Monthly，published on the 28th of each month
Responsible Institution: Hubei Association of Science and Technology
Sponsored by:
Wuhan Branch of Chinese Medical Association
Microcirculation Society of Hubei
Editor-in-Chief: Xu Gang
Editorial Director: Liu Jin
ISSN 1671-2390
CN 42-1637/R
Published by: Editorial Department of Journal of Clinical Nephrology
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Date of publication：2025-03-27
Vol.25
No.3
2025
Abstract：
Objective To investigate the risk factors for atherosclerotic cardiovascular disease（ASCVD） in primary membranous nephropathy（PMN） patients by machine deep learning, and to construct a nomogram. Methods This was a retrospective study including 620 patients with membranous nephropathy diagnosed by renal puncture in the First Affiliated Hospital of Xinjiang Medical University from September 1, 2017 to May 31, 2023. Based on inclusion and exclusion criteria. Eligible 424 PMN patients were finally enrolled, involving 219 ASCVD patients. They were assigned into the training （n=297） and validation groups at a 7∶3 ratio. The Mann-Whitney U test and independent-sample t test were used to screen influencing factors for ASCVD in PMN patients. LASSO regression was applied to optimize the screening variables. A nomogram was constructed and validated for its performance through visualized statistical methods. Results Compared with patients in the non-ASCVD group, those in the ASCVD group were significantly older [56（51, 63） years vs 35（28, 44） years], and had significantly higher proportions of males [154（70.3%） vs 117（57.1%）], smokers[71（32.4%） vs 43（21.0%）], and alcohol consumption[54（24.7%） vs 32（15.6%）]. They also had significantly higher systolic blood pressure [130（120, 142） mmHg（1 mmHg=0.133 kPa） vs 122.0（113.5, 135.5） mmHg], higher diastolic blood pressure [80 （75, 90） mmHg vs 80（70, 85.5） mmHg], higher prevalence of hypertension[142（64.8%） vs 67 （32.7%）], and higher proportion of manual workers[60（27.4%） vs 28（13.7%）] Additionally, lymphocyte count （LYM）, platelet count （PLT）, blood sodium concentration （Na）, blood urea nitrogen （BUN）, blood creatinine （Cr）, estimated glomerular filtration rate （eGFR）, 24-hour quantitative urine protein, glutamic transaminase, urinary occult blood, number of urinary hyaline and pathological tubular patterns, C-reactive protein （CRP）, complement C4, plasma fibrinogen, D-dimer, and centrocyte-lymphocyte ratio were all significantly different between the two groups （P<0.05）. Age, hypertension, BUN and eGFR were selected as risk factors for predicting ASCVD of PMN patients through LASSO regression. The area under the ROC curve （AUC） of the nomogram to predict ASCVD was 0.924 （95% CI： 0.895-0.952） in the training group, and 0.932 （95% CI： 0.892-0.972） in the validation group. The calibration curve Hosmer-Leme showed the fit was good （P=0.827 for the training group； P=0.389 for the validation group）. DCA showed that the use of nomogram prediction model was more beneficial in predicting ASCVD in PMN when the threshold probability of patients was 0.01 to 1. Conclusion The nomogram prediction model containing four predictor variables （age, hypertension, BUN, eGFR） developed in this study can be used to predict the risk of ASCVD in patients with PMN.
Objective To investigate the risk factors for atherosclerotic cardiovascular disease（ASCVD） in primary membranous nephropathy（PMN） patients by machine deep learning, and to construct a nomogram. Methods This was a retrospective study including 620 patients with membranous nephropathy diagnosed by renal puncture in the First Affiliated Hospital of Xinjiang Medical University from September 1, 2017 to May 31, 2023. Based on inclusion and exclusion criteria. Eligible 424 PMN patients were finally enrolled, involving 219 ASCVD patients. They were assigned into the training （n=297） and validation groups at a 7∶3 ratio. The Mann-Whitney U test and independent-sample t test were used to screen influencing factors for ASCVD in PMN patients. LASSO regression was applied to optimize the screening variables. A nomogram was constructed and validated for its performance through visualized statistical methods. Results Compared with patients in the non-ASCVD group, those in the ASCVD group were significantly older [56（51, 63） years vs 35（28, 44） years], and had significantly higher proportions of males [154（70.3%） vs 117（57.1%）], smokers[71（32.4%） vs 43（21.0%）], and alcohol consumption[54（24.7%） vs 32（15.6%）]. They also had significantly higher systolic blood pressure [130（120, 142） mmHg（1 mmHg=0.133 kPa） vs 122.0（113.5, 135.5） mmHg], higher diastolic blood pressure [80 （75, 90） mmHg vs 80（70, 85.5） mmHg], higher prevalence of hypertension[142（64.8%） vs 67 （32.7%）], and higher proportion of manual workers[60（27.4%） vs 28（13.7%）] Additionally, lymphocyte count （LYM）, platelet count （PLT）, blood sodium concentration （Na）, blood urea nitrogen （BUN）, blood creatinine （Cr）, estimated glomerular filtration rate （eGFR）, 24-hour quantitative urine protein, glutamic transaminase, urinary occult blood, number of urinary hyaline and pathological tubular patterns, C-reactive protein （CRP）, complement C4, plasma fibrinogen, D-dimer, and centrocyte-lymphocyte ratio were all significantly different between the two groups （P<0.05）. Age, hypertension, BUN and eGFR were selected as risk factors for predicting ASCVD of PMN patients through LASSO regression. The area under the ROC curve （AUC） of the nomogram to predict ASCVD was 0.924 （95% CI： 0.895-0.952） in the training group, and 0.932 （95% CI： 0.892-0.972） in the validation group. The calibration curve Hosmer-Leme showed the fit was good （P=0.827 for the training group； P=0.389 for the validation group）. DCA showed that the use of nomogram prediction model was more beneficial in predicting ASCVD in PMN when the threshold probability of patients was 0.01 to 1. Conclusion The nomogram prediction model containing four predictor variables （age, hypertension, BUN, eGFR） developed in this study can be used to predict the risk of ASCVD in patients with PMN.
2025, 25(3): 186-193.
