Search

Background Electrolyte abnormalities are common symptoms of chronic kidney disease (CKD), but previous studies have mainly focussed on serum potassium and sodium levels. Chloride is an important biomarker for the prognosis of various diseases. However, the relationship between serum chloride levels and atrial fibrillation (AF) in CKD patients is unclear. Objective In this study, we sought to determine the association between serum chloride homeostasis and AF in CKD patients. Methods In this retrospective cohort study, we included patients who met the diagnostic criteria for CKD in China between 2000 and 2021. Competing risk regression for AF was performed. The associations of the baseline serum chloride concentration with heart failure (HF) and stroke incidence were also calculated by competing risk regression. The association of baseline serum chloride levels with all-cause death was determined by a Cox regression model. Results The study cohort comprised 20   550 participants. During a median follow-up of 350 days (interquartile range, 123–730 days), 211 of the 20   550 CKD patients developed AF. After multivariable adjustment, every decrease in the standard deviation of serum chloride (5.02 mmol/l) was associated with a high risk for AF [sub-hazard ratio (sHR) 0.78, 95% confidence interval (CI) 0.65–0.94, P  = .008]. These results were also consistent with those of the stratified and sensitivity analyses. According to the fully adjusted models, the serum chloride concentration was also associated with a high risk for incident HF (sHR 0.85, 95% CI 0.80–0.91, P  < .001), a high risk for incident stroke (sHR 0.87, 95% CI 0.81–0.94, P  < .001), and a high risk for all-cause death [hazard ratio (HR) 0.82, 95% CI 0.73–0.91, P  < .001]. Conclusion In this CKD population, serum chloride levels were independently and inversely associated with the incidence of AF. Lower serum chloride levels were also associated with an increased risk of incident HF, stroke, and all-cause death. [ABSTRACT FROM AUTHOR]

Dear Editor Diabetes mellitus (DM) has become a significant chronic condition that seriously affects human health.[1] Nowadays, China has become the country with the largest number of DM patients worldwide, of which more than 90% are type 2 diabetes mellitus (T2DM).[2] The increasing prevalence of DM exacerbates the incidence of end-stage renal disease (ESRD).[3] T2DM-related ESRD not only reduces survival rate and health-related quality of life but also places a significant cost on patients as well as society.[[4], [6]] To identify clinical predictive factors and develop prediction models for ESRD risk in T2DM patients, we used the study population extracted from the China Renal Data System, a database containing the information of more than seven million patients attended at 19 hospitals in the Chinese mainland, as previously described.[7] ESRD, including an eGFR of 15 mL/min/1.73 m SP 2 sp or less, or the commencement of dialysis or kidney transplantation due to ESRD, was classified as the outcome. These prediction models were further provided as simple bedside tools, including a risk score and a nomogram, which could be extensively applied to assess T2DM patients' ESRD risk in clinical practice, to aid clinical decision-making and sensible resource allocation. Using a randomized approach, 55 824 patients with T2DM from 10 medical centers were included in the derivation cohort, and 25 745 patients from seven additional medical institutions were included for external validation. [Extracted from the article]

