慢性肾脏病患者成纤维细胞生长因子23与心脏瓣膜钙化的关系研究

目的 观察慢性肾脏病(chronic kidney disease,CKD)患者血中成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)水平,探讨CKD患者FGF23的水平与心脏瓣膜钙化之间的关系.方法 选择CKD患者89例为CKD组,28例非CKD患者为对照组;将CKD组患者根据肾脏病/透析的临床实践指南(Kidney Disease Outcome Quality Initiative,K/DOQI),按估算肾小球滤过率(estimated glomerular filtration rate,eGFR)水平分为CKD 1～2期组16例,CKD 3～4期组20例,CKD 5期组16例及CKD 5D期组37例.应用酶联免疫分析法测定血清FGF23,同时测定血清全段甲状旁腺激素水平(parathyroid hormone,iPTH)、血钙、血磷、三酰甘油、血总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等指标.所有患者应用超声心动检测心脏瓣膜是否存在钙化.比较对照组及CKD 1～2期组、CKD 3～4期组、CKD 5期组及CKD 5D期组年龄、血钙、血磷、三酰甘油、血总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、iPTH、FGF23水平及糖尿病、心血管疾病、瓣膜钙化比例.根据是否存在心脏瓣膜钙化将CKD患者89例分为瓣膜钙化组14例和无瓣膜钙化组75例,比较2组间年龄、相关指标、糖尿病、冠心病及透析所占比例.结果 ①CKD 5期组Log iPTH(2.40±0.26)及CKD 5D期组(2.47±0.20)较对照组(1.57±0.14)、CKD 1～2期组(1.54±0.10)、CKD 3～4期组(1.82±0.29)明显升高(P＜0.001),CKD 5D期组(2.67±0.54)的Log FGF23较对照组(1.37±0.11)、CKD 1～2期组(1.42±0.12)、CKD 3～4期组(1.62±0.26)、CKD 5期组(1.83±0.37)明显升高(P＜0.001).CKD 5D期组的心脏瓣膜钙化比例(12/37)明显高于对照组(2/28)、CKD 1～2期组(2/26)、CKD 3～4期组(1/20)及CKD 5期组(0/16),差异有统计学意义(P＜0.05);②瓣膜钙化组的年龄[(73.3±9.9)岁]、三酰甘油[(4.10±2.09) mmol/L]、Log FGF23 (2.52±0.71)、透析患者所占比例(11/14)较无钙化组的年龄[(64.8±12.6)岁]、三酰甘油[(1.90±1.59)mmol/L]、Log FGF23(1.96±0.62)、透析患者所占比例(26/75)明显升高,差异有统计学意义(P＜0.05);③Logistic回归分析显示,年龄、Log FGF23、血总胆固醇及糖尿病病史是影响心脏瓣膜钙化的独立影响因素.结论 CKD患者血清FGF23升高,且随着肾功能的恶化,FGF23水平呈升高趋势,FGF23升高为心脏瓣膜钙化的危险因素.     

维持性血液透析患者主动脉瓣和二尖瓣钙化的危险因素

目的 探讨主动脉瓣和二尖瓣钙化发病的相关危险因素。 方法 对符合标准的维持性血液透析（MHD）患者（年龄≥18岁,透析龄>6个月,排除曾因瓣膜疾病行外科手术或介入治疗者）,采用超声心动图检查心脏瓣膜钙化情况。采用Logisitc回归分析主动脉瓣和二尖瓣钙化的危险因素。 结果 在入选的181例（男98例,女83例）MHD患者中,94例（51.9%）主动脉瓣或二尖瓣钙化,其中主动脉瓣钙化90例（49.7%）,二尖瓣钙化30例（16.6%）,主动脉瓣和二尖瓣双瓣膜钙化26例（14.4%）。多因素Logistic回归分析表明年龄（β = 5.52, P = 0.007）、透析龄（β = 6.99,P = 0.039）和前白蛋白（β = -12.616,P = 0.004）与主动脉瓣钙化独立相关;年龄（β = 0.085,P = 0.05）与二尖瓣钙化呈弱正相关;透析龄（β = 6.057,P = 0.002）、原发性高血压病病史（β = 3.054,P = 0.008）、血红蛋白（β = -0.061,P = 0.035）和β2微球蛋白（β = 7.63,P = 0.01）与二尖瓣钙化独立相关。 结论 MHD患者主动脉瓣及二尖瓣钙化多发,且以主动脉瓣钙化更多见。年龄、透析龄和低前白蛋白血症是主动脉瓣钙化的危险因素,而二尖瓣钙化的危险因素包括年龄、透析龄、原发性高血压病病史、贫血和高β2微球蛋白血症。     

