BackgroundCurrent evidence for finerenone in T2DM with CKD is derived primarily from patients with microalbuminuria to macroalbuminuria, and data in those with moderate-to-heavy proteinuria remain limited. This study aimed to investigate the effect of finerenone on sustained graded improvement of 24h-UTP and its safety profile in T2DM patients with CKD and proteinuria >1 g/d.MethodsThis retrospective cohort study included patients with T2DM and CKD with proteinuria >1 g/d treated at hospital. Patients were divided into the finerenone group and the control group based on whether they received finerenone during the follow-up period. Proteinuria was graded as Stage 2 (1-3.5 g/d) and Stage 3 (>3.5 g/d). The primary endpoint was sustained graded improvement in 24h-UTP. The secondary endpoint was the percentage reduction in proteinuria from baseline at different timepoints. Propensity score weighting was applied to address baseline imbalances. Logistic regression and Kaplan-Meier analysis were used to assess the association between finerenone use and graded proteinuria improvement. A mixed model for repeated measures (MMRM) was employed to compare changes in 24h-UTP, eGFR, and serum potassium levels between the two groups. Safety outcomes included hyperkalemia incidence.ResultsA total of 134 patients were included in this study, comprising 53 in the finerenone group and 81 in the control group. Over 12 months, 28 patients (52.8%) in the finerenone group and 27 patients (33.3%) in the control group achieved sustained graded improvement in 24h-UTP. After propensity score weighting, finerenone use was independently associated with sustained graded improvement (OR 1.26, 95% CI 1.07–1.47, P = 0.004). Kaplan-Meier analysis showed a significant difference in time to sustained improvement between groups (Log-rank P = 0.026-0.033). MMRM analysis revealed a greater reduction in 24h-UTP in the finerenone group, while eGFR and serum potassium changes did not differ significantly between groups.ConclusionsIn patients with T2DM and proteinuria >1 g/d, finerenone increased the probability of sustained graded proteinuria improvement, shortened the time to improvement, and was not associated with a significantly increased risk of hyperkalemia over 12 months, although the interpretation of safety findings is limited by baseline differences in kidney function and concomitant medication use between groups.

BACKGROUND:Restless legs syndrome (RLS) is common in maintenance hemodialysis (MHD) patients, with limited pharmacological options due to adverse effects. This study aimed to evaluate the effects of adding abdominal massage to Sanjiao acupuncture for RLS in MHD patients. METHODS:In a single-center randomized trial (March-September 2025, with follow-up through December 2025), 88 MHD patients with moderate-to-severe RLS were assigned to Sanjiao acupuncture (n = 44) or combined therapy (n = 44). Both groups received conventional MHD; the combined group added abdominal massage. Interventions were performed 3 times weekly for 3 weeks, 1.5 h before dialysis session end. The primary outcome was serial International Restless Legs Syndrome Rating Scale (IRLS) scores at different timepoints compared with baseline. Secondary outcomes included the overall responder rate based on IRLS reduction rate at endpoint, the Pittsburgh Sleep Quality Index (PSQI), and 3-month recurrence rate. Adverse events were monitored as safety indicators. Efficacy analyses were performed on both the intention-to-treat (ITT) population (n = 88, with missing data imputed using baseline observation carried forward) and the per-protocol (PP) population (n = 80). RESULTS:Both groups showed significant reductions in serial IRLS scores from baseline (both P < 0.001), with the combined group demonstrating further reduction from week 1 to endpoint compared with the acupuncture group (P < 0.05). In the ITT analysis, the combined group showed a higher responder rate than the acupuncture group (72.7% vs. 47.7%, P = 0.029) and lower endpoint IRLS scores (median 0.00 vs. 14.50, P = 0.029). The PP analysis yielded consistent results (responder rate: 80.0% vs. 52.5%, P = 0.018; endpoint IRLS: median 0.00 vs. 12.00, P = 0.017). Both groups improved in PSQI (P < 0.01), with no significant between-group difference. At 3-month follow-up, recurrence showed a numerical difference favoring combined therapy (12.5% vs. 23.8%), though this exploratory analysis was severely underpowered and the between-group difference was not statistically significant (P = 0.297). Adverse events were similar between groups (15.9% vs. 13.6%, P = 0.772), with no serious events. CONCLUSIONS:The addition of abdominal massage to Sanjiao acupuncture was associated with greater improvement in RLS symptoms in MHD patients with favorable safety, supporting the use of adjunctive abdominal massage as a non-pharmacological option for RLS in end-stage renal disease, though the specific contribution of massage independent of increased therapeutic contact time remains to be determined.

