Polimorfismo genético associado a doença renal crônica e periodontite: uma revisão sistemática de literatura / Genetic polymorphism associated with chronic kidney disease and periodontitis: a systematic literature review / Polimorfismo genético asociado a enfermedad renal crónica y periodontitis: una revisión sistemática de la literatura

A periodontite é uma doença infecto-inflamatória associada ao biofilme disbiótico que afeta os tecidos de proteção e de suporte dos dentes. O processo inflamatório que ocorre durante a periodontite tem sido associado à inflamação sistêmica em pacientes com doença renal crônica. Os polimorfismos genéticos são alterações no DNA que podem ter classificações diferentes dependendo da mutação gerada, e podem ser criados ou destruídos. Objetivo: O objetivo desta revisão sistemática da literatura foi elucidar a seguinte questão: os polimorfismos genéticos estão associados à doença renal crônica e à periodontite? Material e Métodos: A pesquisa foi realizada no PubMed, Biblioteca Cochrane, EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Bibliografia Brasileira de Odontologia (BBO), Biblioteca Virtual em Saúde (BVS), SciELO, Scopus, Web of Science e bases de dados de literatura cinzenta (Google Scholar) sem restrições de data ou idioma em 28 de junho de 2021 e atualizada em 26 de janeiro de 2023. Os descritores padronizados (Medical Subject Headings, MeSH) utilizados foram: "polimorfismo genético", "doença renal crônica" e "periodontite", de acordo com o banco de dados consultado, utilizando os operadores booleanos "AND". Resultado: 25 publicações foram identificadas. Após a análise do título, do resumo e do texto completo, 6 estudos de caso-controle foram selecionados para análise. Todos incluíam artigos investigando o papel de diferentes polimorfismos genéticos em ambas as doenças. Alguns genes apresentavam uma relação próxima com o perfil inflamatório que caracteriza ambas as doenças. Conclusão: Entre os polimorfismos estudados, os polimorfismos VNTR no gene IL4 e MCP-1-2518 A/G apresentaram uma associação positiva tanto com a periodontite quanto com a doença renal crônica. Entretanto, são necessários mais estudos para melhor compreensão do papel dos polimorfismos genéticos nessas doenças.

Periodontitis is an infectious-inflammatory disease associated with dysbiotic biofilm that affects the protective and supporting tissues of the teeth. The inflammatory process that occurs during periodontitis has been associated with systemic inflammation in patients with chronic kidney disease. Genetic polymorphisms are changes in DNA that can have different classifications depending on the mutation generated, and can be created or destroyed. Objective: The aim of this systematic review of the literature was to elucidate the following question: are genetic polymorphisms associated with chronic kidney disease and periodontitis? Material and Methods: The search was conducted in PubMed, Cochrane Library, EMBASE, Latin American and Caribbean Literature on Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO), Virtual Health Library (VHL), SciELO, Scopus, Web of Science and gray literature databases (Google Scholar) without date or language restrictions on June 28, 2021 and updated on January 26, 2023. The standardized descriptors (Medical Subject Headings, MeSH) used were: "genetic polymorphism", "chronic kidney disease" and "periodontitis", according to the database consulted, using the Boolean operators "AND". Result: 25 publications were identified. After reviewing the title, abstract, and full text, 6 case-control studies were selected for analysis. All included articles investigating the role of different genetic polymorphisms in both diseases. Some genes showed a close relationship with the inflammatory profile that characterizes both diseases. Conclusion: Among the polymorphisms studied, the VNTR polymorphisms in the IL4 gene and MCP- 1-2518 A/G showed a positive association with both periodontitis and chronic kidney disease. However, further studies are needed to better understand the role of genetic polymorphisms in these diseases.

La periodontitis es una enfermedad infeccioso-inflamatoria asociada a un biofilm disbiótico que afecta a los tejidos protectores y de soporte de los dientes. El proceso inflamatorio que se produce durante la periodontitis se ha asociado con la inflamación sistémica en pacientes con enfermedad renal crónica. Los polimorfismos genéticos son cambios en el ADN que pueden tener diferentes clasificaciones dependiendo de la mutación generada, pudiendo ser creados o destruidos. Objetivo: El objetivo de esta revisión sistemática de la literatura fue dilucidar la siguiente pregunta: ¿están asociados los polimorfismos genéticos con la enfermedad renal crónica y la periodontitis? Material y Métodos: La búsqueda fue realizada en PubMed, Cochrane Library, EMBASE, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Bibliografía Brasileña de Odontología (BBO), Biblioteca Virtual en Salud (BVS), SciELO, Scopus, Web of Science y bases de datos de literatura gris (Google Scholar) sin restricciones de fecha o idioma el 28 de junio de 2021 y actualizada el 26 de enero de 2023. Los descriptores normalizados (Medical Subject Headings, MeSH) utilizados fueron: "polimorfismo genético", "enfermedad renal crónica" y "periodontitis", según la base de datos consultada, utilizando los operadores booleanos "AND". Resultado: Se identificaron 25 publicaciones. Tras analizar el título, el resumen y el texto completo, se seleccionaron 6 estudios de casos y controles para su análisis. Todos los trabajos incluidos investigaban el papel de diferentes polimorfismos genéticos en ambas enfermedades. Algunos genes mostraron una estrecha relación con el perfil inflamatorio que caracteriza a ambas enfermedades. Conclusión: Entre los polimorfismos estudiados, los polimorfismos VNTR en el gen IL4 y MCP-1-2518 A/G mostraron una asociación positiva tanto con la periodontitis como con la enfermedad renal crónica. Sin embargo, se necesitan más estudios para comprender mejor el papel de los polimorfismos genéticos en estas enfermedades.

