Uremia Patients Research Articles

Observation and nursing for uremia patients with 3rd cephalosporin-associated enephalopathy

近年来由于人口老龄化、经济条件的改善,透析人群日益增多,透析年限延长.尿毒症患者机体免疫力低下,是细菌感染的高发人群[1],因此抗生素的应用不可避免.第三代头孢菌素类抗生素有良好抗菌活性,体内分布广,组织穿透力强,对肾脏基本无毒性,临床广泛应用。

Reasons and nursing of elderly uremia patients with insomnia

目的 对老年尿毒症患者失眠原因进行分析,以便采取相应的护理对策,达到消除或减轻失眠的目的 .方法 对56例患者失眠的原因进行分析,并采取相应的护理措施.结果 56例患者中存在心理负担的19例,皮肤瘙痒14例,血液透析不充分9例,睡眠体位8例,环境因素6例,通过相应的护理措施均能消除或减轻患者的失眠现象.结论 对老年尿毒症患者失眠的原因进行分析,并在常规专科护理的基础上给予相应的护理措施,是提高患者失眠乃至生活质量的有效保证。

Elevation of serum apelin-13 is positively correlated with ADMA in patients on maintenance hemodialysis

Apelin and ADMA may have opposite impacts on the activity of NOS and production of NO. However, the circulating level and cardiovascular role of apelin are unclear in uremia patients with elevated ADMA. Our present study was to detect the serum level of apelin-13 and ADMA, and their correlations in maintenance hemodialysis (MHD) patients. 159 MHD patients without heart failure (HF) and twenty healthy volunteers were enrolled. Pre- and post-dialysis concentrations of serum apelin-13 and ADMA in MHD patients and in controls were determined. Nitrite and nitrate (NOx) were measured at the same time. The levels of apelin-13, ADMA, and NOx in dialysate or ultrafiltrate were tested, and the total removal (TR) of them in 1 session were calculated. It was also analyzed for the correlations among apelin-13, ADMA, NOx, apelin/ADMA ratio and other clinical parameters, such as blood pressure, urea reduction rate (URR), and so on. The serum levels of apelin-13 and ADMA in MHD patients were both higher than healthy controls (104.63 +/- 40.35 ng/ml versus 55.57 +/- 21.06 ng/ml, p = 0.016; 1.05 +/- 0.67microM vs. 0.35 +/- 0.06 microM, p = 0.002, respectively). There was no significant difference in serum NOx levels between MHD patients and healthy controls (58.30 +/- 40.09 microM vs. 68.11 +/- 13.63 microM, p = 0.596). Except for the significantly increased NOx (from 58.30 +/- 40.09 microM to 96.14 +/- 58.07 microM, p < 0.001), the serum levels of apelin-13 (from 104.63 +/- 40.35 ng/ml to 76.44 +/- 40.47 ng/ml, p = 0.012) and ADMA (from 1.05 +/- 0.67 microM to 0.83 +/- 0.53 microM, p < 0.001) decreased significantly after hemodialysis session. Apelin-13, ADMA, and NOx all can be removed by HD. The predialysis serum level of apelin-13 was positively correlated with the one of ADMA (r = 0.349, p = 0.001) and LDL (r = 0.204, p = 0.041), but ADMA was positively correlated with SCr (r = 0.277, p = 0.027). There were negative relationships between serum levels of ADMA and NOx for both pre- and post-dialysis (r = -0.344, p = 0.047, and r = -0.612, p = 0.001, respectively). The apelin/ADMA ratio had significantly negative correlations with systolic blood pressure (SBP) (for predialysis, r = -0.277, p = 0.037, for postdialysis r = -0.754, p = 0.019, respectively). The serum concentrations of both ADMA and apelin-13 are increased in MHD patients without HF, and there were positive correlations between them predialysis. Both of them might affect patients blood pressure.

