American Journal of Nephrology最新文献

{"title":"Plasma Transcriptome Profile Associated with Chronic Kidney Disease Progression.","authors":"Anvesha Srivastava, Mark Maienschein-Cline, Richard L Amdur, Katalin Susztak, Jeffrey Burnett Kopp, Haiming Cao, Divya Shankaranarayanan, Yoosif Abdalla, Ana Pabalan, Michael Gombert, Dominic Raj","doi":"10.1159/000542707","DOIUrl":"10.1159/000542707","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding the molecular signals associated with the progression of kidney disease is vital for risk stratification and targeted treatment. Recent advances in RNA-sequencing technique have enabled us to characterize extracellular transcriptome profiles for precision diagnostics.</p><p><strong>Method: </strong>We evaluated the plasma mRNA profile of participants exhibiting slow (n = 119) and fast (n = 119) decline in estimated glomerular filtration rate (eGFR) among the Chronic Renal Insufficiency Cohort (CRIC) in a nested case control study. The two groups were matched for age, sex, race, baseline eGFR, proteinuria, and diabetes status. The next-generation sequencing data were analyzed using edgeR to identify differentially expressed genes (DEGs) and ingenuity pathway analysis was done to identify the associated pathways. We also compared the top plasma DEGs with gene expression in microdissected human chronic kidney disease (CKD) kidney.</p><p><strong>Results: </strong>We identified fragments from ∼28,000 annotated genes, of which 783 transcripts exhibited differential expression between slow and fast CKD progressors. Among 629 protein coding genes, 469 were overexpressed in slow progressors, while 157 showed increased expression in fast progressors. Expression of GLI2, CUX1, NOTCH1, and LRP1 transcripts were amplified in slow progressors. Pathway analysis linked these DEG to WNT/β-catenin signaling, IL-12 signaling and production in macrophages, Netrin-1 Signaling and Epithelial-Mesenchymal Transition pathways. Many of the plasma DEGs were also upregulated in microdissected human CKD kidney.</p><p><strong>Conclusion: </strong>Warranting further validation, circulating levels of aberrantly expressed transcripts hold potential to be used as biomarkers for fast CKD progression.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-13"},"PeriodicalIF":4.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal Change Disease and Focal Segmental Glomerulosclerosis Are Associated with Good Kidney Prognosis and Thrombotic Microangiopathy with Poor Kidney Survival in Patients with COVID-19-Associated Nephropathies.","authors":"Precil Diego Miranda de Menezes Neves, Stanley Almeida Araújo, David Campos Wanderley, Andressa Monteiro Sodré, Marcos Adriano Garcia Campos, Elieser Hitoshi Watanabe, Denise Maria Avancini Costa Malheiros, Lívia Barreira Cavalcante, Felipe Lourenço Ledesma, Karla Cristina Petruccelli Israel, Flávia Lara Barcelos, Laila Lopes de Farias Pinho, Fabrício Augusto Marques Barbosa, Silvana Maria Carvalho Miranda, Márcio Dantas, Welluma Lomarques de Mendonça Britto, Jenaine Oliveira Paixão, Rafael Lage Madeira, Felipe Leite Guedes, Weverton Machado Luchi, Américo Lourenço Cuvello-Neto, Igor Denizarde Bacelar Marques, Jose Bruno Almeida, Rafael Fernandes Vanderlei Vasco, Antonio Monteiro, Francisco Rasiah Ladchumananandasivam, Antônio Augusto Lima Teixeira Júnior, Orlando Vieira Gomes, Rodrigo Hagemann, Oreste Angelo Ferra-Neto, Ricardo Ferreira Santos, Denise Maria do Nascimento Costa, Epitácio Rafael Luz-Neto, Leandro de Castro Bahia Alvarenga Soares, Rebecca Souza Mubarac, Kellen Micheline Alves Henrique Costa, Rafael Weissheimer, Christiany Moreira Almeida, Barbara Antunes Bruno da Silva, Leandro Santos Miranda, Leandro Rodrigues Iannuzzi, Gilson Masahiro Murata, Irene de Lourdes Noronha, Natalino Salgado-Filho, Luiz Fernando Onuchic, Gyl Eanes de Barros Silva","doi":"10.1159/000542836","DOIUrl":"10.1159/000542836","url":null,"abstract":"<p><strong>Introduction: </strong>The kidney is a frequent target of SARS-CoV-2, potentially developing lesions in glomeruli, vessels, and tubulointerstitium in response to this infection. Herein, we present the analysis of the first large Latin American cohort of adult patients undergoing kidney biopsy due to COVID-19-associated kidney disorders.</p><p><strong>Methods: </strong>This retrospective, multicenter, national study was based on the collection of information on demographics, comorbidities, laboratory data, kidney histology, therapy, and therapeutic response. Patients diagnosed with collapsing glomerulopathy (CG) were genotyped for APOL1.