Effect of intravenous iron sucrose on oxidative stress in peritoneal dialysis patients

AIM: Intravenous iron therapy is an accepted treatment for patients receiving hemodialysis and continuous ambulatory peritoneal dialysis (CAPD). Studies have found enhanced oxidative stress in hemodialysis patients receiving intravenous iron, but there are no clinical data for CAPD patients. The aim of the current study was to investigate the effect of 100 mg of intravenous iron-sucrose on the erythrocyte (RBC) antioxidant enzymes (namely, superoxide dismutase [SOD], catalase [CAT], and glutathione peroxidase [GSHPx]) and plasma malondialdehyde (MDA), an oxidant molecule, in CAPD patients. METHODS: Twelve CAPD patients receiving maintenance intravenous iron-sucrose were recruited. After a 12-hour fast, blood samples were taken for hemoglobin, iron, ferritin, and high-sensitivity C-reactive protein (hsCRP), and for baseline activities of erythrocyte antioxidant enzymes (i.e., SOD, CAT, GSHPx) and the plasma oxidant molecule, MDA. 100 mg iron-sucrose was infused over 30 minutes. Blood samples taken during (i.e., 15 minutes after commencement of infusion) and after (i.e., at 30 minutes, 60 minutes, and 6 hours after commencement) the infusion were taken for measurement of plasma iron, ferritin, TSAT, RBC SOD, CAT, GSHPx, and plasma MDA. RESULTS: Plasma iron and transferrin saturation elevated significantly during infusion (p < 0.05). There was no significant change in erythrocyte SOD, CAT, GSHPx, or in MDA activities. There was a reduction of GSHPx activity at the 30th minute (from 153.69 +/- 66.69 to 123.68 +/- 25.50 mU/mL), but it was not statistically significant. The patients were grouped according to baseline ferritin (100-400 and 400-800 ng/mL); 60th-minute MDA was significantly higher in the latter group (p < 0.05). There was no correlation between hsCRP and oxidant-antioxidant balance. No correlation was noted between RBC antioxidant enzymes or plasma oxidant molecule and ferritin levels. CONCLUSION: There are no acute deteriorating effects from a 100 mg of intravenous iron-sucrose in CAPD patients with optimal iron stores. This dose may be applied safely in CAPD patients.     

Efficacy and safety of sevelamer hydrochloride and calcium acetate in patients on peritoneal dialysis

Background. Inadequate phosphorus control is associated withincreased morbidity and mortality in patients with CKD stage5. Although phosphate binders are often used in patients onperitoneal dialysis (PD), no large randomized controlled studiesevaluating their use solely in this population have previouslybeen reported. Methods. In this multicentre, open-label study, adult patientson PD with serum phosphorus >5.5 mg/dl were randomized (2:1)to 12 weeks of treatment with sevelamer hydrochloride or calciumacetate. Doses were titrated to achieve serum phosphorus of3.0–5.5 mg/dl. Changes in serum phosphorus, calcium, intactparathyroid hormone (iPTH), lipids and plasma biomarkers wereassessed. Results. A total of 253 patients were screened, 143 of whomwere randomized (sevelamer hydrochloride, n = 97; calcium acetate,n = 46). Treatment groups were well balanced with regard tobaseline demographics. Serum phosphorus levels were significantlyreduced after 12 weeks with both sevelamer hydrochloride andcalcium acetate (P < 0.001). Serum PTH was also reduced inboth groups while serum calcium increased in the calcium acetategroup (P = 0.001) but not in the sevelamer hydrochloride group.Sevelamer hydrochloride was also associated with decreases intotal cholesterol, low-density lipoprotein cholesterol and uricacid and an increase in bone-specific alkaline phosphatase (allP < 0.001 versus baseline). Both treatments were well toleratedand safety profiles were consistent with previous reports inhaemodialysis patients. Hypercalcaemia was experienced by morecalcium acetate-treated patients (18 versus 2%; P = 0.001). Conclusions. In summary, sevelamer hydrochloride provides areduction in serum phosphorus compared to that obtained withcalcium-based binders in PD patients. The effects of sevelamerhydrochloride appear similar in both PD and haemodialysis populations.     