Introduction: In recent years, consciousness impairment in patients with end‐stage renal disease (ESRD) has been paid more and more attention, but the cause and mechanism of consciousness state change is not clear. Methods: As the hippocampus played a crucial role in consciousness, we explored the pathological and electrophysiological changes in chronic kidney disease (CKD) mouse hippocampus. Results: Whole‐cell recordings in hippocampal neurons showed that miniature excitatory postsynaptic current (mEPSC) frequency decreased, but the amplitude was unaltered in CKD_8w mice. In addition, α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazole‐propionic acid receptor‐mediated EPSCs (AMPAR‐EPSCs) and N‐methyl‐D‐aspartic acid receptor‐mediated EPSCs (NMDAR‐EPSCs) in hippocampal Schaffer collateral‐CA1 synapses displayed a significant decline in CKD_8w mice. Although the ratio of AMPAR‐/NMDAR‐EPSCs did not change, the paired‐pulse ratio (PPR) in CKD_8w mice increased. Intriguingly, the mEPSC frequency and AMPAR‐/NMDAR‐EPSCs amplitudes were positively associated with body weight, and the mEPSC frequency was negatively correlated with serum creatinine in CKD_8w mice, indicating a potential correlation between cognition and nutritional status in patients with CKD. To confirm the above hypothesis, we collected the clinical data from multiple hemodialysis centers to analyze the correlation between cognition and nutritional status. Conclusion: Our analysis indicated that protein energy wasting (PEW) was a possible independent risk factor for consciousness dysfunction in maintenance hemodialysis (MHD) patients. Our results provided a more detailed mechanism underlying the cognitive impairment (CI) in ESRD patients at the synaptic level. Last but not least, our results showed that PEW was a probable new independent risk factor for CI in cases with ESRD. [ABSTRACT FROM AUTHOR]

Background: Anemia is one of the common complications in patients with chronic kidney disease (CKD). However, there is no systematic investigation on the prevalence of anemia in CKD patients and its relationship with the quality of life in China.Methods: The data for this study comes from baseline data from the Chinese Chronic Kidney Disease Cohort Study (C-STRIDE), which recruited predialysis CKD patients in China. The kidney disease quality of life summary (KDQOL-TM) was used to assess health-related quality of life (HRQoL). Use linear regression model to estimate the relationship between hemoglobin level and quality of life.Results: A total of 2921 patients were included in this study. The adjusted prevalence of hemoglobin (Hb) less than 100 g/L was 10.3% (95% confidence interval [CI]: 9.9,11.4%), and showed an increased trend through reduced eGFR levels from 4.0% (95%CI:2.3,5.9%) in the 45-60 ml/min/1.73m2 group to 23.4% (95%CI:20.5,26.2%) in the 15-29 ml/min/1.73m2 group. The prevalence of anti-anemia treatment was 34.0% (95%CI: 28.7,39.3%) and it is shown by reducing eGFR levels from 15.8% (95%CI:0,36.7%) in the 45-60 ml/min/1.73m2 group to 38.2% (95%CI: 30.7,45.2%) in the 15-29 ml/min/1.73m2 group. All five dimensions of the KDQOL scores in patients with CKD decreased as hemoglobin declined. After multivariable adjustments,the degrees of decrease became somewhat blunted. For example, compared with hemoglobin of ≥130 g/L, regression coefficients in the hemoglobin of < 100 g/L were - 0.047(95%CI: - 0.049,-0.045) for Symptoms and Problems(S), - 0.047(95%CI: - 0.049,-0.044) for Effects of the Kidney Disease(E), - 0.207(95%CI: - 0.212,-0.203) for Burden of the Kidney Disease(B), - 0.112(95%CI: - 0.115,-0.109) for SF-12 Physical Functioning (PCS), - 0.295(95%CI: - 0.299, -0.292) for SF-12 Mental Functioning (MCS), respectively.Conclusions: In our cross-sectional analysis of patients with CKD in China, prevalence of both anemia and anti-anemia treatment increased with decreased eGFR. In addition, anemia was associated with reduced HRQoL. [ABSTRACT FROM AUTHOR]

