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ABSTRACT: PURPOSE: Hypertension is an independent risk factor for mortality in chronic kidney disease (CKD) and is suboptimally controlled worldwide. Therefore, this study aimed to examine the rate of BP control and the main barriers to achieving target BP, according to K/DOQI guidelines, in China. METHODS: We performed a single-center, prospective cohort study. Two hundred and sixty CKD patients were referred by general physicians to nephrologists, and their BP was treated in accordance with K/DOQI guidelines for a 1-year follow-up. We evaluated improvement of BP target achievement and factors affecting BP control. We defined "not-at-goal" as persistence of systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg after 1 year. RESULTS: The BP decreased from 138 ± 12/84 ± 7 mmHg at baseline to 124 ± 13/73 ± 7 mmHg after 1 year. The rate of achieving the BP goal (<130/80 mmHg) increased from 25.4 to 61.5 %. The decrease in BP was associated with a significant reduction of proteinuria (median, 0.14 vs 0.06 g/24 h; P < 0.05). Logistic regression analysis identified proteinuria levels ≥1.0 g/24 h (odds ratio [OR]: 5.21; 95 % confidence interval [CI]: 1.37-19.77) and high basal systolic BP (OR: 2.17; 95 % CI: 1.25-3.77) and diastolic BP (OR: 6.62; 95 % CI: 2.03-21.60) as independent predictors of not-at-goal BP. Higher educational level was independently associated with at-goal BP (OR: 0.21; 95 % CI: 0.06-0.78). CONCLUSIONS: In CKD patients, BP control is poor when managed by general physicians and may be improved after nephrologist referral. High basal BP and proteinuria levels ≥1.0 g/24 h are the main barriers that preclude the optimal control of BP.
International Urology and Nephrology 12/2012; · 1.47 Impact Factor
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ABSTRACT: We reported a rare case of a dialysis patient coincident pituitary prolactinoma with calcification. A 55-year-old woman who had undergone hemodialysis for 8 years was admitted to the nephrology unit because of headache, blurred vision, and hypotension. Physical examination was normal; endocrinological examination demonstrated elevated serum levels of prolactin (> 4240 mIU/L), but other hormonal profiles, such as growth hormon, adrenocorticotropic hormone, thyroid stimulating hormone, free triiodothyronine, free thyroxine, follicle-stimulating hormone and luteinizing hormone, were absolutely or relatively lower. A cranial computed tomography (CT) suggested saddle area a high-density screenage with an anteroposterior diameter of 1.0 cm. A cerebral magnetic resonance scan confirmed the pituitary adenoma accompanied with calcification. Contrast-enhanced T1-weighted images revealed a less enhancing tumor, 14 mm wide round lesion with a high intensity signal. It enlarges the sella turcica, but the optic chiasma is not displaced. We suggest that in the differential diagnosis of any hemodialysis patient with severe headache, hypotension, and visual disturbances, this syndrome should be considered as prompt pituitary adenoma.
Chinese medical journal 08/2012; 125(15):2787-9. · 0.86 Impact Factor
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ABSTRACT: To analyze predictive factors for all-cause mortality, cardiovascular (CV) mortality, nonfatal CV events (CVE) in maintenance hemodialysis (MHD) patients, and to compare the effects of standard hemodialysis (HD) and online hemodiafiltration (HDF) on these factors and outcomes. A total of 333 MHD patients were prospectively followed up for 50 ± 15 months and all-cause death, CV death and CVE were registered. At the baseline, demographic, clinical, and laboratory data of the whole population were recorded. Then, patients were stratified into two groups according to the dialysis modalities, HD (n = 268) and HDF (n = 65). At the end of 6th month, clinical and laboratory data were recorded again. The predictive factors at baseline for all-cause mortality, CV mortality, and CVE were analyzed by Cox regression. The effects of HD and HDF on these factors at the 6th month and long-term outcomes were compared by t-test and Kaplan-Meier method, respectively. Age, gender, left ventricular mass index (LVMI), aortic arch calcification score (AoACS), hemoglobin (Hb) <10 g/dL, and ferritin >500 ng/mL maintained independent associations with all-cause mortality. C-reactive protein (CRP), LVMI, AoACS, and Hb <10 g/dL were associated with CV mortality. Prior cardiovascular disease (CVD), AoACS and LVMI were independent predictors of nonfatal CVE. Higher body mass index (BMI), body weight, total serum cholesterol, Hb concentration, and lower CRP level, LVMI, and AoACS were found in patients on HDF at the end of the 6th month. Improved outcomes with longer survival time for all-cause mortality, CV mortality, and CVE were found in HDF group. Age, gender, LVMI, AoACS, Hb, and ferritin were predictors of all-cause mortality in MHD patients. CRP, LVMI, AoACS, and Hb were associated with CV mortality. Prior CVD, AoACS, and LVMI were independent predictors of nonfatal CVE. HDF could improve BMI, body weight, total serum cholesterol, Hb, CRP, LVMI, AoACS, and long-term outcomes, including all-cause mortality, CV mortality, and CVE.
