Noninvasive identificational diagnosis of diabetic nephropathy and non-diabetic renal disease based on clinical characteristics of Traditional Chinese Medicine symptom pattern and conventional medicine.

OBJECTIVE: To study the clinical characteristics relating to differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD). METHODS: The subjects were patients with type 2 diabetes mellitus (T2DM) complicated with chronic kidney disease (CKD). Western medical history data and Traditional Chinese Medicine (TCM) symptom pattern were collected, and logistic regression was used to analyze. RESULTS: Blood deficiency pattern [odds ratio () = 2.269, 0.017] and stagnation pattern ( = 1.999, 0.041) are independently related to DN. CONCLUSIONS: TCM factors blood deficiency pattern and stagnation pattern are relating to differential diagnosis of DN and NDRD.

The effects of aging on the renal function of a healthy population in Beijing and an evaluation of a range of estimation equations for glomerular filtration rate.

We investigated how age affected renal function in healthy subjects in Beijing and compared different estimated glomerular filtration rate (eGFR) equations. Kidney function was evaluated by five equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); Modification of Diet in Renal Disease Study (MDRD); the Chinese version of the MDRD (MDRDc); Full Age Spectrum (FAS); and Berlin Initiative Study (BIS). A total of 46,708 subjects were enrolled and followed-up for 3 years. All showed an increase in sCr and a reduction in eGFR with increasing age. Over the 3 years, the eGFR and serum creatinine (sCr) remained unchanged in most subjects. Different equations showed good consistency; the intraclass correlation coefficients (ICC) was 0.849 for males, and 0.817 for females. The CKD-EPI equation yielded higher GFR values than the other equations (according to sCr levels). For subjects aged over 70 years, the BIS equation produced the lowest eGFR values. In summary, we observed that the renal function of individuals was relatively stable with increasing age, although different eGFR equations yielded data that varied across different populations of subjects and sCr levels.

Comparison of clinical features between elderly and non-elderly patients with corona virus disease 2019 / 中华老年医学杂志

Objective:We aimed to compare the characteristics between elderly and non-elderly corona virus disease 2019(COVID-19)patients, especially patients with different severity, in order to achieve a good understanding of elderly patients' clinical presentations.Methods:Records of patients diagnosed with COVID-19 and hospitalized at Tongji Hospital from February 9, 2020 to February 29, 2020 were retrospectively reviewed.They were divided into the elderly(≥65 years old)and non-elderly(<65 years old)groups according to age.Data on morbidity, underlying diseases, clinical symptoms, laboratory test results, imaging characteristics and hospitalization outcomes were collected retrospectively and analyzed statistically.Results:A total of 51 patients were enrolled with 21 in the elderly group(41.2%), with an average age of(71.9±6.4)years, and 30 non-elderly patients(58.8%). There were 13 elderly patients(61.9%)exhibiting fever, representing a lower rate than in the non-elderly patients(27 or 90%)( χ2=5.764, P=0.016). Bilateral pneumonia was present on chest CT scans in all of the elderly patients, while it was seen in 83.3% of the non-elderly patients( χ2=3.880, P=0.049). The proportion of elderly patients with coronary heart disease(61.9%)or hypertension(26.8%)was higher than that of non-elderly patients.The usage rates of antiviral drugs, systemic hormones and antibiotics were all higher and the causes of death were all due to multiple organ failure in elderly patients. Conclusions:Elderly patients with COVID-19 possess special characteristics, showing atypical symptoms, and multiple concomitant diseases may be the reason for their poor clinical prognosis.More rigorous monitoring and careful treatment should be conducted for elderly COVID-19 patients.

