Clinical Kidney Journal最新文献_第10页

The validity of pathology codes for biopsy-confirmed kidney disease in the Danish National Patobank 丹麦国家患者资料库中活检确诊肾病的病理学代码的有效性

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-10 DOI: 10.1093/ckj/sfae203

Marie Møller, Iain Bressendorff, Rikke Borg, Hans Dieperink, Jon W Gregersen, Helle Hansen, Kristine Hommel, Mads Hornum, Per Ivarsen, Karina H Jensen, Morten B Jørgensen, Tilde Kristensen, Dorrit Krustrup, Frank H Mose, Peter Rossing, Kjeld E Otte, Frederik Persson, Kristine D Schandorff, Ditte Hansen

Introduction This study validates the application of Systematized Nomenclature of Medicine second edition (SNOMED II) codes used to describe medical kidney biopsies in Denmark in encoded form, aiming to support robust epidemiological research on the causes, treatments, and prognosis of kidney diseases. Methods Kidney biopsy reports from January 1st, 1998, to December 31st, 2018, were randomly extracted from the Danish National Patobank, using SNOMED codes. A 5% sample was selected, and nephrologists assessed the corresponding medical records, assigning each case the applied clinical diagnoses. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and Cohen's kappa coefficient (κ) for the retrieved SNOMED codes were calculated. Results A total of 613 kidney biopsies were included. The primary clinical disease groups were glomerular disease (n = 368), tubulointerstitial disease (n = 67), renal vascular disease (n = 51), diabetic nephropathy (n = 51), and various renal disorders (n = 40). Several SNOMED codes were used to describe each clinical disease group and PPV for the combined SNOMED codes were high for glomerular disease (94%), diabetic nephropathy (85%), and systemic diseases affecting the kidney (96%). Conversely, tubulointerstitial disease (62%), renal vascular disease (60%), and other renal disorders (17%) showed lower PPVs. Conclusion and perspective SNOMED codes have a high PPV for glomerular diseases, diabetic nephropathy, and systemic diseases affecting the kidney, in which they could be applied for future epidemiological research.

引言本研究验证了用于以编码形式描述丹麦医学肾脏活检的《医学系统命名法》第二版（SNOMED II）代码的应用，旨在为有关肾脏疾病的病因、治疗和预后的流行病学研究提供有力支持。方法使用 SNOMED 代码从丹麦国家 Patobank 中随机提取 1998 年 1 月 1 日至 2018 年 12 月 31 日的肾活检报告。抽取5%的样本，由肾病专家评估相应的医疗记录，为每个病例指定适用的临床诊断。计算了检索到的 SNOMED 代码的敏感性、特异性、阳性预测值 (PPV)、阴性预测值 (NPV) 和科恩卡帕系数 (κ)。结果共纳入 613 例肾脏活组织检查。主要临床疾病分组为肾小球疾病（368 例）、肾小管间质疾病（67 例）、肾血管疾病（51 例）、糖尿病肾病（51 例）和各种肾脏疾病（40 例）。使用多个 SNOMED 代码来描述每组临床疾病，合并 SNOMED 代码后，肾小球疾病（94%）、糖尿病肾病（85%）和影响肾脏的全身性疾病（96%）的 PPV 很高。相反，肾小管间质疾病（62%）、肾血管疾病（60%）和其他肾脏疾病（17%）的 PPV 值较低。结论与展望 SNOMED 代码对肾小球疾病、糖尿病肾病和影响肾脏的全身性疾病具有较高的 PPV 值，可用于未来的流行病学研究。

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引用次数: 0

Apical tubular complement activation and the loss of kidney function in proteinuric kidney diseases. 蛋白尿肾病中肾小管补体激活和肾功能丧失。

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-10 eCollection Date: 2024-08-01 DOI: 10.1093/ckj/sfae215

Firas F Alkaff, Rosa G M Lammerts, Mohamed R Daha, Stefan P Berger, Jacob van den Born

Many kidney diseases are associated with proteinuria. Since proteinuria is independently associated with kidney function loss, anti-proteinuric medication, often in combination with dietary salt restriction, comprises a major cornerstone in the prevention of progressive kidney failure. Nevertheless, complete remission of proteinuria is very difficult to achieve, and most patients with persistent proteinuria slowly progress toward kidney failure. It is well-recognized that proteinuria leads to kidney inflammation and fibrosis via various mechanisms. Among others, complement activation at the apical side of the proximal tubular epithelial cells is suggested to play a crucial role as a cause of progressive loss of kidney function. However, hitherto limited attention is given to the pathophysiological role of tubular complement activation relative to glomerular complement activation. This review aims to summarize the evidence for tubular epithelial complement activation in proteinuric kidney diseases in relation to loss of kidney function.

