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Comprehensive analysis of pyroptosis-related gene signatures in renal fibrosis. 肾纤维化中焦热相关基因特征的综合分析。
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-07-03 DOI: 10.1007/s10157-025-02726-4
Dao-Hai Zhang, Rui Wang, Liang Liu, Peng Zhang, Jing-Hong Zhao, Bo Liang

Background: Renal fibrosis is key histopathological lesion in chronic kidney disease progression. This study explored pyroptosis-related gene signatures, potential molecular pathways and chemicals, as well as immune infiltration in renal fibrosis.

Methods: Renal fibrosis datasets and pyroptosis-related genes were obtained and differentially expressed pyroptosis-related genes (DEPGs) were identified. Then functional enrichment analysis was performed and core DEPGs were screened by WGCNA and LASSO regression analysis. Subsequently, miRNA-core DEPG interactions and potential chemicals were established. Finally, immune cell subtype distribution was evaluated and the core DEPGs were externally validated.

Results: A total of 38 DEPGs were identified which were enriched in inflammatory- and immune-related pathways. Nine core DEPGs were identified and the risk core = (0.1003 × Bak1) + (0.0944 × Zbp1) + (0.0882 × Tlr2) + (0.0585 × Il18) + (0.0497 × Adora2b) + (0.0418 × Stat3) + (0.0325 × Icam1) + (0.0272 × Pycard) + (0.0132 × Epha2). Nine core DEPGs exhibited high sensitivity and specificity for predicting UUO occurrence. A total of 444 miRNA-core DEPG interactions were obtained and miR-124-3p, miR-92a-3p, and miR-6807-5p were identified as core miRNAs. Adenosine served as a potential chemical that directly bound to Adora2b. Immune cells, including naïve B cells, CD4+ effector memory T cells, (plasmacytoid) dendritic cells, monocytes, and neutrophils were significantly enriched in fibrotic kidneys. Finally, the differential expression, temporal expression patterns, and clinical correlation with renal function of core DEPGs were externally validated.

Conclusions: This study sheds light on the novel pyroptosis-related gene signatures in renal fibrosis.

背景:肾纤维化是慢性肾脏疾病进展的关键组织病理病变。本研究探讨了肾纤维化中与热降解相关的基因特征、潜在的分子途径和化学物质以及免疫浸润。方法:获取肾纤维化数据集和焦热相关基因,鉴定差异表达的焦热相关基因(depg)。然后进行功能富集分析,并通过WGCNA和LASSO回归分析筛选核心depg。随后,mirna -核心DEPG相互作用和潜在的化学物质被建立。最后,评估免疫细胞亚型分布,并对核心depg进行外部验证。结果:共鉴定出38个在炎症和免疫相关途径中富集的depg。九个核心DEPGs识别和风险核心=(0.1003×Bak1) +(0.0944×Zbp1) +(0.0882×Tlr2) +(0.0585×Il18) +(0.0497×Adora2b) +(0.0418×Stat3) +(0.0325×Icam1) +(0.0272×Pycard) +(0.0132×Epha2)。9个核心depg预测UUO的发生具有较高的敏感性和特异性。共获得了444个mirna -核心DEPG相互作用,miR-124-3p、miR-92a-3p和miR-6807-5p被鉴定为核心mirna。腺苷作为一种潜在的化学物质直接与Adora2b结合。免疫细胞,包括naïve B细胞、CD4+效应记忆T细胞、(浆细胞样)树突状细胞、单核细胞和中性粒细胞在纤维化肾脏中显著富集。最后,外部验证核心depg的差异表达、时间表达模式以及与肾功能的临床相关性。结论:本研究揭示了肾纤维化中新的热作用相关基因特征。
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引用次数: 0
Clinical outcomes of immunosuppressive therapy in patients with seronegative anti-PLA2R antibodies and PLA2R-related membranous nephropathy. 抗pla2r抗体血清阴性伴pla2r相关膜性肾病患者免疫抑制治疗的临床疗效
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-07-20 DOI: 10.1007/s10157-025-02731-7
Di Wu, Wen Liu, Zhihang Su, Kaiting Li, Rui Xue, Haofei Hu, Qijun Wan

Background: The study aims to investigate the impact of immunosuppressive therapy on clinical outcomes in patients with baseline negative PLA2R antibody, providing new therapeutic insights for this patient population.

Methods: This study included 133 patients with positive histological PLA2R antigen and baseline serum anti-PLA2R antibody data. ELISA (enzyme-linked immunosorbent assay) was used to measure serum anti-PLA2R antibody levels. Renal biopsy specimens were analyzed by light microscopy, immunofluorescence, and electron microscopy.

