The Investigation of Kidney Involvement in 430 Hospitalized Patients with Omicron COVID-19 in Tianjin, China.

INTRODUCTION: This study evaluated the incidence, clinical characteristics, and risk factors of kidney involvement in patients with the Omicron variant infection in the post-acute treatment phase in Tianjin, China. METHODS: Data were collected from 430 patients with Omicron variant infection in Tianjin, China. Demographics, comorbidities, laboratory blood tests, urinalysis, vaccination status, and COVID-19 clinical classification were assessed. Patients were grouped based on kidney involvement, and associated risk factors of kidney involvement were also investigated. RESULTS: Asymptomatic, mild, ordinary, and severe patients with Omicron COVID-19 variant comprised 1.5%, 49.1%, 48.9%, and 0.5% of the sample population, respectively, without critical illness or death. The incidences of hematuria, proteinuria, and concurrent hematuria and proteinuria were 14.7%, 14.2%, and 5.1%, respectively. Patients with and without kidney involvement differed in age, body mass index (BMI), comorbidity, creatinine levels, estimated glomerular filtration rate, and C-reactive protein (CRP) levels. Age, hypertension, higher CRP levels, and higher BMI were linked with kidney involvement. CONCLUSION: The majority of the patients suffered from mild or ordinary symptoms of Omicron COVID-19 infection. The primary kidney involvement was hematuria and proteinuria. Proteinuria was significantly associated with Omicron variant infection, and patients with hypertensive comorbidity, higher CRP, and higher creatinine levels were at increased risk of proteinuria after Omicron variant infection.

The pattern of cytokines expression and dynamic changes of renal function at 6 months in patients with Omicron COVID-19.

To analyze the dynamic changes of renal function longitudinally and investigate the cytokine profiles at 6 months in patients with Omicron COVID-19. Forty-seven patients with a proven diagnosis of Omicron COVID-19 from January to February 2022 attended a 6-month follow-up after discharge at Tianjin First Central Hospital. The demographic parameters, clinical features, and laboratory indexes were collected during hospitalization and 6 months after discharge. The serum cytokine levels at 6 months were also assessed. Patients were grouped according to with or without kidney involvement at admission. The levels of serum creatinine and estimated glomerular filtration rate (eGFR) were all normal both in the hospital and at follow-up. Whereas, compared with renal function in the hospital, serum creatinine levels at 6 months increased remarkably; meanwhile, eGFR decreased significantly in all patients. The serum levels of interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, and TNF-α and IFN-γ significantly decreased and TGF-ß remarkably increased in the kidney involvement group. The serum levels of IL-2 and IL-5 were positively correlated with age; contrarily, TGF-ß showed a negative correlation with aging. The younger was an independent risk factor of the higher TGF-ß levels. Omicron patients showed a decline in renal function at follow-up, reflecting the trend of CKD. Serum cytokine profiles were characterized with the majority of cytokines decreased and TGF-ß increased in the kidney involvement group; the latter may be used as a sign of CKD. The tendency of CKD is one of the manifestations of long COVID and deserves attention.

Expression pattern of peritoneum IL-6 is associated with baseline peritoneal transport function in uremic patients before dialysis.

OBJECTIVE: This study aimed to investigate the biological factors associated with baseline peritoneal transport in uremic patients before dialysis. METHODS: Thirty patients with uremia were grouped according to their peritoneal dialysate creatinine/serum creatinine ratio (D/P) as high-transport (H, 16 cases) with D/P>0.65 and low-transport (L, 14 cases) with D/P≤0.65 one month after continuous ambulatory peritoneal dialysis treatment. Multi-inflammatory levels such as serum IL-6 and albumin, peritoneal IL-6 level, and microvessel density (MVD) of visceral peritoneal were compared and correlated between the two groups to determine the associated factors. RESULTS: There were no significant differences in clinical parameters between the two groups (p < 0.05). There were no significant differences in serum IL-6 and albumin between the two groups. However, peritoneal IL-6 and MVD in group H were significantly higher than group L (p=0.012, p=0.044), and they were positively correlated (r=0.368, p=0.045). Furthermore, baseline D/P was positively correlated with IL-6 expressions (r=0.640, p=0.000) and peritoneal MVD (r=0.476, p=0.008), and independently associated with peritoneal IL-6 expression (p=0.004). CONCLUSIONS: The baseline peritoneal transport performance is associated with peritoneal IL-6 expression and MVD but not circulatory IL-6.

