Kidney Disease In China Research Articles

Efficacy and safety of entecavir for hepatitis B virus-associated glomerulonephritis with renal insufficiency.

HBV-GN is one of the most common secondary kidney diseases in China. Entecavir is a first-line antiviral therapy in patients with HBV-GN. This retrospective study explored whether entecavir is effective and safe for the treatment of HBV-GN with renal insufficiency. We screened patients diagnosed with HBV-GN in The Affiliated Hospital of Qingdao University who had elevated serum creatinine levels. Group 1 (30 patients) was given entecavir as antiviral treatment. Group 2 (28 patients) was treated with ARBs. Changes in renal function and the possible influencing factors were observed, with a mean follow-up duration of 36months. At the end of follow-up, the elevation in the serum creatinine level and reduction in the eGFR were greater in group 1 than in group 2. The overall renal survival rate, using eGFR < 15ml/min as the primary renal end point, was 96.7% in group 1 and 67.9% in group 2. Urine protein excretion was decreased in both groups. Treatment with entecavir and the remission of proteinuria were protective factors against renal function impairment, while a lower baseline eGFR was a risk factor for progression to ESRD. Entecavir slows the progression of renal function impairment in HBV-GN and exerts a significant renal protective effect.

Prevalence of Chronic Kidney Disease in China

To our knowledge, there has been no update on the prevalence of chronic kidney disease (CKD) in China since 2012. To provide periodic nationwide data on the prevalence of CKD and the associated behavioral and metabolic risk factors in China. This nationally representative cross-sectional study included data from 176 874 adults from all 31 provincial-level administrative divisions in mainland China, as reported in the sixth China Chronic Disease and Risk Factor Surveillance conducted from August 2018 to June 2019. Data analysis was performed in 2021 to 2022. Serum creatinine, urinal creatinine, and urine albumin were measured for all participants. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI equation. The primary outcome was weighted prevalence of CKD in the overall population and different strata, defined as presence of impaired kidney function (eGFR of <60 mL/min/1.73m2) or albuminuria (urine albumin-to-creatinine ratio of ≥30 mg/g). Secondary outcomes were awareness of CKD and control of comorbidities. Logistic regression was used to examine the association of sociodemographic characteristics, behavioral and dietary habits, physical activity, and comorbidities with CKD. A total of 184 876 participants contributed data to this study, and of the 176 874 adults 18 years and older with measurements of eGFR and urine albumin-to-creatinine ratio in 2018 to 2019, the mean age was 43.8 years and the weighted proportion of women was 44.6%. The estimated prevalence of CKD, impaired kidney function, and albuminuria were 8.2%, 2.2%, and 6.7%, respectively. A higher prevalence of CKD was observed in the subgroups characterized by older age, female gender, non-Han ethnicity, residency of rural or north and central parts of China, receiving less education or lower income, former smoking, no alcohol drinking, lacking physical activity, and presence of risk factors such as obesity, hypertension, diabetes, dyslipidemia, and self-reported cardiovascular disease. Among the adults with CKD, 73.3%, 25.0%, and 1.8% were at stage 1 to 2, 3, and 4 to 5, respectively, and the awareness of CKD was 10.0%. This cross-sectional study found a weighted estimated of 82 million adults with CKD in China in 2018 to 2019. The prevalence appears to have decreased by 30% in the past decade. Better environmental protection, integration of CKD into the national public health surveillance program, and control of common CKD comorbidities appear to be associated with reducing the disease burden of CKD.

Short-term air pollution exposure associated with death from kidney diseases: a nationwide time-stratified case-crossover study in China from 2015 to 2019

BackgroundLong-term exposure to air pollution has been associated with the onset and progression of kidney diseases, but the association between short-term exposure to air pollution and mortality of kidney diseases has not yet been reported.MethodsA nationally representative sample of 101,919 deaths from kidney diseases was collected from the Chinese Center for Disease Control and Prevention from 2015 to 2019. A time-stratified case-crossover study was applied to determine the associations. Satellite-based estimates of air pollution were assigned to each case and control day using a bilinear interpolation approach and geo-coded residential addresses. Conditional logistic regression models were constructed to estimate the associations adjusting for nonlinear splines of temperature and relative humidity.ResultsEach 10 µg/m3 increment in lag 0–1 mean concentrations of air pollutants was associated with a percent increase in death from kidney disease: 1.33% (95% confidence interval [CI]: 0.57% to 2.1%) for PM1, 0.49% (95% CI: 0.10% to 0.88%) for PM2.5, 0.32% (95% CI: 0.08% to 0.57%) for PM10, 1.26% (95% CI: 0.29% to 2.24%) for NO2, and 2.9% (95% CI: 1.68% to 4.15%) for SO2. ConclusionsOur study suggests that short-term exposure to ambient PM1, PM2.5, PM10, NO2, and SO2 might be important environmental risk factors for death due to kidney diseases in China.

