Search

The aim of the study was to investigate the clinicopathological characteristics, risk factors and renal outcome in IgA nephropathy (IgAN) patients with crescents.Four hundred and fifty-eight biopsy-proven primary IgAN patients included between January 2010 and October 2021 for a retrospective analysis were divided into three groups according to crescent score of the updated Oxford classification: C0 group (n = 255), C1 group (n = 187) and C2 group (n = 16). The clinicopathological features and renal outcomes were recorded. In univariate and multivariate models, the association between crescents and renal outcome and C2-associated clinical factors were analyzed.Patients with a higher proportion of crescents presented worse clinical characteristics with regard to kidney function, proteinuria, hematuria, hemoglobin, uric acid, cholesterol, and serum albumin, while global glomerulosclerosis, segmental adhesion, tuft necrosis, segmental glomerulosclerosis (S1), tubular atrophy/interstitial fibrosis (T1/2), and lymphocyte and monocyte infiltration were more severe. By multivariate logistic regression analysis, eGFR (OR 0.981, 95% CI 0.964-0.999, P = 0.039), proteinuria (OR 1.655, 95% CI 1.180-2.321, P = 0.004), and hematuria (OR 4.752, 95% CI 1.426-15.835, P = 0.011) were significantly associated with C2. C2 was significantly associated with poorer renal survival even in patients receiving immunosuppressive therapy. Nevertheless, only eGFR at baseline, rather than crescents, was an independent predictor for renal survival in multivariate Cox analyses.IgAN patients with crescents presented more severe clinical and pathological features. Renal function, proteinuria and hematuria contributed to identifying patients with crescents. Crescents were associated with poorer renal survival, even in patients receiving immunosuppressive therapy, but it was not an independent predictor.

Fang Cao, Fuyuan Hong, Yiping Ruan, Miao Lin Department of Nephrology, Provincial Clinical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, People’s Republic of ChinaCorrespondence: Fang Cao; Miao Lin, Department of Nephrology, Provincial clinical college, Fujian Medical University, Fujian Provincial Hospital, 134 East Street, Fuzhou, People’s Republic of China, 350001, Tel/Fax +86-591-87557768, Email 422512642@qq.com; 10151246@qq.comObjective: Patient empowerment can be achieved through the PBL model. The purpose of the present study was to evaluate the effectiveness and feasibility of patient empowerment through the PBL model in health continuing education of peritoneal dialysis (PD) patients.Methods: From March 2017 to April 2017, a total of 94 participants were randomly assigned to the PBL group and the traditional group, with 47 patients in each group. Patients of the PBL group were divided into 5 study groups; and six PBL health education activities were held. The basic knowledge, self-management behavior, quality of life, anxiety, and depression were assessed among the traditional group and the PBL group. The average follow-up duration was 10.6± 1.5 months.Results: Compared with patients in the traditional group, patients in the PBL group had higher scores of basic knowledges for PD (84.33± 3.55 vs 91.19± 3.07; P< 0.001), higher scores of self-management (61.19± 3.71 vs 71.47± 2.89; P< 0.001), better scores of quality of life (85.99± 14.33 vs 102.64± 9.43; P < 0.001), and better scores of satisfaction (90.78± 1.32 vs 98.21± 1.25; P < 0.001). Furthermore, the scores of anxieties (52.39± 4.55 vs 46.46± 4.63; P < 0.001) and the scores of depressions were lower (49.95± 6.76 vs 45.80± 8.77; P =0.01) in patients who participated in the PBL mode of education than in the traditional educational group.Conclusion: The empowerment model of PBL health education can effectively improve the knowledge, skills and quality of life of PD patients.Relevance to Clinical Practice: The findings identified in this study will help to improve the quality of nursing care and health education for PD patients.Patient or Public Contribution: The study design involved patients on PD training. The knowledge and skills of PD and quality of life will improve after they participate the PBL health education activities.Keywords: patient empowerment, PBL, peritoneal dialysis, patient education, quality of life, chronic kidney disease

