Correlates for end-stage renal disease patients

In this study 112 end-stage renal disease patients on hemodialysis were analyzed for their state of well-being, cognition, ambulatory capacity, and dexterity. The Nottingham Health Profile, the locomotion and dexterity sections of the Office of Population Censuses and Surveys disability scale, the modified Mini Mental State examination and a weighted index of comorbidity were used for assessment. The study revealed that good cognition, good mood, young age, and milder comorbid conditions were positively linked with good functional levels of locomotion and dexterity. The test instruments used in the investigation were considered simple to use and were effective in revealing relationships between the above-mentioned parameters.     

终末期肾病患者发生高同型半胱氨酸血症的影响因素

目的探讨终末期肾病(end-stage renal disease, ESRD)患者血清同型半胱氨酸(homocysteine, Hcy)水平变化及发生高同型半胱氨酸血症(hyperhomocysteinemia, HHcy)的影响因素。方法 140例ESRD患者,依据血清Hcy水平分为正常组(血清Hcy≤15μmol/L)21例和HHcy组(血清Hcy>15μmol/L)119例。比较2组一般资料、血红蛋白及血清白蛋白、尿酸、β2-微球蛋白、C反应蛋白等水平;多因素logistic回归分析ESRD患者发生HHcy的影响因素。结果 HHcy组合并冠心病比率(43.2%)高于正常组(14.3%)(P<0.05),合并高血压、糖尿病比率(97.5%、36.9%)与正常组(85.7%、28.6%)比较差异无统计学意义(P>0.05)。2组原发病、透析模式比较差异无统计学意义(P>0.05)。HHcy组血红蛋白[(92.24±20.81)g/L]、血清白蛋白[(35.06±5.01)g/L]水平低于正常组[(103.81±16.65)、(37.48±3.43)g/L],C反应蛋白[19.8(15.0,27.9)mg/dL]、β2-微球蛋白[(23.04±11.00)mg/dL]、尿酸[434(378,521)μmol/L]水平高于正常组[8.6(5.4,12.9)mg/dL、(17.20±5.77)mg/dL、393(351,455)μmol/L](P<0.05),血肌酐[(816.14±396.24)μmol/L]、甲状旁腺激素[(423.30±146.17)ng/L]、铁蛋白[358(182,716)μg/L]与正常组[(863.98±303.52)μmol/L、(467.20±85.90)ng/L、357(289,675)μg/L]比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,合并冠心病(OR=10.974,95%CI:1.923~62.631,P=0.007)、C反应蛋白(OR=1.083、95%CI:1.027~1.283,P=0.003)、β2-微球蛋白(OR=1.077、95%CI:1.002~1.157,P=0.043)是ESRD患者发生HHcy的影响因素。结论 ESRD患者HHcy发生率高,有冠心病及血清C反应蛋白、β2-微球蛋白增高是其发生HHcy的危险因素。     

Klotho基因多态性与终末期肾病及继发性甲状旁腺功能亢进的相关性

目的观察klotho基因G-395A多态性与终末期肾病(ESRD)及继发性甲状旁腺功能亢进(SHPT)发病风险的相关性。方法选取2015年4月至2016年12月期间就诊于苏北人民医院肾内科及扬州市四区县血液净化中心的ESRD患者200例,体检中心正常体检者80名为对照组,运用FQ-PCR(Taqman法)对各研究对象进行Klotho基因G-395A多态性分型,检测SHPT相关指标:钙(Ca)、磷(P)、全段甲状旁腺激素(i PTH);比较各组间基因分型、等位基因频率,分析不同基因亚型与SHPT的相关性因素。结果研究人群Klotho基因G-395A位点分布符合HardyWeinberg平衡(P>0.05);ESRD组GA+AA基因型频率高于对照组(P<0.05);ESRD组患者A等位基因频率为34.75%,对照组A等位基因频率为23.12%,两者比较差异有统计学意义(P<0.05);重度SHPT患者GA+AA基因频率高于轻度SHPT患者(P<0.05);重度SHPT患者A等位基因频率为47.73%,轻度SHPT患者A等位基因频率为29.91%,两者比较差异有统计学意义(P<0.05);ESRD组不同基因型间钙磷及PTH指标差异无统计学意义(P>0.05)。结论研究人群中存在Klotho基因G-395A多态性Klotho基因G-395A位点A等位基因可能是发生ESRD遗传易感基因Klotho基因G-395A位点A等位基因可能是发生重度SHPT遗传易感基因。     