DOI: 10.3969/j.issn.1671-2390.2025.03.002
Abstract：
Objective To investigate the differences in C-reactive protein（CRP）, neutrophil-to-lymphocyte ratio（NLR） and hemoglobin（Hb） levels in maintenance hemodialysis （MHD） patients with tunnel catheter and arteriovenous fistula（AVF） and their value in predicting infections. Methods A total of 108 MHD patients from 1 January 2020 to 30 June 2022 were selected from Affiliated Hopital of Panzhihua College and grouped according to different vascular accesses. Forty-seven patients with tunnel catheter vascular access were included in the catheter group and 61 patients with AVF vascular access were included in the AVF group. Renal function indicators （serum creatinine [Scr], blood urea nitrogen [BUN]）, dialysis adequacy （single ventricular urea clearance index [spKt/V], urea reduction ratio[URR], post-equilibrium urea clearance index[eKt/V]）, CRP, NLR, Hb and incidence of infection were compared between the two groups at baseline and at 6-month follow-up. The predictive values of CRP, NLR and Hb levels for infections were analyzed. Results There were no significant differences in Scr, BUN, spKt/V, URR, and eKt/V between the two groups at baseline and at 6 months follow-up（P>0.05）. At the 6-month follow-up, CRP （12.92 ± 3.17 mg/L vs. 16.35 ± 5.11 mg/L） and NLR（3.36 ± 0.74 vs. 4.57 ± 1.23） in the AVF group were significantly lower than those of the catheter group,while Hb（110.52 ± 12.16 g/L vs.100.31 ± 14.47 g/L） was significantly higher（P<0.05）. The incidence of infection in the AVF group was significantly lower than the catheter group（13.11% vs.31.91%, P<0.05）. At the 6-month follow-up, CRP（18.85 ± 5.09 mg/L vs.13.21 ± 3.36 mg/L） and NLR（5.60 ± 1.21 vs. 3.43 ± 1.08） in the infection group were significantly higher than those at baseline, while Hb（94.70 ± 11.96 g/L vs.109.16 ± 14.14 g/L） was significantly lower（P<0.05）. Receiver operating characteristic（ROC） curve results showed that the area under the curve（AUC） of a combination of CRP, NLR, and Hb in predicting MHD-related infection at 6 months of follow-up was 0.928（95% CI： 0.862-0.969）, with a sensitivity of 78.26% and a specificity of 91.76%, which was significantly greater than that of each indicator alone（P<0.05）. At the 6-month follow-up, the cut-off values of CRP, NLR, and Hb were divided into low and high levels. The risk of infection in patients with high levels of CRP and NLR at the 6-month follow-up was 7.180 times（95% CI： 2.623-19.656） and 4.750 times （95% CI： 1.730-13.043） higher than that in patients with low levels. The risk of infection in patients with low Hb levels was 5.567 times higher than that in patients with high Hb levels（95% CI： 2.272-14.085）（P<0.05）. Conclusion Compared with patients with a tunnel catheter vascular access, patients with an AVF vascular access have abnormal levels of CRP, NLR and Hb, and the incidence of infection is lower. The combination of CRP, NLR and Hb in predicting MHD co-infection has a good reference value, and can provide references for clinical evaluation of MHD infection.
Objective To investigate the differences in C-reactive protein（CRP）, neutrophil-to-lymphocyte ratio（NLR） and hemoglobin（Hb） levels in maintenance hemodialysis （MHD） patients with tunnel catheter and arteriovenous fistula（AVF） and their value in predicting infections. Methods A total of 108 MHD patients from 1 January 2020 to 30 June 2022 were selected from Affiliated Hopital of Panzhihua College and grouped according to different vascular accesses. Forty-seven patients with tunnel catheter vascular access were included in the catheter group and 61 patients with AVF vascular access were included in the AVF group. Renal function indicators （serum creatinine [Scr], blood urea nitrogen [BUN]）, dialysis adequacy （single ventricular urea clearance index [spKt/V], urea reduction ratio[URR], post-equilibrium urea clearance index[eKt/V]）, CRP, NLR, Hb and incidence of infection were compared between the two groups at baseline and at 6-month follow-up. The predictive values of CRP, NLR and Hb levels for infections were analyzed. Results There were no significant differences in Scr, BUN, spKt/V, URR, and eKt/V between the two groups at baseline and at 6 months follow-up（P>0.05）. At the 6-month follow-up, CRP （12.92 ± 3.17 mg/L vs. 16.35 ± 5.11 mg/L） and NLR（3.36 ± 0.74 vs. 4.57 ± 1.23） in the AVF group were significantly lower than those of the catheter group,while Hb（110.52 ± 12.16 g/L vs.100.31 ± 14.47 g/L） was significantly higher（P<0.05）. The incidence of infection in the AVF group was significantly lower than the catheter group（13.11% vs.31.91%, P<0.05）. At the 6-month follow-up, CRP（18.85 ± 5.09 mg/L vs.13.21 ± 3.36 mg/L） and NLR（5.60 ± 1.21 vs. 3.43 ± 1.08） in the infection group were significantly higher than those at baseline, while Hb（94.70 ± 11.96 g/L vs.109.16 ± 14.14 g/L） was significantly lower（P<0.05）. Receiver operating characteristic（ROC） curve results showed that the area under the curve（AUC） of a combination of CRP, NLR, and Hb in predicting MHD-related infection at 6 months of follow-up was 0.928（95% CI： 0.862-0.969）, with a sensitivity of 78.26% and a specificity of 91.76%, which was significantly greater than that of each indicator alone（P<0.05）. At the 6-month follow-up, the cut-off values of CRP, NLR, and Hb were divided into low and high levels. The risk of infection in patients with high levels of CRP and NLR at the 6-month follow-up was 7.180 times（95% CI： 2.623-19.656） and 4.750 times （95% CI： 1.730-13.043） higher than that in patients with low levels. The risk of infection in patients with low Hb levels was 5.567 times higher than that in patients with high Hb levels（95% CI： 2.272-14.085）（P<0.05）. Conclusion Compared with patients with a tunnel catheter vascular access, patients with an AVF vascular access have abnormal levels of CRP, NLR and Hb, and the incidence of infection is lower. The combination of CRP, NLR and Hb in predicting MHD co-infection has a good reference value, and can provide references for clinical evaluation of MHD infection.
