Blood Pressure ; Cardiovascular Diseases ; Cardiovascular System ; Humans ; Kidney Failure, Chronic/therapy* ; Renal Dialysis

BACKGROUNDWith the increase in hemodialysis (HD) patients, the blood dialysis patient's quality of life (QoL) and long-term survival are still a challenge for clinicians. Recent studies have found that most of the HD patients have sleep disorders, which have a certain correlation with long-term survival and QoL. But there are few studies of Chinese in this field. This study aimed to investigate whether increasing the dialysis dose can improve sleep quality, so we treated HD patients on long intermittent hemodialysis (LIHD).

METHODSForty patients who were treated by conventional HD at the Beijing Friendship Hospital Blood Purification Center were offered the option of LIHD. The patients' laboratory data, medication use, and questionnaire answers were analyzed. Conventional HD was delivered thrice weekly with 4 hours per treatment, and LIHD was delivered thrice weekly with 8 hours per treatment. The study lasted 6 months. Questionnaires included sleep quality survey and QoL SF-36; the former includes the Athens Insomnia Scale, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS).

RESULTSAfter conversion to LIHD the dialysis efficiency (Kt/V) significantly increased than before (P < 0.05) and clearance rate of urea nitrogen also increased from 67 to 78% (P < 0.01). After conversion, median values for Hb increased from 108.95 to 126.55 g/L (P < 0.01); albumin increased from 38.85 to 40.05 g/L (P < 0.01). Phosphorus decreased from 2.69 to 1.54 mmol/L (P < 0.01), but there was no alteration in blood calcium; phosphorus and calcium-phosphate product levels were under more control, but parathyroid hormone (iPTH) level did not change after conversion to LIHD. After conversion, blood pressure (BP) was better controlled than before and the mean number of antihypertensive drugs prescribed declined from 2.9 to 0.5 (P < 0.01). There was a significant reduction in the use of erythropoietin-stimulating agent of 5250 U/w (P < 0.01). Sleep quality significantly improved in the 2 months after conversion to LIHD, and the PSQI score decreased from 10.80 to 5.45 and the ESS score decreased from 12.05 to 5.30 (P < 0.01). However, sleep quality started to decline after 2 months on LIHD. QoL SF-36 score increased from 410.92 to 592.53 (P < 0.01).

CONCLUSIONLIHD offers an effective improvement in dialysis adequacy for Chinese maintenance HD patients, but it improves sleep quality only briefly which may be related to loss of serum calcium and parathyroid dysfunction.

Adult ; Calcium ; blood ; Female ; Humans ; Kidney Failure, Chronic ; blood ; therapy ; Male ; Middle Aged ; Phosphorus ; blood ; Quality of Life ; Renal Dialysis ; standards

OBJECTIVETo observe the effect of Yishen Jiedu Recipe (YSJDR) in retarding the course of chronic renal failure (CRF).

METHODSForty-five patients were divided into two groups, the 22 patients in Group A were treated with low-protein diet and blood pressure controlling therapy only, while the 23 patients in Group B were treated with additional YSJDR. The time (month) for doubling serum creatinine (SCr) level was taken to evaluate the speed of CRF progression.

RESULTSIn Group A, the time for SCr increased from 288.4 +/- 96.7 mumol/L to 586.3 +/- 251.3 mumol/L was 16.7 +/- 5.1 months, while in Group B the time for SCr increased from 291.2 +/- 101.2 mumol/L to 589.6 +/- 257.5 mumol/L was 28.2 +/- 8.7 months. Comparison between the two groups showed significant difference (P < 0.05).

CONCLUSIONOn the basis of low-protein diet and blood pressure controlling therapy, the additional treatment of YSJDR could markedly retard the progression speed of CRF.

Adult ; Creatinine ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Kidney Failure, Chronic ; drug therapy ; Male ; Middle Aged ; Phytotherapy

BACKGROUND/AIMS: Increased levels of pancreatic enzymes have been reported in patients with renal insufficiency even in the absence of pancreatic diseases. Here, we analyzed serum amylase and lipase levels in chronic renal failure patients according to the degree of azotemia and the treatment modality. METHODS: Serum amylase and lipase levels were reviewed in 95 patients on continuous ambulatory peritoneal dialysis, 105 patients on hemodialysis, 71 patients with renal transplantation, and 73 patients without treatment. Age and sex matched 344 normal healthy controls were selected among those who checked their serum amylase and lipase levels during the same study period. RESULTS: Mean value of amylase level in the patient group (93.7+/-76.5 U/L) was higher than healthy controls (63.8+/-21.4 U/L) (p<0.001) and lipase level in the patient group (212.3+/-195.0 U/L) was higher than healthy control (95.2+/-45.1 U/L) (p<0.001). There was no significant difference in amylase and lipase levels according to the treatment modality in the patient group. The correlations between creatinine clearance and amylase (r=-0.148, p=0.012) or lipase (r=-0.119, p=0.042) were found to be inverse only when the creatinine clearance falls below 50 mL/min. CONCLUSIONS: Serum amylase and lipase levels are about 1.5 times and 2.2 times higher in chronic renal failure patients than healthy controls regardless of treatment modality. The elevations of amylase and lipase levels are inversely correlated with creatinine clearance when it falls below 50 mL/min.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Amylases/*blood ; Creatinine/blood ; Female ; Humans ; Kidney Failure, Chronic/*enzymology/therapy ; Lipase/*blood ; Male ; Middle Aged ; Renal Replacement Therapy

