An in vitro evaluation of the glycation potential of a natural disaccharide,trehalose

Background. Glucose, an osmotic agent generally used in continuous ambulatory peritoneal dialysis (CAPD) dialysate, has a critical characteristic of forming advanced glycation endproducts (AGEs). We undertook this study to investigate whether a possible osmotic agent, trehalose, formed fewer AGEs than glucose. Methods. Hemoglobin (Hb), a counter-protein of AGE, was incubated in four kinds of medium; glucose-phosphate buffered saline (PBS), autoclaved glucose-PBS, trehalose-PBS, and autoclaved trehalose-PBS, for 3, 7, 14, and 30 days, respectively. Polymerization of the Hb molecule was detected by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and carboxymethylated Hb was detected by Western blotting, using specific mono-clonal antibody for carboxymethylated N-terminal valine-Hb (CMV-Hb). Results. PBS containing glucose showed bands of polymerized Hb molecule, a phenomenon which was markedly exaggerated by autoclaving. Likely, PBS containing glucose showed the formation of CMV-Hb in the long incubation of 30 days, and PBS containing autoclaved glucose showed accelerated formation of CMV-Hb in an incubation as short as 3 days. By contrast, PBS containing trehalose showed much less increase in a band of 30k Dalton and in CMV-Hb formation even in autoclaved medium. Conclusions. Our present in vitro study clearly showed the superior characteristic of trehalose to produce fewer AGEs. Based upon the results of this study, we propose that the application of trehalose should be considered for CAPD solution.     

Pylorus-preserving pancreaticoduodenectomy in patients undergoing chronic hemodialysis

This report describes three patients who underwent a pylorus-preserving pancreaticoduodenectomy (PpPD) and received maintenance hemodialysis due to chronic renal failure. The three cases were diagnosed to have bile duct cancer, intraductal papillary mucinous neoplasm, and carcinoma of the ampulla of Vater, respectively. They underwent chronic hemodialysis for 7.7 years. They all underwent a PpPD with lymph node dissection. The mean operation time was 373 min and mean blood loss was 647 ml. During the postoperative courses, hemodialysis was restarted on postoperative day 1 in all three cases. In the three patients, only minor complications were experienced and these were treated conservatively. The mean postoperative hospital stay was 48 days. Two patients are still alive 135 and 21 months after the operation, respectively, but the other patient died of another disease 21 months after the PpPD. A PpPD may therefore be safe and feasible even in patients receiving chronic hemodialysis.     

维持性血液透析患者心血管钙化的发生率及相关因素

目的 探讨维持性血液透析患者心血管钙化的发生率及相关因素.方法 选择接受维持性血液透析≥3月的非住院患者60例,完善相关实验室检查,腹部侧位X线片检测腹主动脉钙化评分(Kauppila法),心脏超声检测心脏瓣膜钙化情况,并计算心血管钙化指数.结果 本组患者影像学检查可见钙化的总发生率为68.3％,腹主动脉钙化的患者中5≤腹主动脉钙化评分＜ 16者占41.4％,瓣膜钙化以主动脉瓣为主(占64.5％).有钙化组与无钙化组患者的年龄、血钙、心血管钙化指数存在差异(均P ＜0.05),而透析龄(月)、身高、体质量、握力、血磷、血红蛋白、血清总蛋白、血清白蛋白、血脂未见差异(均P≥0.05).结论 本组患者心血管钙化部位不均衡,随患者年龄和血钙水平的增加,心血管钙化的发生风险升高.     

慢性肾功能衰竭血液透析患者合并感染的临床分析

目的 探讨慢性肾功能衰竭血液透析患者感染的临床特点和相关因素.方法 回顾分析60例慢性肾功能衰竭透析患者的感染部位、病原菌种类、免疫功能、营养状况、肾功能、原发病因等与感染的相关性.结果 感染组30例患者共发生感染42例次,以肺部感染和静脉导管感染最常见.行各类标本细菌培养40例次,培养阳性24例,病原学检查以革兰阴性...     