Abstract：
Objective To investigate the correlation of monocyte/high-density lipoprotein ratio （MHR） and urinary albumin/creatinine ratio （UACR） with the severity and prognosis of diabetic kidney disease （DKD）. Methods A total of 115 DKD patients treated in Bengbu Second People's Hospital from May 1, 2021 to May 1, 2022 were prospectively enrolled. They were divided into stage 1 group, stage 2 group, stage 3 group and stage 4 group according to the degree of renal pathological injury. MHR and UACR of each group were compared, and Spearman correlation analysis was used to evaluate the correlation of MHR and UACR with DKD severity. After discharge, patients were followed up by outpatient visit or telephone contact for 1 year. According to whether they developed end-stage renal disease （ESRD）, the patients were divided into good prognosis group and poor prognosis group. Logistic multivariate regression analysis was used to identify the risk factors for the prognosis of DKD patients. The receiver operating characteristic curve （ROC） was plotted to evaluate the efficacy of MHR and UACR in predicting the poor prognosis of DKD. Results There were significant differences in MHR and UACR among DKD patients with different stages （P<0.05）. The lowest MHR and UACR were detected in stage 1 group [（5.35 ± 0.45） and （10.62 ± 2.15）, respectively], and the highest values were found in stage 4 group [（9.35 ± 1.02） and （200.50 ± 40.58）, respectively]. Spearman correlation analysis showed that MHR and UACR were positively correlated with the severity of DKD （r=0.867, 0.905, P<0.05）. There were significant differences in HBA1c [（9.71 ± 1.08）% vs（12.95 ± 1.17）%], total cholesterol [（4.80 ± 0.85） mmol/L vs（8.56 ± 1.75） mmol/L], triglyceride [（1.46 ± 0.22） mmol/L vs（3.46 ± 0.52） mmol/L], serum creatinine [（89.12 ± 10.30） μmol/L vs（170.44 ± 22.85） μmol/L], serum uric acid [（5.18 ± 0.75） μmol/L vs（7.96 ± 1.16） μmol/L], cystatin C [（0.90 ± 0.15） mg/L vs（1.88 ± 0.42） mg/L], low density lipoprotein [（1.89 ± 0.46） mmol/L vs [（3.85 ± 0.69） mmol/L], MHR [（4.38 ± 0.29） vs（11.05 ± 0.85）] and UACR [（21.69 ± 4.10） vs （170.16 ± 26.50）] between good and bad prognosis groups （P<0.05）. Logistic multivariate regression analysis showed that hemoglobin A1c （OR=2.344, 95% CI： 1.925-2.764）, total cholesterol （OR=2.208, 95% CI： 1.940-2.476）, triglyceride （OR=2.234, 95% CI： 1.986-2.363）, serum creatinine （OR=2.328, 95% CI： 2.025-2.631）, serum uric acid （OR=2.351, 95% CI： 2.082-2.621）, cystatin C （OR=2.363, 95% CI： 2.071-2.655）, low density lipoprotein （OR=2.421, 95% CI： 2.165-2.676）, MHR （OR=2.489, 95% CI： 2.109-2.870）, UACR （OR=2.537, 95% CI： 2.106-2.968） were independent risk factors for poor prognosis of DKD. The above indicators were all correlated with the prognosis of DKD. ROC curve showed that the sensitivity and AUC of MHR combined with UACR in predicting the poor prognosis of DKD were 90.50% and 0.896, respectively, which were significantly higher than those of MHR （84.50%, 0.871） and UACR （82.50%, 0.853） alone. Conclusion MHR and UACR are correlated with DKD severity and patient prognosis, and the combination of MHR and UACR is more effective in predicting poor prognosis of DKD.
Objective To investigate the correlation of monocyte/high-density lipoprotein ratio （MHR） and urinary albumin/creatinine ratio （UACR） with the severity and prognosis of diabetic kidney disease （DKD）. Methods A total of 115 DKD patients treated in Bengbu Second People's Hospital from May 1, 2021 to May 1, 2022 were prospectively enrolled. They were divided into stage 1 group, stage 2 group, stage 3 group and stage 4 group according to the degree of renal pathological injury. MHR and UACR of each group were compared, and Spearman correlation analysis was used to evaluate the correlation of MHR and UACR with DKD severity. After discharge, patients were followed up by outpatient visit or telephone contact for 1 year. According to whether they developed end-stage renal disease （ESRD）, the patients were divided into good prognosis group and poor prognosis group. Logistic multivariate regression analysis was used to identify the risk factors for the prognosis of DKD patients. The receiver operating characteristic curve （ROC） was plotted to evaluate the efficacy of MHR and UACR in predicting the poor prognosis of DKD. Results There were significant differences in MHR and UACR among DKD patients with different stages （P<0.05）. The lowest MHR and UACR were detected in stage 1 group [（5.35 ± 0.45） and （10.62 ± 2.15）, respectively], and the highest values were found in stage 4 group [（9.35 ± 1.02） and （200.50 ± 40.58）, respectively]. Spearman correlation analysis showed that MHR and UACR were positively correlated with the severity of DKD （r=0.867, 0.905, P<0.05）. There were significant differences in HBA1c [（9.71 ± 1.08）% vs（12.95 ± 1.17）%], total cholesterol [（4.80 ± 0.85） mmol/L vs（8.56 ± 1.75） mmol/L], triglyceride [（1.46 ± 0.22） mmol/L vs（3.46 ± 0.52） mmol/L], serum creatinine [（89.12 ± 10.30） μmol/L vs（170.44 ± 22.85） μmol/L], serum uric acid [（5.18 ± 0.75） μmol/L vs（7.96 ± 1.16） μmol/L], cystatin C [（0.90 ± 0.15） mg/L vs（1.88 ± 0.42） mg/L], low density lipoprotein [（1.89 ± 0.46） mmol/L vs [（3.85 ± 0.69） mmol/L], MHR [（4.38 ± 0.29） vs（11.05 ± 0.85）] and UACR [（21.69 ± 4.10） vs （170.16 ± 26.50）] between good and bad prognosis groups （P<0.05）. Logistic multivariate regression analysis showed that hemoglobin A1c （OR=2.344, 95% CI： 1.925-2.764）, total cholesterol （OR=2.208, 95% CI： 1.940-2.476）, triglyceride （OR=2.234, 95% CI： 1.986-2.363）, serum creatinine （OR=2.328, 95% CI： 2.025-2.631）, serum uric acid （OR=2.351, 95% CI： 2.082-2.621）, cystatin C （OR=2.363, 95% CI： 2.071-2.655）, low density lipoprotein （OR=2.421, 95% CI： 2.165-2.676）, MHR （OR=2.489, 95% CI： 2.109-2.870）, UACR （OR=2.537, 95% CI： 2.106-2.968） were independent risk factors for poor prognosis of DKD. The above indicators were all correlated with the prognosis of DKD. ROC curve showed that the sensitivity and AUC of MHR combined with UACR in predicting the poor prognosis of DKD were 90.50% and 0.896, respectively, which were significantly higher than those of MHR （84.50%, 0.871） and UACR （82.50%, 0.853） alone. Conclusion MHR and UACR are correlated with DKD severity and patient prognosis, and the combination of MHR and UACR is more effective in predicting poor prognosis of DKD.
