Clinical and Experimental Nephrology最新文献

Background: Few studies have observed the direct effect of obesity on renal prognoses in immunoglobulin A nephropathy (IgAN) or separately evaluated its effects according to sex. We aimed to evaluate the direct and indirect effects of obesity on the renal outcomes of IgAN and observe these effects separately according to renal function and sex.

Methods: We extracted patients with body mass index (BMI) descriptions from a multicenter retrospective cohort analysis in Japan, and excluded those with < 30 days of follow-up, diabetes mellitus, and steroid treatment. Patients were divided into normal (n = 720; 18.5 ≤ BMI < 25) and obese (n = 212; BMI ≥ 25) groups, which were then compared. The endpoints were a 1.5-fold increase in serum creatinine levels and the initiation of renal replacement therapy.

Results: The obese group was older, included more males, and was more likely have hypertension, dyslipidemia, proteinuria, tubular atrophy, and lower renal function than the normal group. Patients with an eGFR < 60 mL/min/1.73 m² had well-matched characteristics between the groups; however, hypertension, low high-density lipoprotein cholesterol, and hypertriglyceridemia were more common in the obese group. Obesity contributed to tubular atrophy, even when adjusted for renal function. In addition, it contributed to proteinuria only in females. However, obesity itself was not a significant prognostic factor.

Conclusions: Although no independent effect on renal prognosis was observed during the study period, the obese group had more risk factors for IgAN progression and obesity contributed to tubular atrophy and female proteinuria. Our results suggest that separately analyzing the prognostic effect of obesity according to sex is important.

This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients.

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in patients undergoing maintenance hemodialysis (HD), with various reported risk factors. Recovery time (RT) is a valuable indicator of post-dialysis fatigue. However, the association between RT and the onset of CVD remains unexplored. As such, this study aimed to determine the effect of RT on the onset of CVD.

Methods: Data from 620 patients undergoing maintenance HD at Yabuki Hospital and 3 related facilities (Yamagata Prefecture, Japan) as of December 31, 2020, were retrospectively analyzed. Patients were asked to respond to the question "How long does it take you to recover from a dialysis session?"; the response was defined as RT. The analysis was performed by categorizing patients into 2 groups according to RT: short RT (< 2 h); and long RT (≥ 2 h). The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause death and hospitalization.

Results: During the 24-month follow-up, 70 (11.3%) patients developed MACE. The long RT group exhibited a higher incidence of MACE; multivariate analysis revealed that age and long RT were associated with the onset of MACE. All-cause death was observed in 45 (7.3%) patients, with no significant difference between the 2 groups. Hospitalization occurred in 252 (40.6%) patients and was more frequent in the long RT group. Multivariate analysis revealed that age, sex, duration of HD, intact parathyroid hormone level, and long RT were associated with hospitalization.

Conclusion: Long RT was an independent risk factor for the onset of CVD.

Background: An increase in free oxygen radicals and proinflammatory cytokines and decrease in intracellular adenosine triphosphate account for the nephrotoxic effect of amiodarone. This study investigated the protective effects of Coenzyme Q10 (CoQ10), cinnamon extract (CE) and the combination of the two (CoCE) on possible amiodarone-induced renal injury in rats.

Methods: Thirty male albino Wistar rats were cetegorized into healthy (HG), amiodarone (ADG), CoQ10 + amiodarone (CoQA), CE + amiodarone (CEA), and CoCE + amiodarone (CoCEA) groups. First, CoQ10 (10 mg/kg) and CE (100 mg/kg) were orally given. After 1 h, 50 mg/kg amiodarone was orally given to all groups except for HG. Amiodarone, CoQ10, and CE administration was continued orally at the indicated doses once daily for 10 days.Then, blood samples were collected from all groups to determine creatinine, blood urea nitrogen (BUN), and kidney injury molecule (KIM-1) levels, followed by euthanasia and removal of kidney tissues. Oxidative stress and inflammatory parameters were analysed in the tissue samples. Histopathological examination was also performed on the tissues.