许多肾脏疾病都与蛋白尿有关。由于蛋白尿与肾功能丧失密切相关，因此抗蛋白尿药物通常与饮食限盐相结合，是预防肾功能逐渐衰竭的重要基石。然而，蛋白尿很难完全缓解，大多数持续蛋白尿的患者会慢慢发展为肾衰竭。众所周知，蛋白尿通过各种机制导致肾脏炎症和纤维化。其中，近端肾小管上皮细胞顶端的补体激活被认为是导致肾功能逐渐丧失的关键因素。然而，与肾小球补体活化相比，肾小管补体活化的病理生理作用迄今受到的关注有限。本综述旨在总结蛋白尿肾病中肾小管上皮补体激活与肾功能丧失相关的证据。

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引用次数: 0

Correlation between retinal vascular geometric parameters and pathologically diagnosed type 2 diabetic nephropathy 视网膜血管几何参数与病理诊断的 2 型糖尿病肾病之间的相关性

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-10 DOI: 10.1093/ckj/sfae204

Fang Liu, Xiaoniao Chen, Qian Wang, Wenwen Lin, Ying Li, Ruimin Zhang, Hui Huang, Shuangshuang Jiang, Yue Niu, Weicen Liu, Liqiang Wang, Weiguang Zhang, Ying Zheng, Xueying Cao, Yong Wang, Jie Wu, Li Zhang, Li Tang, Jianhui Zhou, Zheyi Dong

Background Diabetic nephropathy (DN) and diabetic retinopathy (DR) are common microvascular complications of diabetes. The purpose of this study was to investigate the correlation between retinal vascular geometric parameters and pathologically diagnosed type 2 DN, and to determine the capacity of retinal vascular geometric parameters in differentiating DN from non-diabetic nephropathy (NDRD). Methods The study participants were adult patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) who underwent a renal biopsy. Univariate and multivariable regression analyses were performed to evaluate associations between retinal vessel geometry parameters and pathologically diagnosed DN. Multivariate binary logistic regression analyses were performed to establish a differential diagnostic model for DN. Results In total, 403 patients were examined in this cross-sectional study, including 152 (37.7%) with DN, 157 (39.0%) with NDRD, and 94 (23.3%) with DN combined with NDRD. After univariate logistic regression, Total vessel fractal dimension, arteriolar fractal dimension, venular fractal dimension were all found to be associated with DN. In multivariate analyses adjusting for age, sex, blood pressure, diabetes, DR, and other factors, smaller retinal vascular fractal dimensions were significantly associated with DN (P < .05). We developed a differential diagnostic model for DN combining traditional clinical indicators and retinal vascular geometric parameters, the area under the curve of the model for equation established by multivariate logistic regression was 0.930. Conclusions Retinal vessel fractal dimension is of great significance for the rapid and noninvasive differentiation of DN. Incorporating retinal vessel fractal dimension into the diagnostic model for DN and NDRD can improve the diagnostic efficiency.

背景糖尿病肾病（DN）和糖尿病视网膜病变（DR）是糖尿病常见的微血管并发症。本研究旨在探讨视网膜血管几何参数与病理诊断的 2 型糖尿病肾病之间的相关性，并确定视网膜血管几何参数在区分糖尿病肾病和非糖尿病肾病（NDRD）方面的能力。方法研究对象为接受肾活检的 2 型糖尿病（T2DM）和慢性肾病（CKD）成年患者。进行单变量和多变量回归分析，以评估视网膜血管几何参数与病理诊断的 DN 之间的关联。进行多变量二元逻辑回归分析以建立 DN 的鉴别诊断模型。结果这项横断面研究共检查了 403 名患者，其中包括 152 名（37.7%）DN 患者、157 名（39.0%）NDRD 患者和 94 名（23.3%）DN 合并 NDRD 患者。经过单变量逻辑回归，发现总血管断裂维度、动脉断裂维度和静脉断裂维度均与 DN 相关。在调整了年龄、性别、血压、糖尿病、DR 和其他因素的多变量分析中，较小的视网膜血管断裂维度与 DN 显著相关（P &p;lt;.05）。我们建立了一个结合传统临床指标和视网膜血管几何参数的 DN 鉴别诊断模型，多变量逻辑回归建立的方程模型的曲线下面积为 0.930。结论视网膜血管断裂维度对于快速、无创地鉴别 DN 具有重要意义。将视网膜血管断裂维度纳入 DN 和 NDRD 诊断模型可提高诊断效率。

