Background Previous studies found the dysbiosis of intestinal microbiota in diabetic kidney disease (DKD), especially the decreased SCFA-producing bacteria. We aimed to investigate the concentration of the stool and serum short-chain fatty acids (SCFAs), gut microbiota-derived metabolites, in individuals with DKD and reveal the correlations between SCFAs and renal function. Methods A total of 30 participants with DKD, 30 participants with type 2 diabetes mellitus (DM), and 30 normal controls (NC) in HwaMei Hospital were recruited from 1/1/2018 to 12/31/2019. Participants with DKD were divided into low estimated glomerular filtration rate (eGFR)(eGFR<60ml/min, n=14) and high eGFR (eGFR >= 60ml/min, n=16) subgroups. Stool and serum were measured for SCFAs with gas chromatograph-mass spectrometry. Results The DKD group showed markedly lower levels of fecal acetate, propionate, and butyrate versus NC (p<0.001, p<0.001, p=0.018, respectively) [1027.32(784.21-1357.90)]vs[2064.59(1561.82-2637.44)]mu g/g,[929.53(493.65-1344.26)]vs[1684.57(1110.54-2324.69)]mu g/g,[851.39(409.57-1611.65)] vs[1440.74(1004.15-2594.73)]mu g/g, respectively, and the lowest fecal total SCFAs concentration among the groups. DKD group also had a lower serum caproate concentration than that with diabetes (p=0.020)[0.57(0.47-0.61)]vs[0.65(0.53-0.79)]mu mol/L. In the univariate regression analysis, fecal and serum acetate correlated with eGFR (OR=1.013, p=0.072; OR=1.017, p=0.032). The correlation between serum total SCFAs and eGFR showed statistical significance (OR=1.019, p=0.024) unadjusted and a borderline significance (OR=1.024, p=0.063) when adjusted for Hb and LDL. The decrease in serum acetate and total SCFAs were found of borderline significant difference in both subgroups (p=0.055, p=0.050). Conclusion This study provides evidence that in individuals with DKD, serum and fecal SCFAs levels (fecal level in particular) were lowered, and there was a negative correlation between SCFAs and renal function.

Objectives Previous studies found the dysbiosis of intestinal microbiota in individuals with diabetic kidney disease (DKD),especially the decreased SCFA-producing bacteria. We aimed to investigate stool and serum short-chain fatty acids (SCFAs), gut microbiota-derived metabolites, in individuals with DKD and the correlations. Methods A total of 30 participants with DKD, 30 participants with type 2 diabetes mellitus (DM) and 30 normal controls (NC) in HwaMei Hospital were recruited from 1/1/2018 to 12/31/2019. Participants with DKD were divided into low estimated glomerular filtration rate (eGFR) (eGFR<60ml/min, n=14) and high eGFR (eGFR≥60ml/min, n=16) subgroups. Stool and serum were measured for SCFAs with gas chromatograph-mass spectrometry. Results The group with DKD showed markedly lower levels of fecal acetate, propionate and butyrate versus NC group ( P <0.05), and the lowest fecal total SCFAs concentration among the the groups. The group with DKD also had a lower serum caproate concentration than that with diabetes ( P <0.05). In the univariate regression analysis, fecal and serum acetate correlated with eGFR in the group with DKD (OR= 1.013, P =0.072; OR=1.017, P =0.032). The correlation between serum total SCFAs and eGFR showed statistical significance (OR= 0.019, P =0.024) unadjusted and a borderline significance (OR= 1.024, P =0.063) when adjusted for Hb and LDL. The decrease in serum acetate and total SCFAs were found of borderline significant correlation in both subgroups ( P =0.055, P =0.050). Conclusion This study provides evidence that in individuals with DKD, serum and fecal SCFAs levels (fecal level in particular) were lowered, and there was a correlation between lower SCFAs and a worsened renal function.

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.