Abstract：
Objective To investigate the clinical features of antiphospholipid antibody-positive Takayasu arteritis and to enhance the awareness of its diagnosis and treatment. Methods The clinical features and imaging data of one patient with antiphospholipid antibody-positive Takayasu arteritis were retrospectively analyzed. Literature review was performed by searching the keywords “Takayasu arteritis” and “antibodies, antiphospholipid” or “antiphospholipid syndrome” in databases such as Wanfang, VIP, China National Knowledge Infrastructure （CNKI）, and PubMed. Results The 41 year-old male patient presented with intermittent abdominal pain and unconsciousness. The imaging findings showed multiple stenosis and occlusion of large arteries. The patient was combined with cardiovascular and cerebrovascular disease, renal failure and infection. Despite the treatment of anti-inflammatory drugs, anticoagulation, hormones, immunosuppressive agents, immunoglobulin, and plasma exchange, the clinical outcome did not improve. Through literature review, 8 cases of Takayasu arteritis with positive antiphospholipid antibodies, aged between 17 and 72 years were identified, including 2 males. Except for one death, the outcomes of the remaining 7 patients were improved through comprehensive treatment. Conclusion For patients with antiphospholipid antibody-positive Takayasu arteritis, early diagnosis, comprehensive evaluation, and stratified intervention are critical for successful diagnosis and treatment. Clinicians should enhance their awareness of early diagnosis and differential diagnosis, standardize anticoagulation and immunosuppressive therapy, and consider interventional and surgical treatment when necessary to improve the outcomes.
Objective To investigate the clinical features of antiphospholipid antibody-positive Takayasu arteritis and to enhance the awareness of its diagnosis and treatment. Methods The clinical features and imaging data of one patient with antiphospholipid antibody-positive Takayasu arteritis were retrospectively analyzed. Literature review was performed by searching the keywords “Takayasu arteritis” and “antibodies, antiphospholipid” or “antiphospholipid syndrome” in databases such as Wanfang, VIP, China National Knowledge Infrastructure （CNKI）, and PubMed. Results The 41 year-old male patient presented with intermittent abdominal pain and unconsciousness. The imaging findings showed multiple stenosis and occlusion of large arteries. The patient was combined with cardiovascular and cerebrovascular disease, renal failure and infection. Despite the treatment of anti-inflammatory drugs, anticoagulation, hormones, immunosuppressive agents, immunoglobulin, and plasma exchange, the clinical outcome did not improve. Through literature review, 8 cases of Takayasu arteritis with positive antiphospholipid antibodies, aged between 17 and 72 years were identified, including 2 males. Except for one death, the outcomes of the remaining 7 patients were improved through comprehensive treatment. Conclusion For patients with antiphospholipid antibody-positive Takayasu arteritis, early diagnosis, comprehensive evaluation, and stratified intervention are critical for successful diagnosis and treatment. Clinicians should enhance their awareness of early diagnosis and differential diagnosis, standardize anticoagulation and immunosuppressive therapy, and consider interventional and surgical treatment when necessary to improve the outcomes.
Abstract：
Objective To clarify the clinicopathological features of immunoglobulin A nephropathy（IgAN） in children and adults by categorizing crescentic lesions into cellular crescents, fibrocellular crescents and fibrous crescents based on the Oxford classification. Methods Clinicopathological data of 168 cases of pediatric IgAN（children group） and 381 cases of adult IgAN pathologically confirmed by renal biopsy between January 1, 2012 and December 31, 2022 in the First Affiliated Hospital of Henan University of Chinese Medicine were retrospectively collected. Adult IgAN patients were subdivided into the youth group and the middle-aged and older adult group. The differences and correlations of clinical classification and pathological indexes among children group, youth group and middle-aged and older adult group were compared. Results The statistical results of clinical classification in the three groups showed that the proportion of nephrotic syndrome type（37.50% vs 11.99% vs 11.24%,63 cases vs 35 cases vs 10 cases）in the children group was significantly higher than that of the youth group and the middle-aged and older adult group（P<0.05）. The proportion of hematuria with proteinuria（43.49% vs 32.74% vs 29.21%,127 cases vs 55 cases vs 26 cases）was significantly higher in the youth group than that of the children group and the middle-aged and older adult group （P<0.05）. The proportion of chronic nephritis type（53.93% vs 4.17% vs 37.67%,48 cases vs 7 cases vs 110 cases）was significantly higher in the middle-aged and older adult group than that of the children group and the youth group （P<0.05）. According to the Oxford classification, significantly higher proportions of glomerular mesangial cell proliferation （76.19% vs 60.37%,128 cases vs 230 cases）, endothelial cell hyperplasia （45.83% vs 13.65%,77 cases vs 52 cases） and cellular crescent （50.00% vs 30.71%,84 cases vs 117 cases） were seen in the children group than the remaining two groups, and significantly higher proportions of glomerular segmental sclerosis（69.82% vs 44.64%,266 cases vs 75 cases）,fibrous crescents （18.90% vs 8.93%,72 cases vs 15 cases）, tubular atrophy and interstitial fibrosis （29.40% vs 2.39%,112 cases vs 4 cases） were seen in the youth group and the middle-aged and older adult group than the children group （P<0.05）. The 24 h urine protein quantification was moderately positively correlated with the percentage of cellular crescent, percentage of total cellular crescent and fibrocellular crescent, and percentage of endothelial cellular hyperplasia （r= 0.65,r= 0.56,and r= 0.41,respectively； P<0.05）. The estimated glomerular filtration rate （eGFR） was moderately negatively correlated with renal tubular atrophy/interstitial fibrosis （r= -0.61,P<0.05）.ConclusionsPediatric IgAN is dominated by acute glomerular lesions, and the nephrotic syndrome type is the main clinical type. Chronic glomerular, tubulointerstitial and vascular lesions in adults are the pathological basis for the formation of the chronic nephritis type. Cellular crescents, fibrocellular crescents and fibrous crescents were scored respectively in the Oxford classification is more clinically instructive.
