Clinical Kidney Journal最新文献

{"title":"Apolipoprotein B-48 and late graft failure in kidney transplant recipients","authors":"Tamas Szili-Torok, Martin H de Borst, Alexandra Soteriou, Laura Post, Stephan J L Bakker, Uwe J F Tietge","doi":"10.1093/ckj/sfae289","DOIUrl":"https://doi.org/10.1093/ckj/sfae289","url":null,"abstract":"Introduction Transplant vasculopathy resembles atherosclerotic plaque formation and is a major contributor to late graft failure in kidney transplant recipients (KTR). Remnant lipoproteins and associated triglycerides are causal risk factors for atherosclerotic plaques and have been implicated in late kidney graft failure. However, whether remnants derived from liver (containing apolipoprotein [apo] B100) or intestine (containing apoB48) are clinically more important is unclear. The current study investigated the association between baseline fasting apoB48 levels and late kidney graft failure. Methods 481 KTR with a functioning graft for at least one year were included in this retrospective, observational longitudinal single center cohort study. The primary endpoint was death-censored late graft failure, defined as need for initiation of dialysis or re-transplantation. ApoB48 was measured by enzyme-linked immunosorbent assay. Results During a median follow-up of 9.5 years, 61 KTR developed graft failure (12.7%). At baseline, KTR with higher apoB48 levels had lower eGFR (p<0.001), lower HDL cholesterol (p<0.001), increased triglycerides (p<0.001) and used cyclosporine more frequently (p=0.003). Cox regression showed that higher baseline apoB48 was associated with higher risk of late graft failure (hazard ratio [95% confidence interval], 1.59 [1.22, 2.07], p<0.001), independent of stepwise adjustment for potential confounders, including age and sex , immunosuppression type and proteinuria , triglycerides , and waist circumference (fully adjusted HR, 1.78 [1.29, 2.47], p<0.001). Conclusion ApoB48 is strongly associated with late graft failure, independent of potential confounders. Since apoB48-containing lipoproteins originate from the intestine, this study provides a rationale for considering pharmacological interventions targeting lipid absorption to improve graft outcome.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral white matter injury in hemodialysis patients: a cross-sectional tract-based spatial statistics and fixel-based analysis","authors":"Yu Qi, Lijun Song, Xu Liu, Boyan Xu, Wenbo Yang, Mingan Li, Min Li, Zhengyang Zhu, Wenhu Liu, Zhenghan Yang, Zhenchang Wang, Hao Wang","doi":"10.1093/ckj/sfae286","DOIUrl":"https://doi.org/10.1093/ckj/sfae286","url":null,"abstract":"Background End-stage renal disease (ESRD) patients with maintenance hemodialysis (HD) are often accompanied by damage to brain white matter (WM) and cognitive impairment. However, whether this damage is caused by maintenance HD or renal dysfunction is unclear. Purpose To investigate the natural progression of WM damage in patients with ESRD and the effects of HD on WM using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA). Population Eighty-one ESRD patients including 41 with no dialysis (ND) and 40 with HD and forty-six healthy controls (HCs) were enrolled in this study. Field Strength/Sequence A 3 T, single-shot spin–echo echo planar imaging (EPI). Assessment The difference of WM among the three groups (ESRD patients with HD, ESRD patients without HD and HCs) were analyzed using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA), pairwise comparison was then used to compare the difference of WM between two groups. Relationship between WM and neurocognitive assessments/clinical data were analyzed in ESRD patients with or without HD. Statistical Tests Group t-test, Chi-square Test, Kruskal–Wallis test, Mann–Whitney U-Test, Spearman’ correlation analysis, non-parametric permutation testing. Results The damage of WM in ESRD with ND and ESRD HD appeared around the lateral ventricles similarly used for TBSS while FBA reflected the changes had extended to adjacent WM in anterior hemisphere, with larger region in ESRD HD compared to ESRD ND and the brainstem was also widely affected in ESRD HD. The levels of MoCA score were lower in ESRD HD group. RD in body of corpus callosum (BCC) were negatively correlated with MoCA score