Research progress on the relationship between serum magnesium and survival and prognosis of uremic maintenance dialysis patients / 中国综合临床

With the gradual maturity of renal replacement therapy technology, prolonging life span and improving quality of life of patients with uremia have become the ultimate management goals. In recent years, many studies at home and abroad have suggested that hypomagnesemia has an adverse effect on the prognosis of dialysis patients, which may be related to an increased risk of death. We understand the correlation between blood magnesium and blood pressure, cardiovascular disease, bone metabolism and vascular calcification, point out that blood magnesium may become one of the control indicators to reduce the mortality of dialysis patients, and explore its new clinical application.

Disruptive technologies for hemodialysis: medium and high cutoff membranes. Is the future now? / Tecnologias disruptivas para hemodiálise: membranas de ponto de corte médio e alto. O futuro é agora?

Abstract In the past decade, a new class of hemodialysis (HD) membranes (high retention onset class) became available for clinical use. The high cutoff (HCO) and the medium cutoff (MCO) membranes have wider pores and more uniformity in pore size, allowing an increased clearance of uremic toxins. Owing to the mechanism of backfiltration/internal filtration, middle molecules are dragged by the convective forces, and no substitution solution is needed. The HCO dialyzer is applied in septic patients with acute kidney injury requiring continuous kidney replacement therapy. The immune response is modulated thanks to the removal of inflammatory mediators. Another current application for the HCO dialyzer is in hematology, for patients on HD secondary to myeloma-kidney, since free light chains are more efficiently removed with the HCO membrane, reducing their deleterious effect on the renal tubules. In its turn, the MCO dialyzer is used for maintenance HD patients. A myriad of clinical trials published in the last three years consistently demonstrates the ability of this membrane to remove uremic toxins more efficiently than the high-flux membrane, an evolutionary disruption in the HD standard of care. Safety concerns regarding albumin loss as well as blood contamination from pyrogens in the dialysate have been overcome. In this update article, we explore the rise of new dialysis membranes in the light of the scientific evidence that supports their use in clinical practice.

Resumo Na última década, uma nova classe de membranas de hemodiálise (HD) (classe de início de alta retenção) tornou-se disponível para uso clínico. As membranas de ponto de corte alto (HCO) e ponto de corte médio (MCO) têm poros mais largos e maior uniformidade no tamanho dos poros, permitindo uma maior depuração de toxinas urêmicas. Devido ao mecanismo de retrofiltração/filtração interna, as moléculas médias são arrastadas pelas forças convectivas, não sendo necessária uma solução de substituição. O dialisador de HCO é aplicado em pacientes sépticos com lesão renal aguda que requerem terapia renal substitutiva contínua. A resposta imunológica é modulada graças à remoção de mediadores inflamatórios. Outra aplicação atual para o dialisador de HCO é em hematologia, para pacientes em HD secundária ao rim do mieloma, uma vez que as cadeias leves livres são removidas mais eficientemente com a membrana de HCO, reduzindo seu efeito deletério sobre os túbulos renais. Por sua vez, o dialisador de MCO é utilizado para pacientes em HD de manutenção. Uma miríade de ensaios clínicos publicados nos últimos três anos demonstra consistentemente a capacidade desta membrana de remover toxinas urêmicas de forma mais eficiente do que a membrana de alto fluxo, uma ruptura evolutiva no padrão de cuidado em HD. As preocupações de segurança em relação à perda de albumina, bem como a contaminação do sangue por pirogênios no dialisato foram superadas. Neste artigo de atualização, exploramos o surgimento de novas membranas de diálise à luz das evidências científicas que apoiam seu uso na prática clínica.

AGEs accumulation is related to muscle degeneration and vascular calcification in peritoneal dialysis patients / O acúmulo de AGEs está relacionado à degeneração muscular e calcificação vascular em pacientes em diálise peritoneal

Abstract Background: Patients with chronic kidney disease (CKD) are affected by dynapenia, sarcopenia, and vascular calcification. Advanced glycation end products (AGEs) may accumulate in peritoneal dialysis (PD) patients and favor sarcopenia via changes in collagen cross-linking, muscle protein breakdown, and the calcification of arterial smooth muscle cells via p38-MAPK activation. The aim of this study is to explore the relationships between AGEs, muscle degeneration, and coronary artery calcification. Methods: This was a clinical observational study in patients with CKD undergoing PD, in which serum and skin AGEs (AGEs-sAF), cumulative glucose load, muscle strength and functional tests, muscle ultrasounds with elastography, coronary artery calcium (CAC) quantification, and muscle density by multislice computed tomography were measured. Results: 27 patients aged 48±16 years, dialysis vintage of 27±17 months, had AGEs-sAF levels of 3.09±0.65 AU (elevated in 13 [87%] patients), grip strength levels of 26.2±9.2 kg (11 [42%] patients with dynapenia), gait speed of 1.04±0.3 m/s (abnormal in 14 [58%] patients) and "timed-up-and-go test" (TUG) of 10.5±2.2s (abnormal in 7 [26%] patients). Correlations between AGEs-sAF levels and femoral rectus elastography (R=-0.74; p=0.02), anterior-tibialis elastography (R= -0.68; p=0.04) and CAC (R=0.64; p=0.04) were detected. Cumulative glucose load correlated with femoral rectal elastography (R=-0.6; p=0.02), and serum glycated hemoglobin concentrations correlated with psoas muscle density (R= -0.58; p=0.04) and CAC correlated with psoas muscle density (R=0.57; p=0.01) and lumbar square muscle density (R=-0.63; p=0.005). Conclusions: The study revealed associations between AGEs accumulation and lower muscle stiffness/density. Associations that linked muscle degeneration parameters with vascular calcification were observed.

