Frontiers in nephrology最新文献

{"title":"Measured sodium excretion is associated with cardiovascular outcomes in non-dialysis CKD patients: results from the KNOW-CKD study.","authors":"Seong Cheol Kang,&nbsp;Minjung Kang,&nbsp;Hyunjin Ryu,&nbsp;Seonmi Kim,&nbsp;Ji Hye Kim,&nbsp;Eunjeong Kang,&nbsp;Yujin Jeong,&nbsp;Jayoun Kim,&nbsp;Yong-Soo Kim,&nbsp;Soo Wan Kim,&nbsp;Yeong Hoon Kim,&nbsp;Kook-Hwan Oh","doi":"10.3389/fneph.2023.1236177","DOIUrl":"10.3389/fneph.2023.1236177","url":null,"abstract":"<p><strong>Background: </strong>There are insufficient studies on the effect of dietary salt intake on cardiovascular (CV) outcomes in chronic kidney disease (CKD) patients, and there is no consensus on the sodium (Na) intake level that increases the risk of CV disease in CKD patients. Therefore, we investigated the association between dietary salt intake and CV outcomes in CKD patients.</p><p><strong>Methods: </strong>In the Korean cohort study for Outcome in patients with CKD (KNOW-CKD), 1,937 patients were eligible for the study, and their dietary Na intake was estimated using measured 24h urinary Na excretion. The primary outcome was a composite of CV events and/or all-cause death. The secondary outcome was a major adverse cardiac event (MACE).</p><p><strong>Results: </strong>Among 1,937 subjects, there were 205 (10.5%) events for the composite outcome and 110 (5.6%) events for MACE. Compared to the reference group (urinary Na excretion< 2.0g/day), the group with the highest measured 24h urinary Na excretion (urinary Na excretion ≥ 8.0g/day) was associated with increased risk of both the composite outcome (hazard ratio 3.29 [95% confidence interval 1.00-10.81]; P = 0.049) and MACE (hazard ratio 6.28 [95% confidence interval 1.45-27.20]; P = 0.013) in a cause-specific hazard model. Subgroup analysis also showed a pronounced association between dietary salt intake and the composite outcome in subgroups of patients with abdominal obesity, female, lower estimated glomerular filtration rate (< 60 ml/min per 1.73m²), no overt proteinuria, or a lower urinary potassium-to-creatinine ratio (< 46 mmol/g).</p><p><strong>Conclusion: </strong>A high-salt diet is associated with CV outcomes in non-dialysis CKD patients.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1236177"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10183860","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":"Non-invasive intradialytic percutaneous perfusion monitoring: a view to the heart through the skin.","authors":"Jarrin D Penny, Lisa Hur, Fabio R Salerno, Dickson Wong, M Hussain Jan, Christopher W McIntyre","doi":"10.3389/fneph.2023.1124130","DOIUrl":"10.3389/fneph.2023.1124130","url":null,"abstract":"<p><strong>Introduction: </strong>The life-sustaining treatment of hemodialysis (HD) induces recurrent and cumulative systemic circulatory stress resulting in cardiovascular injury. These recurrent insults compound preexisting cardiovascular sequalae leading to the development of myocardial injury and resulting in extremely high morbidity/mortality. This is largely a consequence of challenged microcirculatory flow within the myocardium (evidenced by detailed imaging-based studies). Currently, monitoring during HD is performed at the macrovascular level. Non-invasive monitoring of organ perfusion would allow the detection and therapeutic amelioration of this pathophysiological response to HD. Non-invasive percutaneous perfusion monitoring of the skin (using photoplethysmography-PPG) has been shown to be predictive of HD-induced myocardial stunning (a consequence of segmental ischemia). In this study, we extended these observations to include a dynamic assessment of skin perfusion during HD compared with directly measured myocardial perfusion during dialysis and cardiac contractile function.</p><p><strong>Methods: </strong>We evaluated the intradialytic microcirculatory response in 12 patients receiving conventional HD treatments using continuous percutaneous perfusion monitoring throughout HD. Cardiac echocardiography was performed prior to the initiation of HD, and again at peak-HD stress, to assess the development of regional wall motion abnormalities (RWMAs). Myocardial perfusion imaging was obtained at the same timepoints (pre-HD and peak-HD stress), utilizing intravenous administered contrast and a computerized tomography (CT)-based method. Intradialytic changes in pulse strength (derived from PPG) were compared with the development of HD-induced RWMAs (indicative of myocardial stunning) and changes in myocardial perfusion.