住院患者慢性肾脏病的危险因素分析

目的：回顾性分析慢性肾脏病（CKD）住院患者肾功能进展的危险因素。方法：收集2001年1月1日～2008年12月31日,在我院肾内科首次住院,未接受替代治疗16岁以上CKD患者655例,分析患者的性别、年龄、血压、原发病、肾穿病理、Hb、Alb、PA、UA、Ca2＋、P3-、TC、TG、LDL、HDL及肾功能进展的危险因素。结果：（1）起病较集中在31岁～60岁,占CKD的53.9%。（2）原发性肾小球疾病、糖尿病、高血压（69.5%、8.9%、8.9%）是导致CKD的主要病因。（3）58.2%患者行肾脏穿刺,病理结果以IgA肾病、系膜增生性肾炎、局灶节段性肾小球硬化、微小病变（31.2%、23.6%、11.3%、10.2%）为主。（4）各期患者血尿存在明显统计学差异（P〈0.01）;蛋白尿差异无统计学意义。与CKD1期比较,除PA、TG外,各期SBP、DBP、Hb、Alb、UA、Ca2＋、P3-、TC、LDL、HDL差异均有统计学意义（P〈0.05）。（5）多元相关回归分析显示eGFR与Hb呈正相关（P〈0.05）,与年龄、血压、UA呈负相关（P〈0.05）。多元Logistic回归分析显示年龄、贫血、高尿酸血症、高血压是CKD肾功能进展的危险因素（P〈0.05）。结论：原发性肾小球肾炎、糖尿病、高血压是主要病因。年龄、贫血、高尿酸血症、高血压为CKD进展的危险因素。     

不同低蛋白饮食延缓CRF进程的临床研究

目的：观察大豆蛋白为主的低蛋白饮食（LVPD）和动物蛋白为主的低蛋白饮食（LAPD）延缓CKD3～4期患者肾功能减退的疗效和安全性。方法：42例CKD3～4期（eGFR15～59ml/min）患者分成LVPD（22例）和LAPD（20例）两组,其人口学、疾病程度、治疗状况、蛋白质与热量摄入均具可比性,但LAPD组要求动物蛋白摄入占总蛋白的50%,LVPD组要求动、植物蛋白之比30%和70%,且植物蛋白中大豆蛋白占50%以上。研究周期为12个月。主要观察u-pro、eGFR、Scr、BUN、TC、TG、LDL、HDL、Alb、PA、TF、Ca2＋、P3-及人体测量指数等。结果：两组患者均能改善eGFR、减少u-pro,其中LVPD组自身前后对比差异有统计学意义（P〈0.05～P〈0.01）,LAPD组差异无统计学意义（P〉0.05）,两组间对比差异亦无统计学（P〉0.05）;LVPD组治后较治前血PA、TF、HDL、Ca2＋增高,LDL、P3-降低（P〈0.05～P〈0.01）,其中对HDL、Ca2＋、P3-的疗效优于LAPD组（P〈0.01）;两组血Alb、TC、TG以及人体测量指数基本稳定。结论：LVPD和LAPD对CKD3～4期患者均有一定的减少尿蛋白,延缓肾功能减退的作用,但LVPD在调节脂质及钙磷代谢方面更具有优势。     

2型糖尿病肾病不同时期的胰岛素抵抗分析

目的：探讨2型糖尿病肾病（DN）患者不同时期的胰岛分泌功能及特点。方法：2型糖尿病患者94例,按照蛋白尿及肾功能将DN分期：正常白蛋白尿期（DN0）30例,微量白蛋白尿期（DN1）23例,临床蛋白尿期（DN2）22例,肾衰竭期（DN3）19例。观察血压（BP）、体重指数（BMI）、腰臀比（WHR）、糖化血红蛋白（HbA1C）、糖化血清蛋白（GSP）、口服葡萄糖耐量及胰岛功能试验、尿白蛋白及低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、血尿酸（UA）、纤维蛋白原（FG）等。按HOMA-IR公式,计算胰岛素敏感指数（IAI）。结果：DN各组与正常白蛋白尿组比较DN病程、DBP、TG明显升高（P〈0.05）,HDL-C、IAI明显下降（P〈0.05-0.01）,各组研究对象间FG、SDP两两比较差异有统计学意义（P〈0.05-0.01）,DN各组与正常白蛋白尿组比较HbA1C、GSP、FBP、2 h PBG、FINS、BMI、WHR差异无统计学意义。结论：2型糖尿病肾病患者存在明显的胰岛素抵抗,且各个分期的患者胰岛素抵抗程度相当。     

