Efficacy and safety of Nafamostat mesylate in patients with endstage renal failure

BACKGROUND Recent studies on dialysis anticoagulation therapy in patients with renal failure have shown that Nafamostat mesylate,a broad-spectrum potent serine protease inhibitor,has strong anticoagulation and anti-fiber activity.AIM To evaluate the efficacy and safety of Nafamostat mesylate in patients with end-stage renal failure.METHODS Seventy-five patients with end-stage renal failure who received hemodialysis at our hospital between January 2020 and August 2021 were selected and divided into the observation group(Nafamostat mesylate for injection,n=33)and control group(heparin sodium injection,n=32).General patient data,indicators of clinical efficacy,dialyzer hemocoagulation parameters,coagulation function indices,and hemoglobin concentration and platelet count before and after treatment,and the occurrence of adverse reactions after treatment were compared between the two groups.RESULTS The two groups showed no significant differences in general patient data(P>0.05).The post-treatment effectiveness rate in the control group was lower than that in the observation group(P<0.05).The two groups showed no significant difference in the number of patients in grade I(P>0.05),while the number of patients in grade 0 was lower in the control group,and the number of patients in grades II and III was higher in the control group(P<0.05).The post-treatment prothrombin time,activated partial thromboplastin time,thrombin time,and international normalized ratio values in the control group were higher than those in the observation group,while the fibrinogen level in the control group was lower than that in the observation group(P<0.05).The two groups showed no significant difference in the platelet count and hemoglobin level before and after treatment(P>0.05).The total number of post-treatment adverse reactions in the observation group was lower than that in the control group(P<0.05).CONCLUSION Treatment of patients showing end-stage renal failure with Nafamostat mesylate can significantly improve therapeutic efficacy and has high safety and clinical value.

Assessment of the Level of Knowledge about Chronic Renal Failure in 271 Hypertensive Patients in Brazzaville

Background and Objectives: Chronic kidney disease (CKD) is now a global public health problem. In low- and middle-income countries such as the Congo, access to dialysis is low and inequitable. The prevention of CKD involves raising awareness among patients at risk, such as those suffering from arterial hypertension (AH), by improving their knowledge of CKD. The objectives of our work were to determine the level of knowledge about CKD among hypertensive patients and to identify the factors associated with a low level of knowledge. Methodology: We conducted a 3-month descriptive and analytical cross-sectional study from 1 August to 30 October 2023 in 3 large public hospitals in Brazzaville (capital of the Republic of Congo). We included: hypertensive patients aged 18 and over who had freely consented to participate in our study and were able to answer the questions on the survey form. Patients with known hypertension who had been followed for less than 3 years and those with known chronic renal failure were not included. Results: The mean age was 58.4 ± 14.4 years (29 - 88 years). There were 121 men and 150 women (sex ratio = 0.8). All the patients were educated;37.2% with a higher level of education and 13.6% with primary education. 24 patients (9%) had a good level of knowledge about CKD and 153 (56%) had poor knowledge. A good level of knowledge was associated with the duration of hypertension, intellectual level and the existence of associated heart disease. Conclusion: Our study reveals a significant lack of knowledge about chronic kidney disease among hypertensive patients in Brazzaville.

Predictive Factors of Renal Failure in COVID-19 Patients at the Anti-COVID Center in Lome, Togo

Background: Angiotensin-converting enzyme 2 has been identified as the receptor that allows the entry of SarsCov2 into the human cell. Its expression in the kidney is 100 times higher than in the lung;thus, making the kidney an excellent target for SarsCov2 infection manifesting as renal failure (RF). The objective of this study was to determine the predictive factors of RF during COVID-19 in the Togolese context. Patients and Methods: This was a retrospective descriptive and analytical study conducted at the Lomé Anti-COVID Center including the records of patients hospitalized for COVID-19, of age ≥ 18 years and having performed a creatinemia. RF was defined by a GFR 2 calculated according to the MDRD formula. Patients were randomized into 2 groups according to GFRResults: 482 patients were selected for this study with a mean age of 58.02 years. Sixty-five percent of the patients were men, i.e., a sex ratio of 1.88. Fifty-two patients had RF, i.e., a frequency of 10.8%.There were 65% men (315 cases), for a sex ratio (M/F) of 1.88. Risk factors for renal failure in COVID-19 were age ≥ 65 years (ORa 2.42;CIa95% [1.17 - 4.95];p = 0.016), anemia (ORa 2.49;CIa95% [1.21 - 5.26];p = 0.015), moderate (ORa 13;CIa95% [2.30 - 2.44];p = 0.017), severe (ORa 26.2;CIa95% [4.85 - 4.93];p = 0.002) and critical (ORa 108;CIa95% [16.5 - 21.76];p Conclusion: Renal failure would therefore be related to the severity of COVID-19 and is the most formidable factor, conditioning the course of the disease and the patient’s vital prognosis.

