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BACKGROUND: According to the trend of global population aging, the proportion of elderly patients with chronic kidney disease (CKD) is expected to increase. However, there are more than 20 million people in China with decompensated kidney function, of which 19.25% are elderly people. Therefore, special attention should be paid to the education years, sleep quality, anxiety status, comorbidities with diabetes, cardiovascular disease (CVD), and anemia as independent risk factors for depression in elderly CKD patients. This study explores the clinical mana-gement of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis. AIM: To investigate depression risk factors in older patients receiving peritoneal dialysis, aiding future prevention of depression in these patients. METHODS: This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022. We assessed the patients' mental status using the Beck Depression Inventory Score-II (BDI-II), Self-Rating Anxiety Scale (SAS), Anxiety Inventory Score, and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was employed to identify depression independent risk factors among these patients. RESULTS: The non-depressed group had a significantly longer education period than the depressed group (P < 0.05). The depressed group exhibited significantly higher mental status scores than the non-depressed group (P < 0.001). Patients with diabetes mellitus (DM) or CVD had a higher probability of developing dep-ression. Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression (P < 0.05). Spearman correlation analysis of BDI-II scale scores, measuring depression, indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD. In contrast, years of education, hemoglobin levels, and peritoneal Kt/V were negatively correlated, serving as protective factors against depression. An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling, BDI-II, SAS, PSQI, DM, CVD, and hemoglobin levels independently influenced depression in older patients with CKD. CONCLUSION: Education, BDI-II, SAS, PSQI, DM, and CVD are independent risk factors for depression in older patients with CKD; therefore, post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.

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BACKGROUND: Diabetic nephropathy (DN) is frequently seen in the development of diabetes mellitus, and its pathogenic factors are complicated. Its current treatment is controversial, and there is a lack of a relevant efficacy prediction model. AIM: To determine the effects of paricalcitol combined with hemodiafiltration on bone-metabolism-related indexes in patients with DN and chronic renal failure (CRF), and to construct an efficacy prediction model. METHODS: We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022. We selected 94 patients who met the inclusion and exclusion criteria. Patients were assigned to a dialysis group (n = 45) and a joint group (n = 49) in relation to therapeutic regimen. The clinical efficacy of the two groups was compared after treatment. The changes in laboratory indexes after treatment were evaluated, and the two groups were compared for the incidence of adverse reactions. The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed. RESULTS: The dialysis group showed a notably worse improvement in clinical efficacy than the joint group (P = 0.017). After treatment, the joint group showed notably lower serum levels of serum creatinine, uric acid (UA) and blood urea nitrogen (BUN) than the dialysis group (P < 0.05). After treatment, the joint group had lower serum levels of phosphorus, procollagen type I amino-terminal propeptide (PINP) and intact parathyroid hormone than the dialysis group, but a higher calcium level (P < 0.001). Both groups had a similar incidence of adverse reactions (P > 0.05). According to least absolute shrinkage and selection operator regression analysis, UA, BUN, phosphorus and PINP were related to treatment efficacy. According to further comparison, the non-improvement group had higher risk scores than the improvement group (P < 0.0001), and the area under the curve of the risk score in efficacy prediction was 0.945. CONCLUSION: For treatment of CRF and DN, combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients, with good safety.

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INTRODUCTION: Cardiovascular disease is the most common cause of death and morbidity in patients with end-stage renal disease. Sacubitril/valsartan (SAC/VAL) can reduce the risk of cardiovascular mortality among patients with heart failure (HF). The present study set out to evaluate the efficacy of SAC/VAL in the treatment of patients with HF with preserved ejection fraction (HFpEF) undergoing peritoneal dialysis (PD) (HFpEF&PD). METHODS: A total of 160 patients with HFpEF&PD were enrolled and randomly divided into the control group (N = 80) and SAC/VAL group (N = 80). The cardiac function efficacy, HF scoring efficacy, echocardiographic parameters, serological indicators, and 6-minute walking test were compared before and after treatment. RESULTS: After 6 months of treatment, the total number of patients who responded to treatment in the SAC/VAL group was higher than that of the control group in terms of cardiac function and HF scoring efficacy. After treatment, levels of early diastolic/late diastolic filling velocity and left ventricular ejection fraction were increased in both groups, while the levels of left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, inter-ventricular septal diameter, and left ventricular posterior wall diameter were decreased; the NT-proBNP levels were diminished in both groups, while hemoglobin levels and the 6-minute walk distance were increased; the systolic blood pressure, diastolic blood pressure, and 24-h ultrafiltration volume were lowered in all patients. The changes in these indexes in the SAC/VAL group were more obvious than those in the controls. CONCLUSION: SAC/VAL can significantly improve cardiac function in patients with HFpEF&PD.