Considerations on diagnostic criteria for acute kidney injury in elderly patients and application of novel biomarkers / 中华老年医学杂志

Acute kidney injury(AKI)refers to a clinical syndrome in which the glomerular filtration rate decreases sharply in a short period of time due to various causes.Since elderly patients often have low renal functional reserve, complex underlying diseases, frequent acute events and various types of drug combinations, the incidence of AKI in elderly patients is significantly higher than that in the general population and trends upward each year.The prevention and treatment of elderly AKI should place an emphasis on the identification of risk factors and early diagnosis.There is considerable controversy over whether the existing real-world diagnostic criteria are clinically practical and appropriate.The application of novel diagnostic biomarkers for the diagnosis of AKI in the elderly population remains to be justified.This paper reviews considerations on the diagnostic criteria for AKI in the elderly and the clinical application of new biomarkers, in order to arrive at improved diagnosis and treatment recommendations.

Influence of clinical features at initial hemodialysis on long-term prognosis in advance-aged patients / 中华老年医学杂志

Objective:To analyze the association of clinical characteristics and laboratory indicators at initial maintenance hemodialysis(MHD)with long-term prognosis in advance-aged patients, and to find influencing factors for the prognosis in advance-aged MHD patients.Methods:This retrospective study was conducted at the Nephrology Department of Beijing Hospital between April 2007 and January 2018.A total of 61 patients receiving first-time hemodialysis at ≥ 80 years of age and undergone regular dialysis for 3 months or longer were enrolled.All patients were followed-up until death or the end of July 1, 2018.Patients were divided into the survivor and non-survivor groups, and differences in clinical characteristics and laboratory indicator values were compared between the two groups.Influencing factors for prognosis in advance-aged MHD patients were analyzed by using multivariate Cox regression.Results:For the 61 subjects, the median follow-up time was 25.8 months.During the follow-up, 32 patients died(52.5%). The main death causes were infectious diseases(40.6%, n=13)and cardiovascular and cerebrovascular diseases(37.5%, n=12). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 75.4%(46/61), 54.1%(33/61), 37.7%(23/61), 22.9%(14/61)and 16.4%(10/61), respectively.The median survival time was 25.8 months for all patients, 27.5 months for patients aged 80-84 years, and 14.9 months for patients aged 85 years and over.The non-survivor group had a higher male ratio(65.6% or 21/32 vs.37.9% or 11/29, χ2=4.678, P=0.031)and lower levels of hemoglobin(85.4±13.0 vs.95.0±17.6 g/L, t=2.867, P=0.019)and albumin(30.3±5.0 vs.34.6±4.8 g/L, t=3.039, P=0.001)than the survivor group.Kaplan-Meier curves indicated that the survival rate decreased with age, and subjects aged less than 85 years had a higher survival rate than subjects aged 85 years and older(the median survival time: 14.9 months vs.27.5 months, Log Rank P=0.006); patients who received continuous renal replacement therapy(CRRT)before dialysis had lower survival rates than patients who did not receive CRRT(the median survival time: 7.8 months vs.29.2 months, Log Rank P=0.002); patients with high serum levels of albumin(≥33 g/L)had higher survival rates than patients with low serum levels of albumin(<33 g/L)(the median survival time: 29.2 months vs.18.9 months, Log Rank P=0.003). Multivariate Cox regression analysis showed that age at initial dialysis( HR=1.136, 95% CI: 1.005-1.285, P=0.041), female( HR=0.409; 95% CI: 0.169-0.994, P=0.048), serum albumin level( HR=0.836, 95% CI: 0.772-0.906, P<0.001)and CRRT before dialysis( HR=6.161, 95% CI: 1.848-20.538, P=0.003)were independent predictors of all-cause mortality in advance-aged patients. Conclusions:Advance-aged patients undergoing hemodialysis have complicated clinical conditions and poor prognosis.Age, gender and serum albumin level at initial dialysis and CRRT before dialysis are independent predictors of prognosis in these patients.

Tripterygium wilfordii Hook F Treatment for Stage IV Diabetic Nephropathy: Protocol for a Prospective, Randomized Controlled Trial.

