Background:Self-management (SMP) is a novel treatment comprised of multidimensional interventions. Researchers have reported its reliable effects on short-term improvements in surrogate indicators like 24-h urinary protein excretion and systolic blood pressure. However, whether it has any effect on long-term changes in other surrogate indicators and chronic kidney disease (CKD) endpoints remains unclear. Methods:Patients with CKD stages 3-4 were grouped into either a SMP group or a nonself-management (non-SMP) group whether they had complied any of five characterized elements: regular visits, medication adjustment, nutritional intervention, lifestyle modification, education, and behavior guide. We used 1:1 nearest-neighbor propensity score matching (PSM) to balance between-group differences. Cox regression was used to explore the long-term association between SMP and composite outcomes (all-cause mortality, end-stage kidney disease (ESKD), ≥ 50% decline in estimated glomerular filtration rate (eGFR), or doubling of serum creatinine (SCr) from baseline). Linear mixed-effects (LME) model and marginal means comparisons were used to surrogate indicators analysis. Results:The study included 1160 patients with a median follow-up of 27.20 months. Among them, 580 individuals were in the SMP group and 580 were in the non-SMP group. In the non-SMP group, the median follow-up was 24.48 (12.21, 43.39) months with 174 (30.00%) events, whereas the SMP group had a median follow-up of 29.34 (14.75, 42.00) months with 134 (23.10%) composite outcomes. Participation in a SMP program was associated with a 30.9% reduction in CKD progression risk (hazard ratio (HR) of composite outcome: 0.691, 95% CI: 0.549-0.869, and p = 0.002). LME and marginal means comparison indicated that patients with SMP had higher mean difference of eGFR and serum albumin (Alb) than the non-SMP individuals (mean difference of eGFR: 1.791 (0.721, 2.861) mL/min/1.73 m2, p = 0.001; marginal mean difference of eGFR: 2.560 (1.660, 3.470) mL/min/1.73 m2, p < 0.0001; mean difference of Alb: 0.654 (0.202, 1.105) g/L, p = 0.005; and marginal mean difference of Alb: 0.460 (0.166, 0.753) g/L, p = 0.002). Conclusion:SMP programs are associated with a 30.9% reduction in CKD progression risk and improvements in kidney function and nutrition-related surrogate markers, benefiting CKD patients in stages 3-4.

Background:Early intervention and management of anemia, particularly the commonly used measures of hemoglobin (Hb) and hematocrit (HCT), are important in slowing and preventing the progression of chronic kidney disease (CKD). However, the optimal range for regulating Hb and HCT levels remains uncertain. Objective:The aim of this study was to elucidate the intrinsic relationship between Hb and HCT and the short- and long-term prognosis of CKD, and determine optimal ranges for Hb and HCT. Methods:We retrospectively collected demographic and clinical data over a 6-year follow-up period in Lingnan, China, to show the long-term characteristics of Hb and HCT, and studied the association between Hb, HCT, and the prognosis of patients with CKD stages 3-4. We constructed Cox and group-based trajectory modeling (GBTM) models to examine Hb's and HCT's associations with short- and long-term risk of composite outcomes in patients with CKD stages 3-4. Results:A total of 730 individuals were included, with a median age of 59.30 (48.47, 68.63) years, 306 (41.92%) were women, and median eGFR was 39.24 (26.26, 50.67) mL/min/1.73 m2. A multivariate time-dependent Cox model revealed mean_Hb and mean_HCT as independent protective factors for the composite outcome {hazard ratio (HR) (95% confidence interval [CI]): 0.851 (0.786, 0.921) g/L, p=0.000; 0.578% (0.441%, 0.758%), p=0.000}. Optimized GBTM models categorized Hb and HCT into four groups. Group 1 ("lower and decreasing") (Hb<100 g/L, HCT approximately 30%) served as the reference. Groups 2 ("lower and growing slightly") (Hb 110-120 g/L, HCT approximately 35%), 3 ("higher and growing slightly") (Hb 125-135 g/L, HCT approximately 40%), and 4 ("higher and growing steadily") (Hb 145-160 g/L, HCT approximately 45%) served as independent protective factors for patients with CKD stages 3-4 for the composite outcome (p=0.000; p for trend<0.000). Subgroup analyses showed interactions between mean_Hb and sex (p for interaction=0.034), as well as between Hb trajectory group 2 and CKD stage (p for interaction=0.015). Conclusions:Maintenance of stable and higher Hb levels of 110-130 g/L and HCT levels of 35%-40% in patients with CKD stages 3-4 is both protective and reliable in delaying CKD progression.

