BackgroundPeritoneal dialysis (PD) and conventional in‐center hemodialysis (HD) are treatment options for patients with end‐stage kidney disease (ESKD). However, their impact on all‐cause mortality is unclear.MethodsWe conducted a multicenter, open‐label, randomized, non‐inferiority trial to determine the effect of dialysis modality on mortality in patients with ESKD. Eligible patients were recruited from 30 sites across China and assigned to receive either PD or HD in a ratio of 1:1. The primary outcome was all‐cause mortality. Non‐inferiority was defined as the upper bound of the one‐sided 95% confidence interval (CI) for the hazard ratio (HR) being ≤1.25.ResultsA total of 414 patients with incident ESKD were randomly assigned to PD (n = 213) or HD (n = 201). During a median follow‐up of 1.7 years, 37 patients in the PD group and 31 in the HD group died, giving respective event rates per patient‐year of 0.061 and 0.071. The HR for mortality on PD in comparison with HD was 0.76 (95% CI 0.47–1.24) after adjustment for age, sex, and diabetes status, achieving the limit for non‐inferiority. There were more adverse events (p = 0.003), serious adverse events (p = 0.009), and adverse events leading to hospitalization (p = 0.003) in the PD group than in the HD group; however, there was no significant between‐group difference in adverse events leading to death or discontinuation of treatment.ConclusionsPD was non‐inferior to conventional in‐center HD in terms of survival in patients with ESKD. Our findings underscore the need for shared decision‐making between physicians and patients regarding the selection of dialysis modality.Trial registrationRegistered at ClinicalTrials.gov (NCT01413074).

The purpose of this study was to investigate the efficacy and safety of a low-dose Rituximab (RTX) regimen driven by peripheral blood B lymphocyte count in the treatment of adult patients with nephrotic syndrome (NS) complicated with acute kidney disease (AKI). We conducted a prospective single-arm study to evaluate the effect of B cells-driven RTX regimen. Patients with NS (MCD, FSGS, MN, IgAN) complicated with AKI fulfilling the inclusion criteria were eligible for this study. Patients were followed up at intervals of 2 months. Student's t-test and Chi-squared test were used to analyze normally distributed continuous variables and non-normally distributed continuous variables, respectively. From August 2018 to January 2022, 23 patients met the inclusion criteria and agreed to participate in the study. 3, 9, and 11 patients were AKI stage 1, 2, and 3, respectively. From baseline to the latest follow-up, 20 patients had complete and partial recovery of renal function. Accompanied by depletion of B cells, significant reduction of urinary protein excretion, serum total cholesterol, and the number of relapses were observed during the 12 months after the first RTX infusion as compared with during the 12 months before RTX injection. The number of patients who maintained steroids and immunosuppressive medications also remarkably decreased. This study indicates that the targets-driven treatment of low-dose RTX can achieve a high remission rate and alleviate the loss of kidney function in treating NS with AKI. The long-term efficacy, side effects, and therapeutic economics of RTX are reasonable.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

