NMR equation, which combines creatinine, cystatin C, valine, and myo-inositol with age and sex. We compared GFRNMR performance to that of the 2021 CKD-EPI creatinine and creatinine-cystatin C equations (CKD-EPI2021Cr and CKD-EPI2021CrCys), using 115 fresh routine samples of patients scheduled for urinary iothalamate clearance measurement (mGFR). Median bias to mGFR of the three eGFR equations was comparably low, ranging from 0.4 to 2.0 mL/min/1.73 m2. GFRNMR outperformed the 2021 CKD-EPI equations in terms of precision  and accuracy . Clinical parameters such as etiology, comorbidities, or medications did not significantly alter the performance of the three eGFR equations. Altogether, this study confirmed the utility of GFRNMR for accurate GFR estimation, and its potential value in routine clinical practice for improved medical care.An accurate estimate of glomerular filtration rate (eGFR) is essential for proper clinical management, especially in patients with kidney dysfunction. This prospective observational study evaluated the real-world performance of the nuclear magnetic resonance (NMR)-based GFR Glomerular filtration rate (GFR) is a critical clinical parameter in routine medical care and for the diagnosis and monitoring of kidney diseases . To mini2021Cr) for US adults [2021CrCys) are more accurate [NMR, a nuclear magnetic resonance (NMR)-based equation without a race variable, combining the serum biomarkers creatinine, cystatin C, valine, and myo-inositol [NMR demonstrated lower bias, and higher accuracy and precision than the 2009 and 2012 CDK-EPI equations [2021Cr equation, GFRNMR showed comparable bias and significantly higher P15 accuracy in patients with or without a kidney transplant, and a stronger agreement with CKD staging by measured GFR (mGFR) in kidney transplant recipients [NMR may fulfill the recommendation of the NKF-ASN Task Force and hold promise for an alternative, well-performing and equitable eGFR equation.The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force recently recommended the implementation of the race-free 2021 CKD-EPI creatinine equation  study was conducted in 120 patients ≥ 18 years old scheduled for urinary iothalamate clearance measurement between May and September 2022. During the recruiting period, all patients scheduled for mGFR as part of clinical routine were screened for eligibility. Patients under hemodialysis or under peritoneal dialysis within seven days before urinary iothalamate clearance measurement were excluded from enrolment. Some patients were recruited repeatedly in the study, and the results considered as independent. Patients’ demographic and clinical data (including comorbidities and medications) were documented on the day of examination. NMR in the actual daily routine setting of clinical practice. The clinical reference standard was GFR measured by urinary iothalamate clearance, which is part of standard care at Mayo Clinic . Fresh blood samples were collected immediately prior to mGFR measurement to estimate GFR (eGFR) using the NMR-based GFRNMR equation [2021Cr and CKD-EPI2021CrCys) [The aim of the study was to validate GFRequation ,12 and t21CrCys) ,9,10. PhThe study was conducted according to the guidelines of the Declaration of Helsinki and approved by the respective Institutional Review Board . All patients gave written informed consent prior to enrolment.A total of 120 blood samples (9 mL) were collected by venipuncture immediately before injection of iothalamate to measure GFR by urinary iothalamate clearance. Whole blood was allowed to clot for 30–120 min at room temperature and was centrifuged to collect blood serum. Fresh sera (at least 3 mL) were aliquoted  and stored at 4 °C until testing. On the day of examination, one 0.5 mL aliquot was used to measure creatinine and cystatin C levels, as described in 0.725 × weight0.425 × 0.007184) and expressed as milliliter per minute per 1.73 m2 body surface area (mL/min/1.73 m2).GFR was measured at the Mayo Clinic Renal Testing Laboratory  by urinary iothalamate clearance (non-radiolabeled) using liquid chromatography-tandem mass spectrometry, as previously reported ,14. The Biomarker measurements were performed on fresh refrigerated sera at Central Clinical Chemistry Laboratory, Mayo Clinic, Rochester, MN, USA. Serum creatinine was measured by enzymatic assay standardized to international reference materials , using R® serum additive solution and 600 μL was transferred into a 5 mm NMR tube with a barcoded cap. Samples were pre-heated at 37 °C for 7.5 min before NMR measurement in a Bruker Avance III 600 MHz, and a 5 mm PATXI probe equipped with automatic Z gradients shimming. The 1H-NMR spectra were recorded using a spectral width of 20 ppm, with a recycling delay of 1.5 s, 16 scans, and a fixed receiver gain of 50.4. A cycling time d2 of 8 ms was used together with a corresponding T2 filter of 112 ms. The mixing time τ between two consecutive spin echoes was 400 μs. The NMR data were automatically phase- and baseline-corrected using the lactate doublet at 1.32 ppm as reference. Metabolite quantification used curve-fitted pseudo-Voigt profiles, as previously described [Serum creatinine, valine, and myo-inositol were measured by NMR spectroscopy as previously described ,13,17. BNMR, CKD-EPI2021Cr, and CKD-EPI2021CrCys. GFRNMR test results were automatically generated by the Axinon® NMR software , integrating age, sex, cystatin C (immunoturbidometric assay) and NMR measurements of creatinine, myo-inositol, and valine. The 2021 CKD-EPI equations were calculated within R using the reported formulas [2021Cr, or age, sex, creatinine (enzymatic assay), and cystatin C (immunoturbidometric assay) for CKD-EPI2021CrCys.GFR was estimated (eGFR) via three methods: GFRformulas , combiniNMR P20 accuracy results using the MedCalc Statistical Software version 12.7.7, according to Machin et al. [Sample size was estimated based on existing GFRn et al. . Based oNMR result. Subgroup analyses were also conducted to evaluate the impact of disease, comorbidities, or medication on the performance of each eGFR equation.Performance evaluation  was conducted in all enrolled patients with a valid GFRp-values ≤ 0.05 were considered statistically significant.All statistical evaluations were performed within R 4.0.2 . Data stp-value correction for multiple testing according to Benjamini-Hochberg [Bias was calculated as ‘eGFR-mGFR’ and expressed as median signed bias to mGFR. Pairwise significance levels between bias distributions were assessed via the Wilcoxon-signed rank test ,27 with Hochberg ,29.Precision was assessed by the interquartile range (IQR) of the difference to mGFR. Significance of differences was assessed via the bootstrap method. Accuracy was evaluated by the percentage of samples with an eGFR within 15% (P15), 20% (P20), or 30% (P30) of mGFR. Pairwise comparisons were tested using the McNemar’s Chi-squared test ,29.NMR, CKD-EPI2021Cr and CKD-EPI2021CrCys), mGFR distribution was calculated at given eGFR thresholds . These thresholds were chosen as they represent GFR decision values for CKD staging [2) was defined as the predicted mGFR by the 97.5th quantile model at eGFR equals 30 mL/min/1.73 m2 minus the predicted mGFR by the 2.5th quantile model at eGFR equals 30 mL/min/1.73 m2. This 95% PI is thus expected to include approximately 95% of the mGFR values from patients with a given eGFR.Distribution of mGFR at any given eGFR was assessed by fitting a quantile regression model for quantiles 2.5th, 10th, 25th, 50th, 75th, 90th, and 97.5th . Quantile regression differs from the ordinary least squares (OLS) regression in that OLS regression estimates the conditional mean, whereas quantile regression estimates the conditional quantile of interest  ,33,34,35 staging . The 95%NMR [2021Cr, and CKD-EPI2021CrCys [NMR result were included in the analysis  are shown in Demographic and clinical characteristics of the study population  eGFR for GFRNMR, CKD-EPI2021Cr, and CKD-EPI2021CrCys were 64.1 (18.7), 63.6 (20.2), and 63.8 (21.5) mL/min/1.73 m2, respectively (Mean (SD) mGFR in the study population was 64.2 (20.8) mL/min/1.73 mectively .2)  . Median e biases . This heNMR showed a significantly higher precision than CKD-EPI2021Cr (p = 0.01) and CKD-EPI2021CrCys (p = 0.01), with an interquartile range (IQR) of the difference to mGFR of 10.5 mL/min/1.73 m2 (GFR/1.73 m2 .NMR accuracy ranged from 66.1% (P15) to 95.7% (P30) , but not CKD-EPI2021Cr  (GFR7% (P30) , and was7% (P30) . GFRNMR  = 0.19) .NMR, CKD-EPI2021Cr and CKD-EPI2021CrCys), we assessed the distribution of mGFR at eGFR thresholds used to define CKD stages, by determining the mGFR 95% prediction intervals (PI). The 95% PI is expected to include approximately 95% (2.5th to 97.5th percentiles) of the mGFR values from patients with a given eGFR. The width of the 95% PI has direct clinical implications on the precision of CKD staging [n = 3) of patients with GFR < 30 mL/min/1.73 m2 in our study population (2. For each of the studied equations (GFR staging . Due to 2), the width of the 95% PI, but also of the 50% PI, was consistently smaller for GFRNMR compared to either CKD-EPI2021Cr or CKD-EPI2021CrCys  by no more than 1.7 mL/min/1.73 m2 , and GFRNMR between beta-blocker treatment groups , bias distribution between subgroups was not statistically significantly different  was compared using fresh samples of patients with clinically ordered urinary iothalamate clearance mGFR. The three equations showed an overall low median bias, however the bias distributions differed in subtle but potentially important ways. Bias distribution for GFRNMR was centered around its median of 2.0 mL/min/1.73 m2, while that of the CKD-EPI equations was broad and bimodal, indicating heterogeneity in performance. This heterogenicity may be reflective of the different confounders for creatinine and cystatin C, which can be in opposite directions. On the other hand, GFRNMR outperformed the 2021 CKD-EPI equations in terms of precision (interquartile range to mGFR of 10.5 mL/min/1.73 m2) and accuracy .The performance of three eGFR equations  and accuracy . This finding further supports the suitability of GFRNMR for use in clinical routine settings, particularly for e.g., the accurate classification of CKD stages, assessment of renal impairment and renal drug dose adjustment.The GFRon study . Both stNMR results. Although clinical data were collected on a wide range of conditions, the statistical analysis had to be restricted to groups of > 25 samples and to univariate statistics to ensure result integrity. While in most comparisons, no statistically significant differences in bias distributions were found between groups, we observed a significant difference in bias for GFRNMR between beta-blocker treatment groups . In the kidney, adrenergic receptors mediate vasoconstriction, renin secretion, and vasodilation, respectively [For the first time, we were able to systematically investigate the impact of a variety of etiologies, comorbidities, and medications on GFRectively ,42,43. Bectively ,42,43. In = 115), its single center nature, the high proportion (88.7%) of solid-organ transplant recipients, the small proportion (<3%) of non-White participants, and the small number (n = 3) of patients with low (<30 mL/min/1.73 m2) mGFR. The latter is critical because low mGFR thresholds represent essential clinical decision points, such as to eligibility to kidney transplantation listing (at GFR < 20 mL/min/1.73 m2 in the US). The weak representation of non-White participants and of patients with low mGFR, and the strong representation of certain medical conditions (such as solid-organ transplantation) constitute the drawback of a real-world single-center study. Future real-world studies should be conducted at multiple centers to cover more ethnicities, more patients with severe CKD, and more diverse medical conditions.Limitations of our study include its small population size . This is important because the use of mixed mGFR determination methods might introduce a bias in eGFR performance interpretation ,14,44,45tudy and ).NMR to meet the NKF-ASN Task Force recommendations, and hold promise for an alternative, well-performing, and equitable eGFR equation.Overall, our results add real-world eGFR validation data to the growing body of evidence confirming the suitability of GFRNMR compared to the CKD-EPI2021Cr and CKD-EPI2021CrCys equations on routine samples. This study thus validates the use of GFRNMR for accurate estimation of GFR in routine clinical practice, potentially improving patient management.This real-world study demonstrated a superior performance of GFR


