Kidney Medicine最新文献

{"title":"Acute Kidney Injury Prevention Following Cardiac Catheterization: The Ins and Outs of Management","authors":"Richard J. Solomon MD","doi":"10.1016/j.xkme.2024.100865","DOIUrl":"10.1016/j.xkme.2024.100865","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000761/pdfft?md5=7fcc00074214f3549dc457369aa55727&pid=1-s2.0-S2590059524000761-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Transplant in Children: Strategic Timing During Summer School Breaks","authors":"Lindsey M. Maclay BS , Lloyd Ratner MD, MPH , P. Rodrigo Sandoval MD , Miko Yu MA , Sumit Mohan MD, MPH , Syed Ali Husain MD, MPH","doi":"10.1016/j.xkme.2024.100864","DOIUrl":"10.1016/j.xkme.2024.100864","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400075X/pdfft?md5=95d0159ca8b8928d42862422732acb28&pid=1-s2.0-S259005952400075X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulse of Prudence: Navigating Isolated Lung Ultrasound in Patients Receiving Hemodialysis","authors":"Bhavna Bhasin-Chhabra MD , Abhilash Koratala MD","doi":"10.1016/j.xkme.2024.100862","DOIUrl":"10.1016/j.xkme.2024.100862","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000736/pdfft?md5=42eb898790aab05fd634c07eda04c55d&pid=1-s2.0-S2590059524000736-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141949539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dementia Care Among United States Dialysis Providers: A Mixed Methods Study Evaluating Clinician Comfort and Knowledge","authors":"Alexis A. Bender , Megan Urbanski , Jennifer Craft Morgan , Courtney Hoge , Jessica Joseph , Kelli Collins Damron , Clarica Douglas-Ajayi , Fran Rickenbach , Bernard G. Jaar , Anoop Sheshadri , Laura C. Plantinga","doi":"10.1016/j.xkme.2024.100884","DOIUrl":"10.1016/j.xkme.2024.100884","url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>Given the high burden of dementia in dialysis patients, the dialysis workforce needs to be prepared to provide high-quality, person-centered dementia care. We explored comfort with and knowledge of dementia among US dialysis care providers.</p></div><div><h3>Study Design</h3><p>Web-based survey.</p></div><div><h3>Setting & Participants</h3><p>Emails were sent to National Kidney Foundation and National Association of Nephrology Technicians/Technologists membership listservs (September 26, 2022-October 22, 2022). In total, 1,121 respondents had complete data for analysis (57%, 35-49 years; 62% female; 62%/22% White/African American) including 81 physicians, 61 advanced practice providers, 230 nurse managers, 260 nurses, 202 social workers, 195 dietitians, and 86 dialysis patient care technicians.</p></div><div><h3>Exposures</h3><p>Provider role, age, tenure, self-reported gender, previous dementia training, and awareness of dementia guidance.</p></div><div><h3>Outcomes</h3><p>Dementia Knowledge (assessed using Dementia Knowledge Assessment Scale [DKAS; score range, 0-25]).</p></div><div><h3>Analytic Approach</h3><p>Characteristics of respondents, comfort with dementia care, and dementia knowledge were summarized and tabulated overall and by role. Robust regression was used to obtain coefficients confidence intervals for the associations between characteristics and DKAS scores, adjusting for role and tenure. Free-text responses to an open-ended question about treating patients with dementia or cognitive impairment were analyzed using thematic analysis.</p></div><div><h3>Results</h3><p>Dementia knowledge among US dialysis providers may be limited (overall DKAS score<!--> <!-->=<!--> <!-->17; range, 13-21 across roles), despite most reporting knowing when patients had dementia (97%) and receiving training in dementia care (62%). Further, training may be inadequate: those who reported receiving dementia training had lower DKAS scores than those who reported not receiving training (β, –3.9; 95% CI, –4.4 to –3.4). Thematic analysis of open-ended responses suggested that the impact of dementia on dialysis care and management and treatment beyond dialysis care are challenging for providers.</p></div><div><h3>Limitations</h3><p>Data were self-reported and limited information was gathered about quality, content, and timing of dementia training received.</p></div><div><h3>Conclusion</h3><p>Many US dialysis care providers had suboptimal dementia knowledge, despite reporting being comfortable with providing dementia care and reporting they received prior training. Qualitative findings indicate complexity among providers regarding comfort with and knowledge of treating patients with cognitive impairment. Targeted training for the dialysis workforce in dementia knowledge and best practices for person-centered dementia care is warranted.