Clinical Kidney Journal最新文献

{"title":"Kidney transplantation in patients with polycystic kidney disease: increased risk of infection does not compromise graft and patient survival.","authors":"Johannes Waiser, Jens Klotsche, Petra Glander, Danilo Schmidt, Marcel Naik, Lutz Liefeldt, Klemens Budde, Jan Halbritter, Fabian Halleck, Bianca Zukunft, Robert Peters, Frank Friedersdorff, Nils Lachmann, Kai-Uwe Eckardt, Leonie d'Anjou, Friederike Bachmann","doi":"10.1093/ckj/sfae330","DOIUrl":"10.1093/ckj/sfae330","url":null,"abstract":"<p><strong>Background: </strong>Patients with autosomal dominant polycystic kidney disease (ADPKD) represent >10% of patients awaiting kidney transplantation. These patients are prone to potentially severe urinary tract (UTI) and liver cyst infections after transplantation. Whether such infections compromise outcome is unclear.</p><p><strong>Methods: </strong>Between 2000 and 2017 we performed 193 kidney transplantations in patients with ADPKD. In 189 patients, we assessed the occurrence, frequency, and severity of infection episodes requiring inpatient treatment and their impact on graft and patient outcomes compared with 189 matched controls. Risk factors were analyzed by uni- and multivariable analyses.</p><p><strong>Results: </strong>During a mean observation period of 77 months UTIs occurred more frequently in ADPKD patients (39.1% vs. 26.7%, <i>P </i>= .022; 0.8 ± 1.4 vs. 0.5 ± 1.1 episodes, <i>P </i>< .001). Eight ADPKD patients suffered from 19 episodes of liver cyst infection. Steroid medication (RR 3.04; <i>P </i>< .001) and recipient age (RR 1.05; <i>P </i>= .003) increased the risk for UTI/urosepsis, while nephrectomy reduced it (unilateral, RR 0.60; <i>P </i>= .088; bilateral, RR 0.45; <i>P </i>= .020). Patient survival was similar in both groups. The risk of graft failure was lower in ADPKD patients [hazard ratio (HR) 0.67; <i>P </i>= .047] due to a lower risk of death-censored graft loss (HR 0.47; <i>P </i>= .014). Donor age (HR 1.34; <i>P </i>= .002) and rejection (HR 8.47; <i>P </i>< .001) were risk factors for death-censored graft loss.</p><p><strong>Conclusions: </strong>ADPKD patients are at increased risk of UTI and liver cyst infection after transplantation. Steroid medication and recipient age seem to increase the risk of UTI/urosepsis, while nephrectomy seems to reduce it. Nevertheless, patient survival was similar compared to non-ADPKD patients and death-censored graft survival even better.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae330"},"PeriodicalIF":3.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812283","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":"Adding biomarker change information to the kidney failure risk equation improves predictive ability for dialysis dependency in eGFR <30 ml/min/1.73 m².","authors":"Akira Okada, Shotaro Aso, Kayo Ikeda Kurakawa, Reiko Inoue, Hideaki Watanabe, Yusuke Sasabuchi, Toshimasa Yamauchi, Hideo Yasunaga, Takashi Kadowaki, Satoko Yamaguchi, Masaomi Nangaku","doi":"10.1093/ckj/sfae321","DOIUrl":"10.1093/ckj/sfae321","url":null,"abstract":"<p><strong>Background: </strong>Although the kidney failure risk equation (KFRE), a well-known predictive model for predicting dialysis dependency, is useful, it remains unclear whether the addition of biomarker changes to the KFRE model in patients with an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m² will improve its predictive value.</p><p><strong>Methods: </strong>We retrospectively identified adults with eGFR <30 ml/min/1.73 m² without dialysis dependency, and available health checkup data for two successive years using a large Japanese claims database (DeSC, Tokyo, Japan). We dichotomized the entire population into a training set (50%) and a validation set (the other half). To assess the incremental value in the predictive ability for dialysis dependency by the addition of changes in eGFR and proteinuria, we calculated the difference in the C-statistics and net reclassification index (NRI).</p><p><strong>Results: </strong>We identified 4499 individuals and observed 422 individuals (incidence of 45.2 per 1000 person-years) who developed dialysis dependency during the observation period (9343 person-years). Adding biomarker changes to the KFRE model improved C-statistics from 0.862 to 0.921, with an improvement of 0.060 (95% confidence intervals (CI) of 0.043-0.076, <i>P</i> < .001). The corresponding NRI was 0.773 (95% CI: 0.637-0.908), with an NRI for events of 0.544 (95% CI of 0.415-0.672) and NRI for non-events of 0.229 (95% CI of 0.186-0.272).