The prevalence of respiratory viruses in children changed under strict infection control measures during the coronavirus disease 2019 (COVID-19) outbreak. In this study, we investigated the frequency of viral detection in the nasopharynx of paediatric patients with asthma exacerbations requiring hospitalization during the COVID-19 pandemic, as well as the distribution of causative viruses.We included paediatric patients admitted for asthma exacerbations between November 2020 and December 2022 at a single centre in Kobe, Japan. Demographic, clinical, and laboratory data were collected from their medical records and using additional questionnaires. All patients enrolled in this study met the diagnostic criteria for asthma exacerbations outlined in the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2020. Statistical differences were calculated using univariate analyses (chi-square or Mann‒Whitney U test).p = 0.033), exhibited higher WBC counts (p < 0.001) and higher Eos counts (p < 0.001), had elevated total IgE levels (p < 0.001) and house dust mite-specific IgE levels (p = 0.019), had a shorter duration of hospitalization (p < 0.001), and had a shorter duration of oxygen therapy (p < 0.001). In patients positive for RV/EV, the use of ICSs significantly reduced the severity of the condition (p < 0.001).We enrolled 203 children hospitalized for asthma attacks and collected nasopharyngeal samples from 189 patients. The median patient age was 3.0 years. Asthma severity was classified as mild (4.0%), moderate (82.3%), or severe (13.8%). The proportion of viral respiratory infections was 95.2% (180/189). The rate of patients with multiple viral infections was 20.6% (39/189). The most frequently detected pathogens were rhinovirus and enterovirus (RV/EV) at 69.3% (131/189), allowing for duplicate detection, followed by respiratory syncytial virus (RSV) at 28.6% (54/189). We also detected RV/EV almost every month compared to RSV and other viruses. In addition, RV/EV-positive patients were significantly older (Even under strict infection control measures, respiratory viruses were detected in the nasopharynx of almost all paediatric patients who had asthma exacerbations requiring hospitalization.The online version contains supplementary material available at 10.1186/s12890-023-02779-9. Paediatric asthma exacerbations are closely related to viral respiratory infections , 2. FurtWhile the prevalence of respiratory viruses declined, that of RV, the most common cause of bronchial asthma exacerbations, increased during the COVID-19 pandemic. Several studies have demonstrated that, compared with that of other seasonal respiratory viruses, the proportion of RV among the causative agents of respiratory infections increased worldwide, including in Japan, after schools reopened in September 2020 –16. NoneOur study aimed to determine the proportion of asthma exacerbations caused by viral infections during the COVID-19 outbreak and identify the causative viruses.This study was conducted at Kobe City Medical Center General Hospital, Japan, between November 2020 and December 2022. Our institution is a tertiary care centre equipped with 768 beds. We attended to 18,330 emergency patients in 2020, 21,230 in 2021, and 26,848 in 2022. Throughout the study period, residents of Kobe were advised to adhere to preventive measures, including wearing masks, practising hand hygiene, avoiding indoor gatherings, and self-isolating if exhibiting fever or upper respiratory symptoms. In educational settings such as elementary and nursery schools, both students and staff were mandated to monitor their body temperature and overall health before attendance, ensure regular handwashing, maintain adequate classroom ventilation, and minimize verbal interactions during meals. No lockdowns or major school closures were experienced during this period. Additionally, the vaccination campaign for the adult population was initiated in April 2021 . We retrBased on the JPGL 2020 criteria, asthma control was categorized as well-controlled, partially controlled, or uncontrolled . This cl2) cut-off level of 95% . Attacks were considered to be severe if children were restless even at rest and had audible wheezing and visible retractive breathing and an SpO2 < 91%.The severity of asthma exacerbations was determined according to the JPGL 2020 . Attacks2 level of ≥ 95%, while the duration of systemic steroid administration was determined at the discretion of the attending physician, considering the patient’s response to treatment, the current intensity of long-term treatment, and whether the patient had been hospitalized for an acute exacerbation in the past year.The main treatment for paediatric asthma exacerbations was short-acting beta-agonist inhalation and oxygen administration as needed, with systemic steroid and aminophylline infusion in refractory cases. Patients were admitted to the hospital if they had severe exacerbations, did not respond to outpatient treatment within 2 h, or if complications were observed. Patients were discharged when oxygen demand ceased and expiratory effort disappeared during nighttime sleep. The criteria for the duration of hospitalization and oxygen and systemic steroid administration were set according to the JPGL 2020 . The durBlood tests were performed on admission, although not for all patients, and included white blood cell (WBC) and eosinophil (Eos) counts and total and house dust mite-specific immunoglobulin E (IgE) levels. Calculations were performed only for patients who underwent testing.Bordetella pertussis, Bordetella parapertussis, Chlamydia pneumoniae, and Mycoplasma pneumoniae. This method cannot distinguish between RV and EV because they have genetically similar structures [Nasopharyngeal samples were analysed using the BioFire® Respiratory Panel 2.1, which can detect major causative respiratory microorganisms , 20, incructures , 22.Demographic (age and sex), clinical , and laboratory data  were collected from the patients’ medical records. In cases of missing data, we referred to the patients’ parents and administered additional questionnaires.Collected data were analysed using univariate analyses by employing the chi-square or Mann‒Whitney U test, as appropriate. House dust mite-specific IgE levels below the limit of detection (< 0.1 UA/mL) were regarded as 0.01 UA/mL. JMP® 17  was used for statistical analysis. A p value less than 0.05 was considered statistically significant.During the study period, 230 children were hospitalized for the treatment of asthma exacerbations. After excluding 27 children who did not meet the JPGL 2020 criteria, 203 children were included in this study, including three children who were transferred to other hospitals. The patients’ characteristics are presented in Table There were 110 (54.2%) boys and 93 (45.8%) girls with a median age of 3.0 years . Asthma control classifications indicated that 59 patients had well-controlled asthma, 72 had partially controlled asthma, and another 72 exhibited uncontrolled asthma. In terms of long-term treatment, 92 patients were on controller medications, while 111 patients were not receiving any such treatments. Of these participants, 44 were treated with leukotriene receptor antagonist (LTRA) monotherapy, 4 received inhaled corticosteroid (ICS) monotherapy, 30 were on a combined regimen of LTRAs and ICSs, 1 was administered inhaled corticosteroid and long-acting beta-agonist (ICS/LABA) combination therapy, 12 received both LTRAs and ICSs/LABAs, and 1 patient was on a comprehensive treatment comprising LTRAs, ICSs/LABAs, long-acting muscarinic antagonists (LAMAs), and dupilumab. The median duration of hospitalization was 5 days . Asthma exacerbations were classified as mild in 8 (4.0%), moderate in 167 (82.3%), and severe in 28 (13.8%) patients. Data on WBC and Eos counts and total and house dust mite-specific IgE levels were available for 157/203, 148/203, 131/203, and 129/203 patients, respectively.n = 189), the most common causative agents were RV/EV and RSV, accounting for 69.3% and 28.6% of cases, respectively, with coinfection confirmed in 19 (10.1%) patients , RV/EV and RSV were also most commonly confirmed, accounting for 69.5% and 22.0% of cases, respectively, followed by PIV3, hMPV, PIV1, and AdV . The rate of patients with multiple viral infections was 20.6% (39/189). Twenty-seven patients were infected with two types of viruses, eleven patients with three types, and one patient with four types. Among all patients , exhibited higher WBC counts (p < 0.001) and higher Eos counts (p < 0.001), had elevated total IgE levels (p < 0.001) and house dust mite-specific IgE levels (p = 0.019), had a shorter duration of hospitalization (p < 0.001), and had a shorter duration of oxygen therapy (p < 0.001). There were no significant differences in sex (p = 0.093), asthma control (p = 0.66), controller medications (p = 0.25), duration of systemic glucocorticoid treatment (p = 0.42), or exacerbation severity (p = 0.62). In patients who tested positive for RV/EV, the use of ICSs significantly reduced the severity of the condition (p < 0.001) (Table p = 0.51) (Table p = 0.39) and RV/EV-negative patients (p = 0.74)  tested children, whereas in previous studies, the probability of viral detection was 80–85% , 27, 28.In this study, RV/EV was most commonly implicated in childhood asthma exacerbations and was detected in 131 of 189 (69.3%) patients. RV was also the most common pathogen in childhood asthma before the COVID-19 outbreak , 24, 26.To the best of our knowledge, no prior study has investigated the change in the rate of RV infections in Japan over 3 years. Our results did not contradict previously reported findings that the number of detected RV infections did not decrease during the COVID-19 outbreak worldwide –16. The In the present study, the RV/EV-positive group tended to have more Th2 immune reactions than the RV/EV-negative group. Previous reports showed that RV infection was associated with higher serum total IgE, Eos, Eos cationic protein, and interleukin-5 levels than infections with other viruses , 38. ICSOur study had several limitations. First, this was a single-centre study; thus, the results may not reflect the overall trends. Second, the detection of viruses using the BioFire® Respiratory Panel 2.1 also had limitations. Namely, a positive result for Flu, hMPV, PIV, or RSV typically indicates a current infection. Conversely, positive findings for RV/EV or AdV can sometimes reflect past infections as well. Therefore, test results may not always reflect the current infection . FurtherThe rate of virus-induced asthma exacerbations among children was high even during the COVID-19 pandemic, and RV/EV was the most common cause, similar to before the pandemic. In addition, asthma exacerbations caused by RV/EV were associated with higher Eos, total IgE, and house dust mite-specific IgE levels. Thus, it can be inferred that RV/EV infections are closely related to Th2 cell responses, even during the COVID-19 pandemic.Additional file 1: Table S1. Comparison between before and after RV/EV infection in White blood cell , Eosinophils , Total IgE , and House dust mite specific IgE.


