American Journal of Nephrology最新文献_第4页

Kidney Amyloidosis: Updates on Pathogenesis and Therapeutic Frontiers. 肾脏淀粉样变性：发病机制和治疗前沿的最新进展。

IF 4.3 3区医学

American Journal of Nephrology Pub Date : 2024-06-12 DOI: 10.1159/000539596

C Elena Cervantes, Mohamed G Atta

{"title":"Kidney Amyloidosis: Updates on Pathogenesis and Therapeutic Frontiers.","authors":"C Elena Cervantes, Mohamed G Atta","doi":"10.1159/000539596","DOIUrl":"10.1159/000539596","url":null,"abstract":"Background: Amyloidosis includes a diverse group of rare diseases characterized by the misfolding of native or mutant proteins, leading to extracellular accumulation in various organs. While 42 proteins have been identified to date, their distribution differs between systemic and localized forms.Summary: Mass spectrometry analysis of tissue samples in the USA shows immunoglobulin light chain (AL) amyloidosis as the most prevalent systemic type, followed by transthyretin (ATTR). Heart and kidney involvements are common. Although there are 14 recognized types of kidney-related amyloidosis, clinicopathologic studies in the USA have identified 11 types, with AL amyloidosis being the most prevalent cause of kidney involvement.Key messages: This review focuses on AL, AA, and ATTR amyloidosis due to their common systemic presentations. Recent US-based clinicopathologic studies challenge conventional beliefs that toxicity is primarily driven by amyloid deposition and highlight the role of the complement pathway. Diagnostic methods, particularly mass spectrometry, are crucial for accurate typing. Treatment strategies vary depending on the underlying type, with AL amyloidosis primarily targeting plasma cell clones, AA amyloidosis addressing underlying inflammation with systemic therapies, and ATTR amyloidosis focusing on ATTR stabilization or gene silencing.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"1-12"},"PeriodicalIF":4.3,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141309386","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}

引用次数: 0

Onco-Hypertension in Patients with Kidney Disease. 肾病患者的肿瘤性高血压。

IF 4.2 3区医学

American Journal of Nephrology Pub Date : 2024-03-17 DOI: 10.1159/000538375

Shubhi Pandey, Simon Kashfi, Susana Hong, Amar Kalaria, Agnes S Kim

{"title":"Onco-Hypertension in Patients with Kidney Disease.","authors":"Shubhi Pandey, Simon Kashfi, Susana Hong, Amar Kalaria, Agnes S Kim","doi":"10.1159/000538375","DOIUrl":"https://doi.org/10.1159/000538375","url":null,"abstract":"Background: Cancer, hypertension, and kidney disease are closely interrelated. Knowledge of the potential hypertensive and nephrotoxic effects of antineoplastic medications is critical to minimizing interruptions in cancer treatment.Summary: Antineoplastic medications can cause hypertension, proteinuria, and kidney injury, often mediated by common mechanisms. Notably, inhibitors of the vascular endothelial growth factor pathway have the strongest association with both hypertension and proteinuria, typically acute in onset and often reversible after drug discontinuation. The abrupt rise in blood pressure can cause clinically significant hypertensive syndromes and contribute to overall morbidity. Significant proteinuria can herald kidney failure. Close monitoring of blood pressure and renal function during antineoplastic therapy and appropriate hypertension treatment are important. This article reviews available literature and proposes a step-by-step approach to manage cancer patients with concurrent hypertension and kidney disease.Key messages: For antineoplastic medications with known hypertensive effect, blood pressure should be checked at baseline and serially during cancer treatment. Hypertensive crisis with end-organ damage, significant proteinuria, microscopic hematuria, or unexplained acute kidney injury necessitates drug cessation until further evaluation and resolution. In patients with chronic kidney disease and cancer therapy-related hypertension, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is the preferred antihypertensive choice. Finally, multidisciplinary collaboration in these patients will yield the best results.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142632","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}

引用次数: 0

Proton Pump Inhibitors and Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Hemodialysis Patients: Results from the Japan Dialysis Outcomes and Practice Patterns Study. 血液透析患者的质子泵抑制剂和对红细胞生成刺激剂的低反应性：来自日本透析结果和实践模式研究的结果。

