Journal of Nephrology最新文献

{"title":"Improving the sustainability and quality of kidney health care through life cycle assessments, quality improvement, education and technical innovations: the KitNewCare approach.","authors":"Brett Duane, Ingeborg Steinbach, Rachel Stancliffe, Stefi Barna, David Cameron, Ilaria de Barbieri, Edita Noruisiene, Frances Mortimer, Karin Gerritsen, Raymond Vanholder, Gabriele Donati, Gaetano Alfano, Jolanta Malyszko, Giulia Ligabue, Bridget Johnston, Mary Louise Wratten, Marialuisa Caiazzo, Elisabeth Schmid, Alberto Ortiz","doi":"10.1007/s40620-024-02114-3","DOIUrl":"https://doi.org/10.1007/s40620-024-02114-3","url":null,"abstract":"<p><p>The European Union (EU)-funded KitNewCare consortium aims to create and manage a comprehensive EU-wide programme focusing on sustainability in Kidney Care. Around 850 million people have chronic kidney disease (CKD) worldwide and by 2030, 6 million will need kidney replacement therapy, mainly haemodialysis. As the world population gets older, projections for the end of the century worsen. From a sustainability perspective, healthcare systems contribute around 5-11% of total carbon emissions. Kidney care is one of the most resource-intensive specialties. In addition to energy, haemodialysis and peritoneal dialysis require transportation of patients and personnel to and from facilities, use large volumes of water and generate significant plastic waste. Overall, current dialysis is not sustainable in the medium term. Primary prevention, early diagnosis and treatment of CKD and transplantation will decrease the need for dialysis, but this will take time and will not prevent the need for dialysis in millions of persons. There is a need to improve knowledge around the environmental and financial cost of kidney care and social and health outcomes of each patient pathway including using holistic tools such as life cycle assessment. This knowledge will allow workflow optimisations, organisational transformations and technological innovations across Europe, learning from different clinical sites. KitNewCare will build a European-wide knowledge base for sustainability in kidney care, develop and introduce a novel 4-factor database for comprehensive impact analysis, implement optimised processes and organisational transformations in four European clinical sites. It will also pilot innovations from small- and medium-sized high-tech enterprises with a focus on kidney care, and establish a network for continuous monitoring, benchmarking, and implementation of sustainable solutions across healthcare sectors. This paper presents the rationale behind selecting kidney disease as a focal point, summarises the current state of knowledge, and outlines the foundational statement underlying KitNewCare's operational framework.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604789","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":"Predictors of acute kidney injury in chronic kidney disease patients treated for cardiovascular disease in the cardiac intensive care unit (MORCOR-TURK subgroup analysis).","authors":"Omer Dogan, Aybike Gul Tasdelen Acar, Mural Gul, Ozgen Safak, Sefa Erdi Omur, Adem Atıcı, Hasan Ali Barman, Muhammed Erkam Cengil, Ahmet Seyda Yilmaz, İbrahim Ersoy","doi":"10.1007/s40620-024-02127-y","DOIUrl":"https://doi.org/10.1007/s40620-024-02127-y","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common complication in chronic kidney disease (CKD) patients in the cardiac intensive care unit (cardiac ICU). In this study, we aimed to identify predictors of AKI in CKD patients treated in the cardiac ICU for cardiovascular diseases.</p><p><strong>Methods: </strong>The MORCOR-TURK trial was conducted as a multicenter, prospective, cross-sectional, and noninterventional investigation. A total of 3157 patients treated in the cardiac ICU were enrolled from 50 centers over the course of one month. In this subgroup analysis, 615 patients with CKD treated in the cardiac ICU for cardiovascular disease were included in the study. The primary outcome of this study was the development of AKI. During hospitalization, patients who developed AKI were identified.</p><p><strong>Results: </strong>AKI developed in 288 patients (46%). After multivariable analysis, decompensated heart failure (OR: 3.72, p = 0.005), primary percutaneous coronary intervention (OR: 3.75, p = 0.004), non-primary percutaneous coronary intervention (OR: 2.85, p = 0.033), troponin levels (OR: 1.04, p = 0.031), and need for mechanical ventilation (OR: 3.11, p < 0.001) were identified as independent predictors of AKI development in CKD patients.</p><p><strong>Conclusion: </strong>Our efforts to identify AKI predictors in cardiac ICU patients with CKD have yielded directly applicable results in clinical practice. AKI can be prevented by developing personalized strategies to follow up and treat cardiac ICU patients with CKD who have decompensated heart failure, are undergoing percutaneous coronary intervention (primary and non-primary), have high troponin levels, and need mechanical ventilation.