Yi-Shen-Hua-Shi regulates intestinal microbiota dysbiosis and protects against proteinuria in patients with chronic kidney disease: a randomized controlled study.

CONTEXT: Yi-Shen-Hua-Shi (YSHS) is a traditional Chinese medicine that treats chronic kidney disease (CKD). However, its efficacy in reducing proteinuria and underlying mechanisms is unknown. OBJECTIVE: This single-center randomized controlled trial explored whether YSHS could improve proteinuria and modulate the gut microbiota. MATERIALS AND METHODS: 120 CKD patients were enrolled and randomized to receive the renin-angiotensin-aldosterone system (RAAS) inhibitor plus YSHS (n = 56) or RAAS inhibitor (n = 47) alone for 4 months, and 103 patients completed the study. We collected baseline and follow-up fecal samples and clinical outcomes from participants. Total bacterial DNA was extracted, and the fecal microbiome was analyzed using bioinformatics. RESULTS: Patients in the intervention group had a significantly higher decrease in 24-h proteinuria. After 4 months of the YSHS intervention, the relative abundance of bacteria that have beneficial effects on the body, such as Faecalibacterium, Lachnospiraceae, Lachnoclostridium, and Sutterella increased significantly, while pathogenic bacteria such as the Eggerthella and Clostridium innocuum group decreased. However, we could not find these changes in the control group. Redundancy analysis showed that the decline in 24-h proteinuria during follow-up was significantly correlated with various taxa of gut bacteria, such as Lachnospiraceae and the Lachnoclostridium genus in the YSHS group. KEGG analysis also showed the potential role of YSHS in regulating glycan, lipid, and vitamin metabolism. DISCUSSION AND CONCLUSION: The YSHS granule reduced proteinuria associated with mitigating intestinal microbiota dysbiosis in CKD patients. The definite mechanisms of YSHS to improve proteinuria need to be further explored. TRIAL REGISTRATION: ChiCTR2300076136, retrospectively registered.

Severe flood modulates the sources and age of dissolved organic carbon in the Yangtze River Estuary.

Floods in global large rivers modulate the transport of dissolved organic carbon (DOC) and estuarine hydrological characteristics significantly. This study investigated the impact of a severe flood on the sources and age of DOC in the Yangtze River Estuary (YRE) in 2020. Comparing the flood period in 2020 to the non-flood period in 2017, we found that the flood enhanced the transport of young DOC to the East China Sea (ECS), resulting in significantly enriched Δ14C-DOC values. During the flood period, the proportion of modern terrestrial organic carbon (OC) was significantly higher compared to the non-flood period. Conversely, the proportion of pre-aged sediment OC was significantly lower during the flood period. The high turbidity associated with the flood facilitated rapid transformation and mineralization of sedimentary and fresh terrestrial OC, modifying the sources of DOC. The flux of modern terrestrial OC transported to the ECS during the flood period was 1.58 times higher than that of the non-flood period. These findings suggest that floods can modulate the sources and decrease the age of DOC, potentially leading to increased greenhouse gas emissions. Further research is needed to understand the long-term impacts of floods on DOC dynamics in global estuaries.

Application of 3.0 T multimodal MRI in FIGO staging of cervical cancer.

BACKGROUND: In malignant tumours of the female reproductive system, cervical cancer is second only to breast cancer, seriously threatening the health and safety of most women. OBJECTIVE: To evaluate the clinical value of 3.0 T multimodal nuclear magnetic resonance imaging (MRI) in the International Federation of Gynecology and Obstetrics' (FIGO) staging of cervical cancer. METHODS: The clinical data of 30 patients with pathologically diagnosed cervical cancer admitted to our hospital from January 2018 to August 2022 were analysed retrospectively. Before treatment, all patients were examined with conventional MRI, diffusion-weighted imaging and multi-directional contrast-enhanced imaging. RESULTS: The accuracy of multimodal MRI in the FIGO staging of cervical cancer (29/30, 96.7%) was significantly higher than the accuracy obtained in a control group (21/30, 70.0%), with a statistically significant difference (p= 0.013). In addition, there was good agreement between two observers applying multimodal imaging (kappa= 0.881) and moderate agreement between two observers in the control group (kappa= 0.538). CONCLUSION: Multimodal MRI can evaluate cervical cancer comprehensively and accurately to enable accurate FIGO staging, providing significant evidence for clinical operation planning and subsequent combined therapy.

