Clinical Kidney Journal最新文献

{"title":"Modified creatinine index as a marker of skeletal muscle mass in peritoneal dialysis patients.","authors":"Jack Kit-Chung Ng, Winston Wing-Shing Fung, Gordon Chun-Kau Chan, Phyllis Mei-Shan Cheng, Wing-Fai Pang, Kai-Ming Chow, Cheuk-Chun Szeto","doi":"10.1093/ckj/sfae297","DOIUrl":"10.1093/ckj/sfae297","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is common in peritoneal dialysis (PD) patients. Modified creatinine index (MCrI) by the Canaud's formula and single-pool Kt/V value is an accurate surrogate marker for muscle mass in hemodialysis patients. However, the method of calculation and validity of MCrI has not been tested in PD.</p><p><strong>Methods: </strong>In the exploratory cohort, we studied 138 consecutive patients converted from PD to hemodialysis. Their MCrI during PD, calculated by the Canaud's formula with total weekly Kt/V, and the conventional MCrI after conversion to HD, were compared by the Bland-Altman method. Their correlation with muscle mass as determined by bioimpedance spectroscopy and creatinine kinetic methods was explored. The result was then validated in a second cohort of 605 incident PD patients.</p><p><strong>Results: </strong>In the exploratory cohort, the average bias of computing MCrI during PD and hemodialysis was 0.758 mg/kg/day (95%CI -4.356 to 5.873 mg/kg/day). The MCrI during PD significantly correlated with the muscle mass by creatinine kinetics (<i>r</i> = .684, <i>P</i> < .0001) and by bioimpedance spectroscopy (<i>r</i> = .641, <i>P</i> < .0001), but not with protein nitrogen appearance, overhydration, or adipose tissue mass, and the result was similar in the validation cohort. For incident PD patients, MCrI quartile was significantly associated with the risk of death from all cause in 12 months (Gray's test, <i>P</i> = .013) but not conversion to chronic hemodialysis (<i>P</i> = .14).</p><p><strong>Conclusion: </strong>In PD patients, MCrI computed by the Canaud's formula and total weekly Kt/V is a simple and reliable marker of skeletal muscle mass and may serve as a short-term prognostic indicator.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 10","pages":"sfae297"},"PeriodicalIF":3.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459677","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":"N-terminal pro-B-type natriuretic peptide, eGFR, and progression of kidney disease in chronic kidney disease patients without heart failure.","authors":"Yi Lu, Junzhe Chen, Licong Su, Andrew Fanuel Lukwaro, Shiyu Zhou, Shaoxin Zheng, Yuxin Luo, Sha Fu, Sheng Nie, Ying Tang","doi":"10.1093/ckj/sfae298","DOIUrl":"10.1093/ckj/sfae298","url":null,"abstract":"<p><strong>Background: </strong>Cardiorenal syndrome highlights the bidirectional relationship between kidney and heart dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is the gold standard biomarker in heart failure (HF), may be an important biomarker for chronic kidney disease (CKD) progression. However, NT-proBNP is negatively related with estimated glomerular filtration rate (eGFR). In this study, we investigated the association of NT-proBNP, eGFR, and progression of kidney disease in CKD patients without HF.</p><p><strong>Methods: </strong>This multicentric retrospective cohort study recruited 23 860 CKD patients without HF, who had at least one NT-proBNP record from China Renal Data System database. Linear regression model evaluated the relationship between eGFR and NT-proBNP. Cox regression analysis assessed the association between NT-proBNP and CKD progression. Sensitivity analysis examined the robustness of the main findings.</p><p><strong>Results: </strong>This study involved 23 860 CKD patients without HF, distributed across different CKD stages: 10 526 in stages G1-2, 4665 in G3a, 3702 in G3b, 2704 in G4, and 2263 in G5. NT-proBNP was negatively correlated with eGFR, particularly in stages 4-5 CKD. A 15-unit decrease in eGFR was associated with increases in log (NT-proBNP) levels by 1.04-fold, 1.27-fold, 1.29-fold, 1.80-fold, and 3.50-fold for stages 1-2, 3a, 3b, 4, and 5, respectively. After excluding patients who developed CKD progression within 1 year, the Cox regression analysis revealed that the relationship between NT-proBNP and CKD progression was not significant in stages 4 and 5. However, for stages 1-3, each standard deviation increase in log (NT-proBNP) was associated with a 26%, 36%, and 28% higher risk of CKD progression, with <i>P</i> interaction ≤.001. The hazard ratios were 1.26 (95% confidence intervals (CI), 1.18 to 1.35), 1.36 (95% CI, 1.22 to 1.51), and 1.28 (95% CI, 1.14 to 1.43) for stages 1-2, stage 3a, and stage 3b, respectively.