Kidney Medicine最新文献_第7页

Pregnancy in Women Receiving Maintenance Dialysis

IF 3.2

Kidney Medicine Pub Date : 2024-12-19 DOI: 10.1016/j.xkme.2024.100950

Cristina Popa , Priyadarshini John , Prasoon Verma , Sehrish Ali , Silvi Shah

引用次数: 0

Living Donor Candidates’ Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study 活体捐献者候选人的自我健康报告和健康认知与捐献者评估的完成情况：队列研究

IF 3.2

Kidney Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.xkme.2024.100909

Elaine Ku , Sabrina Legaspi , Timothy P. Copeland , Deborah B. Adey , Adrian M. Whelan , Garrett R. Roll , Charles E. McCulloch , Brian K. Lee , Kirsten L. Johansen

{"title":"Living Donor Candidates’ Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study","authors":"Elaine Ku , Sabrina Legaspi , Timothy P. Copeland , Deborah B. Adey , Adrian M. Whelan , Garrett R. Roll , Charles E. McCulloch , Brian K. Lee , Kirsten L. Johansen","doi":"10.1016/j.xkme.2024.100909","DOIUrl":"10.1016/j.xkme.2024.100909","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Given the organ shortage in the United States, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors’ perceived health and its association with the likelihood of completing the donor evaluation process.</div></div><div><h3>Study Design</h3><div>Potential donors’ self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware Health Perceptions surveys.</div></div><div><h3>Setting & Participants</h3><div>Potential living donors who expressed interest in donation at a single medical center were recruited prospectively between 2017 and 2022.</div></div><div><h3>Exposure</h3><div>Donors' self-reported health and health perceptions.</div></div><div><h3>Outcomes</h3><div>Completion of the donor evaluation.</div></div><div><h3>Analytical Approach</h3><div>Adjusted linear and logistic regression models were used to examine the association between self-reported health and health perceptions with outcomes.</div></div><div><h3>Results</h3><div>A total of 1,347 individuals were included for study; 46% (N=613) were<40 years of age, 71% (n=951) were female, 22% (n=294) were of Hispanic ethnicity, and 16% (n=215) completed the donor evaluation. The mean PROMIS global physical health (17.0±1.9) and mental health (15.5±2.7) raw scores were higher among donor candidates proceeding to completion of the donor evaluation when compared with those who withdrew early in the process (16.3±2.2 for physical health and 14.9±3.1 for mental health). Every z-score change in the PROMIS physical health score was associated with 1.48-fold higher odds of completing the donor evaluation (95% CI, 1.19-1.85). Fully adjusted models incorporating the PROMIS scores for predicting the completion of donor evaluations had a c-statistic of 0.70. Potential donors’ Davies and Wares health perceptions did not predict the likelihood of completing the donor evaluation in fully adjusted models.</div></div><div><h3>Limitations</h3><div>Data are derived from a single center and may not generalize to the donor evaluation process at other transplant centers.</div></div><div><h3>Conclusions</h3><div>Donor candidates’ self-reported physical health may serve as a predictor of the likelihood of completing the donor evaluation process and a potential avenue for future interventions.</div></div><div><h3>Plain Language Summary</h3><div>This study was designed to understand the health perceptions of living donor candidates. We found that donor candidates’ self-reported physical health strongly predicted their lik","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100909"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554192","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}

引用次数: 0

Hypokalemia in Peritoneal Dialysis: A Systematic Review and Meta-analysis of Prevalence, Treatment, and Outcomes 腹膜透析中的低钾血症：关于发病率、治疗和结果的系统回顾和元分析

IF 3.2

Kidney Medicine Pub Date : 2024-10-18 DOI: 10.1016/j.xkme.2024.100923

Changyuan Yang , Xiaoxuan Hu , Xitao Ling , Cuixia Xiao , Ruolan Duan , Jiamei Qiu , Qin Li , Xindong Qin , Jiahao Zeng , La Zhang , Haijing Hou , Yu Peng , Yuan Xu , Jingxu Su , Xusheng Liu , Bengt Lindholm , David W. Johnson , Fuhua Lu , Guobin Su