Resumo Histórico: Pacientes com doença renal crônica (DRC) são afetados pela dinapenia, sarcopenia e calcificação vascular. Produtos finais da glicação avançada (AGEs) podem se acumular em pacientes em diálise peritoneal (DP) e favorecer a sarcopenia por meio de alterações em ligações cruzadas do colágeno, quebra da proteína muscular e calcificação das células do músculo liso arterial por meio da ativação da p38-MAPK. O objetivo deste estudo é explorar as relações entre AGEs, degeneração muscular e calcificação da artéria coronária. Métodos: Este foi um estudo clínico observacional em pacientes com DRC submetidos à DP, no qual foram medidos os AGEs séricos e teciduais (AGEs-sAF), a carga cumulativa de glicose, a força muscular e testes funcionais, ultrassonografias musculares com elastografia, quantificação do cálcio da artéria coronária (CAC), e a densidade muscular por tomografia computadorizada multislice. Resultados: 27 pacientes com idade entre 48±16 anos, tempo de diálise entre 27±17 meses, tinham níveis de AGEs-sAF de 3,09±0,65 UA (elevado em 13 [87%] pacientes), níveis de força de preensão de 26,2±9,2 kg (11 [42%] pacientes com dinapenia), velocidade de marcha de 1,04±0,3 m/s (anormal em 14 [58%] pacientes) e teste "timed-up-and-go" (TUG) de 10,5±2,2s (anormal em 7 [26%] pacientes). Foram detectadas correlações entre os níveis AGEs-sAF e a elastografia do reto femoral (R=-0,74; p=0,02), a elastografia tibial anterior (R= -0,68; p=0,04) e a CAC (R=0,64; p=0,04). A carga cumulativa de glicose se correlacionou com a elastografia do reto femoral (R=-0,6; p=0,02), as concentrações séricas de hemoglobina glicada se correlacionaram com a densidade muscular do psoas (R= -0,58; p=0,04) e o CAC se correlacionou com a densidade do músculo psoas (R=-0,57; p=0,01) e a densidade do músculo quadrado lombar (R=-0,63; p=0,005). Conclusões: O estudo revelou associações entre o acúmulo de AGEs e menor rigidez/densidade muscular. Foram observadas associações que ligavam parâmetros de degeneração muscular com a calcificação vascular.

Dental implant treatment for patients with chronic kidney disease / 口腔疾病防治

@#Chronic kidney disease is a global public health problem threatening human health and affects the function of multiple organ systems. The oral health of patients is often affected as the disease progresses. Dental implants have become the best way to repair tooth loss. It is necessary and challenging to provide safe and reliable dental implant treatment for patients with chronic kidney disease. Dental clinicians should evaluate the health of patients comprehensively, complete blood biochemistry, coagulation function, and imaging examinations, and provide feasible, reliable and personalized treatment plans. During the treatment phase, dental clinicians need to consider prophylactic antibiotics, painless minimally invasive surgery, infection control, and delayed restoration, and they must cooperate with other clinicians in multiple disciplines to reduce risks to provide personalized, safe, and effective oral implant treatment for patients with chronic kidney disease.

Arteriolopatía urémica calcificante: presentación de caso clínico con manejo médico conservador / Calcific uremic arteriolopathy: presentation of a clinical case with conservative medical management

Antecedentes: La arteriolopatia calcificante urémica o calcifilaxis es un síndrome raro, potencialmente mortal, que afec-ta casi en exclusiva a pacientes con insuficiencia renal y diálisis, caracterizado por calcificación vascular de arterias de pequeño y mediano calibre, con posterior proliferación, fibrosis y trombosis que conducen finalmente a necrosis y úlceras cutáneas. Se asocia con la enfermedad renal crónica terminal y trasplante renal, con preva-lencia de 1-4% de los pacientes con insuficiencia renal crónica. El tratamiento es especializado a base de cámara hiperbárica y para-tiroidectomía para inducir curación. Descripción del caso clínico: Femenina de 42 años, captada en la consulta externa de nefrología en el Instituto Hondureño de Seguridad Social en el año 2017, con antecedente de hipertensión arterial y nefropatía crónica, sometida a trasplante renal en 1998 el cual fue fallido, posteriormente en pro-grama de hemodiálisis y manejo conservador desde el año 2005. La paciente desarrolló lesiones equimóticas en tronco y úlceras en sitios de nódulos subcutáneos que se sobreinfectaron, desarrollan-do signos de respuesta inflamatoria sistémica. Los exámenes de laboratorio mostraron hiperfosfatemia, paratohormona 3518 pg/ml, producto calcio-fósforo 73.5. Ante la falta de manejo quirúrgico (pa-ratiroidectomía) y cámara hiperbárica en la institución, en el 2017 se estableció tratamiento conservador a base de antibióticos, analgési-cos, y hemodiálisis diarias, con lo que presentó mejoría del cuadro clínico; sin embargo, sin resolución de su cuadro de base de la calci-filaxis. Conclusión: El manejo conservador en el caso de pacientes con calcifilaxis es una opción de tratamiento disponible con buena respuesta en pacientes con seguimiento estrecho...(AU)

Effect of aldehyde scavenger-salicylamine on atherosclerosis of uremic ApoE-/- mice / 西安交通大学学报(医学版)

