Primary Sjögren’s disease (pSjD) is a chronic systemic autoimmune disease in which immune-mediated pathology is not confined to exocrine glands but also affects multiple organ systems. Renal involvement constitutes a clinically meaningful manifestation of pSjD and may exert a considerable impact on disease progression, prognosis, and treatment selection. However, the pathogenic basis of renal injury in pSjD is still incompletely understood, and existing therapeutic approaches remain largely empirical. Available studies suggest that renal involvement in pSjD arises from the interaction of multiple determinants, including inherited susceptibility, environmental factors, and endocrine dysregulation. At the core of these pathogenic mechanisms lies persistent activation of the type I interferon (IFN-I) system and immune dysregulation driven by excessive responses of T and B lymphocytes. Such immune abnormalities favor sustained autoantibody production and ectopic germinal center (EGC) formation, thereby amplifying autoimmune inflammation and promoting renal structural and functional injury. Here, this review integrates relevant literature to examine the multifactorial pathogenic mechanisms described above and to systematically elucidate how these mechanisms drive autoimmune responses through diverse immune cell populations. In addition, the potential application prospects of relevant novel targeted therapeutic strategies in pSjD-related renal damage are discussed.

PURPOSE:Approximately 850 million individuals worldwide are diagnosed with kidney disease; however, current therapeutic options remain limited, and patient prognosis is still suboptimal. The Apelin system comprising the G protein-coupled receptor APJ and the ligands Apelin and Elabela, plays a critical role in the physiological and pathological regulation of renal function. However, the full involvement of the Apelin system in kidney disease remains unclear. This study aimed to characterize the current research on Apelin in renal diseases and validate the robustness of the findings through a multi-database comparative approach. METHODS:We searched the Web of Science Core Collection (SCI-EXPANDED) for publications from January 1, 2006, to October 18, 2025, and performed equivalent searches in Scopus and PubMed using the same keywords, timeframes, and eligibility criteria to ensure result stability and generalizability. Analyses were visualized using CiteSpace, the Bibliometrix R package, online bibliometric tools, and Excel software. Key elements included publication trends, contributions from countries, institutions, journals, highly global cited documents, and emerging research themes. RESULTS:The number of related publications has increased rapidly, reflecting growing interest in the role of the Apelin system in kidney diseases. Of the top ten journals publishing on this topic, seven were in the Q1 category of Journal Citation Reports, indicating strong academic influence. Current research focuses on acute kidney injury, diabetic kidney disease, and chronic kidney disease. Mechanistically, studies have predominantly focused on factors such as inflammation, apoptosis, oxidative stress, blood pressure, and fibrosis. Cross-database validation revealed high consistency in annual publication trends, substantial keyword overlap, and stable geographical disease distribution. CONCLUSION:This study offers a comprehensive overview of Apelin system research in kidney disease and provides key insights for future investigations.

Background:Metabolic syndrome (MetS) is associated with a higher risk of mortality. Oral microbiome diversity is related to health outcomes, but its role in forecasting MetS prognosis and the relevant pathogenic mechanisms is still largely unexplored. Methods:Data from 1,769 MetS patients were extracted from the National Health and Nutrition Examination Survey (NHANES) 2009-2012 cycle. To evaluate alpha diversity, the Shannon index, Faith's phylogenetic diversity (PD), observed operational taxonomic units (OTUs), and the Inverse Simpson index were determined. ALDEx2 was employed for differential abundance analysis in the high-diversity subgroup. Co-occurrence network analysis was subsequently conducted, followed by partitioning around medoids (PAM) clustering for community typing. Prognostic associations were validated through Cox regression. Results:Both the Shannon index (hazard ratio [HR] = 0.78, 95% confidence interval [CI]: 0.63-0.96) and the Inverse Simpson index (HR = 0.84, 95% CI: 0.74-0.96) were inversely associated with mortality. In the high-diversity subgroup, differential abundance analysis did not identify any OTU whose relative abundance differed significantly by survival status. According to network analysis, the deceased group exhibited a higher density of positive co-occurrences (283 vs. 224 edges) alongside a notable expansion of negative interactions (71 vs. 15 edges), which was a hallmark of declining community stability. Two clusters were identified through community typing, yet this classification was not significantly related to survival outcomes (CType_2 vs. CType_1: HR = 1.05, 95% CI: 0.73-1.49). Conclusions:Oral microbiome diversity exhibits a negative association with mortality among MetS patients. However, in the high-diversity subgroup, ecological network disruption, rather than alpha diversity or differential taxonomic richness, differentiates the deceased patients from the alive counterparts. This suggests that community structure is a promising risk marker with a higher sensitivity than diversity alone.