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引用次数: 0

Transfers from home to facility-based dialysis: comparisons of HHD, assisted PD and autonomous PD. 从居家透析到设施内透析：居家透析、辅助透析和自主透析的比较。

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-10 eCollection Date: 2024-07-01 DOI: 10.1093/ckj/sfae094

Antoine Lanot, Clémence Bechade, Cécile Couchoud, Mathilde Lassalle, François Chantrel, Ayman Sarraj, Maxence Ficheux, Annabel Boyer, Thierry Lobbedez

Background: Home dialysis therapies such as peritoneal dialysis (PD) and home hemodialysis (HHD) are beneficial for quality of life and patient empowerment. The short technique survival time partly explains their low prevalence. We aimed to assess the risk of transfer to facility-based hemodialysis in patients treated with autonomous PD, assisted PD and HHD.

Methods: This was a retrospective study using data from the REIN registry of patients starting home dialysis in France from 2002 to 2019. The risks of transfer to facility-based hemodialysis (HD) were compared between three modalities of home dialysis (HHD, nurse-assisted PD, autonomous PD) using survival models with a propensity score (PS)-matched and unmatched cohort of patients.

Results: The study included 17 909 patients: 628 in the HHD group, 10 214 in the autonomous PD group, and 7067 in the assisted PD group. During the follow-up period, there were 5347 transfers to facility-based HD. The observed number of transfers was 2458 (13.7%) at 1 year and 5069 (28.3) at 5 years after the start of home dialysis, including 3272 (32%) on autonomous PD, 1648 (23.3%) on assisted PD, and 149 (23.7) on HHD. Owing to clinical characteristics differences, only 38% of HHD patients could be matched to patients from the others group. In the PS-matched cohort, the adjusted Cox model showed no difference in the risk of transfer for assisted PD (cs-HR 1.04, 95% CI 0.75-1.44) or HHD (cs-HR 1.07, 95% CI 0.77-1.48) compared with autonomous PD.

Conclusions: Unlike results from other countries, where nurse assistance is not fully available for PD-associated care, there was no difference in technique survival between autonomous PD, nurse-assisted PD, and HHD in France. This discrepancy may be attributed to our inclusion of a broader spectrum of patients who derive significant benefits from assisted PD.

背景：腹膜透析（PD）和家庭血液透析（HHD）等家庭透析疗法有利于提高生活质量和增强患者能力。但其技术存活时间较短，这也是其使用率较低的部分原因。我们的目的是评估接受自主透析、辅助透析和家庭血液透析治疗的患者转入设施血液透析的风险：这是一项回顾性研究，使用的数据来自 REIN 登记处，登记的是 2002 年至 2019 年期间在法国开始家庭透析的患者。利用倾向得分（PS）匹配和非匹配患者队列的生存模型，比较了三种家庭透析方式（HHD、护士辅助透析、自主透析）转入设施血液透析（HD）的风险：研究包括 17 909 名患者：HHD组628人，自主PD组10214人，辅助PD组7067人。在随访期间，共有 5347 例患者转入设施内的血液透析。在开始家庭透析后的 1 年和 5 年中，观察到的转院人数分别为 2458 人（13.7%）和 5069 人（28.3%），其中自主透析组 3272 人（32%），辅助透析组 1648 人（23.3%），HHD 组 149 人（23.7%）。由于临床特征的差异，只有 38% 的 HHD 患者能与其他组的患者匹配。在 PS 匹配队列中，调整后的 Cox 模型显示，与自主 PD 相比，辅助 PD（cs-HR 1.04，95% CI 0.75-1.44）或 HHD（cs-HR 1.07，95% CI 0.77-1.48）的转院风险没有差异：与其他国家的结果不同的是，在法国，与腹腔镜手术相关的护理并不完全由护士协助，而自主腹腔镜手术、护士协助腹腔镜手术和HHD在技术存活率方面没有差异。这种差异可能是由于我们纳入了更多从辅助腹腔镜手术中获益的患者。

