Background This nationwide multi-centre cross-sectional study (May 2025) examined central venous catheter (CVC) maintenance practices and exit site infection (ESI) rates across China’s 31 regions. Using a questionnaire for nursing managers (2388 valid responses; 97.63% response rate), data covered 60,119 patients undergoing blood purification. Methods A nationwide, multi-centre, cross-sectional study was conducted in May 2025 across all 31 provincial-level regions of mainland China. Nursing managers from blood purification centres were surveyed using a structured questionnaire. Results Of the 2446 questionnaires distributed, 2388 were valid, yielding a response rate of 97.63%. Among 60,119 patients using CVCs for blood purification, the overall ESI rate was 3.58%. ESI rates differed significantly by geographic region, hospital grade, and dialysis-centre scale, with higher rates observed in Southeastern China (4.26%), primary hospitals (5.45%), and large-scale dialysis centres (4.21%) (all P < 0.001). Catheter maintenance practices varied substantially across centres. Most hospitals performed dressing changes three times per week (82.50%), predominantly used povidone-iodine as the disinfectant (91.75%), and assigned dedicated supervisory personnel (69.43%). ESI rates were significantly associated with supervision models, dressing and disinfectant selection, dressing change frequency, and patient self-management behaviours during the interdialytic period (all P < 0.001). Conclusion This nationwide survey demonstrates substantial heterogeneity in CVC maintenance practices and ESI rates across blood purification centres in China. These findings underscore the need for optimized, evidence-based catheter maintenance strategies and targeted infection control measures to reduce catheter-related complications and improve the quality of blood purification care.

ABSTRACT Objective To investigate the longitudinal pathological changes in the spectrum of biopsy‐proven renal diseases among elderly patients over the past 20 years at a single center in China. Methods We retrospectively enrolled patients aged ≥ 60 years who underwent renal biopsy at Beijing Hospital between January 2005 and December 2024. Patients were stratified into four 5‐year periods (2005–2009, 2010–2014, 2015–2019, and 2020–2024) based on biopsy date. The frequency and distribution of biopsy‐proven renal diseases across these periods were analyzed. Results A total of 594 elderly patients were included, accounting for 29.2% of all native biopsies in our cohort. The mean age was 67.9 ± 5.7 years, with a male‐to‐female ratio of 1.4:1. The proportion of elderly patients undergoing renal biopsy increased significantly across the four periods (19.1%, 22.5%, 33.9%, 38.9%; χ2 = 60.160, p < 0.01). Nephrotic syndrome (NS) was the most common indication for biopsy, although its proportion declined over time. In contrast, the proportion of biopsies performed for chronic kidney disease (CKD) increased substantially. Primary glomerular nephropathy (PGN), secondary glomerular nephropathy (SGN), and tubulointerstitial nephropathy (TIN) accounted for 54%, 39.9%, and 6.1% of all cases, respectively. The most prevalent cause of PGN was membranous nephropathy (MN), and the leading pathological types of SGN included diabetic nephropathy (DN), antineutrophil cytoplasmic antibody‐associated vasculitis (AAV), and hypertensive nephropathy (HTN). Throughout the study period, the proportion of PGN decreased significantly (64.6%, 64.9%, 54.1%, 42.6%; χ2 = 18.5, p < 0.001), driven by a decline in MN (34.1%, 39.6%, 32.6%, 23%; χ2 = 10.015, p = 0.018). Conversely, the proportion of SGN increased markedly (29.3%, 32.4%, 39.4%, and 49.2%; χ2 = 13.0, p = 0.004), primarily due to rising trends in DN and HTN. Notably, during the period 2020–2024, SGN surpassed PGN as the predominant form of biopsy‐proven renal diseases among elderly individuals. Conclusions The utilization of renal biopsy in elderly patients has increased significantly over the past two decades. While NS remains the most common indication, a notable rise in biopsies for CKD has been observed. The pathological spectrum has undergone a significant shift, characterized by a dramatic decrease in PGN (especially MN) and a continuous increase in SGN (predominantly DN and HTN). The predominance shifted to SGN over PGN in biopsy‐proven renal diseases among the elderly in the most recent period.

