Changes in Intestinal Flora From Chronic Renal Failure Complicated With Coronary Heart Disease and its Correlation With Arterial Stiffness Index.

Context: One common and serious cardiovascular complication of chronic renal failure (CRF) is coronary heart disease (CHD). CRF can lead to an imbalance of patients' gut microbiota, and changes in intestinal flora might heavily affect CRF's development. Objective: The study intended to investigate the changes in intestinal flora of patients with CRF complicated with CHD and their relationship with ASI to understand the association of those changes and ASI with CRF comorbid with CHD, with the goal of offering a reliable clinical basis for active prevention and treatment of CRF and CHD in the future. Design: The research team designed a prospective controlled study. Setting: The study took place at the Affiliated Hospital of Hebei University in Baoding, Hebei, China. Participants: Participants were 86 patients with both CRF and CHD and 72 patients with CHD only who had been admitted to the hospital between October 2019 and January 2021. Intervention: The intervention group included participants who had received a diagnosis of CRF complicated with CHD and the control group included participants who had received a diagnosis of CHD only. Outcome Measures: The research team counted participants' intestinal flora and measured their ambulatory blood pressure and arterial stiffness index (ASI) to analyze the correlation of the ASI with the intestinal flora and the related factors impacting CHD in patients with CRF. Results: The monitoring of participants' ambulatory blood pressures showed that the intervention group's day systolic blood pressure (dSBP) and 24h SBP were significantly higher, while the group's day diastolic blood pressure (dDBP) and 24h DBP were significantly lower than those of the control group. The intervention group's levels of lactobacillus, bacteroidaceae, and bifidobacterium were significantly lower than those of the control group, and those intestinal flora were negatively correlated with ASI. The intervention group's levels of Escherichia coli and yeasts were significantly higher than those of the control group, and those intestinal flora were positively correlated with ASI. A significant relationship existed between lactobacillus and yeast and the occurrence of CHD in the CRF participants. Conclusions: Patients with both CRF and CHD have an obvious intestinal-flora imbalance, and the imbalance is strongly bound up with their ASI, which is of great reference significance for novel therapy of such patients and for the clinical application of ASI.

Comparison Between Hemodialysis and Peritoneal Dialysis in the Risks for Disease Activity in LN-ESRD Patients: A Systematic Review and Meta-analysis.

Context: End-stage renal disease (ESRD) is the advanced stage of a progressive loss of kidney function. About 10% of all patients with lupus nephritis (LN) eventually progress to ESRD, which may necessitate renal replacement therapy (RRT), such as hemodialysis (HD), peritoneal dialysis (PD), and/or kidney transplant. Research hasn't confirmed which dialysis options, prior to kidney transplantation, are beneficial to patients' prognoses. Objective: The study intended to compare the risks-related to disease activity, exercise, all-cause infection, all-cause cardiovascular events, and mortality-of the use of HD and PD for LN-ESRD adults, as the initial alternative treatment before renal transplantation. Design: The research team performed a narrative review and analyzed the data obtained about clinical outcomes for HD and peritoneal dialysis. For the review, the research team searched the PubMed, EMBASE, and SCOPUS databases. The search used the keywords: end-stage renal disease, renal replacement therapy, hemodialysis and peritoneal dialysis. Setting: The study made in Affiliated Hospital of Hebei University, China. Participants: The studies included 15 636 patients who had been diagnosed with LN-ESRD prior to renal transplantation. Outcome Measures: For the data analysis, the research team divided the data into two groups, one of which included the data on the clinical outcomes for HD patientsand one of which included the data on the clinical outcomes for PD patients. The study evaluated four types of risks: lupus-flare risks, all-cause infection risks, all-cause cardiovascular events risk, and risk of mortality. Results: The 16 studies found in the review reported one or more outcomes of interest for the two dialysis modalities, HD and PD. The analysis of the data from the 16 studies showed that HD was associated with a higher risk than PD: (1) of lupus flares, with RR = 1.23 (confidence interval: 0.82, 1.85), but the difference didn't reach statistical significance (P = .31); (2) of all-cause infection risk, with RR = 1.02 (confidence interval: 0.66, 1.59), but the difference didn't reach statistical significance (P = .92); (3) of all-cause cardiovascular events, with RR = 1.44 (confidence interval: 1.02, 2.04), and the difference reached statistical significance (P = .04); and (4) of mortality risk, with RR = 1.29 (confidence interval: 0.95, 1.75), but the difference didn't reach statistical significance (P = .10). Conclusions: The current study may have reference significance for clinical treatment of ESRD. Except for all-cause cardiovascular events in which PD was superior to HD, offering better outcomes, both treatment modalities provide more or less similar clinical outcomes as effective initial choices for RRT in LN-ESRD patients prior to renal transplant. The current research team, however, encourages further research on the question, addressing better the possible sources of biases encountered in the current study.