Telemedicine and Clinical Outcomes in Peritoneal Dialysis: A Propensity-Matched Study.

INTRODUCTION: Telemedicine (TM) has shown to provide potential benefits on clinical outcomes in patients with chronic kidney disease but limited evidences published in the peritoneal dialysis (PD) population. This study aimed to explore the long-term effects of TM on the mortality and technique failure. METHODS: The Peritoneal Dialysis Telemedicine-assisted Platform Cohort Study (PDTAP Study) was conducted prospectively in 27 hospitals in China since 2016. Patient and practice data were collected through the doctor-end of the TM app (Manburs) for all participants. TM including self-monitoring records, on-line education materials, and real-time physician-patient contact was only performed for the patient-end users of the Manburs. The primary outcome was all-cause mortality. The secondary outcomes were cause-specific mortality and all-cause and cause-specific permanent transfer to hemodialysis. RESULTS: A total of 7,539 PD patients were enrolled between June 2016 and April 2019, with follow-up till December 2020. Patients were divided into two cohorts: TM group (39.1%) and non-TM group (60.9%). A propensity score was used to create 2,160 matched pairs in which the baseline covariates were well-balanced. There were significantly lower risks of all-cause mortality (HR 0.59 [0.51, 0.67], p < 0.001), CVD mortality (HR 0.59 [0.49, 0.70], p < 0.001), all-cause transfer to hemodialysis (0.57 [0.48, 0.67], p < 0.001), transfer to hemodialysis from PD-related infection (0.67 [0.51, 0.88], p = 0.003), severe fluid overload (0.40 [0.30, 0.55], p < 0.001), inadequate solute clearance (0.49 [0.26, 0.92], p = 0.026), and catheter-related noninfectious complications (0.41 [0.17, 0.97], p = 0.041) in the TM group compared with the non-TM group. CONCLUSION: This study indicated real-world associations between TM usage and reduction in patient survival and technique survival through a multicenter prospective cohort.

[The clinical efficacy and safety of modified Ponticelli regimen for treatment of idiopathic membranous nephropathy].

OBJECTIVE: To explore the clinical efficacy and safety of modified Ponticelli regimen in treating patients with idiopathic membranous nephropathy(IMN). METHODS: A retrospective analysis was performed in 90 patients with IMN (type Ⅰ/Ⅱ, 79/11 respectively) diagnosed by clinical data and renal biopsy. The patients were divided into modified Ponticelli group (n=23), steroid plus cyclophosphamide(CTX) (CTX group, n=39) and steroid plus cyclosporine A(CsA) (CsA group, n=28) according to the treatment. Liver function, renal function, serum lipid, proteinuria were recorded before and after treatment. Efficacy and adverse reactions were evaluated in three groups. RESULTS: (1)In all three groups, the quantity of proteinuria after treatment for 3 months [(3.33 ± 1.53) g/d, (4.70 ± 2.97) g/d, (3.92 ± 2.57) g/d], 6 months [(1.60 ± 1.10) g/d, (2.34 ± 1.61) g/d, (2.25 ± 1.78) g/d] was significantly decreased compared with baseline level[(7.26 ± 2.06) g/d, (7.50 ± 2.55) g/d, (7.54 ± 2.70) g/d; P<0.05]. Serum albumin levels at 3 months[(31.42 ± 3.86) g/d, (30.59 ± 5.79) g/d, (30.90 ± 7.87) g/d], 6 months [(36.25 ± 4.20) g/d, (34.70 ± 6.70) g/d, (35.36 ± 8.29) g/d] were significantly increased compared with baseline levels [(24.13 ± 2.61) g/d, (23.98 ± 3.79) g/d, (22.94 ± 4.57) g/d; P<0.05], whereas serum creatinine at 3 and 6 months had no significant changes (P>0.05). (2)After treatment for 3 months, partial remission rates in modified Ponticelli group, CTX group and CsA group were 39.1%, 35.9%, 35.7% respectively and complete remission rates were 8.7%, 5.1%, 10.7%, which were not statistically significant in all three groups (P>0.05). At 6 months, partial remission rates in three groups were 56.5%, 41.0%, 42.9% respectively and complete remission rates were 21.7%, 20.5%, 28.6%, which did not suggested significant difference in all three groups either (P>0.05). (3)In modified Ponticelli group, steroid diabetes, impaired liver dysfunction, infections and gastrointestinal adverse events occurred in 1, 1, 2 and 2 patients, respectively. In CTX group, steroid diabetes, infections and gastrointestinal adverse events occurred in 5, 8 and 2 patients, respectively. In CsA group, steroid diabetes and infections occurred in 1 and 3 patients, respectively. CONCLUSION: Modified Ponticelli regimen to treat patients with IMN has a trend of better outcome than classic CTX regimen. The efficacy is not inferior to CsA regimen with fewer side effects.