Evaluation of leftventricular rotation and twist in uremia patients by two-dimensional ultrasound speckletracking imaging

：Objective To analyze theleft ventricular(LV) rotation and twist by two-dimensional ultrasound speckle-trackingimaging(STI),and evaluate the correlation between twist and other components of LVcontraction in uremia patients. Methods Twenty-nine uremia patients and twenty-ninehealthy volunteers were included. High frame rate two-dimensional images were recordedfrom the left ventricular short-axis views both of the basal and apical planes. Segmentaland global LV rotation were recorded at both The peak systolic LV twist was significantlydecreased in uremia patients(P <0. 001). The loss of LV twist occurred mainly by theimpairment of maximal global counterclockwise apical rotation(P <0. 001),and wasaugmented by somewhat less reduction in global clockwise basal rotation although thedifferences was not significantly reduced(P<0.01), while only the posterior andinferior of the basal plane was significantly fraction(r=0.645,P=0.000), LV end-diastolicvolume (r=-0.549,P=0.002), LV end-systolic volume(r=-0.673, P = 0.000) in uremia patients.Conclusions STI enables quantification of segmental and global LV rotation in an objectivemanner in uremia patients,and provides a new method for evaluation of segmental and globalLV systolic function.

Systemic inflammation is associated with pulmonary hypertension in patients undergoing haemodialysis

Pulmonary hypertension (PH) is an overlooked cardiovascular morbidity in patients undergoing haemodialysis. Inflammation has been demonstrated to play a significant role with certain types of PH in non-uraemic patients, but studies analysing the mechanisms in dialyzed patients with PH are rare. Hence, we investigated systemic and local inflammation biomarkers associated with PH in uraemia patients to elucidate the potential mechanism. A cross-sectional study was conducted in which 97 haemodialysis patients were initially evaluated in our hospital. Twelve inflammatory cytokines were measured using a cytometric beads assay in patients with and without PH. FE(NO) (fractional exhaled nitric oxide) was checked by a chemiluminescence analyser in patients with and without PH as well as by normal controls. Thirty-nine eligible patients were enrolled. Compared to patients without PH (group A), patients with PH (group B) had significantly higher serum levels of hs-CRP, IL-1beta, TNF-alpha and IL-6. FE(NO) was also measured. Though the pre-dialysis FE(NO) levels were elevated in both groups; group B patients had significantly higher pre-dialysis FE(NO) levels than group A patients (39.9 +/- 16.7 versus 31.8 +/- 10.3, P = 0.045). The post-dialysis FE(NO) levels returned to normal in group A while the remaining were significantly higher in group B (30.3 +/- 10.3 versus 20.1 +/- 10.9, P = 0.003). Our study revealed that dialyzed patients with PH had a significantly higher level of airway FE(NO) as well as serum levels of acute phase reactive protein and cytokines, including IL-1beta, TNF-alpha and IL-6. A chronic inflammation might play an important role in the pathogenesis of PH in patients undergoing haemodialysis.

Determination of oxidative stress markers and their importance in early diagnosis of uremia-related complications

The existence of oxidative stress and the higher incidence of cardiovascular diseases in association with uremia is well proved. The uremic status of serum copper, ceruloplasmin (CP), protein thiols, malonyldialdehyde (MDA), and glutathione S-transferase (GST) levels was studied. The study was carried out on 51 chronic renal failure (CRF) patients who were not on hemodialysis therapy and on 42 healthy controls. Serum urea, creatinine, and MDA levels were found to be significantly increased (P < 0.001), and total protein, albumin, protein thiols, and copper levels were found to be significantly decreased in CRF patients compared to normal controls (P < 0.001). Ceruloplasmin levels were decreased significantly (P < 0.05), and there was no significant change in serum GST levels in CRF patients compared to normal controls. In conclusion, the significant increase in levels of MDA, and the decrease in levels of protein thiols, CP, and copper in uremia patients when compared to controls, reconfirms the presence of stress in this patient population. In view of the changes in other markers of oxidative stress, this absence of any significant change in the activity of GST in uremia patients compared to controls, warrants further study.

