Chronic kidney disease-associated pruritus (CKD-aP), one of the most common and intolerable complications in hemodialysis patients, not only seriously affects patients' quality of life and physical and mental health, but also increases the risk of long-term mortality. The pathogenesis of CKD-aP remains unclear, and immune-inflammatory dysregulation, imbalance of endogenous opioid system, abnormal accumulation of metabolites, xerosis, abnormal histamine level as well as hyperparathyroidism, have all been shown to be associated with pruritus. There is a lack of satisfactory and effective treatment strategies for CKD-aP, which mainly include pharmacological treatment, non-pharmacological treatment and dialysis modality modification. This article mainly reviews recent advances in the pathogenesis and pharmacological treatment of pruritus among hemodialysis patients.

In recent years, ultrasound-guided percutaneous transluminal angioplasty (PTA) has been widely used for the treatment of stenotic or occlusive lesions in hemodialysis vascular access. However, there is currently a dearth of clinical guidelines or expert consensus for this technology. Therefore, it becomes an urgent problem in the field of hemodialysis vascular access how to further standardize the clinical procedures of ultrasound-guided PTA to ensure its efficacy and safety in clinical diagnosis and treatment. For this purpose, Chinese consensus expert group on ultrasound interventional therapy for hemodialysis vascular access has formulated this "Expert consensus on ultrasound interventional therapy for hemodialysis vascular access in China (2024)". The present consensus encompasses several key aspects, including preoperative assessment, ultrasound diagnostic procedures, interventional treatment standards, surgical operating procedures, and strategies for managing complications. It aims to provide practical guidance for clinicians to improve treatment outcomes, mitigate the risk of complications, and enhance patients' quality of life. The promotion of this consensus is expected to facilitate the standardized application and popularization of ultrasound interventional techniques in the treatment of arteriovenous dialysis access.

Chronic kidney disease (CKD) is a serious health problem worldwide, whereas there is still no efficient cure. The gut microbiota plays a crucial role in maintaining human health and disease resistance, and multiple studies have confirmed that the gut microbiota is closely related to the occurrence and development of CKD. Starting from the "gut-kidney axis" theory, this article provides a systematic review of the changes in gut microbiota composition and function in patients with CKD, such as a decrease in the abundance of butyrate-producing bacteria Roseburia and Faecalibacterium prausnitzii. Besides that, the article explores the mechanisms by which the gut microbiota affects CKD progression, such as inflammation and immunity, and also describes the application methods of using the gut microbiota as a therapeutic target for CKD, such as fecal microbiota transplantation, microecologics, and dietary therapy, in order to provide microbial- based targets for the clinical diagnosis and treatment of CKD.

Chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD) is a common complication of CKD, which seriously affects the prognosis of patients. It is a series of abnormal mineral and bone metabolism syndrome caused by chronic renal function decline. The clinical manifestations are mainly decreased or increased serum calcium, increased serum phosphorus, increased intact parathyroid hormone, osteoporosis, and vascular calcification, etc. The paper reviews the research progress in the diagnosis, treatment and management based on the basic and clinical studies of hyperphosphatemia, secondary hyperparathyroidism, renal osteodystrophy and vascular calcification, etc.

Relapsing is the clinical characteristic of nephrotic syndrome (NS) in children, and some steroid-sensitive NS (SSNS) children have frequently relapsing NS and steroid-dependent NS. The long-term and frequent uses of glucocorticoids, as well as the adverse effects of immunosuppressants, seriously affect the quality of life in children with NS. The International Pediatric Nephrology Association released the clinical practice recommendation for SSNS in children in 2022. Based on the guideline for the diagnosis and treatment of steroid-sensitive, frequently- relapsing/dependent NS in children (2016) formulated by the Nephrology Group of Pediatrics Society of Chinese Medical Association, we interpreted the guideline on clinical treatment and management suggestions of SSNS, to provide references for the diagnosis and treatment of SSNS in children.

Objective To explore the changes of disease burden and risk factors of chronic kidney disease (CKD) due to type 1 and type 2 diabetes mellitus in China from 1990 to 2019, and to provide reference data for the prevention and control of diabetic kidney disease (DKD). Methods The Chinese DKD data were obtained from the 2019 Global Burden of Disease (GBD) database. The morbidity, prevalence, mortality, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life year (DALY) were used to compare the disease burden of CKD due to type 1 and type 2 diabetes mellitus from 1990 to 2019. In addition, the risk factors of DKD were analyzed. Results The numbers of CKD patients due to type 1 and type 2 diabetes mellitus in China were 574 (95% UI 495-665) and 31 076 (95% UI 28 152-33 909) thousand, and the numbers of new cases were 9 (95% UI 8-11) and 434 (95% UI 390-481) thousand in 2019, respectively. The numbers of death were 13 (95% UI 8-18) and 63 (95% UI 50-77) thousand, respectively. The age groups with the largest number of patients and new cases of CKD due to type 1 diabetes mellitus were 30-34 years old and <5 years old, respectively. The age group with the largest number of patients and new cases of CKD due to type 2 diabetes mellitus were 50-54 years old and 70-74 years old, respectively. From 1990 to 2019, the age-standardized prevalence rate of DKD patients in China was relatively stable, but the age-standardized incidence rate and YLD rate showed an upward trend, while the age-standardized mortality rate, YLL rate, and DALY rate showed a downward trend. The main risk factors associated with DKD death were high fasting plasma glucose, kidney dysfunction, high systolic blood pressure, high body mass index, high sodium diet, and lead exposure. The proportions of DKD death caused by high systolic blood pressure and high body mass index in the Chinese population were still increasing. Conclusions From 1990 to 2019, the age-standardized incidence and YLD rate of DKD in China shows an upward trend, while the age-standardized prevalence rate is relatively stable, and the age-standardized mortality rate, YLL rate, and DALY rate show a decreasing trend. High fasting glucose, renal failure, high systolic blood pressure, high body mass index, high sodium diet, and lead exposure are risk factors associated with death in DKD patients. With the progress of aging, the disease burden of DKD in China will continuously increase. Future work should be focused on population-specific interventions, taking into consideration the risk factors identified within the study.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

The risk factors of acute kidney injury caused by strenuous exercise include dehydration of the body, elevated body temperature, and intake of large amounts of sugary drinks after exercise, etc. The possible mechanism of the injury may be the inflammatory reaction of the body or the kidney itself, and the accumulation of various metabolites causing damage to the structure and function of the kidney under the induction of various risk factors. Repeated exposure to those risk factors not only increase the risk of acute kidney disease, but also may lead to chronic kidney disease. The paper reviews the definition, epidemiology, clinical manifestations, pathogenesis, and prevention measures of exercise-related kidney injury, to provide guidance for the formulation of appropriate exercise programs.

