Effects of oral alkali drug therapy on clinical outcomes in pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis

BackgroundMetabolic acidosis accelerates the progression of chronic kidney disease (CKD) and increases the mortality rate. Whether oral alkali drug therapy benefits pre-dialysis CKD patients is controversial. We performed a meta-analysis of the effects of oral alkali drug therapy on major clinical outcomes in pre-dialysis CKD patients.MethodsWe systematically searched MEDLINE using the Ovid, EMBASE, and Cochrane Library databases without language restriction. We included all eligible clinical studies that involved pre-dialysis CKD adults and compared those who received oral alkali drug therapy with controls.ResultsA total of 18 eligible studies, including 14 randomized controlled trials and 4 cohort studies reported in 19 publications with 3695 participants, were included. Oral alkali drug therapy led to a 55% reduction in renal failure events (relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.25–0.82), a rate of decline in the estimated glomerular filtration rate (eGFR) of 2.59 mL/min/1.73 m² per year (95% CI, 0.88–4.31). There was no significant effect on decline in eGFR events (RR: 0.34; 95% CI: 0.09–1.23), proteinuria (standardized mean difference: −0.32; 95% CI: −1.08 to 0.43), all-cause mortality events (RR: 0.90; 95% CI: 0.40–2.02) and cardiovascular (CV) events (RR: 1.03; 95% CI: 0.32–3.37) compared with the control groups.ConclusionBased on the available and low-to-moderate certainty evidence, oral alkali drug therapy might potentially reduce the risk of kidney failure events, but no benefit in reducing all-cause mortality events, CV events, decline in eGFR and porteninuria.     

慢性肾脏病患者动态血压参数及血压变异的特点分析

目的 分析慢性肾脏病（chronic kidney disease,CKD）患者动态血压参数与肾小球滤过率（GFR）及尿蛋白定量的相关性,并探讨血压变异性参数特点.方法 收集首次治疗的伴有高血压及蛋白尿的CKD患者70例.测量肾功能、24 h尿蛋白定量等生化检测结果,采用动态血压监测仪监测24 h血压并记录参数.根据GFR将患者分为CKD1~2期组和CKD3~5期组.根据24 h尿蛋白定量分为以下3组：Ⅰ组＜1.0 g,Ⅱ组1.0～3.5 g,Ⅲ组＞3.5 g.比较各组动态血压参数,并探讨监测结果与肾功能及蛋白尿的关系.结果 随着患者肾功能恶化,24 h收缩压、舒张压、脉压差、白昼收缩压、夜间收缩压等指标明显升高（P＜0.05）,且与GFR成负相关,白昼收缩压是GFR下降的独立危险因素.Ⅲ组的白昼舒张压（92.94±15.32）mm Hg明显高于Ⅰ组的（85.25±8.64）mm Hg（P＜0.05）.白昼舒张压与蛋白尿水平呈正相关（r=0.257,P=0.032）.所有患者舒张压变异性均明显高于收缩压变异性（P＜0.05）.结论 本研究样本中收缩压与肾功能恶化明显相关,白昼收缩压和舒张压分别与GFR下降及蛋白尿有关,舒张压变异性应受到更多重视.     

Efficacy of statins on renal function in patients with chronic kidney disease: a systematic review and meta-analysis

BackgroundStudies have shown that the use of statins could significantly improve lipid profiles; however, it remains controversial whether the use of statins could improve renal function in patients with chronic kidney disease (CKD). Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of statins on renal function in patients with CKD.MethodsWe systematically searched PubMed, EMBASE, and the Cochrane Library databases for eligible RCTs from inception to October 2020. Pooled effect estimates were assigned as weighted mean differences (WMDs) with 95% confidence intervals (CIs) using the random-effects model.ResultsWe selected 33 RCTs that recruited 37,391 patients with CKD patients. The summary results suggested that statin use significantly reduced urinary albumin (WMD: −2.04; 95%CI: −3.53 to −0.56; p = .007) and protein (WMD: −0.58; 95%CI: −0.95 to −0.21; p = .002) excretions and increased creatinine clearance (WMD: 0.86; 95%CI: 0.32–1.41; p = .002). However, there were no significant differences between statin and control groups in terms of changes in estimated glomerular filtration rate (WMD: 0.38; 95%CI: −0.04 to 0.79; p = .075), and serum creatinine levels (WMD: −0.07; 95%CI: −0.25, 0.12; p = .475).ConclusionsWe found that statin use in patients with CKD may slow CKD progression by lowering urinary albumin and protein excretions or increasing creatinine clearance. Further large-scale RCTs should be conducted to evaluate the long-term effects of statins on renal outcomes. Abbreviations: CKD: chronic kidney disease; RCT: randomized controlled trials; WMD: weighted mean differences; CI: confidence intervals; ACEI: angiotensin-converting enzyme inhibitors; eGFR: estimated glomerular filtration rate     

Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease.

