Nephrology Dialysis Transplantation最新文献

{"title":"Very low SBP targets and the boom-and-bust cycle of benefit and adverse kidney events.","authors":"Beatriz Fernandez-Fernandez, Jose M Valdivielso, Shanmugakumar Chinnappa, Pantelis Sarafidis, Alberto Ortiz","doi":"10.1093/ndt/gfaf053","DOIUrl":"https://doi.org/10.1093/ndt/gfaf053","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and design of the Renal Lifecycle Trial assessing the Effect of Dapagliflozin on Cardiorenal Outcomes in Severe Chronic Kidney Disease.","authors":"Wisanne M Bakker, Hiddo J L Heerspink, Stefan P Berger, Christoph Wanner, Sunil V Badve, Clare Arnott, Alferso C Abrahams, Joost C van den Born, Tim C van Faassen, Carlo A J M Gaillard, Mariëlle A C J Gelens, Jose L Górris, Marc H Hemmelder, Lilly Jakulj, Rob C M van Kruijsdijk, Dirk R J Kuypers, Peter van der Meer, Jeroen B van der Net, Heleen H Nijmeijer, Marc G Vervloet, Aiko P J de Vries, Michael Walsh, Angela Y Wang, Ron T Gansevoort","doi":"10.1093/ndt/gfaf046","DOIUrl":"https://doi.org/10.1093/ndt/gfaf046","url":null,"abstract":"<p><strong>Background: </strong>Several clinical trials have shown beneficial effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on kidney disease progression and cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) with and without type 2 diabetes mellitus. However, some subgroups of patients with CKD have been excluded from participation in these trials, such as patients with severely impaired kidney function, patients on dialysis, and kidney transplant recipients.</p><p><strong>Methods: </strong>The Renal Lifecycle trial (NCT05374291) is a pragmatic, international, multicenter, investigator-initiated, randomized, placebo-controlled, clinical trial planned to enroll approximately 1500 patients with 1) an estimated glomerular filtration rate (eGFR) ≤25 ml/min/1.73m2, 2) on hemo- or peritoneal dialysis 3) a kidney transplant and an eGFR ≤45 ml/min/1.73m2, who will be randomized 1:1 to receive either dapagliflozin 10 mg once daily or matching placebo.</p><p><strong>Results: </strong>The primary endpoint is a composite of heart failure hospitalization, all-cause mortality or, for those not on dialysis, kidney failure (start of dialysis longer than 1 month, receiving a kidney transplantation or death due to kidney failure). The trial is event-driven, indicating that it will end after 468 first primary endpoint events have occurred with a power of 80% and an alpha of 0.05 to detect a 25% relative risk reduction assuming an annual 12.5% incidence of the primary outcome. The secondary endpoints include a separate analysis of the incidence of each component of the primary endpoint in the overall trial population as well as the incidence of the combined primary endpoint in each of the three subgroups of patients. Other (exploratory) endpoints are efficacy, safety, tolerability, health-related quality of life and cognition.</p><p><strong>Conclusion: </strong>The Renal Lifecycle trial aims to investigate the effects of the SGLT2 inhibitor dapagliflozin compared to placebo on the incidence of kidney failure, heart failure, mortality, and safety in three subgroups of patients with advanced CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real world data on dual BLyS/APRIL inhibition with telitacicept for lupus nephritis.","authors":"Jingjing Jin, Meng Tan, Ying Tan, Minghui Zhao","doi":"10.1093/ndt/gfaf049","DOIUrl":"https://doi.org/10.1093/ndt/gfaf049","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the efficacy and safety of telitacicept for the treatment of lupus nephritis (LN) in real-world clinical practice.</p><p><strong>Methods: </strong>Adult patients with lupus nephritis receiving additional telitacicept at 80/160 mg once per week were recruited, while patients receiving only standard therapy were included as the control group using a 1:1 propensity score matching approach. The primary outcomes were the proportions of patients achieving complete renal response (CRR) and primary efficacy renal response (PERR).</p><p><strong>Results: </strong>Forty-four patients in both the control and telitacicept groups were enrolled, with median follow-up periods of 10.78 ± 3.37 and 10.5 ± 3.78 months, respectively. Compared to the control group, a significant improvement was observed in the proportion of patients achieving CRR (11.36% vs. 29.55%, P = 0.034) and PERR (45.45% vs. 68.18%, P = 0.031) in the telitacicept group at the last visit. Median proteinuria was reduced by 0.97 g/d (63.82%) from baseline in the telitacicept group, compared to a reduction of 0.31 g/d (25.31%) in the control group. Additionally, the telitacicept group showed notable treatment responses in the median SLEDAI score, PGA score, and glucocorticoid dose reduction. Subgroup analysis revealed that telitacicept exhibited a more prominent therapeutic effect in patients with type V LN and those with proteinuria exceeding 3 g/d. Telitacicept was well tolerated, and the incidence of adverse events was similar between the two groups.</p><p><strong>Conclusions: </strong>Lupus nephritis patients receiving additional telitacicept treatment demonstrated better disease remission, particularly in those with type V LN and proteinuria ≥ 3 g/d, with a favorable safety profile in real-world clinical practice.