Association of vitamin D receptor BsmI (rs1544410) gene polymorphism with the intact parathyroid hormone (iPTH) level among patients with end-stage renal disease

Abstract

Association of vitamin D receptor (VDR) BsmI (rs1544410) gene polymorphism with the intact parathyroid hormone (iPTH) level among patients with end-stage renal disease (ESRD) from the published reports is still conflicting. This meta-analysis was performed to evaluate the relationship between VDR BsmI (rs1544410) gene polymorphism and the iPTH level among patients with ESRD. The association studies were identified from PubMed, and Cochrane Library on 1 March 2014, and eligible investigations were included and synthesized using meta-analysis method. Six reports were recruited into this meta-analysis for the association of VDR BsmI gene polymorphism with iPTH level among patients with ESRD. In this meta-analysis, the iPTH level in ESRD patients carrying BsmI Bb genotype was higher than that in ESRD patients carrying bb genotype in overall populations (Bb versus bb: OR?=?61.40, 95% CI: 19.65–103.16, p?=?0.004). However, the iPTH level in ESRD patients carrying BB genotype was not significant different from that in ESRD patients with Bb genotype and bb genotype in overall populations (BB versus Bb: OR?=??18.30, 95% CI: ?126.28–89.69, p?=?0.74; BB versus bb: OR?=?22.85, 95% CI: ?70.81–116.51, p?=?0.63). Furthermore, the results for Caucasians were similar to those in overall populations. In conclusion, the iPTH level in ESRD patients carrying BsmI Bb genotype was higher than that in ESRD patients carrying bb genotype in overall populations and in Caucasians. However, more studies should be conducted to confirm it.     

Left ventricular assist device for end-stage heart failure: results of the first LVAD destination program in the Netherlands

PurposeMechanical circulatory support with a continuous-flow left ventricular assist device (LVAD) may be a valuable treatment in end-stage heart failure patients for an extended period of time. The purpose of this study was to evaluate the safety and efficacy of implantation of a continuous-flow LVAD in end-stage heart failure patients within the first destination program in the Netherlands.MethodsA third-generation LVAD was implanted in 16 heart failure patients (age 61 ± 8; 81 % male; left ventricular ejection fraction 20 ± 6 %) as destination therapy. All patients were ineligible for heart transplant. At baseline, 3 and 6 months, New York Heart Association (NYHA) functional class, quality-of-life and exercise capacity were assessed. Clinical adverse events were registered.ResultsSurvival at 30 days and 6 months was 88 and 75 %, respectively. In the postoperative phase, 6 (38 %) patients required continuous veno-venous haemofiltration for renal failure and 2 (13 %) patients required extracorporeal membrane oxygenation because of severe right ventricular failure. During follow-up, NYHA functional class and quality-of-life improved from 3.7 ± 0.1 to 2.3 ± 0.1 and 57 ± 5 to 23 ± 3 at 6 months (P < 0.001), respectively. The 6 min walking distance improved from 168 ± 42 m to 291 ± 29 m at 6 months (P = 0.001).ConclusionContinuous-flow LVAD therapy is a promising treatment for patients with end-stage heart failure ineligible for heart transplant.     

终末期肾病透析患者的疲劳与生活质量的相关性研究

目的:评价终末期肾病行透析治疗患者的疲劳,探讨疲劳的影响因素及其与生活质量之间的相关性。方法:采用自行设计的患者一般情况调查问卷、多维疲劳量表MIF-20、健康状况问卷量表SF-36对204例ESRD进行血液透析与腹膜透析治疗的患者进行调查,分析治疗效果差异之间的相关因素。结果:204例透析患者的疲劳总分为60.47+11.75;经多元线性逐步回归分析透析患者疲劳的主要相关因素为年龄、文化程度、经济状况;除疲劳的活动减少与生活质量的躯体疼痛、情感职能无显著相关外,两者总分及各维度之间均呈显著性负相关。结论:终末期肾病透析患者存在重度疲劳;临床上重视患者的疲劳评估,进行有效干预,提高患者生活质量。     

终末期肾脏病患者行维持性血液透析的营养状况及影响因素分析

目的:探究并分析终末期肾脏病患者行维持性血液透析的营养状况及影响因素。方法:选取2010年1月-2014年1月在我院接受维持性血液透析治疗的82例终末期肾脏病患者,根据改良的定量主观整体评估表(MQSGA)评分将患者分为营养不良组(10分)以及营养正常组,比较两组患者年龄、性别、透析时间、身体质量指数(BMI)、血红蛋白(Hb)、血尿素氮(BUN)、甘油三酯(TG)、超敏C反应蛋白(hs-CRP)、白蛋白(Alb)、尿素清除指数(Kt/v)指标差异,分析血液透析患者发生营养不良的独立危险因素。结果:营养正常组患者年龄、透析时间、BUN、hs-CRP及Kt/v1.2的比例均显著低于营养不良组,Hb、BMI、Alb以及Kt/v≥1.2的比例均显著高于营养不良组,差异均具有统计学意义(P均0.05);多因素分析显示,年龄70岁、透析时间25个月、Kt/v1.2均是导致血液透析患者发生营养不良的独立危险因素(P均0.05)。结论:终末期肾脏病患者的年龄、透析充分性以及透析时间长短均是导致维持性血液透析并发营养不良的独立危险因素。     

