Objective To investigate the related factors and prognosis of pulmonary hypertension (PAH) in hemodialysis (HD) patients for early diagnosis and intervention of PAH. Methods A retrospective cohort study was conducted in 183 long?term hemodialysis patients with complete follow?up data from January 1, 2010 to December 30, 2015 from the blood purification center of the Third Affiliated Hospital of Sun Yat?sen University. The follow?up deadline was December 30, 2017, and the endpoints were death and cardiovascular events. The clinical data, laboratory examinations, cardiac color Doppler ultrasound parameters and prognosis of patients with and without PAH were compared. Multivariate logistic regression was used to analyze the risk factors for PAH in HD patients. The survival rates were calculated by Kaplan?Meier method, and the survival curves were compared by Log?rank test between the two groups. A multivariate Cox proportional hazard regression model was used to examine the association between PAH and all?cause mortality in HD patients. Results Of the 183 hemodialysis patients, 79(43.2%) were female, 104(56.8%) were male, and the age was (56.1±16.9) years, of which 72(39.3%) were complicated with PAH. Compared with the non?PAH group, patients in the PAH group was older and had a longer duration of dialysis (both P＜0.05). The left atrial diameter (P=0.002) and the proportion of valvular calcification (P=0.004) were significantly higher in the PAH group than that in the non?PAH group. Logistic regression analysis showed increased age (OR=1.027, 95% CI 1.001-1.053, P=0.041) and increased duration of dialysis (OR=1.129, 95% CI 1.004-1.269, P=0.042) were risk factors for PAH in HD patients. After a median follow?up of 27.8 months, Kaplan?Meier survival analysis showed that all?cause mortality was higher in the PAH group than that in the non?PAH group (χ2=5.636, P=0.018). The main cause of death in two groups was cardiovascular event. After adjusting for age, diabetes mellitus, duration of dialysis, valvular calcification, and hypertension, Cox regression showed that PAH increased the risk of all?cause mortality in HD patients (HR=1.894, 95% CI 1.083-3.313, P=0.025). Conclusions HD patients complicated with PAH are more common and the prognosis is poor. Increased age and increased duration of dialysis may be risk factors for PAH in HD patients. Regular color Doppler echocardiography is helpful for early detection and diagnosis of PAH.

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta, and provide clinically useful information for the prevention and treatment of BPV. Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively. According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV), patients were divided into four groups, and clinical data, biochemical indicators and drug use were compared among 4 groups. Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV. Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study. Their dialysis duration was (48.4±36.1) months, and the median of interdialysis SBP-CV was 8.07% (5.72%, 11.34%). According to the quartile of SBP-CV, the patients were divided into four groups: low BPV group (SBP-CV≤5.72%, 253 cases), middle BPV group (5.72%＜SBP-CV≤8.07%, 252 cases), high BPV group (8.07%＜SBP-CV≤11.34%, 253 cases) and extremely high BPV group (SBP-CV＞11.34%, 252 cases), and the dialysis duration, diabetes, ultrafiltration, interdialysis weight gain rate (IDWGR), serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P＜0.05). Logistic multiple regression analysis showed that high IDWGR (OR=1.216, 95%CI 1.108-1.435, P＜0.001) was an independent risk factors for interdialysis BPV in MHD patients, while high ultrafiltration volume (OR=0.436, 95%CI 0.330-0.575, P＜0.001) and calcium channel antagonists used (OR=0.686, 95%CI 0.477-0.986, P=0.042) were independent protective factors. Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients, while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.

Objective To investigate the effects and related risk factors of different vascular access types on new atrial fibrillation in maintenance hemodialysis (MHD) patients. Methods This was a single-center prospective cohort study. Patients who established long-term dialysis access and were voluntarily followed up in the Second Hospital of Tianjin Medical University from January 1, 2013 to June 30, 2013 were enrolled to follow-up for 5 years. Patients were divided into fistula group (patients with autogenous arteriovenous fistula) and catheter group (patients with tunneled cuffed internal jugular vein catheter). The incidences of new atrial fibrillation in the two groups were compared by Kaplan-Meier survival analysis. Cox regression analysis and receiver operator characteristic curve (ROC) were used to assess the risk factors of new atrial fibrillation. Results A total of 315 eligible patients were enrolled, including 150 males (47.62%). There were 189 patients (60.00%) in the fistula group, and 126 patients (40.00%) in the catheter group. Multivariate Cox regression analysis showed that older age (HR=1.021, 95%CI 1.003-1.040), arteriovenous fistula (HR=1.899, 95%CI 1.019-3.539), increased dialysis blood flow (HR=1.030, 95%CI 1.010-1.051) and left atrial diameter (HR=1.097, 95%CI 1.022-1.177) were independent risk factors for new atrial fibrillation in MHD patients (all P＜0.05). Kaplan-Meier survival analysis showed that the incidence of new atrial fibrillation in fistula group was higher than that in catheter group (Log-rank χ2=9.53，P=0.002). ROC curve analysis showed that age [the area under the curve (AUC)=0.608, P=0.008], arteriovenous fistula (AUC=0.594, P=0.021), dialysis blood flow (AUC=0.659, P＜0.001) and left atrial diameter (AUC=0.604, P=0.011) could predict the occurrence of new atrial fibrillation. Conclusions Older age, arteriovenous fistula, increased blood flow during dialysis and left atrial diameter are independent risk factors for new atrial fibrillation in MHD patients, which can predict the occurrence of atrial fibrillation. The incidence of new atrial fibrillation in patients with arteriovenous fistula is higher than that in patients with catheter.