低剂量与标准剂量腹膜透析的部分疗效比较

腹膜透析是终末期肾病（ESRD）患者的一种重要肾替代治疗手段，经典的连续不卧床腹膜透析（CAPD）标准剂量为4×2L／d。本研究前瞻性分析较低透析量（3×2L／d）与标准剂量透析对CAPD患者临床若干状况的比较。     

艾考糊精腹透液单袋长时间留腹治疗连续性非卧床腹膜透析患者的安全性和有效性

Objective To evaluate the efficacy and safety of 7.5% icodextrin peritoneal dialysis solution for once-daily long dwell exchange in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A prospective, multicenter, randomized, double blind, parallel controlled study was conducted for 5 weeks in 201 CAPD patients (96 male, 105 female) with mean age (56.1±13.7) years old. These patients were from 7 centers with 98 allocated to the icodextrin group and 103 to the dextrose group randomly. Patients in the icodextrin group were given 7.5% icodextrin and those in the dextrose group were given 2.5% Dianeal?誖PD-2 or PD-4 for the nocturnal long dwell exchange while the diurnal dialysis remained unchanged. During the 4- week treatment, patients were tested every other week for net ultrafiltration, peritoneal creatinine and urea nitrogen clearance after the long dwell. Other laboratory tests and adverse events were recorded. Results Compared to the dextrose group, the net ultrafiltration was up-regulated more significantly from the baseline in the icodextrin group [(342.53±25.79) ml vs (73.59±24.09) ml, P<0.01]. Episodes of net ultrafiltration less than 0 ml in the icodextrin group were much less than those in the dextrose group. Similarly, the mean difference between groups for change from baseline for peritoneal creatinine and urea nitrogen clearance was much higher[（428.02±53.14） ml/12 h vs （－99.79±50.19） ml/12 h， P<0.01； （306.43±53.31） ml/12 h vs (－116.02±51.05） ml/12 h， P<0.01， respectively] in the icodextrin group. In the icodextrin group, there was a decrease in serum sodium and chloride compared with baseline (P<0.01). Serum amylase activity decreased from (87.04±48.01) U/L to (21.59±13.58) U/L(P<0.01). Cholesterol in the icodextrin group was lower than baseline (P<0.05). There was no significant difference between two groups for the incidence and severity of adverse events. Conclusion 7.5% icodextrin is a safe and effective peritoneal dialysis solution for once-daily long dwell exchange in CAPD patients.     

A prospective crossover trial comparing intermittent intravenous and continuous oral iron supplements in peritoneal dialysis patients.

BACKGROUND: Concomitant iron supplementation is required in the great majority of erythropoietin (Epo)-treated patients with end-stage renal failure. Intravenous (i.v.) iron supplementation has been demonstrated to be superior to oral iron therapy in Epo-treated haemodialysis patients, but comparative data in iron-replete peritoneal dialysis (PD) patients are lacking. METHODS: A 12-month, prospective, crossover trial comparing oral and i.v. iron supplementation was conducted in all Princess Alexandra Hospital PD patients who were on a stable dose of Epo, had no identifiable cause of impaired haemopoiesis other than uraemia, and had normal iron stores (transferrin saturation >20% and serum ferritin 100-500 mg/l). Patients received daily oral iron supplements (210 mg elemental iron per day) for 4 months followed by intermittent, outpatient i.v. iron infusions (200 mg every 2 months) for 4 months, followed by a further 4 months of oral iron. Haemoglobin levels and body iron stores were measured monthly. RESULTS: Twenty-eight individuals were entered into the study and 16 patients completed 12 months of follow-up. Using repeated-measures analysis of variance, haemoglobin concentrations increased significantly during the i.v. phase (108+/-3 to 114+/-3 g/l) compared with each of the oral phases (109+/-3 to 108+/-3 g/l and 114+/-3 to 107+/-4 g/l, P<0.05). Similar patterns were seen for both percentage transferrin saturation (23.8+/-2.3 to 30.8+/-3.0%, 24.8+/-2.1 to 23.8+/-2.3%, and 30.8+/-3.0 to 26.8+/-2.1%, respectively, P<0.05) and ferritin (385+/-47 to 544+/-103 mg/l, 317+/-46 to 385+/-47 mg/l, 544+/-103 to 463+/-50 mg/l, respectively, P=0.10). No significant changes in Epo dosages were observed throughout the study. I.v. iron supplementation was associated with a much lower incidence of gastrointestinal disturbances (11 vs 46%, P<0.05), but exceeded the cost of oral iron treatment by 6.5-fold. CONCLUSIONS: Two-monthly i.v. iron infusions represent a practical alternative to oral iron and can be safely administered to PD patients in an outpatient setting. Compared with daily oral therapy, 2-monthly i.v. iron supplementation in PD patients was better tolerated and resulted in superior haemoglobin levels and body iron stores.     

慢性肾小球肾炎患者血清新蝶呤的水平及其意义

静脉使用蔗糖铁已被广泛地用于血液透析患者肾性贫血的治疗,但在非透析慢性肾脏病(NDCKD)患者中使用不多,大剂量蔗糖铁在NDCKD患者中使用的研究报道更少.我科对使用大剂量蔗糖铁治疗肾性贫血伴铁缺乏的NDCKD患者的安全性及有效性进行了观察.     

