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Objective To compare the difference of mortality risk between patients undergoing nocturnal hemodialysis (NHD) and conventional hemodialysis (CHD) and to explore the related factors of mortality.Methods The study cohort comprised the maintenance hemodialysis patients receiving either NHD (n=111) or CHD (n=722) in Changzheng Hospital of Second Military Medical University from Feb.2009 to Feb.2017.The demographic information,clinical characteristics,survival status,causes of death and laboratory examination indexes were obtained from hemodialysis management system.The urea clearance index (Kt/V),hemoglobin,blood phosphorus concentration and mortality were compared between NHD and CHD patients.The multivariate-adjusted Cox model was used to analyze the mortality risk of all patients.Results Compared with the patients receiving CHD,the proportion of male was more in the NHD group,and the baseline age was younger (P＜0.01) and baseline dialysis vintage was longer (P＜0.01).There was no significant difference in incidences of primary disease and comorbidities,or laboratory examination results.Compared with the CHD group,the levels of Kt/V and hemoglobin in the NHD group were significantly higher (P＜0.01),and the blood phosphorus concentration was significantly lower (P＜0.05).Mortality in the NHD and CHD groups was 3.5 per 100 patients-years and 6.2 per 100 patients-years,respectively.After the adjustment by baseline age,dialysis vintage,gender,and comorbidities,Cox model analysis showed that the mortality risk in the NHD group was lower than in the CHD group (HR=0.67,95％CI:0.39-1.00,P=0.05).Subgroup analysis showed NHD was of more survival benefit for male (P＜0.05),non-diabetic patients (P =0.05) and patients with conventional dialysis vintage ＞3 years (P＜0.05).Conclusion NHD can effectively increase the solute clearance,improve anemia and calcium and phosphate metabolism,and thus reduce the mortality risk of maintenance hemodialysis patients.
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Objective To identify the therapeutic effect and safety of mini -percutaneous nephrolithotomy combined with antegrade modular flexible ureteroscope for the treatment of staghorn stone.Methods The clinical data of 116 patients with staghorn calculi who underwent mini -percutaneous nephrolithotomy combined with antegrade modular flexible ureteroscope were retrospectively analyzed.Of the 116 patients,63 cases were men,53 cases were women .Age ranged from 2 5 to 6 7 years .The diameter ofcalculi ranged from 4 6 to 9 8 (mean =4 6 )mm .There were 63 large complete staghorn renal calculi in these patients.Results All procedures were performed successfully using a single lithotripsy tract.The mean surgical time was (125.4 ±30.0)minutes.The initial stone -free rate was 81.03%(94 /116).Twenty -two cases had several residual calculi from 12 to 25mm.Post -procedure complications included hemorrhage in 9 patients,fever(>38.5 ℃)in four patients,and reactive pleural effusion in one patient. Blood loss requiring transfusion,sepsis,adjacent organ injury and kidney loss were not observed.Conclusion Mini -percutaneous nephrolithotomy combined with antegrade modular flexible ureteroscope has good therapeutic effect in treating renal staghorn calculi,since the technique in treating the renal staghorn calculi makes the operation period shorter,the rate of stone -free higher,the operation wounds smaller,the rate of complication lower,the rate of surrounding organ injury less.
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Objective To identify the therapeutic effect and safety of anterograde flexibleureteroscopy on the treatment of upper -middle ureteral calculi.Methods The clinical data of 47 patients who underwent anterograde flexible ureteroscopy for the treatment of upper -middle ureteral calculi in our center were retrospectively reviewed. During the 47 patients,28 cases were men,19 cases were women.Age ranged from 20 to 68 years.The diameter of calculi ranged from 8 to 22mm(mean =14 mm).Results The flexible ureteroscopic lithotripsy procedure were successful in all the cases.The mean operative time was (65.3 ±8.5)min.The mean hospital stay was 8 days.The average blood loss was less than 50mL.The initial stone -free rate was 93.62%(44 /47).No severe complications occurred intraoperative and postoperative.Conclusion Anterograde flexible ureteroscope has good therapeutic effect in treating upper -middle ureteral calculi.It is safe and effective procedure,with less complication and a high calculus removing rate.The surgical methods is worthy of clinical application.
