Objective To analyze the clinical application of different diagnostic methods for heart failure with preserved ejection fraction (HFpEF) in maintenance hemodialysis (MHD) patients. Methods It was a single-center retrospective cohort study. Uremia patients who underwent hemodialysis at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to June 2021 were enrolled. The demographic characteristics, laboratory indicators, and echocardiography parameters were collected. The 2016 European Society of Cardiology (ESC) criteria, H₂FPEF score [composite score based on weighted scores of heavy (H), hypertensive (H), atrial fibrillation (F), pulmonary hypertension (P), elder (E), and filling pressure (F)], and Heart Failure Association (HFA) -PEFF score [including pre-test assessment (P), echocardiography and natriuretic peptide score (E), functional testing (F) and final aetiology (F)] were used to diagnose HFpEF, respectively, and the difference of three diagnostic methods was compared. The association between HFpEF diagnosed by the three methods and poor outcomes (all-cause death, cardiovascular death) was analyzed. Results A total of 160 MHD patients were included, whose age was (58.5±13.4) years, median dialysis age was 5.0 (2.3, 9.6) years, median H₂FPEF score was 2 (1, 3), median HFA?PEFF score was 4 (3, 5), and 92 (57.5%) were males. Of these patients, 118 patients (73.8%) met the 2016 ESC criteria for diagnosis of HFpEF, 4 (2.5%) met H₂FPEF score for diagnosis of HFpEF, and 56 (35.0%) met HFA?PEFF score for diagnosis of HFpEF. The consistency of three methods in diagnosing HFpEF was poor with κ values of 0.018 between ESC criteria and H₂FPEF score, 0.322 between ESC criteria and HFA?PEFF score, and 0.056 between H₂FPEF score and HFA?PEFF score. After a median follow-up of 2.6 years, 20 (12.5%) of the 160 MHD patients died. The Kaplan?Meier survival analysis showed a significant difference in mortality between patients diagnosed with HFpEF and those without using the H₂FPEF score (Log?rank test, χ²=6.95, P=0.008). After adjusting for demographic and clinical parameters, multivariate Cox regression analysis showed that HFpEF diagnosed by HFA?PEFF score was associated with all-cause mortality (HR=2.73, 95%CI 1.07-6.98, P=0.036) and cardiovascular mortality (HR=4.77, 95%CI 1.31-17.30, P=0.018). Conclusions The 2016 ESC criteria, H₂FPEF score, and HFA?PEFF score have high heterogeneity and poor consistency in diagnosing HFpEF in MHD patients. Among the three diagnostic methods, only the diagnosis based on HFA?PEFF score is associated with the prognosis of MHD patients. The HFA?PEFF score can be used to assess the risk of HFpEF in MHD patients, and more clinical studies are needed to further verify it in the future.

Objective To investigate the application of virtual reality (VR) technology on intraoperative pain in patients undergoing peritoneal dialysis (PD)-related procedures with local infiltration anesthesia and the satisfaction. Methods It was a single-center, prospective, concurrent controlled study. Patients were divided into two groups: VR group and control group. In the VR group, patients wore a VR headset to watch soothing audio and video content during surgery, while the control group underwent routine procedures. Intraoperative pain and satisfaction were assessed using the visual analog scale (VAS) and a 5-point satisfaction scale within 30 minutes of surgery. In addition, tolerance of the VR experience in the VR group was assessed using the VR sickness questionnaire. Results A total of 43 patients were included in the study, including 25 males (58.1%). Chronic glomerulonephritis [17 cases (39.5%)] and diabetic nephropathy [6 cases (14.0%)] were the main primary diseases. There were 23 cases in the control group and 20 cases in the VR group. There were no significant differences between the two groups in age, sex ratio, proportion of primary disease, diabetes, hypertension, distribution of operation methods, preoperative vital signs and operation time (all P>0.05). VAS pain score was significantly lower in the VR group than that in the control group (5.90±2.38 vs. 7.43±1.67, t=2.469, P=0.018). The percentage of patients who were satisfied was 89.5% (17/19) in the VR group and 78.3% (18/23) in the control group, but there was no significant difference (chi-square test for continuity correction, χ2=0.308, P=0.579). Three patients in the VR group withdrew from the study due to severe discomfort, while the remaining participants found the VR experience to be tolerable. Common adverse effects included fatigue and blurred vision. Conclusions The application of VR technology in PD-related procedures has been effective in reducing intraoperative pain when combined with local infiltration anesthesia. Furthermore, the utilization of VR technology in PD-related procedures is associated with a safe and tolerable outcome, despite the observation of some adverse effects.

