Clinical nephrology最新文献

Objective: A growing body of research has shown a connection between chronic pain and chronic kidney disease (CKD). However, it is unclear if these correlations point to a cause-and-effect link. Our goal is to investigate the causal link between renal function or CKD and chronic pain.

Materials and methods: Using genome-wide association study (GWAS) datasets on these traits, we performed bidirectional two-sample Mendelian randomization (MR) analyses in this work to evaluate genetic linkages and possible causal links between chronic pain and CKD or renal function. The CKD Genetics Consortium provided the GWAS data for CKD symptoms, estimated creatinine-based glomerular filtration rate (eGFRcrea) and cystatin C-based GFR (eGFRcys). A sizable biomedical database of GWAS provided summary statistics for both chronic widespread musculoskeletal pain (CWP) and multisite chronic pain (MCP).

Results: MR analysis revealed that MCP was significantly associated with an increased risk of CKD (OR = 1.52; 95% CI: 0.97 - 2.40; p = 0.037) and eGFRcys decline (OR = 0.97; 95% CI: 0.95 - 0.99; p = 0.014). The reliability of the MR analysis was demonstrated by sensitivity analysis. However, MR analysis did not find a significant association between CWP and CKD or renal function decline. Additionally, this study did not discover a link between renal function decline or CKD and chronic pain.

Conclusion: Our research revealed a substantial correlation between MCP and a higher risk of CKD and renal function deterioration.

Objective: Chronic kidney disease (CKD) is prevalent among Veterans and is strongly associated with cardiovascular disease (CVD) and mortality. Fruit and vegetable intake may help manage CKD and CVD. However, the relationships of dietary intake of kidney-impacting nutrients from plant-based foods with vascular function, oxidation, and inflammation in CKD is uncertain.

Materials and methods: We conducted a post-hoc analysis of the Phosphate Lowering in CKD Trial evaluating the association of unprocessed, plant-based energy and nutrient intake with pulse wave velocity (PWV), flow meditated dilation (FMD), and markers of oxidative stress and inflammation. Participants had stage 3b - 4 CKD and serum phosphorus of 2.8 - 5.5 mg/dL. Linear regression models were adjusted for age, sex, body mass index, blood pressure, diabetes, CVD, and kidney function.

Results: Participants (n = 42) were aged 66 ± 7 years with estimated glomerular filtration rate 36.2 ± 10.1 mL/min/1.73m²; 88% were male. Diets comprised large proportions of animal and processed foods. Higher daily intake of unprocessed plant-based energy, potassium, phosphorus, and protein were each significantly associated with lower PWV in fully adjusted models: -1.11 cm/s (95% CI: -1.98, -0.25 cm/s), -0.49 cm/s (95% CI: -0.86, -0.12 cm/s), -312.4 cm/s (95% CI: -514.5, -110.3 cm/s), and -280.3 cm/s (95% CI: -484.4, -76.2 cm/s), respectively. However, unprocessed, plant-based nutrient intakes were not associated with FMD or markers of oxidation or inflammation.

Conclusion: Despite overall low diet quality, higher consumption of unprocessed, plant-based energy and nutrients was associated with lower arterial stiffness. Future studies are needed to explore these associations in larger cohorts with CKD and the effects of diet quality interventions.

Aims: Longitudinal trajectory analysis can provide important insights into the optimal levels of metabolic factors in chronic kidney disease (CKD). This study evaluated the association between longitudinal trajectories of metabolic disturbances and prognosis in CKD.

Materials and methods: We used data from the National Health Insurance Service-National Health Screening Cohort, which comprises data from 514,866 subjects randomly selected from the 2002 and 2003 health screening participants, who were aged between 40 and 79 years. Subjects were classified into trajectory groups using K-means clustering - an algorithm that assigns individual data points to groups according to similarity of the data - based on metabolic parameters, including blood pressure (BP), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI). Subjects were classified into groups with similar trajectories based on the central value with the minimum distance. The optimal number of clusters was selected using the Calinski-Harabasz index. Outcomes were a decline in renal function and all-cause mortality.

