In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney dis...In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive. Nevertheless, several reports show that the value of this assay to estimate GFR is strongly challenged in cirrhotic patients, especially in patients with liver failure and/or severely impaired renal function. This has led to seek new alternatives to estimate more reliably the GFR in these patients. Although the reference methods, based on the utilization of exogenous markers, allow measuring GFR and thereby constitute the “gold standard” to evaluate renal function, they are not feasible in routine clinical practice. Several studies have shown that a cystatin C (CysC) based formula perform better than the SCr-based estimates in cirrhotic patients and the estimation of GFR by these formulas could therefore lead to optimize the management of the patients. A new estimate based on CysC has been recently developed using a large number of patients and the first results regarding the evaluation of its performance are promising, making this new formula the best candidate for a reference estimate of the renal function in cirrhotic patients.展开更多
AIM: To investigate the effects of different methylenetetrahydrofolate reductase(MTHFR) 677C>T gene polymorphism and hyperhomocysteinemia for the development of renal failure and cardiovascular events, which are co...AIM: To investigate the effects of different methylenetetrahydrofolate reductase(MTHFR) 677C>T gene polymorphism and hyperhomocysteinemia for the development of renal failure and cardiovascular events, which are controversial.METHODS: We challenged the relationship, if any, of MTHFR 677C>T and MTHFR 1298A>C polymorphisms with renal and heart function. The present article is a reappraisal of these concepts, investigating within a larger population, and including a subgroup of dialysis patients, if the two most common MTHFR polymorphisms, C677 T and A1298 C, as homozygous, heterozygous or with a compound heterozygous state, show different association with chronic renal failure requiring hemodialysis. MTHFR polymorphism could be a favorable evolutionary factor, i.e., a protective factor for many ominous conditions, like cancer and renal failure. A similar finding was reported in fatty liver disease in which it is suggested that MTHFR polymorphisms could have maintained and maintain their persistence by an heterozygosis advantage mechanism. We studied a total of 630 Italian Caucasian subject aged 54.60 ± 16.35 years, addressing to the increased hazard of hemodialysis, if any, according to the studied MTHFR genetic polymorphisms. RESULTS: A favorable association with normal renal function of MTHFR polymorphisms, and notably of MTHFR C677 T is present independently of the negative effects of left ventricular hypertrophy, increased IntraRenal arterial Resistance and hyperparathyroidism. CONCLUSION: MTHFR gene polymorphisms could have a protective role on renal function as suggested by their lower frequency among our dialysis patients in end-stage renal failure; differently, the association with left ventricular hypertrophy and reduced left ventricular relaxation suggest some type of indirect, or concurrent mechanism.展开更多
AIMTo make efficacy and safety comparison of telbivudine-raodmap and tenofovir-roadmap in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients. METHODSThis was the first prospective, randomised, t...AIMTo make efficacy and safety comparison of telbivudine-raodmap and tenofovir-roadmap in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients. METHODSThis was the first prospective, randomised, two-arm, open-label, non-inferiority study in HBeAg-negative CHB patients that compared telbivudine and tenofovir administered as per roadmap concept. Patients were treated up to 24 wk and, depending on virologic response, continued the same therapy or received add-on therapy up to 104 wk. Eligible patients received an additional 52 wk of treatment in the extension period (i.e., up to 156 wk). Patients who developed virologic breakthrough (VB) while on monotherapy also received add-on therapy. The primary efficacy endpoint was the rate of patients achieving hepatitis B virus (HBV) DNA RESULTSA total of 241 patients were randomised. Non-inferiority of telbivudine arm to tenofovir arm was demonstrated at week 52 (± 7 d window), with over 91% of patients in each treatment arm achieving HBV DNA level CONCLUSIONEfficacy was shown for both telbivudine-roadmap and tenofovir-roadmap regimens in HBeAg-negative CHB patients over 156 wk. Telbivudine arm was associated with renal improvement.展开更多
