American Journal of Nephrology

<b><i>Background:</i></b> Inadequate dialysis, renal hypertension, and impaired exercise capacity are factors that affect the quality of life (QoL) and mortality of adults with end-stage renal disease (ESRD) undergoing hemodialysis (HD). This systematic review provided valid evidence about the effect of exercise training on single-pool Kt/V (sp Kt/V), blood pressure, and peak uptake oxygen (VO₂ peak). <b><i>Method:</i></b> A systematic review and meta-analysis of published randomized controlled trials (RCTs) that evaluated the effects of no &#x3c;8 weeks’ exercise training on the physical fitness outcomes for adults with ESRD undergoing HD were accepted in this study. <b><i>Results:</i></b> Included 20 trials (677 participants) indicated that various exercise types improved aerobic capacity, walking capacity, and health-related QoL totally. Of note, aerobic exercise and combined exercise were the predominant exercise types. <b><i>Conclusion:</i></b> Based on our evidence, aerobic exercise or combined exercise at least for 8 weeks to 12 months, 3 times weekly, will be beneficial to physical conditions of the patients with ESRD undergoing HD. The clinical staff can treat patients with the evidence above. Future studies need to provide more information basis for the construction of patient exercise system by adding various exercise combinations.

<b><i>Background:</i></b> Obesity is an independent risk factor for morbidity and mortality in cardiovascular diseases not only in the general population, but also in hemodialysis (HD) patients. We previously reported that an increased visceral fat area (VFA) determined using computed tomography (CT) scans was associated with atherosclerosis in HD patients. However, whether a high VFA is associated with increased cardiovascular mortality in HD patients remains unknown. Therefore, we investigated the relationship between VFA and prognosis in HD patients. <b><i>Methods:</i></b> VFA was estimated in 126 patients on maintenance HD using CT scans. These patients were followed for 60 months. <b><i>Results:</i></b> Kaplan-Meier analysis revealed that the cardiovascular survival rate was significantly lower in the high-VFA group, with a VFA of 71.5 cm² or greater, than in the low-VFA group, with a VFA of less than 71.5cm². In univariate Cox proportional hazards analyses, age, albumin, low-density lipoprotein cholesterol, cardio-thoracic ratio and VFA above 71.5 cm² were significantly correlated with cardiovascular deaths. In multivariate analyses testing these factors as dependent variables, VFA above 71.5 cm² was estimated to be an independent predictor of cardiovascular deaths. <b><i>Conclusion:</i></b> These results suggest that an increased VFA is a stronger risk factor for cardiovascular deaths in HD patients. Measuring VFA may be recommended for predicting the risk of cardiovascular diseases in HD patients.

<i>Background/Aims:</i> This study focuses on the chemopreventive effect of five drugs on renal interstitial fibrosis induced by an aristolochic acid-containing Chinese herb Mu-Tong. <i>Methods:</i> Renal interstitial fibrosis was induced in rats by administration of the Mu-Tong solution intragastrically for 6 weeks, and 36 rats were randomly divided into six groups: (1) Mu-Tong, (2) Mu-Tong + captopril, (3) Mu-Tong + losartan, (4) Mu-Tong + simvastatin, (5) Mu-Tong + spironolactone, and (6) Mu-Tong + diammonium glycyrrhizinate. Blood biochemistry and extracellular matrix were detected at weeks 0, 2, 4, and 6. At the end of week 6, kidney tissue of all groups was evaluated with special Masson staining for the degree of renal fibrosis as well as regular histopathology. <i>Results:</i> Mu-Tong caused progressive elevation of blood urea nitrogen, creatinine, hyaluronic acid, procollagen type III, and laminin. All five drugs suppressed elevation of blood biochemistry and extracellular matrix to some degree, but only the simvastatin group showed a significantly reduced percentage of positive Masson staining area in renal section compared to the Mu-Tong group (p < 0.05). <i>Conclusions:</i> Our study indicates that Mu-Tong induces a similar kidney injury with general characteristics in patients with renal interstitial fibrosis. All five different drugs have suppressive effects on Mu-Tong-induced renal function damage, and in particular, simvastatin shows a protective effect on development of Mu-Tong-induced renal interstitial fibrosis to a certain degree.

<i>Background/Aims:</i> Hyperoxaluria is a major risk factor for recurrent urolithiasis and nephrocalcinosis. We tested an oral therapy with a crystalline, cross-linked formulation of oxalate-decarboxylase (OxDc-CLEC®) on the reduction of urinary oxalate and decrease in the severity of kidney injury in two models: AGT1 knockout mice (AGT1KO) in which hyperoxaluria is the result of an <i>Agxt</i> gene deficiency, and in AGT1KO mice challenged with ethylene glycol (EG). <i>Methods:</i> Four different doses of OxDc-CLEC mixed with the food, or placebo were given to AGT1KO mice (200 mg/day, n = 7) for 16 days and to EG-AGT1KO mice (5, 25, and 80 mg, n = 11) for 32 days. <i>Results:</i> Oral therapy with 200 mg OxDc-CLEC reduced both urinary (44%) and fecal oxalate (72%) in AGT1KO mice when compared to controls. Similarly, in EG-AGT1KO mice, each of the three doses of OxDc-CLEC produced a 30–50% reduction in hyperoxaluria. A sustained urinary oxalate reduction of 40% or more in the 80 mg group led to 100% animal survival and complete prevention of nephrocalcinosis and urolithiasis. <i>Conclusion:</i> These data suggest that oral therapy with OxDc-CLEC may reduce hyperoxaluria, prevent calcium oxalate nephrocalcinosis and urolithiasis, and can represent a realistic option for the treatment of human hyperoxaluria, independent of cause.