To explore the role of non-invasive assessment in fluid volume management of patients with acute kidney injury （AKI） treated with continuous renal replacement therapy （CRRT） by combining the ultrasonic cardiac output monitor （USCOM） and the body composition monitor （BCM）.
Methods
This study adopted a single-center， randomized， parallel-controlled method. Patients with AKI who underwent CRRT in the intensive care unit of the Department of Nephrology， First Medical Center of Chinese PLA General Hospital from April 2022 to October 2023 were included. The patients were divided into a control group and a test group according to the volume assessment methods. In the control group，traditional parameters such as central venous pressure and blood pressure were used to guide fluid volume management， while in the test group， non-invasive assessment with the ultrasonic cardiac output monitor combined with the body composition monitor was used to guide fluid volume management. The clinical baseline characteristics， hemodynamic parameters， incidence of complications， and hospital outcomes of the two groups of patients before and after CRRT were compared.
Results
A total of 50 patients were included，with 25 patients in each group. There were no statistically significant differences in baseline characteristics such as age， gender， etiology of AKI， underlying diseases， severity scores， and laboratory examinations between the two groups （all P＞0.05）. Compared with the control group， the test group after CRRT showed higher levels in the mean arterial pressure， stroke volume， and extracellular water （all P＜0.05）， but lower levels in the incidences of complications such as heart failure， hypotension， and muscle spasm， the total number of hospitalization days， the number of ICU hospitalization days， the total treatment time of CRRT，and the in-hospital mortality rate （all P＜0.05）.
Conclusion
For patients with AKI undergoing CRRT， the combination of the USCOM and the BCM could quickly and non-invasively assess the fluid volume overload，guide the prescription dosage of CRRT， achieving the precise volume management.
To evaluate the impact of statins on the prognosis of sepsis-associated acute kidney injury （SA-AKI） patients with elevated triglyceride-glucose index.
Methods
This study was a retrospective cohort study that included SA-AKI patients with elevated triglyceride-glucose index. Patients were divided into a statin group （with use of statins） and a non-statin group （no use of statins） based on whether they received statins. The primary outcome was the 28-day all-cause mortality rate. Survival analysis was performed with the Kaplan-Meier curve， and the log-rank test was used to compare survival rates. Univariate and multivariate Cox regression models were used to identify risk factors for the death endpoint， and subgroup analysis was conducted to explore the relationship between statin use and 28-day mortality rate.
Results
A total of 835 patients were included， with 366 patients in the statin group and 469 in the non-statin group. Compared with the non-statin group， the statin group showed lower levels in inhospital mortality rate， 28-day mortality rate， and 90-day mortality rate （all P＜0.05）. The Kaplan-Meier survival curve showed that the difference in survival rates between the two groups was statistically significant（P＜0.05）. Multivariate Cox regression analysis showed that the use of statins was an independent protective factor for 28-day mortality rate （HR=0.59， 95%CI： 0.43-0.81， P=0.001）. Subgroup analysis showed that the use of statins was associated with a reduced risk of 28-day mortality， which was consistent across subgroups stratified by age， gender， sequential organ failure assessment score， acute kidney injury stage，lactate levels， body mass index≥28， complication of diabetes mellitus， mechanical ventilation， and continuous renal replacement therapy.
Conclusion
The use of statins significantly reduced in-hospital mortality rate and improved short-term survival rate in the SA-AKI patients with elevated triglyceride-glucose index.
To explore the relationship between serum β2-microglobulin and all-cause death in patients undergoing maintenance hemodialysis （MHD）.
Methods
A retrospective analysis was conducted in the MHD patients （dialysis vintage ≥3 months） admitted to the Hemodialysis Center of Beijing Civil Aviation General Hospital from January 2018 to December 2023. The patients were divided into a low β2-MG group （β2-MG ＜ 28.0 mg/L） and a high β2-MG group （β2-MG ≥ 28.0 mg/L）. Their general information， biochemical indicators， and prognosis data were collected. The differences in indicator levels and mortality rates between the two groups were analyzed and compared. Kaplan-Meier survival curves were used for survival analysis， and Cox regression model for the relationship analysis between β2-MG and allcause mortality in the MHD patients. Logistic regression method was applied to analyze the risk factors for the high level of β2-MG.
