Clinical Kidney Journal最新文献_第4页

Effects of SGLT2 inhibitors on parameters of renal venous congestion in intrarenal Doppler ultrasonography. SGLT2 抑制剂对肾内多普勒超声检查中肾静脉充血参数的影响

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-14 DOI: 10.1093/ckj/sfae234

Manuel Wallbach,Jamil Ajrab,Bilgin Bayram,Dennis Pieper,Ann-Kathrin Schäfer,Stephan Lüders,Fani Delistefani,Dieter Müller,Michael Koziolek

BackgroundCardiorenal syndrome is a common condition in clinical practice in which renal venous congestion (VC) plays an important role. Intrarenal Doppler ultrasound (IRD) is a non-invasive method to assess and quantify renal VC. The current study aims to investigate the effects of SGLT2 inhibitor (SGLT2i) therapy on IRD parameters of renal VC.MethodsThis prospective observational study included patients with chronic kidney disease (CKD) with or without type 2 diabetes mellitus and/or heart failure (HF) with reduced and preserved ejection fraction who had an indication for standard of care SGLT2i therapy. IRD, assessing venous impedance index (VII), and intrarenal venous flow pattern (IRVF) analysis were performed within the interlobar vessels of the right kidney before and 6 months after initiation of SGLT2i therapy.ResultsA number of 64 patients with CKD and a cardiorenal risk profile were included (mean eGFR 42.9 ml/min/1.73 m2; 56% with HF, and 38% with type 2 diabetes mellitus). 17 patients exhibited signs of VC in the IRD. VII was significantly correlated with levels of NT-proBNP, female gender, NYHA class, and was significantly negative correlated with body mass index. After 6 months, a notable decrease in the mean VII of the right interlobar veins by 0.13 (P < .01) was observed. Stratification according to IRVF pattern showed a significant shift towards reduced renal VC pattern after 6 months (P = .03).ConclusionsIn this study, SGLT2i therapy resulted in a reduction in renal VC as assessed by IRD. These findings underscore the potential haemodynamic benefits of SGLT2 inhibitors in cardiorenal syndrome and warrant further investigation into their clinical implications.

背景心肾综合征是临床上的一种常见病，肾静脉充血（VC）在其中起着重要作用。肾内多普勒超声（IRD）是一种评估和量化肾静脉充血的无创方法。本研究旨在探讨 SGLT2 抑制剂（SGLT2i）治疗对 IRD 肾脏 VC 参数的影响。方法这项前瞻性观察性研究纳入了有 SGLT2i 标准疗法适应症的慢性肾脏病（CKD）伴或不伴 2 型糖尿病和/或射血分数降低和保留射血分数的心力衰竭（HF）患者。结果共纳入了 64 名患有慢性肾脏病和心肾风险的患者（平均 eGFR 42.9 毫升/分钟/1.73 平方米；56% 患有心力衰竭，38% 患有 2 型糖尿病）。17 名患者在 IRD 中显示出 VC 的迹象。VII 与 NT-proBNP 水平、女性性别、NYHA 分级有明显相关性，与体重指数呈明显负相关。6 个月后，观察到右叶间静脉的平均 VII 明显下降了 0.13（P < .01）。根据 IRVF 模式进行的分层显示，6 个月后，肾脏 VC 模式明显向减少方向转变（P = .03）。这些发现强调了 SGLT2 抑制剂对心肾综合征潜在的血流动力学益处，值得进一步研究其临床意义。

