Objective To compare the safety and efficacy of erythropoietin (EPO) and roxadustat in the treatment of anemia in patients with chronic kidney disease (CKD) during the peri-dialysis period, providing a reference for clinical practice. Methods This was a multicenter retrospective cohort study. Clinical data of peri-dialysis patients with CKD stage 5 and anemia treated with EPO or roxadustat between January 1, 2015, and December 31, 2021, were collected from 82 hospitals (42 tertiary and 40 secondary hospitals) on the health medical big data platform of Tianjin. Patients were divided into EPO group and roxadustat group based on their treatment regimens. After propensity score matching was performed at a 1:4 ratio between the two groups and baseline characteristics were compared. The incidence rates of cardio-cerebrovascular events, thrombotic events, major adverse cardiovascular events (MACE), and hospitalization rate due to complications, as well as the length of hospital stay, were compared between the two groups during different time periods (within 6 and 12 months of initial treatment, within 3 months after the initiation of dialysis, and within 12 months after the peri-dialysis period). Kaplan-Meier method was used to analyze the cumulative event-free rates of cardiovascular and cerebrovascular events as well as thrombotic events between the two groups. Changes of hemoglobin (Hb) levels from baseline during the 3-month treatment period were recorded. Results A total of 35 324 peri-dialysis patients with CKD stage 5 and anemia were included, comprising 6 017 patients in the EPO group and 548 patients in the roxadustat group. After propensity score matching, 545 patients were included in the roxadustat group and 1 804 in the EPO group. There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The incidence of cardio-cerebrovascular events [83.7% (456/545) vs. 66.9% (1 206/1 804), χ2=57.213, P<0.001; 87.9% (479/545) vs. 76.9% (1 388/1 804), χ2=30.771, P<0.001; 71.7% (391/545) vs. 54.4% (982/1 804), χ2=51.632, P<0.001], MACE [52.7% (287/545) vs. 29.8% (538/1 804), χ2=95.806, P<0.001; 62.8% (342/545) vs. 40.7% (735/1 804), χ2=81.665, P<0.001; 42.4% (231/545) vs. 20.5% (370/1 804), χ2=105.200, P<0.001], and the rate of hospitalizations due to complications [70.6% (385/545) vs. 53.9% (972/1 804), χ2=48.203, P<0.001; 75.8% (413/545) vs. 63.0% (1 137/1 804), χ2=30.330, P<0.001; 60.2% (328/545) vs. 44.8% (808/1 804), χ2=39.718, P<0.001] were significantly higher in the roxadustat group than in the EPO group within the first 6 months and 12 months of treatment, and within 3 months after the first dialysis. However, there were no statistically significant differences observed in these outcomes between the two groups within 12 months of follow-up after the peri-dialysis period (all P>0.05). The incidences of cardiovascular and cerebrovascular events (log-rank test, χ2=84.243, P<0.001) and thrombotic events (log-rank test, χ2=7.123, P=0.008) in the roxadustat group were both lower than those in the EPO group. The change of average Hb levels in the EPO group was higher than that in the roxadustat group of the first month of treatment [5.00 (-3.70,14.70) g/L vs 1.00 (-8.30,9.00) g/L, Z=-3.700, P<0.001], but lower than that in the roxadustat group in the second month [8.20 (0, 18.00) g/L vs. 10.50 (2.50, 20.70) g/L, Z=2.807, P=0.005]; there was no statistically significant difference in average Hb change between the two groups in the third month (Z=0.972, P=0.331). The proportion of patients maintaining average Hb concentrations within the target range after 3 months of continuous administration in the EPO group was higher compared to the roxadustat group [10.9% (197/1 804) vs. 7.5% (41/545), χ2=5.305, P=0.021]. Conclusion For patients with CKD stage 5 and anemia during the peri-dialysis period, EPO demonstrates superior cardiovascular safety profile compared to roxadustat and is more effective in improving Hb level in the short term.

