Objective To study the Bailing capsule combined losartan for UMA and lipid metabolism in patients with early diabetic nephropathy impact analysis.Methods 118 patients with early diabetic nephropathy from October 2015 to May 2016 in our hospital, according to the random lottery was divided into observation group and control group, control group using losartan treatment, observation group on the basis of the combination of Bailing capsule for treatment.Two groups of patients were treated after 3 months, observing two groups of patients with UMA and lipid metabolism related situation, and analyzes the effect of the treatment.Results The UMA ( 125.00 ±44.00 ) mg/24 h and UAER ( 54.64 ±17.31 )μg/min were significantly lower in the observation group than in the control group UMA (216.00 ±46.00) mg/24 h, UAER (67.42 ±21.86) μg/min, 2 group difference was statistically significant (P<0.05).The total cholesterol (TC) of the observation group was (6.15 ±0.75) mmol/L, triglyceride (TG) was (2.34 ±0.48) mmol/L, low density lipoprotein (LDL-C) was (3.55 ±0.73) mmol/L.The levels of TC (6.74 ±0.78) mmol /L, TG (3.01 ± 0.41) mmol/L and LDL-C (4.06 ±0.64) mmol/L, respectively.The levels of TC, TG and LDL-C in the observation group were significantly lower than those in the control group, and high-density lipoprotein (HDL-C) (1.39 ±0.26)mmol/L was significantly higher than that in the control group (1.26 ±0.42) mmol/L, the difference was statistically significant (P<0.05); Two groups of patients after treatment, the observation group total effective rate was 89.7%, significantly higher than that of control group total effective rate 75.0%, two groups are significant difference (P<0.05). Conclusion Bailing capsule combined losartan treatment of early diabetic nephropathy , can effectively reduce the levels of UMA, improve blood lipid in patients with blood sugar levels, which has significant therapeutic effect.

Objective To compare the infection free and overall survival between first and subsequent tunneled cuffed hemodialysis catheters in geriatric patients.Methods The study involved57 geriatric patients [32 male,25 female; mean age (72.4 ± 6.7) years]undergoing maintenance hemodialysis in our blood purfication unit over a period of 72 months.Among a total of 131 catheters and 2686 catheter months including 57 first catheters and 74 consecutive catheters,48 wire guided exchange (WGE) and 26 removal and replacement (RAR),55/131 (42.0％) catheters were exchanged because of catheter-related bacteremia (CRB),37131 (28.2％) exchanged because of malfunction or cuff extrusion,39 /131 (29.9％)catheters were removed electively or was still functional at the end of the study period.Results One-year survival rates for first and consecutive catheters were 35.8％ and 28.4％,respectively.There was no difference in the overall survival between first catheters group and subsequent catheters group [(29.8±7.9)months vs.(28.7±6.0)months,t=0.711,P=0.443].However,infection free survival of first catheters group was significantly prolonged in comparison with that of subsequent catheters group [(13.1 ± 3.5) months vs.(11.6±2.7) months,t =2.415,P=0.018].The overall and infection-free survival in WGE group were not different with those of RAR group [(28.2 ± 7.2 ) months vs.( 28.5 ± 5.8 ) months,(11.1±3.1)months vs.(12.2±2.1)months,t=-0.163,0.103,P＞0.05].The infection free survival of first catheters group and WGE group was prolonged in comparison with that of in situ group[(13.1±3.5)months and (11.1±3.1)months vs.(8.2±2.1)months,t =7.602,5.601,P＜0.05].Conclusions WGE is safe and effective in the elderly patients if the tunnel and the exit site are not infected and has the potential benefit of preserving the vascular access site.

Objective To investigate the types and outcome of vascular access in patients with end stage renal disease (ESRD) initiated hemodialysis (HD), and provide the basis for advancing the proportion of planned HD with arteriovenous fistula (AVF). Methods Clinical data, vascular access types at the initiation of HD, the outcomes of all types of dialysis access and the conversion of renal replacement therapy of ESRD patients who initiated HD in the first affiliated hospital of zhejiang university between January 2009 and December 2011 were retrospectively studied. Results A total of 836 patients were included in our study. Among them 510 were males and 326 were females. The average age was (49.77 ± 17.65) years old. The major primary diseases were primary glomerular disease (72.73%), diabetic nephropathy (11.60%)and hypertensive nephrosclerosis (3.95%). Only 73 patients (8.73%) used AVF as the vascular access at the initiation of HD, another 763 patients (91.27%) used central venous catheter. Six months after the start of dialysis, 542 patients (81.5%) had used AVF as permanent vascular access, 123 patients (18.5%)had used the tunneled cuffed catheter, 54 patients had received a transplant and 55 patients had converted to peritoneal dialysis. The results of logistic regression analysis suggested that being male, patients from outside hangzhou and patients whose glomerular filtration rate were lower than 5 ml·min-1·(1.73 m2)-1 were the risk factors of using central venous catheters at the initiation of HD. Conclusions Only a minority of patients used AVF at the initiation of HD, but most of the other patients switched to AVF within the following six months. Increasing the proportion of AVF as the vascular access of planned HD is still our current goal.