</p><p><strong>Conclusions: </strong>The KFRE model was improved by incorporating yearly changes in its components. The added information may help clinicians identify high-risk individuals and improve their care.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae321"},"PeriodicalIF":3.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675039","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":"Diagnostic validity and solute-corrected prevalence for hyponatremia and hypernatremia among 1 813 356 admissions.","authors":"Akira Okada, Hayato Yamana, Hideaki Watanabe, Katsunori Manaka, Sachiko Ono, Kayo Ikeda Kurakawa, Masako Nishikawa, Makoto Kurano, Reiko Inoue, Hideo Yasunaga, Toshimasa Yamauchi, Takashi Kadowaki, Satoko Yamaguchi, Masaomi Nangaku","doi":"10.1093/ckj/sfae319","DOIUrl":"10.1093/ckj/sfae319","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>We aimed to evaluate the diagnostic validity of the International Classification of Diseases, 10th Revision (ICD-10) codes for hyponatremia and hypernatremia, using a database containing laboratory data. We also aimed to clarify whether corrections for blood glucose, triglyceride, and total protein may affect the prevalence and the diagnostic validity.</p><p><strong>Methods: </strong>We retrospectively identified admissions with laboratory values using a Japanese hospital-based database. We calculated the sensitivity, specificity, and positive/negative predictive values of recorded ICD-10-based diagnoses of hyponatremia (E87.1) and hypernatremia (E87.2), using serum sodium measurements during hospitalization (<135 and >145 mmol/l, respectively) as the reference standard. We also performed analyses with corrections of sodium concentrations for blood glucose, triglyceride, and total protein.</p><p><strong>Results: </strong>We identified 1 813 356 hospitalizations, including 419 470 hyponatremic and 132 563 hypernatremic cases based on laboratory measurements, and 18 378 hyponatremic and 2950 hypernatremic cases based on ICD-10 codes. The sensitivity, specificity, positive predictive value, and negative predictive value of the ICD-10 codes were 4.1%, 99.9%, 92.5%, and 77.6%, respectively, for hyponatremia and 2.2%, >99.9%, 96.5%, and 92.8%, respectively, for hypernatremia. Corrections for blood glucose, triglyceride, and total protein did not largely alter diagnostic values, although prevalence changed especially after corrections for blood glucose and total protein.</p><p><strong>Conclusions: </strong>The ICD-10 diagnostic codes showed low sensitivity, high specificity, and high positive predictive value for identifying hyponatremia and hypernatremia. Corrections for glucose or total protein did not affect diagnostic values but would be necessary for accurate prevalence calculation.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae319"},"PeriodicalIF":3.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812282","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 Emboless® venous chamber efficiently reduces air bubbles: a randomized study of chronic hemodialysis patients.","authors":"Ulf Forsberg, Per Jonsson, Bernd Stegmayr","doi":"10.1093/ckj/sfae323","DOIUrl":"10.1093/ckj/sfae323","url":null,"abstract":"<p><strong>Background: </strong>When blood passes the extracorporeal circuit, air microbubbles (MBs) contaminate the blood. Some MBs will end up as microemboli in the lung, heart, and brain. MB exposure has no medical purpose and is considered to be bio-incompatible. Selecting venous chambers with a high removal rate of MBs is warranted to reduce the risks of air bio-incompatibility. The primary aim was to compare the Fresenius 5008 (F5008-VC) and the Emboless^® (Emboless-VC) venous chambers regarding the elimination of MBs in the return bloodline during hemodialysis (HD).</p><p><strong>Methods: </strong>Twenty patients underwent 80 sessions of cross-over HD using both the F5008-VC and the Emboless-VC randomized such that half started with the F5008-VC and half with the Emboless-VC. For 32 of the 80 sessions, measurements were also performed during hemodiafiltrations (HDF) after the initial HD. MBs were measured with an ultrasound device (within the size range of 20-500 µm) at the \"inlet\" and \"outlet\" bloodline of the venous chambers. The Wilcoxon pairwise test compared the percentage of MB elimination between venous chambers.</p><p><strong>Results: </strong>During HD, the median reduction of MBs for the outlet was 39% with the F5008-VC and 76% with the Emboless-VC (<i>P </i>< .001). During HDF, the reduction was 28% with the F5008-VC and 70% with the Emboless-VC (<i>P </i>< .001).