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Analysis of occurrence and risk factors of chronic kidney disease in the ICU patients

Yuhong ZHAO ; Kaiqiang JI ; Bin ZANG ; Detian LI

Chinese Journal of Nephrology.2013;29(9):660-664. doi:10.3760/cma.j.issn.1001-7097.2013.09.004

Objective To analyze the occurrence and clinical features of chronic kidney disease (CKD) in the ICU patients and identify the possible risk factors.Methods A retrospective study was performed in 2281 ICU patients enrolled from Shengjing hospital between January 2007 and December 2010,in which 1860 cases had complete data and were followed-up,the other 421 cases were excluded for the reasons of dying,suffering from CKD originally,lacking complete data and missing.The cases were divided into CKD and non-CKD groups according to SCODRED and CKD diagnosis standards.Assessment was performed to screen risk factors of CKD.Results There were obvious differences between CKD and non-CKD groups at age,pregnancy,AKI and liver function (P ＜0.05).The CKD's annual morbidity rate of ICU patients was 20％-30％,and the incidence showed an increasing trend with time.Age,pregnancy,AKI,APACHE-Ⅱ score,invasive diagnosis and treatment,mechanical ventilation,organ failure and kidney-hurt drugs were risk factors for CKD in the ICU patients.Conclusions The morbidity rate of CKD in the ICU patients is high,and the number of CKD patients show an increasing trend with time.Age,APACHE-Ⅱ score ＞ 15,the number of failed organs ≥2,the variety of kidney-hurt drug≥2,pregnancy,AKI,the number of invasive diagnosis and treatment≥3,mechanical ventilation are independent risk factors of CKD in the ICU patients.

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Role of inhibitor of nuclear factor kappa B kinase alpha on renal inflammation after ischemia-reperfusion injury and its associated mechanism

Qian ZHANG ; Xin WAN ; Lin LIU ; Xin CHEN ; Wenjuan HUANG ; Wen CHEN ; Changchun CAO

Chinese Journal of Nephrology.2013;29(9):670-675. doi:10.3760/cma.j.issn.1001-7097.2013.09.006

Objective To reveal the role of inhibitor of nuclear factor kappa B kinase alpha (IKKα) in renal inflammation after renal ischemia-reperfusion (IR) injury and its potential associated mechanism.Methods Ischemia-reperfusion injury models were induced in a total of 24 healthy C57BL/6 male mice.Renal function and histological changes were estimated.The expression and site of IKKα,p52,RelB,IL-10 and IL-18 were determined by immunohistochemistry and Western blotting.After the short hairpin RNA(shRNA)targeting IKKα was injected into renal parenchyma,renal function and protein expressions of IKKα,p52,RelB,IL-10,IL-18 were detected.Results Compared with sham-operated group[Scr(7.30±0.13) μmol/L,BUN (8.39± 0.30) mmol/L],levels of Scr [(29.80± 2.10)μmol/L,(27.00±3.40) μmol/L,(23.00±3.70) μmol/L] and BUN [(9.47±3.50) mmol/L,(11.68 ±4.30)mmol/L,(13.12±2.10) mmol/L] were higher on day 1,3,7 and the injury of kidney was serious in IR injury group.Immunohistochemical expression of both IL-18 and IL-10 were increased.Markedly increased IKKα,p52 and RelB protein expression were noted in experiments from day 1 to day 7 during kidney recovery period,with a peak on day 3 and then decreasing toward baseline after day 7.Compared with IR injury group,low-expression of IKKα by injection of shRNA up-regulated the expression of IL-18 and down-regulated the expression of IKKα,p52,RelB and IL-10.Conclusions The NF-κB pathway is activated and IKKα expression is up-regulated during the kidney ischemiareperfusion injury,low-expression of IKKα may block inflammation resolution via down-regulation of alternative NF-κB pathway family members of both p52 and RelB.

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Effects of D-cresol on the proliferation and cell cycle of human umbilical vein endothelial cells

Li LI ; Lixia GUANG ; Daihong WANG ; Xiang DU ; Fahuan YUAN

Chinese Journal of Nephrology.2013;29(9):676-680. doi:10.3760/cma.j.issn.1001-7097.2013.09.007

Objective To investigate the effects of p-cresol on human umbilical vein endothelial cells.Methods The effects of p-cresol on endothelial cell growth,cell cycle,cell morphological change and p21 protein were detected by the CCK-8 assay,flow cytometry assay,inverted microscope and Western blotting.Results P-cresol could inhibit the growth of human umbilical vein endothelial cells in dose-and time-dependent manners (all P ＜ 0.05).The human umbilical vein endothelial cells treated with p-cresol became elongated processes,cloudy cytoplasm,and irregular shapes.The p-cresol stopped human umbilical vein endothelial cells at cell cycle G1 and had no effect on cell apoptosis.The p-cresol could increase protein expression of p21 in a dose dependent manner (P ＜ 0.05).Conclusion P-cresol can increase protein expression of p21,induce cell cycle arrest at G1 stage and inhibit the proliferation of human umbilical vein endothelial cells.