To evaluate the efficacy of sacubitril/valsartan for the treatment of patients with chronic heart failure (CHF) after cardiac valve surgery (CVS).Data were collected from 259 patients who underwent CVS due to valvular heart disease and were admitted to the hospital with CHF from January 2018 to December 2020. The patients were divided into Group A  and Group B . The duration of treatment and follow-up was 6 months. The two groups’ prior and clinical characteristics, post-treatment data, mortality, and follow-up data were analysed.The effective rate of Group A was higher than that of Group B . The left ventricular ejection fraction  was improved in both groups. The final value minus the initial value was . The left ventricular end-diastolic/-systolic diameter  in Group A decreased more than in Group B. The final value minus the initial value was . Both groups decreased the N-terminal prohormone of B-type natriuretic peptide . The final value minus initial value was . The systolic and diastolic blood pressure  in Group A decreased more than in Group B. The final value minus the initial value was . Liver and renal insufficiency, hyperkalaemia, symptomatic hypotension, angioedema, and acute heart failure had no statistical differences between the two groups.Sacubitril/valsartan can effectively improve the cardiac function of patients with CHF after CVS by increasing LVEF and reducing LVEDD, LVESD, NT-proBNP, and BP, with good safety. Currently, the incidence of heart failure (HF) is increasing worldwide. HF with a reduced ejection fraction (HFrEF) has various causes , 2. It iPrevious studies have revealed that blocking RAAS decreases morbidity and mortality in patients with HFrEF –15. HoweData were collected from 259 patients who underwent CVS owing to valvular heart disease and were admitted to the Union Hospital, Fujian Medical University, with CHF, from January 2018 to December 2020. The patients were divided into Group A (172 cases) and Group B (87 cases) based on whether the patients were regularly treated with sacubitril/valsartan.CVS owing to valvular heart disease, without treatment with sacubitril/valsartan before surgery.Meeting the relevant diagnostic criteria for CHF according to the ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2016 . There was no significant difference in serum creatinine, alanine aminotransferase, aspartate aminotransferase, potassium ion, sodium ion, haemoglobin, haematocrit, and blood glucose levels between the two groups (P > 0.05). . (Tables 5.During follow-up, no adverse reactions, such as liver and renal insufficiency, hyperkalaemia, symptomatic hypotension, and angioedema, were observed in both groups. No deaths occurred. Three patients in Group A and two in Group B were hospitalised for acute HFTable .In most cases, CHF develops slowly owing to the decompensation of cardiac function. Most patients with CHF go through the compensatory stage of cardiac hypertrophy, accompanied by water and sodium retention and increased inter-tissue fluid accumulation. The course of the disease is long, and the prognosis is poor, owing to which CHF is the terminal manifestation of the vast majority of cardiovascular diseases. Related research reveals that the pathogenesis of CHF involves the abnormal activation of the neuroendocrine system and cytokines, leading to ventricular remodelling and the progressive decompensation of chronic CHF . ChronicThe present results suggest that sacubitril/valsartan treatment improved cardiac function, ventricular remodelling, LVEF, reduced LVEDD, and LVESD in patients who underwent CVS. The active neprilysin inhibitor sacubitrilat can inhibit the degradation of natriuretic peptide, dilate blood vessels, maintain the balance of water and sodium ions, and improve ventricular remodelling. It is also beneficial in reducing cardiac load and improving myocardial remodelling. Valsartan can inhibit the binding of angiotensin II and angiotensin I receptors, block the physiological activity of angiotensin II, thereby reducing the toxic effect of norepinephrine on cardiomyocytes, and reduce the proliferation and hypertrophy of vascular smooth muscle and cardiomyocytes –29. By cThe present results showed that sacubitril/valsartan alleviated the symptoms of CHF and significantly reduced NT-proBNP. Sacubitril/valsartan has a significant double-target regulatory effect. On the one hand, it can significantly inhibit the activation of RAAS by the angiotensin II receptor, and on the other hand, it can improve the level of guanine nucleosides through a neprilysin inhibitor, thereby reducing the level of neuroendocrine factors and alleviating the condition of chronic HFrEF. By acting on the RASS and the NPs, sacubitril/valsartan can reduce the secretion of aldosterone, sympathetic nerve activity, cardiac hypertrophy and myocardial fibrosis, and the degradation of NT-proBNP , 18, 32.The present results, together with those of existing reports, demonstrate that sacubitril/valsartan can reduce SBP and DBP. Related randomised controlled trial studies have revealed that sacubitril/valsartan significantly increases urinary sodium excretion and significantly lowers arterial blood pressure compared with angiotensin receptor blockers, with a greater decrease in blood pressure at night than during the day , 34. HowAlthough sacubitril/valsartan demonstrates beneficial effects against CHF, the following study had certain limitations. The sample size of this study was small, and there was a lack of non-surgical patients with CHF, which is the focus of a prospective, double-blind controlled study. Patients have different sensitivities to drugs, and their basic blood pressure is different. Therefore, the dosage of drugs cannot be standardised but needs to be changed based on the actual conditions of patients, which may result in some bias in our research results.In conclusion, based on the reported results, sacubitril/valsartan has potential as a treatment for patients with CHF after CVS. It can improve the cardiac function of such patients, increase their LVEF, and improve ventricular remodelling. Thus, Sacubitril/valsartan has good clinical efficacy and safety in patients with CHF after CVS, which is worthy of active promotion in clinical practice.


Self-monitoring of blood pressure at home is a better predictor of prognosis and recommended in hypertension guidelines. However, the influence of baseline blood pressure category and measurement schedule on BP values during a period of home blood pressure monitoring (HBPM) are still poorly defined, particularly when used in conjunction with a digital application.We analysed temporal BP changes and performed BP classification tracking in users with self-reported hypertension performing HBPM with a digital and interactive blood pressure coach.n = 864) showed a mean SBP/DBP decrease of 2.6/1.6 mmHg, which improved hypertension control from 55.6% to 68.1%.Of 3175 users who enrolled in HBPM, 74.1% completed the first measurement period. Overall, mean systolic BP dropped significantly after the first day, but stratification by BP category demonstrated that initial category influenced BP course. BP classification tracking revealed that time to reach final BP category was dependent on baseline category, with users in categories high normal and grade 1 hypertension requiring more days to decrease BP class volatility and to reach their definitive BP class. This was driven by an intense switching between directly neighbouring categories until the middle phase of the HBPM period, while more distant class switching occurred less often and only early on. Overall, >90% of users maintained their category by day 5. Omitting the first day from analysis lead to therapeutically relevant reclassification in 3.8% of users. Users who completed at least two HBPM periods (The optimal length of HBPM period depends on BP category. HBPM with a digital coach is associated with a reduction in average BP and improvement in BP control. Adequate HBPM requires appropriate training, constant motivation and patient guidance. With limited resources, practical implementation in everyday clinical practice can be challenging . In thisTherefore, we aimed to analyse usage behaviour, user adherence and possible clinical effects of a guideline-compliant HBPM-protocol implemented by an interactive chatbot . The coaching app guides users to measure and document their blood pressure correctly and regularly in accordance with current guideline recommendations and provides an assessment based on home BP categories. However, current guidelines differ in terms of the proposed HBPM schedule  , 7, 15. 2.2.1.This study is a prospective analysis of real-world user data from a digital BP-coach (Manoa app) in the period from April 2020 (release of the Manoa app) to November 2021 in Germany. The app was freely available in Germany during this period in all major app stores . The Department of Nephrology and Hypertension, Hanover Medical School initiated this analysis. It was approved by the local ethics committee (9033_B0_K_2020). Users gave their informed consent that their data may be evaluated for scientific purposes.2.2.Manoa is a conversational smartphone app which collects user information and provides coaching and support to promote hypertension self-management. It also covers topics like healthy lifestyle  and medication adherence. The app was developed in collaboration with Hannover Medical School (MHH).via the smartphone camera or import the blood pressure values directly from a compatible measurement device. For the analysis, the first HBPM period (baseline) was considered as successfully completed if the user had taken 2 measurements per day (in the morning and in the evening) on at least 6 days within a period of 6–14 days. For the following HBPM periods, 3 complete measurement days (each with one measurement in the morning and in the evening) within 7 days were sufficient.Core element is the blood pressure diary. The digital coach provides individual feedback on the user's blood pressure level, based on the results from a structured HBPM protocol. Encouragement by the digital Coach “Manoa” (chatbot), reminders, and tracking are used to promote home monitoring. The app motivates users to measure their blood pressure twice a day (every morning and evening) for 6 days (HBPM period). After completion of the first HBPM period, the user is asked and reminded periodically (every 4 weeks) to monitor his or her blood pressure. The app also allows the user to reschedule the HBPM period. Users can record their blood pressure manually, scan the result During the first HBPM period, the user receives relevant information  through puzzles, articles or videos, for example. After completing an HBPM measurement period, the user receives evaluative feedback and further recommendations based on his blood pressure values. In addition, the app offers a visualisation of the blood pressure values in a diary. This diary can be exported and shared with the doctor.2.3.n = 3175). Depending on the analysis, subgroups were defined as indicated.The participants downloaded the app voluntarily and self-motivated. Persons under 18 and pregnant women were excluded from app usage. The analysis is based on all users with self-reported diagnosis of hypertension who started a first measurement week  that considers the repeated measures and a potential non-linear relationship between BP values and day of measurement was applied in the analysis using the R package mgcv (v1.8.40)  was analysed with a paired t-test. Differences in categorical variables were compared through a v1.8.40) , 19. OnePearson correlation test was performed to evaluate the relationship between change in systolic BP (follow-up—baseline) and systolic BP at baseline. Piecewise linear regression was used to test if baseline systolic BP predicted change (follow up—baseline) in systolic BP. Cohen's kappa was computed to assess the agreement between different HBPM protocols in classifying hypertension.3.3.1.n = 2666), the average reported OBP (SD) was 138.7 (14.4) /83.9 (9.7) mmHg, which is in the controlled range for systolic BP (SBP) and diastolic BP (DBP) (<140/90 mm Hg). However, 54.1% of users had at least one OBP value (systolic or diastolic) which classified them as uncontrolled. We also queried previous HBPM experience of users at the beginning of the coaching program (n = 3983). 