Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

BackgroundWe aim to develop and validate a nomogram model for predicting severe acute kidney injury (AKI) after orthotopic liver transplantation (OLT).MethodsA total of 576 patients who received OLT in our center were enrolled. They were assigned to the development and validation cohort according to the time of inclusion. Univariable and multivariable logistic regression using the forward variable selection routine were applied to find risk factors for post-OLT severe AKI. Based on the results of multivariable analysis, a nomogram was developed and validated. Patients were followed up to assess the long-term mortality and development of chronic kidney disease (CKD).ResultsOverall, 35.9% of patients were diagnosed with severe AKI. Multivariable logistic regression analysis revealed that recipients’ BMI (OR 1.10, 95% CI 1.04–1.17, p = 0.012), hypertension (OR 2.32, 95% CI 1.22–4.45, p = 0.010), preoperative serum creatine (sCr) (OR 0.96, 95% CI 0.95–0.97, p < 0.001), and intraoperative fresh frozen plasm (FFP) transfusion (OR for each 1000 ml increase 1.34, 95% CI 1.03–1.75, p = 0.031) were independent risk factors for post-OLT severe AKI. They were all incorporated into the nomogram. The area under the ROC curve (AUC) was 0.73 (p < 0.05) and 0.81 (p < 0.05) in the development and validation cohort. The calibration curve demonstrated the predicted probabilities of severe AKI agreed with the observed probabilities (p > 0.05). Kaplan-Meier survival analysis showed that patients in the high-risk group stratified by the nomogram suffered significantly poorer long-term survival than the low-risk group (HR 1.92, p < 0.01). The cumulative risk of CKD was higher in the severe AKI group than no severe AKI group after competitive risk analysis (HR 1.48, p < 0.05).ConclusionsWith excellent predictive abilities, the nomogram may be a simple and reliable tool to identify patients at high risk for severe AKI and poor long-term prognosis after OLT.     

Preoperative proteinuria may be a risk factor for postoperative acute kidney injury：a meta-analysis

ObjectiveTo investigate the relationship between preoperative proteinuria and postoperative acute kidney injury (AKI).MethodsWe performed a search on databases included PubMed, Embase, the Cochrane Library, and Web of Science, from December 2009 to September 2020. Data extracted from eligible studies were synthesized to calculate the odds ratio (OR) and 95% confidence interval (CI). A fixed or random effects model was applied to calculate the pooled OR based on heterogeneity through the included studies.ResultsThis meta-analysis of 11 observational studies included 203,987 participants, of whom 21,621 patients suffered from postoperative AKI and 182,366 patients did not suffer from postoperative AKI. The combined results demonstrated that preoperative proteinuria is an independent risk factor for postoperative AKI (adjusted OR = 1.65, 95%CI:1.44–1.89, p < 0.001). Subgroup analysis showed that both preoperative mild proteinuria (adjusted OR = 1.30, 95%CI:1.24–1.36, p < 0.001) and preoperative heavy proteinuria (adjusted OR = 1.93, 95%CI:1.65–2.27, p < 0.001) were independent risk factors for postoperative AKI. The heterogeneity was combined because its values were lower. Further subgroup analysis found that preoperative proteinuria measured using dipstick was an independent risk factor for postoperative AKI (adjusted OR = 1.48, 95%CI:1.37–1.60, p < 0.001). Finally, preoperative proteinuria was an independent risk factor for postoperative AKI in the non-cardiac surgery group (adjusted OR = 2.06, 95%CI:1.31–3.24, p = 0.002) and cardiac surgery group (adjusted OR = 1.69, 95%CI:1.39–2.06, p < 0.001)ConclusionPreoperative proteinuria is an independent risk factor for postoperative AKI and in instances when proteinuria is detected using dipsticks.     

The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients

Background and objectivesPatients who develop post-operative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after non-cardiac surgery and the possible risk factors for this complication.MethodsA multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after non-cardiac surgery was conducted to assess whether they developed AKI. The patients who developed AKI were then compared to non-AKI patients.ResultsA total of 29 ICUs participated, of which 904 high-risk surgical patients were involved in the study. The occurrence of AKI in the post-operative period was 15.8%, and the mortality rate of post-operative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51–5.62; p = 0.001), and a higher length of ICU and hospital stay (p < 0.001). Independent factors for the risk of developing AKI were pre-operative anemia (OR = 7.01; 95% CI 1.69–29.07), elective surgery (OR = 0.45; 95% CI 0.21–0.97), SAPS 3 (OR = 1.04; 95% CI 1.02–1.06), post-operative vasopressor use (OR = 2.47; 95% CI 1.34–4.55), post-operative infection (OR = 8.82; 95% CI 2.43–32.05) and the need for reoperation (OR= 7.15; 95% CI 2.58–19.79).ConclusionAKI was associated with the risk of death in surgical patients and those with anemia before surgery, who had a higher SAPS 3, needed a post-operative vasopressor, or had a post-operative infection or needed reoperation were more likely to develop AKI post-operatively.     