Pharmacokinetics of intravenous ceftizoxime in patients on continuous ambulatory peritoneal dialysis

The pharmacokinetics of ceftizoxime (CZM) were determined in 16 non-infected CAPD patients. Patients received either 500 mg or 1000 mg CZM by i.v. bolus. The dialysate exchange volume was 2 l. Serum CZM concentrations at 10 min were 69.7 +/- 19.7 micrograms/ml (1000 mg dose) and 39.2 +/- 8.4 micrograms/ml (500 mg dose), and declined to 33.7 +/- 13.9 micrograms/ml and 16.9 +/- 3.2 micrograms/ml respectively at 360 min. Dialysate CZM levels at 10 and 360 min were 1.8 +/- 1.3 and 19.9 +/- 6.6 micrograms/ml respectively (1000 mg dose) and 1.4 +/- 0.9 and 12.6 +/- 3.5 micrograms/ml (500 mg dose). The half-time of CZM was 14.1 +/- 4.6 h. Peritoneal clearance of CZM was low and equilibrium was not achieved in 6 h. However peritoneal CZM concentrations were adequate within 1 h for the treatment of most organisms which cause CAPD-related peritonitis.     

腹膜透析初透剂量对患者残余肾功能的影响

目的 探讨腹膜透析（腹透）初透剂量对患者残余肾功能的影响。 方法 追踪观察我院3个月内连续门诊随访的178例开始腹透的患者,测定24 h尿量。根据透析第1、3个月尿量的变化分为少尿组（LU,97例）、尿量减少组（DU,19例）、尿量正常组（NU,62例）,记录并分析其透析剂量、腹透液葡萄糖含量、超滤量、尿素清除指数（Kt/V）、体质量、水肿程度及尿量变化等的相关性。 结果 3组患者的年龄和性别比例差异无统计学意义。透析1个月后,DU组的体质量和水肿程度大于LU和NU组（P < 0.05）;腹透液总入量、腹透液葡萄糖含量、超滤量、残余肾尿素清除指数Kt/V（rKt/V）高于LU组,与NU组差异无统计学意义。透析3个月后,DU组的体质量和水肿程度有所下降（P < 0.05）,但仍高于LU和NU组（P < 0.05）;腹透液总入量、超滤量、尿量下降速度比LU组和NU组高（P < 0.05）;rKt/V 比腹透前显著下降（P < 0.05）。3组的血清白蛋白和tKt/V差异无统计学意义。 结论 开始腹透患者过度超滤可引起残余肾功能下降。对于有一定残余肾功能的患者要注意避免快速或过多超滤。     

Efficacy and safety of monthly oral minodronate in patients with involutional osteoporosis

Summary

Monthly minodronate at 30 or 50?mg had similar efficacy as 1?mg daily in terms of change in bone mineral density (BMD) and bone turnover markers with similar safety profiles. This new regimen provides patients with a new option for taking minodronate.

Introduction

Minodronate at a daily oral dose of 1?mg has been proven to have antivertebral fracture efficacy. In the present study, the efficacy and safety of oral minodronate at monthly doses of either 30?mg or 50?mg were compared with a daily dose of 1?mg.

Methods

A total of 692 patients with involutional osteoporosis were randomized to receive minodronate at either 30 or 50?mg monthly or a daily dose of 1?mg. The primary endpoint was the percent change from baseline in lumbar spine (LS) BMD at 12?months. Total hip BMD, bone turnover markers, serum calcium (Ca), and parathyroid hormone (PTH) levels were also evaluated.

Results

Minodronate at monthly doses of 30 or 50?mg were noninferior to the 1?mg daily dose in terms of change in LS-BMD. Changes in total hip BMD were also comparable. Although a transient decrease in serum Ca and increase in PTH levels were observed in all three groups at slightly different magnitudes and time courses, changes in bone turnover markers were comparable among the different dosage groups with a similar time course. Safety profiles were also comparable.

Conclusion

Minodronate at monthly doses of 30 or 50?mg has similar efficacy to the daily 1?mg dose in terms of BMD and bone turnover markers with similar tolerability.     

