Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

Impact of a Nurse-Led Chronic Disease Management Intervention Model on Quality of Care and Satisfaction of Maintenance Hemodialysis Patients

Objective:To explore the impact of a nurse-led chronic disease management model on the quality of care and satisfaction of maintenance hemodialysis patients.Methods:72 patients who received maintenance hemodialysis(MHD)from June 2021 to March 2022 were selected to undergo the nurse-led chronic disease management model.The hemodialysis indexes,nutritional status,and the occurrence of adverse events were assessed after 24 weeks of the intervention,and patients’satisfaction was investigated and analyzed.Results:Comparing pre-intervention and after 24 weeks of intervention,urea reduction rate and urea clearance were improved but not statistically different(P>0.05),butβ2-microglobulin was significantly reduced compared with pre-intervention(P<0.05);after 24 weeks of intervention,the effect of decreasing blood calcium,parathyroid hormone,and potassium levels was not obvious(P>0.05),and the level of blood phosphorus decreased significantly compared with pre-intervention(P<0.01),albumin and hemoglobin levels were increased and better than before intervention(P<0.05);after 24 weeks of intervention,the incidence of intradialytic hypotension and hypertension was lower than before intervention(P<0.05),and the total incidence of complications was significantly lower than before intervention(P<0.01);there was no significant difference in the Self-Depression Scale scores after 24 weeks of intervention(P>0.05),and Self-Anxiety Scale scores were significantly lower and better than before intervention(P<0.01).Patient satisfaction was greatly improved,with a statistically significant difference(P<0.05).Conclusion:The chronic disease management intervention model led by specialized nurses is conducive to improving the psychological state and nutritional status of dialysis patients,enhancing the adequacy of dialysis for patients,reducing the incidence of related complications,and ultimately achieving the purpose of improving the quality of life of patients,which has significant clinical value.

Effect of Nephritis Rehabilitation Tablets combined with tacrolimus in treatment of idiopathic membranous nephropathy

BACKGROUND Idiopathic membranous nephropathy(IMN)has a high incidence in the middleaged and elderly population,and poses a great threat to the physical and mental health and quality of life of patients.Nephritis Rehabilitation Tablets have many potential effects,such as clearing residual toxins,tumefying the kidney and spleen,replenishing qi,and nourishing yin,and have played an important role in the treatment of a variety of kidney diseases.AIM To investigate the efficacy and safety of Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN.METHODS Eighty-four patients with IMN recruited from January 2017 to September 2020 were randomly divided into a study group(n=42)and a control group(n=42).On the basis of routine symptomatic treatment,both groups were treated with tacrolimus,and the study group was additionally treated with Nephritis Rehabilitation Tablets.Both groups were treated for 12 wk.The therapeutic effect,the levels of renal function indexes[serum creatinine(Scr),serum albumin,and 24-h urinary protein],urinary immunoglobulin(IgG4),membrane attack complex(C5b-9),and the incidence of adverse reactions were measured before and after 12 wk of treatment.RESULTS The total effective rate in the study group was significantly higher than that of the control group.Before treatment,there was no significant difference in Scr,serum albumin,or 24 h urinary protein between the two groups.After 12 wk of treatment,the levels of Scr and 24-h urinary protein in both groups were significantly lower and serum albumin was significantly higher than those before treatment(P<0.05),and the levels of Scr and 24-h urinary protein were significantly lower(P=0.003 and 0.000,respectively),and the level of serum albumin was significantly higher(P=0.00)in the study group than in the control group.Before treatment,there was no significant difference in urinary IgG4 and C5b-9 levels between the study group and the control group(P=0.336 and 0.438,respectively).After 12 wk of treatment,the levels of urinary IgG4 and C5b-9 in the two groups were lower than those before treatment,and the levels of urinary IgG4 and C5b-9 in the study group were significantly lower than those in the control group(P=0.000).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.710).CONCLUSION Based on routine intervention,Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN can effectively improve the renal function of patients and downregulate the expression of urinary IgG4 and C5b-9.In addition,they can improve the overall therapeutic effect while not increasing the risk of adverse reactions.

