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Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the German Chronic Kidney Disease(GCKD)cohort

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Bone Research 2023年第4期11卷 764-771页

作者： Katharina Charlotte Reimer Jennifer Nadal Heike Meiselbach Matthias Schmid Ulla T.Schultheiss Fruzsina Kotsis Helena Stockmann Nele Friedrich Matthias Nauck Vera Krane kai-uwe eckardt Markus P.Schneider Rafael Kramann Jürgen Floege Turgay Saritas Department of Nephrology Rheumatologyand Clinical ImmunologyUniversity Hospital RWTH AachenAachenGermany Institute of Experimental Medicine and Systems Biology RWTH Aachen UniversityAachenGermany Institute for Cell and Tumor Biology RWTH Aachen UniversityAachenGermany Institute of Medical Biometry Informatics and EpidemiologyUniversity Hospital of BonnBonnGermany Department of Nephrology and Hypertension University of Erlangen-NürnbergErlangenGermany Institute of Genetic Epidemiology Faculty of Medicine and Medical Center-University of FreiburgFreiburgGermany Department of Medicine IV-Nephrology and Primary Care Faculty of Medicine and Medical Center-University of FreiburgFreiburgGermany Department of Nephrology and Medical Intensive Care Charité-Universitätsmedizin BerlinBerlinGermany Department of Nephrology University Medical Center RegensburgRegensburgGermany Institute of Clinical Chemistry and Laboratory Medicine University Medicine GreifswaldGreifswaldGermany DZHK(German Centre for Cardiovascular Research) Partner Site GreifswaldUniversity MedicineGreifswaldGermany Department of Medicine I Division of NephrologyUniversity Hospital WürzburgWürzburgGermany

Mineral and bone disorder(MBD)in chronic kidney disease(CKD)is tightly linked to cardiovascular disease(CVD).In this study,we aimed to compare the prognostic value of nine MBD biomarkers to determine those associated best with adverse cardiovascular(CV)outcomes and mortality.In 5217 participants of the German CKD(GCKD)study enrolled with an estimated glomerular filtration rate(eG FR)between 30–60 mL·min-1 per 1.73 m2 or overt proteinuria,serum osteoprotegerin(OPG),C-terminal fibroblast growth factor-23(FGF23),intact parathyroid hormone(iP TH),bone alkaline phosphatase(BAP),cross-linked C-telopeptide of type 1 collagen(CTX1),procollagen 1intact N-terminal propeptide(P1NP),phosphate,calcium,and 25-OH vitamin D were measured at baseline.Participants with missing values among these parameters(n=971)were excluded,leaving a total of 4246 participants for analysis.During a median follow-up of6.5 years,387 non-CV deaths,173 CV deaths,645 nonfatal major adverse CV events(MACEs)and 368 hospitalizations for congestive heart failure(CHF)were observed.OPG and FGF23 were associated with all outcomes,with the highest hazard ratios(HRs)for OPG.In the final Cox regression model,adjusted for CV risk factors,including kidney function and all other investigated biomarkers,each standard deviation increase in OPG was associated with non-CV death(HR 1.76,95%CI:1.35–2.30),CV death(HR 2.18,95%CI:1.50–3.16),MACE(HR 1.38,95%CI:1.12–1.71)and hospitalization for CHF(HR 2.05,95%CI:1.56–2.69).Out of the nine biomarkers examined,stratification based on serum OPG best identified the CKD patients who were at the highest risk for any adverse CV outcome and mortality.