Causes and Prognosis of Cases of Acute Obstructive Renal Failure Managed at the Donka National Hemodialysis Center

Introduction: Acute obstructive renal failure (AORF) is a frequent clinical situation, secondary to obstruction of the urinary excretory tract. Whatever the cause, urinary tract obstruction suddenly opposes glomerular filtration and is responsible for tubulointerstitial lesions. It accounts for 10% of acute renal failure (ARF). The aim of this study was to identify the causes and prognosis of cases of acute obstructive renal failure managed at the Centre National d’hémodialyse Donka. Material and Methods: This was a prospective descriptive study lasting 6 months, from September 1, 2022 to February 29, 2023. All patients undergoing haemodialysis for acute obstructive renal failure who agreed to participate in the study and whose medical records were complete were included. Results: During the course of the study, we registered 97 haemodialysis patients, including 20 cases (20.62%) of acute obstructive renal failure. The mean age of the patients was 57.8 ± 10.54 years, with a male predominance of 11 cases (55%) and a sex ratio of 1.22. The reasons for consultation were dominated by physical asthenia 11 cases (55%), lumbar pain 9 cases (50%), vomiting 6 cases (30%) and acute urine retention 6 cases (30%). Arterial hypertension 16 cases (80%) and urinary tract infection 10 cases (50%) were the most common antecedents. The etiologies of RAOI were dominated by lithiasis 10 cases (50%), neoplasia 6 cases (30%) and benign prostatic hypertrophy 3 cases (15%). mean creatinine was 1267.60 ± 710.76 μmol/l with extremes of 243 μmol/l and 2822 μmol/l, mean urea was 39.56 ± 18.36, hyperkalemia in 14 cases (70%) and hyponatremia in 8 cases (40%). After hemodialysis, 9 cases (45%) recovered renal function, 4 cases (20%) became chronic and 7 cases (35%) died. Conclusion: The frequency of AKI remains non-negligible in our department, and early detection and prompt management would considerably reduce the morbidity and mortality associated with this pathology.

High Urine Retention: Experience in a Series of Patients with Renal Failure Patients

Purpose: High urinary retention (HUR) can negatively impact renal function. Our study aimed to present the epidemiological, diagnostic, and therapeutic aspects of HUR in a Senegalese academic hospital. Patients and Methods: We conducted a retrospective study of 70 patients with HUR associated with renal failure from January 2017 to December 2020. Parameters examined included: age, sex, coexisting conditions affecting renal function, clinical symptoms, diagnostic tests, causes of HUR, urinary diversion, and patient outcomes. Results: The average age was 66, with a majority of male patients (87%). Twenty-three patients had pre-existing medical conditions. Oligo-anuria was the most common reason for detecting HUR (70%). Half of the patients had an ECOG score ≥ 2. The mean creatinine level was 50.7 mg/l. Nineteen patients exhibited hydroelectrolytic disorders. Bacterial colonization was observed in 25 patients. Ultrasound and computed tomography were the most frequently performed imaging tests (100% and 62.8%, respectively). Sixty-seven patients had ureterohydronephrosis (UHN), with bilateral UHN in 88.6% of cases. Pelvic cancers (47.1%) were the primary cause of HUR, primarily bladder cancers (27.1%). Nephrostomy was the most common urinary drainage method (50%), particularly for obstructions due to pelvic cancer (88.6%). The majority of patients (52.8%) regained normal renal function after drainage. Nineteen deaths occurred among elderly patients with compromised general health. Conclusion: Urinary drainage significantly improved renal function for most patients. Pelvic cancer emerged as the leading cause of HUR. Nephrostomy was the predominant drainage method.

Morbidity and Mortality of Acute Renal Failure in COVID-19 Patients in Intensive Care According to Waves/Variant: Case of the Grand Hôpital de l’Est Francilien Site de Meaux

Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1st 2020 to December, 31st 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.