Objective To investigate the relationship of red cell distribution width (RDW) with all-cause mortality and cardiovascular disease (CVD) mortality in patients undergoing maintenance hemodialysis (MHD). Methods A retrospective analysis was performed in patients who initiated MHD from January 2008 to September 2017 in the hemodialysis center of the Second Affiliated Hospital of Soochow University. Basic data on demographic, dialysis and laboratory were collected, and echocardiography indicators and clinical outcomes were recorded. Patients were divided into four groups according to the quartile of RDW level. Kaplan-Meier survival analysis was used to compare the difference of survival rate among the groups. Cox regression analysis was used to analyze the risk factors of all-cause and CVD-related mortality, and predictive value of RDW for all-cause and CVD-related death in hemodialysis patients. Results A total of 268 MHD patients were enrolled in this study with age of (60.9±15.8) years and dialysis duration of (58.1±9.1) months, including 159 males(59.3%). Kaplan-Meier survival analysis showed that the 1-year overall survival rates of Q1 group (RDW≤13.8%, n=61), Q2 group (RDW 13.9%-14.6%, n=66), Q3 group (RDW 14.7%-15.6%, n=73) and Q4 group (RDW≥15.7%, n=68) were 96.8%, 95.1%, 93.1% and 85.7% respectively; 3-year overall survival rates were 88.5%, 87.5%, 59.2% and 51.8% respectively; 5-year overall survival rates were 71.5%, 65.4%, 33.6% and 17.7% respectively; The difference between the groups was statistically significant (all P＜0.01). The 1-year CVD survival rates were 98.4%, 96.6%, 95.8% and 92.4% respectively; 3-year CVD survival rates were 94.8%, 92.5%, 84.4% and 70.4% respectively; 5-year CVD survival rates were 86.9%, 81.3%, 65.6% and 51.3% respectively; The difference between the groups was statistically significant (all P＜0.01). Multivariate Cox regression analysis showed that RDW≥15.7% was an independent risk factor for all-cause and CVD-related mortality in MHD patients. The risk of all-cause mortality in Q4 group was 3.098 times higher than that in Q1 group (95%CI 1.072-8.950, P=0.037) and the risk of CVD-related mortality was 2.661 times (95%CI 1.111-8.342, P=0.048). Receiver operating characteristic curve (ROC) showed that RDW=14.85% was the best cut-off point for predicting the all-cause mortality in HD patients (P＜0.01), RDW=15.45% was the best cut-off point for predicting the cardiovascular disease mortality (P＜0.01), and RDW=14.45% had a higher 5-year survival rate (P＜0.01). Conclusion RDW can independently predict all-cause and CVD-related mortality risk in hemodialysis patients, and it has important value for prognosis.

Objective To investigate the prevalence and risk factors of sarcopenia in peritoneal dialysis (PD) patients. Methods The patients who underwent regular peritoneal dialysis at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine between November 2016 and March 2018 were enrolled. Handgrip strength (HGS) was measured to assess muscle strength. Bioelectrical impedance spectroscopy (BIS) was applied to measure the lean tissue index (LTI). Reduced LTI plus decreased HGS was defined as sarcopenia. The prevalence of sarcopenia in PD patients was evaluated. According to the presence or absence of sarcopenia, they were divided into the sarcopenia group and the non-sarcopenia group, and the differences in clinical indicators between the two groups were compared. Multivariate logistic regression was used to explore the risk factors of sarcopenia in PD patients. Results A total of 207 patients were enrolled in the study with age of (55.3±13.7) years and a median PD duration of 22.9(7.3, 60.9) months. Of them, 122 patients (58.9%) were male, 45 patients (21.7%) had diabetics and 32 patients (15.5%) suffered from cardiovascular diseases. There were 27 patients (13.0%) diagnosed with sarcopenia. These patients presented with longer PD duration, more prevalent diabetics, lower residual renal function (RRF) and serum pre-albumin, greater ratio of extracellular water to intracellular water (ECW/ICW) and high sensitive C-reactive protein in contrast with those in the non-sarcopenia group (all P＜0.05). Multivariate logistic analysis showed that male (OR=3.94，95%CI 1.35-11.50，P=0.012), longer PD duration (OR=1.01, 95%CI 1.00-1.02，P=0.029) and higher ECW/ICW (OR=1.09, 95%CI 1.05-1.14，P＜0.001) were independent risk factors of sarcopenia in PD patients. Conclusions Sarcopenia is common in PD patients. Male, longer PD duration and higher ECW/ICW were independent risk factors of sarcopenia in PD patients.