Cross-sectional study of traumatic stress disorder in frontline nurses 6 mo after the outbreak of the COVID-19 in Wuhan

BACKGROUND Frontline nurses in Wuhan directly fighting severe acute respiratory syndrome coronavirus-2 diseases are at a high risk of infection and are extremely susceptible to psychological stress,especially due to the global coronavirus disease 2019(COVID-19)pandemic.The psychological after-effects of this public health emergency on frontline nurses will last for years.AIM To assess factors influencing post-traumatic stress disorder(PTSD)among frontline nurses in Wuhan 6 mo after the COVID-19 pandemic began.METHODS A total of 757 frontline nurses from five hospitals in Wuhan,China,participated in an online survey from July 27 to August 13,2020.This cross-sectional online study used a demographic information questionnaire,the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders,the Connor-Davidson Resilience Scale,and the Patient Health Questionnaire-4.The chisquare test and logistic regression were used to analyze the association of demographics,COVID-19-related variables,and PTSD.Logistic regression was also conducted to investigate which variables were associated with PTSD outcomes.RESULTS A total of 13.5%,24.3%,and 21.4%of the frontline nurses showed symptoms of PTSD,depression,and anxiety,respectively.The multivariate logistic regression analysis showed that the following factors were strongly associated with PTSD:Having a relative,friend,or colleague who died of COVID-19;experiencing stigma;or having psychological assistance needs,depressive symptoms or anxiety.Showing resilience and receiving praise after the COVID-19 outbreak were protective factors.CONCLUSION Frontline nurses still experienced PTSD(13.5%)six months after the COVID-19 outbreak began.Peer support,social support,official recognition,reward mechanisms,exercise,better sleep,and timely provision of information(such as vaccine research progress)by the government via social media,and adequate protective supplies could mitigate the level of PTSD among nurses responding to COVID-19.Stigmatization,depression,and anxiety might be associated with a greater risk of PTSD among nurses.

Efficacy and tolerability of low-dose interferon-α in hemodialysis patients with chronic hepatitis C virus infection

AIM:To evaluate the efficacy and tolerability of lowdose standard or pegylated interferon(PEG-IFN)in hepatitis C virus(HCV)-positive hemodialysis patients.METHODS:In total,19 patients were enrolled in this study,of which 12 received PEG-IFNα-2a 67.5μg 1time/wk(Group 1)and 7 received standard interferonα-2b subcutaneously 1.5×106 U 3 times/wk(Group2).The treatment durations were 48 wk for patients infected with HCV genotype 1 and 24 wk for patients infected with HCV genotype 2/3.All patients were prospectively followed after the completion of therapy.The efficacy and tolerability of the treatment were evaluated based on the sustained virological response(SVR)and treatment-related drop-out rate.RESULTS:In Group 1,11 of the 12 patients completed the treatment.Early virological response(EVR)and sustained virological response(SVR)rates were 83.3%and 91.7%,respectively.One patient withdrew from treatment due to an adverse event(leukopenia).The drop-out rate was 8.3%in this group.In Group 2,5 of the 7 patients completed the treatment with an EVR and SVR of 85.7%and 71.4%,respectively.Two patients withdrew due to treatment-related adverse events(nausea and depression).In this group,the drop-out rate was 28.6%.In total,16 of the patients attained EVR,and 15 of them completed the treatment.The SVR rate for the patients who attained EVR was93.7%.Anemia was the most frequent side effect and was observed in 10/19 patients(55.5%),but could be effectively managed with erythropoietin.CONCLUSION:Low-dose interferon monotherapy,either with PEG-IFNα-2a or standard interferonα-2b,is an effective treatment option for hemodialysis patients with chronic hepatitis C.

