Clinical nephrology最新文献

Background: Patients receiving maintenance hemodialysis (MHD) are at increased risk of osteoporosis. The effects of bilirubin on bone metabolism vary among different disease populations. However, the relationship between total bilirubin (TBIL) and bone metabolism in MHD has not been investigated yet.

Materials and methods: This cross-sectional study included 122 MHD patients aged ≥ 18 years who underwent regular hemodialysis at the Blood Purification Center of Aerospace Central Hospital from April 2021 to April 2023. Blood sampling and bone mineral density (BMD) examinations were conducted. Multivariate linear regression, restricted cubic spline and subgroup analyses were performed to evaluate the association between TBIL and BMD.

Results: TBIL (correlation coefficient: 1.7 (0.17, 3.25); p = 0.04) was independently associated with BMD in the multivariate linear regression analysis. The results showed that BMD was nonlinearly related to TBIL in MHD patients, exhibiting a J shaped curve (p = 0.035). When plasma TBIL level < 0.64 mg/dL, there is an average increase of 5.3 (95% CI: 2.0 - 8.7; p = 0.002) g/cm² in BMD for every 1-unit increase in plasma TBIL level. The association between TBIL and BMD was not significant when the plasma TBIL level was ≥ 0.64 mg/dL.

Conclusion: The relationship between TBIL and BMD in MHD patients is J-shaped, with an inflection point of 0.64 mg/dL.

Introduction: After kidney transplantation, persistent hyperparathyroidism commonly occurs, often alongside increased serum calcium levels. It is reasonable to infer that kidney transplant recipients (KTRs) with hypercalcemia related to persistent hyperparathyroidism are more susceptible to developing anemia. However, reports suggest that hypercalcemia could be a contributing factor to erythrocytosis. Our aim was to assess the effect of persistent hypercalcemia on the trajectory of hemoglobin levels after transplantation.

Materials and methods: We conducted a retrospective cohort study investigating the trajectory of hemoglobin in 385 KTRs with and without persistent hypercalcemia (free Ca > 5.2 mg/dL). We performed mixed-model analyses adjusting for potential confounders.

Results: Persistent hypercalcemia was present in 62% KTRs (56% male, median age 36 (IQR 28 - 48) years, median follow-up 4.1 (IQR 1 - 8.2) years). Compared to KTRs without hypercalcemia, KTRs with persistent hypercalcemia had a mean positive difference in hemoglobin levels of +0.76 g/dL/year (95% CI +0.45 - +1.08, p < 0.001) throughout the follow-up period. Specifically, the change slope was +0.80 (95% CI +0.32 - +1.27, p < 0.001) g/dL/year for males and +0.36 (95% CI +0.16 - +1.08, p < 0.001) g/dL/year for females. Persistent hypercalcemia was significantly associated with post-transplant erythrocytosis according to the WHO (47 vs. 24%, OR 2.8, 95% CI 1.8 - 4.4) and altitude-adjusted criteria (22 vs. 10%, OR 2.5, 95% CI 1.2 - 4.5). The effect of hypercalcemia on hemoglobin levels was consistent after adjusting for confounders, except in KTRs who developed an estimated glomerular filtration rate < 45 mL/min/1.73m2 after transplantation.

Conclusion: Persistent hypercalcemia after kidney transplantation was significantly associated with higher hemoglobin levels and an increased risk of developing post-transplant erythrocytosis.

Introduction: Hemodialysis patients need long-term frequent use of parenteral anticoagulants, and the side effects need to be taken seriously. This study aimed to assess the reporting of adverse drug reactions (ADRs) following administration of unfractionated heparin (UFH), low molecular weight heparins (LMWHs), fondaparinux, and danaparoid, in relation to their usage in European Economic Area (EEA).

Materials and methods: The total number of ADRs of each anticoagulant between 2017 to 2021 was collected using data from the EudraVigilance database. The number of hemorrhages, thrombocytopenia, injection-site reaction, liver injury, hypersensitivity and bone disorder were collected, respectively. Usage of these anticoagulants was estimated using sales data from the IQVIA MIDAS database. The reporting rates of ADRs were calculated and compared using χ²-test.

Results: Between 2017 and 2021 in the EEA, the overall ADRs reporting rates per 10,000,000 standard units (SU) of UFH, enoxaparin, nadroparin, dalteparin, fondaparinux, and danaparoid were 12.3, 40.8, 23.6, 36.5, 91.4, and 430.0, respectively. There were significant differences among these drugs (χ² = 7,239.26, p < 0.001). Specifically, hemorrhage and thrombocytopenia were reported at higher rates, ranging from 2.8 to 140.1, and 2.0 to 115.9 per 10,000,000 SU among different anticoagulants. Injection-site reactions and hypersensitivity came in second, between 0.2 - 29.0 and 0.1 - 53.1 per 10,000,000 SU, respectively. The reporting rates for liver injury and bone disorder were reported at low rates.

Conclusion: The reporting rates of ADRs for heparin and its derivates were all very low. In comparison, the reporting rate of ADRs for danaparoid and fondaparinux was relatively high. The most commonly reported ADRs were hemorrhage, thrombocytopenia, followed by injection-site reactions and hypersensitivity.