Guidelines for hypertension management in patients with chronic kidney disease in China (2023)

The population of chronic kidney disease (CKD) with hypertension in China is characterized by complex etiology, high incidence rate, low awareness and control rate. How to diagnose and treat hypertension in CKD patients properly and improve their prognosis is particularly urgent. Several clinical guidelines or expert consensus on the diagnosis, treatment and management of hypertension have been issued. Some of them involve the diagnosis and treatment of hypertension in CKD patients, but they still can not meet the demand for diagnosis and treatment of hypertension in CKD patients. Based on the situation of hypertension in CKD patients in China, the Chinese Society of Nephrology organized an expert group to formulate this guideline. This guideline systematically introduces the diagnostic criteria, epidemiology, risk factors, poor prognosis of hypertension, the purpose, timing and control goals of antihypertensive therapy in CKD patients, as well as blood pressure control goals for special populations, non drug treatment and drug treatment of hypertension. This guideline aims to further strengthen the management of hypertension in CKD patients, standardize the diagnosis and treatment standards, formulate reasonable treatment plans, effectively control hypertension, reduce complications, so as to delay the progress of kidney diseases and improve the long-term prognosis of hypertension in Chinese CKD patients.

Influential factors of intercity patient mobility and its network structure in China

Intercity patient mobility reflects the geographic mismatch between healthcare resources and the population, and has rarely been studied with big data at large spatial scales. In this paper, we investigated the patterns of intercity patient mobility and factors influencing this behavior based on >4 million hospitalization records of patients with chronic kidney disease in China. To provide practical policy recommendations, a role identification framework informed by complex network theory was proposed considering the strength and distribution of connections of cities in mobility networks. Such a mobility network features multiscale community structure with “universal administrative constraints and a few boundary breaches”. We discovered that cross-module visits which accounted for only 20 % of total visits, accounted for >50 % of the total travel distance. The explainable machine learning modeling results revealed that distance has a power-law-like effect on flow volume, and high-quality healthcare resources are an important driving factor. This paper provides not only a methodological reference for patient mobility studies but also valuable insights into public health policies. • More than 4 million multi-year mobility records from a national database were investigated. • The distribution of travel distance of patients differs from the results of general human mobility studies. • The network features multiscale community structure with “universal administrative constraints and a few boundary breaches”. • An identification framework was proposed to understand cities’ roles in the mobility network. • The explainable AI model revealed that distance and high-quality healthcare resources are two critical factors.

Shen Qi Wan-Containing Serum Alleviates Renal Interstitial Fibrosis via Restraining Notch1-Mediated Epithelial-Mesenchymal Transition.

Shen Qi Wan (SQW) is the most classic prescription for the clinical therapy of chronic kidney disease in China. Nevertheless, the function of SQW in renal interstitial fibrosis (RIF) has not been clearly clarified. Our purpose was to explore the protective function of SQW on RIF. After intervention with SQW-containing serum alone at increasing concentrations (2.5, 5, and 10%) or in combination with siNotch1, the transforming growth factor-beta (TGF-β)-induced HK-2 cell viability, extracellular matrix (ECM)-, epithelial-mesenchymal transition (EMT), and Notch1 pathway-associated protein expressions were assessed by cell counting kit-8, qRT-PCR, western blot, and immunofluorescence assays. SQW-containing serum intensified the viability of TGF-β-mediated HK-2 cells. Besides, it augmented the collagen II and E-cadherin levels, and weakened the fibronectin, α-SMA, vimentin, N-cadherin, and collagen I levels in HK-2 cells triggered by TGF-β. Moreover, it is found that TGF-β led to the upregulation of Notch1, Jag1, HEY1, HES1, and TGF-β in HK-2 cells, which was partially offset by SQW-containing serum. Furthermore, cotreatment of SQW-containing serum and Notch1 knockdown further apparently alleviated the Notch1, vimentin, N-cadherin, collagen I, and fibronectin levels in HK-2 cells induced by TGF-β. Collectively, these findings elucidated that SQW-containing serum attenuated RIF via restraining EMT through the repression of the Notch1 pathway.

