Apelin alleviates the damage of renal podocytes induced by high glucose / 基础医学与临床

Objective To explore the protective effect of polypeptide Apelin on podocyte mitochondria in diabetic nephropathy and underling mechanisms.Methods Human renal podocytes were divided into four experimental groups:control group,high glucose(HG)group(glucose 25 mmol/L,48 h),Apelin intervention HG group(Ape-lin-13 1 μmol/L,48 h)and Apelin group(Apelin-13 1 μmol/L,48 h).The podocyte apoptosis was observed by TUNEL staining,the expression of mitochondrial membrane protein FUNDC1 was detected by Western blot,and the binding of mitochondrial fission protein DRP1 to FUNDC1 was examined by immunoprecipitation.The 8-week-old male mice were divided into three experimental groups:control group,diabetes group(intraperito-neal injection of streptozotocin 150 mg/kg,only one time)and Apelin intervention DM group(intraperitoneal injection of Apelin-13 0.3 μmol/kg,daily).The morphology of renal was observed by PAS staining and trans-mission electron microscopy.Plasma creatinine(Cr),urea nitrogen,urinary albumin and creatinine were de-tected by ELISA kit.The level of creatinine clearance rate(Ccr)and urinary albumin/creatinine(ACR)was calculated.Results Compared with the control group,the podocyte apoptosis and expression of FUNDC1 in the HG group increased significantly(P＜0.05),and the combination of mitochondrial fission division protein DRP1 to FUNDC1 raised.Meanwhile,compared with the HG group,the number of apoptosis,the expression of FUNDC1(P＜0.05),and the combination of DRP1 to FUNDC1 all reduced in Apelin intervention HG group.Animal experiments showed that the kidney structure of the control group was intact.In the DM group,the num-ber of podocytes decreased significantly,the foot processes were fused and dropped off.In the Apelin intervention DM group,podocyte lesions were less severe than those in the DM group.Compared with the control group,the level of plasma Cr,BUN and urine ACR in the DM group increased,while the level of Ccr decreased significantly(P＜0.05).However,compared with the DM group,the level of above biomarkers in the Apelin intervention DM group was improved(P＜0.05).Conclusions Apelin keeps mitochondrial homeostasis and reduces podocyte ap-optosis by inhibiting the expression of mitochondrial membrane protein FUNDC1,which may contribute to allevia-tion of diabetic nephropathy.

Acute subdural hematoma secondary to sacral arachnoid cyst surgery: a case report / 中华神经科杂志

Sacral cyst usually occurs around the nerve root, which is the accumulation of cerebrospinal fluid between the intima and the perineurium at the junction of the posterior spinal nerve root and the dorsal root ganglion. Its typical clinical manifestations include low back pain, lower limb radiation pain, rectal/bladder dysfunction and so on. Complications of acute subdural hematoma with cerebral hernia after posterior midline cystectomy of sacral cyst are rare. A middle-aged female patient with sacral cyst was admitted to Gansu Provincial Hospital. After the operation, acute subdural hematoma occurred in the right frontoparietal temporal occipital region, and cerebral herniation was formed. After the operation, the patient was given rehabilitation exercise and discharged well. No neurological deficits were observed during follow-up.

Recent advance in neutrophil extracellular traps in ischemic stroke / 中华神经医学杂志

Neutrophil extracellular traps (NETs) are compounds composed of depolymerized DNA fibers and antimicrobial peptides released by neutrophils. NETs formation not only plays a role in pathological process of non-infectious diseases such as cystic fibrosis, systemic lupus erythematosus, diabetes and cancer, but also is closely related to many central nervous system diseases. In recent years, a large number of studies have found the presence of neutrophils and NETs in perivascular space of the infarcted lesions in patients with ischemic stroke (IS) and corresponding animal models. This article provides a review on NETs formation and clearance process, characteristics of NETs changes after IS, pathological processes involved in NETs after IS, and effects of NETs on neurons, to provide some references for IS.