</p><p><strong>Conclusion: </strong>Fewer MBs and subsequently fewer microemboli entered the bloodline of the patient using the Emboless-VC compared to the F5008-VC venous chamber during HD and during HDF. Venous chambers with a high removal rate of MBs will reduce the extent of air emboli.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae323"},"PeriodicalIF":3.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686265","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":"Post-transplant glomerular diseases: update on pathophysiology, risk factors and management strategies.","authors":"Anna Regalia, Matteo Abinti, Carlo Maria Alfieri, Mariarosaria Campise, Simona Verdesca, Francesca Zanoni, Giuseppe Castellano","doi":"10.1093/ckj/sfae320","DOIUrl":"10.1093/ckj/sfae320","url":null,"abstract":"<p><p>In recent years, advancements in immunosuppressive medications and post-transplant management have led to a significant decrease in acute rejection rates in renal allografts and consequent improvement in short-term graft survival. In contrast, recent data have shown an increased incidence of post-transplant glomerular diseases, which currently represent a leading cause of allograft loss. Although pathogenesis is not fully understood, growing evidence supports the role of inherited and immunological factors and has identified potential pre- and post-transplant predictors. In this review, we illustrate recent advancements in the pathogenesis of post-transplant glomerular disease and the role of risk factors and immunological triggers. In addition, we discuss potential prevention and management strategies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae320"},"PeriodicalIF":3.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812214","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":"Tubular glycogen accumulation in acute kidney injury associated with red yeast rice supplement.","authors":"Reina Miyazaki, Yasuhito Takahashi, Yuri Katayama, Tetsuya Kawamura, Nobuo Tsuboi, Takashi Yokoo","doi":"10.1093/ckj/sfae318","DOIUrl":"10.1093/ckj/sfae318","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae318"},"PeriodicalIF":3.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11570830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667461","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":"Adult-onset female focal segmental glomerulosclerosis with nephrotic syndrome caused by a <i>TBC1D8B</i> variant: a case report.","authors":"Xiaoying Hu, Wenrong Cheng, Xiaoyi Xu, Lijun Sun, Guoqin Wang, Hong Cheng","doi":"10.1093/ckj/sfae310","DOIUrl":"10.1093/ckj/sfae310","url":null,"abstract":"<p><p>We report the case of a 49-year-old Chinese woman with nephrotic syndrome, characterized by normal kidney function but poor response to hormonal and immunosuppressive therapy, indicative of steroid-resistant nephrotic syndrome. Through renal biopsy, the patient was diagnosed as havingfocal segmental glomerulosclerosis (perihilar type), and subsequent whole-exome sequencing identified a pathogenic frameshift variant concerning the TBC domain of the <i>TBC1D8B</i> gene. This patient represents the first late-onset Chinese female who was found to carry a novel, pathogenic variant in the gene <i>TBC1D8B</i>.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 12","pages":"sfae310"},"PeriodicalIF":3.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812278","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":"Sodium zirconium cyclosilicate treatment and rates of emergency interventions for hyperkalaemia: a propensity-score weighted case-control study.","authors":"William R Marshall, Gabriel A Curran, Jamie P Traynor, Keith A Gillis, Patrick B Mark, Jennifer S Lees","doi":"10.1093/ckj/sfae313","DOIUrl":"10.1093/ckj/sfae313","url":null,"abstract":"<p><strong>Background: </strong>Sodium zirconium cyclosilicate (SZC) reduces serum potassium in patients with chronic hyperkalaemia in clinical trials, but its role in the emergency treatment of hyperkalaemia is unproven. We hypothesized that SZC use for emergent hyperkalaemia would be associated with a reduction in rates of emergency interventions for hyperkalaemia.