{"title":"The triglyceride-glucose index and acute kidney injury risk in critically ill patients with coronary artery disease.","authors":"Yi Zhang, Gang Li, Junjie Li, Bohao Jian, Keke Wang, Jiantao Chen, Jian Hou, Jianbo Liao, Zhuoming Zhou, Zhongkai Wu, Mengya Liang","doi":"10.1080/0886022X.2025.2466818","DOIUrl":"10.1080/0886022X.2025.2466818","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index, proven a reliable and simple surrogate of insulin resistance, has shown potential associations with cardiovascular outcomes and renal diseases. This research delved into the utility of the TyG index in predicting the risk of acute kidney injury (AKI) in patients with coronary artery disease (CAD), an area not extensively covered in existing literature.</p><p><strong>Methods: </strong>A cohort of patients with CAD was recruited from the Medical Information Mart for Intensive Care-IV database, and categorized into quartiles based on their TyG index. The primary outcome was AKI incidence, and the secondary outcome was renal replacement therapy (RRT). Scatterplot histograms, cox proportional hazards models, Kaplan-Meier survival curves, and restricted cubic splines were employed to investigate the association between the TyG index and the risk of AKI in patients with CAD.</p><p><strong>Results: </strong>A total of 1,501 patients were enrolled in this study, predominantly male (61.56%), with a median age of 69.80 years. The AKI incidence was 67.22% among all patients, with the AKI stages increased with higher TyG levels (<i>P</i> for trend <0.001). The Kaplan-Meier survival analyses demonstrated statistically significant differences in AKI incidence and RRT application throughout the entire cohort, stratified by the TyG index quartiles (<i>p</i> < 0.001). Additionally, the restricted cubic spline analysis revealed a non-linear association between the TyG index and the risk of AKI (<i>P</i> for non-linear =0.637). Both multivariate Cox proportional hazards analyses (HR 1.62; 95% CI 1.15-2.27; <i>p</i> = 0.005) and multivariate logistic regression analyses (OR 2.16; 95% CI 1.18-3.94; <i>p</i> = 0.012) showed that the elevated TyG index was significantly related to AKI incidence. The association between TyG index and the risk of AKI is more significant in patients without diabetes (HR 1.27; 95% CI 1.14-1.42; <i>p</i> < 0.001), compared to patients with diabetes (<i>P</i> for interaction =0.013).</p><p><strong>Conclusions: </strong>In summary, the TyG index emerged as a reliable predictor for the occurrence of AKI in CAD patients during ICU stay. Furthermore, it is also anticipated to serve as a valuable indicator for non-diabetic patients in predicting the incidence of AKI.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2466818"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal FailurePub Date : 2025-12-01Epub Date: 2025-02-16DOI: 10.1080/0886022X.2025.2463579
Yuqin Xiong, Yan Wang, Xiaoqin He, Yi Ruan, Yue Wen, Yang Yu, Ping Fu
{"title":"Long-term outcomes of refractory central venous occlusive disease treated by stent deployment in patients undergoing maintenance hemodialysis.","authors":"Yuqin Xiong, Yan Wang, Xiaoqin He, Yi Ruan, Yue Wen, Yang Yu, Ping Fu","doi":"10.1080/0886022X.2025.2463579","DOIUrl":"10.1080/0886022X.2025.2463579","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the long-term outcomes of stent deployment in the treatment of refractory central venous occlusive disease (CVOD) in patients undergoing maintenance hemodialysis (MHD).</p><p><strong>Methods: </strong>MHD patients who were successfully treated with stenting for symptomatic CVOD that was resistant to balloon angioplasty alone were consecutively included in this retrospective study. The primary (PPR) and assisted (APR) patency rates of the central vein and hemodialysis vascular access (VA), reintervention, and survival rates after stenting were followed. Multivariate logistic regression analyses were conducted to determine the factors influencing VA abandonment and mortality.</p><p><strong>Results: </strong>The cohort comprised 65 patients (52.3% male) aged 61.5 ± 13.5 years, with a mean dialysis vintage of 54.7 ± 39.1 months. During 40 (20-54) months of follow-up, symptomatic CVOD recurred in 32 (49.2%) patients, accounting for 51 secondary angioplasties, including 34 stenting procedures. The PPR and APR at 12, 24, 36, 48, and 60 months were 81%, 52%, 47%, 41%, and 41% and 98%, 98%, 82%, 82%, and 82%, respectively. VA abandonment was noted in 10 (15.4%) patients. Six (9.2%) and 17 (26.2%) patients died due to cardiovascular conditions and all causes, respectively. The number of secondary stenting procedures was significantly associated with decreased VA abandonment [odds ratio (OR) = 0.089, 95% confidence interval (CI): 0.008-0.992, <i>p</i> = 0.049] and all-cause mortality (OR = 0.104, 95% CI: 0.011-0.947, <i>p</i> = 0.045).</p><p><strong>Conclusions: </strong>Angioplasty with stenting is an effective and promising strategy for MHD patients with refractory CVOD.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2463579"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal FailurePub Date : 2025-12-01Epub Date: 2025-05-07DOI: 10.1080/0886022X.2025.2495861
