Nephrology Dialysis Transplantation最新文献

{"title":"Heart failure events in randomized controlled trials for adults receiving maintenance dialysis: a meta-epidemiologic study.","authors":"David Collister, Lonnie Pyne, Arrti A Bhasin, Brendan Smyth, William Herrington, Meg Jardine, Patrick B Mark, Sunil Badve, Patrick Rossignol, Laura M Dember, Christoph Wanner, Justin Ezekowitz, P J Devereaux, Patrick Parfrey, Ron Gansevoort, Michael Walsh","doi":"10.1093/ndt/gfae156","DOIUrl":"10.1093/ndt/gfae156","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Heart failure is characterized as cardiac dysfunction resulting in elevated cardiac filling pressures with symptoms and signs of congestion. Distinguishing heart failure from other causes of similar presentations in patients with kidney failure is challenging but necessary, and is needed in randomized controlled trials (RCTs) to accurately estimate treatment effects. The objective of this study was to review heart failure events, their diagnostic criteria, and adjudication in RCTs of patients with kidney failure treated with dialysis. We hypothesized that heart failure events, diagnostic criteria, and adjudication were infrequently reported in RCTs in dialysis.</p><p><strong>Methods: </strong>We conducted a meta-epidemiologic systematic review of RCTs from high-impact medical, nephrology, and cardiology journals from 2000 to 2020. RCTs were eligible if they enrolled adults receiving maintenance dialysis for kidney failure and evaluated any intervention.</p><p><strong>Results: </strong>Of 561 RCTs in patients receiving dialysis, 36 (6.4%) reported heart failure events as primary (10, 27.8%) or secondary (31, 86.1%) outcomes. Ten of the 36 (27.8%) RCTs provided heart failure event diagnostic criteria and five of these (50%) adjudicated heart failure events. These 10 RCTs included event diagnostic criteria for heart failure or heart failure hospitalizations, and their criteria included dyspnoea (5/10), oedema (2/10), rales/crackles (4/10), chest X-ray pulmonary oedema or vascular redistribution (4/10), treatment in an acute setting (6/10), and ultrafiltration or dialysis (4/10). No study explicitly distinguished heart failure from volume overload secondary to non-adherence or underdialysis.</p><p><strong>Conclusion: </strong>Overall, we found that heart failure events are infrequently reported in RCTs in dialysis and are heterogeneously defined. Further research is required to develop standardized diagnostic criteria that are practical and meaningful to patients and clinicians.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"371-384"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580292","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":"Borderline (suspicious) for T-cell-mediated rejection, the Banff classification's Achilles' heel.","authors":"Myrthe van Baardwijk, Anne Wagenmakers, Thierry P P van den Bosch, Dennis A Hesselink, Alexandre Loupy, Rafael Kramann, Jean-Paul Duong van Huyen, Marion Rabant, Marian C Clahsen-van Groningen","doi":"10.1093/ndt/gfae192","DOIUrl":"10.1093/ndt/gfae192","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"224-226"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109921","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 impact of acute kidney damage in the community.","authors":"Javier Diaz, Laura Lidon, Inma Sauri, Antonio Fernandez, Maria Grau, Jose L Gorriz, Maria J Forner, Josep Redon","doi":"10.1093/ndt/gfae175","DOIUrl":"10.1093/ndt/gfae175","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>The aim was to assess incidence of acute kidney disease and disorders (AKD) and acute kidney injury (AKI) episodes and their impact on progression of renal dysfunction and risk of all-cause mortality in the community.</p><p><strong>Methods: </strong>Community of 1 863 731 aged >23 years with at least two serum creatinine measurements. eGFR was calculated using the chronic kidney disease (CKD)-EPI formula. CKD, AKD and AKI were defined according to the harmonized KDIGO criteria (Lameire 2021). The sCr values and Risk, Injury, Failure, Loss, End-stage (RIFLE) scale was used to classify episodes. Progression of renal dysfunction and mortality were evaluated.