ABSTRACT
Objective To observe the relationship between serum Klotho levels and the progression of renal function in patients with chronic kidney disease (CKD)and investigate further the feasibility of serum Klotho levels for predicting the progression of renal function in CKD patients.Methods Eighty-one non-dialysis patients with CKD 3 to 5 stages and 30 healthy volunteers in the First People's Hospital of Kunshan were enrolled for a 12 months of follow-up.The levels of Klotho and fibroblast growth factor 23 (FGF23) in serum were detected by ELISA at the beginning and the end of the follow-up.The other related indicators were also tested simultaneously.GFR values were calculated by MDRD and GC formulas.According to the decreasing range of GFR,the CKD patients were subdivided into two groups:deterioration group and stability group for renal function,and the relationships between Klotho levels and progression of kidney function were evaluated.Results The patients were followed up for an average of (9.5 + 2.9) months.GFR in CKD patients decreased from (24.8 ± 12.4) mL/min to (18.7 ± 12.1) mL/min (P ＜ 0.0 1),and serum Klotho level decreased from 2.53 (1.41,3.67)ng/mL to 1.63 (1.07,3.19)ng/mL (P ＜0.01)with more pronounced trend in the patients with renal function deterioration than the patients in stability group (P ＜0.01).Fifteen patients with high Klotho level suffered from adverse kidney outcomes while 26 ones with lower Klotho level suffered from deterioration of renal function (63.4％ vs 36.5％,P =0.02).KaplanMeier analysis revealed the high risk of adverse kidney outcomes arose in the CKD patients with lower Klotho level (P =0.013).Conclusion Klotho level in CKD patients may significantly decrease and should be more apparent with renal function progresses.Lower Klotho level in serum may be associated with high risk of adverse kidney outcomes and become a promising marker to predict CKD progression.
ABSTRACT
AIM: The survival outcome of patients with unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) who received transarterial chemoembolization (TACE) combined with radiotherapy (RT) remains unclear. METHODS: A total of 112 and 735 HCC patients with PVTT undergoing TACE combined with RT and TACE alone, respectively, were evaluated. One hundred and eight pairs of matched patients were selected from each treatment arm by using a propensity score matching (PSM) analysis. RESULTS: Of the whole study population, TACE combined with RT showed significant survival benefits compared with TACE in all patients (median survival, 11.0 vs 4.8 months; P < 0.001), especially in patients with PVTT involving the right/left portal vein (median survival, 12.5 vs 5.2 months; P < 0.001) and main portal vein trunk (median survival, 8.9 vs 4.3 months; P < 0.001). After one-to-one PSM, 108 pairs of matched patients were selected for further analysis. In the propensity model, the median survival time was 10.9 versus 4.1 months (P < 0.001) in all patients, 12.5 versus 4.4 months (P = 0.002) in patients with PVTT involving the right/left portal vein and 8.9 versus 4.0 months (P < 0.001) in patients with PVTT involving the main portal vein trunk. The treatment, maximum lesion diameter and main trunk PVTT were the independent prognostic factors for survival at uni- and multivariate analysis. CONCLUSION: TACE combined with RT provides a significantly better survival outcome than TACE for unresectable HCC patients with PVTT, especially for patients with PVTT involving the right/left portal vein or main trunk.
