Background: 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 10 years. Methods: 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. Results: In 2019, there were 150.5 million cases of (10.6%) and 196 726 deaths from (13.8 per 100 000 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 8.3/100 000 to 13.8/100 000. 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 60–64 years 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 100 000, respectively, by 2029. Conclusions: 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.

Background: The burden of gout is increasing worldwide, which places a heavy burden on society and healthcare systems. This study investigates the independent effects of age, period, and cohort on the gout prevalence from 1990 to 2019 in China, compares these effects by gender and then predicts the future burden of gout over the next decade.Methods: The data were obtained from the Global Burden of Disease (GBD) study in 2019. Joinpoint regression model was employed to calculate the annual percentage change (APC) in gout prevalence, and the age-period-cohort analysis was utilized to estimate the independent effects of age, period, and cohort. ARIMA model was extended to predict the gout epidemic in 2020–2029.Results: In 2019, there were 16.2 million cases of gout in China, with an age-standardized prevalence rate (ASPR) of 12.3‰ and 3.9‰ in men and women, respectively. During 1990–2019, the ASPR of gout was increasing significantly, with an average APC of 0.9%. The periods of 2014–2017 and 2001–2005 were “joinpoint” for men and women (APC: 6.3 and 5.6%). The age-period-cohort analyses revealed that the relative risk (RR) of developing gout increased with age, peaking at 70–74 years in men (RR_age(70−74) = 162.9) and 75–79 years in women (RR_age(75−79)=142.3). The period effect trended upward, with a more rapid increase in women (RR_period(2019) = 2.31) than men (RR_period(2019) = 2.23). The cohort effect generally peaked in the earlier cohort born in 1905–1909 for both sexes. Gout prevalence showed a strong positive correlation with the consumption of meat and aquatic products (r_meat = 0.966, r_{aquaticproducts} = 0.953). Within 2029, the ASPR of gout was projected to be 11.7‰ and 4.0‰ in men and women, respectively.Conclusion: The prevalence of gout is increasing at an alarming rate in China; thus, it is necessary to provide targeted health education, regular screening, and accessible urate-lowering therapy healthcare to prevent and protect against gout in China, particularly in older women.

BACKGROUND: Remote ischemic preconditioning (RIPC) has 2 time windows for organ protection: acute and delayed. Previous studies have mainly focused on the organoprotective effects of acute RIPC. We aimed to determine whether delayed RIPC can reduce the occurrence of acute kidney injury (AKI) and postoperative complications in patients undergoing cardiac surgery. METHODS: This prospective, single-center, double-blind, randomized controlled trial involved 509 patients at high risk for AKI who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass. Patients were randomized to receive RIPC (4 cycles of 5-minute inflation and 5-minute deflation on 1 upper arm with a blood pressure cuff) 24 hours before surgery or a sham condition (control group) that was induced by 4 cycles of 5-minute inflation to a pressure of 20 mm Hg followed by 5-minute cuff deflation. The primary end point was the incidence of AKI within the prior 7 days after cardiac surgery. The secondary end points included renal replacement therapy during hospitalization, change in urinary biomarkers of AKI and markers of myocardial injury, duration of intensive care unit stay and mechanical ventilation, and occurrence of nonfatal myocardial infarction, stroke, and all-cause mortality by day 90. RESULTS: A total of 509 patients (mean age, 65.2±8.2 years; 348 men [68.4%]) were randomly assigned to the RIPC group (n=254) or control group (n=255). AKI was significantly reduced in the RIPC group compared with the control group (69/254 [27.2%] versus 90/255 [35.3%]; odds ratio, 0.68 [95% CI, 0.47–1.00]; P =0.048). There were no significant between-group differences in the secondary end points of perioperative myocardial injury (assessed by the concentrations of cardiac troponin T, creatine kinase myocardial isoenzyme, and NT-proBNP [N-terminal pro-brain natriuretic peptide]), duration of stay in the intensive care unit and hospital, and occurrence of nonfatal myocardial infarction, stroke, and all-cause mortality by day 90. CONCLUSIONS: Among high-risk patients undergoing cardiac surgery, delayed RIPC significantly reduced the occurrence of AKI. REGISTRATION: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2000035568.

Background: Based on the admission data, we applied the XGBoost algorithm to create a prediction model to estimate the AKI risk in patients with hepatobiliary malignancies and then compare its prediction capacity with the logistic model. Methods: We reviewed clinical data of 7968 and 589 liver/gallbladder cancer patients admitted to Zhongshan Hospital during 2014 and 2015. They were randomly divided into the training set and test set. Data were collected from the electronic medical record system. XGBoost and LASSO-logistic were used to develop prediction models, respectively. The performance measures included the classification matrix, the area under the receiver operating characteristic curve (AUC), lift chart and learning curve. Results: Of 6846 participants in the training set, 792 (11.6%) cases developed AKI. In XGBoost model, the top 3 most important variables for AKI were serum creatinine (SCr), glomerular filtration rate (eGFR) and antitumor treatment in liver cancer patients. Similarly, SCr and eGFR also ranked second and third most important variables in the gallbladder cancer-related AKI model just after phosphorus. In the classification matrix, XGBoost model possessed a comparably better agreement between the actual observations and the predictions than LASSO-logistic model. The Youden’s index of XGBoost model was 47.5% and 59.3%, respectively, which was significantly higher than that of LASSO-logistic model (41.6% and 32.7%). The AUCs of XGBoost model were 0.822 in liver cancer and 0.850 in gallbladder cancer. By comparison, the AUC values of Logistic models were significantly lower as 0.793 and 0.740 (p=0.024 and 0.018). With the accumulation of training samples, XGBoost model maintained greater robustness in the learning curve. Conclusion: XGBoost model based on admission data has higher accuracy and stronger robustness in predicting AKI. It will benefit AKI risk classification management in clinical practice and take an advanced intervention among patients with hepatobiliary malignancies.

Background and Aims: Remote ischaemic pre-conditioning (RIPC) delivered shortly prior to an angiographic procedure may reduce contrast-associated acute kidney injury (CA-AKI). Whether a longer interval between RIPC and contrast administration also reduces CA-AKI and post-procedural complications after coronary angiography (CAG) or percutaneous coronary intervention (PCI) is unknown. Methods: This was a multicentre, randomized trial of patients at risk of CA-AKI undergoing elective CAG or PCI comparing delayed RIPC (four cycles of 5 min inflations on one upper arm 24 h before the procedure) with sham RIPC. The primary endpoint was the incidence of AKI, defined according to the Kidney Disease Improving Global Outcomes criteria. Secondary endpoints included renal replacement therapy during hospitalization, changes in urinary biomarkers of kidney injury, and occurrence of non-fatal myocardial infarction, stroke, re-hospitalization, and all-cause mortality by day 90. Results: Altogether, 501 patients (age, 74 [66, 78] years) were randomly assigned to delayed (n = 250) or sham (n = 251) RIPC, of which 467 (93.2%) completed outcome assessments at day 90. The incidence of CA-AKI was 7.6% with sham and 3.2% with delayed RIPC (odds ratio 0.4, 95% confidence interval 0.17–0.94; P = .03). The trial was not adequately powered to show effects on secondary outcomes. Conclusions: Among at-risk patients undergoing CAG or PCI, the incidence of CA-AKI was lower in patients receiving delayed compared with sham RIPC. These results should be confirmed in larger trials to investigate whether reductions in CA-AKI with delayed RIPC lead to important clinical benefits.