Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(...Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.展开更多
Hyperkalemia,usually associated with predisposing chronic diseases as heart failure(HF),severe kidney disease or diabetes mellitus(DM),[1]is defined as an elevation of potassium concentration more than 5.5 mmol/L,[2].
Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during ...Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis. Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows： permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were fbund with mitral valve involvement, two with aor tic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure alter further hemodialysis for three months. One was well on maintenance hemodi alvsis for three months after surgery. Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, lull course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective cndocarditis.展开更多
BACKGROUND：Carotid intima media thickness （CIMT） and stiffness are taken as useful surrogate markers of atherosclerosis. In China, the number of elderly patients undergoing hemodialysis has increased year by year, ...BACKGROUND：Carotid intima media thickness （CIMT） and stiffness are taken as useful surrogate markers of atherosclerosis. In China, the number of elderly patients undergoing hemodialysis has increased year by year, with the increase of dialysis-related cardiovascular events. This study was undertaken to examine carotid stiffness in elderly hemodialysis patients by the ultrasound techniques in order to find out the possible risk factors. From January 2006 to February 2010, a total of 87 patients （41 males and 46 females） treated with routine hemodialysis at the 97th Hospital of People＇s Liberation Army were enrolled in this study. The distensibility coefficient （DC） of the carotid artery was detected by Doppler ultrasonic diagnosis apparatus （Philips HBI5000, frequency 12 MHz） for evaluation of arterial stiffness. Serum albumin, total cholesterol （TC）, high density lipoprotein （HDL）, low density lipoprotein （LDL）, triglyceride （TG）, glucose, creatinine, calcium, phosphorus, and intact parathyroid hormone （iPTH） were examined with standard methods. The liner correlation and multiple stepwise regression analysis were used to find correlations between them. RESULTS： In this study, the systolic blood pressure was 153.33±25.98 mmHg, DBP 84.22± 10.39 mmHg, TC 4.39±1.05 mmol/L, TG 1.36±0.72 mmol/L, LDL 2.47±0.77 mmol/L, Cr 889.82± 207.38 μmol/L, Glu 5.36±1.87 mmol/L, Ca 12.00±2.19±0.21 mmol/L, and DC 13.39±5.32×10-3/kPa. DC was associated with age （r =-0.459, P〈0.001）, SBP （r =-0.527, P〈0.001）, and serum calcium （r =-0.273, P=0.011）. The multiple stepwise regression analysis showed that SBP, age, increased serum calcium level, and diabetes were independent risk factors for decreasing DC. CONCLUSION： Systolic blood pressure, age, increased serum calcium level and diabetes in elderly hemodialysis patients are independent risk factors for increased carotid arterial stiffness.展开更多
Objective To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. Methods Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in C...Objective To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. Methods Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy. Results All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction. Conclusion Surgical repair is the best choice for PA of AVF for renal hemodialysis.展开更多
This study was to investigate the effects of different dialytic membranes and dialysates on cytokine production in patients undergoing hemodialysis and their relationship with hernodialytic complications. Two dialytic...This study was to investigate the effects of different dialytic membranes and dialysates on cytokine production in patients undergoing hemodialysis and their relationship with hernodialytic complications. Two dialytic membranes (cuprophane and polysulfone membranes ) and two dialysates (bicarbonate and acetate ) were used for hemodialysis. Twenty-one patients were divided into 3 groups and dialyzed respectively with cuprophane acetate (CU-A), cuprophane bicarbonate (CU-B), and polysulfone bicarbonate (PS-B). It was found that the incidence of complications was the highest and lowest in itU A group and PS-B group respectively. The levels of plasma IL-6,IL-8 and TNFα were significantly increased in CU-A and CU-B groups in the lst h (P<0. 01), further increased in the 4th h (P<0. 001 ) and then decreased to the pre-dialytic levels in the 24th h after hemodialysis. These parameters were significantly higher in CU-A group than in CU-B group (P<0. 05). No significant changes of these cytokines were found in PS-B during and after hemodialysis. The plasma level of acid glycoprotein (AG) was significantly increased in CU-A and CU B groups in the 4th h after hemodialysis (P<0.05) and markedly correlated to the plasma levels of cytokines. α-AP level was remarkably higher in CU-A group than in CU-B group (P<0. 05)but there were no significant changes in PS-B group. our findings suggest that systemic release of such cytokines as IL-6, IL-8 and TNFα in patients undergoing hemodialysis might be related to the bio compatibility of dialytic membranes and dialysates and responsible for the side effects of hemodialysis. Polysulfone membrane and bicarbonate are relatively better materials for hemodlalysis. Improvement of bio-compatibility of the dialytic membranes and dialysates is helpful to reduce hemodialytic complications.展开更多