Pharmacokinetics of rosiglitazone in patients with end-stage renal disease

The pharmacokinetics and tolerability of a single 8-mg oral dose of rosiglitazone, an anti-diabetic agent, were compared in 10 long-term haemodialysis patients and 10 healthy volunteers. Haemodialysis patients received rosiglitazone 4 h after haemodialysis (non-dialysis day) and 3 h before haemodialysis (dialysis day). Haemodialysis did not influence rosiglitazone pharmacokinetics, and dialytic clearance was low (0.10 1/h). The mean area under the concentration-time curve (AUC(0-infinity)), the maximum observed plasma concentration (Cmax) and the half-life for rosiglitazone were similar in haemodialysis patients (non-dialysis day) and healthy individuals (2192 +/- 598 ng.h/ml versus 2388 +/- 494 ng.h/ml, 338 +/- 114 ng/ml versus 373 +/- 95 ng/ml, and 3.70 +/- 0.75 h versus 3.81 +/- 0.86 h, respectively). AUC(0-infinity) and Cmax were not markedly influenced by haemodialysis. Rosiglitazone dose adjustments are not warranted in patients with type 2 diabetes with end-stage renal failure on haemodialysis.     

Functional status of patients with end-stage renal disease

A longitudinal study of 979 patients with end-stage renal disease from 27 dialysis centers in the Upper Midwest was conducted to measure the patients' functional status with use of the Karnofsky Activity Scale. At the initiation of dialysis, 50% of all patients were rehabilitated or caring for themselves, and the three variables that most influenced the initial rehabilitation score were age, diabetic status, and sex. Initial functional status was also analyzed for three cohorts of dialysis patients, grouped according to outcome (renal transplantation, continued dialysis, and death). Patients who received a renal transplant had initial rehabilitation scores that were higher than those who underwent dialysis for 2 years or those who died. In the group of patients who underwent dialysis for 2 years, a statistically significant improvement in rehabilitation scores was noted at 2 years in comparison with the scores obtained at the initiation of dialysis. Initial rehabilitation scores were good predictors of the 2-year scores. Of the patients in the 2-year dialysis cohort, 78% maintained or had improvement in their functional status.     

Psychotropic medication in the patients with end-stage renal disease

The majority of psychotropic drugs are well tolerated in the patients with end-stage renal disease. There are exceptions for which tolerance and safety are questionable. These include psychotropic drugs such as milnacipran, sulpiride, lithium carbonate, memantine, gabapentin, pregabalin and topiramate.     

25例高转换型肾性骨病的骨组织学研究

目的通过对慢性肾脏病(chronic kidney disease,CKD)5期维持性血液透析(maintenance hemodialysis,MHD)患者行骨活检获得骨标本,对骨病理进行骨形态计量学分析,观察各型骨病尤其是高转换型肾性骨病的骨病理学特点并探讨临床各项常用无创性检查的意义。方法选择40例CKD5期MHD患者和3例正常人进行髂骨活检术,获得骨标本。采用全自动图像分析系统进行骨组织形态计量学测定。外周血各项检测指标和临床常用的骨密度和骨骼摄片与骨病理学指标行相关分析。结果25例CKD5期MHD患者经骨病理学检查证实为高转换型骨病,占同期骨活检的62.5%(25/40),骨病理学检查以破骨细胞活化形成骨吸收陷窝伴或不伴骨矿化不全为特点。外周血钙、骨钙素水平与骨病理指标呈显著正相关。骨密度和骨骼摄片的阳性率低于骨活检。结论通过对CKD5期MHD患者行骨活检发现,高转换性肾性骨病的比例仍占大多数。在高转换型肾性骨病中,目前的各种无创性检查中血钙、骨钙素可能具有一定的预测价值。骨活检仍是诊断肾性骨病的金指标。     

Exercise capacity in pediatric patients with end-stage renal disease.

OBJECTIVE: To evaluate the correlation between exercise capacity and hemoglobin in pediatric patients with end-stage renal disease (ESRD) treated with automated peritoneal dialysis (APD) and hemodialysis. DESIGN: Prospective case-control study and retrospective review. SETTING: Dialysis summer camp and Children's Mercy Hospital exercise laboratory. PARTICIPANTS: Prospective evaluation conducted with 14 patients (9 males, mean age 14.5 +/- 2.5 years) who received either home APD (5 patients) or in-center hemodialysis (9 patients), and 8 healthy age-matched controls. Retrospective data derived from 10 children (7 males, mean age 12.3 +/- 3.3 years), all of whom received APD. INTERVENTION: Maximal treadmill evaluation conducted with each patient and control. The hemoglobin value of each patient was also assessed. MAIN OUTCOME MEASURES: Comparison of the following data generated during treadmill protocol: peak heart rate, blood pressure, oxygen saturation, treadmill time, oxygen consumption (VO2), ventilation (Ve), oxygen consumption at anaerobic threshold (VO2AT), and respiratory exchange ratio. RESULTS: The hemoglobin value of the current patient group (12.8 +/- 1.6 g/dL) was significantly greater than the previously studied patients (10.5 +/- 1.1 g/dL) (p = 0.001). Treadmill time, VO2, and VO2AT were significantly lower in both groups of dialysis patients compared to the control subjects (p < 0.05). No differences were noted in any of these variables when comparing these two groups of dialysis patients only. CONCLUSION: The exercise capacity of pediatric dialysis patients is significantly poorer than that of healthy children, an outcome apparently related to factors other than normalization of the hemoglobin value.     

