Clinical Kidney Journal最新文献

{"title":"Quality of life trajectories for different dialysis modalities-a nationwide study.","authors":"Helena Rydell, Aurora Caldinelli, Jenny Wrackefeldt, Aline Kåveryd-Hult, Bengt Lindholm, Abdul Rashid Qureshi, Nicholas C Chesnaye, Marie Evans","doi":"10.1093/ckj/sfae420","DOIUrl":"10.1093/ckj/sfae420","url":null,"abstract":"<p><strong>Background: </strong>Few contemporary studies have investigated the changes in quality of life across dialysis modalities. Our aim was to compare longitudinal changes in health-related physical and mental quality of life between patients on institutional hemodialysis (IHD), peritoneal dialysis (PD) and home hemodialysis (HHD).</p><p><strong>Methods: </strong>Patients on dialysis with registered Research and Development 36 (RAND-36) questionnaires between 2017-2021 in the Swedish Renal Registry (SRR) were eligible for inclusion. Information on dialysis, patient characteristics and medication were collected from SRR and other registries. Patients were followed up to 39 months. Changes in physical (PCS) and mental (MCS) component summary scores were analyzed in adjusted linear mixed models and joint models.</p><p><strong>Results: </strong>We included 930 patients (IHD 714, PD 128, HHD 88) with a median follow-up of 1.8 years (interquartile range 1.0-2.1). At baseline, the mean unadjusted PCS was lower in IHD (30.7; 95% CI 29.9, 31.4) compared with HHD (35.3; 95% CI 33.0, 37.5) and PD (33.2; 95% CI 31.3, 35.1). PCS declined over time in all modalities, but faster for PD compared with IHD (-1.2; 95% CI -2.1, -0.3 per year) and HHD (-1.5, 95% CI -2.9, -0.04). MCS was similar at baseline. HHD had improving MCS trajectory compared to IHD (-1.5, 95% CI -2.8, 0.2) and PD (-2.3, 95% CI -3.9, 0.7), largely resulting from improvement in role limitations caused by mental health (6.2, 95% CI 0.9, 11.5).</p><p><strong>Conclusion: </strong>Insights about the variation in quality-of-life trajectories for different dialysis modalities are important for patients to make informed choices.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae420"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448430","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":"Transplant candidacy and unscheduled emergent surgery-a neglected aspect in prescribing direct oral anticoagulants in patients receiving dialysis.","authors":"Simon Aberger, Michael Kolland, Thomas Gary, Alexander R Rosenkranz, Alexander H Kirsch","doi":"10.1093/ckj/sfae410","DOIUrl":"10.1093/ckj/sfae410","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae410"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499657","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":"How to improve the environmental impact in haemodialysis: small actions, big changes.","authors":"María Dolores Arenas Jiménez, Julia Audije-Gil, Rodrigo Martínez, Natalia Martín Vaquero, Miquel Gómez, Jesús Portillo, Gerard Pereda, David Hernán Gascueña, Brett Duane, Marta Sanjuan, José Luis Fernández Martín, Fabiola Dapena, Alberto Ortiz, Marta Arias","doi":"10.1093/ckj/sfae407","DOIUrl":"10.1093/ckj/sfae407","url":null,"abstract":"<p><strong>Background: </strong>The burden of chronic kidney disease is increasing, driven by population aging and the increase in risk factors. In-centre haemodialysis (HD), which accounts for most of the environmental impact of kidney replacement therapy, is a power-hungry, water-hungry and a waste-generating intervention.</p><p><strong>Methods: </strong>Here we characterize the environmental impact of 20 HD centres over 5 years and its modulation by operational changes (centre size, opening days, geographic location, type of water treatment plant and disinfection, dialysis modalities such as HD versus haemodiafiltration, seasonal variations and the impact of various corrective actions throughout time).</p><p><strong>Results: </strong>Average water and energy consumption per session were lower in larger centres compared with smaller ones, as well as in centres that operated daily compared with those that opened three times a week (both <i>P</i> < .05). Seasonality, which depends on the geographic region, had a marked influence (<i>P</i> < .001) on water and energy consumption, as does the choice of water treatment plant (<i>P</i> < .001). Actions taken in certain centres significantly reduced energy consumption up to 30%, plastic waste up to 65% and hazardous waste up to 63%.