Clinical and Experimental Nephrology最新文献

{"title":"Influence of infection control for COVID-19 on nutrition in relatively healthy Japanese HD patients: a retrospective observational study.","authors":"Yuki Chiba, Ryotaro Takahashi, Rui Makino, Mai Yoshida, Koji Okamoto, Tasuku Nagasawa, Ichiro Kato, Sadatoshi Ito, Tetsuhiro Tanaka, Mariko Miyazaki","doi":"10.1007/s10157-025-02638-3","DOIUrl":"https://doi.org/10.1007/s10157-025-02638-3","url":null,"abstract":"<p><strong>Background: </strong>Infection control for the novel coronavirus disease 2019 (COVID-19) has been linked to decreased physical activity and nutritional deterioration in the general population; however, the influence on hemodialysis (HD) patients is not well discussed.</p><p><strong>Methods: </strong>This multicenter retrospective study utilized the Geriatric Nutritional Risk Index (GNRI), Survival Index, and Nutritional Risk Index for Japanese HD patients (NRI-JH) to assess nutritional status and body composition over five observation periods. The primary endpoint was the body fluid removal rate (%) pre- and post-HD, whereas secondary endpoints included changes in GNRI, SI, body composition, and differences in NRI-JH.</p><p><strong>Results: </strong>We enrolled 139 HD patients in three facilities. The results showed a decrease in GNRI score, which indicates nutritional deterioration, between February 2020 and August 2020 (96.8 (93.2-98.9) vs. 93.8 (90.8-97.6)) (P = 0.0005). Multivariable analysis revealed that nutritional deterioration was associated with higher C-reactive protein and lower hemoglobin levels (P = 0.0004 and P = 0.0010, respectively), which were more noticeable in the urban facility. Furthermore, nutritional deterioration was linked to a decrease in soft lean and somatic cell mass and an increase in body fat mass, suggesting reduced physical activity.</p><p><strong>Conclusions: </strong>Nutritional deterioration was observed shortly after the first COVID-19 outbreak, suggesting an association with decreased physical activity.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the single nucleotide polymorphism rs1697421 with an increased postprandial serum phosphorus level.","authors":"Sachi Nii-Nakayama, Misaki Katsumoto, Satono Ishitani, Yoko Narasaki, Chihiro Seko, Michiyo Yamasaki, Hirokazu Ohminami, Kohta Ohnishi, Masashi Masuda, Hisami Yamanaka-Okumura, Hironori Yamamoto, Yutaka Taketani","doi":"10.1007/s10157-025-02644-5","DOIUrl":"https://doi.org/10.1007/s10157-025-02644-5","url":null,"abstract":"<p><strong>Background: </strong>A high serum phosphorus (P) level is a risk factor for cardiovascular disease (CVD) and mortality in patients with chronic kidney disease (CKD). Moreover, increased postprandial serum P levels after high dietary P intake impair vascular endothelial function. Therefore, management of postprandial serum P levels is important in CKD patients. Recently, a genome-wide association study identified single nucleotide polymorphisms (SNPs) associated with fasting serum P levels in individuals of European ancestry. However, the effects of these SNPs on postprandial serum P levels and vascular endothelial function remain unclear.</p><p><strong>Methods: </strong>A randomized, single-blind, crossover study in 99 healthy Japanese was performed to determine the association between SNPs and postprandial serum P levels, flow-mediated dilation (FMD) or alkaline phosphatase activity. The impact of SNP on gene transcriptional activity was also analyzed using in vitro experiment.</p><p><strong>Results: </strong>The participants who were TT homozygotes of SNP rs1697421 (located near the tissue nonspecific alkaline phosphatase [TNAP] gene) had higher postprandial serum P levels than C allele carriers. FMD was more significantly impaired in the TT homozygotes than in the CC homozygotes in men. In the in vitro experiment, TNAP transcriptional activity was significantly lower in TT homozygotes than in the others.</p><p><strong>Conclusion: </strong>These results suggest that in TT homozygotes of SNP rs1697421, hepatic P uptake is affected through changes in serum TNAP levels, leading to high postprandial serum P levels and impairment of FMD. The present findings can contribute to the development of gene-based therapeutic approaches for the management of serum P levels.