Effects of Low-Protein Diet on lipid and anthropometric profiles of patients with chronic kidney disease on conservative management / Efeitos da dieta hipoproteica sobre os perfis lipídico e antropométrico de pacientes com doença renal crônica em tratamento conservador

ABSTRACT Introduction: Chronic Kidney disease (CKD) patients have a high prevalence of cardiovascular mortality, and among the risk factors are dyslipidemia and obesity, common findings in the early stages of CKD. The aim of this study was to evaluate the effects of low protein diet (LPD) on the lipid and anthropometric profile in non-dialysis CKD patients. Methods: Forty CKD patients were studied (20 men, 62.7 ± 15.2 years, glomerular filtration rate (GFR) 26.16 ± 9.4 mL/min/1.73m2). LPD (0.6g/kg/d) was prescribed for six months and, biochemical and anthropometric parameters like body mass index (BMI), waist circumference and body fat mass (assessed by dual X-ray absorptiometry - DXA) were evaluated before and after six months with LPD. Results: After six months of nutritional intervention, patients presented reduction on BMI (from 28.1 ± 5.6 to 27.0 ± 5.3 Kg/m2, p = 0.001), total cholesterol (from 199.7 ± 57.1 to 176.0 ± 43.6mg/dL, p = 0.0001), LDL (from 116.2 ± 48.1 to 97.4 ± 39.1 mg/dL, p = 0,001) and uric acid (from 6.8 ± 1.4 to 6.2 ± 1.3 mg/dL, p = 0.004). In addition, GFR values were increased from 26.2 ± 9.5 to 28.9 ± 12.7mL/min (p = 0.02). The energy, proteins, cholesterol and fiber intake were reduced significantly. Conclusion: LPD prescribe to non-dialysis CKD patients for six months was able to improve some cardiovascular risk factors as overweight and plasma lipid profile, suggesting that LPD can be also an important tool for protection against cardiovascular diseases in these patients.

RESUMO Introdução: Pacientes com Doença Renal Crônica (DRC) possuem alta prevalência de mortalidade cardiovascular e, dentre os fatores de risco, encontram-se alterações no perfil lipídico e excesso de peso, que são achados comuns na DRC. O objetivo deste estudo foi avaliar os efeitos da dieta hipoproteica sobre o perfil antropométrico e lipídico de pacientes com DRC em tratamento conservador. Métodos: Foram estudados 40 pacientes com DRC (20 homens, 62,7 ± 15,2 anos, e Taxa de Filtração Glomerular (TFG) de 26,2 ± 9,4 mL/min/1,73m2). Os pacientes receberam prescrição de dieta hipoproteica (0,6g/kg/d) e parâmetros bioquímicos e antropométricos como índice de massa corporal (IMC), circunferência da cintura (CC) e percentual de gordura corporal (GC) avaliado por absorciometria com raio-x de dupla energia (DXA), foram analisados antes e após 6 meses de intervenção. Resultados: Os pacientes apresentaram após 6 meses, redução do IMC (de 28,1 ± 5,6 para 27,0 ± 5,3Kg/m2, p = 0,001), colesterol total (de 199,7 ± 57,1 para 176,0 ± 43,6mg/dL, p = 0,0001), LDL (de 116,2 ± 48,1 para 97,4 ± 39,1 mg/dL, p = 0,001) e ácido úrico (de 6,8 ± 1,4 para 6,2 ± 1,3 mg/dL, p = 0,004) e, aumento da TFG de 26,2 ± 9,5 para 28,9 ± 12,7mL/min (p = 0,02). Houve redução significativa na ingestão de energia e proteínas, bem como de colesterol e fibras. Conclusão: A intervenção com dieta hipoproteica para pacientes com DRC em tratamento conservador por seis meses foi capaz de melhorar alguns fatores de risco cardiovascular, como o excesso de peso e o perfil lipídico plasmático, sugerindo que a dieta hipoproteica, além de outros benefícios pode também ser importante ferramenta para a proteção de doenças cardiovasculares nesses pacientes.

Effect of urate-lowering therapy on renal function in chronic kidney disease stages 2-5 patients with hyperuricemia / 中华肾脏病杂志

