Background Pegmolesatide, a synthetic peptide-based erythropoietin (EPO) receptor agonist, is being evaluated as an alternative to epoetin alfa for treating anemia of chronic kidney disease (CKD) in Chinese dialysis patients. There is a critical need for a long-acting, cost-effective erythropoiesis-stimulating agent that does not produce EPO antibodies.Methods A randomized, open-label, active-comparator, non-inferiority phase three trial was conducted at 43 dialysis centers in China between May 17th, 2019, and March 28th, 2022. Eligible patients aged 18-70 years were randomly assigned (2:1) to receive pegmolesatide once every four weeks or epoetin alfa one to three times per week, with doses adjusted to maintain a hemoglobin level between 10.0 and 12.0 g/dL. The primary efficacy endpoint was the mean change in hemoglobin level from baseline to the efficacy evaluation period in the per-protocol set (PPS) population. Non-inferiority of pegmolesatide to epoetin alfa was established if the lower limit of the two-sided 95% confidence interval for the between-group difference was >= -1.0 g/dL. Safety assessment included adverse events and potential anaphylaxis reactions. This trial is registered at ClinicalTrials.gov, NCT03902691.Findings Three hundreds and seventy-two patients were randomly assigned to the pegmolesatide group (248 patients) or the epoetin alfa group (124 patients). A total of 347 patients (233 in the pegmolesatide group and 114 in the epoetin alfa group) were included in the PPS population. In the PPS, the mean change (standard deviation, SD) in hemoglobin level from baseline to the efficacy evaluation period was 0.07 (0.92) g/dL in the pegmolesatide group and -0.22 (0.97) g/dL in the epoetin alfa group. The between-group difference was 0.29 g/ dL (95% confidence interval: 0.11-0.47), verifying non-inferiority of pegmolesatide to epoetin alfa. Adverse events occurred in 231 (94%) participants in the pegmolesatide group and in 110 (89%) in the epoetin alfa group. Hypertension was the most common treatment-related adverse event. No fatal cases of anaphylaxis or hypotension were reported.Interpretation Monthly subcutaneously injection of pegmolesatide was as effective and safe as conventional epoetin alfa administrated one to three times a week in treating anemia in Chinese dialysis patients.

Acute glomerulonephritis (GN) is an acute episode of glomerular injury accompanied by inflammation, usually characterizing by edema, hematuria, hypertension, and acute kidney injury.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar In the classification of the clinical renal presentation, acute GN (International Classification of Diseases code: N00-N01.9) (Table S1) generally includes nephritic syndrome and rapidly progressive GN.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar The clinical outcome of patients with acute GN depends on the disease severity and the underlying cause. Acute post-infectious glomerulonephritis is the most common form of acute GN, particularly in children. Viral, bacterial, and protozoal organisms can cause infections, with subsequent acute post-infectious glomerulonephritis.2Prasad N. Patel M.R. Infection-induced kidney diseases.Front Med. 2018; 5: 327Crossref Scopus (12) Google Scholar With the aging population growing, acute GN is increasingly common in older patients due to the increased rates of endocarditis, which is associated with the ongoing utility of intravenous drugs and cardiac devices.3Boils C.L. Nasr S.H. Walker P.D. et al.Update on endocarditis-associated glomerulonephritis.Kidney Int. 2015; 87: 1241-1249Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Thus, not only younger children but also older adults are affected by this disease. In addition to acute post-infectious glomerulonephritis, the other forms of acute GN include immunoglobulin A nephropathy and rapidly progressive GN.