Kidney Medicine最新文献

{"title":"“The Heart of the Center”: Exploring the Role of the Patient Care Technician in US Dialysis Care","authors":"Megan Urbanski , Emma Blythe , Alicia Hamblin , Alexis A. Bender , Courtney Hoge , Clarica Douglas-Ajayi , Fran Rickenbach , Jessica Joseph , Kelli Collins Damron , Jennifer Craft Morgan , Bernard Jaar , Laura Plantinga","doi":"10.1016/j.xkme.2024.100934","DOIUrl":"10.1016/j.xkme.2024.100934","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Dialysis patient care technicians (PCTs) provide essential, frontline care for patients receiving in-center hemodialysis. We qualitatively explored perceptions of the PCT job role, responsibilities, and training among current PCTs, non-PCT dialysis staff, and patients receiving hemodialysis.</div></div><div><h3>Study Design</h3><div>Focus group study.</div></div><div><h3>Setting & Participants</h3><div>Discussions were conducted in March–May 2023 among US PCTs, non-PCT staff, and patients.</div></div><div><h3>Analytical Approach</h3><div>Thematic analysis was conducted using inductive and deductive strategies.</div></div><div><h3>Results</h3><div>Seven focus groups (N = 36 participants) were conducted (3 with PCTs [n = 19], 2 with non-PCT staff [n = 6], and 2 with patients [n = 11]). Eight themes emerged: (1) value of PCT role is not reflected in job or organizational policies and structures; (2) PCTs play a flexible and often ill-defined role in dialysis clinics; (3) despite being in a position with high risk of burnout, PCTs find ways to persevere and provide high-quality care; (4) PCTs are often perceived as “helpers” or ancillary rather than an integral part of the dialysis care team; (5) PCT job training and qualifications are not standardized and often not commensurate with job expectations and responsibilities; (6) PCT-patient relationships are deeply valued, but boundaries can be fluid and become blurred because of the frequency and nature of dialysis care; (7) dialysis patients and staff are vulnerable to multilevel workplace safety issues; and (8) PCT-staff dynamics have a strong impact on employee morale, clinic efficiency, and patient satisfaction.</div></div><div><h3>Limitations</h3><div>Non-English-speaking participants and physicians were excluded, limiting diversity in perspectives.</div></div><div><h3>Conclusions</h3><div>PCTs play a multifaceted role in dialysis care that is highly valued among patients and staff but not always reflected in actual tasks performed by PCTs, training received by PCTs, or the respect afforded to PCTs. Our findings are actionable and can inform future intervention-based work aimed at improving the PCT role in US hemodialysis care.</div></div><div><h3>Plain-Language Summary</h3><div>In the United States, patient care technicians (PCTs) spend the most chair-side time with patients receiving hemodialysis, but little is known about the role of patient care technicians (PCTs) in dialysis care. We conducted 7 focus groups with US PCTs, other dialysis staff, and patients receiving hemodialysis. Discussions showed that the PCT role is highly valued among dialysis staff and patients, but this is often poorly reflected in organizational structures. PCTs also often work outside of their scope and training. Additionally, PCTs and patients form strong bonds, but these relationships are sometimes viewed as problematic. Results highlight the complex, valuable role PCT","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100934"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907367","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":"Acute Kidney Injury Prognosis Prediction Using Machine Learning Methods: A Systematic Review","authors":"Yu Lin , Tongyue Shi , Guilan Kong","doi":"10.1016/j.xkme.2024.100936","DOIUrl":"10.1016/j.xkme.2024.100936","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Accurate estimation of in-hospital outcomes for patients with acute kidney injury (AKI) is crucial for aiding physicians in making optimal clinical decisions. We aimed to review prediction models constructed by machine learning methods for predicting AKI prognosis using administrative databases.</div></div><div><h3>Study Design</h3><div>A systematic review following PRISMA guidelines.</div></div><div><h3>Setting & Study Populations</h3><div>Adult patients diagnosed with AKI who are admitted to either hospitals or intensive care units.