Objective:To investigate the correlation between statins and contrast-induced acute kidney injury (CI-AKI) and provide a reference basis for clinical practice.Methods:It was a retrospective cohort study. The adult patients were admitted to Peking University First Hospital from January 1, 2018, to December 31, 2020, and received at least one intravascular iodinated contrast administration during hospitalization. The clinical data of the patients were collected. The enrolled patients were divided into statin group and non-statin group according to statin exposure. The exposure of statins was defined as use of any type of statins within 48 hours before iodinated contrast administration. The primary outcome was in-hospital AKI defined as AKI developed after contrast administration and before discharge, with 30 days as the endpoint observation time, and the secondary outcome was post-contrast AKI (PC-AKI) defined as AKI onset within 72 hours after contrast administration. Cox regression model was applied to investigate the correlation between statin prescription prior to contrast administration and clinical outcomes. Pre-specified interaction analysis was conducted to examine modification effect of age, gender, baseline estimated glomerular filtration rate (eGFR), diabetes and the injection method of contrast.Results:Among 10 321 enrolled patients, the age was 63 (54, 71) years old, and 6 274 (60.8%) patients were males. There were 2 372 (23.0%) patients taking statins before the use of iodinated contrast agents, and the person-time incidence rate of in-hospital AKI was 2.5 per 1 000 person-days. The person-time incidence rate of statin users and statin non-users was 3.2 and 2.4 per 1 000 person-days, respectively. Compared with the non-statin group, age, serum creatinine and the proportions of males, admitted to the intensive care unit, lipid metabolism disorder, hypertension, diabetes, cerebrovascular diseases, cardiovascular diseases, using renin-angiotensin- aldosterone inhibitors, using diuretics, using non-steroidal anti-inflammatory drugs, using proton pump inhibitors, iodinated contrast administration via artery, eGFR<60 ml·min -1·(1.73 m 2) -1 were higher, while the proportions of general anesthesia surgery, severe liver diseases and tumors, and eGFR were lower in the statin group (all P<0.05). Among 10 321 patients, 5 867 patients had serum creatinine measurement within 72 hours after iodinated contrast administration, among which 70 patients (4.0 per 1 000 person-days) developed PC-AKI. Multivariate Cox regression analysis showed that statin use was an independent protective factor for in-hospital AKI ( HR=0.65, 95% CI 0.45?0.93, P=0.017) and PC-AKI ( HR=0.44, 95% CI 0.22?0.88, P=0.020). Subgroup analysis showed the significant interaction between diabetes and statin use ( P for interaction=0.039), and the protective effect of statins against in-hospital AKI was only observed in non-diabetic group ( HR=0.45, 95% CI 0.26?0.77). There were no significant differences in subgroups stratified by age, sex, baseline eGFR and the injection method of contrast (all P for interaction>0.05). Conclusions:Statin use prior to iodinated contrast administration is correlated with reduced risks of in-hospital AKI and PC-AKI in hospitalized patients, and the correlation between statin use and in-hospital AKI is more significant in non-diabetic patients. It is suggested that statin use before the application of iodinated contrast agents in hospitalized patients may prevent the occurrence of AKI.

Objective:To explore the effectiveness of a discharge preparation service based on interaction attainment theory in bladder cancer patients undergoing transurethral resection of bladder tumors (TURBT) .Methods:Convenience sampling was used to select 158 bladder cancer patients who underwent TURBT from January to December 2022 in the First Affiliated Hospital of Xinxiang Medical University as the study subjects. The subjects were divided into observation group and control group of 79 cases each according to the random number table method. Control group implemented routine TURBT postoperative management and discharge guidance, and observation group implemented a discharge preparation service based on interaction attainment theory on the basis of control group. Readiness for Hospital Discharge Scale-Chinese version (RHDS-C) scores, post-discharge bladder perfusion adherence, 30-day unplanned readmission rates, and first-year tumor recurrence rates were compared between the two groups.Results:A total of 154 patients eventually completed the intervention, 76 in control group and 78 in observation group. The total RHDS-C score and the four dimensions scores of observation group were all higher than those of control group, and the differences were statistically significant (all P<0.05). Bladder perfusion adherence in observation and control groups were 99.60% (1 476/1 482) and 98.41% (1 421/1 444), respectively, and the difference was statistically significant (χ 2=10.518, P<0.01). The 30-day unplanned readmission rate and tumor recurrence rate in the first year were 15.79% (12/76) and 42.11% (32/76) in control group, 3.85% (3/78) and 17.95% (14/78) in observation group, respectively, and the differences were statistically significant (χ 2=6.246, 10.723; all P<0.05) . Conclusions:A discharge preparation service based on the interaction attainment theory is effective in improving discharge readiness and bladder perfusion adherence in patients with TURBT for bladder cancer, and it reduces the 30-day unplanned readmission rate and the first-year tumor recurrence rate.

