氯沙坦对慢性肾功能不全患者血红蛋白、电解质及NO水平的影响

目的:探讨氯沙坦对慢性肾脏功能不全患者血红蛋白、电解质及NO水平的影响。方法:收集我院收治的慢性肾功能不全患者140例,根据用药不同分为对照组和实验组,每组各70例,对照组给予洛汀新口服治疗,实验组给予氯沙坦口服治疗。分别于治疗前后检测两组患者血红蛋白(Hb)、红细胞压积(HCT)、血钙、血磷、血钾、内皮素(ET)及一氧化氮(NO)的水平。结果:与治疗前比较,两组患者治疗后Hb、HCT、血钙及NO水平升高,而血钾、血磷及ET水平降低,差异具有统计学意义(P0.05);与对照组比较,实验组患者治疗后Hb、HCT、血钙及NO水平较高,而血钾、血磷及ET水平较低,差异具有统计学意义(P0.05)。结论:氯沙坦能够明显升高慢性肾功能不全患者血红蛋白及NO水平,恢复电解质平衡,改善预后,对临床具有指导意义。     

低剂量多巴胺对急性心衰合并肾功能不全患者的影响

目的:探讨低剂量多巴胺能否通过利尿作用改善急性左心衰患者的充血症状以及肾功能。方法:将2013年9月至2013年12月我院收治的80例急性心衰合并肾功能不全的患者随机分为对照组和治疗组,每组各40例。对照组给予常规治疗,治疗组在常规治疗的基础上加用小剂量多巴胺静脉泵入48小时。观察和比较两组患者48小时内的总尿量及血清胱抑素C的变化、充血症状、肾功能及临床疗效的差异。结果:与对照组相比,治疗组48小时总尿量、血清胱抑素C的变化、体重变化、BNP变化、肌酐变化、进展性心衰发生率、死亡率、治疗失败患者比例均无明显差异(P0.05)。结论:低剂量多巴胺不能在利尿治疗基础上减轻急性心力衰竭并发肾功能不全患者的充血症状或改善肾功能。     

大鼠慢性肾功能不全模型两种制作方式的比较

目的比较大鼠肾大部切除与肾结扎两种方法制备的5／6肾切除慢性肾功能不全模型的异同。方法雄性SD大鼠随机分为三组。A组行左肾2／3切除加右肾切除,B组行结扎左肾动脉2／3分支加右肾切除,C组为假手术组。分别于第二次手术后5周、9周及13周测血压,处死大鼠,留取24h尿及肾组织。检测尿蛋白,肾组织切片染色。用半定量法评价肾小球硬化指数。结果第5周时,B组大鼠的收缩压显著升高,而A组与C组相比无显著差异,第9周和13周A组和B组与C组大鼠相比,收缩压均显著升高。肾部分切除术后,尿蛋白随时间进行性增加。B组与A组相比,尿蛋白增加更为显著。A组和B组在各观察点均有不同程度肾小球硬化,B组较A组肾小球硬化程度重。结论肾大部切除和肾结扎两种方法制备的大鼠5／6肾切除模型表现有所不同。     

鼻饲极低蛋白匀浆联合α 酮酸疗法对老年慢性肾功能不全患者 营养状况的影响

目的:评估鼻饲极低蛋白匀浆饮食联合α酮酸疗法是否延缓慢性肾功能衰竭(CRF)老年患者病情发展,改善患者营养状况.方法:将我院收治的无法耐受常规低蛋白饮食治疗的肾功能衰竭的老年患者,共24例,随机分为两组,每组12例,一组病人给予极低蛋白匀浆饮食联合α酮酸治疗,为α酮酸组;一组病人给予单纯低蛋白匀浆饮食,为低蛋白组,均进行了6个月的治疗,然后调查患者营养状况.结果:治疗后两组患者的血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)水平较治疗前上升,无明显营养不良,但α酮酸组上升幅度更大(P＜0.05).与治疗前相比,d酮酸组患者经治疗后,血胆固醇(CH)、三酰甘油(TG)、磷(P)水平均下降,血钙(Ca)水平上升(P＜0.05),上述指标在低蛋白组无显著性改变.两组患者治疗后血肌酐(Cr)和尿素氮(BUN)在治疗期间均保持稳定.结论:①极低蛋白匀浆饮食联合α酮酸疗法和单纯低蛋白匀浆饮食治疗在短期内均可延缓慢性肾功能不全进展并改善营养状况,而且前者效果更优;②联合α酮酸治疗对改善血脂和钙磷代谢紊乱具有明显作用,单纯低蛋白肠内营养治疗无显著作用.     

