Pub Date : 2024-09-27eCollection Date: 2024-10-01DOI: 10.1093/ckj/sfae290
Valerie A Luyckx, Wim Van Biesen, Jadranka Buturovic Ponikvar, Peter Heering, Ali Abu-Alfa, Ji Silberzweig, Monica Fontana, Serhan Tuglular, Mehmet Sukru Sever
With the increasing frequency and severity of disasters and the increasing number of patients living with kidney disease, on dialysis and with transplants around the world, the need for kidney care in humanitarian settings is increasing. Almost all humanitarian emergencies pose a threat to kidney health because all treatments are highly susceptible to interruption, and interruption can be deadly. Providing support for people requiring dialysis in humanitarian settings can be complex and is associated with many trade-offs. The global kidney care community must become familiar with the ethics, principles and duties essential to meeting the overarching goals of ethical and effective disaster relief. Ethics principles and values must be considered on the individual, public health and global levels. The wellbeing of a single patient must be considered in the context of the competing needs of many others, and optimal treatment may not be possible due to resource constraints. Public health ethics principles, including considerations of triage and resource allocation, maximization of benefit and feasibility, often become directly relevant at the bedside. Individuals delivering humanitarian relief must be well trained, competent, respectful and professional, while involved organizations need to uphold the highest professional and ethical standards. There may be dissonance between ethical guidance and practical realities in humanitarian settings, which for inexperienced individuals may present significant challenges. Sustaining dialysis care in emergencies brings these issues starkly to the fore. Preparedness for dialysis in emergencies is an ethical imperative that mandates multisectoral stakeholder engagement and action, development of surge response plans, clinical and ethics guidance, and transparent priority setting. This manuscript outlines common ethics challenges and considerations that apply in all humanitarian actions, and illustrates their relevance to kidney care as a whole, using examples of how these may apply to dialysis and kidney disaster relief efforts in humanitarian settings.
{"title":"Ethics in humanitarian settings-relevance and consequences for dialysis and kidney care.","authors":"Valerie A Luyckx, Wim Van Biesen, Jadranka Buturovic Ponikvar, Peter Heering, Ali Abu-Alfa, Ji Silberzweig, Monica Fontana, Serhan Tuglular, Mehmet Sukru Sever","doi":"10.1093/ckj/sfae290","DOIUrl":"https://doi.org/10.1093/ckj/sfae290","url":null,"abstract":"<p><p>With the increasing frequency and severity of disasters and the increasing number of patients living with kidney disease, on dialysis and with transplants around the world, the need for kidney care in humanitarian settings is increasing. Almost all humanitarian emergencies pose a threat to kidney health because all treatments are highly susceptible to interruption, and interruption can be deadly. Providing support for people requiring dialysis in humanitarian settings can be complex and is associated with many trade-offs. The global kidney care community must become familiar with the ethics, principles and duties essential to meeting the overarching goals of ethical and effective disaster relief. Ethics principles and values must be considered on the individual, public health and global levels. The wellbeing of a single patient must be considered in the context of the competing needs of many others, and optimal treatment may not be possible due to resource constraints. Public health ethics principles, including considerations of triage and resource allocation, maximization of benefit and feasibility, often become directly relevant at the bedside. Individuals delivering humanitarian relief must be well trained, competent, respectful and professional, while involved organizations need to uphold the highest professional and ethical standards. There may be dissonance between ethical guidance and practical realities in humanitarian settings, which for inexperienced individuals may present significant challenges. Sustaining dialysis care in emergencies brings these issues starkly to the fore. Preparedness for dialysis in emergencies is an ethical imperative that mandates multisectoral stakeholder engagement and action, development of surge response plans, clinical and ethics guidance, and transparent priority setting. This manuscript outlines common ethics challenges and considerations that apply in all humanitarian actions, and illustrates their relevance to kidney care as a whole, using examples of how these may apply to dialysis and kidney disaster relief efforts in humanitarian settings.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 10","pages":"sfae290"},"PeriodicalIF":3.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tamas Szili-Torok, Martin H de Borst, Alexandra Soteriou, Laura Post, Stephan J L Bakker, Uwe J F Tietge
Introduction Transplant vasculopathy resembles atherosclerotic plaque formation and is a major contributor to late graft failure in kidney transplant recipients (KTR). Remnant lipoproteins and associated triglycerides are causal risk factors for atherosclerotic plaques and have been implicated in late kidney graft failure. However, whether remnants derived from liver (containing apolipoprotein [apo] B100) or intestine (containing apoB48) are clinically more important is unclear. The current study investigated the association between baseline fasting apoB48 levels and late kidney graft failure. Methods 481 KTR with a functioning graft for at least one year were included in this retrospective, observational longitudinal single center cohort study. The primary endpoint was death-censored late graft failure, defined as need for initiation of dialysis or re-transplantation. ApoB48 was measured by enzyme-linked immunosorbent assay. Results During a median follow-up of 9.5 years, 61 KTR developed graft failure (12.7%). At baseline, KTR with higher apoB48 levels had lower eGFR (p<0.001), lower HDL cholesterol (p<0.001), increased triglycerides (p<0.001) and used cyclosporine more frequently (p=0.003). Cox regression showed that higher baseline apoB48 was associated with higher risk of late graft failure (hazard ratio [95% confidence interval], 1.59 [1.22, 2.07], p<0.001), independent of stepwise adjustment for potential confounders, including age and sex , immunosuppression type and proteinuria , triglycerides , and waist circumference (fully adjusted HR, 1.78 [1.29, 2.47], p<0.001). Conclusion ApoB48 is strongly associated with late graft failure, independent of potential confounders. Since apoB48-containing lipoproteins originate from the intestine, this study provides a rationale for considering pharmacological interventions targeting lipid absorption to improve graft outcome.