Results: Among the 133 patients, 84 (63.2%) were positive for serum antibodies (SAb +) and glomerular antigen (GAg +), while 49 (36.8%) were negative for serum antibodies (SAb-) but positive for glomerular antigen (GAg +). Compared with the Sab-/GAg + group, the SAb + /GAg + group exhibited more severe clinical features compared to the SAb-/GAg + group; however, there was no significant difference in the pathological characteristics between the two groups of patients. The complete remission (CR) rate was significantly higher in the SAb-/GAg + group (67.35% vs. 33.33%, P < 0.001), with higher CR rates at 12, 24, and 36 months. The SAb-/GAg + group also had a lower relapse rate than Sab + /GAg + (12.24% vs. 36.90%, P = 0.002). In the SAb-/GAg + group, 67.3% received conservative treatment, while 32.7% underwent immunotherapy. Patients receiving immunosuppressive therapy in the SAb-/GAg + group exhibited more severe proteinuria, more impaired renal function, and higher hyperlipidemia at baseline. Compared with conservative treatment, immunotherapy improved overall remission rates (100.00% vs. 75.76%, P = 0.041) in the SAb-/GAg + group. Cox regression analysis showed that immunotherapy significantly predicted urinary protein remission (HR 3.92, 95% CI 1.58-9.70, P = 0.003).

Conclusion: Immunosuppressive therapy in PLA2R-related membranous nephropathy patients with severe baseline clinical manifestations may help predict urine protein remission, even if they are serum anti-PLA2R antibody negative.

背景:本研究旨在探讨免疫抑制治疗对基线PLA2R抗体阴性患者临床结局的影响,为该患者群体提供新的治疗见解。方法:本研究纳入133例组织学PLA2R抗原阳性和血清抗PLA2R抗体基线数据的患者。ELISA(酶联免疫吸附试验)检测血清抗pla2r抗体水平。采用光镜、免疫荧光和电子显微镜对肾活检标本进行分析。结果133例患者中血清抗体(SAb +)和肾小球抗原(GAg +)阳性84例(63.2%),血清抗体(SAb-)阴性但肾小球抗原(GAg +)阳性49例(36.8%)。与Sab-/GAg +组相比,Sab + /GAg +组表现出较Sab-/GAg +组更严重的临床特征;但两组患者的病理特征无明显差异。SAb-/GAg +组的完全缓解率(CR)显著高于SAb-/GAg +组(67.35% vs. 33.33%), P结论:对具有严重基线临床表现的pla2r相关膜性肾病患者进行免疫抑制治疗可能有助于预测尿蛋白缓解,即使他们血清抗pla2r抗体阴性。
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引用次数: 0
Exploring genetic association of chronic kidney disease with sarcopenia among European population: a bidirectional Mendelian randomization study. 探索欧洲人群中慢性肾脏疾病与肌肉减少症的遗传关联:一项双向孟德尔随机研究。
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-08-18 DOI: 10.1007/s10157-025-02752-2
Xiaoli Zhu, Qin Wu

Background: This study aims to investigate the bidirectional causal relationship between chronic kidney disease (CKD) and sarcopenia using two-sample Mendelian randomization (MR) analysis.

Methods: A bidirectional MR analysis was performed using genetic data for CKD from the MEGASTROKE consortium and sarcopenia traits from the UK Biobank. SNPs associated with CKD and sarcopenia were used as instrumental variables. MR analysis was conducted with inverse variance weighting (IVW), weighted median, and MR-Egger methods. Sensitivity analyses included Cochran's Q test, MR-Egger intercept, and the leave-one-out method. Enrichment analysis was performed using GO and KEGG pathways.

Results: The results indicate a positive association between CKD and both left-hand grip strength (OR = 1.03, 95% CI 1.01-1.04, P < 0.001) and right-hand grip strength (OR = 1.03, 95% CI 1.02-1.04, P < 0.001) for both sides. In addition, appendicular lean mass (ALM) was found to be positively associated with an increased risk of CKD (OR = 1.35, 95% CI 1.19-1.53, P < 0.001). However, no significant causal relationships were observed between CKD and ALM or usual walking pace. Enrichment analysis identified several relevant biological processes and pathways, such as DNA transcription regulation, protein degradation, and immune response pathways, that may mediate the relationship between CKD and sarcopenia.

Conclusions: This study provides evidence for a bidirectional causal relationship between CKD and sarcopenia, with CKD contributing to decreased hand grip strength and ALM being associated with an increased risk of CKD.

背景:本研究旨在通过双样本孟德尔随机化(MR)分析,探讨慢性肾脏疾病(CKD)与肌肉减少症之间的双向因果关系。方法:使用来自MEGASTROKE联盟的CKD遗传数据和来自UK Biobank的肌肉减少症特征进行双向MR分析。与CKD和肌肉减少症相关的snp被用作工具变量。MR分析采用逆方差加权(IVW)、加权中位数和MR- egger方法。敏感性分析包括科克伦Q检验、艾格先生截距和留一法。利用GO和KEGG途径进行富集分析。结果:结果表明CKD与左手握力呈正相关(OR = 1.03, 95% CI 1.01-1.04, P)。结论:本研究为CKD与肌肉减少症之间的双向因果关系提供了证据,CKD导致手部握力下降,ALM与CKD风险增加相关。
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引用次数: 0
Acid-base and electrolyte disorders in patients with hyperglycaemia: a monocentric, observational study. 高血糖患者的酸碱和电解质紊乱:一项单中心观察性研究
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-08-14 DOI: 10.1007/s10157-025-02738-0
Christoph Schwarz, Fabian Ruttinger, Georg-Christian Funk, Gregor Lindner, Roland Edlinger, Martin Auinger, Thomas Stulnig

Background: Acute hyperglycaemia is often accompanied by acid-base and electrolyte disorders as well as changes in serum osmolality which have a significant clinical impact. This study explores the prevalence of complex acid-base disorders in patients with hyperglycaemia, focusing on the limitations of current diagnostic criteria which primarily rely on pH, serum bicarbonate and anion gap.

