OBJECTIVETo observe the alteration of QT dispersion (QTd) and QTc dispersion (QTcd) in hemodialysis patients after oral administration of Zhigancao Decoction (, Roasted Licorice Decoction, RLD).

METHODSTo investigate the alteration of QTd and QTcd in 68 routine hemodialysis patients before and after hemodialysis with 12-lead electrocardiogram (ECG) after orally administrated RLD for 4 weeks. Blood was also taken for measurement of plasma electrolytes, liver function, renal function, hemoglobin (Hgb) and hematocrit (HCT).

RESULTSAfter hemodialysis, QTd and QTcd were prolonged evidently; the difference was significant between before and after hemodialysis (P<0.05). After RLD orally administrated for 4 weeks, QTd and QTcd only slightly increased after dialysis compared with pre-dialysis (P>0.05). The QTd and QTcd of the post-therapy-post-dialysis decreased significantly compared with the pre-therapy-post-dialysis (P<0.05). There were no other significant changes in other variables (post-therapy-pre-dialysis vs. pre-therapy-pre-dialysis, or post-therapy-post-dialysis vs. pre-therapy-post-dialysis;P>0.05). After therapy, the number of patients with supraventricular arrhythmia, occasional ventricular premature beat and multiple ventricular premature beat were decreased from 15 to 4, 10 to 2 and 7 to 1, respectively.

CONCLUSIONRLD therapy not only lowered the increased QTd and QTcd after hemodialysis, but also displayed a safety profile.

Adult ; Aged ; Demography ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Electrocardiography ; Female ; Humans ; Kidney Failure, Chronic ; drug therapy ; physiopathology ; Male ; Middle Aged ; Renal Dialysis

PURPOSE: Endothelial dysfunction (ED) is a pivotal phenomenon in the development of cardiovascular disease (CVD) in patients receiving hemodialysis (HD). Indoxyl sulfate (IS) is a known uremic toxin that induces ED in patients with chronic kidney disease. The aim of this study was to investigate whether AST-120, an absorbent of IS, improves microvascular or macrovascular ED in HD patients. MATERIALS AND METHODS: We conducted a prospective, case-controlled trial. Fourteen patients each were enrolled in respective AST-120 and control groups. The subjects in the AST-120 group were treated with AST-120 (6 g/day) for 6 months. Microvascular function was assessed by laser Doppler flowmetry using iontophoresis of acetylcholine (Ach) and sodium nitroprusside (SNP) at baseline and again at 3 and 6 months. Carotid arterial intima-media thickness (cIMT) and flow-mediated vasodilation were measured at baseline and 6 months. The Wilcoxon rank test was used to compare values before and after AST-120 treatment. RESULTS: Ach-induced iontophoresis (endothelium-dependent response) was dramatically ameliorated at 3 months and 6 months in the AST-120 group. SNP-induced response showed delayed improvement only at 6 months in the AST-120 group. The IS level was decreased at 3 months in the AST-120 group, but remained stable thereafter. cIMT was significantly reduced after AST-120 treatment. No significant complications in patients taking AST-120 were reported. CONCLUSION: AST-120 ameliorated microvascular ED and cIMT in HD patients. A randomized study including a larger population will be required to establish a definitive role of AST-120 as a preventive medication for CVD in HD patients.
Acetylcholine ; Adult ; Carbon/*therapeutic use ; Cardiovascular Diseases/etiology/*prevention & control ; Carotid Intima-Media Thickness ; Endothelium, Vascular/*physiopathology ; Female ; Humans ; Iontophoresis ; Kidney Failure, Chronic/complications/*physiopathology/*therapy ; Laser-Doppler Flowmetry ; Male ; Microcirculation/physiology ; Middle Aged ; Nitroprusside ; Oxides/*therapeutic use ; Prospective Studies ; *Renal Dialysis ; Young Adult