</p><p><strong>Results: </strong>Our cohort included 94 patients, most male (62.8%). The median age was 44 (33-52) years, and 50% of them were previously hypertensive. The time between COVID-19 diagnosis and kidney biopsy was 30 (15-60) days. Most patients had decreased kidney function at diagnosis, 43.5% required dialysis upon diagnosis, 77.6% received immunosuppression, and 2/3 achieved a clinical remission. CG was the most common kidney involvement (18 cases), reproducing previous findings. Focal segmental glomerulosclerosis (FSGS), thrombotic microangiopathy (TMA), and IgA nephropathy were also frequent, with 10 cases each. FSGS and minimal change disease (MCD) were associated with the best cumulative kidney survival; none started dialysis. In contrast, patients with TMA/C3 glomerulopathy presented a poor kidney prognosis, with more than half progressing to kidney replacement therapy.</p><p><strong>Conclusion: </strong>A novel and striking finding of our study, therefore, was the association of FSGS and MCD with the best kidney outcome among all COVID-19-related histological patterns. Moreover, the overall distribution of histological profiles showed significant particularities in the analyzed patient cohort, the most important being the higher frequency of TMA cases.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-17"},"PeriodicalIF":4.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.1159/000542861","DOIUrl":"https://doi.org/10.1159/000542861","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1"},"PeriodicalIF":4.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Roxadustat on Thyroid Profiles in Patients and Animals with Chronic Kidney Disease.","authors":"Wangyang Li, Tao Cao, Guangluan Huang, Jianying Guo, Tangkun Zhu, Haofei Hu, Huiwei Huang, Xueting Liu, Liling Wu, Jia Chen, Dongli Qi, Tie Chen, Qijun Wan, Yuan Cheng","doi":"10.1159/000542699","DOIUrl":"10.1159/000542699","url":null,"abstract":"<p><strong>Introduction: </strong>Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor used in renal anemia treatment, has been associated with thyroid hormone suppression. This study investigated the patterns of thyroid profile changes following roxadustat administration and their clinical implications.</p><p><strong>Methods: </strong>In this retrospective study (2019-2023) at Shenzhen Second People's Hospital, patients were categorized based on thyroid-stimulating hormone (TSH) reduction during follow-up (≥50% decrease vs. <50% decrease). Thyroid profiles, clinical symptoms, and laboratory indicators were analyzed. Quality of life was assessed using EQ-5D-3L and ThyPRO questionnaires. Complementary animal experiments were conducted to verify the effects of roxadustat on thyroid function.</p><p><strong>Results: </strong>A total of 118 patients were finally enrolled in our study. Among patients with initially normal thyroid function, 31 developed euthyroid sick syndrome post-roxadustat treatment. Treatment significantly decreased TT3, FT3, FT4, and TSH levels, with TSH showing marked reduction within the first 10 weeks. Contrastingly, animal models exhibited decreased T3 but increased TSH levels, regardless of renal status. Blood lipid levels decreased in all patients, particularly in those with substantial TSH reduction. Despite thyroid alterations, quality-of-life scores remained unchanged between roxadustat-treated and untreated patients, with no overt clinical symptoms in either humans or animals.</p><p><strong>Conclusion: </strong>While roxadustat induces significant thyroid hormone suppression in patients, these alterations rarely manifest as clinical symptoms. Euthyroid sick syndrome is the predominant thyroid dysfunction pattern observed. Regular thyroid function monitoring is recommended during roxadustat therapy, particularly during the initial treatment phase when TSH changes are most pronounced.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-15"},"PeriodicalIF":4.