</p><p><strong>Conclusion: </strong>Annual monitoring must be performed to detect variations and plans must be designed to reduce the environmental impact. As it is not possible to reduce HD water and energy consumption to zero, implementing targeted actions offers a promising strategy for reducing the environmental burden.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae407"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381781","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":"Synergistic effect of teclistamab with PD-1 inhibition: a case of acute interstitial nephritis with dual immunotherapy.","authors":"Arjunmohan Mohan, Elena-Bianca Barbir, Loren Herrera Hernandez, Nelson Leung, Sandra M Herrmann","doi":"10.1093/ckj/sfae425","DOIUrl":"10.1093/ckj/sfae425","url":null,"abstract":"<p><p>We report a case of acute interstitial nephritis (AIN) in a 68-year-old male with squamous cell carcinoma (SCC) and relapsed/refractory multiple myeloma (RRMM) who developed acute kidney injury (AKI) shortly after starting teclistamab for RRMM. Despite stable renal function on immune checkpoint inhibitor (ICI) therapy for SCC, proton pump inhibitors and trimethoprim-sulfamethoxazole for 3 years, AKI only occurred post-teclistamab initiation. Biopsy-confirmed AIN with serum creatinine improved only after pulse-dose steroids. This case highlights a potential synergistic nephrotoxic effect of teclistamab and ICIs, warranting further investigation into teclistamab's renal safety.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae425"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457049","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":"Cancer diagnosis and prognosis after initiation of hemodialysis: multicenter Japan CANcer and DialYsis (J-CANDY) study.","authors":"Naoya Toriu, Shinya Yamamoto, Takeshi Matsubara, Yuki Kataoka, Kaoru Sakai, Taro Funakoshi, Takahiro Horimatsu, Tatsuo Tsukamoto, Naoka Murakami, Kenar D Jhaveri, Shingo Fukuma, Tomohiro Terada, Manabu Muto, Shunichi Fukuhara, Motoko Yanagita","doi":"10.1093/ckj/sfae430","DOIUrl":"https://doi.org/10.1093/ckj/sfae430","url":null,"abstract":"<p><strong>Background: </strong>Cancer is a leading cause of death among patients on hemodialysis; however, the data on its diagnosis, treatment and prognosis are limited. Here we analyzed the surgical practice patterns and outcomes of patients on hemodialysis with cancer and compared them with those of general cancer patients from the National Cancer Center database.</p><p><strong>Methods: </strong>This nationwide registry enrolled hemodialysis patients who were subsequently diagnosed with primary cancers of the kidney, colorectum, stomach, lung, liver, bladder, pancreas and breast in 20 hospitals in Japan between 2010 and 2012. The primary endpoint was the overall 3-year survival rate. We also examined the association of factors with mortality using Cox regression analysis.</p><p><strong>Results: </strong>Of the 502 patients, 370 (74%) underwent surgery. More than half of the patients (57%) were asymptomatic at diagnosis and diagnosed with cancer through screening. Among the patients who underwent surgery, most (99%) had resectable cancers; while among those who did not undergo surgery, more than half (52%) had metastatic cancers. The 3-year overall survival in the surgery and non-surgery groups was 83% and 32%, respectively. Non-cancer-related deaths were dominant (80%) in the surgery group, whereas cancer-related deaths were dominant in the non-surgery group (70%). Pancreatic cancer and anemia were associated with a poor prognosis in the surgery group. Surgery and 3-year overall survival rates were comparable between the patients on hemodialysis and the general cancer patients.</p><p><strong>Conclusion: </strong>Prognosis in hemodialysis cancer patients might be equivalent to that of general cancer patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae430"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440102","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":"Potassium management and heart failure: a nephrologist's perspective.","authors":"Denis Fouque, Carmine Zoccali, Francesco Pesce","doi":"10.1093/ckj/sfae424","DOIUrl":"10.1093/ckj/sfae424","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae424"},"PeriodicalIF":3.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398563","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":"Effects of spironolactone on intradialytic hypertension: a multicentre, double-blind, randomized, crossover study.","authors":"Thanawat Vongchaiudomchoke, Phimpraphan Khumngeon, Nuttaya Wachiraphansakul, Wipada Songwattana, Jomchai Luechoowong, Surapon Nochaiwong, Chidchanok Ruengorn, Kajohnsak Noppakun","doi":"10.1093/ckj/sfae415","DOIUrl":"10.1093/ckj/sfae415","url":null,"abstract":"<p><strong>Background: </strong>Intradialytic hypertension (IDH) is associated with an increase in hospitalization and mortality. Several studies have shown that spironolactone reduces pre-dialysis blood pressure. However, none evaluated its effect on IDH. This study aims to evaluate the effects of spironolactone on IDH.