Chinese Journal of Nephrology

Select

Effect of long session hemodialysis on the quality of life in maintenance hemodialysis patients

DAI Wen-di;ZHANG Dong-liang;LIU Wen-hu.

2012, 28(10): 747-751.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To study the effect of long session hemodialysis (LSHD) on the quality of life in maintenance hemodialysis (MHD) patients. Methods A total of 40 MHD patients in our dialysis center were enrolled in the study. Quality of life was investigated by SF-36 table. Sleep questionnaire survey concluded the Athens insomnia scale (AIS), Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale（ESS). Clinical data were collected. Forty MHD patients were equally divided into HD and LSHD groups according to clinical data and sleep quality score for prospective study. Hemodialysis dose of HD group was 4 h thrice weekly, and of LSHD group was 8 h thrice weekly. The trial lasted for 6 months. Changes of life quality were compared between two groups. Results As compared to HD group, LSHD group had significant higher Kt/V (1.73±0.36 vs 1.41±0.23, P＜0.05), higher levels of serum hemoglobin [(124.67±9.08) vs (110.55±9.01) g/L, P<0.01] and albumin [(45.01±2.66) vs (39.28±2.63) g/L, P<0.01]. better sleep quality score(16/20 vs 5/20, P=0.001) and higher blood pressure control proportion (14/20 vs 5/20, P=0.010), higher score of SF-36(P<0.05). Conclusion LSHD can improve the life quality of MHD patients by increasing sleep quality and nutrition level.

Select

Association of pro-hepcidin with inflammation and iron metabolism in hemodialysis patients with erythropoietin resistance

WANG Lei;GUAN Guang-ju;WANG Gong-ling.

2012, 28(10): 752-756.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To examine the association of pro-hepcidin with iron metabolism and inflammation in maintenance hemodialysis (MHD) patients with erythropoietin (EPO) resistance. Methods Forty MHD patients and twenty healthy controls were enrolled in the study. Among MHD patients, 20 were hyporesponsive to EPO therapy and 20 were normal responsive to EPO therapy. Complete blood red cell count (RBC), Hb concentration, hematocrit (Hct), reticulocyte count (Ret), and serum ferritin (SF), serum iron (Fe), total ironbinding capacity (TIBC), saturation rate of transferrin (TSAT), transferrin (TF), hyper-sensitive C-reactive protein(hs-CRP), pro-hepcidin were measured in all the patients and controls. Differences were compared between groups. Influencing factors were analyzed by Pearson correlation. Predicting value of pro-hepcidin was investigated by ROC curve. Results Serum levels of SF, pro-hepcidin and hs-CRP were significantly higher in MHD patients than those in healthy controls (P<0.01), while serum TF was lower in MHD patients(P<0.05). Serum levels of SF, pro-hepcidin and hs-CRP were significantly higher in EPO resistant patients as compared to normal responsive cases(P<0.01). Serum pro-hepcidin level was positively correlated with SF (r=0.843, P=0.000) and hs-CRP (r=0.695, P=0.001). In predicting EPO resistance, area under ROC curve of pro-hepcidin, SF and hs-CRP was 0.713, 0.769 and 0.958 respectively. Conclusions EPO resistance is correlated with inflammation and iron metabolism. Serum pro-hepcidin, SF and hs-CRP may be used as markers of EPO resistance in MHD patients.

Select

Association of residual renal function at initiation of dialysis with prognosis in maintenance dialysis patients

ZHU Li-na;LV Wen-lv;TENG Jie;ZOU Jian-zhou;LIU Zhong-hua;SHEN Bo;ZHONG Yi-hong;DING Xiao-qiang.