Objective:To evaluate the efficacy and safety of Abelmoschus manihot ( A. Manihot) alone and in combination with irbesartan, for reduction of albuminuria in patients with type 2 diabetic kidney disease. Methods:A multicenter randomized double-blind and parallel controlled clinical trial was performed in 9 hospitals of Jiangsu Province (Affiliated Hospital of Nanjing University of Chinese Medicine, First People′s Hospital of Changzhou, First People′s Hospital of Xuzhou, Wuxi People′s Hospital, Affiliated Hospital of Nantong University, Taizhou Hospital of Traditional Chinese Medicine, First Affiliated Hospital of Soochow University, Zhongda Hospital, Southeast University, Changzhou Hospital of Traditional Chinese Medicine) from May 2017 to March 2021. Huangkui capsule, as a traditional Chinese medicine, is made from the ethanol extract of flowers in A. Manihot. All enrolled patients were randomly assigned to the irbesartan group [irbesartan tablets (150 mg/dose, 1 dose/day)+Huangkui capsule simulant (2.5 g/dose, 3 doses/day)], Huangkui capsule group [Huangkui capsule (2.5 g/dose, 3 doses/day)+irbesartan simulant (150 mg/dose, 1 dose/day)], and combined treatment group [irbesartan tablets (150 mg/dose, 1 dose/day)+Huangkui capsule (2.5 g/dose, 3 doses/day)]. The duration of intervention was 24 weeks. Urinary creatinine and urinary albumin were detected at baseline and 24 weeks after treatment, and the urinary albumin-to-creatinine ratio was calculated to observe the change value and rate of UACR compared with baseline. The occurrence of adverse events, adverse reactions, serious adverse events, serious adverse events, and adverse events leading to withdrawal were recorded and the incidence was calculated. One-way analysis of variance (ANOVA), χ2 test or Fisher's exact test were used to compare among groups. Results:A total of 413 patients with type 2 diabetic kidney disease were included, including 138 in the irbesartan group, 137 in the Huangkui capsule group and 138 in the combined treatment group. After 24 weeks of treatment, the UACR changes of three groups were (-89.07±51.17) mg/g in the irbesartan group, (-146.06±45.52) mg/g in the Huangkui capsule group, and (-262.31±39.08) mg/g in the combined treatment group. The rate of UACR change was (-5.21±6.12)% in the irbesartan group, (-11.89±5.75)% in the Huangkui capsule group, and (-28.56±4.65)% in the combined treatment group, respectively. There were significant differences between the combined treatment group and the irbesartan group in the change value and rate of UACR ( P<0.001), while there were no statistical differences between the Huangkui capsule group and irbesartan group ( P>0.05). After 24 weeks of treatment, there were no significant differences in the incidence of adverse events, adverse reactions, serious adverse events and serious adverse reactions among the 3 groups ( P>0.05). Conclusion:The combination of irbesartan and Huangkui capsule can reduce the level of UACR in patients with type 2 diabetic kidney disease, and it shows good efficacy and safety in the treatment of albuminuria in patients with type 2 diabetic kidney disease.

from the of fl owers in Abelmoschus of of patients with type 2 diabetes and microalbuminuria undertaken a multicenter randomized double-blind parallel controlled clinical trial to evaluate the ef fi cacy and safety of huangkui capsule alone and in combination with irbesartan for reduction of albuminuria and proteinuria in T2D patients with diabetic kidney disease (DKD).

目的 探讨成纤维细胞生长因子23(fibroblast growth factor-23,FGF-23)水平在终末期肾病(end stage renal disease,ESRD)患者桡动脉钙化(radial artery calcification,RAC)与自体动静脉内瘘(arteriovenous fistula,AVF)失功中的预测价值.方法 收集212例在南京医科大学附属无锡市人民医院行AVF手术的ESRD患者的临床资料,采用ELISA检测患者术前血清FGF-23水平.采用HE染色法对桡动脉血管进行钙化染色以评估RAC程度.据随访期间临床及影像学资料将患者分为AVF失功及AVF通畅组.比较FGF-23水平在不同分组中的差异及预测作用.结果 212例患者中有57.8％发生RAC(123/212).当 cut-off 值取 FGF-23＞488.5ng/ml 时,FGF-23预测 RAC 的敏感性为0.797,特异性为0.921;当cut-off值取FGF-23＞490.9ng/ml时,预测AVF失功的敏感性为0.757,特异性为0.560.结论 ESRD患者RAC的发生率高,FGF-23可能是预测RAC及AVF失功的理想标志物.

目的:系统评价内皮型一氧化氮合酶(endothelial nitric oxide synthase,eNOS)基因G894T多态性与糖尿病肾病(diabetic nephropathy,DN)易感性之间的关系.方法:全面检索建库以来至2019年6月与eNOS基因G894T多态性及DN易感性相关的文献,通过纽卡斯尔渥太华(Newcastle-Ottawa Scale,NOS)标准对纳入文献进行质量评价.采用Stata 15.0进行统计学分析,通过计算发病风险比值比(odds ratio,OR)及95％置信区间(confidence interval,CI)来评估eNOS基因G894T多态性与DN易感性之间的关系.结果:共纳入29项病例对照研究,包含实验组5345例,对照组4827例.分析结果显示eNOS基因G894T多态性可显著增加DN发病风险[等位基因模型T vs G:OR=1.39(95％CI:1.19～1.64),P<0.001;纯合子模型TT vs GG:OR=1.34(95％CI:1.02～1.77),P=0.038;显性遗传模型TT+GT vs GG:OR=1.48(95％CI:1.21～1.81),P<0.001;隐性遗传模型TT vs GG+GT:OR=1.30(95％CI:1.04～1.63),P=0.022;杂合子模型TG vs GG:OR=1.43(95％CI:1.17～1.75),P=0.001].结论:eNOS基因G894T多态性可明显增加DN易感性.

