Clinical nephrology最新文献

{"title":"Associations of life's crucial 9 and its components with all-cause and cardiovascular mortality in diabetic kidney disease patients.","authors":"Chao Chen, Wen Wen, Lu Wang","doi":"10.5414/CN112078","DOIUrl":"https://doi.org/10.5414/CN112078","url":null,"abstract":"<p><strong>Objective: </strong>To assess the associations of life's crucial 9 (LC9) and its components with all-cause and cardiovascular disease (CVD)-related mortality in patients with diabetic kidney disease (DKD).</p><p><strong>Materials and methods: </strong>Records of DKD patients were extracted from the National Health and Nutrition Examination Survey database. The relationships of LC9 scores with all-cause and CVD-related mortality were investigated by weighted univariate and multivariable COX proportional hazard models, with hazard ratios (HRs) and 95% confidence intervals (CIs). The associations were further explored based on different characteristics of DKD patients, including age, sex, CVD, cancer, diabetic retinopathy, and anemia. Random forest models were used to evaluate the importance of LC9 components for all-cause and CVD-related mortality.</p><p><strong>Results: </strong>Among 1,877 DKD patients, 586 died from any cause, and 193 were CVD-related. DKD patients with elevated LC9 scores (≥ 47.778) had lower odds of all-cause and CVD-related mortality, compared to those with LC9 score < 47.778. For per 10-point increase in LC9 score, the risk of all-cause and CVD-related mortality decreased by 0.26 and 0.37 times in DKD patients, respectively. Similar results were found in different characteristics of DKD patients. Physical activity, sleep duration, and BMI were the most important factors for all-cause mortality in DKD patients, followed by depression. For CVD-related mortality risk, sleep duration and depression were of significant importance, followed by dietary quality.</p><p><strong>Conclusion: </strong>High LC9 scores were associated with lower odds of all-cause and CVD-related mortality, suggesting that incremental improvements in modifiable factors may be beneficial to the prognosis of DKD patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of the effects of peritoneal dialysis modes, initial doses, and frequencies on residual renal function and quality of life in patients initiating peritoneal dialysis.","authors":"Yunhui Zhang, Hong Wang, Keming Geng, Guifen Chai, Jun Luo","doi":"10.5414/CN112024","DOIUrl":"https://doi.org/10.5414/CN112024","url":null,"abstract":"<p><strong>Background: </strong>Residual kidney function influences outcomes and quality of life in peritoneal dialysis (PD), but the optimal initiation strategy remains uncertain.</p><p><strong>Materials and methods: </strong>We retrospectively studied 120 incident PD patients treated at a tertiary nephrology center in China from February to December 2023. Patients were categorized by initial prescription as low-dose continuous ambulatory PD (CAPD-L), full-dose CAPD (CAPD-F), daytime ambulatory PD (DAPD), or automated full-dose PD (APD-F). Twelve-month outcomes included 24-hour residual urine volume, weekly total Kt/V, nutritional and mineral markers, and documented uremia-related symptoms. Baseline imbalance was assessed using standardized mean differences, and longitudinal changes were analyzed using repeated-measures models with group-by-time interactions. Urine volume was considered a surrogate measure of residual kidney function.</p><p><strong>Results: </strong>Baseline imbalance was notable, particularly for age and urine volume. At 12 months, mean 24-hour urine volumes were 962.7 ± 198.6, 790.5 ± 210.4, 960.1 ± 180.3, and 945.7 ± 190.2 mL/day in the CAPD-L, CAPD-F, DAPD, and APD-F groups, respectively. The between-group difference was significant (p = 0.006), as was the unadjusted group-by-time interaction (p = 0.003). Weekly total Kt/V remained above 1.7 in all groups. No significant between-group differences were observed in serum albumin or documented uremia-related symptoms at 12 months.</p><p><strong>Conclusion: </strong>Initial low-dose CAPD and daytime PD were associated with different residual urine-volume trajectories while dialysis adequacy was maintained. No symptom-burden benefit was demonstrated. Given the non-randomized design, baseline imbalance, limited adjustment for treatment selection, and use of urine volume as a surrogate, these findings are exploratory and require prospective confirmation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of henagliflozin in IgA nephropathy: A real-world observational study from China.","authors":"Yi Qian Zhang, Jun Xia Wu, Hai Yan Tu, Zhao Ting Ren, Pei Pei Chen, Jia Xiu Zhang, Kun Ling Ma","doi":"10.5414/CN111956","DOIUrl":"https://doi.org/10.5414/CN111956","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are now recommended as first-line therapies for chronic kidney disease. However, real-world evidence on henagliflozin, China's first-developed SGLT2 inhibitor, for treating IgA nephropathy (IgAN) is lacking. This study explored the real-world efficacy and safety of henagliflozin in Chinese IgAN patients.