Kidney International Reports最新文献

{"title":"Paradigm Shift: Dialysis as a Terminal Condition","authors":"Lydia S. Dugdale","doi":"10.1016/j.ekir.2024.08.016","DOIUrl":"10.1016/j.ekir.2024.08.016","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions Related to Careers in Nephrology on Student Doctor Network Using Natural Language Processing","authors":"Kullaya Takkavatakarn , Yang Dai , Abhinaya Sridhar , Miriam Borvick , Ricki Ehrenfeld , Cristina Liriano Cepin , Girish N. Nadkarni , Lili Chan","doi":"10.1016/j.ekir.2024.07.030","DOIUrl":"10.1016/j.ekir.2024.07.030","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extremely Long-Lasting B-cell Depletion and BAFFling Effects Following Obinutuzumab-Based Regimen in Lupus Nephritis","authors":"Dario Roccatello , Savino Sciascia , Emanuele De Simone , Thomas Schindler , Elsa Martins , Huiyan (Ashley) Mao , Daniela Rossi , Roberta Fenoglio","doi":"10.1016/j.ekir.2024.08.008","DOIUrl":"10.1016/j.ekir.2024.08.008","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrafamilial Disease Heterogeneity in Primary Hyperoxaluria Type 1","authors":"Lisa J. Deesker ,&nbsp;Hazal A. Karacoban ,&nbsp;Elisabeth L. Metry ,&nbsp;Sander F. Garrelfs ,&nbsp;Justine Bacchetta ,&nbsp;Olivia Boyer ,&nbsp;Laure Collard ,&nbsp;Arnaud Devresse ,&nbsp;Wesley Hayes ,&nbsp;Sally-Anne Hulton ,&nbsp;Cristina Martin-Higueras ,&nbsp;Shabbir H. Moochhala ,&nbsp;Thomas J. Neuhaus ,&nbsp;Jun Oh ,&nbsp;Larisa Prikhodina ,&nbsp;Przemyslaw Sikora ,&nbsp;Michiel J.S. Oosterveld ,&nbsp;Jaap W. Groothoff ,&nbsp;Giorgia Mandrile ,&nbsp;Bodo B. Beck","doi":"10.1016/j.ekir.2024.07.026","DOIUrl":"10.1016/j.ekir.2024.07.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary hyperoxaluria type 1 (PH1) is known for its variable clinical course, even within families. However, the extent of this heterogeneity has not been well-studied. We aimed to analyze intrafamilial clinical heterogeneity and disease course among siblings in a large cohort of familial PH1 cases.</div></div><div><h3>Methods</h3><div>A retrospective registry study was performed using data from OxalEurope. All PH1 families with 2 or more affected siblings were included. A 6-point PH1 clinical outcome scoring system was developed to grade heterogeneity within a family. Intrafamilial clinical heterogeneity was defined as a score ≥2. Kaplan-Meier analyses were used to analyze differences in kidney survival between index cases and siblings.</div></div><div><h3>Results</h3><div>We included 88 families, encompassing 193 patients with PH1. The median interquartile range (IQR) follow-up time was 7.8 (1.9–17) years. Intrafamilial clinical heterogeneity, as defined by our score, was found in 38 (43%) PH1 families. In 54% of the families, affected siblings had a better outcome than the index case. Clinically asymptomatic siblings at the time of their diagnosis had a significantly more favorable clinical outcome based on the authors’ scoring system than siblings with clinical signs and index cases (<em>P</em> &lt; 0.001). Kaplan-Meier analyses revealed that index cases reached kidney failure at an earlier age and earlier in follow-up compared to siblings (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Intrafamilial clinical heterogeneity was found in a substantial number of familial PH1 cases. Compared to index cases, siblings had significantly better clinical outcomes and kidney survival; thereby supporting the policy of family screening to diagnose affected siblings early to improve their prognosis.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stepped-Wedge Trial of Decision Support for Acute Kidney Injury on Surgical Units","authors":"Matthew T. James ,&nbsp;Elijah Dixon ,&nbsp;Zhi Tan ,&nbsp;Pamela Mathura ,&nbsp;Indraneel Datta ,&nbsp;Rohan N. Lall ,&nbsp;Jennifer Landry ,&nbsp;Evan P. Minty ,&nbsp;Gregory A. Samis ,&nbsp;Gerald B. Winkelaar ,&nbsp;Neesh Pannu","doi":"10.1016/j.ekir.2024.07.025","DOIUrl":"10.1016/j.ekir.2024.07.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute kidney injury (AKI) is common in the perioperative setting and associated with poor outcomes. Whether clinical decision support improves early management and outcomes of AKI on surgical units is uncertain.