Machine learning-based comparison of factors influencing estimated glomerular filtration rate in Chinese women with or without nonalcoholic fatty liver

BACKGROUND The prevalence of non-alcoholic fatty liver(NAFLD)has increased recently.Subjects with NAFLD are known to have higher chance for renal function impairment.Many past studies used traditional multiple linear regression(MLR)to identify risk factors for decreased estimated glomerular filtration rate(eGFR).However,medical research is increasingly relying on emerging machine learning(Mach-L)methods.The present study enrolled healthy women to identify factors affecting eGFR in subjects with and without NAFLD(NAFLD+,NAFLD-)and to rank their importance.AIM To uses three different Mach-L methods to identify key impact factors for eGFR in healthy women with and without NAFLD.METHODS A total of 65535 healthy female study participants were enrolled from the Taiwan MJ cohort,accounting for 32 independent variables including demographic,biochemistry and lifestyle parameters(independent variables),while eGFR was used as the dependent variable.Aside from MLR,three Mach-L methods were applied,including stochastic gradient boosting,eXtreme gradient boosting and elastic net.Errors of estimation were used to define method accuracy,where smaller degree of error indicated better model performance.RESULTS Income,albumin,eGFR,High density lipoprotein-Cholesterol,phosphorus,forced expiratory volume in one second(FEV1),and sleep time were all lower in the NAFLD+group,while other factors were all significantly higher except for smoking area.Mach-L had lower estimation errors,thus outperforming MLR.In Model 1,age,uric acid(UA),FEV1,plasma calcium level(Ca),plasma albumin level(Alb)and T-bilirubin were the most important factors in the NAFLD+group,as opposed to age,UA,FEV1,Alb,lactic dehydrogenase(LDH)and Ca for the NAFLD-group.Given the importance percentage was much higher than the 2nd important factor,we built Model 2 by removing age.CONCLUSION The eGFR were lower in the NAFLD+group compared to the NAFLD-group,with age being was the most important impact factor in both groups of healthy Chinese women,followed by LDH,UA,FEV1 and Alb.However,for the NAFLD-group,TSH and SBP were the 5th and 6th most important factors,as opposed to Ca and BF in the NAFLD+group.

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention

Background： Mounts of studies have shown that low estimated glomerular filtration rate （eGFR） is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury （CI-AKI） in a Chinese population who underwent an emergency percutaneous coronary intervention （PCI）. Methods： Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint （including nonfatal myocardial infarction, revascularization, stroke, and all-cause death） at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.Results： A total of 1061 patients were included and the overall CI-AKI rate was 22.7% （241 / 1061）. The separate rates were 77.8% （7/9） in Group 1 （eGFR 〉 120 ml·min^-1 -1.73 m^-2）, 26.0% （118/454） in Group 2 （120 ml·min^-1·min^-11.73 m^-2〉 eGFR≥90 ml·min^-1 1.73^-2）, 18.3% （86/469） in Group 3 （90 ml·min^-1 1.73 m^-2〉 eGFR 〉60 ml·min^-1·min^-11.73 m^-2）, 21.8% （26/119） in Group 4 （60 ml·min^-1·1.73 m^-2〉 eGFR≥30 ml·min^-1·min^-11.73 m^-2）, and 40.0% （4/10） in Group 5 （eGFR 〈30 ml·min^-1·min^-1·min^-11.73 m^-2）, with statistical significance （χ^2 = 25.19, P 〈 0.001）. The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing （the higher the level of eGFR, the higher the CI-AKI occurrence in case ofeGFR_〉60 ml·min^-1·1.73 m^-2）. The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences （χ^2 = 16.26, P = 0.009 at 6-month follow-up, and χ^2 = 49.05, P 〈 0.001 at 12-month follow-up）. The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients. Conclusions： High level ofeGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

Impact of dyslipidemia on estimated glomerular filtration rate in apparently healthy children and adolescents:the CASPIAN-V study

