Clinical nephrology最新文献

{"title":"The nonlinear correlation between total bilirubin and lumbar spine bone mineral density in patients receiving maintenance hemodialysis.","authors":"Na Zhao, Song-Tao Yang, Xiao-Fang Shen, Yue-Fei Xiao","doi":"10.5414/CN111473","DOIUrl":"10.5414/CN111473","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving maintenance hemodialysis (MHD) are at increased risk of osteoporosis. The effects of bilirubin on bone metabolism vary among different disease populations. However, the relationship between total bilirubin (TBIL) and bone metabolism in MHD has not been investigated yet.</p><p><strong>Materials and methods: </strong>This cross-sectional study included 122 MHD patients aged ≥ 18 years who underwent regular hemodialysis at the Blood Purification Center of Aerospace Central Hospital from April 2021 to April 2023. Blood sampling and bone mineral density (BMD) examinations were conducted. Multivariate linear regression, restricted cubic spline and subgroup analyses were performed to evaluate the association between TBIL and BMD.</p><p><strong>Results: </strong>TBIL (correlation coefficient: 1.7 (0.17, 3.25); p = 0.04) was independently associated with BMD in the multivariate linear regression analysis. The results showed that BMD was nonlinearly related to TBIL in MHD patients, exhibiting a J shaped curve (p = 0.035). When plasma TBIL level < 0.64 mg/dL, there is an average increase of 5.3 (95% CI: 2.0 - 8.7; p = 0.002) g/cm² in BMD for every 1-unit increase in plasma TBIL level. The association between TBIL and BMD was not significant when the plasma TBIL level was ≥ 0.64 mg/dL.</p><p><strong>Conclusion: </strong>The relationship between TBIL and BMD in MHD patients is J-shaped, with an inflection point of 0.64 mg/dL.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"318-325"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982633","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":"Acute renal injury induced by ensartinib in a lung adenocarcinoma patient treated with sequential ALK inhibitors: A case report and literature review.","authors":"Xinmiao Xie, Jing Yang, Fuhua Chen, Xiaoxia Wang","doi":"10.5414/CN111539","DOIUrl":"10.5414/CN111539","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer ranks among the foremost causes of mortality associated with cancer. Ensartinib is a highly effective oral anaplastic lymphoma kinase (ALK) inhibitor utilized in the treatment of ALK-positive lung adenocarcinoma. This report presents a case of acute renal failure attributed to the administration of ensartinib. This is the first case report documenting the nephrotoxic effects of ensartinib, specifically manifesting as acute tubulointerstitial nephritis (ATIN) and IgA nephropathy.</p><p><strong>Case presentation: </strong>This report details the case of a 52-year-old man diagnosed with ALK-positive lung adenocarcinoma. The patient was initially treated with crizotinib for a duration exceeding 6 months; however, he was subsequently transitioned to ensartinib due to disease progression characterized by the development of brain metastases. Within 3 months of initiating treatment with ensartinib, the patient experienced acute kidney failure. The renal failure was attributed to ATIN and IgA nephropathy, which were considered manifestations of renal toxicity associated with ensartinib.</p><p><strong>Conclusion: </strong>This case underscores the uncommon adverse effect of ALK-targeting therapy, specifically regarding acute renal failure induced by ensartinib. We recommend conducting a renal biopsy to ascertain the presence of drug-induced nephrotoxicity. An accurate diagnosis and timely intervention can prevent the deterioration of renal function.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"296-302"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913818","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":"Standing on the shoulders of a giant.","authors":"B Peter Sawaya","doi":"10.5414/CNP103241","DOIUrl":"10.5414/CNP103241","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"241-242"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604217","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 mindset of kidney transplant recipients regarding COVID-19 vaccination: An insightful survey analysis.","authors":"Burak Pacacı, Ilay Berke, Dilek Barutcu Atas, Murat Tugcu, Hakki Arikan, Ebru Asicioglu, Serhan Tuglular, Arzu Velioglu","doi":"10.5414/CN111530","DOIUrl":"10.5414/CN111530","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant (KT) recipients are at risk of severe disease and high mortality from COVID-19, and vaccination offers some degree of protection. In this study, KT recipients' and controls' attitudes towards COVID-19 vaccination were examined.</p><p><strong>Materials and methods: </strong>In this cross-sectional survey-based study, the willingness and hesitancy towards COVID-19 vaccines in KT recipients and a control group from the general population were assessed via questionnaire. Vaccine hesitancy was described as either not being fully vaccinated or vaccine refusal.