Analysis of the efficacy of hematoma aspiration combined with low posterior osteotomy in the treatment of hypertensive intracerebral hemorrhage / 中国现代医生

Objective To explore the effect of hematoma aspiration device combined with low posterior osteotomy and small bone window craniotomy on neurological function and prognosis in patients with hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 132 patients with HICH in the Department of Neurosurgery,Gansu Provincial people's Hospital from February 2020 to February 2022 were collected and divided into small bone window group(n=52)and aspiration group(n=80).The levels of serum neuron specific enolase(NSE)and interleukin-6(IL-6)were detected by enzyme linked immunosorbent assay(ELISA).The intraoperative condition(duration of operation and intraoperative blood loss),intracranial pressure,complete clearance rate of intracranial hematoma and the incidence of postoperative complications were compared.The prognosis of the patients was evaluated by activity of daily living scale(ADL).Results There was no significant difference in the levels of serum NSE and IL-6 between the two groups before operation(P>0.05).The levels of NSE and IL-6 in serum after operation were significantly lower than those before operation,and the intracranial pressure was improved after treatment,the difference has statistic significance(P<0.05).The postoperative serum NSE and IL-6 levels,operation duration,postoperative intracranial pressure and the total incidence of complications in aspiration group were lower than those in small bone window group(P<0.05),but there was no significant difference in intraoperative blood loss and the total incidence of long-term complications between the two groups(P>0.05).During the 6-month follow-up after surgery,the good prognosis rate of aspiration group was higher than that of small bone window group,and the difference was statistically significant(P<0.05);There was no statistically significant difference in the complete clearance rate of intracranial hematoma between the two groups of patients(P>0.05).Conclusion Low posterior osteotomy combined with hematoma aspiration can effectively treat HICH,promote the recovery of neurological function in patients.

Pathological analysis of 4 652 cases of renal biopsy: a multicentral study in Beijing from 2008 to 2020 / 中华全科医师杂志

Objective:To analyze characteristics and trends of histopathological diagnosis of adult renal biopsy in Beijing from 2008 to 2020.Methods:A total of 4 652 cases of adult renal biopsy were collected from three hospitals in Beijing between 2008 and 2020. The patients were divided into three age groups: 18-40 years, 40-65 years and≥ 65 years; and also divided into three period: 2008-2011, 2012-2015, and 2016-2020. The pathological characteristics and changes of renal biopsy were analyzed in three age groups at different periods.Results:Among 4 652 cases primary glomerular disease accounted for 81.8%, the membranous nephropathy (MN, 32.4%, 1 509/4 652), IgA nephropathy (IgAN, 29.2%, 1 356/4 652) and minor glomerular abnormalities (MGA, 11.3%, 526/4 652) were the top three pathological types. The overall proportion of MN and diabetic nephropathy (DN) increased from 20.3% and 2.3% in 2008-2011 to 37.3% and 10.1% in 2016-2020) (χ2=99.9 and 96.1, both P<0.01), respectively. For age group 18-40 years, the MN and DN increased from 11.2% and 1.6% in 2008-2011 to 24.7% and 5.5% in 2016-2020 (χ2=32.7 and 20.7, both P<0.01), respectively. For age group 40-65 years the MN and DN increased from 26.6% and 3.2% in 2008-2011 to 41.5% and 13.1% in 2016-2020 (χ2=39.1 and 57.3, both P<0.01), respectively. For age group≥65 years the MN was the most common pathological type in the three periods, fluctuating between 41.3% and 55.0% (χ2=5.2, P=0.08); and DN increased from 0(0/63) in 2008-2011 to 7.5%(22/292) in 2016-2020 (χ2=8.1, P=0.02). Conclusion:The renal biopsy data show that membranous nephropathy and diabetic nephropathy are the most common primary and secondary adult glomerular diseases in Beijing recently.

