BACKGROUND:A worldwide evaluation exploring the link between a broad-spectrum kidney function and cognitive impairment (CI) prevalence, and related risk factors has yet to be conducted. METHODS:Studies published before November 2024 were retrieved from PubMed and Web of Science. R software (R Foundation for Statistical Computing, Vienna, Austria) and Review Manager (Cochrane Collaboration, London, UK) were used to analyze the relationship of CI with various estimated glomerular filtration rate (eGFR) level and the associated risk factors. A random model effect was adopted for a heterogeneity (I2) of more than 50%. RESULTS:Seventeen (involving 32,141 participants) out of 5892 studies were included. The MMSE and MoCA were the most commonly used tests to assess cognitive function. The prevalence of CI raised significantly with declining kidney function: 10% for eGFR ≥60 mL/min/1.73 m2, 47.3% for 60-30 mL/min/1.73 m2, and 60.6% for <30 mL/min/1.73 m2, totaling 16.7% overall. Thirteen potential risk factors were ascertained and analyzed. In the forest-plot analysis, T2DM, cardiovascular diseases, cerebrovascular diseases, and lower education emerged as strong predictors of risk, with odds ratios of 1.55, 1.63, 1.95, and 2.59, respectively. A mean meta-analysis of the continuous variable indicators revealed that advanced age and elevated parathyroid hormone (PTH) levels were statistically significant in the occurrence of CI. CONCLUSIONS:The poorer the renal function, the higher the prevalence rate of CI. Patients with chronic kidney disease (CKD) have multiple risk factors that lead to CI.

Cardiovascular–kidney–metabolic (CKM) syndrome involves interconnected cardiovascular, renal, and metabolic dysfunctions. While rapid kidney function decline (RKFD) portends poor prognosis in CKM patients, reliable early predictors remain limited. The triglyceride–glucose (TyG) index and atherogenic index of plasma (AIP) have recently emerged as promising indicators of metabolic dysregulation, but their predictive value for RKFD in CKM syndrome requires further investigation. We conducted a prospective cohort analysis of 2763 participants aged ≥ 45 years with CKM syndrome using data from the China Health and Retirement Longitudinal Study (CHARLS). The main outcome measured was the occurrence of RKFD, characterized by an annual estimated glomerular filtration rate decline at least 3 mL/min/1.73 m2 during follow-up. Multivariable logistic regression was employed to examine associations between the TyG index, AIP and RKFD, with dose–response relationships assessed using restricted cubic splines. Subgroup analyses evaluated effect modifications by key covariates, with multiplicity adjustment. A mediation analysis was conducted to explore potential mediators. During 4-year follow-up, 278 cases (10.1

Background Although simple renal cyst (SRC) is a kind of structural alterations of kidney with age, the relationship between SRC and renal function is still obscure. We investigated the relationship between SRC and renal function in Chinese population. Methods The medical records of 41,842 individuals who underwent physical examinations at the Health Check-up Center at our institution in 2018 were reviewed. According to whether with SRC, they were divided into no-SRC and SRC groups. SRCs were classified into subgroups based on number (< 2 vs. ≥ 2) and size (< 2 cm vs. ≥ 2 cm). Logistic regression was used to examine the relationship between SRC and estimated glomerular filtration rate (eGFR). Results Multinomial logistic regression analysis showed that the adjusted odds ratio (OR) for eGFR slight decline in subjects with SRC was 1.26(95% confidence interval (95% CI):1.17–1.35, p < 0.001), and the OR for eGFR severe decline was 1.35(95% CI: 1.16–1.56, p < 0.001) compared with no-SRC. The adjusted OR of SRC number ≥ 2 and ≥ 2 cm on the risk of eGFR severe decline was the highest (OR:1.68, 95% CI:1.25–2.23, p < 0.01) of four SRC subgroups. Conclusions SRC is related to eGFR decline, especially when the person with one more SRCs and the size of SRC is more than 2 cm. SRC could be a warning sign for clinicians to judge the decline of renal function.

