Similarities in Skeletal Muscle Strength and Exercise Capacity Between Renal Transplant and Hemodialysis Patients

Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients. Aim of the study was to assess to what extent exercise capacity and skeletal muscle strength of RTx patients differ from HD patients and healthy controls and to elucidate potential determinants of exercise capacity in RTx patients. Exercise capacity, muscle strength, lean body mass (LBM) and physical activity level (PAL) were measured by cycle-ergometry, isokinetic dynamometry, DEXA and Baecke Questionnaire, respectively, in 35 RTx, 16 HD and 21 controls. VO2peak and muscle strength of the RTx patients were significantly lower compared to controls (p<0.01), but not different compared to HD patients. In RTx patients, strength (p<0.001), PAL (p=0.001) and age (p=0.045) were significant predictors of VO2peak. Muscle strength was related to LBM (p=0.001) and age (p=0.001), whereas gender (p<0.001) and renal function (p=0.01) turned out to be significant predictors of LBM. No effects of corticosteroids were observed. Exercise capacity and muscle strength seem equally reduced in RTx and HD patients compared to controls. In RTx patients, muscle strength and PAL are highly related to exercise capacity. Renal function appears to be a significant predictor of LBM, and through the LBM, of muscle strength and exercise capacity.     

血液透析动静脉瘘的建立及并发症的处理

目的 通过对238例内瘘患者的总结，探讨更好的血透患者的内瘘手术方法及并发症的治疗。方法 总结我院从1998年至今实行的内瘘手术238例，分别采用钛轮钉和显微外科血管吻合术建立动静脉瘘。手术部位多位于前臂桡侧腕横纹上3～5cm或鼻烟窝处将头静脉与桡动脉作端端或端侧吻合，前臂尺侧腕横纹上贵要静脉与尺动脉端侧吻合。比较各种类型的内瘘的成功率和并发症发生率。结果 显微外科血管吻合术制作的内瘘成功率高，并发症少，6年的内瘘通畅率达90％以上。结论采用动静脉直接吻合制作内瘘是建立血透患者血管通路的良好方法。     

Diagnostic value of serum prostate-specific antigen in hemodialysis patients

BACKGROUND: The value of serum prostate-specific antigen (PSA) screening was examined to detect prostate cancer in men receiving hemodialysis. METHODS: Forty-one male patients age 60-95 (median age, 70 years) receiving hemodialysis were investigated for PSA levels. We set the cut-off point at 4 ng/mL (the usual reference range). Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) of the prostate were performed in patients whose PSA was more than 4 ng/mL and/or who expected further examination of the prostate. When prostate cancer was suspected, biopsy of the prostate was performed. In patients with prostate cancer, magnetic resonance imaging, computed tomography and bone scintigraphy were performed to diagnose the clinical stage. RESULTS: The mean serum level of PSA was 2.10 +/- 0.49 ng/mL. In this screening study, four of 41 men required further examinations for prostate cancer. Two of four refused further examinations. The other two were diagnosed with prostate cancer. The incidence of prostate cancer was at least 5% in our hemodialysis patients. One man, whose clinical stage was T2aN0M0, was treated with radical retropubic prostatectomy. Another man, whose clinical stage was T2bN0M0, was treated with luteinizing hormone-releasing hormone analogue. CONCLUSION: In our preliminary study, prostate cancer screening with PSA was useful for the early detection of prostate cancer in hemodialysis patients. If possible, DRE and TRUS should be performed in conjunction with PSA tests.     

Dynamic observations on NK cell activity and IL-2 and IFNγ productionin vitro in patients on maintenance hemodialysis

Summary In order to study the immune function of patients on maintenance hemodialysis (MHD), we assayed NK cell cytotoxicity against K⁵⁶² targets in 40 patients on MHD, and the production of IL-2 and IFN in peripheral blood mononuclear cells (PBMC) after PHA stimulation, in contrast to those in normal controls. The results showed that NK cell activity and IL-2 and IFN levels were markedly lower in the patients than in the controls. Afeter a single dialysis, NK cell activity as well as IL-2 and IFN levels were elevated to different extent. But there was no significant change in patients after long-term dialysis. There was a positive correlation between the NK cell activity and IL-2 and IFN activity in the controls, but no such correlation was found in the patients on MHD. There was a positive correlation between the NK cell activity and IL-2 activity in patients after dialysis, suggesting that immune function were impaired in the patients on MHD, with a decline in the activity of NK cell and IL-2 and IFN, and a disorder of immune regulation cycle. These abnormal immune impairments in the patients could be partly corrected by hemodialysis. However, long-term hemodialysis is not much helpful in the improvement of patient’s immune function.     

