The neutrophil percentage-to-albumin ratio (NPAR) emerges as a novel inflammation marker, demonstrating prognostic ability in a variety of cardiovascular diseases. However, its impact on mortality among patients undergoing maintenance hemodialysis (MHD) remains uncertain. Our research aims to determine whether NPAR is a reliable predictor of mortality in MHD patients. A total of 1803 MHD patients were recruited in this prospective cohort. Patients were stratified into three groups based on baseline NPAR levels. The association between NPAR and all-cause and cardiovascular mortality was evaluated using multivariate Cox proportional risk model and sensitivity analysis. NPAR’s predictive performance was assessed using the receiver operating characteristic (ROC) curve, compared to several conventional biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil count, and serum albumin. The area under the curve (AUC) values of NPAR and these biomarkers were compared using the DeLong’s test. Throughout a median follow-up period of 28 months, 239 (13.3

The incidence of cardiovascular disease is increasing around the world, and it is one of the main causes of death in chronic kidney diseases patients. It is urgent to early identify the factors of cardiometabolic risk. Sleep problems have been recognized as a risk factor for cardiometabolic risk in both healthy people and chronic patients. However, the relationship between sleep problems and cardiometabolic risk has not been clearly explored in hemodialysis patients. This study aimed to investigate the relationship between sleep problems and cardiometabolic risk in 3025 hemodialysis patients by a multicenter study. After adjusting for confounders, binary logistic regression models showed that hemodialysis patients reported sleep duration greater than 7 h were more likely to be with hypertension, hyperglycemia, hypertriglyceridemia, and hypercholesterolemia. Patients reported sleep duration less than 7 h were more likely to be with hypertriglyceridemia and hypercholesterolemia, but the risks of hyperglycemia and Low HDL-cholesterol were decreased. Poor sleep quality was negatively correlated to low HDL cholesterol and hypertriglyceridemia. Moreover, gender-based differences were explained.

OBJECTIVE:Aging is a complex process of physiological dysregulation of the body system and is common in hemodialysis patients. However, limited studies have investigated the links between dialysis vintage, calcium, phosphorus, and iPTH control and aging. The purpose of the current study was to examine these associations. METHODS:During 2020, a cross-sectional study was conducted in 3025 hemodialysis patients from 27 centers in Anhui Province, China. Biological age was calculated by a formula using chronological age and clinical indicators. The absence of the target range for serum phosphorus (0.87-1.45 mmol/L), corrected calcium (2.1-2.5 mmol/L) and iPTH (130-585 pg/mL) were identified as abnormal calcium, phosphorus, and iPTH control. RESULTS:A total of 1131 hemodialysis patients were included, 59.2% of whom were males (669/1131). The mean (standard deviation) of actual age and biological age were 56.07 (12.79) years and 66.94 (25.88), respectively. The median of dialysis vintage was 4.3 years. After adjusting for the confounders, linear regression models showed patients with abnormal calcium, phosphorus, and iPTH control and on hemodialysis for less than 4.3 years (B = 0.211, p = .002) or on hemodialysis for 4.3 years or more (B = 0.302, p < .001), patients with normal calcium, phosphorus, and iPTH control and on hemodialysis for 4.3 years or more (B = 0.087, p = .013) had a higher biological age. CONCLUSION:Our findings support the hypothesis that long-term hemodialysis and abnormal calcium, phosphorus, and iPTH control may accelerate aging in the hemodialysis population. Further studies are warrant to verify the significance of maintaining normal calcium-phosphorus metabolism in aging.