Strategies to Improve Long-Term Outcomes for Patients with Chronic Kidney Disease in China.

Chronic kidney disease (CKD) is an incurable disease requiring lifelong management. China has a high prevalence of CKD, which disproportionately affects older adults and those with chronic risk factors for CKD development. The rising prevalence of CKD in China places a substantial burden on the general population and the healthcare system. In China, there are currently many unmet needs for patients with CKD and high-risk individuals, resulting from a lack of education and support to reduce risk factors, delayed diagnoses, limited knowledge of CKD among primary-care physicians, and poor access to treatments among some patient populations. An integrated, nationwide approach is required to improve the current situation of CKD management in China. There are currently several national healthcare frameworks in place that focus on new major health policies to prevent disease and encourage people to adopt healthier lifestyles, and while they do not directly target CKD, they may have a positive indirect impact. We explore the unmet needs for patients with CKD in China and discuss the potential strategies that may be required to overcome them. Such strategies include improving physician and patient education, establishing a targeted screening programme, supporting patients to improve self-management behaviours, accelerating the creation of medical consortia and medical satellite centres, and migrating from hospital- to community-based management. In addition to policy-driven strategies, development of novel therapies will be key to providing new solutions for the long-term management of CKD. An integrated, nationwide approach is required, incorporating policy-driven changes to the clinical management of CKD, as well as the development of novel CKD treatments.

Temporal trends in prevalence and mortality for chronic kidney disease in China from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019.

This study aimed to characterize the temporal trends of chronic kidney disease (CKD) burden in China during 1990-2019, evaluate their age, period and cohort effects, and predict the disease burden for the next 10years. Data were obtained from the Global Burden of Disease (GBD) 2019 study. Join-point regression model was used to estimate the average annual percentage change (AAPC) of CKD prevalence and mortality, and the age-period-cohort analysis was used to estimate the age, period and cohort effects. We extended the autoregressive integrated moving average (ARIMA) model to predict the disease burden of CKD in 2020-2029. In 2019, there were 150.5million cases of (10.6%) and 196726 deaths from (13.8 per 100000 general population) CKD in China. Between 1990 and 2019, the prevalence and mortality rate of CKD increased significantly from 6.7% to 10.6%, and from 8.3/100000 to 13.8/100000. The AAPC was estimated as 1.6% and 1.8%, respectively. Females had a higher CKD prevalence of CKD but a lower mortality rate. Setting the mean level of age, period and cohort as reference groups, the risk of developing CKD increased with age [RRage(15-19) = 0.18 to RRage(85-89) = 2.45]. The cohort risk was significantly higher in the early birth cohort [RRcohort(1905-1909) = 1.56]. In contrast, the increase in age-specific CKD mortality rate after 60-64years was exponential [RRage(60-64) = 1.24]. The cohort-based mortality risk remained high prior to the 1945-1949 birth cohorts (RRcohort ranging from 1.69 to 1.89) and then declined in the 2000-2004 birth cohort [RRcohort(2000-2004) = 0.22]. The CKD prevalence and mortality are projected to rise to 11.7% and 17.1 per 100000, respectively, by 2029. To reduce the disease burden of CKD, a comprehensive strategy that includes risk factors prevention at the primary care level, CKD screening among the elderly and high-risk population, and access to high-quality medical services is required.

Clinical practice guideline for early screening of pediatric chronic kidney disease in China(version 2021)

儿童慢性肾脏病是指由各种原因引起的慢性持续性肾脏结构和功能障碍，是威胁儿童健康的重大问题之一。国家儿童健康与疾病临床医学研究中心、中华医学会儿科学分会肾脏学组和中华儿科杂志编辑委员会联合发起制订中国儿童慢性肾脏病早期筛查临床实践指南（2021版），回答15个与儿童慢性肾脏病早期筛查相关的重要临床问题，以规范早期诊疗、改善疾病预后，为临床医务工作者对儿童慢性肾脏病早期筛查这一重要问题提供科学、规范的指导。.