BACKGROUND: Blood pressure shows an inverse association with mortality in patients with chronic kidney disease (CKD) on dialysis. It is unclear if the same phenomenon exists in patients with CKD not yet on dialysis. METHODS: We examined the association of systolic (SBP) and diastolic (DBP) blood pressure with all-cause mortality in a historical prospective cohort of 860 patients (age 68.1+/-10.1 years, 99.1% male, 24.4% black) with estimated glomerular filtration rate (GFR) < 60 ml/min/1.73 m2. We used Cox models to adjust for the effects of age, race, diabetes mellitus, atherosclerotic cardiovascular disease (ASCVD), congestive heart failure, smoking, antihypertensive medications, body mass index, GFR, albumin, cholesterol, haemoglobin and proteinuria. To examine the role of comorbidities, we performed subgroup analyses based on prevalent ASCVD status and level of estimated GFR. RESULTS: Higher SBP and higher DBP were both associated with lower mortality [adjusted hazard ratio (95% confidence interval) for SBP 133-154, 155-170 and > 170 mmHg, compared with < 133 mmHg, respectively: 0.61 (0.44-0.85), 0.62 (0.45-0.87) and 0.68 (0.49-0.96); and for DBP 65-75, 76-86 and > 86 mmHg, compared with < 65 mmHg: 0.85 (0.62-1.18), 0.72 (0.52-1.00) and 0.60 (0.41-0.86)]. The same association was present for both SBP and DBP only in subgroups with GFR < or = 30 ml/min/1.73 m2 and for DBP only in the subgroup with ASCVD. CONCLUSIONS: Lower blood pressure is associated with higher mortality in patients with moderate to severe CKD, but interactions with kidney function and with ASCVD suggest that blood pressure may play a surrogate rather than a causative role in this association.     

慢性肾脏病患者24小时动态血压的特点分析

目的采用24h动态血压监测的方法,分析慢性肾脏病（CKD）不同分期患者24h动态血压特点。方法将152例CKD患者分为5组：CKD1期组（A组）15例;CKD2期组（B组）29例;CKD3期组（C组）42例;CKD4期（D组）组34例;CKD5期组（E组）32例。所有患者均无糖尿病、非肾脏替代治疗。采用携带式的动态血压检测仪测定各组患者动态血压参数和昼夜节律。结果①随着肾功能下降,24h、日间和夜间平均收缩压越来越高;②CKD患者总体非杓型血压比例为81．6o,4,肾功能下降组（CKD2～5期）非杓型血压比例显著高于肾功能正常组（CKD1期）;③夜间收缩压与24h尿蛋白定量呈正相关（r=0．427,P〈0．01）,与。肾小球滤过率（GFR）呈负相关（r=-0．352,P〈0．05）。结论CKD患者的血压非杓型节律现象比较普遍,并随着肾功能下降,其发生率逐渐升高;夜间收缩压与尿蛋白排泄、肾功能有相关性。     

The association of echocardiographic parameters on renal outcomes in chronic kidney disease

BackgroundPatients with chronic kidney disease (CKD) often have structural abnormalities of the heart due to pressure and volume overload. The aim of this study was to evaluate associations between echocardiographic parameters and renal outcomes (estimated glomerular filtration rate [eGFR] slope and progression to dialysis) in patients with stage 3–5 CKD.MethodsThis longitudinal study enrolled 419 patients. Changes in renal function were assessed using the eGFR slope. Rapid renal progression was defined as an eGFR slope < −3 mL/min/1.73 m²/year, and the renal endpoint was defined as commencing dialysis.ResultsIncreased left atrial diameter (LAD), ratio of left ventricular mass to body surface area (LVM/BSA), ratio of LVM to height^2.7 (LVM/ht^2.7), and ratio of observed to predicted LVM (o/p LVM) were associated with eGFR slope in an adjusted model, but left ventricular ejection fraction (LVEF) was not. Furthermore, LAD ≥ 4.7 cm, LVM/BSA > 115 g/m² in males and > 95 g/m² in females, and LVM/ht^2.7 > 48 g/ht^2.7 in males and > 44 g/ht^2.7 in females were correlated with progression to dialysis, but o/p LVM and LVEF were not. The maximum change in χ² change to predict renal outcomes was observed for LAD, followed by LVM/BSA and LVM/ht^2.7.ConclusionsA large LAD and increased LVM, regardless of how it was measured (LVM/BSA, LVM/ht^2.7 and o/p LVM), were correlated with adverse renal outcomes in patients with CKD stage 3–5. LAD had superior prognostic value to LVM and LVEF.     

