Analysis of predictive factors for the decline of residual renal function in new peritoneal dialysis patients

Objective To prospectively evaluate the risk factors for the decline of residual renal function (RRF) in new peritoneal dialysis (PD) patients. Methods A total of 84 new PD patients in our PD center were included in this study. Clinical comprehensive assessment were made, and regression models was established to analyze the relationship between the decline of RRF and clinical indicators, which included the rate of peritonitis, systolic pressure, diastolic pressure, urine volume, 24 h urinary protein, serum albumin, C-reactive protein(CRP), history of diabetes mellitus, and the use of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) drugs, cardiac functional grading, sodium and water retention and biochemical indicators. The primary outcome was defined as two consecutive urine volume ≤100 ml/24 h. Results The mean follow-up time was (11.7± 1.1) months, primary outcome occurred in 20 patients, accounting for 23.8%, and their average period progressed to the primary outcome was (10.5±2.0) months. The 20 patients had higher ultrafiltration volume [(551.6±328.2) ml vs（294.1±288.0) ml, P=0.001], higher systolic blood pressure [(145.2±16.5) mmHg vs (136.0±13.8) mmHg, P=0.016], worse cardiac functional grading [(1.7±0.8) vs (1.3±0.4), P=0.000], more serious water-sodium retention [(1.0±0.7) vs (0.6±0.5), P=0.012], higher peritonitis rates (35.0% vs 4.7% ,P=0.000), lower Kt/V [(1.7 ± 0.4) vs (2.0 ± 0.3), P=0.003], lower hemoglobin levels [(89.0±14.9) g/L vs (99.5±17.8) g/L, P=0.020], higher C - reactive protein levels [(19.4±34.4) mg/L vs(8.7±12.6) mg/L, P=0.017], higher Scr levels [(1 004.6±291.1) μmol/L vs (753.1± 254.3) μmol/L, P=0.000], lower serum calcium levels[(1.86±0.1) mmol/L vs (2.02±0.2) mmol/L, P=0.000], higher serum phosphorus [(2.1±0.6) mmol/L vs (1.6±0.4）mmol/L, P=0.001] and higher calcium phosphorus product [(3.8±1.1) mmol2/L2 vs (3.1±0.8) mmol2/L2, P=0.010] as compared with those of the patients without the primary outcome. Based on the results of multivariable Cox regression analysis, ultrafiltration volume, cardiac functional grading, peritonitis, Kt/V and serum phosphorus level contributed to the decline of RRF significantly. Conclusion The higher Kt/V in PD patients plays a protective role, the higher ultrafiltration volume, the worse heart function, the more peritonitis rate and higher serum phosphorus predict more rapid declination of RRF.     

Assessment and risk factors of abdominal aortic calcification in peritoneal dialysis patients

Objectives To evaluate the incidence and risk factors of abdominal aortic calcification (AAC) in chronic kidney disease (CKD) stage 5 patients undergoing peritoneal dialysis (PD). Methods Eligible CKD stage 5 patients undergoing PD in Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled in present study. Demographic features, blood pressure, laboratory parameters, residual renal function (RRF), dialysis adequacy and medication were determined. Lateral abdominal X-ray plain film was used to assess AAC, and abdominal aortic calcification score (AACS) was calculated. Risk factors for AAC were analyzed by Logistic regression. Results A total of 206 PD patients aged (55.6±15.0) years with median PD duration 20 (8, 44) months were enrolled in present study. Among them, 108 (52.4%) patients were males and 35(17.0%) complicated with diabetes mellitus. AAC was presented in 118 (57.3%) patients, and 49 (23.8%) patients had severe calcification (calcification involving more than 3 lumber segments). Compared to those without AAC, patients with AAC were elder [ (62.3±11.9) years old vs (46.7±13.9) years old, P＜0.01], had longer PD duration [28(11, 57) months vs 16(7, 29)months, P＜0.01], higher diabetic nephropathy （18.6% vs 6.8%, P＜0.05）and diabetic incidence（23.7% vs 8.0%, P＜0.01）proportion, higher pulse pressure [52.0(44.0, 66.3) mmHg vs 48.0(40.0, 58.0) mmHg, P＜0.05], lower diastolic blood pressure[(81.4±11.7) mmHg vs (88.6±14.6) mmHg, P＜0.01] and mean arterial pressure [ (99.6±13.3) mmHg vs (104.8±15.1) mmHg, P＜0.05], higher high-sensitivity C-reactive protein [2.8(0.7, 5.6) mg/L vs 1.1(0.3, 4.4) mg/L, P＜0.05], lower serum albumin [ (36.9±4.5) g/L vs (38.7±4.5) g/L, P＜0.01], pre-albumin [ (373.2±89.1) g/L vs (404.9±74.7) g/L, P＜0.01], high density lipoprotein [1.1(0.9, 1.4) mmol/L vs 1.3(0.9, 1.5) mmol/L, P＜0.05], and total creatinine clearance rate [(59.1±18.9) L•week-1•(1.73 m2)-1 vs (67.8±29.8) L•week-1•(1.73 m2)-1, P＜0.05]. Logistic regression showed that old age (OR=1.104, 95%CI 1.071-1.138, P＜0.01) and high calcium phosphorus product (OR=1.467, 95%CI 1.037-2.074, P＜0.05) were independent risk factors for AAC, while RRF (OR=0.858, 95%CI 0.740-0.995, P＜0.05) as a protective factor. Conclusions AAC is prevalent in CKD stage 5 patients undergoing PD. Advancing age and high calcium phosphorus product are independent risk factors for AAC, while high RRF is a protective factor. The lateral abdominal X-ray plain film is an inexpensive, simple and promising tool for assessment of AAC, even though its prognostic value of PD patients requires more follow-up studies.     

