Clinical Kidney Journal最新文献

{"title":"The role of blood purification therapies in the treatment of chronic kidney disease-associated pruritus: a systematic review","authors":"Matteo Marcello, Davide Marturano, Claudio Ronco, Monica Zanella","doi":"10.1093/ckj/sfae266","DOIUrl":"https://doi.org/10.1093/ckj/sfae266","url":null,"abstract":"Background Chronic kidney disease-associated pruritus (CKD-aP) is a common complication in dialysis patients not fully addressed by pharmacological and dialytic therapy. Objective to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. Population patients aged ≥ 18 years on chronic dialysis. Selection criteria PubMed, Embase, and Medline were systematically searched until February 2024 for clinical studies comparing the effect of different dialysis modalities on pruritus intensity. 2 reviewers extracted data independently. Risk of bias for RCTs was assessed using the Cochrane tool. Intervention any extracorporeal blood purification therapy for the treatment of CKD-aP was included. Outcomes quantitative change in pruritus intensity on a validated itching scale. Synthesis of results This review included 8 RCTs examining 5 different dialysis modalities, 3 observational studies examining 3 dialysis modalities, and 6 prospective clinical trials assessing 4 dialysis modalities. These treatments included peritoneal dialysis, low-flux, and high-flux dialysis, hemodiafiltration, expanded hemodialysis, hemadsorption, hemodiafiltration with endogenous reinfusion, and dialysis with PMMA membrane. Risk of bias was high in most studies. The largest body of evidence was found for the efficacy of hemadsorption. Limitations of evidence heterogeneity in diagnostic tools and treatment, risk of selection bias, small sample sizes, and short follow-up durations that made it challenging to perform a robust systematic review and meta-analysis. Interpretation Despite the high prevalence of pruritus among dialysis patients, except for hemadsorption, current evidence for dialytic treatment is weak. More high-quality studies are needed to confirm the long-term benefits.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196398","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":"Estimating glomerular filtration in young people.","authors":"Pierre Delanaye, Laurence Derain-Dubourg, Jonas Björk, Marie Courbebaisse, Lionel Couzi, Francois Gaillard, Cyril Garrouste, Anders Grubb, Lola Jacquemont, Magnus Hansson, Nassim Kamar, Christophe Legendre, Karin Littmann, Christophe Mariat, Lionel Rostaing, Andrew D Rule, Per-Ola Sundin, Arend Bökenkamp, Ulla Berg, Kajsa Åsling-Monemi, Anna Åkesson, Anders Larsson, Ulf Nyman, Hans Pottel","doi":"10.1093/ckj/sfae261","DOIUrl":"https://doi.org/10.1093/ckj/sfae261","url":null,"abstract":"<p><strong>Background: </strong>Creatinine-based equations are the most used to estimate glomerular filtration rate (eGFR). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the re-expressed Lund-Malmö Revised (r-LMR) and the European Kidney Function Consortium (EKFC) equations are the most validated. The EKFC and r-LMR equations have been suggested to have better performances in young adults, but this is debated.</p><p><strong>Methods: </strong>We collected data (GFR) measured by clearance of an exogenous marker (reference method), serum creatinine, age and sex from 2366 young adults (aged between 18 and 25 years) both from Europe and the USA.</p><p><strong>Results: </strong>In the European cohorts (<i>n</i> = 1892), the bias (in mL/min/1.73 m²) was systematically better for the EKFC and r-LMR equations compared with the CKD-EPI equation [2.28, 95% confidence interval (1.59; 2.91), -2.50 (-3.85; -1.76), 17.41 (16.49; 18.47), respectively]. The percentage of estimated GFR within 30% of measured GFR (P30) was also better for EKFC and r-LMR equations compared with the CKD-EPI equation [84.4% (82.8; 86.0), 87.2% (85.7; 88.7) and 65.4% (63.3; 67.6), respectively]. In the US cohorts (<i>n</i> = 474), the bias for the EKFC and r-LMR equations was better than for the CKD-EPI equation in the non-Black population [0.97 (-1.69; 3.06), -2.62 (-5.14; -1.43) and 7.74 (5.97; 9.63), respectively], whereas the bias was similar in Black US individuals. P30 results were not different between the three equations in US cohorts. Analyses in sub-populations confirmed these results, except in individuals with high GFR levels (GFR ≥120 mL/min/1.73 m²) for whom the CKD-EPI equation might have a lower bias.