Correlation between serum asymmetric dimethylarginine and blood pressure variability in chronic kidney disease patients

Objective To determine the correlation between serum asymmetric dimethylarginine (ADMA) and non-spoon-shaped blood pressure of non-dialysis chronic kidney disease (CKD) patients, also to observe the impact of the serum ADMA level on the structure and function of left ventricle. Methods One hundred and twenty cases of non-dialysis CKD patients underwent 24-hour ambulatory blood pressure monitoring were divided into three groups: CKD1-2, CKD3, CKD 4-5. Serum ADMA concentration was measured using liquid chromatograph and other clnical data such as uric acid (UA), left ventricular mass index (LVMI), 24 h urine protein, and high-sensitivity C-reactive protein (hs-CRP) were collected for further statistical analysis. Results (1) With the decline of renal function, ADMA concentration was increased, from CKD 1-2 (1.70±0.48) μmol/L rose to CKD 4-5 (4.46±1.56) μmol/L (P＜0.05). (2)There were 42 cases of CKD patients with hypertension and 78 cases of CKD patients with normal blood pressure. The serum ADMA levels in hypertension group was significantly higher than those in non-hypertensive group [(3.53±1.70) μmol/L vs (2.01±0.65) μmol/L, P＜0.05]. (3)There were 50 cases of non-spoon-shaped normotensive CKD patients and 28 cases of spoon-shaped normotensive CKD patients. Serum ADMA level and LVMI in non-spoon-shaped group were significantly higher than that in spoon-shaped group when kidney functions appeared to be equal (P＜0.05). (4)Serum ADMA level was positively correlated with UA(r=0.352, P＜0.01), LVMI (r=0.345, P＜0.05), 24 h urine protein(r=0.200, P＜0.05), and high-sensitivity C-reactive protein (r=0.309, P＜0.01), but negatively correlated with the left ventricular ejection fraction (LVEF)(r=-0.329, P＜0.01) and estimated glomerular filtration rate (eGFR)(r=-0.011, P＜0.01). Multiple regression results showed that eGFR, UA, LVMI, hs-CRP, 24 h urine protein were associated with ADMA level. The regression equation was Y=1.991-0.011×[eGFR]+0.002×[UA]+0.008×[LVMI]+0.036× [hs-CRP]-0.084×[24 h urinary protein]. Conclusions Serum ADMA level begins to increase in early stage CKD and it progressively increases with the decline of renal function, also the non-spoon-shaped blood pressure ratio and the left ventricular damage increase. Kidney function, urine protein and microinflammatory state may impact on the serum ADMA level.     

慢性肾脏病患者24h动态血压与中医辨证分型的相关性研究

目的探讨慢性肾脏病（chronic kidney disease,CKD）患者动态血压变化与中医辨证分型的相关性。方法收集湖北省中医院符合CKD2～4期诊断标准的门诊及住院患者145例。对入组患者进行24h动态血压监测,根据血压变化情况,分为昼夜平均血压正常组（血压≤130／80mrnHg）,昼夜平均血压升高组（血压≥131／81mmHg）,日间平均血压升高组（血压〉135／85mmHg）,夜间平均血压升高组（血压〉125／75mmHg）;并根据临床表现,对患者进行中医辨证,分为本虚证及邪实证。观察中医各证型在血压正常组和血压升高组中的分布情况。结果①昼夜平均血压正常组的本虚证型分布以脾肾阳虚为主,邪实证型以血瘀证为主;昼夜平均血压升高组的本虚证型以气阴两虚为主,邪实证型以湿浊证为主;②在动态血压从日间升高到夜间升高的过程中,本虚证型中阴阳两虚证型逐渐上升,邪实证型中浊毒证型逐渐上升;③随着24h动态血压升高,本虚证型中,阴阳两虚证型逐渐上升;邪实证型中,浊毒证逐渐上升。结论动态血压变化在一定程度上反映中医正虚邪实的证候变化规律。     