Objective To investigate the epidemiology features, intervention effects and influencing factors of thrombosis in arteriovenous graft (AVG), and to provide reference for optimizing vascular access scheme in hemodialysis patients. Methods It was a retrospective study. The clinical and follow-up data of patients with AVG constructed in the Blood Purification Center, the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were analyzed. According to whether AVG thrombosis occurred during the follow-up period, they were divided into thrombosis group and non-thrombosis group, and the epidemiology status, influencing factors and patency rates of AVG thrombosis were analyzed. AVG was followed up until June 30, 2023 or abandonment or death of patient or loss of follow-up. Kaplan?Meier method was used to analyze the patency rates of AVG. Log?rank test was used to compare the differences of patency rates between groups. Logistic regression model was used to analyze the influencing factors of AVG thrombosis. Results The study included 475 AVG from 464 patients, with age of (55.50 ± 11.85) years old, 193 males (40.6%), 185 diabetes patients (38.9%) and dialysis age of 24 (1, 68) months. One hundred and fifty-four AVG (32.4%) had a total of 307 AVG thrombotic events during the follow-up of 602 (380, 920) days, with a standardized incidence of 0.34 times per patient-year. Among them, 60 cases (19.5%, 60/307) had frequent thrombosis. Kaplan?Meier survival analysis showed that AVG secondary patency rates at 2-years and 3-years in the thrombosis group and frequent thrombosis subgroup were inferior to those in the non-thrombosis group (84.0% vs. 92.5%, P=0.017; 66.5% vs. 85.7%, P<0.001; 78.9% vs. 92.5%, P=0.030; 54.6% vs. 85.7%, P<0.001). Two hundred and sixty-nine AVG thrombotic events were analyzed to evaluate the treatment effects. Endovascular interventional surgery was used for thrombectomy in 215 cases (79.9%), and hybrid surgery (endovascular interventional surgery combined with surgical incision) was used in 54 cases (20.1%), with a technical success rate of 98.9% (266/269) and a clinical success rate of 98.1% (264/269). Kaplan?Meier survival analysis showed that there were no statistically significant differences in the primary post-intervention patency rates at 90 days and 365 days, respectively (all P>0.05), and there was statistically significant difference in the primary post-intervention patency rate at 180 days (45.1% vs. 26.5%, Z=2.563, P=0.015). Multivariate logistic regression analysis showed that graft-applied type (intering as the reference, propaten OR=1.953, 95%CI 1.139-3.350, P=0.015; acuseal OR=2.628, 95%CI 1.438-4.800, P=0.002), body mass index < 18.5 kg/m² (18.5-24.0 kg/m² as the reference, OR=0.291,95%CI 0.090-0.943,P=0.040), serum albumin < 40 g/L (OR=1.579, 95%CI 1.019-2.445, P=0.041), serum ferritin < 200 μg/L (OR=1.818, 95%CI 1.162-2.845, P=0.009) and mean arterial pressure < 70 mmHg (OR=7.180, 95%CI 1.339-38.501, P=0.021) were the independent influencing factors of AVG thrombosis. Conclusions The incidence of AVG thrombotic events is 0.34 times per patient-year, mainly concentrated in a small number of patients. Thrombosis reduces the secondary patency rate of AVG. AVG thrombosis treatment with endovascular interventional surgery or hybrid surgery has a high technical success rate and a clinical success rate. The thrombosis is related to graft-applied types, nutritional status of patients and mean arterial pressure level.