The Cardiovascular–kidney–metabolic (CKM) syndrome, a concept recently proposed by the American Heart Association (AHA), highlights the intricate connection between metabolic, renal, and cardiovascular illnesses. Furthermore, the Atherogenic Index of Plasma (AIP), a useful biomarker for evaluating the risk of Cardiovascular Diseases (CVDs), has been associated with the risk of Adverse Cardiovascular Events (ACEs). Nonetheless, its precise function in populations in CKM syndrome Stages 0–3 remains unknown. This prospective study analyzed the data of 7,708 eligible participants (aged ≥ 45 years) from the Chinese Longitudinal Research of Ageing (CHARLS), particularly the 2011–2012 baseline survey (Wave 1). The primary exposure variable was AIP—a natural logarithm of the ratio of Triglycerides (TGs) to High-Density Lipoprotein Cholesterol (HDL-C). On the other hand, the primary endpoint was CVD incidence, which was determined based on self-reported past diagnoses. The relationship between AIP and CVD risk in the population in CKM syndrome stages 0–3 was examined using a Cox proportional risk model. Subgroup and mediation analyses were performed to further elucidate the interactions among these factors. This study involved 7,708 participants in the CKM syndrome stages 0–3 [Mean age = 58.00 years; Interquartile Range (IQR) = 52.00–65.00 years]. The risk of developing CVD increased significantly with higher AIP levels. Specifically, the risk ratio for each unit increase in AIP was 1.31 (95

Urgent-start peritoneal dialysis (USPD) has been identified as the efficient approach to initiate renal replacement treatment in end-stage renal disease patients. Cardiovascular mortality of urgent dialysis is an important issue. The present work focused on assessing risk factors related to cardiovascular death in USPD patients. We carried out the present multicenter retrospective cohort study in Northeast China, included adults initiating USPD between 2013 and 2019. Follow-up was conducted in every patient till the occurrence events below: technical failure, death, loss-to-follow-up, and renal transplantation. There were altogether 1549 cases enrolled into this work. Among them, 123 encountered cardiovascular death. Upon multivariate regression, predictors of cardiovascular death included advanced age (HR 1.045, 95% CI [1.031, 1.060]; p < 0.001), higher eGFR (HR 1.084, 95% CI [1.052, 1.117]; p = 0.001), combined with DM (HR 1.471, 95% CI [1.026, 2.110]; p = 0.036), and advanced HF stage (class III versus class 0-I, HR 5.262; 95% CI [3.281, 8.437]; p < 0.001; class IV versus class 0-I, HR 6.409; 95% CI [4.145, 9.912]; p < 0.001). In addition, the predictors of cardiovascular death in diabetic USPD patients included advanced age (HR 1.052, 95% CI [1.027, 1.078]; p < 0.001) and advanced HF stages (class III versus class 0-I, HR 7.843; 95% CI [4.249, 14.476]; p < 0.001; class IV versus class 0-I, HR 5.285; 95% CI [2.880, 9.698]; p < 0.001). Moreover, the predictors of cardiovascular death in elderly USPD patients were advanced age (HR 1.045, 95% CI [1.016, 1.075]; p < 0.001) and advanced HF stages (class III versus class 0-I, HR 3.407; 95% CI [1.911, 6.073]; p < 0.001; class IV versus class 0-I, HR 5.039; 95% CI [2.982, 8.516]; p < 0.001). Risk factors related to cardiovascular death included advanced age, higher eGFR, combined with diabetes, and advanced heart failure stages among USPD patients.