</p><p><strong>Results: </strong>A total of 56 850 episodes of AKD in 47 972 patients over 4.8 years were identified. AKD incidence of AKD was 3.51 and 12.56/1000 patients/year in non-CKD and CKD, respectively. One AKD episode was observed in 87.3% patients, two in 9.3%, and three or more in 3.4%. A second episode was less common in patients without CKD (10.3%) compared to those with CKD (18.4%). Among patients without CKD a total of 43.8% progressed to CKD, and those with previous CKD 63.1% had eGFR decline of >50%. The risk of progression to CKD was higher in women, older, overweight-obesity, and heart failure, as was the risk of eGFR decline >50% in CKD patients, although the number of AKD episodes was also a risk factor. AKI episodes were observed in 5646 patients with or without CKD. Of these, 12.7% progressed to CKD and of those with pre-existing CKD, 43.2% had an eGFR decline of >20%. In the total population, mortality within 3 months of detection of AKD episode occurred in 7% patients, and was even higher in patients with AKI at 30.1%.</p><p><strong>Conclusion: </strong>Acute elevations in serum creatinine in the community may pose a health risk and contribute to the development of CKD. Identification of therapeutic targets and provision of appropriate follow-up for those who survive an episode is warranted.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"385-392"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760011","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 kidney-skeletal muscle-heart axis in chronic kidney disease: implications for myokines.","authors":"Borja Quiroga, Javier Díez","doi":"10.1093/ndt/gfae193","DOIUrl":"10.1093/ndt/gfae193","url":null,"abstract":"<p><p>Myokines are signalling moieties released by the skeletal muscle in response to acute and/or chronic exercise, which exert their beneficial or detrimental effects through paracrine and/or autocrine pathways on the skeletal muscle and through endocrine pathways in many other organs (e.g. the heart). Interestingly, alterations in myokines have been described in patients with heart failure (HF) that are associated with adverse structural and functional left ventricular remodelling and poor cardiac outcomes. Recent experimental and clinical studies have shown that the muscle regulation of a number of myokines is altered in chronic kidney disease (CKD) thus representing a new molecular aspect of the pathophysiology of skeletal myopathy present in patients with CKD. Muscle dysregulation of myokines may contribute to a number of disorders in non-dialysis and dialysis patients with CKD, including the high risk of developing HF. This possibility would translate into a range of new diagnostic and therapeutic options. In fact, the measurement of circulating myokines opens their possible usefulness as biomarkers to personalize exercise training and pharmacological therapies for the prevention and treatment of HF in patients with CKD and skeletal myopathy. This review will analyse information on some myokines that target the heart and are altered at the level of skeletal muscle and circulation in patients with CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"255-263"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109922","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":"Limitations of biopsy-based transcript diagnostics to detect T-cell-mediated allograft rejection.","authors":"Lukas Weidmann, Dusan Harmacek, Kai Castrezana Lopez, Birgit Maria Helmchen, Ariana Gaspert, Raphael Korach, Nicola Bortel, Nicolas Schmid, Seraina von Moos, Elena Rho, Thomas Schachtner","doi":"10.1093/ndt/gfae147","DOIUrl":"10.1093/ndt/gfae147","url":null,"abstract":"<p><strong>Background: </strong>Isolated tubulitis, borderline changes and isolated arteritis suspicious for histologic T-cell-mediated rejection (hTCMR) remain findings of uncertain significance. Although the Molecular Microscope Diagnostics System (MMDx) has not been trained on those lesions, it was suggested that MMDx might reclassify a subgroup to molecular TCMR (mTCMR).</p><p><strong>Methods: </strong>In this single-center cohort of 326 consecutive, unselected kidney allograft biopsies assessed by histology and MMDx, we analyzed 249 cases with isolated tubulitis (i0, t1-3, v0; n = 101), borderline changes (according to Banff 2022, v0; n = 9), isolated arteritis (no borderline, v1; n = 37), no inflammation (i0, t0, v0; n = 67) and a positive control cohort (hTCMR, n = 27; mixed histologic rejection, n = 8; both according to Banff 2022; total n = 35). The first three groups were summarized as TCMR-suspicion (n = 147). Subcategorization included the presence and absence of microvascular inflammation (MVI); g+ptc ptc ≥2. Molecular rejection rates and differentiation were investigated.