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of fasting triglyceride variability with renal dysfunction and proteinuria in medical checkup participants.","authors":"Natsumi Matsuoka-Uchiyama, Haruhito A Uchida, Tomohiko Asakawa, Yoshimasa Sakurabu, Katsuyoshi Katayama, Shugo Okamoto, Yasuhiro Onishi, Keiko Tanaka, Hidemi Takeuchi, Rika Takemoto, Ryoko Umebayashi, Jun Wada","doi":"10.1007/s10157-025-02640-9","DOIUrl":"https://doi.org/10.1007/s10157-025-02640-9","url":null,"abstract":"<p><strong>Background: </strong>The association between the variability of triglyceride (TG) and chronic kidney disease (CKD) progression remains unclear. We examined whether intraindividual variability in fasting TG was associated with the exacerbation of CKD.</p><p><strong>Methods: </strong>We conducted a retrospective and observational study. 18,339 participants, who went through medical checkups and had checked their estimated glomerular filtration rate (eGFR) and semi-quantitative proteinuria by urine dipstick every year since 2017 for 4 years were registered. Variability in fasting TG was determined using the standard deviation (SD), and maximum minus minimum difference (MMD) between 2017 and 2021. The primary end point for the analysis of eGFR decline was eGFR < 60 mL/min/1.73 m². The secondary end point for the analysis of proteinuria was the incidence of proteinuria ≥ ( ±) by urine dipstick.</p><p><strong>Results: </strong>The renal survival was lower in the higher-SD, and higher-MMD groups than in the lower-SD, and lower-MMD groups, respectively (log-rank test p < 0.001, and < 0.001, respectively). Lower SD and lower MMD were significantly associated with renal survival in the adjusted model (hazard ratio (HR), 1.12; 95% confidence intervals (CI), 1.04-1.21, and HR, 1.13; 95% CI 1.05-1.23, respectively). The non-incidence of proteinuria was lower in the higher-SD, and higher-MMD groups than in the lower-SD, and lower-MMD groups, respectively (log-rank test p < 0.001 and < 0.001, respectively).</p><p><strong>Conclusion: </strong>Fasting TG variability was associated with CKD progression in participants who went through medical checkups.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the causal association between circulating leukocyte count and IgA nephropathy based on two-sample Mendelian randomization: possible role of transitional B cells.","authors":"Fang Fang, Hong Wang, Jun Luo, Fatong Hong","doi":"10.1007/s10157-025-02646-3","DOIUrl":"https://doi.org/10.1007/s10157-025-02646-3","url":null,"abstract":"<p><strong>Background: </strong>To examine the causal association between genetically predicted circulating leukocyte counts and IgA nephropathy.</p><p><strong>Methods: </strong>A two-sample Mendelian randomization (MR) design was used. The exposures were the neutrophil, lymphocyte (with subsequent analyses for memory B-cell %lymphocyte, IgD^- CD38^br %lymphocyte, IgD⁺ CD38^br %lymphocyte, CD24⁺ CD27⁺ %lymphocyte, Sw mem %lymphocyte, transitional %lymphocyte, and naïve-mature B-cell %lymphocyte), monocyte, basophil, and eosinophil counts. The outcome was IgA nephropathy. Analysis was conducted using the inverse variance weighted (IVW), MR-Egger, weighted median, and weighted mode. The Cochran's Q-test and MR-Egger regression were used to assess heterogeneity and horizontal pleiotropy, respectively. The robustness of the results was tested using MR-PRESSO and leave-one-out analyses.</p><p><strong>Results: </strong>The genetic prediction results showed causal associations between the neutrophil counts and IgA nephropathy (OR = 2.62, 95%CI 2.47-2.77, P < 0.001) and between the lymphocyte counts and IgA nephropathy (OR = 0.76, 95%CI 0.58-0.99, P = 0.04). Monocyte, basophil, and eosinophil counts showed no causal associations with IgA nephropathy. The supplementary genetic prediction analyses showed a causal association between transitional %lymphocytes and IgA nephropathy (OR = 0.58, 95%CI 0.39-0.87, P = 0.008). Cochran's Q test revealed heterogeneity for the neutrophil, lymphocyte, monocyte, eosinophil, transitional %lymphocytes, and count analyses (all P < 0.05), but the MR-Egger test revealed no pleiotropy. After removing the outliers, the associations remained the same.