To further enhance the clinical diagnosis and treatment level of diabetic kidney disease（DKD）， standardize the clinical application of Western and traditional Chinese medicines for DKD， and promote the development of precise diagnosis and treatment of DKD by integrated traditional Chinese and Western medicine， the Chinese Association of Integrative Medicine， the China Association of Chinese Medicine， the Chinese Medical Association， and the Chinese PLA General Hospital have taken the lead in initiating the formulation of guidelines for diagnosis and treatment of DKD with integrated traditional Chinese and Western medicine. This article elaborated on the formation process of the guideline development committee， the definition of clinical questions， data collection and selection strategies， the retrieval and screening process for evidence， the establishment of recommendations， external review of the guidelines，publication strategies， and promotion and implementation measures. The aim of this article was to provide a clear framework and technical support for the development of the guidelines， enhance the transparency of the guidelines development process， and offer references and insights for the formulation of other diagnostic and treatment guidelines in the field of integrated traditional Chinese and Western medicine.
To evaluate the effect of Yiqiheluo formula combined with valsartan in the treatment of IgA nephropathy with deficiency of both qi and yin plus blood stasis syndrome.
Methods
A randomized， controlled， double-blind research was conducted. The subjects were 60 patients with IgA nephropathy with deficiency of both qi and yin plus blood stasis syndrome in the department of nephrology of the Beijing Changping District Hospital of Integrated Traditional Chinese and Western Medicine from October 2020 to October 2022. They were randomly divided into a treatment group and a control group，with 30 cases in each. Both groups received the capsule of valsartan （80 mg， once a day）， while the treatment group were added with Yiqiheluo particles formula （1 dose， twice a day）， and the control group was added with Yiqiheluo simulation agent， the therapy course of which was 48 weeks. Relevant laboratory indicators were measured before the treatment as well as after 12 weeks，24 weeks，and 48 weeks of the treatment，including serum creatinine， blood urea nitrogen， albumin， IgA， complement C3， triglyceride， total cholesterol，together with urinary red blood cell count and 24 h urinary protein quantity， etc. The total effective rate and the changes of the relevant indexes were compared between the two groups.
Results
Compared with those before treatment，the treatment group showed lower levels of 24 h urinary protein quantity，urinary red blood cell count，serum IgA，blood urea nitrogen，and serum creatinine after 24 and 48 weeks of the treatment （all P ＜0.05），but higher levels of estimated glomerular filtration rate （eGFR） and serum complement C3 （both P ＜0.05）. After 48 weeks of the treatment，the control group displayed lower levels of 24 h urinary protein and red blood cell count（P ＜0.05），but no significant changes in levels of serum IgA，blood urea nitrogen， and serum creatinine （P ＞0.05）. Compared with the control group，the treatment group had significantly lower levels of 24 h urinary protein quantity，urinary red blood cell count，serum IgA，blood urea nitrogen，and serum creatinine（all P ＜0.05），but higher levels of eGFR and serum complement C3 （all P ＜0.05） after 48 weeks of the treatment. After 12 weeks，24 weeks，and 48 weeks of the treatment， the main symptom scores and total symptom scores of the treatment group were significantly lower than those of the control group（P ＜0.05）. The total effective rate of the syndromes was significantly higher in the treatment group than in the control group after 48 weeks of the treatment ［26 cases（86.7%） vs 19 cases （63.3%）， P ＜0.05］， and the total clinical effective rate was significantly higher in the treatment group than in the control group ［23 cases （76.7%） vs 13 cases （43.3%）， P ＜0.05］. No adverse events occurred in both of the two groups during the treatment.
Conclusion
In the treatment of IgA nephropathy with deficiency of both qi and yin plus blood stasis syndrome， the Yiqiheluo formula combined with valsartan treatment was superior to valsartan treatment alone in improving the remission rate of proteinuria， clinical symptoms，and quality of life of the patients.
To explore the characteristics and changes of intestinal microbiome in hemodialysis patients with type 2 diabetes mellitus based on RNA sequencing technology.
Methods
This cross-sectional study enrolled hemodialysis patients who visited the Chinese PLA General Hospital from May to December 2023. The hemodialysis patients with type 2 diabetes were divided into a type 2 diabetes group，while those matched at the same time without type 2 diabetes were divided as a control group. General information and clinical data were collected from all the enrolled patients. Fecal samples from the patients were analyzed for their microbial composition by means of high-throughput RNA sequencing techniques，exploring the differences in α diversity， β diversity， and species of intestinal microbiota between the two groups.
Results
A total of 52 hemodialysis patients were included，with 26 in the type 2 diabetes group and 26 in the control group. There was a statistically significant difference in the β diversity of intestinal microbiota between the two groups （P ＜0. 05）， but not in the α diversity （P ＞0. 05）. There were significant differences between the two groups in a total of 11 intestinal microbiota （linear discriminant analysis threshold 4， P ＜0.05）. The type 2 diabetes group significantly enriched Proteobacteria， Gamma Proteobacteria， Enterobacteriaceae， Christenseniaceae， Enterobacteriaceae， and its Escherichia， while the control group significantly enriched Firmicutes， Clostridia， Eubacilli， Trichospiriceae， and its Brautzia.
