Kidney Medicine最新文献

{"title":"SGLT2 Inhibitor Use in Chronic Kidney Disease: Supporting Cardiovascular, Kidney, and Metabolic Health","authors":"Magdalena Madero ,&nbsp;Glenn M. Chertow ,&nbsp;Patrick B. Mark","doi":"10.1016/j.xkme.2024.100851","DOIUrl":"10.1016/j.xkme.2024.100851","url":null,"abstract":"<div><p>Originally developed for use in type 2 diabetes mellitus (T2DM), sodium–glucose co-transporter-2 (SGLT2) inhibitors demonstrated diverse cardiovascular- and kidney-protective effects in large outcome trials. Their subsequent approval as a treatment for chronic kidney disease (CKD) marked a pivotal shift in the landscape of CKD management. Further to this, the approval of dapagliflozin and empagliflozin for use in patients with CKD with and without T2DM afforded new treatment opportunities for this population. SGLT2 inhibitors provide an effective treatment for CKD with a favorable safety profile. However, their uptake has been slow, especially among patients without T2DM, owing perhaps to a lack of certainty and familiarity among health care professionals. As the landscape of CKD management continues to evolve, health care professionals should remain knowledgeable about these changes, and implement new guideline recommendations promptly to avoid therapeutic inertia. SGLT2 inhibitors are recommended for patients with CKD with or without T2DM and are foundational agents to support cardiovascular, kidney, and metabolic health. In this review, we provide evidence-based answers to questions that may be asked in the clinic regarding the use of SGLT2 inhibitors to treat CKD.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 8","pages":"Article 100851"},"PeriodicalIF":3.2,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000621/pdfft?md5=0ee161fd897a66153850b1f67cefccdc&pid=1-s2.0-S2590059524000621-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141415295","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":"Matrix Metalloproteinase-2 and CKD Progression: The Chronic Renal Insufficiency Cohort (CRIC) Study","authors":"","doi":"10.1016/j.xkme.2024.100850","DOIUrl":"10.1016/j.xkme.2024.100850","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;Matrix metalloproteinase 2 (MMP-2) plays an important role in the development of fibrosis, the final common pathway of chronic kidney disease (CKD). This study aimed to assess the relationship between repeated measures of MMP-2 and CKD progression in a large, diverse prospective cohort.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;In a prospective cohort of Chronic Renal Insufficiency Cohort (CRIC) participants (N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;3,827), MMP-2 was measured at baseline. In a case-cohort design, MMP-2 was additionally measured at year 2 in a randomly selected subcohort and cases of estimated glomerular filtration rate (eGFR) halving or kidney replacement therapy (KRT) (N = 1,439).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;CRIC is a multicenter prospective cohort of adults with CKD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;p&gt;MMP-2 measured in plasma at baseline and at year 2.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;A composite kidney endpoint (KRT/eGFR halving)&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Weighted Cox proportional hazards models for case-cohort participants.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Participants were followed for a median of 4.6 years from year 2 and 6.9 years from the baseline. Persistently elevated MMP-2 (≥300&lt;!--&gt; &lt;!--&gt;ng/mL at both baseline and year 2) increased the hazard of the composite kidney endpoint (HR, 1.61; 95% CI, 1.07-2.42; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.09) after adjusting for covariates. The relationship of persistently elevated MMP-2 was modified by levels of inflammation, with a 2.6 times higher rate of the composite kidney endpoint in those with high-sensitivity C-reactive protein&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;2.5&lt;!--&gt; &lt;!--&gt;g/dL at study entry. Heterogeneity of effect was found with proteinuria, with a baseline MMP-2 level of&lt;!--&gt; &lt;!--&gt;≥300&lt;!--&gt; &lt;!--&gt;ng/mL associated with an increased risk of the composite kidney endpoint (HR, 1.30; 95% CI, 1.09-1.54) only with proteinuria&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;442&lt;!--&gt; &lt;!--&gt;mg/g.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;The observational study design limits causal interpretation.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Elevated MMP-2 is associated with CKD progression, particularly among those with low inflammation and those with proteinuria. Future investigations are warranted to confirm the reduction in risk of CKD progression among these subgroups of patients with CKD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;p&gt;Matrix metalloproteinase 2 (MMP-2) is a matrix-degrading protease involved in fibrosis and elevated in chronic kidney disease (CKD). Longitudinal patterns of MMP-2 have not previously been assessed as a predictor of CKD progression in a large prospective cohort. Here, we found that a higher baseline level and an increasing or persistently elevated 2-year pattern of MMP-2 were associated with CKD progression, independent of all covariates except proteinuria. The association of baseline MMP-2 with CKD progression differed by level of p","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 8","pages":"Article 