Efficacy and safety of expanded hemodialysis in hemodialysis patients: a meta-analysis and systematic review

BackgroundExpanded hemodialysis (HDx) is a new dialysis modality, but a systematic review of the clinical effects of using HDx is lacking. This systematic review and meta-analysis aimed to assess the efficacy and safety of HDx for hemodialysis (HD) patients.MethodsPubMed, the Cochrane library, and EMBASE databases were systematically searched for prospective interventional studies comparing the efficacy and safety of HDx with those of high flux HD or HDF in HD patients.ResultsEighteen trials including a total of 853 HD patients were enrolled. HDx increased the reduction ratio (RR) of β2-microglobulin (SMD 6.28%, 95% CI 0.83, 1.73, p = .02), κFLC (SMD 15.86%, 95% CI 6.96, 24.76, p = .0005), and λFLC (SMD 22.42%, 95% CI, 17.95, 26.88, p < .0001) compared with high flux HD. The RR of β2-microglobulin in the HDx group was lower than that in the HDF group (SMD −3.53%, 95% CI −1.16, −1.9, p < .0001). HDx increased the RRs of κFLC (SMD 1.34%, 95% CI 0.52, 2.16, p = .001) and λFLC (SMD 7.28%, 95% CI 1.08, 13.48, p = .02) compared to HDF. There was no significant difference in albumin loss into the dialysate between the HDx and HDF groups (SMD 0.35 g/session, 95% CI −2.38, 3.09, p = .8).ConclusionsThis meta-analysis indicated that compared with high-flux HD and HDF, HDx can increase the clearance of medium and large-molecular-weight uremic toxins. And it does not increase the loss of albumin compared with HDF.     

Survival outcomes and adverse events in patients with chronic kidney disease after coronary artery bypass grafting and percutaneous coronary intervention: a meta-analysis of propensity score-matching studies

BackgroundThe present meta-analysis of propensity score-matching studies aimed to compare the long-term survival outcomes and adverse events associated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD).MethodsElectronic databases were searched for studies comparing CABG and PCI in patients with CKD. The search period extended to 13 February 2021. The primary outcome was all-cause mortality, and the secondary endpoints included myocardial infarction, revascularization, and stroke. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were used to express the pooled effect. Study quality was assessed using the Newcastle–Ottawa scale. The analyses were performed using RevMan 5.3.ResultsThirteen studies involving 18,005 patients were included in the meta-analysis. Long-term mortality risk was significantly lower in the CABG group than in the PCI group (HR: 0.76, 95% CI: 0.70–0.83, p < .001), and similar results were observed in the subgroup analysis of patients undergoing dialysis and for different estimated glomerular filtration rate ranges. The incidence rates of myocardial infarction (OR: 0.25, 95% CI: 0.12–0.54, p < .001) and revascularization (OR: 0.17, 95% CI: 0.08–0.35, p < .001) were lower in the CABG group than in the PCI group, although there were no significant differences in the incidence of stroke between the two groups (OR: 1.24; 95% CI: 0.89–1.73, p > .05). Subgroup analysis among patients on dialysis yielded similar results.ConclusionsOur propensity score matching analysis revealed that, based on long-term follow-up outcomes, CABG remains superior to PCI in patients with CKD.     

