Improvement of restless leg syndrome in maintenance hemodialysis patients with limb ischemic preconditioning: a single-center randomized controlled clinical trial.

OBJECTIVE: This study evaluated the efficacy and safety of limb ischemic preconditioning (LIPC) in treating restless leg syndrome (RLS) in maintenance hemodialysis (MHD) patients. METHODS: A total number of 45 patients participated in the study. They were randomly divided into LIPC group and control group. The LIPC was performed by inflating the limb ischemic preconditioning training device in the patient's thigh to 200 mmHg to create transient ischemia, whereas control group inflated the device to 20 mmHg. International Restless Legs Syndrome (IRLS), Clinical Global Impression Scale (CGI-S), and Medical Outputs Study Sleep Scale were employed to evaluate LIPC effectiveness. The primary endpoint was the 'rate of clinical improvement in RLS severity', defined as the percentage of patients who had an IRLS score decrease of ≥5 points in each group. RESULTS: After intervention, the rate of clinical improvement in RLS severity was 56.5% in the LIPC group and 13.6% in the control group (13 (56.5) vs 3 (13.6), p = 0.003). In addition, the LIPC group's IRLS, CGI-S scores, the sleep disturbance and somnolence scores showed a significant downward trend compared to the control group (-5.5 ± 5.3 vs - 1.0 ± 3.8, p = 0.002; -1.7 ± 1.2 vs - 0.5 ± 1.4, p = 0.003; -15.5 ± 17.8 vs 3.7 ± 12.0, p < 0.001; -9.9 ± 18.8 vs - 2.4 ± 8.6, p = 0.003). During the study, there were no serious adverse event in any of the patients. CONCLUSIONS: LIPC could be employed to effectively and safely alleviate the RLS symptoms in MHD patients.

Association between long-term pulse pressure trajectories and risk of end-stage renal diseases in incident malignant hypertensive nephropathy: a cohort study.

OBJECTIVE: The trajectories of pulse pressure (PP) might affect the prognosis of malignant hypertensive nephropathy (MHN). We aimed to describe the association between PP trajectories and the future risk of end-stage renal disease and to identify and compare the associated patient characteristics of any distinct trajectory patterns in MHN patients. METHODS: Patients with newly diagnosed biopsy-proven MHN 2010-2015 were included. Latent class growth analysis was applied to the PP measured over 3 years prior to biopsy to identify distinct trajectories. Concurrent systolic blood pressure, diastolic blood pressure, plasma creatinine, and 24-h urine protein measurements for each trajectory group were modelled using generalized estimating equations. The risk of end-stage renal disease (with kidney replacement therapy as a proxy) was estimated using Logistic regression. RESULTS: Two hundred three patients were included (median-age 34 years, and 19.7% female). A two-group cubic model was optimal, with trajectories distinguished by the rate of PP and absolute level at final measurement. Trajectory Group-1 (n = 84) was characterized by 'first-increased-then-decreased' PP and trajectory Group-2 (n = 119) was characterized by 'first-decreased-then-increased' PP over 3 years prior to biopsy. Systolic and diastolic blood pressures, plasma creatinine, and 24-h urine protein were differed by the trajectory group. Baseline characteristics differed substantially between trajectory groups. Compared with Group-1, Group-2 had a 66% greater risk of developing into end-stage renal disease in the subsequent 3 years. CONCLUSIONS: Two distinct 3-year trajectories for PP exist with MHN. Early introduction of intensive antihypertensive treatment might delay the development of end-stage renal disease among patients with malignant hypertension.

[Study on abnormal glucose and lipid metabolism among 771 in-patients with ischemic stroke].

OBJECTIVE: To study the epidemiological characteristics of abnormal glucose and lipid metabolism in in-patients with ischemic stroke. METHODS: A total number of 771 in-patients with ischemic stroke, hospitalized in the Department of Neurology/Endocrinology from Changzhou No. 2 Hospital from April 2007 to April 2008 were enrolled in this study. After identifying the condition of glucose metabolism, all diagnosis-undetermined patients received oral glucose tolerance test. RESULTS: Among in-patients with ischemic stroke, 41.8% of the patients were finally diagnosed as diabetes, with 23.4% classified as 'impaired glucose tolerance'. The prevalence of 'abnormal glucose metabolism' was 65.2% in total. If diabetes in the in-patients with ischemic stroke was diagnosed only by fast plasma glucose instead of oral glucose tolerance test, 58.5% diabetic patients would have been misdiagnosed. Abnormal lipid metabolism existed in inpatients with cerebral ischemic stroke were noticed. These abnormalities of lipid metabolism were mainly consisting of increased triglyceride and decreased HDL-C cholesterol. CONCLUSION: The majority of in-patients with ischemic stroke appeared to have had abnormal glucose and lipid metabolism. It seemed necessary to promptly and correctly diagnose these patients with abnormal glucose metabolism by oral glucose tolerance test to reduce the chances of developing the recurrence of stroke.