</p><p><strong>Conclusions: </strong>We demonstrated that both the EKFC and r-LMR creatinine-based equations have a better performance than the CKD-EPI equation in a young population. The only exception might be in patients with hyperfiltration.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307260","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":"Transportable, portable, wearable and (partially) implantable hemodialysis systems: comparison of technologies and readiness levels","authors":"Fokko P Wieringa, Dian Bolhuis, Henning Søndergaard, Stephen R Ash, Cian Cummins, Karin G F Gerritsen, Jeroen Vollenbroek, Tugrul Irmak","doi":"10.1093/ckj/sfae259","DOIUrl":"https://doi.org/10.1093/ckj/sfae259","url":null,"abstract":"Background Dialysis modalities and their various treatment schedules result from complex compromises (‘trade-offs’) between medical, financial, technological, ergonomic and ecological factors. This study targets summarizing the mutual influence of these trade-offs on (trans)portable, wearable or even (partially) implantable hemodialysis (HD) systems, identify what systems are in development, and how they might improve Quality-of-Life (QoL) for kidney failure patients. Methods Hemodialysis as defined by international standard IEC 60601–2-16 was applied on a PUBMED database query regarding (trans)portable, wearable and (partly) implantable HD systems. 24 out of 159 search results were included and scanned for specific HD devices and/or HD systems in development. Additional information about weight, size and development status was collected via internet and/or contacting manufacturers. International airplane hand baggage criteria formed the boundary between transportable and portable. Technology Readiness Levels (TRLs) were assigned by combining TRL-scales from the European Union and NATO medical staff. Results The query revealed 13 devices/projects: 7 transportable (6xTRL9, 1xTRL5); 2 portable (1xTRL6-7, 1xTRL4); 2 wearable (1xTRL6, 1xfrozen); and 2 partly implantable (1xTRL4-5, 1xTRL2-3). Discussion 3 main categories of technical approaches were distinguished: Single-pass, Dialysate regenerating, and Implantable HD filter with extracorporeal dialysate regeneration (in climbing order of mobility). Conclusions Kidneys facilitate mobility by excreting strongly concentrated waste solutes with minimal water loss. Mimicking this kidney function can increase HD system mobility. Dialysate regenerating HD systems are enablers for portability/wearability and, combined with durable implantable HD filters (once available), they may enable HD without needles or intravascular catheters. But lack of funding severely hampers progress.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196401","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":"Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort","authors":"Gianmarco Lombardi, Nicholas C Chesnaye, Fergus J Caskey, Friedo W Dekker, Marie Evans, Olof Heimburger, Maria Pippias, Claudia Torino, Maciej Szymczak, Christiane Drechsler, Christoph Wanner, Giovanni Gambaro, Vianda S Stel, Kitty J Jager, Pietro Manuel Ferraro","doi":"10.1093/ckj/sfae254","DOIUrl":"https://doi.org/10.1093/ckj/sfae254","url":null,"abstract":"Background and hypothesis We aimed to explore the relationship between serum bicarbonate (SBC) and mortality in advanced CKD during three distinct treatment periods: during the pre-kidney replacement therapy (KRT) period, during the transition phase surrounding the start of KRT (transition-CKD), and during KRT. Methods Using the EQUAL cohort, which includes patients aged ≥ 65 years and eGFR ≤20 ml/min per 1.73 m2 from six European countries, we explored the association between longitudinal SBC and all-cause mortality in three separate CKD populations: pre-KRT, transition-CKD and in the KRT populations, using multivariable time-dependent Cox regression models. We evaluated effect modification by pre-specified variables on the relationship between SBC and mortality. Results We included 1 485 patients with a median follow-up of 2.9 (IQR 2.7) years, during which 529 (35.6%) patients died. A U-shaped relationship between SBC levels and all-cause mortality was observed in the pre-KRT population (P = 0.03). Low cumulative exposure, defined as the area under the SBC trajectory before KRT initiation, was associated with increased mortality risk after transitioning to KRT (P = 0.01). Similarly, in the KRT population, low SBC levels showed a trend towards increased mortality risk (P = 0.13). We observed effect modification by subjective global assessment (SGA) category (p-value for interaction = 0.02) and KRT (p-value for interaction = 0.02). Conclusions A U-shaped relationship describes the association between SBC and mortality in the advanced CKD pre-KRT population, whereas in the KRT population a trend towards an increased mortality risk was observed for low SBC levels.