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引用次数: 0

The Association of Sleep Duration with the Risk of Chronic Kidney Disease: a Systematic Review and Meta-Analysis 睡眠时间与慢性肾病风险的关系：系统回顾与元分析

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-10 DOI: 10.1093/ckj/sfae177

Jin Hean Koh, Brian Sheng Yep Yeo, Timothy Wei En Tan, Mark Yong Siang See, Adele Chin Wei Ng, Shaun Ray Han Loh, Joshua Gooley, Chieh Suai Tan, Song Tar Toh

Background and hypothesis Published literature suggests that sleep duration and quality may be affected in adults with chronic kidney disease. However, the relationship between these two entities remains a matter of debate. The objective of this systematic review and meta-analysis is to assess the effect of sleep duration and quality on chronic kidney disease. Methods A systematic review of the Medline/PubMed, Embase, Cochrane Library and CINAHL databases was conducted for articles pertaining to the association between sleep duration and quality on chronic kidney disease. The main outcome was the hazard/risk ratio of chronic kidney disease in patients of varying sleep durations and quality. Results 42 studies (2 613 971 patients) with a mean age of 43.55 ± 14.01 years were included in the meta-analysis. Compared with a reference range of 7 to 8 hours of sleep, short sleep duration of ≤ 4 hours (RR 1.41, 95% CI: 1.16 to 1.71, p < 0.01), ≤5 hours (RR 1.46, 95% CI: 1.22 to 1.76, p < 0.01), ≤6 hours (RR 1.18, 95% CI: 1.09 to 1.29, p < 0.01) and ≤ 7 hours (RR 1.19, 95% CI: 1.12 to 1.28, p < 0.01) were significantly associated with an increased risk of incident chronic kidney disease. Long sleep duration of ≥ 8 hours (RR 1.15, 95% CI: 1.03 to 1.28, p < 0.01) and ≥ 9 hours (RR 1.46, 95% CI: 1.28 to 1.68, p < 0.01) were also significantly associated with an increased risk of incident chronic kidney disease. Meta-regression did not find any significant effect of age, gender, geographical region and BMI and the association of sleep duration and risk of incident chronic kidney disease. Conclusion Both short and long sleep duration were significantly associated with a higher risk of chronic kidney disease. Interventions targeted towards achieving an optimal duration of sleep may reduce the risk of incident chronic kidney disease.

背景与假设已发表的文献表明，慢性肾脏病成人患者的睡眠时间和质量可能会受到影响。然而，这两者之间的关系仍存在争议。本系统综述和荟萃分析旨在评估睡眠时间和质量对慢性肾脏病的影响。方法对 Medline/PubMed、Embase、Cochrane Library 和 CINAHL 数据库中与睡眠时间和质量对慢性肾病的影响有关的文章进行了系统回顾。主要结果是不同睡眠时间和质量的患者患慢性肾病的危险/风险比。结果 42 项研究（2 613 971 名患者）被纳入荟萃分析，平均年龄为 43.55 ± 14.01 岁。与 7 至 8 小时睡眠的参考范围相比，睡眠时间≤ 4 小时（RR 1.41，95% CI：1.16 至 1.71，p< 0.01）、≤5 小时（RR 1.46，95% CI：1.22 至 1.76，p< 0.01）、≤6 小时（RR 1.18，95% CI：1.09 至 1.29，p &p;lt;0.01）和≤7 小时（RR 1.19，95% CI：1.12 至 1.28，p &p;lt;0.01）与慢性肾脏病发病风险增加显著相关。睡眠时间长于≥8小时（RR 1.15，95% CI：1.03 至 1.28，pamp &;lt;0.01）和≥9小时（RR 1.46，95% CI：1.28 至 1.68，pamp &;lt;0.01）也与慢性肾脏病发病风险的增加显著相关。元回归没有发现年龄、性别、地理区域和体重指数对睡眠时间与慢性肾脏病发病风险的相关性有明显影响。结论睡眠时间长短与罹患慢性肾脏病的风险高低有明显关系。为达到最佳睡眠时间而采取的干预措施可降低慢性肾脏病的发病风险。

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引用次数: 0

Pathogenic heterozygous TRPM7 variants and hypomagnesemia with developmental delay 致病性杂合子TRPM7变体和伴有发育迟缓的低镁血症

