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

Analysis of research trends and hotspots in the primary treatment of end-stage renal disease

BACKGROUND

There is a lack of bibliometric analysis in research regarding primary therapy for end-stage renal disease (ESRD). This study aims to analyze the literature on ESRD therapy published over the past decade to understand current conditions and study trends for future research.

METHODS

Data were collected from the Web of Science Core Collection (WOSCC) database. Tools like CiteSpace 6.2.R4, 6.1.R6, VOSviewer 1.6.18, and Bibliometrix R4.1.1 were used to reveal research trends and hotspots. In addition, KEGG/GO analysis examined the probable functionalities of genes implicated in ESRD therapy to guide future research.

RESULTS

The bibliometric analysis presented in this paper indicates that the number of publications has remained relatively stable since 2013. The level of international collaboration is notably high, with the United States serving as the dominant research hub in this field. The University of California system is the most prolific institution, and Transplantation Proceedings is the most frequently published journal in this area. Kalantar-Zadeh, Kamyar is recognized as the most published and cited author. Keywords such as "secondary hyperparathyroidism," "uremic toxins," "cyclosporine," "mycophenolate mofetil," and "biomarkers" have seen a surge in interest recently, reflecting emerging research trends. Furthermore, inflammation and stem cell research have been identified as promising new therapeutic avenues for ESRD.

CONCLUSION

This study identifies major areas, frontiers, and trends in research on primary treatments for ESRD, providing significant implications for future research.

Machine learning-based prediction models for renal impairment in Chinese adults with hyperuricaemia: risk factor analysis

In hyperuricaemic populations, multiple factors may contribute to impaired renal function. This study aimed to establish a machine learning-based model to identify characteristic factors related to renal impairment in hyperuricaemic patients, determine dose‒response relationships, and facilitate early intervention strategies. Data were collected through the big data platform of Nanjing Hospital of Traditional Chinese Medicine, encompassing 2,705 patients with hyperuricaemia (1,577 with renal impairment, 828 without) from June 2019 to June 2022. After multiple imputations for missing values, the dataset was randomly split into training (70%) and validation (30%) sets. We employed three machine learning algorithms for feature selection: random forest (with 100 decision trees and an OOB error rate of 23.34%), LASSO regression (optimal lambda of -3.58), and XGBoost (learning rate of 0.3, maximum tree depth of 1, and 50 rounds of boosting). The intersection of features identified by these algorithms through Venn diagram analysis yielded four key predictors. A logistic regression model was subsequently constructed and evaluated for discrimination (AUC), calibration (Brier score), and clinical utility (DCA). Restricted cubic spline (RCS) curves were utilized to analyse the dose‒response relationships. The model, which incorporates age, cystatin C (Cys-C), uric acid (UA), and sex, demonstrated robust performance, with an AUC of 0.818 [95% CI (0.796-0.817)] in the training set and an AUC of 0.82 [95% CI (0.787-0.853)] in the validation set. Calibration tests yielded Brier scores of 0.160 and 0.158, respectively. Clinical decision curves revealed optimal prediction probability intervals of 6-99.02% and 7-93.14%. In the hyperuricaemic population, each 0.5 mg/L increase in Cys-C, 10-year increase in age, and 100 µmol/L increase in UA corresponded to increased risks of 13%, 81%, and 73%, respectively. RCS analysis revealed nonlinear relationships for Age and Cys-C and a linear relationship for UA, with sex-specific distribution patterns. The machine learning-based model incorporating these four indicators demonstrated excellent predictive performance for renal impairment in hyperuricaemic patients. These findings suggest that monitoring Cys-C and UA levels while considering age and sex differences is crucial for risk assessment and prevention strategies.

Cost-effectiveness of universal genetic screening for familial hypercholesterolemia in young adults aged 18-40 years in China

BACKGROUND

Mortality from familial hypercholesterolemia (FH) remains high due to late diagnosis, and the rate of timely diagnosis remains low (< 10% globally and < 1% in China). Early screening and treatment could significantly reduce mortality risk, especially among young adults. This study aims to evaluate the cost-effectiveness of universal genetic screening of young adults aged 18-40 years compared to universal cholesterol screening or current passive screening strategies (opportunistic cholesterol screening and genetic cascade testing) for FH in China.

METHODS

A decision-analytic Markov model was constructed to simulate the lifetime (until 100 years old or 99% of patients died) coronary heart disease (CHD) events, discounted costs, gains in quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) of different screening strategies. The model targeted the general population aged 18-40 years (226,869,800 males and 209,030,180 females) from a healthcare provider's perspective. Model parameters were derived from published literatures and the largest nationwide screening program of FH in China. The willingness-to-pay threshold (US$38,042) was chosen as three times the Chinese per-capita gross domestic product (GDP) in 2023. Sensitivity analyses and threshold analyses were conducted to assess the robustness of the results.