Objective To investigate the effect of urate-lowering therapy on renal function in chronic kidney disease (CKD) stages 2-5 patients with hyperuricemia (HUA).Methods A total of 132 patients of CKD stages 2-5 with HUA between July 2016 and December 2017 in Department of Nephrology of the Second Affiliated Hospital of Anhui Medical University were prospectively and self-controlled analyzed.Serum uric acid (SUA),estimated glomerular filtration rate (eGFR) and other clinical parameters were measured at baseline and after 1-6 months treatment.The patients were divided into group A (CKD stages 2-3a) and group B (CKD stages 3b-5) on the baseline value of eGFR.The changes of SUA and eGFR before and after treatment were compared.According to the level of SUA after 6 months treatment,patients were divided into attainment group (SUA ＜ 360 μmol/L) and nonattainment group (SUA ≥ 360 μmol/L).The difference of renal function in pre-treatment and post-treatment was compared.Multiple stepwise linear regression was used to analyze the relationship among the change of eGFR after receiving 6 months' treatment (deGFR) and SUA level,baseline eGFR and other indexes.Results After 1,3,6 months treatment,the average levels of SUA,Scr and urea nitrogen of all patients were decreased significantly while eGFR value was increased significantly (all P ＜ 0.050) than those in pre-treatment period.After six-month-therapy,proteinuria and hematuria were improved significantly in all patients (P ＜ 0.001,P=0.001).Compared with pre-treatment period,both the SUA levels of group A and group B were declined significantly while eGFR had a significant rise after treatment (P ＜ 0.001).The change of eGFR post-treatment in group A was significantly higher than that of group B [(13.64±15.35) vs (8.97±9.79) ml· min-1· (1.73 m2)-1,P=0.044].At 6 months after treatment,the eGFR value increased markedly in both attainment group and nonattainment group compared with pre-treatment period (P ＜ 0.001).After six-month-therapy,the eGFR value in attainment group was increased more obviously than that of nonattainment group [(13.96 ± 14.64) vs (8.03±9.69) ml· min-1· (1.73 m2)-1,P=0.021].Multiple stepwise linear regression analysis showed that the baseline eGFR value was an influencing factor of deGFR (b=0.161,P=0.020).Conclusions The renal function of CKD stages 2-5 patients with HUA can be significantly improved by urate-lowering therapy,which can effectively reduce proteinuria and hematuria.

Social construction of the experience of living with chronic kidney disease / A construção social da experiência de viver com uma doença renal crônica / La construcción social de la experiencia de vivir con una enfermedad renal crónica

ABSTRACT Objective: To understand the experience of people living with Chronic Kidney Disease who have been transplanted, from the meanings constructed based on the experienced phenomenon. Method: Hermeneutic-phenomenological study based on the five lifeworld existentials, according to Van Manen's theoretical framework. Eleven transplanted patients participated in the study and data collection was carried out through semi-structured interviews, after approval of the study by the Ethics Committee of the University of Antioquia. Results: The theme of Living with Chronic Kidney Disease emerged, and the subthemes were grouped as lifeworld existentials of Temporality: something unexpected, being present and not seeing it, being young and sick. Relationality: support, feeling stuck and Terminal Chronic Renal Failure. Spatiality: changes in life, sadness and depression. Corporeality: body deterioration and changes in sex life. Materiality: effects on the economic status. Conclusions: The care provided to people must be oriented in order to recognize their individualities, understanding what the illness means for the individual and his family, how they live with it and what the changes are, leading them to modify their lives and start a long process, such as living with a chronic disease.

RESUMO Objetivo: Compreender a experiência vivida por pessoas com Doença Renal Crônica que foram transplantadas, a partir dos significados construídos em relação ao fenômeno vivenciado. Método: Estudo hermenêutico-fenomenológico baseado nos cinco existenciais, de acordo com o referencial teórico de Van Manen. Onze pessoas transplantadas participaram do estudo, e os dados foram coletados por meio de entrevistas semiestruturadas, após a aprovação do estudo pelo comitê de ética da Universidade de Antioquia. Resultados: Surgiu o tema de Viver com Doença Renal Crônica, e os subtemas foram agrupados como existenciais de Temporalidade: algo inesperado, estar presente e não vê-la, ser jovem e estar doente. Relacionalidade: o apoio, se sentir atados e Doença Renal Crônica Terminal. Espacialidade: mudanças de vida, tristeza e depressão. Corporeidade: deterioração do corpo e alteração da vida sexual. Materialidade: impacto na situação econômica. Conclusões: O cuidado proporcionado às pessoas deve ser orientado para o reconhecimento de suas individualidades, entendendo o que a doença significa para o indivíduo e para a família, como eles vivem com ela e quais são as mudanças que enfrentam, levando-os a modificar sua vida e iniciar um processo de longa duração, como é o fato de viver com uma condição de natureza crônica.

RESUMEN Objetivo: Comprender la experiencia vivida por personas con Enfermedad Renal Crónica que han sido trasplantadas, desde los significados construidos con respecto al fenómeno experimentado. Método: Estudio fenomenológico-hermenéutico, fundamentado en los cinco existenciales, desde el referencial teórico de Van Manen; 11 personas trasplantadas participaron en el estudio, los datos recolectados a través de entrevistas semiestructuradas, previa aprobación del comité de ética de la Universidad de Antioquia. Resultados: Emerge el tema de Vivir con Enfermedad Renal Crónica, los subtemas agrupados en los existenciales de Temporalidad: algo inesperado, estar presente y no verla, ser joven y estar enfermo. Relacionalidad: el apoyo, sentirse atados y Enfermedad Renal Crónica Terminal. Espacialidad: la vida cambia, tristeza y depresión. Corporeidad: el cuerpo deteriorado y la alteración de la vida sexual. Materialidad: impacto en la situación económica. Conclusiones: El cuidado brindado a las personas, debe orientarse a reconocer sus individualidades comprendiendo lo que para el individuo y familia significa la enfermedad, como la vive y cuáles son los cambios a los que se enfrentan, llevándolos a modificar su vida e iniciar un proceso de larga duración, como es el hecho de vivir en cronicidad.