{"title":"Apolipoprotein B-48 and late graft failure in kidney transplant recipients","authors":"Tamas Szili-Torok, Martin H de Borst, Alexandra Soteriou, Laura Post, Stephan J L Bakker, Uwe J F Tietge","doi":"10.1093/ckj/sfae289","DOIUrl":"https://doi.org/10.1093/ckj/sfae289","url":null,"abstract":"Introduction Transplant vasculopathy resembles atherosclerotic plaque formation and is a major contributor to late graft failure in kidney transplant recipients (KTR). Remnant lipoproteins and associated triglycerides are causal risk factors for atherosclerotic plaques and have been implicated in late kidney graft failure. However, whether remnants derived from liver (containing apolipoprotein [apo] B100) or intestine (containing apoB48) are clinically more important is unclear. The current study investigated the association between baseline fasting apoB48 levels and late kidney graft failure. Methods 481 KTR with a functioning graft for at least one year were included in this retrospective, observational longitudinal single center cohort study. The primary endpoint was death-censored late graft failure, defined as need for initiation of dialysis or re-transplantation. ApoB48 was measured by enzyme-linked immunosorbent assay. Results During a median follow-up of 9.5 years, 61 KTR developed graft failure (12.7%). At baseline, KTR with higher apoB48 levels had lower eGFR (p&lt;0.001), lower HDL cholesterol (p&lt;0.001), increased triglycerides (p&lt;0.001) and used cyclosporine more frequently (p=0.003). Cox regression showed that higher baseline apoB48 was associated with higher risk of late graft failure (hazard ratio [95% confidence interval], 1.59 [1.22, 2.07], p&lt;0.001), independent of stepwise adjustment for potential confounders, including age and sex , immunosuppression type and proteinuria , triglycerides , and waist circumference (fully adjusted HR, 1.78 [1.29, 2.47], p&lt;0.001). Conclusion ApoB48 is strongly associated with late graft failure, independent of potential confounders. Since apoB48-containing lipoproteins originate from the intestine, this study provides a rationale for considering pharmacological interventions targeting lipid absorption to improve graft outcome.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background End-stage renal disease (ESRD) patients with maintenance hemodialysis (HD) are often accompanied by damage to brain white matter (WM) and cognitive impairment. However, whether this damage is caused by maintenance HD or renal dysfunction is unclear. Purpose To investigate the natural progression of WM damage in patients with ESRD and the effects of HD on WM using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA). Population Eighty-one ESRD patients including 41 with no dialysis (ND) and 40 with HD and forty-six healthy controls (HCs) were enrolled in this study. Field Strength/Sequence A 3 T, single-shot spin–echo echo planar imaging (EPI). Assessment The difference of WM among the three groups (ESRD patients with HD, ESRD patients without HD and HCs) were analyzed using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA), pairwise comparison was then used to compare the difference of WM between two groups. Relationship between WM and neurocognitive assessments/clinical data were analyzed in ESRD patients with or without HD. Statistical Tests Group t-test, Chi-square Test, Kruskal–Wallis test, Mann–Whitney U-Test, Spearman’ correlation analysis, non-parametric permutation testing. Results The damage of WM in ESRD with ND and ESRD HD appeared around the lateral ventricles similarly used for TBSS while FBA reflected the changes had extended to adjacent WM in anterior hemisphere, with larger region in ESRD HD compared to ESRD ND and the brainstem was also widely affected in ESRD HD. The levels of MoCA score were lower in ESRD HD group. RD in body of corpus callosum (BCC) were negatively correlated with MoCA score in both groups. FDC in left Thalamo-prefrontal projection (T_PREFL), left and right cingulum (CGL and CGR) were positively correlated with MoCA score in both groups. Creatinine (Cr) was positively correlated with FDC in some frontal projection fibers in striatum and thalamus, CG and fronto-pontine tract (FPT), Cr was positively correlated with FD mainly in premotor projection fibers in striatum and thalamus in ESRD HD group. Cr was negatively correlated with MD and RD in regions of corona radiata ESRD ND group. Data Conclusion FBA is more sensitive in detecting differences between ESRD patients and HCs. When ESRD patients receive maintenance HD, the degree of WM damage may not be aggravated, however, the range of damaged WM can be expanded, especially in anterior hemisphere and brainstem, some of these changes in anterior hemisphere may contribute to cognitive decline.
