Clinical Kidney Journal最新文献

{"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":"64 1","pages":""},"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":"105 1","pages":""},"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":"27 1","pages":""},"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":"67 1","pages":""},"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":"190 1","pages":""},"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}

{"title":"Associations between acute kidney injury and bone fractures: a retrospective cohort study","authors":"Hicham I Cheikh Hassan, Bridie S Mulholland, Brendan McAlister, Kelly Lambert, Karumathil M Murali, Stephen Moules, Judy Mullan","doi":"10.1093/ckj/sfae282","DOIUrl":"https://doi.org/10.1093/ckj/sfae282","url":null,"abstract":"Background Acute kidney injury (AKI) is common. An AKI episode may disrupt the normal mineral bone balance maintained by normal kidney function, thereby modifying the risk of developing bone fractures. However, it remains unclear if an AKI episode is associated with the risk of bone fractures. Methods Using retrospective cohort study from an Australian Local Health District, we examined the association between an AKI episode and bone fractures using patient data between 2008 and 2017. Time-varying Cox proportional hazards and propensity-matched analysis were used to examine the association. Sensitivity analyses were undertaken to capture the impact of confirmed AKI status and AKI severity. Results Of 123 426 included patients, 14 549 (12%) had an AKI episode and 12 505 (10%) had a bone fracture. In the unadjusted analysis, AKI was associated with bone fractures [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.88- 2.11]. This association persisted in the adjusted analysis (HR 1.50, 95%CI 1.41- 1.59) and propensity matched dataset (HR 1.71, 95%CI 1.59- 1.83). The sensitivity analysis yielded similar results with the AKI patients having a higher risk of fractures compared to no AKI patients in the adjusted analysis (HR 1.34, 95%CI 1.25- 1.43) and in the propensity matched dataset (HR 1.44, 95%CI 1.33- 1.55). Similar results were seen in the subsidiary sensitivity analysis excluding patients without baseline creatinine. We did not find an increased risk of bone fractures with increasing AKI severity (P = 0.7). Interaction tests demonstrated a significant association between sex and age category with AKI status and fractures, but not CKD stage or osteoporosis. Conclusions AKI is associated with a greater risk of bone fractures. This could have implications for managing and screening for bone disease in patients post AKI episode. This association should be examined in other cohorts and populations for verification.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"47 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196379","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: a comparison of instruments and associations with patient-reported outcomes using an electronic patient reported outcome survey in Europe","authors":"Murilo Guedes, Charlotte Tu, Nidhi Sukul, Elham Asgari, Fitsum Guebre-Egziabher, Despina Ruessmann, Thilo Schaufler, Hugh Rayner, Michel Jadoul, Laura Labriola, Roberto Pecoits-Filho, Ronald L Pisoni, Angelo Karaboyas","doi":"10.1093/ckj/sfae276","DOIUrl":"https://doi.org/10.1093/ckj/sfae276","url":null,"abstract":"Background and Hypothesis The associations between self-reported chronic kidney disease-associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care. Methods An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021–2023. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: average and worst itching intensity numerical rating scales (AI-NRS, WI-NRS) and a KDQOL-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs. Results This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden, and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1, and 3.1 for extremely, very much, moderately, and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question. Discussion Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs. the AI- and WI-NRS (24 hours). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"10 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196382","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":"The impact of severe nephrotic syndrome on thyroid function, nutrition and coagulation","authors":"Anna Matyjek, Stanisław Niemczyk, Sławomir Literacki, Wojciech Fendler, Tomasz Rozmysłowicz, Andreas Kronbichler","doi":"10.1093/ckj/sfae280","DOIUrl":"https://doi.org/10.1093/ckj/sfae280","url":null,"abstract":"Background Nephrotic syndrome (NS) is characterized by urinary loss of proteins, including hormones and their carrier proteins, potentially resulting in endocrine disorders. This study aimed to assess thyroid dysfunction frequency and potential implications in NS. Methods In this case-control study, patients with severe NS (serum albumin ≤ 2.5 g/dL) and controls without proteinuria were evaluated for thyroid, hemostatic, and nutritional parameters, including body composition. Results Forty-two nephrotic and 40 non-proteinuric patients were enrolled. The NS group showed higher thyroid-stimulating hormone and lower free hormones, corresponding to a higher frequency of both euthyroid sick syndrome (ESS; 36% vs 5%; OR = 10.6, 95%CI: 2.2–50.0), and hypothyroidism (31% vs 5%; OR = 8.5, 95%CI: 1.8–40.7) compared to the control group. Levothyroxine supplementation was required for 11 NS patients (26% of the NS group). In addition, in comparison to the control individuals, NS patients exhibited lower lean tissue mass and a trend towards hypercoagulability, which was evidenced by higher levels of most coagulation factors and fibrinolysis inhibitors, and reduced endogenous anticoagulants activities. Furthermore, NS patients with ESS presented with a 10.4 kg (95% CI: −18.68 to −2.12) lower lean tissue mass. Those with hypothyroidism had a significantly reduced activity of coagulation factor X (by −30%, 95%CI: −47 to −13) and protein S (by −27%, 95%CI: −41 to −13) compared to euthyroid NS individuals. Conclusions Thyroid dysfunction is common in severe NS, often necessitating levothyroxine supplementation, which supports routine thyroid workup. A potential link between thyroid, nutritional, and coagulation disorders in NS requires further investigation.