Validity and applicability of the global leadership initiative on malnutrition criteria in non-dialysis patients with chronic kidney disease.

Introduction: There are no standardized assessment criteria for selecting nutritional risk screening tools or indicators to assess reduced muscle mass (RMM) in the Global Leadership Initiative on Malnutrition (GLIM) criteria. We aimed to compare the consistency of different GLIM criteria with Subjective Global Assessment (SGA) and protein-energy wasting (PEW). Methods: In this study, nutritional risk screening 2002 first four questions (NRS-2002-4Q), Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Mini-Nutritional Assessment Short-Form (MNA-SF) tools were used as the first step of nutritional risk screening for the GLIM. The RMM is expressed using different metrics. The SGA and PEW were used to diagnose patients and classify them as malnourished and non-malnourished. Kappa (κ) tests were used to compare the concordance between the SGA, PEW, and GLIM of each combination of screening tools. Results: A total of 157 patients were included. Patients with Chronic kidney disease (CKD) stage 1-3 accounted for a large proportion (79.0%). The prevalence rates of malnutrition diagnosed using the SGA and PEW were 18.5% and 19.7%, respectively. The prevalence of GLIM-diagnosed malnutrition ranges from 5.1% to 37.6%, depending on the different screening methods for nutritional risk and the different indicators denoting RMM. The SGA was moderately consistent with the PEW (κ = 0.423, p < 0.001). The consistency among the GLIM, SGA, and PEW was generally low. Using the NRS-2002-4Q to screen for nutritional risk, GLIM had the best agreement with SGA and PEW when skeletal muscle index (SMI), fat-free mass index (FFMI), and hand grip strength (HGS) indicated a reduction in muscle mass (SGA: κ = 0.464, 95% CI 0.28-0.65; PEW: κ = 0.306, 95% CI 0.12-0.49). Conclusion: The concordance between the GLIM criteria and the SGA and PEW depended on the screening tool used in the GLIM process. The inclusion of RMM in the GLIM framework is important. The addition of HGS could further improve the performance of the GLIM standard compared to the use of body composition measurements.

Vaccinium as Potential Therapy for Diabetes and Microvascular Complications.

Diabetes mellitus is one of the most critical global health concerns, with a fast-growing prevalence. The incidence of diabetic vascular complications is also rapidly increasing, exacerbating the burden on individuals with diabetes and the consumption of public medical resources. Despite the overall improvements in the prevention, diagnosis, and treatment of diabetic microvascular complications in recent years, safe and effective alternative or adjunctive therapies are urgently needed. The mechanisms underlying diabetic vascular complications are complex, with hyperglycemia-induced oxidative stress and inflammation being the leading causes. Therefore, glycemic control, antioxidation, and anti-inflammation are considered the main targets for the treatment of diabetes and its vascular comorbidities. Vaccinium L. (Ericaceae) is a genus of plants enriched with polyphenolic compounds in their leaves and fruits. Vaccinium and its extracts have demonstrated good bioactivity in reducing blood glucose, oxidative stress, and inflammation, making them excellent candidates for the management of diabetes and diabetic vascular complications. Here, we review recent preclinical and clinical studies on the potential effect of Vaccinium on ameliorating diabetes and diabetic complications, particularly diabetic kidney disease and diabetic retinopathy.

Serum cystatin C is associated with peripheral artery stiffness in patients with type 2 diabetes mellitus combined with chronic kidney disease.

OBJECTIVE: Cystatin C (CysC) is associated with arterial stiffness. However, its suitability for evaluating patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) remains unclear. We aimed to investigate the relationship between CysC levels and peripheral arterial stiffness (PAS) in patients with T2DM combined with CKD. METHODS: Participants' arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV), and those with a baPWV ≥ 1800 cm/s were included in the PAS group. Additionally, patients were divided into young (18-44 years old), middle-aged (45-59 years old), and older (≥60 years old) groups. RESULTS: Of 200 patients, 94 (47%) were diagnosed with PAS. Multivariate logistic regression revealed that age, pulse pressure, and CysC levels (odds ratio = 1.525, 95% confidence interval: 1.072-2.168, P = 0.019) were independently correlated with PAS in patients with T2DM combined with CKD. The levels of CysC in different age groups were positively correlated with baPWV, and the correlation was significantly higher in the young group (r = 0.739, P < 0.001) than in the middle-aged (r = 0.329, P < 0.001) and older (r = 0.496, P < 0.001) groups. The multifactor linear regression analysis revealed that CysC was significantly correlated with baPWV in the young group (ß = 0.455, P = 0.002). CONCLUSION: CysC was an independent predictor of PAS in patients with T2DM combined with CKD and was more significantly associated with baPWV in young patients than in middle-aged and older patients. CysC may may be an early predictor of peripheral arteriosclerosis in patients with T2DM combined with CKD.