</div></div><div><h3>Search Strategy & Sources</h3><div>We searched PubMed, Embase, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health for studies published between January 1, 2014 and February 29, 2024. Eligible studies employed machine learning models to predict in-hospital outcomes of AKI based on administrative databases.</div></div><div><h3>Data Extraction</h3><div>Extracted data included prediction outcomes and population, prediction models with performance, feature selection methods, and predictive features.</div></div><div><h3>Analytical Approach</h3><div>The included studies were qualitatively synthesized with assessments of quality and bias. We calculated the pooled model discrimination of different AKI prognoses using random-effects models.</div></div><div><h3>Results</h3><div>Of 3,029 studies, 27 studies were eligible for qualitative review. In-hospital outcomes for patients with AKI included acute kidney disease, chronic kidney disease, renal function recovery or kidney failure, and mortality. Compared with models predicting the mortality of patients with AKI during hospitalization, the prediction performance of models on kidney function recovery was less accurate. Meta-analysis showed that machine learning methods outperformed traditional approaches in mortality prediction (area under the receiver operating characteristic curve, 0.831; 95% CI, 0.799-0.859 vs 0.772; 95% CI, 0.744-0.797). The overlapping predictive features for in-hospital mortality identified from<!--> <!-->≥6 studies were age, serum creatinine level, serum urea nitrogen level, anion gap, and white blood cell count. Similarly, age, serum creatinine level, AKI stage, estimated glomerular filtration rate, and comorbid conditions were the common predictive features for kidney function recovery.</div></div><div><h3>Limitations</h3><div>Many studies developed prediction models within specific hospital settings without broad validation, restricting their generalizability and clinical application.</div></div><div><h3>Conclusions</h3><div>Machine learning models outperformed traditional approaches in predicting mortality for patients with AKI, although they are less accurate in predicting kidney function recovery. Overall, these models demonstrate significant potential to help physicians improve clinical decision making and patient outcomes.</div></div><div><h3>Registrati","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100936"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932273","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":"Factors Influencing Recruitment, Retention, and Adherence Rates in Exercise Interventions in ESKD: A Scoping Review","authors":"Malvika Agarwal , Jamie Alexiuk , Clara Bohm , Lindsey Sikora , Deborah Zimmerman","doi":"10.1016/j.xkme.2024.100933","DOIUrl":"10.1016/j.xkme.2024.100933","url":null,"abstract":"<div><h3>Rational & Objective</h3><div>Majority of people with end-stage kidney disease (ESKD) are sedentary, which increases risk for decreased quality and quantity of life. Development of exercise programs with characteristics that address individual preferences may increase interest in participating and completing exercise programs. We evaluated which exercise intervention characteristics affect exercise program recruitment, adherence, and completion in people with ESKD receiving dialysis.</div></div><div><h3>Study Design</h3><div>Scoping review of randomized controlled trials (RCTs) with searching of Medline, Embase, Cochrane, and CINAHL databases through May 12, 2023.</div></div><div><h3>Setting & Study Populations</h3><div>Adults with ESKD receiving dialysis.</div></div><div><h3>Selection Criteria</h3><div>RCTs with exercise interventions of<!--> <!-->≥12 weeks that included more than 10 people with ESKD receiving dialysis in each study arm.</div></div><div><h3>Data Extraction</h3><div>One individual extracted data and the second author checked for accuracy.</div></div><div><h3>Analytical Approach</h3><div>Data were synthesized qualitatively. Associations between intervention characteristics and recruitment, retention and adherence rates were assessed through one-way analysis of variance tests. Risk of bias was assessed using the Cochrane Risk of Bias 1.0 tool.</div></div><div><h3>Results</h3><div>Of 7,396 studies identified, 55 studies with 3,269 trial participants were included. The majority of participants were male (63.2%) and treated with hemodialysis (89.1%). Mean age was 56<!--> <!-->±<!--> <!