{"title":"Hypokalemia in Peritoneal Dialysis: A Systematic Review and Meta-analysis of Prevalence, Treatment, and Outcomes","authors":"Changyuan Yang , Xiaoxuan Hu , Xitao Ling , Cuixia Xiao , Ruolan Duan , Jiamei Qiu , Qin Li , Xindong Qin , Jiahao Zeng , La Zhang , Haijing Hou , Yu Peng , Yuan Xu , Jingxu Su , Xusheng Liu , Bengt Lindholm , David W. Johnson , Fuhua Lu , Guobin Su","doi":"10.1016/j.xkme.2024.100923","DOIUrl":"10.1016/j.xkme.2024.100923","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Hypokalemia is common and potentially life-threatening in patients undergoing peritoneal dialysis (PD). However, the current literature has produced varying results. This study aimed to evaluate the prevalence and adverse outcomes of hypokalemia and the role of potassium supplementation in patients receiving PD.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis of randomized controlled trials and observational studies.</div></div><div><h3>Setting & Study Populations</h3><div>Adults receiving maintenance PD.</div></div><div><h3>Selection Criteria for Studies</h3><div>Studies that investigated the prevalence and adverse outcomes of hypokalemia and the effect of potassium supplementation.</div></div><div><h3>Data Extraction</h3><div>Two independent reviewers evaluated studies for eligibility and extracted relevant data.</div></div><div><h3>Analytical Approach</h3><div>Random effects meta-analysis was conducted to pool hazard ratios (HRs) and 95% CIs for the outcomes of interest. The certainty of findings was rated according to the Grading of Recommendations Assessment, Development and Evaluation criteria.</div></div><div><h3>Results</h3><div>Of 3,632 reports identified, 24 studies involving 60,313 participants met the inclusion criteria. The prevalence of hypokalemia was 37.9% (95% CI, 27.2%-52.7%), 17.7% (95% CI, 12.0%-25.9%), and 4.4% (95% CI, 1.9%-10.2%) in patients with potassium level<4.0, 3.5, and 3.0mmol/L, respectively. Hypokalemia, according to the study’s definition, was associated with increased risks of all-cause mortality (HR, 1.49; 95% CI, 1.18-1.89), cardiovascular mortality (HR, 1.50; 95% CI, 1.19-1.88), and PD-associated peritonitis (HR, 1.42; 95% CI, 1.17-1.73). These associations were consistent but with low to very low certainty. The effect of correcting hypokalemia with potassium supplementation in patients undergoing PD remains uncertain.</div></div><div><h3>Limitations</h3><div>Heterogeneity persisted across most of the examined subgroups, and observational studies preclude causation.</div></div><div><h3>Conclusions</h3><div>Hypokalemia is common and portends poorer survival and a higher risk of peritonitis among patients undergoing PD. Further research into the optimal prevention and treatment strategies for hypokalemia is warranted to improve outcomes.</div></div><div><h3>Registration</h3><div>Registered at PROSPERO with registration number CRD42022358236.</div></div><div><h3>Plain-Language Summary</h3><div>Hypokalemia is common and can be fatal in patients undergoing peritoneal dialysis (PD). The reported prevalence of hypokalemia in patients undergoing PD varies significantly across studies, and there is inconsistency regarding the relationship between hypokalemia and adverse outcomes. This systematic review and meta-analysis showed that hypokalemia is prevalent and associated with decreased survival rates and higher risk o","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100923"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703304","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}

引用次数: 0

Methotrexate Crystals on Electron Microscopy of Kidney Biopsy for Acute Kidney Injury 急性肾损伤肾活检电子显微镜下的甲氨蝶呤晶体

IF 3.2

Kidney Medicine Pub Date : 2024-10-18 DOI: 10.1016/j.xkme.2024.100924

Diana Fang MD , Noah Poznanski MD , Lois J. Arend MD, PhD

引用次数: 0

Pediatric Acute Kidney Injury Care: A Qualitative Study of Clinicians 小儿急性肾损伤护理：临床医生定性研究

IF 3.2

Kidney Medicine Pub Date : 2024-10-18 DOI: 10.1016/j.xkme.2024.100925

Anna E. Williams MD , Erin B. Chang MPH , Rasheed A. Gbadegesin MBBS, MD , Clarissa J. Diamantidis MD, MHS