Background Recent studies have indicated that patients with chronic kidney disease (CKD) experience central hypothyroidism (CH) following treatment with roxadustat. Our objective is to assess the effect of roxadustat on the hypothalamic-pituitary-thyroid (HPT) axis in patients undergoing maintenance hemodialysis (MHD) and to explore whether it may cause potential tissue toxicity. Methods A total of 140 patients undergoing MHD were enrolled in this cross-sectional study. Thyroid hormones, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), as well as parameters of lipid metabolism, cardiac function, and bone metabolism, were assessed. The patients were divided into two groups based on their roxadustat treatment status: the roxadustat group (n = 53) and the control group (n = 87), differences between groups were evaluated using the Student’s t-test or the Mann-Whitney U test. Unconditional logistic regression analysis was utilized to identify risk factors for hypothyroidism. Results The roxadustat group demonstrated lower serum levels of TSH, FT3, and FT4 compared to the control group. Additionally, four cases (7.5%) exhibited abnormalities in all three indicators, and seven cases had TSH levels below 0.4 mU/L. Notably, none of the patients exhibited clinical symptoms of hypothyroidism. Unconditional logistic regression analysis indicated that roxadustat was an independent risk factor for hypothyroidism, with an odds ratio (95% confidence interval) of 3.635 (1.593, 8.291). Furthermore, the roxadustat group had lower levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), and higher levels of serum total procollagen type I N-terminal propeptide (TPINP). Conclusions Roxadustat is an independent risk factor for hypothyroidism; however, no adverse off-target effects on organs were observed.

Aging is the primary risk factor for most chronic diseases, yet substantial heterogeneity highlights a fundamental gap between chronological age and biological aging processes. Despite the high predictive accuracy of multi-omics clocks, their clinical implementation remains limited by cost and complexity, underscoring the need for scalable and clinically actionable alternatives. Here, we developed a physical clock that integrates routine clinical biomarkers with multidimensional physical performance using ElasticNet regression in the large-scale PENG ZU cohort. This model was further reduced to a simplified 11-marker model, primarily capturing key domains of kidney function, glucose metabolism, and physical performance. Accelerated aging, as measured by physical clock-derived ΔPhysicalAge, was strongly associated with chronic disease incidence, functional decline, reduced intrinsic capacity, and mortality. Across independent validation in UKB Biobank and NHANES, it robustly predicted disease onset, disease-specific, and all-cause mortality. Notably, ΔPhysicalAge outperformed ΔPhenoAge in predicting major age-related diseases and enabled effective risk stratification even among individuals conventionally classified as low risk. We observed an association between postmenopausal HRT use and lower ΔPhysicalAge, providing preliminary evidence supporting the validity and responsiveness of the physical clock. To facilitate clinical translation, we established age- and sex-specific healthy reference intervals (HRI) derived from individuals with normal or decelerated aging, demonstrating that maintenance within these ranges is associated with substantially reduced mortality risk. Furthermore, modifiable lifestyle and psychosocial factors, including healthy diet, physical activity, health consciousness, and social engagement, were associated with slower aging, highlighting actionable intervention pathways. Together, the physical clock bridges the gap between biological aging assessment and real-world clinical practice, offering a clinically accessible tool for risk stratification and personalized intervention to promote healthy aging.

OBJECTIVE:To compare the efficacy and safety of 95% ethanol rinse combined with lauromacrogol injection versus lauromacrogol injection alone in sclerotherapy for simple renal cysts in elderly patients. METHODS:This retrospective analysis included 94 patients (63 males, 31 females; mean age, 70.15 years) with symptomatic simple renal cysts who underwent ultrasound-guided percutaneous sclerotherapy between 2019 and 2025. Forty-eight patients received lauromacrogol injection alone, while 46 patients received 95% ethanol rinse combined with lauromacrogol injection. All patients were followed up at 1, 6, and 12 months after the procedure. RESULTS:The volume of simple renal cysts decreased during follow-up, from a mean initial volume of 113.2 mL to a final volume of 0.30 mL. At 12 months, the total resolution rate was 98.9% (93/94), and the cure rate was 97.9% (92/94). No significant differences were observed between the two groups in volume reduction rate, resolution rate, or cure rate during follow-up (all P > 0.05). The adverse event rate was significantly higher in the ethanol-combination group than in the lauromacrogol-monotherapy group (56.5% [26/46] vs. 29.2% [14/48]; P < 0.05). Ethanol use was associated with significantly more pain and a higher incidence of fever, even when limited to rinsing the cyst lumen prior to lauromacrogol injection. CONCLUSION:Percutaneous sclerotherapy was successful in both groups of elderly patients with simple renal cysts. Lauromacrogol injection alone was associated with a significantly lower incidence of minor adverse events. CLINICAL TRIAL NUMBER:Not applicable.