Objective To evaluate the short-term efficacy of sucroferric oxyhydroxide in treating hyperphosphatemia in patients with end-stage renal disease. Methods A self-controlled before-and-after study was performed. The clinical data of patients with end-stage renal disease complicated with hyperphosphatemia who received regular treatment and follow-up at the First Affiliated Hospital of Ningbo University and used sucroferric oxyhydroxide for phosphorus reduction treatment from May to August 2024 were retrospectively analyzed. Based on the quartiles of the initial serum phosphorus levels, patients were divided into 4 groups: 1.78-<1.91 mmol/L group (n=15), 1.91-<2.11 mmol/L group (n=15), 2.11-<2.35 mmol/L group (n=16), and ≥2.35 mmol/L group (n=15). The decrease in serum phosphorus levels before and after treatment in each group and the differences in the extent of decrease among the 4 groups were compared. The correlation between the degree of decrease in blood phosphorus and the pre-medication venous blood phosphorus level was analyzed using Pearson correlation analysis. Results A total of 61 patients were included, and the age was (51.89±12.29) years old. Among them, 40 patients were males (65.6%). There were 20 patients (32.8%) on maintenance hemodialysis, 39 patients (63.9%) on peritoneal dialysis, and 2 patients (3.3%) on combined dialysis. After one month of administration, the venous phosphorus level decreased from (2.19±0.37) mmol/L to (1.72±0.57) mmol/L (t=5.925, P<0.001). Meanwhile, the calcium-phosphorus product decreased from (61.87±12.34) mg²/dl² to (51.01±17.15) mg²/dl² (t=4.370, P<0.001). After one month of medication, 33 patients achieved the target blood phosphorus level, with an achievement rate of 54.1%. The reductions in serum phosphorus were (0.11±0.59) mmol/L in the 1.78-<1.91 mmol/L group, (0.32±0.54) mmol/L in the 1.91-<2.11 mmol/L group, (0.54±0.35) mmol/L in the 2.11-<2.35 mmol/L group, and (0.89±0.70) mmol/L in the ≥2.35 mmol/L group. A statistically significant difference was observed in the reduction of serum phosphorus among the 4 groups (F=5.343, P=0.003). Pearson correlation analysis revealed a positive correlation between the degree of decrease in serum phosphorus at one month of medication and the pre-medication venous blood phosphorus level (r=0.417, P=0.001). Conclusion Sucroferric oxyhydroxide effectively reduces serum phosphorus and calcium-phosphorus product in patients with end-stage renal disease and hyperphosphatemia within one month.

Objective To compare the differences in complications between 4-6 mm tapered arteriovenous graft (AVG) and 6 mm standard AVG and evaluate the patency rates of the two types of AVG. Methods This study was a single-center retrospective cohort study. The relevant data of patients who underwent upper arm AVG surgery in the Department of Nephrology, Beijing Haidian Hospital from January 2017 to July 2018 were analyzed. According to the type of graft, the patients were divided into 4 to 6 mm-tapered grafts (4-6 mm group) and 6 mm-standard grafts (6 mm group). The occurrence of hemodialysis access-induced distal ischemia (HAIDI), high-output heart failure, and access-related complications was recorded. Kaplan-Meier survival curve analysis was performed to analyze the patency rates of AVG in the two groups. Results A total of 116 patients were enrolled in this study, with 59 patients (50.9%) in the 4-6 mm group and 57 patients (49.1%) in the 6 mm group. There was no statistically significant difference in the baseline data, preoperative and postoperative 6-month and 12-month vascular ultrasound indicators between the two groups (all P>0.05). Three patients experienced fistula thrombosis within 30 days after the operation, including one in the 4-6 mm group and two in the 6 mm group. Two patients developed infections during the 6-month to 1-year follow-up period after surgery, both in the 6 mm group. One patient in the 4-6 mm group developed HAIDI and improved after conservative drug treatment. None of the patients in either group developed high-output heart failure. Kaplan-Meier survival analysis showed that the primary patency rates of patients in the 4-6 mm group at 1 (37.9% vs. 56.4%, log-rank test, χ²=3.996, P=0.046) and 2 (17.2% vs. 33.5%, log-rank test, χ²=5.193, P=0.023) years after surgery were significantly lower than those in the 6 mm group. There was no statistically significant difference in the primary patency rates of the two groups at 3 and 5 years after surgery (all P>0.05). After 1, 2, 3 and 5 years of the operation, there was no statistically significant difference in the secondary patency rates between the two groups (all P>0.05). Conclusions Compared with the 6 mm standard AVG, 4-6 mm tapered AVG does not reduce the risk of HAIDI, nor does it improve the patency rates. Therefore, tapered grafts are not recommended for routine use.

