Clinical nephrology最新文献

Background: Acute kidney injury (AKI) is common in critically ill patients in the medical intensive care unit (ICU), and it is associated with increased morbidity and mortality. Recent studies suggest a significant link between AKI and disturbances in the gut microbiota (GM).

Materials and methods: We used summary genome-wide association studies (GWAS) data from MiBioGen for GM and AKI data from the FinnGen cohort. Causal relationships were primarily assessed using the inverse variance weighted (IVW) method, with MR-PRESSO and MR-Egger tests to address potential horizontal pleiotropy. Heterogeneity was evaluated using Cochran's Q and I² values.

Results: The IVW method revealed a causal association between 14 gut microbial taxa and AKI. The Phylum Firmicutes (id. 1672), Order Pasteurellales (id. 3688), Genus unknowngenus (id. 2071), Genus RuminococcaceaeUCG010 (id. 11367), Genus RuminococcaceaeUCG005 (id. 11363), Genus Haemophilus (id. 3698), Genus Flavonifractor (id. 2059), Genus ErysipelotrichaceaeUCG003 (id. 11384), Genus Dialister (id. 2183), Genus Coprococcus2 (id. 11302), and Family Pasteurellaceae (id. 3689) were negatively associated with AKI risk. Conversely, Genus Victivallis (id. 2256), Genus RuminococcaceaeUCG013 (id. 11370), and Genus Erysipelatoclostridium (id. 11381) were positively associated with AKI risk. Additionally, hepatocyte growth factor (HGF), interleukin-10 (IL-10), fibroblast growth factor-23 (FGF-23), and tumor necrosis factor alpha (TNF-α) were potentially causative in AKI onset.

Conclusion: This study emphasizes the significant role of gut microbiota interactions with inflammatory factors in AKI pathogenesis. The identified risk factors underscore their essential role in both the onset and progression of AKI.

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.

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.

Aims: To investigate the effect of atrial fibrillation (AF) on the risk for new-onset chronic kidney disease (CKD) and all-cause mortality in a sample Chinese population.

Materials and methods: A total of 1,432 patients with AF were propensity matched (1 : 4) with 5,722 individuals without AF (non-AF group). Clinical endpoints included new-onset CKD or all-cause mortality. The cumulative incidence of new-onset CKD in the two groups was compared using Kaplan-Meier curve analysis. The association between AF and the risk for new-onset CKD or all-cause mortality was assessed using a Cox proportional hazards model.

Results: During the 5.9-year follow-up, 190 and 641 cases of new-onset CKD were recorded in the AF and non-AF groups, respectively. The AF group had a significantly higher cumulative incidence of new-onset CKD at 21.66% compared to the non-AF group at 17.33% (p < 0.001). In addition, 346 and 841 deaths occurred in the AF and non-AF groups, respectively. The AF group had a significantly higher cumulative incidence of all-cause mortality at 39.65% compared to the non-AF group at 23.86% (p < 0.001). The multivariate Cox proportional hazards regression analysis model revealed that AF was significantly associated with new-onset CKD and all-cause mortality.

Conclusion: Atrial fibrillation was significantly associated with both new-onset CKD and all-cause mortality, suggesting that AF is a potential risk factor for new-onset CKD.

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.

Background: No drug has been shown to be effective in preventing cardiac surgery-associated acute kidney injury (CSA-AKI). In different clinical settings, sodium-glucose transporter 2 (SGLT2) inhibitors confer renal protection and may be promising drug candidates. We examined the association between preoperative dapagliflozin use and the incidence and prognosis of CSA-AKI.

Materials and methods: Data were obtained for consecutive patients undergoing cardiac surgery with cardiopulmonary bypass between December 2020 and November 2022 at a large teaching hospital in Eastern China. The exposure was preoperative dapagliflozin use, and the primary outcome was the incidence of AKI within seven days following cardiac surgery. The secondary outcomes included dialysis, death, AKI recovery, and length of hospitalization. The association between the exposures and outcomes was determined by various logistic regression models with propensity scores.

Results: A total of 1,424 patients were included, of which 201 (14.1%) received dapagliflozin preoperatively, and 321 (22.5%) developed CSA-AKI. Patients with dapagliflozin use developed CSA-AKI more frequently than those without (32.3 vs. 20.9%, unadjusted odds ratio 1.81; 95% CI, 1.30 - 2.50). However, the association became non-significant in the multivariate model (adjusted odds ratio, 1.11; 95% CI, 0.73 - 1.68), in the adjusted model with inverse probability weighting (odds ratio, 1.21; 95% CI, 0.76 - 1.93), or in the propensity-score-matched model (odds ratio, 1.09, 95% CI, 0.68 - 1.73). Furthermore, there was no significant association between preoperative dapagliflozin use and secondary outcomes.

Conclusion: Results from this study suggest that preoperative dapagliflozin use was not associated with a lower risk of CSA-AKI.

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.

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.

Background: Chronic kidney disease (CKD) is a highly prevalent condition with complications such as constipation, inflammation, and dietary restrictions. Gut microbiota is an ecosystem of trillions of bacteria and other microorganisms such as viruses, fungi, and other eukaryotes. This review aimed to analyze the correlation between CKD and the microbiota.

Materials and methods: This is a literature review of recent articles published in the Medline database.

Results: As CKD progresses, there is a change in the composition of the gut bacteria colonies, with the production of gut-derived uremic toxins. Gut-impaired permeability facilitates the bacteria fragments' translocation, increasing the stimulus for producing inflammatory mediators. Many interventions have been suggested to modulate the gut composition, and the administration of substances to interact with bacteria or decrease inflammatory status is of central interest. Probiotics are live microorganisms that interact with the local microbiota, and prebiotics are non-digested compounds that reach the colon. Their administration reduces the production of uremic toxins and inflammatory substances but fails to protect against chronic kidney disease progression.

Conclusion: Curcumin decreases uremic compounds and inflammation. Physical exercise did not act as a gut microbiota modulator. Systematic reviews and metanalysis evaluating gut microbiota modulators revealed a lack of positive impact on renal deterioration but a good reduction in the production of uremic toxins.