Astragalus membranaceus ultrafine powder alleviates hyperuricemia by regulating the gut microbiome and reversing bile acid and adrenal hormone biosynthesis dysregulation

Metabolic syndrome is closely related to the intestinal microbiota and disturbances in the host metabolome. Hyperuricemia (HUA), a manifestation of metabolic syndrome, can induce various cardiovascular diseases and gout, seriously affecting a patient’s quality of life. Astragalus membranaceus has a long history as a commonly used traditional Chinese medicine to treat kidney disease in China and East Asia. We compared the therapeutic effect of benzbromarone and two different doses Astragalus membranaceus ultrafine powder (AMUP) in rats with HUA. Ultra-performance liquid chromatography-mass spectrometer was used to analyze the AMUP metabolism in the plasma, urine, and feces. Further, 16S ribosome RNA sequencing and feces metabolomic were performed to capture the variation of the gut microbiota and metabolites changes before and after drug administration. AMUP had a notable impact on reducing blood uric acid levels while protecting the liver and kidney. Drug metabolism analysis demonstrated that effective constituent flavonoids are distributed in the blood, whereas saponins remain in the intestine. Gut microbiota analysis showed that low-dose AMUP ameliorated HUA-induced gut dysbiosis by reducing the abundance of harmful bacteria and increasing that of some beneficial bacteria with anti-inflammatory properties, such as Clostridia, Lachnospiraceae, and Muribaculaceae. In addition, HUA-induced changes in metabolite contents in bile acid and adrenal hormone biosynthesis pathways were restored after treatment with AMUP. Low-dose AMUP exerts remarkable therapeutic effects on HUA by regulating the gut microbiome and mediating gut metabolism pathways associated with uric acid excretion.

Quality Evaluation of Crude and Salt-Processed Cuscutae Semen through Qualitative and Quantitative Analysis of Multiple Components Using HPLC Combined with Chemometrics

Cuscutae Semen (CS; Chinese common name “Tusizi”) is one of the most common traditional herbal medicines used to treat liver and kidney diseases in China. Although it is most commonly used as a processed product, little progress has been made on the quality control of CS and salt-processed Cuscutae Semen (PCS). The purpose of this study was to establish a comprehensive strategy integrating chromatographic analysis and chemometric methods for quality evaluation and discrimination of CS and PCS. An accurate and reliable HPLC method was established for the simultaneous quantification of 12 analyte compounds in CS and PCS. The results showed that this method exhibited desirable sensitivity, precision, stability, and repeatability. Multivariate chemometric methods were applied to analyze the obtained HPLC fingerprints, including hierarchical cluster analysis (HCA), principle component analysis (PCA), and partial least squares discriminant analysis (PLS-DA). The results indicated that CS and PCS samples showed a clear classification of the two groups, and three chemical markers with great contributions to the differentiation were screened out. Collectively, the chemometrics combined with the quantitative analysis based on HPLC fingerprint results indicated that salt processing may change the contents and types of components in Cuscutae Semen.

Quantitative Crotonylome Analysis Reveals the Mechanism of Shenkang Injection on Diabetic Nephropathy.

Shenkang injection (SKI) has been widely used in the clinical treatment of chronic kidney diseases in China because of its efficacy and safety. However, the underlying mechanism of SKI in diabetic nephropathy (DN) remains unclear. The present study aimed to investigate the renoprotective effects and possible mechanisms of SKI in diabetic db/db mice. We showed that SKI ameliorated hyperglycemia and abnormal renal biochemical parameters in db/db mice. Crotonylome and subsequent bioinformatics analyses indicated that the molecular functions of the significantly different crotonylated proteins regulated by SKI were closely related to oxidoreductase activity and oxidative phosphorylation might be one of the main pathways through which SKI functions in DN. Subsequent PRM validation of the selected crotonylated proteins confirmed these findings. In addition, we determined that SKI could regulate the expression of specific proteins in oxidative phosphorylation complexes and enhance antioxidant capacity. Taken together, our data suggest that SKI exerted the protective effect against DN potentially through reversing the abnormal crotonylation expression of oxidoreductase-related proteins.

The Burden of Diabetes-Related Chronic Kidney Disease in China From 1990 to 2019.