Objective To investigate the efficacy and safety of peripheral cutting balloon (PCB) in the treatment of long stenosis of arteriovenous fistula, and to explore the influencing factors of restenosis after PCB treatment. Methods It was a single-center retrospective study. The patients with long stenosis (>2 cm) of arteriovenous fistula who received PCB treatment of percutaneous transluminal angioplasty (PTA) in Haidian Hospital, the Third Hospital of Peking University from August to November 2021. The clinical and follow-up data after PTA operation were collected and analyzed, and the primary patency rate and primary assist patency rate of fistula at 3, 6 and 12 months after PTA operation were calculated. Kaplan?Meier method was used to draw the survival curve of the primary patency rate of fistula, and log-rank test was used to compare the differences of primary patency rates of fistula between two groups. Multivariate Cox regression analysis was used to analyze the influencing factors of fistula restenosis after PCB treatment. Results A total of 65 patients aged (62.57±11.55) years old were included in this study, including 42 males (64.62%), 61 (93.85%) autologous arteriovenous fistula and 4 (6.15%) arteriovenous graft. The narrowest diameter of fistula stenosis (t=-41.731, P<0.001) and brachial artery blood flow (t=-12.510, P<0.001) after PCB treatment were significantly higher than those before PCB treatment. The resistance index of fistula after PCB treatment was significantly lower than that before PCB treatment (t=9.241, P<0.001). The technical success rate of PTA was 100% (65/65), and the clinical success rate of PTA was 96.92% (63/65). Only 2 patients failed to complete hemodialysis after PCB treatment, and no serious postoperative complications occurred. The follow-up time was 12 (7, 13) months. Fistula dysfunction occurred in 24 patients (36.92%) within 12 months. Kaplan?Meier survival analysis showed that the primary patency rates were 90.77%, 81.54% and 63.08% at 3, 6, and 12 months, respectively, and the primary assist patency rate at 12 months was 100% (65/65). The risk of fistula restenosis in patients with long stenosis ≥36 mm was significantly higher than that in patients with long stenosis <36 mm (log-rank χ²=6.007, P=0.014). Multivariate Cox regression analysis showed that increased stenosis length (HR=1.022, 95% CI 1.001-1.045, P=0.042) was an independent influencing factor of fistula restenosis within 12 months after PCB treatment. Conclusions PCB is safe and effective in the treatment of long segment stenosis associated with fistula. The increased stenosis length is an independent influencing factor of restenosis in fistula after PCB treatment.