Rituximab (RTX) is a human mouse chimeric monoclonal antibody that acts on CD20 molecules on the surface of B cells. Currently, its application in the treatment of immune glomerular diseases is becoming increasingly widespread. However, there are still many problems in the application of RTX by clinical physicians. In response to this, we organized multiple rounds of discussions and revisions among national nephrologists on the 50 clinical issues that everyone is most concerned about and formed this article. The content covers the scope of application, evidence-based evidence, therapeutic regimen, drug usage methods and precautions, medication for special populations, and drug safety of rituximab in the treatment of membranous nephropathy, minimal change nephropathy, antineutrophil cytoplasmic antibody (ANCA) associated vasculitis and other immune glomerular diseases. In particular, specific answers are provided to typical questions raised by clinical doctors, aiming to provide practical guidance and reference for the broader clinicians.

Chronic kidney disease (CKD) is a major disease that severely harms the public health. As the disease progresses, patients may experience systemic complications involving multiple organs and finally develop end-stage kidney disease (ESKD), which severely threatens the lives of patients. And they have to rely on renal replacement therapies such as hemodialysis, peritoneal dialysis, or kidney transplantation to survive, imposing a heavy burden on families and society. Delaying the progression of CKD to reduce the incidence of ESKD and the risk of various severe complications is the primary goal of CKD treatment. Based on the latest evidence-based data and integrating the clinical practice experience of experts, this guideline has focused on formulating the comprehensive strategies including risk assessment for disease progression, strategies for delaying the disease progression, and management of complications in CKD. It is the aim to provide clinical practitioners with guidance on CKD management practices based on the latest evidence and suitable national conditions.

Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. 2023 International Society for Peritoneal Dialysis (ISPD) catheter-related infection recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection, such as cause-specific catheter-related infection, culture-negative catheter-related infection, refractory catheter-related infection, and infection- related catheter removal. A new target for the exit site infection rate should not exceed 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations for exit site infection include clarified suggestion of exit site dressing cover and revised topical antibacterial agents as well as antibiotics treatment duration. In addition to catheter removal and reinsertion, new salvage options for catheter are suggested. The paper outlines the updated main content of the guide.

It was a retrospective cohort study. Patients diagnosed with idiopathic membranous nephropathy (IMN) and received rituximab (RTX) alone for one course of treatment during hospitalization in the Department of Nephrology of the First Hospital of Jilin University from March 2020 to March 2022 were enrolled. The patients were divided into 1 g standard treatment group (once 1 g every 2 weeks for twice) and 375 mg/m² experimental treatment group (375 mg/m² once a week for 4 weeks) according to the different methods of drug administration, and the efficacy and safety of different doses of RTX in the treatment of IMN were compared between the two groups to provide a reference for optimizing the clinical treatment protocol. The patients were followed up regularly for more than 9 months after treatment and the data were complete. A total of 69 patients were included with age of (51.7±11.8) years old, and 46 males (66.7%). There were 31 patients in the 1 g standard treatment group and 38 patients in the 375 mg/m² experimental treatment group. The proportion of first-treatment patients in the 1 g standard treatment group was higher than that in the 375 mg/m² experimental treatment group (87.1% vs. 65.8%, χ ²=4.174, P=0.041). There were no statistically significant differences in the general data, clinical characteristics and baseline laboratory parameters between the two groups (all P>0.05). At the end of 3 months of treatment, 22 patients (31.9%) experienced remission, including 9 patients (29.0%) in the 1 g standard treatment group and 13 patients (34.2%) in the 375 mg/m² experimental treatment group (χ ²=0.211, P=0.646). At 6 months, 30 patients (43.5%) experienced remission, including 12 patients (38.7%) in the 1 g standard treatment group and 18 patients (47.4%) in the 375 mg/m² experimental treatment group (χ ²=0.521, P=0.470). At 9 months, 38 patients (55.1%) achieved remission, including 18 patients (58.1%) in the 1 g standard treatment group and 20 patients (52.6%) in the 375 mg/m² experimental treatment group (χ ²=0.204, P=0.652). At 9 months, the 24 h urine protein of 1 g standard treatment group and 375 mg/m² experimental treatment group decreased by 7.93 (6.24, 8.46) g and 7.45 (5.66, 8.67) g (both P<0.05), respectively, and serum albumin increased by 16.4 (15.5, 17.5) g/L and 15.5 (9.0, 15.8) g/L (both P<0.05), respectively, from the baseline value. Kaplan-Meier survival analysis result showed that there was no significant difference in the time of phospholipase A2 receptor titer decreasing to <5 RU/ml between the two groups (Log-rank χ ²=3.653, P=0.056). Twenty-three non-serious adverse events occurred in the 1 g standard treatment group, involving 16 patients, and 10 non-serious adverse events occurred in the 375 mg/m² experimental treatment group, involving 10 patients. There was better safety in the 375 mg/m² experimental treatment group than that in the 1 g standard treatment group (Fisher value=8.593, P=0.015). Both 375 mg/m² regimen and 1 g regimen of RTX in IMN patients are effective in relieving proteinuria and elevating serum albumin. The 375 mg/m² regimen of RTX has a lower incidence of adverse events compared with the 1 g regimen.

IgA nephropathy is the most common primary glomerular disease globally, with the highest incidence in the Asian region, and has a high risk of progressing to end-stage renal disease even in patients with low proteinuria. The treatment paradigm for IgA nephropathy has undergone significant changes. Treatment should aim to reduce pathogenic IgA and IgA immune complex formation, including intestinal mucosal B cell immune modulators such as budesonide enteric-coated capsules, targeted APRIL and BAFF agents, and B cell depletors; it should also manage glomerular inflammation, including corticosteroids, mycophenolate mofetil, hydroxychloroquine, and targeting complement therapy; and it should manage general responses to nephron loss, including lifestyle interventions, renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and endothelin receptor antagonists. This article provides a comprehensive overview of the treatment paradigm and drug advancements for IgA nephropathy, aiming to provide more rational treatment options for IgA nephropathy patients and improve their outcomes.

