Background and aims:Cardiovascular disease (CVD) remains a leading cause of death in China. Systemic inflammation (SI) is an emerging risk factor in atherosclerotic CVD (ASCVD) and chronic kidney disease (CKD). High-sensitivity C-reactive protein (hsCRP) is increasingly recognised for prognostication. The SPARK-CVD China survey assessed Chinese cardiologists' and nephrologists' awareness and perceptions of SI and hsCRP in patients with both ASCVD and CKD. Methods:A nationwide cross-sectional survey was conducted (September to December 2024) across 31 provinces in China mainland among physicians with ≥3 years of clinical experience and managing ≥20 adult patients with both ASCVD and CKD per month. Descriptive and comparative statistics were used. Results:Among 1500 respondents, SI was used more to aid treatment than diagnosis (65.2% vs 45.5%). Although 73.3% viewed SI as a key determinant of cardiovascular events, only 35.2% discussed SI as a risk factor with patients. Non-testers cited no expected impact on decisions (71.3%), lack of guideline direction (44.0%), and limited treatments (37.2%). A knowledge-practice gap for hsCRP was observed: 29.7% identified hsCRP unprompted versus 87.7% when prompted; perceived diagnostic thresholds varied widely. Fewer than 1/4 of ASCVD and/or CKD patients would be prescribed colchicine; barriers included limited experience (55.2%), potential contraindications (54.1%), and side effects (47.1%). Cardiorenal benefits of GLP-1 receptor agonists were widely recognised (97.9%), with 76.5% attributing benefits partly to anti-inflammatory effects. Conclusion:SI is acknowledged but inconsistently operationalised domestically. Targeted professional education, explicit guideline recommendations, and further evidence for risk-stratified, inflammation-guided care may help refine treatment pathways for ASCVD with CKD.

We aimed to evaluate the application value of multiparametric diffusion weighted magnetic resonance imaging (MRI) for the assessment and risk stratification of renal histopathological injuries in patients with IgA nephropathy (IgAN), as an exploratory study. 95 patients were prospectively enrolled, intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI) were performed, and a renal biopsy was performed within 3 days after MRI examination. Finally, 31 patients with pathologically confirmed IgAN were selected for analysis, and glomerulosclerosis index (GSI) and tubulointerstitial fibrosis index (TBI) were assessed by two experienced pathologists who were blinded to the clinical and multiparametric diffusion weighted imaging MRI data. Correlation analysis showed that eGFR was negatively correlated with age, GSI, and TBI. Both GSI and TBI were negatively correlated with the true diffusion coefficient (D, cortex), mean diffusivity (MD, cortex and medulla), fractional anisotropy (FA, medulla), and axial diffusivity (Da, cortex and medulla), and positively correlated with the mean kurtosis (MK, cortex) and axial kurtosis (Ka, cortex and medulla). Compared with the normal control group, the moderate-to-severe GSI/TBI groups showed significant decreases in most diffusion parameters and increases in kurtosis parameters, while there was no significant difference in all MRI parameters between the mild injury groups and the control group. Multivariate regression and model validation showed that medullary FA was the independent imaging predictor of moderate-to-severe GSI in the DTI-based model (p = 0.013), and the clinical+DTI combined model had a high diagnostic efficacy (AUC = 0.932, optimism-corrected AUC = 0.858); eGFR was the only significant predictor in the DKI-based model (p = 0.023), with the clinical+DKI combined model AUC reaching 0.891 (optimism-corrected AUC = 0.801). As a preliminary exploratory study,DTI and DKI may provide useful non-invasive information for assessing renal histopathological alterations in IgAN patients. Medullary FA is a promising imaging biomarker for glomerulosclerosis, and its combination with clinical variables shows potential for identifying patients with moderate-to-severe disease. The originally hypothesized superiority of DKI-derived MK was not clearly demonstrated. These findings warrant further validation in larger cohorts. This study was registered at the Chinese Clinical Trial registry with the registration number was ChiCTR1800020390.