Efficacy of a non-vancomycin-based peritoneal dialysis peritonitis protocol

BACKGROUND: Peritonitis has a significant impact upon morbidity and mortality of peritoneal dialysis (PD) patients. Gram-positive organisms account for the majority of infections and vancomycin is a cost effective broad-spectrum antimicrobial treatment for PD peritonitis, but this may lead to the emergence of multiple antibiotic-resistant organisms. The purpose of the present paper was to evaluate the efficacy of a non-vancomycin-based protocol comprising cephazolin and gentamicin, which was introduced in the present PD population as empirical treatment for peritonitis. METHODS: The study involved 82 peritonitis episodes over a 4-year period in 58 patients, excluding those with previous methicillin-resistant staphylococcal peritonitis. RESULTS: With cephazolin and gentamicin there was no apparent difference in response or relapse rates in comparison to reported studies using vancomycin-based first-line therapy protocols. CONCLUSION: We advocate initial treatment of PD peritonitis with non-vancomycin-based therapy given similar efficacy and the potential for reduction of resistant organisms.     

Meta-analysis of the efficacy of two-compartment peritoneal dialysis fluid with low glucose degradation products in peritoneal dialysis patients

Objectives To study the efficacy of the two-compartment peritoneal dialysis fluid with low glucose degradation products in peritoneal dialysis (PD) patients. Methods Pubmed, EBMASE,Cochrane Library, Wanfang, VIP, CNKI, CBM and other databases were searched, at the same time the information form relevant literatures until December 2013 were searched by hand. To be eligible, studies had to be randomized controlled trials that allocated PD patients to two-compartment peritoneal dialysis fluid with low glucose degradation products (low-GPDs group) or to traditional dialysis fluid (control group). The qualities of included articles were assessed and then a meta-analysis was conducted by using RevMan 5.2 software. Results A total of 12 documents, 11 studies met the inclusion criteria, and 1 059 cases were included. Meta-analysis results were as follows: (1)the low-GPDs group had higher level of CA125 in peritoneal dialysis effluent, higher residual renal function compared with that in the control group and the weighted mean difference were 19.61 (95%CI 12.04-27.18, P＜0.01) and 0.78 (0.14-1.43, P=0.02), respectively; (2)There was no statistically significant difference between control and low-GPDs group in the ultrafiltration, peritonitis and plasma bicarbonate (all P＞0.05); (3)Four studies showed no difference in peritoneal dialysis technique survival between the two group (P＞0.05). Conclusions The two-compartment peritoneal dialysis fluid with low glucose degradation products is effective and safe, has no negative effects on the frequency of peritonitis, patient’s peritoneal member transport function and plasma bicarbonate, but it causes less mesothelial damage and has higher residual renal function in patients than conventional ones, and does not affect the technique survival time.     

血清脂联素水平与尿毒症患者炎性反应状态的关系

我们采用前瞻、随机对照方法观察蔗糖铁注射液森铁能纠正血液透析患者铁缺乏的疗效，现报告如下。     

Short-term small-dose intravenous iron trial to detect functional iron deficiency in dialysis patients

BACKGROUND/AIM: Management of renal anemia in end-stage renal disease requires careful evaluation of the iron status before and in particular during erythropoietin treatment. However, there is no simple and practical iron index accurately predictive of functional iron deficiency in these patients till now. The purpose of this prospective study, therefore, is to evaluate whether a short course of low-dose intravenous iron challenge can detect functional iron deficiency in hemodialysis patients. METHODS: Twenty-four patients with baseline serum ferritin levels between 100 and 500 ng/ml were treated with intravenous saccharated ferric oxide, 960 mg over 24 hemodialysis treatments, and the hemoglobin level was checked every week. RESULTS: Patients whose hemoglobin value increased at least by 1 g/dl within the 8-week period were classified as having functional iron deficiency or as responders (n = 26; 81.2%). All other subjects were classified as having adequate iron levels or as nonresponders (n = 6; 18.8%). There were no significant differences in age, sex, dialysis years, Kt/V, dialyzers, hemoglobin, and basal and final transferrin saturation and ferritin between responders and nonresponders. In addition, there were no iron indices with acceptable levels of sensitivity and specificity. On the contrary, the cutoff value of increments of hemoglobin of at least 0.2 g/dl after a 2-week intravenous iron trial had a sensitivity of 96.2% and a specificity of 100% in all patients (n = 32) and a sensitivity of 100% and a specificity of 100% after patients with transferrin saturation <20% were excluded (n = 24). These values had the greatest utility of the tests studied in this work. CONCLUSION: A 240-mg intravenous iron challenge during a 2-week period may be a simple, accurate, and straightforward method to detect a functional iron deficiency status in hemodialysis patients undergoing erythropoietin therapy.     

静脉注射与静脉滴注蔗糖铁治疗血液透析患者肾性贫血的疗效比较

本研究对静脉注射与静脉滴射蔗糖铁的疗效及安全性用随机、对照的方法进行了比较。