{"title":"Effects of SGLT2 inhibitors on parameters of renal venous congestion in intrarenal Doppler ultrasonography.","authors":"Manuel Wallbach,Jamil Ajrab,Bilgin Bayram,Dennis Pieper,Ann-Kathrin Schäfer,Stephan Lüders,Fani Delistefani,Dieter Müller,Michael Koziolek","doi":"10.1093/ckj/sfae234","DOIUrl":"https://doi.org/10.1093/ckj/sfae234","url":null,"abstract":"BackgroundCardiorenal syndrome is a common condition in clinical practice in which renal venous congestion (VC) plays an important role. Intrarenal Doppler ultrasound (IRD) is a non-invasive method to assess and quantify renal VC. The current study aims to investigate the effects of SGLT2 inhibitor (SGLT2i) therapy on IRD parameters of renal VC.MethodsThis prospective observational study included patients with chronic kidney disease (CKD) with or without type 2 diabetes mellitus and/or heart failure (HF) with reduced and preserved ejection fraction who had an indication for standard of care SGLT2i therapy. IRD, assessing venous impedance index (VII), and intrarenal venous flow pattern (IRVF) analysis were performed within the interlobar vessels of the right kidney before and 6 months after initiation of SGLT2i therapy.ResultsA number of 64 patients with CKD and a cardiorenal risk profile were included (mean eGFR 42.9 ml/min/1.73 m2; 56% with HF, and 38% with type 2 diabetes mellitus). 17 patients exhibited signs of VC in the IRD. VII was significantly correlated with levels of NT-proBNP, female gender, NYHA class, and was significantly negative correlated with body mass index. After 6 months, a notable decrease in the mean VII of the right interlobar veins by 0.13 (P < .01) was observed. Stratification according to IRVF pattern showed a significant shift towards reduced renal VC pattern after 6 months (P = .03).ConclusionsIn this study, SGLT2i therapy resulted in a reduction in renal VC as assessed by IRD. These findings underscore the potential haemodynamic benefits of SGLT2 inhibitors in cardiorenal syndrome and warrant further investigation into their clinical implications.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196407","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}

引用次数: 0

Kidney transplantation and gut microbiota. 肾移植与肠道微生物群

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-14 eCollection Date: 2024-08-01 DOI: 10.1093/ckj/sfae214

Zehuan Chen, Xinhua Chang, Qianyu Ye, Yifang Gao, Ronghai Deng

Kidney transplantation is an effective way to improve the condition of patients with end-stage renal disease. However, maintaining long-term graft function and improving patient survival remain a key challenge after kidney transplantation. Dysbiosis of intestinal flora has been reported to be associated with complications in renal transplant recipients. The commensal microbiota plays an important role in the immunomodulation of the transplant recipient responses. However, several processes, such as the use of perioperative antibiotics and high-dose immunosuppressants in renal transplant recipients, can lead to gut dysbiosis and disrupt the interaction between the microbiota and the host immune responses, which in turn can lead to complications such as infection and rejection in organ recipients. In this review, we summarize and discuss the changes in intestinal flora and their influencing factors in patients after renal transplantation as well as the evidence related to the impact of intestinal dysbiosis on the prognosis of renal transplantation from in vivo and clinical studies, and conclude with a discussion of the use of microbial therapy in the transplant population. Hopefully, a deeper understanding of the function and composition of the microbiota in patients after renal transplantation may assist in the development of clinical strategies to restore a normal microbiota and facilitate the clinical management of grafts in the future.

肾移植是改善终末期肾病患者病情的有效方法。然而，维持长期移植物功能和提高患者存活率仍是肾移植术后面临的主要挑战。据报道，肠道菌群失调与肾移植受者的并发症有关。共生微生物群在移植受体反应的免疫调节中发挥着重要作用。然而，一些过程，如肾移植受者围手术期抗生素和大剂量免疫抑制剂的使用，可导致肠道菌群失调，破坏微生物群与宿主免疫反应之间的相互作用，进而导致器官受者出现感染和排斥等并发症。在这篇综述中，我们总结并讨论了肾移植后患者肠道菌群的变化及其影响因素，以及体内和临床研究中与肠道菌群失调对肾移植预后的影响有关的证据，最后还讨论了在移植人群中使用微生物疗法的问题。希望对肾移植后患者体内微生物群的功能和组成有更深入的了解，这将有助于制定临床策略来恢复正常的微生物群，并促进未来对移植物的临床管理。