慢性肾脏病患者脂质代谢紊乱危险因素分析

目的探讨慢性肾脏病(chronic kidney disease,CKD)3~5期患者血清甲状腺素(thyroid hormone,TH)水平的变化与血脂代谢的关系及其临床意义。方法选择在我院住院治疗的CKD 3~5期患者120例,根据CKD不同分期将其分为CKD 3期组(76例)、CKD 4期组(28例)、CKD 5期组(16例)。另选择我院50名同期健康体检者为对照组,采用放射免疫法分别检测CKD患者与健康体检者血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、超敏促甲状腺素(sensitive thyroid stimulating hormones,sTSH)的含量,同时采用全自动生化分析仪测定其血总胆固醇(serum total cholesterol,TC)、三酰甘油(triglycerides,TG)、高密度脂蛋白胆固醇(high density lipoprotein,HDL-C)、低密度脂蛋白胆固醇(10w density lipoprotein,LDLC)、血肌酐(SCr)、尿素氮(BUN)、尿酸(uric acid,UA)、血红蛋白(hemoglobin,Hb)、血白蛋白(alburnin,Alb)等,运用美国慢性肾脏病流行病合作工作组新开发的公式方程估算肾小球滤过率(estimated glomerular filtration rate,eGFR)。结果 CKD 3~5期患者血清FT3、FT4、eGFR低于正常对照组(P0,05),TSH与对照组比较,无统计学差异(P0.05);血清TG、TC、LDL-C高于正常对照组(P0.05),HDL-C低于对照组,但差异无统计学意义(P0.05)。Pearson相关性分析显示,CKD患者血清FT3分别与TG、TC呈负相关(r=-0.288,P0.05;r=-0.312,P0.05),与eGFR、HDL-C、Alb、Hb呈正相关(r=0.356,P0.01;r=0.199,P0.05;r=0.266,P0.01;r=0.276,P0.01);FT4分别与TC、LDL-C呈负相关(r=-0.199,P0.01;r=-0.297,P0.05),与eGFR、Alb、Hb呈正相关(r=0.405,P0.01;r=0.237,P0.01;r=0.24,P0.01);与TG、HDL-C均无明显相关性(P0.05);sTSH与Alb呈负相关(r=-0.195,P0.05),与eGFR、TG、TC、HDL-C、LDL-C均无明显相关性(P0.05)。回归分析发现TG的独立相关因素是eGFR和FT3。结论中晚期CKD患者常伴有TH水平异常,主要表现为低T3综合征,且与肾功能损害程度密切相关;中晚期CKD患者多合并有高脂血症,影响其血脂的因素较为复杂,其中eGFR、FT3是CKD患者脂质代谢紊乱的独立危险因素。     

血清25羟维生素D_3的缺乏对慢性肾脏病的影响

目的探讨血清25羟维生素D_3[25(OH)D_3]与慢性肾脏病(CKD)的关系。方法选取2014年1月-2016年1月深圳市龙岗区第五人民医院肾内科确诊的120例CKD患者,根据估算肾小球滤过率(eGFR)分成1~5期,另选取健康人群30例(对照组),分别测定各组的血清25(OH)D_3水平及相关实验室指标,并分析其相关性。结果对照组和CKD各期患者的血肌酐(Scr)、eGFR、白蛋白、甲状旁腺素(PTH)、血红蛋白(Hb)、25(OH)D_3水平差异具有统计学意义(P0.05);CKD患者随着分期增加,Scr、PTH水平逐渐增加,eGFR、Hb、25(OH)D_3水平逐渐降低;各组间血钙、血磷差异均无统计学意义(P0.05)。CKD 4期、5期患者25(OH)D_3水平不足患者占比显著高于对照组以及CKD 1期、2期、3期患者(P0.05);CKD 5期患者25(OH)D_3水平不足患者占比显著高于CKD 4期患者(P0.05)。CKD患者25(OH)D_3与Scr、白蛋白、PTH呈显著的负相关(P0.05);与eGFR、Hb呈显著的正相关(P0.05)。结论CKD患者的25(OH)D_3水平较健康人群低,并且与CKD患者肾功能损害程度关系密切。     

