Kidney Diseases最新文献

{"title":"Stabilizing hypoxia-inducible factor manage anemia in chronic kidney disease：From basic theory to clinical study","authors":"Yudian Wang, Xiaoyong Yu","doi":"10.1159/000536039","DOIUrl":"https://doi.org/10.1159/000536039","url":null,"abstract":"Background: Anemia is one of the common complications of chronic kidney disease (CKD), and its prevalence has been arising globally. The key cause of anemia in CKD patients is the diseased kidney's reduced ability to synthesize endogenous erythropoietin, yet this is not the sole reason. Inflammatory elements, functional iron deficiency, and uremic toxins together participate in the development of anemia. According to research data, anemia is an independent risk factor for cardiovascular events, all-cause mortality and worsening renal function, and affects the clinical prognosis and quality of life of CKD patients. Regular treatments for anemia in CKD patients include the use of erythropoietin stimulators (ESA), iron supplements, and blood transfusions. Summary：Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) is a novel and small molecule pharmacological compound that targets the HIF pathway and is another option for improving anemia in CKD patients. HIF-PHIs simulates hypoxia, stabilizes HIF protein, stimulates EPO synthesis, reduces hepcidin level and boosts iron utilization, induces the creation of red blood cells and alleviates anemia. The results of several HIF-PHIs phase III trials indicated that HIF-PHIs are similarly effective as ESA at raising hemoglobin (Hb) concentration. Key Messages: This article summarizes the structure of HIF and the mechanism of stabilizing HIF to improve anemia, discusses the efficacy of HIF-PHIs in CKD patients with or without dialysis, as well as emphasizes the potential safety concerns with HIF-PHIs.\u0000\u0000","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"42 24","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139451695","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":"Peripheral Neuropathy Associated with Higher Mortality in Population with Chronic Kidney Disease: National Health and Nutrition Examination Surveys","authors":"Wei-Lan Li, X-Y Cai, Shu-Wang Ge, Gang Xu","doi":"10.1159/000535481","DOIUrl":"https://doi.org/10.1159/000535481","url":null,"abstract":"Background: Peripheral neuropathy (PN), one of the commonest neurological complications of chronic kidney disease (CKD), was associated with physical limitation. Studies showed that a decrease in physical capability in patients with CKD is related with an increased risk of mortality. The objective of our research is directly exploring the relationship between PN and risk of mortality in patients with CKD. Method: 1836 participants with CKD and 6036 participants without CKD, which were classified by peripheral neuropathy based on monofilament examination in National Health and Nutrition Examination Survey (NHANES), were collected from the 1999 to 2004 National Health and Nutrition Examination Surveys. Multi-variable Cox proportional hazards models was conducted to assess the relationships of peripheral neuropathy and deaths in patients with CKD and non-CKD. Results: During 14 years of a median follow up from 1999 to 2015 and 2004 to 2015, 1072 (58.4%) and 1389 (23.0%) deaths were recorded in participants with CKD and without CKD, respectively. PN was related with increased all-cause mortality even after adjusting possible confounding factors in population with CKD (HR 1.34, 95% confidence interval [CI] 1.17-1.53) and without CKD (HR 1.27 95% CI 1.12-1.43). And the adjusted HRs (95% CI) for cardiovascular mortality of the people with CKD and without CKD who suffering from peripheral neuropathy were 1.42 (1.07, 1.90) and 1.23 (0.91, 1.67), respectively, versus those without peripheral neuropathy. Conclusion: PN was related with a higher risk of all-cause and cardiovascular death in people with CKD, which clinically suggests that the adverse prognostic impact of PN in the CKD population deserve attention and are an important target for intervention.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"2 6","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163135","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":"Pyroptosis: The Determinator of Cell Death and Fate in Acute Kidney Injury","authors":"Jiachuan Xiong, Jinghong Zhao","doi":"10.1159/000535894","DOIUrl":"https://doi.org/10.1159/000535894","url":null,"abstract":"Background: Acute kidney injury (AKI) is kidney damage that leads to a rapid decline in function. AKI primarily occurs when the tubular epithelium is damaged, causing swelling, loss of brush margin, and eventual apoptosis. Research has shown that tubular epithelial cell damage in AKI is linked to cell cycle arrest, autophagy, and regulation of cell death.