Objective To investigate the influencing factors of post-dialysis hypertension in maintenance hemodialysis (MHD) patients. Methods This study was a cross-sectional and retrospective study. The patients receiving hemodialysis from January 9, 2017 to January 14, 2017 in 5 hemodialysis centers of Beijing area were selected. Post-dialysis hypertension was defined as an event characterized by an average increase of more than 15 mmHg in post-dialysis mean artery pressure (MAP) compared to intradialytic 3 h MAP during 3 consecutive hemodialysis sessions. Post-dialysis stable blood pressure was defined as an event characterized by an increase of less than 15 mmHg or a decrease of less than 10 mmHg in post-dialysis MAP compared to intradialytic 3 h MAP, with the exception of patients with post-dialysis hypertension and post-dialysis hypotension. The patients were divided into hypertension group and stable blood pressure group based on whether they had post-dialysis hypertension, and the differences of clinical data between the two groups were compared. The influencing factors of post-dialysis hypertension were analyzed by multivariate unconditional logistic regression. Results A total of 491 MHD patients were enrolled in this study, including 65 patients (13.2%) in the hypertension group, 406 patients (82.7%) in the stable blood pressure group and 20 patients (4.1%) in the hypotension group. The age, blood calcium before dialysis and the proportion of patients using 1.75 mmol/L Ca²⁺ dialysate in the hypertension group were higher than those of the stable blood pressure group, and pre-dialysis serum intact parathyroid hormone and pre-dialysis serum uric acid in the post hypertension group were lower than those of the stable blood pressure group (all P<0.05). The age, pre-dialysis serum intact parathyroid hormone, pre-dialysis serum calcium, pre-dialysis serum uric acid, dialysate Ca²⁺ concentration of statistical differences between hypertension group and stable blood pressure group (P<0.05), and post-dialysis serum calcium, pre-dialysis total serum cholesterol, application of β receptor blocker, gender of univariate analysis (P<0.1) were included into the logistic regression equation as covariates. Multivariate logistic regression analysis showed that using 1.75 mmol/L Ca²⁺ dialysate was the independent influencing factor of post-dialysis hypertension (with using 1.50 mmol/L Ca²⁺ dialysate as reference, OR=2.930, 95%CI 1.282-6.694, P=0.011). The age and pre-dialysis serum calcium of statistical differences between hypertension group and stable blood pressure group (P<0.05), and pre-dialysis serum sodium and pre-dialysis serum uric acid of univariate analysis (P<0.1) were included into the logistic regression equation as covariates. The older age (OR=1.046, 95%CI 1.000-1.093, P=0.049) and higher pre-dialysis serum calcium (OR=21.847, 95%CI 2.111-226.075, P=0.010) were the independent influencing factors of post-dialysis hypertension when the 1.50 mmol/L Ca²⁺ dialysate was used. Conclusions The independent influencing factor of post-dialysis hypertension is using 1.75 mmol/L Ca²⁺ dialysate, while the independent influencing factors of post-dialysis hypertension are the older age and the higher pre-dialysis serum calcium level when the dialysate Ca²⁺ concentration was 1.50 mmol/L.

Objective To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD). Methods A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91%(496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age (OR=1.110, 95%CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95%CI 0.115-0.909, P=0.032), history of diabetes (OR=2.151，95%CI 1.272-3.636, P=0.004), history of stroke (OR=2.546, 95%CI 1.244-5.210, P=0.011), increased dialysis vintage (OR=1.016, 95%CI 1.010-1.022, P<0.001), reduced Kt/V(OR=0.008, 95%CI 0.002-0.035, P<0.001), and increased iPTH level (OR=1.002, 95%CI 1.002-1.003, P=0.012). Conclusions The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.