Recombinant human erythropoietin (rhEPO) fused with human immunoglobulin G (IgG) Fc fragment (rhEPO-Fc) is a novel erythropoiesis-stimulating agent designed to extend plasma half-life and enhance biological activity. However, data on the efficacy and safety of rhEPO-Fc in hemodialysis patients with chronic kidney disease (CKD)-related anemia remain limited. This phase 3 trial enrolled patients from 45 Chinese hospitals. Participants were randomized (2:1) to receive either rhEPO-Fc or rhEPO (Chinese hamster ovary cell-derived) for 28 weeks. The rhEPO-Fc responders were eligible for a 24-week extension period. The primary endpoint was the least square mean (LSM) change in hemoglobin (Hb) levels from baseline between weeks 21 and 28. Among 356 rhEPO-Fc and 178 rhEPO recipients, patients receiving rhEPO-Fc demonstrated non-inferiority Hb maintenance compared with rhEPO. The inter-group LSM differences in the full analysis set and per-protocol set were 3.96 g/L (95% CI: 3.02-4.89; p < 0.001) and 2.27 g/L (95% CI: 0.60-3.95; p = 0.008), respectively. Adverse drug reaction rates were comparable (rhEPO-Fc: 39.2% vs. rhEPO: 40.2%). Dose adjustments due to treatment-emergent adverse events were significantly lower with rhEPO-Fc (0.0% vs. 2.2%; p < 0.05). Deaths unrelated to the study drugs occurred in two rhEPO-Fc and four rhEPO patients. These findings indicated that rhEPO-Fc effectively maintained Hb levels in patients with CKD anemia undergoing hemodialysis, showing comparable efficacy to rhEPO with reduced dosing frequency and a similar safety profile.

BackgroundAnemia and protein-energy wasting (PEW) are common complications in chronic kidney disease (CKD) and are associated with disease progression. However, the prognostic significance of longitudinal hemoglobin (Hb) trajectory patterns, particularly in the context of nutritional status, remains unclear. This study aimed to identify distinct Hb trajectories in CKD stages 3–4 patients and evaluate their associations with renal outcomes, employing a dual analytical approach: exploratory analysis of concurrent eGFR decline and predictive analysis of subsequent dialysis risk using a landmark design.MethodsThis retrospective landmark cohort study included 694 non-dialysis CKD patients from a Japanese medical center. All completed a 2-year landmark period with Hb measured at regular 90-day intervals (± 15 days). Feature-Based Clustering of Longitudinal Trajectories was applied to Hb measurements during the 2-year landmark period to identify trajectory groups. For exploratory association analysis, Cox proportional hazards regression assessed the relationship between Hb trajectories and concurrent ≥30% eGFR decline within the landmark period. For predictive risk stratification, competing risk Fine-Gray regression models (with death as the competing event) evaluated the risk of dialysis initiation occurring after the 2-year landmark period, with trajectory groups serving as baseline predictors.ResultsFive distinct Hb trajectory groups were identified: (1) Low-Stable (n = 181, 26.1%); (2) High-Stable (n = 157, 22.6%); (3) Rapid-Declining (n = 124, 17.9%); (4) Lowest-Plateau (n = 122, 17.6%); and (5) Low-Declining (n = 110, 15.9%). Group 2 patients were younger, predominantly male, with better renal function and nutritional status (higher albumin, lower BUN). During a median follow-up of 2,057 days, 163 patients (23.5%) experienced ≥30% eGFR decline over 2 years and 119 (17.1%) initiated dialysis. Compared with Group 2 (reference), all other Groups showed significantly increased risks of both outcomes. Group 3 exhibited the highest risks for both outcomes, with adjusted HRs of 9.98 (95% CI 4.45–22.4) and 2.99 (95% CI 1.06–8.56) respectively after adjusting for confounders.ConclusionsDistinct longitudinal Hb trajectories exist in non-dialysis CKD patients and are independently associated with renal progression risk. Maintaining higher, stable Hb levels is associated with delayed renal replacement therapy initiation, whereas rapid Hb decline identifies a high-risk subgroup requiring intensive monitoring and integrated nutritional intervention.

