Objective To investigate and compare the efficacy and safety of intravenous iron sucrose and iron dextran for the treatment of iron deficiency in anemic hemodialysis patients. Methods In this prospective randomized controlled multi-center clinical study， 80 chronic hemodialysis patients were divided into two groups: treatment group (iron sucrose group， n=40) and control group (iron dextran group， n=40). There were no significant differences in the basic data (gender， age， duration of hemodialysis ， Hb，Hct， ferritin and transferring saturation，etc) between two groups at pre-treatment. The patients were treated with iron sucrose or iron dextran， 100 mg intravenous， during 10 consecutive hemodialysis sessions， twice a week for five weeks. The duration of follow-up was eight weeks. The total supplement iron amount of both groups was 1000 mg.Erythropoietin (EPO) was used at a dose of 120~150 U·kg^-1·week^-1. The efficacy and safety were assessed by evaluating the changes in Hb， Hct， ferritin， transferring saturation and side effects in both groups pre?-and post-treatment. Results Compared with the pre-treatment， the Hb levels in both groups significantly increased at post-treatment [iron sucrose group:(98.85±17.45)g/L vs (75.20±9.66) g/L，P < 0.01， iron dextran group: (94.93±14.03) g/L vs (75.53±10.61) g/L，P < 0.01， respectively]. The Hct levels in both groups significantly increased (P < 0.01). The levels of ferritin and transferring saturation increased significantly in both groups. The increament rates of Hb， Hct， ferritin and transferring saturation in iron sucrose group were higher than those in iron dextran group， although no significant difference occurred. There were no obvious changes in BUN， Scr， ALT and AST. There were no severe adverse events in both groups and 1 case suffered from muscular soreness in the lower limbs in iron dextran group. Conclusion Intravenous iron sucrose is an effective and safe agent for the treatment of iron deficiency in anemic hemodialysis patients.

Objective To measure the ultrasonic backscatter parameters of myocardium in maintenance hemodialysis(MHD) patients and to evaluate the effects of anemia-correction on the patients＇ myocardial properties. Methods Forty-five maintenance hemodialysis patients whose blood pressure were in good control and 15 healthy volunteers(M∶F 10∶5)were involved， with 30 anemia(M∶F 20∶10)and 15 non-anemia(M∶F 10∶5). With a history of 3 to 6 months maintenance hemodialysis， all the patients undertook echocardiography for ultrasonic tissue characterization at the beginning of the study and at the end of one-year follow-up. Following the initial echocardiography， anemic patients were randomly divided into two subgroups， one was to correct anemia within the first 3 months and to maintain it， the other was to keep a hemoglobin below 100 g/L. Non-anemic patients maintained their hemoglobin level within the normal range. During the follow-up， all patients- blood pressure were kept in good control in each group. Results At the beginning of the study， the value of the average integrated backscatter(AIB) and the cyclic variation of integrated backscatter(CVIB) was 6.21±0.22 and 9.88±0.61 in non-anemia group， 8.20±0.19 and 7.87±0.51 in anemia group， 5.94±0.21 and 10.52±0.86 in control gourp respectively. After one year-s therapy， ultrasonicbackscatter parameters (AIB and CVIB) in anemia-corrected subgroup were improved， but the values were still different from those of the control group. As for the anemia-uncorrected subgroup， its AIB was elevated while CVIB was reduced compared with the initial values. There was no significant change in non-anemic group. Conclusions Anemic hemodialysis patients have a higher intergrated backscatter value than non-anemic patients， while non-anemic， non- hypertensive patients have a similar ultrasonic integrated values to the healthy people. Anemia may be one of the major factors contributing to myocardial fibrosis in the early stage of cardiomyopathy.

