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.

Diabetes is a major risk factor for chronic kidney disease (CKD). Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, has been confirmed to have a definite renal and cardiovascular protective effect on diabetes mellitus with CKD. Long-term use can significantly reduce the urinary albumin to creatinine ratio in patients with diabetes mellitus and has little effect on blood potassium. In order to make the clinical application of finerenone more reasonable and standardized, based on research evidence and clinical practice experience, the expert group formed the Chinese expert consensus on the use of finerenone in patients with diabetes mellitus and CKD after many discussions. The mechanism of action and pharmacological properties of finerenone, evidence-based medical evidence, suitable population, specific usage and precautions were described, and 27 recommendations were formed to provide reference for clinical use of finerenone and benefit patients.

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.

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.

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.

Systemic lupus erythematosus (SLE) is an autoimmune disease that causes damage to multiple vital tissues and target organs, and lupus nephritis (LN) is a serious complication of SLE involving the kidneys. The use of glucocorticoids and immunosuppressants has been dominant in the treatment strategy of LN, while their adverse effects have also raised concerns. In recent years, the development and use of biologics have provided new ideas for the treatment of LN and have also achieved positive efficacy in several clinical trials in SLE and LN. Biologics can be divided into monoclonal antibodies and recombinant proteins, which exert therapeutic effects on SLE and LN through a variety of mechanisms at the cellular-molecular level. In this article, we review recent research advances in the treatment of SLE and LN from the perspective of the different mechanisms of action of biologics.

为加强透析前期和初始透析慢性肾脏病（chronic kidney disease，CKD）患者的管理，《中国围透析期慢性肾脏病管理规范》专家组编写了本规范。规范首先提出“围透析期CKD”的概念及特征，其并发症发生率、病死率及治疗费用显著增高，同时肾小球滤过率快速降低，需要强化管理；接着本规范系统全面地阐述了围透析期CKD患者病情评估指标与频率、肾脏替代治疗时机与模式选择、透析充分性评估、围透析期常见并发症的诊断和处理；最后提出了围透析期CKD的未来研究方向。围透析期CKD管理一直是肾脏病临床的难点，本管理规范的制定、宣传及落实能够提高我国围透析期CKD患者的管理水平，从而对改善患者的存活率和生存质量、减轻医疗负担具有重要意义。

Objective To determine the prevalence of sarcopenia and explore related influencing factors of sarcopenia in maintenance hemodialysis (MHD) patients. Methods MHD patients aged ≥18 years old and receiving therapies of ≥3 months from March 2019 to December 2019 in Blood Purification Centre of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively enrolled in this study. General data of the patients were collected. Grip strength was measured by the Jamar dynamometer and the chair stand was measured by a chair of standard height to assess skeletal muscle strength and appendicular skeletal muscle mass was measured by dual energy X-ray absorptiometry. Baseline data between MHD patients with and without myasthenia were compared. Logistic regression analysis method was used to analyze the influencing factors for sarcopenia in MHD patients. Results A total of 125 MHD patients were enrolled, with 68 males (54.4%), age of (59.4±14.9) years and median dialysis age of 51.0(23.5, 101.0) months. Sarcopenia was diagnosed in 39 cases (31.2%). Compared with MHD patients without sarcopenia, age, tumor necrosis factor-α, von Willebrand factor (vWF) and proportion of using α ketones were higher, and serum carbondioxide combining power (CO₂CP), prealbumin, albumin and proportion of regular exercise were lower in MHD patients with sarcopenia (all P<0.05). Multivariable logistic regression analysis results showed that low CO₂CP (OR=0.717, 95%CI 0.576-0.892, P=0.003), high vWF (OR=1.037, 95%CI 1.016-1.058, P<0.001) and no regular exercise (OR=0.309, 95%CI 0.118-0.810, P=0.017) were independent influencing factors of sarcopenia in MHD patients. Conclusions The prevalence of sarcopenia in MHD patients is high. Low CO₂CP, high vWF and no regular exercise are independent influencing factors for sarcopenia in MHD patients.

糖尿病肾脏疾病（diabetic kidney disease，DKD）是我国常见病与多发病，同时也是引起终末期肾脏病的主要原因。因此，加强DKD防治具有重要意义。目前，国内外已颁布了多种有关糖尿病诊断、治疗、管理的临床指南或专家共识，其中也涉及了DKD诊疗的部分内容，但并不能满足肾科医生的需求。对DKD患者这一特殊人群，合理用药、规范诊疗、细化管理等问题仍有待解决。另外，随着医疗新技术的发展，有关DKD的知识不断更新，特别是新型药物的临床应用，拓展了DKD诊疗策略，因此有必要编写一部适用于中国人群的DKD诊疗指南。鉴于此，中华医学会肾脏病学分会组织了专家组编写了这部《DKD临床诊疗中国指南》。该指南参考了国内外相关指南与专家共识，整合了中国肾脏病专家的临床经验，系统地介绍了DKD诊断、肾脏病理活检、治疗与管理、合并症处理及常用药物的合理应用等问题。另外，专家组在编写过程中本着严谨、简明、权威的原则，参阅了国际指南格式，提出诊疗要点、逐条列证说明。该指南反映了当今DKD诊疗的新趋势、新观点，对进一步加强DKD认识、规范DKD诊疗体系、制定合理治疗原则、指导精准用药、延缓肾脏病进展、提高患者生活质量具有重要价值，可供广大医师在临床工作中参考。

Objective To investigate the effects of rituximab on lymphocytes and immunoglobulin in the treatment of focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD). Methods The subjects were FSGS and MCD patients admitted to Ruijin Hospital affiliated to Shanghai Jiaotong University on July 1, 2014 and July 1, 2019. All the enrolled patients were confirmed by clinical examination and renal biopsy, and received rituximab treatment (4 infusions of 375 mg/m² with the interval of 7-14 d). The levels of immunoglobulin IgA, IgG, IgM, and lymphocytes of CD19⁺, CD20⁺, CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺ and natural killer cells (CD56⁺CD16⁺) were compared between baseline and the third month, the sixth month, the ninth month and the twelfth month after treatment. Results Ninety-six patients with FSGS or MCD were enrolled in this study. The midian age was 28 years old (14-77 years old). The ratio of men to woman was 1.8∶1. There were 65 cases of MCD and 31 cases of FSGS. After rituximab treatment, the 24 h-proteinuria was significantly lower than that before treatment, and the serum albumin level was increased (both P<0.05). After rituximab treatment of 3 months, 6 months, 9 months and 12 months, CD19⁺ and CD20⁺ lymphocyte counts were significantly decreased (all P<0.01), and gradually recovered after 6 months. Compared with baseline, at 3, 6, 9, 12 months after rituximab treatment, the level of blood IgG was significantly increased (P=0.004,<0.001,<0.001,<0.001, respectively), and the level of blood IgM was significantly decreased (P<0.001, =0.008, =0.005,<0.001, respectively) but the median level still within the normal range (400-3 450 mg/L). The level of blood IgA was not significantly changed (all P<0.05). T lymphocytes (CD3⁺, CD3⁺CD4⁺ and CD3⁺CD8⁺) and natural killer cells (CD56⁺CD16⁺) showed no significant difference from baseline (all P>0.05). Conclusions Rituximab can effectively eliminate CD19⁺ and CD20⁺ lymphocytes, and has little influence on peripheral blood lymphocyte count and immunoglobulin level except CD19⁺ and CD20⁺ lymphocytes. The standard administration of rituximab is safe for patients with FSGS and MCD.