{"title":"Kidney transplantation and gut microbiota.","authors":"Zehuan Chen, Xinhua Chang, Qianyu Ye, Yifang Gao, Ronghai Deng","doi":"10.1093/ckj/sfae214","DOIUrl":"10.1093/ckj/sfae214","url":null,"abstract":"Kidney transplantation is an effective way to improve the condition of patients with end-stage renal disease. However, maintaining long-term graft function and improving patient survival remain a key challenge after kidney transplantation. Dysbiosis of intestinal flora has been reported to be associated with complications in renal transplant recipients. The commensal microbiota plays an important role in the immunomodulation of the transplant recipient responses. However, several processes, such as the use of perioperative antibiotics and high-dose immunosuppressants in renal transplant recipients, can lead to gut dysbiosis and disrupt the interaction between the microbiota and the host immune responses, which in turn can lead to complications such as infection and rejection in organ recipients. In this review, we summarize and discuss the changes in intestinal flora and their influencing factors in patients after renal transplantation as well as the evidence related to the impact of intestinal dysbiosis on the prognosis of renal transplantation from in vivo and clinical studies, and conclude with a discussion of the use of microbial therapy in the transplant population. Hopefully, a deeper understanding of the function and composition of the microbiota in patients after renal transplantation may assist in the development of clinical strategies to restore a normal microbiota and facilitate the clinical management of grafts in the future.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11336673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016587","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}

引用次数: 0

Point-of-care ultrasound Training in Nephrology: a position statement by the International Alliance for POCUS in Nephrology 肾脏病护理点超声波培训：国际肾脏病护理点超声波联盟立场声明

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-14 DOI: 10.1093/ckj/sfae245

Abhilash Koratala, Eduardo R Argaiz, Gregorio Romero-González, Nathaniel Reisinger, Siddiq Anwar, William Beaubien-Souligny, Bhavna Bhasin-Chhabra, Hugo Diniz, Marco Antonio Vaco Gallardo, Fredzzia Graterol Torres, Faeq Husein-Syed, Jennifer Hanko, Aala Jaberi, Amir Kazory, Rupesh Raina, Claudio Ronco, Octavio J Salgado, Sidharth Kumar Sethi, Vanessa Villavicencio Cerón, Manjusha Yadla, Marcus Gomes Bastos

Point-of-care Ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities, and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond.

护理点超声造影 (POCUS) 已从一项小众技术迅速发展成为包括肾脏病学在内的各医学专科不可或缺的工具。技术的进步和急诊医学及其他领域临床医生的远见卓识推动了这一发展。医学院认识到了 POCUS 的潜力，正越来越多地将其纳入培训课程，强调其在提高诊断准确性和患者护理方面的作用。尽管取得了这些进步，但师资力量和标准化指南有限等障碍阻碍了其广泛应用和规范。国际肾脏病学 POCUS 联盟 (IAPN) 通过本立场声明，旨在指导肾脏病学家负责任地、有效地利用 POCUS 的诊断能力。通过概述核心能力、推荐培训模式和倡导强有力的质量保证措施，我们展望未来，POCUS 将在全球范围内提高肾脏病学的实践水平，通过知情、循证的决策确保患者获得最佳治疗效果。国际合作和教育对于克服当前的挑战并充分发挥 POCUS 在肾脏病学及其他领域的潜力至关重要。

{"title":"Point-of-care ultrasound Training in Nephrology: a position statement by the International Alliance for POCUS in Nephrology","authors":"Abhilash Koratala, Eduardo R Argaiz, Gregorio Romero-González, Nathaniel Reisinger, Siddiq Anwar, William Beaubien-Souligny, Bhavna Bhasin-Chhabra, Hugo Diniz, Marco Antonio Vaco Gallardo, Fredzzia Graterol Torres, Faeq Husein-Syed, Jennifer Hanko, Aala Jaberi, Amir Kazory, Rupesh Raina, Claudio Ronco, Octavio J Salgado, Sidharth Kumar Sethi, Vanessa Villavicencio Cerón, Manjusha Yadla, Marcus Gomes Bastos","doi":"10.1093/ckj/sfae245","DOIUrl":"https://doi.org/10.1093/ckj/sfae245","url":null,"abstract":"Point-of-care Ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities, and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196408","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}

引用次数: 0

Reduced renal function is associated with faster loss of bone mineral density in patients with non-dialysis CKD 肾功能减退与非透析性慢性肾功能衰竭患者骨矿物质密度流失加快有关

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-14 DOI: 10.1093/ckj/sfae248

Dong Hoon Kang, Cheol Ho Park, Hyung Woo Kim, Jung Tak Park, Seung Hyeok Han, Jayoun Kim, Jong Cheol Jeong, Yaeni Kim, Soo Wan Kim, Kook-Hwan Oh, Shin-Wook Kang, Tae-Hyun Yoo

