Clinical and Experimental Nephrology最新文献

{"title":"Estimating the prevalence of chronic kidney disease in the older population using health screening data in Japan.","authors":"Arisa Kobayashi, Keita Hirano, Tadahisa Okuda, Tatsuyoshi Ikenoue, Takashi Yokoo, Shingo Fukuma","doi":"10.1007/s10157-024-02570-y","DOIUrl":"https://doi.org/10.1007/s10157-024-02570-y","url":null,"abstract":"<p><strong>Background: </strong>In aging societies, the prevalence of chronic kidney disease (CKD) is expected to increase but may be underestimated because many asymptomatic patients remain undiagnosed. This study aimed to estimate the CKD prevalence among the general older population in Japan.</p><p><strong>Methods: </strong>This cross-sectional study used health screening data from the Japan Health Insurance Association collected between April 2014 and March 2023. Data from older people aged 65-90 years who underwent renal function screening for estimated glomerular filtration rate (eGFR) and urine protein tests were analyzed. CKD was defined as eGFR < 60 mL/min/1.73 m² or proteinuria ≥ 1 + . Inverse probability weighting was used to account for the selection bias. The variables used for weighting were age, sex, insurance status, and the number of previous screenings.</p><p><strong>Results: </strong>Among 2.98 million older individuals, 588,809 (19.7%) had undergone screening (median [IQR] age, 69.9 [67.9-76.2] years, 337,862 women [57.4%]). Regarding the weighted CKD prevalence, 25.3% of the individuals aged 65-90 years had CKD; 11.8% of those aged 65-75 years and 34.6% of those aged 75 years and over showed an increase in prevalence with age. Among the patients with CKD, over half exhibited mild renal dysfunction without proteinuria. Hypertension and diabetes were common comorbidities in older patients with CKD.</p><p><strong>Conclusions: </strong>This cross-sectional study revealed that the weighted prevalence of CKD in the older population aged 65-90 years was high (one in four individuals), indicating that it increases with age. Further studies are required to examine the clinical significance of these findings.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379172","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":"Clinical outcomes in peritoneal dialysis with refractory peritonitis: significance of the day 5 cell count.","authors":"Ilay Berke, Dilek Barutcu Atas, Murat Tugcu, Hakki Arikan, Arzu Velioglu, Ebru Asicioglu","doi":"10.1007/s10157-024-02564-w","DOIUrl":"https://doi.org/10.1007/s10157-024-02564-w","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis-associated peritonitis is a common and severe complication of peritoneal dialysis, associated with high morbidity and mortality. However, there's a lack of research on refractory peritonitis, which is difficult to manage and has a poor prognosis. Our study aimed to investigate factors affecting clinical outcomes in peritoneal dialysis patients with refractory peritonitis over a 12-year period at a medical faculty hospital in Turkey.</p><p><strong>Methods: </strong>We conducted a retrospective study at a single center from January 2009 to December 2020, involving 135 patients with 236 episodes of refractory peritonitis. The average age of the patient cohort was 53.0 ± 15.9 years, and 72 (53.4%) of the patients were male. The leading identified causes of end-stage kidney disease were glomerulonephritis, hypertensive glomerulosclerosis, and diabetic nephropathy. Data on microbiological etiology, dialysate white blood cell counts, and patient demographics were analyzed to identify catheter removal risk factors. Statistical significance was set at p ≤ 0.05.</p><p><strong>Results: </strong>Comparative analysis between patients with and without catheter loss revealed no significant differences in gender, age, presence of diabetes, prior hemodialysis, or duration of peritoneal dialysis. However, multivariate logistic regression analysis showed that a dialysate white blood cell count exceeding 1000/mm³ on day 5 and hospitalization had a positive association with catheter loss, while the presence of gram-positive bacterial growth had an inverse correlation.</p><p><strong>Conclusion: </strong>Our study shows that fifth-day dialysate white blood cell count predicts refractory peritonitis outcomes. Future research should focus on developing tools to manage catheter removal proactively and enhance patient prognosis.