Nephron最新文献

{"title":"THE INFLAMMATORY PATHOGENETIC PATHWAYS OF FABRY NEPHROPATHY AND AGALOPATHY; GLA VARIANTS INDUCTION OF ENDOPLASMIC RETICULUM STRESS.","authors":"Sandro Feriozzi, Paula Rozenfeld","doi":"10.1159/000544760","DOIUrl":"https://doi.org/10.1159/000544760","url":null,"abstract":"<p><p>Fabry disease (FD) is a monogenic disease with highly variable clinical features. This variability suggests that additional pathogenetic pathways may exist besides the intra-lysosomal deposition of globotriaosylceramide (Gb3) and its deacylated form globotriaosylsphingosine (LysoGb3) caused by an enzyme deficiency. Research studies proved that the deposition of Gb3 and LysoGb3 can stimulate inflammatory processes. Mononuclear immune competent cells exposed to Gb3 deposition express adhesion molecules and release proinflammatory and fibrotic cytokines such as interleukin β, tumour necrosis factor-alpha (TNFα), and transforming growth factor beta (TGFβ). These processes determine the activation of inflammation processes associated with chronic inflammation and tissue fibrosis. The pathogenetic mechanisms stimulated by Gb3 and LysoGb3 deposition could become independent from the initial stimulus, causing an irreversible effect, in which Fabry disease-specific therapy can play a limited role. A new disease mechanism, \"Agalopathy\", would coexist with the enzyme deficiency. Missense variants in the coding sequence of the GLA gene would generate the misfolding of the altered protein alpha-galactosidase A. Emergence of misfolded proteins may generate stress of the endoplasmic reticulum (ER), leading to induction of the unfolded protein response (UPR). The UPR causes the release of proinflammatory cytokines and contributes to inflammatory status. This mechanism could be activated independently of glycolipid deposition, and its relationship with inflammatory pathways deserves more research. Strikingly, a zebrafish GLA knockout model that naturally lacks the enzyme that synthesizes Gb3 shows many alterations in lysosomal functions. These pieces of evidence suggest the involvement of alternative pathways independent of Gb3 in FD pathogenesis. This review aims to describe these processes' role in the pathogenesis of renal damage in FD or Agalopathy nephropathies.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-9"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical inflammation and renal allograft dysfunction: myth or reality?","authors":"Carlos Couceiro, Maria Visent, Josep M Cruzado","doi":"10.1159/000544762","DOIUrl":"https://doi.org/10.1159/000544762","url":null,"abstract":"<p><p>Since the implementation of the Banff classification, the diagnosis and treatment of transplant rejection has been standardized. However, the rigid categorization of transplant pathology has limited our perspective on allograft inflammation, particularly disregarding those inflammatory infiltrates who do not reach the category of rejection. The term subclinical inflammation was introduced to designate the inflammation found in protocol biopsies, without significant renal function deterioration. Following the introduction of modern immunosuppression with tacrolimus and mycophenolate, subclinical rejection rate decreased, and less attention was paid to this entity. However, in the last decades several studies have evaluated the impact of lower levels of inflammation and demonstrated its negative consequences on long-term outcomes. Although, in some patients this subclinical inflammation is not permanent and can spontaneously disappear. The uncomplete definition of subclinical inflammation, which only considered renal function stability, and the evaluation of the biopsy as a definitive diagnosis, and not as a picture of an evolving process are the main reasons why managing this inflammation represents a challenge, especially when there is no pathogenic mechanism identified. In this review, we revise the \"natural\" history of inflammation in the kidney allograft and its possible origins based on cellular composition and transcriptomic expression changes in kidney biopsies. In addition, we propose an updated definition and an approach to manage it.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-11"},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and tailoring a person-centred pathway for mental health care for people receiving dialysis.","authors":"Kara Schick-Makaroff, Charlotte Berendonk, Marlo Salum, Peter Yoeun, Jenny Wichart, Marni Armstrong, Stephanie Thompson, Meghan Elliott, Loretta Lee, Terry Smith, Frances Reintjes, Denise Fillier, Scott Klarenbach, Richard Sawatzky","doi":"10.1159/000544058","DOIUrl":"https://doi.org/10.1159/000544058","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Mental health symptoms are underdiagnosed and undertreated among people receiving dialysis treatment. Despite a high prevalence of depression (40%) and anxiety (42%) symptoms in this