Ambulatory blood pressure monitoring and renal functions in children with a solitary kidney

The aim of this study is to investigate the blood pressure (BP) profile, microalbuminuria, renal functions, and relations with remaining normal kidney size in children with unilateral functioning solitary kidney (UFSK). Sixty-six children with UFSK were equally divided into three groups: unilateral renal agenesis (URA), unilateral atrophic kidney (UAK), and unilateral nephrectomy (UNP). Twenty-two age-, weight-, and height-matched healthy children were considered as a control group. The serum creatinine level and first-morning urine microalbumin and creatinine concentrations were determined by the standard methods. Also, the BP profile was determined by ambulatory blood pressure monitoring (ABPM). We found that the serum creatinine level was higher and creatinine clearance was lower in each patient groups compared to those of the control group (p < 0.05). Compared with the controls, each group of patients had mean office, 24-h, daytime, and night-time systolic and diastolic BP values similar to those of the controls (p > 0.05). An inverse correlation was found between the renal size standard deviation scores (SDS) of normal kidneys and 24-h systolic and diastolic BP load SDS in all of the patients (p < 0.05; r = −0.372, r = −0.295, respectively). The observed relationship between renal size SDS and 24-h mean arterial pressure (MAP), systolic and diastolic BP load SDS suggests that children with UFSK should be evaluated by using ABPM for the risk of hypertension.     

别嘌呤醇对慢性肾衰竭患者肾脏保护作用及机制

目的观察别嘌呤醇对慢性肾衰竭（CRF）患者肾功能的保护作用。方法将入选的86例CRF（除外尿酸性肾病）患者分成对照组和治疗组,对照组给予CRF常规非透析疗法治疗;治疗组则在对照组基础上加用别嘌呤醇治疗;观察4周。测定2组治疗前后患者的尿素氮（BUN）、血肌酐（SCr）、血尿酸、一氧化氮（NO）,内皮素1（ET-1）,血栓素B2（TXB2）、6-酮-前列腺素F1α（6-keto-PGF-1α）及超敏C反应蛋白（hs-CRP）。结果治疗组治疗后,BUN、SCr及血尿酸较同组治疗前显著降低（P〈0．05）,与对照组比较有统计学差异（P〈0．05）;ET-1和NO分别较同组治疗前降低和升高（P〈0．05）,TXB2和6-keto-PGF-1α分别较治疗前降低和升高（P〈0．05）,hs-CRP较同组治疗前下降（P〈0．05）,与对照组比较均有统计学差异（P〈0．05）。结论别嘌呤醇对CRF患者肾功能具有保护作用,其可能是通过抗微炎症状况和改善血管内皮功能的作用。     

双重阻断肾素-血管紧张素系统对慢性肾脏疾病血压、蛋白尿和肾功能的影响

目的 观察长程应用ACEI联合ARB治疗慢性肾脏疾病的疗效和安全性。 方法 60例慢性肾脏疾病患者随机分为3组：ACEI组、ARB组和联合组，ACEI组接受贝那普利治疗，ARB组接受缬沙坦治疗，联合组接受贝那普利联合缬沙坦治疗。观察治疗后1、3、6、9和12个月的相关临床指标变化，并进行评价。 结果 3 组患者经过12个月治疗后，24 h尿蛋白从(1.08±0.68) g降至(0.27±0.29) g，P < 0.05；收缩压从(129±24) mm Hg降至(116±18) mm Hg(P < 0.05)；肾小球滤过率从(67.5±30.2)ml/min升至(69.3±34.6)ml/min(P > 0.05)；血钾变化不大(P > 0.05)；不良反应轻微。3 组相比，联合组有最强的减少尿蛋白和降低舒张压作用(P < 0.05)，而在肾功能改善、血钾变化及不良反应方面，3 组间差异无统计学意义(P > 0.05)。结论 长期联合治疗双重阻断RAS系统有更强地降低蛋白尿和舒张压作用，而不良反应轻微。     