Objective This study investigates the characteristics of pregnancy-related thrombotic microangiopathy (TMA) and its renal manifestations, with a focus on factors that affect renal prognosis. Methods Clinical data, renal involvement, treatment regimens, and prognosis were collected for patients diagnosed with pregnancy-related TMA who were admitted to the Nephrology Department of the National Center of Geriatrics at Beijing Hospital from 2014 to 2023. Results Eight clinically and/or pathologically diagnosed cases of pregnancy-related TMA were identified. The average age was (32.12 ± 5.14) years, and the onset of TMA during pregnancy occurred at an average of (28.75 ± 8.73) weeks. Common peripartum symptoms included abdominal pain, placental abruption, and postpartum hemorrhage. Causes of TMA included pre-eclampsia (PE) in 6 cases, among which 1 case was complicated by systemic lupus erythematosus (SLE) and 1 case by malignant hypertension, and atypical hemolytic uremic syndrome (aHUS) in 2 cases. Laboratory findings revealed significantly elevated levels of LDH and D-dimer, with platelet counts at (93.63 ± 86.39)×10 9 /l and hemoglobin at (75.75 ± 33.36) g/l. Renal manifestations showed varying degrees of proteinuria and hematuria in all 8 patients, with 6 patients experiencing different degrees of renal impairment and 2 patients showing no renal function impairment. The highest serum creatinine recorded was (366.58 ± 275.06) umol/l, with 2 cases of aHUS patients requiring renal replacement therapy and 4 patients (2 cases of aHUS patients, 1 case of PE patient, and 1 case of PE combined with SLE patient.) needing plasma exchange treatment (≥ 1time). Among the 6 patients who underwent renal biopsy, 50% exhibited glomerular capillary endothelial cell swelling (83.3%), capillary lumen opening disparity (66.7%), small vessel endothelial cell swelling (66.7%), or brush border loss of renal tubules (66.7%). Four cases of patients had electron microscopy results: 1 case showed endothelial cell proliferation and segmental widening of the basal membrane's loose layer; 1 case showed a large number of fragmented red blood cells within the capillary loops; and 2 cases did not exhibit typical TMA electron microscopy findings. Comparisons between aHUS and PE groups revealed significant differences in serum creatinine levels and the proportion of patients requiring renal replacement therapy (P < 0.05). Patients with aHUS tended to develop the condition later in pregnancy and also had lower platelet counts. Prognosis results showed that 1 patient remained on hemodialysis, 1 patient came off dialysis, 1 patient was discharged automatically, and 3 patients exhibited a significant decrease in serum creatinine upon discharge among the 6 patients with kidney function impairment. Conclusion Pregnancy-related TMA mostly manifests in mid to late pregnancy, with PE being the most common cause and renal manifestations primarily presenting as proteinuria, hematuria, and acute renal failure. Furthermore, patients with pregnancy-related aHUS tend to develop the condition later in pregnancy, experience more severe renal function impairments, have lower platelet levels, and require renal replacement therapy at a higher rate. Once diagnosed with aHUS as the cause of pregnancy-related TMA, promptly terminating the pregnancy and actively engaging in plasma exchange treatment may improve prognosis.

Diabetic nephropathy (DN) represents the most prevalent and severe microvascular complication associated with diabetes. Along with DN mechanism developing, inflammation were regarded as critical process in its development. Due to tripterygium glycosides (TWP) anti-inflammation effects, it was adapted as DN symptoms releasing treatment. Considering TWP significant pharmacokinetic variability, solid effect marker was required for TWP further clinical applications.

The development of blood-based multi-biomarker panels for screening diabetic patients, and as an easy-to-access tool for identifying individuals at greatest risk of developing diabetic kidney disease (DKD) and its progression, is essential. However, conventional blood biomarker-based methodologies (e.g. clinical tests and ELISA) are unable to predict DKD progression with high sensitivity and specificity.

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ABSTRACT The development of blood-based multi-biomarker panels for screening diabetic patients, and as an easy-to-access tool for identifying individuals at greatest risk of developing diabetic kidney disease (DKD) and its progression, is essential. However, conventional blood biomarker-based methodologies (e.g. clinical tests and ELISA) are unable to predict DKD progression with high sensitivity and specificity. To overcome these challenges, we developed a deep, untargeted plasma proteome profiling technology (Proteonano™ platform) to identify potential multiple protein biomarkers involved in DKD progression. The Proteonano™ technology is an affinity selective mass spectrometric platform that comprises nanoparticle-based affinity binders (nanobinders) for low abundant protein enrichment, automated workflow for parallel sample preparation, and machine learning empowered bioinformatic software for data analysis. Using the Proteonano™ platform, we performed untargeted proteomics on 75 subjects (DKD progressors, n = 30; DKD non-progressors, n = 45) and identified an average of 953 ± 80 (AVG ± SD) protein groups, with a wide dynamic range of 8 orders of magnitude (with the lowest concentration down to 3.00 pg/mL). Among these, 38 proteins were differentially expressed between DKD progressors relative to non-progressors, and the predictive power for these proteins were assessed. Further, we performed random forest and LASSO analyses for additional variable selection. Variables selected by these approaches were assessed by Akaike information criterion method followed by ROC analysis, which identified a combination of multiple proteins (including VWF, PTGDS, B2M, BT3A2, and LCAT) that showed excellent predictive power over current methods, with an area under the curve value up to 0.97. Some of these plasma proteins are not previously recognized in the context of DKD progression, suggesting they are novel biomarkers. Our studies pave the way to develop multi-biomarker panels for DKD progression management. This study suggests that the Proteonano™ technology platform reported here can be employed as an established workflow enabling untargeted deep proteomic analysis to identify highly discriminative biomarkers for precise medicine.