Results
A total of 370 patients were included， with an age of 65.24±13.22 years， a median dialysis vintage of 73.0 （35.0， 129.3） months， a median follow-up time of 51.5（30.0， 69.0） months， and β2-MG level of 28.0 ± 5.45 mg/L. There were 175 patients in the low β2-MG group and 195 patients in the high β2-MG group. Compared with the high β2-MG group， the low β2-MG group had lower levels of dialysis vintage， β2-MG， CRP， iPTH levels， and serum uric acid （all P＜0.05），but higher levels of serum albumin， serum phosphorus， hemoglobin， serum creatinine， and blood urea nitrogen， as well as a higher proportion of patients complicated with diabetes （all P＜0.05）. The mortality rate in the low β2-MG group was lower than that in the high β2-MG group （χ2=5.694， P=0.017）. Kaplan-Meier curve analysis showed that the survival rate in the low β2-MG group was significantly higher than that in the high β2-MG group （χ2=25.292， P＜0.001）. Multivariate Cox regression model analysis showed that β2-MG （HR=1.056， 95%CI： 1.016-1.097， P=0.048）， age （HR=1.026，95%CI： 1.009-1.043， P=0.002）， concomitant diabetes （HR=1.680， 95%CI： 1.149-2.457， P=0.007）， and CRP （HR=1.015， 95%CI： 1.002-1.029， P=0.014） were independent risk factors for allcause mortality in the MHD patients. The risk of death was higher in the high β2-MG group （HR=1.142，95%CI： 1.014-1.431， P=0.030）.
Conclusion
β2-MG was an independent risk factor for the all-cause death in the MHD patients. High β2-MG was associated with an increased risk of all-cause death in the MHD patients.
To explore the impact of hypernatremia on the short-term prognosis of elderly patients with in-hospital acute kidney injury （AKI）.
Methods
Retrospective analysis of elderly patients who developed AKI during their hospitalization in the geriatric ward of Chinese PLA General Hospital from January 2015 to December 2022. According to the serum sodium levels at time of the diagnosis of AKI， the patients were divided into low blood sodium group （blood sodium＜135 mmol/L）， normal blood sodium group A （135 mmol/L≤blood sodium＜140 mmol/L）， normal blood sodium group B （140 mmol/L≤blood sodium≤145 mmol/L）， and high blood sodium group （blood sodium＞145 mmol/L）. Data were collected including the patients’ demographic data， comorbidities， laboratory test data， and outcome data （all-cause mortality after 28 and 90 days）. The Cox proportional hazards regression model was applied to evaluate the relationship between serum sodium concentration and all-cause mortality after 28 and 90 days.
Results
A total of 661 elderly patients with in-hospital AKI were included， with an average age of 90 （87， 94） years and a male proportion of 74.20%. There were 133 cases （20.12%） in the hyponatremia group， 210 cases（31.77%） in the normal natremia group A， 168 cases （25.42%） in the normal natremia group B， and 150 cases （22.69%） in the hypernatremia group. Within 28 days after AKI， 135 cases （20.42%） died， among whom the mortality rate of normal sodium group A was the lowest （11.9%）， and the mortality rate of the hypernatremia group was the highest （39.3%）， while the Cox regression analysis showed that the risk of mortality in the hypernatremia group was higher than that of the normal sodium group A， （adjusted OR： 3.10，95%CI： 1.896-5.067， P＜0.001）. Within 90 days after AKI， 228 cases （34.50%） died， among whom the mortality rate of normal sodium group A was the lowest （24.8%）， and the mortality rate of hypernatremia group was the highest （57.3%）， while the Cox regression analysis also showed that the risk of mortality in the hypernatremia group was higher than that of the normal sodium group A （adjusted OR： 2.18， 95%CI： 1.501-3.162， P＜0.001）.