引用次数: 0

Insulin Resistance in Hypercalciuric Calcium Kidney Stone Patients 高钙肾结石患者的胰岛素抵抗

IF 3.2

Kidney Medicine Pub Date : 2024-10-18 DOI: 10.1016/j.xkme.2024.100922

Megan Prochaska , Gloria Adeola , Noah Vetter , Raghavendra G. Mirmira , Fredric Coe , Elaine Worcester

{"title":"Insulin Resistance in Hypercalciuric Calcium Kidney Stone Patients","authors":"Megan Prochaska , Gloria Adeola , Noah Vetter , Raghavendra G. Mirmira , Fredric Coe , Elaine Worcester","doi":"10.1016/j.xkme.2024.100922","DOIUrl":"10.1016/j.xkme.2024.100922","url":null,"abstract":"<div><h3>Rational & Objective</h3><div>Diabetes and uric acid kidney stones are strongly associated. Patients with calcium kidney stones also have higher risk of developing diabetes compared with nonkidney stone patients yet this has not been further investigated. We aimed to characterize insulin resistance in calcium kidney stone patients.</div></div><div><h3>Study Design</h3><div>Observational.</div></div><div><h3>Setting & Population</h3><div>This study was performed in the University of Chicago Clinical Research Center. Kidney stone patients (N=42) were selected for having idiopathic hypercalciuria and calcium stones with no other medical conditions, and controls (N=27) were healthy.</div></div><div><h3>Exposures</h3><div>All participants presented to the Clinical Research Center in a fasting state and at least 2 timed fasting blood and urine collections were collected before a fixed breakfast. Six additional timed blood and urine collections were performed after breakfast.</div></div><div><h3>Outcomes</h3><div>We compared fasting and fed indices of insulin resistance between the groups.</div></div><div><h3>Analytic Approach</h3><div>We used <em>t</em> tests and multivariable linear regression models. A sensitivity analysis removing all patients who had ever been on a thiazide diuretic was also performed.</div></div><div><h3>Results</h3><div>In separate multivariable linear models, kidney stone patients had higher fasting serum insulin levels (24 (3-46pmol/L), <em>P</em>  =0.02). In separate multivariable linear models, kidney stone patients had higher fed serum glucose levels (10 (2-18mg/dL), <em>P</em>  <!-->0.01). Results were similar in a sensitivity analysis removing all patients who had ever been on a thiazide diuretic. There were no differences in urine composition based on HOMA-IR levels.</div></div><div><h3>Limitations</h3><div>Single institution. Small sample size limited subanalyses by different calcium stone types.</div></div><div><h3>Conclusions</h3><div>Calcium kidney stone patients without diabetes or other medical conditions demonstrated signs of insulin resistance compared with healthy matched controls.</div></div><div><h3>Plain-Language Summary</h3><div>Diabetes is strongly associated with kidney stones, particularly uric acid kidney stones. However, patients who form calcium kidney stones may also have an increased risk of developing diabetes, but this has not been further explored. We collected markers of insulin resistance in otherwise healthy patients with calcium kidney stones and healthy control volunteers to evaluate for early signs of insulin resistance in patients with calcium kidney stones. Compared to healthy control participants, we found that patients with calcium kidney stones are more likely to have ins","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100922"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654847","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}

引用次数: 0

Circulating Protein and Metabolite Correlates of Histologically Confirmed Diabetic Kidney Disease 组织学确诊糖尿病肾病的循环蛋白和代谢物相关性

IF 3.2

Kidney Medicine Pub Date : 2024-10-16 DOI: 10.1016/j.xkme.2024.100920

Carolina Lopez-Silva , Aditya Surapaneni , Insa M. Schmidt , Dhairya Upadhyay , Anand Srivastava , Ragnar Palsson , Isaac E. Stillman , Eugene P. Rhee , Sushrut S. Waikar , Morgan E. Grams

