Journal of Nephrology最新文献

{"title":"Bimodal solutions in peritoneal dialysis: what can we expect from different glucose volumes added to the icodextrin bag? Data from a simulation procedure.","authors":"Alexis Davy, Carl M Öberg, Annabel Boyer, Antoine Lanot, Sarah Lebastard, Stéphane Allouche, Thierry Lobbedez, Clémence Béchade","doi":"10.1007/s40620-025-02206-8","DOIUrl":"https://doi.org/10.1007/s40620-025-02206-8","url":null,"abstract":"<p><strong>Background: </strong>Ultrafiltration (UF) insufficiency in peritoneal dialysis (PD) often leads to transfer to hemodialysis. Therefore, strategies to prolong time on therapy are needed. The use of a combined crystalloid and colloid solution, also called bimodal PD, can help improve UF.</p><p><strong>Methods: </strong>We propose a method for reconstituting bimodal solutions. Three bimodal PD solutions, with respectively 100 ml (solution 100), 150 ml (solution 150) and 200 ml (solution 200) of 30% glucose for intravenous (IV) infusion, were prepared to explore whether a variation of the amount of glucose can be useful to adapt the PD prescription. Biochemical analyses and computer simulations (based on the 3-pore model) were carried out on these solutions to assess their Na and UF efficiency. Data on the clinical use of solution 200 were retrospectively collected.</p><p><strong>Results: </strong>The addition of 30% glucose to the icodextrin 7.5% bag resulted in a low-sodium solution. After a 6-h dwell with the solution 200, in a high-average transporter patient with a Dialysate over Plasma (D/P) creatinine at 0.7, the theoretical volume of ultrafiltration was 943.0 ml and the amount of sodium removed was 8.29 g compared to 650.3 ml and 6.14 g with solution 100. When considering the glucose absorption during the dwell, solution 100 was associated with the best ultrafiltration efficiency, defined as the volume of UF obtained divided by the amount of free glucose absorbed, and the best sodium efficiency, defined as the mass of sodium removed divided by the amount of free glucose absorbed during the dwell. Four patients used bimodal solution 200 for at least 2 months between 2018 and 2023 and were included in the retrospective study on clinical use. Mean time spent on PD before bimodal PD first prescription was 26 months (6-38 months). Median time spent using a bimodal PD regimen was 15 months (12-19 months). No episodes of peritonitis were reported while using this strategy.</p><p><strong>Conclusion: </strong>Our study describes a simple method to prepare a bimodal solution. Biochemical and computer study of 3 solutions suggested that using 100 ml of 30% glucose to 2 L of icodextrin 7.5% gives the best UF and Na efficiency.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal dialysis in acute kidney injury: twenty years of experience at a single center in a developing country.","authors":"Daniela Ponce, Julia Bannwart, Maryanne Zilli Canedo Silva, Welder Zamoner, Dayana Bitencourt Dias, André Luís Balbi","doi":"10.1007/s40620-024-02189-y","DOIUrl":"https://doi.org/10.1007/s40620-024-02189-y","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore the role of peritoneal dialysis (PD) in patients with acute kidney injury (AKI) in relation to metabolic and fluid control, outcome and risk factors for death.</p><p><strong>Methods: </strong>We performed a retrospective cohort study collecting data from a large reference Center in Brazil on patient characteristics, hospitalization, PD prescription and delivery, clinical outcomes and laboratory exams. We evaluated all patients who had been consecutively treated by PD between January 2004 and January 2024.</p><p><strong>Results: </strong>Four hundred eighty-seven patients were included. Median age was 64.02 ± 15 years, most of the patients were hospitalized in the intensive care unit (ICU) and needed vasoactive drugs and mechanical ventilation. Sepsis was the main cause of AKI followed by cardiorenal syndrome type 1. Uremia was the main indication for dialysis, followed by the need to meet metabolic and fluid demands. Blood urea nitrogen and creatinine levels stabilized after a median of four dialysis sessions. Fluid removal increased progressively and stabilized at around 2.320 ± 0.91 ml after four sessions. Mechanical complications occurred in 9.2% and peritonitis in 6.2% of patients. Regarding AKI outcome, 34.9% recovered renal function, 6.8% remained on dialysis for over 30 days, and 55.8% died. Technique failure occurred in 19.9% of the cases and the main cause was a mechanical complication. Age, hepatorenal syndrome, APACHE score and dropout from PD due to insufficient fluid control were identified as risk factors for death, while cardiorenal syndrome, need to meet metabolic and fluid demand as indication of dialysis, and negative fluid balance after 4 sessions of PD were identified as protective factors.