Clinical Kidney Journal最新文献

{"title":"Association of serum zinc with mineral stress in chronic kidney disease.","authors":"Azmat Sohail,Jakob Obereigner,Gregor Mitter,Thomas Schmid,Anna-Sofie Hofer,Gerhard Schuster,Astrid Hügl,Angelika H Dorninger,Markus Mandl,Andreas Pasch,Helmut K Lackner,Ilona Papousek,Benjamin Dieplinger,Susanne Suessner,Marlies Antlanger,Daniel Cejka,Ioana Alesutan,Jakob Voelkl","doi":"10.1093/ckj/sfae258","DOIUrl":"https://doi.org/10.1093/ckj/sfae258","url":null,"abstract":"BackgroundThe excessive cardiovascular mortality of patients with chronic kidney disease (CKD) could be linked to mineral stress, the biological consequence of calcium-phosphate nanoparticle exposure. This study investigated whether zinc is associated with mineral stress markers in CKD.MethodsZinc and T50 (serum calcification propensity) as well as hydrodynamic radius of secondary calciprotein particles (CPP2) were measured in blood donors and CKD patients with/out dialysis.ResultsSerum zinc concentrations and T50 were reduced, while CPP2 radius was increased in CKD patients. Serum zinc levels positively correlated with T50 and inversely correlated with CPP2 radius. In a hierarchical linear regression model, T50 was associated with age, calcium, phosphate, magnesium and albumin. Addition of zinc significantly improved prediction of the model, confirming an additional contribution of zinc to T50. Similar observations were made for the association of zinc and CPP2 radius, but spiking experiments indicated that zinc may stronger modify T50 than CPP2 radius. Also, urinary zinc excretion was increased in patients with kidney disease and correlated to T50 and CPP2 radius. Serum zinc further correlated with markers of arterial stiffness in blood donors and CKD patients, but these associations did not remain significant in a multivariate linear regression model.ConclusionsReduced serum zinc levels in CKD appear directly linked to lower T50 and associated with larger CPP2 radius. Further studies on the associations of zinc and mineral stress as well as putative therapeutic benefits of zinc supplementation are required.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae258"},"PeriodicalIF":4.6,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262466","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":"Immunosuppression and transplantation-related characteristics affect the difference between eGFR equations based on creatinine compared to cystatin C in kidney transplant recipients.","authors":"Lukas Weidmann, Catherine Laux, Kai Castrezana Lopez, Dusan Harmacek, Britta George, Seraina von Moos, Thomas Schachtner","doi":"10.1093/ckj/sfae253","DOIUrl":"10.1093/ckj/sfae253","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies show heterogeneity when applying estimated glomerular filtration (eGFR) equations to kidney transplant recipients (KTRs). However, research on the impact of transplantation-related characteristics on eGFR equations using creatinine (eGFRcr) compared to cystatin C (eGFRcys) is scarce.</p><p><strong>Methods: </strong>We conducted a comprehensive analysis with three eGFRcr equations (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009, European Kidney Function Consortium (EKFC) 2021, kidney recipient specific-glomerular filtration rate KRS-GFR) 2023), comparing them to two eGFRcys (CKD-EPI 2012 and EKFC 2023) in 596 KTRs. Bland-Altman plots demonstrated relative differences according to different eGFR-stages. Multivariable logistic regression identified transplantation-related characteristics independently associated with smaller or greater differences between eGFRcr and eGFRcys equations.</p><p><strong>Results: </strong>94.3% of the cohort were White individuals. Median eGFR differed as much as 9 ml/min/1.73 m² between equations. The median relative differences (Q2) were greater (more negative) when comparing the eGFRcr equations to eGFRcys CKD-EPI 2012, than when comparing them to eGFRcys EKFC 2023 (<i>P</i> < .001). Better average eGFR was associated with smaller mean relative differences in all comparisons but eGFRcr CKD-EPI 2009 with eGFR EKFC 2023 and eGFRcr EKFC 2021 with eGFRcys EKFC 2023. Living kidney donation and belatacept use were independent factors associated with a smaller difference (≥Q3) between eGFRcr and eGFRcys equations, while prednisone use or higher HbA1c were independently associated with a greater difference (≤Q1) between equations.