背景 接受维持性血液透析（HD）的终末期肾病（ESRD）患者通常伴有脑白质（WM）损伤和认知障碍。然而，这种损害是由维持性血液透析还是肾功能障碍引起的尚不清楚。目的 使用基于瓣膜的空间统计（TBSS）和基于固定颗粒的分析（FBA）研究 ESRD 患者脑白质损伤的自然进展以及 HD 对脑白质的影响。研究对象 本研究共纳入 81 名 ESRD 患者（包括 41 名未透析患者 (ND)、40 名 HD 患者和 46 名健康对照组 (HC)）。场强/序列 3 T、单发自旋回波平面成像（EPI）。评估 采用ract-based spatial statistics (TBSS)和fixel-based analysis (FBA)分析三组（患有HD的ESRD患者、未患有HD的ESRD患者和HCs）之间的WM差异，然后采用配对比较法比较两组之间的WM差异。分析合并或未合并 HD 的 ESRD 患者的 WM 与神经认知评估/临床数据之间的关系。统计检验方法 组间 t 检验、卡方检验、曼-惠特尼 U 检验、斯皮尔曼相关分析、非参数置换检验。结果 ESRD合并ND和ESRD HD的WM损害出现在侧脑室周围，与TBSS相似，而FBA反映出其改变已扩展到前半球邻近的WM，ESRD HD比ESRD ND受影响的区域更大，ESRD HD的脑干也受到广泛影响。ESRD HD 组的 MoCA 评分水平较低。两组胼胝体（BCC）的RD均与MoCA评分呈负相关。两组患者左侧Thalamo-prefrontal投射（T_PREFL）、左右侧cingulum（CGL和CGR）的FDC均与MoCA评分呈正相关。肌酸酐（Cr）与纹状体和丘脑部分额叶投射纤维、CG和前脑束（FPT）的FDC呈正相关，Cr与FD呈正相关，ESRD HD组的FD主要存在于纹状体和丘脑的前运动投射纤维中。在 ESRD ND 组，Cr 与放射冠区域的 MD 和 RD 呈负相关。数据结论 FBA 在检测 ESRD 患者和 HC 之间的差异方面更为敏感。ESRD 患者在接受维持性 HD 治疗时，WM 的损伤程度可能不会加重，但 WM 受损的范围可能会扩大，尤其是前半球和脑干，前半球的某些变化可能会导致认知能力下降。
{"title":"Cerebral white matter injury in hemodialysis patients: a cross-sectional tract-based spatial statistics and fixel-based analysis","authors":"Yu Qi, Lijun Song, Xu Liu, Boyan Xu, Wenbo Yang, Mingan Li, Min Li, Zhengyang Zhu, Wenhu Liu, Zhenghan Yang, Zhenchang Wang, Hao Wang","doi":"10.1093/ckj/sfae286","DOIUrl":"https://doi.org/10.1093/ckj/sfae286","url":null,"abstract":"Background End-stage renal disease (ESRD) patients with maintenance hemodialysis (HD) are often accompanied by damage to brain white matter (WM) and cognitive impairment. However, whether this damage is caused by maintenance HD or renal dysfunction is unclear. Purpose To investigate the natural progression of WM damage in patients with ESRD and the effects of HD on WM using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA). Population Eighty-one ESRD patients including 41 with no dialysis (ND) and 40 with HD and forty-six healthy controls (HCs) were enrolled in this study. Field Strength/Sequence A 3 T, single-shot spin–echo echo planar imaging (EPI). Assessment The difference of WM among the three groups (ESRD patients with HD, ESRD patients without HD and HCs) were analyzed using Tract-based spatial statistics (TBSS) and fixel-based analysis (FBA), pairwise comparison was then used to compare the difference of WM between two groups. Relationship between WM and neurocognitive assessments/clinical data were analyzed in ESRD patients with or without HD. Statistical Tests Group t-test, Chi-square Test, Kruskal–Wallis test, Mann–Whitney U-Test, Spearman’ correlation analysis, non-parametric permutation testing. Results The damage of WM in ESRD with ND and ESRD HD appeared around the lateral ventricles similarly used for TBSS while FBA reflected the changes had extended to adjacent WM in anterior hemisphere, with larger region in ESRD HD compared to ESRD ND and the brainstem was also widely affected in ESRD HD. The levels of MoCA score were lower in ESRD HD group. RD in body of corpus callosum (BCC) were negatively correlated with MoCA score in both groups. FDC in left Thalamo-prefrontal projection (T_PREFL), left and right cingulum (CGL and CGR) were positively correlated with MoCA score in both groups. Creatinine (Cr) was positively correlated with FDC in some frontal projection fibers in striatum and thalamus, CG and fronto-pontine tract (FPT), Cr was positively correlated with FD mainly in premotor projection fibers in striatum and thalamus in ESRD HD group. Cr was negatively correlated with MD and RD in regions of corona radiata ESRD ND group. Data Conclusion FBA is more sensitive in detecting differences between ESRD patients and HCs. When ESRD patients receive maintenance HD, the degree of WM damage may not be aggravated, however, the range of damaged WM can be expanded, especially in anterior hemisphere and brainstem, some of these changes in anterior hemisphere may contribute to cognitive decline.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"53 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Telitacicept, a BLyS/APRIL dual-target fusion protein, has recently been used in autoimmune diseases. We assessed Telitacicept’ s efficacy and safety in IgA nephropathy (IgAN) patients. Methods This study included 42 IgAN patients who received Telitacicept treatment, forming the ‘whole Telitacicept group’. Among them, 20 patients who had not previously received corticosteroid (CS) therapy or immunosuppressive (IS) agents were categorized as the ‘newly treated Telitacicept subgroup’. Additionally, 28 patients who were selected to match historical controls received conventional IS (CS therapy with/without IS agents) therapy and were classified as the ‘conventional IS group’. Telitacicept was partially used in combination with conventional IS, including initial CS in different doses. Various indicators were compared at 4-week intervals up to 24 weeks among the three groups. Results After 24 weeks of treatment, the 24-hour proteinuria decreased from 1.70 [interquartile range (IQR), 1.05–2.58]g to 0.21 (0.39–0.13) g (P = 0.043) in the newly treated Telitacicept subgroup, from 1.78 (0.97–2.82) g to 0.44 (1.48–0.16) g (P = 0.001) in the conventional