American Journal of Nephrology最新文献

{"title":"Erratum.","authors":"","doi":"10.1159/000542861","DOIUrl":"10.1159/000542861","url":null,"abstract":"","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"121"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","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":"Vitamin A Deficiency Disturbs Ret Expression and Induces Urinary Tract Developmental Abnormalities in Mice.","authors":"Minghui Yu, Haixin Ju, Ningli Ye, Jing Chen, Lei Sun, Xiaohui Wu, Hong Xu, Qian Shen","doi":"10.1159/000541289","DOIUrl":"10.1159/000541289","url":null,"abstract":"<p><strong>Introduction: </strong>Moderate vitamin A levels during pregnancy are strongly related to normal embryonic development in both animal models and population studies. Abnormal development of urinary tract system is linked to either an excess or a shortage of vitamin A. The relationships among maternal vitamin A deficiency prior to conception, moderate vitamin A supplementation during pregnancy, and abnormal urinary system development in offspring are unclear.</p><p><strong>Methods: </strong>By creating preconception and preconception + pregnancy vitamin A insufficiency mouse models, we investigated whether moderate vitamin A treatment during pregnancy may reduce the prevalence of CAKUT and increase distant vitamin A levels in offspring, as well as any potential pathways involved.</p><p><strong>Results: </strong>We effectively established a prepregnancy vitamin A-deficient mouse model by providing a particular diet with or without vitamin A for 4 weeks. The offspring of the hypovitaminosis A model group presented a greater proportion of neonatal urinary tract developmental malformations. Abnormalities in ureteral bud emergence and key molecules during renal development, such as p-Plcγ and Ret, may be the primary causes of offspring development of CAKUT as a result of mothers' hypovitaminosis A. Normal vitamin A diets, on the other hand, may help mitigate the teratogenic consequences of prepregnancy hypovitaminosis A, as well as defects produced by ureteral budding and major molecular changes.</p><p><strong>Conclusion: </strong>In contrast, the administration of normal vitamin A feeds during pregnancy may ameliorate the teratogenic effects of prepregnancy hypovitaminosis A to a certain extent and may also ameliorate the abnormalities associated with ureteral budding and key molecular changes.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"187-197"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455859","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}

{"title":"Off-Label Use of Mycophenolate Mofetil in Immunoglobulin A Nephropathy: A Systematic Review and Meta-Analysis.","authors":"Luda Feng, Xuan Song, Xinyi Shi, Mingzhen Qin, Ning Liang, Boyang Li, Boya Zhang, Jianguo Qin","doi":"10.1159/000541576","DOIUrl":"10.1159/000541576","url":null,"abstract":"<p><strong>Introduction: </strong>Mycophenolate mofetil (MMF) is widely used off-label in patients with immunoglobulin A nephropathy (IgAN), although the literature does not consistently agree on its efficacy and safety.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, CENTRAL, CNKI, VIP, Wanfang Data, and SinoMed from their inception to August 2023. We included randomized controlled trials that enrolled patients of IgAN who received MMF treatment and compared effects with placebo or as an add-on therapy to usual care. Literature screening, risk of bias assessment, and data extraction were independently conducted in duplicate. Fixed-effects or random-effects meta-analyses were performed for pooling data where eligible. The primary outcomes were the composite kidney outcomes of major adverse kidney events (MAKDE) defined as doubling of serum creatinine, end-stage renal disease (ESRD), or death from a kidney disease-related or cardiovascular cause.</p><p><strong>Results: </strong>Of 13 studies identified, 918 participants (463 [50.4%] treated with MMF) with IgAN were included in the analysis. MMF treatment in IgAN was associated with decreasing the occurrence of MAKDE (relative risk [RR], 0.32; 95% confidence interval [CI], 0.13-0.77), reducing proteinuria (RR, 1.41; 95% CI, 1.22-1.64), and lessening the probability of doubling blood creatinine (RR, 0.32, 95% CI, 0.14-0.72). No significant differences were detected in the incidence of ESRD (RR, 0.87, 95% CI, 0.38-2.03), or progression of chronic kidney disease (RR, 1.01; 95% CI, 0.22-4.57). Patients receiving MMF had a higher risk of infection (RR, 2.20; 95% CI, 1.21-4.00).</p><p><strong>Conclusion: </strong>MMF administration in IgAN indicates promising in decreasing the occurrence of MAKDE, reducing proteinuria level, and lessening the probability of doubling blood creatinine, but also comes with the risk of infection. These findings tend to be introduced to non-Caucasian population. The long-term favorable effects that MMF improved kidney outcomes still need further cross-regional and cross-ethnical verification.