The Atherogenic Index of Plasma (AIP) has been reported as a strong predictor of all-cause mortality in the overall population. However, the lipid profile changes in individuals with end-stage kidney disease (ESKD) undergoing peritoneal dialysis (PD) may affect the prognostic utility of AIP for all-cause mortality. The connection between them remains unclear. This study included patients receiving PD at five hospitals in China from January 1, 2013, to December 31, 2019, with follow-up until June 30, 2020. The primary exposure variable in this investigation was the logarithm of the triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) ratio, which was used to compute the AIP, and the outcome variable was all-cause mortality. A Cox proportional hazards regression model was employed to analyze the association between AIP and all-cause mortality. Moreover, stratified analyses were performed to investigate this association further. Kaplan-Meier curves were employed for survival analysis, assessing the prognostic implications of varying AIP levels. Nonlinear associations were examined using smooth curve fitting techniques. A total of 869 patients were included in this study, of whom 153 died during the follow-up period. An inverse association was observed between AIP and all-cause mortality risk in the highest tertile compared to the lowest tertile (HR: 0.56, 95

Introduction:Acute kidney injury (AKI) is a key clinical condition that has puzzled clinicians for many years since there is currently no efficient drug therapy. Vitamin E is found to exert a vital antioxidant role and can protect the kidney. However, clinical studies that analyze the correlation between vitamin E and AKI are scarce, and no consistent conclusions are reported from current studies. Therefore, this study was performed to evaluate the impact of vitamin E on treating AKI. Methods:The PubMed, Embase, and Cochrane Library databases were comprehensively searched on 27 December 2023. Qualified studies were selected following the eligibility criteria. The incidence of AKI, serum creatinine, and urea nitrogen levels after vitamin E treatment were evaluated. Then, the data were combined with a fixed- or random-effects model, depending on the heterogeneity test results. Results:Six eligible randomized controlled trials that used vitamin E for the prevention of kidney injury were included. According to our pooled analysis, vitamin E elevated eGFR levels [MD: 0.36; 95% CI (0.19, 0.53), p = 0.000], reduced serum creatinine levels [MD: -0.32; 95% CI (-0.48, 0.16), p = 0.000], and effectively inhibited the occurrence of AKI [RR: 0.69; 95% CI (0.49, 0.98), p = 0.036]. Conclusion:Vitamin E elevates eGFR levels, reduces serum creatinine levels, and efficiently suppresses AKI occurrence. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024499597, identifier CRD42024499597.

End-stage kidney disease (ESKD) is a growing health issue, especially among the very elderly. The optimal dialysis method for very elderly patients with ESKD remains uncertain, and there is a lack of evidence regarding the survival benefits of hemodialysis (HD) versus peritoneal dialysis (PD). This study is a multicenter cohort investigation that included 234 very elderly patients aged 75 years and older with ESKD who received HD or PD across six hospitals in China from January 2013 to December 2020. We employed Propensity Score Matching (PSM) to minimize the influence of confounding factors. Survival analyses were conducted using Kaplan-Meier curves, log-rank tests, and multivariable Cox proportional hazards regression models for the matched cohorts. In the multicenter cohort study with 234 very elderly ESKD patients, PSM was employed, with each group consisting of 56 participants, averaging 79.76 ± 4.15 years in age and having a male composition of 47.44%. Kaplan-Meier survival analysis indicated with no significant difference in survival rates (log-rank p = 0.123). Further analysis, excluding participants with less than 3 months of survival, also showed no significant differences. Cox regression with multiple variables indicated a HR of 0.73 (95% CI: 0.49, 1.10) for HD versus PD, with a p-value of 0.132. This investigation did not demonstrate a statistically significant difference in survival between PD and HD among very elderly patients with ESKD.