Jialing Rao, Yuanqing Li, Xiaohao Zhang, Wenbo Zhao, Yanru Chen, Jun Zhang, Hui Peng, Zengchun Ye
{"title":"The prognostic value of the neutrophil-percentage-to-albumin ratio for all-cause and cardiovascular mortality in chronic kidney disease stages G3a to G5: insights from NHANES 2003-2018.","authors":"Jialing Rao, Yuanqing Li, Xiaohao Zhang, Wenbo Zhao, Yanru Chen, Jun Zhang, Hui Peng, Zengchun Ye","doi":"10.1080/0886022X.2025.2495861","DOIUrl":"https://doi.org/10.1080/0886022X.2025.2495861","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) stages G3a to G5 frequently experience heightened systemic inflammation and nutritional loss. Identifying laboratory-accessible, cost-effective markers that can effectively predict the prognosis of CKD stages G3a to G5 is crucial.</p><p><strong>Methods: </strong>This prospective cohort study included 3,331 patients with CKD stages G3a to G5 who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Multivariable adjusted Cox proportional hazards regression models and restricted cubic spline analyses were used to assess the associations of neutrophil percentage-to-albumin ratio (NPAR) levels with all-cause mortality, CVD, and non-CVD mortality.</p><p><strong>Results: </strong>The cohort study encompassed data from 3,331 participants for analysis. Nonlinear J-shaped associations were observed between NPAR levels and the risk of all-cause, CVD, and non-CVD mortality in patients with CKD stages G3a to G5. High levels NPAR exhibited a significantly elevated risk of both all-cause and CVD mortality in the fully adjusted model. The respective hazard ratios (HRs) for all-cause mortality were 1.23 [95% confidence interval (CI), 1.05-1.44], and for CVD mortality, 1.513 (95% CI, 1.131-2.024).</p><p><strong>Conclusions: </strong>Elevated NPAR can predict both all-cause and CVD deaths in advanced CKD patients. Individuals with high NPAR levels face an elevated risk of mortality and exhibit a decreased survival rate in the context of CKD. This finding offers evidence supporting the timely evaluation and intervention for inflammation and nutritional status in individuals with CKD stages G3a to G5.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2495861"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal FailurePub Date : 2025-12-01Epub Date: 2025-04-23DOI: 10.1080/0886022X.2025.2492374
Abdul Hamid Borghol, Marie Therese Bou Antoun, Christian Hanna, Mahdi Salih, Frederic F Rahbari-Oskoui, Fouad T Chebib
{"title":"Autosomal dominant polycystic kidney disease: an overview of recent genetic and clinical advances.","authors":"Abdul Hamid Borghol, Marie Therese Bou Antoun, Christian Hanna, Mahdi Salih, Frederic F Rahbari-Oskoui, Fouad T Chebib","doi":"10.1080/0886022X.2025.2492374","DOIUrl":"https://doi.org/10.1080/0886022X.2025.2492374","url":null,"abstract":"<p><p>Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disease, characterized by the progressive development of multiple kidney cysts, leading to a gradual decline in kidney function. ADPKD is also the fourth leading cause of kidney failure (KF) in adults. In addition to kidney manifestations, ADPKD is associated with various extrarenal features, including liver cysts, cardiovascular abnormalities, intracranial aneurysms, and chronic pain with significant impact on patients' quality of life. While several disease-modifying agents have been tested in ADPKD, tolvaptan remains the only approved drug by the US Food and Drug Administration. The Mayo Imaging Classification is currently the most practical tool for predicting rate of kidney disease progression in ADPKD. This review provides a comprehensive overview of ADPKD, focusing on its genetics, pathophysiology, clinical presentation, management, and prognostic tools. Advances in diagnostic imaging and genetic testing have improved the early detection of ADPKD, allowing better classification of patients and prediction of KF. The review also discusses current therapeutic approaches to ADPKD, including tolvaptan, a vasopressin V2-receptor antagonist. Additionally, we address specific issues in children and pregnant individuals with ADPKD. Despite substantial progress in understanding ADPKD, there is a large need for additional effective treatments and prognostic markers to provide a more personalized care for these patients.