Objective To investigate the prevalence and related factors of peritoneal calcification in peritoneal dialysis (PD) patients with long dialysis duration, and to explore the relationship between peritoneal calcification and vascular calcification. Methods This cross-section study enrolled PD patients who had received PD for more than 4 years in Peking University People's Hospital. Peritoneal calcification and abdominal aortic calcification were reviewed by CT scan. Demographic data, clinical characteristics, laboratory data including calcium phosphorus metabolism indexes (Ca, P, ALP and iPTH) and PD adequacy were collected. The influencing factors of peritoneal calcification were analyzed by Logistic regression analysis. The correlation between peritoneal calcification and abdominal aortic calcification were tested by Spearman correlation analysis. SPSS 19.0 was used for statistical analysis. Results (1) Seventy-nine PD patients were enrolled: 32 males (40.5%); mean age was (58.7±13.1) years and average PD duration was 77.25(58.00, 88.00) months. The major primary diseases were glomerulonephritis (46.8%) and diabetic nephropathy (30.4%). (2) 6 patients (7.6%) had CT-detectable peritoneal calcification. 77(97.5%) patients were found with various degrees of peritoneal thickening. The prevalence of peritoneal calcification was 7.6% in patients with PD duration more than 4 years, 10.3% in patients with PD duration more than 6 years, 18.8% in patients with PD duration more than 8 years and 40.0% in patients with PD duration more than 10 years, showing an increasing trend. Compared with non-peritoneal calcification group, the patients in peritoneal calcification group received higher doses of Vitamin D (P＜0.001) and lower triglyceride levels (P=0.041). The patients were divided into two groups according to whether dialysis duration was longer than 9 years, and the proportion of patients with long PD duration in peritoneal calcification group was higher (P=0.013). Logistic regression analysis showed that PD duration, calcium and phosphorus metabolism indexes were not independent risk factors of peritoneal calcification. High vitamin D dose was an independent risk factor for peritoneal calcification (B=2.667, OR=14.394, 95%CI 1.655 - 125.165, P=0.016). (3) 74 patients were found with abdominal aortic calcification in different degrees, and the prevalence rate of abdominal aortic calcification was 93.7%. Spearman correlation analysis showed that there was no correlation between peritoneal calcification and vascular calcification (r=0.70, P=0.542). Conclusions The prevalence of peritoneal calcification in long PD duration patients is low. Peritoneal calcification may be associated with high Vitamin D dose and long PD duration.

Objective To analysis the post-dialysis fatigue status of maintenance hemodialysis patients, explore the influencing factors in these patients and propose effective interventions. Methods One hundred and twenty maintenance hemodialysis patients in Department of Nephrology, Second Affiliated Hospital of Nanjing Medical University were enrolled. Clinical data were obtained by questionnaires. Biochemical changes before and post hemodialysis were recorded. The serum concentrations of hemoglobin, albumin, electrolyte, bicarbonate and lactic acid were collected for analysis. Results One hundred and nine (90.8%) effective questionnaires were collected, in which more than half of patients claimed to experience post-dialysis fatigue. Time to recover from hemodialysis (TIRD) was different: the median (interquartile range) time was 2.00(0.00, 3.00) hours. In the study, 30.3% patients reported no fatigue after hemodialysis. Recovery time in 35.8% patients was more than 30 minutes to 2 hours, 22.0% was 3 to 4 hours, 11.0% was 5 to 12 hours, 0.9% patients took longer time to recover from a dialysis session. According to the recovery time, these patients were divided into three groups. Among the three groups, the ultrafiltration, the serum sodium and lactic acid after dialysis showed significant difference. It was showed by the unconditional logistic regression analysis that ultrafiltration (OR=2.35, 95%CI 1.44-3.83), serum sodium (OR=0.75, 95%CI 0.65-0.88) , lactic acid (OR=3.16, 95%CI 1.32-7.55) were associated of TIRD. Conclusions The incidence of post-dialysis fatigue is high. Most of the patients require more rest or sleep immediately after dialysis. The level of lactic acid is a significant influencing factor of the fatigue of patients. TIRD is correlated with the elevation of lactic acid during the dialysis process, and more attention should be paid to post-dialysis fatigue.