Background:The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS).But the gap between artery stenosis and the glomerular filtration ...Background:The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS).But the gap between artery stenosis and the glomerular filtration ability is still unclear.Methods:Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing,level of estimated glomerular filtration rate (eGFR),respectively.The different levels of eGFR,renal microcirculation markers,and RAS severity were compared with each other,to determine the relationships among them.Results:A total of 215 consecutive patients were enrolled in the prospective cohort study.Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50％) and no RAS group (RAS ＜ 50％) or did not change correspondingly to RAS severity.The value of eGFR in RAS group was lower than that in the no RAS group,but it did not decline parallel to the progressive severity of RAS.The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency,especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR,with strong (r =-0.713,P ＜ 0.001) and moderate (r =-0.580,P ＜ 0.001) correlations.In the subgroup analysis of severe RAS (RAS ≥ 80％),the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR,(r =-0.827,P ＜ 0.001) and (r =-0.672,P ＜ 0.001) correlations,respectively.Conclusions:Severity of RAS could not accurately predict the value of eGFR,whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.展开更多
Progressive rising population of diabetes and related nephropathy, namely, diabetic kidney disease and associated end stage renal disease has become a major global public health issue. Results of observational studies...Progressive rising population of diabetes and related nephropathy, namely, diabetic kidney disease and associated end stage renal disease has become a major global public health issue. Results of observational studies indicate that most diabetic kidney disease progresses over decades; however, certain diabetes patients display a rapid decline in renal function, which may lead to renal failure within months. Although the definition of rapid renal function decline remained speculative, in general,it is defined by the decrease of estimated glomerular filtration rate(e GFR) in absolute rate of loss or percent change. Based on the Kidney Disease: Improving Global Outcomes 2012 clinical practice guidelines, a rapid decline in renal function is defined as a sustained declinein e GFR of 】 5 m L/min per 1.73 m2 per year. It has been reported that potential factors contributing to a rapid decline in renal function include ethnic/genetic and demographic causes, smoking habits, increased glycated hemoglobin levels, obesity, albuminuria, anemia, low serum magnesium levels, high serum phosphate levels, vitamin D deficiency, elevated systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity values, retinopathy, and cardiac autonomic neuropathy. This article reviews current literatures in this area and provides insight on the early detection of diabetic subjects who are at risk of a rapid decline in renal function in order to develop a more aggressive approach to renal and cardiovascular protection.展开更多
BACKGROUND The prevalence of non-alcoholic fatty liver(NAFLD)has increased recently.Subjects with NAFLD are known to have higher chance for renal function impairment.Many past studies used traditional multiple linear ...BACKGROUND The prevalence of non-alcoholic fatty liver(NAFLD)has increased recently.Subjects with NAFLD are known to have higher chance for renal function impairment.Many past studies used traditional multiple linear regression(MLR)to identify risk factors for decreased estimated glomerular filtration rate(eGFR).However,medical research is increasingly relying on emerging machine learning(Mach-L)methods.The present study enrolled healthy women to identify factors affecting eGFR in subjects with and without NAFLD(NAFLD+,NAFLD-)and to rank their importance.AIM To uses three different Mach-L methods to identify key impact factors for eGFR in healthy women with and without NAFLD.METHODS A total of 65535 healthy female study participants were enrolled from the Taiwan MJ cohort,accounting for 32 independent variables including demographic,biochemistry and lifestyle parameters(independent variables),while eGFR was used as the dependent variable.Aside from MLR,three Mach-L methods were applied,including stochastic gradient boosting,eXtreme gradient boosting and elastic net.Errors of estimation were used to define method accuracy,where smaller degree of error indicated better model performance.RESULTS Income,albumin,eGFR,High density lipoprotein-Cholesterol,phosphorus,forced expiratory volume in one second(FEV1),and sleep time were all lower in the NAFLD+group,while other factors were all significantly higher except for smoking area.Mach-L had lower estimation errors,thus outperforming MLR.In Model 1,age,uric acid(UA),FEV1,plasma calcium level(Ca),plasma albumin level(Alb)and T-bilirubin were the most important factors in the NAFLD+group,as opposed to age,UA,FEV1,Alb,lactic dehydrogenase(LDH)and Ca for the NAFLD-group.Given the importance percentage was much higher than the 2nd important factor,we built Model 2 by removing age.CONCLUSION The eGFR were lower in the NAFLD+group compared to the NAFLD-group,with age being was the most important impact factor in both groups of healthy Chinese women,followed by LDH,UA,FEV1 and 展开更多