For the exosomes secreted by umbilical cord-originated mesenchymal stem cells (so-called hucMSC-exo), they can be applied to treat a variety of clinical diseases as a therapeutic strategy. The Wnt/β-catenin signal pathway has received widespread attention for its capability to modulate multiple kinds of diseases including diabetic nephropathy. Our study aimed to assess the therapeutic efficiency of exosomes secreted by hucMSC-exo on the rat model with diabetic nephropathy (DN). Rats were given an intraperitoneal injection of streptozotocin (60 mg/kg) to induce diabetes, while rats in blank group received same amount of buffer. The DN rats were randomized into DN group and treatment group (treated with hucMSC-exo) followed by analysis of total urine protein, creatinine and urea nitrogen in serum, the histopathological changes in rat kidneys and Wnt-4 and β-catenin expression by western blot. In comparison with the rats in DN group, those in hucMSC-exo treatment group exhibited significantly reduced indexes related to urinary and renal function biochemical tests (P < 0.05). HE staining of kidney tissues showed that abnormal degree of renal damage was significantly alleviated after treatment. In addition, exosomes can ameliorate the symptoms of renal damage in DN rats through modulating the Wnt-4/β-catenin signal pathway. It provides an experimental basis for hucMSC-exo as a new treatment method for DN. hucMSC-exo can ameliorate the renal function and the tissue damage in DN rats through impeding Wnt-4/β-catenin signal pathway thereby providing a basis for the prevention and treatment of DN.

UNSTRUCTURED Objective The study presented here aimed to establish a predictive model for heart failure and all-cause mortality in PD patients with machine learning algorithm. Methods The baseline clinical variables of 606 patients on PD were collected. We implemented machine learning algorithm to construct the models to predictive the risk of the heart failure and all-cause mortality. In addition, the prediction performance of machine learning methods and cox regression was compared. Results Over a median follow-up of 49 months.298 patients developed heart failure required hospitalization. According to randomforest model (AUC=0.82), the risk factors were cci2, SBP, BMI, etc. 79 patients developed heart failure during the first year follow-up. According to randomforest (AUC=0.82) model, the risk factors were BMI, age, SBP, etc. 246 patients developed heart failure during 5-year follow-up. According to xgboost (AUC=0.81) model, the risk factors were cci score, BMI, SBP，etc. The machine learning model (AUC =0.885) demonstrated better discrimination than cox regression (C-Index=0.77) for heart failure. Regarding all-cause mortality, 199 patients died during the follow-up. According to randomforest model (AUC=0.86), the risk factors predicting death were age, cci score, creatinine, etc. 64 patients died during the first year follow-up. According to xgboost model (AUC=0.84), the predictive risk factors for 1-year all-cause mortality were age, HDL-C, Total cholesterol, etc. A total of 161 patients died during 5-year follow-up. According to randomforest model (AUC=0.84), the predictive risk factors were age, cci score, eGFR, etc. The machine learning model (AUC=0.83) demonstrated better discrimination than cox regression (C-Index=0.79) for all-cause mortality. Conclusion We developed a novel method to predict the risks of heart failure and all-cause mortality on PD patients that integrates readily available clinical, laboratory variables.

Background: Depression is prevalent in patients with all stages of CKD and is associated with adverse outcome. Abnormally elevated GFR, or hyperfiltration, may play a crucial role in the initiation and progression of CKD. However, the association between depression and hyperfiltration is not known. The aim of this study is to investigate the relationship between depression and hyperfiltration. Methods: This was an observational cross-sectional study. A total of 3,716 volunteers (1,303 males and 2,413 females) aged 40–75 years without CKD from a community in China were included for the study. Depressive symptoms and the presence of a minor or major depressive episode were assessed with the 9-item Patient Health Questionnaire (PHQ-9) and Diagnostic and Statistical Manual of Mental Disorders (4th edition)-based structured interview, respectively. Results: The mean age of the participants in the present study was 53.8 ± 9.0 years. 115 participants had clinically relevant depression, and 122 participants had a minor or major depressive episode. In a multivariable logistic regression analysis adjusted for potential confounders, the association between clinically relevant depression and renal hyperfiltration remained significant in men but not in women. As compared with men without depression (PHQ p = 0.005), those with a major depressive episode had a higher risk of renal hyperfiltration (OR 7.45; 95% CI 2.04–27.21, p = 0.002). Conclusion: Depressive symptoms and major depressive episodes are associated with renal hyperfiltration in middle-aged and elderly Chinese men without CKD. Future studies are needed to verify and clarify the role of depression in the development of abnormally high eGFR and CKD.

