Clinical nephrology最新文献

{"title":"Effects of chronic kidney disease-associated pruritus on quality of life in hemodialysis and non-dialysis patients: A cross-sectional study.","authors":"Abdullah Ucar, Mevlut Tamer Dincer, Safak Mirioglu, Siddik Keskin, Cebrail Karaca","doi":"10.5414/CN111649","DOIUrl":"10.5414/CN111649","url":null,"abstract":"<p><strong>Aims: </strong>Chronic kidney disease-associated pruritus (CKD-aP) is a common and distressing symptom, particularly in hemodialysis (HD) patients, significantly impacting their quality of life. This study aimed to investigate the effects of CKD-aP frequency and severity on quality of life in both HD and non-HD stage 3 - 5 CKD patients.</p><p><strong>Materials and methods: </strong>This cross-sectional case-control study was conducted from January to May 2024. Pruritus was assessed using the 5-D itch scale, and quality of life was evaluated with the World Health Organization Quality of Life Scale-Short Form (WHOQoL-BREF) questionnaire. Correlations between pruritus severity and patient characteristics were analyzed.</p><p><strong>Results: </strong>The study involved 169 patients, comprising 80 non-HD stage 3 - 5 CKD patients and 89 HD patients, with a mean age of 55.2 ± 16.7 years. Pruritus was significantly more prevalent in the HD group than in the non-HD group (61.8 vs. 41.3%, p = 0.008). HD patients had more pruritic body areas and higher 5-D itch scale scores (0 (0 - 8.5) vs. 0 (0 - 3.75), p = 0.002; 9.3 (8.0 - 14.8) vs. 8.0 (8.0 - 10.3), p = 0.003). In the HD group, pruritus was associated with lower quality of life in the psychological health, social relationships, and environment domains of the WHOQoL-BREF questionnaire (50.0 (35.4 - 58.3)% vs. 54.2 (42.7 - 66.7)%, p = 0.027; 50.0 (33.3 - 58.3)% vs. 50.0 (41.6 - 66.7)%, p = 0.046; 53.1 (40.6 - 65.5)% vs. 56.3 (50.0 - 68.8)%, p = 0.026, respectively). Pruritus also correlated with lower hemoglobin levels, higher serum creatinine levels, and poorer overall quality of life in both groups, with female sex and erythropoiesis-stimulating agent use as significant contributing factors.</p><p><strong>Conclusion: </strong>Pruritus significantly impairs the quality of life in HD patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109977","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 repositioning malfunctioning peritoneal dialysis catheters with fluoroscopically guided guidewire manipulation.","authors":"Ron Cheuk Lau Wong, Eric Wai Pan Cheung, Agnes Wong, Brian Kar Ho Lee, Ka King Cheng, Danny Hing Yan Cho","doi":"10.5414/CN111605","DOIUrl":"https://doi.org/10.5414/CN111605","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of fluoroscopic-guided repositioning of peritoneal dialysis (PD) catheter using guidewire manipulation in our center in Hong Kong.</p><p><strong>Materials and methods: </strong>All patients underwent fluoroscopic-guided PD catheter repositioning in our institution between November 1, 2017 to December 31, 2022 were reviewed. Patients fulfilling the selection criteria were identified, with their clinical notes, relevant radiological reports, interventional images, and operative records retrospectively reviewed. The success rate was evaluated, with the technical success defined as improved free contrast flow or return of continuous steady stream after test injection of normal saline immediately after repositioning; clinical success defined as functional peritoneal dialysis catheter at 30 days post-repositioning. Logistic regression models were applied to evaluate the variables associated with successful manipulation. Post-manipulation complications and the PD time gained after successful manipulation were also reviewed.</p><p><strong>Results: </strong>46 patients were identified and 54 procedures were performed over the study period. 35 of the interventions (64.8%) resulted in technical success, and 25 cases (46.3%) resulted in clinical success. The median extra PD time gained after successful manipulation was 619 days (IQR, 313.5 - 1,007; range, 110 - 1,872). The median for number of days of hospital stay after the procedure was 2.5 days (IQR, 2 - 5; range, 1 - 65). Seven cases (13.0%) developed immediate complications, with most cases being peritonitis (n = 5), and all were successfully treated with intraperitoneal antibiotics. There was no associated mortality.</p><p><strong>Conclusion: </strong>Fluoroscopic-guided repositioning of the PD catheter was found to be a useful and safe treatment option for malfunctioning PD catheter and could potentially spare patients from the conventional operative intervention.