Objective To investigate the clinicopathological characteristics and influencing factors of kidney prognosis in primary IgA nephropathy (IgAN) patients. Methods The data of primary IgAN patients diagnosed with renal biopsy in the First Affiliated Hospital of Anhui Medical University from January 2015 to September 2019 were retrospective analyzed. According to the level of baseline estimated glomerular filtration rate (eGFR) when performing renal biopsy, the patients were divided into group A[eGFR≥90 ml·min^-1·(1.73 m²)^-1], group B[eGFR 61-89 ml·min^-1·(1.73 m²)^-1] and group C[eGFR≤60 ml·min^-1·(1.73 m²)^-1]. The clinical and pathological data were collected and compared among the three groups. Kaplan-Meier method was conducted for renal results, whereas the Cox proportional-hazards regression model was exploited to analyze the influencing factors of kidney prognosis in IgAN patients. Results A total of 742 patients were included in the study, including 394 cases (53.1%) in group A, 203 cases (27.4%) in group B, and 145 cases (19.5%) in group C. There were 325 males (43.8%) and 417 females (56.2%). The median duration of renal biopsy was 6 (1, 24) months, and the median age was 36 years old (18-68 years old). As the baseline level of renal function decreased, the proportion of patients with nephrotic syndrome, hypertension, anemia and hyperuricemia and the levels of 24 h urinary protein, serum triglyceride and total cholesterol increased significantly (all P<0.05), while the proportion of gross hematuria episodes and the ratio of serum albumin to globulin significantly decreased (all P<0.05). For the aspect of pathological manifestations, the proportions of cell proliferation in capillaries (E1), segmental sclerosis or adhesion (S1), renal tubular atrophy or interstitial fibrosis (T1/2), globular sclerosis, renal arteriole wall thickening and vitreous degeneration, Lee's gradeⅣ andⅤ increased with the decrease of baseline renal function (all P<0.05). Kaplan-Meier analysis showed that the cumulative renal survival rate decreased with the decline of baseline renal function (Log-rank χ²=88.510, P<0.001). As a result of multivariate Cox regression analysis, nephrotic syndrome (HR=2.399, 95%CI 1.054-5.459, P=0.037), hypertension (HR=1.806, 95%CI 1.071-3.048, P=0.027), low baseline eGFR (taking group A as the reference, group B: HR=2.383, 95%CI 1.053-5.392, P=0.037; group C: HR=6.878, 95%CI 3.074-15.393, P<0.001), IgG deposition (HR=2.224, 95%CI 1.384-3.574, P=0.001) and globular sclerosis (HR=2.075, 95%CI 1.230-3.501, P=0.006) were the independent influencing factors for renal progression in primary IgAN patients. Conclusions The level of baseline renal function in primary IgAN patients can be used to predict the extent of clinic-pathological damage. Nephrotic syndrome, hypertension, low baseline eGFR, IgG deposition and globular sclerosis are the independent influencing factors for renal progression in primary IgAN patients.

Objective To explore the relationship between end-dialysis over-weight (edOW) in initial stage of hemodialysis and long-term prognosis in maintenance hemodialysis patients. Methods The data of initial uremia patients receiving hemodialysis in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017 were retrospectively analyzed. The end point of follow-up was death or until April 30, 2018. The general data including age, gender, body mass index, primary disease, complications and laboratory indicators of the patients and the related parameters of dialysis from four to twelve months were collected. Kaplan-Meier method was used to analyze survival rate. Cox multivariate regression was used to analyze the relationship between edOW and all-cause mortality and cardiovascular disease (CVD) mortality. Results A total of 469 patients (300 males, 64.0%) were enrolled, with age of (56.9±17.1)years old. During the follow-up period of (4.1±2.4) years (1.0-10.3 years), 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.1%(45/102). The value of edOW was (0.28±0.02) kg. The patients were divided into edOW<0.28 kg group (n=292) and edOW≥0.28 kg group (n=177) according to the mean value of edOW. Kaplan-Meier survival analysis showed that the long-term survival rate in edOW<0.28 kg group was higher than that in edOW≥0.28 kg group (Log-rank χ²=4.134, P=0.043), and the CVD mortality in edOW≥0.28 kg group was significantly higher than that in edOW<0.28 kg group (Log-rank χ²=11.136, P=0.001). Cox multivariate regression analysis showed that high edOW was an independent influencing factor for all-cause death and CVD death in hemodialysis patients (HR=1.541, 95%CI 1.057-2.249, P=0.025; HR=1.930, 95%CI 1.198-3.107, P=0.007). Conclusion High edOW in early phase is an independent influencing factor of all-cause and CVD death in hemodialysis patients.

Objective To investigate the level of trimethylamine N-oxide (TMAO), one of gut metabolites, in patients undergoing maintenance hemodialysis (MHD) accompanied by congestive heart failure (HF) and its influencing factors. Methods Those patients of 18-75 years old who received three or more times of hemodialysis sessions per week for three months or longer during Nov 2018 and Mar 2019 were enrolled. Those attended health checkup at the same time without obvious kidney abnormality served as non-kidney disease controls. Serum TMAO concentrations were measured using high-performance liquid chromatography electrospray ionization-tandem mass spectrometry (HPLC-ESI-MS/MS). The levels of TMAO were compared between patients on hemodialysis and controls, between those with heart failure and without heart failure using logrithmically transformed TMAO (lnTMAO). Linear regression analysis was performed to investigate factors influencing TMAO levels. Results A total of 195 patients undergoing MHD and 40 controls were enrolled. Among them, 30 hemodialysis cases (15.4%) manifested as heart failure symptoms and /or left ventricular ejection fraction less than 50%. Males accounted for 67.2% in patients on hemodialysis and 37.5% in controls (χ²=12.426, P<0.001) respectively, while the median ages in both groups were 62.0(48.0, 71.0), 45.0(33.3, 55.0) years old respectively (Z=5.685, P<0.001). TMAO concentrations were significantly higher in patients on hemodialysis than controls [5.54(3.84, 8.91) mg/L vs 0.17(0.11, 0.30) mg/L, after log transformed, t=21.687, P<0.001]. However, there was no statistically significant difference between those with heat failure and those without in male [63.3% vs 67.9%, χ² =0.238, P=0.626], age [64.5(56.8, 71.0) years old vs 61.0(47.0, 72.0) years old, Z=0.894, P=0.372] and TMAO [5.17(3.30, 9.46) mg/L vs 5.57(3.87, 8.95) mg/L, after log transformed, t=-1.537, P=0.135]. Multivariate linear regression analysis demonstrated that in all the participants, serum urea was the main risk factor for TMAO [standardized coefficient (SB)=0.483]. lnTMAO=0.078×[serum urea(mmol/L)]+0.001×[serum creatinine (μmol/L)]-0.002×[serum uric acid (μmol/L)]-0.003×[platelet (×10⁹/L)]+0.014×[age (years old)]+0.344 (if diabetic)-1.266. While in those undergoing MHD, ultrafiltration volume had the most significant effect on TMAO levels (SB=0.279). lnTMAO=0.249×[ultrafiltration volume(L)]+0.059×[serum albumin (g/L)]+0.008×[age (years old)-0.526 (if heart failure existed)-1.865. Conclusions MHD patients have gut dysbiosis, while those hemodialysis patients accompanied by heart failure may have peculiar gut microbiota which induces lower serum TMAO levels than those without heart failure after adjusting for multiple related factors. Serum TMAO levels may be associated with ultrafiltration volume and nutrition status etc.