Background: Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations ...Background: Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy. Methods: A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the k statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis. Results: The k values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P<0.001). Conclusions: The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS 1 equations and the CKD-EPI and BIS 1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.展开更多
OBJECTIVE: To analyze the distribution of Traditional Chinese medicine(TCM) syndromes in patients with diabetic kidney disease(DKD) and its related factors.METHODS: We enrolled 435 patients with DKD, who were not unde...OBJECTIVE: To analyze the distribution of Traditional Chinese medicine(TCM) syndromes in patients with diabetic kidney disease(DKD) and its related factors.METHODS: We enrolled 435 patients with DKD, who were not undergoing dialysis, admitted to the Department of Nephrology, First Medical Center, Chinese PLA General Hospital from April 2020 to August 2021.Analysis of their TCM syndromes and related factors was carried out.RESULTS: The 435 patients included 109, 117, 86, and 123 chronic kidney disease(CKD) 1-2, CKD3, CKD4, and CKD5 cases, respectively. With the progression of CKD1-5, the proportion of Yin deficiency and dry heat syndrome,and that of Qi and Yin deficiency syndrome showed a downward trend, whereas the proportion of spleen-kidney Yang deficiency, blood deficiency, blood stasis, water stagnation, and phlegm turbidity syndromes showed an upward trend;the differences were statistically significant(P < 0.05). Multivariate logistic regression analysis showed that Yin deficiency and dry heat syndrome was positively correlated with hemoglobin [odds ratio(OR) =1.022, P = 0.005], albumin(OR = 1.058, P = 0.006), and estimated glomerular filtration rate(eGFR)(OR = 1.020,P < 0.001) but negatively correlated with male sex(OR =0.277, P = 0.004). Qi and Yin deficiency syndrome was positively correlated with albumin(OR = 1.056, P < 0.001)and eGFR(OR = 1.008, P = 0.022) but negatively correlated with age(OR = 0.977, P = 0.023). Liver-kidney Yin deficiency syndrome was positively correlated with age(OR = 1.028, P = 0.021) and glycosylated hemoglobin(OR = 1.223, P = 0.007) but negatively correlated with total cholesterol(OR = 0.792, P = 0.006).Spleen-kidney Yang deficiency syndrome was negatively correlated with hemoglobin(OR = 0.977, P < 0.001),albumin(OR = 0.891, P < 0.001), and eGFR(OR = 0.978,P < 0.001) but positively correlated with high density lipoprotein(OR = 3.376, P = 0.001). CONCLUSION: With CKD1-5 progression, TCM syndromes changed from Yin deficiency and dry heat syndrome to syndrome of deficiency of both 展开更多
Background The relationship between estimated glomerular filtration rate(e GFR)and depression in patients with coronary artery disease(CAD)remained unclear.Methods A total of 561 patients with CAD were selected from D...Background The relationship between estimated glomerular filtration rate(e GFR)and depression in patients with coronary artery disease(CAD)remained unclear.Methods A total of 561 patients with CAD were selected from Department of Cardiology between October 2017 and February 2018 while their depression status was evaluated by Patient Health Questionnaire-9(PHQ-9).The e GFR levels were compared between patients with and without depression and the link between e GFR and depression in CAD patients was explored.Results Among 561CAD patients,63 patients(11.23%)were diagnosed with comorbid depression(PHQ-9≥10).The depression group presented significantly lower e GFR level than the non-depression group.In fully-adjusted multivariate analysis,higher e GFR level was proved to be a protective factor for depression in CAD patients,reducing a 22%risk of depression for every 10 m L/(min·1.73 m2)increase of e GFR level(OR:0.78,95%CI:0.66-0.93).Similar results were found in the stratified analyses of both e GFR quartiles and chronic kidney disease(CKD)stages(P for trend<0.05),while no significant differences were found among subgroups(P for interaction>0.05).A negative linear association was estimated between e GFR level and depression in CAD patients.Conclusions Our results suggested lower e GFR level in CAD patients with comorbid depression,displaying a negative linear correlation between e GFR and risk of depression in CAD patients.The findings implied that screening depression in CAD patients with decreased e GFR level or concomitant CKD should be highlighted in clinical practice.[S Chin J Cardiol 2024;25(1):1-10]展开更多