Natural bioactive compounds (NBCs) are widely used in clinical treatment. For example, Tripterygium wilfordii Hook f. is commonly known in China as Lei-Gong-Teng which means thunder god vine. This herb is widely distributed in Eastern and Southern China, Korea, and Japan. The natural bioactive compounds of this herb can be extracted and made into tripterygium glycoside tablets. It is one of the most commonly used and effective traditional Chinese herbal medicines against rheumatoid arthritis (RA), nephrotic syndrome (NS), autoimmune hepatis (AIH), and so on. However, many NBCs are difficult to reliably quantify in the serum due to the effects of matrix and RSD. In addition, the targeted compound’s internal standard (IS) is rarely sold due to the complex isotope internal standard synthesis pathway. In this study, a new quantitation method for 18O labeling combined with off-line SPE was formulated. We contrasted the recoveries and matrix effects of various separation methods in order to choose the best method. Furthermore, we optimized the conditions for SPE loading and washing. An isotopic internal standard was prepared by the 16O/18O exchanging reaction in order to eliminate the matrix effects. The method’s accuracy and precision met the requirements for method validation. The recovery of this method was close to 60

To evaluate whether contrast-enhanced ultrasound (CEUS) is an accurate, non-nephrotoxic diagnostic method and follow-up tool for use in patients with chronic kidney disease (CKD) and renal artery stenosis (RAS). In this prospective and monocentric study, we compared the sensitivity and specificity of CEUS for the diagnosis of RAS in CKD patients, using digital subtraction angiography (DSA) or computed tomographic angiography (CTA) as the gold standard methods. Further, the value of CEUS for distinguishing restenosis from other diseases was assessed. The ultrasound physicians conducted the examinations and served as the CEUS report readers who were blinded to the DSA or CTA results. Patients with RAS (n = 60) were enrolled. Average patient age was 64.4 ± 18.0 years and median estimated glomerular filtration rate was 66.1 mL/min/1.73 m2. CEUS was used to image 94 stenotic renal arteries and DSA- or CTA-verified stenosis was present in 96 renal arteries. The kappa value for CEUS was 0.776 (P < 0.001), with an accuracy of 92.5%, a sensitivity of 94.7%, and a specificity of 84.0%. The accuracy of CEUS was the same for the diagnosis of the CKD3b–5 group as for the CKD1–3a group (100% vs. 87.5%, P = 0.148). There was no difference in CEUS accuracy for the diagnosis of Takayasu RAS compared with atherosclerotic RAS (95.8% vs. 91.7%, P = 0.795). Twenty-nine CEUS examinations were performed to follow in-stent restenosis or progression of RAS, with a median follow-up time of 5.0 months (range 1.0–20.0). Two cases of in-stent restenosis in patients suffering from deteriorating kidney function and recurrent hypertension were examined by CEUS. CEUS examination is a credible alternative for diagnosing moderate and severe RAS in patients with CKD, and is a reliable tool for follow-up surveillance after renal artery revascularization treatment. It shouldn’t be thought as a color-coded duplex ultrasonography rescue in these patients.

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.