BACKGROUND: Diabetic nephropathy (DN) is a major cause of chronic kidney disease (CKD). There are no effective treatments to prevent or reverse the progression of DN. A preliminary study showed that Tripterygium glycosides from Tripterygium wilfordii Hook F (TwHF) with valsartan decrease proteinuria in patients with DN. OBJECTIVES: The objective of the present study is to investigate the efficacy and safety of Tripterygium glycosides from TwHF, a traditional Chinese medicine, for the treatment of DN. Methods and Analysis. This is a prospective, single-center randomized controlled trial. Seventy participants diagnosed with DN were recruited and randomized 1 : 1 to two groups: (1) angiotensin receptor blocker (ARB) combined with TwHF and (2) ARB-only. The treatment period is 48 weeks. The primary endpoint is 24 h proteinuria decreased level (reduction of 30% vs. baseline) after 48 weeks of treatment. The secondary endpoints are (1) all-cause and cardiovascular-related mortality, (2) development of ESRD (serum creatinine > 530.4 µmol/L or estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2), (3) the need for renal replacement therapy, and (4) increased serum creatinine (2-fold higher than the baseline value or ≥442 µmol/L, with confirmation of the initial results after 4 weeks). A health economics analysis will be carried out. Discussion. A meta-analysis of RCTs carried out in patients with stage 4 (Mogensen classification) diabetic CKD showed that TwHF combined with an ARB was more effective than an ARB alone when considering 24 h proteinuria and serum albumin, but with an increase in adverse event (AE) frequency of 8%. This is a prospective clinical trial that may provide information on a safe and effective novel method for the treatment of DN, especially for patients with macroproteinuria. Ethics and Dissemination. The protocol is approved by the ethics committee of Beijing Hospital (2016BJYYEC-059-02). The results will be disseminated through peer-reviewed publications and international conferences. This trial is registered with ChiCTR-IOR-17010623.

Analysis of causes of death in elderly patients undergoing hemodialysis and peritoneal dialysis / 中华老年医学杂志

Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.

Impact of serum fibroblast growth factor(FGF)23 and carotid intima-media thickness on long-term outcome in maintenance hemodialysis patients / 中华老年医学杂志

Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness (CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients.Methods A total of 88 MHD patients were enrolled,with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months).CIMT and atherosclerotic plaques were measured by Bmode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the-80℃ refrigerator for measuring serum FGF23 levels.Results The 88 patients were aged(64.2±11.5)years,with 52 males and 36 females,and the mean CIMT was (1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8％)subjects.Carotid artery atherosclerotic plaques (CASP)were found in 58 (65.9％)patients aged 60 years and over.Compared with non-elderly patients,elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow up period,34 patients died and 23 (67.6％) patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003).And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P =0.043).Multivariate COX regression analysis showed that FGF23(HR=1.056,95％CI:1.007-1.108,P=0.026)and CIMT(HR=1.165,95％CI:1.032 1.315,P =0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium (HR =0.022,95％ CI:0.001-0.489,P =0.016),hemoglobin(HR =0.966,95％CI:0.937-0.997,P =0.033),FGF23 (HR =1.071,95％ CI:1.017-1.128,P =0.010) and CIMT (HR =1.202,95％ CI:1.049-1.377,P =0.008) were independent predictors for cardiovascular mortality in elderly MHD patients.Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with cardiovascular disease is higher,in which the factors affecting prognosis are more complex.

Comparison of different equations for estimating glomerular filtration rate for evaluating renal function in people aged 70 years and older / 中华老年医学杂志