</p><p><strong>Results: </strong>We found an association between the lowest pulse strength reduction (PPG) and the development of RWMAs (<i>p</i> = 0.03) and also with changes in global myocardial perfusion (CT) (<i>p</i> = 0.05). Ultrafiltration rate (mL/kg/hour) was a significant driver of HD-induced circulatory stress [(associated with the greatest pulse strength reduction (<i>p</i> = 0.01), a reduction in global myocardial perfusion (<i>p</i> = 0.001), and the development of RWMAs (<i>p</i> = 0.03)].</p><p><strong>Discussion: </strong>Percutaneous perfusion monitoring using PPG is a useful method of assessing intradialytic hemodynamic stability and HD-induced circulatory stress. The information generated at the microcirculatory level of the skin is reflective of direct measures of myocardial perfusion and the development of HD-induced myocardial stunning. This approach for the detection and management of HD-induced cardiac injury warrants additional evaluation.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1124130"},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10533788","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":"Case Report: Multisystem inflammatory syndrome in children with associated proximal tubular injury.","authors":"Silvia Maria Orsi, Carlotta Pepino, Lisa Rossoni, Margherita Serafino, Roberta Caorsi, Stefano Volpi, Serena Palmieri, Alessandro Faragli, Francesca Lugani, Carolina Bigatti, Gian Marco Ghiggeri, Enrico Eugenio Verrina, Edoardo La Porta, Andrea Angeletti","doi":"10.3389/fneph.2023.1194989","DOIUrl":"10.3389/fneph.2023.1194989","url":null,"abstract":"<p><strong>Introduction: </strong>SARS-CoV-2 infection in the pediatric population can be associated with a multiorgan inflammatory syndrome called children's multisystem inflammatory syndrome (MIS-C). The kidneys can be affected by a broad spectrum of possible injuries, whose pathogenetic mechanisms are still unclear.<b>Case report:</b> We report the case of a 5-year-old boy with severe cardiac involvement in the context of MIS-C. After two weeks of hospitalization, an abdominal ultrasound showed massive bladder \"debris\", followed by the onset of normoglycemic glycosuria. Over time, there was a progressive increase in glycosuria, and the presence of a mat of amorphous phosphate crystals was evidenced on urinary sediment. Together with the findings of hypo-uricemia, increased urinary uric acid, and globally increased urinary amino acids, a clinical picture of kidney proximal tubular damage with secondary Fanconi-like syndrome took shape.</p><p><strong>Discussion: </strong>This case report describes the case of a patient with MIS-C with cardiac and kidney involvement characterized by proximal tubular damage, which slowly improved but still persisted at the 8-month follow-up. The pathogenesis of the damage is unclear and probably multifactorial.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1194989"},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171642","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":"Continuation of immunosuppression vs. immunosuppression weaning in potential repeat kidney transplant candidates: a care management perspective.","authors":"Michelle J Hickey,&nbsp;Gurbir Singh,&nbsp;Erik L Lum","doi":"10.3389/fneph.2023.1163581","DOIUrl":"https://doi.org/10.3389/fneph.2023.1163581","url":null,"abstract":"<p><p>Management of immunosuppression in patients with a failing or failed kidney transplant requires a complete assessment of their clinical condition. One of the major considerations in determining immunosuppression is whether or not such an individual is considered a candidate for re-transplantation. Withdrawal of immunosuppression in a re-transplant candidate can result in allosensitization and markedly reduce the chances of a repeat transplant. In this review, we summarize the effects of immunosuppression reduction on HLA sensitization, discuss the impacts of allosensitization in these patients, and explore reduction protocols and future directions. Risks of chronic immunosuppression, medical management of the failing allograft, and the effect of nephrectomy are covered elsewhere in this issue.