Journal of Nephrology最新文献

{"title":"Adenovirus infection.","authors":"Kanza Haq, Chloe Shreve, Divyanshu Malhotra","doi":"10.1007/s40620-024-02138-9","DOIUrl":"https://doi.org/10.1007/s40620-024-02138-9","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769850","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":"How to incorporate generative artificial intelligence in nephrology fellowship education.","authors":"Jing Miao, Charat Thongprayoon, Iasmina M Craici, Wisit Cheungpasitporn","doi":"10.1007/s40620-024-02165-6","DOIUrl":"https://doi.org/10.1007/s40620-024-02165-6","url":null,"abstract":"<p><p>Traditional nephrology education faces challenges due to expanding medical knowledge, case complexity, and personalized learning needs. Generative artificial intelligence (AI), like ChatGPT, offers potential solutions to enhance nephrology education through dynamic, adaptive, and personalized learning experiences. We discuss integrating generative AI into nephrology education at our institution, highlighting its importance and potential applications. It explores how AI can complement traditional teaching methods by addressing challenges like information overload, diverse learning needs, and continuous learning. Generative AI models should be actively utilized under human supervision to ensure accuracy when summarizing key teaching points, creating discussion topics for journal clubs, and aiding in curriculum development for our Nephrology fellowship. Potential future applications include simulation-based learning, interactive learning modules, personalized learning plans, and enhanced research capabilities. AI can also facilitate mentorship, improve assessment, and support administrative tasks. The integration of AI addresses challenges such as keeping pace with knowledge expansion, providing personalized learning experiences, and improving access to expertise. In summary, the integration of generative AI into nephrology education represents a paradigm shift in preparing future kidney specialists. While AI offers numerous benefits, challenges such as data privacy and maintaining the human element in patient care must be addressed. A balanced approach that preserves human mentorship while employing AI's capabilities is crucial for cultivating well-rounded, competent, and compassionate nephrologists ready to tackle future kidney health challenges.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769794","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":"Opioid use and poisoning in hospitalized patients with chronic kidney disease.","authors":"Nadim Zaidan, Youssef Jalloul, David S Goldfarb, Hiba Azar, Suzanne El-Sayegh","doi":"10.1007/s40620-024-02159-4","DOIUrl":"https://doi.org/10.1007/s40620-024-02159-4","url":null,"abstract":"<p><strong>Background: </strong>Identifying factors associated with uncomplicated and complicated opioid use is essential, especially with regard to safety concerns in impaired kidney function. Literature about opioid prescription and their potential complications in patients with different stages of chronic kidney disease (CKD) is scarce. This study describes opioid use and poisoning in hospitalized CKD patients.</p><p><strong>Methods: </strong>The National Inpatient Database (NIS) was queried from 2016 to 2020 to identify which patients with known CKD stages were admitted with diagnoses of uncomplicated and complicated opioid use, and opioid poisoning. Patients with end-stage kidney disease receiving any form of renal replacement therapy were excluded. CKD1 served as a reference, and demographic and socio-economic characteristics were accounted for. Logistic regressions were performed to evaluate the relationship between CKD stages and each condition.</p><p><strong>Results: </strong>The final cohort included 2,917,404 (14,587,017 weighted) CKD patients, of whom 1.763 ± 0.023% and 1.177 ± 0.016% had uncomplicated and complicated opioid use, respectively. Odds of uncomplicated use were lower with more advanced CKD stages. We observed an increase of complicated use with milder forms of CKD. No differences in odds of complicated opioid use were found when CKD4-5 patients were compared to CKD1. After adjustment, opioid use was found to be the main predictor of poisoning in hospitalized CKD patients.</p><p><strong>Conclusion: </strong>Prescribers appear to be more cautious in patients with advanced CKD, with lower odds of being on opioid analgesics in this group. Most CKD patients had higher odds of complicated use, and poisoning was essentially driven by complicated opioid use rather than CKD stage.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769795","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":"Efficacy and safety of novel anticoagulant therapies in patients with chronic kidney disease-a systematic review and meta-analysis.","authors":"Ernesto Calderon Martinez, Camila Sanchez Cruz, Edna Y Diarte Acosta, Daniel Alejandro Aguirre Cano, Ana Maria Espinosa, Diana Othón Martínez, Flor Furman, Sebastian Obando Vera","doi":"10.1007/s40620-024-02130-3","DOIUrl":"https://doi.org/10.1007/s40620-024-02130-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic Kidney Disease (CKD) significantly increases the risk of cardiovascular diseases, including atrial fibrillation, which usually requires anticoagulant therapy. The effectiveness and safety of direct oral anticoagulants compared to vitamin K antagonists in patients with CKD remain insufficiently studied, particularly in the more advanced stages.</p><p><strong>Methods: </strong>This systematic review, registered in PROSPERO (CRD42023410192), adhered to PRISMA guidelines and included randomized clinical trials and cohort studies comparing direct oral anticoagulants and vitamin K antagonists in CKD patients. Major databases were searched, and studies were selected based on strict inclusion criteria. A meta-analysis was performed using random-effects models.