51.0% of users had performed HBPM regularly, while 47.8% of users had performed HBPM sporadically and 1.3% of users had never performed HBPM , whereas diastolic BP decreased non-linearly  with changes being greatest between day 1 and day 2 (p = 2.8 × 10−10).Across all participants, mean SBP (SD) was highest after the first measurement day [132.6 (13.0)]. During the following measurement days, systolic and diastolic blood pressure decreased significantly over time. Using generalized additive mixed modelling (GAMM), systolic BP decreased in a linear fashing with a slope of -0.25(3) mmHg/day . In this analysis the significant changes . To investigate whether this change is clinically relevant, we analysed the relative change in the distribution of BD categories after exclusion of day 1. When the first day was omitted from HBPM, BP categories changed in 8.2% of cases (189 out of 2307). Different BP categories were affected to varying extent: while there was a 95.7% agreement in normal BP, accordance with full 6-day protocol in grade I hypertension was only 87.7%  decreased significantly from 131.7 (11.2) mmHg to 131.5 (11.3) mmHg (ly 87.7% . Howeverly 87.7% .3.4.n = 864) are described in To study the association of app usage and blood pressure change, we analysed BP values at baseline and 8–16 weeks after successful completion of the first HBPM period. Previous studies suggest that the BP lowering effect of app-based BP management tools can be detected after more than 8 weeks , 23. If p < 0.0001, 95% C.I. = −3.09−2.02; p < 0.0001, 95% C.I. = −1.94−1.28; n = 384), mean (SD) SBP at baseline was 138.8 (9.9) mmHg and decreased significantly to 132.7(8.9) at follow up  = 10.92, p = .0009, r(624) = −.55, p < 0.0001], while below 125mmHg the degree of correlation was lower . Participants with a very low baseline SBP showed a modest increase of blood pressure (Baseline mean (SD) SBP was 131.2 (10.8) mmHg, which was in the controlled range. After 8–16 weeks, the mean (SD) systolic blood pressure decreased significantly by 2.6 mmHg to 128.6 (8.9) mmHg , therefore the decrease of BP was most pronounced in initially uncontrolled users. The reduction in absolute BP resulted in improved BP control. The clinical effects of such BP changes are difficult to estimate in a relatively uncharacterized user population with a normal average BP. Several studies have shown that the reduction in relative risk for all-cause mortality, but also for stroke or heart failure, is proportional to the extent of the BP decrease . MoreoveHBPM is recommended by guidelines for the diagnosis and management of hypertension , 7, 29. Guideline recommendations are inconsistent with regard to the design of the HBPM protocol , 7, 15. A recent study compared a protocol compatible with the current ESH recommendations with shorter versions . Interestingly, the mean blood pressure from 4.5 consecutive measurement days already showed good agreement with the standard protocol . We hereIdeally, a HBPM protocol should be tailored to the individual case. In our analysis, there were pronounced class changes, especially in the area of therapeutically relevant threshold values . This was driven by bidirectional switching between directly neighbouring categories during the course of HBPM. Therefore, these users seem to require more measurement days for diagnostic certainty compared to users at the respective ends of the diagnostic spectrum. Of note, users with normal BP after day 2 never switch to a hypertensive class later (compared with the classification of the previous day).In this context, exclusion of the first day is also often discussed, since a high blood pressure variability can be observed in the early phase of HBPM. However, in a recent meta-analysis exclusion of day 1 had no significant effect on the predictive value of HBPM . In lineThese results underline that general HBPM recommendations  do not fully apply to all patients. In some cases, the clinician still needs to (re)adjust the protocol to obtain an adequate diagnosis. Therefore, the ideal HBPM protocol would need to be individually tailored to specific user requirements. This is an argument for an individual, patient-centred approach, especially in the context of digital applications. Individualised digital  HBPM could potentially improve both diagnostics and patient adherence.Our study has limitations: The data are self-reported and were obtained in a non-controlled setting of voluntary and self-motivated users. The available data on demographic variables or antihypertensive medication are limited. Regarding the effect of the app, the user analysis therefore remains descriptive, further conclusions are not possible. This question requires a large, randomised, controlled trial (RCT). However, a recently published prospective RCT has already demonstrated a positive effect of an interactive app-based lifestyle change intervention. In a trial with 390 patients, the digital intervention resulted in a between-group difference of −4.3 mmHg in systolic home BP after 12 weeks . MoreoveIn conclusion, this analysis of real-world data suggests that HBPM provided by a digital coach may have the potential to improve diagnosis and therapy of home blood pressure. The use of the app is associated with a reduction in average BP and improvement of hypertension control. More importantly, this study confirmed that blood pressure categories on the population level were >90% accurate after 5 measurement days when implemented by a digital coach. However, the requirements for measurement days depend on the individual baseline BP and course and may need to be adjusted near the diagnostic threshold. For intelligent digital interventions, this diagnostic gap may offer the potential to further improve HBPM and facilitate diagnosis as well as monitoring of hypertension in future.


Roxadustat treatment in PD patients is equivalent to ESAs in increasing hemoglobin (Hb). But blood pressure, cardiovascular parameters, cardio-cerebrovascular complications and prognosis in the two groups before and after treatment has not been sufficiently discussed.Sixty PD patients who were treated with roxadustat for renal anemia in our PD center recruited from June 2019 to April 2020 as roxadustat group. PD patients treated with rHuEPO were enrolled at a 1:1 ratio as rHuEPO group using the method of propensity score matching. Hb, blood pressure, cardiovascular parameters, cardio-cerebrovascular complications and prognosis were compared between the two group. All patients were followed up for at least 24 months.p > 0.05). There were no significant changes in blood pressure, or the incidence of nocturnal hypertension before and after treatment in roxadustat group (p > 0.05), while blood pressure significantly increased in rHuEPO group after treatment (p < 0.05). Compared with roxadustat group after follow-up, rHuEPO group had a higher incidence of hypertension, the levels of cardiovascular parameters were worse and cardio-cerebrovascular complications had a higher incidence (p < 0.05). Cox regression analysis showed age, systolic blood pressure, fasting blood glucose, and rHuEPO use before baseline were risk factors for cardio-cerebrovascular complications in PD patients, while treatment with roxadustat was a protective factor for cardiovascular and cerebrovascular complications.There were no significant differences in baseline clinical data or laboratory values between roxadustat group and rHuEPO group. After 24 months of follow-up, there was no significant difference in Hb levels (Compared with rHuEPO, roxadustat had less influence on blood pressure or cardiovascular parameters, and it was associated with a lower risk of cardio-cerebrovascular complications in patients undergoing PD. Roxadustat has a cardio-cerebrovascular protective advantage in PD patients with renal anemia. Treatment with erythropoiesis-stimulating agents (ESAs) is an important therapy in peritoneal dialysis (PD) patients with renal anemia . When hiRecent studies , 8 have In this study, we retrospectively compared the effect of roxadustat and recombinant human erythropoietin (rHuEPO) on blood pressure, cardiovascular parameters and cardio-cerebrovascular complications in PD patients with renal anemia.This retrospective study analyzed renal anemia patients who underwent PD from June 2019 to April 2020 in the PD center of the National Clinical Research Center of Kidney Diseases in China. We enrolled 60 PD patients who were treated with roxadustat via oral administration for renal anemia as roxadustat group and 60 PD patients who were treated with rHuEPO via subcutaneous injection in a 1:1 ratio as rHuEPO group. The two groups were matched 1:1 by clinical data and biochemical data using the method of propensity score matching. Follow-up was finished in March 2022. All patients were followed up for at least 24 months.The inclusion criteria were as follows: (1) 18–80 years old, (2) PD patients with renal anemia, and (3) the treatment with roxadustat or rHuEPO was not interrupted during follow-up.The exclusion criteria were as follows: (1) history of cardiovascular and cerebrovascular diseases, (2) abnormal liver function, (3) anemia due to hematological system diseases, tumors, rheumatoid diseases, gastrointestinal hemorrhage, and so on, (4) the treatment with roxadustat or rHuEPO was interrupted during follow-up, (5) incomplete clinical data.The initial dose of roxadustat in PD patients weighing between 45 and 60 kg was 100 mg; in patients weighing ≥60 kg, the initial dose was 120 mg three times a week according to the instructions. The follow-up dose of roxadustat was adjusted to keep the latter target Hb level. rHuEPO was used according to the degree of anemia, age, initial dose and dose adjustment based on package insert guidelines. The Hb target is 110 ~ 120 g/dL, but no more than 130 g/dL. When transferrin saturation (TSAT) ≤20% or (and) ferritin ≤100 μg/L, oral iron therapy was the first choice. Iron status was evaluated 1 to 3 months later. The target values of TSAT and serum ferritin were 20 ~ 50% and 100 ~ 500 μg /L, respectively. If the values of TSAT and serum ferritin were not up to the target level, we could treat the patients with intravenous iron. Patients with serum ferritin ≥500 μg/L should not receive iron supplements. Hb levels were monitored at baseline, 2 weeks, 1 month, 2 months, 3 months, 6 months, 9 months, 12 months, 15 months, 18 months and 24 months; blood pressure and cardiovascular parameters were monitored at baseline and after follow-up, and we observed the occurrence and prognosis of cardiovascular and cerebrovascular complications after follow-up.Measurements: (1) Clinical data included age, sex, weight, height, duration of dialysis, blood pressure, diabetes, medication history, PD modalities, and urine volume, (2) Biochemical data and cardiovascular parameters included serum, dialysate and urine urea nitrogen, creatinine and glucose, serum albumin, Hb, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ferritin, serum iron, total iron-binding capacity, hypersensitive C-reactive protein (CRP), fasting blood glucose, N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin T (TnT), troponin I (TnI) and