Results: A total of 24,094 CKD patients were included in the trajectory analysis. After clustering, BP, triglycerides, and LDL-C were divided into low and high categories, while BMI was classified into 6 categories according to the distribution of participants. Logistic regression analysis showed that a high systolic BP trajectory and underweight trajectory were associated with all-cause mortality, while high systolic BP, low diastolic BP, and high triglyceride trajectories were associated with a decline in renal function.

Conclusion: This study demonstrated the association between longitudinal trajectories of metabolic disturbances and the prognosis of CKD. Using trajectories of metabolic parameters could be helpful for predicting renal outcomes and mortality in CKD.

Aims: To evaluate if the association between anemia and mortality is affected by blood glucose levels in hemodialysis patients.

Materials and methods: A total of 818 consecutive patients who started hemodialysis between January 2013 and December 2016 were included in this study, followed until December 2022. Patients were categorized into five HbA1c groups (< 5%, 5 - 5.9%, 6 - 6.9%, 7 - 7.9%, and ≥ 8%) and six hemoglobin (Hb) groups (< 9, 9 - 10, 10 - 11, 11 - 12, 12 - 13, and > 13 g/dL). Kaplan-Meier survival analysis and multivariate Cox regression were performed to evaluate the association between Hb levels and all-cause mortality, adjusting for confounders.

Results: There were 310 (37.9%) deaths during a maximum follow-up of 120 months. Lower Hb levels were significantly associated with increased mortality risk (p for trend < 0.01). However, subgroup analysis revealed a significant interaction between Hb and HbA1c levels (p for interaction < 0.01). In patients with HbA1c < 5% and 5 - 5.9%, lower Hb levels (< 11 g/dL) were associated with a higher risk of mortality (p for trend < 0.05). In contrast, in patients with HbA1c ≥ 6%, Hb levels were not significantly associated with mortality risk (p for trend > 0.05).

Conclusion: The association between anemia and mortality in hemodialysis patients varies across HbA1c levels. Lower Hb levels were associated with increased mortality risk in patients with HbA1c < 6%, whereas this association was not observed in those with HbA1c ≥ 6%.

Objective: To evaluate the efficacy and safety of fluoroscopic-guided repositioning of peritoneal dialysis (PD) catheter using guidewire manipulation in our center in Hong Kong.

Materials and methods: All patients underwent fluoroscopic-guided PD catheter repositioning in our institution between November 1, 2017 to December 31, 2022 were reviewed. Patients fulfilling the selection criteria were identified, with their clinical notes, relevant radiological reports, interventional images, and operative records retrospectively reviewed. The success rate was evaluated, with the technical success defined as improved free contrast flow or return of continuous steady stream after test injection of normal saline immediately after repositioning; clinical success defined as functional peritoneal dialysis catheter at 30 days post-repositioning. Logistic regression models were applied to evaluate the variables associated with successful manipulation. Post-manipulation complications and the PD time gained after successful manipulation were also reviewed.

Results: 46 patients were identified and 54 procedures were performed over the study period. 35 of the interventions (64.8%) resulted in technical success, and 25 cases (46.3%) resulted in clinical success. The median extra PD time gained after successful manipulation was 619 days (IQR, 313.5 - 1,007; range, 110 - 1,872). The median for number of days of hospital stay after the procedure was 2.5 days (IQR, 2 - 5; range, 1 - 65). Seven cases (13.0%) developed immediate complications, with most cases being peritonitis (n = 5), and all were successfully treated with intraperitoneal antibiotics. There was no associated mortality.

Conclusion: Fluoroscopic-guided repositioning of the PD catheter was found to be a useful and safe treatment option for malfunctioning PD catheter and could potentially spare patients from the conventional operative intervention.