An Invitation of the Combination of the Geriatric Nutritional Risk Index and the Triglyceride to High-Density Lipoprotein Cholesterol Ratio as a Mortality Predictor in Maintenance Hemodialysis Patients

Background: The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been shown to be a predictor of cardiovascular (CV) outcomes in the general population. Objectives: The aim of this study was to determine whether the combination of GNRI and TG/HDL-C ratio is a predictor of all-cause mortality and CV deaths in maintenance hemodialysis (MHD) patients. Methods: We performed a retrospective, observational cohort study in which we enrolled 341 MHD patients from a single center in Japan who had been followed up for a mean of 48.0 ± 12.7 months. The outcomes were defined as the occurrence of all-cause mortality and CV deaths during the follow-up period. Baseline GNRI and TG/HDL-C ratios were investigated for associations with outcomes by using Cox proportion hazards models adjusted for demographic parameters. Results: Overall, 101 of the subjects had died, of whom 52 died due to CV events during the mean follow-up period of 48.0 ± 12.7 months. The patients were grouped into four categories according to a median GNRI Conclusion: The combination of GNRI and TG/HDL-C ratio is an easily accessible marker for predicting all-cause mortality and CV deaths in MHD patients.

Hepatitis B viral infection in maintenance hemodialysis patients:A three year follow-up

AIM: To observe the prevalence of hepatitis B virus (HBV) infection in maintenance hemodialysis patients. METHODS: Eighty-eight hemodialysis patients who had been receiving hemodialysis regularly for an average of 39.45 ± 7.57 (range from 36 to 49) mo were enrolled in this study. HBV markers were measured in these patients before hemodialysis and in 100 healthy controls by the chemiluminescent microparticle immunoassay (CMI) method in order to compare the incidence of HBV infection in hemodialysis patients versus normal healthy people. All patients were then divided into two groups: patients positive for HBV markers (i.e. those positive for HBsAg, anti-HBc, HBeAg, anti-HBe, with or without positive anti-HBs) (n = 33), and patients negative for HBV markers (including those only positive anti-HBs) (n = 55). The following information was obtained for all patients: socio-demographic data, number of blood transfusions and some laboratory investigations. After 39.45 ± 7.57 mo follow-up, HBV markers were measured in these patients by CMI. RESULTS: The incidence of HBV infection in maintenance hemodialysis patients was 37.5%, which was higher than in controls (9%). In the patients positive for HBV markers, there were 13 patients (39.4%) who had a history of blood transfusion, which was more than the number [12 (21.8%), P = 0.04] of patients negative for HBV markers. Eight of the 88 patients negative for HBV markers turned out to be positive, while three of the 33 patients positive for HBV markers turned out to be negative. There was no cirrhosis of the liver or hepatoma occurring in these patients. CONCLUSION: Maintenance hemodialysis patientshave a higher risk of HBV infection than the average population. The number of blood transfusions is associated with an increased prevalence of HBV. While it is hard for hemodialysis patients to eliminate HBV, the prognosis of patients with positive HBV markers is good.

Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Hemodialysis Patients

Background: Left ventricular hypertrophy (LVH) is a common cardiovascular complication and an independent risk factor for cardiovascular death in hemodialysis (HD) patients. Previous studies have shown that fibroblast growth factor 23 (FGF23), which has an important role in phosphate metabolism, is elevated in HD patients. Objectives: The aim of this study was to determine the association of FGF23 and LVH and the prognostic value of serum FGF23 level in HD patients. One hundred seven HD patients were evaluated for LVH by echocardiography. Serum FGF23 levels were measured using a commercial enzyme-linked immunosorbent assay kit. Results: Patients with LVH were more likely to have higher systolic blood pressure (BP) and LVH was significantly associated with female gender and higher serum levels of phosphate and calcium ×phosphate products. LVH was also associated with higher serum FGF23 level. Multivariate analysis indicated that serum FGF23 level, systolic BP, and serum phosphate level remained correlated with LVH. This suggested that serum FGF23 level is independently associated with LVH in our HD patients. Cox analysis indicated no significant difference in risk of death for patients with elevated serum FGF23 level. Conclusion: LVH has a high prevalence in HD patients, and FGF23 is independently associated with LVH but is not a predictor for prognosis during a 4-year follow-up period.