The effect of a methylxanthine vasodilator: pentoxifylline on the treatment of diabetic nephropathy-a meta-analysis.

This meta-analysis aimed to comprehensively evaluate the efficacy and safety of pentoxifylline (PTF) in the treatment of diabetic nephropathy (DN) and to offer fresh perspectives and evidence-based references for this condition. Meta-analysis. Relevant randomized controlled trials (RCTs) were searched from PubMed, Embase, Cochrane Library, China Knowledge Network (CNKI), Wanfang, and China Biomedical Literature Database. All trials were screened for compliance with the inclusion and exclusion criteria, and relevant data were extracted after quality evaluation. Eighteen studies with a total of 1280 patients were finally included. Compared to the control group, high sensitivity C-reactive protein (hsCRP) was improved (MD = - 0.23. 95% CI = [- 0.41, - 0.05], P = 0.01); urinary albumin excretion (UAE) rate was reduced (MD = - 16.50, 95% CI = [- 18.87, - 14.13], P<0.00001); the change of serum creatinine (Scr) from baseline was reduced (MD = - 0.05, 95%CI = [- 0.08, - 0.01], P = 0.009); fasting plasma glucose (FPG) was decreased (MD = - 5.66, 95% CI = [- 9.79, - 1.53], P = 0.007); and the improvement of glomerular filtration rate (eGFR) from baseline was increased (MD = 4.38, 95% CI = [3.28, 5.48], P<0.00001) in the treatment group. No significant difference was observed between the two groups concerning systolic blood pressure, diastolic blood pressure, total cholesterol, and triglycerides. And in terms of safety, the use of PTF was relatively safe with some self-limiting adverse events. FPG was decreased by PTF more effectively, but there was no effect of PTF on glycated hemoglobin (HbA1c). PTF could improve hsCRP, decrease UAE and Scr, and raise eGFR in the treatment of DN.

Relationship between ferroptosis and mitophagy in renal fibrosis: a systematic review.

Renal fibrosis, characterised by glomerulosclerosis and tubulointerstitial fibrosis, is a typical pathological alteration in the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD). However, the limited and expensive options for treating renal fibrosis place a heavy financial burden on patients and healthcare systems. Therefore, it is significant to find an effective treatment for renal fibrosis. Ferroptosis, a non-traditional form of cell death, has been found to play an important role in acute kidney injury (AKI), tumours, neurodegenerative diseases, and so on. Moreover, a growing body of research suggests that ferroptosis might be a potential target of renal fibrosis. Meanwhile, mitophagy is a type of selective autophagy that can selectively degrade damaged or dysfunctional mitochondria as a form of mitochondrial quality control, reducing the production of reactive oxygen species (ROS), the accumulation of which is the main cause of renal fibrosis. Additionally, as a receptor of mitophagy, NIX can release beclin1 to induce mitophagy, which can also bind to solute carrier family 7 member 11 (SLC7A11) to block the activity of cystine/glutamate antitransporter (system Xc-) and inhibit ferroptosis, thereby suggesting a link between mitophagy and ferroptosis. However, there have been only limited studies on the relationship among mitophagy, ferroptosis and renal fibrosis. In this paper, we review the mechanisms of mitophagy, and describe how ferroptosis and mitophagy are related to renal fibrosis in an effort to identify potential novel targets for the treatment of renal fibrosis.

Global trends and focuses of GLP-1RA in renal disease: a bibliometric analysis and visualization from 2005 to 2022.

Glucagon-like peptide 1 receptor agonist (GLP-1RA) is a new class of glucose-lowing agents with the kidney benefit effect. This paper aims at finding the current state and hotspots of the research on GLP-1RA in kidney disease by using bibliometric methodologies and visualization maps to analyze publications and provide the direction for future studies on that topic. Literature information was obtained by retrieving the WoSCC database. Then, software like Microsoft Excel, VOSviewer, and CiteSpace was used to analyze and process obtained data. Bibliometric analysis and visualization of nations, authors, organizations, journals, keywords, and references were also done by VOSviewer and CiteSpace. A total of 991 publications written by 4747 authors from 1637 organizations in 75 countries on GLP-1RA in renal disease in Web of Science Core Collection were retrieved. The number of publications and citations kept growing from 2015 to 2022. The USA, Univ Copenhagen, and Rossing Peter are the leading country, organization, and author on this topic, respectively. All literature was published in 346 journals, and DIABETES OBESITY & METABOLISM is the journal with the most contributions. Meanwhile, most references are from DIABETES CARE. "Cardiovascular outcome" is the most frequent keyword in the total publications, and the reference cited most times is "Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes" by Marso SP. The topic of GLP-1RA in renal disease has attracted more and more attention all over the world. Existing studies are mainly about clinical use in patients with diabetes, and studies on the mechanism are lacking.

