[Clinical control study of dialysates with different concentrations of calcium on blood pressure in patients under hemodialysis for prolonged period].

OBJECTIVE: To investigate the changes in blood pressure in hemodialysis patients treated with low calcium dialysate or high calcium dialysate for long time. METHODS: Fifteen patients undergoing hemodialysis were enrolled in this study. High calcium dialysate (1.75 mmol/L, Dca1.75) was first used for 6 months, then low calcium dialysate (1.25 mmol/L, Dca1.25) was used for 6 months. Serum calcium, phosphate, blood urea nitrogen, and creatinine were measured, blood pressure was recorded before and after hemodialysis at the beginning, and also at 1, 2, 3 and 4 hours after hemodialysis. RESULTS: Compared with that before the treatment, systolic and diastolic blood pressure lowered significantly after single low calcium hemodialysis for 4 hours (both P<0.05), while systolic and diastolic blood pressure rose significantly after single high calcium hemodialysis (both P<0.05). Systolic blood pressure changed more obviously after two hemodialyses (both P<0.05). Changes in systolic, diastolic and mean blood pressure were positively related to changes in serum total calcium (r(1)=0.326, P(1)=0.054; r(2)=0.383, P(2)=0.037; r(3)=0.391, P(3)=0.032). During 6 months of hemodialysis with low calcium dialysate, blood pressure lowered slightly with no significant difference in it (P>0.05), while systolic blood pressure rose during 6 months of hemodialysis with high calcium dialysate (P<0.05). Changes in systolic blood pressure were significantly different between two groups using dialysates with different calcium concentrations (P<0.05). CONCLUSION: Systolic blood pressure and incidence of hypertension decrease after single low calcium hemodialysis.

[The role of TGF-beta1/Smads in the development of peritoneal fibrosis induced by high glucose peritoneal dialysate and LPS].

OBJECTIVE: To investigate the expression and the potential role of TGF-beta/Smads in peritoneal fibrosis induced by high glucose dialysate and LPS in rats. METHODS: 24 male Sprague-Dawley rats were randomly allocated into four groups: control group, normal rats; LPS group: rats were treated with intraperitoneal injection of LPS (0.6 mg/kg body weight) on days 1, 3, 5, 7; dialysate Group: rats were treated with daily intraperitoneal injection of 4.25% peritoneal dialysate (100 ml/kg body weight) for 4 weeks; LPS + dialysate Group: daily intraperitoneal injection of 4.25% dialysate combined with four times injection of LPS (0.6 mg/kg body weight on days 1, 3, 5, 7) for 4 weeks. The parietal thickness was measured with masson stain. The expression of alpha-SMA, TGF-beta1, Smad 2/3, Smad 7 and ColI in peritoneal membrane was detected with confocal microscope by immuno-fluorescence, Western-blot and RT-PCR. RESULTS: Masson stain show the parietal thickness of the rats in all groups was significantly increased compared with control group and collagen deposition was evident in the thickened submesothelial compact zone. Parietal thickness of the rats in LPS + dialysate Group was most (vs LPS group: 41.5 +/- 3.3 microm vs 34.70 +/- 3.6 microm, P = 0.007, vs dialysate Group, 41.5 +/- 3.3 microm vs 20.2 +/- 3.6 microm, P = 0.000). The expression of alpha-SMA, Col I, TGF-beta1, Smad 3 was up-regulated in protein and mRNA level and the protein level of phosphorylated-Smad 2/3 was increased significantly. The most significant changes were found in LPS + dialysate Group. Compared with control group the mRNA and protein level of Smad7 was increased, but the protein ratio of phosphorylated Smad/Smad 7 in all groups was higher. Under electro-microscope, the mesothelial cells in LPS + dialysate Group had myofibroblast morphology with the presence of large bundles of actin microfilaments and dense bodies within the cytoplasm. CONCLUSIONS: High concentration glucose dialysate or LPS contributes to peritoneal fibrosis by stimulating TGF-beta/Smads signaling. 4.25% peritoneal dialysate can coordinate with LPS to activate TGF-beta/Smads signaling pathway and induce mesenchymal transdifferentiation and peritoneal fibrosis.

[Association of CTLA-4 promoter -1722 polymorphism with systemic lupus erythematosus in Chinese].

OBJECTIVE: To investigate the possible association of cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) promoter -1722 polymorphism with systemic lupus erythematosus (SLE) in the population in southern China. METHODS: A total of 103 SLE patients (13 males and 90 females with an average age of 33.63+/-12.58 years) diagnosed according to the SLE diagnostic criteria of the American College of Rheumatology revised in 1982 and 110 healthy ethnically matched controls (21 males and 89 females with an average age of 27.49+/-8.60 years), all from southern China, were enrolled in the study. DNA was extracted from EDTA-treated blood samples according to the standard isolation procedure. The restriction fragment length polymorphism-polymerase chain reaction was used to analyze CTLA-4 promoter-1722 polymorphism in SLE patients and healthy controls. RESULTS: Compared with the controls, the SLE patients had higher frequencies of TC genotype (42% vs 58%, P<0.05) and lower frequency of CC genotype (25% vs 15%, P<0.05). There were no significant differences in the frequencies of TT genotype, alleles and phenotypes between SLE patients and controls; however, significant differences in the frequencies of TT genotype and alleles of CTLA-4 promoter -1722 were found among different races (P<0.05). CONCLUSION: CTLA-4 promoter -1722 polymorphism appears to be associated with SLE susceptibility in southern Chinese population.

[Clearance effect of different blood purification techniques on parathyroid hormone in renal function failure patients on maintenance hemodialysis].

OBJECTIVE: To evaluate the effect of different blood purification techniques on serum parathyroid hormone (PTH) level in chronic hemodialysis (HD) patients with renal failure. METHODS: Ninety patients were randomly divided into three groups: absorption (AP) group, hemodiafiltration (HDF) group, and HD group. Patients in AP group received therapy with resin absorptive devices associated with HD, patients in HDF group received HDF, while patients in HD group received HD. Blood routine examination, serum albumin, globulin, blood urea nitrogen, creatinine and PTH were measured before and after these treatments, and vital signs and side effects were recorded during HD. Glomerular filtration rate (GFR) and the length of HD were compared among three group. RESULTS: (1)Serum PTH in AP group was decrease from (291.7+/-237.5)ng/L to (122.2+/-114.5)ng/L, the difference was statistically significant. The mean single clearance rate was 48.6%+/-55.2%, the rate of relief from skin discomfort was 83.3%e10/12 cases). (2)Serum PTH in HDF group was decreased from(325.9+/-423.1)ng/L to (90.9+/-93.7)ng/L, the difference was statistically significant. The mean single clearance rate was 59.5%+/-22.7%, and the rate of relief from skin discomfort was 50.0%(4/8 cases).(3)Serum PTH in HD group was decreased from (297.7+/-211.3)ng/L to (248.1+/-105.5)ng/L, which showed no statistically significant difference. The mean single clearance rate was 13.1%+/-30.2%, the rate of relief from skin discomfort was 14.3%(1/7 cases). CONCLUSION: Resin absorptive devices and HDF can safely and effectively clear PTH, relieve skin discomfort; while hemodialysis alone can not.