BackgroundRestless legs syndrome (RLS) is highly prevalent among end-stage renal disease (ESRD) patients undergoing dialysis, causing significant sleep disruption. Whether dialysis modality influences RLS occurrence remains controversial. This study compared RLS prevalence, severity, and sleep outcomes between hemodialysis (HD) and peritoneal dialysis (PD) patients using propensity score matching.MethodsFrom April to October 2024, 396 ESRD patients (173 HD, 223 PD) were enrolled. RLS was diagnosed using IRLSSG 2014 criteria. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI ≥11 indicating clinically significant sleep disturbance). 1:1 propensity score matching was performed on age, sex, education, dialysis vintage, smoking, alcohol consumption, and comorbidities. Matched groups (140 HD, 140 PD) were compared for RLS prevalence, severity, and sleep outcomes.ResultsAfter matching, RLS prevalence was comparable between HD and PD (39.28% vs. 40.00%, p = 1.0000). However, sleep disturbance was significantly more prevalent among PD patients with RLS (73.2% vs. 50.9%, p = 0.022). HD patients showed a trend toward more severe RLS (32.73% severe vs. 19.64% in PD, p = 0.754). Modality-specific risk factors, confirmed by formal interaction testing, were limited to lower hemoglobin and elevated eosinophil counts in PD patients; associations with age (HD) and alcohol consumption (PD) showed only borderline effect modification. Elevated β2-microglobulin was a shared independent risk factor with comparable effect sizes (P_interaction = 0.335).ConclusionHD and PD showed similar RLS prevalence but divergent sleep disturbance patterns. Distinct risk factor profiles suggest dialysis-specific mechanisms differentially influence RLS pathophysiology. β2-Microglobulin emerged as a universal risk factor, supporting unified, risk factor-based screening strategies to improve sleep quality in dialysis populations regardless of modality.

BackgroundRestless legs syndrome (RLS) is a common and debilitating complication in end-stage renal disease (ESRD) patients undergoing dialysis, significantly impairing sleep quality and quality of life. Screening of prevalent cases remains challenging. This study aimed to develop and validate an interpretable machine learning-based classification model for identifying RLS status in ESRD patients.MethodsA total of 396 ESRD patients (173 hemodialysis, 223 peritoneal dialysis) were enrolled from April to October 2024. Patients were randomly divided into training (70%, n = 287) and testing (30%, n = 109) sets. Feature selection was performed using LASSO regression with five-fold cross-validation, followed by Akaike Information Criterion (AIC) refinement. Nine machine learning algorithms were developed: Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), Gradient Boosting Machine (GBM), K-Nearest Neighbors (KNN), Decision Tree (DT), Artificial Neural Network (ANN), Multivariate Adaptive Regression Splines (MARS), and Quadratic Discriminant Analysis (QDA). Model performance was evaluated using discrimination (AUC-ROC), calibration (Brier score, calibration curves), and clinical utility (Decision Curve Analysis, DCA). SHapley Additive exPlanations (SHAP) was employed to enhance model interpretability.ResultsFive variables were selected: β2-microglobulin, hemoglobin, diabetes mellitus, coronary heart disease, and alcohol consumption. SVM demonstrated optimal performance with AUC of 0.791 (95% CI: 0.702–0.879) in the testing set, outperforming other models. SVM achieved accuracy of 0.761, sensitivity of 0.711, specificity of 0.797, F1-score of 0.711, and Brier score of 0.183. Calibration curves showed good agreement between estimated and observed probabilities. DCA confirmed favorable net clinical benefit across threshold probabilities. SHAP analysis identified β2-microglobulin (mean |SHAP| = 0.131) and anemia as the most influential variables with diabetes, coronary heart disease, and alcohol consumption contributing moderately. SHAP dependence plots revealed interactions between β2-microglobulin and hemoglobin, as well as diabetes modifying the protective effect of higher hemoglobin.ConclusionWe developed and validated an interpretable SVM-based classification model for identifying RLS in ESRD patients using readily available clinical variables. This model demonstrates promising performance and requires prospective external validation in multi-center cohorts before clinical implementation. This tool may facilitate screening of prevalent RLS cases and inform clinical decision-making.

