Introduction: Individuals with end-stage kidney disease frequently grapple with uncontrolled hypertension, which elevates their risk for cardiovascular complications. Methods: This randomized, controlled, multicenter study, conducted across 10 hospitals, aimed to compare the effectiveness and safety of sacubitril-valsartan versus irbesartan in managing hypertension among dialysis patients. The primary efficacy variable of the present study was the reduction in office blood pressure (BP) after 12 months of treatment. Participants were randomly allocated to receive either sacubitril-valsartan (angiotensin receptor-neprilysin inhibitor [ARNI]) or irbesartan (angiotensin receptor blocker [ARB]) treatment over a 12-month period. We gauged treatment efficacy through office and 24-h ambulatory BP readings, as well as serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP). Safety outcomes were also evaluated. Results: Baseline office BP averaged 150/82 mm Hg and median NT-proBNP was 6,336 pg/mL. In the intention-to-treat analysis, office systolic BP reduction was significantly greater in the ARNI than ARB group (−10.4 vs. −4.6 mm Hg, p = 0.003) after adjustment for baseline BP. In hemodialysis (HD) patients, the mean systolic/diastolic BP reduction was also greater in the ARNI than ARB group (−15.9/2.4 vs. −6.6/1.1 mm Hg, p < 0.05). While for peritoneal dialysis (PD) patients, there were no significant between-group differences (p = 0.087). Per-protocol analyses in 215 patients on office BP and 137 patients on 24-h BP produced similar results. During the study period, there was no between-group difference in the overall incidence of fatal and nonfatal events and hyperkalemia. Conclusion: In dialysis patients with hypertension, especially those undergoing HD, ARNI demonstrated superior effectiveness in reducing BP compared to ARB. The safety profiles of both treatments were comparable and acceptable.

The increasing adoption of accelerometers for the assessment of sedentary behaviour and physical activity among dialysis patients demands robust validation of these monitoring devices. This study aims to determine the comparability of wrist- versus waist-worn ActiGraph GT3X accelerometers, using placement-specific cut-points for peritoneal dialysis patients, to refine research and clinical practices. This was a cross-sectional study. Thirty-one participants wore two ActiGraph GT3X accelerometers, positioned on the right waist and nondominant wrist, and monitored over a seven-day period in a naturalistic setting. Data were processed with ActiLife v6.13.3 and analysed using intraclass correlation coefficients (ICC), limits of agreement, and pairwise 90

BackgroundProtein energy wasting (PEW) is common in patients on hemodialysis, and its development may involve gut microbial dysbiosis. However, the exact relationship between the composition of different flora and the development of PEW remains unclear.MethodsThis is an observational longitudinal study on 115 patients undergoing hemodialysis who were followed up for 1 year. All the patients were evaluated at baseline, and different microbiota compositions were determined. After a 1 year follow-up period, the correlations between clinical parameter variations and the relative abundance of different gut flora were assessed using Spearman correlation. Moreover, the associations of the abundance of different gut microbiota with decrease in lean tissue mass and the development of PEW were analyzed using ROC curve and logistical regression analyses.ResultsWe found that the relative abundances of Actinobacteria and Bifidobacteriaceae were significantly lower in patients with PEW than in those who did not develop PEW (p < 0.05). The abundance of Actinobacteria and Bifidobacteriaceae correlated positively with variations in serum albumin levels (r = 0.213, p = 0.035 and r = 0.214, p = 0.034, respectively), lean tissue mass (r = 0.296, p = 0.007 and r = 0.238, p = 0.002, respectively), and lean tissue index (r = 0.377, p < 0.001 and r = 0.419, p < 0.001, respectively). The area under the ROC curve or AUC values of Actinobacteria and Bifidobacteriaceae for the prediction of lean tissue mass decrease ranged from 0.676 to 0.708 (p < 0.05). Thus, decrease in the abundance of Actinobacteria and Bifidobacteriaceae may be associated with decrease in lean tissue mass and the occurrence of PEW.ConclusionThe present findings imply Actinobacteria and Bifidobacteriaceae may be potential markers for predicting skeletal muscle mass decrease and PEW development in patients on hemodialysis.