</p><p><strong>Conclusion: </strong>Causal associations were observed between neutrophil and lymphocyte counts as exposures and IgA nephropathy as outcome. Among lymphocytes, transitional B cells could be involved in the pathogenesis of IgA nephropathy. Attention should be paid to neutrophil and lymphocyte counts in future studies on IgA nephropathy.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and gender differences in the urinary proteome of healthy subjects using the advantages of quantitative proteomics.","authors":"Keiko Yamamoto, Tadashi Yamamoto","doi":"10.1007/s10157-025-02639-2","DOIUrl":"https://doi.org/10.1007/s10157-025-02639-2","url":null,"abstract":"<p><strong>Background: </strong>Advances in quantitative proteomics have enabled accurate and comprehensive quantification of proteins. In this study, urine from healthy volunteers was analyzed using this method to confirm the depth of protein identification and quantitative stability, and to examine changes in abundance with age and sex, as well as the amounts of proteins known to be urinary biomarkers of kidney damage.</p><p><strong>Methods: </strong>Urine samples were collected from 89 healthy male and female volunteers in their 20s to 70s. Proteins were precipitated with methanol/chloroform, digested with trypsin, and peptides were identified and quantified by mass spectrometry. The quantitative relative value of a protein in the total protein was multiplied by 1,000,000 to obtain a normalized relative value (ppm). The stability of the quantitative proteomics was examined by measuring quality control samples prepared from healthy volunteer urine mix (HVmix) or diabetic urine mix (DMmix) 5 times in every 20 sample measurements.</p><p><strong>Results: </strong>The number of proteins identified was stable at approximately 3000 in five measurements of HVmix and DMmix, as quality control samples. The average coefficient of variation (CV) of the quantitative values was 12.6% for HVmix and 14.8% for DMmix. Approximately 90% of the proteins did not change significantly with age, while approximately 10% of the proteins increased or decreased with age. The quantitative values of some proteins, such as KLK3 in men and A2ML1 in women, differed significantly between the sexes. In addition, several proteins that have already been reported as biomarkers of kidney damage were also quantified.</p><p><strong>Conclusion(s): </strong>This study demonstrated that advanced proteomics enabled comprehensive quantification of urinary proteins, some proteins varied in abundance with age and gender, and provided insight into protein structure.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of drug-coated balloon versus uncoated balloon for dysfunctional dialysis access: a systematic review and meta-analysis.","authors":"Aarij Elahi, Momina Qamar, Fasih Mand Khan, Rameesha Babar, Muhammad Jawad Zahid, Muhammad Omar Ahmad, Shah Wali, Sharib Afzal, Moeen Ikram, Syed Ahsan Ali Shah, Mohammad Ebad Ur Rehman, Huzaifa Ahmad Cheema, Usama Anwar, Muhammad Mohid Tahir, Ioannis Bellos","doi":"10.1007/s10157-025-02642-7","DOIUrl":"https://doi.org/10.1007/s10157-025-02642-7","url":null,"abstract":"<p><strong>Background: </strong>Dysfunctional vascular access is a major cause of morbidity and mortality in patients undergoing hemodialysis, affecting both arteriovenous fistulas and grafts. The most optimal strategy to restore long-term patency has not been established. This meta-analysis compares drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty for dysfunctional vascular access.</p><p><strong>Methods: </strong>We performed a systematic literature search across multiple databases from inception to June 2024. Randomized-controlled trials (RCTs) comparing DCB and UCB in dialysis patients with dysfunctional vascular access were included. Risk ratios were pooled using a random-effects model.</p><p><strong>Results: </strong>Twenty-seven RCTs (2645 patients) were included. Target lesion patency (TLP) at 6 months was significantly superior in the DCB group (RR 1.22, 95% CI 1.07-1.39, p = 0.003). The two regimens were comparable for TLP at 3 months (RR 1.14, p = 0.24) and 12 months (RR 1.14, p = 0.10). The two regimens were comparable in terms of circuit patency rate, target-lesion revascularization, and all-cause mortality.</p><p><strong>Conclusion: </strong>DCB has significantly superior TLP and a comparable risk of mortality to UCB. Further research is warranted to identify factors affecting outcomes following DCB angioplasty for dysfunctional dialysis access.