Effect of N-acetylcysteine on renal function in patients with chronic kidney disease

BACKGROUND: N-acetylcysteine (NAC) is commonly administered to high-risk individuals to attenuate the risk of contrast-induced nephropathy in spite of the debate regarding its efficacy. In several studies serum creatinine decreased after exposure to NAC and contrast dye. The mechanism by which NAC attenuates the decline in renal function is not known. Studies in subjects with normal renal function suggest NAC may have an effect on tubular secretion. AIM: The aim of this study was to determine the effect of NAC on renal function, measured by serum creatinine and Cystatin C, in patients with stage 3 chronic kidney disease. METHOD: Serum creatinine and Cystatin C were measured prior to, 4, 24 and 48 h after the administration of 600 mg oral NAC in 30 patients. The protocol was repeated with the addition of 1200 mg oral cimetidine administered 3 h before NAC. RESULTs: Serum creatinine was not significantly different from baseline (186 +/- 65 micromol/L) to 4 h (185 +/- 62 micromol/L), 24 h (187 +/- 64 micromol/L) or 48 h (184 +/- 61 micromol/L) post NAC, nor were Cystatin C levels. Co-administration of cimetidine resulted in a significant rise in serum creatinine with no change in Cystatin C levels. CONCLUSION: This study failed to detect a change in serum creatinine or Cystatin C after a single dose of NAC in participants with stage 3 chronic kidney disease. Further randomized trials of multiple doses and longer follow up are needed to confirm these results.     

Effect of anaemia on mortality, cardiovascular hospitalizations and end-stage renal disease among patients with chronic kidney disease

Objective:   To determine whether an independent association exists between anaemia and chronic kidney disease (CKD) outcomes in a quasi-incidence cohort when patients' most recent laboratory values are considered.
Methods:   We conducted a dynamic, retrospective cohort study among patients with incident CKD in a large health maintenance organization administrative data set. CKD was defined by two estimated glomerular filtration rates (eGFR). We measured the absolute rates for all-cause mortality, cardiovascular hospitalizations and end-stage renal disease.
Results:   Our completed cases Cox regression model followed 5885 patients with both CKD and haemoglobin measures. For patients with the most severe anaemia (haemoglobin <10.5 g/dL), we estimated an increased rate of mortality (hazard ratio (HR) = 5.27, CI 4.37–6.35), cardiovascular hospitalizations (HR = 2.18, CI 1.76–2.70) and end-stage renal disease (HR = 5.46, CI 3.38–8.82) when compared with patients who were not anaemic; the HR reflect time-varying haemoglobins and eGFR.
Conclusion:   Anaemia is a predictor of excess mortality, excess cardiovascular hospitalizations and excess end-stage renal disease even when the progression of CKD is considered by controlling for time-varying eGFR values.     

Relationship between serum 1,25-dihydroxyvitamin D and mortality in patients with pre-dialysis chronic kidney disease

Background It is known that vitamin D has many functions besides involvement in calcium metabolism. It has recently been recognized that vitamin D deficiency is associated with mortality, especially in cardiovascular disease (CVD). Vitamin D deficiency is common in end-stage renal disease, but develops from the early stage of chronic kidney disease (CKD). So we investigated whether the serum level of the activated form of vitamin D (1,25-dihydroxyvitamin D) affected mortality in patients with CKD stages 3 and 4. Methods Between January 1, 1995, and June 30, 2006 we measured serum 1,25-dihydroxyvitamin D In 226 patients with CKD stages 3 and 4 and classified the results into two groups depending on whether the level was below (group I) or above (group II) 20 pg/ml. We ended the follow-up period on December 31, 2006. We compared all-cause and cardiovascular mortality between the two groups. We also examined predictors of mortality by using Cox proportional regression analysis. Results Two-hundred and twenty-six patients (67 men and 159 women, mean age 67.0) were registered in this study, and groups 1 and 2 comprised 84 and 142 patients, respectively. During the follow-up period 43 patients died. CVD was the major cause of death, followed by infectious disease. The Kaplan–Meier survival curve revealed that all-cause mortality was significantly higher in group I, but a significant difference between CVD mortality in the two groups was not demonstrated. By Cox proportional regression analysis, group I was related to all-cause mortality, but this was not proved to be an independent predictor. Conclusion The results suggested that serum level of 1,25-dihydroxyvitamin D was associated with all-cause mortality in patients with CKD stages 3 and 4.     