</p><p><strong>Conclusion: </strong>Different eGFR-stages, donor, or recipient characteristics, along with immunosuppression such as belatacept or prednisone, contribute to differences between eGFRcr and eGFRcys. These effects need to be considered in the clinical management of KTRs.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae253"},"PeriodicalIF":3.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582383","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":"Short-term peritoneal rest reduces peritoneal solute transport rate and increases ultrafiltration in high/high average transport peritoneal dialysis patients: a crossover randomized controlled trial.","authors":"Bei Wu, Huiping Zhao, Li Zuo, Aichun Liu, Lixia Lu, Jie Qiao, Xinxin Chu, Chuncui Men, Yuting He","doi":"10.1093/ckj/sfae251","DOIUrl":"https://doi.org/10.1093/ckj/sfae251","url":null,"abstract":"<p><strong>Background: </strong>The peritoneal solute transport rate (PSTR) tends to increase over time in some patients undergoing peritoneal dialysis (PD), potentially leading to ultrafiltration (UF) failure. Previous case reports have shown a significant decrease in PSTR and subsequent recovery of UF after discontinuing PD for a while. Therefore, we conducted a randomized controlled crossover study to evaluate the impact of short-term peritoneal rest on PSTR.</p><p><strong>Methods: </strong>The study involved 14 continuous ambulatory peritoneal dialysis (CAPD) patients with high/high-average transport rate. Two groups were randomly assigned different treatment sequences: one group underwent daily intermittent peritoneal dialysis (IPD) for 4 weeks followed by CAPD, while the other group initially received CAPD treatment for 4 weeks and then switched to IPD. Peritoneal equilibration tests were performed before and after each treatment to evaluate PSTR and paired <i>t</i>-tests were used to compare the changes. Volume load, serum potassium and other clinical indicators were monitored at the same time.</p><p><strong>Results: </strong>Short-term peritoneal rest (daily IPD) significantly reduced PSTR, with a decrease in the dialysate:plasma creatinine ratio from 0.71 ± 0.05 to 0.65 ± 0.07 (<i>P</i> < .001). Additionally, ultrafiltration significantly increased from 210 ± 165 ml to 407 ± 209 ml (<i>P</i> = .001). But there were no significant changes in interleukin-6 and vascular endothelial growth factor of PD effluent. No serious adverse events such as hypotension or hyperkalaemia occurred.</p><p><strong>Conclusions: </strong>In PD patients with high and high-average transport, a 4-week period of short-term peritoneal rest by switching from CAPD to IPD (without long dwell) can lead to reductions in PSTR and increases in UF volumes, while maintaining clinical safety.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 9","pages":"sfae251"},"PeriodicalIF":3.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11411283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281416","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 association between klotho and kidney and cardiovascular outcomes: a comprehensive systematic review and meta-analysis","authors":"Mehmet Kanbay, Crischentian Brinza, Lasin Ozbek, Mustafa Guldan, Uluman Sisman, Sidar Copur, Andreea Covic, Dragos-Viorel Scripcariu, Alexandru Burlacu, Adrian Covic","doi":"10.1093/ckj/sfae255","DOIUrl":"https://doi.org/10.1093/ckj/sfae255","url":null,"abstract":"Background and Aim Chronic kidney disease (CKD) and end-stage renal disease (ESKD) are significant global health challenges associated with progressive kidney dysfunction and numerous complications, including cardiovascular disease and mortality. This study aims to explore the potential association between plasma Klotho levels and various prognostic outcomes in CKD and ESKD, including all-cause mortality, cardiovascular events, metabolic syndrome development, and adverse renal events necessitating renal replacement therapies. Materials and Methods A literature search was conducted up to June 3, 2024, using the electronic databases Cochrane Library, Ovid MEDLINE, CINAHL, Web of Science, SCOPUS, and