Background Chronic kidney disease(CKD)is a leading risk factor for development of cardiovascular disease(CVD).Dyslipidemia is also known as risk factor for CVD development.However,the association of dyslipidemia with glomerular injury among healthy children and adolescents remains controversial.We aimed to investigate the relationship between estimated glomerular filtration rate(eGFR)and lipid profile risk factors among healthy children and adolescents.Methods In this nationwide survey,3808 participants(1992 males,1816 females),aged 7-18 years,were selected by cluster random sampling method from 30 provinces in Iran.Body mass index(BMI)and systolic and diastolic blood pressures were measured.Blood samples were obtained for serum creatinine,fasting blood glucose,total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),and triglyceride(TG)determinations.GFR was estimated using Schwartz equation.Results Girls had higher eGFR than boys(P=0.04).In a multiple regression analysis,eGFR demonstrated a positive correlation with systolic blood pressure,BMI,fasting glucose,TC,HDL-C,and TG.By the analysis of covariance,TC,HDL-C,and TG showed a negative correlation with eGFR after adjustments for BMI,systolic and diastolic blood pressures,and fasting glucose(OR=0.56,95%CI=0.29-0.89).Conclusion The study showed that dyslipidemia is associated with reduced eGFR among the healthy children and adolescents.

Establishing the presence or absence of chronic kidney disease:Uses and limitations of formulas estimating the glomerular filtration rate

The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.

Impact of creatinine methodology on glomerular filtration rate estimation in diabetes

AIM To evaluate the influence of creatinine methodology on the performance of chronic kidney disease(CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate(CKD-EPI-eGFR) for CKD diagnosis/staging in a large cohort of diabetic patients. METHODS Fasting blood samples were taken from diabetic patients attending our clinic for their regular annual examination, including laboratory measurement of serum creatinine and eGFR.RESULTS Our results indicated an overall excellent agreement in CKD staging(kappa = 0.918) between the Jaffé serum creatinine-and enzymatic serum creatinine-based CKDEPI-eGFR, with 9% of discordant cases. As compared to the enzymatic creatinine, the majority of discordances(8%) were positive, i.e., associated with the more advanced CKD stage re-classification, whereas only 1% of cases were negatively discordant if Jaffé creatinine was used for eGFR calculation. A minor proportion of the discordant cases(3.5%) were re-classified into clinically relevant CKD stage indicating mildly to moderately decreased kidney function(< 60 m L/min per 1.73 m^2). Significant acute and chronic hyperglycaemia, assessedas plasma glucose and Hb A1 c levels far above the recommended glycaemic goals, was associated with positively discordant cases. Due to a very low frequency, positive discordance is not likely to present a great burden for the health-care providers, while intensified medical care may actually be beneficial for the small number of discordant patients. On the other hand, a very low proportion of negatively discordant cases(1%) at the 60 m L/min per 1.73 m^2 eGFR level indicate a negligible possibility to miss the CKD diagnosis, which could be the most prominent clinical problem affecting patient care, considering high risk of CKD for adverse patient outcomes. CONCLUSION This study indicate that compensated Jaffé creatinine procedure, in spite of the glucose-dependent bias, is not inferior to enzymatic creatinine in CKD diagnosis/staging and therefore may provide a reliable and cost-effective tool for the renal function assessment in diabetic patients.

High-normal serum uric acid is associated with albuminuria and impaired glomerular filtration rate in Chinese type 2 diabetic patients

Background Recently, some studies had shown that elevated serum uric acid （SUA） itself may increase the risk for development of renal disease in patients with diabetes. This study aimed to explore whether SUA was a predictor of microalbuminuria and impaired renal function in type 2 diabetes in Chinese patients. Methods This cross-sectional study included 2108 type 2 diabetic patients. Kidney function was estimated using the simplified modification of diet in renal disease （MDRD） equation to obtain estimated glomerular filtration rate. The urine samples were obtained for measuring the albumin-to-creatinine ratio （ACR）. Results According to the ACR level, these patients were divided into two groups, normal ACR （NA） and non-normal ACR （non-NA）. Both SUA and creatinine were significantly higher in the non-NA group than those in the NA group （（318.89±107.52） vs. （283.44±88.64） pmol/L, and （95.08±53.24） vs. （79.63±18.20） μmol/L, respectively）. Logistic regression analysis showed that diabetic duration, systolic blood pressure, creatinine and SUA were the independent predictors of albuminuria. Furthermore, to identify the factors associated with renal function, these patients were divided into two groups according to the MDRD level （MDRD〈90 or MDRD〉90）. Both SUA and creatinine were significantly higher in the lower MDRD group than those in the higher MDRD group （（301.90±96.46） vs. （264.07±84.74） μmol/L, and （89.10±31.00） vs. （66.37±11.15） μmol/L, respectively）. Logistic regression analysis showed that only age and SUA were the independent predictors of MDRD. Conclusion High-normal SUA was associated with albuminuria and impaired glomerular filtration rate in Chinese type 2 diabetic patients.