Objective To investigate the status of frailty and activities of daily living (ADL) in maintenance hemodialysis (MHD) patients, and to explore the effect of frailty phenotype on ADL. Methods The patients who underwent MHD in Kidney Disease Center of the First Affiliated Hospital from March 2019 to March 2020 were enrolled in this study. The demographic and laboratorial data were collected by cross-sectional survey method. Fried frailty phenotype scale and ADL scale were used to evaluate the frailty and ADL, respectively. The differences of basic data and different frailty phenotypes between the normal function group and the function decline group were compared in terms of ADL, physical self-maintenance ability and instrumental ADL ability. Pearson correlation analysis was used to analyze the correlation between frailty and ADL, and binary logistic regression analysis was used to analyze the influencing factors of ADL. Results A total of 676 MHD patients were included in this study, including 434 males (64.2%) and 242 females (35.8%). The age was (59.2±19.4) years old, and the median dialysis age was 59.0 (25.3, 110.0) months. There were 159 frailty patients (23.5%), 230 pre-frailty patients (34.0%), and 287 non-frailty patients (42.5%). The ADL was decreased in 163 patients (24.1%), including 131 patients (19.4%) with decreased physical self-maintenance ability and 161 patients (23.8%) with decreased instrumental ADL ability. Pearson correlation analysis showed that the frailty score was positively correlated with total ADL score (r=0.728, P<0.001), physical self-maintenance ability score (r=0.669, P<0.001) and instrumental ADL ability score (r=0.729, P<0.001). Binary logistic regression analysis results showed that older age and lower physical activity, fatigue, slowed steps and lower grip strength in the frailty phenotypes were the independent influencing factors of ADL, physical self-maintenance ability and instrumental ADL ability (all P<0.05). Conclusions The prevalence of frailty is 23.5% in MHD patients, and 24.1% of MHD patients have decreased ADL. Elder age and lower physical activity, fatigue, reduced step counts, and lower grip strength in frailty phenotypes are the independent influencing factors for poor ADL, poor physical self-maintenance ability and poor instrumental ADL ability.

Objective To determine the prognostic values of clinical and laboratory features at the time of presentation on renal survival of patients with myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody(ANCA)-associated glomerulonephritis (MPO-ANCA-GN). Methods A total of 172 patients with MPO-ANCA-GN and hospitalized at the First Affiliated Hospital of Nanjing Medical University from January 2005 to December 2018 were enrolled. The baseline clinical characteristics and renal biopsy pathological data were analyzed, and the renal prognosis was followed up. The clinical and pathological characteristics of different renal prognosis in all patients and 112 patients who underwent renal biopsy were analyzed, and the related factors affecting renal survival were further discussed. Results Among these 172 patients, 81 were males and 91 were females. The median serum creatinine at diagnosis was 343.7(174.2, 606.6) μmol/L and the median estimated glomerular filtration rate (eGFR) was 15.81(7.61, 38.04) ml·min^-1·(1.73 m²)^-1. In total, 76 patients (44.2%) received initial renal replacement therapy (RRT). During a median follow-up duration of 20(3, 60) months, 73 patients (42.4%) progressed to end-stage renal disease (ESRD) and required dialysis, including 6 (8.2%) patients who entered RRT during follow-up and 67 (91.8%) patients who received RRT at the beginning. Among the 112 patients who underwent renal biopsy, the proportion of patients who progressed to ESRD in the sclerotic group was the highest (15/25, 60.0%). The baseline serum creatinine level (P<0.001), urine red blood cell count (P=0.012) and the proportion of glomerular sclerosis (P=0.002) in the non-dialysis dependent group were significantly lower than those in the dialysis dependent group, while the levels of eGFR (P<0.001), serum albumin (P=0.002) and hemoglobin (P<0.001) were higher than those of the dialysis-dependent group. Kaplan-Meier survival analysis showed that the renal survival rate of the focal group was the highest ( χ²=19.488, P<0.001, log-rank test), while the renal survival rate of the sclerotic group was significantly lower than that of the crescentic group ( χ²=5.655, P=0.017); higher levels of serum creatinine (>320 μmol/L, χ²=77.229, P<0.001) and urine red blood cell count (>300 cells/μl, χ²=8.511, P=0.004), lower levels of rheumatoid factor (<20 IU/ml, χ²=8.610, P=0.003), serum albumin (<30 g/L, χ²=11.060, P=0.001) and hemoglobin (<90 g/L, χ²=21.921, P<0.001) were associated with lower renal survival rate; in terms of treatment, the renal survival rate of the glucocorticoids plus mycophenolate mofetil group was significantly higher than that of the glucocorticoids plus cyclophosphamide ( χ²=5.056, P=0.025) or the glucocorticoids alone group ( χ²=16.459, P<0.001). Multivariate Cox regression showed that baseline serum creatinine >320 μmol/L (HR=8.803, 95%CI 3.087-25.106, P<0.001) and serum albumin <30 g/L (HR=2.566, 95%CI 1.246-5.281, P=0.011) were the related factors affecting renal survival. Conclusion Serum creatinine and albumin levels of MPO-ANCA-GN patients at diagnosis may be the related factors that affect the patient's renal prognosis.