-->11.5 years. Average recruitment, retention and adherence rates were 77.4%, 81.2%, and 76.0%, respectively. Only 27% of studies reported adherence rates. No significant associations were found between intervention characteristics (ie, exercise type, duration, frequency, setting, and supervision) and recruitment, adherence, and retention rates.</div></div><div><h3>Limitations</h3><div>Data were limited by small sample size, suboptimal risk of bias, selective recruiting methods, and variability in definitions of adherence rates.</div></div><div><h3>Conclusion</h3><div>Average recruitment, retention, and adherence rates in exercise interventions for patients receiving dialysis were high although less than 1 in 4 studies reported adherence rates. These results call for standardized reporting of recruitment, retention, and adherence rates in exercise interventions.</div></div><div><h3>Plain-Language Summary</h3><div>Regular exercise for people with end-stage kidney disease (ESKD) can improve their quality of life. We sought to determine if there were certain characteristics of an exercise program such as exercise type, frequency, program length, and setting that were associated with enhanced recruitment, retention, and adherence to the program. From the 55 identified studies, average recruitment, retention, and adherence rates in exercise i","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100933"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983864","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":"Glomerular and Nephron Size and Kidney Disease Outcomes: A Comparison of Manual Versus Deep Learning Methods in Kidney Pathology","authors":"Jaidip M. Jagtap PhD, MS , Andrew R. Janowczyk PhD, MS , Yijiang Chen PhD , Afsana A. Shaik MBBS , Aidan F. Mullan MA , Bradley J. Erickson MD, PhD , Vidit Sharma MD , Timothy L. Kline PhD, MS , Laura Barisoni MD , Aleksandar Denic MD, PhD , Andrew D. Rule MD","doi":"10.1016/j.xkme.2024.100939","DOIUrl":"10.1016/j.xkme.2024.100939","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100939"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979082","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":"Spinal Cord Compression as the First Presentation of Primary Hyperoxaluria in a Patient With Kidney Failure: A Case Report and Literature Review","authors":"Marwa Kliea ,&nbsp;Mohammad Alsultan ,&nbsp;Safaa Qatleesh ,&nbsp;Yousef Haroun ,&nbsp;Osama Abdul Aziz ,&nbsp;Kassem Basha","doi":"10.1016/j.xkme.2024.100932","DOIUrl":"10.1016/j.xkme.2024.100932","url":null,"abstract":"<div><div>A 50-year-old woman with kidney failure complained of back pain and an inability to walk. The medical history included hypothyroidism, nephrolithiasis, and resistant anemia aligned with several transfusions. The examination showed hepatosplenomegaly, lower limb weakness, absence of reflexes, and lack of sensations with a sensory level T6. Laboratory results showed hypercalcemia with suppression of parathyroid hormone levels. Magnetic resonance imaging showed vertebral fractures and mass-like lesions that compressed the spine at T4, T9, L4, and L5. Vertebral and bone marrow biopsies showed calcium oxalate (CaOx) depositions. Here, we reported a rare case of primary hyperoxaluria (PH) in a patient with kidney failure who presented with spinal cord compression caused by vertebral fractures and mass-like lesions. We summarized a literature review of PH patients with spinal cord compression, which showed only 3 cases. The multiorgan CaOx infiltration in this patient also caused resistant anemia, hepatosplenomegaly, extensive bone lesions, hypoparathyroidism, hypothyroidism, and hypercalcemia. The overdiagnosis of renal osteodystrophy and the negative family history could delay the diagnosis of PH in patients with kidney failure. Thus, clinicians should always consider PH in the differential diagnosis of kidney failure patients with stone events given that the early diagnosis of PH could be lifesaving.