Introduction: Our study focused on the evaluation of renal function in children with sickle cell disease compared to children without sickle cell disease at the pediatric emergency unit of the Donka National Hospital ...Introduction: Our study focused on the evaluation of renal function in children with sickle cell disease compared to children without sickle cell disease at the pediatric emergency unit of the Donka National Hospital and SOS Drepano-Guinea center. Patients and Methods: This was a cross-sectional descriptive and analytical study lasting 3 months (October 1 to December 31, 2020). Were included, all sickle cell and non-sickle cell children aged 0 to 15 received on an outpatient basis and had undergone an exploration of renal function (serum creatinine and urine dipstick). Results: We performed the urine dipstick and serum creatinine in 75 children, 45 of whom were sickle cell and 30 were not sickle cell. 27 of our patients or 36% had a reduction in GFR, among them 9 or 20% were sickle cell and 18 or 60% were not sickle cell. The most affected age group was 5 to 9 years in sickle cell (66.7%) and non-sickle cell (38.9%). In sickle cell patients, 9 cases (100%) had mild renal failure (IRL). Non-sickle cell patients, had 14 cases or 77.8% of IRL and 4 cases (22.2%) of moderate IR. Sickle cell disease and antibiotics which had the respective p-value (0.01);(0.02), were statistically significant with the onset of renal failure. Conclusion: Several factors including sickle cell anemia and antibiotics are believed to be involved in lowering GFR. It would be essential to detect early the children received in consultation.展开更多
OBJECTIVE:To collect data and investigate the effects of Huangkui capsule(黄葵胶囊,HKC)on chronic kidney disease(CKD).METHODS:PubM ed,Embase,Cochrane Library,and three Chinese databases(China National Knowledge Infras...OBJECTIVE:To collect data and investigate the effects of Huangkui capsule(黄葵胶囊,HKC)on chronic kidney disease(CKD).METHODS:PubM ed,Embase,Cochrane Library,and three Chinese databases(China National Knowledge Infrastructure,Wanfang,and China Science and Technology Journal Database)were searched for articles published until October 2020.Randomized controlled trials(RCTs)of HKCs used for treating CKD were reviewed.Data were organized and analyzed using RevMan 5.3 software.RESULTS:HKC significantly lowered the blood urea nitrogen(BUN)level[mean difference(MD)=-2.26;95%confidence interval(CI),-2.91 to-1.61],serum creatinine level(MD=-17.45;95%CI,-22.29 to-12.60),and 24-h urine protein content(MD=-0.73;95%CI,-1.00 to-0.46)and improved the glomerular filtration rate(GFR)(MD=10.69;95%CI,5.57 to 15.81)and serum albumin level(MD=2.20;95%CI,0.49 to 3.90).CONCLUSIONS:Our findings show that HKC could lower the BUN level,serum creatinine level,and 24-h urine protein content.HKC also improved GFR and serum albumin levels.However,high-quality RCTs in other countries with larger sample sizes are warranted to confirm these findings.展开更多
文摘In the clinical context of the patients with liver cirrhosis, accurate evaluation of the renal function is potentially crucial. Indeed, it can lead to early diagnosis of both acute kidney injury and chronic kidney disease and to reliable characterization of the renal status of the patient before performing a liver transplantation. Despite some limitations, the assay of serum creatinine (SCr) is universally used to estimate glomerular filtration rate (GFR) because of its wide availability, its simplicity and because it is inexpensive. Nevertheless, several reports show that the value of this assay to estimate GFR is strongly challenged in cirrhotic patients, especially in patients with liver failure and/or severely impaired renal function. This has led to seek new alternatives to estimate more reliably the GFR in these patients. Although the reference methods, based on the utilization of exogenous markers, allow measuring GFR and thereby constitute the “gold standard” to evaluate renal function, they are not feasible in routine clinical practice. Several studies have shown that a cystatin C (CysC) based formula perform better than the SCr-based estimates in cirrhotic patients and the estimation of GFR by these formulas could therefore lead to optimize the management of the patients. A new estimate based on CysC has been recently developed using a large number of patients and the first results regarding the evaluation of its performance are promising, making this new formula the best candidate for a reference estimate of the renal function in cirrhotic patients.
