Objective To explore the association between urinary stone disease (USD) and peripheral arterial disease (PAD). Methods The study was based on the cross-sectional chronic diseases survey performed in Pinggu district, Beijing from March to May, 2014. All subjects completed a questionnaire, physical examination, renal ultrasound examination to detect USD, ankle-brachial index (ABI) examination to detect PAD (defined as ABI<0.9 on either side of the body), and brachial-ankle pulse wave velocity (baPWV) measurement to estimate arterial stiffness. Blood and first morning urine sample were detected for serum creatinine, blood glucose and so on. Results There were 10 281 participants included in this study. Among these participants, the prevalences of USD and PAD were 5.66% and 3.95%, respectively. Compared with non-stone participants, the persistent USD formers had a higher prevalence of PAD (8.26% vs 3.90%, P<0.001) and baPWV [(16.3±3.5) m/s vs (15.5±3.2) m/s, P<0.001]. Even after adjusting the confounding factors, the persistent USD formers also had a 2.066-fold increased risk of PAD (OR=2.066, 95%CI 1.276-3.343, P=0.003). In the subgroup analysis, persistent USD patients in older participants who were≥60 years old, women, chronic kidney disease, and central obesity had a significantly increased risk of PAD. Conclusions In the present population, persistent USD is positively associated with a high risk of PAD and increased arterial stiffness. Patients with persistent USD should be screened for vascular diseases.

Objective To determine whether the early stage platelet count can predict the outcome of peritoneal dialysis-associated peritonitis (PDAP). Methods A retrospective cohort study was conducted by selecting PDAP patients who were hospitalized in the First People's Hospital of Foshan from January 2012 to January 2019. According to the final treatment outcome, the patients were divided into cured group and withdrawn group. The withdrawn group included patients who transferred to hemodialysis or died. Basic data on demography, blood routine examination, peritoneal fluid, biochemical indicators were compared between the two groups. Logistic regression analysis was used to analyze the withdrawn risk factors of PDAP. Results There were 180 patients included in the study, including 112 cases in the cured group and 68 cases in the withdrawn group. Compared with the cured group, there were older age [(53.38±14.17) years old vs (48.41±13.04) years old, t=2.407, P=0.017], longer age of dialysis [(49.20±26.05) months vs (30.36±32.97) months, t=4.034, P<0.001], longer hospital stay [(23.88±11.50) d vs (17.80±3.95) d, t=5.133, P<0.001] and higher platelet count [(285.55±107.23)×10⁹/L vs (234.90±74.03)×10⁹/L, t=3.450, P=0.001], lower serum albumin [(31.72±7.47) g/L vs (35.40±4.93) g/L, t=-3.972, P<0.001] in the withdrawn group. Multivariate logistic regression analysis showed that longer dialysis age (OR=1.012, 95%CI 1.007-1.024, P=0.015) and higher platelet count (OR=1.013, 95%CI 1.004-1.026, P=0.008) were independent risk factors, and higher serum albumin (OR=0.941, 95%CI 0.896-0.988, P=0.005) was an independent protective factor of withdrawal from peritoneal dialysis in PDAP patients. Conclusions The long dialysis age, early high platelet count are independent risk factors and high serum albumin level is an independent protective factor for withdrawal from peritoneal dialysis in PDAP patients.

Objective To explore the effect of continuous quality improvement (CQI) on reducing the incidence of peritoneal dialysis (PD)-related peritonitis in patients within the first year of PD initiation. Methods The patients who received catheter placement from January 2006 to December 2016 in our hospital were enrolled in this study. All patients were divided into four groups: pre-CQI group patients who initiated PD treatment from 2006 to 2007 (before CQI phase, group A), CQI Ⅰphrase patients who initiated PD treatment from 2008 to 2010 (group B), CQI Ⅱ phrase patients who initiated PD treatment from 2011 to 2013 (group C), and CQI Ⅲ phrase patients who initiated PD treatment from 2014 to 2016 (group D). The method of plan, do, check and act (PDCA) was conducted to decrease the incidence of PDRP. All the patients were followed up for 12 months or until they withdrew from PD in this period. Poisson analysis was used to compare the incidence of PDRP among the groups. Results There were 2 383 PD patients recruited in this study, including 346 cases in group A, 850 cases in group B, 688 cases in group C and 499 cases in group D, with an age of (47.1±15.8) years, among whom 59.1% of the patients were male, and 21.4% with diabetes. The follow-up time was (10.9±2.8) months. Compared with group A, the incidence of PDRP was lower than that in group C (0.156 episodes/patient year vs 0.234 episodes/patient year, P=0.020); the incidence of gram positive PDRP decreased (0.052, 0.049, 0.054 episodes/patient year vs 0.104 episodes/patient year, all P<0.05) in group B, C, D; the incidence of gram negative PDRP increased in group B, then decreased in group C and group D (all P>0.05). Cox regression analysis indicated that CQI was independently associated with the incidence of gram positive PDRP (HR=0.526, 95%CI 0.349-0.792, P=0.002). Conclusion CQI can effectively reduce the incidence of gram positive PDRP in patients within the first year of PD initiation.