2012, 28(10): 757-764.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To examine the association between residual renal function at initiation of dialysis and prognosis in maintenance dialysis patients. Methods Incident patients with end-stage renal diseases initiating dialysis between 1 January 2005 and 30 September 2009, followed up to 31 March 2010 were enrolled in this study. Residual renal function was evaluated using eGFR estimated by the abbreviated MDRD equation. Patients were classified into four groups according to eGFR of ≥10.5, 8 to <10.5, 6 to <8, <6 ml•min-1•(1.73 m2)-1. The outcome was all-cause and cardiocerebral vascular mortality. Results (1) A total of 562 patients were included. The median eGFR at initiation of dialysis was 5.60 (2.26-12.62) ml•min-1•(1.73 m2)-1. The median follow-up time was 17 (0-58) months from initiation of dialysis and 141 patients died within this period. The median survival time was 45.48 (43.05-47.90) months. With eGFR declined, Scr, BUN, serum uric acid, serum prealbumin, phosphorus, calcium and phosphate product, iPTH, mean arterial pressure (MAP) at initiation of dialysis increased (P<0.05), and hemoglobin, proportion of male, proportion of diabetes comorbidity, proportion of the Charlson comorbidity index≥5 decreased (P<0.05). Though there was no significant difference among the four groups, the proportion of left ventricular hypertrophy comorbidity increased when eGFR declined. (2) There was no significant difference of all-cause mortality among four groups using Kaplan-Meire survival curve. Cox regression model indicated no significant difference of all-cause mortality in levels of eGFR (HR=1.012, 95%CI 0.961-1.065, P=0.654). Without patients died in the first 3 months, the multivariate Cox regression model indicated eGFR at initiation of dialysis was the protective factor to 1 year survival (HR=0.791, 95%CI 0.669-0.935, P<0.01). (3) The multivariate Cox regression model indicated the risk of overall and 1 year cardiocerebral vascular death decreased with eGFR at initiation of dialysis increased (HR=0.868, 95%CI 0.777-0.971, P<0.05; HR=0.937, 95%CI 0.851-0.992, P<0.05, respectively). (4) The multivariate Cox regression model indicated eGFR at initiation of dialysis was benefit to survival of patients treated by peritoneal dialysis, with all-cause death risk decreased by 10% when eGFR increased by 1 ml•min-1•(1.73 m2)-1 (HR=0.90, 95%CI 0.81-0.99, P<0.05). In hemodialysis patients, Kaplan-Meire survival curve was significantly different among the four groups (Log-rank test, P=0.047); the survival of the group of 8 to <10.5 ml•min-1•(1.73 m2)-1 was lower as compared to the groups of 6 to <8 (Log-rank test, P=0.033) and <6 ml•min-1•(1.73 m2)-1 (Log-rank test, P=0.005); but the multivariate Cox regression model indicated no relationship between survival and eGFR. In the subgroup of chronic glomerulonephritis as primary renal disease, the eGFR at initiation of dialysis was the benefit factor, with all-cause death risk decreased by 16.6% (HR=0.834, 95%CI 0.736-0.946, P<0.01) and cardiocerebral vascular death risk decreased by 18.2% (HR=0.818, 95%CI 0.669-0.999, P<0.05) when eGFR increased by 1 ml•min-1•(1.73 m2)-1. In the subgroup of chronic glomerulonephritis treated by peritoneal dialysis, the all-cause death risk decreased by 32.1% with eGFR increased by 1 ml•min-1•(1.73 m2)-1 (HR=0.679, 95%CI 0.535-0.862, P<0.01). Conclusions Early initiation of dialysis may not be associated with improved overall survival, but may reduce cardiocerebral vascular and 1 year all-cause mortality, improve the survival of chronic glomerulonephritis patients and peritoneal dialysis patients.

Select

Analysis of risk factor of acute kidney injury after craniocerebral injury

DUAN Lei;ZENG Rong;KONG Yu-ke;WANG Jian-qin;YANG Xiao-yan;YANG Ke-hu;LI You-ping.