Objective To assess the value of different equations for estimating glomerular filtration rate (GFR) for evaluating renal function in people aged 70 years and older.Methods A retrospective study was conducted involving 11 966 elderly people aged 70 years and older,including 5 741males (48.0％),who underwent routine physical examinations in Beijing Hospital from January 2012 to December 2014 and were followed up for 3 years.Baseline data,including the age,gender,and serum creatinine,were recorded.Results function was assessed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI),Modification of Diet in Renal Disease (MDRD) Study,Chinese Modification of Diet in Renal Disease (MDRD) Study,full age spectrum (FAS) equation and Berlin Initiative Study (BIS) equation,respectively.Results The serum creatinine level increased with age in male and female subjects,and the standard deviation also increased with age,indicating greater variability of serum creatinine in the elderly.Of all equations,the FAS and BIS equations had the lowest GFR estimates.The five equations showed good consistency.In males,the Kendall's W coefficient was 0.796 (P =0.000);the female Kendall's W coefficient was 0.715 (P =0.000)Based on three ranges of serum creatinine (＜88.4 μmol/L,≥88.4 μmol/L and ＜132.6 μmol/L,≥132.6 μmol/L),all patients were divided into three groups.The BIS,MDRD,MDRDc and FAS equations were all consistent in staging CKD at any creatinine level;however,the CKD-EPI equation significantly overestimated renal function at higher levels of serum creatinine.There was no clear age-related trend when each of the five equations was used to calculate the average 3-year eGFR rate.Conclusions The CKD-EPI,MDRD,MDRDc,FAS and BIS equations can be used to assess renal function,but the results vary among different populations.Which equation has the best accuracy for the elderly in China remains inconclusive and further research is urgently needed.

Comparison of different equations for estimating glomerular filtration rate for evaluating renal function in people aged 70 years and older / 中华老年医学杂志

Objective@#To assess the value of different equations for estimating glomerular filtration rate (GFR) for evaluating renal function in people aged 70 years and older.@*Methods@#A retrospective study was conducted involving 11 966 elderly people aged 70 years and older, including 5 741 males (48.0%), who underwent routine physical examinations in Beijing Hospital from January 2012 to December 2014 and were followed up for 3 years.Baseline data, including the age, gender, and serum creatinine, were recorded.@*Results@#function was assessed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study, Chinese Modification of Diet in Renal Disease (MDRD) Study, full age spectrum (FAS) equation and Berlin Initiative Study (BIS) equation, respectively.Results The serum creatinine level increased with age in male and female subjects, and the standard deviation also increased with age, indicating greater variability of serum creatinine in the elderly.Of all equations, the FAS and BIS equations had the lowest GFR estimates.The five equations showed good consistency.In males, the Kendall's W coefficient was 0.796 (P = 0.000); the female Kendall's W coefficient was 0.715 (P = 0.000). Based on three ranges of serum creatinine (<88.4 μmol/L, ≥88.4 μmol/L and <132.6 μmol/L, ≥132.6 μmol/L), all patients were divided into three groups.The BIS, MDRD, MDRDc and FAS equations were all consistent in staging CKD at any creatinine level; however, the CKD-EPI equation significantly overestimated renal function at higher levels of serum creatinine.There was no clear age-related trend when each of the five equations was used to calculate the average 3-year eGFR rate.@*Conclusions@#The CKD-EPI, MDRD, MDRDc, FAS and BIS equations can be used to assess renal function, but the results vary among different populations.Which equation has the best accuracy for the elderly in China remains inconclusive and further research is urgently needed.

Analysis of the causes of death in maintenance hemodialysis patients: a 20-year single-center study / 中华老年医学杂志

Objective To analyze the causes of death of maintenance hemodialysis (MHD) patients,and to compare the long term survival rate between elderly patients and non-elderly patients and between diabetic nephropathy (DN) patients and non-DN patients at our hemodialysis center during last 20 years.Methods A total of 317 MHD patients were collected,and divided into elderly (≥60 years) and non-elderly (＜60 years) groups based on the age at starting hemodialysis.Besides,data of gender,primary diseases,and the direct cause of death in maintenance hemodialysis patients from 1996 to 2016 were collected.Results Cardiogenic diseases,infections,and cerebrovascular accidents were the three leading causes of death.The mean dialysis age was shorter in elderly MHD patients than in non-elderly MHD patients[(51.8 ± 45.7) months vs.(81.6 ± 66.5) months,t =4.271,P=0.000]with a lower survival rate (x2 =32.422,P =0.000).The mean dialysis age was significantly lower in DN patients than in non-DN patients[(44.1±33.8) months vs.(69.4±60.6) months,t=3.632,P =0.000)] with a lower survival rate (x2 =13.361,P =0.000).The overall survival rate was 59.8％ after the fifth year of MHD,was 33.3％ after the 10th year,was 8.4％ after the 20th year,in our dialysis center.Conclusions The long-term survival rate of patients receiving maintenance hemodialysis in our center is as high as that in the developed countries and in other hospitals in Beijing.The top three death causes are cardiac diseases,infections,and cerebrovascular accidents.For old or DN patients,the overall prognosis is poor.