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.

Objective To investigate the effects of abdominal aortic calcification (AAC) progression on outcomes in maintenance hemodialysis (MHD) patients. Methods Patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center of the Second Hospital of Tianjin Medical University and finished the AAC examination at baseline and two years later were included prospectively. The progression of AAC by AAC score (AACs) at baseline and two years later was evaluated. According to the change of AACs, the patients were divided into rapid AAC progression group and non-rapid AAC progression group. The effect of AAC progression on outcomes in MHD patients in the follow-up period was investigated. Kaplan-Meier analysis was used to compare their survival rates. Multivariable Cox regression model was used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results A total of 111 MHD patients were included, including 51 males and 60 females, aged (52.24±12.69) years. Baseline AAC prevalence was 45.9% (51/111), and median AACs was 0 (0, 5); After 2 years, the prevalence of AAC was 78.4% (87/111), and the median AACs was 6 (2, 11). There were 54 cases in the AAC rapid progression group (AACs change value>2) and 57 cases in the non-rapid AAC progression group (AACs change value≤2). The median follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (Log-rank χ²=5.695, P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI 1.001-1.286, P=0.048), hypoalbuminemia (HR=0.789, 95%CI 0.640-0.972, P=0.026) were independent risk factors for all-cause mortality in MHD patients. High baseline AACs (HR=1.187, 95%CI 1.038-1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013-0.801, P=0.030) were independent risk factors for cardiovascular mortality in MHD patients. Low spKt/V (HR=0.018, 95%CI 0.003-0.115, P<0.001), hypoalbuminemia (HR=0.736, 95%CI 0.608-0.890, P=0.002) were independent risk factors for cardiovascular events in MHD patients. Conclusions Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of AAC, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.

Objective To investigate the impact of different type of dyslipidemia on clinical and pathological characteristics in children with IgA nephropathy (IgAN). Methods A retrospective study was performed at the Children Kidney Disease Center, the First Affiliated Hospital of Sun Yat-sen University between January 2006 to September 2019. Children diagnosed with primary IgAN was divided into dyslipidemia group and normal blood lipid group according to whether the blood lipid is normal, and was divided into the following four groups: hypercholesterolemia group, hypertriglyceridemia group, mixed hyperlipidemia group and low high-density lipoprotein cholesterol (HDL-C) group according to clinical classification. The clinical and pathological features in different groups were analyzed, and the risk factors of dyslipidemia were analyzed by using multivariate logistic regression analysis. Results A total of 252 children with IgAN were enrolled in this study, including 169 males and 83 females, with a male/female ratio of 2.04∶1 and an age of (9.3±3.1) years. Among them, 34.5% IgAN children were complicated with hypertension, and 170 cases (67.5%) were in dyslipidemia group, 82 cases (32.5%) in normal blood lipid group. According to clinical classification, the children in dyslipidemia group were divided into hypercholesterolemia group (58 cases, 23.0%), hypertriglyceridemia group (16 cases, 6.3%), mixed hyperlipidemia group (77 cases, 30.6%) and low HDL-C group (19 cases, 7.5%). The systolic blood pressure, diastolic blood pressure, proportion of hypertension, blood urea nitrogen, uric acid and urinary protein in dyslipidemia group were higher than those in normal blood lipid group (all P<0.05), and the levels of serum albumin, blood IgA and estimated glomerular filtration rate (eGFR) were less (all P<0.05). The proportion of IgAN children in chronic kidney disease (CKD) stage 1 and CKD stage 2-5 with dyslipidemia was 65.0% and 84.4% respectively, and the proportion of IgAN children with CKD stage 2-5 in dyslipidemia group was higher than that in normal group (P<0.05). The dyslipidemia group had a higher proportion of Lee Ⅲ-V grade than normal blood lipid group (P<0.01). The results of Oxford pathological classification showed that the proportions of M1 and E1 in dyslipidemia group were higher than those in normal lipid group (all P<0.05), and there was no significant difference in segmental glomerulosclerosis, tubular atrophy or interstitial fibrosis and crescent between the two groups (all P>0.05). The comparison results between groups with different types of dyslipidemia showed that systolic blood pressure, diastolic blood pressure, serum uric acid and urinary protein in the mixed hyperlipidemia group were higher than those in other groups (all P<0.05), and the serum albumin level was less (P<0.01). The results of Oxford pathological classification showed that the proportion of E1 in hypercholesterolemia group and mixed hyperlipidemia group was higher (P<0.05). Multivariate logistic regression analysis showed that hypertension (OR=2.734, 95%CI 1.327-5.632, P=0.006) and low serum albumin (OR=0.838, 95%CI 0.791-0.889, P<0.001) were the risk factors of dyslipidemia in children with IgAN. Conclusions In our center, 67.5% IgAN children are accompanied by dyslipidemia. The clinical manifestations and pathological changes of these dyslipidemia children are more severe than those with normal blood lipid, and the IgAN children with mixed hyperlipidemia are more notable. Hypertension and low serum albumin are the risk factors of dyslipidemia in children with IgAN.