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Objective To validate the hypothesis that the phenotype reversion occurs in the smooth muscle cells in the corpus cavernosum of hypertensive rats with selenium food and explore selenium′s impact on erectile function. Methods 25 14-week-old male spontaneously hypertensive rates (SHR) were divided into 2 groups (SHR-ED-Se group n = 8 and SHR-ED-N group n = 9). SHR-ED-Se rats were fed with selenium diet, SHR-ED-N rats and WKY rats with normal diet. And 10 syngeneic normotensive rats (WKY) were used as control group. All rats were killed after 4-week feeding. Immunohistochemical staining and color image analysis system were used to observe expression of α-actin, desmin and osteopontin (OPN) in rats corpus cavernosum of different group. Results 2 SHR-ED-N rats died. Expression of α-actin of smooth muscle in corpus cavernosum in SHR-ED-N group was the lowest in all groups (P = 0.000), so did erection frequency (P 0.05). Conclusions Phenotype modulation of smooth muscle in corpus cavernosum of SHR rats can be reversed by selenium which means the smooth cells can transform from synthetic phenotype into the contractile phenotype, resulting ultimately in improving erectile function.
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Objective To analyze the causes of 652 hospitalizations in the patients with autosomal dominant polycystic kidney disease (ADPKD).Methods The medical records of all ADPKD inpatients in our hospital from January 1,1990 to December 31,2010 were collected.The differences of hospitalization causes in different age,gender and period were analyzed.Results (1)In 652 hospitalizations,the most common cause was lumbar pain (15.2％),followed by cystic bleeding (14.6％),aggravating renal failure (10.1％),dialysis-related problems (9.4％),renal transplant related issues (8.3％),renal replacement therapy for ESRD (8.0％),urinary tract infection (6.4％),end stage renal failure (5.8％),hypertension (4.1％),renal cyst volume enlargement (3.7％),finding polycystic kidney disease (2.1％),urinary lithiasis (1.8％) and others (10.4％).(2)Younger patients were admitted into hospital because of polycystic kidney bleeding and finding PKD.With the increase of patients age,hospitalization due to dialysis-related problems increased,while many middle-aged patients were hospitalized because of back pain.(3)Male patients were admitted into hospital for aggravating renal failure,ESRD,kidney transplantation-related problems and urinary lithiasis,while female patients mainly for lumbar pain,dialysis-related problems and urinary tract infection.(4)The proportion was significantly reduced with time of finding PKD,renal failure and polycystic kidney bleeding,the proportion of renal cysts increasing and aggravating renal failure increased,there was a significant increase in the proportion of patients with hypertension,while a significant decrease in the proportion of patients with uncontrolled hypertension,and the average SBP was also significantly reduced.Conclusions The highest rate of hospitalization of ADPKD patients is in 40 to 60 age group.Cause of admission varies with age and gender,and changes with the change of time.Over the past decade,the proportion of hospitalization due to renal cysts enlargement and renal failure aggravation increased significantly.The incidence of hypertension is higher than that in the first 10 years,but hypertension control rate increases compared with the previous.Prevention should focus on finding the suppression measures of renal cysts enlargement.