Effects of uremia serum on monolayer permeability and F-actin in rat pulmonary microvascular endothelial cells

To observe the effects of uremia serum on monolayer permeability and F-actin in cultured rat pulmonary microvascular endothelial cell (RPMVEC) and to investigate the mechanism of injury of RPMVEC induced by uremia serum. RPMVEC was isolated and cultured from Wistar rat in vitro. The effects of serum of uremia patients on monolayer permeability of RPMVEC were observed with microfilter, and F-actin expression was evaluated by flow cytometry. Serum of uremia patients induced the increased permeability of RPMVEC monolayer for 6 h and 12 h (P < 0.01), depolymerization of F-actin for 6 h and 12 h (P < 0.01), the increased permeability of RPMVEC monolayer induced by serum of uremia patients is significantly correlated with the depolymerization of F-actin (r = -0.927, P < 0.01). Serum of uremia patients may induce the elevation of permeability monolayer and the depolymerization of F-actin in RPMVEC. The elevation of permeability monolayer induced by serum of uremia patients in RPMVEC is significantly correlated with the depolymerization of F-actin.

Perioperative care of peritoneal dialysis catheter implantation

To investigate the perioperative care of peritoneal dialysis catheter implantation.23 uremia patients with chronic renal failure were selected and underwent nursing and health education before and after the operation.23 patients were successfully implanted and family continuous ambulatory peritoneal dialysis after leaving the hospital.The tube of one patient was obstructed and diagnosed the displacement of peritoneal dialysis catheter by X ray.The catheter were pstency by poetural reduction.Careful nursing and health education before and after operation are important guarantee of dialysis catheter implantation. Key words: Peritoneal dialysis; Perioperative; Care

Evaluation of ultrasound on peripheral atheral atherosderosis after treatment by folicacid in combination with mecobalamin in uremia patient

Objective To evaluate the clinical significance of peripheral atheral atherosclerosis after treatment by folicacid in combination with mecobalarain in uremia patient using vascular ultrasound.Methods 99 cases of uremia patients with carotid atherosclerosis were treated with folie acid tablets and mecobalamin tablets for six months.The carotid intimia-media thiclmess(IMT),total plaque area,numbers and ultrasound types of carotid atherosclerotic before and after treatment were observed.Results After six months,carotid IMT became tinner significantly,and the totsl plaque area decreased(P＜0.05).The ultrasound types of carotid atherosclerotic plagues have changed after six montha.and the plaque numbers decreased significantly(P＜0.05).Conclusion Threatment by folie acid combination with mecobalamin in uremia patients maybe helpful to the progression of carotid athereaclerotie disease. Key words: Uremia; Atherosclerosis; Carotid arteries; Ultrasonograpy; Folic acid

STUDY ON PROTEOMICS EXPRESSION PROFILE OF SERA FROM PATIENTS WITH UREMIA

Aim: To establish and optimize two-dimensional electrophoresis (2DE) and relevant techniques for the study of serum proteome of the patients with uremia, and compare serum protein 2DE pattern between the uremia patients and the normal. Methods: Using immobiline pH gradients isoelectricfocusing (IEF) as the 1st dimension and vertical SDS-PAGE as the 2nd dimension, we performed the comparison and conditional optimization of the factors. Immobilized pH gradient two-dimensional polyacrylamide gel electrophoresis,silver staining, ImageMaster 2D 5.0 analysis software, matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-TOF-MS) and IPI human database searching, were used to separate and indentify the proteome of the sera from the patients with uremia. Results: Satisfactory 2DE patterns of the serum proteins were obtained. 26 protein spots were remarkably hanged in uremia patients, and 20 protein spots were identified by MALDI-TOF-TOF-MS.. Conclusion: Good reproducibility could be obtained by applying immobilized pH gradient 2DE to separate and identify the proteome in sera, which contributes to the further study on uremia toxins pertaining to protein.