Introduction Achieving target blood pressure (BP) goals in patients with chronic kidney disease (CKD) and uncontrolled hypertension is a challenge. Various studies have shown the efficacy of nifedipine gastrointestinal therapeutic system (GITS) 60 mg in patients with hypertension. However, there is a paucity of clinical studies in patients with CKD. Hence, we conducted this study to evaluate the effectiveness and tolerability of nifedipine GITS 60 mg in Chinese patients with CKD and uncontrolled hypertension in real-world clinical settings. Methods In a prospective, multicenter, observational study, Chinese patients with CKD and uncontrolled hypertension were given nifedipine GITS 60 mg with a primary endpoint of change in office systolic BP (SBP) at 12 weeks. The secondary endpoints included changes at 12 weeks in office diastolic BP (DBP), office SBP and DBP in SBP subgroups (140–160 mmHg and ≥ 160 mmHg) and CKD stages subgroups, SBP and DBP control rate, and the adverse events (AEs). Statistical analysis was performed using SAS® version 9.4. Results In total, 871 and 622 patients were included in the safety analysis set and efficacy analysis set respectively. The mean office SBP and DBP at baseline were 162.9 and 97.3 mmHg, respectively. At week 12, the mean change in SBP was − 24.0 mmHg (95% confidence interval [CI] − 25.32, − 22.65 mmHg); after missing data were accounted for, it was − 23.9 mmHg (95% CI − 25.25, − 22.60 mmHg). Marked decreases in DBP, and office SBP and DBP in baseline SBP subgroups as well as CKD stages were observed at week 12. The BP control rate at week 12 was 50.0%. Twenty-three (2.6%) patients reported at least one drug-related AEs. No event of hypotension or death occurred during the study. Conclusion Nifedipine GITS 60 mg showed effectiveness and tolerability in reducing office SBP and DBP in Chinese patients with CKD and uncontrolled hypertension. Trial Registration ClinicalTrials.gov identifier NCT03194633. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01850-3.

Few studies have investigated the relationship between sarcopenia and mild to moderate renal decline. This study aimed to investigate the relationship between chronic kidney disease (CKD) and sarcopenia. In total, 123 patients hospitalized with CKD and 57 healthy volunteers who underwent physical examination during the same period (control group) were analyzed. Body compositions were measured by dual-energy X-ray absorptiometry, and the relative appendicular skeletal muscle index (RASMI) was calculated. Muscular strength was evaluated using a pinch meter. Walking speed within 6 m was measured for muscular function assessment. Single-photon emission computed tomography was performed to measure the glomerular filtration rate (GFR) of CKD patients, who were then divided into CKD1 (55 patients in CKD stages 1 and 2) and CKD2 (68 patients in CKD stages 3-5). The incidence rates of sarcopenia were significantly higher in the CKD1 (40.0%) and CKD2 (55.9%) groups than in the control group (19.3%) (P

AIMS AND OBJECTIVES This study aims to investigate the application value of Internet-based instant messaging software in the follow-up of patients using peritoneal dialysis. BACKGROUND Peritoneal dialysis is an effective renal replacement treatment for end-stage renal disease. The clinical usefulness of Internet-based instant messaging software in the follow-up of peritoneal dialysis patients, including the incidence of peritonitis and exit-site infection, the levels of albumin and electrolytes and the degree of patients' satisfaction, remains unknown. DESIGN Between January 2009-April 2016, a total of 160 patients underwent continuous peritoneal dialysis in the Department of Nephrology, Fujian Provincial Hospital were invited to participate voluntarily in this study. The patients were randomly assigned to the instant messenger (QQ) follow-up group (n = 80) and the traditional follow-up group (n = 80). The differences in death, hospitalisation, peritonitis, exit-site infection, and patients' satisfaction were investigated during 1 year of follow-up. The mean follow-up duration is 11.4 ± 1.5 months. RESULTS Compared with the patients in the traditional follow-up group, patients in the QQ follow-up group showed higher levels of serum albumin (p = .009) and haemoglobin (p = .009), lower levels of phosphorus (p

In this work, we report the syntheses and characterizations of two titanium-based metal–organic frameworks (Ti-MOFs), MIL-125 and MIL-125-NH2 as potential drug carriers for chloroquine (CQ). Both materials exhibited high loading capability for CQ owing to their large surface area. The sustainable CQ release could reach ca. 70% after 13 days in phosphate buffer solution. The experimental results suggested that Ti-MOFs could be a valuable CQ carriers to realize the slow release.