Objective To clarify the clinicopathological features of immunoglobulin A nephropathy（IgAN） in children and adults by categorizing crescentic lesions into cellular crescents, fibrocellular crescents and fibrous crescents based on the Oxford classification. Methods Clinicopathological data of 168 cases of pediatric IgAN（children group） and 381 cases of adult IgAN pathologically confirmed by renal biopsy between January 1, 2012 and December 31, 2022 in the First Affiliated Hospital of Henan University of Chinese Medicine were retrospectively collected. Adult IgAN patients were subdivided into the youth group and the middle-aged and older adult group. The differences and correlations of clinical classification and pathological indexes among children group, youth group and middle-aged and older adult group were compared. Results The statistical results of clinical classification in the three groups showed that the proportion of nephrotic syndrome type（37.50% vs 11.99% vs 11.24%,63 cases vs 35 cases vs 10 cases）in the children group was significantly higher than that of the youth group and the middle-aged and older adult group（P<0.05）. The proportion of hematuria with proteinuria（43.49% vs 32.74% vs 29.21%,127 cases vs 55 cases vs 26 cases）was significantly higher in the youth group than that of the children group and the middle-aged and older adult group （P<0.05）. The proportion of chronic nephritis type（53.93% vs 4.17% vs 37.67%,48 cases vs 7 cases vs 110 cases）was significantly higher in the middle-aged and older adult group than that of the children group and the youth group （P<0.05）. According to the Oxford classification, significantly higher proportions of glomerular mesangial cell proliferation （76.19% vs 60.37%,128 cases vs 230 cases）, endothelial cell hyperplasia （45.83% vs 13.65%,77 cases vs 52 cases） and cellular crescent （50.00% vs 30.71%,84 cases vs 117 cases） were seen in the children group than the remaining two groups, and significantly higher proportions of glomerular segmental sclerosis（69.82% vs 44.64%,266 cases vs 75 cases）,fibrous crescents （18.90% vs 8.93%,72 cases vs 15 cases）, tubular atrophy and interstitial fibrosis （29.40% vs 2.39%,112 cases vs 4 cases） were seen in the youth group and the middle-aged and older adult group than the children group （P<0.05）. The 24 h urine protein quantification was moderately positively correlated with the percentage of cellular crescent, percentage of total cellular crescent and fibrocellular crescent, and percentage of endothelial cellular hyperplasia （r= 0.65,r= 0.56,and r= 0.41,respectively； P<0.05）. The estimated glomerular filtration rate （eGFR） was moderately negatively correlated with renal tubular atrophy/interstitial fibrosis （r= -0.61,P<0.05）.ConclusionsPediatric IgAN is dominated by acute glomerular lesions, and the nephrotic syndrome type is the main clinical type. Chronic glomerular, tubulointerstitial and vascular lesions in adults are the pathological basis for the formation of the chronic nephritis type. Cellular crescents, fibrocellular crescents and fibrous crescents were scored respectively in the Oxford classification is more clinically instructive.
Abstract：
Objective To investigate the predictive values of serum fibroblast growth factor 21（FGF21） and signal peptide, CUB and EGF-like domain-containing protein 1（SCUBE-1） in predicting major adverse cardiovascular events（MACEs） in maintenance hemodialysis（MHD） patients. Methods A total of 164 MHD patients admitted to our hospital from February 1, 2020 to February 28, 2023 were regarded as the observation group. The patients were followed up for 1 year and separated into an occurrence group （117 cases） and a non-occurrence group （47 cases） based on whether they had MACEs. A total of 164 healthy individuals who underwent physical examinations were as the control group. Enzyme linked immunosorbent assay （ELISA） was applied to detect serum FGF21 and SCUBE-1 levels. Multivariate Logistic regression was employed to analyze the influencing factors of MACE in MHD patients. The receiver operating characteristic （ROC） curve was used to analyze the predictive values of serum FGF21 and SCUBE-1 in MACEs of MHD patients. Results Serum FGF21 [（39.67 ± 5.54） ng/L vs （30.33 ± 3.21） ng/L] and SCUBE-1 [（33.28 ± 4.41） μg/L vs （25.19 ± 2.68） μg/L] in the observation group were significantly higher than those of the control group （P<0.05）. Serum FGF21 [（44.94 ± 4.52） ng/L vs （37.55 ± 4.43） ng/L], SCUBE-1 [（36.86 ± 3.87） μg/L vs （31.84 ± 3.74） μg/L], history of diabetes （80.85% vs 25.64%） and LDL-C[（3.26 ± 0.36） mmol/L vs （2.89 ± 0.30） mmol/L] in the occurrence group were significantly higher than those in the non-occurrence group（P<0.05）. FGF21 and SCUBE-1 were influencing factors for the occurrence of MACEs in MHD patients （P<0.05）. The area under the curve （AUC） of serum FGF21 and SCUBE-1 in predicting MACEs was 0.881 and 0.823, respectively, which of their combination for MACE was 0.926. The combination of the two was better than that of the individual prediction （Z combination - FGF21=2.024, Z combination - SCUBE-1=3.082, P=0.043, and 0.002）. Conclusion Serum levels of FGF21 and SCUBE-1 are obviously elevated, which are risk factors for MACEs in MHD patients. The combination of the two has high predictive value for MACE in MHD patients.
Objective To investigate the predictive values of serum fibroblast growth factor 21（FGF21） and signal peptide, CUB and EGF-like domain-containing protein 1（SCUBE-1） in predicting major adverse cardiovascular events（MACEs） in maintenance hemodialysis（MHD） patients. Methods A total of 164 MHD patients admitted to our hospital from February 1, 2020 to February 28, 2023 were regarded as the observation group. The patients were followed up for 1 year and separated into an occurrence group （117 cases） and a non-occurrence group （47 cases） based on whether they had MACEs. A total of 164 healthy individuals who underwent physical examinations were as the control group. Enzyme linked immunosorbent assay （ELISA） was applied to detect serum FGF21 and SCUBE-1 levels. Multivariate Logistic regression was employed to analyze the influencing factors of MACE in MHD patients. The receiver operating characteristic （ROC） curve was used to analyze the predictive values of serum FGF21 and SCUBE-1 in MACEs of MHD patients. Results Serum FGF21 [（39.67 ± 5.54） ng/L vs （30.33 ± 3.21） ng/L] and SCUBE-1 [（33.28 ± 4.41） μg/L vs （25.19 ± 2.68） μg/L] in the observation group were significantly higher than those of the control group （P<0.05）. Serum FGF21 [（44.94 ± 4.52） ng/L vs （37.55 ± 4.43） ng/L], SCUBE-1 [（36.86 ± 3.87） μg/L vs （31.84 ± 3.74） μg/L], history of diabetes （80.85% vs 25.64%） and LDL-C[（3.26 ± 0.36） mmol/L vs （2.89 ± 0.30） mmol/L] in the occurrence group were significantly higher than those in the non-occurrence group（P<0.05）. FGF21 and SCUBE-1 were influencing factors for the occurrence of MACEs in MHD patients （P<0.05）. The area under the curve （AUC） of serum FGF21 and SCUBE-1 in predicting MACEs was 0.881 and 0.823, respectively, which of their combination for MACE was 0.926. The combination of the two was better than that of the individual prediction （Z combination - FGF21=2.024, Z combination - SCUBE-1=3.082, P=0.043, and 0.002）. Conclusion Serum levels of FGF21 and SCUBE-1 are obviously elevated, which are risk factors for MACEs in MHD patients. The combination of the two has high predictive value for MACE in MHD patients.