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implementation of Nephrologist-Led Genomic Testing for Glomerular Diseases in Singapore: Rationale and Protocol.","authors":"Cynthia Lim, Ru Sin Lim, Jason Choo, Esther Huimin Leow, Gek Cher Chan, Yaochun Zhang, Jun Li Ng, Hui-Lin Chin, Ee Shien Tan, Jeannette Goh, Naline Gandhi, Yong Hong Ng, Mya Than, Indra Ganesan, Siew Le Chong, Celeste Yap, Sing Ming Chao, Breana Cham, Sylvia Kam, Jiin Ying Lim, Irene Mok, Hui Zhuan Tan, Jia Liang Kwek, Tung Lin Lee, Ziyin Wang, Su Mein Goh, Regina Lim, See Cheng Yeo, Boon Wee Teo, Yi Da, David Matchar, Kar Hui Ng","doi":"10.1159/000542942","DOIUrl":"10.1159/000542942","url":null,"abstract":"<p><strong>Introduction: </strong>The early diagnosis and appropriate treatment of monogenic glomerular diseases can reduce kidney failure, avoid unnecessary investigations such as kidney biopsies and ineffective treatment with immunosuppressants, guide transplant decisions, and inform the genetic risks of their family members. Yet, genetic testing for kidney disease is underutilized in Singapore. We aimed to implement a nephrologist-led genetic service and evaluate the acceptance, adoption, utility, and cost-effectiveness of genetic testing for monogenic glomerular disease in Singapore.</p><p><strong>Methods: </strong>We will perform a prospective, multi-centre, type II hybrid effectiveness-implementation study with a post-design to evaluate both implementation and clinical outcomes of nephrologist-led genetic testing for suspected genetic glomerular kidney diseases. The multi-disciplinary implementation team will train \"genetic nephrologists\" to provide pre- and post-test counselling, order targeted exome panel sequencing for suspected glomerular kidney diseases (persistent microscopic haematuria and/or albuminuria or proteinuria in the absence of known causes, steroid-resistant primary nephrotic syndrome, apparent familial IgA nephropathy, or chronic kidney disease with no apparent cause), and interpret genetic test results; create workflows for patient referral, evaluation and management, and discuss genetic results at regular genomic board meetings. The outcomes are acceptance, appropriateness and adoption among patients and nephrologists, utility (proportion of patients who received genetic testing and have a confirmed diagnosis of genetic glomerular disease), and cost-effectiveness.</p><p><strong>Conclusion: </strong>This study will create and evaluate a nephrologist-led genetic service, develop an efficient variant curation process, and inform future recommendations on the optimal referral and genetic testing strategy for monogenic glomerular disease in Singapore. This will facilitate the future mainstreaming of genetic testing that will enable precision medicine in kidney care.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-14"},"PeriodicalIF":4.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and the Role of Gene-Environment Interactions in Idiopathic Membranous Nephropathy in Northern China.","authors":"Wanyin Hou, Sufang Shi, Zhe Yan, Maodong Liu, Gengxin Guo, Yujing Zhang, Yun Dong, Junjie Gao, Fuyun Sun, Guicai Hu, Zhaoxia Zheng, Liping Duan, Haisong Zhang, Bing Liu, Shaomei Li, Sumin Jiao, Jinwei Wang, Zhao Cui, Suxia Wang, Ying Li, Shuxia Fu, Minghui Zhao","doi":"10.1159/000542910","DOIUrl":"https://doi.org/10.1159/000542910","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic membranous nephropathy (iMN) has become one of the most prevalent primary glomerular diseases, with a marked increase in prevalence over the past two decades in northern China. Fine particulate matter (PM2.5) is considered to be associated with this rising prevalence. In this study, we aim to evaluate the trends of iMN in relation to improved air quality and conduct a cross-sectional study in Hebei province (northern China, near Beijing) to investigate the role of gene-environment interactions in its development.</p><p><strong>Methods: </strong>This study established two cohorts. Cohort 1 included 22,937 pathology reports from Peking University First Hospital (2002-2021) to assess iMN prevalence. Cohort 2 comprised 5,635 iMN patients from 11 cities in Hebei Province (2009-2013). DNA samples from 374 iMN patients and 1,259 controls were genotyped for SNPs rs4664608 (PLA2R1) and rs2187668 (HLA-DQA1). Patients were stratified by air pollution risk levels. The annual percentage change (APC) and average annual percentage change (AAPC) were estimated using a join-point regression model. Gene-environment interactions were analyzed using logistic regression and epinet-calculation.