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100932"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932297","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":"Development of a Novel Intraperitoneal Icodextrin/Dextrose Solution for Enhanced Sodium Removal","authors":"Jennifer L. Asher ,&nbsp;Juan B. Ivey-Miranda ,&nbsp;Christopher Maulion ,&nbsp;Zachary L. Cox ,&nbsp;Julian A. Borges-Vela ,&nbsp;Genaro H. Mendoza-Zavala ,&nbsp;Jose A. Cigarroa-Lopez ,&nbsp;Rogelio I. Silva-Rueda ,&nbsp;Cristina Revilla-Monsalve ,&nbsp;Julieta Moreno-Villagomez ,&nbsp;Daniela Ramos-Mastache ,&nbsp;Oliver Goedje ,&nbsp;Ian Crosbie ,&nbsp;Christopher McIntyre ,&nbsp;Fredrick Finkelstein ,&nbsp;Jeffrey M. Turner ,&nbsp;Jeffrey M. Testani ,&nbsp;Veena S. Rao","doi":"10.1016/j.xkme.2024.100938","DOIUrl":"10.1016/j.xkme.2024.100938","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Peritoneal dialysis (PD) solutions provide both clearance of uremic toxins and sodium and water. An intraperitoneal (IP) solution of icodextrin and glucose designed without the requirement for uremic toxin clearance could provide substantially greater sodium and water removal than PD solutions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We examined varying concentrations of icodextrin and dextrose IP solutions in rats. We evaluated a 30% icodextrin and 10% dextrose IP solution in animals and humans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Small and large animal models, and humans (N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;10) with kidney failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;30% icodextrin and 10% dextrose IP solution.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;We evaluated ultrafiltration (UF), sodium removal, and peritoneal health in animals. We evaluated safety, tolerability, and efficacy in humans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In rats, increasing concentrations of icodextrin and dextrose IP solutions, up to 30% icodextrin and 10% dextrose, produced progressively greater UF (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). In sheep treated with 30% icodextrin and 10% dextrose, the mean UF was ∼3.5-fold greater (1.77&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;0.22&lt;!--&gt; &lt;!--&gt;L vs 0.47&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;0.34&lt;!--&gt; &lt;!--&gt;L; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.005) and the mean sodium removal was ∼4-fold greater (7.07&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;0.72&lt;!--&gt; &lt;!--&gt;g vs 1.78&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.27&lt;!--&gt; &lt;!--&gt;g; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.003) compared with commercially available 7.5% icodextrin PD solution. Long-term exposure of mice (30 days) and sheep (30-45 days) to a 30% icodextrin and 10% dextrose IP solution resulted in no significant structural tissue changes compared with the control 4.25% commercially available PD solution. In humans, a 24-hour dwell of a 30% icodextrin and 10% dextrose IP solution resulted in median net UF of 2,498&lt;!--&gt; &lt;!--&gt;mL (IQR, 2,249-2,768), and median sodium removal of 387&lt;!--&gt; &lt;!--&gt;mmol (IQR, 372-434&lt;!--&gt; &lt;!--&gt;mmol). No serious adverse events occurred.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The long-term safety with chronic therapy and the efficacy in patients without kidney failure were not established and require future studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;A 30% icodextrin and 10% dextrose IP solution provides more efficient UF and sodium removal than traditional PD solutions. The promising inhuman safety and efficacy results warrant future investigation as a sodium removal therapy in patients with edematous disorders such as heart failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registration&lt;/h3&gt;&lt;div&gt;NCT05780086.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Summary&lt;/h3&gt;&lt;div&gt;We aimed to design a novel intraperitoneal solution designed for optimal sodium and water removal. A sodium-free 30% icodextrin and 10% dextrose intraperitoneal solution was evaluated in animal models and humans to determine the safety and efficacy. A 30% i","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100938"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950822","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":"Artificial Intelligence in Nephrology: Clinical Applications and Challenges","authors":"Prabhat Singh ,&nbsp;Lokesh Goyal ,&nbsp;Deobrat C. Mallick ,&nbsp;Salim R. Surani ,&nbsp;Nayanjyoti Kaushik ,&nbsp;Deepak Chandramohan ,&nbsp;Prathap K. Simhadri","doi":"10.1016/j.xkme.2024.100927","DOIUrl":"10.1016/j.xkme.2024.100927","url":null,"abstract":"<div><div>Artificial intelligence (AI) is increasingly used in many medical specialties. However, nephrology has lagged in adopting and incorporating machine learning techniques. Nephrology is well positioned to capitalize on the benefits of AI. The abundance of structured clinical data, combined with the mathematical nature of