A Study on the Correlations of Anxiety and Depression With Self-Management Ability and Endogenous Creatinine Clearance Rate in Renal Transplant Recipients

Objective: To explore the effects of anxiety and depression on the self-management ability and endogenous creatinine clearance rate of renal transplant patients.Method: Eighty-eight renal transplant recipients who were followed up in the outpatient clinic of the Affiliated Hospital of Zunyi Medical University were selected using convenient sampling. The self-made general data sheet, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Self-Management Scale for Kidney Transplant Recipients were used. Correlation analysis was used to find factors related to endogenous creatinine clearance, while multiple linear regression was used to identify factors influencing endogenous creatinine clearance. Patients with or without anxiety and depression were divided into groups, and the indexes of the groups were compared using the independent samples t test, rank-sum test, or chi-squared test.Results: Anxiety was present in 12.5% of patients, depression in 25%, and a moderate level of self-management in 34.1%. Only 9.1% of renal transplant recipients had endogenous creatinine clearance within the normal range, and 34.1% had a body mass index not in the normal range (25% were overweight, and 9.1% were underweight). The endogenous creatinine clearance rate was negatively correlated with age and degree of depression, and positively correlated with body mass index, treatment management score, and psychosocial management score. The main influencing factors of endogenous creatinine clearance rate were age, sex, depression, body mass index, and treatment management score. The endogenous creatinine clearance rate and psychosocial management ability were significantly higher in patients without anxiety and depression than in patients with anxiety and depression (all P < 0.05).Conclusions: Anxiety and depression showed significant negative effects on the psychosocial self-management ability and endogenous creatinine clearance rate of renal transplant recipients and thus should be given more attention.

Polyporus Umbellatus Protects Against Renal Fibrosis by Regulating Intrarenal Fatty Acyl Metabolites

Background: Chronic renal failure (CRF) results in significant dyslipidemia and profound changes in lipid metabolism. Polyporus umbellatus (PPU) has been shown to prevent kidney injury and subsequent kidney fibrosis.Methods: Lipidomic analysis was performed to explore the intrarenal profile of lipid metabolites and further investigate the effect of PPU and its main bioactive component, ergone, on disorders of lipid metabolism in rats induced by adenine. Univariate and multivariate statistical analyses were performed for choosing intrarenal differential lipid species in CRF rats and the intervening effect of n-hexane extract of PPU and ergone on CRF rats.Results: Compared with control group, decreased creatinine clearance rate indicated declining kidney function in CRF group. Based on the lipidomics, we identified 65 lipid species that showed significant differences between CRF and control groups. The levels of 12 lipid species, especially fatty acyl lipids including docosahexaenoic acid, docosapentaenoic acid (22n-3), 10,11-Dihydro-12R-hydroxy-leukotriene C4, 3-hydroxydodecanoyl carnitine, eicosapentaenoic acid, hypogeic acid and 3-hydroxypentadecanoic acid had a strong linear correlation with creatinine clearance rate, which indicated these lipid species were associated with impaired renal function. In addition, receiver operating characteristics analysis showed that 12 lipid species had high area under the curve values with high sensitivity and specificity for differentiating CRF group from control group. These changes are related to the perturbation of fatty acyl metabolism. Treatment with PPU and ergone improved the impaired kidney function and mitigated renal fibrosis. Both chemometrics and cluster analyses showed that rats treated by PPU and ergone could be separated from CRF rats by using 12 lipid species. Intriguingly, PPU treatment could restore the levels of 12 lipid species, while treatment with ergone could only reverse the changes of six fatty acids in CRF rats.Conclusion: Altered intrarenal fatty acyl metabolites were implicated in pathogenesis of renal fibrosis. PPU and ergone administration alleviated renal fibrosis and partially improved fatty acyl metabolism. These findings suggest that PPU exerted its renoprotective effect by regulating fatty acyl metabolism as a potential biochemical mechanism. Therefore, these findings indicated that fatty acyl metabolism played an important role in renal fibrosis and could be considered as an effective therapeutic avenue against renal fibrosis.

Off-pump versus on-pump coronary artery bypass grafting in patient of impaired renal function

The purpose of this study was to compare the renal function in patients undergoing coronary artery bypass grafting in off-pump and on-pump having pre-operative impaired renal function. In the on-pump, the serum creatinine and urea levels were significantly increased on post-operative day 1, 3 and 7. On day 1, it was maximum, then gradually decreased but not reached to pre-operative level. In case of off-pump, serum creatinine and urea levels were significantly increased on post-operative day 1 and 3. On day 1, it was maximum. Then decreased and the serum creatinine reached below pre-operative level on day 7. In case of on-pump, the creatinine clearance rate was significantly decreased on post-operative day 1, 3 and 7. On day 1, it was minimum. Then gradually increased but not reached the pre-operative level. In case off-pump, the creatinine clearance rate was significantly decreased on day 1 and 3. On day 1, it was minimum, then gradually increased and reached above the pre-operative level. A significant low level creatinine clearance rate was observed in on-pump group. Renal function was better preserved in patients undergoing off-pump in comparison to on-pump coronary artery bypass grafting.