Objective:Phase angle (PhA) obtained through bioimpedance analysis has been linked to mortality and malnutrition in dialysis patients. However, it remains unclear whether PhA is associated with renal prognosis in non-dialysis CKD patients. Methods:Two thousand two hundred two CKD patients were enrolled in the SMP-CKD cohort, Guangdong Provincial Hospital of Traditional Chinese Medicine from July 1, 2015 to May 31, 2024. Participants undertook bioimpedance measures, and the correlation between PhA and renal endpoint was analyzed. Analytical approaches include Cox proportional hazards analysis and group-based trajectory modeling. Composite outcome is defined as the first occurrence of >30% decline or <5 mL/min/1.73m2in eGFR, doubled of SCr from the baseline, initiation of continuous dialysis therapy or receipt of a kidney transplant, or all-cause mortality. Results:During a mean follow-up of time 2.5 years, 570(25.9%) participants reached the composite endpoint. In the multivariable Cox regression model, subjects belonging to higher quartiles of phase angle presented with a decreased risk of poor prognosis, showing 29 and 38% risk reductions in Q3 (aHR 0.71, 95%CI 0.55-0.93) and Q4 (aHR 0.62, 0.45-0.85) versus Q1 (both p < 0.05). When modeled in 2 groups according to the turning point of 5.0°, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for broad-PhA group was 0.77(0.63, 0.95) compared with narrow-PhA group. The group-based trajectory modelling (GBTM) identified 4 trajectories, and the beneficial association remained consistent, with aHR (95% CIs) for group 2, group 3, group 4 were 0.69 (0.50-0.95), 0.59 (0.39-0.90), 0.47 (0.24-0.93), respectively, compared with group 1. Conclusion:Phase angle could be useful in determining nutritional status of CKD patients, lower phase angle is an independent risk factor for poor prognosis in CKD patients.

This study aims to investigate the relationship between handgrip strength (HGS) and the progression of chronic kidney disease (CKD) in non-dialysis patients in China, as part of the Self-Management Program for Patients with CKD Cohort (SMP-CKD). In the SMP-CKD cohort, we utilized Cox regression and Kaplan–Meier survival analysis to explore the association between HGS and CKD progression. Data were stratified by sex-specific HGS quartiles, sarcopenia status, and HGS thresholds. The HGS thresholds were determined through curve analysis of HGS against composite renal outcomes. Group differences were compared to assess the impact of HGS on CKD outcomes. A total of 441 participants (mean age 57.0 ± 17 years, 56.0

BACKGROUND:The association between dietary energy intake and disease outcomes in CKD 3-5 remains unclear. This study explored this relationship in Southern Chinese CKD 3-5 patients. METHODS:This retrospective cohort study included 234 CKD 3-5 patients from the Self-Management Program for Patients with Chronic Kidney Disease (SMP-CKD) database. The endpoint was a composite of sustained decline of at least 30% in estimated glomerular filtration rate (eGFR), the initiation of kidney replacement therapy, or all-cause mortality. The main variable was energy intake. Kaplan-Meier analysis, restricted cubic splines, and Cox regression models were performed to assess the association. RESULTS:85 (36.3%) individuals reached the endpoint with a median follow-up of 33 months. The median age was 56.0 (46.3, 63.3) years, and 121 (51.7%) were male. The association between energy intake and the endpoint in CKD 3-5 patients showed a U-shaped relationship. We reclassified patients according to energy intake: Group 1 (<24.6 kcal/kg/d), Group 2 (24.6-29.5 kcal/kg/d), and Group 3 (>29.5 kcal/kg/d). Compared to Group 2, Group 3 (HR = 3.0; 95%CI, 1.118-7.993, p = 0.029) and Group 1 (HR = 2.5; 95%CI, 1.068-5.966, p = 0.035) had a higher risk of reaching the endpoint. Subgroup analysis showed no significant interaction except for age, with a consistent U-shaped relationship in those ≤ 60 years. CONCLUSION:High and low energy intake are significantly associated with an increased risk of adverse outcomes in non-dialysis CKD 3-5 patients. An energy intake of 24.6-29.5 kcal/kg/day may be optimal to reduce the risk of poor health outcomes.

