Objective To explore the effectiveness and complications of non-incision removal of tunneled cuffed catheter (TCC). Methods The clinical characteristics, surgical plans and complications of patients with TCC removal in the Renal Division of Peking University First Hospital from January 1, 2015 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into non-incision removal group and traditional incision removal group. The clinical characteristics, procedure success rate, procedural duration and complications were compared between the two groups. Results A total of 349 patients were included in this study, for whom 368 catheter removal procedures were performed, including 286 procedures in the non-incision removal group, 75 procedures in the traditional incision removal group, and 7 procedures without records of surgical plans. There was no significant difference in age, sex, basic kidney diseases and catheter remaining time and location between the two groups (all P>0.05). Two procedures in the non-incision removal group and 1 procedure in the traditional incision removal group failed respectively, and there was no significant difference in the procedure success rate between the two groups (99.3% vs 98.7%, χ²=0.290, P=0.590). The procedural duration in the non-incision removal group was lower than that in the traditional incision removal group [(5.36±1.70) min vs (17.55±3.28) min, t=44.198, P<0.001]. Among the patients who needed TCC exchange, there was no significant difference in the selection of new catheter position between the two groups (P=0.330). In terms of complications, there were 2 procedures of local hematoma in the non-incision removal group and 1 procedure of infection in the traditional incision removal group, and there was no severe complication in both groups. Conclusions There was no significant difference in the procedural success rate and complications between non-incision removal group and traditional incision removal group, and non-incision procedure may be superior in reducing the procedure duration and harm less to the patients. Non-incision procedure is a safe and effective method to remove TCC.

Objective To explore the risk factors of autogenous arteriovenous fistula (AVF) aneurysms (AVFAs) in maintenance hemodialysis (MHD) patients. Methods The patients who used internal arteriovenous fistula (end to side anastomosis) of cephalic vein-radial artery at wrist as vascular access in Hainan Provincial People′s Hospital from June 1 to June 30, 2021 were selected as the research objects. The patients were divided into AVFAs group and non-AVFAs group according to whether AVF formed AVFAs. The clinical data and laboratory examination results between the two groups were compared. Binary logistic regression model was used to analyze the risk factors for the formation of AVFAs. Results A total of 170 MHD patients were enrolled in this study, including 111 males (65.3%) and 59 females (34.7%), with age of (51.65±12.70) years old and dialysis age of (57.03±49.25) months. There were 33 cases in AVFAs group and 137 cases in non-AVFAs group. The incidence of AVFAs was 19.4%. Compared with non-AVFAs group, the proportion of males ( χ²=4.934, P=0.026) and the levels of serum uric acid (t=2.547, P=0.012) and serum albumin (t=2.122, P=0.010) in AVFAs group were higher; The age (t=-2.210, P=0.028), the proportion of diabetes nephropathy ( χ²=11.788, P=0.001), systolic blood pressure (t=-1.994, P=0.048) and total cholesterol (t=-2.174, P=0.031) were lower; The diameter of anastomosis was wider (Z=-3.224, P=0.001); Mantel-Haenszel chi square test analysis showed that dialysis age ( χ²=53.832, OR=0.518, P<0.001), AVF service time ( χ²=51.355, OR=0.516, P<0.001), and brachial artery blood flow ( χ²=25.315, OR=0.331, P<0.001) were correlated to the formation of AVFAs. The results of multivariate logistic regression analysis showed that males (OR=10.005, 95%CI 1.875-53.394, P=0.007), longer dialysis age (OR=1.341, 95%CI 1.104-1.628, P=0.003), longer AVF use time (OR=1.187, 95%CI 1.002-1.405, P=0.047), higher brachial artery blood flow (OR=1.002, 95%CI 1.000-1.004, P=0.028) and lower total cholesterol (OR=0.388, 95%CI 0.172-0.875, P=0.022) were the independent risk factors for the formation of AVFAs. Conclusions The incidence of AVFAs in MHD patients is 19.4%. Males, long dialysis age, long AVF use time, high brachial artery blood flow and low total cholesterol level are the independent risk factors for the formation of AVFAs.

