Objective: To investigate whether metabolic syndrome (MS) independently influences the renal outcomes of chronic kidney disease (CKD) 1-4 stage patients. Methods: Since July 2006 to September 2008, a total of 766 clinically stable CKD patients in the hospital were enrolled in this prospective study and followed up until December 31th, 2016. The CKD patients were divided into MS group and non-MS group according to the Chinese Diabetes Society (CDS) criterion of MS. The renal outcomes that needs to initiate renal replacement therapy were observed and recorded during the follow-up. Kaplan-Meier analysis was used to evaluate the influence of MS on CKD patients′ renal outcomes. Cox regression analysis was used to assess the independent risk factors of renal outcome of CKD patients. Results: Among 766 patients with CKD 1-4 stage, 97 patients initiated renal replacement therapy, and the prevalence of MS was 31.5%(241/766) in CKD patients. In the CKD 1-4 stage patients, the occurring rate of initiating renal replacement therapy was significantly higher in MS group than that of non-MS group (χ²=56.367, P<0.001). Cox regression analysis showed that 24-hour urine protein ≥1.0 g, MS and initial serum phosphate ≥1.3 mmol/L were the independent risk factors of initiating renal replacement therapy in CKD 1-4 stages. Conclusions More than 1/3 CKD patients are accompanied with MS. It has been demonstrated that MS, as well as 24-hour urine protein ≥1.0 g and initial serum phosphate ≥1.3 mmol/L, are the independent influencing factors of the renal outcomes in CKD 1-4 stage patients.

Objective:To explore the incidence, influencing factors and prognostic value of cardiac valve calcification (CVC) in chronic kidney disease (CKD) non-dialysis patients.Methods:The non-dialysis patients with CKD stage 1-5 who were hospitalized and underwent echocardiography in the Department of Nephrology, Xuanwu Hospital, Capital Medical University from January 1, 2018 to December 31, 2019 were retrospectively admitted. The patients were divided into CVC group and non-CVC group, and the clinical data were compared between the two groups. The deadline for follow-up was November 1, 2021, and the follow-up end point event was all-cause mortality. Logistic regression model was used to analyze the risk factors of CVC in patients with CKD, and Cox proportional hazards regression model was used to analyze the risk factors of all-cause mortality in patients with CKD.Results:A total of 563 patients with CKD were enrolled in the study, with age of (59.49±13.97) years old, and 352 males (62.52%). There were 325 patients (57.73%) with CKD stage 1-3 and 238 patients (42.27%) with CKD stage 4-5. The incidence of CVC in CKD stage 1-5 patients was 32.32%(182/563). Aortic valve calcification occurred in 30.73%(173/563), mitral valve calcification occurred in 9.77% (55/563), double valve (mitral and aortic valve) calcification occurred in 8.35% (47/563), and tricuspid valve calcification occurred in 0.18%(1/563). Age (t=12.223, P<0.001) and the proportions of CKD stage 4-5 ( χ 2=10.854, P=0.001), hypertension ( χ 2=7.811, P=0.005), diabetes ( χ 2=8.424, P=0.004), hyperlipidemia ( χ 2=9.331, P=0.002), and taking statins ( χ 2=4.868, P=0.027) in CVC group were significantly higher than those in non-CVC group. Total cholesterol (t=2.243, P=0.025), low density lipoprotein cholesterol (t=2.025, P=0.043), platelet count (t=2.230, P=0.026) and estimated glomerular filtration rate (t=8.630, P<0.001) in CVC group were lower than those in the non-CVC group. Logistic regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, OR=7.412, 95% CI 4.514-12.170, P<0.001), CKD stage 4-5 (stage 4-5/stage 1-3, OR=2.791, 95% CI 1.730-4.505, P<0.001) and hyperlipidemia ( OR=5.241, 95% CI 3.283-8.367, P<0.001) were the independent influencing factors of CVC in patients with CKD. Five hundred and sixty-three patients were followed up for an average of 26 months, including 68 cases (12.08%) of death, 436 cases (77.44%) of survival and 59 cases (10.48%) of loss to follow-up. Multivariate Cox regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, HR=2.157, 95% CI 1.127-4.127, P=0.020), serum albumin<30 g/L (<30 g/L/≥30 g/L, HR=1.923, 95% CI 1.037-3.568, P=0.038) and double valve calcification (double valve calcification/no valve calcification, HR=2.516, 95% CI 1.279-4.950, P=0.008) were the independent influencing factors of all-cause death in patients with CKD. Conclusions:CVC accounts for 32.32% in non-dialysis patients with CKD stage 1-5. Older age, worse renal function and hyperlipidemia are the independent risk factors of CVC in CKD patients. Older age, hypoproteinemia and double valve calcification are the independent risk factors of all-cause death in patients with CKD.