ObjectivesThere is a lack of data regarding the quality of the diet and the adherence to dietary guidelines of patients with non-dialysis-dependent CKD (NDD-CKD) in China.Design and methodsSingle-center cross-sectional study of 261 patients with CKD stages 3–5, who responded to 3-day dietary records and undertook 24-h urine samples along with clinical, laboratory, and anthropometric assessments. We compared their food intake with Chinese recommendations for CKD patients, assessed dietary quality through the Chinese Healthy Eating Index (CHEI), and calculated the contribution to energy intake by processed foods according to the NOVA classification.ResultsAverage energy intake was 30 ± 9 Kcal/kg/d, and 65% consumed less energy than recommended. The average protein intake was 1.2 ± 0.5 g/Kg/d, and 81% consumed more than recommended. 71% of patients consumed excess sodium and 80% consumed too little fiber. These proportions worsened across more severe CKD stages (all P trend value <0.05). The diet was considered of moderate quality (CHEI score 59.5 ± 11.0), and patients with CKD stages 4–5 scored progressively worse (P trend = 0.008). Total grains and tubers supplied 50 and 30% of the total energy and protein intake, respectively. Processed and ultra-processed foods contributed to 23.3% of dietary energy and 11.7% of food weight.ConclusionA large proportion of NDD-CKD at our center showed low adherence to diet recommendations. Although consumption of processed foods was low, diet quality worsened with more severe CKD, with low intake of whole grains, dairy, and soybean.

Background Lipid management in clinic is critical to the prevention and treatment of Chronic kidney disease (CKD), while the manifestations of lipid indicators vary in types and have flexible association with CKD prognosis. Purpose Explore the associations between the widely used indicators of lipid metabolism and their distribution in clinic and CKD prognosis; provide a reference for lipid management and inform treatment decisions for patients with non-dialysis CKD stage 3–5. Methods This is a retrospective cohort study utilizing the Self-Management Program for Patients with Chronic Kidney Disease Cohort (SMP-CKD) database of 794 individuals with CKD stages 3–5. It covers demographic data, clinical diagnosis and medical history collection, laboratory results, circulating lipid profiles and lipid distribution assessments. Primary endpoint was defined as a composite outcome(the initiation of chronic dialysis or renal transplantation, sustained decline of 40% or more in estimated glomerular filtration rate (eGFR), doubled of serum creatinine (SCr) from the baseline, eGFR less than 5 mL/min/1.73m 2 , or all-cause mortality). Exposure variables were circulating lipid profiles and lipid distribution measurements. Association were assessed using Relative risks (RRs) (95% confidence intervals (CIs)) computed by multivariate Poisson models combined with least absolute shrinkage and selection operator (LASSO) regression according to categories of lipid manifestations. The best model was selected via akaike information criterion (AIC), area under curve (AUC), receiver operating characteristic curve (ROC) and net reclassification index (NRI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness.. Results 255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.8 [48.7, 67.2] years with a median eGFR of 33.7 [17.6, 47.8] ml/min/1.73 m 2 . Five dataset were built after multiple imputation and five category-based Possion models were constructed for each dataset. Model 5 across five datasets had the best fitness with smallest AIC and largest AUC. The pooled results of Model 5 showed that total cholesterol (TC) (RR (95%CI) (per mmol/L) :1.143[1.023,1.278], P = 0.018) and percentage of body fat (PBF) (RR (95%CI) (per percentage):0.976[0.961,0.992], P = 0.003) were significant factors of composite outcome. The results indicated that comprehensive consideration of lipid metabolism and fat distribution is more critical in the prediction of CKD prognosis.. Conclusion Comprehensive consideration of lipid manifestations is optimal in predicting the prognosis of individuals with non-dialysis CKD stages 3–5.