Survey on knowledge of chronic kidney disease among medical staff in suburbs of Shanghai / 中华全科医师杂志

A questionnaire survey on knowledge of chronic kidney disease (CKD) was conducted among 168 medical staff in suburban Shanghai on March 2016.The results showed that the average score was 53.53±13.35,with the lowest score of 17.5 and the highest score of 82.5;the score of 118 participants (70.2%) was 0.05).

Low protein diet for patients with chronic kidney disease / 中华全科医师杂志

Diet therapy is considered as the basic treatment of chronic kidney disease (CKD),and its primary goals are improving metabolic disorder,relieving symptoms and prevent complications,hence to retard renal function lost of CKD patients.However,there have been controversies about the results of clinical studies on nutritional treatment for CKD.This article reviews the effectiveness,safety and compliance of low-protein diet (LPD) for CKD patients,and related clinical management strategies.The article also recommends the feasible diet scheme to provide a reference of clinical LPD therapy for patients with CKD.

Stratified random sampling survey on senile chronic kidney diseases among elderly people aged over a certain Crops / 重庆医学

Objective To understand the prevalence rate and related factors of chronic kidney disease (CKD) among elderly people aged more than 65 years old in the 66th regiment of the fourth division of A Crops in Xinjiang .Methods A total of 2 030 elderly people aged more than 65 years old in the 66th regiment of the fourth division of XPCC were distributed in 6 communities . Totally 334 permanent residents aged more than 65 years old were chosen from 2 communities by the stratified random sampling method .The renal injury indicators and related factors were detected .Results Among 329 residents with intact data ,after the age correction ,the prevalence rate of albuminuria ,hematuria and renal function decrease were 22 .2% ,14 .2% ,4 .9% ,respectively .The prevalence rate of CKD in this group was 32 .8% ,CKD stage 1―3 were dominated .The awareness rate was 15 .1% .The multiva‐riate Logistic regression analysis showed that gender and hypertension were independently associated with CKD .Conclusion The prevalence rate of CKD among elderly people aged over 65 years old in the 66th regiment of the fourth division of this Crops is high‐er .The related factors are gender and hypertension .

Features of ambulatory blood pressure in 540 patients with chronic kidney disease / 中华肾脏病杂志

Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease (CKD) patients.Methods A total of 540 CKD patients from May 2010 to May 2012 in our department were enrolled in this study.Ambulatory blood pressure monitoring was carried out.Blood pressure (BP),proteinuria and other clinical parameters were measured regularly.Ultrasonography was used to evaluate cardiac structure and function,carotid intima-media thickness and plaque.Univariate and multivariate analysis were used to examine the association between BP and clinical parameters.Results 63.9％ of CKD patients was non-dipper BP pattern,and 36.1％ was dipper BP pattern.As compared to dipper BP patients,those with non-dipper BP had higher ratio of nighttime/daytime proteinuria (0.51±0.29 vs 0.42±0.21,P ＜ 0.01),lower estimated glomerular filtration rate (eGFR) [(56.2±48.2) vs (75.5±56.5) ml· min 1 · (1.73 m2)-1,P ＜ 0.01],higher serum cystatin C[(2.8±2.0) mg/L vs (2.1±2.0) mg/L,P ＜ 0.01],higher left ventricular mass index [(53.7±23.2) vs (45.1± 16.3) g/m2,P ＜ 0.01] and severely damaged left ventricular diastolic function and higher carotid intima-media thickness [(0.7±0.3) vs (0.6±0.2) mm,P＜ 0.01].Nighttime blood pressure was independent predictor for proteinuria,eGFR and left ventricular mass index.Conclusions Nondipper blood pressure pattern is very common in CKD patients.Nighttime pressure is closely associated to renal damage and cardiovascular injuries.

Epidemiologic study of chronic kidney disease in adult population of Anhui province / 中华肾脏病杂志

Objective To explore the prevalence,awareness and risk factors of chronic kidney disease (CKD) in general adult population of Anhui province,China. Methods A total of 3800 residents (older than 18 years) from Anhui province were randomly selected using a stratified,multi-stage sampling.All the residents were interviewed and tested for urinary albumin to creatinine ratio (abnormal:≥30 mg/g) and reduced estimated GFR [abnormal:＜60 ml·min1·(1.73 m2)-1]. The associations of CKD with demographic characteristics, healthy charactefistcs (hypertension,diabetes and hyperuricemia) were examined. Results Eligible data of 3374 subjects were enrolled in the study.After the adjustment of age and gender component,the prevalence of albuminuria was 9.8％ (95％CI 8.8％-10.9％),and reduced eGFR was 2.1％ (95％ CI 1.7％-2.7％).Approximately 10.4％(95％CI 9.4％-11.5％)subjects had at least one indicator of kidney damage.The awareness rate of CKD was 6.5％.Female,age,hypertension,diabetes mellitus,and hyperuricemia were independently associated with CKD.While obesity,hyperlipdemia.smoking and alcohol drinking were not associated with the prevalence of CKD. Conclusions The prevalace of chronic kidney disease is 10.4％ and the awareness rate is 6.5％ in general adult population of Anhui province.Independent risk factors associated with CKD are female,age,hypersion,diabetes mellitus and hyeruricemia.