维持性血液透析和维持性腹膜透析患者脂代谢特征及其与营养状况关系的临床研究

目的：比较维持性血液透析（MHD）和维持性腹膜透析（CAPD）患者脂代谢紊乱的异同,探讨各自脂代谢紊乱的特征及其与营养状况的关系。方法：选取2009年7月～2009年10月门诊行MHD的124例患者和行CAPD的65例患者为研究对象。观察指标包括：（1）脂代谢指标：包括胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、载脂蛋白A（Apo-A）和载脂蛋白B（Apo-B）;（2）营养指标：包括营养不良炎症评分（MIS）、肱三头肌皮褶厚度（TSF）、中臂围（MAC）、中臂肌围（AMC）和血清白蛋白（Alb）。结果：（1）MHD患者高TG的发生率为25%,低HDL和低Apo-A发生率分别为72.58%和67%;CAPD组高TC、TG、LDL发生率分别为32.31%、38.46%和35.38%,低LDL、HDL和Apo-A发生率分别为43.08%、73.85%和55.38%;（2）CAPD组的TC、TG、LDL和Apo-A均高于MHD组,差异有统计学意义（P〈0.05）。（3）MHD组MIS低于CAPD组,差异有统计学意义（P〈0.05）;MHD组MAC、MAMC和Alb高于CAPD组,差异有统计学意义（P〈0.05）,两组间TSF差异无统计学意义（P〉0.05）。（4）MHD组TG、HDL和Apo-A与MIS显著负相关（P〈0.05）,与Alb和HDL显著正相关（P〈0.05）。PD组脂代谢指标与MIS和Alb等营养指标无相关性（P〉0.05）。结论：脂代谢紊乱是MHD和CAPD患者常见的并发症。MHD患者脂代谢紊乱的特征是高TG、低HDL和低Apo-A,而高TC却不常见。CAPD患者脂代谢紊乱特征是高TC、高TG和高LDL并存,低LDL、低HDL和低Apo-A并存。CAPD患者脂代谢紊乱和营养不良较MHD患者严重。TG、HDL和Apo-A是可用来评价MHD患者营养状况的指标,而脂代谢指标不能放映PD患者的营养状况。     

慢性肾脏疾病患者钙磷代谢的控制对血管钙化的影响

目的观察慢性肾脏疾病（chronickidneydisease,CKD）3期开始纠正钙磷代谢紊乱对患者血管钙化的影响。方法选择本院门诊或住院的CKD3～4期非透析患者80例,按随机数字表法分为干预组及观察组,每组40例。干预组进行钙磷代谢紊乱严格干预,观察组则给予CKD的常规治疗,观察并比较2组患者的血压、血尿素氮、血肌酐、血钙、血磷、全段甲状旁腺素（intactparathyroidhor—mone,iPTH）、血红蛋白（hemoglobin,Hb）、血白蛋白等指标,同时通过腹部、骨盆、手部x线平片进行血管钙化的定量测量。结果2组治疗后的血钙、血磷、钙磷乘积、iPTH、收缩压（systolicbloodpressure,SBP）和血白蛋白较治疗前明显变化,而舒张压（diastolicbloodpressure,DBP）和Hb较治疗前无明显变化（P〉O．05）。干预组血钙治疗后高于治疗前（P〈O．05）,亦高于对照组（P〈O．05）;干预组和观察组血磷和血白蛋白治疗前相比均升高,但观察组升高更显著（P〈0．05）。干预组和观察组血SBP和iFrrH与治疗前相比均降低,但干预组降低更显著（P〈O．05）。干预组发生血管钙化4例,观察组发生血管钙化10例,干预组血管钙化的发生率低于观察组（P〈O．05）。结论钙磷代谢紊乱参与了CKD血管钙化的进展,在CKD3期开始干预可明显延缓其进展,提高患者预后质量。     