</p><p><strong>Conclusion: </strong>PD may be an effective solution for AKI patients, allowing adequate metabolic and fluid control. Age, APACHE score, hepatorenal syndrome and dropout from PD were associated with death, while cardiorenal syndrome, need to meet metabolic and fluid demands as indication of dialysis, and negative fluid balance were positive prognostic factors.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum zinc level is associated with aortic arch calcification in incident dialysis patients.","authors":"Yosuke Saka, Tomohiko Naruse, Yuichi Katsurayama, Yuki Sato, Shun Ito, Motoki Anbe, Yusuke Kakizaki, Hiroshi Takahashi, Yuzo Watanabe","doi":"10.1007/s40620-025-02283-9","DOIUrl":"https://doi.org/10.1007/s40620-025-02283-9","url":null,"abstract":"<p><strong>Background: </strong>Aortic calcification is a predictor of cardiovascular events. Several studies have shown an association between zinc deficiency and aortic calcification in patients with chronic kidney disease (CKD). We therefore investigated the associations between serum zinc levels and aortic arch calcifications in incident patients on dialysis.</p><p><strong>Methods: </strong>We analyzed data from 773 patients who started dialysis at our hospital between January 2013 and December 2023. Aortic arch calcification was graded 0-3 on chest X-ray, as follows: grade 0, no visible calcification; grade 1, < 50% calcification in the arch; grade 2, 50% calcification; or grade 3, circumferential calcification. We defined grades 2-3 as severe calcification. We stratified patients into tertiles of serum zinc levels.</p><p><strong>Results: </strong>Median serum zinc levels were 51, 47 and 44 μg/dL in patients with grade 0, 1 and 2-3 aortic arch calcification, respectively (p < 0.001). In multivariate analysis, low serum zinc level was independently associated with aortic arch calcification (OR 3.12, 95% CI 1.84-5.27; p < 0.001), particularly with severe aortic arch calcification (OR 6.91, 95% CI 3.11-15.40; p < 0.001). Adding serum zinc level to a model with established risk factors for aortic arch calcification ameliorated net reclassification (0.308; p < 0.001) and integrated discrimination improvement (0.018; p = 0.0074). More robust findings for net reclassification improvement (0.427; p < 0.001) and integrated discrimination improvement (0.035; p < 0.001) were observed with severe aortic arch calcifications.</p><p><strong>Conclusion: </strong>Low serum zinc level was independently associated with aortic arch calcification, and in particular, with severe aortic arch calcifications, among patients who started dialysis.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of exercise training on quality of life in people with chronic kidney disease requiring dialysis. A systematic review with meta-analysis.","authors":"Annette Traise, Gudrun Dieberg, Elizabeth Degotardi, Bailey Hart, Fiza Kaippilly, Darcy McInnes, Melissa J Pearson, David Ryan, Neil A Smart","doi":"10.1007/s40620-025-02245-1","DOIUrl":"https://doi.org/10.1007/s40620-025-02245-1","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a debilitating condition associated with poor health outcomes, including reduced quality of life (QoL), frequent hospitalisation and premature mortality.</p><p><strong>Aim: </strong>This study aimed to determine the effect of exercise training on health-related QoL in individuals with CKD requiring dialysis, focusing on mental health scores. Secondary aims included analysing the effect of exercise modality, intensity, and delivery context to maximise exercise training benefits for QoL. Additionally, differences in mental component summary and physical component summary scores using CKD-specific generic QoL patient reported outcome measures were examined.