Renal dysfunction frequently occurs in patients with portal hypertension and is linked to unfavorable clinical outcomes. Transjugular intrahepatic portosystemic shunt (TIPS) has the potential to enhance renal perfusion through portal decompression; however, factors predicting early improvement in renal function remain insufficiently defined. This retrospective, single-center study analyzed 188 consecutive patients with portal hypertension who underwent TIPS. Patients receiving renal replacement therapy or with baseline eGFR < 15 mL/min/1.73 m2 were excluded. The primary endpoint was early renal function improvement, defined as a > 10% reduction in serum creatinine within 7 days. Early renal function improvement was observed in 27.7% of the cohort. Lower baseline eGFR was independently associated with higher probability of improvement (adjusted OR: 0.980, 95% CI: 0.966-0.993; p = 0.004). Neither pre- nor post-TIPS portal venous pressure nor the magnitude of pressure reduction was significantly associated with renal response. Restricted cubic spline analysis indicated a linear inverse relationship between baseline eGFR and improvement probability. The multivariable model demonstrated modest discriminative ability (AUC 0.666). Baseline renal function was associated with early post-TIPS early renal function improvement, whereas intra-procedural portal pressure parameters were not predictive. These findings suggest that early renal function improvement following TIPS may predominantly reflect reversible functional impairment rather than established structural kidney injury.

Background Cerebral small vessel disease (CSVD) is a major vascular contributor to dementia, cognitive decline, gait impairment, mood disturbance and stroke. Maintenance hemodialysis (MHD) patients have a high CSVD prevalence with poor prognosis. However, the dynamic progressive features and associated risk factors of CSVD in MHD patients remain unclear. We aimed to explore the progression of CSVD subtypes and their associated risk factors in MHD patients. Method This prospective cohort study enrolled MHD patients from January to June 2023 at Beijing Shijitan Hospital. Clinical and dialysis-related data were collected. Transcranial Doppler (TCD) was used to monitor the mean flow velocity (MFV) of the middle cerebral artery during dialysis, and the MFV reduction rate during dialysis was calculated. The cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and Lacunes on brain magnetic resonance imaging (MRI) were assessed at baseline and at the 12-month follow-up. Multivariate linear regression model was used to analyze the risk factors associated with the progression of CSVD. Results A total of 92 MHD patients were included in this study, with a mean age of (63.21 ± 8.21) years (40–85 years old) and 71 males (77.17%). Compared with baseline, significant progression was observed in CMBs, WMHs and Lacunes at the 12-month follow-up ( p < 0.05). Multivariate linear regression analysis showed that longer dialysis vintage, higher MVF reduction rate, and elevated hsCRP levels were significantly associated with CMBs progression ( B = 0.065, 95% CI : 0.021–0.109, p = 0.004; B = 19.274, 95% CI : 0.379–38.168, p = 0.046; B = 0.311, 95% CI : 0.068–0.554, p = 0.013). Aging and increased MVF reduction rate were associated with WMHs progression ( B = 0.023, 95% CI : 0.006–0.040, p = 0.010; B = 1.352, 95% CI : 0.156–1.636, p = 0.013). In addition, smoking status and diabetes mellitus were significantly linked to lacunars progression ( B = 0.896, 95% CI : 0.156–1.636, p = 0.018; B = 1.230, 95% CI : 0.414–2.045, p = 0.004). Conclusion In addition to age, dialysis vintage, diabetes mellitus and smoking, the reduction in cerebral blood flow during hemodialysis is an independent risk factor for the progression of CSVD in MHD patients.