Risk estimation of chronic kidney disease in a leptospirosis endemic area: A case-control study from south Andaman Islands of India

Objective:To estimate the risk of chronic kidney disease in patients with leptospirosis.Methods:All reported(41890)and later confirmed leptospirosis(1990)cases from 2010-2020 were traced by universal sampling.386 Laboratory-confirmed leptospirosis cases were enrolled and 413 age,gender,area,and occupation matched healthy persons were included as controls.Variables including socio-demographic characteristics,medical history,and health-related behaviours were compared between the two groups and association between these variables and reduced estimated glomerular filtration rate(eGFR)was analyzed with multiple linear regression.Results:The median of eGFR was 49.0(27.0,75.0)mL/min/1.73 m^(2) in the cases and 96.0(72.0,121.0)mL/min/1.73 m^(2) in the controls,showing significant differences(P<0.001).Bivariate analysis showed that leptospirosis seropositivitiy,repeat leptospirosis infection,diabetes,male gender,working in field(sun exposure),COVID-19 infection and smoking had statistically significant association with reduced eGFR.Leptospirosis seropositivity had negative effects on eGFR.Multiple linear regression confirmed that leptospirosis seropositivity had negative effects on eGFR(unstandardised β coefficients=−30.86,95%CI−49.7 to−11.9,P<0.001).Conclusions:Chronic kidney disease is a complex disease with multiple risk factors involved.Exposure to leptospirosis is one of the essential factors in accelerating its progression.

A Greater Association of Hyperuricemia than of Metabolic Syndrome with the New Incidence of Chronic Kidney Disease

Background: To what extent uric acid (UA) levels and/or metabolic syndrome (Mets) contribute to the onset of chronic kidney disease (CKD) is largely unknown. The present study explores how these two factors have an association with the new incidence of CKD. Methods: Study design is a cohort study. A total of 14,485 participants were eligible for the cross-sectional analysis on UA levels and the prevalence of Mets. Among those individuals, 8,223 participants without CKD and 4,839 without Mets were eligible for the longitudinal analysis of the new incidence of CKD. Parameters monitored were body mass index, systolic and diastolic blood pressure, serum creatinine concentration, estimated glolerular filtration rate, lipid profiles, plasma glucose, HbA1c. The primary predictor was the level of UA and Mets to explain the newly-developed CKD. The observation period was 4 years. Results: In a cross-sectional analysis, higher UA levels were associated with the greater prevalence of Mets. In addition, UA levels were associated with the numbers of the Mets constituents in both genders. In a longitudinal analysis, higher UA levels were associated with the greater rate of CKD and the greater incidence of Mets. In addition, the incidence of CKD at year 4 was influenced by the presence of hyperuricemia, but not by that of the Mets. The odd ratio (OR) to predict the CKD incidence was 1.42 (95% confidence intervals (CI), 0.52 to 3.78) in the presence of Mets alone, 2.10 (95% CI, 1.36 to 3.23) in the presence of hyperuricemia alone, and 3.56 (95% CI, 1.55 to 8.21) in the presence of both. Conclusion: Hyperuricemia has a greater association with the incidence of CKD than Mets does. Hyperuricemia complicated by Mets is additionally detrimental.

