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The purpose of this study was to evaluate the stability of small-incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK) when ascending from near sea level to an altitude of 3874 m. The visual acuity (VA), intraocular pressure (IOP), spherical equivalent refraction (SER) and biometric parameters of 20 normal subjects (40 eyes, controls) and 36 subjects who underwent corneal refractive surgery (35 eyes with SMILE and 36 eyes with LASIK) were examined in Chongqing (C, 500 m above sea level) and 7–10 days after a collective travel to Shigatse (S, 3874 m above sea level). SER and corneal thickness (CT) were choosed as main indicators of the stability of corneal refractive surgery at high altitude. The IOP decreased and CT increased from C to S, while VA and SER did not significantly change in the control subjects. The VA and IOP of both the SMILE and LASIK subjects did not significantly change at an altitude of 3874 m. At high altitudes, no significant difference in the SER was found among the SMILE subjects, while a significant myopic shift was found among the LASIK subjects. With an increase in the altitude of 3874 m in S, an obvious increase in CT was observed in subjects who underwent corneal refraction surgery. The increase in CT in the SMILE group was significantly less than the increase in CT in the LASIK group. In addition, the biometric parameters of the SMILE and LASIK subjects showed the same minor changes as those of the control subjects when exposed to high altitude. The VA, IOP and biometric parameters of the subjects who underwent SMILE and LASIK remained stable at an altitude of 3874 m. SMILE shows better stability than LASIK in the refractive state and CT when exposed to high altitude. Trial registration: This study was approved by the Ethics Committee of The Second Affiliated Hospital of Army Medical University (ID: 2022-No.084-1) and adhered to the principles of the Declaration of Helsinki. The study was registered at (Study NO. ChiCTR2200059833) on 12/5/2022. [ABSTRACT FROM AUTHOR]

Aim: Diabetic nephropathy (DN) is the most common cause of end-stage kidney disease (ESKD). Remnant cholesterol has been investigated as a predictor for the progression of DN in type 1 diabetes mellitus patients, as well as the incidence of DN in type 2 diabetes mellitus (T2DM) patients. This study aimed to evaluate the longitudinal relationship between baseline remnant cholesterol and kidney outcomes using a Chinese T2DM with biopsy-confirmed DN cohort. Methods: We included 334 patients with T2DM and biopsy-confirmed DN during 2010–2019 West China Hospital T2DM-DN cohort. Remnant cholesterol was defined by Martin-Hopkins equation. Patients were divided into four groups based on the median (IQR) remnant cholesterol concentration at the time of renal biopsy. The kidney outcome was defined as ESKD, which was defined as the need for chronic kidney replacement therapy or estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2. The relationship between remnant cholesterol and kidney outcome was analyzed using the Kaplan‒Meier method and Cox regression analysis. Results: The mean age was 51.1 years, and 235 (70%) were men. During follow-up, a total of 121 (36.2%) patients reached ESKD. The Kaplan‒Meier analysis showed that patients in the highest quartile (quartile 4) group had lower cumulative renal survival (log-rank test, p = 0.033) and shorter median renal survival time [34.0 (26.4–41.6) vs. 55.0 (29.8–80.2) months] than patients in the lowest quartile (quartile 1) group. By univariate analysis, the high remnant cholesterol group was associated with a higher risk of progression to ESKD. Moreover, the risk of progression to ESKD in the highest quartile was still 2.857-fold (95% CI 1.305–6.257, p = 0.009) higher than that in the lowest quartile, and one-SD increase of remnant cholesterol was associated with a higher risk (HR = 1.424; 95% CI 1.075–1.886, p = 0.014) of progression to ESKD, after adjusted for confounding factors. Conclusions: High remnant cholesterol is independently associated with a higher risk of ESKD in patients with T2DM-DN, and it may be a new noninvasive marker of ESKD. Clinical relevance: Calculated remnant cholesterol has the advantages of being economical and clinically accessible. Moreover, to our knowledge, there are no longitudinal cohort studies for investigating the risk of progression of T2DM-DN to ESKD. In our study, higher remnant cholesterol was associated with a higher risk of ESKD in patients with T2DM-DN, and it may be a new noninvasive predictor of ESKD. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationship between metabolic-associated fatty liver disease (MAFLD) and end-stage renal disease (ESRD) in patients with biopsy-confirmed diabetic nephropathy (DN). Methods: A total of 316 participants with biopsy-confirmed DN between January 2008 and December 2019 were retrospectively assessed. Kaplan–Meier curve and Cox proportional hazard models were used to compare the risk of incident ESRD in 50 patients with MAFLD and 50 patients without MAFLD, after using propensity score matching (PSM) to address the imbalances of sex, age, baseline-estimated glomerular filtration rate, serum albumin, 24-h urine protein, hemoglobin and systolic blood pressure. Results: During the median follow-up period of 3 years, there were 19 ESRD outcome events (19%) in PSM cohort. Kaplan–Meier curve analysis suggested that renal survival significantly deteriorated in patients with MAFLD versus those without MAFLD (p = 0.021). Additionally, the hazard ratios (95% confidence interval) of MAFLD were 3.12 (1.09–8.95, p = 0.035), 3.36 (1.09–10.43, p = 0.036), 3.66 (1.22–10.98, p = 0.021), 4.25 (1.34–13.45, p = 0.014), 3.11 (1.08–8.96, p = 0.035) and 5.84 (1.94–18.5, p = 0.003) after adjustment for six models, including demographic, clinical and pathological characteristics as well as medication use at the time of renal biopsy, respectively. Besides, patients with higher liver fibrosis score had a greater possibility of ESRD, comparing to those with lower liver fibrosis score (p = 0.002). Conclusions: MAFLD increases the risk of incident ESRD in patients with biopsy-proven DN. Further research is needed to determine whether treatment targeting MAFLD improves the prognosis of DN. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prognostic value of metabolic syndrome (MetS) and its relationship with renal structure changes in patients with type 2 diabetes and associated diabetic nephropathy (DN). Methods: 411 Chinese patients with type 2 diabetes and biopsy-confirmed DN were enrolled in this retrospective study. MetS was defined according to the modified criteria of the 2005 International Diabetes Federation. Baseline demographics and clinical information at the time of renal biopsy were extracted from the hospital's electronic medical records system. Renal pathological findings were assessed according to Renal Pathology Society system. Univariate and multivariate logistic regression analyses were performed to define the pathological covariates associated with MetS. A competing risk model, with death as the competing risk, was used to estimate the sub-distribution hazard ratio (SHR) of MetS for end-stage kidney disease (ESKD). Results: 224 (55%) patients had MetS. Patients with MetS had poor renal function and more severe interstitial fibrosis tubular atrophy scores (IFTA) than those without MetS. Multivariate logistic regression analysis revealed that IFTA was significantly associated with MetS (odds ratio per score increase 1.45, 95% confidence interval [CI] 1.02–2.05). Of the patients with DN at risk, 40% of patients progressed to ESKD. After adjusting for renal function and pathological parameters, the presence of MetS was an independent predictor for progression to ESKD (SHR 1.93, 95% CI 1.34–2.79). The SHRs for progression to ESKD also increased as the number of MetS components increased. Additionally, adding the IFTA scores improved the prognostic power of a model that only contained MetS and clinical covariates for predicting future ESKD. Conclusion: MetS is an independent prognostic predictor of ESKD in patients with T2D and DN, while adding the IFTA scores increased the prognostic value of MetS for renal outcome. [ABSTRACT FROM AUTHOR]