Impaired resistance artery function in patients with end-stage renal disease

We investigated an effect of uraemia on structural and functional features of human resistance vasculature. Arteries (≈?200?μm) isolated from subcutaneous fat biopsies obtained from 35 ESRD (end-stage renal disease) patients starting peritoneal dialysis and 30 matched controls were studied using isolated small artery bioassays. Flow-mediated dilatation was attenuated in ESRD patients compared with controls. NO (nitric oxide) contribution to flow was lacking in ESRD patients, but present in the controls. ADMA (asymmetrical dimethyl L-arginine) levels were higher in the ESRD group compared with the control group. Dilatation in response to acetylcholine was reduced in ESRD patients compared with controls, but response to NO donor was similar. Expression of nitrotyrosine and heat shock proteins 70 and 27, but not 90, was increased in arteries from ESRD patients compared with controls. Arterial remodelling was absent in ESRD patients. There was no difference between the groups in myogenic tone, vascular reactivity or sensitivity to several vasoconstrictors. Arterial distensibility, reflecting passive properties of the vascular wall, was reduced in ESRD patients compared with controls. Exclusion of ESRD patients with diabetes and/or cardiovascular disease from analyses had no influence on the main findings. Thus we propose that uraemia has a strong impact on endothelial function and passive properties of the arterial wall of human peripheral resistance vasculature. The reduced contribution of NO to flow stimulus via enhanced nitrosative stress and higher plasma concentrations of ADMA may suggest potential mechanisms behind endothelial dysfunction in the resistance peripheral circulation in ESRD.     

Survival rates of 2,728 patients with end-stage renal disease

This multicenter regional study analyzes survival of a large group of patients who began chronic dialysis or received their first renal transplant during the 5 1/2-year period that ended in June 1983. Survival was determined from the onset of renal replacement therapy, irrespective of changes in treatment modality. Univariate life-table analysis was used to examine more than 35 risk factors. Age of patients at entry into the therapeutic program significantly affected survival. General survival rates were lower for patients with diabetes than for nondiabetics, irrespective of treatment modality, with the exception of those older than 60 years of age. Five-year graft survival was lower for diabetics than for nondiabetics in all age groups, irrespective of source. Patients with systemic lupus erythematosus, focal glomerulosclerosis, or glomerulonephritis had the highest survival rates, whereas those with primary renal malignant lesions, primary hypertensive disease, or diabetes mellitus as the cause of renal failure had the lowest. Concurrent morbid conditions that adversely affected survival included arteriosclerotic heart disease, peripheral vascular disease, noncutaneous malignant lesions, chronic pulmonary disease, and multiple coexisting morbid conditions. Although the objective of this study was to analyze survival for single patient characteristics, irrespective of treatment modality, analyses of survival rates by treatment modality for a control group indicated that minimal differences were evident by the third year among the four treatment groups: in-center hemodialysis, home hemodialysis, living related donor transplantation, and cadaver transplantation; however, recipients of cadaver grafts had lower survival rates than all other groups, even those maintained by in-center hemodialysis (P = 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)     

Reproducibility of exercise tolerance in patients with end-stage renal disease

OBJECTIVE: To determine the interday reproducibility of peak and submaximal exercise tolerance of patients with end-stage renal disease (ESRD). DESIGN: Repeated measures. SETTING: Day-patient rehabilitation center. PARTICIPANTS: Twelve consecutively presenting, self-selected patients with ESRD. INTERVENTIONS: All patients performed peak exercise tolerance assessments on a cycle ergometer up to the point of volitional fatigue, with a 1-week interval between the 2 tests. MAIN OUTCOME MEASURES: Cardiopulmonary, hemodynamic, and physical performance parameters were assessed at peak exercise and at the lactate threshold. Standard error of measurement, percentage coefficient of variation (CV%), intraclass correlation coefficient (ICC), and limits of agreement (LOA) were calculated to determine the reproducibility of all variables. RESULTS: CV% (range, 5%-7%) and ICCs (range, .94 - .98) for oxygen uptake and heart rate at peak exercise and lactate threshold indicated highly acceptable levels of group mean reproducibility. LOA analysis revealed satisfactory levels of reproducibility for individual patients. CONCLUSION: Taken together, these reproducibility data may be applied to clinical work, requiring the quantification of changes in the exercise tolerance of patients with ESRD after short-term interventions (eg, exercise training, therapeutic use of recombinant erythropoietin).     