ObjectiveTo analyze the trends in disease burden of diabetes-related chronic kidney disease (CKD) by year, age, gender and types of diabetes in China from 1990 to 2019.MethodsData on prevalence, deaths and disability-adjusted life years (DALYs) for diabetes-related CKD were extracted from the Global Burden of Disease (GBD) 2019 study. Analyses were performed by year, age, gender and types of diabetes.ResultsIn China, the numbers of deaths and DALYs of diabetes-related CKD continuously increased but the age-standardized rates (per 100,000 population) decreased over 30 years, in which the numbers of deaths and DALYs attributable to type 1 diabetes mellitus (T1DM)-related CKD barely changed and the age-standardized rates decreased over the years; and the number of deaths and DALYs attributable to type 2 diabetes mellitus (T2DM)-related CKD continuously increased, but the age-standardized rates also decreased. In 2019, 76.03 (58.24-95.61) thousand deaths and 2.13 (1.65–2.67) million DALYs were attributable to diabetes-related CKD, of which, T2DM accounted for 83.32% and 77.0% respectively, and T1DM accounted for the rest. Increasing gender disparity was seen, with males being more heavily impacted. The burden of diabetes-related CKD varied among different age groups, with the numbers of deaths and DALYs attributable to T1DM-related CKD peaking between 45 and 54 years of age and T2DM-related CKD peaking between 75 and 79 years of age; and the crude rates of deaths and DALYs attributable to T1DM-related CKD peaking between 70 and 79 years of age and 40 to 54 years of age, respectively, and T2DM-related CKD peaking over 90 years of age. Among neighboring and G20 countries, the burden of diabetes-related CKD in China was relatively controlled reflected by the ranking of adjusted death and DALYs rates.ConclusionsThe burden of diabetes-related CKD in China worsens and shows gender disparities and different age distribution. Greater efforts are needed to improve the health outcomes of these patients, especially among males.

Disease spectrum of 9 310 cases of renal biopsy pathological diagnosis from a single center in China.

The pathological types of renal diseases have changed in the past decade, but it lacks large sample analysis in Hunan Province. This study aims to retrospectively analyze the composition characteristics of pathological spectrum of kidney disease in Hunan Province in recent 10 years, compare the changes of pathological types of kidney disease. We collected a total of 9 310 kidney biopsy cases from 2011 to 2020 registered in the kidney biopsy system of the Nephrology Institute of the Second Xiangya Hospital of Central South University. Patients were assigned into a 14-24 years old group, a 25-44 years old group, a 45-59 years old group, and a ≥60 years old group, and divided into 2 time periods, namely 2011-2015 and 2016-2020. Pathological types of renal disease were divided into primary glomerulonephritis (PGN), secondary glomerulonephritis (SGN), tubulo-interstitial nephritis (TIN), hereditary kidney disease, and other pathological types. PGN accounted for 66.93% cases. Among PGN, IgA nephropathy (IgAN) (42.83%), membranous nephropathy (MN) (19.16%), minimal change glomerulopathy (12.46%), and focal segmental glomerulosclerosis (FSGS) (14.97%) were the 4 most common pathological types. Compared with the group in the period of 2011-2015, IgAN (46.74% vs 37.33%) and MN (21.26% vs 16.18%) were increased significantly in years 2016-2020 (both P<0.001). SGN accounted for 24.49% cases, of which lupus nephritis (LN) (26.91%), hypertensive nephropathy (HT) (14.47%), diabetic nephropathy (DN) (12.25%), and henoch-schonlein purpuric nephritis (HSPN) (13.44%) were the 4 most common pathological types. LN (32.53%), HSPN (12.97%), hepatitis B virus associated nephritis (HBVN) (10.98%), HT (9.48%) were the most common SGN in the period of 2011-2015. In the period of 2016-2020, the top 4 pathological types of SGN were LN (23.21%), HT (17.75%), DN (15.84%), and HSPN (13.74%). LN was the most common type in young adults ≤44 years old. HT, DN, and monoclonal immunoglobulin associated renal disease (including amyloidosis nephropathy) became the main pathological types of SGN in middle-aged and elderly patients. IgAN remains the primary pathological type of kidney disease in China in the recent years. The patients with the age of 25-44 years old have the largest proportion of IgAN. With increases in age, the proportion of IgAN gradually decreases. MN increases to different degrees at various ages, while cases of HT, DN, and monoclonal immunoglobulin-related renal damage have increased. This single-center renal pathology spectrum can provide clinical evidence for diagnosis, prevention and epidemiological study.

