Objective: The objective of this study was to investigate the ability of phase angle and body composition to identify risk factors for mortality among patients receiving maintenance hemodialysis (MHD) treatment. Methods: In this retrospective study, we examined the causes of death in 43 MHD patients who were treated at our hemodialysis center between January 2016 and December 2021 and compared the patients to 71 patients who survived during the same period. Body composition was measured using direct segmental multi-frequency bioelectrical impedance to obtain phase angle, fat-free mass (FFM), extracellular water/total body water (ECW/TBW), and waist circumference (WC). Laboratory data were also collected. Phase angle cut-off value-associated variables were identified using ROC analysis. The ability of body composition variables to identify risk factors for death in MHD patients was evaluated. Results: We found that cardiovascular disease was the most common cause of death among MHD patients. ROC curve analysis revealed that the optimal cut-off value for phase angle as a predictor of death risk in MHD patients was 4.50°. Additionally, lower phase angle, increased age, longer dialysis vintage, lower KT/V, and hypoproteinemia were identified as significant risk factors for death in MHD patients. Conclusion: In conclusion, our findings suggest that cardiovascular disease is the leading cause of death among MHD patients and that lower phase angle, increased age, longer dialysis duration, and hypoproteinemia can be used to predict the risk of mortality in this patient population. The underlying mechanism by which lower phase angle can be used to predict the prognosis of MHD patients warrants further investigation.

Background: Sepsis-associated acute kidney injury (SA-AKI) is a critical condition with high mortality. Red cell distribution width (RDW) has emerged as a potential dynamic biomarker, but longitudinal RDW changes in SA-AKI remain underexplored. Methods: This retrospective cohort study analyzed adult SA-AKI patients from the MIMIC-IV database (2008–2022). Group-Based Trajectory Modeling (GBTM) identified distinct longitudinal RDW patterns. Primary outcome was 28-day all-cause mortality. Secondary outcomes included 90-day mortality, continuous renal replacement therapy (CRRT) requirement, and ICU length of stay. Multivariable Cox models assessed associations. adjustment for any transfusion and any major hemorrhage, and an exclusion analysis in which all transfused patients were removed. Results: Among 6,694 patients (mean age 65.5 years, 57.7% male), 28-day mortality was 22.5%. Four RDW trajectory groups were identified: Stable Low (27.8%), Gradual Increase (38.5%), Continuous Increase (27.6%), and Rapid Increase (6.1%). The Rapid Increase group demonstrated highest disease severity scores and poorest laboratory profiles. Compared to the Stable Low group, the Rapid Increase group had significantly elevated 28-day mortality risk after full adjustment (HR 4.27, P < 0.001), with consistent patterns for 90-day mortality and resource use. Associations remained consistent across subgroup analyses, multiple-imputation datasets, and the relaxed-inclusion cohort, and were minimally altered after adjusting for transfusion/hemorrhage or excluding transfused patients. Conclusions: Dynamic RDW trajectories were independently associated with adverse outcomes in SA-AKI patients. Across extensive sensitivity analyses, these trajectories functioned as dynamic prognostic indicators without implying causality, supporting their use for risk stratification and individualized patient care.

Astragaloside IV (AS-IV) has been shown to provide renal protection in various kidney injury models. However, the metabolic profile variation of AS-IV in pathological models in vivo is not well established. This study aims to explore the metabolic pathway of AS-IV in vivo in the classical puromycin aminonucleoside (PAN)-induced kidney injury in a rat model. Twelve Wistar rats were randomly divided into the AS-IV (CA) and the PAN+AS-IV (PA) treatment groups. PAN was injected by a single tail intravenous (i. v.) injection at 5 mg/100 g body weight, and AS-IV was administered intragastrically (i. g.) at 40 mg/kg for 10 days. Fecal samples of these rats were collected, and metabolites of AS-IV were detected by ultra-performance liquid chromatography coupled with quadrupole/time-of-flight mass spectrometry (UPLC-Q-TOF-MS/MS) to explore the AS-IV metabolic pathway. The metabolic differences between the AS-IV and PAN+AS-IV groups were compared. A total of 25 metabolites were detected, and deglycosylation, deoxygenation, and methyl oxidation were found to be the main metabolic pathways of AS-IV in vivo. The abundance of most of these metabolites in the PAN+AS-IV group was lower than that in the AS-IV treatment group, and differences for seven of them were statistically significant. Our study indicates that AS-IV metabolism is affected in the PAN-induced kidney injury rat model.