Kidney Research and Clinical Practice最新文献

{"title":"Renal fibrosis: research progress on mechanisms and therapeutic strategies.","authors":"Cheng-Xiao Yin, Jia-Rui Fan, Xiao-Gang Du","doi":"10.23876/j.krcp.24.158","DOIUrl":"https://doi.org/10.23876/j.krcp.24.158","url":null,"abstract":"<p><p>Renal fibrosis (RF) is a prevalent clinical symptom of numerous chronic kidney illnesses and a significant pathological alteration in end-stage renal disease resulting from various mechanisms, such as abnormally activated signaling pathways, microRNAs, aging, autophagy disorders, and fibrotic ecological niches, all of which contribute to RF development. Inhibiting, blocking, or delaying the aforementioned mechanisms may yield novel approaches for treating RF. This article explores advancements in the comprehension of the mechanisms and therapeutic approaches for RF.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life, socioeconomic impact, and medical consideration of living kidney donors: a comprehensive survey in Korea.","authors":"Eunjeong Kang, Yaerim Kim, Jang Wook Lee, Seungyeup Han, Hyeong Dong Yuk, Chang Wook Jeong, Ahram Han, Sangil Min, Sehoon Park, Yong Chul Kim, Yon Su Kim, Jongwon Ha, Hajeong Lee","doi":"10.23876/j.krcp.24.191","DOIUrl":"https://doi.org/10.23876/j.krcp.24.191","url":null,"abstract":"<p><strong>Background: </strong>South Korea stands out as a prominent nation relying heavily on living-donor transplants, with a high incidence of living-donor kidney transplants. This study aimed to obtain objective data on the psychological, social, and mental health status of living kidney donors in South Korea.</p><p><strong>Methods: </strong>A questionnaire was administered to living kidney donors at two tertiary hospitals between June 2020 and November 2020. The survey covered demographic information, motives for donation, concerns during donation, medical and socioeconomic evaluation, pain assessment, quality of life using the 36-Item Short Form Health Survey measurement, and depression screening using the nine-item Patient Health Questionnaire.</p><p><strong>Results: </strong>A total of 95 donors completed the pre-donation survey, 273 completed the post-donation survey, and 68 completed both surveys. Most donors prioritized altruistic reasons for donating, with concerns primarily related to physical issues. After donation, the donors experienced a decrease in subjective health scores and quality of life and an increase in depressive symptoms. Economic and social changes were reported by 34.2% of the donors, with significant financial burdens related to surgical costs and insurance restrictions.</p><p><strong>Conclusion: </strong>Living kidney donors in Korea face psychological, social, and economic challenges after donation. Understanding the donors' concerns and difficulties is crucial to ensure their wellbeing and provide appropriate support.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology and potential treatment of uremic sarcopenia.","authors":"Shao-Yu Yang, Jia-Huang Chen, Chih-Kang Chiang, Kuan-Yu Hung","doi":"10.23876/j.krcp.24.176","DOIUrl":"https://doi.org/10.23876/j.krcp.24.176","url":null,"abstract":"<p><p>Sarcopenia, commonly found in the elderly and characterized by the loss of skeletal muscle mass, decreased muscle strength, and reduced physical performance, draws attention because it often leads to frailty, an increased risk of falls and fractures, and higher morbidity and mortality. Patients with chronic kidney disease (CKD) usually suffer from malnutrition, physical inactivity, inflammation, metabolic acidosis, insulin resistance, and other hormonal changes, which are all aggravating factors of sarcopenia. Therefore, the prevention, early detection, and adequate management for sarcopenia in patients with CKD help to improve their quality of life, prevent various complications and disabilities, as well as to reduce the risk of major morbidities and death. We reviewed the diagnosis and prevalence of sarcopenia in CKD and discussed the risk factors, etiology, pathophysiology, clinical impacts, and present treatment strategies for sarcopenia in CKD. The applications of exercises along with nutritional interventions, correction of metabolic acidosis caused by CKD, anabolic hormones, appetite stimulants, and other agents in uremic sarcopenia were discussed. Early detection and adequate management help to improve muscle strength and mass and enhance physical performance, therefore improving the quality of life and reducing mortality in CKD patients with sarcopenia.