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Classification tree model analysis on related factors of early renal damage in type 2 diabetic patients

Wenbo ZHAO ; Ming LI ; Hua TANG ; Xun LIU ; Meijun SI ; Hui PENG ; Tanqi LOU

Chinese Journal of Nephrology.2013;29(8):563-568. doi:10.3760/cma.j.issn.1001-7097.2013.08.001

Objective To analyze the impact factors for early renal damage in type 2 diabetic patients by the classification tree model.Methods A total of 601 patients with type 2 diabetes were enrolled.According to glomerular filtration rates and urine albumin quantification,the patients were divided into type 2 diabetes group (418 cases) and early diabetic renal damage group (183 cases).The clinical data of the patients were recorded to analyze the main influential factors for the microalbuminuria of type 2 diabetic patients using the Exhaustive CHAID classification tree algorithm.Results Six important explanatory variables were screened out by the classification tree model from the 34 candidate variables related to early renal damage,including fibrinogen,history of hypertension,retinopathy,Cys C levels,SBP and peripheral neuropathy.Elevated fibrinogen was the main factor.Conclusion The classification tree model can analyze the major influential factors of early renal damage in type 2 diabetic patients effectively,and it can help develop the prevention and treatment methods.

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Association of vascular calcification, fetuin A, C-reaction protein and the influence on cardiovascular events in peritoneal dialysis patients

Jianbo LIANG ; Jingyun OU ; Zebin WANG ; Liping JIANG ; Junlin ZHAN

Chinese Journal of Nephrology.2013;29(8):569-573. doi:10.3760/cma.j.issn.1001-7097.2013.08.002

Objective To investigate the association of vascular calcification,fetuin A and Creaction protein (CRP),and explore the influence on cardiovascular events.Methods Sixty peritoneal dialysis (PD) patients were enrolled in this study.Carotid intima-media thickness (cIMT),fetuin A and CRP,along with the other serum related parameters were detected to find out their influence on vascular calcification in PD patients.The relationship between cIMT,fetuin A,CPR and cardiovascular events was analyzed in PD patients with 18 months followed-up.Results Of the 60 PD patients,carotid intima-media thickness (cIMT) was increased in 38 patients(63.3％).Compared with the non-increased cIMT patients,serum fetuin A concentration was significantly decreased(P ＜ 0.05),CRP(P＜0.01) and calcium × phosphate products(P＜0.05) were significantly increased in the highincreased cIMT group.Compared with the low-increased cIMT patients,fetuin A concentration was obviously lower(P ＜ 0.05) and calcium×phosphate products were obviously higher(P ＜ 0.05) in the highincreased cIMT group.Linear regression analysis discovered an obvious negative correlation between CRP and fetuin A(R2 =0.629,F=47.522,P ＜ 0.01),as well as fetuin A and calcium×phosphate products (R2=0.299,F=11.948,P=0.002).Multiple regression analysis indicated that fetuin A was independently negatively correlated with cIMT(B=-0.019,t =-6.042,P ＜ 0.01).At 18 months,there were 36 newly-happened cardiovascular events and among which 6 cases died.Logistic regression analysis found that increased cIMT was risk factor to cardiovascular events in PD patients(OR=3.691,95％CI 1.467-9.258,P=0.006).Conclusion Decreased fetuin A and increased calcium×phosphate products deteriorate carotid calcification in PD patients.Micro-inflammation of PD patients represented by high CRP levels may increase calcium×phosphate products by depressing the fetuin A level,and in the end will stimulate carotid calcification.Increased cIMT is a risk factor for cardiovascular events.

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Citrate lock versus heparin lock for the prevention of catheter related infections in hemodialysis patients with tunneled catheters: a Meta-analysis of randomized controlled trials

Yuliang ZHAO ; Jiqiao YANG ; Ling ZHANG ; Zheng LI ; Yingying YANG ; Yi TANG ; Ping FU

Chinese Journal of Nephrology.2013;29(8):574-582. doi:10.3760/cma.j.issn.1001-7097.2013.08.003

