To investigate the correlation of mean platelet volume (MPV) and MPV to platelet count ratio MPV/PLT with vascular access failure (VAF) in maintenance hemodialysis (MHD) patients, and to evaluate the predictive value of MPV and MPV/PLT for VAF events.
Methods
This study was a single center retrospective study. MHD patients with autologous arteriovenous fistula (AVF) as the vascular access at the Renal Blood Purification Center of Beijing Chaoyang Hospital from January 2015 to June 2021 were selected. The study subjects were divided into two groups based on the occurrence of vascular dysfunction: VAF group and non-VAF group. The differences in MPV and MPV/PLT changes between the two groups were compared with the mixed linear model. Kaplan Meier curve was used to compare the VAF incidence at different levels of MPV and MPV/PLT. The multivariate Cox regression model was applied to analyze independent risk factors for VAF events. The receiver operating characteristic (ROC) curve was used to evaluate the value of MPV and MPV/PLT in predicting VAF events in the hemodialysis patients.
Results
This study included 307 MHD patients, with 99 in the VAF group and 208 in the non-VAF group. The MPV, MPV/PLT, total cholesterol, uric acid, and dialysis age of the VAF group were higher than those of the non-VAF group (P<0.05). The mixed linear model comparison showed that there was no significant difference in MPV between the two groups, while MPV/PLT of the VAF group was significantly higher than that of the non-VAF group with the follow-up time prolonging (P<0.001). The Kaplan Meier curve showed statistically significant differences in the incidence of VAF at different levels of MPV and MPV/PLT(χ2=30.580, P<0.001 and χ2=9.599, P=0.008). The higher the levels of MPV and MPV/PLT, the higher the incidence of VAF events. After correction for the total cholesterol, uric acid, and dialysis age, multivariate Cox regression model analysis showed that MPV (HR=1.97, 95%CI: 1.60-2.42, P<0.001) and MPV/PLT (HR=1.59, 95%CI: 1.32-1.92, P<0.001) were independent risk factors for the occurrence of VAF. The area under the ROC curve (AUC) were 0.713 and 0.643, respectively, while the AUC of the combination of them was 0.716.
Conclusions
Elevated levels of MPV and MPV/PLT in the MHD patients were associated with the occurrence of VAF, and might have potential predictive value.
To investigate the influencing factors of renal insufficiency in children with Henoch-Schönlein purpura nephritis.
Methods
The clinical data of 165 children with Henoch-Schönlein purpura nephritis treated in our hospital were retrospectively analyzed. Levels of serum IgG subclasses were collected. Cox regression model was used to analyze the influencing factors of renal insufficiency in the children with Henoch-Schönlein purpura nephritis.
Results
The incidence of renal insufficiency was 35.15%. The levels of IgG1, IgG2, IgG3, and IgG4 in the patients with renal insufficiency were lower than those in the patients without renal insufficiency (P<0.05). IgG1 (RR=0.435, 95%CI: 0.249-0.671, P=0.013), IgG2 (RR=0.452, 95%CI: 0.302-0.668, P=0.010), IgG3 (RR=0.396, 95%CI: 0.245-0.676, P=0.012), and IgG4 (RR=0.471, 95%CI: 0.220-0.668, P=0.018) were the protective factors against renal insufficiency (P<0.05). Repeated rash (RR=4.189, 95%CI: 2.637-5.952, P=0.019), elevated platelet count (RR=4.157, 95%CI: 2.881-4.762, P<0.001), elevated blood pressure (RR=5.220, 95%CI: 2.314-6.888, P=0.001), elevated blood glucose (RR=5.125, 95%CI: 3.582-6.720, P<0.001), anemia (RR=5.231, 95%CI: 4.037-7.869, P=0.007), crescent formation (RR=5.172, 95%CI: 3.562-7.074, P=0.004), renal tubular atrophy (RR=5.519, 95%CI: 3.289-6.968, P=0.021), renal interstitial fibrosis (RR=6.460, 95%CI: 4.560-7.887, P=0.003), and non-compliance with treatment (RR=4.994, 95%CI: 3.462-6.840, P=0.001) were risk factors for the renal insufficiency (P<0.05).
Conclusion
IgG subclasses levels, repeated rash, elevated platelets, elevated blood pressure, elevated blood glucose, anemia, crescent formation, tubular atrophy, renal interstitial fibrosis, and non-compliance with treatment were the influencing factors of renal insufficiency in the children patients with Henoch-Schönlein purpura nephritis.
To explore the relationship between serum soluble urokinase-type plasminogen activator receptor (suPAR) level and arteriovenous fistula (AVF) stenosis in patients with maintenance hemodialysis (MHD).
Methods
A total of 115 patients, who underwent MHD treatment with AVF in our hospital from June 2018 to October 2020, were selected as the research objects. According to whether the patients had AVF stenosis, they were divided into AVF stenosis group (51 cases) and AVF non-stenosis group (64 cases). General data and laboratory indicators were collected. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum suPAR level. The factors influencing suPAR level were analyzed by multiple linear regression method. The risk factors of AVF stenosis in MHD patients were analyzed by logistic regression method. The value of serum suPAR in the diagnosis of AVF stenosis in MHD patients was evaluated by receiver operating characteristic (ROC) curve method.