in both groups. FDC in left Thalamo-prefrontal projection (T_PREFL), left and right cingulum (CGL and CGR) were positively correlated with MoCA score in both groups. Creatinine (Cr) was positively correlated with FDC in some frontal projection fibers in striatum and thalamus, CG and fronto-pontine tract (FPT), Cr was positively correlated with FD mainly in premotor projection fibers in striatum and thalamus in ESRD HD group. Cr was negatively correlated with MD and RD in regions of corona radiata ESRD ND group. Data Conclusion FBA is more sensitive in detecting differences between ESRD patients and HCs. When ESRD patients receive maintenance HD, the degree of WM damage may not be aggravated, however, the range of damaged WM can be expanded, especially in anterior hemisphere and brainstem, some of these changes in anterior hemisphere may contribute to cognitive decline.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 telitacicept, a BLyS/APRIL dual inhibitor, in the treatment of IgA nephropathy: a retrospective case-control study","authors":"Meng Wang, Jianfei Ma, Li Yao, Yi Fan","doi":"10.1093/ckj/sfae285","DOIUrl":"https://doi.org/10.1093/ckj/sfae285","url":null,"abstract":"Background Telitacicept, a BLyS/APRIL dual-target fusion protein, has recently been used in autoimmune diseases. We assessed Telitacicept’ s efficacy and safety in IgA nephropathy (IgAN) patients. Methods This study included 42 IgAN patients who received Telitacicept treatment, forming the ‘whole Telitacicept group’. Among them, 20 patients who had not previously received corticosteroid (CS) therapy or immunosuppressive (IS) agents were categorized as the ‘newly treated Telitacicept subgroup’. Additionally, 28 patients who were selected to match historical controls received conventional IS (CS therapy with/without IS agents) therapy and were classified as the ‘conventional IS group’. Telitacicept was partially used in combination with conventional IS, including initial CS in different doses. Various indicators were compared at 4-week intervals up to 24 weeks among the three groups. Results After 24 weeks of treatment, the 24-hour proteinuria decreased from 1.70 [interquartile range (IQR), 1.05–2.58]g to 0.21 (0.39–0.13) g (P = 0.043) in the newly treated Telitacicept subgroup, from 1.78 (0.97–2.82) g to 0.44 (1.48–0.16) g (P = 0.001) in the conventional IS group, and from 1.07 (0.66–1.99) g to 0.26 (0.59–0.17) g (P = 0.028) in the whole Telitacicept group. The estimated glomerular filtration rate (eGFR) increased from (76.58 ± 30.26) ml/min/1.73m2 to (80.30 ± 26.76) ml/min/1.73m2 (P = 0.016) in the newly treated Telitacicept subgroup, from (72.73 ± 33.41) ml/min/1.73m2 to (84.08.10 ± 26.81) ml/min/1.73m2 (P = 0.011) in the conventional IS group, and from (70.10 ± 32.88) ml/min/1.73m2 to (71.21 ± 31.49) ml/min/1.73m2 (P = 0.065) in the whole Telitacicept group. During follow-up periods, the efficacy rates of the three groups did not show statistically significant differences, and no serious adverse events (SAEs) were observed. Conclusions Telitacicept may be a safe and effective treatment for IgAN, offering similar reductions in proteinuria and increases in eGFR as conventional IS therapy. After a 24-week follow-up, the incidence of adverse events (AEs) was lower for Telitacicept than for conventional IS therapy.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basiliximab induction alone vs. a dual ATG-Basiliximab approach in first live-donor non-sensitized kidney transplant recipients with low HLA matching","authors":"Tammy Hod, Shmuel Levinger, Enosh Askenasy, Maya Siman-Tov, Yana Davidov, Ronen Ghinea, Niv Pencovich, Ido Nachmani, Eytan Mor","doi":"10.1093/ckj/sfae236","DOIUrl":"https://doi.org/10.1093/ckj/sfae236","url":null,"abstract":"Background Individualizing induction therapy based on immunological risk is crucial for optimizing outcomes in kidney transplantation. Methods A retrospective analysis included 157 first live-donor non-sensitized kidney transplant recipients (KTRs). Within this cohort, 96 individuals exhibited low HLA matching (5–6 HLA mismatches). The low HLA match subgroup was categorized into 52 KTRs receiving basiliximab alone and 44 recipients treated with a combined single ATG dose of 1.5 mg/kg and basiliximab. The primary endpoint