Background Bone mineral density (BMD) predicts fracture risk in patients with chronic kidney disease (CKD) and in the general population. However, few studies have investigated risk factors for bone loss in patients with CKD. The aim of this study was to investigate whether renal function is associated with the rate of BMD decline. Methods A prospective cohort study included 1 006 patients with CKD stages 2–4 between 2011 and 2016. BMD was measured using dual-energy X-ray absorptiometry at baseline and 4 years. The eGFR was measured 2–6 times during the 4-year follow-up. We analyzed the decline in bone mineral density according to CKD stage and further compared the rate of BMD decline according to eGFR trajectories at each stage. Results Advanced CKD stage was associated with a faster rate of decline in total hip BMD (stage 2: −0.23, stage 3A: −0.39, stage 3B: −0.80, stage 4: −1.23% change/year in men [p < 0.001]; stage 2: −0.86, stage 3A: −1.19, stage 3B: −1.20, stage 4: −1.58% change/year in women [p < 0.03]). Two distinct eGFR trajectories (Class 1: stable group; Class 2: rapid decline group) were observed. The rapid decline group showed a trend toward an increased rate of decline in total hip BMD. Subgroup analysis according to eGFR trajectories revealed a significant difference in BMD decline rate between stable and rapid decline groups. Conclusions Advanced CKD stage and accelerated decline in renal function were associated with rapid BMD decline in non-dialysis patients with CKD.

背景骨矿物质密度（BMD）可预测慢性肾脏病（CKD）患者和普通人群的骨折风险。然而，很少有研究对 CKD 患者骨质流失的风险因素进行调查。本研究旨在探讨肾功能是否与 BMD 的下降速度有关。方法一项前瞻性队列研究纳入了 2011 年至 2016 年间的 1006 名 2-4 期 CKD 患者。在基线和 4 年时使用双能 X 射线吸收测量法测量 BMD。在 4 年的随访期间，对 eGFR 进行了 2-6 次测量。我们根据 CKD 阶段分析了骨矿物质密度的下降情况，并根据每个阶段的 eGFR 轨迹进一步比较了 BMD 的下降率。结果 CKD 晚期与总髋骨矿物质密度下降速度较快有关联（2 期：-0.23，3A 期：-0.23，3B 期：-0.23）：-0.23，3A 阶段-0.39，3B 阶段3B期：-0.80，4期：-1.23男性每年变化-1.23% [pamp;lt;0.001]；阶段 2：-0.86，3A 阶段：-1.19，3B 阶段：-1.23-0.86，第 3A 阶段：-1.19，第 3B 阶段：-1.20，第 4 阶段：-1.23-0.86，3A 阶段：-1.19，3B 阶段：-1.20，4：女性的变化率为-1.58%/年 [pamp&;lt;0.03]）。观察到两种不同的 eGFR 变化轨迹（1 级：稳定组；2 级：快速下降组）。快速下降组显示出总髋关节 BMD 下降率增加的趋势。根据 eGFR 轨迹进行的分组分析显示，稳定组和快速下降组的 BMD 下降率存在显著差异。结论在非透析的慢性肾脏病患者中，慢性肾脏病晚期和肾功能加速衰退与 BMD 快速下降有关。