Improvement in eGFR in patients with chronic kidney disease attending a nephrology clinic

BACKGROUND: The adverse effects arising from late referral to a nephrologist of patients with chronic kidney disease (CKD) are well known. Retrospectively we examined the initial characteristics of patients referred in various stages of CKD to our nephrology division and tried to identify potential baseline factors associated with subsequent changes in estimated glomerular filtration rate (eGFR). PATIENTS AND METHODS: Between September 1997 and June 2006 1,443 patients (909 male, 534 female) with CKD, with eGFRs ranging from 15 to 89 ml/min, were referred to our nephrology division and categorized using the National Kidney Foundation classification for CKD based on eGFR. The slope of eGFR change (ml/min-1/1.73/m2-1/year-1) was determined by linear regression analysis and the patients were divided into five groups: (1) significantly progressive slope (deterioration) (more negative than -5 ml/min/year); (2) mildly progressive slope (>-5 to -1 to +1 to or=+5). RESULTS: At the first nephrology referral, 5.8% of the patients were on CKD stage 2 (eGFR: 90-60 ml/m), 46.7% on CKD stage 3 (eGFR: 59-30 ml/m), and 47.5% on CKD stage 4 (eGFR: 29-15 ml/m) CKD. Significantly improved slope was detected in 48.2% of CKD stage 2 patients, 29.3% of CKD stage 3 patients, and only 14.7% of CKD stage 4 patients (P<0.05). Being in stage 4 or stage 3 versus being in stage 2 significantly reduced the likelihood of an improved slope in logistic regression analysis whereas age, gender, presence of hypertension, and diabetes mellitus did not reach the level of significance. CONCLUSION: Referral to a nephrology clinic can lead not only to arrest of progression of CKD but also to regression/improvement. Early referral is a positive predictive factor for improvement in eGFR, which emphasizes the importance of such referral. The previously held idea that, once established, CKD progresses invariably is not valid anymore.     

Pseudoexfoliation syndrome in chronic kidney disease patients

Abstract

This study was performed to determine whether chronic kidney disease (CKD) is associated with an increased risk of pseudoexfoliation (PEX) syndrome. This is an age-matched case control study evaluating frequency of PEX in patients over age 40 with the diagnosis of stage 1–4 CKD and those undergoing hemodialysis (HD). Subjects over age 40 with hypertension and/or diabetes mellitus (DM) and normal kidney functions were studied as a control group. CKD was diagnosed as decreased glomerular filtration rate (GFR) of less than 60?mL/min/1.73?m² for at least 3 months. Study groups were arranged as group 1 consisting of HD receiving CKD patients, group 2 consisting of CKD patients who do not need HD and group 3 as a control. Demographic properties and the prevalence of PEX were evaluated and compared between groups. Because of the effect of DM on PEX occurrence, it was also evaluated after exclusion of diabetic patients. A total of 101 cases in group 1, 106 cases in group 2 and 117 cases in group 3 were included in the study. Pseudoexfoliation was found in 7 (6.9%) patients in group 1, 5 (4.7%) patients in group 2 and 7 (5.9%) patients in group 3 (p?>?0.05). After exclusion of diabetic patients the prevalence of PEX changed as 4 (5.6%) in group 1, 2 (4.4%) in group 2 and 1 (1.8%) in group 3 (p?>?0.05). In conclusion, CKD was not associated with increased prevalence of PEX in this study.     

电子辅助工具改善慢性肾病患者饮食依从性及酸负荷状况的研究

目的 探讨电子辅助工具改善慢性肾病患者饮食依从性及酸负荷状况的效果.方法 抽取本中心慢性肾病管理门诊慢性肾脏病(chronic kidney disease,CKD)3-4期合并代谢性酸中毒的116例患者,采用单双数字随机法,分为两组:(1)对照组,根据CKD分期给予患者常规护理及健康教育.(2)研究组,在常规治疗和护...     