Objective To compare the performance of 11 glomerular filtration rate(GFR)equations in Chinese elderly hospitalized patients using dynamic renal imaging as the reference standard.Methods The retrospective study involved patients aged 60 years and older who were admitted to Beijing Hospital between January,2017,and January 2020.Glomerular filtration rate(GFR)was assessed through dynamic renal imaging for all participants.Estimated GFR(eGFR)was calculated using various equations based on serum creatinine and/or cystatin C levels,including All Age Spectrum(FAS),Berlin Initiative Study(BIS),Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI),Modification of Diet in Renal Disease Study(MDRD),MDRD in China(MDRDc),and Xiangya..Results A total of 691 patients,of which 383 were males,with an age range of 60 to 90 years(mean age 71.9±7.7 years),were included in the study.Among the different equations used to estimate glomerular filtration rate(GFR)in ml·min-1·1.73m-2,the smallest deviations were observed with FAScys(2.48),FAScr-cys(3.07),CKD-EPIcys(4.20),and BIScr-cys(7.42).Conversely,the most accurate estimations were found with BIScr-cys(10.38),FAScr-cys(11.94),FAScys(12.08),CKD-EPIcr-cys(13.21),and CKD-EPIcys(13.51).The highest P30 values,indicating the proportion of estimates within 30％of the true GFR,were achieved by FAScr-cys(68.97％),FAScys(68.96％),CKD-EPIcys(63.22％),and BIScr-cys(61.67％).The equations with the lowest root mean square errors were BIScr-cys(9.73),CKD-EPIcr-cys(10.98),FAScr-cys(11.27),CKD-EPIcys(11.52),and FAScys(11.53).Specifically,the FAS equation showed higher accuracy in men,while BIScr-cys and CKD-EPIcys were more accurate in women.Among patients with chronic kidney disease(CKD),the P30 values for BIScr-cys,FAScys,and FAScr-cys were 86.96％,83.33％,and 80.95％respectively.Notably,for patients with mGFR ≥ 30 ml/min,MDRDc overestimated GFR the most,whereas for patients with mGFR＜30 ml/min,Xiangya exhibited the most significant overestimation of GFR.Conclusions Among the equations tested,BIScr-cys,FAScys,and FAScr-cys demonstrated the highest accuracy and are therefore recommended for use in Chinese elderly hospitalized patients.

Background: This study aims to investigate GFR decline in elderly subjects with varying physical conditions and analyze key risk factors impacting renal function changes. Methods: We obtained data from patients between 2017 and 2019, and matched healthy elderly subjects based on gender and age. Data collected for all subjects included annual measurements of fast blood glucose (GLU), glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-c), blood albumin (ALB), blood uric acid (UA), urine protein (UP), and systolic blood pressure (SBP). Additionally, information on coexisting diseases was gathered. The Full Age Spectrum (FAS) equation was used to calculate eGFR. Results: A total of 162 patients with complete 3-year renal dynamic imaging were included, including 84 patients in the kidney disease group (K group) and 78 patients in the non-kidney disease group (NK group). Ninety individuals were selected as the healthy group (H group). The annual decline rate in the K group was the fastest, which exceeded 5mL/min/1.73m(2) (P < 0.05). Group (K group: beta=- 40.31, P< 0.001; NK group: beta=- 26.96, P< 0.001), ALB (beta=- 0.38, P=0.038) and HbA1c (beta=1.36, P=0.029) had a significant negative impact on the eGFR changes. For participants who had negative proteinuria: K group had the most significant annual eGFR decline. Conclusion: The presence of kidney disease, along with proteinuria nor not, can lead to a marked acceleration in kidney function decline in elderly. We categorize elderly individuals with an annual eGFR decline of more than 5 mL/min/1.73m(2) as the "kidney accelerated aging" population.