Methods: A retrospective analysis of 1159 episodes of severe hyperglycaemia was performed. Arterial blood gas analysis, serum osmolality and electrolyte levels were measured at admission to hospital and patient's outcome was observed until day seven. Patients were evaluated for acid-base and electrolyte disorders as well as for changes in measured or calculated serum osmolality.

Results: Our findings reveal that 90.7% of patients exhibited some form of acid-base disorder, mixed acid-base disorders were the most prevalent (75%). Patients with an accompanying respiratory acidosis showed higher mortality rates (12%) than patients with respiratory alkalosis (6%, p = 0.006) or no respiratory disorder (5%, p = 0.003). An elevated serum osmolality was associated with higher mortality when using the calculated, effective osmolality (19% vs 4%, p < 0.001) as well as the measured osmolality (10% vs 4%, p = 0.001). Only 20% of our population had no electrolyte disorder. This group had a significantly lower mortality rate (2%) compared to patients with elevated or decreased sodium, potassium and phosphate levels.

Conclusion: Patients with severe hyperglycaemia often had complex acid-base and electrolyte disorders but current criteria for diagnosing diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) ignore combined disorders of acid-base homeostasis, potentially influencing patient management and outcomes.

背景:急性高血糖常伴有酸碱和电解质紊乱以及血清渗透压的改变,这对临床有重要影响。本研究探讨了高血糖患者中复杂酸碱紊乱的患病率,重点关注当前主要依赖pH值、血清碳酸氢盐和阴离子间隙的诊断标准的局限性。方法:对1159例重度高血糖患者进行回顾性分析。入院时测量动脉血气分析、血清渗透压和电解质水平,观察患者预后至第7天。评估患者的酸碱和电解质紊乱以及测定或计算的血清渗透压的变化。结果:我们的研究结果显示90.7%的患者表现出某种形式的酸碱失调,混合型酸碱失调最为普遍(75%)。伴有呼吸性酸中毒的患者死亡率(12%)高于呼吸性碱中毒患者(6%,p = 0.006)或无呼吸疾病患者(5%,p = 0.003)。结论:严重高血糖患者通常有复杂的酸碱和电解质紊乱,但目前诊断糖尿病酮症酸中毒(DKA)和高渗透性高血糖状态(HHS)的标准忽略了酸碱平衡的综合紊乱,这可能影响患者的管理和预后。
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引用次数: 0
Incidence and risk of cancer emergence among patients post-kidney transplantation in Japan. 日本肾移植术后患者癌症发生的发生率和风险
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-08-27 DOI: 10.1007/s10157-025-02748-y
Saho Kanno, Tatsuya Noda, Tomoya Myojin, Yuichi Nishioka, Shinichiro Kubo, Masahiro Eriguchi, Ken-Ichi Samejima, Kazuhiko Tsuruya, Tomoaki Imamura

Background: Cancer is one of the most common complications after kidney transplantation and an important cause of mortality. However, no large, nationally representative study has investigated cancer incidence post-kidney transplantation. This study aimed to determine the standardized incidence ratio (SIR) for cancer after kidney transplantation using the National Database of Health Insurance Claims (NDB).

Methods: We used NDB from April 2013 to March 2022; patients were included if they had been on dialysis for at least one year, were diagnosed with cancer related to post-kidney transplantation, and were prescribed immunosuppressant drugs in FY2014 or FY2015. We defined patients with cancer as those who were coded as ICD-10 for cancer in FY2016 or later. The number of patients and SIRs were tabulated according to the duration after kidney transplantation and cancer type.

Results: The total number of patients was 4484 (males: 2879; females: 1605). The SIRs of all cancers from the first to the seventh year after kidney transplantation were 232/291/235/248/257/187/149, respectively, showing a gradual downward trend over time. The predilection sites of cancer in both men and women were post-transplant lymphoproliferative disease, Kaposi sarcoma, and the kidney.

Conclusion: This observational study, which followed over 100 million people, is the first large-scale research to track kidney transplant recipients for under 10 years. It incorporates an unprecedented sample size and uniquely identified short-term cancer risk trends following kidney transplantation.

