Association between systemic immune inflammation Index and all-cause mortality in incident peritoneal dialysis-treated CKD patients: a multi-center retrospective cohort study.

BACKGROUND: Chronic inflammatory disorders in peritoneal dialysis (PD) contribute to the adverse clinical outcome. Systemic immune inflammation index (SII) is the novel and convenient measurement that is positively associated with various diseases. However, scarce is known regarding the association between SII with all-cause mortality among PD patients. METHODS: In this multi-center retrospective cohort study, 1,677 incident patients with PD were enrolled. Eligible patients were stratified into groups based on SII level: tertile 1(< 456.76), tertile 2(456.76 to 819.03), and tertile 3(> 819.03). The primary endpoint was the all-cause mortality. Both Cox regression analysis and competing risk models were used to examine the association between SII and all-cause mortality. Subgroup analysis was performed to assess the influence of the SII tertiles on all-cause mortality in different subgroups. RESULTS: During the follow-up period of 30.5 ± 20.0 months, 26.0% (437/1,677) patients died, of whom the SII tertile 3 group accounted for 39.1% (171/437) of the deaths. Patients in the SII tertile 3 group had a higher all-cause mortality rate than patients in the SII tertile 1 and 2 groups (log-rank = 13.037, P < 0.001). The SII tertile 3 group was significantly associated with 80% greater risk (95% confidence interval:1.13 to 2.85; P = 0.013) compared with the SII tertile 1 group in multivariable Cox regression analysis. The competing risk model also indicated that the relationship between SII tertiles and all-cause mortality remains (subdistribution hazard ratio: 1.86; 95% confidence interval: 1.15 to 2.02, P = 0.011). Furthermore, the relationship between the log-transformed SII and all-cause mortality in patients with PD was nearly linear (P = 0.124). CONCLUSION: A close relationship was observed between the SII and all-cause mortality in patients undergoing PD, suggesting that more attention should be paid to the SII, which is a convenient and effective measurement in clinical practice.

The association between blood nickel level and handgrip strength in patients undergoing maintenance hemodialysis.

BACKGROUND: Progressive loss of peripheral muscle strength is highly pronounced in patients receiving maintenance hemodialysis (MHD), of which the pathological mechanism tends to be multifactorial. Plasma nickel was reportedly correlated with muscular strength in non-dialysis patients. However, scarce is known regarding the association between blood nickel level and handgrip strength among the patients undergoing MHD. METHODS: This cross-sectional study included patients undergoing MHD at our center in October 2021. Blood samples were collected before the hemodialysis sessions. Nickel level was measured using inductively coupled plasma mass spectrometry. Eligible patients were stratified into three groups by the blood nickel level: tertile 1 (≥ 5.2 ug/L); tertile 2 (< 5.2 ug/L and ≥ 4.5 ug/L); and tertile 3 (< 4.5 ug/L). Handgrip strength measurement was used to evaluate the muscle status. Spearman's analyses and multivariable linear regression analyses were performed to study the relationship between blood nickel level and handgrip strength. RESULTS: A total of 236 patients were enrolled, with an average age of 55.51 ± 14.27 years and a median dialysis vintage of 83 (IQR: 48-125) months. Patients in group with a higher blood nickel level (tertile 1) tended to be female, had longer dialysis vintage and higher Kt/V, but lower BMI, serum creatinine, hemoglobin, and handgrip strength level (all p < 0.05). After adjustment for confounding factors in multivariable models, for every 1ug/L increase in nickel level, the patient's handgrip strength decreases by 2.81 kg (ß: - 2.810, 95% confidence interval: - 5.036 to - 0.584, p = 0.014). Restricted cubic spline confirmed the relationship was nearly linear. CONCLUSIONS: Our study highlighted that blood nickel level was related to handgrip strength in patients undergoing MHD. Prospective studies with larger sample sizes are still needed to confirm the result.

Activating the MnS0.5Se0.5 Microspheres as High-Performance Cathode Materials for Aqueous Zinc-Ion Batteries: Insight into In Situ Electrooxidation Behavior and Energy Storage Mechanisms.