AbstractObjectivesComorbidity prediction models have been demonstrated to offer more comprehensive and accurate predictions of death risk compared to single indices. However, their application in China has been limited, particularly among maintenance hemodialysis (MHD) patients. Therefore, the objective of this study was to evaluate the utility of comorbidity index models in predicting mortality risk among Chinese MHD patients.MethodologyThe MHD patients in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were taken as the subjects. Claims‐based disease‐specific refinements matching translation to ICD‐10 and flexibility (CDMF‐CCI) model and Liu model were selected as the candidate models for this verification research. Univariate and multivariate Cox regression calculations were used to analyze the independent predictive effect of the models on survival rate.ResultsAnnually, nearly 500 patients undergo hemodialysis treatment. From January 2019 to June 2022, a total of 199 patients succumbed, with a mean age of 65.2 years. During these 4 years, the mortality rates were 13.04%, 9.68%, 11.69%, and 6.39%, respectively. The leading causes of death were sudden demise (82 patients, 41.2%), cardiovascular disease (48 patients, 24.1%), pulmonary infection (33 patients, 16.5%), and stroke (19 patients, 9.5%). When compared to individual indices, the CDMF‐CCI model displayed more accurate and predictive results, with an HR of 1.190 (P = 0.037). Conversely, the Liu model failed to identify high‐risk individuals.ConclusionThe MHD patients face a significant risk of mortality. When compared to univariate parameters and the Liu model, the CDMF‐CCI model exhibits superior predictive accuracy for mortality in MHD patients.

Methyltransferase-like protein 3 (METTL3) mediated N6-Methyladenosine (m6A) modification has been implicated in many physiological and pathological processes. However, its function and mechanism in kidney aging are not entirely clear. Here, we investigated changes in m6A levels of aging kidneys and the role of METTL3 in senescent renal tubular epithelial cells and its potential mechanisms. First, we used the naturally aged mouse model and the D-galactose (D-gal)-induced aged mouse model. Dot blot and m6A RNA methylation quantification showed significantly decreased m6A levels in both models. In addition, we observed that METTL3 was down-regulated in D-gal-induced senescent human renal tubular epithelial cell line (HK-2). METTL3 reduction was associated with senescence-related phenotypes of HK-2 cells. We also found that miR-181a-5p attenuated HK-2 senescence by targeting the NF-κB pathway. Moreover, METTL3 was able to promote the maturation of miR-181a-5p and then inhibited the expression of NF-κB and IL-1α. Taken together, we demonstrate that the METTL3/miR-181a-5p/NF-κB axis counteracts HK-2 senescence. Our results suggest that METTL3 may be a novel biomarker and a potential therapy target for kidney aging.

Although serum creatinine and/or serum cystatin C have been widely used in clinical practice to estimate glomerular filtration rate (GFR), they cannot replace nuclide labeled GFR measurement when measuring independent renal function and reflecting the true level of GFR. Nuclide labeled GFR methods include nuclide renal dynamic imaging method and nuclide plasma clearance method. These two methods have their own advantages and disadvantages, thus, we expect to objectively and comprehensively introduce their characteristics for rational use by clinicians.

Globally, air pollution is amongst the most significant causes of premature death. Nevertheless, studies on the relationship between fine particulate matter (PM 2.5 ) exposure and blood lipids have typically not been population-based. In a large, community-based sample of residents in Yixing city, we assessed the relationship between short-term outdoor PM 2.5 exposure and blood lipid concentrations. Participants who attended the physical examination were enrolled from Yixing People’s hospital from 2015 to 2020. We collected general characteristics of participants, including gender and age, as well as test results of indicators of blood lipids. Data on daily meteorological factors were collected from the National Meteorological Data Sharing Center ( http://data.cma.cn/ ) and air pollutant concentrations were collected from the China Air Quality Online Monitoring and Analysis Platform ( https://www.aqistudy.cn/ ) during this period. We applied generalized additive models to estimate short-term effects of ambient PM 2.5 exposure on each measured blood lipid-related indicators and converted these indicators into dichotomous variables (non- hyperlipidemia and hyperlipidemia) to calculate risks of hyperlipidemia associated with PM 2.5 exposure. A total of 197,957 participants were included in the analysis with mean age 47.90 years (± SD, 14.28). The increase in PM 2.5 was significantly associated with hyperlipidemia (odds ratio (OR) 1.003, 95% CI 1.001–1.004), and it was still significant in subgroups of males and age < 60 years. For every 10 μg/m 3 increase in PM 2.5 , triglyceride levels decreased by 0.5447% (95% CI − 0.7873, − 0.3015), the low-density lipoprotein cholesterol concentration increased by 0.0127 mmol/L (95% CI 0.0099, 0.0156), the total cholesterol concentration increased by 0.0095 mmol/L (95% CI 0.0053, 0.0136), and no significant association was observed between PM 2.5 and the high-density lipoprotein cholesterol concentration. After excluding people with abnormal blood lipid concentrations, the associations remained significant except for the high-density lipoprotein cholesterol concentration. PM 2.5 was positively correlated with low-density lipoprotein cholesterol and total cholesterol, and negatively correlated with triglyceride, indicating PM 2.5 can potentially affect health through blood lipid levels.

