Effect of age on markers of bone metabolism in renal hemodialysis patients

Bone metabolic markers were investigated in the male hemodialysis patients within and over 60 years old and the female hemodialysis patients within and over 50 years old. Our results indicated that bone metabolic markers were more increased in the lower values of serum estradiol in the male patients, but inversely were more enhanced in higher values of serum estradiol in the female patients.     

Markers of bone pain in hemodialysis patients with renal insufficiency

The patients receiving maintenance hemodialysis were divided into two groups in the absence and the presence of bone pain and investigated the markers of bone pain in these patients. These results suggested that the duration of receiving hemodialysis, serum concentrations of alkaline phosphatase, osteocalcin and parathyroid hormone became to be the markers of bone pain.     

Polymorphisms in two genes, IL-1B and ACE, are associated with erythropoietin resistance in Korean patients on maintenance hemodialysis

Genetic polymorphisms may be linked to inter-individual differences in erythropoietin (EPO) resistance. We investigated the -511C/T polymorphism of the IL-1B gene and the I/D polymorphism of the ACE gene for any association with EPO resistance index (ERI) in maintenance hemodialysis patients (n=167). Because EPO responsiveness is multi-factorial, we also included other possible influences (age, sex, time on dialysis, ACE inhibitor or angiotensin receptor blocker use, ferritin, transferrin saturation, intact PTH, high sensitivity C-reactive protein, albumin, Kt/V, and presence of diabetes mellitus) on ERI in our analyses. Multiple regression analysis showed significant association of the IL-1B-511CC and ACE DD polymorphisms with ERI (P=0.038 and P=0.004 in the recessive model, respectively). The combination (C) of alleles of two loci showed that C1 (I-T) was significantly associated with ERI in the co-dominant and recessive models (P=0.005 and P=0.0001, respectively). Subjects who did not carry C1 showed significantly decreased ERI (10.10+/-5.15 IU/kg weight/g hemoglobin) compared to other study subjects (C1/C1 and C1/-; 12.97+/-4.90 and 15.12+/-7.43 IU/kg weight/g hemoglobin, respectively). Our study indicates that the IL-1B-511C/T and ACE I/D polymorphisms may be useful genetic markers of EPO requirement in hemodialysis patients. These findings might also provide a new perspective on therapeutic approaches to the treatment of end stage renal disease patients with anemia.     

Parathyroid hormone and bone mineral content in male and female patients receiving hemodialysis

Relative bone mineral content in the lumbar spine was measured by phantom B-MAs with the apparatus of computerized tomography in order to study the relationships between bone mineral content with age and parathyroid hormone in sera of randomized out- and in-patients and the hemodialysis patients. There exists a significant difference between male and female in the loss of bone mineral content of three groups.     

In vivo monitoring of skeletal aluminum burden in patients with renal failure

In vivo neutron activation analysis was used to examine the total body and partial body (hand) aluminum levels in patients with end-stage renal failure. Patients maintained on chronic hemodialysis had higher mean body burdens of aluminum than, did those clinically managed without dialysis. Approximately 70% of the patients examined indicated elevated levels of body or skeletal aluminum. A significant correlation was observed between the in vivo aluminum/calcium ratio obtained for the hand measurement and the increase in serum aluminum levels following a disferroxamine infusion test. The direct in vivo monitoring of hand Al/Ca values in patients may provide an alternate choice to bone biopsy for the detection of aluminum intoxication.     

Past,Present, and Future of Artificial Kidney Treatment

The past has seen the evolution of hemodialysis from a very complex operation to a systematized approach which allows the procedure to be instituted by minimally trained individuals. The first big advance in the application of hemodialysis to the problem of chronic renal insufficiency came in 1960 when a permanently implanted arteriovenous plastic fistulae was established. Improvements in dialyzer design and the logistics of hemodialysis since then have resulted in expansion of hemodialysis facilities. There is still a deficit between facilities available and suitable patients in need of therapy. Closure of this gap will depend upon a cheap, small, disposable dialyzer which most patients can operate themselves. In addition, an improvement in kidney transplantation results will remove many patients from the pool of those needing hemodialysis. It is likely that other medical applications of hemodialysis will be discovered in the future.     