{"title":"Reduced renal function is associated with faster loss of bone mineral density in patients with non-dialysis CKD","authors":"Dong Hoon Kang, Cheol Ho Park, Hyung Woo Kim, Jung Tak Park, Seung Hyeok Han, Jayoun Kim, Jong Cheol Jeong, Yaeni Kim, Soo Wan Kim, Kook-Hwan Oh, Shin-Wook Kang, Tae-Hyun Yoo","doi":"10.1093/ckj/sfae248","DOIUrl":"https://doi.org/10.1093/ckj/sfae248","url":null,"abstract":"Background Bone mineral density (BMD) predicts fracture risk in patients with chronic kidney disease (CKD) and in the general population. However, few studies have investigated risk factors for bone loss in patients with CKD. The aim of this study was to investigate whether renal function is associated with the rate of BMD decline. Methods A prospective cohort study included 1 006 patients with CKD stages 2–4 between 2011 and 2016. BMD was measured using dual-energy X-ray absorptiometry at baseline and 4 years. The eGFR was measured 2–6 times during the 4-year follow-up. We analyzed the decline in bone mineral density according to CKD stage and further compared the rate of BMD decline according to eGFR trajectories at each stage. Results Advanced CKD stage was associated with a faster rate of decline in total hip BMD (stage 2: −0.23, stage 3A: −0.39, stage 3B: −0.80, stage 4: −1.23% change/year in men [p &lt; 0.001]; stage 2: −0.86, stage 3A: −1.19, stage 3B: −1.20, stage 4: −1.58% change/year in women [p &lt; 0.03]). Two distinct eGFR trajectories (Class 1: stable group; Class 2: rapid decline group) were observed. The rapid decline group showed a trend toward an increased rate of decline in total hip BMD. Subgroup analysis according to eGFR trajectories revealed a significant difference in BMD decline rate between stable and rapid decline groups. Conclusions Advanced CKD stage and accelerated decline in renal function were associated with rapid BMD decline in non-dialysis patients with CKD.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196411","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}

引用次数: 0

Therapeutic targets in membranous nephropathy: plasma cells and complement. 膜性肾病的治疗目标：浆细胞和补体。

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-13 eCollection Date: 2024-09-01 DOI: 10.1093/ckj/sfae243

Nicola M Tomas

Membranous nephropathy (MN) is an antibody-mediated autoimmune disease and the most common cause of nephrotic syndrome in adults. The discovery of phospholipase A2 receptor 1 (PLA2R1) as the first target antigen in patients with MN 15 years ago has led to a paradigm shift in the pathobiological understanding of this disease. Autoantibodies against PLA2R1 as well as thrombospondin type-1 domain-containing 7A, the second identified antigen in adults, were shown to be disease-causing and act through local activation of the complement system, primarily via the classical and lectin pathways. These findings indicate that both plasma cells, the main source of antibodies and autoantibodies, as well as the complement system, the main pathogenic effector mechanism in MN, are rational and pathogenesis-based treatment targets in MN. This review summarizes pathomechanistic and clinical evidence for and against plasma cell- and complement-targeted treatments in MN.

膜性肾病（MN）是一种抗体介导的自身免疫性疾病，也是成人肾病综合征最常见的病因。15 年前发现磷脂酶 A2 受体 1（PLA2R1）是膜性肾病患者的第一个靶抗原，这导致了对该病病理生物学认识的范式转变。针对 PLA2R1 和凝血酶原 1 型结构域的 7A 的自身抗体（成人中第二个确定的抗原）被证明是致病的，并主要通过经典途径和凝集素途径通过局部激活补体系统发挥作用。这些发现表明，抗体和自身抗体的主要来源--浆细胞以及MN的主要致病效应机制--补体系统都是MN的合理和基于发病机制的治疗目标。本综述总结了支持和反对以浆细胞和补体为靶点治疗 MN 的病理机制和临床证据。

引用次数: 0

The impact of quality of life on the survival of elderly patients with end-stage renal disease: a prospective multicenter cohort study in Korea. 生活质量对终末期肾病老年患者生存期的影响：韩国一项前瞻性多中心队列研究。

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-13 eCollection Date: 2024-09-01 DOI: 10.1093/ckj/sfae241

Yu-Kyung Chung, Jeong-Hoon Lim, Ye-Na Jeon, You Hyun Jeon, Hee-Yeon Jung, Ji-Young Choi, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim, Jang-Hee Cho

Background: Quality of life (QOL) is associated with mortality in dialysis patients. However, the impact of QOL index or score on elderly patients undergoing maintenance dialysis is unclear. We analyzed the relationship between QOL domains and survival in elderly end-stage renal disease (ESRD) patients on dialysis.

Methods: We included 492 incident ESRD patients aged ≥65 years from a Korean nationwide prospective cohort study who were assessed for QOL with a follow-up duration of 67.3 ± 34.6 months after dialysis initiation. Their QOL was evaluated using the Kidney Disease Quality of Life (KDQOL) instrument, and the effect of each QOL domain on mortality was analyzed. Multivariable Cox regression analysis was performed to identify independent risk factors for death after adjusting for confounding factors.