\u0000Summary: Pyroptosis, a type of programmed cell death triggered by inflammation, is believed to play a role in the pathophysiology of AKI. Cumulative evidence has shown that pyroptosis is the main cause of tubular cell death in AKI. Thus, targeted intervention of pyroptosis may be a promising therapeutic approach for AKI. In this review, we delve deep into the cutting-edge research surrounding pyroptosis in the context of AKI, shedding light on its intricate mechanisms and potential implications for clinical practice. Additionally, we explore the exciting realm of potential pre-clinical treatment options for AKI, aiming to pave the way for future therapeutic advancements.\u0000Key Messages: Pyroptosis, a highly regulated form of cell death, plays a crucial role in determining the fate of cells during the development of AKI. This intricate process involves the activation of inflammasomes, which are multi-protein complexes that initiate pyroptotic cell death. By understanding the mechanisms underlying pyroptosis, researchers aim to gain insights into the pathogenesis of AKI and potentially identify new therapeutic targets for this condition.\u0000","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"23 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947418","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":"Association between the triglyceride-glucose index and all-cause mortality in critically ill patients with acute kidney injury","authors":"Liangjing Lv, Jiachuan Xiong, Yinghui Huang, Ting He, Jinghong Zhao","doi":"10.1159/000535891","DOIUrl":"https://doi.org/10.1159/000535891","url":null,"abstract":"Background: The triglyceride-glucose (TyG) Index is a reliable alternative biomarker of insulin resistance, but the association between the TyG Index and acute kidney injury(AKI) in critically ill patients remains unclear. Methods: The data for the study was extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Cox regression and restricted cubic spline(RCS) analysis were performed to analyze the association between the TyG index and all cause mortality. Besides, cox regression was carried out in subgroups of age, gender, BMI, diabetes history and dialysis status. Results: A total of 7508 critically ill participants with AKI from the MIMIC-IV database were included in study, with 3688(49.12%) participants failed to survive. In cox regression, after confounder adjustment, patients with a higher TyG Index had a higher risk of all cause mortality (HR = 1.845, 95% CI =1.49-2.285, p <0.001). In RCS, after confounder adjustment, the risk of death was positively correlated with the increased value of the TyG index when TyG index surpassed 10.014. This relationship was validated in age, gender, BMI and diabetes subgroups but not in the dialysis subgroup. Interestingly, RCS analysis demonstrated that, in patients undertaking dialysis, there is a “U” shape curve for the value of TyG index and risk of all cause mortality. When TyG index is less than 10.460, the risk of all cause mortality would decrease with the increase value of TyG index, while when TyG index is higher than 11.180, the risk of all cause mortality would increase firmly with the increase value of TyG index. Conclusion: Overall, higher TyG index is associated with higher risk of all-cause mortality in critically ill AKI. Interestingly, the relationship in dialysis subgroup follows a \"U\"-shaped curve, indicating the importance of a properly clinical blood glucose and lipid management of this particular population.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"45 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139164405","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":"Contents Vol. 9, 2023","authors":"Ettenheim Stückle Druck, Arun D. Singh, Rubens N. Belfort, Maria Antonietta Blasi, Dan S. Gombos, Martine Jager, Stefan Seregard – St, Geeta K. Vemuganti, Matthew W. Wilson, G. S. Sodhi, OH Cleveland, N. Singh, MA Boston, J. Wrenn, J. Singaravelu, A. Melendez-Moreno, J. London, Cambridge, L. AlHarby, M. S. L. Sagoo, B. L. Damato","doi":"10.1159/000535318","DOIUrl":"https://doi.org/10.1159/000535318","url":null,"abstract":"","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"26 3","pages":"I - VI"},"PeriodicalIF":3.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014653","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":"Roxadustat for Patients with Post-transplant Anemia: A Narrative Review","authors":"Xiaoxiao Tang, Fei Liu, Qiuyu Li, Jianhua Mao","doi":"10.1159/000535071","DOIUrl":"https://doi.org/10.1159/000535071","url":null,"abstract":"Background: Hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) are novel oral agents used for renal anemia treatment. Roxadustat, a first-in-class HIF-PHI used for treating anemia in chronic kidney disease patients, has been approved in China, Japan, South Korea, Chile, and Europe. Roxadustat is involved in HIF degradation, which can stimulate endogenous erythropoietin (EPO) production and improve iron utilization. Besides, roxadustat can promote