目的:探讨miR-101靶向雷帕霉素靶蛋白(mTOR)信号通路调控足细胞自噬在小鼠糖尿病肾病发病中的作用.方法:将成年雄性C57 BL/6小鼠分为对照组、模型组和雷帕霉素组,每组10只.模型组和雷帕霉素组小鼠连续腹腔注射链脲佐菌素(55 mg·kg-1)5 d,对照组腹腔注射等量生理盐水.腹腔注射链脲佐菌素后1周,雷帕霉素组小鼠腹腔注射雷帕霉素(2 mg·kg-1),对照组和模型组小鼠腹腔注射等量生理盐水,隔天1次,连续12周后对小鼠肾脏组织行PAS染色,用透射电镜观察足细胞损伤及自噬情况,同时检测肾组织中miR-101、Nephrin、LC3Ⅰ、LC3Ⅱ、mTOR和AMPK mRNA的表达.结果:对照组小鼠肾脏和足细胞足突正常,模型组小鼠肾脏局部可见球囊融合;与对照组相比模型组小鼠肾脏系膜基质明显增多,基底膜明显增厚,足突明显增宽、融合,自噬体明显减少;与模型组相比,雷帕霉素组小鼠肾脏系膜基质明显减少,基底膜增厚和足突融合明显减轻,自噬体明显增加.与对照组相比,模型组和雷帕霉素组小鼠肾脏系膜基质面积增大、mTOR mRNA表达水平明显升高,Nephrin、LC3Ⅰ、LC3Ⅱ、miR-101和AMPK mRNA表达水平明显降低(P<0.05);与模型组相比,雷帕霉素组小鼠mTOR mRNA表达水平明显降低,Nephrin、LC3Ⅰ、LC3Ⅱ、miR-101和AMPK mRNA表达水平明显升高(P<0.05).结论:miR-101通过靶向调控mTOR信号通路促进糖尿病肾病小鼠足细胞自噬,为糖尿病肾病的治疗提供了新方向.

Introduction: C-X-C motif chemokine ligand 16 (CXCL16) is an inflammatory marker that has been found to be predictive of outcomes in patients with cardiovascular disease. Our previous work has also demonstrated its relation to cardiac injury in dialysis patients. However, it is yet unclear whether there is an association between CXCL16 and adverse outcomes in dialysis patients. We aimed to evaluate its prognostic value along with several traditional inflammatory markers in the current study. Methods: This is a multicenter longitudinal study of prevalent dialysis patients. Circulating inflammatory markers including CXCL16, C-reactive protein (CRP), tumor necrosis factor-α, and interleukin-6 (IL-6) were measured using a multiplex assay. The primary outcomes were all-cause mortality and a composite of major adverse cardiovascular events (MACEs). The associations between biomarkers and outcomes were analyzed using Cox proportional hazards regression models. Results: Of the 366 participants with available plasma samples, the average age was 52.5 (±12.1) years, and there were 160 (43.7%) female participants. For all-cause mortality, logarithmically transformed CXCL16, IL-6, and CRP were independent predictors after adjustment for covariates. When the 3 markers were included in the same model, CXCL16 was the only one remaining its significance. For MACEs, logarithmically transformed CXCL16 and IL-6 were significant predictors when analyzed separately and CXCL16 was an independent predictor even after adjustment for IL-6. When the biomarkers were analyzed as categorical variables, only CXCL16 was associated with both outcomes. Adding CXCL16 to established risk factors improved risk prediction as revealed by Net Reclassification Index (NRI). Conclusion: Using a multimarker approach, we determined that CXCL16 is a potent predictor of all-cause mortality and cardiovascular events in dialysis patients. Our data suggest CXCL16 may improve risk stratification and could be a potential interventional target.