Objective To analyze the prognostic factor of arteriovenous fistula (AVF) maturation and provide the theoretical basis for the hemodialysis patients' AVF surgery. Methods Retrospective investigation was conducted on patients that underwent AVF surgery in Wuhan Central Hospital from January 2017 to June 2019 as study subjects to investigate the prognostic factor of AVF maturation. The general information, hematological indicators, preoperative and postoperative ultrasound data of patients were recorded. Patients were divided into mature group and immature group according to the physical examination status, functional status and postoperative color doppler ultrasound data after AVF surgery, and the differences between the two groups were compared. Logistic regression analysis was used to analyze the prognostic factors of AVF maturation, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each factor for AVF maturation. Results A total of 164 patients were included, including 110 patients in the mature group and 54 patients in the immature group. There were statistically significant differences between the two groups in surgical vein diameter, surgical artery diameter, brachial artery flow, cardiac ejection fractions, systolic blood pressure, diastolic blood pressure and history of diabetes (all P<0.05), while there were no statistically significant differences in other indicators such as gender, age, etc. Logistic regression analysis showed that preoperative surgical artery diameter (every increase by 0.1 mm, OR=1.402, 95%CI 1.159-1.697, P=0.001), surgical vein diameter (every increase by 0.1 mm, OR=1.341, 95%CI 1.176-1.528, P<0.001), cardiac ejection fraction (every increase by 5%, OR=1.184, 95%CI 1.087-1.289, P<0.001), systolic blood pressure (every increase by 10 mmHg, OR=1.407, 95%CI 1.103-1.796, P=0.006), brachial artery flow (every increase by 10 ml/min, OR=1.047, 95%CI 1.004-1.091, P=0.034) and history of diabetes (OR=0.271, 95%CI 0.103-0.715, P=0.008) were the independent influencing factors for AVF maturation. ROC curve showed that preoperative surgical artery diameter (AUC=0.728, 95%CI 0.643-0.839, P<0.001), surgical vein diameter (AUC=0.762, 95%CI 0.686-0.839, P<0.001), cardiac ejection fraction (AUC=0.711, 95%CI 0.626-0.796, P<0.001) were the important indicators for predicting AVF maturation. Conclusions Preoperative surgical artery diameter, surgical vein diameter, cardiac ejection fraction and diabetes mellitus are the prognostic factors of AVF maturation. In preoperative vascular assessment, attention should be paid to the diameter of target arteries and veins, as well as to the cardiac function and diabetes mellitus of patients.

Objective To investigate the effect and mechanism of astragaloside IV (AS-IV) combined with glucocorticoids in the treatment of puromycin aminonucleoside (PAN) rat nephropathy model. Methods Forty specific pathogen-free healthy male Wistar rats (150-180 g) were randomly divided into 5 groups: control group, PAN group, AS-IV treatment group (PAN+AS-IV group), methylprednisone (MP) treatment group (PAN+MP group), and AS-IV+MP treatment group (PAN+AS-IV+MP group). The model was established by a single tail vein injection of PAN (50 mg/kg body weight). The treatment groups were given 40 mg·kg^-1·d^-1 AS-IV by intragastric administration and 15 mg·kg^-1·d^-1 MP by intraperitoneal injection for 10 consecutive days at the same time of modeling. Urine sample was collected on the 11th day of the experiment. The urine protein, urine creatinine and blood albumin were detected by biochemical analyzer. The changes of nephrin and synaptopodin in renal tissues were detected by immunofluorescence assay, and the expressions of nephrin, RhoA and Rac/Cdc42 proteins were detected by Western blotting. Results Compared with the control group, urine protein creatinine ratio (uPCR) was significantly increased, serum albumin (Alb) was significantly decreased in the PAN group, nephrin expression was significantly down-regulated, and the expressions of RhoA and Rac/Cdc42 were significantly up-regulated in the renal tissue of the PAN group (all P<0.01). Compared with PAN group, serum Alb levels in PAN+AS-IV group and PAN+AS-IV+MP group were significantly increased (both P<0.01), and the uPCR levels in PAN+MP group (P<0.05) and PAN+AS-IV+MP group (P<0.01) were significantly decreased (all P<0.05). Compared with the PAN group, the relative expressions of nephrin in renal tissue of all drug intervention group (PAN+AS-IV group, PAN+MP group and PAN+AS-IV+MP group) were significantly increased, while the relative expressions of RhoA and Rac/Cdc42 were significantly decreased (all P<0.01). The immunofluorescence results suggested that the expressions of nephrin and synaptopodin in renal tissue of PAN group were significantly down-regulated compared with the control group, which were reversed in all treatment groups, and the reversion was most pronounced in the PAN+AS-IV+MP group. Conclusion Both AS-IV and glucocorticoid can improve PAN-induced podocyte injury, and the combination of the two has synergistic action, which may be related to inhibiting the activation of Rho family signaling pathway.