was early acute cellular rejection (ACR) within 6 months post-transplant while secondary outcomes encompassed infection rates, renal allograft function, length of stay (LOS), and readmissions post-transplant. Results The incidence of early ACR was decreased for low HLA match KTRs, who received ATG-Basiliximab, when compared to low HLA-matched KTRs who received Basiliximab alone (9.1% vs. 23.9%, p = 0.067). Age was a predictor for rejection, and subgroup analysis showed consistent rejection reduction across age groups. No significant differences were observed in admission for transplant LOS or in peri-operative complications, nor in infections rate including BK and CMV viremia, allograft function and number of readmissions post-transplant up to 6 months post-transplant. Conclusion In non-sensitized first live-donor KTRs with low HLA matching, a dual ATG-basiliximab induction approach significantly reduced early ACR without compromising safety.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten tips to carry out video consultations in nephrology","authors":"Alexander Woywodt, Rebecca E Payne, Brooke M Huuskes, Bartu Hezer","doi":"10.1093/ckj/sfae287","DOIUrl":"https://doi.org/10.1093/ckj/sfae287","url":null,"abstract":"Video consultations have seen increasing use in nephrology since the COVID-19 pandemic with an aim to address constraints in F2F outpatient capacity and also patients’ concerns around risks of infection when attending healthcare facilities. Nephrologists have learned through experience to use video consultations for providing routine follow up but also for ad-hoc triage of unwell patients. Advantages of video consultations include convenience, cost savings through avoiding clinic overheads, and reducing the carbon footprint of care. The latter is increasingly relevant as nephrologists consider climate change and its implications. Video consultations are not a panacea to overcome challenges in nephrology and risks also exist for example when it comes to redesigning pathways and maintaining access to F2F assessments when required. It is equally important to consider practical aspects such as reimbursement, prescribing, and documentation. Some clinicians may wish to carry out video consultations from home to save time spent in commute but this, too, requires careful thought. Another consideration is the digital divide and support should be provided for patients who are less IT literate or who have no access to the digital world. Patients with special needs such as those with visual or hearing impairment and those with language issues also require consideration. We view video consultations as a developing and growing part of the portfolio of renal care. We see their main role in providing routine follow up to stable and IT literate outpatients, particularly where there is provider continuity and where care is provided across a large geographical area.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral white matter damage in patients with end stage kidney disease associates with cognitive impairment","authors":"Yi-Chou Hou, Chih-Chien Tsai, Ruei-Ming Chen, Yi-Chien Liu, Kuo-Cheng Lu, Yao-Liang Chen, Ting-Wen Shen, Jiun-Jie Wang","doi":"10.1093/ckj/sfae283","DOIUrl":"https://doi.org/10.1093/ckj/sfae283","url":null,"abstract":"Background and hypothesis Damages in brain white matter often occurs in individuals with chronic kidney disease, which might be related to their cognitive decline. This study aims to investigate tract specific white matter damage in patients with end stage renal disease by using fixel based analysis. Methods Images of 31 end stage renal disease patients and 16 normal controls (aged: 61.1 ± 10.4 years; 11 men) were acquired from a 1.5 T MR scanner. The patients were subsequently divided into with normal cognition (N = 17, aged: 66.9 ± 7.2 years; 10 men) and cognitive impairment (N = 14, aged: 72.4 ± 9.4 years; 7 men). Cognitive assessment, neurologic, hematologic and biochemical samples were collected. Fixel-based analysis was used to examine the tract-specific damage within white matter. Differences between groups were evaluated through connectivity-based fixel enhancement and non-parametric permutation testing. Correlation with biomarkers was conducted through general linear model. Significance