Immune checkpoint inhibitors (ICIs) are a novel and promising anti-cancer therapy. We conducted this systematic review to precisely quantify the occurrence and development for actue kidney injury(AKI) following ICIs treatment for cancer. We conducted a search of the PubMed, Embase, Web of Science, and Cochrane Library databases. Twenty-nine studies, comprising 24,953 cancer patients who received ICIs were finally eligible. The incidence of AKI was 16.2% (95%CI:12.8%-19.8%); the incidence of immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) was 3.1%(95%CI:2.4%-4%); the incidence of non-ICPi-AKI was 11.2%(95%CI:8.4%-14.3%), and the incidence of sustained AKI was 14.9%(95%CI:7.5%-24.3%). Patients who developed AKI (HR = 1.521(95%CI:1.208-1.916)) and ICPi-AKI (HR = 1.407(95%CI:1.059-1.869)) exhibited an elevated risk of all-cause mortality. An increased risk for AKI was observed with preexisting chronic kidney disease (CKD) and combined with other extrarenal immune-related adverse events (irAEs). The use of nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitor (PPI), diuretic, renin-angiotensin-aldosterone system (RAASi), antibiotics and fluidone was also significantly associated with incident AKI. Combined therapy had a greater impact on renal injury compared to monotherapy. Patients using ipilimumab were more prone to developing AKI, compared to those using nivoluma. CTLA4 (ref'PD-1) was associated with a higher likelihood of sustained AKI. The use of PDL-1(ref='PD-1) was linked to an increased susceptibility to ICPi-AKI. The occurrence of AKI was intricately linked to specific complications, the concomitant use of certain medications, and the specific regimen of ICIs. This deserves our attention.

BackgroundAs a state of metabolic and nutritional derangements, protein-energy wasting (PEW) is highly prevalent and associated with increased morbidity and mortality in hemodialysis patients. Fibroblast growth factor-23 (FGF-23) and Klotho have been proven to contribute to chronic kidney disease-mineral and bone disorder (CKD-MBD) in patients undergoing hemodialysis. Previous evidence suggested that FGF-23 and Klotho may also contribute to the malnutritional status among these patients; however, the inter-relationship between the FGF-23–Klotho axis and PEW remains unclear. Therefore, we conducted this cross-sectional study to evaluate the association between plasma FGF-23 and Klotho levels and PEW in hemodialysis patients and to explore whether these markers could predict the presence of PEW.MethodsPlasma concentrations of FGF-23 and Klotho were measured, and their associations with PEW were assessed. PEW was evaluated based on body weight, muscle mass, biochemical data, and protein and energy intake, according to the 2008 criteria from the International Society of Renal Nutrition and Metabolism (ISRNM).ResultsIn this study, 147 hemodialysis patients (mean age 61.05 ± 13.32 years) were enrolled, of whom 66 (44.90%) had PEW. PEW was significant positively correlated with FGF-23 (r = 0.403, p < 0.001), age (r = 0.225, p = 0.006), C-reactive protein (r = 0.236, p = 0.004), intact parathyroid hormone (r = 0.237, p = 0.004), and single-pool Kt/V (r = 0.170, p = 0.040), while it was negatively correlated with Klotho (r = −0.361, p < 0.001), hemoglobin (r = −0.215, p = 0.009), and serum creatinine (r = −0.278, p = 0.001). Logistic regression analyses showed that plasma FGF-23 and Klotho were independently associated with PEW, even after adjusting for covariables. The area under the ROC curve (AUC) of FGF-23 and Klotho in predicting PEW was 0.734 and 0.710 (p < 0.001), respectively. When the combination of FGF-23 and Klotho was used to predict PEW, its sensitivity was 81.8%, specificity was 60.5%, and the AUC was 0.746.ConclusionPlasma levels of FGF-23 and Klotho are associated with PEW in hemodialysis patients. Higher plasma FGF-23 levels and lower Klotho levels may serve as valuable predictors of PEW in these patients.

