BACKGROUND:Despite treatment advances, there are limited data on the development of chronic kidney disease (CKD) in patients with lupus nephritis (LN) on long-term follow up. In this study, we aim to investigate the prevalence of CKD, its progression over time, and associated risk factors in patients with LN. METHODS:We conducted a retrospective study on Chinese patients with biopsy-proven LN diagnosed in 1981-2017. CKD G3-5 was defined according to an estimated glomerular filtration rate (eGFR) of <60 ml/min/m2, for >3 months. Risk factors for CKD progression and adverse outcomes were determined by multivariate logistic regression. RESULTS:In total, 183 patients were included. Over a mean follow up of 19.9 ± 9.7 years, 34.4% (63 patients) developed CKD G3-5, 9.8% developed kidney failure (KF) and 14.2% died. CKD G3-5 was associated with older age, renal impairment and hypertension at presentation, and the occurrence of nephritis flares. eGFR <60 ml/min/1.73 m2 was present in 24.6% of patients at presentation, and the prevalence decreased to 13.6% and 12% after 6 and 12 months of treatment, respectively, followed by a gradual increase to 15.3%, 16.4%, and 20.8% after 2, 5, and 10 years of follow up, respectively. In multivariate analysis, eGFR <80 ml/min/1.73 m2 at 1 year [OR 16.684 (95% CI 4.305-64.660), P < .001] and ≥2 nephritis flares [OR 7.237 (95% CI 2.041-25.919), P = .002] were significant predictors of CKD G3-5 development and adverse clinical outcomes during follow up. Continuous induction-maintenance treatment with mycophenolate and glucocorticoid was associated with reduced risk of CKD G3-5 at 10-years [OR 0.196 (95% CI 0.046-0.835), P = .028]. CONCLUSION:CKD G3-5 is common, affecting approximately one-fifth of LN patients after 10 years of follow up. eGFR <80 ml/min/1.73 m2 at 1 year after treatment for active LN and ≥2 nephritis flares are important risk factors, while mycophenolate and glucocorticoid induction-maintenance treatment regimen was associated with a reduced risk of CKD G3-5 during follow up.

Human metapneumovirus (hMPV) causes mild and self-limiting disease in adults. However, the risk factors for serious adverse outcomes following hMPV infection in adult patients without preexisting chronic airway diseases remain poorly understood. We conducted a territory-wide retrospective study on adult patients (aged ≥ 18 years) without chronic airway diseases hospitalized for hMPV infections between January 1, 2016 and June 30, 2023 in Hong Kong. We assessed the incidence and risk factors for in-patient mortality, severe respiratory failure (SRF), secondary bacterial pneumonia and acute kidney injury (AKI) were assessed. A total of 1552 eligible adult patients without chronic airway diseases hospitalized for hMPV infections were analyzed. Within the index admission, 92 (5.9%) patients died. Ischemic heart disease (IHD) was associated with increased risks of SRF [adjusted odds ratio (aOR) 2.00 (95% CI 1.48-2.71), p < 0.001]. IHD, heart failure (HF), and history of ischemic stroke were significant predictors for AKI [aOR 1.51 (95% CI 1.12-2.04), 2.87 (95% CI 2.14-3.85), and 1.47 (95% CI = 1.12-1.93), p = 0.007, < 0.001, and 0.005, respectively). Patients with end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) were at increased risk of in-patient mortality [aOR 6.36 (95% CI 2.34-17.26), p < 0.001] and SRF [aOR 8.80 (95% CI 3.84-20.16), p < 0.001]. The presence of cardiovascular diseases and ESKD requiring RRT is a strong predictor of severe in-hospital outcomes among adult patients without chronic airway diseases who are hospitalized for hMPV infections.