Although malignant hypertension (MH) treatment has significantly advanced with the introduction of modern antihypertensive agents, progression to end-stage renal disease remains a significant cause of morbidity and mortality. Additionally, the efficacy of sacubitril/valsartan, which is an angiotensin receptor-neprilysin inhibitor (ARNI), for patients with advanced kidney dysfunction and MH remains unknown. We report the cases of two patients with severe kidney and cardiac dysfunction who received uninterrupted antihypertensive treatment, including sacubitril/valsartan and experienced significant clinical improvement in proteinuria and renal function as well as left ventricular reverse remodeling. This report highlights the benefits of ARNI therapy for MH and its renoprotective effects.

Aim: Chronic glomerulonephritis (GN) encompasses various disorders that lead to glomerular inflammation and damage through the interaction of environmental triggers such as immune-mediated mechanisms and infections. The aim of the study was to investigate the relationship between proteinuria and left ventricular hypertrophy (LVH) in non-diabetic chronic GN patients.

Materials and methods: This study was conducted with 103 (62.4%) male and 62 (37.6%) female chronic GN patients with a mean age of 55.65 ± 15.81 years. Patients were compared with 90 healthy individuals of similar age and gender. Proteinuria levels were measured using 24-hour proteinuria quantification (24h QP). Left ventricular (LV) ejection fraction (LVEF), LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), and LV mass index (LVMI) were calculated using echocardiography.

Results: Proteinuria was determined to be ≥ 3.5 g/day in 54 (32.7%) of the patients. In patients, creatinine, LVMI, and LVH were significantly higher compared to healthy individuals. Patients with nephrotic proteinuria had higher LVMI and LVH compared to those with non-nephrotic proteinuria. A significant relationship was found between LVMI and LVH in patients with nephrotic proteinuria. In the univariate logistic regression analysis, an increase in LVH and LVMI values was found to be associated with an increase in nephrotic proteinuria levels.

Conclusion: Increased development of LVH was observed in patients compared to healthy individuals. Significantly higher development of LVH was observed in those with nephrotic proteinuria compared to those without. A significant relationship was observed between nephrotic proteinuria and LVH as well as LVMI in patients with chronic GN.

Background: Acute kidney injury (AKI) is a common condition present at admission to hospital in a proportion of general medical patients and it contributes to mortality. Presence of associated malnutrition could worsen the prognosis. We aimed to study the prevalence of malnutrition in patients with community-acquired AKI requiring hospitalization and its association with short-term (in-hospital and 1-month post-discharge) mortality, admission to the intensive care unit (ICU) and length of hospitalization (LOH).

Materials and methods: We did a prospective observational study including adult general medical patients who had AKI at admission; patients with chronic kidney disease were excluded. We calculated the Charlson Comorbidity Index (CCI) and Sequential Organ Failure Assessment Score (SOFA). Nutritional assessment was done using Subjective Global Assessment (SGA) and also Prognostic Nutritional Index (PNI). Clinical course and vital status at 1 month after discharge was noted. Predictors of mortality were identified using logistic regression.

Results: We recruited 230 patients. The median (interquartile range (IQR)) age was 51 (40 - 64) years; 171 (74.3%) were males. Based on admission creatinine, 60 (26%) were in Kidney Disease Improving Global Outcomes (KDIGO) stage 1, 82 (35.6%) in stage 2, and 88 (38.3%) in stage 3. We found that 132 (57.4%) belonged to SGA category A, 77 (33.5%) to SGA B, and 21 (9.1%) to SGA C. The median (IQR) PNI was 36.3 (30 - 46.6). The short-term mortality was 59 (25.6%). Multivariable analysis showed that male sex (adjusted OR (aOR) (2.75 (1.08 - 6.98); p = 0.033), higher CCI (aOR 1.43 (1.18 - 1.74); p < 0.001), higher SOFA scores (aOR 1.36 (1.19 - 1.55); p < 0.001), and SGA C category (aOR 4.4 (1.39 - 14.03); p = 0.012) to be associated with mortality, while AKI due to underlying infections was associated with survival (aOR 0.38 (0.18 - 0.78); p = 0.008). There was no association of malnutrition with ICU admission or LOH. PNI did not predict mortality.

