Kidney Diseases最新文献

{"title":"Long-term impact of renin-angiotensin system inhibitors for secondary prevention in patients with chronic kidney disease who underwent percutaneous coronary intervention","authors":"Tatsuya Fukase, Tomotaka Dohi, Ryota Nishio, Mitsuhiro Takeuchi, Norihito Takahashi, Yuichi Chikata, Hirohisa Endo, Shinichiro Doi, Hiroki Nishiyama, Iwao Okai, Hiroshi Iwata, Shinya Okazaki, Katsumi Miyauchi, Hiroyuki Daida, Tohru Minamino","doi":"10.1159/000532055","DOIUrl":"https://doi.org/10.1159/000532055","url":null,"abstract":"<b><i>Introduction:</i></b> The long-term impact of renin-angiotensin system (RAS) inhibitors for secondary prevention in patients with chronic kidney disease (CKD) and coexisting coronary artery disease remains unclear. <b><i>Methods:</i></b> Altogether, 1,160 consecutive patients with CKD (mean age, 70 ± 9 years; 78% men) who underwent their first percutaneous coronary intervention (PCI) between 2000 and 2018 were included and analyzed. Based on their RAS inhibitor use, 674 patients (58%) were allocated to the RAS inhibitor group, and 486 patients (42%) were allocated to the non-RAS inhibitor group. This study evaluated the incidence of 3-point major adverse cardiovascular events (3P-MACE), including cardiovascular death, nonfatal acute coronary syndrome and nonfatal stroke, admission for heart failure (HF), target vessel revascularization (TVR), and all-cause death. <b><i>Results:</i></b> During a median follow-up duration of 7.8 years, 280 patients (24.1%) developed 3P-MACE, 134 patients (11.6%) were hospitalized for HF, 171 patients (14.7%) underwent TVR, and 348 patients (30.0%) died of any causes. The cumulative incidence rate of 3P-MACE in the RAS inhibitor group was significantly lower than in the non-RAS inhibitor group (31.7% vs. 39.0%, log-rank test, <i>p</i> = 0.034); however, that of admission for HF in the RAS inhibitor group was significantly higher than in the non-RAS inhibitor group (28.1% vs. 13.3%, log-rank test, <i>p</i> &amp;lt; 0.001). The subgroup of preserved ejection fraction, non-acute myocardial infarction, and non-proteinuria tended to promote the onset of HF rather than cardiovascular prevention by RAS inhibitors. <b><i>Conclusion:</i></b> The long-term RAS inhibitor use for patients with CKD after PCI might prevent cardiovascular events but increase the risk of HF.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135918567","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":"Rapid initiation of peritoneal dialysis by automated peritoneal dialysis or hemodialysis: a randomized clinical trial","authors":"Qianying Zhang, Pei Wu, Jingyuan Xie, Xiao Li, Tian Xu, Xiaomin Huang, Chunyan Zhang, Nan Chen, Hong Ren","doi":"10.1159/000534334","DOIUrl":"https://doi.org/10.1159/000534334","url":null,"abstract":"Introduction: It is still controversial whether automated peritoneal dialysis (APD) or hemodialysis (HD) is a more favorable choice for the rapid initiation of peritoneal dialysis. Methods: A pilot randomized prospective controlled trial was carried out in Shanghai Ruijin Hospital. Sixty-seven patients who chose long-term peritoneal dialysis treatment and needed unplanned dialysis were enrolled and randomized into HD-CAPD group (33 cases) or APD-CAPD group (34 cases) based on the dialysis modality during the transition period (within 14 days from the day PD catheter was implanted). Continuous ambulatory peritoneal dialysis started after the transition period. The primary outcome was the decline rates of residual glomerular filtration rate (GFR). Secondary outcomes included the rates of mechanical complications, the rates of infectious complications and complications of ESRD. Results: We found residual GFR decline were faster in HD-CAPD group than in APD-CAPD group (0.06 ml/min/w vs 0.03ml/min/w, P<0.01). The incidences of mechanical complications were similar in APD-CAPD group comparing with HD-CAPD group, including hernia (2.9% vs 3.0%, P=1.00), catheter malposition (0.02 episodes/patient-months vs 0.02 episodes/patient-months, P=0.70), leakage (5.9% vs 6.1%, P=1.00) and omental wrap (0 episode vs 3 episodes, P=0.368). Though the one-year overall infection rates were similar (0.03 episodes/patient-months vs 0.05 episodes/patient-months, P=0.10), APD-CAPD group had lower rate of bacteremia compared to HD-CAPD group (0 episodes/patient-months vs 0.02 episodes/patient-months, P<0.01). Conclusions: Both APD and HD could be used for patients who need to start dialysis in an unplanned manner. APD may have the advantage in protecting residual renal functions among these patients.