Objective:To explore the effectiveness of a discharge preparation service based on interaction attainment theory in bladder cancer patients undergoing transurethral resection of bladder tumors (TURBT) .Methods:Convenience sampling was used to select 158 bladder cancer patients who underwent TURBT from January to December 2022 in the First Affiliated Hospital of Xinxiang Medical University as the study subjects. The subjects were divided into observation group and control group of 79 cases each according to the random number table method. Control group implemented routine TURBT postoperative management and discharge guidance, and observation group implemented a discharge preparation service based on interaction attainment theory on the basis of control group. Readiness for Hospital Discharge Scale-Chinese version (RHDS-C) scores, post-discharge bladder perfusion adherence, 30-day unplanned readmission rates, and first-year tumor recurrence rates were compared between the two groups.Results:A total of 154 patients eventually completed the intervention, 76 in control group and 78 in observation group. The total RHDS-C score and the four dimensions scores of observation group were all higher than those of control group, and the differences were statistically significant (all P<0.05). Bladder perfusion adherence in observation and control groups were 99.60% (1 476/1 482) and 98.41% (1 421/1 444), respectively, and the difference was statistically significant (χ 2=10.518, P<0.01). The 30-day unplanned readmission rate and tumor recurrence rate in the first year were 15.79% (12/76) and 42.11% (32/76) in control group, 3.85% (3/78) and 17.95% (14/78) in observation group, respectively, and the differences were statistically significant (χ 2=6.246, 10.723; all P<0.05) . Conclusions:A discharge preparation service based on the interaction attainment theory is effective in improving discharge readiness and bladder perfusion adherence in patients with TURBT for bladder cancer, and it reduces the 30-day unplanned readmission rate and the first-year tumor recurrence rate.