Diabetic kidney disease is a microvascular complication of diabetes mellitus and the leading cause of end-stage renal disease resulting in renal replacement therapy. Approximately 30% to 40% of diabetic patients have diabetic kidney disease, which contributes to a significant increase in morbidity and mortality. Microalbuminuria is considered the gold standard for diabetic kidney disease diagnosis; however, its predictive value is restricted. Although blood glucose control, blood pressure control, and angiotensin converting enzyme inhibitors have been the primary treatment strategies, there are no definitive treatment modalities capable of inhibiting the progression of kidney dysfunction in these patients. This study was undertaken to answer seven questions regarding the various aspects of diabetic kidney disease. Why does it develop? what kind of factors affect its development? How is it diagnosed? What are its possible biomarkers? When is a kidney biopsy necessary? What are the preventive and therapeutic options? And what are the novel treatments?
Angiotensin-Converting Enzyme Inhibitors ; Biomarkers ; Biopsy ; Blood Glucose ; Blood Pressure ; Diabetes Mellitus ; Diabetic Nephropathies ; Diagnosis ; Humans ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Replacement Therapy

OBJECTIVES: Recent reports have suggested that patients treated by CAPD have a relatively increased risk of death compared to patients undergoing HD, although the cause of this discrepancy is poorly understood. Protein malnutrition is an important risk factor in ESRD. Also, amino acid concentrations, for which the physiological function differs from that of protein, may be an independent risk factor in ESRD. There is no doubt concerning the prevalence of low amino acid levels in both HD and CAPD patients. But the difference in plasma amino acid levels between these two groups has not been well defined. The purpose of this study is to compare plasma amino acid levels between patients with ESRD on HD and CAPD. METHODS: A cross sectional study of overnight fasting plasma amino acid concentrations was performed on 12 CAPD and 45 HD patients with ESRD, matched by age, sex and body mass index. The levels of individual plasma amino acid and TAA, EAA, NEAA and BCAA were compared for the HD and CAPD groups. In order to measure losses during HD and CAPD, amino acid and protein concentrations were measured from 10 dialysates obtained from 10 HD patients and 12 peritoneal dialysis solutions from 12 CAPD patients. RESULTS: All of the measured amino acid concentrations were found to be lower in the CAPD group compared to the HD group. Furthermore, the levels of TAA (2017.3 +/- 781.1 vs. 903.3 +/- 316.1 mumole/L), EAA(1201.8 +/- 492.6 vs. 567.6 +/- 223.2 mumole/L), NEAA(815.5 +/- 308.6 vs. 335.7 +/- 100.2 mumole/L); and BCAA (315.0 +/- 146.0 vs. 145.2 +/- 65.0 mumole/L), were all lower in the CAPD group than in the HD group. The protein loss was 2.0 +/- 0.2 g/L in the peritoneal dialysate but was not detectable in the hemodialysates. TAA loss over a one week period was about 61.8 +/- 13.0mmole for the HD group and 38.0 +/- 13.0 mmole for the CAPD group. CONCLUSIONS: Our results show that amino acid concentrations are lower in ESRD patients on CAPD than on HD. It seems likely that protein loss in the peritoneal dialysate is a contributing factor to lowered plasma amino acid concentrations in ESRD patients on CAPD than on HD. We believe that the lowered amino acid concentrations observed in CAPD patients may worsen the clinical outcome compared to HD patients.
Adult ; Amino Acids/blood* ; Amino Acids/analysis ; Comparative Study ; Dialysis Solutions/chemistry ; Female ; Human ; Kidney Failure, Chronic/therapy* ; Kidney Failure, Chronic/blood* ; Male ; Middle Age ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects* ; Renal Dialysis*/adverse effects

BACKGROUND/AIMS: Fabry disease is an X-linked recessive and progressive disease caused by alpha-galactosidase A (alpha-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. METHODS: A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. RESULTS: Twenty-nine patients had elevated serum GL3 levels. The alpha-GaL A activity was determined for the 26 patients with high GL3 levels. The mean alpha-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased alpha-GaL A activity. Among the group with high GL3 levels, 15 women had a alpha-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and alpha-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. CONCLUSIONS: Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease.
Adult ; Aged ; Fabry Disease/blood/*diagnosis ; Female ; Humans ; Kidney Failure, Chronic/blood/*therapy ; Male ; Middle Aged ; *Renal Dialysis ; Trihexosylceramides/*blood ; alpha-Galactosidase/genetics/metabolism

OBJECTIVETo investigate the effects of alpha-keto acid on the expression of neuropeptide Y in malnutrition rats with chronic renal failure.