关键词： Kidney cardiovascular vitamin

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慢性肾脏病患者铁剂应用的争议：来自改善全球肾脏病预后组织(KDIGO)会议的结论

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肾脏病与透析肾移植杂志 2016年第4期25卷 363-370页

作者： Iain C.Macdougall Andreas J.Bircher kai-uwe eckardt Gregorio T.Obrador Carol A.Pollock Peter Stenvinkel Dorine W.Swinkels Christoph Wanner Gü nter Weiss Glenn M.Chertow 陈佩玲(翻译) 龚德华(审校) Department of Renal Medicine King's College Hospital London UK Allergy Unit Dermatology Clinic University Hospital Basel Basel Switzerland Department of Nephrology and Hypertension Friedrich-Alexander-Universitat Erlangen-Numberg Erlangen Germany Universidad Panamericana School of Medicine Mexico City Mexico University of Sydney Sydney Australia Royal North Shore Hospital Sydney Australia Division of Renal Medicine Department of Clinical Science Intervention and Technology Karolinska University Hospital Stockholm Sweden Department of Laboratory Medicine Translational Metabolic Laboratory Radboud University Medical Center Nijmegen the Netherlands Renal Division University Hospital of Wiirzburg Wiirzburg Germany Department of Internal Medicine VI Infectious Disease Immunology Rheumatology Pneumology Medical University of Innsbruck Innsbruck Austria Division of Nephrology Stanford University School of Medicine Palo Alto California USA 南京军区南京总医院肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所南京210016 不详

慢性肾脏病和终末期肾病患者常需补铁治疗。但近年来铁剂的使用逐年增加,带来了铁超载、氧化应激和超敏反应等新问题,并可能促进感染的发生,其使用的安全性受到关注。为此,改善全球肾脏病预后组织(KDIGO)召开专家组会议,全面评估铁剂使... 详细信息

慢性肾脏病和终末期肾病患者常需补铁治疗。但近年来铁剂的使用逐年增加,带来了铁超载、氧化应激和超敏反应等新问题,并可能促进感染的发生,其使用的安全性受到关注。为此,改善全球肾脏病预后组织(KDIGO)召开专家组会议,全面评估铁剂使用的利和弊,并且提供合理使用方案以减轻急性反应及其他毒副作用。

关键词：慢性肾脏病超敏反应感染铁超载氧化应激

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肾脏病学的新创意：“肾脏疾病：改善全球预后”（KDIGO）

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中华肾脏病杂志 2005年第12期21卷 757-760页

作者： Norbert Lameire Garabed Eknoyan Rashad Barsoum kai-uwe eckardt Adeera Levin Nathan Levin Francesco Locatelli Alison Macleod Raymond Vanholder Rowan Walker Haiyan Wang 张路霞王海燕 100034 北京大学第一医院肾内科

慢性肾脏病(CKD)是世界范围的医疗和公共卫生问题,并开始呈现流行性的特点.美国肾脏数据系统(USRDS)的数据提示,终末期肾衰的发病率呈上升趋势,因此对于这一问题的重视日益增加.根据近期USRDS登记系统提供的资料,世界范围内需要肾脏替... 详细信息

慢性肾脏病(CKD)是世界范围的医疗和公共卫生问题,并开始呈现流行性的特点.美国肾脏数据系统(USRDS)的数据提示,终末期肾衰的发病率呈上升趋势,因此对于这一问题的重视日益增加.根据近期USRDS登记系统提供的资料,世界范围内需要肾脏替代治疗(RRT)的终末期肾病(ESRD)患者数目持续上升,其中我国台湾、美国和日本最多(254～365人/100万人)[1].卡塔尔和巴斯克地区的儿童患病率最高,分别为33.7人/100万人和22.7人/100万人;在大于等于20岁患者中患病率最高的是卡塔尔、美国和台湾.在欧洲,德国的患病率最高,2000年为175人/100万人.在RRT仍在发展中的东欧,报道的患病率低于西欧[2].