IF 4.2 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2023-11-07 DOI: 10.1159/000534701

Akio Nakashima, Yoshia Miyawaki, Hirotaka Komaba, Noriaki Kurita, Yoshihiro Onishi, Takashi Yokoo, Masafumi Fukagawa

{"title":"Proton Pump Inhibitors and Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Hemodialysis Patients: Results from the Japan Dialysis Outcomes and Practice Patterns Study.","authors":"Akio Nakashima, Yoshia Miyawaki, Hirotaka Komaba, Noriaki Kurita, Yoshihiro Onishi, Takashi Yokoo, Masafumi Fukagawa","doi":"10.1159/000534701","DOIUrl":"10.1159/000534701","url":null,"abstract":"Introduction: Hyporesponsiveness to erythropoiesis stimulating agents (ESAs) is important problem in dialysis patients. While proton pump inhibitors (PPIs) may inhibit iron absorption, few studies have examined associations between PPIs and ESA-resistant anemia in hemodialysis patients. This study examined the associations between PPIs and ESA-resistant anemia in hemodialysis patients.Methods: The present study was a cross-sectional study using repeated 4-month observations, up to eight observations/patient, from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS). The primary outcome was erythropoietin resistance index (ERI). ESA dose, hemoglobin, proportion of erythropoietin-resistant anemia, transferrin saturation (TSAT), and ferritin were also examined. Linear or risk-difference regression models were used with generalized estimating equations to account for repeated measurements.Results: Of 1,644 patients, 867 patients had PPI prescriptions (52.7%). Patients prescribed PPI had higher ERI, higher ESA dose, and lower TSAT levels. Multivariable analysis for 12,048 four-month observations showed significantly greater ERI in PPI users (adjusted difference 0.95 IU/week/kg/[g/dL] [95% CI: 0.40-1.50]). Significant differences were also found in ESA dose (336 IU/week [95% CI: 70-602]) and the prevalence of erythropoietin-resistant anemia (3.9% [2.0-5.8%]) even after adjusted for TSAT and ferritin. Among possible mediators between the association of PPIs and anemia, TSAT was significantly different between PPI users and non-users (adjusted difference, -0.82% [95% CI: -1.56 to -0.07]).Conclusions: This study showed the associations between PPI and ERI, ESA dose, and TSAT in hemodialysis patients; physicians should consider anemia's associations with PPIs in hemodialysis patients.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"165-174"},"PeriodicalIF":4.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477109","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}

引用次数: 0

Autonomic Nervous System Dysfunction in Peritoneal Dialysis Patients: An Underrecognized Cardiovascular Risk Factor? 腹膜透析患者的自主神经系统功能障碍：一个未被充分认识的心血管危险因素？

IF 4.2 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2023-10-03 DOI: 10.1159/000534318

Danai Faitatzidou, Artemios G Karagiannidis, Marieta P Theodorakopoulou, Andrew Xanthopoulos, Filippos Triposkiadis, Pantelis A Sarafidis

{"title":"Autonomic Nervous System Dysfunction in Peritoneal Dialysis Patients: An Underrecognized Cardiovascular Risk Factor?","authors":"Danai Faitatzidou, Artemios G Karagiannidis, Marieta P Theodorakopoulou, Andrew Xanthopoulos, Filippos Triposkiadis, Pantelis A Sarafidis","doi":"10.1159/000534318","DOIUrl":"10.1159/000534318","url":null,"abstract":"Background: In patients with end-stage kidney disease (ESKD) receiving peritoneal dialysis (PD), cardiovascular events represent the predominant cause of morbidity and mortality, with cardiac arrhythmias and sudden death being the leading causes of death in this population. Autonomic nervous system (ANS) dysfunction is listed among the non-traditional risk factors accounting for the observed high cardiovascular burden, with a plethora of complex and not yet fully understood pathophysiologic mechanisms being involved.Summary: In recent years, preliminary studies have investigated and confirmed the presence of ANS dysfunction in PD patients, while relevant results from cohort studies have linked ANS dysfunction with adverse clinical outcomes in these patients. In light of these findings, ANS dysfunction has been recently receiving wider consideration as an independent cardiovascular risk factor in PD patients. The aim of this review was to describe the mechanisms involved in the pathogenesis of ANS dysfunction in ESKD and particularly PD patients and to summarize the existing studies evaluating ANS dysfunction in PD patients.Key messages: ANS dysfunction in PD patients is related to multiple complex mechanisms that impair the balance between SNS/PNS, and this disruption represents a crucial intermediator of cardiovascular morbidity and mortality in this population.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"37-55"},"PeriodicalIF":4.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41111552","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}