Membranous nephropathy (MN) is a type of glomerular disease characterized by diffuse thickening of glomerular basement membrane with subepithelial immune complex deposition, and traditional diagnosis of MN mainly relies on the pathological results of renal biopsy. In recent years, the emergence of biomarkers related to MN such as phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A has changed the diagnosis and treatment mode of MN, providing a new basis for the diagnosis, treatment and prognosis of MN. MN patients with positive specific target antigens exhibit different clinical manifestations and prognoses. Specific target antigens can not only guide diagnosis, but also has predictive value for prognosis. Immunosuppressive therapy is a common treatment for idiopathic MN patients, and the emergence of novel medications such as biologics represents a advance in the treatment of MN, providing a broader array of options for managing the condition. Conversely, the treatment approach for secondary MN primarily targets the management of the primary disease. Based on multiple and new literature, we reviewed the researches progress of target antigens and immunosuppressive therapy related to MN, so as to provide references for clinical diagnosis and treatment of MN.

As a new strategy for the application of sacubitril/valsartan (LCZ696) in patients with CKD, much evidence showed that it improved the prognosis of patients with CKD. This review summarizes the efficacy and safety of sacubitril/valsartan in physiology, pathology, pharmacology and clinical application by searching Wanfang, CNKI, PubMed and other databases for related articles on the application of sacubitril/valsartan in CKD patients. Although LBQ657, the active product of sacubitril, has a high drug accumulation in patients with moderate, severe renal injury, and ESRD, it is not cleared in hemodialysis, and has very little eliminated in peritoneal dialysis, which does not affect its safety. Compared with angiotensin converting enzyme inhibitor and angiotensin receptor blocker drugs, LCZ696 could increase the blood pressure control rate, improve cardiac function, slow down the decline of glomerular filtration rate, and significantly improve cardiovascular outcomes without more adverse events. Sacubitril/valsartan can be used in all levels of CKD patients complicated with hypertension and/or heart failure, with reliable safety and tolerance.

In recent years, artificial intelligence has received extensive attention in the field of kidney pathology, such as identifying kidney tissue structure and evaluating the degree of lesions. Renal pathology is the gold standard for the diagnosis of renal diseases, and histochemistry staining is the prerequisite for the assessment of renal lesions. Renal biopsy is usually evaluated by various staining methods, including hematoxylin-eosin staining, periodic acid-Schiff reaction, Masson's trichrome staining and immunol staining, among that, different staining methods focus on different structures. The paper reviewed the application and progress of artificial intelligence in renal pathology, especially in different staining methods.

As a home treatment and economical and practical treatment mode, peritoneal dialysis (PD) is an effective renal replacement therapy for end-stage kidney disease. The number of PD patients in the world is increasing, and prognosis has been significantly improved. However, compared with the general population, the quality of life of PD patients is not satisfactory, and the disease burden is still very high. There is significant heterogeneity in the reports of clinical outcomes of PD in different countries and regions. The heterogeneity seriously affects the validity of clinical research evidence and the continuous improvement of the quality of PD centers. New progress has been made in the study of standardized clinical outcome of PD in recent years. The article reviews the heterogeneity of PD clinical outcome report, standardized clinical outcome classification and core outcome to standardize the report of PD clinical outcome, improve the clinical research quality and management level of PD, and finally improve the prognosis of patients.

Sepsis-associated acute kidney injury (SA-AKI) is defined as the presence of acute kidney injury (AKI) in the context of sepsis. In the setting of genetic susceptibility, sepsis can lead to SA-AKI through various mechanisms. Based on differences in pathophysiological mechanisms, SA-AKI is categorized into different "endotypes" and manifests as distinct "subtypes". The combination of biomarkers and predictive models has the potential to early identify high-risk AKI patients and elucidate SA-AKI "endotypes". Volume resuscitation and blood purification are optimized strategies for SA-AKI treatment. Furthermore, clinical research on SA-AKI in children is promising.

Alport syndrome (AS), also known as "eye-ear-kidney syndrome or hereditary nephritis", is a common hereditary disorder. AS is caused by pathogenic mutations of type Ⅳ collagen genes (COL4α3, COL4α4 and COL4α5), leading to defects in the basement membrane of glomeruli, cochlea, and ocular lens. Patients present with hematuria, proteinuria, and progressive renal failure. With the redefinition of AS and the clinical application of high-throughput sequencing technology, the prevalence of AS may be much higher than the previously recognized. The specific pathogenic mechanism of AS is unknown. Recent studies have showed that type Ⅳ collagen gene mutation may lead to kidney injury by causing abnormal basement membrane components, lipid deposition, energy metabolism disorders, endoplasmic reticulum stress, inflammation and fibrosis. Renin-angiotensin system inhibitor is the main therapy of AS, but the effect is not satisfactory. The new therapeutic strategies mainly include inhibition of abnormal collagen signal transduction, reduction of endoplasmic reticulum stress in podocytes, regulation of energy metabolism, antioxidant stress, anti-inflammation and fibrosis, gene and stem cell therapy. The paper reviewed the research progress on pathogenesis and new therapies of AS.

Objective To elucidate the prevalence of hyperphosphatemia and utilization rate of phosphorus-lowering drugs in adult non-dialysis chronic kidney disease (CKD) patients in China, and explore the relationship between hyperphosphatemia, phosphate-lowering therapy, and clinical outcomes. Methods It was a large retrospective and multicenter cohort study. The study subjects were sourced from the China Renal Data System. The first-time hospitalized patients aged 18 years old and above and diagnosed with CKD who did not enter dialysis and having serum phosphorus test results from 2013 to 2020 were included. Hyperphosphatemia was defined as an initial serum phosphorus level exceeding 1.45 mmol/L during hospitalization, and normal serum phosphorus was defined as 0.97 mmol/L ≤ serum phosphorus ≤ 1.45 mmol/L. Cox regression model was employed to assess the association of hyperphosphatemia with all-cause mortality, cardiovascular mortality, and CKD progression as well as the association of phosphorus-lowering therapy with all-cause mortality and cardiovascular mortality. Results A total of 157 987 adult non-dialysis CKD patients with serum phosphorus test results were included in the study, with age of 60 (47, 72) years old and 91 453 males (57.89%). The estimated glomerular filtration rate was 63.49 (39.12, 92.90) ml·min^-1·(1.73 m²)^-1. The common comorbidities included hyperlipidemia (53.48%, 84 497/157 987), hypertension (37.23%, 58 818/157 987) and heart failure (27.02%, 42 686/157 987). The prevalence of hyperphosphatemia was 14.83% (23 431/157 987). Among CKD stage 3-5 patients with hyperphosphatemia, the utilization rate of phosphate-lowering medications was 13.34% (3 962/29 705). Multivariate Cox regression analysis showed that among 64 662 patients with ≥ 90 days of follow-up [3.3 (1.5, 5.4) years], hyperphosphatemia was significantly correlated with an increased risk of all-cause mortality and cardiovascular mortality (hyperphosphatemia/normal serum phosphorus, HR=1.13, 95% CI 1.06-1.22, P=0.001; HR=1.28, 95% CI 1.04-1.56, P=0.018, respectively). Among 47 581 patients with ≥ 90 days of follow-up [1.8 (0.9, 3.2) years] and baseline estimated glomerular filtration rate > 30 ml · min^-1 ·(1.73 m²)^-1, hyperphosphatemia was significantly correlated with an increased risk of CKD progression (hyperphosphatemia/normal serum phosphorus, HR=1.08, 95% CI 1.00-1.17, P=0.038). Among 8 856 patients with follow-up data of death [3.3 (1.5, 5.4) years] and hyperphosphatemia,phosphate-lowering medication use was significantly correlated with a reduced risk of all-cause mortality (HR=0.88, 95% CI 0.82-0.95, P<0.001) and cardiovascular mortality (HR=0.84, 95% CI 0.72-0.97, P=0.022). Conclusions The prevalence of hyperphosphatemia is high among Chinese adult non-dialysis CKD patients, but the utilization rate of phosphate-lowering medications remains low. Hyperphosphatemia is an independent risk factor of all-cause mortality, cardiovascular mortality, and kidney function progression, while phosphate-lowering medications may mitigate these risks in non-dialysis CKD patients. Regular monitoring of serum phosphorus level for non-dialysis CKD patients, and initiating phosphate-lowering therapy for hyperphosphatemia patients may positively improve clinical outcomes.