Objective To present the accurate level of renal function of 514 ESRD patients at the initiation of dialysis and analyze the correlative factors to provide evidence for the selection of the possible better time of dialysis start. Methods Levels of serum creatinine (Scr)， blood urea nitrogen(BUN) and serum albumin(Salb) together with other demographic and laboratory data were obtained through reviewing the case records of 514 ESRD in-patients initiated their first dialysis treatment from January 1998 to August 2004 in two large dialysis centers in Changsha. The patients were divided into different groups by various conditions. Mean Scr， evaluation GFR (eGFR) and other variables of the whole patient population and subgroups were measured and calculated. Then the differences were compared among groups and with foreign patient population. Results (1) Patients were relatively young， male more than female. Percentage of patients with medical insurance increased. 91.8% patients chose hemodialysis as the first treatment. Glomerulonephritis was the main cause of ESRD but its percentage decreased meanwhile the percentage of hypertension and diabetes increased. (2)The levels of Scr and eGFR were (1121.92±458.24) μmol/L and (4.98±2.24) ml·min-1·(1.73 m2)-1. (3) In subgroups of younger， uninsured， unemployed， farmer， incumbent， students， selecting hemodialysis and non-diabetes， the mean Scr was significantly higher and mean eGFR was significantly lower as compared to corresponding groups (P < 0.01). The mean Scr and eGFR were significantly higher in male than those in female patients (P < 0.01 and P < 0.05， respectively). (4) 53.1% had hypoalbuminemia. When eGFR < 8.4 ml·min-1·(1.73 m2)-1， Salb was significantly correlated with eGFR (r = 0.093，P = 0.044). (5) Compared to the data of the United States 1999， the eGFR of these 514 patients at the beginning of dialysis was significantly lower than that of US patients(P < 0.01). Conclusions These 514 ESRD patients in Changsha possess certain demographic and clinical characteristics. Wide variation exists in renal function at the initiation of dialysis. Most patients start dialysis at very low levels of eGFR. Salb is positively correlated with eGFR only under certain conditions. The eGFR of ESRD patients at the beginning of dialysis is significantly lower than that of US patients.

Objective To evaluate the impact of OL-HDF on in vivo removal of a wide spectrum of solutes (urea， creatinine， iPTH and β2-microglobulin) in comparison to LF-HD and HF-HD. Methods Twenty-five patients(17 men，8 women)were studied. Every patient underwent three dialysis sessions with routine HD parameters. Effects were compared among 1.8 m2 polysulfone LF-HD，1.8 m2 polysulfone HF-HD and OL-HDF. Predialysis and postdialysis solute concentrations were measured.The percentage of reduction ratios for each solute were calculated. Results Urea (molecular mass of 60 daltons)and creatinine(molecular mass of 113 daltons)reduction ratios were similar in LF-HD， HF-HD and OL-HDF. B2-microglobulim and iPTH reduction ratios for LF-HD were negligible. Mean β2-microglobalin reduction rates were 32.5%±7.0% for HF-HD versus 44.2%±10% for OL-HDF.(reinfusion volume mean 36 L/session； P < 0.05).Mean iPTH reduction rates were 42.7%±9.2% and 54.4%±8.8% for HF-HD and OL-HDF， respectively(P < 0.05).Conclusion Removal of solutes with small molecular weight is similar in three type therapies of hemopurification techniques. LF-HD does not seem to remove solutes with a molecular weight greater than 9500 daltons.OL-HDF provides marked enhancement of convection volume and enables a significant increase in β2-microglobulin and iPTH removal. β2-microaglobulin extraction is almost nil with LF-HD， better with HF-HD， and more effective with OL-HDF.

Objective To investigate serum cardiac troponin T(cTnT) and C-reactive protein(CRP) levels and assess the prognostic values of cTnT and CRP of mortality and cardiovascular events in maintenance hemodialysis(MHD) patients. Methods One hundred and six MHD patients were enrolled in this study. Serum cTnT， CRP， creatinine， albumin were measured in pre-hemodialysis at the beginning of the study. The mortality and cardiovascular events were recorded during the period of follow up. Results At the initiation of the study，28 patients (26.42%) were recorded with positive cTnT level， 32(30.19%) with positive CRP and 16 (15.09%) with positive cTnT and CRP. Logistic regression analysis showed a significant correlation between serum cTnT and serum CRP and Scr. Patients with positive cTnT and CRP levels had higher mortality and more cardiovascular events than those with negative levels. Kaplan-Meier survival analysis showed a significant difference between patients with normal and abnormal cTnT and CRP levels. Conclusions Some MHD patients have elevated serum cTnT level. Serum cTnT level is correlated with serum CRP and creatinine level. Patients with positive cTnT and CRP levels have higher mortality and more cardiovascular events than those with negative levels.