was determined with familywise error-corrected p-value < 0.05. Results Reduced fixel-based metrics were observed in specific tract located the cerebral peduncle, internal capsule, corpus callosum, fornix, and superior corona radiata in patients when compared to normal controls, indicating a reduction in fiber content. The fibers crossing the corpus callosum and the fornix/stria terminalis are particularly vulnerable sites, which can be associated with the decrease in both Mini-Mental State Examination (R2 ranged between 0.420 and 0.556) and Montreal Cognitive Assessment (R2 ranged between 0.425 and 0.509), as well as the plasma concentration of calcium (R2 ranged between 0.207 and 0.322). The plasma concentration of indoxyl sulfate was associated with the descending tracts from right posterior limb of internal capsule to cerebral peduncle (R2 ranged between 0.262 and 0.335). Conclusions Tract specific white matter damage can be noticed in the patients with end stage renal disease, and can be associated with their cognitive decline.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning models for mortality prediction in critically ill patients with acute pancreatitis-associated acute kidney injury","authors":"Yamin Liu, Xu Zhu, Jing Xue, Rehanguli Maimaitituerxun, Wenhang Chen, Wenjie Dai","doi":"10.1093/ckj/sfae284","DOIUrl":"https://doi.org/10.1093/ckj/sfae284","url":null,"abstract":"Background The occurrence of acute kidney injury (AKI) was associated with an increased mortality rate among acute pancreatitis (AP) patients, indicating the importance of accurately predicting the mortality rate of critically ill patients with acute pancreatitis-associated acute kidney injury (AP-AKI) at an early stage. This study aimed to develop and validate machine learning-based predictive models for in-hospital mortality rate in critically ill patients with AP-AKI by comparing their performance with the traditional logistic regression (LR) model. Methods This study used the data from three clinical databases. The predictors were identified by the Recursive Feature Elimination algorithm. The LR and two machine learning models including random forest (RF) and extreme gradient boosting (XGBoost) were developed using the ten-fold cross-validation to predict in-hospital mortality rate in AP-AKI patients. Results A total of 1,089 patients from Medical Information Mart for Intensive Care-IV (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) were included in the training set, and 176 patients from Xiangya Hospital were included in the external validation set. The in-hospital mortality rate of the training and external validation sets was 13.77% and 54.55%, respectively. Compared to the AUC values of the LR model and the RF model, the AUC value of the XGBoost model [0.941, 95% confidence interval (CI): 0.931-0.952] was significantly higher (both P < 0.001), and the XGBoost model had the smallest Brier score of 0.039 in the training set. In the external validation set, the performance of the XGBoost model was acceptable with an AUC value of 0.724 (95% CI: 0.648-0.800). However, it did not differ significantly from the LR and RF model models. Conclusions The XGBoost model was superior to the LR and RF models in terms of both the discrimination and calibration in the training set, while whether the findings can be generalized needs to be further validated.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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-associated pruritus and quality of life with difelikefalin treatment: a post hoc analysis of phase 3 data using the Skindex-10 questionnaire","authors":"Sonja Ständer, Steven Fishbane, Thilo Schaufler, Despina Ruessmann, Isabelle Morin, Frédérique Menzaghi, Warren Wen, Kamyar Kalantar-Zadeh","doi":"10.1093/ckj/sfae274","DOIUrl":"https://doi.org/10.1093/ckj/sfae274","url":null,"abstract":"Background Pruritus is a common condition in chronic kidney disease, especially for patients receiving haemodialysis. Chronic kidney disease associated-pruritus (CKD-aP) can be distressing and have a negative impact on quality of life (QoL). This post hoc analysis aimed to assess the relationship between pruritus relief and QoL. Methods Data from phase 3 trials ([NCT03422653, NCT03636269 grouped], and NCT03998163) of