Clinical and Experimental Nephrology最新文献

Background: Despite of long-lasting tolvaptan treatment, individual renal outcomes are unclear in autosomal dominant polycystic kidney disease (ADPKD). This post-hoc analysis of the TEMPO 3:4 trial aimed to evaluate the predictability of estimated height-adjusted total kidney volume growth rate (eHTKV-α) on renal outcomes.

Methods: In TEMPO 3:4, 1445 patients with ADPKD were randomised to tolvaptan or placebo for 3 years. The present analysis included patients with total kidney volume (TKV) data available at baseline and month 12 (tolvaptan, n = 812; placebo, n = 453); tolvaptan-assigned patients were grouped into quartiles based on percent change in eHTKV-α from baseline at 1 year. Clinical parameters were compared between quartiles, and regression analyses evaluated the predictive value of 1-year percent change in eHTKV-α and other factors on annual changes in TKV and estimated GFR (eGFR) over 3 years.

Results: Trend tests identified significant differences between quartiles for several baseline parameters. Multivariate regression models confirmed that 1-year percent change in eHTKV-α was a significant predictor of annual changes in both TKV and eGFR over 3 years. Other significant predictors of annual changes in TKV and eGFR over 3 years were sex, age and body mass index, and first-year change in eGFR, race and baseline eGFR, respectively. Predicting factors using urine osmolality and plasma copeptin levels were not significant by backward stepwise selection analysis.

Conclusions: 1-year percent change in eHTKV-α is useful biomarker to identify treatment good responders and may be utilized for early estimate of trial outcomes of new drugs in ADPKD.

Background: There is limited evidence on clinical outcomes and treatment pattern in Japanese patients with severe chronic kidney disease (CKD), hospitalized for coronavirus disease-2019 (COVID-19). We aimed to describe patient characteristics, treatment pattern, and clinical outcomes in Japanese patients with severe CKD, hospitalized for COVID-19 who received remdesivir (RDV).

Methods: We used the anonymized claims database from Medical Data Vision Co., Ltd., Japan. The analysis included patients aged ≥ 18 years with severe CKD, hospitalized for moderate to severe COVID-19, and administered ≥ 1 dose of RDV between October 2021 and September 2023. All-cause inpatient mortality, disease progression, and recovery up to 56 days from hospitalization were evaluated.

Results: Data of 847 patients were analyzed (mean age 73.0 ± 14.1 years). Median (Q1-Q3) time to RDV initiation was 1.0 day (1.0-2.0) from hospitalization and treatment duration was 5.0 days (3.0-5.0). At RDV initiation, 44.27% patients required non-invasive positive pressure ventilation/high or low flow oxygen; 4.25% required invasive mechanical ventilation/extracorporeal membrane oxygenation/intensive care unit hospitalization. Proportion of patients with all-cause mortality was 11.45% (stage 4, 14.89%; stage 5, 10.47%) by 28 days and 12.28% (stage 4, 16.49%; stage 5, 11.08%) by 56 days. At 28 days, 12.28% had disease progression and 72.14% recovered.

Conclusion: Most patients with severe CKD received RDV immediately after hospitalization. The majority of patients recovered by 28 days. The study provided insights into RDV treatment in inpatient settings, which could contribute to the discussion on standard of care in this population in Japan.

Purpose: The study aimed to evaluate the efficacy and safety of rituximab (RTX) in primary IgA nephropathy (IgAN).

Methods: A retrospective review was conducted on the medical records of 22 patients diagnosed with primary IgAN who received RTX treatment. The clinical data, including blood tests, urine examinations and estimated glomerular filtration rate (eGFR), were analyzed at four time point: baseline, 3 months, 6 months and 12 months. Adverse events were also recorded.

Results: Our study included 9 male and 13 female participants. The level of serum albumin significantly increased after three months with RTX applied (P < 0.01). Furthermore, we observed a significant reduction in microalbuminuria and urine albumin-to-creatinine ratio at twelve months (P < 0.01). However, there was no change in serum creatinine (P = 0.08), urinary red blood cell (P = 0.11) or eGFR (P = 0.09) during the course of one year. Two cases achieved complete remission, while eleven cases experienced partial remission, resulting in an overall remission rate of 50.0%. During the treatment period, three patients developed infections and two patients encountered infusion-related adverse reactions.