Background Chronic kidney disease-mineral bone disorder (CKD-MBD) is a common comorbidity in patients with CKD. The study aims to describe the control rates of serum-corrected calcium (Ca), phosphate (P) and intact parathyroid hormone (iPTH) and its risk factors among maintenance hemodialysis (MHD) patients in Anhui Province of China. Methods The study was conducted in 27 hemodialysis centers of Anhui Province between January 1st 2020 and December 31th 2020. Chi-square test was used to compare the control rates of serum-corrected Ca, P and iPTH between the present study and DOPPS 4 or Anhui Province in 2014. Binary logistic regression analysis was used to explore the risk factors of the control rates of serum-corrected Ca, P and iPTH. Results A total of 3 025 MHD patients were recruited in this study, with a mean age of 54.8 (SD: 12.8) years, and 60.1% were males. According to the Chinese Diagnosis and Treatment Guidelines for CKD-MBD, the control rates of serum-corrected Ca, P and iPTH in the present study were 57.9%, 20.0% and 56.0%, respectively. Based on KDOQI guidelines (2003), the control rates of the above indicators were 43.1%, 35.3% and 22.3%, respectively. The control rates of serum-corrected Ca, P and iPTH in this study were lower than those of DOPPS 4 (P < 0.001). Compared to the results of Anhui Province in 2014, the control rate of corrected Ca was higher (P < 0.001) and the control rate of iPTH was lower (P = 0.005). Age, residential area, BMI, dialysis vintage, albumin and hemoglobin levels were factors of serum-corrected Ca, P and iPTH not within target range. Conclusion The control rates of serum-corrected Ca, P and iPTH in MHD patients in Anhui Province are relatively low. Monitoring and management should be strengthened to improve the prognosis of patients undergoing dialysis.

Objective: Serum magnesium (Mg2+) levels are associated with insulin resistance, hypertension, lipid abnormalities, and inflammation. However, limited studies have indicated the relationship between Mg2+ and multiple system indexes. The purpose of this study was to investigate the association between Mg2+ and allostatic load (AL) in hemodialysis patients.Methods: A cross-sectional survey was conducted on hemodialysis patients from different centers in Anhui Province, China, between January and December 2020. A total of 3,025 hemodialysis patients were recruited. Their clinical data were measured before hemodialysis. Information was collected by an online self-reported questionnaire and medical record. Serum Mg2+ was divided into three groups by tertiles. A score of AL greater than or equal to 3 was defined as high AL. A binary logistic regression model was applied to examine the relationship between serum Mg2+ and AL.Results: A total of 1,222 patients undergoing hemodialysis were included, 60% of whom were males (733/1,222). The mean (standard deviation) age of patients was 55.90 (12.75). The median level of serum Mg2+ was 1.22 mmol/L. The rate of high AL levels was 23.4%. Serum Mg2+ was negatively correlated with body mass index, fasting blood glucose (Glu), and C-reactive protein and positively correlated with high-density lipoprotein, low-density lipoprotein, total cholesterol, diastolic blood pressure (DBP), and serum phosphorus. After adjusting for gender, anxiety, diabetes, family residence, lipid-lowering agents, antihypertensive medications, albumin, and Glu, the binary logistic regression model showed that patients with lower levels of serum Mg2+ were more likely have high AL (OR for the T1 group of serum Mg2+:1.945, 95% CI: 1.365–2.773, and OR for the T2 group of serum Mg2+:1.556, 95% CI: 1.099–2.201).Conclusion: Our data support the hypothesis that higher serum Mg2+ concentrations may contribute to lower health risk in hemodialysis populations. Further randomized controlled trials and cohort studies are warranted to verify whether Mg2+ supplementation could be part of routine examinations in hemodialysis populations.