Background: Since little is known about the acute kidney injury (AKI) in aging population infected with SARS-CoV-2 Omicron variant, we investigated the incidence, clinical features, risk factors and mid-term outcomes of AKI in hospitalized geriatric patients with and without COVID-19 and established a prediction model for mortality.Methods: A real-time data from the Shanghai Ninth People's Hospital information system of inpatients with COVID-19 from 1 April 2022 to 30 June 2022 were extracted. Clinical spectrum, laboratory results, and clinical prognosis were included for the risk analyses. Moreover, Cox and Lasso regression analyses were applied to predict the 90-day death and a nomogram was established.Results: A total of 1607 SARS-CoV-2 infected patients were enrolled; hypertension was the most common comorbidity, followed by chronic cardiovascular disease, diabetes mellitus, and lung disease. Most of the participants were non-vaccinated and the mean age of patients was 82.6 years old (range, 60-103 years). The AKI incidence was higher in relatively older patients (16.29% vs 3.63% in patients older than 80 years and 60 to 80 years, respectively). Linear regression models identified some variables associated with the incidence of AKI, such as older age, clinical spectrum, D-dimer level, number of comorbidities, baseline eGFR, and antibiotic or corticosteroid treatment. In this cohort, 11 patients died in-hospital and 21 patients died at 90-day follow-up. The predictive nomogram of 90-day death achieved a good C-index of 0.823 by using 5 predictor variables: ICU admission, D-dimer, peak of serum creatinine, rate of serum creatinine decline and white blood cell count (WBC).Conclusion: Older age, clinical spectrum, D-dimer level, number of comorbidities, baseline eGFR, and antibiotic or corticosteroid treatment are clinical risk factors for the incidence of AKI in geriatric COVID-19 patients. The prediction nomogram achieved an excellent performance at the prediction of 90-day mortality.

OBJECTIVES:Chronic kidney disease (CKD) is a serious health problem that is associated with several systemic changes, including protein energy wasting (PEW). However, the exact mechanism of PEW in CKD remains unclear. As one of the important intestinal flora metabolites and uremic toxins, trimethylamine-N-oxide (TMAO) is involved in CKD-associated mortality, which might play a role in the development of PEW in CKD patients especially in patients on maintenance hemodialysis (MHD). However, this possibility has not been investigated. METHODS:PEW was diagnosed in a group of CKD patients on MHD according to the criteria of the International Society of Renal Nutrition and Metabolism. Serum TMAO concentration was assessed by high-performance liquid chromatography and mass spectrometry. The association between TMAO concentration and PEW was assessed using linear regression and logistic analysis after adjustment for confounding factors, including basic characteristics, comorbidities, and laboratory findings. RESULTS:The circulating TMAO level was higher in the MHD patients than in control (healthy) individuals (5653.76 ± 2853.51 vs. 254.92 ± 197.88 ng/mL, p < 0.001). Further, after the MHD patients were screened for PEW, those with PEW were found to have significantly higher serum TMAO levels than those without PEW (6760.9 vs. 4016.1 ng/mL, p < 0.001). Further, the serum TMAO concentration exhibited a significant negative correlation with body mass index (BMI) and dietary protein intake. In the logistic regression analysis, after adjustment for confounding factors, the serum TMAO concentration was still significantly correlated with PEW occurrence. CONCLUSIONS:The circulating TMAO level is significantly correlated with the prevalence of PEW in MHD patients. TMAO might be a potential target in the prevention and treatment of PEW in CKD especially ESRD.

ABSTRACTBackgroundSarcopenia is a clinical condition that is common in patients with chronic kidney disease (CKD), especially in those on dialysis. However, the relatively complicated diagnostic procedure limits its use in clinical situations. In this study we aimed to establish a simplified tool for the diagnosis of sarcopenia in patients on hemodialysis (HD).MethodsOverall, 757 eligible patients from seven HD centers in Shanghai and Suzhou, China, were recruited from 2020 to 2021. The cross-sectional data were analyzed. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Among them, 511 consecutive patients (77 with and 434 without sarcopenia) from five centers were included in the training set for the establishment of a diagnostic nomogram. Ten investigative parameters including clinical characteristics, body measurements and physical performance were used to derive the diagnostic nomogram. A total of 246 consecutive patients (47 with and 199 without sarcopenia) were included for validation of the diagnostic model.ResultsThe average age of the enrolled patients was 60.4 ± 12.1 years, 59.8% were males and 90.5% received dialysis using an arteriovenous fistula. Overall, the sarcopenia rate was 16.4%. The training and validation sets showed no significant differences in sarcopenia rate (15.1% and 19.1%, respectively; P = .160). The nomogram derived from the training set for sarcopenia, which was based on only four features—age, sex, body weight and grip strength—achieved high C-indexes of 0.929 [95% confidence interval (CI) 0.904–0.953] and 0.955 (95% CI 0.931–0.979) in the training and external sets, respectively, and had a well-fitted calibration curve. The cut-off value was 0.725, with a sensitivity of 0.909 and a specificity of 0.816. The nomogram accurately diagnosed sarcopenia with fewer variables and more simplified diagnostic procedures.ConclusionsThe nomogram had a good diagnostic capability for sarcopenia in patients on HD and may be a convenient tool for clinical use.