Abstract：
Objective To explore the intervention effect of diluted essential balm mouthwash on thirst in hemodialysis patients. Methods A total of 43 patients with thirst who underwent maintenance hemodialysis at the Blood Purification Center of Taihe County People's Hospital （The Taihe Hospital of Wannan Medical College） from March 2023 to May 2023 were recruited. They were randomly divided into Group A （21 cases） and Group B （22 cases） using a random number table method. Group A and Group B were divided into two stages with a cross design, each stage lasting for 2 weeks. After the completion of the first stage, a 2-week washout period was passed, and the intervention methods of the two groups were switched to enter the second stage, with the same steps and methods as the first stage. Before and after the start of the first and second stages, the degree of thirst and thirst pain were assessed by the Visual Analogue Scale （VAS） and the Thirst Distress Scale （TDS）, respectively. The Interdialytic Weight Gain （IDWG） was calculated for statistical processing. Results At the end of the first stage, the VAS score（3.13 ± 2.97）, TDS score（10.14 ± 6.76）, and average IDWG（2.51 ± 1.87） kg score of thirst in Group A were significantly lower than those of Group B （P<0.05）. After a 2-week washout period, in the second stage, the VAS score（6.84 ± 2.15）, TDS score（22.32 ± 4.75）, and average IDWG（3.12 ± 2.47） kg score of group A were significantly higher than those of group B （P<0.05）. Conclusion Diluting orally available essential balm for oral gargling can alleviate thirst and thirst-induced pain in hemodialysis patients, and reduce IDWG. This measure is simple, feasible, cost-effective, and safe, and can be included in the daily habits of patients.
Objective To explore the intervention effect of diluted essential balm mouthwash on thirst in hemodialysis patients. Methods A total of 43 patients with thirst who underwent maintenance hemodialysis at the Blood Purification Center of Taihe County People's Hospital （The Taihe Hospital of Wannan Medical College） from March 2023 to May 2023 were recruited. They were randomly divided into Group A （21 cases） and Group B （22 cases） using a random number table method. Group A and Group B were divided into two stages with a cross design, each stage lasting for 2 weeks. After the completion of the first stage, a 2-week washout period was passed, and the intervention methods of the two groups were switched to enter the second stage, with the same steps and methods as the first stage. Before and after the start of the first and second stages, the degree of thirst and thirst pain were assessed by the Visual Analogue Scale （VAS） and the Thirst Distress Scale （TDS）, respectively. The Interdialytic Weight Gain （IDWG） was calculated for statistical processing. Results At the end of the first stage, the VAS score（3.13 ± 2.97）, TDS score（10.14 ± 6.76）, and average IDWG（2.51 ± 1.87） kg score of thirst in Group A were significantly lower than those of Group B （P<0.05）. After a 2-week washout period, in the second stage, the VAS score（6.84 ± 2.15）, TDS score（22.32 ± 4.75）, and average IDWG（3.12 ± 2.47） kg score of group A were significantly higher than those of group B （P<0.05）. Conclusion Diluting orally available essential balm for oral gargling can alleviate thirst and thirst-induced pain in hemodialysis patients, and reduce IDWG. This measure is simple, feasible, cost-effective, and safe, and can be included in the daily habits of patients.
Abstract：
Objective To explore the mechanism by which astragaloside IV （AS-IV） regulates the injury of normal rat kidney cells-52E （NRK-52E） induced by Urotensin II （UII） through the Ras homolog gene family member A （RhoA）/Rho-associated protein kinase 1 （ROCK1） signaling pathway. Methods NRK-52E cells were cultured in vitro, and the effects of different concentrations of UII on NRK-52E cells were detected using the CCK8 assay. An appropriate concentration was selected for subsequent experiments. The experimental groups were divided as follows： （1）control group； （2）model group； （3）UII receptor antagonist group； （4）AS-IV group； （5）RhoA kinase inhibitor （fasudil） group； （6）losartan group. The expression levels of G protein-coupled receptor 14, α-smooth muscle actin （α-SMA）, and kidney injury molecule-1 （KIM-1） in each group of cells were detected using cell immunofluorescence. The mRNA expression levels of RhoA, ROCK1, and α-SMA in each group of cells were measured using reverse transcription polymerase chain reaction（RT-PCR）. The protein expression levels of RhoA, ROCK1, and caspase-1 in each group of cells were detected using Western blot. Results （1）The cell viability of the 0 mol/L UII group was 100%, while that in NRK-52E cells induced with 10-10、10-9、10-8、10-7, and 10-6 mol/L UII was （51.52 ± 0.15）%, （61.70 ± 0.09）%, （71.90 ± 0.17）%, （61.27 ± 0.11）%, and （52.73 ± 0.13）%, respectively. UII could cause certain damage to cells, with the 10-⁸ mol/L UII group exhibiting less damage compared to the other four groups （P<0.05）. （2）Immunofluorescence results showed that the quantitative analysis of α-SMA immunofluorescence intensity in the control group, model group, SB-611812 group, AS-IV group, Fasudil group, and Losartan group was （6.72 ± 0.10）, （9.59 ± 2.23）, （8.00 ± 0.13）, （7.93 ± 