population, international guidance does not exist. To address this gap, a multi-phase project involved collaboration by diverse groups in Alberta, Canada to develop and tailor a pathway that supports person-centred mental health care for Albertans receiving dialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This mixed methods patient-oriented research was conducted in two phases. Phase 1 included: a) an online clinician survey (n=199), b) 11 focus groups and 2 interviews involving 10 people with lived experience and 44 clinicians and administrators, and c) a scoping review of evidence-based pharmacological treatment. Descriptive analyses of the survey data and summative content analysis of qualitative data (written survey comments and data from focus groups and interviews) were conducted to understand current processes, health services, and interventions for mental health care in Alberta Kidney Care for people receiving dialysis, and to determine appropriateness and opportunities of existing mental health services and interventions. The results were used to develop preliminary statements to inform development of the pathway. Attributes of centredness in health care - being unique, being heard, and shared responsibility - guided pathway development. Phase 2 involved building consensus on these statements via two rounds of modified Delphi surveys (n=59 and 51 for Rounds 1 and 2, respectively), followed by a consensus call on a virtual platform for discussion and voting involving 27 participants. Voters rated their agreement for each statement using a 3-point Likert scale. Consensus was defined a priori as ≥80 % agreement by two groups of voters: people with lived experience and clinicians/others.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Phase 1 results informed the development of 68 statements in Round 1 of Delphi voting; 42 were approved. Based on voter comments, 11 new statements were developed and 23 statements were revised. Round 2 of Delphi voting included 34 statements. A call was held with people with lived experience to understand why they voted differently than clinicians/others. We learned that some statement language was too technical, such as \"assessment\" or \"score\". We talked through each statement and people with lived experience verbally approved the intention of all statements. Through this dialogue, and Round 2 voting, 20 statements were approved. A consensus call was held, concluding with voting on 5 statements previously not approved by both groups; 3 were approved. In total, 66 statements were approved for use in development of a pathway addressing symptoms of depression and anxiety, as well as coping. Approved statements guided depiction of the pathway as an algorithm for initial conversations, assessment, follow-up (including \"red-","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-28"},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Membranoproliferative glomerulonephritis with striated ultrastructural deposits with significantly elevated fibrinogen and fibronectin on mass spectrometry analysis: A case report and literature review.","authors":"Manna Ishida, Shinya Yamamoto, Yohei Iwashige, Shuma Miyazawa, Hirosuke Nakata, Seta Koichi, Kensei Yahata, Sachiko Minamiguchi, Yoko Endo, Akiko Mii, Akira Shimizu, Motoko Yanagita","doi":"10.1159/000544709","DOIUrl":"https://doi.org/10.1159/000544709","url":null,"abstract":"<p><p>Glomerular diseases with organized deposits can be classified into various etiologies. A diagnostic algorithm based on clinical and pathological findings has been proposed. However, some cases cannot be diagnosed using existing algorithms. Here, we report the case of a 77-year-old man diagnosed with membranoproliferative glomerulonephritis (MPGN) with striated ultrastructural deposits, microfilament-like substructures with straight bands arranged in parallel in the subendothelial space by two sequential renal biopsies. His examinations and clinical findings were incompatible with known glomerular diseases with organized deposits. Dialysis was initiated 10 months after the second biopsy procedure. Furthermore, we report the first mass spectrometry analysis of laser micro-dissected glomeruli with striated ultrastructural deposits, which revealed significant levels of fibrinogen and fibronectin. Immunostaining was positive for fibrinogen, fibrin, and fibronectin in the subendothelial space. These findings suggest that the deposits were composed of a fibrin-fibronectin complex, and that accumulation of these fibrin-fibronectin complexes possibly induced endothelial injury, leading to MPGN. We also reviewed the literature on the clinical and pathological characteristics of the four cases with striated ultrastructural deposits. Our investigation showed that all patients had the MPGN pattern and striated ultrastructural deposits in the subendothelial space, and all underwent hemodialysis within 3 years after renal biopsy. Clinicians should be aware of the findings of glomerulonephritis with striated ultrastructural deposits since this disease may be a new entity and has a poor prognosis.  .</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-17"},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHA2DS2-VASc score as a predictor of cardiovascular and all-cause mortality in a prospective cohort of hemodialysis patients of predominantly African ancestry: The PROHEMO.","authors":"Gabriel Brayan Gutiérrez-Peredo, Andrea Jimena Gutiérrez-Peredo, Iris Montaño-Castellón, Marinho Marques da Silva Neto, Fernanda Albuquerque da Silva, Marcia Tereza Silva Martins, Cacia Mendes Matos, Jean Michell Correia Monteiro, Pedro Guimarães Silva, Gildete Barreto Lopes, Marcelo Barreto Lopes, Luis Claudio Correia, Roberto Pecoits-Filho, Keith C Norris, Antonio Alberto Lopes","doi":"10.1159/000543720","DOIUrl":"https://doi.org/10.1159/000543720","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) elevates the risk of cardiovascular and overall mortality among maintenance hemodialysis (MHD) patients. Although initially designed to predict stroke in cases of atrial fibrillation, the CHA2DS2-VASc score demonstrates predictive utility, spanning several cardiovascular conditions. This study seeks to evaluate if the CHA2DS2-VASc score is effective in predicting cardiovascular and all-cause mortality for MHD patients.</p><p><strong>Methods: </strong>The data are part of the \"Prospective Study of the Prognosis of Patients on Chronic Hemodialysis\" (PROHEMO) developed in Salvador, BA, Brazil. We grouped patients according to CHA2DS2-VASc score ≤2 (group 1) and >2 (group 2). Cox regression was used to estimate the hazard ratio of death (HR): unadjusted; and adjusted for hemoglobin, creatinine, albumin, phosphorus, PTH, liver disease, neoplasia/cancer, months of hemodialysis. Additionally, the distribution of each variable in the CHA2DS2-VASc score and its association with mortality were evaluated. Based on the observed associations and the distribution of age (with only 1.3% of patients aged >75 years) and hypertension (only 4.6% normotensive, leading to an imprecise association estimate), a modified CHA2DS2-VASc score was created.</p><p><strong>Results: </strong>A total of 237 patients on hemodialysis (51.57 ± 12.46, 57% male) were included. Mean age was 51.6 ± 12.5 years. A total of 55 deaths, 21 from cardiovascular causes. Compared with CHA2DS2-VASc score <2, the unadjusted hazard of death (Model 1) for score ≥2 was twofold for all-cause mortality (HR=2.05; 95% CI: 1.20, 3.49) and more than three times higher for cardiovascular deaths (HR=3.53; 95% CI: 1.46, 8.54). These HRs did not change substantially with adjustment for covariates. In the most comprehensively adjusted Cox model, the HR for all-cause mortality was 2.43 (95% CI: 1.38, 4.23) and for cardiovascular mortality was 3.52 (95% CI: 1.40, 8.84). These results were similar to those observe for the modified version of CHA2DS2-VASc score.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-23"},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Tubular Necrosis Attributed to High-Dose Everolimus with High-Potency Bisphosphonates for Advanced Breast Cancer - A Case Report.","authors":"Itamar Loewenstein, Nimrod Orr Urtreger, Doron Schwartz, Asia Zubkov, Merav Ingbir","doi":"10.1159/000543924","DOIUrl":"https://doi.org/10.1159/000543924","url":null,"abstract":"<p><strong>Introduction: </strong>Everolimus (EVR)-induced kidney injury is rarely reported. Conversely, acute tubular necrosis (ATN) is a recognized complication of high-dose bisphosphonate therapy.</p><p><strong>Case presentation: </strong>SM, a 69-year-old female patient with advanced breast cancer, who developed severe kidney injury necessitating renal replacement therapy (RRT) shortly after initiating EVR treatment, while concurrently receiving chronic high-potency bisphosphonate therapy. Kidney biopsy confirmed ATN. Upon discontinuation of both EVR and bisphosphonates, her renal function gradually improved over several months, leading to the cessation of RRT. At a two-year follow-up, her kidney function has returned to baseline.</p><p><strong>Conclusion: </strong>In this case report, we outline the patient's clinical course and provide a pathophysiological rationale for the synergistic effect of EVR and bisphosphonates in promoting ATN. With the increasing use of EVR in various oncologic indications, we emphasize the reversible nature of this kidney injury and stress the importance of timely recognition and intervention.