IS group, and from 1.07 (0.66–1.99) g to 0.26 (0.59–0.17) g (P = 0.028) in the whole Telitacicept group. The estimated glomerular filtration rate (eGFR) increased from (76.58 ± 30.26) ml/min/1.73m2 to (80.30 ± 26.76) ml/min/1.73m2 (P = 0.016) in the newly treated Telitacicept subgroup, from (72.73 ± 33.41) ml/min/1.73m2 to (84.08.10 ± 26.81) ml/min/1.73m2 (P = 0.011) in the conventional IS group, and from (70.10 ± 32.88) ml/min/1.73m2 to (71.21 ± 31.49) ml/min/1.73m2 (P = 0.065) in the whole Telitacicept group. During follow-up periods, the efficacy rates of the three groups did not show statistically significant differences, and no serious adverse events (SAEs) were observed. Conclusions Telitacicept may be a safe and effective treatment for IgAN, offering similar reductions in proteinuria and increases in eGFR as conventional IS therapy. After a 24-week follow-up, the incidence of adverse events (AEs) was lower for Telitacicept than for conventional IS therapy.
{"title":"Efficacy and safety of telitacicept, a BLyS/APRIL dual inhibitor, in the treatment of IgA nephropathy: a retrospective case-control study","authors":"Meng Wang, Jianfei Ma, Li Yao, Yi Fan","doi":"10.1093/ckj/sfae285","DOIUrl":"https://doi.org/10.1093/ckj/sfae285","url":null,"abstract":"Background Telitacicept, a BLyS/APRIL dual-target fusion protein, has recently been used in autoimmune diseases. We assessed Telitacicept’ s efficacy and safety in IgA nephropathy (IgAN) patients. Methods This study included 42 IgAN patients who received Telitacicept treatment, forming the ‘whole Telitacicept group’. Among them, 20 patients who had not previously received corticosteroid (CS) therapy or immunosuppressive (IS) agents were categorized as the ‘newly treated Telitacicept subgroup’. Additionally, 28 patients who were selected to match historical controls received conventional IS (CS therapy with/without IS agents) therapy and were classified as the ‘conventional IS group’. Telitacicept was partially used in combination with conventional IS, including initial CS in different doses. Various indicators were compared at 4-week intervals up to 24 weeks among the three groups. Results After 24 weeks of treatment, the 24-hour proteinuria decreased from 1.70 [interquartile range (IQR), 1.05–2.58]g to 0.21 (0.39–0.13) g (P = 0.043) in the newly treated Telitacicept subgroup, from 1.78 (0.97–2.82) g to 0.44 (1.48–0.16) g (P = 0.001) in the conventional IS group, and from 1.07 (0.66–1.99) g to 0.26 (0.59–0.17) g (P = 0.028) in the whole Telitacicept group. The estimated glomerular filtration rate (eGFR) increased from (76.58 ± 30.26) ml/min/1.73m2 to (80.30 ± 26.76) ml/min/1.73m2 (P = 0.016) in the newly treated Telitacicept subgroup, from (72.73 ± 33.41) ml/min/1.73m2 to (84.08.10 ± 26.81) ml/min/1.73m2 (P = 0.011) in the conventional IS group, and from (70.10 ± 32.88) ml/min/1.73m2 to (71.21 ± 31.49) ml/min/1.73m2 (P = 0.065) in the whole Telitacicept group. During follow-up periods, the efficacy rates of the three groups did not show statistically significant differences, and no serious adverse events (SAEs) were observed. Conclusions Telitacicept may be a safe and effective treatment for IgAN, offering similar reductions in proteinuria and increases in eGFR as conventional IS therapy. After a 24-week follow-up, the incidence of adverse events (AEs) was lower for Telitacicept than for conventional IS therapy.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"29 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tammy Hod, Shmuel Levinger, Enosh Askenasy, Maya Siman-Tov, Yana Davidov, Ronen Ghinea, Niv Pencovich, Ido Nachmani, Eytan Mor
Background Individualizing induction therapy based on immunological risk is crucial for optimizing outcomes in kidney transplantation. Methods A retrospective analysis included 157 first live-donor non-sensitized kidney transplant recipients (KTRs). Within this cohort, 96 individuals exhibited low HLA matching (5–6 HLA mismatches). The low HLA match subgroup was categorized into 52 KTRs receiving basiliximab alone and 44 recipients treated with a combined single ATG dose of 1.5 mg/kg and basiliximab. The primary endpoint was early acute cellular rejection (ACR) within 6 months post-transplant while secondary outcomes encompassed infection rates, renal allograft function, length of stay (LOS), and readmissions post-transplant. Results The incidence of early ACR was decreased for low HLA match KTRs, who received ATG-Basiliximab, when compared to low HLA-matched KTRs who received Basiliximab alone (9.1% vs. 23.9%, p = 0.067). Age was a predictor for rejection, and subgroup analysis showed consistent rejection reduction across age groups. No significant differences were observed in admission for transplant LOS or in peri-operative complications, nor in infections rate including BK and CMV viremia, allograft function and number of readmissions post-transplant up to 6 months post-transplant. Conclusion In non-sensitized first live-donor KTRs with low HLA matching, a dual ATG-basiliximab induction approach significantly reduced early ACR without compromising safety.