Conclusion: In our retrospective study, RTX demonstrated a significant improvement in serum albumin levels and a reduction in proteinuria among primary IgAN patients. Although no statistically significant difference was observed in terms of renal function, there was an observable trend towards improvement. Therefore, we propose that RTX may be an alternative treatment option for primary IgAN patients who cannot tolerate glucocorticoids or immunosuppressants.

Background: Whether diabetic retinopathy (DR) can predict kidney disease progression in individuals with diabetes remains unclear. Furthermore, there are only a limited number of studies investigating the association between DR and kidney outcomes classified according to baseline kidney function and albuminuria status. Here, we examined the association of DR with kidney disease progression in individuals with type 2 diabetes.

Methods: This retrospective cohort study included 6759 Japanese adults with type 2 diabetes (36.3% women). Kidney insufficiency and albuminuria were defined as eGFR < 60 mL/min/1.73 m² and urinary albumin-to-creatinine ratio ≥ 30 mg/g, respectively. The exposure and outcome were baseline DR and the composite of eGFR halving or the initiation of kidney replacement therapy, respectively. The hazard ratios for the outcome were estimated using the multivariable Cox proportional hazards model.

Results: During the median follow-up period of 8.4 years, 922 reached the outcome. Among the individuals without kidney insufficiency, those with DR at baseline had a significantly higher incidence of the outcome than those without DR regardless of baseline albuminuria status (p < 0.05), whereas the presence of DR was not the risk factor among individuals with kidney insufficiency. There was an interaction between baseline DR and kidney insufficiency with respect to the outcome incidence (p = 0.043). When baseline eGFRs were classified into eGFR categories based on the Kidney Disease: Improving Global Outcomes guideline, the above findings were more clearly shown.

Conclusions: DR may be able to predict kidney disease progression only among individuals with type 2 diabetes exhibiting preserved kidney function.

Background: Patients diagnosed with congenital kidney malformations are at an increased risk of developing hypertension, proteinuria, and progressing to chronic kidney disease (CKD). The present study aimed to determine the frequency of masked hypertension and ambulatory arterial stiffness index (AASI) in patients with congenital kidney malformations.

Methods: The study included 174 patients with congenital kidney malformations (48 patients with unilateral renal agenesis (URA), 40 patients with ectopic kidney (EK), 36 patients with horseshoe kidney (HK), 31 patients with multicystic dysplastic kidney (MCDK), 19 patients with unilateral renal hypoplasia (URH), and 45 healthy controls.

Results: The mean age was 12.9 ± 2.9 years, and the male-to-female ratio was 1.5. No significant differences were observed between the congenital kidney malformations groups concerning age, sex, follow-up period, proteinuria, or estimated glomerular filtration rate (eGFR) (P > 0.05). Nevertheless, the prevalence of masked hypertension exhibited a statistically significant increase in the congenital kidney malformations groups (except the URH group) compared to the control group (P < 0.05). The AASI was significantly greater in the congenital kidney malformations groups than in the control group (P < 0.05). The nighttime diastolic blood pressure (DBP), mean arterial pressure (MAP), and DBP index were significantly different between the congenital kidney malformations groups (P < 0.05). However, there were no significant differences in nondipping pattern, proteinuria, or masked hypertension between the congenital kidney malformations groups.

Conclusions: Patients with congenital kidney malformations should be periodically evaluated throughout life for BP. Based on the present findings, we strongly recommend ABPM for the diagnosis of masked hypertension and outcomes, including AASI score.

Renal lesions due to systemic lupus erythematosus (SLE) are defined as lupus nephritis (LN), a renal disease characterized by the deposition of immunoglobulin (Ig)G-based immune complexes in the kidney and the appearance of double-stranded DNA and Smith antibodies. In particular, deposition of IgG3, which has strong complement binding properties, under the endothelium or in the mesangium activates the classical complement pathway of C1q, C4, and C3, leading to renal damage. This step is followed by migration of inflammatory cells, including neutrophils and monocytes, which induce inflammation in the glomerular capillaries and cause mesangiolysis and endothelial cell damage, resulting in endocapillary proliferative nephritis. LN is classified as class I to IV depending on the degree of inflammation or as class V in cases of subepithelial deposition of immune complexes in glomeruli. Deposition in the renal small arterioles by the same mechanism induces thrombus formation, resulting in lupus vasculopathy. Deposition in the tubular basement membrane and peritubular capillaries leads to tubulointerstitial lupus nephropathy. The appearance of antiphospholipid antibodies leads to acute and chronic forms of antiphospholipid antibody nephropathy (APSN) due to thrombus formation. This article reviews cases of the typical diverse renal lesions in LN.