背景:肿瘤是肾移植术后最常见的并发症之一,也是导致死亡的重要原因。然而,没有大型的、具有全国代表性的研究调查肾移植后的癌症发病率。本研究旨在利用国家健康保险索赔数据库(NDB)确定肾移植后癌症的标准化发病率(SIR)。方法:2013年4月至2022年3月使用NDB;如果患者接受透析治疗至少一年,被诊断患有与肾移植后相关的癌症,并在2014财年或2015财年服用免疫抑制剂,则纳入患者。我们将癌症患者定义为在2016财年或之后被编码为ICD-10的癌症患者。根据肾移植术后持续时间和肿瘤类型将患者数量和SIRs制成表格。结果:共4484例患者,其中男性2879例,女性1605例。肾移植术后1 - 7年所有癌症的SIRs分别为232/291/235/248/257/187/149,随时间呈逐渐下降趋势。男性和女性的癌症易发部位均为移植后淋巴增生性疾病、卡波西肉瘤和肾脏。结论:这项观察性研究追踪了超过1亿人,是第一个追踪肾移植受者不到10年的大规模研究。它纳入了前所未有的样本量,并独特地确定了肾移植后的短期癌症风险趋势。
{"title":"Incidence and risk of cancer emergence among patients post-kidney transplantation in Japan.","authors":"Saho Kanno, Tatsuya Noda, Tomoya Myojin, Yuichi Nishioka, Shinichiro Kubo, Masahiro Eriguchi, Ken-Ichi Samejima, Kazuhiko Tsuruya, Tomoaki Imamura","doi":"10.1007/s10157-025-02748-y","DOIUrl":"10.1007/s10157-025-02748-y","url":null,"abstract":"<p><strong>Background: </strong>Cancer is one of the most common complications after kidney transplantation and an important cause of mortality. However, no large, nationally representative study has investigated cancer incidence post-kidney transplantation. This study aimed to determine the standardized incidence ratio (SIR) for cancer after kidney transplantation using the National Database of Health Insurance Claims (NDB).</p><p><strong>Methods: </strong>We used NDB from April 2013 to March 2022; patients were included if they had been on dialysis for at least one year, were diagnosed with cancer related to post-kidney transplantation, and were prescribed immunosuppressant drugs in FY2014 or FY2015. We defined patients with cancer as those who were coded as ICD-10 for cancer in FY2016 or later. The number of patients and SIRs were tabulated according to the duration after kidney transplantation and cancer type.</p><p><strong>Results: </strong>The total number of patients was 4484 (males: 2879; females: 1605). The SIRs of all cancers from the first to the seventh year after kidney transplantation were 232/291/235/248/257/187/149, respectively, showing a gradual downward trend over time. The predilection sites of cancer in both men and women were post-transplant lymphoproliferative disease, Kaposi sarcoma, and the kidney.</p><p><strong>Conclusion: </strong>This observational study, which followed over 100 million people, is the first large-scale research to track kidney transplant recipients for under 10 years. It incorporates an unprecedented sample size and uniquely identified short-term cancer risk trends following kidney transplantation.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1892-1901"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12660435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Post-transplantation management of hyperparathyroidism and its association with kidney graft survival and fibrosis. 移植后甲状旁腺功能亢进的处理及其与移植肾存活和纤维化的关系。
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-07-04 DOI: 10.1007/s10157-025-02723-7
Manabu Okada, Tetsuhiko Sato, Tomoki Himeno, Yuki Hasegawa, Yuki Shimamoto, Kenta Futamura, Takahisa Hiramitsu, Norihiko Goto, Shunji Narumi, Asami Takeda, Toshihiro Ichimori, Yoshihiko Watarai

Background: Hyperparathyroidism (HPT) is a potential risk factor for graft loss after kidney transplantation (KTx). However, the effects of HPT management on graft outcomes remain unclear. This retrospective study aimed to investigate the impact of HPT status and its management on graft outcomes.

Methods: Patients who underwent KTx were categorized based on their HPT status and treatment at 1-year post-KTx into four groups: normal (no HPT), normocalcemic HPT, hypercalcemic HPT, or intervention (parathyroidectomy or calcimimetics within 1 year after KTx). Patients treated for HPT beyond the first year post-KTx were censored. The primary outcome was death-censored graft survival and the secondary outcome was the progression of interstitial fibrosis and tubular atrophy (IFTA) at 1-year post KTx.

Results: Among 1264 patients, the 10-year death-censored graft-survival rate was lowest in the hypercalcemic HPT group (79.7%), whereas the intervention group had a survival rate of 100.0%. In the multivariate Cox regression analysis, hypercalcemic HPT was associated with an increased risk of graft loss (fully adjusted hazard ratio [HR] = 4.25, P = 0.001, compared to the normal group). Contrarily, the intervention group did not show an increased risk of graft loss (fully adjusted HR = 0.28, P = 0.239). Additionally, hypercalcemia during the first year after KTx was significantly associated with IFTA progression (fully adjusted odds ratio = 1.91, P = 0.038).

Conclusion: Hypercalcemic HPT was associated with inferior graft survival and IFTA progression. Proactive management of HPT may reduce the risk of graft loss and mitigate IFTA progression.

