinical diagnosis of sarcopenia.Methods:Elderly patients with advanced CKD at the Department of Nephrology of Shanghai Sixth People's Hospital were included.Parameters for physical performance included handgrip strength and gait speed, and body muscle mass was measured by DXA and multifrequency BIA.The consistency between the two methods was assessed by the intraclass correlation coefficient, Bland-Altman analysis and kappa coefficient test.Results:This study included 67 elderly patients with advanced CKD with a mean age of(70.7±6.1)years and an average BMI of(24.6±3.5)kg/m 2.The proportion of enrolled male patients was 61.2% and the mean estimated glomerular filtration rate was(27.7±12.7)ml·min -1·1.73m -2.The intraclass correlation coefficients of muscle mass and appendicular skeletal-muscle mass index(ASMI)measured by BIA and DXA ranged from 0.81 to 0.90.Bland-Altman analysis showed that BIA overestimated muscle mass against DXA, and the mean difference in ASMI was(0.44±0.13)kg/m 2.In addition, there was a moderate agreement between the two measurement methods for determining muscle loss(Kappa=0.47). Conclusions:BIA and DXA offer a fair level of consistency in the assessment of muscle mass in elderly patients with advanced CKD.However, compared with DXA, BIA overestimates muscle mass in elderly patients with CKD.

Analysis of risk factors associated with protein-energy wasting in elderly hemodialysis and peritoneal dialysis patients / 中华老年医学杂志

Objective:To analyze the risk factors for protein-energy wasting(PEW)in elderly patients undergoing hemodialysis(HD)and peritoneal dialysis(PD), in order to provide evidence for the prevention of PEW and improve the prognosis in these patients.Methods:According to the diagnostic criteria for PEW proposed by the International Society for Renal Nutrition and Metabolism, 112 elderly patients who had undergone PD and HD without PEW from May 2016 to June 2020 in the renal medicine department of the Eighth People's Hospital of Shanghai, the geriatric medicine department of Zhongshan Hospital Affiliated to Fudan University and the renal medicine department of the Sixth People's Hospital Affiliated to Shanghai Jiaotong University were included as the non-PEW group.During the same period, 114 cases with PEW were recruited as the PEW group.Differences in general patient data, biochemical test values, anthropometric measurements, bioelectrical impedance and other index values were compared between the two groups.Independent risk factors for PEW in elderly HD and PD patients were analyzed by using binary Logistic regression analysis.Results:Compared with the non-PEW group, the PEW group had a higher mean age( t=0.951, P<0.001), a higher proportion of patients aged ≥65 years( χ2=17.161, P<0.001), a lower body mass index( t=6.740, P<0.001), a higher incidence of diabetic nephropathy( χ2=14.176, P<0.001), a higher hemodialysis rate( χ2=4.543, P=0.033), and a longer duration(months)of dialysis( t=2.306, P=0.023). Levels of serum transferrin, prealbumin, total protein, hemoglobin and total cholesterol and body cell mass index were lower( t=6.262, 13.405, 9.507, 8.341, 4.610, 5.599 and 2.499, all P<0.05), high-sensitivity C-reactive protein levels and the body water percentage were higher( t=6.380, 4.519, both P<0.001), and the upper arm muscle circumference was smaller( t=5.418, P=0.000)in the PEW group than in the non-PEW group.Binary Logistic regression analysis showed that age≥65 years, dialysis duration, serum albumin and high-sensitivity C-reactive protein levels were independent influencing factors for PEW in elderly HD patients( OR=2.762, 0.182, 2.694 and 2.980, P=0.023, 0.007, 0.009 and 0.027). Age ≥65 years, body mass index and the hemoglobin level were independent influencing factors for PEW in elderly PD patients( OR=2.452, 0.671 and 0.962, P=0.013, 0.000 and 0.000). Conclusions:The incidence of PEW is lower in elderly HD patients than in elderly PD patients.Clinical intervention should be carried out based on influencing factors, in order to prevent the occurrence of PEW.