目的 研究白芍总苷对糖尿病大鼠肾损伤的保护性作用及机制.方法 用高糖高脂饲养及腹腔注射链佐菌素的方法构建糖尿病大鼠模型,将建模成功的大鼠随机分为模型组(n=10)和低(n=10)、高剂量实验组(n=10),另选10只正常大鼠,腹腔注射10 mL·kg-1枸橼酸钠缓冲液作为对照组.低、高剂量实验组分别给予80 mg·kg-1·d-1和160 mg·kg-1·d-1白芍总苷,灌胃,对照组和模型组给予25 mL·kg-11％羧甲基纤维素钠溶液,灌胃,连续干预10 d.测量大鼠体重(BW),用全自动生化分析仪测量大鼠空腹血糖(FBG)、空腹胰岛素(FINS)、血清肌酸酐(Scr)和24 h尿微量白蛋白(mALB)水平;取各组大鼠肾上皮细胞,用细胞计数试剂盒-8(CCK-8)法测定细胞存活率;用原位末端转移酶标记技术(TUNEL)法检测细胞凋亡率;用蛋白质印迹(Western blot)法检测B淋巴细胞瘤-2(Bcl-2)、Bcl-2相关X蛋白(Bax)、微管相关蛋白1轻链3β(LC3B)、硫氧还蛋白相互作用蛋白(Thioredoxin-interacting protein,TXNIP)的表达.结果 对照组、模型组和低、高剂量实验组大鼠空腹体重分别为(379.32±60.36),(549.96±70.96),(496.12±74.07)和(480.56±61.73)g;FBG分别为(5.42±0.57),(19.30±1.84),(14.85±1.68)和(13.72±1.08)mmol·L-1;FINS分别为(18.66±1.52),(29.48±4.10),(26.21±3.92)和(21.26±3.65)mU·L-1;Scr分别为(25.75±3.63),(39.28±4.99),(30.70±3.43),(23.94±3.22)μmol·L-1;mALB分别为(89.71±7.98),(337.78±35.64),(205.01±25.11)和(173.37±26.90)μg;细胞存活率分别为(100.00±0.00)％,(53.64±4.23)％,(62.26±5.05)％,(69.21±3.75)％;细胞凋亡率分别为(8.55±0.92)％,(37.14±2.88)％,(33.33±4.03)％,(26.79±2.74)％.以上指标,模型组与对照组相比较,低、高剂量实验组与模型组相比较,差异均有统计学意义(均P<0.05).结论 白芍总苷能显著抑制肾小管上皮细胞凋亡,促进细胞增殖并诱导自噬减轻糖尿病大鼠肾损伤,其作用机制可能与下调TXNIP表达有关.

选取2018年1月至2020年6月于产科住院的妊娠期高血压伴蛋白尿患者95例为观察组,另选取同期妊娠期高血压无蛋白尿患者60例为对照组,采用酶联免疫吸附法检测两组孕妇空腹外周血中C反应蛋白(CRP)、肿瘤坏死因子α (TNF-α)和单核细胞趋化蛋白1(MCP-1),分析其与患者蛋白尿转归和妊娠结局的关系.结果 表明:观察组患者血清CRP、TNF-α、MCP-1、尿素氮(BUN)及肌酐(Scr)水平均高于对照组,估算肾小球滤过率(eGFR)水平低于对照组;受试者工作特征(ROC)分析显示,血清CRP、TNF-α、MCP-1联合筛查妊娠期蛋白尿患者AUC为0.891(95％ CI为0.841～0.940),均显著高于单一检测指标;重度患者CRP、MCP-1和24 h尿蛋白水平高于中度组和轻度组,中度组上述指标水平显著高于轻度组;蛋白尿转归和妊娠结局转归良好患者CRP、TNF-α、MCP-1水平均显著低于不良患者.这说明外周血CRP、TNF-α、MCP-1水平的变化,对妊娠期高血压伴蛋白尿患者的筛查及转归评估具有重要意义.

Objective To understand the prevalence,treatment and influence factors of hypertension in maintenance hemodialysis (MHD) patients in Anhui Province.Methods A total of 2724 adult patients on MHD from January 1st 2014 to March 31st 2014 in 26 hospitals of southern,northern and central Anhui Province were investigated.Their demographic characteristics,primary disease,complications,medications,dialysis and laboratory examination were explored.The prevalence treatment rate and control rate of hypertension were analyzed.Associated factors for controlling hypertension [systolic blood pressure (SBP) ＜ 140 mmHg and diastolic blood pressure (DBP) ＜ 90 mmHg] were assessed by logistic regression analysis.Results (1) The prevalence of hypertension in the hemodialysis patients was 87.0％.Their treatment rate and control rate were 93.2％ and 23.9％ respectively.The average of SBP was (145.90±21.18) mmHg,and the DBP on average was (83.60± 12.21) mmHg.The most commonly used anti-hypertensive drug is calcium channel blocker (88.2％).Over one third (45.7％) of patients were treated with two kinds of anti-hypertensive drug,26.2％ with 1 kind,21.7％ with 3 kinds,and 6.4％ with 4 kinds or more.(2) Compared with non-hypertension patients,patients with hypertension have older age,higher body mass index (BMI),phosphorus,SBP and DBP,as well as lower hemoglobin and Kt/V (all P ＜ 0.05).(3) The multivariate logistic regression analysis showed that Ca ＞ 2.50 mmol/L (OR=2.084,95％CI 1.008-4.307,P=0.047) positively correlated with controlling hypertension,while smoke (OR=0.594,95％CI 0.356-0.911,P=0.046) and BMI 18.5 ～ 23.9 kg/m2 (OR=0.516,95％CI 0.293-0.907,P=0.022) negatively correlated with it.Conclusions High prevalence yet low control rate of hypertension in MHD patients in Anhui Province were observed.Hypocalcemia may be a protective factor for hypertension control,while smoke and BMI may be risk factors for it.