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622407","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":"Communicating health risk in chronic kidney disease: a scoping review.","authors":"Emma Caton, Ros Aird, Maria Da Silva-Gane, Sivakumar Sridharan, David Wellsted, Shivani Sharma, Ken Farrington","doi":"10.1007/s40620-024-02098-0","DOIUrl":"https://doi.org/10.1007/s40620-024-02098-0","url":null,"abstract":"<p><strong>Background: </strong>Communicating risk is a key component of shared decision-making and is vital for the management of advanced chronic kidney disease (CKD). Despite this, there is little evidence to suggest how best to communicate health risk information to people living with CKD. The aim of this review was to identify and understand the nature of evidence-based risk communication strategies for people living with CKD.</p><p><strong>Methods: </strong>We searched MEDLINE, CINAHL and Scopus databases for articles which described or evaluated the use of risk communication strategies within the renal population. Similar risk communication strategies were collated and summarised narratively.</p><p><strong>Results: </strong>A total of 3700 sources were retrieved from the search, of which 19 were included in the review. Eleven studies reported primary research, and eight reported either narrative or systematic reviews. Seven main risk communication strategies were identified: framing, absolute versus relative risk, natural frequencies versus percentages, personalised risk estimates, qualitative risk communication, best-case/worst-case framework and use of graphs and graphics. There was a paucity of risk communication strategies specific to the CKD population.</p><p><strong>Conclusion: </strong>Evidence-based strategies to improve health risk communication for patients living with CKD are lacking. There is a need to establish the informational and communication preferences for patients living with CKD to better understand how to best communicate health risk information to individuals in this population.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604782","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":"Integrating the new pharmacological standard of care with traditional nutritional interventions in non-dialysis CKD.","authors":"Luca De Nicola, Adamasco Cupisti, Claudia D'Alessandro, Loreto Gesualdo, Domenico Santoro, Vincenzo Bellizzi","doi":"10.1007/s40620-024-02135-y","DOIUrl":"https://doi.org/10.1007/s40620-024-02135-y","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is widely recognized as a leading and growing contributor to global morbidity and mortality worldwide. Nutritional therapy is the basic treatment for metabolic control, and may contribute to nephroprotection; however, the absence of solid evidence on slowing CKD progression together with poor adherence to dietary prescription limit de facto its efficacy and prevent its more widespread use. Sodium-glucose transport protein 2 inhibitors (SGLT2is) are now considered the new standard of care in CKD; in addition, novel potassium binders, glucagon-like peptide-1 receptor antagonists (GLP1-RAs) and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) show either direct (SGLT2i, GLP1-RA, nsMRA) or indirect (potassium binders that enable the optimal use of renin-angiotensin-aldosterone system inhibitors) nephroprotective effects. These drugs could potentially lead to a more permissive diet, thereby allowing the patient to reap the benefits of this approach. In particular, SGLT2is, and to a lesser extent also GLP1-RAs and nsMRAs in patients with diabetic kidney disease, can counterbalance hyperfiltration as well as the higher protein intake often recorded in obese patients; on the other hand, potassium binders can facilitate following plant-based diets, which are considered healthy because of the high content of essential micronutrients such as antioxidant vitamins, minerals, alkalies, and fibers. In this review paper, we discuss the current pharmacological paradigm shift that places a new, broader standard of care in light of its interaction with nutritional therapy in order to optimize the global approach to patients with CKD not on dialysis.