Prognostic value of red cell distribution width in elderly patients undergoing peritoneal dialysis / 中华老年医学杂志

Objective To examine the clinical characteristics and red cell distribution width (RDW) changes and to investigate the prognostic value of RDW in elderly patients undergoing peritoneal dialysis(PD). Methods We retrospectively analyzed the data of 59 elderly patients aged 60 or over who had undergone regular PD for over three months at Beijing Hospital from July 1 ,2005 to June 30 ,2017.All patients were followed up until the occurrence of a composite event or until December 31 ,2017. General characteristics ,baseline laboratory data ,RDW at baseline ,and time-average RDW during the follow-up were compared between the non-survival group and the survival group.Cox regression analysis was performed to determine whether RDW was an independent risk factor of all-cause mortality. Results Fifty-nine elderly PD patients with a mean age of (70.5 ± 6.6) years were included.The median follow-up duration was 40(25 ,56)months and the median survival duration was 57(36.6 ,74.4)months. The 1-,3-,and 5-year survival rates of all patients were 98.3%(n＝58) ,72.9%(n＝ 43) ,and 52.5%(n＝ 31) ,respectively.Twenty-eight patients died during the follow-up ,of whom 15 died of infection ,8 of cardio-cerebrovascular disease and 5 of other causes.Non-survivors had higher Charlson Comorbidity Index (CCI)scores ,higher levels of RDW at baseline ,higher time-average RDW ,lower initial total KT/V ,and lower initial total CCr (all P＜0.01).In univariate analysis ,high CCI ,high basic RDW ,high time-average RDW ,low serum albumin ,low serum ferrum , and low serum cholesterol were associated with all-cause mortality (all P＜ 0.05).In multivariate- adjusted Cox analysis ,high CCI(HR＝1.679 ,95% CI :1.238-2.236 ,P＝0.001)and high time-average RDW(HR ＝ 1.889 ,95% CI :1.195-2.987 ,P ＝ 0.007)were independent predictors for all-cause mortality in elderly PD patients. Conclusions Time-average RDW may independently predict the mortality of elderly PD patients. The prognostic value of dynamic RDW may be similar to that of CCI.

Comparison of clinical and pathological features of idiopathic membranous nephropathy between elderly and non-elderly patients / 中华老年医学杂志

Objective To explore the differences in clinical and pathological characteristics of idiopathic membranous nephropathy between elderly and non elderly patients.Methods The clinical and pathological data,which were used for biopsy diagnosing idiopathic membranous nephropathy in elderly patients (aged ≥65 years) versus non elderly patients (aged ＜65 years) in our hospital during the recently 10 years,were retrospectively analyzed and compared.Results The elderly patients with idiopathic membranous nephropathy accounted for 26.29％ and patients aged less than 45 years with idiopathic membranous nephropathy accounted for 25.26％.The proportions of idiopathic membranous nephropathy in the two different age groups were similar.The occurrence rate of hypertension and microscopic hematuria as well as levels of blood serum creatinine and urinary N-acetyl-β-D-glucosaminidase were higher,while the urinary osmotic pressure,estimated glomerular filtration rate (eGFR) and blood albumin were lower in elderly group than in non-elderly group (all P＜0.05).The proportions of glomerulosclerosis,tubulointerstitial lesions and vascular lesions were higher in elderly group than in non-elderly patients (all P＜ 0.05).There were no significant differences in the immunofluorescence intensity of IgG,positive rates of IgA,C3,C4 and Fi between the two groups,while the positive rate of C1q was lower in elderly group than in non elderly.Among 51 patients receiving IgG4 immunohistochemical staining,the positive rate of IgG4 staining and the intensity were higher in elderly group than in non-elderly [100.00％ vs.81.25％,(2.11±0.46) vs.(1.59 ± 0.95),both P ＜ 0.05].Conclusions The proportion of idiopathic membranous nephropathy is increased in non-elderly patients.Elderly patients are more susceptible to hypertension,hematuria and renal dysfunction.The positive rate and the intensity of IgG4 are higher and the positive rate of C1q is lower in elderly group than in non-elderly group,which indicate that patients with negative IgG4 and positive C1q have secondary causes which have not yet been demonstrated,and they should be closely observed during the follow-up.

