Clinical Kidney Journal最新文献

{"title":"Iron management and exercise training in individuals with chronic kidney disease: lived experiences.","authors":"Courtney J Lightfoot, Sharlene A Greenwood, Elham Asgari, Debasish Banerjee, Sunil Bhandari, James O Burton, Philip A Kalra, Kieran McCafferty, Benjamin A Oliveira, Chante Reid, Pauline A Swift, David C Wheeler, Thomas J Wilkinson, Kate Bramham, Alice C Smith","doi":"10.1093/ckj/sfae433","DOIUrl":"10.1093/ckj/sfae433","url":null,"abstract":"<p><strong>Background: </strong>Non-anaemic iron deficiency is highly prevalent in people living with chronic kidney disease (CKD) but is underdiagnosed and undertreated, especially in earlier stages of CKD. A multicentre trial assessing the effect of intravenous iron supplementation in iron-deficiency but not anaemic people with CKD included a qualitative sub-study that aimed to explore the patient experience and psychosocial impact of living with CKD and iron deficiency, and the experience of the therapeutic intervention (intravenous iron and exercise).</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 23 trial participants blinded to treatment. Topics explored included experiences of living with CKD and iron deficiency, symptoms, social and leisure activities, quality of life, and participants' views and experiences of receiving the therapeutic intervention. Thematic analysis was used to identify and report themes.</p><p><strong>Results: </strong>Six overarching themes were identified: lack of awareness of iron deficiency; overwhelming feelings of tiredness; feeling limited; balancing emotions; perceptions and experiences of therapeutic treatment received; and impact of trial participation on life participation. Trial participation, specifically the exercise training, was perceived to be beneficial, with improvements in life participation and psychological wellbeing experienced. However, there were no clear differences between treatment groups, with mixed perceptions about which therapeutic treatment was received.</p><p><strong>Conclusions: </strong>The impact of tiredness on individuals with CKD is profound and can result in reduced vitality, impaired ability to engage in life activities and emotional conflict. Improved communication and support about psychosocial impact and management of symptoms, particularly fatigue, for people with CKD may be required, alongside effective therapeutic interventions, to improve symptom management and quality of life.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae433"},"PeriodicalIF":3.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel <i>NUP160</i> mutations related to simultaneous congenital nephropathy and ovarian insufficiency.","authors":"Yuhao Liu, Xiaoying Huang, Lubin Xu, Yaqing Cao, Min Nie, Mingxi Li","doi":"10.1093/ckj/sfae388","DOIUrl":"https://doi.org/10.1093/ckj/sfae388","url":null,"abstract":"<p><p>Nucleoporins, as major components of nuclear pore complex, have been recently discovered to participate in organ development. Here, we report a young female patient with nephrotic proteinuria resistant to immune suppressant treatment and congenital ovarian insufficiency. Renal pathology confirmed focal segmental glomerulosclerosis and whole-exome sequencing revealed compound heterozygous mutations in Nucleoporin 160 (<i>NUP160</i>), NM_015231.2 c.4154C>T (p.Pro1385Leu) and c.1102-9T>G. Notably, <i>NUP160</i> mutations have been associated with congenital nephropathy in four families. We also ruled out competing genetic variants implicated in focal segmental glomerulosclerosis and ovarian dysgenesis. Our identification of two novel <i>NUP160</i> mutations associated with congenital nephropathy and ovarian insufficiency simultaneously contributes to a deeper understanding of nuclear pore complex function in the urogenital system.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae388"},"PeriodicalIF":3.9,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury as a key predictor of cardiovascular events in chronic kidney disease patients: the CKD-REIN study.","authors":"Nans Florens, Estelle Aymes, Victoria Gauthier, Luc Frimat, Maurice Laville, Dimitri Bedo, Thomas Beaudrey, Philippe Amouyel, Nicolas Mansencal, Céline Lange, Sophie Liabeuf, Ziad A Massy, Benedicte Stengel, Natalia Alencar de Pinho, Aghiles Hamroun","doi":"10.1093/ckj/sfae337","DOIUrl":"10.1093/ckj/sfae337","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Cardiovascular diseases are a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Acute kidney injury (AKI) has been increasingly recognized as a potential exacerbating factor for cardiovascular events in these patients. The CKD-REIN study aims to explore the relationship between AKI and the risk of major adverse cardiovascular events (MACE) in a cohort of CKD patients. We hypothesize that AKI is a significant and independent predictor of MACE in patients with CKD, and that the severity of AKI correlates with the risk of subsequent cardiovascular events.