Results: Amiodarone increased malondialdehyde levels and decreased total glutathione, superoxide dismutase, and catalase levels (p < 0.001). Amiodarone increased the expression and tissue levels of tissue nuclear factor kappa B, tumor necrosis factor-alpha, interleukin-1β and interleukin-6, and led to increases in serum creatinine and BUN and KIM-1 levels (p < 0.001). Amiodarone also caused histopathological damage (p < 0.001).CoQ10, CE and especially CoCE inhibited biochemical changes and tissue damage (p < 0.001).

Conclusion: Although CoQ10, CE, and CoCE effectively prevent amiodarone-induced oxidative and inflammatory nephrotoxicity, CoCE appears to be superior.

Background: Preventing the progression of chronic kidney disease (CKD), reducing the incidence of new dialysis patients, and increasing public awareness about CKD are pivotal in mitigating renal impairment. This study aimed to assess the relevance of kidney disease and CKD knowledge among junior high school students and their parents.

Methods: A questionnaire survey on kidney function and CKD was conducted among students aged 14-15 years and their parents (851 pairs). Parents were also asked about their age, sex, and participation in health checkups.

Results: The study achieved a collection rate of 49.1%, with a valid response rate of 79.7%. Both junior high school students and their parents exhibited limited knowledge about kidney functions, primarily understanding these functions only in terms of waste product excretion and lacking awareness of other functions. A significant positive correlation was observed in awareness of kidney functions between students and their parents. Regarding CKD awareness, only 2.4% of students and 16.5% of parents were knowledgeable about CKD itself, while 18.9% of students and 45.3% of parents were aware of its name only. Importantly, CKD knowledge among both students and parents was associated, with those aware of CKD also demonstrating better understanding of kidney functions.

Conclusion: This study highlights inadequate knowledge among junior high school students and their parents regarding renal function and CKD. A significant correlation was observed in CKD awareness between students and their parents. These findings underscore the need for targeted strategies to enhance public education and awareness about kidney health.

Background: This study assessed the association of pathological kidney lesions with cardiovascular events in biopsy-proven diabetic kidney disease (DKD) with type 2 diabetes.

Methods: This multicenter, retrospective study involved 244 patients with no previous cardiovascular events before biopsy, estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m² at biopsy (baseline), and ≥ 1 year of observation after biopsy. The outcomes were the first occurrence of cardiovascular events (cardiovascular death, non-fatal myocardial infarction, coronary intervention, or non-fatal stroke), and non-cardiovascular deaths before cardiovascular events were considered competing events. The association between the severity of each pathological lesion and cardiovascular events was investigated.

Results: During follow-up (median: 6.4 years), 43 patients experienced cardiovascular events. The baseline clinical characteristics did not differ according to cardiovascular events. The cumulative incidence of cardiovascular events was higher in patients with mesangiolysis, global glomerulosclerosis ≥ 50%, moderate/severe interstitial inflammation, and moderate/severe arteriolar hyalinosis than in those having less advanced each lesion. Fine-Gray regression models revealed that global glomerulosclerosis ≥ 50% (subdistribution hazard ratio [SHR]: 3.85; 95% confidence interval [95% CI] 1.28-11.52), moderate/severe interstitial inflammation (SHR: 2.49; 95% CI 1.18-5.29), and moderate/severe arteriolar hyalinosis (SHR: 3.51; 95% CI 1.15-10.69) were linked to increased risk of cardiovascular events, after adjusting for clinical variables including RAAS inhibitors use at baseline. Adding the severity of these lesions to clinical variables improved the predictive value for cardiovascular events.

Conclusions: In DKD with type 2 diabetes, advanced glomerulosclerosis, interstitial inflammation, and arteriolar hyalinosis were associated with cardiovascular events, adding predictive value to clinical features.

Background: Anticoagulation is recommended for thromboprophylaxis after lower-limb orthopedic surgery. The suggested dosage is based on creatinine clearance (CCr) in the labels. However, most facilities only provide estimated glomerular filtration rate (eGFR) as laboratory data. Because the eGFR equation adjusts for a body surface area (BSA) of 1.73 m², it may overestimate renal function in patients with a small BSA. This retrospective study aimed to determine whether different renal function estimation formulas affect the incidences of venous thromboembolism (VTE) and bleeding when determining anticoagulant dosages.