Association of D-dimer and acute kidney injury associated with rhabdomyolysis in patients with exertional heatstroke: an over 10-year intensive care survey

Patients with rhabdomyolysis (RM) following exertional heatstroke (EHS) are often accompanied by dysfunction of coagulation and acute kidney injury (AKI). The purpose of this study was to investigate the relationship between D-dimer and AKI in patients with RM following EHS. A retrospective study was performed on patients with EHS admitted to the intensive care unit over 10-year. Data including baseline clinical information at admission, vital organ dysfunction, and 90-day mortality were collected. A total of 84 patients were finally included, of whom 41 (48.8%) had AKI. AKI patients had more severe organ injury and higher 90-day mortality (34.1 vs.0.0%, p < 0.001) than non-AKI patients. Multivariate logistic analysis showed that D-dimer (OR 1.3, 95% CI 1.1–1.7, p = 0.018) was an independent risk factor for AKI with RM following EHS. Curve fitting showed a curve relationship between D-dimer and AKI. Two-piecewise linear regression showed that D-dimer was associated with AKI in all populations (OR 1.3, 95% CI 1.2–1.5, p < 0.001) when D-dimer <10.0 mg/L, in RM group (OR 1.3, 95% CI 1.1–1.5, p < 0.001) when D-dimer >0.4 mg/L, in the non-RM group (OR 6.4, 95% CI 1.7–23.9, p = 0.005) when D-dimer <1.3 mg/L and D-dimer did not increase the incidence of AKI in the non-RM group when D-dimer >1.3 mg/L. AKI is a life-threatening complication of RM following EHS. D-dimer is associated with AKI in critically ill patients with EHS. The relationship between D-dimer and AKI depends on whether RM is present or not.     

Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study

BackgroundEarly reports indicate that AKI is common during COVID-19 infection. Different mortality rates of AKI due to SARS-CoV-2 have been reported, based on the degree of organic dysfunction and varying from public to private hospitals. However, there is a lack of data about AKI among critically ill patients with COVID-19.MethodsWe conducted a multicenter cohort study of 424 critically ill adults with severe acute respiratory syndrome (SARS) and AKI, both associated with SARS-CoV-2, admitted to six public ICUs in Brazil. We used multivariable logistic regression to identify risk factors for AKI severity and in-hospital mortality.ResultsThe average age was 66.42 ± 13.79 years, 90.3% were on mechanical ventilation (MV), 76.6% were at KDIGO stage 3, and 79% underwent hemodialysis. The overall mortality was 90.1%. We found a higher frequency of dialysis (82.7% versus 45.2%), MV (95% versus 47.6%), vasopressors (81.2% versus 35.7%) (p < 0.001) and severe AKI (79.3% versus 52.4%; p = 0.002) in nonsurvivors. MV, vasopressors, dialysis, sepsis-associated AKI, and death (p < 0.001) were more frequent in KDIGO 3. Logistic regression for death demonstrated an association with MV (OR = 8.44; CI 3.43–20.74) and vasopressors (OR = 2.93; CI 1.28–6.71; p < 0.001). Severe AKI and dialysis need were not independent risk factors for death. MV (OR = 2.60; CI 1.23–5.45) and vasopressors (OR = 1.95; CI 1.12–3.99) were also independent risk factors for KDIGO 3 (p < 0.001).ConclusionCritically ill patients with SARS and AKI due to COVID-19 had high mortality in this cohort. Mortality was largely determined by the need for mechanical ventilation and vasopressors rather than AKI severity.     

Coronavirus-associated kidney outcomes in COVID-19, SARS,and MERS: a meta-analysis and systematic review

ObjectivesA meta-analysis and systematic review was conducted on kidney-related outcomes of three recent pandemics: SARS, MERS, and COVID-19, which were associated with potentially fatal acute respiratory distress syndrome (ARDS).MethodsA search of all published studies until 16 June 2020 was performed. The incidence/prevalence and mortality risk of acute and chronic renal events were evaluated, virus prevalence, and mortality in preexisting hemodialysis patients was investigated.ResultsA total of 58 eligible studies involving 13452 hospitalized patients with three types of coronavirus infection were included. The reported incidence of new-onset acute kidney injury (AKI) was 12.5% (95% CI: 7.6%–18.3%). AKI significantly increased the mortality risk (OR = 5.75, 95% CI 3.75–8.77, p < 0.00001) in patients with coronavirus infection. The overall rate of urgent-start kidney replacement therapy (urgent-start KRT) use was 8.9% (95% CI: 5.0%–13.8%) and those who received urgent-start KRT had a higher risk of mortality (OR = 3.43, 95% CI 2.02–5.85, p < 0.00001). Patients with known chronic kidney disease (CKD) had a higher mortality than those without CKD (OR = 1.97, 95% CI 1.56–2.49, p < 0.00001). The incidence of coronavirus infection was 7.7% (95% CI: 4.9%–11.1%) in prevalent hemodialysis patients with an overall mortality rate of 26.2% (95% CI: 20.6%–32.6%).ConclusionsPrimary kidney involvement is common with coronavirus infection and is associated with significantly increased mortality. The recognition of AKI, CKD, and urgent-start KRT as major risk factors for mortality in coronavirus-infected patients are important steps in reducing future mortality and long-term morbidity in hospitalized patients with coronavirus infection.     