Acute kidney injury (AKI) is a common postoperative complication associated with increased mortality. The transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertension in patients with decompensated cirrhosis; however, the incidence and risk factors for AKI following TIPS in patients with cirrhosis have not been fully elucidated. We aimed to investigate the clinical features of AKI after TIPS in patients with cirrhosis. Data from 384 patients with decompensated cirrhosis who underwent TIPS treatment were retrospectively collected. AKI was defined using the criteria recommended by 2012 the clinical practice guideline of Kidney Disease Improving Global Outcomes (KDIGO). We conducted univariate and multivariate logistic regression analyses to evaluate the risk factors for AKI and the association between AKI and all-cause mortality. Of these 384 cirrhosis patients, 8.3

Functional diarrhea (FDr) accounts for a relatively high proportion of digestive diseases. It is an infection that is not accompanied by abdominal pain and shows negative results in laboratory tests for bacteria and viruses. The main symptoms are persistent or recurrent discharge of watery and soft stools. The course of the disease is prolonged and recurring, and the treatment cost is higher and greatly affects the patient’s daily life. The incidence rate has a gradual increase in the trend. Its pathogenesis is complex where Western medicine is mostly used in symptomatic drug treatment. The treatment can be fast-acting and effective in relieving diarrhea. However, the long-term use of Western medicine poses a high risk in terms of side effects and a high chance of recurring upon stopping medication. At the same time, some diarrhea patients show the existence of drug-resistant strains of bacteria, and the overall efficacy of the drug is limited. Chinese medicine is mild and able to provide excellent treatment of diarrhea. With its lower price and cost, most families can afford it. Fengliang Tian, director of traditional Chinese medicine, implemented the “needle and medicine” method, which combines medicine and acupuncture, involving the usage of Jianpi Yishen Sechang Decoction and acupuncture in the treatment of functional diarrhea. The method has a low price, fewer side effects, is easy to accept, and can significantly reduce the recurrence rate with high efficacy. The study would like to share the clinical thinking and cases as follows to provide ideas and methods for the treatment of functional diarrhea by traditional Chinese medicine.

BackgroundThe mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood.ObjectiveTo investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis.MethodsIn this prospective observational cohort study of 121 older patients undergoing hemodialysis, we used transcranial Doppler ultrasound (TCD) to measure cerebral arterial mean flow velocity (MFV) throughout dialysis, assessed cognitive function at baseline and 12-month follow-up, and then analyzed associations between MFV and changes on cognitive scores.ResultsTCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p < 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 0.032). Compared with the baseline assessments, cognitive scores of participants at the 12-month follow-up were significantly worsened in global cognition (MOCA), some tests of memory (CFT-memory), executive function (TMT-B, SCWT-C, and SCWT-T), attention/processing speed (SDMT), and visuospatial function (CFT-copy) (p < 0.05). The worsening scores in global cognition (MOCA) (β = 0.066, 95% CI 0.018–0.113, p = 0.007) and some tests of memory (AVLT5) (β = 0.050, 95% CI 0.004–0.097, p = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) (β = 1.955, 95% CI 0.457–3.453, p = 0.011; β = 0.298, 95% CI 0.112–0.484, p = 0.002 and β = 1.371, 95% CI 0.429–2.303, p = 0.004, respectively) were significantly associated with the reduction of MFV.ConclusionHemodialysis may significantly reduce cerebral blood flow in older patients; Repetitive intradialytic decreases in CBF may be one of the mechanisms underlying the decline of cognitive function.Clinical trial registrationhttps://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&selectaction=Edit&uid=U0003QEL&ts=4&cx=-djoi2

目的 评价沙库巴曲缬沙坦(SV)治疗老年维持性血液透析(MHD)患者慢性心力衰竭的临床疗效及安全性.方法 纳入2021年1月至12月在我院肾内科就诊的合并慢性心力衰竭的老年MHD患者82例,根据是否服用SV分为治疗组40例和对照组42例,治疗组服用SV治疗,对照组使用血管紧张素转化酶抑制剂或血管紧张素受体阻滞剂治疗,比较2组血压、N末端B型钠尿肽前体(NT-proBNP)及心脏超声指标左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、LVEF,采用多元有序logistic回归分析疗效的影响因素.结果 治疗组治疗后LVEF明显高于对照组,收缩压、舒张压、NT-proBNP、LVEDD、LVESD明显低于对照组(P<0.05).治疗组总有效率明显高于对照组(92.5％vs 64.3％,P<0.01),心力衰竭再住院率明显低于对照组(10.0％vs 28.6％,P<0.05).多元有序logistic回归分析显示,应用SV是影响治疗效果的独立因素(OR=2.166,95％CI:1.093～4.293,P=0.027).2组治疗后高钾血症发生率比较,差异无统计学意义(P>0.05).结论 SV能有效控制合并慢性心力衰竭的老年MHD患者血压,抑制心室重构,改善心脏功能,治疗中应该警惕高钾血症发生.