Insulin resistance in non -diabetic peritoneal dialysis patients and its influencing factors

Objective To observe insulin resistance (IR) in non-diabetic peritoneal dialysis (PD) patients, and analyze its related factors. Methods The non-diabetic PD patients who had been on stable PD at least three months were eligible to enroll． The patients were measured for their height, weight, waist to hip ratio, fasting glucose, fasting insulin, lipids and other biochemical indicators, dialysis adequacy indicators in August 2012, and divided into two groups depended on median HOMA-IR in August 2012. Results A total of 56 patients were enrolled and divided into two groups according to median HOMA-IR, including high IR group (HOMA-IR≥1.79, n=29) and low IR group (HOMA-IR＜1.79, n=27). Compared to low IR group, high IR group were older [(57.9±14.2) years vs (48.7±14.5) years], had higher daily dialysate glucose load [(138.7±28.5) mmol/L vs (114.0±21.5) mmol/L], higher waist-to-hip ratio [(0.91±0.08) vs (0.86±0.07)], higher BMI [(23.0±3.0) kg/m2 vs (21.2±3.1) kg/m2], higher triglycerides [(2.51±1.36) mmol/L vs (1.42±0.48) mmol/L], lower high-density lipoprotein cholesterol [(1.00±0.27) mmol/L vs (1.23±0.32) mmol/L], and lower Kt/V [(1.74±0.37) vs (2.08±0.56)]. Multivariate logistic regression showed that age (β =0.122, P=0.033), triglycerides (β = 1.798, P=0.030) and daily dialysate glucose load (β =0.094, P=0.031) associated with the degree of insulin resistance. Conclusion More dialysate glucose exposure is a risk factor of the occurrence of insulin resistance in non-diabetic patients with peritoneal dialysis.     

Prognostic comparison of patients starting peritoneal dialysis within two weeks and more than two weeks after catheter implantation

Objective To compare the outcomes of patients starting peritoneal dialysis (PD) within two weeks and more than two weeks after catheter implantation. Methods All the patients undergoing Tenckhoff catheter implantation and initiating PD in Renji Hospital from January 2001 to December 2010 were enrolled in the study. Patients started PD within 2 weeks after catheter insertion were defined as urgent group, and those started PD 2 weeks later were defined as planned group. Kaplan?Meier curves and Log-rank tests were used to compare outcomes between two groups. Results Among 657 patients in this study, median break-in period was 6 days of 469 (71.4%) patients in urgent group and 26 days of 188 (28.6%) patients in planned group. Compared to planned group, patients of urgent group were younger [(52.6±17.3) vs (56.1±15.3) year, P＝0.017], had less eGFR [(5.36±2.03) vs (6.50±2.50) ml•min-1•(1.73 m2）-1, P＜0.01], lower serum albumin [(34.0±5.7) vs (36.2±5.9) g/L, P＜0.01] and hemoglobin [(76.9±18.8) vs (80.8±17.9) g/L, P＝0.018], and higher phosphate [(2.19±0.67) vs (1.98±0.52) mmol/L, P＜0.01]. Urgent group presented more catheter dysfunctions needed to transfer to hemodialysis (2.1% vs 0%, P＝0.044). The 1-, 2-, 3- and 5-year technique survival rates of urgent and planned group were 94% vs 98%, 92% vs 94%, 90% vs 92% and 86% vs 85% respectively. There was no significant difference in technique survival (Log-rank＝1.536, P＝0.22) and peritonitis?free survival (Log-rank＝0.035, P＝0.85) between two groups. The 1-, 2-, 3- and 5-year patient survival rates of urgent and planned group were 90% vs 95%, 81% vs 90%, 74% vs 79% and 67% vs 74% respectively, and no significant difference was found (Log-rank＝2.364, P＝0.12). Conclusions Although patients needing urgent initial PD have poorer residual renal function and nutritional condition compared to those of planned initial PD, their outcomes are similar. Peritoneal dialysis may be a feasible and safe dialysis modality for patients who need urgent start.     

The treatment of tacrolimus in primary IgA nephropathy with mild or moderate renal injury: a randomized controlled study