关键词：肾脏疾病肾脏病学终末期肾病(ESRD) 世界范围内预后全球创意公共卫生问题肾脏替代治疗数据系统

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Barriers to WHO Mental Health Action Plan updates to expand family and caregiver involvement in mental healthcare

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General Psychiatry 2022年第2期35卷 154-156页

作者： Jens Peter eckardt Research Unit Bedre PsykiatriCopenhagenDenmark

In 2021,the 74th World Health Assembly endorsed updates to the WHO's Comprehensive Mental Health Action Plan extending to 2030,including revised indicators to measure progress towards reaching defined targets and expa... 详细信息

关键词： expanded revised Action

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肾功能和疾病规范命名:改善全球肾脏病预后(KDIGO)会议共识

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临床儿科杂志 2022年第8期40卷 627-633页

作者：王忍高春林夏正坤张沛(译) 东部战区总医院儿科江苏南京210002

为规范描述肾功能和疾病的专业术语,2019年6月改善全球肾脏病预后组织(KDIGO)召开共识会议,对肾脏功能和疾病、肾衰竭、急性肾脏病和急性肾损伤、慢性肾脏病及肾脏评估共5个部分的内容制定了相应的术语表,并就以下建议达成共识。①对于... 详细信息

为规范描述肾功能和疾病的专业术语,2019年6月改善全球肾脏病预后组织(KDIGO)召开共识会议,对肾脏功能和疾病、肾衰竭、急性肾脏病和急性肾损伤、慢性肾脏病及肾脏评估共5个部分的内容制定了相应的术语表,并就以下建议达成共识。①对于肾脏功能和疾病的一般描述,使用术语“kidney”,而不使用“renal”或前缀“nephro-”;②使用“肾衰竭(kidney failure)”并适当描述是否存在相应症状、体征和治疗,而不是“终末期肾脏疾病(end-stage kidney disease)”;③使用KDIGO对急性肾脏病(AKD)和急性肾损伤(AKI)进行定义和分类;④使用KDIGO对慢性肾脏病(CKD)进行定义和分类;⑤使用特定的肾脏检测指标,例如蛋白尿或肾小球滤过率(GFR)降低,而不是肾功能“异常(abnormal)”或“降低(reduced)”来描述肾脏结构和功能的改变。文章简要总结会议的主要讨论。

关键词：肾脏功能肾脏疾病术语

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Current clinical approach to achalasia

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World Journal of Gastroenterology 2009年第32期15卷 3969-3975页

作者： Alexander J eckardt Volker F eckardt Central Interdisciplinary Endoscopy Unit Department of Gastroenterology and HepatologyCharité University Hospitals BerlinCampus VirchowD-13353 BerlinGermany Department of Gastroenterology Deutsche Klinik für DiagnostikD-65191 WiesbadenGermany

Idiopathic achalasia is a rare primary motility disorder of the esophagus. The classical features are incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and a lack of peristalsis in the tubular esophagus. These motor abnormalities lead to dysphagia, stasis, regurgitation, weight loss, or secondary respiratory complications. Although major strides have been made in understanding the pathogenesis of this rare disorder, including a probable autoimmune mediated destruction of inhibitory neurons in response to an unknown insult in genetically susceptible individuals, a definite trigger has not been identified. The diagnosis of achalasia is suggested by clinical features and conf irmed by further diagnostic tests, such as esophagogastroduodenoscopy (EGD), manometry or barium swallow. These studies are not only used to exclude pseudoachalasia, but also might help to categorize the disease by severity or clinical subtype. Recent advances in diagnostic methods, including high resolution manometry (HRM), might allow prediction of treatment responses. The primary treatments for achieving long-term symptom relief are surgery and endoscopic methods. Although limited high-quality data exist, it appears that laparoscopic Heller myotomy with partial fundoplication is superior to endoscopic methods in achieving long-term relief of symptoms in the majority of patients. However, the current clinical approach to achalasia will depend not only on patients' characteristics and clinical subtypes of the disease, but also on local expertise and patient preferences.