Effects of metal-catalyzed oxidation on the formation of advanced oxidation protein products

To explore the relationship between metal-catalyzed oxidation (MCO) and the formation of advanced oxidation protein products (AOPPs). Specimens of human serum albumin (HSA) and pooled plasma were collected from 3 healthy volunteers and 4 uremia patients were divided into 3 groups: Group A incubated with copper sulfate solution of the concentrations of 0, 0.2, or 0.5 mmol/L, Group B, incubated with hydrogen peroxide 2 mmol/L, and Group C, incubated with copper sulfate 0.2 or 0.5 mmol/L plus hydrogen peroxide 2 mmol/L. 30 min and 24 h later the AOPP level was determined by ultraviolet visible spectrophotometry. High-performance liquid chromatography (HPLC) was used to observe the fragmentation effect on plasma proteins. Ninhydrin method was used to examine the protein fragments. The scavenging capacity of hydroxyl radical by macromolecules was measured so as to estimate the extent of damage for proteins induced by MCO. (1) The AOPP level of the HSA and plasma specimens of the uremia patients increased along with the increase of cupric ion concentration in a dose-dependent manner, especially in the presence of hydrogen peroxide (P < 0.05). (2) Aggregation of proteins was almost negligible in all groups, however, HPLC showed that cupric ion with or without hydrogen peroxide increased the fragments in the HAS specimens (with a relative molecular mass of 5000) and uremia patients' plasma proteins (with the molecular mass 7000). (3) The plasma AOPP level of the healthy volunteers was 68.2 micromol/L +/- 2.4 micromol/L, significantly lower than that of the uremia patients (158.5 micromol/L +/- 8.2 micromol/L). (4) The scavenging ability to clear hydroxyl radical by plasma proteins of the healthy volunteers was 1.38 -9.03 times as higher than that of the uremia patients. MCO contributes to the formation of AOPPs mainly through its fragmentation effect to proteins.

Proteomic Analysis of Peritoneal Dialysate Fluid in Patients with Dialysis-Related Peritonitis

The prognosis of uremia patients on continuous ambulatory peritoneal dialysis (CAPD) is related to frequent peritonitis rate. Frequent peritonitis will lead to peritoneum failure, making CAPD unfeasible. We have performed proteomic profiling of peritoneal dialysis effluent samples from a cross-section of CAPD patients with and without peritonitis in order to identify biomarkers of peritonitis. We performed 2D gel electrophoresis and surface-enhanced laser esorption/ionization time of flight mass spectrometry (SELDI-TOF MS) on peritoneal dialysis effluent from 16 subjects with peritonitis. A genetic algorithm search of principal component space revealed a group of a peak distinguishing peritonitis-positive subjects, with mass/charge (m/z) values of 11,117.4. Our analyses identified the peak at m/z 11,117.4 with an accuracy of 95% for classifying peritonitis. Mass spectrometric analysis of peritonitis PDE samples identified the 11,117.4 protein as β2-microglobulin (B2M). Using an unbiased protein profiling approach, we have validated previously reported findings of B2M as a biomarker associated with CAPD peritonitis. Prospective studies are warranted to establish additional biomarkers that would be predictive of peritoneal dialysis peritonitis. Besides, extending the study to a larger number of patients with subgroup analyses may yield additional information of the peritoneal dialysate proteins in association with dialysis adequacy, residual renal function, nutritional status, and risk of peritoneal infection.

Effects of uremia patients sera on bone marrow derived CFU-E proliferation

目的 通过将尿毒症未透析患者血清与小鼠骨髓细胞进行培养,分析尿毒症患者对小鼠骨髓红系爆式形成单位和红系集落形成单位生长的影响,初步探讨红细胞生成抑制因子是否存在.方法 选择12例尿毒症肾性贫血未经透析患者为实验组,其中男5例,女7例,平均年龄(50±12)岁.另选12例正常健康体检者设为对照组.将实验组、对照组血清分别稀释成不同终浓度(0%用等量堵养液代替血清,1.25%、2.5%、5.0%),采用甲基纤维素细胞培养方法与小鼠骨髓细胞进行培养,观察两组不同浓度血清对小鼠骨髓CFU-E、BFU-E集落生长的影响.结果 实验组中,与对照组相比,各浓度血清共同培养的小鼠骨髓红系造血祖细胞CFU-E和BFU-E的集落数均明显减少,且随血清浓度的增加,小鼠骨髓红系造血祖细胞CFU-E和BFU-E的集落数逐渐减少,各浓度组间差异有统计学意义;在相同浓度时,与实验组患者血清共同培养的小鼠骨髓红系造血祖细胞CFU-E和BFU-E的集落数较与正常对照组血清共同培养的CFU-E和BFU-E集落数明显减少,且差异均有统计学意义.结论 尿毒症患者血清中存在红细胞生成抑制因子,其对红系造血祖细胞的抑制作用具有剂量依赖性。