Background The relationship between malnutrition-inflammation-atherosclerosis syndrome (MIAS) and self-management ability has not been previously revealed even though both play an important role in the management of peritoneal dialysis (PD) patients. Methods In total, 93 patients were enrolled in this study. A self-management questionnaire was used for the evaluation of self-management ability. The identification of MIAS was based on one or more of the following three conditions: C-reactive protein (CRP) ≥10 mg/L, malnutrition–inflammation score (MIS) >7, and the presence of atherosclerosis-related medical records. The possible association between different self-management abilities and MIAS was analyzed with a Spearman correlation analysis. Results There were 40 (43.0%) patients in the atherosclerosis group, and 38 (40.9%), 38 (40.9%), 10 (10.8%), and 7 (7.5%) patients in the MIAS0, MIAS1, MIAS2, and MIAS3 groups, respectively. The group with a score above the mean score of the Dialysis Effect Evaluation and Monitoring dimension had a fewer number of hospitalizations, higher albumin levels, lower MIS scores, a lower level of IL-6, and a lower number of MIAS factors. The Pearson and Spearman correlation analyses also revealed that this dimension was negatively correlated with the MIAS, MIS, IL-6, BNP, number of hospitalizations, and age and positively associated with albumin and prealbumin. Conclusion The Dialysis Effect Evaluation and Monitoring dimension of the self-management scale for PD patients is closely linked to the MIAS, and a better dialysis effect evaluation and monitoring capacity results in a decreased likelihood of exposure to malnutrition and inflammation. Trial registration Chinese Clinical Trial Registry: SH9H-2020-T20-2, retrospectively registered January 15, 2020.

目的 调查维持性血液透析(maintenance hemodialysis,MHD)患者矿物质和骨代谢异常(min-eral and bone disorder,MBD)知识行为现况,探讨其影响因素,为相关干预研究提供依据.方法 采用慢性肾脏病MBD知识行为问卷,对上海交通大学医学院附属第九人民医院303例行MHD患者进行调查.结果 MHD患者MBD知识得分为(21.21±10.14)分,得分指数为46.11％;行为得分为(99.43±8.22)分,得分指数为82.86％.其中教育程度(β=0.463,P<0.001)、年龄(β=-0.243,P<0.001)、每日服药总数(β＝-0.211,P<0.001)及透析龄(β=0.160,P<0.001)是MHD患者MBD知识影响因素;性别(β=0.245,P<0.001)、每日服药总数(β =-0.193,P<0.001)、年龄(β=0.177,P=0.001)及合并症(β=0.169,P=0.002)是MHD患者MBD行为影响因素.结论 MHD患者MBD知识和行为有待提高且受多因素影响.护理人员应基于患者个性特征制定个性化干预措施,提高知识水平,促进行为改善.