Association between serum potassium, risk and prognosis of peritonitis in peritoneal dialysis patients - results from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study.

BACKGROUND: Hypokalemia has been associated with an increased risk of peritoneal dialysis (PD)-associated peritonitis. However, hypokalemia is commonly associated with malnutrition, inflammation, and severe coexisting comorbidities, which thus are suspected of being potential confounders. This study was aimed at testing whether hypokalemia was independently associated with the occurrence and prognosis of PD-associated peritonitis. METHODS: A national-level dataset from the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study was used to explore the independent association of serum potassium with PD-associated peritonitis. Unmatched and propensity score-adjusted multivariate competing risk models, as well as univariate competing risk models following 1:1 propensity score matching, were conducted to balance potential biases between patients with and without hypokalemia. The association between potassium levels prior to peritonitis and treatment failure due to peritonitis was also investigated. RESULTS: During a median follow-up of 25.7 months in 7220 PD patients, there was a higher incidence of peritonitis in patients with serum potassium below 4.0 mmol/L compared to those with higher serum levels (677 [0.114/patient-year] vs. 914 [0.096/patient-year], P = 0.001). After adjusting for demographics, laboratory tests, residual renal function, and medication use, baseline potassium levels below 4.0 mmol/L were not linked to an increased risk of peritonitis, with a hazard ratio of 0.983 (95% CI 0.855-1.130, P = 0.810). This result remained consistent in both the propensity score adjusted multivariate competing risk regression (HR = 0.974, 95% CI 0.829-1.145, P = 0.750) and the univariate competing risk regression after 1:1 propensity score matching (Fine-Gray test, P = 0.218). The results were similar when analyzing patients with serum potassium level above or below 3.5 mmol/L. Lastly, hypokalemia before the occurrence of peritonitis was not independently associated with treatment failure. CONCLUSION: Hypokalemia was not found to be an independent risk factor for PD-associated peritonitis or treatment failure of peritonitis in China.

Macrophage Wnt7b is critical for kidney repair and regeneration.

Macrophages are required for tissue homeostasis through their role in regulation of the immune response and the resolution of injury. Here we show, using the kidney as a model, that the Wnt pathway ligand Wnt7b is produced by macrophages to stimulate repair and regeneration. When macrophages are inducibly ablated from the injured kidney, the canonical Wnt pathway response in kidney epithelial cells is reduced. Furthermore, when Wnt7b is somatically deleted in macrophages, repair of injury is greatly diminished. Finally, injection of the Wnt pathway regulator Dkk2 enhances the repair process and suggests a therapeutic option. Because Wnt7b is known to stimulate epithelial responses during kidney development, these findings suggest that macrophages are able to rapidly invade an injured tissue and reestablish a developmental program that is beneficial for repair and regeneration.

The Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study: Design and methods.

OBJECTIVES: The primary objective of the Peritoneal Dialysis Telemedicine-assisted Platform Cohort (PDTAP) Study is to explore potential predictors and their effects on patient survival, technique survival, and the occurrence of infectious and noninfectious complications. DESIGN: The PDTAP study is a national-level cohort study in China. A newly developed PD telemedicine application provided a unique and convenient way to collect multicenter, structured data across units. SETTING: The PDTAP study was underway in 27 hospitals from 14 provinces located at 7 geographical regions (northwest, northeast, north, central, southwest, southeast, and south) in China. PARTICIPANTS: Our study aims to enroll at least 7000 adult patients with end-stage renal disease receiving PD. METHODS: Approval has been obtained through the ethics committees of all hospitals. All participants signed the informed consent form after the center had received ethics board approval in accordance with the Declaration of Helsinki. MAIN OUTCOME MEASURES: Patient survival, technique survival, hospitalization, and the occurrence of infectious and noninfectious complications. CONCLUSIONS: The PDTAP study aims to explore potential predictors and their effects on patient survival, technique survival, and infectious and noninfectious complications using a newly developed PD telemedicine system to collect multicenter, structured data in real-world practice. Substantial and transformable findings in relation to PD practices were expected. This study also developed a national-level infrastructure for further collaboration and ancillary investigation.

Hypertension Control in Adults With CKD in China: Baseline Results From the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE).