119例合并高血压的中重度慢性肾脏病患者心脏彩超评价心脏结构和功能的临床研究

目的：研究合并高血压的中重度慢性肾脏病（2~5期）患者心脏彩超的心脏结构和功能及其相关因素。方法：分析在南京医科大学第二附属医院肾脏科住院并确诊为慢性肾脏病的119例患者的病历资料,包括多普勒心脏彩超等。结果：本研究发现,左心室心腔内径和心肌厚度（左心室后壁和室间隔）随肾功能的进展而增加（P〈0.05）,左心室质量和质量指数亦随肾功能的进展而增加（P〈0.005）,左心室肥厚的总患病率达到57.98%,其相关因素包括心力衰竭、胱抑素C升高、肾小球滤过率降低、血红蛋白降低,71.43%的患者出现室壁相对厚度增加,45.38%的患者出现心肌向心性肥厚,12.61%为离心性肥厚,26.05%为向心性重构,心脏瓣膜钙化的总患病率为30.25%,二尖瓣瓣膜钙化6.72%,主动脉瓣瓣膜钙化26.05%,其相关因素包括心力衰竭、年龄增加、左心室质量指数增加、载脂蛋白A1降低。结论：合并高血压的中重度慢性肾脏病患者中普遍存在左心室肥厚、心脏瓣膜钙化。     

慢性肾脏病患者的颈动脉粥样硬化及心脏瓣膜钙化

颈动脉粥样硬化与心脏瓣膜钙化是慢性肾脏病（chronic renal disease,CKD）患者心血管疾病（cardiovascular disease,CVD）发病和死亡的重要危险因素。因此,研究动脉粥样硬化及心脏瓣膜钙化的防治措施将有助于降低慢性肾脏病患者的死亡率、延长生存时间。本文就CKD患者颈动脉粥样硬化及心脏瓣膜钙化的流行病学、危险因素、诊断及治疗情况作一综述。     

MHD患者心脏瓣膜钙化与营养状况的相关性分析

目的:分析维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化(cardiac valve calcification,CVC)与营养状况的相关性。方法:选取2019年10月—2020年10月在我院行血液透析且资料完整的MHD患者110例,收集患者的一般临床资料、生化结果,并测量人体学指标,使用MQSGA评分量表评估患者的营养状况,通过多普勒超声心动图评估心脏瓣膜钙化的情况,根据有无瓣膜钙化分为两组,钙化组45例,非钙化组65例,比较两组间临床资料的差异,分析营养状况评分及其他营养相关指标与心脏瓣膜钙化的关系。结果:与非钙化组相比,钙化组MQSGA评分、年龄、透析龄、碱性磷酸酶、血清钙、超敏C反应蛋白水平均显著增高,上臂围、肱三头肌皮褶厚度、血清白蛋白、前白蛋白均显著降低,差异均具有统计学意义(P0.05);Spearman相关性分析显示MQSGA评分(r=0.413,P0.001)与心脏瓣膜钙化呈正相关;肱三头肌皮褶厚度(r=-0.389,P0.001)、血清白蛋白(r=-0.190,P=0.047)与心脏瓣膜钙化呈负相关。logistic回归分析显示影响MHD患者心脏瓣膜钙化的危险因素包括MQSGA评分、年龄、透析龄、肱三头肌皮褶厚度、超敏C反应蛋白。结论:MHD患者心脏瓣膜钙化发生率高;营养不良是维持性血液透析患者心脏瓣膜钙化发生的危险因素。     

腹膜透析患者钙磷代谢影响因素的研究进展

腹膜透析（peritoneal dialysis,PD）是终末期肾病的有效替代方法之一,较血液透析具有更有效的保护患者残肾功能、改善贫血、有利于血流动力学稳定等优点。钙磷代谢紊乱作为维持性透析患者的常见并发症之一,其对患者机体的影响不仅局限于骨骼系统,还可引起异位钙化、心脑血管并发症等。高磷血症可导致透析患者出现异位钙盐沉积,刺激血管及心脏瓣膜钙化,引起心律失常和心力衰竭,是透析患者心脑血管并发症的独立危险因素。血磷水平每增加1mg／dl,对冠脉动脉钙化造成的危险性相当于增加2．5年的透析时间,尿毒症患者死亡风险升高18％。2009年KDIGO临床实践指南提出对于CKD3—5期患者血磷水平应控制在正常范围,CKD5期,包括透析患者血磷水平应接近正常范围。影响维持性腹透患者钙磷代谢的因素诸多,包括饮食、残余肾功能、透膜的转运特性、透析液的钙离子浓度、磷结合剂药物的应用等,且个体差异较大,有关其影响因素的研究文献较多。本文就有关维持性腹膜透析患者钙磷代谢紊乱影响因素的研究进展作一综述。     