Objective To preliminarily explore the role of silent information regulator 3 (SIRT3) in ferroptosis induced by high glucose in renal tubular epithelial cells, and to provide a new theoretical basis and treatment ideas for renal tubular injury in diabetic kidney disease patients. Methods The single-cell transcriptomic analysis from "Tabula-muris" database was used to evaluate the expression of SIRT3 gene in different cellular subtypes of kidney tissues. HK-2 cells, a human immortalized proximal tubule epithelial cell line, were cultured in vitro and divided into following groups: (1) control group, mannitol group and high glucose group; (2) control group, negative control group, SIRT3 overexpression group, high glucose group and SIRT3 overexpression + high glucose group; (3) control group, negative control group, SIRT3 knockdown group, high glucose group and SIRT3 knockdown + high glucose group; (4) control group, Erastin intervention group and SIRT3 overexpression + Erastin intervention group. Normal glucose was 5.5 mmol/L, high glucose was 30 mmol/L, mannitol was 24.5 mmol/L, Erastin was 10 μmol/L, and the intervention time was 48 h. Cell counting kit-8 proliferation and cytotoxicity assay was used to determine cell viability. Real-time quantitative PCR and Western blotting were performed to assess the expression of SIRT3, kidney injury molecule-1 (KIM-1), and ferroptosis-related proteins acyl?CoA synthetase long chain family member 4 (ACSL4) and glutathione peroxidase 4 (GPX4) at the mRNA and protein levels. The malondialdehyde, glutathione, and iron levels were measured to evaluate the degree of cellular ferroptosis. DCFH-DA was used to analyze the intracellular reactive oxygen species level, while the JC-1 staining method was employed to evaluate alterations of mitochondrial membrane potential in HK-2 cells. Results (1) The results of single-cell transcriptomic database analysis demonstrated that SIRT3 gene was expressed at the highest level in the subtypes of proximal tubule epithelial cells of kidney tissues. (2) Compared with the control group, the expression levels of KIM-1 and ACSL4 were higher, and the expression levels of SIRT3 and GPX4 and cell viability were lower in the high glucose group (all P<0.05), while there was no statistically significant difference of the aforementioned indicators between the mannitol group and the control group (all P>0.05). (3) Compared with the high glucose group, HK-2 cell vitality, GPX4 expression and intracellular glutathione were higher, ACSL4 expression, intracellular iron, malondialdehyde and reactive oxygen species were lower, mitochondrial membrane potential partially recovered in SIRT3 overexpression + high glucose group (all P<0.05). Compared with the high glucose group, HK?2 cell vitality and GPX4 expression were lower, ACSL4 expression was higher in SIRT3 knockdown + high glucose group (all P<0.05), and there were no statistically significant differences in intracellular iron, malondialdehyde and glutathione (all P>0.05). (4) Compared with the control group, Erastin intervention group had upregulated ACSL4 expression and downregulated GPX4 expression in HK-2 cells (all P<0.05). Compared with the Erastin intervention group, SIRT3 overexpression + Erastin intervention group had upregulated GPX4 expression and downregulated ACSL4 expression (all P<0.05). Conclusions High glucose can decrease SIRT3 expression and mitochondrial membrane potential, and increase oxidative stress and ferroptosis in HK-2 cells. Overexpression of SIRT3 may reduce oxidative stress and alleviate mitochondrial dysfunction, thereby mitigating glucose-induced ferroptosis in HK-2 cells.

It was a retrospective study. The case data of thirteen patients diagnosed with methylmalonic acidemia (MMA) combined with hemolytic uremic syndrome (HUS) hospitalized at the Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2010 to December 2022 were analyzed, to explore clinical and genetic characteristics of MMA combined with HUS (MMA?HUS). The onset age of MMA was 18 days to 5 years old, with 11 patients of early onset and 2 patients of late onset, 4 patients of simple MMA and 9 patients of combined MMA, and 7 patients of secondary hypertension and 3 patients of secondary pulmonary arterial hypertension. Among 13 patients, 7 patients underwent genetic testing, with 1 patient of MMUT gene mutation and 6 patients of MMACHC gene mutation. The mutation sites were all from their parents and all were known pathogenic variants. Among them, 5 patients had MMACHC gene c.80A>G heterozygous variation, accompanied by cardiovascular involvement. After etiological and symptomatic treatment, 6 patients improved, 7 patients died of multiple organ failure, and all the deaths were early-onset MMA. This study shows that MMA?HUS is more common in early-onset MMA, with a severe condition and a high mortality rate. Its prognosis is related to multiple factors such as genotype, diagnosis and treatment timing. c.80A>G variation of MMACHC gene may be related to HUS and cardiovascular involvement.

The paper reports a rarely case of hemophagocytic syndrome complicated with thrombotic microangiopathy, first presented with fever of unknown origin. A 37-year-old female patient mainly presented with fever, hemolytic anemia, thrombocytopenia, and progressive decline in renal function. After infusion of fresh frozen plasma and high dose of glucocorticoid after double plasma exchange, the patient showed good prognosis, no further fever or hemolysis occurred, recovered platelet and renal function. After acute episode phase, kidney biopsy was performed and acute tubular necrosis was diagnosed. During the follow-up period, the disease did not recur, and the renal function was normal.