非布司他与别嘌醇治疗慢性肾脏病合并高尿酸血症的疗效比较

目的探讨非布司他与别嘌醇在治疗慢性肾脏患者合并高尿酸血症的临床疗效分析比较。方法回顾性分析2013年1月至2015年2月中国人民解放军第174医院收治的78例慢性肾脏病合并高尿酸血症患者,并根据治疗方法将其分为对照组和治疗组。2组患者均采用优质低蛋白饮食、降压[钙通道阻滞剂和(或)β受体阻滞剂]、纠正贫血(促红细胞生长素)、补充α酮酸(开同)及纠正水、电解质酸碱平衡(碳酸氢钠)等综合治疗;观察组加用非布司他20 mg/d,对照组加用别嘌醇100 mg/d;2组均治疗观察24周。分析治疗前后2组患者血肌酐、血尿酸及临床疗效,并进行统计学分析。结果 2组治疗前后实验室相关指标比较结果表明2组治疗后血尿酸与治疗前比较,均有显著改善(均P0.05),且治疗组患者治疗后尿酸与对照组行组间比较有统计学差异(P0.05)。治疗组治疗后血肌酐与治疗前比较明显降低,有统计学差异(P0.05);而对照组治疗前后血肌酐无明显变化(P0.05)。治疗组临床总有效率高于对照组(P0.05)。2组均未发现明显的不良反应。结论非布司他相对于别嘌醇降低血尿酸水平的作用更强,且可改善肾功能,药物不良反应较小,因此在治疗慢性肾脏合并高尿酸血症患者上具有良好的应用前景。     

慢性尿酸性肾病致肾功能损害患者的临床诊治研究

目的：探讨慢性尿酸性肾病致肾功能损害患者的临床诊治方法。方法选取本院2011年10月～2013年10月诊治的慢性尿酸性肾病致肾功能损害患者83例,根据治疗方案分为两组,41例患者实施常规治疗为对照组,42例患者加用别嘌呤醇为观察组,疗程8周,比较两组患者相关临床指标的改变情况、临床疗效、不良反应情况。结果治疗后,对照组患者血尿酸显著下降,而尿pH值显著升高。观察组患者血尿酸、血肌酐、尿素氮、24h尿蛋白均显著下降,而肾小球滤过率、尿pH值均显著升高。观察组患者血尿酸、血肌酐、尿素氮、24h尿蛋白均明显低于对照组,观察组患者肾小球滤过率、总有效率均明显高于对照组,差异均有统计学意义（P＜0.05）。结论别嘌呤醇是治疗慢性尿酸性肾病致肾功能损害的有效药物,可明显改善患者的临床指标,提高治愈率,引发的不良反应少,具有较高的安全性,值得临床推广使用。     

心衰患者尿酸对血管内皮功能的影响及别嘌呤醇的干预

目的探讨心力衰竭（心衰）患者尿酸（UA）升高对血管内皮功能的影响及别嘌呤醇干预对尿酸升高的慢性心衰内皮依赖性血管舒张功能的影响。方法将30例心衰患者随机分为别嘌呤醇组和对照组，对照组15例，用常规药物治疗2周；别嘌呤醇组15例，在常规药物治疗基础上加用别嘌呤醇。采用高分辨超声技术检测血流介导和硝酸甘油介导的肱动脉舒张功能，并测定治疗前后血浆UA和内皮素（ET-1）。结果（1）用药前，二者比较UA水平及ET-1水平，差异无统计学意义（P〉0．05）；用药后，别嘌呤醇组UA水平及ET-1水平和对照组比较均降低，差异有统计学意义（P〈0．05）。各组用药后UA水平及ET-1水平均明显降低（P〈0．01）。（2）别嘌呤醇组和对照组肱动脉内径基础值无明显差异（P〉0．05），反应性充血引起肱动脉内径变化别嘌呤醇组明显增加（P〈0．01）。含服硝酸甘油后两组肱动脉内径均明显扩张，但两组肱动脉内径变化无明显差异（P〉0．05）。结论心衰患者经药物干预后，UA水平降低，ET-1水平随之下降，尤以别嘌呤醇组降低明显。别嘌呤醇治疗后UA水平明显降低，内皮依赖性血管舒张功能明显改善，别嘌呤醇是慢性心衰的一种便宜而有效的辅助药物。     

No myelosuppression when mizoribine is combined with allopurinol for the treatment of hyperuricemia in renal transplant patients