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980290","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":"Central blood volume and cardiac output index predict all-cause and cardiovascular mortality in chronic hemodialysis patients.","authors":"Chung-Kuan Wu, Li-Juan Lin, Chew-Teng Kor, Chia Lin Wu","doi":"10.5414/CN111484","DOIUrl":"https://doi.org/10.5414/CN111484","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the effect of central blood volume (CBV) and cardiac output index (COI) on the all-cause and cardiovascular mortality in chronic hemodialysis (CHD) patients.</p><p><strong>Materials and methods: </strong>Adult CHD patients with functional arteriovenous access at the hemodialysis center of a medical center between January 1, 2003, and December 31, 2014, were recruited in this retrospective observational study. The primary and secondary endpoints were all-cause and cardiovascular mortality. Cumulative incidences of all-cause and cardiovascular mortality during the follow-up period were estimated and compared using the Kaplan-Meier method and log-rank test. Logistic regression and Cox proportional hazards models were used to calculate odds and hazard ratios.</p><p><strong>Results: </strong>A total of 390 CHD patients were enrolled, including 34 patients with early mortality. The early mortality group had a higher CBV than the survival group. CBV and COI were independently associated with all-cause and cardiovascular mortality. Low COI (< 3 L/min/m2) and high CBV (≥ 1.25 L) independently predicted long-term all-cause and cardiovascular mortality. The highest risks of all-cause and cardiovascular mortality were observed in patients with low COI and high CBV, followed by high COI and high CBV and then low COI and low CBV. Mortality was the lowest in those with high COI and low CBV.</p><p><strong>Conclusion: </strong>CBV and COI are important factors for predicting death in CHD patients. Those with low COI and high CBV had the worst outcomes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966788","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":"Atypical hemolytic uremic syndrome associated with acute pancreatitis.","authors":"Kunxiao Zhao, Jie Feng, Qiongzhen Lin, Ying Lei","doi":"10.5414/CN111660","DOIUrl":"https://doi.org/10.5414/CN111660","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977330","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":"Malnutrition and short-term mortality in hospitalized general medical patients with acute kidney injury: A prospective observational study.","authors":"Vishal Choudhary, Surendran Deepanjali","doi":"10.5414/CN111715","DOIUrl":"https://doi.org/10.5414/CN111715","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common condition present at admission to hospital in a proportion of general medical patients and it contributes to mortality. Presence of associated malnutrition could worsen the prognosis. We aimed to study the prevalence of malnutrition in patients with community-acquired AKI requiring hospitalization and its association with short-term (in-hospital and 1-month post-discharge) mortality, admission to the intensive care unit (ICU) and length of hospitalization (LOH).</p><p><strong>Materials and methods: </strong>We did a prospective observational study including adult general medical patients who had AKI at admission; patients with chronic kidney disease were excluded. We calculated the Charlson Comorbidity Index (CCI) and Sequential Organ Failure Assessment Score (SOFA). Nutritional assessment was done using Subjective Global Assessment (SGA) and also Prognostic Nutritional Index (PNI). Clinical course and vital status at 1 month after discharge was noted. Predictors of mortality were identified using logistic regression.</p><p><strong>Results: </strong>We recruited 230 patients. The median (interquartile range (IQR)) age was 51 (40 - 64) years; 171 (74.3%) were males. Based on admission creatinine, 60 (26%) were in Kidney Disease Improving Global Outcomes (KDIGO) stage 1, 82 (35.6%) in stage 2, and 88 (38.3%) in stage 3. We found that 132 (57.4%) belonged to SGA category A, 77 (33.5%) to SGA B, and 21 (9.1%) to SGA C. The median (IQR) PNI was 36.3 (30 - 46.6). The short-term mortality was 59 (25.6%). Multivariable analysis showed that male sex (adjusted OR (aOR) (2.75 (1.08 - 6.98); p = 0.033), higher CCI (aOR 1.43 (1.18 - 1.74); p < 0.001), higher SOFA scores (aOR 1.36 (1.19 - 1.55); p < 0.001), and SGA C category (aOR 4.4 (1.39 - 14.03); p = 0.012) to be associated with mortality, while AKI due to underlying infections was associated with survival (aOR 0.38 (0.18 - 0.78); p = 0.008). There was no association of malnutrition with ICU admission or LOH. PNI did not predict mortality.</p><p><strong>Conclusion: </strong>About 10% of patients with community-acquired AKI had severe malnutrition, and it independently predicts mortality. Male sex, higher CCI, and higher SOFA scores were also associated with mortality. AKI associated with infections has a better prognosis.