Chronic kidney disease (CKD) is one of the most important non-infectious chronic diseases in China, posting a serious threat to the health of older adults. Currently, there is still a lack of guidelines or consensus on the comprehensive management of CKD in older adults, particularly for primary care providers. Therefore, Chinese Society of Gerontology and Geriatrics collaborated with nephrology experts in China to develop a guideline specifically tailored for older CKD patients. This guideline clearly defines CKD in older adults, recommends using CKD Epidemiology Collaboration equation (CKD-EPI) combined serum creatinine-cystatin C (cr-cyst) formula to assess renal function in order to facilitate disease staging and stratified management in this population. It emphasizes the importance of a multidisciplinary team in the comprehensive assessment of the health status in older CKD patients. Regarding treatment strategies, the guideline advocates for first identifying the cause of CKD and then developing personalized precise treatment plans based on clinical and pathological diagnoses, as well as introduces the methods for rational medication use. In terms of patient management, the guideline suggests that older CKD patients should adopt healthy lifestyle and dietary habits, engage in regular physical activities, and receive standardized disease management. It also encourages the integration of traditional Chinese medicine for treatment based on syndrome differentiation in older CKD patients. Additionally, it provides recommendations on referrals and renal replacement therapy. The purpose of this guideline is to offer a comprehensive management strategy for older CKD patients to healthcare providers in primary medical institutions, aiming to enhance their overall management capabilities, postpone disease progression, and ultimately improve the quality of life for older adults in China.

Coronavirus disease 2019 (COVID-19) is a systemic disease including pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 infects several organs and systems besides the respiratory system, including the urinary system, cardiovascular system, gastrointestinal system, nervous system, hematological system and immune system. The kidney, as one of the targeted organs of COVID-19, is damaged by SARS-CoV-2 in both direct and indirect ways. The clinical manifestations of kidney involvements include acute kidney injury (AKI), proteinuria, hematuria, etc. Patients with chronic kidney disease (CKD) are often combined with a variety of immunodeficiency, especially those receiving hormones/immunosuppressants for immune nephropathy, kidney transplantation, undergoing renal replacement therapy for end-stage renal disease (ESRD). Moreover, these patients are not only susceptible to SARS-CoV-2, but also prone to becoming seriously or critically ill after infection. The treatment of CKD patients with COVID-19 is different from that of non-CKD patients, and the use of antiviral drugs in patients with severe renal insufficiency remains controversial. Furthermore, CKD patients are often combined with malnutrition, hypercoagulability, chronic inflammation, and water-electrolyte disorders, which make treatment of COVID-19 difficult. Therefore, this expert consensus was developed to enhance the clinicians' awareness of CKD with COVID-19, standardize the clinical diagnosis and treatment, and further improve the prognosis of patients.

IgA nephropathy (IgAN) is the most common primary glomerular disease and main reason of progression to end?stage renal disease in patients with kidney diseases. Various clinical, pathological, demographic and new factors discovered by researchers in recent years play important roles in the prognosis assessment of IgAN. Furthermore, developing prognostic evaluation models based on several different factors to identify patients at high risk of progression in the early disease stage is clinically significant. This article reviews the researches progress of influencing factors and relevant evaluation models for prognosis of IgAN.

As the most important component of renal parenchyma, tubular epithelial cells (TECs) play numerous regulatory roles in the occurrence and development of chronic kidney disease(CKD). Exosomes, double-membrane vesicles that are naturally secreted by cells, contain various bioactive molecules, including proteins, nucleic acids, and lipids, and serve as mediators for intercellular communications. This article reviewed the sources and characteristics of TECs-derived exosomes, the roles of TECs-derived exosomes affecting renal interstitial fibrosis in CKD, and the roles of TECs-derived exosomes in the diagnosis of CKD, to provide new ideas for the prevention and treatment in CKD.