</p></div><div><h3>Plain-Language Summary</h3><p>There is a high burden of mild cog","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000955/pdfft?md5=a0b04cd88e5b314d79d775103f9d523a&pid=1-s2.0-S2590059524000955-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care Acceptability for Older Adults with Advanced CKD: A Qualitative Study of Patients and Nephrologists","authors":"Fahad Saeed ,&nbsp;Areeba Jawed ,&nbsp;Spencer Dahl ,&nbsp;Frances R. Nedjat-Haiem ,&nbsp;Paul R. Duberstein ,&nbsp;Kevin A. Fiscella ,&nbsp;Reza Yousefi Nooraie ,&nbsp;Ronald M. Epstein ,&nbsp;Rebecca J. Allen","doi":"10.1016/j.xkme.2024.100883","DOIUrl":"10.1016/j.xkme.2024.100883","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Older adults in the United States often receive kidney therapies that do not align with their goals. Palliative care (PC) specialists are experts in assisting patients with the goals of care discussions and decision support, yet views and experiences of older patients who have received PC while contemplating kidney therapy decisions and their nephrologists remain unexplored. We evaluated the acceptability of CKD-EDU, a PC-based kidney therapy decision support intervention for adults<!--> <!-->≥75 years of age.</p></div><div><h3>Study Design</h3><p>Qualitative study.</p></div><div><h3>Setting &amp; Participants</h3><p>Two trained research coordinators interviewed patients and nephrologists participating in the CKD-EDU study.</p></div><div><h3>Analytical Approach</h3><p>Three coders analyzed the qualitative data using a thematic analysis approach to identify salient themes pertaining to intervention acceptability.</p></div><div><h3>Results</h3><p>Patients (n<!--> <!-->=<!--> <!-->19; mean age: 80 years) viewed the PC intervention favorably, noting PC physicians' excellent communication skills, whole-person care, and decision-making support, including comprehension of prognostic information. Nephrologists (n<!--> <!-->=<!--> <!-->24; mean age) welcomed PC assistance in decision making, support for conservative kidney management, and symptom management; a minority voiced concerns about third-party involvement in their practice.</p></div><div><h3>Limitations</h3><p>Single-center study.</p></div><div><h3>Conclusions</h3><p>Overall, patients and nephrologists generally found the PC intervention to be acceptable. Future testing of the current PC-based decision support intervention in a larger randomized controlled trial for older people navigating kidney therapy decisions is needed.</p></div><div><h3>Plain-Language Summary</h3><p>Literature on the acceptability of palliative care for kidney therapy decision making for older adults is scarce. This qualitative study establishes the acceptability of a palliative care (PC)-based kidney therapy decision support pilot intervention among older adults with advanced chronic kidney disease (CKD). Both patients and nephrologists found the intervention acceptable. Future testing of this PC-based intervention in an adequately powered randomized controlled trial for older individuals navigating kidney therapy decisions is needed.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000943/pdfft?md5=ffcd6ae6838bcc87da1b2cfe544f873b&pid=1-s2.0-S2590059524000943-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Center Hemodialysis Symptom Burden: Differences Between Men and Women","authors":"Georgia Parsons MBBS,&nbsp;Sai Liu MPH,&nbsp;Tara I. Chang MD, MS","doi":"10.1016/j.xkme.2024.100881","DOIUrl":"10.1016/j.xkme.2024.100881","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400092X/pdfft?md5=82685c0485b11e9177c865c9c4170da2&pid=1-s2.0-S259005952400092X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"False-positive Serum Antiglomerular Basement Membrane Antibody due to Bovine Serum Albumin-containing Surgical Adhesive: A Case Report","authors":"Ryuto Yoshida ,&nbsp;Tatsuhiko Azegami ,&nbsp;Shintaro Yamaguchi ,&nbsp;Aika Hagiwara ,&nbsp;Akihito Hishikawa ,&nbsp;Norifumi Yoshimoto ,&nbsp;Akinori Hashiguchi ,&nbsp;Kaori Hayashi","doi":"10.1016/j.xkme.2024.100880","DOIUrl":"10.1016/j.xkme.2024.100880","url":null,"abstract":"<div><p>Antiglomerular basement membrane (GBM) disease has a poor prognosis. The rapid detection of serum anti-GBM antibody using an enzyme immunoassay, which has a high sensitivity and specificity, leads to an early diagnosis and improved prognosis. We report a case of acute kidney injury with false-positive anti-GBM antibody. A man in his early fifties underwent aortic arch replacement using bovine serum albumin (BSA)-containing surgical adhesion. After intravenous administration of vancomycin for a fever, he developed acute kidney injury without an abnormal urinalysis, and his anti-GBM antibody titer (fluorescence enzyme immunoassay [FEIA]) was 70.4<!--> <!