The outcome of patients with primary membranous nephropathy (pMN) who present with nephrotic syndrome (NS) is variable and difficult to predict. The goal of this study was to develop a nomogram to predict the risk of progression for specific individuals. This retrospective study involved biopsy-proven patients with pMN and NS treated between January 2012 and June 2018. The primary outcome of our investigation was progression, defined as a reduction of estimated glomerular filtration rate (eGFR) that was equal to or over 20% compared with baseline at the end of follow-up or the onset of end-stage renal disease (ESRD). We used backwards stepwise logistic regression analysis to create a nomogram to predict prognosis. The model was validated internally using bootstrap resampling. A total of 111 patients were enrolled. After a median follow-up of 40.0 months (range 12–92 months), 18.9% (21/111) patients showed progression. Backwards stepwise selection using the Akaike information criterion (AIC) identified the following four variables as independent risk factors for progression, which were all used in the nomogram: age ≥ 65 years [odds ratio (OR) 7.004; 95% confidence interval (CI) 1.783–27.505; p = 0.005], Ln (sPLA2R-Ab) (OR 2.150; 95% CI 1.293–3.577; p = 0.003), Ln (proteinuria) (OR 5.939; 95% CI 1.055–33.436; p = 0.043) and Ln (Uα1m/Cr) (OR 2.808; 95% CI 1.035–7.619; p = 0.043). The discriminative ability and calibration of the nomogram revealed good predictive ability, as indicated by a C-index of 0.888 (95% CI 0.814–0.940) and a bootstrap-corrected C-index of 0.869; calibration curves were also well fitted. A receiver operating characteristic (ROC) curve for the nomogram score revealed significantly better discrimination than each of the three risk factors alone, including Ln (sPLA2R-Ab) [area under the curve (AUC) 0.769], Ln (proteinuria) (AUC 0.653) and Ln (Uα1m) (AUC 0.781) in the prediction of progression (p < 0.05). The optimal cutoff value of the nomogram score was 117.8 with a positive predictive value of 44.4% and a negative predictive value of 98.5%. The nomogram successfully achieved good predictive ability of progression for patients with pMN who present with NS. It can therefore help clinicians to individualize treatment plans and improve the outcome of pMN.

Objective:To analyze the association of clinical characteristics and laboratory indicators at initial maintenance hemodialysis(MHD)with long-term prognosis in advance-aged patients, and to find influencing factors for the prognosis in advance-aged MHD patients.Methods:This retrospective study was conducted at the Nephrology Department of Beijing Hospital between April 2007 and January 2018.A total of 61 patients receiving first-time hemodialysis at ≥ 80 years of age and undergone regular dialysis for 3 months or longer were enrolled.All patients were followed-up until death or the end of July 1, 2018.Patients were divided into the survivor and non-survivor groups, and differences in clinical characteristics and laboratory indicator values were compared between the two groups.Influencing factors for prognosis in advance-aged MHD patients were analyzed by using multivariate Cox regression.Results:For the 61 subjects, the median follow-up time was 25.8 months.During the follow-up, 32 patients died(52.5%). The main death causes were infectious diseases(40.6%, n=13)and cardiovascular and cerebrovascular diseases(37.5%, n=12). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 75.4%(46/61), 54.1%(33/61), 37.7%(23/61), 22.9%(14/61)and 16.4%(10/61), respectively.The median survival time was 25.8 months for all patients, 27.5 months for patients aged 80-84 years, and 14.9 months for patients aged 85 years and over.The non-survivor group had a higher male ratio(65.6% or 21/32 vs.37.9% or 11/29, χ2=4.678, P=0.031)and lower levels of hemoglobin(85.4±13.0 vs.95.0±17.6 g/L, t=2.867, P=0.019)and albumin(30.3±5.0 vs.34.6±4.8 g/L, t=3.039, P=0.001)than the survivor group.Kaplan-Meier curves indicated that the survival rate decreased with age, and subjects aged less than 85 years had a higher survival rate than subjects aged 85 years and older(the median survival time: 14.9 months vs.27.5 months, Log Rank P=0.006); patients who received continuous renal replacement therapy(CRRT)before dialysis had lower survival rates than patients who did not receive CRRT(the median survival time: 7.8 months vs.29.2 months, Log Rank P=0.002); patients with high serum levels of albumin(≥33 g/L)had higher survival rates than patients with low serum levels of albumin(<33 g/L)(the median survival time: 29.2 months vs.18.9 months, Log Rank P=0.003). Multivariate Cox regression analysis showed that age at initial dialysis( HR=1.136, 95% CI: 1.005-1.285, P=0.041), female( HR=0.409; 95% CI: 0.169-0.994, P=0.048), serum albumin level( HR=0.836, 95% CI: 0.772-0.906, P<0.001)and CRRT before dialysis( HR=6.161, 95% CI: 1.848-20.538, P=0.003)were independent predictors of all-cause mortality in advance-aged patients. Conclusions:Advance-aged patients undergoing hemodialysis have complicated clinical conditions and poor prognosis.Age, gender and serum albumin level at initial dialysis and CRRT before dialysis are independent predictors of prognosis in these patients.

Acute kidney injury(AKI)refers to a clinical syndrome in which the glomerular filtration rate decreases sharply in a short period of time due to various causes.Since elderly patients often have low renal functional reserve, complex underlying diseases, frequent acute events and various types of drug combinations, the incidence of AKI in elderly patients is significantly higher than that in the general population and trends upward each year.The prevention and treatment of elderly AKI should place an emphasis on the identification of risk factors and early diagnosis.There is considerable controversy over whether the existing real-world diagnostic criteria are clinically practical and appropriate.The application of novel diagnostic biomarkers for the diagnosis of AKI in the elderly population remains to be justified.This paper reviews considerations on the diagnostic criteria for AKI in the elderly and the clinical application of new biomarkers, in order to arrive at improved diagnosis and treatment recommendations.