2012, 28(10): 765-768.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To investigate the incidence and risk factors of acute kidney injury (AKI) after craniocerebral injury. Methods A single cohort of 791 patients who suffered from craniocerebral injury from January 2008 to January 2010 in the Second Hospital of Lanzhou University were prospectively analyzed. Craniocerebral injury was defined according to definite medical history of craniocerebral injury, the verification of CT and Glasgow coma scale (GCS) score. AKI was defined as a relative 50% increase or an absolute increment of 26.4 μmol/L in Scr within 48 hours and/or urine volume ＜0.5 ml•kg-1•h-1 up to 6 h. Multivariate Logistic regression analysis was used to evaluate possible risk factors associated with post-craniocerebral injury AKI. Results Of the 791 patients, the incidence of AKI was 39.4%. In hospital mortality of AKI patients was 27.9%, which was 5.065 times of non-AKI patients(P＜0.01). The incidence of AKI in patients with lower GCS score(≤8 score，heavy group）was 69.7%, which was significantly higher as compared to moderate and mild groups(P＜0.01). Unconditional multivariate Logistic regression analysis revealed that lower GCS score (≤8 score), hypotension (systolic pressure＜90 mm Hg), elderly and male were the independent predictors of AKI episodes, the corresponding OR values were 2.932, 2.176, 1.789, 1.544 respectively. Conclusions AKI is a common complication after craniocerebral injury. Lower GCS score, hypotension, elderly and male are the independent risk factors of AKI in patients after craniocerebral injury.

Select

Causes analysis of 652 hospital stays in patients with autosomal dominant polycystic kidney disease

RONG Shu;MA Yi-yi;CHEN Dong-ping;ZHANG Tong;SUN Hai-peng;HE Liang-liang;LI Lan-jun;CHEN Zhou;CHENG Ye;LI Lin;SUN Li-jun;XU Cheng-gang;YU Sheng-qiang;ZHAO Xue-zhi;YE Chao-yang;MEI Chang-lin.

2012, 28(10): 769-774.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To analyze the causes of 652 hospitalizations in the patients with autosomal dominant polycystic kidney disease (ADPKD). Methods The medical records of all ADPKD inpatients in our hospital from January 1, 1990 to December 31, 2010 were collected. The differences of hospitalization causes in different age, gender and period were analyzed. Results (1)In 652 hospitalizations, the most common cause was lumbar pain (15.2%), followed by cystic bleeding (14.6%), aggravating renal failure (10.1%), dialysis-related problems (9.4%), renal transplant related issues (8.3%), renal replacement therapy for ESRD (8.0%), urinary tract infection (6.4%), end stage renal failure (5.8%), hypertension (4.1%), renal cyst volume enlargement (3.7%), finding polycystic kidney disease (2.1%), urinary lithiasis (1.8%) and others (10.4%). (2)Younger patients were admitted into hospital because of polycystic kidney bleeding and finding PKD. With the increase of patients age, hospitalization due to dialysis-related problems increased, while many middle-aged patients were hospitalized because of back pain. (3)Male patients were admitted into hospital for aggravating renal failure, ESRD, kidney transplantation-related problems and urinary lithiasis, while female patients mainly for lumbar pain, dialysis-related problems and urinary tract infection. (4)The proportion was significantly reduced with time of finding PKD, renal failure and polycystic kidney bleeding, the proportion of renal cysts increasing and aggravating renal failure increased, there was a significant increase in the proportion of patients with hypertension, while a significant decrease in the proportion of patients with uncontrolled hypertension, and the average SBP was also significantly reduced. Conclusions The highest rate of hospitalization of ADPKD patients is in 40 to 60 age group. Cause of admission varies with age and gender, and changes with the change of time. Over the past decade, the proportion of hospitalization due to renal cysts enlargement and renal failure aggravation increased significantly. The incidence of hypertension is higher than that in the first 10 years, but hypertension control rate increases compared with the previous. Prevention should focus on finding the suppression measures of renal cysts enlargement.

Select

A meta-analysis of hemoglobin target for anemia of patients with chronic kidney disease

HOU Jing;YUAN Wei-jie.

