1031例冠脉造影患者慢性肾脏病流行情况调查

目的 调查疑似冠心病行冠脉造影患者的慢性肾脏病（CKD）流行情况。 方法 2008年12月至2009年10月,于东南大学附属中大医院心内科住院行选择性冠脉造影的1031例患者为对象,观察其CKD的患病率及其危险因素。CKD的定义为eGFR <60 ml?min-1?(1.73 m2)-1和(或)蛋白尿,eGFR以简化MDRD公式计算。冠心病定义为至少1支冠脉狭窄≥50%。 结果 患者平均年龄(64.37±11.02）岁,其中男性543例,女性488例;冠心病551例,CKD 134例（13%）。冠心病组CKD的患病率显著高于非冠心病组（18.33%比6.88%,P < 0.01）。随冠脉病变支数增加（0、1、2、3支）,eGFR逐渐下降[（84.24±19.00）、（81.61±23.92）、（75.16±20.99）、（73.92±20.66） ml?min-1?(1.73 m2)-1,P < 0.01];蛋白尿患者比例逐渐增加（0.42%、0.82%、1.96%、3.25%,P = 0.006）;CKD患病率逐渐增高（6.88%、13.11%、21.57%、23.38%,P < 0.01）。Logistic回归提示年龄增长（OR=1.094,95%CI 1.068~1.120）、冠脉病变支数增加（OR=1.288,95%CI 1.074~1.543）、高血压（OR=1.974,95%CI 1.082~3.603）、心脏收缩功能不全（OR=3.183,95%CI 1.696~5.972）、高尿酸血症（OR=5.366,95%CI 3.224~8.931）是CKD的重要危险因素。 结果 冠脉造影证实的冠心病患者中,CKD患病率显著高于非冠心病者,且随冠脉病变支数增加而显著增加。年龄增长、冠脉病变支数增加、高血压、心脏收缩功能不全、高尿酸血症为CKD的危险因素。     

慢性乙型肝炎病毒感染者合并慢性肾脏病患病率及影响因素

目的研究慢性乙型肝炎病毒(HBV)感染者合并慢性肾脏病患病率及影响因素。 方法选取2016年7月至2017年7月于首都医科大学附属地坛医院就诊的慢性HBV感染者,根据研究对象的血清肌酐(Scr)水平、年龄、性别应用简化肾脏病饮食调整工作组(MDRD)方程计算目标人群的肾小球滤过率(eGFR),评估目标人群合并慢性肾脏病情况,同时分析影响患病率的危险因素。 结果本研究共收集6 665例慢性HBV感染者,其中男性4 457例,女性2 208例;HBV携带者607例,慢性乙型病毒性肝炎患者4 630例,乙型肝炎后肝硬化患者1 428例。合并慢性肾脏病(CKD)患病率：eGFR<60 ml/min/1.73 m²患者72例(1.08%),60 ml/min/1.73 m²≤eGFR<90 ml/min/1.73 m²患者586例(8.79%),男性患者患病率高于女性,但差异无统计学意义(χ²= 0.52、P= 0.473)。随着年龄增长,CKD患病率增加,不同年龄段患者患病率差异有统计学意义(χ²= 356.71、P <0.001)。肝硬化患者合并CKD患病率(3.15%)显著高于HBV携带者(0.16%)及慢性乙型肝炎患者(0.59%),差异有统计学意义(χ²= 144.00、P <0.001)。 结论慢性HBV感染者随着疾病进展,慢性肾脏病患病率增加,高龄、肝硬化、高血压、糖尿病均为慢性HBV感染者发生CKD的独立危险因素。     

云南省西双版纳地区成人慢性肾脏病流行病学调查

目的 了解我国云南省西双版纳少数民族地区成人慢性肾脏病(CKD)患病率及危险因素.方法 对该地区20岁以上常住居民进行随机分层抽样,留取晨尿,分别采用尿白蛋白,肌酐比值方法检测白蛋白尿发生率(≥30 mg/g为阳性);干化学法结合尿离心后显微镜检查法检测血尿发生率(≥3红细胞/高倍视野为阳性);以中国人简化MDRD公式计算估计肾小球滤过率(eGFR)[低于60 ml·min-1·(1.73m2)-1者为eGFR异常].检测CKD相关危险因素指标.结果 符合入选条件的被调查者共5566例,白蛋白尿阳性率为8.06%;血尿阳性率为4.01%;eGFR低于60 ml·min-1(1.73 m2)-1者为2.89%;去除白蛋白尿、血尿及eGFR下降共同存在造成的重复.该地区CKD患病率为12.53%.性别、年龄、民族以及相关危险因素分层后比较结果与多因素Logistic回归分析结果一致,年龄增加、血压升高、空腹血糖升高及三酰甘油升高与白蛋白尿独立相关;年龄增加、收缩压升高与肾功能下降独立相关;年龄增加与血尿独立相关.结论 云南省西双版纳地区成人CKD患病率为12.53%,相关危险因素包括年龄增加、高血压、血糖及血脂异常.     