</p><p><strong>Results: </strong>In Cohort 1, 5,586 patients with iMN were identified, representing 24.3% of the 22,937 patients from 2002 to 2021. The general population showed a significant increase in iMN proportion with an APC of +12.7% per year from 2002 to 2014 (95% CI: 10.3 to 17.5, p < 0.001), followed by a decline with an APC of -5.6% per year from 2014 to 2021 (95% CI: -9.6 to -2.6, p < 0.001).In Hebei Province, the iMN frequency rose significantly with an APC of +17.6% per year from 2002 to 2016 (95% CI: 14.5 to 28.6, p < 0.001), peaking at 60%, and then declined with an APC of -5.5% per year from 2016 to 2021 (95% CI: -13.1 to -1.2, p = 0.02). Cohort 2 highlighted significant regional variation in iMN incidence across Hebei Province. Geographic exposure to pollution was identified as an independent risk factor for iMN (RR 1.49, 95% CI 1.38-1.56, p<0.001). Gene-environment interaction analysis revealed that patients with risk alleles in the PLA2R1 gene and exposure to risk environments had a markedly increased risk of developing iMN (OR=38.72, 95% CI 11.95-125.46, p<0.01).</p><p><strong>Conclusion: </strong>The annual growth rate of iMN in northern China appears to be slowing down. Gene-environment interactions may have contributed to the previously observed increase in iMN prevalence.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-17"},"PeriodicalIF":4.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Generational Impact of Maternal Exposure to Low Level of PM2.5 on Kidney Health.","authors":"Hui Chen, Long The Nguyen, Min Feng, Baoming Wang, Bai Xu, Rochelle A Yarak, Yik Lung Chan, Seethalakshmi Viswanathan, Muralikrishna Gangadharan Komala, Carol A Pollock, Brian G Oliver, Sonia Saad","doi":"10.1159/000542135","DOIUrl":"10.1159/000542135","url":null,"abstract":"<p><strong>Introduction: </strong>Inhaled fine and ultrafine particulate matter may affect organs other than the lung, including the kidney. Recent studies have consistently shown the possibility of air pollution in highly polluted countries to be nephrotoxic. However, in countries like Australia, where air quality generally adheres to or remains below the WHO standards, the subtle yet consequential impacts of chronic exposure to seemingly safe levels of traffic PM2.5, are a subject of increasing significance. However, how such exposures in the peri-pregnancy period affect kidney health in mothers and the offspring is unclear, which formed the aims of this study.</p><p><strong>Methods: </strong>Female Balb/c mice were exposed to PM2.5 (5 μg/day) delivered nasally for 6 weeks prior to mating, during gestation and lactation (PM group). In a subgroup, PM2.5 was switched to saline from mating until offspring were weaned to model mothers moving to areas with clean air. Kidneys were analysed in dams and adult offspring at 13 weeks of age.</p><p><strong>Results: </strong>PM2.5 induced oxidative stress without histological changes in the dam's kidney. However, male PM offspring displayed in utero underdevelopment, characterised by reduced body weight and kidney-to-body weight at birth compared to control offspring, and lower glomerular numbers, with a marked increase in albuminuria, glomerulosclerosis, inflammation, oxidative stress, and mitochondrial injury. Female PM offspring had delayed postnatal development, lower glomerular numbers, increased glomerulosclerosis, and oxidative stress injury markers. Removal of PM2.5 from conception significantly reduced DNA oxidation and kidney damage in the offspring.</p><p><strong>Conclusion: </strong>There is no safe level of ambient PM2.5 for kidney health when exposed in utero. Maternal PM2.5 exposure equally impacts the kidney health of male and female offspring. Removal of PM2.5 from conception was overall protective to the offspring.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-14"},"PeriodicalIF":4.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Peritoneal Neutrophil Extracellular Traps on Peritoneal Characteristics and Technical Failure in Patients Undergoing Peritoneal Dialysis.","authors":"Insoo Kim, Sei Hong Min, Hoi Woul Lee, Jung Nam An, Hyung Seok Lee, Sung Gyun Kim, Jwa-Kyung Kim","doi":"10.1159/000542427","DOIUrl":"10.1159/000542427","url":null,"abstract":"<p><strong>Introduction: </strong>Peritoneal dialysis (PD) is an effective home therapy for end-stage kidney disease. However, continuous exposure to PD fluids with high glucose concentration and recurrent peritonitis may lead to the activation of cellular and molecular processes of peritoneal damage, including inflammation and fibrosis. In particular, recent studies have highlighted the role of neutrophils in chronic inflammation. This study explores how neutrophil extracellular traps (NETs) affect peritoneal membrane function and contribute to technical failures in PD patients.