Efficacy and safety of leflunomide combined with corticosteroids for the treatment of IgA nephropathy: a Meta-analysis of randomized controlled trials

ObjectiveWe performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of leflunomide combined with corticosteroids, compared with corticosteroids alone, for IgA nephropathy.Materials and methodsStudies were retrieved by searching of PubMed, Embase, Cochrane’s Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases on 11 October 2021. A random-effect model incorporating the heterogeneity was used to pool the results. The efficacy outcomes included the complete remission rate of proteinuria, overall response rate (the combined rates of patients with complete and partial remission of proteinuria), changes of urine protein excretion (UPE), serum creatinine (SCr), and estimated glomerular infiltrating rate (eGFR).ResultsNineteen studies were included. Patients receiving the combined therapy had a higher complete remission rate (relative risk [RR]: 1.29, 95% CI: 1.08–1.55, p = 0.006; I² = 0%) and overall response rate (RR: 1.18, 95% CI: 1.10–1.26, p < 0.001, I² = 0%) compared to patients who received CS alone. Besides, combined therapy was associated with significantly reduced levels of UPE (mean difference [MD]: −0.30 g/24h, 95% CI: −0.43 to −0.16, p < 0.001; I² = 34%) and SCr (MD: −7.55 mmol/L, 95% CI: −11.06 to −4.04, p < 0.001; I² = 34%), and increased level of eGFR (MD: 6.51 mL/min/1.73 m², 95% CI: 4.06–8.97, p < 0.001; I² = 0%). The incidence of adverse events was not significantly different.ConclusionsCombined treatment with leflunomide and corticosteroids was more effective than corticosteroids alone for patients with IgA nephropathy.     

Histopathological assessment of radial artery calcification in patients with end-stage kidney disease

BackgroundA comprehensive understanding of vascular calcification pathology is significant for the development of cardiovascular disease therapy in high-risk populations. This cross-sectional study aimed to evaluate the prevalence and characteristics of radial artery calcification (RAC) and to identify the factors that are associated with RAC in end-stage kidney disease (ESKD).MethodsDetailed medical histories of 180 patients with ESKD were recorded. Fragments of the radial artery obtained during the creation of arteriovenous fistula for hemodialysis access were stained with alizarin red S.ResultsCalcification was localized in the arterial media layer. The prevalence of positive calcification staining in the radial arteries was 21.1% (n = 38). Patients with RAC had a higher glycated hemoglobin level (p < 0.01), higher prevalence of dialysis duration >5 years (p = 0.022), and diabetes mellitus (p < 0.01) than those without RAC. Multiple logistic regression models showed dialysis duration >5 years (odds ratio [OR], 9.864; 95% confidence interval [CI], 2.666–36.502; p < 0.01) and diabetes mellitus (OR, 12.689; 95% CI, 2.796–34.597; p < 0.01) were independent risk factors for RAC in patients with ESKD. Patients with dialysis duration >5 years had a higher prevalence of RAC (p = 0.012) than those with dialysis duration ≤5 years. Patients with diabetes mellitus had a higher prevalence of RAC (p < 0.01) than those without diabetes mellitus. Patients with diabetes mellitus ≥15 years had a higher prevalence of RAC (p = 0.042) than those with diabetes mellitus <15 years. Radial artery calcification level showed a significantly positive correlation with dialysis duration (p < 0.05), diabetes mellitus duration (p < 0.01), HbA1c level (p < 0.01) and Calcium level (p < 0.01).ConclusionsIn patients with ESKD, dialysis duration >5 years and diabetes predict RAC. Thus, the combination of prolonged dialysis and hyperglycemic conditions exerts a synergistic effect on RAC.     

