Clinical Kidney Journal最新文献

{"title":"Validation of arteriovenous access stage (AVAS) classification: a prospective, international multicentre study.","authors":"Katerina Lawrie, Petr Waldauf, Peter Balaz, Ricardo Lacerda, Emma Aitken, Krzysztof Letachowicz, Mario D'Oria, Vittorio Di Maso, Pavel Stasko, Antonio Gomes, Joana Fontainhas, Matej Pekar, Alena Srdelic, Stephen O'Neill","doi":"10.1093/ckj/sfae272","DOIUrl":"https://doi.org/10.1093/ckj/sfae272","url":null,"abstract":"<p><strong>Background: </strong>The arteriovenous access stage (AVAS) classification provides evaluation of upper extremity vessels for vascular access (VA) suitability. It divides patients into classes within three main groups: suitable for native fistula (AVAS1) or prosthetic graft (AVAS2), and patients not suitable for conventional native or prosthetic VA (AVAS3). We validated this system on a prospective dataset.</p><p><strong>Methods: </strong>A prospective, international observational study (NCT04796558) involved 11 centres from 8 countries. Patient recruitment was from March 2021 to January 2024. Demographic data, risk factors, vessels parameters, VA types, AVAS class and early VA failure were collected. Percentage agreement was used to assess predictive ability of AVAS (comparison of AVAS and created VA) and consistency of AVAS assessment between evaluators. Pearson's Chi-squared test was used for comparison of early failure rate of conventional (predicted by AVAS) and unconventional (not predicted by AVAS) VA.</p><p><strong>Results: </strong>From 1034 enrolled patients, 935 had arteriovenous fistula or graft, 99 patients did not undergo VA creation due opting for alternative renal replacement therapies, experiencing health complications, death or non-compliance. AVAS1 had 91.2%, AVAS2 7.2% and AVAS3 1.6% of patients. Agreement between evaluators was 89%. The most frequently created VAs were radial-cephalic (46%) and brachial-cephalic (27%) fistulae. The accuracy of AVAS versus created access was 79%. In comparison, VA predicted by clinicians versus created access was 62.1%. Inaccuracy of AVAS prediction was more common with higher AVAS classes, and the most common reason for inaccuracy was creation of distal VA despite less favourable anatomy (17%). Patients with unconventional VA had higher early failure rate than patients with conventional VA (20% vs 9.3%, respectively, <i>P</i> = .002).</p><p><strong>Conclusion: </strong>AVAS is effective in predicting VA creation, but overall accuracy is reduced at higher AVAS classes when the complexity of decision-making increases and proximal vessels require preservation. When AVAS was followed by clinicians, early failure was significantly decreased.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 9","pages":"sfae272"},"PeriodicalIF":3.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342921","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 renal anaemia: a call to action from a national study in routine clinical practice","authors":"Jose Portoles, Marta Crespo, Miguel Martínez Belotto, Eduardo Martínez Morales, Emma Calatayud Aristoy, Paula Mora Lopez, S C González Garcia, Laia Oliveras, Julio Colina, A Singh, Asunción Sancho Calabuig, Emilio Rodrigo Calabia, Nuria Montero, Alex Gutierrez-Dalmau, Auxiliadora Mazuecos, Julio Pascual","doi":"10.1093/ckj/sfae269","DOIUrl":"https://doi.org/10.1093/ckj/sfae269","url":null,"abstract":"Background Post-transplant anaemia is a prevalent yet often overlooked condition that poses significant risks. Current guidelines consider the same treatment recommendations and goals for these patients as for chronic kidney disease patients not on dialysis (CKD-NDD). Previous old reports demonstrated lack of awareness and suboptimal management indicating a pressing need for improvement. We therefore wanted to update this information on post-transplant anemia. Aims To describe the present state of anaemia management, goals, and adherence to guidelines within a representative sample of the kidney transplant (KTx) population. Methods We designed a retrospective nationwide multicentre study including outpatients from 8 KTx hospitals. Nephrologists gathered data from electronic medical records encompassing demographics, comorbidities, KTx characteristics and immunosuppressive therapy and information pertaining to anaemia management (laboratory values, previously prescribed treatments, and subsequent adjustments). The European statement on KDIGO guidelines was the reference for definitions, drug prescriptions and targets. Anemia occurring within the initial six months post-transplantation was classified as early onset. Results We included 297 patients with post-transplant anemia aged 62.8 (SD 13.6) and 60% male. They had received a graft from cardiac-death