INTRODUCTION:Physical inactivity is prevalent and associated with adverse outcomes among patients with chronic kidney disease (CKD). Most previous studies have relied on subjective questionnaires to assess levels of physical activity (PA) and mainly focused on patients undergoing dialysis. Therefore, the Physical Activity Elements and Adverse Outcomes in Patients with Chronic Kidney Disease in Guangdong study aims to investigate the levels and types of PA elements and their association with adverse outcomes in Chinese non-dialysis CKD (ND-CKD) patients. METHODS AND ANALYSIS:In this prospective cohort study, 374 patients with ND-CKD will be recruited from Guangdong province, South of China. The primary exposure will be levels of PA assessed by ActiGraph GT3X+ accelerometer including the intensity, duration, frequency and type of PA. The traditional Chinese exercises such as tai chi and Baduanjin will also be assessed. The primary outcomes will be all-cause mortality. Other variables including demographics, comorbidities, medication and laboratory markers will be registered. All data will be updated annually for at least 5 years, or until the occurrence of death or initiation of renal replacement therapy. The Spearman correlation coefficient will be used to investigate the correlation between questionnaire-derived and accelerometry-derived PA. The Cox proportional hazards model will be used to investigate the association between level of PA and adverse outcomes. Non-linear associations between PA levels and outcomes, as well as the minimum desirable PA level, will be evaluated using restricted cubic splines. ETHICS AND DISSEMINATION:The ethical permission for this study was obtained from the ethics committee of Guangdong Provincial Hospital of Chinese Medicine in Guangzhou, China (B2015-152-02). Written informed consent is obtained from all participants. The results will be disseminated by publication in a peer-reviewed journal and presented at relevant conferences.

BackgroundChinese patent medicine is commonly used in China as an important treatment mechanism to thwart the progression of chronic kidney disease (CKD) stages 3–5, among which Niaoduqing granules are a representative Chinese patent medicine; however, its long-term efficacy on CKD prognosis remains unclear.MethodsPatients were grouped according to Niaoduqing granule prescription duration (non-Niaoduqing granule (non-NDQ) group vs Niaoduqing granule (NDQ) group). Serum creatinine (SCr) variation was compared using a generalized linear mixed model (GLMM). Multivariate Cox regression models were constructed, adjusting for confounding factors, to explore the risk of composite outcomes (receiving renal replacement therapy (RRT) or having an estimated glomerular filtration rate (eGFR)<5 mL/min/1.73 m2, ≥50% decline in the eGFR from the baseline, and doubling of SCr) in individuals consuming Niaoduqing granules.ResultsA total of 1,271 patients were included, with a median follow-up duration of 29.71 (12.10, 56.07) months. The mean SCr Z-scores for the non-NDQ group and NDQ group were −0.175 and 0.153, respectively, at baseline (p = 0.015). The coefficients of the NDQ group from visit 1 to visit 5 were −0.207 (95% CI: −0.346, −0.068, p = 0.004), −0.214 (95% CI: 0.389, −0.039, p = 0.017), −0.324 (95% CI: 0.538, −0.109, p = 0.003), −0.502 (95% CI: 0.761, −0.243, p = 0.000), and −0.252 (95% CI: 0.569, 0.065, p = 0.119), respectively. The survival probability was significantly higher in the NDQ group (p = 0.0039). Taking Niaoduqing granules was a significant protective factor for thwarting disease progression (model 1: HR 0.654 (95% CI 0.489–0.875, p = 0.004); model 2: HR 0.646 (95% CI 0.476, 0.877, p = 0.005); and model 3: HR 0.602 (95% CI 0.442, 0.820, p = 0.001)).ConclusionThe long-term use of Niaoduqing granules improved SCr variation and lowered the risk of CKD progression by 39.8%.

