Urinary vanin‐1 associated with chronic kidney disease in hypertensive patients: A pilot study

Hypertension and chronic kidney disease (CKD) are serious interrelated public health problems. Despite the monitoring and control of high blood pressure, symptoms of CKD are not usually apparent in its early stages. Previously, we reported the utility of urinary vanin‐1 as an early biomarker of kidney injury in spontaneously hypertensive rats, but it remains unknown whether urinary vanin‐1 is associated with CKD in humans. In this study, we estimated associations between urinary vanin‐1 and parameters of kidney function in a cross‐sectional study of hypertensive patients. We measured concentrations of vanin‐1 using spot urine from 147 adult hypertensive patients (mean age, 72.8 years; 39.5% women). Patients were divided into 2 groups based on the median of the estimated glomerular filtration rate (eGFR). The group with eGFR < 60 mL/min per 1.73 m² showed significantly higher levels of urinary vanin‐1 than those with eGFR ≥ 60 mL/min per 1.73 m². On univariate analysis, urinary vanin‐1 as well as neutrophil gelatinase‐associated lipocalin (NGAL) showed significant negative correlations with eGFR; however, multivariate analysis revealed that urinary vanin‐1, but not NGAL, significantly correlated with eGFR. In addition, urinary vanin‐1 had a significant positive correlation with the urinary protein‐to‐creatinine ratio (UPCR) (r = 0.21; P = .021) and albumin‐to‐creatinine ratio (UACR) (r = 0.61; P < .01). In conclusion, urinary vanin‐1 is associated with lower eGFR and higher UPCR and UACR, and might be a potential marker of decreased kidney function in hypertensive patients. Further studies are needed to confirm these findings.     

慢性阻塞性肺疾病合并慢性肾脏病危险因素分析

目的探讨住院COPD患者合并慢性肾脏病的患病率及危险因素。方法对2012年1月至2013年11月住院确诊的COPD患者进行慢性肾脏病的患病率及危险因素回顾性凋查。结果在资料完整的948例COPD患者人群中,慢性肾脏病总的患病率约为24．5％,COPD合并慢性肾脏病组PaCO2、吸烟指数、血尿酸水平、糖尿病及高血压病患病率较无合并慢性肾脏病组高,而PaO2、体质量指数较无合并慢性肾脏病组低,差异有统计学意义。COPD患者合并慢性肾脏病与COPD严重程度分级无明显的相关性。经多因素Logistic回归分析表明：低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素（OR值分别为2．34、3．25、2．67和1．8,9,5％（71分别为2．01～2．75、2．95～3．77、1．99～3．27、1．18～2．63,P值均〈0．05）。结论COPD合并慢性肾脏病的患病率高,低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素,应引起重视。     

Prerenal success in chronic kidney disease

Renin-angiotensin system inhibitors and diuretics are commonly prescribed to patients with chronic kidney disease to reduce systemic blood pressure. The renin-angiotensin inhibitors also reduce intraglomerular pressure. The lower pressures may result in initial increases in the serum creatinine. The long-term renoprotection provided by these therapies establishes the basis for tolerating the initial increases. However, physicians are sometimes reluctant to continue these treatments when the serum creatinine increases. Several reasons for this reluctance are discussed, including the failure to distinguish between hemodynamic- and parenchymal-mediated changes in kidney function. In addition, the lack of a formal term and place in our diagnostic algorithm for increases in serum creatinine that derive from ultimately beneficial hemodynamic alterations may be a hindrance. The term “prerenal success” is proposed to describe hemodynamic alterations associated with improved prognosis and is placed in a new algorithm. Finally, recent literature describing harmful effects of increases in serum creatinine in other cohorts is reviewed; these cohorts are sufficiently different from the stable chronic kidney disease patient that the results ought not to be extrapolated.     