[Analysis of age-based stratified renal involvement in Tianjin first batch of 430 patients with Omicron variant of novel coronavirus infection].

OBJECTIVE: To investigate the incidence and clinical characteristics of renal involvement with Omicron coronavirus infection in age-based stratified patients. METHODS: The first batch of 430 convalescent patients with Omicron coronavirus treated in Tianjin First Central Hospital from January 21, 2022 to March 7, 2022 were enrolled in this study. The baseline information, vaccination status and laboratory examination information of patients were extracted in order to analyze the incidence of renal involvement in age-based stratified patients. Multivariate Logistic regression analysis was conducted to determine the risk factors of renal involvement in different age groups. RESULTS: Excluding those younger than 1 year old and those with a history of chronic kidney disease, a total of 421 patients were included. There were 184 males and 237 females with an average age of (36.65±21.28) years. The types of renal involvement included pathological tubular urine (28.9%), proteinuria (16.9%), renal hematuria (14.7%), a slight decrease of estimated glomerular filtration rate (eGFR, 9.3%), renal glycosuria (0.5%). According to their age, all patients were divided into three groups: 113 cases of ≤ 18 years old, 244 cases of 19-59 years old and 64 cases of ≥ 60 years old. Significant difference was founded in the incidence of renal involvement among the three groups. The incidence of proteinuria, pathological tubular urine and slight decline of eGFR in the ≥ 60 years old group were significantly higher than those in the ≤ 18 years old group [28.1% (18/64) vs. 8.0% (9/112), 42.2% (27/64) vs. 19.6% (22/112), 34.9% (22/63) vs. 6.2% (7/113), respectively, all P < 0.01]. The incidence of slight decline of eGFR was significantly higher than that in 19-59 years old group [34.9% (22/63) vs. 4.1% (10/243), P < 0.01]. Multivariate Logistic regression analysis showed that age was significantly correlated with renal involvement after adjusting for the baseline situation, serological indexes and Omicron infection related indexes [odds ratio (OR) = 1.059, 95% confidence interval (95%CI) was 1.021-1.097, P = 0.002]. Compared with the group ≤ 18 years old, the risk of renal involvement in the group ≥ 60 years old was significantly increased (OR = 26.245, 95%CI was 1.357-507.458, P = 0.031). Age ≥ 60 years old was an independent risk factor for renal involvement with Omicron coronavirus infection. CONCLUSIONS: Although a low incidence of severe cases in Tianjin first batch of 430 patients with Omicron coronavirus infection, there is still a high incidence of renal involvement. Advanced age is the risk factor of renal involvement. We should pay more attention to the renal involvement of elderly with Omicron coronavirus infection.

Serum Galectin-3 levels and all-cause and cardiovascular mortality in maintenance hemodialysis patients: a prospective cohort study.

BACKGROUND: Higher serum galectin-3 levels are related to adverse outcomes in different disease states. However, the association of galectin-3 with mortality in the maintenance hemodialysis (HD) population has not been fully described. Thus, we aimed to assess the predictive significance of galectin-3 for all-cause and cardiovascular (CV) mortality through a Chinese maintenance HD population. METHODS: A prospective cohort study was conducted in five hundred and six patients with end-stage renal disease who underwent hemodialysis at Dalian Central Hospital before December 31, 2014. Serum galectin-3 levels were measured at baseline and classified as high (> 8.65 ng/ml) or low (≤ 8.65 ng/ml) according to the "X-tile" program. Primary and secondary outcomes were all-cause and CV mortality, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by the Cox proportional hazards regression models. RESULTS: During the median follow-up of 60 months, there were 188 all-cause deaths and 125 CV deaths. Compared with maintenance HD population with galectin-3 ≤ 8.65 ng/ml, the adjusted HR for all-cause mortality among those with galectin-3 >  8.65 ng/ml was 1.59 (CI: 0.96-2.65, p = 0.07). Furthermore, multivariable analysis showed that maintenance HD patients with galectin-3 >  8.65 ng/ml had a 2.13-fold higher risk of CV death than those with galectin-3 ≤ 8.65 ng/ml (HR = 2.13, 95% CI 1.07-4.26). CONCLUSION: Galectin-3 is an independent predictor of CV mortality in maintenance HD patients.