0.14）, （8.09 ± 0.09）, and （8.10 ± 0.17）, respectively. The quantitative analysis of KIM-1 immunofluorescence intensity was （7.48 ± 0.09）, （10.42 ± 0.08）, （7.51 ± 0.08）, （7.71 ± 0.08）, （7.70 ± 0.07）, and （7.45 ± 0.15）, respectively. The quantitative analysis of GPR-14 immunofluorescence intensity was （4.05 ± 0.07）, （8.00 ± 0.06）, （5.04 ± 0.02）, （6.03 ± 0.07）, （6.02 ± 0.08）, and （6.02 ± 0.09）, respectively. （3）RT-PCR results showed that the quantitative analysis of α-SMA mRNA in the control group, model group, SB-611812 group, AS-IV group, Fasudil group, and Losartan group was （1.00 ± 0.00）, （1.96 ± 0.01）, （1.53 ± 0.02）, （1.52 ± 0.08）, （1.53 ± 0.03）, and （1.52 ± 0.09）, respectively. The quantitative analysis of mRNA level of RhoA was （1.00 ± 0.00）, （2.10 ± 0.02）, （1.44 ± 0.02）, （1.55 ± 0.03）, （1.53 ± 0.07）, and （1.66 ± 0.04）, respectively. The quantitative analysis of mRNA level of ROCK1 was （1.00 ± 0.00）, （2.09 ± 0.04）, （1.51 ± 0.02）, （1.56 ± 0.02）, （1.54 ± 0.01）, and （1.51 ± 0.02）, respectively. （4）Western Blot results showed that the quantitative analysis of protein expression of Caspase-1 in the control group, model group, SB-611812 group, AS-IV group, Fasudil group, and Losartan group was （1.00 ± 0.00）, （2.53 ± 0.03）, （1.57 ± 0.01）, （1.55 ± 0.09）, （1.56 ± 0.06）, and （1.56 ± 0.01）, respectively. The quantitative analysis of protein expression of RhoA was （1.00 ± 0.00）, （2.85 ± 0.08）, （1.62 ± 0.07）, （1.60 ± 0.01）, （1.61 ± 0.02）, and （1.60 ± 0.01）, respectively. The quantitative analysis of protein expression of ROCK1 was （1.00 ± 0.00）, （2.37 ± 0.09）, （1.45 ± 0.05）, （1.54 ± 0.03）, （1.39 ± 0.05）, and （1.52 ± 0.01）, respectively. Conclusion AS-Ⅳ alleviates UⅡ-induced NRK-52E cell damage by downregulating the RhoA/ROCK1 signaling pathway.
Objective To explore the mechanism by which astragaloside IV （AS-IV） regulates the injury of normal rat kidney cells-52E （NRK-52E） induced by Urotensin II （UII） through the Ras homolog gene family member A （RhoA）/Rho-associated protein kinase 1 （ROCK1） signaling pathway. Methods NRK-52E cells were cultured in vitro, and the effects of different concentrations of UII on NRK-52E cells were detected using the CCK8 assay. An appropriate concentration was selected for subsequent experiments. The experimental groups were divided as follows： （1）control group； （2）model group； （3）UII receptor antagonist group； （4）AS-IV group； （5）RhoA kinase inhibitor （fasudil） group； （6）losartan group. The expression levels of G protein-coupled receptor 14, α-smooth muscle actin （α-SMA）, and kidney injury molecule-1 （KIM-1） in each group of cells were detected using cell immunofluorescence. The mRNA expression levels of RhoA, ROCK1, and α-SMA in each group of cells were measured using reverse transcription polymerase chain reaction（RT-PCR）. The protein expression levels of RhoA, ROCK1, and caspase-1 in each group of cells were detected using Western blot. Results （1）The cell viability of the 0 mol/L UII group was 100%, while that in NRK-52E cells induced with 10-10、10-9、10-8、10-7, and 10-6 mol/L UII was （51.52 ± 0.15）%, （61.70 ± 0.09）%, （71.90 ± 0.17）%, （61.27 ± 0.11）%, and （52.73 ± 0.13）%, respectively. UII could cause certain damage to cells, with the 10-⁸ mol/L UII group exhibiting less damage compared to the other four groups （P<0.05）. （2）Immunofluorescence results showed that the quantitative analysis of α-SMA immunofluorescence intensity in the control group, model group, SB-611812 group, AS-IV group, Fasudil group, and Losartan group was （6.72 ± 0.10）, （9.59 ± 2.23）, （8.00 ± 0.13）, （7.93 ± 0.14）, （8.09 ± 0.09）, and （8.10 ± 0.17）, respectively. The quantitative analysis of KIM-1 immunofluorescence intensity was （7.48 ± 0.09）, （10.42 ± 0.08）, （7.51 ± 0.08）, （7.71 ± 0.08）, （7.70 ± 0.07）, and （7.45 ± 0.15）, respectively. The quantitative analysis of GPR-14 immunofluorescence intensity was （4.05 ± 0.07）, （8.00 ± 0.06）, （5.04 ± 0.02）, （6.03 ± 0.07）, （6.02 ± 0.08）, and （6.02 ± 0.09）, respectively. （3）RT-PCR results showed that the quantitative analysis of α-SMA mRNA in the control group, model group, SB-611812 group, AS-IV group, Fasudil group, and Losartan group was （1.00 ± 0.00）, （1.96 ± 0.01）, （1.53 ± 0.02）, （1.52 ± 0.08）, （1.53 ± 0.03）, and （1.52 ± 0.09）, respectively. The quantitative analysis of mRNA level of RhoA was （1.00 ± 0.00）, （2.10 ± 0.02）, （1.44 ± 0.02）, （1.55 ± 0.03）, （1.53 ± 0.07）, and （1.66 ± 0.04）, respectively. The quantitative analysis of mRNA level of ROCK1 was （1.00 ± 0.00）, （2.09 ± 0.04）, （1.51 ± 0.02）, （1.56 ± 0.02）, （1.54 ± 0.01）, and （1.51 ± 0.02）, respectively. （4）Western Blot results showed that the quantitative analysis of protein expression of Caspase-1 in the control group, model group, SB-611812 group, AS-IV group, Fasudil group, and Losartan group was （1.00 ± 0.00）, （2.53 ± 0.03）, （1.57 ± 0.01）, （1.55 ± 0.09）, （1.56 ± 0.06）, and （1.56 ± 0.01）, respectively. The quantitative analysis of protein expression of RhoA was （1.00 ± 0.00）, （2.85 ± 0.08）, （1.62 ± 0.07）, （1.60 ± 0.01）, （1.61 ± 0.02）, and （1.60 ± 0.01）, respectively. The quantitative analysis of protein expression of ROCK1 was （1.00 ± 0.00）, （2.37 ± 0.09）, （1.45 ± 0.05）, （1.54 ± 0.03）, （1.39 ± 0.05）, and （1.52 ± 0.01）, respectively. Conclusion AS-Ⅳ alleviates UⅡ-induced NRK-52E cell damage by downregulating the RhoA/ROCK1 signaling pathway.