Objective To explore the related factors for the early occurrence of acute kidney disease (AKD) in patients with idiopathic membranous nephropathy (IMN) and to establish a scoring prediction system. Methods It was a retrospective cohort study. The clinical data were collected from patients diagnosed with IMN through renal biopsy and undergoing regular follow-up ≥3 months at the Nephrology Department of Beijing Anzhen Hospital, Capital Medical University from January 2010 to March 2023. Based on whether AKD occurred within 3 months after diagnosis, the patients were divided into AKD group and non-AKD group. The clinical, pathological, treatment, and prognosis were compared between the two groups. Multivariate logistic regression analysis was used to identify influencing factors of AKD. Based on the odds ratios (OR) of the independent correlated factors and clinical considerations, each factor was assigned a score to develop a risk scoring system. Receiver operating characteristic curve was used to evaluate the calibration ability of this risk scoring system. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the calibration ability of this risk scoring system. Results A total of 372 patients with IMN were included in this study, with age of (52.4±14.1) years, including 151 females (40.6%). Among the 372 patients, 63 patients (16.9%) were in the AKD group and 309 patients (83.1%) were in the non-AKD group. Compared with the non-AKD group, the AKD group had older age (Z=4.709, P<0.001), and higher proportion of females (χ²=5.628, P=0.018), proportion of hypertension (χ²=13.608, P<0.001), proportion of anemia (χ²=22.344, P<0.001), serum anti-phospholipase A2 receptor antibody titer (Z=2.781, P=0.005), proportion of diuretic use (χ²=11.631, P=0.001), proportion of ischemic glomeruli (t=3.839, P=0.001), proportion of sclerotic glomeruli (t=3.958, P<0.001), and proportion of complement C3 positivity in renal tissues (χ²=11.341, P=0.001). Additionally, serum albumin (Z=-3.553, P<0.001), dosage of used cyclosporine (t=-3.060, P=0.002) and estimated glomerular filtration rate (eGFR, Z=-3.842, P<0.001) in the AKD group were lower than those in the non-AKD group. Multivariate logistic regression analysis showed that, after adjusting for eGFR, serum anti-phospholipase A2 receptor antibody titer, use of diuretics, and the proportion of ischemic glomeruli, females [OR=0.375, 95% confidence interval (CI) 0.187-0.750, P=0.006], increase age (OR=1.352, 95% CI 0.999-1.830, P=0.050), hypertension (OR=2.661, 95% CI 1.091-6.489, P=0.031), decreased serum albumin (<30 g/L, OR=0.650, 95% CI 0.406-0.901, P=0.013), anemia (OR=2.050, 95% CI 1.059-3.970, P=0.033), and complement C3 positivity of renal tissues (OR=2.793, 95% CI 0.998-7.818, P=0.050) were independent factors correlated with AKD in IMN patients. Based on these correlated factors, a risk scoring system was established for AKD in IMN patients. The area under the receiver operating characteristic curve was 0.787 (95% CI 0.730-0.844), indicating good discriminative ability. The Hosmer-Lemeshow goodness-of-fit test demonstrated good calibration ability (χ² =7.752, P=0.458). The risk of AKD for IMN patients with low-risk (≤8 points), moderate-risk (9-14 points), and high-risk (≥15 points) was 5.9%, 24.9%, and 63.5%, respectively, based on the established risk scoring system. In terms of prognosis, there was no statistically significant difference in the 6-month disease remission rate between AKD and non-AKD groups (χ²=1.931, P=0.165). However, the proportion of eGFR decline ≥ 30% at 1 year in the AKD group was higher than that in the non-AKD group (χ²=27.481, P<0.001), and both AKD group with short-term renal function recovery and AKD group without short-term renal function recovery had higher proportions of eGFR decline ≥ 30% at 1 year than that of the non-AKD group (all P<0.05). Conclusions IMN patients with AKD in the early stage have poorer long-term renal outcomes. Females, increasing age, hypertension, hypoalbuminemia, anemia, and positive complement C3 in renal tissues are independent related factors for the occurrence of AKD in IMN patients. The established risk scoring system may assist clinicians in identifying high-risk AKD patients early and implementing preventive interventions may help improve long-term renal prognosis.

