Clinical nephrology最新文献

Background: To evaluate the safety and efficacy of low-dose roxadustat combined with low-dose recombinant human erythropoietin (rhEPO) for the treatment of renal anemia in hemodialysis patients.

Materials and methods: We retrospectively reviewed the medical records of hemodialysis patients with moderate renal anemia between December 2019 and July 2023 from two medical centers. Patients were classified into 3 groups: rhEPO (150 - 300 IU/kg/week), roxadustat (1.5 - 2.5 mg/kg thrice weekly), and combination therapy (low-dose (≤ 1.5 mg/kg thrice weekly) roxadustat in addition to low-dose (≤ 150 IU/kg per week) rhEPO. After 24 weeks of treatment, the efficacy therapeutic endpoints and the safety endpoints were evaluated.

Results: Overall, a total of 158 patients were included: 53 in the rhEPO group, 52 in the roxadustat group, and 53 in the combination group. The median time to achieve Hb response in the combination therapy group was 20 days, which was shorter than that in the roxadustat group (20 vs. 25.5 days, log-rank p = 0.027) and the rhEPO group (20 vs. 27 days, log-rank p = 0.004). The mean rate of increase in Hb (g/L/month) during the first month of the treatment period was significantly greater in the combination group than in the roxadustat group (15.4 ± 4.7 vs. 11.1 ± 5.7, p = 0.038) or in the rhEPO group (15.4 ± 4.7 vs. 10.5 ± 4.3, p = 0.026). The incidence and frequency of adverse events were similar among the 3 groups.

Conclusion: The combination of low-dose roxadustat and rhEPO appears to have better effects in treating hemodialysis patients with moderate anemia by shortening the hemoglobin response time with minimal adverse effects.

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.

This cross-sectional survey assessed the status and the associated factors of stigma among patients undergoing maintenance hemodialysis (MHD). 154 MHD patients were enrolled. General information was collected. The Social Impact Scale, the Generalized Anxiety Disorder-7 Scale, the Patient Health Questionnaire-9, the Perceived Social Support Scale, and the Barthel Index Scale were used for data collection. These patients had an average age of 60.89 years, with 76 (49.4%) male patients, and an average hemodialysis duration of 8.35 years. The total score of stigma was 58.11 ± 9.22, with the highest score in the social rejection dimension (19.03 ± 3.93) and the lowest score in the financial insecurity dimension (7.95 ± 1.87). Univariate analysis showed that there were significant differences in stigma in terms of self-perceived financial burden (p = 0.001), history of falls in the past year (p = 0.004), and different hemodialysis durations (p = 0.042). Pearson correlation analysis revealed that the total score of stigma was positively correlated with the total scores of anxiety and depression, negatively correlated with the total score of social support, and not correlated with the total score of activities of daily living. Multivariate linear regression analysis indicated that self-perceived financial burden, a history of falls in the past year, and anxiety were significant factors associated with stigma. Collectively, the stigma in MHD patients is closely related to self-perceived financial burden, history of falls in the past year, and total anxiety score, suggesting that intervention strategies should be enhanced based on these risk factors. Our findings may guide the intervention of stigma in this population.

Background: The use of human albumin in patients with minimal change disease (MCD) remains controversial. The aim of the current study was to assess whether infusion of human albumin increased the risk of acute kidney injury (AKI) in adult patients with MCD.

Materials and methods: Adult patients who underwent renal biopsy for the diagnosis of MCD at the center between 2017 and 2022 were screened. Logistic regression and Nelson-Aalen cumulative risk curve analysis were used to compare data from patients with and without human albumin infusion.

Results: A total of 190 adult patients with MCD diagnosed by renal biopsy were included, of whom 45 received human albumin infusion before MCD diagnosis and 34 developed AKI within 4 weeks of MCD diagnosis. Nelson-Aalen cumulative risk curve analysis showed that patients who received human albumin infusion had a longer time to partial or complete response (p < 0.001), were more likely to develop AKI (p < 0.001), and were more likely to relapse (p = 0.002) than those who did not receive human albumin infusion. Multivariate logistic regression analysis showed that human albumin infusion was an independent risk factor for AKI in adult patients with MCD after adjusting for confounding factors (OR = 3.259, 95% CI, 1.209 - 8.780, p = 0.020).

Conclusion: Receiving human albumin infusions may be associated with the development of AKI in adult patients with MCD. Adult MCD patients who received human albumin infusion had a longer time to achieve partial or complete remission and were more likely to relapse.

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.

Acute kidney injury (AKI) is a frequent, severe complication of hematopoietic stem cell transplantation (HSCT) and is associated with an increased risk of morbidity and mortality. Recent advances in artificial intelligence (AI) and machine learning (ML) have showcased their proficiency in predicting AKI, projecting disease progression, and accurately identifying underlying etiologies. This review examines the central aspects of AKI post-HSCT, veno-occlusive disease (VOD) in HSCT recipients, discusses present-day applications of artificial intelligence in AKI, and introduces a proposed ML framework for the early detection of AKI risk.

Background: Acute kidney injury (AKI) is a common complication of critically ill COVID-19 patients which is associated with adverse outcomes. We examined clinical factors associated with hospital mortality in critically ill adult COVID-19 patients with AKI who required continuous renal replacement therapy (CRRT).