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Objective To summarize the clinical characteristics and outcome of renal cyst infection in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods Clinical data of 40 ADPKD patients with 43 episodes of renal cyst infection admitted in Shanghai Changzheng Hospital from 1st January 1991 to 31st December 2010 were retrospectively analyzed.Differences of microbiological data and treatments between 1st January 1991 to 31st December 2000 and 1st January 2001 to 31st December 2010 were compared. Results Among 473 identified patients with ADPKD and 662 episodes of hospitalization,40 patients had 43 episodes of renal cyst infection,including 8 definite and 35 likely cases.Microbiological documentation was available for 34 episodes (79.0％),Escherichia coli accounting for 82.4％ of all retrieved bacterial strains.Resistant Escherichia coli to quinolone and certain β-lactamine increased in recent decade.Clinical efficacy of initial antibiotic treatment was noted in 69.8％ of episodes. Antibiotic treatment modification was more frequently required for patients receiving initial monotherapy compared with those receiving combination therapy.In the first ten-year group,initial combination therapy and clinical efficacy were noted in 30.0％ and 60.0％ of episodes respectively,and hospital stay was (20.2±6.7) d.In the second ten-year group,initial combination therapy and clinical efficacy were noted in 61.9％ and 78.2％ of episodes respectively,and hospital stay was (16.3±3.2) d.Large infected cysts (diameter ＞5 cm) frequently required drainage. Conclusions In renal cyst infection,the source of the organisms is often a gram negative enteric organism.Empiric therapy is often initiated with two antibiotics.The drainage of large infected cysts remains the main treatment for cyst infection.
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Objective To observe the influence of nocturnal prolonged hemodialysis (INHD) on patients＇ nutrition status. Methods Thirty-two maintenance hemodialysis patients received INHD (3 times per week and 7.5 hours each session) and thirty-five maintenance hemodialysis patients received conventional hemodialysis (3 times per week and 4 hours each session) as control were observed for 6 months.The nutrition status of these patients on various aspects which concluded physical measurements,laboratory tests,and dietary record at baseline(0month) and exit (6 months) were recorded. Results (1)There were no differences in age,sex,body weight,and primary diseases between two groups.(2)The body weight,triceps skinfold thickness (TSF),and hand grip strength increased at exit point,but no statistical difference compared with the control group.Mid-upper arm circumference (MAC) increased signicantly from (27.1±4.2) to (30.5±6.1) cm (P＜0.05).Compared with the control group (26.9±3.4) cm,there was a significant difference (P＜0.05).(3)Serum phosphate decreased significantly from (0.5±0.5) to (0.1±0.6) μ mol/L (P=0.001) in INHD group.(4)The nutrition status were improved in INHD group evaluated by subjective global assessment (SGA)(P=0.03).(5) Dietary intake was recorded by a 3-day food record.Dietary intake of energy,protein,lipid,calcium,potassium,and phosphate increased in INHD group.None of the differences achieved statistical significance between two groups. Conclusion As compared with conventional hemodialysis,INHD can increase the dietary intake,decrease serum phosphate level,and improve patients nutrition status.
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Abstract Objective To compare the quality of life in long-term hemodialysis patients using tunnel cuffed catheter with arterio-venous fistula. Methods Thirty patients using tunnel cuffed catheter (catheter group) and another 30 patients using arterio-venous fistula (fistula group) were observed. The rate of infection,thrombus and blood flow were recorded. The lab examinations such as blood urea nitrogen,creatinine,serum electrolyte,hemoglobin, C reactive protein, parathyrine, β2 microglobulin were measured,subjective global assessment (SGA) was made, KT/V and urea reduction ratio (URR) were calculated.Quality of life was surveyed with KDQOL-SFTM questionnaire and to conduct comparative analysis. Results KT/V was 1.49 ± 0.25 in catheter group, and 1.45 ± 0.28 in fistula group, there was no significant difference between the two groups. The lab examinations and SGA were similar in two groups. There were no significant difference of quality of life between the two groups except for pain (the score in catheter group was significantly higher than that in fistula group). The rate of infection was significantly higher in catheter group than that in fistula group. The rate of thrombus was similar in two groups. Conclusions As alternative of fistula in patients whose fistula could not be established, the tunnel cuffed catheter could give adequate dialysis and satisfactory quality of life,and is predominating in pain-reducing. The rates of infection and thrombus are decreased, but maintain the important problems to be solved.