Low-molecular-weight heparin (LMWH) is an anticoagulant used to prevent clotting during blood purification treatments. This study aimed to evaluate the clinical use of the anti-factor Xa level (anti-Xa) for monitoring LMWH anticoagulant levels during intermittent venovenous hemofiltration (IVVHF). This prospective observational study enrolled patients who required IVVHF for renal failure in Beijing Hospital between May 2019 and February 2021. The LMWH anticoagulation was assessed by the coagulation grade of the filter and line. One hundred and ten participants were included. There were 90 patients with a filter and line coagulation grade of ≤ 1 and 20 patients with grade > 1. The anti-Xa level of 0.2 IU/mL was a critical value. The multivariable logistic regression analysis showed that anti-Xa level > 0.2 IU/mL (odd ratio [OR] = 2.263; 95% CI: 1.290–4.871, P = 0.034) and cardiovascular disease (OR = 10.028; 95% CI: 1.204–83.488; P = 0.033) were independently associated with the coagulation grade of the filter and line. Anti-Xa level could monitor LMWH anticoagulation during IVVHF.

目的 建立影响老年血液透析(HD)患者体外循环管路凝血的预测模型.方法 回顾性病例对照研究,纳入2019年3月1日至2022年1月30日在我院血液净化中心首次进行4 h血液透析的老年慢性肾衰竭患者196例,入组患者均采用肝素类药物进行抗凝(包括普通肝素和低分子量肝素),凝血分级≥1为凝血组14例(7.1％),非凝血组182例(92.9％).收集人口学资料,透析前静息状态下坐位生命体征及实验室检查.得出预测模型后,在2022年2月1日至2023年2月1日在我院首次完成4 h血液透析的年龄≥60岁老年慢性肾衰竭患者中进行验证.结果 凝血组和非凝血组患者心率[(82.6±12.3)次/min比(74.4±11.1)次/min]和总胆固醇[(4.3±1.2)mmol/L比(3.2±1.2)mmol/L]比较,差异有统计学意义(t值分别为2.231、2.012,均P＜0.05).多因素Logistic 分析结果显示心率(OR=0.930,95％CI:0.871～0.993,P＜0.05)和胆固醇(OR=0.623,95％CI:0.391～0.992,P＜0.05)对体外循环管路凝血有影响.心率预测体外循环管路凝血的受试者工作特征曲线下面积(AUC)为0.639(最佳截断点值为71次/min),总胆固醇预测凝血的AUC为0.708(最佳截断点值:4.275 mmol/L),将心率和总胆固醇联合预测时效能更高(AUC值为0.735).对模型在98例患者中进行验证,效果较好(AUC值为0.895).结论 根据列线图可初步判断初始血液透析的老年患者体外循环管路的凝血风险.

Background and Objectives: Older adults are more susceptible to coronavirus disease 2019 (COVID-19). Interleukin-6 (IL-6) is an important cytokine in the cytokine release syndrome (CRS), and tocilizumab blocks the IL-6 receptor. The objective is to analyze the effect of tocilizumab on CRS in older patients with severe COVID-19. Materials and Methods: Between February 10 and March 21, 2020, a total of 19 patients aged ≥60 years with severe or critical COVID-19 met the study inclusion criteria at the Tongji Hospital in Wuhan City, Hubei Province, China. The patients were divided into two groups: the tocilizumab group, with IL-6 levels, which exceeded the upper limit of normal by >10-fold and non-tocilizumab group. Results: Patients in the tocilizumab group were older (73.20 ± 4.44 vs. 66.21 ± 5.06 years, P = 0.014), had lower lymphocyte counts (0.71 ± 0.18 vs. 1.18 ± 0.59 × 109/L, P = 0.016), and higher high-sensitivity C-reactive protein (hsCRP) levels (94.04 ± 57.24 vs. 51.65 ± 45.37 mg/L, P = 0.035). Increases in ferritin (FER) and hsCRP levels in patients in the tocilizumab group were marked. Except for one patient who died, IL-6, FER, hsCRP levels, and the neutrophil/lymphocyte ratio in the remaining four patients decreased following treatment with tocilizumab. Tocilizumab did not cause any serious adverse reactions. There were no differences in mortality, days until lung computerized tomography improvement, or renal function between the two groups. The total mortality rate was 10.53%. Conclusions: Our results support the therapeutic efficacy and safety of tocilizumab in older patients with severe COVID-19.

低分子肝素(low molecular weight heparin,LMWH)是普遍应用的抗凝剂之一,临床常通过抗Xa因子活性来监测其抗凝效应以及评估出血风险,合理的抗Xa因子活性区间在临床指南也都有相应推荐.而具体到血液透析患者中,使用LMWH抗凝时抗Xa因子的监测目标范围尚未形成共识,本综述主要论述抗Xa因子活性检测在血液透析LMWH抗凝中的应用价值,以及具体监测策略的研究进展.