Relationship of Transforming Growth Factor-β1 and Arginase-1 Levels with Long-term Survival after Kidney Transplantation

In this study, we compared the serum levels of transforming growth factor-β1 （TGF-β1）, interleukin-10 （IL-10）, and arginase-1 in long-term survival kidney transplant recipients （LTSKTRs） with those in short-term survival kidney transplant recipients （STSKTRs）. We then evaluated the relationship between these levels and graft function. Blood samples were collected from 50 adult LTSKTRs and 20 STSKTRs （graft survival approximately 1-3 years post-transplantation）. All patients had stable kidney function. The samples were collected at our institution during the patients＇ follow-up examinations between March 2017 and September 2017. The plasma levels of TGF-β1, IL- 10, and arginase- 1 were analyzed using enzyme-linked immunosorbent assays （ELISA）. The levels of TGF-β1 and arginase-1 were significantly higher in the LTSKTRs than in the STSKTRs. The time elapsed since transplantation was positively correlated with the levels of TGF-β1 and arginase-1 in the LTSKTRs. The estimated glomerular filtration rate was positively correlated with the TGF-β1 level, and the serum creatinine level was negatively correlated with the TGF-β1 level. Higher serum levels of TGF-β1 and arginase-1 were found in LTSKTRs than in STSKTRs, and we found that TGF-β1 was positively correlated with long-term graft survival and function. Additionally, TGF-β1 and arginase-1 levels were positively correlated with the time elapsed since transplantation. On the basis of these findings, TGF-β1 and arginase- 1 may play important roles in determining long-term graft survival. Thus, we propose that TGF-β1 and arginase-1 may potentially be used as predictive markers for evaluating long-term graft survival.

eGFR is a reliable preoperative renal function parameter in patients with gastric cancer

AIM: To evaluate the validity of the estimated glomerular filtration rate (eGFR) as a preoperative renal function parameter in patients with gastric cancer. METHODS: A retrospective study was conducted in 147 patients with gastric cancer. Preoperative creatinine clearance (Ccr), eGFR, and preand postoperative serum creatinine (sCr) data were examined. Preoperative Ccr and eGFR were then compared for their reliability in predicting postoperative renal dysfunction. RESULTS: Among 110 patients with normal preoperative Ccr values, 7 (6.3%) had abnormal postoperative sCr values, and among 112 patients with normal preoperative eGFR values, postoperative sCr was abnormal in 5 (4.5%) (P = 0.53). Among 37 patients with abnormal preoperative Ccr values, 30 (81.1%) had normal postoperative sCr values, and of 35 patients with abnormal preoperative eGFR values, postoperative sCr was normal in 25 (71.4%) (P = 0.34). PreoperativeCcr was signifi cantly correlated with eGFR (r = 0.514), and postoperative sCr was significantly correlated with preoperative Ccr (r = -0.334) and eGFR (r = -0.02). CONCLUSION: Preoperative eGFR is as effective as Ccr for predicting postoperative renal dysfunction. eGFR should therefore be used as an indicator of preoperative renal function in place of Ccr since it is a cheaper and easier to perform test.

The role of endothelial biomarkers in predicting damp-heat syndrome in diabetic kidney disease

Objective:To explore the role of endothelial biomarkers in predicting damp-heat syndrome in diabetic kidney disease(DKD).Methods:A total of 183 patients with DKD were divided into 3 groups:the early DKD group,established DKD group,and advanced DKD group.All patients were classified according to traditional Chinese medicine(TCM)syndrome type,and clinical indexes were collected for statistical analysis.Results:A total of 183 DKD patients were included in this study.Fibroblast growth factor 23(FGF23),chitinase-3-like protein 1(CHI3L1),endocan,tumor necrosis factor receptor 1(TNFR1),secretory leukocyte protease inhibitor(SLPI),and vascular endothelial growth factor A(VEGF-A)were increased in advanced DKD.FGF23,CHI3L1,endocan,SLPI,and TNFR1 showed a negative correlation with estimated glomerular filtration rate(eGFR),while they had a positive correlation with 24 h urine protein.After adjusting for age,gender,diabetes duration,body mass index(BMI),hemoglobin,glucose,uric acid,24 h urine protein,cholesterol,triglyceride,low-density lipoprotein,and hemoglobin A1c(HbA1c),the multiple regression analysis showed that FGF23,endocan,TNFR1,and SLPI significantly correlated with eGFR.Conclusions:FGF23,endocan,TNFR1,and SLPI are elevated in advanced DKD compared with early stage,and they may take part in the pathogenesis and progression of DKD.Our study provides useful biomarkers for predicting the appearance of damp-heat syndrome,including FGF23,endocan,TNFR1,and SLPI.

Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignancies worldwide.However,the number of patients with chronic kidney disease(CKD)is on the rise because of the increase in lifestyle-related diseases.AIM To establish a tailored management strategy for HCC patients,we evaluated the impact of comorbid renal dysfunction(RD),as stratified by using the estimated glomerular filtration rate(EGFR),and assessed the oncologic validity of hepatectomy for HCC patients with RD.METHODS We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital.We categorized patients into two(RD,EGFR<60 mL/min/1.73 m^(2);non-RD,EGFR≥60 mL/min/1.73 m^(2))and three groups(severe CKD,EGFR<30 mL/min/1.73 m^(2);mild CKD,30≤EGFR<60 mL/min/1.73 m2;control,EGFR≥60 mL/min/1.73 m^(2))according to renal function as defined by the EGFR.Overall survival(OS)and recurrence-free survival(RFS)were compared among these groups with the log-rank test,and we also analyzed survival by using a propensity score matching(PSM)model to exclude the influence of patient characteristics.The mean postoperative observation period was 64.7±53.0 mo.RESULTS The RD patients were significantly older and had lower serum total bilirubin,aspartate aminotransferase,and aspartate aminotransferase levels than the non-RD patients(P<0.0001,P<0.001,P<0.05,and P<0.01,respectively).No patient received maintenance hemodialysis after surgery.Although the overall postoperative complication rates were similar between the RD and non-RD patients,the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients(5.5%vs 1.8%;P<0.05,3.9%vs 1.8%;P<0.05,respectively),and postoperative bleeding was the highest in the severe CKD group(P<0.05).Regardless of the degree of comorbid RD,OS and RFS were comparable,even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics,liver function,and other causes of death.CONCLUSION Comorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management,and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.

The inverse association between eGFR and depression in patients with coronary artery disease: A cross-sectional study

Background The relationship between estimated glomerular filtration rate(e GFR)and depression in patients with coronary artery disease(CAD)remained unclear.Methods A total of 561 patients with CAD were selected from Department of Cardiology between October 2017 and February 2018 while their depression status was evaluated by Patient Health Questionnaire-9(PHQ-9).The e GFR levels were compared between patients with and without depression and the link between e GFR and depression in CAD patients was explored.Results Among 561CAD patients,63 patients(11.23%)were diagnosed with comorbid depression(PHQ-9≥10).The depression group presented significantly lower e GFR level than the non-depression group.In fully-adjusted multivariate analysis,higher e GFR level was proved to be a protective factor for depression in CAD patients,reducing a 22%risk of depression for every 10 m L/(min·1.73 m2)increase of e GFR level(OR:0.78,95%CI:0.66-0.93).Similar results were found in the stratified analyses of both e GFR quartiles and chronic kidney disease(CKD)stages(P for trend<0.05),while no significant differences were found among subgroups(P for interaction>0.05).A negative linear association was estimated between e GFR level and depression in CAD patients.Conclusions Our results suggested lower e GFR level in CAD patients with comorbid depression,displaying a negative linear correlation between e GFR and risk of depression in CAD patients.The findings implied that screening depression in CAD patients with decreased e GFR level or concomitant CKD should be highlighted in clinical practice.[S Chin J Cardiol 2024;25(1):1-10]

Association between dyslipidemia and chronic kidney disease： a cross-sectional study in the middle-aged and elderly Chinese population