糖化白蛋白在CKD 3~5期非透析和血液透析合并糖尿病患者中的血糖评估价值

目的：探讨糖化白蛋白在CKD 3~5期非透析和血液透析合并糖尿病患者中的血糖评估价值.方法：入选187例糖尿病患者,其中CKD 1~2期68例,CKD 3~5期ND患者89例,CKD 5期HD患者30例,比较各组患者空腹血糖与糖化白蛋白、糖化血红蛋白的相关性,应用多因素回归分析方法分析影响终末期肾脏病合并糖尿病患者糖化白蛋白、糖化血红蛋白的因素.结果：HbAlc与GA在每组均显著相关（CKD 1~2期：r=0.632,P〈0.001、CKD 3~5 ND期：r=0.647,P〈0.05、CKD 5 HD期：r=0.585,P〈0.001）,但血液透析患者直线回归方程的斜率显著高于CKD 1~2期及CKD 3~5期非透析患者（4.14 vs 1.84、2.12,P〈0.05）.CKD 5 HD组GA/HbAlc的值显著低于非透析组（3.01±0.75 vs 2.48±0.58、2.48±0.59）.多因素回归分析提示在透析组仅空腹血糖是影响GA的因素.结论：GA与HbAlc在CKD 3~5期非透析合并糖尿病患者的血糖评估价值差异无统计学意义,而在血液透析合并糖尿病患者,HbAlc明显低估了血糖的真实水平,GA较HbAlc更能反映真实的血糖水平.     

慢性肾脏病患者维生素D不足与缺乏

目的 了解慢性肾脏病(CKD)患者维生素D不足与缺乏的患病率,为合理的维生素D治疗提供依据。 方法 对358例住院CKD患者的临床资料进行回顾性分析。用酶标法测定血清25（OH）D3水平,并常规检测血红蛋白（Hb）、Scr、BUN、CO2CP、白蛋白(Alb)、血清钙、磷、全段甲状旁腺激素（iPTH）等。分析25（OH）D3水平与临床指标的关系。 结果 358例患者的25（OH）D3平均水平为（18.58±11.7） µg/L,显著低于正常值（P < 0.01）;CKD1~5期患者25（OH）D3水平分别为（25.84±9.71）、（20.76±6.99）、（20.40±17.02）、（19.49±11.29）和（14.16±7.98） µg/L。维生素D缺乏患病率为39.66%;在CKD1~5期中分别为5.00%、17.50%、37.21%、42.37%和57.14%,患病率随CKD分期逐级增加。维生素D不足患病率为44.97%,在CKD1~5期中分别为72.50%、47.50%、45.35%、33.90%和40.60%。维生素D缺乏及不足患病率为84.63%,在CKD1~5期中分别为77.50%、65.00%、82.56%、76.27%和97.74%,CKD各期间差异无统计学意义。单因素相关分析显示,25（OH）D3与Hb（r = 0.163）、Alb（r = 0.291）、Scr（r = -0.236）、eGFR（r = 0.156）和iPTH（r = -0.178）相关（P < 0.01）。多元线性回归分析显示,25（OH）D3与Alb呈正相关,而和iPTH、Scr呈负相关。CRP、钙磷乘积等与25（OH）D3无相关。按K/DOQI指南,根据25（OH）D3和iPTH水平,CKD3~5期患者符合维生素D治疗指征的比例分别为87.20%、83.05%和26.31%;而仅根据iPTH水平,符合治疗指征的比例仅为16.28%、35.59%和26.31%。 结论 CKD患者维生素D缺乏和不足患病率高。Alb、Scr和iPTH是CKD患者维生素D水平的重要影响因子。应在CKD人群中开展维生素D水平检测,并早期、合理治疗维生素D缺乏和不足。     

