The effect of urgent-start peritoneal dialysis and urgent-start hemodialysis on clinical outcomes in patients with chronic kidney disease: an updated systematic review and meta-analysis.

OBJECTIVE: Recently, urgent-start peritoneal dialysis (PD) has been suggested in place of urgent-start hemodialysis (HD) in cases of chronic kidney disease (CKD). However, the comparative effectiveness of these methods is still unclear. This study compared the outcomes of urgent-start PD and urgent-start HD in CKD patients. METHODS: Electronic searches were conducted in PubMed, EMbase, Google Scholar databases, and Cochrane Library, up to 30th July 2023 for studies reporting data on all-cause mortality. Secondary outcomes included dialysis-related infectious and mechanical complications. Risk ratios (RRs) with 95% confidence interval (CI) were calculated. RESULTS: Nine eligible studies involving 941 PD and 779 HD patients were analyzed. Pooled analysis demonstrated elevated risk of all-cause mortality (RR: 1.06, 95% CI: 1.02 to 1.09), dialysis-related infectious complications (RR: 1.05, 95% CI: 1.02 to 1.07), and mechanical complications (RR: 1.08, 95% CI: 1.04 to 1.13) in patients undergoing urgent-start HD than in patients on urgent-start PD. CONCLUSION: Our findings indicate that CKD patients that received urgent-start HD are at increased risk of all-cause mortality and infectious, and mechanical complications that are associated with the dialysis than patients that received urgent-start PD. These findings have to be considered when making treatment decisions for patients with acute kidney injury. Better understanding of the mechanism of these differences may help to create guidelines for more informed clinical practices.

How large of a grant size is appropriate? Evidence from the National Natural Science Foundation of China.

Under the current universal trend towards larger grant sizes in research funding systems, we focus on how large of a grant size is appropriate. We study the directional returns to scale (RTS) to assess whether current grant sizes are the most productive. We take the General Program of the National Natural Science Foundation of China (NSFC) as an example and select three samples of physics, geography and management for an empirical study. We find that the optimal input direction and the most productive grant size scale is different for the three disciplines; based on the current grant size, physics should not expand the grant size and team size input, geography should further increase the grant size to improve performance and management should further expand the team size rather than the grant size. In this paper, we demonstrate a new method to calculate the optimal direction, which is the lowest rate of congestion, according to the characteristics of the General Program. Based on these results, we also calculate the most productive scale size. This method has certain value for project management.

Association of the key genes in the pathophysiology between the Type 2 diabetes and Lung cancer.

BACKGROUND: Although several studies have demonstrated that preexisting diabetes mellitus (DM) may increase the risk of lung cancer (LC), rare research of the certain pathophysiology was reported up to now. METHODS: Aiming to identify the differentially expressed genes (DEGs) between type 2 diabetes mellitus (T2DM) and LC, gene expression profiles GSE55650 and GSE136043 were downloaded in the Gene Expression Omnibus (GEO) database. We carried out biological function analysis to seek significantly enriched pathways and functions for DEGs. A protein-protein interaction (PPI) network was performed to explore hub genes for diabetes and LC during Metformin's treatment. RESULTS: Finally, the study found that there were 756 genes overlapped between T2DM and LC samples. It contained 133 common genes up-regulated both in T2DM and LC (DEGs1), 275 independent genes down-regulated in LC (DEGs2), 246 common genes down-regulated in both (DEGs3), and 102 independent genes down-regulated in diabetes (DEGs4). Glycine, serine and threonine metabolism, arginine and proline metabolism, TGF-beta signaling pathway, and pathways in cancer were significantly enriched in DEGs2 and DEGs4. Four hub genes (C3, THBS1, CXCL1, and TTN) were identified after treatment of Metformin (P<0.05, T-test). CONCLUSION: Our findings demonstrated that the above-mentioned hub genes might play functional roles in the treatment of metformin for patients with diabetes and LC.

Real-world comparison of direct-acting oral anticoagulants and vitamin K antagonists in chronic kidney disease: a systematic review and meta-analysis.

Background: No clear clinical guidelines exist on anticoagulant use for chronic kidney disease (CKD) patients. We compared the efficacy and safety of direct-acting oral anticoagulants (DOACs) vs. vitamin K antagonists (VKA) in patients with CKD by pooling data from real-world observational studies.Research design & methods: This systematic review searched PubMed, Embase, and CENTRAL databases and pooled multivariable-adjusted hazard ratios (HR) of outcomes.Results: Fifteen studies were included. Our results indicated a small but significant reduction in the risk of all-cause mortality (p = 0.01), stroke or systemic embolism (p = 0.03), and major bleeding (p = 0.01) with DOAC as compared to VKA. In subgroup analysis based on the severity of CKD, no difference in the risk of stroke or systemic embolism was noted in any subgroups. The risk of mortality was reduced only in patients with moderate-severe or severe CKD and the risk of major bleeding was reduced only in patients with moderate-severe or moderate CKD.Conclusion: DOACs are associated with only a modest reduction in stroke or systemic embolism, major bleeding, and mortality when compared to VKA in CKD patients. Reduction in mortality and major bleeding with DOAC may only be seen in moderate-to-severe CKD patients.

Effectiveness of hypoxia-induced factor prolyl hydroxylase inhibitor for managing anemia in chronic kidney disease: a systematic review and meta-analysis.

PURPOSE: To meta-statistically compare the efficiency of hypoxia-induced factor prolyl hydroxylase inhibitor on hemoglobin, ferritin, hepcidin rate, and adverse events. METHODS: A systematic identification of literature was performed according to PRISMA guidelines on 4 academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis evaluating the influence of hypoxia-induced factors was performed for patients undergoing/not undergoing hemodialysis. The analysis evaluated the efficacy of hypoxia-induced factors on hemoglobin, ferritin, hepcidin rate, and the number of adverse events. RESULTS: Out of 1052 records, 15 articles including 2045 patients (mean age 62.1 ± 5.4 years) were included in this review. The systematic review presents a 1a level of evidence supporting the use of hypoxia-induced factor for mediating anemia in patients with chronic kidney disease. The meta-analysis reveals medium to large beneficial effects of the hypoxia-induced factor on hemoglobin rate for patients receiving (0.72) and not receiving (1.04) hemodialysis. Moreover, the administration of hypoxia-induced factors was reported to reduce ferritin rate and the hepcidin rate, and the number of adverse events in patients with chronic kidney disease. CONCLUSION: The current meta-analysis recommends the use of hypoxia-induced factor prolyl hydroxylase inhibitor for managing anemia in chronic kidney disease.