Clinical nephrology最新文献

{"title":"Prognostic significance of NT-proBNP levels in patients treated with empagliflozin.","authors":"Beyza Algul Durak, Musa Ilker Durak, Naim Ata, Mahir Ülgü, Şuayip Birinci","doi":"10.5414/CN111640","DOIUrl":"10.5414/CN111640","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been added to the mainstay of treatment for chronic heart failure. Recent studies suggest that empagliflozin may also reverse cardiac remodeling in heart failure by reducing N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. In our study, we wanted to show the decrease in NT-proBNP levels, which is an indicator of poor prognosis in heart failure, and to see if there was a decrease in the rate of renal progression in patients with HF after empagliflozin use.</p><p><strong>Materials and methods: </strong>Patients with type 2 diabetes mellitus and heart failure using empagliflozin were selected from the system and 456 patients were found. Patients were divided into two groups: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). The patients were divided into two groups according to their NT-proBNP levels at the beginning of the drug and on the 90^th day. The laboratory data were analyzed at the time of drug initiation and at day 90.</p><p><strong>Results: </strong>There was a statistically significant difference between baseline and day 90 HbA1C and NT-proBNP levels (p < 0.001), (p < 0.001). NT-proBNP and creatinine levels at baseline and day 90 were significantly higher in patients with HFrEF than in those with HFpEF (p < 0.001). According to the multivariate analysis, patients with HFrEF were 11.42 times more likely to have an NT-proBNP change above 300 pg/mL than patients with HFpEF (OR: 11.42, p = 0.028).</p><p><strong>Conclusion: </strong>In our study, a significant reduction in NT-proBNP and HbA1C levels was observed, while renal function was preserved.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"225-231"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064108","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 efficacy and safety of low-dose roxadustat in combination with recombinant human erythropoietin for treating hemodialysis patients with moderate anemia: A retrospective cohort study.","authors":"Yanfei Huang, Xinxin Jiang, Guiqin Shu, Hui Li, Jingjing Lin, Qingqing Duan, Xue Cao, Min Cheng, Zhigui Zheng","doi":"10.5414/CN111433","DOIUrl":"10.5414/CN111433","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the safety and efficacy of low-dose roxadustat combined with low-dose recombinant human erythropoietin (rhEPO) for the treatment of renal anemia in hemodialysis patients.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the medical records of hemodialysis patients with moderate renal anemia between December 2019 and July 2023 from two medical centers. Patients were classified into 3 groups: rhEPO (150 - 300 IU/kg/week), roxadustat (1.5 - 2.5 mg/kg thrice weekly), and combination therapy (low-dose (≤ 1.5 mg/kg thrice weekly) roxadustat in addition to low-dose (≤ 150 IU/kg per week) rhEPO. After 24 weeks of treatment, the efficacy therapeutic endpoints and the safety endpoints were evaluated.</p><p><strong>Results: </strong>Overall, a total of 158 patients were included: 53 in the rhEPO group, 52 in the roxadustat group, and 53 in the combination group. The median time to achieve Hb response in the combination therapy group was 20 days, which was shorter than that in the roxadustat group (20 vs. 25.5 days, log-rank p = 0.027) and the rhEPO group (20 vs. 27 days, log-rank p = 0.004). The mean rate of increase in Hb (g/L/month) during the first month of the treatment period was significantly greater in the combination group than in the roxadustat group (15.4 ± 4.7 vs. 11.1 ± 5.7, p = 0.038) or in the rhEPO group (15.4 ± 4.7 vs. 10.5 ± 4.3, p = 0.026). The incidence and frequency of adverse events were similar among the 3 groups.</p><p><strong>Conclusion: </strong>The combination of low-dose roxadustat and rhEPO appears to have better effects in treating hemodialysis patients with moderate anemia by shortening the hemoglobin response time with minimal adverse effects.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"172-183"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779513","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":"Evaluation of kidney disease knowledge and its determinants among patients with chronic kidney disease.","authors":"Sibel Gulcicek, Zeynep Atli, Ertugrul Erol, Talat Alp Ikizler, Nurhan Seyahi","doi":"10.5414/CN111543","DOIUrl":"10.5414/CN111543","url":null,"abstract":"<p><strong>Purpose: </strong>Patient self-care and knowledge of chronic kidney disease (CKD) play a crucial role in treatment effectiveness at slowing disease progression and reducing complications. There is need for tools that can quantitatively assess patients' knowledge of CKD. We aimed to translate the Kidney Disease Knowledge Survey (KiKS) to Turkish, validate the questionnaire among CKD patients, and identify the determinants of CKD knowledge.