Methods: This study included patients who underwent lower-limb orthopedic surgery and received anticoagulants (edoxaban, enoxaparin, and fondaparinux) between 2017 and 2020 at Yaizu City Hospital. Anticoagulant dosing was evaluated using CCr, eGFR, and de-indexed eGFR (without correction for BSA), and the incidences of VTE and bleeding were compared among these formulas.

Results: The median values for BSA, CCr, eGFR, and de-indexed eGFR were 1.40 m², 56.0 mL/min, 73.0 mL/min/1.73m², and 60.9 mL/min, respectively. There was no significant difference in the VTE incidence among these formulas. However, when dose reduction or contraindication threshold was determined by eGFR vs. CCr, the bleeding incidence was significantly higher in the group that was overdosed by CCr (6.0% vs. 25.7%, p < 0.05). Similarly, using de-indexed eGFR vs. CCr, the bleeding incidence was significantly higher in the group that was overdosed by CCr (7.5% vs. 28.6%, p < 0.05).

Conclusions: In orthopedic surgery, anticoagulant dosages should be based on CCr for patients with a small BSA to avoid bleeding risks.

Background: Rituximab (RIT) induction therapy is widely used for desensitization against ABO-incompatible living-donor kidney transplants (KT). However, the efficacy of valganciclovir (VGCV) prophylaxis against cytomegalovirus (CMV) disease and infection in KT recipients (KTRs) following RIT induction remains unclear.

Methods: The current multicenter retrospective study included 213 KTRs who received low-dose RIT induction between 1998 and 2021, across 6 facilities included in the Michinoku Renal Transplant Network (MRTN). VGCV dosage varied from 450 mg/day (twice weekly) to 900 mg/day (daily), with treatment durations of 3-12 months. The primary and secondary endpoints were the incidence of CMV disease and infection, respectively.

Results: The incidence of CMV disease was significantly higher in the VGCV group (23.5%; 16 patients) than in the non-VGCV group (5.5%; 8 patients) (p < 0.01). The incidence of CMV infection was 54.5% (79 patients) in the non-VGCV group and 48.5% (33 patients) in the VGCV group, with no significant difference (p = 0.42). In the subgroup of CMV-seronegative KTRs receiving allografts from CMV-seropositive donors (CMV IgG (D + /R-)), 18 out of 24 KTRs received VGCV prophylaxis, of whom 10 (55.6%) developed CMV disease. Within this subgroup, only 4 KTRs received VGCV with the standard protocol (900 mg daily for 6 months), and none developed CMV disease.

Conclusion: Insufficient VGCV prophylaxis does not reduce the incidence of CMV disease in KTRs following low-dose RIT induction. Despite concerns about leukopenia due to RIT and VGCV, in KTRs with CMV IgG (D + /R-) serostatus, VGCV prophylaxis with a standard protocol may be advisable.

Objective: Irregular sleep duration has been linked with systemic diseases as well as chronic kidney disease (CKD). However, most of the evidence is low-quality and from cross-sectional data. We hereby present a meta-analysis of cohort studies examining the longitudinal association between short and long sleep with the risk of CKD or proteinuria.

Methods: Databases of Embase, PubMed, CENTRAL, Web of Science, and Scopus were searched up to 5th April 2024. The risk of CKD/proteinuria was assessed with short or long sleep duration.

Results: Nine studies were included. Both short and long sleep duration were associated with a mild increase in the risk of CKD/proteinuria. Based on different cutoffs for short sleep, we noted that sleep of ≤ 7 h was not associated with a significantly increased risk of CKD/proteinuria. A mild significant risk was noted in the subgroup of ≤ 6 h while a significant association was noted for sleep ≤ 5 h. For longer sleep duration, individuals with ≥ 8 h of sleep had an increased risk of CKD/proteinuria. However, the results were non-significant for individuals with ≥ 9 h of sleep. Non-significant results were noted for separate analyses on male, female, high body mass index, and elderly (≥ 60 years) individuals.

Conclusion: Both short and long sleep durations are associated with a significant increase in the risk of CKD/proteinuria in the adult population.