Objective To investigate the efficacy and safety of immunosuppressive therapy (Tacrolimus or CTX) in primary IgA nephropathy (IgAN) with mild or moderate renal dysfunction. Methods Thirty-six primary IgAN patients diagnosed by renal biopsy, with mild or moderate renal dysfunction[30 ml•min-1•(1.73m2)-1≤eGFR＜90 ml•min-1•(1.73m2)-1, proteinuria＞1.0 g/24 h] were recruited in this randomized controlled trial. All the patients were assigned into steroid therapy alone, steroid combined with CTX (CTX group) and steroid combined with tacrolimus (tacrolimus group). Results The 24-hour proteinuria at baseline were (1.91±0.81) g/24 h, (2.42±1.46) g/24 h, (2.57±1.87) g/24 h in steroid group, CTX group and tacrolimus group respectively. Compared with baseline, it was significantly decreased in steroid group at 3 months [(0.90±0.75) g/24 h, P＜0.05], 6 months [(0.76±0.73) g/24 h, P＜0.05] and 12 months [(0.35±0.35) g/24 h, P＜0.05], in CTX group at 3 months [(1.40±1.24) g/24 h, P＜0.05], 6 months [(0.87±0.83) g/24 h, P＜0.05] and 12 months [(0.68±0.70) g/24 h, P＜0.05], and in FK506 group at 3 months [(1.10±1.33) g/24 h, P＜0.05], 6 months [(0.78±0.69) g/24 h, P＜0.05] and 12 months [(0.69±0.82) g/24 h, P＜0.05]. At 6 months, serum creatinine were decreased in steroid alone [(111.72±31.23) μmol/L vs (121.17±36.51) μmol/L, P＜0.05] and in CTX group [(111.33±22.76) μmol/L vs (124.33±35.51) μmol/L, P＜0.05], while no significant difference was detected in tacrolimus group. At 12 months, there was no significant difference in terms of serum creatinine in all three groups. Besides, there was no significant difference in terms of eGFR (CKD-EPI) in all three groups. One case presented hyperglycemia and one case had liver dysfunction during the treatment in steroid group. Two cases had hyperglycemia, one case had impaired glucose tolerance and one case had liver dysfunction in the tacrolimus group. Conclusions Steroid along, steroid combined with tacrolimus or combined with CTX are efficient in reducing urine protein in the treatment of primary IgAN with mild or moderate renal dysfunction without inducing increased serum creatinine. Given the occurrence of hyperglycemia during the treatment with steroid combined with tacrolimus, it is important to monitor tacrolimus concentration during the treatment.     

透析中心夜间血液透析治疗尿毒症患者的疗效及安全性

目的 观察透析中心夜间血液透析（INHD）治疗尿毒症患者的疗效和安全性。 方法 32例维持性血液透析（MHD）患者行INHD共6个月,3次/周,7.5 h/次。进入INHD前及开始后1、3、6（或3、6）个月测定透析相关指标,做心脏彩超检查、SF-36问卷调查,记录药物使用情况。 结果 进入INHD后,患者透前血压显著下降（130.3/86.0比139.3/88.6 mm Hg, P < 0.01）;透后血压显著上升（121.1/80.5比115.0/77.8 mm Hg,P < 0.01）;透析中高血压（9.8%比24.0%）及低血压发生率（7.3%比14.9%）均显著减少（均P < 0.01）。INHD 6个月后血磷[（1.37±0.27）比（2.08±0.49） mmol/L,P < 0.01]和iPTH值[（355.4±139.6）比（632.3±750.0） ng/L,P < 0.01]显著下降;血钙水平显著上升[（2.64±0.25）比（2.28±0.37） mmol/L,P < 0.05]。与INHD 1个月相比,INHD 6个月时高密度脂蛋白（HDL）显著升高[（1.27±0.29）比（0.75±0.08） mmol/L];低密度脂蛋白（LDL）显著下降[（2.04±0.52）比（2.75±0.75） mmol/L,P < 0.05];尿素下降率（URR）[（79.7±0.1）%比（64.7±4.7）%]和Kt/V（1.40±0.44比0.89±0.25,P < 0.01）显著增加;β2-MG水平显著下降[（17.3±3.9）比（24.6±5.9） mg/L,P < 0.01];左室质量指数（LVMI）显著下降（99.8±29.0比114.8±72.7,P < 0.05）;SF-36量表生理功能、生理职能和情感职能得分显著升高（均P < 0.01）。INHD 6个月时降压药物使用种类、EPO剂量、活性维生素D3（P < 0.05）及降磷药物剂量（P < 0.01）均显著减少,停用降压药、活性维生素D3及降磷药物患者数显著增加（P < 0.05）。 结论 INHD能改善高血压、贫血、钙磷代谢、脂质代谢紊乱,改善心功能,提高生活质量,不良反应少,具有很好的应用前景。     

Relationship between serum adiopocyte fatty acid binding protein and atherosclerosis in chronic kidney disease

Objective To investigate the expression of serum adiopocyte fatty acid binding protein(A-FABP) in chronic kidney disease (CKD) and the role that A-FABP plays in CKD with atherosclerosis. Methods A total of 138 patients with CKD and 20 health control volunteers (HC) were involved in this study. The levels of serum A-FABP, free fatty acid (FFA), interleukin- 6 (IL-6), monocyte chemotactic protein 1(MCP-1) were measured by enzyme-linked immunosorbent assay(ELISA). Inteima-media thickness of common carotid artery was measured by color doppler ultrasound.Results According to the progression of glomerular filtration rate(GFR), the patients with CKD were divided into three groups: group CKD1-2[eGFR≥ 60 ml·min-1·(1.73 m2)-1], group CKD 3-4[60 ml·min-1·(1.73 m2)-1 > eGFR ≥ 15 ml·min-1·(1.73 m2)-1], group CKD5[eGFR ＜ 15 ml·min-1·(1.73 m2)-1].The levels of serum A-FABP were relatively higher in CKD than that in HC group(P＜0.05), and that in the group CKD5 were the most highest (P＜0.01). The level of serum FFA in group CKD 1-2 was relatively higher than that in group HC (P＜0.05), and FFA had a rising trend with decreased eGFR. The level of serum A-FABP was positively correlated with the levels of serum FFA (r＝0.825, P＜0.01), and also positively correlated with IL-6 (r＝0.569, P＜0.01), MCP-1(r＝0.657, P＜0.01) in CKD by Pearson correlation analysis. The levels of A-FABP in 56 patients of CKD with vascular atherosclerosis were significantly higher than that in 82 patients without vascular atherosclerosis (P＜0.01). Conclusion Serum A-FABP maybe play an important role in the progression of vascular atherosclerosis in CKD.     