An Exploratory Study on a New Method for Nutritional Status Assessment in Patients with Chronic Kidney Disease.

Malnutrition is a risk factor for disease progression and poor prognosis in chronic kidney disease (CKD). However, the complexity of nutritional status assessment limits its clinical application. This study explored a new method of nutritional assessment in CKD (stage 1-5) patients using the Subjective Global Assessment (SGA) as the gold standard and evaluated its applicability. The kappa test was used to analyze the consistency of the Renal Inpatient Nutrition Screening Tool (Renal iNUT) with SGA and protein-energy wasting. Logistic regression analysis was used to analyze the risk factors of CKD malnutrition and calculate the prediction probability of multiple indicators combined for the diagnosis of CKD malnutrition. The receiver operating characteristic curve of the prediction probability was drawn to evaluate its diagnostic efficiency. A total of 161 CKD patients were included in this study. The prevalence of malnutrition according to SGA was 19.9%. The results showed that Renal iNUT had a moderate consistency with SGA and a general consistency with protein-energy wasting. Age > 60 years (odds ratio, OR = 6.78), neutrophil-lymphocyte ratio > 2.62 (OR = 3.862), transferrin < 200 mg/dL (OR = 4.222), phase angle < 4.5° (OR = 7.478), and body fat percentage < 10% (OR = 19.119) were risk factors for malnutrition in patients with CKD. The area under the receiver operating characteristic curve of multiple indicators for the diagnosis of CKD malnutrition was 0.89 (95% confidence interval: 0.834-0.946, p < 0.001). This study demonstrated that Renal iNUT has good specificity as a new tool for the nutrition screening of CKD patients, but its sensitivity needs to be optimized. Advanced age, high neutrophil-lymphocyte ratio, low transferrin level, low phase angle, and low body fat percentage are risk factors for malnutrition in patients with CKD. The combination of the above indicators has high diagnostic efficiency in the diagnosis of CKD malnutrition, which may be an objective, simple, and reliable method to evaluate the nutritional status of patients with CKD.

Clinical Factors Associated with Arterial Stiffness in Chronic Kidney Disease.

BACKGROUND: Arterial stiffness influences the prognosis of patients with end-stage kidney disease; however, the factors that promote arterial stiffness in chronic kidney disease (CKD) patients remain unknown. We aimed to explore the clinical factors associated with arterial stiffness in CKD. METHODS: Between September 2017 and September 2022, all CKD patients treated at the Department of Nephrology, General Hospital of the Chinese People's Liberation Army, excluding dialysis patients, were screened and their medical records within the last month were collected. Arterial stiffness was measured by the augmentation index (AIx). The correlative clinical factors with arterial stiffness were explored in different linear regression models. RESULTS: 559 patients were included in the study. AIx@75 increased as the deterioration of CKDG1-CKDG5, with values of 1 (-9, 11), 5.5 (-4, 13.25), 9 (0, 16), 12 (1.5, 23.5), and 22 (13, 28), respectively (Z = 63.03, p < 0.001). Multivariate linear regression analysis showed that AIx@75 was positively associated with female sex (ß = 8.926, 95% confidence interval (CI) 6.291, 11.562, p < 0.001), age (ß = 0. 485, 95% CI 0.39, 0.58, p < 0.001), mean arterial pressure (MAP) (ß = 0.255, 95% CI 0.159, 0.35, p < 0.001), and was negatively associated with ACEI/ARB (ß = -4.466, 95% CI -6.963, -1.969, p < 0.001) and glucocorticoid (ß = -3.163, 95% CI -6.143, -0.183, p = 0.038). Smoking, eGFR, hemoglobin, and cause of disease were associated with AIx@75 in multivariate linear regression models when considering factors partly. CONCLUSIONS: Female, age, smoking, MAP, eGFR, cause of disease, ACEI/ARB, and glucocorticoid were found to be associated with atherosclerosis in CKD patients.

