Clinical Kidney Journal最新文献

{"title":"Quality matters: chronic kidney disease progression is associated with reduced muscle strength independently of changes in skeletal muscle mass: an observational study.","authors":"Antoine Chatrenet, Pierre-Yves de Müllenheim, Massimo Torreggiani, Julia Nava Hernández, Rocío Urbina Arronte, Abril Gutiérrez Espinoza, Giorgina Barbara Piccoli","doi":"10.1093/ckj/sfaf036","DOIUrl":"10.1093/ckj/sfaf036","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is commonly associated with multifactorial neuromuscular impairments. Few studies have investigated CKD-induced changes in maximal voluntary force (MVF), and even fewer have longitudinal follow-up. The aim of this study is to investigate whether CKD progression modifies the relationship between skeletal muscle mass and force, and the prevalence of sarcopaenia and sarcopenic obesity.</p><p><strong>Methods: </strong>The data used were prospectively collected during routine check-ups in a network of nutritional centres in Mexico and retrospectively analysed. From a dataset of 5430 patients, we selected 1098 patients with available anthropometric, kidney function, handgrip and bioimpedance data. The relationship between appendicular skeletal muscle mass (ASM) and MVF was investigated using mixed models and adjusted for age, sex, body mass index, physical activity level and CKD aetiology. Sarcopaenia prevalence were tested across period of follow-up using the Cochran-Mantel-Haenzen for repeated measures and across CKD stages using the Chi-2 test.</p><p><strong>Results: </strong>After normalization with ASM, MVF was higher in CKD G1-G3 compared with G4 and G5 (<i>P</i> ≤ .001, Cohen's d = 0.270-0.576). Slopes between MVF and ASM were lower in CKD G3, G4 and G5 than in CKD G1-G2 [-2.268 (-3.927, -0.609), <i>P</i> <i> </i>= .008; -2.694 (-4.593, -0.794), <i>P</i> <i> </i>= .006; -3.675 (-5.326, -1.725), <i>P</i> <i> </i>< .001, respectively]. The prevalence of sarcopaenia and sarcopaenic obesity did not differ across CKD stages, but recovery was most commonly observed in CKD G1-G2. Slope analysis showed an independent interaction between the slopes of kidney function and ASM on MVF evolution over time.</p><p><strong>Conclusions: </strong>CKD negatively, progressively and independently affects the neuromuscular system, and force production is reduced for any given muscle mass as CKD progresses. While no association was found between CKD stage and prevalence of sarcopaenia, recovery was more frequent in the early CKD stages. These results suggest the importance of early rehabilitation programs to improve musculoskeletal health, quality of life and survival in CKD patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf036"},"PeriodicalIF":3.9,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572313","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 hidden interplay between sex and adverse outcomes in incident dialysis patients: the role of aortic calcification.","authors":"Xue Zhao, Zitong Lei, Meng Wang, Hua Liu, Mengyao Yan, Linhui Huo, Zhumei Gao, Hongli Jiang, Limin Wei","doi":"10.1093/ckj/sfaf034","DOIUrl":"10.1093/ckj/sfaf034","url":null,"abstract":"<p><strong>Background: </strong>Research on the sex disparity in the prognosis of chronic kidney disease (CKD), particularly among those who are newly initiating dialysis, is limited and inconclusive. This study aimed to investigate the associations between sex, and all-cause mortality and major cardiovascular adverse events (MACE), with a particular focus on the presence of aortic calcification (AC).</p><p><strong>Methods: </strong>We conducted a <i>post hoc</i> analysis of 1459 incident dialysis patients included in this prospective cohort study. The primary outcome of interest was all-cause mortality, and the secondary endpoint was a composite of MACE.