Immunofecal occult blood test predicts the prognosis of patients with chronic kidney disease / 中华肾脏病杂志

Objective To evaluate the value of immunofecal occult blood test (IFOBT) as a prognostic indicator in CKD patients with colorectal impairment.Methods A total of 176CKD patients and 180 healthy adults as control were enrolled.Serum biochemistry was measured at baseline and gastrointestinal bleeding was determined by IFOBT.All the CKD patients were followed up for 4.5 years.Renal replacement therapy or death was defined as end-point event.The Logistic regression analysis was used for risk factors.Kaplan-Meier analysis and COX regression model were used for survival analysis.Results The positive rate of IFOBT in CKD patients was significantly higher than healthy control (17％ vs 5.3％,χ2=13.236,P＜0.01).When comparing with IFOBT negitive patients,IFOBT positive patients were older [(62.030±15.544) years old vs (48.660±19.018)years old,P＜0.01],had higher ESR [(71.800±31.657) mu/h vs (57.210±32.712) mm/h,P＜0.05],C-reactive protein [6.230 (3.000～14.148) mg/L vs 3.000 (3.000～6.833)mg/L,P＜0.05],serum creatinine [419.100 (103.200～546.625) μmol/L vs 175.100 (68.150～462.950) μmol/L,P＜0.05],and had lower hemoglobin level [(97.970±20.590) g/L vs (107.170±27.988) g/L,P＜0.05] and eGFR [11.400 (8.671～53.544) ml·min1·(1.73 m2)1 vs 35.274(10.961～82.145) ml·min-1·(1.73 m2)-1,P＜0.01].There was a negative correlation between IFOBT value and eGFR in CKD patients (r=-0.20,P＜0.01).Positive correlations of IFOBT value with age (r=0.175,P＜0.05) and serum creatinine (r=0.171,P＜0.05) were found.Logistic regression and COX regression analysis showed that IFOBT value,eGFR and ESR were important factors that influenced the prognosis of CKD patients.Kaplan-Meier analysis revealed that IFOBT value ＞100μg/L predicted progression of renal function.Conclusions The prevalence of gastrointestinal bleeding disorder is high in patients with CKD.Value of IFOBT independently predicts decline in renal function of CKD patients.

Efficacy,safety and tolerance of continuous erythropoietin receptor activator intravenous administration on anemia correction in dialysis patients with chronic renal anemia / 中华肾脏病杂志

Objective To evaluate the efficacy,safety and tolerance of continuous erythropoietin receptor activator (CERA) once every 2 weeks intravenous injection on anemia correction in dialysis patients compared to Epoetin-3 (EPO-β) administration.Methods An open-label,randomized,parallel,active-control and multi-center clinical trial was performed.All the hemodialysis or peritoneal dialysis patients with chronic renal anemia who had not been treated with erythropoiesis-stimulating agents (ESAs)for at least 8 weeks before entering the treatment phase were randomized (1∶1) to receive either CERA once every 2 weeks intravenous administration (CERA group,n=132) or intravenous EPO-β three times weekly (EPO group,n=133) for 24 weeks including 16-week correction period and 8-week efficacy evaluation period.At week 25,the patients who reached the target Hb (defined as Hb≥ 110 g/L and increase in Hb≥10 g/L from baseline without red blood cell transfusion during the 24 weeks after the first dose) were kept on CERA or EPO-β treatment regimen for the subsequent 28 weeks to evaluate the long-term safety and tolerability.The starting dose of CERA was 0.4 μg/kg.Two primary endpoints were (1) the Hb response rate during the first 24 weeks; and (2)the mean change in Hb between the baseline and the evaluation periods (week 17 to week 24).Results Totally 232 patients (87.5％) completed the first 24-week treatment and 198 patients (74.7％) completed the whole study treatment (52 weeks).The response rate in CERA group during the first 24 weeks was 87.12％[95％ CI(80.2％ to 92.3％)].Since the lower limit of the 95％CI was greater than 60％ (P ＜ 0.01),CERA once every 2 weeks intravenous administration was considered as effective in correction of renal anemia.The difference between CERA group and EPO group in mean change of Hb from evaluation periods to baseline in the per-protocol (PP) population was-4.7 g/L [95％CI (-7.38 g/L to-1.92 g/L)].Since the lower limit of 95％CI was greater than the pre-defined noninferiority margin-7.5 g/L (P=0.0205),CERA was considered as non-inferior to EPO in the maintenance of Hb after anemia correction.The Hb level remained stable during the subsequent 28-week extension period in both CERA and EPO groups.During the whole study period,the overall safety findings were similar in CERA and EPO groups,50.0％ and 54.6％ of patients experienced at least one adverse event (AE) respectively.The findings from AEs were in accordance with the characteristics of the studied population.Conclusions Intravenous CERA once every 2 weeks is safe and effective for correcting anemia in dialysis patients.Treatment with CERA once every 2 weeks is also non-inferior to 3 times weekly EPO in maintaining the Hb level after the correction.In general,long-term intravenous administration of CERA is well tolerated by dialysis patients with chronic renal anemia.

