Kidney Diseases最新文献

{"title":"Repeated Kidney Biopsy in Membranoproliferative Glomerulonephritis.","authors":"Ai-Hui Li, Yang Li, Meng-Shi Li, Zhuo-Ran Song, Ji-Cheng Lv, Hong Zhang, Xiao-Juan Yu, Xu-Jie Zhou","doi":"10.1159/000545727","DOIUrl":"https://doi.org/10.1159/000545727","url":null,"abstract":"<p><strong>Introduction: </strong>Membranoproliferative glomerulonephritis (MPGN) is a heterogeneous pattern of glomerular injury. Repeated kidney biopsies may elucidate pathogenic mechanisms and guide diagnostic strategies.</p><p><strong>Methods: </strong>We included 82 patients diagnosed with MPGN by kidney biopsy who underwent at least two biopsies between 1997 and 2023 at Peking University First Hospital. Clinical and pathological data were analyzed retrospectively.</p><p><strong>Results: </strong>Of 342 MPGN patients, 95 (28%) had repeated biopsies (0.9-4.0 years apart). This incidence was higher than in other glomerulonephropathies under immunosuppression. Among the 82 patients analyzed (excluding kidney transplants and ≤3-month biopsy intervals), 42 were initially diagnosed with non-MPGN pathology. At the second biopsy, proteinuria increased (from 2.9 to 6.3 g/day), eGFR declined (from 76 to 47 mL/min/1.73 m²), and renal C3 deposition was stronger (<i>p</i> = 0.04). Thirty patients (37%) had etiological reclassification, mostly to monoclonal gammopathy of renal significance (MGRS). Compared to idiopathic MPGN, MGRS patients were older (53 vs. 35 years) and had worse renal function (eGFR 57 vs. 81 mL/min/1.73 m²) but slower eGFR decline (-7 vs. -12 mL/min/1.73 m²/year). Most MGRS patients (64%) remained negative for monoclonal protein in serum or urine immunofixation, necessitating repeat biopsy and clone-directed therapy.</p><p><strong>Conclusion: </strong>In this study, about half and one-third of patients underwent morphological and etiological reclassification, respectively. Stronger complement deposition may drive morphological changes. Repeated kidney biopsies are crucial for diagnosing MGRS, especially in patients with negative immunofixation.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"258-269"},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Prescription of SGLT2 Inhibitors with Expanded Indications to the Elderly Population in Japan.","authors":"Yasuhiro Oda, Hiroshi Nishi, Mariko Sekiguchi, Motoki Odawara, Masaomi Nangaku","doi":"10.1159/000545626","DOIUrl":"10.1159/000545626","url":null,"abstract":"<p><strong>Introduction: </strong>Indications for sodium-glucose cotransporter-2 (SGLT2) inhibitors have expanded to include heart failure and chronic kidney disease after the year 2020. Whether and how the demographic trends in the prescription of SGLT2 inhibitors have changed after the expansion of indications have not been studied extensively.</p><p><strong>Methods: </strong>This study is a descriptive analysis of serial, cross-sectional data on nationwide prescription of SGLT2 inhibitors between April 2016 and March 2023 obtained from NDB Open Data Japan, which contains more than 95% of total health insurance reimbursement claims in the nation.</p><p><strong>Results: </strong>The total number of SGLT2 inhibitor tablets prescribed in outpatient settings with prescriptions papers increased from 577,996,158 tablets in fiscal year (FY) 2020 to 904,598,175 tablets in FY 2022. Patients aged 75 years and older accounted for 20.3% of the total prescriptions in FY 2020, and this proportion increased to 27.8% in FY 2022. Among all SGLT2 inhibitors, the tablet that expanded its indications for patients with heart failure and chronic kidney disease the earliest showed the largest percentage increase in the number of prescribed tablets during this period and the highest share of the elderly population in its recipients in both sexes (men, 35.9%; women, 49.4%) in FY 2022. The number of prescribed SGLT2 inhibitor tablets per population was constantly higher in men than in women between FY 2020 and 2022, which is consistent with the sex difference in the prevalence of these diseases.</p><p><strong>Conclusion: </strong>Prescription of SGLT2 inhibitors to the elderly population is no longer infrequent and accounts for a large portion of the entire prescription of SGLT2 inhibitors in Japan. These findings contribute to updating our perception on the demographics of SGLT2 inhibitor recipients.