Background: Increasing evidence suggests that angiotensin II (Ang II), the bioactive pro-oxidant in the renin-angiotensin system, aggravates fibrosis, and the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome is involved in multiple diseases, such as renal fibrosis. However, the role and underlying mechanism of Ang II in renal fibrosis remain unclear. Here, we investigated whether the NLRP3 inflammasome mediated Ang II-induced renal fibrosis, as well as the downstream pathways involved in this process. Methods: NLRP3−/− mice were used as a model to study Ang II-infused renal fibrosis. Mice were divided into 4 groups: sham wild type, Ang II-infused wild type, sham NLRP3−/−, and Ang II-infused NLRP3−/− groups. Ang II infusion-induced renal injury was confirmed by periodic acid-Schiff and Masson’s staining, immunohistochemistry, and transmission electron microscopy (TEM). Mitochondrial morphology was presented on TEM micrographs, and mitochondrial function was reflected by the protein levels of peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α), mitochondrial transcription factor A (TFAM), dynamin-related protein 1 (DRP1), and mitofusin 2 (MFN2), as assessed by Western blotting. Endoplasmic reticulum (ER) stress was characterized by changes in the levels of ER chaperones, such as GRP94, BiP, CHOP, and caspase 12. Results: Ang II infusion increased cell proliferation, extracellular matrix overproduction, inflammatory cell infiltration, and glomerulosclerosis and induced obvious morphological abnormalities in podocytes. Ang II infusion promoted mitochondrial damage, as indicated by TEM, and induced mitochondrial dysfunction, as evidenced by downregulation of PGC-1α, TFAM, and increased mitochondrial ROS. In addition, DRP1 expression was upregulated, while MFN2 expression was markedly decreased. The levels of GRP94, BiP, CHOP, and caspase 12 were significantly increased. However, all these detrimental effects were attenuated by NLRP3 deletion. Conclusions: NLRP3 deletion may attenuate angiotensin II-induced renal fibrosis by improving mitochondrial dysfunction and ER stress.

Purpose To develop a knowledge, attitude, and practice (KAP) scale for medication safety in patients with chronic kidney disease (CKD), test its reliability and validity, and provide a reliable assessment instrument for the self-medication of patients with CKD. Methods The initial scale was formulated based on the KAP theory together with a literature review, research group discussion and semi-structured interviews of patients with CKD. An expert panel consultation and pre-investigation were conducted to improve the scale. Next, 209 patients with CKD were enrolled to undertake the questionnaire linked to the primary scale. The item analysis, exploratory factor analysis (EFA), Cronbach’s alpha coefficient and split-half reliability were used to evaluate the validity and reliability of the scale. Results The primary scale consisted of 32 items with three dimensions. Three items were deleted after the item analysis. Then, the principal component analysis with Varimax rotation was employed to analyze the construct and factor structure. Finally, item 20 was deteled and the formal scale was formed with 28 items and four dimensions. The cumulative variance contribution rate was 65.132%. The alpha coefficient was 0.944 and the split-half reliability coefficient was 0.834 for the scale. Conclusion The KAP scale has good reliability and validity. It may be valuable for evaluating the levels of medication adherence and managing the self-medication of patients with CKD in China. In the future, further translation and validation in different regions with expansion of sample size are required, so that this scale can be further applied worldwide.

目的·完成腹膜透析(腹透)患者居家透析操作过程中自我管理水平量表的编制及信度、效度分析.方法·通过患者访谈、专家咨询、查阅文献等方式,在结合腹透患者管理临床经验的基础上完成对初始量表的编制.采用方便抽样的方式发放问卷,通过临界比值法、同质性检验筛选条目,探索性因子分析评估结构效度,最终确定量表共同因素数目及条目.计算Cronbach's α系数、折半系数对量表信度进行分析.结果·初始量表由5个维度26个条目组成,共发放136份问卷,收集有效问卷132份.根据项目分析结果,除条目3未达到校正题项与总分相关性、共同性、因素负荷量的筛选条件外,其余条目均满足入选标准.因条目3是考察患者无菌意识的关键步骤,经专家咨询后保留该条目至因素分析.初始量表取样适切性量数(KMO)值为0.880,Bartlett's球形检验x2值为2 272.938(P=0.000),提示总体的相关矩阵有共同因素存在,适合进行因素分析.根据量表初始设计条目初衷,限定萃取5个共同因素,采取直交转轴的最大变异法,最终删除条目7、11、16,根据各因素构面包含的条目变量特性,提取的共同因素分别命名为"对腹透并发症和腹透充分性评价的知晓度""腹透规范化操作能力""药物管理能力""饮食管理能力""腹透效果评估和监测能力",形成5个维度23个条目的正式量表,各维度的特征值分别为4.604、3.286、3.207、2.817、2.140,累积方差贡献率为66.428％.最终总量表Cronbach's α系数为0.930,折半系数为0.946.结论·腹透患者自我管理水平量表具有良好的信度和效度,可用于腹透患者自我管理能力测评.