Background:Lipid peroxidation is a major factor known to contribute to occurrence of cardiovascular events in dialysis patients. This study aims to investigate whether antioxidant interventions can improve lipid peroxidation damage in dialysis patients. Methods:A comprehensive search in PubMed, Embase, and the Cochrane Library was conducted to identify eligible randomized controlled trials (RCTs) up to June 2024. Endpoints of interest included biomarkers related to Lipid peroxidation. The results from eligible studies were performed using RevMan 5.3 and Stata17.0 software. Results:A total of 25 RCTs were included, involving eight interventions such as vitamin C supplementation, vitamin E supplementation, vitamin E-coated dialyzer, ω-fatty acid supplementation, curcumin supplementation, pomegranate juice supplementation, exercise intervention, and multiple antioxidant interventions. Outcome indicators included malondialdehyde (MDA) and oxidized low-density lipoprotein (Ox-LDL). The meta-analysis revealed that vitamin E supplementation caused significant reductions in MDA (p = 0.01). Treatment with vitamin E-coated dialyzer markedly decreased MDA levels (p < 0.0001). Curcumin supplementation significantly reduced Ox-LDL levels (p = 0.03). Exercise intervention decreased MDA levels (p < 0.0001). Multiple antioxidant interventions significantly decreased MDA (p = 0.01). Conclusion:Supplementation of vitamin E, vitamin E-coated dialyzer treatment, curcumin supplementation, exercise intervention, and multiple antioxidant interventions can effectively reduce the level of lipid peroxidation biomarkers in dialysis patients. Systematic review registration:https://www.crd.york.ac.uk/PROSPERO (CRD42023455399).

Primary Sjögren's syndrome (pSS) is a chronic inflammatory autoimmune disease characterized by lymphocyte proliferation and progressive exocrine gland damage. The kidneys are one of the most frequently involved systems, and the continuous activation of B cells plays a key role in the pathophysiology of renal involvement. Among them, B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL) are two critical factors in the B cell activation process. This study aims to observe the clinical efficacy and safety of Telitacicept, a B cell dual-targeting drug, in patients with pSS complicated by renal involvement. Four patients with renal involvement in pSS, who met the diagnostic criteria of the “Guidelines for the Diagnosis and Treatment of Primary Sjögren's Syndrome” and were confirmed by renal biopsy, were included in this study (Table 1). They were treated withTelitacicept, and the correction of renal involvement and clinical efficacy were observed before and after treatment. Additionally, immunohistochemical staining was performed on renal specimens to observe the expression of APRIL/BLyS in the kidneys of patients with pSS complicated by renal involvement. Expression of APRIL/BLyS was observed in the renal tissues of all four patients(Fig. 1). After treatment with Telitacicept, all four patients experienced relief of symptoms such as dry mouth and dry eyes. Urinary protein levels returned to normal, and the disease activity scores of pSS, including EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) and EULAR Sjögren's Syndrome Patient-Reported Index (ESSPRI), were improved (Table 2). No significant adverse reactions were observed in any of the four patients. Membranous nephropathy is the most common type of glomerular involvement in pSS. The expression of B cell stimulatory factors BLyS/APRIL was detected in renal specimens of patients with pSS complicated by renal involvement. This clinical observation confirms the efficacy and safety of Telitacicept in treating renal involvement in pSS.

BACKGROUND AND AIM:There is growing interest in the intricate relationships among metabolic processes, renal health, and cardiovascular disease (CVD). Individuals in the early stages of Cardiovascular-Kidney-Metabolic (CKM) syndrome (stages 0-3) experience a notably higher incidence of CVD. Previous research has indicated a potential link between the estimated glucose disposal rate (eGDR) and the development of CVD; however, this association within the context of CKM syndrome stages 0-3 remains inadequately explored. METHODS AND RESULTS:The study comprised 5,286 participants, with an average age of 58 years (range: 52-65 years), including 46.86 % males. The study employed information from the CHARLS dataset to analyze the eGDR, calculated using parameters such as glycated hemoglobin levels, blood pressure, and waist circumference (WC). CVD diagnoses were identified through standardized questionnaires. To investigate the link eGDR-CVD risk across CKM syndrome stages 0-3, we applied a Cox proportional hazards model. Additionally, we assessed the nonlinear relationship through smooth curve fitting and threshold effect analysis. The Cox model indicated that individuals with the highest eGDR experienced a 44 % reduction in CVD risk compared to those with the lowest eGDR. Smooth curve fitting displayed an L-shaped trend, revealing a critical threshold at 11.46 mg/kg/min. This threshold can help clinicians identify individuals at higher CVD risk and guide more intensive prevention strategies. CONCLUSION:Our findings reveal a significant inverse relationship eGDR-CVD risk among patients with CKM syndrome stages 0-3. This association exhibited a non-linear, L-shaped pattern, with a crucial threshold identified at 11.46 mg/kg/min.