辛伐他汀对糖尿病肾脏病微炎症状态的影响

目的观察糖尿病肾脏病（DKD）微炎症状态及辛伐他汀对微炎症状态的影响。方法选择2010年1月至2010年12月在我科住院并长期随访的DKD患者60例,根据。肾小球滤过率（GFR）水平,将所有患者分为3组,其中慢性肾脏病（CKD）3期组19例,CKD4期组23例,CKD5期组18例。同时从我科医护人员中选取20名健康志愿者为正常对照组。对CKD3、4、5期组患者给予辛伐他汀口服,每次40mg,每晚1次,连用8周。分别在治疗前、后测定患者血清白细胞介素（IL）-6、C反应蛋白（CRP）、铁蛋白、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）等。并测定正常对照组IL-6、CRP、铁蛋白等微炎症指标。结果与正常对照组相比,CKD3、4、5期组治疗前IL-6、CRP较高（P〈0．05）,CKD5期组铁蛋白较高（P〈0．05）。治疗后,CKD3、4、5期组IL-6、CRP、铁蛋白较治疗前降低（P〈0．05）,CKD4、5期组LDL降低（P〈0．05）,CKD3期组LDL及各组TG、TC治疗前、后差异无统计学意义（P〉0．05）。结论辛伐他汀能够改善DKD患者的微炎症状态,其改善与血脂的下降无明显相关性。     

慢性肾脏病肺动脉压变化及其相关因素分析

目的：探讨慢性肾脏病（CKD）患者肺动脉压变化情况及其相关因素。方法：选取167例（CKD1期～CKD5期）非透析慢性肾脏病患者和17例健康对照者,测定并比较各组肺动脉压（PASP）和血浆脑钠肽（BNP）、血红蛋白（Hb）、甲状旁腺素（PTH）及钙磷乘积的差异,探讨CKD患者肺动脉压变化及其相关因素。结果：（1）从CKD1期起,肺动脉压随肾功能恶化逐渐升高,CKD3期开始其变化更加明显。CKD3期较CKD2期、CKD4期较CKD3期、CKD5期较CKD4期之肺动脉压差异均有统计学意义（P〈0.01）;17.96%（30/167）CKD患者合并肺动脉高压（PHT;PASP≥40mmHg）;（2）与肺动脉压正常组相比,PHT组患者BUN、Scr、PTH、钙磷乘积和ln（BNP）均显著增高（P〈0.05）,而Hb却明显下降（P〈0.01）。肺动脉压与ln（BNP）、Scr、BUN、PTH、钙磷乘积呈正相关（P〈0.01）,与Hb水平负相关（P〈0.01）。ln（BNP）和Hb进入以肺动脉压为因变量的回归方程：y=20.404＋3.556x1-0.103x2,其中y代表PASP（mmHg）,x1为血浆ln（BNP）（pg/ml）,x2为Hb（g/L）。结论：慢性肾脏病患者容易合并肺动脉高压,其严重程度及发生率与CKD严重程度相关。血浆脑钠肽水平和贫血程度与肺动脉高压形成密切相关。     

血液透析与腹膜透析对终末期肾衰竭患者脂质影响的调查与分析

目的：调查血液透析和腹膜透析对终末期肾衰竭患者脂质代谢的影响。方法：采用回顾性分析的方法调查尿毒症患者共96例,腹透及血透各48例,比较其各自透析前后脂质改变及透析后两组脂质改变有无差异。结果：（1）腹透治疗组三酰甘油（TG）、低密度脂蛋白（LDL）、极低密度脂蛋白（VLDL）较透析前明显升高（P〈0.01）,总胆固醇（TC）较透析前升高（P〈0.05）,高密度脂蛋白（HDL）较透析前降低（P〈0.05）,LP（a）较透析前无统计学差异;（2）血透组LDL、TG、LP（a）较透析前明显升高（P〈0.05）,HDL较透析前降低无统计学意义;（3）腹透组与血透组血脂变化比较：TG、LDL二者的升高腹透组较血透组明显（P〈0.05）,LP（a）升高血透较腹透明显（P〈0.05）。结论：透析会加重终末期肾衰竭患者的脂质异常,腹膜透析表现更明显,腹膜透析与血液透析存在统计学差异。血液透析在LP（a）的升高应引起重视。     

Prevention of chronic kidney disease: a global challenge

In view of the increasing number of patients requiring renal replacement therapy (RRT) every year worldwide, attention has focused over the last two decades on meeting the health care need of patients with end-stage renal failure (ESRF). More recently, increasing awareness of the growing burden of chronic kidney disease (CKD), with a large percentage of the population affected by early stages of CKD, has shifted attention and health care priority to the prevention and early detection of CKD. This article addresses issues related to general population as well as targeted screening, favoring the latter. It also examines some of the screening initiatives undertaken in both the developing and developed worlds. It also highlights the links between albuminuria, CKD, and cardiovascular disease (CVD) as an increasing number of studies identify albuminuria/proteinuria, as well as CKD as major markers of CVD. Finally, a brief review is included of primary and secondary intervention strategies for CKD and issues related to their implementation: manpower and funding.     