维持性血液透析患者皮肤瘙痒情况的调查

目的 分析维持性血液透析患者皮肤瘙痒的部位、程度及治疗情况.方法 对我院血液净化中心63例维持性血液透析患者的皮肤瘙痒发生部位、以视觉模拟评分法评估瘙痒程度并调查其治疗情况.结果 63例维持性血液透析患者常见的瘙痒部位依次为背部、下肢、胸部、上肢、头颈部;轻度、中度、重度瘙痒分别为22例(34.9%)、25例(39.6%)、16例(25.4%);合并皮肤感染5例.63例患者中有40例患者接受血液灌流和(或)血液透析滤过治疗,经规律血液灌流和(或)血液透析滤过治疗后症状缓解.单纯行血液透析治疗的23例瘙痒患者中有14例去皮肤科就诊,经局部对症治疗效果不明显.结论 维持性血液透析患者皮肤瘙痒多为中、重度并可能发生皮肤感染.规律血液灌流和(或)血液透析滤过治疗能有效地缓解维持性血液透析患者皮肤瘙痒,而单纯局部对症治疗无效.     

高龄维持性血液透析患者的临床分析

目的 评估高龄肾衰竭患者维持性血液透析（maintenance hemodialysis,MHD）的临床特点.方法 分析82例高龄肾衰竭患者（高龄组）行血液透析治疗前基线情况,包括血压、体质量指数、血红蛋白（haemoglobin,Hb）、尿素氮（BUN）、血肌酐（SCr）、血白蛋白（serum albumin,Alb）;同期进行血液透析治疗的156例非高龄患者设为对照组,定期监测2组患者透析阶段一般治疗情况、透析充分性、血红蛋白（haemoglobin,Hb）、血白蛋白（serum albumin,Alb）、甲状旁腺素、C反应蛋白、心功能测定、营养状况等,透析中合并症和治疗阶段心脑血管并发症的发生情况,统计分析高龄透析患者临床治疗特点.通过生存率和死亡原因分析,总结影响高龄患者透析生存质量的主要因素.结果 高龄组与对照组相比,病因以继发性（高血压、糖尿病）为主、整个透析阶段Alb和SGA低于对照组（P＜0.05）,Kt/V值低于对照组（P＜0.05）、心功能指标左心室舒张末内径、左心室射血分数低于对照组（P＜0.05）,透析中并发症发生率（40.8％）高于对照组（29.3％）,死亡原因1年内主要为脑血管意外及心血管疾病,超过1年的死亡原因主要为脑血管意外、感染、心血管疾病及严重营养不良,比较不同生存时间（3年以内和超过3年）的临床特征,影响高龄患者生存率的主要因素是糖尿病、低血压、透析前SCr水平高,Kt/V值不达标,贫血,营养不良.增加透析频次,联合采用血液透析滤过（hemodiafiltration,HDF）、血液灌流（hemoperfusion,HP）组合治疗有助于延长透析存活时间.结论 高龄MHD患者营养不良较为普遍,并伴随贫血程度重,心功能差,易感染,从而导致了患者并发症、合并症的发生率增加,生存时间减少,通过改善营养、纠正贫血、采取个体化的透析方案,组合治疗,可以减少高龄透析患者的并发症,提高生存率.     

单中心维持性血液透析患者临床分析

目的：调查深圳市中医院维持性血液透析（maintenance hemodialysis,MHD）患者的现状。方法选择2013年3月至6月在本中心透析的147例 MHD 患者为研究对象,进行横断面调查,统计患者血管通路的种类和人数、每次透析的超滤情况,检测患者血红蛋白、血电解质、甲状旁腺素及透析前、透析后肾功能,并进行统计学分析,评价其透析状况。结果147例 MHD患者中,男女比例为1.58∶1,平均年龄（50.1±14.9）岁,原发病前2位分别为慢性肾小球肾炎和糖尿病肾脏疾病,血管通路以自体动静脉内瘘为主（140例,占95.23%）;本组147例 MHD 患者中,配合采血者122例,采血依从性为82.99%;血红蛋白为（103.03±15.32）g/L,达到贫血治疗目标的患者有33例,达标率为27.04%,半数以上的患者存在轻度贫血;血钾为（5.32±0.79）mmol/L,高血钾症（＆gt;5.3 mmol/L）的患者49例（占40.16%）;血钙为（2.15±0.22）mmol/L（未用血白蛋白校正）,血磷（1.98±0.51）mmol/L,甲状旁腺素为359.2（163.35,825.2）ng/L（四分位分析法）,贫血、血钾和钙磷代谢紊乱控制较差;透析充分性方面,尿素清除指数（Kt/V）值达标率为90.16%;乙型病毒性肝炎患者9例（占6.12%）,无院内新增传染病患者。结论本中心患者大部分透析充分,传染病控制好,但部分患者慢性并发症控制欠佳,有待于加强对患者的管理和治疗。     