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar Immunoglobulin A nephropathy is characterized by a mesangial proliferative GN. Rapidly progressive GN has the potential to destroy renal function within days. These forms of acute GN usually cannot be expected to resolve spontaneously.1Vinen C.S. Oliveira D.B.G. Acute glomerulonephritis.Postgrad Med J. 2003; 79 (quiz 212–213): 206-213Crossref PubMed Scopus (23) Google Scholar Acute GN can result in acute renal failure requiring dialysis and intensive care and results in economic costs to families and the health system. Therefore, we do not turn a blind eye to the disease burden of acute GN. Previous predominantly single-center studies have described the clinical characteristics, complications, and clinical outcome of adults and children with acute GN.4Eison T.M. Ault B.H. Jones D.P. et al.Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis.Pediatr Nephrol. 2011; 26: 165-180Crossref PubMed Scopus (88) Google Scholar,5Dowler J. Wilson A. Acute post-streptococcal glomerulonephritis in Central Australia.Australian J Rural Health. 2020; 28: 74-80Crossref PubMed Scopus (2) Google Scholar However, a large-scale systematic analysis of the global disease burden of acute GN is lacking. The Global Burden of Disease (GBD) Study 2019 provides up-to-date data regarding the epidemiology of acute GN for 195 countries and territories from 1990 to 2019.6Diseases G.B.D. Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2020; 396: 1204-1222Abstract Full Text Full Text PDF PubMed Scopus (541) Google Scholar Using this data source, we analyzed rates in 2019, and temporal trends between 1990 and 2019, for the point prevalence, incidence, disability-adjusted life-years (DALYs), and mortality (Table S2) associated with acute GN at a global, regional, and national level. Globally, there were 48,375 point prevalent cases, 722,244 incident cases, 10,522 deaths, and 307,480 DALYs attributed to acute GN in 2019. The age-standardized rates in 2019 for prevalence per 100,000 population were 0.63 (95% uncertainty interval [UI], 0.52 to 0.76), for incidence was 9.45 (95% UI, 7.72 to 11.55), the mortality rate was 0.13 (95% UI, 0.10 to 0.16), and the DALY rate was 3.90 (95% UI, 2.57 to 4.61) (Table 1). The highest age-standardized rates were in North Korea (1.75; 95% UI, 1.27 to 2.32) for prevalence, in Vietnam (25.44; 95% UI, 19.32 to 32.90) for incidence, in China (0.40; 95% UI, 0.27 to 0.46) for mortality, and in Timor-Leste (21.70; 95% UI, 8.04 to 32.32) for DALYs (rate per 100,000 population in 2019) (Table 1, Figure 1). These rates decreased significantly from 1990 to 2019 per year. Generally, East Asia had the highest decreased trend of age-standardized prevalence and age-standardized incidence rate during 1990 to 2019, respectively. Eastern Europe had the highest decreased trend of age-standardized mortality and age-standardized DALYs over the same period. By contrast, the highest increased trend in age-standardized incidence and age-standardized prevalence rate was in South Asia. At the same time, North Africa and Middle East, High-income North America, and Central Latin America had the highest increased trends of age-standardized mortality and age-standardized DALYs from 1990 to 2019 (Table 1, Figure S1). The national age-standardized rates and trends of prevalence, incidence, mortality, and DALYs across the 195 countries and territories were seen in Table S3. Here, we found the highest disease burden in Asian countries, particularly in Brunei, Uzbekistan, Vietnam, and North Korea with the highest prevalence and incidence, and in China, Laos, Afghanistan, North Korea, and Cambodia with the highest mortality and DALYs.Table 1Numbers, age-standardized rates of prevalence, incidence, mortality, and disability-adjusted life years from acute glomerulonephritis in 2019, and trends from 1990 to 2019 in the global and regional levelsVariablesPrevalenceCount (IQR)Age-standardized prevalence (95% UI)Annual percent change in rate (CI)aPercent change in rate refer to average annual percent changes between 1990 and 2019.Prevalence Global level48,375 (39,386, 58,295)0.63 (0.52 to 0.76)-1.92 (-2.14, -1.69) Male25,791 (21,044, 31,044)0.67 (0.55 to 0.8)-2.02 (-2.26, -1.78) Female22,583 (18,339, 27,267)0.60 (0.48 to 0.72)-1.81 (-2.02, -1.6) Regional levelLow SDI6196 (4870, 7745)0.55 (0.45 to 0.67)0.54 (0.43, 0.66)Low-middle SDI13,997 (11,377, 16,925)0.78 (0.64 to 0.93)-0.1 (-0.18, -0.02)Middle SDI15,894 (12903,19163)0.69 (0.56 to 0.83)-2.75 (-3.12, -2.37)High-middle SDI8427 (6902, 10,229)0.62 (0.5 to 0.75)-3.28 (-3.66, -2.9)High SDI3832 (3121, 4605)0.41 (0.32 to 0.5)-0.74 (-0.8, -0.68) Andean Latin America202 (154, 259)0.32 (0.24 to 0.41)0.24 (0.11, 0.37) Australasia93 (69, 120)0.35 (0.25 to 0.47)-0.02 (-0.07, 0.04) Caribbean279 (207, 363)0.6 (0.44 to 0.78)0.18 (0.15, 0.2) Central Asia1377 (1078, 1753)1.45 (1.14 to 1.84)-0.46 (-0.64, -0.28) Central Europe936 (753, 1150)0.94 (0.74 to 1.18)-0.18 (-0.28, -0.08) Central Latin America1166(904,1468)0.48 (0.37 to 0.6)-0.24 (-0.4, -0.07) Central sub-Saharan Africa590 (425, 776)0.49 (0.37 to 0.63)-0.04 (-0.1, 0.02) East Asia6805 (5516, 8513)0.53 (0.42 to 0.66)-5.34 (-6.1, -4.58) Eastern Europe2876 (2412, 3448)1.3 (1.09 to 1.55)-1.62 (-1.86, -1.38) Eastern sub-Saharan Africa2144 (1641, 2738)0.54 (0.43 to 0.67)-0.11 (-0.16, -0.05) High-income Asia Pacific1939 (1558, 2345)1.41 (1.08 to 1.80)0.27 (0.21, 0.33) High-income North America526 (457, 600)0.12 (0.10 to 0.14)-0.32 (-0.49, -0.14) North Africa and Middle East2683 (2092, 3415)0.46 (0.36 to 0.58)0.96 (0.91, 1.01) Oceania128 (91, 174)0.91 (0.67 to 1.19)0.21 (0.17, 0.25) South Asia14,564 (11,840, 17,670)0.78 (0.64 to 0.94)1.75 (1.44, 2.07) Southeast Asia6790 (5344, 8557)1.05 (0.83 to 1.34)-0.85 (-0.95, -0.74) Southern Latin America131 (97, 174)0.19 (0.14 to 0.26)0.01 (-0.13, 0.16) Southern sub-Saharan Africa398 (321, 489)0.5 (0.41 to 0.61)0.09 (0.04, 0.14) Tropical Latin America2889 (2385, 3516)1.43 (1.17 to 1.78)-1.14 (-1.32, -0.97) Western Europe682 (535, 853)0.17 (0.13 to 0.22)0.01 (-0.07, 0.1) Western sub-Saharan Africa1176 (886, 1497)0.26 (0.2 to 0.32)0.26 (0.19, 0.32)Incidence Global level722,244 (595,182, 877,834)9.45 (7.72 to 11.55)-1.84 (-2.05, -1.62) Male384,881 (317,618, 466,573)10 (8.23 to 12.16)-1.94 (-2.17,-1.71) Female337,363 (277,087, 410,579)8.91 (7.23 to 10.9)-1.72 (-1.93 ,-1.52) Regional levelLow SDI90,785 (71,609, 113,621)8.13 (6.57 to 9.93)0.53 (0.39, 0.68)Low-middle SDI209,162 (171,704, 254,192)11.71 (9.67 to 14.18)-0.04 (-0.12, 0.05)Middle SDI229,525 (188,587, 279,710)9.96 (8.15 to 12.2)-2.49 (-2.81, -2.17)High-middle SDI124,479 (102,778, 150,652)9.13 (7.41 to 11.24)-3.23 (-3.61, -2.86)High SDI56,795 (47,068, 68,265)6.00 (4.78 to 7.51)-0.75 (-0.81, -0.68) Andean Latin America3034 (2312, 3921)4.79 (3.65 to 6.18)0.25 (0.12, 0.38) Australasia1368 (1037, 1770)5.15 (3.79 to 6.85)-0.03 (-0.09, 0.03) Caribbean4196 (3119, 5510)9.01 (6.67 to 11.88)0.16 (0.14, 0.19) Central Asia20,600 (16,148, 26,447)21.67 (16.95 to 27.73)-0.39 (-0.55, -0.23) Central Europe13,940 (11,329, 17,197)13.98 (11.1 to 17.69)-0.18 (-0.27, -0.08) Central Latin America17,472 (13,693, 22,068)7.17 (5.63 to 9.05)-0.27 (-0.43, -0.11) Central sub-Saharan Africa8854 (6432, 11,696)7.46 (5.69 to 9.59)0 (-0.06, 0.05) East Asia97,614 (79,539, 119,180)7.65 (6.16 to 9.4)-5.34 (-6.1, -4.57) Eastern Europe43,027 (36,442, 51,278)19.53 (16.55 to 23.27)-1.5 (-1.73, -1.27) Eastern sub-Saharan Africa32,783 (25,239, 41,795)8.31 (6.66 to 10.38)-0.12 (-0.17, -0.06) High-income Asia Pacific28,660 (23,389, 34,876)20.76 (16.04 to 26.93)0.26 (0.2, 0.32) High-income North America7723 (6781, 8749)1.76 (1.56 to 2)-0.36 (-0.53, -0.2) North Africa and Middle East39,991 (31,202, 51,879)6.88 (5.4 to 8.72)0.92 (0.87, 0.96) Oceania1938 (1400, 2654)13.73 (10.09 to 18.28)0.2 (0.16, 0.24) South Asia220,143 (180,802, 265,753)11.86 (9.88 to 14.25)1.72 (1.4, 2.04) Southeast Asia101,025 (79,100, 129,176)15.73 (12.31 to 20.21)-0.82 (-0.92, -0.72) Southern Latin America1969 (1479, 2559)2.87 (2.15 to 3.79)0 (-0.15, 0.15) Southern sub-Saharan Africa6005 (4851, 7402)7.56 (6.2 to 9.27)0.1 (0.05, 0.15) Tropical Latin America43,849 (36,483, 52,981)21.8 (17.88 to 26.71)-1.11 (-1.28, -0.93) Western Europe10,091 (8034, 12,503)2.55 (1.99 to 3.28)0 (-0.09, 0.08) Western sub-Saharan Africa17,961 (13,753, 22,763)3.93 (3.11 to 4.9)0.23 (0.17, 0.29)Mortality