Objective To investigate the clinical characteristics and risk factors of frailty syndrome in elderly patients undergoing maintenance hemodialysis (MHD) and the effect of frailty syndrome on all-cause mortality. Methods This was a prospective cohort study. MHD patients aged≥60 years in 5 hemodialysis centers in Beijing from April to June 2017 were selected as the study subjects. Baseline data were collected and compared, and the patients were then classified into non-frailty, pre-frailty and frailty syndrome groups according to the Fried criteria and followed up until June 2018. The end point event was all-cause death. Multivariate logistic regression was used to analyze the independent risk factors of frailty syndrome. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate among the 3 groups. A multivariate Cox regression model was used to analyze the independent risk factors of all-cause mortality. Results A total of 204 patients aged (71.65±5.89) years (60-81 years) were enrolled into this study, including 123 males (60.29%), 147 patients (72.06%) in the frailty syndrome group, 41 patients (20.10%) in the pre-frailty group, and 16 patients (7.84%) in the non-frailty group. Patients with frailty syndrome tended to be older, longer dialysis vintage, a higher proportion of diabetes, lower urea clearance index (Kt/V) and lower serum albumin level (all P<0.05). Multivariate Logistic regression showed that factors independently associated with frailty syndrome included age (OR=1.393, 95%CI 1.241-1.563, P<0.001), history of diabetes (OR=3.610, 95%CI 1.262-10.327, P=0.017), dialysis vintage (OR=1.011, 95%CI 1.002-1.020, P=0.019), Kt/V (OR=0.711, 95%CI 0.516-0.979, P=0.037), serum albumin (OR=0.754, 95%CI 0.644-0.882, P<0.001) and intact parathyroid hormone (iPTH, OR=1.344, 95%CI 1.024-1.763, P=0.033). Kaplan-Meier survival analysis showed that the cumulative survival rate in frailty syndrome group was significantly lower than those of pre-frailty (Log-rank χ²=7.265, P=0.007) and non-frailty groups (Log-rank χ²=5.238, P=0.022). Multivariate Cox regression analysis indicated that frailty syndrome (HR=3.832, 95%CI 1.116-13.157, P=0.033), age (HR=1.074, 95%CI 1.014-1.136, P=0.014), history of diabetes (HR=2.009, 95%CI 1.067-3.784, P=0.031), cognitive impairment (Montreal cognitive assessment<26, HR=2.627, 95%CI 1.142-6.042, P=0.023), Kt/V (HR=0.701, 95%CI 0.545-0.902, P=0.006), serum albumin (HR=0.891, 95%CI 0.806-0.986, P=0.025) and iPTH (HR=1.226, 95%CI 1.100-1.367, P<0.001) were independently associated with all-cause mortality. Conclusions The prevalence of frailty syndrome in elderly patients undergoing hemodialysis is high. Ageing, diabetes history, long dialysis vintage, low levels of Kt/V and serum albumin, and elevated iPTH level are independent risk factors for frailty syndrome in such patients. Frailty syndrome is independently associated with an increased risk of all-cause mortality.

Objective To explore the relationship between low serum albumin levels and its duration on first episode of peritonitis in peritoneal dialysis (PD) patients. Methods PD patients who were regularly followed up in the Pearl River Delta region from September 1, 2000 to July 6, 2021 in Shunde Hospital of Southern Medical University, Nanfang Hospital of Southern Medical University, and Foshan First People′s Hospital were retrospectively selected. The patients were divided into low serum albumin group (LSA group, mean albumin<35 g/L), moderate serum albumin group (MSA group, 35 g/L≤mean albumin<40 g/L) and high serum albumin group (HSA group, mean albumin≥40 g/L) according to the mean albumin of the patients, and the differences among the three groups were compared. The Kaplan-Meier survival analysis method was used to compare the risk of peritonitis events in different mean albumin groups and different durations of hypoalbuminemia. The multivariate Cox regression model was used to analyze the relationship between serum albumin levels and duration of hypoalbuminemia and new-onset peritonitis. Results A total of 1 853 PD patients were included in this study, aged (49.72±15.34) years, and 1 036(55.9%) males. There were 551 patients (29.7%) in the LSA group, 920 patients (49.7%) in the MSA group, and 382 patients (20.6%) in the HSA group. The median follow-up was 37 (15, 66) months and there were 508 patients (27.4%) with new-onset peritonitis during the follow-up. Compared with the LSA group, the incidence of new peritonitis in the MSA group and HSA group was lower ( χ²=14.053, P<0.001; χ²=21.857, P<0.001), but there was no significant difference in the incidence of new peritonitis between the HSA group and MSA group. The Kaplan-Meier survival analysis showed that the cumulative incidence of peritonitis in the LSA group was significantly higher than that in the MSA group and HSA group (Log-rank χ²=22.128, P<0.001). Compared with PD patients with normal serum albumin, the patients with longer duration of hypoalbuminemia tended to have a higher incidence of new peritonitis. Multivariate Cox regression analysis showed that the mean albumin<35 g/L (LSA group/MSA group, HR=1.495, 95%CI 1.198-1.866, P<0.001; LSA group /HSA group, HR=1.459, 95%CI 1.104-1.928, P=0.008) was an independent risk factor of new-onset peritonitis in PD patients and the prolongation of duration of hypoalbuminemia had a significantly higher risk of new-onset peritonitis (HR=1.013, 95%CI 1.003-1.024, P=0.014). Conclusion The mean albumin<35 g/L and prolong duration of hypoalbuminemia are independent risk factors of PD-related peritonitis in PD patients.