To observe the efficacy and safety of Ripertamab in the treatment of Idiopathic Membranous Nephropathy (IMN). Clinical data from patients with IMN treated with Ripertamab or Rituximab were retrospectively collected from six tertiary hospitals in Jilin Province between January and December 2023. Patients were grouped based on treatment regimen into the Ripertamab and Rituximab groups and matched 1:1 by age and gender. Follow-ups were conducted over six months to assess baseline characteristics, laboratory parameters, and adverse reactions related to anti-CD20 monoclonal antibody therapy. A total of 112 patients with IMN were identified, including 52 treated with Ripertamab and 60 with Rituximab. After matching, 40 patients were included in each group. Baseline clinical characteristics were comparable between the groups (P > 0.05). There was no statistically significant difference in efficacy between the two groups (P > 0.05). At 6 months, the overall effectiveness rate of Ripertamab in the treatment of IMN was 65.0%, of which the partial and complete remission rates were 50.0% and 15.0%, respectively. The overall effectiveness rate of Rituximab was 60.0%, of which the partial and complete remission rates were 47.5% and 12.5%, respectively. Similarly, there were no significant differences in the incidence of infusion reactions, pulmonary infections, interstitial lung disease, HBV reactivation, neutropenia, or thrombocytopenia (P > 0.05). Ripertamab demonstrates a therapeutic efficacy comparable to Rituximab for IMN, with a similar incidence of infusion-related adverse reactions and complications.

The increasing prevalence of diabetes has led to a growing population of end-stage kidney disease (ESKD) patients with diabetes. Currently, kidney transplantation is the best treatment option for ESKD patients; however, it is limited by the lack of donors. Therefore, dialysis has become the standard treatment for ESKD patients. However, the optimal dialysis method for diabetic ESKD patients remains controversial. ESKD patients with diabetes often present with complex conditions and numerous complications. Furthermore, these patients face a high risk of infection and technical failure, are more susceptible to malnutrition, have difficulty establishing vascular access, and experience more frequent blood sugar fluctuations than the general population. Therefore, this article reviews nine critical aspects: Survival rate, glucose metabolism disorder, infectious complications, cardiovascular events, residual renal function, quality of life, economic benefits, malnutrition, and volume load. This study aims to assist clinicians in selecting individualized treatment methods by comparing the advantages and disadvantages of hemodialysis and peritoneal dialysis, thereby improving patients’ quality of life and survival rates.