</p><p><strong>Results: </strong>Molecular rejection rates were 37/147 cases (25.2%; 32 with MVI) in TCMR-suspicion, 6/67 (9%; 4 with MVI) in no inflammation and 30/35 (85.7%; 19 with MVI) in the positive control cohort. Molecular antibody-mediated rejection (mAMR) was present in 39/73 (53.4%) of cases. The presence of donor-specific antibodies at the time of the biopsy was high (127/249, 51%). Only 3 mAMR/TCMR and 0 pure mTCMR cases were detected in TCMR-suspicion and no inflammation, compared with 12 mAMR/TCMR and 10 mTCMR cases in the positive control cohort (P < .001). Even though the TCMR-specific molecular (Classifier) score differentiated between TCMR-suspicion and no inflammation (P = 0.005), rejection phenotype scores (R2 and R3) did not (P = .157 and .121).</p><p><strong>Conclusions: </strong>MMDx did not identify pure mTCMR among isolated tubulitis, borderline changes or isolated arteritis, likely due to low sensitivity for TCMR lesions. However, it identified mAMR or mAMR/TCMR, especially in cases with MVI. Subthreshold findings remain to be further studied.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"294-307"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141458353","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":"Antibody-mediated podocytopathies: a disease entity that implies immunotherapy.","authors":"Andreas Kronbichler, Cecilia Barnini, Anna Matyjek, Philipp Gauckler, Annette Bruchfeld, Fernando Caravaca-Fontan, Jürgen Floege, Eleni Frangou, Safak Mirioglu, Sarah M Moran, Kate I Stevens, Y K Onno Teng, Stefanie Steiger","doi":"10.1093/ndt/gfae166","DOIUrl":"10.1093/ndt/gfae166","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"218-221"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634043","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":"Kidney failure from kidney stones: an ANZDATA study.","authors":"Hicham Cheikh Hassan, David J Tunnicliffe, Lyn Loyd, Adam Mullan, Ieuan Wickham, Brydee Cashmore, Matthew Jose, Andrew J Mallett","doi":"10.1093/ndt/gfae137","DOIUrl":"10.1093/ndt/gfae137","url":null,"abstract":"<p><strong>Background: </strong>Kidney stones are common, with an increasing trend over time, and have been well studied in the general population. However, the incidence and outcomes of kidney stones leading to kidney failure (KF) and the receipt of kidney replacement therapy (KRT) are poorly examined. We examined the incidence of KF due to kidney stones and compared outcomes with KRT patients due to other causes.</p><p><strong>Methods: </strong>We studied adult patients who started KRT (January 1981-December 2020) and are included in the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Exposure was KRT patients due to kidney stones, comparing them with patients with other causes. We examined incidence, prevalence, patient survival (KRT and transplant) and graft survival (transplant). Cox regression models were fitted to compare patient survival between the kidney stones and non-kidney stones groups, overall KRT, dialysis and patient and graft survival after kidney transplant.</p><p><strong>Results: </strong>A total of 834 (1.1%) patients commenced KRT due to kidney stones. The incidence was 1.17 per million population per year and remained stable during the study period (annual change -0.3% [95% confidence interval (CI) -1.5-0.9]. Survival was higher in kidney stone patients receiving dialysis compared with the non-kidney stone group [hazard ratio (HR) 0.89 (95% CI 0.82-0.96)], with similar estimates in a matched cohort. In kidney transplant patients, time to transplant was longer for patients with kidney stones compared with non-kidney stone patients (2.5 versus 1.7 years; P = .001). There was no difference in mortality [HR 1.02 (95% CI 0.82-1.28)] or graft loss [HR 1.07 (95% CI 0.79-1.45)] between the kidney stones and non-kidney stones patients in the kidney transplant group.</p><p><strong>Conclusion: </strong>The incidence of KF due to kidney stones was unchanged over the study period. Survival of patients with kidney stones who require KRT was better compared with patients with other causes. For the kidney transplant group, survival and risk of graft failure were similar.