Background. In cadaveric renal transplant recipients, a commonly used triple immunosuppression regimen includes azathioprine, cyclosporin, and prednisolone. Azathioprine is a potential bone marrow suppressant. Allopurinol is a commonly used drug to treat hyperuricemia, which frequently occurs in kidney transplant recipients. Azathioprine is metabolized by xanthine oxidase, which is inhibited by allopurinol, leading to accumulation of its active metabolites, which are potential myelosuppressants. Moreover, in certain clinical situations, azathioprine is contraindicated. The immunosuppressive drug mizoribine has been used to prevent rejection of organ allografts in humans. Its effect is mediated through a different pathway in purine metabolism, and allopurinol does not interfere with its metabolism. Therefore, a combination of mizoribine with allopurinol does not cause myelosuppression. Methods. Thirteen cadaveric renal transplant recipients who had hyperuricemia were treated with allopurinol and mizoribine as an alternative to azathioprine, along with steroids and cyclosporin A. They were followed up for 12 months. Results. None of these patients developed bone marrow suppression and all had adequate control of hyperuricemia and had no deterioration in allograft function. Conclusions. Mizoribine can be safely combined with allopurinol in cadaveric renal transplant recipients who have hyperuricemia, without causing bone marrow suppression. Received: October 31, 2000 / Accepted: March 14, 2001     

Management of atherosclerotic renovascular disease: the effect of renal artery stenting on renal function and blood pressure

In the last few years, renal artery stenting has gradually evolved into one of the most important therapeutic modalities in the management of atherosclerotic renovascular disease. Stenting is nowadays preferred by a steadily increasing number of physicians, not only because of its significant contribution to blood pressure control, but also because of its documented ability to maintain, and even improve, renal function. At the same time, procedure-related morbidity and mortality rates are extremely low, while recurrent stenosis rates have been repeatedly reported to be␣minimal. Percutaneous transluminal renal angioplasty (PTRA) and stenting are nowadays considered by many physicians to be the treatment of choice for atherosclerotic renovascular disease.     

肾动脉狭窄患者肾动脉支架置入术后再狭窄及肾功能和血压的改变

目的评估肾动脉支架术后再狭窄的发生及肾功能及血压的改变。方法对135 例单侧或双侧肾动脉明显狭窄(管腔内径减少≥70％)的患者行肾动脉支架置入术(PTRAS),术后行肾动脉造影、血压及血肌酐(Scr)的随访观察。结果 135例患者植入147枚支架均获成功。术后肾动脉造影随访率70％,平均随访时间为(7．2±5．6)月,再狭窄率为7．4％。血压及肾功能随访率为95％,平均随访时间(22±6)月,随访患者的收缩压与舒张压均明显下降,分别为 [(172±23)比(159±20)mm Hg,P<0．05,(93±16)比(85±13)mm Hg,P<0．05]。但术后12个月及24个月Scr和GFR与术前比较无显著性差异。结论肾动脉支架置入术后的再狭窄率较低,PTRAS有助于患者的血压控制。     

右美托咪定对异体肾移植患者围术期肾功能的影响

目的研究右美托咪定对同种异体肾移植患者围术期肾功能的影响。方法选择行同种异体肾移植患者60例,男36例,女24例,年龄25~45岁,ASAⅡ或Ⅲ级,随机分为两组:右美托咪定组和对照组,每组30例。右美托咪定组麻醉诱导前给予右美托咪定1μg/kg泵注10min,随后以0.6μg·kg~(-1)·h~(-1)维持泵注至手术结束前30min;对照组以等容量生理盐水维持至手术结束前30min。记录两组患者在麻醉诱导前(T_1)、吻合血管开放前(T_2)、吻合血管开放后即刻(T_3)、吻合血管开放后30min(T_4)和手术结束后(T_5)的HR和SBP,于T_2、T_4、术后24h(T6)及术后48h(T7)采取静脉血检测血尿素氮(BUN)、血肌酐(Cr)、IL~(-1)8和半胱氨酸蛋白酶抑制剂C(Cys C)的浓度;记录术中液体输注量和尿量。结果 T_3时右美托咪定组HR明显慢于对照组;T_2、T_3时右美托咪定组SBP明显高于对照组(P0.05)。与T_2时比较,T6、T7时两组Cys C、BUN、Cr浓度明显降低,且T7时右美托咪定组Cys C浓度明显低于对照组(P0.05)。与T_2时比较,T6、T7时两组IL~(-1)8浓度明显降低,且右美托咪定组降低幅度明显大于对照组(P0.05)。右美托咪定组围术期尿量明显多于对照组(P0.05)。两组术中液体输注量差异无统计学意义。结论围术期应用右美托咪定可有效保护肾移植患者的肾功能。     