Association of morning hypertension with chronic kidney disease progression and cardiovascular events in patients with chronic kidney disease and hypertension

Background and aimAssociations of morning hypertension with chronic kidney disease are rarely investigated in prospective studies. We aim to investigate the predictive value of uncontrolled morning hypertension (UMH) to chronic kidney disease (CKD) progression and cardiovascular (CV) events in patients with CKD and hypertension.Methods and resultsIn this prospective two-center observational study, 304 hypertensive patients with CKD were enrolled. Time to total mortality, CKD progression and CV events was recorded; Kaplan–Meier survival function estimates and Multivariable Cox proportional hazard model were used to investigate associations between UMH and outcomes. The study protocol was approved by the Institutional Review Board (http://www.thaiclinicaltrials.org; TCTR20180313004). After a follow-up for median 30 months, 23 (7.6%) patients died, 34 (11.2%) had CKD progression, and 95 (31.3%) occurred new-onset CV events, respectively. UMH was shown to be a strong predictor of CKD progression [hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.22–4.94] and CV events (HR 1.69, 95% CI 1.12–2.53). When morning hypertension was analyzed as a continuous variable, morning systolic blood pressure (per 10 mmHg) was also shown to be predictive to CKD progression (HR 1.28, 95% CI 1.07–1.53, P < 0.01) and CV events (HR 1.15, 95% CI 1.03–1.28, P < 0.01).ConclusionsUMH is strongly associated with CKD progression and CV events in patients with CKD and hypertension. UMH in CKD patients deserves further attentions.     

慢性肾脏病血管钙化机制的研究进展

慢性肾脏病（chronic kidney disease, CKD）是世界公认的健康问题,我国CKD的患病率约为10.8%,并且CKD的死亡率也很高。心血管疾病（cardiovascular disease, CVD）是CKD最常见的死亡原因,而血管钙化（vascular calcification, VC)是导致CVD的重要危险因素。因此本文对CKD血管钙化的流行病学现状、病理学特点、危险因素、发病机制等方面进行综述,希望能为血管钙化的防治提供新的思路。     

The effects of hypertension and diabetes on new‐onset chronic kidney disease: A prospective cohort study

The study aimed to determine the different status of hypertension and diabetes on the risk of new‐onset chronic kidney disease (CKD) events in Kailuan Study. A total of 21 905 individuals were enrolled in the study. The new‐onset incidents of CKD, hypertension, and diabetes were collected in the follow‐ups. All the individuals were divided into five groups according to baseline and follow‐up hypertension and diabetes status: baseline hypertension (BH), baseline hypertension and incidence of diabetes (BHID), baseline diabetes (BD), baseline diabetes and incidence of hypertension (BDIH), and baseline hypertension and diabetes (BHD). The risk of new‐onset CKD of the five groups was calculated using the Cox regression analysis. In the median follow‐up of 7.05 ± 2.59 years, the prevalence of new‐onset CKD in the group of BH, BHID, BD, BDIH, and BHD were 27.1, 43.79, 25.4, 36.6, and 45.1 per 1000 years, respectively. When adjusted possible confounders, the hazard ratios (HRs) and 95% confidence intervals (CIs) of new‐onset CKD were 1.50 (95% CI: 1.38‐1.63), 1.25(95% CI: 1.07‐1.47), and 1.52 (95% CI: 1.35‐1.7) in the group of BHID, BDIH, and BHD, respectively, as referred to the BH group (P < .001). No obvious difference was observed in the group of BH and BD for the incidence of new‐onset CKD. Sensitivity analysis still showed the similar results among the five groups. The study showed that the effect of simple hypertension or simple diabetes on new‐onset CKD was not significantly different, but the incidence of new‐onset hypertension or diabetes increased the risk of new‐onset CKD. Hypertension and diabetes had a synergistic influence on the risk of new‐onset CKD.     