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196402","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":"Non-dilated obstructive nephropathy","authors":"Valeria Feliciangeli, Annalisa Noce, Giulia Montalto, Stefano Germani, Roberto Miano, Anastasios D Asimakopoulos","doi":"10.1093/ckj/sfae249","DOIUrl":"https://doi.org/10.1093/ckj/sfae249","url":null,"abstract":"Obstructive nephropathy (ON) is a common and reversible cause of post-renal acute kidney injury (AKI) and may be caused by a variety of conditions. It occurs when both the upper urinary tracts are obstructed or when one tract is obstructed in patients with a solitary kidney. ON is suspected whenever there is evidence of hydronephrosis at imaging. However, not all patients with obstruction develop hydronephrosis and significant obstruction can be present in the absence of hydronephrosis. This syndrome is called non-dilated obstructive uropathy (NDOU). It accounts for about 5% of cases of urinary obstruction and the diagnosis can be challenging. The current paper provides an overview of the literature aiming to identify the main causes NDOU and its clinical presentation, in order to clarify when to suspect it among AKI cases. A narrative review was performed due to the overall low quality of the available evidence. Only patients with post-renal AKI and a non-dilated or minimal dilation of the intrarenal collecting system were included. As evidenced by our review, NDOU is most prevalent in the fifth and sixth decade of life and affects mainly the male gender. On hospital admission serum creatinine levels are usually very high. Among the most common clinical presentations are the oliguria/anuria, abdominal pain, signs of retention like oedema or pleural effusion and nausea/vomiting. About three out of four cases of NDOU are due to an ab-extrinsic compression of the ureters caused by retroperitoneal fibrosis or malignant disease. An effective and minimally invasive urinary diversion is obtained with ureteric stenting or a percutaneous nephrostomy. A correct diagnosis of NDOU may be challenging but it is of paramount importance as it can lead to a prompt management with a potential complete resolution of both obstruction and acute renal failure.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196409","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":"Kidney function-specific cut-off values of high-sensitivity cardiac troponin T for the diagnosis of acute myocardial infarction.","authors":"Ruixuan Chen, Mingzhen Pang, Hongxue Yu, Fan Luo, Xiaodong Zhang, Licong Su, Yanqin Li, Shiyu Zhou, Ruqi Xu, Qi Gao, Daojing Gan, Xin Xu, Sheng Nie, Fan Fan Hou","doi":"10.1093/ckj/sfae247","DOIUrl":"10.1093/ckj/sfae247","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin T (hs-cTnT) remains challenging in patients with kidney dysfunction.</p><p><strong>Methods: </strong>In this large, multicenter cohort study, a total of 20 912 adults who underwent coronary angiography were included. Kidney function-specific cut-off values of hs-cTnT were determined to improve the specificity without sacrificing sensitivity, as compared with that using traditional cut-off value (14 ng/L) in the normal kidney function group. The diagnostic accuracy of the novel cut-off values was validated in an independent validation cohort.