Manganese-based materials are regarded as the most prospective cathode materials because of their high natural abundance, low toxicity, and high specific capacity. Nevertheless, the low conductivity, poor cycling performance, and controversial energy storage mechanisms hinder their practical application. Here, the MnS0.5Se0.5 microspheres are synthesized by a two-step hydrothermal approach and employed as cathode materials for aqueous zinc-ion batteries (AZIBs) for the first time. Interestingly, in-depth ex situ tests and electrochemical kinetic analyses reveal that MnS0.5Se0.5 is first irreversibly converted into low-crystallinity ZnMnO3 and MnOx by in situ electrooxidation (MnS0.5Se0.5-EOP) during the first charging process, and then a reversible co-insertion/extraction of H+/Zn2+ occurs in the as-obtained MnS0.5Se0.5-EOP electrode during the subsequent discharging and charging processes. Benefiting from the increased surface area, shortened ion transport path, and stable lamellar microsphere structure, the MnS0.5Se0.5-EOP electrodes deliver high reversible capacity (272.8 mAh g-1 at 0.1 A g-1), excellent rate capability (91.8 mAh g-1 at 2 A g-1), and satisfactory cyclic stability (82.1% capacity retention after 500 cycles at 1 A g-1). This study not only provides a powerful impetus for developing new types of manganese-based chalcogenides, but also puts forward a novel perspective for exploring the intrinsic mechanisms of in situ electrooxidation behavior.

Atherogenic index predicts all-cause and cardiovascular mortality in incident peritoneal dialysis patients.

BACKGROUND AND AIMS: Atherosclerosis, the main cause of cardiovascular disease (CVD), is prevalent in patients undergoing peritoneal dialysis (PD). Atherogenic index (AI) is a strong predictor of atherosclerosis. However, its prognostic value in CVD outcomes and all-cause mortality among patients undergoing PD remains uncertain. Therefore, we aimed to evaluate the association between AI and all-cause and CVD mortality in PD patients. METHODS: Calculated based on lipid profiles obtained through standard laboratory procedures, AI was evaluated in 2682 patients who underwent PD therapy between January 2006 and December 2017 and were followed up until December 2018. The study population was divided into four groups according to the quartile distribution of AI (Q1: <2.20, Q2: 2.20 to <2.97, Q3: 2.97 to <4.04, and Q4: ≥4.04). Multivariable Cox models were employed to explore the associations between AI and CVD and all-cause mortality was evaluated. RESULTS: During a median follow-up of 35.5 months (interquartile range, 20.9-57.2 months), 800 patients died, including 416 deaths from CVD. Restricted cubic splines showed non-linear relationship between AI and adverse clinical outcomes. The risks of all-cause and CVD mortality gradually increased across quartiles (log-rank, p < 0.001). After adjusting for potential confounders, the highest quartile (Q4) showed significantly elevated hazard ratio (HR) for both all-cause mortality (HR 1.54 [95% confidence interval (CI), 1.21-1.96]) and CVD mortality risk (HR 1.78 [95% CI, 1.26-2.52]), compared to the lowest quartile (Q1). CONCLUSIONS: AI was independently associated with all-cause and CVD mortality in patients undergoing PD, suggesting that AI might be a useful prognostic marker.

Combined influence of depression and low-grade inflammation on mortality in peritoneal dialysis patients.

BACKGROUND: The relationship between depression and systemic inflammation as risk factors for mortality is not well understood and requires further investigation. METHODS: Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) between July 01, 2015 to December 31, 2019, were analyzed and followed up until December 31, 2020. According to their status of depression (PHQ-9 score ≥ 5) and low-grade inflammation (hs-CRP level ≥ 3 mg/L), patients were divided into four groups (G1, without depression, nor inflammation; G2, with depression, without inflammation; G3, with inflammation, without depression; G4, with both depression and inflammation). We performed Kaplan-Meier and multivariable Cox proportional analyses of mortality for the combined influence of depression and systemic inflammation in this cohort. RESULTS: During the mean follow-up of 36.3 ± 14.8 months, 73 deaths were recorded in 358 participants. Compared with patients in group G1, patients in group G2 and G3 carried 137% {hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.06-5.23, p = 0.035} and 140% (HR: 2.40, 95% CI: 1.01-5.69, p = 0.048) higher risk of mortality. Patients in group G4 (with both depression and inflammation) showed the highest risks of all-cause mortality with 276% higher mortality risk (HR: 3.76, 95% CI: 1.73-8.15, p = 0.001), respectively. CONCLUSION: The combined of depression and inflammation is associated with all-cause mortality in peritoneal dialysis patients, suggesting a need for further study of depression and low-grade inflammation in PD patients and potential relationship between them.

Clinical significance of serum glucose to lymphocyte ratio as a prognostic marker in peritoneal dialysis patients.