Background:Ovarian cancer is one of the most common gynecologic cancers with the highest mortality rate in China. Acute kidney injury (AKI) is a postoperative complication associated with all-cause mortality. The incidence and risk factors for AKI after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) have not been fully elucidated. The purpose of this study was to determine the incidence and associate ed risk factors of AKI among those patients undergoing CRS-HIPEC.Methods:This retrospective study collected demographic, tumor-related, preoperative, intraoperative, and postoperative data from 282 advanced ovarian cancer patients who underwent CRS-HIPECs. AKI was defined and staged according to the clinical practice guideline of Kidney Disease Improving Global Outcomes (KDIGO) in 2012. The prognosis of AKI was determined according to the change in serum creatinine 90 days after the operation. We conducted univariate and multivariate logistic regression analyses to assess the association between variables of interest and the occurrence of AKI.Results:Of 282 advanced ovarian cancer patients, 11.7% of them developed AKI. The Multivariate logistic regression analysis showed that the risk factors independently associated with AKI included cisplatin dose≥70mg/m2 (OR=3.668, 95%CI 1.336-10.070, P=0.012); Baseline eGFR<60 mL/min/1.73 m2 (OR=2.704, 95%CI 1.373-5.322, P=0.004); and concomitant medications of angiotensin convert enzyme inhibitor or angiotensin receptor blocker (ACEI or ARB) (OR=3.122, 95%CI 1.545-14.892, P=0.039).Conclusion:Our study demonstrates that the incidence of AKI after CRS plus cisplatin-based HIPEC is not uncommon among advanced ovarian cancer patients. Cisplatin overdose, baseline kidney dysfunction, and use of ACEI or ARB are independent risk factors for the occurrence of AKI among those patients.

Objective:To investigate the association between body mass index (BMI) and waist circumference (WC) with all-cause mortality in middle-aged and elderly patients receiving maintenance hemodialysis (MHD).Methods:It was a prospective cohort study. The clinical data of MHD patients aged ≥50 years old from eleven hemodialysis centers from April to June 2017 in Beijing were analyzed. The patients were divided into low BMI group [body mass index (BMI)<18.5 kg/m 2], normal BMI group (18.5 kg/m 2≤BMI <24.0 kg/m 2), overweight group (24.0 kg/m 2≤BMI<28.0 kg/m 2) and obesity group (BMI≥28.0 kg/m 2) by BMI, and central obesity group (male ≥85 cm, female ≥80 cm) and normal WC group (male <85 cm, female <80 cm) by WC. Kaplan-Meier survival analysis method was used to compare the difference of all-cause mortality between those groups. Multivariate Cox regression model was used to analyze the association of BMI and WC with all-cause mortality. Results:A total of 613 MHD patients were enrolled, with age of (63.82±7.14) years old and 258 (42.09%) females. There were 46 (7.50%) patients in the low BMI group, 303 (49.43%) patients in the normal BMI group, 227 (37.03%) patients in the overweight group and 37 (6.04%) patients in the obesity group. In addition, 346 (56.44%) patients were categorized as central obesity. Kaplan-Meier survival analysis results showed that the all-cause mortality rates of low BMI group (log-rank χ2=13.571, P<0.001) and obesity group (log-rank χ2=6.664 P=0.010) were higher than that of normal BMI group, and the all-cause mortality rate of central obesity group was higher than that of normal WC group (log-rank χ2=5.698, P=0.017). Multivariate Cox regression analysis results showed that，besides the low BMI group and obesity group (with normal BMI group as a reference, HR=5.289, 95% CI 2.318-12.067, P<0.001; HR=5.360, 95% CI 2.088-13.760, P<0.001, respectively), normal BMI and overweight combined with central obesity were also independently correlated with all-cause mortality (with normal WC group as a reference, HR=2.605, 95% CI 1.199-5.663, P=0.016; HR=1.787, 95% CI 1.026-3.732, P=0.031, respectively). Conclusions:Lower and higher BMI or combined central obesity are independently associated with all-cause mortality in the middle-aged and elderly patients receiving MHD.