Conclusion: About 10% of patients with community-acquired AKI had severe malnutrition, and it independently predicts mortality. Male sex, higher CCI, and higher SOFA scores were also associated with mortality. AKI associated with infections has a better prognosis.

Introduction: Acute kidney injury (AKI) constitutes a complication frequently encountered in patients with severe forms of COVID-19. The aim of this study was to evaluate the prevalence of acute kidney injury and to describe its associated factors.

Materials and methods: This was a retrospective, descriptive, analytical study over a period of 18 months at Dalal Jamm Hospital in Dakar. We included all patients admitted to the intensive care unit for the treatment of COVID-19. AKI was defined according to KDIGO 2012.

Results: During the study period, we collected 170 files. The mean age was 59.38 ± 14.81 years, and 40.6% were women. Hypertension and diabetes mellitus were the most frequently found comorbidities, respectively, in 37.65% and 31.18% of cases. AKI was present in 50 (29.4%) patients. Acute tubular injury was found in 44% of cases. Hemodialysis was performed in 10% of cases, and the indications were hyperkalemia (100%), and uremic encephalopathy (40%). Death occurred in 62.36% of cases. Recovery of renal function during hospitalization was noted in 16% of patients. In multivariable analysis, the factors associated with AKI were obesity (p = 0.020; adjusted odds ratio (aOR) = 7.406; 95% CI = 2.25 - 37.11) and non-renal Sequential Organ Failure Assessment (SOFA) (p = 0.001; aOR = 5.851; 95% CI = 3.04 - 11.2). AKI was an independently associated factor with death (p = 0.002; aOR = 4.510; 95% CI = 2.51 - 9.52).

Conclusion: AKI is common during COVID-19. AKI is correlated with the severity of the disease and the presence of comorbidities. AKI is independently associated with increased risk of death in COVID-19.

Objectives: This study aimed to analyze the clinical and prognostic differences in immune-mediated membranous nephropathy (MN) concurrent with other forms of glomerulonephritis.

Materials and methods: A retrospective cohort study at Jinling Hospital from 2015 to 2023 included patients with PLA2R antibody levels ≥ 14RU/mL who underwent renal biopsy. Those with immune-mediated MN and concurrent glomerulonephritides were compared to a control group with isolated MN diagnosed in 2015.

Results: Concurrent glomerulonephritis was found in 5.53% of the MN cohort, including 61 patients with IgA nephropathy (IgAN-MN), 49 with diabetic nephropathy (DN-MN), and 131 with focal segmental glomerulosclerosis (FSGS-MN). Compared to the control group, those with IgAN-MN showed increased severity of glomerular injury yet had a reduced degree of interstitial fibrosis. The DN-MN group exhibited intensified glomerular damage; however, no significant difference was observed in the extent of tubulointerstitial damage. Additionally, the FSGS-MN group displayed more severe damage to both glomerular and tubulointerstitial structures. Both the DN-MN group and the FSGS-MN group exhibited a significantly lower complete remission rate compared to the control group. The renal endpoint event rates were 29.51% for IgAN-MN, 46.94% for DN-MN, and 33.59% for FSGS-MN, which were all significantly higher than the 18.99% rate in the control group.

Conclusion: Patients with MN who test positive for serum Anti-PLA2R antibodies may present with other forms of glomerulonephritis. The prognostic outcomes of MN in the presence of concurrent IgAN, DN, or FSGS are notably poorer than those of isolated MN. Renal biopsy is valuable for definitive diagnosis and prognostic evaluation.