引用次数: 0

Clinical Implications of C2 Lesion in IgA Nephropathy: A Cohort Study. C2 病变对 IgA 肾病的临床影响：一项队列研究

IF 4.3 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2024-07-29 DOI: 10.1159/000540268

Zi Wang, Xujie Zhou, Sufang Shi, Lijun Liu, Jicheng Lv, Hong Zhang

{"title":"Clinical Implications of C2 Lesion in IgA Nephropathy: A Cohort Study.","authors":"Zi Wang, Xujie Zhou, Sufang Shi, Lijun Liu, Jicheng Lv, Hong Zhang","doi":"10.1159/000540268","DOIUrl":"10.1159/000540268","url":null,"abstract":"Introduction: In 2016, the Oxford Classification of IgA nephropathy (IgAN) updated its scoring system for the glomerular crescents. Despite this, the clinical significance of crescentic lesions in the updated Oxford classification is still unexplored through prospective cohort studies.Methods: 134 patients diagnosed with IgAN accompanied with C2 lesions at Peking University First Hospital were consecutively enrolled and prospectively followed up for analysis. Multivariate Cox regression in combination with LASSO regression was used to analyze risk factors associated with end-stage kidney disease (ESKD).Results: During biopsy, the mean estimated glomerular filtration rate (eGFR) was 39.3 mL/min/1.73 m2, and the mean proteinuria was 4.4 g/day. The proportion of kidney failure at 1 year, 2 years, and 3 years were 24%, 34%, and 47%, respectively. The results of LASSO in combination with Cox regression showed that mean arterial pressure (hazard ratio [HR] = 1.035, 95% confidence interval [95% CI] 1.013-1.056, p = 0.001), eGFR at biopsy (HR = 0.968, 95% CI [0.948-0.990], p < 0.004) and T2 lesions (HR = 2.490, 95% CI [1.179-5.259], p = 0.017) were independent risk factor associated with ESKD in patients with C2 lesions. Furthermore, based on univariate analyses, we found that patients with kidney function declined more than 50% within 3 months prior to biopsy or pathological findings indicated a proportion of crescents exceeding 50% were both associated with a poor kidney prognosis. Lastly, when the proportion of the crescent was less than 50%, patients receiving combined steroid and immunosuppressant treatment did not exhibit a better renal prognosis than those receiving steroid only.Conclusion: Patients diagnosed with IgAN and concurrent C2 lesions exhibited a poor clinical prognosis, necessitating more effective treatment strategies.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"529-538"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791609","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}

引用次数: 0

Deliverables from Metabolomics in Kidney Disease: Adenine, New Insights, and Implication for Clinical Decision-Making. 肾病中的代谢组学》的成果：腺嘌呤、新见解和对临床决策的影响。

IF 4.3 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2024-03-03 DOI: 10.1159/000538051