Objective To discuss the efficacy and safety of Calcitriol injection and oral pulse therapies in maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT).Methods Forty hemodialysis patients with SHPT but without hypercalcemia or hyperphosphatemia were randomly assigned into intravenous Calcitriol group (group A) and oral Calcitriol pulse group (group B),and accepted treatment for 12 weeks.Serum iPTH,alkaline phosphatase (AKP),calcium and phosphorus of the two groups were monitored before treatment and 4,8 and 12 weeks after treatment.The side effects and symptom improvement were also recorded.Results After 4 weeks of treatment,serum iPTH level was significantly reduced in both groups (P ＜ 0.05).After 12 weeks of treatment,the AKP level decreased significantly in both groups (P ＜ 0.05).After 8 weeks of treatment,serum iPTH of the group A decreased significantly compared to the group B,the difference was still significant until the end of treatment (P ＜ 0.05).Serum calcium tended to increase in the later treatment in both groups,the group B had significant changes in serum calcium (P ＜ 0.05).There was no significant difference in serum phosphorus before and after treatment in the two groups.Clinical symptoms such as osteodynia,restless legs,pruritus and anemia were improved to various degrees in both groups,while more significant improvement in pruritus was observed in the group A (P ＜ 0.05).Conclusions Oral pulse and intravenous Calcitriol therapies can effectively decrease the levels of iPTH and AKP in chronic hemodialysis patients with secondary hyperparathyroidism,and relieve osteodynia and pruritus.Hypercalcemia is the main side effect.Intravenous Calcitriol has more rapid and significant effect compared with oral pulse therapy,rarely causes hypercalcemia,has better compliance at the end of hemodialysis,and is safe and convenient for maintenance hemodialysis patients.

Objective To understand the quality of life（QOL）and its influencing factors in maintenance hemodialysis patients（hemodialysis maintenance,MHD）,and to provide theoretical basis for improving QOL of patients.Methods A cross-sectional study was conducted in the blood purification centre in 8 hospitals in Hefei,and patients’clinical data were collected.KDQOL-SF self-ad-

目的:观察培哚普利联合尿毒清颗粒对早期糖尿病肾病疗效.方法:入选57例患者随机分为对照组28例及治疗组29例,对照组给予培哚普利4mg每日1次口服;治疗组在培哚普利4mg每日1次口服基础上,加用尿毒清颗粒每日4次,其中6,12,18时各服1袋(5g),22时(睡前)服2袋.用药间隔不超过8h.2组均以12周为1个疗程.观察治疗前及治疗后4、8、12周尿微量白蛋白排泄率(UAER),空腹血糖(FPG),血清总胆固醇(Tc),血清甘油三酯(TG),血清胱抑素-C(Cys-C)的变化.结果:2组UAER水平均随着治疗时间延长而不断降低,治疗后12周为最低,且治疗组明显低于对照组(P＜0.05).治疗后2组FPG、TC、TG、Cys-C水平均显著降低,治疗组降低程度较对照组更显著(P＜0.05).结论:培哚普利联合尿毒清颗粒治疗DN可以有效降低尿微量白蛋白排泄率,改善血糖、血脂水平,降低胱抑素-C水平.二者联用具有协同保护肾脏、辅助降糖降脂作用.

目的探讨血液净化中心患者抑郁情况并提出相应干预措施。方法选取血液净化患者63例,借助抑郁自评量表对其抑郁情况进行评价,并分析基本资料,提出干预措施。结果 63例血液净化患者中伴有抑郁者14例,不伴抑郁49例,发生率为22.22%。结论对于进行血液净化的患者应积极主动给予相应的治疗和心理疏导,避免其发生抑郁情绪。