Distinct Radiocarbon Ages Reveal Two Black Carbon Pools Preserved in Large River Estuarine Sediments.

Black carbon (BC), a group of environmentally concentrated organic pollutants, is widely distributed in marine sediments via riverine run-off and atmospheric deposition. The fate of BC transformation and cycling in marine sediments, however, has not been well studied. Here, we present radiocarbon measurements for sedimentary solid-phase BC (SBC) and porewater-dissolved BC (DBC) in surface sediments collected from the Yangtze and Yellow River estuaries and their adjacent coastal regions. Radiocarbon results revealed that two distinct BC pools in the sediments of the SBC had ancient radiocarbon ages (7110-15,850 years BP) that were 5370-14,935 years older than the 14C ages of porewater DBC. Using a radiocarbon mass balance model, we calculated that modern biomass-derived BC contributed 77-97% of the DBC pool and that fossil material-produced BC accounted for 61-87% of the SBC pools. This discrepancy between modern and dead BC contributions was associated with the BC budget after particulate BC (PBC) deposition; 38 ± 13% of the PBC was transferred to porewater as DBC and 62 ± 13% was sequestrated as SBC in sediments, serving as an important CO2 sink in marine sediments. We also provide evidence suggesting that DBC likely comprises some very fine particulate forms that are not completely dissolved as molecules. The nature and transformation mechanisms of DBC in natural aquatic systems need to be further studied.

Evaluation the role of soluble microbial products for denitrification sludge characteristic under starvation stress.

Physiological changes with the assist role of soluble microbial products (SMP) of preserved denitrifying sludge (DS) undergoing long-term stress of starvation under different storage temperature is extremely important. In this study, SMP extracted from DS were added into DS in starvation condition under room temperature (15-20 °C), 4 °C and -20 °C with three different bio-augmentation phases of 10, 15 and 30 days. Experimental results showed that added SMP in room temperature was optimal for preservation of DS under starvation stress with optimized dosage of 2.0 mL mL-1 sludge and bio-augmentation phase of 10 d. SMP was more effective in maintaining the specific denitrification activity of DS, and it was nearly boosted to 94.1 % of control one due to assist of 2 times SMP addition with 10 days interval of each. Under assist of SMP, extracellular polymeric substances (EPS) secretion was enhanced as the defense layer to withstand starvation stress, and the protein may be utilized as an alternative substrate to gain energy, accelerate electron transport and transfer during denitrification process. This investigation revealed the feasibility of SMP as an economical and robust strategy for preservation of DS.

Facile synthesis of nanostrip-structured pseudo-boehmite "nest" for nano-TiO2/γ-Al2O3construction to remove tetracycline hydrochloride in water.

A particular bird's nest-like pseudo-boehmite (PB) composed of cohesive nanostrips was prepared by a novel and facile approach based on the reaction of Al-Ga-In-Sn alloy and water, together with ammonium carbonate. The PB possesses a large specific surface area (465.2 m2g-1), pore volume (1.0 cm3g-1), and pore diameter (8.7 nm). Subsequently, it was utilized as a precursor to form the TiO2/γ-Al2O3nanocomposite for tetracycline hydrochloride removal. The removal efficiency can reach above 90% at TiO2:PB = 1:1.5 under the Sunlight irradiation simulated by a LED lamp. Our results indicate that the nest-like PB is a promising carrier precursor for efficient nanocomposite catalysts.

The Complete Mitochondrial Genome of the Hermit Crab Diogenes edwardsii (Anomura: Diogenidae) and Phylogenetic Relationships within Infraorder Anomura.