Abdominal aortic calcification score can predict all-cause and cardiovascular mortality in maintenance hemodialysis patients

Purpose: Abdominal aortic calcification (AAC) assessed by using standard lateral lumbar radiographs can be graded, and composite summary scores (range, 0–24) have been shown to be highly predictive of subsequent cardiovascular morbidity and mortality in hemodialysis (HD) patients. However, few studies have sought to determine the optimal AAC score cutoff values for the prediction of mortality among HD patients.Methods: This retrospective cohort study included 408 hemodialysis patients. AAC severity was quantified by the AAC score, which was measured by lateral lumbar radiography with complete follow-up data from January 2015 to December 2021. We used receiver operating characteristic (ROC) analysis to find the cutoff AAC value for the prediction of mortality. The Kaplan–Meier method was used to analyze all-cause and cardiovascular mortality.Results: The cutoff calcification score for the prediction of mortality was 4.5 (sensitivity, 67.3%; specificity, 70.4%). The patients with AAC scores above 4.5 had significantly higher all-cause (log-rank p < 0.001) and cardiovascular (log-rank p < 0.001) mortality rates than those with AAC scores below 4.5. In the multivariate regression analyses, an AAC score above 4.5 was a significant factor associated with all-cause mortality (HR: 2.079, p = 0.002) and cardiovascular mortality (HR: 2.610, p < 0.001).Conclusions: AAC is a reliable aortic calcification marker. HD patients with an AAC score > 4.5 have significantly elevated all-cause and cardiovascular mortality compared with those with an AAC score ≤ 4.5. AAC was a better predictor than cardiac valve calcification for mortality in HD patients.     

An oral load of the early glycation compound lactuloselysine fails to accumulate in the serum of uraemic patients.

BACKGROUND: It has been hypothesized that in renal failure, exogenous glycation compounds from food accumulate and play a major pathogenetic role when renal excretion is impaired. METHODS: To address this, a diet containing a defined amount of the lysine Amadori product (AP) lactuloselysine was used. Plasma concentrations and cumulative urinary excretion of AP were assessed in 16 healthy subjects, 12 renal failure patients and 6 continuous ambulatory peitoneal dialysis (CAPD) patients. Amadori product was measured as furosine using reverse phase high performance liquid chromatography (RP-HPLC) after acid hydrolysis. RESULTS: A diet low in glycation compounds significantly decreased excretion of APs in healthy subjects. In healthy individuals, ingestion of lactuloselysine bound to food proteins caused only a minor acute increase (8.24+/-1.11 mg/day, 2% of the administered dose) of AP excretion in the urine; in patients with renal failure not yet on dialysis, the increase in AP excretion in the urine was significantly less (4.0+/-0.51 mg/day) and the same was true in CAPD patients (0.21+/-0.09 mg/day). The plasma concentration of total APs, i.e. the sum of APs as free amino acids and residues bound to plasma proteins, did not change in any of the three groups, however. CONCLUSION: Dietary APs do not accumulate in the blood even in advanced renal failure. The amount of APs measured as furosine excreted in the urine is significantly less, however, in renal failure and CAPD patients compared with healthy subjects. Although the findings exclude accumulation of lactuloselysine in renal failure, they do not generally exclude accumulation of other food-derived advanced glycation end products (AGEs).     

