Clinical and Experimental Nephrology最新文献

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: This study aimed to comparatively evaluate the prognostic value of the Japanese Renal Pathology Society (JRPS) classification for predicting diabetic kidney disease (DKD) progression in Chinese patients.

Methods: This retrospective cohort study included 124 patients diagnosed with DKD from 2014 to 2020. Patients were classified into four JRPS classification grades based on the J-score. Renal survival was assessed using Kaplan-Meier analysis and Cox regression, and predictive accuracy was compared with the RPS classification and total renal chronicity score using receiver operating characteristic (ROC) curve analysis and the DeLong test.

Results: Over a median follow-up of 37 months, 76.6% of patients reached renal outcomes, including 40.3% progressing to end-stage kidney disease (ESKD). Higher JRPS classification grades were independently associated with adverse renal outcomes. However, ROC analysis demonstrated that the JRPS classification exhibited inferior discriminative performance compared with the traditional RPS classification system.

Conclusion: The JRPS classification was independently associated with renal outcomes but showed inferior discriminatory performance compared with the RPS classification. These findings suggest that JRPS classification may provide complementary pathological information rather than serving as a primary prognostic tool.

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: The role of Janus kinase (JAK) 2 in chronic kidney disease (CKD) remains unreported. This Mendelian randomisation (MR) study investigates the causal associations of JAK2 with CKD and provides references for the identification of possible therapeutic targets and the prevention of renal dysfunction.

Methods: Summary data for JAK2 and various CKD endpoints are extracted from genome-wide association study findings provided by the MRC Integrative Epidemiology Unit and FinnGen. The causal relationships are assessed using inverse variance weighted estimates, weighted median and MR-Egger regression. To ensure rigour, reverse MR, radial MR and leave-one-out approaches are employed for sensitivity analyses, with Cochran's Q used to assess heterogeneity.

Results: Inverse variance weighted estimates indicate potential two-way causal associations between JAK2 and membranous nephropathy (MN) (odds ratio [OR] = 1.138, 95% confidence interval [CI]: 1.073-1.206; reverse causal association: OR = 1.040, 95% CI: 1.002-1.079). Sensitivity analyses demonstrate that these relationships are relatively robust. An underlying causal relationship between JAK2 and estimated glomerular filtration rate is identified (OR = 0.996, 95%CI 0.993-1.000); however, this becomes non-significant after the radial MR test (P > 0.05). In addition, polycystic kidney disease exhibits a potential causal relationship with JAK2 (OR = 1.066, 95%CI 1.009-1.127).

Conclusions: Elevated relative expression of JAK2 may represent a potential risk factor for the occurrence of MN. Conversely, patients with MN may exhibit high relative expression of JAK2. These two-way causal associations may inform future efforts aimed at the prevention of CKD and the identification of possible therapeutic targets.

Background: Fabry disease is a hereditary disorder that leads to the accumulation of glycolipids, such as globotriaosylceramide, because of the absence or decreased activity of the enzyme alpha-galactosidase A, causing various organ dysfunctions. Urinary mulberry bodies (MBs) are specific markers of Fabry disease and can be identified in urinary sediments through microscopic visual evaluation. However, MBs are present in small quantities in urine, and some are difficult to distinguish morphologically from other urinary components, necessitating a highly accurate and objective automated detection method. Here, we examined the detection of MBs using molecular imaging flow cytometry (MI-FCM).

Methods: Urine samples from patients with and without Fabry disease were analyzed by MI-FCM for MB detection. Microscopy was used as a control method to identify MBs.

Results: MI-FCM detected MBs in 33 of 36 Fabry disease patients (sensitivity: 91.7%) and did not detect MBs in any of the nine non-Fabry patients (specificity: 100%). In comparison, visual inspection under an optical microscope detected MBs in 23 of 36 Fabry disease patients (sensitivity: 63.9%), confirming that MI-FCM provided more accurate detection. MBs were detected by MI-FCM in 29 of 30 patients with negative urinary protein.

Conclusion: MI-FCM frequently detected MBs in Fabry disease patients, even before the onset of renal dysfunction. Screening for MBs may be useful for the early detection of Fabry disease.

Infections at hemodialysis access sites remain a critical challenge in managing end-stage renal disease patients, significantly affecting morbidity and mortality. This comprehensive review synthesizes current knowledge on risk factors, surveillance methods, diagnostic approaches, treatment strategies, and preventive measures for these infections. Through systematic analysis of literature from major databases up to July 2024, we explore infection-related complications, pathogenic agents, and management strategies. Staphylococcus aureus emerges as a primary pathogen, with concerning increases in multidrug-resistant strains. The review emphasizes the superior safety profile of arteriovenous fistulas compared to central venous catheters, highlighting the importance of access type selection. Continuous monitoring and early detection through physical examinations and specialized tests are crucial. Diagnostic accuracy is optimized by combining clinical assessment with laboratory testing and imaging studies. Treatment strategies focus on empiric systemic antibiotic therapy, guided by local epidemiology and culture results, often necessitating catheter removal for persistent infections. Preventive measures, including strict adherence to aseptic techniques and targeted use of antimicrobial locks, are detailed. The study advocates for a multifaceted approach to infection management, emphasizing multidisciplinary collaboration and adherence to evidence-based guidelines. Promising future directions, such as novel antimicrobial surfaces and lock solutions, offer potential for further reducing infection risks. This review provides valuable insights for healthcare providers, aiming to improve long-term outcomes and quality of life for hemodialysis-dependent patients through enhanced infection control strategies.

Background: Early reduction in proteinuria has been validated as a surrogate endpoint for IgA nephropathy (IgAN) in Western trials and is used for accelerated drug approval. However, its applicability to Japanese patients remains unclear. We aimed to evaluate the association between early proteinuria reduction and long-term renal outcomes in Japanese patients with IgAN.

Methods: This retrospective observational study used data from J-CKD-DB-Ex, a real-world database of CKD in Japan. Adult participants with IgAN, baseline urine protein/creatinine ratio (UPCR) ≥ 0.5 g/gCr, and eGFR ≥ 30 mL/min/1.73 m² were included. The exposure was a ≥ 30% UPCR reduction at 9-12 months after the index date (UPCR reduction group), vs participants without such reduction (non-UPCR reduction group). The primary endpoint was a composite of 40% decline in eGFR from baseline or onset of CKD stage G5. Cox proportional hazards and linear mixed-effects models evaluated the association between UPCR reduction, renal events, and eGFR slope.

Results: Among 385 participants (mean observation period 2,040 days), 245 achieved ≥ 30% reductions in UPCR. The UPCR reduction group showed significantly lower cumulative incidence of renal composite events than the non-UPCR reduction group. Annual eGFR decline was slower in the UPCR reduction group than that in the non-UPCR group (-1.9 vs -3.4 mL/min/1.73 m²/year). Greater UPCR reductions were linearly associated with more favorable eGFR slope.

Conclusions: Early proteinuria reduction is associated with decreased risk of renal failure and attenuated eGFR decline in Japanese patients with IgAN, supporting its validity as a surrogate endpoint for renal prognosis.