</div></div><div><h3>Methods</h3><div>In this cluster-randomized, stepped-wedge trial, 8 surgical units in Alberta, Canada were randomized to various start dates to receive an education and clinical decision support intervention for recognition and early management of AKI. Eligible patients were aged ≥18 years, receiving care on a surgical unit, not already receiving dialysis, and with AKI.</div></div><div><h3>Results</h3><div>There were 2135 admissions of 2038 patients who met the inclusion criteria; mean (SD) age was 64.3 (16.2) years, and 885 (41.4%) were females. The proportion of patients who experienced the composite primary outcome of progression of AKI to a higher stage, receipt of dialysis, or death was 16.0% (178 events/1113 admissions) in the intervention group; and 17.5% (179 events/1022 admissions) in the control group (time-adjusted odds ratio, 0.76; 95% confidence interval [CI], 0.53–1.08; <em>P</em> = 0.12). There were no significant differences between groups in process of care outcomes within 48 hours of AKI onset, including administration of i.v. fluids, or withdrawal of medications affecting kidney function. Both groups experienced similar lengths of stay in hospital after AKI and change in estimated glomerular filtration rate (eGFR) at 3 months.</div></div><div><h3>Conclusion</h3><div>An education and clinical decision support intervention did not significantly improve processes of care or reduce progression of AKI, length of hospital stays, or recovery of kidney function in patients with AKI on surgical units.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Ambient Temperature Associated With Increased Cardiovascular Disease–Risk Among Patients on Hemodialysis","authors":"Yuzhi Xi ,&nbsp;Zachary S. Wettstein ,&nbsp;Abhijit V. Kshirsagar ,&nbsp;Yang Liu ,&nbsp;Danlu Zhang ,&nbsp;Yun Hang ,&nbsp;Ana G. Rappold","doi":"10.1016/j.ekir.2024.07.015","DOIUrl":"10.1016/j.ekir.2024.07.015","url":null,"abstract":"<div><h3>Introduction</h3><div>In many parts of the world, ambient temperatures have increased due to climate change. Due to loss of renal function, which impacts the regulation of thermoregulatory mechanisms, the ability to adapt and to be resilient to changing conditions is particularly concerning among individuals with kidney failure. The aim of this study was to assess the effect of heat on mortality and health care utilization among US patients on hemodialysis.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis from 2011 to 2016 in the contiguous United States during warmer months among eligible patients on dialysis who were identified in the United States Renal Data System (USRDS). Daily ambient temperature was estimated on a 1 km grid and assigned to ZIP-code. Case-crossover design with conditional Poisson models were used to assess the risk of developing adverse health outcomes associated with temperature exposure.</div></div><div><h3>Results</h3><div>Overall, exposure to high temperature is associated with elevated risk for both mortality and health care utilization among hemodialysis patients. The risk ratios for all-cause mortality and daily temperature were 1.07 (95% confidence interval [CI]: 1.03–1.11), 1.17 (1.14–1.21) for fluid disorder-related hospital admissions, and 1.19 (1.16–1.22) for cardiovascular event-related emergency department (ED) visits, comparing 99th percentile versus 50th percentile daily temperatures. Larger effects were observed for cumulative lagged exposure 3 days prior to the outcome and for Southwest and Northwest climate regions.</div></div><div><h3>Conclusion</h3><div>Heat exposure is associated with elevated risk for cardiovascular disease (CVD)–related mortality and health care utilization among this vulnerable population. Furthermore, the effect appears to be potentially cumulative in the short-term and varies geographically.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak Tricuspid Regurgitation Jet Velocity and Kidney Outcomes in Patients With Heart Failure With Preserved Ejection Fraction","authors":"Tatsufumi Oka ,&nbsp;Hocine Tighiouart ,&nbsp;Wendy McCallum ,&nbsp;Marcelle Tuttle ,&nbsp;Jeffrey M. Testani ,&nbsp;Mark J. Sarnak","doi":"10.1016/j.ekir.2024.07.009","DOIUrl":"10.1016/j.ekir.2024.07.