dietary iron uptake and transport. In comparison with traditional erythropoiesis-stimulating agent (ESA) treatment, it might reduce cardiovascular risk and mortality as it causes only a slight increase in the plasma EPO level. Phase II and III clinical trial reports have shown that roxadustat is effective for treating chronic kidney disease patients. The role of roxadustat in kidney transplant recipients (KTRs) needs to be examined as patients with chronic kidney disease are different from those receiving renal transplants. Summary: Clinical trials have demonstrated that roxadustat effectively increases and maintains hemoglobin levels in patients with dialysis-dependent and non-dialysis-dependent chronic kidney disease by stimulating endogenous EPO production and optimizing iron utilization. Roxadustat has recently been used effectively to treat patients with EPO-resistant anemia. It has also been used for treating patients with post-transplant anemia (PTA), which is a prognostic factor for mortality in kidney transplant recipients with an iron deficiency and impaired glomerular filtration rate. Here, we examined the findings of four studies in a narrative review and discussed our perspectives regarding this field of study. Key Messages: Roxadustat significantly improves hemoglobin levels without affecting renal function in KTRs with PTA. It also enhances iron utilization by decreasing ferritin and hepcidin levels and increasing total iron binding capacity, transferrin, and serum iron levels. Roxadustat ameliorates anemia and inflammation, and might have reno-protective effects in KTRs.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"85 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135092424","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":"Monogenic Causes Identified in 23.68% of Children with Steroid Resistant Nephrotic Syndrome: A Single-Centre Study","authors":"Luyan Zhang, Fei Zhao, Guixia Ding, Ying Chen, Sanlong Zhao, Qiuxia Chen, Yugen Sha, Ruochen Che, Songming Huang, Bixia Zheng, Aihua Zhang","doi":"10.1159/000534853","DOIUrl":"https://doi.org/10.1159/000534853","url":null,"abstract":"Introduction: Steroid resistant nephrotic syndrome (SRNS) is the second most common cause of end-stage kidney disease in children, mostly associated with focal segmental glomerulosclerosis (FSGS). Advances in genomic science have enabled the identification of causative variants in 20 – 30% of SRNS patients. Methods: We used whole exome sequencing (WES) to explore the genetic causes of SRNS in children. Totally 101 patients with SRNS, and 13 patients with nephrotic proteinuria and FSGS were retrospectively enrolled in our hospital between 2018 and 2022. For the known monogenic causes analysis, we generated a known SRNS gene list of 71 genes through reviewing the OMIM database and literature. Results: Causative variants were identified in 23.68% of our cohort, and the most frequently mutated genes in our cohort were WT1 (7/27), NPHS1 (3/27), ADCK4(3/27), and ANLN (2/27). Five patients carried variants in phenocopy genes, including MYH9, MAFB, TTC21B, AGRN, and FAT4. The variant detection rate was the highest in the two subtype groups with congenital nephrotic syndrome and syndromic SRNS. In total, 68.75% of variants we identified were novel, and have not been previously reported in literature. Conclusion: Comprehensive genetic analysis is key to realizing the clinical benefits of a genetic diagnosis. We suggest that all children with SRNS undergo genetic testing, especially those with early onset and extrarenal phenotypes.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"95 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135818827","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":"Magnetic resonance imaging in Atherosclerotic Renal Artery Stenosis: the update and future directions from interventional perspective","authors":"Jia Fu, Zhi-Yong Lin, Bi-Hui Zhang, Li Song, Nai-Shan Qin, Jian-Xing Qiu, Min Yang, Ying-Hua Zou","doi":"10.1159/000534499","DOIUrl":"https://doi.org/10.1159/000534499","url":null,"abstract":"Background: Atherosclerotic renal artery stenosis (ARAS) is a condition where the renal arteries become narrowed due to atherosclerosis, leading to reduced blood flow to the kidneys and various renal complications. The effectiveness of interventional treatments, such as renal artery angioplasty and stenting, remains debated, making patient selection for these procedures challenging. Summary: This review focuses on the diagnosis and management of ARAS, with a particular emphasis on the potential role of functional MRI in evaluating renal function and mechanisms. By summarizing current diagnostic approaches and outcomes of interventional treatments, the review highlights the importance of informed clinical decision-making in ARAS management. Functional MRI emerges as a promising non-invasive tool to assess renal function, aiding in patient stratification and treatment planning.Key Messages:The efficacy of interventional treatments for ARAS requires further investigation and careful patient selection. Functional MRI holds promise as a non-invasive means to assess renal function and mechanisms, potentially guiding more effective clinical decisions in ARAS management. Advancing research in diagnostic methods, particularly functional MRI, can enhance our understanding and improve the treatment outcomes for ARAS patients.