the novel antipruritic difelikefalin (N = 914) were used to assess the relationship between reductions in pruritus intensity at Week 12 (24-hour Worst Itching Intensity Numeric Rating Scale; WI-NRS), perceived improvement in itch (Patient Global Impression of Change, PGI-C) and pruritus-related QoL (Skindex-10 questionnaire). Results Patients receiving difelikefalin had greater improvements in Skindex-10 total scores than those receiving placebo (LS mean treatment difference –3.4; 95% CI –5.5, –1.3; P = 0.002) and greater improvements across Skindex-10 domains (disease, mood, and social functioning) at Week 12. In patients receiving difelikefalin, those with clinically meaningful improvements in pruritus (≥3-point reduction in WI-NRS score) at Week 12 had a greater improvement in Skindex-10 total score (mean difference 14.2; 95% CI 11.0, 17.3; P < 0.001) and Skindex-10 domains than those with a < 3-point reduction in WI-NRS score. Improvements in Skindex-10 total scores correlated with PGI-C. Conclusions Improvements in pruritus intensity following 12 weeks’ treatment with difelikefalin were associated with improvements in QoL. Larger improvements in Skindex-10 scores were seen in patients with a greater reduction in pruritus intensity, indicating that improvements in pruritus are associated with a range of factors, such as mood and social functioning, that affect pruritus-related QoL.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxychloroquine as an add-on therapy for the induction therapy of MPO-AAV: a retrospective observational cohort study","authors":"Yizi Gong, Ting Meng, Wei Lin, Xueling Hu, Rong Tang, Qi Xiong, Joshua D Ooi, Peter J Eggenhuizen, Jinbiao Chen, Ya-Ou Zhou, Hui Luo, Jia Xu, Ning Liu, Ping Xiao, Xiangcheng Xiao, Yong Zhong","doi":"10.1093/ckj/sfae264","DOIUrl":"https://doi.org/10.1093/ckj/sfae264","url":null,"abstract":"Background The remission rate of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) patients who received standard induction therapy is far from satisfactory. Improving the remission rate of MPO-AAV patients is essential. Hydroxychloroquine (HCQ), one of the classic antimalarial drugs, has been widely used in various autoimmune rheumatic diseases. This retrospective observational cohort study is aimed to evaluate the efficacy and safety of HCQ during induction treatment for MPO-AAV. Methods The medical records of patients diagnosed with MPO-AAV at Xiangya Hospital, Central South University from January 2021 to September 2023 were collected. They were assigned to the HCQ group or control group according to whether they used HCQ. The patients included were screened by propensity score matching. To evaluate whether MPO-AAV patients benefited from HCQ, we compared the prognosis of the two groups. The adverse effects of HCQ during follow-up were recorded. Results The composition ratio of complete remission, response and treatment resistance between HCQ group and control group were different statistically (P = 0.021). There was no significant difference between the two groups in one-year renal survival (P = 0.789). The HCQ group had better one-year patient survival than the control group (P = 0.049). No serious adverse effects were documented in the HCQ group. Conclusions HCQ together with standard induction treatment may improve the remission rate of MPO-AAV patients, and HCQ has good safety in our study.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to make a shared decision with older persons for end-stage kidney disease treatment? The added value of geronto-nephrology","authors":"Florent Guerville, Marion Pépin, Antoine Garnier-Crussard, Jean-Baptiste Beuscart, Salvatore Citarda, Aldjia Hocine, Cédric Villain, Thomas Tannou","doi":"10.1093/ckj/sfae281","DOIUrl":"https://doi.org/10.1093/ckj/sfae281","url":null,"abstract":"Improving care for older people with end-stage kidney disease (ESKD) requires standards to be adapted to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline, and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to: (1) describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; (2) apply these concepts to the context of ESKD; (3) identify components and modalities of shared decision-making, and (4) suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}