Global level10,522 (7199, 12,200)0.13 (0.09 to 0.15)-2.89 (-3.15, -2.63) Male5670 (2969, 6847)0.16 (0.08 to 0.19)-2.67 (-2.96, -2.38) Female4853 (3784, 5980)0.11 (0.09 to 0.14)-3.17 (-3.4, -2.94) Regional levelLow SDI548 (153, 1053)0.08 (0.02 to 0.18)-2.1 (-2.19, -2.02)Low-middle SDI1971 (1010, 2297)0.15 (0.08 to 0.18)-2.86 (-3.01, -2.7)Middle SDI5502 (3660, 6453)0.24 (0.17 to 0.29)-2.86 (-3.18, -2.55)High-middle SDI1945 (1539, 2256)0.1 (0.08 to 0.12)-4.07 (-4.37, -3.77)High SDI554 (476, 606)0.03 (0.02 to 0.03)-0.02 (-1.15, 1.1) Andean Latin America8 (6, 11)0.02 (0.01 to 0.02)-5.41 (-6.06, -4.75) Australasia7 (6, 9)0.01 (0.01 to 0.02)-0.65 (-3.21, 1.91) Caribbean17 (10, 27)0.04 (0.02 to 0.06)-1.42 (-1.99, -0.85) Central Asia110 (93, 134)0.12 (0.1 to 0.15)-3.79 (-4.55, -3.03) Central Europe41 (35, 47)0.02 (0.02 to 0.02)-5.18 (-6.2, -4.16) Central Latin America281 (242, 320)0.12 (0.11 to 0.14)3.2 (0.57, 5.84) Central sub-Saharan Africa110 (30, 221)0.18 (0.04,0.41)-1.33 (-1.62, -1.05) East Asia7175 (4789, 8407)0.39 (0.27 to 0.45)-3.24 (-3.5, -2.97) Eastern Europe156 (132, 182)0.05 (0.05 to 0.06)-7.86 (-8.72, -7) Eastern sub-Saharan Africa317 (76, 761)0.15 (0.03 to 0.41)-2.74 (-2.83, -2.65) High-income Asia Pacific151 (119, 172)0.03 (0.02 to 0.03)-1.52 (-1.75, -1.29) High-income North America269(236,297)0.04 (0.04 to 0.04)2.99 (0.25, 5.73) North Africa and Middle East424 (58, 528)0.1 (0.02 to 0.12)3.17 (2.66, 3.69) Oceania4 (1, 8)0.04 (0.01 to 0.08)0.04 (-0.18, 0.25) South Asia171 (124, 226)0.01 (0.01 to 0.02)-3.9 (-4.06, -3.74) Southeast Asia1060 (311, 1464)0.19 (0.06 to 0.26)-3.17 (-3.28, -3.05) Southern Latin America3 (2, 3)0.003 (0.0029 to 0.004)-3.56 (-4.75, -2.38) Southern sub-Saharan Africa35 (30, 41)0.06 (0.05 to 0.06)-0.69 (-0.98, -0.39) Tropical Latin America58 (53, 63)0.03 (0.02 to 0.03)-6.15 (-6.71, -5.59) Western Europe92 (80, 101)0.0087 (0.008 to 0.009)-1.18 (-3, 0.65) Western sub-Saharan Africa34 (12, 63)0.01 (0 to 0.02)-1.94 (-2.13, -1.75)DALYs Global level307,480 (204,185, 362,573)3.90 (2.57 to 4.61)-3.89 (-4.08, -3.7) Male168,933 (84,118, 207,613)4.39 (2.18 to 5.36)-3.59 (-3.81, -3.36) Female138,547 (94,777, 178,442)3.46 (2.29 to 4.5)-4.24 (-4.38, -4.09) Regional levelLow SDI27,352 (8248, 47,095)2.67 (0.77 to 5.1)-2.7 (-2.77, -2.63)Low-middle SDI62,601 (31,604, 74,473)4.05 (2.05 to 4.79)-3.96 (-4.09, -3.83)Middle SDI158,186 (102,853, 185,699)6.61 (4.28 to 7.72)-3.77 (-4.05, -3.49)High-middle SDI50,545 (41,348, 58,939)2.86 (2.32 to 3.33)-5.02 (-5.29, -4.75)High SDI8668 (7820, 9364)0.52 (0.48 to 0.56)-0.78 (-1.77, 0.21) Andean Latin America241 (162, 333)0.4 (0.28 to 0.56)-7.11 (-7.79, -6.44) Australasia123 (101, 148)0.28 (0.23 to 0.33)-1.06 (-3.2, 1.09) Caribbean782 (423, 1369)1.73 (0.92 to 3.08)-1.58 (-2.04, -1.11) Central Asia4728 (3952, 5765)4.99 (4.20 to 6.04)-3.82 (-4.57, -3.07) Central Europe1012 (871, 1163)0.65 (0.56 to 0.75)-5.72 (-6.68, -4.76) Central Latin America6802 (5875, 7754)2.84 (2.45 to 3.23)2.1 (-0.38, 4.58) Central sub-Saharan Africa5067 (1465, 10,186)4.98 (1.38 to 10.05)-2.17 (-2.48, -1.86) East Asia183,639 (125,297, 217,608)10.17 (7.02 to 11.93)-4.18 (-4.41, -3.95) Eastern Europe5495 (4680, 6414)2.14 (1.83 to 2.5)-7.96 (-8.81, -7.11) Eastern sub-Saharan Africa15,382 (4016, 31,248)4.49 (1.09 to 10.97)-3.55 (-3.65, -3.45) High-income Asia Pacific2029 (1723, 2241)0.51 (0.45 to 0.56)-1.48 (-1.71, -1.26) High-income North America4107 (3772, 4440)0.71 (0.66 to 0.76)2.65 (0.02, 5.27) North Africa and Middle East16,079 (2321, 20,747)2.97 (0.44 to 3.79)2.74 (2.25, 3.24) Oceania190 (44, 428)1.51 (0.36 to 3.22)0.17 (-0.08, 0.43) South Asia6692 (4863, 8314)0.41 (0.3 to 0.51)-3.94 (-4.04, -3.84) Southeast Asia47,484 (11,297, 64,070)7.66 (1.88 to 10.42)-3.7 (-3.85, -3.56) Southern Latin America73 (62, 87)0.10 (0.09 to 0.13)-3.65 (-4.52, -2.78) Southern sub-Saharan Africa1510 (1279, 1824)2.01 (1.72 to 2.41)-1.63 (-1.95, -1.31) Tropical Latin America2410 (2181, 2656)1.19 (1.06 to 1.33)-6.9 (-7.35, -6.44) Western Europe1311 (1182, 1418)0.17 (0.15 to 0.18)-1.67 (-3.2, -0.15) Western sub-Saharan Africa2323 (695, 4595)0.41 (0.15 to 0.76)-2.06 (-2.27, -1.84)CI, confidence interval; DALY, disability-adjusted life-years; IQR, interquartile range; SDI, sociodemographic index; UI, uncertainty interval.a Percent change in rate refer to average annual percent changes between 1990 and 2019. Open table in a new tab CI, confidence interval; DALY, disability-adjusted life-years; IQR, interquartile range; SDI, sociodemographic index; UI, uncertainty interval. Notably, acute GN most often results from a soft tissue infection such as beta-hemolytic streptococci pharyngitis in children, namely acute post-streptococcal GN.7Balasubramanian R. Marks S.D. Post-infectious glomerulonephritis.Paediatr Int Child Health. 2017; 37: 240-247Crossref PubMed Scopus (15) Google Scholar Consistent with the previous studies, we found that the highest rate of prevalence and incidence occurred in children. As shown in Figure S2, the initial increased peak in the age-standardized prevalence and incidence was, respectively, in the 10 to 14 age group, followed by a decline in younger adults, and accompanied by a small wave with some fluctuations in the older population. Acute GN can also occur in adults. Most previous studies about acute GN were limited to children with acute post-streptococcal GN. Therefore, studies involving adults are needed. Different forms of acute GN occur in elderly people, especially those who are immunocompromised with health conditions such as diabetes. For example, protozoal and viral infections in the skin occur more frequently than streptococcal pharyngeal infections as a cause of acute GN in elderly patients.8Hamouda M. Mrabet I. Dhia N.B. et al.Acute post-infectious glomerulonephritis in adults: a single center report.Saudi J Didney Dis Transpl. 2014; 25: 567-571Crossref PubMed Scopus (5) Google Scholar Also, immunoglobulin A nephropathy and membranoproliferative GN can result in acute GN8Hamouda M. Mrabet I. Dhia N.B. et al.Acute post-infectious glomerulonephritis in adults: a single center report.Saudi J Didney Dis Transpl. 2014; 25: 567-571Crossref PubMed Scopus (5) Google Scholar; membranous GN is the underlying cause of acute GN in the elderly due to a variety of malignancies including carcinoma of the lung, stomach, breast, and colon. Rapidly progressive GN can result in acute kidney injury requiring dialysis, and become a major contributor to morbidity and disability within the growing aging population. In this study, we found that the age-standardized rates of mortality and DALYs increased with age, and peaked in the 80- to 85-year-old age groups in 2019 (Figure S2). These rates were slightly higher in males than in females, although no statistically significant differences were observed. Distributions of these rates were similar to those of case numbers of prevalence, incidence, mortality, and DALYs in 2019 (Figure S3). Thus, policymakers should take the elderly population into account when deciding on approaches to reducing the disease burden of acute GN in the future. In this study, no association was found between age-standardized incidence, age-standardized prevalence rates or sociodemographic index (SDI) in 2019 regionally and nationally (Figure S4 and S5). However, a negative association between SDI and age-standardized mortality as well as DALYs was observed. Similar results were also seen in expected age-standardized rates based on their own SDI values in 21 regions (Figure S6–S9). Notably, East Asia and Southeast Asia had a higher observed burden than expected to mortality and disability from 1990 to 2019 (Figure S8 and S9). Likewise, countries and territories such as China, Myanmar, Timor-Leste, Cambodia, Laos, and North Korea had much higher observed age-standardized mortality and DALYs than expected in 2019 (Figure S10 and S11). These results indicated that the burden of acute GN may be generally higher at lower socioeconomic levels of development possible due to the higher frequency of acute post-infectious glomerulonephritis. The underlying reason may be explained by the hygiene hypothesis, namely, early and frequent exposure to bacterial antigens is more common in developing countries than in industrialized nations, which had fewer infections due to better public hygiene.9Hurtado A. Johnson R.J. Hygiene hypothesis and prevalence of glomerulonephritis.Kidney Int Suppl. 