Relationship Between Inflammation and Sex Hormone Profile in Female Patients Receiving Different Types of Renal Replacement Therapy

Background

Patients with end-stage renal disease (ESRD) experience female sexual dysfunction (FSD). The purpose of this study was to compare FSD in different types of renal replacement therapy and control patients.

Methods

The study was consisted of 47 renal transplantation (RT), 46 hemodialysis (HD), and 28 continuous ambulatory peritoneal dialysis (CAPD) patients and 36 healthy control subjects. All groups were evaluated with the following scales: Female Sexual Function Index (FSFI) questionnaire, Short Form (SF)–36 questionnaires, and Beck Depression Inventory (BDI). Demographic data, laboratory values, and hormone levels were obtained. The patients with FSFI score <26.55 were accepted as experiencing sexual dysfunction.

Results

Overall, total FSFI scores in RT, HD, CAPD, and control were 22 (range, 2–35), 22.4 (4–34), 18.35 (2–34), and 29.6 (2–35), respectively. The mean total FSFI score was not different in patients receiving different kinds of renal replacement therapy (P > .05) although they were significantly worse then the control group (P < .001). On regression analysis, age was significantly associated with FSD (β = −0.14; P = .001). In addition, the physiologic health domain of SF-36 was significantly better in control groups (P < .001). The difference in terms of mean of BDI score did not reach statistical significance among patient groups (P > .05). Female sexual dysfunction score was negatively correlated with BDI (r = −0.371; P < .001) and positively correlated with the mental-physical components score of SF-36 (r = 0.423 [P < .001] and r = 0.494 [P < .001], respectively) in all patients groups. Regarding the hormones of the patients, there was a significant difference between RT and the HD and CAPD groups in dihydroepiandrosterone sulfate (DHEAS; P < .001), RT and HD in prolactin (P < .001), and RT and CAPD in free testesterone (P < .001).

Conclusions

Renal transplantation, hemodialysis, and peritoneal dialysis patients were at more risk of developing sexual dysfunction and lower quality of life scores than healthy subjects. Notably, the mode of renal replacement therapy had no impact on female sexual function.     

不同前列腺切除手术方法对性功能的影响

伴随老年化社会的到来,良性前列腺增生(BPH)和前列腺癌(PCa)的患者人数也在逐渐增加,尤其近年来PCa的患者数量增加极为迅速。在两者的治疗上,前列腺手术是金标准,但前列腺手术术式多样,术后性功能恢复上也各有特点。近年来腔镜技术逐渐取代了传统的开放手术,在术后功能恢复的评判标准上,术者和患者已不满足于排尿功能的改善,性功能的术前持续和术后恢复开始受到重视。本文就前列腺各种手术方式术后对性功能的影响作一综述。     

Gastric Emptying in Patients on Renal Replacement Therapy

In addition to gastrointestinal tract symptoms such as nausea, vomiting, and loss of appetite, impaired gastric emptying time (GET) may be related to nutritional parameters and nutritional status of patients on renal replacement therapy (RRT). Patients on RRT are affected by several factors such as uremic toxins, the presence of dialysate in the peritoneal cavity, and the drugs used against renal allograft rejection. In this study, we investigated the gastric emptying time and its relationship with biochemical and nutritional parameters in patients on RRT: those on hemodialysis and peritoneal dialysis, and renal transplantation patients. Seventy‐five patients, 44 on hemodialysis, 16 on peritoneal dialysis, and 15 renal transplant patients, were included in the study. They were examined for gastric emptying time using a radioisotopic method. The results were compared with the GET of healthy subjects. Each group of patients was evaluated in terms of hemoglobin, hematocrit, blood urea nitrogen (BUN), creatinine, blood glucose, total protein, albumin, serum lipids, parathyroid hormone (PTH) and body mass index and biceps and triceps skinfold. The mean GET of patients on RRT was significantly longer than the mean GET of healthy subjects (87.8 ± 23.4 vs. 55 ± 18 min, p < 0.05). The mean GET of each therapy subgroups was significantly longer than the healthy subjects (the mean GET was 85.1 ± 22.4 min for hemodialysis, 87.7 ± 31.8 min for peritoneal dialysis, and 94.6 ± 16.7 min for renal transplant patients, respectively, p < 0.05). On the other hand, the differences in the mean GET between the three therapy subgroups were not statistically significant (p > 0.05). In addition, time on replacement therapy inversely and blood glucose positively correlated with GET in renal transplant patients. In conclusion, GET was longer in patients on all three RRT modalities than in healthy subjects. GET was not significantly different in dialysis patients and renal transplant patients.     

