不同性别高尿酸血症与慢性肾脏病的相关研究

目的评价不同性别中老年健康体检人群高尿酸血症和慢性肾脏病(CKD)的关系。方法本横断面研究中共纳入24095名观察对象,常规测量血压、身高、体质量,同时检测血脂、血糖及肾功能指标,观察男女血尿酸水平和慢性肾脏病之间的关系。CKD定义为eGFR60 mL/min/1.73 m~2。结果高尿酸血症患病率为16.0%,其中男性(21.6%)高于女性(7.3%),并随着年龄的增长,高尿酸血症患病率增加,其中女性在绝经后血尿酸水平显著增长。CKD患病率随着血尿酸水平的增长而增加,多因素校正回归分析显示,与血尿酸1分位水平比较,男女血尿酸4分位水平CKD风险分别增加6.30倍(95%CI为4.84~8.19)和9.08倍(95%CI为6.27~13.14)。结论高尿酸血症患病率呈年龄依赖性增长,同时高尿酸血症是CKD的独立危险因素,并随血尿酸水平增高CKD风险增加,女性高尿酸血症人群CKD风险高于男性。     

慢性肾脏病与高尿酸血症

慢性肾脏病(CKD)是一种以肾损伤和肾功能下降为主要表现的综合性疾病,全球发病率约为13.1%,且会导致心血管及全因死亡率升高,严重影响患者生活质量和寿命。目前,CKD的治疗仍存在很大的困难和挑战,需要明确可干预的危险因素,以延缓疾病进展。既往人们认为高尿酸血症(HUA)是肾功能下降的标志物,最近的观察性研究表明HUA是CKD发生和进展的一个独立危险因素。CKD患者血尿酸水平随估算的肾小球滤过率(eGFR)下降而升高,血尿酸与CKD之间的因果关系存在争议,越来越多的证据表明HUA可导致肾功能下降,通过促进炎症反应、氧化应激、激活肾素血管紧张素(RAS)系统、促肾脏纤维化等机制损伤肾脏。目前,降尿酸治疗是否可延缓CKD的发生和进展尚存在争议,未来需要更多大型随机对照研究来确定干预时机和阈值。     

慢性肾脏病患者高磷血症的治疗

慢性肾脏病(CKD)在全球有很高的患病率和死亡率,我国慢性肾脏病总患病率达10.8％[1],约50％的终末期肾病透析患者有不同程度的心脑血管疾病,在终末期肾衰竭维持血透的患者中因心脑血管疾病导致的死亡率高达50％以上[2].高磷血症可以促进甲状旁腺素(PTH)分泌,导致慢性肾脏病-矿物质和骨异常(CKD-MBD),增加成纤维细胞生长因子,23(FGF-23)的水平,促进血管钙化,增加心血管事件的发生,与慢性肾脏病的病死率密切相关.因此,控制高血磷对于防止慢性肾脏病相关并发症,降低患者死亡率具有重要的意义.     

妊娠期糖尿病并发严重脓毒血症二例救治体会

妊娠糖尿病系高危妊娠,严重危害母儿的健康,部分孕妇出现糖尿病并发症如妊娠高血压综合征、酮症酸中毒、巨大胎儿、死胎及死产、产科感染率增高等,但在分娩后糖尿病的临床表现均逐渐消失,在以后的妊娠中又出现,分娩后又恢复,部分患者在数年后可发展为临床糖尿病.我们近来收治2例妊娠糖尿病并发严重脓毒血症患者.现将诊治情况报道如下。     

慢性肝病合并慢性肾脏病患者的临床特征分析

目的 探讨慢性肝病合并慢性肾脏病(chronic kidney disease, CKD)患者的临床特征。方法 纳入2020年6月至2021年12月于首都医科大学附属北京佑安医院肝病中心四科就诊的慢性肝病合并CKD患者65例,根据CKD分期分为1-2期组32例,3期组24例,4-5期组9例。比较各组患者临床特征,采用logistic回归分析慢性肝病患者CKD进展至4-5期的危险因素。结果 随着CKD分期进展,血β2微球蛋白(CKD1-2期2.6 mg/L,CKD3期6.9 mg/L,CKD4-5期12.8 mg/L,P<0.01)、尿α1微球蛋白(CKD1-2期23.3 mg/L,CKD3期30.1 mg/L,CKD4-5期72.6 mg/L,P=0.001)、尿β2微球蛋白(CKD1-2期0.4 mg/L,CKD3期0.5 mg/L,CKD4-5期8.3 mg/L,P=0.005)水平显著增加,尿肌酐(CKD1-2期8881μmol/L,CKD3期5512μmol/L,CKD4-5期4388μmol/L,P<0.01)、尿钠(CKD1-2期111.4 mmol/L,CKD...     