-->IU/mL. A kidney biopsy showed acute tubular injury and minor glomerular abnormalities without immunoglobulin G deposits, suggesting no evidence of anti-GBM glomerulonephritis. Consistent with the false-positive anti-GBM antibody test results, anti-GBM antibody determined using a chemiluminescent enzyme immunoassay was negative. A serum sample showed crossbinding to the FEIA plate from which the GBM antigen was removed. This finding indicated a nonspecific reaction to BSA, which contains a coating solution for the FEIA plate. This reaction was likely caused by anti-BSA antibody produced using BSA-containing surgical adhesion. Our findings suggest emerging challenges in diagnosing anti-GBM disease. Nephrologists must remain vigilant regarding false-positive anti-GBM antibody test results, particularly in cases evaluated with immunoassays that contain BSA.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000918/pdfft?md5=6379370b97e8f692de418fe13af97e3c&pid=1-s2.0-S2590059524000918-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein Intake and High Uric Acid Stone Risk","authors":"Tinika A. Montgomery ,&nbsp;Hari R. Nair ,&nbsp;Manali Phadke ,&nbsp;Erin Morhardt ,&nbsp;Adam Ludvigson ,&nbsp;Piruz Motamedinia ,&nbsp;Dinesh Singh ,&nbsp;Neera K. Dahl","doi":"10.1016/j.xkme.2024.100878","DOIUrl":"10.1016/j.xkme.2024.100878","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>We evaluated the metabolic differences between pure and impure uric acid stone formers in this retrospective study of uric acid kidney stone formers diagnosed between 1996 and 2021.</p></div><div><h3>Study Design</h3><p>Demographics and medical history were compared by χ² tests. Twenty-four-hour urine chemistries were compared using logistic regressions while controlling for demographics and comorbid conditions.</p></div><div><h3>Setting &amp; Participants</h3><p>Patients from Yale Urology and Nephrology Clinics with a documented kidney stone analysis containing uric acid were included. In total, 4,294 kidney stone formers had a stone analysis, and 722 (16.8%) contained uric acid. Patients with all stone analyses<!--> <span><math><mrow><mo>≥</mo></mrow></math></span> 50% uric acid were allocated to the pure group, while patients with<!--> <!-->≥1 stone analysis<!--> <!-->&lt;50% uric acid were allocated to the impure group.</p></div><div><h3>Results</h3><p>Among kidney stone formers, the prevalence of uric acid nephrolithiasis was 16.8%. Pure uric acid stone formers were more likely to be older, heavier, and were 1.5 times more likely to have chronic kidney disease. When controlling for age, sex, race, ethnicity, and body mass index, pure uric acid stone formers had lower urinary pH and lower urine citrate normalized for creatinine. Additionally, they had a higher protein catabolic rate, urine urea nitrogen, and urine sulfur normalized for creatinine, all markers of dietary protein intake. These findings persisted after controlling for chronic kidney disease.</p></div><div><h3>Limitations</h3><p>This is a retrospective study from a single center.</p></div><div><h3>Conclusions</h3><p>Pure uric acid stone formation is more common with diminished kidney function; however, after controlling for kidney function, pure uric acid stone formation is associated with protein intake, suggesting that modifying protein intake may reduce risk.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400089X/pdfft?md5=70f010b68791a23e924a007cab14eda0&pid=1-s2.0-S259005952400089X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperkalemia Incidence in Patients With Non-Dialysis Chronic Kidney Disease: A Large Retrospective Cohort Study From United States Clinical Care","authors":"Sascha van Boemmel-Wegmann ,&nbsp;Chris Bauer ,&nbsp;Johannes Schuchhardt ,&nbsp;Alexander Hartenstein ,&nbsp;Glen James ,&nbsp;Elena Pessina ,&nbsp;Scott Beeman ,&nbsp;Robert Edfors ,&nbsp;Roberto Pecoits-Filho","doi":"10.1016/j.xkme.2024.100879","DOIUrl":"10.1016/j.xkme.2024.100879","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;Estimates of the incidence of hyperkalemia in patients with chronic kidney disease (CKD) vary widely. Our objective was to estimate hyperkalemia incidence in patients with CKD from routine clinical care, including by level of kidney damage or function and among important patient subgroups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Retrospective cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;1,771,900 patients with stage 1-4 CKD identified from the US Optum De-Identified electronic health records database.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures or Predictors&lt;/h3&gt;&lt;p&gt;Impaired kidney damage or function level at baseline based on urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), respectively, and selected patient subgroups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;Hyperkalemia: 2 elevated serum potassium values (≥5.5&lt;!--&gt; &lt;!--&gt;mmol/L) from the inpatient setting (2-24 hours apart) or outpatient setting (maximum 7 days apart), or 1 elevated serum potassium value plus pharmacotherapy initiation or hyperkalemia diagnosis (maximum 3 days apart).