Although cisplatin is an effective chemotherapy drug for the treatment of various cancers, its clinical use is limited due to its side effects, especially nephrotoxicity. Unfortunately, acute kidney injury (AKI) caused by cisplatin remains one of the main challenges in effective cancer treatment. Evidence increasingly suggests that renal inflammation and pyroptotic inflammatory cell death of renal tubular epithelial cells (RTECs) mainly determine the progression and outcome of cisplatin-induced AKI. However, it is not clear how cisplatin regulates the pyroptosis of RTECs cells in AKI. The current study aimed to determine the regulation mechanism of AKI induced by cisplatin. We used cisplatin to induce AKI in vivo. We performed H&E staining of mouse kidney tissue sections and evaluated serological indicators of kidney injury (including blood urea nitrogen (BUN), serum creatinine, and tumor necrosis factor alpha (TNF-alpha)). We used immunohistochemistry and western blot to detect the important substrate protein gasdermin D (GSDMD) and key target caspase-1 of pyroptosis, respectively. Cisplatin induced mouse AKI and RTECs pyroptosis. HK2 cell-derived exosomes treated with cisplatin influenced pyroptosis of the surrounding HK2 cells. Cisplatin-treated HK2 cells exosomederived miR-122 regulated pyroptosis in the surrounding cells. Exosome-derived miR-122 affected cisplatin-induced AKI and HK2 cells pyroptosis by regulating the expression of embryonic lethal abnormal vision (ELAVL1). These results suggest that exosome miR-122 inhibited pyroptosis and AKI by targeting ELAVL1 under cisplatin treatment, and this offers a potential target for the treatment of AKI.

Abstract Objectives: Falls are a major cause of morbidity and disability in older adults with multiple diseases. This study aimed to evaluate whether hemodialysis is related to fall risk in older adults with multiple diseases ,and to explore the effect of dialysis on falls was mediated through the ratio of Cr / CysC and activities of daily living (ADL).Methods: This retrospective study included patients aged ≥60 years-old with at least two comorbid diseases admitted to the Geriatric Nephrology Department of Jiangsu Province Hospital between December 2019 and June 2021. Clinical data were extracted from the medical records. Fall risk was evaluated with a modified Thomas scale. Results: The study included 91 patients in the non-hemodialysis group and 40 patients in the hemodialysis group. The hemodialysis group had lower activities of daily living (ADL) and higher body mass index/skeletal muscle index (SMI) ratio and modified Thomas score than the non-hemodialysis group. Linear regression revealed that older age (b= 0.07, 95% confidence interval [95%CI] = 0.06-0.09, P < 0.001) and hemodialysis (b= 0.67, 95%CI = 0.27-1.06, P = 0.001) were associated with higher fall risk. Hemodialysis exerted a significant direct effect on the modified Thomas fall risk score (b = 0.526, 95%CI = 0.432–1.433, P = 0.015) as well as a significant indirect effect via the Barthel index (b = 0.172, 95%CI = 0.010–0.333, P = 0.037)Conclusion: Hemodialysis increases the risk of falling in older adults with comorbidities. The effects of hemodialysis on fall risk were direct and indirect. Identifying inpatients on hemodialysis who are at risk of falling would facilitate targeted intervention strategies.

2020年初始,我国出现新型冠状病毒( 2019 novel coro-navirus,2019-nCoV)感染流行.国家卫生健康委于2020年1月20日,将新型冠状病毒肺炎( coronavirus disease 2019, COVID-19)纳入法定传染病乙类管理,采取甲类传染病的预防、控制措施.慢性肾脏病( chronic kidney disease,CKD)患者免疫力低下,属于 COVID-19易感人群[1].血液透析室是2019-nCoV暴露风险极高的医疗场所[2].在患者病情危急、没有转运条件的情况下,如何对疑似 COVID-19的多器官功能衰竭患者进行就地抢救,是对基层医院及医护人员的较大挑战.2020年4月,南京市栖霞区医院血液透析室成功救治1例疑似 COVID-19的危重心肾综合征患者,现报道如下.

