Kidney Medicine最新文献

{"title":"Circulating Protein and Metabolite Correlates of Histologically Confirmed Diabetic Kidney Disease","authors":"Carolina Lopez-Silva ,&nbsp;Aditya Surapaneni ,&nbsp;Insa M. Schmidt ,&nbsp;Dhairya Upadhyay ,&nbsp;Anand Srivastava ,&nbsp;Ragnar Palsson ,&nbsp;Isaac E. Stillman ,&nbsp;Eugene P. Rhee ,&nbsp;Sushrut S. Waikar ,&nbsp;Morgan E. Grams","doi":"10.1016/j.xkme.2024.100920","DOIUrl":"10.1016/j.xkme.2024.100920","url":null,"abstract":"<div><h3>Rationale &amp; 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 &amp; 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}

{"title":"Perceptions of Palliative Care Among Patients With Kidney Allograft Dysfunction: A Qualitative Study","authors":"Cameron E. Comrie ,&nbsp;Katherine He ,&nbsp;Jolene Wong ,&nbsp;Anil K. Chandraker ,&nbsp;Naoka Murakami ,&nbsp;Joshua R. Lakin ,&nbsp;Amanda J. Reich","doi":"10.1016/j.xkme.2024.100917","DOIUrl":"10.1016/j.xkme.2024.100917","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A qualitative study using semistructured interviews.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult kidney transplant recipients with a glomerular filtration rate of&lt;!--&gt; &lt;!--&gt;&lt;20&lt;!--&gt; &lt;!--&gt;mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt; followed at a single transplant center were interviewed from April 2022 to November 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;An interdisciplinary team, including nephrology, palliative care, and surgery, conducted a thematic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Limitations include recruitment from a single institution, lack of subject familiarity with palliative care, and limited racial and ethnic diversity among participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;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}

{"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 ,&nbsp;Aditya L. Surapaneni ,&nbsp;Insa M. Schmidt ,&nbsp;Sushrut S. Waikar ,&nbsp;Josef Coresh ,&nbsp;Hongbo Liu ,&nbsp;Katalin Susztak ,&nbsp;Eugene P. Rhee ,&nbsp;Celina Liu ,&nbsp;Pascal Schlosser ,&nbsp;Morgan E. Grams","doi":"10.1016/j.xkme.2024.100921","DOIUrl":"10.1016/j.xkme.2024.100921","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Prospective cohort.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;703 African American Study of Kidney Disease and Hypertension (AASK) and 434 Boston Kidney Biopsy Cohort (BKBC) participants with baseline proteomics data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Circulating proteins measured using SomaScan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Kidney failure, defined as dialysis initiation or kidney transplantation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over median follow-up periods of 8.8 and 3.1 years, 210 AASK (mean age: 55 years, 39% female, mean GFR: 46&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;) and 115 BKBC (mean age: 54 years, 47% female, mean eGFR: 51&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;) 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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Possible residual confounding.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Multimodal data identified proteins and pathways associated with the development of kidney failure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;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}

{"title":"Patient Perspectives on Arteriovenous Fistula Placement, Maturation, and Use: A Qualitative Study","authors":"Dipal M. Patel ,&nbsp;Bryce M. Churilla ,&nbsp;Timmy C. Lee ,&nbsp;Mae Thamer ,&nbsp;Yi Zhang ,&nbsp;Michael Allon ,&nbsp;Deidra C. Crews","doi":"10.1016/j.xkme.2024.100919","DOIUrl":"10.1016/j.xkme.2024.100919","url":null,"abstract":"<div><h3>Rationale &amp; 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 &amp; 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}