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Objective To assess the safety and efficacy of gabapentin in treatment of refractory uremic pruritus in maintenance hemodialysis (MHD)patients. Methods A randomized controlled trial was performed.Forty-nine MHD patients with severe pruritus were randomly divided into treatment group(gabapentin 100-300 mg at dialysis day before sleep)and the control group(loratadine 10 mg daily).The efficacy was assessed by visual analogue score,pruritus score and improved Duo's VAG Score after 12-week treatment,and the side effect was also observed to assess the safety. Results After treatment,the frequency,degree and area of pruritus in 25 patients of treatment group were significantly reduced,and VAS score(1.46±1.38vs 8.71±1.17,P＜0.01),VAG score(2.92±1.63 vs 8.29±0.68,P＜0.01)and the improved Duo's pruritus score(11.33±3.99 vs 30.75±4.87,P＜0.01)decreased significantly compared with that of prior treatment.The symptoms of 24 patients in control group were improved partly,which were not as good as those in treatment group(P＜0.01).The side effects of gabapentin were drowsiness and dizziness,but most symptoms were relieved or disappeared within 1 week and no patient interrupted therapy.No serious adverse events were observed. Conclusion Gabapentin is safe and effective for refractory uremic pruritus,but long-term efficacy and safety requires larger sample and long-term observation.
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Objective To observe the efficacy and safety of in-center nocturnal hemodialysis (INHD) in uremic patients. Methods Thirty-two maintenence hemodialysis (MHD) patients received INHD (3 times per week and 7.5 hours each session) for 6 months.Before and 1, 3 and 6 months after entering INHD, blood routine, hepatic and renal function,serum electrolyte, lipids, parathyroid hormone and β2-microglobulin(β2-MG) were assayed, Kt/V and URR were calculated. Blood pressure of each dialysis session 2 months before and 6 months after INHD was recorded. Cardiac ultrasound and SF-36 questionnaire before and after INHD were performed. Use of drugs was recorded. Results Compared with 2 months before INHD, predialysis BP decreased [(130.3/86.0) vs (139.3/88.6) mm Hg, P＜0.01], while post-dialysis BP raised significantly [(121.1/80.5) vs (115.0/77.8) mm Hg, P＜0.01] 6 months after INHD.Intradialysis hypertension (9.8%vs 24.0%) and hypotension (7.3% vs 14.9%) both reduced (all P＜0.01). Serum phosphorus [(1.37±0.27) vs (2.08±0.49) mmol/L, P＜0.01] and iPTH [(355.4±139.6) vs (632.3±750.0) ng/L, P＜0.01] decreased, while calcium increased [(2.64±0.25) vs (2.28±0.37) mmol/L, P＜0.01], HDL[(1.27±0.29) vs (0.75±0.08) mmol/L] increased, LDL [(2.04±0.52) vs (2.75±0.75) mmol/L] decreased (all P＜0.05). URR [(79.7±0.1)% vs (64.7±4.7)%] and Kt/V (1.40±0.44 vs 0.89±0.25, P＜0.01) increased. Serum β2-MG decreased [(17.3±3.9) vs (24.6±5.9) mg/L, P＜0.01]. LVMI decreased [(99.8±29.0) vs (114.8±72.7), P＜0.05]. Physical functioning, role-physical and role-emotional of SF-36 increased (all P＜0.01). The types of antihypertension drug, dosage of EPO, Vitamin D3 and phosphorus binder decreased (all P＜0.01).Patients of drug withdrawal increased (P＜0.05). Conclusion The hypertension, anemia,calcium-phosphorus metabolism, lipid disorder, cardiac malfunction and the quality of life are improved in INHD patients.
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Objective To investigate the safety and tolerability of darbepoetin alfa.a long-lasting erythmpoietin,single intravenous administration in maintenance hemodialysis(MHD) patients. Methods A single center,open clinical trial was carried out.Forty-three stable MHD patients were divided into 5 groups and received darbepoetin α at dosage of 0.225,0.45,0.9,1.8,3.6 μg/kg respectively.The vital signs,symptoms,ECG and laboratory examinations were monitored and detected before and after administration. Results Of the 43 patients (male 26and female 17),the largest tolerable dosage of darbepoetin alfa was 3.6 μg/kg.During the study,the main side effect associated with darbepoetin was hypertension aggravation(7%).One patient died but that was not associated with darbepoetin alfa. Conclusion Darbepoetin alfa is sale and well tolerated.