高尿酸血症对慢性肾脏病影响的研究进展

［摘要］　慢性肾脏病（CKD）发病率高、危害大,早期发现及干预对CKD治疗至关重要。高尿酸血症是CKD常见并发症及合并症,其不仅是肾功能减退的结果,也是肾功能恶化进展的危险因素。该文就高尿酸血症对CKD发生发展的影响、致病机制以及降尿酸治疗对CKD产生的影响作一综述。     

慢性阻塞性肺疾病合并慢性肾脏病危险因素分析

目的探讨住院COPD患者合并慢性肾脏病的患病率及危险因素。方法对2012年1月至2013年11月住院确诊的COPD患者进行慢性肾脏病的患病率及危险因素回顾性凋查。结果在资料完整的948例COPD患者人群中,慢性肾脏病总的患病率约为24．5％,COPD合并慢性肾脏病组PaCO2、吸烟指数、血尿酸水平、糖尿病及高血压病患病率较无合并慢性肾脏病组高,而PaO2、体质量指数较无合并慢性肾脏病组低,差异有统计学意义。COPD患者合并慢性肾脏病与COPD严重程度分级无明显的相关性。经多因素Logistic回归分析表明：低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素（OR值分别为2．34、3．25、2．67和1．8,9,5％（71分别为2．01～2．75、2．95～3．77、1．99～3．27、1．18～2．63,P值均〈0．05）。结论COPD合并慢性肾脏病的患病率高,低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素,应引起重视。     

慢性肾脏病患者心包积液的临床特征和预后分析

目的:分析慢性肾脏病伴心包积液患者的临床特征和影响因素,并研究其与预后的关系。方法:纳入在我院治疗的慢性肾脏病患者,分为心包积液组(139例)和无心包积液组(142例),比较两组的临床特征,分析心包积液的危险因素;随访12个月因心血管疾病再次入院和心源性死亡事件,分析其影响因素。结果:与无心包积液组比较,心包积液组钾离子(K+)、血尿素氮(BUN)、肌酐(Cr)浓度较高,而钙离子(Ca2+)、血红蛋白(Hb)、肾小球滤过率(GFR)、白蛋白水平均较低,差异均有统计学意义(均P0.01);Logistic回归分析显示,快心率(OR:1.43;95%CI:1.04～1.98)、高K+(OR:2.14;95%CI:1.32～3.17)、高Ca2+(OR:1.37;95%CI:1.09～1.76)、低白蛋白(OR:1.86;95%CI:1.22～2.93)是心包积液的危险因素(均P0.05)。随访结果显示,心包积液显著增加因心血管疾病再次入院率(58/139∶41/142,P=0.02),而不增加心源性死亡率(9/139∶10/142,P=0.52)。Cox回归分析显示,中重度心包积液(HR:2.15;95%CI:1.29～3.48)、终末期肾衰竭(HR:1.76;95%CI:1.16～2.51)、高K+(HR:1.54;95%CI:1.07～2.29)、低白蛋白(HR:1.62;95%CI:1.14～2.37)是12个月联合事件的独立危险因素(均P0.05)。结论:慢性肾脏病患者心包积液与快心率、高K+、高Ca2+、低白蛋白相关,心包积液增加慢性肾脏病患者12个月的因心血管疾病再次入院率,其与中重度心包积液、高K+、低白蛋白密切相关。     