</p><p><strong>Results: </strong>In the derivation cohort (<i>n</i> = 12 900), 3247 patients had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². Even in the absence of AMI, 50.2% of participants with eGFR <60 mL/min/1.73 m² had a hs-cTnT concentration ≥14 ng/L. Using 14 ng/L as the threshold of hs-cTnT for diagnosing AMI led to a significantly reduced specificity and positive predictive value in patients with kidney dysfunction, as compared with that in patients with normal kidney function. The kidney function-specific cut-off values were determined as 14, 18 and 48 ng/L for patients with eGFR >60, 60-30 and <30 mL/min/1.73 m², respectively. Using the novel cut-off values, the specificities for diagnosing AMI in participants with different levels of kidney dysfunction were remarkably improved (from 9.1%-52.7% to 52.8-63.0%), without compromising sensitivity (96.6%-97.9%). Similar improvement of diagnostic accuracy was observed in the validation cohort (<i>n</i> = 8012).</p><p><strong>Conclusions: </strong>The kidney function-specific cut-off values of hs-cTnT may help clinicians to accurately diagnose AMI in patients with kidney dysfunction and avoid the potential overtreatment in practice.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153298","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":"Immobilization-associated hypercalcaemia in patients with malignancy in the hospital setting.","authors":"Swetha R Kanduri,Anabella Stark,Juan Carlos Q Velez","doi":"10.1093/ckj/sfae252","DOIUrl":"https://doi.org/10.1093/ckj/sfae252","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262268","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":"Association of serum zinc with mineral stress in chronic kidney disease.","authors":"Azmat Sohail,Jakob Obereigner,Gregor Mitter,Thomas Schmid,Anna-Sofie Hofer,Gerhard Schuster,Astrid Hügl,Angelika H Dorninger,Markus Mandl,Andreas Pasch,Helmut K Lackner,Ilona Papousek,Benjamin Dieplinger,Susanne Suessner,Marlies Antlanger,Daniel Cejka,Ioana Alesutan,Jakob Voelkl","doi":"10.1093/ckj/sfae258","DOIUrl":"https://doi.org/10.1093/ckj/sfae258","url":null,"abstract":"BackgroundThe excessive cardiovascular mortality of patients with chronic kidney disease (CKD) could be linked to mineral stress, the biological consequence of calcium-phosphate nanoparticle exposure. This study investigated whether zinc is associated with mineral stress markers in CKD.MethodsZinc and T50 (serum calcification propensity) as well as hydrodynamic radius of secondary calciprotein particles (CPP2) were measured in blood donors and CKD patients with/out dialysis.ResultsSerum zinc concentrations and T50 were reduced, while CPP2 radius was increased in CKD patients. Serum zinc levels positively correlated with T50 and inversely correlated with CPP2 radius. In a hierarchical linear regression model, T50 was associated with age, calcium, phosphate, magnesium and albumin. Addition of zinc significantly improved prediction of the model, confirming an additional contribution of zinc to T50. Similar observations were made for the association of zinc and CPP2 radius, but spiking experiments indicated that zinc may stronger modify T50 than CPP2 radius. Also, urinary zinc excretion was increased in patients with kidney disease and correlated to T50 and CPP2 radius. Serum zinc further correlated with markers of arterial stiffness in blood donors and CKD patients, but these associations did not remain significant in a multivariate linear regression model.ConclusionsReduced serum zinc levels in CKD appear directly linked to lower T50 and associated with larger CPP2 radius. Further studies on the associations of zinc and mineral stress as well as putative therapeutic benefits of zinc supplementation are required.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262466","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":"Short-term peritoneal rest reduces peritoneal solute transport rate and increases ultrafiltration in high/high average transport peritoneal dialysis patients: a crossover randomized controlled trial.","authors":"Bei Wu, Huiping Zhao, Li Zuo, Aichun Liu, Lixia Lu, Jie Qiao, Xinxin Chu, Chuncui Men, Yuting He","doi":"10.1093/ckj/sfae251","DOIUrl":"https://doi.org/10.1093/ckj/sfae251","url":null,"abstract":"<p><strong>Background: </strong>The peritoneal solute transport rate (PSTR) tends to increase over time in some patients undergoing peritoneal dialysis (PD), potentially leading to ultrafiltration (UF) failure. Previous case reports have shown a significant decrease in PSTR and subsequent recovery of UF after discontinuing PD for a while. Therefore, we conducted a randomized controlled crossover study to evaluate the impact of short-term peritoneal rest on PSTR.