{"title":"Basiliximab induction alone vs. a dual ATG-Basiliximab approach in first live-donor non-sensitized kidney transplant recipients with low HLA matching","authors":"Tammy Hod, Shmuel Levinger, Enosh Askenasy, Maya Siman-Tov, Yana Davidov, Ronen Ghinea, Niv Pencovich, Ido Nachmani, Eytan Mor","doi":"10.1093/ckj/sfae236","DOIUrl":"https://doi.org/10.1093/ckj/sfae236","url":null,"abstract":"Background Individualizing induction therapy based on immunological risk is crucial for optimizing outcomes in kidney transplantation. Methods A retrospective analysis included 157 first live-donor non-sensitized kidney transplant recipients (KTRs). Within this cohort, 96 individuals exhibited low HLA matching (5–6 HLA mismatches). The low HLA match subgroup was categorized into 52 KTRs receiving basiliximab alone and 44 recipients treated with a combined single ATG dose of 1.5 mg/kg and basiliximab. The primary endpoint was early acute cellular rejection (ACR) within 6 months post-transplant while secondary outcomes encompassed infection rates, renal allograft function, length of stay (LOS), and readmissions post-transplant. Results The incidence of early ACR was decreased for low HLA match KTRs, who received ATG-Basiliximab, when compared to low HLA-matched KTRs who received Basiliximab alone (9.1% vs. 23.9%, p = 0.067). Age was a predictor for rejection, and subgroup analysis showed consistent rejection reduction across age groups. No significant differences were observed in admission for transplant LOS or in peri-operative complications, nor in infections rate including BK and CMV viremia, allograft function and number of readmissions post-transplant up to 6 months post-transplant. Conclusion In non-sensitized first live-donor KTRs with low HLA matching, a dual ATG-basiliximab induction approach significantly reduced early ACR without compromising safety.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"11 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander Woywodt, Rebecca E Payne, Brooke M Huuskes, Bartu Hezer
Video consultations have seen increasing use in nephrology since the COVID-19 pandemic with an aim to address constraints in F2F outpatient capacity and also patients’ concerns around risks of infection when attending healthcare facilities. Nephrologists have learned through experience to use video consultations for providing routine follow up but also for ad-hoc triage of unwell patients. Advantages of video consultations include convenience, cost savings through avoiding clinic overheads, and reducing the carbon footprint of care. The latter is increasingly relevant as nephrologists consider climate change and its implications. Video consultations are not a panacea to overcome challenges in nephrology and risks also exist for example when it comes to redesigning pathways and maintaining access to F2F assessments when required. It is equally important to consider practical aspects such as reimbursement, prescribing, and documentation. Some clinicians may wish to carry out video consultations from home to save time spent in commute but this, too, requires careful thought. Another consideration is the digital divide and support should be provided for patients who are less IT literate or who have no access to the digital world. Patients with special needs such as those with visual or hearing impairment and those with language issues also require consideration. We view video consultations as a developing and growing part of the portfolio of renal care. We see their main role in providing routine follow up to stable and IT literate outpatients, particularly where there is provider continuity and where care is provided across a large geographical area.