鼻饲极低蛋白匀浆联合α酮酸疗法对老年慢性肾功能不全患者营养状况的影响

目的：评估鼻饲极低蛋白匀浆饮食联合α酮酸疗法是否延缓慢性肾功能衰竭（CRF）老年患者病情发展,改善患者营养状况。方法：将我院收治的无法耐受常规低蛋白饮食治疗的肾功能衰竭的老年患者,共24例,随机分为两组,每组12例,一组病人给予极低蛋白匀浆饮食联合α酮酸治疗,为α酮酸组;一组病人给予单纯低蛋白匀浆饮食,为低蛋白组,均进行了6个月的治疗,然后调查患者营养状况。结果：治疗后两组患者的血清总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）水平较治疗前上升,无明显营养不良,但α酮酸组上升幅度更大（P〈0.05）。与治疗前相比,α酮酸组患者经治疗后,血胆固醇（CH）、三酰甘油（TG）、磷（P）水平均下降,血钙（Ca）水平上升（P〈0.05）,上述指标在低蛋白组无显著性改变。两组患者治疗后血肌酐（Cr）和尿素氮（BUN）在治疗期间均保持稳定。结论：①极低蛋白匀浆饮食联合α酮酸疗法和单纯低蛋白匀浆饮食治疗在短期内均可延缓慢性肾功能不全进展并改善营养状况,而且前者效果更优;②联合α酮酸治疗对改善血脂和钙磷代谢紊乱具有明显作用,单纯低蛋白肠内营养治疗无显著作用。     

不同剂量百令胶囊联合非布司他对慢性肾功能不全伴高尿酸血症患者肾功能及血脂水平的影响

目的:探讨不同剂量百令胶囊联合非布司他对慢性肾功能不全(CRF)伴高尿酸血症(HU)肾功能及血脂水平的影响。方法:选取2017年7月至2018年8月三亚市人民医院收治的CRF伴HU患者167例为研究对象,按照数表法随机分为大剂量联合组(n=42)、中剂量联合组(n=42)、小剂量联合组(n=42)和非布司他单用组(n=41),所有研究对象均给予非布司他(40 mg/次,1次/日)治疗,大、中、小剂量联合组再分别给予百令胶囊3g/次、2g/次、1g/次,均3次/日。比较治疗后的临床疗效、治疗前后肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)、血β_2微球蛋白(血β_2-MG)、尿β_2-MG、24 h尿蛋白定量]、血脂指标[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]水平以及不良反应。结果:治疗后,大剂量联合组肾功能及高尿酸血症的临床总有效率最优(P0.05),其次为中剂量联合组,小剂量联合组和非布司他单用组比较差异无统计学意义(P0.05);各组患者治疗后BUN、Scr、UA、血β_2-MG、尿β_2-MG、24h尿蛋白定量水平均有不同程度的下降,其中大剂量联合组降低最显著(P0.05),小剂量联合组和非布司他单用组比较差异无统计学意义(P0.05);大、中、小剂量联合组患者治疗后TG、TC、LDL均有下降,HDL上升,其中大剂量联合组TG、TC、LDL降低最显著(P0.05),HDL升高最显著(P0.05);各组患者不良反应发生率比较无统计学差异(P0.05)。结论:大剂量百令胶囊联合非布司他治疗CRF伴HU能改善患者的肾功能和血脂指标,其不良反应发生率较低,但是稍高于其他剂量组,建议临床医师根据患者病情选择合适的剂量。     