2012, 28(10): 775-779.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To explore the role of hemoglobin(Hb) level in mortality and morbidity of chronic kidney disease(CKD) patients, aiming to give some evidence for therapy of anemia. Methods Randomized, clinical trials（RCTs) were identified by searching Medline, Embase and the Cochrane library. All the analyses were performed using the Revman software available free from the Cochrane collaboration. Results Twenty-three trials involving 10 204 patients were identified. Overall, the high Hb target was associated with increased risk of all-cause mortality (RR=1.10, 95% CI 1.00 to 1.21), hypertension (RR=1.40, 95% CI 1.12 to 1.75), stroke and hospitalization (RR=1.07, 95% CI 1.00 to 1.14) compared with low Hb target (P<0.05). No significant difference was found in the risks of non-fatal mycardial infarction (RR=1.13, 95% CI 0.79 to 1.62) and renal replacement therapy (RR=1.00, 95% CI 0.85 to 1.18). Conclusions Targeting low Hb target is beneficial to CKD patients based on reduced risk of hypertension, hospitalization, stroke and all-cause mortality. However, no significant difference is found in non-fatal mycardial infarction and renal replacement therapy.

Select

Association of MYH9 gene single nucleotide polymorphism with clinic，pathology and prognosis of IgA nephropathy patients among Han nationality population in Inner Mongolia

WANG Cai-li;TIAN Yuan-qing;LIU Li-ping;JIA Ni-ya;NAN Lei.

2012, 28(10): 780-784.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To study the association of MYH9 gene single nucleotide polymorphism (SNP) with clinical manifestation, pathology and prognosis of IgA nephropathy (IgAN) patients of Han nationality population in Inner Mongolia Autonomous Region. Method One hundred and forty-eight IgAN patients proven by biopsy were enrolled in the study. Fifty-six patients were followed up for 1-97 months. DNA was extracted from the peripheral blood of above patients. PCR restriction fragment length polymorphism (RFLP) assay was used to detect the single nucleotide polymorphisms of MYH9 gene Rs3752462, Rs4821480 sites. Association of different genotypes with clinical features, pathology and prognosis im patients with IgA nephropathy was examined. Result (1) Rs3752462 site was consistent with Hardy-Weinberg equilibrium，while Rs4821480 site did not meet the Hardy-Weinberg equilibrium. (2) IgAN patients with MYH9 gene Rs3752462 site TT genotype had lower systolic blood pressure as compared to those with CC+CT genotype(P<0.05). There were significant differences in systolic blood pressure, diastolic blood pressure and age between patients with Rs4821480 site GG genotype and patients with TT or GT genotype(P<0.05). There were no significant differences in Scr, Ccr, plasma albumin, hemoglobin, microscopic hematuria, proteinuria, pathological HASS classification, pathological lesion among Rs4821480 site GG, TT, GT genotypes. (3) Kaplan-Meier survival analysis revealed the time from renal biopsy to renal function decline was shorted in patients with Rs3752462 site CC genotype and Rs4821480 site TT genotype. Conclusions C allele of MYH9 gene Rs3752462 site is an independent risk factor of high blood pressure damage in IgAN patients. Polymorphism of 3 genotypes of MYH9 gene Rs4821480 site is associated to the prognosis of patients. Carrying Rs3752462 site C allele and Rs4821480 site T allele may affect the prognosis of patients.

Select

Preliminary study of microRNA related to renal interstitial fibrosis in rats

YOU Xiao-han;ZHANG Hui-di;SU Zhen;XUE Xiang-yang;HUANG Zhao-xing.