Continuous Renal Replacement Therapy for Burned Patients: Renal and Systemic Considerations

Significant improvements in wound care have re-sulted in decreased mortality rates in burned pa-tients since the mid-seventies. The main determi-nants of survival remain the extent of the burn and the age. Infection is still the most frequent cause of mortality. Burned patients are prone to develop MOF, not only following sepsis, but from the sys-temic inflammation associated with thermal injury. Many metabolic derangements occur after a burn:hypermetabolism with several hormonal changes, enhanced catabolism and gluconeogenesis, im-paired ketogenesis and lipolysis. Aggressive nutri-tional support is particularly important in burned patients and avoiding a negative nitrogen balance is priority. Since early aggressive fluid resuscitation is widely applied, ARF occurs later during the course hospitalization, often after 10 days. Its pathogen-esis seems multifactorial, mainly related to sepsis and nephrotoxic agents, and is usually part of MOF. Dialytic support is challenged by the important fluid intake and removal required, the high catabolism, and the hemodynamic instability that characterize burned patients. Since they allow a better hemody-namic tolerance, a more precise fluid balance, and a more stable metabolic control, CRRTs appear as modalities of choice for ARF burned patients. How-ever, only three series report their usefulness for this selected population. In our experience, CRRTs have been performed over long periods and have allowed significant fluid loss over time. Bleeding complications from wounds have been much more frequent than for intensive care patients treated by CRRT with a similar anticoagulation regimen, and mandate prudent monitoring. Owing to limited vas- cular access sites and inherent risks of arterial cath-eterization, venovenous might be preferred to arte-riovenous modalities, if they are available. Despite more aggressive management, the mor-tality rates of burned patients with ARF remain high80%, reflecting the associated MOF. From a sys-temic point of view, considering the important vol-ume loss required, the potential for enhanced cyto-kine removal, and the important cumulative soluteclearances provided over time by CRRT, ARF burned patients should particularly benefit from continuous over intermittent modalities. When dia-lytic support has to be initiated, we consider CRRT, particularly hemodiafiltration which provides a larger dialysis dose, as the modality of choice.     

男性慢性肾功能不全病人的性功能障碍研究

目的 :研究四川省男性慢性肾功能不全病人性功能障碍的发病情况、表现形式和相关因素。　方法 :多中心合作、临床横断面调查 ,利用性功能电脑测评与诊断系统 (SCASF) ,对四川省 12 4例慢性肾功能不全病人和 12 5例慢性肾脏病肾功能正常病人 (对照组 )的性功能状态进行综合评价 ,同时测定其血常规、肾功能、性激素、性激素结合球蛋白等指标。　结果 :①慢性肾功能不全病人性功能障碍主要表现为性欲减退、勃起功能障碍 (ED)、早泄。②慢性肾功能不全病人性欲减退、ED、早泄、性操作焦虑、性合作缺乏的发生率明显高于对照组 (P <0 .0 5 )。③血液透析和腹膜透析病人各种形式的性功能障碍的发生率和障碍的严重程度没有差异 ;透析组 (血液透析和腹膜透析 )、未替代治疗组、肾移植组比较 ,未替代治疗组性欲减退和性操作焦虑的发生率高于透析组与肾移植组 ;未替代治疗组和透析组ED的发生率高于肾移植组。④多因素分析表明 ,性功能障碍的发生与病人的病程、肌酐清除率、甲状旁腺激素、血浆白蛋白无关。贫血、抑郁和应用 β受体阻滞剂是性欲减退的危险因素。年龄增加是ED的危险因素。应用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂和应用人基因重组促红细胞生成素 (r HuEpo)可减少ED的发生。　结论 :男性慢性     