mTORC1在慢性肾功能不全胰岛素抵抗中的作用

代谢综合征(MetS)在慢性肾功能不全(CKD)患者中普遍存在,与CKD预后密切相关。胰岛素抵抗(IR)作为MetS的基础,是非糖尿病CKD患者疾病进展的独立危险因素。而mTORC1信号通路可感受多种环境变化调节机体的生长代谢稳态,参与肿瘤、肥胖、2型糖尿病等多种疾病发生发展过程。mTORC1过度激活被认为是2型糖尿病IR的机制之一,但在CKD疾病状态下,mTORC1与IR的关系尚不十分清楚。本文就CKD疾病状下,mTORC1对胰岛素信号通路的影响,做一简要概述,为CKD患者IR的治疗提供参考。     

三维斑点追踪技术对慢性肾功能不全患者左心室收缩功能和右心室功能的评估价值研究

摘要 目的：探讨慢性肾功能不全患者应用三维斑点追踪技术对其左心室收缩功能和右心室功能的评估价值。方法：选择我院收治的慢性肾功能不全患者82例,根据患者肾功能将其分为轻度慢性肾功能不全组[慢性肾脏病（CKD） 2期,47例],中-重度慢性肾功能不全组（CKD 3~5期,35例）,另选取同期医院体检的健康志愿者30例作为对照组,应用二维超声及三维斑点追踪技术检测各组心脏指标,比较三组二维超声指标、三维斑点追踪技术指标,应用受试者工作特征（ROC）曲线分析三维斑点追踪技术对患者左心室收缩功能和右心室功能的评估价值。结果：中-重度慢性肾功能不全组室间隔舒张末期厚度（IVSTd）、肺动脉收缩压（PASP）显著高于轻度慢性肾功能不全组、对照组,右心室面积变化分数（RVFAC）、组织运动三尖瓣环位移（TAPSE）、左心室射血分数（LVEF）显著低于轻度慢性肾功能不全组、对照组（P<0.05）。中-重度慢性肾功能不全组左室整体圆周收缩期峰值应变（LGCS）、左室整体纵向收缩期峰值应变（LGLS）、右室整体圆周收缩期峰值应变（RGCS）右室整体纵向收缩期峰值应变（RGLS）、显著高于轻度慢性肾功能不全组、对照组,左室整体径向收缩期峰值应变（LGRS）、三维左室射血分数（3D-LVEF）、右室整体径向收缩期峰值应变（RGRS）、三维右室射血分数（3D-RVEF）显著低于轻度慢性肾功能不全组、对照组（P<0.05）。ROC曲线分析显示,三维斑点追踪技术对慢性肾功能不全患者左心室收缩功能和右心室功能的评估价值较高。结论：三维斑点追踪技术可以准确检测心脏的纵向运动、圆周运动、径向运动,为临床早期发现慢性肾功能不全患者的心脏功能异常提供依据。     

老年心功能不全患者mink S38G多态性与房颤的相关性

探讨老年慢性心功能不全患者中,心肌细胞Iks通道β亚单位基因mink-S38G多态性与心房颤动（atrial fibrillation, AF）发生的相关性.收集慢性心功能不全患者共127例,其中房颤组63例,窦律组64例.采用聚合酶链反应限制性片段长度多态性（restriction fragment length polymorphism, PCR—RFLP）检测房颤组和窦律组的mink基因S38G多态性位点的基因型.房颤组与窦律组之间minkS38G的3种基因型频率为SS(9.52% vs 23.44%),SG(41.27% vs 50.00%),GG(49.21% vs 26.56%).在房颤组中,GG基因型的频率明显高于窦律组,两组间基因型存在明显差异, P=0.013;多因素Logistic回归提示,minkS38G多态性与房颤的发生有明显相关（P=0.010）.因此,在老年慢性心功能不全患者中,mink基因S38G多态性与房颤的发生有关,具有GG基因型的患者其发生房颤的风险较高     