Background: Chronic kidney disease (CKD) awareness could help prevent disease progression through modifiable risk factors. However, few patients with CKD are aware of their disease. We aimed to investigate the factors associated with CKD awareness and impact of CKD awareness on renal prognosis.

Methods: We investigated the proportion of participants with CKD who answered 'aware of CKD' in the questionnaire among those undergoing health check-ups from 2013 to 2022. Participants included working-age employees and their dependents covered by health insurance associations for large and medium-sized companies. The outcome was defined as the change from 'unaware' to 'aware' of CKD; multivariable logistic regression analysis assessed the association of urine tests or nutritional guidance with CKD awareness. A control group was randomly selected from the unaware group and matched for age, sex, estimated glomerular filtration rate (eGFR), urinary protein categories, and follow-up period. Changes in eGFR slopes before and after awareness were compared using linear mixed-effects models.

Results: Of the 13,489 participants, 2.8% were aware of CKD at baseline; of the 1,614 with CKD-related disease codes, only 19.6% were aware. The odds ratios of urine tests or nutritional guidance in relation to awareness occurrence were 1.98 (1.29-3.05) and 3.01 (1.38-6.53), respectively. The difference in the eGFR slope improvement from before to after CKD awareness was + 0.92 mL/min/1.73 m² per year (0.18-1.67; P = 0.015) in the aware group.

Conclusion: Our findings suggest that urine tests and nutritional guidance may promote CKD awareness, which may help slow its progression.

Background: The objective of this analysis was to estimate the clinical and economic impact of undertaking urine albumin-to-creatinine ratio (UACR) testing alongside regular estimated glomerular filtration rate testing for chronic kidney disease in non-diabetic Japanese patients versus no testing and versus urine protein-creatinine ratio (UPCR) testing.

Methods: An economic model, taking a Japanese healthcare perspective, estimated the health-economic impact of UACR testing over a lifetime time horizon. Outcomes reported were additional costs, clinical benefits measured, such as prevented dialyses and cardiovascular events, quality-adjusted life years gained, and incremental cost-effectiveness ratios. Health states were derived from risk levels reported in the Kidney Disease: Improving Global Outcomes heatmap. Results were derived assuming that after testing, treatment was available in the form of current standard-of-care or emerging chronic kidney disease therapies.

Results: Repeated UACR testing was found to be cost-effective compared to both no urine testing and UPCR testing, with incremental cost-effectiveness ratios of ¥1,953,958 and ¥1,966,433, respectively.

Conclusion: Overall, this model demonstrates the health-economic value of undertaking UACR testing within the non-diabetic Japanese population.

Background and hypothesis: We observed lower risk of all-cause mortally among continuous positive airway pressure (CPAP) users compared to those non-users using a large polysomnography (PSG) registry. However, the effect of CPAP on mortality risk has not been examined in dialysis patents.

Methods: We studied 9841 patients with PSG performed from September 1990 to 2010 in Nakamura clinic, Okinawa. Among them, we found 195 dialysis patients: 16 (1.0%) dialysis patients with apnea hypopnea index (AHI) < 5/hour in 1665 subjects and 179 (2.2%) in 8176 obstructive sleep apnea (OSA) patients. CPAP users were defined as patients who had been on CPAP for more than one month. Patients qualified and eligible for CPAP but refused were assigned as CPAP non-users. The median observation was 6.6 years. Mortality rates were compared between CPAP users and non-users using multivariate logistic analysis adjusted for age, sex, body mass index (BMI), AHI and medical history.

Results: Among OSA dialysis patients (men 127, women 37), 116 (2.6%) were CPAP users and 48 (2.3%) were CPAP non-users. The number of deaths was 52 (29 CPAP users and 23 (CPAP non-users) during follow-up. The death rate was 25.0% for CPAP users and 47.9% for non-users. CPAP users showed better survival; hazard ratio (HR) 0.47 and 95% confidence interval (CI) of 0.27-0.81 (P = 0.007).

Conclusion: Dialysis patients with OSA showed better survival rates with the use of CPAP. Screening for OSA is recommended if patients complain of sleep problems, such as insomnia, daytime sleepiness, headache, and fatigue.