Objective: To observe the effect of aldehyde scavenger, salicylamine (SAM), on atherosclerosis (AS) and its phenotype in uremic apolipoprotein E knockout (ApoE-/-) mice. Methods:Uremic ApoE-/- mice model was created by 5/6 nephrectomy; control ApoE-/- mice were sham-operated. Three subgroups of experimental mice were set up: uremia SAM intervention group, uremia group and control group, which were treated with SAM (1 g/L) or vehicle for 6 weeks, respectively. After the intervention was completed, we assessed the body weight, blood pressure, renal function, serum lipid profile, serum SAM concentration, extent and characteristic of aortic atherosclerotic lesion in each group of mice. Results: Compared with control group: aortic AS lesion area, necrotic area and macrophage content in AS lesion increased but collagen content in AS lesion decreased in uremia group. SAM treatment for 6 weeks lessened the atherosclerotic lesion area, necrotic area and macrophage content of plaques, and meanwhile increased collagen content of plaques in uremic mice, not accompanied by changes in body weight, blood pressure, serum lipid profile or renal function. SAM did not accumulate or induce toxic effect on uremic ApoE-/- mice. Conclusion: Aldehyde scavenger SAM ameliorates renal injury-induced acceleration of AS, alters atherosclerotic phenotype, and increases the stability of plaques. These benefits are independent of effects on blood pressure, lipid profile or renal function. SAM does not accumulate or induce toxic effect in uremic ApoE-/- mice.

Dystrophic mineralization in uremic dogs: an update / Mineralização distrófica em cães urêmicos: uma atualização

Pathological mineralization is the abnormal deposition of minerals in body tissues, previously injured or not. In these lesions, in addition to calcium, other minerals can be found at lower concentrations. Classically, mineralization is divided into two types: dystrophic and metastatic. However, currently, there is no consensus among researchers on the type of mineralization that occurs in uremic dogs. The objective of this study was to elucidate the type of pathological mineralization that occurs in dogs with uremic syndrome through the correlation of biochemical examinations with gross and histopathological changes, given the existence of controversial information on this theme in the specialized literature. The Shapiro-Wilk, D'Agostino and Pearson tests were used to evaluate data normality distribution, and analysis of variance (ANOVA) was applied to compare the data between more than two groups. Additionally, the Dunnett's multiple comparison test was used in the comparison between the Control Group (CG) and the Experimental Groups (G1, G2, and G3). Serum levels of urea, creatinine, total and ionized calcium, phosphorus, calcium-phosphorus product (CPP), parathyroid hormone (PTH), and albumin of 40 azotemic dogs with chronic kidney disease (CKD) were evaluated. Dogs were categorized by degree of azotemia (mild, moderate, and severe). Ionized hypocalcemia was observed in 97.5% (39/40) of the dogs, and no animals presented ionized hypercalcemia. Hyperphosphatemia was frequent (62.5%), especially in dogs with severe azotemia. PTH concentration increased with progression of azotemia, and high PTH levels were verified in 100% of the dogs with severe azotemia. CPP >60mg2/dl2 was observed in 75% (30/40) of the dogs. Of the 29 dogs that died during the study period, 16 were necropsied. Soft tissue mineralization was observed in 93.7% (15/16) of these dogs at gross and histopathological evaluation (HE and Von Kossa), regardless of the degree of azotemia, in nine organs/tissues: kidneys (75%), lungs (50%), stomach (31.2%), heart (25%), larynx (25%), intercostal muscles (25%), aorta (6.2%), intestines (6.2%), and tongue (6.2%). In one animal, the serosa of all segments of the small intestine showed whitish, rough, irregular, multifocal plaques of varying sizes, confirmed by histopathology as dystrophic mineralization of the longitudinal outer muscular layer, which presented necrosis of coagulation and of the intestinal serosa. This intestinal lesion has not been described in dogs with uremic syndrome to date. In conclusion, the laboratory and histopathologic data previously described, especially regarding tissue and vascular mineralization, which occur in association with previous degenerative/necrotic lesions in the absence of hypercalcemia in dogs with CKD, assist with clarifying inconsistencies found in the existing literature. Therefore, conceptually, mineralization that occurs in uremic dogs should be considered dystrophic.(AU)

Mineralização patológica é a deposição anormal de minerais em tecidos previamente lesados ou não. Nessas lesões, além do cálcio, outros minerais podem ser encontrados em concentrações inferiores. Classicamente, as mineralizações são divididas em dois tipos: distrófica e metastática. Contudo, atualmente, ainda não há consenso entre os pesquisadores sobre o tipo de mineralização que ocorre em cães urêmicos. Objetivou-se com esse estudo elucidar o tipo de mineralização patológica que ocorre em cães com síndrome urêmica através da correlação de exames bioquímicos com alterações macroscópicas e histopatológicas, visto a existência de informações controversas na literatura especializada. Os dados obtidos foram submetidos ao teste de Shapiro-Wilk e teste de D'Agostino e Pearson para avaliação da normalidade da distribuição e para comparação de dados em mais de dois grupos foi utilizado o teste ANOVA. Adicionalmente, o teste de comparações múltiplas de Dunnett permitiu a comparação entre o grupo controle (GC) com os demais grupos (G1, G2 e G3). Foram avaliados os níveis séricos de ureia, creatinina, cálcio total e ionizado, fósforo, produto cálcio-fósforo (PCF), PTH e albumina de 40 cães azotêmicos com doença renal crônica (DRC). Os cães foram classificados quanto ao grau de azotemia (leve, moderada e severa). Verificou-se hipocalcemia ionizada em 97,5% (39/40) dos cães e, em nenhum animal houve hipercalcemia ionizada. Hiperfosfatemia foi frequente (62,5%), principalmente em cães com azotemia severa. A concentração do PTH aumentou conforme a progressão da azotemia, encontrando-se elevada em 100% dos cães com azotemia severa. Em 75% (30/40) dos cães o PCF foi superior a 60mg2/dl2. Durante o estudo, 29 cães morreram, sendo 16 desses necropsiados. Em 93,7% (15/16) desses cães observou-se mineralização de tecidos moles, durante a avaliação macroscópica e histopatológica (HE e Von Kossa), independentemente do grau de azotemia, em nove órgãos/tecidos: rins (75%), pulmões (50%), estômago (31,2%), coração (25%), laringe (25%), músculos intercostais (25%), aorta (6,2%), intestino (6,2%) e língua (6,2%). Adicionalmente, em um animal verificou-se na serosa de todos os segmentos do intestino delgado placas multifocais brancacentas, rugosas, irregulares de tamanhos variados, cuja histopatologia confirmou tratar-se de mineralização distrófica da camada longitudinal muscular externa que apresentava necrose de coagulação e da serosa intestinal. Essa lesão intestinal nunca havia sido descrita em cães com síndrome urêmica. Em suma, os dados laboratoriais e histopatológicos aqui descritos, sobretudo, no que se refere à mineralização tecidual e vascular, que ocorrem relacionadas a lesões degenerativo-necróticas prévias, na ausência de hipercalcemia, em cães com DRC, ajudam a esclarecer as incongruências existentes na literatura. Por conseguinte, conceitualmente, as mineralizações que ocorrem em cães urêmicos devem ser consideradas distróficas.(AU)