微创血肿抽吸术治疗脑出血并肾功能不全患者的临床研究

目的：评价微创血肿抽吸引流术在脑出血合并肾功能不全患者中的治疗效果。方法：回顾性分析2000年1月至2009年3月间我院收治的15例脑出血合并肾功能不全进行微创抽吸引流术患者的临床资料,并与同期22例保守治疗的患者进行比较。结果：微创手术组显效率为66.67%,总有效率为86.67%,明显高于保守治疗组的22.73%和40.91%（P〈0.01）;治疗后微创组血肌酐值为107.65±22.06μmol/L,显著低于保守组139.45±22.8μmol/L,P〈0.001。结论：早期应用微创血肿穿刺抽吸术能迅速有效地解除脑室内高压,阻断恶性循坏而使病情得到缓解,同时也能明显改善肾功能。     

The effects of intraoperative dexamethasone on left atrial function and postoperative atrial fibrillation in cardiac surgical patients

Postoperative new-onset atrial fibrillation (PNAF) is very common after cardiac surgery and postoperative inflammation may contribute to PNAF by inducing atrial dysfunction. Corticosteroids reduce inflammation and may thus reduce atrial dysfunction and PNAF development. This study aimed to determine whether dexamethasone protects against left atrial dysfunction and PNAF in cardiac surgical patients. Cardiac surgical patients were randomised to a single dose of dexamethasone (1 mg.kg⁻¹) or placebo after inducing anaesthesia. Transoesophageal echocardiography was performed in patients before and after surgery. Primary outcome was left atrial total ejection fraction (LA-TEF) after sternal closure; secondary outcomes included left atrial diameter and PNAF. 62 patients were included. Baseline characteristics were well balanced. Postoperative LA-TEF was 36.4 % in the dexamethasone group and 40.2 % in the placebo group (difference −3.8 %; 95 % confidence interval (CI) -9.0 to 1.4 %; P = 0.15). Postoperative left atrial diameter was 4.6 and 4.3 cm, respectively (difference 0.3; 95 % CI −0.2 to 0.7; P = 0.19). The incidence of PNAF was 30 % in the dexamethasone group and 39 % in the placebo group (P = 0.47). Intraoperative high-dose dexamethasone did not protect against postoperative left atrial dysfunction and did not reduce the risk of PNAF in cardiac surgical patients.     

左房增大对起搏器术后的老年阵发性房颤患者再发房颤的影响

目的：探讨植入心脏起搏器的老年阵发性房颤患者再发房颤（包括无症状性房颤）发生率及左房容积指数对再发房颤的影响。方法：收集2012年1月-2013年12月在我院起搏器门诊长期随访且未服用抗心律失常药物的起搏器术后老年阵发性房颤患者148例,记录基线特征、超声心动图参数及随访期间内房颤发生情况。分别根据左房容积指数及房颤负荷进行分组,应用Cox回归分析探讨起搏器检测的再发房颤及房颤高负荷的危险因素。结果：患者平均随访时间为22.79个月,期间57.43%的患者再发房颤,22.97%的患者为房颤高负荷,15.54%的患者为无症状房颤。多因素Cox回归分析发现左房增大分别是再发房颤及房颤高负荷的独立危险因素。结论：左房容积指数是预测起搏器术后老年阵发性房颤患者房颤复发及房颤高负荷的独立危险因素。     

The effect of ranolazine on maintaining sinus rhythm in patients with resistant atrial fibrillation

Background

Atrial fibrillation (AF) may arise out of anomalous impulse activity at atrial venous junctions. Triggered activity may be a source of abnormal impulse activity. Ranolazine is an anti-anginal agent, which inhibits normal and abnormal late Na+ channel current in the ventricle and peak Na+ channel current in the atrium. This produces an energy sparing effect and stabilizes cardiac membranes. Ranolazine is a potent inhibitor of triggered activity. The purpose of this report is to describe our initial experience with ranolazine used in patients with resistant AF.

Methods

Seven patients (4 males, 3 females, 67 ± 9 years) who developed recurrent AF within hours to a few days of restoring sinus rhythm despite AF ablation and /or failing one or more anti-arrhythmic agents were started on ranolazine (500-1000 mg/twice/day) after stopping all other anti-arrhythmic therapy. All but one patient had some form of associated structural heart disease.