Objective To understand the distribution of body mass index(BMI)in non-dialysis patients with chronic kidney disease(CKD)and explore the possible influencing factors.Methods A to-tal of 369 patients participated in this cohort study for more than 6 months.And uni/multifactorial compar-isons were made for distribution of BMI,diet/exercise profiles,nature/type of food and frequency of exer-cise.Results The level of BMI was excess(n=84,22.76%),normal(n=263,71.27%)and too-low(n=22,5.97%).No statistically significant inter-group differences existed in nature/type of food.Statisti-cally significant inter-group differences in exercise frequency existed(P=0.008).Regression models were constructed by combining the above-mentioned influencing factors and other potential factors.The model revealed that exercise frequency(β=-0.201,P＜0.01)and beverage intake(β=0.110,P=0.032)were independent influencing factors of BMI.Conclusion BMI is generally normal for non-dialysis CKD patients at our center.And the number of BMI overload is greater than that of underload.Exercise frequency and beverage intake may be independent influencing factors of BMI.

BACKGROUND:Recent individual studies have indicated that ultra-processed food (UPF) consumption may be associated with the incidence of chronic kidney disease (CKD). We conducted a systematic review and meta-analysis based on those longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD, and synthesizing the results. METHOD:PubMed, Embase, The Cochrane Library, Web of Science, and Scopus were searched from inception through 22 March 2023. Any longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD were included. Two researchers independently conducted the literature screening and data extraction. RR and its 95% CI were regarded as the effect size. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of the studies included, and the effect of UPF consumption on the risk of incident CKD was analyzed with STATA version 15.1. This study's protocol was registered in PROSPERO (CRD42023411951). RESULTS:Four cohort studies with a total of 219,132 participants were included after screening. The results of the meta-analysis suggested that the highest UPF intake was associated with an increased risk of incident CKD (RR = 1.25; 95% CI: 1.18-1.33). CONCLUSIONS:High-dose UPF intake was associated with an increased risk of incident CKD. However, the underlying mechanisms remain unknown. Thus, more standardized clinical studies and further exploration of the mechanisms are needed in the future.

Context A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction.Objective To investigate the regulatory effect of TXD on gut dysbiosis, as a treatment of constipation in patients with peritoneal dialysis (PD).Materials and methods The chemical content of TXD was assessed by high-performance liquid chromatography. A total of 29 PD patients were enrolled and treated with TXD orally (3 g crude drug/each/twice/day) for 3 months. Blood and faecal samples were collected at the beginning and end, to determine the changes in biochemical characteristics and gut microbial composition. The stool conditions were asked to be scored. Additional 30 healthy individuals were recruited as a control for the analysis of gut microbiota.Results Although having no significant effects on serum biochemical characteristics, 3-month TXD intervention improved constipation in PD patients: decreased 80% abdominal distention (p < 0.01), increased 2.6-fold sloppy stools (p < 0.05) and eliminated hard stool completely (p < 0.01). The analysis of gut microbiota showed that, compared to the healthy group, the microbial richness was reduced in PD patients. After a 3-month TXD treatment, this reduced richness was raised, and Paraprevotella clara, Lachnospiraceae bacterium 2-146FA, Phascolarctobaterium succinatutens, Lachnospiraceae bacterium 2-1-58FAA, Fusobacterium mortiferum, and Prevotella copri were accumulated in the intestinal flora. Furthermore, the bacterial species enriched by TXD correlated with the improvement of constipation.Discussion and conclusions TXD treatment may improve constipation by modulating gut dysbiosis in PD patients. These findings provide data to support the further application of TXD in the adjuvant treatment of PD.