Iron Indices and Mortality in Maintenance Hemodialysis Patients

Background: The relationship between the iron indices and mortality in maintenance hemodialysis (MHD) patients has remained unclear. We performed a retrospective, observational cohort study to investigate the relationships between serum ferritin levels and mortality in MHD patients. Methods: MHD outpatients (n = 150) were followed up for a median period of 49 months. Their ESA and low-dose iron supplement dosages were adjusted to maintain their hemoglobin (Hb) concentrations in the 10 - 11 g/dl range in accordance with Japanese guidelines. The Kaplan-Meier method, log-rank tests, and Cox proportional hazards models were used to perform the statistical analyses. The patients were divided into 3 groups according to their serum ferritin levels: a serum ferritin 100 ng/ml group. Results: During the median follow-up period of 49 months, there were 55 deaths. The multivariate analysis showed no significant associations between the ferritin level groups and all-cause mortality or cardiovascular (CV) events, and the Kaplan-Meier analysis showed no significant differences among the 3 ferritin level groups in all-cause mortality and CV event rates. However, the multivariate analysis revealed that age, CRP level and a history of previous CV disease were independently associated with all-cause mortality, while diabetes, previous CV disease, and iron administration were independently associated with CV events. Conclusion: The results of this study revealed no significant associations of MHD patients between the ferritin ranges and all-cause mortality or CV events. Thus, the adverse clinical outcomes in these patients were independently associated with other markers and not with their serum ferritin levels.

Kidney transplantation after liver transplantation

Kidney transplantation after liver transplanta tion（KALT） offers longer survival and a better quality of life to liver transplantation recipients who develop chronic renal failure. This article aimed to discuss the efficacy and safety of KALT compared with other treatments. The medical records of 5 patients who had undergone KALT were retrospectively studied, together with a literature review of studies. Three of them developed chronic renal failure after liver transplanta tion because of calcineurin inhibitor（CNI）-induced neph rotoxicity, while the others had lupus nephritis or non-CNI drug-induced nephrotoxicity. No mortality was observed in the 5 patients. Three KALT cases showed good prognoses maintaining a normal serum creatinine level during entire follow-up period. Chronic rejection occurred in the other two patients, and a kidney graft was removed from one of them Our data suggested that KALT is a good alternative to dialysis for liver transplantation recipients. The cases also indicate that KALT can be performed with good long-term survival.

Correlation of Lower Concentrations of Hydrogen Sulfide with Activation of Protein Kinase CIVIl in Uremic Accelerated Atherosclerosis Patients

Background： Hydrogen sulfide （H,S） plays a protective role in chronic hemodialysis （CHD） patients. In this study, we further investigate the relationship between H,S and conventional protein kinase CβII （cPKCβII） in CHD patients with uremic accelerated atherosclerosis （UAAS）. Methods： A total of 30 healthy people, 30 CHD patients without AS and 30 CHD patients with AS （CHD ＋ AS） were studied. Plasma H,S was measured with a sulfide sensitive electrode, and cPKCβ11 membrane translocation was detected by Western blotting. Results： Plasma H2S in CHD ＋ AS group was significantly lower than that in CHD patients, cPKCβII membrane translocation in CHD ＋AS group increased significantly compared with CHD group. Plasma H,S concentration was negatively correlated with cPKCβ11 membrane translocation in CHD ＋ AS patients. Conclusions： These findings suggest a possible linkage between H,S metabolism and cPKCβ11 activation, which may contribute to the development of UAAS in CHD patients.

Application of regional citrate anticoagulation in patients at high risk of bleeding during intermittent hemodialysis:a prospective multicenter randomized controlled trial

Objective:Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding.The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation(RCA)combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis(IHD)treatment.Methods:Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments,and were randomly divided into RCA group and saline flushing group.In the RCA group,0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber.The sodium citrate was stopped after 3 h of dialysis,which was changed to sequential dialysis without anticoagulant.The hazard ratios for coagulation were according to baseline.Results:A total of 159 patients and 208 sessions were enrolled,including RCA group(80 patients,110 sessions)and saline flushing group(79 patients,98 sessions).The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group(3.64%vs.20.41%,P<0.001).The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group((238.34±9.33)min vs.(221.73±34.10)min,P<0.001).The urea clearance index(Kt/V)in the RCA group was similar to that in the saline flushing group with no statistically significant difference(1.12±0.34 vs.1.08±0.34,P=0.41).Conclusions:Compared with saline flushing,the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.