Nagarjunachary Ragi, Kumar Sharma

{"title":"Deliverables from Metabolomics in Kidney Disease: Adenine, New Insights, and Implication for Clinical Decision-Making.","authors":"Nagarjunachary Ragi, Kumar Sharma","doi":"10.1159/000538051","DOIUrl":"10.1159/000538051","url":null,"abstract":"Background: Chronic kidney disease (CKD) presents a persistent global health challenge, characterized by complex pathophysiology and diverse progression patterns. Metabolomics has emerged as a valuable tool in unraveling the intricate molecular mechanisms driving CKD progression.Summary: This comprehensive review provides a summary of recent progress in the field of metabolomics in kidney disease with a focus on spatial metabolomics to shed important insights to enhancing our understanding of CKD progression, emphasizing its transformative potential in early disease detection, refined risk assessment, and the development of targeted interventions to improve patient outcomes.Key message: Through an extensive analysis of metabolic pathways and small-molecule fluctuations, bulk and spatial metabolomics offers unique insights spanning the entire spectrum of CKD, from early stages to advanced disease states. Recent advances in metabolomics technology have enabled spatial identification of biomarkers to provide breakthrough discoveries in predicting CKD trajectory and enabling personalized risk assessment. Furthermore, metabolomics can help decipher the complex molecular intricacies associated with kidney diseases for exciting novel therapeutic approaches. A recent example is the identification of adenine as a key marker of kidney fibrosis for diabetic kidney disease using both untargeted and targeted bulk and spatial metabolomics. The metabolomics studies were critical to identify a new biomarker for kidney failure and to guide new therapeutics for diabetic kidney disease. Similar approaches are being pursued for acute kidney injury and other kidney diseases to enhance precision medicine decision-making.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"421-438"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140020704","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}

引用次数: 0

Difelikefalin in Black/African American Hemodialysis Patients with Moderate-to-Severe Pruritus: Post hoc Analysis of KALM-1 and KALM-2. Difelikefalin 在中度至重度瘙痒的黑人/非裔美国血液透析患者中的应用：KALM-1 和 KALM-2 的事后分析。

IF 4.3 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2024-01-22 DOI: 10.1159/000534227

Steven Fishbane, Deborah J Clegg, Edgar V Lerma, Anjay Rastogi, Jeffrey Budden, Isabelle Morin, Warren Wen, Frédérique Menzaghi, Joel Topf

{"title":"Difelikefalin in Black/African American Hemodialysis Patients with Moderate-to-Severe Pruritus: Post hoc Analysis of KALM-1 and KALM-2.","authors":"Steven Fishbane, Deborah J Clegg, Edgar V Lerma, Anjay Rastogi, Jeffrey Budden, Isabelle Morin, Warren Wen, Frédérique Menzaghi, Joel Topf","doi":"10.1159/000534227","DOIUrl":"10.1159/000534227","url":null,"abstract":"Introduction: Black and African American (AA) people are over-represented in the kidney failure population; therefore, the safety and efficacy of difelikefalin in Black/AA patients was evaluated.Methods: This was a post hoc, pooled exploratory subgroup analysis of the Phase 3 KALM-1 and -2 studies. Patients undergoing hemodialysis (HD) who had moderate-to-severe chronic kidney disease-associated pruritus (CKD-aP) at enrollment were stratified into self-reported Black/AA or White subgroups. Patients were randomized (1:1) to receive intravenous (IV) difelikefalin 0.5 µg/kg or placebo for 12 weeks. Difelikefalin efficacy was assessed with validated patient-reported outcome questionnaires: 24-h Worst Itch Numerical Rating Scale (WI-NRS), 5-D itch, and Skindex‑10.Results: There were 249 (29.3%) patients from the KALM studies that self-identified as Black/AA (n = 135 difelikefalin; n = 114 placebo). Clinically meaningful (≥3-point) reduction in WI-NRS score was achieved by 47.9% of Black/AA patients with difelikefalin versus 24.6% with placebo (p < 0.001). More Black/AA patients achieved a ≥5-point 5-D itch total improvement (54.9% vs. 35.7%; p = 0.013) and a ≥15-point Skindex-10 score improvement with difelikefalin versus placebo (49.0% vs. 28.9%; p = 0.006) compared with White patients. Incidence of treatment-emergent adverse events (TEAEs) was higher for Black/AA patients (difelikefalin: 78.5%; placebo: 70.8%) versus White patients (difelikefalin: 64.8%; placebo: 61.8%).Conclusion: In this post hoc analysis, difelikefalin was efficacious in the Black/AA population and had an acceptable safety profile.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"329-333"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of Diabetes with Changes in Blood Pressure during Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network Daily Trial. 糖尿病与血液透析期间血压变化的关系：频繁血液透析网络日常试验的二次分析。

