[Effect of renal function on sarcopenia in elderly male patients with chronic kidney disease].

Objective: To evaluate the effect of renal function on sarcopenia in elderly male patients with chronic kidney disease (CKD). Methods: A total of 105 male CKD patients aged ≥65 years who were admitted to the Chinese PLA General Hospital between October 1, 2018 and January 30, 2019 were included in this study. Using two different equations to estimate glomerular filtration rate (GFR), respectively. According to the sarcopenia criteria, the participants were categorized as the non-sarcopenia group (n=72) and the sarcopenia group (n=33), respectively. The association of estimated GFR (eGFR) and the sarcopenia in the male CKD patients was analyzed using the model of multivariate logistic regression. Results: Among the 105 patients, the median age was 74 (68, 77) years old. The prevalence of sarcopenia was 31.4% (33/105). According to the multivariate logistic regression analysis, eGFR based on serum creatinine and Cys-C (eGFRscr-cys) lower than 45 ml·min(-1)·(1.73 m(2))(-1) (OR=4.17, 95%CI:1.08-16.02, P=0.038) and eGFR based on Cys-C (eGFRcys) lower than 45 ml·min(-1)·(1.73 m(2))(-1) (OR=3.99, 95%CI:1.08-14.75, P=0.038) were independent risk factors for underlying sarcopenic, respectively. The area under the receiver operating characteristics curve (AUC) revealed that eGFRscr-cys (AUC=0.67) was more suitable than eGFRcys (AUC=0.64) to predict the sarcopenia in elderly male patients with CKD. Conclusion: The increased incidence of sarcopenia in elderly men with CKD is accompanied with deterioration of renal function.

[Related factors of frailty in the elderly male patients with chronic kidney disease].

Objective: To investigate the characteristics of frailty in the elderly male patients with chronic kidney disease (CKD) and the effects of renal function on the incidence of frailty. Methods: A total of 105 non-dialysis CKD patients aged ≥65 years who were admitted to the Chinese PLA General Hospital between October 1, 2018 and January 30, 2019 were included in this study. Their clinical data and laboratory indicators were collected. Frailty was defined according to Fried frailty criteria. According to the frailty scores, the participants were categorized as non-frail (n=37), intermediately frail (n=37) and frail (n=31). The association of frailty and the level of estimated glomerular filtration rate (eGFR) in the patients was analyzed using the model of multivariate Logistic regression. Results: Among the 105 patients, the mean age was 74 (68, 77) years old. The incidence of frail and intermediate frail was 35.2% (37/105) and 29.5% (31/105), respectively. Multivariate logistic analysis showed statistically significant associations of frailty with age (OR=1.14, 95%CI:1.08-1.20, P<0.001), body mass index (OR=0.87, 95%CI:0.79-0.95, P=0.001) and the level of eGFR (OR=0.98, 95%CI:0.96-0.99, P=0.003) in those patients. The incidence of frail in patients with eGFR<45 ml·min(-1)·(1.73 m(2))(-1) and 45-59 ml·min(-1)·(1.73 m(2))(-1) was 1.02 (OR=2.02, 95%CI: 1.06~3.87) and 0.84 (OR=1.84, 95%CI: 1.05-3.22) times higher than that of eGFR≥60 ml·min(-1)·(1.73 m(2))(-1), respectively. Conclusion: The incidence of frailty in the elderly patients with CKD is affected by many factors, such as age, body mass index and renal function, and increases with decreased renal function.

[High glucose reduced the repair function of kidney stem cells conditional medium to the hypoxia-injured renal tubular epithelium cells].