Background Dyslipidemia, a well-known risk factor for cardiovascular disease, is common in patients with kidney disease. Recent studies discerned that dyslipidemias play a critical role in renal damage progression in renal diseases, but the association between dyslipidemias and chronic kidney disease （CKD） in the general population remains unknown. Thus, we assessed whether the growing prevalence of dyslipidemia could increase the risk of CKD.Methods A total of 4779 middle-aged and elderl-yparticipants participated in this study. Dyslipidemias were defined by the 2007 Guidelines in Chinese Adults. Incident CKD was defined as albuminuria and/or reduced estimated glomerular filtration rate （eGFR, 〈60 ml.minl^-1.73 m^2）. Regression analysis was used to evaluate the association between dyslipidemia and albuminuria/reduced eGFR.Results Participants with hypercholesterolemia exhibited a greater prevalence of albuminuria and reduced eGFR （10.0% vs. 6.1%, P=0.001; 4.0% vs. 2.4%, P=0.028, respectively）. Both hypercholesterolemia and low high density lipoprotein cholesterol （HDL-C） were independently associated with albuminuria （odds ratio （OR） 1.49; 95% confidence interval （CI） 1.08-2.07 and OR 1.53; 95% CI 1.13-2.09, respectively）. The multivariable adjusted OR of reduced eGFR in participants with hypercholesterolemia was 1.65 （95% CI 1.03-2.65）. As the number of dyslipidemia components increased, so did the OR of CKD： 0.87 （95% CI 0.65-1.15）, 1.29 （95% CI, 0.83-2.01）, and 7.87 （95% CI, 3.75-16.50） for albuminuria, and 0.38 （95% CI 0.21-0.69）, 1.92 （95% CI 1.14-3.25）, and 5.85 （95% CI 2.36-14.51） for reduced eGFR, respectively.Conclusions Our findings indicate that dyslipidemias increase the risk of CKD in the middle-aged and elderly Chinese population. Hypercholesterolemia plays an important role in reducing total eGFR. Both low HDL-C and hypercholesterolemia are associated with an increased risk for albuminuria.

Whether Warfarin Therapy is Associated with Damage on Renal Function in Chinese Patients with Nonvalvular Atrial Fibrillation

Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF （NVAF）. The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods： From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate （eGFR） was calculated from baseline and fbllow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a 〉25% decline in eGFR （hereafter, endpoint）~ while Cox models estimated hazard ratios （HRs） and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a -〉25% decline in eGFR. Results： After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin （n = 655） and no anticoagulation groups （n = 296） and 120 （12.6%） patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups （χ2 = 0.178, log-rank P = 0.67）, but patients with systolic blood pressure （SBP） 〈140 mmHg have significant difference with patients with SBP ≥140 mmHg （χ2 = 4.903, log-rank P = 0.03）. Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion： In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.

Effects of decline in renal function with age on the outcome of asymptomatic carotid plaque in healthy adults： a 5-year follow-up study

Background It has been long suggested that abnormal clinical factors in the body, such as dyslipidemia and diabetes, can affect the presence of atherosclerosis. However, few studies on the effect of factors within the normal range, such as the loss of renal function with age, on the prevalence of atherosclerosis are few know in healthy individuals. The aim of this study was to investigate risk factors affecting the presence of asymptomatic carotid plaques in a middle-aged and elderly healthy population. Methods In this regard, we prospectively evaluated 245 healthy individuals （98 males and 147 females） at baseline and after 5 years. Changes in the presence of carotid plaque between 2003 and 2008 were categorized into four groups, i.e. subjects without plaque at entry （n=165）： Group 1 （without plaque on two occasions, n=129） and Group 2 （with nascent plaque at follow-up, n=36）; subjects with plaque at entry （n=80）; Group 3 （with plaque regression at follow-up, n=29） and Group 4 （with plaque on two occasions, n=51）. Results Univariate analysis showed that the positive rate of carotid plaques in males was higher than that in females at the baseline, and that a significantly inverse correlation existed between the prevalence rate of plaque and aging. Logistic regression analysis of cross-sectional research showed that independent risk factors for the prevalence of atherosclerosis were male gender, lower estimated glomerular filtration rate （eGFR） and higher low-density lipoprotein cholesterol （LDL-C） at the baseline, and older age and lower eGFR were involved in the presence of carotid plaques at follow-up point. However, logistic regression analysis of the longitudinal data showed that older age, decreased eGFR and increased systolic blood pressure （SBP） independently predicted the presence of carotid plaques after 5 years in subjects without plaque at entry. In addition, in subjects with plaque at entry, age, changes in eGFR and the baseline levels of serum albumin （ALB） and serum total bilirubin （BIL） dependently influenced the outcome of carotid plaque. Conclusion Physiological decline of renal function, together with advancing age, was an independent risk factor which consistently affected the presence of carotid atherosclerosis in two categories of healthy individuals.