</p><p><strong>Results: </strong>A total of 154 KT recipients and 172 controls completed the questionnaire. The rate of those who had received at least 1 dose of COVID-19 vaccine was similar in the two study groups (92.4 vs. 92.9%, p = 0.88). The proportion of those fully vaccinated against COVID-19 was significantly lower in the KT recipients (58.7 vs. 70.4% p = 0.033). Only 11 (7.1%) of the KT recipients refused the COVID-19 vaccination. There was no significant difference between the groups in terms of vaccine refusal and vaccine hesitancy rates. Concerns about vaccine-related adverse events were common in both groups (63.6 vs. 53.8%; p = 0.488).</p><p><strong>Conclusion: </strong>Although participants showed a high willingness towards COVID-19 vaccination, the number of KT recipients who were fully vaccinated appears to be lower than controls. Concerns about vaccine-related adverse events were the main reason for avoiding vaccination. Healthcare personnel, particularly nephrologists and public health experts, must take a proactive role in addressing vaccine hesitancy and ensuring that patients receive the required protection against COVID-19.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"268-276"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945765","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 persistent hypercalcemia on hemoglobin levels after kidney transplantation.","authors":"Gabriel Cojuc-Konigsberg, Alfonso Gindl-Bracho, Cielo Estefanny Linares-Pérez, Sophia Albarrán-Muñoz, Estefania Reul-Linares, Nathalie Desire Pichardo-Cabrera, Lluvia A Marino-Vazquez, Luis Eduardo Morales-Buenrostro, Juan C Ramírez-Sandoval","doi":"10.5414/CN111553","DOIUrl":"10.5414/CN111553","url":null,"abstract":"<p><strong>Introduction: </strong>After kidney transplantation, persistent hyperparathyroidism commonly occurs, often alongside increased serum calcium levels. It is reasonable to infer that kidney transplant recipients (KTRs) with hypercalcemia related to persistent hyperparathyroidism are more susceptible to developing anemia. However, reports suggest that hypercalcemia could be a contributing factor to erythrocytosis. Our aim was to assess the effect of persistent hypercalcemia on the trajectory of hemoglobin levels after transplantation.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study investigating the trajectory of hemoglobin in 385 KTRs with and without persistent hypercalcemia (free Ca > 5.2 mg/dL). We performed mixed-model analyses adjusting for potential confounders.</p><p><strong>Results: </strong>Persistent hypercalcemia was present in 62% KTRs (56% male, median age 36 (IQR 28 - 48) years, median follow-up 4.1 (IQR 1 - 8.2) years). Compared to KTRs without hypercalcemia, KTRs with persistent hypercalcemia had a mean positive difference in hemoglobin levels of +0.76 g/dL/year (95% CI +0.45 - +1.08, p < 0.001) throughout the follow-up period. Specifically, the change slope was +0.80 (95% CI +0.32 - +1.27, p < 0.001) g/dL/year for males and +0.36 (95% CI +0.16 - +1.08, p < 0.001) g/dL/year for females. Persistent hypercalcemia was significantly associated with post-transplant erythrocytosis according to the WHO (47 vs. 24%, OR 2.8, 95% CI 1.8 - 4.4) and altitude-adjusted criteria (22 vs. 10%, OR 2.5, 95% CI 1.2 - 4.5). The effect of hypercalcemia on hemoglobin levels was consistent after adjusting for confounders, except in KTRs who developed an estimated glomerular filtration rate < 45 mL/min/1.73m² after transplantation.</p><p><strong>Conclusion: </strong>Persistent hypercalcemia after kidney transplantation was significantly associated with higher hemoglobin levels and an increased risk of developing post-transplant erythrocytosis.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"277-289"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945763","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":"Preoperative dapagliflozin use and cardiac surgery-associated acute kidney injury: A single-center retrospective cohort study.","authors":"Zitong Chen, Kang Liu, Xiaohua Liu, Buyun Wu, Zhimin Huang, Changying Xing, Huijuan Mao","doi":"10.5414/CN111514","DOIUrl":"10.5414/CN111514","url":null,"abstract":"<p><strong>Background: </strong>No drug has been shown to be effective in preventing cardiac surgery-associated acute kidney injury (CSA-AKI). In different clinical settings, sodium-glucose transporter 2 (SGLT2) inhibitors confer renal protection and may be promising drug candidates. We examined the association between preoperative dapagliflozin use and the incidence and prognosis of CSA-AKI.</p><p><strong>Materials and methods: </strong>Data were obtained for consecutive patients undergoing cardiac surgery with cardiopulmonary bypass between December 2020 and November 2022 at a large teaching hospital in Eastern China. The exposure was preoperative dapagliflozin use, and the primary outcome was the incidence of AKI within seven days following cardiac surgery. The secondary outcomes included dialysis, death, AKI recovery, and length of hospitalization. The association between the exposures and outcomes was determined by various logistic regression models with propensity scores.