IntroductionObesity in patients undergoing hemodialysis is common. However, there is limited information on the relationship between obesity types defined by the combined body mass index (BMI) and waist circumference (WC) classification criteria and all-cause mortality in Chinese hemodialysis patients. Our objective was to determine the association between obesity types and all-cause mortality in hemodialysis patients.MethodsWe conducted a prospective cohort study including patients from 11 hemodialysis centers in Beijing. According to the World Health Organization’s standards, patients were classified into 2 categories with WC and 4 categories with BMI and then followed up for 1 year. Kaplan–Meier survival analysis was used to compare the difference in the cumulative survival rate in different BMI and WC groups. A multivariate Cox regression analysis was used to determine the association between different types of obesity and all-cause mortality.ResultsA total of 613 patients were enrolled, the mean age was 63.8 ± 7.1 years old, and 42.1% were women. Based on the baseline BMI, there were 303 (49.4%) patients with normal weight, 227 (37.0%) with overweight, 37(6.0%) with obesity, and 46 (7.5%) with underweight. Based on the baseline WC, 346 (56.4%) patients had abdominal obesity. During a median follow-up of 52 weeks, 69 deaths occurred. Kaplan–Meier plots demonstrated a significant association of BMI categories (log-rank χ2 = 18.574, p<0.001) and WC categories (log-rank χ2 = 5.698, p=0.017) with all-cause death. With normal BMI and non-abdominal obesity as a reference, multivariate Cox regression analysis results showed that obesity (HR 5.36, 95% CI, 2.09-13.76, p<0.001), underweight (HR, 5.29, 95% CI, 2.32-12.07, p<0.001), normal weight combined with abdominal obesity (HR 2.61, 95% CI, 1.20-5.66, p=0.016), and overweight combined with abdominal obesity (HR 1.79, 95% CI, 1.03-3.73, p=0.031, respectively) were significantly associated with higher risks of all-cause mortality.ConclusionOur study indicated that abdominal obesity is common and associated with all-cause mortality among Chinese hemodialysis patients.

目的 探讨初诊的多发性骨髓瘤(MM)患者急性肾损伤(AKI)的发生率及其相关风险因素.方法 选取2010 年 1 月至 2020 年 6 月期间首都医科大学附属北京世纪坛医院血液科收治的初诊MM患者作为研究对象,依据改善全球肾脏疾病预后组织(KDIGO)标准,根据化疗期间是否发生AKI,将患者分为AKI组和非AKI组.采用多因素Logistic回归方法分析AKI发生的风险因素.结果 共纳入初诊的MM患者 107 例,AKI组 39 例(36.45％),非AKI组 68 例(63.55％);AKI组在年龄≥60 岁比例、糖尿病史比例、利尿剂使用比例、传统化疗药物使用比例、血β2 微球蛋白和尿轻链水平均高于非AKI组,而肾小球滤过率(eGFR)和血清白蛋白水平低于非AKI组,差异均有统计学意义(P<0.05).多因素Logistic回归分析结果显示,尿轻链水平升高(OR = 1.189,95％CI:1.061～1.333,P= 0.003)、年龄增长(OR = 1.072,95％CI:1.020～1.126,P= 0.006)、eGFR减低(OR=0.965,95％CI:0.944～0.988,P= 0.003)、血清白蛋白减低(OR= 0.794,95％CI:0.704～0.895,P<0.001)以及使用包括美法仑及环磷酰胺的传统化疗药物(OR=4.933,95％CI:1.327～18.341,P=0.017)与AKI的发生独立相关.结论 初诊MM患者AKI发病率较高,高龄、eGFR和血清白蛋白水平降低、尿轻链水平升高及使用传统化疗药物是AKI发生的独立风险因素.