BACKGROUND: The glucose-to-lymphocyte ratio (GLR), a glucose metabolism and systemic inflammatory response parameter, is associated with an adverse prognosis for various diseases. However, the association between serum GLR and prognosis in patients undergoing peritoneal dialysis (PD) is poorly understood. METHODS: In this multi-center cohort study, 3236 PD patients were consecutively enrolled between 1 January 2009 and 31 December 2018. Patients were divided into four groups according to the quartiles of baseline GLR levels (Q1: GLR ≤ 2.91, Q2:2.91 < GLR ≤ 3.91, Q3:3.91 < GLR < 5.59 and Q4: GLR ≥ 5.59). The primary endpoint was all-cause and cardiovascular disease (CVD) related mortality. The correlation between GLR and mortality was examined using Kaplan-Meier and multivariable Cox proportional analyses. RESULTS: During the follow-up period of 45.93 ± 29.01 months, 25.53% (826/3236) patients died, of whom 31% (254/826) were in Q4 (GLR ≥ 5.59). Multivariable analysis revealed that GLR was significantly associated with all-cause mortality (adjusted HR 1.02; CI 1.00 ∼ 1.04, p = .019) and CVD mortality (adjusted HR 1.02; CI 1.00 ∼ 1.04, p = .04). Compared with the Q1 (GLR ≤ 2.91), placement in Q4 was associated with an increased risk of all-cause mortality (adjusted HR: 1.26, 95% CI: 1.02 ∼ 1.56, p = .03) and CVD mortality (adjusted HR 1.76; CI 1.31 ∼ 2.38, p < .001). A nonlinear relationship was found between GLR and all-cause or CVD mortality in patients undergoing PD (p = .032). CONCLUSION: A higher serum GLR level is an independent prognostic factor for all-cause and CVD mortality in patients undergoing PD, suggesting that more attention should be paid to GLR.

Remnant cholesterol as a risk factor for all-cause and cardiovascular mortality in incident peritoneal dialysis patients.

BACKGROUND AND AIMS: Remnant cholesterol (RC) adversely contributes to cardiovascular disease (CVD) and overall survival in various diseases. However, its role in CVD outcomes and all-cause mortality in patients undergoing peritoneal dialysis (PD) is limited. Therefore, we aimed to investigate the association between RC and all-cause and CVD mortality in patients undergoing PD. METHODS AND RESULTS: Based on lipid profiles recorded using standard laboratory procedures, fasting RC levels were calculated in 2710 incident patients undergoing PD who were enrolled between January 2006 and December 2017 and followed up until December 2018. Patients were divided into four groups according to the quartile distribution of baseline RC levels (Q1: <0.40 mmol/L, Q2: 0.40 to <0.64 mmol/L, Q3: 0.64 to <1.03 mmol/L, and Q4: ≥1.03 mmol/L). Associations between RC and CVD and all-cause mortality were evaluated using multivariable Cox models. During the median follow-up period of 35.4 months (interquartile range, 20.9-57.2 months), 820 deaths were recorded, of which 438 were CVD-related. Smoothing plots showed non-linear relationships between RC and adverse outcomes. The risks of all-cause and CVD mortality increased progressively through the quartiles (log-rank, p < 0.001). Using adjusted proportional hazard models, a comparison of the highest (Q4) to lowest (Q1) quartiles revealed significant increases in the hazard ratio (HR) for all-cause mortality (HR 1.95 [95% confidence interval (CI), 1.51-2.51]) and CVD mortality risk (HR 2.60 [95% CI, 1.80-3.75]). CONCLUSION: An increased RC level was independently associated with all-cause and CVD mortality in patients undergoing PD, suggesting that RC was important clinically and required further research.

Association of a low ankle brachial index with progression to end-stage kidney disease in patients with advanced-stage diabetic kidney disease.

INTRODUCTIONS: The effect of a low ankle-brachial index (ABI) in patients with advanced-stage diabetic kidney disease is not fully understood. This study investigates the prevalence of a low ABI in patients with advanced-stage diabetic kidney disease, which was defined as a urinary albumin-to-creatinine ratio (UACR) ≥300 mg/g and an estimated glomerular filtration rate (eGFR) between 15-60 mL/min/1.73 m2. Furthermore, the association between a low ABI and end-stage kidney disease (ESKD) was determined. METHODS: This single-center, retrospective, cohort study included 529 patients with advanced-stage diabetic kidney disease who were stratified into groups according to the ABI: high (>1.3), normal (0.9-1.3), and low (<0.9). The Kaplan-Meier method and Cox proportional analysis were used to examine the association between the ABI and ESKD. RESULTS: A total of 42.5% of patients with a low ABI progressed to ESKD. A low ABI was associated with a greater risk of ESKD (hazard ratio (HR): 1.073). After adjusting for traditional chronic kidney disease risk factors, a low ABI remained associated with a greater risk of ESKD (HR: 1.758; 95% confidence interval: 1.243-2.487; p = 0.001). CONCLUSIONS: These results indicate that patients with a low ABI should be monitored carefully. Furthermore, preventive therapy should be considered to improve the long-term kidney survival of patients with residual kidney function.

Association between the blood manganese (Mn) and hemoglobin in patients undergoing maintenance hemodialysis.