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"292-301"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Insights into Urinary Stone Formation: Evidence from Mendelian Randomization, Clinical, and in vivo Studies.","authors":"Lintao Miao, Jiacheng Xiang, Yuanyuan Yang, Senyuan Hong, Jianxuan Sun, Sihan Zhang, Yuan Gong, Qidong Xia, Shaogang Wang","doi":"10.1159/000545550","DOIUrl":"https://doi.org/10.1159/000545550","url":null,"abstract":"<p><strong>Introduction: </strong>The global rise in urinary stone prevalence has become a significant health and economic challenge. Linked to metabolic disorders such as obesity and diabetes, urinary stones represent a complex systemic condition that requires a comprehensive understanding of metabolic profiles for effective management.</p><p><strong>Methods: </strong>The methodological quality of this study was evaluated in accordance with the STROBE-MR checklist. Using genome-wide association study (GWAS) data for 1,091 blood and 1,172 urine metabolites, we conducted a two-sample Mendelian randomization (MR) analysis, validated by meta-analysis, to explore metabolic influences on stone formation. Multivariable and mediation MR analyses were performed to identify independent metabolite influences and their interaction with gut microbiota and metabolism-related genes. Clinical metabolomic analysis and further animal experiments substantiated our findings.</p><p><strong>Results: </strong>Univariable MR identified 119 blood and 63 urine metabolites associated with urinary stones, with 16 blood and 2 urine metabolites showing robust associations post-correction. Notably, mannose and 3-aminoisobutyrate emerged as independent influencers of stone formation. Mediation MR suggested these metabolites as potential mediators in the gut microbiota's influence on stone formation. Clinical urine sample analysis indicates higher mannose levels in normal renal sides than stone sides. Animal studies confirmed mannose's protective role by reducing renal calcium oxalate crystal deposition.</p><p><strong>Conclusion: </strong>Our study establishes causal links between specific metabolites and urinary stones, shedding light on the intricate biological mechanisms of stone formation. The discovery of mannose as a protective factor opens avenues for future research and clinical applications, offering promising directions for the prevention and treatment of stones.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"240-257"},"PeriodicalIF":3.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Efficacy Evaluation of the KHA-200 Hemoperfusion Device in the Treatment of End-Stage Renal Disease Patients Undergoing Blood Purification Therapy.","authors":"Qing Yang, Guiqun Liu, Min Guo, Dunlu Yuan, Jingjing Huang, Zhu Zhou, Qing Li","doi":"10.1159/000545262","DOIUrl":"https://doi.org/10.1159/000545262","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to assess the impact of employing the KHA-200 hemoperfusion device in conjunction with hemodialysis therapy in the elimination of serum solutes among maintenance hemodialysis (MHD) patients.</p><p><strong>Methods: </strong>A total of ninety-two MHD patients from our hospital's hemodialysis center were judiciously chosen and allocated randomly into two groups: the conventional hemodialysis group, serving as the control group, and the group utilizing the KHA-200 hemoperfusion device in combination with hemodialysis, denoted as the experimental group, in a 1:1 ratio. We compared variations in serum solute indices, including blood urea nitrogen, creatinine, potassium, calcium, phosphorus, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), β2-microglobulin (β2-MG), parathyroid hormone (PTH), homocysteine (Hcy), albumin, both prior to and post-treatment. Meanwhile, a comparison of the serum solute clearance rates in the two groups was performed.</p><p><strong>Results: </strong>Following treatment, both groups exhibited substantial reductions in blood urea nitrogen, creatinine, uric acid, potassium, phosphorus, PTH, and Hcy (<i>p</i> < 0.001). There were no statistically significant distinctions between the two groups in terms of urea nitrogen, creatinine, uric acid, and potassium clearance (<i>p</i> > 0.05). Conversely, the experimental group demonstrated a significant effect on the elimination of IL-6 and β2-MG (<i>p</i> < 0.001). Furthermore, the experimental group's performance in reducing blood phosphorus, PTH, IL-6, β2-MG, and Hcy was significantly superior to that of the control group (<i>p</i> < 0.05). Moreover, the reduction in systolic blood pressure in the experimental group was better than in the control group.