Background:Free light chains κ and λ (FLC κ, FLC λ) are of great significance in diagnostic and monitoring monoclonal gammopathy. Freelite and N-Latex methods are two common monitoring methods at present. But the two meanings are not completely equivalent, especially for patients with renal insufficiency. We analyzed the changes of serum and urine FLC in renal insufficiency patients without monoclonal gammopathy and the clinical significance of these changes.Methods:This study is an observational study. Patients ≥ 18 years old, who met the diagnostic criteria of chronic kidney disease (CKD), excluding monoclonal gammopathy, were selected. Fasting serum and 24-hour urine were taken to detect serum FLC κ, serum FLC λ, SCr, serum β 2-microglobulin, urinary FLC κ, urinary FLC λ, urinary α 1-microglobulin, and urinary β 2-microglobulin.Results:There was a good correlation between the two methods for determining serum/urinary FLC. No matter serum or urine, FLC showed a good correlation with renal function by the N-Latex method, but not by the Freelite method. Under the N-Latex method, FLC κ/λ remained stable, which was basically within the reference range of healthy people and was not affected by renal function. There was a good correlation between FLC detected by N-Latex and microglobulin in serum and urine.Conclusion:When the concentration of FLC is low, the N-Latex method is more recommended to monitor FLC. The FLC measured by the N-Latex method is more closely related to renal function. The ratio of FLC κ/λ determined by the N-Latex method remained stable within the recommended range.

AbstractThis study aimed to use network pharmacology to detail the natural components isolated from Triptergium wilfordii Hook F (TwHF) and examine the effect of the main component (demethylzeylasteral, DEM) on rat models of diabetic nephropathy (DN). In this study, we used network pharmacology to detail the natural components isolated from TwHF, referenced a gene library when screening for components effective in the management of DN, and DEM was confirmed in DN rats. All data were analyzed using the Discovery Studio 4.5 System and the systems Dock online docking method platform. All 24 rats were divided into 4 groups: control, DN, TwHF, and DEM. Blood and urine samples were tested at 0, 8, and 12 weeks. Renal histopathological changes were scored. Network pharmacology indicated that 370 compounds and 46 small molecules (including DEM) were biologically active constituents of TwHF, mainly affecting the inflammatory response through PI3K‐Akt and Jak–STAT pathways. Proteinuria in the TwHF and DEM groups was significantly lower than in the DN group (p ≤ .001), and the decrease in proteinuria in the DEM group was more obvious than in the TwHF group (p = .004). The tubular interstitial scores were better in the DEM group than in the TwHF and DN groups. These results indicate that DEM effectively reduced proteinuria and alleviated the tubular interstitial changes in rat models of DN, which may be provide a scientific foundation for the development of novel drugs for treatment of DN.

We investigated how age affected renal function in healthy subjects in Beijing and compared different estimated glomerular filtration rate (eGFR) equations. Kidney function was evaluated by five equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); Modification of Diet in Renal Disease Study (MDRD); the Chinese version of the MDRD (MDRDc); Full Age Spectrum (FAS); and Berlin Initiative Study (BIS). A total of 46,708 subjects were enrolled and followed-up for 3 years. All showed an increase in sCr and a reduction in eGFR with increasing age. Over the 3 years, the eGFR and serum creatinine (sCr) remained unchanged in most subjects. Different equations showed good consistency; the intraclass correlation coefficients (ICC) was 0.849 for males, and 0.817 for females. The CKD-EPI equation yielded higher GFR values than the other equations (according to sCr levels). For subjects aged over 70 years, the BIS equation produced the lowest eGFR values. In summary, we observed that the renal function of individuals was relatively stable with increasing age, although different eGFR equations yielded data that varied across different populations of subjects and sCr levels.