</p><p><strong>Materials and methods: </strong>The 28-item KiKS was translated into Turkish and administered to 271 CKD patients not on dialysis. Reliability of survey questions was assessed using Cronbach's α coefficient. Hotelling's T-squared test was used to measure effectiveness and homogeneity of the scale. Univariate and multivariate regression analyses were performed to identify the determinants of CKD knowledge.</p><p><strong>Results: </strong>The mean age of participants was 56.7 ± 13.0 years; 54.2% were male, and 68.3% had CKD stages 3 - 5. Cronbach's α value of scale for the 28-item KiKS was 0.804, confirming its reliability (p < 0.001). Multivariate linear regression analysis showed that CKD stage 3 patients were associated with lower KiKS scores compared to stage 1. Participants who were aware of their CKD diagnosis and used the internet to obtain information about kidney disease had higher scores.</p><p><strong>Conclusion: </strong>The Turkish version of KiKS is reliable and valid to assess the knowledge level of Turkish CKD patients. Advanced stages of CKD were associated with less knowledge about kidney disease in this population. Targeted educational interventions or longitudinal studies are needed to assess the impact of improved CKD knowledge on clinical outcomes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"213-224"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945764","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":"Analysis of the status and associated factors of stigma in patients undergoing maintenance hemodialysis.","authors":"Qiyun Zhuo, Na Xu, Huixian Wang, Bihong Huang, Wenwen Lu","doi":"10.5414/CN111405","DOIUrl":"10.5414/CN111405","url":null,"abstract":"<p><p>This cross-sectional survey assessed the status and the associated factors of stigma among patients undergoing maintenance hemodialysis (MHD). 154 MHD patients were enrolled. General information was collected. The Social Impact Scale, the Generalized Anxiety Disorder-7 Scale, the Patient Health Questionnaire-9, the Perceived Social Support Scale, and the Barthel Index Scale were used for data collection. These patients had an average age of 60.89 years, with 76 (49.4%) male patients, and an average hemodialysis duration of 8.35 years. The total score of stigma was 58.11 ± 9.22, with the highest score in the social rejection dimension (19.03 ± 3.93) and the lowest score in the financial insecurity dimension (7.95 ± 1.87). Univariate analysis showed that there were significant differences in stigma in terms of self-perceived financial burden (p = 0.001), history of falls in the past year (p = 0.004), and different hemodialysis durations (p = 0.042). Pearson correlation analysis revealed that the total score of stigma was positively correlated with the total scores of anxiety and depression, negatively correlated with the total score of social support, and not correlated with the total score of activities of daily living. Multivariate linear regression analysis indicated that self-perceived financial burden, a history of falls in the past year, and anxiety were significant factors associated with stigma. Collectively, the stigma in MHD patients is closely related to self-perceived financial burden, history of falls in the past year, and total anxiety score, suggesting that intervention strategies should be enhanced based on these risk factors. Our findings may guide the intervention of stigma in this population.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"161-171"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806020","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":"Human albumin infusion and risk of acute kidney injury in adults with nephrotic syndrome due to minimal change disease: A single-center retrospective study.","authors":"Siwei Tang, Siyan Tang, Tong Liu, Xiaolan Chen, Xiayin Li, Yi Liu, Shiren Sun, Peng Zhang, Ming Bai","doi":"10.5414/CN111480","DOIUrl":"10.5414/CN111480","url":null,"abstract":"<p><strong>Background: </strong>The use of human albumin in patients with minimal change disease (MCD) remains controversial. The aim of the current study was to assess whether infusion of human albumin increased the risk of acute kidney injury (AKI) in adult patients with MCD.</p><p><strong>Materials and methods: </strong>Adult patients who underwent renal biopsy for the diagnosis of MCD at the center between 2017 and 2022 were screened. Logistic regression and Nelson-Aalen cumulative risk curve analysis were used to compare data from patients with and without human albumin infusion.