Analysis of the influencing factors for post-dialysis hypertension in maintenance hemodialysis patients / 中华肾脏病杂志

Objective:To investigate the influencing factors of post-dialysis hypertension in maintenance hemodialysis (MHD) patients.Methods:This study was a cross-sectional and retrospective study. The patients receiving hemodialysis from January 9, 2017 to January 14, 2017 in 5 hemodialysis centers of Beijing area were selected. Post-dialysis hypertension was defined as an event characterized by an average increase of more than 15 mmHg in post-dialysis mean artery pressure (MAP) compared to intradialytic 3 h MAP during 3 consecutive hemodialysis sessions. Post-dialysis stable blood pressure was defined as an event characterized by an increase of less than 15 mmHg or a decrease of less than 10 mmHg in post-dialysis MAP compared to intradialytic 3 h MAP, with the exception of patients with post-dialysis hypertension and post-dialysis hypotension. The patients were divided into hypertension group and stable blood pressure group based on whether they had post-dialysis hypertension, and the differences of clinical data between the two groups were compared. The influencing factors of post-dialysis hypertension were analyzed by multivariate unconditional logistic regression.Results:A total of 491 MHD patients were enrolled in this study, including 65 patients (13.2%) in the hypertension group, 406 patients (82.7%) in the stable blood pressure group and 20 patients (4.1%) in the hypotension group. The age, blood calcium before dialysis and the proportion of patients using 1.75 mmol/L Ca 2+ dialysate in the hypertension group were higher than those of the stable blood pressure group, and pre-dialysis serum intact parathyroid hormone and pre-dialysis serum uric acid in the post hypertension group were lower than those of the stable blood pressure group (all P<0.05). The age, pre-dialysis serum intact parathyroid hormone, pre-dialysis serum calcium, pre-dialysis serum uric acid, dialysate Ca 2+ concentration of statistical differences between hypertension group and stable blood pressure group ( P<0.05), and post-dialysis serum calcium, pre-dialysis total serum cholesterol, application of β receptor blocker, gender of univariate analysis ( P<0.1) were included into the logistic regression equation as covariates. Multivariate logistic regression analysis showed that using 1.75 mmol/L Ca 2+ dialysate was the independent influencing factor of post-dialysis hypertension (with using 1.50 mmol/L Ca 2+ dialysate as reference, OR=2.930, 95% CI 1.282-6.694, P=0.011). The age and pre-dialysis serum calcium of statistical differences between hypertension group and stable blood pressure group ( P<0.05), and pre-dialysis serum sodium and pre-dialysis serum uric acid of univariate analysis ( P<0.1) were included into the logistic regression equation as covariates. The older age ( OR=1.046, 95% CI 1.000-1.093, P=0.049) and higher pre-dialysis serum calcium ( OR=21.847, 95% CI 2.111-226.075, P=0.010) were the independent influencing factors of post-dialysis hypertension when the 1.50 mmol/L Ca 2+ dialysate was used. Conclusions:The independent influencing factor of post-dialysis hypertension is using 1.75 mmol/L Ca 2+ dialysate, while the independent influencing factors of post-dialysis hypertension are the older age and the higher pre-dialysis serum calcium level when the dialysate Ca 2+ concentration was 1.50 mmol/L.

Quercetin Inhibited ADMA-induced Endoplasmic Reticulum Stress Responses and HUVECs Apotosis / 医学研究杂志

Objective To study the effect of quercetin on ADMA induced endoplasmic reticulum stress responses (ER stress).Methods Human umbilical veins endothelial cells (HUVECs) were cultured,and left untreated or challenged for 24h with 100μmol/L ADMA in the absence and presence of 20μmol/L quercetin,the PERK and IRE1 was determined by Western blot.ATF4 and CHOP mRNA was detected by RT-PCR.Cells apoptosis was detected by flow cytometry.Results ADMA induced HUVECs apoptosis.Quercetin inhibited ADMA-induced PERK and IRE1 protein expression and ATF4 and CHOP mRNA expression.At last,Quercetin inhibited ADMA-induced cells apoptosis.Conclusion ADMA induced ER stress and HUVECs apotosis while quercetin inhibited ADMA-induced ER stress and apoptosis.