3～4期慢性肾脏病对肾癌术后患者的预后影响分析

目的:分析患有3～4期慢性肾脏病(CKD)的肾癌患者术后的预后状况及其影响因素。方法:回顾性分析2002年1月～2010年12月病理证实的1 353例肾癌患者的临床资料,根据患者术前肾小球滤过率(eGFR)水平,将eGFR≥60ml·min~(-1)·(1.73m~2)~(-1)(1～2期CKD)的1 182例患者设为对照组,将15ml·min~(-1)·(1.73m~2)~(-1)≤eGFR60ml·min~(-1)·(1.73m~2)~(-1)(3～4期CKD)的171例患者设为试验组,比较两组患者临床资料和预后情况。结果:试验组患者中位年龄55(25～84)岁,对照组中位年龄55(24～87)岁。男性患者试验组110例(64.3%),对照组837例(70.8%)。两组BMI、高血压病、糖尿病比较差异无统计学意义(P0.05)。试验组eGFR显著低于对照组[(50.77±8.49)ml·min~(-1)·(1.73m~2)~(-1) vs.(92.00±34.65)ml·min~(-1)·(1.73m~2)~(-1),P0.01]。试验组行肾根治性切除术患者明显多于对照组(85.4%vs.76.1%,P0.01)。试验组和对照组5年肿瘤特异性生存率(CSS)分别为91.2%和89.1%(P=0.171),5年总体生存率(OS)分别为89.3%和87.4%,两组比较差异无统计学意义(P0.05)。多因素分析中,eGFR60ml·min~(-1)·(1.73m~2)~(-1)均不是影响CSS或OS的独立危险因素。结论:本研究单因素及多因素分析显示术前存在3～4期CKD并不影响肾癌患者的预后。     

成都市高尿酸血症患者慢性肾脏病流行病学调查研究

目的分析成都市高尿酸血症患者中慢性肾脏病(chronic kidney disease,CKD)的患病情况及相关危险因素。方法选择2009年9月至2010年12月在成都铁路分局医院进行健康体检且有完整资料的5,326名体检者(分散居住在成都市各区),收集所有体检者的性别、年龄、体质量、吸烟、饮酒、既往病史、血液以及尿液的检测结果等,对资料进行分析、对比。结果5 326名体检者中有1 321例高尿酸血症患者,其中男1 187例(患病率28.76%),女134例(患病率10.93%),平均年龄(44.6±10.2)岁。①高尿酸血症患者白蛋白尿、血尿和eGFR下降的患病率分别为14.00%、1.97%和4.69%。1 321例高尿酸血症患者中CKD患病率为18.09%,知晓率2.93%。高尿酸血症患者白蛋白尿、eGFR下降和CKD的患病率均明显高于无高尿酸患者;高尿酸血症合并高血脂和(或)糖尿病和(或)高血压患者白蛋白尿、eGFR下降和CKD的患病率均明显高于单纯高尿酸血症患者。②血尿酸每升高60μmol/L,白蛋白尿、eGFR下降和CKD的患病率均明显增加;血尿酸与尿微量白蛋白/肌酐比值呈正相关,血尿酸与eGFR呈负相关。③高血压、糖尿病和体质量指数是白蛋白尿的独立危险因素;高尿酸血症患者中的女性是血尿的独立危险因素;高尿酸血症患者中的女性、年龄和高血压是eGFR下降的独立危险因素;高尿酸血症患者中的女性、高血压、糖尿病和体质量指数是CKD独立的危险因素。结论成都市高尿酸血症患者中,CKD的患病率较普通患者高,与血尿酸的水平有关。控制血压、血糖、尿酸、血脂和体质量指数,可减少CKD的发生和发展。     