</p><p><strong>Results: </strong>Twenty-three studies with a total of 465,673 CKD patients were included. Direct oral anticoagulants showed a significant reduction in major bleeding events compared to vitamin K antagonists (Relative Risk [RR] = 0.62, 95% Confidence Interval: 0.49-0.79, p < 0.01) and a non-significant trend toward reducing thromboembolic events (RR = 0.69, 95% Confidence Interval: 0.43-1.14, p = 0.11). Furthermore, direct oral anticoagulants were associated with a significant reduction in all-cause mortality (RR = 0.63, 95% Confidence Interval: 0.43-0.91, p = 0.02).</p><p><strong>Conclusion: </strong>Direct oral anticoagulants may offer a safe alternative to vitamin K antagonists in CKD patients, particularly in terms of reducing bleeding risks and potentially improving survival. However, their role in preventing thromboembolic events remains uncertain, highlighting the need for further research, especially in patients with advanced CKD and kidney failure.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755240","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":"Development and evaluation of a kidney health questionnaire and estimates of chronic kidney disease prevalence in the Cooperative Health Research in South Tyrol (CHRIS) study.","authors":"Giulia Barbieri, Lucia Cazzoletti, Roberto Melotti, Essi Hantikainen, Rebecca Lundin, Laura Barin, Martin Gögele, Peter Riegler, Pietro Manuel Ferraro, Peter Paul Pramstaller, Giovanni Gambaro, Maria Elisabetta Zanolin, Cristian Pattaro","doi":"10.1007/s40620-024-02157-6","DOIUrl":"https://doi.org/10.1007/s40620-024-02157-6","url":null,"abstract":"<p><strong>Background: </strong>Kidney diseases are a public health burden but are poorly investigated in the general population. In light of inadequate survey tools, we developed a novel questionnaire for use in population-based studies, to retrospectively assess kidney diseases.</p><p><strong>Methods: </strong>The questionnaire covered general kidney diseases, reduced kidney function, and renal surgeries. It was administered between 2011 and 2018 to 11,684 participants (median age = 45 years) of the Cooperative Health Research in South Tyrol (CHRIS) study. Fasting estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were measured. By factor analysis we contextualized the questionnaire content with respect to the biochemical measurements. We estimated overall and sex-stratified prevalence of kidney diseases, including possible CKD, calibrating them to the general target population via relative sampling weights.</p><p><strong>Results: </strong>Population-representative prevalence of glomerulonephritis, pyelonephritis, and congenital kidney diseases was 1.0%, 3.0%, and 0.2%, respectively, with corresponding odds ratios for females versus males of 1.4 (95% confidence interval: 1.0, 2.0), 8.7 (6.2, 12.3), and 0.7 (0.3, 1.6), respectively. Prevalence of kidney dysfunction (eGFR < 60 mL/min/1.73 m² or UACR > 30 mg/g) was 8.59%, while prevalence of self-reported CKD was 0.69%, indicating 95.3% of lack of disease awareness, with a similar figure in people with diabetes or hypertension. Overall, 15.76% of the population was affected by a kidney disease of any kind.</p><p><strong>Conclusion: </strong>In the Val Venosta/Vinschgau alpine district, CKD prevalence aligned with Western European estimates. Kidney health questionnaire implementation in population studies is feasible and valuable to assess CKD awareness, which we found to be dramatically low.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729445","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":"Nationwide mortality following acute type B aortic dissection and the survival advantage of obesity among dialysis patients in Japan.","authors":"Yuta Nakano, Shintaro Mandai, Yutaro Mori, Fumiaki Ando, Koichiro Susa, Takayasu Mori, Soichiro Iimori, Shotaro Naito, Eisei Sohara, Kiyohide Fushimi, Shinichi Uchida","doi":"10.1007/s40620-024-02147-8","DOIUrl":"https://doi.org/10.1007/s40620-024-02147-8","url":null,"abstract":"<p><strong>Background: </strong>The incidence of acute type B aortic dissection is higher than that of acute type A aortic dissection among patients on dialysis. However, the impact of being on chronic dialysis on outcomes after type B aortic dissection remains unknown. This study aimed to investigate the trends in in-hospital mortality after type B aortic dissection and the association between body mass index (BMI) and survival paradox on dialysis.</p><p><strong>Methods: </strong>This study included 48,889 type B aortic dissection hospitalizations in Japan from 2010 to 2020 based on data from a nationwide administrative database. Logistic regression was used to examine mortality risks and restricted cubic spline to investigate the non-linear association between mortality and BMI.</p><p><strong>Results: </strong>There were 2,116 in-hospital deaths, and the mortality rates were 8.0% in patients receiving chronic dialysis and 4.3% in patients not receiving dialysis. Patients not receiving dialysis had decreased trends of absolute mortality. Meanwhile, patients receiving chronic dialysis had a higher mortality rate from 2010 to 2020. The mortality risk was high in patients receiving chronic dialysis who were underweight and had normal BMI, but not in those who were overweight. Restricted cubic spline analysis showed that a higher BMI was associated with a lower mortality risk in dialysis patients. This finding contrasted the U-shape observed in patients not receiving dialysis.</p><p><strong>Conclusions: </strong>A lower BMI was associated with a higher risk of in-hospital mortality after type B aortic dissection among dialysis patients, thereby illustrating the obesity paradox. Our findings provide insights that can enhance the management strategies for dialysis patients facing type B aortic dissection.