文摘AIM: To investigate the effects of different methylenetetrahydrofolate reductase(MTHFR) 677C>T gene polymorphism and hyperhomocysteinemia for the development of renal failure and cardiovascular events, which are controversial.METHODS: We challenged the relationship, if any, of MTHFR 677C>T and MTHFR 1298A>C polymorphisms with renal and heart function. The present article is a reappraisal of these concepts, investigating within a larger population, and including a subgroup of dialysis patients, if the two most common MTHFR polymorphisms, C677 T and A1298 C, as homozygous, heterozygous or with a compound heterozygous state, show different association with chronic renal failure requiring hemodialysis. MTHFR polymorphism could be a favorable evolutionary factor, i.e., a protective factor for many ominous conditions, like cancer and renal failure. A similar finding was reported in fatty liver disease in which it is suggested that MTHFR polymorphisms could have maintained and maintain their persistence by an heterozygosis advantage mechanism. We studied a total of 630 Italian Caucasian subject aged 54.60 ± 16.35 years, addressing to the increased hazard of hemodialysis, if any, according to the studied MTHFR genetic polymorphisms. RESULTS: A favorable association with normal renal function of MTHFR polymorphisms, and notably of MTHFR C677 T is present independently of the negative effects of left ventricular hypertrophy, increased IntraRenal arterial Resistance and hyperparathyroidism. CONCLUSION: MTHFR gene polymorphisms could have a protective role on renal function as suggested by their lower frequency among our dialysis patients in end-stage renal failure; differently, the association with left ventricular hypertrophy and reduced left ventricular relaxation suggest some type of indirect, or concurrent mechanism.
文摘AIMTo make efficacy and safety comparison of telbivudine-raodmap and tenofovir-roadmap in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients. METHODSThis was the first prospective, randomised, two-arm, open-label, non-inferiority study in HBeAg-negative CHB patients that compared telbivudine and tenofovir administered as per roadmap concept. Patients were treated up to 24 wk and, depending on virologic response, continued the same therapy or received add-on therapy up to 104 wk. Eligible patients received an additional 52 wk of treatment in the extension period (i.e., up to 156 wk). Patients who developed virologic breakthrough (VB) while on monotherapy also received add-on therapy. The primary efficacy endpoint was the rate of patients achieving hepatitis B virus (HBV) DNA RESULTSA total of 241 patients were randomised. Non-inferiority of telbivudine arm to tenofovir arm was demonstrated at week 52 (± 7 d window), with over 91% of patients in each treatment arm achieving HBV DNA level CONCLUSIONEfficacy was shown for both telbivudine-roadmap and tenofovir-roadmap regimens in HBeAg-negative CHB patients over 156 wk. Telbivudine arm was associated with renal improvement.