Abstract Background/Aims Diabetic nephropathy (DN) is one of the main causes of end-stage kidney disease worldwide. Emerging studies have suggested that its pathogenesis is distinct from nondiabetic renal diseases in many aspects. However, it still lacks a comprehensive understanding of the unique molecular mechanism of DN. Methods A total of 255 Affymetrix U133 microarray datasets (Affymetrix, Santa Calra, CA, USA) of human glomerular and tubulointerstitial tissues were collected. The 22 215 Affymetrix identifiers shared by the Human Genome U133 Plus 2.0 and U133A Array were extracted to facilitate dataset pooling. Next, a linear model was constructed and the empirical Bayes method was used to select the differentially expressed genes (DEGs) of each kidney disease. Based on these DEG sets, the unique DEGs of DN were identified and further analyzed using gene ontology and pathway enrichment analysis. Finally, the protein–protein interaction networks (PINs) were constructed and hub genes were selected to further refine the results. Results A total of 129 and 1251 unique DEGs were identified in the diabetic glomerulus (upregulated n = 83 and downregulated n = 203) and the diabetic tubulointerstitium (upregulated n = 399 and downregulated n = 874), respectively. Enrichment analysis revealed that the DEGs in the diabetic glomerulus were significantly associated with the extracellular matrix, cell growth, regulation of blood coagulation, cholesterol homeostasis, intrinsic apoptotic signaling pathway and renal filtration cell differentiation. In the diabetic tubulointerstitium, the significantly enriched biological processes and pathways included metabolism, the advanced glycation end products–receptor for advanced glycation end products signaling pathway in diabetic complications, the epidermal growth factor receptor (EGFR) signaling pathway, the FoxO signaling pathway, autophagy and ferroptosis. By constructing PINs, several nodes, such as AGR2, CSNK2A1, EGFR and HSPD1, were identified as hub genes, which might play key roles in regulating the development of DN. Conclusions Our study not only reveals the unique molecular mechanism of DN but also provides a valuable resource for biomarker and therapeutic target discovery. Some of our findings are promising and should be explored in future work.

Supplemental Digital Content is available in the text Objective: Studies in the general population suggest that central blood pressure (BP) may be superior to peripheral BP in risk assessment. Although ambulatory brachial BP is recognized as the most reliable BP measurement in the dialysis population, there is no comparison of office central BP with ambulatory BP regarding risk stratification in these patients. Methods: In a multicenter prospective study of dialysis patients, central BP was measured noninvasively on a midweek nondialysis day, with interdialytic ambulatory BP and predialysis BP also collected. The primary outcomes were a composite of major adverse cardiovascular events (MACE) and all-cause mortality. Agreement between central and ambulatory BP was assessed using Cohen's Kappa index and Bland--Altman plot. Linear and nonlinear Cox regression models were used to determine the association of BP parameters with outcomes. Results: A total of 368 patients were recruited and 366 underwent central BP measurement. Central BP had a moderate agreement with ambulatory BP in defining hypertension (κ = 0.42) with wide limits of agreement in Bland--Altman analysis. After a median follow-up of 51.5 months, central pulse pressure, ambulatory SBP and ambulatory pulse pressure were associated with all-cause mortality, whereas all BP parameters, except for predialysis DBP, were significant predictors of MACE. However, whenever evaluated in a stepwise variable selection Cox model, only ambulatory pulse pressure, but not any central BP, was determined as the best candidate for prediction of both all-cause mortality and MACE. Nonlinear Cox models revealed no significant nonlinear trend of the association between central BP and outcomes. Conclusion: Central BP is predictive of all-cause mortality and cardiovascular events in dialysis patients but its prognostic value does not outperform ambulatory peripheral BP. Our data support the superiority of ambulatory BP in the dialysis population.