血液透析联合血液灌流治疗急性肾功能衰竭的临床效果分析

目的分析急性肾功能衰竭采取血液透析联合血液灌流治疗的临床效果。方法选取2010年1月—2015年1月期间惠州市中医医院收治的24例急性肾功能衰竭患者作为研究对象,按治疗方法的不同将本组患者分为两组,对照组12例患者接受单纯血液透析治疗,观察组12例患者接受血液透析联合血液灌流治疗,治疗2个月后,对两组患者的临床指标及临床效果进行统计对比。结果观察组治疗后CRP、Cr、BUN、MMS指标优于对照组,差异有统计学意义(P0.05);观察组治疗有效率为91.67%(11/12),高于对照组75.00%(9/12),差异有统计学意义(P0.05)。结论对急性肾功能衰竭患者的治疗,采取血液透析联合血液灌流治疗的临床效果显著,促进患者康复,在临床中具有良好的应用价值。     

Effect of gender, season, and vitamin D status on bone biochemical markers in Saudi diabetes patients

Biochemical bone turnover markers (BTMs) provide important information on the diagnosis, therapy and monitoring of metabolic bone diseases. They are evident before measurable changes in bone mineral density (BMD) take place. A total of 35 adult Saudi patients (23 males; 12 females) with type 2 diabetes and diagnosed to be vitamin D deficient were recruited in this prospective study. Here we investigated the effects of gender, season, and vitamin D status on bone biochemical markers of bone remodeling. Anthropometry and blood samples were collected at different intervals. Metabolic parameters and bone biomarkers were measured routinely and by ELISA. Both males and females had a significant increase in their vitamin D status over time, but no significant changes in the bone biomarkers were observed in females. In males there was a significant increase in circulating levels of corrected calcium and OPN (p = 0.004 and 0.01 respectively) and a significant decrease in crosslaps (p = 0.005). In all subjects there was a modest but significant positive relationship between vitamin D status and OC (R = 0.34; p = 0.04). In conclusion, our study demonstrates that changes in bone remodeling markers are affected by season, gender, and possibly vitamin D status. This gender difference may well reflect the physiologic pathway responsible for the higher peak bone mass achieved in males compared to females.     

The measurement of parathyroid hormone in sera of hemodialysis patients with renal insufficiency by employing the various kinds of parathyroid hormone kits

This study focussed on elucidating difference of blood PTH levels, by employing the various kinds of PTH kits. We carried out the measurements of PTH levels in sera of the hemodialysis patients with renal insufficiency presumably inactivated PTH degradative regulation in kidney. Our results showed the remarkable significant relationships among blood PTH levels of carboxyl and mid-region PTH and intact PTH in hemodialysis patients and was deduced that the difference of PTH levels by using various kinds of PTH kits was responsible of PTH cleavage effect in the kidney.     

Plasma fingerprinting with GC-MS in acute coronary syndrome

New biomarkers of cardiovascular disease are needed to augment the information obtained from traditional indicators and to illuminate disease mechanisms. One of the approaches used in metabolomics/metabonomics for that purpose is metabolic fingerprinting aiming to profile large numbers of chemically diverse metabolites in an essentially nonselective way. In this study, gas chromatography-mass spectrometry was employed to evaluate the major metabolic changes in low molecular weight plasma metabolites of patients with acute coronary syndrome (n = 9) and with stable atherosclerosis (n = 10) vs healthy subjects without significant differences in age and sex (n = 10). Reproducible differences between cases and controls were obtained with pattern recognition techniques, and metabolites accounting for higher weight in the classification have been identified through their mass spectra. On this basis, it seems inherently plausible that even a simple metabolite profile might be able to offer improved clinical diagnosis and prognosis, but in addition, specific markers are being identified.     

Measurement of 24-hr whole-body retention of 99mTc-MDP with a thyroid uptake probe (author's transl)

A new method for measurement of 24-hr whole-body retention (WBR) of 99mTc-MDP, using a thyroid uptake probe was established and its clinical significance was evaluated in various bone diseases. (1) Reproducibility of 24-hr WBR in 9 patients was very good. Correlation coefficient was 0.997 and coefficient of variability was only 1.83%. (2) Radiochemical purity of 99mTc-MDP was 97.8 +/- 0.7% (n = 5), indicating no significant inter-lot variations. (3) 24-hr WBR of normal adult males (n = 5) was 30.0 +/- 4.9%, which was significantly elevated compared to the reported 99mTc-HEDP WBR of 19.2 +/- 1.7%. Whole-body retentions of chronic renal failure, metastatic bone disease and hyperthyroidism groups were significantly elevated compared to that of the normal group. However, WBR of steroid-induced osteoporotic group was significantly decreased. Based on these results, this thyroid uptake probe method was simple, reproducible and accurate to measure 24-hr WBR of 99mTc-MDP. Quantification of WBR of 99mTc-MDP was of great clinical value to diagnose metabolic bone disease and to follow-up metabolic and metastatic bone diseases.     