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604801","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":"Oxalate nephropathy from high-dose intravenous vitamin C in a patient with multiple myeloma.","authors":"Guangchen Zou, Jonathan Lim, Avi Z Rosenberg","doi":"10.1007/s40620-024-02078-4","DOIUrl":"https://doi.org/10.1007/s40620-024-02078-4","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604804","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":"Octreotide-LAR in ADPKD patients with very low kidney function: a single-center real-life experience.","authors":"Eleonora Riccio, Maria Amicone, Ivana Capuano, Daniela Pacella, Antonio Pisani","doi":"10.1007/s40620-024-02145-w","DOIUrl":"https://doi.org/10.1007/s40620-024-02145-w","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583157","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":"Patient-specific multifactorial mortality risk assessment using classification and regression tree analysis in the context of ambulatory blood pressure monitoring.","authors":"Bahar Tekin Çetin, Nuri Baris Hasbal, Enes Cevik, Ozgun Ekin Sahin, Merve Akyol, Zeynepgul Kalay, Duygu Ucku, Cem Tanriover, Mustafa Güldan, Lasin Özbek, Onur Memetoglu, Mert Emre Erden, Sidar Copur, Ianis Siriopol, Dimitrie Siriopol, Paola Ciceri, Mario Cozzolino, Mehmet Kanbay","doi":"10.1007/s40620-024-02128-x","DOIUrl":"https://doi.org/10.1007/s40620-024-02128-x","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory blood pressure monitoring is essential for understanding blood pressure patterns beyond clinical visits, aiding in risk assessment, treatment evaluation, and managing hypertension. This retrospective cohort study aimed to identify risk factors for all-cause mortality and major cardiovascular events in patients who underwent ambulatory blood pressure monitoring.</p><p><strong>Methodology: </strong>Eligible participants aged 18 or older, with an estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m², who underwent ambulatory blood pressure monitoring for various reasons, were included in the study. Data were gathered through telephone interviews, electronic health records, and the national health record system. Descriptive analysis and classification and regression tree modeling were used to uncover significant risk factors related to all-cause mortality and cardiovascular events, and to assess the model's performance compared to traditional Cox survival analysis.</p><p><strong>Results: </strong>The study included 1291 patients, primarily male (51.8%) with a mean age of 61.1 ± 15.2 years. During a mean follow-up of 46.9 months, 76 (5.9%) patients died of any cause, and 195 (15.1%) had a cardiovascular event. The highest survival rates were observed in patients with a diastolic blood pressure (BP) dipping percentage between - 2% and 29%, nighttime systolic BP variability below 32 mmHg, and age below 72. Conversely, smokers with a diastolic BP dipping percentage below - 10% showed the lowest survival rates. The best cardiovascular outcomes were observed in patients with diastolic BP dipping above - 11%, nighttime mean systolic BP < 144 mmHg, no statin use, normotensive status, and daytime mean heart rate ≥ 60 bpm. Conversely, the worst outcomes were seen in patients with diastolic BP dipping below - 11% and a morning surge ≥ 14 mmHg. In all-cause mortality and cardiovascular event analysis, the combined model demonstrated excellent calibration and predictive power, like the classification and regression tree model and traditional analysis.</p><p><strong>Conclusion: </strong>These findings highlight the potential of a combined model for assessing mortality and cardiovascular event risk in patients who have undergone ambulatory blood pressure monitoring.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583158","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 characteristics and outcomes of kidney transplantation in autosomal dominant polycystic kidney disease patients.","authors":"Jin Hyeog Lee, Jiyeon Myung, Sujin Gang, Hyun Jin Ryu, Nam Joon Yi, Jaeseok Yang","doi":"10.1007/s40620-024-02101-8","DOIUrl":"https://doi.org/10.1007/s40620-024-02101-8","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation (KT) is the best kidney replacement treatment for autosomal dominant polycystic kidney disease (ADPKD). We aimed to investigate the clinical characteristics and outcomes of KT in ADPKD patients compared to those in non-ADPKD patients.</p><p><strong>Methods: </strong>We retrospectively analyzed KT recipients in two Korean transplantation centers from 2005 to 2020. Propensity score-matching and Cox regression analysis were used to assess the clinical outcomes of ADPKD compared to non-ADPKD and identify prognostic factors influencing outcomes in ADPKD.</p><p><strong>Results: </strong>Among a total of 4452 KT patients, 189 (4.2%) were ADPKD patients. Median age at transplantation was 53.0 and 47.0 in ADPKD and non-ADPKD patients, respectively. In both groups, living-donor KT was more common than deceased-donor KT. The ADPKD group had a 4.09-fold higher risk of post-transplant diabetes mellitus and a 1.65-fold higher risk of post-transplant infection compared to the non-ADPKD group; however, subjects with ADPKD had similar risk of rejection, graft failure, and mortality. In the ADPKD group, kidney volume decreased after KT, irrespective of kidney volume status (Mayo classification), while the size of hepatic cysts increased. Neither kidney volume nor nephrectomy of native kidneys were associated with risk of infection, graft failure, or mortality in the ADPKD group.