Clinical Kidney Journal最新文献

{"title":"When the whole is greater than the sum of its parts: why machine learning and conventional statistics are complementary for predicting future health outcomes.","authors":"Roemer J Janse, Ameen Abu-Hanna, Iacopo Vagliano, Vianda S Stel, Kitty J Jager, Giovanni Tripepi, Carmine Zoccali, Friedo W Dekker, Merel van Diepen","doi":"10.1093/ckj/sfaf059","DOIUrl":"https://doi.org/10.1093/ckj/sfaf059","url":null,"abstract":"<p><p>An artificial intelligence boom is currently ongoing, mainly due to large language models, leading to significant interest in artificial intelligence and subsequently also in machine learning (ML). One area where ML is often applied, prediction modelling, has also long been a focus of conventional statistics. As a result, multiple studies have aimed to prove superiority of one of the two scientific disciplines over the other. However, we argue that ML and conventional statistics should not be competing fields. Instead, both fields are intertwined and complementary to each other. To illustrate this, we discuss some essentials of prediction modelling, elaborate on prediction modelling using techniques from conventional statistics, and explain prediction modelling using common ML techniques such as support vector machines, random forests, and artificial neural networks. We then showcase that conventional statistics and ML are in fact similar in many aspects, including underlying statistical concepts and methods used in model development and validation. Finally, we argue that conventional statistics and ML can and should be seen as a single integrated field. This integration can further improve prediction modelling for both disciplines (e.g. regarding fairness and reporting standards) and will support the ultimate goal: developing the best performing prediction models for the patient and healthcare provider.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf059"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987527","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":"Use of rituximab and plasma exchange in treatment and prophylaxis of recurrent FSGS.","authors":"Sophie Gharaei, Julia Gharaei, Omar Ragy, Durga A K Kanigicherla","doi":"10.1093/ckj/sfaf058","DOIUrl":"10.1093/ckj/sfaf058","url":null,"abstract":"<p><strong>Background: </strong>Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome and renal failure, requiring transplantation. However, FSGS can often recur after transplantation resulting in graft failure. The most used therapeutic intervention for rFSGS is plasma exchange (PE), with variable success. Recently, rituximab has found increasing use in both treatment and prevention of recurrent FSGS.</p><p><strong>Methods: </strong>We undertook a systematic review of therapeutic ± preventative plasma exchange, rituximab or a combination of both for recurrent FSGS. Studies published between 2017 and 2024 were included, to reflect the most contemporary clinical practice.</p><p><strong>Results: </strong>Twenty-seven studies with a total of 475 patients received treatment for recurrence post-transplantation and/or for prevention of recurrent FSGS. Of 221 patients who received plasma exchange on its own as therapy, 156 (71%) achieved either complete or partial remission. Rituximab alone was used in only four patients (75% remission rate), while 67% achieved remission with a combination of both. One hundred and forty-two patients received pre/peri-transplantation treatment to prevent recurrence in the graft. Fifty-one patients (36%) experienced recurrence despite prophylaxis. Recurrence rates were 35% with plasma exchange alone and 38% with rituximab alone<i>.</i></p><p><strong>Conclusion: </strong>We conclude that rituximab did not add significant benefit to plasma exchange when used as initial therapeutic intervention in post-transplant recurrent FSGS. The modest benefit of prophylactic therapies highlights the need for risk stratification to identify patients most likely to benefit from such interventions. Larger prospective studies with standardized approaches to treatment are essential in improving outcomes in rFSGS.