The awareness rate, treatment rate and control rate of mineral and bone disorder in patients with moderate or advanced stage chronic kidney disease / 中华肾脏病杂志

Objective To investigate the awareness rate,treatment rate and control rate of mineral and bone disorder in patients with moderate or advanced stage chronic kidney disease (CKD). Methods The awareness rate,treatment rate and control rate of mineral and bone disorder were evaluated based on a questionnaire and related laboratory examinations in 503 CKD stage 3 to 5 patients. Results The awareness rate of mineral and bone disorder in patients with moderate or advanced stage CKD was highest in hemodialysis patients,moderate in peritoneal dialysis patients and lowest in non-dialyzed patients (all P ＜0.01).The total scores of the questionnaire were lowest in non-dialyzed patients [6 (5,8)] and were significantly higher in peritoneal dialysis [11 (9,12)] and hemodialysis patients [13 (11,15)] (P＜0.01).The extent of awareness was negatively correlated with age (r=-0.11,P＜0.05),and positively correlated with educational background (r=0.226,P＜0.01),duration of CKD (r=0.597,P＜0.01) and duration of dialysis (r=0.366,P＜0.01).The source of knowledge was mainly from publicity and education made by medical staff,which accounted for 94.0％,79.5％ and 69.4％ respectively in nondialyzed,peritoneal dialysis and hemodialysis patients.The treatment rate was significantly higher in peritoneal dialysis (88.6％) and hemodialysis patients (96.9％) than that in non-dialyzed patients (58.2％) (all P＜0.01).According to K/DOQI guideline,the control rate of serum calcium,phosphorus,calcium and phosphorus product and parathyroid hormone (PTH) were much better in non-dialyzed patients as compared to dialyzed ones.The percentage of number of lab indicators meeting the standard was significantly higher in non-dialyzed patients as compared to dialyzed ones (P＜0.01).According to KDIGO guideline,the control rate of serum phosphorus was significantly lower in hemodialysis patients (23.6％) than that in peritoneal dialysis (36.9％) and non-dialyzed patients (46.7％) (P＜0.01). Conclusions In non-dialyzed patients with moderate or advanced stage CKD,the awareness rate and treatment rate of mineral and bone disorder are relatively low,and the control rate is relatively high.Whereas in dialyzed patients,the awareness rate and treatment rate are relatively high,and the control rate is relatively low.

Risk factors for progression of advanced chronic kidney disease——A monocentric cohort study from a specific CKD outpatient management clinic / 中华肾脏病杂志

Objective To identify the risk factors for progression of advanced chronic kidney disease(CKD) patients who were cared by nephrologists in a specific CKD outpatient management clinic.Methods A prospective monocentric cohort study was performed.CKD patients of stage 3, 4 and 5 without renal replacement treatment were followed up regularly by nephrologists in this specific CKD management clinic.Patients with established atherosclerotic renal artery stenosis(ARAS) and chronic tubulointerstitial nephritis, and those who had not been followed-up for at least 12 months before Jun.30, 2010 were excluded.Clinical and laboratory data including blood pressure (BP), proteinuria, hemoglobulin (Hb), calcium phosphate product (Ca×P) and serum creatinine were consecutively collected.The treatment regimen was also recorded.Estimated glomerular filtration rate(eGFR) was calculated with the formula modified for Chinese to evaluate the change of renal function.The progression of kidney disease was defined as initiation of renal replacement therapy, the annual decrease of eGFR＞4 ml·min-1·(1.73 m2)-1, and/or death associated with renal disease.Results A total of 138 patients were enrolled in the final analysis with 84 patients of CKD stage 3, 36 of CKD stage 4 and 18 of CKD stage 5, respectively.At the time of enrollment, patients had an average age of (56.5:±:16.7) years old with an average eGFR of (32.3±13.4) ml·min-1·(1.73 m2)-1.During a mean follow-up interval of (27.1±12.1) months, the patients were well-controlled with an average blood pressure of (126.5±12.4)/(76.4±7.9) mm Hg in 50.7％(70/138), less than or equal to 130/80 mm Hg, an average Hb of(123.8±17.1) g/L in 73.9％(102/138), above or equal to 110 g/L and an average Ca×P of (45.2±7.7) mg2/dl2 in 89.1％(123/138), less than or equal to 55 mg2/dl2.Sixty-two patients (44.9％) had progression of kidney disease. On univariate analysis, factors predicting progression were low eGFR at referral, high systolic pressure, low Hb level, high Ca×P and proteinuria during follow-up, and renin-angiotensin system inhibitors treatment did not affect the progression.After the adjustment, multivariate analysis revealed proteinuria and low Hb level were independent factors for the progression of kidney disease.Conclusions The co-morbidities of advanced CKD patients can be managed efficiently in specific CKD outpatient management clinic.Control of proteinuria and correction of anemia may be beneficial to prevent the progression of advanced CKD.

Epidemiology investigation of chronic kidney disease in 1031 consecutive cases undergoing coronary angiography / 中华肾脏病杂志