Results

Two patients received no apparent benefit from ranolazine developing recurrent AF within 2 days. All other patients derived significant benefit. Four patients have experienced no recurrent AF. The other patient relapsed at 3 months and again at 6 months. The mean time in sinus rhythm to date, or to the first relapse, for the five responders was 27 ± 11 weeks. No clinically evident pro-arrhythmic episodes occurred.

Conclusion

Ranolazine was helpful in maintaining sinus rhythm in the majority of patients in which more established measures had failed. A controlled prospective trial is warranted to further investigate the efficacy of ranolazine in AF.     

Relationship of troponin to incident atrial fibrillation occurrence,recurrence after radiofrequency ablation and prognosis: a systematic review,meta-analysis and meta-regression

Objective: To explore the association between the levels of troponin (Tn) and incident atrial fibrillation (AF) occurrence, AF recurrence after radiofrequency ablation (RFA), and the risk trend of AF related prognosis (stroke, major bleeding and mortality).

Methods: Twenty-seven studies were included after a systematic search in PubMed from 2005 to 2017, including 13 associated with incident AF occurrence, 8 associated with AF recurrence after RFA and 6 studies evaluating the risk trend of AF-related prognosis with increased Tn levels.

Results: Compared with ‘no incident AF occurrence’ patients, the incident AF occurrence group had similar baseline troponin I (TnI) levels (standardized mean differences [SMD]?=?0.42, 95% CI: ?0.02–0.86, p?=?0.06; I²?=?87.0%, N?=?6), but higher troponin T (TnT) levels (SMD?=?3.77, 2.13–5.42, p?<0.001; I²=99.7%, N?=?8). AF recurrence patients had similar peri-ablation TnI levels, but higher peri-ablation TnT levels compared to the ‘no AF recurrence’ group with pooled SMD. (TnI: SMD: ?0.61, ?1.22to 0, p?=?0.049; I²?=?87.1%; TnT: 0.38, 0.14–0.62, p?=?0.002; I²?=?64.7%). On meta-regression, there was an increased risk trend for stroke/systemic embolism (SE) (r²?=?0.93, p?=?0.04) or major bleeding (r²?=?0.99, p?r²?=?0.09, p?=?0.25) or TnT (r²?=?0.20, p?=?0.31), and stroke/SE (r²?=?0.02, p?=?0.74) or major bleeding (r²?=?0.002, p?=?0.92) was non-significantly related to increasing TnI levels.

Conclusions: In our systematic review, meta-analysis and meta-regression, TnT was associated with both incident AF occurrence and AF recurrence after RFA, as well as stroke/SE and major bleeding. In contrast, TnI was not associated with incident AF occurrence, AF recurrence after RFA or prognosis (stroke/SE, major bleeding).     

老年房颤患者肠道菌群变化及其影响因素

目的 探讨老年房颤患者肠道菌群变化及影响菌群变化的相关因素。 方法 回顾性收集20例老年房颤患者作为房颤组,并选取性别、年龄与患者匹配的30例老年健康体检者作为对照组,分析两组对象肠道优势菌的特点。同时收集房颤组患者C反应蛋白(CRP)、总胆汁酸(TBA)、同型半胱氨酸(Hcy)、B型纳尿肽(BNP)、左室射血分数数值(LVEF)等检测结果,分析上述因素与肠道优势菌群的关系。 结果 房颤组患者直肠真杆菌数量为(4.66±1.62)lg copies/g粪便,低于对照组的(6.10±1.44)lg copies/g粪便,差异有统计学意义(t=-3.286,P=0.002)。房颤组患者肠道普拉梭菌、肠球菌、类杆菌、乳杆菌、双歧杆菌、柔嫩梭菌、酪酸梭菌、Atopobium cluster(Ato)、肠杆菌数量及双歧杆菌/肠杆菌(B/E)值与对照组比较差异无统计学意义(均P>0.05)。在房颤组中,CRP升高患者肠道双歧杆菌数量和B/E值显著高于CRP正常患者,CRP升高与双歧杆菌数量呈正相关(r=0.651,P=0.002);Hcy升高患者肠道肠杆菌数量显著高于Hcy正常患者,Hcy升高与肠杆菌数量呈正相关(r=0.567,P=0.009)。BNP、TBA、LVEF与优势菌群无显著相关性。 结论 老年房颤患者存在肠道菌群失调。CRP、Hcy和老年房颤患者肠道菌群具有一定的相关性。     

