Clinical and Experimental Nephrology最新文献

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.

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.

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.

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.

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.

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.

Background: Pseudo-Bartter/Gitelman syndrome (PBS/PGS) is caused by medication and lifestyle factors, leading to hypokalemia and potentially impairing kidney function. Treatment primarily involves eliminating the underlying causes, which typically results in rapid improvement. However, PBS/PGS findings may persist long after the removal of causative factors, and its pathogenesis remains unclear.

Methods: This study focused on 49 cases diagnosed with PBS/PGS. All cases presented with hypokalemia, attributed to apparent causes, and comprehensive genetic testing detected no pathogenic variants associated with hereditary kidney diseases. They were categorized into two groups: the current group (n = 39), where causative factors persisted, and the past group (n = 10), where more than 1 year had elapsed since the elimination of the causative factors at the time of examination. A retrospective comparative analysis was conducted between these groups.

Results: All patients were female, except for two in the current group. The median time since the elimination of causes in the past group was 7.5 years. Hypokalemia and kidney dysfunction were observed in both groups without statistically significant differences. Both groups exhibited overactivation of renin-angiotensin systems.

Conclusion: This study is the first to reveal the possibility of persistent PBS/PGS findings even after the removal of causative factors. While swift removal of the cause of PBS/PGS is crucial, long-term post-removal monitoring is essential to improve renal prognosis.

Background: The risk of mortality and cardiovascular disease (CVD) may be higher among some super-older adults with chronic kidney disease (CKD). We assessed outcomes across CKD stages in an aging Japanese population.

Methods: This retrospective cohort study using nationwide health examination and insurance claims database enrolled individuals aged 75-90 years whose renal function was measured > 2 times during the observation period. CKD stages were classified using eGFR and urinary protein levels. We used a Cox proportional hazards model to evaluate all-cause mortality and CVD events by CKD stage and a logistic regression model to assess dialysis initiation by renal function and proteinuria among patients with advanced CKD.

Results: Of 365,664 individuals aged 75-90 years, > 30% met the CKD diagnosis criteria, mostly the CKD G3aA1 category. During follow-up, 18,238 deaths and 48,937 CVD events occurred. Mortality and CVD incidence increased with advancing CKD stages. Mortality risk was elevated only among G3a patients with urinary protein (A2/3: HR 1.64 [95% CI 1.53-1.76]), but not without (A1: HR 1.01 [0.97-1.05]). CVD risk increased significantly across all A2/3 stages, but not in A1. Dialysis was initiated in 9.5% of patients with CKD G4/5, with an earlier risk observed in the A2/3 group.

Conclusion: In older adults, CKD prognosis varies according to stage and proteinuria. Most individuals with early-stage, proteinuria-negative CKD do not experience adverse outcomes, whereas trace or greater proteinuria indicates higher risk. Outcome-based CKD management in a super-older population is essential to avoid overtreatment and ensure appropriate care.

Background: In 2011, the Great East Japan Earthquake hit the Futaba District on the northeast coast of Japan, followed by a tsunami and a nuclear power plant accident. In this study, we investigated the impact of post-earthquake life on the onset of chronic kidney disease (CKD) among the residents of the Futaba District.

Methods: Data on 17,859 residents of the Futaba District (7333 men, 10,526 women; mean age: 61.0 ± 10.2 years; mean follow-up period: 3.42 ± 1.51 years) who underwent health checkups and completed self-administered questionnaires in the Fukushima Mental Health and Lifestyle Survey were analyzed. These residents were confirmed to be CKD-free in 2012. Hence, they were assessed for the onset of CKD from 2013 to 2017.

Results: Univariate analysis results showed significant differences between residents with and without CKD. Differences in age, diabetes mellitus, body mass index (BMI), dyslipidemia, hypertension, hyperuricemia, Kessler 6 Psychological Distress Scale (K6) score, smoking habit, alcohol drinking history, exercise habit, history of job change, history of job loss, and evacuation experience were observed. Multivariate analysis was conducted to adjust for multiple factors, and age, BMI, dyslipidemia, hypertension, hyperuricemia, and K6 score were identified as significant promotional factors for CKD onset.

Conclusion: Among the well-recognized risk factors, severe stress reflected by a high K6 score was established to be correlated with CKD onset among residents originally without CKD. Stress management may be another treatment strategy for treating CKD.

Background: Chronic kidney disease (CKD) is a progressive, irreversible condition that causes kidney damage and has systemic repercussions. The aim of the present study was to summarize the literature on the clinical and nutritional repercussions of dialysis.

Methods: Searches were conducted of the PubMed/MEDLINE, Scopus, and Embase databases for relevant articles published up to April 2023. The eligibility criteria were studies published in the English language involving male and female patients between 18 and 80 years of age diagnosed with CKD and undergoing dialysis. No restrictions were imposed regarding year of publication. The outcomes of interest were nutritional and clinical status.

Results: A total of 9.266 records were retrieved, 20 of which were included in the qualitative synthesis and 14 were included in the meta-analysis. The samples ranged from 11 to 601 patients and mean age was 57.6 ± 7.69 years. Time on dialysis ranged from 36 months to 14.48 years. Greater increases in body weight [MD 9.70, CI 7.58-11.82, Z = 8.96, p < 0.0001], arm muscle area [MD 2.36, CI 1.05-3.67, Z = 3.52, p = 0.0004], phase angle [MD0.81, CI0.50-1.12, Z = 5.16, p < 0.00001], creatinine [MD1.93, CI 1.67-2.20, Z = 14.43, p < 0.00001], albumin [MD1.35, CI 0.88-1.82, Z = 5.61, p < 0.00001], urea [MD11.13, CI 4.67-17.59, Z = 3.37, p = 0.0007], and Kt/v [MD-0.97,CI-2.30-0.35, Z = 1.44, p = 0.15] were found in male patients undergoing dialysis compared to female patients. Heterogeneity among the studies ranged from 0 to 85%.

Conclusions: Dialysis exerts an impact on the nutritional status of patients with CKD, especially men. Therefore, monitoring clinical-nutritional variables is of fundamental importance in this population.