</p><p><strong>Methods: </strong>This was a single-centre, propensity score-weighted case-control study of patients admitted with hyperkalaemia to a specialist renal centre. We randomly selected 250 patients admitted between April 2021 and September 2022 (post-SZC era) with a potassium level ≥5.5 mmol/l treated with at least one ≥10 g dose of SZC (treatment group). We randomly selected a comparator group of 250 patients admitted between January 2018 and December 2019 (pre-SZC era) with a potassium level ≥5.5 mmol/l (control group). Baseline demographic and clinical characteristics were recorded and used as covariates for propensity scoring and inverse probability treatment weighting (IPTW). Our primary outcome measure, rates of emergency haemodialysis (HD), was tested using unadjusted models and multivariable logistic regression models on unweighted data in addition to unadjusted models on weighted data. We also reviewed rates of emergency temporary central venous access as a secondary outcome.</p><p><strong>Results: </strong>A total of 59% were male, the mean age was 67 years (standard deviation 14) and 149 (30%) were receiving maintenance dialysis. IPTW achieved satisfactory balance of covariates between the treatment and control groups. In the treatment group, patients were 77% less likely to need emergency HD {odds ratio [OR] 0.23 [confidence interval (CI) 0.17-0.31]}. This result was consistent following analysis of weighted and unweighted data. Similarly, patients treated with SZC were 73% less likely to require emergency temporary central venous access [OR 0.27 (CI 0.20-0.36)].</p><p><strong>Conclusion: </strong>SZC was associated with a significant reduction in the rates of emergency HD and emergency temporary central venous access in patients admitted to a specialized renal centre with emergent hyperkalaemia.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae313"},"PeriodicalIF":3.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817403","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":"Ten tips on how to manage obesity in the presence of CKD.","authors":"Nadine Kaesler, Susanne Fleig","doi":"10.1093/ckj/sfae317","DOIUrl":"10.1093/ckj/sfae317","url":null,"abstract":"<p><p>Patients with chronic kidney disease are frequently facing the challenge of weight reduction. Finding a weight loss strategy is on the one hand essential to reduce the co-morbidity risks in CKD but remains complex due to the metabolic abnormalities with declining renal function. Here, we provide ten tips to support our CKD patients on their journey, focussing on dietary and behavioural habits and health professional supportive therapies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae317"},"PeriodicalIF":3.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715419","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":"Comparing bioimpedance spectrometry and traditional creatinine kinetics methods for the assessment of muscle mass in peritoneal dialysis patients.","authors":"Lixing Xu, Jack Kit-Chung Ng, Gordon Chun-Kau Chan, Winston Wing-Shing Fung, Kai-Ming Chow, Cheuk-Chun Szeto","doi":"10.1093/ckj/sfae315","DOIUrl":"10.1093/ckj/sfae315","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is a common and serious problem in patients receiving peritoneal dialysis (PD). Lean tissue mass (LTM) by bioimpedance spectrometry is a reasonably accurate method for measuring muscle mass. Fat-free edema-free body mass (FEBM) as determined by the creatinine kinetics method is a traditional method but evidence to support its use is limited.</p><p><strong>Methods: </strong>We studied 198 new PD patients. Their serial LTM and FEBM were reviewed and compared by the Bland and Altman method. Multi-variable regression model was used to determine factors associated with the disparity between the two methods.</p><p><strong>Results: </strong>There was a significant but moderate correlation between LTM and FEBM (r = 0.309, <i>P</i> < .0001). LTM was consistently higher than FEBM, with an average difference 13.98 kg (95% confidence interval -5.90 to 33.86 kg), and the difference strongly correlated with LTM (r = 0.781, <i>P</i> < .0001). By multivariable linear regression analysis, LTM and residual renal function were independent predictors of the LTM-FEBM difference. Where the measurements were repeated in 12 months, there was no significant correlation between ∆LTM and ∆FEBM (r = -0.031, <i>P</i> = .799).</p><p><strong>Conclusion: </strong>There is a significant difference between LTM and FFBM. This discrepancy correlated with LTM and residual renal function, highlighting the limitations of FFBM in assessing skeletal muscle mass.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae315"},"PeriodicalIF":3.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582379","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}