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To analyze the changes and correlation of Mir-129 and Mir-29A-5p in vascular calcification in end-stage renal disease. A total of 97 patients with end-stage renal disease admitted to our hospital from August 2021 to August 2020 were selected as the research objects, and another 97 healthy people who underwent physical examination in our hospital during the same period were selected as the control study. According to X-ray examination, 97 subjects were divided into the vascular calcification group (39 cases) and the non-vascular calcification group (58 cases). Blood samples were extracted from each group, and the expressions of serum Mir-129 and Mir-29A-5p were detected by RT-PCR after centrifugation. The expressions of Mir-129 and Mir-29A-5p in healthy people with end-stage renal disease and vascular calcification were analyzed. To analyze the correlation of Mir-129 and Mir-29A-5p in vascular calcification of end-stage renal disease and its correlation with vascular calcification of end-stage renal disease. Compared with healthy people, the expression of Mir-129 and Mir-29A-5p in patients with the end-stage renal disease was abnormally increased, and there was a difference between the two groups (P<0.05). The expression levels of Mir-129 and Mir-29A-5p in patients with end-stage renal disease without vascular calcification were lower than those in the vascular calcification group, and there were differences between the two groups (P<0.05). Compared with mild vascular calcification, mir-129 and Mir-29A-5p expressions were higher in moderate and severe vascular calcification patients. In addition, compared with moderate patients, the expressions of Mir-129 and Mir-29a-5p were lower in mild patients and higher in severe patients. The expressions of Mir-129 and Mir-29A-5p in patients with mild and moderate vascular calcification were lower than those in patients with severe vascular calcification, and there were differences among the three groups (P < 0.05). Mir-129 and Mir-29A-5p were positively correlated with vascular calcification in end-stage renal disease (R =5.426, P=0.001). Mir-129 was positively correlated with vascular calcification in end-stage renal disease (r=0.649, P=0.001). Mir-29a-5p was positively correlated with vascular calcification in end-stage renal disease (r=0.529, P=0.001). Mir-129 and Mir-29a-5p showed high expression in the patients with end-stage renal disease, and they also increased with the occurrence of vascular calcification, and they showed a positive correlation in the vascular calcification of end-stage renal disease.

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The objective of the current study was to analyze the expression of mir-29a-5p, osteosclerotin and fetuin-A in patients with chronic kidney disease and their correlation with vascular calcification. For this purpose, 162 patients with chronic kidney disease treated in our hospital from January 2020 to January 2022 were selected retrospectively, and then 162 healthy people who underwent physical examination with our hospital in the same period were selected. The expressions of serum mir-29a-5p, sclerostin and fetuin-A were analyzed after fasting venous blood was drawn from the two groups. According to the coronary artery calcification score (CACS), patients with chronic kidney disease were divided into the calcification group (69 cases) and the non-calcification group (93 cases). The expressions of mir-29a-5p, sclerostin and fetuin-A in the two groups were analyzed, and the correlation between the three in chronic kidney disease and vascular calcification was analyzed. Results showed that compared with the control group, the expression of mir-29a-5p and sclerostin in the study group was higher, and the expression of fetuin-A was lower, the difference was statistically significant (P < 0.05); The expression of mir-29a-5p, sclerostin and fetuin-A in calcified group was higher than that in non-calcified group, and the expression of fetuin-A was lower (P < 0.05); Mir-29a-5p and sclerostin showed positive correlation (r=6.776, P=0.011); The expression of mir-29a-5p and fetuin-A showed negative correlation (r=-5.326, P=0.001); The expression of mir-29a-5p and sclerostin showed negative correlation (r=-9.677, P=0.001); Mir-29a-5p and sclerostin were positively correlated with vascular calcification (r=0.695, P=0.001; r=0.715, P=0.001), and fetuin-A was positively correlated with vascular calcification (r = -0.953, P = 0.001). Then, Mir-29a-5p, sclerostin and fetuin-A are abnormally expressed in chronic kidney disease. There is an abnormal correlation among them in chronic kidney disease, and they are correlated with vascular calcification.

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BACKGROUND: Peritoneal dialysis (PD) is the main renal replacement therapy in elderly patients account for hemodynamic stability. The clinical characteristics and prognosis of elderly PD patients are varies in different dialysis centers. We analyzed the characteristics, outcomes and prognosis factors of survival in elderly PD patients in China, to better understand their status and improve their quality of life. METHODS: This prospective, observational study categorized 202 PD patients by age: elderly group ≥65 years, younger group <65 years. The inclusion criteria were: age >18 years, first PD treatment and dialysis time >3 months, and complete data. Clinical characteristics including demographic data, hemodynamic variables were compared between groups. After a median follow-up of 44 months, prognosis outcomes between young and elderly groups were measured. Multivariate Cox regression analysis were used to establish the models for predicting outcomes. Then the nomogram of the model was generated. RESULTS: A total of 202 PD patients were enrolled: 61 in the elderly group and 141 in the younger group. The comparison of baseline data revealed decreased serum albumin, normalized protein catabolic rate and higher incidence of previous cardiovascular, cerebrovascular diseases, Charlson Comorbidity Index (CCI) in the elderly group. The mortality rate was substantially higher in the elderly group. Cardiovascular disease was the main cause of death in elderly PD patients. High body mass index (BMI) [hazard ratio (HR) =1.0, 95% confidence interval (CI): 1.0-1.1, P=0.005], high CCI (HR =1.1, 95% CI: 1.0-1.2, P=0.022), and ischemic heart disease (ISD) (HR =2.5, 95% CI: 1.0-6.1, P=0.042) were risk factors for the long-term survival of elderly PD patients. CONCLUSIONS: High BMI, high CCI and ISD were important factors for evaluating the adverse outcomes of elderly PD patients. Larger studied are needed to identify risk factors in elderly PD patients and to improve their outcomes.

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