Objective:To investigate the incidence, risk factors, and outcomes of acute kidney injury (AKI) in cancer patients receiving immune checkpoint inhibitors (ICIs).Methods:A retrospective analysis was performed on the inpatients who received ICIs therapy in Beijing Shijitan Hospital, Capital Medical University from October 2015 to December 2020. According to the Kidney Disease: Improving Global Outcomes (KDIGO) definition of AKI, patients were divided into AKI group and non-AKI group, and the patients in the AKI group were further divided into ICIs related AKI (ICIs-AKI) and AKI due to other etiologies. The clinical characteristics of the patients were compared. Multivariate logistic regression was used to analyze the influencing factors of AKI, and sensitivity analysis was used to evaluate the influencing factors of ICIs-AKI.Results:A total of 279 cancer patients over 18 years old were included in this study, in which 175(62.7%) were males. There were 41 patients (14.70%) in AKI group, including 25 patients (8.96%) in ICIs-AKI group and 16 patients (5.73%) in AKI due to other etiologies group. Patients in the AKI group were characterized by higher proportions of hypertension, diuretics use and baseline eGFR<60 ml·min -1·(1.73 m 2) -1, extrarenal immune-related adverse events (irAEs) and a lower plasma albumin level (all P<0.05). The patients in the ICIs-AKI group had higher proportions of new aseptic leukocyturia, blood eosinophil count>500/ml, combined extrarenal irAEs, glucocorticoid use and discontinued ICIs treatment (all P<0.05). Multivariate logistic regression results showed that hypertension ( OR=3.424, 95% CI 1.559-7.522, P=0.002), use of diuretics ( OR=4.620, 95% CI 2.111-10.112, P<0.001), baseline eGFR<60 ml·min -1·(1.73 m 2) -1 ( OR=3.668, 95% CI 1.336-10.070, P=0.012) and extrarenal irAEs ( OR=9.909, 95% CI 4.198-23.391, P<0.001) were associated with AKI in cancer patients receiving ICIs therapy. Sensitivity analysis indicated that the risk factors of ICIs-AKI included use of diuretics and baseline eGFR<60 ml·min -1·(1.73 m 2) -1, similar to the results of the above analysis, extrarenal irAEs ( OR=17.572, 95% CI 6.302-48.995, P<0.001) were also associated with ICIs-AKI independently. Conclusions:AKI is not uncommon in patients treated with ICIs. Concomitant hypertension, baseline eGFR<60 ml·min -1·(1.73 m 2) -1 and use of diuretics are independent risk factors for AKI in such patients. Patients should be alert to the risk of ICIs-AKI when appearing extrarenal irAEs. Distinguishing ICIs-AKI from AKI caused by other causes will present a frequent challenge to clinical practitioners.

Abstract Background Acute kidney disease (AKD) evolves a spectrum of acute and subacute kidney disease requiring a global strategy to address. The present study aimed to explore the impact of AKD on the prognosis of ischemic stroke. Methods The Third China National Stroke Registry (CNSR-III) was a nationwide registry of ischemic stroke or transient ischemic attack between August 2015 and March 2018. As a subgroup of CNSR-III, the patients who had serum creatinine (sCr) and serum cystatin C (sCysC) centrally tested on admission and at 3-month, and with 1-year follow-up data were enrolled. Modified AKD criteria were applied to identify patients with AKD during the first 3 months post stroke according to the guidelines developed by the Kidney Disease: Improving Global Outcomes in 2012. The primary clinical outcome was 1-year all-cause death, and secondary outcomes were stroke recurrence and post stroke disability. Results Five thousand sixty-five patients were recruited in the study. AKD was identified in 3.9%, 6.7%, 9.9% and 6.2% of the patients by using sCr, sCr-based estimated glomerular filtration rate (eGFRsCr), sCysC-based eGFR (eGFRsCysC), and combined sCr and sCysC-based eGFR (eGFRsCr+sCysC) criteria, respectively. AKD defined as sCr or eGFRsCr criteria significantly increased the risk of all-cause mortality (adjusted HR 2.67, 95% CI: 1.27–5.61; adjusted HR 2.19, 95% CI: 1.17–4.10) and post stroke disability (adjusted OR 1.60, 95% CI: 1.04–2.44; adjusted OR 1.51, 95% CI: 1.08–2.11). AKD diagnosed by eGFRsCysC or eGFRsCr+sCysC criteria had no significant impact on the risk of all-cause death and post stroke disability. AKD, defined by whichever criteria, was not associated with the risk of stroke recurrence in the adjusted model. Conclusions AKD, diagnosed by sCr or eGFRsCr criteria, were independently associated with 1-year all-cause death and post stroke disability in Chinese ischemic stroke patients.