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967980","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":"Autosomal dominant polycystic kidney disease without apparent family history: A single-center experience.","authors":"Marrissa Samuels, Omar Maarouf, Wing Zeng, Mehrdad Hamrahian, Neera K Dahl, Jingjing Zhang","doi":"10.5414/CN111677","DOIUrl":"https://doi.org/10.5414/CN111677","url":null,"abstract":"<p><p>Autosomal dominant polycystic kidney disease (ADPKD) - the most common hereditary kidney disease - accounts for nearly 5% of patients with kidney failure. Due to de novo mutations or other causes, nearly 25% of patients with a clinical diagnosis of PKD have no apparent family history. This poses a challenge for practicing nephrologists in making an accurate diagnosis. We evaluated ADPKD patients with and without a family history and compared genetic testing, kidney imaging, and kidney function results. We reviewed the genetic testing results of 54 PKD patients at Thomas Jefferson University Hospital between 2020 and 2024. A total of 38 patients (70%) had a family history of ADPKD. Of these patients, 92% had either a <i>PKD1</i> or <i>PKD2</i> disease-causing variant. 16 patients (30%) had no family history. Of these patients, 56% had either a <i>PKD1</i> or <i>PKD2</i> disease-causing variant and 19% had variants in minor genes associated with ADPKD. Five patients (9%) had no genetic diagnosis. We propose an algorithm to help classify patients with an ADPKD phenotype but without family history.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985874","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 relationship between proteinuria and left ventricular hypertrophy in non-diabetic chronic glomerulonephritis patients.","authors":"Musa Ilker Durak, Beyza Algul Durak, Melahat Coban, Mine Sebnem Karakan","doi":"10.5414/CN111637","DOIUrl":"https://doi.org/10.5414/CN111637","url":null,"abstract":"<p><strong>Aim: </strong>Chronic glomerulonephritis (GN) encompasses various disorders that lead to glomerular inflammation and damage through the interaction of environmental triggers such as immune-mediated mechanisms and infections. The aim of the study was to investigate the relationship between proteinuria and left ventricular hypertrophy (LVH) in non-diabetic chronic GN patients.</p><p><strong>Materials and methods: </strong>This study was conducted with 103 (62.4%) male and 62 (37.6%) female chronic GN patients with a mean age of 55.65 ± 15.81 years. Patients were compared with 90 healthy individuals of similar age and gender. Proteinuria levels were measured using 24-hour proteinuria quantification (24h QP). Left ventricular (LV) ejection fraction (LVEF), LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), and LV mass index (LVMI) were calculated using echocardiography.</p><p><strong>Results: </strong>Proteinuria was determined to be ≥ 3.5 g/day in 54 (32.7%) of the patients. In patients, creatinine, LVMI, and LVH were significantly higher compared to healthy individuals. Patients with nephrotic proteinuria had higher LVMI and LVH compared to those with non-nephrotic proteinuria. A significant relationship was found between LVMI and LVH in patients with nephrotic proteinuria. In the univariate logistic regression analysis, an increase in LVH and LVMI values was found to be associated with an increase in nephrotic proteinuria levels.</p><p><strong>Conclusion: </strong>Increased development of LVH was observed in patients compared to healthy individuals. Significantly higher development of LVH was observed in those with nephrotic proteinuria compared to those without. A significant relationship was observed between nephrotic proteinuria and LVH as well as LVMI in patients with chronic GN.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976588","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":"Trends and surgical outcomes in laparoscopic and open peritoneal dialysis catheter insertion.","authors":"Ankur D Shah, Susie L Hu, Anvitha Rangan, Adena J Osband, Christina A Raker","doi":"10.5414/CN111497","DOIUrl":"10.5414/CN111497","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) catheters can be inserted via open or laparoscopic techniques. Recent guidelines suggest advanced laparoscopic insertion for suitable patients, due to known catheter-related benefits, but surgical outcomes literature is lacking.</p><p><strong>Materials and methods: </strong>We analyzed 11,731 PD catheter insertions from 2013 - 2018 in the National Surgical Quality Improvement Program database, including preoperative characteristics, operative details, and 30-day outcomes. Trends over time and factors associated with approach were assessed. Logistic regression examined the association between approach and postoperative mortality, complications, and length of stay.