</p><p><strong>Methods: </strong>A 24-week, two-treatment, four-period, multicentre, double-blind, randomized, crossover study was conducted in stable maintenance haemodialysis (HD) patients who experienced IDH in >30% of their sessions during the past 3 months. Each participant was randomly assigned to one of four treatment sequences. In each intervention period, patients received a single dose of 50 mg spironolactone or a placebo 30 minutes before undergoing HD for 4 weeks according to their preassigned sequence, separated by a 2-week washout period. The primary outcome was an incidence of IDH.</p><p><strong>Results: </strong>A total of 49 eligible patients were recruited with a total of 1211 dialysis sessions. The mean age was 54 ± 14 years and the mean systolic and diastolic blood pressures (SBP and DBP) were 145 ± 15 and 75 ± 10 mmHg, respectively. All patients had hypertension. The average number of antihypertensive drugs was 3.5 ± 1.4. Spironolactone reduced the incidence of IDH compared with placebo (57% versus 69%, <i>P</i> for treatment effect < .001). Patients receiving spironolactone had lower peak intradialytic SBP (161 ± 14 versus 165 ± 13 mmHg, <i>P</i> = .003), mean intradialytic SBP (149 ± 13 versus 152 ± 12 mmHg, <i>P</i> = .01) and post-dialysis SBP (152 ± 15 versus 157 ± 14 mmHg, <i>P</i> < .001) than placebo.</p><p><strong>Conclusion: </strong>In maintenance HD patients who had frequent IDH, a pre-dialysis 50-mg spironolactone administration significantly decreased the incidence of IDH.</p><p><strong>Trial registration: </strong>Thai Clinical Trial Registry, reference number TCTR20200604013.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae415"},"PeriodicalIF":3.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448378","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":"Designing qualitative research with value in the clinical and epidemiological context: what, why and how.","authors":"Yvette Meuleman, Eline Schade van Westrum, Willem Jan W Bos, Simon P Mooijaart, Marjolijn van Buren, Giovanni Tripepi, Vianda S Stel, Kitty J Jager, Carmine Zoccali, Friedo W Dekker","doi":"10.1093/ckj/sfae422","DOIUrl":"10.1093/ckj/sfae422","url":null,"abstract":"<p><p>Clinical and epidemiological research is indispensable for improvements in evidence-based healthcare and health outcomes, but it also leaves important gaps in our understanding of health and illness. Qualitative research has been increasingly recognized as a key to addressing some of these gaps, using both exploratory (to gain a more complete and in-depth understanding of problems) and explanatory (to explain quantitative results) approaches. By finding out 'what's going on' and bringing people's stories to light, qualitative research is widely advocated as crucial in enhancing patient-centered research and healthcare. To date, most clinicians, clinical researchers and epidemiologists are relatively unfamiliar with and untrained in qualitative research-a type of research that, compared with quantitative research, requires different research skills and uses a different jargon, type of reasoning, and methods. This article aims to equip them with the basic knowledge necessary to appraise and design qualitative research. Specifically, we provide a comprehensive overview of (i) what qualitative research is, including various examples of qualitative research questions and explanations of the contrasting properties of quantitative and qualitative research; (ii) what constitutes the added value of qualitative research in the clinical and epidemiological context, illustrated using numerous research studies conducted within nephrology; and (iii) practical guidelines for designing qualitative research within this context, including a self-developed checklist containing essential information to include in qualitative research protocols. In doing so, we hope to enrich clinical and epidemiological research with complementary qualitative evidence-amongst others, invaluable insights into patients' lived experiences and perceptions-and thereby greatly enhance patient-centered research and evidence-based healthcare.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfae422"},"PeriodicalIF":3.