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-06 DOI: 10.1093/ckj/sfae211

Willem Bosman, Kameryn M Butler, Caitlin A Chang, Mythily Ganapathi, Edwin Guzman, Femke Latta, Wendy K Chung, Felix Claverie-Martin, Jessica M Davis, Joost G J Hoenderop, Jeroen H F de Baaij

Background Heterozygous variants in TRPM7, encoding an essential and ubiquitously expressed cation channel, may cause hypomagnesemia, but current evidence is insufficient to draw definite conclusions and it is unclear whether any other phenotypes can occur. Methods Individuals with unexplained hypomagnesemia underwent whole exome sequencing which identified TRPM7 variants. Pathogenicity of the identified variants was assessed by combining phenotypic, functional and in silico analyses. Results We report three new heterozygous missense variants in TRPM7 (p.Met1000Thr, p.Gly1046Arg, p.Leu1081Arg) in individuals with hypomagnesemia. Strikingly, autism spectrum disorder and developmental delay, mainly affecting speech and motor skills, was observed in all three individuals, while two out of three also presented with seizures. The three variants are predicted to be severely damaging by in silico prediction tools and structural modeling. Furthermore, these variants result in a clear loss-of-function of TRPM7-mediated magnesium uptake in vitro, while not affecting TRPM7 expression or insertion into the plasma membrane. Conclusions This study provides additional evidence for the association between heterozygous TRPM7 variants and hypomagnesemia and adds developmental delay to the phenotypic spectrum of TRPM7-related disorders. Considering the TRPM7 gene is relatively tolerant to loss-of-function variants, future research should aim to unravel by which mechanisms specific heterozygous TRPM7 variants can cause disease.

背景 TRPM7编码一种必需的、普遍表达的阳离子通道，其杂合变异可能导致低镁血症，但目前的证据不足以得出明确的结论，也不清楚是否会出现其他表型。方法对不明原因的低镁血症患者进行全外显子组测序，发现了 TRPM7 变异。通过结合表型、功能和硅学分析，对所发现变异的致病性进行了评估。结果我们报告了在低镁血症患者中发现的三个新的 TRPM7 杂合性错义变异（p.Met1000Thr、p.Gly1046Arg 和 p.Leu1081Arg）。令人震惊的是，这三个人都出现了自闭症谱系障碍和发育迟缓，主要影响言语和运动技能，其中两人还伴有癫痫发作。根据硅学预测工具和结构模型预测，这三个变体具有严重的损害性。此外，这些变异导致 TRPM7 在体外介导的镁摄取功能明显丧失，同时不影响 TRPM7 的表达或插入质膜。结论本研究为杂合TRPM7变异与低镁血症之间的关联提供了更多证据，并为TRPM7相关疾病的表型谱增添了发育迟缓的内容。考虑到TRPM7基因对功能缺失变异的耐受性相对较强，未来的研究应致力于揭示特定杂合TRPM7变异可导致疾病的机制。

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引用次数: 0

Hypoaldosteronism due to a novel SEC61A1 variant successfully treated with fludrocortisone 氟氢可的松成功治疗新型 SEC61A1 变异引起的醛固酮过多症

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-06 DOI: 10.1093/ckj/sfae213

Diana Karpman, Martin L Lindström, Mattias Möller, Sofie Ivarsson, Ann-Charlotte Kristoffersson, Zivile Bekassy, Agnes B Fogo, Maria Elfving

Genetic variants in SEC61A1 are associated with autosomal dominant tubulointerstitial kidney disease. SEC61A1 is a translocon in the endoplasmic reticulum membrane and variants affect biosynthesis of renin and uromodulin. We describe a patient with a novel de novo heterozygous SEC61A1 variant, Phe458Val, detected by whole genome sequencing. The patient presented at 1 year of age with failure-to-thrive, kidney failure (glomerular filtration rate, GFR, 18 ml/min/1.73m2), hyperkalemia and acidosis. Plasma renin was low or normal, aldosterone was low or undetectable and uromodulin was low. Kidney biopsy at 2 years exhibited subtle changes suggestive of tubular dysgenesis without tubulocystic or glomerulocystic lesions and with renin staining of the juxtaglomerular cells. The patient experienced extreme fatigue due to severe hypotension attributed to hypoaldosteronism and at 8 years of age fludrocortisone treatment was initiated with marked improvement in her well-being. Blood pressure normalized as did potassium. Biopsy at 9 years showed extensive glomerulosclerosis and mild tubulointerstitial fibrosis, as well as tubular mitochondrial abnormalities, but without specific diagnostic changes. Her GFR improved to 54 ml/min/1.73m2. As the renin-angiotensin system promotes aldosterone release, and the patient had repeatedly undetectable aldosterone levels, the SEC61A1 variant presumably contributed to severe hypotension. Treatment with a mineralocorticoid had a beneficial effect and corrected the electrolyte and acid-base disorder. We suggest that the increased blood pressure hemodynamically improved the patient's kidney function.