Hemodialysis International 04/2012; · 1.54 Impact Factor
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ABSTRACT: Peritoneal transport status is important not only for prescription, but also as a prognostic index. Flt-1 and Flk-1, the major vascular endothelial growth factor receptors involved in angiogenesis and hyperpermeability, may play a potent role in determining peritoneal transport characteristics. However, the relationship between them has not been studied to date. We hypothesized that Flt-1 and Flk-1 expression in the peritoneal vasculature of uremic patients could be closely related to baseline peritoneal transport status.
Thirty-six new patients without a previous history of peritonitis were enrolled. Clinical parameters such as age, sex, height, weight, causes of renal failure, and residual renal function were assessed. Parietal peritoneal biopsies were obtained during implantation of peritoneal dialytic catheters. Flt-1 and Flk-1 were semi-quantitatively evaluated by immunohistochemical staining. Peritoneal microvascular density (MVD) was counted. Within 6 weeks after commencing peritoneal dialysis, a standard peritoneal equilibration test was performed, and the dialysate-to-plasma concentration ratio for creatinine at 4 h (D4/P Cr) was determined. The patients were divided into two groups based on the D4/P Cr: more than 0.65 (Group H, n = 22) and less than or equal to 0.65 (Group L, n = 14). The 24-h peritoneal protein excretion (PPE) was assayed. Flt-1 and Flk-1 were correlated with peritoneal MVD, D4/P Cr, and PPE.
Flt-1 and Flk-1 were detected in the peritoneal vasculature of uremic patients. Flt-1 expression was similar between the two groups, but Flk-1 expression in Group H was significantly higher than that in Group L (p = 0.001). Flt-1 expression did not show significant correlations with peritoneal MVD, D4/P Cr, and PPE. However, Flk-1 expression showed significant correlations with the above three parameters (p < 0.001 for all).
For the first time, the expressions of Flt-1 and Flk-1 in peritoneal vasculature of uremic patients were detected. Flk-1 expression in peritoneal vasculature of uremic patients is closely correlated with the number of peritoneal microvessels, peritoneal small solute transport rate, and PPE. Our findings strongly suggest that Flk-1 may be a crucial determinant of baseline peritoneal transport characteristics. Further interventional studies are needed.
Renal Failure 01/2012; 34(5):582-9. · 0.82 Impact Factor
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ABSTRACT: Asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, is associated with vascular dysfunction. The polypeptide apelin mediates two major actions on blood vessels. However, their combined effects on vascular function are not fully understood. The present study aimed to determine the effect of apelin-13 on myosin light chain (MLC) phosphorylation in vascular smooth muscle cells (VSMCs) under ADMA-induced endothelial leakage conditions. To assess the increased permeability induced by ADMA, human umbilical vein endothelium cells (HUVECs) were plated in transwell dishes. The FITC-dextran flux and FITC-apelin-13 flux through the endothelial monolayer were measured. To examine the effect of leakage of apelin-13 on MLC phosphorylation in HUVSMCs, transwell dishes were used to establish a coculture system with HUVECs in upper chambers and HUVSMCs in lower chambers. Western blot was performed to assess the phospho-MLC levels. ADMA increased endothelial permeability in a concentration- and time-dependent manner, accompanied by actin stress fiber assembly and intercellular gap formation. When HUVECs were treated with ADMA, the permeability to both macromolecular dextran and micromolecular apelin-13 increased significantly. Both p38 MAPK inhibitor and NADPH oxidase inhibitor could prevent HUVECs from the increased permeability, and the changes of cytoskeleton and intercellular junction, which were induced by ADMA. Apelin-13 passed through the ADMA-stimulated endothelial monolayer and increased the expression of phospho-MLC in VSMCs. These results suggest that ADMA increases endothelial permeability, which may involve the p38 MAPK and NADPH oxidase pathway. Apelin-13 can pass through the damaged endothelial barrier, and acts directly on VSMCs to increase MLC phosphorylation.