Background: Controversy remains whether white coat hypertension (WCH) is associated with renal prognosis in patients with chronic kidney disease (CKD). Methods: In the present multicenter, prospective study, we analyzed data of participants with CKD stage 1–4 from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). WCH was defined according to two criteria as follows: A, clinical blood pressure (BP) ≥ 140/90 mm Hg and average 24-h ambulatory BP < 130/80 mm Hg; B, clinical BP ≥ 130/80 mm Hg and daytime ambulatory BP < 130/80 mm Hg. Renal outcome was defined as initiation of renal replacement therapy. The association of WCH with renal events was evaluated by Cox regression model. Results: A total of 1714 patients with CKD were included in the present analysis. The mean age of the population was 48.9 ± 13.8 years and 56.8% were men. The mean baseline estimated glomerular filtration rate (eGFR) was 52.2 ± 30.1 ml/min/1.73 m2 and urinary protein was 1.0 (0.4, 2.4) g/day. The overall prevalence of WCH was 4.7% and 16.6% according to criteria A and B, respectively. Incidence rates of renal events were 49.58 and 26.51 according to criteria A and B, respectively, per 1000 person-years during a median follow-up of 4.8 years. After full adjustment, WCH was associated with an increased risk of renal event (criterion A: hazard ratio 2.36, 95% confidence interval 1.29–4.34; for criterion B: hazard ratio 1.90, 95% confidence interval 1.04–3.49) compared with patients with normal BP. Conclusions: WCH is associated with a greater risk for renal events in non-dialysis dependent Chinese patients with CKD. [ABSTRACT FROM AUTHOR]

Background: The lack of consensus criteria of acute on chronic kidney injury (ACKI) affects the judgment for its clinical prognosis.Methods: In this study, we analyzed the data from 711,615 hospitalized adults who had at least 2 serum creatinine (SCr) tests within 30 days. We estimated the reference change value (RCV) of SCr given initial SCr level in adults without known risks of acute kidney injury other than chronic kidney disease (CKD). We proposed a criterion for ACKI based on the RCV of SCr (cROCK), which defined ACKI as a ≥25% increase in SCr in 7 days. We validated cROCK by its association with the risks of in-hospital mortality, death after discharge, and CKD progression in a large cohort of patients with CKD stage 3.Results: In 21,661 patients with CKD stage 3, a total of 3,145 (14.5%), 1,512 (7.0%), and 221 (1.0%) ACKI events were detected by both cROCK and Kidney Disease Improving Global Outcomes (KDIGO), cROCK only, and KDIGO only, respectively. cROCK detected 40% more ACKI events than KDIGO. Compared with patients without ACKI by both definitions, those with cROCK- but not KDIGO-defined ACKI had a significantly increased risk of in-hospital mortality (hazard ratio [HR] 5.53; 95% CI 3.75-8.16), death after discharge (HR 1.51; 95% CI 1.21-1.83), and CKD progression (OR 5.65; 95% CI 3.05-10.48).Conclusions: RCV-based criterion (cROCK) for ACKI is clinically valid in that it has a substantially improved sensitivity in identifying patients with high risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

The role of calcitriol (1,25-dihydroxyvitamin D 3 or 1,25-(OH) 2 D 3) in physiological processes, such as anti-fibrosis, anti-inflammation, and immunoregulation is known; however, its role in the remodeling of the glomerular capillary endothelium in rats with chronic renal failure (CRF) remains unclear. Here, we analyzed the role/number of endothelial progenitor cells (EPCs), renal function, and pathological alterations in rats with CRF, and compared the results before and after supplementation with calcitriol in vivo. Amongst the three experimental groups (sham group, CRF group, and calcitriol-treated group (0.03 μg/kg/d), we observed substantially elevated cell adhesion and vasculogenesis in vivo in the calcitriol-treated group. Additionally, lower levels of serum creatinine (Scr) and blood urea nitrogen (BUN) was recorded in the calcitriol-treated group than the CRF group (p > 0.05). Calcitriol treatment also resulted in an improvement in renal pathological injury. Thus, calcitriol could ameliorate the damage of glomerular arterial structural and renal tubules vascular network integrity, maybe through regulating the number and function of EPCs in the peripheral blood of CRF rats. Treatment with it may improve outcomes in patients with renal insufficiency or combined cardiac insufficiency. Calcitriol could ameliorate CRF-induced renal pathological injury and renal dysfunction by remodeling of the glomerular capillary endothelium, thus, improving the function of glomerular endothelial cells. [ABSTRACT FROM AUTHOR]