老年慢性肾脏病患者既存在衰老相关的肌肉力量下降,又存在慢性肾脏病引发的肌肉衰减,该人群的肌少症更加明显,肌少症导致的跌倒、失能、虚弱和死亡更加突出.目前临床医生对肌少症的认识还停留在概念普及和基础研究方面,缺乏切实可行的诊疗流程和临床防治实践.该文从肌少症的定义演变谈起,详述老年慢性肾脏病患者肌少症的特点,以及老年慢性肾脏病患者中肌少症的运动康复,旨在提高肾科同仁对老年慢性肾脏患者群体中肌少症的重视与认识.

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.

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.

Background The biomarkers predicting long-term outcome of idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS) remains indeterminacy. We conducted this study to evaluate the different features between phospholipase A2 receptor (PLA2R)-associated and non-PLA2R-associated IMN, and to explore the association between serum PLA2R antibody (PLA2R-Ab), urinary immunoglobulin G (UIgG), urinary α1-macroglobulin (Uα1m) and renal outcomes in patients with idiopathic membranous nephropathy (IMN) and nephrotic syndrome (NS). Methods IMN patients who were biopsy-proven and presenting NS were retrospectively recruited for the present study. Serum PLA2R-Ab levels were detected by enzyme-linked immunosorbent assay (ELISA) kits, and values over 20 RU/mL was considered positive. UIgG) and Uα1m were measured by immunonephelometry and corrected by urinary creatinine. The clinicopathologic features, remission and renal outcome were compared between the PLA2R-associated and non-PLA2R-associated IMN patients. Furthermore, the predictive values of biomarkers (PLA2R-Ab, UIgG/Cr and Uα1m/Cr) for remission and renal outcome were assessed by multivariate regression. The renal endpoint was defined as progression to end stage kidney disease (ESRD) or estimated glomerular filtration rate (eGFR) decline ≥50% of baseline. Results A total of 111 IMN patients were enrolled this study, and 81 (73.0%) of them were PLA2R-associated. The mean age, 24-hour proteinuria and eGFR showed no difference between PLA2R-associated and non-PLA2R-associated groups (p>0.05). However, PLA2R-associated IMN patients had significantly higher UIgG/Cr (17.78 vs. 9.82 mg/g; median, p=0.001) and Uα1m (0.339 vs 0.202 mg/g; median, p<0.001) when compared to non-PLA2R-associated patients. Histologically, the PLA2R-associated group represented more proportion of patients with acute tubular necrosis (ATN) (27.16% vs. 3.33%, P=0.006) and glomerular C3 deposits (88.89% vs. 70.00%, P=0.016) than the non-PLA2R-associated group. During a median follow-up of 40 months (range 9 to 92), non-PLA2R-associated patients had significantly higher remission rate at the 6th and 12th month and end of follow-up, even after adjusting for the use of immunosuppressor. Furthermore, 11 (13.6%) patients reaching renal endpoint were all PLA2R-associated IMN. Multivariate regression analysis represented that baseline serum PLA2R-Ab titer was an independent predictor of remission (OR, 1.002; 95% confidence interval [CI] 1.001 to 1.004; p=0.002) and renal outcome (HR, 1.002; 95% CI 1.001-1.003, p= 0.004). Receiver operating characteristic (ROC) showed that serum PLA2R-Ab titer >216.93 RU/ml (AUC=0.778, p=0.003), UIgG/Cr >15.76mg/g (AUC=0.758, p=0.005) and Uα1m/Cr >0.3042mg/g (AUC=0.738, p=0.010) predicted renal failure in patients with IMN and NS. Kaplan-Meier curves indicated that subjects with combination of all three high biomarkers had significantly shorter renal survival (log rank p=0.007) than subjects with ≤2 high biomarkers. Conclusion High PLA2R-Ab levels is poor prognosis predictor of IMN in addition to proteinuria. In addition, combination of multiple factors (PLA2R-Ab, UIgG and Uα1m) represents a stronger predictive power. These findings suggested the potential different pathogenesis and progression in IMN with NS. Keywords: idiopathic membranous nephropathy, phospholipase A2 receptor antibody, urinary IgG, urinary α1- macroglobulin, nephrotic syndrome.