</p><p><strong>Results: </strong>During a median follow-up period of 3.55 years, 362 (269 male and 93 female) patients died and 477 (342 male and 135 female) patients developed MACE. The risks for all-cause mortality [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.47-0.79] and MACE (HR 0.74, 95% CI 0.60-0.93) were lower in females than in males. This finding was robust across multiple sensitivity analyses and most subgroups. Moreover, the associations between sex and adverse outcomes were significantly modified by AC status at dialysis initiation (<i>P</i> for interaction <.05). Specifically, among patients without AC, females exhibited lower risks for all-cause mortality (HR 0.45, 95% CI 0.29-0.69; <i>P</i> < .001) and MACE (HR 0.67, 95% CI 0.49-0.93; <i>P</i> = .015), whereas no differences were observed for all-cause mortality (HR 0.82, 95% CI 0.59-1.15; <i>P</i> = .256) or MACE (HR 0.80, 95% CI 0.59-1.10; <i>P</i> = .174) among patients with AC.</p><p><strong>Conclusions: </strong>In patients with renal failure receiving dialysis, AC abolished the survival and cardiovascular protection observed in female versus male patients. This finding supports the need for greater awareness of the AC burden in female dialysis patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf034"},"PeriodicalIF":3.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572316","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":"Associations between initial dialysis access types and death from dialysis withdrawal in incident patients with kidney failure.","authors":"Jenny H C Chen, David W Johnson, Matthew A Roberts, Mark A Brown, Frank Brennan, Germaine Wong, Hicham Cheikh Hassan, Wing-Chi G Yeung, Alice Kennard, Christopher E Davies, Neil Boudville, Charmaine E Lok, Wai H Lim","doi":"10.1093/ckj/sfaf024","DOIUrl":"10.1093/ckj/sfaf024","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving haemodialysis via a central venous catheter (HD-CVC) have been shown to have an increased risk of all-cause mortality. It is unclear whether death from dialysis withdrawal is associated with the high mortality risk observed in patients initiated on HD-CVC.</p><p><strong>Methods: </strong>Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the association between initial dialysis access [HD-CVC, haemodialysis via arteriovenous fistula (HD-AVF), and peritoneal dialysis (PD) via PD catheter (PD-PDC)] and death from dialysis withdrawal in adult patients starting dialysis in Australia between 2005 and 2022, analysed by time-stratified adjusted Cox regression with propensity score-matched cohorts.</p><p><strong>Results: </strong>Of 47 412 incident patients followed for a median of 2.65 years (interquartile range 1.19-4.87), 8170 (17%) died from dialysis withdrawal. Compared with patients initiated on HD-AVF, patients initiated on HD-CVC were more likely to experience death from dialysis withdrawal in the first 3 years after dialysis initiation, but not after 3 years [adjusted hazard ratios 2.43 (95% confidence interval 1.95-3.02), 2.06 (1.67-2.53), 1.57 (1.40-1.76), and 1.06 (0.97-1.15) for 0-6 months, >6-12 months, >1-3 years, and >3 years after dialysis initiation, respectively]. Comparison between patients initiated on HD-CVD and PD-PDC showed similar estimates. No difference in withdrawal risk was observed between patients initiated on HD-AVF and PD-PDC.</p><p><strong>Conclusions: </strong>Patients initiated on HD-CVC were twice as likely to experience early death from dialysis withdrawal compared with patients who had initiated dialysis with HD-AVF or PD-PDC. The increased risks diminished over time and were not observed after 3 years on dialysis.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf024"},"PeriodicalIF":3.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566044","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":"COVID-19 among kidney transplant recipients: evaluating risk factors during the initial phase of the pandemic.","authors":"Alexandra Nowak, Aurora Caldinelli, Mårten Segelmark, Helena Rydell, Angelica Artborg, Rino Bellocco, Maria Stendahl, Bengt Lindholm, Julia Wijkström, Marie Evans","doi":"10.1093/ckj/sfaf030","DOIUrl":"10.1093/ckj/sfaf030","url":null,"abstract":"<p><strong>Background: </strong>Current knowledge about risk factors for severe COVID-19 among kidney transplant recipients stem from meta-analyses of small or regional studies.</p><p><strong>Methods: </strong>All kidney transplant recipients in Sweden as of 1 January 2020 (<i>n</i> = 5824) were followed during the first 2 years of the pandemic. Data from the Swedish Renal Registry and linked health care registries were analyzed by multivariable adjusted logistic regression to identify risk factors for severe COVID-19, defined as hospitalization or death due to COVID-19.