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Objective To evaluate the effects of alendronate sodium on bone mineral density (BMD) in maintenance haemodialysis (MHD) patients with osteoporosis. Methods Twenty-eight MHD patients with osteoporosis diagnosed by dual energy X-ray absorptiometry were randomly divided into control group (n=15) and treatment group (n=13). Patients in treatment group were treated with oral 70 mg alendronate sodium once a week for 18 months. BMD of hip and lumbar spine was measured by dual energy X-ray absorptiometry at baseline and the end of the 6th, 12th and 18th month. Parathyroid hormone, calcium, phosphorous, alkaline phosphatase levels, blood routine, hepatic and renal function were assayed at baseline and the end of the 18th month, Kt/V was calculated, new bone fracture was recorded. Results The BMD, T-scores and Z-scores in the lumbar spine and specific regions of the hip were stable in the treatment group and obviously decreased in the control group (P<0.01). New bone fracture was found in 1 patient of the treatment group and 5 patients of the control group. The side-effect of alendronate sodium was epigastric discomfort in 1 cases. Conclusions Oral alendronate sodium appears to be well tolerated in MHD patients and keep the BMD stable in the lumbar spine and specific regions of the hip.
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Objective:To investigate the cardiovascular protection effect of cilazapril in hemodialystic patients|(HD). Methods:Thirty HD with hypertension and left ventricular hypertrophy patients were randomly divided into two groups.Group A(n=20) cilazapril 2.5 mg～5 mg,group B(n=10) as control. After six mouths,the left ventricular mass and function were monitored by color Doppler cardiography. Results:BP was decreased in both group.LVDd,IVS,LVPWD and LVMI were decreased in cilazapril group. Conclusion:Cilazapril is not only effective and safe in treatment of hypertension,reversed the ventricular hypertrophy and improved the diastolic function in HD patients also.
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Objective: To study the prevalence and pathogenesis of TT virus (TTV) in hemodialysis patients. Methods: Serum TTV DNA was tested in 69 hemodialysis patients from our hospital by nested-PCR using primers from a conservative region of TTV genenome, genetic analysis and detection of hepatitis C virus antibody (anti-HCV) and the levels of alanine aminotransferase (ALT) were also carried out simultaneously. Results: The overall prevalence of TTV viremia was 27.5%. The PCR-amplified gene fragment from one patient was sequenced, and its gene sequence homologies with GH1,TA278, TTVCHN1 and TTVCHN2 ranged from 89% to 100%, its deduced amino acid sequence ranged from 87% to 100%. There was no significant difference of TTV prevalence between anti-HCV positive and negative patients. No significant elevation of ALT was found in all patients. Conclusion: High prevalence of TTV infection is found among hemodialysis patients, and TTV infection has no significant association with HCV infection or elevation of ALT.
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Objective To study the quantitative method of determination of Fas ligand (FasL) and T-cell intracellular antigen-1 (TIA-1) in renal allografts and to evaluate its clinical significance. Methods The magnitude of intragraft FasL and TIA-1 mRNA was quantified by competitive PCR in 42 samples obtained to diagnose the etiology of graft dysfunction, and the results were expressed as the ratio of picograms of target gene to picograms of ?-actin, and were compared with the histopathogical diagnosis based on Banff criteria. Results Of all 42 samples, the transcripts were detectable in 11 for FasL and 27 for TIA-1. Intragraft expression of FasL and TIA-1 was significantly up-regulated in acute rejection group compared with chronic rejection group (P
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10 years) groups.The form and function of ventricle were measured.And the blood pressure,hemoglobin,plasma albumin,pre-albumin,lipid,C responsive protein,calcium,phosphate and parathyroid hormone before dialysis were determined.Results The cardiac output(CO) of 1～2 years group was the highest.The left ventricular end-systolic and end-diastolic dimension(LVEDd/s)and left ventricular mass index(LVMI)of ≤1 year group were the lowest.With the increase of the dialysis ages,the blood pressure and the proportion of diabetes patients and those with LVH decreased,but the hemoglobin,plasma albumin,pre-albumin,calcium,phosphate and parathyroid hormone increased,while the CRP decreased.Conclusion With the increase of the dialysis ages,the left ventricular function of the uremic hemodialysis patients improves,which is probably associated with the improvement of anemia,malnutrition and inflammation.