2012, 28(10): 785-789.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To investigate the expression pattern of microRNA (miRNA) in the kidneys of unilateral ureteral obstruction (UUO) rats and to identify specific miRNA related to renal interstitial fibrosis (RIF). Methods Forty-eight male SD rats were divided into two groups: UUO group and sham-operated (Sham) group. Rats were sacrificed at 3, 7 and 14 days after operation. Histologic changes were examined by Masson staining. Forty-eight selected miRNAs were examined by stem-loop real-time qPCR. Results At the 3rd day after operation, obstructed kidneys from operation rats showed mild edema in the interstitium and mononuclear cell infiltration. At the 7th day after operation, focal interstitial fibrosis was observed. At the 14th day after operation, fibrosis became more severe. The Sham kidneys showed no pathological changes. At the 3th day after operation, 25 miRNAs were differentially expressed. At the 7th day after operation, 24 miRNAs were aberrantly expressed, whereas 21 miRNAs were differentially expressed at the 14th day after operation (P<0.05). Among these miRNAs, miR-132, miR-192, miR-194, miR-29c and miR-203 were consistently up-regulated or down-regulated in a time-dependent manner after operation. There were significantly correlations between the expression of five miRNAs and severity of tubulointerstitial injury (P<0.05). Conclusions There are at least 20 miRNAs differentially expressed in the process of RIF induced by UUO. There are significantly correlations between the expression of miR-132, miR-192, miR-194, miR-29c and miR-203 and the severity of tubulointerstitial injury. They may be closely related to RIF. A further study is needed.

Select

Role of SARA in renal tubular epithelial to mesenchymal transition in diabetic nephropathy and its associated mechanism

TANG Wen-bin;LING Guang-hui;SUN Lin;PENG You-ming;DUAN Shao-bin;LIU Hong;LI Ying;XIAO Li;LIU Fu-you.

2012, 28(10): 790-797.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To determine the effect of smad anchor for receptor activation (SARA) on renal tubular epithelial to mesenchymal transtion (EMT) induced by high glucose and to investigate the associated mechanism. Methods HK-2 cells were exposed to high glucose (30 mmol/L). HK-2 cells were transfected with the plasmids of wild-type SARA [SARA (WT)] or SARA mutant [SARA with SBD deletion, called SARA (dSBD)] and then was stimulated by high glucose. The gene expression was assayed by real-time PCR and the protein expression was detected by Western blotting. Results During the process of high glucose-induced EMT of HK-2 cells, the gene and protein expression of SARA were down-regulated. The expression of TGF-β1 and Smad3 increased after stimulation of high glucose in HK-2. However, the Smad2 mRNA expression increased while its protein expression was down-regulated in a time-dependent manner. Smad2 and Smad3 were activated by high glucose stimulation and Smad3 kept activation for longer time than Smad2. Compared with high glucose group, over-expression of SARA by transfection of SARA (WT) up-regulated the expression of zona occludens(ZO)1 and down-regulated the expression of vimentin (P<0.05). However, SARA (dSBD) had no such effects on above expressions. The Smad2 protein expression increased along with the over-expression of SARA. Meanwhile, over-expression of SARA prolonged the activation time of Smad2 and shortened the activation time of Smad3. Conclusions TGF-β1 signaling is activated and SARA expression is down-regulated during the process of high glucose-induced EMT in HK-2 cells. Over-expression of SARA can inhibit the EMT via increase of Smad2 protein expression and longer activation time of Smad2.

Select

Effect of angiotensin 1-7 on renal tubulointerstitial fibrosis of diabetic rats

LI Xiang-you;DING Guo-hua;XIA Yuan-yu;CHEN Xing-hua;LIANG Wei.　

2012, 28(10): 798-803.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To investigate the effects of angiotensin1-7 (Ang1-7) on renal tubulointerstitial fibrosis of diabetic rats. Methods Thirty-two male Wistar rats were randomly divided into four groups: normal control group, diabetic group, telmisartan group, Ang1-7-treated group. For 9 weeks after diabetes mellitus model established, 24 h proteinuria, urine NAG/Cr, glucose, insulin, TG, TC, BUN, Scr, Na+ and K+ were assessed. Renal pathological changes were evaluated by PAS staining; Expression of TGF-βl, PPARγ and α-SMA mRNA was deteeted by real-time PCR; Protein levels of PPARγ, α-SMA and TGF-βl were detected by Western blotting. Results (1)At the end of the ninth week, the blood pressure, proteinuria, renal weight/body weight in group DM were significantly higher than those in group NC (P＜0.05). (2)Renal interstitial fibrosis in group DM was obviously severe as compared to group NC (P＜0.05), but was improved in group TM and group T(P＜0.05). (3)TGF-βl and α-SMA mRNA in group DM were significantly increased, and PPARγ mRNA was significantly decreased. Compared with group DM, TGF-βl and α-SMA mRNA were significantly decreased, and PPARγ mRNA was significantly increased in group TM and group T, especially in group T. (4)TGF-βl and α-SMA in group DM were significantly increased, and PPARγ decreased significantly. Compared with group DM, TGF-βl and α-SMA decreased significantly, PPARγ increased significantly in group TM and group T, especially in group T. Conclusion Ang1-7 inhibits high glucose-induced α-SMA expression in vivo through up-regulating the PPAR expression and may inhibit renal tubulointerstitial fibrosis of diabetic rats.