Peptides 12/2011; 32(12):2436-43. · 2.43 Impact Factor
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ABSTRACT: Asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase (NOS) inhibitor, increases the activity of NF-κB (NF-κB) and then induces the expression of intercellular adhesion molecule-1 (ICAM-1). However, the mechanisms regulating ADMA-induced NF-κB activation are unknown. This study investigated the function of actin cytoskeleton for ADMA-induced NF-κB activation and ICAM-1 expression in endothelial cells.
Human umbilical vein endothelial cells (HUVEC) were cultured and left untreated or challenged for 24 h with 100 µM ADMA in the absence and presence of 5 µM cytochalasin D (Cyt D), or 1 µM Jasplakinolide (Jas). The form of actin cytoskeleton, the translocation of NF-κB, NF-κB DNA binding activity, and the expression of ICAM-1 were determined.
ADMA increased the formation of stress fiber in endothelial cells, and Cyt D clearly induced destabilization of the actin filaments. Either stabilizing or destabilizing the actin cytoskeleton prevented ADMA-induced NF-κB activation. It also showed that the inhibition of NF-κB activity was due to the impaired NF-κB nuclear translocation. Further, stabilizing or destabilizing the actin cytoskeleton inhibited the expression of the NF-κB target protein, ICAM-1.
Actin cytoskeleton may be engaged in modulated ADMA-induced NF-κB activation and thereby ICAM-1 expression in endothelial cells.
Medical science monitor: international medical journal of experimental and clinical research 08/2011; 17(9):BR242-7. · 1.70 Impact Factor
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ABSTRACT: Following the introduction of modified cellulosic and then synthetic membrane dialyzers, it was realized that the dialyzer bio-incompatibility depends on the membrane composition. We designed a prospective, randomized, cohort study of 6 months to determine several parameters of biocompatibility in maintenance hemodialysis (MHD) patients treated with four different membrane dialyzers.
There were 60 MHD patients enrolled in the study. In baseline, synthetic low-flux dialyzer, polysulfone (PS) membrane was used in all patients for at least 3 months. Then the patients were randomly divided into three groups according to different dialyzer membranes. Synthetic high-flux dialyzer group, polyethersulfone membrane, cellulose triacetate (CTA) high-flux membrane, and synthetic low-flux dialyzer, polymethylmethacrylate (PMMA) membrane were used in 6 months. A new dialyzer was used for each study treatment, and there was no dialyzer reuse. The biocompatibility markers and solutes removal markers were detected repeatedly at different time points.
The blood levels of highly sensitive C reactive protein, interleukin (IL)-1β, and interleukin (IL)-13 showed no difference among different groups at al time points. However, the blood complement levels and white blood cell counts were significantly different among three groups. When the dialyzers changed from PS to PMMA membrane, C3a levels and white blood cell counts changed significantly (p < 0.05). Moreover, the changes of C5a levels were significantly different between group CTA and group PMMA in month 3 (p < 0.05).
There were much more differences on bio-incompatibility among different dialyzer membranes.
Renal Failure 01/2011; 33(7):682-91. · 0.82 Impact Factor
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ABSTRACT: Common variable immunodeficiency disease (CVID) represents a heterogeneous group of primary hypogammaglobulinemias of unknown etiology, characterized by decreased serum immunoglobulin levels and recurrent bacterial infections and is often accompanied by autoimmune disease. Renal involvement is rare in CVID, despite widespread involvement of other organ systems. We describe a 21-year-old girl who presented with recurrent infections, hepatosplenomegaly, renomegaly, and renal insufficiency. Renal biopsy revealed a remarkable diffused interstitial infiltration and severe degenerative tubular lesions. Interstitial infiltration consisted mainly of CD8(+) T cells and CD68(+) macrophages with less CD4(+) T and rare B cells. For the cases with recurrent infections, multiple organomegaly, and renal insufficiency, clinicians should consider to exclude CVID, so as to make the timely diagnosis and appropriate management.