中国南京地区慢性肾脏病人群中血清尿酸水平与肾功能的关系

目的:探讨南京地区慢性肾脏病(CKD)患者血尿酸(UA)与肾小球滤过率(GFR)的关系。方法:收集2010年01月~2015年01月期间江苏省中医院肾脏病科住院CKD患者(共187例,其中男102例,女85例)的血尿酸、血压、血脂、血糖等可能影响GFR的因素,以及GFR值(通过核素测定)。通过pearson线性相关及Logistic逐步回归对血尿酸与GFR在总体CKD人群及男性组、女性组的关系进行了探讨。结果:CKD患者尿酸水平与GFR呈线性相关,r=-0.373,P0.01;男组r=-0.296,P0.01;女组r=-0.480,P0.01。性别间GFR/UA差异有统计学意义,女性比值高于男性。Logistic逐步回归显示在CKD患者中,尿酸是GFR的影响因素之一,且在女性中UA的回归系数高于男性。GFR≥60 ml·min-1·1.73 m-2)时未能发现尿酸与GFR的关系。GFR60 ml·min-1·1.73 m-2时,CKD患者中可见血尿酸水平与GFR线性相关,r=-0.304,P0.01;女组r=-0.474,P0.01;且Logistic回归显示尿酸是GFR的影响因素之一;但在男性组未发现。结论:CKD患者血尿酸是GFR的影响因素之一,且在女性中表现更明显。     

免疫法粪便隐血试验预测慢性肾脏病患者预后的意义

目的 探讨免疫法粪便隐血试验(IFOBT)在慢性肾脏病患者发生结直肠病变的预测意义及作为慢性肾脏病患者预后指标的临床价值.方法 前瞻性纳入176例慢性肾脏病(CKD)患者和180例健康人作为对照.使用免疫法粪便隐血试验进行检测,比较两组粪便隐血阳性发生率.同时对CKD患者随访4.5年,分析各项临床、生化指标,并以患者接受肾脏替代治疗或死亡为终点事件.采用Logistic回归进行危险因素分析,采用Kaplan-Meier分析和COX回归模型进行生存分析.结果 176例CKD患者IFOBT阳性率17％,高于健康对照组5.3％(x2=13.236,P＜ 0.01).与IFOBT阴性的CKD患者相比,IFOBT阳性的CKD患者年龄较大[(62.030±15.544)岁比(48.660±19.018)岁,P＜0.01]、红细胞沉降率明显升高[(71.800±31.657) mm/h比(57.210±32.712) mm/h,P＜0.05]、C反应蛋白明显升高[6.230 (3.000～14.148) mg/L比3.000(3.000 ～6.833)mg/L,P＜0.05]、Scr明显升高[419.100(103.200～546.625) μmol/L比175.100 (68.150～462.950) μmol/L,P＜0.05],而血红蛋白[(97.970±20.590 )g/L比(107.170±27.988)g/L,P＜0.05]及肾小球滤过率(eGFR)[11.400 (8.671～53.544) ml· min-1· (1.73 m2)-1比35.274(10.961～82.145)ml·min-1.(1.73 m2)-1,P＜0.01]显著降低.相关法分析显示CKD患者IFOBT检测值与eGFR(r=-0.20,P＜0.01)呈负相关;与Scr呈正相关(r=0.171,P＜0.05);与年龄呈正相关(r=0.175,P＜0.05).Logistic回归和COX回归分析结果显示IFOBT检测值、eGFR和红细胞沉降率是CKD患者预后的重要影响因素.Kaplan-Meier分析显示IFOBT检测值＞100 μg/L是影响CKD患者生存率的重要因素.结论 慢性肾脏病患者易发生结直肠出血性疾病,粪便隐血阳性是影响CKD患者预后的重要危险因素,而免疫法粪便隐血试验是可行有效的检测方法,对于CKD患者结直肠病变的预测具有重要的临床意义.     