Network Pharmacology and In Vivo Analysis of Dahuang-Huangqi Decoction Effectiveness in Alleviating Renal Interstitial Fibrosis.

Dahuang and Huangqi are the most frequently prescribed treatment methods for chronic kidney disease in China. Our study aimed to clarify the pharmacological mechanism of action of Dahuang-Huangqi decoction (DHHQD) in renal interstitial fibrosis (RIF). The intersection of genes targeted by DHHQD active ingredients and RIF target genes was searched using network pharmacology to build a chemical ingredient and disease target network. For in vivo analysis, Sprague–Dawley rats with unilateral urethral obstruction (UUO) were administered DHHQD, and their kidney function-related indicators and pathological indices were determined. The expression of core targets was quantified using real-time polymerase chain reaction and western blotting. A total of 139 common targets for DHHQD and RIF in chronic kidney disease were detected. Compared with the untreated UUO rats, the DHHQD-treated rats showed reductions in the following: blood urea nitrogen and serum creatinine levels, kidney tubular atrophy and necrosis, interstitial fibrosis, hyperplasia and abnormal deposition of extracellular matrix, and microstructural changes in the mesangial matrix and glomerular basement membrane. DHHQD treatment significantly regulated the levels of renal core proteins, such as eNOS, IL-6, EGFR, and VEGF and reduced the mRNA and protein expression of the core targets involved in inflammation pathways, such as PI3K/AKT and TLR4/NF-κB. DHHQD treatment ameliorated the severity of RIF by potentially regulating the AKT/PI3K and TLR4/NF-κB signaling pathways. Our study findings provide insights into the mechanisms associated with DHHQD action and essential data for future research.

Effect Modification of Hyperuricemia, Cardiovascular Risk, and Age on Chronic Kidney Disease in China: A Cross-Sectional Study Based on the China Health and Nutrition Survey Cohort.

IntroductionThe question of whether the increased burden of chronic kidney disease (CKD) is caused by the interaction of hyperuricemia and cardiovascular disease (CVD) risk factors or is accelerated by aging remains unresolved. The purpose of this study is to better understand the effect modification of hyperuricemia, cardiovascular risk, and age on CKD among the Chinese population.MethodsThis cross-sectional study of 8243 participants was derived from the China Health and Nutrition Survey (CHNS) in 2009. Inclusion criteria included age ≥18 years, non-pregnancy, and no history of high-protein diet prior to blood test. Demographics, comorbidities, health-related behaviors, and serum biomarkers were collected. Interaction association of hyperuricemia, CVD risk and age with CKD were analyzed using Logistic regression.ResultsCKD was detected in 359 (27.2%, 95% CI 24.8∼29.7%) of 1321 participants with hyperuricemia and 680 (9.8%, 95% CI 9.1∼10.5%) of 6,922 participants without hyperuricemia, and these patterns remained significant after controlling for age, gender, and Framingham risk score (adjusted odds ratio [aOR] 3.82, 95% CI 3.20∼4.57). We found a negative multiplicative interaction between hyperuricemia and CVD risk on CKD. The aOR in low-CVD risk groups was 5.51 (95% CI 4.03∼7.52), followed by medium-CVD risk groups (aOR: 3.64, 95% CI 2.61∼5.09) and high-CVD risk groups (aOR: 2.89, 95% CI 2.12∼3.96). CVD risk was less associated with CKD in hyperuricemia group (aOR: 0.92, 95% CI 0.68∼1.22) than in non-hyperuricemia group (aOR: 1.43, 95% CI 1.21∼1.70). Furthermore, hyperuricemia and age had a significant additive effect on CKD, with a synergy index of 2.26 (95% CI 1.45∼3.52). Coexisting with older age and hyperuricemia, the likelihood of developing CKD was higher than the sum of the two alone.ConclusionThe link between hyperuricemia and CKD begins at a young age and becomes stronger in the low CVD risk group. For young adults, early detection of hyperuricemia, routine CVD risk assessment, and timely intervention of modifiable factors are warranted.