Objective To establish a conditional knockout mouse model of polycystic kidney disease 1 (Pkd1) gene based on CRISPR/Cas9 and Cre-loxP gene editing technology, and to provide an animal model for in-depth research on the role of Pkd1 gene in the development of polycystic kidney disease. Methods In-Fusion technology was used to construct a targeting vector. Corresponding gRNAs, Cas9 mRNAs, and donor vectors carrying the loxP site were prepared based on the Pkd1 gene, and injected into the fertilized eggs of C57BL/6N mice. The fertilized eggs were transferred to the fallopian tubes of female mice with pseudopregnancy. After the newborn mice were identified by PCR and sequencing analysis, Pkd1^flox/flox F0 generation positive mice were selected. The F0 generation positive mice were bred with wild-type mice, and F1 generation heterozygous mice with Pkd1^flox/+ genotype were selected for offspring. F2 generation homozygous mice with Pkd1^flox/flox genotype were obtained through internal expansion, and then hybridized with Cre positive Ggt1/Cre mice. F3 generation mice with Pkd1^{flox/+Ggt1Cre} genotype were obtained. F4 generation mice with Pkd1^flox/flox Ggt1^Cre genotype were obtained by self crossing or backcrossing with F2 generation Pkd1^flox/flox, namely kidney-specific Pkd1 gene knockout mice (Ggt1-cKO mice). PCR method was used to identify the genotype of mice, and then the mice were divided into wild-type control (WT) group (n=6), Pkd1 homozygous control (PKD) group (n=6), and Ggt1-cKO knockout validation (CKO) group (n=6) according to the gene identification results. Real-time fluorescence quantitative PCR (RT-qPCR) was used to detect the expression of Pkd1 mRNA in the kidneys and other organs of mice in each group. HE staining was used to detect the pathological changes in renal tissues of mice in each group. The automatic biochemical detector was used to detect the blood urea nitrogen and serum creatinine levels of mice, and the kidney coefficient was calculated. Results The PCR detection results showed that the genotype of offspring mice in CKO group was consistent with Pkd1^{floxflox Ggt1Cre . Pkd1 gene was only specifically expressed in the kidney, but not in other tissues. The RT-qPCR results showed that the relative expression of Pkd1 mRNA in the renal medulla of CKO group was significantly lower than that of WT and PKD groups. The kidney volume of the CKO group had increased by about twice compared to the WT group. Under the microscope, it could be observed that there were multiple vacuoles of varying sizes and shapes in the kidneys of the CKO group, and there was a significant increase in the interstitial space of the medullary tissue. The kidney coefficient, blood urea nitrogen, and serum creatinine in the CKO group were significantly higher than those in the WT and PKD groups (all P<0.05). Conclusion Based on CRISPR/Cas9 and Cre-loxP gene editing technology, Pkd1 gene kidney conditional knockout mice can be successfully constructed, providing an animal model for further studying the action mechanism of Pkd1 gene in polycystic kidney disease.}

Objective To analyze the disease burden of chronic kidney disease (CKD) in the Belt and Road countries and its change trend. Methods It was a cross-sectional epidemiological study based on surveillance data. Data on age-standardized prevalence rate (ASPR) and age-standardized mortality rate (ASMR) of CKD were derived from the 2019 Global Burden of Disease Study. The annual percentage change (APC) was calculated to evaluate the ASPR trend of CKD from 1990 to 2019. Results In 2019, the number of CKD cases and deaths in the Belt and Road countries was 426 million and 798 000, respectively, accounting for 61.1% and 55.9% of CKD cases and deaths worldwide. The ASPR and ASMR of CKD in China were 8.1% and 11.2 per 100 000 population, slightly lower than the global average. Countries in North America and Oceania had a higher burden of CKD, and European countries had a lower burden. In the etiology, hypertension and diabetes-related CKD morbidity and mortality accounted for 23.7% and 68.8% of total CKD morbidity and mortality, respectively. From 1990 to 2019, the ASPR of CKD increased in 150 countries (98.0%) and the fastest increase was observed in Morocco (APC=1.52%). The hotspots with high ASPR of CKD were located in Belt and Road countries from Asia, South/North America and Oceania, and the hotspots with high ASMR were distributed in countries from Africa, South/North America and Oceania. The sociodemographic index and life expectancy were positively correlated with the ASPR of CKD (r=0.409, P<0.001; r=0.361, P<0.001) , and negatively correlated with the ASMR of CKD (r=-0.317, P<0.001; r=-0.391, P<0.001). Conclusions Belt and Road countries have substantial disease burdens of CKD, and the prevalence rate of CKD is rising fast. Health cooperation among member states should be strengthened to jointly address the challenges posed by chronic diseases such as CKD.

Osteoporosis is a comorbidity or complication of chronic kidney disease (CKD). Low bone mineral density, osteoporosis, and fractures are risk factors of poor prognosis in patients with CKD. Active prevention and treatment of osteoporosis is essential for patients with CKD. Denosumab is a fully human monoclonal antibody that targets receptor activator of nuclear factor-κB ligand (RANKL) and is not metabolized or excreted by the kidney. Clinical studies have shown that the use of denosumab in CKD (including dialysis and renal transplantation) patients with osteoporosis, can increase bone mineral density and reduce the incidence of fractures with acceptable safety. As hypocalcemia has been observed in patients with CKD, close monitoring and early supplementation of calcium and vitamin D are required before denosumab initiation, and serum calcium levels need to be monitored during treatment. The review summarized the published literature of denosumab in bone protection of CKD.

Objective To study the incidence and risk factors of central vein stenosis (CVS) in chronic kidney disease (CKD) patients who received arteriovenous fistula (AVF) creation for the first time, as well as effects of CVS on patency of ipsilateral AVF. Methods It was a retrospective study. The CKD patients who received AVF creation for the first time in the First Affiliated Hospital of Zhengzhou University from January 2019 to August 2020, with central vein digital subtraction angiography (DSA) results prior to angioplasty were selected as the study subjects. The differences of incidence of CVS in CKD patients with/without a history of cervical catheterization and primary patency rates of AVF between CVS and non-CVS groups were compared. Logistic regression analysis method was applied to analyze the influencing factors of CVS in CKD patients. Kaplan-Meier method was used to analyze the primary patency rate of AVF. Cox regression analysis method was used to analyze the effect of CVS on the primary patency of ipsilateral AVF. Results A total of 283 CKD patients aged (50.45±14.76) years were enrolled in the study, including 165 males (58.3%). The dialysis age was 0.5 (0, 7.0) months. There were 55 patients (19.4%) diagnosed with CVS before AVF, including 39 patients with stenosis <50% and 16 patients with stenosis ≥50%. The incidence of CVS in patients with history of right internal jugular vein central venous catheter insertion was significantly higher than that in those without this history [60.5% (26/43) vs. 9.9% (15/151), χ²=51.274, P<0.001]. Multivariate logistic regression analysis results showed that hemodialysis catheters indwelling time ≥3 months elevated the risk of CVS (OR=4.345, 95% CI 1.540-12.263, P=0.006). A subset of 268 patients who had AVF creation ipsilateral to CVS were analyzed to determine the effects of CVS on patency of AVF. The median follow-up time was 34 months. The primary patency rate of AVF in the moderate to severe CVS group was significantly lower than that in the non-CVS group (5/7 vs. 58/228, χ²=7.720, P=0.005). The primary patency rates of AVF in the subclavian vein stenosis group and superior vena cava stenosis group were significantly lower than those in the brachiocephalic vein stenosis group (4/5 vs. 8/27, χ² =6.974, P=0.008; 6/8 vs. 8/27, χ² =6.908, P=0.009, respectively). Moderate to severe CVS and combined diabetes were independent influencing factors of primary patency of AVF (HR=4.362, 95% CI 1.644-11.574, P=0.003; HR=2.682, 95% CI 1.624-4.431, P<0.001, respectively). Conclusions The incidence of CVS is higher in CKD patients who establish an arteriovenous fistula for the first time. Hemodialysis catheter indwelling time ≥3 months is an independent risk factor of CVS. The moderate to severe CVS is an independent risk factor of primary patency of AVF.