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf058"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691334","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 gastric acid suppressants on peritonitis risk in peritoneal dialysis patients: a systematic review and meta-analysis.","authors":"Ching-Chung Hsiao, Chieh-Li Yen, Shu-Chun Huang, Cheng-Yi Chen, Ya-Chung Tian, Yung-Chang Chen, Wen-Yu Ho, Jia-Jin Chen","doi":"10.1093/ckj/sfaf054","DOIUrl":"10.1093/ckj/sfaf054","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf054"},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691315","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":"Stroke risk in ADPKD patients treated by dialysis: a retrospective study.","authors":"Damiano Cerasuolo, Darbelis Tejeda-Reyes, Cécile Couchoud, Dominique Guerrot, Fatouma Touré-Diabira, Henri Vacher-Coponat, Thierry Lobbedez, Rémy Morello, Clémence Béchade, Lydia Guittet","doi":"10.1093/ckj/sfaf028","DOIUrl":"https://doi.org/10.1093/ckj/sfaf028","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>The risk of ischaemic or haemorrhagic strokes in patients living with end-stage renal disease and receiving replacement therapy is more than double that of non-dialysed individuals. Autosomal dominant polycystic kidney disease (ADPKD) is an inherited systemic disorder associated with renal and non-renal manifestations, including intracerebral aneurysms. The role of underlying nephropathy in determining the onset of the stroke is unclear.</p><p><strong>Methods: </strong>All patients who started dialysis between 1 January 2015 and 31 December 2019 were included in the analysis. Data were retrieved from the REIN registry and the French national Health Data System (SNDS). Cases of stroke were extracted from the SNDS by using ICD-10 codes. The first stroke observed during the follow-up, irrespective of its nature, was considered as the event of the main analysis, based on a semi-parametric survival model.</p><p><strong>Results: </strong>The analysis included 40 980 patients on dialysis. Overall, 1549 patients experienced stroke during the follow-up. The first stroke was ischaemic in 1148 (74.1%) and haemorrhagic in the remaining 281 patients. The cumulative incidence of stroke on dialysis was 1.58 per 100 person-years (95% CI = 1.51, 1.70). Among 2182 ADPKD patients, only 44 (2%) experienced stroke. ADPKD was not significantly associated with an increased risk of all types of stroke, after considering major risk factors.</p><p><strong>Conclusions: </strong>We found no increase in the risk of stroke in ADPKD patients under dialysis. We believe that the findings of our study support a similar screening strategy in ADPKD patients on dialysis compared with patients not on dialysis.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf028"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969996","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":"CD163 detection in immune check-point inhibitors-related acute interstitial nephritis.","authors":"Thomas Perier, Yves Renaudineau, Juliette Pellegrini, Magali Colombat, Angie Arango Ramirez, Pierre Guy, Thibaut Jamme, Nathalie Van Acker, Clément Koundé, David Ribes, Antoine Huart, Audrey Casemayou, Julie Belliere","doi":"10.1093/ckj/sfaf009","DOIUrl":"10.1093/ckj/sfaf009","url":null,"abstract":"<p><strong>Background: </strong>Acute interstitial nephritis (AIN) is the most common renal immune-related adverse event after immune check-point inhibitors (ICI). We hypothesized that alternatively activated macrophages (CD163-M) could be involved in ICI-AIN and wished to evaluate the use of their soluble urinary form (us)CD163 as a non-invasive diagnostic marker.</p><p><strong>Methods: </strong>CD163-M infiltrates were evaluated by both immune-histochemistry and multiplex immunofluorescence and imaging. usCD163 was detected with ELLA technology and evaluated together with urinary creatinine to be expressed as a ratio to creatinuria in ng/mmol. Clinical data were collected to perform correlations with renal function assessed by estimated glomerular filtration rate (eGFR).</p><p><strong>Results: </strong>A retrospective cohort of 63 ICI-exposed patients with tubular acute kidney injury profile requiring a biopsy were selected. AIN patients (<i>n</i> = 44) were compared to acute tubular necrosis (ATN) patients (<i>n</i> = 19). CD163-M staining was detectable in all ICI-AIN patients, which was significantly higher than in ATN patients (18.4% vs 3.6% of area, <i>P</i> <i> </i>= .005). CD163-M staining was restricted to the interstitial compartment. CD163-M infiltrate inversely correlated with initial eGFR (<i>r</i> = -0.6, <i>P</i> <i> </i>= .003), and was positively correlated with delta eGFR, reflecting a renal improvement outcome (<i>r</i> = 0.48; <i>P</i> <i> </i>= .02). usCD163 was well detected in urines of patients, but did not allow us to distinguish ATN from AIN patients at diagnosis. No correlation was observed, neither between usCD163 and CD163-M staining nor with renal response after 3 months of glucocorticoid tapering.</p><p><strong>Conclusion: </strong>CD163-M are detected in ICI-AIN and correlate both with severity at diagnosis and better prognosis at 3 months. CD163-M may help us to distinguish AIN from ATN but, it does not allow us to assess ICI imputability. Although detected in urine, usCD163 is clearly not a surrogate biomarker for AIN diagnosis.