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Objective:To explore the clinical value of N terminal pro B type natriuretic peptide (NT-proBNP) in diagnosing or predicting heart failure in peridialysis chronic kidney disease (CKD) population.Methods:It was a single-center retrospective study. Patients with peridialysis CKD who visited the Department of Nephrology, First Affiliated Hospital of Zhengzhou University from January 2021 to June 2021 were collected and divided into 4 groups according to the presence or absence of heart failure and the level of left ventricular ejection fraction (LVEF), namely the non-heart failure group, heart failure with reduced ejection fraction (HFrEF) group (LVEF<40%), heart failure with mid-range ejection fraction (HFmrEF) group (40％≤LVEF<50％), and heart failure with preserved ejection fraction (HFpEF) group (LVEF≥50％). The NT-proBNP, echocardiography and other indicators of the 4 groups were compared. The value of plasma NT-proBNP in diagnosing heart failure, HFpEF, HFmrEF and HFrEF was analyzed by drawing receiver operating characteristic curve (ROC curve). Logistic regression analysis was used to analyze the related factors of heart failure in peridialysis CKD patients.Results:A total of 508 patients were included, including 11 cases in the HFrEF group, 29 cases in the HFmrEF group, 152 cases in the HFpEF group, and 316 cases without heart failure. The differences in age, 24-h urine volume, hemodialysis proportion, non-dialysis proportion, serum creatinine, estimated glomerular filtration rate, hemoglobin, serum albumin, C-reactive protein, NT-proBNP, cardiac troponin I, left ventricular internal diameter, LVEF, pulmonary artery systolic pressure, left ventricular end-diastolic volume, E/A value, septal thickness, and left ventricular posterior wall thickness among the four groups were statistically significant ( P < 0.05, respectively). A two-pair comparison (all P values corrected by Bonferroni method) revealed that the 24-h urine volume was higher in the non-heart failure group than in the other three groups (corrected P<0.05, respectively), while the proportion of hemodialysis patients and the levels of NT-proBNP and C-reactive protein were lower in the non-heart failure group than in the other three groups (corrected P<0.001, respectively); the levels of hemoglobin and serum albumin were lower in the HFpEF group than in the non-heart failure group (corrected P<0.001, respectively); troponin I was lower in the non-heart failure group than in the HFpEF group (corrected P<0.001), HFmrEF group (corrected P=0.001) and HFrEF group (corrected P<0.001), and troponin I was lower in the HFpEF group than in the HFrEF group (corrected P=0.008); LVEF was higher in the non-heart failure group than in the other three groups (corrected P<0.001, respectively), and LVEF in the HFpEF group was higher than in the HFmrEF and HFrEF groups (corrected P<0.001, respectively). For patients with peridialysis CKD, the cut-off values of plasma NT-proBNP for diagnosing or predicting heart failure, HFpEF, HFmrEF and HFrEF were 4 943.33 ng/L, 4 976.83 ng/L, 14 964.5 ng/L and 17 847.55 ng/L, respectively. Multivariate logistic regression analysis showed that NT-proBNP (every 500 ng/L increase, OR=1.390, 95% CI 1.287-1.501, P<0.001), LVEF ( OR=0.747, 95% CI 0.656-0.851, P<0.001) and 24-h urine volume (every 100 ml increase, OR=0.842, 95% CI 0.763-0.929, P=0.001) were independently correlated with heart failure. Conclusions:The cut-off value of plasma NT-proBNP for diagnosing or predicting heart failure in peridialysis CKD patients is much higher than that in patients with normal renal function. NT-proBNP, LVEF and 24-h urine volume are independently associated with heart failure in peridialysis CKD patients.
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Objective To evaluate the effects of KIM-1 on high glucose induced the expression of MCP-1 and FN in rat tubular epithelial cells and to explore the possible mechanisms of KIM-1 involved in renal interstitial fibrosis of DN.Methods The rat renal tubular epithelial cells (NRK52E) were cultured in vitro and divided into five groups:Normal control group (D-glucose 5.6 mmol/L),Hypertonic group (D-glucose 5.6 mmol/L + D-mannitol 24.4 mmol/L),High glucose group (Dglucose 30 rmmol/L),Control siRNA group,KIM-1 siRNA group.ELISA assay was used to assess the levels of MCP-1 and FN in the cells supernatant; Western blotting was used to detect the protein expression of KIM-1; RT-PCR was used to detect mRNA expression of KIM-1,MCP-1 and FN.Results Compared with the control group,the protein and mRNA expression of KIM-1 in the high glucose group were increased at 12 h (P ＜ 0.05),and reached the peak at 48 h (P ＜ 0.05); the protein and mRNA expression of MCP-1 and FN in high glucose group were increased at 24 h significantly (P ＜ 0.05),and peaked at 48 h (P ＜ 0.05).Compared with the high glucose group,the protein and mRNA expressions of MCP-1 and FN in KIM-1 siRNA group were decreased (P＜0.05).Conclusions Down-regulating the expression of KIM-1 can significantly inhibit the expression of MCP-1 and FN,which suggests that KIM-1 may be involved in renal interstitial fibrosis of DN by regulating expression of MCP-1 and FN.
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Objective To investigate the effect of valsartan on expression of HIF-1α,TIMP-1,MMP-9 in the process of renal interstitial fibrosis(RIF) in diabetic nephropathy(DN) rats.Methods Fifty-four SD rats were randomly divided to 3 groups:control group (group C),DN group (group D),valsartan treatment group (group T).Rats of group D and T were given streptozocin (STZ) by intraperitoneal injection to establish animal model of diabetes.After diabetic models were successfully made,rats of group T were treated by valsartan (40 mg·kg-1·d-1).Serum glucose,serum creatinine and urinary protein were measured at the 4th,8th and 12th weeks.Masson staining was used to calculate the area of RIF.The methods of immunohistochemistry and real-time PCR were used to detect the expressions of HIF-1α,TIMP-1,MMP-9 in renal interstitium.Results Compared with group C,the areas of RIF were larger,24-hour urinary protein,Scr were higher,the mRNA and protein expression of HIF-1α and TIMP-1 increased,while the mRNA and protein expression of MMP-9 decreased in D and T group (P＜0.05).At the 8th,12th weeks,compared with group D,the areas of RIF were smaller,24-hour urinary protein,Scr were relatively lower expressions of HIF-1α and TIMP-1 decreased,while the eapressions of MMP-9 increased in group T (P＜0.05).Conclusion Valsartan may delay the progress of RIF in DN rats by down-regulating the expressions of HIF-1α,TIMP-1,up-regulating the expression of MMP-9,then improve renal function.