The development of comorbidity-based disease progression and mortality prediction models incorporating demographic and sociological characteristics and the type and severity of comorbidities has been a hot topic in recent clinical studies.The elderly population now constitutes the majority of patients on maintenance dialysis(MHD)and is still rising.It is difficult to predict outcomes for elderly MHD patients, who are often associated with comorbidities, late start on hemodialysis and high mortality.However, very few researchers have closely followed the development of comorbidity-based predictive models for these patients.Therefore, this article reviews relevant studies and offers insights on this topic, in order to attract the attention of colleagues in this county and, as we work together, to improve the survival of elderly patients on dialysis.

目的 探讨miR-200c是否通过调节自噬缓解转化生长因子-β1(TGF-β1)诱导的肾小管上皮细胞纤维化.方法 不同浓度(0、5、10、15、20、30 ng/ml)TGF-β1刺激HK2细胞48 h后倒置显微镜下观察细胞形态,CCK-8检测细胞增殖情况.选择致HK2细胞增殖最快的TGF-β1浓度(c)进行转染实验:细胞转染40 nmol/L无意义序列RNA(NC组);细胞转染40 nmol/L无意义序列RNA后c浓度TGF-β1处理细胞48 h(NC+T组);细胞转染40 nmol/L miR-200c mimics(M组);细胞转染40 nmol/L miR-200c mimics后c浓度TGF-β1处理细胞48 h(M+T组).qRT-PCR检测miR-200c转染效率.Western blotting检测4组细胞Smad通路蛋白Smad2和Smad3、α-平滑肌肌动蛋白(α-SMA)、钙黏蛋白(E-cad)表达量,以及自噬相关蛋白LC3(包括LC3Ⅱ/LC3Ⅰ比值)和P62.结果 10 ng/ml的TGF-β1刺激HK2细胞48 h后增殖最快,镜下细胞形态由正常的卵圆形铺路石状变为长梭形,纤维化形态最明显.qRT-PCR显示M组miR-200c表达量是NC组(212.42±12.25)倍(t=24.41,P=0.000),说明转染有效.Western blotting结果显示,与NC组比较,NC+T组加入10 ng/ml TGF-β1的HK2细胞Smad2、Smad3和α-SMA表达量增加,E-cad蛋白表达量降低(P<0.05).与NC+T组比较,M+T组Smad2、Smad3和α-SMA表达量减少,E-cad表达量增加(P<0.05),提示miR-200c表达增加抑制了纤维化.进一步发现,M组较NC组的LC3-Ⅱ/LC3-Ⅰ表达水平增加,P62表达水平降低,提示自噬活性增加;M+T组较NC+T组LC3-Ⅱ/LC3-Ⅰ表达水平增加,P62表达水平降低,提示miR-200c表达升高缓解了纤维化程度.结论 miR-200c可能通过激活细胞自噬缓解TGF-β1诱导的肾小管上皮细胞纤维化.

Objective The aim of this study was to establish a risk scoring system for the decreased glomerular filtration rate (GFR) in Chinese general population. Methods Totally 781 participants who underwent a health checkup in The First Affiliated Hospital of Nanjing Medical University from January to September 2017 were involved in the study. Significant variables chosen by multivariable logistic regression analysis were allocated the integral scores in proportion to its odds ratio (OR), and then the risk of decreased GFR was assessed based on the scores. Results The people with abnormal homocysteine (Hcy) level (OR: 1.534, 95% confidential interval [CI]: 1.075-2.190, P = .018), males (OR: 2.054, 95%CI: 1.365-3.092, P < .001), and those at the age of 46-52 years (OR: 2.943, 95%CI: 1.546-5.605, P = .001), 52-59 years (OR: 3.664, 95%CI: 1.937-6.931, P < .001) and >= 59 years (OR: 13.452, 95%CI: 7.339-24.657, P < .001) were subjected to GFR reduction. These three variables were allocated the integral scores in proportion to its OR, and four risk categories were divided according to the scores. The prevalence of the decreased GFR in people with low (score 0-4, n = 8), below the average (score 4-6, n = 37), above the average (score 6-13, n = 47), and high risks (score >= 13, n = 103) was 5.26%, 16.89%, 22.93% and 50.24%, respectively, and this prevalence raised with the increase of scores (P < .001). Conclusions A risk scoring system is developed in this study, which may offer a specific risk stratification for GFR reduction in Chinese general population.