维持性血液透析患者动静脉内瘘成形术后功能丧失与相关临床指标的关系研究

目的 探讨维持性血液透析患者动静脉内瘘成形术后功能丧失与相关临床指标的关系。方法 回顾性纳入2019年1月至2021年1月在本院诊治并完成动静脉内瘘成形术维持性血液透析患者共85例,根据随访24个月是否出现功能丧失分为功能丧失组（24例）和功能正常组（61例）,采用单因素法和多因素法分析维持性血液透析患者动静脉内瘘成形术后功能丧失独立危险因素,描绘ROC曲线评估上述临床指标用于动静脉内瘘成形术后功能丧失风险预测临床效能。结果 单因素分析结果显示,年龄、脉压差、校正血钙水平、血磷水平、舒张压及血全段甲状旁腺激素（iPTH）水平均可能与维持性血液透析患者动静脉内瘘成形术后功能丧失有关（P<0.05）;Logistic回归模型多因素分析结果显示,校正血钙水平升高、血磷水平升高及合并主动脉弓钙化均是维持性血液透析患者动静脉内瘘成形术后功能丧失独立危险因素（P<0.05）;ROC曲线分析结果显示,校正血钙水平、血磷水平及合并主动脉弓钙化联合用于维持性血液透析患者动静脉内瘘成形术后功能丧失风险预测效能优于三者单用（P<0.05）。结论 维持性血液透析患者动静脉内瘘成形术后功能丧失...     

慢性肾脏病3～5期患者血尿酸水平及影响因素分析

目的研究慢性肾脏病(CKD) 3～5期患者高尿酸血症(HUA)的患病率,分析CKD 3～5期患者合并HUA的相关危险因素,探讨血尿酸和肾功能的关系。方法选取280例CKD 3～5期患者作为研究对象,收集患者临床资料,根据血尿酸水平分为高尿酸血症组和血尿酸正常组,运用SPSS 23统计软件分析CKD 3～5期患者HUA的患病率,2组之间血肌酐、尿素氮、血糖、血压、血脂、视黄醇结合蛋白、β2微球蛋白、胱抑素C等之间的差异性以及CKD 3～5期患者HUA的相关危险因素。结果 280例CKD患者中,高尿酸血症组203例,正常血尿酸组77例,HUA的总患病率为72. 5%,其中CKD 3期患者HUA的患病率为61. 46%,CKD 4期为74. 12%,CKD 5期为81. 82%。随着肾小球滤过率(eGFR)下降,HUA的患病率逐渐增高。2组患者高血压患病率的差异有统计学意义(P 0. 05)。与正常血尿酸组比较,高尿酸血症组eGFR明显降低,舒张压、视黄醇结合蛋白、β2微球蛋白、胱抑素C明显增高,差异有统计学意义(P 0. 05)。多元线性回归分析发现,CKD 3～5期患者的基线血尿酸水平与eGFR呈线性负相关(r=-0. 277,P 0. 001)。多因素Logistic回归分析显示,CKD 3～5期患者HUA的独立危险因素为合并高血压、舒张压升高、视黄醇结合蛋白和eGFR下降(P 0. 05)。结论 CKD 3～5期患者HUA的患病率高,且随着eGFR下降逐渐增高。合并高血压、舒张压升高、视黄醇结合蛋白和eGFR下降均是其发生的独立危险因素。     

Relationship between serum 25-hydroxyvitamin D3 and heart valvular calcification in chronic kidney disease patients stage 3-5

Objective To detect the prevalence of heart valvular calcification (VC) and its related risk factors, and to investigate correlation between serum 25-hydroxyvitamin D3[25(OH)D3] and VC in chronic kidney disease (CKD) stage 3-5 patients. Methods A total of 294 CKD patients stage 3-5 were admitted in The Second Affiliated Hospital of Anhui Medical University. Their clinical and laboratory data were collected, patients were classified into two groups according echocardiography: patients with VC were defined as VC group while others were defined as non-VC group. The differences of 25(OH)D3 level and other data in two group were assessed, and related risk factors of VC were analyzed. Results Among 294 CKD patients, 82 were with VC (27.9%) while 212 were without VC (72.1%); serum 25(OH)D3 level was significantly higher in VC group than in non-VC group [(11.9±9.3) μg/L vs (9.6±7.2) μg/L, P＜0.05]. Age, cystatin C, hypersensitive C-reactive protein, pulmonary artery pressure, proportion of secondary hyperparathyroidism, incidence of abdominal aortic calcification and taking active vitamin D proportion were higher in VC group than in non-VC group (P＜0.05). Two classification logistic regression analyses showed that advanced age, high intact parathyroid hormone (iPTH) and 25(OH)D3, pulmonary arterial hypertension were risk factors for VC in CKD stage 3-5 patients. Conclusions The prevalence of VC is high in CKD stage 3-5 patients. Advanced age, bone metabolic disorder and pulmonary arterial hypertension are associated with VC.     