interventricular septal (IVS), left ventricular posterior wall thickness (LVPW), cardiothoracic ratio (CTR), and left ventricular ejection fraction (LVEF). Laboratory tests were performed at each follow-up visit, echocardiography was performed annually, (3) Cardio-cerebrovascular complications included angina pectoris, myocardial infarction and other coronary heart diseases, heart failure caused by various reasons, atrial fibrillation, atrioventricular block and other arrhythmias, stroke  which were recorded by diagnosis codes, laboratory and image studies, and (4) The changes in the abovementioned parameters were recorded at baseline and after treatment.Variable definitions: Renal anemia is defined as anemia caused by impaired production of EPO from the kidney and a hemoglobin level of <110 g/L. The control rate of Hb means the proportion of Hb controlled between 110 and 130 g/L. Mean arterial pressure (MAP) is defined as diastolic blood pressure + 1/3 (systolic blood pressure - diastolic blood pressure), systolic blood pressure and diastolic blood pressure were conducted by office, home or ambulatory blood pressure monitoring and we chose the mean value of blood pressure over multiple time points; nocturnal hypertension is defined as a blood pressure value of ≥120/70 mmHg at night  and 95% confidence interval (CI) of each factor. GraphPad 8.0 software was used to draw the survival curve of cardio-cerebrovascular complications by Kaplan–Meier. The log-rank test was used to compare the survival curve between the two groups. p < 0.05 was considered to indicate statistical significance.We used the propensity score matching method to improve the equilibrium between the two groups. Statistical analysis was performed using SPSS statistical software version 26.0 . Descriptive parametric data consistent with a normal distribution are expressed as the mean ± standard deviation (SD), and nonparametric data are expressed as the median (interquartile range). We used Student’s t-test and Mann–Whitney tests to compare continuous variables between the two groups. Categorical variables were expressed as percentages and compared using the p > 0.05)  .p = 0.716). The control rate of Hb in roxadustat group and rHuEPO group were 90 and 88.3%, respectively (p > 0. 05).There was no significant difference in Hb between the two groups of PD patients at baseline, and both Hb levels increased significantly after treatment . There wp > 0.05). After 24 months of follow-up, both systolic blood pressure and diastolic blood pressure in rHuEPO group were significantly higher than those at baseline, and the incidence of nocturnal hypertension increased (p < 0.05). However, after 24 months of follow-up, systolic and diastolic blood pressure and nocturnal hypertension increased in rHuEPO group compared with roxadustat group (p < 0.05)  .p > 0.05). NT-proBNP, TnT, TnI and CTR increased and LVEF decreased in rHuEPO group compared with baseline (p < 0.05), but there was no significant change in IVS and LVPW (p > 0.05). Compared with roxadustat group, the levels of NT-proBNP, TnT, TnI and CTR in rHuEPO group increased, while LVEF decreased (p < 0.05). IVS and LVPW showed no significant difference (p > 0.05) (p < 0.05). Cardiovascular and cerebrovascular complications increased in the rHuEPO group compared with those in roxadustat group after follow-up  (There were no significant differences in cardiovascular parameters before and after treatment in roxadustat group ( > 0.05) . Compare < 0.05) .Cox regression analysis showed that age, systolic blood pressure, fasting blood glucose, and rHuEPO use before baseline were risk factors for cardio-cerebrovascular complications in PD patients, while treatment with roxadustat was a protective factor for cardiovascular and cerebrovascular complications .Renal anemia is a common complication in patients with CKD and is associated with increased cardiovascular events, hospitalization rates and mortality . RoxadusESAs are direct vasoconstrictors that can raise blood pressure, and can also raise blood pressure by stimulating the production of endothelin, epinephrine, renin, and angiotensin. Furthermore, the effect of ESAs on blood viscosity is also a mechanism of hypertension ; as a reSignore et al.  showed tProvenzano et al.  showed tAcet et al.  showed tretrospective study in a single center. And then the 2 years of follow-up time of cardio-cerebrovascular complications in this study was insufficient. Therefore, the results of this study need to be further validated with longer follow up in a multi-center prospective study.However, there are some limitations in this study. It is a In this study, compared with rHuEPO in PD patients, roxadustat has less impact on blood pressure and cardiovascular parameters, and the incidence of cardio-cerebrovascular complications is lower. Treatment with roxadustat in PD renal anemia patients offers cardio-cerebrovascular protection, especially in PD patients with cardiovascular complications or elevated cardiovascular parameters, which is worthy of in-depth clinical study and discussion. It is necessary to further increase the sample size and observation parameters to make the research results more objective and comprehensive.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by the Local Ethics Committee of Jinling Hospital. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.SC, TZ, and LY conceived the study, researched literatures and develop the protocol. YY and SC obtained ethical approval. LY and ZZ performed data analysis. SC, TZ, and LY wrote the first draft of the manuscript. YY approved the final version of this manuscript. All authors contributed to the article and approved the submitted version.This study was financially supported by the Jiangsu Clinical Medical Center Project (Grant no. YYS2016001).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Multivariate analysis revealed that post-dialysis systolic BP, CRP, and GNRI or PhA were independently associated with NT-proBNP. The higher NT-proBNP group experienced muscle attenuation and/or inflammation and an enlarged left atrium. Consequently, the elevated NT-proBNP by such an imbalance in body fluid composition is associated with lower health-related QOL.Natriuretic peptides may be associated with the complex interaction between malnutrition and fluid overload. This study assessed the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP), body fluid composition, and quality of life (QOL) domains. A multicenter, cross-sectional study was conducted between 2019 and 2022. The QOL survey of 322 patients undergoing maintenance hemodialysis  was conducted using the Kidney Disease QOL-Short Form v. 1.3. The patients in the higher NT-proBNP quartile group were older and had a longer dialysis vintage; lower body mass index, serum albumin, blood urea nitrogen, creatinine, sodium, uric acid, total cholesterol, triglycerides, and hemoglobin levels; lower geriatric nutritional risk index (GNRI), skeretal mascle mass index, and phase angle (PhA); and higher pre- and post-dialysis systolic blood pressure (BP), cardiothoracic index, and C-reactive protein (CRP) ( Cardiovascular diseases are the most common cause of death in patients undergoing hemodialysis . The proPatients undergoing hemodialysis have a significantly reduced quality of life (QOL) compared with the general population ,13,14. HIn the current aging Japanese society, malnutrition and sarcopenia in patients undergoing hemodialysis are widely recognized as indicators of poor health that can decrease the QOL of older people . We hypoThis is a sub-analysis study of patients who consented to a QOL questionnaire in our previous cross-sectional study. The detailed study design has been published elsewhere . ParticiThis study was approved by the Ethics Committee of Toho University Sakura Medical Center, Tokyo, Japan , and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants.2 was considered as the ideal body mass index (BMI) [Patient’s age, sex, diabetes mellitus status, hemodialysis vintage, comorbidity of cardiovascular disease, height, body weight, and pre- and post-dialysis blood pressure (BP) were recorded as baseline data. The following standard laboratory parameters were measured during the long-interval hemodialysis session  at the beginning of the month: total protein, serum albumin, blood urea nitrogen (BUN), serum creatinine (Cr), sodium, potassium, chloride, calcium, phosphorus, uric acid, total cholesterol (TC), triglyceride (TG), glucose, Fe, total iron-binding capacity, ferritin, hemoglobin (Hb), hematocrit, and C-reactive protein (CRP). Dialysis adequacy, which refers to the urea reduction ratio and single-pool Kt/Vurea, was measured using the Shinzato formula . The gerex (BMI) . Pre-diaex (BMI) , and thehttps://inbodyusa.com/ accessed on 1 November 2019) was used. Microprocessor-controlled switches and an impedance analyzer were activated, and segmental resistances of the arms, trunk, and legs were measured at four frequencies . Subsequently, total body water, intracellular water (ICW), extracellular water (ECW), ECW to ICW ratio, protein, mineral, fat, fat-free mass, and body cell mass were calculated using the InBody S10® software. The phase angle (PhA) was calculated based on the resistance (R) and reactance  using the following equation: PhA (°) = arctangent (Xc/R) × (180/π) [2, kg/m2) was measured as the sum of lean soft tissue of the two upper and lower limbs.Standard multi-frequency-bioimpedance analysis (MF-BIA) was performed with the patient in the supine position placed on a bed after hemodialysis. For body composition measurements, a segmental MF-BIA device  . The skeParticipants completed the Kidney Disease QOL-Short Form (KDQOL-SF) v. 1.3 survey, which is a modified version of SF-36 that was developed specifically for patients undergoing dialysis, within the first 60 min of their dialysis treatment . The usep < 0.05) with NT-proBNP were analyzed using multivariate analysis. However, BUN, Cr, UA, TC, TG, and sodium were excluded from the variables because they were considered confounders of NT-proBNP, GNRI, or PhA. In addition, age, BMI, and serum albumin were also excluded from the variables in Model 1 because they are included in the formula for GNRI; then, GNRI was excluded from variables in Model 2 because it was considered to have multicollinearity PhA. To evaluate the independent associations of NT-proBNP for QOL domains, explanatory variables that showed a significant relationship (p < 0.05) with each QOL domain were analyzed using multivariate analysis. Data were analyzed using JMP pro . p of <0.05 was considered statistically significant.The measured values were expressed as medians (interquartile ranges). Statistical significance was assessed using a linear regression model for continuous variables and Pearson’s chi-square test for categorical variables. Correlations between the variables were determined using the Pearson product–moment correlation coefficient. To evaluate independent associations, explanatory variables that showed a significant relationship (p < 0.05). In the multivariate analysis, post-dialysis systolic BP, CRP, and GNRI were independently associated with NT-proBNP in model 1, or post-dialysis systolic BP, CRP, and PhA remained independently associated with NT-proBNP in model 2  are presented based on NT-proBNP quartiles in  model 2 .10-transformed NT-proBNP level quartiles are shown in 10-transformed NT-proBNP had a weak negative correlation with ICW content in men ; however, the correlation was insignificant in women . Nevertheless, the log10-transformed NT-proBNP had no significant correlation with ECW content in both men and women . Interestingly, the log10-transformed NT-proBNP had a significant negative correlation with SMI   (The body fluid