Objective To investigate the correlation between body composition and cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Methods CKD patients who were hospitalized in the Department of Nephrology of Chongqing General Hospital from January 2017 to December 2019 and had complete clinical biochemical data were divided into CKD patients with CVD and CKD patients without CVD according to their medical history and corresponding auxiliary examinations. Clinical data were collected and anthropometric measurements were conducted. Skeletal muscle index (SMI), appendage lean mass/height², total body fat (TBF), visceral adipose tissue (VAT), bone mineral capacity, bone mineral density and et al, were measured by dual-energy X-ray absorptiometry. T test, U test and Chi-square test were used for statistical analysis. Logistic regression was used to analyze the relationship between body composition and CVD. Results A total of 604 CKD patients were included in this study, including 560 patients (92.7%) with CKD stage 3, 44 patients (7.3%) with CKD stage 4, and 180 CKD patients with CVD (29.8%), 424 CKD patients without CVD (70.2%). Compared with CKD patients without CVD, the proportion of men, the proportion of hypertension, the proportion of diabetes, age, duration of CKD, systolic blood pressure, blood uric acid, waist to hip ratio and waist circumference were higher (all P<0.05), while low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, and estimated glomerular filtration rate (eGFR) were lower in CKD patients with CVD (all P<0.05). In terms of body composition, SMI (t=-11.964, P<0.001) and body mass index (t=-4.462, P<0.001) in CKD patients with CVD were significantly lower than those in CKD patients without CVD, but VAT (t=3.089, P=0.002) and TBF (t=5.177, P<0.001) in CKD patients with CVD were significantly higher. After adjusting for confounders such as age, CKD duration, hypertension history, diabetes history, LDL-C, body mass index, eGFR, TBF, etc. by multivariate logistic regression analysis, the risk of CKD patients suffering from CVD increased significantly with the decrease of SMI [with SMI high tertile (36.37%-50.80%) as reference, SMI middle tertile (28.23%-36.31%): OR=1.49, 95%CI 1.24-1.71, P=0.003; SMI low tertile (15.28%-28.19%): OR=2.17, 95%CI 1.79-2.62, P<0.001], and VAT was not found to be associated with the risk of CVD in CKD patients (P>0.05). Conclusion Reduction of SMI is independently associated with CVD in CKD patients.

Objective To understand the comprehensive geriatric assessment (CGA) scores in chronic kidney disease (CKD) patients aged 65 years and older, and analyze the related influencing factors of quality of life. Methods A total of 189 patients who were over 65 years old and diagnosed with CKD in the Department of Nephrology of Shanxi Provincial People's Hospital from October 2016 to October 2019 were included retrospectively. The patients were divided into dialysis group (n=90 cases) and non-dialysis group (n=99 cases) according to whether dialysis or not. The concise CGA scores included age, basic activities of daily living (BADL), instrumental activities of daily living (IADL), and modified cumulative illness rating score for geriatrics (MCIRS-G). Pearson correlation analysis was used to analyze the relationship between different scale scores and clinical indexes. Multiple linear regression analysis was used to further analyze independent related factors of the quality of life in elderly CKD patients. Results Compared with the non-dialysis group, the BADL score and IADL score in the dialysis group were significantly reduced [(70.00±33.28) vs (93.38±14.32), t=6.166, P<0.001；(9.78±7.12) vs (15.95±5.74), t=6.520, P<0.001], while the MCIRS-G score was significantly increased [(31.13±4.00) vs (27.29±5.17), t=-5.741, P<0.001]. Linear regression analysis performed on the data of non-dialysis group patients showed that estimated glomerular filtration rate (eGFR), serum uric acid (SUA), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), blood potassium and chlorine were positively correlated with BADL and IADL scores (all P<0.05). B-type natriuretic peptide (BNP) was negatively correlated with BADL score (P<0.01). BNP and age were negatively correlated with IADL score (both P<0.05). Fasting blood glucose (FBG) was positively correlated with MCIRS-G or MCIRS-G other than kidney (both P<0.05), and eGFR, SUA, total cholesterol, and HDL-C were negatively correlated with MCIRS-G or MCIRS-G other than kidney (all P<0.05). Multiple linear regression analysis showed that eGFR was an independent influencing factor for BADL (P<0.01). Age and eGFR were independent influencing factors for IADL (both P<0.05). Conclusions The decline of quality of life in elderly CKD patients is related with eGFR, SUA, age, BNP and HDL-C levels, and eGFR and age are independent influencing factors.

Objective To investigate the effects and underlying mechanisms of phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/NF-κB signaling pathway in human kidney-2 (HK-2) cells of hyperuricemic nephropathy. Methods HK-2 cells were cultured in vitro and randomly divided into control group and experimental group. The experimental group was induced by high uric acid (720 μmol/L) immersion for 48 h to establish a cell model of hyperuricemic nephropathy in vitro and subsequently divided into hyperuricemic group, overexpressed protease activated receptor 2 (PAR2) and knockdown PAR2 group. The expressions of PAR2, PI3K, AKT, NF-κB mRNA were measured by real-time PCR. The expressions of PAR2, PI3K, AKT and NF-κB protein were measured by Western blotting. The expressions of tumor necrosis factor-α (TNF-α), monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6), pro-interleukin-1β (pro-IL-1β), interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) were detected by enzyme linked immunosorbent assay (ELISA). Results (1) Compared with the control group, the expressions of PAR2, PI3K, AKT and NF-κB mRNA and protein in hyperuricemic group were significantly increased (all P<0.05), the expressions of TNF-α, MCP-1, IL-6, pro-IL-1β, IL-1β and TGF-β1 in the supernatant in hyperuricemic group were significantly increased (all P<0.01). (2) Compared with the hyperuricemic group, the expressions of PAR2, PI3K, AKT and NF-κB mRNA and protein in overexpressed PAR2 group were significantly increased (all P<0.05), the expressions of TNF-α, MCP-1, IL-6, IL-1β and TGF-β1 in the supernatant were significantly increased (all P<0.05). (3) Compared with the hyperuricemic group, the expression of PAR2, PI3K, AKT and NF-κB mRNA and protein in knockdown PAR2 group were significantly decreased (all P<0.05), the expressions of IL-6, pro-IL-1β, IL-1β and TGF-β1 in the supernatant were significantly decreased (all P<0.05). Conclusions In the process of uric acid-induced HK-2 cell damage, uric acid significantly up-regulates the expression of PI3K/AKT/NF-κB signaling pathway by activating PAR2, leading to a marked increase in inflammatory damage. Knocking down PAR2 inhibits the expression of PI3K/AKT/NF-κB signaling pathway, which can effectively reduce the inflammatory damage of HK-2 cells.

重组人促红细胞生成素（rhuEPO）是治疗尿毒症肾性贫血的最常用药物，但rhuEPO可引起纯红细胞再生障碍性贫血（PRCA）。尿毒症合并PRCA临床上较为少见。我们报告1例用罗沙司他联合免疫抑制剂治疗尿毒症合并PRCA病例，患者贫血得到快速纠正，未见明显不良反应，出院后随访期间无复发。