Purpose: Patient self-care and knowledge of chronic kidney disease (CKD) play a crucial role in treatment effectiveness at slowing disease progression and reducing complications. There is need for tools that can quantitatively assess patients' knowledge of CKD. We aimed to translate the Kidney Disease Knowledge Survey (KiKS) to Turkish, validate the questionnaire among CKD patients, and identify the determinants of CKD knowledge.

Materials and methods: The 28-item KiKS was translated into Turkish and administered to 271 CKD patients not on dialysis. Reliability of survey questions was assessed using Cronbach's α coefficient. Hotelling's T-squared test was used to measure effectiveness and homogeneity of the scale. Univariate and multivariate regression analyses were performed to identify the determinants of CKD knowledge.

Results: The mean age of participants was 56.7 ± 13.0 years; 54.2% were male, and 68.3% had CKD stages 3 - 5. Cronbach's α value of scale for the 28-item KiKS was 0.804, confirming its reliability (p < 0.001). Multivariate linear regression analysis showed that CKD stage 3 patients were associated with lower KiKS scores compared to stage 1. Participants who were aware of their CKD diagnosis and used the internet to obtain information about kidney disease had higher scores.

Conclusion: The Turkish version of KiKS is reliable and valid to assess the knowledge level of Turkish CKD patients. Advanced stages of CKD were associated with less knowledge about kidney disease in this population. Targeted educational interventions or longitudinal studies are needed to assess the impact of improved CKD knowledge on clinical outcomes.

Background: Kidney transplant (KT) recipients are at risk of severe disease and high mortality from COVID-19, and vaccination offers some degree of protection. In this study, KT recipients' and controls' attitudes towards COVID-19 vaccination were examined.

Materials and methods: In this cross-sectional survey-based study, the willingness and hesitancy towards COVID-19 vaccines in KT recipients and a control group from the general population were assessed via questionnaire. Vaccine hesitancy was described as either not being fully vaccinated or vaccine refusal.

Results: A total of 154 KT recipients and 172 controls completed the questionnaire. The rate of those who had received at least 1 dose of COVID-19 vaccine was similar in the two study groups (92.4 vs. 92.9%, p = 0.88). The proportion of those fully vaccinated against COVID-19 was significantly lower in the KT recipients (58.7 vs. 70.4% p = 0.033). Only 11 (7.1%) of the KT recipients refused the COVID-19 vaccination. There was no significant difference between the groups in terms of vaccine refusal and vaccine hesitancy rates. Concerns about vaccine-related adverse events were common in both groups (63.6 vs. 53.8%; p = 0.488).

Conclusion: Although participants showed a high willingness towards COVID-19 vaccination, the number of KT recipients who were fully vaccinated appears to be lower than controls. Concerns about vaccine-related adverse events were the main reason for avoiding vaccination. Healthcare personnel, particularly nephrologists and public health experts, must take a proactive role in addressing vaccine hesitancy and ensuring that patients receive the required protection against COVID-19.

Background: Patients with chronic kidney disease (CKD) have serum, bone, and vascular abnormalities presenting as chronic kidney disease-mineral bone disorder (CKD-MBD) syndrome. This study sought to identify the parameters with the greatest relative impact on progression of CKD-MBD abnormalities.

Materials and methods: This prospective study measured 237 parameters including serum markers, clinical variables, dual-energy X-ray absorptiometry (DXA) measurements, vascular calcifications, and histomorphometric results from bone samples obtained at baseline and after 2 - 3 years. Relative impact of these parameters on kidney function, bone changes, and vascular calcification were assessed using machine learning, a subset of artificial intelligence analyses.

Results: Baseline estimated glomerular filtration rate (eGFR) values ranged from 18 to 70 mL/min and declined in 52% of subjects by at least 3.3% annually during the study. These declines in eGFR were associated with changes in specific serum markers, bone quantity decreases, and bone quality alterations, but not with arterial calcifications. Arterial calcifications were associated with collagen crosslinking heterogeneity, serum phosphorus, diuretics and atorvastatin treatment, but not with kidney function. Baseline collagen crosslinking heterogeneity was an important factor impacting progression of coronary, but not aortic calcification. Baseline serum phosphorus was a factor primarily associated with progression of aortic calcification.

Conclusion: Machine learning revealed specific bone and vascular abnormalities occurring early during loss of kidney function. Bone, vascular, blood, medication use, and other parameters were identified impacting the presence and progression of arterial calcification and altering bone quality and quantity in this understudied patient population. Serum phosphorus levels considered normal impacted progression of arterial calcification. Identification of these parameters and their relative importance enhances our understanding of CKD progression and should improve patient care.

Aims: Reliable national estimates for the incidence and prevalence of immunoglobulin A nephropathy (IgAN) in the United States (U.S.) are needed. We performed a national survey with pathologists and used insurance claims data to estimate IgAN frequency nationwide.

Materials and methods: An online survey with pathologists was conducted between November and December 2021 to obtain data on the number and types of biopsies evaluated and the proportion with IgAN confirmed. Biopsy data were extrapolated to two different claims databases to estimate incidence and prevalence. Results were validated against a separate dataset of electronic health records.