{"title":"Undetected Air Embolism During Hemodialysis from a Defective Central Venous Catheter Causing Intradialytic Cardiac Arrest: An Imaging Teaching Case","authors":"Taesoo Kim ,&nbsp;Dirk M. Hentschel ,&nbsp;David B. Mount ,&nbsp;Katherine Scovner Ravi","doi":"10.1016/j.xkme.2024.100915","DOIUrl":"10.1016/j.xkme.2024.100915","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100915"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537384","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":"Predicting Nephrotoxic Acute Kidney Injury in Hospitalized Adults: A Machine Learning Algorithm","authors":"Benjamin R. Griffin ,&nbsp;Avinash Mudireddy ,&nbsp;Benjamin D. Horne ,&nbsp;Michel Chonchol ,&nbsp;Stuart L. Goldstein ,&nbsp;Michihiko Goto ,&nbsp;Michael E. Matheny ,&nbsp;W. Nick Street ,&nbsp;Mary Vaughan-Sarrazin ,&nbsp;Diana I. Jalal ,&nbsp;Jason Misurac","doi":"10.1016/j.xkme.2024.100918","DOIUrl":"10.1016/j.xkme.2024.100918","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale and Objective&lt;/h3&gt;&lt;div&gt;Acute kidney injury (AKI) is a common complication among hospitalized adults, but AKI prediction and prevention among adults has proved challenging. We used machine learning to update the nephrotoxic injury negated by just-in time action (NINJA), a pediatric program that predicts nephrotoxic AKI, to improve accuracy among adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting and Population&lt;/h3&gt;&lt;div&gt;Adults admitted for&lt;!--&gt; &lt;!--&gt;&gt;&lt;!--&gt; &lt;!--&gt;48 hours to the University of Iowa Hospital from 2017 to 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;A NINJA high-nephrotoxin exposure (≥3 nephrotoxins on 1&lt;!--&gt; &lt;!--&gt;day or intravenous aminoglycoside or vancomycin for&lt;!--&gt; &lt;!--&gt;≥3 days).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;AKI within 48 hours of high-nephrotoxin exposure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;We collected 85 variables, including demographics, laboratory tests, vital signs, and medications. AKI was defined as a serum creatinine increase of&lt;!--&gt; &lt;!--&gt;≥0.3&lt;!--&gt; &lt;!--&gt;mg/dL. A gated recurrent unit (GRU)-based recurrent neural network (RNN) was trained on 85% of the data, and then tested on the remaining 15%. Model performance was evaluated with precision, recall, negative predictive value, and area under the curve. We used an artificial neural network to determine risk factor importance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 14,480 patients, 18,180 admissions, and 37,300 high-nephrotoxin exposure events meeting inclusion criteria. In the testing cohort, 29% of exposures developed AKI within 48 hours. The RNN-GRU model predicted AKI with a precision of 0.60, reducing the number of false alerts from 2.5 to 0.7 per AKI case. Lowest hemoglobin, lowest blood pressure, and highest white blood cell count were the most important variables in the artificial neural network model. Acyclovir, piperacillin-tazobactam, calcineurin inhibitors, and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers were the most important medications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Clinical variables and medications were not exhaustive, drug levels or dosing were not incorporated, and Iowa’s racial makeup may limit generalizability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our RNN-GRU model substantially reduced the number of false alerts for nephrotoxic AKI, which may facilitate NINJA translation to adult hospitals by providing more targeted intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Nephrotoxic acute kidney injury (AKI) is common and can potentially be prevented through preemptive adjustments of medications, as demonstrated by the success of the nephrotoxic injury negated by just-in time action (NINJA) program in pediatric populations. Translation of NINJA to the adult population has been challenging, and major barriers include high alert volume in adults that can lead to high resource utilization and alert ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100918"},"PeriodicalIF":3.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654848","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":"The Surprise Question in Hemodialysis, Frailty, Nutrition, Patient-reported Quality of Life, and All-Cause Mortality: The Osaka Dialysis Complication Study (ODCS)","authors":"Tetsuo Shoji ,&nbsp;Daijiro Kabata ,&nbsp;Seiichi Kimura ,&nbsp;Yuki Nagata ,&nbsp;Katsuhito Mori ,&nbsp;Shinya Nakatani ,&nbsp;Hisako Fujii ,&nbsp;Tomoaki Morioka ,&nbsp;Masanori Emoto","doi":"10.1016/j.xkme.2024.100914","DOIUrl":"10.1016/j.xkme.2024.100914","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;A response “no” (SQ-No) to the surprise question (SQ) of whether a clinician would be surprised if a dialysis patient died in the next 6 months is associated with a higher risk of all-cause death. It is uncertain what domains are intuitively assessed with the SQ. We hypothesized that the SQ would assess the patient’s frailty, malnutrition, or patient-perceived health-related quality of life in a cohort of patients on maintenance hemodialysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A multicenter study including 994 patients on maintenance hemodialysis in Japan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Predictors&lt;/h3&gt;&lt;div&gt;(1) SQ answered by nurses; (2) frailty by modified Cardiovascular Health Study criteria; (3) malnutrition as evaluated by Geriatric Nutritional Risk Index (GNRI); and (4) patient-perceived health-related quality of life examined by the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;All-cause mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Cox proportional hazard models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Median age and dialysis vintage were 66 and 5.9 years, respectively, 35.8% were women, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 45.9%. Median GNRI and SF-36 PCS scores were 96.3 and 36.9, respectively. During the 5-year follow-up, 247 patients died. SQ-No, being frail, low GNRI, and low SF-36 PCS were each significant predictors of a higher risk for mortality independent of potential confounders. SQ-No remained a significant predictor after further adjustment for frailty or GNRI, but SQ-No was no longer significant when adjusted for SF-36 PCS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;We did not assess the agreement of responses to the SQ between different raters.