Renal Failure 01/2011; 33(1):92-5. · 0.82 Impact Factor
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ABSTRACT: T helper 1 (Th1)/T helper 2 (Th2) profile is pivotal in the development of fibrosis. Renal interstitial fibroblasts, which play a central role in the development of renal interstitial fibrosis, have an intimate relation with lymphocytes. However, there is little knowledge of the effect of fibroblasts on the profile of CD4 T-lymphocyte subsets.
After coculture with rat renal interstitial fibroblasts, the proportions of Th1 and Th2 cells in CD4 T lymphocytes and the apoptosis rates of the two subsets were detected by flow cytometry. Galectin-9 expression in rat renal interstitial fibroblasts was detected by immunofluorescence, Western blotting, and enzyme-linked immunosorbent assay.
After 48 h of coculture, rat renal interstitial fibroblasts increased the proportion of Th2 cells, lowering the ratio of Th1/Th2. Meanwhile, interferon-gamma production in Th1 cells was inhibited and interleukin-4 production in Th2 was promoted. After coculture with activated rat renal interstitial fibroblasts for 24 h, apoptosis of Th1 was more highly promoted than that of Th2 cells. In addition, rat renal interstitial fibroblasts induced stronger Th2 cell differentiation than that of Th1 cells in vitro. Rat renal interstitial fibroblasts expressed but did not secrete galectin-9 (an apoptosis-inducing factor for Th1 cells) in vitro and the expression level decreased when cocultured with CD4 T lymphocytes.
Rat renal interstitial fibroblasts shift the Th1/Th2 profile in vitro, and this may be another pathway by which renal interstitial fibroblasts promote fibrosis.
Renal Failure 01/2011; 33(10):1025-31. · 0.82 Impact Factor
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ABSTRACT: Asymmetric dimethylarginine (ADMA) as a uremia toxin is accumulated in end-stage renal disease (ESRD) patients. Elevated ADMA level has been shown to be predictive of cardiovascular diseases (CVDs) and all-cause mortality in ESRD. Therefore, we investigated the removal of ADMA by different dialysis treatments.
There were 30 each of hemodialysis (HD), hemodiafiltration (HDF), peritoneal dialysis (PD) patients, and healthy volunteers enrolled. The ADMA concentrations in serum, urine, and spent dialysate samples were determined. The urine and spent dialysate volumes were recorded. The ADMA removals by urine and spent dialysate in 1 week were calculated and compared among four groups. It was also analyzed for the correlations between the total removal of ADMA in 1 week and the parameters of age, durance of dialysis, glomerular filtration rate, urine volume, urinal ADMA level, spent dialysate volume, and spent dialysate ADMA level.
The serum levels of ADMA in dialysis patients were much higher than in healthy subjects (0.32 +/- 0.09 micromol/L), and their 1-week total removals of ADMA were much lower than healthy controls (249.21 +/- 57.04 micromol/week) (p-values all were less than 0.01). Among dialysis groups, serum ADMA levels decreased significantly in PD patients compared with HD or HDF patients (1.38 +/- 0.30 micromol/L vs. 1.82 +/- 0.38 micromol/L and 1.63 +/- 0.32 micromol/L, p < 0.01), and the total removal of ADMA diminished remarkably by turns of PD, HDF, and HD groups (47.79 +/- 8.20 micromol/week, 31.79 +/- 8.92 micromol/week, 14.63 +/- 6.53 micromol/week, respectively, p < 0.01). The total removal of ADMA in 1 week was related directly with the spent dialysate concentrations of ADMA, the spent dialysate volume, and the urine volume.
ADMA was mainly removed by dialysate in dialysis patients. Different dialysis models have different clearance capability on plasma ADMA. PD might be more effective on ADMA removal than HD and HDF, with HDF being more effective than HD.