</p><p><strong>Methods: </strong>We conducted a prospective observational study involving 250 noninfectious and 30 acute peritonitis patients. NETs were measured using nucleosome and myeloperoxidase DNA levels in PD fluids. Monocyte chemoattractant protein-1 (MCP-1) and matrix metalloproteinase-8 (MMP-8) were also measured to assess peritoneal inflammation and damage.</p><p><strong>Results: </strong>A significant increase in peritoneal NETs, as determined by nucleosome and myeloperoxidase DNA levels, was observed in patients with acute peritonitis compared to patients without peritonitis. Even in noninfectious samples, NET levels were widely distributed and closely correlated with levels of MCP-1 and MMP-8. Higher levels of peritoneal NETs were closely associated with increased 4-h dialyzate/peritoneal (D/P) creatinine ratio and 1-h D/P sodium levels, indicating a higher prevalence of fast transport and limited free water transport. These factors were associated with a higher risk of technical failure. During a mean follow-up of 34 months, 39.2% (98 patients) switched from PD to hemodialysis, with higher NET levels significantly increasing the risk by 1.9 times (95% confidence interval: 1.27-2.83, p = 0.020).</p><p><strong>Conclusion: </strong>This study suggests the importance of peritoneal NETs not only as markers of acute inflammation but also as significant immunological predictors of chronic peritoneal membrane inflammation and dysfunction and as potential risk factors for technical failure.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":4.3,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mineralocorticoid Receptor Antagonist Combined with SGLT2 Inhibitor versus SGLT2 Inhibitor Alone in Chronic Kidney Disease: A Meta-Analysis of Randomized Trials.","authors":"João Pedro Ferreira, Ana Cristina Oliveira, Francisco Vasques-Novoa, Ana Rita Leite, Luís Mendonça, Faiez Zannad, Javed Butler, Adelino Leite-Moreira, Francisca Saraiva, João Sérgio Neves","doi":"10.1159/000541686","DOIUrl":"10.1159/000541686","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRAs) reduce the progression of kidney disease. Whether the combination of these agents provides additional benefits compared to SGLT2i alone is worth exploring using data from randomized trials designed for this purpose. The aim of the study was to assess the randomized treatment effect of MRAs combined with SGLT2i versus SGLT2i alone on markers of kidney and cardiovascular health.</p><p><strong>Methods: </strong>Random-effects meta-analysis of randomized trials testing the combination of MRAs with SGLT2i versus SGLT2i alone on albuminuria, blood pressure, estimated glomerular filtration rate (eGFR), and serum potassium among patients with chronic kidney disease (CKD).</p><p><strong>Results: </strong>Four randomized trials were included with a total of 272 patients with CKD: eGFR varying between 30 and 60 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio (UACR) between 90 and 500 mg/g, with >60% having type 2 diabetes. Treatment with MRAs plus SGLT2i versus SGLT2i alone reduced UACR by -33.6% (-42.6 to -24.7%), p < 0.001, I2 = 0%. MRAs plus SGLT2i versus SGLT2i alone reduced systolic blood pressure by -6.1 mm Hg (-8.9 to -3.3) mm Hg, eGFR by -3.4 mm Hg (-5.2 to -1.6) mm Hg, and increased serum potassium by + 0.23 mmol/L (0.15-0.34) mmol/L; p < 0.001 for all, without significant heterogeneity between trials (I2 <25%).</p><p><strong>Conclusion: </strong>In this meta-analysis, MRAs plus SGLT2i provided greater reductions in albuminuria and blood pressure compared to SGLT2i alone. Larger randomized trials with longer follow-up should test whether MRA/SGLT2i combination therapies improve cardiovascular and renal outcomes compared to SGLT2i alone.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-7"},"PeriodicalIF":4.3,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Interplay of Nonalcoholic Fatty Liver Disease and Chronic Kidney Disease: A Call for Integrated Management.","authors":"Carmine Zoccali, Francesca Mallamaci","doi":"10.1159/000541889","DOIUrl":"https://doi.org/10.1159/000541889","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-4"},"PeriodicalIF":4.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}