Renal insufficiency and/or chronic kidney disease are common comorbidities in patients with lung cancer, potentially affecting their prognosis. The aim of the present study was to assess the existing evidence on the association between renal insufficiency (RI)/chronic kidney disease (CKD) and the overall survival (OS) and disease-free survival (DFS) of patients with lung cancer (LC). Comprehensive electronic searches in the PubMed, Embase and Scopus databases were performed for observational cohort and case-control studies and randomized controlled trials that investigated the association between RI/CKD and the OS and/or DFS of patients with LC. Random-effect models were used, and the combined effect sizes were reported as either standardized mean differences or relative risks, along with 95% confidence intervals (CI). A total of 10 studies were included. The duration of follow-up in the included studies ranged from 12 months to 5 years. Compared with patients with normal renal function, patients with LC with RI/CKD had worse OS rates [hazard ratio (HR), 1.38; 95% CI, 1.16-1.63] but similar DFS rates (HR, 1.12; 95% CI, 0.75-1.67) at follow-up. Subgroup analysis demonstrated a significant association between poor OS and RI/CKD in patients with stage I/II LC [HR, 1.76; 95% CI, 1.30-2.37] but not in patients with stage III/IV LC [HR, 1.18; 95% CI, 0.91, 1.54]. Furthermore, irrespective of the treatment modality i.e., surgery [HR, 1.78; 95% CI, 1.40-2.27] or medical management [HR, 1.37; 95% CI, 1.25-1.50], RI/CKD was notably associated with a poor OS at follow-up. The findings of the present study underscore the adverse impact of RI/CKD on the long-term survival of patients with LC.

BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy. Genetic defects in the alternative complement (AP) pathway have been identified in 60-70% of individuals. Eculizumab is recommended as a first-line therapy.
METHODS: We collected the clinical data of a pediatric patient with aHUS accompanied by protein-losing enteropathy (PLE). Genetic testing was performed. Related literature on aHUS combined with PLE was reviewed.
RESULTS: A 15-year-old Chinese girl was diagnosed with aHUS at 3.7 years of age and experienced five episodes; her symptoms completely resolved with plasma treatment. Severe gastrointestinal symptoms and hypoalbuminemia presented after the first episode, and PLE was diagnosed. A novel homozygous CD46 variant was identified, and FACS revealed significantly decreased CD46 expression. She presented at a recent relapse with persistent GI symptoms and headache and progressed to chronic kidney failure; peritoneal dialysis was initiated. Eculizumab was given 8 months after the last recurrence. Surprisingly, PLE was cured. Afterward, dialysis was discontinued, and eGFR recovered to 44.8 ml/min/1.73 m2. A review of the literature indicated that PLE with thrombosis was caused by CD55 variants via hyperactivation of the AP system. We report an aHUS patient with PLE caused by CD46 variants. Symptoms of both PLE and aHUS were significantly alleviated in our patient and patients with CD55 variants treated with eculizumab, indicating that PLE was a new symptom of aHUS in our patient with a CD46 variant.
CONCLUSIONS: Our case expands the phenotype of aHUS caused by a CD46 mutation and provides evidence of the efficacy of eculizumab after a long phase of chronic kidney failure.

Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia (HK), there is therefore a need to establish a multi-specialty approach to optimal renin-angiotension-aldosterone system inhibitors (RAASi) usage and HK management in patients with chronic kidney disease (CKD) & heart failure (HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF. Methods A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique. The group then created a list of 41 statements for a consensus questionnaire, which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China. Consensus was assessed using a modified Delphi technique, with agreement defined as \"strong\" (≥75% and <90%) and \"very strong\" (≥90%). The steering group, data collection, and analysis were aided by an independent facilitator. Results A total of 150 responses from 21 provinces across China were recruited in the survey. Respondents were comprised of an even split (n=75, 50%) between cardiologists and nephrologists. All 41 statements achieved the 75% consensus agreement threshold, of which 27 statements attained very strong consensus (≥90% agreement) and 14 attained strong consensus (agreement between 75% and 90%). Conclusion Based on the agreement levels from respondents, the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.