</p><p><strong>Methods: </strong>This prospective cohort study included 3033 adult CKD patients from 40 outpatient nephrology clinics in France. Patients were followed for a median of 5.2 years. AKI episodes were identified and staged based on the KDIGO-AKI criteria. Cardiovascular events, including myocardial infarction, stroke, heart failure hospitalization, and cardiovascular death, were systematically recorded. The association between AKI and MACE was analyzed using a multivariable Cox model, adjusting for confounders such as demographic characteristics, medical history, and baseline kidney function.</p><p><strong>Results: </strong>During the follow-up, 530 patients experienced at least one episode of AKI. The cumulative incidence of MACE at 1 year post-AKI was 8.1%. Patients with AKI had a significantly increased risk of MACE, with an adjusted hazard ratio (HR) of 5.78 (<i>P</i> < .001). The risk was consistent across different MACE components and was independent of age, sex, CKD stage, or comorbidities. The risk of MACE was higher for more severe AKI stages and for AKI events requiring hospitalization or associated with incomplete renal recovery.</p><p><strong>Conclusion: </strong>The findings of this study confirm that AKI is a significant independent predictor of MACE in CKD patients, demonstrating a strong severity-response relationship. These results underscore the importance of vigilant cardiovascular monitoring and preventive strategies in CKD patients following AKI episodes. Understanding the mechanisms linking AKI to cardiovascular outcomes is crucial for developing targeted interventions to mitigate these risks.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae337"},"PeriodicalIF":3.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health outcomes in chronic kidney disease patients with cognitive impairment or dementia: a global collaborative analysis.","authors":"Lino Merlino, Francesco Rainone, Rajkumar Chinnadurai, Gema Hernandez, James Tollitt, Graziana G Battini, Paolo M Colombo, Marco Trivelli, Stuart Stewart, Ross A Dunne, Philip A Kalra","doi":"10.1093/ckj/sfae401","DOIUrl":"10.1093/ckj/sfae401","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Mild cognitive impairment and dementia (CI) are common in patients with CKD. We aim to clarify whether and how CKD and CI coexistence increases adverse health outcomes.</p><p><strong>Methods: </strong>This retrospective observational cohort study was conducted on CKD patients (stages 3-5) from the TriNetX platform. CKD patients with and without pre-existing CI were included from 115 healthcare organizations, and their outcomes were compared. The two cohorts were propensity score matched (PSM) for age, sex, ethnicity, comorbidities, BMI, blood parameters, and medications. The proportional hazard assumption was tested with a 95% confidence interval. Kaplan-Meier analysis was used to calculate survival probability. Outcomes were included from 1 day after the CKD diagnosis until 10 years afterwards.</p><p><strong>Results: </strong>We identified 533 772 CKD patients, and 8184 had co-existent CI. Two cohorts of 8170 PSM patients each were generated. The mean age was 60.5 ± 7.0 years and the eGFR was 52.1±19 mL/min. Mean follow-up was 23.2 months. CKD patients with CI had higher all-cause mortality (18.5% vs 12.6%), higher risk of cerebrovascular disease (11.3% vs 6.9%), transient cerebral ischemic attacks (2.7% vs 1.6%), hypotension (16.5%-12.5%), malnutrition (6.7% vs 4.0%), pneumonia (10.7% vs 7.9%), urinary infections (13.2% vs 9.3%), encephalopathy (9.9% vs 5.0%), mood disorders (13.6% vs 9.7%), psychosis (9.8% vs 4.6%), and epilepsy (4.3% vs 1.5%). Higher use of antidepressants (26.3% vs 16.3%), anticonvulsants (19.5% vs 15.1%), antipsychotics (18.6% vs 9.1%), anticholinesterase (5.6% vs 0.1%), and benzodiazepines (30.6% vs 26.6%) was noted in those with CI. All these findings were statistically significant.</p><p><strong>Conclusion: </strong>Despite the limitations of a retrospective study, real-world data demonstrate that concomitant CI is a decisive risk factor for higher mortality and increased adverse outcomes in patients with CKD. These results highlight the need for routine comprehensive cognitive assessments in patients at any stage of CKD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae401"},"PeriodicalIF":3.