目的 评价白细胞介素10(IL-10)基因-819T/C多态位点与糖尿病肾病(DN)易感性的关系.方法 检索PubMed、Embase、Medline、中国知网、维普数据库、万方数据库中与IL-10基因-819T/C多态性及DN发病相关的研究,检索时间为建库至2019年10月,使用纽卡斯尔渥太华(NOS)标准对纳入文献进行质量评价.以发病风险比值比(OR)及95％可信区间(CI)为效应指标,使用STATA12.0进行统计学分析.结果 共纳入7项病例对照研究,其中实验组均为DN患者,对照组为糖尿病(DM)患者或健康对照者(HC).Meta分析结果显示:①DN组与对照组相比,IL-10基因-819T/C位点在等位基因模型(C vs.T:OR=0.999,P=0.990)、纯合子模型(CC vs.TT:OR=1.040,P=0.713)、显性模型(TC+CC vs.TT:OR=1.052,P=0.561)、隐性模型(CC vs.TC+TT:OR=0.993,P=0.954)、杂合子模型(TC vs.TT:OR=1.039,P=0.679)上的差异均无统计学意义(P>0.05);②地区亚组分析显示,在亚洲及中国人群中,DN组与对照组在各遗传模型上的差异均无统计学意义(P>0.05).结论 IL-10基因-819T/C多态性不增加DN易感性,在亚洲及中国地区人群中可得到类似结论,但仍需高质量的研究进一步验证.

Objective:To observe the expression of serum cystatin C(Cys C) in patients with chronic renal failure(CRF) and coronary heart disease, and to analyze the relationship between Cys C level and micro-inflammatory state in patients with CRF and coronary heart disease.Methods:The clinical data of patients with CRF who treated in the hospital from January 2018 to June 2019 were retrospectively analyzed. Fifty cases with coronary heart disease were included in coronary heart disease group, 50 cases without coronary heart disease were included in non-coronary heart disease group, and 50 healthy controls who were confirmed by physical examination during the same period were included in control group.The serum creatinine(Scr) and 24 hour urinary protein(24 h Upr) levels of CRF patients in the two groups were compared.The Cys C, high-sensitivity C-reactive protein(hs-CRP), interleukin 6(IL-6), and tumor necrosis factor α(TNF-α) levels of the three groups were compared.The correlation between serum Cys-C levels and the levels of inflammatory factors in patients with CRF and coronary heart disease was analyzed by bivariate Pearson linear correlation analysis.Results:The levels of serum Cys C, hs-CRP, IL-6 and TNF-α in coronary heart disease group was the highest, followed by non-coronary heart disease group and control group, and the difference between groups was significant( P<0.05). Bivariate Pearson linear correlation analysis showed that the serum Cys C level was positively correlated with hs-CRP, IL-6 and TNF-α in patients with CRF and coronary heart disease( r>0, P<0.05). Conclusions:Micro-inflammatory state is common in patients with CRF and coronary heart disease. This micro-inflammatory state is related to the expression of serum Cys C in patients.Cys C may be involved in the occurrence of micro-inflammatory state in patients with CRF and coronary heart disease, which may provide new ideas for the assessment and treatment of early micro-inflammatory state in patients with CRF and coronary heart disease.

目的 系统评价白细胞介素-10(interleukin-10,IL-10)基因-1082A/G多态性与糖尿病肾病(diabetic nephrop-athy,DN)易感性之间的关系.方法 检索建库以来至2019年6月间与IL-10基因1082A/G及DN发病风险相关的病例对照研究,使用纽卡斯尔渥太华(Newcastle-Ottawa Scale,NOS)标准对纳入文献进行质量评价.采用STATA12.0软件进行统计分析,选择发病风险比值比(odds ratio,OR)及95％置信区间(confidence interval,CI)为效应指标.结果 本研究共纳入10项研究,包含DN患者1759例,单纯糖尿病(diabetes mellitus,DM)患者1525例,健康对照(heahy control,HC)者2209例.DN组与单纯DM组比较,IL-10基因-1082A/G多态性在各遗传模型上差异均无统计学意义(P＞0.05).DN组与健康人群比较,IL-10基因-1082A/G多态性在纯合子模型下与DN呈明显相关性(GG vs AA:OR=0.577,P＜0.05).将地区进行亚组分析发现,亚洲人群中IL-10基因-1082A/G多态性在除杂合子模型外的其他遗传模型中差异均有统计学意义(G vs A:OR =0.589,P=0.031;GGvsAA:OR=0.349,P=0.000;GG vs GA+AA:OR=0.588,P=0.015;GG+GA vs AA:OR=0.629,P=0.000).结论 IL-10基因-1082A/G多态性与DN发病相关,亚洲人群中G等位基因、GG基因型是DN发病的保护因素.

