慢性肾脏病高血压患者门诊复诊降压达标情况及影响因素分析

目的：了解慢性肾脏病（CKD）1～4期高血压患者在门诊复诊的工作模式下降压达标情况,尽可能分析血压控制不佳的相关因素。方法：采用随机方法从门诊复诊1次及以上的CKD1～4期高血压患者中抽取420例,计算其复诊次数及达标率。结果：420例中降压达标率为38.6%;59岁及以下组与60岁及以上组达标率差异有统计学意义（P〈0.01）;复诊3次及以上患者的达标率高于复诊1～2次者（P〈0.05）;1～2期者高于3～4期者（P〈0.01）;联合应用两种及以上的降压药者较单纯一种者差异有统计学意义（P〈0.01,P〈0.05）。结论：CKD降压达标情况不理想。随着CKD进展,要及时调整治疗方案;中青年患者应作为提高降压达标率的重点对象;鼓励患者定期复诊。     

慢性肾脏病合并心力衰竭患者的防治

慢性肾脏病患心血管疾病风险增加,主要表现为心力衰竭。慢性肾脏病合并心衰十分常见,且常伴不良预后。慢性肾脏病独特的病理生理机制可能是慢性肾脏病合并心力衰竭患者与单纯心血管疾病患者病死率差距较大的原因。目前心力衰竭患者的治疗已经建立了强有力的证据,而慢性肾脏病合并心力衰竭患者的治疗尚无基于高水平的临床证据的指南推荐。本文总结归纳慢性肾脏病合并心力衰竭的诊断和治疗思路,为慢性肾脏病合并心力衰竭的防治提供一些参考。     

328例慢性肾脏病患者高血压影响因素分析

目的：分析慢性肾脏病（CKD）患者血压升高的影响因素。方法：回顾性研究328例住院CKD患者,分析年龄、肾功能、血糖、血脂、血尿酸等因素对血压的影响。结果：77.13%（253/328）的CKD患者伴血压升高,肾小球滤过率与收缩压呈负相关（B=-0.407,F=202.11,P〈0.001）,而年龄、血糖、血脂及血尿酸对CKD患者的收缩压没有显著影响。肾小球滤过率、年龄及血尿酸对CKD患者舒张压均有影响,其中肾小球滤过率与舒张压呈负相关（B=-0.155,F=66.53,P〈0.001）,年龄与舒张压也呈负相关（B=-0.192,F=43.11,P〈0.001）,血尿酸与舒张压呈正相关（B=0.013,F=30.72,P〈0.001）,血糖、血脂对舒张压没有显著影响。CKD各期患者的年龄、收缩压、舒张压、血尿酸及三酰甘油等指标多组比较差异均具有统计学意义（P〈0.001）,即CKD各期发病年龄、血压、血尿酸及三酰甘油水平差异有统计学意义。结论：在CKD患者中,高血压患病率高,肾功能状态、年龄、血尿酸均对血压有影响,其中以肾功能最为关键。     

慢性肾脏病患者高尿酸血症的管理

生理情况下,人体每日尿酸的产生和排泄基本上保持动态平衡。若血清尿酸水平男>420 μmol/L,女>360 μmol/L则称为高尿酸血症。随着居民生活方式、饮食结构的改变以及人口老龄化,高尿酸血症的发病率呈逐年上升趋势。越来越多的研究表明高尿酸血症与慢性肾脏病(CKD)的关系密切。尿酸是嘌呤核苷酸代谢中不易溶解的循环终产物,CKD患者肾小球滤过率降低时,高尿酸血症发生的风险增加,而长期的高尿酸血症会导致肾功能的进行性恶化,增加患者心血管疾病的发生风险及死亡率。因此做好CKD患者高尿酸血症的管理具有重要的临床意义。关于高尿酸血症诊断和治疗有多项专家共识和指南,即改善生活方式是治疗的基础,早期干预和综合管理是治疗的核心。     