别嘌醇预处理对大鼠肾脏缺血-再灌注损伤中Bax、Bcl-2及Caspase-3表达的影响

目的  探讨别嘌醇预处理对大鼠肾脏缺血-再灌注损伤(IRI)的影响及其机制。方法  将24只SD大鼠随机分为3组:假手术组(S组)、缺血-再灌注组(IR组)、别嘌醇预处理组(APC组), 每组8只。手术前2周开始, 向APC组大鼠腹腔注射别嘌醇[50 mg/(kg·d)], 向S组及IR组大鼠腹腔注射等容量的生理盐水。预处理完成后S组切除右肾, IR组及APC组切除右肾并对左肾进行30 min缺血-再灌注处理。再灌注后24 h取血液标本, 术后2周取肾脏组织标本。采用全自动生化分析仪检测血尿素氮(BUN)和血清肌酐(Scr)水平。采用丙二醛(MDA)检测试剂盒与超氧化物歧化酶(SOD)活性检测试剂盒分别检测血浆MDA与总SOD活性水平。采用蛋白印迹法检测大鼠肾组织中Bax、Bcl-2和Caspase-3的表达水平。光学显微镜(光镜)下观察大鼠肾脏组织病理变化。采用dUTP缺口末端标记(TUNEL)染色法检测大鼠肾脏细胞凋亡情况。结果  与S组比较, IR组及APC组大鼠BUN、Scr、血浆MDA水平均明显升高, 血浆SOD活性水平均明显降低; 与IR组比较, APC组BUN、Scr、血浆MDA水平均明显降低, 血浆SOD活性水平明显升高(均为P < 0.05)。与S组比较, IR组与APC组肾组织Bax和Caspase-3蛋白表达量均明显增加, APC组明显低于IR组(均为P < 0.05)。与S组比较, IR组与APC组肾组织Bcl-2蛋白表达量均明显降低, 但APC组明显高于IR组(均为P < 0.05)。光镜下, S组大鼠肾组织结构完整, 形态正常; IR组肾小管管腔明显扩张, 肾小管上皮细胞出现大量坏死, 间质水肿明显, 其内可见大量淋巴细胞浸润; APC组肾小管管腔轻度扩张, 肾间质未见明显水肿, 间质内少量淋巴细胞浸润。TUNEL染色结果显示, S组、IR组和APC组的肾脏细胞凋亡率分别为(4.1±1.7)%、(32.8±8.9)%、(12.6±3.4)%(均为P < 0.05)。结论  别嘌醇预处理可能通过抗氧化作用抑制细胞凋亡, 从而减轻大鼠肾脏IRI, 改善肾功能。     

Blood pressure load,proteinuria and renal function in pre-hypertensive children

It is as yet unclear whether blood pressure load (BPL) can affect renal function in pre-hypertensive children. We have studied 250 children, with a mean age of 9.12 ± 3.28 years, with the aim of assessing if pre-hypertension in children can indeed affect renal function. The study cohort consisted of 146 children with pre-hypertension (group P) and a control group of 104 children with normal blood pressure (group C). All children were tested for orthostatic proteinuria, an exclusion criterion, glomerular filtration rate (GFR), and proteinuria, and ambulatory blood pressure monitoring was performed. Based on the BPL, group P was further subdivided into group P1 (BPL ≤ 40%, low BPL) and group P2 (BPL > 40%, high BPL). We found that GFR was reduced in pre-hypertensive children (90.74 ± 48.69 vs. 110.32 ± 20.30 ml/min per 1.73 m², p < 0.0001) and that proteinuria was increased (145.36 ± 110.91 vs. 66.84 ± 42.94 mg/m² per 24 h; p < 0.0001). However, mean values were still within normal limits. A comparison of the group with high BPL and that with low BPL revealed that the former had relatively reduced GFR (79.15 ± 42.04 vs. 96.78 ± 51.20 ml/min per 1.73 m²; p < 0.006) and increased proteinuria (198.29 ± 142.17 vs. 118.31 ± 80.07 mg/m² per 24 h; p < 0.036). In comparison to the reference values of the normal population, the GFR was reduced and proteinuria was increased in the group with high BPL. Based on our results, pre-hypertension in children with high BPL seems to be associated with reduced GFR and increased proteinuria. A reasonable doubt remains that the patients with higher proteinuria and larger reduction of GFR may harbor an as yet unknown subclinical renal condition responsible for the onset of pre-hypertension. Therefore, children with even mildly elevated BP are at risk of developing renal damage and should change their lifestyle to prevent further increases in BP.     