PURPOSE: Copeptin has been considered as a useful marker for diagnosis and prediction of prognosis in heart diseases. However, copeptin has not been investigated sufficiently in hemodialysis patients. This study aimed to investigate the general features of copeptin in hemodialysis and to examine the usefulness of copeptin in hemodialysis patients with left ventricular dysfunction (LV dysfunction). MATERIALS AND METHODS: This study included 41 patients on regular hemodialysis. Routine laboratory data and peptides such as the N-terminal of the prohormone brain natriuretic peptide and copeptin were measured on the day of hemodialysis. Body fluid volume was estimated by bioimpedance spectroscopy, and the E/Ea ratio was estimated by echocardiography. RESULTS: Copeptin increased to 171.4 pg/mL before hemodialysis. The copeptin had a positive correlation with pre-dialysis body fluid volume (r=0.314; p=0.04). The copeptin level decreased along with body fluid volume and plasma osmolality during hemodialysis. The copeptin increased in the patients with LV dysfunction more than in those with normal LV function (218.7 pg/mL vs. 77.6 pg/mL; p=0.01). Receiver operating characteristic curve analysis showed that copeptin had a diagnostic value in the hemodialysis patients with LV dysfunction (area under curve 0.737; p=0.02) and that the cut-off value was 125.48 pg/mL (sensitivity 0.7, specificity 0.8, positive predictive value 0.9, negative predictive value 0.6). CONCLUSION: Copeptin increases in hemodialysis patients and is higher in patients with LV dysfunction. We believe that copeptin can be a useful marker for the diagnosis of LV dysfunction in hemodialysis patients.
Adult ; Aged ; Biomarkers/blood ; Echocardiography ; Female ; Glycopeptides/*blood ; Humans ; Kidney Failure, Chronic/*blood/complications/therapy ; Male ; Middle Aged ; Natriuretic Peptide, Brain/blood ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Renal Dialysis/*adverse effects ; Sensitivity and Specificity ; Ventricular Dysfunction, Left/*blood/complications/*physiopathology

OBJECTIVETo compare the differences in the clinical efficacy between Guan's quadruple therapy for kidney disease and the conventional western medication in the treatment of chronic renal failure (CRF).

METHODSEighty patients were randomized into an observation group and a control group, 40 cases in each one. In the observation group, besides the physician instruction of low protein and low phosphorus diet in the two groups, Guan's quadruple therapy for kidney disease was applied, including (1) the isolated herbal moxibustion at Shenshu (BL 23) and Pishu (BL 21), or Ganshu (BL 18), Zusanli (ST 36) and Guanyuan (CV 4) alternatively; (2) acupuncture at the auricular points such as shen (CO10), jiaogan (AHR6), Shenshangxian (TG2), fei (CO14) and pizhixia (AT4); (3) injection of mixture of astragalus injection and lidocaine injection at Feishu (BL 13), Pishu (BL 21), Shenshu (BL 23) and the others; (4) modified Shenshuai Yihao decoction according to syndrome differentiation. In the control group, the conventional western medication was used. After 6 months of treatment, the differences were observed between the two groups in the clinical efficacy, serum creatinine (Scr), blood urea nitrogen (BUN), endogenous creatinine (Ccr) and 24 h urine protein quantitation (UPQ).

RESULTSIn the observation group, after treatment, the remarkably effective rate was 50.0% (20/40) and the total effective rate was 82.5% (33/40), which were superior to 25.0% (10/40) and 45.0% (18/40) in the control group (both P < 0.05). After treatment, the levels of Scr, BUN and 24 h UPQ were reduced apparently (all P < 0.05), and the level of Ccr was increased apparently in the two groups (both P < 0.05). After treatment, the levels of Scr, BUN and 24 h UPQ were reduced much more apparently in the observation group as compared with those in the control group (all P < 0.05).

CONCLUSIONGuan's quadruple therapy for kidney disease achieves a better efficacy on CRF compared with the conventional western medication. This therapy improves renal functions, relieves clinical symptoms and physical signs and benefits the life quality of patients.

Acupuncture Therapy ; Adult ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Kidney Failure, Chronic ; drug therapy ; physiopathology ; therapy ; Kidney Function Tests ; Male ; Middle Aged ; Young Adult

OBJECTIVETo discuss the impacts of moxibustion for regulating spleen and stomach function on the survival quality of the patients of end stage renal disease (ESRD) with maintenance hemodialysis (MHD).

METHODSOne hundred and nine cases of uremia with MHD from 3 hemodialysis centers were randomized into an observation group (58 cases) and a control group (51 cases). The regular hemodialysis and conventional medication were used in the two groups. In the observation group, on the basis of the common treatment, moxibustion was applied to Zusanli (ST 36) and Sanyinjiao (SP 6), 2-3 times a day, the treatment of 4 weeks made one session. Totally, 3 sessions were required and the follow-up lasted for 3 months. KDQOL-SF (kidney disease quality of life short form,KDQOL-SFTM 1. 3) was adopted for the questionnaire investigation on survival quality before treatment, after treatment and at the end of follow-up separately in the two groups.