The specific impact of uremic toxins upon cognitive domains: a review / O impacto específico de toxinas urêmicas em domínios cognitivos: uma revisão

ABSTRACT One of the mechanisms proposed for chronic kidney disease (CKD)-related cognitive impairment is the accumulation of uremic toxins due to the deterioration of the renal clearance function. Cognition can be categorized into five major domains according to its information processing functions: memory, attention, language, visual-spatial, and executive. We performed a review using the terms 'uric acid', 'indoxyl sulfate', 'p-cresyl sulfate', 'homocysteine', 'interleukins' and 'parathyroid hormone'. These are the compounds that were found to be strongly associated with cognitive impairment in CKD in the literature. The 26 selected articles point towards an association between higher levels of uric acid, homocysteine, and interleukin 6 with lower cognitive performance in executive, attentional, and memory domains. We also reviewed the hemodialysis effects on cognition. Hemodialysis seems to contribute to an amelioration of CKD-related encephalopathic dysfunction, although this improvement occurs more in some cognitive domains than in others.

RESUMO Um dos mecanismos propostos para explicar o comprometimento cognitivo relacionado à doença renal crônica (DRC) é o acúmulo de toxinas urêmicas devido à deterioração da função de depuração renal. A cognição pode ser categorizada em cinco domínios principais de acordo com suas funções de processamento de informações: memória, atenção, linguagem, visual-espacial e executiva. Realizamos uma revisão usando os termos "ácido úrico", "indoxil sulfato", "p-cresil sulfato", "homocisteína", "interleucinas" e "paratormônio". Estes são os compostos que se mostraram fortemente associados ao comprometimento cognitivo na DRC na literatura. Os 26 artigos selecionados apontam para uma associação entre níveis mais elevados de ácido úrico, homocisteína e interleucina-6 com menor desempenho cognitivo nos domínios executivo, atenção e de memória. Também revisamos os efeitos da hemodiálise na cognição. A hemodiálise parece contribuir para uma melhoria da disfunção encefalopática relacionada à DRC, embora essa melhora ocorra mais em alguns domínios cognitivos do que em outros.

Uremic neuropathy: an overview of the current literature

SUMMARY INTRODUCTION: Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. Objectives: This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. Methods: This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". Results: A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. Conclusion: Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.

RESUMO INTRODUÇÃO: A neuropatia periférica (NU) é um distúrbio que afeta o corpo celular, o axônio ou a mielina do motor ou neurônios sensoriais periféricos e ocorre em 60%-100% dos pacientes que são submetidos à diálise por doença renal crônica. A neuropatia urêmica é atribuída à acumulação de resíduos orgânicos, evidente em pacientes com taxa de filtração glomerular reduzida. Objetivo: O objetivo desta revisão é fazer com que as características clínicas da neuropatia urêmica sejam evidenciadas, permitindo o diagnóstico e tratamento precoce. Método: Esta é uma revisão da literatura de artigos publicados no PubMed nos últimos dez anos usando "Neuropatia Urêmica" como "Título/Resumo". Resultados: No total, foram incluídos nove artigos que atendem aos critérios de inclusão. A NU é uma polineuropatia sensório-motora simétrica distal que ocorre devido ao acúmulo de toxinas urêmicas associadas à atividade de radicais livres relacionados ao estresse oxidativo. A hipercalemia tem um papel importante na sua fisiopatologia. O diagnóstico depende de estudos de condução nervosa e o tratamento inclui diálise ou transplante renal. Conclusão: As apresentações clínicas das NU são amplas e não específicas; no entanto, é importante detectar mudanças iniciais para evitar sua progressão. Quanto mais precoce for a detecção e tratamento da NU, melhor será o resultado clínico.