连续肾脏替代疗法对ICU急性肾功能衰竭患者的临床疗效分析

目的　探讨连续肾脏替代疗法 (CRRT)对ICU急性肾功能衰竭 (ARF)患者的血浆细胞因子、肾功能指标及其预后的影响。方法　选取我科 2 0 0 2年 6月至 2 0 0 3年 11月符合ARF的ICU患者 38例 ,其中治疗组 2 0例采用CRRT治疗 ,对照组 18例采用肾脏非替代治疗 (保守治疗 )。两组患者于治疗前、后分别抽取静脉血标本作血浆细胞因子和肾功能指标的检测 ,并统计两组患者的临床死亡病例数。结果　与对照组比较 ,治疗组的血浆肿瘤坏死因子、白细胞介素 6、白细胞介素 8及血肌酐和血尿素氮水平有显著改善 (P<0 .0 5 ) ,而临床死亡率改变不明显 (P>0 .0 5 )。结论　CRRT能有效清除ICU的ARF患者的炎性细胞因子 ,改善肾功能指标 ,但其最终预后仍然很差。对于ICU的ARF患者 ,应该强调预防的重要性。     

Type of Renal Replacement Therapy and Residual Renal Function May Affect Prohepcidin and Hepcidin

Hepcidin is a small defensin-like peptide, the production of which by hepatocytes is modulated in response to anemia, hypoxia, or inflammation. Kidneys are involved in not only the synthesis of hepcidin, but they also may be involved in its elimination. A cross-sectional study was performed to assess prohepcidin and hepcidin in serum, urine, and ultrafiltrate/peritoneal effluent in relation to type of renal replacement therapy and prohepcidin and hepcidin correlations with renal function, iron status, and markers of inflammation.?Methods.?Prohepcidin and hepcidin high-sensitivity CRP, TNF alpha, and IL-6 were measured using commercially available kits in 102 patients on hemodialyses, 17 on hemodiafiltration, 44 on peritoneal dialyses, and 22 healthy volunteers.?Results.?In hemodialyzed and peritoneally dialyzed patients with residual renal function, serum prohepcidin (264.21 ± 95.84 vs. 341.84 ± 90.45 ng/mL, p < 0.01; 142.76 ± 57.87 vs. 238.42 ± 84.32 ng/mL, p < 0.01, respectively) and hepcidin (178.89 ± 89.87 vs. 295.76 ± 129.65 ng/mL, p < 0.01; 108.43 ± 75.49 vs. 186.53 ± 119.62 ng/mL, p < 0.01, respectively) were significantly lower than in anuric patients. In peritoneal effluent, prohepcidin level was significantly higher than in ultrafiltrate of HD/HDF patients. In multiple regression analysis, residual renal function, ferritin, and hsCRP were predictors of hepcidin in hemodialyzed patients, while residual renal function and ferritin were predictors of hepcidin in peritoneally dialyzed patients.?Conclusions.?Residual renal function seems to play a pivotal role in hepcidin levels in dialyzed patients. In addition, the presence of low-grade inflammation, more pronounced in anuric patients, and functional iron deficiency may also contribute to the elevated hepcidin. The removal of prohepcidin with ultrafiltrate/peritoneal effluent may partially explain its lower concentration in peritoneal dialysis and hemodiafiltration.     