Objective To investigate the prevalence of hyperuricemia in patients at different stages of chronic kidney disease (CKD) and the association of serum uric acid (SUA) with several clinical factors in a retrospective cross-sectional study of non-dialysis CKD patients at two hospitals in Shanghai, China. Methods The prevalence of hyperuricemia in CKD patients and the association of SUA with other clinical factors were examined using analysis of variance, chi-squared test, multivariate analysis, and other statistical methods. Results A total of 663 CKD patients were enrolled, of which approximately 52% had hyperuricemia. CKD patients with hyperuricemia had lower hemoglobin and estimated glomerular filtration rate (eGFR) levels but higher blood urea nitrogen, serum creatinine, and serum phosphate levels than those without hyperuricemia. Serum uric acid level was positively associated with age, blood urea nitrogen , serum creatinine, cystatin C, and serum phosphate and negatively associated with hemoglobin and eGFR. In addition, CKD patients with anemia and hyperphosphatemia had a higher prevalence of hyperuricemia than those without anemia or hyperphosphatemia. Conclusions The prevalence of hyperuricemia increased with CKD progression supporting the use of urate-lowering treatment for patients with CKD stage 1 to 4.

目的·基于单中心人群分析腹膜透析患者慢性牙周炎(chronic periodontitis,CP)的发病状况,探讨CP严重程度与腹膜透析充分性指标的相关性.方法·选取2018年12月—2019年12月于上海交通大学医学院附属第九人民医院肾脏内科腹膜透析患者,符合入选标准者共57例.收集患者基线资料,透析充分性评价指标,包括尿素清除指数、肌酐清除率等,及其他相关生化指标,同时收集CP相关指标,包括临床附着丧失、牙龈指数、探诊深度.比较患者不同严重程度CP的腹膜透析患者透析充分性相关指标及指标达标率的差异,采用Pearson相关性分析、线性回归分析探讨CP相关指标与腹膜透析充分性指标之间相关性.结果·入选的所有腹膜透析患者均患有中度或重度的CP,中度CP患病率为24.6％,重度CP患病率为75.4％.重度CP组中、重度贫血的比例高于中度CP组(28.0％vs 14.3％),但差异无统计学意义(P>0.05);2组的透析充分性评价指标及指标达标率之间差异也均无统计学意义(均P>0.05).CP相关指标与透析充分性相关指标间无明显相关性(均P>0.05).结论·腹膜透析患者中、重度CP患病率较高,同时患有重度CP的腹膜透析患者可能有发生中、重度贫血倾向;CP的严重程度与腹膜透析患者透析充分性之间未发现明显相关性.

目的:观察维持性血液透析(maintenance hemodialysis,MHD)合并丙型肝炎病毒(hepatitis C virus,HCV)感染者的自然病程特点,了解患者生存和治疗情况.方法:收集我院及上海交通大学医学院附属第九人民医院北院2016年1月起所有MHD患者446例,随访2年.收集患者血常规、肝功能、肾功能、HCV抗体、HCV RNA等指标,计算天冬氨酸转氨酶(aspartate aminotransferase,AST)和血小板(platelet,PLT)比例指数(APRI)及基于4因子的纤维化(four-factor-based fibrosis,FIB-4)指数,比较随访初期和随访末期指标变化.检测患者HCV基因型,记录患者自行开展的直接抗病毒药物(direct-acting antiviral agents,DAA)治疗情况,并统计所有患者死亡情况.结果:446例患者初次筛查抗HCV阳性患者43例(9.6％),HCV RNA阳性患者31例(7.0％),随访期间无HCV RNA阳转.31例HCV RNA阳性患者为HCV感染者,其中1例未及检测基因型即死亡,其余30例患者HCV基因1b型27例(90.0％),2a型3例(10.0％).6例患者自行购买和服用DAA,治疗方案均为基于索磷布韦(sofosbuvir,SOF)的抗病毒方案,疗程均为12周,治疗结束时HCV RNA均转阴,平均随访(12.5±3.4)个月后,6例患者HCV RNA仍为阴性.24个月随访期间,HCV RNA阴性组患者死亡50例,HCV RNA阳性组死亡3例,差异无统计学意义.在HCV RNA阳性组中,DAA治疗组治疗前后各项随访指标差异均无统计学意义;DAA未治疗组在随访期间血白细胞由(4.94±1.20)×109/L至(4.31±1.39)×109/L,FIB-4指数由(2.17±1.34)分增至(2.69±2.00)分,差异均有统计学意义(均P<0.05).结论:MHD患者是HCV感染高发区,1b型和2a型是MHD合并HCV感染患者中最主要的HCV病毒基因型.随访期间未接受DAA治疗者肝纤维化指标有显著进展,治疗组无显著差异.