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-11"},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing the Nurse-led Optimization of Volume and blood pressure - Enabling at multi-Levels using TechnologY (NOVELTY) program for Chronic Kidney Disease: a prospective cohort study.","authors":"Zhihua Huang, Li Choo Ng, Irene Mok, Chieh Suai Tan, Cynthia Ciwei Lim","doi":"10.1159/000543948","DOIUrl":"https://doi.org/10.1159/000543948","url":null,"abstract":"<p><strong>Background: </strong>Fluid overload is a common manifestation of chronic kidney disease (CKD) and is associated with increased hospitalizations and death. However, severe symptomatic fluid overload is potentially preventable with early recognition of mild fluid overload and timely institution of appropriate pharmacotherapy and fluid restriction. We implemented and evaluated the outcomes of a nurse-led clinic that incorporated objective fluid volume assessment using body impedance analysis (BIA) into structured patient education and action plan coaching to patients with CKD and fluid overload.</p><p><strong>Methods: </strong>Single-center prospective pre- post implementation study of adults who participated in the program (Table 1) between August 2022 and April 2024. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) >160 mmHg or diastolic BP >100 mmHg. The clinical effectiveness outcomes were symptoms and signs of fluid overload and improvement in blood pressure. The patient-reported effectiveness outcomes were chronic disease self-management assessed using the Partner in Health (PIH) questionnaire and health-related quality of life (HrQOL) assessed by the EuroQOL-5 Dimension (EQ5D5L) survey. The clinical safety outcomes were hypotension and worsening kidney function.</p><p><strong>Results: </strong>Among 107 patients referred to the nurse-led program, 96 attended the first visit. median age was 68.5 (IQR 60.2, 77.3) years and eGFR was 21.6 (14.0, 39.7) ml/min/1.73 m2. Almost all participants (93.8%) had symptoms of fluid overload within the past 1 month before the first review. BIA was performed for 52 (54.2%) patients and the median overhydration was 2.4 (1.3, 3.6) liters. The second and third visits were attended by 38 (39.6%) and 28 (29.2%) patients, respectively. At program completion, patients had reduced symptoms and signs of fluid overload and had improved systolic BP [137 (121, 143) versus 151 (132, 166) mmHg, p=0.03] and self-management [PIH score 96 (89, 104) versus 72 (57, 88), p=0.001] compared to their baseline visit. EQ5D5L scores were significantly different. None experienced hypotension (systolic BP <90 mmHg) and kidney function did not change significantly during follow-up.</p><p><strong>Conclusions: </strong>A nurse-led program that incorporated objective fluid volume assessment, structured patient education and action plan coaching for patients with CKD and fluid overload improved BP and self-management.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-18"},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Support Needs of People with Autosomal Dominant Polycystic Kidney Disease: A Qualitative Phenomenological Descriptive Study.","authors":"Katrine Schmidt Rasmussen, Dinah Sherzad Khatir, Henrik Birn, Selina Emilie Poulsen, Jeanette Finderup","doi":"10.1159/000543269","DOIUrl":"https://doi.org/10.1159/000543269","url":null,"abstract":"<p><strong>Introduction: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent hereditary kidney disease and the fourth most common cause of kidney failure. Patients may be aware of their condition from an early age or discover it unexpectedly, with varying levels of familial knowledge about the disease. This chronic condition presents significant challenges for healthcare professionals. The study aimed to investigate how people with ADPKD experience their participation in a dedicated ADPKD clinic and to investigate their support needs in managing their disease in everyday life.</p><p><strong>Methods: </strong>A qualitative phenomenological descriptive study was conducted, involving semi-structured telephone interviews with patients who attended a newly established dedicated ADPKD clinic between March and April 2023. The data were analyzed using Malterud's principles of systematic text condensation.</p><p><strong>Results: </strong>In total, 18 out of 22 patients agreed to participate in the interviews. Six themes emerged from the interviews. Participants expressed feelings of uncertainty about their future and highlighted the necessity for personalized care tailored to their individual circumstances. They reported challenges in coping with emotions associated with the disease and sought assistance in making difficult decisions. Maintaining control over their health and illness was a significant theme, alongside a desire for increased knowledge about their condition.</p><p><strong>Conclusion: </strong>Our study supports existing knowledge in this area. In this study, the participants experienced satisfaction with the dedicated ADPKD clinic, feeling well informed, listened to, and more at ease after the check-up. Investing in a dedicated ADPKD clinic could help alleviate the uncertainty that many people with ADPKD experience.