Prevalence and related factors of the absence of anemia among Chinese chronic hemodialysis patients: a multicenter cross-sectional study.

BACKGROUND: Some chronic hemodialysis (HD) patients can maintain normal hemoglobin levels without requiring erythropoiesis-stimulating agents (ESAs). However, the prevalence and the factors associated with this condition in Chinese chronic HD patients have not been reported. The aim of this study was to investigate clinical features, iron metabolism, and other characteristics to survey the prevalence rate and the related factors of this condition among Chinese chronic HD patients. METHODS: A total of 1,318 chronic HD patients participated in this study. The patients were classified into a non-ESA group (n = 11) and an ESA group (n = 1,307). The r-HuEPO-independent (non-ESA) HD patients were defined as having hemoglobin greater than 12 g/dl for more than 6 months without r-HuEPO injection, blood transfusion, or androgen therapy. Epidemiological and laboratory data were collected. Renal sonography was also performed on each patient to evaluate the formation of renal and liver cysts, and the number and size of the cysts were recorded. RESULTS: Approximately 0.84 % of all HD patients were found to be r-HuEPO independent. The non-ESA group had a higher proportion of men (79.6 vs. 58.3 %), a longer duration of renal replacement therapy (RRT) (8.6 ± 6.1 vs. 5.1 ± 3.3 years), a higher prevalence of adult polycystic kidney disease (APKD) (46.3 vs. 9.7 %), a higher prevalence of hepatitis C virus (HCV) liver disease (26.2 vs. 3.2 %, P < 0.01), and had older patients (63.3 ± 13.6 vs. 49.6 ± 13.5 years). Endogenous erythropoietin levels in the non-ESA group were significantly higher than those in the ESA group (61.8 ± 27.1 vs. 29.3 ± 11.7 mU/ml). Non-ESA patients had a significantly higher number of renal (38.1 vs. 13.2 %) and hepatic cysts (9.3 vs. 1.9 %), which were also larger in size (2.9 ± 1.6 vs. 1.3 ± 0.3 cm) compared with those of patients in the ESA group. No significant difference in iron metabolism was found between two groups. In the multivariate Cox analysis, the independent predictor factors for the absence of anemia in these HD patients were the number of renal cysts >6 cysts (95 % CI 1.058-1.405; P = 0.00), endogenous erythropoietin levels (95 % CI 1.139-1.361; P = 0.05), HCV+ liver disease (95 % CI 1.129-1.316; P = 0.01), and time on RRT (95 % CI 1.019-1.263; P = 0.05). CONCLUSIONS: To our knowledge, this study is the first to report on r-HuEPO independence among Chinese HD patients. The prevalence among Chinese chronic HD patients is significantly lower than that reported in the literature. Factors contributing to this condition are complex and multiple. The frequency of this condition is higher in men and in older patients with long-term RRT, in patients with HCV+ liver disease, and in APKD patients. This condition is associated with increased endogenous erythropoietin production and the presence of renal and hepatic cysts.

The effect of mesenchymal stromal cells on doxorubicin-induced nephropathy in rats.

BACKGROUND AIMS: The potential protective effects of mesenchymal stromal cells (MSCs) on some kidney diseases has been reported. However, the effect of MSCs on doxorubicin-induced nephropathy is still poorly understood. METHODS: Rats with doxorubicin-induced kidney injuries were treated with human cord-derived MSCs. Human MSCs were first labeled with 5-bromo-2'-deoxyuridine to track their homing in kidneys after infusion. RESULTS: Alleviation of proteinuria, decreased serum albumin, alleviation of lipid disorders and histologic alterations were found in rats 4 weeks after treatment with MSCs, particularly in rats that were given repeat doses. Decreases in serum levels of interleukin-6, tumor necrosis factor-α and prostaglandin E2 and decreases in messenger RNA levels of kidney tissue cylooxygenase-2 and EP4 were found in MSC-treated rats. MSC-treated rats also displayed an increase in serum interleukin-10 levels. CONCLUSIONS: These results indicate that MSCs ameliorate doxorubicin-induced kidney injuries and inflammation, suggesting a potential clinical treatment for inflammatory kidney diseases.

[Transplantation of human umbilical cord mesenchymal stem cells alleviates the progression of FSGS in rats].

OBJECTIVE: To study the protective effect of human umbilical cord mesenchymal stem cells (HuMSCs) on the progression of focal segmental glomerulosclerosis (FSGS) in rats. METHODS: HuMSCs were incubated by adherent culture. Sprague Dawley rats were randomly assigned to 3 groups: No intervention was applied to the rats of normal control group. Model group and transplant group were injected with adriamycin 4 mg/kg (on day 1) and 3.5 mg/kg (on day 8) via the tail vein, in addition, the transplant group rats were injected with 1 mL HuMSCs suspension (2×10(6);/mL) via the tail vein on day 1, 8, 15 and 22, whereas the model group rats were injected with the same dosage of DMEM in the same way. RESULTS: Transplantation of HuMSCs remarkably alleviated urine protein excretion and hypoalbuminemia, decreased serum cystatin C level and improved kidney damage and inflammatory cell infiltration in renal interstitium. Furthermore, HuMSCs decreased the expressions of TGF-ß1 and connective tissue growth factor (CTGF) mRNA in kidney and reduced the levels of serum IL-6 and TNF-α. CONCLUSION: Transplantation of HuMSCs could alleviate or inhibit the progression of FSGS in rats, of which the mechanism might be related to the regulation the synthesis and release of inflammatory mediators and the inhibition of inflammatory cell infiltration.