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"320-328"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420012","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":"Effect of semaglutide on kidney function across different levels of baseline HbA1c, blood pressure, body weight and albuminuria in SUSTAIN 6 and PIONEER 6.","authors":"Ellen M Apperloo, David Z I Cherney, Anja Birk Kuhlman, Johannes F E Mann, Søren Rasmussen, Peter Rossing, Katherine R Tuttle, Blaz Vrhnjak, Hiddo J L Heerspink","doi":"10.1093/ndt/gfae150","DOIUrl":"10.1093/ndt/gfae150","url":null,"abstract":"<p><strong>Background: </strong>This post hoc analysis explored the effects of semaglutide on estimated glomerular filtration (eGFR) slope by baseline glycemic control, blood pressure (BP), body mass index (BMI) and albuminuria status in people with type 2 diabetes and high cardiovascular risk.</p><p><strong>Methods: </strong>Pooled SUSTAIN 6 (Trial to Evaluate Cardiovascular and Other Long-Term Outcomes With Semaglutide in Subjects With Type 2 Diabetes) and PIONEER 6 (A Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects With Type 2 Diabetes) data were analyzed for change in eGFR slope by baseline hemoglobin A1c (HbA1c) (<8%/≥8%; <64/≥64 mmol/mol), systolic BP (<140/90/≥140/90 mmHg) and BMI (<30/≥30 kg/m2). SUSTAIN 6 data were analyzed by baseline urinary albumin:creatinine ratio (UACR; <30/30-300/>300 mg/g).</p><p><strong>Results: </strong>The estimated absolute treatment differences overall in eGFR slope (95% confidence intervals) favored semaglutide versus placebo in the pooled analysis [0.59 (0.29; 0.89) mL/min/1.73 m2/year] and in SUSTAIN 6 [0.60 (0.24; 0.96) mL/min/1.73 m2/year]; the absolute benefit was consistent across all HbA1c, BP, BMI and UACR subgroups (all P-interaction >.5).</p><p><strong>Conclusion: </strong>A clinically meaningful reduction in risk of chronic kidney disease progression was observed with semaglutide versus placebo regardless of HbA1c, BP, BMI, and UACR levels.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"352-359"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492783","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":"KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease in Children and Adults: a commentary from the European Renal Best Practice (ERBP).","authors":"Fotini Iatridi, Juan Jesus Carrero, Emilie Cornec-Le Gall, Mehmet Kanbay, Valerie Luyckx, Rukshana Shroff, Charles J Ferro","doi":"10.1093/ndt/gfae209","DOIUrl":"10.1093/ndt/gfae209","url":null,"abstract":"<p><p>The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Guideline for Identification and Management of Chronic Kidney Disease (CKD) is a welcome development, coming 12 years after the paradigm-changing 2012 guidelines. We are living in an unprecedented era in nephrology with novel therapies, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists, now being proven in multiple randomized controlled clinical trials to reduce both the progression of CKD and cardiovascular morbidity and mortality. The KDIGO 2024 CKD Guideline is aimed at a broad audience looking after children and adults with CKD and provide practical and actionable steps to improve care. This commentary reviews the guideline sections pertaining to the evaluation and risk assessment of individuals with CKD from a European perspective. We feel that despite the last guideline being published 12 years ago, and the fact that the assessment of CKD has been emphasized by many other national/international nephrology, cardiology and diabetology guidelines and societies, the diagnosis and treatment of CKD remains poor across Europe. As such, the KDIGO 2024 CKD Guideline should be seen as an urgent call to action to improve diagnosis and care of children and adults with CKD across Europe. We know what we need to do. We now need to get on and do it.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"273-282"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292074","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":"Urea for hyponatremia: a role for desmopressin?","authors":"Richard H Sterns, Helbert Rondon-Berrios","doi":"10.1093/ndt/gfae169","DOIUrl":"10.1093/ndt/gfae169","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"222-223"},"PeriodicalIF":4.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748673","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}