Renal Failure 01/2010; 32(8):935-40. · 0.82 Impact Factor
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ABSTRACT: Extra glucose load in peritoneal dialysis is an important cause of newly-occurred diabetic mellitus, which initiates insulin treatment in some of the dialytic patients. The purpose of this study was to discuss the influence of the peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients who are on continuous ambulatory peritoneal dialysis (CAPD).
One hundred and forty-five patients with total KT/V per week over 2.0 were recruited, including 60 males and 85 females. Fasting blood glucose (FBG), creatinine, blood urea nitrogen (BUN), blood albumin, blood lipid profile and blood C-reactive protein (CRP) were analyzed at the beginning of the peritoneal dialysis and after 12 months. A peritoneal equilibration test (PET) was carried out at the 3rd month of CAPD, and meantime residual renal function, peritoneal solute clearance rate, ultrafiltration volume and urine volume were also evaluated.
Twenty-one cases were identified as a low transfer group (L), 32 cases as a low average transfer group (LA), 58 cases as a high average transfer group (HA) and 34 cases as a high transfer group (H). At the end of the 12th month, 83 cases had elevated FBG. Through stepwise multiple regression analysis we found the FBG level in these patients was positively related to glucose load and CRP, and negatively related to glucose absorption in the peritoneum (D/D(0)) and blood albumin (P < 0.05). Kaplan-Meier analysis during a 48-month follow-up found the morbidity of hyperglycemia to be 17/34 cases (50.1%) in the high transfer group, 20/58 cases (34.5%) in the high average transfer group, 11/32 cases (34.3%) in the low average transfer group, and 1/21 cases (5.4%) in the low transfer group.
Patients with high peritoneal transfer capacity might have the highest morbidity from hyperglycemia among patients with these four different peritoneal transfer status. Glucose load, baseline CRP and FBG level before peritoneal dialysis, and D/D0 can efficiently predict hyperglycemia in CAPD patients.
Chinese medical journal 12/2009; 122(24):2977-80. · 0.86 Impact Factor
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ABSTRACT: To identify the mortality-related factors in patients undergoing maintenance hemodialysis.
One hundred and seven long-term hemodialysis patients having suffered from chronic glomerulonephritis and received hemodialysis treatment in the hemodialysis center of the Friendship Hospital during February 1990 to February 2002 were selected to take part in a retrospective study. Survival analysis was done using Life Tables study. Cox regression analysis was used to find factors related to risk. Patients were divided into two groups according to the clinical value of the factors which showed statistical significance in Cox regression analysis. Survive rates were compared between two groups on Gehan test.
Among the 107 patients, 22 died (15.3%) and 85 survived (84.7%) during the follow-up period. Cumulative survival rates of 5 years and 10 years were 79.91% and 64.36% respectively. Prognostic factors would include age (P < 0.001), blood urea nitrogen (BUN, P = 0.004), serum creatinine (SCr, P = 0.001), value of plasma calcium multiplied by plasma phosphate (P = 0.019), and KT/V (P = 0.001), which were all tested during the third dialysis month. The Hazard Ratios (HR) were 1.107 (95% Confidence Interval, 95% CI: 1.049 - 1.168), 0.951 (95% CI: 0.918 - 0.984), 0.727 (95% CI: 0.599 - 0.883), 1.025 (95% CI: 1.004 - 1.046), and 0.013 (95% CI: 0.001 - 0.161), respectively. The survival rates between two groups were significant different (age >or= 60 years group vs < 60 years group P = 0.0006, BUN >or= 28.6 mmol/L vs < 28.6 mmol/L group P = 0.0415, SCr >or= 884 micro mol/L vs < 884 micro mol/L group P = 0.0146, value of plasma calcium multiplied by plasma phosphate >or= 40 vs < 40 group P = 0.0464, KT/V >or= 1.30 vs < 1.30 group P = 0.0215).
The mortality related prognostic factors of maintained hemodialysis patients seemed to include age, BUN, SCr, value of plasma calcium multiplied by plasma phosphate, and KT/V, which were all tested during the third dialysis month. Among them, age and the value of plasma calcium multiplied by plasma phosphate were risk factors of death, while the others were protective factors.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 07/2003; 24(6):508-11.