Basic research and clinical progress of sepsis-associated encephalopathy

Sepsis-associated encephalopathy(SAE),a major cerebral complication of sepsis,occurs in 70%of patients admitted to the intensive care unit(ICU).This condition can cause serious impairment of consciousness and is associated with a high mortality rate.Thus far,several experimental screenings and radiological techniques(e.g.,electroencephalography)have been used for the non-invasive assessment of the structure and function of the brain in patients with SAE.Nevertheless,the pathogenesis of SAE is complicated and remains unclear.In the present article,we reviewed the currently available literature on the epidemiology,clinical manifestations,pathology,diagnosis,and management of SAE.However,currently,there is no ideal pharmacological treatment for SAE.Treatment targeting mitochondrial dysfunction may be useful in the management of SAE.

Serum Hepcidin Predicts Uremic Accelerated Atherosclerosis in Chronic Hemodialysis Patients with Diabetic Nephropathy

Background：Hepcidin,as a regulator of body iron stores,has been recently discovered to play a critical role in the pathogenesis of anemia of chronic disease.Atherosclerotic cardiovascular disease is the most common complication and the leading cause of death in chronic hemodialysis （CHD） patients.In the current study,we aimed to explore the relationship between serum hepcidin and uremic accelerated atherosclerosis （UAAS） in CHD patients with diabetic nephropathy （CHD/DN）.Methods：A total of 78 CHD/DN and 86 chronic hemodialyzed nondiabetic patients with chronic glomerulonephritis （CHD/non-DN） were recruited in this study.The level of serum hepcidin-25 was specifically measured by liquid chromatography-tandem mass spectrometry.Serum levels of interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） were measured by enzyme-linked immunosorbent assay.Results：High serum level ofhepcidin-25 was seen in CHD patients.Serum hepcidin-25 in CHD/DN was significantly higher than that in CHD/non-DN patients.Serum hepcidin-25 was positively correlated with ferritin,high-sensitivity C-reactive protein （hs-CRP）,TNF-α,and IL-6 in CHD/DN patients.CHD/DN patients exhibited higher common carotid artery intima media thickness （CCA-IMT）,hs-CRP,and hepcidin-25 levels than that in CHD/non-DN patients.Moreover,in CHD/DN patients,CCA-IMT was positively correlated with serum hepcidin,hs-CRP,and low-density lipoprotein-cholesterol.On multiple regression analysis,serum hepcidin and hs-CRP level exhibited independent association with IMT in CHD/DN patients.Conclusions：These findings suggest possible linkage between iron metabolism and hepcidin modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients.

Sleep disorders and its related risk factors in patients undergoing chronic peritoneal dialysis

Background The prevalence of sleep disorders has been shown to be high in patients with chronic dialysis patients and may contribute to impaired quality of life and higher mortality in this population.However,there are few data on the relationship of sleep disorders and their risk factors in chronic dialysis patients.The aim of this study was to evaluate the relationship of sleep disorders and their risk factors in chronic dialysis patients.Methods A total of 42 continuous ambulatory peritoneal dialysis （CAPD） patients were involved in this cross-sectional study.Sleep quality was assessed by the Pittsburgh Sleep Quality Index （PSQI）.Restless legs syndrome （RLS） was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group.And depression was assessed by Hamilton depression scale.General information and laboratory data were collected.Results The prevalence of sleep disorders was 47.6％ in the CAPD patients.According to the PSQI,the 42 CAPD patients were divided into sleep disturbance group and non-sleep disorders group.There were no significant differences in age,gender,dialysis duration,hemoglobin,serum creatinine,urea nitrogen,β2-microglobulin,parathyroid hormone,calcium,and phosphorus between CAPD patients with sleep disorders and those without sleep disorders.But the level of serum albumin （AIb） in CAPD patients with sleep disorders was significantly lower than that in CAPD patients without sleep disorders （31.3±1.4 vs.34.3±3.7,t=3.603,P=0.001）.And the prevalence of RLS and depression was significantly higher than that in CAPD patients without sleep disorders （RLS：11/22 vs.1/20,x2=10.395,P=0.001; depression：7/22 vs.1/20,x2=4.886,P=0.027）.In CAPD patients with RLS,the prevalence of sleep disorders was significantly higher than that in CAPD patients without RLS （11/22 vs.11/30,x2=10.395,P=0.001）.And in CAPD patients with depression,the prevalence of sleep disorders was significantly higher than that in CAPD patients without depression （7/8 vs.15/34,x2=4.886,P=0.027）.In CAPD patients,bivariate correlation analysis showed that sleep disorders was negatively correlated with serum AIb （r=-0.606,P=0.000） and positively correlated with RLS （r=0.497,P=0.001） and depression （r=0.341,P=0.029）.Multivariate regression analysis revealed that the odds ratio of RLS,depression,and low serum AIb was 22.900,42.209,and 0.597,respectively.Conclusions The prevalence of sleep disorders was relatively high in CAPD patients.RLS,depression,and low serum AIb were the risk factors for CAPD patients with sleep disorders.