Objective To discuss the effect of methyltransferase- like 3 (METTL3) on vascular calcification in chronic kidney disease (CKD) rats by regulating histone deacetylase 1 (HDAC1). Methods Thirty-six healthy male SD rats aged 7?8 weeks were randomly divided into control group, CKD model group (CKD group) and METTL3 inhibitor group (SAH group) by random sampling method. Except for the control group, all other groups were constructed with CKD rat models. The rats in the control group were fed with normal chow, while the rats in the CKD group and the SAH group were given 250 mg/kg of adenine by gavage and fed with a high-phosphorus diet containing 1.8% phosphorus for 4 consecutive weeks. From the 5th to 8th week, adenine was administered by gavage every other day. During the 5th to 8th weeks of the model establishment, rats in the SAH group were intraperitoneally injected with 5 mg/kg SAH twice a week, while rats in the control group and the CKD group were intraperitoneally injected with the same volume of 0.9% sodium chloride solution. Fully automated biochemical analyzer was used to measure serum creatinine (Scr), blood urea nitrogen (BUN), serum calcium and serum phosphorus. HE staining was used to observe pathological changes in renal tissues and thoracic aortic tissues. Von Kossa staining was performed to observe the calcification status of the thoracic aorta. Immunohistochemistry was performed to measure the protein expression levels of bone morphogenetic protein 2 (BMP2) and runt-related transcription factor 2 (Runx2) in the thoracic aorta. Western blotting was used to measure the protein expression levels of METTL3, HDAC1, light chain 3 protein (LC3Ⅱ), and p62 in the thoracic aorta. Colorimetric method was used to detect the level of m6A methylation of total RNA. Results Compared with the control group, the structure of the renal tissues in the CKD group was damaged with clear enlargement of renal tubular lumens, extensive proliferation of renal interstitial fibroblasts, and clear infiltration of inflammatory cells (all P<0.05). Compared with the control group, a large amount of black adenine metabolites were deposited, the aortic vascular structure was severely damaged with obvious calcified nodules, and the middle layer of the aortic vascular tissue showed large areas of black or brownish black color, with severe calcification in the CKD group. The serum calcium level, and the protein expression levels of HDAC1 and LC3Ⅱ were lower, while serum phosphorus, Scr, BUN and m6A methylation levels, and the protein expression levels of BMP2, Runx2, METTL3 and p62 were higher in the CKD group than those in the control group (all P<0.05). The SAH group showed less pathological damage of renal tissues compared to the CKD group, with a relatively normal structure and reduced adenine crystals. The pathological damage of aortic vascular tissues was also reduced, with a relatively normal structure and fewer calcified nodules in SAH group. Compared with the CKD group, the black or brownish black color of aortic vascular tissues was decreased, and the degree of calcification was reduced in SAH group. Compared with the CKD group, the serum calcium level, and the protein expression levels of HDAC1 and LC3Ⅱ were raised, while serum phosphorus, Scr, BUN and m6A methylation levels, and the protein expression levels of BMP2, Runx2, METTL3 and p62 were reduced in SAH group (all P<0.05). Conclusion Inhibition of METTL3 can alleviate vascular calcification by inhibiting m6A methylation modification of HDAC1 in CKD rats.

This article reports a case of exercise-related acute kidney injury without renal hypouricemia. The patient was a 20-year-old male who experienced abdominal pain following a 1 000-meter sprint, accompanied by muscle soreness in the lower limbs. There was no decrease in urine output or presence of brown urine. However, the patient exhibited mild proteinuria, no microscopic hematuria, markedly elevated serum creatinine, hyperuricemia and mildly elevated creatine kinase. Renal biopsy indicated acute tubular interstitial injury. Renal function recovered after treatment with glucocorticoids, hydration, uric acid reduction, and blood pressure control. Further testing demonstrated a normal uric acid excretion fraction, and genetic testing did not identify any mutations associated with renal hypouricemia genes. Based on the clinical and pathological findings, the patient was diagnosed without renal hypouricemia-induced acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise. By reporting this rare case, we aim to enhance clinicians' awareness of the diagnosis and treatment of this disease.