Prevalence and risk factors of hyperuricemia in patients with IgA nephropath

Objective To evaluate the prevalence of hyperuricemia in patients with IgA nephropathy and find out the risk factors of hyperuricemia, including clinical and pathological characteristics. Methods A retrospective study enrolled 2566 adult patients, who admitted to the First Affiliated Hospital, Sun Yat-sen University from 1996.01 to 2012.12 and diagnosed with biopsy- proven IgA nephropathy was conducted. Results Among 2566 IgA nephropathy patients, the prevalence of hyperuricaemia was 36.6%. Prevalence of hyperuricaemia for CKD stage 1, 2, 3, 4, 5 was 16.2%, 37.4%, 66.4%, 87.7% and 76.4%, respectively. Adjusting Logistic regression analysis showed male gender, progressive stages of CKD, increased percentage of global glomerulosclerosis were independent risk factors of IgA nephropathy; male gender, progressive stage of CKD, increased level of cholesterol, increased percentage of global glomerulosclerosis were independent risk factors for CKD stage 1 - 2 patients; progressive stages of CKD and increased percentage of global glomerulosclerosis were independent risk factors for CKD stage 3 - 5 patients. Conclusion The prevalence of hyperuricemia in patients with IgA nephropathy was 36.6%, and identifying the risk factors associated with hyperuricaemia among different CKD stages of IgA nephropathy will be important to improve our understanding in intervention of this disease.     

A Rational Guide to Reducing Fracture Risk in Dialysis Patients

Extrapolation of evidence-based management of disorders in the general population to patients with chronic kidney disease (CKD) is not always appropriate, and the prevention of bone fracture and reduction of fracture risk in CKD stages 3–5 is one example. Compared to the general population, fracture risk is greater in CKD patients, especially those on dialysis (CKD-5D). Fractures in CKD-5D are associated with a marked increase in morbidity and mortality and with an aging dialysis population the burden of disease caused by fracture is likely to increase. Patients with CKD-5D have distinct risks for fracture, as well as sharing risks identified in the general population. The development of the CKD mineral and bone disorder constitutes a significant cause for these differences. Literature addressing the determination of fracture risk and the efficacy of treatments to reduce fracture in patients on dialysis is limited. While some tools used for the diagnosis and monitoring of osteoporosis are applicable to patients on dialysis, bone mineral density measurement by dual-energy X-ray absorptiometry is generally not helpful and therapeutic interventions that reduce fracture risk in the nonuremic population cannot be generalized to patients on dialysis. This review outlines available evidence on the incidence, risk factors, and management of fractures in CKD-5D with recommendations for strategies to reduce fracture risk.     

慢性肾脏病3～5期患者的钙磷代谢影响因素分析

目的分析我院门诊慢性肾脏病（CKD）3-5期患者的钙磷代谢诊疗现状及影响因素。方法分析我院门诊的317例CKD3～5期患者就诊资料,对钙磷代谢诊疗现状及影响因素进行统计学分析。结果CKD3～5期患者血钙、血磷、全段甲状旁腺素（iPTH）检测情况和结果差异有统计学意义（P〈0．05）。规律随诊与血钙、血磷检查与否相关,CKD分期、规律随诊、服用活性维生素D与患者iPTH检查与否相关。CKD分期、合并心血管疾病（CVD）与血钙异常相关。CKD分期与高血磷、高iPTH相关。结论CKD3期即可能出现钙磷代谢异常。CKD分期是影响血钙、血磷和iPTH的共同影响因素。合并CVD与血钙异常相关。规律随诊与钙磷、iPTH检查与否相关。     

Clinical features of chinese coronary heart disease patients with chronic kidney disease