INTRODUCTION:The management of patients with lupus nephritis (LN) in clinical remission who demonstrate asymptomatic serological reactivation remains uncertain. Results from our previous study suggested that a pre-emptive moderate increase of immunosuppressive treatment might reduce disease flares. METHODS:Here, we conducted a prospective multicenter randomized controlled trial to compare pre-emptive treatment (PT) against observant management (Control) in clinically stable patients with LN and asymptomatic serological reactivation who were receiving low-dose glucocorticoid and mycophenolate or azathioprine as maintenance immunosuppression. PT included an increase in prednisolone dose from ≤5 mg/d to 0.4-0.5 mg/kg/d and an increase in mycophenolate or azathioprine dose to 1.5 g/d and 100 mg/d, respectively, followed by tapering of prednisolone dose to the original level by 12 weeks. Patients were followed for 24 months from randomization. The primary outcome was 24-month survival free of kidney flares. Secondary outcomes included survival free of extra-kidney flares, change in kidney and immunological parameters, and adverse events. RESULTS:Forty-nine patients were randomized (24 PT and 25 Control). No kidney flare occurred in PT while five kidney flares occurred at 6.0 (interquartile range: 3.0-10.0) months in Controls. PT patients had superior 24-month survival free of kidney, extra-kidney, and overall flares than Controls (100% vs. 80%, 91% vs. 72%, and 91% vs. 52%, respectively, significant for all). PT patients showed improved anti-dsDNA and C3 compared to baseline, but not patients in the Control arm. Adverse events were few and similar, and kidney function remained stable in both groups. CONCLUSIONS:A pre-emptive moderate increase of immunosuppression was effective in preventing kidney flares in patients with LN and with asymptomatic serological reactivation and was well tolerated. TRIAL REGISTRATION:Registered at ClinicalTrials.gov with study number NCT04870359.

BACKGROUND:While parainfluenza virus infections are common, there is relatively little data on the impact and risk factors of parainfluenza virus infection on severe in-hospital outcomes. METHODS:This territory-wide retrospective study elucidated the risk factors for serious in-hospital outcomes among patients hospitalized due to parainfluenza infection. Data were retrieved from the Clinical Data Analysis and Reporting System managed by the Hospital Authority, Hong Kong, from 1 January 2016 to 30 June 2023. The main outcomes of interest were: (i) death during hospitalization; (ii) severe respiratory failure requiring invasive or non-invasive mechanical ventilation; (iii) secondary bacterial pneumonia; (iv) acute kidney injury. RESULTS:2058 adult patients were hospitalized due to parainfluenza virus infection during the study period. 87 (4.2%) patients died during the index admission, 467 (22.7%) patients developed severe respiratory failure, 1355 (65.8%) patients developed secondary bacterial pneumonia, and 625 (30.3%) patients developed acute kidney injury. Risk factors for severe in-hospital outcomes included underlying cardiopulmonary and kidney diseases (especially those receiving renal replacement therapy) and advanced age. CONCLUSIONS:Important risk factors for severe in-hospital outcomes among patients with parainfluenza infections include underlying age ≥65 years, cardio-pulmonary and kidney diseases. These at-risk patients may benefit from future vaccines and antiviral drugs. Key messages What is already known on this topic: Severe in-hospital outcomes among adult patients with parainfluenza infections are common What this study adds: The risk factors for severe in-hospital outcomes include underlying age ≥ 65 years, cardio-pulmonary, and kidney diseases How this study might affect research, practice, or policy: These at-risk patients may benefit from future vaccines and antiviral drugs.

Aim: Disturbances in exhausted and classical memory B cells have been implicated in the pathogenesis of systemic lupus erythematosus (SLE) and lupus nephritis (LN), but the genetic regulation of their homeostasis remains poorly understood. Methods: We analyzed the single-cell RNA-seq data of peripheral blood mononuclear cells (PBMCs) from the NIH SLE dataset (GSE135779) and another published LN single-cell RNA-seq dataset (dbGAP database accession code phs001457.v1.p1). Overlapping differentially expressed genes (DEGs) in exhausted and classical memory B cells from SLE and LN patients were identified, and their altered expression was validated in B cells obtained from LN patients. GO and KEGG analyses were used to analyze associated pathways. The relationships between exhausted and classical memory B cells and cellular metabolic pathways were also assessed. Results: Three DEGs (IFI44L, XAF1, and MX1) were detected in both exhausted and classical memory B cells, and their increased expression was verified in classical and exhausted memory B cells obtained from LN patients during remission. The protein-protein interaction network of the DEGs suggested that STAT1 showed the highest eigenvector centrality for these DEGs. IFI44L, XAF1 and MX1 were involved in distinct biological processes and immune pathways (especially JAK-STAT). Classical memory B cells showed higher expression of genes involved in sulfur metabolism (SQRDL and TST), amino sugar metabolism (GFPT1 and UAP1), and butanoate metabolism (ACADS and ACAT1), while exhausted B cells exhibited inverse relationships with these metabolic pathways. Conclusions: Altered expression of IFI44L, XAF1 and MX1 is associated with distinct metabolic signatures and immune pathways in exhausted and classical memory B cells in SLE and LN.