</p><p><strong>Conclusions: </strong>Despite its strong inverse association with eGFR, NT-proBNP was positively associated with the risk of progression of kidney disease in CKD patients with stages 1-3 without HF. Future studies should investigate the effectiveness of NT-proBNP as a predictive biomarker for the progression of kidney disease across diverse racial groups and healthcare settings.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 10","pages":"sfae298"},"PeriodicalIF":3.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496339","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":"Design and cohort characteristics of TRACK, a prospective study of hyperkalaemia management decision-making.","authors":"Judith Hsia, Nitin Shivappa, Ameet Bakhai, Jordi Bover, Javed Butler, Pietro Manuel Ferraro, Linda Fried, Markus P Schneider, Navdeep Tangri, Wolfgang C Winkelmayer, Meredith Bishop, Hungta Chen, Anna-Karin Sundin, Marc P Bonaca","doi":"10.1093/ckj/sfae295","DOIUrl":"10.1093/ckj/sfae295","url":null,"abstract":"<p><strong>Background: </strong>Guideline-recommended hyperkalaemia management includes dietary potassium (K⁺) restriction, bicarbonate correction, diuretics and K⁺ binders with dose reduction of renin-angiotensin-aldosterone system inhibitors as a last resort. The extent to which these recommendations are implemented is uncertain, as real-world data on hyperkalaemia management are limited. The Tracking Treatment Pathways in Adult Patients with Hyperkalemia (TRACK) study is a multinational, prospective, longitudinal study that is being conducted to address this knowledge gap. We report the design and baseline cohort characteristics of this real-world study of hyperkalaemia management decision-making.</p><p><strong>Methods: </strong>This study enrolled participants within 21 days of an episode of hyperkalaemia in four European countries (UK, Spain, Germany, Italy) and the USA. During the 12-month follow up, data collected will include participant and healthcare provider characteristics (specialty and practice setting), hyperkalaemia treatment objectives and strategies, rationale for management decisions and indicators of response and patient-reported perceptions of their hyperkalaemia treatment.</p><p><strong>Results: </strong>The enrolled cohort includes 1330 participants, mean age 68 years, of whom 31% were women. At baseline, 6% reported heart failure, 55% chronic kidney disease, 29% both and 9% neither. Most participants (57%) were taking an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker or angiotensin receptor/neprilysin inhibitor at baseline. Mineralocorticoid receptor antagonist use was lower (14%).</p><p><strong>Conclusions: </strong>The prospective TRACK study will shed light on practitioners' hyperkalaemia management decision-making and assess the impact of their decisions on hyperkalaemia recurrence. Understanding practitioners' underlying thought processes will facilitate efforts to improve hyperkalaemia management.ClinicalTrials.gov: NCT05408039.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 10","pages":"sfae295"},"PeriodicalIF":3.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496338","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: Biomarkers in clinical epidemiology studies.","authors":"","doi":"10.1093/ckj/sfae293","DOIUrl":"https://doi.org/10.1093/ckj/sfae293","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfae130.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 9","pages":"sfae293"},"PeriodicalIF":3.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342920","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":"Ethics in humanitarian settings-relevance and consequences for dialysis and kidney care.","authors":"Valerie A Luyckx, Wim Van Biesen, Jadranka Buturovic Ponikvar, Peter Heering, Ali Abu-Alfa, Ji Silberzweig, Monica Fontana, Serhan Tuglular, Mehmet Sukru Sever","doi":"10.1093/ckj/sfae290","DOIUrl":"https://doi.org/10.1093/ckj/sfae290","url":null,"abstract":"<p><p>With the increasing frequency and severity of disasters and the increasing number of patients living with kidney disease, on dialysis and with transplants around the world, the need for kidney care in humanitarian settings is increasing. Almost all humanitarian emergencies pose a threat to kidney health because all treatments are highly susceptible to interruption, and interruption can be deadly. Providing support for people requiring dialysis in humanitarian settings can be complex and is associated with many trade-offs. The global kidney care community must become familiar with the ethics, principles and duties essential to meeting the overarching goals of ethical and effective disaster relief. Ethics principles and values must be considered on the individual, public health and global levels. The wellbeing of a single patient must be