Objective:To investigate the correlation between statins and contrast-induced acute kidney injury (CI-AKI) and provide a reference basis for clinical practice.Methods:It was a retrospective cohort study. The adult patients were admitted to Peking University First Hospital from January 1, 2018, to December 31, 2020, and received at least one intravascular iodinated contrast administration during hospitalization. The clinical data of the patients were collected. The enrolled patients were divided into statin group and non-statin group according to statin exposure. The exposure of statins was defined as use of any type of statins within 48 hours before iodinated contrast administration. The primary outcome was in-hospital AKI defined as AKI developed after contrast administration and before discharge, with 30 days as the endpoint observation time, and the secondary outcome was post-contrast AKI (PC-AKI) defined as AKI onset within 72 hours after contrast administration. Cox regression model was applied to investigate the correlation between statin prescription prior to contrast administration and clinical outcomes. Pre-specified interaction analysis was conducted to examine modification effect of age, gender, baseline estimated glomerular filtration rate (eGFR), diabetes and the injection method of contrast.Results:Among 10 321 enrolled patients, the age was 63 (54, 71) years old, and 6 274 (60.8%) patients were males. There were 2 372 (23.0%) patients taking statins before the use of iodinated contrast agents, and the person-time incidence rate of in-hospital AKI was 2.5 per 1 000 person-days. The person-time incidence rate of statin users and statin non-users was 3.2 and 2.4 per 1 000 person-days, respectively. Compared with the non-statin group, age, serum creatinine and the proportions of males, admitted to the intensive care unit, lipid metabolism disorder, hypertension, diabetes, cerebrovascular diseases, cardiovascular diseases, using renin-angiotensin- aldosterone inhibitors, using diuretics, using non-steroidal anti-inflammatory drugs, using proton pump inhibitors, iodinated contrast administration via artery, eGFR<60 ml·min -1·(1.73 m 2) -1 were higher, while the proportions of general anesthesia surgery, severe liver diseases and tumors, and eGFR were lower in the statin group (all P<0.05). Among 10 321 patients, 5 867 patients had serum creatinine measurement within 72 hours after iodinated contrast administration, among which 70 patients (4.0 per 1 000 person-days) developed PC-AKI. Multivariate Cox regression analysis showed that statin use was an independent protective factor for in-hospital AKI ( HR=0.65, 95% CI 0.45?0.93, P=0.017) and PC-AKI ( HR=0.44, 95% CI 0.22?0.88, P=0.020). Subgroup analysis showed the significant interaction between diabetes and statin use ( P for interaction=0.039), and the protective effect of statins against in-hospital AKI was only observed in non-diabetic group ( HR=0.45, 95% CI 0.26?0.77). There were no significant differences in subgroups stratified by age, sex, baseline eGFR and the injection method of contrast (all P for interaction>0.05). Conclusions:Statin use prior to iodinated contrast administration is correlated with reduced risks of in-hospital AKI and PC-AKI in hospitalized patients, and the correlation between statin use and in-hospital AKI is more significant in non-diabetic patients. It is suggested that statin use before the application of iodinated contrast agents in hospitalized patients may prevent the occurrence of AKI.

Objective:This study aims to summarize the experience of building a research data platform at Peking University First Hospital and propose pathways for constructing healthcare big data platforms in medical institutions to provide insights for the further expansion of the application of the health care big data platform and construction of smart healthcare.Methods:Hospital multi-domain data was collected through a systematic process. After data classification and cleaning, international medical standards and NLP technology were utilized to achieve data standardization and structuring. At the same time, the eCRF form, data source judgment, and mathematical calculations were optimized to ensure the data quality and application value of the scientific research data platform.Results:By carrying out the construction of a scientific research data platform, Peking University First Hospital achieved the transformation of clinical data into research data, completed data collection, pushing, integration, cleaning, and governance, and conducted health care big data research.Conclusions:It is recommended to subsequently expand the data scope, promote the transformation of clinical data into research data, enhance clinical experts' participation in prospective design and data collection, use an integrated data platform for automatic data pushing and calling, explore the application of large language models and conduct technical exploration and reserves.

Anticancer drugs are important causes of kidney injury in cancer patients. Once kidney injury occurs, it will affect anticancer therapy and patient prognosis. Thus, the Japanese Society of Nephrology, Japan Society of Clinical Oncology, Japanese Society of Medical Oncology, and Japanese Society of Nephrology and Pharmacotherapy have jointly formulated the Clinical Practice Guidelines for Management of Kidney Injury During Anticancer Drug Therapy 2022 and made a particular discussion on the prevention and management of anticancer drug-induced kidney injury. This article focuses on interpreting the management of kidney injury related to cytotoxic anticancer drugs, targeted therapies, and immune checkpoint inhibitors to more effectively guide clinical practice.

Anticancer drugs are important causes of kidney injury in cancer patients. Once kidney injury occurs, it will affect anticancer therapy and patient prognosis. Thus, the Japanese Society of Nephrology, Japan Society of Clinical Oncology, Japanese Society of Medical Oncology, and Japanese Society of Nephrology and Pharmacotherapy have jointly formulated the Clinical Practice Guidelines for Management of Kidney Injury During Anticancer Drug Therapy 2022 and made a particular discussion on the prevention and management of anticancer drug-induced kidney injury. This article focuses on interpreting the management of kidney injury related to cytotoxic anticancer drugs, targeted therapies, and immune checkpoint inhibitors to more effectively guide clinical practice.