2005; : S62-S67Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Thus, increasing population awareness about these relations is warranted to reduce the future burden of acute GN, particularly in the Asia region. In conclusion, the prevalence, incidence, mortality, and disability related to acute GN have decreased globally. But a high disease burden remains in children and elderly people, particularly in some Asian regions. Increasing awareness about acute GN in these populations is warranted to reduce the future burden of acute GN. This work is supported by Zhejiang Provincial Natural Science Foundation of China (LY19H080009). The funders had no role in study design, data collection, data analysis, interpretation, writing of this report. The authors thank the GBD collaborator and the IHME leaders who provided the methodologies and datasets in GBD studies; and Yansmin Elhajmoussa at City of Hope/Biomedical Research Center (BRC) at Gehr Leukemia Center for polishing the language of the article. QG and SW contributed equally. The GBD study 2019, conducted by Institute of Health Metrics and Evaluation (IHME), provides the available datasets. IHME uses de-identified and aggregated data, so informed consent is not applicable to the GBD study. This manuscript is a review article and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee. Download .pdf (2.29 MB) Help with pdf files Supplementary File (PDF) Table S1. International Classification of Diseases code (N00-N01.9) as reference to diagnosis acute GN in this study. Table S2. Definitions of measure metrics in GDB 2019. Table S3.Numbers, age-standardized rates of prevalence, incidence, mortality and disability-adjusted life years from acute glomerulonephritis in 2019, and trends from 1990 to 2019 in GBD study in the national levels. Figure S1. Annual percentage changes of prevalence, incidence, mortality, and disability-adjusted life years for 21 regions in 2019. APCpre, APCinc, APCmort, and APCdaly represent annual percent changes of prevalence, incidence, mortality, and disability-adjusted life years, respectively. Figure S2. Age-standardized point prevalence (A), incidence (B), mortality (C) and disability-adjusted life years (D) for acute glomerulonephritis per 100,000 population by sex and age in 2019. Red and green lines represent females and males, respectively. Figure S3. Global number of prevalent cases (A), incident cases (B), mortality cases (C), and DALYs cases (D) by sex and age in 2019. Figure S4. Correlation relationship among sociodemographic index (SDI) and age-standardized rates of prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) in 21 regions in 2019. Figure S5. Correlation relationship among sociodemographic index (SDI) and age-standardized rates of prevalence (Pre), incidence (Inc), mortality (Mort), and disability-adjusted life years (DALYs) in 195 countries in 2019. Figure S6. The estimated relation between SDI and expected age-standardized prevalence from 1900 to 2019 in 21 regions. Figure S7. The estimated relation between SDI and expected age-standardized incidence (ASIR) from 1900 to 2019 in 21 regions. Figure S8. The estimated relation between SDI and expected age-standardized mortality (ASMR) from 1900 to 2019 in 21 regions. Figure S9. The estimated relation between SDI and expected age-standardized disability-adjusted life years (DALYs) from 1900 to 2019 in 21 regions. Figure S10. Age-standardized DALYs rate for acute glomerulonephritis per 100,000 population for 195 countries by sociodemographic index in 2019. Figure S11. Age-standardized mortality rate for acute glomerulonephritis per 100,000 population for 195 countries by sociodemographic index in 2019. Gray ribbon represents expected disease rates based on sociodemographic index in all countries. Points are plotted for the observed age-standardized mortality rate in each country.