Objective To investigate the effects of serum magnesium level on all-cause mortality and cardiovascular and cerebrovascular diseases mortality in maintenance hemodialysis (MHD) patients. Methods Clinical data of MHD patients in Shaoxing People's Hospital from June 1, 2016 to June 30, 2018 were collected retrospectively. The patients were divided into low magnesium group (serum magnesium≤0.96 mmol/L), medium magnesium group (serum magnesium 0.97-1.07 mmol/L) and high magnesium group (serum magnesium≥1.08 mmol/L) according to the tertile of mean serum magnesium level. The differences of clinical data and laboratory results were compared among the three groups. Kaplan-Meier method was used to draw the survival curves, and log-rank test was used to compare the survival rate differences. Multivariate Cox regression was used to analyze the relationship between serum magnesium and all-cause mortality and cardiovascular and cerebrovascular diseases mortality in MHD patients. Results A total of 332 patients [194 males (58.4%)] were included in this study, with a median age of 63(51, 72) years and a median follow-up time of 36(20, 45) months. Kaplan-Meier survival analysis showed that the all-cause survival rate and cardiovascular and cerebrovascular diseases survival rate in the low magnesium group were lower than those in the medium magnesium group and the high magnesium group (Log-rank χ²=36.286, P<0.001; Log-rank χ²=20.145, P<0.001; respectively). After adjusting for multiple confounding factors, the results of multivariate Cox regression analysis suggested that low serum magnesium was an independent risk factor for all-cause death and cardiovascular and cerebrovascular diseases death in MHD patients. The risk of all-cause death and cardiovascular and cerebrovascular diseases death in the low magnesium group were significantly higher than those in the high magnesium group (HR=2.925, 95%CI 1.352-6.330, P=0.006; HR=3.821, 95% CI 1.394-10.473, P=0.009; respectively). Conclusions Hypomagnesemia may be an independent risk factor for all-cause death and cardiovascular and cerebrovascular diseases death in MHD patients. Low serum magnesium level increases the risk of all-cause death and cardiovascular and cerebrovascular diseases in MHD patients.

肾脏在调节人体钾代谢中起着重要作用。肾衰竭患者易发生急性或慢性高钾血症；肾小管酸中毒、失盐性肾病等患者易发生低钾血症。无论高钾血症还是低钾血症均可引起细胞膜电位异常，导致四肢麻痹、心律失常甚至猝死等严重并发症。中华医学会肾脏病学分会专家组参考国内外最新文献，根据中国临床诊疗实践特点，围绕钾代谢的机制、低钾血症、高钾血症及慢性肾脏病患者血钾的监测四部分内容制定了《中国慢性肾脏病患者血钾管理实践专家共识》。本共识是我国首个指导慢性肾脏病（CKD）患者血钾异常综合性管理的临床共识，旨在引起广大肾科医师重视，为我国CKD患者血钾管理的规范化诊断和治疗提供指导性建议。

Objective To analyze the early mortality and related risk factors of new hemodialysis patients in Zhejiang province, and provide basis for reducing the death risk of hemodialysis patients. Methods The early mortality and related factors of new hemodialysis patients from January 1, 2010 to June 30, 2018 were retrospectively analyzed using the database of Zhejiang province hemodialysis registration. The early mortality was defined as death within 90 days of dialysis. Cox regression model was used to analyze the related risk factors of the early mortality in hemodialysis patients. Results The mortality was the highest in the first month after dialysis (46.40/100 person year), and gradually stabilized after three months. The early mortality was 25.33/100 person year. The mortality within 120 days and 360 days were 21.40/100 person year and 11.37/100 person year, respectively. The elderly (≥65 years old, HR=1.981, 95%CI 1.319-2.977, P<0.001), primary tumor (HR=3.308, 95%CI 1.137-5.624, P=0.028), combined with tumors (not including the primary tumor, HR=2.327, 95%CI 1.200-4.513, P=0.012), temporary catheter (the initial dialysis pathway, HR=3.632, 95%CI 1.806-7.307, P<0.001), lower albumin (<30 g/L, HR=2.181, 95%CI 1.459-3.260, P<0.001), lower hemoglobin (every 0.01 g/L increase, HR=0.861, 95%CI 0.793-0.935, P=0.001), lower high density lipoprotein (<0.7 mmol/L, HR=1.796, 95%CI 1.068-3.019, P=0.027) and higher C reactive protein (≥40 mg/L, HR=1.889, 95%CI 1.185-3.012, P=0.008) were the risk factors of early death for hemodialysis patients. Conclusions The early mortality of hemodialysis patients is high after dialysis, and gradually stable after 3 months. The elderly, primary tumor, combined with tumors, the initial dialysis pathway, lower albumin, lower hemoglobin, lower high density lipoprotein and higher C reactive protein are the risk factors of early death for hemodialysis patients.

功能良好的血管通路是进行血液透析治疗的必备条件。随着终末期肾脏病患者逐渐增多、透析龄延长以及糖尿病、高血压等合并症的比例逐渐增加，血管通路的建立、使用和维护已经成为不容忽视的临床问题，能否建立并维护功能良好的血管通路对终末期肾脏病患者的预后至关重要。近期，美国肾脏病基金会（NKF）所属“肾脏病预后质量倡议（KDOQI）”发布了血管通路临床实践指南的2019年更新。该指南在理念和策略上较2006年更新有了较大变化。我们对该指南进行了解读和探讨，以期有助于国内血管通路工作者理解该指南的核心内容，推动我国血管通路事业的发展。

Objective To compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) in end-stage renal disease (ESRD) patients without diabetes mellitus and identify related influencing factors. Methods Patients who started hemodialysis with an arteriovenous graft or fistula or PD in the First Affiliated Hospital of Zhengzhou University from January 1, 2013 to February 1, 2019 were included. They were followed up until May 1, 2019. The patients were divided into HD group and PD group according to the initial dialysis modality. Kaplan-Meier method was used to obtain survival curves, the Cox regression model was used to evaluate influence factors for survival rates, and the inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups. Results There were 371 patients with maintenance dialysis enrolled in this study, including 113 cases (30.5%) in HD group and 258 cases (69.5%) in PD group. At baseline, the scores of standard mean difference (SMD) in age, body mass index (BMI), combined with cerebrovascular disease, Charlson comorbidity index (CCI), blood potassium, plasma albumin and hemoglobin between the two groups were greater than 0.1. The score of SMD decreased after IPTW, and the most data were less than 0.1, which meant that the balance had been reached between the two groups. The Kaplan-Meier survival curve showed that the cumulative survival rates had no significant difference for all-cause death before using IPTW between the two groups (Log-rank χ²=0.094, P=0.759). After adjusting for confounders with IPTW, the Kaplan-Meier survival curve showed that the cumulative survival rates still had no significant difference for all-cause death between the two groups (Log-rank χ²=2.090, P=0.150). Univariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus for all-cause death (PD/HD, HR=1.171, 95%CI 0.426-3.223, P=0.760). Multivariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus (PD/HD, HR=1.460, 95%CI 0.515-4.144, P=0.477), and high plasma albumin (HR=0.893, 95%CI 0.813-0.981, P=0.019) was an independent protective factor for survival in ESRD patients without diabetes mellitus. There was still no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus after using IPTW (PD/HD, HR=1.842, 95%CI 0.514-6.604, P=0.348). Conclusion The difference of cumulative survival rates between HD and PD is not significant in ESRD patients without diabetes mellitus.