Spontaneous major tendon ruptures in patients on chronic hemodialysis

Eight spontaneous ruptures of major tendons (five patellar and three triceps brachii) in five patients receiving long-term hemodialysis were reviewed between 1995 and 2003. The average age of the two men and the three women was 37.2 years. The average length of hemodialysis was 10.8 years. Etiology, pathologic focus, frequency, symptoms, problems, and operative indications were examined. Reconstruction using Perssons technique for patellar tendon ruptures and Levys technique for triceps tendon ruptures (the suture line was then protected with a figure-of-eight tension band wire) provided excellent results in all patients. Hyperparathyroidism existed in all patients. Local amyloid depositions were not found in any of the patients. In all patients, the ruptured site was not in the tendon but at the tendon attachment to the bone, which was smooth and completely free from tendon tissue. Thus, the most likely etiology of tendon ruptures in patients receiving hemodialysis was thought to be the fragility of the bone at the tendon attachment attributable to secondary hyperparathyroidism. To prevent this complication, control of hyperparathyroidism may be important, especially in active young patients.     

Association between serum soluble Klotho level and outcome in patients on maintenance hemodialysis

Objective To determine the relationship between serum soluble Klotho (sKL) level and adverse outcome in maintenance hemodialysis (MHD) patients. Methods One hundred and twenty nine cases of MHD patients were collected prospectively. Serum sKL was detected by ELISA. Abdomen lateral plain was used as a criterion to determine the abdominal aortic calcification. The abdominal aortic calcification score (AAC) was calculated. Cox regression analysis was used to determine the risk factor of cardiovascular death (CVD) in MHD patients. Kaplan-Meier showed the relationship between sKL and CVD in MHD patients. Results There were 27 cases (20.9%) of all-cause death and 19 cases (14.7%) of cardiovascular death. The median sKL was 612.6(379.2-816.6) ng/L, and log[iPTH] was an independent factor of sKL concentration. Low sKL had high AAC and CVD death rate. Kaplan-Meier method showed that the all-cause death rate was similar between two groups, and CVD death rate increased significantly in low sKL patients (P=0.036). Cox regression indicated that lower sKL level was associated with high CVD death rate [OR=0.352, 95%CI(0.127- 0.977), P=0.045].After adjustment for the general condition, biochemical indicators, the relationship still existed [OR=0.331, 95% CI (0.117-0.933), P=0.037]. In no or mild vascular calcification patients (AAC≤4), compared with high sKL patients, low sKL patients had no significant difference rate in all-cause mortality. The CVD mortality was significantly higher in high sKL (P=0.035) compared with low sKL. In severe calcification group (AAC＞4),all-cause death and CVD death rates were similar between different sKL groups (P=0.991 and 0.522, respectively). Conclusions Lower sKL has the high CVD death rate and sKL level decreasing is an independent risk factor for CVD death in MHD patients. The lower sKL concentration in MHD patients with no or mild calcification may predict CVD mortality. This study suggests that sKL levels may be helpful in predicting the outcome of patients with MHD.     

Advanced glycation end products in children with chronic renal failure and type 1 diabetes

Serum levels of advanced glycation end products (AGEs) are markedly elevated in adults with chronic renal failure (CRF) and diabetes mellitus. Accumulation of AGEs in tissues contributes to the development of long-term complications. Up to now little has been known about the formation of AGEs in childhood. We determined serum levels of the well known AGEs pentosidine and Nɛ-carboxymethyllysine (CML) in children with CRF (n=12), end-stage renal disease (ESRD) (n=9), renal transplantation (n=12), and type 1 diabetes mellitus (n=42) and in healthy children (n=20). Pentosidine was measured by high-performance liquid chromatography (HPLC), CML by a competitive enzyme-linked immunosorbent assay (ELISA) system. Serum levels of pentosidine and CML were significantly higher in the children with CRF and ESRD than in controls (P<0.001), but nearly within the normal range after transplantation. Both AGEs showed a significant negative correlation with creatinine clearance (P<0.001). During a single session of low-flux hemodialysis, total pentosidine and CML levels did not change. Free pentosidine, however, was reduced by 78% (P=0.04). Diabe-tic children showed significantly elevated pentosidine levels (P<0.001) despite normal renal function. We conclude that, similar to adults, increased formation and accumulation of AGEs also exist in children with CRF and type 1 diabetes mellitus. At present the best prevention of AGE-related complications is an early renal transplantation in children with ESRD, as well as a careful metabolic monitoring of diabetics. Received: 25 July 2001 / Revised: 14 November 2001 / Accepted: 18 November 2001     

维持性血液透析患者缺血修饰白蛋白水平与腹主动脉钙化相关性分析

目的 研究维持性血液透析(maintenance hemodialysis,MHD)患者中缺血修饰白蛋白(ischemia-modified albumin,IMA)水平及其相关因素,并分析IMA与腹主动脉钙化(ab-dominal aortic calcification,AAC)的关系.方法 选取2016年1月至2...     

