Objective To explore the pulmonary arterial pressure level in patients with predialysis chronic kidney disease ( CKD) and its relationship to cardiac structure and function. Methods 397 patients with predialysis CKD and 50 healthy subjects were enrolled. Cardiac structure was evaluated by Doppler echocardiography. Glomerular filtration rate ( GFR ) were assessed by radiant 99mTc-DTPA.Differences of PAP, BNP, LA, IVST, LVDd, LVDs, LVEF, LVMI and the correlation of PAP with cardiac structure and function were examined. Results The PAP level in the predialysis CKD patients was much higher than that in the healthy subjects [ ( 33. 13 ±9. 00) mm Hg vs. ( 29. 43 ±3. 71) mmHg, P lt;0. 01] .18. 9% of the CKD patients were complicated with pulmonary hypertension. PAP was higher in the CKD patients in stages 4-5 than those CKD patients in stages 1-3 [ ( 35. 90 ±9. 34) mmHg vs. ( 32. 08 ±8. 62)mmHg, P lt;0. 01) ] , so as to the prevalene of pulmonary hypertension ( 21. 60% vs. 13. 47% , P lt;0. 01) .Compared with the healthy, the level of lnBNP [ ( 3. 59 ±1. 63) pg/mL vs. ( 2. 88 ±1. 51) pg/mL, P lt;0. 01] , LA [ ( 40. 42 ±6. 77) mmvs. ( 36. 75 ±4. 94) mm, P lt; 0. 01) ] , LVPW [ ( 9. 55 ±1. 96) mm vs.( 8. 54 ±0. 88) mm, P lt; 0. 01) ] , IVST [ ( 9. 76 ±1. 75) mm vs. ( 8. 71 ±0. 90) mm, P lt; 0. 01) ] , LVMI[ ( 105. 61 ±36. 47) g/m2 vs. ( 87. 41 ±17. 08) g/m2 , P lt; 0. 01) ] were all much higher. There was a negative correlation between PAP and GFR( r = - 0. 461, P lt;0. 01) , and positive correlations between PAP and LA ( r=0. 491, P lt; 0. 01) , LVPW ( r =0. 298, P lt;0. 01) , IVST ( r = 0. 613, P lt;0. 01) , lnBNP ( r =0. 536, P lt;0. 01) , LVMI ( r = 0. 382, P lt;0. 01) . LVMI and lnBNP were both independent risk factors of PAP. The regression equation: y = 16. 447 + 0. 105x1 + 1. 724x2 ( F = 23. 482, P = 0. 000) , y: PAP( mm Hg) , x1 : LVMI( g/m2 ) , x2 : lnBNP( pg/mL) . Conclusions Pulmonary hypertension is a common morbidity of predialysis CKD patients, and deteriorates with degression of renal function. PAP is related to indexes of cardiac structure ( LVMI, LA, LVPW, IVST) and index of cardiac function ( lnBNP) . LnBNP and LVMI are independent risk factors of PAP.
Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.