Transitional cell carcinoma associated with aristolochic acid nephropathy： most common cancer in chronic hemodialysis patients in China

Background The research of cancer in patients on hemodialysis （HD） in China has not been reported. The aim of this study was to investigate the clinical and histological features and outcomes of cancer in Chinese HD patients. Methods The study subjects were 49 cancer patients （1.4%） out of 3448 end stage renal disease （ESRD） patients maintained on HD at China-Japan Friendship Hospital from October 1997 to July 2011. Results Urinary tract cancer （74%） was the most common followed by gastrointestinal tract cancer （12%）, breast cancer （6%）, lung cancer （4%）, thyroid cancer （2%）, and hematologic cancer （2%）. Thirty-three patients （67%） had urinary tract transitional cell carcinoma （TCC） and 29 of them had aristolochic acid nephropathy （AAN） as underlying disease. Death occurred in eight patients out of 49, and the survival rate of HD patients with cancer was similar to those without cancer （P=0.120）. Conclusion The urinary tract TCC is the most common cancer in HD patients with AAN in one of the centers of northern China.

Water and sodium restriction on cardiovascular disease in young chronic hemodialysis patients

Background Left ventricular hypertrophy （LVH） is an independent predictor of morbidity and mortality in chronic hemodialysis （CHD） patients. It remains unclear whether efforts to correct fluid overload in young CHD can reverse LVH. This prospective single-center cohort study evaluated left ventricular masses index （LVMI） evolution in fluid overloaded young CHD patients with or without water-sodium control. Methods A total of 106 young patients aged between 22 and 44 years on CHD were enrolled in this prospective, control study. Patients were divided into three groups according to the percentage of interdialytic weight gain （PIDWG （%） = 100% x （predialysis weight - dry weight）/dry weight） at baseline. Thirty-six patients with PIDWG more than 5% received health education to restrict water-sodium intake strictly （Group I）. Other 36 patients with comparable fluid status levels （the PIDWG more than 5%） did not receive health education to restrict water-sodium intake strictly （Group Ⅱ） and those with PIDWG less than 5% （Group Ⅲ, n=34） were sewed as controls. Echocardiographic studies were performed to evaluate LVMI at baseline and then after 1, 3 and 6 months. The total follow-up time was 6 months. Results There was no significant difference in clinical data （such as age, gender, aetiology of renal failure and nutritional state, etc.） among the three groups at baseline. At baseline, the prevalence of LVH in Group I, Ⅱ and Ⅲ was 75.0%, 72.2% and 55.9%, respectively. LVMI was directly correlated with PIDWG （r = 0.779, P 〈0.01）. After 6 months, the PIDWG in Group I decreased in mean by （3.77±1.09）%, and LVMI decreased in mean by （27.59±12.15） g/m2. The prevalence of LVH decreased in mean by 25.0%, and the blood pressure decreased in mean by （14.69±11.50） mmHg/ （7.14±7.51） mmHg. The medication category and total medication frequency of hypotensive drugs significantly decreased in Group I at 6 months. However the urine volume and the levels of serum creatinine and serum albumin in Group I were not significantly different compared to the baseline. The level of LVMI in Group Ⅱ was significantly increased after 6 months compared with the baseline. After 6 months, the level of LVMI in Group Ⅲ were not significantly different compared with the baseline. Conclusions A high prevalence of LVH was present in young CHD patients, and was associated with fluid overload. Reduction fuild overload with water-sodium control can reverse LVH in young CHD patients.