慢性肾脏病(chronic kidney diseases,CKD)患者由于糖和胰岛素代谢的改变,容易出现低血糖,血液透析患者尤其突出.据统计,40%以上的患者曾在血液透析过程中出现低血糖(血糖<3.9 mmol/L)[1],多数研究认为与药物使用、无糖透析液、进食等因素相关,较少进一步详查病因.对于非糖尿病患者低血糖,目前推荐以监测、预防为主[2],可选择含糖透析液[3],治疗方面一是解除神经供糖不足的症状,根据血糖降低情况选择口服含糖食物或静脉注射葡萄糖溶液,二是纠正导致低血糖的各种潜在原因.本文报道2例血液透析期间频繁出现低血糖的非糖尿病患者,最终分别诊断为高胰岛素血症和糖耐量受损,在规律口服α糖苷酶抑制剂伏格列波糖后,未再出现血液透析时低血糖,非透析时也未出现低血糖.上述病例在以往鲜有报道,希望借此为临床诊疗提供参考.

Chronic kidney disease (CKD) is a serious global health threat. At the terminal stage, kidney function is nearly completely lost. Therefore, predicting the development of CKD based on a patient's visits can enable doctors to intervene early and delay the disease's progression. In this paper, we propose a three-stage prediction model named Imputation-Capture-Prediction (ICP) and based on the Transformer architecture, for chronic kidney disease (CKD) using electronic health records (EHRs). The first stage is to address the missing data problem in EHR, and ICP employs a two-stage imputation method, using the deep learning method SAITS module after recent padding. The second stage is designed to better capture this temporal dependency and the relationships between features, where ICP incorporates a two-branch architecture and introduces two modules: Time-Aware Convolution (TC) and Dynamic-Static-Medical Graph Attention Network (DSMGAT), to extract diverse feature information. The TC module is designed to capture the relationships within visit records, accounting for the unequal lengths of visit intervals while emphasizing the importance of recent records. The DSMGAT module, on the other hand, considers various categories of record features, using a Graph Attention Network (GAT) with learnable weights to model the relationships among them. Then we use a Feed-Forward Network to predict the estimated glomerular filtration rate (eGFR). To evaluate the effectiveness of our method, we compared it with several advanced approaches using a real EHR dataset, TFHCKD. The Mean Absolute Error (MAE) and Mean Squared Error (MSE) were 0.0344 and 0.0028, respectively, demonstrating a significant improvement over existing methods.

BackgroundRipertamab has been used in an off-label manner for treating primary membranous nephropathy (PMN) in real-world settings in China, despite limited evidence supporting the efficacy of this drug. This multicenter, retrospective study is the first to assess the effectiveness and safety of ripertamab for treating PMN in a real-world Chinese clinical setting.MethodsAdult patients with PMN who were treated with at least one course of ripertamab alone were included in this study. Patients were categorized into two groups based on their prior treatment of PMN: the initial therapy group and the non-initial therapy group. The primary outcome was the occurrence of complete remission (CR) or partial remission (PR) at 6 and 12 months. The secondary outcomes included the time to achieve remission, relapse rate and the incidence of adverse events (AEs).ResultsFifty-two patients were ultimately included for analysis. Among these patients, 39 received ripertamab as initial therapy, while 13 were in the non-initial therapy group. The median follow-up duration was 8.7 (4.7, 11.3) months. At 6 months, 24/40 (60.0%) patients achieved clinical remission, with 2/40 (5.0%) achieving CR and 22/40 (55.0%) achieving PR. At 12 months, 22 patients completed follow-up: 2 (9.1%) achieved CR, and 15 (68.2%) achieved PR. The median time to remission for the entire cohort was 90.5 (32, 165) days and four of the 52 patients (7.7%) relapsed. The initial therapy group had a higher remission rate at 12 months than the non-initial therapy group [13/15 (86.7%) vs. 4/7 (57.1%)]. Additionally, the initial therapy group achieved remission more quickly than the non-initial therapy group [79.0 (36, 112) vs. 165.0 (30, 313) days]. Ripertamab was well tolerated, with 9.6% (5/52) of patients experiencing AEs; none of the AEs were severe.ConclusionRipertamab demonstrated efficacy and good tolerability for the treatment of PMN in a Chinese real-world setting. These findings support the use of ripertamab as a therapeutic option for PMN patients and suggest the need for further investigation into its long-term safety and efficacy.