Care of elderly patients with chronic kidney disease

Background Providing optimal care to the growing number of chronic kidney disease (CKD) patients remains a significant problem in the United States. There is little known about the care of elderly CKD patients by primary care physicians as well as nephrologists. Methods We performed a retrospective study of 377 elderly male CKD (serum creatinine >1.4 mg/dl on 2 separate occasions 3 months apart) patients referred to the Nephrology Clinic at the Buffalo Veterans Administration Medical Center between 1999 and 2002 to see if the pattern of care changed during this time. Results The mean age of the patients was 75.9 years. Eighty-four percent were Caucasian, 15% were African-American, and 1% were of other race. Etiology of CKD included hypertensive nephrosclerosis (49%), diabetic nephropathy (23%), renovascular disease (18%), and others (10%). Sixty-five percent of patients had estimated glomerular filtration rate (eGFR) >30 ml/min. Overall angiotensin converting enzyme inhibitor (ACEI) was used in 51% of patients with CKD, and in 63% of patients with diabetic nephropathy. Twenty percent of patients had a hemoglobin <11 g/dl, darbepoietin/epogen was used in 31% of these patients. Screening for kidney related tests were done infrequently while lipid profile and hemoglobin A1C were done in the majority of patients because of clinical reminders in the VA computerized patient record system (CPRS). Conclusion These results emphasize the need for increased education of primary care physicians and nephrologists to improve the care of elderly CKD patients. Although there was a trend towards earlier referral, care did not change significantly between years 1999 and 2002.     

Comparison of eGFR formulas in determining chronic kidney disease stage in bariatric patients and the impact on perioperative outcomes

BackgroundChronic kidney disease (CKD) independently increases the risk of 30-day adverse outcomes following metabolic and bariatric surgery (MBS). However, no studies have evaluated the stage of CKD at which increased perioperative risk is manifested. Here, we correlate 30-day major morbidities after MBS with extent of renal disease based on CKD Stage.ObjectivesTo determine the impact of CKD stage on perioperative outcomes after bariatric surgery.SettingAcademic Hospital.MethodsFrom the 2017 Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) database, we identified patients with CKD who underwent sleeve gastrectomy or laparoscopic gastric bypass surgery. Glomerular filtration rates (GFRs) were calculated and cohorts were generated based on CKD Stage. Complication rates and rates of morbidity and mortality were compared between stages, and strengths of correlation were calculated.ResultsGFR and CKD Stage were calculated for 150,283 patients. There was a significant increase in the risk of major morbidity at each progressive stage of CKD (P < .001 for all compared stages). There was a strong positive linear correlation between increasing CKD Stage and total morbidity (r² = .983), including reoperation ( r² = .784), readmission (r² = .936), unplanned ICU transfer (r² = .853), and aggregate complications such as pulmonary (r² = .900), bleeding (r² = .878), or progressive worsening of renal function (r² = .845). In logistic regression, for every 10-point decrease in GFR, odds of total morbidity increased by 6%.ConclusionAn increased risk of perioperative complications may be seen in early stages of CKD, and risk is compounded in more advanced stages. Bariatric surgical candidates should be counseled on their increased risk of surgical complications even with mild CKD, and the benefits of bariatric surgery should be carefully weighed against significantly increased risks of complications in severe CKD.     

慢性肾脏病患者肾组织Klotho基因启动子的超甲基化与临床病理的相关性

目的 评价慢性肾脏病(CKD)患者肾组织和外周血单个核细胞(PBMC)Klotho基因启动子的甲基化水平,探讨Klotho基因启动子超甲基化与CKD患者临床病理特征的关系.方法 以47例接受肾脏活组织病理检查的CKD患者为研究对象,47例肾癌根治术患者肾脏切除标本中的正常肾脏组织和48例健康志愿者的PBMC分别作为肾组织和PBMC的对照组.采用焦磷酸测序(PS)法检测肾组织和PBMC Klotho基因启动子的甲基化水平.结果 CKD患者肾组织Klotho基因启动子甲基化率显著高于对照组,差异有统计学意义[(17.04±6.42)％比(9.34±2.43)％,P＜ 0.01];PBMC Klotho基因启动子甲基化率亦显著高于对照组,差异有统计学意义[(14.19±5.86)％比(6.90±2.39)％,P＜ 0.01].CKD患者PBMC与肾组织Klotho基因启动子甲基化率呈正相关(r=0.811,P＜0.01),PBMC Klotho基因启动子甲基化率预测肾组织Klotho基因启动子超甲基化的受试者工作曲线下面积为0.958(P＜0.01).肾组织和PBMC Klotho基因启动子甲基化率与eGFR均呈负相关(分别r=-0.827,P＜0.01;r=-0.626,P＜0.01),与肾小管间质纤维化面积呈正相关(r=0.865,P＜0.01;r=0.748,P＜0.01),与24 h尿蛋白量无相关.结论 CKD患者肾组织和PBMC Klotho基因启动子甲基化率升高,PBMC Klotho基因启动子甲基化率可作为肾组织Klotho基因启动子超甲基化的无创评价指标.Klotho基因启动子超甲基化与肾脏纤维化的关系值得进一步研究.