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current practices in prevention, screening, and treatment of diabetes in kidney transplant recipients: European survey highlights from the ERA DESCARTES Working Group.","authors":"Yassine Laghrib, Luuk Hilbrands, Gabriel C Oniscu, Marta Crespo, Ilaria Gandolfini, Christophe Mariat, Geir Mjøen, Mehmet Sukru Sever, Bruno Watschinger, Arzu Velioglu, Erol Demir, Eva Gavela Martinez, Annelies De Weerd, Ivana Dedinska, Maria Pippias, Annick Massart, Daniel Abramowicz, Johan Willem de Fijter, Christophe De Block, Rachel Hellemans","doi":"10.1093/ckj/sfae367","DOIUrl":"10.1093/ckj/sfae367","url":null,"abstract":"<p><strong>Background: </strong>Although post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplantation, there are few data on prevention, optimal screening, and treatment strategies.</p><p><strong>Methods: </strong>The European Renal Association's DESCARTES working group distributed a web-based survey to European transplant centres to gather information on risk assessment, screening procedures, and management practices for preventing and treating PTDM in kidney transplant recipients.</p><p><strong>Results: </strong>Answers were obtained from 121/241 transplant centres (50%) across 15 European countries. Screening practices for diabetes mellitus during the transplant work-up varied, with only 13% of centres using the recommended oral glucose tolerance test (OGTT) and 14% not screening at all. At transplantation, 19% of centres tailored the immunosuppressive regimen based on perceived PTDM risk, using strategies such as cyclosporin use or early steroid withdrawal. Fifty-two percent adopted strict glycaemic control with basal insulin in the first days post-transplant. Sixty-eight percent had defined screening protocols for early PTDM (45 days-6 months), primarily based on fasting glycaemia and/or HbA1c, while only a minority (7%) incorporated an OGTT. Changes in immunosuppression were considered by 41% in cases of early hyperglycaemia (<45 days) and by 58% in established PTDM (>45 days). Besides insulin therapy, dipeptidyl peptidase-4 (DPP4) inhibitors and metformin were most frequently used to manage early hyperglycaemia (<45 days) and PTDM (>45 days). The use of SGLT2 inhibitors and GLP-analogues increased >45 days post-transplantation.</p><p><strong>Conclusion: </strong>This European survey underscores the significant variation in PTDM prevention, screening, and treatment practices, emphasizing the imperative for more explicit guidance in approaching this complication.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae367"},"PeriodicalIF":3.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Push toward pre-emptive kidney transplantation - for sure?","authors":"Orsolya Cseprekal, Christian Jacquelinet, Ziad Massy","doi":"10.1093/ckj/sfae335","DOIUrl":"10.1093/ckj/sfae335","url":null,"abstract":"<p><p>Pre-emptive kidney transplantation (PKT) has long been considered the optimal treatment for patients with end-stage chronic kidney disease (CKD) seeking the most favourable long-term outcomes. However, the significant growth in transplant procedures over recent decades has led to a notable increase in wait-listed patients and a disproportionate demand for donor organs. This situation necessitates a re-evaluation of transplantation timing and the establishment of rational indications from both societal and clinical perspectives. An increasing number of retrospective analyses have challenged the universal benefit of PKT, suggesting that premature indications for living or deceased donor PKT may not always yield superior hard outcomes compared with non-PKT approaches. Conventional predictive models have shown limitations in accurately assessing risks for certain subpopulations, potentially leading to significant disparities among wait-listed patients. To address these challenges, we propose the following considerations. Prediction models should not only optimize the distribution of our limited donor resources, but should also illuminate foreseeable risks associated with a potentially 'unsuccessful' PKT. Therefore, this article seeks to underscore the necessity for further discourse on the smouldering concept of when and for whom living or deceased donor PKT should be considered. Is it universally beneficial, or should the clinical paradigm be re-evaluated? In the endeavour to attain superior post-PKT survival outcomes compared with non-PKT or conservative treatment, it seems critical to acknowledge that other treatments may provide more favourable results for certain individuals. This introduces the intricate task of effectively navigating the complexities associated with 'too early' or 'unsuccessful' PKT.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae335"},"PeriodicalIF":3.