Objective To investigate the incidence of fatigue in maintenance hemodialysis (MHD) patients and its related factors. Methods A total of 289 patients on MHD between January 2016 and March 2017 in hemodialysis centers of the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Yili Kazak Autonomous Prefecture Friendship Hospital, and Yili Prefecture Hospital were enrolled. Internationally standard fatigue rating scale (FAI) was applied to assess the incidence of fatigue in MHD patients, and subjective comprehensive nutrition assessment (SGA) protein energy wasting rating scale was used to assess protein energy wasting (PEW) conditions. All patients were divided into the fatigue group and the non-fatigue group according to the FAI score. The clinical data and the blood biochemical indicators in two groups were compared. The risk factors of fatigue in MHD patients were analyzed by logistic regression method. Results The incidence of fatigue was 83.0% in MHD patients, and the rate of PEW was 62.6%. Blood total cholesterol in the fatigue group was lower than that of the non-fatigue group (P＜0.05). The difference between SGA scores of two groups had statistical significance (P＜0.001). Single factor logistic regression analysis results showed that higher SGA score (OR=1.312, 95%CI: 1.163-1.481, P＜0.001), lower blood total cholesterol (OR=0.661, 95%CI: 0.496-0.880, P=0.005) were risk factors of fatigue in MHD patients. Multivariable logistic regression analysis results showed that higher SGA score (OR=5.286, 95%CI: 2.078-13.442, P＜0.001) was an independent risk factor of fatigue in MHD patients. Conclusions The incidence of fatigue and PEW are high in MHD patients. PEW is an independent risk factor of fatigue in MHD patients.

Objective To explore the feasibility of bioelectrical impedance analysis in assessing resting energy metabolism (REM) and the association of REM with anthropometry in hemodialysis patients. Methods Adult hemodialysis patients from 11 hemodialysis facilities in Guizhou Province were enrolled in this study. Bioelectrical impedance analysis was used to measure the rest metabolic rate (RMR) and body composition of 765 patients undergoing regular dialysis. A standard method was used to measure their height, weight, upper arm circumference, triceps skinfold thickness, left calf circumference and grip strength. The upper arm muscle circumference was also calculated. The level of RMR and body composition in hemodialysis patients were compared by gender grouping. The patients were then divided into four groups according to the RMR quartile. Spearman correlation analysis and multiple linear regression analysis were derived to analyze the relationship between RMR and anthropometry. Results The level of RMR in male patients was significantly higher than that in female patients [1591(1444, 1764) Rcal/d and 1226(1104, 1354) Rcal/d, P＜0.001]. Compared with the first quartile of RMR group, upper arm circumference, upper arm muscle circumference, left calf circumference and grip strength in the fourth quartile group were increased significantly (all P＜0.05). Multiple linear regression analysis showed that height (β=0.572), left calf circumference (β=0.273), upper arm muscle circumference (β=0.092) and suffering from protein energy wasting (PEW, β=-0.184) were independent influential factors of RMR (all P＜0.05). Conclusions RMR levels in patients with maintenance hemodialysis are associated with left calf circumference and upper arm muscle circumference, which may become a new index to evaluate energy consumption and malnutrition in MHD patients.

Objective To evaluate the efficacy and safety of tolvaptan therapy for edema in patients with nephrotic syndrome (NS). Methods Twelve patients with NS who had normal serum sodium and blood volume were enrolled. All of them were treated with oral tolvaptan of 15-30 mg per day for 7 days. The diuretic effects were observed and the adverse reactions including electrolyte disorders (especially hypernatremia), low blood volume, thromboembolic complications, and acute kidney injury were closely monitored. Results The average urine volume was significantly increased (F=5.792, P＜0.001) and the body weight was significantly decreased (F=24.086, P＜0.001) from the first day of tolvaptan therapy until the end of the treatment. The average serum sodium levels were significantly increased from the second day of tolvaptan therapy until the end of the treatment (F=2.790, P=0.012), but only 3 case-times (3.6%) among the total 84 case-times of serum sodium tests showed mild hypernatremia (the highest level 146.5 mmol/L) and all the hypernatremia returned back to normal after suspending tolvaptan for one day. There were no significant changes in the serum potassium levels (F=0.477, P=0.849) within the whole treatment course. There was also no significant difference of the blood volume between the level at the end of treatment and the baseline level [(74.3±3.0) ml/kg vs (74.9±3.0) ml/kg, P=0.855]. The thromboembolic complications and acute kidney injury both also did not take place. Conclusions As long as a rational and prudent treatment regimen is applied, tolvaptan has good diuretic effects and safety for treatment of edema in the NS patients with normal serum sodium and blood volume.

Objective To evaluate the immune status of acute rejection recipients, and to improve the short-term and long-term survival rate of renal transplant recipients and grafts, and to investigate dynamically the changes in the immune repertoire of patients with acute rejection. Methods Combined multiplex PCR amplification technique and high throughput sequencing technique, the TCR β chain complementarity determining region 3 (CDR3) diversity and repertoire characteristics at different time points during renal transplantation were analyzed, in order to reveal the immunological characteristics of T lymphocytes in patients with acute rejection. Results The diversity of TCR CDR3 in acute rejection patients was reduced to the lowest one day after surgery. The diversity of TCR CDR3 before acute rejection was higher than before. The acute rejection-related up-regulated TCR CDR3 amino acid sequences were screened out. In addition, TCR beta chain V and J subfamily showed the phenomenon of advantage usage in pre-acute rejection, which may be due to T cell recognition of transplanted kidney antigens in vivo. Conclusions The immune diversity of patients with acute rejection is significantly lower. In addition, TCR beta chain V and J subfamily show the phenomenon of advantage usage.