中医综合方案治疗老年慢性肾衰竭的疗效研究

目的:对本中心750例老年慢性肾衰患者进行回顾性分析,以评价中医综合治疗对老年肾衰竭的疗效。方法:对本中心慢性肾病数据库进行检索,筛选2009年10月1日~2010年9月30日间eGFR≤60ml·min~(-1)·1.73 m-2的老年患者。对纳入患者进行分组,计算eGFR的年变化率、替代治疗及死亡的发生情况。结果:随访的中位数时间为3.64年,随访结束时eGFR水平为44.21 ml·min~(-1)·1.73 m-2(24.35,59.85),较入组时45.82 ml·min~(-1)·1.73 m-2(33.74,52.76)有轻微的下降,但差异无统计学意义;但血清肌酐、尿素氮、胱抑素C、白蛋白的差异均有统计学意义。eGFR的年变化率为-0.48 ml·min~(-1)·1.73 m-2/a,其中201例(26.80%)患者的eGFR年变化率3 ml·min~(-1)·1.73 m-2/a。共24例(3.2%)进入肾脏替代治疗、死亡87例(11.6%)。结论:中医药综合治疗可以改善肾功损害的发展趋势,延缓病情进展、提高肾存活率,延长达到肾脏替代治疗的时间。     

肾功能不全患者行冠状动脉旁路移植术的长期随访结果

目的 分析估测肾小球滤过率(eGFR)<60 ml/(min·1.73 m~2)的患者冠状动脉旁路移植术后的长期随访结果.方法 回顾性分析1999年1月至2003年9月3371例冠状动脉旁路移植术患者的临床资料,用 Cockcroft-Gault公式计算eGFR,根据eGFR将患者分为肾功能不全组[eGFR<60 ml/(min·1.73 m~2),n=649]肾功能正常组[eGFR>=60 ml/(min·1.73 m~2),n=2722],比较两组患者的近远期随访结果.结果 肾功能不全组的住院病死率和随访4年病死率分别为2.77%和6.81%,明显高于肾功能正常组.肾功能不全组的其他围手术期并发症及远期不良事件发生率也明 显高于肾功能正常组.多因素 COX 回归分析结果显示,eGFR<60 ml/(rain·1.73 m~2)是冠状动脉旁 路移植术后远期死亡的独立危险因素(HR=1.948,95% CI:1.357-2.797,P<0.01).结论 eGFR <60 ml/(min·1.73 m~2)是冠状动脉旁路移植术的独立危险因素.     

上海浦东地区高尿酸血症的流行现状及影响因素分析

目的:探讨上海浦东地区常住人群中高尿酸血症的患病率及与慢性肾脏病危险因素的关系。方法:对上海浦东地区一个社区中1 024例常住居民进行问卷调查、尿酸、肌酐及慢性肾脏病相关危险因素的检测。采用多因素Logistic回归分析高尿酸血症发生的影响因素。本研究中以尿酸420μmol/L(男性)、360μmol/L(女性)定义为高尿酸血症。结果:在1 024例资料完整的居民中,年龄(56±14)岁,男女比例为404∶620,CKD患者为116例,高尿酸血症患者为182例(17.77%),其中非CKD患者为34例(18.58%),CKD患者为148例(81.42%),且CKD患者中女性高于男性;对高尿酸血症患者和非高尿酸血症患者CKD相关危险因素比较发现高尿酸血症患者年龄[(60±15)岁vs(55±13)岁,P0.01]、SBP[(135±13)mm Hg vs(128±15)mm Hg,P0.01]、DBP[(85.55±8.31)mm Hg vs(82.99±8.55)mm Hg,P0.01]、BMI(26.26±3.47)kg/m2vs(23.91±3.64)kg/m2,P0.01]、腰/臀围比[(0.88±0.05)vs(0.86±0.06),P0.01]、血BUN[(5.41±1.50)mmol/L vs(4.87±1.27)mmol/L,P0.01]、血清肌酐[(127.83±36.56)μmol/L vs(143.17±38.46)μmol/L,P0.01]高于非高尿酸血症组,e GFR[(127.83±36.56)ml·min-1·1.73 m-2vs(143.17±38.46)ml·min-1·1.73 m-2,P0.01]低于非高尿酸血症组,且高血压病(P0.01)、心血管病(P=0.04)和高脂血症(P0.01)比例高于非高尿酸血症患者。单因素回归分析显示年龄、SBP、DBP、BMI、腰/臀围比、BUN、血肌酐、Hb和e GFR与尿酸水平具有相关性;多因素Logistic回归显示性别、SBP、BMI和血肌酐以及高脂血症与高尿酸血症发生独立相关。结论:在上海社区人群中,高尿酸血症的患病率为17.77%,随着CKD的进展,高尿酸血症的发病率增加;相关危险因素包括性别、SBP、BMI、腰/臀围比、血肌酐。     

非透析慢性肾脏病患者高尿酸血症的危险因素分析

目的 探讨和分析非透析慢性肾脏病(non-dialysis chronic kidney disease,ND-CKD)患者高尿酸血症(hyperuricemia,HUA)的发生率及其相关危险因素.方法 收集2015年1月至2019年12月于山西医科大学第二医院肾内科就诊的540例ND-CKD患者的临床资料,依据HUA...     