Significance of serum troponin T and C-reactive protein in the long-term prognosis of hemodialysis patients / 中华肾脏病杂志

Objective To investigate the long-term prognostic factors and the significance of serum cardiac troponin T (cTnT) and C-reactive protein (CRP) in maintenance hemodialysis (MHD) patients.Methods Clinical data of 76 MHD patients in our hospital from January 2002 to January 2003 were retrospectively analyzed.Time and cause of death in the next 10 years were recorded.Survival rate was calculated by Kaplan-Meier and impact factors of long-term prognosis were explored.Significance of cTnT and CRP was elucidated by COX regression analysis.Results CRP was positive in 28 cases (36.8％) and cTnT was positive in 22 cases (28.9％) among 76 patients.The median survival time was 37.9 months,2-year survival rate was 65.9％ and 10-year survival rate was 24.2％.Univariate analysis found positive CRP,positive cTnT,old age,diabetes,cardiocerebrovascular disease,anemia,low serum albumin,Kt/V decline were associated with long-term prognosis.Multivariate analysis showed that increased age (P =0.010),cardiocerebrovascular disease (P =0.048),positive cTnT (P =0.036),positive CRP (P =0.009) were independent risk factors of the 10-year survival of MHD patients.Ten-year mortality of cardiocerebrovascular diseases in positive cTnT group was not significantly different as compared with negative cTnT group (50.0％ vs 35.4％,P =0.248).But the positive cTnT group had higher 2-year mortality than negative cTnT group (40.9％ vs 14.6％,P =0.015).Mortality of cardiocerebrovascular disease was higher in positive CRP group as compared to negative CRP group at both 2-year and 10-year time (48.1％ vs 7.0％,P =0.000; 66.7％ vs 23.3％,P =0.000).Compared with both negative cTnT and CRP group,both positive cTnT and CRP group had much higher all-cause mortality (92.9％ vs 55.6％,P =0.030),higher mortality of cardiocerebrovascular disease at 10-year (64.3％ vs 25.0％,P =0.009),and higher mortality of cardiocerebrovascular disease at 2-year (57.1％ vs 5.6％,P =0.000).Conclusions Aging,cardiocerebrovascular disease,positive cTnT and positive CRP are independent risk factors of long-term prognosis for MHD patients.Positive cTnT can predict cardiocerebrovascular mortality of MHD patients in 2 years,while positive CRP can predict short-and long-term cardiocerebrovascular mortality.Positive cTnT combined with positive CRP may be more valuable in predicting the poor prognosis of MHD patients.

Preventive effect of continuous quality improvement on the malnutrition, inflammation, peritoneal dialysis adequacy and cardiovascular events in elderly peritoneal dialysis patients / 中华老年医学杂志

Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8％ vs.93.75％,(1.97±0.36) vs.(2.08±0.33),both P＜ 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P＜0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4％ vs.31.3％,P＜0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM％),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P＜ 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP＞3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1％ vs.25％,both P＜0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P ＜ 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25％ vs.3.13％,P＜0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.