</p><p><strong>Results: </strong>A total of 190 adult patients with MCD diagnosed by renal biopsy were included, of whom 45 received human albumin infusion before MCD diagnosis and 34 developed AKI within 4 weeks of MCD diagnosis. Nelson-Aalen cumulative risk curve analysis showed that patients who received human albumin infusion had a longer time to partial or complete response (p < 0.001), were more likely to develop AKI (p < 0.001), and were more likely to relapse (p = 0.002) than those who did not receive human albumin infusion. Multivariate logistic regression analysis showed that human albumin infusion was an independent risk factor for AKI in adult patients with MCD after adjusting for confounding factors (OR = 3.259, 95% CI, 1.209 - 8.780, p = 0.020).</p><p><strong>Conclusion: </strong>Receiving human albumin infusions may be associated with the development of AKI in adult patients with MCD. Adult MCD patients who received human albumin infusion had a longer time to achieve partial or complete remission and were more likely to relapse.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"184-192"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806034","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":"In Memoriam Hartmut H. Malluche.","authors":"Peter Sawaya","doi":"10.5414/CNP103157","DOIUrl":"https://doi.org/10.5414/CNP103157","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390281","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":"Kidney function, bone health, and vascular calcifications in patients with CKD II - IV: A 2 - 3 year prospective study with bone biopsies.","authors":"Hartmut H Malluche, Qi Qiao, Florence Lima, Jin Chen, Mohamed Issa, David Pienkowski","doi":"10.5414/CN111603","DOIUrl":"10.5414/CN111603","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) have serum, bone, and vascular abnormalities presenting as chronic kidney disease-mineral bone disorder (CKD-MBD) syndrome. This study sought to identify the parameters with the greatest relative impact on progression of CKD-MBD abnormalities.</p><p><strong>Materials and methods: </strong>This prospective study measured 237 parameters including serum markers, clinical variables, dual-energy X-ray absorptiometry (DXA) measurements, vascular calcifications, and histomorphometric results from bone samples obtained at baseline and after 2 - 3 years. Relative impact of these parameters on kidney function, bone changes, and vascular calcification were assessed using machine learning, a subset of artificial intelligence analyses.</p><p><strong>Results: </strong>Baseline estimated glomerular filtration rate (eGFR) values ranged from 18 to 70 mL/min and declined in 52% of subjects by at least 3.3% annually during the study. These declines in eGFR were associated with changes in specific serum markers, bone quantity decreases, and bone quality alterations, but not with arterial calcifications. Arterial calcifications were associated with collagen crosslinking heterogeneity, serum phosphorus, diuretics and atorvastatin treatment, but not with kidney function. Baseline collagen crosslinking heterogeneity was an important factor impacting progression of coronary, but not aortic calcification. Baseline serum phosphorus was a factor primarily associated with progression of aortic calcification.</p><p><strong>Conclusion: </strong>Machine learning revealed specific bone and vascular abnormalities occurring early during loss of kidney function. Bone, vascular, blood, medication use, and other parameters were identified impacting the presence and progression of arterial calcification and altering bone quality and quantity in this understudied patient population. Serum phosphorus levels considered normal impacted progression of arterial calcification. Identification of these parameters and their relative importance enhances our understanding of CKD progression and should improve patient care.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"71-85"},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964045","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":"Application of artificial intelligence and machine learning for risk stratification acute kidney injury among hematopoietic stem cell transplantation patients: PCRRT ICONIC AI Initiative Group Meeting Proceedings.","authors":"Rupesh Raina, Kush Doshi, Pushan Aggarwal, Parker Kim, Jonathan Sasse, Sidharth Sethi, Carolyn Abitbol, Rolla Abu-Arja, Kianoush Kashani","doi":"10.5414/CN111421","DOIUrl":"10.5414/CN111421","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a frequent, severe complication of hematopoietic stem cell transplantation (HSCT) and is associated with an increased risk of morbidity and mortality. Recent advances in artificial intelligence (AI) and machine learning (ML) have showcased their proficiency in predicting AKI, projecting disease progression, and accurately identifying underlying etiologies. This review examines the central aspects of AKI post-HSCT, veno-occlusive disease (VOD) in HSCT recipients, discusses present-day applications of artificial intelligence in AKI, and introduces a proposed ML framework for the early detection of AKI risk.