文摘Background:The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS).But the gap between artery stenosis and the glomerular filtration ability is still unclear.Methods:Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing,level of estimated glomerular filtration rate (eGFR),respectively.The different levels of eGFR,renal microcirculation markers,and RAS severity were compared with each other,to determine the relationships among them.Results:A total of 215 consecutive patients were enrolled in the prospective cohort study.Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50％) and no RAS group (RAS ＜ 50％) or did not change correspondingly to RAS severity.The value of eGFR in RAS group was lower than that in the no RAS group,but it did not decline parallel to the progressive severity of RAS.The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency,especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR,with strong (r =-0.713,P ＜ 0.001) and moderate (r =-0.580,P ＜ 0.001) correlations.In the subgroup analysis of severe RAS (RAS ≥ 80％),the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR,(r =-0.827,P ＜ 0.001) and (r =-0.672,P ＜ 0.001) correlations,respectively.Conclusions:Severity of RAS could not accurately predict the value of eGFR,whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.
文摘Progressive rising population of diabetes and related nephropathy, namely, diabetic kidney disease and associated end stage renal disease has become a major global public health issue. Results of observational studies indicate that most diabetic kidney disease progresses over decades; however, certain diabetes patients display a rapid decline in renal function, which may lead to renal failure within months. Although the definition of rapid renal function decline remained speculative, in general,it is defined by the decrease of estimated glomerular filtration rate(e GFR) in absolute rate of loss or percent change. Based on the Kidney Disease: Improving Global Outcomes 2012 clinical practice guidelines, a rapid decline in renal function is defined as a sustained declinein e GFR of 】 5 m L/min per 1.73 m2 per year. It has been reported that potential factors contributing to a rapid decline in renal function include ethnic/genetic and demographic causes, smoking habits, increased glycated hemoglobin levels, obesity, albuminuria, anemia, low serum magnesium levels, high serum phosphate levels, vitamin D deficiency, elevated systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity values, retinopathy, and cardiac autonomic neuropathy. This article reviews current literatures in this area and provides insight on the early detection of diabetic subjects who are at risk of a rapid decline in renal function in order to develop a more aggressive approach to renal and cardiovascular protection.
基金Supported by the Kaohsiung Armed Forces General Hospital.
文摘BACKGROUND The prevalence of non-alcoholic fatty liver(NAFLD)has increased recently.Subjects with NAFLD are known to have higher chance for renal function impairment.Many past studies used traditional multiple linear regression(MLR)to identify risk factors for decreased estimated glomerular filtration rate(eGFR).However,medical research is increasingly relying on emerging machine learning(Mach-L)methods.The present study enrolled healthy women to identify factors affecting eGFR in subjects with and without NAFLD(NAFLD+,NAFLD-)and to rank their importance.AIM To uses three different Mach-L methods to identify key impact factors for eGFR in healthy women with and without NAFLD.METHODS A total of 65535 healthy female study participants were enrolled from the Taiwan MJ cohort,accounting for 32 independent variables including demographic,biochemistry and lifestyle parameters(independent variables),while eGFR was used as the dependent variable.Aside from MLR,three Mach-L methods were applied,including stochastic gradient boosting,eXtreme gradient boosting and elastic net.Errors of estimation were used to define method accuracy,where smaller degree of error indicated better model performance.RESULTS Income,albumin,eGFR,High density lipoprotein-Cholesterol,phosphorus,forced expiratory volume in one second(FEV1),and sleep time were all lower in the NAFLD+group,while other factors were all significantly higher except for smoking area.Mach-L had lower estimation errors,thus outperforming MLR.In Model 1,age,uric acid(UA),FEV1,plasma calcium level(Ca),plasma albumin level(Alb)and T-bilirubin were the most important factors in the NAFLD+group,as opposed to age,UA,FEV1,Alb,lactic dehydrogenase(LDH)and Ca for the NAFLD-group.Given the importance percentage was much higher than the 2nd important factor,we built Model 2 by removing age.CONCLUSION The eGFR were lower in the NAFLD+group compared to the NAFLD-group,with age being was the most important impact factor in both groups of healthy Chinese women,followed by LDH,UA,FEV1 and
基金National Key R&D Program of China (No.2016YFC1305500)Key Research and Development Program of Hainan (Nos.ZDYF2016135 and ZDYF2017095)+2 种基金the National Natural Science Foundation of China (Nos.61471399,61671479,and 81670663)the National Key Research and Development Program (No. 2016YFC1305404)the Joint Funds of National Natural Science Foundation of China and Henan province (No.U1604284).