</p><p><strong>Conclusion: </strong>Employing the KHA-200 hemoperfusion device in tandem with hemodialysis excels in removing blood phosphorus and certain medium-sized uremic toxins, including PTH, IL-6, β2-MG, and Hcy, surpassing the performance of conventional hemodialysis.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"270-282"},"PeriodicalIF":3.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacubitril-Valsartan Lowers Blood Pressure in Patients on Dialysis: A Randomized Controlled Multicenter Study.","authors":"Li Lin, Weijing Bian, Qun Luo, Liang Wang, Na Liu, Min Yang, Jun Cen, Kedan Cai, Jia Hua, Hongwei Gu, Hualin Qi, Zhihong Wang, Jianying Niu, Yu Chen, Yizheng Gu, Chun Hu, Suhua Li, Yan Li, Nan Chen, Xiao Li","doi":"10.1159/000545195","DOIUrl":"https://doi.org/10.1159/000545195","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with end-stage kidney disease frequently grapple with uncontrolled hypertension, which elevates their risk for cardiovascular complications.</p><p><strong>Methods: </strong>This randomized, controlled, multicenter study, conducted across 10 hospitals, aimed to compare the effectiveness and safety of sacubitril-valsartan versus irbesartan in managing hypertension among dialysis patients. The primary efficacy variable of the present study was the reduction in office blood pressure (BP) after 12 months of treatment. Participants were randomly allocated to receive either sacubitril-valsartan (angiotensin receptor-neprilysin inhibitor [ARNI]) or irbesartan (angiotensin receptor blocker [ARB]) treatment over a 12-month period. We gauged treatment efficacy through office and 24-h ambulatory BP readings, as well as serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP). Safety outcomes were also evaluated.</p><p><strong>Results: </strong>Baseline office BP averaged 150/82 mm Hg and median NT-proBNP was 6,336 pg/mL. In the intention-to-treat analysis, office systolic BP reduction was significantly greater in the ARNI than ARB group (-10.4 vs. -4.6 mm Hg, <i>p</i> = 0.003) after adjustment for baseline BP. In hemodialysis (HD) patients, the mean systolic/diastolic BP reduction was also greater in the ARNI than ARB group (-15.9/2.4 vs. -6.6/1.1 mm Hg, <i>p</i> < 0.05). While for peritoneal dialysis (PD) patients, there were no significant between-group differences (<i>p</i> = 0.087). Per-protocol analyses in 215 patients on office BP and 137 patients on 24-h BP produced similar results. During the study period, there was no between-group difference in the overall incidence of fatal and nonfatal events and hyperkalemia.</p><p><strong>Conclusion: </strong>In dialysis patients with hypertension, especially those undergoing HD, ARNI demonstrated superior effectiveness in reducing BP compared to ARB. The safety profiles of both treatments were comparable and acceptable.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"206-217"},"PeriodicalIF":3.2,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation of Urinary Podocyte Markers in Diabetic Kidney Disease by Sodium-Glucose Cotransporter 2 Inhibitor Therapy.","authors":"Chuanlei Li, Jack Kit-Chung Ng, Gordon Chun-Kau Chan, Winston Wing-Shing Fung, Kai-Ming Chow, Cheuk-Chun Szeto","doi":"10.1159/000545225","DOIUrl":"https://doi.org/10.1159/000545225","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a standard treatment for kidney and cardiovascular protection in diabetic kidney disease (DKD). We investigated the effect of SGLT2i on the urinary podocyte-associated molecule levels in DKD.</p><p><strong>Methods: </strong>We studied 24 DKD patients who were started on SGLT2i treatment and 25 patients who were not treated (control group). Urinary levels of podocyte-associated molecules, their corresponding mRNA levels in urinary sediment, estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) were measured at baseline and 3 months later.