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"35-47"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339173","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":"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":"296-308"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","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":"Associations between Multimorbidity and the Risks of Cardiovascular Disease Events and All-Cause Mortality in Patients with Chronic Kidney Disease.","authors":"Shigeru Tanaka, Kazuhiro Okamura, Shigeru Tanaka, Hiromasa Kitamura, Tatsuya Suenaga, Kazuhiko Tsuruya, Takanari Kitazono, Toshiaki Nakano","doi":"10.1159/000544722","DOIUrl":"10.1159/000544722","url":null,"abstract":"<p><strong>Introduction: </strong>Multimorbidity, defined as the presence of two or more chronic conditions, is associated with poor outcomes and increased cardiovascular risk in the general population. However, the effect of multimorbidity on patients with chronic kidney disease (CKD), a group of patients already at high risk for cardiovascular disease, is not well understood.</p><p><strong>Methods: </strong>We analyzed data from 4,420 patients with non-dialysis CKD enrolled in the Fukuoka Kidney disease Registry Study. We identified 23 comorbidities, including cardiometabolic and non-cardiometabolic conditions. The patients were categorized into four groups according to the number of comorbidities: Group 1 (0-1 comorbidities), Group 2 (2 comorbidities), Group 3 (3 comorbidities), and Group 4 (≥4 comorbidities). We examined the associations between the number of comorbidities and the incidence of major adverse cardiovascular events (MACE) and all-cause mortality using Cox proportional hazards models.</p><p><strong>Results: </strong>Over a 5-year follow-up, 229 patients experienced MACE and 456 died. The risk of MACE increased with the number of comorbidities. The multivariable-adjusted hazard ratios (95% confidence intervals) for MACE were 1.40 (0.80-2.44) for Group 2, 2.27 (1.33-3.88) for Group 3, and 3.53 (2.11-5.91) for Group 4 compared with Group 1. The all-cause mortality risk also increased with the number of comorbidities, with adjusted hazard ratios of 1.13 (0.77-1.66), 1.75 (1.22-2.51), and 2.53 (1.80-3.54) for Groups 2, 3, and 4, respectively.</p><p><strong>Conclusion: </strong>In patients with CKD, multimorbidity is associated with an increased risk of MACE and all-cause mortality.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"605-617"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623177","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":"Gender Differences in Kidney Failure Incidence in Australia: A Registry Study.","authors":"Stephen McDonald, Belinda C Stallard, Stephen P McDonald","doi":"10.1159/000543663","DOIUrl":"10.1159/000543663","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have shown that there is a higher incidence of men initiating kidney replacement therapy (KRT) in comparison to women. However, the contribution of gender disparity may well differ among the different types of kidney disease, and over time. Utilising a Nationwide Registry, we examined disease- and gender-specific trends in incident kidney failure requiring KRT.</p><p><strong>Methods: </strong>Registry-based analysis of all incident patients commencing KRT in Australia using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. All patients who initiated dialysis in Australia from January 1971 to 31 December 2021 were included. Confidence intervals around rates were calculated and compared using Poisson distributions.</p><p><strong>Results: </strong>During the study period, a total of 31,834 women and 47,718 men were recorded in ANZDATA to have commenced KRT in Australia, a male-to-female ratio of 1.51 (1.49-1.53). The male-to-female ratio increased over time from 1.05 (0.83-1.34) in 1971 to 1.78 (1.66-1.92) in 2021. There was a progressive increase in the male:female ratio with age; for those starting in 2017-21, this rose from 1.37 (95% CI: 1.26-1.50) among 25-44-year-olds to 4.38 (2.47-5.53) among those ≥85 years at KRT start.</p><p><strong>Conclusion: </strong>Men had a significantly higher rate of starting KRT in Australia compared with women, and this difference is increasing over time. This disparity also varied between types of primary kidney disease but was higher among older age groups. It is still seen for causes (such as polycystic kidney disease) that have theoretically equal gender disease distribution, suggesting differences in propensity to commence KRT as well as differences in underlying disease processes.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"571-576"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121861","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}