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134945033","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":"tRNA-Derived Small RNAs: A Novel Regulatory Small Noncoding RNA in Renal Diseases","authors":"Dan Li, Xian Xie, Ni Yin, Xueqin Wu, Bin Yi, Hao Zhang, Wei Zhang","doi":"10.1159/000533811","DOIUrl":"https://doi.org/10.1159/000533811","url":null,"abstract":"<b><i>Background:</i></b> tRNA-derived small RNAs (tsRNAs) are an emerging class of small noncoding RNAs derived from tRNA cleavage. <b><i>Summary:</i></b> With the development of high-throughput sequencing, various biological roles of tsRNAs have been gradually revealed, including regulation of mRNA stability, transcription, translation, direct interaction with proteins and as epigenetic factors, etc. Recent studies have shown that tsRNAs are also closely related to renal disease. In clinical acute kidney injury (AKI) patients and preclinical AKI models, the production and differential expression of tsRNAs in renal tissue and plasma were observed. Decreased expression of tsRNAs was also found in urine exosomes from chronic kidney disease patients. Dysregulation of tsRNAs also appears in models of nephrotic syndrome and patients with lupus nephritis. And specific tsRNAs were found in high glucose model in vitro and in serum of diabetic nephropathy patients. In addition, tsRNAs were also differentially expressed in patients with kidney cancer and transplantation. <b><i>Key Messages:</i></b> In the present review, we have summarized up-to-date works and reviewed the relationship and possible mechanisms between tsRNAs and kidney diseases.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135787492","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":"Risk of Hospital-Acquired Acute Kidney Injury among Adult Opioid Analgesic Users: A Multicenter Real-World Data Analysis","authors":"Mingjing Pi, Sheng Nie, Licong Su, Yanqin Li, Yue Cao, Peiyan Gao, Yuxin Lin, Yan Zha, Yongjun Shi, Hua Li, Jiajun Zhao, Yaozhong Kong, Guisen Li, Ying Hu, Huafeng Liu, Qijun Wan, Chunbo Chen, Bicheng Liu, Qiongqiong Yang, Guobin Su, Yilun Zhou, Jianping Weng, Gang Xu, Hong Xu, Ying Tang, Mengchun Gong, Fan Fan Hou, Xin Xu","doi":"10.1159/000533556","DOIUrl":"https://doi.org/10.1159/000533556","url":null,"abstract":"<b><i>Introduction:</i></b> Comprehensive data on the risk of hospital-acquired (HA) acute kidney injury (AKI) among adult users of opioid analgesics are lacking. This study aimed to systematically compare the risk of HA-AKI among the users of various opioid analgesics. <b><i>Methods:</i></b> This multicenter, retrospective real-world study analyzed 255,265 adult hospitalized patients who received at least one prescription of opioid analgesic during the first 30 days of hospitalization. The primary outcome was the time from the first opioid analgesic prescription to HA-AKI occurrence. 12 subtypes of opioid analgesics were analyzed, including 9 for treating moderate-to-severe pain and 3 for mild-to-moderate pain. We examined the association between the exposure to each subtype of opioid analgesic and the risk of HA-AKI using Cox proportional hazards models, using the most commonly used opioid analgesic as the reference group. <b><i>Results:</i></b> As compared to dezocine, the most commonly used opioid analgesic for treating moderate-to-severe pain, exposure to morphine, but not the other 7 types of opioid analgesics, was associated with a significantly increased risk of HA-AKI (adjusted hazard ratio: 1.56, 95% confidence interval: 1.40–1.78). The association was consistent in stratified analyses and in a propensity-matched cohort. There were no significant differences in the risk of HA-AKI among the opioid analgesic users with mild-to-moderate pain after adjusting for confounders. <b><i>Conclusion:</i></b> The use of morphine was associated with an increased risk of HA-AKI in adult patients with moderate-to-severe pain. Opioid analgesics other than morphine should be chosen preferentially in adult patients with high risk of HA-AKI when treating moderate-to-severe pain.