目的 探讨终末期肾衰(ESRD)拟透析患者腹主动脉钙化与胰岛素抵抗、微炎症状态、成纤维细胞生长因子23(FGF23)/klotho轴的关系.方法 分析60例ESRD拟行维持性透析患者(ESRD组)的临床资料,检测胰岛素抵抗指数(HOMA-IR),血清微炎症状态指标TGF-β、IL-6,血清FGF23、可溶性klotho蛋白(sklotho)水平,并与健康对照组进行比较.观察ESRD患者腹主动脉钙化的发生情况,比较发生腹主动脉钙化与未发生腹主动脉钙化患者的临床资料,采用Logistic回归分析发生腹主动脉钙化的危险因素.结果 与健康对照组比较,ESRD组HOMA-IR、血清FGF23升高,sklotho降低(P<0.05或<0.01).ESRD组中,35例发生腹主动脉钙化,25例未发生腹主动脉钙化.与无钙化患者比较,钙化患者HOMA-IR及血清FGF23、TC升高,sklotho、Alb降低(P<0.05或<0.01).Logistic回归分析显示,血清FGF23(OR=0.993、P=0.032)、sklotho(OR=1.006、P=0.009)是腹主动脉钙化的独立危险因素.结论 ESRD拟透析患者体内存在胰岛素抵抗、微炎症状态及FGF23/klotho轴异常,血清FGF23升高和sklotho降低是腹主动脉钙化的独立危险因素.FGF23/klotho轴可能与胰岛素抵抗、微炎症状态相互作用,共同参与ESRD患者腹主动脉钙化的发生.

BACKGROUND:It is generally considered that traditional Chinese medicine (TCM) therapy postpones the progression of some chronic kidney diseases (CKDs). Chinese medicine herbs are widely applied in TCM therapy. We aimed to evaluate clinical efficacy and safety of Chinese herbal formula granules in patients with CKD stage 3 through a prospective randomized controlled study.METHODS:A total of 343 participants with CKD stage 3 were recruited from 9 hospitals in Jiangsu Province between April 2014 and October 2016. Participants were randomly assigned to a treatment or control group. Patients in the treatment group orally took Chinese herbal formula granules twice a day, while controls received placebo granules. The duration of intervention was 24 weeks. Primary outcomes were 24-hour proteinuria, serum creatinine, and eGFR, which were measured every 4 weeks.RESULTS:There was no statistical difference in 24-hour proteinuria between the two groups (0.97 ± 1.14 g/d vs. 0.97 ± 1.25 g/d). Patients in the treatment group had significantly lower serum creatinine level (130.78 ± 32.55 μmol/L versus 149.12 ± 41.27 μmol/L) and significantly higher eGFR level (55.74 ± 50.82 ml/min/1.73·m2 versus 44.46 ± 12.60 ml/min/1.73·m2) than those in the control group (P < 0.05). There was no significant difference between two groups in the incidence of adverse events.CONCLUSION:The treatment adopting Chinese herbal formula granules for 24 weeks improved kidney function of patients with CKD stage 3.

BACKGROUND:ESRD (End-stage renal disease) treatment is a comprehensive medical process and requires numerous serological biochemical tests (SBTs) in diagnosis. To reduce these invasive, expensive, cumbersome, and time-consuming SBTs, there is a need to develop an alternative serological biochemical composition evaluation method. Bioelectrical impedance analysis (BIA) is affected by body's chemical and physical components, which might be correlated with serological biochemical composition and can be potentially used to evaluate biochemical composition in hemodialysis patient treatments. In this work, the relationship of classic and specific bioelectrical impedance vector analysis (BIVA) with major serological biochemical indexes in maintenance hemodialysis (MHD) patients was examined.METHODS:Bioelectrical and biochemical datasets were measured from 280 women and 408 men and formed 3872 effective biochemical-bioelectrical records in total. Statistical analysis was performed.RESULTS:The results show that BIVA vectors have strong relationship with phosphorus, hemoglobin, and PTH in both male and female groups. Strong correlation was also observed between Ca, albumin, CHOL, LDLC, and BIVA vectors in the male group. In the female group, a significant correlation was observed between classic BIVA values and NT-proBNP. SVM models are effective for classifying biochemical indexes.CONCLUSIONS:The obtained correlations and SVM classification models imply that BIVA can be used as a preliminary tool to evaluate and classify the degree of anemia, malnutrition, fluid overload, and mineral and bone disorder (MBD) in MHD patients by reducing the number of SBTs.

