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Effect of Peritoneal Dialysis Modality on the 1-Year Rate of Decline of Residual Renal Function
최규헌,김찬호,오형중,이미정,권영은,김영리,남기헌,박경숙,안성영,고광일,구향모,도파미,한승혁,유태현,김범석,강신욱 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.1
Purpose: The effect of different peritoneal dialysis (PD) modalities on the decline in residual renal function (RRF) is unclear due to inconsistencies among studies. In particular,the effect of automated peritoneal dialysis (APD) modalities [continuous cyclic peritoneal dialysis (CCPD) and nightly intermittent peritoneal dialysis (NIPD)] on RRF has not been examined in a large cohort. Materials and Methods: We conducted a single-center retrospective study to investigate the association between PD modalities and decline in RRF in 142 incident PD patients [34 on CCPD, 36 on NIPD, and 72 on continuous ambulatory peritoneal dialysis (CAPD)]. RRF was measured within 2 months from PD start and at 1 year after PD initiation. Results: The RRF at 1 year after PD initiation was 1.98±2.20 mL/min/1.73 m² in CCPD patients and 3.63±3.67 mL/min/1.73 m² in NIPD patients, which were moderately lower than 4.23±3.51 mL/min/1.73 m² in CAPD patients (p=0.064). Moreover, there was no significant difference in the 1-year rate of decline of RRF between CCPD and NIPD patients, although APD patients had a faster 1-year RRF decline rate than CAPD patients (CCPD and NIPD vs. CAPD: -45.68 and -36.69 vs. 1.17%/year, p=0.045). APD was associated with a more rapid decline in RRF in patients with end-stage renal disease undergoing PD, although multivariate analysis attenuated the significance of this finding (β=-31.50; 95% CI, -63.61 to 0.62; p=0.052). Conclusion: Our results suggest that CAPD might be more helpful than APD for preserving RRF during the first year of dialysis therapy, although there was no significant difference in the 1-year rate of decline of RRF between the two APD modalities.
고농도의 당이 백서 메산지움 배양세포내 Phospholipase A₂활동도에 미치는 영향
최규헌 대한신장학회 1993 Kidney Research and Clinical Practice Vol.12 No.4
In order to evaluate the changes of phospholipase A₂ (PLA₂) activity in mesangial cells that might occur in diabetic status, we measured arachidonic acid (A.A.) release, ionomycin (10 pM)- and PMA (phorbol myris- tate acetate: 300 nM)-induced A.A. release, and PLA₂ activity after 24-and 48-hour exposures to high glucose concentrations (20, 50mM) in cultured rat mesangial cells, and also examined the effects of high hlucose concentration on activation of PLA₂ following hor- monal stimulation (PMA 300 nM, Arginine vasopressin: AVP 100nM, Epidermal growth factor: EGF 100nM), compared to normal glucose concentration (5 mM). The following results were obtained: 1) Mesangial cells treated with medium containing high glucose for 24 or 48 hours displayed significant increase in A.A. release, compared with cells treated with normal glucose (20 mM: 2.4±0.4% vs 3.7±0.3, 2.2± 0.2 vs 4.0±0.6, 50 mM: 2.2±0.2 vs 4.0±0.6, 3.8±0.5, p$lt;0. 05), but there was so no significant difference in A.A. release between 20 and 50 mse treated group. 2) After 24-and 48-hour growth in high glucose, the activities of PLA₂in mesangial cells were not signifi- cantly different from the values in normal glucose (20 mM:25.5±5.1pmol/min/mg of protein vs 21.5±4.4, 19. 7±4.8, 50 mM: 24.9±5.8 vs 19.2±6.0, 22.5±3.7, p$gt;0.05), and the difference between 20 and 50 mM glucose treated group was also not significant. 3) Concerning the effects of ionomycin and PMA on A.A. release, both of them stimulated the release of A.A. markedly from mesangial cells cultured in normal and high glucose concentration for 24 hours (normal glucose: 2.7±0.3% vs ionomycin 11.4±3.8, PMA 5.8±21.1, ionomycin+PMA 12.2±2.8, p$lt;0.05; 20 mM: 3.8±0.4 vs 8.9± 1.8, 6.0± 0.7, 12.1± 0.4; 50 mM: 4.0± 0.3 vs 9.3± 1.1, 6. 1±1.3, 13.1±0.7), but there was no further increase when agents were added after 24-hour growth in high glucose concnetration. 4) Mesangial cells treated with PMA, AVP and EGF showed significant increase of PLA, activity after 24 -hour growth in normal oncentration (normal glucose: 22.1+5.8 pmol/min/mg of protein vs 40.7±7.5, 34.3±5.9, 36.2±8.4; 20 mM 19.1±6.4 vs 37.5±7. 5, 28.6±6.8, 31.0±6.1, p$lt;0.05), but high glucose had no significant effect on PMA, AVP, and EGF-induced enhancement of PLA₂ activity. From the above results, it seems that mesangial cell exposure to high concentrations of glucose lead to increase in A.A. release without enhanced activity of PLA₂,suggestive of A.A. release through the other pathway such as DAG lipase, and hormonal regulatory pathway of PLA₂ appears not to be significantly influenced by exposure to high glucose.