100850"},"PeriodicalIF":3.2,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400061X/pdfft?md5=e92d4051238a597ef72f52d56f762295&pid=1-s2.0-S259005952400061X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396647","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":"Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment","authors":"Gajapathiraju Chamarthi ,&nbsp;Tatiana Orozco ,&nbsp;Jennifer Hale-Gallardo ,&nbsp;Shobha Subhash ,&nbsp;Popy Shell ,&nbsp;Kailyn Pearce ,&nbsp;Huanguang Jia ,&nbsp;Ashutosh M. Shukla","doi":"10.1016/j.xkme.2024.100832","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100832","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;The Advancing Americans Kidney Health Executive order has directed substantial increases in home dialysis use for incident kidney replacement therapy (KRT). Clinical guidelines recommend patients’ self-selection of KRT modality through a shared decision-making process, which, at the minimum, requires predialysis nephrology care and KRT-directed comprehensive prekidney failure patient education (CoPE). The current state of these essential services among Americans with advanced (stages 4 and 5) chronic kidney disease (CKD) and their informed preferences for home dialysis are unknown.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;We conducted a community-based, cross-sectional, observational cohort study across a large regional Veteran Healthcare System from October 1, 2020, to September 30, 2021.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Of the 928 Veterans with advanced CKD, 287 (30.9%) were invited for needs assessment evaluations. Of the 218 (76% of invited cohort) responding, 178 (81.6%) were receiving nephrology care, with approximately half of those (43.6%) receiving such care from non-Veterans Affairs providers.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;The study was targeted to assess the prevalent state of ongoing nephrology care and KRT-directed pre-kidney failure education among Veterans with advanced CKD. The secondary outcome included evaluation of dialysis decision-making state among Veterans with advanced CKD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Veterans with advanced CKD with 2 sustained estimated glomerular filtration rates&lt;!--&gt; &lt;!--&gt;&lt;30&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; were identified through an electronic database query, and a randomly selected cohort was invited for their current state of and outstanding needs for predialysis nephrology care and CoPE, essential for informed KRT selection.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Basic awareness of kidney disease was high (92.2%) among Veterans with advanced CKD, although only 38.5% were aware of the severity of their CKD. KRT-directed education during clinical care was reported by 46.8% of Veterans, of which 21.1% reported having received targeted CoPE classes. Three-quarters (74.3%) of Veterans expressed interest in receiving CoPE services. Overall, awareness of CKD and its severity and receipt of KRT-directed education were significantly higher among Veterans with nephrology care than among those without. Of the 61 Veterans providing their KRT preferences, overall decision making was poor, with three-quarters (73.8%) of the cohort unable to choose any KRT modality, irrespective of ongoing nephrology care. Only 8 (13%) felt confident choosing home KRT modalities.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;The study results are primarily applicable to the Veterans with advanced CKD. Furthermore, a limited numbers of respondents provided data on their KRT decision-making state, prohibiting broad generalizations.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Con","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100832"},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000438/pdfft?md5=ebdec942b1d918b8cb2bff9821376eb7&pid=1-s2.0-S2590059524000438-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243340","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 Pursuit of New Treatments for Focal Segmental Glomerulosclerosis: Harmonizing Innovation With the DUET Study of Sparsentan","authors":"Aparajita Mishra,&nbsp;Ai Itoku,&nbsp;Kimberly Reidy,&nbsp;Frederick Kaskel","doi":"10.1016/j.xkme.2024.100844","DOIUrl":"10.1016/j.xkme.2024.100844","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100844"},"PeriodicalIF":3.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000554/pdfft?md5=6bb6a5cf739bfb0ebc9b035668842cef&pid=1-s2.0-S2590059524000554-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130261","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 Using Telemedicine During In-Center Hemodialysis: A Qualitative Study","authors":"Trenton M. Haltom ,&nbsp;Susie Q. Lew ,&nbsp;Wolfgang C. Winkelmayer ,&nbsp;Glenn M. Chertow ,&nbsp;Allison Jaure ,&nbsp;Kevin F. Erickson","doi":"10.1016/j.xkme.2024.100848","DOIUrl":"10.1016/j.xkme.2024.100848","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the United States federal government expanded originating telemedicine sites to include outpatient dialysis units. For the first time, nephrology practitioners across the United States could replace face-to-face visits with telemedicine for patients receiving in-center hemodialysis. This study describes patients’ perspectives on the use of telemedicine during in-center hemodialysis.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;A qualitative study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Thirty-two patients from underserved populations (older, less educated, unemployed, persons of color) receiving in-center hemodialysis who used telemedicine with their nephrologist during the COVID-19 pandemic.