</p><p><strong>Materials and methods: </strong>This study retrospectively reviewed 48 IgAN patients on henagliflozin for 12 weeks. The primary outcome was the urinary albumin-to-creatinine ratio (UACR). Secondary outcomes included estimated glomerular filtration rate (eGFR), serum creatinine (Scr), uric acid (UA), and albumin (Alb). Adverse events (AEs) were also recorded.</p><p><strong>Results: </strong>Henagliflozin induced a significant reduction in UACR between baseline and week 12 (227.26; IQR, 90.13 - 677.85 vs. 153.06; IQR, 24.68 - 401.76 mg/g; p < 0.001), with a median decrease of 47.9%. Clinical response, defined as a ≥ 30% decrease in UACR, was achieved in 64.6% of patients by week 12. The UA levels also decreased markedly (p < 0.001). The eGFR declined until week 8 (p ≤ 0.015) but returned to near-baseline level by week 12 (p = 0.055). Scr increased over time (p = 0.005), and Alb improved until week 8 (p ≤ 0.007) and then plateaued at week 12 (p = 0.45). AEs included urinary tract infections in 5 patients, Scr increase of ≥ 50% in 1, and hyperkalemia in 1.</p><p><strong>Conclusion: </strong>Henagliflozin demonstrated significant albuminuria- and UA-lowering effects over 12 weeks in Chinese IgAN patients. With renal-metabolic benefits and favorable safety, henagliflozin is emerging as an encouraging therapeutic option for IgAN.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the role of urinary electrolyte parameters in the differential diagnosis of hypokalemia.","authors":"Wanbing Lin, Jun Ying, Xianbao Liu, Lijun Mou","doi":"10.5414/CN112140","DOIUrl":"10.5414/CN112140","url":null,"abstract":"<p><strong>Background: </strong>Hypokalemia is a common clinical electrolyte disorder. In normotensive patients with renal potassium (K⁺) wasting, distinguishing vomiting-related upper gastrointestinal (UGI) disorders from renal tubular diseases (RTDs), including Gitelman syndrome (GS) and distal renal tubular acidosis (dRTA), is challenging due to overlapping manifestations. Assessment based on isolated urinary potassium excretion has limited diagnostic value.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 86 normotensive hypokalemic patients with inappropriate renal K⁺ loss admitted to our department (2016 - 2025), divided into the UGI group (n = 25, vomiting-related) and RTD group (n = 61: 34GS, 27dRTA). Clinical characteristics and blood/urine biochemical parameters were systematically collected. The spot urine K⁺/creatinine (Cr) ratio, fractional excretion of electrolytes (FEK, FENa, FECl), and blood/urine Na⁺/Cl^- ratios were calculated. Between-group comparisons and ROC curve analysis were performed.</p><p><strong>Results: </strong>Compared with the RTD group, the UGI group had a significantly higher female proportion, lower BMI, shorter duration of hypokalemia-related symptoms, marked hypochloremia, hyponatremia, severe metabolic alkalosis, and elevated serum Cr and uric acid (UA) (all p < 0.05). Spot urine analysis showed higher Na⁺, lower Cl^-, and elevated Na⁺/Cl^- and FENa/FECl ratios, whereas spot urine K⁺/Cr ratio and FEK did not differ significantly between groups. ROC analysis demonstrated that spot urine Cl^- had the highest diagnostic accuracy for vomiting-induced hypokalemia (AUC 0.978; cutoff < 33.3 mmol/L, sensitivity 92%, specificity 95.1%). Urine Na⁺/Cl^- and FENa/FECl ratios also achieved excellent performance (both AUC 0.965). Notably, serum Cl^- also showed favorable diagnostic performance (AUC 0.939) with a cutoff of < 94.9 mmol/L.</p><p><strong>Conclusion: </strong>Vomiting-related UGI disorders and RTDs both cause normotensive hypokalemia with renal K⁺ wasting. Notably, vomiting-related UGI disorders predominantly affect females with lower BMI and may be complicated by prerenal acute kidney injury (AKI). Serum Cl^- measurement serves as a valuable initial screening tool for suspected UGI disorders. Urinary K⁺ excretion markers have limited diagnostic value, and comprehensive urinary electrolyte analysis is required. Among all evaluated parameters, spot urine Cl^- concentration demonstrates the highest diagnostic performance.