{"title":"Circulating Protein and Metabolite Correlates of Histologically Confirmed Diabetic Kidney Disease","authors":"Carolina Lopez-Silva , Aditya Surapaneni , Insa M. Schmidt , Dhairya Upadhyay , Anand Srivastava , Ragnar Palsson , Isaac E. Stillman , Eugene P. Rhee , Sushrut S. Waikar , Morgan E. Grams","doi":"10.1016/j.xkme.2024.100920","DOIUrl":"10.1016/j.xkme.2024.100920","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Diabetic kidney disease (DKD) is one of the leading causes of end-stage kidney disease globally. We aim to identify proteomic and metabolomic correlates of histologically confirmed DKD that may improve our understanding of its pathophysiology.</div></div><div><h3>Study Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting & Participants</h3><div>A total of 434 Boston Kidney Biopsy Cohort participants.</div></div><div><h3>Predictors</h3><div>Histopathological diagnosis of DKD on biopsy.</div></div><div><h3>Outcomes</h3><div>Proteins and metabolites associated with DKD.</div></div><div><h3>Analytical Approach</h3><div>We performed linear regression to identify circulating proteins and metabolites associated with a histopathological diagnosis of DKD (n=81) compared with normal or thin basement membrane (n=27), and other kidney diseases without diabetes (n=279). Pathway enrichment analysis was used to explore biological pathways enriched in DKD. Identified proteins were assessed for their discriminative ability in cases of DKD versus a distinct set of 48 patients with diabetes but other kidney diseases.</div></div><div><h3>Results</h3><div>After adjusting for age, sex, estimated glomerular filtration, and albuminuria levels, there were 8 proteins and 1 metabolite that differed between DKD and normal/thin basement membrane, and 84 proteins and 11 metabolites that differed between DKD and other kidney diseases without diabetes. Five proteins were significant in both comparisons: C-type mannose receptor 2, plexin-A1, plexin-D1, renin, and transmembrane glycoprotein NMB. The addition of these proteins improved discrimination over clinical variables alone of a histopathological diagnosis of DKD on biopsy among patients with diabetes (change in area under the curve 0.126; <em>P</em>  <!-->0.008).</div></div><div><h3>Limitations</h3><div>A cross-sectional approach and lack of an external validation cohort.</div></div><div><h3>Conclusions</h3><div>Distinct proteins and biological pathways are correlated with a histopathological diagnosis of DKD.</div></div><div><h3>Plain-Language Summary</h3><div>In the following study, we aimed to identify proteins, metabolites, and biological pathways that are associated with a diagnosis of diabetic kidney disease on biopsy. After adjusting for demographic characteristics and baseline renal function, we identified 5 proteins that were significantly associated with diabetic kidney disease, both in comparison to individuals without kidney disease and those with nondiabetic kidney disease: C-type mannose receptor 2, plexin-A1, plexin-D1, renin, and transmembrane glycoprotein NMB. We also found that these proteins may enhance our ability to distinguish between diabetic kidney disease and other causes of kidney disease in a group of patients with diabetes.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100920"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654846","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}

引用次数: 0

Perceptions of Palliative Care Among Patients With Kidney Allograft Dysfunction: A Qualitative Study 肾移植功能障碍患者对姑息治疗的看法：定性研究

IF 3.2

Kidney Medicine Pub Date : 2024-10-16 DOI: 10.1016/j.xkme.2024.100917

Cameron E. Comrie , Katherine He , Jolene Wong , Anil K. Chandraker , Naoka Murakami , Joshua R. Lakin , Amanda J. Reich

{"title":"Perceptions of Palliative Care Among Patients With Kidney Allograft Dysfunction: A Qualitative Study","authors":"Cameron E. Comrie , Katherine He , Jolene Wong , Anil K. Chandraker , Naoka Murakami , Joshua R. Lakin , Amanda J. Reich","doi":"10.1016/j.xkme.2024.100917","DOIUrl":"10.1016/j.xkme.2024.100917","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Nearly half of kidney transplant recipients develop allograft failure within 10 years of transplantation and experience high mortality, significant symptom burden, and complex communication challenges. These patients may benefit from palliative care, but palliative care is infrequently provided in this population. This study explores palliative care perceptions and needs among patients with poorly functioning and declining kidney allografts.</div></div><div><h3>Study Design</h3><div>A qualitative study using semistructured interviews.</div></div><div><h3>Setting & Participants</h3><div>Adult kidney transplant recipients with a glomerular filtration rate of<20mL/min/1.73m<sup>2</sup> followed at a single transplant center were interviewed from April 2022 to November 2022.</div></div><div><h3>Analytical Approach</h3><div>An interdisciplinary team, including nephrology, palliative care, and surgery, conducted a thematic analysis.</div></div><div><h3>Results</h3><div>Twelve participants (3 women, 9 men; 9 White, 2 Black, and 1 Hispanic patient) were interviewed. The median age of participants was 59 (IQR 48-73). At 6 months postinterview, 7 participants had resumed dialysis, 1 participant had been retransplanted, and 1 participant was deceased. Most participants had not heard of palliative care and those who had equated it with end-of-life care. Participants reported that emotional distress, particularly pervasive concern about the worsening of their kidney disease, was their most significant priority related to unmet palliative care needs. They also desired more discussion with their care team about future quality of life and lifespan. Participants described high trust in their transplant teams, suggesting that palliative care integration with these teams would be well-received.</div></div><div><h3>Limitations</h3><div>Limitations include recruitment from a single institution, lack of subject familiarity with palliative care, and limited racial and ethnic diversity among participants.</div></div><div><h3>Conclusions</h3><div>Patients with declining kidney allografts have heterogeneous, unmet palliative care needs, including emotional symptoms and a desire for better prognostic awareness. Our results suggest that patients are largely unaware of palliative care and may benefit from practice models in which transplant teams integrate palliative care education and timely palliative care engagement.</div></div><div><h3>Plain-Language Summary</h3><div>Nearly half of patients with kidney transplants experience failure of their transplant within a decade, leading to high mortality, significant symptoms, and communication challenges. Palliative care can help address these issues but is not frequently provided to these patients. We interviewed 12 patients whose kidney transplants were no longer working well to understand their perspectives on palliative care and palliative care needs. Mo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100917"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703324","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}