Objective To investigate the prevalence of CKD in patients underging coronary angiography with suspected coronary heart disease(CHD). Methods A total of 1031patients with suspected CHD undergoing coronary angiography in Zhongda Hospital from December 2008 to October 2009 were enrolled in the study.The prevalence of CKD and associated risk factors were analyzed.GFR Wag estimated with MDRD equation.CKD was deftned as eGFR<60branches of coronary artery was considered as CHD. Results The mean age of patients were (64.37±11.02)years.There were 543 males and 488 females,including 551 patients with CHD and 134 patients with CKD(13%).Patients with CHD had a significantly higher prevalence of CKD compared with patients without CHD(18.33%vs 6.88%,P<0.01).With the increasing number of stenosis coronary vessels(n=0,1,2,3),eGFR was declined[(84.25±19.00),(81.61±23.92),increased(0.42%,0.82%,1.96%,3.25%,P=0.006),and the prevalence of CKD increased (6.88%,13.11%,21.57%,23.38%,P<0.01).Logistic regression analysis indicated that increasing age(OR 1.094,95%C/1.068 to 1.120),increasing number of stenosis coronary vessels(OR 1.288,95%CI 1.074 to 1.543).hypertension(OR 1.974,95%CI 1.082 to 3.603),cardiac systolic insufficiency(OR 3.183,95%CI 1.696 to 5.972),and hyperuricemia(OR 5.366,95%CI 3.224 to 8.9311 were risk factors for CKD. Conclusions The prevalence of CKD in patients with CHD diagnosed by coronary angiography is quite high.Aging,elevated number of stenosis coronary vessels,hypertension,cardiac systolic insufficiency and hyperuricemia are important risk factors for angiographic patients with CKD.

Effect of parathyroid hormone on renal anemia in patients with chronic kidney disease / 中华肾脏病杂志

Objective To observe the mechanism of elevated parathyroid hormone(PFH) leading to erythrocytes life span shortened in the patients with chronic kidney disease(CKD).Methods Serum samples of 30 healthy people and 75 CKD patients were collected.Patients were divided into three groups according to their renal function.Intact parathyroid hormone(iPTH)was detected by immunochemiluminometry.The erythrocytes phosphatidylserine (PS) exposure and intracellular calcium concentration ([Ca2+]i)were measured by flow cytometry. Results (1)Levels of serum iPTH,[Ca2+]i and erythrocytes PS exposure increased gradually with the decline of renel function in stages 3 to 5 of CKD,the differences were significant with CKD 1 to 2 stages and healthy control group(all P＜0.05).(2)Pearson correlation analysis revealed,during CKD 3 to 5 stages,Hb was negatively correlated with iPTH and erythrocyte PS exposure respectively (r=-0.830 and-0.791,all P＜0.01);iPTH was positively correlated with[Ca2+]i and erythrocyte PS exposure (r=0.882 and 0.924,all P＜0.01),whereas negatively correlated with serum Ca respectively(r=-0.544,P＜0.01);erythrocyte PS exposure was positively correlated with[Ca2+]i(r=0.923,P＜0.01)and not correlated with serum Ca(r=-0.138,P=0.365).(3)The linear regression equation of[Ca2+]i(Y)for iPTH(X)was Y=3.327+0.213X(F=21.529,P＜0.05).The multiple linear regression equation of erythrocytes PS exposure(Y)for PTH (X1)and[Ca2+]i(X2)was Y=-0.303+0.283X2+0.139X1(F=6.59,P＜0.01). Conclusions By increasing intracellular calcium,iPTH can lead to an increase of the erythrocyte PS exposure.which will cause the occurrence of erythrocytes life span being shortened.As a result,the renal anemia will become more severe.

Impact of the new CKD-EPI equation on the staging of patients with chronic kidney disease based on abbreviated MDRD equation / 中华肾脏病杂志

Objective To compare the estimated CFR (eCFR) values using the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation with those from the abbreviated MDRD equation in a Chinese cohort with chronic kidney disease (CKD) and to analyze the impact of the new CKD-EPI equation on the staging of CKD. Methods A total of 450 Chinese patients (239 female and 211 male) with CKD were enrolled. eCFRs obtained by the CKD-EPI equation and the abbreviated MDRD equation were compared with the Bland and Altaian method. The agreement between two equations in CKD staging was assessed by Kappa test. Results Mean eGFR was 2.4 ml ·(min)-1 ·( 1.73 m2)-1 higher with the CKD-EPI equation as compared to the abbreviated MDRD equation. The percentage of CKD staging concordance between equations for stage 1, 2, 3A, 3B, 4, and 5 was 97.10% (n=67), 80.77% (n=105), 6 0.86% (n= 48), 87.69%(n=57), 90.38% (n=47) and 98.18% (n=54) respectively. Kappa index was 0.913 (95%C/: 0.881-0.945). The CKD-EPI equation reclassified 19.23% (n=25) and 39.24% (n=31) of patients with CKD stage 2 and 3A,upward to a higher eCFR category. Conclusions The new CKD-EPI equation reclassifies a number of patients to higher CKD stages, especially those classified as CKD stage 2 or 3A by the abbreviated MDRD equation.

Control of hypertension in patients with chronic kidney disease and its associated factors / 中华肾脏病杂志

Objective To investigate the management and control of hypertension in patients with chronic kidney disease(CKD) and its associated factors.Methods Data of 726in-patients with CKD and hypertension who hospitalized in our hospital from March 2009 to April 2010 were studied.Results 91.74％ of patients was treated with antihypertensive medications,and 21.21％, 22.59％, 19.56％, 28.37％ of patients received 1, 2, 3, ≥4 antihypertensive drugs,respectively.42.4％ of patients with CKD and hypertension could be controlled up to the standard,and the mean blood pressure was(137.86±20.75)/(76.30±11.35) mm Hg.There was significant difference among stage 1 plus 2, 3, 4 plus 5 (non-dialysis), 5 (dialysis) kidney diseases, with the hypertension control rate being 50.8％, 46.7％, 42.0％, 33.5％, respectively.The hypertension control rate of non-dialysis patients was significantly higher than that of dialysis (44.9％ vs 33.5％,P＜0.05).There was no significant difference between blood dialysis group and peritoneal dialysis group(32.3％ vs 38.7％, P＞0.05).Multivariate Logistic regression analysis showed that female (OR=1.787, 95％CI 1.045-3.056)and ACEI application (OR=4.378, 95％CI1.830-10.472) were positively associated with hypertension control.Whereas, diabetes (OR=0.415, 95％CI 0.188-0.919)and pulse pressure (OR =0.847, 95％ CI 0.811-0.885) were associated with inadequate blood pressure control.ConclusionsDespite almost universal hypertension treatment is used in patients with CKD and high blood pressure, the hypertension control rate is still suboptimal.Female and ACEI are positively associated with adequate hypertension control, whereas diabetes and pulse pressure are negatively associated with the standard.