Clearance of Magnesium in Peritoneal Dialysis Patients: A Single-Center Study

Objective: This retrospective study aimed to investigate the clearance of magnesium (Mg) in peritoneal dialysis (PD) patients and its influencing factors. Methods: The demographic information, clinical characteristics and laboratory data of the patients were collected. According to the corrected serum Mg (cS-Mg) concentration, patients were divided into 3 groups including hypomagnesemia (Mg2+ < 0.77 mmol/L, group A), normal serum Mg concentration (0.77 mmol/L ≤ Mg2+ ≤1.03 mmol/L, group B), and hypermagnesemia (Mg2+ > 1.03 mmo/L, group C). Results: One hundred and fifteen patients were enrolled, and their mean 24 h-peritoneal Mg clearance was 39.75 ± 17.42 mg. The mean normalized peritoneal Mg clearance rate was 1.82 ± 0.82 L/day/1.73 m2. Twenty-four-hour peritoneal Mg clearance of group A was significantly lower than that of group C (p < 0.05). Bivariate correlation analysis showed that cS-Mg was positively correlated with peritoneal dialysate Mg concentration (p < 0.01). cS-Mg was negatively correlated with the normalized peritoneal Mg clearance rate (p < 0.05). The normalized peritoneal Mg clearance rate was positively correlated with prealbumin (p < 0.05), daily peritoneal protein loss (p < 0.01) and the normalized PD-creatinine clearance rate (p < 0.01). The normalized peritoneal Mg clearance rate was also negatively correlated with the normalized renal-creatinine clearance rate (p < 0.01). Furthermore, cS-Mg of patients with continuous ambulatory PD (CAPD) was significantly lower than that of patients with daytime ambulatory PD (DAPD, p < 0.01). The normalized peritoneal Mg clearance rate of patients with CAPD was significantly higher than that of patients with DAPD (p < 0.01). Moreover, among the patients with different peritoneal transport characteristics of peritoneal equilibration test, the normalized peritoneal Mg clearance rate of high average transport patients was significantly higher than that in those with low transport, low average transport and high transport (p < 0.05). Conclusions: Serum Mg could be partly cleared by PD. The peritoneal Mg clearance was positively related with serum Mg concentration, which was concentration-dependent. Peritoneal Mg clearance was negatively correlated with the residual renal function, while being positively correlated with the nutritional status and daily peritoneal protein loss. Peritoneal Mg clearance was higher in patients with high transport characteristics or CAPD.

Enoxaparin 20 mg for thromboprophylaxis in severe renal impairment

Objective This study was performed to evaluate the efficacy of daily subcutaneous enoxaparin 20 mg in patients with renal failure. Methods This retrospective cohort study included nonsurgical patients aged ≥18 years with a creatinine clearance rate of <30 mL/minute who were prescribed enoxaparin 20 mg subcutaneously (SC) daily for ≥3 days. The main outcome measures were the occurrence of a venous thromboembolic event (VTE) and bleeding events. Results One hundred sixty patients were identified. VTE occurred in 9 patients (5.6%), and bleeding events occurred in 37 (23.1%). Multivariable analysis showed that an age of >75 years was significantly associated with an increased risk of bleeding, while a creatinine clearance rate of 15 to 29 mL/minute was significantly associated with a lower risk of bleeding. Conclusion In patients with renal failure, enoxaparin 20 mg SC daily resulted in a 5.6% incidence of VTE, which is similar to the previously published acceptable incidence of VTE in patients with normal renal function receiving enoxaparin 40 mg SC daily. The incidence of major bleeding events was 10%, which is lower than that previously published in the literature.

In-hospital prognostic value of on admission creatinine clearance in patients with acute coronary syndrome

Objective: To find out association between creatinine clearance rate (CCR) and in-hospital outcome of acute coronary syndrome (ACS).Methodology: This prospective observational study was carried on 100 patients with acute coronary syndrome, in Coronary Care Unit (CCU) of BIRDEM General Hospital, Shahbag, Dhaka, over a period of six months from July 1, 2012 to December 31, 2012.Results: Subjects were divided into three groups (A:CCR>60,B :CCR-30-60and C:CCR<30) depending on their CCR (ml/min). Mean creatinine clearance rate was 56.15 (±29.57) ml/min and mean serum creatinine level was 3.68 (±2.59) mg/dl. Among 20 patients of Group A subjects 15(75%) were discharged in a stable condition. 2(10%) and 3(15%) patients developed isolated left ventricular failure (LVF) and isolated hypotension respectively. No patient died in this group and none of them developed any bleeding episode (epistaxis,melaena,haematemesis, haematochezia or per vaginal bleeding etc), sepsis or multi-organ dysfunction syndrome (MODS). Among 35 patients of Group B subjects 8(22.8%) were discharged in a stable condition. 9(25.7%) and 6(17.1%) patients developed isolated LVF and isolated hypotension respectively. 2(5.7%) patients died in this group and 7(20%), 2(5.7%),1(2.8%) patients developed bleeding episode, sepsis and MODS respectively. Among 45 patients of Group C subjects 3(6.6%) were discharged in a stable condition. 12(26.7%) and 8(17.7%) patients developed only LVF and only hypotension respectively . 4(8.8%) patients died in this group during their hospital stay and 11(24.4%), 3(6.6%) and 4(8.8%) patients developed bleeding episode, sepsis and MODS respectively. ANOVA test suggested that decreased creatinine clearance rate was significantly related to poor clinical outcome(P<0.05).Conclusion: This study showed that decreased creatinine clearance is directly related to poor outcome of acute coronary syndrome. So subjects with ACS should be closely monitored for decreased creatinine clearance rate to avoid life threatening complications. And subjects with renal impairment suffering from ACS should be closely observed as patients with decreased CCR has poor clinical outcome.Bangladesh Crit Care J March 2015; 3 (1): 3-6