关键词：弛缓临床医学诊断 LES

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Predisposing factors for atrial fibrillation in the elderly

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Journal of Geriatric Cardiology 2017年第3期14卷 179-184页

作者： Kristina Wasmer Lars eckardt Gunter Breithardt Division of Electrophysiology Department of Cardiovascular Medicine University Hospital Miinster Germany

Atrial fibrillation (AF) in the elderly occurs as a consequence of cardiovascular aging and an age related increase of comorbidity. Several predisposing factors for AF have been identified for the overall AF population. Most of them, cardiovascular disease in particular, play a role in younger and older patients. The longer time period during which these risk factors can cause structural changes that ultimately lead to AF may, at least in part, explain the association between age and AF. In addition, less well defined age-related changes in cellular electrophysiologic properties and structure predispose to AF in the elderly.

关键词：诱发因素老年人颤动心房心血管疾病年龄相关结构变化生理学特性

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Is the schatzki ring a unique esophageal entity?

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World Journal of Gastroenterology 2011年第23期17卷 2838-2843页

作者： Michaela Müller Ines Gockel Philip Hedwig Alexander J eckardt Kathrin Kuhr Jochem Knig Volker F eckardt Department of Gastroenterology German Clinic for Diagnostics Wiesbaden65191 WiesbadenGermany Department of General and Abdominal Surgery University Medical Center of the Johannes Gutenberg University Mainz55131 MainzGermany Institute of Medical Statistics Informatics and EpidemiologyUniversity of Cologne50924 CologneGermany Institute of Medical Biostatistics Epidemiology and InformaticsUniversity Medical Center of the Johannes Gutenberg University Mainz55131 MainzGermany

AIM:To study,whether the association of Schatzki rings with other esophageal disorders support one of the theories about its etiology.METHODS:From 1987 until 2007,all patients with newly diagnosed symptomatic Schatzki rings (SRs) were prospectively registered and followed.All of them underwent structured interviews with regards to clinical symptoms,as well as endoscopic and/or radiographic examinations.Endoscopic and radiographic studies determined the presence of an SR and additional morphological abnormalities.RESULTS:One hundred and sixty-seven patients (125 male,42 female) with a mean age of 57.1±14.6 years were studied.All patients complained of intermittent dysphagia for solid food and 113 (79.6%) patients had a history of food impaction.Patients experienced symptoms for a mean of 4.7±5.2 years before diagnosis.Only in 23.4% of the 64 patients who had endoscopic and/or radiological examinations before their first presentation to our clinic,was the SR previously diagnosed.At presentation,the mean ring diameter was 13.9±4.97 mm.One hundred and sixty-two (97%) patients showed a sliding hiatal hernia.Erosive reflux esophagitis was found in 47 (28.1%) patients.Twenty-six (15.6%) of 167 patients showed single or multiple esophageal webs;five (3.0%) patients exhibited eosinophilic esophagitis;and four (2.4%) had esophageal diverticula.Four (7%) of 57 patients undergoing esophageal manometry had nonspecific esophageal motility disorders.CONCLUSION:Schatzki rings are frequently associated with additional esophageal disorders,which support the assumption of a multifactorial etiology.Despite typical symptoms,SRs might be overlooked.

关键词：食管实体临床症状平均年龄嗜酸性粒细胞 SRS 运动障碍非特异性

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Endoscopic findings in patients with Schatzki rings:Evidence for an association with eosinophilic esophagitis

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World Journal of Gastroenterology 2012年第47期18卷 6960-6966页

作者： Michaela Müller Alexander J eckardt Annette Fisseler-Eckhoff Susanne Haas Ines Gockel Till Wehrmann Department of Gastroenterology German Diagnostic ClinicD-65191 WiesbadenGermany Department of Pathology Dr.Horst-Schmidt-Kliniken65199 WiesbadenGermany Department of General and Abdominal Surgery University Medical CenterThe Johannes Gutenberg University55131 MainzGermany