OBJECTIVE: To evaluate the impacts of high glucose on the repair function of kidney stem cells (KSC) conditional medium to the hypoxia-injured renal tubular epithelium cells (RTEC). METHODS: KSC were isolated from the renal papilla in 4-week-Sprague-Dawley rats. The KSC were pretreated in media with high glucose (30 mmol/L) or with normal glucose (5.6 mmol/L), respectively. The supernatants of the pre-treated KSC were collected as the conditional media. The hypoxia/reoxygenation (H/R) model of rat RTEC was established using the NRK-52E cell line. The effects of KSC conditional media on the H/R RTEC were investigated. RESULTS: (1) The best H/R model of RTEC was established using hypoxia for 4 h and reoxygenation 2 h. (2) After hypoxia, the early and late cell apoptosis rates of the H/R RTEC were increased. The H/R RTEC were co-cultured with KSC conditional media for 12 h and 24 h, respectively. The H/R RTEC were co-cultured with DMEM/F12 as a control group. The cell apoptosis rate of H/R RTEC was lower after co-cultured with KSC conditional media (P<0.01), and the cell apoptosis rate of H/R RTEC in high glucose group was much higher than that in normal glucose group after co-cultured 24 h (P=0.02). (3) After hypoxia, the lactic dehydrogenase (LDH) and malondialdehyde (MDA) levels of the H/R RTEC supernatant were increased, and the superoxide dismutase (SOD) level decreased. The LDH and MDA levels were lower and the SOD level was higher after co-cultured with KSC conditional media for 12 h and 24 h, respectively (P<0.01). The LDH and MDA levels of H/R RTEC supernatant were much higher in the high glucose group than in the normal glucose group (P<0.05), and the SOD level of H/R RTEC supernatant was much lower in the high glucose group than in the normal glucose group (P<0.01). CONCLUSION: KSC conditional media could repair the H/R injury of RTEC. The effects were mainly by inhibiting cell apoptosis, and reducing oxidative stress; the anti-cell apoptosis ability and the anti-oxidative stress capacity of the conditional medium were reduced after KSC were pre-treated with high glucose.

[Analysis of risk factors and prognosis for bleeding in very old male patients with stage 5 chronic kidney disease].

Objective: To analyze the risk factors and prognosis of bleeding in very old male patients with stage 5 chronic kidney disease (CKD). Methods: The clinical data of 143 very old male patients with stage 5 CKD was retrospectively analyzed. According to the occurrence of bleeding, the patients were divided into two groups including the hemorrhage group and the non-hemorrhage group. The history of diseases, renal function, blood cell parameters and coagulation index were compared and analyzed between the two groups. The prognosis of patients with a period of 12 months was studied. Results: Among 143 patients, 67 cases (46.85%) suffered bleeding, and the other 76 patients (53.15%) were without bleeding. The age[(89±4) vs (87±5) years, P=0.02], pulmonary infection (32.84% vs 9.21%, P<0.001), activated partial thromboplastin time[(40.86±8.02) vs (38.41±5.72) s, P=0.036], fibrinogen[(4.09±0.75) vs (3.62±0.67) g/L, P<0.001], blood urea nitrogen (BUN)[(37.19±10.66) vs (32.86±8.97)mmol/L, P=0.009]were significantly increased in the hemorrhage group compared with the non-hemorrhage group. Multivariate logistic regression analysis showed that the incidence of pulmonary infection (OR=0.286, P=0.014), lower levels of mean platelet volume (OR=1.290, P=0.048), higher levels of fibrinogen (OR=0.444, P=0.004), BUN (OR=0.959, P=0.034) and systolic blood pressure (OR=0.970, P=0.013) were the independent risk factors of bleeding in the very old male patients with stage 5 CKD (P<0.05). All patients were followed up for 12 months. The proportion of all causes of death at the 3rd month, and bleeding events at the 3rd or 12th month, and recurrent major bleeding events at the 12th month were significantly higher in the hemorrhage group than those in the non-hemorrhage group. Conclusions: Very old male patients with stage 5 CKD are prone to bleeding complications, and have more possibilities to bleed again. Pulmonary infection, average volume of blood platelet, fibrinogen, BUN, and systolic blood pressure were the independent risk factors of bleeding in these patients.