原发性高血压合并慢性肾脏病的危险因素分析

目的:探讨原发性高血压(EH)住院患者中慢性肾脏病(CKD)患病率及危险因素的分析. 方法:回顾性分析2011年2月至2012年2月新疆医科大学第一附属医院高血压科住院确诊的EH患者982例,探讨EH合并CKD的发生情况,对其危险因素分别进行单因素及多因素Logistic回归分析. 结果:(1)EH患者合并蛋白尿、估算的肾小球滤过率(eGFR)下降、CKD的患者构成比分别为20.3％、5.2％、23.5％,男性和女性EH中CKD构成比为26.6％vs20.2％(P＞0.05);汉族和维族EH合并CKD的构成比为22.7％ vs 26.0％ (P＞0.05).(2)收缩压每升高20 mmHg,CKD的构成比明显增加,差异有统计学意义.(3)多因素Logistic回归分析表明,收缩压≥140mmHg(OR=1.503,95％ CI 1.021 ～2.212)、糖尿病病史(OR=1.661,95％ CI 1.174 ～2.351)、高尿酸血症(OR=1.691,95％CI 1.194 ～2.395)是EH合并CKD的独立危险因素. 结论:控制血尿酸、血糖和血压水平可减少EH合并CKD的发生和发展.     

慢性肺心病并发低渗血症58例临床分析

慢性肺心病重症并发低渗血症者占半数以上，低渗血症出现的症状缺乏特异性，并发低渗性脑病常与肺性脑病混淆，易造成漏诊、误诊。本文收集分析58例慢性肺心病急性加重期并低渗血症的诊治情况，现分析如下。     

慢性肾脏病患者心脑血管并发症流行病学意义

目的 探讨慢性肾脏疾病（CKD）患者的心脑血管并发症的发生率,分析心脑血管并发症的危险因素。方法 采用专用调查表进行问卷调查的方式,研究CKD患者心脑血管并发症发生率,以及心脑血管并发症与CKD之间相互影响的情况。结果 CKDⅠ～Ⅴ期患者共129例,其中男性57例,女性72例。CKD主要并发疾病依次为高血压（69．0％）、贫血（44．2％）、高血脂（43．4％）、心脏疾病（41．9％）、糖尿病（30．2％）等。肾小球滤过率（GFR）水平降低和高血压为CKD并发CVD的危险因素;C反应蛋白（CRP）水平、高血脂、年龄增加皆为脑血管并发症的危险因素。结论 GFR水平降低、高血压、CRP水平升高、高血脂、年龄增加为CKD心脑血管并发症的主要危险因素。早发现CKD并发症和严重程度,重视各种危险因素对CVD和CKD的影响有重要意义。     

Chronic kidney disease: an independent risk factor of all-cause mortality for elderly Chinese patients with chronic heart failure

Objective

To evaluate the prognostic value of chronic kidney disease (CKD) in elderly Chinese patients with chronic heart failure (CHF).

Methods

The study consisted of 327 elderly patients with CHF. All-cause mortality was chosen as an endpoint over the median follow-up period of 345 days. Cox regression analysis was used to identify the risk factors of mortality.

Results

The median age of the entire cohort was 85 years (60–100 years). The mortality for 168 elderly patients with CHF and CKD (51.4% of entire cohort) was 39.9% (67 deaths), which was higher than the mortality for CHF patients without CKD [25.2% (40/159 deaths)] and the mortality for entire cohort with CHF [32.7% (107/327 deaths)]. The Cox regression analysis showed that old age [hazard ratio (HR): 1.033; 95% confidence interval (95% CI): 1.004–1.064], CKD (HR: 1.705; 95% CI: 1.132–2.567), CHF New York Heart Association (NYHA) class IV (HR: 1.913; 95% CI: 1.284–2.851), acute myocardial infarction (AMI) (HR: 1.696; 95% CI: 1.036–2.777), elevated resting heart rate (HR: 1.021; 95% CI: 1.009–1.033), and decreased plasma albumin (HR: 0.883; 95% CI: 0.843–0.925) were independent risk factors of mortality for elderly patients with CHF.

Conclusions

CKD was an independent risk factor of mortality for elderly Chinese patients with CHF.     

Prophylaxis of chronic kidney disease after liver transplantation--experience from west China