Objective To explore the clinical characteristics and risk factors of maintenance hemodialysis (MHD) patients combined with infection-related hospitalization. Methods Patients with MHD from December 1, 2013 to February 28, 2018 were retrospectively selected and then followed up for at least 1 year until February 28, 2019. Baseline data including demographic and clinical data of patients were collected. According to whether the infection-related hospitalization occurred, patients were divided into infection group and non-infection group. The clinical characteristics and related factors were compared between the two groups. Logistic regression model was used to analyze the influencing factors. Results A total of 392 patients were included in the study. Two hundred and fifty-five cases were males, accounting for 65.1%. The age was (59.39±15.28) years old. The infection rate of diabetic kidney disease patients was the highest (32.2%). The main site of infection was the lung, accounting for 78.4%, which was far higher than the catheter-related infection in the second position. After infection, quinolones and cephalosporins were often the preferred drugs. Compared with the non-infection group, the infection group had older age [(62.96±15.16) years vs (57.98±15.12) years, t=-2.607, P=0.004], higher proportion of comorbid diabetes (45.9% vs 32.4%, χ²=6.334, P=0.012) and previous smoking history (30.6% vs 18.5%, χ²=6.831, P=0.009), longer time of first dialysis stay [13.0(9.0, 18.0) d vs 12.0(9.0, 17.5) d, Z=3.659, P=0.001] and lower hemoglobin [(74.43±19.93) g/L vs (79.06±17.10) g/L, t=1.612, P=0.022], albumin [(32.63±5.33) g/L vs (33.99±6.14) g/L, t=2.062, P=0.029] and red blood cell count [2.53×10¹²/L (2.06×10¹²/L, 3.06×10¹²/L) vs 2.68×10¹²/L(2.28×10¹²/L, 3.07×10¹²/L), Z=2.118, P=0.034]. Multivariate logistic analysis found that older age (every 1 year, OR=1.016, 95%CI 1.003-1.030, P=0.017) and longer hospital stay at first dialysis (every 1 d, OR=1.047, 95%CI 1.014-1.080, P=0.008) were independent risk factors, and higher hemoglobin (every 1 g/L, OR=0.987, 95%CI 0.975-0.999, P=0.033) was a protective factor for infection-related hospitalization in MHD patients. Conclusions MHD patients with diabetic kidney disease have the highest infection incidence. The incidence of pulmonary infection is much higher than other types of infection such as catheter-related infection, urinary tract infection and sepsis. Aging and low hemoglobin are risk factors for MHD patients to prone to co-infection.

糖尿病（diabetes mellitus，DM）是全球关注的重大慢性病之一，目前我国糖尿病患病人数居全球首位。糖尿病肾病（diabetic kidney disease，DKD）是糖尿病最常见的严重微血管并发症之一，近年来患病率逐年攀升，已经超越原发性肾小球疾病，成为慢性肾脏病的首位病因。由于DKD发生机制复杂，其防治策略一直是国内外研究的热点，研究表明多种疗法在减少DKD患者尿蛋白排泄、延缓肾脏疾病进展中发挥重要作用。本文将从DKD基础治疗及新兴疗法两方面对DKD治疗的研究进展作一综述。

IgA肾病（IgA nephropathy，IgAN）是多基因、多因素参与的复杂疾病，其特征是糖基化异常的IgA1免疫复合物在肾小球系膜沉积并因此引起一系列炎性反应导致肾脏损伤。遗传和黏膜免疫异常在IgAN发病机制中起着关键作用，而免疫调节紊乱是该病发病机制的核心环节。近年来随着基因组高通量测序技术的进步，应用免疫组库测序技术分析T细胞受体或B细胞受体，初步揭示了IgAN相关免疫细胞的广泛激活和功能性克隆潜在的诊断和应用价值，为进一步探索干预IgAN新的靶标和精准个体化治疗奠定了基础。

Objective To analyze the clinicopathological features in diabetic kidney disease (DKD) and non-diabetic kidney disease (NDKD) patients, and provide reference for patients who will receive renal biopsy with diabetes mellitus complicated with chronic kidney disease. Methods The patients with type 2 diabetes mellitus complicated with chronic kidney disease who underwent renal biopsy were collected through the database at the Nanfang Hospital of Southern Medical University from February 2002 to June 2018. According to the results of renal biopsy, they were divided into DKD group and NDKD group (including DKD+NDKD). The clinical manifestations and pathological types were compared between the two groups. Results A total of 507 patients were eventually included in the study. There were 114 cases (22.5%) with DKD and 393 cases (77.5%) with NDKD. Pathologically, the most common pathological types of NDKD were membranous nephropathy (30.0%) and IgA nephropathy (19.1%). Among NDKD patients, 5.6% patients had DKD combing with NDKD. In term of the clinical manifestations, DKD patients had a longer history of diabetes (>1 year, 76.3% vs 36.1%, P<0.001), higher quantity of urinary protein [3.69(1.70, 6.74) g/24 h vs 2.21(0.91, 4.97) g/24 h, P<0.001], higher serum creatinine [117.5(85.8, 194.5) μmol/L vs 89.0(68.0, 143.8) μmol/L, P<0.001] than NDKD patients. But the hemoglobin [(105.07±20.85) g/L vs (124.41±25.02) g/L, P=0.002] and cholesterol [(5.69±1.87) mmol/L vs (6.43±2.75) mmol/L, P=0.001] in DKD patients were lower than those in NDKD patients. Logistic regression analysis showed that diabetes mellitus history (OR=4.162, 95%CI 1.717-10.098, P=0.002）, higer systolic pressure (every 1 mmHg, OR=1.028, 95%CI 1.011-1.045, P=0.001）, history of antihypertensive medication (OR=3.141, 95%CI 1.496-6.591, P=0.002), diabetic retinopathy (OR=5.561, 95%CI 2.361-13.100, P<0.001) and higher glycated hemoglobin level (every 1%, OR=1.680, 95%CI 1.333-2.118, P<0.001) were related factors of DKD, while hematuria (OR=2.781，95%CI 1.334-5.798，P=0.006) and higher hemoglobin level (every 1 g/L, OR=1.022, 95%CI 1.008-1.037, P=0.002) were related factors of NDKD. Conclusions There are differences in clinical manifestations and pathological types between DKD and NDKD. The history of diabetes, antihypertensive medication, fundus examination, higher of proteinuria and glycosylated hemoglobin may predict DKD, while hematuria and higher level of hemoglobin may have certain guiding significance for the diagnosis of NDKD. The indication of renal biopsy in patients with diabetes mellitus complicated with chronic kidney disease should include comprehensive clinical manifestations.

新型冠状病毒肺炎（COVID-19）是新近发现的乙类传染病，不仅表现为以病毒性肺炎为特征的呼吸系统病变，重症患者还合并肾脏、心脏、血液、神经系统等多系统器官损伤。该病自2019年12月在我国暴发以来，目前已蔓延至全球20多个国家和地区，被世界卫生组织（WHO）定义为国际关注的突发公共卫生事件。COVID-19与传染性重症急性呼吸综合征（severe acute respiratory syndrome，SARS，惯称“非典型肺炎”）和中东呼吸综合征（Middle East respiratory syndrome，MERS）均由冠状病毒感染引起，而急性肾损伤（acute kidney injury, AKI）是其重要的并发症之一，早期积极处理与防治十分重要。中华医学会肾脏病学分会专家组对该病合并AKI的流行病学、临床特点、诊断和治疗进行总结并提出有关建议，希望能引起广大肾科医师重视，不断提高本病的防治水平。

Objective To clarify the relationship between the hemoglobin level and renal tubular atrophy/interstitial fibrosis (T) in the Oxford stage of renal pathology in IgA nephropathy (IgAN) patients. Methods Patients diagnosed with IgAN by renal biopsy from January 1^st 2010 to December 31^st 2015 in Shenzhen Second People's Hospital with complete laboratory and imaging data were retrospectively analyzed. Patients were divided into anemic group and non-anemic group. The relationship between hemoglobin level and renal tubular atrophy/interstitial fibrosis was determined by logistic regression analysis. The possible curve relationship between hemoglobin and renal tubular atrophy/interstitial fibrosis was analyzed by smooth curve fitting analysis. The diagnostic value of hemoglobin for renal tubular atrophy/interstitial fibrosis was analyzed by the receiver operating curve (ROC). Results A total of 630 patients with IgAN were included in this study, 130 patients in the anemia group (20.63%) and 500 patients in the non-anemia group (79.37%). There was no statistically significant difference in age between the two groups, but the difference of the gender was statistically significant (male 35.38% vs 53.80%, χ²=10.740, P<0.001). Compared with the non-anemia group, the anemia group had a higher proportion of tubular atrophy/interstitial fibrosis ( χ²=62.586, P<0.001), higher 24 h urinary protein quantification (Z=-6.082, P<0.001), and lower eGFR (t=7.126, P<0.001). Multivariate logistic regression analysis showed that increasing hemoglobin level was an independent protective factor for reducing the risk of renal tubular atrophy/interstitial fibrosis (OR=0.973, 95%CI 0.958-0.987, P<0.001). Smooth curve fitting analysis showed that there was a linear negative correlation between hemoglobin and tubular atrophy/interstitial fibrosis. The ROC curve suggested that the best threshold of hemoglobin was 120.5 g/L when renal tubular atrophy/interstitial fibrosis occurred. That was, when hemoglobin was above 120.5 g/L, the severity level of renal tubular atrophy interstitial fibrosis might be reduced. Conclusion The incidence of renal tubular atrophy/ interstitial fibrosis is higher in IgAN patients with anemia, and hemoglobin>120.5 g/L may reduce the risk of tubular atrophy/interstitial fibrosis.