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Telephone semistructured interviews were conducted in English or Spanish. Transcripts were thematically analyzed.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;We identified 6 themes with subthemes: adapting to telemedicine (gaining familiarity and confidence, overcoming and resolving technical difficulties, and relying on staff for communication); ensuring availability of the physician (enabling an immediate response to urgent medical needs, providing peace of mind, addressing patient needs adequately, and enhanced attention and contact from physicians); safeguarding against infection (limiting COVID-19 exposures and decreasing use); straining communication and physical interactions (loss of personalized touch, limited physical examination, and unable to reapproach physicians about forgotten issues); maintaining privacy (enhancing privacy and projecting voice enables others to hear); and supporting confidence in telemedicine (requiring established rapport with physicians, clinical stabilty of health, and ability to have in-person visits when necessary).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Interviews were conducted later in the pandemic when some nephrology care providers were using telemedicine infrequently.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Patients receiving in-center hemodialysis adapted to telemedicine visits by their nephrologists in the context of the COVID-19 pandemic and observed its benefits. However, further considerations regarding communication, privacy, and physical assessments are necessary. Integrating telemedicine into future in-center hemodialysis care using a hybrid approach could potentially build trust, optimize communication, and augment care.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;p&gt;This study describes patients’ perspectives on the use of telemedicine while receiving in-center hemodialysis during the coronavirus disease 2019 (COVID-19) pandemic. Data are derived from semistructured interviews with thirty-two patients from underserved populations (older, less educated, unemployed, persons of color). We identified 6 major themes including adapting to telemedicine, ensuring availabili","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100848"},"PeriodicalIF":3.9,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000591/pdfft?md5=a161a97b18cb55c54ea28c2abe723fe2&pid=1-s2.0-S2590059524000591-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141137576","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":"A2/A2B Deceased Donor Kidney Transplantation Using A2 Titers Improves Access to Kidney Transplantation: A Single-Center Study","authors":"Erik L. Lum ,&nbsp;Afshin Pirzadeh ,&nbsp;Nakul Datta ,&nbsp;Gerald S. Lipshutz ,&nbsp;Andrea M. McGonigle ,&nbsp;Anum Hamiduzzaman ,&nbsp;Natalie Bjelajac ,&nbsp;Bethany Hale-Durbin ,&nbsp;Suphamai Bunnapradist","doi":"10.1016/j.xkme.2024.100843","DOIUrl":"10.1016/j.xkme.2024.100843","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;The option for A2/A2B deceased donor kidney transplantation was integrated into the kidney allocation system in 2014 to improve access for B blood group waitlist candidates. Despite excellent reported outcomes, center uptake has remained low across the United States. Here, we examined the effect of implementing an A2/A2B protocol using a cutoff titer of&lt;!--&gt; &lt;!--&gt;≤1:8 for IgG and&lt;!--&gt; &lt;!--&gt;≤1:16 for IgM on blood group B kidney transplant recipients at a single center.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Retrospective observational study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Blood group B recipients of deceased donor kidney transplants at a single center from January 1, 2019, to December 2022.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;p&gt;Recipients of deceased donor kidney transplants were analyzed based on donor blood type with comparisons of A2/A2B versus blood group compatible.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;One-year patient survival, death-censored allograft function, primary nonfunction, delayed graft function, allograft function as measured using serum creatinine levels and estimated glomerular filtration rate at 1 year, biopsy-proven rejection, and need for plasmapheresis.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Comparison between the A2/A2B and compatible groups were performed using the Fisher test or the χ&lt;sup&gt;2&lt;/sup&gt; test for categorical variables and the nonparametric Wilcoxon rank-sum test for continuous variables.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 104 blood type B patients received a deceased donor kidney transplant at our center during the study period, 49 (47.1%) of whom received an A2/A2B transplant. Waiting time was lower in A2/A2B recipients compared with blood group compatible recipients (57.9 months vs 74.7 months, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.01). A2/A2B recipients were more likely to receive a donor after cardiac death (24.5% vs 1.8%, &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.05) and experience delayed graft function (65.3% vs 41.8%). There were no observed differences in the average serum creatinine level or estimated glomerular filtration rate at 1 month, 3 months, and 1 year post kidney transplantation, acute rejection, or primary nonfunction.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Single-center study. Small cohort size limiting outcome analysis.