Clinical characteristics and risk factors of sarcopenia in elderly hemodialysis patients / 中华老年医学杂志

Objective:To investigate the clinical characteristics and related risk factors of sarcopenia in elderly patients undergoing maintenance hemodialysis.Methods:This was a retrospectively study involving 135 elderly hemodialysis patients aged(70.6±7.7)years, with 46(34.1%)females and a mean hemodialysis duration of(3.2±2.9)years, at Shanghai Sixth People's Hospital.The incidence of sarcopenia in patients was examined by measuring handgrip strength, walking speed and muscle mass of the limbs using bioelectrical impedance analysis.Related risk factors were analyzed with univariate and multivariate logistic regression analysis.Results:Among 135 elderly hemodialysis patients, the incidence of sarcopenia was 62.9%(85 cases), and severe sarcopenia cases accounted for 44.4%(60 cases). Compared with the non-sarcopenia group, patients with sarcopenia were older, had lower body mass index(BMI)and handgrip strength, walked more slowly and had less muscle mass in their limbs.Advanced age, low BMI and long dialysis duration were correlated with the high incidence of sarcopenia in elderly dialysis patients.The odds ratio( OR)for sarcopenia increased by 12% per year, and the OR decreased by 32% with an increase of 1.0 kg/m 2 in BMI.Advanced age and lower BMI were also correlated with a high incidence of severe sarcopenia( OR=1.12, 95% CI: 1.05~1.18; OR=0.84, 95% CI: 0.74~0.95; all P<0.01). Conclusions:The incidence of sarcopenia is high in elderly hemodialysis patients and is closely related to advanced age and low body weight.Improving nutritional status and avoiding low body weight will help reduce the occurrence and development of sarcopenia in elderly hemodialysis patients.

Telehealth-based dialysis registration system for the improvement of renal anemia in maintenance hemodialysis:multicenter experiences / 中华肾脏病杂志

Objective To analyze the role of telehealth?based dialysis registration systems in real?time and dynamic reflection of renal anemia in hemodialysis (HD) patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin (Hb) level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicians could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059(60.3％) were male.The average rate age was (60.5 ± 13.7) years old. Baseline average Hb was (108.3±16.0) g/L. Baseline detection rate and target rate were 54.2％and 47.5％, respectively. After 28 months follow?up, the detection rate of Hb increased from 54.2％ to 73.6％ (P<0.001), the target rate of Hb increased from 47.5％ to 56.1％ (P<0.001), and the level of average Hb rose from (108.3±16.0) g/L to (110.7±16.0) g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth?based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long?term way. The telehealth?based dialysis registration system, as an improved mode of dialysis registration is a promising way for long?term management of renal anemia in dialysis patients.

Clinical study on the relationship between calcium and phosphorus metabolism with aortic arch calcification in maintenance peritoneal dialysis patients / 中华肾脏病杂志

Objective To retrospectively study the risk factors of aortic arch calcificationand its influence on the survival prognosis of maintenance peritoneal dialysis patients. Methods One hundred seventy-seven cases of maintenance peritoneal dialysis patients were enrolled, including 66 cases of aortic arch calcification cases. Their general dialysis data were collected for the evaluation of dialysis adequacy and residual renal function, and their chest X-rays were recorded to assess the degree of aortic arch calcification. The two variables Logistics regression was used to analyze independent risk factors of aortic arch calcification; Kaplan-Meier analysis was used to analyze the influence on prognosis of dialysis patients; and multivariate COX regression was employed to analyze independent risk factors of death in dialysis patients. Results Among the 177 selected cases of peritoneal dialysis patients, 66 cases (37.29%) presented with aortic arch calcification. Elevated serum phosphorus was an independent risk factor of aortic arch calcification (OR=54.69 ,95%CI:10.01-298.65, P<0.01). The probability of survival in patients with mild and moderate (severe) calcification of aortic arch was less than those without calcification. Moderate (severe) calcification of aortic arch was the independent risk factor of all-cause mortality and cardiovascular disease mortality, whose hazard ratios in patients with calcification were 3.779 times and 5.636 times of those in patients without calcification respectively. Conclusions Hyperphosphatemia is an independent risk factor promoting the development of calcification of aortic arch. The probability of survival in patients with mild and moderate (severe) calcification of aortic arch is less than those without calcification; moderate (severe) calcification of aortic arch is the independent risk factor of all-cause mortality and cardiovascular disease mortality.