this specialty, makes it an attractive option for AI applications. AI can also play a significant role in addressing health inequities, especially in organ transplantation. It has also been used to detect rare diseases such as Fabry disease early. This review article aims to increase awareness on the basic concepts in machine learning and discuss AI applications in nephrology. It also addresses the challenges in integrating AI into clinical practice and the need for creating an AI-competent nephrology workforce. Even though AI will not replace nephrologists, those who are able to incorporate AI into their practice effectively will undoubtedly provide better care to their patients. The integration of AI technology is no longer just an option but a necessity for staying ahead in the field of nephrology. Finally, AI can contribute as a force multiplier in transitioning to a value-based care model.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"Article 100927"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971536","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":"Intracapillary Monoclonal IgM Deposition Concomitant With Cold Agglutinin Disease","authors":"Silvia M. Titan ,&nbsp;Sandra Herrmann ,&nbsp;Nelson Leung ,&nbsp;Pingchuan Zhang ,&nbsp;Stephen Ansell","doi":"10.1016/j.xkme.2024.100964","DOIUrl":"10.1016/j.xkme.2024.100964","url":null,"abstract":"<div><div>Monoclonal gammopathy of renal significance (MGRS) comprises a spectrum of kidney manifestations distinguished by its clinical and pathological presentations. This article reports a case of a female on her 60s who was referred to Nephrology for evaluation of worsening kidney function, hematuria, and proteinuria. Her medical history was notable for marginal zone lymphoma along with immunoglobulin M (IgM)-kappa cold agglutinin disease diagnosed 3 years before the current presentation, which had been treated with rituximab. A kidney biopsy was performed and revealed IgM-kappa monoclonal protein-associated nephropathy with predominantly intracapillary monoclonal IgM deposition injury pattern, a rare form of MGRS, reported for the first time in association with cold agglutinin disease.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100964"},"PeriodicalIF":3.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131169","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":"Acute Kidney Injury, Mild Cognitive Impairment, and Dementia: A Cohort Study of Patients from SPRINT","authors":"Kristen L. Nowak,&nbsp;Anna Ostrow,&nbsp;Ester S. Oh,&nbsp;Zhiying You,&nbsp;Michel Chonchol","doi":"10.1016/j.xkme.2024.100962","DOIUrl":"10.1016/j.xkme.2024.100962","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>It is well accepted that acute cognitive dysfunction and delirium can occur with severe acute kidney injury (AKI). Recent evidence has indicated AKI can contribute to incident dementia years later. However, these observations were limited by lack of adjudication in most of these studies and greater severity of AKI.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study.</div></div><div><h3>Setting &amp; Participants</h3><div>8,148 older adults at high cardiovascular risk enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT).</div></div><div><h3>Predictor</h3><div>Adjudicated AKI as a time-varying predictor.</div></div><div><h3>Outcomes</h3><div>Incident mild cognitive impairment (MCI), probable dementia, and their composite.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard models.</div></div><div><h3>Results</h3><div>Participants were 68<!--> <!-->±<!--> <!-->9 years, 65% male, 28% with prevalent chronic kidney disease), with a median (interquartile range) follow-up time for the composite of 4.0 (2.1-5.4) and 4.6 (3.6-5.9) years in the AKI and non-AKI groups, respectively. The incidence rate of MCI, probable dementia, and their composite was higher in participants who experienced an AKI event (n<!--> <!-->=<!--> <!-->270). In the fully adjusted model, AKI was positively associated with probable dementia (hazard ratio, 1.72; 95% CI, 1.07-2.75) and the composite outcome (1.43 [1.01-2.04]).</div></div><div><h3>Limitations</h3><div>AKI before baseline was not captured; retrospective and associative.</div></div><div><h3>Conclusions</h3><div>Adjudicated AKI, which was largely mild and reversible, was independently associated with increased risk of probable dementia and the composite of probable dementia and MCI in older adults at high cardiovascular risk.