D-dimer is a fibrin degradation product. The increased D-dimer indicates hypercoagulability and secondary hyperfibrinolysis, which can be used as a biomarker for activation of coagulation and fibrinolysis system. D-dimer is routinely used in the diagnosis of thrombotic diseases. D-dimer level is affected by age, pregnancy, blood glucose, infection, liver failure, cancer and stroke. The increased D-dimer is closely related to kidney diseases. The paper reviews the formation mechanism and influencing factors of D-dimer, the relationship between D-dimer and kidney diseases, and the prognostic value of D-dimer in kidney diseases, to provide references for clinical diagnosis and treatment.

Chronic kidney disease-associated pruritus (CKD?aP) is a common complication in patients with end-stage renal disease, which strongly reduces the quality of life. The pathogenesis of CKD?aP is complex, with unclear etiology, and there is no recognized treatment method. This paper reviews the research progress of the pathogenesis of CKD?aP, including the hypotheses of toxin deposition, peripheral neuropathy, immune and inflammatory system disorder, and opioid receptor imbalance, and the treatment of CKD?aP, including adequate dialysis, local skin medication, systemic medication, nutrition, ultraviolet B, and acupuncture.

Autogenous arteriovenous fistula (AVF) is the preferred vascular access of hemodialysis in maintenance hemodialysis patients. However, due to the influence of various factors, new AVF may show immaturity, which will affect the use and dialysis effect of vascular access. AVF maturation is an important clinical concern. It is important to clarify the physiological and biochemical factors, and biological mechanisms of AVF immaturation. Based on the literature, this review focuses on the biological mechanisms of AVF maturation and the physiological and biochemical factors affecting AVF maturation, including vascular conditions, gender and age, and underlying diseases, to provide reference for improving the clinical maturation rate of AVF and the treatment effect in hemodialysis patients.

Ferroptosis is an iron-dependent programmed cell death. Iron overload and lipid reactive oxygen accumulation play a core role in the occurrence and development of ferroptosis. Any factors affecting the balance of iron metabolism and redox system may induce and aggravate ferroptosis. Ferroptosis is involved in the pathological process of acute kidney injury, diabetic nephropathy, renal interstitial fibrosis and some other kidney diseases, and inhibiting ferroptosis has potential renoprotective benefits. This article reviewed the pathophysiological mechanism of ferroptosis and its research progress in renal diseases, and discussed the application prospect of targeted ferroptosis in the treatment of renal diseases.

In recent years, rituximab has been gradually used in the treatment of idiopathic membranous nephropathy (IMN). Compared with traditional treatments, the safety and effectiveness of rituximab in the treatment of IMN have been confirmed, which induces remission in 60%-80% of patients. For the remaining 20%-40% patients, several mechanisms can explain rituximab resistance: decreased rituximab bioavailability; internalized by targeted B cells; the generation of anti-rituximab antibody; chronic and irreversible damage to the glomerular filtration barrier; autoreactive B-cell clones in secondary lymphoid organs that cannot be effectively eliminated. The treatment of patients with rituximab-refractory IMN remains controversial and challenging. The recognition of IMN as an antibody-mediated autoimmune disease has rationalized the use of immunosuppressive drugs such as B cell-targeted therapies, plasma cell-targeted therapies, and complement inhibitors. This review mainly summarizes recent advances in the understanding of the physiological mechanisms of rituximab resistance, and in the management of rituximab-refractory IMN, aiming to aid in the clinical management of IMN.

Objective To construct the risk prediction nomogram model of acute kidney injury (AKI) with R language and traditional statistical methods based on the large sample clinical database, and verify the accuracy of the model. Methods It was a a retrospective case control study. The patients who met the diagnostic criteria of AKI in Tongji Hospital of Tongji University from January 1 to December 31, 2021 were screened in the clinical database, and the patients with monitored serum creatinine within 48 hours but without AKI were included as the control group. The demographic data, disease history, surgical history, medication history and laboratory test data were collected to screen the risk factors of AKI in clinic.Firstly, based on multivariate logistic regression analysis and forward stepwise logistic regression analysis, the selected risk factors were included to construct the nomogram model. At the same time, cross validation, bootstrap validation and randomly split sample validation were used for internal verification, and clinical data of patients in the sane hospital after one year (January to December, 2022) were collected for external verification. The receiver-operating characteristic curve was used to determine the discrimination of the model, and calibration curve and decision curve analysis were carried out to evaluate the accuracy and clinical net benefit, respectively. Results A total of 5 671 patients were enrolled in the study, with 1 884 AKI patients (33.2%) and 3 787 non-AKI patients (66.7%). Compared with non-AKI group, age, and proportions of surgical history, renal replacement therapy, hypertension, diabetes, cerebrovascular accident,chronic kidney disease, drug use histories and mortality in AKI group were all higher (all P<0.05). Multivariate logistic regression analysis showed that the independent influencing factors of AKI were surgical history, hypertension, cerebrovascular accident, diabetes, chronic kidney disease, diuretics, nitroglycerin, antidiuretic hormones, body temperature, serum creatinine, C-reactive protein, red blood cells, white blood cells, D-dimer, myoglobin, hemoglobin, blood urea nitrogen, brain natriuretic peptide, aspartate aminotransferase, alanine aminotransferase, triacylglycerol, lactate dehydrogenase, total bilirubin, activated partial thromboplastin time, blood uric acid and potassium ion (all P<0.05). Finally, the predictive factors in the nomogram were determined by forward stepwise logistic regression analysis, including chronic kidney disease, hypertension, myoglobin, serum creatinine and blood urea nitrogen, and the area under the curve of the prediction nomogram model was 0.926 [95% CI 0.918-0.933, P<0.001]. The calibration curve showed that the calibration effect of nomogram was good (P>0.05). The decision curve showed that when the risk threshold of nomogram model was more than 0.04, the model construction was useful in clinic. In addition, the area under the curve of receiver-operating characteristic curve predicted by nomograph model in external validation set was 0.876 (95% CI 0.865-0.886), which indicated that nomograph model had a high discrimination degree. Conclusion A nomogram model for predicting the occurrence of AKI is established successfully, which is helpful for clinicians to find high-risk AKI patients early, intervene in time and improve the prognosis.