Effect of rehabilitation exercise training on sleep quality and fatigue of hemodialysis patients with uremia / 中国实用护理杂志

Objective@#To study the effects of rehabilitation exercise training on sleep quality and fatigue in hemodialysis patients with uremia.@*Methods@#A convenient sampling method was used to select 94 patients with uremia who underwent hemodialysis from September 2016 to September 2017. The patients were divided into routine group and training group according to the random number table method. example. The routine group was given routine hemodialysis care, and the training group was instructed to perform rehabilitation exercise training on the basis of routine group nursing. Both groups were intervened for 16 weeks. Pittsburgh Sleep Index (PQSI) was used to assess the quality of sleep. The sleep quality of the two groups before intervention, intervention for 8 weeks, and intervention for 16 weeks was compared. The fatigue scale (Fatigue Scale-14, FS-14) was used to assess the degree of fatigue. The degree of fatigue in the two groups before intervention, 8 weeks of intervention, and 16 weeks of intervention.@*Results@#Before the intervention, there was no significant difference in PQSI scores between the two groups (P>0.05). After 8 weeks of intervention, the PQSI values of the training group were significantly lower than those before the intervention (t=4.20, P<0.05). There was no significant change in the conventional group before the intervention. (t=1.43, P>0.05), and the PQSI value of the training group (8.21±2.26) was significantly lower than that of the conventional group (10.15±3.19) (t=3.40, P<0.05); after 16 weeks of intervention, training The PQSI values of the patients were significantly lower than those at 8 weeks (t=2.62, P<0.05). There was no significant change in the conventional group compared with 8 weeks (t=0.33, P>0.05). The PQSI values of the training group (6.97±2.32). PQSI values (8.93 ± 3.28) were significantly lower than those in the conventional group (t = 5.50, P<0.05). Before the intervention, there was no significant difference in FS-14 total score, physical fatigue score and mental fatigue score between the two groups (P>0.05). After 8 weeks of intervention, the FS-14 total score, physical fatigue score and mental fatigue of the training group. The scores were significantly lower than those before the intervention (t=3.83, 3.29, 2.64, P<0.05). The FS-14 total score, physical fatigue score and mental fatigue score of the routine group were not significantly different from those before the intervention (t=0.38, 0.05, 0.10, P>0.05), and the FS-14 total score (7.02±1.12), physical fatigue score (5.30±1.55), and mental fatigue score (1.83±1.02) in the training group were significantly lower than those in the conventional group. -14 total score (9.01±2.14), physical fatigue score (6.23±1.72), mental fatigue score (2.66±1.37) (t=5.65, 2.75, 3.33, P<0.05); after 16 weeks of intervention, the training group The FS-14 total score, physical fatigue score, and mental fatigue score were significantly lower than those at 8 weeks of intervention (t=3.36, 2.39, 2.19, P<0.05). The FS-14 total score, physical fatigue score, and mental fatigue score of the conventional group. There was no significant change at 8 weeks of intervention (t=0.16, 0.27, 0.25, P>0.05), and The FS-14 total score (6.05±1.58), physical fatigue score (4.58±1.36), and mental fatigue score (1.35±1.10) in the training group were significantly lower than those in the conventional group (8.94±2.17), body. Fatigue score (6.33±1.82) and mental fatigue score (2.59±1.36) (t=7.34, 5.28, 4.86, P<0.05).@*Conclusion@#Rehabilitation exercise training can significantly improve the sleep quality of hemodialysis patients with uremia and reduce the fatigue degree of hemodialysis patients with uremia. It is worthy of clinical promotion.

Comparison of clinical effect of different dialysis frequency and methods in the treatment of chronic renal failure uremic patients / 中国基层医药

Objective@#To observe the clinical efficacy of different dialysis frequency and methods in the treatment of chronic renal failure uremia patients, and to provide a reliable reference for clinical practice.@*Methods@#From February 2016 to February 2017, 140 chronic renal failure uremic patients who admitted to the Department of Nephrology at Taizhou Central Hospital were selected and divided into the observation group and the control group by complete random distribution method, with 70 cases in each group.The patients in the control group received 3 times of regular hemodialysis treatment per week, while the observation group received 3 times of regular hemodialysis combined with 1 time of hemodiafiltration treatment per week.The clinical treatment effects and complications of the two groups were compared.@*Results@#Compared with blood uric acid(BUA)[(532.09±71.05)mmol/L], serum creatinine(Scr)[(734.34±63.08)μmol/L], blood urea(BUN)[(23.84±2.58)mmol/L], serum phosphorus[(1.98±0.37)mmol/L], parathyroid hormone(PTH)[(464.37±113.92)ng/L], β2 microglobulin(β2-MG)[(13.48±6.38)mg/L]in the control group, BUA[(495.89±58.23)mmol/L], Scr[(684.34±77.32)μmol/L], BUN[(20.62±1.77)mmol/L], serum phosphorus[(1.74±0.44)mmol/L], PTH[(352.14±123.25)ng/L], β2-MG[(9.58±5.45)mg/L] were significantly lower in the observation group, the differences were statistically significant (t=3.29, 4.19, 8.61, 3.49, 5.59, 3.88, all P<0.01). Compared with the incidence rate of pruritus in the control group(61.43%), the incidence rate of pruritus in the observation group(34.29%) was significantly lower (χ2=9.72, P<0.01), the incidence of other complications had no statistically significant differences(χ2=1.14, 1.58, 3.08, all P>0.05).@*Conclusion@#Hemodialysis 3 times combined with 1 time of hemodiafiltration per week has significant advantage in the treatment of chronic renal failure uremia patients, which can effectively remove urine toxin molecules and reduce the incidence of complications, and it is worthy of clinical application.