终末期肾病患者的心理状态

在治疗患者身体疾病的同时关注其心理健康,改善其生活质量是治疗终末期肾病(ESRD)患者的理想目标[1],然而,对于一些尿毒症患者及透析患者这种目标却远未实现.     

透析前教育对终末期肾病患者透析时机选择的研究

目的 研究探讨透析前教育对终末期肾病(ESRD)患者透析时机选择的影响.方法 选择血肌酐(Scr)＞442μmol/L、内生肌酐清除率(Ccr)＜20 ml/min的慢性肾功能衰竭(CRF)患者129例,随机分为实验组70例和对照组59例.实验组行规范化透析前教育,对照组行常规宣教.比较2组患者入组时基本状况、透析时机的选择、开始透析及透析后6,12个月的抑郁状况及生活质量.结果 2组患者入组时年龄、性别、文化程度、医疗付费方式、就业、Scr、Ccr均无显著差异,透析时机的选择实验组Ccr为(9.49±0.77)ml/min,对照组Ccr为(4.54±1.79)ml/min,2组比较有显著差异,开始透析及透后6,12个月2组的抑郁状况及生活质量比较有显著差异.结论 加强透析前教育有利于ESRD患者适时开始透析并可有效提高患者透析后的生活质量.

Abstract：

Objective To investigate the predialysis education on dialysis timing of patients with end-stage renal disease (ESRD). Methods 129 patients with chronic renal failure (CRF) and serum creatinine(Scr)＞442μmol/L, endogenous creatinine clearance rate (Ccr)＜20 ml/min were randomly divided into the experimental group(70 cases) and the control group(59 cases), the experimental group received predialysis education, the control group received routine care.The basic situation, dialysis timing, depression and quality of life on the 6th,12th months after dialysis were assessed. Results There was no significant difference in age, sex, education background, health care payment manners, employment, serum creatinine, endogenous creatinine clearance rate before education.For the timing of dialysis, Ccr for the experimental group was (9.49 ± 0.77)ml/min, Ccr for the control group was (4.54 ±1.79) ml/min,the difference was significant, depression and quality of life between two groups after 6,12 months of dialysis was also statistically different. Conclusions Strengthening predialysis education is conducive to a timely start of dialysis and can effectively improve the quality of life in patients with ESRD.     

终末期肾脏病患者肌少症的研究进展

肌少症是终末期肾脏病患者的并发症之一,与多种疾病不良结局密切相关。该文对终末期肾脏病患者肌少症的筛查方法、影响因素及干预措施进行综述,旨在为预防和干预终末期肾脏病患者肌少症提供借鉴。     

关注终末期糖尿病肾病患者血液净化治疗中的几个问题

糖尿病肾病是终末期肾病的主要原因,全球终末期糖尿病肾病的治疗方式仍以维持性血液透析治疗为主,尽管血液净化技术本身有了长足的进步,然而由于终末期糖尿病肾病一些严重的合并症,导致其死亡率居高不下。这些患者中普遍存在心血管并发症、营养不良、视网膜病变、糖尿病足以及难以建立的血管通路,本文对终末期糖尿病肾病血液净化治疗中这些常见问题作一阐述。     

Effects of an adaptation training programme for patients with end-stage renal disease

AIMS: This paper reports a study investigating the effectiveness of an adaptation training programme (ATP) to help patients with end-stage renal disease (ESRD) to cope with illness-related stresses and, thus, to alleviate depression and improve quality of life. BACKGROUND: Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. The ability of these patients to cope with and adapt to these stresses, whether related to their medical regimen or to the demands of daily life, has an important influence on physical and psychological well-being. METHODS: The study was a randomized controlled trial using a convenience sample of 57 eligible, fully informed and consenting patients with ESRD who were assigned to experimental (ATP plus usual care) or control (usual care) groups. Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors. A clinical nurse specialist and an experienced psychotherapist led them in three small groups (8-10 per group). Participants in the usual care group received routine care. Instruments comprised the Haemodialysis Stressor Scale, Beck Depression Inventory and Medical Outcomes Study SF-36. Data were collected at baseline and at three months following the intervention. RESULTS: The major stressors for these patients were limitations on time and place related to employment, limitations on fluid intake, transport difficulties, loss of bodily function, length of dialysis treatment, and limitation of physical activities. The ATP had a beneficial effect on perceived stress (P = 0.005), depression (P = 0.001) and quality of life (P = 0.02) 3 months after the intervention. CONCLUSIONS: This study supports the effectiveness of an ATP to decrease stress and depression levels, and to improve the quality of life of ATP patients receiving haemodialysis.