A complete mitochondrial genome (mitogenome) can provide important information for gene rearrangement, molecular evolution and phylogenetic analysis. Currently, only a few mitogenomes of hermit crabs (superfamily Paguridae) in the infraorder Anomura have been reported. This study reports the first complete mitogenome of the hermit crab Diogenes edwardsii assembled using high-throughput sequencing. The mitogenome of Diogenes edwardsii is 19,858 bp in length and comprises 13 protein-coding genes, 2 ribosomal RNA genes, and 22 transfer RNA genes. There are 28 and six genes observed on the heavy and light strands, respectively. The genome composition was highly A + T biased (72.16%), and exhibited a negative AT-skew (-0.110) and positive GC-skew (0.233). Phylogenetic analyses based on the nucleotide dataset of 16 Anomura species indicated that D. edwardsii was closest related to Clibanarius infraspinatus in the same family, Diogenidae. Positive selection analysis showed that two residues located in cox1 and cox2 were identified as positively selected sites with high BEB value (>95%), indicating that these two genes are under positive selection pressure. This is the first complete mitogenome of the genus Diogenes, and this finding helps us to represent a new genomic resource for hermit crab species and provide data for further evolutionary status of Diogenidae in Anomura.

Genomics of clonal evolution in a rare essential thrombocythemia with coexisting Type 2 CALR and MPL S204P mutations.

Essential thrombocythemia (ET) with double driver mutations is a rare disease. ET patients with both MPL and Type 1 CALR mutations have been reported. Here, we report the first case of an ET patient with both MPL S204P and Type 2 CALR mutations and a summary of our literature review findings. In the patient whose case is reported here, the disease progressed to an accelerated phase 3.5 months after diagnosis. CALR mutation disappeared and new mutations emerged as the disease progressed, such as ASXL1, CBL, ETV6, and PTPN11 mutations. This case highlights that screening for additional mutations using NGS should be considered in patients with ET to assess the prognosis, especially as the disease progresses.

Decoding the response of complete autotrophic nitrogen removal over nitrite (CANON) performance and microbial succession to hydrazine and hydroxylamine: Linking performance to mechanism.

The influence of hydrazine (N2H4) and hydroxylamine (NH2OH) on performance and microbial community structures of complete autotrophic nitrogen removal over nitrite (CANON) process were assessed in this study. Experimental results demonstrated that CANON process was successfully started up and got total nitrogen removal efficiency (TNRE) of 53.6 % ± 9.8 % and 56.4 % ± 6.5 % under 1.0 and 0.5 mg L-1 N2H4 and NH2OH, respectively. N2H4 and NH2OH promoted activity of ammonia-oxidizing bacteria (AOB) and anaerobic ammonium oxidation bacteria (AnAOB), and inhibited activity of nitrite-oxidizing bacteria (NOB). Meanwhile, the stable operation of CANON process could be maintained without N2H4 auxiliary. While, performance assisted by NH2OH was fluctuated without NH2OH addition, suggesting that both N2H4 and NH2OH had a persistent and reversible inhibition on NOB. This study reveals new insights into influence of N2H4 and NH2OH on CANON performance.

Sources and cycling of dissolved organic and inorganic carbon on the northern Qinghai-Tibetan Plateau: Radiocarbon results from Qinghai Lake.

Tibetan Plateau lakes are sensitive to climate variabilities and affect regional temperature, precipitation and ecosystems. In this study, we investigated the concentrations and carbon isotope (14C and 13C) compositions of dissolved organic and inorganic carbon (DOC and DIC) along with the concentrations of major lithologic ions (Na+, Mg2+, K+, Ca2+) and dissolved silicate (DSi) in a large lake, namely, Qinghai Lake, and its seven inflowing rivers on the northeastern Qinghai-Tibetan Plateau of China. Our results revealed large differences in concentrations and isotopic compositions between DOC and DIC, as well as differences in the concentrations of major ions between the rivers and lake. The chemical weathering of carbonate and silicates in the catchments played important roles in controlling the fates of major ions in the rivers. In Qinghai Lake, evaporation resulted in 40-290 times the accumulation of Na+, Mg2+, and K+ observed in the rivers, while biological uptake and precipitation reduced the concentrations of Ca2+ and DSi in the lake by 4-17 times compared with those in the rivers. In addition, the concentrations of DOC and DIC in the lake were 6-7 times those in the rivers. The carbon isotope (δ13C and Δ14C) signatures of DOC and DIC revealed that the rivers transport millennium-aged DOC (1254 ± 316 years) and DIC (1513 ± 857 years), as influenced largely by the chemical weathering of rocks and preaged soil carbon on the plateau. In contrast, in Qinghai Lake, the ages of DOC are significantly younger (684 ± 378 years) than the ages of riverine DOC, as regulated by newly biologically produced modern DOC. Moreover, the DIC ages in Qinghai Lake are all modern, indicating that exchange with atmospheric CO2 is the dominant process controlling the lake DIC. The accumulation and removal of riverine-aged DIC in Qinghai Lake, however, are not well understood, and the unbalanced radiocarbon in lake DIC remains a mystery that needs further study.