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1163581"},"PeriodicalIF":0.0,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10513023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting SARS-CoV-2 infection among hemodialysis patients using multimodal data.","authors":"Juntao Duan, Hanmo Li, Xiaoran Ma, Hanjie Zhang, Rachel Lasky, Caitlin K Monaghan, Sheetal Chaudhuri, Len A Usvyat, Mengyang Gu, Wensheng Guo, Peter Kotanko, Yuedong Wang","doi":"10.3389/fneph.2023.1179342","DOIUrl":"10.3389/fneph.2023.1179342","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic has created more devastation among dialysis patients than among the general population. Patient-level prediction models for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are crucial for the early identification of patients to prevent and mitigate outbreaks within dialysis clinics. As the COVID-19 pandemic evolves, it is unclear whether or not previously built prediction models are still sufficiently effective.</p><p><strong>Methods: </strong>We developed a machine learning (XGBoost) model to predict during the incubation period a SARS-CoV-2 infection that is subsequently diagnosed after 3 or more days. We used data from multiple sources, including demographic, clinical, treatment, laboratory, and vaccination information from a national network of hemodialysis clinics, socioeconomic information from the Census Bureau, and county-level COVID-19 infection and mortality information from state and local health agencies. We created prediction models and evaluated their performances on a rolling basis to investigate the evolution of prediction power and risk factors.</p><p><strong>Result: </strong>From April 2020 to August 2020, our machine learning model achieved an area under the receiver operating characteristic curve (AUROC) of 0.75, an improvement of over 0.07 from a previously developed machine learning model published by Kidney360 in 2021. As the pandemic evolved, the prediction performance deteriorated and fluctuated more, with the lowest AUROC of 0.6 in December 2021 and January 2022. Over the whole study period, that is, from April 2020 to February 2022, fixing the false-positive rate at 20%, our model was able to detect 40% of the positive patients. We found that features derived from local infection information reported by the Centers for Disease Control and Prevention (CDC) were the most important predictors, and vaccination status was a useful predictor as well. Whether or not a patient lives in a nursing home was an effective predictor before vaccination, but became less predictive after vaccination.</p><p><strong>Conclusion: </strong>As found in our study, the dynamics of the prediction model are frequently changing as the pandemic evolves. County-level infection information and vaccination information are crucial for the success of early COVID-19 prediction models. Our results show that the proposed model can effectively identify SARS-CoV-2 infections during the incubation period. Prospective studies are warranted to explore the application of such prediction models in daily clinical practice.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1179342"},"PeriodicalIF":0.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237265","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":"IgA nephropathy: a review of existing and emerging therapies.","authors":"Sahibzadi Mahrukh Noor,&nbsp;Farah Abuazzam,&nbsp;Roy Mathew,&nbsp;Zhiwei Zhang,&nbsp;Amir Abdipour,&nbsp;Sayna Norouzi","doi":"10.3389/fneph.2023.1175088","DOIUrl":"10.3389/fneph.2023.1175088","url":null,"abstract":"<p><p>IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. Recently, there have been multiple advances in the understanding of IgAN pathophysiology and therapeutic options. Despite the advent of new treatment options, individual risk stratification of the disease course and choosing the best treatment strategy for the patient remains challenging. A multitude of clinical trials is ongoing, opening multiple opportunities for enrollment. In this brief review we discuss the current approach to the management of IgAN and highlight the ongoing clinical trials.