Mediating function of heart failure in the causal relationship between diastolic blood pressure and hypertensive renal disease with renal failure:a mediated Mendelian randomization study

Objective:To study the causality relationship between diastolic blood pressure(DBP)and hypertensive renal disease with renal failure(HRDRF)and the mediating role of hear t failure(HF)in the causality relationship by network Mendelian randomization(MR).Methods:Genome-wide analysis of DBP,HRDRF,and HF was downloaded from the public database(Genome-Wide Analysis Study[GWAS])and was used to analyze the results and to conduct mediated MR analysis.Results:Analysis showed that DBP was positively correlated with HRDRF(OR=1.0002,95%CI:1.0001–1.0003,P=1.8076e-05)and DBP was positively correlated with HF(OR=1.0295,95%CI:1.0221–1.0370,P=2.5292e-15).HF and HRDRF had a positive causal effect(OR=1.0001,95%CI:1.0000–1.0001,P=0.0152).Mediation analysis showed that the contribution ratio of HF to the combined effect of DBP and HRDRF was 24.69%.Conclusions:DBP can increase the risk of renal disease with renal failure,and HF may play an impor tant role in mediating this causal relationship.

Comparative efficacy of traditional Chinese herbal injection for chronic renal failure:A systematic review and network meta-analysis of randomized controlled trials

Objective: To conduct a systematic review and network meta-analysis(NMA) for the comparison of the efficacy and safety of Chinese herbal injection(CHI) combined with Western medicine(WM) and WM monotherapy for chronic renal failure(CRF).Methods: Eight databases were searched from inception to August 30, 2022. Randomized controlled trials(RCTs) regarding the comparison of CHI-WM combination therapy and WM monotherapy were included. Literature search, risk-of-bias assessment, and data extraction were conducted by 2 reviewers independently. NMA was performed by Stata 14.0, R 4.0.4 software, and the latest risk of bias assessment tool 2(RoB 2).Results: A total of 53 RCTs were finally included, involving 4445 participants and 16 CHIs. RoB 2 showed that 2 of these studies had a high risk of bias. Tianqi injection(TQ) + WM was the most effective in reducing serum creatinine(Scr) level. Xingding injection(XD) + WM was the most effective in reducing blood urea nitrogen(BUN) and cystatin C(Cys C) levels. Guhong injection(GH) + WM had the highest endogenous creatinine clearance rate(Ccr). Shuxuetong injection(SXT) + WM was the most effective in improving the clinical effective rate. Danhong injection(DH) + WM resulted in the lowest 24-h urinary protein quantity(24 h-UPQ), while Danshen injection(DS) + WM led to the lowest blood uric acid(UA)level. Shenfu injection(SF) + WM was the most effective in increasing hemoglobin(Hb) level.Conclusion: CHIs-WM combination therapy is more effective than WM monotherapy in treating CRF.Considering all of the indicators, SK + WM may be the optimal treatment option for improving renal function in patients with CRF.

Epidemiological and Clinical Aspects of Chronic Renal Failure in the Medical Department at the Hospital of Sikasso

Introduction: Chronic renal failure is a real public health problem because of its prevalence, the cost of its management and the high morbidity and mortality rate associated with it. The objective of this study was to determine the frequency, causes and main aggravating factors of chronic renal failure in the medical department of the hospital of Sikasso. Materials and Methods: This was a cross-sectional, retrospective, descriptive study conducted in the medical department of the Sikasso hospital from January 1, 2021 to November 30, 2022. It covered all the records of patients with chronic renal failure hospitalized in the department during this period. The MDRD formula was used to estimate the glomerular filtration rate. The KDIGO 2012 classification was used to stage CKD. Results: Of 820 patient records reviewed, we retained 197 records. The mean age of our patients was 42.25 ± 10 years. The male sex represented 114 (57.9%). The socio-economic level was considered low and precarious in 79.8% of cases. The frequency of chronic renal failure was 24%. The reason for hospitalization was mostly hyper creatinine > 185 μmol/l (92.4%). Herbal medicine was reported in 103 cases (52.3%). Medical history was hypertension 101 cases (51.3%), undocumented gastro duodenal ulcer (UGD) 14 cases (7.6%), hypertension and diabetes 11 cases (5.1%), diabetes 8 cases (4%), lower limb edema 9 cases (4.6%). Hypocalcemia was 147 cases (75.6%) with hyper phosphoremia was 153 cases (77.7%). Hemoglobin level was: <6 g/dl, 44 cases (22.3%);between 6 - 8 g/dl, 77 cases (39.1%), from 8 - 10 g/dl, 54 cases (27.4%). The etiologies of CKD were vascular nephropathy 106 cases (53.8%), interstitial nephropathy, 44 cases (22.3%), glomerular nephropathy, 33 cases (16.8%), diabetic nephropathy, 12 cases (6.1%) and polycystic kidney disease 2 (1%). CKD was classified as stage 5, 171 cases (86.8%), stage 4, 11 cases (5.6%), stage 3, 13 cases (6.6%) and stage 2, 2 cases (1%.) Dialysis was performed in 1095 (5.3%) of our patients. All these patients started dialysis with a central line. Conclusion: This study reveals the high prevalence of chronic renal failure in the department and above all the late diagnosis at very advanced stages. This imposes policies of prevention and effective management of the responsible diseases.

Effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with diabetic nephropathy and chronic renal failure

BACKGROUND Diabetic nephropathy(DN)is frequently seen in the development of diabetes mellitus,and its pathogenic factors are complicated.Its current treatment is controversial,and there is a lack of a relevant efficacy prediction model.AIM To determine the effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with DN and chronic renal failure(CRF),and to construct an efficacy prediction model.METHODS We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022.We selected 94 patients who met the inclusion and exclusion criteria.Patients were assigned to a dialysis group(n=45)and a joint group(n=49)in relation to therapeutic regimen.The clinical efficacy of the two groups was compared after treatment.The changes in laboratory indexes after treatment were evaluated,and the two groups were compared for the incidence of adverse reactions.The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed.RESULTS The dialysis group showed a notably worse improvement in clinical efficacy than the joint group(P=0.017).After treatment,the joint group showed notably lower serum levels of serum creatinine,uric acid(UA)and blood urea nitrogen(BUN)than the dialysis group(P<0.05).After treatment,the joint group had lower serum levels of phosphorus,procollagen type I amino-terminal propeptide(PINP)and intact parathyroid hormone than the dialysis group,but a higher calcium level(P<0.001).Both groups had a similar incidence of adverse reactions(P>0.05).According to least absolute shrinkage and selection operator regression analysis,UA,BUN,phosphorus and PINP were related to treatment efficacy.According to further comparison,the non-improvement group had higher risk scores than the improvement group(P<0.0001),and the area under the curve of the risk score in efficacy prediction was 0.945.CONCLUSION For treatment of CRF and DN,combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients,with good safety.

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

Acute Renal Failure in the Elderly in the Nephrology Department of Aristide Le Dantec Hospital in Senegal: About 45 Cases

Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.

Acute Renal Failure in COVID-19 Patients in Intensive Care at the CHU du Point G in Mali

Introduction: SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-virus 2) causes an acute respiratory disease with interstitial and alveolar pneumonia, which can affect several organs including the kidneys [1] [2] [3]. As Mali is no stranger to this pandemic, we report our experience of the management of cases of kidney failure observed in the COVID-19 intensive care unit at the Point G University Hospital Centre (CHU). The aim of this work was to characterise acute renal failure in COVID-19 patients in intensive care, describing the management methods used and determining the vital prognosis. Materials and Methods: This was a retrospective descriptive study, covering an 18-month period from April 2020 to September 2021. We included all patients admitted to the COVID-19 intensive care unit on the basis of a positive RT-PCR and/or the presence of ground-glass images on thoracic computed tomography. Results: We selected 232 patients admitted for COVID-19. Acute Renal Failure (ARF) developed in 71 patients (30.6%). The stages of AKI according to KDIGO were Stage 1 in 28.2%, Stage 2 in 18.3% and Stage 3 in 53.5%. The mean age was 63.96 years, with a standard deviation of 16.6, and males accounted for the majority (71.8%). Organic ARF was found in 80.3% of cases. Risk factors and comorbidities for ARF included advanced age (60.6%), male sex (71.8%), hypertension (52.1%), diabetes (21.1%), invasive mechanical ventilation (71.8%) and septic shock (56.3%). Extra renal purification (haemodialysis) was used in 29.6% of patients. Admission to intensive care ranged from 7 days to 14 days in 43.7% of cases. More than half the patients (52.1%) were in critical condition on admission. Death occurred in 76.1% of patients. Conclusion: ARF appears to occur more frequently in patients with severe COVID-19. It is associated with a poor prognosis.