Abstract：
Acute kidney injury （AKI） is a globally highly prevalent clinical syndrome characterized by a sudden deterioration of renal function. It occurs in a variety of clinical conditions and its severity is closely associated with increased subsequent mortality, poor prognosis, and chronicity of renal injury. Therefore, an early recognition of AKI and timely interventions are crucial. Currently, there are limited clinical diagnostic techniques for AKI, and there lacks sufficiently sensitive and widely available monitoring methods. Functional magnetic resonance imaging （fMRI） is an increasingly powerful imaging modality, including blood oxygenation level dependent （BOLD）, arterial spin labeling （ASL）, diffusion weighted imaging （DWI）, intravoxel incoherent motion （IVIM）, diffusion kurtosis imaging （DKI）, diffusion tensor imaging （DTI）, and T1 mapping, T2 mapping, etc. These techniques can non-invasively assess renal oxygenation and perfusion, and reflect the changes in renal microstructure, providing the potential to detect AKI and predict the long-term outcome of AKI. This review summarized the recent studies of fMRI in AKI and provides a reference for future clinical applications.
Acute kidney injury （AKI） is a globally highly prevalent clinical syndrome characterized by a sudden deterioration of renal function. It occurs in a variety of clinical conditions and its severity is closely associated with increased subsequent mortality, poor prognosis, and chronicity of renal injury. Therefore, an early recognition of AKI and timely interventions are crucial. Currently, there are limited clinical diagnostic techniques for AKI, and there lacks sufficiently sensitive and widely available monitoring methods. Functional magnetic resonance imaging （fMRI） is an increasingly powerful imaging modality, including blood oxygenation level dependent （BOLD）, arterial spin labeling （ASL）, diffusion weighted imaging （DWI）, intravoxel incoherent motion （IVIM）, diffusion kurtosis imaging （DKI）, diffusion tensor imaging （DTI）, and T1 mapping, T2 mapping, etc. These techniques can non-invasively assess renal oxygenation and perfusion, and reflect the changes in renal microstructure, providing the potential to detect AKI and predict the long-term outcome of AKI. This review summarized the recent studies of fMRI in AKI and provides a reference for future clinical applications.
2025, 25(3): 249-255.
DOI: 10.3969/j.issn.1671-2390.2025.03.011
Abstract：
Acute kidney injury is becoming a common and increasingly frequent disease. It is caused by a variety of factors, including ischemia reperfusion, nephrotoxic drugs and sepsis, eventually progresses to chronic kidney disease and end-stage kidney disease. Hydrogen sulfide （H2S） is the third endogenous gas signaling molecule secondary to nitric oxide and carbon monoxide that can be synthesized in almost all organs, including the kidney. Although research on the regulation of H2S in kidney physiology and pathophysiology is in its infancy, there is evidence that H2S production by kidney cells is reduced in disease states and H2S donors can ameliorate kidney damage. Specifically, abnormal H2S levels have been associated with a variety of renal pathological conditions, including acute kidney injury. This article reviewed the role and research progress of H2S in acute kidney injury, and discussed the prospect and challenge of H2S in the treatment of kidney disease, providing new ideas for clinical application of H2S.
Acute kidney injury is becoming a common and increasingly frequent disease. It is caused by a variety of factors, including ischemia reperfusion, nephrotoxic drugs and sepsis, eventually progresses to chronic kidney disease and end-stage kidney disease. Hydrogen sulfide （H2S） is the third endogenous gas signaling molecule secondary to nitric oxide and carbon monoxide that can be synthesized in almost all organs, including the kidney. Although research on the regulation of H2S in kidney physiology and pathophysiology is in its infancy, there is evidence that H2S production by kidney cells is reduced in disease states and H2S donors can ameliorate kidney damage. Specifically, abnormal H2S levels have been associated with a variety of renal pathological conditions, including acute kidney injury. This article reviewed the role and research progress of H2S in acute kidney injury, and discussed the prospect and challenge of H2S in the treatment of kidney disease, providing new ideas for clinical application of H2S.
Abstract：
Hemodialysis is one of the important ways to prolong the life of patients with end-stage renal disease, but its mortality rate is significantly higher than that of normal people. Cerebrovascular accident, congestive heart failure and pulmonary infection are the most common causes of death in hemodialysis patients in China. The gut microbiota is involved in a complex network of human organs and closely related to many diseases of human systems. The gut microbiota specific to hemodialysis patients and their metabolites-induced gut-heart axis, gut-brain axis and gut-lung axis play an important role in cardiovascular, cerebrovascular and respiratory diseases. All are associated with all-cause mortality in hemodialysis patients. In this review, we focused on describing how gut microbiota and the metabolites in hemodialysis patients affect the occurrence and development of high-risk comorbidities like heart failure, stroke and respiratory tract infection. The results showed that changes in the gut microbiota structure, reduced production of short-chain fatty acids and increased intestinal protein-binding toxins in hemodialysis patients may increase the susceptibility to these diseases, accelerate disease progression and worsen the prognosis.
Hemodialysis is one of the important ways to prolong the life of patients with end-stage renal disease, but its mortality rate is significantly higher than that of normal people. Cerebrovascular accident, congestive heart failure and pulmonary infection are the most common causes of death in hemodialysis patients in China. The gut microbiota is involved in a complex network of human organs and closely related to many diseases of human systems. The gut microbiota specific to hemodialysis patients and their metabolites-induced gut-heart axis, gut-brain axis and gut-lung axis play an important role in cardiovascular, cerebrovascular and respiratory diseases. All are associated with all-cause mortality in hemodialysis patients. In this review, we focused on describing how gut microbiota and the metabolites in hemodialysis patients affect the occurrence and development of high-risk comorbidities like heart failure, stroke and respiratory tract infection. The results showed that changes in the gut microbiota structure, reduced production of short-chain fatty acids and increased intestinal protein-binding toxins in hemodialysis patients may increase the susceptibility to these diseases, accelerate disease progression and worsen the prognosis.
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