Objective To explore the prevalence and independent associated factors of vascular calcification (VC) in non-dialysis chronic kidney disease (CKD) patients of stage 3-5. Methods It was a single-center cross-sectional observational study. Non-dialysis stage 3-5 CKD patients ≥18 years old who were admitted to the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University from May 1, 2022 to December 31, 2022 with VC evaluation were enrolled. The patients' general information, laboratory examination and imaging data were collected. Coronary artery calcification (CAC), thoracic aorta calcification (TAC), abdominal aorta calcification (AAC), carotid artery calcification and aortic valve calcification (AVC) were evaluated by cardiac-gated electron-beam CT (EBCT) scans, lateral lumbar x-ray, cervical macrovascular ultrasound and echocardiography, respectively. The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared, and the prevalence of VC at different sites of patients in different age groups [youth group (18-44 years old), middle-aged group (45-64 years old) and elderly group (≥65 years old)] and patients with or without diabetes were compared. Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas. Results A total of 206 patients aged (51±14) years were included, including 129 (62.6%) males. There were 44 patients with CKD stage 3 (21.4%), 51 patients with CKD stage 4 (24.8%), and 111 patients with CKD stage 5 (53.9%). CKD was caused by chronic glomerulonephritis [104 cases (50.5%)], diabetic kidney damage [35 cases (17.0%)], hypertensive kidney damage [29 cases (14.1%)] and others [38 cases (18.4%)]. Among 206 patients, 131 (63.6%) exhibited cardiovascular calcification, and the prevalence of CAC, TAC, AAC, carotid artery calcification, and AVC was 37.9%, 43.7%, 37.9%, 35.9% and 9.7%, respectively. The overall prevalence of VC in young, middle-aged and elderly patients was 24.6%, 73.6% and 97.4%, respectively. With the increase of age, the prevalence of VC in each site gradually increased, and the increasing trend was statistically significant (all P<0.001). The overall prevalence of VC in CKD patients with diabetes was 92.5% (62/67), and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes (all P<0.001). Multivariate logistic regression analysis revealed that age (every 10 years increase, OR=2.51, 95%CI 1.77-3.56, P<0.001), hypertension (OR=5.88, 95%CI 1.57-22.10, P=0.009), and diabetes (OR=4.66, 95%CI 2.10-10.35, P<0.001) were independently correlated with CAC; Age (every 10 years increase, OR=6.43, 95%CI 3.64-11.36, P<0.001) and hypertension (OR=6.09, 95%CI 1.33-27.84, P=0.020) were independently correlated with TAC; Female (OR=0.23, 95%CI 0.07-0.72,P=0.011), age (every 10 years increase, OR=3.90, 95%CI 2.42-6.29, P<0.001), diabetes (OR=5.37, 95%CI 2.19-13.19, P<0.001) and serum magnesium (OR=0.01,95%CI 0-0.35, P=0.014) were independently correlated with AAC. Moreover, age and diabetes were independently correlated with carotid artery calcification, AVC and overall VC Conclusions The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%, of which CAC reaches 37.9%, TAC is the most common one (43.7%), while AVC is the least one (9.7%). Age and diabetes are the independent associated factors for VC of all sites except TAC, while hypertension is an independent associated factor for both CAC and TAC.

Erythroferrone is a newly discovered and important factor regulating iron homeostasis and mainly produced by erythroblasts. Erythroferrone responds to the increase of erythropoietin and regulates plasma iron level, along with the absorption and utilization of iron via hepcidin, which plays an important role in the pathophysiology of iron metabolism-related diseases. Erythropoietin deficiency and iron metabolism disturbance are prominent features of renal anemia complicated with chronic kidney disease. Accordingly, erythroferrone is corresponding to the pathogenesis, treatment and prognosis of renal anemia. The in-depth study contributes to the further understanding of the mechanism related to iron metabolism disorder, and erythroferrone is also expected to be used as a valuable biomarker in the detection of renal anemia and the evaluation of therapeutic response. The article systematically reviews the physiological function of erythroferrone and its research progress in iron metabolism and renal anemia.

Objective To establish a predictive risk model for acute kidney injury (AKI) in acute myocardial infarction (AMI) patients based on machine learning algorithm and compare with a traditional logistic regression model. Methods It was a retrospective study. The demographic data, laboratory examination, treatment regimen and medication of AMI patients from July 2011 to December 2016 in Beijing Anzhen Hospital, Capital Medical University were collected. The diagnostic criteria of AKI were based on the AKI diagnosis and treatment guidelines published by Kidney Diseases: Improving Global Outcomes in 2012. The selected AMI patients were randomly divided into training set (70%) and internal test set (30%) by simple random sampling. SelectFromModel and Lasso regression models were used to extract clinical parameters as predictors of AKI in AMI patients. Logistic regression model (model A) and machine learning algorithm (model B) were used to establish the risk prediction model of AKI in AMI patients. DeLong method was used to compare the area under the receiver-operating characteristic (ROC) curve (AUC) between model A and model B for selecting the best model. Results A total of 6 014 AMI patients were included in the study, with age of (58.4±11.7) years old and 3 414 males (80.5%). There were 674 patients (11.2%) with AKI. There were 4 252 patients (70.7%) in the training set and 1 762 patients (29.3%) in the test set. The selected twelve clinical parameters by the SelectFromModel and Lasso regression models included the number of myocardial infarctions, ST-segment elevation myocardial infarction, ventricular tachycardia, third degree atrioventricular block, decompensated heart failure at admission, admission serum creatinine, admission blood urea nitrogen, admission peak creatine kinase isoenzyme, diuretics, maximum daily dose of diuretics, days of diuretic use and statins. Logistic regression prediction model showed that AUC for the test set was 0.80 (95% CI 0.76-0.84). The machine learning algorithm model obtained AUC in the test set with 0.82 (95% CI 0.78-0.85).There was no significant difference in AUC between the two models (Z=0.858, P=0.363), and AUC of the machine learning algorithm predictive model was slightly higher than that of the traditional logistic regression model. Conclusions The prediction effect of AKI risk in AMI patients based on machine learning algorithm is similar to that of traditional logistic regression model, and the prediction accuracy of machine learning algorithm is better. The introduction of machine learning algorithm model may improve the ability to predict AKI risk.

Common complications related to nutritional metabolism and somatic function in chronic kidney disease patients include protein-energy wasting, sarcopenia, and frailty. These three complications are different and closely related. This article reviews recent research progress on the definitions, epidemiology, diagnosis and evaluation, underlying causes, intervention measures and their differences and connections of chronic kidney disease in conjunction with protein-energy wasting, sarcopenia and frailty, to help clinicians identify them and personalize interventions.