Results
Compared with the AVF non-stenosis group, the AVF stenosis group showed significantly higher levels of white blood cell count, red blood cell count, blood creatinine, albumin, procalcitonin (PCT), C-reactive protein, and suPAR (P<0.05), but had lower level of high-density lipoprotein cholesterol (P<0.05). Serum suPAR levels in the groups were positively correlated with the white blood cell count, albumin, procalcitonin, and C-reactive protein (P<0.05), and negatively correlated with the high-density lipoprotein cholesterol (P<0.05). Multiple linear regression analysis showed that the white blood cell count, high density lipoprotein cholesterol, albumin, procalcitonin, and C-reactive protein were influencing factors of suPAR level (P<0.05). Logistic regression analysis showed that white blood cell count (OR=1.685, 95%CI: 1.024-2.772), PCT (OR=2.059, 95%CI: 1.108-3.825), C-reactive protein (OR=2.316, 95%CI: 1.225-4.380), and suPAR (OR=3.046, 95%CI: 1.583-5.862) were all associated with AVF stenosis in the MHD patients (P<0.05). To evaluate the diagnostic value of serum suPAR for AVF stenosis in the MHD patients, the area under the curve was 0.943 (95%CI: 0.883-0.977), and the cutoff value was 2.59 μg/L with a sensitivity of 90.7% and a specificity of 90.2%.
Conclusion
Serum suPAR might be of value for clinical diagnosis of AVF stenosis in MHD patients.
To systematacially evaluate the efficacy of exosomes derived from mesenchymal stem cells in the treatment of diabetic kidney disease of animals.
Methods
Relevant articles in the Embase and PubMed databases were retrieved on mesenchymal stem cells-derived exosomes in the treatment of diabetic kidney disease of mice. The retrieval time was from the establishment of the databases until November 25, 2022. SYRCLE′s risk of bias tool was used to evaluate the risk of bias of the animal studies. Meta-analysis was performed by means of the RevMan5.4 software from the Cochrane Collaboration network.
Results
A total of 4 randomized controlled animal experiments were included. There were altogether no less than 98 mice, with no less than 33 mice in the exosome treatment group, 32 mice in the blank control group, and no less than 33 mice in the animal model control group. The results of meta-analysis showed that the blood urea nitrogen level (SMD=-1.97, 95%CI: -3.56 to -0.39, P=0.01) and blood glucose level (SMD=-1.98, 95%CI: -17.45 to -2.22, P=0.002) decreased significantly, while the changes of body weight (SMD=-1.47, 95%CI: -0.21 to 3.16, P=0.09), urinary creatinine (SMD=-1.34, 95%CI: -7.51 to 4.83, P=0.67), and 24 h urinary albumin (SMD=-3.29, 95%CI: -8.40 to -1.82, P=0.21) were of no significant difference after the treatment with exosomes derived from mesenchymal stem cells in the mice diabetic nephropathy animals.
Conclusions
Exosomes derived from mesenchymal stem cells had certain efficacy in the treatment of diabetic kidney disease of animals, which still need to be further studied and verified.
Mesenchymal stem cells (MSCs) are a kind of cells with robust self-renewal, multi-lineage differentiation, and paracrine potential, having a good application prospect in the treatment of renal diseases. This article reviewed the mechanism of MSCs in the repair of renal injury, aiming to provide reference for future clinical application of MSCs.
Osteoporosis is one of the common complications of patients with chronic kidney disease (CKD), and can seriously affect the patients’ quality of life and increase the mortality. According to their mechanisms of action, the anti-osteoporosis drugs are mainly divided into bone resorption inhibitors and osteoanabolic agents. Patients with advanced CKD are more likely to experience adverse effects of anti-osteoporosis drugs, and may have an increased risk of CKD progression. This article reviewed the progress of research on the treatment of osteoporosis in patients with advanced CKD, aiming to provide assistance for clinical work.
Patients with chronic kidney disease, especially end-stage renal disease, who are receiving renal replacement therapy, are at great risk in the epidemic of COVID-19. Studies have shown that the existing COVID-19 vaccines are safe for patients with chronic kidney disease, and the whole course of vaccination can produce specific antibodies in most patients with chronic kidney disease. However, the humoral response and efficacy of the vaccines in patients with chronic kidney disease were significantly weaker than in healthy people. Increase of the number of vaccinations and use of combined vaccinations may have potential value in improving the protective efficacy of the vaccines in patients with chronic kidney disease, but the relevant vaccination strategies still need to be further studied. This paper reviewed the research progress on the feasibility, safety, efficacy, and targeted vaccination strategies of the SARS-CoV-2 vaccination for patients with chronic kidney disease.
Intestinal microorganisms constitute the intestinal microecosystem of human body, and participate in physiopathological functions such as nutrition, metabolism, and immunity. Research findings have indicated that intestinal microecology is closely related to chronic kidney disease. By participating in the innate and adaptive immune responses of patients, intestinal microecology profoundly influences the progression of chronic kidney disease and its associated complications. Moreover, the intestinal mucosal immunity constructed by intestinal flora directly affects the production and secretion of IgA, thus affecting the occurrence and progression of IgA nephropathy. This article reviewed the research progress on the relationship between intestinal microecology and immunity in patients with chronic kidney disease, in order to provide new clues and ideas for the diagnosis and treatment of CKD.
Although some patients with acute kidney injury (AKI) got clinical recovery, they still experienced renal tissue fibrosis due to changes in renal structure and maladaptive repair, leading to progression to chronic kidney disease (CKD) and even end-stage renal disease (ESRD). Therefore, early identification and intervention of the AKI-to-CKD transition is crucial. This article reviewed the research progress on the risk factors, transition mechanisms, biomarkers, and intervention measures of the AKI-to-CKD transition.