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379171","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":"Utility of ultrasound in measuring quadriceps muscle thickness in patients receiving maintenance hemodialysis: comprehensive systematic review and meta-analysis.","authors":"Anas Elgenidy, Shady Sapoor, Hasnaa Abdelrhem, Ahmed Said Ali, Saif Sulliman, Sohieb Hedawy, Ayman Elgharori, Hassaan Mady, Wisam Abraheem Hasan, Mohamed Nasser, Esraa Abd Elaal Atta, Mohamed Ghita, Mostafa G Aly, Jana Zschüntzsch","doi":"10.1007/s10157-024-02557-9","DOIUrl":"https://doi.org/10.1007/s10157-024-02557-9","url":null,"abstract":"<p><strong>Background: </strong>Muscle wasting, a prevalent issue in hemodialysis patients, is effectively assessed by measuring quadriceps muscle thickness, a crucial health indicator. This meta-analysis integrates findings from various studies on the application of ultrasonography (US) for measuring the thickness of quadriceps muscles in patients undergoing maintenance hemodialysis.</p><p><strong>Design and methods: </strong>We conducted a thorough literature search across PubMed, Scopus, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to April 2023. The R software's Meta package was used for mean difference analysis of quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) between hemodialysis patients and healthy controls. All of the patients entered the meta-analysis are Caucasians. Sub-group analyses based on measurement sites and pre- and post-dialysis comparisons were performed.</p><p><strong>Results: </strong>Among 15 studies with 1584 patients, a significant decrease in QRFT and QVIT was observed in hemodialysis patients compared to healthy controls (mean difference = 0.40 cm, 95% CI: -0.49 to -0.31 and 0.46 cm, respectively). Right and left QRFT were notably thinner in hemodialysis patients (RT: mean difference = 0.39 cm; LT: mean difference = 0.42 cm). Similarly, right and left QVIT were notably thinner in hemodialysis patients (RT: mean difference = 0.45 cm; LT: mean difference = 0.47 cm). No significant pre- and post-dialysis QRFT differences were found.</p><p><strong>Conclusion: </strong>Ultrasonography is a reliable, accessible tool for assessing quadriceps muscle thickness in hemodialysis patients, revealing consistent muscle thickness reduction. These findings emphasize the need for routine muscle health monitoring in this population and support ultrasound use for regular assessments.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371145","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":"Predictors of encapsulated peritoneal sclerosis in patients undergoing peritoneal dialysis using neutral-pH dialysate.","authors":"Toshiaki Nakano, Hiromasa Kitamura, Shoji Tsuneyoshi, Akihiro Tsuchimoto, Kumiko Torisu, Hiroaki Tsujikawa, Hideki Kawanishi, Kazuhiko Tsuruya, Takanari Kitazono","doi":"10.1007/s10157-024-02565-9","DOIUrl":"https://doi.org/10.1007/s10157-024-02565-9","url":null,"abstract":"<p><strong>Background: </strong>Encapsulated peritoneal sclerosis (EPS) is a serious complication in patients undergoing peritoneal dialysis (PD). Neutral-pH dialysate is associated with less peritoneal damage and a lower incidence of EPS than conventional PD solution. However, monitoring for peritoneal damage and predicting EPS remain important during PD therapy.</p><p><strong>Methods: </strong>We measured the mesothelial cell area, dialysate-to-plasma ratio of creatinine after 4 h, and concentrations of the potential biological markers effluent fibrin degradation products (eFDPs), cancer antigen-125, and interleukin-6 in the effluent dialysate from patients who had been undergoing PD therapy for > 5 years in our hospital. These biomarkers were obtained from the drainage fluid of the final measurement of peritoneal equilibration testing before withdrawal from PD therapy. The concentrations of these potential biomarkers were measured in 39 patients who withdrew from PD therapy and were enrolled in the study.</p><p><strong>Results: </strong>Three participants developed EPS after withdrawing PD. The dialysate-to-plasma ratio of creatinine, area of mesothelial cells, and interleukin-6 appearance rate in participants who developed EPS tended to be higher than those in patients who did not, but there were no significant differences. Significantly more eFDPs were in participants who developed EPS than in those who did not (138.5 ± 15.1 vs. 32.9 ± 7.4 µg/mL, P = 0.002). There was no difference in the cancer antigen-125 appearance rate between the groups. A cut-off value of eFDPs ≥ 119.1 µg/mL was optimal for predicting EPS (P = 0.006, specificity = 0.972, sensitivity = 1.000).