IF 4.3 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2024-05-24 DOI: 10.1159/000539451

Bróna M Moloney, Glenn Matthew Chertow, Finnian R Mc Causland

{"title":"Association of Diabetes with Changes in Blood Pressure during Hemodialysis: A Secondary Analysis of the Frequent Hemodialysis Network Daily Trial.","authors":"Bróna M Moloney, Glenn Matthew Chertow, Finnian R Mc Causland","doi":"10.1159/000539451","DOIUrl":"10.1159/000539451","url":null,"abstract":"Introduction: Diabetes mellitus is a common cause of kidney failure and is often complicated by autonomic neuropathy, which may have implications for blood pressure (BP) homeostasis during hemodialysis (HD).Methods: In this post hoc analysis of the Frequent Hemodialysis Network (FHN) Daily Trial, we used random effects Poisson and linear regression models to estimate the association of diabetes (vs. not) with intra-dialytic hypotension (IDH) and peri-dialytic BP parameters, respectively. We tested for differential associations according to the randomized treatment (6/week vs. 3/week HD) and pre-HD systolic BP.Results: Of the 244 patients with intra-dialytic BP data, 100 (41%) had diabetes at baseline. The mean age was 51 ± 14 years; overall, 39% were female. In adjusted models, diabetes (vs. not) was associated with a 93% higher risk of developing IDH (IRR: 1.93; 95% CI: 1.26, 2.95). There was no evidence that the randomized treatment assignment modified the association between diabetes and IDH (pinteraction = 0.32), but more potent associations were noted among those with higher pre-HD systolic BP (pinteraction < 0.001). Diabetes (vs. not) was associated with a lower adjusted nadir intra-HD BP (-4.2; 95% CI: -8.3, -0.2 mm Hg) but not with the pre- or post-HD systolic BP.Conclusions: Among participants of the FHN Daily Trial, patients with diabetes had a higher risk of IDH and lower nadir intra-HD systolic BP than patients without diabetes, even when undergoing HD up to 6 times per week.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"409-416"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11305924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diabetic Retinopathy and Chronic Kidney Disease: Associations and Comorbidities in a Large Diabetic Population - The Tongren Health Care Study. 糖尿病视网膜病变和慢性肾脏疾病:在一个大的糖尿病人群的关联和合并症:铜仁保健研究。

IF 4.2 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2023-11-10 DOI: 10.1159/000535059

Li Qin Gao, Can Can Xue, Jing Cui, Jie Xu, Chun Zhang, Dong Ning Chen, Jost B Jonas, Ya Xing Wang

{"title":"Diabetic Retinopathy and Chronic Kidney Disease: Associations and Comorbidities in a Large Diabetic Population - The Tongren Health Care Study.","authors":"Li Qin Gao, Can Can Xue, Jing Cui, Jie Xu, Chun Zhang, Dong Ning Chen, Jost B Jonas, Ya Xing Wang","doi":"10.1159/000535059","DOIUrl":"10.1159/000535059","url":null,"abstract":"Introduction: The aim of the study was to investigate associations between diabetic retinopathy (DR) and chronic kidney disease (CKD) in patients with type 2 diabetes (TD2).Methods: The participants of the cross-sectional, community-based Tongren Health Care Study underwent a detailed medical and ophthalmological examination. We defined TD2 by a fasting plasma glucose concentration of ≥7.0 mmol/L or a medical history. CKD was classified as either reduced estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 mm2 or presence of albuminuria. DR was assessed using color fundus photographs.Results: Out of 62,217 participants of the Tongren Health Care Study, 5,103 (8.2%) patients had TD2. The prevalence of DR was 12.8% (95% CI, 11.8%, 13.7%), CKD was 13.3% (95% CI, 12.4%, 14.3%), and the subtypes of CKD including reduced eGFR and albuminuria was 4.6% (95% CI, 4.2%, 5.1%) and 10.1% (95% CI, 9.3%, 10.9%), respectively. DR was detectable in 21.0% of the patients with CKD, while CKD was present in 20.9% of the DR patients. Higher DR prevalence was associated with higher prevalence of albuminuria and reduced eGFR (both p < 0.05). Factors independently associated with the presence of CKD instead of DR were older age (p < 0.001, OR = 1.05), a higher body mass index (p < 0.001, OR = 1.14), a higher serum concentration of triglycerides (p < 0.001, OR = 1.26), and a lower blood glucose (p < 0.001, OR = 0.93). Having hypertension was additionally associated with the presence of reduced eGFR as compared with DR (p = 0.005, OR = 4.47).Conclusions: TD2 patients of older age and with higher body mass index, hypertension, and dyslipidemia had a higher probability of being affected by CKD rather than DR, while those with a higher blood glucose level were more prone to DR than CKD.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"175-186"},"PeriodicalIF":4.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89716653","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}