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Although venous congestion secondary to elevated pulmonary artery pressure (PAP) has been hypothesized to worsen kidney function, the association of peak tricuspid regurgitation jet velocity (pTRV), a surrogate of PAP, with kidney outcomes remains uncertain in heart failure (HF) with preserved ejection fraction (HFpEF).</div></div><div><h3>Methods</h3><div>This <em>post hoc</em> analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial analyzed participants with a left ventricular ejection fraction (LVEF) of ≥45% who had pTRV measured by echocardiography at baseline. For the cross-sectional analysis, the association of baseline pTRV with baseline estimated glomerular filtration rate (eGFR) was assessed using linear regression. For the longitudinal analysis, the association of baseline pTRV with decline in eGFR of ≥30% and doubling of serum creatinine was assessed using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Among 450 participants, the mean (SD) baseline age, LVEF, pTRV, and eGFR were 72.3 (9.6) years, 58.2% (7.4%), 2.8 (0.5) m/s, and 62.1 (18.7) ml/min per 1.73 m², respectively. Each 1 SD higher pTRV was associated with a lower baseline eGFR (coefficient, −1.79; 95% confidence interval [CI], −3.48 to −0.10 ml/min per 1.73 m²). Over a median (interquartile range) follow-up of 3.0 (2.0–4.4) years, 203 (45%) patients experienced ≥30% eGFR decline, and 48 (11%) experienced creatinine doubling. Each 1 SD higher pTRV was associated with a 20% higher risk of ≥30% eGFR decline (hazard ratio [HR], 1.20; 95% CI, 1.04–1.39) and a 45% higher risk of creatinine doubling (HR, 1.45; 95% CI, 1.09–1.94).</div></div><div><h3>Conclusions</h3><div>Higher pTRV was associated with lower eGFR at baseline, and higher risk of ≥30% eGFR decline and creatinine doubling among patients with HFpEF.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Parathyroid Hormone Levels are Associated With Reduced Fracture Risk in Japanese Patients on Hemodialysis","authors":"Hirotaka Komaba ,&nbsp;Takahiro Imaizumi ,&nbsp;Takayuki Hamano ,&nbsp;Naohiko Fujii ,&nbsp;Masanori Abe ,&nbsp;Norio Hanafusa ,&nbsp;Masafumi Fukagawa","doi":"10.1016/j.ekir.2024.07.008","DOIUrl":"10.1016/j.ekir.2024.07.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Secondary hyperparathyroidism (SHPT) affects bone metabolism and may lead to bone fragility. However, there is conflicting evidence as to whether parathyroid hormone (PTH) levels are associated with fracture risk and whether the relationship is linear or U-shaped.</div></div><div><h3>Methods</h3><div>We examined the association between PTH levels and the risk of any fracture and site-specific fractures in a nationwide cohort of 180,333 patients on hemodialysis. We also examined the association between the percent change in PTH levels during the preceding 1 year and subsequent fracture.</div></div><div><h3>Results</h3><div>At baseline, the median intact PTH level was 141 pg/ml (interquartile range, 78–226 pg/ml). During 1 year of follow-up, there were a total of 3762 fractures requiring hospitalization (1361 hip, 551 vertebral, and 1850 other). In an adjusted analysis, higher baseline PTH levels were associated with an incrementally increased risk of any fracture (odds ratio [OR] per doubling of intact PTH, 1.06; 95% confidence interval, 1.03–1.09). The association between PTH levels and fracture risk was more pronounced for hip fractures but not found for vertebral fractures. The absolute risk difference associated with higher PTH levels appeared to be more pronounced in older individuals, females, and those with lower body mass index (BMI). Change in PTH levels was also associated with fracture risk: the adjusted OR for fracture decreased linearly with decreasing PTH levels over 1 year, regardless of the preceding PTH levels.</div></div><div><h3>Conclusion</h3><div>Lower PTH levels are associated with a graded reduction in fracture risk. Further studies are needed to determine whether intensive PTH control reduces fracture risk.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey on End-of-Life Contemplation Among Patients on Dialysis","authors":"Martin Russwurm ,&nbsp;Anetta Rabaev ,&nbsp;Joachim D. Hoyer ,&nbsp;Christian S. Haas ,&nbsp;Christian Volberg ,&nbsp;Philipp Russ","doi":"10.1016/j.ekir.2024.07.035","DOIUrl":"10.1016/j.ekir.2024.07.