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Objective:To explore the clinical characteristics and risk factors of sarcopenia in elderly patients with chronic kidney disease (CKD) stage 3-4.Methods:It was a single-center, retrospective observational study. CKD stage 3-4 patients aged ≥60 years old from March 2019 to March 2022 in the Geriatrics Department of the First Affiliated Hospital of Zhengzhou University were enrolled in the study. General data of the patients were collected, and laboratory indicators, muscle strength, physical function and appendicular muscle mass index (ASMI) were measured. According to the diagnostic criteria of sarcopenia, the patients were divided into no sarcopenia CKD group and sarcopenia CKD group. Baseline data between these two groups were compared. Logistic regression analysis was used to analyze the related factors of sarcopenia in elderly CKD stage 3-4 patients.Results:A total of 162 CKD stage 3-4 patients were enrolled in this study, with 89 males (54.9%) and a median age of 75 (69, 82) years. Sarcopenia was diagnosed in 40 cases, and the prevalence was 24.7% (95% CI 18.1%-31.3%). Compared with no sarcopenia CKD group, age, proportion of dementia, cystatin C, urea nitrogen, C-reactive protein (CRP) and ratio of urine protein to creatinine were higher (all P<0.05), while body mass index (BMI), hemoglobin, carbon dioxide combining power, estimated glomerular filtration rate (eGFR), serum albumin and the proportion of regular exercise and using α-ketones were lower in sarcopenia CKD group (all P<0.05). Meanwhile, grip strength, walking speed, short physical performance battery score and ASMI were lower in sarcopenia CKD group (all P<0.05). Multivariable logistic regression analysis results showed that low eGFR ( OR=0.824, 95% CI 0.687-0.987, P=0.036), low BMI ( OR=0.463, 95% CI 0.304-0.704, P<0.001), low serum albumin ( OR=0.459, 95% CI 0.263-0.802, P=0.006) and high CRP ( OR=2.754, 95% CI 1.708-4.439, P<0.001) were the independent related factors of sarcopenia in elderly CKD patients. Conclusions:The prevalence of sarcopenia in elderly CKD stage 3-4 patients is high. Low eGFR, low BMI, low serum albumin and high CRP are the independent risk factors for sarcopenia in elderly CKD stage 3-4 patients.
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Objective:To investigate the effect of improving moderate and severe benign prostatic hyperplasia(BPH)with lower urinary tract symptoms(LUTS)on renal function in elderly patients aged 80 years and over.Methods:A total of 129 inpatients with moderate and severe BPH and its associated LUTS(BPH/LUTS)who took tamsulosin combined with finasteride aged 80 years old and over in Geriatric Department of the First Affiliated Hospital of Zhengzhou University were enrolled in the retrospective study from July 2018 to July 2020.Patients were divided into normal blood pressure group(n=51)and hypertension group(n=78)and divided into normal renal function group(n=77)and CKD3a stage group(n=52).Serum creatinine, estimated glomerular filtration rate(eGFR), prostate volume(PV)and post-void residual urine volume(PVR), and International Prostate Symptom Score(IPSS)were compared before versus after 1, 3 and 6 months of treatment.Multivariable linear regression analysis was performed to evaluate the influence of the most relevant factors on renal function in patients with BPH/LUTS.Results:After 1, 3 and 6 months of tamsulosin combined with finastide treatment, the lower urinary tract symptoms of elderly patients with BPH/LUTS were improved, IPSS score and PVR were decreased, and the differences were statistically significant(all P<0.01).PV, serum creatinine and eGFR were not changed after 6 months of treatment(all P>0.05).However, further subgroup analysis showed that serum creatinine level in hypertension group and CKD3a stage group was increased compared with that before treatment, while eGFR in CKD3a stage group was decreased before treatment, and the difference was statistically significant(all P<0.05).Compared with before treatment, serum creatinine and eGFR in hypertensive group improved after 3 months of treatment, and CKD3a group improved after 1 month of treatment, and the differences were statistically significant(all P<0.05).There were no significant changes in serum creatinine and eGFR in normal blood pressure group and normal renal function group after 6 months of treatment(all P>0.05).Multiple linear regression analysis showed that hypertension( β=2.06, P<0.05)and CKD3a stage( β=17.16, P<0.01)were independent risk factors for creatinine changes before and after treatment.Hypertension( β=-2.27, P<0.01), CKD3a stage( β=-11.93, P<0.01)and CKD3A stage( β=-2.27, P<0.01)were independent risk factors for creatinine changes before and after treatment. P<0.01)and PV before treatment( β=-0.11, P<0.05)were independent risk factors for the change of eGFR before and after treatment. Conclusions:Treatment for moderate and severe BPH/LUTS can improve renal function in elderly patients with hypertension or CKD3a.
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Objective To investigate the effect and mechanism of soluble epoxide hydrolase inhibitor (sEHI) for NF-κB pathway and cell circle arrest of tubular epithelial cell in unilateral ureteral obstruction (UUO) mice model.Methods Thirty-two healthy C57BL/6 male mice performed UUO surgery to induce renal interstitial fibrosis.Animals were randomly divided into 4 groups:sham group (n=8),sEHI (1 mg· kg-1·d-1) group (n=8),UUO group (n=8) and UUO+sEHI (1 mg· kg-1· d-1) group (n=8).Daily sEHI [1-(1-methylsulfonyl-piperidin-4-yl)-3-(4-trifluoromethoxy-phenyl)-urea,TUPS] or 2％ DMSO was applied to mice by oral gavage from day 1 to day 14 after surgery.All mice were sacrificed at day 14 and kidneys were harvested for further analysis.The changes of renal tissue morphology and pathology were observed by Hematoxylin and eosin (HE) and sirius red staining.The expressions of sEH,nuclear factor κB p65 (NF-κB p65) and IκB were measured by Western blotting.The expressions of TNF-α,IL-1β,MCP-1,IL-6,TGF-β,CTGF,collagen-Ⅳ and α-SMA were analyzed by real-time PCR.Immunofluorescence staining of phospho-histone H3 (p-HH3) and Ki67 was performed to determine the stage of cell cycle G2/M arrest.Results The expression and activity of sEH increased in UUO group (P ＜ 0.05).Administration of sEHI inhibited activity of sEH and infiltration of inflammatory cell in tubular interstitial,as well as attenuated tubular damage and tubular interstitial fibrosis.Western blotting analysis revealed administration of sEHI inhibited up-regulated NF-κB p65 and down-regulated IκB in UUO group (P ＜ 0.05).Real-time PCR demonstrated that administration of sEHI obviously decreased the mRNA expression of cytokines and fibrosis markers,including of TNF-α,IL-1 β,MCP-1,IL-6,TGF-β,CTGF,Collagen-Ⅳ,α-SMA (P ＜ 0.05).Immunofluorescence staining showed that there were much more p-HH3 and Ki67 double positive nuclear tubular epithelial cells and interstitial cells in UUO group,compared with Sham group (P ＜ 0.05).Administration of sEHI reduced the number of double positive nuclear cell only in tubular epithelial cells (P ＜ 0.05),but not in interstitial cells.Conclusions In UUO tubular interstitial fibrosis model,sEHI inhibits the activation of NF-κB pathway by down-regulating p65 and up-regulating IκB and ameliorates the infiltration of inflammatory cells.In addition,sEHI plays anti-fibrosis effect by moderating cell cycle G2/M arrest and reducing the excrete of pro-fibrosis factors of tubular epithelial cells.