Locking plate can prevent the loss of reduction for intra-articular calcaneal fractures / 中国组织工程研究

BACKGROUND: Comminuted intra-articular fractures of the calcaneus are difficult to treat, and inappropriate treatment will lead to some sequelae such as talalgia, traumatic arthritis and flatfoot, which do harm to functional recovery. OBJECTIVE: To compare the clinical efficacy of locking and traditional plates for intra-articular calcaneal fractures METHODS: Seventy-six patients (94 feet) with intra-articular calcaneal fractures were enrolled, and received open reduction and plate internal fixation. All patients were allotted to two groups based on the fixation materials, including locking plate and traditional plate groups. The healing time, AOFAS scores, Visual Analogue Scale scores, loss of Bohler angle and adverse events were compared between groups. In addition, the loss of Bohler angle of osteoporotic patients was compared between groups.RESULTS AND CONCLUSION: There were no significant differences in the healing time, AOFAS scores, Visual Analogue Scale scores and Bohler angle between two groups after surgery (P > 0.05). But for osteoporotic patients,compared with the traditional plate group, the loss of Bohler angle was smaller in the locking plate group. These results suggest that the various clinical and radiographic indicators of locking plate and traditional plate for intra-articular calcaneal fractures show no significant differences. For osteoporotic patients, locking plate has certain advantages in preventing loss of joint reduction, but large-size trials are needed.

Target value of parathyroid hormone in hemodialysis patients / 中华全科医师杂志

The target value of intact parathyroid hormone (iPTH) in main international guidelines is not consistent completely.Furthermore,the evidence levels of clinical studies these guidelines based on are generally low and most of them are based on observational studies.Some studies even showed that there was no association between iPTH level and clinical outcomes.This review focuses on the following three points for reassessing iPTH target value: comparison of iPTH target value in main international guidelines,the difference of iPTH target value in large clinical studies and reasons for the difference.

Progress of ablation for secondary hyperparathyroidism / 中华全科医师杂志

Secondary hyperparathyroidism (SHPT) is the common complication in chronic kidney disease patients,especially in those with hemodialysis,which is associated with cardiovascular events and mortality.Active vitamin D and its analogues are classic treatment for SHPT,but some patients are resistant to active vitamin D,and ablation would be a choice for such cases.The purpose of this review is to provide current progress in ablation for SHPT.

Investigation of mineral bone disorders in pre-dialysis patients with chronic kidney disease / 中国医师杂志

Objective To investigate mineral bone metabolic conditions of pre-dialysis patients with chronic kidney disease (CKD),and obtain useful information about the management and treatment of CKD.Methods The levels of serum calcium,phosphate,25-HydroxyvitaminD [25 (OH) VitD],and intact parathyroid hormone (iPTH) were compared.Then a correlation analysis was performed for 25 (OH)VitD.Results Hypocalcemia,hyperphosphatemia,secondary hyperparathyroidism and inadequate of 25 (OH) VitD appeared early in CKD2.Deficiency of 25 (OH)VitD was widespread in CKD2 ～ 5.Multiple linear regression analysis showed that 25 (OH) VitD was independently associated with adjusted level of calcium (P =0.002),application of calcium carbonate (P =0.038),and application of calcitriol (P =0.049) (R square =0.360,P =0.000).Conclusions Mineral bone disorder emerges early in CKD2.More attention should be paid to the management of 25 (OH)VitD.

Different calcium concentration Citrate dialysate consequences on calcium and PTH in hemodialysis patients / 中华肾脏病杂志

Objective To evaluate the effects on the mineral bone disorder using different calcium concentration citrate-based dialysate in maintenance hemodialysis (MHD) patients.To compare the concentrations of intact parathyroid hormone(PTH) with biointact PTH(1-84) in these patients.Methods Citrate dialysate with different calcium concentration (DCa 1.75,DCa 1.5,DCa 1.25 mmol/L)were used in turn in 15 stable MHD patients each week.Serum tCa and iCa were measured by automatic biochemistry analyzer.The concentrations of iPTH and bio-iPTH were compared.Results (1) The patients treated with DCa 1.75 citrate dialysate had increased serum iCa and tCa after dialysis,and PTH did not change significantly as compared to those findings before the dialysis.With the DCa 1.5 citrate dialysate,serum iCa and tCa were kept stable and PTH level was increased.With DCa 1.25 citrate dialysate,serum iCa and tCa decreased significantly and PTH decreased.(2)iPTH and bioPTH had excellent correlations.Variation of bio-iPTH was more correlated with the changes of calcium than iPTH.Conclusions Serum levels of iPTH,tCa and iCa can be kept stable in MHD patients treated with DCa 1.75 ～ 1.5 citrate dialysate.Bio-iPTH is a more sensitive marker for mineral bone disease than iPTH.

