Predicting Progression of IgA Nephropathy: New Clinical Progression Risk Score

IgA nephropathy (IgAN) is a common cause of end-stage renal disease (ESRD) in Asia. In this study, based on a large cohort of Chinese patients with IgAN, we aim to identify independent predictive factors associated with disease progression to ESRD. We collected retrospective clinical data and renal outcomes on 619 biopsy-diagnosed IgAN patients with a mean follow-up time of 41.3 months. In total, 67 individuals reached the study endpoint defined by occurrence of ESRD necessitating renal replacement therapy. In the fully adjusted Cox proportional hazards model, there were four baseline variables with a significant independent effect on the risk of ESRD. These included: eGFR [HR = 0.96(0.95–0.97)], serum albumin [HR = 0.47(0.32–0.68)], hemoglobin [HR = 0.79(0.72–0.88)], and SBP [HR = 1.02(1.00–1.03)]. Based on these observations, we developed a 4-variable equation of a clinical risk score for disease progression. Our risk score explained nearly 22% of the total variance in the primary outcome. Survival ROC curves revealed that the risk score provided improved prediction of ESRD at 24th, 60th and 120th month of follow-up compared to the three previously proposed risk scores. In summary, our data indicate that IgAN patients with higher systolic blood pressure, lower eGFR, hemoglobin, and albumin levels at baseline are at a greatest risk of progression to ESRD. The new progression risk score calculated based on these four baseline variables offers a simple clinical tool for risk stratification

Community-based study on CKD subjects and the associated risk factors

Background. The study was performed to investigate the prevalence, awareness and the risk factors of chronic kidney disease (CKD) in the community population in Shanghai, China

ANTI-INFLAMMATORY EFFECTS OF LOW PROTEIN DIET SUPPLEMENTED WITH KETO-AMINO ACID IN THE TREATMENT OF TYPE 2 DIABETIC NEPHROPATHY

Recent clinical research strongly approves that low-protein diet supplemented with keto-amino acid can effectively delay progression of type 2 diabetic nephropathy (DN). Anti-inflammation is one of these effects, but the mechanism is still controversial. This study is designed to further explore roles of ketogenic diets in regulation of inflammation status of type 2 DN. Twenty-one patients with type 2 DN (mean age at 65.14±7.34 years), were followed-up for 52 weeks in this study. All patients were in CKD stages 3–4 with glomerular filtration rates 26–55ml/min/1.73m2 and were all on a low-protein diet containing 0.8g protein/kg BW per day and 30–35Kcal /kg BW per day. The diet was randomly supplemented with keto-amino acids at a dosage of 100mg/kg BW per day in 10 patients, who were assigned into Group II. Other 11 patients were assigned into Group I. At the end of this study, related clinical data showed there was a significant increase in the serum level of TNF-α which could mediate inflammation systemically in Group I (from 230.25±54.34 to 332.11pg/ml, P < 0.01), but non-significant increase in Group II (from 224.59±41.24 to 253.41±31.28pg/ml, P>0.05). The level of CRP, which is produced in response to inflammation, rose greatly in Group I (from 7.5±1.07 to 20.4±3.72ug/ml, P < 0.01), but decreased in Group II (from 8.2±3.07 to 3.9±1.22ug/ml, P < 0.01). The level of adiponectin, an anti-inflammatory factor, was decreased in Group I (from 9.42±0.8 to 7.64±1.4μg/ml, P< 0.05), but showed slight increase in Group II (9.04±0.9 versus 10.47±1.2=μg/ml, P>0.05). Nutritional markers including serum albumin, hemoglobin and basal metabolic index showed no malnutrition happened during the follow-up period. In conclusion, low-protein diet supplemented with keto-amino acids contribute to ameliorate inflammation in the progression of type 2 diabetic nephropathy through regulating inflammatory factors production, including TNF-α, CRP and adiponectin

Clinical and Pathological Features of Idiopathic Membranous Nephropathy in Young Adults and Analysis of Outcomes

Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies

Impact of Etiology on the Outcomes in Heart Failure Patients Treated with Cardiac Resynchronization Therapy: A Meta-Analysis

<div><p>Background</p><p>Cardiac resynchronization therapy (CRT) has been extensively demonstrated to benefit heart failure patients, but the role of underlying heart failure etiology in the outcomes was not consistently proven. This meta-analysis aimed to determine whether efficacy and effectiveness of CRT is affected by underlying heart failure etiology.</p><p>Methods and Results</p><p>Searches of MEDLINE, EMBASE and Cochrane databases were conducted to identify RCTs and observational studies that reported clinical and functional outcomes of CRT in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) patients. Efficacy of CRT was assessed in 7 randomized controlled trials (RCTs) with 7072 patients and effectiveness of CRT was evaluated in 14 observational studies with 3463 patients In the pooled analysis of RCTs, we found that CRT decreased mortality or heart failure hospitalization by 29% in ICM patients (95% confidence interval [CI], 21% to 35%), and by 28% (95% CI, 18% to 37%) in NICM patients. No significant difference was observed between the 2 etiology groups (P = 0.55). In the pooled analysis of observational studies, however, we found that ICM patients had a 54% greater risk for mortality or HF hospitalization than NICM patients (relative risk: 1.54; 95% CI: 1.30–1.83; P<0.001). Both RCTs and observational studies demonstrated that NICM patients had greater echocardiographic improvements in the left ventricular ejection fraction and end-systolic volume, as compared with ICM patients (both P<0.001).</p><p>Conclusion</p><p>CRT might reduce mortality or heart failure hospitalization in both ICM and NICM patients similarly. The improvement of the left ventricular function and remodeling is greater in NICM patients.</p></div

Coffee consumption is positively related to insulin secretion in the Shanghai High-Risk Diabetic Screen (SHiDS) Study

Abstract Background It has been proved that coffee consumption was associated with a lower risk of type 2 diabetes mellitus. But the benefit effect of coffee on hyperglycemia in Chinese population was largely unknown. Besides, the relationship of coffee intake and diabetic pathogenesis was still unclear. Methods The study population was selected from the Shanghai High-Risk Diabetic Screen (SHiDS) project. A total of 1328 individuals over 18 years of age who have the information of coffee intake were enrolled in the study from 2012 to 2016. Each participant finished a five-point 75 g oral glucose tolerance test and finished a standard questionnaire. Insulin resistance was evaluated by HOMA-IR and insulin secretion was evaluated by HOMA-β, Stumvoll first phase and second phase indexes. Results Coffee consumption group had lower plasma glucose levels at 2-h and 3-h and higher insulin levels at fasting, 30-min and 1-h during OGTT after adjustment with age, fat%, BMI, waist, tea intake, smoking habit, alcohol intake, diabetes family history and educational status (P for PG2h = 0.002; P for PG3h = 0.010; P for FIN = 0.010; P for IN30min = 0.001; P for IN1h = 0.002). Both HOMA-β and Stumvoll formula indexes were positively related to coffee consumption (P for HOMA-β = 0.033; P for Stumvoll first phase = 0.003; P for Stumvoll second phase = 0.001). Logistic regression analysis further confirmed that coffee intake was independently associated with higher levels of HOMA-β and Stumvoll insulin secretion indexes [OR (95% CI) for HOMA-β = 2.270 (1.456–3.538); OR (95% CI) for Stumvoll first phase = 2.071 (1.352–3.173); OR (95% CI) for Stumvoll second phase = 1.914 (1.260–2.906)]. Conclusions Coffee intake is independently and positively related to pancreatic beta cell function in a large high-risk diabetic Chinese population

Characteristics of Observational Studies Included in the Meta-analysis.

<p>ICM, ischemic cardiomyopathy; NICM, non-ischemic cardiomyopathy; other abbreviations as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0094614#pone-0094614-t001" target="_blank">Table 1</a>.</p