二十二碳六烯酸对心房颤动大鼠心房肌生理改变及双孔钾通道TASK-1蛋白表达的影响

目的：探讨二十二碳六烯酸（DHA）对大鼠心房颤动（AF）模型心房肌生理特性的影响及相关机制研究。方法：80只乙酰胆碱-氯化钙混合液敏感的SD大鼠分为对照组（CTL组）、DHA处理组（DHA组）、房颤组（AF组）和房颤+DHA处理组（DHA+AF组）,观察房颤持续时间;采用全细胞膜片钳技术记录大鼠心房肌细胞动作电位时程（APD）和双孔钾通道TASK-1电流,Western blot测定大鼠心房组织TASK-1蛋白表达。结果：大鼠尾静脉注射乙酰胆碱-氯化钙混合液后,房颤持续时间随实验天数增加而逐渐延长,DHA干预缩短房颤持续时间。与CTL组相比,AF组大鼠心房肌细胞复极50%时的动作电位时程（APD₅₀）和复极90%时的动作电位时程（APD₉₀）明显缩短,心房肌细胞TASK-1电流密度升高,蛋白表达升高（P<0.05）。与AF组相比,DHA+AF组大鼠心房肌细胞APD₅₀和APD₉₀明显延长,TASK-1电流密度和蛋白表达降低（P<0.05）。结论：DHA具有延长房颤大鼠心房肌细胞APD的作用,可能与其下调心房肌TASK-1蛋白的表达从而降低心房肌细胞TASK-1电流密度有关。     

Oxidative stress in patients with cardiovascular disease and chronic renal failure

Abstract

Oxidative response regulates many physiological response in human health, but if not properly regulated it could also lead to a number of deleterious effects. The importance of oxidative stress injury depends on the molecular target, the severity of the stress, and the mechanism by which the oxidative stress is imposed: it has been implicated in several diseases including cancer, neurodegenerative diseases, malaria, rheumatoid arthritis and cardiovascular and kidney disease. Most of the common diseases, such as hypertension, atherosclerosis, heart failure, and renal dysfunction, are associated with vascular functional and structural alterations including endothelial dysfunction, altered contractility, and vascular remodeling. Common to these processes is increased bioavailability of reactive oxygen species (ROS), decreased nitric oxide (NO) levels, and reduced antioxidant capacity. Oxidative processes are up-regulated also in patients with chronic renal failure (CRF) and seem to be a cause of elevated risk of morbidity and mortality in these patients.

In this review, we highlight the role of oxidative stress in cardiovascular and renal disease.     

