To investigate the clinical characteristics and analyze the risk factors for short-term poor prognosis in cardiology-wards patients undergoing renal replacement therapy （RRT） due to acute kidney injury （AKI）.
Methods
A retrospective analysis was performed on AKI patients treated with RRT in the Cardiology Department of the First Medical Center of the Chinese PLA General Hospital from January 1，2009 to December 31，2018. The AKI patients' data were collected，including demography，concomitant diseases，etiology of AKI，vital signs at RRT initiation，laboratory results，duration of RRT treatment，indications for RRT，vasoactive inotropic score （VIS），norepinephrine equivalent （NEE），acute physiologic assessment and chronic health evaluation II （APACHE II） score，duration of critical and severe illness，and the patients' survival plus renal prognosis at 28 days after RRT treatment. According to the patients' prognosis，they were divided into a survival group and a death group. These AKI patients were divided into a survival group and a death group according to the prognosis，while risk factors affecting the prognosis were analyzed by logistic regression method.
Results
A total of 143 AKI patients were enrolled，of which 91 （63.6%） were males，whose median age was 75.0 （65.0，81.0） years，among whom a total of 87 patients died after 28 days，with a mortality rate of 60. 8%. Most of the patients had multiple underlying diseases at the time，and the main cause of AKI was renal hypoperfusion （63.3%），but the main RRT indication was volume overload （81.1%）. After 4 weeks of RRT treatment，56 patients survived，of whom 14 （25%） were able to be off dialysis while 42 （75%） still required dialysis. The APACHE Ⅱscore of the total enrolled AKI patients was （20.65 ±5.63），but there was no significant difference between the two groups （P=0.187）. The death group disclosed higher scores of VIS and NEE than the survival group（P ＜ 0. 05）. Univariate logistic regression analysis showed that advanced age，low body mass index（BMI），low mean arterial pressure，high hemoglobin，low creatinine at initiation of RRT，prothrombin time（PT），prolonged plasma activated partial thrombin time，cerebral infarction/cerebral hemorrhage，acute myocardial infarction，and high VIS/NEE score were risk factors for the patients' death. Multivariate logistic regression analysis showed that low BMI （OR =0.794，95%CI： 0.648-0.930，P =0.004），low serum creatinine at initiation of RRT （OR =0. 736，95% CI： 0. 558-0. 971，P =0. 030），and prolonged PT（OR=1.019，95%CI：1.004-1.035，P=0.016） were risk factors for the patients' death.
Conclusion
Low BMI at admission，low creatinine at RRT initiation，and prothrombin time prolongation were risk factors for death in the patients undergoing RRT due to AKI in the cardiology wards.
The study aimed to investigate the efficacy of percutaneous transluminal angioplasty （PTA） prior to arteriovenous fistula （AVF） creation for small-diameter artery in hemodialysis patients.
Methods
This study was a single-center prospective cohort study. A total of 108 patients with end-stage renal disease （ESRD） to establish long-term hemodialysis access，whose forearm small artery（radius or ulnar artery） was ＜1. 5 mm in diameter，were enrolled from the Department of Nephrology，Cancer Hospital Affiliated to Guizhou Medical University from June 1，2021 to June 1，2023. Among them，76 patients underwent AVF creation after PTA （PTA+AVF group），while 32 patients underwent only AVF creation as control （AVF group）. All the patients' general information，relevant data during and after PTA，and diameters and blood flow indicators of brachial artery，ulnar artery，radial artery，cephalic vein，and basilic vein，as well fistula maturation indicators after AVF creation. The differences between the two groups were then statistically analyzed.
Results
The radial/ulnar artery diameter and the peak systolic velocity（PSV） immediately after PTA in the PTA+AVF group were higher than those before PTA （t= -10.644，P ＜0.01； t= -6.386，P ＜0.001）. The radial/ulnar artery diameter and PSV at 1 day after PTA were also higher than those before PTA （t= -10.645，P ＜0.01； t= -6.388，P ＜0.00）. However，there were no significant differences between the radial/ulnar artery diameter and PSV immediately after PTA and those at 1 day after PTA （t= -0.129，P =0.897； t =0.571，P =0.569）. At 4，8，and 12 weeks after AVF creation，the blood flow volume of brachial artery and diameters of cephalic/basilic vein and radial/ulnar artery of the PTA+AVF group were all higher than those of the AVF group （P ＜0.05）. And at 4，8，and 12 weeks after AVF，the fistula maturation rates of the PTA +AVF group were 22.97% （17/74 cases），81.08% （60/74 cases），and 93.24% （69/74 cases），respectively，while those in the AVF group were 6.25% （2/32 cases），33.33% （9/27 cases），and 42.31% （11/26 cases），respectively. In the PTA+AVF group，the fistula maturation rates at 4，8，and 12 weeks after AVF were higher than those in the AVF group （χ2 =4.247，P ＜0.05； χ2 =20.836，P ＜0.001； χ2 =31.198，P ＜0.001）.