Background:The triglyceride-glucose-body mass index (TyG-BMI) is a simple indicator of insulin resistance and is linked to an elevated risk of mortality. Nevertheless, limited research has explored the associations between the TyG-BMI and all-cause and cardiovascular mortality in patients undergoing peritoneal dialysis (PD). Methods:Patients initiating PD treatment at the Tianjin First Central Hospital's Nephrology Department from July 2013 to February 2024 had triglycerides, fasting blood glucose, height, and weight measured at baseline and monthly during follow-up. TyG-BMI was calculated, dividing PD patients into high, middle, or low TyG-BMI groups using the tri-quantile method. Cox regression analysis assessed hazard ratios (HRs) for all-cause and cardiovascular mortality among these groups. A restricted cubic spline regression was used to explore the relationship between TyG-BMI and the primary and secondary outcomes. Results:A total of 865 patients were included. The mean TyG-BMI value for the entire study population was 212.27 ± 46.64. Patients in the high TyG-BMI group had a higher proportion of patients whose primary kidney disease was diabetic nephropathy and the greatest proportion of patients with comorbid diabetes mellitus. During the follow-up, 266 (30.75%) deaths occurred, with CVD being the dominant cause in 110 (41.35%) patients. Univariate and multivariate Cox regression analyses showed that middle group patients had a significantly lower risk of all-cause mortality compared to other groups. For CVD mortality, high group patients had a significantly greater hazard ratio than middle group patients, while there was no significant difference between the low and middle groups. Restricted cubic spline regression revealed a U-shaped association between TyG-BMI and all-cause mortality risk, as well as a J-shaped association with CVD mortality; inflection points were identified at 209.73 and 206.64, respectively. In the subgroup analysis, we found that higher TyG-BMI values were associated with increased all-cause and cardiovascular mortality in men, and lower TyG-BMI values were linked to elevated all-cause mortality in women. Conclusion:The TyG-BMI shows U-shaped and J-shaped relationships with all-cause and CVD mortality risk, respectively, in PD patients. Additionally, significant sex differences were observed in these associations.

Introduction:Whether restless legs syndrome (RLS) and sleep disturbance (SD) in hemodialysis (HD) patients influence all-cause and cardiovascular mortality remains controversial. The aim of this study was to evaluate the association between RLS or SD and 3-year mortality in HD patients. Methods:A total of 301 patients who underwent HD were examined in April 2021 and were followed up for 3 years. The median follow-up time was 36.0 [33.3, 36.0] months. Fifty-four patients fulfilled the diagnosis of RLS (17.9%), 126 patients complained of SD (41.9%). Demographic parameters, clinical features, laboratory indices, and two questionnaires to assess the diagnosis of RLS and sleep status were collected. All-cause mortality and cardiovascular mortality in this population were evaluated. Cox regression analyses and Kaplan-Meier curves were performed to determine the effect of RLS or SD on 3-year mortality. Results:The RLS group reported that 29 patients (53.8%) exhibited concurrent symptoms of SD. The presence of RLS or SD alone did not significantly elevate the risk of all-cause mortality (p = 0.053 and p = 0.193). However, the coexistence of RLS and SD was identified as an independent risk factor for all-cause mortality (p = 0.011). Furthermore, the various combinations associated with RLS or SD were found to be independently correlated with the risk of cardiovascular death (p < 0.05). Conclusion:The combination of RLS and SD in HD patients is associated with an increased risk of cardiovascular and all-cause mortality, underscoring the clinical significance of this association.