Background: The long-term kidney outcomes in paediatric osteosarcoma survivors treated with nephrotoxic chemotherapeutic agents are not well-described. Methods: We conducted a multi-centre retrospective cohort study and recruited paediatric osteosarcoma survivors who survived beyond 5 years from cancer diagnosis over a 20-year period. Chronic kidney disease (CKD) was defined as evidence of kidney impairment, chronic tubulopathy, and proteinuria upon last follow-up. Results: We included 89 patients (57% males) with a mean follow-up period of 14.9 years. A total of 42 subjects (47.2%) developed CKD, 28 of whom had CKD stage 1 with either chronic tubulopathy or proteinuria; 14 patients had CKD stage 2 (eGFR < 90 mL/min/1.73 m(2)), while two had CKD stage 3 (eGFR < 60 mL/min/1.73 m(2)). Chronic tubular dysfunction was reported in 34 patients (38%), with hypomagnesemia being the most common manifestation. Proteinuria and hypertension were infrequently observed, in 3% and 8% of cases, respectively. We found that a history of severe AKI and aminoglycoside exposure during the treatment course were significant risk factors for CKD, but the dose-dependent relationships between the development of CKD and cisplatin, ifosfamide, and methotrexate could not be demonstrated. Conclusions: CKD is prevalent among paediatric osteosarcoma survivors. Caution is needed when using multiple nephrotoxic agents at the same time, as this could increase the risk of CKD in the long run. Multi-disciplinary regular surveillance should be performed to identify and manage CKD early, including kidney function, electrolyte, and proteinuria monitoring.

BACKGROUND:A significant proportion of patients present with chronic kidney disease of unexplained cause (CKDx) despite standard-of-care diagnostic workup. Data from Australian, European and United States cohorts show that some are due to monogenic etiology. The diagnostic yield and clinical utility of genetic testing in Chinese patients remains unclear. METHODS:We prospectively recruited adult CKDx patients following up at Queen Mary Hospital nephrology unit from 1 Oct 2022 to 1 June 2024. After genetic counselling, patients underwent whole genome sequencing focused on kidney disease genes(637 genes). Variants classification was performed according to the American College of Medical Genetics guidelines. RESULTS:Among 131 CKDx patients, 92% self-identified as Chinese and 21% presented with kidney failure. Mean age at clinical presentation was 35 years. 36% had positive family history of CKD. We identified Pathogenic/Likely pathogenic variants in 13 patients, giving a diagnostic yield of 10%. 33% of variants identified were novel. Variants in type IV collagen genes(COL4A3, COL4A5, COL4A4) were the most frequent, followed by ALG9, CEP290 and IFT140. Alport-spectrum disorders were the leading genetic diagnoses, representing 77% of all genetically positive cases. A significantly higher proportion of patients with positive genetic findings had positive family history of CKD or CKDx, compared to those with negative genetic findings (CKD: 85% versus 31%, p<0.001; CKDx: 77% versus 19%, p<0.001). CONCLUSIONS:Monogenic etiology could be established in 10% of adult CKDx patients in Hong Kong. Alport-spectrum disorders were the leading genetic diagnoses, followed by atypical Autosomal Dominant Polycystic Kidney Disease and nephronophthisis. Genetic testing in CKDx population is clinically useful since a significant proportion could reach a diagnosis and permit disease specific management.