背景:甲状旁腺功能亢进(HPT)是肾移植(KTx)后移植物丢失的潜在危险因素。然而,HPT治疗对移植物预后的影响尚不清楚。本回顾性研究旨在探讨HPT状态及其管理对移植物预后的影响。方法:接受KTx的患者根据其HPT状态和KTx后1年的治疗分为四组:正常(无HPT)、正常血钙水平HPT、高血钙水平HPT或干预(KTx后1年内甲状旁腺切除术或钙化剂)。ktx后一年以上接受HPT治疗的患者被审查。主要终点是死亡审查的移植物存活,次要终点是KTx后1年间质纤维化和管状萎缩(IFTA)的进展。结果:在1264例患者中,高钙HPT组的10年死亡审查移植存活率最低(79.7%),而干预组的存活率为100.0%。在多变量Cox回归分析中,高钙HPT与移植物丢失的风险增加相关(与正常组相比,完全校正风险比[HR] = 4.25, P = 0.001)。相反,干预组没有显示移植物丢失的风险增加(完全校正HR = 0.28, P = 0.239)。此外,KTx后第一年的高钙血症与IFTA进展显著相关(完全调整优势比= 1.91,P = 0.038)。结论:高钙HPT与移植物存活和IFTA进展有关。主动管理HPT可以降低移植物丢失的风险,减缓IFTA进展。
{"title":"Post-transplantation management of hyperparathyroidism and its association with kidney graft survival and fibrosis.","authors":"Manabu Okada, Tetsuhiko Sato, Tomoki Himeno, Yuki Hasegawa, Yuki Shimamoto, Kenta Futamura, Takahisa Hiramitsu, Norihiko Goto, Shunji Narumi, Asami Takeda, Toshihiro Ichimori, Yoshihiko Watarai","doi":"10.1007/s10157-025-02723-7","DOIUrl":"10.1007/s10157-025-02723-7","url":null,"abstract":"<p><strong>Background: </strong>Hyperparathyroidism (HPT) is a potential risk factor for graft loss after kidney transplantation (KTx). However, the effects of HPT management on graft outcomes remain unclear. This retrospective study aimed to investigate the impact of HPT status and its management on graft outcomes.</p><p><strong>Methods: </strong>Patients who underwent KTx were categorized based on their HPT status and treatment at 1-year post-KTx into four groups: normal (no HPT), normocalcemic HPT, hypercalcemic HPT, or intervention (parathyroidectomy or calcimimetics within 1 year after KTx). Patients treated for HPT beyond the first year post-KTx were censored. The primary outcome was death-censored graft survival and the secondary outcome was the progression of interstitial fibrosis and tubular atrophy (IFTA) at 1-year post KTx.</p><p><strong>Results: </strong>Among 1264 patients, the 10-year death-censored graft-survival rate was lowest in the hypercalcemic HPT group (79.7%), whereas the intervention group had a survival rate of 100.0%. In the multivariate Cox regression analysis, hypercalcemic HPT was associated with an increased risk of graft loss (fully adjusted hazard ratio [HR] = 4.25, P = 0.001, compared to the normal group). Contrarily, the intervention group did not show an increased risk of graft loss (fully adjusted HR = 0.28, P = 0.239). Additionally, hypercalcemia during the first year after KTx was significantly associated with IFTA progression (fully adjusted odds ratio = 1.91, P = 0.038).</p><p><strong>Conclusion: </strong>Hypercalcemic HPT was associated with inferior graft survival and IFTA progression. Proactive management of HPT may reduce the risk of graft loss and mitigate IFTA progression.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1881-1891"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12660426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Current position of Moncrief and Popovich's technique in patients on peritoneal dialysis: who really benefits from this technique from the perspective of mortality and peritonitis development? Moncrief和Popovich技术在腹膜透析患者中的现状:从死亡率和腹膜炎发展的角度来看,谁真正受益于这项技术?
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-07-12 DOI: 10.1007/s10157-025-02730-8
Shunta Hori, Mitsuru Tomizawa, Kuniaki Inoue, Tatsuo Yoneda, Kenta Onishi, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makito Miyake, Nobumichi Tanaka, Kiyohide Fujimoto

Background: The stepwise initiation of peritoneal dialysis (PD) using Moncrief and Popovich's technique (SMAP) is widely used for systemic PD introduction and catheter-related infection prevention. This study aimed to investigate patients who would benefit from SMAP in terms of mortality and PD-related peritonitis development.

Methods: In total, 328 consecutive patients underwent PD catheter implantation at our institute. Inverse probability of treatment weights was calculated, and patients who benefited from SMAP were explored retrospectively.

Results: Overall, 285 patients were analyzed (direct group, n = 96; SMAP group, n = 189). Patients in the SMAP group tended to have a lower mortality risk than those in the direct group, whereas this tendency decreased in the IPW-adjusted population. Peritonitis was observed in 40 and 85 patients in the direct and SMAP groups, and PD catheters were removed in 59 and 118 patients in the direct and SMAP groups. The two main causes were peritonitis and insufficient dialysis. The risk of mortality decreased with SMAP among patients with a nutrition risk index score for Japanese hemodialysis patients ≥ 8, prognostic nutritional index score ≤ 40, serum creatinine level < 8 mg/dl, and body mass index < 23 kg/m2. Additionally, the risk of peritonitis decreased in patients with emergent hemodialysis induction before PD and with previous abdominal surgery.

Conclusion: PD catheter implantation using SMAP may not be mandatory in clinical practice. However, this technique can be a good option, depending on the patient, in terms of mortality and peritonitis. Personalized treatment strategies should be considered to improve patient outcomes.