considered in the context of the competing needs of many others, and optimal treatment may not be possible due to resource constraints. Public health ethics principles, including considerations of triage and resource allocation, maximization of benefit and feasibility, often become directly relevant at the bedside. Individuals delivering humanitarian relief must be well trained, competent, respectful and professional, while involved organizations need to uphold the highest professional and ethical standards. There may be dissonance between ethical guidance and practical realities in humanitarian settings, which for inexperienced individuals may present significant challenges. Sustaining dialysis care in emergencies brings these issues starkly to the fore. Preparedness for dialysis in emergencies is an ethical imperative that mandates multisectoral stakeholder engagement and action, development of surge response plans, clinical and ethics guidance, and transparent priority setting. This manuscript outlines common ethics challenges and considerations that apply in all humanitarian actions, and illustrates their relevance to kidney care as a whole, using examples of how these may apply to dialysis and kidney disaster relief efforts in humanitarian settings.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 10","pages":"sfae290"},"PeriodicalIF":3.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459675","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":"Proenkephalin A 119-159 (penKid) and mortality in stable patients at high cardiovascular risk.","authors":"Matthias Rau, Berkan Kurt, Oliver Hartmann, Fábia Daniela Lobo de Sá, Marvin Schwarz, Kirsten Thiele, Niels-Ulrik Korbinian Hartmann, Jens Spiesshoefer, Julia Möllmann, Mathias Hohl, Simina-Ramona Selejan, Emiel P C van der Vorst, Edgar Dahl, Nikolaus Marx, Florian Kahles, Michael Lehrke","doi":"10.1093/ckj/sfae246","DOIUrl":"10.1093/ckj/sfae246","url":null,"abstract":"<p><strong>Background: </strong>Proenkephalin A 119-159 (penKid) is a novel blood biomarker for real-time assessment of kidney function and was found to be independently associated with worsening kidney function and mortality. A novel penKid-based estimated glomerular filtration rate equation (eGFR_PENK-Crea), outperforms current creatinine-based eGFR equations in predicting iohexol or iothalamate plasma clearance-based measured GFR. In this study, we aimed to evaluate the predictive value of penKid and eGFR_PENK-Crea for all-cause mortality in stable patients at high cardiovascular risk.</p><p><strong>Methods: </strong>Circulating penKid levels were assessed in 615 stable patients hospitalized at the Department of Cardiology at University Hospital Aachen, Germany. The endpoint was all-cause mortality; follow up was 3 years.</p><p><strong>Results: </strong>penKid levels were higher in 46 non-survivors [58.8 (IQR 47.5-85.0) pmol/l] compared to 569 survivors [43.8 (IQR 34.0-58.0) pmol/l; <i>P</i> < .0001]. Univariable Cox regression analyses found penKid and eGFR_PENK-Crea to be associated with all-cause mortality (<i>C</i> index 0.703, <i>χ</i> ² 33.27, <i>P</i> < .00001; C index 0.716, <i>χ</i> ² 36.51, <i>P</i> < .00001). This association remained significant after adjustment for significant baseline parameters including age, smoking, chronic heart failure, use of diuretics, leucocytes, body mass index, sex, and creatinine (C index 0.799, <i>χ</i> ² 72.06, <i>P</i> < .00001). Importantly, penKid provided significant added value on top of eGFR_{CKD-EPI 2021} (eGFR_{CKD-EPI 2021}: C index 0.716, <i>χ</i> ² 34.21; eGFR_{CKD-EPI 2021}+ penKid: C index 0.727, <i>χ</i> ²: 40.02; Delta <i>χ</i> ² 5.81; all <i>P</i> < .00001) for all-cause mortality prediction in our cohort.</p><p><strong>Conclusions: </strong>penKid levels and eGFR_PENK-Crea is associated with all-cause mortality within a 3-year follow-up period and the addition of penKid on top of eGFR_{CKD-EPI 2021} provided significant added value in mortality prediction.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 9","pages":"sfae246"},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11712262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945817","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":"Apolipoprotein B-48 and late graft failure in kidney transplant recipients","authors":"Tamas Szili-Torok, Martin H de Borst, Alexandra Soteriou, Laura Post, Stephan J L Bakker, Uwe J F Tietge","doi":"10.1093/ckj/sfae289","DOIUrl":"https://doi.org/10.1093/ckj/sfae289","url":null,"abstract":"Introduction Transplant vasculopathy resembles atherosclerotic plaque formation and is a major contributor to late graft failure in kidney transplant recipients (KTR). Remnant lipoproteins and associated triglycerides are