Comparisons of the prevalence and correlation factors of chronic kidney disease between the old urban and rural residents in MinHang district of Shanghai

Objective To compare the prevalence and correlation factors of chronic kidney disease (CKD) in urban and rural areas in Minhang district of Shanghai through the social economic and clinical data of the elderly population. Methods Jiangchuan Street and Pujiang town were randomly selected to represent the urban and rural population in Minhang district of Shanghai, respectively. Based on the over-60-year old people health examination program, 6151 objectives with complete clinical-epidemiological data and bio-chemical index were investigated. The prevalence of CKD in urban and rural areas was compared, and the correlation factors for the urban and rural CKD were evaluated by multiple logistic regression analysis. Results (1) The survey objectives with an average age of (69.57±7.04) years, including 4345 cases of the city residents and 1806 cases of rural residents, were enrolled. The age structures of urban and rural showed differences, population over 80 years old account for 13.1% of the rural total, significantly higher than 7.4% in the urban population (P＜0.001). (2) The prevalence rates of diabetes, hyperuricemia, hyperlipidemia and hyperlipidemia in urban residents were higher than those in rural residents, which were 26.4% vs 13.7%, 9.9% vs 2.3%, 53.7% vs 37.4%, 51.4% vs 15.6% (all P＜0.01). The awareness rates of kidney disease and hyperlipidemia showed significant differences in urban and rural areas, which were 32.9% vs 44.2%, 84.6% vs 62.8% (all P＜0.01). Compared with those in rural areas, the treatment rates of hypertension and high blood lipids in urban residents were increased (all P＜0.01). (3) The prevalence of CKD was 23.4%. Female CKD prevalence was higher than male, respectively 26.3% and 18.5% (P＜0.01). In urban CKD prevalence was 22.2%, lower than 25.2% in rural. The prevalence rate of hematuria in urban areas was lower than in rural areas, but the prevalence rate of decline in renal function was higher (all P＜0.05). With the increase of age, the prevalence rate of CKD was increased (P＜0.01). (4) Age (OR=1.072), smoking history (OR=1.543), previous history of kidney disease (OR=1.351), diabetes (OR=1.373), hyperuricemia (OR=2.498), obesity (OR=1.364), history of interventional therapy (OR=1.896) had positive correlation with CKD in city elderly population, while the higher education (OR=0.676, OR=0.604) and drinking (OR=0.585) had negative correlation (all P＜0.05). Age (OR=1.032), female (OR=1.860) had positive correlation with CKD in rural elderly population (all P＜0.05). Conclusions CKD has been a common chronic progressive disease of the aged in Minhang district. The prevalence of CKD is higher in urban areas than in rural. Age is a common factor for CKD in urban and rural. Previous smoking, history of kidney disease, diabetes, hyperuricemia, obesity, history of interventional therapy, education and drinking have correlation with urban CKD patients. Female has correlation with rural CKD population.     

Chronic kidney disease as a risk factor for Clostridium difficile infection

Introduction: Clostridium difficile‐associated diarrhoea (CDAD) is the most common cause of nosocomial diarrhoea in the USA. In this study, we sought to determine the association between chronic kidney disease (CKD) and CDAD. Methods: A case–control study was designed to determine the association between CKD and CDAD in an urban hospital. Over a 2‐year period, all patients diagnosed with CDAD (n = 188) were included as cases and the prevalence of CKD was calculated. Age‐ and sex‐matched patients without CDAD were considered as controls with a ratio of 2:1 controls to cases. The prevalence of different stages of advanced CKD (stages 3–5) was determined and compared between groups. Also the calculated odds ratios (OR) were adjusted for multiple possible confounding variables using logistic regression analysis. Results: There was no significant difference in prevalence of advanced CKD between cases and controls (OR = 1.38, 95% confidence intervals (CI) = 0.90–2.12, P = 0.1365). The association between CKD and CDAD remained insignificant in subjects with CKD stages 3–5 who were not on dialysis (OR = 1.07, 95% CI = 0.65–1.77), P = 0.7970). However, the group with end‐stage renal disease on dialysis showed a significant association (OR = 2.60, 95% CI = 1.25–5.41, P = 0.0165). Controlling for antibiotics as a possible confounding variable, yielded an OR that was not statistically significant (OR = 2.05, 95% CI = 0.94–4.47, P = 0.07), but still showing a trend towards increased risk. Conclusion: End‐stage renal disease may increase the risk of acquiring CDAD through unknown mechanisms. This suggests implementing better surveillance strategies for these patients and eliminating the known risk factors for CDAD.     