PubMed. This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Fourteen studies were included. For all-cause mortality, comparing CKD patients with low versus high Klotho levels showed a significant association (OR 1.81, 95% CI 1.34–2.44, p = 0.0001), with substantial heterogeneity (I2 = 69%). Excluding one study reduced heterogeneity (I2 = 43%) while maintaining significance (OR 1.97, 95% CI 1.45–2.66, p &amp;lt; 0.0001). Cardiovascular mortality was higher in patients with low Klotho levels (OR 2.11, 95% CI 1.61–2.76, p &amp;lt; 0.00001), with low heterogeneity (I2 = 25%). Excluding one study eliminated heterogeneity (I2 = 0%) while maintaining significance (OR 2.39, 95% CI 1.83–3.12, p &amp;lt; 0.00001). Composite cardiovascular events did not differ significantly between low and high Klotho groups (OR 1.51, 95% CI 0.82–2.77, p = 0.18), but with high heterogeneity (I2 = 72%). Patients with low Klotho levels had a higher risk of adverse renal events (OR 2.36, 95% CI 1.37–4.08, p = 0.002), with moderate heterogeneity (I2 = 61%). Sensitivity analysis reduced heterogeneity (I2 = 0%) while maintaining significance (OR 3.08, 95% CI 1.96–4.85, p &amp;lt; 0.00001). Specifically, for ESKD or kidney replacement therapy risk, low Klotho levels were associated with an increased risk (OR 2.30, 95% CI 1.26–4.21, p = 0.007). Similarly, CKD progression risk was higher in patients with lower Klotho levels (OR 2.48, 95% CI 1.45–4.23, p = 0.0009). Conclusion Lower serum Klotho levels serve as a significant predictor of adverse outcomes, including increased risks of all-cause mortality, cardiovascular mortality, and progression to end-stage kidney disease among CKD patients.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"25 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196406","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":"Effects of SGLT2 inhibitors on parameters of renal venous congestion in intrarenal Doppler ultrasonography.","authors":"Manuel Wallbach,Jamil Ajrab,Bilgin Bayram,Dennis Pieper,Ann-Kathrin Schäfer,Stephan Lüders,Fani Delistefani,Dieter Müller,Michael Koziolek","doi":"10.1093/ckj/sfae234","DOIUrl":"https://doi.org/10.1093/ckj/sfae234","url":null,"abstract":"BackgroundCardiorenal syndrome is a common condition in clinical practice in which renal venous congestion (VC) plays an important role. Intrarenal Doppler ultrasound (IRD) is a non-invasive method to assess and quantify renal VC. The current study aims to investigate the effects of SGLT2 inhibitor (SGLT2i) therapy on IRD parameters of renal VC.MethodsThis prospective observational study included patients with chronic kidney disease (CKD) with or without type 2 diabetes mellitus and/or heart failure (HF) with reduced and preserved ejection fraction who had an indication for standard of care SGLT2i therapy. IRD, assessing venous impedance index (VII), and intrarenal venous flow pattern (IRVF) analysis were performed within the interlobar vessels of the right kidney before and 6 months after initiation of SGLT2i therapy.ResultsA number of 64 patients with CKD and a cardiorenal risk profile were included (mean eGFR 42.9 ml/min/1.73 m2; 56% with HF, and 38% with type 2 diabetes mellitus). 17 patients exhibited signs of VC in the IRD. VII was significantly correlated with levels of NT-proBNP, female gender, NYHA class, and was significantly negative correlated with body mass index. After 6 months, a notable decrease in the mean VII of the right interlobar veins by 0.13 (P < .01) was observed. Stratification according to IRVF pattern showed a significant shift towards reduced renal VC pattern after 6 months (P = .03).ConclusionsIn this study, SGLT2i therapy resulted in a reduction in renal VC as assessed by IRD. These findings underscore the potential haemodynamic benefits of SGLT2 inhibitors in cardiorenal syndrome and warrant further investigation into their clinical implications.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"64 1","pages":"sfae234"},"PeriodicalIF":4.