Tacrolimus versus cyclophosphamide for patients with idiopathic membranous nephropathy and treated with steroids: a systematic review and meta-analysis of randomized controlled trials

BackgroundThe therapeutic effects of tacrolimus (TAC) versus cyclophosphamide (CTX) were not fully illustrated for patients with idiopathic membranous nephropathy (IMN).MethodsThe PubMed, EmBase, Cochrane library, and CNKI were systematically searched throughout March 2020 for randomized controlled trials evaluating the therapeutic effects of TAC versus CTX for IMN patients treated with steroids. The pooled relative risks (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using the random-effects model.ResultsTwelve trials recruited a total of 868 IMN patients were identified and contained in final meta-analysis. Patients in TAC group was associated with an increased incidence of overall remission (12 trials: 868 patients; RR: 1.21; 95% CI: 1.11–1.31; p < 0.001) and complete remission (12 trials: 868 patients; RR: 1.50; 95% CI: 1.25–1.80; p < 0.001). Moreover, we noted TAC therapy significantly reduced urinary protein excretion (9 trials: 567 patients; WMD: −1.06; 95%CI: −1.41 to −0.71; p < 0.001), and increased serum albumin (9 trials: 567 patients; WMD: 5.37; 95%CI: 2.97 to 7.77; p < 0.001) than CTX therapy. Furthermore, no significant difference between TAC and CTX for serum creatinine was detected (6 trials: 378 patients; WMD: 0.15; 95%CI: −3.46 to 3.75; p = 0.936). Finally, the risk of alopecia (p = 0.008), infection (p = 0.045), leukocytosis (p = 0.002), and elevated ALT/AST (p = 0.011) in TAC group was significantly lower than CTX group, whereas TAC was associated with an increased risk of tremor than CTX (p = 0.010).ConclusionsThis study found IMN patients treated with TAC combined with steroids provides a better therapeutic effect and less adverse events than those treated with CTX combined with steroids, with moderate-certainty evidence.     

Peritoneal transport status and first episode of peritonitis: a large cohort study

BackgroundPeritonitis is one of the most serious complications of peritoneal dialysis (PD). This study aimed to explore the relationship between peritoneal transport status and the first episode of peritonitis, as well as the prognosis of patients undergoing continuous ambulatory peritoneal dialysis (CAPD).MethodA retrospective cohort study was conducted, analyzing data of CAPD patients from 1st January 2009, to 31st December 2017. Baseline data within 3 months after PD catheter placement was recorded. Cox multivariate regression analysis was performed to determine the risk factors for the first episode of peritonitis, technique failure and overall mortality.ResultsA total of 591 patients were included in our analysis, with a mean follow-up visit of 49 months (range: 27–75months). There were 174 (29.4%) patients who had experienced at least one episode of peritonitis. Multivariate Cox regression analysis revealed that a higher peritoneal transport status (high and high-average) (HR 1.872, 95%CI 1.349–2.599, p = 0.006) and hypoalbuminemia (HR 0.932,95% CI 0.896, 0.969, p = 0.004) were independent risk factors for the occurrence of the first episode of peritonitis. In addition, factors including gender (male) (HR 1.409, 95%CI 1.103, 1.800, p = 0.010), low serum albumin (HR 0.965, 95%CI 0.938, 0.993, p = 0.015) and the place of residence (rural) (HR 1.324, 95%CI 1.037, 1.691, p = 0.024) were independent predictors of technique failure. Furthermore, low serum albumin levels (HR 0.938, 95%CI 0.895, 0.984, p = 0.008) and age (>65years) (HR 1.059, 95%CI 1.042, 1.076, p < 0.001) were significantly associated with the risk of overall mortality of PD patients.ConclusionsBaseline hypoalbuminemia and a higher peritoneal transport status are risk factors for the first episode of peritonitis. Factors including male gender, hypoalbuminemia, and residing in rural areas are associated with technique failure, while hypoalbuminemia and age (>65years) are predictors of the overall mortality in PD patients. Nevertheless, the peritoneal transport status does not predict technique failure or overall mortality of PD patients.     

Morning blood pressure surge in early autosomal dominant polycystic kidney disease and its relation with left ventricular hypertrophy