Impact of high coronary artery calcification score (CACS) on survival in patients on chronic hemodialysis

Background Electron-beam computed tomography (EBCT) is a noninvasive measure of coronary artery calcification and, therefore, could be a marker of developing cardiovascular disease. Whether the coronary artery calcification score (CACS) is a prognostic marker in chronic dialysis patients is not known.Methods In the present study, the mortality rate was observed in relation to the baseline CACS. EBCT was performed in 104 chronic hemodialysis patients (62 men and 42 women) in one dialysis unit. The mean (SD) duration of hemodialysis was 48.7 (62.6) months at the time of EBCT. The mean (SD) age at EBCT was 55.9 (13.6) years, ranging from 23 to 88 years. The duration of follow-up was 43.8 (19.3) months after the EBCT. Cox proportional hazard analysis was performed to examine the impact of CACS on survival after adjusting for age, sex, duration of dialysis, diabetes mellitus, hypertension, serum albumin, and dyslipidemia.Results The CACS was distributed from zero to 5896, with a median of 200. During the study period, 24 patients (15 men and 9 women) died, 7 in the low CACS group (200) and 17 in the high CACS group (200). The 5-year cumulative survival rate was 84.2% in the low CACS group and 67.9% in the high CACS group. The adjusted relative risk (95% confidence interval) of death was 1.001 (1.000–1.002); P = 0.0003, for the absolute value of CACS.Conclusions The present study suggested that CACS was an independent predictor of death in patients on chronic hemodialysis. Patients with a high CACS should be carefully monitored and evaluated for reversible prognostic factors such as dyslipidemia and, probably, hyperphosphatemia and a high value for the calcium × phosphate product.     

Relationship between parameters of the urea kinetic model and serum amino acid levels in patients on hemodialysis

Background. The parameters of the urea kinetic model (UKM) [product of dialyzer urea clearance and treatment time divided by body urea volume (Kt/V), protein catabolic rate (PCR), percent creatinine generation rate (%CGR)] are predictors of prognosis in patients on hemodialysis. In addition, adequate nutritional status has been recently recognized to be important for patient survival. We examined the relationship between serum amino acid levels and the parameters of the UKM, and investigated whether they could be predictors of patients' prognosis. Method. We studied 56 non-diabetic patients undergoing hemodialysis, and compared them with 101 normal controls. Serum amino acid levels were measured by high-performance liquid chromatography. Kt/V, PCR, and %CGR were calculated by Shinzato's method. Results. The serum amino acid patterns of patients on hemodialysis were characterized by low essential amino acid levels and high non-essential amino acid levels. Kt/V did not correlate with any amino acid levels. PCR correlated positively with urea and 3-methylhistidine, and negatively with aspartic acid and glutamic acid. %CGR correlated positively with serine, and negatively with glutamic acid. There were no correlations between valine/glycine and PCR, both of which are indicators of protein intake. Conclusions. We considered that serum amino acid levels are poor predictors of patients' prognosis. Of the various causes of alterations in serum amino acid levels, renal metabolic dysfunction and protein-calorie malnutrition appear to be important. Received: July 6, 1998 / Accepted: November 4, 1998     

Imbalance between production and scavenging of hydroxyl radicals in patients maintained on hemodialysis