</div></div><div><h3>Plain Language Summary</h3><div>It is well accepted that acute cognitive dysfunction and delirium can occur with severe acute kidney injury (AKI), and recent evidence has indicated that AKI can contribute to new onset of dementia years later. We examined whether having an AKI increased risk of adverse cognitive outcomes among 8,148 older adults at high cardiovascular risk enrolled who participated in the Systolic Blood Pressure Intervention Trial. AKI, although generally mild and reversible, independently associated with increased risk of probable dementia and a combined endpoint of probable dementia and mild cognitive impairment. These results suggest that cognitive function should be monitored following AKI in this patient population.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100962"},"PeriodicalIF":3.2,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131174","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":"Sodium–Glucose Cotransporter-2 Inhibitors and Prevention of Adverse Kidney Outcomes in Type 2 Diabetes: A Clinical Multiethnic Asian Cohort","authors":"Liang Feng ,&nbsp;Zhong Hong Liew ,&nbsp;Yong Mong Bee ,&nbsp;Tazeen H. Jafar","doi":"10.1016/j.xkme.2024.100963","DOIUrl":"10.1016/j.xkme.2024.100963","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Studies of sodium-glucose cotransporter-2 (SGLT2) inhibitors assessing kidney outcomes among Asians with type 2 diabetes in a clinical setting are limited. We assessed the association of SGLT2 inhibitors with kidney and safety outcomes in a diverse multiethnic Asian population with type 2 diabetes in a clinical setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Patients with type 2 diabetes from multi-institutional SingHealth Diabetes Registry in Singapore.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Initiators of SGLT2 inhibitors between 2014 to 2018 with a median follow-up duration of 25.6 months (interquartile range, 17.9-31.4).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Composite kidney outcome (≥40% estimated glomerular filtration rate [eGFR] decline or incident kidney failure with replacement therapy [KFRT]), its components, rate of eGFR change, amputation, and acute kidney injury (AKI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Propensity scores for SGLT2 inhibitors initiation were developed, with 1:1 matching with initiators of other antidiabetic drugs. Cox proportional hazards and linear mixed effect models were employed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After matching, there were 4,254 patients newly initiated on either SGLT-2 inhibitors or other glucose-lowering drugs (2,127 in each group). The mean age was 63.4 (SD 9.2) years, with 48.6% women. In total, 67.8% of participants were Chinese, 11.9% Indian, 15.6% Malay, and 4.7% others. Initiating SGLT2 inhibitors was associated with lower risks of composite kidney outcome (hazard ratio [HR], 0.39; 95% CI, 0.31-0.48) and&lt;!--&gt; &lt;!--&gt;≥40% reduction in eGFR from baseline (HR, 0.38; 95% CI, 0.31-0.48). SGLT2 inhibitor initiation was also associated with a slower eGFR decline among the intention-to-treat population (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1,888, difference in slope: 2.67&lt;!--&gt; &lt;!--&gt;mL/min per 1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; per year; 95% CI, 1.90-3.43). No significant association with amputation was found, though SGLT2 inhibitors were associated with reduced AKI risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Potential informed presence bias and residual and unmeasured confounding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;SGLT2 inhibitors significantly benefit kidney outcomes in multiethnic Asians with type 2 diabetes, highlighting their role in preventing kidney complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;Real-world evidence on the kidney benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors among Asians with type 2 diabetes is limited. This study examined the effects of SGLT2 inhibitors on kidney and safety outcomes in a diverse group with type 2 diabetes in Singapore. Data from 2,127 patients initiating SGLT2 inhibitors were matched 1:1 with other glucose-lowering drugs users using propensity scores. Over a median follow-up of 25.6 months,","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100963"},"PeriodicalIF":3.2,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479743","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}