AIM: To evaluate the prophylaxis of chronic kidney disease (CKD) after liver transplantation (LT) with low-dose calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF).METHODS: From March 1999 to December 2009, a total of 572 patients (478 males and 94 females) underwent LT enrolled in the study. Initial immunosuppression was by triple-drug regimens that included a CNI, MMF, and prednisone. The initial dose of CNI was 0.05-0.10 mg/kg per day for tacrolimus (TAC) and 5-10 mg/kg per d for cyclosporine A (CSA) respectively, and was gradually reduced based on a stable graft function. The serum trough level of CNI was 6-8 ng/mL for TAC and 120-150 ng/mL for CSA 3-mo post-operation, 4-6 ng/mL for TAC and 80-120 ng/mL for CSA 1-year after transplantation was expected with stable liver function. MMF was personalized between 1.0-1.5 g/d. Glomerular filtration rate (GFR) was estimated by an abbreviated Modification of Diet in Renal Disease formula. Risk factors of CKD were examined by univariate and multivariate logistic regression.RESULTS: With a definition of GFR < 60 mL/min per 1.73 m², the incidence of CKD was 17.3% 5-year after LT. There were 68.3% (293 of 429 cases) patients managed to control their TAC trough concentrations within 8 ng/mL and 58.0% (83 of 143 cases) patients’ CSA trough concentrations within 150 ng/mL. Of the 450 recipients followed-up over 1 year, 55.5% (183 of 330 cases) of which were treated with TAC had a trough concentration ≤ 6 ng/mL while 65.8% (79 of 120 cases) of which were treated with CSA had a concentration ≤ 120 ng/mL. The incidence of CKD in the groups of lower CNI trough concentrations was significantly lower than the groups with CNI concentrations above the ideal range. Patients with CKD had much higher CNI trough concentrations than that of patients without CKD. MMF was adopted in 359 patients (62.8%). Patients administrated with MMF had a relatively low CNI trough concentrations but with no significant difference. The graft function remained stable during follow-up. No difference was found between different groups of CNI trough concentrations. Pre-LT renal dysfunction, ages, acute kidney injury, high blood trough concentrations of CNI in 3 mo (TAC > 8 ng/mL, CSA > 150 ng/mL) and hypertension after operation were associated with CKD progression, while male gender and adoption of MMF were protection factors.CONCLUSION: Low dose of CNI combined with MMF managed to prevent CKD after LT with stable graft function.     

A comparative analysis of fructosamine with other risk factors for kidney dysfunction in diabetic patients with or without chronic kidney disease

BackgroundHyperglycemia is the driving force for the development of diabetic nephropathy leading to the end stage renal disease. It is well known that in hyperglycaemic condition, serum proteins become glycated through non-enzymatic glycation. With the other risk factors, serum fructosamine may be an important risk factor for kidney impairment. To assess coexistence of frequently documented risk factors of kidney dysfunction with serum fructosamine in diabetic patients with chronic kidney disease (CKD).MethodsIn this study, total 150 individuals, as control, type2 diabetic patients without complication and with CKD were included. Blood samples were collected from all the samples to estimate blood glucose, HbA1c, serum creatinine, fructosamine levels and lipid profile. Statistical analysis i.e. regression and correlation between serum fructosamine and other documented risk factors for diabetic CKD has been done. P < 0.001 was considered significant.ResultsSerum fructosamine, HbA1c, creatinine levels, cholesterol and LDL were increased significantly (P < 0.001) in diabetic patients with CKD compared to without complications. Systolic and diastolic blood pressure and BMI were also significantly higher in diabetic patients compared to control. Serum creatinine, total cholesterol and LDL showed a significant positive correlation but HDL showed a negative correlation with fructosamine in CKD diabetic patients. No significant correlation was found with any risk factors in diabetic patients without complications expect HbA1c.ConclusionIt is concluded that elevated serum fructosamine level is strongly associated with kidney dysfunction in diabetic patients. As there is a significant link between serum fructosamine and other risk factors for CKD diabetic patients.     

Association of morning hypertension with chronic kidney disease progression and cardiovascular events in patients with chronic kidney disease and hypertension

Background and aimAssociations of morning hypertension with chronic kidney disease are rarely investigated in prospective studies. We aim to investigate the predictive value of uncontrolled morning hypertension (UMH) to chronic kidney disease (CKD) progression and cardiovascular (CV) events in patients with CKD and hypertension.Methods and resultsIn this prospective two-center observational study, 304 hypertensive patients with CKD were enrolled. Time to total mortality, CKD progression and CV events was recorded; Kaplan–Meier survival function estimates and Multivariable Cox proportional hazard model were used to investigate associations between UMH and outcomes. The study protocol was approved by the Institutional Review Board (http://www.thaiclinicaltrials.org; TCTR20180313004). After a follow-up for median 30 months, 23 (7.6%) patients died, 34 (11.2%) had CKD progression, and 95 (31.3%) occurred new-onset CV events, respectively. UMH was shown to be a strong predictor of CKD progression [hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.22–4.94] and CV events (HR 1.69, 95% CI 1.12–2.53). When morning hypertension was analyzed as a continuous variable, morning systolic blood pressure (per 10 mmHg) was also shown to be predictive to CKD progression (HR 1.28, 95% CI 1.07–1.53, P < 0.01) and CV events (HR 1.15, 95% CI 1.03–1.28, P < 0.01).ConclusionsUMH is strongly associated with CKD progression and CV events in patients with CKD and hypertension. UMH in CKD patients deserves further attentions.     