慢性肾脏病患者心血管疾病危险因素探讨

目的探讨慢性肾脏病（CKD）患者心血管疾病的危险因素。方法收集我院542例住院CKD患者的病史、实验室检查和辅助检查结果,将患者根据有无心血管疾病分为2组,根据Logistic回归分析结果探讨心血管疾病的危险因素。结果高龄、高血压、高尿酸血症、贫血、蛋白尿是CKD患者心血管疾病的危险因素;CKD1～5期患者心血管疾病的危险因素各不相同。结论CKD进展和CKD患者心血管疾病的发生拥有部分相同的危险因素;在CKD早期以传统危险因素为主,随着肾功能的恶化,非传统危险因素起主导的作用。     

Relationship between renal function at the time of percutaneous coronary intervention and prognosis in ischemic heart disease patients

BACKGROUND: As hypertension and diabetes mellitus increase, the number of patients developing complications of cardiovascular disease (CVD) associated with conventional risk factors is increasing. In addition to these risk factors for CVD, chronic kidney disease (CKD) has also been reported to play an important role. We investigated the association of representative ischemic heart disease and CKD. METHODS: Between July 1, 2000, and June 30, 2005, a total of 790 patients who underwent percutaneous coronary intervention (PCI) for angina pectoris or myocardial infarction in our division of cardiovascular disease were reviewed. Serum markers at the implementation of PCI were compared in patients classified according to renal function. For prognosis, in-hospital mortality, 1-year survival rate, overall mortality, and CVD death were investigated. Changes in renal function were also monitored during the follow-up period. The glomerular filtration rate (GFR) was calculated by the Modification of Diet in Renal Disease Study Group (MDRD) formula. RESULTS: The mean estimated GFR (eGFR) at PCI implementation was 66.2 +/- 21.0 ml/min/1.73 m(2). Stage 2 CKD was shown in 51.5% of all the patients. During the overall follow-up period, 126 patients died. With the progression of CKD stage, all-cause, CVD, and in-hospital mortality increased, and the 1-year survival rate decreased. It was proved that a medical history of hypertension, hyperlipidemia, and diabetes, multiple vessel lesions, hypoalbuminemia, C-reactive protein (CRP), and estimated GFR were independent risk factors for all-cause death. In CVD death, in addition to the above risk factors, anemia and total cholesterol were also an independent risk factor. Renal function deteriorated significantly during the follow-up period. CONCLUSIONS: Patients with ischemic heart disease requiring PCI often develop renal dysfunction, which may considerably affect prognosis.     

The epidemics of cardiovascular disease in elderly patients with chronic kidney disease – Two facets of the same problem

There is increasing evidence that even mild renal dysfunction is a novel potent cardiovascular risk factor in the general elderly population. With more severe renal impairment, cardiovascular risk increases proportionately. This issue deserves attention, as chronic kidney disease (CKD) is predominantly a disease of the elderly, and the mean age of end-stage renal disease patients entering dialysis is growing constantly. In the dialysis population, when clinically significant cardiovascular disease (CVD) (particularly congestive heart failure) is present, survival is worse. Thus, every effort should be made to identify and treat cardiovascular risk factor in the early stages of CKD. However, elderly renal patients receive less proper cardiovascular therapy compared to non-renal subjects of the same age. This review deals briefly with the most significant data published in the last decade on CVD in elderly with CKD.     