Status and Trends of the Association Between Diabetic Nephropathy and Diabetic Retinopathy From 2000 to 2021: Bibliometric and Visual Analysis.

Background: Diabetic nephropathy (DN) and diabetic retinopathy (DR) are microvascular complications of diabetes that share a similar pathogenesis and clinical relevance. The study aimed to visually analyze the research status and development trend of the relationship between DN and DR by means of bibliometrics and knowledge mapping. Methods: Publications were collected from the Science Citation Index-Expanded of the Web of Science Core Collection between 2000 and 2021. CiteSpace, Alluvial Generator, and Microsoft Excel were used to analyze and present the data. Results: A total of 3,348 publications were retrieved and 3,285 were included in the analysis after deduplication. The publications demonstrated an annually increasing trend. The results of the collaborative network analysis showed that the United States, Steno Diabetes Center, and Tien Y. Wong were the most influential country, institution and author, in this field of research, respectively. The analysis of references and keywords showed that the pathogenesis of DN and DR and their relationship with cardiovascular disease are research hotspots. The clinical relevance and drug therapy for DN and DR will become frontiers of future research in this field. Conclusion: This study is the first to visualize the correlation between DN and DR using a bibliometric approach. This study provides a reference of research trends for scholars.

Optimal Obesity- and Lipid-Related Indices for Predicting Metabolic Syndrome in Chronic Kidney Disease Patients with and without Type 2 Diabetes Mellitus in China.

Existing obesity- and lipid-related indices are inconsistent with metabolic syndrome (MetS) in chronic kidney disease (CKD) patients. We compared seven indicators, including waist circumference (WC), body mass index (BMI), visceral fat area (VFA), subcutaneous fat area (SFA), visceral adiposity index (VAI), Chinese VAI and lipid accumulation product (LAP), to evaluate their ability to predict MetS in CKD patients with and without Type 2 diabetes mellitus (T2DM) under various criteria. Multivariate logistic regression analysis was used to investigate the independent associations between the indices and metabolic syndrome among 547 non-dialysis CKD patients, aged ≥18 years. The predictive power of these indices was assessed using receiver operating characteristic (ROC) curve analysis. After adjusting for potential confounders, the correlation between VAI and MetS was strongest based on the optimal cut-off value of 1.51 (sensitivity 86.84%, specificity 91.18%) and 2.35 (sensitivity 83.54%, specificity 86.08%), with OR values of 40.585 (8.683-189.695) and 5.076 (1.247-20.657) for males and females with CKD and T2DM. In CKD patients without T2DM, based on the optimal cut-off values of 1.806 (sensitivity 98.11%, specificity 72.73%) and 3.11 (sensitivity 84.62%, specificity 83.82%), the OR values were 7.514 (3.757-15.027) and 3.008 (1.789-5.056) for males and females, respectively. The area under ROC curve (AUC) and Youden index of VAI were the highest among the seven indexes, indicating its superiority in predicting MetS in both male and female CKD patients, especially those with T2DM.

Photosynthesis and Growth of Pennisetum centrasiaticum (C4) is Superior to Calamagrostis pseudophragmites (C3) During Drought and Recovery.

Global warming and changes in rainfall patterns may put many ecosystems at risk of drought. These stressors could be particularly destructive in arid systems where species are already water-limited. Understanding plant responses in terms of photosynthesis and growth to drought and rewatering is essential for predicting ecosystem-level responses to climate change. Different drought responses of C3 and C4 species could have important ecological implications affecting interspecific competition and distribution of plant communities in the future. For this study, C4 plant Pennisetum centrasiaticum and C3 plant Calamagrostis pseudophragmites were subjected to progressive drought and subsequent rewatering in order to better understand their differential responses to regional climate changes. We tracked responses in gas exchange, chlorophyll fluorescence, biomass as well as soil water status in order to investigate the ecophysiological responses of these two plant functional types. Similar patterns of photosynthetic regulations were observed during drought and rewatering for both psammophytes. They experienced stomatal restriction and nonstomatal restriction successively during drought. Photosynthetic performance recovered to the levels in well-watered plants after rewatering for 6-8 days. The C4 plant, P. centrasiaticum, exhibited the classic CO2-concentrating mechanism and more efficient thermal dissipation in the leaves, which confers more efficient CO2 assimilation and water use efficiency, alleviating drought stress, maintaining their photosynthetic advantage until water deficits became severe and quicker recovery after rewatering. In addition, P. centrasiaticum can allocate a greater proportion of root biomass in case of adequate water supply and a greater proportion of above-ground biomass in case of drought stress. This physiological adaptability and morphological adjustment underline the capacity of C4 plant P. centrasiaticum to withstand drought more efficiently and recover upon rewatering more quickly than C. pseudophragmites and dominate in the Horqin Sandy Land.