Objective To explore the clinical and cytogenetic characteristics and risk factors of multiple myeloma (MM) patients with renal impairment (RI). Methods A total of 113 newly diagnosed patients with MM in the department of nephrology and hematology in Zhongnan Hospital of Wuhan University from January 2013 to December 2017 were enrolled. The patients were divided into RI group and non-renal impairment (NRI) group according to whether serum creatinine (Scr) at the time of diagnosis was higher than 177 μmol/L. The clinical and laboratory data of two groups were compared. The risk factors of RI in MM patients were analyzed by binary logistic regression, and then the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of these risk factors. Results The incidence of RI in 113 MM patients was 34.5%. Compared with NRI group, levels of white blood cells, serum uric acid, blood urea nitrogen, neutrophil-to-lymphocyte ratio (NLR), cystatin C, β₂-microglobulin (β₂-MG), blood phosphorus, urine light chain, bone-marrow plasma cell percentage, International Staging System (ISS) stage III percentage, light chain type percentage, positive urinary Bence-Jones protein percentage and positive urinary protein percentage were higher in RI group, while levels of estimated glomerular filtration rate (eGFR), serum bicarbonate concentration and globulin were lower in RI group (all P<0.05). There were no significant differences in other clinical variables between the two groups (all P>0.05). Fluorescence in situ hybridization (FISH) was applied to 42 MM patients to detect the following five genetic abnormalities: IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion and P53 deletion. Among them, 29 (69.0%) patients were abnormal. The incidence of RB1 deletion in RI group was higher than NRI group (P<0.05), and there were no significant differences in the incidences of other genetic abnormalities (all P>0.05). Further logistic regression analysis showed that increase of NLR (OR=1.589, 95%CI 1.115-2.266, P=0.010), bone-marrow plasma cell percentage (OR=1.053, 95%CI 1.008-1.101, P=0.021) and β₂-MG (OR=22.166, 95%CI 2.146-228.927, P=0.009), light chain type (OR=15.399, 95%CI 1.002-236.880, P=0.049), and hyperuricemia (OR=11.707, 95%CI 1.580-86.717, P=0.016) were the independent risk factors for RI in MM patients. The comparison of area under the ROC (AUC) among these risk factors showed the AUC of β₂-MG was larger than that of NLR or uric acid (both P<0.05), while there were no significant differences in the rest of pairwise comparison (all P>0.05). The AUC of β₂-MG predicting RI was the largest (AUC=0.907, 95%CI 0.853-0.962, P<0.001). Conclusions MM patients have high morbidity of RI, and there are more RI patients with RB1 deletion in RI patients. Light chain type, hyperuricemia, high level of NLR, high bone-marrow plasma cell percentage and increased β₂-MG are the independent risk factors for RI in MM patients. Among them, β₂-MG is the best predictor for RI, and NLR plays an important role in predicting RI as a convenient and effective inflammatory marker.

慢性肾脏病（chronic kidney disease，CKD）患者随着肾功能下降，将会出现不同程度的心肺功能的下降、肌肉萎缩、生理、心理功能障碍，严重影响患者的生活质量（quality of life，QOL）。运动康复增加CKD 患者的心肺耐力、改善肌力和肌肉容积、降低心血管疾病风险、延缓CKD进展、提高QOL评分。适合CKD患者的运动康复处方，包括有氧运动、抗阻运动和灵活性运动，中等强度，每次30～60 min，3～5次/周。对CKD患者做好运动康复前的评估，制定个体化运动处方，对降低运动相关不良事件的风险尤为重要。

Objective To evaluate the prevalence of chronic kidney disease (CKD) in Chinese adult health check-up population, and to compare with the prevalence of CKD in the study of the general population as well as the large CKD cross-sectional study in China. Methods Epidemiological studies about CKD in Chinese adults health check-up population from January 2007 to December 2017 were searched in PubMed, SinoMed, CNKI, VIP and Wanfang Data. Meta-analysis of the prevalence of CKD was performed with software of Stata 12.0. Subgroup analyses of CKD staging, urban and rural, as well as geographical areas of the general population were executed. Results Twenty-two studies from adult health check-up population were included (238 349 persons). Egger's regression showed no publication bias (P＞0.05). The unstandardized prevalence rate of CKD was 12.49% (male 12.8%, female 12.5%). The respective unstandardized prevalences of proteinuria, hematuria and eGFR decline were 5.90%, 5.83% and 2.75%. The unstandardized prevalences of CKD in urban and rural population were 13.21% and 11.90%. The stages of CKD were mainly concentrated in the early stages. There was no significant difference in the non-standard detection rate of total eGFR decline among the adult medical examination population, the general population and the population studied cross-sectionally (P＞0.05). Furthermore, no significant difference in the non-standard detection rate of total hematuria and male hematuria was found between the adult health check-up population and the general population. In addition, the total proteinuric non-standard detection rate of the adult general population was similar with that of population studied cross-sectionally (P＞0.05). Conclusions The prevalence of CKD in Chinese adults is higher, the overall prevalence is however underestimated. The results of epidemiological investigation in adult health check-up population are similar to those of the general population, especially in men.

Objective To investigate vascular access modalities at initiation of hemodialysis for end stage renal disease (ESRD) patients in hospitals of different levels, and to analyze the reasons contributing to the absence of arteriovenous fistula (AVF) during initial hemodialysis. Methods A pre-designed questionnaire was used to collect the information of patients that entered hemodialysis within five years, including basic information and their first vascular access types, and analyze the factors that influence patients' AVF use. Results (1) According to the 203 questionnaires returned from 5 hospitals, central venous catheter (CVC) was chosen by 122 (60.1%) patients, direct arteriovenous puncture by 44 (21.7%) patients, AVF by only 35 (17.2%) patients, and long-term cuffed catheter by 2 (1.0%) patients. For patients in different hospitals, 61.7% of patients in Jiamusi Hospital used direct arteriovenous puncture, while CVC were used most in the other four hospitals. The leading reason contributing to the absence of AVF was patient's refusal [75 cases (44.6%)], among which patients regarding AVF psychologically unacceptable accounted for the most [44 cases (26.2%)]. Following that were 45 cases (26.8%), in which patients were uninformed of AVF and 38 cases (22.6%) caused by time limitation. (3) Logistic regression showed well-educated, female, and urban residential patients were more likely to choose AVF at initiation of hemodialysis. Conclusion The percentage of AVF utility at the start of hemodialysis remains low, with situation varying in different hospitals and regions. Multiple factors are associated with vascular access modalities, among which the influence of doctors cannot be ignored. More efforts should be spared on patient education to improve the dialysis quality of ESRD patients in China.