Select

Protection of NGAL on renal tubular epithelial cells in rat renal ischemia reperfusion injury

2012, 28(10): 804-807.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To investigate the effects of neutrophil gelatinase associated lipocalin(NGAL) on renal tubular epithelial cells apoptosis and apoptosis-regulated protein fas, bcl-2 in rat renal ischemia reperfusion injury(IRI). Methods Renal IRI models of rats were established. Rats were randomly divided into 3 groups, including control group, IRI model group and NGAL group. The pathological change of kidney tissue was investigated by hemotoxylin-eosin staining. Renal tubular epithelial cells apoptosis was detected by TUNEL method. Expression of fas and bcl-2 was measured by real-time PCR and Western blotting. Results Compared with IRI model group, NGAL group showed a decreased number of renal tubular epithelial cells apoptosis [(8.6±3.4)/HP vs (20.8±3.7)/HP, P<0.05], down-regulated fas mRNA (2.34±0.51 vs 6.84±2.34, P< 0.05), fas protein (0.65±0.05 vs 0.95±0.08, P<0.05) and up-regulated bcl-2 protein (0.33±0.05 vs 0.24±0.03, P<0.05), but the bcl-2 mRNA had no significant change. Conclusion NGAL can protect renal tubular epithelial cells in renal IRI, which may be associated with decreasing cell apoptosis and adjusting protein expression by apoptosis-regulated cytokines.

Select

Effect of hyperbaric oxygen treatment on the expression of FasL and caspase-3 in renal tissue after renal ischemia reperfusion injury

SUN Hui, XU Xin-bing, MA Ling-bo, HU Guang-rong, DENG Ying, WANG Xin-chun, WANG Feng-ping.

2012, 28(10): 808-812.

Abstract ( ) PDF ( )

Knowledge map

Save

Objective To observe the effects of hyperbaric oxygen(HBO) on the expression of FasL mRNA and caspase-3 protein in renal tissue after renal ischemia-reperfusion injury(IRI) in order to elucidate the underlying mechanisms. Methods Rats were randomly divided into three groups: sham group(n=8), IRI group(n=8) and IRI+HBO group(n=8). The IRI group and the IRI+HBO group recieved 45 minutes hibateral renal ischima and the IRI+HBO group received additional HBO therapy at the 1st, 24th and 48th hour after ischemia. The kidneys were removed at the end of HBO therapy. Malondialdehyde(MDA) level and superoxide dismutase(SOD) activity were measured to determine the extent of oxidative stress. The expression of FasL mRNA and caspase-3 protein was detected by quantitative real-time PCR and immunohistochemical staining in renal tissue respectively. Results Compared with the sham group, MDA level increased markedly and SOD activity decreased markedly after ischemia. After HBO treatment, MDA level decreased and SOD activity increased significantly(P<0.05). In IRI group, the expression of FasL mRNA and caspase-3 protein were higher than those in the sham group (P<0.01), which were reduced significantly by HBO treatment(P<0.01). Conclusion The expression of FasL mRNA and caspase-3 protein increases along with the lasting of reperfusion and HBO exhibites protection against cell apoptosis through improving the antioxidant-oxidant balance and reducing IRI in acute stage of IRI.

Please choose a citation manager

Content to export

Archive

临床研究

基础研究

临床研究

基础研究