This article reports the diagnosis and treatment of interstitial lung disease (ILD) in a 42-year-old male patient with phospholipase A2 receptor antibody-positive membranous nephropathy following rituximab therapy. The patient received intensive treatment with a single 1 g dose of rituximab for his primary renal condition. Two days later, he developed a perianal abscess, which was resolved after surgical drainage. Ten days post-rituximab infusion, he presented with cough and productive sputum. A chest CT scan revealed newly developed multiple patchy opacities in both lungs, accompanied by pleural effusion. Despite treatment with broad-spectrum antibiotics (meropenem) and antiviral therapy (ganciclovir), his pulmonary infiltrates showed no improvement. Extensive investigations, including pathogen metagenomic next-generation sequencing of bronchoalveolar lavage fluid, identified no definite infectious etiology. Based on the temporal relationship to drug administration and after excluding alternative causes, a diagnosis of rituximab-induced ILD (RTX-ILD) was established. Rituximab was discontinued, and the immunosuppressive regimen was switched to intravenous methylprednisolone (40 mg daily). After one week of glucocorticoid therapy, the patient's respiratory symptoms and radiological findings significantly improved. This case highlights that RTX-ILD should be suspected in patients receiving rituximab who develop new pulmonary lesions refractory to broad-spectrum antibiotics. Early diagnosis, prompt withdrawal of rituximab, and timely initiation of corticosteroid therapy are crucial for improving clinical outcomes.

This case report describes the development of Kaposi sarcoma (KS) in a patient with membranous nephropathy (MN) following immunosuppressive therapy. A 58-year-old man was admitted with a 1-year history of intermittent edema of bilateral lower extremities, and MN was confirmed via renal biopsy. Five months after treatment with glucocorticoids and cyclophosphamide, the patient developed cutaneous lesions on the medial side of the left lower extremity and foot. Skin biopsy results indicated a vascular endothelial-derived tumor, with immunohistochemical positivity for CD31, CD34, ETS-related gene, friend leukemia integration 1 transcription factor and human herpes virus-8, which supported the diagnosis of KS. Based on patient' immunosuppressive medication history, iatrogenic KS was considered. Notably, the lesions showed no clinical remission despite reduction in immunosuppressive therapy intensity, and the patient eventually died of disease progression. By reviewing and summarizing the clinical manifestations and outcomes of relevant cases of glomerular diseases complicated with KS, this case report aims to improve clinicians' awareness of the diagnosis and management of KS complicating MN.

Vacuole, ubiquitin-activating enzyme (E1), X-linked, autoinflammatory, somatic (VEXAS) syndrome is a newly recognized disease featured by somatic mutation of UBA1 gene. Patients present with late-onset inflammatory status and hematological abnormalities, while renal injuries are not commonly seen. This paper reports a 62-year-old male patient with VEXAS syndrome presenting with recurrent fever and anemia. He experienced a gradual onset of relapsing polyarthritis and acute kidney injury. Further laboratory tests showed elevation of serum C reactive protein, as well as erythrocyte sedimentation rate. Bone marrow smear showed vacuoles in myeloid precursor cells. Kidney biopsy showed tubulointerstitial nephritis. The genetic test revealed UBA1 mutation. The patient was diagnosed with VEXAS syndrome with tubulointerstitial nephritis, and received glucocorticoids and cyclophosphamide. Roxadustat was prescribed for anemia. His general condition, renal function as well as anemia significantly improved after treatment follow-up. The case contributes to enhancing clinician's awareness and understanding of VEXAS syndrome.

Autosomal dominant tubulointerstitial kidney disease (ADTKD) is a rare group of inherited tubulointerstitial kidney disorders. To date, pathogenic variants in at least 5 genes—UMOD, MUC1, REN, HNF1B, and SEC61A1—have been identified as associated ADTKD, with SEC61A1-related cases being extremely rare. This article reports the first confirmed case of ADTKD caused by a novel pathogenic variant in the SEC61A1 gene (ADTKD5), c.544T>C (p.F182L) in China. The patient was a young girl whose initial manifestations included congenital anemia and impaired renal tubular concentrating function, which were not initially recognized as significant. She later came to medical attention due to unexplained elevated serum creatinine accompanied by hyperuricemia. The diagnosis of ADTKD was confirmed by whole-exome sequencing. Recombinant human erythropoietin was administered subcutaneously to treat renal anemia, and febuxostat was prescribed orally for the management of hyperuricemia. This case can help to enhance awareness of ADTKD among clinicians, particularly pediatric nephrologists.