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus up to November 14th, 2024, identified randomised controlled trials (RCTs) comparing exercise training to usual care in CKD patients requiring dialysis. Twenty-five RCTs met the inclusion criteria and were pooled for meta-analyses.</p><p><strong>Results: </strong>Pooled analysis revealed significant improvements in QoL scores for mental component summary (MD 3.33 [1.24, 5.41], p = 0.002) and physical component summary (MD 3.75, [2.28, 5.23], p < 0.00001) compared to the usual care. A statistically significant improvement in the mental component summary was found for aerobic training (p = 0.02) and resistance training (p = 0.04). Moderate intensity (p = 0.003), an intervention duration of 12-26 weeks (p = 0.0004), interdialytic delivery (p = 0.003), intradialytic delivery (p = 0.03) and supervised training (p = 0.002) all demonstrated statistically significant improvements in mental component summary. The short form (SF)-36 demonstrated significant improvements in mental component summary (MD 4.15 [1.54, 6.76], p = 0.002), while the kidney disease QoL patient-reported outcome measure did not show significant improvement (p = 0.33).</p><p><strong>Conclusions: </strong>Supervised, inter-dialytic or intra-dialytic exercise, including aerobic or resistance training at a moderate intensity for up to 26 weeks, can significantly improve mental component summary scores in individuals with stage 5 CKD on dialysis.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apotropaic kidney stones.","authors":"João Guilherme Bochnia Küster","doi":"10.1007/s40620-025-02278-6","DOIUrl":"https://doi.org/10.1007/s40620-025-02278-6","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and trend of biopsy-proven IgA nephropathy in China: a systematic review.","authors":"Lichen Xu, Changwei Wu, Guisen Li","doi":"10.1007/s40620-025-02261-1","DOIUrl":"https://doi.org/10.1007/s40620-025-02261-1","url":null,"abstract":"<p><strong>Background: </strong>IgA nephropathy (IgAN) is one of the most common primary glomerulonephritis worldwide, and its distribution varies significantly in different regions. The prevalence and trend of its changes in different regions of China are still unclear. Therefore, this study aims to analyze kidney biopsy data to summarize the prevalence and trend of IgAN in different regions in China.</p><p><strong>Methods: </strong>Through a systematic electronic search of PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (SinoMed), Cochrane Library, and Wanfang databases from inception to March 1, 2023. Kidney biopsy data from the different provinces, municipalities and autonomous regions were recorded and analyzed.</p><p><strong>Results: </strong>Data concerning a total of 143,176 patients with primary glomerulonephritis in 34 provinces of China were extracted from the reported kidney biopsy data and included in the final analysis set, of which 39.73% were IgAN (56,886 cases). The proportions of male and female patients were 58.67% and 41.33%, respectively. The prevalence of IgAN patients was higher in economically developed provinces and municipalities. The weighted average prevalence before 2010 and after 2010 was 40.45% and 37.97%, respectively.</p><p><strong>Conclusions: </strong>IgAN remains the most common biopsy-proven primary glomerulonephritis in China. The prevalence of IgAN was 39.73% in China, and it was higher in developed provinces and municipalities than in other areas. The weighted average prevalence of IgAN in China decreased slightly after 2010.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrolyte imbalance in a patient with weight loss: what is the cause?","authors":"Ophir Eyal, Yael Golomb","doi":"10.1007/s40620-025-02259-9","DOIUrl":"https://doi.org/10.1007/s40620-025-02259-9","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosing practices, pharmacokinetics, and effectiveness of allopurinol in gout patients receiving dialysis: a scoping review.","authors":"Noha A Kamel, Michael A Stokes, Daniel F B Wright, Kamal Sud, Surjit Tarafdar, Ronald L Castelino, Sophie L Stocker","doi":"10.1007/s40620-025-02269-7","DOIUrl":"https://doi.org/10.1007/s40620-025-02269-7","url":null,"abstract":"<p><p>Urate and oxypurinol, allopurinol's active metabolite, are predominantly eliminated by the kidneys. Therefore, optimising allopurinol dosing in patients on dialysis is challenging. This review explores allopurinol dosing