Clinical application of total parathyroidectomy combined with autologous transplantationpatient for Chinese patients with secondary hyperparathyroidism:A single arm meta-analysis / 中国实用外科杂志

OBJECTIVE: To study the curative effect of total parathyroidectomy combined with autologous transplantationpatient for Chinese patients with secondary hyperparathyroidism. METHODS: Chinese and English databases including Wanfang Science and Technology Periodical Full-text Database,VIP Chinese Science and Technology Periodical Full-text Database(VIP)and CNKI,PubMed were searched by computer. Some relevant studies were collected for Meta analysis. RESULTS: A total of 12 studies including a total of 375 subjects for Meta analysis were identified.After analysis,the postoperative complication rate was P=0.15(95% CI 0.04～0.31),the one-time success rate of surgical operation was P=0.93(95% CI 0.90～0.96),the rate of all-cause mortality was P=0.04(95% CI 0.01～0.07),and the rate of improvement of symptoms was P=0.86(95% CI 0.61～0.99). CONCLUSION: The curative effect of total parathyroidectomy combined with autologous transplantation patient for Chinese patients with secondary hyperparathyroidism is effective. The incidence of postoperative complications is low.

HIV-positive patient receiving living related renal transplantation : a report of one case and literature review / 中华器官移植杂志

Objective To summarize the outcomes and clinical experiences of renal transplantation in human immunodeficiency virus (HIV)-positive patients .Methods The clinical data were retrospectively analyzed for one HIV-positive case of renal transplantation .Diagnosed as chronic renal insufficiency 1 year ago ,he received hemodialysis .After a positive screen for HIV ,he received highly active antiretroviral therapy (HAART) and HIV RNA turned negative 3 months later .CD4 + T cell count was 331 cell/μl at pre-operation and there was no HIV-rated opportunistic infection or cancer . Her mother donated her kidney . Basiliximab and steroid pulse therapy were used preoperatively and immunosuppressants were used after transplantation , including tacrolimus , corticosteroids and mycophenolate mofetil .Results The kidney was transplanted successfully and serum creatinine declined to a normal level at day 4 after transplantation .Because of an interaction between efaverenz and tacrolimus ,the blood concentration of tacrolimus was extremely low and the dose of tacrolimus had to be raised to 0 .2 mg/(kg·d) .Antiroviral therapy remained unchanged .No rejection and other complications were observed .And HIV RNA remained negative .Conclusions Renal transplantation is optimal for HIV-positive patients whose HIV status is completely under control .However ,drug interactions needs to be considered during perioperative and postoperative periods .

Comparison of clinical effect of different dialysis frequency and methods in the treatment of chronic renal failure uremic patients / 中国基层医药

Objective To observe the clinical efficacy of different dialysis frequency and methods in the treatment of chronic renal failure uremia patients ,and to provide a reliable reference for clinical practice.Methods From February 2016 to February 2017,140 chronic renal failure uremic patients who admitted to the Department of Nephrology at Taizhou Central Hospital were selected and divided into the observation group and the control group by complete random distribution method ,with 70 cases in each group.The patients in the control group received 3 times of regular hemodialysis treatment per week , while the observation group received 3 times of regular hemodialysis combined with 1 time of hemodiafiltration treatment per week.The clinical treatment effects and complications of the two groups were compared.Results Compared with blood uric acid ( BUA) [(532.09 ±71.05) mmol／L],serum creatinine(Scr) [(734.34 ±63.08) μmol／L],blood urea ( BUN) [(23.84 ±2.58) mmol／L],serum phosphorus [(1.98 ±0.37)mmol／L],parathyroid hormone ( PTH) [(464.37 ±113.92) ng／L],β2 microglobulin ( β2 -MG) [(13.48 ±6.38)mg／L]in the control group,BUA[(495.89 ±58.23) mmol／L],Scr[(684.34 ±77.32)μmol／L], BUN[(20.62 ±1.77) mmol／L],serum phosphorus [(1.74 ±0.44) mmol／L],PTH[(352.14 ±123.25) ng／L], β2 -MG[(9.58 ±5.45) mg／L] were significantly lower in the observation group ,the differences were statistically significant (t＝3.29,4.19,8.61,3.49,5.59,3.88,all P＜0.01).Compared with the incidence rate of pruritus in the control group(61.43%),the incidence rate of pruritus in the observation group (34.29%) was significantly lower (χ2 ＝9.72,P＜0.01),the incidence of other complications had no statistically significant differences ( χ2 ＝1.14, 1.58,3.08,all P＞0.05).Conclusion Hemodialysis 3 times combined with 1 time of hemodiafiltration per week has significant advantage in the treatment of chronic renal failure uremia patients ,which can effectively remove urine toxin molecules and reduce the incidence of complications ,and it is worthy of clinical application.

Effect of rehabilitation exercise training on sleep quality and fatigue of hemodialysis patients with uremia / 中国实用护理杂志

