Renal Failure最新文献

Peritoneal dialysis (PD) transforms the peritoneum into a dynamic therapeutic interface, with each exchange offering direct access to molecular and cellular signals from the peritoneal cavity. Among these, extracellular vesicles (EVs) have emerged as stable, information-rich messengers reflecting peritoneal health, inflammation, and fibrosis. The review explores the peritoneum as a living therapeutic interface, summarizing current evidence on EV biology, their molecular cargo, and potential roles in monitoring inflammation, fibrosis, and membrane function. It also discusses existing knowledge gaps, technological advances, and opportunities for translating EV research into clinical practice.

This observational cohort study aimed to identify factors influencing long-term renal outcomes in 170 patients with biopsy-proven malignant hypertension (MHT)-associated renal thrombotic microangiopathy (TMA) who were dialysis-independent at baseline, recruited between 2008 and 2023. Over a median follow-up of 23.5 months, 52 patients (30.6%) progressed to end-stage renal disease (ESRD). Those developing ESRD exhibited significantly higher total cholesterol levels, heavier proteinuria, a greater proportion of global glomerulosclerosis, more advanced interstitial fibrosis/tubular atrophy, and lower baseline eGFR, along with lower use of renin-angiotensin-aldosterone system (RAAS) inhibitors. In Cox regression analysis, elevated total cholesterol (HR = 1.48 per 1 mmol/L change; 95% CI: 1.24-1.77, p < 0.001) and a higher percentage of glomerulosclerosis (HR = 1.24, 95% CI: 1.15-1.33, p < 0.001; per 5% increase of glomerulosclerosis) were independent risk factors for ESRD, while RAAS inhibitor use was associated with a significantly reduced risk (HR = 0.45, 95% CI: 0.25-0.82, p = 0.009). These findings underscore the prognostic value of lipid profiles and histologic injury severity in MHT-associated TMA and support the protective role of RAAS blockade in preserving renal function, which may guide risk stratification and therapeutic decisions in this high-risk population.

Patients with end-stage renal disease often require arteriovenous fistula (AVF) creation for hemodialysis. However, nearly 40% of patients develop aneurysmal dilatation of AVF (AVFA) after surgery, which can lead to prolonged bleeding at puncture sites, increased infection risk, and even potential rupture. Despite its high incidence, research on AVFA remains remarkably limited. This study makes an innovative discovery by establishing a link between AVFA formation and alternative splicing of fibronectin (FN), a crucial extracellular matrix component. Specifically, we demonstrate that increased inclusion of the EDA exon in FN within vascular smooth muscle cells triggers phenotypic switching to a synthetic state and extracellular matrix remodeling through the ITGB1/FAK/Src/RUNX2 pathway. These changes ultimately reduce vascular mechanical strength and contribute to AVFA development. Furthermore, we identify the splicing factor SRSF5 as a key regulator of EDA inclusion and characterize its potential binding sites, providing potential therapeutic targets for AVFA prevention.

This retrospective study evaluated prognostic factors affecting outcomes in patients with acute kidney injury (AKI) treated with acute intermittent hemodialysis (IHD). Medical records of 193 patients treated between 2014 and 2024 were reviewed. Patients were categorized as recovered, deceased, chronic kidney disease without dialysis (CKD-ND), or chronic kidney disease with dialysis (CKD-D). The main indications for dialysis were hypervolemia (64.8%) and uremia (24.9%). Overall mortality was 50.8%, while 23.8% recovered, 21.2% developed CKD, and 4.1% became dialysis-dependent. Significant differences among outcome groups were found in age and serum concentration of serum creatinine, urea, sodium, phosphorus, calcium, C-reactive protein (CRP), albumin. Multivariate logistic regression analysis identified lower creatinine and calcium levels, as well as higher sodium, urea, and CRP concentrations, as independent predictors of mortality. In conclusion, our findings highlight the prognostic importance of biochemical and inflammatory markers in AKI patients undergoing IHD. Early identification and correction of electrolyte and inflammatory disturbances may improve patient outcomes.