Objective To evaluate the effect and safety of anticoagulant citrate dextrose solution A (ACD-A ) in continuous blood purification (CBP) for patients at high risk of bleeding with ARF. Methods Twelve patients at high risk of bleeding， treated with continuous venovenous hemofiltration(CVVH)， were divided into regional citrate anticoagulant(RCA) group and control group. In the former， ACD-A solution was delivered， pre-filter ，with the rate adjusted to maintain a postfilter ionized calcium (iCa2+) level between 0.30~0.40 mmol/L. Before the extracorporeal blood returned to the patient，10% calcium gluconate was infused to maintain a systemic iCa2+ level between 0.90~1.20 mmol/L. In control group， CVVH were performed either with low dose of heparin LMW sodium(1700~2500 IU/12 h~24 h)or without anticoagulant. The life span of each hemofilter was recorded. In RCA group， prothrombin time (PT)， activated partial thromboplastin time (APTT)， acid-base changes， serum sodium and iCa2+ were monitored pre- and during CVVH. Result In the whole duration 1192.5 hours of CVVH in RCA group and 596 hours in control group， 62 and 42 hemofilters were used， respectively. Filter survival was 65.3% at 24 h and 24.5% at 48 h in RCA group，while 14.5% and 0 in control group. The mean life span of filter in RCA group was significantly longer than that in control group[(29.4±21.0)(1.5~71.5)h vs(14.2±8.2)(4.5~40)h， P < 0.01]. During 38 sessions of CVVH with ACD-A solution anticoagulation， PT， APTT， acid-base status，serum iCa2+ and sodium showed subtle changes， compared with pre-CVVH.There were no significant bleeding events and no muscular spasms induced by ACD-A solution. Conclusion ACD-A solusion as anticoagulant during CBP is safe， convenient and effective for patients at high risk of bleeding with ARF.

Objective To explore the effects of AT1A receptor on extracellular matrix remolding in diabetic mice. Methods Chimeric mice carried AT1A-deficient (Agtr1a -/-) and intact cells. AT1A-intact cells within the kidney can be stained ubiquitously by β-galactosidase. Hyperglycemia was induced by peritoneal injection of streptozotocin in male chimeric mice at the age of 6 months. At week 12， kidneys were harvested and were frozen quickly in dry ice-acetone. LacZ staining and immunohistochemistry were performed on serial frozen section. Extracellular matrix index was measured by PAS staining. The expression levels of TGF-β1， PAI-1， AGE， andnitrotyrosine were semi-quantitated by immunohistochemical method in LacZ-positive(AT1A-intact cells) and LacZ-negative (AT1A-deficient) glomeruli respectively. Results The expression levels of ECM， TGF-β1， PAI-1， AGE， and nitrotyrosine in glomeruli of both kinds were increased significantly in diabetic mice compared with those in control mice(P < 0.05). The expression levels of ECM， TGF-β1， PAI-1， AGE， and nitrotyrosine in AT1A-deficient glomerulus were higher than those in AT1A-intact glomeruli of normal chimeric mice(P < 0.05)， but the increasing extent in AT1A-deficient glomerulus was less obvious than that of AT1A-intact glomeruli(P < 0.01). Conclusions The deficience of AT1A resulted in compensative upregulation of TGF-β1， PAI-1， AGE， and nitrotyrosine in glomeruli. Although not being a predominantly independent factor， local RAS plays a certain role in extracellular matrix remolding by manipulation the expression of TGF-β1， PAI-1， AGE， and nitrotyrosine in the kidney of diabetic mice. Further studies are needed to explore the whole scenario.