</p><p><strong>Conclusion: </strong>This study shows that eFDPs may be a useful biological marker for predicting EPS in patients undergoing PD using neutral-pH dialysate.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371144","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":"Outcomes of kidney transplantation in recipients with SARS-cov-2 infection: a 282-case single-center experience in Japan.","authors":"Eri Sekido, Kohei Unagami, Kazuya Omoto, Ken Arimura, Ikumi Moriyama, Taro Banno, Ayaka Saitoh, Rikako Oki, Daigo Okada, Takafumi Yagisawa, Taichi Kanzawa, Kumiko Kitajima, Toshihito Hirai, Tomokazu Shimizu, Shigeyoshi Yamanaga, Hiroto Egawa, Masashi Inui, Junichi Hoshino, Hideki Ishida, Toshio Takagi","doi":"10.1007/s10157-024-02560-0","DOIUrl":"https://doi.org/10.1007/s10157-024-02560-0","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019, caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has become a global epidemic. There are concerns regarding the severity of SARS-CoV-2 infections in kidney transplant (KTx) recipients. However, there is limited data on how the epidemic has affected the treatment and prognosis of these patients. Therefore, we aimed to report the changes in the treatment and outcomes of KTx recipients infected with SARS-CoV-2 during each wave at our institution.</p><p><strong>Methods: </strong>A total of 282 KTx recipients who were infected with SARS-CoV-2 during the study period were followed up at Tokyo Women's Medical University between March 2020 and August 2022. We investigated the outcomes and treatments of infected KTx recipients.</p><p><strong>Results: </strong>Nineteen (6.7%) patients showed severe outcomes, including eight SARS-CoV-2 infection-related deaths. Risk factors associated with severe outcomes included underlying conditions, such as diabetes mellitus, heart disease, and liver disease (odds ratios, 2.09, 2.88, and 5.52, respectively). Treatment strategies changed throughout the epidemic in response to changes in the SARS-CoV-2 variants. Antiviral drugs were gradually administered as soon as they were approved for use.</p><p><strong>Conclusions: </strong>Treatment strategies for KTx recipients were gradually established over the course of the epidemic. Although the proportion of infected KTx recipients decreased compared to that of the general population throughout the epidemic, many patients still followed a severe course.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364656","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":"Sacubitril/valsartan reduces proteinuria depending on blood pressure in patients with stage 4-5 chronic kidney disease.","authors":"Yosuke Saka, Hiroshi Takahashi, Tomohiko Naruse, Yuzo Watanabe","doi":"10.1007/s10157-024-02561-z","DOIUrl":"https://doi.org/10.1007/s10157-024-02561-z","url":null,"abstract":"<p><strong>Background: </strong>Blood pressure (BP) control is an important factor in the management of chronic kidney disease (CKD). Several studies have shown that BP in many patients with CKD remained uncontrolled even with multiple medications. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has been newly approved for treating hypertension in Japan. However, the renoprotective effects remain unclear, particularly in patients with advanced CKD. Here, we investigated the effects on proteinuria of this ARNI in patients with stage 4-5 CKD.</p><p><strong>Methods: </strong>We retrospectively collected data from outpatients with stage 4-5 CKD who started ARNI from January until December 2023. The primary outcome was the change in urine protein creatinine ratio (UPCR) at 6 months after ARNI initiation. Secondary outcomes were systolic and diastolic BP, estimated glomerular filtration rate (eGFR), serum potassium, and serum uric acid (UA). We analyzed factors associated with 50% UPCR reduction by multivariate analysis.</p><p><strong>Results: </strong>In total, 47 patients were analyzed. ARNI reduced UPCR from 2.14 g/gCr (interquartile range; 1.09-2.91) to 1.05 g/gCr (0.42-1.95; p < 0.001). Systolic BP fell from 150.0 mmHg (139.5-160.0) to 134.0 mmHg (124.5-140.0; p < 0.001). No significant changes in eGFR, serum potassium, and serum uric acid were observed, except for a slight decrease in eGFR among patients with conversion from a renin-angiotensin system inhibitor to ARNI. In multivariate regression analysis, higher systolic BP (per 10-mmHg increase) was significantly associated with reduced proteinuria (odds ratio 2.51, 95% confidence interval 1.35-4.66; p = 0.004).