引用次数: 0

Proteomics and Incident Kidney Failure in Individuals With CKD: The African American Study of Kidney Disease and Hypertension and the Boston Kidney Biopsy Cohort 蛋白质组学与慢性肾脏病患者的肾衰竭：非裔美国人肾脏病和高血压研究与波士顿肾活检队列

IF 3.2

Kidney Medicine Pub Date : 2024-10-16 DOI: 10.1016/j.xkme.2024.100921

Teresa K. Chen , Aditya L. Surapaneni , Insa M. Schmidt , Sushrut S. Waikar , Josef Coresh , Hongbo Liu , Katalin Susztak , Eugene P. Rhee , Celina Liu , Pascal Schlosser , Morgan E. Grams

{"title":"Proteomics and Incident Kidney Failure in Individuals With CKD: The African American Study of Kidney Disease and Hypertension and the Boston Kidney Biopsy Cohort","authors":"Teresa K. Chen , Aditya L. Surapaneni , Insa M. Schmidt , Sushrut S. Waikar , Josef Coresh , Hongbo Liu , Katalin Susztak , Eugene P. Rhee , Celina Liu , Pascal Schlosser , Morgan E. Grams","doi":"10.1016/j.xkme.2024.100921","DOIUrl":"10.1016/j.xkme.2024.100921","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Individuals with chronic kidney disease (CKD) are at increased risk of morbidity and mortality, particularly as they progress to kidney failure. Identifying circulating proteins that underlie kidney failure development may guide the discovery of new targets for intervention.</div></div><div><h3>Study Design</h3><div>Prospective cohort.</div></div><div><h3>Setting & Participants</h3><div>703 African American Study of Kidney Disease and Hypertension (AASK) and 434 Boston Kidney Biopsy Cohort (BKBC) participants with baseline proteomics data.</div></div><div><h3>Exposures</h3><div>Circulating proteins measured using SomaScan.</div></div><div><h3>Outcomes</h3><div>Kidney failure, defined as dialysis initiation or kidney transplantation.</div></div><div><h3>Analytical Approach</h3><div>Using adjusted Cox models, we studied associations of 6,284 circulating proteins with kidney failure risk separately in AASK and BKBC and meta-analyzed results. We then performed gene set enrichment analyses to identify underlying perturbations in biological pathways. In separate data sets with kidney-tissue level gene expression, we ascertained dominant regions of expression and correlated kidney tubular gene expression with fibrosis and estimated glomerular filtration rate (eGFR).</div></div><div><h3>Results</h3><div>Over median follow-up periods of 8.8 and 3.1 years, 210 AASK (mean age: 55 years, 39% female, mean GFR: 46mL/min/1.73m<sup>2</sup>) and 115 BKBC (mean age: 54 years, 47% female, mean eGFR: 51mL/min/1.73m<sup>2</sup>) participants developed kidney failure, respectively. We identified 143 proteins that were associated with incident kidney failure, of which only 1 (Testican-2) had a lower risk. Notable proteins included those related to vascular permeability (endothelial cell-selective adhesion molecule), glomerulosclerosis (ephrin-A1), glomerular development (ephrin-B2), intracellular sorting/transport (vesicular integral-membrane protein VIP36), podocyte effacement (pigment epithelium-derived factor), complement activation (complement decay-accelerating factor), and fibrosis (ephrin-A1, ephrin-B2, and pigment epithelium-derived factor). Gene set enrichment analyses detected overrepresented pathways that could be related to CKD progression, such as ephrin signaling, cell-cell junctions, intracellular transport, immune response, cell proliferation, and apoptosis. At the kidney level, glomerular expression predominated for genes corresponding to circulating proteins of interest, and several gene expression levels were correlated with eGFR and/or fibrosis.</div></div><div><h3>Limitations</h3><div>Possible residual confounding.</div></div><div><h3>Conclusions</h3><div>Multimodal data identified proteins and pathways associated with the development of kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>Circulating proteins that underlie the development of ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100921"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703323","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}