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613673","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":"Influence of autonomic neuropathy, systemic inflammation and other clinical parameters on mortality in dialysis patients.","authors":"Michael Christoph Schramm, Catharina Verena Schramm, John Michael Hoppe, Markus Trautner, Michael Hinz, Steffen Mitzner","doi":"10.1093/ckj/sfae416","DOIUrl":"10.1093/ckj/sfae416","url":null,"abstract":"<p><strong>Background: </strong>Autonomic neuropathy (AN) is prevalent in diabetes and chronic kidney disease. The Composite Autonomic Symptom Score 31 (COMPASS 31) is a self-assessment test developed to determine not only cardiac AN but also AN of other organs, including the vasomotor, pupillomotor, secretomotor, and gastrointestinal systems. As yet there are no data on the effects of combined AN-scores of a variety of affected organ systems on mortality in dialysis patients.</p><p><strong>Methods: </strong>In 119 patients undergoing hemodialysis therapy, symptoms of AN were documented using COMPASS 31. After 5 years, survival rates were calculated depending on AN scores and other parameters. After this 5-year period, AN scores were assessed for a second time and correlated with those obtained 5 years earlier.</p><p><strong>Results: </strong>Survival rates for patients with lower AN scores were better than for those with higher AN scores. Patients with lower C-reactive protein levels showed better survival compared to those with higher values. Dialysis patients with diabetes had a lower survival rate compared to non-diabetic patients. In women, survival rates were better than in men. AN scores remained unchanged over the 5-year period.</p><p><strong>Conclusion: </strong>AN is frequently observed in dialysis patients and can be identified through the COMPASS 31 questionnaire. Patients with higher AN scores exhibit poorer survival rates compared to those with lower scores. This observation is applicable not only for cardiac AN but also to AN scores reflecting changes in other organ systems. Therefore, AN scores can be used effectively to detect various AN symptoms in dialysis patients and identify their increased risk of mortality.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae416"},"PeriodicalIF":3.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467273","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":"Collagen type III formation but not degradation is associated with risk of kidney disease progression and mortality after acute kidney injury.","authors":"Nadja Sparding, Federica Genovese, Morten Asser Karsdal, Nicholas M Selby","doi":"10.1093/ckj/sfae413","DOIUrl":"10.1093/ckj/sfae413","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI), a rapid decrease in kidney function, is associated with increased risk of adverse outcomes including development and progression of CKD. Kidney fibrosis is one of the pathological processes central to this AKI-to-CKD transition. Here we investigate the association of biomarkers of collagen type III turnover with adverse outcome following AKI.</p><p><strong>Methods: </strong>We measured three biomarkers reflecting collagen type III (PRO-C3) formation and degradation (C3M and C3C) in plasma samples collected 1 year after an episode of AKI in 800 patients (392 patients with AKI and 408 non-AKI controls) from the prospective AKI Risk in Derby (ARID) study. Patients were followed until 3 years after the episode of AKI and the following outcomes were assessed: kidney disease progression, mortality, heart failure, cardiovascular events, and hospital readmission.</p><p><strong>Results: </strong>PRO-C3 levels were elevated in the AKI group compared with the controls (<i>P</i> < .001), whereas C3M and C3C levels were not different between groups. In multivariate models including common risk factors, PRO-C3 was prognostic for kidney disease progression and mortality in the AKI group and for heart failure in the control group. C3M and C3C were not prognostic for any of the investigated outcomes.</p><p><strong>Conclusions: </strong>Circulating PRO-C3, a biomarker of fibroblast activity, was prognostic for kidney disease progression and mortality when measured 1 year after an episode of AKI. Biomarkers of fibroblast activity may help patient stratification after an episode of AKI by identifying patients at higher risk of kidney disease progression.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae413"},"PeriodicalIF":3.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381778","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}