Cardiovascular-kidney-metabolic (CKM) syndrome is an increasingly recognized condition that highlights the interaction between three important medical co-morbidities. Whether the presence of CKM syndrome may increase the risk of in-hospital adverse outcomes in patients with pneumococcal pneumonia has not been investigated. We conducted a territory-wide retrospective study on adults hospitalized for pneumococcal pneumonia between 1 January 2016 and 31 December 2024 in Hong Kong. In-patient mortality, severe respiratory failure (SRF) and acute kidney injury (AKI) were compared among patients with cardiovascular-kidney-metabolic (CKM) syndrome at different stages. Subgroup analyses were performed in patients who have or have not received a pneumococcal vaccine. In total, 2192 patients were hospitalized for pneumococcal pneumonia in the study period, with 1005 (45.8%), 373 (17.0%), 684 (31.2%) and 130 (5.9%) at stage 0-1, 2-3, 4a and 4b CKM syndrome. A higher stage of CKM syndrome was associated with increased risks of death during index admission, SRF and AKI. The adjusted odds ratios (aOR) for CKM stage 4a and 4b for death during index admission were 1.82 (95% CI 1.25-2.64) and 10.92 (95% CI 6.82-17.49) respectively (p = 0.002 and <0.001). The aOR for SRF for CKM stage 2-3, 4a and 4b were 1.43 (95% CI 1.01-2.03), 1.88 (95% CI 1.39-2.54) and 28.42 (95% CI 16.92-47.74) respectively (p = 0.042, <0.001 and <0.001). The aOR for AKI for CKM syndrome stage 2-3, 4a and 4b were 2.25 (95% CI 1.53-3.29), 3.00 (95% CI 2.14-4.22) and 4.30 (95% CI 2.69-6.88) (p < 0.001 for all). Subgroup analysis showed consistent results among those who have or have not received a pneumococcal vaccine within the 12 months preceding the index admission date. CKM syndrome, especially at a higher stage, constitutes an independent risk factor for severe in-hospital outcomes in adults hospitalized for pneumococcal pneumonia.

Lactic acid metabolism and neutrophil extracellular traps (NETs) are critical immune regulators, yet their specific crosstalk in systemic lupus erythematosus (SLE) and lupus nephritis (LN) pathogenesis remains poorly understood. Here, by integrating bulk and single-cell RNA sequencing (scRNA-seq) analyses, we identified TKT and ITGAM as pivotal upregulated genes in SLE, demonstrating robust diagnostic value (AUC >0.7) supported by reliable nomogram models. Additional analysis of a human LN renal biopsy dataset (GSE32591) showed increased ITGAM and TKT in LN glomerular samples, supporting their renal relevance. Regulatory network analyses suggested potential molecular interactions involving these genes with specific microRNAs (e.g., hsa-miR-142-5p-ITGAM and hsa-miR-1-3p-TKT), while scRNA-seq analysis suggested cell-type-associated expression patterns, with donor-level analysis showing higher TKT expression in monocytes from SLE patients. To translate these computational insights into biological relevance, we conducted rigorous in vivo validations. In an apoptotic cell-induced LN mouse model, we confirmed renal injury, increased ITGAM and TKT protein expression, and enrichment of TKT in CD14+ monocyte-lineage cells. Crucially, targeted pharmacological inhibition of TKT using oxythiamine significantly mitigated disease progression in LN mice. Oxythiamine treatment not only restored renal function and attenuated tissue fibrosis but also reprogrammed aberrant lipid metabolism and cellular proliferation. Oxythiamine treatment was further associated with reduced ITGAM expression and lower renal Cit-H3 levels, consistent with an attenuation of NET-associated inflammatory activity. Together, our integrated multi-omics and in vivo data indicate that TKT is closely linked to immunometabolic remodeling in experimental lupus nephritis, accompanied by alterations in lactate accumulation, ITGAM expression, and NET-associated inflammatory activity. These findings support TKT-associated metabolic remodeling as a potential therapeutic avenue that warrants further mechanistic investigation in LN.