Conclusion
A good AVF maturation rate could be obtained by AVF creation after PTA for the small-diameter arteries of the hemodialysis patients，which may be one of the strategies to effectively utilize the resources of small-diameter arteries of the patients' forearms.
To investigate the relationship of β-isomerized C-terminal telopeptide of type I collagen （β-CTX），N-terminal midfragment of osteocalcin （N-MID），and procollagen type I carboxyterminal propeptide （PICP） with coronary artery calcification in patients with maintenance hemodialysis（MHD） and its diagnostic value.
Methods
A cross-sectional study on 80 patients with MHD who underwent consultation in our hospital from May 2021 to May 2023 was conducted. They were divided into a calcification group （n = 47） and a non-calcification group （n = 33） according to the Agatston scoring system. The patients' basic information，comorbidities，and serum levels of calcium，phosphorus，β-CTX，N-MID，and PICP were collected. The influencing factors for coronary artery calcification were analyzed by the logistic regression method. The diagnostic value of serum β-CTX，N-MID，and PICP in coronary artery calcification was analyzed by the receiver operating characteristic （ROC） curve.
Results
Compared with the non-calcification group，the calcification group showed obviously higher serum levels of phosphorus （t =2.300， P ＜0.05），N-MID （t =4.653， P ＜0.05），and PICP （t =4.689， P ＜0.05），but significantly lower serum level of β-CTX （t=4.236， P ＜0.05）. Logistic regression analysis results showed that serum phosphorus，CTX，N-MID，and PICP were all influencing factors for the coronary artery calcification in the MHD patients （OR=2.145，95%CI： 1.217-3.779； OR =0.593，95%CI： 0.436-0.807； OR =2.142，95%CI：1.346-3.408； OR =1.533，95%CI： 1.212-1.939）. ROC curve analysis showed that the area under the curve （AUC） of the combination of β-CTX，N-MID，and PICP was 0.951 for diagnosing the coronary artery calcification in the MHD patients，with the specificity and sensitivity being 80. 0% and 83.0%，respectively.
Conclusion
In the MHD patients with the coronary artery calcification，serum level of β-CTX was significantly lower，while serum levels of N-MID and PICP were significantly higher. The combination of them three was of certain value in diagnosing coronary artery calcification in the MHD patients.
To investigate the efficacy of sodium-glucose cotransporter 2 inhibitor（SGLT2i） for idiopathic membranous nephropathy and its effect on Th1/Th2 ratio.
Method
A singlecenter randomized controlled study was conducted by selecting 48 patients with idiopathic membranmembranic nephropathy who were diagnosed by renal biopsy or anti-phospholipase A2 receptor antibody detection and received initial formal treatment in Guiyang First People's Hospital from January 2022 to December 2023. The patients were randomly divided into two groups，a group of angiotensin II receptor blocker （ARB） combined with SGLT2i （treatment group，oral irbesartan 300 mg/d and dagliprazin 10 mg/d），and an ARB group （control group，oral irbesartan only 300 mg/d） with 24 patients in each.Demographic data，indicators of blood lipid，blood glucose，renal function，as well as T lymphocyte subsets Th1/Th2 ratio were collected，which was re-examined at 4 weeks，8 weeks，and 12 weeks after the treatment. The efficacy of therapy and its effect on Th1/Th2 ratio in the two groups were compared.
Results
The total effective rate of the treatment group was higher than that of the control group （95. 93% vs 70.83%， P ＜0.05）. After treating for 4 weeks，8 weeks，and 12 weeks，the treatment group showed lower levels of 24h urinary protein than the control group [（2081.24 ±977.51） mg vs （2577.25 ±1286.44） mg，（1776.50 ± 676. 24） mg vs. （2163. 25 ± 620. 44） mg，（812. 44 ± 383. 25） mg vs （1681. 21 ±477.58） mg，P ＜0.001]. Compared with the control group，the treatment group showed higher levels of serum albumin [（37.53 ±3.87） g/L vs （32.52 ±3.69） g/L，（38.12 ±4.13） g/L vs （33.26 ±4.01） g/L，P ＜0.001] after treating for 8 weeks and 12 weeks，lower level of total cholesterol after treating for 12 weeks [（5.12 ±0.84） mmol/L vs （6.41 ±0.62） mmol/L，P ＜0.001]，and also lower levels of triglycerides after treating for 8 weeks and 12 weeks [（1.62 ±0.81） mmol/L vs （2.01 ±0.53） mmol/L，and （1.50 ±0.91） mmol/L vs （1.99 ±0.74） mmol/L，P ＜0.001]. Besides，the Th1/Th2 ratio in the treatment group was higher than that in the control group after treating for 12 weeks [（1.01 ±0.31） vs（0.38 ±0.19），P ＜0.001].