Background Patients undergoing peritoneal dialysis (PD) face elevated risks of all-cause mortality. We aimed to develop and validate a prediction model for all-cause mortality in PD patients using random survival forest (RSF) methodology. Methods In this retrospective cohort study, patients receiving maintenance PD between 1 January 2017 and 31 December 2019 were enrolled as the training cohort (n = 221), with those treated from 1 January 2020 to 31 December 2022 serving as the temporal validation cohort (n = 256). Eligible participants aged 18–80 years had received PD for ≥ 3 months with complete baseline data. We collected demographic characteristics, laboratory parameters (hemoglobin, albumin, alkaline phosphatase, urea nitrogen, creatinine, electrolytes, etc.), and PD-specific metrics (Kt/V, peritonitis rate). RSF analysis was employed to identify mortality-associated variables. Results The prediction model incorporated multiple clinical and biochemical variables, demonstrating robust discriminative ability in the training set (C-index 0.931, 95% CI 0.894–0.968). Temporal validation maintained satisfactory performance (C-index 0.733, 95% CI 0.635–0.831), with age, hypoalbuminemia, and elevated high-sensitivity C-reactive protein (hsCRP) emerging as key predictors. A clinically applicable nomogram was developed to estimate 3-year survival probabilities. Conclusions This RSF-based model reliably predicts all-cause mortality in PD patients, providing a valuable tool for risk stratification and personalized management. External validation is warranted to confirm generalizability.

BACKGROUND:To explore the risk factors of proteinuria in Omicron variant patients and to construct and verify the risk predictive model. METHODS:1091 Omicron patients who were hospitalized from August 2022 to November 2022 at Tianjin First Central Hospital were defined as the derivation cohort. 306 Omicron patients who were hospitalized from January 2022 to March 2022 at the same hospital were defined as the validation cohort. The risk factors of proteinuria in derivation cohort were screened by univariate and multivariate logistic regression analysis, and proteinuria predicting scoring system was constructed and the receiver operating characteristic(ROC)curve was drawn to test the prediction ability. The proteinuria risk model was externally validated in validation cohort. RESULTS:7 factors including comorbidities, blood urea nitrogen (BUN), serum sodium (Na), uric acid (UA), C reactive protein (CRP) and vaccine dosages were included to construct a risk predictive model. The score ranged from -5 to 16. The area under the ROC curve(AUC) of the model was 0.8326(95% CI 0.7816 to 0.8835, p < 0.0001). Similarly to that observed in derivation cohort, the AUC is 0.833(95% CI 0.7808 to 0.9002, p < 0.0001), which verified good prediction ability and diagnostic accuracy in validation cohort. CONCLUSIONS:The risk model of proteinuria after Omicron infection had better assessing efficiency which could provide reference for clinical prediction of the risk of proteinuria in Omicron patients.

BackgroundDialytic phosphate removal is a cornerstone of the management of hyperphosphatemia in peritoneal dialysis (PD) patients, but the influencing factors on peritoneal phosphate clearance (PPC) are incompletely understood. Our objective was to explore clinically relevant factors associated with PPC in patients with different PD modality and peritoneal transport status and the association of PPC with mortality.MethodsThis is a cross-sectional and prospective observational study. Four hundred eighty-five PD patients were enrolled and divided into 2 groups according to PPC. All-cause mortality was evaluated after followed-up for at least 3 months.ResultsHigh PPC group showed lower mortality compared with Low PPC group by Kaplan-Meier analysis and log-rank test. Both multivariate linear regression and multivariate logistic regression revealed that high transport status, total effluent dialysate volume per day, continuous ambulatory PD (CAPD), and protein in total effluent dialysate volume appeared to be positively correlated with PPC; body mass index (BMI) and the normalized protein equivalent of total nitrogen appearance (nPNA) were negatively correlated with PPC. Besides PD modality and membrane transport status, total effluent dialysate volume showed a strong relationship with PPC, but the correlation differed among PD modalities.ConclusionsHigher PPC was associated with lower all-cause mortality risk in PD patients. Higher PPC correlated with CAPD modality, fast transport status, higher effluent dialysate volume and protein content, and with lower BMI and nPNA.