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The long-term effect of tolvaptan treatment on kidney function and volume in patients with ADPKD.","authors":"Paul Geertsema, Thomas Bais, Vera Kuiken, Martine G E Knol, Niek F Casteleijn, Priya Vart, Esther Meijer, Ron T Gansevoort","doi":"10.1093/ndt/gfaf048","DOIUrl":"https://doi.org/10.1093/ndt/gfaf048","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>The only therapy to ameliorate disease progression in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) is tolvaptan, a vasopressin V2 receptor antagonist. Real-life data on long-term tolvaptan are sparse and limited by restricted follow-up, small patient groups, or lack of a control group. We studied the long-term effect of tolvaptan on kidney function and kidney growth in real-life patients and controls. Moreover, we investigated determinants of long-term treatment efficacy.</p><p><strong>Methods: </strong>Data from the prospective DIPAK cohort and retrospective OBSERVA cohort were pooled. eGFR was measured at least yearly and total kidney volume (TKV) at least every 3 years. Treatment effects from the start to 6 weeks after initiation of tolvaptan were analyzed as 'acute slope'. After this, endpoints were analyzed as 'chronic slope'. As a control group, we included all patients who were not treated with tolvaptan, assessing change in endpoints before and during theoretical treatment (based on the average time of tolvaptan initiation in tolvaptan-treated patients).</p><p><strong>Results: </strong>615 patients (48 ± 12 years, 58.2% female) were included in the full analysis, of which 105 (17.1%) were treated with tolvaptan. The average duration of treatment was 6.1 ± 4.7 years (range: 0.8 to 15.9). After matching, two groups of 92 patients remained for matched analysis. In this analysis, tolvaptan reduced eGFR decline during chronic slope by 14.0% (-4.36 to -3.75 mL/min/1.73m2/year, P = 0.03), versus a decrease of 1.0% (-4.16 to -4.12 mL/min/1.73m2/year, P = 0.9) in the control group. Long-term TKV growth did not significantly change during tolvaptan treatment (5.05 to 5.59%/year P = 0.6). In subgroup analyses, patients with a higher mean osmolar intake had a larger treatment effect of tolvaptan.</p><p><strong>Conclusion: </strong>In this study, with real-life patient data, long-term follow-up, and a well-matched control group, we found that tolvaptan attenuated long-term kidney function decline but seemed not to influence kidney growth.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Celebrating the life and scientific contributions of Barry Brenner in nephrology.","authors":"Giuseppe Remuzzi","doi":"10.1093/ndt/gfae206","DOIUrl":"10.1093/ndt/gfae206","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"409-411"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarker-guided infliximab therapy for immune checkpoint inhibitor-induced acute interstitial nephritis.","authors":"Elena-Bianca Barbir, Arjunmohan Mohan, Priscilla Koirala, Luis E Gutierrez, Callen D Giesen, John C Lieske, Sandra M Herrmann","doi":"10.1093/ndt/gfae257","DOIUrl":"10.1093/ndt/gfae257","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"602-604"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote monitoring of automated peritoneal dialysis reduces mortality, adverse events and hospitalizations: a cluster-randomized controlled trial.","authors":"Ramón Paniagua, Alfonso Ramos, Marcela Ávila, María-de-Jesús Ventura, Armando Nevarez-Sida, Abdul Rashid Qureshi, Bengt Lindholm","doi":"10.1093/ndt/gfae188","DOIUrl":"10.1093/ndt/gfae188","url":null,"abstract":"<p><strong>Background: </strong>Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevents complications and improves treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease, fluid overload and insufficient dialysis efficiency.</p><p><strong>Methods: </strong>In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: (i) Composite Index 1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and (ii) Composite Index 2 comprising cardiovascular mortality, first adverse event and hospitalizations related to cardiovascular disease, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing risk analysis and restricted mean survival time (RMST) analysis.</p><p><strong>Results: </strong>While time to reach Composite Index 1 did not differ between the groups, Composite Index 2 was reached earlier (ΔRMST: -0.86 months; P = .02), and all-cause mortality [55 vs 33 deaths, P = .01; sub-hazard ratio (sHR) 1.69 (95% confidence interval 1.39-2.05), P < .001] and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths [24 vs 13 deaths, P = .05; sHR 2.44 (95% confidence interval 1.72-3.45), P < .001] and rates of adverse events and hospitalizations related to cardiovascular disease, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs 110, P = .048).