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein-energy wasting in chronic kidney disease: mechanisms responsible for loss of muscle mass and function.","authors":"S Russ Price, Xiaonan H Wang","doi":"10.23876/j.krcp.24.214","DOIUrl":"https://doi.org/10.23876/j.krcp.24.214","url":null,"abstract":"<p><p>The worldwide prevalence of chronic kidney disease (CKD) is high and growing, making CKD a leading cause of mortality. Skeletal muscle wasting, sometimes called sarcopenia or protein-energy wasting, is a frequent, serious consequence of CKD that reduces muscle strength and function, diminishes the quality of life of patients, and raises their risk of comorbidities and death. Muscle atrophy results from a disturbance in muscle protein balance that results from some combination of an increased rate of protein degradation, a decreased rate of protein synthesis, and dysfunctional muscle regeneration. Development of therapeutic strategies to ameliorate muscle loss, or maintain muscle mass, is challenging because of the multifactorial nature of the signals that alter protein homeostasis. This review discusses the cellular signals and mechanisms that negatively alter protein turnover in skeletal muscle during CKD.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel approach to the relation of multi-pollutant effect and kidney dysfunction: data analysis from the Korean National Environmental Health Survey Cycle 3 (2015-2017).","authors":"Inae Lee, Junhyug Noh, Yaerim Kim, Jung Nam An, Jae Yoon Park, Yong Chul Kim, Jeonghwan Lee, Jung Pyo Lee, Jong Soo Lee, Kyungho Choi, Kyung Don Yoo","doi":"10.23876/j.krcp.24.173","DOIUrl":"https://doi.org/10.23876/j.krcp.24.173","url":null,"abstract":"<p><strong>Background: </strong>Traditional statistical models for estimating the impact of multiple environmental chemicals on kidney outcomes have limitations. This study aimed to evaluate the risk prediction of kidney disease in the general population using innovative methodologies.</p><p><strong>Methods: </strong>Serum persistent organic pollutant (POP), urinary chemical, serum creatinine, and urinary albumin levels were measured in a subpopulation of adults (n = 1,266) drawn from the Korean National Environmental Health Survey Cycle 3 (n = 3,787). Various machine learning (ML) models, including bagging, ridge, lasso, and random forest, were used to predict chronic kidney disease (CKD) risk, and their results were compared with those of conventional logistic regression methods. Furthermore, the weighted quantile sum (WQS) approach, which assigns weights to mixture components, was employed to evaluate multi-pollutant effects. Presplit was attempted to incorporate existing domain knowledge.</p><p><strong>Results: </strong>A total of 42 variables, including baseline characteristics and laboratory findings, were analyzed during the ML modeling process. The decision tree algorithm generally outperformed logistic regression in risk prediction. Based on the decision tree models, lipid-corrected polychlorinated biphenyl 153 (PCB153) emerged as the strongest predictor of CKD. PCB153 remained a significant predictor of CKD in middle-aged adults (<50 years; p = 0.01) following age stratification. Particularly among middle-aged adults with hemoglobin levels >13.25 g/dL, CKD risk was predicted to be 71.4% in the high serum PCB153 group.</p><p><strong>Conclusion: </strong>Current observations showed that utilizing both WQS regression and ML-based predictions offers valuable insights. In the models, POPs, particularly PCB153, were identified as important risk factors for CKD in Korean adults.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of bortezomib-based desensitization in highly sensitized living and deceased donor kidney transplantation.","authors":"Hyeran Park, Hanbi Lee, Sang Hun Eum, Ji-Won Min, Hye Eun Yoon, Eun-Jee Oh, Chul Woo Yang, Byung Ha Chung","doi":"10.23876/j.krcp.24.077","DOIUrl":"https://doi.org/10.23876/j.krcp.24.077","url":null,"abstract":"<p><strong>Background: </strong>Sensitization acts as an immunological barrier to successful kidney transplantation (KT). We aim to investigate the efficacy and safety of bortezomib-based desensitization (BOZ-DSZ) in both highly sensitized living donor KT (LDKT) and deceased donor KT (DDKT).</p><p><strong>Methods: </strong>We applied BOZ-DSZ to 20 highly sensitized patients-14 LDKT and six DDKT candidates-and analyzed the change in anti-human leukocyte antigen (HLA) antibody, the success rate of transplantation, and posttransplant outcomes including biopsy-proven allograft rejection (BPAR) rate, infectious complication, and allograft survival.