causal risk factors for atherosclerotic plaques and have been implicated in late kidney graft failure. However, whether remnants derived from liver (containing apolipoprotein [apo] B100) or intestine (containing apoB48) are clinically more important is unclear. The current study investigated the association between baseline fasting apoB48 levels and late kidney graft failure. Methods 481 KTR with a functioning graft for at least one year were included in this retrospective, observational longitudinal single center cohort study. The primary endpoint was death-censored late graft failure, defined as need for initiation of dialysis or re-transplantation. ApoB48 was measured by enzyme-linked immunosorbent assay. Results During a median follow-up of 9.5 years, 61 KTR developed graft failure (12.7%). At baseline, KTR with higher apoB48 levels had lower eGFR (p&amp;lt;0.001), lower HDL cholesterol (p&amp;lt;0.001), increased triglycerides (p&amp;lt;0.001) and used cyclosporine more frequently (p=0.003). Cox regression showed that higher baseline apoB48 was associated with higher risk of late graft failure (hazard ratio [95% confidence interval], 1.59 [1.22, 2.07], p&amp;lt;0.001), independent of stepwise adjustment for potential confounders, including age and sex , immunosuppression type and proteinuria , triglycerides , and waist circumference (fully adjusted HR, 1.78 [1.29, 2.47], p&amp;lt;0.001). Conclusion ApoB48 is strongly associated with late graft failure, independent of potential confounders. Since apoB48-containing lipoproteins originate from the intestine, this study provides a rationale for considering pharmacological interventions targeting lipid absorption to improve graft outcome.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262229","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":"Cerebral white matter injury in hemodialysis patients: a cross-sectional tract-based spatial statistics and fixel-based analysis","authors":"Yu Qi, Lijun Song, Xu Liu, Boyan Xu, Wenbo Yang, Mingan Li, Min Li, Zhengyang Zhu, Wenhu Liu, Zhenghan Yang, Zhenchang Wang, Hao Wang","doi":"10.1093/ckj/sfae286","DOIUrl":"https://doi.org/10.1093/ckj/sfae286","url":null,"abstract":"Background End-stage renal disease (ESRD) patients with maintenance hemodialysis (HD) are often accompanied by damage to brain white matter (WM) and cognitive impairment. However, whether this damage is caused by maintenance HD or renal dysfunction is unclear. Purpose To investigate the natural progression of WM damage in patients with ESRD and the effects of HD on WM using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA). Population Eighty-one ESRD patients including 41 with no dialysis (ND) and 40 with HD and forty-six healthy controls (HCs) were enrolled in this study. Field Strength/Sequence A 3 T, single-shot spin–echo echo planar imaging (EPI). Assessment The difference of WM among the three groups (ESRD patients with HD, ESRD patients without HD and HCs) were analyzed using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA), pairwise comparison was then used to compare the difference of WM between two groups. Relationship between WM and neurocognitive assessments/clinical data were analyzed in ESRD patients with or without HD. Statistical Tests Group t-test, Chi-square Test, Kruskal–Wallis test, Mann–Whitney U-Test, Spearman’ correlation analysis, non-parametric permutation testing. Results The damage of WM in ESRD with ND and ESRD HD appeared around the lateral ventricles similarly used for TBSS while FBA reflected the changes had extended to adjacent WM in anterior hemisphere, with larger region in ESRD HD compared to ESRD ND and the brainstem was also widely affected in ESRD HD. The levels of MoCA score were lower in ESRD HD group. RD in body of corpus callosum (BCC) were negatively correlated with MoCA score in both groups. FDC in left Thalamo-prefrontal projection (T_PREFL), left and right cingulum (CGL and CGR) were positively correlated with MoCA score in both groups. Creatinine (Cr) was positively correlated with FDC in some frontal projection fibers in striatum and thalamus, CG and fronto-pontine tract (FPT), Cr was positively correlated with FD mainly in premotor projection fibers in striatum and thalamus in ESRD HD group. Cr was negatively correlated with MD and RD in regions of corona radiata ESRD ND group. Data Conclusion FBA is more sensitive in detecting differences between ESRD patients and HCs. When ESRD patients receive maintenance HD, the degree of WM damage may not be aggravated, however, the range of damaged WM can be expanded, especially in anterior hemisphere and brainstem, some of these changes in anterior hemisphere may contribute to cognitive decline.