Results: Low physical component summary (PCS) and Short Form-36 score were significantly associated with low survival rate (P < .001 and P = .017, respectively), whereas the mental component summary and ESRD-targeted item scores were not correlated with survival rate. Multivariable Cox regression analysis confirmed that only a high PCS score was associated with better survival (hazard ratio 0.71; 95% confidence interval 0.52-0.97; P = .031). Linear regression analysis revealed that age, sex, modified Charlson comorbidity index, albumin and intact parathyroid hormone were associated with PCS. Among the PCS items, only the physical functioning score was significantly associated with mortality (P = .017).

Conclusion: PCS was an independent risk factor for death in elderly ESRD patients. A higher physical functioning score was associated with a better outcome, suggesting the importance of physical condition in elderly dialysis patients.

背景：生活质量（QOL）与透析患者的死亡率有关。然而，QOL 指数或评分对接受维持性透析的老年患者的影响尚不明确。我们分析了老年终末期肾病（ESRD）透析患者的 QOL 领域与生存之间的关系：我们从一项韩国全国性前瞻性队列研究中纳入了 492 名年龄≥65 岁的 ESRD 患者，对他们进行了 QOL 评估，随访时间为开始透析后 67.3 ± 34.6 个月。使用肾脏疾病生活质量（KDQOL）工具对他们的 QOL 进行了评估，并分析了每个 QOL 领域对死亡率的影响。在调整了混杂因素后，进行了多变量考克斯回归分析，以确定死亡的独立风险因素：结果：低体能部分摘要（PCS）和 Short Form-36 评分与低存活率显著相关（P P = .017，分别），而精神部分摘要和 ESRD 目标项目评分与存活率无关。多变量 Cox 回归分析证实，只有 PCS 高分才与较高的生存率相关（危险比 0.71；95% 置信区间 0.52-0.97；P = 0.031）。线性回归分析显示，年龄、性别、改良夏尔森合并症指数、白蛋白和完整甲状旁腺激素与 PCS 相关。在 PCS 项目中，只有身体功能评分与死亡率有显著相关性（P = .017）：结论：PCS是老年ESRD患者死亡的独立风险因素。结论：PCS 是老年 ESRD 患者死亡的独立危险因素，身体功能得分越高，预后越好，这表明身体状况对老年透析患者非常重要。

{"title":"The impact of quality of life on the survival of elderly patients with end-stage renal disease: a prospective multicenter cohort study in Korea.","authors":"Yu-Kyung Chung, Jeong-Hoon Lim, Ye-Na Jeon, You Hyun Jeon, Hee-Yeon Jung, Ji-Young Choi, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim, Jang-Hee Cho","doi":"10.1093/ckj/sfae241","DOIUrl":"10.1093/ckj/sfae241","url":null,"abstract":"Background: Quality of life (QOL) is associated with mortality in dialysis patients. However, the impact of QOL index or score on elderly patients undergoing maintenance dialysis is unclear. We analyzed the relationship between QOL domains and survival in elderly end-stage renal disease (ESRD) patients on dialysis.Methods: We included 492 incident ESRD patients aged ≥65 years from a Korean nationwide prospective cohort study who were assessed for QOL with a follow-up duration of 67.3 ± 34.6 months after dialysis initiation. Their QOL was evaluated using the Kidney Disease Quality of Life (KDQOL) instrument, and the effect of each QOL domain on mortality was analyzed. Multivariable Cox regression analysis was performed to identify independent risk factors for death after adjusting for confounding factors.Results: Low physical component summary (PCS) and Short Form-36 score were significantly associated with low survival rate (P < .001 and P = .017, respectively), whereas the mental component summary and ESRD-targeted item scores were not correlated with survival rate. Multivariable Cox regression analysis confirmed that only a high PCS score was associated with better survival (hazard ratio 0.71; 95% confidence interval 0.52-0.97; P = .031). Linear regression analysis revealed that age, sex, modified Charlson comorbidity index, albumin and intact parathyroid hormone were associated with PCS. Among the PCS items, only the physical functioning score was significantly associated with mortality (P = .017).Conclusion: PCS was an independent risk factor for death in elderly ESRD patients. A higher physical functioning score was associated with a better outcome, suggesting the importance of physical condition in elderly dialysis patients.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125050","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}