</p><p><strong>Results: </strong>Among 14 LDKT candidates, the peak mean fluorescence intensity (MFI) level of donor-specific anti-HLA antibody (HLA-DSA) decreased in 10 patients (p < 0.05), and the success rate of KT was 92.9% (13 of 14). Incidence of BPAR within the first posttransplant year was 53.8% (7 of 13), and all such cases were rescued by antirejection treatment. One case resulted in mortality due to pneumonia, and there was one allograft failure during the follow-up of 34 months (range, 6-129 months). Among the six DDKT candidates, the peak MFI level of HLA-DSA showed a significant decrease after DSZ in five patients (p = 0.098), and the success rate of KT was 50.0% (3 of 6). One BPAR case (33.3%) occurred within the first posttransplant year and was successfully treated. There was one case of Cytomegalovirus viremia, and there was no allograft failure during the 36-month follow-up (range, 17-42 months). Conclusion BOZ-DSZ is effective and safe in terms of successful DSZ, infectious complications, and allograft outcomes for both highly sensitized LDKT and DDKT candidates.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel insights and practical strategies for health professionals to improve the uptake of plant-based diets in people with chronic kidney disease.","authors":"Kelly Lambert, Vanessa Cullen, Brian Jones, Amy McAlpine, Brad Rossiter","doi":"10.23876/j.krcp.24.272","DOIUrl":"https://doi.org/10.23876/j.krcp.24.272","url":null,"abstract":"<p><p>There has been a significant shift in dietary guidance in the past 5 years for people with chronic kidney disease. Multiple best practice guidelines in nephrology now include nutritional guidance that recommends the adoption of healthy dietary patterns with an emphasis on whole foods and diets with adequate fruit, vegetables, legumes, nuts, wholegrain bread and cereals, with minimal amounts of processed foods high in salt, sugar, and fat. While there is shortage of enthusiasm, from health professionals to adopt this new approach, there is a clear knowledge gap on how to get people to adopt plant-based diets. This is particularly apparent in settings where renal dietetic services are lacking. This manuscript, cowritten with consumers with lived experience of chronic kidney disease, outlines seven strategies to facilitate the adoption of plant-based diets and draws on evidence from the fields of marketing, implementation science, and behavior change. These strategies include paying attention to language, starting gradually and increasing variety, then transitioning to increasing vegetable portion size, focusing on adequacy, giving explicit guidance on how to reduce meat, remembering neophobia, and emphasizing the importance of individualized advice. Additional strategies from consumers include the need to address consumer fears about the adequacy of nutrient intake, focus on foods to enjoy not nutrients to restrict; provide advice on how to sensibly include favorite foods and make meals flavorsome and finally consider the adoption of plant-based diets as a spectrum to strive towards-with animal foods included at varying levels depending on food preferences, budget, cultural preferences.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disaster emergency meal plans for Korean patients who require hemodialysis.","authors":"Yumi Jang, Seong Geun Kim, Sua Lee, Hyun Ho Oh, Nara Shin, Young-Ki Lee, Kyung Don Yoo","doi":"10.23876/j.krcp.24.242","DOIUrl":"https://doi.org/10.23876/j.krcp.24.242","url":null,"abstract":"<p><p>Proactive planning and preparation are critical to the safety of patients on dialysis during emergencies, such as natural disasters, and pandemics, such as coronavirus disease 2019. Patients with end-stage kidney disease are particularly vulnerable to disruptions such as power outages, water shortages, transportation issues, and dialysis center closures because they can result in missed dialysis sessions and severe health deterioration. This study aimed to develop tailored dietary guidelines for Korean patients on hemodialysis by applying the U.S. Centers for Disease Control and Prevention guidelines and considering the dietary limitations of these patients. The proposed guidelines impose strict potassium, phosphorus, sodium, and fluid restrictions and include two 3-day emergency meal plans: one for scenarios involving disruptions of electricity and water supply and another for situations in which these utilities are available. The use of a food exchange list enhances the dietary flexibility of these patients. Although these guidelines cannot replace dialysis, they could mitigate the impact of emergencies on patient health by providing essential support during critical periods.