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729485","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":"Clinical trial emulation in nephrology.","authors":"Carmine Zoccali, Giovanni Tripepi","doi":"10.1007/s40620-024-02158-5","DOIUrl":"https://doi.org/10.1007/s40620-024-02158-5","url":null,"abstract":"<p><p>Trial emulation, also known as target trial emulation, has significantly advanced epidemiology and causal inference by providing a robust framework for deriving causal relationships from observational data. This approach aims to reduce biases and confounding factors inherent in observational studies, thereby improving the validity of causal inferences. By designing observational studies to mimic randomized controlled trials (RCTs) as closely as possible, researchers can better control for confounding and bias. Key components of trial emulation include defining a clear time-zero, simulating random assignment using techniques like propensity score matching and inverse probability treatment weighting, assessing group comparability by standardized mean differences and establishing a clear comparison strategy. The increasing availability of large-scale real-world databases, such as research cohorts, patient registries, and hospital records, has driven the popularity of target trial emulation. These data sources offer information on patient outcomes, treatment patterns, and disease progression in real-world settings. By applying the principles of target trial emulation to these rich data sources, researchers can design studies that provide robust causal inferences about the effects of interventions, informing clinical guidelines and regulatory decisions. Despite its advantages, trial emulation faces challenges like data quality, unmeasured confounding, and implementation complexity. Future directions include integrating trial emulation with machine learning techniques and developing methods to address unmeasured confounding. Overall, trial emulation represents a significant advancement in epidemiology, offering a valuable tool for deriving accurate and reliable causal inferences from observational data, ultimately improving public health outcomes.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729442","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":"Computed tomography peritoneography to explore peritoneal dialysis dysfunction: a Nephrology picture.","authors":"Thibault Wallez, Guillaume Fernandes, Cristina Anca Dragean, Michael Moryoussef","doi":"10.1007/s40620-024-02155-8","DOIUrl":"https://doi.org/10.1007/s40620-024-02155-8","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716314","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":"Assessment of total carotid plaque area progression in patients with chronic kidney disease. Good practices for decision-making.","authors":"Daniela J Porta, Mariana N Carrillo, Hernán A Pérez, María A Rivoira, Grisel N Ledesma, Sonia E Muñoz, Laura R Aballay, Luis J Armando, Jeffrey R Schelling, J David Spence, Néstor H García","doi":"10.1007/s40620-024-02146-9","DOIUrl":"https://doi.org/10.1007/s40620-024-02146-9","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) increases cardiovascular risk, however, traditional cardiovascular risk factors cannot entirely explain it. A real-world investigation examined the concept that renal function decline is linked to carotid total plaque area progression, which strongly confirms cardiovascular risk. We analyzed CKD patients in stages 1-3 to find risk factor relationships before the onset of severe CKD.</p><p><strong>Methods: </strong>We monitored 328 patients for 16 ± 5 months. Participants were classified at baseline by estimated glomerular filtration rate (eGFR) stage: G1 (≥ 90), G2 (60-89), and G3 (30-59 ml/min/1.73m²). Ultrasound-guided total plaque area tracked atherosclerosis. Age, sex, blood pressure, lipids, and HbA1c were covariates. Total plaque area and variables were measured on day 1 and at the conclusion of observation. We used a multilevel mixed effects model to assess biological and behavioral factors on total plaque area progression in the general population. For validation, this research was conducted on 73 CKD patients with optimal traditional cardiovascular risk factor management during 15 ± 5 months.</p><p><strong>Results: </strong>Multiple analyses showed an inverse relationship between eGFR decline and total plaque area progression [β-exponent = 0.99 (95% CI = 0.98-0.99)], regardless of age, lipid profile, blood pressure, smoking, diabetes, or hypertension. The correlation remained significant in the 73-patient sample with optimal traditional cardiovascular risk factor management (β-exponent = 0.99; 95% CI 0.97-0.99). Although traditional cardiovascular risk factor management was excellent, total plaque area increased considerably in G2-G3 patients compared to G1.</p><p><strong>Conclusions: </strong>CKD, total plaque area, and eGFR are inversely correlated, independent of traditional cardiovascular risk factors, suggesting that non-traditional mechanisms are responsible for resistant atherosclerosis. The combination of eGFR and total plaque area may be useful in identifying high-risk patients.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695454","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":"Green nephrology for the nephrology curriculum? Opinions of Italian nephrology residents.","authors":"Gaetano Alfano, Mario Salomone, Carole Bonnet, Massimo Torreggiani, Giorgina Barbara Piccoli","doi":"10.1007/s40620-024-02140-1","DOIUrl":"https://doi.org/10.1007/s40620-024-02140-1","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695487","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}