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Implementation of an A2/A2B protocol increased transplant volumes of blood group B waitlisted patients by 83.6% and decreased the waiting time for transplantation by 22.5% with similar transplant outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;p&gt;Recipient blood type is one of the main determinants of waiting time to receive a deceased donor kidney transplant. Patients with blood type B have some of the longest waiting times for a kidney in the United States. Minorities comprise a large percentage of blood group B waitlist patients, contributing to observed racial differences in kid","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100843"},"PeriodicalIF":3.9,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000542/pdfft?md5=92f55a86a71fc81898e1dda383ac65f6&pid=1-s2.0-S2590059524000542-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133589","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":"Urine Epidermal Growth Factor and Kidney Function Decline in Middle-Aged Adults","authors":"Merve Postalcioglu ,&nbsp;Rebecca Scherzer ,&nbsp;Joachim H. Ix ,&nbsp;David R. Jacobs Jr ,&nbsp;Cora E. Lewis ,&nbsp;Sucheta Vaigankar ,&nbsp;Michelle M. Estrella ,&nbsp;Orlando M. Gutierrez ,&nbsp;Michael G. Shlipak","doi":"10.1016/j.xkme.2024.100846","DOIUrl":"10.1016/j.xkme.2024.100846","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;The diagnosis and prognostication of chronic kidney disease (CKD) largely rely on glomerular measures that may not reflect tubular damage. We investigated the associations of urine kidney tubule biomarkers with estimated glomerular filtration rate (eGFR) change among middle-aged adults, when chronic diseases typically emerge.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;An observational cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;A total of 1,145 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study without CKD, hypertension, or cardiovascular disease at the year 20 visit.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;p&gt;Seven different biomarkers of tubular health: urine epidermal growth factor (EGF), alpha-1-microglobulin (α1m), interleukin-18, kidney injury molecule-1, monocyte chemoattractant protein-1, uromodulin, and chitinase-3-like protein 1.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;Ten-year eGFR change and incident reduced eGFR (new onset of eGFR&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;60&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;We examined associations of tubular health biomarkers with 10-year eGFR change and incident reduced eGFR with linear mixed models and interval-censored proportional hazards regression models, respectively. Both minimally and fully adjusted models were controlled for urine creatinine levels.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The mean age of participants was 44.8&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;3.7 years, with 39% African American and 56% female. The average 10-year change in eGFR was -18.6&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; (95% CI, -19.4 to -17.8). In contrast to the other tubular biomarkers, which showed conflicting results, EGF demonstrated strong, consistent associations with both kidney outcomes. Each 1-standard deviation (SD) higher EGF was associated with a 2.37&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; (95% CI, 0.64-4.10) smaller 10-year decrease in eGFR and a 42% (95% CI, 4%-64%) lower risk of incident reduced eGFR in the fully adjusted model.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Observational design, measurements of eGFR were done only at 5-year intervals during follow-up.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;In middle-aged, community-dwelling adults without hypertension, cardiovascular disease or CKD, higher urine EGF concentrations are associated with slower eGFR decline, whereas other kidney tubule biomarkers lacked a consistent association with kidney function decline.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;p&gt;Current measures of chronic kidney disease (CKD) rely on markers of glomerular health and function. This approach inadequately captures the role of kidney tubule health, a known histopathological predictor of CKD development. We investigated associations of 7 biomarkers of kidney tubule health with 10-year estimated glomerular filtration rate (eGFR) change and incident reduced eGFR. ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100846"},"PeriodicalIF":3.9,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000578/pdfft?md5=63afe19094ca813342c047a024fd52cf&pid=1-s2.0-S2590059524000578-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141140528","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":"Chronic Kidney Disease Stage and Cardiovascular and Mortality Events Among Older Adults: The SPRINT Trial","authors":"Valentina Turbay-Caballero ,&nbsp;Ana C. Ricardo ,&nbsp;Jinsong Chen ,&nbsp;Celestin Missikpode ,&nbsp;James P. Lash ,&nbsp;Gustavo Aroca-Martinez ,&nbsp;Carlos G. Musso","doi":"10.1016/j.xkme.2024.100845","DOIUrl":"10.1016/j.xkme.2024.100845","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;The risk implications of the Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease classification in older adults are controversial. We evaluated the risk of adverse outcomes in this population across categories of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Prospective cohort.