Analysis of small biopsy samples by neutron activation analysis

An accurate knowledge of the ratio Ca/P in bone biopsies is very useful in the diagnosis of osteoporosis. Similarly, measurements on muscle biopsies are important in understanding the disturbance of intracellular fluid and electrolyte (Na, Cl, K and P) balance in patients with metabolic myopathies (muscle diseases) and acid-base disturbances including renal failure. The ratio Ca/P in normal subjects was found to be 2.30. Similarly, the ratio K/P was found to be very nearly constant in normal subjects.     

Trace element concentrations in human bone using instrumental neutron activation analysis

Instrumental neutron activation analysis has been applied to analyze 23 bone samples obtained from Libyan patient aged (3–80) years for the study of the concentration levels of trace elements Ba, Br, Ca, Fe, Sr and Zn and their concentration pattems regarding to the age and sex of the patients.     

Comparative study for aluminum determination in bone by atomic absorption techniques and inductively coupled plasma atomic emission spectroscopy

A comparative investigation was carried out on the suitability of atomic absorption spectrometry and inductively coupled plasma atomic emission spectroscopy for aluminum determination in bone. Both techniques give reliable results but the nitrous oxide-acetylene flame method was not found to be sensitive enough to accurately measure low aluminum content. A suitable method for sample treatment is also described. Quantitation of aluminum in bone from patients on regular hemodialysis is also done.     

血透患者微量元素营养状况初步探讨

对门诊维持性血透肾衰患者进行了膳食营养调查。结果表明：（1）在临床检查中发现,血透肾衰患者面黄肌瘦,面色苍白,浮肿,疲劳;体质虚弱,四肢无力;精神不振,具有明显的营养不良的临床表现。（2）在膳食调查中发现,每人每日营养素摄入量为蛋白质41．54mg,热量5288kJ,钙104mg、铁4．86mg和锌8．86mg、硒35μg、铜2．28mg、锰2．86mg、镁76．50mg、磷448mg、钾752mg和钠1385．4mg;视黄醇当量368μg、vitarmin B10.58mg、vitamin B20.39mg、vitarnin C51mg、vitaminPP12.60mg和vitaminE0.38mg。提示血透肾衰患者蛋白质－热量营养不良,K、Na过量,而Ca、Mg、P等宏量元素和Zn、Cu、Fe、Mn、Se等微量元素和RE、vitamin B1、vitamin B2、vitamin C均未达到RDA要求。原因是主食营养不平衡。因此,建议对血透肾衰患者进食主食营养平衡米（NBR）和制订平衡食谱,开展透析日营养治疗和病人家庭营养治疗。改善血透肾衰患者微量元素营养状况。     

中国营养平衡米膳治疗肾衰病人的Zn、Cu、Fe、Mn、Se平衡论证

采用营养调查方法 ,对门诊 30例血透肾衰患者进行了调查 ,并对其进食中国营养平衡米膳改善Zn、Cu、Fe、Mn、Se不平衡进行了论证。结果表明 ,临床表现为面黄肌瘦 ,苍白 ,浮肿 ,疲劳 ,消瘦 ,虚弱 ,无力 ,食欲不振 ,恶心呕吐 ,头晕 ,皮肤瘙痒 ,肌肉震颤 ,手足麻木 ,无精神等明显的营养不良 ,平均体重 5 3 5kg ,皮脂厚度 1 1 2cm ,检验为血清总蛋白 67 31mg dL ,白蛋白 37 4 9mg dL ,RBC 2 4 1× 1 0 12 /L ;氮质血症 (x) :BUN 31mmol l,Cr 1 0 0 2 6μmol L。膳食中平均每人每日微量元素摄入量为 :Fe 1 7 99mg ,Zn 1 0 35mg ,Se 5 9 2 2 μg,Cu 1 71mg ,Mn3 95mg ,以肾衰患者RDA标准评价 ,Zn、Cu未达到RDA ,Fe ,偏高 ,Mn、Se达标。证明血透肾衰患者微量元素营养不平衡。RDA标准评价分别为 1 5 0 %、 69%、 1 1 8%、 86%、 1 5 8%。若改食中国营养平衡米膳 ,Fe、Zn、Se、Cu、Mn摄入量分别为 1 9 74mg、 2 4 64mg、 1 78mg、4 0 9mg ,达标率分别为 1 65 %、 1 64%、 1 5 7%、 89%、 1 64% ,则全部达标率近 90 %以上 ,且比原来膳食中元素平衡 ,证明营养平衡米膳的Fe、Zn、Se、Cu、Mn均与RDA标准模式平衡。因此 ,建议血透肾衰患者进食中国营养平衡米膳 ,可望改善其微量元素营养不平衡状况 ,提高生存质     