Objectives: To investigate the prevalence of chronic kidney disease (CKD) by stage in Chinese patients with coronary heart disease (CHD) and to identify the clinical features and examine control of cardiovascular risk factors. Methods and results: Clinical data of hospitalized patients were collected by investigators in China. CKD stages were classified according to estimated glomerular filtration rate (eGFR). A total of 2509 participants with CHD were included in the final statistical analysis. The overall prevalence of CKD stage 3 and greater (eGFR of less than 60?mL/min/1.73?m(2)) in the CHD patients was 32.5%. As the CKD stage increased, fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and high-sensitivity C-reactive protein (HS-CRP) levels all worsened. As the CKD stage became more severe, CHD patients had comorbidities such as diabetes mellitus, periphery arterial disease, and ischemic stroke, and more CHD patients had triple vessel disease increased. Even when patients received treatment of CHD and risk factors, control of cardiovascular risk factors such as SBP, DBP, FBG, and low-density lipoprotein was worsened as CKD stage became more severe over a 6-week follow-up. Conclusions: The data suggested a high prevalence of CKD in Chinese patients with CHD. Many conventional risk factors and comorbidities were correlated with high prevalence of CKD in CHD patients. Control of cardiovascular risk factors in those patients was poor.     

High Parathyroid Hormone Level and Osteoporosis Predict Progression of Coronary Artery Calcification in Patients on Dialysis

Coronary artery calcifications (CACs) are observed in most patients with CKD on dialysis (CKD-5D). CACs frequently progress and are associated with increased risk for cardiovascular events, the major cause of death in these patients. A link between bone and vascular calcification has been shown. This prospective study was designed to identify noninvasive tests for predicting CAC progression, including measurements of bone mineral density (BMD) and novel bone markers in adult patients with CKD-5D. At baseline and after 1 year, patients underwent routine blood tests and measurement of CAC, BMD, and novel serum bone markers. A total of 213 patients received baseline measurements, of whom about 80% had measurable CAC and almost 50% had CAC Agatston scores>400, conferring high risk for cardiovascular events. Independent positive predictors of baseline CAC included coronary artery disease, diabetes, dialysis vintage, fibroblast growth factor-23 concentration, and age, whereas BMD of the spine measured by quantitative computed tomography was an inverse predictor. Hypertension, HDL level, and smoking were not baseline predictors in these patients. Three quarters of 122 patients completing the study had CAC increases at 1 year. Independent risk factors for CAC progression were age, baseline total or whole parathyroid hormone level greater than nine times the normal value, and osteoporosis by t scores. Our results confirm a role for bone in CKD–associated CAC prevalence and progression.     

Outcomes associated with hypogonadism in women with chronic kidney disease

The successful use of renal replacement therapy has resulted in longer survival and a population of older patients with chronic kidney disease (CKD) that includes patients with other significant preexisting illnesses. In this review, we analyze the short-term and long-term outcomes associated to persisting hypogonadism in CKD patients. The short-term manifestations, commonly observed in normal postmenopausal women, are either a rare complaint of women with CKD or are frequently attributed to the uremic state. These symptoms include hot flashes, sleep disturbances and depression, sexual dysfunction, vaginal dryness and atrophy, urinary incontinence, and skin aging and wrinkling. The long-term outcomes of hypogonadism have potentially devastating effects on bone, cardiovascular system, and cognitive function, which could significantly alter the quality of life and survival of women with stage 5 CKD (CKD-5). Postmenopausal osteoporosis has been recognized as an important entity associated with renal osteodystrophy, and efforts have begun to tackle the reduced bone-mineral density (BMD) and increased fracture rate seen in this population. Similarly, cardiovascular disease represents the major cause of death in the CKD-5 population, with a 10 to 20 times greater mortality than in the general population. The accumulating evidence for a possible link between osteoporosis and atherosclerosis is discussed, as well as new directions in the understanding of postmenopausal osteoporosis in the context of renal bone disease, under the guidance of the Global Bone and Mineral Initiative endorsed by the Kidney Disease: Improving Global Outcomes initiative. Nephrologists must face gynecological issues with their women patients and design interdisciplinary clinical studies that include strategies that utilize well-tested and newer drug regimens in the management of osteoporosis, cardiovascular disease, and other postmenopausal manifestations in CKD-5 patients.     