Association between sex hormone-binding globulin and kidney function in men: results from the SPECT-China study

Background::The association between sex hormone-binding globulin(SHBG)and renal function has rarely been reported in men.We aimed to investigate the above association in a community-based Chinese population.Methods::A total of 5027 men were included from the survey on prevalence for metabolic diseases and risk factors,which is a population-based study conducted from 2014 to 2016 in Eastern China.The estimated glomerular filtration rate(eGFR)was calculated according to the chronic kidney disease Epidemiology Collaboration equation.Low eGFR was defined as eGFR<60 mL·min-1·1.73 m-2.Results::After adjusting for age,smoking,metabolic factors,and testosterone,through increasing quartiles of SHBG,a significantly positive association between SHBG quartiles and eGFR was detected in men(Q1 vs.Q4,β-2.53,95%confidence interval-3.89,-1.17,Ptrend<0.001).Compared with the highest quartile of SHBG,SHBG in the lowest quartile was associated with 96%higher odds of low eGFR(odds ratio 1.96,95%confidence interval 1.10,3.48)in the model after full adjustment.According to the stratified analyses,the associations between a 1-standard deviation increase in serum SHBG and the prevalence of low eGFR were significant in men aged≥60 years old,waist circumference<90 cm,diabetes(no),hypertension(yes),dyslipidemia(no),and nonalcoholic fatty liver disease(no).Conclusions::Lower serum SHBG levels were significantly associated with lower eGFR and a higher prevalence of low eGFR in Chinese men independent of demographics,lifestyle,metabolic-related risk factors,and testosterone.Large prospective cohort and basic mechanistic studies are warranted in the future.

Plasma Hemoglobin Was Decreased in Elderly With Primary Hypertension and/or Type 2 Diabetes Complicated With End-stage Renal Disease

Objectives To study the change in plasma hemoglobin concentration in elderly patients with primary hypertension and/or type 2 diabetes complicated with end-stage renal disease （ESRD） determined by estimated glomerular filtration rate. Methods Two hundred and thirty cases of Chinese patients aged 60 years or older with primary hypertension and/or type 2 diabetes complicated with chronic kidney disease were enrolled in the study. Patients with chronic kidney disease were divided into ESRD group with estimated glomemlar filtration rate less than 15 mL . min^-1.1.73 m^-2 （7.80 ± 3. 14 mL. min^-1 . 1.73 m^-2） and non-ESRD group with estimated glomerular filtration rate 15 mL.min^-1 . 1.73 m^-2（29. 76 ± 12. 90 mL.min^-1 . 1.73 m^-2） or higher. The plasma hemoglobin concentration was compared between the above two groups retrospectively. Results There was significant decrease in plasma hemoglobin concentration in ESRD group compared with non-ESRD group （74.4 ± 22. 5 g/L vs 100. 8 ± 23.0 g/L, P 〈 0. 05 ）. After stratification by sex, there was also significant decrease in plasma hemoglobin concentration both in male and female of ESRD groups compared with their respective non-ESRD groups（77. 2±22. 0 g/L vs 104. 9 ±20. 7 g/L; 69. 7 ±22. 8 g/L vs 96.4± 24.8 g/L, P 〈 0. 05, respectively）. Plasma hemoglobin concentration was positively related to estimated glomerular filtration rate significantly in patients with ESRD （ P 〈 0. 05 ）. Conclusions Plasma hemoglobin concentration is decreased significantly, and is positively related to estimated glomerular filtration rate significantly in elderly patients with primary hypertension and/or type 2 diabetes complicated with ESRD determined by estimated glomerular filtration rate.