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136242369","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":"Iron Supplements Concomitant within Hypoxia-Inducible Factor Prolyl Hydroxylase Domain Inhibitors in the Treatment of Chronic Kidney Disease Anemia","authors":"Xue Wang, Cuiting Wei, Delong Zhao, Xuefeng Sun, Fengge Zhu, Yan Mei, Qian Ma, Guangyan Cai, Xiangmei Chen, Ping Li","doi":"10.1159/000533304","DOIUrl":"https://doi.org/10.1159/000533304","url":null,"abstract":"<b><i>Background:</i></b> Anemia is a common and important complication in patients with chronic kidney disease (CKD). Accordingly, the current treatment is based on erythropoiesis-stimulating agents (ESAs) and iron. Hypoxia-inducible factor (HIF) prolyl hydroxylase domain inhibitors (HIF-PHIs) have been developed to treat renal anemia through a novel mechanism. HIF-PHIs increase erythropoietin at physiologic blood concentrations and also improve the supply of hematopoietic iron. Iron is the main component of hemoglobin, and ensuring efficient iron metabolism is essential in the treatment of anemia. <b><i>Summary:</i></b> HIF-PHIs may have advantages in improving iron utilization and mobilization compared to ESAs. Most HIF-PHI trials revealed a significant decline of hepcidin, increase in transferrin level and total iron binding capacity in patients. From a clinical point of view, improvements in iron metabolism should translate into reductions in iron supplementation. There are differences in the iron treatment regimentation currently used, so it is important to evaluate and timely iron supplementation across studies. <b><i>Key Messages:</i></b> This review summarizes the mechanism of HIF-PHIs on improved iron metabolism and the route of iron usage in the trials for dialysis-dependent CKD and non-dialysis CKD. And this review also makes an interpretation of the clinical practice guidelines in China and recommendation by Asia Pacific Society of Nephrology.","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135620691","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":"Construction of an Early Alert System for Intradialytic Hypotension before Initiating Hemodialysis Based on Machine Learning.","authors":"Daqing Hong,&nbsp;Huan Chang,&nbsp;Xin He,&nbsp;Ya Zhan,&nbsp;Rongsheng Tong,&nbsp;Xingwei Wu,&nbsp;Guisen Li","doi":"10.1159/000531619","DOIUrl":"https://doi.org/10.1159/000531619","url":null,"abstract":"<p><strong>Introduction: </strong>Intradialytic hypotension (IDH) is prevalent and associated with high hospitalization and mortality rates. The purpose of this study was to explore the risk factors for IDH and use artificial intelligence to establish an early alert system before hemodialysis sessions to identify patients at high risk of IDH.</p><p><strong>Materials and methods: </strong>We obtained data on 314,534 hemodialysis sessions conducted at Sichuan Provincial People's Hospital from the renal disease treatment information system. IDH was defined as a systolic blood pressure drop ≥20 mm Hg, a mean arterial pressure drop ≥10 mm Hg during dialysis, or the occurrence of clinical hypotensive events requiring nursing intervention. After pre-processing, the data were randomly divided into training (80%) and testing (20%) sets. Four interpolation methods, three feature selection methods, and 18 machine learning algorithms were used to construct predictive models. The area under the receiver operating characteristic curve (AUC) was the main indicator for evaluating the performance of the models, while Shapley Additive ExPlanation was used to explain the contribution of each variable to the best predictive model.</p><p><strong>Results: </strong>A total of 3,906 patients and 314,534 dialysis sessions were included, of which 142,237 cases showed IDH (incidence rate, 45.2%). Nineteen parameters were identified through artificial intelligence feature screening. They included age, pre-dialysis weight, dry weight, pre-dialysis blood pressure, heart rate, prescribed ultrafiltration, blood cell counts (neutrophil, lymphocyte, monocyte, eosinophil, lymphocyte, and platelet counts), hematocrit, serum calcium, creatinine, urea, glucose, and uric acid. Random forest, gradient boosting, and logistic regression were the three best models, and the AUCs were 0.812 (95% confidence interval [CI], 0.811-0.813), 0.748 (95% CI, 0.747-0.749), and 0.743 (95% CI, 0.742-0.744), respectively.</p><p><strong>Conclusion: </strong>Our dialysis software-based artificial intelligence alert system can be used to predict IDH occurrence, enabling the initiation of relevant interventions.