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized Care in CKD: Moving Beyond Traditional Biomarkers.","authors":"Thomas McDonnell, Rosamonde E Banks, Maarten W Taal, Nicolas Vuilleumier, Philip A Kalra","doi":"10.1159/000543640","DOIUrl":"10.1159/000543640","url":null,"abstract":"<p><strong>Background: </strong>Traditional biomarkers, such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR), have long been central to chronic kidney disease (CKD) diagnosis and management, leading to a standardized CKD classification system. However, these biomarkers are non-specific and fail to capture the heterogeneity within CKD and the nuances of an individual's disease mechanism, limiting personalized treatment approaches. There is an increasing need for novel biomarkers that reflect the diverse pathophysiological processes underlying CKD progression, enabling more precise risk prediction and treatment strategies.</p><p><strong>Summary: </strong>This review examines the limitations of current CKD biomarkers and classification systems, highlighting the need for a precision medicine approach. While traditional markers like eGFR and uACR are foundational, they inadequately capture CKD's complexity. Emerging biomarkers offer insights into specific disease processes, such as inflammation, oxidative stress, fibrosis, and tubular injury, which are crucial for personalized care. The article discusses the potential benefits of integrating these novel biomarkers into clinical practice, including more accurate risk prediction, tailored treatments, and personalized clinical trial designs, as well as the barriers to their implementation. Furthermore, advancements in multi-omics and high-throughput techniques offer opportunities to identify novel causative proteins with druggable targets, pushing CKD care towards greater precision.</p><p><strong>Key messages: </strong>Current CKD classification systems, based on non-specific biomarkers, fail to capture CKD's heterogeneity. Incorporating biomarkers reflecting diverse pathophysiological mechanisms can enhance risk prediction, customized treatments, and personalized clinical trials. High-throughput multi-omic techniques present a promising path towards precision medicine in nephrology.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-19"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Evaluation of Remote Software Based Surveillance Supplementing Clinical Monitoring For Hemodialysis Vascular Access.","authors":"Alshymaa Rafiek Eltahan, Zulfikar Pondor, Rosemary L Donne, David Lewis, Maharajan Raman, Jan Cowperthwaite, Marinela Liliana Resiga, Paul Hinchliffe, Jazzle Lim, Paula Gleave, Jonathan Allsopp, Dimitrios Poulikakos","doi":"10.1159/000543609","DOIUrl":"https://doi.org/10.1159/000543609","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Efficient arteriovenous access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of adding remote software surveillance to standard clinical care across our units.</p><p><strong>Methods: </strong>We conducted a 12-month prospective study on maintenance hemodialysis (HD) patients using Vasc-Alert software technology to assist clinical decision-making in 2 satellite HD units (Group 1) and standard care in the remaining 3 HD units (Group 2) . Patients with Vasc-alert derived high Access Risk Score (ARS) (≥7) underwent clinical assessment and were referred for fistulogram based on relevant Kidney Disease Outcome Quality Initiative (KDOQI) criteria. Data on referrals for fistulogram, subsequent VA events, access abandonment, and complication-free days- extended (CFD-extended) were collected.. VA survival analysis of post-intervention primary patency rate at 3 and 6 months was conducted.</p><p><strong>Results: </strong>There were 23 (28.1%) preemptive correction of stenosis and 6 (7.3%) thrombosis episodes in Group 1, compared to 40 (19.5%)and 21 (10.2%) in Group 2 (p value 0.155, 0.587),respectively). Amongst the thrombotic episodes, 83% of cases in Group 1 had been detected during surveillance and referred for diagnostic fistulogram +/- angioplasty but developed thrombosis whilst awaiting elective intervention compared to 19% in Group 2 (P value = 0.004). Median time from fistulogram request to thrombosed VA was 26 days (IQR 21-42 days).Group 1 exhibited better post-intervention primary patency rates and longer CFD compared to Group 2 (p value < 0.001, 0.002, respectively).</p><p><strong>Conclusion: </strong>Incorporating Vasc-Alert technology into VA clinical surveillance pathway was associated with improved early detection of high-risk VA, higher primary patency rates, and longer CFD-extended compared to standard of care. Improving elective interventional radiology (IR) capacity for timely intervention (< 3 weeks from referral) is crucial to materialise the benefits of enhanced surveillance in preventing acute thrombosis.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-19"},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}