SEC61A1 基因变异与常染色体显性肾小管间质性肾病有关。SEC61A1 是内质网膜上的一个转座子，变体会影响肾素和尿调节素的生物合成。我们描述了一名通过全基因组测序检测到新型新发杂合 SEC61A1 变异 Phe458Val 的患者。患者一岁时出现生长发育障碍、肾衰竭（肾小球滤过率，GFR，18 ml/min/1.73m2）、高钾血症和酸中毒。血浆肾素偏低或正常，醛固酮偏低或检测不到，尿肌酐偏低。2 年后进行的肾活检显示出肾小管发育不良的细微变化，但没有出现肾小管或肾小球囊肿病变，并肾小球细胞有肾素染色。患者在 8 岁时开始接受氟氢可的松治疗，病情明显好转。血压和血钾均恢复正常。9 岁时的活组织检查显示，她的肾小球广泛硬化，肾小管间质轻度纤维化，肾小管线粒体异常，但没有具体的诊断变化。她的 GFR 改善到 54 毫升/分钟/1.73 平方米。由于肾素-血管紧张素系统会促进醛固酮的释放，而患者体内醛固酮水平反复检测不到，SEC61A1变异可能是导致严重低血压的原因之一。使用矿质类固醇治疗产生了有益的效果，纠正了电解质和酸碱紊乱。我们认为，血压升高在血液动力学上改善了患者的肾功能。

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引用次数: 0

Risk factors for major bleeding in patients with atrial fibrillation and CKD G3-G5D on oral anticoagulants 服用口服抗凝剂的心房颤动和慢性肾功能衰竭 G3-G5D 患者大出血的风险因素

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-06 DOI: 10.1093/ckj/sfae206

Frida Welander, Henrik Renlund, Anders Själander

Background Patients with chronic kidney disease (CKD) and atrial fibrillation (AF) on oral anticoagulants (OAC) are at high risk of bleeding. Determinants of major bleeding risk in OAC-users with AF and CKD are not well established and available bleeding score systems do not perform well in CKD. This study aims to present risk factors associated with major bleeding in a Swedish cohort of OAC- treated patients with CKD GFR category 3–5D (G3-G5D). Methods A Swedish register-based cohort study including patients with AF and G3-G5D on warfarin or DOAC between 2009–2018. Data collected from high quality registers including Swedish Renal Registry and Auricula, a register for AF and oral anticoagulants. Risk factors for major bleeding were investigated with Cox regression analysis. Results Of 2453 included patients 59% were on warfarin (time in therapeutic range 67%) and 41% on DOAC. Major bleeding rates were 8.9/100 patient-years. Factors associated with increased bleeding risk were GFR category, G5/5D versus G3, hazard ratio 1.92 (95% confidence interval 1.43–2.56), previous gastrointestinal bleeding, 1.77 (1.39–2.25), previous other bleeding 1.33 (1.09–1.62), congestive heart failure 1.36 (1.11–1.68), male sex 1.28 (1.03–1.60) and vascular disease, 1.35 (1.01–1.79). Conclusion Patients with AF and G3-G5D on OAC are at high risk of bleeding. Previous major bleeding and kidney failure are strongly associated with major bleeding. The present study also shows an association between OAC-associated bleeding and male sex, congestive heart failure and vascular disease. Knowledge about determinants of bleeding in advanced CKD is essential when deciding on when to anticoagulate or not.