引用次数: 0

Efficacy of Rituximab for Minimal Change Disease and Focal Segmental Glomerulosclerosis with Frequently Relapsing or Steroid-Dependent Nephrotic Syndrome in Adults: A Chinese Multicenter Retrospective Study. 利妥昔单抗治疗成人微小病变和局灶节段性肾小球硬化伴频繁复发或类固醇依赖性肾病综合征的疗效:一项中国多中心回顾性研究

IF 4.2 3区医学

American Journal of Nephrology Pub Date : 2024-01-01 Epub Date: 2023-11-14 DOI: 10.1159/000535010

Lan Lan, Yuxin Lin, Binfeng Yu, Yin Wang, Hong Pan, Huijing Wang, Xiaowei Lou, Xiabing Lang, Qiankun Zhang, Lie Jin, Yi Yang, Liang Xiao, Jianghua Chen, Fei Han

{"title":"Efficacy of Rituximab for Minimal Change Disease and Focal Segmental Glomerulosclerosis with Frequently Relapsing or Steroid-Dependent Nephrotic Syndrome in Adults: A Chinese Multicenter Retrospective Study.","authors":"Lan Lan, Yuxin Lin, Binfeng Yu, Yin Wang, Hong Pan, Huijing Wang, Xiaowei Lou, Xiabing Lang, Qiankun Zhang, Lie Jin, Yi Yang, Liang Xiao, Jianghua Chen, Fei Han","doi":"10.1159/000535010","DOIUrl":"10.1159/000535010","url":null,"abstract":"Introduction: Rituximab has been proven effective and safe in pediatric patients with frequently relapsing or steroid-dependent nephrotic syndrome (FR/SDNS). We aimed to analyze the efficacy and safety of rituximab in adult FR/SDNS patients with minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS).Methods: A retrospective cohort study at three nephrology centers in China included adult FR/SDNS patients with biopsy-proven MCD or FSGS. Primary outcomes were relapse frequency and first relapse-free survival time. Adverse events were well recorded, and logistic regression analyses were used to investigate the risk factors of relapse.Results: Eighty-one patients (age, 25.0 years; interquartile range, 20.0-40.5; 67% males; 82.7% MCD) received an average rituximab dose of 1,393.8 ± 618.7 mg/2 years during the 2-year follow-up period. The relapse frequency, calculated as the ratio of relapse times to follow-up years, significantly decreased after rituximab treatment (0.04 [0.00, 0.08] vs. 1.71 [1.00, 2.45], p < 0.001). The first relapse-free survival time was 16.7 ± 8.0 months. Fifty-seven patients (70.4%) achieved cessation of corticosteroids and immunosuppressants within 3 months after the first rituximab infusion. Adverse events were mostly mild, and no severe treatment-related adverse events were observed. Low serum albumin level before rituximab and high CD56+CD16+ natural killer cell count after rituximab were independent risk factors of relapse within 2 years after rituximab treatment.Conclusion: Rituximab was proven an effective and safe treatment option for adult FR/SDNS patients with MCD or FSGS in maintaining disease remission and minimizing corticosteroid exposure.","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"25-36"},"PeriodicalIF":4.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107589975","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}

引用次数: 0