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monotypic IgA nephropathy: A large health system experience.","authors":"Hamza El Falah, Vanesa Bijol, Gashu Ayehu, Yonah C Ziemba, Kenar D Jhaveri, Jordan L Rosenstock","doi":"10.5414/CN112012","DOIUrl":"https://doi.org/10.5414/CN112012","url":null,"abstract":"<p><strong>Aims: </strong>IgA nephropathy (IgAN) is traditionally considered a polytypic disorder, although λ light chain predominance on immunofluorescence (IF) is common. In some cases, monotypic IgA (mIgA) staining is identified. Whether mIgA represents a variant of IgAN or should be classified as proliferative glomerulonephritis with monoclonal immune deposits (PGNMID) remains controversial, particularly in cases with isolated κ deposits or membranoproliferative (MP) or membranous patterns. We performed this study to characterize all mIgA cases in our institutional biopsy database, with emphasis on hematologic evaluation and clinical outcomes.</p><p><strong>Materials and methods: </strong>The Northwell Health kidney biopsy database was reviewed, identifying 8 mIgA cases (1.3% of IgA biopsies). Electronic medical records were reviewed for clinical, laboratory, histological, and follow-up data.</p><p><strong>Results: </strong>Five cases demonstrated κ restriction, and 3 showed λ. Median age was 42 years, and 75% were male. No patient had a known hematologic disorder at presentation. Median serum creatinine was 1.75 mg/dL. Histological patterns included mesangioproliferative +/- sclerosing (62.5%), sclerosing alone (25%), and MP (12.5%). Only 1 patient had a monoclonal gammopathy, but it was non-IgA. Bone marrow biopsies and flow cytometry revealed no hematologic neoplasms. One patient underwent blood mass spectrometry, which was negative. Treatments varied, and most patients achieved stable or improved renal function. One patient with a prior transplant and diabetic nephropathy developed thrombotic microangiopathy and entered hospice. Among 6 patients with follow-up (mean 39.5 months), none developed hematologic malignancy.</p><p><strong>Conclusion: </strong>These findings support the non-monoclonal nature of most mIgA cases, with no detectable clones at baseline or follow-up. Larger studies using advanced detection techniques are needed to clarify clonal risk and guide optimal therapy.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of tacrolimus in patients with lupus nephritis: A randomized controlled trials meta-analysis.","authors":"Dongming Wu, Jinli Dong, Ping Tan, Cuiqing Zeng","doi":"10.5414/CN111685","DOIUrl":"10.5414/CN111685","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the efficacy and safety of tacrolimus in the treatment of lupus nephritis (LN) by synthesizing data from randomized controlled trials (RCTs).</p><p><strong>Materials and methods: </strong>A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science for RCTs involving tacrolimus in patients with LN, published up to October 31, 2024. Eligible studies compared tacrolimus-either as monotherapy or in combination with agents such as prednisolone or mycophenolate mofetil (MMF) to control treatments like placebo or cyclophosphamide. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Statistical analyses were performed using Review Manager 5.3 and Stata 15. Standardized mean differences (SMDs) were used for continuous outcomes, and relative risks (RRs) for dichotomous outcomes.</p><p><strong>Results: </strong>Of the 484 records screened, 9 RCTs involving 1,187 patients met the inclusion criteria. Tacrolimus significantly reduced urine protein compared to MMF, placebo, and intravenous cyclophosphamide (SMD: -0.33, 95% CI: -0.48, -0.19, p < 0.0001). It also led to modest improvements in serum creatinine (SMD: 0.17, 95% CI: 0.03, 0.30, p = 0.01) and serum albumin (SMD: 0.19, 95% CI: 0.06, 0.31, p = 0.005). However, no significant differences were observed in SLE Disease Activity Index, proteinuria, or serum C3 levels (p > 0.05). Tacrolimus was associated with a slightly lower risk of adverse events, although the differences was not statistically significant (RR: 0.96, 95% CI: 0.86 - 1.07, p = 0.46). Sensitivity analyses indicated some instability in the results for urine protein and serum creatinine.</p><p><strong>Conclusion: </strong>Tacrolimus appears effective in improving select renal biomarkers in patients with LN, particularly in reducing urine protein and improving serum creatinine and serum albumin levels. However, it showed no significant benefit in other clinical disease activity markers when compared to standard therapies. Although associated with a sightly lower incidence of adverse events, the overall quality of evidence was moderate to low. Further high-quality studies are warranted to confirm these findings.