</p><p><strong>Results: </strong>Urinary levels of podocin, podocalyxin, and synaptopodin increased significantly over 3 months in the control group, while the levels remained static in the treatment group. After 3 months of treatment, urinary podocin (2.95 [0.92-5.45] vs. 9.15 [1.88-24.80] ng/μmol-Cr, <i>p</i> < 0.01), podocalyxin (367.3 [299.5-768.6] vs. 920.6 [369.3-2,060.4] ng/μmol-Cr, <i>p</i> < 0.01), and synaptopodin levels (13.17 [9.86-47.02] vs. 35.56 [17.59-134.08] ng/μmol-Cr, <i>p</i> < 0.05) were significantly lower in the treatment than the control group. Urinary sediment mRNA levels of podocin, podocalyxin, synaptopodin, and nephrin did not change in both groups. However, there was no significant correlation between urinary podocyte-associated marker levels and eGFR or UACR at baseline or after treatment.</p><p><strong>Conclusion: </strong>SGLT2i prevents the progressive increase in the urinary excretion of podocyte-specific molecules in DKD patients, suggesting that SGLT2 inhibitors have a protective effect on the podocytes.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"218-225"},"PeriodicalIF":3.2,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Clinical Prediction Model for Stages of Acute Kidney Injury in Critically Ill Patients.","authors":"Nam Nguyen-Hoang, Wenbo Zhang, Jacqueline Koeze, Harold Snieder, Eric Keus, Gerton Lunter","doi":"10.1159/000545150","DOIUrl":"https://doi.org/10.1159/000545150","url":null,"abstract":"<p><strong>Introduction: </strong>Among critically ill patients, acute kidney injury (AKI) has a high incidence and leads to poor prognosis. As AKI is often only detected well after onset, early risk stratification is crucial. This study aimed to develop and internally validate the first clinical prediction model for different stages of AKI in critically ill adults.</p><p><strong>Methods: </strong>We utilized data from the Simple Intensive Care Studies II (SICS-II), a prospective cohort study at the University Medical Center Groningen, the Netherlands. The prognostic outcome was the highest KDIGO-based stage of AKI within the first 7 days of ICU stay. Candidate predictors included fifty-nine readily available variables in critical care. Least absolute shrinkage and selection operator and proportional odds logistic regression were used for variable selection and model estimation, respectively. Receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis were applied to evaluate model performance and clinical usefulness.</p><p><strong>Results: </strong>Of the SICS-II cohort, 976 patients were eligible for our analyses (median [interquartile range] age 64 [52-72] years, 38% female). Within 7 days after ICU admission, 29%, 23%, and 14% of patients progressed to their highest severity of AKI at stages 1, 2, and 3, respectively. We derived a 15-variable model for predicting this maximum ordinal outcome with an area under the ROC curve of 0.76 (95% CI, 0.74-0.78) in bootstrap validation. The model showed good calibration and improved net benefit in decision curve analysis over a range of clinically plausible thresholds.</p><p><strong>Conclusion: </strong>Using readily available predictors in the ICU setting, we could develop a prediction model for different stages of AKI with good performance and promising clinical usefulness. Our findings serve as an initial step towards applying a valid and timely prediction model for AKI severity, possibly helping to limit morbidity and improve patient outcomes.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"226-239"},"PeriodicalIF":3.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Manifestations and Prognosis of Chronic Kidney Disease after Hematopoietic Stem Cell Transplantation.","authors":"Yu Zhang, Guisheng Ren, Wencui Chen, Jinzhou Guo, Xiaomei Wu, Weiwei Xu, Xianghua Huang","doi":"10.1159/000545198","DOIUrl":"https://doi.org/10.1159/000545198","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney disease is a common complication of hematopoietic stem cell transplantation (HSCT). However, there is limited research on the clinical pathology and prognosis of patients who develop chronic kidney disease (CKD) after HSCT.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 50 patients diagnosed with CKD through kidney biopsy between September 2008 and May 2024. The patients were categorized based on their pathological presentations into groups with thrombotic microangiopathy (TMA) or membranous nephropathy (MN).