Objective To analysis the relationship between anemia and clinic outcomes retrospectively in maintenance hemodialysis patients for Renji Hospital, Shanghai Jiao Tong University School of Medicine, China. Methods This study enrolled all maintenance hemodialysis（MHD）patients between 1 January, 2007 and 31 December, 2014 at the Renji Hospital. They were followed up until death, cessation of hemodialysis, transfer to other centers or to the end of the study (31 December, 2014). Laboratory parameters, including hemoglobin concentrations, transferrin saturation, ferritin, serum albumin, were measured every 3 months. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, the patients were divided into target-hemoglobin group (110≤Hb ≤120 g/L) and non target-hemoglobin group (< 110 g/L or > 120 g/L), and then the compliance rate of Hb, Ferritin, transferrin saturation, and the influence factors of compliance rate of Hb as well as its relationship with the prognosis were analyzed. Results Total 517 maintenance hemodialysis patients were involved in this study. The mean age was (63.76±14.78) years and 59.96% patients were male. Only 35.20%, 91.26% and 31.18% of them met the K/DOQI defined targets for hemoglobin, transferrin saturation and ferritin levels. The average levels of TSAT and Ferritin had no significant difference between the target-hemoglobin group and the non target-hemoglobin group. Compared with patients in non target-hemoglobin group, the target-hemoglobin group had significantly higher qualified rate of transferrin saturation (94.97% vs 89.41%, P=0.045) and Ferritin (37.22% vs 28.13%, P=0.036). Multivariate logistic regression analysis showed that the serum albumin, blood intact parathyroid hormone (iPTH) and dialysis vintage were independent risk factors that affected whether hemoglobin was up to the target. Kaplan-Meier analysis showed that the 8-year survival rate and cardiovascular survival rate in target-hemoglobin group were obviously higher than that in the non target-hemoglobin group (86.70% vs 75.30%, χ2Log rank=7.134, P=0.008; 93.80% vs 85.30%, χ2Log rank=6.134, P=0.013, respectively). Dialysis frequency, age and ferritin were independent risk factors of all-cause mortality for non target-hemoglobin group, and Dialysis frequency was independent risk factors of cardio-cerebral vascular disease mortality for non target-hemoglobin group. Conclusions The compliance rate of hemoglobin in MHD patients is still not steady controlled. Blood iPTH, serum albumin and dialysis vintage are independent risk factors that affect whether hemoglobin is up to the target in MHD patients. Sub-standard hemoglobin increases both all-cause mortality and cardio-cerebral vascular disease mortality in MHD patients.

Objective    To analyze the efficacy and safety of total parathyroidectomy (PTX) with forearm autograft in uremic patients with secondary hyperparathyroidism (SHPT).    Methods    One hundred and eighteen cases undergoing PTX with forearm autograft in our hospital from 2001-2010 were included in this study. Their preoperative and postoperative serum intact parathyroid hormone (iPTH), biochemistry tests (total calcium，inorganic phosphate and alkaline phosphate) were collected and postoperative symptom relief, complications and recurrence were investigated.    Results    Of all the 118 cases, 32 underwent endoscopic surgery and 86 open surgery. The surgery was performed successfully in 110 cases (93.2%) and one case died in perioperative period. Thyroid carcinoma was diagnosed during surgery in 2 cases and radical operation was performed at the same time. Temporary injury of recurrent laryngeal nerve was found in nine cases (7.6%). Postoperative hypocalcemia was frequently seen in 108 cases (91.5%) and it was effectively controlled by postoperative calcium administration. After operation, bone pain and itching were alleviated, and weakness, anemia and malnutrition status were improved in all the cases who received successful surgery. The postoperative levels of serum iPTH (P＜0.01), calcium (P＜0.01), phosphorus (P＜0.01) and calcium×phosphorus (P＜0.01) were decreased significantly than those in preoperative period. A long-term follow-up of over 3 years was carried out in 21 cases. Six cases recurred, among them, 4 cases relieved after removal of autografted parethroid tissue, and another two cases received the second operation. The longest follow-up period lasted for 9 years in two cases without recurrence.    Conclusions    PTX with forearm autograft is safe and effective in the treatment for uremic patients with SHPT. No severe complication is found during the long-term follow-up period.

Objective To explore the prevalence, awareness and risk factors of chronic kidney disease (CKD) in general adult population of Anhui province, China. Methods A total of 3800 residents (older than 18 years) from Anhui province were randomly selected using a stratified, multi-stage sampling. All the residents were interviewed and tested for urinary albumin to creatinine ratio (abnormal: ≥30 mg/g) and reduced estimated GFR [abnormal: ＜60 ml?min-1?(1.73 m2)-1]. The associations of CKD with demographic characteristics, healthy characteristics (hypertension, diabetes and hyperuricemia) were examined. Results Eligible data of 3374 subjects were enrolled in the study. After the adjustment of age and gender component, the prevalence of albuminuria was 9.8% (95%CI 8.8%-10.9%), and reduced eGFR was 2.1% (95% CI 1.7%-2.7%). Approximately 10.4%(95%CI 9.4%-11.5%）subjects had at least one indicator of kidney damage. The awareness rate of CKD was 6.5%. Female, age, hypertension, diabetes mellitus, and hyperuricemia were independently associated with CKD. While obesity, hyperlipdemia. smoking and alcohol drinking were not associated with the prevalence of CKD. Conclusions The prevalace of chronic kidney disease is 10.4% and the awareness rate is 6.5% in general adult population of Anhui province. Independent risk factors associated with CKD are female, age, hypertension, diabetes mellitus and hyperuricemia.

Objective To investigate the correlation of serum anti-M-type phospholipase A2 receptor (PLA2R) antibody with laboratory parameters of idiopathic membranous nephropathy (IMN) in adult patients with membranous nephropathy (MN), and to explore the role of anti-PLA2R antibody in the pathogenesis of IMN. Methods Forty-six adult patients with biopsy-proved glomerular diseases were involved in this study, including 20 cases with IMN, 7 cases with IgA nephropathy (IgAN), 6 cases with hepatitis B-associated membranous nephropathy (HBV-MN), 6 cases with minimal change nephropathy (MCN), 4 cases with focal segmental glomerulosclerosis (FSGS) and 3 cases with class Ⅴ lupus nephritis. Total RNA was extracted from human glomeruli and was reversely transcribed to the first-strand cDNA. The full-length human M-type PLA2R was amplified by PCR and the 605 bp product was subcloned into eukaryotic expression vector containing CMV promoter. The recombinant human M-type PLA2R plasmid vector was transiently transfected into human embryonic kidney (HEK) 239T cell line using the FuGene6 transfection reagent. Western blotting was used to detect serum anti-PLA2R antibodies. Correlations of anti-PLA2R antibody level with laboratory parameters, including serum albumin, total cholesterol, Scr and 24-hour urine protein, of IMN patients were evaluated. Results Among 20 cases with IMN, 15 cases showed positive anti-PLA2R antibodies (positive rate 75%). Of 7 cases with IgAN and 6 cases with HBV-MN, only 1 case showed positive anti-PLA2R antibody respectively (positive rate 14.29% and 16.67% respectively). Anti-PLA2R antibody was negative in other patients. The positive rate of anti-PLA2R antibody in IMN patients was significantly higher than that in patients with secondary MN and other types of glomerlonephritis (all P<0.01). Furthermore, anti-PLA2R antibody level was positively correlated with 24-hour urine protein(r=0.803, P<0.01) and negatively correlated with serum albumin in IMN patients (r=-0.816, P<0.01). Conclusions The high positive ratio of anti-PLA2R antibody may indicate that it is the specific autoantibody in IMN. Anti-PLA2R antibody is correlated with IMN disease severity, which indicates that it may be the pathogenic autoantibody in IMN.