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196407","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 transplantation and gut microbiota.","authors":"Zehuan Chen, Xinhua Chang, Qianyu Ye, Yifang Gao, Ronghai Deng","doi":"10.1093/ckj/sfae214","DOIUrl":"10.1093/ckj/sfae214","url":null,"abstract":"<p><p>Kidney transplantation is an effective way to improve the condition of patients with end-stage renal disease. However, maintaining long-term graft function and improving patient survival remain a key challenge after kidney transplantation. Dysbiosis of intestinal flora has been reported to be associated with complications in renal transplant recipients. The commensal microbiota plays an important role in the immunomodulation of the transplant recipient responses. However, several processes, such as the use of perioperative antibiotics and high-dose immunosuppressants in renal transplant recipients, can lead to gut dysbiosis and disrupt the interaction between the microbiota and the host immune responses, which in turn can lead to complications such as infection and rejection in organ recipients. In this review, we summarize and discuss the changes in intestinal flora and their influencing factors in patients after renal transplantation as well as the evidence related to the impact of intestinal dysbiosis on the prognosis of renal transplantation from <i>in vivo</i> and clinical studies, and conclude with a discussion of the use of microbial therapy in the transplant population. Hopefully, a deeper understanding of the function and composition of the microbiota in patients after renal transplantation may assist in the development of clinical strategies to restore a normal microbiota and facilitate the clinical management of grafts in the future.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 8","pages":"sfae214"},"PeriodicalIF":3.9,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11336673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016587","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":"Point-of-care ultrasound Training in Nephrology: a position statement by the International Alliance for POCUS in Nephrology","authors":"Abhilash Koratala, Eduardo R Argaiz, Gregorio Romero-González, Nathaniel Reisinger, Siddiq Anwar, William Beaubien-Souligny, Bhavna Bhasin-Chhabra, Hugo Diniz, Marco Antonio Vaco Gallardo, Fredzzia Graterol Torres, Faeq Husein-Syed, Jennifer Hanko, Aala Jaberi, Amir Kazory, Rupesh Raina, Claudio Ronco, Octavio J Salgado, Sidharth Kumar Sethi, Vanessa Villavicencio Cerón, Manjusha Yadla, Marcus Gomes Bastos","doi":"10.1093/ckj/sfae245","DOIUrl":"https://doi.org/10.1093/ckj/sfae245","url":null,"abstract":"Point-of-care Ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities, and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"26 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196408","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":"Reduced renal function is associated with faster loss of bone mineral density in patients with non-dialysis CKD","authors":"Dong Hoon Kang, Cheol Ho Park, Hyung Woo Kim, Jung Tak Park, Seung Hyeok Han, Jayoun Kim, Jong Cheol Jeong, Yaeni Kim, Soo Wan Kim, Kook-Hwan Oh, Shin-Wook Kang, Tae-Hyun Yoo","doi":"10.1093/ckj/sfae248","DOIUrl":"https://doi.org/10.1093/ckj/sfae248","url":null,"abstract":"Background Bone mineral density (BMD) predicts fracture risk in patients with chronic kidney disease (CKD) and in the general population. However, few studies have investigated risk factors for bone loss in patients with CKD. The aim of this study was to investigate whether renal function is associated with the rate of BMD decline. Methods A prospective cohort study included 1 006 patients with CKD stages 2–4 between 2011 and 2016. BMD was measured using dual-energy X-ray absorptiometry at baseline and 4 years. The eGFR was measured 2–6 times during the 4-year follow-up. We analyzed the decline in bone mineral density according to CKD stage and further compared the rate of BMD decline according to eGFR trajectories at each stage. Results Advanced CKD stage was associated with a faster rate of decline in total hip BMD (stage 2: −0.23, stage 3A: −0.39, stage 3B: −0.80, stage 4: −1.23% change/year in men [p &amp;lt; 0.001]; stage 2: −0.86, stage 3A: −1.19, stage 3B: −1.20, stage 4: −1.58% change/year in women [p &amp;lt; 0.03]). Two distinct eGFR trajectories (Class 1: stable group; Class 2: rapid decline group) were observed. The rapid decline group showed a trend toward an increased rate of decline in total hip BMD. Subgroup analysis according to eGFR trajectories revealed a significant difference in BMD decline rate between stable and rapid decline groups. Conclusions Advanced CKD stage and accelerated decline in renal function were associated with rapid BMD decline in non-dialysis patients with CKD.