心房肌胞内钙浓度变化对心房颤动患者小电导钙激活钾通道电流的影响

目的：SK通道存在于心肌细胞上,其中SK2亚型主要表达在心房。SK2通道对胞内游离钙离子高度敏感,可快速将钙离子浓度的变化转换成细胞膜电位变化。本实验应用穿孔膜片钳技术记录人心肌细胞SK2电流,观察心房肌细胞SK2电流在窦性患者和心房颤动患者之间的差别,以及电极液中不同的钙浓度对两组细胞SK2电流的影响。方法：将接受体外循环手术的患者分为两组：心房颤动组和窦性心律组。以心房肌细胞为研究对象,用穿孔膜片钳技术记录人心肌细胞电流,观察窦性组与房颤组SK2通道电流的差异以及两组细胞SK2电流对电极液中钙敏感性的不同。结果：在全细胞穿孔膜片钳模式下,电极液中游离钙离子浓度为5×10-7mol/L时,记录到房颤组SK2通道电流明显大于窦性组,尤其是在超极化水平。膜电位在-130 mV时,窦性组与房颤组的SK2通道电流密度分别为（-2.92±0.35）pA/pF（n=6）,（-6.83±0.19）pA/pF（n=3,P〈0.05）。在电极液游离钙离子浓度分别为0 mol/L、5×10-7mol/L、10-6mol/L,膜电位为-130 mV时,窦性组SK2通道电流密度分别为（-1.43±0.33）pA/pF（n=7）,（-2.92±0.35）pA/pF（n=6）,（-10.11±2.15）pA/pF（n=8,P〈0.05）;房颤组SK2通道电流密度分别为（-2.17±0.40）pA/pF（n=4）（-6.83±0.19）pA/pF（n=3）（-14.47±2.89）pA/pF（n=4）（P〈0.05）。结论：人心房肌细胞SK2通道具有电压不敏感、内向整流、apamin敏感的特性。电极液中钙浓度相同的情况下,房颤组的SK2电流密度明显大于窦性组,SK2通道电流对钙离子的敏感性高于窦性组,提示SK2通道钙敏感性增加可能与心房颤动的发生发展密切相关。     

Glutathione and its associated enzymes in peripheral blood cells in different stages of chronic renal insufficiency

Summary Reduced glutathione (GSH) levels and glutathione reductase (GR) and glutathione S-transferase (GST) activities were investigated in the erythrocytes and lymphocytes of non-dialyzed patients with varying degrees of chronic renal insufficiency, and also of patients on regular hemodialysis treatment. GSH, GR and GST levels were higher in erythrocytes and lymphocytes of examined patients as compared to their corresponding age-matched healthy controls. A correlation was found between the degree of renal insufficiency and the above parameters tested. A routine hemodialysis did not significantly affect erythrocyte and lymphocyte GSH content and activities of its associated enzymes. The increased GSH levels as well as GSH-linked enzyme activities of blood cells in uremia may be a protective mechanism for the cells due to the accumulation of toxic, oxidizing, wastes in the blood as a result of the uremic state. This view is supported by the results ofin vitro experiments, which have shown that GR and GST activities of normal human lymphocytes are increased when incubated with plasma from uremic patients.     

Safety and Efficacy of Apixaban versus warfarin in patients with atrial fibrillation or Venous Thromboembolism and End-Stage renal disease on hemodialysis: A systematic review and meta-analysis

BackgroundWarfarin is traditionally the drug of choice for stroke prophylaxis or treatment of venous thromboembolism in patients with end-stage renal disease (ESRD) on hemodialysis as data on apixaban use is scarce. We aimed to assess the safety and efficacy of Apixaban in patients with ESRD on hemodialysis when compared with warfarin.MethodsA comprehensive literature search in PubMed, Google Scholar, and Cochrane databases from inception until Nov 25, 2019, was performed. Studies reporting clinical outcomes comparing Apixaban (2.5 mg BID or 5 mg BID) versus Warfarin in ESRD patients on hemodialysis were included. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data.ResultsFour studies (three retrospective and one randomized) with a total of 9862 patients (apixaban = 2,547, warfarin = 7315) met inclusion criteria. The overall mean age was 66.6 ± 3.9 years and mean CHA2DS2-VASc score 4.56 ± 0.58. Apixaban was associated with lower rates of major bleeding (RR 0.53, 95% CI 0.45–0.64, p < 0.0001], gastrointestinal (GI) bleed (RR 0.65, 95% CI 0.55–0.76, p < 0.0001), intracranial bleed (RR 0.56, 95% CI 0.36–0.89, p = 0.01), and stroke/systemic embolism [RR 0.65, 95% CI 0.52–0.83, p = 0.0004] compared with warfarin in patients with ESRD on hemodialysis. There was no significant increased risk of all-cause mortality with the apixaban vs. warfarin (RR 0.90, 95% CI 0.41–1.96, p = 0.78).ConclusionApixaban had an overall favorable risk-benefit profile, with significant reductions in ischemic stroke, major bleeding, and intracranial bleeding compared to Warfarin in ESRD patients on hemodialysis with non-valvular AF and/or venous thromboembolism.