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"9 5","pages":"433-442"},"PeriodicalIF":3.7,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412822","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":"Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis.","authors":"Henry H L Wu,&nbsp;Dimitrios Poulikakos,&nbsp;Helen Hurst,&nbsp;David Lewis,&nbsp;Rajkumar Chinnadurai","doi":"10.1159/000531367","DOIUrl":"https://doi.org/10.1159/000531367","url":null,"abstract":"<p><strong>Background: </strong>An aging population living with chronic kidney disease and progressing to kidney failure, subsequently receiving peritoneal dialysis (PD) is growing. A significant proportion of these patients are also living with multi-morbidities and some degree of frailty. Recent practice recommendations from the International Society of Peritoneal Dialysis advocate for high-quality, goal-directed PD prescription, and the Standardized Outcomes of Nephrology-PD initiative emphasized the need for an individualized, goal-based care approach in all patients receiving PD treatment. In older patients, this approach to PD care is even more important. A frailty screening assessment, followed by a comprehensive geriatric assessment (CGA) prior to PD initiation and when dictated by change in relevant circumstances is paramount in tailoring PD care and prescription according to the needs, life goals, as well as clinical status of older patients with kidney failure.</p><p><strong>Summary: </strong>Our review aimed to summarize the different dimensions to be taken into account when delivering PD care to the older patient - from frailty screening and CGA in older patients receiving PD to employing a personalized, goal-directed PD prescription strategy, to preserving residual kidney function, optimizing blood pressure (BP) control, and managing anemia, to addressing symptom burden, to managing nutritional intake and promoting physical exercise, and to explore telehealth opportunities for the older PD population.</p><p><strong>Key messages: </strong>What matters most to older PD patients may not be simply extending survival, but more importantly, to be living comfortably on PD treatment with minimal symptom burden in a home environment and to minimize treatment complications.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"9 5","pages":"358-370"},"PeriodicalIF":3.7,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412823","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":"Genetic Diagnosis and Treatment of Inherited Renal Tubular Acidosis.","authors":"Wenkai Guo,&nbsp;Pengcheng Ji,&nbsp;Yuansheng Xie","doi":"10.1159/000531556","DOIUrl":"https://doi.org/10.1159/000531556","url":null,"abstract":"<p><strong>Background: </strong>Renal tubular acidosis (RTA) is caused by various disruptions to the secretion of H⁺ by distal renal tubules and/or dysfunctional reabsorption of HCO₃^- by proximal renal tubules, which causes renal acidification dysfunction, ultimately leading to a clinical syndrome characterized by hyperchloremic metabolic acidosis with a normal anion gap. With the development of molecular genetics and gene sequencing technology, inherited RTA has also attracted attention, and an increasing number of RTA-related pathogenic genes have been discovered and reported.</p><p><strong>Summary: </strong>This paper focuses on the latest progress in the research of inherited RTA and systematically reviews the pathogenic genes, protein functions, clinical manifestations, internal relationship between genotypes and clinical phenotypes, diagnostic clues, differential diagnosis, and treatment strategies associated with inherited RTA. This paper aims to deepen the understanding of inherited RTA and reduce the missed diagnosis and misdiagnosis of RTA.</p><p><strong>Key messages: </strong>This review systematically summarizes the pathogenic genes, pathophysiological mechanisms, differential diagnosis, and treatment of different types of inherited RTA, which has good clinical value for guiding the diagnosis and treatment of inherited RTA.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"9 5","pages":"371-383"},"PeriodicalIF":3.7,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412827","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":"Cognitive Impairment in Chronic Kidney Disease Is Associated with Glymphatic System Dysfunction.","authors":"Shuqin Xu,&nbsp;Jiuqi Wang,&nbsp;Kedi Sun,&nbsp;Lin Meng,&nbsp;Chi Qin,&nbsp;Renyi Feng,&nbsp;Yiming Tian,&nbsp;Yanping Zhai,&nbsp;Dongxiao Liang,&nbsp;Rui Zhang,&nbsp;Haiyan Tian,&nbsp;Han Liu,&nbsp;Yongkang Chen,&nbsp;Yu Fu,&nbsp;Pei Chen,&nbsp;Qingyong Zhu,&nbsp;Junfang Teng,&nbsp;Xuejing Wang","doi":"10.1159/000530635","DOIUrl":"https://doi.org/10.1159/000530635","url":null,"abstract":"<p><strong>Introduction: </strong>This study was designed to explore the associations between impaired cognition in chronic kidney disease (CKD) patients and the dysfunction of the glymphatic system.