OBJECTIVE: The objective of this study is to investigate the associated risk factors of pulmonary infection in individuals diagnosed with chronic kidney disease (CKD). The primary goal is to develop a predictive model that can anticipate the likelihood of pulmonary infection during hospitalization among CKD patients.
METHODS: This retrospective cohort study was conducted at two prominent tertiary teaching hospitals. Three distinct models were formulated employing three different approaches: (1) the statistics-driven model, (2) the clinical knowledge-driven model, and (3) the decision tree model. The simplest and most efficient model was obtained by comparing their predictive power, stability, and practicability.
RESULTS: This study involved a total of 971 patients, with 388 individuals comprising the modeling group and 583 individuals comprising the validation group. Three different models, namely Models A, B, and C, were utilized, resulting in the identification of seven, four, and eleven predictors, respectively. Ultimately, a statistical knowledge-driven model was selected, which exhibited a C-statistic of 0.891 (0.855-0.927) and a Brier score of 0.012. Furthermore, the Hosmer-Lemeshow test indicated that the model demonstrated good calibration. Additionally, Model A displayed a satisfactory C-statistic of 0.883 (0.856-0.911) during external validation. The statistical-driven model, known as the A-C2GH2S risk score (which incorporates factors such as albumin, C2 [previous COPD history, blood calcium], random venous blood glucose, H2 [hemoglobin, high-density lipoprotein], and smoking), was utilized to determine the risk score for the incidence rate of lung infection in patients with CKD. The findings revealed a gradual increase in the occurrence of pulmonary infections, ranging from 1.84% for individuals with an A-C2GH2S Risk Score ≤ 6, to 93.96% for those with an A-C2GH2S Risk Score ≥ 18.5.
CONCLUSIONS: A predictive model comprising seven predictors was developed to forecast pulmonary infection in patients with CKD. This model is characterized by its simplicity, practicality, and it also has good specificity and sensitivity after verification.

Hope is a goal-directed thought that reflects the sense of control over uncertainties and can promote adjustment to chronic illness. This study aimed to assess the level of hope among patients on peritoneal dialysis and evaluate the association of hope with health-related quality of life and psychological distress. This cross-sectional study included 134 Chinese patients receiving peritoneal dialysis in Hong Kong. Patients\' level of hope was assessed using the Adult Trait Hope Scale. Participants who were employed, had a higher income, and received automated peritoneal dialysis reported a higher hope score. Hope was found to have significant correlations with age and social support. A higher hope score was associated with better mental well-being and less severe depressive symptoms. Specific relationships between agency/pathway thinking and these outcomes were identified. The patient subgroups at risk for losing hope need to be identified and received early interventions to prevent adverse outcomes.

To provide reliable evidence to exercise rehabilitation therapists and clinicians, we compared and analyzed the effects of different exercise modalities on cardiopulmonary function in hemodialysis patients using Bayesian network meta-analysis.
PubMed, OVID, Web of Science, Cochrane Library, Embase, Scopus, CINAHL, SPORT Discus, SinoMed, CNKI, Wanfang, and VIP were searched from inception to July 20, 2022. We included randomized controlled trials comparing 12 exercise modalities to improve cardiorespiratory fitness in hemodialysis patients. All statistical analysis was performed using STATA and R.
A total of 82 randomized controlled trials involving 4146 maintenance hemodialysis patients were included in this study. The pair-wise meta-analysis showed that all exercise modalities had a positive effect on all indicators of cardiorespiratory capacity. The network meta-analysis demonstrated that Blood flow restriction training (BFRT), Cycle exercise (CE), Inspiratory muscle training (IMT), Combined aerobic and resistance training (CT), and Aerobic training (AT) were significantly better than usual care for 6-min walkability; Medium intensity continuous training (MICT), CT, CE, and AT were considerably better than usual care for VO2Peak; body and mind training (MBT) and CT significantly improved SBP compared to usual care; and only MBT was significantly better than usual care for DBP. Both the two-dimensional plot and the radar plot demonstrated that CT had the best combined-effect on each index of cardiorespiratory fitness. Subgroup and sensitivity analyses demonstrated the robustness of the results. The evidence was mainly \"low\" to \"very low\" for this network meta-analysis.
There is no one exercise that can achieve the best effect on all of the outcomes. The benefits of MBT in decreasing arterial blood pressure are unsurpassed by other exercise methods. The intervention effect of the CT is better and more stable. Electrical muscle stimulation training (MEST) can be employed in individuals who do not wish to exercise actively but may cause an increase in blood pressure. On the basis of the characteristics of different exercise types, guidelines developers, clinicians, and patients may employ them appropriately.
https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