</p><p><strong>Conclusions: </strong>ARNI reduced proteinuria in patients with stage 4-5 CKD, particularly for those with uncontrolled hypertension.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364657","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":"Annual change in eGFR in renal hypouricemia: a retrospective pilot study.","authors":"Shinobu Sugihara, Yasutaka Yamamoto, Kei Teramoto, Toshiro Hamada, Satoshi Miyazaki, Kazuhide Ogino, Masanari Kuwabara, Akira Ohtahara, Einosuke Mizuta, Kimiyoshi Ichida, Yusuke Endo, Hiroyuki Minato, Haruaki Ninomiya, Masahiko Kato, Kazuhiro Yamamoto, Ichiro Hisatome","doi":"10.1007/s10157-024-02558-8","DOIUrl":"https://doi.org/10.1007/s10157-024-02558-8","url":null,"abstract":"<p><strong>Background: </strong>Extremely low uric acid (UA) levels or increased urinary UA (Uua) excretion might be risk factors for kidney disease in renal hypouricemia (RHU) patients, but their relationship with kidney dysfunction is unclear. This study investigated time-dependent changes in eGFR in RHU patients.</p><p><strong>Methods: </strong>This multicenter retrospective study assessed UA metabolism and changes in eGFR (median 5.5 years) in 13 RHU patients. We then compared eGFR change in 7 of 13 RHU patients whose eGFR could be measured for 4 years with those in normouricemic group (n = 31). In addition, 7 RHU patients were divided into two groups based on URAT1 gene mutations: homozygote and compound heterozygote mutations (Homo/Com group, n = 3), and wild-type and heterogeneous mutations (WT/Hetero group, n = 4).</p><p><strong>Results: </strong>In 13 RHU patients, the median and mean serum UA (SUA) were 0.8 (0.4-2.5) and 1.1 ± 0.7 mg/dL. The median and mean Uua were 44.3 (12.7-141.1) and 49.7 ± 36.2 mg/dL. The median and mean urinary urate clearance (Cua/Ccr) were 46.8 (11.3-73.6) and 43.3 ± 19.7%. Over 4 years, eGFR did not change in the RHU group but declined in the normouricemic group. Annual mean eGFR decline and change rate in the RHU group were the same as those in the normouricemic group (- 1.09 ± 1.11 vs. - 1.09 ± 1.92 mL/min/1.73 m²/year, p = 0.996) (- 1.74 ± 1.96 vs. - 1.36 ± 2.10%, p = 0.664). And no significant difference was found in eGFR decline or change rate between Homo/Com and WT/Hetero groups (- 0.33 ± 1.03 vs. - 1.67 ± 0.85 mL/min/1.73 m²/year, p = 0.116) (- 0.61 ± 1.62 vs. - 2.59 ± 1.91%, p = 0.210).</p><p><strong>Conclusion: </strong>RHU from URAT1 genetic mutation may not show eGFR decline over 4 consecutive years.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364646","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":"Research progress on the pathogenesis of AKI complicated by ECMO.","authors":"Keke Sun, Congcong Yao, Guowu Xu, Jinxiang Wang, Songtao Shou, Heng Jin","doi":"10.1007/s10157-024-02559-7","DOIUrl":"https://doi.org/10.1007/s10157-024-02559-7","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) stands as a pivotal intervention for patients grappling with cardiopulmonary insufficiency. However, alongside its therapeutic benefits, ECMO carries the risk of complications, with acute kidney injury (AKI) emerging as a significant concern. The precise pathophysiological underpinnings of AKI in the context of ECMO remain incompletely elucidated.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted to explore the epidemiology and pathophysiological mechanisms underlying the utilization of ECMO in the management of AKI.</p><p><strong>Results: </strong>ECMO initiates a multifaceted cascade of inflammatory reactions, encompassing complement activation, endothelial dysfunction, white blood cell activation, and cytokine release. Furthermore, factors such as renal hypoperfusion, ischemia-reperfusion injury, hemolysis, and fluid overload exacerbate AKI. Specifically, veno-arterial ECMO (VA-ECMO) may directly induce renal hypoperfusion, whereas veno-venous ECMO (VV-ECMO) predominantly impacts pulmonary function, indirectly influencing renal function.</p><p><strong>Conclusion: </strong>While ECMO offers significant therapeutic advantages, AKI persists as a potentially fatal complication. A thorough comprehension of the pathogenesis underlying ECMO-associated AKI is imperative for effective prevention and management strategies. Moreover, additional research is warranted to delineate the incidence of AKI secondary to ECMO and to refine clinical approaches accordingly.