背景:采用Moncrief and Popovich技术(SMAP)逐步启动腹膜透析(PD)被广泛应用于全身PD导入和导管相关感染预防。本研究旨在调查从死亡率和pd相关腹膜炎发展方面受益于SMAP的患者。方法:我院连续328例患者行PD导管植入术。计算治疗权重的逆概率,并回顾性探讨从SMAP获益的患者。结果:共分析285例患者(直接组,n = 96;SMAP组,n = 189)。SMAP组患者的死亡风险往往比直接组患者低,而ipw调整人群的这一趋势则有所下降。直接组和SMAP组分别有40例和85例患者出现腹膜炎,直接组和SMAP组分别有59例和118例患者切除了PD导管。两个主要原因是腹膜炎和透析不足。日本血液透析患者的营养风险指数评分≥8,预后营养指数评分≤40,血清肌酐水平为2时,SMAP患者的死亡风险降低。此外,腹膜炎的风险降低紧急血液透析诱导患者PD前和既往腹部手术。结论:应用SMAP植入PD导管在临床应用中不一定是强制性的。然而,就死亡率和腹膜炎而言,这项技术可能是一个很好的选择。应考虑个性化的治疗策略以改善患者的预后。
{"title":"Current position of Moncrief and Popovich's technique in patients on peritoneal dialysis: who really benefits from this technique from the perspective of mortality and peritonitis development?","authors":"Shunta Hori, Mitsuru Tomizawa, Kuniaki Inoue, Tatsuo Yoneda, Kenta Onishi, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makito Miyake, Nobumichi Tanaka, Kiyohide Fujimoto","doi":"10.1007/s10157-025-02730-8","DOIUrl":"10.1007/s10157-025-02730-8","url":null,"abstract":"<p><strong>Background: </strong>The stepwise initiation of peritoneal dialysis (PD) using Moncrief and Popovich's technique (SMAP) is widely used for systemic PD introduction and catheter-related infection prevention. This study aimed to investigate patients who would benefit from SMAP in terms of mortality and PD-related peritonitis development.</p><p><strong>Methods: </strong>In total, 328 consecutive patients underwent PD catheter implantation at our institute. Inverse probability of treatment weights was calculated, and patients who benefited from SMAP were explored retrospectively.</p><p><strong>Results: </strong>Overall, 285 patients were analyzed (direct group, n = 96; SMAP group, n = 189). Patients in the SMAP group tended to have a lower mortality risk than those in the direct group, whereas this tendency decreased in the IPW-adjusted population. Peritonitis was observed in 40 and 85 patients in the direct and SMAP groups, and PD catheters were removed in 59 and 118 patients in the direct and SMAP groups. The two main causes were peritonitis and insufficient dialysis. The risk of mortality decreased with SMAP among patients with a nutrition risk index score for Japanese hemodialysis patients ≥ 8, prognostic nutritional index score ≤ 40, serum creatinine level < 8 mg/dl, and body mass index < 23 kg/m<sup>2</sup>. Additionally, the risk of peritonitis decreased in patients with emergent hemodialysis induction before PD and with previous abdominal surgery.</p><p><strong>Conclusion: </strong>PD catheter implantation using SMAP may not be mandatory in clinical practice. However, this technique can be a good option, depending on the patient, in terms of mortality and peritonitis. Personalized treatment strategies should be considered to improve patient outcomes.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1871-1880"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Blood pressure load associated with progressive kidney function decline in biopsy-proven atherosclerotic chronic kidney disease patients. 活组织检查证实动脉粥样硬化性慢性肾病患者血压负荷与进行性肾功能下降相关
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-08-04 DOI: 10.1007/s10157-025-02746-0
Hiroki Nobayashi, Go Kanzaki, Haruki Mae, Kotaro Haruhara, Nobuo Tsuboi, Takashi Yokoo

Background: Hypertension is a major risk factor for the progression of chronic kidney disease (CKD). However, the impact of blood pressure (BP) load, especially when office BP is normal, remains unclear. Thus, we conducted a retrospective cohort study to elucidate the impact of elevated BP load in patients with biopsy-proven CKD, BP load elevation, and a normal office BP compared with normotensive patients with CKD but without BP load elevation and those with hypertension.

Methods: We retrospectively analyzed patients with histologically confirmed atherosclerotic CKD who underwent kidney biopsy and 24-h ambulatory BP monitoring (ABPM). Patients were classified into normotension, isolated BP load elevation, and hypertension groups. The primary outcome was a ≥ 30% sustained decline in estimated glomerular filtration rate (eGFR) within 3 years.

Results: A total of 57 patients were analyzed. The isolated BP load elevation and hypertension groups showed a significantly higher incidence of adverse kidney events than the normotension group (p < 0.01). After adjusting for confounding factors (age, sex, urinary protein, and Mayo Clinic Chronicity Score), the hazard for kidney outcomes remained significant in the isolated BP load elevation group (hazard ratio, 9.25; 95% confidence interval, 1.29-66.30).

Conclusions: Isolated BP load elevation is a significant risk factor for CKD progression even in patients with normal office BP. Normalization of BP load may be a potential therapeutic target in patients with CKD. Comprehensive BP assessment using 24-h ABPM is crucial for CKD management, as it reveals clinically important abnormalities that conventional measurements may not capture.