METHODSSD rats received 5/6 nephrectomy and were fed with 4% casein to establish models of malnutrition with chronic renal failure. Serum albumin, urea nitrogen, serum creatinine, type-1 insulin like growth factor and body weight of the rats were measured. The rat models were randomized into chronic renal failure group, alpha-keto acid group and normal control group, and after a 4-week treatment as indicated, neuropeptide Y mRNA levels in the hypothalamus were measured by RT-PCR in rats with surgically induced renal failure (two-stage subtotal nephrectomy). The blood neuropeptide Y of the rats were analyzed by radioimmunoassay.

RESULTSMalnutrition occurred in chronic renal failure rats at the end of 10 weeks. Compared with those in the chronic renal failure group, the plasma neuropeptide Y concentrations in alpha-keto acid group were significantly lowered with substantially elevated neuropeptide Y mRNA expression in the hypothalamus.

CONCLUSIONalpha-keto acid capsule can improve malnutrition in rats with renal insufficiency possibly by up-regulating neuropeptide Y mRNA expression in the hypothalamus and reducing the level of blood neuropeptide Y.

Animals ; Hypothalamus ; metabolism ; Keto Acids ; pharmacology ; therapeutic use ; Kidney Failure, Chronic ; blood ; Male ; Malnutrition ; blood ; drug therapy ; Neuropeptide Y ; blood ; RNA, Messenger ; genetics ; Rats ; Rats, Sprague-Dawley

To evaluate the feasibility and accuracy of contrast-enhanced ultrasonography (CEUS) for the measurement of hemodialysis access recirculation (AR) and access flow rate (Qa), a two pump system was used to simulate access and dialyzer flow. AR and Qa under different conditions, such as reversal connection of dialysis lines and the needle orientation, were compared with each other. The value of access flow and recirculation flow were calculated based on the formulas introduced in this paper, and the correlation and consistency between true flow rate and calculated values were analyzed. The measured R correlated well with true value of flow rate (r = 0.57, P = 0.038, Qa > Qb; r = 0.95, P = 0.001, Qa < Qb). The Bland-altman test showed good agreement between the calculated value based on CEUS and true values. The CEUS can be used as a new advanced technology for AR and Qa measurement.
Arteriovenous Shunt, Surgical ; Blood Flow Velocity ; Computer Simulation ; Contrast Media ; Humans ; Kidney Failure, Chronic ; blood ; therapy ; Models, Biological ; Monitoring, Physiologic ; instrumentation ; Regional Blood Flow ; Renal Dialysis ; methods ; Ultrasonography

OBJECTIVETo probe into the mechanisms of thread implantation at Zusanli(ST 36) and Chinese herbs in treatment of chronic renal failure(CRF).

METHODSCRF rat model was made by Platt subtotal nephrectomy. They were divided into 5 groups, sham operation group, model group, Chinese herbs group, thread implantation group and thread implantation plus Chinese herbs group. After treatment of 8 weeks, serum parathyroid hormone (PHT), transforming growth factor beta1 (TGF-beta1) expression in residual renal cells, malondialdehyde(MDA) content in the residual renal tissue, serum urea nitrogen(BUN) and creatinine(Scr), protein in urine and pathological changes were investigated.

RESULTSThe above indexes after treatment by thread implantation at acupoint, Chinese herbs, and acupoint thread implantation plus Chinese herbs showed begin reversion, especially, the most obviously improvement in the acupoint thread implantation plus Chinese herbs treatment group.

CONCLUSIONThe mechanism of acupoint thread implantation and Chinese herbs in improvement of CRF is related with decrease of PTH, inhibition of TGF-beta1 expression, decrease of MDA content and resisting lesion of renal fibrosis.

Acupuncture Points ; Animals ; Drugs, Chinese Herbal ; pharmacology ; Kidney Failure, Chronic ; blood ; therapy ; Male ; Parathyroid Hormone ; blood ; Rats ; Rats, Wistar ; Transforming Growth Factor beta ; blood ; Transforming Growth Factor beta1