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Incidence rates of hyperkalemia were calculated. Estimates were stratified by UACR and eGFR level at baseline and patient subgroups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Over a mean follow-up of 3.9 years, the incidence of hyperkalemia was 3.37 events/100 person-years (95% confidence intervals, 3.36-3.38). Higher incidence rates were observed with increased UACR and lower eGFR. Highest rates were observed with UACR&lt;!--&gt; &lt;!--&gt;≥3,500 (up to 19.1/100 person-years) irrespective of decreased eGFR level. High rates also occurred in patients with type 2 diabetes mellitus (T2DM, 5.43/100 person-years), heart failure (8.7/100 person-years), and those prescribed steroidal mineralocorticoid receptor antagonists (sMRAs, 7.7/100 person-years).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Potential misclassification of variables from possible medical coding errors; potential data incompleteness issues if patients received care at institutions not included in Optum.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Hyperkalemia is a frequent occurrence in CKD, particularly in patients with T2DM, heart failure, or prescribed sMRAs, indicating the need for regular serum potassium and UACR monitoring in this patient population to help mitigate risk.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;p&gt;People with chronic kidney disease (CKD) have a higher risk of illness, hospitalization, and death than those without CKD. Medicines that are commonly used to slow down CKD progression can sometimes lead to hyperkalemia, where levels of potassium in the blood are higher than normal and which can be potentially dangerous. Concerns about hyperkalemia have led some people with CKD to stop taking their medication. Our study of 1.7 million patients from the United States found that patients with severe kidney damage, as well as those with type 2 dia","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000906/pdfft?md5=0e3fa784406a1a8d98cf4fdb7c63494e&pid=1-s2.0-S2590059524000906-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Anuria in Incident Peritoneal Dialysis Patients: Incidence, Risk Factors, and Associated Clinical Outcomes","authors":"Shiyan Tu ,&nbsp;Hongjian Ye ,&nbsp;Yangyang Xin ,&nbsp;Yuan Peng ,&nbsp;Ruihua Liu ,&nbsp;Jing Guo ,&nbsp;Chunyan Yi ,&nbsp;Haiping Mao ,&nbsp;Xiao Yang","doi":"10.1016/j.xkme.2024.100882","DOIUrl":"10.1016/j.xkme.2024.100882","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;The development of anuria has been linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after starting PD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Retrospective cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Patients who started continuous ambulatory peritoneal dialysis at our center between 2006 and 2020 were included and followed up until January 31, 2023.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;p&gt;Age, sex, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;The primary outcome was early anuria, defined as 24-hour urine volume&lt;!--&gt; &lt;!--&gt;≤100&lt;!--&gt; &lt;!--&gt;mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease mortality, technique failure, and peritonitis.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Cox proportional hazards model.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 2,592 patients undergoing continuous ambulatory peritoneal dialysis aged 46.7&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;14.9 years were recruited. Among them, 58.9% were male, and 24.0% had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range, 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.90-0.97), higher serum albumin (HR, 0.92; 95% CI, 0.88-0.95), having diabetes before PD (HR, 0.57; 95% CI, 0.35-0.92), and prescribed incremental PD (HR, 0.27; 95% CI, 0.14-0.51) were associated with a reduced risk for early anuria, whereas a higher level of daily glucose exposure (HR, 1.01; 95% CI, 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEis or ARBs was linked to a lower risk of early anuria (HR, 0.25; 95% CI, 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR, 1.69; 95% CI, 1.23-2.32) and technique failure (HR, 1.43; 95% CI, 1.00-2.04) after adjusting for confounding factors.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Single-center and observational study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Among PD patients at a single center in China, early anuria was relatively uncommon but associated with an increased risk of mortality and PD technique failure. Incremental PD, higher baseline urine output and serum albumin, and lower daily glucose exposure were associated with a lower risk of early anuria. Clinical trials are needed to evaluate the optimal PD techniques to preserve residual kidney function and maximaze outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000931/pdfft?md5=44ca96080dd7541b3c31776390c58d80&pid=1-s2.0-S2590059524000931-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}