妊高征患者蛋白尿及肾功能与围产期结局的关系

目的:探讨妊娠高血压综合征(妊高征)患者蛋白尿、肾功能与围产期结局的关系.方法:测定150例妊高征患者和40例正常孕产妇的24 h尿蛋白定量、血清尿素氮(BUN)、尿酸(UA)、肌酐(Cr)、钙(Ca2 )和血压水平.结果:(1)妊高征患者分娩时间明显提前,早产儿发生率和围产儿病死率均明显高于正常妊娠组(P<0.01),新生儿体重则明显低于正常妊娠对照组(P<0.001).(2)妊高征组血压、BUN、UA、Cr、24 h尿蛋白量均明显高于正常妊娠组(P<0.001),而白蛋白(Alb)、Ca2 均明显低于正常妊娠组(P<0.001).(3)随着收缩压的升高和24 h尿蛋白量的增加,新生儿体重逐渐降低(P<0.001).(4)随着24 h尿蛋白量的增加,分娩周数逐渐缩短(P<0.05),血压、BUN、UA、Cr均逐渐升高(P<0.001),而Alb和Ca2 则逐渐降低(P<0.001).(5)相关分析表明新生儿体重与分娩周数、Ca2 呈明显正相关,而与24 h尿蛋白量、SBp、BUN呈明显负相关;24 h尿蛋白量与分娩周数、新生儿体重、DBp、BUN、UA、Alb、Ca2 等7项指标呈明显相关性;BUN与分娩周数、新生儿体重、24 h尿蛋白量、UA、Cr、Ca2 等6项指标呈明显相关性;UA与分娩周数、24 h尿蛋白量、BUN、Cr、Alb、Ca2 等6项指标呈明显相关性;Ca2 则与分娩周数、新生儿体重、24 h尿蛋白量、SBp、DBp、BUN、UA、Cr、Alb等9项指标均呈明显相关性.结论:血压、24 h尿蛋白量、尿素氮、尿酸和钙的变化与妊高征患者的病情及围产儿预后密切相关,不仅可作为临床监测指标,而且对妊高征的诊断和治疗以及改善母婴预后均有十分重要的意义.     

低中心静脉压对肝叶切除病人术中出血及肾功能的影响

目的观察低中心静脉压(LCVP)对肝叶切除手术出血量和肾功能的影响。方法LCVP组在肝实质完全离断过程中中心静脉压(CVP)控制在0～5cmH2O(1cmH2O=0.098kPa),C组CVP维持在6～12cmH2O之间。观察两组病人术中总失血量、输血率和输血量,比较肝脏手术部位不同及第一肝门血流处理法不同的两组病人术中出血量,术前、术毕肾功能变化。结果LCVP组和C组术中出血量分别为(427±317)mL和(800±709)mL,P<0.05。LCVP组在不同部位肝叶切除术术中出血量均少于C组。进行第一肝门阻断者,LCVP组出血量明显少于C组。术中LCVP组输血量明显少于C组。两组病人术前、术中肾功能无明显变化。结论低中心静脉压可减少肝叶切除术中的出血量,对手术中病人肾功能无明显影响。     

Evaluation of renal function and proteinuria based on mass health examinations in young Japanese obese adults

Background  Although obesity is recognized to be a risk factor for chronic kidney disease (CKD), few studies have reported the association between obesity and CKD in the young population. We investigated the relationship between obesity and renal function including proteinuria in young Japanese. Methods  This cross-sectional study consisted of 16,031 men and 5,746 women aged from 20 to 39 years who received health examinations. The subjects were stratified into four age groups (20–24, 25–29, 30–34, and 35–39 years) or into four groups based on the number of risk factors (hypertension, hyperglycemia, dyslipidemia, and hyperuricemia). The relationship between obesity and risk factors and the relationship between obesity and estimated glomerular filtration rate (eGFR) were analyzed. Results  There were no significant differences in eGFR between obese and nonobese groups, except in the male 35–39 years age group. Body mass index (BMI) in both men and women increased with increase in number of risk factors (P < 0.001). Multivariate analysis revealed that hypertension, hyperglycemia, dyslipidemia, and hyperuricemia were independently associated with obesity. Obesity and the risk factors were independently associated with proteinuria. Conclusion  The present study indicated that obesity was an independent risk factor for proteinuria in healthy subjects younger than 40 years of age. The other risk factors were independently associated with obesity. These findings suggest that obesity causes proteinuria concomitantly with other risk factors such as hypertension, diabetes, and dyslipidemia in young adults.     