Objective To investigate the effect of postoperative hypoalbuminemia on acute kidney injury (AKI) after cardiac surgery under cardiopulmonary bypass (CPB). Methods The clinical data of adult patients undergoing cardiac surgery under CPB were retrospectively analyzed. The difference between preoperative and postoperative serum albumin level was compared. The patients were divided into hypoalbuminemia group (≤35 g/L) and non-hypoalbuminemia group (>35 g/L) according to the lowest serum albumin concentration within 48 hours after surgery. The incidence and severity of postoperative AKI were compared between the two groups. Univariate analysis and binary logistic regression analysis were used to evaluate the effect of postoperative hypoalbuminemia on the incidence of postoperative AKI. Results Among the 749 patients, the serum albumin level after cardiac surgery was significantly lower than that before surgery (Z=-15.739, P<0.001), and the proportion of patients with hypoalbuminemia increased from 9.6% to 27.6%(χ²=83.516, P<0.001). Postoperative AKI occurred in 273 patients, including 109 cases (52.7%) in hypoalbuminemia group and 164 cases (30.3%) in non-hypoalbuminemia group. The incidence of AKI in hypoalbuminemia group was significantly higher than that in non-hypoalbuminemia group (χ²=32.443, P<0.001), and the severity of AKI in hypoalbuminemia group increased than that in non-hypoalbuminemia group (Z=-2.098, P=0.036), and the time of hospital stay extended (Z=-2.442, P=0.015). After adjusted by gender, age, preoperative hypoalbuminemia, comorbidities (hypertension, hyperuricemia, diabetes mellitus, cerebrovascular disease), renal insufficiency, preoperative heart function, coronary angiography, CPB time, aorta blocking time, type of heart surgery and postoperative hypotension, binary logistic regression analysis revealed that postoperative hypoalbuminemia was an independent risk factor for CPB-associated AKI (OR=2.319, 95%CI 1.586-3.392, P<0.001). Conclusions AKI is a common complication following cardiac surgery under CPB. Serum albumin after CBP is significantly lower than that before CBP, and postoperative hypoalbuminemia within 48 hours after surgery is an independent risk factor for AKI.

Objective To prospectively investigate the characteristics of acute kidney injury (AKI) that progressed to chronic kidney disease (CKD) (AKI to CKD) in patients hospitalized for AKI, determine the risk factors of AKI to CKD, and preliminarily evaluate the performance of clinical risk factor model for predicting AKI to CKD. Methods This was a prospective, observational cohort study. Patients hospitalized for AKI and without a prior CKD [estimated glomerular filtration rate (eGFR)<60 ml·min^-1·(1.73 m²)^-1] were enrolled in Nanfang Hospital of Southern Medical University from April 2015 to December 2019. Survived patients were followed 90 days after AKI and the renal function 90 days post AKI was determined. The primary endpoint was AKI to CKD, defined as new-onset CKD [eGFR<60 ml·min^-1·(1.73 m²)^-1 90 days post AKI]. According to AKI progressed to CKD or not, AKI patients were divided into two groups (with or without AKI to CKD). The baseline clinical data of demographics, comorbidities, baseline renal function, AKI severity, receiving hemodialysis or not, and other lab parameters were compared between two groups. The logistic regression model was used to analyze the risk factors of AKI to CKD. Finally, receiver operator characteristic (ROC) curve was drawn to evaluate the performance of clinical risk factor model for predicting AKI to CKD. Results A total of 168 patients with AKI was enrolled in this study[male, n=91; female, n=77; age (44.0±18.4) years], in which 64 patients (38.1%) developed new-onset CKD 90 days post AKI and 104 patients (61.9%) did not. Compared to those without AKI to CKD, patients with AKI to CKD were older, and had a higher proportion of hypertension, lower levels of eGFR and hemoglobin, higher proportion of receiving hemodialysis, and higher level of discharged serum creatinine (all P<0.05). There was no significant difference in the proportion of diabetes and use of RAS inhibitors, urine protein level, and other lab parameters between two groups. Multivariate logistic regression analysis shows that receiving hemodialysis (OR=2.516, 95%CI 1.251-5.060, P=0.010), hypertension (OR=2.446, 95%CI 1.124-5.324, P=0.024), and lower baseline eGFR (OR=0.975, 95%CI 0.950-0.999, P=0.043) were the independent risk factors for AKI to CKD. The clinical risk factor model including age, receiving hemodialysis, hypertension, and baseline eGFR produced moderate performance for predicting AKI to CKD, with the area under ROC curve of 0.712, 95%CI 0.634-0.790. Conclusions AKI survivors are at high risk for developing CKD. Receiving hemodialysis, hypertension, and lower baseline eGFR are independent risk factors for predicting AKI to CKD. More studies are needed to improve the performance of clinical risk factor model for early detecting high risk patients who will develop AKI to CKD.