引用次数: 0

Semaglutide associated kidney injury 塞马鲁肽相关肾损伤

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-13 DOI: 10.1093/ckj/sfae250

Farhana Begum, Kelly Chang, Krishna Kapoor, Rajiv Vij, Gautam Phadke, Wesley M Hiser, Rimda Wanchoo, Purva Sharma, Nirja Sutaria, Kenar D Jhaveri

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are multipurpose agents effective in improving glycemic control in patients with type 2 diabetes while also achieving weight loss and risk reduction of major cardiovascular (CV) events and chronic kidney disease(CKD) progression. With their increased utility in diabetes, obesity, CV health, and renal protection, the use of GLP1-agonists have increased. However, with this increased use, there have also been increased reports of associated kidney adverse events including case reports of acute interstitial nephritis (AIN) associated with GLP-1RA use. We report the data from the FDA adverse event reporting system (FAERS) in relation to GLP-1RA use and adverse kidney events, with AKI being the most common. In addition, we report two cases of semaglutide associated biopsy-proven AIN and one with associated podocytopathy. To our knowledge, this is the first case of biopsy-proven AIN with podocytopathy associated with semaglutide use. Both patients experienced complete remission shortly after discontinuing semaglutide and undergoing immunosuppressive therapy. Further analysis of the FAERS database, revealed 17 cases of proteinuria and 1 case of glomerulonephritis associated with semaglutide in the FAERS database, however no further information was available. While further research is needed to establish causality, this case series adds to the growing body of literature that semaglutide is associated with AIN and adds a new association, semaglutide with AIN and podocytopathies. While the overall clinical and mortality benefits of GLP-1RAs may outweigh the rarer risks, prescribers need to be aware of these associations, particularly as the use of GLP-1RAs continues to expand.

胰高血糖素样肽-1 受体激动剂（GLP-1RAs）是一种多用途药物，能有效改善 2 型糖尿病患者的血糖控制，同时还能减轻体重，降低主要心血管（CV）事件和慢性肾病（CKD）恶化的风险。随着 GLP1- 激动剂在糖尿病、肥胖症、心血管健康和肾脏保护方面的作用越来越大，其用量也越来越多。然而，随着使用的增加，相关肾脏不良事件的报告也在增加，包括与使用 GLP-1RA 相关的急性间质性肾炎 (AIN) 的病例报告。我们报告了 FDA 不良事件报告系统（FAERS）中有关 GLP-1RA 使用和肾脏不良事件的数据，其中 AKI 最为常见。此外，我们还报告了两例与舍马鲁肽相关的活组织检查证实的 AIN，以及一例与相关的荚膜细胞病变。据我们所知，这是首例经活检证实的AIN伴有荚膜细胞病变并与使用塞马鲁肽有关的病例。两名患者在停用塞马鲁肽并接受免疫抑制治疗后不久，病情都得到了完全缓解。对 FAERS 数据库的进一步分析显示，FAERS 数据库中有 17 例蛋白尿病例和 1 例肾小球肾炎病例与使用塞马鲁肽有关，但没有进一步的信息。虽然还需要进一步研究才能确定因果关系，但本系列病例为越来越多的文献增添了新的内容，即塞马鲁肽与AIN有关，并增加了一个新的关联，即塞马鲁肽与AIN和荚膜细胞病变有关。虽然 GLP-1RAs 在临床和死亡率方面的总体益处可能大于罕见的风险，但处方者需要注意这些关联，尤其是随着 GLP-1RAs 的使用范围不断扩大。