</p><p><strong>Method: </strong>Data were obtained from 77 CKD patients and 50 age-matched healthy control individuals from the First Affiliated Hospital of Zhengzhou University. CKD patients were stratified into with and without impaired cognitive function. T2-weighted magnetic resonance imaging results were used to assess area ratios for the perivascular space and ventricles in participants, while the Montreal Cognitive Assessment and the Mini-Mental State Examination were employed to measure cognitive function. Correlations between the perivascular space or ventricle area ratios and cognitive impairment were assessed in CKD patients.</p><p><strong>Results: </strong>Significant increases in the burden of enlarged perivascular spaces in the frontal cortex and basal ganglia were observed in CKD patients with cognitive impairment relative to those without such impairment, with a concomitant increase in analyzed ventricle area ratios. Enlarged perivascular spaces in the frontal cortex, basal ganglia and increased area ratios of lateral ventricles and 4th ventricle exhibited relatively high sensitivity and specificity as means of differing between the CKD patients with and without cognitive impairment.</p><p><strong>Conclusion: </strong>These results indicate that the burden of enlarged perivascular spaces in the frontal cortex and basal ganglia and increases in ventricle area ratio values may offer utility as biomarkers that can aid in detection of even mild cognitive decline in individuals with CKD. The dysfunction of the glymphatic system may play a key role in the pathogenesis of CKD-related cognitive impairment.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"9 5","pages":"384-397"},"PeriodicalIF":3.7,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412821","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":"Impact of Angiotensin Receptor Blockers Use on In-Hospital Mortality in Community-Acquired Pneumonia Patients with Hypertension.","authors":"Dawei Chen,&nbsp;Yan Tan,&nbsp;Xin Wan","doi":"10.1159/000531479","DOIUrl":"https://doi.org/10.1159/000531479","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to explore the association of angiotensin receptor blockers (ARBs) use with in-hospital mortality among Chinese patients with hypertension hospitalized with community-acquired pneumonia (CAP).</p><p><strong>Methods: </strong>This study was conducted from January 2014 to January 2017, and data from patients with hypertension hospitalized with CAP were analyzed retrospectively. Multivariable logistic regression and propensity score matching (PSM) were used to investigate any association.</p><p><strong>Results: </strong>1,510 patients were included in this study. The crude in-hospital mortality was significantly lower in patients with ARBs use (4.2% vs. 12.5%, <i>p</i> < 0.001). In the extended multivariable logistic models, the odds ratios (ORs) of ARBs use were consistently significant in all six models (OR range 0.27-0.48, <i>p</i> < 0.05 for all). After subgroup analysis, ARBs use remained a potentially protective factor against in-hospital mortality, and no interaction was detected. After PSM, the in-hospital mortality remained significantly lower in the ARBs use group (4.2% vs. 10.9%, <i>p</i> = 0.002). In the univariate analysis, using ARBs was associated with in-hospital mortality (PSM OR, 0.36; 95% CI, 0.19-0.68; <i>p</i> = 0.002). Additionally, compared with the control group, ARBs use did not significantly increase the risk of acute kidney injury (12.4% vs. 10.9%, <i>p</i> = 0.628), renal replacement therapy (0.6% vs. 0.3%, <i>p</i> = 1.000), and hyperkalemia (1.8% vs. 2.1%, <i>p</i> = 1.000).</p><p><strong>Conclusion: </strong>Although residual confounding cannot be excluded, the use of ARBs was associated with lower in-hospital mortality in Chinese patients with hypertension hospitalized with CAP.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"9 5","pages":"424-432"},"PeriodicalIF":3.7,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412828","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}