Effects of Nitrogen Addition and Reproductive Effort on Nutrient Resorption of a Sand-Fixing Shrub.

Caragana microphylla is a sand-fixing leguminous shrub with strong resistance to drought, cold, and low soil fertility. As a result, it plays an essential role in combating desertification in northern China, but little is known about its nutrient budget. Nutrient resorption is a key process in plant nutrient conservation and has marked ecological implications for plant fitness and ecosystem nutrient cycling. We studied the effects of both nitrogen (N) addition and reproductive effort on leaf N resorption of C. microphylla in a temperate semi-arid sandy land in China. The results showed that sprouting of the early leaves from over-wintered buds employs a strategy for slow returns on nutrient investment with smaller specific leaf area (SLA) and higher N resorption efficiency, whereas the late leaves, which sprout from current-year buds, employ a strategy for quick returns on nutrient investment with higher SLA and lower N resorption efficiency. N addition significantly increased the N resorption efficiency from early leaves while exerting no impact on late leaves, suggesting that the increased N recovery from early leaves is done to sustain the high N demands of late leaves. Reproductive effort did not affect the N resorption from early or late leaves due to the temporal separation between fruit production and leaf senescence. Taken together, our results demonstrate that C. microphylla has evolved different investment strategies for leaf N in early and late leaves to conserve nutrients and facilitate its growth in desertified environments.

Community carbon and water exchange responses to warming and precipitation enhancement in sandy grassland along a restoration gradient.

Temperature increasing and precipitation alteration are predicted to occur in arid and semiarid lands; however, the response mechanism of carbon and water exchange at community level is still unclear in semiarid sandy land. We investigated the responses of carbon and water exchanges to warming and precipitation enhancement along a sand dune restoration gradient: mobile sand dunes (MD), semifixed sand dunes (SFD), and fixed sand dunes (FD). The average net ecosystem productivity (NEP) and evapotranspiration (ET) between May and August increased by 98% and 59%, respectively, from MD to SFD, while they had no significant differences between FD and the other two habitats. Warming inhibited ecosystem NEP, ET, and water use efficiency (WUE) by 69%, 49% (p < .001), and 80%, respectively, in SFD, while it nearly had no significant effects in MD and FD. However, precipitation addition by 30% nearly had no significant effects on community NEP, ET, and WUE, except for warming treatment in FD. In general, precipitation addition of 30% may still not be enough to prevent drought stress for growth of plants, due to with low water holding capacity and high evaporation rates in sandy land. Temperature increase magnified drought stress as it increased evapotranspiration rates especially in summer. In addition, community NEP, ET, and WUE were usually influenced by interactions between habitats and temperature, as well as the interactions among habitats, temperature, and precipitation. Species differences in each habitat along the restoration gradient may alter climate sensitivity of sandy land. These results will support in understanding and the prediction of the impacts of warming and precipitation change in semiarid sandy grassland.

Growth and Physiology of Two Psammophytes to Precipitation Manipulation in Horqin Sandy Land, Eastern China.

The availability of water is the critical factor driving plant growth, physiological responses, population and community succession in arid and semiarid regions, thus a precipitation addition-reduction platform with five experimental treatments, was established to explore the growth and physiology of two psammophytes (also known as psammophiles) to precipitation manipulation in Horqin Sandy Land. Changes in coverage and density were measured, and antioxidant enzymes and osmoregulatory substances in both of the studied species were determined. Investigation results showed that the average vegetation coverage increased with an increasing precipitation, and reached a maximum in July. Under the -60% precipitation treatment, Tribulus terrestris accounted for a large proportion of the area, but Bassia dasyphylla was the dominant species in the +60% treatment. T. terrestris was found to have higher a drought stress resistance than B. dasyphylla. From days 4 to 7 after rainfall, B. dasyphylla under precipitation reduction showed obvious water stress. The malondialdehyde (MDA) content of B. dasyphylla was higher than that of T. terrestris, but that of B. dasyphylla had the lower relative water content (RWC). The MDA content in the precipitation reduction treatments of the two studied species was higher than that in the precipitation addition treatments from days 4 to 10. Peroxidase (POD) and superoxide dismutase (SOD) activity and the soluble proteins and free proline content of T. terrestris were higher than those of B. dasyphylla. The free proline content of T. terrestris and B. dasyphylla increased with increasing drought stress. Our data illustrated that T. terrestris had a higher drought stress resistance than B. dasyphylla, which was correlated with the augmentation of some antioxidant enzymes and osmoregulatory substance. The adaptive mechanism provides solid physiological support for an understanding of psammophyte adaptation to drought stress, and of community succession or species manipulation for desertified land restoration.