</p><p><strong>Results: </strong>A total of 1,424 patients were included, of which 201 (14.1%) received dapagliflozin preoperatively, and 321 (22.5%) developed CSA-AKI. Patients with dapagliflozin use developed CSA-AKI more frequently than those without (32.3 vs. 20.9%, unadjusted odds ratio 1.81; 95% CI, 1.30 - 2.50). However, the association became non-significant in the multivariate model (adjusted odds ratio, 1.11; 95% CI, 0.73 - 1.68), in the adjusted model with inverse probability weighting (odds ratio, 1.21; 95% CI, 0.76 - 1.93), or in the propensity-score-matched model (odds ratio, 1.09, 95% CI, 0.68 - 1.73). Furthermore, there was no significant association between preoperative dapagliflozin use and secondary outcomes.</p><p><strong>Conclusion: </strong>Results from this study suggest that preoperative dapagliflozin use was not associated with a lower risk of CSA-AKI.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"259-267"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001229","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":"Comparison of adverse drug reactions of heparin and its derivates in the European Economic Area based on data from EudraVigilance between 2017 and 2021.","authors":"Yan Wang, Liang-Ying Gan, Zhun Sui, Mi Wang, Li Zuo","doi":"10.5414/CN111448","DOIUrl":"10.5414/CN111448","url":null,"abstract":"<p><strong>Introduction: </strong>Hemodialysis patients need long-term frequent use of parenteral anticoagulants, and the side effects need to be taken seriously. This study aimed to assess the reporting of adverse drug reactions (ADRs) following administration of unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, and danaparoid, in relation to their usage in European Economic Area (EEA).</p><p><strong>Materials and methods: </strong>The total number of ADRs of each anticoagulant between 2017 to 2021 was collected using data from the EudraVigilance database. The number of hemorrhages, thrombocytopenia, injection-site reaction, liver injury, hypersensitivity and bone disorder were collected, respectively. Usage of these anticoagulants was estimated using sales data from the IQVIA MIDAS database. The reporting rates of ADRs were calculated and compared using χ²-test.</p><p><strong>Results: </strong>Between 2017 and 2021 in the EEA, the overall ADRs reporting rates per 10,000,000 standard units (SU) of UFH, enoxaparin, nadroparin, dalteparin, fondaparinux, and danaparoid were 12.3, 40.8, 23.6, 36.5, 91.4, and 430.0, respectively. There were significant differences among these drugs (χ² = 7,239.26, p < 0.001). Specifically, hemorrhage and thrombocytopenia were reported at higher rates, ranging from 2.8 to 140.1, and 2.0 to 115.9 per 10,000,000 SU among different anticoagulants. Injection-site reactions and hypersensitivity came in second, between 0.2 - 29.0 and 0.1 - 53.1 per 10,000,000 SU, respectively. The reporting rates for liver injury and bone disorder were reported at low rates.</p><p><strong>Conclusion: </strong>The reporting rates of ADRs for heparin and its derivates were all very low. In comparison, the reporting rate of ADRs for danaparoid and fondaparinux was relatively high. The most commonly reported ADRs were hemorrhage, thrombocytopenia, followed by injection-site reactions and hypersensitivity.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"290-295"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945762","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":"Unplanned dialysis initiation in patients known to renal services: A case-control study.","authors":"Tony Lopez, Damien Ashby","doi":"10.5414/CN111455","DOIUrl":"10.5414/CN111455","url":null,"abstract":"<p><p>Dialysis initiation during an emergency hospital admission is associated with increased complications, more temporary access, and higher mortality. Even in patients known to nephrologists, more than one-third start dialysis in an unplanned fashion. This retrospective case-control study sought to identify features of the pre-dialysis period that are associated with unplanned dialysis initiation in patients known to nephrology services. 