Abstract Objective Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). Hungry bone syndrome (HBS) after parathyroidectomy (PTX) is a serious complication, which can lead to diarrhea, convulsion, arrhythmia and even death. This study was aimed to determine the risk factors for HBS after PTX in dialysis patients with SHPT and construct a nomogram prediction model to predict the incidence of postoperative complications. Methods Clinical data were collected from 80 maintenance hemodialysis (MHD) patients with SHPT who received total PTX in the Second Hospital of Jilin University from January 2018 to September 2021. In line with the inclusion and exclusion criteria, totally 75 patients were finally enrolled for analysis. Patients were divided into two groups for retrospective analysis according to the severity of postoperative HBS, including HBS group and non-HBS (N-HBS) group. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors for postoperative HBS. Afterwards, the receiver operating characteristic (ROC) curves were plotted based on the statistical analysis results, aiming to compare the prediction effects of different predicting factors. Finally, the nomogram was established to evaluate the occurrence probability of postoperative complications predicted by the risk factors. Results Among the 75 patients, 32 had HBS (HBS group), while 43 did not have HBS (N-HBS group). Univariate analysis results indicated that, the preoperative intact parathyroid hormone (iPTH) and serum alkaline phosphatase (ALP) levels in HBS group were significantly higher than those in N-HBS group, while preoperative hemoglobin and preoperative albumin (Alb) levels were significantly lower than those in N-HBS group. As discovered by multivariate logistic regression analysis, preoperative iPTH (OR = 1.111, P = 0.029) and ALP (OR = 1.010, P < 0.001) were the independent risk factors for postoperative HBS. ROC curve analysis suggested that the area under the curve (AUC) values of these two indicators were 0.873 and 0.926, respectively (P < 0.0001). Subsequently, the nomogram model for predicting HBS was constructed. The model verification results indicated that the predicted values were basically consistent with the measured values, with the C-index of 0.943 (95% CI 0.892–0.994). Besides, the calibration curve was consistent with the ideal curve, demonstrating the favorable accuracy and discrimination of the model. Conclusions Preoperative iPTH and preoperative ALP are the risk factors for postoperative HBS, which can be used to guide the early clinical intervention.

Abstract Background The first six months of therapy represents a high-risk period for peritoneal dialysis (PD) failure. The risk of death in the first six months is higher for older patients treated with urgent-start PD (USPD). However, there are still gaps in research on mortality and risk factors for death in this particular group of patients. We aimed to investigate mortality rates and risk factors for death in older patients with end-stage renal disease (ESRD) receiving USPD within and after six months of therapy. Methods We retrospectively studied the clinical information of older adults aged ≥ 65 years with ESRD who received USPD between 2013 and 2019 in five Chinese hospitals. Patients were followed up to June 30, 2020. The mortality and risk factors for death in the first six months of USPD treatment and beyond were analyzed. Results Of the 379 elderly patients in the study, 130 died over the study period. During the follow-up period, the highest number (45, 34.6%) of deaths occurred within the first six months. Cardiovascular disease was the most common cause of death. The baseline New York Heart Association (NYHA) class III–IV cardiac function [hazard ratio (HR) = 2.457, 95% confidence interval (CI): 1.200–5.030, p = 0.014] and higher white blood cell (WBC) count (HR = 1.082, 95% CI: 1.021–1.147, p = 0.008) increased the mortality risk within six months of USPD. The baseline NYHA class III–IV cardiac function (HR = 1.945, 95% CI: 1.149–3.294, p = 0.013), lower WBC count (HR = 0.917, 95% CI: 0.845–0.996, p = 0.040), lower potassium levels (HR = 0.584, 95% CI: 0.429–0.796, p = 0.001), and higher calcium levels (HR = 2.160, 95% CI: 1.025–4.554, p = 0.043) increased the mortality risk after six months of USPD. Conclusion Different risk factors correlated with mortality in older adults with ESRD within and after six months of undergoing USPD, including baseline NYHA class III–IV cardiac function, WBC count, potassium, and calcium levels.

Peritoneal dialysis (PD) is a commonly used renal replacement therapy for patients with end-stage renal disease (ESRD). During PD, the peritoneum (PM), a semi-permeable membrane, is exposed to nonbiocompatible PD solutions. Peritonitis can occur, leading to structural and functional PM disorders, resulting in peritoneal fibrosis and ultrafiltration failure, which are important reasons for patients with ESRD to discontinue PD. Increasing evidence suggests that oxidative stress (OS) plays a key role in the pathogenesis of peritoneal fibrosis. Furthermore, zinc deficiency is often present to a certain extent in patients undergoing PD. As an essential trace element, zinc is also an antioxidant, potentially playing an anti-OS role and slowing down peritoneal fibrosis progression. This study summarises and analyses recent research conducted by domestic and foreign scholars on the possible mechanisms through which zinc prevents peritoneal fibrosis.