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf009"},"PeriodicalIF":3.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572219","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":"Postoperative mid-to-long-term adverse event prediction model for patients receiving non-cardiac surgery: An extension of the Simple Postoperative AKI RisK (SPARK) model.","authors":"Soie Kwon, Sehoon Park, Sunah Yang, Chaiho Shin, Jeonghwan Lee, Jiwon Ryu, Sejoong Kim, Jeong Min Cho, Hyung-Jin Yoon, Dong Ki Kim, Kwon Wook Joo, Yon Su Kim, Minsu Park, Kwangsoo Kim, Hajeong Lee","doi":"10.1093/ckj/sfaf045","DOIUrl":"https://doi.org/10.1093/ckj/sfaf045","url":null,"abstract":"<p><strong>Background: </strong>Postoperative acute kidney injury (PO-AKI) is a critical complication of adverse kidney outcomes, both short and long-term. We aimed to expand our pre-existing PO-AKI prediction model to predict mid-to long-term adverse kidney outcomes.</p><p><strong>Methods: </strong>We included patients who underwent major non-cardiac surgeries from the original SPARK cohort, two external validation cohorts, and a temporal validation cohort. Mid-to-long-term adverse kidney outcomes were defined as end-stage kidney disease progression or death within 1 or 3 years after surgery. We verified and tuned the original Simple Postoperative AKI RisK (SPARK) model to predict mid-to-long-term adverse kidney events.</p><p><strong>Results: </strong>We included 33 636 patients in development, 71 232 patients in external validation, and 33 944 patients in temporal validation cohorts, respectively. One- and 3-year adverse kidney events occurred in 5.5% and 13.2% in the development cohort, respectively. The original SPARK score demonstrated an acceptable discriminative power for 1-year and 3-year adverse outcome risks with C indices mostly >0.7. However, the power was relatively poor when restricted to high-risk patients or those who actually developed PO-AKI. When we re-calculated the regression coefficients from a Cox model, the discriminative performances were better, especially for those with high-risk characteristics (e.g. 1-year outcome, C-index 0.72 in developmental and 0.73‒0.77 in validation datasets). Furthermore, when the model integrated the PO-AKI stage and history of malignancy with the SPARK variables, the performance was significantly enhanced (1-year, C-index 0.86 in development and 0.86‒0.88 in validation results). With the above findings, we constructed an online postoperative risk prediction system (https://snuhnephrology.github.io/postop/).</p><p><strong>Conclusions: </strong>The addition of two clinical factors and recalibration of SPARK variables significantly improved mid-to-long-term postoperative risk prediction for mortality or dialysis after non-cardiac surgery. Our calculator helps clinicians easily predict a mid-to-long-term risk and PO-AKI occurrence by entering a few variables.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 5","pages":"sfaf045"},"PeriodicalIF":3.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968348","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":"Correction to: Mortality associated with the COVID-19 pandemic in the Swiss dialysis population beyond SARS-CoV-2 infection.","authors":"","doi":"10.1093/ckj/sfaf042","DOIUrl":"https://doi.org/10.1093/ckj/sfaf042","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfae322.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfaf042"},"PeriodicalIF":3.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440105","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":"When should the nephrologist think about genetics in patients with glomerular diseases?","authors":"Roser Torra, Xoana Barros, Montserrat Díaz-Encarnación, Leonor Fayos, Mónica Furlano, Melissa Pilco, Marc Pybus, Amir Shabaka, Elizabeth Viera, Elisabet Ars","doi":"10.1093/ckj/sfaf044","DOIUrl":"10.1093/ckj/sfaf044","url":null,"abstract":"<p><p>This review discusses the significance of genetics in diagnosing glomerular diseases. Advances in genetic testing, particularly next-generation sequencing, have improved the accessibility and accuracy of diagnosing monogenic diseases, allowing for targeted gene panels and whole-exome/genome sequencing to identify genetic variants associated with glomerular diseases. Key indicators for considering a genetic cause include the age of onset, extrarenal features, family history, and inconclusive kidney biopsy results. Early-onset diseases, for instance, have a higher likelihood of being genetically caused, while extrarenal manifestations can also suggest an underlying genetic condition. A thorough family history can reveal patterns of inheritance that