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of urinary [TIMP-2]⋅[IGFBP7], L-FABP, and NGAL levels for predicting community-acquired acute kidney injury in Japanese patients: a single-center, prospective cohort study.","authors":"Satoshi Inotani, Takeshi Kashio, Yuki Osakabe, Tatsuki Matsumoto, Yoshiki Nagao, Masayuki Ishihara, Hideki Iwata, Keita Mitani, Yutaka Hatakeyama, Taro Horino","doi":"10.1007/s10157-025-02641-8","DOIUrl":"https://doi.org/10.1007/s10157-025-02641-8","url":null,"abstract":"<p><strong>Background: </strong>The combination of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) ([TIMP-2]⋅[IGFBP7]) has emerged as a strong predictor of acute kidney injury (AKI), which is associated with poor outcomes. However, most studies have focused on non-Asian populations, and comparisons of [TIMP-2]⋅[IGFBP7] with other AKI biomarkers in Asian populations have not been performed. Furthermore, no study has examined the efficacy of [TIMP-2]⋅[IGFBP7] for predicting community-acquired AKI.</p><p><strong>Methods: </strong>We prospectively enrolled adult patients at Kochi Medical School Hospital in Kochi, Japan, and performed a receiver-operating characteristic (ROC) curve analysis to assess the ability of [TIMP-2]⋅[IGFBP7], neutrophil gelatinase-associated lipocalin (NGAL), and liver fatty acid-binding protein (L-FABP) measured at the time of admission to predict AKI.</p><p><strong>Results: </strong>Of the 170 enrolled patients, 40 (23.5%) developed AKI. Risk factors for AKI development were male sex, history of hypertension, low albumin levels, and high [TIMP-2]⋅[IGFBP7] and NGAL levels. The ROC curve analysis showed that the area under the ROC curve (AUC) of [TIMP-2]•[IGFBP7] for predicting AKI was 0.804 (95% confidence interval [CI], 0.728-0.880); however, the AUCs of L-FABP and NGAL were 0.688 (95% CI, 0.594-0.782) and 0.726 (95% CI, 0.639-0.813), respectively.</p><p><strong>Conclusion: </strong>Urinary [TIMP-2]⋅[IGFBP7] is a good predictor of community-acquired AKI.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotype and genotype of autosomal dominant tubulointerstitial kidney disease in a Japanese cohort.","authors":"Yu Tanaka, China Nagano, Nana Sakakibara, Eri Okada, Shuhei Aoyama, Yuka Kimura, Yuta Inoki, Yuta Ichikawa, Chika Ueda, Hideaki Kitakado, Tomoko Horinouchi, Tomohiko Yamamura, Shingo Ishimori, Kazumoto Iijima, Kandai Nozu, Naoya Morisada","doi":"10.1007/s10157-025-02629-4","DOIUrl":"https://doi.org/10.1007/s10157-025-02629-4","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant tubulointerstitial kidney disease (ADTKD) is characterized by tubular atrophy, interstitial fibrosis, and progressive kidney dysfunction. Its causative genes include UMOD, MUC1, REN, HNF1B, and SEC61A1. ADTKD contributes to unexplained chronic kidney disease (CKD), and many cases remain genetically undiagnosed. This study aimed to elucidate the clinical features of patients genetically diagnosed with ADTKD in Japan.</p><p><strong>Methods: </strong>We included individuals with suspected congenital anomalies of the kidney and urinary tract, nephronophthisis, polycystic kidney disease, or ADTKD. Genetic analyses using direct sequencing, short-read next-generation sequencing (SRS), and/or long-read next-generation sequencing (LRS) were performed on 1097 families. Patients with ADTKD-HNF1B were excluded due to prior reporting.</p><p><strong>Results: </strong>Variants in UMOD, MUC1, REN, and SEC61A1 were identified in 52 patients from 40 families (18, 16, 5, and 1 family, respectively). The median age at diagnosis was 38.5 years, and the urinary protein-to-creatinine ratio was 0.05 g/gCr. End-stage kidney disease was present at diagnosis in 37% of patients. Genetic testing was performed in 58% due to suspected ADTKD based on pathology or clinical course and in 38% due to unexplained CKD. Kidney biopsies were performed in 55%, with ADTKD confirmed pathologically in 41%. SRS and LRS were used in 55% and 30% of all families, respectively; for ADTKD-MUC1, 75% of families were analyzed using LRS.</p><p><strong>Conclusions: </strong>Clinical and pathological diagnosis of ADTKD remains challenging, emphasizing the importance of comprehensive genetic testing. Enhanced access to advanced genetic testing such as LRS is essential to improve diagnostic precision and management.