Purpose: The study aimed to determine the prevalence and risk factors of frailty among a Chinese cohort of hemodialysis patients and to assess the degree to which frailty was associated with all-cause mortality. Participants and Methods: We enrolled a group of older adults (≥60 years old) in a prospective cohort study of cognitive impairment in Chinese patients undergoing hemodialysis (registered in Clinical Trials.gov, ID: NCT03251573). We assessed the prevalence of frailty using Fried’s definition in the Cardiovascular Health Study, then we evaluated the associated risk factors of frailty using multivariate logistic regression analysis. Finally, we assessed the association of frailty and all-cause mortality with multivariable Cox proportional hazard regression analyses. Results: The prevalence of frailty in these 204 enrolled hemodialysis patients was 72.1%. Patients with frailty were more inclined to have composite abnormal components that included poor physical functioning, exhaustion, low physical activity, and undernutrition. Multivariable logistic regression analysis suggested that increased age, female gender, history of diabetes, longer dialysis vintage, lower Kt/V, lower serum level of albumin concentrations, and increased serum iPTH concentrations were independently associated with frailty. Cox regression analysis indicated that frailty as a dichotomous construct was strongly associated with an increased risk of mortality (HR 6.092, 95% CI 1.886–19.677, P = 0.003) in unadjusted analyses. After adjusting (Model I = no adjusted; II = adjusted for age, gender; III = adjusted for age, gender, history of diabetes; IV = adjusted for all covariates associated at the p ≤ 0.10 level with death in unadjusted analyses, including age, history of diabetes, MoCA<26, single-pool Kt/V, and the levels of albumin and iPTH), the association was slightly affected but observed consistent as before. Conclusion: Frailty is extremely common and is associated with serious clinical outcomes among older hemodialysis patients. Based on those clinical features of frailty, future studies should focus on exploring effective interventions aimed to prevent or attenuate frailty in the older hemodialysis population.

The highly prevalent cognitive impairment in hemodialysis patients is associated with all-cause mortality; however, the role of different cognitive domain impairments in this association is still not clarified. Our objective was to determine the association between cognitive domain impairment and all-cause mortality in elderly adult patients undergoing hemodialysis. We conducted a prospective cohort study including patients from 11 hemodialysis centers in Beijing. Baseline data were collected, and a series of neuropsychological batteries covering 5 domains of cognitive function were included for the assessment of cognitive function. According to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V), the patients were classified as normal, mild, and major cognitive impairment for global and domain cognitive function, then followed up for 1 year. Kaplan–Meier survival analysis was used to compare the difference in the cumulative survival rate in different cognitive domains. A multivariate Cox proportional hazards regression analysis was used to determine the association between global or domain cognitive impairment and all-cause mortality. A total of 613 patients were enrolled, the mean age was 63.82 ± 7.14 years old, and 42.1% were women. After 49.53 ± 8.42 weeks of follow-up, 69 deaths occurred. Kaplan–Meier plots demonstrated a significant association of cognitive impairment in memory, executive function, attention, and language domains with all-cause death. Multivariate Cox regression analysis showed that mild and major impairment of global cognition (HR = 2.89 (95% CI, 1.01–8.34), p = 0.049 and HR = 4.35 (95% CI, 1.55–12.16), p = 0.005, respectively), executive cognitive domain (HR = 2.51 (95% CI, 1.20–5.24), p = 0.014; HR = 3.91 (95% CI, 1.70–9.03), p = 0.001, respectively), and memory cognitive domain (HR = 2.13 (95% CI, 1.07–4.24), p = 0.031; HR = 3.67 (95% CI, 1.71–7.92), p = 0.001, respectively) were associated with all-cause mortality. Combined impairment of 3, 4, and 5 cognitive domains was associated with all-cause mortality [HR = 5.75 (95% CI, 1.88–17.57), p = 0.002; HR = 12.42 (95% CI, 3.69–41.80), p < 0.001; HR = 13.48 (95% CI, 3.38–53.73), p < 0.001, respectively]. We demonstrate an association between the executive and memory cognitive domain impairment and all-cause mortality in hemodialysis patients. Our data suggest that the impairments in these cognitive domains might help in the early identification of hemodialysis patients at risk of death.