</p><p><strong>Results: </strong>Laparoscopic PD catheter insertions increased from 76.1 to 87% of cases over the study period (p < 0.0001). Compared to laparoscopic procedures, open insertions were performed in older patients (58.8 vs. 58.1 years) with higher comorbidity. After adjustment, odds of 30-day mortality (OR 1.16, 95% CI 0.72 - 1.89), surgical site infections (OR 1.18, 95% CI 0.84 - 1.66), and other complications were similar between groups, although length of stay > 7 days remained modestly higher for open procedures (OR 1.43, 95% CI 1.03 - 1.99).</p><p><strong>Conclusion: </strong>Use of laparoscopic PD catheter insertion has steadily increased from 2013 - 2018. After accounting for confounders, laparoscopic and open techniques had comparable early morbidity and mortality. These real-world data indicate increasing adoption of laparoscopic insertion as the predominant approach for PD access creation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"326-332"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540412","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":"Timing of magnesium supplementation in patients with nephrolithiasis: A randomized controlled trial.","authors":"Adam J Sharbaugh, Omar M Ayyash, Julie M Riley, Timothy D Averch, Michelle J Semins","doi":"10.5414/CN111168","DOIUrl":"10.5414/CN111168","url":null,"abstract":"<p><strong>Background: </strong>Urinary magnesium plays an important role in the prevention of calcium oxalate stone formation, but the role of magnesium supplementation has yet to be clearly defined. We examined the urinary biochemistry of patients taking magnesium supplementation with meals versus while fasting.</p><p><strong>Materials and methods: </strong>This was a single-institution, prospective, randomized controlled pilot study examining magnesium supplementation taken with meals versus while fasting in patients with a history of calcium oxalate stones and isolated hyperoxaluria. Patients were provided a controlled diet and randomized to take magnesium supplementation either fasting or with meals during a 7-day study period. A pre-intervention and post-intervention 24-hour urinalysis was completed for all patients.</p><p><strong>Results: </strong>Eight patients were enrolled with 4 patients randomized to each arm of magnesium supplementation. Those taking magnesium supplementation with meals experienced a median decrease of 17.8 mg/d in urinary oxalate, increase of 33.6 mg/d in urinary magnesium, and increase of 134.8 mg/d in urinary citrate from the pre- to the post-intervention 24-hour urinalysis. Those taking supplementation while fasting experienced an average decrease of 8.5 mg/d in urinary oxalate, increase of 21.8 mg/d in urinary magnesium, and increase of 116.6 mg/d of urinary citrate.</p><p><strong>Conclusion: </strong>Patients with a prior history of calcium oxalate stone formation and isolated hyperoxaluria who took magnesium supplementation with meals were found to have a more substantial improvement in urinary parameters on 24-hour urinalysis compared to those who took magnesium supplementation while fasting. Magnesium supplementation should be taken with meals if prescribed for the prevention of recurrent calcium oxalate nephrolithiasis.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"312-317"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363968","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":"Corrigendum for the article Clin Nephrol. 2025; 103: 1-4.","authors":"Fredrik Barth Brekke, Nanna von der Lippe, Ine Røed, Helga Gudmundsdottir, Martin Braaten, Espen Nordheim","doi":"10.5414/CN111423Cor","DOIUrl":"10.5414/CN111423Cor","url":null,"abstract":"<p><p>Regarding the article by Fredrik Barth Brekke, Nanna von der Lippe, Ine Røed, Helga Gudmundsdottir, Martin Braaten, Espen Nordheim. Hyperbaric oxygen treatment in addition to conventional multidisciplinary care in patients with calciphylaxis. Clin Nephrol. 2025; 103: 1-4. doi: 10.5414/ CN111423, the authors would like to apologize for the error in Table 1 of page 2. Five patients were misclassified as CKD5 patients when established in dialysis. The correct number of patients in different CKD5 stage is corrected and <b>marked in bold</b> in revised Table 1 presented below. The same information is referred in the text in the following sentence: Ten patients (40%) had end-stage renal disease in need of renal replacement therapy at diagnosis (…). The correct number is 15 (60%). We have recalculated the statistics to make sure this has not affected the rest of our results including page 3 \"there was no survival difference between patients on renal replacement therapy and patients not treated with renal replacement therapy\" which is still correct. We are very sorry for any inconvenience due to these unfortunate errors.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"358"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699860","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}