{"title":"Ten tips to carry out video consultations in nephrology","authors":"Alexander Woywodt, Rebecca E Payne, Brooke M Huuskes, Bartu Hezer","doi":"10.1093/ckj/sfae287","DOIUrl":"https://doi.org/10.1093/ckj/sfae287","url":null,"abstract":"Video consultations have seen increasing use in nephrology since the COVID-19 pandemic with an aim to address constraints in F2F outpatient capacity and also patients’ concerns around risks of infection when attending healthcare facilities. Nephrologists have learned through experience to use video consultations for providing routine follow up but also for ad-hoc triage of unwell patients. Advantages of video consultations include convenience, cost savings through avoiding clinic overheads, and reducing the carbon footprint of care. The latter is increasingly relevant as nephrologists consider climate change and its implications. Video consultations are not a panacea to overcome challenges in nephrology and risks also exist for example when it comes to redesigning pathways and maintaining access to F2F assessments when required. It is equally important to consider practical aspects such as reimbursement, prescribing, and documentation. Some clinicians may wish to carry out video consultations from home to save time spent in commute but this, too, requires careful thought. Another consideration is the digital divide and support should be provided for patients who are less IT literate or who have no access to the digital world. Patients with special needs such as those with visual or hearing impairment and those with language issues also require consideration. We view video consultations as a developing and growing part of the portfolio of renal care. We see their main role in providing routine follow up to stable and IT literate outpatients, particularly where there is provider continuity and where care is provided across a large geographical area.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"27 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and hypothesis Damages in brain white matter often occurs in individuals with chronic kidney disease, which might be related to their cognitive decline. This study aims to investigate tract specific white matter damage in patients with end stage renal disease by using fixel based analysis. Methods Images of 31 end stage renal disease patients and 16 normal controls (aged: 61.1 ± 10.4 years; 11 men) were acquired from a 1.5 T MR scanner. The patients were subsequently divided into with normal cognition (N = 17, aged: 66.9 ± 7.2 years; 10 men) and cognitive impairment (N = 14, aged: 72.4 ± 9.4 years; 7 men). Cognitive assessment, neurologic, hematologic and biochemical samples were collected. Fixel-based analysis was used to examine the tract-specific damage within white matter. Differences between groups were evaluated through connectivity-based fixel enhancement and non-parametric permutation testing. Correlation with biomarkers was conducted through general linear model. Significance was determined with familywise error-corrected p-value < 0.05. Results Reduced fixel-based metrics were observed in specific tract located the cerebral peduncle, internal capsule, corpus callosum, fornix, and superior corona radiata in patients when compared to normal controls, indicating a reduction in fiber content. The fibers crossing the corpus callosum and the fornix/stria terminalis are particularly vulnerable sites, which can be associated with the decrease in both Mini-Mental State Examination (R2 ranged between 0.420 and 0.556) and Montreal Cognitive Assessment (R2 ranged between 0.425 and 0.509), as well as the plasma concentration of calcium (R2 ranged between 0.207 and 0.322). The plasma concentration of indoxyl sulfate was associated with the descending tracts from right posterior limb of internal capsule to cerebral peduncle (R2 ranged between 0.262 and 0.335). Conclusions Tract specific white matter damage can be noticed in the patients with end stage renal disease, and can be associated with their cognitive decline.
{"title":"Cerebral white matter damage in patients with end stage kidney disease associates with cognitive impairment","authors":"Yi-Chou Hou, Chih-Chien Tsai, Ruei-Ming Chen, Yi-Chien Liu, Kuo-Cheng Lu, Yao-Liang Chen, Ting-Wen Shen, Jiun-Jie Wang","doi":"10.1093/ckj/sfae283","DOIUrl":"https://doi.org/10.1093/ckj/sfae283","url":null,"abstract":"Background and hypothesis Damages in brain white matter often occurs in individuals with chronic kidney disease, which might be related to their cognitive decline. This study aims to investigate tract specific white matter damage in patients with end stage renal disease by using fixel based analysis. Methods Images of 31 end stage renal disease patients and 16 normal controls (aged: 61.1 ± 10.4 years; 11 men) were acquired from a 1.5 T MR scanner. The patients were subsequently divided into with normal cognition (N = 17, aged: 66.9 ± 7.2 years; 10 men) and cognitive impairment (N = 14, aged: 72.4 ± 9.4 years; 7 men). Cognitive assessment, neurologic, hematologic and biochemical samples were collected. Fixel-based analysis was used to examine the tract-specific damage within white matter. Differences between groups were evaluated through connectivity-based fixel enhancement and non-parametric permutation testing. Correlation with biomarkers was conducted through general linear model. Significance was determined with familywise error-corrected p-value &lt; 0.05. Results Reduced fixel-based metrics were observed in specific tract located the cerebral peduncle, internal capsule, corpus callosum, fornix, and superior corona radiata in patients when compared to normal controls, indicating a reduction in fiber content. The fibers crossing the corpus callosum and the fornix/stria terminalis are particularly vulnerable sites, which can be associated with the decrease in both Mini-Mental State Examination (R2 ranged between 0.420 and 0.556) and Montreal Cognitive Assessment (R2 ranged between 0.425 and 0.509), as well as the plasma concentration of calcium (R2 ranged between 0.207 and 0.322). The plasma concentration of indoxyl sulfate was associated with the descending tracts from right posterior limb of internal capsule to cerebral peduncle (R2 ranged between 0.262 and 0.335). Conclusions Tract specific white matter damage can be noticed in the patients with end stage renal disease, and can be associated with their cognitive decline.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"64 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The occurrence of acute kidney injury (AKI) was associated with an increased mortality rate among acute pancreatitis (AP) patients, indicating the importance of accurately predicting the mortality rate of critically ill patients with acute pancreatitis-associated acute kidney injury (AP-AKI) at an early stage. This study aimed to develop and validate machine learning-based predictive models for in-hospital mortality rate in critically ill patients with AP-AKI by comparing their performance with the traditional logistic regression (LR) model. Methods This study used the data from three clinical databases. The predictors were identified by the Recursive Feature Elimination algorithm. The LR and two machine learning models including random forest (RF) and extreme gradient boosting (XGBoost) were developed using the ten-fold cross-validation to predict in-hospital mortality rate in AP-AKI patients. Results A total of 1,089 patients from Medical Information Mart for Intensive Care-IV (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) were included in the training set, and 176 patients from Xiangya Hospital were included in the external validation set. The in-hospital mortality rate of the training and external validation sets was 13.77% and 54.55%, respectively. Compared to the AUC values of the LR model and the RF model, the AUC value of the XGBoost model [0.941, 95% confidence interval (CI): 0.931-0.952] was significantly higher (both P < 0.001), and the XGBoost model had the smallest Brier score of 0.039 in the training set. In the external validation set, the performance of the XGBoost model was acceptable with an AUC value of 0.724 (95% CI: 0.648-0.800). However, it did not differ significantly from the LR and RF model models. Conclusions The XGBoost model was superior to the LR and RF models in terms of both the discrimination and calibration in the training set, while whether the findings can be generalized needs to be further validated.