Real-time Shear Wave Elastography Assessment of Muscle Elasticity in Patients with Renal Failure

Objective:To explore the value of real-time elastic shear wave in evaluating muscle elasticity in patients with renal failure.Methods:50 patients with chronic renal failure from January 2019 to December 2022 were randomly selected as the experimental group,and 50 healthy patients aged 21-61 during the same period were selected as the control group,and the basic information of the patients,including age,gender,body mass index,etc.,were collected.Besides,the Young's modulus of the two groups of patients were observed and analyzed.Results:The Young's modulus values of left and right gastrocnemius muscles in the experimental group were significantly lower than those in the control group(P<0.05),and there was no statistical difference between the left and right sides of the experimental group and the control group(P>0.05).Conclusion:Real-time shear wave elastography provides a non-invasive,real-time and effective tool for the assessment of muscle elasticity in patients with renal failure.Through further research and optimization,real-time shear wave elastography will play a greater role in the prevention and treatment of patients with renal failure,improving the quality of life and prognosis of patients.

Dental implant treatment for renal failure patients on dialysis:a clinical guideline

Chronic kidney disease （CKD） is a worldwide public health problem that is growing in prevalence and is associated with severe complications. During the progression of the disease, a majority of CKD patients suffer oral complications. Dental implants are currently the most reliable and successful treatment for missing teeth. However, due to complications of CKD such as infections, bone lesions, bleeding risks, and altered drug metabolism, dental implant treatment for renal failure patients on dialysis is more challenging. In this review, we have summarized the characteristics of CKD and previous publications regarding dental treatments for renal failure patients. In addition, we discuss our recent research results and clinical experience in order to provide dental implant practitioners with a clinical guideline for dental implant treatment for renal failure patients undergoing hemodialysis.

Clinical outcomes of isolated renal failure compared to other forms of organ failure in patients with severe acute pancreatitis

To assess differences in clinical outcomes of isolated renal failure (RF) compared to other forms of organ failure (OF) in patients with severe acute pancreatitis (SAP). METHODSUsing a prospectively maintained database of patients with acute pancreatitis admitted to a tertiary medical center between 2003 and 2016, those with evidence of persistent OF were classified to renal, respiratory, cardiovascular, or multi-organ (2 or more organs). Data regarding demographics, comorbidities, etiology of acute pancreatitis, and clinical outcomes were prospectively recorded. Differences in clinical outcomes after development of isolated RF in comparison to other forms of OF were determined using independent t and Mann-Whitney U tests for continues variables, and χ2 test for discrete variables. RESULTSAmong 500 patients with acute pancreatitis, 111 patients developed persistent OF: mean age was 54 years, and 75 (67.6%) were male. Forty-three patients had isolated OF: 17 (15.3%) renal, 25 (21.6%) respiratory, and 1 (0.9%) patient with cardiovascular failure. No differences in demographics, etiology of acute pancreatitis, systemic inflammatory response syndrome scores, or development of pancreatic necrosis were seen between patients with isolated RF vs isolated respiratory failure. Patients with isolated RF were less likely to require nutritional support (76.5% vs 96%, P = 0.001), ICU admission (58.8% vs 100%, P = 0.001), and had shorter mean ICU stay (2.4 d vs 15.7 d, P < 0.001), compared to isolated respiratory failure. None of the patients with isolated RF or isolated respiratory failure died. CONCLUSIONAmong patients with SAP per the Revised Atlanta Classification, approximately 15% develop isolated RF. This subgroup seems to have a less protracted clinical course compared to other forms of OF. Isolated RF might be weighed less than isolated respiratory failure in risk predictive modeling of acute pancreatitis.

Effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure

AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided into four groups with respect to their Helicobacter pylori （H pylori） and CRF status. Groups were labeled as follows： la： normal renal function, H pylori negative （n = 12）, lb： normal renal function, H pylori positive （n = 11）, 2a： CRF, H pylori negative （n = 10）, 2b： CRF, H pylori positive （n = 11）. Upper gastrointestinal endoscopy was done in all the patients involved in the study. During endoscopical investigation, antral biopsy specimens were taken from each patient. In order to evaluate the cell apoptosis and proliferation in gastric epithelial cells, Bax and proliferating cell nuclear antigen （PCNA） labeling indexes （LI） were assessed with immunohistochemical staining method. RESULTS： For groups la, lb, 2a, and 2b, mean Bax LI was identified as 34.4±13.7, 44.1±16.5, 46.3±20.5, 60.7±13.8, respectively and mean PCNA LI was identified as 36.2±17.2, 53.6±25.6, 59.5±25.6, 67.2±22, respectively. When the one-way ANOVA test was applied, statistically significant differences were detected between the groups for both Bax LI （P = 0.004 〈0.01） and PCNA LI （P = 0.009 〈0.01）. When groups were compared further in terms of Bax LI and PCNA LI with Tukey＇s HSD test for multiple pairwise comparisons, statistically significant difference was observed only between groups la and 2b （P = 0.006 〈0.01）.CONCLUSION： In gastric epithelial cells, expression of both the pre-apoptotic protein Bax and the proliferation marker PCNA increase with H pylori infection. This increase is more evident in patients with uremia. These findings suggest that uremia accelerates apoptosis and proliferation in gastric epithelial cells.

Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data)

AIM： To investigate the role of wireless capsule endoscopy （WCE） in detection of small bowel （SB） pathology in patients with chronic renal failure （CRF） and obscure bleeding. METHODS： Consecutive CRF patients with obscure bleeding were prospectively studied. Patients with normal renal function and obscure bleeding, investigated during the same period with WCE, were used for the interpretation of results. RESULTS： Seventeen CRF patients （11 overt, 6 occult bleeding） and 51 patients （33 overt, 18 occult bleeding） with normal renal function were enrolled in this study. Positive SB findings were detected in 70.6% of CRF patients and in 41.2% of non-CRF patients （P〈0.05）. SB angiodysplasia was identified in 47% of CRF patients and in 17.6% of non-CRF patients. Univariate logistic regression revealed CRF as a significant predictive factor for angiodysplasia （P〈0.05）. Therapeutic measures were undertaken in 66% of the patients with the positive findings. CONCLUSION： According to our preliminary results, SB angiodysplasia was found in an increased prevalence among CRF patients with obscure bleeding. WCE is useful in diagnosis of gastrointestinal pathologies and in planning appropriate therapeutic intervention and, therefore, should be included in the work-up of this group of patients.

Doctor-led intensive diet education on health-related quality of life in patients with chronic renal failure and hyperphosphatemia

BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal failure.Besides the use of phosphorus binders,clinical control measures for hyperphosphatemia in these patients should also incorporate diet control.AIM To observe doctor-led intensive diet education effects on health-related quality of life in patients with chronic renal failure and hyperphosphatemia.METHODS We assessed 120 patients with hyperphosphatemia and chronic renal failure on hemodialysis admitted to our hospital(July 2018 to March 2020).The control group(n=60)was given routine nursing guidance,and the observation group(n=60)was given doctor-led intensive diet education.The changes in EQ-5D-3L scores,disease-related knowledge,and compliance scores before intervention and 3 and 6 mo after intervention in the two groups were recorded.The levels of serum parathyroid hormone(iPTH),calcium(Ca),phosphorus(P),calciumphosphorus product(Ca×P),serum creatinine(Scr),and blood urea nitrogen(BUN)before intervention and 3 and 6 mo after intervention in the two groups were assessed along with patient satisfaction.RESULTS There was no significant difference in blood iPTH,Ca,P,Ca×P,Scr,or BUN levels between the groups before intervention.After 3 and 6 mo of intervention,the blood iPTH,Ca,P,and Ca×P levels in the two groups decreased gradually(P<0.05),but there were no significant differences in Scr or BUN.The blood iPTH,Ca,P,and Ca×P levels in the observation group were lower than those in the control group(P<0.05).The satisfaction rate in the observation group after 3 mo was 93.33%and after 6,90.00%,which was high compared with the 80.00%and 71.67%,respectively,in the control group(P<0.05).There was no significant difference in EQ-5D-3L score between the two groups before intervention.After 3 and 6 mo of intervention,the visual analogue scale score of the two groups increased gradually(P<0.05);and the scores of action ability,self-care,daily activities,pain and discomfort,and anxiety and depression decreased gradually(P<0.05).The overall EQ-5D-3L score in the observation group was better than that in the control group(P<0.05).There was no significant difference in diseaserelated knowledge or compliance scores between the groups before intervention.After 3 and 6 mo of intervention,the scores of disease,diet,and medication knowledge and compliance in the two groups increased gradually(P<0.05).The scores of disease-related knowledge and compliance were higher in the observation group than in the control group(P<0.05).CONCLUSION Doctor-led intensive diet education can improve patient satisfaction and the quality of life in patients with chronic renal failure and hyperphosphatemia and promote low-phosphorus diet behavior.

Detection of the Level of Urinary FPA in Chronic Nephritis with Renal Failure and Its Clinical Implication

The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.