引用次数: 0

Patient Perspectives on Arteriovenous Fistula Placement, Maturation, and Use: A Qualitative Study 患者对动静脉瘘置入、成熟和使用的看法：定性研究

IF 3.2

Kidney Medicine Pub Date : 2024-10-16 DOI: 10.1016/j.xkme.2024.100919

Dipal M. Patel , Bryce M. Churilla , Timmy C. Lee , Mae Thamer , Yi Zhang , Michael Allon , Deidra C. Crews

{"title":"Patient Perspectives on Arteriovenous Fistula Placement, Maturation, and Use: A Qualitative Study","authors":"Dipal M. Patel , Bryce M. Churilla , Timmy C. Lee , Mae Thamer , Yi Zhang , Michael Allon , Deidra C. Crews","doi":"10.1016/j.xkme.2024.100919","DOIUrl":"10.1016/j.xkme.2024.100919","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Arteriovenous fistula (AVF) use among US hemodialysis (HD) patients is suboptimal, especially among Black patients. We interviewed a group of predominantly Black HD patients to probe experiences and perspectives surrounding steps along the AVF care continuum, which includes placement, maturation, and use of AVFs.</div></div><div><h3>Study Design</h3><div>Individual semistructured interviews.</div></div><div><h3>Setting & Participants</h3><div>Patients with kidney failure receiving HD in Birmingham, Alabama.</div></div><div><h3>Analytical Approach</h3><div>Transcripts were coded and thematically analyzed.</div></div><div><h3>Results</h3><div>We interviewed 53 Black and 6 White patients at different steps of the AVF care continuum: 29 were dialyzing with a central venous catheter (15 had not undergone AVF placement, 9 had a maturing AVF, and 5 had a nonfunctional AVF) and 30 were dialyzing with an AVF. We coded transcripts using qualitative thematic analysis. Three themes emerged: (1) the circumstances of dialysis initiation sometimes altered the timeline of AV access placement; (2) patients had variable levels of knowledge of steps along the AVF continuum; and (3) the life impacts of dialysis access were a significant factor in patients’ experience of dialysis.</div></div><div><h3>Limitations</h3><div>Single-institution study; low number of non-Black participants limited comparison of patient experiences by race.</div></div><div><h3>Conclusions</h3><div>Among a group of predominantly Black HD patients, perspectives surrounding the AVF care continuum included consideration of the circumstances of dialysis initiation, patient knowledge, and the life impacts of dialysis access. These findings may inform targeted interventions aimed at optimizing dialysis access use and addressing disparities across the AVF continuum.</div></div><div><h3>Plain-Language Summary</h3><div>People with kidney failure receiving hemodialysis (HD) rely on vascular access to undergo HD treatments. Though arteriovenous fistulas (AVFs) are preferred over tunneled dialysis catheters, AVF use is suboptimal especially among Black people with kidney failure. We interviewed 59 predominantly Black people with kidney failure who were at various stages of having an AVF placed. We aimed to understand their perspectives and experiences surrounding AVF placement, maintenance, and use. We learned that the circumstances of dialysis initiation, patient knowledge, and perceived life impacts of dialysis access contributed to perspectives on AVFs. These findings can help guide interventions that may address disparities in use of AVFs and optimize patient experiences around dialysis access.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100919"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654849","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}

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