BACKGROUND: Peritonitis is a common cause of hospitalisation and death among patients undergoing peritoneal dialysis. Periodic retraining is recommended to prevent peritonitis, especially in older adults.
OBJECTIVE: We evaluated the effectiveness of a retraining programme for reducing peritonitis and exit site infection rates in older adults on peritoneal dialysis. The cost-benefit ratio was also calculated.
METHODS: A two-arm prospective randomised controlled trial.
METHODS: One hundred and thirty patients aged 55 years or older were recruited. Participants were randomly assigned to the intervention or control group. While both groups received usual care, the intervention group received a retraining programme (a knowledge and practical assessment and a one-on-one retraining session) 90 days after starting home-based continuous ambulatory peritoneal dialysis therapy.
METHODS: The outcomes included peritonitis rate, exit site infection rate and direct medical costs at 180, 270, and 360 days after starting home-based continuous ambulatory peritoneal dialysis therapy.
RESULTS: No significant differences were found in the baseline characteristics between groups. The peritonitis rates were 0.11 episodes per patient-year in the intervention group versus 0.13 in the control group. The incidence of exit site infection was 20.0% in the intervention group and 12.3% in the control group. The cost-benefit ratio of retraining was 1:9.6. None of the results were statistically significant.
CONCLUSIONS: The absence of statistical significance may be partly explained by the premature termination of the study. Large-scale multi-centre trials are warranted to examine the effectiveness of retraining. The timing and long-term effects of retraining also need to be examined.

Despite high rates of complications in patients with CKD without diabetes, the implementation of proven therapies in this group remains low. Expressing the clinical benefit of a therapy in terms of extra years free from the disease or death may facilitate implementation. We estimated lifetime survival free of kidney failure for patients with albuminuric CKD without diabetes treated with the combination therapy of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and sodium-glucose cotransporter-2 (SGLT2) inhibitors relative to patients not treated.
We used trial-level estimates of the effect of treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ramipril/benazepril; n=690) and SGLT2 inhibitors (dapagliflozin; n=1398) compared with placebo to derive the effect of combination therapy versus no treatment. Using this effect, we estimated treatment effect of combination therapy to the active treatment group of patients with albuminuric CKD without diabetes participating in the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial (n=697) and projected eventfree and overall survival for those treated and not treated with combination therapy. We also performed our calculations anticipating lower adherence and less pronounced benefits than were observed in the clinical trials. The primary outcome was a composite of doubling of serum creatinine, kidney failure, or death.
The aggregate estimated hazard ratio comparing combination therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and SGLT2 inhibitor versus no treatment for the primary end point was 0.35 (95% confidence interval, 0.30 to 0.41). For a 50-year-old patient until the age of 75 years, the estimated survival free from the primary composite end point was 17.0 (95% confidence interval, 12.4 to 19.6) years with the combination therapy and 9.6 years (95% confidence interval, 8.4 to 10.7) with no treatment with any of these agents, corresponding to a gain in eventfree survival of 7.4 (95% confidence interval, 6.4 to 8.7) years. When assuming lower adherence and less pronounced efficacy of combination therapy, the gain in eventfree survival ranged from 5.3 years (95% confidence interval, 4.4 to 6.1) to 5.8 years (95% confidence interval, 4.8 to 6.8).
Treatment with the combination of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and SGLT2 inhibitor in patients with albuminuric CKD without diabetes is expected to substantially increase kidney failure-free survival.
Benazepril for Advanced Chronic Renal Insufficiency, NCT00270426, and a Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (Dapa-CKD), NCT03036150.