[目的]研究维持性血液透析(MHD)患者并发不宁腿综合征(RLS)的危险因素及与中医证素特点相关性研究.[方法]选取 2021 年 9 月—2022 年 10 月于天津市第一中心医院血液净化中心治疗的MHD患者 305 例,根据是否发生RLS分为阳性组和阴性组,其中RLS阳性组患者72例,RLS阴性组患者233例,通过Logistic回归分析MHD并发RLS患者的危险因素及与中医证素特点的关系.[结果]多因素Logistic回归分析显示Hb＜110 g/L、PTH≥350 pg/mL、原发糖尿病肾病是MHD患者并发RLS的危险因素(P＜0.05).病性证素中最常见的是血虚 45 例(62.50%)、阴虚42 例(58.33%)、湿 40 例(55.56%)、动风 38 例(52.78%),病位证素最常见的是肾 50 例(69.44%)、肝 44 例(61.11%)、经络 41 例(56.94%)、脾 36 例(50.00%),中医证素与危险因素回归分析中,年龄是血虚、湿、痰的危险因素,原发肾小球疾病是气虚、血瘀的危险因素.[结论]糖尿病肾病、贫血、高PTH水平是MHD并发RLS的独立危险因素.MHD并发RLS中医证素常见肾、血虚、肝、阴虚等,危险因素相关性分析中,年龄与血虚、湿、痰证素呈正相关,慢性肾小球肾炎与气虚、血瘀呈正相关.

To analyze the dynamic changes of renal function longitudinally and investigate the cytokine profiles at 6 months in patients with Omicron COVID‐19. Forty‐seven patients with a proven diagnosis of Omicron COVID‐19 from January to February 2022 attended a 6‐month follow‐up after discharge at Tianjin First Central Hospital. The demographic parameters, clinical features, and laboratory indexes were collected during hospitalization and 6 months after discharge. The serum cytokine levels at 6 months were also assessed. Patients were grouped according to with or without kidney involvement at admission. The levels of serum creatinine and estimated glomerular filtration rate (eGFR) were all normal both in the hospital and at follow‐up. Whereas, compared with renal function in the hospital, serum creatinine levels at 6 months increased remarkably; meanwhile, eGFR decreased significantly in all patients. The serum levels of interleukin (IL)‐2, IL‐4, IL‐5, IL‐6, IL‐10, and TNF‐α and IFN‐γ significantly decreased and TGF‐β remarkably increased in the kidney involvement group. The serum levels of IL‐2 and IL‐5 were positively correlated with age; contrarily, TGF‐β showed a negative correlation with aging. The younger was an independent risk factor of the higher TGF‐β levels. Omicron patients showed a decline in renal function at follow‐up, reflecting the trend of CKD. Serum cytokine profiles were characterized with the majority of cytokines decreased and TGF‐β increased in the kidney involvement group; the latter may be used as a sign of CKD. The tendency of CKD is one of the manifestations of long COVID and deserves attention.

INTRODUCTION:This study evaluated the incidence, clinical characteristics, and risk factors of kidney involvement in patients with the Omicron variant infection in the post-acute treatment phase in Tianjin, China. METHODS:Data were collected from 430 patients with Omicron variant infection in Tianjin, China. Demographics, comorbidities, laboratory blood tests, urinalysis, vaccination status, and COVID-19 clinical classification were assessed. Patients were grouped based on kidney involvement, and associated risk factors of kidney involvement were also investigated. RESULTS:Asymptomatic, mild, ordinary, and severe patients with Omicron COVID-19 variant comprised 1.5%, 49.1%, 48.9%, and 0.5% of the sample population, respectively, without critical illness or death. The incidences of hematuria, proteinuria, and concurrent hematuria and proteinuria were 14.7%, 14.2%, and 5.1%, respectively. Patients with and without kidney involvement differed in age, body mass index (BMI), comorbidity, creatinine levels, estimated glomerular filtration rate, and C-reactive protein (CRP) levels. Age, hypertension, higher CRP levels, and higher BMI were linked with kidney involvement. CONCLUSION:The majority of the patients suffered from mild or ordinary symptoms of Omicron COVID-19 infection. The primary kidney involvement was hematuria and proteinuria. Proteinuria was significantly associated with Omicron variant infection, and patients with hypertensive comorbidity, higher CRP, and higher creatinine levels were at increased risk of proteinuria after Omicron variant infection.