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"47 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196411","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":"Therapeutic targets in membranous nephropathy: plasma cells and complement.","authors":"Nicola M Tomas","doi":"10.1093/ckj/sfae243","DOIUrl":"10.1093/ckj/sfae243","url":null,"abstract":"<p><p>Membranous nephropathy (MN) is an antibody-mediated autoimmune disease and the most common cause of nephrotic syndrome in adults. The discovery of phospholipase A2 receptor 1 (PLA2R1) as the first target antigen in patients with MN 15 years ago has led to a paradigm shift in the pathobiological understanding of this disease. Autoantibodies against PLA2R1 as well as thrombospondin type-1 domain-containing 7A, the second identified antigen in adults, were shown to be disease-causing and act through local activation of the complement system, primarily via the classical and lectin pathways. These findings indicate that both plasma cells, the main source of antibodies and autoantibodies, as well as the complement system, the main pathogenic effector mechanism in MN, are rational and pathogenesis-based treatment targets in MN. This review summarizes pathomechanistic and clinical evidence for and against plasma cell- and complement-targeted treatments in MN.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 9","pages":"sfae243"},"PeriodicalIF":3.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139515","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 impact of quality of life on the survival of elderly patients with end-stage renal disease: a prospective multicenter cohort study in Korea.","authors":"Yu-Kyung Chung, Jeong-Hoon Lim, Ye-Na Jeon, You Hyun Jeon, Hee-Yeon Jung, Ji-Young Choi, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim, Jang-Hee Cho","doi":"10.1093/ckj/sfae241","DOIUrl":"10.1093/ckj/sfae241","url":null,"abstract":"<p><strong>Background: </strong>Quality of life (QOL) is associated with mortality in dialysis patients. However, the impact of QOL index or score on elderly patients undergoing maintenance dialysis is unclear. We analyzed the relationship between QOL domains and survival in elderly end-stage renal disease (ESRD) patients on dialysis.</p><p><strong>Methods: </strong>We included 492 incident ESRD patients aged ≥65 years from a Korean nationwide prospective cohort study who were assessed for QOL with a follow-up duration of 67.3 ± 34.6 months after dialysis initiation. Their QOL was evaluated using the Kidney Disease Quality of Life (KDQOL) instrument, and the effect of each QOL domain on mortality was analyzed. Multivariable Cox regression analysis was performed to identify independent risk factors for death after adjusting for confounding factors.</p><p><strong>Results: </strong>Low physical component summary (PCS) and Short Form-36 score were significantly associated with low survival rate (<i>P </i>< .001 and <i>P </i>= .017, respectively), whereas the mental component summary and ESRD-targeted item scores were not correlated with survival rate. Multivariable Cox regression analysis confirmed that only a high PCS score was associated with better survival (hazard ratio 0.71; 95% confidence interval 0.52-0.97; <i>P </i>= .031). Linear regression analysis revealed that age, sex, modified Charlson comorbidity index, albumin and intact parathyroid hormone were associated with PCS. Among the PCS items, only the physical functioning score was significantly associated with mortality (<i>P </i>= .017).</p><p><strong>Conclusion: </strong>PCS was an independent risk factor for death in elderly ESRD patients. A higher physical functioning score was associated with a better outcome, suggesting the importance of physical condition in elderly dialysis patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 9","pages":"sfae241"},"PeriodicalIF":3.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125050","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}