背景:高血压是慢性肾脏疾病(CKD)进展的主要危险因素。然而,血压负荷的影响,特别是当办公室血压正常时,仍不清楚。因此,我们进行了一项回顾性队列研究,以阐明血压负荷升高对活检证实的CKD患者的影响,血压负荷升高,与血压正常的CKD患者相比,没有血压负荷升高和高血压患者。方法:我们回顾性分析了组织学证实的动脉粥样硬化性CKD患者,他们接受了肾活检和24小时动态血压监测(ABPM)。将患者分为血压正常组、孤立性血压负荷升高组和高血压组。主要结局是3年内估计肾小球滤过率(eGFR)持续下降≥30%。结果:共分析57例患者。孤立血压负荷升高组和高血压组的肾脏不良事件发生率明显高于血压正常组(p结论:孤立血压负荷升高是CKD进展的重要危险因素,即使在血压正常的患者中也是如此。血压负荷正常化可能是CKD患者的潜在治疗目标。使用24小时ABPM进行全面的血压评估对CKD治疗至关重要,因为它可以揭示常规测量可能无法捕获的临床重要异常。
{"title":"Blood pressure load associated with progressive kidney function decline in biopsy-proven atherosclerotic chronic kidney disease patients.","authors":"Hiroki Nobayashi, Go Kanzaki, Haruki Mae, Kotaro Haruhara, Nobuo Tsuboi, Takashi Yokoo","doi":"10.1007/s10157-025-02746-0","DOIUrl":"10.1007/s10157-025-02746-0","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is a major risk factor for the progression of chronic kidney disease (CKD). However, the impact of blood pressure (BP) load, especially when office BP is normal, remains unclear. Thus, we conducted a retrospective cohort study to elucidate the impact of elevated BP load in patients with biopsy-proven CKD, BP load elevation, and a normal office BP compared with normotensive patients with CKD but without BP load elevation and those with hypertension.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with histologically confirmed atherosclerotic CKD who underwent kidney biopsy and 24-h ambulatory BP monitoring (ABPM). Patients were classified into normotension, isolated BP load elevation, and hypertension groups. The primary outcome was a ≥ 30% sustained decline in estimated glomerular filtration rate (eGFR) within 3 years.</p><p><strong>Results: </strong>A total of 57 patients were analyzed. The isolated BP load elevation and hypertension groups showed a significantly higher incidence of adverse kidney events than the normotension group (p < 0.01). After adjusting for confounding factors (age, sex, urinary protein, and Mayo Clinic Chronicity Score), the hazard for kidney outcomes remained significant in the isolated BP load elevation group (hazard ratio, 9.25; 95% confidence interval, 1.29-66.30).</p><p><strong>Conclusions: </strong>Isolated BP load elevation is a significant risk factor for CKD progression even in patients with normal office BP. Normalization of BP load may be a potential therapeutic target in patients with CKD. Comprehensive BP assessment using 24-h ABPM is crucial for CKD management, as it reveals clinically important abnormalities that conventional measurements may not capture.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1812-1820"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Association between blood pressure and cardiovascular events and mortality in patients on peritoneal dialysis: a systematic review and meta-analysis of observational studies. 腹膜透析患者血压与心血管事件和死亡率之间的关系:观察性研究的系统回顾和荟萃分析
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-06-22 DOI: 10.1007/s10157-025-02719-3
Rodrigo Bezerra, Flavio Teles, Wilson Nadruz, Audes D M Feitosa, Jorge A P M Coelho, Daniela Ponce, Roberto Pecoits-Filho, Cibele I S Rodrigues

Background: The association between blood pressure (BP) and adverse outcomes in peritoneal dialysis (PD) remains uncertain. This study aims to address this knowledge gap.

Materials and methods: We systematically searched five databases (1964-2025) for observational studies assessing associations between BP and mortality or cardiovascular (CV) outcomes in adults on PD. Risk of bias was evaluated using the Newcastle-Ottawa Scale and ROBINS-I. Meta-analyses were performed using random- or fixed-effects models, and pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for continuous and categorical BP exposures.

Results: Twenty-four studies comprising 28,016 patients (55% males; hypertension prevalence ranging from 39 to 95%) were included. Higher pulse pressure (PP) was consistently associated with increased all-cause (HR per 10 mmHg: 1.20; 95%CI 1.02-1.40) and CV (HR per 10 mmHg: 1.35; 95%CI 1.16-1.58) mortality. For systolic BP (SBP), no significant association was found when analyzed as a continuous variable. However, predefined thresholds revealed that all-cause mortality was significantly associated with SBP < 120 mmHg (HR: 1.55; 95%CI 1.15-2.11) and with SBP > 140 mmHg (HR: 1.18; 95%CI 1.07-1.31). Diastolic BP was not significantly associated with mortality. Additional studies linked higher BP to left ventricular hypertrophy and non-fatal CV events.

Conclusion: In PD patients, SBP < 120 mmHg and > 140 mmHg are associated with increased all-cause mortality, while elevated PP robustly predicts all-cause and CV mortality. These findings identify SBP and PP as key prognostic markers and potential targets in PD management.