Background Time-restricted feeding (TRF) has become a popular weight loss method in recent years. It is widely used in the nutritional treatment of normal obese people and obese people with chronic diseases such as diabetes mellitus and hypertension, and has shown many benefits. However, most TRF studies have excluded chronic kidney disease (CKD) patients, resulting in a lack of sufficient evidence-based practice for the efficacy and safety of TRF therapy for CKD. Therefore, we explore the efficacy and safety of TRF in overweight and obese patients with moderate-to-severe stage CKD through this pilot study, and observe patient compliance to assess the feasibility of the therapy. Methods This is a prospective, non-randomized controlled short-term clinical trial. We recruited overweight and obese patients with CKD stages 3-4 from an outpatient clinic and assigned them to either a TRF group or a control diet (CD) group according to their preferences. Changes in renal function, other biochemical data, anthropometric parameters, gut microbiota, and adverse events were measured before the intervention and after 12 weeks. Results The change in estimated glomerular filtration rate (eGFR) before and after intervention in the TRF group (Δ = 3.1 ± 5.3 ml/min/1.73m2) showed significant improvement compared with the CD group (Δ = -0.8 ± 4.4 ml/min/1.73m2). Furthermore, the TRF group had a significant decrease in uric acid (Δ = -70.8 ± 124.2 μmol/L), but an increase in total protein (Δ = 1.7 ± 2.5 g/L), while the changes were inconsistent for inflammatory factors. In addition, the TRF group showed a significant decrease in body weight (Δ = -2.8 ± 2.9 kg) compared to the CD group, and body composition indicated the same decrease in body fat mass, fat free mass and body water. Additionally, TRF shifted the gut microbiota in a positive direction. Conclusion Preliminary studies suggest that overweight and obese patients with moderate-to-severe CKD with weight loss needs, and who were under strict medical supervision by healthcare professionals, performed TRF with good compliance. They did so without apparent adverse events, and showed efficacy in protecting renal function. These results may be due to changes in body composition and alterations in gut microbiota.

目的 慢性肾脏病(chronic kidney disease,CKD)3～5期患者蛋白质能量消耗发生率远高于CKD1～2期患者.营养干预作为一种非药物治疗,有效改善CKD3～5期患者的蛋白质能量消耗情况,成为近年研究的热点.方法 构建证据图,以系统梳理目前CKD营养干预的临床研究文献,了解该领域证据分布情况,寻找营养干预,探究C K D3～5期营养干预研究趋势.检索Pubmed、Cochrane、Embase、中国知网、维普、万方、Clinicaltrials、Chictr及其参考文献数据库,时限由建库至2020年4月.纳入CKD营养干预临床研究与系统评价.采用文字描述结合图表分析的方法,展示证据的分布特征.结果 共纳入文献773篇,从年度发表趋势、地区分布、研究类型、临床研究规模和结果等方面进行分析.结论(1)C K D 3～5期营养干预临床研究数量整体呈增长趋势,主要以中美为主;(2)C K D3～5期营养干预方式以单一营养素干预为主,占比达98％,少量研究涉及饮食结构干预;(3)就疗效指标的选择而言,酮酸辅助蛋白饮食研究的疗效指标有43个,需要进行研究时间更长、规模更大的研究进一步统一疗效评价指标;限制钠饮食干预的疗效指标涉及血压、肾功能、依从性等,临床研究质量有待商榷,需要进一步规范,以提供更可靠的研究证据;饮食结构干预的疗效指标涉及肾功能、血压、营养状况等;(4)饮食结构干预的研究可能是未来的研究方向.

The feasibility and efficacy of low-protein diets (LPD) treatment in chronic kidney disease (CKD) is controversial. Based on the characteristics of the Chinese diet, we observe the qualification rates and short-term clinical effects of LPD for CKD patients in our center. This is a retrospective cohort study. CKD stages 3–5 patients who were regularly followed up 5 times (over 2 years) and treated with LPD were included. We collected clinical data to observe the changes in LPD qualification rates and divided patients into LPD and non-LPD group according to the average dietary protein intake (DPI) of 5 follow-up time points and compared the changes in primary and secondary outcome measures between the two groups. We analyzed data from 161 eligible CKD stages 3–5 patients. From baseline to the 5th follow-up time point, the LPD qualification rates of all patients were 11.80%, 35.40%, 47.82%, 53.43% and 54.04%, respectively. For primary outcome measures, the urine protein/creatinine ratio (UPCR) decreased more in the LPD group than in the non-LPD group [Median (interquartile range, IQR) of the difference between the 5th follow-up time point and baseline: 0.19 (− 0.01–0.73) vs. 0.10 (− 0.08–0.27), P < 0.001]. We constructed three classes of mixed linear models (model I, II, III). The UPCR slopes were all negative in the LPD group and positive in the non-LPD group (P < 0.001). Meanwhile, in model I, the estimate glomerular filtration rate(eGFR) decline slope in the LPD group was lower than that in the non-LPD group [slope (standard error): − 1.32 (0.37) vs. − 2.35 (0.33), P = 0.036]. For secondary outcome measures, body mass index (BMI) triglycerides (TG), body weight, and fat free mass (FFM) showed stable statistical differences in the comparison of LPD and non-LPD groups, with greater declines in the former. The results of this study suggest that LPD treatment can reduce UPCR in patients with CKD stages 3–5, and may also delay the decline in eGFR. Meanwhile, it also reduces BMI, TG, body weight, and FFM, thus the need to prevent malnutrition in clinical implementation.