Conclusion
SGLT2i could reduce proteinuria，improve lipid metabolism，and increase Th1/Th2 ratio in the patients with idiopathic membranous nephropathy.
To investigate the relationship of 25-hydroxyvitamin D3 and the ratio of serum iron to C-reactive protein with renal function impairment in the elderly.
Methods
A cross-sectional study design was conducted，and 6512 people who underwent health examinations from 2017 to 2022 in our hospital were enrolled. Based on their glomerular filtration rate，the subjects were divided into the normal renal group and the abnormal renal function group （GFR ＜60 ml/min/1.73 m2）. Restricted cubic splines and multivariate logistic model were used to analyze the relationship of 25-hydroxyvitamin D3 and the ratio of serum iron to C-reactive protein with the renal function impairment in the elderly. The recipient operating characteristic curve and decision curve analysis methods were used to evaluate their clinical diagnostic value.
Results
The average age of the 6512 elderly people was 65.52 ±5.24 years old，and the rate of renal function impairment was 42.5%，with the male accounting for 64.3% of the total. After adjusting for age，gender，body mass index，diastolic blood pressure，total cholesterol，fasting blood glucose，homocysteine，folic acid，and other factors，the results of multivariate logistic regression analysis showed that 25-hydroxyvitamin D3 level was negatively correlated with the prevalence of renal function impairment （P ＜0.05），and so was the ratio of serum iron to C-reactive protein，with the latter being more significant in the male （P ＜0.05）. In addition，the area under the curve of 25-hydroxyvitamin D3 plus the ratio of serum iron to C-reactive protein was 0. 8295 for diagnosis of the renal function impairment.
Conclusion
25-hydroxyvitamin D3 and the ratio of serum iron to C-reactive protein were inversely correlated with the prevalence of renal function impairment in the elderly.
Cardiovascular disease （CVD） is a common complication and leading cause of death in patients with chronic kidney disease （CKD）. Early identification and intervention of CKD patients at risk for CVD can help reduce the incidence of CVD complications and mortality of CKD patients. This article reviewed the research progress of novel biomarkers related to complication of CVD in patients with CKD，such as renal function-related markers，circulatory system markers，and enterotoxin-derived toxins.
With the increasing use of contrast media in clinical diagnosis and treatment，contrastinduced acute kidney injury （CIAKI） has become one of the main causes of renal insufficiency. CIAKI is characterized by a sudden decline in kidney function following contrast agent administration. The underlying pathophysiological mechanisms include renal medullary ischemia，direct contrast agent toxicity，oxidative stress，and inflammation. So far，except for the strategy of reducing the toxicity of contrast media，there is no effective means to prevent and treat CIAKI. This article reviewed the molecular mechanism of CIAKI，and introduced the potential value of targets related to apoptosis，inflammation，oxidative stress，and renal hemodynamic for the prevention and treatment of CIAKI，in order to provide reference for reducing the incidence of CIAKI，and improving the prognosis of the patients.
Acute kidney injury （AKI） is characterized by rapid deterioration of kidney function，whose remnant renal injury may progressively lead to chronic kidney disease （CKD） even after the complete recovery of kidney function. At present，the mechanism of transition from AKI to CKD has not been fully understood，in which AKI-related abnormalities of amino acid metabolism may play an important role in the transition from AKI to CKD. This article reviewed the research progress on the role of abnormalities in amino acid metabolism in the transition from AKI to CKD，aiming to provide new ideas for preventing the transition from AKI to CKD.
To explore the effect of multimodal teaching method in the teaching of contact heat-evoked potentials （CHEPs）.
Methods
A total of 35 graduate students and residents participating in standardized training of internal medicine from the First and Second Medical Centers of Chinese PLA General Hospital from October 2021 to August 2023 were selected as the research subjects.After stratification based on educational level，they were randomly divided into an experimental group （n=18） and a control group （n=17）. Both groups received theoretical training of chronic renal failure as well as theoretical and practical training of CHEPs. The control group received the teaching by the traditional method，while the experimental group received the teaching by the multimodal teaching method. After training，the assessment results of the two groups were compared.
Results
Compared with the assessment of the control group，the experimental group's theoretical test score [（86. 23 ± 3. 90） vs （82. 08 ±4.88） points]，operational test score [（86. 57 ± 4. 52） vs （82. 21 ± 3. 21） points]，and total score[（86.41 ±4.26） vs （82.11 ±4.07） score] were all significantly increased （P ＜0.05）.
Conclusion
The multimodal teaching method could significantly improve the teaching effect of CHEPs.