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342797","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":"Effect of age, sex, and chronic kidney disease on urinary creatinine excretion in Japanese patients.","authors":"Shigehiro Yasui, Taro Horino, Keita Mitani, Yoshio Terada, Yoshiyasu Okuhara, Yutaka Hatakeyama","doi":"10.1007/s10157-024-02569-5","DOIUrl":"https://doi.org/10.1007/s10157-024-02569-5","url":null,"abstract":"<p><strong>Background: </strong>Urinary creatinine levels are used to estimate the excretion rates of certain analytes from the respective analyte-to-creatinine ratios. We clarified the influence of age and sex on estimated daily urinary creatinine excretion (eUCrE) based on the urinary creatinine level and daily urine volume.</p><p><strong>Methods: </strong>All inpatients aged ≥ 18 years who attended the Kochi Medical School Hospital with serum and urinary creatinine measurement results were enrolled. Serum and urinary creatinine concentrations were extracted from the database and fluctuations with sex and age were investigated. The eUCrE was calculated for patients with early morning spot urine protein excretion (UPE), and daily urine volume was measured on the same day.</p><p><strong>Results: </strong>Overall, 643 participants (322 men, 321 women) were enrolled. The eUCrE levels of men and women aged 18 - 64 and 18 - 44 years, respectively, significantly exceeded 1 g/day. Those of women aged 65-74 and ≥ 75 years were significantly lower than 1 g/day. Each age group was further categorised into Groups A (patients with eGFR ≥ 30 mL/min/1.73 m² and UPE < 0.5 g/gCr), B (eGFR ≥ 30 mL/min/1.73 m² and UPE ≥ 0.5 g/gCr), and C (eGFR < 30 mL/min/1.73 m² and UPE ≥ 0.5 g/gCr). The eUCrE levels were the highest in Group A, followed by Groups B and C.</p><p><strong>Conclusion: </strong>This study revealed age-, sex-, and renal function-related biases in adjusted values using urinary biomarkers, including proteinuria and creatinine ratio.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342796","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 hyperphosphatemia with renal prognosis in patients with autosomal dominant polycystic kidney disease.","authors":"Kosaku Nitta, Hiroshi Kataoka, Shun Manabe, Shiho Makabe, Taro Akihisa, Yusuke Ushio, Momoko Seki, Ken Tsuchiya, Junichi Hoshino, Toshio Mochizuki","doi":"10.1007/s10157-024-02568-6","DOIUrl":"https://doi.org/10.1007/s10157-024-02568-6","url":null,"abstract":"<p><strong>Background: </strong>Serum phosphate (P) levels are generally lower in autosomal dominant polycystic kidney disease (ADPKD) than in other kidney disorders, potentially masking the clinical significance of hyperphosphatemia. This study aimed to determine if serum P levels can predict renal outcomes in ADPKD patients.</p><p><strong>Methods: </strong>We included 235 patients with ADPKD who were not taking drugs to treat hyperphosphatemia. Survival analysis was performed for the renal outcome of a 50% reduction in estimated glomerular filtration rate or initiation of renal replacement therapy.</p><p><strong>Results: </strong>Multivariable Cox regression analyses revealed that serum P (1 mg/dL increase, HR = 2.03, P < 0.0001) was a significant risk factor for kidney disease progression. Similarly, hyperphosphatemia (P > 3.5 mg/dL, HR = 2.05; P > 4.0 mg/dL, HR = 1.90; P > 4.5 mg/dL, HR = 2.78; P > 5.0 mg/dL, HR = 27.22) was significantly associated with renal prognosis. Kaplan-Meier analysis showed significantly lower kidney survival rates in patients with P > 3.5 mg/dL than in those without hyperphosphatemia (log-rank test, P < 0.0001), and similar Kaplan-Meier analysis results were found for P > 4.0 mg/dL, P > 4.5 mg/dL, and P > 5.0 mg/dL. The 2 year kidney survival rate for ADPKD patients with P > 3.5 mg/dL was 66.7% overall and 41.4% in those with stage 4-5 CKD. For patients with P > 4.0 mg/dL, the survival rate dropped to 46.8% overall and 28.2% in those with stage 4-5 CKD, indicating a very poor prognosis.</p><p><strong>Conclusion: </strong>Hyperphosphatemia was associated with renal prognosis in patients with ADPKD. In these patients, attention should be paid to even mild serum P elevation of > 3.5 or > 4.0 mg/dL.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342795","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}