Protein damage and inflammation in uraemia and dialysis patients

The presence of high molecular weight toxins in the uraemic blood had largely been ignored until the beginning of the era of proteomics. In the last decade, increasing interest focused on these solutes has yielded evidence to suggest that some of these proteinaceous uraemic compounds can play pathogenic roles in the inflammatory and vascular comorbidities and mortality in patients with end-stage renal disease (ESRD). The finding that the blood levels of a number of glycation and oxidation markers are simultaneously increased in patients with uraemia suggests that several uraemic and inflammatory pathways may conspire to sustain the protein damage. Although the molecular characteristics and biological roles of the solutes derived from this abnormal chemistry remain poorly understood, it is proposed that they are not only laboratory hallmarks, but that their accumulation might also be the key underlying event in the establishment of a vicious and self-propelled 'inflammatory loop'. The 'switch' is believed to be turned on by the scavenger receptor-dependent recognition of these protein damage products and activation of inflammatory and vascular reactions, which once activated generate further and even more marked protein injuries and inflammatory mediators, establishing a vicious loop together with the contribution of the uraemic intoxication and dialysis-related events. This paper provides the description of this inflammatory model, along with an overview of the literature on the proteinaceous solutes associated with inflammation and oxidative stress reactions, their biological roles, expected therapeutic tools--either pharmacological or dialytic--and investigation strategies based on the most recently introduced proteomic approaches.

Comparative Study of the Blood Gas and the Acid Base Measurements of Arterial and Venous Blood Samples in Uremia Patients Presenting to the ED

Comparative Study of the Blood Gas and the Acid Base Measurements of Arterial and Venous Blood Samples in Uremia Patients Presenting to the ED

Serum trace element concentrations in children with chronic renal failure

Sirs, I read with interest the study by Esfahani et al. [1] on serum trace element levels in children with chronic renal failure. I would like to note the limitations and confounding variables that may have affected the study results and conclusions. First, zinc concentrations were not measured in the spent dialysate. As such, possible zinc losses via the hemodiafilter cannot be ascertained. Second, the use of body mass index (BMI) to compare the nutritional status between the three study groups with the aim of comparing body trace element status is inaccurate. BMI relates a person’s body weight to their height and is not an indication of nutrient reserves. The absence of significant difference in the BMI between different groups does not necessarily translate to similar trace element body stores. Third, it is stated that study results showed “an inverse linear relation between the duration of hemodialysis and serum levels of zinc”. This conclusion does not necessarily indicate that there were more zinc losses with longer duration of hemodialysis as stated in the conclusion “with the severity of the changes increasing with the duration of hemodialysis”. Chronic renal failure patients treated with long-term hemodialysis can be sicker and have poorer dietary intake. Poor nutritional intake may as well be the cause of zinc deficiency. Last, chronic renal failure and uremia can be associated with tissue trace element redistribution. Studies in patients with renal failure requiring intermittent hemodialysis have shown plasma zinc concentrations to be decreased or increased [2–7]. A decrease in serum zinc concentrations due to tissue zinc redistribution occurs during stress as part of the acute phase response and may not necessarily indicate zinc deficiency. Trace element redistribution is mediated by the release of cytokines, especially tumor necrosis factor-α (TNF-α) and interleukin-6 [8]. Significantly higher serum concentrations of TNF-α and interleukin-2 were found in pediatric chronic hemodialysis patients compared with healthy subjects. Serum concentrations of TNF-α, interleukin-6 and interleukin-2 were comparable before and after the hemodialysis session [9]. This indicates that chronic renal failure patients may have elevated serum cytokine concentrations. In the study by Esfahani et al. [1], serum trace elements were collected before hemodialysis. It is unlikely that timing of trace element collection may have been affected much differently whether sampling occurred before or after the hemodialysis session. Thus, cytokine effects on serum trace element redistribution may have been similar before or after hemodialysis. Although trace element disturbances have been reported in uremia and renal failure patients, the clinical implications of these disturbances and the direct implication of hemodialysis on trace element status remain to be fully elucidated.