小剂量日间非卧床腹膜透析对残肾功能较好的糖尿病终末期肾病患者的疗效

目的　研究小剂量日间非卧床腹膜透析（DAPD）和小剂量持续非卧床腹膜透析（CAPD）对残肾功能较好的糖尿病终末期肾病（ESRD）患者的疗效。 方法 病情稳定、残肾功能较好（rGFR≥5 ml/min,且尿量≥750 ml/d）的40例糖尿病ESRD患者入选。按数字随机法分为小剂量DAPD组20例和小剂量CAPD组20例。DAPD组透析处方为1.5 L或2 L,3次/d,每次留腹3～4 h,夜间干腹。CAPD组透析处方为1.5～2 Ｌ,3次/d,或1.5 L,4次/d,夜间留腹。在研究开始及6个月后,分别计算两组腹膜尿素氮清除率（Kt/V）、残肾Kt/V、每周总Ｋt/V、Ccr、rGFR等指标;测定24 h尿蛋白量、24 h腹透液蛋白、血清白蛋白、空腹血糖、糖化血红蛋白及胰岛素剂量;用改良主观综合性营养评估法（SGA）评估患者营养状况。 结果 共35例患者完成研究。两组患者年龄、性别、体质量指数、透析龄、透析液肌酐/血肌酐（D/Pcr）等基线值差异无统计学意义。6个月后,CAPD组胰岛素剂量和24 h腹透液丢失蛋白明显高于DAPD组,分别为（33.6±10.9） U/d 比（20.6±6.2） U/d（P < 0.05）和（11.13±4.95） g比（5.66±2.88） g（P < 0.01）,而血清白蛋白明显低于DAPD组[（29.7±4.2） 比（36.5±3.9） g/L,P < 0.05]。DAPD组与CAPD组相比,24 h净超滤量为（554±187） ml比（309±177） ml,24 h尿量为（1090±361） ml比（750±258） ml,rGFR为（8.21±2.40） ml/min比（4.88±2.11） ml/min,DAPD组均显著高于CAPD组（均P < 0.05）。 结论 对于残肾功能较好的糖尿病ESRD患者,小剂量DAPD较小剂量CAPD能更好地控制血糖,改善营养状态及保护残肾功能。     

Features of ambulatory blood pressure in 540 patients with chronic kidney disease

Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease (CKD) patients. Methods A total of 540 CKD patients from May 2010 to May 2012 in our department were enrolled in this study. Ambulatory blood pressure monitoring was carried out. Blood pressure (BP), proteinuria and other clinical parameters were measured regularly. Ultrasonography was used to evaluate cardiac structure and function, carotid intima-media thickness and plaque. Univariate and multivariate analysis were used to examine the association between BP and clinical parameters. Results 63.9% of CKD patients was non-dipper BP pattern, and 36.1% was dipper BP pattern. As compared to dipper BP patients, those with non--dipper BP had higher ratio of nighttime/daytime proteinuria (0.51±0.29 vs 0.42±0.21, P＜0.01), lower estimated glomerular filtration rate (eGFR) [(56.2±48.2) vs (75.5±56.5) ml•min-1•（1.73 m2）-1, P＜0.01], higher serum cystatin C[(2.8±2.0) mg/L vs (2.1±2.0) mg/L, P＜0.01], higher left ventricular mass index [(53.7±23.2) vs (45.1±16.3) g/m2, P＜0.01] and severely damaged left ventricular diastolic function and higher carotid intima-media thickness [(0.7±0.3) vs (0.6±0.2) mm, P＜0.01]. Nighttime blood pressure was independent predictor for proteinuria, eGFR and left ventricular mass index. Conclusions Non-dipper blood pressure pattern is very common in CKD patients. Nighttime pressure is closely associated to renal damage and cardiovascular injuries.     

Validation of cystatin C-based equations for evaluation of residual renal function among patients undergoing continuous ambulatory peritoneal dialysis

Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function （RRF） in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods Fifty patients on CAPD from our department were enrolled in the study. Eight patients with residual urine volume ≤100 ml/d and 42 patients with residual urine volume ＞100 ml/d were enrolled into anuria group and non-anuric group respectively. The clinical and laboratory status of each group were compared and equations (Hoek’s, Yang’s and abbreviated MDRD equations) were validated in the non-anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF. Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46±1.15) mg/L, t＝2.39, P＝0.02)]. (2) RRF estimated by each equation was correlated well with measured RRF (r＝0.56, 0.56 and 0.39, all P＜0.05). (3) Yang’s equation [0.10 ml•min-1•(1.73 m2)-1] was least biased, followed by Hoek’s equation [-0.73 ml•min-1•(1.73 m2)-1] and abbreviated MDRD equation [3.15 ml•min-1•(1.73 m2)-1]. (4) The precision of Yang’s equation was equivalent to that of Hoek’s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml•min-1•(1.73 m2)-1]. (5) 50% accuracy according to Yang’s equation and Hoek’s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5% and 54.8% vs 23.8%, respectively, all P＜0.01). Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias, precision and 50% accuracy. For patients undergoing CAPD, the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.     