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1175088"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179976","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 need for kidney biopsy in the management of side effects of target and immunotherapy.","authors":"Roberta Fenoglio, Martina Cozzi, Giulio Del Vecchio, Savino Sciascia, Antonella Barreca, Alessandro Comandone, Dario Roccatello","doi":"10.3389/fneph.2023.1043874","DOIUrl":"10.3389/fneph.2023.1043874","url":null,"abstract":"<p><strong>Introduction: </strong>The introduction of innovative therapies, resulting from revisiting cancer as a disease of the immune system, has changed the scenario of complications. These new classes of drugs, such as targeted therapies and immune checkpoint inhibitors, assure substantial advantages in cancer therapy, despite some side effects affecting various organs, including the kidney. Histological evaluations of kidney disorders induced by targeted/immunotherapy are limited.</p><p><strong>Method: </strong>In this study we examined the histological features of patients treated with new cancer agents who underwent a kidney biopsy for new onset kidney failure and/or urinary abnormalities.</p><p><strong>Results: </strong>The cohort included 30 adult patients. The most frequently administered therapies were immunotherapy (30%), targeted therapy (26.7%), immunotherapy plus targeted therapy (13.3%), immunotherapy plus chemotherapy (13.3%), targeted therapy plus chemotherapy (16.7%). The most common histological finding was tubular interstitial nephritis (30%) that was associated with acute tubular necrosis in 4 cases, and thrombotic microangiopathy (23.3%). After kidney biopsy, 16 of the 30 patients were treated according to the histological diagnosis. Fourteen patients were treated with steroids. One patient with membranous nephropathy was treated with a single dose of rituximab. A patient with severe thrombotic microangiopathy requiring dialysis received a treatment with eculizumab for 3 months. Overall some renal response was obtained in all patients treated with glucocorticoids, while complete kidney response was achieved in the patient treated with rituximab. Cancer treatment was resumed without change in 21 out of 30 patients.</p><p><strong>Conclusion: </strong>Kidney biopsy is critical for the management of kidney toxicities and should be strongly encouraged for patients showing adverse kidney effects of novel cancer agents.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1043874"},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179975","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 changing landscape in nephrology education in India.","authors":"P S Vali, Namrata Parikh, Krithika Mohan, Urmila Anandh","doi":"10.3389/fneph.2023.1110704","DOIUrl":"10.3389/fneph.2023.1110704","url":null,"abstract":"<p><p>Digital tools have revolutionized education in nephrology in India. All forms of in-person learning are moving online. Social media have taken over the world, with clinicians learning and promoting multidirectional education methods. E-learning is better equipped to keep up with the rapid pace of new knowledge generation and dissemination. The use of digital multimedia tools to enhance rapid learning is backed by science, viz., dual-coding theory. Digital tools such as Twitter, blogs, podcasts, YouTube, and Nephrology Simulator (NephSIM) have had an impact in facilitating nephrology education among medical professionals and the general public. Digital tools, such as NephMadness, have resulted in the gamification of nephrology learning. Social media usage by the nephrology community in India is growing at a rapid pace. Everyday Cases in Nephrology (#ECNeph), a monthly Twitter-based discussion focused on academically challenging clinical cases, has its origins in India. The Women in Nephrology, India (WIN-India) initiative is very active in facilitating digital education in India and has, in a short space of time, created phenomenal momentum. Furthermore, non-governmental organizations in India, such as the Kidney Warriors Foundation and the Multi Organ Harvesting Aid Network (MOHAN) Foundation, have successfully tapped into social media to educate and aid kidney disease patients. All technologies come with some drawbacks. Despite their acceptance and validation, digital tools have their own pitfalls. These relate to (1) accessibility and connectivity, (2) accuracy of the scientific information, (3) social media noise, and (4) patient privacy. All pitfalls of digital education can be addressed by avoiding excessive social media overload and adopting an appropriate peer-review process. It is advisable to seek written consent from patients whenever patient data are posted online, to avoid privacy issues.