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"85-95"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of thyroid dysfunction in patients with primary nephrotic syndrome: A single-center retrospective cohort study.","authors":"Longzhu Li, Meijun Wu, Xin Yang, Ying Zeng, Dan Wen, Qing Deng, Jingchun Yao, Jinlei Lv","doi":"10.5414/CN111942","DOIUrl":"10.5414/CN111942","url":null,"abstract":"<p><strong>Objective: </strong>Research on autoimmune diseases has revealed multi-organ interactions, including thyroid-renal associations. This study aims to investigate the clinical features of primary nephrotic syndrome (PNS) patients with thyroid dysfunction, assess the impact of thyroid autoantibodies (anti-TPO Ab and anti-Tg Ab) on renal damage, and identify risk factors for thyroid dysfunction to facilitate early clinical intervention.</p><p><strong>Materials and methods: </strong>A total of 175 PNS patients diagnosed between January 2023 and June 2024 were enrolled. Thyroid function and autoantibodies were measured upon admission. Comparisons were made between groups with normal and abnormal thyroid function, and between autoantibody-positive and double-negative patients. Logistic regression was used to analyze risk factors for thyroid dysfunction.</p><p><strong>Results: </strong>A total of 134 patients were identified with thyroid dysfunction. The abnormal group showed higher total cholesterol, triglycerides, low-density lipoprotein cholesterol, and 24-hour urinary protein (UP), and lower total protein, albumin (ALB), calcium, immunoglobulin G, and immunoglobulin A. Autoantibody-positive patients had higher TSH, 24-hour UP, and urinary albumin-to-creatinine ratio, and lower FT4 (p < 0.05), though renal pathology did not differ significantly. Logistic regression analysis identified reduced ALB (OR = 0.900, 95% CI 0.815 - 0.993, p = 0.036) and elevated 24-hour UP (OR = 1.192, 95% CI 1.040 - 1.368, p = 0.012) as independent risk factors.</p><p><strong>Conclusion: </strong>Thyroid dysfunction is common in PNS and is associated with more severe proteinuria and hypoalbuminemia, though not with specific pathological types. Thyroid autoimmunity was not an independent predictor; however, antibody-positive patients had significantly higher TSH and proteinuria levels. Routine thyroid function and antibody screening are recommended for early intervention in PNS patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"390-398"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult male Fournier gangrene hospitalizations with and without end-stage kidney disease: A 5-year nationwide analysis.","authors":"Jay Manadan, William Whittier","doi":"10.5414/CN111912","DOIUrl":"10.5414/CN111912","url":null,"abstract":"<p><strong>Introduction: </strong>Fournier gangrene (FG) is a severe acute necrotizing fasciitis affecting the genitalia and carries a high mortality. Patients with end-stage kidney disease (ESKD) are an overlooked but potentially vulnerable subgroup given their high burden of comorbidities. As such, we aimed to study FG in those with and without ESKD.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of all adult male FG hospitalizations from 2017 - 2021 in the National Inpatient Sample (NIS) database. We sought to identify independent predictors of in-hospital mortality. Univariable logistic regression analyses were used to calculate unadjusted odds ratios (OR) for an outcome of in-hospital death. All variables with p-values ≤ 0.2 were included in a multivariable logistic regression model. P-values ≤ 0.05 were considered significant in the multivariable analysis.</p><p><strong>Results: </strong>Among 35,415 adult hospitalizations with FG in the NIS database, 2,210 (6.2%) had ESKD. Those with FG and ESKD, compared to those without ESKD, had higher rates of diabetes mellitus (DM) (85.3 vs. 65.1%; p < 0.001), higher in-hospital mortality (13.4 vs. 5.3%; p < 0.001), greater median length of stay (LOS) (10 vs. 8 days; p < 0.001), and greater median total hospital charges (USD 119,402 vs. 89,108; p < 0.001). The prevalence of sepsis was very high but similar between the groups (59.7 vs. 56.8%; p = 0.230). Multivariable analysis revealed the following factors were independently associated with higher odds of in-hospital death: age (OR 1.04; 95% CI: 1.033 - 1.055), alcohol abuse (OR 2.31; 95% CI: 1.622 - 3.278), and ESKD (OR 3.14; 95% CI: 2.279 - 4.331).</p><p><strong>Conclusion: </strong>Patients with ESKD represent a distinct and high-risk subgroup, characterized by longer hospital LOS, increased total hospital charges, and over three-fold increased odds of in-hospital death. Comorbid DM was found in the majority of cases suggesting it was a strong FG risk factor, but DM itself did not independently increase the odds of in-hospital death. Sepsis was a very common complication and the most frequent cause of death. These findings underscore the need for targeted management strategies and early recognition of high-risk features in FG patients, particularly those with underlying ESKD, to improve outcomes in this severe and complex condition.