Skeletal muscle wasting in diabetic kidney disease rats and the effect of low-protein diet combined with ɑ-keto acids

Objective To observe the muscle wasting in diabetic kidney disease (DKD) model of type 2 and non-obese diabetes mellitus in Goto-Kakizaki (GK) rats, and to evaluate the effect of low-protein diet supplemented with ɑ-keto acids on muscle wasting. Methods Forty-five male 24-week-age GK rats were randomly divided into three groups: normal protein diet group (22% casein diet, NPD), low protein diet group (6% casein diet, LPD) and LPD＋ɑ-keto group (5% casein＋1% ɑ-keto, Keto). Fifteen gender- and age-matched Wistar rats were served as the control group (CTL). The living condition of GK rats was observed and body weight was measured once a week. Urine albumin, serum glucose, lipids, albumin, creatinine and urea nitrogen were measured at the age of 24, 32, 40, 48 weeks. Soleus muscle at the age of 48-week was observed to calculate the muscle size with software. Expressions of atrogin-1, MuRF-1 and MyoD, myogenin were examined by Q-PCR and Western blotting. Results Compared with the CTL group, NPD, LPD, Keto groups had lower body weight [(317.90±13.81), (330.38±11.96), (390.44±12.25) g vs (429.43±16.85) g, all P＜0.05], higher urine albumin [(14.36±5.52), (8.12±4.61), (5.58±3.50) mg/24 h vs (0.61±0.16) mg/24 h, all P＜0.05], higher serum creatinine [(81.50±7.88), (66.32±8.36), (63.44±8.21) μmol/L vs (24.43±6.15) μmol/L, all P＜0.05] and urea nitrogen [(7.53±1.05), (5.63±1.40), (5.54±0.97) mmol/L vs (2.98±0.62) mmol/L, all P＜0.05]. The cross-sectional area of soleus muscle fibers was larger in CTL group. Compared with CTL group, the expression levels of atrogin-1 and MuRF-1 increased significantly (all P＜0.05), and of MyoD and myogenin decreased significantly in NPD, LPD, Keto groups (all P＜0.05). In Keto group after 40 weeks, muscle wasting was improved compared with NPD and LPD group [body weight (381.62±15.82) g vs (331.50±17.58), （326.60±13.43) g, all P＜0.05], cross-sectional area of soleus muscle increased, levels of urine albumin, serum creatinine and urea nitrogen decreased (all P＜0.05), the protein expressions of atrogin-1 and MuRF-1 decreased, and myogenin and MyoD were higher as compared to CTL group (all P＜0.05). There were no significant differences between NPD and LPD group. Conclusions In DKD condition, protein degradation in the skeletal muscle is accelerated, the genes which control muscle atrophy are activated, and proliferation and differentiation of the muscle satellite cells are impaired. Low-protein diet supplemented with ɑ-keto acids can improve muscle wasting induced by DKD.     

Effect of gender matching on the outcomes of living-donor renal transplantation

Objective To evaluate the effect of gender matching on the outcomes of living-donor renal transplantation. Methods A total of 419 cases of living-donor renal transplantation in our center were divided into male-donor-male-recipient (MDMR) group, male-donor-female-recipient (MDFR) group, female-donor-male-recipient (FDMR) group, female-donor-female-recipient (FDFR) group. The outcomes including graft and patient survival, acute rejection and renal function were analyzed retrospectively. Results Compared to MDMR group, MDFR group and FDFR group had lower Scr [(80.7±17.9), (87.4±21.9) μmol/L vs (120.3±72.5) μmol/L, all P＜0.05] and uric acid (UA) [(318.1±86.4), (303.5±66.9) μmol/L vs (358.4±77.8) μmol/L, P＜0.05] 6 months after operation. Compared to MDFR group, FDMR group had higher Scr[(117.7±27.4) μmol/L vs (80.7±17.9) μmol/L, P＜0.01], UA [(371.0±92.4) μmol/L vs (318.1±86.4) μmol/L, P＜0.05] and lower glomerular filtration rate (GFR) [(70.4±17.8) ml/min vs (79.6±18.9) ml/min, P＜0.05]. Compared to FDMR group, FDFR group had lower Scr [(87.4±21.9) μmol/L vs (117.7±27.4) μmol/L, P＜0.01] and UA [(303.5±66.9) μmol/L vs (371.0±92.4) μmol/L, P＜0.01]. Compared to MDFR group, FDFR group showed lower GFR [(72.4±25.3) ml/min vs (82.7±18.7) ml/min, P＜0.05] 1 year after operation. Compared to MDMR group, FDFR group showed lower UA [(322.9±69.7) μmol/L vs (376.0±66.2) μmol/L, P＜0.05] 2 years after operation. Compared to FDMR group, FDFR group showed lower Scr [(88.7±27.0) μmol/L vs (112.7±27.8) μmol/L, P＜0.05] and UA [(318.3±61.2) μmol/L vs (396.2±100.3) μmol/L, P＜0.05] 3 years after operation. 5 years after operation, there were no significant differences in above indexes, the incidence of slow graft function, acute rejection and survival of graft and patient among groups. Conclusions Male recipients of female donors have the worst renal function while female recipients have better outcomes after operation.     