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Settings &amp; Participants&lt;/h3&gt;&lt;p&gt;In total, 2,509 participants aged&lt;!--&gt; &lt;!--&gt;≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;p&gt;KDIGO eGFR and UACR categories. We combined KDIGO categories G1 and G2, G3b and G4, as well as A2 and A3.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;Primary SPRINT outcome (composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), and all-cause death.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Multivariable Cox proportional hazard models.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Mean age was 79.8 years, and 37.4% were female. The mean eGFR was 64.0&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;, and the median UACR was 13.1&lt;!--&gt; &lt;!--&gt;mg/g. In multivariable Cox proportional hazard analysis, compared with participants with eGFR&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;60&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; and UACR&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;30&lt;!--&gt; &lt;!--&gt;mg/g, there was no statistically significant difference in the risk of the primary outcome among participants with eGFR 45-59 or 15-44&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; and UACR&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;30&lt;!--&gt; &lt;!--&gt;mg/g. However, those with eGFR 45-59 or 15-44&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; and UACR&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;30&lt;!--&gt; &lt;!--&gt;mg/g had higher risk of the primary outcome (HR [95% CI], 1.97 [1.27-3.04] and 3.32 [2.23-4.93], respectively). The risk for all-cause death was higher for each category of abnormal eGFR and UACR, with the highest risk observed among those with eGFR 15-44&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; and UACR&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;30&lt;!--&gt; &lt;!--&gt;mg/g (3.34 [2.05-5.44]).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Individuals with diabetes and urine protein&lt;!--&gt; &lt;!--&gt;&gt;1&lt;!--&gt; &lt;!--&gt;g/day were excluded from SPRINT.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;Among older adults SPRINT participants, low eGFR without albuminuria was associated with higher mortality but not with increased risk of cardiovascular events. Additional studies are needed to evaluate an adapted chronic kidney disease stage-based risk stratification for older adults.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;p&gt;Using data from participants in the SPRINT trial, we evaluated the association of chronic kidney disease stage with adverse clinical outcomes among adults older than 75 years without diabetes. We found that low level of kidney function determined by a low estimated glomerular filtration rate with moderately or severely inc","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100845"},"PeriodicalIF":3.9,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000566/pdfft?md5=574ad26fcf880b684cde618eaef02325&pid=1-s2.0-S2590059524000566-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141135125","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":"Atomoxetine for Intradialytic Hypotension in a Patient on Hemodialysis: A Case Report","authors":"Yi-Hsin Chen ,&nbsp;Chih-Tsung Chen","doi":"10.1016/j.xkme.2024.100840","DOIUrl":"10.1016/j.xkme.2024.100840","url":null,"abstract":"<div><p>Intradialytic hypotension significantly affects patient safety and clinical outcomes during hemodialysis. Despite various pharmacological and nonpharmacological interventions, effective management remains elusive. In this report, we detail a case of intradialytic hypotension in a male patient in his 40s, undergoing hemodialysis with a history of polycystic kidney disease. Eight years ago, the patient underwent bilateral nephrectomy because of a severe cystic infection, after which his systolic blood pressure (BP) persistently remained at 50-70<!--> <!-->mm Hg during dialysis sessions. The initial treatment strategy for hypotension included fludrocortisone, midodrine, and prednisolone, leading to a slight temporary increase in BP, which subsequently declined. As the patient’s condition deteriorated, the administration of norepinephrine or dopamine became necessary to sustain BP during dialysis. Given the patient’s resistance to these treatments, a daily dose of 25<!--> <!-->mg of atomoxetine was introduced. Following this treatment, there was a gradual improvement in the patient’s vertigo, weakness, and BP. This case illustrates that low-dose atomoxetine can alleviate symptoms and elevate BP in patients experiencing severe intradialytic hypotension during hemodialysis.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100840"},"PeriodicalIF":3.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000517/pdfft?md5=d74e8429e43b1b9ca37c2cb2a24f7ad3&pid=1-s2.0-S2590059524000517-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141046266","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":"APOL1 High-Risk Genotypes and Kidney Disease Risk in Middle-Aged Black Adults: More Questions Than Answers","authors":"Orlando M. Gutiérrez","doi":"10.1016/j.xkme.2024.100842","DOIUrl":"10.1016/j.xkme.2024.100842","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100842"},"PeriodicalIF":3.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000530/pdfft?md5=54380f6f9db2beabd25c9ccf34caf2c9&pid=1-s2.0-S2590059524000530-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032853","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}