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of patiromer for hyperkalemia: a randomized, placebo-controlled phase 3 study.","authors":"Naoki Kashihara, Hirokazu Okada, Yusuke Suzuki, Tamio Iwamoto, Masashi Yasutomi, Masaru Matsui, Ryo Takezawa, Takayuki Ishii, Yusuke Tomioka","doi":"10.1007/s10157-025-02637-4","DOIUrl":"https://doi.org/10.1007/s10157-025-02637-4","url":null,"abstract":"<p><strong>Background: </strong>This is the phase 3 study in Japan designed to verify the superiority of patiromer over placebo using the change in serum potassium level (sK-level).</p><p><strong>Methods: </strong>This study was a multicenter, randomized withdrawal study targeting Japanese hyperkalemic patients. It consisted of the run-in period and the double-blind period. The run-in period was an active single-arm, open-label period (4 or 5 weeks). The double-blind period was a randomized, placebo-controlled, parallel-group, double-blind period (4 weeks). Patients whose sK-level was within the normal range at week 4 or 5 of the run-in period entered the double-blind period. Patients who entered the double-blind period were randomly assigned to the patiromer group or the placebo group.</p><p><strong>Results: </strong>As a result of the primary analysis, the change of the sK-level (95% CI) from baseline to week 4 in the double-blind-period, was - 0.02 (- 0.19, 0.15) mmol/L in the patiromer group, and 0.78 (0.60, 0.96) mmol/L in the placebo group, with a statistically significant difference between the two treatment groups (p < 0.001). Similarly, statistically significant differences were also observed between the two groups at weeks 1, 2, and 3. Furthermore, the proportion of patients whose sK-level was maintained within the normal range were statistically significantly higher in the patiromer group than in the placebo group at all time points. No adverse events requiring particular attention were observed.</p><p><strong>Conclusion: </strong>Patiromer can improve hyperkalemia by lowering sK-level and can suppress the recurrence of hyperkalemia with continued administration, and is safe and easy-to-use for a wide range of patients.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of tolvaptan in real‑world Japanese patients with autosomal dominant polycystic kidney disease: final results of SLOW‑PKD surveillance.","authors":"Toshio Mochizuki, Satoru Muto, Kyoko Suzue, Satoshi Komaniwa, Toshiki Tanaka, Yasuhiko Fukuta, Yuko Yamashige","doi":"10.1007/s10157-025-02634-7","DOIUrl":"https://doi.org/10.1007/s10157-025-02634-7","url":null,"abstract":"<p><strong>Background: </strong>Tolvaptan, a vasopressin type 2 receptor antagonist, has been used to treat autosomal dominant polycystic kidney disease in Japan since 2014.</p><p><strong>Methods: </strong>This long-term, real-world, post-marketing surveillance (PMS) was conducted in Japan from March 2014 to March 2022. Safety was assessed based on adverse drug reactions (ADRs). For efficacy, changes in the slope of total kidney volume (TKV) and estimated glomerular filtration rate (eGFR) were assessed before and during the administration of tolvaptan.</p><p><strong>Results: </strong>A total of 1676 patients were enrolled, with mean TKV (n = 1000) of 2149 ± 1339 mL and eGFR (n = 1641) of 44.4 ± 21.7 mL/min/1.73 m². Frequent ADRs were hepatic function abnormal (9.6%), hyperuricaemia (8.3%), and thirst (8.1%). Most of the increased alanine aminotransferase exceeding 3 times the upper limit of the reference level occurred from 3  to  14 months after the start of treatment, but about 20% was observed after 15 months. There was no increase in ADRs over 36 months, suggesting that no other safety concerns need to be monitored during administration over 3-7 years. The mean slope of the estimated TKV increase before and during tolvaptan treatment was 6.58 and 3.71%/year, respectively (P = 0.0020). The mean slope of eGFR decline was - 3.63 and - 3.26 mL/min/1.73 m²/year, respectively (P = 0.2728).</p><p><strong>Conclusion: </strong>There were no major problems with the safety of tolvaptan treatment, and efficacy in limiting TKV increase in this PMS was comparable to the previous, pivotal randomized control trials. Trial registration ClinicalTrials.gov; NCT02847624.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}