Effect of ramipril on ambulatory blood pressure and albuminuria in renal hypertension

Inhibition of the angiotensin-converting enzyme (ACE) exerts a renoprotective effect in adult patients with chronic kidney disease. We evaluated prospectively changes in blood pressure (BP), protein excretion and renal function after administration of the long-acting ACE inhibitor ramipril as monotherapy during 6 months in 14 moderately hypertensive children aged 5–18 years with various nephropathies. Four patients initially had a decreased glomerular filtration rate (GFR below 60 ml/min/1.73 m²). BP was evaluated by ambulatory 24-h monitoring. After 2 weeks of treatment by oral ramipril (1.5 mg/m² once daily), mean values of systolic and diastolic 24-h ambulatory BP fell by more than 5 mmHg in nine patients. In eight patients the dose was doubled. At the end of the study systolic BP was below the 95th percentile in 9 and diastolic BP in 13 patients. The initially reduced nocturnal dip increased significantly. Of 11 patients with an increased albumin excretion (median 1.3 g/g creatinine), 6 responded to ramipril by a median reduction of 78% (range 24–83%), whilst in 5 albuminuria increased (median +19%). GFR was well preserved and no other adverse effects from the drug were noted. The study demonstrates that ramipril is an efficacious antihypertensive agent in children with renal hypertension. It is well tolerated, even in mild renal insufficiency. In addition, the drug has a persistent antiproteinuric action in about half of the patients contributing to conserve renal function. Received: 4 August 1999 / Revised: 27 March 2000 / Accepted: 29 March 2000     

Multicenter study on the influencing factors of interdialysis blood pressure variability in maintenance hemodialysis patients

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta, and provide clinically useful information for the prevention and treatment of BPV. Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively. According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV), patients were divided into four groups, and clinical data, biochemical indicators and drug use were compared among 4 groups. Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV. Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study. Their dialysis duration was (48.4±36.1) months, and the median of interdialysis SBP-CV was 8.07% (5.72%, 11.34%). According to the quartile of SBP-CV, the patients were divided into four groups: low BPV group (SBP-CV≤5.72%, 253 cases), middle BPV group (5.72%＜SBP-CV≤8.07%, 252 cases), high BPV group (8.07%＜SBP-CV≤11.34%, 253 cases) and extremely high BPV group (SBP-CV＞11.34%, 252 cases), and the dialysis duration, diabetes, ultrafiltration, interdialysis weight gain rate (IDWGR), serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P＜0.05). Logistic multiple regression analysis showed that high IDWGR (OR=1.216, 95%CI 1.108-1.435, P＜0.001) was an independent risk factors for interdialysis BPV in MHD patients, while high ultrafiltration volume (OR=0.436, 95%CI 0.330-0.575, P＜0.001) and calcium channel antagonists used (OR=0.686, 95%CI 0.477-0.986, P=0.042) were independent protective factors. Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients, while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.     

探讨透析液钙浓度对血液透析患者血压及血清钙磷变化的影响

目的观察不同钙离子浓度的透析液对血液透析患者血压及血清钙磷代谢的影响,为血液透析患者的高血压及高钙血症的防治提供参考。方法选取我院血液净化中心维持性血液透析患者15例,采取自身对照的方法,先后应用钙浓度为1．75mmol／L（dCa2＋1．75）及1．50mmol／L（dCa2＋ 1．5）的透析液各连续进行35次透析,记录每次透析上机前、1h、2h、3h及透析结束后的血压,并分别于第1次及第35次透析前后观察一般临床指标及血清总钙、磷、钙磷乘积、甲状旁腺素及碱性磷酸酶的变化。结果两种透析液一般指标差异无显著性（P〉O．05）。与采用dCa2＋ 1．75相比,采用dCa2＋ 1．5进行透析,患者的血压降低,尤其在透析3h及透析结束后,差异有显著性（P〈0．05或P〈0．01）,透析后磷升高,差异有统计学意义（P〈0．05）,其他指标变化无显著性（P〉0．05）。结论透析液钙离子浓度与血液透析患者血压呈正相关,低钙透析液透析有助于维持性血液透析患者高血压的控制,但本研究未观察到其对血清钙浓度的影响。     