composition of men and women according to the log= 0.048) a and PhA< 0.001) b. Detail2 in men and 5.3 kg/m2 in women) and/or inflammation (CRP ≥0.3 mg/dL); moreover, 53 of these (66.3%) had the lowest PhA quartile (4.7° in men and 4.1° in women) and/or inflammation  with the highest quartile of NT-proBNP (≥7200 pg/mL) had the lowest SMI quartile (6.9 kg/mammation .p < 0.05).Echocardiography findings performed within 1 year are shown in The mean values of QOL domains according to the NT-proBNP level quartiles are shown in This study revealed that NT-proBNP in patients undergoing hemodialysis was significantly associated with BP, CRP, and GNRI or PhA. Most patients in the higher NT-proBNP quartiles had muscle attenuation and/or inflammation, enlarged left atrium by volume overload, and hypertension. The elevated NT-proBNP by such imbalance in body fluid composition was associated with lower health-related QOL.Natriuretic peptides are neurohormones synthesized in cardiac myocytes in response to increased left ventricular wall stress and stretching, which are reportedly associated with fluid volume accumulation ,25. PrevMost older patients undergoing hemodialysis have limited life expectancy, multiple comorbidities, and functional impairment. Fatigue is associated with poor health-related QOL and is an important predictor of survival in patients undergoing hemodialysis. However, its pathophysiology is multifactorial, which may include decreased oxygen supply and increased reliance on anaerobic metabolism to cause lactic acidosis in response to exertion, chronic metabolic acidosis, hyperphosphatemia in skeletal muscle myocytes, PEW, sarcopenia, and depression . We suspThis study has several limitations. First, this four-center study included 322 of the 1094 patients (29.4%) who were undergoing maintenance hemodialysis in clinics; hence, a generalization of our results to the general population may not be valid. Second, we could not quantitatively measure overhydration with a body cell mass device. Therefore, we determined the presence or absence of volume overload based on the elevated NT-proBNP. Third, we could not quantitatively measure overhydration using a body cell mass device. Fourth, performing blood tests for measuring NT-proBNP and body fluid composition analysis are deemed unnecessary on the same day of hemodialysis (a median (10th–90th percentile) of −7 days (−21 to 0 days)). Moreover, echocardiography was performed at the time of the annual transthoracic echocardiographic examination instead of at the time of recruitment or taking NT-proBNP measurements. Fifth, natriuretic peptide levels are influenced by various factors, such as age and BMI. These confounding factors may have affected the association between GNRI, SMI, and natriuretic peptide levels. Sixth, we did not investigate the association between post-dialysis fatigue and natriuretic peptide. Therefore, future studies are warranted to address these issues.Most patients with higher NT-proBNP levels had muscle attenuation and/or inflammation and body fluid overload. Elevated NT-proBNP levels due to such an imbalance in the body fluid composition are associated with a low health-related QOL. In our daily clinical practice, we recommend resetting the dry weight when the NT-proBNP levels increase in patients undergoing hemodialysis. It is also important to assess their nutritional status, QOL, and new-onset cardiovascular disease.


A cross-sectional study was conducted, which included patients with suspected HT. Cardiac output, Ct, and total peripheral resistance (TPR) were derived through a two-element Windkessel model without having a pressure waveform. Arterial hemodynamics were analyzed according to HT subtypes in 7434 individuals (5523 untreated HT and 1950 normotensive controls [N]). The individuals mean age was 46.2 ± 13.0 years; 54.8% were male, and 22.1% were obese. In isolated diastolic hypertension (IDH), the cardiac index (CI) was greater than that in normotensive (N) controls , with no significant clinical difference in Ct. Isolated systolic hypertension (ISH) and divergent systolic-diastolic hypertension (D-SDH) had lower Ct values than nondivergent HT subtype . Additionally, D-SDH displayed the highest TPR . A new method is provided for the simultaneous assessment of arterial hemodynamics with 24 h ABPM as a single diagnostic tool, which allows a comprehensive assessment of arterial function for hypertension subtypes.Blood pressure (BP) measurements obtained during a twenty-four-hour ambulatory blood pressure monitoring (24 h ABPM) have not been reliably applied to extract arterial hemodynamics. We aimed to describe the hemodynamic profiles of different hypertension (HT) subtypes derived from a new method for total arterial compliance . SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; PP: pulse pressure; N: normotension; HT: hypertension; IDH: isolated diastolic hypertension; ND-SDH: nondivergent systole-diastolic hypertension; D-SDH: divergent systolic-diastolic hypertension; ISH: isolated systolic hypertension; Ct: total arterial compliance; TPR: total peripheral resistance; CO: cardiac output; 24 h ABPM: 24 h ambulatory blood pressure monitoring.Main hemodynamic findings in arterial HT subtypes with regard to C Current HT guidelines accept 24 h ABPM as the method of choice for a precise diagnosis and evaluation of HT [t), cardiac output (CO), or total peripheral resistance (TPR).Twentyon of HT , 2 and ct [t and other hemodynamic parameters could need dedicated instrumentation or devices which require trained observers [t and its effects on aortic pulsatility and pulse pressure (PP) to understand the pathogenesis of arterial hypertension [t in clinical studies of hypertension hemodynamics has been limited. Recently, Majajan et al. [t.Some of the hemodynamic abnormalities observed in HT are attributed to an increased TPR or a low Ct , 4, and t . Neverthbservers , 6–8. Prrtension , 10. How–Great heterogeneity was observed in the hemodynamic phenotype between patients with similar degrees of BP elevation, with no clear explanation for those findings  Also, st11t estimation method obtained from the average ambulatory BP and heart rate (HR) values in a large group of individuals undergoing 24 h ABPM. We hypothesize that there are different hemodynamic profiles according to the HT subtypes.The possibility of deriving hemodynamic features with the same BP values obtained during a 24 h ABPM study would refine this method by adding complementary pathophysiological information about the function of the arterial system in hypertensive patients . We aimeA cross-sectional study was conducted, which included patients with suspected BP abnormalities who were referred to the Centro Clinico y de Investigacion SICOR, Medellín (Colombia), to undergo a 24 h ABPM between November 2017 and November 2021.The population was conformed by Latin-American individuals with the vast majority being mestizos. Patients were referred by independent physicians mainly due to suspicion of HT. Patients with missing data, unsatisfactory 24 h ABPM recordings and under the age of 18 were excluded. Unsatisfactory recordings were considered when less than 40 measurements or more than 100 measurements were obtained. Additionally, whenever a difference between two measurements was greater than 2 h, the study lasted less than 18 h or more than 24 h, and if BP measurements were less than 30 during the day and less than 10 or more than 25 during the night.Each patient was put on a validated Custo-Screen®  24 h ABPM device . Before t and CO without a BP waveform analysis through a two-element Windkessel (2-WK) model) [s) [In a previous study, we developed and validated a mean systolic pressure (MSP) method for estimating C) model) . MSP is del) [s) .t was defined as the ratio between aortic systolic volume and the theorical pulse pressure (PPth)  ; Ts, systolic time; and τ, diastolic pressure decay time constant.Ct and a regression model for Ct was developed and applied to estimate CO. For Ct assessment, a parsimonious model based on the 2-WK was incorporated by changing the exponential approximation for the time constant of diastolic pressure decay (τ) [The stroke volume (SV) obtained with echocardiography in two hundred and thirty consecutive patients was used to calculate Cecay (τ)  with a necay (τ) .Then, Ct was estimated as:With, Ct, total arterial compliance; BSA, body surface area; Td, diastolic time; T, cardiac period; PPth, theoretical pulse pressure  level I as inactive or exercise of less than one hour a week; ii) level II as participating in moderate-intensity exercise between one to less than three hours per week; and iii) level III as exercise equal to or greater than three hours per week. A smoker was defined as a current smoker, and liquor intake was considered frequent if consumed at least once a week.t, and TPR. The means, standard deviations, medians, and percentiles were used to describe the quantitative variables. Proportions were utilized to describe the categorical variables. One-factor ANOVA with Bonferroni correction was used to compare the quantitative variables between the subgroups, while the chi-square test of independence was employed to compare categorical variables. The results are presented as the mean differences with their respective confidence intervals of 95%; an alpha error of 0.05 was considered. Analyses were conducted using STATA®, v.14.0  and MATLAB®®, v.9.6 .Initially, an exploratory analysis of the data was conducted to detect errors in the coding of the variables, including possible inconsistencies in the data, lost data, and outliers. This analysis also allowed us to become familiar with the basic distribution characteristics of the variables. Graphical methods  were used to evaluate whether the variables came from a normally distributed population. The variables that correlated with the body surface area (BSA) were indexed . For theThe Institutional Ethics Committee approved this study. Prior to installing the equipment for the diagnostic evaluation, informed written consent was obtained to use the examination results for research purposes. The health research rules of Resolution 008430 of 1993 from the Ministry of Social Protection of Colombia and the principles of the Declaration of Helsinki in its latest revision were considered .n = 91), studies that did not meet technical requirements (n = 3038) or patients under 18 years (n = 88), 10.8% of all 24 h ABPMs were excluded. Among all patients with inclusion criteria , 7473 subjects (28.2%) who did not receive any type of pharmacological treatment were analyzed . Figure 2; CI 95% 0.08 to 0.12; p value < 0.001), with no significant clinical difference in Ct  (Table t than nondivergent HT subtypes (IDH and ND-SDH)   (Table t (0.72 ± 0.19 mL/mmHg), this subgroup showed less TPR than D-SDH.   met the inclusion criteria. Due to missing data n = 9, studies9) Table . Diverge1) Table . In addi1) Table . Finally1) Table .Fig. 1Flt and TPR are the key hemodynamic parameters responsible for the 24 h ABPM profile. When BP increases without changes in HR, TPR is the main reason for BP elevation, and BP rises with a nondivergent HT subtype . On the other hand, if both pressures are elevated with a divergent HT subtype , a reduction in Ct also occurs in addition to TPR elevation. Most importantly, an IDH subtype is present when Ct is normal. Finally, the ISH subtype characteristically has the largest reduction in Ct with the greatest divergence in SBP and DBP . Age effects on arterial pressure profile (and HT subtype) are highly influenced by Cce Table . Those c studies .Table 2St and a high TPR. As shown in Fig. t with age may counteract the effect of a TPR increment on DBP . Although uncommon, those extreme HR instances during a 24 h ABPM may introduce a limitation in our hemodynamic estimates; in such cases, Frank-Starling effects on SV are noticeable and influence CO values. In the same fashion, obesity leads to an increase in CO estimates. Since TPR has an inverse variation with CO values, these effects must be considered during hemodynamic analysis.Current analysis concentrated in four HT subtypes and did not take into consideration other important BP phenotypes such as white coat, masked or nocturnal hypertension. In addition, antihypertensive therapy have vascular effects, which may affect to some extent the results with the present method.Last, due to the a priori definition of each HT subtype, whether these patterns of hemodynamic behavior correspond to particular stages of the disease or different clinical hypertensive phenotypes could not be answered with our cross-sectional study. This important question framed by previous studies of HT hemodynamics  needs toThis work is an effort to close the gap between HT pathophysiology knowledge and its clinical application. For clinicians, it is important to synthesize readily available clinical data, such as BP and HR, into useful physiological information. In Table t and TPR, which were extracted with BP and HR values readily available from a 24 h ABPM plus anthropometric features. The new method enables the translation of BP data into useful features of arterial function to build a more accurate pathophysiological description of arterial HT with 24 h ABPM.HT subtypes showed distinctive hemodynamics with regard to CSupplementary information