To explore the predictive effect of neutrophil percentage-to-albumin ratio（NPAR） on all-cause mortality in patients undergoing maintenance hemodialysis （MHD）.
Methods
A retrospective analysis was performed on 100 MHD patients admitted to the Blood Purification Center of Nanjing Central Hospital from November 2014 to November 2020. The patients were divided into high NPAR and low NPAR groups based on the median NPAR. Baseline clinical data， laboratory indicators， NPAR，neutrophil/lymphocyte ratio， and monocyte/HDL ratio were collected and compared between the two groups.The risk factors of all-cause mortality in the MHD patients were analyzed by COX regression analysis. The survival analysis was conducted using the Kaplan-Meier method， and receiver operating characteristics（ROC） curves were used to assess the predictive effect of relevant indicators for all-cause death in the MHD patients.
Results
The follow-up at the end of the study disclosed that 76 patients survived and 24 patients died. The age of patients in the survival group was lower than that in the death group （P ＜0. 001）.Compared with the death group， the survival group showed lower levels of diabetes mellitus complication，neutrophil percentage， neutrophil/lymphocyte ratio， NPAR， C-reactive protein， and monocyte/high-density lipoprotein ratio （all P ＜0. 05）， but showed higher level of high-density lipoprotein （P = 0. 006）.Multivariate Cox regression model analysis showed that age increase （HR=1.089， 95%CI： 1.042-1.139，P ＜0.001）， diabetes complication （HR =5.365， 95%CI： 1.957-14.706， P =0.001）， NPAR increase（HR=4.196，95%CI：1.409-12.496， P=0.01）， and C-reactive protein increase （HR =1.169， 95%CI：1.048-1. 304， P = 0.005） were independent risk factors for the all-cause death in the MHD patients.Compared with the low NPAR group，the overall survival rate of the high NPAR group was lower （χ2 =19.094，P ＜0.001）. For predicting the all-cause mortality in the MHD patients， the areas under the ROC curves of NPAR， C-reactive protein， neutrophil/lymphocyte ratio， and monocyte/high-density lipoprotein ratio were 0.766 （95%CI：0.659-0.874， P ＜0.001）， 0.682（95%CI：0.560-0.804，P =0.007）， 0.650（95%CI：0.508-0.792，P=0.027）， and 0.694（95%CI：0.581-0.808，P=0.004）， respectively.
Conclusion
NPAR has a certain clinical predictive effect on the all-cause mortality in the MHD patients.
IgA nephropathy is an autoimmune disease characterized by IgA-predominant deposition of immunoglobulins in the mesangial area the glomeruli， accompanied by mesangial cell proliferation and mesangial matrix expansion. Currently， there is no unified treatment regimen for IgA nephropathy. In the treatment process， it is necessary to consider the patients’ clinical manifestations， renal pathological changes， and the pathogenesis of the disease. Balancing efficacy and safety， personalized diagnosis and treatment should be provided to the patients. In recent years， with an increasing understanding of the autoimmune pathogenesis of IgA nephropathy， the combined use of traditional medications and various novel agents targeting different pathways can complement each other mechanistically to achieve precise individualized control of the disease， thereby improving renal outcomes. This article systematically summerized the ten treatment measures for IgA nephropathy and the respective action mechanisms of relevant drugs， aiming to deepen understanding of IgA nephropathy treatment and provide guidance for clinical practice.
Insulin resistance is closely related to the occurrence， progression， and outcomes of chronic kidney disease （CKD）. Hyperinsulinemic-euglycemic clamp （HEGC） technique can quantitatively evaluate insulin sensitivity and insulin resistance levels. This article reviewed the progress of research on the HEGC method in evaluating insulin resistance of CKD patients， analyzing the relationship between renal function and insulin resistance， the potential mechanisms of insulin resistance， and its impact on prognosis.
Peritoneal dialysis-associated peritonitis is a serious complication of peritoneal dialysis with poor prognosis. Western medicine mainly relies on antibiotics for treatment. As more and more drugresistant bacteria increase， recurrent peritonitis and refractory peritonitis frequently occur. Traditional Chinese medicine （TCM） has antibacterial and immune-enhancing effects， and has no risk of drug resistance in the treatment of PDAP. The clinical effect of PDAP can be further improved by giving full play to the characteristics of TCM′s differentiation of syndromes and multi-channel overall regulation. In this paper， the research progress in recent years was reviewed in prevention and treatment of PDAP by TCM in the context of antibiotic resistance.
Anti-neutrophil cytoplasmic antibody （ANCA）-associated vasculitis （AAV） is a group of systemic autoimmune diseases characterized by small vessel vasculitis， with a complex pathological mechanism and a high recurrence rate. In recent years， significant progress has been made in treatment strategies with the deepening understanding of the pathophysiological mechanisms of AAV. This article reviewed the progress of research on AAV treatment， including remission-induction therapy， remissionmaintenance therapy， and management strategies for recurrent cases， aiming to provide ideas for optimizing treatment plans and developing new drugs.