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Considering that mortality among patients on dialysis is high, it would be advisable for patients, relatives, and care givers to acknowledge that after dialysis initiation for many patients, the last phase in life has begun. We sought to investigate the frequency of precautionary planning directives, contemplation about the end-of-life (EOL) and embedding of patients’ wishes in the interaction with relatives and the treating nephrologists.</div></div><div><h3>Methods</h3><div>In a questionnaire-based interview survey, we investigated the frequency of precautionary planning, EOL wishes, and frequency of relatives’ or medical professionals’ conversations with patients about those wishes as well as possibly associated demographic, socioeconomic and medical factors. The interviews were conducted by a single investigator in 7 dialysis centers in Germany.</div></div><div><h3>Results</h3><div>From 349 identified patients, 268 (77%) participated. The participants (36% female) had a median age of 70 (interquartile range [IQR]: 58–80) years and had spent a median of 3 (IQR: 1–7.5) years on dialysis. Overall, 46% of patients on dialysis contemplated their EOL wishes at least occasionally. Of those, 85% talked about EOL wishes with their relatives, whereas 19% discussed them with their nephrologists, yet another 28% would like to have such a discussion with their nephrologist.</div></div><div><h3>Conclusion</h3><div>Almost half of patients on dialysis contemplate their EOL and the vast majority engage in discussions about that with their relatives. Despite patients being interested, the frequency of consultation of nephrologists on EOL care is low. This study suggests that there is a substantial but unmet need for EOL care consultation for patients on dialysis.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Urinary Soluble CD163 Levels With Disease Activity and Treatment Response in IgA Nephropathy","authors":"Jingyi Li ,&nbsp;Jicheng Lv ,&nbsp;Muh Goet Wong ,&nbsp;Sufang Shi ,&nbsp;Jincan Zan ,&nbsp;Helen Monaghan ,&nbsp;Vlado Perkovic ,&nbsp;Hong Zhang","doi":"10.1016/j.ekir.2024.07.031","DOIUrl":"10.1016/j.ekir.2024.07.031","url":null,"abstract":"<div><h3>Introduction</h3><div>The TESTING trial demonstrated that corticosteroids reduce the risk of kidney failure in patients with IgA nephropathy (IgAN) but increase the risk of serious adverse events. Reliable noninvasive biomarkers are needed to identify patients who would benefit most from corticosteroid therapy. Previous studies suggest glomerular macrophage infiltration is associated with response to immunosuppressive therapy in IgAN and urinary soluble CD163 ([u-sCD163], a marker of alternatively activated macrophages [M2]c macrophage) is correlated with clinical remission in vasculitis. This study aims to investigate the association between u-sCD163 and response of steroids therapy in IgAN.</div></div><div><h3>Methods</h3><div>We measured u-sCD163 in patients from a large IgAN cohort and Chinese participants of the TESTING trial. The correlation of baseline or serial u-sCD163 and their response of corticosteroids therapy or kidney outcomes were investigated.</div></div><div><h3>Results</h3><div>In cross-sectional analysis, u-sCD163 levels correlated with kidney macrophage infiltration, especially in crescentic areas, and with active lesions. Subgroup analysis of the TESTING cohort showed higher levels u-sCD163 were associated with greater benefits from corticosteroids therapy in proteinuria remission (odds ratio, 35.56 [95% confidence interval, CI: 7.62–292.34] vs. 3.94 [95% CI: 1.39–12.93], <em>P</em> for interaction: 0.036). Corticosteroids therapy significantly reduced u-sCD163 levels at 6 months compared to placebo group (79% [interquartile range: 58%–91%] vs. 37% [−11% to 58%], <em>P</em> &lt;0.001). There was no difference in the suppressive effects on u-sCD163 by either dosage of corticosteroids (full and reduced-dose). The suppression of u-sCD163 was significantly associated with a reduced risk of kidney progression events (adjusted hazard ratio: 0.52, 95% CI: 0.30–0.93, <em>P</em> = 0.027).</div></div><div><h3>Conclusion</h3><div>u-sCD163 is a reliable noninvasive biomarker associated with active pathological lesions in IgAN and can guide glucocorticoid therapy.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}