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia, sarcopenic obesity, and frailty in individuals with chronic kidney disease: a comprehensive review.","authors":"Chia-Ter Chao, Csaba P Kovesdy, Reshma Aziz Merchant","doi":"10.23876/j.krcp.24.207","DOIUrl":"https://doi.org/10.23876/j.krcp.24.207","url":null,"abstract":"<p><p>Population aging is a global challenge that increases the burden of chronic kidney disease (CKD) and geriatric syndromes such as sarcopenia, sarcopenic obesity, and frailty. These conditions affect almost half of older CKD individuals and are associated with poor outcomes, including CKD progression, cardiometabolic complications, increased health and social care costs, and mortality. They can be both the cause and consequent of CKD and lead to a vicious downward spiral if not addressed early. Frailty is a multidimensional syndrome characterized by reduced physiological reserve and increased vulnerability to stressors. Sarcopenia refers to the progressive and generalized loss of skeletal muscle mass, strength, and/or physical performance with aging. Sarcopenic obesity denotes the combination of sarcopenia and obesity that synergistically leads to poor outcomes. They share common pathogenic mechanisms, such as multimorbidity, inflammation, oxidative stress, uremic milieu, insulin resistance, endocrine disturbances, CKD complications, and psychosocial factors that may limit access to proper nutrition and resources. Management requires a multidisciplinary and patient-centered approach, taking into consideration their baseline physical function and endurance, CKD stage, nutrition status, comorbidities, symptoms, treatment goals, cost, and accessibility. Interventions include exercise, nutrition, comorbidity optimization, geriatric assessment, sensory training, and kidney-oriented care. This review summarizes the current knowledge on the diagnosis and treatment of sarcopenia, sarcopenic obesity, and frailty in individuals with CKD, followed by up-to-date summaries of how best to manage affected individuals.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microstructural and functional connectivity changes of decision-related brain networks in end-stage kidney disease patients undergoing peritoneal dialysis.","authors":"Jingjing Yin, Dongxue Luo, Shuhua Ma, Chudan Cai, Xiaoyan Shi, Yanqiang Peng, Jianwei Peng, Lingyu Chen, Yanmin Zheng, Ruiwei Guo, Zelin Zhuang, Zhirong Lin, Lei Xie","doi":"10.23876/j.krcp.24.146","DOIUrl":"https://doi.org/10.23876/j.krcp.24.146","url":null,"abstract":"<p><strong>Background: </strong>We aimed to explore changes in decision-related brain microstructure, brain functional activities, and functional connectivity, and their correlations with cognitive function in end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Furthermore, the impact of dialysis on these changes was examined.</p><p><strong>Methods: </strong>Thirty ESKD patients undergoing PD, 20 chronic kidney disease (CKD) stage 5 patients without dialysis (predialysis CKD stage 5), and 30 healthy controls (HC) were recruited for the study. Various assessments have been conducted, including neuropsychological scale testing, decision-related behavioral tests, voxel-based morphometry, and functional magnetic resonance imaging.</p><p><strong>Results: </strong>Compared to the HC group, PD patients showed decreased functional activation and gray matter volume in multiple decision-related brain areas, including the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC) (p < 0.05, false discovery rate-corrected). The default mode network (DMN) and salience network (SAN) were the primary brain regions that showed decreased functional connectivity to the vmPFC and ACC. Additionally, compared to the predialysis group, the PD group showed enhanced brain activation in decision-related brain regions such as the ACC, vmPFC, and insula. Though PD and predialysis CKD stage 5 patients performed poorly in the neuropsychological and Iowa Gambling Task (IGT), there was no significant difference between the two groups. The structure and function variabilities of the vmPFC were correlated with IGT and Montreal Cognitive Assessment score, and the activation of OFC was negatively associated with blood creatinine, cystatin, and parathyroid hormone levels.</p><p><strong>Conclusion: </strong>In summary, PD can change the structure and function of decision-related brain circuits (vmPFC-OFC-ACC) and reduce integration within DMN and SAN, which is correlated with cognitive function and clinical features. Moreover, our findings may suggest the comparable capability of PD in preserving one's cognitive function and disease progression. Multimodal neuroimaging based on structure and function can provide more objective information for the early diagnosis and intervention of cognitive impairment in ESKD patients.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}