ABSTRACT
Introduction: Previous studies suggested that sevelamer carbonate is well tolerated with a favorable efficacy and safety profile in both dialysis and nondialysis patients in Europe; however, the efficacy remains controversial, and few studies have examined sevelamer carbonate therapy in other ethnic nondialysis CKD patients. This study assessed the efficacy and safety of sevelamer carbonate in Chinese nondialysis CKD patients with hyperphosphatemia. Methods: The multicenter, randomized, double-blind, parallel-group, placebo-controlled, and phase 3 clinical trial enrolled 202 Chinese nondialysis CKD patients with serum phosphorus ≥1.78 mmol/L. Patients were randomly assigned 1:1 to receive sevelamer carbonate (2.4-12 g per day) or placebo for 8 weeks. The primary outcome was the change in serum phosphorous between baseline and week 8. Results: Totally 482 Chinese patients were screened and 202 were randomized (sevelamer carbonate, n = 101; placebo, n = 101). The mean serum phosphorous decreased significantly in patients treated with sevelamer carbonate compared with placebo (-0.22 ± 0.47 vs. 0.05 ± 0.44 mmol/L, p < 0.0001). Significantly (p < 0.0001), decreases of serum total cholesterol, low-density lipoprotein cholesterol, and calcium-phosphorus (Ca × P) product levels from baseline to week 8 were shown in sevelamer carbonate group compared with placebo group. Serum intact parathyroid hormone was not significantly changed in the sevelamer carbonate group (p = 0.83). Patients in the sevelamer carbonate group experienced similar adverse events as the placebo group. Conclusion: Sevelamer carbonate is an effective and well-tolerated phosphate binder in advanced nondialysis CKD Chinese patients with hyperphosphatemia.
ABSTRACT
Objective: To explore the application value of nursing intervention under the guidance of risk prevention management concept in preventing vascular access infection in patients undergoing maintenance hemodialysis (MHD). Methods: A total of 100 MHD patients who were admitted to the intensive care unit (ICU) of our hospital from May 2019 to May 2020 were enrolled. Based on the principle of double-blind grouping, patients were randomly divided into the risk management group and control group, with 50 cases in each group. The control group was given routine nursing, while the risk management group was given nursing intervention under the guidance of risk prevention management concept on the basis of the control group. The nursing intervention effect and incidence of vascular access infection were compared between the two groups. The psychological status and quality of life in both the groups were evaluated by the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Short Form 36 Health Survey (SF-36). Results: After intervention, biochemical indexes (serum albumin, creatinine, and hemoglobin) and body mass in the risk management group were significantly higher than those in the control group, while malnutrition-inflammation score (MIS) was significantly lower than the control group (P < 0.05). After intervention, SAS and SDS scores in both the groups were significantly decreased, which were significantly lower in the risk management group than in the control group (P < 0.05). At 8 w and 12 w after intervention, incidence rates of vascular access infection in risk management group were significantly lower than those in the control group (10.00% vs. 26.00% and 12.00% vs. 34.00%, P < 0.05). After intervention, SF-36 scores in each dimension of both the groups were significantly increased, which were significantly higher in the risk management group than in the control group (P < 0.05). Conclusion: The implementation of nursing intervention under the guidance of risk prevention management concept for MHD patients can effectively improve biochemical indexes, nutritional status, and body mass and reduce the incidence of vascular access infection, which is of great significance for improving psychological status and quality of life.
ABSTRACT
Podocyte injury contributes to glomerular injury and is implicated in the pathogenesis of diabetic nephropathy. Formyl peptide receptor (FPR) 1 is abundantly expressed in neutrophils and mediates intracellular transport of Ca 2+. Intracellular Ca 2+ regulates pathological process in renal podocyte and plays a role in diabetic nephropathy. However, the role of formyl peptide receptor 1 in podocyte injury of diabetic nephropathy has not been reported yet. Firstly, a rat model with diabetic nephropathy was established by streptozotocin injection, and a cell model was established via high glucose treatment of mouse podocytes (MPC5). Formyl peptide receptor 1 was enhanced in streptozotocin-induced rats and high glucose-treated MPC5. Secondly, streptozotocin injection promoted the glomerular injury with decreased nephrin and podocin. However, tail injection with adenovirus containing shRNA for silencing of formyl peptide receptor 1 attenuated streptozotocin-induced glomerular injury and the decrease in nephrin and podocin. Moreover, silencing of formyl peptide receptor 1 repressed cell apoptosis of podocytes in diabetic rats and high glucose-treated MPC5. Lastly, protein expression levels of p-p38, p-ERK, and p-JNK protein were up-regulated in streptozotocin-induced rats and high glucose-treated MPC5. Silencing of formyl peptide receptor 1 attenuated high glucose-induced increase in p-p38, p-ERK, and p-JNK in MPC5, and over-expression of formyl peptide receptor 1 aggravated high glucose-induced increase in p-p38, p-ERK, and p-JNK. In conclusion, inhibition of formyl peptide receptor 1 preserved glomerular function and protected against podocyte dysfunction in diabetic nephropathy.