Effect of changing treatment to high-flux hemodialysis (HFHD) on mortality in patients with long-term low flux hemodialysis (LFHD): a propensity score matched cohort study.

BACKGROUND: The purpose of this study was to explore the effect of changing treatment to high-flux hemodialysis (HFHD) on mortality rate in patients with long-term low flux hemodialysis (LFHD). METHODS: The patients with end-stage renal disease (ESRD) who underwent LFHD with dialysis age more than 36 months and stable condition in our hospital before December 31, 2014 were included in this study. They were divided into control group and observation group. Propensity score matched method was used to select patients in the control group. The hemodialysis was performed 3 times a week for 4 h. The deadline for follow-up is December 31, 2018. End-point event is all-cause death. The survival rates of the two groups were compared and multivariate Cox regression analysis was carried out. RESULTS: K-M survival analysis showed that the 1-year, 2-year, 3-year and 4-year survival rates of HFHD group were 98, 96, 96 and 96%, respectively. The 1-year, 2-year, 3-year and 4-year survival rates of LFHD group were 95, 85, 80 and 78%, respectively. Log-rank test showed that the survival rate of HFHD group was significantly higher than that of LFHD group (x2= 7.278, P = 0.007). Multivariate Cox regression analysis showed that male, age, hemoglobin and low-throughput dialysis were independent predictors of death (P < 0.05). Compared with LFHD, HFHD can significantly reduce the mortality risk ratio of patients, as high as 86%. CONCLUSION: The prognosis of patients with ESRD who performed long-term LFHD can be significantly improved after changing to HFHD.

Peritoneal microvascular endothelial function and the microinflammatory state are associated with baseline peritoneal transport characteristics in uremic patients.

PURPOSE: To investigate microvessel density (MVD), vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), and interleukin-6 (IL-6) mRNA expression in peritoneal tissues, and their relationships with baseline peritoneal transport in uremia. METHODS: Thirty uremic patients with a peritoneal dialysis catheter were selected in the Department of Nephrology in Dalian Central Hospital, Liaoning, China between 2010 and 2012. Peritoneal specimens were harvested for assessment of MVD, VEGF, eNOS, and IL-6 mRNA expression. One month after continuous ambulatory peritoneal dialysis, a peritoneal equilibration test was conducted. According to the 4-h peritoneal dialysate and plasma creatinine ratio (D/P Cr), patients were divided into high (n=16) and low (n=14) transport groups. RESULTS: General clinical data of high and low transport groups were similar (P>0.05). The MVD in peritoneal tissues was significantly higher in the high than in the low transport group (P<0.05). Correspondingly, VEGF (P<0.01), eNOS (P<0.01), and IL-6 (P<0.05) mRNA expression levels were significantly higher in the high as compared the low transport groups. Correlation analysis showed that the baseline D/P Cr was positively correlated with MVD and VEGF, eNOS, and IL-6 mRNA expression levels in the peritoneum (r=0.506, 0.646, 0.638, and 0.686, respectively; P<0.01). CONCLUSIONS: Uremic patients display differences in peritoneal microvascular endothelial function and microinflammatory states before peritoneal dialysis. Patients of the high transport group have higher MVD, increased expression of endothelial function markers (VEGF and eNOS), and the microinflammatory marker (IL-6). These observations are closely related to high baseline peritoneal transport.