RESULTSAfter treatment, the survival quality scores in terms of physical functioning (83.62+/-13.27 vs 79.32+/- 22. 17), general health (58. 88+/- 20.24 vs 48.82+/-20.89) and vitality (77.07+/-15.56 vs 70. 59+/-22.61) in the observation group were higher than those in the control group (all P<0. 05). In comparison before and after treatment in the same group, the survival quality scores in terms of physical functioning, general health, vitality and symptoms/problems were all improved in the observation group (all P<0. 05). At the end of follow-up, the survival quality scores in terms of physical functioning, general health, mental health, social functioning, vitality, effects of kidney disease and cognitive function were higher in the observation group as compared with those in the control group (all P<0. 05). In comparison of the results at the end of follow-up with those before treatment, the survival quality scores in terms of vitality, symptoms/problems and cognitive function in the observation group were improved (all P< 0. 05). The differences were not significant in all of the 19 fields of survival quality evaluation before and after treatment, and after follow-up in the control group (all P>0. 05).

CONCLUSIONMoxibustion for regulating spleen and stomach function improves the survival quality of the patients with hemodialysis in terms of physical functioning, general health and vitality, which benefits the psychological condition of the patients, resulting in the improvements of the survival quality in the fields of mental health, social functioning, effects of kidney disease and cognitive function.

Adult ; Aged ; Female ; Humans ; Kidney Failure, Chronic ; physiopathology ; therapy ; Male ; Middle Aged ; Moxibustion ; Quality of Life ; Renal Dialysis ; Spleen ; physiopathology ; Stomach ; physiopathology

PURPOSE: The effect of different peritoneal dialysis (PD) modalities on the decline in residual renal function (RRF) is unclear due to inconsistencies among studies. In particular, the effect of automated peritoneal dialysis (APD) modalities [continuous cyclic peritoneal dialysis (CCPD) and nightly intermittent peritoneal dialysis (NIPD)] on RRF has not been examined in a large cohort. MATERIALS AND METHODS: We conducted a single-center retrospective study to investigate the association between PD modalities and decline in RRF in 142 incident PD patients [34 on CCPD, 36 on NIPD, and 72 on continuous ambulatory peritoneal dialysis (CAPD)]. RRF was measured within 2 months from PD start and at 1 year after PD initiation. RESULTS: The RRF at 1 year after PD initiation was 1.98+/-2.20 mL/min/1.73 m2 in CCPD patients and 3.63+/-3.67 mL/min/1.73 m2 in NIPD patients, which were moderately lower than 4.23+/-3.51 mL/min/1.73 m2 in CAPD patients (p=0.064). Moreover, there was no significant difference in the 1-year rate of decline of RRF between CCPD and NIPD patients, although APD patients had a faster 1-year RRF decline rate than CAPD patients (CCPD and NIPD vs. CAPD: -45.68 and -36.69 vs. 1.17%/year, p=0.045). APD was associated with a more rapid decline in RRF in patients with end-stage renal disease undergoing PD, although multivariate analysis attenuated the significance of this finding (beta=-31.50; 95% CI, -63.61 to 0.62; p=0.052). CONCLUSION: Our results suggest that CAPD might be more helpful than APD for preserving RRF during the first year of dialysis therapy, although there was no significant difference in the 1-year rate of decline of RRF between the two APD modalities.
Adult ; Female ; Glomerular Filtration Rate/physiology ; Humans ; Kidney/pathology/physiopathology ; Kidney Failure, Chronic/*therapy ; Male ; Middle Aged ; Peritoneal Dialysis/*adverse effects ; Retrospective Studies