</p><p><strong>Results: </strong>Male sex increased the risk of severe COVID-19. While many comorbidities were associated with increased risk, their significance diminished after adjustment for other factors. Kidney transplant recipients of working age, 49-58 years adjusted odds ratio (aOR) 2.32 (95% CI 1.53-3.51) and 59-68 years aOR (1.92; 1.26-2.91) had the highest risk compared to the youngest age group (18-38 years). Compared to recently (<1 year) transplanted patients, those transplanted >5 years ago had a lower risk of severe COVID-19 (aOR 0.52; 0.36-0.75 for 6-10 years; aOR 0.57; 0.41-0.79 for >10 years). Longer pre-transplant dialysis vintage (aOR_1-year 1.04; 1.01-1.06) and deceased donor kidneys (aOR 1.41; 1.09-1.84) increased the risk. Immunosuppression with mycophenolate mofetil (aOR 1.47, 95% CI 1.08-1.99) and proton pump inhibitor use (aOR 1.58, 95% CI 1.24-2.01) were strongly associated with severe COVID-19.</p><p><strong>Conclusions: </strong>While kidney transplant recipients share risk factors with the general population, working age groups were at the highest risk, unlike in the general population. These findings emphasize the need for targeted prevention and treatment strategies for kidney transplant recipients in future pandemics.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf030"},"PeriodicalIF":3.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572297","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":"Women in academic nephrology: have we bridged the gender gap?","authors":"Rose Mary Attieh, Karima Wehbe, Wafaa Khaled, Darshil Jhaveri, Hay Me Me, Salman Bhutta, Kiran Munir, Kenar D Jhaveri","doi":"10.1093/ckj/sfaf019","DOIUrl":"10.1093/ckj/sfaf019","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf019"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566059","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":"Development and validation of a measure to assess patient experience of needling of arteriovenous fistulas or grafts for haemodialysis access: the NPREM.","authors":"Currie Moore, Amanda Busby, Rebecca Flanagan, Helen Ellis-Caird, Faizan Awan, Tarsem Paul, Catherine Fielding, Kieran McCafferty, Sabine N van der Veer, Ken Farrington, David Wellsted","doi":"10.1093/ckj/sfaf029","DOIUrl":"10.1093/ckj/sfaf029","url":null,"abstract":"<p><strong>Background: </strong>Needling is a key step in haemodialysis. Research suggests that needling experience is sub-optimal; however, no validated measure exists to inform improvements. We addressed this by developing the Needling Patient Reported Experience Measure (NPREM).</p><p><strong>Methods: </strong>We used mixed methods and co-production. All participants were adults with working fistulas/grafts from eight UK kidney centres. Phase 1 involved developing concepts and items: in interviews (<i>n</i> = 41), we explored patients' needling experience and identified key aspects of needling using thematic analysis. This informed the 98-item NPREM(v0.1). Phase 2 was piloting the measure: cognitive interviews (<i>n</i> = 16) assessed face validity. Items were amended or removed, yielding a 48-item NPREM(v0.2). A pilot survey (<i>n</i> = 183) examined initial psychometric properties. NPREM(v0.2) showed good internal consistency (Cronbach's alpha = 0.95). Review of analyses resulted in a 35-item NPREM(v0.3). Phase 3 involved evaluating the measure's dimensionality, validity and reliability: patients (<i>n</i> = 468) completed the NPREM(v0.3), Vascular Access Quality of Life (VASQoL), EuroQol 5-Dimension-5-Level (EQ-5D-5L) and Patient Activation Measure (PAM), with a sub-set completing a follow-up NPREM (<i>n</i> = 99). Items were evaluated with 28 items retained in the NPREM(v1.0). Confirmatory factor analysis confirmed a unidimensional model fit (comparative fit index = 0.899). Validity of the NPREM(v1.0) was good [convergent: VASQoL (<i>r </i>= 0.60) and overall experience (<i>r </i>= 0.79); divergent: EQ-5D (<i>r </i>= -0.31), EQ-5D visul analogue scale (<i>r </i>= 0.24) and PAM (<i>r </i>= 0.17)]. Test-retest scores were strongly correlated (<i>r </i>= 0.88), demonstrating high reliability. Known-groups validity was demonstrated between centre scores [range 5.21 (standard deviation 1.20) to 5.94 (0.75)].