老年维持性血液透析患者常合并心血管基础疾病,如心肌肥厚、心肌病、冠心病、心力衰竭等,透析过程易发生心律失常[1] ,表现为心房颤动、房性早搏、房室传导阻滞、室性心律失常[2] ,若室性心动过速持续存在,易进展为室颤,病情危重,若处理不当或不及时,死亡率极高. 近期,我科发现1例血透中并发室性心动过速伴低血压,经胺碘酮静脉注射、心脏同步电复律后抢救成功的病例,现报告如下.

Renal dysfunction is a common side-effect of chemotherapeutic agents in patients with hematopathy. Although broadly used, glomerular filtration rate (GFR) estimation equations were not fully validated in this specific population. Thus, this study was designed to further assess the accuracy of various GFR equations, including the newly 2012 CKD-EPI equations. Referring to 99mTc-DTPA clearance method, three Scr-based (MDRD, Peking, and CKD-EPIScr), three Scys C-based (Steven 1, Steven 2, and CKD-EPIScys C), and three Scr-Scys C combination based (Ma, Steven 3, and CKD-EPIScr-Scys C) equations were included. Bias, P30, and misclassification rate were applied to compare the applicability of the selected equations. A total of 180 Chinese hematological patients were enrolled. Mean bias, absolute mean bias, P30, misclassification rate and Bland-Altman plots of the CKD-EPIScr-Scys C equation were 7.90 mL/minute/1.73 m2, 17.77 mL/minute/1.73 m2, 73.3%, 38% and 79.7 mL/minute/1.73 m2, respectively. CKD-EPIScr-Scys C predicted the most precise eGFR both in lymphoma and leukemia subgroups. Additionally, CKD-EPIScys C equation in the rGFR ≧ 90 mL/minute/1.73 m2 subgroup and Steven 2 equation in the rGFR<90 mL/minute/1.73 m2 subgroup provided more accurate estimates in each subgroup. The CKD-EPIScr-Scys C equation could be recommended to monitor kidney function in hematopathy patients. The accuracy of GFR equations may be closely related with GFR level and kidney function markers, but not the primary cause of hematopathy.

Objective: The goal of this study was to evaluate the incidence of cognitive impairment in chronic kidney disease CKD patients with hypertension or diabetes and to explore its pathological mechanism. Methods: PubMed and Embase were systematically searched to collect literature on cognitive function changes in CKD patients with hypertension or diabetes published on or before Novermber 30th 2016. Heterogeneity test was performed by RevMan 5.3 software. Overall odds ratio and 95% confidence interval was calculated. Results: A total of 8 references were included in this meta-analysis, including 138,943 CKD patients. The incidence of cognitive impairment was calculated for CKD with hypertension or diabetes groups. Meta-analysis showed that the incidence of cognitive impairment in CKD patients with hypertension or diabetes was higher compared with CKD alone (CKD with hypertension vs. CKD alone, P < 0.0001, OR = 1.33, 95% CI: 1.26 to 1.53; CKD with diabetes vs. CKD alone, P < 0.00001; OR = 1.39, 95% CI, 1.16 to 1.53). The incidence of cognitive impairment in CKD with diabetes was higher compared with CKD with hypertension (P = 0.02; OR = 1.16; 95% CI, 1.02 to 1.33). The high incidence rate of cognitive impairment in CKD with the diabetes group might be associated with calcium overload, mitochondrial damage, and longterm hyperglycemia, leading to A beta deposition and brain tissue damage. The use of angiotensin-converting-enzyme inhibitor to lower the blood pressure in CKD patients with hypertension not only reduced endothelial damage, but also decreased A beta deposition. Conclusion: The incidence of cognitive impairment in CKD patients with diabetes is higher compared with other CKD patients including those with hypertension. The specific pathogenesis needs further exploration.

The recent guidelines recommend using the estimated glomerular filtration rate (eGFR) to evaluate renal function. There are two reported full-age-spectrum (FAS) equations in 2017, which are based on serum cystatin C concentrations with or without accompanying serum creatinine level (FASCr–Cys or FASCys). We compared the performance and assessed the applicability of the new FAS equation with the 2012 CKD-EPI (CKD-EPICys and CKD-EPICr–Cys) equation in Chinese subjects.