Effects of mildly increasing dialysis sodium removal on renin and sympathetic system in hemodialysis patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has been argued that the benefits of reducing sodium loading may be offset by increased activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system. This study aimed to investigate the long-term effects of an increase in dialysis sodium removal on circulating RAAS and sympathetic system in hypertensive hemodialysis (HD) patients with "normal" post-HD volume status.</p><p><b>METHODS</b>Thirty hypertensive HD patients were enrolled in this pilot trial. After one month period of dialysis with standard dialysate sodium of 138 mmol/L, the patients were followed up for a four months period with dialysate sodium set at 136 mmol/L, without changes in instructions regarding dietary sodium control. During the period of study, the dry weight was adjusted monthly under the guidance of bioimpedance spectroscopy to maintain post-HD volume status in a steady state; 44-hour ambulatory blood pressure, plasma renin, angiotensin II (Ang II), aldosterone, and norepinephrine (NE) were measured.</p><p><b>RESULTS</b>After four months of HD with low dialysate sodium of 136 mmol/L, 44-hour systolic and diastolic blood pressures (BPs) were significantly lower (-10 and -6 mmHg), in the absence of changes in antihypertensive medications. No significant changes were observed in plasma renin, Ang II, aldosterone, and NE concentrations. The post-HD volume parameters were kept constant.</p><p><b>CONCLUSION</b>Mildly increasing dialysis sodium removal over 4 months can significantly improve BP control and does not activate circulating RAAS and sympathetic nervous system in hypertensive HD patients.</p>

Design, synthesis and anti-proliferative activity of novel coumarin derivatives linking Schiff base and aryl nitrogen mustard / 药学学报

To explore novel coumarin derivatives with more potent anti-proliferative activity, a series of novel compounds were designed and synthesized by linking Schiff base and N, N-bis (2-chloroethyl) amine pharmacophore of nitrogen mustards to the coumarin's framework. Their structures were confirmed by 1H NMR, MS and element analysis techniques. In vitro anti-proliferative activities were evaluated against HepG2, DU145 and MCF7 cell lines by the standard MTT assay. The results showed that some of the target compounds exhibited strong anti-proliferative activities against selected tumor cells, and compounds 7c, 7f, 7g, 7h and 7q were better than or equal to the activities of positive control, they deserved further development.

Synthesis and antitumor activity of 5-substituted-2-(pyridyl)benzothiazole compounds / 药学学报

Fifteen novel 5-substituted-2-(pyridyl)benzothiazole compounds were designed and synthesized by simple hydrolization and condensation reaction of the 2-amino-5-substituent benzothiazole. Activities of these synthesized compounds were evaluated on Bcap-37, HCT-15 and HepG2 tumor cells in vitro by standard MTT assay. 5-Fluorouracil (5-FU) was used as the positive control. The results revealed that most of the new compounds had potent effects on Bcap-37, HCT-15 and HepG2 tumor cells, and had no or less effect on 293T and L02 normal cells. Particularly, compounds 1c and 2e exhibited better activities on HCT-15 and HepG2 cells with IC50 values of 41.59 and 38.65 micromol x L(-1), and 1i showed excellent activities on Bcap-37 and HepG2 cells with IC50 values of 46.63 and 23.51 micromol x L(-1), respectively. The structure-activity relationship of 5-substituted-2-(pyridyl)benzothiazole compounds were also discussed preliminarily.

Design, synthesis and activities of novel benzothiazole derivatives containing arylpiperazine / 药学学报

Twenty-four novel benzothiazole derivatives containing arylpiperazine were designed and synthesized by bioisosterism principle. Anti-proliferative effect of these synthesized compounds against four cancer cell and two normal cell lines were evaluated in vitro by the standard MTT assay. Pharmacological test showed that most of the compounds exhibited potent antitumor activity. Some of the compounds (II2, II3, II6, II7) showed strong anti-proliferation activities against HepG2 and HeLa229 cell lines with the IC 50 values of 1.6-4.5 micromol x L(-1) and 2.5-5.3 micromol x L(-1), respectively, and compounds having cyan in p-substituted benzene ring (I4, I8, I12, II4, II8 and II12) were found to have better antitumor activities against AsPC-1 cell lines with the IC50 values of 5.2-11.3 micromol x L(-1). The structure-activity relationship of benzothiazole derivatives containing arylpiperazine was also discussed preliminarily.