Atypical hemolytic uremic syndrome (aHUS) is a rare and severe thrombotic microangiopathy. This study retrospectively analyzed the clinical data of 15 adult aHUS patients treated with eculizumab, aiming to evaluate its therapeutic efficacy and investigate the impact of treatment timing on patient outcomes, prognosis, and safety, so as to provide evidence for optimizing the clinical management of aHUS. The cohort included 12 females and 3 males, who received 4 to 20 doses of eculizumab. The patient's age was (43.4±20.2) years old. At the last follow-up, serum creatinine and lactate dehydrogenase levels were significantly decreased compared to pre-treatment values, while estimated glomerular filtration rate, hemoglobin, and platelet counts were significantly increased. Hematological remission was achieved in 8 patients, and renal remission was achieved in 8 patients. Among the 9 patients who required dialysis at the onset of the disease, 3 patients were able to discontinue dialysis, 1 patient died of heart disease, and the rest progressed to chronic renal failure. The median time from the onset of aHUS to the initiation of eculizumab treatment was 7 (7, 30) days. The patients were divided into group 1 (≤7 d, n=8) and group 2 (>7 d, n=7) based on the median. At the last follow-up, the renal and hematological remission rates of patients in group 1 were significantly higher than those in group 2 (7/8 vs. 1/7, P=0.010; 8/8 vs. 0/7, P<0.001), and the proportion of patients without dialysis in group 1 was significantly higher than that in group 2 (8/8 vs. 2/7, P=0.007). The results indicate that eculizumab treatment can significantly improve hematological parameters and renal function in aHUS patients with a favorable safety profile. Furthermore, initiation of treatment within 7 days of disease onset is associated with a more pronounced therapeutic response.

Acute kidney injury (AKI) is a clinical syndrome characterized by high morbidity and mortality, yet effective treatment options remain limited. Sodium-glucose transporter 2 inhibitors (SGLT2i) have been extensively utilized in the management of chronic kidney disease. Although their pharmacological mechanisms may theoretically predispose people to AKI, a growing body of clinical studies and experimental evidences suggest that SGLT2i may confer protective effects against AKI through multiple pathways. However, the use of SGLT2i in the specific populations may elevate the risk of AKI. This review summarizes the dual roles of SGLT2i and the underlying mechanisms on AKI and discusses the potential applications and controversies in clinical practice, with the aim of providing new strategies for the prevention and treatment of AKI.

Antiplatelet drugs are widely used in the prevention and treatment of cardiovascular diseases in the general population. However, people with chronic kidney disease (CKD) face tendencies of thrombosis and bleeding, as well as significantly increasing risk of cardiovascular events. Owing to the lack of results of large-scale clinical randomized controlled trials, there is no definite conclusion on how to choose appropriate antiplatelet drugs to prevent cardiovascular complications, or how to balance the antiplatelet effects with bleeding risks. This article will overview the pathogenesis of cardiovascular complications in patients with CKD, the effects and mechanisms of commonly used antiplatelet drugs and their application in preventing cardiovascular complications, to better understand and prevent the cardiovascular complications of CKD and help improve the prognosis of patients.

Patients with end-stage renal disease undergoing peritoneal dialysis (PD) often experience multiple complications that require medication. The PD process can influence the pharmacokinetic characteristics of certain drugs, including absorption, distribution, metabolism and excretion, presenting challenges for clinical drug use. This paper summarizes the factors affecting pharmacokinetic characteristics in PD patients, including systemic conditions, dialysis-related variables, and drug-specific properties, and also examines the pharmacokinetics of antibiotics for PD-related peritonitis and medications for chronic kidney disease complications, along with clinical considerations for their use, aiming to provide a reference for guiding the clinical medication of PD patients and inform future research.