Comparison of blood pressure variability and rhythm between peritoneal dialysis patients and hemodialysis patients and the correlations with cardiovascular disease-related death

Objective To compare the differences of blood pressure variability (BPV) and blood pressure rhythm (BPR) between maintenance peritoneal dialysis (MPD) and maintenance hemodialysis (MHD) patients, and explore the relationship of BPV and BPR with cardiovascular disease (CVD)-related death. Methods This was a prospective cohort study. Patients with maintenance dialysis treatment for more than 3 months in the General Hospital of Ningxia Medical University and stable clinical status were recruited from December 2015 to July 2016. The patients' general data, biochemical indexes and dialysis-related indexes were collected. BPV and BPR were observed by ambulatory blood pressure monitoring in all patients. The prospective follow-up was up to February 2020. All patients were divided into high 24 h systolic blood pressure variability (24hSBPV) group and low 24hSBPV group based on the median of 24hSBPV, and the baseline data of the two groups were compared. The BPV and BPR between MPD and MHD patients were compared. Kaplan-Meier method was used for survival analysis. The relationship between BPV and CVD-related death was analyzed by Cox regression. Results A total of 120 dialysis patients were included in the study, including 76 males (63.33%). The age was (50.89±14.61) years old and the median dialysis age was 42(28, 58) months. There were 60 patients in the high 24hSBPV group and 60 patients in the low 24hSBPV group, and the differences in total Kt/V (urea clearance), calcium channel blocker and β-blockerrs between the two groups were statistically significant (all P＜0.05). There were no statistically significant differences in age, gender, primary disease, CVD, hemoglobin, blood calcium, blood phosphorus, estimated glomerular filtration rate, blood uric acid, intact parathyroid hormone, serum iron and so on between the two groups. 24hSBPV in MHD patients was significantly higher than that in MPD patients [(13.92±3.79) mmHg vs (12.49±3.99) mmHg, t=2.01, P=0.041]. The incidence of abnormal circadian rhythm of blood pressure in all patients was 93.33%(112/120), and non-dipper blood pressure accounted for 84.17%(101/120). There was no significant difference in BPR between the MPD and MHD patients. With follow-up of 42.00(14.25, 42.00) months, a total of 60 cases (50%) CVD events occurred, of which there were 31 cases (25.83%) CVD-related death. The multivariate Cox regression analysis showed that the high 24hSBPV was an independent influencing factor for CVD-related death in patients with MHD and MPD after the confounding factors (ages, sex, body mass index, serum creatinine, hemoglobin, uric acid, hypersensitivity C-reactive protein and so on) were corrected (HR=1.25, 95% CI 1.06-1.47, P=0.007; HR=1.24, 95%CI 1.09-1.40, P=0.001). Conclusions The 24hSBPV in MHD patients is higher than that in MPD patients. With the increase of 24hSBPV, the risk of CVD increases in patients with MHD and MPD. 24hSBPV is an independent influencing factor for CVD-related death in both MHD and MPD patients.     

Influence of feeding,blood sampling method and type of anaesthesia on renal function parameters in the normal laboratory rat

With sophisticated experiments it is necessary to handle laboratory animals many times. To determine the effect of minor handling a series of experiments was performed to measure the impact of fasting, anaesthesia, blood collection method and serum creatinine analysis on renal function. Simple clinical methods to measure renal function parameters such as diuresis, urinary osmolality, urinary creatinine excretion and serum creatinine were used. During fasting a significant increase (P<0.01) in diuresis and a significant decrease (P<0.01) in urinary osmolality were noted. Fasting and anaesthesia have the additional effect of significantly decreasing (P<0.05) urinary creatinine excretion. Blood sampling method also has a significant impact on serum creatinine: venous sampling causes false-positive differences compared with simultaneous arterial sampling.