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"384-389"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress hyperglycemia ratio emerges as a novel independent predictor of acute kidney injury among critically ill patients with acute heart failure: A retrospective analysis of the MIMIC-IV database.","authors":"Keran Xie, Siqi Gao, Xinran Liu, Aibin Cheng, Runhao Liang, Jianjun Wang, Jianmin Li, Junjie Liu","doi":"10.5414/CN111989","DOIUrl":"10.5414/CN111989","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) frequently complicates acute heart failure (AHF), predicting worse outcomes. Early risk identification is crucial. The stress hyperglycemia ratio (SHR), reflecting acute dysglycemia, may predict AKI, but its utility in AHF remains unestablished.</p><p><strong>Materials and methods: </strong>We analyzed 1,241 AHF patients stratified by SHR. Associations with outcomes were assessed using logistic and Cox regression. The relationship between continuous SHR and AKI development was evaluated with restricted cubic splines (RCS). The primary endpoint was incident AKI during hospitalization.</p><p><strong>Results: </strong>AKI occurred in 79.7% of patients. After multivariable adjustment, SHR demonstrated a linear association with AKI risk. For 28-day mortality, the relationship with SHR was U-shaped, with an inflection point at 0.841. An SHR > 0.841 was associated with significantly increased mortality (OR = 2.086; 95% CI: 1.368 - 3.182). An elevated SHR was consistently associated with higher AKI risk across all patient subgroups, with an overall adjusted OR of 1.60 (95% CI: 1.15 - 2.22).</p><p><strong>Conclusion: </strong>The study demonstrates a linear association between the SHR and AKI, in contrast to a U-shaped relationship with 28-day in-hospital mortality among AHF patients. An SHR of 0.841 represents a critical threshold for evaluating in-hospital mortality risk.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"399-413"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of prediction models for cardiovascular disease mortality risk in maintenance hemodialysis patients based on nomogram and CART algorithm.","authors":"Xiaona He, Xu Zhang, Nan Mao, Yalan Zhang, Xin Ma","doi":"10.5414/CN111819","DOIUrl":"10.5414/CN111819","url":null,"abstract":"<p><strong>Background: </strong>Patients on maintenance hemodialysis (MHD) face a dramatically elevated risk of cardiovascular death, which is 10 - 20 times higher than in the general population. To address this high risk, we developed and validated a prediction model to accurately estimate cardiovascular disease (CVD) mortality and guide preemptive clinical management.</p><p><strong>Materials and methods: </strong>This study retrospectively collected data from MHD patients at the First Affiliated Hospital of Chengdu Medical College from 2016 to 2021 (Approval No. CYFYEC-C-005), including demographic characteristics, medical history, biochemical indicators, and echocardiogram indices. Variables were screened using univariate logistic regression and stepwise regression to construct a nomogram model. The dataset was randomly divided (6 : 4) into training and validation sets, and a classification and regression tree (CART) decision tree model was also constructed. Both models' discrimination, calibration, and clinical utility were evaluated.</p><p><strong>Results: </strong>The nomogram identified systolic blood pressure, uric acid, total cholesterol, diabetes, myoglobin, serum albumin, and procalcitonin as predictors, with an AUC of 0.947 (95% CI: 0.903 - 0.991) and good clinical applicability. The CART model identified serum albumin, procalcitonin, and myoglobin as predictors, categorizing the population into four groups. AUC values were 0.933 (95% CI: 0.851 - 1.000) in the training set and 0.774 (95% CI: 0.612 - 0.936) in the validation set.</p><p><strong>Conclusion: </strong>In conclusion, this study consistently identified serum albumin, procalcitonin, and myoglobin as key factors associated with CVD mortality risk in MHD patients. Both models demonstrated promising predictive performance in our cohort. These findings suggest the potential of such models to inform clinical risk assessment. However, external validation in larger, multi-center studies is necessary before these tools can be considered for direct clinical decision-making.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"370-383"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}