上海市脑血管疾病住院患者慢性肾脏病调查研究

目的 调查上海城市脑血管疾病住院患者的慢性肾脏病（CKD）发生情况及其并发症,从而有助高危人群中CKD的早发现、早诊断和早治疗。 方法 收集上海市瑞金医院、第九人民医院、新华医院、解放军第八五医院、仁济医院5家医院神经内科2007年6月至2008年2月间住院的脑血管疾病患者的临床资料。所有患者均分别经脑CT、脑血管CT（CTA）、磁共振成像（MRI）、脑血管MRI（MRA）及经颅多普勒超声（TCD）确诊。对患者进行肾脏损伤指标（Scr、尿常规+沉渣镜检、尿微量白蛋白/肌酐比值）及相关危险因素（血压、空腹血糖、餐后2 h血糖、血脂、胸部X线片、心电图等）的检测。Scr检测统一在瑞金医院检验中心进行。采用MDRD复杂公式估算GFR,并根据K/DOQI指南进行CKD分期。 结果 共调查脑血管疾病住院患者1014例,男性559例,女性455例,平均年龄（68.56±12.17）岁。病因依次为缺血性脑血管疾病（708例）、出血性脑血管疾病（197例）和短暂性脑缺血发作（TIA）（109例）。11.2%的患者伴有微量白蛋白尿(MAU),而24.8%患者为显性蛋白尿。脑血管疾病患者的CKD患病率为47.7%;CKD 1~5期分别占该人群的6.90%、14.69%、21.60%、2.56% 和1.97%。多因素Logistic回归提示,影响脑血管疾病患者短期（30 d）预后的危险因素为蛋白尿（OR = 1.69,P = 0.0005）、空腹血糖升高（OR = 1.67,P = 0.0005）和贫血（OR = 1.37,P = 0.04）。 结论 首次在我国进行脑血管疾病人群中肾功能情况调查分析,报道了上海脑血管疾病人群中CKD流行病学数据。脑血管疾病住院患者中CKD的发生率为47.7%。对该人群进行CKD评估,尤其是在早期进行尿微量白蛋白/肌酐比值（ACR）筛查尤为重要。     

成纤维细胞生长因子23与慢性肾脏病中晚期患者冠状动脉钙化的关系

目的 探讨慢性肾脏病（CKD）中晚期患者血成纤维细胞生长因子23（FGF23）水平与冠状动脉钙化的关系。 方法 2010年4月至12月我院肾脏科病房、腹透中心、血透中心的CKD非透析（CKD 3~5期）、腹膜透析和血液透析患者共150例为对象;年龄、性别匹配的25例健康体检者为对照。收集患者临床和相关生化指标资料。采用酶联免疫法测定血清全段FGF23水平。对入选患者进行冠脉多层螺旋CT（MSCT）检查。分析FGF23水平与CKD中晚期患者冠脉钙化的关系。 结果 CKD中晚期患者血清FGF23水平显著高于健康对照组[196.46（83.09,355.02） ng/L比27.17（21.63,51.20） ng/L,P < 0.01];透析患者的FGF23水平显著高于非透析患者（P < 0.01）;血透患者的FGF23水平显著高于腹透患者[6048.29 （1129.08,34807.45） ng/L比1625.80（602.83,7521.78） ng/L,P < 0.01]。CKD中晚期患者冠脉钙化发生率较高（74/130,56.9%）,血清FGF23水平与冠脉钙化分数（CaS）呈正相关（r = 0.177,P < 0.05）。Logistic回归分析显示年龄（β = 0.091,OR = 1.095,P < 0.01）、透析龄（β = 2.013,OR = 7.483,P < 0.05）和FGF23水平（β = 0.838,OR = 2.311,P < 0.05）是CKD中晚期患者发生冠脉钙化的独立危险因素。冠状动脉钙化的ROC曲线显示,FGF23曲线下面积为0.705（P < 0.01）,当检测的截点为786.73 ng/L时,其敏感度和特异性分别为62.5%和75.9%;碱性磷酸酶（AKP）的曲线下面积为0.626（P = 0.017）,当检测的截点为79.75 U/L时,其敏感度和特异性分别为84.5%和41.5%。血磷在诊断冠脉钙化时没有统计学意义。 结论 血清FGF23水平与CKD中晚期患者冠脉钙化发生相关。FGF23作为诊断冠脉钙化的参考指标,其敏感度低于AKP,特异性优于AKP。     