Objective To evaluate the efficacy and safety of sacubitril?valsartan (SV) in reducing blood pressure in patients with non-dialysis-dependent chronic kidney disease(NDD-CKD) stage 3-5 and concomitant hypertension. Methods It was a retrospective study. Adult NDD-CKD stage 3-5 patients with hypertension treated with SV alone or in combination with SV on the basis of 2 to 4 antihypertensive drugs having unsatisfactory effects from March 1, 2022 to June 30, 2023 in Zhongda Hospital Affiliated to Southeast University were included. SV doses ranged from 25 mg once daily to 200 mg twice daily. The primary outcome was blood pressure control. The changes of blood pressure and laboratory examination indexes between baseline and 1 to 2 months after SV treatment were compared, and adverse events were also recorded. Results A total of 37 NDD-CKD stages 3-5 patients with hypertension were included in the study, with age ranging from 29 to 85 years old, and 15 males (40.5%). The SV duration of medication was 1 (1, 1) month. At the study endpoint, there was a significant decrease in mean systolic blood pressure, diastolic blood pressure, and pulse pressure from baseline, with reduction of 20.4 (9.6, 28.8) mmHg (1 mmHg=0.133 kPa, Z=-5.243, P<0.001), (6.9±7.6) mmHg (t=5.532, P<0.001), and 13.0 (8.0, 18.8) mmHg (Z=-4.941, P<0.001), respectively. During the study period, 8 patients (21.6%) experienced worsening of renal function, and there were no statistically significant differences in the changes of serum creatinine and estimated glomerular filtration rate before and after treatment (Z=-0.487, P=0.626; Z=-0.110, P=0.912, respectively). No adverse drug reactions such as hyperkalemia, symptomatic hypotension, angioedema, hepatic impairment, and decreased hemoglobin level were observed during the study period. Conclusion SV effectively lowers blood pressure in NDD-CKD stage 3-5 patients with hypertension and exhibits good safety.

Objective To analyze the status of anemia at the beginning of dialysis in maintenance hemodialysis (MHD) adult patients, and to explore the relationship between early dialysis anemia and early survival and long-term survival. Methods It was a retrospective cohort study. The baseline demographic and clinical data of newly admitted MHD patients from January 1, 2013 to December 31, 2020 were retrospectively analyzed. According to the hemoglobin (Hb) level at the beginning of dialysis, the patients were divided into high Hb group (Hb≥110 g/L), middle Hb group (80 g/L≤Hb<110 g/L) and low Hb group (Hb<80 g/L). The baseline data among the three groups were compared, and the changing trend of Hb level in MHD patients during the 8 years was analyzed. The follow-up ended at peritoneal dialysis, kidney transplantation, death or on December 31, 2021. All-cause death event within 6 months after the initiation of dialysis was defined as early death, while all-cause death event more than 6 months after the initiation of dialysis was defined as long-term death. Kaplan-Meier survival curve was used to analyze the survival rate, and log-rank test was used to compare the survival rates among the three groups. Multivariate Cox regression analysis model was used to analyze the association between anemia (Hb<110 g/L) at the beginning of dialysis and both early and long-term mortality. Results A total of 36 216 MHD patients were included in this study, with age of (61.3±15.5) years old and 22 163 males (61.20%). The Hb at the beginning of dialysis was (89.33±20.89) g/L. The compliance rate of Hb (≥110 g/L) was 16.43% (5 952/36 216). There were 12 232 patients (33.78%), 18 032 patients (49.79%), and 5 952 patients (16.43%) in low Hb group, middle Hb group, and high Hb group, respectively. There were statistically significant differences in gender distribution, age, serum creatinine, blood phosphorus, blood calcium, C-reactive protein, intact parathyroid hormone, blood leukocytes, platelets, serum albumin, triglyceride, total cholesterol, and proportions of chronic glomerulonephritis, diabetic nephropathy, diabetes mellitus, cardiovascular and cerebrovascular diseases, tumors, emporary catheter, long-term catheter and autologous arteriovenous fistula among the three groups (all P<0.05). During the 8-year period, the Hb level had an increased trend steadily each year, and Hb was (88.48±22.07) g/L, (88.52±21.43) g/L, (87.86±21.29) g/L, (88.93±20.69) g/L, (88.87±20.69) g/L, (90.03±20.47) g/L, (90.74±20.31) g/L and (90.31±20.54) g/L year by year. There were 2 176 early deaths (6.01%), and 6 557 long-term deaths (18.10%) by the end of follow-up. Kaplan-Meier survival curve showed that early survival rate of low Hb group was significantly lower than those of high Hb group (log-rank test, χ²=57.115, P<0.001) and middle Hb group (log-rank test, χ²=49.918, P<0.001), and long-term survival rates of low Hb group (log-rank test, χ²=107.097, P<0.001) and middle Hb group (log-rank test, χ²=47.430, P<0.001) were significantly lower than that of high Hb group. Multivariate Cox regression analysis showed that Hb<80 g/L at the beginning of dialysis was an independent influencing factor of early death (Hb ≥110 g/L as a reference, HR=1.307, 95% CI 1.096-1.559), and 80 g/L≤Hb<110 g/L and Hb<80 g/L at the beginning of dialysis were the independent influencing factors of long-term death (Hb≥110 g/L as a reference, HR=1.108, 95% CI 1.021-1.203; HR=1.228, 95% CI 1.127-1.339, respectively) in MHD patients. Conclusions The compliance rate of Hb at the beginning of dialysis in MHD patients is low. Hb <80 g/L at the beginning of dialysis is an independent risk factor of early death, and Hb <110 g/L at the beginning of dialysis is an independent risk factor of long-term death in MHD patients.

The identification of pathogenic antigens in membranous nephropathy (MN) is a hot topic in the research field of kidney diseases. In recent years, the widespread application of mass spectrometry has brought a breakthrough in the identification of MN-pathogenic antigens. As the antigen spectrum continues to be refined, the diagnosis of MN has evolved from morphological level to molecular level. This article reviewed the research progress of currently identified antigens of MN, such as phospholipase A2 receptor (a major pathogenic antigen of primary MN), thrombospondin type 1 domain-containing 7A (a potential tumor-associated antigen), neural epidermal growth factor-like protein 1 (an antigen associated with various secondary factors), semaphorin 3B (an antigen specific to pediatric MN) and so on, and the pathogenic mechanisms and clinical significance of these antigens.