Association between preoperative C-reactive protein to albumin ratio and late arteriovenous fistula dysfunction in hemodialysis patients: a cohort study.

Arteriovenous fistula (AVF) dysfunction is a critical complication in hemodialysis (HD) patients, with inflammation potentially contributing to its development. This retrospective cohort study aimed to investigate the association between preoperative C-reactive protein to albumin ratio (CAR) and AVF dysfunction in Chinese HD patients. A total of 726 adults with end-stage renal disease who underwent new AVF placement between 2011 and 2019 were included. Multivariable Cox regression and Fine and Gray competing risk models were employed to assess the relationship between CAR and AVF dysfunction, considering death and renal transplantation as competing risks. Among 726 HD patients, 29.2% experienced AVF dysfunction during a median follow-up of 36 months. Adjusted analyses revealed that higher CAR levels were associated with an increased risk of AVF dysfunction, with a 27% higher risk per one-unit increase in CAR. Furthermore, patients with CAR values ≥ 0.153 exhibited a 75% elevated risk compared to those with CAR values < 0.035 (P = 0.004). The relationship between CAR and AVF dysfunction varied by the site of internal jugular vein catheter placement (P for trend = 0.011). Notably, the Fine and Gray analysis confirmed the association between CAR and AVF dysfunction, with a 31% increased risk per one-unit increase in CAR. The highest CAR tertile remained an independent predictor of AVF dysfunction (HR = 1.77, 95% CI 1.21-2.58, P = 0.003). These findings highlight the potential of CAR as a prognostic marker for AVF dysfunction in Chinese HD patients. Clinicians should consider CAR levels and catheter placement site when assessing the risk of AVF dysfunction in this population.

Association between Preoperative Monocyte-to-Lymphocyte Ratio and Late Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Cohort Study.

BACKGROUND: Inflammation appears to be at the biological core of arteriovenous fistula (AVF) dysfunction, and the occurrence of AVF dysfunction is related to high death and disability in hemodialysis (HD) patients. Despite several studies on the correlations between AVF dysfunction and inflammatory indicators, how AVF dysfunction is related to the monocyte-to-lymphocyte ratio (MLR) is much unclear. We hypothesize that preoperative MLR is associated with AVF dysfunction in Chinese HD patients. METHODS: In this single-center retrospective cohort study, totally 769 adult HD patients with a new AVF created between 2011 and 2019 were included. Association of preoperative MLR with AVF dysfunction (thrombosis or decrease of normal vessel diameter by >50%, requiring either surgical revision or percutaneous transluminal angioplasty) was assessed by multivariable Cox proportional hazard regression. RESULTS: The patients were aged 55.8 ± 12.2 years and were mostly males (55%). During the average 32-month follow-up (maximum 119 months), 223 (29.0%) patients had permanent vascular access dysfunction. In adjusted multivariable Cox proportional hazard regression analyses, the risk of AVF dysfunction was 4.32 times higher with 1 unit increase in MLR (hazard ratio [HR]: 5.32; 95% confidence interval [CI]: 3.1-9.11). Compared with patients with MLR <0.28, HRs associated with an MLR of 0.28-0.41 and ≥0.41 are 1.54 (95% CI: 1.02-2.32) and 3.17 (2.18-4.62), respectively. CONCLUSIONS: A higher preoperative MLR is independently connected with a severer risk of AVF dysfunction in HD patients. Its clinical value should be determined in the future.

Identification of key genes and pathways in IgA nephropathy using bioinformatics analysis.

BACKGROUND: IgA nephropathy (IgAN) is the most frequent type of primary glomerulonephritis globally and the leading cause of end-stage renal disease in young adults. Its pathogenesis is not fully known, but is largely attributed to genetic factors. This study was aimed to explore the prognostic values of key genes in IgAN. METHODS: The gene expression profile GSE93798 of 20 IgAN samples and 22 normal samples using glomeruli from kidney biopsy was adopted. Totally 447 upregulated and 719 downregulated differentially expressed genes were found in IgAN patients on the R software. The Gene Ontology enrichment and the Kyoto Encyclopedia of Gene and Genomes pathway were investigated on DAVID, and the protein-protein interaction network and the top 13 hub genes of the differentially expressed genes were built via the plug-in molecular complex detection and cytoHubba of Cytoscape. RESULTS: From the protein-protein interaction network, of the top 13 hub genes, FOS, EGFR, SIRT1, ALB, TFRC, JUN, IGF1, HIF1A, and SOCS3 were upregulated, while CTTN, ACTR2, CREB1, and CTNNB1 were downregulated. The upregulated genes took part in the HIF-1 signaling pathway, Choline metabolism in cancer, Pathways in cancer, Amphetamine addiction, Estrogen, TNF, and FoxO signaling pathways, and Osteoclast differentiation, while the downregulated genes were involved in Pathogenic Escherichia coli infection, Bacterial invasion of epithelial cells, prostate cancer, and melanogenesis. CONCLUSION: This study based on the Gene Expression Omnibus database updates the knowledge about the mechanism of IgAN and may offer new treatment targets.

Diagnostic value of phospholipase A2 receptor in idiopathic membranous nephropathy: a systematic review and meta-analysis.