【摘要】 目的 探讨细胞角蛋白19的可溶性片段CYFRA21-1在慢性肾脏病（chronic kidney disease，CKD）患者血清中的表达及其临床意义。 方法 2008年10月-2009年4月随机选取45例CKD患者，根据肌酐清除率（creatinine clearance rate，Ccr）的大小分为Ccrlt;15 mL/min组（23例）和Ccrgt;15 mL/min组（22例），并以正常体检者（10例）为正常对照组，肺鳞癌患者（10例）为阳性对照组，每位参与研究者取血后采用酶联免疫吸附法测定血清CYFRA21-1的浓度。 结果 正常对照组、阳性对照组、Ccrgt;15 mL/min组和Ccrlt;15 mL/min组的血清CFRA21-1浓度分别为（1.720±0.535）、（21.010±11.809）、（3.310±1.569）和（5.090±1.306） ng/mL。与正常对照组比较，其余3组的CYFRA21-1浓度均显著升高，有统计学意义（Plt;0.05），且均值大于正常参考值（0~3.3 ng/mL）；Ccrgt;15 mL/min组和Ccrlt;15 mL/min组的CFRA21-1浓度显著低于阳性对照组，有统计学意义（Plt;0.05）；两个实验组间随着Ccr的降低，CYFRA21-1浓度升高，有统计学意义（Plt;0.05）。 结论 CKD患者血清CYFRA21-1水平的升高与肾功能减退存在一定关系，可将其作为临床上预测肾脏纤维化程度的指标。【Abstract】 Objective To discuss the clinical Between significance of cytokeratin 19 fragment (CYFRA21-1) in patients with chronic kidney disease (CKD). Methods From October 2008 to April 2009, 45 inpatients were randomly selected and assigned into three groups according to creatinine clearance rate (Ccr) level: Ccrlt;15 mL/min, Ccrgt;15 mL/min. Ten healthy volunteers were chosen as control group, and other 10 patients with lung squamous cell carcinoma as positive control group. ELISA was used to measure the serum concentration of CYFRA21-1. Results Compared with control group, the serum concentration of CYFRA21-1 in CKD groups and positive control group was elevated (Plt;0.05). As the Ccr decreased, the serum concentration of CYFRA21-1 was elevated (Plt;0.05) in two CKD groups. Conclusion Serum concentration of CYFRA21-1 in CKD patients has a relationship with the renal function decrease, and may be used as an indication of renal interstitial fibrosis (RIF).
ObjectiveTo observe whether proteinuria is relate to the decline of residual renal function (RRF) in peritoneal dialysis (PD) patients. MethodsThis is a prospective cohort study including 45 PD patients (underwent PD between January 2011 and January 2013) with a 12-month follow-up. All the patients were divided into 2 groups with respect to the initial proteinuria level: massive proteinuria group A (n=20) and non-massive proteinuria group B (n=25) at baseline. We established regression models to do univariate analysis and multivariate analysis of the relationship between the decline of RRF≥50% of baseline and the indices of age, sex, PD-associated peritonitis, baseliner residual glomerular filtration rate (rGFR), initial proteinuria, and use of ACEI/ARB. ResultsThe primary outcome (RRF>50% of baseline) at 12 months was 65% in group A, and 80% in group B (P<0.05). Based both on the results of univariate and multivariate Cox regression analysis, non-massive proteinuria and higher rGFR at baseline were factors to protect RRF from decline (P<0.05). ConclusionThe study demonstrates that massive proteinuria and lower rGFR at baseline may be associated with a rapid decline of RRF in PD patients. Treatment aimed at reducing albuminuria may lead to protect RRF and improve life quality of patients.
ObjectiveTo collect the nutrition data in patients with chronic kidney disease (CKD) from stage 1 to 4 and provide the basis for further intervention by analyzing the specific problems of the patients. MethodsA total of 132 CKD patients from stage 1 to 4 were enrolled between December 2012 and December 2013. Nutritionists used inbodyS10ww as a body composition analyzer to test the patients. The data from inbodyS10ww and laboratory indexes were analyzed on marasmus, overweight and obesity, risk of malnutrition, malnutrition, anemia and hypoalbuminemia. ResultsThe percentage of marasmus in those CKD patients was 3.0%, overweight and obesity was 39.4%, the risk of malnutrition was 22.7%, malnutrition was 19.7%, anemia was 34.1%, and hypoalbuminemia was 9.8%. ConclusionOur search shows that combining the application of anthropometry and laboratory indexes can evaluate the nutritional status of patients with CKD. The most common nutritional problems in CKD patients include malnutrition, overweight and obesity, risk of malnutrition, and anemia. As for hypoalbuminemia, it is low in early CKD patients.