Objective:To investigate the clinical characteristics and risk factors of frailty syndrome in elderly patients undergoing maintenance hemodialysis (MHD) and the effect of frailty syndrome on all-cause mortality.Methods:This was a prospective cohort study. MHD patients aged≥60 years in 5 hemodialysis centers in Beijing from April to June 2017 were selected as the study subjects. Baseline data were collected and compared, and the patients were then classified into non-frailty, pre-frailty and frailty syndrome groups according to the Fried criteria and followed up until June 2018. The end point event was all-cause death. Multivariate logistic regression was used to analyze the independent risk factors of frailty syndrome. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate among the 3 groups. A multivariate Cox regression model was used to analyze the independent risk factors of all-cause mortality.Results:A total of 204 patients aged (71.65±5.89) years (60-81 years) were enrolled into this study, including 123 males (60.29%), 147 patients (72.06%) in the frailty syndrome group, 41 patients (20.10%) in the pre-frailty group, and 16 patients (7.84%) in the non-frailty group. Patients with frailty syndrome tended to be older, longer dialysis vintage, a higher proportion of diabetes, lower urea clearance index (Kt/V) and lower serum albumin level (all P<0.05). Multivariate Logistic regression showed that factors independently associated with frailty syndrome included age ( OR=1.393, 95% CI 1.241-1.563, P<0.001), history of diabetes ( OR=3.610, 95% CI 1.262-10.327, P=0.017), dialysis vintage ( OR=1.011, 95% CI 1.002-1.020, P=0.019), Kt/V ( OR=0.711, 95% CI 0.516-0.979, P=0.037), serum albumin ( OR=0.754, 95% CI 0.644-0.882, P<0.001) and intact parathyroid hormone (iPTH, OR=1.344, 95% CI 1.024-1.763, P=0.033). Kaplan-Meier survival analysis showed that the cumulative survival rate in frailty syndrome group was significantly lower than those of pre-frailty (Log-rank χ2=7.265, P=0.007) and non-frailty groups (Log-rank χ2=5.238, P=0.022). Multivariate Cox regression analysis indicated that frailty syndrome ( HR=3.832, 95% CI 1.116-13.157, P=0.033), age ( HR=1.074, 95% CI 1.014-1.136, P=0.014), history of diabetes ( HR=2.009, 95% CI 1.067-3.784, P=0.031), cognitive impairment (Montreal cognitive assessment<26, HR=2.627, 95% CI 1.142-6.042, P=0.023), Kt/V ( HR=0.701, 95% CI 0.545-0.902, P=0.006), serum albumin ( HR=0.891, 95% CI 0.806-0.986, P=0.025) and iPTH ( HR=1.226, 95% CI 1.100-1.367, P<0.001) were independently associated with all-cause mortality. Conclusions:The prevalence of frailty syndrome in elderly patients undergoing hemodialysis is high. Ageing, diabetes history, long dialysis vintage, low levels of Kt/V and serum albumin, and elevated iPTH level are independent risk factors for frailty syndrome in such patients. Frailty syndrome is independently associated with an increased risk of all-cause mortality.

[This corrects the article DOI: 10.3389/fnagi.2021.757453.].