{"title":"Phosphorus Restriction Prevents Rapamycin-Induced Kidney Damage in Rats.","authors":"Ana I Raya, Angela Vidal, Ignacio López, Mariano Rodríguez, Escolástico Aguilera-Tejero, Carmen Pineda","doi":"10.1159/000541411","DOIUrl":"10.1159/000541411","url":null,"abstract":"<p><strong>Introduction: </strong>There are conflicting reports about the effect or rapamycin on the kidneys. Rapamycin is known to promote phosphaturia that may be associated to renal injury.</p><p><strong>Methods: </strong>Detailed histopathological studies were performed on the kidneys of rats with normal (control) and reduced (Nx) renal mass that were treated with rapamycin (1.3 mg/kg for 22 days) or placebo. The effect of rapamycin was also evaluated in control and Nx rats fed different amounts of phosphorus: 0.6% P (NP), 1.2% P (HP), and 0.2% P (LP). Quantitative scores of kidney lesions were obtained for interstitial nephritis (IN), tubular damage (TD), and nephrocalcinosis (NC).</p><p><strong>Results: </strong>When compared with placebo, rapamycin administration to Nx rats resulted in significant increases in IN (4.17 ± 0.74 vs. 1.51 ± 0.53%) and TD (14.45 ± 1.51 vs. 8.61 ± 1.83%). Rapamycin also increased NC both in control (0.86 ± 0.23 vs. 0.14 ± 0.06%) and Nx (0.86 ± 0.32 vs. 0.15 ± 0.14%) rats. In control rats receiving rapamycin, feeding HP aggravated IN (3.25 ± 0.48%), TD (22.47 ± 4.56%), and NC (3.66 ± 0.75%), while feeding LP prevented development of any renal lesions. In Nx rats treated with rapamycin, HP intake also increased IN (8.95 ± 1.94%), TD (26.86 ± 3.95%), and NC (2.77 ± 0.60%), whereas feeding LP reduced all lesions to lower levels than in rats fed NP. Rapamycin treatment increased fractional excretion of P (FEP), and an excellent correlation between scores for renal lesions and FEP was found.</p><p><strong>Conclusion: </strong>Rapamycin has deleterious effects on kidney pathology causing lesions that are located mainly at tubular and tubulointerstitial level. Rapamycin-induced kidney damage is more evident in rats that already have decreased renal function and seems to be related to the phosphaturic effect of the drug. Dietary P restriction prevents kidney damage in rats treated with rapamycin.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"48-57"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387299","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":"Obinutuzumab May Be an Effective and Safe Option for Adult Minimal Change Disease and Focal Segmental Glomerulosclerosis Patients after Multitarget Therapy Including Rituximab.","authors":"Yuxin Lin, Yixuan Pan, Quan Han, Jianhang Xu, Junni Wang, Xin Lei, Liangliang Chen, Yaomin Wang, Pingping Ren, Lan Lan, Jianghua Chen, Fei Han","doi":"10.1159/000541972","DOIUrl":"10.1159/000541972","url":null,"abstract":"<p><strong>Introduction: </strong>Rituximab has proven effective and safe in pediatric and adult minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) patients with frequently relapsing nephrotic syndrome. However, its efficacy diminishes in several patients who experience nephrotic syndrome relapsing in short durations or failing to achieve remission. We aimed to explore the efficacy and safety of obinutuzumab, a novel anti-CD20 antibody, in these patients.</p><p><strong>Methods: </strong>A retrospective case series study at our center included 11 adult MCD or FSGS patients who presented with nephrotic syndrome characterized by short-duration relapses or lack of remission after multitarget therapy, including rituximab. Primary outcomes included the first relapse-free time, relapse rate during follow-up, and the use of immunosuppressants after obinutuzumab. All adverse events were recorded.</p><p><strong>Results: </strong>Eleven adult patients (median age 26.0 years, 81.9% males) received an average obinutuzumab dose of 2.0 (1.0, 2.0) g during a median follow-up period of 17.0 (12.0, 22.0) months. The first relapse-free time was 12.1 (10.8, 18.9) months. Two patients with FSGS experienced relapses, while the remaining maintained remission by the end of follow-up. Six patients (54.5%) achieved cessation of corticosteroids and immunosuppressants within 3 months after obinutuzumab. Adverse events were mostly mild.</p><p><strong>Conclusion: </strong>Obinutuzumab may be an efficient and safe option for inducing remission in adult MCD and FSGS patients who presented with nephrotic syndrome relapsing in short durations or failed to achieve remission after multitarget therapy, including rituximab. It was effective in maintaining remission in MCD patients, while its efficacy in maintaining remission in FSGS patients remained uncertain.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"111-120"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455857","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 Value of Diffusion Kurtosis Imaging to Assess Liver and Kidney Recovery after Mesenchymal Stem Cell Intervention in CCl4-Induced Cirrhotic Rats.","authors":"Jiaming Qin, Shuangshuang Xie, Yongquan Yu, Cheng Zhang, Yumeng Zhao, Dan Tong, Zhandong Hu, Jinxia Zhu, Wen Shen, Wen Shen","doi":"10.1159/000544056","DOIUrl":"10.1159/000544056","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to investigate the potential of diffusion kurtosis imaging (DKI) in monitoring the improvement of liver and kidney injury in cirrhotic rats after bone marrow-derived mesenchymal stem cell (BMSCs) treatment.