Estimation of Burden of Kidney Dysfunction in HIV-Infected Pediatrics and Adolescents by Use of Urinary Neutrophil Gelatinase-Associated Lipocalin: A Single Center Experience in Kenya

Background:About 75%of patients infected with human immunodeficiency virus(HIV)live in sub-Saharan Africa.In Kenya,about 1.5 million Kenyans are living with HIV,of whom almost 100,000 are children and adolescents.Highly active antiretroviral therapy(HAART)has converted HIV infection to a chronic illness with its attendant complications.Kidney disease is a common complication of HIV infection and its treatment.Kidney disease in HIV-infected persons can be asymptomatic,insidious onset and may lack specific clinical features.It can only be detected on active screening.The urine albumin-to-creatinine ratio and estimated glomerular filtration rate(eGFR)using serum creatinine are not sensitive in identification of early kidney injury.Urinary neutrophil gelatinase-associated lipocalin(uNGAL)has been used as marker of early kidney injury.Methods:This cross-sectional study used uNGAL and serum creatinine to determine the prevalence of kidney dysfunction in HIVinfected children and adolescents with HAART at Gertrude’s Children’s Hospital,Nairobi,Kenya,from March 2016 to February 2017.Urine samples were assayed for uNGAL using the Bio Porto®enzyme-linked immunosorbent assay.Serum creatinine was assayed using the Jaffe reaction in the Cobas®6000 biochemistry analyzer and eGFR calculated using the Schwartz formula.Scatter plot of eGFR against log uNGAL levles was performed by Statistical Package for Social Sciences and Pearson correlation coefficeint between log uNGAL levles and eGFR was analyzed.Results:Ninety-three patients were recruited.Their mean age was 11.8±3.6 years and the median duration on HAART was 72.6 months.Males were 47(50.5%).The prevalence of kidney dysfunction using uNGAL was 15.1%(95%CI 7.6%–22.5%)and 5.4%(95%CI 1.8%–12.1%)by eGFR.The mean eGFR was 131±25mL·min1·1.73m2 and median uNGAL was 10 ng/mL.For every one ng/mL increase in uNGAL value above the normal value,eGFR decreases by 4.8mL·min1·1.73m2(P=0.038).Patients with elevated uNGAL were older when compared with those with normal uNGAL(13.5 vs.11.5 years).Conclusion:Urinary NGAL picked up to three times more patients with kidney dysfunction than eGFR derived from serum creatinine.All the patients were asymptomatic.Older children and adolescents were more likely to manifest with kidney dysfunction.Further studies are necessary to evaluate if uNGAL can be utilized routinely to evaluate for early kidney disease in HIV-infected patients.

Association of microalbuminuria with ambulatory arterial stiffness index in patients with type 2 diabets mellitus

Background Microalbuminuria （MAU） and ambulatory arterial stiffness index （AASI） may predict cardiovascular events and death. However, there is little information about the correlation between the two parameters in patients with type 2 diabetes mellitus （T2DM）. Therefore, we examined the association of MAU with 24-hour AASI in patients with T2DM. Methods A total of 189 patients with 24-hour ambulatory blood pressure monitoring （24h-ABPM） who were hospitalized from January 2011 to January 2017 were selected. 136 patients without hypertension were screened. The subjects were divided into two groups according to urinary albumin-to-creatinine ratio （uACR）. MAU group was defined as uACR of 30-299 mg/g （n=69）, NMAU group was defined as uACR 〈30 mg/g （n=67）. AASI was calculated as 1 minus the regression slope of diastolic blood pressure （DBP） value vs. systolic blood pressure （SBP） value according to ABPM. The differences of clinical and bio- chemical indicators between the two groups were determined. The correlation between AASI and MAU was analyzed by unconditional forward stepwise logistic regression. Results Patients with MAU had significantly higher level of diabetic duration, TC, LDL-C, Scr, AASI and lower eGFR than NMAU group （P〈0.05）. Using MAU as the dependent variable （ 1 with MAU and 0 without MAU）, LDL-C, decreased eGFR, AASI were independent risk factors of MAU in patients with T2DM. The ROC curve of AASI in predicting the risk of MAU showed when AASI was 0.48, the area under the curve was the largest 0.659（95 % CI 0.568-0.750, P=0.001）. The sensitivity was 71.0% and the specificity was 56.7%. Conclusions Patients with MAU have higher AASI than patients without MAU. As a new index of arterial stiffness, AASI is associated with MAU, and could inde- pendently predict MAU in patients with T2DM.