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First real-world evidence of sparsentan efficacy in patients with IgA nephropathy treated with SGLT2 inhibitors.","authors":"Moritz Schanz, Claudia Seikrit, Bernd Hohenstein, Aline Zimmermann, Leonie Kraft, Severin Schricker, Susann Berger, Andrea Schwab, Tina Oberacker, Joerg Latus","doi":"10.1093/ckj/sfae394","DOIUrl":"https://doi.org/10.1093/ckj/sfae394","url":null,"abstract":"<p><strong>Background: </strong>Sparsentan, a dual-acting antagonist for both the angiotensin II receptor type 1 and the endothelin receptor type A, has emerged as a promising therapeutic agent for the treatment of IgA nephropathy (IgAN). Following the publication of the PROTECT trial, sparsentan recently received approval for the treatment of IgAN in Europe. However, it remains uncertain whether an additive effect can be observed in the context of existing treatment with sodium-glucose co-transporter 2 (SGLT2) inhibitors, given that the PROTECT study did not investigate this dual therapy approach.</p><p><strong>Methods: </strong>A total of 23 patients with IgAN were treated with sparsentan via the Managed Access Programme between December 2023 and August 2024. The patients were stable on maximum tolerated doses of renin-angiotensin system (RAS) and SGLT2 inhibitors, with an estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m² and a urine protein/creatinine ratio (UPCR) >0.75 g/g.</p><p><strong>Results: </strong>In the 23 patients, median (IQR) baseline eGFR (CKD-EPI) was 42 mL/min/1.73 m² (32-63) and median baseline UPCR was 1.5 g/g (0.9-1.8). After initiation of sparsentan, UPCR significantly decreased (<i>P</i> < 0.0001) to a median of 0.85 g/g (0.42-1.15) in the 2-week follow-up and further declined (<i>P</i> = 0.001) to a median of 0.60 g/g (0.32-0.82) after 14 weeks, equivalent to a relative reduction in proteinuria up to 62% (45-74). A similar significant reduction was observed for the urine albumin/creatinine ratio. No drug-related serious adverse events were reported.</p><p><strong>Conclusions: </strong>In this real-world setting, sparsentan shows a significant impact on proteinuria, leading to a relative reduction of 62% in UPCR after 14 weeks and beyond, even in patients already receiving SGLT2 inhibitors.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae394"},"PeriodicalIF":3.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of dapagliflozin in patients with CKD: real-world experience in 93 Italian renal clinics.","authors":"Roberto Minutolo, Silvio Borrelli, Andrea Ambrosini, Luigi Amoroso, Filippo Aucella, Valentina Batini, Yuri Battaglia, Laura Bregoli, Vincenzo Cantaluppi, Giuseppe Cianciolo, Paolo Conti, Paolo Fabbrini, Carlo Giammarresi, Egidio Imbalzano, Sandra La Rosa, Marita Marengo, Vincenzo Montinaro, Dario Musone, Marcello Napoli, Felice Nappi, Corrado Pluvio, Domenico Santoro, Roberto Scarpioni, Franco Sopranzi, Tiziana Tullio, Luca De Nicola","doi":"10.1093/ckj/sfae396","DOIUrl":"https://doi.org/10.1093/ckj/sfae396","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are recommended for reducing the renal and cardiovascular risk in patients with chronic kidney disease (CKD) based on the positive results reported by clinical trials. However, real-world data on the efficacy and the safety of these drugs in CKD population followed in nephrology setting are lacking.</p><p><strong>Methods: </strong>We report the effects of dapagliflozin in CKD patients by using data collected during a learning program in which 105 nephrologists added dapagliflozin (10 mg/day) to consecutive patients referred to their renal clinics. Efficacy endpoints were the albuminuria change and the determinants of an albuminuria decline ≥30%. Adverse events were also collected.</p><p><strong>Results: </strong>A total of 1724 patients with CKD (age 67.4 ± 13.2 years, 72.8% males, diabetes 59.9%, eGFR 43.5 ± 17.4 ml/min/1.73 m², severe albuminuria 70.1%) received dapagliflozin for 4 ± 1 months. Dapagliflozin significantly reduced body weight (-1.3 kg), eGFR (-0.27 ml/min/month), and blood pressure (-3.6/-1.7 mmHg). Albuminuria declined by 25.1% (95%CI 23.0-27.2) from 500 mg/day [IQR 225-1425] to 320 mg/day [IQR 100-900]. Albuminuria reduction was ≥30% in 48.3% of patients, 0-29% in 37.6% while it increased in 14.1% of patients. At logistic regression analysis, older age, female sex, use of mineralocorticoid receptor antagonist, higher eGFR, and higher albuminuria were all significant predictors of albuminuria decline ≥30%. We collected 46 side effects leading to drug discontinuation in 36 patients (2%), with acute kidney injury and urinary tract infection being the most frequent adverse events.</p><p><strong>Conclusions: </strong>We provide evidence of the anti-proteinuric efficacy of short-term dapagliflozin in the presence of good safety profile in patients with CKD followed in nephrology.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae396"},"PeriodicalIF":3.