The prognostic role of the stress-induced hyperglycemia ratio (SHR) in patients with acute kidney injury related to cardiac surgery has not been fully explored. This study aims to examine the association between the SHR index and mortality in patients with cardiac surgery-associated acute kidney injury (CS-AKI). Data for this research were collected from the MIMIC database. This study investigated the relationship between SHR and prognosis of CS-AKI patients by survival analysis, restricted cubic lines, and subgroup analysis. In the final analysis, 3,249 patients were categorized into four groups based on the quartiles of the SHR. Multivariable Cox proportional hazards regression analysis demonstrated that patients in the highest quartile (Q4) had a significantly increased risk of mortality compared to those in the lower three quartiles (Q1-Q3) (p < 0.005). Receiver operating characteristic (ROC) curve analysis indicated a U-shaped relationship between SHR and patient mortality, with both low and high SHR values associated with increased risk. Incorporation of SHR into existing prognostic models (SHR+SAPS II, SHR+APACHE III, and SHR+SOFA) led to improved discriminative performance, as reflected by increased area under the curve (AUC) values. Additionally, the inclusion of SHR significantly enhanced model performance as demonstrated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) metrics (p < 0.046). The findings of this study indicate a U-shaped association between the SHR and prognosis in patients with CS-AKI. However, only elevated SHR values were independently associated with an increased risk of mortality after adjustment for confounding variables.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are novel renoprotective agents for patients with chronic kidney disease (CKD) and have diverse effects, including on the regulation of electrolyte balance. However, their effects on serum chloride concentrations remain unclear. We conducted a retrospective single-center study of 343 CKD patients without diabetes or proteinuria who were not taking diuretics, including 202 SGLT2i users and 141 non-users, and applied propensity score (PS) matching and LASSO regression analysis. The outcomes were the change in chloride concentration with adjustment for covariates, before and after PS matching. Factors associated with these changes were identified using multivariable analysis and LASSO regression. An adjusted linear mixed effects model showed that the annual changes in chloride concentration for the non-SGLT2i and SGLT2i users were -0.39 (95% CI: -0.61 to 0.17) mEq/L/year and 0.49 (95% CI: -0.02 to 1.00) mEq/L/year, respectively [difference 0.88 (95% CI: 0.58 to 1.17) mEq/L/year] (p < 0.001). After PS matching, there was also a significant difference between users and non-users of SGLT2is in the mean change in chloride concentration [difference 0.44 (95% CI: 0.03 to 0.84) mEq/L/year] (p = 0.036). Subgroup analyses confirmed these findings. Furthermore, the use of SGLT2is had the strongest influence on the 2-year change in serum chloride concentration. To our knowledge, this is the first propensity-matched study to demonstrate a sustained chloride-preserving effect of SGLT2 inhibitors in non-diabetic CKD. In conclusion, this study identifies a previously underrecognized tubular electrolyte effect of SGLT2 inhibitors-preservation of serum chloride-which may partly explain their consistent cardioprotective effects across diverse CKD populations.

Objective: To explore the risk factors for uric acid-lowering therapy-resistant gout (UALT-RG) and its relationships with the estimated glomerular filtration rate (eGFR), body roundness index (BRI), and visceral adiposity index (VAI) via 2007-2018 National Health and Nutrition Examination Survey (NHANES) data.

Methods: We calculated the BRI using waist circumference and standing height; the VAI using triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and body mass index (BMI); and the eGFR from serum creatinine levels. We also collected gout data. We explored the relationships of the eGFR, BRI, and VAI with UALT-RG risk via univariable and multivariable weighted logistic regression, trend analysis, and restricted cubic splines.