Interleukin-1β and receptor antagonist (IL-1Ra) gene polymorphisms and the prediction of the risk of end-stage renal disease

Abstract

Cytokines play an important role in the pathogenesis of kidney disease and its progression to end-stage renal disease (ESRD). Inflammation is regulated by the genes of the interleukin 1 (IL-1) gene cluster. Therefore, it was hypothesized that a polymorphism in this gene cluster may be associated with the risk of ESRD. Polymorphisms in the IL-1 gene cluster were examined in a cohort of 222 ESRD patients and 206 controls of similar ethnicity. These individuals were genotyped for IL-1 β (promoter –511 and exon-5 +3953) genes and a variable number of tandem repeats (VNTR) in the IL-1 receptor antagonist gene (IL-1Ra). There was significant difference in genotype frequencies between ESRD patients and control group for IL-1β (promoter region and exon-5) and IL-1Ra gene polymorphism (p<0.001, 0.006 and?<?0.001, respectively). A significant difference was observed in IL-1Ra for 1/1 (410/410) and 1/2 (410/240) genotypes, and the risk for ESRD was higher in those carrying the 1/1 genotype (p=0.014, OR?=?1.692, and p<0.001, OR?=?0.163). Also identified was a novel, rare allele of a single copy of 86 bp in ESRD patients as compared with the controls. The haplotype ‘T-E2-1’ frequency distribution between patients and controls revealed greater than threefold risk (p=0.001, OR?=?3.572, 95% CI?=?1.589–8.032). Genetic linkage between the IL-1β promoter region and exon-5 and between the IL-1β promoter and IL-1Ra of IL-1 gene demonstrated a strong association among the variants in controls (D′?=?0.42, p<0.001, and D′?=?0.39, p=0.001). Thus, the three polymorphisms within the IL-1 cluster are associated with ESRD. This finding is perhaps one of the strongest associations between genotype and ESRD reported, and it suggests that the IL-1 gene cluster affects the risk of development of ESRD.     

影响早期糖尿病肾病预后危险因素探讨分析

目的:探讨研究影响早期糖尿病肾病(DN)预后的主要危险因素,为延缓早期糖尿病肾病向糖尿病终末期肾病进展提供依据。方法:回顾性分析52例早期DN的临床、实验室及治疗等临床资料,了解年龄、控制血糖、血压、血脂、尿蛋白对早期糖尿病肾病预后的影响。结果:50岁以下早期糖尿病肾病患者5年进展为终末期肾病高达25%,明显低于50岁以上的患者(75%)。血糖、血压、血红蛋白、血浆白蛋白、血脂、尿蛋白等指标控制良好的早期糖尿病肾病的预后明显好于控制不佳者(P<0.05)。结论:控制血糖、血压、血脂、尿蛋白和不吸烟或戒烟对改善早期糖尿病肾病的预后、提高患者生活质量、延长患者的肾存活期和生存期有着十分重要的意义。     

Serum sulfatides as a novel biomarker for cardiovascular disease in patients with end-stage renal failure

Sulfatides, normal components of serum lipoproteins, may play an important role in cardiovascular disease due to their various modulatory functions in haemostasis. The incidence of cardiovascular disease in patients with end-stage renal failure undergoing maintenance hemodialysis has been reported to be approximately 10 to 30 times higher than that in the general population. To elucidate the possible roles of serum sulfatides in this high incidence, we measured the level of sulfatides in 59 such patients, by converting them to lysosulfatides according to a recently developed quantitative, qualitative, high-throughput technique using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The mean level of sulfatides in patients 3.58 ± 1.18 nmol/ml was significantly lower than that in age-matched normal subjects (8.21 ± 1.50 nmol/ml; P < 0.001). Patients receiving maintenance hemodialysis over a longer period had lower levels of sulfatides. When the mean levels of sulfatides were compared between patients with cardiovascular disease (N = 22) and those without the disease (N = 37), the level in the former group 2.85 ± 0.67 nmol/ml was found to be significantly lower than that in the latter group 4.01 ± 1.22 nmol/ml (P < 0.001). These findings reveal a close correlation between low levels of serum sulfatides and a high risk of cardiovascular disease in these patients. Determination of the level of serum sulfatides can contribute to predictions of the incidence of cardiovascular disease in patients with end-stage renal failure undergoing maintenance hemodialysis.     

Functional gene arrays-based analysis of fecal microbiomes in patients with liver cirrhosis

Background

Human gut microbiota plays an important role in the pathogenesis of cirrhosis complications. Although the phylogenetic diversity of intestinal microbiota in patients with liver cirrhosis has been examined in several studies, little is known about their functional composition and structure.