Objective:This study aims to summarize the experience of building a research data platform at Peking University First Hospital and propose pathways for constructing healthcare big data platforms in medical institutions to provide insights for the further expansion of the application of the health care big data platform and construction of smart healthcare.Methods:Hospital multi-domain data was collected through a systematic process. After data classification and cleaning, international medical standards and NLP technology were utilized to achieve data standardization and structuring. At the same time, the eCRF form, data source judgment, and mathematical calculations were optimized to ensure the data quality and application value of the scientific research data platform.Results:By carrying out the construction of a scientific research data platform, Peking University First Hospital achieved the transformation of clinical data into research data, completed data collection, pushing, integration, cleaning, and governance, and conducted health care big data research.Conclusions:It is recommended to subsequently expand the data scope, promote the transformation of clinical data into research data, enhance clinical experts' participation in prospective design and data collection, use an integrated data platform for automatic data pushing and calling, explore the application of large language models and conduct technical exploration and reserves.

Objective:To investigate the urinary sediment findings and the clinicopathologic features of IgA nephropathy (IgAN) patients with acute kidney injury (AKI).Methods:It was a retrospective study. The patients with renal biopsy-proven primary IgAN in Peking University First Hospital from January 31, 2013 to July 31, 2015 were selected. According to whether AKI occurred at renal biopsy or not, the patients were divided into AKI group and non-AKI group. Morning urine samples were obtained on the day of renal biopsy. Urine sediments, including various cells and casts, were examined. The clinical data, urinary sediments, and renal pathological changes were compared between the two groups. Logistic regression analysis was performed to identify the association between clinical pathological changes, urinary sediment indicators and AKI, or clinical pathological changes and urinary sediment indicators.Results:There were 502 IgAN patients enrolled in this study, with age of (36.1±12.1) years old and 261 males (52.0%). The incidence of AKI was 11.4% (57/502) among the enrolled patients at the time of renal biopsy. Common causes of AKI included gross hematuria-induced AKI (10 cases), acute tubulointerstitial nephritis (10 cases), crescentic IgAN (9 cases), malignant hypertensive renal damage (6 cases), and multiple etioloqy or unknown etiology (22 cases). Compared with non-AKI group, AKI group had higher proportions of males and malignant hypertension, higher levels of proteinuria and urinary erythrocyte counts, and higher frequencies of gross hematuria, leukocyturia, renal tubular epithelial cells, and granular casts (all P<0.05). AKI group also had higher proportions of severe tubular atrophy/interstitial fibrosis (T2) and cellular/cellular fibrous crescent formation (C2) than non-AKI group (both P<0.05). Logistic regression analysis results showed that, there were statistically significant differences in the correlation between AKI and gender, 24 h urinary protein, urinary erythrocyte counts, granular casts and renal tubular atrophy/interstitial fibrosis (T) scores (all P<0.05). Hematuria, leukocyturia, red blood cell casts, white blood cell casts, granular casts, and fatty casts were correlated with endothelial hypercellularity (E) and cellular/cellular fibrous crescent formation (C) scores, respectively (all P<0.05). Hematuria was correlated with mesangial hypercellularity (M) scores ( OR=2.613, 95% CI 1.520-4.493, P=0.001). Hematuria ( OR=1.723, 95% CI 1.017-2.919, P=0.043) and fatty casts ( OR=2.646, 95% CI 1.122-6.238, P=0.026) were correlated with segmental sclerosis or adhesion (S) scores. Leukocyturia ( OR=1.645, 95% CI 1.154-2.347, P=0.006) and fatty casts ( OR=2.344, 95% CI 1.202-4.572, P=0.012) were correlated with T scores. Epithelial cell cast was correlated with C scores ( OR=1.857, 95% CI 1.174-2.939, P=0.008). Conclusions:AKI is a common complication among IgAN patients with diverse etiology and more severe clinicopathological features. Urinary sediment findings can reflect renal pathological changes to some extent, and therefore assist in the clinical diagnosis and treatment of IgAN patients with AKI.

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