目的 分析单中心维持性血液透析(maintenance hemodialysis,MHD)患者在不同药物治疗模式下矿物质和骨代谢异常(mineral and bone disorder,MBD)的生化指标、临床事件及相关药品使用费用情况,探讨透析患者MBD优化治疗管理方案.方法 根据北京医院血液透析中心不同时期MBD相关药物使用情况,纳入相应时间段的MHD患者.选取2017年1月1-31日151例患者为传统药物按需治疗组,2019年1月1-31日151例患者为新型药物受限治疗组,2020年1月1-31日153例患者为新型药物按需治疗组.3组患者均随访1年,比较3组生化指标、骨痛、临床事件和药品使用费用的情况.结果 传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组患者性别、年龄、透析龄和合并糖尿病的比例比较,差异均无统计学意义(P＞0.05).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组血钙水平[2.30(2.15,2.43) mmol/L、2.20(2.11,2.34) mmol/L和2.21(2.12,2.30) mmol/L]比较,差异有统计学意义(P＜ 0.001),按照K/DOQI标准的达标率分别为49.0％、57.6％和65.4％,组间比较差异有统计学意义(P=0.016);血磷水平[(1.74±0.51)mmol/L、(1.76±0.50)mmol/L和(1.65±0.44)mmol/L]比较,差异无统计学意义(P=0.081),按照K/DOQI标准的达标率分别为45.0％、43.7％和58.8％,差异有统计学意义(P=0.014);钙磷乘积[49.25(40.13,58.46)、47.42(38.59,55.95)和43.44(35.41,52.62)]比较,差异有统计学意义(P=0.024).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺激素(parathyroid hormone,PTH)水平比较,差异无统计学意义(P=0.465),按照K/DOQI标准PTH达标率分别为24.5％、35.8％和36.6％,按照KDIGO标准PTH达标率分别为51.0％、60.3％和66.0％,组间比较差异均有统计学意义(P=0.042和P=0.048).传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组分别有109例(72.2％)、101例(66.9％)和87例(56.9％)患者使用含钙的磷结合剂,有0例(0.0％)、76例(50.3％)和87例(56.9％)患者使用不含钙的磷结合剂,有0例(0.0％)、35例(23.2％)和47例(30.7％)患者使用拟钙剂,差异均有统计学意义(P＜0.05).随访期内3组骨折和心脑血管事件发生率比较,差异均无统计学意义(P=0.703和P=0.889),传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺切除手术分别有2、0和0例次.传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组CKD-MBD治疗相关药物月均费用分别为100.2(11.1,322.9)元、361.6(50.1,866.9)元和633.3(121.5,1323.4)元,组间比较差异有统计学意义(P＜ 0.001).结论 新型药物按需治疗模式能明显提高MHD患者MBD生化指标的达标率,减少甲状旁腺切除手术需求,但增加了MBD相关治疗药物的费用.

Objective:We aimed to compare the characteristics between elderly and non-elderly corona virus disease 2019(COVID-19)patients, especially patients with different severity, in order to achieve a good understanding of elderly patients' clinical presentations.Methods:Records of patients diagnosed with COVID-19 and hospitalized at Tongji Hospital from February 9, 2020 to February 29, 2020 were retrospectively reviewed.They were divided into the elderly(≥65 years old)and non-elderly(<65 years old)groups according to age.Data on morbidity, underlying diseases, clinical symptoms, laboratory test results, imaging characteristics and hospitalization outcomes were collected retrospectively and analyzed statistically.Results:A total of 51 patients were enrolled with 21 in the elderly group(41.2%), with an average age of(71.9±6.4)years, and 30 non-elderly patients(58.8%). There were 13 elderly patients(61.9%)exhibiting fever, representing a lower rate than in the non-elderly patients(27 or 90%)( χ2=5.764, P=0.016). Bilateral pneumonia was present on chest CT scans in all of the elderly patients, while it was seen in 83.3% of the non-elderly patients( χ2=3.880, P=0.049). The proportion of elderly patients with coronary heart disease(61.9%)or hypertension(26.8%)was higher than that of non-elderly patients.The usage rates of antiviral drugs, systemic hormones and antibiotics were all higher and the causes of death were all due to multiple organ failure in elderly patients. Conclusions:Elderly patients with COVID-19 possess special characteristics, showing atypical symptoms, and multiple concomitant diseases may be the reason for their poor clinical prognosis.More rigorous monitoring and careful treatment should be conducted for elderly COVID-19 patients.