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"129-139"},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616145","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 factors associated with hospital mortality in critically ill adult COVID-19 patients with AKI requiring CRRT: A multicenter study.","authors":"Augusto Cama-Olivares, Ashutosh Tamhane, Victor Ortiz-Soriano, Douglas Farrell, Huei Hsun Wen, Tomonori Takeuchi, Patel Devansh, Francesco Galasso, Jin Chen, Lili Chan, Ashita J Tolwani, Girish N Nadkarni, Javier A Neyra","doi":"10.5414/CN111404","DOIUrl":"10.5414/CN111404","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common complication of critically ill COVID-19 patients which is associated with adverse outcomes. We examined clinical factors associated with hospital mortality in critically ill adult COVID-19 patients with AKI who required continuous renal replacement therapy (CRRT).</p><p><strong>Materials and methods: </strong>We conducted a multicenter retrospective cohort study including data from two large academic medical centers. Adult (age ≥ 18 years) patients with AKI and requiring CRRT admitted from March 2020 to April 2021 were included in the study. Patients with end-stage kidney disease or renal transplantation were excluded. Multivariable Poisson regression analyses were used to identify clinical predictors of hospital mortality.</p><p><strong>Results: </strong>A total of 178 patients were included. Patients were predominantly men (68.2%), 13.1% were Black, and 57.9% White. Median hospital and ICU length of stay were 20 days and 14 days, respectively. Mechanical ventilation and extracorporeal membrane oxygenation were utilized in 97.2% and 17.4% of patients, respectively. Overall, 130 (73.0%) patients died in the hospital (mortality rate of 2.7 per 100 person-days). In multivariable analyses, SOFA score ≥ 12 at ICU admission (MRRadj = 1.88; 95% CI 1.17 - 3.01) was associated with increased risk of mortality, while Black race (MRRadj = 0.56; 95% CI 0.31 - 1.01) was associated with a decreased risk of mortality.</p><p><strong>Conclusion: </strong>More than two-thirds of critically ill adult COVID-19 patients with AKI requiring CRRT died during hospitalization. SOFA score ≥ 12 at ICU admission was an independent predictor of hospital mortality, and Black patients had a lower risk of mortality.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"96-107"},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674988","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":"A hemodialysis patient unable to walk - brown tumor as the culprit: Case report and review of the literature.","authors":"Guangyan Nie, Ting Bao, Deguang Wang, Xuerong Wang","doi":"10.5414/CN111469","DOIUrl":"10.5414/CN111469","url":null,"abstract":"<p><strong>Introduction: </strong>Brown tumors are benign lesions caused by hyperparathyroidism and characterized by increased osteoclast activity and mass effect, which can lead to paraplegia when the spine is involved. Secondary hyperparathyroidism is common in patients on long-term hemodialysis therapy.</p><p><strong>Case report: </strong>We report the case of a 48-year-old man on regular dialysis who presented with leg weakness as well as back pain and was diagnosed with secondary hyperparathyroidism and thoracic spine tumor. Since the spinal cord was compressed, T12 mass excision combined with spinal canal decompression was performed under general anesthesia. Post-operative pathology demonstrated abundant fibrovascular tissue and osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment deposition. The patient was diagnosed with brown tumor. Following operation, the patient recovered well. He remains on regular hemodialysis with follow-ups and unaffected activities 10 years later.</p><p><strong>Discussion: </strong>In dialysis patients with combined spinal tumors, brown tumors should be considered. For patients presenting with symptoms of spinal cord compression, surgical resection can lead to a favorable prognosis.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"148-156"},"PeriodicalIF":1.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779507","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}