A Facile Temperature-Controlled "Green" Method to Prepare Multi-kinds of High-Quality Alumina Hydrates via a Ga-In-Sn-Alloyed Aluminum-Water Interface Reaction.

The Al sheets alloyed by Ga-In-Sn are generally utilized to react with water for H2 production, while the valuable byproducts, i.e., alumina hydrates, have not been fully studied. In this work, through controlling the reaction temperature, three types of alumina hydrates, bayerite (40 °C), pseudo-boehmite (PB) (70-120 °C), and boehmite (130-160 °C), were successfully prepared based on a series of interface reactions and structural transformations. These alumina hydrates and their calcined products (alumina) possess high purity with a total impurity element content of <450 ppm, especially an extremely low sodium content (<21 ppm) and iron content (<52 ppm). Significantly, the obtained pseudo-boehmite displays excellent surface properties (specific surface area: 332.7 m2 g-1, pore volume: 0.3 cm3 g-1, and pore diameter: 3.6 nm), competitive to the current commercial SB powder by Sasol. This work not only deepens the understanding of the byproducts in a Ga-In-Sn-alloyed Al-water reaction but also establishes a facile "green" method oriented to industrial applications, which is promising for the linkage benefits of the hydrogen production industry.

Ferroptosis, a new target for treatment of renal injury and fibrosis in a 5/6 nephrectomy-induced CKD rat model.

Ferroptosis is a non-traditional form of regulated cell death, characterized by iron overload and lipid peroxidation. Exploration of ferroptosis in chronic kidney disease (CKD) has been extremely limited to date. In this study, we established a rat model of CKD by 5/6 nephrectomy, treated CKD rats with the ferroptosis inducer, cisplatin (CDDP), and the ferroptosis inhibitor, deferoxamine mesylate (DFO), and observed the resulting pathologic changes (injury markers and fibrosis) and ferroptotic biochemical indices. Kidney iron deposition, lipid peroxidation, mitochondrial defects, ferroptosis marker induction, and TUNEL staining positivity were detected in CKD group rats. Further, treatment with CDDP or DFO influenced renal injury and fibrosis by affecting ferroptosis, rather than apoptosis, and ferroptosis occurs in the remnant kidney due to disordered iron metabolism. In conclusion, our study shows for the first time that 5/6 nephrectomy induces ferroptosis in the remnant kidney and clarifies the underlying pathogenesis. Moreover, we demonstrate that ferroptosis is involved in CKD progression and represents a therapeutic target in chronic kidney injury and renal fibrosis.

Highly fluorescent N doped C-dots as sensor for selective detection of Hg2+ in beverages.

In this work, nitrogen doped carbon dots (NCDs) were synthesized through one step hydrothermal reaction using citric acid and ethylenediamine as precursors. The prepared NCDs exhibit high quantum yield of 67.4%, good stability, excellent selectivity and sensitivity. It was found that the NCDs have potential as a fluorescence sensor for the detection of Hg2+. Under optimal conditions, good linearity between the change in NCDs fluorescence intensity and Hg2+ concentration was obtained in the range of 0.3 to 2.0 µM with a detection limit at 0.24 µM. The possible detection mechanism was static quenching of NCDs by Hg2+. The established method was successfully applied to the determination of Hg2+ in beverage samples. The results indicated that the NCDs-based sensor has potential for detection of Hg2+ in real beverage sample.

Two unusual cases of autologous HSCT related TMA with kidney injury.