OBJECTIVE: To explore the diagnostic potential of texture analysis applied to native T1 maps obtained from cardiac magnetic resonance (CMR) images for the assessment of heart failure with preserved ejection fraction (HFpEF) among patients with end-stage renal disease (ESRD).
METHODS: This study, conducted from June 2018 to November 2020, included 119 patients (35 on hemodialysis, 55 on peritoneal dialysis, and 29 with kidney transplants) in Renji Hospital. Native T1 maps were assessed with texture analysis, using a freely available software package, in participants who underwent cardiac MRI at 3.0 T. Four texture features, selected by dimension reduction specific to the diagnosis of HFpEF, were analyzed. Multivariate logistic regression was performed to examine the independent association between the selected features and HFpEF in ESRD patients.
RESULTS: Seventy-six of 119 patients were diagnosed with HFpEF. Demographic, laboratory, cardiac MRI, and echocardiogram characteristics were compared between HFpEF and non-HFpEF groups. The four texture features that were analyzed showed statistically significant differences between groups. In multivariate analysis, age, left atrial volume index (LAVI), and sum average 4 (SA4) turned out to be independent predictors for HFpEF in ESRD patients. Combining the texture feature, SA4, with typical predictive factors resulted in higher C-index (0.923 vs. 0.898, p = 0.045) and a sensitivity and specificity of 79.2% and 95.2%, respectively.
CONCLUSIONS: Texture analysis of T1 maps adds diagnostic value to typical clinical parameters for the assessment of heart failure with preserved ejection fraction in patients with end-stage renal disease.
CONCLUSIONS: • Non-invasive assessment of HFpEF can help predict prognosis in ESRD patients and help them take timely preventative measures. • Texture analysis of native T1 maps adds diagnostic value to the typical clinical parameters for the assessment of HFpEF in patients with ESRD.

Partial nephrectomy (PN) induced kidney injury is still a challenging clinical matter that has not been completely conquered. This study aimed to explore the influences of perioperative anemia on renal function after PN.
A total of 114 patients undergoing PN were retrospectively studied. Serum creatinine was tested preoperatively and 24 hours and 3 days after PN to evaluate the occurrence of acute kidney injury (AKI). Perioperative anemia was evaluated on the basis of the hemoglobin (Hb) value at 24 hours and 3 days postoperation. Patients were then followed up for the development of chronic kidney disease (CKD). Associations between perioperative anemia and postoperative AKI and CKD were determined.
The cumulative incidence of perioperative anemia was 33.33% in the study. A total of 32.46% of patients suffered from postoperative AKI, and 16.67% of patients progressed to CKD. The incidences of AKI and CKD in perioperative anemia patients were dramatically exceeded in those without anemia. Further statistical analyses indicated that perioperative anemia was a relevant factor for postoperative kidney injury, presenting the highest odds ratio of 31.272 for postoperative AKI and 17.179 for postoperative CKD. Receiver operating characteristic curve analysis showed that ΔHb=(preoperative Hb)-(postoperative Hb nadir) was a meaningful predictor of postoperative kidney injury, with an area under the curve of 0.784 for predicting postoperative AKI and 0.805 for postoperative CKD.
Perioperative anemia can predict kidney injury after PN, and ΔHb shows a meaningful predictive value for postoperative AKI and CKD.