BACKGROUND: Hypertension contributes to increased morbidity and mortality in the chronic kidney disease (CKD) population. Studies on blood pressure control in CKD patients in China are limited. In this study, we aimed to describe the status of blood pressure control in Chinese CKD patients based on the first national prospective CKD cohort data. METHODS: A subgroup of Chinese Cohort Study of Chronic Kidney Disease participants with hypertension at baseline was included in the present study. Uncontrolled blood pressure was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Defined daily doses (DDDs) are used as a standard measurement of drug utilization in this population. Factors associated with uncontrolled blood pressure were analyzed using multivariable logistic regression. RESULTS: There were 2,251 hypertensive CKD subjects among 2,873 predialysis CKD participants. The awareness, treatment, and control rates of hypertension were 80.7%, 95.6%, and 57.1%, respectively. Factors independently associated with uncontrolled blood pressure were overweight, obesity, albuminuria, decreased estimated glomerular filtration rate (eGFR), and diabetes. Over 50% of study subjects were prescribed 2 or more antihypertensive medications and only 7% were prescribed diuretics. Uncontrolled hypertensive patients were prescribed less antihypertensive medication than controlled hypertensives (DDD 1.3 [1.0-2.3] vs. 2.0 [1.0-3.1], P < 0.001). CONCLUSIONS: Hypertension control was suboptimal among hypertensive CKD patients in China, especially among those overweight or with obesity, albuminuria, lower eGFR, and diabetes. Patients with uncontrolled hypertension should undergo treatment regimen evaluation to select the appropriate dosage and type of antihypertensive medications.

[Roles of endogenous carbon monoxide in vasorelaxation disorder of femoral artery in diabetic rats].

OBJECTIVE: To explore the effects of CO on femoral vasorelaxation in diabetic rats. METHODS: Using isolated vascular ring tension detecting technique, cumulative relaxation responses of femoral arteries to 10(-8) - 10(-4) mol/L acetylcholine (ACh) were measured. The content of COHb in blood was detected. RESULTS: Diabetic animals expressed lower weight [(249.38+/-7.58) g] than control rats [(345.83+/-12.14) g , P<0.01]. The blood sugar levels in diabetic rats [(20.28+/-0.35) mmol/L] were significantly higher than that in control rats [(5.56+/-0.19) mmol/L]. In addition,diabetic animals demonstrated elevated blood pressure [(118.75+/-8.33) mm Hg] after 4 weeks, (132.43+/-10.98) mm Hg after 8 weeks, (139.0+/-10.41) mm Hg after 12 weeks compared with control (108.43+/-4.18) mm Hg, P<0.01, 1 mm Hg=0.133 kPa] in a time-dependent manner. The COHb content in the blood was decreased in 4 weeks [(1.50%+/-0.21%) vs (2.50%+/-0.61%)], and restored to normal in 8 weeks and 12 weeks in diabetic rats. The dose cumulative vasorelaxation-response to ACh in diabetic rats was diminished (63.46%+/-2.48% after 4 weeks; 69.76%+/-7.61% after 8 weeks; 49.37%+/-4.74% after 12 weeks compared with control 96.81%+/-3.15%). Treatment with hemin did not affect weight, blood sugar and blood pressure in diabetic rats, markedly increased the COHb content in the blood (3.20%+/-0.73%, P<0.01) and improved the vasorelaxation disturbance of femoral arteries (69.76%+/-7.60%, P<0.01) in diabetic rats. While administration with ZnPP-IX could inhibit the production of COHb (0.93%+/-0.35%), and worse the hypertension [(130.84+/- 8.56) mm Hg] and aggravate the vasorelaxation disturbance (37.70%+/-5.65%) vs diabetes (63.46%+/-2.48%) in diabetic rats. CONCLUSION: The results suggested that the decrease of blood CO in early stage of diabetic rats were related to the vasorelaxation disorder of femoral arteries, and that lead to hypertension in diabetic rats,which may be one of the important mechanisms of diabetes company hypertension.

[Clinical and histo-pathological characteristics of 2874 cases with chronic kidney diseases in Southern parts of Hebei province].

OBJECTIVE: The aim of this study was to analyze the characteristics of patients with chronic kidney disease (CKD) in Southern parts of Hebei province. METHODS: Records of 2874 CKD patients during January, 2008 to May, 2011 were retrospectively reviewed. Demographic, clinical and histo-pathological data were analyzed and compared to ones from the past five years. RESULTS: The age distribution of the groups was between 16 and 84 years old, with 62.39% of them between 20 and 50. All patients underwent renal biopsy that with primary glomerulonephritis occurring in 1966 cases (68.41%), secondary glomerulonephritis in 826 cases (28.74%). The frequently seen pathological patterns were IgA nephropathy (IgAN), membranous nephropathy (MN) and minimal change disease (MCD) in proper order in the former group while Henoch-Schonlein purpura nephritis (HSPN) and lupus nephritis (LN) were seen in the latter group. Comparing to data of the past five years, the incidence rates of MN, MCD and HBV-GN increased to 16.84%, 15.73% and 4.41% respectively, but all IgAN, HSPN and LN had respectively decreased to 24.70%, 5.50% and 6.65%. MN, IgAN, MCD were commonly appeared in histo-pathological patterns among patients over 50 years of age. CONCLUSION: IgAN was still the most commonly seen renal disease. Compared to data of the past five years, the incidence rates of MN, MCD and HBV-GN showed an increase at different levels. Epidemiological and pathological pattern of patients with CKD in Southern Hebei province had only mild changes over the last 3 years.