文摘Background: Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy. Methods: A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the k statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis. Results: The k values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P<0.001). Conclusions: The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS 1 equations and the CKD-EPI and BIS 1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.
基金the Beijing Science and Technology Plan Project:Study on Multidimensional Precise Diagnosis and Treatment Technology and Clinical Transformation of Type 2 Diabetic Nephropathy (No. Z221100007422121)the Beijing Science and Technology Plan Project:Correlation between Clinical Phenotype and Pathological Diagnosis of Type 2 Diabetic Nephropathy (D171100002817002)+2 种基金the State Key Research and Development Program:Study on the Core Pathogenesis and Clinical Evolution of Damp-heat Symptom in Diabetic Nephropathy (2018YFC1704203)National Key R&D Program of China (2018YFC1704200)Natural Science Foundation of China:Mechanism of Organ Immune Injury and Basic Research of Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment (No. 32141005)。
文摘OBJECTIVE: To analyze the distribution of Traditional Chinese medicine(TCM) syndromes in patients with diabetic kidney disease(DKD) and its related factors.METHODS: We enrolled 435 patients with DKD, who were not undergoing dialysis, admitted to the Department of Nephrology, First Medical Center, Chinese PLA General Hospital from April 2020 to August 2021.Analysis of their TCM syndromes and related factors was carried out.RESULTS: The 435 patients included 109, 117, 86, and 123 chronic kidney disease(CKD) 1-2, CKD3, CKD4, and CKD5 cases, respectively. With the progression of CKD1-5, the proportion of Yin deficiency and dry heat syndrome,and that of Qi and Yin deficiency syndrome showed a downward trend, whereas the proportion of spleen-kidney Yang deficiency, blood deficiency, blood stasis, water stagnation, and phlegm turbidity syndromes showed an upward trend;the differences were statistically significant(P < 0.05). Multivariate logistic regression analysis showed that Yin deficiency and dry heat syndrome was positively correlated with hemoglobin [odds ratio(OR) =1.022, P = 0.005], albumin(OR = 1.058, P = 0.006), and estimated glomerular filtration rate(eGFR)(OR = 1.020,P < 0.001) but negatively correlated with male sex(OR =0.277, P = 0.004). Qi and Yin deficiency syndrome was positively correlated with albumin(OR = 1.056, P < 0.001)and eGFR(OR = 1.008, P = 0.022) but negatively correlated with age(OR = 0.977, P = 0.023). Liver-kidney Yin deficiency syndrome was positively correlated with age(OR = 1.028, P = 0.021) and glycosylated hemoglobin(OR = 1.223, P = 0.007) but negatively correlated with total cholesterol(OR = 0.792, P = 0.006).Spleen-kidney Yang deficiency syndrome was negatively correlated with hemoglobin(OR = 0.977, P < 0.001),albumin(OR = 0.891, P < 0.001), and eGFR(OR = 0.978,P < 0.001) but positively correlated with high density lipoprotein(OR = 3.376, P = 0.001). CONCLUSION: With CKD1-5 progression, TCM syndromes changed from Yin deficiency and dry heat syndrome to syndrome of deficiency of both
文摘Background The relationship between estimated glomerular filtration rate(e GFR)and depression in patients with coronary artery disease(CAD)remained unclear.Methods A total of 561 patients with CAD were selected from Department of Cardiology between October 2017 and February 2018 while their depression status was evaluated by Patient Health Questionnaire-9(PHQ-9).The e GFR levels were compared between patients with and without depression and the link between e GFR and depression in CAD patients was explored.Results Among 561CAD patients,63 patients(11.23%)were diagnosed with comorbid depression(PHQ-9≥10).The depression group presented significantly lower e GFR level than the non-depression group.In fully-adjusted multivariate analysis,higher e GFR level was proved to be a protective factor for depression in CAD