AIM:To investigate endoscopic findings in patients with Schatzki rings(SRs) with a focus on evidence for eosinophilic esophagitis(EoE).METHODS:We consecutively approached all adult patients scheduled for elective outpatient upper endoscopy for a variety of indications at the German Diagnostic Clinic,Wiesbaden,Germany between July 2007 and July 2010.All patients with endoscopically diagnosed SRs,defined as thin,symmetrical,mucosal structures located at the esophagogastric junction,were prospectively registered.Additional endoscopic findings,clinical information and histopathological findings with a focus on esophageal eosinophilia(≥ 20 eosinophils/high power field) were recorded.The criteria for active EoE were defined as:(1) eosinophilic tissue infiltration ≥ 20 eosinophils/hpf;(2) symptoms of esophageal dysfunction;and(3) exclusion of other causes of esophageal eosinophilia.Gastroesophageal reflux disease was excluded by proton pump inhibitor treatment prior to endoscopy.The presence of ≥ 20 eosinophils/hpf in esophageal biopsies in patients that did not fulfil the criteria of EoE was defined as esophageal hypereosinophilia.RESULTS:A SR was diagnosed in 171(3.3%;128 males,43 females,mean age 66 ± 12.9 years) of the 5163 patients that underwent upper gastrointestinalendoscopy.Twenty of the 116 patients(17%) from whom esophageal biopsies were obtained showed histological hypereosinophilia(≥ 20 eosinophils/hpf).Nine of these patients(8 males,1 female,mean age 49 ± 10 years) did not fulfill all diagnostic criteria of EoE,whereas in 11(9%) patients with ≥ 20 eosinophils/hpf,a definite diagnosis of EoE was made.Three of the 11 patients(27%) with definite EoE had no suspicious endoscopic features of EoE.In contrast,in the 25 patients in whom EoE was suspected by endoscopic features,EoE was only confirmed in 7(28%) patients.Patients with EoE were younger(mean age 41.5 ± 6.5 vs 50.5 ± 11.5 years,P = 0.012),were more likely to have a history of allergies(73% vs 29%,P = 0.007) and complained more often of dysphagia(91% vs

关键词：嗜酸性粒细胞食管癌患者证据平均年龄组织病理学关联质子泵抑制剂

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Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy: A retrospective study at a single center

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World Journal of Gastroenterology 2017年第9期23卷 1637-1644页

作者： Wen-Gang Zhang En-Qiang Linghu Hui-kai Li Departmen of Gastroenterology Chinese PLA General HospitalBeijing 100853China

AIM To assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy(POEM).METHODS Twenty-four patients who underwent POEM and experienced mucosal injury of the cardia during the procedure were retrospectively identified. Of the 24 patients, 21 had mucosal penetration and 3 had only slight mucosal damage without penetration. The 21 patients with mucosal penetration received fibrin sealant for closure at the site of penetration. Penetration-related characteristics, treatment, and recovery were reviewed for all 21 patients to assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia. Clinical data, including general characteristics, procedure-related parameters, eckardt scores, lower esophageal sphincter pressures (LESP), and esophagogastroduodenoscopy(EGD) results, were analyzed to determine their influence on treatment success after mucosal penetration during POEM.RESULTS All 21 patients had a solitary mucosal penetration in the cardia (12 in esophageal region of the cardia, 9 in the stomach region of the cardia, and 1 in both the esophageal and stomach regions). Twelve had ahole-like penetration and 9 had a linear penetration. For those with a hole-like penetration, the mean size was 0.14 cm2 (0.02-0.32 cm2). For those with a linear penetration, the median size was 0.37 cm (0.10-1.00 cm). Closure of the mucosal penetration using fibrin sealant was performed successfully in all 21 patients(two patients required 5 m L fibrin sealant, and the remaining 19 patients required 2.5 mL). Two patients had a nasogastric tube placed for five days after POEM; the remaining 19 patients were kept fasting for 3 d. All 21 patients were discharged after a median of 5 d(range: 5-7 d) postoperatively. During a median 42 mo (range: 9-62 mo) follow-up, all 21 patients with a mucosal penetration successfully healed without the occurrence of infection, ulcer, or esophagitis. Furthermore, the median LESP decreased from 31.9 mm H

关键词：血纤维蛋白密封剂 Mucosal 穿入 Peroral 内视镜的肌切开术功效安全

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