Kidney injury caused by transplant-associated thrombotic microangiopathy (TA-TMA) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo HSCT) is relatively frequent. However, it is rarely reported in patients undergoing autologous HSCT (aHSCT). There are a few studies reported that TA-TMA could occur in pediatric patients undergoing aHSCT, but the condition in adult patients is rarely described. Furthermore, almost all the patients who suffered from TA-TMA developed typical and severe manifestations which should be treated with aggressive target therapy. Nevertheless, we presented two cases of kidney injury caused by TA-TMA after aHSCT with specific clinical features. Case 1, a 33-year-old Chinese male diagnosed with Hodgkin's lymphoma developed TA-TMA-associated kidney injury 4 months after transplantation. Case 2, a 49-year-old Chinese female with central nervous lymphoma developed TA-TMA-related kidney injury 3 months after transplantation. Both patients presented "mild" and atypical features of TA-TMA and their kidney function was managed effectively with low-dose prednisone therapy. TA-TMA related kidney injury can occur in patients who underwent aHSCT. Patients with TA-TMA could develop atypically "mild" features. Low-dose prednisone may be effective in place of routine eculizumab treatment regimen. We recommend that clinicians prompt an investigation for TA-TMA in patients presenting kidney injury in the background of aHSCT to facilitate early diagnosis.

Universality of mesoporous coal gasification slag for reinforcement and deodorization in four common polymers.

Mesoporous adsorbents and polymer deodorants are difficult to implement on a large scale because of their complicated preparation methods. Herein, a mesoporous adsorbent (CGSA) with a specific surface area of 564 m2g-1and a pore volume of 0.807 cm3g-1was prepared from solid waste coal gasification slag using a simple acid leaching process. The adsorption thermodynamics and adsorption kinetics results verified that the adsorption mechanism of propane on CGSA was mainly physisorption. Then the universality of CGSA in different polymers was investigated by introducing CGSA and its commercialized counterparts (CaCO3, and zeolite) into four common polymers. When the filler content was 30 wt%, the average reinforcement effect of CGSA on the tensile, flexural, and impact strengths of the four polymers was 46.68%, 83.62%, and 211.90% higher than that of CaCO3, respectively. Gas chromatography results also showed that CGSA significantly decreased total volatile organic compound emissions from the composites, and its optimal deodorization performance reached 69.58%, 81.33%, and 91.09% for different polymers, respectively, far exceeding that of zeolite. Therefore, this study showed that low-cost, high-performance, and multifunctional mesoporous polymer fillers with excellent universality can be manufactured from solid contaminants.

Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China.

Background: Frailty is known to be highly prevalent in older hemodialysis (HD) patients. We studied the prevalence of frailty and its associated factors in Chinese HD patients. We further studied if frailty could predict survival in HD patients. Methods: This is a prospective study involving patients receiving maintenance HD in the dialysis center of Xuanwu Hospital, Beijing. Study subjects were enrolled from October to December, 2017 and followed up for two years. Demographic data, comorbidities and biological parameters were collected. Frailty was assessed using the Fried frailty phenotype at baseline. Cox regression analysis was performed to identify the relationship between frailty and mortality in HD patients. Kaplan-Meier was plotted using the cutoff value obtained by ROC curve to evaluate survival rates in different frailty status. Results: Total of 208 HD patients were enrolled with a mean age of 60.5±12.7 years. According to the frailty criteria, at baseline the prevalence of robust, pre-frail and frail in HD patients was 28.7%, 45.9%, and 25.4%, respectively. The two-year all-cause mortality was 18.8% (39/207) and underlying causes of death included coronary artery disease (CAD), cerebrovascular disease (CVD), hyperkalemia, severe infection, malignant tumor and others. Survival curve showed the patients with frailty score ≥4 to have significantly shorter survival time as compared to patients with frailty score ≤ 3. Frailty predicted two-year mortality when frailty score ≥4 with a sensitivity of 70% and a specificity of 83.67% with an AUC of 0.819. Frailty score was positively associated with age and ratio of ultrafiltration volume to dry weight, while negatively associated with levels of serum albumin, uric acid and diastolic blood pressure after HD. Conclusions: Our results confirm frailty to be very common among HD patients and severity of frailty was a significant predictor of mortality for HD patients. Factors such as age, malnutrition and low blood pressure are the factors to be associated with frailty. Interdialytic weight gain inducing excessive ultrafiltration volume is an important risk factor.