目的·探究行维持性血液透析终末期肾病（end-stage renal disease,ESRD）患者脑部结构性异常和认知功能变化特点,分析可能影响其神经系统结构和功能异常的相关因素。方法·选取于上海交通大学医学院附属第九人民医院进行维持性血液透析治疗的ESRD患者37例,所有患者既往均无脑卒中史。对入选患者进行颅脑磁共振成像（magnetic resonance imaging,MRI）平扫和简易精神状态量表（Mini-Mental State Examination,MMSE）评价。根据MRI结果分为腔隙性脑梗死患病组（n=33）和对照组（n=4）,或者分为脑白质高信号患病组（n=14）和对照组（n=23）。采用t检验、Mann-Whitney U检验、χ~2检验及Fisher精确检验比较患病组和相应对照组在人口学特征、既往病史、血液指标、透析充分性等方面的差异,采用Spearman相关性分析研究临床特征、脑结构性异常与认知功能间的相关性。结果·37例患者中,男性19例、女性18例,平均年龄（59.4±12.3）岁。腔隙性脑梗死和脑白质高信号发生率分别为89.2%和37.8%,24.3%的患者存在认知损害。腔隙性脑梗死患者年龄较大,血红蛋白、红细胞比容、血清白蛋白、总蛋白水平较低,甲状旁腺素、红细胞沉降率、肿瘤坏死因子α、白介素-6水平较高。脑白质高信号患者年龄较大,转铁蛋白饱和度较低,甲状旁腺素水平较高,且差异具有统计学意义（均P＜0.05）。相关性分析结果显示,MMSE 总分与年龄负相关（r=-0.471,P=0.003）,与受教育程度（r=0.355,P=0.031）、高血压史（r=0.358,P=0.030）正相关。研究未发现腔隙性脑梗死或脑白质高信号与MMSE总分之间的关联,但回忆力与腔隙性脑梗死存在一定程度负相关（r=-0.357,P=0.030）。结论·行维持性血液透析ESRD患者脑血管病变及认知损害发生率较高,高龄、贫血、炎症状态、慢性肾脏病矿物质和骨异常等可能是血液透析患者出现脑结构性异常及认知损害的影响因素。

Chronic kidney disease (CKD) causes several systemic changes, including muscular homeostasis, and eventually results in muscle atrophy. CKD-induced muscle atrophy is highly prevalent, and exercise is well known to enhance muscle function in these cases, although the exact mechanism remains unclear. Here, we aim to assess whether the protective effect of aerobic exercise in 5/6 nephrectomized (CKD) mice is associated with mitochondrial dysfunction, autophagy, or inflammation. C57BL/6J mice were randomly allocated into 3 different experimental groups: Sham, CKD, and CKD+aerobic exercise (CKD+AE). Renal function was assessed via serum creatinine and urea levels, and histological PAS and Masson staining were performed. Muscle wasting was determined based on grip strength, cross-sectional area (CSA), and MyHC protein expression. We also measured mitochondrial dysfunction in mice by assessing mtDNA, ROS, ATP production, and mitochondrial configuration. Autophagy was determined via assessments for Atg7, LC3, and SQSTM1 on western blotting. Inflammation was identified via proinflammatory cytokines and NLRP3 inflammasome components using real-time PCR and western blotting. We found that CKD mice exhibited higher BUN and creatinine levels and more severe glomerulosclerosis in the glomeruli and renal tubulointerstitial fibrosis, relative to the Sham group; all these effects were relieved by aerobic exercise. Moreover, grip strength, CSA, and MyHC protein expression were improved after 8 weeks of aerobic exercise. Furthermore, aerobic exercise significantly decreased MDA levels, increased SOD2 activity and ATP production, and improved mitochondrial configuration, relative to the CKD group. In addition, aerobic exercise downregulated the overexpression of proinflammatory cytokines and NLRP3 inflammasome components and balanced the mitochondrial biogenesis and autophagy-lysosomal system. Thus, we observed that aerobic exercise may ameliorate CKD-induced muscle wasting by improving mitochondrial dysfunction, inflammation, and autophagy-lysosomal system in uremic cachexia.