Objective To explore the reasons for withdrawal from peritoneal dialysis (PD) in our hospital. Methods This was a single-center, retrospective cohort study. Patients who started PD in the Department of Nephrology, the First Affiliated Hospital of Nanchang University from November 1st, 2005 to February 28th, 2017, were enrolled, and followed up to May 31, 2017. Patients who continued PD after May 31, 2017 were as the control group. Patients who withdrew from PD were divided into 4 subgroups: death group, hemodialysis group, kidney transplantation group and loss of follow-up group. The clinical characters of 4 subgroups were compared with the control group. Results A total of 998 patients were enrolled with age of (49.36±14.94) when PD started and median dialysis duration of 27.13(12.84, 42.29) months, in whom 570 patients (57.11%) were male. Five hundred and seventeen dropout events were recorded, and the dropout rate was 51.80%. The main reason for withdrawal from PD was death (258 patients, 49.90%), followed by hemodialysis (166 patients, 32.11%), kidney transplantation (66 patients, 12.77%) and loss to follow-up (27 patients, 5.22%). The leading cause of death was cardio-cerebro-vascular diseases (136 cases, 52.71%), followed by infection (42 cases, 16.28%), dyscrasia (20 cases, 7.75%) and tumor (5 cases, 1.94%). The main reason for transfering to hemodialysis was insufficient dialysis (76 cases, 45.78%), followed by peritonitis (55 cases, 33.13%) and catheter dysfunction (24 cases, 14.46%). Compared with those in the control group, in the death group patients were older at PD commencement, and had higher proportions of hypertension, diabetes and cardio-cerebro-vascular diseases (all P＜0.05). The proportions of male and diabetes mellitus were higher in the hemodialysis group than those in the control group (both P＜0.05). Biochemical indicators showed that serum albumin and blood phosphorus were lower in the death group than those in the control group (both P＜0.05); blood albumin was significantly lower in the hemodialysis group than that in the control group (P＜0.05). Conclusions The main reasons for withdrawal from PD in our center are death and transfering to hemodialysis. The cardio-cerebro-vascular disease is the leading cause of death, and inadequate dialysis is the main reason for transfering to hemodialysis.

Objective To compare the consistency between single-(I-GFR-SS) and dual- (I-GFR-DS) sample methods with three-sample method (I-GFR-TS) of iohexol plasma clearance in chronic kidney disease (CKD) patients for choosing the optimizing project of glomerular filtration rate (GFR) measurement. Methods The multiple-sample methods were performed in 174 patients with CKD admitted to the Department of Nephrology, Shanghai Ruijin Hospital from August 2017 to July 2018. Plasma concentrations of iohexol were measured three times at different time points after receiving 5 ml iohexol (300 g/L) intravenous injection, according to estimated GFR (eGFR) grouping. The first blood sample was collected at 2 hours, and the time for the last sample was delayed from 4 hours to 6 hours with reduction of eGFR. The synchronized Gates (99mTc-Gates-GFR) method was detected as control. With I-GFR-TS as the golden standard, the accuracies of I-GFR-DS, I-GFR-SS and 99mTc-Gates-GFR were compared. Results The median differences of I-GFR-DS, I-GFR-SS and 99mTc-Gates-GFR in overall patients were -0.15, -1.00, 6.76 ml?min-1?(1.73 m2)-1 comparing with I-GFR-TS; P10(percentage of the GFR measurements that was within 10% of the standard method) were 95.4%, 74.1%, 28.7%, and P30 were 100%, 93.7%, 72.4% separately. In the patients with eGFR＜30 ml?min-1?(1.73 m2)-1, I-GFR-SS was more accurate when last point collecting extended to 6 h from 4 h[P10: 43.5% vs 17.4%, P=0.055; P30: 73.9% vs 43.5%, P＜0.05]. Conclusions The dual-sample plasma clearance of iohexol is recommended in clinical practice, and the single-sample method can be a secondary option because of its slightly poor accuracy but more convenient. Sample-collection protocol should be adjusted according to eGFR especially in moderate-to-severe CKD patients. The Gates method is not recommended.