Objective To explore the hormone medication compliance in children with chronic kidney disease (CKD) and analyze its influencing factors. Methods Between May and December 2013, 96 children were investigated by questionnaires about medication compliance when they were out of the hospital. Then we analyzed the influencing factors for medication compliance. All the data were analyzed by SPSS 19.0 software. Results Of these 96 children, medication nonadherence accounted for 52% (50). The main guardian, educational level of the father, educational level of the mother, residence, duration of illness, time of hospitalization, and understanding of the treatment plan played significant roles in causing different medication compliance among these children (P＜0.05). Logistic regression analysis showed that duration of illness [OR=2.204, 95%CI (1.253, 3.875), P=0.006], residence [OR=2.615, 95%CI (1.0 23, 6.687), P=0.045] and the mother’s educational level [OR=0.147, 95%CI (0.028, 0.788), P=0.025] were the independent factors for medication compliance. Conclusions According to the survey, hormone medication compliance in children with chronic kidney disease is not satisfying. We should strengthen the health education in children and their parents, and adopt specific interventions to enhance the medication compliance so as to effectively control the disease and delay the progression.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) of lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, PROSPERO, CNKI, CBM, WanFang Data and VIP to collect systematic reviews and meta-analysis about lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia from inception to August 31st, 2016. Two reviewers independently screened literature and extracted data, then AMSTAR tool was used to assess the methodological quality of included studies and the GRADE tool was used to grade the evidence quality of outcome measures included in the SRs. ResultsA total of eight relevant SRs were included and containing three main outcome measures. The assessment results of AMSTAR tool suggested that:four SRs were of high quality, and the other four were of medium quality. GRADE results showed:for serum phosphorus level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, four SRs were low, low, low and very low; compared with sevelamer, one SR was low. For serum calcium level, compared with placebo, the quality of the evidence of three SRs were high, medium and low, respectively; compared with calcium carbonate or conventional phosphorus binder, five SRs were low, low, low, very low and very low; compared with sevelamer, one SR was very low. For serum iPTH level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, five SRs were medium, low, low, very low and very low; compared with sevelamer, one SR was low. ConclusionAt present, methodological quality assessment for the treatment of hyperphosphatemia in chronic kidney disease with lanthanum carbonate is generally not high and the level of evidence for the conclusion is generally low. In drug safety, especially in the occurrence of adverse events of the digestive system is still controversial, and a large amount of high quality experimental is needed to demonstrate the safety of its long-term use. Clinicians need to be cautious in using these evidence to make clinical decisions.
Objective To investigate the prevalence and risk factors of sleep-disordered breathing (SDB) in patients with different severity of chronic kidney diseases (CKD). Methods A total of 144 patients of non-dialysis CKD patients in nephrology unit were recruited in the study. The patients were divided into CKD 1-2 period, CKD 3-4 period, and CKD5 period according to the severity of renal function. Results The prevalence of moderate SDB in CKD 1-2 period, CKD 3-4 period and CKD5 period were 30.0%, 53.5% and 60.5%, respectively (P=0.03), the prevalence of nocturnal hypoxemia were 23.3%, 56.3% and 65.1%, respectively ( P=0.001), and the prevalence of excessive daytime sleepiness (EDS) were 33.3%, 57.7% and 62.8%, respectively (P=0.032). Logistic regression analysis showed that age, male, body mass index (BMI), hypertension, diabetes and heart failure were independent risk factors for CKD merged with moderate to severe SDB, and the highest risk factor was heart failure (OR=7.034, 95%CI 1.255-39.420). Compared with CKD 1-2 period and CKD 3-4 period, the risk degree of CKD5 period was higher (OR=3.569 95%CI 1.324-9.620). Correlation analysis showed that glomerular filtration rate (eGFR) was negatively correlated with sleep apnea-hypopnea index (AHI) (r=–0.327, P=0.000). Conclusions There is a high prevalence of SDB (predominantly obstructive) in CKD patients and the increased risk of SDB is significantly associated with decreased eGFR among these patients. Associated comorbidities in CKD patients, especially for cardiac dysfunction, are important risk factors for SDB.