Microvascularity,blood flow and tissue structure at the subchondral plate using an X-ray fluorescence technique

The measurement of blood flow and blood in bone and cartilaginous tissues is crucial to understanding of the development of various diseases, but it presents a formidable technical challenge. We have therefore developed a method based on the detection of metallized microspheres using X-ray fluorescence. This approach provides unrivalled sensitivity and spatial resolution and also allows us simultaneously to measure other markers of the metabolic status of the tissue.     

基于拟靶向液相色谱-质谱联用的胃癌患者血清代谢组分析

胃癌是一种高发的恶性肿瘤,是癌症相关死亡的第二大病因。早期筛查是提高患者生存率的有效手段,但目前临床上尚缺乏实现胃癌无创筛检的可靠标志物。本研究采用了基于液相色谱-质谱联用的拟靶向代谢组学方法分析了20例胃癌患者及40例正常人血清代谢组,以期发现新的潜在代谢标志物。代谢组数据的主成分分析和偏最小二乘法数据分析结果显示,胃癌患者与健康人群的血清代谢组存在明显的差异,结合非参数检验进一步筛选并定性出57个差异代谢物。其中二氢胆固醇经验证组样本验证,具有成为胃癌代谢标志物的潜力。本研究在发现胃癌的潜在代谢标志物的同时,也为胃癌患者代谢分型提供了重要的科学依据。     

Significance of renal high uptake in bone marrow scintigraphy with 111In-chloride

The significance of high renal uptake found in patients with hematological disease who underwent bone marrow scintigraphy with 111In-chloride was investigated. In patients with a high renal uptake, the uptake in bone marrow was low, suggesting a reflection of erythropoietic activity. The reversal relationship, however, was not necessarily present. With regard to correlation with iron metabolism, significantly higher uptake of serum Fe and lower UIBC were found among those with high renal uptake, suggesting that the level of free trans ferrin in the serum is largely involved in the high uptake in the kidney.     

Determination of creatinine-related molecules in saliva by reversed-phase liquid chromatography with tandem mass spectrometry and the evaluation of hemodialysis in chronic kidney disease patients

The serum concentrations of creatinine (Cre) and urea are used for the determination of the renal function. However, the use of blood is not always suitable due to the invasive, hygienic and infection problems during its sample collection and handling. In contrast, saliva is relatively clean and the samples can be quickly and noninvasively collected and easily stored. Therefore, the simultaneous determination of Arginine (Arg), creatine (Cr) and Cre in the saliva of chronic kidney disease (CKD) patients was performed by UPLC-ESI-MS/MS together with the saliva of healthy volunteers. The evaluation of hemodialysis of CKD patients was also carried out by the determinations before and after the dialysis. An HS-F5 column was used for the simultaneous determination of Arg, Cr and Cre in the saliva. These molecules were rapidly separated within 4 min and sensitively determined by the multiple reaction monitoring (MRM) of the precursor ion [M+H]⁺ → product ions (m/z 175.1 → 70.1 for Arg; m/z 132.0 → 44.1 for Cr; m/z 114.0 → 44.1 for Cre). The concentration of Cre in the CKD patients was higher than that in the healthy persons. The concentrations of Cre in the saliva of the patients before hemodialysis were moderately correlated with the serum Cre concentrations (R² = 0.661). Furthermore, the concentration in the saliva obviously decreased after hemodialysis (before 0.73 mg/dL, after 0.25 mg/dL; p < 0.02). Thus, the proposed detection method using saliva by UPLC-MS/MS is useful for the evaluation of the renal function in CKD patients. The present method offers a new option for monitoring the hemodialysis of CKD patients.