RESULTS

Universal genetic screening of young adults aged 18-40 years is cost-effective when compared to both current passive screening strategies and universal cholesterol screening. Compared with current passive screening, universal genetic screening could prevent 172,956 CHD events (88,766 non-fatal, 84,191 fatal) with additional costs of US$40.45 billion and gaining additional 1.23 million QALYs, corresponding to an ICER of US$32,960/QALY gained. Implementing universal genetic screening at younger ages would reduce the ICER from US$36,901/QALY to US$28,910/QALY. The model was most sensitive to the cost and sensitivity of genetic testing. If the cost of genetic testing decreased from US$96.50 to US$38.83 or $2.76, universal genetic screening would become very cost-effective or even cost-saving.

CONCLUSIONS

Universal FH genetic screening in young adults has the potential to be cost-effective in China, compared to current passive screening strategy and universal cholesterol screening strategy. Performing screening in younger age would result in better cost-effectiveness benefit.

Higher dietary acid load is associated with hyperuricemia in Chinese adults: a case-control study

BACKGROUND

This study aims to explore the association between dietary acid load and hyperuricemia in Chinese adults.

METHODS

A case-control study was conducted. Adult participants with hyperuricemia were recruited as the cases and those without hyperuricemia were as the controls. Food consumption was evaluated by food frequency questionnaire (FFQ). Dietary acid load was assessed by potential renal acid load (PRAL) and net endogenous acid production (NEAP). Dietary acid load was divided into four levels: the first quartile (Q1), the second quartile (Q2), the third quartile (Q3) and the fourth quartile (Q4). Logistic regression model was applied for exploring the association between dietary acid load (PRAL and NEAP) and hyperuricemia. Odds ratio (OR) and its correspondence confidence interval (CI) were computed.

RESULTS

A total of 290 participants were eligible in this study, in which there were 143 individuals in case group and 147 in control group. A higher level of PRAL was found to be associated with odds of hyperuricemia. ORs of hyperuricemia for Q2, Q3 and Q4 of PRAL were 2.74 (95%CI: 1.94 ~ 3.88, p-value: 0.004), 2.90 (95%CI: 2.05 ~ 4.10, p-value: 0.002) and 3.14 (95%CI: 2.22 ~ 4.45, p-value: 0.001), respectively. There was a positive association between elevated NEAP and hyperuricemia. OR of hyperuricemia for Q2 was not material significance (OR:1.54, 95%CI: 0.93 ~ 2.53, p-value: 0.210), however, ORs of hyperuricemia for Q3 (OR: 2.40, 95%CI: 1.70 ~ 3.38, p-value: 0.011) and Q4 (OR: 3.27, 95%CI: 2.31 ~ 4.62, p-value: 0.001) were statistically significant.

CONCLUSION

Higher level of dietary acid load was found to be associated with hyperuricemia in Chinese adults, indicative of advocation of a well-balanced diet in this population.

Associations of specific types of physical activities with 10-year risk of cardiovascular disease among adults: Data from the national health and nutrition examination survey 1999–2006

Background

Physical activity plays a key role in the prevention of cardiovascular disease (CVD). However, previous studies focused predominantly on the associations of the total amount of physical activity with CVD. There were few evidences on the associations of specific sport disciplines with CVD. Furthermore, little was known on the interactions between the different types of sports on CVD risk. Therefore, this study aimed to examine the independent associations of specific types of physical activities with the 10-year risk of CVD, and further evaluate the interactions between specific types of physical activities on the 10-year risk of CVD in US adults.

Methods

This study used the data of the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Participants aged ≥ 30 years and with free of CVD were eligible. The physical activity questionnaire is used to collect general information on leisure-time activities in the past 30 days, including the frequency, duration, and intensity of participation in each activity. The exposures of interest included cycling, swimming, aerobics, running, American Football, basketball, and racquet sports. The Framingham risk score algorithm was used to assess 10-year CVD risk based on age, high density lipoprotein, total cholesterol, systolic blood pressure, smoking status, and diabetes. A higher total score reflects a greater risk of CVD.

Results

This study included 10829 participants. Compared to no participation, participation in cycling (β = −0.890, 95% CI:−1.278,−0.502, P < 0.001), running (β = −1.466, 95% CI:−1.837,−1.095, P < 0.001), American Football (β = −2.934, 95% CI:−3.750,−2.119, P < 0.001), basketball (β = −1.968, 95% CI:−2.645,−1.291, P < 0.001), and aerobics (β = −0.980, 95% CI:−1.352,−0.608, P < 0.001) was associated with a lower CVD risk. Furthermore, cycling was antagonistic with basketball and racquet sports in the associations with CVD risk. An antagonistic action between swimming and aerobics was also observed. Nevertheless, running was synergistic with cycling, aerobics, and racquet sports in the associations with CVD risk.

Conclusions

There were inverse associations of specific types of physical activities with CVD risk. Furthermore, there might be synergistic and antagonistic associations of multiple types of physical activities with CVD risk.