BACKGROUND: Detection of M-type phospholipase A2 receptor (PLA2R) can be used in serologic diagnosis of idiopathic membranous nephropathy (IMN), but there are limited data about the sensitivity and specificity of its diagnostic values. METHODS AND RESULTS: Meta-analysis of diagnostic test studies assessing the values of PLA2R in diagnosis of IMN. MEDLINE, EMBASE, and CENTRAL databases and congress abstracts were searched for studies reporting the value of PLA2R to predict IMN. The quality of the studies was evaluated using the guidelines of the updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The results are summarized as sensitivity, specificity, and diagnostic odds ratio (OR). Data from 10 studies involving 1,550 participants were analyzed. Across all settings, the diagnostic OR for serum anti-PLA2R level to predict IMN at different stages was 247.41, with sensitivity of 0.69 and specificity of 0.99. The estimated sensitivity and specificity of serum anti-PLA2R level for diagnosis of IMN in the active stage were 74.0 and 95.0%, respectively, with diagnostic OR of 54.22. The estimated sensitivity and specificity of biopsy anti-PLA2R for diagnosis of IMN at different stages was 73.0 and 83.0%, respectively, with diagnostic OR of 13.75. CONCLUSIONS: This meta-analysis shows that serum anti-PLA2R level is of diagnostic value for IMN in the active stage. Future large-cohort prospective studies are required to reveal the diagnostic value of circulating anti-PLA2R antibodies versus PLA2R antigens in kidney biopsy for IMN at different stages.

The report of sustained low-efficiency dialysis (SLED) treatment in fifteen patients of severe snakebite.

To investigate the therapeutic efficacy of sustained low-efficiency dialysis (SLED) in severe snakebite patients. Fifteen patients of severe snakebite was treated with SLED from July 2005 to August 2009 were included in the study. Central venous access was established in all patients. SLED was administered using Dialog(+) dialyzer (B. Braun, Germany). SLED sessions were 6-12 h in duration at a blood flow rate of 200 ml/min and a dialysate flow rate of 300 ml/min. Heparin or low molecular weight heparin was used as anticoagulant. Biochemical indicators, APACHE II scores before and after SLED, and clinical outcomes were evaluated. The levels of serum creatinine, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, creatine kinase isozyme MB, and creatine kinase were significantly lower than the level before SLED (P < 0.05); the level of cholinesterase was significantly higher after SLED (P < 0.01); the APACHE II score before SLED was 14.1 ± 3.8, but decreased significantly to 7.9 ± 1.4, 6.2 ± 1.1, and 4.2 ± 0.8 on days 1, 2, and 7 after SLED, respectively (P < 0.01). Three patients died on days 1, 3, and 4 after SLED, respectively. The remaining twelve patients were either cured or showed improvement at the time of discharge. The survival rate was 80 % where as mortality was 20 %. SLED may be an effective treatment option in severe snakebite patients. It can reduce mortality, thereby, resulting in increased survival rates.

Therapeutic effectiveness of sustained low-efficiency hemodialysis plus hemoperfusion and continuous hemofiltration plus hemoperfusion for acute severe organophosphate poisoning.

There is no report on the effects of sustained low-efficiency dialysis (SLED) plus hemoperfusion (HP) (SLED + HP) in patients with acute severe organophosphate (OP) poisoning (ASOPP). This study was designed to compare the therapeutic effectiveness between SLED + HP and continuous hemofiltration (CHF) plus HP (CHF + HP) in patients with ASOPP. In order to assess the two treatment methods, 56 patients with ASOPP were divided into CHF + HP group and SLED + HP group. The biochemical indicators, in-hospital duration, hemodynamic parameters, Acute Physiology, and Chronic Health Evaluation (APACHE II) score, and survival and mortality rates were compared. In both groups after treatment, the levels of serum creatine kinase isozyme MB, creatine kinase, creatinine, glutamic-oxalacetic transaminease, and glutamate-pyruvate transaminase, and the APACHE II scores on the first, second, and seventh day decreased (P < 0.05), whereas the levels of serum acetylcholinesterase increased. The two groups showed no statistical differences in in-hospital duration, biochemical indicators, APACHE II score, hemodynamic parameters, survival rate, or the mortality rate (P > 0.05). In conclusion, SLED has similar hemodynamic stability to CHF and the two treatment methods have similar effects on ASOPP patients. More importantly, SLED plus HP is relatively economical and convenient for patients with ASOPP in clinical practice.

Comparison of the therapeutic effectiveness of sustained low-efficiency dialysis (SLED) with continuous blood purification (CBP) in critically ill patients.

The differences in therapeutic effectiveness between sustained low-efficiency dialysis (SLED) and continuous blood purification (CBP) were investigated. In order to assess the different treatment methods, 56 critically ill patients were divided into two groups, the CBP group and the SLED group. A comparison was made between all the biochemical indicators, in-hospital duration, hemodynamic parameters, acute physiology and chronic health evaluation (APACHE-II), the survival, and the mortality rates. After treatment, the levels of serum creatine kinase isozyme MB (CK-MB), creatine kinase, creatinine, glutamate-oxalacetate transaminase (AST), glutamate-pyruvate transaminase (ALT), APACHE II score on the 1st, 2nd, and 7th day in both the treatment groups were lower than that before the treatment (P < 0.05). There are no statistical differences in in-hospital duration, biochemical indicators, APACHE II score, hemodynamic parameters, the survival rate and the mortality rate between the two groups (P > 0.05). It was concluded that SLED has similar hemodynamic stability with CBP and the two methods have similar treatment effects in critically ill patients. However, we noticed that SLED can be relatively economical and convenient for critically ill patients in clinical practice.