Objective:To explore the relationship between end-dialysis over-weight (edOW) in initial stage of hemodialysis and long-term prognosis in maintenance hemodialysis patients.Methods:The data of initial uremia patients receiving hemodialysis in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017 were retrospectively analyzed. The end point of follow-up was death or until April 30, 2018. The general data including age, gender, body mass index, primary disease, complications and laboratory indicators of the patients and the related parameters of dialysis from four to twelve months were collected. Kaplan-Meier method was used to analyze survival rate. Cox multivariate regression was used to analyze the relationship between edOW and all-cause mortality and cardiovascular disease (CVD) mortality.Results:A total of 469 patients (300 males, 64.0%) were enrolled, with age of (56.9±17.1)years old. During the follow-up period of (4.1±2.4) years (1.0-10.3 years), 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.1% (45/102). The value of edOW was (0.28±0.02) kg. The patients were divided into edOW<0.28 kg group ( n=292) and edOW≥0.28 kg group ( n=177) according to the mean value of edOW. Kaplan-Meier survival analysis showed that the long-term survival rate in edOW<0.28 kg group was higher than that in edOW≥0.28 kg group (Log-rank χ2=4.134, P=0.043), and the CVD mortality in edOW≥0.28 kg group was significantly higher than that in edOW<0.28 kg group (Log-rank χ2=11.136, P=0.001). Cox multivariate regression analysis showed that high edOW was an independent influencing factor for all-cause death and CVD death in hemodialysis patients ( HR=1.541, 95% CI 1.057-2.249, P=0.025; HR=1.930, 95% CI 1.198-3.107, P=0.007). Conclusion:High edOW in early phase is an independent influencing factor of all-cause and CVD death in hemodialysis patients.

Objective To investigate risk factors of the 28 d survival rate in patients with acute kidney injury after continuous renal replacement therapy (CRRT) in ICU. Methods A total of 1720 patients with acute kidney injury treated with CRRT in ICU of the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to December 31, 2013 were selected, and then 1165 patients were analyzed. The patients were divided into the death group (689 cases) and the survival group (476 cases) according to the 28 d survival after CRRT treatment, and the 28 d mortality was 59.14% (689/1165). The general data of the two groups were compared, and the risk factors for the 28 d survival rate were identified by Logistic multivariate regression analysis. Results The age≥65 years, the 24 h urine volume<400 mL, the use of mechanical ventilation, the application of vasopressors, the mean arterial pressure<80 mmHg, the platelet count<100 × 109/L, the bicarbonate radical<22 mmol/L, the lactic acid≥1.7 mmol/L, the total bilirubin ≥100μmol/L, the serum creatinine<250 μmol/L, the blood glucose<3.9 mmol/L, the acute physiology and chronic health evaluation (APACHE) Ⅱ score≥23 and the simplified acute physiology score (SAPS) Ⅱ ≥ 56 of patients with acute kidney injury before CRRT in these two groups were significantly different (χ2=10.376, 11.596, 85.674, 103.017, 86.318, 41.626, 9.862, 86.269, 30.228, 28.691, 13.664, 212.194, 232.712; all P<0.05). Logistic regression analysis showed that the age≥65 years [OR=1.643, 95%CI (1.214, 2.224)], the mean arterial pressure<80 mmHg [OR=1.932, 95%CI (1.417, 2.633)], the platelet count<100 × 109/L [OR=1.968, 95%CI (1.467, 2.640)], the lactic acid≥1.7 mmol/L [OR=1.665, 95%CI (1.226, 2.262)], the total bilirubin≥100μmol/L [OR=2.263, 95%CI (1.518, 3.375)], the serum creatinine<250μmol/L [OR=1.733, 95%CI (1.269, 2.366)], the blood glucose<3.9 mmol/L [OR=3.365, 95%CI (1.282, 8.831)], the APACHEⅡ score≥23 [OR=3.233, 95%CI (2.325, 4.495)] and the SAPSⅡ score≥56 [OR=3.058, 95%CI (2.170, 4.309)] were the risk factors of 28 d survival rate in patients with acute kidney injury after CRRT in ICU (all P<0.05). Conclusion The age≥65 years, the mean arterial pressure<80 mmHg, the platelet count<100 × 109/L, the lactic acid≥1.7 mmol/L, the total bilirubin≥100μmol/L, the serum creatinine<250μmol/L, the blood glucose<3.9 mmol/L, the APACHEⅡ score≥23 and the SAPSⅡ score≥56 were the risk factors of the 28 d survival rate in patients with acute kidney injury after CRRT in ICU.