POS-551 MONOACYLGLYCEROL LIPASE MEDIATES RENAL FIBROSIS THROUGH ENDOGENOUS CANNABINOID SYSTEM

Chronic kidney disease (CKD) has become one of the most severe diseases that threats human life. The rate of adult chronic kidney disease in China is as high as 10.8%, and death rate is ranked firstly among chronic diseases. Kidney fibrosis is the endstage of CKD. However, there is currently no effective treatment for CKD to reverse the development of renal fibrosis. Researchers are committed to explore the specific mechanisms of kidney fibrosis. Several studies have proved that the endogenous cannabinoid system (ECS) plays an important role in kidney fibrosis and senescence.

POS-445 CONTRIBUTION OF RENAL SYMPATHETIC NERVES TO THE DEVELOPMENT OF IgA NEPHROPATHY IN MICE

Renal sympathetic overactivity has been associated with the progression of various chronic kidney diseases. It not only contributes to the development of hypertension, but also impairs the kidney via pressure-independent mechanisms. IgA nephropathy (IgAN) is a leading cause of chronic kidney disease in China. However, whether and how renal sympathetic nerves play a role in IgA nephropathy remain obscure.

Food Literacy and Its Associated Factors in Non-Dialysis Patients with Chronic Kidney Disease in China: A Cross-Sectional Study.

PurposeNephrology professionals’ understanding of food literacy (FL) and influencing factors is significant for nutrition management, which is key to controlling disease progress among non-dialysis patients with chronic kidney disease (CKD). However, few studies have explored FL in CKD patients. Hence, this study aimed to investigate the level of FL of non-dialysis patients with CKD and to analyze influencing factors in China.Patients and MethodsA total of 203 CKD patients without dialysis were recruited from August to December 2020 to participate in a cross-sectional study. Food literacy was assessed by a modified short food literacy questionnaire for adults. Related influencing factors were measured by the motivation for dietary self-control scale and the satisfaction with dietary behavior scale. Data were also collected regarding patients’ health information-seeking behavior (four items), satisfaction and compliance with dietary advice from healthcare professionals (two items), and demographics and clinical diagnoses.ResultsThe mean age of patients was 44.5 years (range 18 to 75), and 42.5% were male. Most (50.2%) were in stages 1–2 of CKD. The mean FL score of these patients was 38.75±0.38. The multivariable linear regression analysis shows that secondary educational level (β=0.221, p=0.004), motivation for controlling diet (β=0.198, p=0.003), satisfaction with dietary behaviors (β=0.319, p<0.001), and health information-seeking behavior (β=0.146, p=0.019) were significant influencing factors.ConclusionFood literacy of Chinese CKD patients without dialysis should be improved. Patients with higher education levels exhibit more active information-seeking behaviors, have greater satisfaction with dietary behaviors, and their motivation for dietary self-control is more likely to be associated with better FL. Healthcare workers should be aware of factors influencing FL and attempt to integrate assessment of FL into routine food-related education for CKD patients.

Mechanism of Rhubarb for Diabetic Kidney Disease through the AMPK/NF‐κB Signaling Pathway Based on Network Pharmacology

AbstractRhubarb (Da‐huang in pinyin, Radix Rhei Et Rhizome in pharmaceutical name) is a heat‐clearing and laxative herbal medicine, which is widely used to treat diabetic kidney disease in China. The study aims to decrypt the underlying mechanisms of the treatment of diabetic kidney disease using a systems pharmacology approach. Active compounds and corresponding potential therapeutic targets were harvested by utilizing the database of TCMSP. DKD targets were adopted from DrugBank, OMIM, TTD, and GAD databases. Then a network of Rhubarb‐ compounds ‐ target ‐ DKD network was harvested. The PPI network was then generated by the String database and subjected to Cytoscape software to harvest major and core targets network by topological analysis. Genes from the core targets network were further subjected to GO and KEGG enrichment analysis to figure out potential targeting pathways. Human podocyte cells (HPC) were used to further investigate the mechanism of against DKD. A total of 6 active ingredients and 271 targets of Rhubarb were picked out. 11 cellular biological processes and 18 pathways of mostly associated with inflammatory response, apoptosis, fibrosis, and peripheral circulation. Moreover, experimental validation suggests that Rhubarb increased cell viability. Rhubarb extract significantly suppressed the expression of NF‐kappa B, Bcl‐2, Caspase‐3, and Cleaved Caspase‐3, promoted the expression of AMPK and Bax, and decreased the release of cytokines. Rhubarb could alleviate DKD via the molecular mechanisms predicted by network pharmacology.