Objective:To observe the risk of acute kidney disease and disorders (AKD) in patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time in our hospital.Methods:A retrospective case-control analysis was performed using the hospital database to screen for patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time for more than 3 months during January 1, 2018 to June 30, 2019. A total of 279 patients with serum creatinine reviewed within 3 months were as the rivaroxaban group, and 317 patients with coronary heart disease or non-valvular atrial fibrillation who did not take rivaroxaban during the same period in our hospital were selected as the control group. The general condition and the incidence of AKD were compared between the two groups, and the influencing factors of AKD were analyzed by logistic regression analysis.Results:The prothrombin time and international normalized ratio were higher in the rivaroxaban group than those in the control group (both P<0.01). There was no significant difference in age, gender, serum creatinine and urea level between the two groups. The incidence of AKD in the rivaroxaban group was 4.30%(12/279), and the incidence of AKD in the control group was 1.26%(4/317). The relative risk ( RR) of the two groups of patients was 3.409. Logistic regression analysis showed that older age (≥75 years old, OR=1.166, 95% CI 1.012-1.343, P=0.033) and diabetes ( OR=34.261, 95% CI 1.639-716.326, P=0.023) were risk factors for AKD in patients taking rivaroxaban. Rivaroxaban was a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation ( OR=3.500, 95% CI 1.115-10.988, P=0.032). Conclusions:The incidence of AKD in patients taking rivaroxaban for the first time due to coronary heart disease or non-valvular atrial fibrillation was 4.30%. Taking rivaroxaban is a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation. Older age and diabetes are the risk factors for AKD in the rivaroxaban group.

Objective:To evaluate the correlation between age and renal outcomes in patients with stage 2-4 chronic kidney disease (CKD) and the impact of age on CKD outcomes in kidney diseases of different etiologies.Methods:A prospective cohort study included 470 patients with stage 2-4 CKD. The Kaplan Meier method was used to analyze the differences in CKD outcomes among different age groups. The independent risk factors for CKD progression were analyzed using a multivariate Cox regression model. We adjusted for baseline differences in risk factors for CKD outcomes between two age groups using propensity score matching (PSM).Results:Among 470 patients, 39 cases of end-stage renal disease (ESRD) events (all starting dialysis) and 51 deaths were observed. The Kaplan Meier survival curve ( P=0.039) and Cox regression univariate survival analysis ( P=0.043) both showed that <60 years old is a risk factor for CKD patients to progress to ESRD. In multivariate Cox regression, age remained an independent risk factor for the progression of CKD patients (hazard ratio 0.386, 95% CI: 0.163-0.916; P=0.031). For kidney diseases with different causes, in patients with hypertensive kidney damage ( P=0.024) and primary glomerulonephritis ( P=0.047), the cumulative incidence rate of ESRD in patients <60 years old was higher than that in patients ≥60 years old. There was no statistically significant difference in all-cause mortality rates between patients aged <60 and ≥60 years old ( P=0.646). Conclusions:Elderly patients with stage 2-4 CKD have a lower ESRD risk than younger patients. This discovery helps nephrologists and decision-makers optimize the management of elderly CKD patients.