背景使用口服抗凝剂（OAC）的慢性肾脏病（CKD）和心房颤动（AF）患者的出血风险很高。心房颤动和慢性肾脏病 OAC 使用者大出血风险的决定因素尚未完全确定，现有的出血评分系统在慢性肾脏病患者中表现不佳。本研究旨在介绍在瑞典接受 OAC 治疗的 CKD GFR 3-5D 级（G3-G5D）患者队列中与大出血相关的风险因素。方法一项基于瑞典登记册的队列研究，包括 2009-2018 年间接受华法林或 DOAC 治疗的房颤和 G3-G5D 患者。数据收集自高质量登记册，包括瑞典肾脏登记册和 Auricula（房颤和口服抗凝药登记册）。通过 Cox 回归分析研究了大出血的风险因素。结果在纳入的 2453 名患者中，59% 使用华法林（67% 的时间在治疗范围内），41% 使用 DOAC。大出血率为 8.9/100患者年。与出血风险增加相关的因素有：GFR 类别，G5/5D 与 G3，危险比 1.92（95% 置信区间 1.43-2.56）；既往胃肠道出血，1.77（1.39-2.25）；既往其他出血，1.33（1.09-1.62）；充血性心力衰竭，1.36（1.11-1.68）；男性，1.28（1.03-1.60）；血管疾病，1.35（1.01-1.79）。结论使用 OAC 的房颤和 G3-G5D 患者出血风险高。既往大出血和肾衰竭与大出血密切相关。本研究还显示，OAC 相关出血与男性、充血性心力衰竭和血管疾病有关。在决定何时进行抗凝治疗时，了解晚期慢性肾脏病患者出血的决定因素至关重要。

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引用次数: 0

Integrating multiple kidney function markers to predict all-cause and cardiovascular disease mortality: prospective analysis of 366,758 UK Biobank participants 综合多种肾功能指标预测全因和心血管疾病死亡率：对 366 758 名英国生物库参与者的前瞻性分析

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-06 DOI: 10.1093/ckj/sfae207

Ryosuke Fujii, Roberto Melotti, Anna Köttgen, Alexander Teumer, Daniele Giardiello, Cristian Pattaro

Background & Hypothesis Reduced kidney function is a risk factor of cardiovascular and all-cause mortality. This association was demonstrated for several kidney function markers, but it is unclear whether integrating multiple measured markers may improve mortality risk prediction. Methods We conducted an exploratory factor analysis (EFA) of serum creatinine- and cystatin C-based estimated glomerular filtration rate (eGFRcre and eGFRcys, derived by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) equations), blood urea nitrogen (BUN), uric acid, and serum albumin among 366 758 participants of the UK Biobank without history of kidney failure. Fitting Cox-proportional hazard models, we compared ability of the identified latent factors to predict overall mortality and mortality by cardiovascular disease (CVD), also considering CVD-specific causes like coronary heart disease and cerebrovascular disease. Results During 12.5 years of follow-up, 26 327 deceased from any cause, 5 376 died from CVD, 2 908 from CHD, and 1 116 from cerebrovascular disease. We identified two latent factors, EFA1 and EFA2 both representing kidney function variations. When using the CKD-EPI equations, EFA1 performed like eGFRcys, with EFA1 showing slightly larger hazard ratios for overall and CVD-related mortality. At 10-years of follow-up, EFA1 and eGFRcys showed moderate discrimination performance for CVD-related mortality, outperforming all other kidney indices. eGFRcre was the least predictive marker across all outcomes. When using the EKFC equations, eGFRcys performed better than EFA1, all other results remaining similar. Conclusions While EFA is an attractive approach to capture the complex effects of kidney function, eGFRcys remains the most practical and effective measurement for all-cause and CVD mortality risk prediction.