Dysfunction of mesangial cells plays a significant role in the glomerular lesions and is implicated in the pathophysiology of diabetic nephropathy (DN). Macrophages infiltration is the main pathological feature of DN, which can ultimately lead to renal inflammation. Recent studies suggest that the crosstalk between kidney resident cells and inflammatory cells influences the development of DN, and that controlling this crosstalk may help treat DN. Here, we found that DN mice appeared renal pathological damage, including dilation of mesangial matrix and significant infiltration of macrophages, accompanied by increased inflammatory response, NLRP3 inflammasome activation and autophagy deficiency. Additionally, mesangial cells internalized exosomes from high glucose (HG) treated macrophage, resulting the activation of inflammatory cytokines and NLRP3 inflammasome and deficiency of autophagy in vitro and in vivo. Moreover, C57BL/6 mice injected HG-stimulated macrophages-derived exosomes exhibited renal dysfunction and mesangial matrix expansion. Taken together, the present study demonstrated that mesangial cells responded to HG treated macrophage-derived exosomes by promoting the activation of NLRP3 inflammasome and autophagy deficiency, thereby participating in the development of DN.

Abstract Background Lipid management in clinic is critical to the prevention and treatment of CKD, while the manifestations of fat metabolism vary in type and have flexible correlations with CKD prognosis. Purpose Explore correlations between the widely used indicators of lipid metabolism in clinic and CKD prognosis; provide a reference for lipid management and treatment among non-dialysis CKD stages 3–5. Methods This is a retrospective cohort study utilizing the SMP-CKD database of 794 individuals with CKD stages 3–5. Variables with P < 0.10 in univariate Poisson models were induced to construct several timescale-based Poisson models with a stepwise regression according to lipid manifestation categories. We selected the best model via AIC, AUC and ROC and confirmed the independent relative exposures via RRs (95% CI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness. Results 255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.35 [48.50, 66.69] years with a median eGFR of 33.68 [17.55, 47.81] ml/min/1.73 m2. The fully adjusted category-based Poisson Model 4 in Dataset 5 had the largest AUC (0.717 [0.684, 0.751]) with P for ROC < 0.05. TC (1.158 [1.056, 1.271], P = 0.002) and PBF (0.948 [0.906, 0.992], P = 0.021) were significant factors of composite outcome and no manual measurements had any statistically significance. The

慢性肾脏病（chronic kidney disease，CKD）是一种长期不良生活方式导致的慢性疾病，具有“三高”“三低”的流行病学特点。目前，我国CKD的管理模式尚处于摸索阶段，为提高CKD患者的管理效率，规范诊疗管理过程，本研究就广东省中医院慢病管理中心5A模式的慢病管理模式的建立及应用情况进行报道，期望为我国CKD非透析期患者的诊疗和管理提供参考策略。