The paper reports a case of 2,8-dihydroxyadenine (2,8?DHA) crystalline nephropathy caused by mutation of adenine phosphoribosyltransferase (APRT) gene. The female patient was 60 years old, and sought medical advice due to "foaming urine increased for half a year". Renal biopsy result showed irregular yellowish brown 2,8?DHA crystals with refraction under polarized light. 2,8?DHA crystals were found by urine sediment detection, and homozygous deletion of c.521_523delTCT on exon 5 of APRT gene was found by genetic testing. Finally this patient was diagnosed as 2,8?DHA crystalline nephropathy. Renal function improved after treatment with allopurinol. The case report aims to improve the clinician's understanding of 2,8?DHA crystalline nephropathy. Early recognition, correct diagnosis, and early drug intervention may delay the progression of renal failure and improve the prognosis.

The identification of pathogenic antigens in membranous nephropathy (MN) is a hot topic in the research field of kidney diseases. In recent years, the widespread application of mass spectrometry has brought a breakthrough in the identification of MN-pathogenic antigens. As the antigen spectrum continues to be refined, the diagnosis of MN has evolved from morphological level to molecular level. This article reviewed the research progress of currently identified antigens of MN, such as phospholipase A2 receptor (a major pathogenic antigen of primary MN), thrombospondin type 1 domain-containing 7A (a potential tumor-associated antigen), neural epidermal growth factor-like protein 1 (an antigen associated with various secondary factors), semaphorin 3B (an antigen specific to pediatric MN) and so on, and the pathogenic mechanisms and clinical significance of these antigens.

There are numerous novel therapies available for heart failure (HF) nowadays, but the condition of HF patients with diuretic resistance is notably complicated and severe, and its treatment is challenging. The main mechanisms of diuretic resistance in HF patients were the decrease of body's response to diuretics due to various reasons, and the retention of water and sodium. Peritoneal dialysis stands out as a safe and effective choice for the treatment of diuretic resistance in HF patients because of its advantages of ultrafiltration, sodium excretion, improvement of cardiac function, and preservation of residual renal function. This review outlines the rationale and clinical application of peritoneal dialysis in treating HF patients with diuretic resistance, to provide clinical guidance.

Rituximab (RTX) is a human mouse chimeric monoclonal antibody that acts on CD20 molecules on the surface of B cells. Currently, its application in the treatment of immune glomerular diseases is becoming increasingly widespread. However, there are still many problems in the application of RTX by clinical physicians. In response to this, we organized multiple rounds of discussions and revisions among national nephrologists on the 50 clinical issues that everyone is most concerned about and formed this article. The content covers the scope of application, evidence-based evidence, therapeutic regimen, drug usage methods and precautions, medication for special populations, and drug safety of rituximab in the treatment of membranous nephropathy, minimal change nephropathy, antineutrophil cytoplasmic antibody (ANCA) associated vasculitis and other immune glomerular diseases. In particular, specific answers are provided to typical questions raised by clinical doctors, aiming to provide practical guidance and reference for the broader clinicians.

Sarcopenia is a common complication in patients with chronic kidney disease (CKD), especially those with end-stage kidney disease (ESKD). It significantly affects the quality of life and prognosis of the patients. However, currently, there is a lack of consensus regarding the diagnosis, treatment, and prevention of sarcopenia in CKD patients. Therefore, combining the existing clinical evidence with the characteristics of Chinese population and medical conditions, expert consensus workinggroup constructed this consensus. The consensus focuses on the pathogenesis, diagnosis, treatment, rehabilitation strategies, and prevention of sarcopenia in CKD. It is the first in China to guide the diagnosis and treatment of sarcopenia in CKD, aiming to enhance nephrologists' understanding of sarcopenia and standardize its diagnosis and treatment.