Objective To study the effects of rehabilitation exercise training on sleep quality and fatigue in hemodialysis patients with uremia. Methods A convenient sampling method was used to select 94 patients with uremia who underwent hemodialysis from September 2016 to September 2017. The patients were divided into routine group and training group according to the random number table method. example. The routine group was given routine hemodialysis care, and the training group was instructed to perform rehabilitation exercise training on the basis of routine group nursing. Both groups were intervened for 16 weeks. Pittsburgh Sleep Index (PQSI) was used to assess the quality of sleep. The sleep quality of the two groups before intervention, intervention for 8 weeks, and intervention for 16 weeks was compared. The fatigue scale (Fatigue Scale-14, FS-14) was used to assess the degree of fatigue. The degree of fatigue in the two groups before intervention, 8 weeks of intervention, and 16 weeks of intervention. Results Before the intervention, there was no significant difference in PQSI scores between the two groups (P＞0.05). After 8 weeks of intervention, the PQSI values of the training group were significantly lower than those before the intervention (t=4.20, P<0.05). There was no significant change in the conventional group before the intervention. (t=1.43, P＞0.05), and the PQSI value of the training group (8.21 ± 2.26) was significantly lower than that of the conventional group (10.15±3.19) (t=3.40, P<0.05); after 16 weeks of intervention, training The PQSI values of the patients were significantly lower than those at 8 weeks (t=2.62, P<0.05). There was no significant change in the conventional group compared with 8 weeks (t=0.33, P＞0.05). The PQSI values of the training group (6.97±2.32). PQSI values (8.93 ± 3.28) were significantly lower than those in the conventional group (t = 5.50, P<0.05). Before the intervention, there was no significant difference in FS-14 total score, physical fatigue score and mental fatigue score between the two groups (P＞0.05). After 8 weeks of intervention, the FS-14 total score, physical fatigue score and mental fatigue of the training group. The scores were significantly lower than those before the intervention (t=3.83, 3.29, 2.64, P<0.05). The FS-14 total score, physical fatigue score and mental fatigue score of the routine group were not significantly different from those before the intervention (t=0.38, 0.05, 0.10, P＞0.05), and the FS-14 total score (7.02±1.12), physical fatigue score (5.30±1.55), and mental fatigue score (1.83±1.02) in the training group were significantly lower than those in the conventional group.-14 total score (9.01± 2.14), physical fatigue score (6.23±1.72), mental fatigue score (2.66±1.37) (t=5.65, 2.75, 3.33, P<0.05);after 16 weeks of intervention, the training group The FS-14 total score, physical fatigue score, and mental fatigue score were significantly lower than those at 8 weeks of intervention (t=3.36, 2.39, 2.19, P<0.05). The FS-14 total score, physical fatigue score, and mental fatigue score of the conventional group. There was no significant change at 8 weeks of intervention (t=0.16, 0.27, 0.25, P＞0.05), and The FS-14 total score (6.05±1.58), physical fatigue score (4.58±1.36), and mental fatigue score (1.35± 1.10) in the training group were significantly lower than those in the conventional group (8.94±2.17), body. Fatigue score (6.33±1.82) and mental fatigue score (2.59±1.36) (t=7.34, 5.28, 4.86, P<0.05). Conclusion Rehabilitation exercise training can significantly improve the sleep quality of hemodialysis patients with uremia and reduce the fatigue degree of hemodialysis patients with uremia. It is worthy of clinical promotion.

Hemorragias após hemodiálise em paciente com insuficiência renal. Previsíveis? Estudo de casos e revisão da literatura / Hemorrhagia after hemodialysis in a patient with renal failure. Preventable? Case studies and literature revision

A doença renal crônica cursa com alterações hematológicas na série vermelha (anemia) e nas plaquetas (alteração funcional). A anemia estaria relacionada a fatores tanto de hemorragias quanto de tromboses. As plaquetas por disfunção de sua coagulação intrínseca pela qualidade da plaqueta circulante. Somente a alteração da coagulação intrínseca pela uremia proporciona o surgimento de complicações em até 50% dos pacientes dialíticos. Neste trabalho, em três casos, observou-se hemorragias em paciente renais crônicos que apresentavam elevado grau de morbi-mortalidade. A avaliação criteriosa destes pacientes urêmicos pode contribuir para minimizar eventos adversos em seus cuidados

The chronic kidney disease presents hematological on red cell distribution width and platelets (function abnormalities). Anemia was related with both hemorrhagic or thrombosis events. The platelets had disfunction because their alteration in the quality of the circulant platelet. Uremia alone can contribute up to 50% of the diabetic patients. In our work, in three cases, hemorrhagic events associated with end stage kidney disease had a higher degree of morbid-mortality. The strict evaluation of these patients can minimize adverse events

Velocity vector imaging in evaluation of impact of hemodialysis on left ventricular longitudinal strain of myocardium in uremia patients / 中国医学影像技术

Objective: To investigate the value of velocity vector imaging (VVI) technique in evaluation of the impact of hemodialysis on left ventricular longitudinal strain of myocardium in uremia patients. Methods: Echocardiography was performed in 35 uremia patients who underwent high flux hemodialysis before and 2 h after dialysis. The peak systolic longitudinal strain (LPS) of 3 layers at 17 segments of left ventricular were obtained using VVI software after conventional measurement. Results: The left atrial diameter, left ventricular end diastolic and end systolic diameter, left ventricular end diastolic and end systolic volume as well as stroke volume reduced after dialysis (all P0.05). Conclusion: VVI technique can sensitively and accurately evaluate the impact of hemodialysis on the global and local systolic function of left ventricular myocardium in uremic patients.

Comportamento da variabilidade da frequência cardíaca e da capacidade funcional de acordo com o tempo de transplante renal / Behavior of variability of heart rate and functional capacity according to renal transplant time

Introdução: Desequilíbrio autonômico, com aumento da atividade simpática e redução da parassimpática, pode ocorrer no transplantado renal, representando forte indicador de risco cardíaco. Objetivo: Avaliar a variabilidade da frequência cardíaca (VFC) e a capacidade funcional dos transplantados renais de acordo com o tempo de transplante renal. Métodos: Série de casos envolvendo transplantados renais divididos em grupos de acordo com a mediana do tempo de transplante renal (158 meses). Foram avaliados a VFC através do Holter por 24 horas, o nível de atividade física (IPAQ) e o desempenho funcional (teste de caminhada de 6 minutos). Resultados: Os indivíduos comportaram-se diferentemente em relação à VFC e à capacidade funcional. No entanto, aqueles com maior tempo de transplante apresentaram maior VFC, eram menos ativos e variaram mais no desempenho funcional. Conclusão: O presente estudo constata a presença de diferenças individuais na VFC e no desempenho funcional entre os transplantados renais de acordo com o tempo de realização do TX.