or brain-death donors (61.6% and 31.1%, respectively) a median of 2.5 years [0.5–8.7] before. Among them 77% (n = 228) were classified as having late post-transplant anemia, characterized by a higher prevalence of microcytic and iron deficiency anemia. A total of 158 patients were on erythropoietic stimulating agents (ESAs) treatment, yet surprising 110 of them lacked iron supplementation. Notably, 44 patients had an indication for iron supplementation and among them, 30 exhibited absolute iron deficiency. Out of the 158 patients receiving ESAs, only 39 surpassed the limit for the ESA resistance index indicating poor response. This resistance was more frequent among patients with early post-transplant anemia (26.1 vs 9.2%). We have identified iron profile, early post-transplant anemia and eGFR as factors associated with the highest risk of resistance Conclusion We found that Hb targets are individualized upwards in post-transplant anemia. In this setting, iron therapy continues to be underutilized, especially intravenous, and iron deficiency and prior events (blood transfusion or hospital admission) explain most of the hyporesponsiveness to ESA. This highlights missed opportunities for precise prescription targeting and adherence to established guidelines, suggesting a need for improved management strategies in post-transplant anemia patients.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"14 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196397","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 effects of triple CFTR modulator therapy in people with cystic fibrosis","authors":"Pierre Gabai, Etienne Novel-Catin, Quitterie Reynaud, Raphaële Nove-Josserand, Solenne Pelletier, Denis Fouque, Laetitia Koppe, Isabelle Durieu","doi":"10.1093/ckj/sfae256","DOIUrl":"https://doi.org/10.1093/ckj/sfae256","url":null,"abstract":"Background Elexacaftor/tezacaftor/ivacaftor (ETI) is a new cystic fibrosis transmembrane conductance regulator (CFTR) modulator that has transformed the respiratory prognosis of people with cystic fibrosis (pwCF). However, its impact on other organs such as the kidneys, where CFTR is expressed, remains unclear. Since pwCF are risk of both kidney disease and urolithiasis, we aimed to study the potential effects of ETI on renal function, volume status, and risk factors for urolithiasis. Methods This prospective, observational, single-center, before-after cohort study, involved adult pwCF eligible for ETI. The changes in plasma and urinary profiles were assessed by comparing renal function (using 2021 CKD-EPIcreatinine and 2021 CKD-EPIcreatinine-cystatin C formulas), volume status (using aldosterone/renin ratio and blood pressure), and risk factors for urolithiasis, at the time of ETI introduction (M0) and 7 months after (M7). Results Nineteen pwCF were included. No significant change in renal function was observed between M0 and M7 (2021 CKD-EPIcreatinine: 105.5 mL/min/1.73m² at M0 vs. 103.3 mL/min/1.73m² at M7; p = 0.17). There was a significant reduction in aldosterone level (370.3 pmol/L at M0 vs. 232.4 pmol/L at M7; p = 0.02) and aldosterone/renin ratio (33.6 at M0 vs. 21.8 at M7; p = 0.03). Among the risk factors for urolithiasis, a significant reduction in magnesuria level was found (4.6 mmol/d at M0 vs. 3.8 mmol/d at M7; p = 0.01). Conclusion These findings suggest that ETI seem to have no short-term impact on the renal function of adult pwCF and appears to correct secondary hyperaldosteronism due to excessive sweat losses. Further investigations are needed to determine the potential impact of decreased magnesuria observed under ETI therapy on the risk of urolithiasis.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"47 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196400","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":"A step forward for estimating GFR in young adults.","authors":"Guido Filler,Mara Medeiros","doi":"10.1093/ckj/sfae262","DOIUrl":"https://doi.org/10.1093/ckj/sfae262","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"2 1","pages":"sfae262"},"PeriodicalIF":4.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262223","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 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":"9 1","pages":""},"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":"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":"17 9","pages":"sfae261"},"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":"87 1","pages":""},"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":"68 1","pages":""},"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":"42 1","pages":""},"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":"17 9","pages":"sfae247"},"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}