Clinical assessment and management of dyslipidemia in patients with chronic kidney disease

Chronic kidney disease (CKD) is a common cause of cardiovascular disease (CVD). Several factors contribute to the onset and progression of atherosclerosis and CVD in CKD patients. Most of the cases of coronary heart disease in the general population can be explained by traditional risk factors, whereas non-traditional risk factors, including oxidative stress, anemia, inflammation, malnutrition, vascular calcification, and endothelial dysfunction, have been proposed to play a central role in the pathogenesis of CVD in CKD patients. However, the precise mechanism of CVD initiation in CKD patients remains unclear. Lipid-lowering therapies may decrease proteinuria, and increase or maintain renal function. Because the serum levels of triglyceride-rich lipoproteins are increased in CKD patients, particularly in advanced stages, the serum non-HDL cholesterol level may be a better biomarker of dyslipidemia than the serum LDL cholesterol level in this population. A meta-analysis showed that statin therapy was associated with decreased albuminuria in comparison with a placebo. Moreover, lipid-lowering therapy with statins is effective in reducing the risk of CVD in the early stages of CKD, whereas the benefit of statins in patients with end-stage renal disease may be limited.     

血浆不对称二甲基精氨酸与慢性肾脏疾病非透析患者心血管并发症的关系

目的 探讨不对称二甲基精氨酸（ADMA）与慢性肾脏疾病（CKD）非透析患者心血管并发症（CVD）的关系。 方法 高效液相色谱-质谱联用仪检测76例患者的血浆ADMA水平，分析其与颈动脉超声、心脏超声等相关指标及既往CVD病史的关系。 结果 CKD非透析患者的血浆ADMA水平较健康对照组显著升高[(41.56±12.76) 比 (17.12±7.09) mg/L, P < 0.01]。逐步多元回归分析显示ADMA是颈总动脉内-中膜厚度（β = 0.544, P < 0.01）和左室心肌重量指数（β = 2.521, P < 0.01）的独立危险因素。既往有CVD史者其血浆ADMA水平较既往无CVD史者显著升高[(47.60±15.14)比 (36.93±8.10) mg/L，P < 0.01]。Logistic回归分析显示血浆ADMA（β = 1.117，95%CI：1.013~1.232, P < 0.05）是CKD非透析患者CVD的独立危险因素。 结论 CKD患者普遍存在CVD，ADMA可能参与了CKD非透析患者CVD的发生发展。     

慢性肾脏病血清β-脑钠肽、同型半胱氨酸与心血管病变的关系

目的探讨血清β-钠肽（BNP）、同型半胱氨酸（Hcy）与慢性肾脏病（CKD）35期心血管事件的发生和病死率的关系。方法本组77例CKD患者，按NKF-DOQI指南分为CKD3期（A组）17例，CKD4期（B组）21例和CKD5期（C组）39例。正常对照组30例，观察各组临床表现、生化指标，血清BNP、Hcy等变化。同时，将77例患者根据Hcy数值分为升高组和正常组，观察其与心血管疾病（CVD）的相关性。结果与正常对照组比较，A、B、C组血肌酐（SCr）、尿素氮（BUN）、BNP明显升高，B组与A组比较，C组与B组比较，各组数值差异均有统计学意义。与Hcy正常组比较，Hcy升高组发生CVD明显增加，具有正相关关系。结论本研究显示，BNP和Hcy可作为慢性肾衰竭早期心血管损害的指标之一，BNP，Hcy与CVD发生及病死率的关系密切，BNP、Hcy越高，CVD的发生率越高，病死率也越高。     

Associations of Plasma Pentraxin 3 and Monocyte Chemoattractant Protein-1 Concentrations with Cardiovascular Disease in Patients with Chronic Kidney Disease

We examined the associations of circulating levels of pentraxin 3 (PTX3), monocyte chemoattractant protein-1 (MCP-1), and some other inflammatory mediators with cardiorenal syndrome. In advanced chronic kidney disease (CKD) patients (estimated glomerular filtration rate <30 mL/min/1.73 m²), the values of area under the curve of PTX3, tumor necrosis factor α, and high-sensitivity C-reactive protein for the detection of the association of cardiovascular disease (CVD) were 0.664, 0.507, and 0.318, respectively. In contrast, serum levels of MCP-1 were significantly higher in CKD patients than in control subjects independently of association with CVD.