Objective To investigate the effects of fluorofenidone (AKF-PD) on diabetic kidney disease in db/db mice and its possible mechanisms. Methods (1) Fifty-six mice aged 8 weeks (half male and half female), including 42 db/db mice and 14 wild-type mice were studied. Forty-two db/db mice randomly were divided into model group (mock-treated diabetic db/db mice), AKF-PD (250 mg?kg-1?d-1) treatment group and losartan (20 mg?kg-1?d-1) treatment group. Wild-type mice and model mice were treated with vehicle (0.5% sodium carboxymethylcellulose), while the treatment groups received either AKF-PD or losartan. After 18 weeks, the blood glucose and urinary albumin were measured, the pathological changes of kidney were observed by PAS staining. The protein expressions of type Ⅳ collagen and fibronectin (FN) in kidney tissue were detected by immunohistochemistry. (2) Mouse glomerular mesangial cells (MES-13 cells) were divided into six groups: normal glucose group (5.5 mmol/L glucose), hypertonic group (5.5 mmol/L glucose+19.5 mmol/L mannitol), high glucose group (25.0 mmol/L glucose), AKF-PD group (25.0 mmol/L glucose+400 mg/L AKF-PD) and losartan group (25.0 mmol/L glucose+2 μmol/L losartan). After 72 h treatment, the expressions of type Ⅰ collagen, type Ⅳ collagen and transforming growth factor-β1 (TGF-β1) mRNA were detected by real-time PCR, and the content of TGF-β1 protein in the culture supernatant was detected by ELISA. Results (1) Compared with the wild type mice, model mice had increased weight, blood glucose and glomerulosclerosis index (all P＜0.01), accompanied with heavy albuminuria, glomerular hypertrophy, mesangial area expansion and deposition of collagen type Ⅳ and FN (all P＜0.01). Compared with model mice, in AKF-PD and losartan groups 24 h urinary albumin and glomerulosclerosis index decreased (all P＜0.01), glomerular hypertrophy and mesangial area expansion alleviated, and the protein expressions of collagen type Ⅳ and FN were inhibited (all P＜0.01). (2) Compared with the normal glucose group, the mRNA expressions of type Ⅰ collagen and type Ⅳ collagen increased in high glucose group, meanwhile the mRNA and protein expressions of TGF-β1 increased (all P＜0.01). In AKF-PD and losartan groups the expressions of type Ⅰ collagen, type Ⅳ collagen and TGF-β1 were inhibited as compared with high glucose group (all P＜0.05). Conclusion Fluorofenidone may play an anti-fibrotic effect in db/db mice by reducing the expression of TGF-β1 and inhibiting collagen synthesis in glomerular mesangial cells.

Objective To investigate the possible effects of histone methyltransferase MLL1 on renal interstitial fibrosis and epithelial-mesenchymal transition (EMT). Methods Forty-two male SD rats were randomly divided into normal group, sham operation group and unilateral ureteral occlusion (UUO) group, and then UUO group was further divided into group 1 d, 1 week, 2 week, 3 week and 4 week after operation. The expression of MLL1, E-cadherin, α-SMA, Vimentin and Col3α1 in UUO rat kidney tissue as well as TGF-β1 stimulated HK-2 cells were detected by real-time PCR and Western blotting. siRNA-MLL1 plasmids was used to inhibit the expression of MLL1 and the protein levels of MLL1, α-SMA, Vimentin, E-cadherin, Col3α1 and H3K4me3 induced by TGF-β1 stimulation were detected by Western blotting. The level of H3K4me3 in promoter region of EMT related genes was observed by chromatin immunoprecipitation (CHIP). Results Compared with normal and sham operated groups, the loss of renal function in UUO group was more obvious with the obstruction time (P＜0.05). The renal fibrosis was most obvious 1 week and 2 weeks after the rats underwent the UUO operation (all P＜0.05), with the highest protein expressions of MLL1, E-cadherin, α-SMA, Vimentin and Col3α1 (all P＜0.05). Compared with the control group, 3 ng/ml TGF-β1 induced the highest expression of MLL1 and the most obvious EMT in HK-2 cells (all P＜0.05). Moreover, the EMT and the high level of H3K4me3 in HK-2 triggered by TGF-β1 were all inhibited by siRNA-MLL1 plasmids transfection (all P＜0.05). Conclusions MLL1 can enhance the occurrence of EMT induced by TGF-β1 in HK-2 cells by increasing the level of H3K4me3 in the promoter region of α-SMA and Vimentin.