Background. M-type phospholipase A2 receptor (PLA2R) is the first autoantigen responsible for idiopathic membranous nephropathy (IMN). However, serum PLA2R antibody (PLA2R-Ab) can be inaccurate in distinguishing between IMN and secondary membranous nephropathy, while renal PLA2R antigen (PLA2R-Ag) emerges as an ancillary diagnostic. The present study is aimed at examining the associations between PLA2R-Ab in sera and PLA2R-Ag in kidneys in IMN patients. Methods. A total of 93 patients with IMN were retrospectively identified. Their serum PLA2R-Ab and renal PLA2R-Ag expression levels were determined, and the clinical correlations between these parameters and clinical features were examined. Results. The sensitivities of serum PLA2R-Ab and renal PLA2R-Ag for diagnosing IMN were 74.2% and 88.2%, respectively (P<0.001), with poor consistency. Higher serum PLA2R-Ab levels were correlated to stronger renal PLA2R-Ag expression (P=0.048). Patients with positive PLA2R-Ab significantly differed from those with negative levels, in terms of proteinuric levels over 24 hours (4.54 vs. 3.46 g/day, P=0.015) and serum albumin (23.28 vs. 27.95 g/L, P=0.038). Among patients with positive renal PLA2R-Ag, patients with positive PLA2R-Ab had significantly higher 24-hour proteinuria, when compared to patients with negative PLA2R-Ab (4.57 vs. 3.08 g/day, P=0.005). Among those with positive PLA2R-Ab in sera, their PLA2R-Ab levels were correlated with the estimated glomerular filtration and serum creatinine. Conclusion. Serum PLA2R-Ab exhibits a closer correlation with proteinuric severity and renal function, when compared to renal PLA2R-Ag.

糖尿病肾脏病(DKD)是糖尿病最主要的微血管并发症,也是终末期肾脏疾病的主要原因之一.近年来,随着糖尿病患病率的增加,DKD的发病机制迅速成为研究热点.DKD的发病机制多种多样,错综复杂.但普遍认同的是,糖代谢的异常是DKD起始的重要原因.同时,能量代谢也被发现是DKD的进展的重要途径.本文简述了糖代谢紊乱在DKD进展中的影响,并概述了参与能量代谢的线粒体的功能障碍在DKD中的作用.

目的 维持性血液透析患者的心脑血管事件的患病率远高于一般人群.在文章中分析维持性血液透析(maintenance hemodialysis,MHD)患者心脑血管疾病(cardio-cerebrovascular diseases,CVD)患病的现状,并研究患者发生心脑血管意外的危险因素.方法 研究共纳入42名维持性血液透析患者,记录患者既往是否有心脑血管病史等临床病史,完善相关血液检查.参加本研究的患者同时完成动态血压(ambulatory blood pressure,ABP)监测及颈动脉-股动脉脉搏波速度(carotid-femoral pulse wave veloity,cfPWV)测定;根据患者既往是否存在心脑血管意外病史将患者分为发生心脑血管意外组(CVD组)及未发生心脑血管意外组(non-CVD)组,比较两组组间差异,并探讨MHD患者发生心脑血管事件的危险因素.结果 研究发现MHD患者心脑血管事件的患病率14.29％,CVD组患者血脂(triglyceride,TG)、cfPWV高于non-CVD组,而24 h动态血压的舒张压(24 h DBP)、白天动态血压的舒张压(d DBP)低于non-CVD组,差异具有统计学意义;通过二元logistic多因素回归分析,研究发现24 h DBP[β=-0.201,P=0.024]及cfPWV[β=0.412,P=0.026]是患者发生心脑血管事件的独立危险因素.结论 维持性血液透析患者CVD的患病率高于一般人群,过低的舒张压及过高的cfPWV促进患者心脑血管事件的发生.