Preliminary study on the intradialytic blood pressure variability and influencing factors / 中华肾脏病杂志

Objective To understand the blood pressure variability (BPV) and the influencing factors through ambulatory blood pressure monitoring during hemodialysis (HD) in the end-stage renal disease (ESRD) patients.Method Eighty-one ESRD patients on maintenancing HD for more than three months were enrolled into the study.The patients were with properly dry body weight.The blood pressure was monitored using dynamic blood pressure monitor around the HD.BPV was estimated with the coefficient of variation (CV) and standard deviation (SD) of the systolic blood pressure (SBP-CV,SBP-SD).Patients were divided into two groups according to the mean of SBP-CV:high SBPV group and low SBPV group.The possible influencing factors such as age,dialysis duration,ultrafitration volume,ultrafiltration/body weight,therapy of antihypertensive,electrolyte,nutrition state,metabolic bone disease indexes,inflammatory state and serum lipid state were analyzed and compared between the two groups.And multivariate stepwise regression analysis was made between the SBP-CV,SBP-SD and the above observational parameters.Results The average SBP-CV of the 81 patients was (8.12± 3.16)％,SBP-SD was (11.22±4.55) mm Hg.The proportion of hypertention and hypotention in high SBPV(SBP-CV≥8.12％) group (20.0％,25.7％) was higher than that in the low SBPV(SBP-CV ＜8.12％) group (8.7％,6.5％)(P =0.009).Serum high-sensitivity c-reactive protein (hs-CRP) and alkaline phosphatase (ALP) were higher in high SBPV group than that in the low SBPV group[(7.19± 5.95) mg/L vs (3.35±2.78) mg/L,P =0.001 and (180.31±96.32) U/L vs (98.00±41.19) U/L,P =0.049].Serum creatinine and potassium were higher in the low SBPV group than that in the high SBPV group [(1015.83±276.20) μmol/L vs (893.63±216.61) μmol/L,P =0.034 and (5.27±0.78) mmol/L vs (4.80± 0.23) mmol/L,P =0.005].SBP-SD was positively correlated with hs-CRP (β =0.499,P ＜ 0.01),SBP-CV was positively correlated with hs-CRP and dialysis vintage (β =0.464 and 0.211,P ＜ 0.01 and P ＜ 0.05) by the multivariate stepwise regression analysis.Conclusions The SBP-CV during HD is 8.12％ in ESRD patients.Hypertention and hypotention are more often in the higher SBPV patients.SBPV is closely related to the serum hs-CRP.

Analysis of age-related changes and risk factors of renal tubular function in elderly male cases / 中华老年医学杂志

Objective To summarize the age-related changes and the risk factors of renal tubular function in the elderly male cases.Methods Totally 229 cases without chronic kidney disease were divided into two groups:group aged ＜80 years and group aged ≥80 years.We measured the urine routine,serum creatine,serum urea,urine β2-microglobin (β2-MG),urine α1-microglobin (α1-MG)and calculated the eGFR based on Cockcroft-Gault equation.Logistic regression was used to analyze the risk factors which may accelerate the progression of the renal tubular impairment.Results The average age of 229 cases was (76±10)years.There were 142 cases in the group of ＜80 years old and 87 cases in the group of ≥80 years old.The level of eGFR in the group of ≥80 years old was (55.0±12.7) ml/min,which was lower than that of the group of ＜ 80 years old (80.3 ± 18.0 ml/min) (t =9.882,P＜0.01).The level of urine SG was decreased in the group of ≥80 years old versus in the group of ＜80 years old(1.016±0.006 vs.1.013±0.006).The value changes of urine pH,urine β2-MG and urine α1-MG were of statistical differences between the two groups [(6.2±0.8) vs.(6.6±0.8),(0.96±1.02)mg/L vs.(2.08 ±3.56)mg/L,(6.67±3.57) mg/L vs.(8.71±6.59)mg/L].The correlation analysis showed that age correlated negatively with eGFR and urine SG(r =-0.692and r=-0.280,both P＜0.01)and positively with urine pH(r=0.255),urine β2 MG(r=0.262),urine α1-MG(r=0.228)(all P＜0.01).The Logistic regression analysis showed that coronary heart disease was an independent risk factor for the progression of renal tubular impairment (OR=4.251,P=0.002).Conclusions Renal tubular functions is decreased with ageing age in the elderly male,especially in the advanced elderly.The coronary heart disease is an independent risk factor of the progression of renal tubular impairment.