肾功能损伤分级在心脏术后肾脏替代治疗中的应用

目的 探讨肾功能损伤分级(AKIN分级)在心脏术后肾脏替代治疗时机选择中的作用. 方法 2006年9月至2007年10月在我院首次行冠状动脉旁路移植术和/或心瓣膜手术100例患者中,根据AKIN分级,选取最高分级在2级、3级的患者,并结合是否接受肾脏替代治疗(RRT)将患者分为4组:A组:2级接受RRT治疗;B组:2级未接受RRT治疗;C组:3级接受RRT治疗;D组:3级未接受RRT治疗,记录4组患者临床资料和临床转归等. 结果 4组患者术后肾功能均出现不同程度的损伤,血肌酐最高值分别为197.8±32.1 μmol/L,154.1±40.1 μmol/L,330.9±78.2 μmol/L和339.1±107.7 μmol/L,明显高于术前.4组患者住院病死率分别为16.7%、14.3%、52.2%和56.3%,C组患者住院病死率高于A组(χ2=5.487,P=0.019)和B组(χ2=11.036,P=0.001),D组患者住院病死率明显高于A组(χ2=5.812,P=0.016)和B组(χ2=11.003,P=0.001),其中以D组患者的病死率最高. 结论 心脏术后患者肾功能损伤分级进入AKIN分级2级时接受RRT有可能改善其临床预后.     

床旁持续性肾脏替代治疗在心脏移植术后急性肾功能不全患者中的应用

目的 总结床旁持续性肾脏替代治疗(CRRT)在心脏移植术后急性肾功能不全患者中应用的经验,分析其临床结果.方法 2007年9月至2008年9月北京阜外心血管病医院共施行原位心脏移植39例,其中有7例患者心脏移植术后因急性肾功能不全而使用PRISMA CRRT和M100血滤器行连续性静脉一静脉血液透析滤过(CVVHDF)治疗,全血激活凝血时间(ACT)维持在160～200 s.结果 术后生存6例,出院时心功能分级(NYHA)Ⅰ级;死亡1例,死于多器官功能衰竭、严重感染.CRRT时间48～658 h,平均252 h,治疗期间基本少尿或无尿,但血流动力学及内环境维持稳定,停CRRT后肌酐值最高达267.1±68.5μmol/L,随着尿量增多后逐渐下降至正常范围.术后肾小球滤过率(GFR)56.5±19.0 ml/min,与术前比较差异无统计学意义(P>0.05).术后随访6例均生存,随访时间5～13个月(9.7±3.8个月),肌酐值均在正常范围(90.6±26.7μmol/L),与出院时肌酐值(83.2±26.5 μmol/L)比较差异无统计学意义(P>0.05).结论 对心脏移植术后并发急性肾功能不全的患者及时应用CRRT预后良好,术后随访未出现明显的肾功能损害.     

Acute Renal Failure in Patients with Kidney Transplant: Continuous Versus Intermittent Renal Replacement Therapy

Mortality from acute renal failure in critically ill patients remains in excess of 50% despite decades of improvement in supportive care. It is not known whether replacement of other failing organs by non-renal organ transplantation affects mortality in acute renal failure. We retrospectively reviewed the course of 169 patients with acute renal failure managed at a single university medical center over a 1-year period. Measures of disease severity (need for renal replacement therapy, mechanical ventilation or parenteral nutrition, presence of oliguria and APACHE II scores) and final outcome were compared in 97 patients with acute renal failure who did not receive transplants and 72 patients with acute renal failure who underwent non-renal solid organ transplants. Overall mortality was 50.3% and directly correlated with APACHE II score. Compared to nontransplant patients, transplant recipients were younger, more frequently male, and less often oliguric; but the groups were similar in mean APACHE II scores and need for renal replacement therapy, prolonged mechanical ventilation, and parenteral nutrition. Overall, mortality was significantly lower for transplant patients compared to nontransplant patients (34.7% vs. 61.9%, p < 0.05). In nonoliguric acute renal failure and renal failure not requiring renal replacement therapy, mortality was low and similar in both transplant and nontransplant patients. Compared to nontransplant patients with similar risk factors and similar APACHE II scores, mortality was significantly lower for transplant patients who were oliguric, or who required renal replacement therapy, mechanical ventilation, or parenteral nutrition. Organ transplantation is associated with a survival advantage in acute renal failure when compared to the outcome of critically ill nontransplant patients. The relation between APACHE II scores and survival is altered by transplantation.