Objective To screen Oxalobacter formigenes (OxF) from fresh feces of healthy adults, and study its effect on the the prevention of calcium oxalate kidney stones. Methods OxF was screened and cultured from fresh feces of healthy adults. The rat model of calcium oxalate stone was established by esophageal gavage of 0.8% of ethylene glycol. Rats were divided into a control group and four groups of rats with ethylene glycol-induced calcium oxalate kidney stones according to random number table. Three groups were treated with 106 CFU, 107 CFU, 108 CFU viable OxF every day, respectively, for 4 weeks. The blood and 24-hour urine samples were collected to detect the serum creatinine, urea nitrogen, serum and urine calcium, phosphorus, magnesium and urine oxalate every week. At the end of the 4th week, the rats were sacrificed and the kidney tissues were stained with HE and Yasue. The deposition and content of calcium oxalate crystals were observed under a light microscope. Results The bacteria strain isolated from fresh feces of healthy adults was 100% as same as the known ATCC35274 bacteria strain, which means the strain screened is OxF. Among the 5 groups, there were no significant differences in body weight, Scr, BUN, serum calcium, blood magnesium, blood phosphorus, urinary magnesium and urinary phosphorus. The 24-hour urinary calcium excretion in the model group was significantly lower than that of the control group (P＜0.05). After intervention with OxF solution, the 24-hour urinary calcium excretion in the 108 CFU OxF group was significantly higher than that in the model group (P＜0.05), while there was no significant difference between the other intervention groups and the model. The oxalic acid excretion of 106 CFU OxF group and 107 CFU OxF group was lower than that of the model, but the difference did not reach statistical significance (P＞0.05). The 24 h oxalic acid excretion in the 108 CFU OxF group was significantly lower than that of the model at the end of first week (P＜0.05), and continued to decrease for the next 3 weeks. After 4 weeks of intervention, no crystal formation was observed in the control group under the deflection microscope, but a large amount of calcium oxalate crystals were formed in the renal cortex and renal medulla. The crystals were piled up and connected to each other. Yasue staining coincided with the calcium oxalate crystal in the same part of the kidneys. Compared with the model, there was no significant change in the score of calcium oxalate crystal in the kidneys of 106 CFU OxF group and 107 CFU OxF group, while the score of calcium oxalate crystal in the kidneys of 108 CFU OxF group was significantly lower (P＜0.05). Conclusions OxF are successively screened from healthy adults. Daily administration of 108 CFU OxF can safely and effectively reduce the urinary oxalic acid excretion, prevent the formation of calcium oxalate crystals and inhibit the formation of stones in kidneys of rats.

Objective To observe the level of CD4+CD25+ regulatory T cells (CD4+CD25+ Treg cells) with positive fork head transcription factor 3 (Foxp3) and changes of T-box transcription factor TBX1 (TBX1) and myocyte specific enhancer 2D (MEF2D) expression in peripheral blood of rats with acute rejection after renal transplantation, and to investigate its regulatory mechanisms by combined with renal function, plasma interleukin-10 (IL-10), interferon-γ (IFN-γ) and renal histopathological changes. Methods Rat renal transplantation model was established and divided into two groups: acute rejection group (AR group) and non-acute rejection group (non-AR group). Their renal function including serum creatinine (Scr) and blood urea nitrogen (BUN) in plasma was measured. The renal histopathology was observed by HE staining. Levels of IL-10 and IFN-γ in plasma were detected by ELISA. The proportion of CD4+CD25+ Treg cells was measured by flow cytometry. The mRNA expressions of Foxp3, TBX1 and MEF2D in CD4+CD25+ Treg cells were detected by real-time PCR, and their protein expressions were tested by Western blotting. Results Compared with those in the non-AR group, the levels of BUN, Scr and IFN-γ significantly increased in AR group (all P＜0.05), while IL-10 decreased (P＜0.05). Renal histopathology in the acute rejection group showed glomerular hypertrophy and mesangial cell proliferation, capillary proliferation and neutrophil infiltration; renal interstitial edema and tubular necrosis, accompanied by lymphocytes, plasma cells and neutrophils infiltration. Compared with that in the non-AR group, the percentage of CD4+CD25+ Treg cells in peripheral blood was notably lowered in AR group (4.50%±0.50% vs 5.74%±1.96%, P＜0.05). The mRNA and protein expressions of Foxp3 and MEF2D were lower in AR group than those in non-AR group, while the expressions of TBX1 was elevated (all P＜0.05). Conclusions In rats with acute renal allograft rejection, the percentage of CD4+CD25+ Treg cells and expressions of Foxp3, MEF2D and IL-10 decrease, while the expressions of TBX1 and IFN-γ enhance. These participate in the development of acute rejection after renal transplantation, and aggravate the renal damage.