Results

To characterize the functional gene diversity of the gut microbiome in cirrhotic patients, we recruited a total of 42 individuals, 12 alcoholic cirrhosis patients, 18 hepatitis B virus (HBV)-related cirrhosis patients, and 12 normal controls. We determined the functional structure of these samples using a specific functional gene array, which is a combination of GeoChip for monitoring biogeochemical processes and HuMiChip specifically designed for analyzing human microbiomes. Our experimental data showed that the microbial community functional composition and structure were dramatically distinctive in the alcoholic cirrhosis. Various microbial functional genes involved in organic remediation, stress response, antibiotic resistance, metal resistance, and virulence were highly enriched in the alcoholic cirrhosis group compared to the control group and HBV-related cirrhosis group. Cirrhosis may have distinct influences on metabolic potential of fecal microbial communities. The abundance of functional genes relevant to nutrient metabolism, including amino acid metabolism, lipid metabolism, nucleotide metabolism, and isoprenoid biosynthesis, were significantly decreased in both alcoholic cirrhosis group and HBV-related cirrhosis group. Significant correlations were observed between functional gene abundances and Child-Pugh scores, such as those encoding aspartate-ammonia ligase, transaldolase, adenylosuccinate synthetase and IMP dehydrogenase.

Conclusions

Functional gene array was utilized to study the gut microbiome in alcoholic and HBV-related cirrhosis patients and controls in this study. Our array data indicated that the functional composition of fecal microbiomes was heavily influenced by cirrhosis, especially by alcoholic cirrhosis. This study provides new insights into the functional potentials and activity of gut microbiota in cirrhotic patients with different etiologies.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2164-15-753) contains supplementary material, which is available to authorized users.     

成纤维细胞生长因子23（FGF23)在终末期肾病患者继发性甲状旁腺功能 亢进中的作用

目的:探究成纤维细胞生长因子23(FGF23)在终末期肾病患者继发性甲状旁腺功能亢进中的作用机制。方法:选取我院2013年2月-2015年5月期间收治的58例终末期肾病进入血液透析的患者,所有患者均经甲状旁腺CT增强扫描,无增生及结节。按照i PTH值将其分为两组,i PTH300 pg/m L为观察组,150 pg/m L≤i PHT≤300 pg/m L为对照组,每组29例。患者均予碳酸钙以及活性维生素D3进行治疗。对患者钙、磷、白蛋白、血脂以及FGF23、i PTH、1,25(OH)_2D_3进行检验。结果:治疗后观察组患者FGF23及i PTH均高于对照组,差异具有统计学意义(P0.05)。观察组血尿素氮、血肌酐与透析前相比明显下降,对照组血尿素氮、血肌酐与透析前相比明显下降,差异有统计学意义(P0.01);1,25(OH)_2D_3以及血白蛋白水平是影响Log FGF23的独立影响因素。结论:FGF23在终末期肾病患者继发性甲状旁腺功能亢进发病中发生作用,可作用临床诊断依据。     

Design and protocol for the Dialysis Optimal Health Program (DOHP) randomised controlled trial

BackgroundChronic kidney disease (CKD) and end-stage kidney disease (ESKD) are serious and growing health problems with enormous impact on psychological and social functioning. Despite high rates of comorbid depression and anxiety in these patient populations, and the adverse impact these have upon treatment adherence, quality of life, social connectedness and healthcare costs there has been little attention focused on the prevention or management of these problems. Thus, our aim was to evaluate the Dialysis Optimal Health Program (DOHP) that adopts a person-centred approach and engages collaborative therapy to educate and support those diagnosed with ESKD who are commencing dialysis.MethodsThe study design is a randomised controlled trial. Ninety-six adult patients initiating haemodialysis or peritoneal dialysis will be randomly allocated to either the intervention (DOHP) or usual care group. Participants receiving the intervention will receive nine (8 + 1 booster session) sequential sessions based on a structured information/workbook, psychosocial and educational supports and skills building. The primary outcome measures are depression and anxiety (assessed by the Hospital Anxiety and Depression Scale; HADS). Secondary outcomes include health-related quality of life (assessed by the Kidney Disease Quality of Life instrument; KDQOL), self-efficacy (assessed by General Self-Efficacy Scale) and clinical indices (e.g. albumin and haemoglobin levels). Cost-effectiveness analysis and process evaluation will also be performed to assess the economic value and efficacy of the DOHP. Primary and secondary measures will be collected at baseline and at 3-, 6-, and 12-month follow-up time points.DiscussionWe believe that this innovative trial will enhance knowledge of interventions aimed at supporting patients in the process of starting dialysis, and will broaden the focus from physical symptoms to include psychosocial factors such as depression, anxiety, self-efficacy, wellbeing and community support. The outcomes associated with this study are significant in terms of enhancing an at-risk population’s psychosocial health and reducing treatment-related costs and associated pressures on the healthcare system.

Trial registration

ANZCTR no. 12615000810516. Registered on 5 August 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1558-z) contains supplementary material, which is available to authorized users.