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者自体动静脉内瘘近吻合口狭窄,数字减影血管造影(digital subtraction angiography,DSA)下经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)与内瘘血管狭窄段近端重建手术的效果比较.方法 搜集2017年6月至2019年6月在北京医院接受治疗的MHD患者自体动静脉内瘘近吻合口狭窄71例,根据手术方式分为PTA(扩张组)37例及内瘘血管狭窄段近端重建术(手术组)34例.比较两种治疗方法成功率,3个月、6个月及12个月的内瘘通畅率及对血管资源的保护情况.结果 两组性别、年龄、透析龄、内瘘使用时间和糖尿病所占比例比较差异无显著性.扩张组手术成功率100％,其中,3个月内瘘通畅率为97.30％、6个月内瘘通畅率为78.38％,12个月内瘘通畅率为51.35％,所有病例在围术期没有留置中心静脉导管作为透析通路,没有血管的损失.手术组手术成功率100％,其中3个月内瘘通畅率94.12％(χ2=0.443,P=0.506),6个月内瘘通畅率82.35％(χ2=0.177,P=0.674),12个月内瘘通畅率64.71％(χ2=1.295,P=0.255),与扩张组比较差异无显著性.手术组围术期有5例患者留置中心静脉导管作为血液透析通路,血管损失(2.43±0.93)cm.结论 PTA治疗自体动静脉内瘘近吻合口狭窄是有效安全的治疗手段,和同期内瘘重建术相比效果相当.PTA治疗可以减少中心静脉插管率,减轻患者痛苦,更能充分保护血管资源.

Purpose Sclerostin is an antagonist of the Wnt/β-catenin pathway. We previously reported that sclerostin is closely related to carotid artery atherosclerosis and long-term outcome in hemodialysis patients. The present study investigated the association between sclerostin, renal function, and carotid artery atherosclerosis in non-dialysis patients with stage 3–5 chronic kidney disease (CKD 3–5ND). Methods A total of 140 patients with CKD 3–5ND were enrolled in this cross-sectional study. The Chronic Kidney Disease Epidemiology Collaboration equation was used to calculate estimated glomerular filtration rate (eGFR). Atherosclerotic plaques in the carotid artery were detected by B-mode Doppler ultrasound. Blood samples were collected to assess serum sclerostin levels. Unconditional logistic regression analysis was used to identify risk factors for carotid atherosclerotic plaques. Results The median eGFR was 24.9 ml/min/1.73 m 2 (interquartile range [IQR] 10.0–40.3 ml/min/1.73 m 2 ) and median serum sclerostin level was 46.76 pmol/l (IQR 30.18–67.56 pmol/l). Carotid atherosclerotic plaques were detected in 104 subjects (74.3%). There was a negative association between sclerostin level and eGFR ( r = − 0.214, p = 0.011). Unconditional logistic regression analysis revealed that sclerostin level was an independent risk factor for the occurrence of carotid plaques, with an odds ratio (95% confidence interval) of 1.026 (1.003, 1.051). Conclusion Serum sclerostin increases with declining renal function in patients with CKD 3–5ND. Sclerostin is an independent risk factor for carotid atherosclerosis.

Background Older adults are more susceptible to the novel coronavirus disease 2019 (hereafter, COVID-19) and more likely to develop severe illness. Cytokine release syndrome (CRS) may be an important factor in the development of severe disease in patients with COVID-19. Interleukin-6 (IL-6) is an important cytokine in CRS, and tocilizumab can block the IL-6 receptor. In this study, we analyzed the therapeutic effects and safety of tocilizumab on CRS in older patients with severe COVID-19. Methods Between February 10 and March 21, 2020, a total of 19 patients with severe or critical COVID-19 aged ≥ 60 years met the study inclusion criteria at Tongji hospital in Wuhan city, Hubei Province, China. Patients were divided into two groups: 1. The tocilizumab group, whose IL-6 levels exceeded the upper limit of normal by > 10-fold; and 2. The no tocilizumab group, with 1L-6 levels < 10-fold the upper normal limit. Results Patients in the tocilizumab group were older (73.20 ± 4.44 vs. 66.21 ± 5.06 years, P = 0.014); had lower lymphocyte counts (0.71 ± 0.18 vs. 1.18 ± 0.59 × 10 9 /L, P = 0.016); and higher high-sensitivity C-reactive protein (hsCRP) levels (94.04 ± 57.24 vs. 51.65 ± 45.37 mg/L, P = 0.035). The increases in ferritin (FER) and hsCRP levels in patients in the tocilizumab group were marked. Except in one patient who died, IL-6, FER, and hsCRP levels, and the neutrophil/lymphocyte ratio, in the remaining four patients decreased following treatment with tocilizumab. Further, patient computerized tomography scan results improved after 3–8 days of tocilizumab treatment. Tocilizumab did not cause any serious adverse reactions. There were no differences in mortality or days until lung computerized tomography improvement between the two groups. The total mortality rate was 10.53%. Conclusions Our results support the therapeutic efficacy and safety of tocilizumab on older patients with severe COVID-19.

Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.