ABSTRACT Introduction Advances in mesothelioma management have translated into longer patient survival and different treatment‐related side effects including nephrotoxicity. The risk of developing adverse renal outcomes in patients with mesothelioma and associated risk factors remains undefined. Methods We analysed territory‐wide data from electronic health records of patients with mesothelioma followed at public hospitals in Hong Kong between 1st January 2000 to 31st December 2022. Prevalence of acute kidney injury (AKI), renal progression (> 30 mL/min drop in eGFR), and upstaging of chronic kidney disease (CKD) and associated risk factors were evaluated. Results 222 patients were included. 18 (5.1%) patients developed acute kidney injury (AKI), and risk factors included diabetes mellitus (DM), use of bevacizumab and the presence of third space fluid (pleural effusion, pericardial effusion, ascites). 47 (21.2%) patients had upstage of CKD, and 31 (14.0%) patients showed renal progression. 18, 9, and 4 patients developed renal progression within 12 months from diagnosis, 12–24 months from diagnosis, and more than 24 months from diagnosis. Risk factors for upstage of CKD included the presence of third space fluid, platinum‐based chemotherapy, use of immune check‐point inhibitors, AKI during follow‐up, more lines of cytotoxic chemotherapy received, and cycles of pemetrexed used. Predictors for renal progression included the presence of ascites and use of bevacizumab. Conclusion Short‐ and long‐term adverse kidney outcomes are prevalent in patients with mesothelioma and show strong associations with treatments received. Careful patient selection and close monitoring of renal function may help avoid untoward acute and chronic nephrotoxicity.

Background:Anaemia is a common complication of chronic kidney disease (CKD), often treated with erythropoiesis-stimulating agents (ESAs). The association between erythropoietin use and osteoporotic fractures in humans is yet to be fully elucidated. It is also unclear whether responsiveness to ESA treatment independently contributes to fracture risk. We aimed to evaluate the risk of osteoporotic fractures associated with ESA use in patients with chronic kidney disease (CKD). Methods:In this nested case-control study, we identified 19,720 patients newly diagnosed with CKD between 2005 and 2017 who received ESA treatment before Dec 31, 2022 from the Clinical Data Analysis and Reporting System, the territory-wide electronic health record database in Hong Kong. Patients were included irrespective of dialysis status (peritoneal dialysis, haemodialysis, and non-dialysis). Fracture cases were matched with up to 10 fracture-free controls, according to age, sex, and year of fracture, to investigate associations with ESA use. Fracture cases were defined as major osteoporotic fractures, including overall fractures and specific types (spine, humerus, wrist, and hip fractures), identified using ICD-9-CM codes. Main exposures of interest were duration of ESA treatment before fracture (index date), cumulative defined daily dose of ESA before index date, and ESA responsiveness. Responsiveness was defined as haemoglobin increase ≥1 g/dL within 2 months of ESA initiation. Conditional logistic regression was used to estimate odds ratios (ORs) adjusted for time since CKD diagnosis, comorbidities, fracture-related medications, frailty, CKD-related procedures, and laboratory values. Findings:In total, 959 osteoporotic fracture cases were matched with 9262 controls. Among the fracture types, the majority of cases were hip fractures (n = 622), followed by wrist (n = 164), humerus (n = 154), and spine fractures (n = 80). Fracture patients had a longer ESA treatment duration (mean 2.1 years [SD 2.1] vs. 1.4 years [SD 1.7]) and received a higher cumulative defined daily dose (mean 14,559.8 [SD 21,270.1] vs. 9610.3 [SD 15,702.0]) than their matched controls. Longer ESA treatment duration, but not cumulative dose, was independently associated with increased risks of overall fracture (OR per additional year 1.31; 95% CI 1.23-1.39) and hip fracture (1.28; 1.18-1.39). Results remained largely consistent after adjusting for anaemia severity, excluding patients with hyperparathyroidism, and in subgroup analyses. Additionally, ESA responders had a significantly higher fracture risk compared to non-responders (OR 1.36; 95% CI 1.14-1.63). Interpretation:Our findings suggest that prolonged ESA use and ESA responsiveness are associated with increased osteoporotic fracture risk in patients with CKD, highlighting the need for optimisation of treatment regimens for anaemia in patients with CKD to balance treatment benefits against fracture risk. Further research is warranted to better understand this association. Funding:None.