patients,reducing a 22%risk of depression for every 10 m L/(min·1.73 m2)increase of e GFR level(OR:0.78,95%CI:0.66-0.93).Similar results were found in the stratified analyses of both e GFR quartiles and chronic kidney disease(CKD)stages(P for trend<0.05),while no significant differences were found among subgroups(P for interaction>0.05).A negative linear association was estimated between e GFR level and depression in CAD patients.Conclusions Our results suggested lower e GFR level in CAD patients with comorbid depression,displaying a negative linear correlation between e GFR and risk of depression in CAD patients.The findings implied that screening depression in CAD patients with decreased e GFR level or concomitant CKD should be highlighted in clinical practice.[S Chin J Cardiol 2024;25(1):1-10]
文摘Introduction: Our study focused on the evaluation of renal function in children with sickle cell disease compared to children without sickle cell disease at the pediatric emergency unit of the Donka National Hospital and SOS Drepano-Guinea center. Patients and Methods: This was a cross-sectional descriptive and analytical study lasting 3 months (October 1 to December 31, 2020). Were included, all sickle cell and non-sickle cell children aged 0 to 15 received on an outpatient basis and had undergone an exploration of renal function (serum creatinine and urine dipstick). Results: We performed the urine dipstick and serum creatinine in 75 children, 45 of whom were sickle cell and 30 were not sickle cell. 27 of our patients or 36% had a reduction in GFR, among them 9 or 20% were sickle cell and 18 or 60% were not sickle cell. The most affected age group was 5 to 9 years in sickle cell (66.7%) and non-sickle cell (38.9%). In sickle cell patients, 9 cases (100%) had mild renal failure (IRL). Non-sickle cell patients, had 14 cases or 77.8% of IRL and 4 cases (22.2%) of moderate IR. Sickle cell disease and antibiotics which had the respective p-value (0.01);(0.02), were statistically significant with the onset of renal failure. Conclusion: Several factors including sickle cell anemia and antibiotics are believed to be involved in lowering GFR. It would be essential to detect early the children received in consultation.
基金Supported by the National Natural Science Foundation of China:Study on the mechanism of Yishen Qingli Huoxue formula regulating autophagy in kidney injury caused by metabolic disorder(No.81774245)the Protective Effect of Abelmoschus Manihot via Regulating NLRP3 Inflammasome—Pyroptosis on Renal Tubule Cells(No.81873259)+1 种基金the Mechanism of Tanshinone IIA Regulates Txnip/TRX-NLRP3 Inflammasome to Inhibit Pyroptosis and Protect Glomerular Endothelial Cells(No.82004107)Jiangsu Province Hospital of Chinese Medicine Hospital-level Project,Molecular Mechanism of Abelmoschus Manihot Regulating Fatty Acid Oxidation in Renal Tubule Cells and Antagonizing Renal Fibrosis(No.Y20026)。
文摘OBJECTIVE:To collect data and investigate the effects of Huangkui capsule(黄葵胶囊,HKC)on chronic kidney disease(CKD).METHODS:PubM ed,Embase,Cochrane Library,and three Chinese databases(China National Knowledge Infrastructure,Wanfang,and China Science and Technology Journal Database)were searched for articles published until October 2020.Randomized controlled trials(RCTs)of HKCs used for treating CKD were reviewed.Data were organized and analyzed using RevMan 5.3 software.RESULTS:HKC significantly lowered the blood urea nitrogen(BUN)level[mean difference(MD)=-2.26;95%confidence interval(CI),-2.91 to-1.61],serum creatinine level(MD=-17.45;95%CI,-22.29 to-12.60),and 24-h urine protein content(MD=-0.73;95%CI,-1.00 to-0.46)and improved the glomerular filtration rate(GFR)(MD=10.69;95%CI,5.57 to 15.81)and serum albumin level(MD=2.20;95%CI,0.49 to 3.90).CONCLUSIONS:Our findings show that HKC could lower the BUN level,serum creatinine level,and 24-h urine protein content.HKC also improved GFR and serum albumin levels.However,high-quality RCTs in other countries with larger sample sizes are warranted to confirm these findings.