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1110704"},"PeriodicalIF":0.0,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179977","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":"Octogenarians with chronic kidney disease in the nephrology clinic: Progressors vs. non-progressors.","authors":"Aida Frías,&nbsp;Francisco Vargas,&nbsp;Justo Sandino,&nbsp;Raquel Berzal,&nbsp;Marta Rivero,&nbsp;Lucía Cordero,&nbsp;Teresa Cavero,&nbsp;Julián Segura,&nbsp;Florencio García,&nbsp;Eduardo Hernández,&nbsp;Eduardo Gutiérrez,&nbsp;Pilar Auñón,&nbsp;Irene Zamanillo,&nbsp;Julio Pascual,&nbsp;Enrique Morales","doi":"10.3389/fneph.2023.1114486","DOIUrl":"10.3389/fneph.2023.1114486","url":null,"abstract":"<p><strong>Background: </strong>The current definition of chronic kidney disease applied to patients over the age of 80 has increased the number of referrals to Nephrology. However not all of these patients may benefit from its assessment. This study aims to analyze the evolution of ≥80 years old patients referred to Nephrology.</p><p><strong>Methods: </strong>Single-center study including patients ≥80 years old with eGFR <60 mL/min/1,73m2 who were referred to Nephrology consultation for the first time. Clinical and analytical parameters were collected retrospectively 12 months before the visit, and prospectively at baseline, and 12 and 24 months after the initial visit. We divided patients into two groups based on annual eGFR loss: progressors (>5 mL/min/1.73m2) and non-progressors (≤5 mL/min/1,73m2).</p><p><strong>Results: </strong>A total of 318 patients were included, mean age was 84,9 ± 4 (80-97) years. Baseline serum creatinine was 1,65 ± 0,62 mg/dL, eGRF 35 (28-42) mL/min/1,73, and albumin/creatinine ratio 36 (7-229) mg/g. 55,7% of the patients met the definition of progressor at baseline (initial-progressors), 26,3% were progressors after a 12-month follow-up and 13,4% after 24 months. 21,2% and 11,4% of initial-progressors met this definition at 12 and 24 month follow up. The main risk factor for progression was albuminuria. No relationship was found between the nephrologist intervention and the evolution of renal function among initial non-progressors.</p><p><strong>Conclusion: </strong>Elderly patients who have stable renal function at the time of referral will continue to have stable renal function over the subsequent 24 months and thus may not need to be referred to a nephrologist.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1114486"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171637","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":"Extracorporeal blood purification in patients with liver failure: Considerations for the low-and-middle income countries of Latin America.","authors":"Vladimir Barrera Villanueva, Daniel Alejandro Barrera Amorós, Eira Ingrid Castillo Echeverria, Luis F Budar-Fernández, Omar Israel Salas Nolasco, Luis A Juncos, Lilia Rizo-Topete","doi":"10.3389/fneph.2023.938710","DOIUrl":"10.3389/fneph.2023.938710","url":null,"abstract":"<p><p>Severe liver failure is common in Low-and-Medium Income Countries (LMIC) and is associated with a high morbidity, mortality and represents an important burden to the healthcare system. In its most severe state, liver failure is a medical emergency, that requires supportive care until either the liver recovers or a liver transplant is performed. Frequently the patient requires intensive support until their liver recovers or they receive a liver transplant. Extracorporeal blood purification techniques can be employed as a strategy for bridging to transplantation or recovery. The most common type of extracorporeal support provided to these patients is kidney replacement therapy (KRT), as acute kidney injury is very common in these patients and KRT devices more readily available. However, because most of the substances that the liver clears are lipophilic and albumin-bound, they are not cleared effectively by KRT. Hence, there has been much effort in developing devices that more closely resemble the clearance function of the liver. This article provides a review of various non-biologic extracorporeal liver support devices that can be used to support these patients, and our perspective keeping in mind the needs and unique challenges present in the LMIC of Latin America.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"938710"},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10551194","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}