Results: Among the 1,811 patients with gout, ∼9.08% had UALT-RG; these patients were more likely to have obesity, comorbid diabetes (36% [27-47%] vs. 25% [22-28%]) or impaired kidney function (eGFR < 60 mL/min/1.73 m², 34.5% [27-43%] vs. 22.5% [20-26%]); be former smokers; and take colchicine (10% [5.6-19%] vs. 4.3% [2.8-6.7%]). Logistic regression and trend analysis suggested that an elevated BRI and decreased eGFR were independent risk factors and potential screening indicators for UALT-RG. Restricted cubic spline analysis revealed a negative linear trend between the eGFR and UALT-RG risk (p-overall < 0.0001) and a significant positive correlation between the BRI and UALT-RG risk (p-overall < 0.0001).

Conclusion: An increased BRI and decreased eGFR may be independent risk factors and assessment indicators for UALT-RG in U.S. adults. It is necessary to monitor serum urate levels more closely and conduct early multidisciplinary comanagement when gout is comorbid with visceral obesity and chronic kidney disease stages 3-5.

Objective: The study aimed to compare ultrasound-guided brachial plexus block (BPB) with local anesthesia (LA) on efficacy, safety and 12-month patency rate for percutaneous transluminal angioplasty (PTA) treatment of dysfunctional arteriovenous fistula (AVF).

Methods: Consecutive patients with dysfunctional AVF who underwent PTA from January 2021 to December 2022 were included. Overlap weighting was performed to adjust for significant differences between the two groups. The primary efficacy outcomes included visual analogue scale (VAS) score and 12-month target-lesion primary patency rate. The secondary efficacy outcomes included target-lesion primary-assisted patency rate, secondary patency rate, access-circuit thrombosis rate, access-circuit reintervention rate, and number of reinterventions within 12 months. Univariate analysis and multivariate analysis by log-binomial regression were used to identify the independent factors associated with intraoperative pain.

Results: 218 patients were included in the study: 82 patients underwent PTA under BPB and 136 patients underwent PTA under LA. After overlap weighting, the baseline, lesion characteristics and intraoperative details had no significant difference between the two groups. Patients under BPB had significantly lower VAS scores than those under LA (2.4 ± 1.4 vs 5.1 ± 1.9, p < 0.001). The 12-month target-lesion primary patency rate was significantly higher in the BPB group than that in the LA group (58.3% vs 40.0%, p = 0.037). The 12-month target-lesion primary-assisted patency rate and access-circuit secondary patency rate were significantly higher in the BPB group than those in the LA group (p = 0.023 and p = 0.028). The access-circuit thrombosis rate was significantly lower in the BPB group (10.0%) than that in the LA group (28.3%) (p = 0.011). BPB was the only independent factor associated with mild pain (p < 0.001, OR: 0.037, 95%CI: 0.011-0.119).

Conclusions: BPB could decrease the intraoperative pain and improve the 12-month primary patency rates compared with LA for patients underwent PTA treatment of dysfunctional AVF.

Background: Diabetic kidney disease (DKD) is a common and serious complication of diabetic mellitus (DM). More sensitive methods for early DKD prediction are urgently needed. This study aimed to set up DKD risk prediction models based on machine learning algorithms (MLAs) in patients with type 2 DM (T2DM).

Methods: The electronic health records of 12,190 T2DM patients with 3-year follow-ups were extracted, and the dataset was divided into a training and testing dataset in a 4:1 ratio. The risk variables for DKD development were ranked and selected to establish forecasting models. The performance of models was further evaluated by the indexes of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, as well as F1 score, using the testing dataset. The value of accuracy was used to select the optimal model.

Results: Using the importance ranking in the random forest package, the variables of age, urinary albumin-to-creatinine ratio, serum cystatin C, estimated glomerular filtration rate, and neutrophil percentage were selected as the predictors for DKD onset. Among the seven forecasting models constructed by MLAs, the accuracy of the Light Gradient Boosting Machine (LightGBM) model was the highest, indicated that the LightGBM algorithms might perform the best for predicting 3-year risk of DKD onset.

Conclusions: Our study could provide powerful tools for early DKD risk prediction, which might help optimize intervention strategies and improve the renal prognosis in T2DM patients.