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Objective: To study the application of glucose infusion test (GIT) in assaying the vascular access recirculation rate in hemodialysis patients. Methods: Access recirculation was assayed by both urea test (UT) and GIT in 82 hemodialysis patients, and 17 patients were also examined by Doppler ultrosonics method. The results of the Doppler ultrosonics were compared with those of UT and GIT. Results: Thirty-seven (45.12%) patients showed positive results with GIT and 29 patients (35.36%) with UT.All 17 patients had recirculation confirmed by Doppler ultrosonics and all had positive results by GIT (100%), but only 9 (52.94%) of the 17 patients had positive results by UT. Conclusion: Comapared with UT, GIT is more sensitive, more ecnomical,and simpler in determining vascular access recirculation, and can be used as a new method for screening vascular access recirculation.
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Objective:To demonstrate whether L carnitine can further improve the effect of recombinant human erythropoietin (rhEPO) in treatment of anemia. Methods: The patients were randomly divided into 3 groups, group A : L carnitine 1.0 g intravenously infused after every dialysis session; group B: rhEPO 50 150 IU/kg subcutaneously injected once or twice a week; group C: L carnitine and rhEPO given together. The serum albumin, hemoglobin(Hb) and hematocrit(Hct) were monitored for 6 months. Results: The albumin value in L carnitine group was significantly higher than that in rhEPO group ( P
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Objective:To construct a mutispecific internal control for competitive RT-PCR analysis of Fas、FasL、GB、P、TIA-1 and ?-actin.Methods:Invitro synthesized fragments were amplified by PCR,there are two products,of which 145 and 147 bp.The 145 bp one contained 5′ primer sequences of Fas、FasL、GB、P、TIA-1 and ?-actin,another contained 3′ primer sequences of the same genes.The products with restriction sites were inserted into the vector PKF_3.Results:Restriction enzyme analysis and DNA sequencing were used to identify the recombinant plasmid,corresponding internal control was obtained by the amplification of the recombinant plasmid with each primer pair.The mutispecific internal control was then used for quantitative detection of TIA-1 in peripheral blood leukocytes from a patient with acutely rejecting allograft.Our study on Fas、FasL、GB、P、TIA-1 and ?-actin showed that the coamplified templates accumulated in a parallel manner throughout not only the exponential phase.Conclusion:The mutispecific internal control can be used for quantitative detection of the six genes. [
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Objective Peripheral arterial diseases(PAD)are most common conditions in patients with end stage renal disease(ESRD). However, PAD hasn′t been extensively studied like other cardiovascular or cerebrovascular diseases such as coronary heart disease and cerebral infarction among ESRD patients. The present study aims to investigate the ultrasonic characteristics of PAD and risk factors related to peripheral arterial intima thickening and plaques formation. Methods Seventy-three ESRD patients and 21 healthy individuals (as control) were involved in the investigation, and their carotid and lower-extremity arteries including tunica intima, lumen diameter, plaques and Doppler spectrums were examined with color Doppler ultrasonic technique. Then, the risk factors related to intima thickening and plaques formation among ESRD patients were studied combining with their clinical data and biochemical makers. Results The lesions of varying degrees in peripheral arteries occured in 52.1%(38/73) ESRD patients, including intima thickening, coarse and chaotic tunica intima, strong echo masses or atheromatous plaques with different shapes and sizes, widened and deformed Doppler spectrums, accelerated peak systolic velocity and lowered or disappeared diastolic reverse peak at narrow sites, low resistant blood flow at apo-stenosis sites (prolonged systolic accelerative time and decreased acceleration). The incidence of PAD was significantly higher in ESRD patients than that in control group (14.3%, P