Impact of visit-to-visit variability in blood pressure on renal function of stage 3-4 chronic kidney diseases patients with hypertension / 中华肾脏病杂志

Objective To clarify the clinical significance of visit-to-visit variability in blood pressure (BP) of stage 3-4 chronic kidney disease (CKD) patients with hypertension.Methods One hundred and fifty-two cases of stage 3-4 CKD patients with hypertension were enrolled in the study.Variability in BP was defined as the standard deviation (SD) in BP.For each patient,SD and mean BP from BP measurements were calculated at all the visits.Correlations between the decline in estimated glomerular filtration rate (eGFR) and SD in BP were analyzed by multivariable regression.Results Visit-to-visit variability in BP was significantly associated with renal function decline (P ＜ 0.05),in addition,baseline eGFR,baseline albuminuria and mean SBP during follow-up were significantly associated with renal function decline as well (all P ＜ 0.05).The percentage of CCBs used in low SD of the SBP group was higher than that in high SD of the SBP (76.1％ vs 58.2％,P ＜ 0.05).Conclusion Visit-to-visit variability in BP is significantly associated with renal function decline.Drugs which can decrease the variability of blood pressure should be the first choice in the treatment of hypertension.

Effects of continuous quality improvement on dietary and nutrition management in patients with chronic kidney disease / 中华临床营养杂志

Objective To evaluate the effects of continuous quality improvement (CQI) management on nutritional status,renal function progression,and compliance of low protein diet in patients with chronic kidney disease (CKD).Methods Totally 115 CKD patients who were regularly followed up in CKD clinic services were recruited in this study.Plan,Do,Check,and Act (PDCA) method was adopted to manage the dietary of these patients for 12 months.The clinical indicators and diet compliance before and after receiving CQI management were compared.Results After receiving the CQI management,the nutritional status of patients was well maintained;meanwhile,the average hand strength and the hemoglobin,serum albumin,total cholesterol,and triglyceride levels showed no significant changes (all P ＞ 0.05).Subjective feelings of patients were improved.The modified Subjective Global Assessment of Nutrition (mSGA) score was decreased from 7.0 (7.0,8.0) to 7.0 (7.0,7.0) (P =0.000).The estimated glomerular filtration rate (eGFR) calculated by formula of modified MDRD was decreased from (40.74 ± 14.49) to (37.94 ± 16.86) ml/(min · 1.73 m2) (P =0.000),and the average descended speed was (2.81 ±7.42) ml/(min · 1.73 m2) per year.The creatinine clearance rate had no statistical difference between pre-and post management (P =0.910),and the average descended speed was (0.19 ± 17.01) ml/min per year.The daily protein intake (DPI) and protein equivalent of nitrogen appearance rate (PNA) were both significandy descended:DPI/kg decreased from (0.79 ± 0.27) to (0.64 ± 0.15) g/ (24 h · kg) (P =0.000),and PNA/kg dropped from (1.02 ± 0.32) to (0.82 ± 0.24) g/ (24 h · kg) (P =0.000).The scores of awareness and compliance of patients on low protein diet were significantly increased after CQI management (P =0.000).Conculsion Applying CQI on dietary and nutrition management in CKD patients can maintain the good nutritional status and improve the compliance of low protein diet.

The efficacy and safety of continuous erythropoietin receptor activator in dialytic patients with chronic renal anemia: an open, randomized, controlled, multi-center trial / 中华内科杂志