</p><p><strong>Methods: </strong>The study involved 14 continuous ambulatory peritoneal dialysis (CAPD) patients with high/high-average transport rate. Two groups were randomly assigned different treatment sequences: one group underwent daily intermittent peritoneal dialysis (IPD) for 4 weeks followed by CAPD, while the other group initially received CAPD treatment for 4 weeks and then switched to IPD. Peritoneal equilibration tests were performed before and after each treatment to evaluate PSTR and paired <i>t</i>-tests were used to compare the changes. Volume load, serum potassium and other clinical indicators were monitored at the same time.</p><p><strong>Results: </strong>Short-term peritoneal rest (daily IPD) significantly reduced PSTR, with a decrease in the dialysate:plasma creatinine ratio from 0.71 ± 0.05 to 0.65 ± 0.07 (<i>P</i> < .001). Additionally, ultrafiltration significantly increased from 210 ± 165 ml to 407 ± 209 ml (<i>P</i> = .001). But there were no significant changes in interleukin-6 and vascular endothelial growth factor of PD effluent. No serious adverse events such as hypotension or hyperkalaemia occurred.</p><p><strong>Conclusions: </strong>In PD patients with high and high-average transport, a 4-week period of short-term peritoneal rest by switching from CAPD to IPD (without long dwell) can lead to reductions in PSTR and increases in UF volumes, while maintaining clinical safety.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11411283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281416","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":"The association between klotho and kidney and cardiovascular outcomes: a comprehensive systematic review and meta-analysis","authors":"Mehmet Kanbay, Crischentian Brinza, Lasin Ozbek, Mustafa Guldan, Uluman Sisman, Sidar Copur, Andreea Covic, Dragos-Viorel Scripcariu, Alexandru Burlacu, Adrian Covic","doi":"10.1093/ckj/sfae255","DOIUrl":"https://doi.org/10.1093/ckj/sfae255","url":null,"abstract":"Background and Aim Chronic kidney disease (CKD) and end-stage renal disease (ESKD) are significant global health challenges associated with progressive kidney dysfunction and numerous complications, including cardiovascular disease and mortality. This study aims to explore the potential association between plasma Klotho levels and various prognostic outcomes in CKD and ESKD, including all-cause mortality, cardiovascular events, metabolic syndrome development, and adverse renal events necessitating renal replacement therapies. Materials and Methods A literature search was conducted up to June 3, 2024, using the electronic databases Cochrane Library, Ovid MEDLINE, CINAHL, Web of Science, SCOPUS, and PubMed. This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Fourteen studies were included. For all-cause mortality, comparing CKD patients with low versus high Klotho levels showed a significant association (OR 1.81, 95% CI 1.34–2.44, p = 0.0001), with substantial heterogeneity (I2 = 69%). Excluding one study reduced heterogeneity (I2 = 43%) while maintaining significance (OR 1.97, 95% CI 1.45–2.66, p &amp;lt; 0.0001). Cardiovascular mortality was higher in patients with low Klotho levels (OR 2.11, 95% CI 1.61–2.76, p &amp;lt; 0.00001), with low heterogeneity (I2 = 25%). Excluding one study eliminated heterogeneity (I2 = 0%) while maintaining significance (OR 2.39, 95% CI 1.83–3.12, p &amp;lt; 0.00001). Composite cardiovascular events did not differ significantly between low and high Klotho groups (OR 1.51, 95% CI 0.82–2.77, p = 0.18), but with high heterogeneity (I2 = 72%). Patients with low Klotho levels had a higher risk of adverse renal events (OR 2.36, 95% CI 1.37–4.08, p = 0.002), with moderate heterogeneity (I2 = 61%). Sensitivity analysis reduced heterogeneity (I2 = 0%) while maintaining significance (OR 3.08, 95% CI 1.96–4.85, p &amp;lt; 0.00001). Specifically, for ESKD or kidney replacement therapy risk, low Klotho levels were associated with an increased risk (OR 2.30, 95% CI 1.26–4.21, p = 0.007). Similarly, CKD progression risk was higher in patients with lower Klotho levels (OR 2.48, 95% CI 1.45–4.23, p = 0.0009). Conclusion Lower serum Klotho levels serve as a significant predictor of adverse outcomes, including increased risks of all-cause mortality, cardiovascular mortality, and progression to end-stage kidney disease among CKD patients.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196406","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}