Antagonist of leukotriene B4 receptor 1 attenuates cisplatin induced acute kidney injury in mice and its associated mechanism

Objective To investigate the effect of pretreatment with U75302, antagonist of leukotriene B4 receptor 1 (BLT1), on cisplatin induced acute kidney injury in mice and its immuno- regulatory mechanism. Methods Healthy C57BL/6 mice were randomized into four subgroups: 1. healthy control group; 2.cisplatin group; 3.U75302 control group; 4.cisplatin + U75302 group, n=6. Group 2 and 4 received intraperitoneal injection of cisplatin (20 mg/kg) on day 0, group 3 and 4 received intraperitoneal injection of U75302 (5 μg/mouse) on day 0 and day 2. Mice were sacrificed on the 3rd day and blood and kidney were collected. Renal function and histological changes were estimated, the infiltration of immune cells were determined by flow cytometry, the level of peroxidase (MPO) in kidney were determined by colorimetry, relative expression of TNF - α, IL - 1β, CXCL1, CXCL2 were detected by Real-time PCR. Results Compared with healthy control group, levels of BUN, Scr were higher in cisplatin group with serious tubular structural damage. There were more neutrophils, macrophages, CD4+ T lymphocytes, CD8+ T lymphocytes in kidneys of cisplatin group, the level of MPO and relative expression of TNF-α, IL-1β, CXCL1, CXCL2 were also higher in cisplatin group. Compared with cisplatin group, lower BUN [(17.75±1.80) mmol/L vs（42.6±6.66）mmol/L, P＜ 0.05], Scr were found in cisplatin + U75302 group with less tubular structural damage. Meanwhile, U75302 reduced infiltration of neutrophils [(146±13)×103/g vs (296±66) ×103/g, P＜0.05], macrophages [(245±13)×103/g vs (420±78)×103/g, P＜0.05] in the kidney. Levels of MPO [(1.756±0.283) U/g vs (3.308±0.577) U/g, P＜0.05] and relative expression of TNF - α, IL - 1β, CXCL1, CXCL2 were also lower. Conclusions BLT1 antagonist U75302 protects mice against AKI induced by cisplatin, and the mechanism is associated with reduced infiltration of inflammatory cells in kidney and the inhibition of kidney inflammation.     

Analysis of cardiovascular disorder related factorsin non-dialysis patients with chronic renal failure

Objective To retrospectively analyze the changes of cardiovascular disorder and explore the risk factors in non-dialysis patients with chronic renal failure(CRF). Methods A total of 106 patients with CRF were enrolled in the cross-sectional study. The patients were divided into four groups by estimated glomerular filtration rate (eGFR): ≥45, 30-44, 15-29, ＜15 ml·min-1·(1.73 m2)-1. Clinical data and biochemical indicators were collected. Cardiac ultrasound measurement of cardiac lumen diameter parameters and function were assessed by echocardiography. The associations of different stages of eGFR with changes of cardiac structure and function were analyzed. Results A negative linear correlation was observed by liner regression between eGFR(MDRD) and left ventricular mass index (r=-0.345, P＜0.01). Logistic regressive analysis revealed that categories of eGFR(MDRD) [β=0.940, OR=2.561, 95%CI (1.380, 4.755), P＜0.01], the history of cardiovascular diseases[β=2.156, OR=8.639, 95%CI(1.991, 37.476), P＜0.01], urinary protein/creatinine ratio[β=0.001, OR=1.001，95%CI(1.000, 1.001), P＜0.01] correlated with left ventricular hypertrophy in the chronic renal failure without renal replacement therapy. The prevalence of concentric hypertrophy in eGFR(MDRD)≥45 ml·min-1·(1.73 m2)-1 was 3/3, while in eGFR(MDRD)=15-29 ml·min-1·(1.73 m2)-1 the prevalence was 3/12. The difference between two groups was significant(P＜0.01). There were no significant difference among the four groups in left ventricular diastolic function and systolic function. Left ventricular mass index had a linear correlation with eGFR measured by creatinine and Cystatin C(r=-0.378, P＜0.01). Conclusions Reduced kidney function is associated with increased left ventricular mass index. The type of left ventricular hypertrophy is mainly concentric hypertrophy at early stage of chronic renal failure. Categories of eGFR (MDRD), the history of cardiovascular diease, urinary protein /creatinine ratio may be important risk factors ofleft ventricular hypertrophy in the patients with chronic renal failure without renal replacement therapy.     