背景 急性肾损伤（AKI）的发生与急性胰腺炎（AP）患者死亡率的增加有关，这表明早期准确预测急性胰腺炎相关急性肾损伤（AP-AKI）重症患者死亡率的重要性。本研究旨在开发和验证基于机器学习的急性胰腺炎相关急性肾损伤重症患者院内死亡率预测模型，并将其与传统的逻辑回归（LR）模型进行比较。方法 本研究使用了三个临床数据库的数据。预测因子通过递归特征消除算法确定。使用十倍交叉验证法开发了 LR 模型和两种机器学习模型，包括随机森林（RF）和极端梯度提升（XGBoost），用于预测 AP-AKI 患者的院内死亡率。结果 共有 1,089 名来自重症监护医学信息中心-IV（MIMIC-IV）和 eICU 合作研究数据库（eICU-CRD）的患者被纳入训练集，176 名来自湘雅医院的患者被纳入外部验证集。训练集和外部验证集的院内死亡率分别为13.77%和54.55%。与LR模型和RF模型的AUC值相比，XGBoost模型的AUC值[0.941，95%置信区间（CI）：0.931-0.952]明显更高（均为P<0.001），且XGBoost模型在训练集中的Brier得分最小，为0.039。在外部验证集中，XGBoost 模型的 AUC 值为 0.724（95% CI：0.648-0.800），表现尚可。但是，它与 LR 模型和 RF 模型的差异不大。结论 XGBoost 模型在训练集的区分度和校准方面均优于 LR 和 RF 模型，但这一结论能否推广还需要进一步验证。
{"title":"Machine learning models for mortality prediction in critically ill patients with acute pancreatitis-associated acute kidney injury","authors":"Yamin Liu, Xu Zhu, Jing Xue, Rehanguli Maimaitituerxun, Wenhang Chen, Wenjie Dai","doi":"10.1093/ckj/sfae284","DOIUrl":"https://doi.org/10.1093/ckj/sfae284","url":null,"abstract":"Background The occurrence of acute kidney injury (AKI) was associated with an increased mortality rate among acute pancreatitis (AP) patients, indicating the importance of accurately predicting the mortality rate of critically ill patients with acute pancreatitis-associated acute kidney injury (AP-AKI) at an early stage. This study aimed to develop and validate machine learning-based predictive models for in-hospital mortality rate in critically ill patients with AP-AKI by comparing their performance with the traditional logistic regression (LR) model. Methods This study used the data from three clinical databases. The predictors were identified by the Recursive Feature Elimination algorithm. The LR and two machine learning models including random forest (RF) and extreme gradient boosting (XGBoost) were developed using the ten-fold cross-validation to predict in-hospital mortality rate in AP-AKI patients. Results A total of 1,089 patients from Medical Information Mart for Intensive Care-IV (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) were included in the training set, and 176 patients from Xiangya Hospital were included in the external validation set. The in-hospital mortality rate of the training and external validation sets was 13.77% and 54.55%, respectively. Compared to the AUC values of the LR model and the RF model, the AUC value of the XGBoost model [0.941, 95% confidence interval (CI): 0.931-0.952] was significantly higher (both P &lt; 0.001), and the XGBoost model had the smallest Brier score of 0.039 in the training set. In the external validation set, the performance of the XGBoost model was acceptable with an AUC value of 0.724 (95% CI: 0.648-0.800). However, it did not differ significantly from the LR and RF model models. Conclusions The XGBoost model was superior to the LR and RF models in terms of both the discrimination and calibration in the training set, while whether the findings can be generalized needs to be further validated.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"105 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Pruritus is a common condition in chronic kidney disease, especially for patients receiving haemodialysis. Chronic kidney disease associated-pruritus (CKD-aP) can be distressing and have a negative impact on quality of life (QoL). This post hoc analysis aimed to assess the relationship between pruritus relief and QoL. Methods Data from phase 3 trials ([NCT03422653, NCT03636269 grouped], and NCT03998163) of the novel antipruritic difelikefalin (N = 914) were used to assess the relationship between reductions in pruritus intensity at Week 12 (24-hour Worst Itching Intensity Numeric Rating Scale; WI-NRS), perceived improvement in itch (Patient Global Impression of Change, PGI-C) and pruritus-related QoL (Skindex-10 questionnaire). Results Patients receiving difelikefalin had greater improvements in Skindex-10 total scores than those receiving placebo (LS mean treatment difference –3.4; 95% CI –5.5, –1.3; P = 0.002) and greater improvements across Skindex-10 domains (disease, mood, and social functioning) at Week 12. In patients receiving difelikefalin, those with clinically meaningful improvements in pruritus (≥3-point reduction in WI-NRS score) at Week 12 had a greater improvement in Skindex-10 total score (mean difference 14.2; 95% CI 11.0, 17.3; P < 0.001) and Skindex-10 domains than those with a < 3-point reduction in WI-NRS score. Improvements in Skindex-10 total scores correlated with PGI-C. Conclusions Improvements in pruritus intensity following 12 weeks’ treatment with difelikefalin were associated with improvements in QoL. Larger improvements in Skindex-10 scores were seen in patients with a greater reduction in pruritus intensity, indicating that improvements in pruritus are associated with a range of factors, such as mood and social functioning, that affect pruritus-related QoL.