Two sets of PCR primers in the 5’ non-coding region were designed according to published hepatitis G virus (HGV) sequence. Using these primers, a nested reverse transcription PCR was carried out in 47 hepatitis C pat...Two sets of PCR primers in the 5’ non-coding region were designed according to published hepatitis G virus (HGV) sequence. Using these primers, a nested reverse transcription PCR was carried out in 47 hepatitis C patients and 10 HCV RNA (+ ) hemodialysis patients. Ten of the hepatitis C patients and one of the hemodialysis patients (11/57, 19. 3% ) were found to be positive for HGV RNA. The PCR products from two HGV RNA positive patients were cloned and sequenced. The cDNA homologies were 83% -90% as compared with the published sequences. The results show that HGV infection is rather common in hepatitis C-infected patients, suggesting that it is necessary to investigate the effect of HGV on the course of HCV infection.展开更多
Objective: To study the prevalence and pathogenesis of transfusion-transmitted virus (TTV) in hemodialysis patients. Methods: Serum TTV DNA was tested in 69 hemodialysis patients from our hospital by nested-PCR using ...Objective: To study the prevalence and pathogenesis of transfusion-transmitted virus (TTV) in hemodialysis patients. Methods: Serum TTV DNA was tested in 69 hemodialysis patients from our hospital by nested-PCR using primers from a conservative region of TTV genenome, gene sequence analysis and detection of hepatitis C virus antibody (anti-HCV) and the levels of alanine transaminase (ALT) were determined simultaneously. Results: The overall prevalence of TTV viremia was 27.5%. The PCR-amplified gene fragment from one patient was sequenced, and its Sequence homologies with TTV-UHI, TTV-TA278, TTVCHN1 and TTVCHN2 ranged from 89% to 100%, and its deduced amino acid sequence homologies with these 4 isolates ranged from 87% to 100%. There was no significant difference in 1TV prevalence between anti-UCV positive and negative patients (P＞0.05). No significant elevation of ALT is found in all patients. Conclusion: High prevalence of TTV infection is found among hemodialysis patients, and TTV infection has no significant association with HCV infection or elevation of ALT.展开更多
Administration of iodinated contrast agents can give rise to allergic/hypersensitivity reactions and contrast-induced nephropathy.In extremely rare cases,intravascularly administered iodinated contrast agents can trig...Administration of iodinated contrast agents can give rise to allergic/hypersensitivity reactions and contrast-induced nephropathy.In extremely rare cases,intravascularly administered iodinated contrast agents can trigger contrast-induced encephalopathy(CIE)in patients undergoing percutaneous coronary intervention(PCI).[1]Here,we describe the case of a male patient diagnosed with CIE after undergoing PCI with a non-ionic contrast agent,iodixanol.This is the first such case to be reported in a patient undergoing hemodialysis after kidney transplantation.展开更多
Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the pr...Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.展开更多
基金supported by the National Natural Science Foundation of China(81400262)the Backbone Fund of Peking University Third Hospital(Y72497-04)
文摘Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.
基金supported by the Gansu Provincial Health Research Project (GSWSKY2020-01)。
文摘Hyperkalemia,usually associated with predisposing chronic diseases as heart failure(HF),severe kidney disease or diabetes mellitus(DM),[1]is defined as an elevation of potassium concentration more than 5.5 mmol/L,[2].
基金Supported by the grant from the National Natural Science Foundation of China (30700373)
文摘Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis. Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows： permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were fbund with mitral valve involvement, two with aor tic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure alter further hemodialysis for three months. One was well on maintenance hemodi alvsis for three months after surgery. Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, lull course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective cndocarditis.
文摘BACKGROUND：Carotid intima media thickness （CIMT） and stiffness are taken as useful surrogate markers of atherosclerosis. In China, the number of elderly patients undergoing hemodialysis has increased year by year, with the increase of dialysis-related cardiovascular events. This study was undertaken to examine carotid stiffness in elderly hemodialysis patients by the ultrasound techniques in order to find out the possible risk factors. From January 2006 to February 2010, a total of 87 patients （41 males and 46 females） treated with routine hemodialysis at the 97th Hospital of People＇s Liberation Army were enrolled in this study. The distensibility coefficient （DC） of the carotid artery was detected by Doppler ultrasonic diagnosis apparatus （Philips HBI5000, frequency 12 MHz） for evaluation of arterial stiffness. Serum albumin, total cholesterol （TC）, high density lipoprotein （HDL）, low density lipoprotein （LDL）, triglyceride （TG）, glucose, creatinine, calcium, phosphorus, and intact parathyroid hormone （iPTH） were examined with standard methods. The liner correlation and multiple stepwise regression analysis were used to find correlations between them. RESULTS： In this study, the systolic blood pressure was 153.33±25.98 mmHg, DBP 84.22± 10.39 mmHg, TC 4.39±1.05 mmol/L, TG 1.36±0.72 mmol/L, LDL 2.47±0.77 mmol/L, Cr 889.82± 207.38 μmol/L, Glu 5.36±1.87 mmol/L, Ca 12.00±2.19±0.21 mmol/L, and DC 13.39±5.32×10-3/kPa. DC was associated with age （r =-0.459, P〈0.001）, SBP （r =-0.527, P〈0.001）, and serum calcium （r =-0.273, P=0.011）. The multiple stepwise regression analysis showed that SBP, age, increased serum calcium level, and diabetes were independent risk factors for decreasing DC. CONCLUSION： Systolic blood pressure, age, increased serum calcium level and diabetes in elderly hemodialysis patients are independent risk factors for increased carotid arterial stiffness.