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2492374"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Application value of weight-adjusted waist circumference index and cardiometabolic index in hypertensive patients with albuminuria: results from the National Health and Nutrition Examination Survey 2005-2020.","authors":"Yulu Yang, Jianwu Huang, Jiacheng Wu, Xuehan Li, Yalei Wang, Hao Chen, Zhihua Qiu, Zihua Zhou","doi":"10.1080/0886022X.2025.2506813","DOIUrl":"10.1080/0886022X.2025.2506813","url":null,"abstract":"<p><strong>Background: </strong>The Weight-adjusted Waist Index (WWI) and Cardiometabolic Index (CMI) are novel metrics developed to evaluate visceral fat distribution and metabolic health. This study aimed to explore the associations between these indices and albuminuria in hypertensive patients.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES), obtained between 2005 and 2020. Multivariate logistic regression models, generalized additive models, and smooth curve fitting were employed to examine the relationships between WWI, CMI, and albuminuria. Nonlinear associations were further investigated using a piecewise linear model to identify inflection points. Subgroup analyses were performed, and the diagnostic performance of these indices was evaluated using Receiver Operating Characteristic (ROC) curves.</p><p><strong>Results: </strong>After adjusting for potential confounders, both WWI and CMI were significantly associated with increased odds of albuminuria (OR = 1.37 and 1.09, respectively). The relationship between WWI and urinary albumin-creatinine ratio (UACR) exhibited a nonlinear pattern, with an inflection point at 11.65. For WWI values lower than 11.65, significant correlations were observed. Subgroup analysis revealed a stronger association between WWI and albuminuria in males. ROC curve analysis indicated that WWI outperformed CMI in detecting albuminuria, with CMI showing slightly lower diagnostic accuracy. When combined with other clinical indicators, the integrated area under the curve (AUC) reached 0.732.</p><p><strong>Conclusion: </strong>Both WWI and CMI demonstrated significant associations with albuminuria in hypertensive patients, highlighting their potential utility in disease screening. Clinical attention should be directed toward individuals with WWI below 11.65, particularly male subjects, as this threshold was associated with significantly increased prevalence of albuminuria.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2506813"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal FailurePub Date : 2025-12-01Epub Date: 2025-02-17DOI: 10.1080/0886022X.2025.2455524
Lin Li, Wenbin Xu, Yiqian Fang, Qian Jiang, Yanfei Zhou, Yan Chen, Qian Yang
{"title":"Construction and validation of a fall risk prediction model in elderly maintenance hemodialysis patients: a multicenter prospective cohort study.","authors":"Lin Li, Wenbin Xu, Yiqian Fang, Qian Jiang, Yanfei Zhou, Yan Chen, Qian Yang","doi":"10.1080/0886022X.2025.2455524","DOIUrl":"10.1080/0886022X.2025.2455524","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the risk factors for falls in elderly maintenance hemodialysis patients, construct a nomogram prediction model and validate the application.</p><p><strong>Background: </strong>Elderly maintenance hemodialysis patients face a high risk of falls, and there are fewer and less effective fall-specific assessment tools.</p><p><strong>Method: </strong>A total of 871 elderly hemodialysis patients from 9 hospitals in Chengdu City from October 2023 to December 2024 were selected as the study objects. Baseline characteristics and fall outcomes of patients in the fall group and non-fall group were recorded and compared through 6-month follow-up. Multivariable logistic regression analysis was employed to identify independent risk factors, and construct the nomogram prediction model and complete the internal verification of the model. 218 elderly maintenance hemodialysis patients from three other hospitals in Chengdu City were selected for a 6-month follow-up of falls from January to February 2024 to complete the external validation of the model.</p><p><strong>Result: </strong>The incidence of falls in elderly maintenance hemodialysis patients was 31.96%, and logistic regression analysis showed that age, sex, visual impairment, intradialytic hypotension, cognitive impairment and depression were independent risk factors for falls. Both internal and external validation of the model demonstrated area under the curve greater than 0.80. Furthermore, calibration plots, the Hosmer-Lemeshow test, and clinical decision curves all demonstrated that the model had good calibration and clinical utility.</p><p><strong>Conclusion: </strong>The nomogram constructed based on the above risk factors can provide scientific basis and practical tools for early clinical identification of high-risk groups of falls.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2455524"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal FailurePub Date : 2025-12-01Epub Date: 2025-06-08DOI: 10.1080/0886022X.2025.2513016