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of heart rate on eGFR decline in ischemic stroke patients.","authors":"Jiann-Der Lee, Ya-Wen Kuo, Chuan-Pin Lee, Yen-Chu Huang, Meng Lee, Tsong-Hai Lee","doi":"10.1093/ckj/sfae387","DOIUrl":"https://doi.org/10.1093/ckj/sfae387","url":null,"abstract":"<p><strong>Background: </strong>Resting heart rate is a potent predictor of various renal outcomes. However, the decline rate of renal function in ischemic stroke patients is not well defined. We tested the association of heart rate with estimated eGFR decline and the composite renal outcomes in patients with recent ischemic stroke.</p><p><strong>Methods: </strong>The data of 9366 patients with ischemic stroke with an eGFR of ≥30 mL/min/1.73 m² were retrieved from the Chang Gung Research Database. Mean initial in-hospital heart rates were averaged and categorized into 10-beats-per-minute (bpm) increments. The outcomes were the annualized change in eGFR across the heart rate subgroups and composite renal outcomes, namely a ≥40% sustained decline in eGFR, end-stage renal disease, or renal death. Generalized estimating equation models were used to determine the annualized change in eGFR and Cox proportional hazards regression models were used to estimate the relative hazard of composite renal outcomes by referencing the subgroup with a heart rate of <60 bpm.</p><p><strong>Results: </strong>The annual eGFR decline in the patients with a mean heart rate of <60, 60-69, 70-79, 80-89, and ≥90 bpm was 2.12, 2.49, 2.83, 3.35, and 3.90 mL/min/1.73 m², respectively. Compared with the reference group, the adjusted hazard ratios for composite renal outcomes were 1.17 [95% confidence interval (CI), 0.89-1.53), 1.54 (95% CI, 1.19-2.00), 1.72 (95% CI, 1.30-2.28), and 1.84 (95% CI, 1.29-2.54] for the patients with a heart rate of 60-69, 70-79, 80-89, and ≥90 bpm, respectively. In the subgroup analysis, the associations between higher heart rate and both eGFR decline and composite renal outcomes were more evident and statistically significant in patients without atrial fibrillation.</p><p><strong>Conclusions: </strong>A higher heart rate is associated with a faster rate of eGFR decline and an increased risk of composite renal outcomes after ischemic stroke, particularly in patients without atrial fibrillation. These results underscore the importance of heart rate monitoring and management in ischemic stroke patients in sinus rhythm to potentially mitigate renal function decline. Further studies are needed to explore this relationship in patients with atrial fibrillation and across different ethnic groups.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae387"},"PeriodicalIF":3.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients with infective endocarditis-associated acute kidney injury: a retrospective cohort study.","authors":"SanXi Ai, Xiang Feng, Kai Sun, Gang Chen, XinPei Liu, Qi Miao, Yan Qin, XueMei Li","doi":"10.1093/ckj/sfae382","DOIUrl":"10.1093/ckj/sfae382","url":null,"abstract":"<p><strong>Background: </strong>The outcomes of patients with infective endocarditis (IE)-associated acute kidney injury (AKI) are poorly understood.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted in a tertiary hospital in China to analyze the short- and long-term outcomes among patients with IE-associated AKI. The risk factors for 90-day mortality, long-term outcomes and kidney non-recovery were analyzed via multivariable logistic regression, the Cox regression, and the Fine-Gray competing risk model, respectively.</p><p><strong>Results: </strong>Among 294 patients with IE-associated AKI, 14.3% died within 90 days, and the risk factors for 90-day mortality were similar to those identified in the general IE population. Among the 230 AKI survivors in whom 90-day kidney recovery could be assessed, 17.4% did not recover kidney function at 90 days. Kidney non-recovery at 90 days was associated with an increased risk of the long-term composite outcome of mortality, end-stage renal disease or sustained doubling of serum creatinine [hazard ratio (HR) 3.00, 95% confidence interval (CI) 1.19-7.59]. Five variables were related to kidney non-recovery: low baseline estimated glomerular filtration rate (eGFR) (HR 2.52, 95% CI 1.73-3.65), stage of AKI (HR 3.03, 95% CI 2.07-4.42 for stage 3), shock (HR 5.56, 95% CI 3.02-10.22), glomerulonephritis-related AKI (HR 3.04, 95% CI 1.93-4.77) and drug-related AKI (HR 2.77, 95% CI 1.86-4.13).</p><p><strong>Conclusion: </strong>Patients with IE-associated AKI had a high 90-day mortality, and a substantial proportion of survivors did not recover kidney function at 90 days. Kidney non-recovery at 90 days was associated with adverse long-term outcomes. Low baseline eGFR, severe AKI, shock, drug-related AKI and glomerulonephritis-related AKI were risk factors for kidney non-recovery.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae382"},"PeriodicalIF":3.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}