文摘Objective To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. Methods Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy. Results All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction. Conclusion Surgical repair is the best choice for PA of AVF for renal hemodialysis.
文摘This study was to investigate the effects of different dialytic membranes and dialysates on cytokine production in patients undergoing hemodialysis and their relationship with hernodialytic complications. Two dialytic membranes (cuprophane and polysulfone membranes ) and two dialysates (bicarbonate and acetate ) were used for hemodialysis. Twenty-one patients were divided into 3 groups and dialyzed respectively with cuprophane acetate (CU-A), cuprophane bicarbonate (CU-B), and polysulfone bicarbonate (PS-B). It was found that the incidence of complications was the highest and lowest in itU A group and PS-B group respectively. The levels of plasma IL-6,IL-8 and TNFα were significantly increased in CU-A and CU-B groups in the lst h (P<0. 01), further increased in the 4th h (P<0. 001 ) and then decreased to the pre-dialytic levels in the 24th h after hemodialysis. These parameters were significantly higher in CU-A group than in CU-B group (P<0. 05). No significant changes of these cytokines were found in PS-B during and after hemodialysis. The plasma level of acid glycoprotein (AG) was significantly increased in CU-A and CU B groups in the 4th h after hemodialysis (P<0.05) and markedly correlated to the plasma levels of cytokines. α-AP level was remarkably higher in CU-A group than in CU-B group (P<0. 05)but there were no significant changes in PS-B group. our findings suggest that systemic release of such cytokines as IL-6, IL-8 and TNFα in patients undergoing hemodialysis might be related to the bio compatibility of dialytic membranes and dialysates and responsible for the side effects of hemodialysis. Polysulfone membrane and bicarbonate are relatively better materials for hemodlalysis. Improvement of bio-compatibility of the dialytic membranes and dialysates is helpful to reduce hemodialytic complications.
文摘Two sets of PCR primers in the 5’ non-coding region were designed according to published hepatitis G virus (HGV) sequence. Using these primers, a nested reverse transcription PCR was carried out in 47 hepatitis C patients and 10 HCV RNA (+ ) hemodialysis patients. Ten of the hepatitis C patients and one of the hemodialysis patients (11/57, 19. 3% ) were found to be positive for HGV RNA. The PCR products from two HGV RNA positive patients were cloned and sequenced. The cDNA homologies were 83% -90% as compared with the published sequences. The results show that HGV infection is rather common in hepatitis C-infected patients, suggesting that it is necessary to investigate the effect of HGV on the course of HCV infection.
文摘Objective: To study the prevalence and pathogenesis of transfusion-transmitted virus (TTV) in hemodialysis patients. Methods: Serum TTV DNA was tested in 69 hemodialysis patients from our hospital by nested-PCR using primers from a conservative region of TTV genenome, gene sequence analysis and detection of hepatitis C virus antibody (anti-HCV) and the levels of alanine transaminase (ALT) were determined simultaneously. Results: The overall prevalence of TTV viremia was 27.5%. The PCR-amplified gene fragment from one patient was sequenced, and its Sequence homologies with TTV-UHI, TTV-TA278, TTVCHN1 and TTVCHN2 ranged from 89% to 100%, and its deduced amino acid sequence homologies with these 4 isolates ranged from 87% to 100%. There was no significant difference in 1TV prevalence between anti-UCV positive and negative patients (P＞0.05). No significant elevation of ALT is found in all patients. Conclusion: High prevalence of TTV infection is found among hemodialysis patients, and TTV infection has no significant association with HCV infection or elevation of ALT.
基金supported by the China Postdoctoral Science Foundation(2019M650032)the China Scholarship Council(CSC) award(201706210415)
文摘Administration of iodinated contrast agents can give rise to allergic/hypersensitivity reactions and contrast-induced nephropathy.In extremely rare cases,intravascularly administered iodinated contrast agents can trigger contrast-induced encephalopathy(CIE)in patients undergoing percutaneous coronary intervention(PCI).[1]Here,we describe the case of a male patient diagnosed with CIE after undergoing PCI with a non-ionic contrast agent,iodixanol.This is the first such case to be reported in a patient undergoing hemodialysis after kidney transplantation.
基金Supported by the Science Foundation of Shaanxi Province (No. SJ08C201)
文摘Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.