Effective clinician-patient communication is essential for delivering quality end-of-life care. However, there are no validated measures to assess the quality of end-of-life communication for Chinese patients. This study aims to cross-culturally adapt and validate the patient-reported Quality of Communication Questionnaire (QOC) for Chinese speaking patients. The QOC was translated and adapted using a standardized methodology consisting of forward translations, backward translations, expert panel review, and testing with patients. We conducted a cross-sectional study to perform principal component, content validity, internal consistency, convergent and discriminant validity analyses of the 16-item Chinese QOC (C-QOC). Subjects were Chinese-speaking advanced cancer (n = 82) and advanced chronic kidney disease (n = 68) patients attending outpatient clinics in five hospitals or receiving home-based palliative care in Hong Kong. The content validity of the C-QOC was established by an expert panel. The C-QOC has a 3-component structure (general communication skills, communication about illness trajectory, and end-of-life care planning subscales) and demonstrated good internal consistency (Cronbach’s α = 0.88; subscales 0.84–0.90). Convergent validity was supported by positive association between C-QOC score and overall clinician communication quality (r = 0.47, p < 0.001) and clinician comfort in discussing dying (r = 0.63, p < 0.001). Discriminant validity was demonstrated by the stronger association between overall clinician communication quality and general communication skills, compared to the other two subscales. The C-QOC is a valid, reliable, and culturally relevant instrument for evaluating the quality of clinician end-of-life care communication by Chinese patients with advanced cancer and chronic kidney disease.

Complement-amplifying events/conditions associated with thrombotic microangiopathy (TMA) include pregnancy/postpartum period, severe hypertension, autoimmune diseases, drug exposures, infections and organ transplantation. Some of these 'triggers' may exist comorbidly with atypical haemolytic uraemic syndrome (aHUS; a complement-mediated form of TMA), unmask previously undiagnosed aHUS, or occur secondary to aHUS, thus creating a considerable diagnostic challenge. A major goal in patients presenting with TMA is to differentiate complement-mediated aHUS from other causes of TMA such that appropriate targeted treatment with complement 5 (C5) inhibitors can be initiated rapidly to avoid irreversible end-organ damage. To this end, nephrologists and haematologists from Australia, Hong Kong, Japan, Korea and Taiwan met virtually to discuss the management of TMA/aHUS in the presence of trigger conditions, focusing on the role of C5 inhibitors. To assist primary healthcare physicians and specialists from other disciplines in identifying and managing aHUS in the presence of triggers, the panel developed diagnostic and treatment algorithms as the main meeting output. Individual algorithms are presented for the settings of pregnancy, hypertension, autoimmune diseases, drug exposures, and kidney transplant. The algorithms combine clinical evidence with the panel's collective expertise to provide practical steps to differentiate aHUS and can be refined by local experts to reflect respective healthcare systems, approval and reimbursement procedures, resources and access to treatments for aHUS in any Asia-Pacific country.

Patients with acquired immunocompromising conditions face considerable risk of developing herpes zoster (HZ). Based on the underlying medical conditions and degree of immune dysfunction, these patients require tailored strategies for HZ prevention. In Hong Kong, there is currently a lack of guidelines addressing the unique needs of this vulnerable population, including the use of prophylactic measures such as antivirals and vaccines. An expert panel comprising clinical immunologists, nephrologists, infectious diseases specialists, rheumatologists, hematologists and oncologists in Hong Kong met to review current literature and international guidelines to propose a locally adapted decision-making framework for HZ prophylaxis, in patients with acquired immunocompromised conditions. This article summarizes the consensus and presents a guiding criteria for clinicians to navigate the complexities associated with HZ prevention, in the context of acquired immunodeficiency.