Management of asymptomatic hyperuricaemia in patients with chronic kidney disease by Japanese nephrologists: a questionnaire survey

Aim: Hyperuricaemia is associated with chronic kidney disease (CKD) progression and cardiovascular events (CVE). In a US study, only 4% of rheumatologists initiated urate‐lowering therapy in patients with asymptomatic hyperuricaemia (AHU). The present study aimed to clarify how Japanese board‐certified nephrologists manage AHU in CKD patients. Methods: Questionnaires on management of AHU in CKD stage 3 or more were mailed to 1500 Japanese board‐certified nephrologists, excluding paediatricians and urologists, randomly selected from the directory of the Japanese Society of Nephrology (n = 2976). Results: Five hundred and ninety‐five nephrologists (40%) responded. Most nephrologists (84–89%) recommended that AHU in patients in CKD stages 3–5 should be treated, but fewer nephrologists (63%) recommended that AHU in patients of CKD stage 5D should be treated. The serum urate level to start urate‐lowering therapy and the target serum urate level to be achieved (mg/dL) were 8.2 ± 0.9 and 6.9 ± 0.9, 8.4 ± 0.9 and 7.0 ± 1.0, 8.6 ± 1.0 and 7.3 ± 1.1, and 9.1 ± 1.2 and 7.8 ± 1.3 at stages 3, 4, 5 and 5D, respectively. The most frequently used maximal dosage of allopurinol was 100 mg/day at each stage. Benzbromarone was used in 52% of patients at stage 3, but only in 29%, 13% and 5% of patients at stages 4, 5 and 5D, respectively. The most important reasons to treat AHU at CKD stages 3–5 were prevention of CKD progression (45%), CVE (33%), gout (18%) and urolithiasis (3%). Conclusion: Most Japanese nephrologists treat AHU in pre‐dialysis CKD with an aim to prevent CKD progression or CVE mainly by allopurinol.     

Beta-blockers for coronary heart disease in chronic kidney disease.

BACKGROUND: Limited data exist on whether the cardioprotective benefit of beta-blockers is modified by the presence of chronic kidney disease (CKD). METHODS: A post hoc analysis of the data from the Bezafibrate Infarction Prevention (BIP) study was performed. CKD was defined according to the Modification of Diet in Renal Disease (MDRD) equation as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m(2). The Cox proportional hazard model, including adjustment for propensity score, was used to estimate the hazard ratios (HR) for the composite endpoint combining acute myocardial infarction (AMI) or sudden cardiac death (SCD). RESULTS: In this cohort of 3075 coronary heart disease (CHD) patients, 568 (18.5%) had CKD and 1185 (38.5%) were treated with beta-blockers. A total of 245 (43.1%) CKD patients received beta-blockers at baseline. The mean (+/- SD) estimated GFR in the CKD and non-CKD subgroups was 55 (+/- 4) and 73 (+/- 9) mL/min/1.73 m(2), respectively. After a median follow-up of 6.2 years, the crude incidence rates of AMI or SCD/1000 person years (PY) were 25.6, 21.9, 34.6 and 27.5 for the beta-blockers-/CKD-, beta-blockers+/CKD-, beta-blockers-/CKD+ and beta-blockers+/CKD+ groups, respectively. Compared to patients with beta-blockers-/CKD-, the adjusted HR of AMI or SCD was 0.87 (90% CI 0.71-1.06) for the beta-blockers+/CKD-, 1.35 (90% CI 1.05-1.73) for the beta-blockers-/CKD+ and 1.06 (90% CI 0.76-1.46) for the beta-blockers+/CKD+. CONCLUSIONS: These analyses suggest that the use of beta-blockers is associated with a reduction in event risk in patients with CHD regardless of the presence or absence of CKD.     

Plasma malondialdehyde may not predict mortality in patient with chronic kidney disease

The role of oxidative stress in patients with chronic kidney disease (CKD) as a potential marker of morbidity and mortality remains poorly evaluated. The aim of the present study aims was thus: to determine plasma levels of malondialdehyde (MDA), end product of lipid peroxidation in patients at different CKD stages (predialysis and dialysis); to evaluate the association between plasma MDA levels and vascular disease or overall and cardiovascular mortality. Plasma MDA levels evaluated by HPLC, pulse wave velocity, aortic calcification score were evaluated in 94?CKD patients (67±13?years, 54% males, 29% at CKD stages?2-3, 32% at stages?4-5, 39% at stage?5D) prospectively followed for mortality. We observed that the plasma MDA levels were increased in patient with CKD and augmented progressively with CKD stages. However, we did not find any independent association between plasma levels of MDA and pulse wave velocity, aortic calcification score, or overall and cardiovascular mortality. Our results suggest that plasma MDA is not a useful biomarker in CKD patients.