High prevalence of occult coronary artery stenosis in patients with chronic kidney disease at the initiation of renal replacement therapy: an angiographic examination

The prevalence of coronary artery stenosis (CAS) at the initiation of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) and no previous history of angina and/or myocardial infarction (MI) has not been fully elucidated. The prevalence of significant CAS was evaluated in 30 asymptomatic stage 5 CKD patients without a history of angina and/or MI by coronary angiography at the initiation of RRT. The correlations of various parameters with the prevalence of CAS were also examined. Atherosclerotic surrogate markers, including intima-media thickness of carotid artery and ankle-brachial BP index (ABI), were also evaluated. Significant CAS (>50% stenosis) was seen in 16 (53.3%) of 30 asymptomatic CKD patients on coronary angiography at the start of RRT. Stress cardiac scintigraphy was not effective for detecting hidden cardiac ischemia among the CKD patients. Univariate analysis showed that diabetes (P = 0.01), left ventricular mass index (P = 0.04), hyperlipidemia (P = 0.04), total cholesterol (P = 0.02), LDL cholesterol (P < 0.01), intima-media thickness (P = 0.04), and fibrinogen (P = 0.01) were positively correlated with the presence of CAS, whereas ABI (P < 0.01) showed a negative correlation with CAS. Stepwise logistic regression analysis revealed that diabetes and fibrinogen were significant and independent risk factors for CAS in asymptomatic CKD patients who started RRT. The results clearly demonstrated that despite the absence of cardiac events, stage 5 CKD patients are already in a very high risk group for CAS at the initiation of RRT, which was also closely associated with a significant decrease in ABI.     

The impact of chronic kidney disease on lower extremity bypass outcomes in patients with critical limb ischemia

Objective

Patient selection for open lower extremity revascularization in patients with chronic kidney disease (CKD) remains a clinical challenge. This study investigates the impact of CKD on early graft failure, postoperative complications, and mortality in patients undergoing lower extremity bypass for critical limb ischemia.

Clinical presentation of myocardial infarction contributes to lower use of coronary angiography in patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have high mortality following myocardial infarction (MI), but are less likely to undergo coronary angiography than those without CKD. Whether this phenomenon is explained by differences in the presentation of MI or by bias against performing coronary angiography in patients with CKD is unclear. We examined the clinical presentation of 1876 elderly patients who presented with MI and categorized them by estimated glomerular filtration rate: >60 ml/min (no/mild CKD), 30-60 ml/min (CKD Stage 3) or <30 ml/min (CKD Stage 4/5). Compared with patients with no/mild CKD, patients with CKD Stage 3 or Stage 4/5 had more comorbidity, greater prior nursing home use, and higher frequency of conduction abnormalities or anterior infarction. By contrast, peak creatinine kinase-MB fraction (CK-MB) concentrations were lower and ST-elevation MI was less common in patients with CKD Stage 3 or Stage 4/5. In univariate analyses, patients with CKD Stage 4/5 (odds ratio (OR)=0.34, 95% confidence interval (CI): 0.23-0.50) or Stage 3 (OR=0.57, 95% CI: 0.45-0.73) were markedly less likely to undergo angiography than subjects with no/mild CKD. After multivariable adjustment, the association of CKD Stage 3 with the use of coronary angiography was attenuated (OR=0.78, 95% CI: 0.60-1.03), but CKD Stage 4/5 remained strongly associated with lower use (OR=0.52, 95% CI: 0.34-0.80). Clinical features of MI are different in patients with and without CKD and may partly explain the low use of angiography in patients with CKD Stage 3. However, the clinical features of MI do not account for its underuse in MI patients with CKD Stages 4/5. Whether reduced use of angiography in patients with advanced CKD is justified must be evaluated in formal risk-benefit analyses.