40 consecutive patients (median age 61, 85% male) who underwent unplanned dialysis initiation (cases) were individually matched by age and sex with patients who started dialysis in a planned fashion during a similar period (controls). Clinical and laboratory data were collected from electronic patient records and correspondence. Across the pre-dialysis year, cases had a faster estimated glomerular filtration rate (eGFR) decline, greater weight gain, missed more nephrology clinic appointments, and had more emergency hospital admissions compared to controls. In multivariable analysis, predictors of unplanned dialysis initiation were eGFR trajectory (OR 1.91 per -1 mL/min/1.73m²/month, 95% CI 1.10 - 3.30, p = 0.021), weight gain (OR 1.97 per +1%/month, 95% CI 1.33 - 2.93, p < 0.001), and clinic non-attendance (OR 1.54 per clinic, 95% CI 1.09 - 2.18, p = 0.015). The findings of this study suggest that to better identify individuals nearing dialysis who are at high risk for unplanned initiation, nephrologists need to move away from traditional markers of disease progression, such as latest eGFR and proteinuria, and instead look at trends in eGFR, trends in weight, and levels of patient engagement with pre-dialysis care.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"251-258"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913837","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":"Chronic kidney disease and dysbiosis: An overview of gut microbiota and uremic toxins.","authors":"Marcelo Rodrigues Bacci","doi":"10.5414/CN111393","DOIUrl":"10.5414/CN111393","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a highly prevalent condition with complications such as constipation, inflammation, and dietary restrictions. Gut microbiota is an ecosystem of trillions of bacteria and other microorganisms such as viruses, fungi, and other eukaryotes. This review aimed to analyze the correlation between CKD and the microbiota.</p><p><strong>Materials and methods: </strong>This is a literature review of recent articles published in the Medline database.</p><p><strong>Results: </strong>As CKD progresses, there is a change in the composition of the gut bacteria colonies, with the production of gut-derived uremic toxins. Gut-impaired permeability facilitates the bacteria fragments' translocation, increasing the stimulus for producing inflammatory mediators. Many interventions have been suggested to modulate the gut composition, and the administration of substances to interact with bacteria or decrease inflammatory status is of central interest. Probiotics are live microorganisms that interact with the local microbiota, and prebiotics are non-digested compounds that reach the colon. Their administration reduces the production of uremic toxins and inflammatory substances but fails to protect against chronic kidney disease progression.</p><p><strong>Conclusion: </strong>Curcumin decreases uremic compounds and inflammation. Physical exercise did not act as a gut microbiota modulator. Systematic reviews and metanalysis evaluating gut microbiota modulators revealed a lack of positive impact on renal deterioration but a good reduction in the production of uremic toxins.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"243-250"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913823","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 dietary vitamin E intake with current stone formation: A NHANES analysis 2017 - 2020.","authors":"Vikram Lyall, Tyler Bartholomew, Vernon Pais","doi":"10.5414/CN111499","DOIUrl":"10.5414/CN111499","url":null,"abstract":"<p><strong>Introduction: </strong>Free radical-mediated oxidative renal tubular injury secondary to hyperoxaluria is a proposed mechanism in the formation of calcium oxalate stones. Vitamin E, an important physiologic antioxidant, has been shown in rat models to prevent calcium oxalate crystal deposition. Our objective was to determine if low dietary vitamin E intake was associated with a higher incidence of stones.</p><p><strong>Materials and methods: </strong>We analyzed data from the 2017 to 2020 National Health and Nutrition Examination Survey, a nationally representative sample (n = 7,707). A multivariable logistic regression model was used to assess the association between elevated dietary vitamin E intake (≥ 15 mg/day) and nephrolithiasis controlling for key demographic variables: water and nutrient intake (sodium, calcium, vitamin C), and diabetes mellitus.</p><p><strong>Results: </strong>The incidence of nephrolithiasis was 1.66% (1.38% - 1.95%). In patients consuming &lt; 15 mg/day vitamin E, the incidence was 1.8% compared to 0.8% in patients with vitamin E intake ≥ 15 mg/day (p = 0.024). In adjusted models, participants with low vitamin E intake had a significantly higher odds of reporting stone passage (aOR = 2.83, 95% CI (1.07 - 7.5)).</p><p><strong>Conclusion: </strong>We found that low vitamin E intake is associated with a > 2.5× greater odds of stone passage. These data are consistent with animal models suggesting that vitamin E may play an important protective role in the pathogenesis of calcium oxalate stone formation. This is the first study assessing the relationship between vitamin E intake and nephrolithiasis in humans. Future investigation of vitamin E supplementation in stone formers may help further determine if vitamin E is useful in the management of calcium oxalate stones.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"193-199"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913820","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}