背景 & 假设肾功能减退是心血管和全因死亡率的一个风险因素。几种肾功能标志物都证明了这种关联，但目前还不清楚整合多种测量标志物是否能改善死亡率风险预测。方法我们对英国生物库中 366 758 名无肾衰竭病史的参与者进行了探索性因子分析（EFA），分析了基于血清肌酐和胱抑素 C 的估计肾小球滤过率（eGFRcre 和 eGFRcys，由慢性肾脏病流行病学协作组（CKD-EPI）和欧洲肾功能联盟（EKFC）公式得出）、血尿素氮（BUN）、尿酸和血清白蛋白。通过拟合 Cox 比例危险模型，我们比较了已确定的潜在因素预测总死亡率和心血管疾病（CVD）死亡率的能力，同时还考虑了冠心病和脑血管疾病等心血管疾病的特异性病因。结果在 12.5 年的随访中，26 327 人死于任何原因，5 376 人死于心血管疾病，2 908 人死于冠心病，1 116 人死于脑血管疾病。我们发现了两个潜在因素，即 EFA1 和 EFA2，它们都代表肾功能的变化。在使用 CKD-EPI 方程时，EFA1 的表现与 eGFRcys 相似，但 EFA1 对总体死亡率和心血管疾病相关死亡率的危险比稍高。在 10 年的随访中，EFA1 和 eGFRcys 对心血管疾病相关死亡率显示出中等程度的鉴别性能，优于所有其他肾脏指数。在使用 EKFC 方程时，eGFRcys 的表现优于 EFA1，而所有其他结果均相似。结论虽然 EFA 是捕捉肾功能复杂效应的一种有吸引力的方法，但 eGFRcys 仍是预测全因和心血管疾病死亡风险的最实用、最有效的测量方法。

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引用次数: 0

Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action 慢性肾脏病患者和普通人群中的椎体骨折：呼吁诊断和行动

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-07-06 DOI: 10.1093/ckj/sfae191

Laia Gifre, Elisabeth Massó, Maria Fusaro, Mathias Haarhaus, Pablo Ureña, Mario Cozzolino, Sandro Mazzaferro, Jordi Calabia, Pilar Peris, Jordi Bover

Vertebral fractures (VFs) are the most common osteoporotic fractures in the general population, and they have been associated with high mortality, decreased quality of life and high risk of subsequent fractures, especially when recent, multiple or severe. Currently, VF diagnosis and classification determine fracture risk and the most appropriate anti-osteoporotic treatment. However, VFs are clearly underdiagnosed, especially in patients with chronic kidney disease (CKD), and CKD-associated osteoporosis has been disregarded until recently. VFs are associated with higher morbidity and mortality, and their prevalence and incidence differ depending on the grade of renal dysfunction (CKD G1–G5) and/or the type of renal replacement therapy (dialysis or transplantation). In addition to classical risk factors [such as higher age, female sex, reduced bone mineral density (BMD), diabetes and steroid use], various other factors have been associated with an increased risk of VFs in CKD, including CKD grade, haemodialysis vintage, time since renal transplantation, low or high intact parathyroid hormone and phosphate levels, and/or vitamin D and K1 deficiencies. Importantly, several clinical societies have recently modified their algorithms according to the fracture risk classification (including the presence of VFs) and determined the most appropriate anti-osteoporotic treatment for the general population. However, there are no specific guidelines addressing this topic in patients with CKD despite an important paradigm shift regarding the prognostic value of BMD in 2017 after the publication of the CKD-Mineral and Bone Disorder (CKD-MBD) KDIGO guidelines. A proactive attitude towards diagnosis, treatment and research is proposed to avoid therapeutic nihilism.

椎体骨折（VFs）是普通人群中最常见的骨质疏松性骨折，与高死亡率、生活质量下降和后续骨折的高风险有关，尤其是近期、多发性或严重骨折。目前，VF 的诊断和分类决定了骨折风险和最合适的抗骨质疏松治疗。然而，VF 明显诊断不足，尤其是在慢性肾脏病（CKD）患者中，而且直到最近，CKD 相关骨质疏松症一直被忽视。骨质疏松症与较高的发病率和死亡率相关，其发病率和发生率因肾功能障碍的等级（CKD G1-G5）和/或肾替代治疗的类型（透析或移植）而异。除了传统的风险因素（如高龄、女性、骨矿物质密度（BMD）降低、糖尿病和使用类固醇）外，其他各种因素也与 CKD VFs 风险增加有关，包括 CKD 等级、血液透析年份、肾移植后的时间、甲状旁腺激素和磷酸盐水平过低或过高、和/或维生素 D 和 K1 缺乏。重要的是，一些临床学会最近根据骨折风险分类（包括是否存在室间隔缺损）修改了其算法，并确定了最适合普通人群的抗骨质疏松治疗方法。然而，尽管在 2017 年《慢性肾脏病-矿物质和骨质紊乱（CKD-MBD）KDIGO 指南》发布后，有关 BMD 预后价值的范式发生了重要转变，但目前还没有针对慢性肾脏病患者的具体指南。建议对诊断、治疗和研究采取积极主动的态度，以避免治疗虚无主义。

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引用次数: 0