Adverse effect of β lactam antibiotic on acute injury of renal tubular function in elderly patients / 中华老年医学杂志

Objective To investigate the change of renal tubular function in elderly patients after use of β lactam antibiotic. Methods The elderly patients with pulmonary infection were treated with β lactam antibiotic,the dosage was 50%-70% of normal use. The renal tubular function indicated by urine α1-MG, β2-MG, pro/Cre, NAG/Cre and glomerulus function marked by eGFR, serum creatinine (Cre)), cystatin C were detected during drugs treatment and 7 days after stopping medications. Results The infection was controlled well in 3-7 days after treatment. Urine α1-MG, β2-MG, pro/Cre and NAG/Cre were abnormal before treatment, were elevated in 3, 14 days after using antibiotic, and came down to the level before treatment on 7 days after stopping treatment. The level of Cre and eGFR was (89.0±25.97) μmol/L and (26.39±8.17) ml/min before treatment, then elevated and decreased in 14 days after treatment, respectively, and down to the level before treatment on 7 days after stopping of antibiotic. Cystatin c was abnormal before treatment and did not change significantly after treatment and after stopping antibiotic. Conclusions It is important to protect renal tubular function and to adjust antibiotic dosage according to eGFR during using antibiotic in elderly patients to control infection.

Bacteria Distribution and Antibiotic Resistance Analysis of Urinary Tract Infection in 2004 / 中华医院感染学杂志

OBJECTIVE To investigate the bacteria distribution and antibiotic resistance in urinary tract infection in 2004.METHODS During Jan 1st 2004 to Dec 31st 2004,1007 urine specimens were collected from inpatient and outpatient departments of Beijing Hospital.Totally 632 strains of pathogens were identified and the drug resistance was(performed.) RESULTS Among pathogens of urinary tract infection in 2004,Escherichia coli rated the first(38.29%),(followed) by Enterococcus(18.67%),fungi(17.41%),Streptococcus(8.07%),Proteus(3.4%),Staphylococcus(3.95%),Pseudomonas aeruginosa(3.17%) and Klebsiella pneumoniae(2.37%).Enterobacteriaceae were sensitive to imipenem(100%).(G~+) cocci were sensitive to nitrofurantoin and vancomycin(nearly to 100%).Compared to pathogens of UTI in 2001,fungi showed obviously increasing trend.CONCLUSIONS In 2004,(Enterobacteriaceae)(mostly E.coli) are the major pathogens in urinary tract infection.Fungi infection in(urinary) tract has an obviously increasing tendency and should be carefully treated.

The observation of cardiac troponin T in hemodialysis patients / 中华老年医学杂志

Objective To observe the possible relationship of cardiac troponin T (cTnT) with cardiac disease and death events in hemodialysis patients Methods The cTnT was measured with dry chemical method in 57 hemodialysis patients The patients were followed up for one year Results The concentration of cTnT was more than 0 10 ?g/L in 12 of the 57 unselected hemodialysis patients 8 in the 12 patients were diagnosed as diabetes mellitus 7 of 12 patients died and the death reason was acute left ventricular failure(33 3%) in 4 patients In other 45 patients with normal cTnT, 3 died and only 1 died of heart failure(2 22%) The cTnT concentrations of pre-and post-hemodialysis were measured in 24 patients The concentration was more than 0 1 ?g/L in 6 patients before dialysis Post-dialysis concentration was increased in 5 patients', the value was decreased in the other one Conclusions In hemodialysis patients without acute myocardial infarction, mortality and cardiovascular events are closely correlated with the increase of cTnT concentration. Patients with diabetes mellitus have higher incidence in the abnormality of cTnT concentration.The process of hemodialysis does not affect the concentration of cTnT.