Objective To evaluate the efficacy and safety of continuous erythropoietin receptor activator (C.E.R.A.) once every 4 weeks by subcutaneous administration on hemoglobin (Hb)maintenance in dialytic patients with chronic renal anemia who had been treated with stable dose of erythropoietin (EPO).Methods This was an open,randomized,controlled,multi-center trial.All the hemodialysis or peritoneal dialytic patients in EPO maintenance treatment received subcutaneous EPO-β during the 6-week pre-treatment period to maintain Hb level between 100 g/L and 120 g/L.Eligible patients were randomized (2∶1 ) to accept either C.E.R.A.once every 4 weeks by subcutaneous administration ( C.E.R.A.group,n =187 ) or subcutaneous EPO-β 1-3 times weekly ( EPO group,n =94) for 28 weeks (including 20-week dose titration period and 8-week efficacy evaluation period ). The starting dose of C.E.R.A.was converted according to the dose of EPO-β administered in the week preceding the first study drug administration.The primary outcome was the change of Hb level between the baseline and that in the efficacy evaluation period.Results Totally 253 patients completed the whole 28-week treatment.The change of baseline-adjusted mean Hb was +2.57 g/L for C.E.R.A.group and + 1.23 g/L for EPO group,resulting in a treatment difference of 1.34 g/L (95％ CI - 1.11-3.78 g/L).Since the lower limit of 95％ CI was greater than the pre-defined non-inferiority margin -7.5 g/L( P ＜ 0.0001 ),C.E.R.A.once every 4 weeks by subcutaneous administration was clinically non-inferior to EPO regarding the maintenance of stable Hb level.The proportion of patients maintaining Hb level within the range of 100-120 g/L through efficacy evaluation period was similar between the two groups ( 69.0％ for C.E.R.A.group vs 68.9％ for EPO group,P ＞0.05 ).The overall incidence of adverse events was similar between the C.E.R.A.(41.7％)and EPO (46.2％ ) groups ( P ＞ 0.05 ).The safety findings were in accordance with the patients' primary diseases rather than the administration.Conclusions Conversion from EPO to C.E.R.A.once every 4 weeks by subcutaneous injection could maintain the Hb in target level in dialytic patients with renal anemia,and it was non-inferior to EPO.In general,subcutaneous administration of C.E.R.A.is well tolerated in dialytic patients with chronic renal anemia.

Effect of acute cardiovascular disease on the healthcare costs associated with chronic kidney disease / 中华肾脏病杂志

Objective To evaluate the effect of cardiovascular disease (CVD) on the healthcare costs associated with chronic kidney disease (CKD).Methods A total of 96 patients with stage 3-4 CKD treated at CKD clinic of Beijing Friendship Hospital,Capital Medical University were enrolled in the study.Their mean age was (61.6±9.5) years including 65 male and 31 female patients.A retrospective analysis of clinical material and health claims between January 2010 and October 2010 was conducted.Firstly,patients were grouped according to median CKD-associated healthcare cost and clinical characteristics were compared between two groups.Secondly,patients were stratified into three categories based on CVD prevalence (with acute cardiovascular events,with CVD but no acute events,and without CVD),and CKD-associated healthcare costs were assessed among the groups.Finally,the potential factors influencing CKD-associated healthcare costs were evaluated by optimal scaling regression analysis.Results During January to October in 2010,median CKD-associated healthcare costs was 13960.5 yuan (interquartile range 10226.5,19667.2 yuan).In the group with higher healthcare costs,more females,greater urine albumin-creatinine ratio,more emergency observations and/or hospitalizations caused by acute cardiovascular events,higher diabetes mellitus prevalence and calcium-phosphorus products,and lower eGFR and hemoglobin levels were found (P＜0.05,respectively).In contrast,the total prevalence of CVD was not significantly different between the groups (P=0.386).When grouping by CVD prevalence,significant differences of CKD-associated healthcare costs were observed only between patients with acute cardiovascular events and the other two groups (P＜0.01,respectively).The median healthcare cost of the former was approximately twice as higher as that of the other two groups,and the maximal cost was also found in the acute-cardiovascular-event group.For the optimal scaling regression analysis,both emergency observations and/or hospitalizations caused by acute cardiovascular events and diabetes mellitus entered the equation,and standardized coefficients were -0.538 and -0.217 respectively (P＜0.01 and P＜0.05).Conclusions Emergency observations and/or hospitalizations caused by acute cardiovascular events are important factors inducing high CKD-associated healthcare costs in patients with stage 3-4 CKD.Therefore,the prevention of acute cardiovascular events may be favorable to reduce CKD-associated healthcare costs.Larger and longer-time perspective studies are required to confirm it.In addition,diabetes mellitus also influences CKD-associated healthcare costs.