Yunfei Xiao, Yaqing Yang, Hao Zhang, Jia Wang, Tao Lin, Yunjin Bai
{"title":"Healthy Eating Index-2015, a protective factor for mitochondria-derived methylmalonic acid in the low poverty/income ratio with chronic kidney diseases: results from NHANES 2011-2014.","authors":"Yunfei Xiao, Yaqing Yang, Hao Zhang, Jia Wang, Tao Lin, Yunjin Bai","doi":"10.1080/0886022X.2025.2513016","DOIUrl":"10.1080/0886022X.2025.2513016","url":null,"abstract":"<p><strong>Objective: </strong>Serum methylmalonic acid (MMA) arises from impaired metabolism of methylmalonyl-CoA and is exacerbated in chronic kidney disease (CKD) due to reduced renal clearance and nutritional deficiencies. The quality of diet may influence MMA levels by affecting vitamin B12 intake and mitigating inflammatory dietary components. This study aims to explore the relationship between the Healthy Eating Index-2015 (HEI-2015) and the prevalence of high MMA among low poverty/income ratio (PIR) patients with CKD.</p><p><strong>Method: </strong>We conducted a cross-sectional study of participants aged ≥20 years using the data drawn from the NHANES 2011-2014. Individuals under low PIR suffering from CKD were included. HEI-2015 was calculated to evaluate diet quality. Multivariable logistic regression models were applied to examine the association between HEI-2015 and high MMA prevalence with covariates adjusted. Stratified and interaction analysis were also performed.</p><p><strong>Results: </strong>A total of 582 CKD patients with low PIR were enrolled. The logistic analysis showed that higher HEI-2015 was significantly associated with a lower prevalence of high MMA. Patients in the highest quartile of HEI-2015 scores (>61.17) showed a 57.8% reduction in high MMA prevalence compared to those in the lowest quartile. Subgroup and interaction analysis revealed that alcohol consumption reduced the diet quality-related protection against high MMA.</p><p><strong>Conclusion: </strong>The protective role of high-quality diets, as reflected by HEI-2015, in reducing the prevalence of high MMA in low PIR CKD patients is noteworthy. Improving diet quality in this population could potentially mitigate the risks associated with high MMA in CKD patients with low PIR.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2513016"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal FailurePub Date : 2025-12-01Epub Date: 2025-06-23DOI: 10.1080/0886022X.2025.2512404
Quanchao Zhang, Caibao Lu, Zhifen Wu, Shaofa Wu, Lili Jiang, Han Wang, Jin He, Bingshuang Tang, Bingfeng Yang, Shengli Liao, Liao Wang, Hongwei Chen, Moqi Li, Wenchang He, Yiqin Wang, Jie Li, Jinghong Zhao, Ling Nie
{"title":"C-reactive protein-to-prealbumin ratio as prognostic marker in hemodialysis patients with Omicron infection.","authors":"Quanchao Zhang, Caibao Lu, Zhifen Wu, Shaofa Wu, Lili Jiang, Han Wang, Jin He, Bingshuang Tang, Bingfeng Yang, Shengli Liao, Liao Wang, Hongwei Chen, Moqi Li, Wenchang He, Yiqin Wang, Jie Li, Jinghong Zhao, Ling Nie","doi":"10.1080/0886022X.2025.2512404","DOIUrl":"10.1080/0886022X.2025.2512404","url":null,"abstract":"<p><strong>Background: </strong>Hemodialysis patients frequently experience chronic inflammation and malnutrition, while C-reactive protein to prealbumin ratio (CP ratio) is a comprehensive assessment approach of inflammatory and nutritional status. Howerer, there is limited research on the prognostic value of the CP ratio specifically in hemodialysis patients infected with the Omicron variant.</p><p><strong>Methods: </strong>Data from 847 hemodialysis patients, diagnosed with Omicron across 6 hemodialysis centers between December 2022 and February 2023, were analyzed. Hazard ratios were estimated using univariate and multivariable Cox regression, and receiver operating characteristic curves were used to evaluate the predictive abilities. Survival rate differences between higher and lower CP ratio groups were analyzed using the Kaplan-Meier method.</p><p><strong>Results: </strong>From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month post-infection. C-reactive protein, prealbumin, and CP ratio were all associated with all-cause mortality in the crude model. After adjusting for other confounding factors, the CP ratio remained an independent risk factor for all-cause mortality (HR 1.97; 95% CI 1.07-3.63; <i>p</i> = 0.029). In addition, we also found that the CP ratio has better discriminatory ability, than the C-reactive protein to albumin ratio (areas under the curve; 0.84 vs. 0.80; Z-test; <i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>This study underscores that CP ratio substantially influence the mortality rates in hemodialysis patients following Omicron infection. Careful monitoring and consideration of the CP ratio could inform more effective patient management strategies, potentially leading to reduced mortality rates in this vulnerable group.