Objective To study whether citrate lock is superior to heparin lock in the prevention of catheter related infections,bleeding complications and catheter malfunctions among hemodialysis patients with tunneled catheters.Methods By searching in Pubmed,the Cochrane Library,EMBASE,Ovid,WanFang,VIP,CNKI and CBM databases as well as related journals,qualified randomized controlled trials were included in a Meta-analysis using Revman 5.0 and STATA 10.0 software.The endpoints included catheter related infection,bleeding complication,thrombolytic treatment,catheter removal for malfunction,catheter thrombosis and all-cause death.Results Fifteen randomized controlled trials were included with 1621 patients involved.Eight studies compared citrate alone with heparin lock,while 7 trials focused on citrate in combination with other antimicrobials.Pooled analysis demonstrated that incidence of catheter related infections in patients receiving citrate lock decreased by 47％ compared with those on heparin (RR=0.53,95％CI 0.36-0.77,P ＜ 0.01).Subgroup analysis by types of citrate lock indicated that all combined lock solutions of citrate and other antimicrobials (citrate + gentamicin,citrate + taurolidine,citrate + methylene blue +methylparaben + propylparaben) were superior to heparin lock in preventing catheter-related infections (P =0.01,0.04,0.01,respectively); citrate alone seemed to reduce catheter-related infection risk (RR =0.68),but no statistically significant difference was observed (95％CI 0.38-1.21,P=0.19).There were fewer patients with bleeding complications in citrate group (RR =0.53,95％ CI 0.34-0.S4,P ＜ 0.01),while citrate showed no advantage over heparin lock in terms of thrombolytic treatment (P =0.93),catheter removal for malfunction (P =0.35),catheter thrombosis (P =0.64) and all-cause death (P =0.35).Conclusions For hemodialysis patients with tunneled catheters,combined lock solutions of citrate and other antimicrobials,rather than citrate alone,are superior to heparin in preventing catheter related infections.Citrate locks are associated with less bleeding complications,and are comparable to heparin in the maintenance of catheter patency.

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Decreased lymphocyte and increased monocyte count in peripheral blood is associated with cardiovascular disease and one-year mortality in maintenance hemodialysis patients

Fangfang XIANG ; Xuesen CAO ; Shaowei XU ; Bo SHEN ; Jianzhou ZOU ; Jie TENG ; Xiaoqiang DING

Chinese Journal of Nephrology.2013;29(8):589-594. doi:10.3760/cma.j.issn.1001-7097.2013.08.005

Objective To investigate the association between peripheral white blood cell count including its subtypes and cardiovascular disease (CVD) incidence and one-year all-cause mortality in maintenance hemodialysis (MHD) patients.Methods A total of 371 MHD patients at Zhongshan Hospital,Fudan University between March 2009 and February,2011 were enrolled.Demographic,hematological,nutritional and inflammatory markers were obtained.All patients were followed for one year to investigate the risks for CVD event and mortality.Spearman correlation and linear regression were used to assess the relationship between white blood cell count and other laboratory parameters.Difference in categorical factors between two groups were determined with Chi-square test,Difference in continuous values between two groups were assessed with t test.Kaplan-Meier analysis and Cox proportional hazards model were applied to assess one-year mortality predictors.Results Patients with CVD event had lower lymphocyte count level (1.17±0.38 vs 1.34±0.51,P＜ 0.05) and higher monocyte count level (0.44 ± 0.15 vs 0.37 ± 0.15,P＜0.01) than those without CVD event.Cox proportional hazard regression showed that an increased lymphocyte count was associated with reduced mortality risk,95％CI:0.136-0.719,P ＜ 0.01) and that an increased monocyte count was associated with increased mortality risk,95％ CI:2.657-74.396,P＜0.01) after adjustment for hsCRP.Conclusion Decreased lymphocyte level and increased monocyte level are significantly related to CVD event and are independent predictors of increased one-year all-cause mortality risk in MHD patients.

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The relationship of hepcidin level with renal anemia and micro-inflammation status in peritoneal dialysis patients

Min YANG ; Xiaozhou HE ; Cuixing ZHOU ; Min LI ; Bin WANG

Chinese Journal of Nephrology.2013;29(8):595-599. doi:10.3760/cma.j.issn.1001-7097.2013.08.006

Objective To observe the level of serum hepcidin and the relationship of hepcidin with renal anemia and micro-inflammation state in peritoneal dialysis(PD) patients.Methods Serum hepcidin,interleukin-6(IL-6),soluble transferrin receptor (sTfR) and erythropoietin (EPO) were measured in 50 PD patients with anemia,30 PD patients without anemia and 40 cases of normal control by ELISA.The indexes of blood routine examination,biochemistry and iron metabolism were also detected at the same time.Results The level of hepcidin in PD patients was significantly higher than that in normal control[(103.65±43.6) μg/L vs (56.39±35.7) μg/L,P ＜ 0.05].Furthermore,the level of hepcidin in PD patients with anemia was higher than that in PD patients without anemia [(122.67±36.6) μg/L vs (83.65±26.4) μg/L,P ＜ 0.05].The results of correlation analysis showed that serum IL-6,sTfR,EPO and ferritin were positively correlated with hepcidin(R =0.821,0.742,0.711,0.531,all P ＜ 0.05),while creatinine clearance of residual kidney in 24 hours and hemoglobin were negatively correlated with hepcidin(R =-0.533,-0.685,all P ＜ 0.05).Conclusions The higher level of hepcidin in PD patients is related with the residual renal function and the micro-inflammatory state.The higher level of hepcidin may induce the iron metabolism imbalance,and then influence the state of renal anemia.The adjustment of hepcidin may provide clinical research value of improving renal anemia and micro-inflammatory state in PD patients.