IntroductionThe activation of the sympathetic nervous system, which usually leads to a swift surge in blood pressure in the morning hours (MBPS) may be the cause of left ventricular hypertrophy (LVH) and endothelial dysfunction (ED) in early autosomal dominant polycystic kidney disease (ADPKD) patients. We studied the association between MBPS and LVH in ADPKD patients with preserved renal functions.MethodsPatients with ADPKD with preserved renal functions were enrolled. Prewaking MBPS was calculated using ambulatory blood pressure monitoring. The patients were categorized as MBPS (≥median) and non-MBPS (<median). Left ventricular mass index (LVMI), endothelial-dependent dilatation (FMD, %), and carotid intima-media thickness (CIMT) evaluated.ResultsFifty-six patients (30 females and 26 males) were enrolled. Gender distribution was similar-among-the-groups. The mean age was higher in the MBPS group (50.1 ± 13 vs 37.3 ± 10.3). Urinary albumin (49.5 vs 16 mg/g creatinine, p < 0.001), hs-CRP (0.59 vs 0.37 mg/dl, p = 0.045) LVMI (124 ± 27.7 vs 95.2 ± 19.7 g/m², p < 0.001) and mean awake SBP surge was higher (42 vs 20 mmHg, p < 0.001) and FMD (%) was lower (14.4 ± 6.6 vs 18.9 ± 5.7, p = 0.009) in MBPS group. In the binary logistic regression analysis, the presence of MBPS in model 1 (OR: 6.625, 95% CI [1.048–41.882] p = 0.044), and age in model 2 (OR: 1.160, 95% CI [1.065–1.263] p = 0.001) were the only independent determinant of LVH.ConclusionsMBPS seems to be an important and independent determinant of LVH in ADPKD patients with preserved renal functions. It may be worth assessing the effect of reduction in MBPS as a new therapeutic target to prevent LVH in-patients-with-ADPKD.     

Anti-PLA2R antibody measured by ELISA predicts the risk of vein thrombosis in patients with primary membranous nephropathy

BackgroundPrimary membranous nephropathy (PMN) is associated with the highest risk for developing venous thrombosis compared with other nephrotic diseases. The aim of the study was to assess the predictive value of the pathognomonic anti-phospholipase A2 receptor (PLA2R) antibody with regard to incidence of venous thrombosis in PMN.MethodsA total of 365 in-hospital patients diagnosed with PMN were enrolled in the study. Anti-PLA2R antibody was detected by commercial enzyme-linked immunosorbent assay. Multivariate logistic regression was used to detect the independent risk factors for venous thrombosis.ResultsThirty-seven patients (10.14%) had venous thrombosis. Patients with venous thrombosis had higher levels of cholesterol (CHOL), low-density lipoprotein (LDL), and D-dimer than those without venous thrombosis (p < .05). Patients with venous thrombosis had significantly lower levels of albumin (23.95 ± 5.53 vs. 26.18 ± 6.59 g/L, p = .049). No significant differences were found in proteinuria, serum creatinine, estimated glomerular filtration rate, platelets, and fibrinogen between patients with and without thrombosis. Anti-PLA2R antibody levels in patients with venous thrombosis were significantly higher than in patients without it (p = .002). In the univariate logistic regression, Ln anti-PLA2R antibody (OR: 1.340; p = .004), albumin (OR: 0.945; p = .050), CHOL (OR: 1.191; p = .006), and LDL (OR: 1.271, p = .006) were associated with venous thrombosis. Ln anti-PLA2R antibody (OR = 1.269; 95%CI: 1.032–1.561), and LDL (OR = 1.213; 95%CI: 1.017–1.448) were the independent risk factors for venous thrombosis (p < .05) in multivariate analysis.ConclusionsAnti-PLA2R antibody was the independent risk factor for venous thrombosis in PMN. Larger prospective studies were warranted to verify the results in future.     

Prevalence of depression and anxiety and their predictors among patients undergoing maintenance hemodialysis in Northern China: a cross-sectional study

ObjectiveTo investigate the prevalence of depression and anxiety in patients undergoing maintenance hemodialysis (MHD) in Hohhot, a large city on the northern border of China, and to identify independent risk factors for depression and anxiety in these patients.MethodsPatients receiving MHD for >3 months were enrolled in the four largest hemodialysis centers between September 2020 and December 2020. Depression and anxiety were assessed using the Zung self-rated depression scale (SDS) and Zung self-rated anxiety scale (SAS), respectively, with demographic and other data collected for logistic regression analyses.ResultsAmong 305 MHD patients included in this study, the prevalence of depression was 55.1%, including 27.5%, 21.0%, and 6.6% with mild, moderate and severe cases, respectively. The prevalence of anxiety was 25.9%, with 20.0%, 4.6%, and 1.3% having mild, moderate, and severe cases, respectively. An independent protective factor for depression was family income of ≥1415 US dollars/month relative to <157 US dollars/month (odds ratio [OR] 0.209, 95% confidence interval [CI] 0.065–0.673), and predictors of depression included ≥3 comorbidities (OR 18.527, 95% CI 1.674–205.028) and severe pruritus (OR 15.971, 95% CI 5.173–49.315). Independent predictors of anxiety included infrequent exercise (OR 3.289, 95% CI 1.411–7.664) and severe pruritus (OR 5.912, 95% CI 1.733–20.168). The correlation between depression and anxiety in these patients was significant (r_s = 0.775, p < 0.001).ConclusionMHD patients in Northern China had high prevalence rates of depression (55.1%) and anxiety (25.9%). Lower family income, more comorbidities, and a higher degree of pruritus were predictors of depression, while infrequent exercise and severe pruritus were predictors of anxiety. Depression correlated significantly with anxiety. Attention should be given to family income, comorbidity, exercise, and pruritus severity for improved management of depression and anxiety among MHD patients.     