慢性肾脏病患者脑血管病的预防

脑血管病已成为世界范围内的第二位死亡原因，全世界每年约有510万人死于中风，每年每10万人群中有200人发生首次中风。在慢性肾脏病(CKD)患者中，脑血管病的患病率及相关的病死率均远远高于普通人群。日本慢性透析患者中脑血管事件相关的病夕匕率为12．7％，在美国为4．8％。Kawamura等对1064例维持性血液透析的患者进行回顾性分析发现，脑血管事件的发生率为9．2％，脑血管病导致的病死率为19．2％。Lloveras等的研究结果显示，肾移植术后10年内中风的患病率是7．97％。由于其患病率及病死率高，现有治疗方法的安全性有效性还不确定，且治疗经费大，因此CKD患者脑血管病的预防重于治疗。     

慢性肾脏病并发高血压危象临床分析

目的探讨慢性肾脏病（CKD）合并高血压危象患者的发病诱因、诊治时间与肾功能改善的相关性。方法回顾性分析我院10年来发生高血压危象的38例CKD患者的临床资料,对表现为慢性肾衰竭急性加重的患者进行随访。结果38例中,15例发生高血压危象时有明确诱因,主要为情绪激动、过度劳累和大量饮酒。高血压危象发病季节以秋冬季为主,就诊时间在起病24h之后居多。在18例表现为慢性肾衰竭急性加重的CKD患者中,24h内就诊者出院时肾功能明显改善,平均随访1年,坚持降压治疗者进入替代治疗的比率显著低于未规律服药者（P=0．020）。结论高血压危象使CKD患者的肾功能急剧恶化,及时就诊和有效的降压治疗可以延缓肾功能恶化。     

慢性肾脏病的定义及分期

慢性肾脏病越来越成为严重危害公众健康的问题,通过临床以及基础研究,人们已经认识到这种疾病通过常规的实验室检查就能被发现,而且早期发现和治疗可以防止慢性肾脏病的进展.无论何种类型的肾脏病,都可以按照伴有或不伴有肾脏损害和肾功能水平诊断为慢性肾脏病.这些患者可根据肾功能的水平进行分期,尽管这种分期显得有些主观,但是便于临床实践.     

合并慢性前列腺炎的慢性肾脏病患者临床病理特点

目的：探讨合并慢性前列腺炎（CP）的男性慢性肾脏病（CKD）患者临床病理特点。方法：比较伴CP与不伴CP的CKD患者的年龄、婚姻情况、蛋白尿、血尿、肾功能水平及病理类型等临床病理指标。结果：（1）合并CP组平均年龄较不伴CP组大[（232.6±12.7）岁vs（9.5±11.4）岁],CP组已婚率高（63.7%vs47.3%）（P均〈0.05）;大量蛋白尿（〉3.5g/24h）52例（57.1%）,CP组中最常见的3种肾脏病为IgA肾病31例（34.1%）,非IgAN系膜增生性肾小球肾炎24例（26.4%）,膜性肾病12例（13.2%）,其中膜性肾病的发生率较不伴CP组（4.4%）高（P〈0.05）;伴CP的IgAN患者血管襻IgA沉积率较不伴CP患者高（P〈0.05）。（3）CP组与不伴CP组在蛋白尿、血尿、肾功能方面比较差异无统计学意义。结论：伴CP的CKD者年龄较大,多为已婚,半数伴大量蛋白尿,具有一定的临床病理特点,CP可能造成某些CKD患者慢性化改变。     

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.     

Asymptomatic atherosclerosis and hypertension in nondiabetic patients with chronic kidney disease