Association of vascular calcification and gremlin expression in radial arteries of patients with stage 5 of chronic kidney disease / 中华肾脏病杂志

Objective To study the association of the expression of bone morphogenetic protein (BMP) antagonist gremlin and vascular calcification in radial arteries of patients with stage 5 of chronic kidney disease (CKD).Methods Radial arteries of 40 patients with stage 5 of CKD were collected as specimens of the study group,which were trimmed off during arterial venous fistula operations.Splenic trabecular arteries were collected as specimens of the control group,which were removed from 38 patients with simple traumatic splenic rupture.All the arteries were examined histologically for calcification with yon Kossa stain.Expressions of gremlin and BMP-2,-7were detected by immunohistochemistry and their serum concentrations were detected by ELISA.Images of histological sections were semi-quantitatively analyzed by Image-Pro Plus 6.0.SPSS 19.0software was used to perform statistical analysis.Results Significantly positive von Kossa stain was found in radial arteries from 12 of 40 patients (30％) in study group,which located in the layer of medial smooth muscle cells.However,there was no obvious positive stain in control group.Additionally,in study group,significant expressions of gremlin and BMP-2 were detected in those radial arteries of positive yon Kossa stain,which also located in the layer of medial smooth muscle cells.Positive correlations were found among gremlin expression level,BMP-2 expression level and yon Kossa stain intensity.However,the BMP-7 expression intensity in arteries of study group was much weaker as compared to control group.Conclusions Both gremlin and BMP-2 may be involved in the process that the smooth muscle cells of radial arteries in patients with stage 5 of CKD phenotypically transform into osteoblast-like cells.However,BMP-7 possibly prevents this process.

Epidemiologic study of chronic kidney disease in Changsha county of Hunan province / 中华肾脏病杂志

Objective To investigate the prevalence of chronic kidney disease (CKD) and associated factors in Changsha county of Hunan province. Methods Using a stratified, multistage sampling, 1950 residents (older than 20 years old) from 3 towns of Changsha county were randomly selected to be interviewed and tested for the kidney damage indicators and the associated factors with CKD. Results Eligible data of 1727 subjects were enrolled in the study. After the adjustment of age and gender compenent, the prevalence of albuminuria was 8.5%, hematuria 5.1%, and reduced eGFR 1.5%. Approximately 14.6% subjects had at least one indicator of kidney damage, and the awareness rate was 16.5%. Age, hypercholesteremia, hypertriglyceridemia, hypertension and diabetes were independently correlated with albuminuria. Female, age, hypertriglyceridemia and hyperuricemia were independently correlated with reduced renal function. Female was independently correlated with hematuria. Conclusions The prevalence of chronic kidney disease is 14.6% and the awareness rate is 16.5% in suburban adult population of the central south area of China. The spectrum and correlated factors of CKD in this county undergoing fast economic development are close to those of Guangzhou and developed countries.

Peritoneal protein losses, a novel predictor of cardiovascular diseases in patients on continuous ambulatory peritoneal dialysis / 中华肾脏病杂志

Objective To study the relationship between cardiovascular diseases (CVD)and 24-h peritoneal protein losses (PPL) in continuous ambulatory peritoneal dialysis (CAPD)patients. Methods One hundred and seventy-eight CAPD patients in our department were enrolled in this study. Their 24-h PPL was measured and other clinical data were recorded at the beginning. Meanwhile, Doppler ultrasound examination was performed. They were then followed-up prospectively for the development of CVD. Results The average of 24-h PPL was (5.0±1.8) g.Patients with diabetic status or preexisting CVD or carotid arteries arteriosclerosis had higher 24-h PPL than those without (t=2.082, P=0.039; t=2.601, P=0.010; t=2.217, P=0.029). 24-h PPL was positively correlated with left ventricular end-diastolic diameter (LVDd), interventricular septal thickness (IVSTd), posterior wall diameter of left ventricle at end-diastolic (LVPWd) and left ventricular mass index (LVMI) (r=0.222, P=0.040; r=0.217, P=0.043; r=0.339, P=0.002; r=0.305, P=0.007). It was negatively correlated with ejection fraction of left ventricle (r=0.221, P=0.040). One hundred and fourteen CAPD patients were prospectively followed-up for at least twelve months. Patients developing CVD were 40.4% and 19.3% for high and low PPL groups respectively (x2=6.035, P=0.014). In the multivariable logistic regression analysis, the 24-h PPL was one of the independent factors for developing CVD. Conclusions There is a significant and independent relationship between 24-h PPL and new cardiovascular events. 24-h PPL may be an important predictor of cardiovascular disease.