Materials and methods: We conducted a multicenter retrospective cohort study including data from two large academic medical centers. Adult (age ≥ 18 years) patients with AKI and requiring CRRT admitted from March 2020 to April 2021 were included in the study. Patients with end-stage kidney disease or renal transplantation were excluded. Multivariable Poisson regression analyses were used to identify clinical predictors of hospital mortality.

Results: A total of 178 patients were included. Patients were predominantly men (68.2%), 13.1% were Black, and 57.9% White. Median hospital and ICU length of stay were 20 days and 14 days, respectively. Mechanical ventilation and extracorporeal membrane oxygenation were utilized in 97.2% and 17.4% of patients, respectively. Overall, 130 (73.0%) patients died in the hospital (mortality rate of 2.7 per 100 person-days). In multivariable analyses, SOFA score ≥ 12 at ICU admission (MRRadj = 1.88; 95% CI 1.17 - 3.01) was associated with increased risk of mortality, while Black race (MRRadj = 0.56; 95% CI 0.31 - 1.01) was associated with a decreased risk of mortality.

Conclusion: More than two-thirds of critically ill adult COVID-19 patients with AKI requiring CRRT died during hospitalization. SOFA score ≥ 12 at ICU admission was an independent predictor of hospital mortality, and Black patients had a lower risk of mortality.

Introduction: Computed tomography peritoneography (CTp) is pivotal for evaluating peritoneal dialysis (PD)-related complications, yet it comes with drawbacks, specifically exposure to iodinated contrast media (ICM). This study aimed to explore the feasibility of reducing ICM dosage utilizing spectral detector CT (SDCT).

Materials and methods: 35 rabbits were strategically divided into 7 groups (A - G) according to the ICM concentration ratio in the injection protocol, with respective doses of 10, 15, 20, 25, 30, 40, and 50 mL/2L. The CTp injection protocol involved a 300-mL mixture of non-ionic ICM omnipaque (350 mgI/mL) and peritoneal dialysate (1.5% lactate, 2 L), followed by scans using dual-layer SDCT. Virtual monoenergetic images (VMIs) at 4 distinct energy levels (40 - 70 keV, in 10-keV steps), iodine maps (IMs), and effective atomic number (Zeff) maps were subsequently reconstructed. Both quantitative and qualitative image assessments were conducted, and the parameters from these analyses were compared across images from groups A - G and traditional 50 mL/2L 120-kVp images. In post-determination of the optimal concentration and reconstructions, we illustrated their applications in patients with suspected PD-related complications.

Results: The quantitative image quality (IQ) of 15 mL/2L VMIs at 40 keV surpassed that of the 50 mL/2L 120-kVp images (p < 0.05). Furthermore, the diagnostic performance utilizing 15 mL/2L VMIs40 keV, when combined with IMs and Zeff maps, was found to be optimal.

Conclusion: The employment of SDCT in CTp allows for a substantial reduction in the ICM dose by 70%, compared to the benchmark concentration of 50 mL/2L, without compromising diagnostic precision.

Background: Drug-induced kidney damage (DIKD) is a significant medical concern linked to many drugs, including nonsteroidal anti-inflammatory drugs, antibiotics, and chemotherapy agents, due to its complex pathophysiology. L-theanine, a tea leaf amino acid, is explored for its protective effects against DIKD, considering its cognitive and calming benefits.

Materials and methods: In the theoretical part of the article, the role of L-theanine in combating DIKD is reviewed, highlighting its ability to mitigate oxidative stress and inflammation by neutralizing reactive oxygen species, enhancing antioxidant defenses, and modulating anti-inflammatory pathways. L-theanine's influence on cell signaling and its synergy with other nephroprotective agents are discussed. The practical part describes an experimental study using a murine model, where 60 male C57BL/6 mice were divided into four groups: a control group, a nephrotoxic group treated with cisplatin, and two treatment groups that received L-theanine either before or after cisplatin administration. Serum biomarkers (creatinine and blood urea nitrogen (BUN)), histopathological kidney damage scores, and oxidative stress markers (malondialdehyde (MDA) and superoxide dismutase (SOD)) were measured.

Results: Evidence from the murine study indicates that L-theanine protects against DIKD through antioxidative, anti-inflammatory, and anti-apoptotic mechanisms, potentially enhancing its synergy with other nephroprotective agents. In the nephrotoxic group (N), serum creatinine and BUN levels were significantly elevated, while pre-treatment with L-theanine (LTP) reduced these levels to 1.2 ± 0.3 mg/dL and 34 ± 4 mg/dL, respectively. Histopathological analysis revealed severe tubular necrosis in the N group (score: 3.8 ± 0.3), which was significantly reduced in the LTP group (1.6 ± 0.4). Oxidative stress markers, such as MDA, were markedly lowered in the LTP group compared to the N group, with corresponding increases in SOD activity, indicating enhanced antioxidant defense. These findings underscore L-theanine's potential in preserving renal health amidst pharmacotherapy-induced toxicity.

Conclusion: L-theanine emerges as a promising nephroprotective agent, particularly in the context of increasing incidence of DIKD and the associated challenges in clinical management. The practical findings from this study in a murine model provide compelling evidence that L-theanine significantly reduces serum biomarkers of renal injury, attenuates tubular necrosis, and mitigates oxidative stress, with pronounced effects observed when administered as a pre-treatment. While these results are promising, the predominance of preclinical data underscores the need for rigorous human studies to validate L-theanine's efficacy and safety in the prevention of drug-related renal injuries. Such research is crucial for advancing renal protection strate