Background Reactive oxygen species are as being related to the pathophysiology of endstage renal disease (ESRD). We measured the plasma hydroxyl radical (·OH)-producing ability and ·OH-scavenging activity in patients with ESRD to clarify the pathophysiological states involved. Methods We used electron spin resonance to measure plasma N-t-butyl-α-phenylnitron radical spin adduct (pPBN rsa) as ·OH-producing ability and plasma 3,3,5,5-tetramethyl-1-pyrroline-N-oxide radical spin adduct (pM4PO rsa) as ·OH-scavenging activity. Oxidative injuries were evaluated by determining oxidised low-density lipoprotein (Ox-LDL). Results The pPBN rsa of the ESRD patients was lower than that of the controls (1.83 vs 2.94 μmol/g protein). The pM4PO rsa of the ESRD patients was higher than that of the controls (3.85 vs 3.15 mmol l-ascorbic acid 2-[3,4-dihydro-2,5,7,8-tetramethyl-2-(4,8,12-trimethyltridecyl)-2H-1-benzopyran-6-yl hydrogen phosphate] potassium salt (EPC-K₁)/g protein). The pPBN rsa and pM4PO rsa were correlated, both in the ESRD patients and in the controls (r = 0.47 and r = 0.53). Ox-LDL was correlated with hemodialysis (HD) duration (r = 0.49) and was negatively correlated with pPBN rsa (r = −0.54), which indicates that oxidative stress was increased as HD therapy was prolonged and suppressed pPBN rsa. Conclusions There was an imbalance between ·OH-producing ability and ·OH-scavenging activity, in the ESRD patients, and this may be responsible for compromising the health of ESRD patients.     

Serum adiponectin and markers of endothelial injury in hemodialysis patients with arteriosclerosis obliterans

Background Arteriosclerosis obliterans (ASO) in hemodialysis patients is the dominant cause of morbidity evolving from arteriosclerosis. Adiponectin is an adipose-derived cytokine which, because of its modulation of endothelial adhesion molecules, has potential anti-inflammatory and anti-atherogenic properties. However, the implications of adiponectin and endothelial function in ASO of hemodialysis patients has not been fully elucidated. Methods In this study we measured serum levels of adiponectin, adhesion molecules (VCAM-1 and ICAM-1), and an endothelial cell injury marker (CD146) in patients with ASO. We sought to determine clinical and laboratory correlates of ASO in ESRD patients. A total of 80 hemodialysis patients and 82 patients with normal serum creatinine levels were enrolled. Serum levels of adiponectin, ICAM-1, VCAM-1, and CD146 were measured by ELISA. Results Serum adiponectin levels in 41 hemodialysis patients with ASO were significantly lower than in 39 patients without ASO. Serum CD146 levels in hemodialysis patients with ASO were significantly higher than in patients without ASO. There were no significant differences between levels of ICAM-1 and VCAM-1 in these two groups. Similar results were obtained for patients with normal renal function. Serum adiponectin was related to hemodialysis duration and BMI in hemodialysis patients. In patients with normal renal function, adiponectin was related to HDL-cholesterol, triglyceride, and ICAM-1. Conclusion A decrease in serum adiponectin levels and an increase in serum CD146 may be closely associated with the development of ASO, regardless of renal function. However, there are different mechanisms determining serum adiponectin levels in patients with normal kidney function and in hemodialysis patients. In memory of Dr Kenji Okuda (1944–2007).     

Serum levels of C-terminal telopeptide of type I collagen: a useful new marker of cortical bone loss in hemodialysis patients