</p><p><strong>Conclusions: </strong>This randomized controlled trial shows that RM may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"588-597"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgA class-switched CD27-CD21+ B cells in IgA nephropathy.","authors":"Anna Popova, Baiba Slisere, Karlis Racenis, Viktorija Kuzema, Roberts Karklins, Mikus Saulite, Janis Seilis, Anna Jana Saulite, Aiga Vasilvolfa, Kristine Vaivode, Dace Pjanova, Juta Kroica, Harijs Cernevskis, Aivars Lejnieks, Aivars Petersons, Kristine Oleinika","doi":"10.1093/ndt/gfae173","DOIUrl":"10.1093/ndt/gfae173","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin A nephropathy (IgAN) is characterized by the production of galactose-deficient IgA1 (GdIgA1) antibodies. As the source of pathogenic antibodies, B cells are central to IgAN pathogenesis, but the B cell activation pathways as well as the potential B cell source of dysregulated IgA secretion remain unknown.</p><p><strong>Methods: </strong>We carried out flow cytometry analysis of peripheral blood B cells in patients with IgAN and control subjects with a focus on IgA-expressing B cells to uncover the pathways of B cell activation in IgAN and how these could give rise to pathogenic GdIgA1 antibodies.</p><p><strong>Results: </strong>In addition to global changes in the B cell landscape-expansion of naïve and reduction in memory B cells-IgAN patients present with an increased frequency of IgA-expressing B cells that lack the classical memory marker CD27, but are CD21+. IgAN patients furthermore have an expanded population of IgA+ antibody-secreting cells, which correlate with serum IgA levels. Both IgA+ plasmabalsts and CD27- B cells co-express GdIgA1. Implicating dysregulation at mucosal surfaces as the driver of such B cell differentiation, we found a correlation between lipopolysaccharide in the serum and IgA+CD27- B cell frequency.</p><p><strong>Conclusion: </strong>We propose that dysregulated immunity in the mucosa may drive de novo B cell activation within germinal centres, giving rise to IgA+CD27- B cells and subsequently IgA-producing plasmablasts. These data integrate B cells into the paradigm of IgAN pathogenesis and allow further investigation of this pathway to uncover biomarkers and develop therapeutic interventions.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"505-515"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Associations of neutral pH, low-GDP peritoneal dialysis solutions with patient survival, transfer to haemodialysis and peritonitis.","authors":"","doi":"10.1093/ndt/gfae073","DOIUrl":"10.1093/ndt/gfae073","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"606"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized disease recurrence modeling using iPSC-derived podocytes in patients with idiopathic nephrotic syndrome.","authors":"Bartholomeus T van den Berge, Martijn van den Broek, Gianluca Di Giovanni, Hanna Debiec, Sharon Gloudemans, Quinty Leusink, Dirk den Braanker, Jack F M Wetzels, Pierre Ronco, Bart Smeets, Jitske Jansen, Rutger J Maas","doi":"10.1093/ndt/gfaf045","DOIUrl":"https://doi.org/10.1093/ndt/gfaf045","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Primary focal segmental glomerulosclerosis (FSGS) is characterized by podocyte injury and treatment-resistant nephrotic syndrome. Recurrence of the original disease after kidney transplantation (rFSGS) occurs in 10-50% of patients. Unidentified circulating permeability factors (CPF) are likely involved in FSGS pathogenesis. We hypothesized that donor podocyte susceptibility to CPF is also relevant. We developed a personalized model for (r)FSGS using induced pluripotent stem cell (iPSC)-derived podocytes from patients and kidney donors.</p><p><strong>Methods: </strong>Five patients and their respective living kidney donors were included. Three patients had developed rFSGS, and two patients manifested no symptoms of rFSGS. One patient (P5) had heterozygous mutations in NPHS2. Peripheral blood mononuclear cells were reprogrammed to iPSC, and differentiated to podocytes. iPSC-derived podocytes from either patients or donors were exposed to presumed CPF-containing plasma/serum of corresponding patients. Three assays to detect podocyte injury were performed: (1) reactive oxygen species (ROS) formation, (2) cellular granularity induction, and (3) quantitative assessment of F-actin redistribution (FAR), a new quantitative method. Crossmatch experiments with donor iPSC-derived podocytes and patients samples assessed individual susceptibility to CPF-induced injury.</p><p><strong>Results: </strong>Successful podocyte differentiation was confirmed by morphology and protein expression. Only FAR differentiated consistently between patient and healthy donor samples. All pre-transplant patient samples except P5 caused significant FAR in corresponding patient podocytes. Significant FAR was observed in donor podocytes exposed to corresponding patient samples in the setting of rFSGS, and not in donor podocytes exposed to samples of patients who did not develop rFSGS. Effects of FSGS patient samples on non-corresponding donor podocytes were variable.</p><p><strong>Conclusions: </strong>In vitro assays using iPSC-derived donor podocytes may allow individualized assessment of rFSGS. Prospective studies in a larger cohort are required to validate our findings.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}