The mechanism of focal necrotizing glomerulonephritis induced by FimH fusion protein

Objective To investigate the mechanism of focal necrotizing glomerulonephritis induced by FimH fusion protein. Methods Wistar-Kyoto (WKY) rats were immunized with purified FimH fusion protein (150 μg) emulsified in Titermax Gold. Controls received PBS in Titermax Gold alone. Glomerular injuries were assessed by 24-hour urinary protein, urea nitrogen (BUN), serum creatinine (Scr), serum uric acid (UA) and histomorphology. The levels of interleukin-17A (IL-17A) were detected by ELISA assay. Results The levels of 24-hour urinary protein began to rise at 3rd day after immunization with FimH fusion protein, and were significantly higher than control group on 7th , 35th and 50th day [(8.59±1.25) mg vs (3.08±1.08) mg, (10.33±1.10) mg vs (6.40±0.61) mg, (12.45±1.73) mg vs (5.93±0.83) mg, all P＜0.05].The serum levels of BUN, Scr, UA in model rats were increased significantly at 50th day [(6.76±0.20) mmol/L vs (5.82±0.13) mmol/L, (58.00±1.53) μmol/L vs (25.67±1.45) μmol/L,(61.67±7.27) μmol/L vs (31.33±2.73) μmol/L, all P＜0.05] compared to control group. WKY rats immunized with FimH fusion protein showed segmental necrosis of glomerular capillaries, alveolar wall thickening, and significant inflammatory cells infiltration on 35 th day, and glomerular crescent formation after 50 days. The serum levels of IL-17A were increased significantly compared to control group on 35th and 50th day [(46.97±5.00) ng/L vs (11.27±2.67) ng/L, (41.95±5.51) ng/L vs (16.31±1.64) ng/L, P＜0.05]. The IL-17A level was positively correlated with 24-hour urinary protein in model group (r＝0.557, P＝0.021). Conclusion Bacteria FimH protein can induce glomerular focal necrotic lesion and lung injury in WKY rats, and IL - 17Amay involve in the damage process.     

甲状旁腺切除术对血液透析患者合并继发性甲状旁腺功能亢进骨代谢及骨密度的影响

目的 观察甲状旁腺切除术(parathyroidectomy,PTX)对继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性血液透析患者骨代谢及骨密度(BMD)的影响.方法 26例SHPT患者行PTX.术前及术后1、3、6、12、18、24个月时常规检测血钙、血磷、血清碱性磷酸酶,化学发光法检测血清全段甲状旁腺素(intact parathyroid,iPTH)、骨钙素(OC)、Ⅰ型前胶原氨基末端前肽(PINP)、β胶原蛋白(β-C TX),术前及术后24个月时双能X线法测定腰椎、股骨颈、骨盆各部位骨密度,观察患者甲状旁腺切除术前、术后骨代谢指标及骨密度变化.结果 (1)与术前比较,血清OC水平[(104.49±25.42) μg/L比(695.46±355.62) μg/L,P＜ 0.01]、PINP水平[(248.36±159.38) μg/L比(809.28±283.50) μg/L,P＜0.01]于手术3个月后明显降低,β-CTX水平于手术1个月后明显降低[(1.60±0.64) μg/L比(3.37±1.34) μg/L,P＜0.01].(2)与术前比较,术后24个月时腰椎BMD[(0.88±0.23) g/cm2比(0.78±0.23) g/cm2,P＜0.01]、股骨颈BMD[(0.96±0.19) g/cm2比(0.84±0.24) g/cm2,P＜ 0.01]及腰椎Z评分[(-1.24±0.55)比(-1.66±0.24),P＜0.01]、股骨颈Z评分[(-1.51±0.72)比(-1.93±0.40),P＜0.01]均升高.(3)相关分析显示,术前血清iPTH水平与⊿腰椎Z评分(r=0.584,P=0.002)、⊿股骨颈Z评分(r=0.400,P=0.043)呈正相关,术前血清OC水平与⊿腰椎Z评分(r=0.651,P＜0.001)、⊿股骨颈Z评分(r=0.509,P=0.008)呈正相关.结论 PTX术可以降低患者升高的iPTH、OC、PINP及β-CTX水平,增加骨密度,同时改善多项生化指标,提高患者生活质量.     

Complications and prognosis of urgent-start peritoneal dialysis and urgent-start hemodialysis in end-stage renal disease patients

Objective To compare the complications and outcomes of urgent-start peritoneal dialysis (PD) and hemodialysis (HD) in end-stage renal disease (ESRD) patients, and explore the safety and effectiveness of PD which was as an urgent-start dialysis modality in ESRD patients. Methods All patients for urgent-start dialysis, who initiated dialysis without a long-term dialysis access or had the long-term dialysis access under 30 days in Renji Hospital from January 1st 2013 to December 31st 2014, were enrolled. According to the dialysis modalities, patients were divided into PD group and HD group. Participants were followed up until death, transferred to other centers, lost of follow up or January 1st 2016. Dialysis-related complications within 30 days of implantation, complications of reimplantation and the occurrence of bacteremia between two groups were compared, and their survival rates were tested by Kaplan-Meier curves. Results Among 178 patients in this study, there were 96 (53.9%) patients in PD group and 82 (46.1%) patients in HD group. Compared with those of HD group, patients of PD group presented more cardiovascular disease [21(21.9%) vs 8(9.8%), P=0.029], higher serum potassium [(4.5±0.8) mmol/L vs (4.3±0.8) mmol/L, P=0.038], but less heart failure (NYHA Ⅲ-Ⅳ) [26(30.2%) vs 40 (48.8%), P=0.014], lower brain natriuretic peptide (BNP) [328.5 (129.5, 776.8) ng/L vs 503.5(206.0, 1430.0) ng/L, P=0.008], higher hemoglobin [(81.5±17.7) g/L vs (75.3±22.5) g/L, P=0.039], higher serum albumin (33.5±5.7) g/L vs (31.3±6.7) g/L, P=0.022] and higher serum pre-albumin (304.5±78.0) mg/L vs (257.0±86.1) mg/L, P＜0.001]. PD group presented less dialysis-related complications [5(5.2%) vs 20(24.4%), P＜0.001], less dialysis-related complications requiring reimplantation [1(1.0%) vs 20(24.4%), P＜0.001] and less bacteraemia [3(3.1%) vs 11(13.4%), P=0.011]. The 3-, 6-and 12-month patient survival rates of PD and HD group were 97.9% vs 98.4%, 97.9% vs 98.4%, and 92.1% vs 93.0% respectively, and no significant difference was found (Log-rank=0.004, P=0.947). Conclusions Patients with urgent-start PD have less complications within 30 days of implantation and occurrence of bacteremia than patients with urgent-start HD, and the same survival rates. PD may be a feasible and safe urgent-start dialysis modality for ESRD patients.     