Objective To investigate the correlation between food intolerance and Henoch-Schonlein purpura (HSP) in children and the efficacy of food forbidden or alternative therapy. Methods The levels of IgG against several common food in serum obtained from 40 children with HSP were measured by ELISA. The efficacy of food forbidden or alternative food therapy was assessed after 3 months. Results Total positive rate of serum food-intolerant IgG antibodies in HSP children was 92.5%. Among these 14 intolerant foods, the positive percentage of egg was the highest (33.8%), followed by tomato (14.9%), milk (13.5%) and morrhua (12.2%). Significant differences of the sort and degree of food intolerance existed among different age groups (t=2.257, P=0.045), but not between boys and girls(t=1.053, P=0.315), city and countryside(t=1.388, P=0.193). There was no linear correlation between total food intolerance and serum IgG level (t=0.793, P=0.445). Food intolerance had no direct relation to immune complex deposition in kidneys of HSP nephritis(r=-0.262, P=0.387). The efficacy of adjusting diet was 95%. Conclusions HSP is closely related to food intolerance. Egg is the most common intolerant food. Food forbidden or alternative therapy shows acceptable efficacy in the treatment of most Henoch-Schonlein purpura children.

Objective To study the prevalence and risk factors of chronic kidney disease (CKD) among adults in Zhengzhou. Methods One thousand eight hundred and fifty five residents (≥20 years) from 4 communities in 4 districts of Zhengzhou city were randomly selected by using a stratified，multistage sampling． They were interviewed, and received physical examination and measurements of urine and blood for renal damage as well as risk factors. Results Eligible data of 1752 subjects were included in the study． After the adjustment of age and gender component, albuminuria was found in 5.78％ of the subjects, hematuria in 8.19％, and reduced renal function in 1.58％. Male had lower prevalence of albuminuria and hematuria (4.37％ vs 7.29％, χ2=6.252, P=0.012; 5.08％ vs 11.51％, χ2=24.499, P＜0.01), but higher prevalence of reduced eGFR（2.26％ vs 0.86％, χ2=5.830, P=0.016) as compared with female. The prevalence of albuminuria and reduced eGFR increased with age. The crude prevalence of CKD was 14.50%, while the standardized rate was 13.57％. The prevalence of female was higher than that of male (17.83％ vs 9.59％, χ2=23.132, P＜0.01), which also increased with age. The most common manifestations of CKD were hematuria and albuminuria. Gender, age, smoking, hypertension, diabetes mellitus, obesity and hyperuricaemia were independently associated with CKD. The awareness rate of CKD was 8.27% and only 7.09% of the subjects received treatment. Conclusions The prevalence of CKD is 13.57％ and the recognition is 8.27％ in urban adult population of Zhengzhou．Independent risk factors associated with kidney damage are gender, age, smoking, hypertension, diabetes mellitus, obesity and hyperuricaemia．

Objectives To determine the incidence, the constitution of causes and the prognosis of acute kidney injury (AKI) among hospitalized patients in a tertiary hospital, and to evaluate the impact of AKI on hospital cost and length of stay (LOS). Methods Patients who were admitted in Zhongshan Hospital, Fudan University from September 1st 2004 to August 31st 2005 were involved. After checking the computer-based data on kidney function, patients with acute kidney injury were picked out and further history reviews were demanded to get the information of clinical characteristics, prognosis, severity of kidney injury and the causes of AKI. Results There were 37 365 admissions during the study period and 1263 met with the diagnostic criteria of acute kidney injury(AKI). The overall incidence of AKI was 3.38%. In-hospital mortality was 1.52% in all discharges while 18.57% in patients with AKI. The multivariable-adjust OR for death associated with AKI was 10.08 (P<0.01). The results of logistic regression analysis suggested that old age and the elevation percentage of serum creatinine were the risk factors of death among AKI patients. Conclusions Acute kidney injury is prevalent in hospitalized patients. A slight elevation of serum creatinine is associated with significantly increased mortality, LOS and hospital cost. Moreover, outcomes are related directly to the severity of acute kidney injury, which characterized by elevation percentage of serum creatinine

Objective To investigate the prevalence of chronic kidney disease(CKD) and associated factors in a village of Zhejiang province. Methods All residents older than 18 years in the village were interviewed and screened for albuminuria with morning spot urine albumin to creatinine ratio (abnormal:≥30 mg/g), reduced renal function with estimated glomerular filtration rate by modified MDRD equation [abnomal: <60 ml·min^-1·（173 m²)^-1; hematuria with morning spot urine dipstick confirmed by urine sediments microscopy test. The correlations among demographic characteristics, health characteristics (eg. smoking, diabetes and hypertension) and indicators of kidney damage were examined. Results Complete information was obtained in 76.2% of the residents. After age and gender adjustment, the prevalence of albuminuria, reduced renal function and hematuria was 10.4%, 3.0% and 1.4%, respectively. Compared with subjects older than 40 years in Beijing and NHANES Ⅲ, participants older than 40 years in the present study tended to have lower prevalence of diabetes and hypertension, and higher prevalence of albuminuria and reduced renal function. Age and diabetes and systolic blood pressure were independently correlated with albuminuria. Female, age and hyperuricemia were independently correlated with reduced renal function. Age and smoking were independently correlated with reduced renal function. Conclusion The spectrum and correlated factors of CKD in a village undergoing rapidly economic development are close to those of Beijing and developed countries, while certain specific factors might contribute to the high prevalence of CKD in the present village.

Objective To investigate the characteristics of infecting pathogens, their changes and antimicrobial susceptibilities on CAPD related peritonitis in our peritoneal dialysis(PD) center in the past 15 years. Methods Two hundred and six CAPD related peritonitis episodes in 145 patients from 2000 to 2005 were analyzed and compared with 109 episodes from 1991 to 2000. The causative pathogens, their antimicrobial susceptibilities and outcomes on CAPD related peritonitis from the two periods were retrospectively reviewed and compared. Results Culture negative rate decreased from 60.6% in 1990 s to 47.6% in the last five years(P = 0.031). Among culture positive peritonitis episodes, the incidence of gram positive bacteria (GPB) peritonitis increased from 25.6% to 39.8% (P = 0.059). This was mainly due to a significant increase in coagulase-neagative staphylococcus peritonitis, which significantly increased from 4.7% to 26.9% (P = 0.01). Gram negative bacteria(GNB) peritonitis decreased slightly (44.2% vs 34.3%, P=0.322). The incidence of Klebsiella pneumoniae peritonitis significantly decreased (14.0% vs 3.7%, P = 0.023), while Pseudomonas aeruginosa and Escherichis coli peritonitis rates slightly increased (4.7% vs 9.3%, P = 0.338; 7% vs 18.7%, P = 0.072). The decrease of fungal peritonitis rate was not significant (30.2% vs 17.6%,P = 0.123). The comparison of clinical outcomes showed an improvement of total recovery rate from 68.8% in 1990 s to 73.9% for 2000-2005(P = 0.09). The catheter removal rate decreased from 19.2% to 14.3% (P = 0.238), and the mortality from 10.1% to 5.4% (P = 0.118). In both periods, fungal peritonitis had the poorest results, which all the patients either withdrew from PD or died. Conclusions Compared with that in 1990 s, the culture positive rate for CAPD related peritonitis in 2000-2005 has been greatly improved. Coagulase-negative staphylococcus is the most common causative pathogen. The mortality and catheter removal rate have been markedly reduced in the last five years. Fungal peritonitis is the most important reason for patients′ dropout.