practices, oxypurinol pharmacokinetics, and effectiveness in gout patients receiving haemodialysis or peritoneal dialysis (PD). Five databases and grey literature were searched. Studies on gout patients on allopurinol, receiving dialysis, and reporting dosing, pharmacokinetics, or effectiveness (reduction in urate and/or gout flares) were included. Abstract, full text screening and data extraction were done by two authors. Studies were grouped by dialysis modality. Eighteen studies were identified including 390 patients, most (n = 274, 70%) on haemodialysis with allopurinol administered after dialysis. The peritoneal dialytic clearance of oxypurinol (3.14 mL/min, n = 5) and urate (2.7-4 mL/min, n = 25) was similar. The haemodialytic clearance was 78-137 mL/min for oxypurinol (n = 21) and 80-165 mL/min for urate (n = 19). Allopurinol doses were higher in haemodialysis (100-600 mg/day) than PD (110-125 mg/day). Haemodialysis sessions decreased oxypurinol and urate concentrations by 39-57% (n = 30) and 56-71% (n = 6), respectively. Over time (1-230 days), urate concentrations in haemodialysis (n = 85) reduced by 14-41%. Target serum urate (< 0.36 mmol/L) was achieved in 61% (20/33) and 47% (13/28) of haemodialysis and PD patients, respectively. Gout flares decreased from 2 to 0.1 attacks/year in patients receiving dialysis (n = 79). Oxypurinol and urate clearance by haemodialysis was higher than PD, necessitating higher doses of allopurinol. POST dialysis allopurinol doses titrated to target urate are suggested. Future studies considering the impact of dialysis modality on allopurinol dose requirements are needed.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical performance and nutritional status in patients with Fabry disease: study design of an Italian multicenter cross-sectional study.","authors":"Yuri Battaglia, Claudia Momentè, Giorgia Gugelmo, Federica Bagica, Federica Duregon, Andrea Gasperetti, Federica Caccia, Livia Lenzini, Gianni Carraro, Giacomo Marchi, Nicola Vitturi","doi":"10.1007/s40620-025-02253-1","DOIUrl":"https://doi.org/10.1007/s40620-025-02253-1","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, trajectories and outcomes of acute kidney injury among hospitalized patients: a large retrospective multicenter cohort study.","authors":"Esra Adiyeke, Yuanfang Ren, Shmuel Fogel, Parisa Rashidi, Mark Segal, Elizabeth A Shenkman, Azra Bihorac, Tezcan Ozrazgat-Baslanti","doi":"10.1007/s40620-025-02234-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02234-4","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a clinical syndrome affecting almost one-fifth of hospitalized patients, as well as over half of the patients who are admitted to the intensive care unit (ICU). Stratifying AKI patients into groups based on severity and duration would facilitate targeted efforts for treating AKI.</p><p><strong>Methods: </strong>In a retrospective, multicenter longitudinal cohort study of 2,187,254 hospital encounters from 935,679 patients who were admitted between 2012 and 2020 to health centers in the OneFlorida + Network, we analyzed the impact of AKI trajectories (i.e. rapidly reversed AKI, persistent AKI with renal recovery, and persistent AKI without renal recovery) on patients' clinical outcomes, including hospital, 30-day, 1-year, and 3-year mortality, kidney replacement therapy, new chronic kidney disease (CKD) within 90 days or 1-year of discharge, CKD progression within 1-year of discharge, resource utilization, hospital disposition, and major complications during hospitalization.</p><p><strong>Results: </strong>Among all encounters, 14% of patients had AKI, of whom 63%, 21%, and 16% had Stage 1, 2, and 3, respectively, as the worst AKI stage. The fraction of patients with persistent AKI was 31%. Patients with AKI had worse clinical outcomes and increased resource utilization compared to patients without the condition. One-year mortality was 5 times greater for patients with persistent AKI compared to those without AKI.</p><p><strong>Conclusions: </strong>Persistent AKI was associated with prolonged hospitalization, increased ICU admission and greater mortality compared to the other groups. This may emphasize the critical need for devising strategies targeting effective management of AKI and prevention of persisting AKI.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}