ABSTRACTIntroductionBronchiectasis exacerbation (BE) is associated with unfavorable sequelae in other organs such as the cardiovascular system; data regarding its impact on adverse term renal outcomes, however, is lacking.MethodsA territory‐wide retrospective cohort study was conducted in Hong Kong between 1/1/1993 and 31/12/2017. All patients with bronchiectasis followed in the public healthcare system in 2017 were classified as “Exacerbators” or “Non‐Exacerbators,” and their adverse renal outcomes (renal progression [decrease in eGFR by 30 mL/min lasted for more than 12 months during follow up], acute kidney injury [AKI], and annual rate of eGFR decline) in the ensuing 7 years were compared. Results were also analyzed in the 1:1 propensity score matched (PSM) cohort.ResultsA total of 7929 patients (1074 “Exacerbators” group and 6855 “Non‐exacerbators”) were followed for 6.2 ± 1.6 years. A total of 1570 patients (19.8%) had renal progression, and 935 (11.8%) patients developed AKI. “Exacerbators” showed significantly increased risk of renal progression (adjusted odds ratio [aOR] 1. 27 [95% CI 1.08–1.50, p = 0.003]), more rapid eGFR decline (−3.67 [−1.74 to −6.54] vs. −3.03 [−1.56 to −5.12] mL/min/1.73 m2/year, p = 0.004) and AKI (aOR 1.99; 95% CI 1.44–2.73, p < 0.001) than the “Non‐exacerbators.” Annual number of BE was associated with renal progression (aOR 1.45; 95% CI 1.22–1.72, p < 0.001) and AKI (aOR 2.00; 95% CI 1.38–2.91, p < 0.001). Results were consistent in the analysis with the PSM cohort.ConclusionsRenal progression and AKI are common among patients with bronchiectasis, and BE is an independent risk factor for adverse renal outcomes.

BACKGROUND AND OBJECTIVES:Poor long-term blood pressure (BP) control due to undertreatment of hypertension is not uncommon after intracerebral hemorrhage (ICH). It heightens the risk of ICH recurrence and subsequent stroke, which is the highest within the first year. Promptly achieving BP targets would significantly reduce these risks. To accomplish this, upfront triple antihypertensive medications could be prescribed soon after ICH because many ICH survivors require ≥3 antihypertensives. However, not all would suit this approach, particularly those with cerebral amyloid angiopathy (CAA), where elevated admission BP may be due to acute hypertensive response rather than underlying hypertension. In addition, overtreatment and excessive BP lowering would cause more side effects and have been associated with increased mortality in older patients. Hence, to facilitate individualized treatment, we aimed to develop a score (TRICH) to predict the need for ≥3 antihypertensives at 3 months after ICH. METHODS:We developed the score using data from the University of Hong Kong prospective ICH registry (2011-2022) and validated it in 3 hospitals (2020-2022) locally. Consecutive patients with spontaneous ICH who survived >90 days and had follow-up BP 3 months after ICH were included. Predictors for needing ≥3 antihypertensive medications at 3 months were identified using multivariate logistic regression, and the score was created using the β-coefficients. RESULTS:The TRICH score was developed from 462 patients (mean age 66.6 ± 14.3 years, 60% male) and validated in 203 patients (mean age 66.3 ± 14.6 years, 62% male). The 9-point score (age younger than 60 years = 1, male = 1, ischemic heart disease = 1, admission estimated glomerular filtration rate <60 mL/min/1.73 m2 = 2, admission systolic BP 190-230 mm Hg = 2 while >230 mm Hg = 4) has a c-statistic (95% CI) of 0.79 (0.75-0.83) in the development cohort and 0.76 (0.69-0.82) in validation. A dichotomized score (≥3 points) predicted the need for ≥3 antihypertensives with 0.73 (95% CI 0.67-0.80) sensitivity and 0.76 (95% CI 0.70-0.81) specificity. The score performed better in patients with untreated/uncontrolled hypertension before ICH than in controlled patients (c-statistic [95% CI] 0.81 [0.77-0.86] vs 0.74 [0.69-0.80], p = 0.037) but showed no difference between patients with CAA and non-CAA patients. DISCUSSION:The TRICH score identifies patients with ICH who need ≥3 antihypertensive medications 3 months after ICH with good discrimination ability. It may guide upfront triple antihypertensive prescription, but further research is warranted, particularly in non-Han Chinese populations.