Abstract

Both pentraxin 3 (PTX3) and monocyte chemoattractant protein-1 (MCP-1) are mediators of inflammation. They also appear to play critical roles in vascular endothelial dysfunction but their associations with cardiorenal syndrome remain largely unknown. The objective of this study was to examine their associations with cardiorenal syndrome. Circulating levels of PTX3, MCP-1, and some other biomarkers were evaluated in 134 patients with chronic kidney disease (CKD) and/or cardiovascular disease (CVD) and 55 age- and gender-matched subjects without CKD or CVD. Levels of PTX3, high-sensitivity C-reactive protein (hsCRP), and tumor necrosis factor α (TNFα) were significantly higher in CKD patients with CVD than in those without CVD. In advanced CKD patients (estimated glomerular filtration rate <30 mL/min/1.73 m²), the values of area under the curve of PTX3, TNFα, and hsCRP for the detection of the association of CVD were 0.664, 0.507, and 0.318, respectively. In contrast, serum levels of MCP-1 were significantly higher in CKD patients than in control subjects independently of association with CVD. PTX3, hsCRP, and TNFα, but not MCP-1 could predict the presence of CVD as a complication associated with CKD. Additionally, PTX3 might be a more sensitive marker for the association of CVD than hsCRP and TNFα in patients with advanced CKD.     

The unrecognized prevalence of chronic kidney disease in diabetes.

BACKGROUND: Diabetes mellitus and chronic kidney disease (CKD) are common and exhibit synergistic associations with premature mortality. Current diabetes guidelines in the UK recommend annual urinary albumin and serum creatinine determinations to screen for diabetic kidney disease. The aim of this study was to estimate the burden of CKD in patients with diabetes and examine the ability of serum creatinine and albuminuria to detect clinically meaningful CKD compared with estimated glomerular filtration rate (eGFR). METHODS: All adults known to have diabetes in primary and secondary care in Salford, UK, alive with independent renal function on 1 January 2004 were included in this observational study (n=7596). Demographic and laboratory parameters were obtained from the Electronic Patient Record. eGFR was determined using the 4-variable modification of diet in renal disease (MDRD) formula. Clinically meaningful CKD was defined as an eGFR <60 ml/min/1.73 m(2). RESULTS: Creatinine and albuminuria were measured in the preceding 2 years in 82.3 and 55.2% of subjects, respectively. In patients with CKD, normoalbuminuria was present in 48.8%, and serum creatinine was normal (or=120 micromol/l) had a sensitivity and specificity of 45.3 and 100%, respectively, to identify CKD. The combination of abnormal creatinine and albuminuria had an improved performance but still failed to detect a large number with CKD (sensitivity 82.4%, specificity 75.4%). Serum creatinine failed to identify CKD more often in females (OR 8.22, CI 6.56-10.29). CONCLUSIONS: Undiagnosed CKD is common in diabetes. Current screening strategies, based on creatinine or albuminuria, fail to identify a considerable number of subjects with CKD. Incorporating eGFR into screening for CKD would identify individuals earlier in the natural history of the disease and enable early effective treatment to delay progression of CKD.     

The risk of cardiovascular disease in adults who have had childhood nephrotic syndrome

While increased risk of cardiovascular disease (CVD) in patients with hyperlipidemia, chronic kidney disease (CKD), or end-stage renal disease (ESRD) is well documented, transient hyperlipidemia or intermittent renal disease as a consequence of relapsing nephrotic syndrome (NS) has not been studied. To investigate this enigma, 62 patients, between 25 and 53 years of age, who had steroid-responsive/dependent NS during childhood, were identified from the records of the Division of Pediatric Nephrology at Yale School of Medicine. Forty patients were located and contacted to ascertain symptoms or occurrences of CVD via a telephone interview. At the time of follow-up, 23–46 years after cessation of NS, none of these patients had ESRD or CKD. Three patients had experienced a myocardial infarction (MI): a 32-year-old male with a family history of CVD; a 41-year-old male with a history of heavy smoking, hypertension, diabetes mellitus, and elevated cholesterol; a 31-year-old male after a cocaine overdose. The occurrence of events (8%) and mortality from CVD (none) in this cohort of patients is comparable to patients of a similar age in the general population and is lower than that of patients of the same age who are on dialysis. The data suggest that relapsing NS during childhood does not place patients at increased risk for CVD mortality or morbidity compared with the general population. Consequently, it would appear that factors related to persistent proteinuria or renal insufficiency, rather than transient proteinuria and renal disease, contribute to the CVD documented in patients with CKD or ESRD.