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The predictive ability of the SQ was closely related to SF-36 PCS in hemodialysis patients. Nurses’ answer to the SQ appears to assess the physical domain of patient-perceived health-related quality of life rather than objectively assessed frailty or malnutrition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;“Would I be surprised if this patient died in the next 6 months?” This question posed to a clinician is called the “surprise question” (SQ) and the answer “no” (SQ-No) has been shown to predict a higher risk of mortality in patients undergoing hemodialysis. We examined which domains are intuitively assessed with the SQ, such as frailty, malnutrition, and patient-perceived quality of life in a cohort of hemodialysis patients. We found that the association between the SQ response and mortality was independent of frailty and malnutrition but was closely related to the physical domain of patient-perceived quality of life. The results suggest that the SQ appears to assess the physical domain of patient-per","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100914"},"PeriodicalIF":3.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594064","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":"Nephroprotective Effects of Cilastatin in People at Risk of Acute Kidney Injury: A Systematic Review and Meta-analysis","authors":"Dilaram Acharya ,&nbsp;Fanar Ghanim ,&nbsp;Tyrone G. Harrison ,&nbsp;Tayler Dawn Scory ,&nbsp;Nusrat Shommu ,&nbsp;Paul E. Ronksley ,&nbsp;Meghan J. Elliott ,&nbsp;David Collister ,&nbsp;Neesh Pannu ,&nbsp;Matthew T. James","doi":"10.1016/j.xkme.2024.100913","DOIUrl":"10.1016/j.xkme.2024.100913","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Cilastatin is an inhibitor of drug metabolism in the proximal tubule that demonstrates nephroprotective effects in animals. It has been used in humans in combination with the antibiotic imipenem to block imipenem’s renal metabolism. This systematic review and meta-analysis evaluated the nephroprotective effects of cilastatin in humans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis of observational (comparative effectiveness) studies or randomized clinical trials (RCTs).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Study Populations&lt;/h3&gt;&lt;div&gt;People of any age at risk of acute kidney injury (AKI).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Selection Criteria for Studies&lt;/h3&gt;&lt;div&gt;We systematically searched MEDLINE, Embase, Web of Science, and the Cochrane Controlled Trials registry from database inception to November 2023 for observational studies or RCTs that compared kidney outcomes among groups treated with cilastatin, either alone or as combination imipenem-cilastatin, versus an inactive or active control group not treated with cilastatin.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Extraction&lt;/h3&gt;&lt;div&gt;Two reviewers independently evaluated studies for inclusion and risk of bias.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Treatment effects were estimated using random-effects models, and heterogeneity was quantified using the &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; statistic.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We identified 10 studies (5 RCTs, n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;531&lt;!--&gt; &lt;!--&gt;patients; 5 observational studies, n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;6,321 participants) that met the inclusion criteria, including 4 studies with comparisons to inactive controls and 6 studies with comparisons to alternate antibiotics. Based on pooled results from 7 studies, the risk of AKI was lower with imipenem-cilastatin (risk ratio [RR], 0.52; 95% confidence intervals [CI], 0.40-0.67; &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;26.5%), with consistent results observed in RCTs (3 RCTs, RR, 0.26; 95% CI, 0.09-0.77; &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;44.4%) and observational studies (4 studies, RR, 0.54; 95% CI, 0.41-0.72; &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;44.4%). Based on results from 6 studies, serum creatinine concentration was lower following treatment with imipenem-cilastatin than comparators (weighted mean difference in serum creatinine&lt;!--&gt; &lt;!--&gt;−0.14 mg/dL (95% CI, −0.21 to&lt;!--&gt; &lt;!--&gt;−0.07; &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0%). The overall certainty of the evidence was low due to heterogeneity of the results, high risk of bias, and indirectness among the identified studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Clinical and statistical heterogeneity could not be fully explained due to a limited number of studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients treated with imipenem-cilastatin developed AKI less frequently and had lower serum creatinine concentration following treatment than control groups or those who had received compar","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100913"},"PeriodicalIF":3.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654935","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":"Pegloticase-Induced Rapid Uric Acid Lowering and Kidney and Cardiac Health Markers in Youth-Onset Type 2 Diabetes: A Pilot Clinical Trial","authors":"Phoom Narongkiatikhun MD ,&nbsp;Sungho Park PhD ,&nbsp;Amy Rydin MD ,&nbsp;Callie Rountree-Jablin ,&nbsp;Ye Ji Choi MPH ,&nbsp;Jo Ann Antenor PhD, MPH ,&nbsp;Laura Pyle PhD ,&nbsp;Lynette Driscoll PA-C, MA ,&nbsp;Daniel van Raalte MD ,&nbsp;Maureen Pushea CCLS ,&nbsp;Alyssa Caldwell-McGee MS ,&nbsp;Vuddhidej Ophascharoensuk MD ,&nbsp;Kristen Nadeau MD ,&nbsp;Kalie Tommerdahl MD ,&nbsp;Richard J. Johnson MD ,&nbsp;Lorna Browne MD ,&nbsp;Alex J. Barker MD ,&nbsp;Petter Bjornstad MD","doi":"10.1016/j.xkme.2024.100911","DOIUrl":"10.1016/j.xkme.2024.100911","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100911"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594065","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":"Advanced CKD of Uncertain Etiology Among Children in Guatemala: Genetic and Clinical Characteristics","authors":"Ankana Daga MD ,&nbsp;Ana Luz Morales MD ,&nbsp;Shirlee Shril MD ,&nbsp;Elizabeth Benoit MPH ,&nbsp;Dalia Pantel MD ,&nbsp;Angie Aguilar-González MD ,&nbsp;Mario García MD ,&nbsp;Ana C. Onuchic-Whitford MD ,&nbsp;Randall Lou-Meda MD ,&nbsp;Friedhelm Hildebrandt MD","doi":"10.1016/j.xkme.2024.100910","DOIUrl":"10.1016/j.xkme.2024.100910","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100910"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586707","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}