慢性肾脏病并发急性肾损伤和无慢性肾脏病基础急性肾损伤的预后比较分析

目的 分析不同分期慢性肾脏病（CKD）并发急性肾损伤患者的预后,了解急性肾损伤与CKD短期预后的关系.方法 回顾性分析2010年1月～2013年6月我院临床和病理确诊为CKD并发急性肾损伤住院患者的临床和病理资料,并比较其与无CKD基础急性肾损伤患者在短期（6个月）预后上的差异.按基础肾功能情况将CKD并发急性肾损伤患者分为4组,即CKD1期组、CKD2期组、CKD3期组和CKD4期组;按照危险、损伤、衰竭、肾功能丧失和终期肾脏病（RIFLE）标准将CKD并发急性肾损伤和无CKD基础急性肾损伤分别分级.结果 57例CKD并发急性肾损伤患者水肿、高血压、肾病范围蛋白尿、肾病综合征和血尿的发生率高于无CKD基础急性肾损伤患者,差异有统计学意义（P＜0.05）;前者的血红蛋白值高于后者（P＜0.05）,血清白蛋白值低于后者（P＜0.05）,肉眼血尿发生率比较,差异无统计学意义（P＞0.05）;两组患者肾功能各有不同程度的恢复,无CKD基础急性肾损伤患者肾功能恢复比例相对高,但两者比较差异无统计学意义（P＞0.05）;两组患者恢复时间比较,差异有统计学意义（P＜0.01）,无CKD基础急性肾损伤肾功能恢复时间相对短.结论 急性肾损伤影响CKD的预后,加速CKD的病情进展;无论有无CKD基础,急性肾损伤均是CKD和终末期肾病（ESRD）的危险因素.     

冠心病合并轻中度慢性肾脏病患者PCI后支架内再狭窄的相关因素分析

目的 分析冠状动脉粥样硬化性心脏病(冠心病)合并轻中度慢性肾脏病患者冠状动脉(冠脉)药物洗脱支架术后支架内再狭窄(ISR)的相关因素.方法 选择陕西省人民医院心内科自2015年11月至2018年9月行药物洗脱支架置入且合并轻中度慢性肾脏病的冠心病患者189例,术后9～15月复查冠脉造影后,分为支架术后再狭窄组和无再狭窄...     

慢性阻塞性肺疾病合并高血压的临床特征及危险因素分析

目的观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并高血压的临床特征,同时分析其相关的危险因素。 方法收集陆军军医大学新桥医院2016年1月至2018年12月住院的COPD合并高血压患者122例,观察COPD合并高血压的临床特征,同时以单纯COPD患者40例为对照组,应用多因素Logistic回归分析COPD合并高血压的危险因素。 结果122例COPD合并高血压患者中,29.41%合并冠心病、22.99%合并肾疾病和糖尿病、21.39%合并肺心病、14.97%合并脑梗死、4.28%合并心绞痛、4.28%合并心肌梗死、9.63%合并其他心血管疾病。合并冠心病、心肌梗死、其他心血管疾病患者平均年龄显著高于COPD合并高血压患者对照组(P<0.05);合并肺心病患者病程显著长于对照组(P<0.05);合并冠心病、糖尿病、脑梗死、心绞痛、心肌梗死患者每年急性加重次数显著多余对照组(P<0.05);合并心绞痛和其他心血管疾病患者住院时间显著长于对照组(P<0.05)。多因素Logistic回归分析显示年龄(>80岁)、吸烟支数(>700支/年)、饮酒史、CRP(>50 mg/L)、BNP(>100 ng/L)、高血糖是COPD患者合并高血压的危险因素。 结论COPD合并高血压易引起其他相关性疾病而加重病情,及早关注其危险因素可提高患者预后。