Advances in protein energy malnutrition in patients with chronic kidney disease / 中华临床营养杂志

The incidence of malnutrition among patients with chronic kidney disease (CKD) constantly increases despite the development of health care and dialysis techniques.New nutritional targets for CKD patients upon maintenance treatment have been developed.Before dialysis,evidences have shown that a long-term nutritional care plan,with a control of protein intake,can effectively correct metabolic disorders including proteinuria and acidosis.During the maintenance dialysis,the optimal protein and energy intakes have been recently challenged.The new classification of nutritional disorders in CKD patients may help the easily identification of protein-energy wasting.

Clinical analysis of arrhythmia in chronic kidney disease patients without renal replacement therapy / 中华肾脏病杂志

Objective To observe the occurrence and risk factors of arrhythmia in chronic kidney disease (CKD) patients in different stages of renal function. Methods A total of 405 CKD patients were enrolled in this study and none of them received renal replacement therapy.The 24 h dynamic electrocardiogram (DCG) was performed,and baseline characteristics were compared.Multivariable Logistic regression analysis was used to examine the relationship between the severe arrhythmia and the potential risk factors,such as age,gender,CKD stage,diabetes,hypertension,hyperpotassaemia,left ventricular hypertrophy (LVH),etc. Results There were 69 patients (17.04％),79 patients (19.51％),82 patients (20.25％),88 patients (21.73 ％) and 87 patients (21.48％) in CKD stage 1,2,3,4 and 5,respectively.As high as 45.68％ of all the patients had severe arrhythmia,represented by 27.54％,29.11％,42.68％,57.95％ and 65.52％ in CKD stages 1-5 respectively.The occurrence of severe arrhythmia increased as the eGFR decreased in CKD stages 2,3,4 (p＜0.05).On multivariable Logistic regression analysis,the occurrence of severe arrhythmia was related to LVH,CKD stage,diaberes hyertension and hyperpotassaemia are signidicantly assoxiated with severe arrhythmia.

The therapeutic effects of the long term therapy in elderly patients with recurrent urinary tract infection / 中华老年医学杂志

Objective To observe the therapeutic effects of the drugs alternation multiple stages and long term therapy in elderly patients with recurrent urinary tract infection.Methods The patients were divided into elderly group (age≥65 years,n=30) and non-elderly group (n=48).The multiple effective antibiotics were selected for alternate use.The treatment included four periods as follows:(1)Treatment period:the regular dose of antibiotic was maintained until the urine routine test result became normal;(2)Consolidation period:the dosage of antibiotic was reduced;(3)Maintenance period:the dosage of antibiotic was reduced to once every night and the treatment should be kept for three months;(4)Observation period:the patients were observed for six months after withdrawal of antibiotics.During the treatment,if the urine routine test became abnormal repeatedly,the patient should return to the previous treatment period.During the treatment and consolidation period,each medication should be applied for one week alternatively.Results Among 78 patients,69 cases (88.5%) were cured,7 cases (8.9%) were effective,and two cases (2.56%) were invalid.There were 28 cured cases,1 effective case and 1 invalid case in elderly group.The corresponding data were 41,6 and 1 in non-elderly group,respectively.There was no difference in cure rate between the two groups (F= 0.469).Compared with non-elderly group,the overall treatment time [(54.8± 16.2)weeks vs.(44.5± 13.7) weeks,t= 2.8467,P＜0.01],treatment period [( 34.3± 15.2) weeks vs.(26.2±14.8) weeks,t=2.2081,P＜0.05] and consolidation period [(5.7±2.6) weeks vs.(4.1±0.2) weeks,t=3.9369,P＜0.01] were all prolonged in elderly group.But there was no difference in maintenance period [(14.8±4.6) weeks vs.(14.2±3.1) weeks,t=0.6480,P＞0.05].There were no markedly changes in blood routine,liver and kidney function during the course of treatment.Conclusions For the elderly patients with recurrent urinary tract infection,the drugs alternation,multiple stages and long-term treatment has a high cure rate and no adverse effect on blood routine,liver and renal function.