Paclitaxel coated balloon versus conventional balloon angioplasty in dysfunctional dialysis arteriovenous fistula: a systematic review and meta-analysis of randomized controlled trials

PurposeTo compare the efficacy and safety between paclitaxel coated balloon (PCB) angioplasty and conventional balloon (CB) angioplasty in the treatment of dysfunctional arteriovenous fistula (AVF).MethodsWe searched four major electronic databases (PubMed, EMBASE, Web of Science and the Cochrane Library) for randomized controlled trials (RCTs) published from inception through November 28, 2021. Outcomes of interest included target lesion primary patency (TLPP), technical success and all-cause mortality. The STATA package version 15.1 was utilized to undertake meta-analyses.ResultsFourteen RCTs totaling 1535 patients were analyzed. The available data showed that there were no significant differences of TLPP rates at 3, 6, 9 and 12 months between the PCB group and the CB group (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.93–1.07, p = 1.000, I² = 33.5%, Cochrane Q test p = 0.185, fixed-effect model; RR 1.17, 95% CI 0.99–1.39, p = 0.065, I² = 75.4%, Cochrane Q test p = 0.000, random-effect model; RR 0.81, 95% CI 0.35–1.89, p = 0.625, I² = 62.8%, Cochrane Q test p = 0.045, random-effect model; RR 1.19, 95% CI 0.97–1.47, p = 0.096, I² = 40.5%, Cochrane Q test p = 0.071, random-effect model). In addition, two groups had similar technical success rates (RR 1.00, 95% CI 0.97–1.03, p = 1.000, I² = 0.0%, Cochrane Q test p = 0.596, fixed-effect model) and all-cause mortality rates (RR 1.00, 95% CI 0.54–1.84, p = 1.000, I² = 0.0%, Cochrane Q test p = 0.599, fixed-effect model).ConclusionsPCB angioplasty did not appear to convey any obvious advantage over CB angioplasty in the treatment of dysfunctional AVF. However, further multi-center, large-scale and well-designed RCTs are needed to prove outcomes.     

Elevated atherogenic index and higher triglyceride increase risk of kidney function decline: a 7-year cohort study in Chinese adults

ObjectiveThis study explored whether lipid disorders or an elevated atherogenic index of plasma (AIP, a risk factor for cardiovascular diseases) could predict major kidney function decline.MethodsWe conducted a retrospective 7-year cohort study of 3712 Chinese adults followed up between 2010 and 2017. Major kidney function decline was defined as a ≥ 30% reduction in the estimated glomerular filtration rate (eGFR) from baseline. Multivariable logistic regression models were used to evaluate the relationship between lipid profiles and major kidney function decline. Smoking habits, waist circumference, and physical activity were not assessed.ResultsDuring the 7-year follow-up, 1.70% (n = 63) of the participants developed major kidney function decline. After adjustment for potential confounders, the odds ratios (ORs) for developing eGFR decline with per standard deviation increase were 1.23 [95% confidence interval (CI): 1.06–1.43] for triglyceride and 2.55 (95% CI: 1.01–6.42) for AIP in all participants. Furthermore, in the stratified analysis, we found sex-related differences; triglyceride and AIP were only independently associated with the risk of eGFR decline in men (OR, 1.27, 95% CI: 1.08–1.48; OR, 3.98, 95% CI: 1.22–12.99, respectively). When the participants were divided into groups according to the baseline lipid status, association was observed only between abnormal AIP and eGFR decline (all p values < 0.05).ConclusionOur findings suggest that a higher serum triglyceride level or an elevated AIP increases the risk of major kidney function decline in Chinese men with normal kidney function. Thus, assessment of AIP may help identify the risk of eGFR decline.     