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Comparative analysis of clinical characters between acute focal bacterial nephritis and acute pylonephritis

Zhan LI ; Jihong YANG ; Yanjing ZHANG

Chinese Journal of Nephrology.2013;29(8):600-604. doi:10.3760/cma.j.issn.1001-7097.2013.08.007

Objective To improve standards of diagnosis and therapy for acute focal bacterial nephritis bY comparing the characters of acute focal bacterial nephritis and acute pylonephritis.Methods Thirty-five patients of upper urinary tract infection whoever accepted ultrasonographic and computed tomographic (CT) examinations in Beijing Hospital from January 2007 to January 2013 were studied retrospectively.Eighteen patients were diagnosed as acute focal bacterial nephritis (AFBN) according to CT imaging features,the other 17 patients were diagnosed as acute pyelonephritis (non-AFBN).The clinical feature,laboratory and imaging examination were compared between the two groups.Results Leukocyte count,percentage of neutrophil,fasting blood-glucose,ESR,NAG/Cre of urine,the combination of more than one kind of antibiotics and duration of antibiotic treatment were higher or much more in AFBN group patients than non AFBN patients,the differences between two groups were statistical significance(P ＜ 0.05).Urine microorganism culture was mainly Escherichia coli no matter in AFBN group or non-AFBN group,microorganism species of AFBN patients were more complex than non-AFBN patients.The most common contrast-enhanced CT feature of AFBN included local distribution of inflammatory area,wedge-shaped or unregular-shaped hypodense lesions on bilateral or single kidney,and mass-like hypodense lesions in more severe cases.NAG/CRE of urine was higher in AFBN group patients with bilateral kidney lesions than with single kidney lesions and non AFBN patients.The remission time of AFBN and non-AFBN was (3.4 ± 2.9) d,(3.0 ± 1.8)d respectively.The relapsing rate of AFBN and non-AFBN within half a year was 2/18,2/17,respectively.Conclusions The symptoms of acute focal bacterial nephritis are not specific.Abdominal contrast-Enhanced CT,ESR,leukocyte count,urine NAG/CRE are probably a predictor of AFBN.Antibiotic treatment with appropriate usage and sufficient duration could bring satisfactory outcomes and prognosis in acute focal bacterial nephritis and pyelonephritis patients.

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Gut bacterial translocation contributes to microinflammationin experimental uremia

Pan ZHANG ; Meng WEI ; Hongli JIANG ; Yi REN ; Kehui SHI ; Feiqian WANG

Chinese Journal of Nephrology.2013;29(8):611-615. doi:10.3760/cma.j.issn.1001-7097.2013.08.009

Objective To investigate whether gut microbiome dysbiosis and translocation occurred in experimental uremia,and whether they consequently contribute to microinflammation.Methods Health male SD rats were randomly divided into uremic group and sham group.Uremic group were operated for 5/6 nephrectomy to establish uremic models,while sham group were only operated for nephrocapsulotomy.Postoperative blood,livers,spleens,and mesenteric lymph nodes (MLNs) were subjected to bacterial 16S ribosomal DNA amplification to determine if bacteria were present.Bacterial genomic DNA samples from the MLNs and colon were amplified with specific primers designed by the 16SrRNA sequence of the species obtained from blood,livers and spleens.Pyrosequencing was used to analyze the ileum and colonic microbio.me of each subject.Intestinal permeability to 99mTc-DTPA,plasma hs-CRP,and IL-6 were measured.Results Bacterial DNA in extraiutestinal sites and altered colonic microbiomes at the phylum,family,and genus levels were detected in some rats in the uremic group.Bacterial genomic DNA in MLNs and colon were obtained by primers specific for bacterial species observed from blood,livers,and spleens of identical individuals.Intestinal permeability,plasma hs-CRP,and IL-6 levels were statistically higher in the uremic group compared with that in sham group(all P ＜ 0.05).Conclusion Gut microbiome dysbiosis occurs and presumably bacteria translocate to the systemic and lymph circulation,thereby contributing to microinflammation in experimental uremia.

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