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"68 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196381","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 re-transplantation in the ipsilateral iliac fossa: a surgeon's perspective on perioperative outcome","authors":"Philipp Tessmer, Clara A Weigle, Anna Meyer, Bengt A Wiemann, Wilfried Gwinner, Gunilla Einecke, Jürgen Klempnauer, Florian W R Vondran, Nicolas Richter, Felix Oldhafer, Oliver Beetz","doi":"10.1093/ckj/sfae271","DOIUrl":"https://doi.org/10.1093/ckj/sfae271","url":null,"abstract":"Background Compared to primary transplantation, ipsilateral renal re-transplantation is associated with an increased risk of surgical complications and inferior graft outcomes. This study investigates whether an ipsilateral re-transplantation approach per se is an independent risk factor for surgical complications and early graft loss. Methods In this retrospective, single-centre analysis, surgical complications and early graft outcomes of ipsilateral kidney re-transplantations from January 2007 to December 2017 were compared with primary transplantations and contralateral re-transplantations. Univariate and multivariate binary logistic regression analyses were performed to identify risk factors for surgical complications requiring surgical revision and graft loss within the first year after transplantation. Results Of the 1.489 kidney transplantations, 51 were ipsilateral, 159 were contralateral re-transplantations, and 1.279 were primary transplantations. Baseline characteristics did not differ between the ipsilateral and contralateral re-transplant recipients except for current and highest PRA levels. Major complications requiring surgical revision were significantly more frequent in ipsilateral re-transplantations (P = 0.010) than in primary transplantations but did not differ between ipsilateral and contralateral re-transplantations (P = 0.217). Graft loss within the first year after transplant was 15.7% in the ipsilateral versus 8.8% in the contralateral re-transplant group (P = 0.163) versus 6.4% in the primary transplantation group (P = 0.009). In a multivariate regression model, ipsilateral re-transplantation was not identified as an independent risk factor for complications requiring surgical revision or first-year graft loss. Conclusions Ipsilateral renal re-transplantation is no risk factor for inferior outcomes. Graft implantation into a pre-transplanted iliac fossa is a feasible and valid therapeutic option.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"26 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196383","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":"Sex and gender differences in health-related quality of life in individuals treated with incremental and conventional hemodialysis.","authors":"Victoria J Riehl-Tonn, Jennifer M MacRae, Sandra M Dumanski, Meghan J Elliott, Neesh Pannu, Kara Schick-Makaroff, Kelsea Drall, Colleen Norris, Kara A Nerenberg, Louise Pilote, Hassan Behlouli, Taryn Gantar, Sofia B Ahmed","doi":"10.1093/ckj/sfae273","DOIUrl":"https://doi.org/10.1093/ckj/sfae273","url":null,"abstract":"<p><strong>Background: </strong>Women treated with hemodialysis report lower health-related quality of life (HRQoL) compared with men. Whether this is related to sex-specific (biological) (e.g. under-dialysis due to body composition differences) or gender-specific (sociocultural) factors (e.g. greater domestic/caregiver responsibilities for women) is unknown. We examined the association between sex assigned at birth, gender score and HRQoL in individuals initiating conventional and incremental hemodialysis.</p><p><strong>Methods: </strong>In this prospective multi-center cohort study, incident adult hemodialysis patients were recruited between 1 June 2020 and 30 April 2022 in Alberta, Canada. Sex assigned at birth and gender identity were self-reported. Gender-related characteristics were assessed by self-administered questionnaire to derive a composite measure of gender. The primary outcome was change in Kidney Disease Quality of Life 36 physical (PCS) and mental (MCS) component scores after 3 months of hemodialysis.</p><p><strong>Results: </strong>Sixty participants were enrolled (conventional hemodialysis: 14 female, 19 male; incremental hemodialysis: 12 female, 15 male). PCS improved from baseline with conventional (<i>P </i>= .01) but not incremental (<i>P </i>= .52) hemodialysis in female participants. No difference in MCS was observed by hemodialysis type in female participants. Gender score was not associated with changes in PCS in female participants, irrespective of hemodialysis type. Higher gender score was associated with increased MCS with incremental (<i>P </i>= .04), but not conventional (<i>P </i>= .14), hemodialysis (<i>P </i>= .03 conventional vs incremental) in female participants. No change in PCS or MCS was seen in male participants, irrespective of hemodialysis type or gender score.</p><p><strong>Conclusion: </strong>In this exploratory study, conventional hemodialysis was associated with improved PCS in female participants, while incremental hemodialysis was associated with improved MCS in female participants with more roles and responsibilities traditionally ascribed to women. Large prospective studies are required to further investigate these relationships.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 10","pages":"sfae273"},"PeriodicalIF":3.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388611","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}