Objective To investigate the efficacy and safety of peritoneal dialysis (PD) in end-stage renal disease (ESRD) patients with liver cirrhosis (LC). Methods Clinical data of PD patients receiving regular treatment followed up for≥6 months, and aged≥18 years in the Third Affiliated Hospital of Hebei Medical University Peritoneal Dialysis Center from January 1, 2013 to March 31, 2020 were retrospectively collected. The patients were divided into LC-PD group and non-LC-PD group according to whether they had LC or not. Propensity score matching (PSM) was used to match the LC-PD group and the non-LC-PD group with 1:4 ratio. The baseline clinical data, dialysis adequacy, peritonitis and clinical outcomes between the two groups were compared. Kaplan-Meier survival curve and Log-rank test were used to compare the survival rate and technical survival rate between the two groups. Results A total of 241 PD patients were included in this study. After PSM, 13 cases in LC-PD group and 52 cases in non-LC-PD group were included. Compared with non-LC-PD group, patients in LC-PD group had lower baseline urine volume (Z=-3.546, P<0.001) and serum albumin (Z=-2.609, P=0.009). At the follow-up of 3, 6, 12 and 24 months, total serum protein (t=-3.319, P=0.002), serum albumin (t=-4.019, P<0.001), triglyceride (Z=-2.263, P=0.024), and serum phosphorus (Z=-2.173, P=0.030) in the LC-PD group were lower than those in non-LC-PD group. During the follow-up period of 2 years, the patients in the LC-PD group had significantly higher serum albumin than baseline values ( χ²=16.901, P=0.001), and there was no statistically significant difference between the two groups ( χ²=0.155, P=0.694). The decline rate of residual kidney Kt/V in the LC-PD group was slower than that in the non-LC-PD group ( χ²=44.589, P<0.001). The incidence of peritonitis in LC-PD group was higher than that in the non-LC-PD group, with a statistically significant difference (0.59/patient-year vs 0.20/patient-year, Z=-2.135, P=0.033). The composition ratio of pathogenic bacteria in both groups was mainly gram-positive bacteria (10/25 vs 11/30) and proportion of Streptococcus in LC-PD group was higher than that in non-LC-PD group (4/10 vs 0/11, P=0.035). The proportion of Escherichia coli in the first peritonitis was higher than that in LC-PD group (4/9 vs 1/22, P=0.017). The Kaplan-Meier survival curve results showed no statistically significant difference in survival rate (Log-rank χ²=0.491, P=0.484) and technical survival rate (Log-rank χ²=0.408, P=0.523) between the two groups. Conclusions PD is a safe and effective treatment mode for ESRD patients with LC, and the survival rate and technical survival rate are comparable to those patients without LC. The incidence of peritonitis in patients with LC-PD in our dialysis center is higher than that in the non-LC-PD patients, and gram-positive bacterial infections are the mainstay, suggesting that attention should be paid to strengthening patient management and training.

Objective To explore the relative genes that may influence kidney aging and verify the expression of clock gene Arntl in aging kidney. Methods The differentially expressed genes between C57BL/6 male aging mice (24 months old) group and young mice (3 months old) group were identified by whole transcriptome sequencing, and the enriched biological pathways and key proteins were analyzed by bioinformatics methods. RT-qPCR and Western blotting were used to verify the mRNA and protein expression of Arntl. Results (1) A total of 119 differentially expressed genes were screened between aging mice group and young mice group by whole transcriptome sequencing. Differentially expressed genes were mainly enriched in biological processes such as rhythmic process, circadian rhythm and circadian regulation of gene expression (all P<0.001). Protein-protein interaction analysis results showed that Nfil3, Hspa8, Arntl, Hlf, Rorc, Per3 and Npas2 and so on, were the key proteins in these differentially expressed genes. The results of RT-qPCR confirmed that the expression differences of clock genes Arntl, Nfil3, Npas2 and Per3 between aging mice group and young mice group were consistent with sequencing results (all P<0.05). (2) Compared with C57BL/6 young mice group and SAMR1 rapidly aging mice, the protein expression of Arntl in aging mice group and SAMP8 rapidly aging mice had downward trends. Conclusions Clock genes and their circadian biological pathways may play an important role in the process of renal aging. The expression of Arntl in aging kidney has a downward trend.