Oxidatively-modified and glycated proteins as candidate pro-inflammatory toxins in uremia and dialysis patients

End stage renal disease (ESRD) patients accumulate blood hallmarks of protein glycation and oxidation. It is now well established that these protein damage products may represent a heterogeneous class of uremic toxins with pro-inflammatory and pro-oxidant properties. These toxins could be directly involved in the pathogenesis of the inflammatory syndrome and vascular complications, which are mainly sustained by the uremic state and bioincompatibility of dialysis therapy. A key underlying event in the toxicity of these proteinaceous solutes has been identified in scavenger receptor-dependent recognition and elimination by inflammatory and endothelial cells, which once activated generate further and even more pronounced protein injuries by a self-feeding mechanism based on inflammation and oxidative stress-derived events. This review examines the literature and provides original information on the techniques for investigating proteinaceous pro-inflammatory toxins. We have also evaluated therapeutic - either pharmacological or dialytic - strategies proposed to alleviate the accumulation of these toxins and to constrain the inflammatory and oxidative burden of ESRD.

Role of non-transferrin-bound iron in chronic renal failure and other disease conditions

Iron is an essential transitional metal required by the body for various biological functions. Iron is securely stored in ferritin and other biomolecules, either in ferrous or ferric state, and there are safe mechanisms for its storage or release from proteins to catalyze biological reactions. Under stress or some pathological conditions, there occurs the release of free iron or non-transferrin bound iron, which is free from its protein bound form, and it undergoes Fenton and Heiber-Weiss reactions to generate powerful reactive oxygen species. The reactive oxygen species generated will damage the biological macromolecules. It has been proved that in uremia or chronic renal failure patients, on conservative management or on hemodialysis program or under many other disease conditions, free iron or non-transferrin bound iron does exist; it induces damage to the biomolecules, thereby enhancing the disease process. In this review I have discussed the role of free iron or non-transferrin iron in general in biology and medicine, particulary in chronic renal failure.

The Nursing Countermeasure of Maintaining Blood Dialysis in Older Patient

目的 探讨老年尿毒症病人维持性血液透析的护理对策.方法对2001年1月至2005年6月132例60岁以上尿毒症病人行维持性血液透析的护理进行回顾性总结分析.结果132例病人因各种原因停止透析者67例,改腹膜透析者3例,因心力衰竭、脑出血、心肌梗死、肺部感染等并发症引起死亡者27例.现仍在行维持性血液透析38例.结论老年病人维持性血液透析并发症多,危险性大,做好透析全过程的心理护理,严密观察透析中病情变化,及时处理并发症,加强饮食指导和管理,是提高老年病人维持性血液透析质量和延长生命的关键。

Analysis of proteomic components of sera from patients with uremia by two dimensional electrophoresis and matrix assisted laser desorption/ionization time of flight mass spectrometry

The different sera proteomic components between uremia patients and normal subjects were studied through two-dimensional gel electrophoresis technique. Immobilized pH gradient two-dimensional polyacrylamide gel electrophoresis (2DE), silver staining, ImageMaster 2D 5.0 analysis software, matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-TOF-MS) and IPI human database searching were used to separate and identify the proteome of the sera from the patients with uremia. The results showed that satisfactory 2DE patterns of the serum proteins were obtained. Twenty-six protein spots showed significant difference in quantity in uremia patients, and 20 protein spots were identified by MALDI-TOF-TOF-MS. It was concluded that good reproducibility could be obtained by applying immobilized pH gradient 2DE to separate and identify the proteome in serum, which provided the foundation for the further study on uremia toxins pertaining to protein.