BACKGROUND AND AIMS: Manganese (Mn) and iron metabolism are closely related. Iron metabolism disorders often lead to anemia in patients undergoing maintenance hemodialysis (MHD). Here, we aimed to investigate the relationship between blood Mn and hemoglobin (Hb) in patients undergoing MHD. METHODS: Patients undergoing MHD in September 2019 were included in a cross-sectional study. Clinical and demographic data and blood samples were collected before hemodialysis sessions, and blood levels of Mn were measured by inductively coupled plasma mass spectrometry. Both multivariable linear and binary logistic regression analyses were performed to study the relationship between the blood Mn and Hb. RESULTS: A total of 144 patients undergoing MHD were enrolled in the study. The patients had a mean age of 64.33 ± 13.39 years, median vintage of 33.50 (16.25-57.50) months. Among them, 66 were females (45.8%). The median blood Mn level was 13.55 µg/L (IQR:9.92-17.48). Ninety-nine patients were anemic (68.8%). The mean Hb level was 99.83 ± 19.68 g/L. The patient group with high blood Mn had a high proportion of females, and these patients had high levels of RBC, hemoglobin, Hct, UIBC, serum TCHOL, and serum LDL, yet short dialysis vintage, low prevalence of anemia, low levels of serum ferritin, serum iron, and TSAT. Following adjustment for confounding factors, we found that low blood Mn level was independently associated with lower Hb level and anemia in patients undergoing MHD by multivariate linear and multivariate binary logistic regression, respectively, in different models. CONCLUSION: Whilst our study showed that high levels of blood Mn were independently associated with high hemoglobin in patients undergoing MHD, further multicenter studies with large sample sizes are still required.

High Blood Cu/Zn Ratio is Associated with Nutritional Risk in Patients Undergoing Maintenance Hemodialysis.

Patients undergoing maintenance hemodialysis (MHD) are at risk of an imbalance of copper and zinc homeostasis. We hypothesized that there is an association between the blood copper-zinc (Cu/Zn) ratio and nutritional status in these patients. For this cross-sectional study, blood samples were collected from patients undergoing MHD at Guangzhou Red Cross Hospital in September 2019. Zinc and copper levels were measured using inductively coupled plasma mass spectrometry. The seven-point subjective global assessment (SGA), nutritional risk screening 2002 (NRS2002), and geriatric nutritional risk index (GNRI) were used to evaluate the overall nutritional status. We enrolled 144 MHD patients (men:women = 78:66), with an average age of 64.33 ± 13.39 years and a median dialysis vintage of 33.50 (16.25-57.50) months. Patients with a higher blood Cu/Zn ratio had lower levels of hemoglobin, blood zinc, serum prealbumin, albumin, and creatinine as well as low SGA and GNRI scores, but higher modified Charlson comorbidity index score, serum C-reactive protein level, interleukin-6 level, blood copper level, and NRS2002 score (all p < 0.05). After adjustment for confounding factors in multivariable models, a high blood Cu/Zn ratio was independently associated with nutritional risk defined by all nutritional parameters (SGA, NRS2002, and GNRI). Prospective studies with larger sample sizes are warranted to confirm these results.

Levels of trace blood elements associated with severe sleep disturbance in maintenance hemodialysis patients.

PURPOSE: Sleep disturbance is frequently observed in patients on maintenance hemodialysis (MHD), and this population usually presents imbalances in trace elements. We investigated the association between blood trace element levels and sleep quality in patients on MHD. METHODS: This cross-sectional and single-center study was performed in September 2019. Patients regularly undergoing hemodialysis for > 3 months at our center were recruited, and demographic, clinical, and laboratory parameters were recorded. The Pittsburgh Sleep Quality Index (PSQI) was applied to define sleep disturbance. Blood trace element (zinc, manganese, copper, selenium, and lead) levels were measured using an inductively coupled plasma mass spectrometer. RESULTS: In total, 121 patients on MHD (male/female = 68:53) were enrolled in the study (mean age 63.7 ± 13.9 years, median dialysis vintage 38.0 [20.0, 60.0] months). According to PSQI, 56 (46%) patients experienced severe sleep disturbance. These patients were characterized by older age, higher serum parathyroid hormone levels, and lower blood selenium levels (all P < 0.05). No significant differences in blood zinc, manganese, copper, and lead levels were observed between groups. Univariate binary logistic regression showed that lower blood selenium levels were associated with severe sleep disturbance (odds ratio = 0.976, 95% confidence interval: 0.954-0.999, P = 0.038). Multivariate analyses also confirmed the results after adjusting for confounding factors. CONCLUSION: Our study indicated an association between lower blood selenium levels and the occurrence of severe sleep disturbances in patients on MHD. However, a prospective study with a larger sample size and assessing the importance of selenium supplementation are needed to confirm the results.