</p><p><strong>Conclusion: </strong>The NPREM measures patient experience of needling for haemodialysis. It offers kidney services a means of assessing needling experience, informing patient-focused clinical and service improvements.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf029"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691287","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":"Automated dialysate sodium control system: a word of caution regarding potassium.","authors":"Maxime Ingwiller","doi":"10.1093/ckj/sfaf018","DOIUrl":"10.1093/ckj/sfaf018","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf018"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596420","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":"International validation of a pre-transplant risk assessment tool for graft survival in pediatric kidney transplant recipients.","authors":"Loes Oomen, Liesbeth L de Wall, Burkhard Tönshoff, Kai Krupka, Jerome Harambat, Julien Hogan, Cécile Couchoud, Emilie Savoye, Huib de Jong, Elisabeth A M Cornelissen, Antonia H M Bouts, Mandy G Keijzer-Veen, Wout F J Feitz, Charlotte M H H T Bootsma-Robroeks","doi":"10.1093/ckj/sfaf031","DOIUrl":"10.1093/ckj/sfaf031","url":null,"abstract":"<p><strong>Background: </strong>A pre-transplant prediction model using commonly available factors is valuable for optimizing donor selection, communication, and counseling for pediatric kidney transplant (PKT) recipients. This study aims to externally validate a Dutch PKT prediction model and assess its international applicability.</p><p><strong>Materials and methods: </strong>Data from the Dutch-, CERTAIN-, and CRISTAL registries, covering PKT from 2005 to 2021, were used. The Dutch prediction model was externally validated in a German and French cohort and then adapted to these specific countries. An international prediction model was also developed using all available data. Models were based on 80% derivation cohorts and internally validated using areas under the receiver operating characteristic curve (ROC-AUC) and calibration plots.</p><p><strong>Results: </strong>Of 3266 transplantations, 2475 (273 Dutch, 356 German, 1622 French, and 224 other) were used for analysis. Cohorts differed significantly in baseline characteristics and outcomes. Internal validation of the Dutch model showed ROC-AUC of 0.77 and 0.75 at 10 and 15 years. External validation in German and French cohorts yielded 10-year ROC-AUC of 0.63 and 0.60, respectively.Internal validation of the international prediction model showed AUC of 0.61 and 0.60 at 10 and 15 years with poor calibration, indicating inferior performance. The adapted national models showed better internal validation performance, with 10-year ROC-AUC of 0.77, 0.76, and 0.73 in Dutch, French, and German cohorts, respectively.</p><p><strong>Conclusions: </strong>The Dutch PKT prediction tool requires country-specific adaptations for use in other countries, given the diversity of clinical practice across Europe. A country-specific model is preferable to an international model in the current landscape.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf031"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572292","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":"Breaking barriers: giving HOPE to people living with HIV and end-stage renal disease.","authors":"Matthias Diebold, Adnan Sharif","doi":"10.1093/ckj/sfaf027","DOIUrl":"10.1093/ckj/sfaf027","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfaf027"},"PeriodicalIF":3.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491198","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":"Life beyond antibodies: quality of life after desensitization in kidney transplantation.","authors":"Patrice Zoehinga, Thomas Jouve, Eloi Chevallier, Paolo Malvezzi, Lionel Rostaing, Johan Noble","doi":"10.1093/ckj/sfae411","DOIUrl":"10.1093/ckj/sfae411","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfae411"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691308","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}