Conclusion
Hypernatremia is a common complication in the elderly patients with inhospital AKI， and may be associated with an increased risk of mortality for the patients in the short term.
Renal tubulointerstitial fibrosis represents a universal pathway in the progression of various types of chronic kidney disease to end-stage renal disease， and its severity serves as a critical pathological predictor for renal function and prognosis. With significant progress in the study of the mechanism of occurrence and development of renal tubulointerstitial fibrosis， more and more biomarkers have been discovered and become a new auxiliary tool for judging the degree of renal tubulointerstitial fibrosis，showing early diagnostic advantages. This article aimed to review the blood and urine biomarkers related to renal tubulointerstitial fibrosis from the perspective of renal pathological characteristics and pathophysiological mechanisms combining with animal experiments and clinical research results， in order to provide reference for in-depth research on early and non-invasive diagnosis of renal tubulointerstitial fibrosis and the prognosis of kidney diseases.
Heat stress-induced kidney injury is a renal dysfunction caused by high-temperature environments or intense activities in hot environments. However， its specific molecular mechanisms have not been fully elucidated. This article reviewed the risk factors， pathogenesis， early warning indicators， early diagnostic criteria， and main prevention and treatment measures for heat stress-induced kidney injury， in order to provide references for the clinical prevention and treatment of heat stress-induced kidney injury.
Diabetic nephropathy （DKD）， as a characteristic microvascular complication of diabetes， has become the leading cause of chronic kidney disease. However， there is still a lack of effective means to prevent its progression to end-stage renal disease （ESRD）. Recent studies have suggested that endoplasmic reticulum stress （ERS） was involved in the occurrence and progression of DKD， and the ERS signaling pathway may become a new target for the treatment of DKD. This article reviewed the research progress on treating DKD by regulating the endoplasmic reticulum stress signaling pathway.
Toevaluatetheeffectivenessofcase-basedcollaborativelearning（CBCL）teaching mode in clinical teaching of coronary atherosclerotic disease complicated with chronic kidney disease.
Methods
Medical students with bachelor degree or above who received standardized training in nephrology department of our hospital from December 2022 to May 2024 were randomly divided into an observation group and a control group. The CBCL teaching mode was used in the observation group， while conventional teaching methods were used in the control group. After the same training period， the examination results of the two groups of students were analyzed and compared， and the effects of the two teaching methods were evaluated. And the satisfaction levels of the participating medical students with the training were collected through a questionnaire survey.
Results
A total of 30 medical students were included， with 15 in the observation group and 15 in the control group. Both the theoretical ［（95.29±2.99）vs （85.13±4.74）， P＜0.001］and operational ［（94.07±1.98） vs （86.47±6.49）， P＜0.001］assessment scores of the observation group students were higher than those of the control group. The observation group students showed higher satisfaction with the overall course （93.3%）， and the teaching mode （86.7%） （P＜0.05）. In terms of theoretical knowledge understanding and clinical thinking cultivation， the satisfaction of the observation group was also higher than that of the control group （P＜0.05）.
Conclusion
The application of CBCL teaching mode in the clinical teaching of coronary atherosclerotic disease complicated with chronic kidney disease could improve the theoretical and operational scores of the medical students as well as satisfaction from them.
As an interdisciplinary and cutting-edge discipline integrating life sciences， computer science， and other disciplines， bioinformatics has become increasingly important in basic and clinical research on kidney diseases. For postgraduate students majoring in nephrology， mastering basic bioinformatics knowledge and analytical skills is conducive to understanding the pathogenesis of kidney diseases under big data. At present， there are still some problems and challenges in postgraduate students majoring in nephrology in terms of acquiring bioinformatics knowledge and improving relevant capabilities.This article analyzed the current situation of bioinformatics teaching for postgraduate students in nephrology and explored innovative teaching approaches， being committed to cultivating high-quality nephrology postgraduate students and promoting basic and clinical research on kidney diseases.