BACKGROUND/AIMS: Aims: Inflammation is an important factor in renal injury. Ferritin, an inflammatory marker, is considered an independent predictor of rapid renal progression in patients with chronic kidney disease. However, the relationship between ferritin and residual renal function (RRF) in patients undergoing peritoneal dialysis (PD) remains unclear. METHODS: We reviewed the medical records of patients who started PD between June 2001 and March 2012 at Soonchunhyang University Bucheon Hospital, Korea. A total of 123 patients were enrolled in the study. At 1 month after the initiation of PD, RRF was determined by a 24-hour urine collection and measured every 6 months thereafter. Clinical and biochemical data at the time of the initial 24-hour urine collection were considered as baseline. RESULTS: The RRF reduction rate was significantly greater in patients with high ferritin (ferritin > or = 250 ng/mL) compared with those with low ferritin (ferritin < 250 ng/mL; -1.71 +/- 1.36 mL/min/yr/1.73 m2 vs. -0.84 +/- 1.63 mL/min/yr/1.73 m2, respectively; p = 0.007). Pearson correlation analysis revealed a significant negative correlation between the baseline serum ferritin level and the RRF reduction rate (r = -0.219, p = 0.015). Using multiple linear regression analysis and adjusting for other risk factors, baseline serum ferritin was an independent factor for the RRF reduction rate (beta = -0.002, p = 0.002). CONCLUSIONS: In this study we showed that a higher ferritin level was significantly associated with a more rapid RRF decline in patients undergoing PD.
Adult ; Aged ; Biological Markers/blood ; Chi-Square Distribution ; Disease Progression ; Female ; Ferritins/*blood ; Hospitals, University ; Humans ; Inflammation Mediators/*blood ; Kaplan-Meier Estimate ; Kidney/*physiopathology ; Kidney Failure, Chronic/blood/diagnosis/physiopathology/*therapy ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Peritoneal Dialysis/*adverse effects ; Predictive Value of Tests ; Proportional Hazards Models ; Republic of Korea ; Risk Factors ; Time Factors ; Treatment Outcome ; Up-Regulation

Metabolic acidosis, which is observed in salt-sensitive hypertension, is also associated with kidney injury. Alkali therapy in chronic renal failure (CRF) may ameliorate the progression of kidney disease; however, few studies have examined the effects of alkali therapy on salt sensitivity and kidney injury in CRF. We randomly administered standard diet (SD), sodium chloride with 20% casein diet (NACL), or sodium citrate with 20% casein diet (NACT) to Sprague-Dawley rats after a CRF or a sham operation. Four weeks after 5/6 nephrectomy, serum bicarbonate levels were higher in the NACT-treated group. On the pressure-natriuresis curve, NACT-treated CRF rats were more salt-resistant than NACL-treated CRF rats. Additionally, the NACT-treated CRF group showed less tubulointerstitial damage than the NACL-treated CRF group. The expression and immunoreactivity of NHE3 in the kidney in the NACT-treated CRF group were lower than those in the NACL-treated CRF group. We observed that dietary NACT as alkali therapy in CRF might improve the altered salt-sensitivity and ameliorate the progression of kidney injury compared to the NACL diet, which may be related to reduced renal NHE3 expression.
Acute Kidney Injury/diagnosis/*drug therapy/*physiopathology ; Administration, Oral ; Animals ; Citrates/*administration & dosage ; *Dietary Supplements ; Kidney Failure, Chronic/*diet therapy/*physiopathology ; Male ; Rats ; Rats, Sprague-Dawley ; Salt-Tolerance/*drug effects ; Treatment Outcome

In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Delta1.2+/-2.9 mL/min/1.73 m2, P=0.027) and urine volume (-Delta363.6+/-543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Delta0.5+/-2.7 mL/min/1.73 m2, P=0.266; -Delta108.6+/-543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, beta2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]
Adult ; Aged ; CA-125 Antigen/analysis ; Creatinine/urine ; Dialysis Solutions/*therapeutic use ; Female ; Glomerular Filtration Rate ; Glucans/*therapeutic use ; Glucose/*therapeutic use ; Humans ; Interleukin-6/analysis ; Kidney/physiopathology ; Kidney Failure, Chronic/*therapy ; Male ; Membrane Proteins/analysis ; Middle Aged ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Urea/urine

In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Delta1.2+/-2.9 mL/min/1.73 m2, P=0.027) and urine volume (-Delta363.6+/-543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Delta0.5+/-2.7 mL/min/1.73 m2, P=0.266; -Delta108.6+/-543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, beta2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]
Adult ; Aged ; CA-125 Antigen/analysis ; Creatinine/urine ; Dialysis Solutions/*therapeutic use ; Female ; Glomerular Filtration Rate ; Glucans/*therapeutic use ; Glucose/*therapeutic use ; Humans ; Interleukin-6/analysis ; Kidney/physiopathology ; Kidney Failure, Chronic/*therapy ; Male ; Membrane Proteins/analysis ; Middle Aged ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Urea/urine