</p><p><strong>Methods: </strong>Thirty rats were induced with liver cirrhosis via subcutaneous injection of carbon tetrachloride. Six rats were randomly selected for DKI scanning and subsequently euthanized for biochemical and histological analysis. The remaining 24 rats were randomly divided into a BMSC group (n = 12) and a control group (n = 12). In the BMSC group, six rats underwent dynamic DKI scans and were sacrificed after 13, 14, 15, and 16 weeks, while the other 6 rats were sacrificed after being scanned in the 14th week. The control group followed the same protocol as the BMSC group. Additionally, six normal rats were euthanized after undergoing DKI scanning to provide baseline data. Liver and kidney DKI parameters, biochemical markers, liver fibers, kidney hematoxylin and eosin (HE) score, and alpha smooth muscle actin (α-SMA) were analyzed.</p><p><strong>Results: </strong>Compared to baseline, there was a significant increase in liver fibers and kidney HE scores by week 12. At weeks 13, 14, 15, and 16, the mean kurtosis (MK) of the liver in the BMSC group was significantly lower than that at week 12 and in the control group. At week 16, the mean diffusion in the BMSC group was significantly higher than that at week 12 and in the control group. The apparent diffusivity coefficient (ADC) values in the BMSC group were higher than those at week 12 and in the control group at weeks 13, 14, and 16. All regions of kidney showed decreased MK values from weeks 14-16 compared to week 12 and the control group. Liver fiber was moderately or highly correlated with all DKI parameters. MK and ADC of the renal cortex and outer stripe of the outer medulla showed moderate correlation with HE scores and α-SMA.</p><p><strong>Conclusion: </strong>DKI can serve as a non-invasive means to effectively monitor the process of liver and kidney injury improvement in cirrhotic rats treated with BMSCs.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"475-489"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397762","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":"A Pilot, Single-Blinded, Randomized Crossover Trial of Cramp Reduction with Angiotensin II in Maintenance Patients on Hemodialysis (the CRAMP-HD Study).","authors":"Atthaphong Phongphithakchai, Rinaldo Bellomo, Peter Mount, Cindy-Anne T Bach, Greta Gurry, Wendy Liu, Akinori Maeda, Nuttapol Pattamin, Yukiko Hikasa, Sofia Spano, Anis Chaba, Glenn Eastwood, Mink Chawla, Arthur J Atkinson, James Wilkie, Emily J See","doi":"10.1159/000543280","DOIUrl":"10.1159/000543280","url":null,"abstract":"<p><strong>Introduction: </strong>Angiotensin II may reduce muscle ischemia during intermittent hemodialysis (IHD) and thereby decrease the incidence and/or intensity of intradialytic muscle cramps. We aimed to test whether angiotensin II infusion during IHD is safe, feasible, and effective in the attenuation of muscle cramps.</p><p><strong>Methods: </strong>We performed a pilot, single-blinded, randomized crossover trial of patients receiving IHD who frequently experience intradialytic muscle cramps. Patients were randomly allocated to receive either intravenous angiotensin II or placebo for the duration of their first dialysis session of the week. They crossed over to the alternate arm each week for 4 weeks. The primary outcome was safety. Secondary outcomes included cramp-related symptoms, hemodynamic parameters, dialysis prescription alterations, and biomarkers.</p><p><strong>Results: </strong>We studied 24 sessions in 6 patients. Intradialytic hypertension (systolic blood pressure >180 mm Hg) occurred more often with angiotensin II than with placebo (4/12 sessions, 33% vs. 2/12 sessions, 17% sessions, p = 0.64). There were no other adverse events. Compared with placebo, muscle cramps were less frequent (4/12 sessions, 33% vs. 11/12 sessions, 92% sessions, p = 0.009) and of lower intensity with angiotensin II (median Brief Pain Inventory score 1.4 vs. 5.3; p < 0.001; maximal Brief Pain Inventory score 1.2 vs. 6.0; p < 0.001). Fluid bolus administration for cramps was less common during angiotensin II infusion than placebo (0/12 sessions, 0% vs. 5/12 sessions, 42% sessions, p = 0.037).</p><p><strong>Conclusion: </strong>Angiotensin II increased blood pressure and heart rate but not cardiac output or levels of troponin, creatine kinase, or renin. Angiotensin II infusion during IHD appears safe and effective at reducing intradialytic muscle cramps. These observations justify further investigation in larger controlled studies.</p>","PeriodicalId":7570,"journal":{"name":"American Journal of Nephrology","volume":" ","pages":"377-388"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982230","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}