慢性低度炎性反应与糖尿病肾脏疾病的相关性分析:一项大样本病例-对照研究

目的 探讨慢性低度炎性反应与糖尿病肾脏疾病(DKD)的关系.方法 将1254例2型糖尿病患者分为DKD组(487例)与单纯T2DM组(767例),DKD诊断依据:符合估算的肾小球滤过率(eGFR)＜ 60 mL/(min·1.73 m2)或尿微量白蛋白/肌酐比值(UACR) ≥30 mg/g.通过自动分析仪测定血清慢性低度炎性反应指标:超敏C反应蛋白(hs-CRP)、白细胞总数、中性粒细胞百分比(NCR),并记录性别、病程、收缩压、舒张压等指标.利用多元Logistic回归分析慢性低度炎性反应指标与DKD的关系.结果 与单纯T2DM组相比,DKD组的hs-CRP、白细胞总数、NCR均显著升高(t=-3.60、-3.43、3.10,P均＜0.01).多元Logistic回归分析显示,hs-CRP(OR=1.116,95％ CI:1.042 ～1.195,P=0.002)、白细胞总数(OR=1.092,95％ CI:1.002 ～1.189,P=0.044)和NCR(OR =1.018,95％ CI:1.004～ 1.033,P=0.015)与DKD风险增加显著相关.结论 DKD的慢性低度炎性反应指标显著升高,hs-CRP、白细胞总数、NCR是DKD的独立危险因素.     

Quality of life in chronic kidney disease

Background — Quality of life (QOL) is suboptimal in end‐stage renal disease. However, studies indicate that QOL is already impaired prior to the initiation of renal replacement therapy, implying that the initial decline originates in the chronic kidney disease (CKD) phase of the renal disease trajectory. Given the significance of QOL as a clinical outcome, there is a paucity of QOL research in CKD. Aims — To measure QOL at three distinct phases (based on creatinine clearance — Ccr) of the disease trajectory in CKD: normal renal function (NRF) with underlying renal disease, moderate CKD, and advanced CKD (Ccr ≥75, 40–60, and ≤30 ml/minute, respectively), and to establish if QOL is different between these groups. Methods — Data was collected from 25 patients from each of the Ccr bands (N=75). We measured self‐reported QOL (Schedule for the Evaluation of Individual Quality of Life — SEIQOL), uraemic symptoms (Leicester Uraemic Symptom Scale — LUSS), and laboratory variables. Results — SEIQOL was significantly lower (p<0.001), and symptom number, frequency, and intrusiveness significantly higher (all p<0.001) in the advanced CKD group when compared to the NRF group. Although SEIQOL and symptom intrusiveness did not differ between the advanced and moderate CKD groups, SEIQOL was significantly lower (p<0.05) and symptom intrusiveness significantly higher (p<0.05) in the moderate CKD group when compared to the NRF group. Conclusion — QOL is already impaired in moderate CKD. The significant difference in QOL and symptom intrusiveness between the moderate CKD and NRF groups may denote a causal relationship between symptom intrusiveness and QOL early in CKD.     

慢性肾脏病患者发生心衰的危险因素分析

目的探讨慢性肾脏病（CKD）患者发生心衰的危险因素。方法将366例CKD患者按2002年K/DOQI慢性肾脏病的分期标准分为5期,再按是否发生心衰分为2组,比较两组患者年龄、既往病史、吸烟史、心电图T波改变、血红蛋白（Hb）、C反应蛋白（CRP）、血脂、血压等方面的变化以及住院期间两组患者的病死率。结果发生心衰组的年龄升高,有既往高血压、糖尿病、冠心病、吸烟史者、心电图T波改变均比未发生心衰组明显增多（P〈0.05）;心衰组C反应蛋白（CRP）、高密度脂蛋白胆固醇（HDL-L）、舒张压（DBP）均比未心衰组明显升高（P〈0.01）,而Hb、低密度脂蛋白胆固醇（LDL-L）则比未心衰组明显降低（P〈0.01）结论患者年龄升高、既往有心血管病史、吸烟、CRP水平、Hb水平是CKD患者发生心衰的独立危险因素,针对性地干预这些危险因素,有可能降低心衰的发生率和病死率,改善CKD患者的预后。     

慢性肾脏病胰岛素抵抗的研究进展

胰岛素抵抗是代谢综合征的核心.胰岛素抵抗和高胰岛素血症在慢性肾脏病的早期即可出现,某些脂肪细胞因子如瘦素、脂联素、抵抗素在慢性肾脏病胰岛素抵抗的发生、发展中起重要作用.胰岛素抵抗可增加慢性肾脏病患者心血管疾病的发病率和死亡率,促进肾脏病的进展,临床上需要于预.