Mineral and bone disorder in patients with chronic kidney disease: a cross - sectional single center study

Objective To investigate and analyze the mineral and bone disorder (MBD) in the patients with chronic kidney disease (CKD), reveal the change of related indexes of CKD-MBD. Methods A cross-sectional study was carried out in the First Affiliated Hospital of Harbin Medical University. From October 2011 to May 2014, 1318 inpatients and hemodialysis outpatients were enrolled. Parameters related to MBD, including serum phosphorus (P), total calcium (t - Ca), intact parathyroid hormone (iPTH) and alkaline phosphatase (AKP) were analyzed. Last, it was analyzed with multiple regression analysis to related factors of the secondary hyperparathyroidism (SHPT) in patients with CKD. Results Serum calcium, phosphorus and iPTH had no obvious abnormalities at the early stages of CKD [GFR＞60 ml•min-1•(1.73 m2）-1], and relatively stable before GFR＞30 ml•min-1•(1.73 m2)-1. After entering the CKD4 stage, serum phosphorus, iPTH increased sharply and serum calcium decreased obviously along with the decreased glomerular filtration rate (GFR). Serum P, t-Ca and iPTH levels were statistically significant in CKD 1 to 5D patients, respectively, serum P: (1.13±0.20) mmol/L, (1.14±0.22) mmol/L, (1.26±0.23) mmol/L, (1.48±0.34) mmol/L, (2.05±0.61) mmol/L and (2.08±0.58) mmol/L; serum t-Ca (mmol/L) (2.35±0.13) mmol/L, (2.35±0.12) mmol/L, (2.35±0.15) mmol/L, (2.26± 0.18) mmol/L, (2.07±0.29) mmol/L and (2.31±0.26) mmol/L; iPTH: 57.8(45.6, 91.8) ng/L, 54.1(37.8, 74.6) ng/L, 71.6(45.8, 102.2) ng/L, 131.1(81.7, 205.1) ng/L, 277.5(173.6, 395.3) ng/L and 354.9 (194.4, 720.3) ng/L; The stepwise logistic regression analysis showed: hypocalcemia (OR=3.32, P＜0.01) and decreased GFR (OR=5.28, P＜0.01) were independent risk factors of iPTH elevation at stage CKD3～5. Conclusions From the beginning of the CKD3 stage, serum t - Ca, P, iPTH level began to be relatively abnormal as renal function declined. Hyperphosphatemia, SHPT has not been improved significantly in CKD5D stage patients even with hemodialysis. The regulation of hemodialysis on serum calcium showed "overcorrecting" phenomenon.     

A comparison between residual renal function and peritoneal clearance for Na/H2O and urea removal in peritoneal dialysis patients

Background: To compare the Na/H₂O and urea removal between residual renal function (RRF) and peritoneal clearance (PC) in peritoneal dialysis patients. Try to explore the difference between RRF and PC in prognosis of chronic kidney disease patients who need peritoneal dialysis (PD) treatment. Methods: Weekly Na/H₂O and urea removal by PC and RRF were investigated individually. Independent samples t-test was carried out to compare the efficiency of removal between RRF and PC treatment. Pearson correlated analysis was applied to reveal the relationship between Na/H₂O and urea removal and Kt/V. Results: Although a higher Na/H₂O removal rate by RRF was showed in this investigation, the difference was not statistical significant compared to the one by PC. On the other hand, urea removal by RRF was obviously higher than PC. For every 0.1?Kt/V, Na/H₂O removal by RRF was distinctly higher than PD. The Na and H₂O removal of RRF were 147.88?±?83.72?mmol and 46.54?±?39.11?mmol, respectively; and the ones of PD were 11.40?±?6.08?mmol and 4.47?±?4.79?mmol. By using statistical assay, the correlations relevance between Na/H₂O removal and Kt/V in RRF were showed stronger than in PC. However, the total removal of Na/H₂O showed a poor correlation with Kt/V in both RRF and PC. Conclusions: The removal efficiency of RRF is much higher than PC. This study suggests that it is important to adjust dialysis program when RRF gets declined. Also the correlation between Na/H₂O removal rate and Kt/V is an important monitoring factor for the patients who are receiving peritoneal dialysis.