</p><p><strong>Conclusions: </strong>ADPKD patients have a higher risk of post-transplant diabetes mellitus and infection than non-ADPKD patients, with no significant impact of kidney volume or nephrectomy on post-transplant outcomes.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567320","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 ABCs of post-preeclampsia outpatient nephrology care: the Le Mans strategy.","authors":"Giorgina Barbara Piccoli, Oriana De Marco, Linda Njandjo, Marie-Thérèse Chevé, Massimo Torreggiani","doi":"10.1007/s40620-024-02137-w","DOIUrl":"https://doi.org/10.1007/s40620-024-02137-w","url":null,"abstract":"<p><p>Preeclampsia and hypertensive disorders of pregnancy complicate 3 to 5% of all pregnancies. Chronic kidney disease (CKD), at any stage, reportedly affects 3% of women in childbearing age but most of the time is underdiagnosed, especially in asymptomatic early stages. The link between preeclampsia/hypertensive disorders of pregnancy and CKD is bidirectional and women experiencing a preeclampsia/hypertensive disorder of pregnancy episode are at higher risk for developing CKD later in life, as well as metabolic and cardiovascular diseases. In turn, CKD is a risk factor for preeclampsia/hypertensive disorders of pregnancy. Thus, it is important to follow up patients after an episode of preeclampsia/hypertensive disorders of pregnancy in order to make a timely diagnosis of CKD or reduce the risk of another episode of preeclampsia/hypertensive disorder of pregnancy during a subsequent pregnancy. In Le Mans, we set up a dedicated outpatient clinic for women who experienced an episode of preeclampsia/hypertensive disorder of pregnancy. In this point of view paper, we present how we manage post-preeclampsia, in the hope that sharing this experience can promote the creation of dedicated outpatient clinics in other settings that will contribute to women's health.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564395","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":"Premature mortality and disparities in kidney healthcare for people with chronic kidney disease and severe mental health difficulties.","authors":"Clodagh Cogley, Mimi Smith-Jones, Elizabeth R Ralston, Jessica Bramham, Joseph Chilcot, Paul D'Alton, Claire Carswell, Chun Chiang Sin Fai Lam, Ashutosh Ratnam, Mohammad Al-Agil, Hugh Cairns, Kufreabasi Imo Etuk, Kate Bramham","doi":"10.1007/s40620-024-02103-6","DOIUrl":"https://doi.org/10.1007/s40620-024-02103-6","url":null,"abstract":"<p><strong>Background: </strong>People with severe mental health difficulties, including schizophrenia, bipolar disorder and psychosis, have higher risk of chronic kidney disease (CKD). Little was known regarding clinical outcomes and utilisation of kidney care for people with CKD and severe mental health difficulties.</p><p><strong>Methods: </strong>We conducted a retrospective cohort analysis of individuals with CKD attending a tertiary renal unit in London, between 2006 and 2019. Individuals with severe mental health difficulty diagnoses were identified, and differences between those with and without severe mental health difficulties were analysed.</p><p><strong>Results: </strong>Of the 5105 individuals with CKD, 112 (2.2%) had a recorded severe mental health difficulty diagnosis. The mean lifespan of those with severe mental health difficulties was 13.1 years shorter than those without severe mental health difficulties, t(1269) = 5.752, p < 0.001. People with severe mental health difficulties had more advanced CKD at their first nephrology appointment. There were no statistically significant differences between groups in the rates of kidney failure, age at onset of kidney failure, or time elapsed between first appointment and death/kidney failure. The number of inpatient admissions was similar between groups, but those with severe mental health difficulties had higher rates of emergency and ICU admissions. Among individuals on renal replacement therapy (RRT), those with severe mental health difficulties were less likely to receive a kidney transplant and peritoneal dialysis. For patients receiving haemodialysis, those with severe mental health difficulties had a higher proportion of shortened sessions, greater mean weight loss during sessions, and a higher proportion of serum potassium and phosphate levels outside normal ranges.</p><p><strong>Conclusions: </strong>Findings illustrate a number of disparities in kidney healthcare between people with and without severe mental health difficulties, underscoring the need for interventions which prevent premature mortality and improve kidney care for this population.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564389","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}