Renal osteodystrophy is a major complication in hemodialysis patients. Measurement of serum peptide derived from the degradation of bone collagen could potentially provide an indirect estimate of bone resorption. The present study estimated the significance of the C-terminal telopeptide of type I collagen (-CTx) as a serum bone resorption marker in male hemodialysis patients. The mean age and hemodialysis duration of the 160 patients were 59.7 years (26–86 years) and 67.2 months (17–142 months), respectively. Bone mineral density (BMD) in the distal third of the radius was measured using dual-energy X-ray absorptiometry twice with a 2-year interval. A blood sample was collected immediately before the hemodialysis session at the time of the second BMD measurement. Other serum bone markers determined were bone-specific alkaline phosphatase (BAP) and intact and N-terminal midfragment (N-Mid) osteocalcin (OC) as bone-formation markers and serum pyridinoline (PYD) and deoxypyridinoline (DPD) as bone resorption markers. Serum -CTx correlated significantly in a positive manner with serum PYD, DPD, BAP, intact OC, and N-Mid OC. Serum -CTx, as well as PYD, DPD, BAP, intact OC, and N-Mid OC, correlated significantly with BMD in the distal third of the radius at the second measurement and with the rate of BMD reduction during the preceding 2 years. The highest quartile of serum -CTx was positively associated with rapid bone loss, defined as a change in the value for BMD in the distal third of the radius falling within the upper tertile of patients, in 55% of cases, and each quartile progress in serum -CTx increased the odds ratio of rapid bone loss by a factor of 1.73. Since the Youden index was twice as accurate for -CTx, BAP and N-Mid OC as for intact PTH, these bone-remodeling markers may be better risk markers of cortical bone loss than intact PTH. Inclusion in the highest quartile of PTH (above 288 pg/ml) predicted rapid bone loss with a sensitivity of only 26%. This means that the upper limit for serum PTH level recommended by K/DOQI may be too high, since 74% of cases with rapid bone loss showed serum PTH levels of below 288 pg/ml. In conclusion, serum measurement of -CTx may provide a new commercially viable and relevant serum assay to reflect cortical bone resorption in hemodialysis patients.     

Evaluation of serum fetuin-A relationships with biochemical parameters in patients on hemodialysis

Background Complications associated with atherosclerosis in dialysis patients are attracting attention. Fetuin-A, a circulating calcium-regulatory glycoprotein that inhibits vascular calcification, is associated with inflammation and outcome in dialysis patients. In this study, the relation between serum fetuin-A concentration and biochemical parameters in patients on hemodialysis was investigated. Methods Forty hemodialysis patients, 22 men and 18 women, aged 57 ± 12 years; and 20 controls, 10 men and 10 women, aged 50 ± 10 years, participated in this study. We measured serum fetuin-A by enzyme-linked immunosorbent assay. The biochemical parameters of serum albumin, alkaline phosphatase, calcium, phosphate, intact parathyroid hormone, total cholesterol, triglyceride, lipoprotein (a), brain natriuretic peptide (BNP), highly sensitive C-reactive protein (hsCRP), hemoglobin, and hematocrit in whole blood were also measured before starting dialysis sessions. Other parameters included the cardio ankle vascular index, age, mean arterial pressure, total weekly urea clearance (Kt/V), smoking habit, body mass index (BMI), and duration of dialysis. These variables were included in simple regression analysis. Results Levels of serum fetuin-A in the hemodialysis patients (331 ± 55 μg/ml) were significantly lower than those in the healthy controls (361 ± 55 μg/ml; P < 0.05). There was a negative correlation between serum fetuin-A levels and duration of dialysis (r = −0.37, P < 0.01), BNP (r = −0.37, P < 0.001), and hsCRP (r = −0.40, P < 0.01), and a positive association with serum albumin (r = 0.31, P < 0.05). Conclusions These data suggest that a low fetuin-A level is a useful predictor of malnutrition and inflammation, as well as being a useful predictor of the cardiac failure caused by an increased ventricular load in hemodialysis patients.     

2型糖尿病患者血清戊糖素与骨转换指标之间的相关性分析

目的 探讨在2型糖尿病患者中血清戊糖素水平与骨转换指标之间的相关性以了解戊糖素对骨代谢的影响。方法 190例绝经后女性及＞60岁男性2型糖尿病患者于空腹状态下抽取空腹静脉血液查肝肾功能、糖化血红蛋白(HbA1C)、I型胶原羧基端肽β特殊序列（β-CTX）、I型前胶原氨基端前肽(PINP)、骨钙素（OC）及戊糖素水平,分析戊糖素与肝肾功能及骨转换指标之间的相关性。结果 相关分析结果提示戊糖素与糖尿病病程、HbA1c、β-CTX水平相关（r=0.492、0.158和-0.156,P均＜0.05）,而与P?NP及OC之间的相关性无统计学意义（P =0.646和0.72）。多元线性回归分析结果提示戊糖素水平与糖尿病病程、HbA1C相关（P均＜0.05）,而与β-CTX的相关性无统计学意义（P =0.199）。结论 2型糖尿病患者血戊糖素水平与骨转换指标P?NP、β-CTX及OC水平之间无明显的相关性。