[Challenge to the desertification reversion in Horqin Sandy Land].

Analyses of the changes in desertified land area, water resource availability, land use, and plant productivity in Horqin Sandy Land in recent 50 years showed that from 1950 to the late 1980s, the land desertification in Horqin Sandy Land had a rapid expansion, but reversed since then. The annual runoff of Xiliaohe River decreased consistently, and in 1999, the middle reach at Tongliao section was dried up. In recent 20 years, the water table of Xihu Lake was decreased by about 10 m, and dried up in 2001. The above-ground biomass of grasslands decreased from 520 g x m(-2) in 1937 to 197 g x m(-2) in 2005. The main cause of these results was the change of land use pattern, i. e., the overuse of water resources for re-vegetation or cropland irrigation. Water resources reduction was the major challenge to the desertification reversion in Horqin Sandy Land.

[Spatial heterogeneity of soil organic carbon and total nitrogen of sandy grassland in the restoration of degraded vegetation in Horqin Sandy Land, northern China].

Based on the field investigation and lab analysis, we used geostatistics method to examine the spatial heterogeneity of soil organic carbon and total nitrogen in a 0-year fenced mobile dune (MD11), an 11-year fenced mobile dune (MD11) and a 20-year fenced mobile dune (MD20) in Horqin Sandy Land. The results showed that the average values of vegetation cover, species number and diversity, soil organic carbon and total nitrogen (0-20 cm) contents increased with the increase in fenced age of mobile dunes. Geostatistical analysis showed that the proportions of relative structural variance C/(C0 + C) of soil organic carbon and total nitrogen in each dune were over 65% , which suggested that they had obvious spatial autocorrelation. Calculated ranges of spatial autocorrelation for soil organic carbon and total nitrogen were 58.39 m and 91.00 m (MDO), 28.59 m and 23.61 m (MD11) and 63.31 m and 61.05 m (MD20), respectively. The analysis from semivariance calculated parameters and spatial distributed maps showed that the spatial heterogeneity of soil organic carbon and total nitrogen firstly increased from MDO to MD11 then decreased from MD11 to MD20. Correlation analysis indicated that there were significantly positive correlations among vegetation cover, species richness and diversity index, soil organic carbon and total nitrogen (p < 0.01) . The analyzed results indicate that the spatial distributions of soil organic carbon and total nitrogen are most strongly related the topography features and vegetation changes in sand dune ecosystems prone to wind erosion. The accumulation and spatial haterogeniety of soil organic carbon and total nitrogen in the restoration of dune degraded vegetation are greatly affected by vegetation restoration succession.

[Responses of Agriophyllum squarrosum phenotypic plasticity to the changes of soil nutrient and moisture contents and population density].

This paper studied the phenotypic plasticity of Agriophyllum squarrosum under effects of soil nutrient and moisture contents and population density. The results showed that with the increase of soil nutrient content, the root/shoot ratio of A. squarrosum was decreased from 0.135 to 0.073. However, soil moisture content and population density had less effect on the root/shoot ratio. The plasticity of reproductive allocation of A. squarrosum as responding to the changes of soil nutrient and moisture contents was a "real plasticity", and the allocation was negatively correlated with soil nutrient content but positively correlated with soil moisture content. When soil nutrient content was high or moisture content was low, the reproductive allocation of A. squarrosum changed larger with plant size. Population density had no effects on the reproductive allocation, while plant size conditioned the allocation. Among the three test affecting factors, soil nutrient content had the greatest effects on the morphological characters and biomass of A. squarrosum.