Results: A total of 43 pathologists from across U.S. regions reported evaluating a mean of 169 kidney biopsies (standard deviation 179.1) in the past 12 months. Of the 7,267 total biopsies evaluated, 632 (8.7%) were IgAN. Based on the respective claims databases, annual incidence rates of 2.1 and 2.2 per 100,000 and prevalence rates of 59.9 and 62.7 per 100,000 were estimated. Results from the validation dataset were similar, with an incidence of 1.9 per 100,000 and prevalence of 54.2 per 100,000.

Conclusion: This study estimated incidence and prevalence of IgAN. Extrapolating the findings to the U.S. population for 2021, total prevalence was 198,887 - 208,184 persons.

Introduction: Lung cancer ranks among the foremost causes of mortality associated with cancer. Ensartinib is a highly effective oral anaplastic lymphoma kinase (ALK) inhibitor utilized in the treatment of ALK-positive lung adenocarcinoma. This report presents a case of acute renal failure attributed to the administration of ensartinib. This is the first case report documenting the nephrotoxic effects of ensartinib, specifically manifesting as acute tubulointerstitial nephritis (ATIN) and IgA nephropathy.

Case presentation: This report details the case of a 52-year-old man diagnosed with ALK-positive lung adenocarcinoma. The patient was initially treated with crizotinib for a duration exceeding 6 months; however, he was subsequently transitioned to ensartinib due to disease progression characterized by the development of brain metastases. Within 3 months of initiating treatment with ensartinib, the patient experienced acute kidney failure. The renal failure was attributed to ATIN and IgA nephropathy, which were considered manifestations of renal toxicity associated with ensartinib.

Conclusion: This case underscores the uncommon adverse effect of ALK-targeting therapy, specifically regarding acute renal failure induced by ensartinib. We recommend conducting a renal biopsy to ascertain the presence of drug-induced nephrotoxicity. An accurate diagnosis and timely intervention can prevent the deterioration of renal function.

Introduction: Free radical-mediated oxidative renal tubular injury secondary to hyperoxaluria is a proposed mechanism in the formation of calcium oxalate stones. Vitamin E, an important physiologic antioxidant, has been shown in rat models to prevent calcium oxalate crystal deposition. Our objective was to determine if low dietary vitamin E intake was associated with a higher incidence of stones.

Materials and methods: We analyzed data from the 2017 to 2020 National Health and Nutrition Examination Survey, a nationally representative sample (n = 7,707). A multivariable logistic regression model was used to assess the association between elevated dietary vitamin E intake (≥ 15 mg/day) and nephrolithiasis controlling for key demographic variables: water and nutrient intake (sodium, calcium, vitamin C), and diabetes mellitus.

Results: The incidence of nephrolithiasis was 1.66% (1.38% - 1.95%). In patients consuming < 15 mg/day vitamin E, the incidence was 1.8% compared to 0.8% in patients with vitamin E intake ≥ 15 mg/day (p = 0.024). In adjusted models, participants with low vitamin E intake had a significantly higher odds of reporting stone passage (aOR = 2.83, 95% CI (1.07 - 7.5)).

Conclusion: We found that low vitamin E intake is associated with a > 2.5× greater odds of stone passage. These data are consistent with animal models suggesting that vitamin E may play an important protective role in the pathogenesis of calcium oxalate stone formation. This is the first study assessing the relationship between vitamin E intake and nephrolithiasis in humans. Future investigation of vitamin E supplementation in stone formers may help further determine if vitamin E is useful in the management of calcium oxalate stones.

Dialysis initiation during an emergency hospital admission is associated with increased complications, more temporary access, and higher mortality. Even in patients known to nephrologists, more than one-third start dialysis in an unplanned fashion. This retrospective case-control study sought to identify features of the pre-dialysis period that are associated with unplanned dialysis initiation in patients known to nephrology services. 40 consecutive patients (median age 61, 85% male) who underwent unplanned dialysis initiation (cases) were individually matched by age and sex with patients who started dialysis in a planned fashion during a similar period (controls). Clinical and laboratory data were collected from electronic patient records and correspondence. Across the pre-dialysis year, cases had a faster estimated glomerular filtration rate (eGFR) decline, greater weight gain, missed more nephrology clinic appointments, and had more emergency hospital admissions compared to controls. In multivariable analysis, predictors of unplanned dialysis initiation were eGFR trajectory (OR 1.91 per -1 mL/min/1.73m²/month, 95% CI 1.10 - 3.30, p = 0.021), weight gain (OR 1.97 per +1%/month, 95% CI 1.33 - 2.93, p < 0.001), and clinic non-attendance (OR 1.54 per clinic, 95% CI 1.09 - 2.18, p = 0.015). The findings of this study suggest that to better identify individuals nearing dialysis who are at high risk for unplanned initiation, nephrologists need to move away from traditional markers of disease progression, such as latest eGFR and proteinuria, and instead look at trends in eGFR, trends in weight, and levels of patient engagement with pre-dialysis care.