point to monogenic causes, although complexities like incomplete penetrance, skewed X inactivation and mosaicism can complicate the assessment. Also, autosomal recessive conditions imply asymptomatic parents, making genetic suspicion less likely, while <i>de novo</i> mutations can occur without any family history, further obscuring genetic assessment. Focal segmental glomerulosclerosis (FSGS) is characterized by podocyte injury and depletion, presenting in various forms, including primary, genetic, and secondary FSGS. Accurate classification of FSGS patients based on clinical and histological features is essential for guiding treatment decisions, optimizing therapeutic plans, avoiding unnecessary immunosuppression, and predicting relapse risk after kidney transplantation. Overall, a clinicopathological approach, enriched by genetic testing, offers a precise framework for diagnosis and management in glomerular diseases. Future directions for research and clinical practice include potential advancements in genetic testing and personalized medicine, which could further improve diagnostic precision and individualized treatment strategies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf044"},"PeriodicalIF":3.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669288","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":"Digital physical activity intervention via the Kidney BEAM platform in patients with polycystic kidney disease: a randomized controlled trial.","authors":"Juliet Briggs, Elizabeth Ralston, Thomas J Wilkinson, Christy Walklin, Emmanuel Mangahis, Hannah M L Young, Ellen M Castle, Roseanne E Billany, Elham Asgari, Sunil Bhandari, Kate Bramham, James O Burton, Jackie Campbell, Joseph Chilcot, Vashist Deelchand, Alexander Hamilton, Mark Jesky, Philip A Kalra, Kieran McCafferty, Andrew C Nixon, Zoe L Saynor, Maarten W Taal, James Tollitt, David C Wheeler, Jamie Macdonald, Sharlene A Greenwood","doi":"10.1093/ckj/sfaf041","DOIUrl":"10.1093/ckj/sfaf041","url":null,"abstract":"<p><strong>Background: </strong>In people living with polycystic kidney disease (PKD), physical inactivity may contribute to poor health-related quality of life (HRQoL). To date, no research has elucidated the impact of a PKD-specific physical activity programme on HRQoL and physical health. This substudy of the Kidney BEAM Trial evaluated the impact of a PKD-specific 12-week educational and physical activity digital health intervention for people living with PKD.</p><p><strong>Methods: </strong>This study was a mixed-methods, single-blind, randomized waitlist-controlled trial. Sixty adults with a diagnosis of PKD were randomized 1:1 to the intervention or a waitlist control group. Primary outcome was difference in the Kidney Disease QoL Short Form 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between baseline and 12 weeks. Six participants completed individualized semi-structured interviews.</p><p><strong>Results: </strong>All 60 individuals (mean 53 years, 37% male) were included in the intention-to-treat analysis. At 12 weeks, there was a significant difference in mean adjusted change in KDQoL MCS score between the intervention group and waitlist control [4.2 (95% confidence interval 1.0-7.4) arbitrary units, <i>P =</i> .012]. Significant between-group differences in KDQoL subscales-burden of kidney disease (<i>P</i> = .034), emotional wellbeing (<i>P</i> = .001) and energy/fatigue (<i>P</i> = .001)-were also achieved. There was no significant between-group difference in KDQoL PCS scores (<i>P</i> = .505). Per-protocol analyses revealed significant between group differences in the PAM-13 patient activation score (<i>P</i> = .010) and body mass (<i>P</i> = .027). Mixed-methods analyses revealed key influences of the programme, including opportunities for peer support and to build on new skills and knowledge, as well as the empowerment and self-management.</p><p><strong>Conclusion: </strong>A PKD-specific digital health educational and physical activity intervention is acceptable and has the potential to improve HRQoL. Further research is needed to better understand how specific education and lifestyle management may help to support self-management behaviour.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf041"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596423","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":"Monkeypox infection in kidney transplant recipients.","authors":"Ola Suliman, Mohammad Joomye, Henry H L Wu, Rajkumar Chinnadurai","doi":"10.1093/ckj/sfaf048","DOIUrl":"10.1093/ckj/sfaf048","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf048"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656245","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}