Background: Acute kidney injury (AKI) is associated with the increased short-term mortality of critically ill patients on continuous renal replacement therapy (CRRT). The aim of this research was to evaluate the association of kidney function at discharge with the long-term renal and overall survival of critically ill patients with AKI who were on CRRT in an intensive care unit (ICU).Methods: We retrospectively collected data for critically ill patients with AKI who were admitted to ICU on CRRT at a tertiary metropolitan hospital in China between 2008 and 2013. The patients were followed up to their death or to 30 September 2016 by telephone.Results: A total of 403 patients were enrolled in this study. The 1-, 3- and 5-year patient survival rates were 64.3 ± 2.4, 55.8 ± 2.5 and 46.3 ± 2.7%, respectively. In multivariate analysis, age, sepsis, decreased renal perfusion (including volume contraction, congestive heart failure, hypotension and cardiac arrest), preexisting kidney disease, Apache II score, Saps II score, vasopressors and eGFR <45 mL/min/1.73 m2 at discharge were independent factors for worse long-term patient survival. And age, preexisting kidney disease, Apache II score, mechanical ventilation (MV) and eGFR <45 mL/min/1.73 m2 at discharge were also associated with worse renal survival.Conclusions: This study showed that impaired kidney function at discharge was shown to be an important risk factor affecting the long-term renal survival rates of critically ill patients with AKI. An eGFR <45 mL/min/1.73 m2 was an independent risk factor for decreased overall survival and renal survival.

Objective To analyze the causes and characteristics of hemodialysis patients,the history of renal disease,vascular access,to provide evidence for screening,prevention and reduction of vascular injury and medical expenses of patients with end-stage renal disease. Methods We did retrospective analysis by collecting the clinical data like gender,age,primary disease,duration of nephrosis,hemodialysisvascular access,blood pressure before hemodialysis and so on from the new hemodialysis in the three years,then analysed their clinical characteristics. Results During 2012-2014 we received totally 776 hemodialysis patient for the first time treated by hemodialysis,the gender proportion(male to female)was 1.9∶1, the age of onset mostly between51-60years old. The top 5 primary disease were chronicglomerulonephritis,diabetic nephropathy,polycystic kidney disease,hyperpieticnephropathy and obstructive nephropathy,chronicglomerulonephritisaccounted for62.4%. There are 304 patients(39.2%) whose chronic kidney disease historyis not clear. As a treatment of vascular access builtfor the first time,the temporary catheterranked first which accounting for 90.9%,and the proportionof fistula was only6.4%. Before the firstdialysis,75.1%patients withsystolic blood pressure. Conclusions There were more male new patients during this period,chronicglomerulonephritis ranked the first as a primary disease. 39.2% of patients need hemodialysis at the first clinic,temporary catheterranked is still the first major vascular access.

Objective To compare the survival rates of elderly hemodialysis（HD）and peritoneal dialysis（PD）patients and identify their independent prognostic predictors.Methods Patients aging＞60 years old who initiated dialysis between January 1,2008 and December 31,2014were included.Propensity score method（PSM）was applied to adjust for selection bias.Kaplan-Meier method

OBJECTIVE To explore the management strategies of acute toxication of 2, 4-dinitrophenol by hemoperfusion. METHODS A total of 14 patients with acute toxication of 2, 4-dinitrophenol were admitted on September 14, 2009. And they were divided into severe and mild groups according to the severity of clinical manifestation. All patients in both groups received 2-hour blood perfusion within 2 hour post-admission. Their clinical manifestations, laboratory parameters and 2, 4-dinitrophenol levels were carefully observed before and after each perfusion. And oxygenation, intravenous use of furosemide, corticosteroids and symptomatic therapies were simultaneously given to improve general conditions. RESULTS In serious group, the levels of before and after the first perfusion were 28.21(15.56-45.23) and 16.11(10.10-27.52) mg/L (P < 0.05), respectively. In both groups, all levels of 2, 4-dinitrophenol were significantly reduced before and after each perfusion (all P < 0.05). The patients in severe group would get relieved after 3 vs 2 perfusions in mild group. In severe group, there was a remarked decrease in neutrophil and platelet count after perfusion than those in mild group. The liver enzymes and blood lipids in both groups after therapy significantly elevated than those before therapy (all P < 0.05). CONCLUSION Crucial for managing acute toxication of 2, 4-dinitrophenol, early hemoperfusion reduces mortality.

目的调查2011年浙江省维持性透析患者的血清钙、磷、甲状旁腺激素水平。方法统计2011年浙江省血液透析和腹膜透析患者血清钙、磷、全段甲状旁腺激素的资料,根据肾脏病改善全球预后（Kidney Disease:Improving Global Outcomes,KDIGO）指南标准,分析患者的钙、磷、iPTH的达标率。结果 2011年浙江省维持性透析患者中,血液透析患者血清钙、磷、iPTH的达标率分别为58.1%、27.2%、56.3%,腹膜透析患者的达标率分别是71.1%、44.2%、65.6%。结论有相当比例的透析患者未能较好的控制血清钙、磷和iPTH水平,尤其是血磷的达标率更低,在血液透析患者中更加明显。