BACKGROUND:Renal anemia is one of the most important complications in patients on maintenance hemodialysis (MHD). Telehealth-based dialysis registration systems have the advantage of real-time monitoring and have gradually been applied to the management of chronic diseases.OBJECTIVE:The objective of our study was to evaluate the impact of a telehealth-based dialysis registration system on patients on MHD in terms of renal anemia control.METHODS:The Red China project aimed to develop a dialysis registration system based on the WeChat mobile platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, and baseline creatinine levels were recorded using this system. In addition, the hemoglobin and hematocrit levels were recorded monthly. The platform then generated a hemoglobin and hematocrit statistics report for each hemodialysis center monthly, including the detection rate, target rate, and distribution of hemoglobin and released it to physicians via the WeChat mobile phone app. The physicians were then able to treat the individual's anemia appropriately by changing the doses of erythropoiesis-stimulating agents or iron use on the basis of this report. We analyzed the demographic and baseline laboratory parameters, detection rate, target rate, and average level and distribution of hemoglobin 28 months after the launch of the project.RESULTS:A total of 8392 patients on MHD from 28 hemodialysis centers in Shanghai were enrolled from June 2015 to October 2017. The detection rate of hemoglobin increased from 54.18% to 73.61% (P<.001), the target rate of hemoglobin increased from 47.55% to 56.07% (P<.001), and the mean level of hemoglobin increased from 10.83 (SD 1. 60) g/dL to 11.07 (SD 1.60) g/dL (P<.001). In addition, the proportion of patients with hemoglobin levels ≥11 g/dL but <13 g/dL increased from 40.40% to 47.48%.CONCLUSIONS:This telehealth-based dialysis registration system can provide timely reporting of the anemia status in patients on MHD, which may improve the awareness of anemia and the attention to and compliance with anemia monitoring.

PURPOSE:Protein-energy wasting (PEW) is highly prevalent in end-stage renal disease (ESRD) patients with inflammation who are on haemodialysis treatment. Interleukin-18 (IL-18) is an important pro-inflammatory cytokine that is significantly elevated in ESRD patients. However, the relationship between PEW and IL-18 is unclear. We therefore performed a cross-sectional study on 100 ESRD patients undergoing haemodialysis to clarify this.METHODS:PEW was defined according to the diagnostic criteria of the International Society of Renal Nutrition and Metabolism. Inflammation was assessed based on the serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and IL-18. We analysed the association between PEW and IL-18 by using logistic analysis and linear regression after adjustment for basic characteristics, comorbidities and laboratory findings.RESULTS:Among the 100 haemodialysis patients who were recruited, 56 had PEW. Even though there was no difference between the PEW group and non-PEW group with regard to disease causes, age, gender, cholesterol, ferritin, and haemoglobin, the levels of inflammation indicators such as CRP, IL-6, TNF-α and IL-1β were significantly higher in the PEW group. Moreover, IL-18 was found to contribute to PEW, but was negatively correlated with pre-albumin after adjustment for possible confounding factors.CONCLUSIONS:Thus, the findings indicate that IL-18 is associated with PEW in ESRD patients on haemodialysis, which suggests that IL-18 may be involved in the pathogenesis of PEW in this setting.

BACKGROUND Insulin resistance (IR) and inflammation are associated with increased risk of complications in chronic kidney disease (CKD) patients. However, the relationship between IR and the important proinflammatory interleukin-1β (IL-1β) is unclear in CKD patients. MATERIAL AND METHODS We conducted a cross-sectional study including 79 non-diabetic patients who received hemodialysis after the exclusion process. Homeostasis model assessment (HOMA-IR) and leptin adiponectin ratio (LAR) were used to evaluate IR. Inflammation was assessed through C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-1β evaluation. We tested associations of IR with IL-1β using logistic analysis and linear regression. RESULTS Patients were divided into a HOMA-IR-positive group and a HOMA-IR-negative group. Although there were no differences between the 2 groups in terms of etiological causes, age, sex, BMI, triglyceride, cholesterol, ferritin, uric acid, and inflammatory indicators such as CRP, we found that IL-6, TNF-α, and IL-1β were significantly increased in the HOMA-IR-positive group compared with the HOMA-IR-negative group. Moreover, IL-1β contributed to HOMA-IR positivity and was positively correlated with LAR after adjusting for possible confounding factors. CONCLUSIONS Insulin resistance correlates positively with IL-1β among non-diabetic hemodialysis patients, which suggests that IL-1β may be involved in the pathogenesis of IR in this setting.