高危出血患者应用吉派林抗凝血液透析疗效观察

目的：观察危重型肾功能衰竭合并高危出血患者选择抗凝药物进行血液透析治疗的效果。方法：应用吉派林(低分子肝素钠)作为抗凝剂进行血液透析。结果：129例病人进行血液透析386次，均没有出血发生。结论：吉派林在高危出血患者血液透析中使用方便，安全，效果良好。     

血液透析对血管内皮功能的影响及氟伐他汀的作用

目的：探讨血液透析对血管内皮功能有无损伤及氟伐他汀对该类病人的内皮功能有无保护作用和可能的机制。方法：以16名维持性血透患者为对象，分别在应用和不用氟伐他汀的情况下，单次血透前后测量上臂动脉扩张度、血浆氧化应激标志物丙二醛（MDA）、脂质过氧化物（LPO）、血浆抗活性氧基标志酶--谷光甘肽过氧化物酶（GSH-Px）、血脂，比较血透前后和用药前后各指标的差异。结果：维持性血透病人血透后血管内皮功能较血透前降低，体内氧化应激性增强。在应用氟伐他汀后患者透析后体内氧化应激活性减低，因血透所致的内皮功能损害也减轻。结论：血液透析加重血管内皮功能损害，其机制可能与其引起氧化活性产物增加有关，而氟伐他汀对这种损害发挥保护作用。     

尿毒症患者血透中血液动力学监测

目的：观察尿毒症患者血透过程中血液动力学改变，方法：尿毒症患者20例，均在透析放血前，放血后，30min,60min,120min,180min，回血前，回因后测定血压，脉搏，中心静脉压，平均直接动脉压，结果：透析过程中血压，脉搏以及直接平均动脉压较稳定，中心静脉压放血前较正常为高，且高于血透过程中其它时间段（P＜0．05），结论：血透过程中血液动力学稳定，且中心静脉压的变化有利于心功能的改善。     

Renal cell adenomas and carcinomas in hemodialysis patients: Relationship between hemodialysis period and development of lesions

Step-sections of 96 whole kidneys from 50 chronic hemodialysis patients were subjected to a histopathological and quantitative investigation with regard to the development of renal neoplastic lesions. The range of hemodialysis duration was from 1 to 222 months. A total of 349 renal cell adenomas were found in 41 cases (82%). They were commonly multiple and present bilaterally. Renal cell carcinomas were evident in four cases (8%), with hemodialysis durations of 54, 57, 112 and 222 months. The incidence of adenomas increased in a hemodialysis duration-dependent manner, indicating a high risk of renal cell tumor development in chronic hemodialysis patients. Furthermore, acquired cystic disease of the kidney (ACDK) was also observed in 12 cases (24.0%), where the mean hemodialysis period was 143.4 ± 48.0 months. This value was significantly longer than that of non-ACDK cases (P < 0.001). There was, however, no clear relationship between the appearance of ACDK and renal cell tumors. The present results underline the necessity for attention to possible neoplasia of the kidney in patients on long-term hemodialysis.     

重组促红细胞生成素对血透患者NO的影响研究

目的 :探讨基因重组促红细胞生成素 (rHuEpo)对维持性血透患者血管活性介质一氧化氮 (NO)的影响。方法 :将长期规律性血透尿毒症患者 80例分为血液透析应用rHuEpo者 (HDepo组n =4 3例 ) ,血液透析不应用rHuEpo者 (HD组n =37例 ) ,根据血压情况两组再分为HDepo高血压亚组 (HDepo - 1组 ,n =2 3)、HDe po血压正常亚组 (HDepo - 2组 ,n =2 0 )和HD高血压亚组 (HD - 1组 ,n =19)、HD血压正常亚组 (HD - 2组 ,n =18)。另选尿毒症未透析患者 2 0例 (NHD组 )、原发性高血压患者 2 0例、健康对照组 35例 (CON组 )。HDepo组患者均接受rHuEpo治疗 3个月以上 ,用比色法测定血NO水平。结果 :尿毒症未透析患者血清NO水平明显高于正常对照组 ,p <0 0 0 1;尿毒症透析患者血清NO浓度较正常对照组高 ,p <0 0 0 1,但经透析治疗的尿毒症患者与尿毒症未透析者比较 ,血清NO水平较未透析者低 ,p <0 0 5 ;HDepo组经rHuEpo治疗三月后血NO浓度下降 ,与用药前及对照组比较 ,p<0 0 0 1,p <0 0 5。且用rHuEpo治疗后 ,HDepo组收缩压、舒张压、平均动脉压均较HD组高 ,p <0 0 0 1,血压增高与NO浓度的降低有相关性。结论 :rHuEpo可使尿毒症透析患者血NO浓度降低 ,rHuEpo致高血压与血NO浓度降低有一定的关系