背景:腹膜透析(PD)患者血压(BP)与不良结局之间的关系尚不确定。本研究旨在解决这一知识差距。材料和方法:我们系统地检索了5个数据库(1964-2025),以获得评估血压与成人PD患者死亡率或心血管(CV)结局之间关系的观察性研究。使用Newcastle-Ottawa量表和ROBINS-I评估偏倚风险。使用随机或固定效应模型进行meta分析,并计算连续和分类BP暴露的合并风险比(hr)和95%置信区间(ci)。结果:24项研究包括28,016例患者(55%男性;高血压患病率从39%到95%不等)。较高的脉压(PP)始终与全因(HR / 10mmhg: 1.20;95%CI 1.02-1.40)和CV (HR / 10mmhg: 1.35;95%CI 1.16-1.58)死亡率。收缩压(SBP)作为一个连续变量分析时,没有发现显著的关联。然而,预定义阈值显示,全因死亡率与收缩压140 mmHg显著相关(HR: 1.18;95%可信区间1.07 - -1.31)。舒张压与死亡率无显著相关性。其他研究将血压升高与左室肥厚和非致命性CV事件联系起来。结论:在PD患者中,收缩压140 mmHg与全因死亡率增加相关,而PP升高有力地预测了全因和CV死亡率。这些发现确定收缩压和PP是PD治疗的关键预后指标和潜在靶点。
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引用次数: 0
Development and validation of a simplified CT volumetry for estimating total liver volume in patients with autosomal dominant polycystic kidney and liver disease. 常染色体显性多囊肾和肝脏疾病患者肝脏总体积的简化CT容积法的开发和验证
IF 1.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2025-12-01 Epub Date: 2025-07-23 DOI: 10.1007/s10157-025-02721-9
Fumihiko Hattanda, Yusuke Watanabe, Yusuke Sakuhara, Shun Takenaka, Tauro Kawamura, Naoko Matsuoka, Daigo Nakazawa, Yoichi M Ito, Hiroshi Kondo, Shin Goto, Yoshitaka Isaka, Ken Tsuchiya, Toshio Mochizuki, Satoru Muto, Haruna Kawano, Tatsuya Atsumi, Saori Nishio

Background: Accurate liver volume measurement is crucial for evaluating liver cyst severity and treatment efficacy in polycystic liver disease (PLD). Previous methods are impractical because they are time-consuming and labor-intensive. This study developed and validated two simplified CT imaging methods: the Bi-axial Simplified Measurement Method (BASiM) and the Quadri-dimensional Simplified Measurement Method (QDSiM).

Methods: This retrospective study analyzed 76 CT images from 26 PLD patients who underwent transarterial hepatic artery embolization (TAE). Images were obtained before TAE, 24 weeks after TAE and during the follow-up period. Liver volumes were measured using semi-automatic volumetry, BASiM, and QDSiM. BASiM calculates liver volume based on cranio-caudal, anterior-posterior, and medial-lateral dimensions, while QDSiM divides the liver into left- and right-side sections. This study assessed inter-assessor reliability, measurement accuracy, volume change rate, and calculation times.

Results: BASiM demonstrated strong inter-assessor reliability (intraclass correlation coefficient [ICC]: 0.991, 95% confidence interval [CI] 0.986-0.994) superior to QDSiM (ICC: 0.851, 95% CI 0.205-0.949). Calibrated liver volumes using BASiM and QDSiM were consistent with semi-automatic volumetry (ICC: 0.924, 95% CI 0.858 to 0.957, and ICC: 0.934, 95% CI 0.806-0.970, respectively). BASiM showed better alignment with volume changes (ICC: 0.835, 95% CI 0.537-0.927) compared to QDSiM (ICC: 0.607, 95% CI 0.203-0.800) and required less measurement time (61 ± 4 s vs. 107 ± 9 s, p < 0.01).

Conclusion: BASiM provided superior reliability, accuracy, and efficiency for liver volume measurement in PLD, thus useful for the clinical management of PLD.

背景:准确的肝体积测量是评估多囊性肝病(PLD)肝囊肿严重程度和治疗效果的关键。以前的方法由于耗时费力而不切实际。本研究开发并验证了两种简化的CT成像方法:双轴简化测量法(BASiM)和四维简化测量法(QDSiM)。方法:回顾性分析26例经动脉肝动脉栓塞(TAE)的PLD患者的76张CT图像。分别于TAE前、TAE后24周及随访期间采集图像。采用半自动体积仪、BASiM和QDSiM测量肝脏体积。BASiM根据颅尾、前后和中外侧尺寸计算肝脏体积,而QDSiM将肝脏分为左右两部分。本研究评估了评估者间的可靠性、测量准确性、体积变化率和计算时间。结果:BASiM表现出较强的评估者间信度(类内相关系数[ICC]: 0.991, 95%可信区间[CI] 0.986 ~ 0.994)优于QDSiM (ICC: 0.851, 95% CI 0.205 ~ 0.949)。使用BASiM和QDSiM校准的肝脏体积与半自动体积法一致(ICC: 0.924, 95% CI 0.858 ~ 0.957, ICC: 0.934, 95% CI 0.806 ~ 0.970)。与QDSiM (ICC: 0.607, 95% CI 0.103 -0.800)相比,BASiM与体积变化的一致性更好(ICC: 0.835, 95% CI 0.537-0.927),所需的测量时间更短(61±4 s vs 107±9 s, p结论:BASiM对PLD肝体积测量具有更高的可靠性、准确性和效率,可用于PLD的临床治疗。
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引用次数: 0
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Clinical and Experimental Nephrology
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