Abstract:  Atherosclerosis is accelerated in dialysis patients, but less is known about asymptomatic atherosclerosis and major risk factors in patients with different stages of chronic kidney disease (CKD). We compared intima media thickness (IMT) and plaque occurrence in the carotid arteries in 104 nondiabetic patients (stages 1–5 of CKD; mean age: 51.6 years) with those in 40 healthy control subjects. The IMT values (0.69 vs. 0.59 mm; P  < 0.002) were higher in patients. More patients had plaques (46.2 vs. 17.5%; P  < 0.002), and number of plaques was higher ( P  < 0.003). Negative correlation between IMT ( P  < 0.0001), presence of plaques ( P  < 0.0001), their number ( P  < 0.040), and chromium 51-labeled ethylenediaminetetraacetate (⁵¹Cr-EDTA) clearance were found in patients. With multiple regression analysis, relationship between IMT and ⁵¹Cr-EDTA clearance ( P  < 0.001) and presence of hypertension ( P  < 0.001) was found. Nondiabetic patients with CKD showed advanced atherosclerosis and IMT, plaque occurrence, and number increased directly with the level of renal dysfunction. Another important risk factor was hypertension.       

The association of serum inflammatory biomarkers with chronic kidney disease in hypertensive patients

A positive association between inflammation and chronic kidney disease (CKD) has been reported but the impact of hypertension on this relation remains unclear. The aim of this study is to investigate the association of various inflammation markers with risk of CKD in hypertensive patients. 387 hypertensive patients (mean age 55.5 years) were recruited. Serum matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1(TIMP-1), high-sensitivity C-reactive protein (hsCRP) and osteopontin (OPN) were measured by ELISA. CKD was diagnosed either as evidence of kidney damage, including microalbuminuria, or by low glomerular filtration rate (GFR) (<60?mL/min/1.73?m²), which was estimated using the Modification of Diet in Renal Disease (MDRD) abbreviated equation. Compared with the reference groups (eGFR?≥?60?mL/min/1.73?m²), the serum levels of TIMP-1, OPN, hsCRP were significantly higher, and the MMP-9/TIMP-1 ratio was lower in the risk group (eGFR?2). Multiple logistic regression analysis showed that TIMP-1, MMP-9/TIMP-1 ratio, OPN and hsCRP were associated with low GFR separately after adjustment, whereas MMP-9/TIMP-1 ratio, OPN and hsCRP were associated with microalbuminuria. The significant association of MMP-9/TIMP-1 ratio and OPN with low GFR and microalbuminuria persisted after additional adjustment for other studied inflammatory biomarkers. Our data suggest that inflammation is strongly and independently associated with renal damage in hypertensive patients. MMP-9/TIMP-1 ratio and OPN may serve as novel risk factors and therapeutic targets for the treatment of CKD in hypertensive patients.     

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.     

Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages

The aim of this study was to assess whether chronic kidney disease (CKD) has any impact on semen quality parameters in men with CKD stage 1–5. Results were collected from 66 men with different CKD stages (age 18–50 years). Age and BMI (body mass index) were recorded for each male. Higher CKD stage had a significant negative linear trend on semen volume (P < 0.05), progressive motility (P < 0.01), nonprogressive motility (P < 0.001), sperm concentration (P < 0.01), total sperm number (P < 0.01), cytoplasmic droplets (P < 0.01), teratozoospermia index (P < 0.05) and accessory gland markers, α‐glucosidase activity (P < 0.05), zinc (P < 0.01) and fructose (P < 0.01). BMI per se had no significant effect on semen volume, sperm number, sperm concentration, morphology, α‐glucosidase activity, fructose concentration or zinc level. A significant negative correlation between BMI and sexual‐hormone‐binding globulin (SHBG) (P < 0.01) was observed but not with other sex hormones. Age per se was related to a significant decrease of sperm concentration (P < 0.05), normal forms (P < 0.01) and testosterone level (P < 0.05). Our results indicate that CKD stage per se is a factor determining the number of spermatozoa available in the epididymis for ejaculation, in part independent of age‐related decrease of testosterone level and BMI.     

非透析慢性肾脏病患者高尿酸血症的危险因素分析

目的 探讨和分析非透析慢性肾脏病(non-dialysis chronic kidney disease,ND-CKD)患者高尿酸血症(hyperuricemia,HUA)的发生率及其相关危险因素.方法 收集2015年1月至2019年12月于山西医科大学第二医院肾内科就诊的540例ND-CKD患者的临床资料,依据HUA...     

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.