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2512404"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Leveraging large language models for preoperative prevention of cardiopulmonary bypass-associated acute kidney injury.","authors":"Kai Wang, Ling Lin, Rui Zheng, Shan Nan, Xudong Lu, Huilong Duan","doi":"10.1080/0886022X.2025.2509786","DOIUrl":"10.1080/0886022X.2025.2509786","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) usually occurs after cardiopulmonary bypass (CPB) and threatens life without timely intervention. Early assessment and prevention are critical for saving AKI patients. However, numerical data-driven models make it difficult to predict the AKI risk using preoperative data and lack preventive measures. Large language models (LLM) have demonstrated significant potential for medical decision-making, offering a promising approach.</p><p><strong>Objective: </strong>For preoperative assessment and prevention of CPB-associated AKI (CPB-AKI).</p><p><strong>Methods: </strong>Clinical variables were converted into text through prompt engineering and a LLM was used to extract information hidden in the semantics of subtle changes. A multimodal fusion model, fuzing semantic and numerical information, was proposed to assess the AKI risk before surgery. We then used a structural equation model to analyze the impact of preoperative features and intraoperative interventions on CPB-AKI prevention.</p><p><strong>Results: </strong>A total of 2,056 patients who underwent CPB were enrolled from the intensive care unit of Sir Run Run Shaw Hospital between 2014 and 2022, with 40.5% progressing to AKI. Our model performed better with an area under the receiver operating characteristic curve of 0.9201 compared with the baseline models. The structural equation model's chi-square to degrees of freedom ratio was 0.46, less than 2.0. We discussed how the preoperative prediction model could optimize intraoperative interventions to prevent CPB-AKI.</p><p><strong>Conclusions: </strong>The prediction model can predict CPB-AKI risk earlier after fuzing the clinical characteristics and their semantics. Preoperative assessment and intraoperative interventions provide decision-making to prevent CPB-AKI.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2509786"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal FailurePub Date : 2025-12-01Epub Date: 2025-06-26DOI: 10.1080/0886022X.2025.2519822
Meng-Huan Wu, Yu-Ting Gao, Yu-Xin Ren, Wen Zhou, Jing Zheng, Shi-Mei Hou, Yao Wang, Jing-Yuan Cao, Xiao-Xu Wang, Yan Yang, Bin Wang, Min Yang, Jing-Ting Jiang, Min Li
{"title":"Mediation effects of age, intramuscular adipose tissue index and serum albumin on survival status in initial dialysis patients.","authors":"Meng-Huan Wu, Yu-Ting Gao, Yu-Xin Ren, Wen Zhou, Jing Zheng, Shi-Mei Hou, Yao Wang, Jing-Yuan Cao, Xiao-Xu Wang, Yan Yang, Bin Wang, Min Yang, Jing-Ting Jiang, Min Li","doi":"10.1080/0886022X.2025.2519822","DOIUrl":"10.1080/0886022X.2025.2519822","url":null,"abstract":"<p><strong>Background: </strong>To explore the associations of age, intramuscular adipose tissue index (IATI), and serum albumin with survival status in initial dialysis patients and the mediating effects.</p><p><strong>Methods: </strong>Totally 1,044 Chinese initial dialysis patients from four hospitals (2014-2020) were eventually enrolled and followed up to December 31, 2022 or until death in this retrospective cohort study. IATI was defined as the ratio of low attenuation muscle density to skeletal muscle density assessed by CT at the first lumbar vertebra level. Multivariate Cox regression and two-piecewise Cox proportional hazards models were used to determine the risk factors for all-cause mortality and to perform stratified analysis. Mediation analysis was conducted to identify mediators.</p><p><strong>Results: </strong>High IATI, age > 60 years, and low serum albumin were significant independent risk factors for all-cause mortality. The association between IATI and all-cause mortality remained significant in female patients, and those with low neutrophil/lymphocyte ratios, or without coronary heart disease. When age and IATI were categorical variables, age had a significant indirect effect on all-cause mortality (0.015) and survival time (-1.262) <i>via</i> IATI, while IATI indirectly influenced all-cause mortality through serum albumin (0.012).</p><p><strong>Conclusions: </strong>Age > 60 years and high IATI are risk factors for all-cause mortality while serum albumin is protective in initial dialysis patients. The relationship between age and survival status may be mediated by IATI, while the effect of IATI on all-cause mortality may be mediated by serum albumin.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2519822"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}