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"17 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136018829","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":"Thickened Perirenal Fat Predicts Poor Renal Outcome in Patients with IgA Nephropathy: A Population-Based Retrospective Cohort Study","authors":"Hongtu Hu, Zongwei Zhang, Zikang Liu, Fan Chu, Jialu Ran, wei Liang","doi":"10.1159/000533507","DOIUrl":"https://doi.org/10.1159/000533507","url":null,"abstract":"<b><i>Introduction:</i></b> Perirenal fat is a pad that fills the retroperitoneal space outside the kidney, which affects kidney function in various ways. However, the association between perirenal fat and IgA nephropathy (IgAN) has not yet been elucidated. This study aimed to investigate the role of perirenal fat in predicting IgAN progression. <b><i>Methods:</i></b> A total of 473 patients with biopsy-proven IgAN and follow-up information were recruited, and perirenal fat thickness (PFT) was measured using color Doppler ultrasonography at renal biopsy. Patients were divided into two groups according to the median PFT: the low-PFT group (PFT ≤1.34 cm, <i>n</i> = 239) and the high PFT group (PFT &amp;gt;1.35 cm, <i>n</i> = 234). A total of 473 healthy participants were included in the control group. Basic clinical characteristics were assessed at the time of renal biopsy, and the relationship between PFT and combined endpoints was analyzed. The renal composite endpoints were defined as a two-fold increase in blood creatinine level, end-stage renal disease (dialysis over 3 months). Kaplan-Meier survival analysis was used to explore the role of PFT in the progression of IgAN. Three clinicopathological models of multivariate Cox regression analysis were established to evaluate the association between PFT and renal prognosis in patients with IgAN. <b><i>Results:</i></b> Compared to healthy subjects, patients with IgAN showed significantly higher PFT. After a median follow-up of 50 months, 75 of 473 patients (15.9%) with IgAN reached renal composite endpoints. Among those, 13 of 239 patients (5.4%) were in the low PFT group, and 62 of 234 patients (26.5%) were in the high PFT group (<i>p</i> &amp;lt; 0.001). The results of three Cox regression models (including demographics, pathological and clinical indicators, and PFT) demonstrated that a higher PFT was significantly associated with a higher risk of reaching renal composite endpoints in patients with IgAN. <b><i>Conclusion:</i></b> This study indicated a positive relationship between PFT at renal biopsy and renal progression in patients with IgAN, suggesting that perirenal fat might act as a marker of poor prognosis in patients with IgAN.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729189","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 treatment of coronary artery disease in patients with chronic kidney disease: gaps, challenges and solutions.","authors":"Ilya Losin, Keren-Cohen Hagai, David Pereg","doi":"10.1159/000533970","DOIUrl":"https://doi.org/10.1159/000533970","url":null,"abstract":"<b><i>Background:</i></b> Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the leading cause of death in CKD patients. Despite the high cardiovascular risk, ACS patients with renal dysfunction are less commonly treated with guideline-based medical therapy and are less frequently referred for coronary revascularization. <b><i>Summary:</i></b> The management of CAD is more challenging in patients with CKD than in the general population due to concerns regarding side effects and renal toxicity, as well as uncertainty regarding clinical benefit of guideline-based medical therapy and interventions. Patients with advanced CKD and especially those receiving dialysis have not traditionally been represented in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses are available. Recently published studies suggest that there are significant opportunities to substantially improve both cardiovascular and renal outcomes of patients with CAD and CKD, including new medications and interventions. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to improvement of both cardiovascular and renal outcomes. <b><i>Key Messages:</i></b> Adequate medical therapy and coronary interventions using evidence-based strategies can improve both cardiac and renal outcomes in patients with CAD and CKD.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135825243","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}