A multi-center survey of hypertension and its treatment in patients with maintenance hemodialysis in Shanghai / 中华内科杂志

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure(SBP) ≥ 140 and/or diastolic blood pressure (DBP) ≥90 mm Hg ( 1 mm Hg = 0.133 kPa).Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure ＜ 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half (50.4% ) of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker (CCB) was the most frequently prescribed drug (61.0%), followed by angiotensin Ⅱ receptor blockers ( 56.4% ), centrally acting anti-hypertensive agent ( 26.4% ), beta blockers and alpha, beta-blockers( 14.0% ).The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.

Significance and expression of soluble CD146 in peripheral blood from patients with ankylosing spondlitis / 中国组织工程研究

BACKGROUND: Research has been reported that serum soluble CD146 (sCD146) expression was improved on the surface of endothelial cells and activated T cells by the stimulation of inflammatory factor. Therefore, it predicts that CD146 may participate in inflammatory reaction of tissue.OBJECTIVE: To investigate the expression and clinical significance of serum sCD146 in peripheral blood from patients with ankylosing spondylitis.METHODS: A total of 62 patients with ankylosing spondylitis were selected from the Sixth People's Hospital AffiUated to Shanghai Jiao Tong University. All patients were divided into two groups: active group (n=46) and inactive group (n=16); while, 20 healthy subjects were selected as the control group. Indicators including Bath Ankylosing SpondyUtis Disease ActivityIndex (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI), patient's global assessment (PGA), night pain, visual analogue scale (VAS),morning stiffness time, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured in all patients. The serum concentration of sCD146 from 62 patients with ankylosing spondlitis and 20 healthy controls was measured by enzyme-linked immunosorbent assay. Westergren method was used to measure ESR and immunoturbidimetry for CRP. Clinical data of the patients were collected as well.RESULTS AND CONCLUSION: sCD146 levels of patients with ankylosing spondlitis were significantly higher than normal control group (P ＜ 0.05). The sCD146 expression in the active group was significantly higher than inactive and normal control groups (P ＜0.05). Positive correlations were observed between sCD146 and BASDAI index of patients with ankylosing spondlitis (P ＜ 0.05).The sCD146 levels of ankylosing spondUtis patients with peripheral joint involvement were significantly higher than the patients with axial involvement alone or the normal controls (P ＜ 0.05).The expression level of sCD146 in peripheral blood was positively correlated with disease activities of patients with ankylosing spondlitis. It may play important roles in the pathogenesis in ankylosing spondlitis.

Clinical analysis of 320 cases with acute renal failure / 中华肾脏病杂志

Objective To investigate the cause,prognosis and risk factors of hospitalized patients with acute renal failure(ARF). Methods The clinical data of patients with ARF in our hospital from December 2003 to December 2006 were studied retrospectively. Results There were 108 744 admissions during the study period and 320 met with the diagnostic criteria of ARF.Of 320 ARF patients,135(42.2%)were indentified with the onset of the disease over or at the age of 60.Infection,heart failure and drug were the major causes of ARF.The overall mortality rate of ARF patients was 31.9%.The mortality rate of the elderly was significantly higher than that of the non-elderly.The Logistic regression analysis revealed that heart failure,respiratory failure and malignant tumor were the related risk factors of prognosis.The mortality in replacement therapy group was lower than that in conservative treatment group (23.2% vs 35.6%,P＜0.05).Conclusions The incidence and mortality of hospitalized patients with acute renal failure are high.The prognosis of replacement therapy group is better than conservative treatment group.