</p><p><strong>Results: </strong>The renal pathological results revealed that TMA was the most prevalent pathological type, accounting for 40% of cases, followed by MN at 32%, and mesangial proliferative glomerulonephritis at 16%, among others. Clinically, patients with TMA predominantly presented with renal insufficiency, whereas those with MN mainly exhibited nephrotic syndrome. Patients with MN showed favorable responses to treatment, achieving complete and partial response rates of 14.3% and 71.4%, respectively. Among the 50-patient cohort, 45 remained alive, corresponding to a 5-year overall survival rate of 87.8%. The 5-year renal survival rate was observed to be 78.8%, with 3 patients (6.98%) requiring kidney replacement therapy.</p><p><strong>Conclusion: </strong>TMA and MN are the two most common pathological findings in patients with CKD following HSCT. Both conditions exhibit favorable responses to combined steroids and immunosuppressant therapy. Notably, patients with MN demonstrate a higher overall response rate and superior treatment outcomes compared to those with TMA.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"195-205"},"PeriodicalIF":3.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Treatment of IgA Nephropathy Based on a New Framework: Angiorenal Protection, Immunity Inhibition, B-Cell/Plasma-Cell Modulation, and Complement Inhibition.","authors":"Cheng Xue, Shengqiang Yu, Wei Gou, Yelei Xu, Li Yang, Bing Dai","doi":"10.1159/000544998","DOIUrl":"10.1159/000544998","url":null,"abstract":"","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"154-159"},"PeriodicalIF":3.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Blood Pressure Rhythmicity for Estimated Glomerular Filtration Rate in Male Hypertensive Patients Aged 55 and Older.","authors":"Lulu Wang, Han Tian, Xinxin Xu, Xinyan Gu, Liu Li, Hui Zheng, Jie Xu, Chunsun Dai, Lei Jiang","doi":"10.1159/000544992","DOIUrl":"10.1159/000544992","url":null,"abstract":"<p><strong>Introduction: </strong>Blood pressure (BP) exhibits a circadian rhythm characterized by higher levels during wakefulness and lower levels during sleep; however, the functional and structural impact of the rhythms of BP remains uncertain.</p><p><strong>Methods: </strong>Two hundred hypertensive males aged 55 and older without overt cardiovascular or cerebrovascular diseases were enrolled in this longitudinal study. Of these, 188 were included in the analyses (12 lacked valid BP records for part of the 24-h period). Rhythmic profiling of BP was performed using ARSER, and rhythmicity was considered significant at <i>p</i> < 0.05. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology (CKD-EPI) formula. The primary outcome was the change in eGFR.</p><p><strong>Results: </strong>The average age was 64.9 ± 7.2 years. For systolic BP (SBP), 38 of the subjects exhibited a 12-h rhythm and 43 subjects a 24-h rhythm; for diastolic BP (DBP), 38 exhibited a 12-h rhythm, and 36 exhibited a 24-h rhythm. During the 3-year follow-up period, 16 of the subjects died, and 36 were lost to follow-up. The mean eGFR at baseline and follow-up were, respectively, 86.6 ± 14.0 and 81.0 ± 17.1 mL min^-1 1.73 m^-2 (<i>p</i> = 0.001). The urinary albumin:creatinine ratio did not vary significantly among the groups (<i>p</i> = 0.059). Subjects with 12-h rhythmic SBP exhibited a smaller reduction in eGFR than those with arrhythmic SBP (<i>p</i> = 0.014). However, the changes in eGFR were similar among the groups displaying 12-h or 24-h rhythmic DBP or arrhythmic DBP. We defined a decline in eGFR as a reduction of >1/2 SD between baseline and follow-up. Adjusting for confounding factors (including age, smoking, alcohol consumption, diabetes mellitus, BMI, albumin levels, administration time of antihypertensive drugs, and duration of hypertension), the risk of a decline in eGFR was 70% lower in subjects with 12-h rhythmic SBP than in those with arrhythmic SBP (heart rate = 0.307 [0.108-0.874], <i>p</i> = 0.027).</p><p><strong>Conclusion: </strong>SBP with a 12-h period is a protective predictor of the decline in eGFR in hypertensive males. It is, therefore, necessary to focus on the rhythmic profiling of BP.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"186-193"},"PeriodicalIF":3.2,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}