Introduction: Autonomic imbalance, with increased sympathetic activity and reduction of parasympathetic activity, may occur in the renal transplantation patient, representing a strong indicator of cardiac risk. Objective: To assess heart rate variability (HRV) and functional capacity of kidney transplantation recipients according to the time of transplantation. Methods: A case series involving renal transplant recipients divided into groups according to the median of kidney transplantation time (158 months). HRV was evaluated through 24-hour Holter monitoring, physical activity level (IPAQ) and functional performance (6-minute walk test). Results: The individuals behaved differently in relation to HRV and functional capacity. Those with longer transplantation had higher HRV, were less active and presented more diverse functional performance. Conclusion: The present study notes the presence of individual differences in HRV and functional performance between renal transplants according to the time of TX.

In vitro effect of uremic serum on barrier function and inflammation in human colonocytes / Efeito in vitro do soro urêmico sobre a função de barreira e inflamação em colonócitos humanos

ABSTRACT Introduction: In chronic kidney disease (CKD), it has been suggested that alterations within the gut are associated with an inflammatory state and uremic toxicity. Studies suggest that uremia may impair the function of the intestinal barrier via the promotion of increased intestinal permeability. To understand the mechanisms that are involved in intestinal barrier damage in the setting of uremia, we evaluated the in vitro effect of uremic serum on transepithelial electrical resistance (TER), inflammation, and apoptosis in intestinal epithelial cells (T84). Methods: Pools of serum from healthy individuals, patients not on dialysis, and patients on hemodialysis (Pre-HD and Post-HD) were prepared. T84 cells were incubated for 24 h in medium, of which 10% consisted of the pooled serum from each group. After incubation, the TER was measured and the following parameters were determined by flow cytometry: expression of toll-like receptors (TLRs), production of reactive oxygen species (ROS), and apoptosis. The level of IL-6 in the culture supernatant was determined by ELISA. Results: No difference was observed among the groups with respect to TER, apoptosis, and ROS or the expression of TLR-2, TLR-4, and TLR-9. IL-6 secretion was higher (p < 0.001) in cells that were incubated with pre- and post-HD serum. Conclusion: The results that were obtained from this model suggest that uremic serum per se does not seem to impair the integrity of intestinal epithelial cells. The increased IL-6 secretion by cells that were incubated with HD serum suggests a potential effect of uremia in the intestinal inflammatory response.

RESUMO Introdução: Tem sido sugerido que na doença renal crônica (DRC) a uremia pode causar alterações intestinais, tais como modificações na microbiota e danos à barreira intestinal, e que estas possíveis alterações podem ter uma relação importante com o estado inflamatório e a toxicidade urêmica apresentadas por pacientes com DRC. Objetivos: Avaliar o efeito in vitro do soro urêmico sobre a permeabilidade da monocamada de células epiteliais do intestino, inflamação e apoptose. Métodos: Pools de soro foram preparados a partir de soros de indivíduos saudáveis, pacientes em tratamento conservador e em hemodiálise (Pré e Pós-HD). As células T84 foram incubadas por 24 horas com os diferentes pools. Em seguida a TER foi medida e as células foram submetidas às seguintes análises: apoptose, produção de espécies reativas de oxigênio (EROs) e expressão de receptores toll-like (TLR) por citometria de fluxo e detecção de IL-6 no sobrenadante da cultura por ELISA. Resultados: Não foram encontradas diferenças, entre os grupos, com relação a TER, apoptose, EROs e expressão de TLR-2, TLR-4 e TLR-9. Já a secreção de IL-6 foi maior (p < 0,001) pelas células incubadas com soro pré-HD e pós-HD. Conclusão: Os resultados obtidos a partir deste modelo sugerem que a uremia per se parece não comprometer a integridade das células epiteliais do intestino. O aumento da secreção de IL-6 pelas células incubadas com soro HD (pré e pós) sugere um potencial efeito da uremia sobre a resposta inflamatória intestinal.

Diclofenac-induced biochemical changes in nephrotoxicity among male Albino rats

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with adverse renal effects caused by the reduction in synthesis of renal prostaglandins in sensitive persons or animal species, and potentially during long-term use in non-sensitive persons if resistance to side effects decreases with age. The effects of diclofenac sodium on the kidneys were studied during 4 1/2 hours in eight patients with normal renal function. Urinary output decreased within 10 min after the injection, and maximally by 80%. The renal plasma flow and the glomerular filtration rate initially diminished significantly, by 35%, but began to increase after only 2 hours. The dominant and persistent effect was a reduction of free water clearance, with maximum fall from 5.9 to 0.08ml/min after 2 1/2 hours. Aim: The aim of this study was to evaluate the effects of diclofenac-induced acute nephrotoxicity using biochemical parameters in rats.Methods: 12 male Wistar rats allotted in 4 equal groups were intraperitoneally injected with 0, 10, 50 and 100mg/kg diclofenac, respectively and 12 hours after injection, blood serum samples were collected for assessment of basic renal function test parameters such as urea, creatinine, and uric acid, sodium, Potassium.Results: Rats treated up to 50mg/kg diclofenac were considered to be within normal range in rats. By increase in dose more than 50mg/kg showed significant increases in uremia were evidenced in intoxicated animals. Observed specifically in group IV Rats.Conclusions: In this study, uremia, as an indicator of kidney damage, was significantly increased depending on dose. Diclofenac may cause kidney damage depending on dose and this effect may also be observed. NSAIDs-induced nephrotoxicity may be due to the inhibitory effect of these drugs on prostaglandin synthesis, thus causing kidney ischemia.