Volatile oil of Magnolia biondii inhibits expressions of P-selectin protein in serum and renal tissue of rats with diabetic nephropathy / 中西医结合学报

OBJECTIVE: To investigate the protection mechanism of volatile oil of Magnolia biondii Pamp. (VOMBP) against diabetic nephropathy in rats by observing its effects on level of soluble P-selectin (sP-selectin) in serum and expression of P-selectin in renal tissue. METHODS: Fifty SD rats were randomly divided into normal control group, untreated group, and low-, medium- and high-dose VOMBP-treated group. Diabetic nephropathy was induced in rats by intraperitoneal injection of 1% streptozotocin. Before and the 1st day, 4th, 8th and 12th week after the induction, random blood glucose (RBG) and 24-hour urinary micro-albumin were detected in different groups. At the 12th week, the rats were sacrificed to collect the blood samples and renal tissues. The contents of blood urea nitrogen (BUN) and serum creatinine (SCr) were detected and the pathological change in renal tissues was observed by light microscope; the level of sP-selectin was detected by enzyme-linked immunosorbent assay and the expression of P-selectin protein in renal tissues was measured by immunohistochemical method. RESULTS: Compared with the normal control group, RBG, 24-hour urinary micro-albumin, the contents of BUN, sP-selectin in serum and expression of P-selectin protein in renal tissue in the untreated group were significantly increased (P0.05). CONCLUSION: VOMBP can protect the kidney in rats with diabetic nephropathy by inhibiting the expressions of P-selectin protein in serum and in renal tissue.

Multi-center clinical studies on pazufloxacin sodium chloride injection in treatment for acute bacterial infections / 中华全科医师杂志

Objective To evaluate efficacy and safety of locally-produced pazufloxacin mesilate sodium chloride injection in the treatment of bacterial infections of respiratory and urinary tract.Methods A multi-center double-blind randomized controlled clinical trial was carried out to evaluate efficacy and safety of pazufloxacin mesilate sodium chloride in treatment for acute bacterial infection, as compared to those of levofloxacin hydrochloride and glucose injection as control treatment.A total of 244 patients with acute bacterial infection of respiratory and urinary tract were enrolled in the studies.120 in trial group and 120 in control group, with four withdrawals.Pazufloxacin mesilate and levofloxacin were administered intravenously by drip at a dose of 300 mg and 200 mg, every 12 hours for 7 to 14 days for trial and control groups, respectively.Resuits Overall efficacy of pazufloxacin mesilate was 77.0 percent and 93.5 percent in treatment for acute bacterial infections of respiratory and urinary tract.respectively, and that of levofloxacin was 80.6 percent and 89.6 percent, respectively.Overall bacterial clearance rate WaS 91.5 percent for pazufloxacin mesilate, 89.6 percent for respiratory tract infection and 94.1 percent for urinary tract infection, respectively.and 93.4 percent for levofloxacin, 97.3 percent for respiratory tract infection and 89.7 percent for urinary tract infection, respectively.No significant difference in adverse drug reactions between the two groups(P＞0.05)was found, with 4.88 percent and 7.44 percent for trial and control groups, respectively.Conclusions Pazufloxacin mesilate sodium chloride injection produced locally is a safe and effective antibiotic in treatment for acute infections of respiratory and urinary tract.

Prospective study of acute renal failure in 135 elderly patients / 中国综合临床

Objective To investigate the etiology,prognosis and risk factors of hospitalized elaerly patients with acute renal failure(ARF).Methods The clinical data of elderly patients with ARF in our hospital from De-cember 2003 to December 2006 were studied prospectively.The clinical features were comparea with those of the non-aged patients with ARF during the same period.Results Of 320 patients,135(42.2%)were identified with the onset of ARF.Infections and postrenal obstructive diseases were the major causes of ARF in the elderly.Fifty-one dead patients in the young,thirty-one in the 60-79 years old group,and twenty in the above 80 years old group(P<0.05).The results of logistic regression analysis suggested that oliguria,previous renal inadequacy and heart failure were the related risk factors of prognosis.Conclusion The incidence and mortality of hospitalized elderly patients with ARF are high.With the rising of age.the mortality of ARF increases.Dialysis in time might improve the progno-sis of ARF.