Peritoneal dialysis-related peritonitis caused by gram-negative organisms: ten-years experience in a single center

ObjectivesConcerns are increasing about the clinical characteristics of gram- negative bacterial peritonitis for providing reference for clinical diagnosis, treatment and prevention.MethodsA retrospective analysis was performed examining patients who developed peritoneal dialysis-related peritonitis (PDRP) from 1 January 2009 to 31 December 2018.ResultsAmong 898 PD patients, 677 episodes of peritonitis occurred in 344 patients. Over 10 years, the proportion of gram-negative bacterial peritonitis increased from 0% to 26.15% (p = .045). E. coli was the leading cause (38.51%) of the 148 cases of gram-negative bacterial peritonitis. The increase of E. coli peritonitis between the first 5 and the last 5 years was obvious (20.45% vs. 46.15%). The antimicrobial sensitivity of gram-negative organisms to cefotaxime decreased from 71.43% to 55.84% (p = .017). In the gram-negative group, the effluent white cell count (WCC) on the first day was larger (OR: 1.374;95%CI: 1.248–1.563; p < .001), the time required for the WCC to normalize was longer (OR: 1.100;95%CI: 1.037–1.189; p = .003), and the level of C-reactive protein (CRP) was higher (OR: 1.038;95%CI: 1.026–1.042; p < .001) than those in the gram-positive group. The complete cure rate and treatment failure rate of gram-negative bacteria peritonitis were 87.8% and 12.2% respectively.ConclusionsOver 10 years, the proportion of gram-negative bacterial peritonitis increased, with E. coli epidermidis being the most common pathogen. More effluent WCC on the first day, longer time required for the WCC to normalize, and higher level of CRP are more common for gram-negative bacterial peritonitis. Prognosis of gram-negative bacterial peritonitis is worse.     

A new way to use transit-time flow measurement for coronary artery bypass grafting

 Open in a separate windowOBJECTIVESTransit-time flow measurement is a recognized method for graft evaluation in coronary surgery. However, single flow measurement has been associated with a low specificity for detecting graft dysfunction. The goal of this study was to assess the value of transit-time flow measurement for assessing in situ internal mammary artery grafts during non-existent native coronary circulation and the relevance of collateral blood flow in target vessels.METHODSBetween 2014 and 2018, a total of 134 patients undergoing on-pump coronary artery bypass grafting were evaluated using transit-time flow measurement. We analysed 111 single left internal mammary artery and 57 single right internal mammary artery bypasses. Correlations between coronary relevant parameters were calculated using Spearman’s ρ coefficient. Risk factors for decreased flow with an arrested heart (FAH) <30 ml/min and an increased pulsatility index (PI) >3.0 as well as flow reduction >30% were calculated.RESULTSFAH correlated with the diameter of the target vessel (Spearman’s ρ = 0.32; P < 0.001), the amount of blood distribution (Spearman’s ρ = 0.34; P < 0.001), the PI (Spearman’s ρ = 0.19; P = 0.019) and the degree of stenosis (Spearman’s ρ = −0.17; P = 0.042). The percentage of flow change was found to correlate with the PI (Spearman’s ρ = −0.47; P < 0.0001), the degree of stenosis (Spearman’s ρ = 0.42; P < 0.001), the diameter of the target vessel (Spearman’s ρ = −0.22; P = 0.008) and the area of blood distribution (Spearman’s ρ = −0.19; P = 0.018). A small blood distribution area was the only risk factor for decreased FAH [odds ratio (OR) 8.43, confidence interval (CI) 95% (3.04–23.41); P < 0.001]. Binary logistic regression identified PI [OR 2.05, CI 95% (1.36–3.10); P = 0.001], FAH [OR 0.98, CI 95% (0.97–0.99); P = 0.005] and degree of stenosis [OR 0.95, CI 95% (0.92–0.99); P = 0.011] as risk factors for decreased flow after cardiopulmonary bypass (<30 ml/min). An increased PI (>3) was mainly influenced by percentage of flow change [OR 0.99, CI 95% (0.98–1.00); P = 0.031].CONCLUSIONSFAH and percentage of flow change are related to the dimensions of the target vessel and the degree of stenosis. The addition of flow measurements with the heart arrested provides additional information about the bypass graft, the quality of the anastomosis and the physiology of the coronary circulation.