Background Kidney disease progression rates vary among patients. Rapid and accurate prediction of kidney disease outcomes is crucial for disease management. In recent years, various prediction models using Machine Learning (ML) algorithms have been established in nephrology. However, their accuracy have been inconsistent. Therefore, we conducted a systematic review and meta-analysis to investigate the diagnostic accuracy of ML algorithms for kidney disease progression. Methods We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the Chinese Biomedicine Literature Database, Chinese National Knowledge Infrastructure, Wanfang Database, and the VIP Database for diagnostic studies on ML algorithms’ accuracy in predicting kidney disease prognosis, from the establishment of these databases until October 2020. Two investigators independently evaluate study quality by QUADAS-2 tool and extracted data from single ML algorithm for data synthesis using the bivariate model and the hierarchical summary receiver operating characteristic (HSROC) model. Results Fifteen studies were left after screening, only 6 studies were eligible for data synthesis. The sample size of these 6 studies was 12,534, and the kidney disease types could be divided into chronic kidney disease (CKD) and Immunoglobulin A Nephropathy, with 5 articles using end-stage renal diseases occurrence as the primary outcome. The main results indicated that the area under curve (AUC) of the HSROC was 0.87 (0.84–0.90) and ML algorithm exhibited a strong specificity, 95% confidence interval and heterogeneity (I 2 ) of (0.87, 0.84–0.90, [I 2 99.0%]) and a weak sensitivity of (0.68, 0.58–0.77, [I 2 99.7%]) in predicting kidney disease deterioration. And the the results of subgroup analysis indicated that ML algorithm’s AUC for predicting CKD prognosis was 0.82 (0.79–0.85), with the pool sensitivity of (0.64, 0.49–0.77, [I 2 99.20%]) and pool specificity of (0.84, 0.74–0.91, [I 2 99.84%]). The ML algorithm’s AUC for predicting IgA nephropathy prognosis was 0.78 (0.74–0.81), with the pool sensitivity of (0.74, 0.71–0.77, [I 2 7.10%]) and pool specificity of (0.93, 0.91–0.95, [I 2 83.92%]). Conclusion Taking advantage of big data, ML algorithm-based prediction models have high accuracy in predicting kidney disease progression, we recommend ML algorithms as an auxiliary tool for clinicians to determine proper treatment and disease management strategies.

Abstract Background Chronic kidney disease (CKD) is a major global health problem. Short-term self-management has been considered to effect some renal and psychological endpoints. However, there are currently very few studies about self-management for CKD that a) have been scientifically designed by a theory-based framework and b) that evaluate the long-term effects and working mechanism. This study presents the rationale and design of a theory-based cohort study to explore how this self-management intervention works and its effectiveness on the Chinese CKD population. Methods In this ambispective intervention cohort study,1,200 patients with CKD stages 1–5 will be recruited from July 2015 to July 2024 in 3 branches of Guangdong Provincial Hospital of Chinese Medicine (GPHCM) in Guangdong province, China. The patients in the self-management cohort will choose to receive an intervention that consists of education, nutrition/diet modification, lifestyle change recommendation, medication review, and psychology support based on Social Cognition Theory (SCT). The patients in the control cohort will do regular follow-ups based on the clinic rules. All the patients will be followed up for 5 years, or until the occurrence of a primary outcome. Detailed clinical, laboratory markers, nutritional status, psychological exposures and outcome questionaries will be collected semiannually in CKD stage 1–2 and trimonthly in stage 3–5 patients. The primary outcome is the occurrence of composite clinical endpoints (doubling of serum creatinine level, ESKD, loss of renal function (≥ 40% decline in GFR from baseline), death, major cardiovascular or cerebrovascular events). The main secondary outcomes include the absolute change and slope of eGFR, absolute changes of urinary protein creatinine ratio, 24-h urine proteinuria, intact parathyroid hormone level, and self-management adherence rate and quality of life from baseline to end of the study. The effectiveness of self-management will be analyzed and the association between longitudinal trajectories of self-management and renal outcomes will be evaluated. Discussion This study aims to provide further evidence for the effectiveness of theory-based self-management in CKD patients and to improve the lives of patients with CKD by slowing progression, improving psychological well-being and overall quality of life. Trial registration Chinese Clinical Trial Register (ChiCTR1900024633). 19 July, 2019. http://www.chictr.org.cn/showproj.aspx?proj=38378