Background/Aims: The aim of the study was to investigate clinicopathological characteristics, the role of immunosuppressive therapy and renal outcome in IgA nephropathy (IgAN) patients with hyperuricemia. Methods: 206 biopsy-proven primary IgAN patients were included between January 2010 and December 2015, and divided into two groups: patients without hyperuricemia (n=122), and patients with hyperuricemia (n=84). The clinicopathological features, response, renal outcome and safety were recorded. In univariate and multivariate models, hyperuricemia-associated pathological factors were analyzed. Results: The patients with hyperuricemia presented higher systolic blood pressure, worse kidney function and more severe time-averaged proteinuria. Proportions of glomerulosclerosis, segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis, lymphocytes and monocytes infiltration were higher, while the proportion of segmental adhesion was lower in patients with hyperuricemia. By multivariate logistic regression analysis, only tubular atrophy/interstitial fibrosis (T1∼2) (HR=3.969, 95% CI=1.439−10.945, P=0.008) was significantly associated with hyperuricemia. For hyperuricemic patients, the response rate to therapy and renal survival rate were significantly higher in patients that received RAS blockade in combination with immunosuppressive therapy. After RAS blockade treatment, renal survival in the patients with hyperuricemia was worse compared with the patients without hyperuricemia. Conclusion: Hyperuricemic IgAN patients presented more severe clinical features. Tubulointerstitial injury could be a pathological feature closely related to hyperuricemia in IgAN. Immunosuppressive therapy and RAS blockade could reduce proteinuria and improve renal outcome in IgAN patients with hyperuricemia.

Young adults with longstanding ketamine abuse present with lower urinary tract symptoms (LUTSs), which may be accompanied by urinary tract infection (UTI). However, the morbidity and risk factors for ketamine-associated LUTS accompanied by UTI (KALAUTI) are still unknown. To ascertain these, we surveyed patients with a history of ketamine abuse and LUTS at the time of their initial presentation. One hundred untreated patients with ketamine-associated LUTS were initially surveyed at 3 medical institutions. The patients’ basic demographic and clinical information, KALAUTI status, and possible risk factors were obtained via a questionnaire and analyzed. Eighty-one patients were finally enrolled. Eight patients (9.88%) had a definitive diagnosis of KALAUTI and 16 (19.75%) had suspected KALAUTI. The diagnosis of KALAUTI was ruled out in the remaining 57 patients (70.37%). Patients with upper urinary tract involvement, longer duration of drug use, or more severe LUTS (P

Limited data are available on epidemiology and drug use in Chinese hypertensive patients with chronic kidney disease (CKD). We determined the prevalence; awareness, treatment, and control rates of hypertension; anti-hypertensive use, expenditure pattern; and factors associated with hypertension prevalence and control in Chinese patients with CKD. This was one of the largest cross-sectional surveys that enrolled 6079 CKD participants (mean age, 51.0 ± 16.37 years) with or without hypertension from 22 centres across China. The prevalence, awareness, and treatment rates were 71.2%, 95.4%, and 93.7%, respectively. Control rates 1 and 2 (Blood pressure, BP

Objective To explore the relationship between ankle-brachial index (ABI) and atherosclerosis in patients with non-dialysis chronic kidney disease (CKD). Method As a cross-sectional study, 118 patients with diagnosis of non-dialysis CKD (stage 1–5) were selected in our hospital from October 2008 to October 2009. Clinical data were recorded, including sex, age, height, weight, smoking status, blood pressure (BP), fasting glucose, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and renal function. eGFR was calculated by modification of diet in renal disease study equation. ABI values were determined with a Doppler prober. ANOVA, bivariate correlation analysis and multiple linear regression were used for statistical analysis. Results According to eGFR, all patients were divided into five groups as CKD stage 1 group to CKD stage 5 group. There were significant differences in ABI value between five groups (F=28.123, p 0.05). ABI value was significantly decreased with gradual decline of eGFR level (p Conclusion Renal dysfunction is an independent risk factor for atherosclerosis. Decline of eGFR was closely related with the degree of atherosclerotic lesions. ABI can be used as important clinical indicators of atherosclerosis in patients with CKD.