背景瘙痒是慢性肾脏病的一种常见症状，尤其是对接受血液透析的患者而言。慢性肾脏病相关性瘙痒症（CKD-aP）会给患者带来痛苦，并对生活质量（QoL）产生负面影响。这项事后分析旨在评估瘙痒缓解与 QoL 之间的关系。方法 采用新型抗瘙痒剂地匹法林（N = 914）3 期试验（[NCT03422653、NCT03636269 组]和 NCT03998163）的数据，评估第 12 周时瘙痒强度降低（24 小时最严重瘙痒强度数字评分量表；WI-NRS）、瘙痒改善感（患者总体变化印象，PGI-C）和瘙痒相关 QoL（Skindex-10 问卷）之间的关系。结果 第12周时，接受地匹法林治疗的患者的Skindex-10总分比接受安慰剂治疗的患者有更大改善（LS平均治疗差异-3.4；95% CI -5.5，-1.3；P = 0.002），Skindex-10各领域（疾病、情绪和社会功能）也有更大改善。在接受地匹法林治疗的患者中，与WI-NRS评分减少3分的患者相比，第12周时瘙痒症状有临床意义改善（WI-NRS评分减少≥3分）的患者在Skindex-10总分（平均差14.2；95% CI 11.0，17.3；P< 0.001）和Skindex-10领域的改善幅度更大。Skindex-10总分的改善与PGI-C相关。结论 使用地匹福林治疗 12 周后，瘙痒强度的改善与 QoL 的改善相关。瘙痒强度降低较多的患者的 Skindex-10 评分改善幅度较大，这表明瘙痒的改善与一系列影响瘙痒相关 QoL 的因素有关，如情绪和社会功能。
{"title":"Chronic kidney disease-associated pruritus and quality of life with difelikefalin treatment: a post hoc analysis of phase 3 data using the Skindex-10 questionnaire","authors":"Sonja Ständer, Steven Fishbane, Thilo Schaufler, Despina Ruessmann, Isabelle Morin, Frédérique Menzaghi, Warren Wen, Kamyar Kalantar-Zadeh","doi":"10.1093/ckj/sfae274","DOIUrl":"https://doi.org/10.1093/ckj/sfae274","url":null,"abstract":"Background Pruritus is a common condition in chronic kidney disease, especially for patients receiving haemodialysis. Chronic kidney disease associated-pruritus (CKD-aP) can be distressing and have a negative impact on quality of life (QoL). This post hoc analysis aimed to assess the relationship between pruritus relief and QoL. Methods Data from phase 3 trials ([NCT03422653, NCT03636269 grouped], and NCT03998163) of the novel antipruritic difelikefalin (N = 914) were used to assess the relationship between reductions in pruritus intensity at Week 12 (24-hour Worst Itching Intensity Numeric Rating Scale; WI-NRS), perceived improvement in itch (Patient Global Impression of Change, PGI-C) and pruritus-related QoL (Skindex-10 questionnaire). Results Patients receiving difelikefalin had greater improvements in Skindex-10 total scores than those receiving placebo (LS mean treatment difference –3.4; 95% CI –5.5, –1.3; P = 0.002) and greater improvements across Skindex-10 domains (disease, mood, and social functioning) at Week 12. In patients receiving difelikefalin, those with clinically meaningful improvements in pruritus (≥3-point reduction in WI-NRS score) at Week 12 had a greater improvement in Skindex-10 total score (mean difference 14.2; 95% CI 11.0, 17.3; P &lt; 0.001) and Skindex-10 domains than those with a &lt; 3-point reduction in WI-NRS score. Improvements in Skindex-10 total scores correlated with PGI-C. Conclusions Improvements in pruritus intensity following 12 weeks’ treatment with difelikefalin were associated with improvements in QoL. Larger improvements in Skindex-10 scores were seen in patients with a greater reduction in pruritus intensity, indicating that improvements in pruritus are associated with a range of factors, such as mood and social functioning, that affect pruritus-related QoL.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"27 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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