In conclusion, based on the studied anthropometric, nutritional, and functional variables, CD patients were not diagnosed with sarcopenia in the present study. Body composition patterns were related to the inflammatory burden, underlying the interplay of inflammation and malnutrition, even in remission states. Further studies on older populations and during disease exacerbation are necessary to explore the potential link between CD, inflammation, and sarcopenia. Patients with Crohn’s disease (CD) face malnutrition risk, which, combined with inflammation, can lead to sarcopenia, associated with a worse prognosis. The purpose of the present study was to assess malnutrition and sarcopenia in patients with CD. Fifty-three patients (26 women) participated . Body composition, physical performance, nutritional questionnaires, and biomarkers were performed. Malnutrition was screened with the Mini Nutritional Assessment (MNA) and the Malnutrition Inflammation Risk Tool (MIRT) and was assessed with the Global Leadership Initiative on Malnutrition (GLIM) tool using etiologic along with three different phenotypic criteria: low Body Mass Index (BMI), low Calf Circumference (CC), and low Fat-Free Mass Index (FFMI). To find cases and evaluate sarcopenia, the Sarcopenia Questionnaire (SARC-F) and European Working Group on Sarcopenia2 (EWGSOP2) criteria were used. Malnutrition rates were 11.3% (n = 6), 7.5% (n = 4), and 5.6% (n = 3) based on low FFMI, CC, and BMI, correspondingly. Four (7%) patients had low Hand-Grip Strength (HGS), n = 8 (14.8%) had low Appendicular Lean Mass (ALM), and n = 3 (5.6%) had low gait speed. No-one had sarcopenia. A high albumin and triceps skinfold pattern, identified by principal component analysis, was related to reduced C-Reactive Protein (CRP) levels (B = −0.180, SE = 0.085,  Inflammatory Bowel Disease (IBD) represents a severe and complex spectrum of gastrointestinal diseases characterized by chronic or recurrent inflammation , impactiRegarding the nutritional status of patients with CD, they are at risk of malnutrition due to reduced food intake, malabsorption, increased gastrointestinal losses, and side effects of medication ,9. PatieMalnutrition can result in loss of muscle mass and function and possibly sarcopenia , definedHowever, there are severe biases and flaws in that kind of study. A main flaw is the heterogeneity of the sarcopenia assessment because of the plethora of existing detection tools . AdditioThe early detection and management of both malnutrition and sarcopenia are of utmost importance since they are both connected to postoperative complications, increased infection rates, and worse prognosis ,21. ThusParticipants  were recruited from a public Greek hospital and were assessed without comparisons with a control group. Inclusion criteria were (a) confirmed CD patients in remission or mild or moderate symptoms, (b) aged ≥18 years old and (c) capable to self-serve in their daily routine activities, (d) physical activity at least two times per week, (e) controlled diet and (f) in pharmaceutical treatment . ExclusiBefore proceeding to the measurements, all the patients were informed about the study’s process and the safety of the study. Then, a consent form was signed to ensure patients’ participation. The protocol was carried out in accordance with the Declaration of Helsinki (1989) of the World Medical Association. The protocol of the study was approved by the Scientific Board of Theageneio Hospital with approval code: 3734/2-3-2022.Considering the extensive array of screening tools ,23 and mThe body weight was measured on a scale without shoes and wearing minimal clothes to the nearest 0.01 kg, and the height was measured to the nearest 0.1 cm with a stadiometer  . The cir® 1500MDD Bodystat 1500 . The participants, during the measurement, stayed relaxed in the supine position, connecting the two electrodes on the hand and feet, respectively, as proposed by the manufacturer. The appendicular lean mass (ALM) was estimated from published equations by using weight, height, sex, and raw Resistance values measured from bioelectrical impedance analysis [Patients came to the hospital refraining from any type of exercise, caffeine , and alcohol the day before the body composition measurements. In addition, they had fasted for at least 2–3 h . Moreover, shoes, socks, tights, or everything else which could affect the measurement was removed, and females were in the middle period of menstruation . Body coanalysis .A physical performance assessment was conducted in a separate room of the hospital and included four tests. Before the measurements, patients completed a standardized eight minutes warm-up, which included two cycles of five full-body dynamic stretching exercises. The duration and the interval of each exercise were 30 and 15 s, respectively. Afterward, the patients started the following performance tests. 30-s Chair Stand TestTo perform the 30-s chair stand test, the participants were seated on a chair with their arms crossed at the chest level and their hands over their shoulders. They had to stand up from this seated position until they reached a complete knee extension and then sit down again until the back touched the backrest of the chair. This procedure was repeated as many times as they could in 30 s .One Leg Standing Test (OLST) for Both LegsParticipants were asked to stand on either their left or right leg and were instructed to keep their legs from touching and to maintain a single-leg stance for as long as possible, recording each try with a stopwatch. The try began once the foot was lifted off the floor and ended when the lifted foot was placed on the floor or with arm movements and the placement of their hand on the wall, which was in front of them for support if they needed it. Each leg was tested three times unless subjects performed perfectly on the first two trials .6-m Walk Test (Slow and Fast)Each participant completed two trials, a slow and a fast, starting at the standing position. Patients were instructed to stand with their toes touching the taped start line and walk at their usual (slow) and fast pace to a few steps beyond the taped finish line. Patient’s performance was recorded from the moment their foot crossed the start line to the moment their foot crossed the finish line .Hand-grip Strength Test (HGS)HGS was measured using a digital hand-grip strength meter  with a range of 5 to 99.9 kg. Before the test, participants adapted to the grip with some probationary tries. They performed three maximal intensity tries, with 45″ intervals between them, for each hand, calculating the average kilos. During the measurement, participants kept their bodies upright, feet naturally apart, arms diagonally down, palms facing inward, and maintaining an upright posture .Global Leadership Initiative on Malnutrition (GLIM) tool(i)2 if <70 yrs or BMI < 22 kg/m2 if ≥70 yrs, indicating moderate malnutrition; BMI < 18.5 kg/m2 if <70 yrs or BMI< 20 kg/m2 if ≥70 yrs, indicating severe malnutrition) [low BMI  .(ii)low CC.(iii)2 for men and <15 kg/m2 for women [low FFMI < 17 kg/mor women .Malnutrition Inflammation Risk Tool (MIRT)The nutritional status was assessed with the GLIM tool . In orde(i)2 (0 points), 28.5–20 kg/m2 (1 point), <18.5 kg/m2 (2 points).BMI: >20 kg/m(ii)Weight loss in the previous 3 months: <5% (0 points), 5–10% (2 points), ≥10% (3 points).(iii)CRP: <5 (0 points), 5–50 (2 points), ≥50 (3 points).The MIRT tool was developed by Jansen et al. in 2016 and was found to predict clinical outcomes in CD patients, including CD-related flares, hospitalizations, and surgeries . It is aTo evaluate sarcopenia, the European Working Group on Sarcopenia2 in Older People (EWGSOP2) criteria were used, namely hand strength , peripheral lean body mass  (<20 kg and <15 kg for men and women respectively) and gait speed (speed ≤ 0.8 m/s) .The participants, during their therapy with biological agents, answered the questionnaires, which were read and filled out by one volunteer, making it easier for them to give the answers. The following questionnaires were used: (i) the modified Harvey Bradshaw Index (MHBI)  to examiCRP (high sensitivity), albumin, and creatinine were measured. Data on the disease activity, duration, localization, and behavior were recorded. Moreover, data regarding the extended small intestine disease, peri-proctal disease, enterectomy, extra-intestinal manifestations, endoscopic response, and endoscopic healing were recorded . Smoking habits were also recorded as a dichotomous variable . t-test  or Mann-Whitney test  was used for possible differences between the genders. Pearson’s or Spearman correlation coefficients were used, for normally distributed and skewed variables/patterns, respectively. Also, linear regression analysis was conducted to find out the percentage of prediction of independent to dependent variables.The Kolmogorov-Smirnoff test was used to test the normality. The values are shown as means, standard deviation (SD) for normally distributed variables, or median with interquartile range (IQR) for non-normally distributed variables. The independent sample a = 0.05.A Principal Components Analysis (PCA) was applied for the identification of body composition/function patterns. More than one component with eigenvalues (originating from the correlation matrix of the standardized variables) was retained for the data analyses. The scree plot was also used to check the previous decision. The orthogonal varimax rotation was applied to generate optimal, non-correlated patterns. Five components of body composition/function patterns were identified based on the principle that the higher absolute scores indicate the variables contributing most to a particular component . Linear regression models were developed to evaluate the association of the extracted body composition/function components (independent variables) on log CRP (dependent variable) after adjustment for age. It is noted that CRP was transformed in a log form to achieve normality. Moreover, Spearman correlation coefficients were applied to test the association of the derived patterns with the MNA score. The analysis was performed with the statistical software IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY, USA: IBM Corp. The level of significance was set at The prediction of the sample size (n) occurred with G*Power 3.1.9.7  for Windows . Determip < 0.05). No differences were observed in OLST (R), and phase angle  for the LIADLS and ADLS was 8 (8–8) and (6–6), respectively. Indeed, all patients achieved the maximum score on both scales, suggesting a good functional ability for complex and basic daily activities. It is noted that disability was defined as an exclusion criterion. Moreover, they were physically active at least two times per week with activities such as walking, running, swimming, football, volleyball, tennis, etc.In In 2 = 23.7%). It is noted that the model remained significant after further adjustment for disease severity. The linear regression model was also applied to a subsample of patients being in remission in order to avoid potential bias pertaining to disease severity. The pattern of increased albumin and TSF was significant logCRP “prediction” after adjustment for age . Furthermore, a Spearman correlation was performed between the identified body composition/function patterns and MNA total score as well its constructive components (MNA sub-scores) (p = 0.043), the MNA sub-score for food intake was related to Pattern 5  , the MNA sub-score of weight loss was associated to Pattern 1   and the MNA sub-score pertaining to BMI was also related to Pattern 1  (In -scores) . As show< 0.001) .In the present study, the rate of malnutrition varied according to the GLIM criteria used, and its detection rate increased with the use of more accurate indicators, such as the FFMI. Sarcopenia was not detected in the present sample, while a pattern with high albumin and TSF identified with the use of PCA analysis was related to reduced CRP levels.In general, patients with CD have a high risk of malnutrition due to loss of appetite, reduced food intake, impaired absorption, increased gastrointestinal losses, possibly increased energy requirements, and side effects of medication ,9. The e2 or (iii) albumin < 30 g/L [In the present study, the rate of malnutrition was relatively low compared to other studies . This fi< 30 g/L . In the It is noted that in other studies, including patients in remission, participants were also characterized as well-nourished . PatientWomen presented higher rates of malnutrition according to the GLIM criteria in the present sample. Gender differences have not adequately been addressed in the literature, but women with CD have been reported to have lower FFMI  and to b2), but with the BMI-based GLIM phenotypic criteria, three subjects still had problematic values. Compared to other studies, including IBD patients in remission, our results are comparable to a study reporting a mean BMI of 26.2 kg/m2 [2) [2 [2 in our study vs. 17.3 kg/m2) [Regarding BMI, body composition values and physical performance measurements may be adversely affected in patients with CD, even in patients in remission in some  but not .2 kg/m2  or higheg/m2 [2)  or other2 [2) [2 . Regardi3 kg/m2) . Women h3 kg/m2) . Fat mas3 kg/m2) , which m3 kg/m2) . The sam3 kg/m2) .The assessment of muscle functionality is crucial in both CD , and sarRegarding sarcopenia, which combines the phenotypes of muscle quantity and function in its definition, it is estimated that fifty percent of patients with CD have sarcopenia . Howevera (TNF-α) can increase muscle breakdown and reduce protein synthesis, while in cachexia and sarcopenia, the inflammatory burden is increased, implying a bi-directional relationship [CRP correlates with IBD activity, and it is related to postoperative complications, especially in patients with CRP > 10 mg/L. . In the tionship ,88,89,90tionship  and CD ationship , and thetionship . Thus, tIt is also noted that several body composition/function patterns were detected instead of fewer that would simply categorize patients into those with bad/good function. This may be explained by the sample size and the sample characteristics. It is, however, also possible that each test reflects different angles of nutritional status. This hypothesis is in line with the fact that only selected correlations were significant regarding the identified patterns and MNA-score and its components. The strengths of the present study include the assessment of a plethora of anthropometric, body composition, and function parameters related to malnutrition and sarcopenia. In parallel, certain biochemical indices were measured, which enabled the association of inflammatory fluctuations with body composition/function patterns. 2, which is implicated in PAF metabolism [2 in cachexia [Limitations of the present study include the relatively small but adequate sample size, as suggested by the power analysis performed. Given that certain variables had zero variability, no other comparisons/correlations could be performed. The cross-sectional nature of the present work cannot imply causality in the observed associations. In addition, the data-driven by nature of identified patterns limits the repeatability and “translation” of the present results in a different clinical context. It is also possible that other inflammatory indices may have been affected by alterations in body composition, such as Lp-PLAtabolism , is altetabolism ,96,97, atabolism . Such dacachexia ,87 and tcachexia ,100. In cachexia . MoreoveThe present study is the first to be conducted using a variety of sarcopenia detection tools to determine the presence of sarcopenia in a sample of patients with CD in remission without making comparisons to a control group. This is in contrast to many studies where the prevalence of sarcopenia among patients with CD exceeds 40%. Furthermore, when comparing genders, females had a higher percentage of malnutrition compared to males. However, this difference was not related to the presence of sarcopenia in either gender.Future research should be directed toward exploring novel perspectives that could streamline the detection of both sarcopenia and CD. One promising avenue is the utilization of the Mendelian randomization method, which assesses genetic variations and investigates the causal impact of a modifiable factor on disease within observational studies ,102,103.In conclusion, based on the studied anthropometric, nutritional, and functional variables, CD patients were not diagnosed with sarcopenia in the present study. Body composition patterns were related to the inflammatory burden, underlying the interplay of inflammation and malnutrition, even in remission states. Further studies on older populations and during disease exacerbation are necessary to explore the potential link between CD, inflammation, and sarcopenia.


Kidney failure patients on chronic hemodialysis are at risk for cardiovascular complications. Dry weight (DW), one of the dialysis parameters, should be optimized to reduce the complications caused by high blood pressure. By definition, DW is the lowest weight at which patients are clinically euvolemic, not hypotensive or hypertensive after dialysis, and do not require antihypertensives. In hemodialysis patients, DW is achieved by removing fluid from the body through ultrafiltration. Although it is usually determined by trial and error in clinical practice, more objective data are needed. Echocardiography to determine the inferior vena cava diameter and collapse index, bioimpedance analysis to quantify the fluid compartments of the body and blood volume monitoring are among the options. In addition, blood viscosity measurement may be a new method to determine DW. Kidney failure is a global public health problem causing significant morbidity and mortality. Kidney failure patients on chronic hemodialysis have a poor prognosis due to cardiovascular complications, especially those caused by abnormalities in blood pressure. Therefore, dialysis parameters, especially dry weight (DW), need to be optimized to reduce cardiovascular complications .DW is generally defined as the lowest weight that a patient on chronic hemodialysis can tolerate. Overestimation of DW leads to hypertension, left ventricular hypertrophy and cardiac dysfunction, while underestimation of DW leads to hypotension, asthenia and ischemia. In children, DW may be underestimated due to ponderal growth of patients or overestimated in patients who are malnourished and have weight loss. Therefore, a child’s DW is usually more difficult to assess than that of an adult and usually requires an objective assessment. It is estimated clinically by physical examination, looking for edema or cutaneous folds and blood pressure measurements. In addition, measurement of the cardio-thoracic ratio on chest X-rays, ultrasonic measurement of the diameter of the inferior vena cava, brain natriuretic peptide (BNP)/N-terminal pro-BNP serum levels, multi-frequency bio-impedancemetry, thoracic ultrasound and blood volume monitoring during hemodialysis are helpful methods to determine DW. However, the interindividual variability of many of these methods remains a problem in determining the correct DW. To date, no perfect tool has emerged to precisely assess DW in kidney failure patients on chronic hemodialysis .Viscosity is the resistance of a liquid to flow due to the internal friction between its molecules. Blood is a complex fluid composed of plasma and cells, and blood viscosity is affected by the properties of both these components. The possible role of increased plasma viscosity and decreased cellular deformability in the pathogenesis of atherosclerotic coronary artery disease, a common complication in kidney failure, has been demonstrated . TherefoThe binding of erythrocytes to each other on their large surfaces by means of high molecular weight macromolecules is called aggregation. Aggregation, which is a physiologic state, is achieved with very weak forces, so it is possible to be reversed. In the case of high hematocrit, there is an increase in aggregation as the interactions of erythrocytes with each other will increase, resulting in an increase in blood viscosity. Conversely, if the hematocrit level is low due to anemia and/or hemodilution, there will be a decrease in aggregation and therefore a decrease in viscosity. Erythrocytes are biconcave disk-shaped. Thanks to their deformability, they can easily pass through capillaries with smaller diameters than themselves. The deformability of erythrocytes is influenced by the flexibility of the membrane skeleton, intracellular viscosity and surface/volume ratio. As water enters the erythrocyte, the volume of the cell increases, and the surface/volume ratio decreases as the surface area remains constant. This is expected to decrease erythrocyte deformability. However, since intracellular viscosity will also decrease with water entry into the cell, some improvement in deformability will occur. The net effect depends on whether the medium is hypotonic or hypertonic and the amount of fluid entering the cell. Plasma viscosity depends on the properties of water, the main substance of plasma, and the macromolecules dissolved in it. If the amount of water in the plasma increases, as in hypervolemia, plasma viscosity decreases. However, an increase in plasma proteins, salt and glucose will lead to an increase in viscosity .Low hematocrit, total protein and albumin values in patients with chronic kidney disease lead to significantly lower blood viscosity levels . In a stBased on these studies, it is thought that the lower and upper limits of blood viscosity can be determined with only a few milliliters of blood samples before and after dialysis in pediatric chronic hemodialysis patients, where there are many confounding factors for the determination of DW, and thus, blood viscosity can be used as an important tool in estimating the DW of pediatric patients.