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"53 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262269","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":"Efficacy and safety of telitacicept, a BLyS/APRIL dual inhibitor, in the treatment of IgA nephropathy: a retrospective case-control study","authors":"Meng Wang, Jianfei Ma, Li Yao, Yi Fan","doi":"10.1093/ckj/sfae285","DOIUrl":"https://doi.org/10.1093/ckj/sfae285","url":null,"abstract":"Background Telitacicept, a BLyS/APRIL dual-target fusion protein, has recently been used in autoimmune diseases. We assessed Telitacicept’ s efficacy and safety in IgA nephropathy (IgAN) patients. Methods This study included 42 IgAN patients who received Telitacicept treatment, forming the ‘whole Telitacicept group’. Among them, 20 patients who had not previously received corticosteroid (CS) therapy or immunosuppressive (IS) agents were categorized as the ‘newly treated Telitacicept subgroup’. Additionally, 28 patients who were selected to match historical controls received conventional IS (CS therapy with/without IS agents) therapy and were classified as the ‘conventional IS group’. Telitacicept was partially used in combination with conventional IS, including initial CS in different doses. Various indicators were compared at 4-week intervals up to 24 weeks among the three groups. Results After 24 weeks of treatment, the 24-hour proteinuria decreased from 1.70 [interquartile range (IQR), 1.05–2.58]g to 0.21 (0.39–0.13) g (P = 0.043) in the newly treated Telitacicept subgroup, from 1.78 (0.97–2.82) g to 0.44 (1.48–0.16) g (P = 0.001) in the conventional IS group, and from 1.07 (0.66–1.99) g to 0.26 (0.59–0.17) g (P = 0.028) in the whole Telitacicept group. The estimated glomerular filtration rate (eGFR) increased from (76.58 ± 30.26) ml/min/1.73m2 to (80.30 ± 26.76) ml/min/1.73m2 (P = 0.016) in the newly treated Telitacicept subgroup, from (72.73 ± 33.41) ml/min/1.73m2 to (84.08.10 ± 26.81) ml/min/1.73m2 (P = 0.011) in the conventional IS group, and from (70.10 ± 32.88) ml/min/1.73m2 to (71.21 ± 31.49) ml/min/1.73m2 (P = 0.065) in the whole Telitacicept group. During follow-up periods, the efficacy rates of the three groups did not show statistically significant differences, and no serious adverse events (SAEs) were observed. Conclusions Telitacicept may be a safe and effective treatment for IgAN, offering similar reductions in proteinuria and increases in eGFR as conventional IS therapy. After a 24-week follow-up, the incidence of adverse events (AEs) was lower for Telitacicept than for conventional IS therapy.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"29 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262221","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":"Basiliximab induction alone vs. a dual ATG-Basiliximab approach in first live-donor non-sensitized kidney transplant recipients with low HLA matching","authors":"Tammy Hod, Shmuel Levinger, Enosh Askenasy, Maya Siman-Tov, Yana Davidov, Ronen Ghinea, Niv Pencovich, Ido Nachmani, Eytan Mor","doi":"10.1093/ckj/sfae236","DOIUrl":"https://doi.org/10.1093/ckj/sfae236","url":null,"abstract":"Background Individualizing induction therapy based on immunological risk is crucial for optimizing outcomes in kidney transplantation. Methods A retrospective analysis included 157 first live-donor non-sensitized kidney transplant recipients (KTRs). Within this cohort, 96 individuals exhibited low HLA matching (5–6 HLA mismatches). The low HLA match subgroup was categorized into 52 KTRs receiving basiliximab alone and 44 recipients treated with a combined single ATG dose of 1.5 mg/kg and basiliximab. The primary endpoint was early acute cellular rejection (ACR) within 6 months post-transplant while secondary outcomes encompassed infection rates, renal allograft function, length of stay (LOS), and readmissions post-transplant. Results The incidence of early ACR was decreased for low HLA match KTRs, who received ATG-Basiliximab, when compared to low HLA-matched KTRs who received Basiliximab alone (9.1% vs. 23.9%, p = 0.067). Age was a predictor for rejection, and subgroup analysis showed consistent rejection reduction across age groups. No significant differences were observed in admission for transplant LOS or in peri-operative complications, nor in infections rate including BK and CMV viremia, allograft function and number of readmissions post-transplant up to 6 months post-transplant. Conclusion In non-sensitized first live-donor KTRs with low HLA matching, a dual ATG-basiliximab induction approach significantly reduced early ACR without compromising safety.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"11 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269753","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}