{"title":"Semaglutide associated kidney injury","authors":"Farhana Begum, Kelly Chang, Krishna Kapoor, Rajiv Vij, Gautam Phadke, Wesley M Hiser, Rimda Wanchoo, Purva Sharma, Nirja Sutaria, Kenar D Jhaveri","doi":"10.1093/ckj/sfae250","DOIUrl":"https://doi.org/10.1093/ckj/sfae250","url":null,"abstract":"Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are multipurpose agents effective in improving glycemic control in patients with type 2 diabetes while also achieving weight loss and risk reduction of major cardiovascular (CV) events and chronic kidney disease(CKD) progression. With their increased utility in diabetes, obesity, CV health, and renal protection, the use of GLP1-agonists have increased. However, with this increased use, there have also been increased reports of associated kidney adverse events including case reports of acute interstitial nephritis (AIN) associated with GLP-1RA use. We report the data from the FDA adverse event reporting system (FAERS) in relation to GLP-1RA use and adverse kidney events, with AKI being the most common. In addition, we report two cases of semaglutide associated biopsy-proven AIN and one with associated podocytopathy. To our knowledge, this is the first case of biopsy-proven AIN with podocytopathy associated with semaglutide use. Both patients experienced complete remission shortly after discontinuing semaglutide and undergoing immunosuppressive therapy. Further analysis of the FAERS database, revealed 17 cases of proteinuria and 1 case of glomerulonephritis associated with semaglutide in the FAERS database, however no further information was available. While further research is needed to establish causality, this case series adds to the growing body of literature that semaglutide is associated with AIN and adds a new association, semaglutide with AIN and podocytopathies. While the overall clinical and mortality benefits of GLP-1RAs may outweigh the rarer risks, prescribers need to be aware of these associations, particularly as the use of GLP-1RAs continues to expand.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196410","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}

引用次数: 0

Association between CKD-MBD and hip-bone microstructures in dialysis patients. 透析患者的慢性肾脏病-骨髓疾病与髋骨微结构之间的关系。

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-12 eCollection Date: 2024-08-01 DOI: 10.1093/ckj/sfae240

Ken Iseri, Masahide Mizobuchi, Kanji Shishido, Noriko Hida

Background: The longitudinal changes in hip-bone microstructures and estimated bone strength in dialysis patients, and the impact of chronic kidney disease-mineral and bone disorder (CKD-MBD) biomarkers on these changes, remain insufficiently explored.

Methods: This retrospective study examined changes in cortical and trabecular bone compartments and estimated bone-strength indices, obtained by using 3D-SHAPER software, in the hip regions of 276 dialysis patients over up to 2.5 years. We used multivariate mixed models to investigate the associations between time-dependent CKD-MBD biomarkers and bone health metrics.

Results: There was a significant decrease in areal bone mineral density (aBMD), integral volumetric BMD (vBMD), trabecular vBMD, cortical thickness and cortical surface BMD (sBMD). Similar deteriorations were found in estimated bone-strength indices [cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (SM) and buckling ratio]. Neither serum calcium nor phosphate levels were significantly associated with changes in three-dimensional parameters or estimated bone-strength indices. In contrast, serum alkaline phosphatase levels showed a significant inverse correlation with aBMD and CSA. The intact-parathyroid hormone (i-PTH) was significantly inversely correlated with aBMD, integral vBMD, trabecular vBMD, cortical thickness, cortical vBMD, CSA, CSMI and SM. When applying the KDIGO criteria as a sensitivity analysis, the higher PTH group had significant negative associations with aBMD, integral vBMD, cortical vBMD, cortical thickness and cortical sBMD. Notably, the lower PTH group showed a positive significant correlation with integral vBMD and trabecular vBMD.

Conclusions: Elevated PTH, not low PTH, was associated with deterioration of hip-bone microstructures. Better management of PTH levels may play a crucial role in the hip-bone microstructure in dialysis patients.

背景：透析患者髋骨微结构和估计骨强度的纵向变化，以及慢性肾脏病-矿物质和骨质紊乱（CKD-MBD）生物标志物对这些变化的影响仍未得到充分探讨：这项回顾性研究考察了 276 名透析患者在长达 2.5 年的时间里髋部皮质骨和骨小梁的变化，以及通过 3D-SHAPER 软件获得的骨强度指数。我们使用多变量混合模型研究了随时间变化的 CKD-MBD 生物标志物与骨健康指标之间的关系：结果：平均骨矿物质密度（aBMD）、整体体积骨矿物质密度（vBMD）、骨小梁骨矿物质密度（vBMD）、皮质厚度和皮质表面骨矿物质密度（sBMD）均有明显下降。估计的骨强度指数[横截面积 (CSA)、横截面惯性矩 (CSMI)、截面模量 (SM) 和屈曲比]也出现了类似的恶化。血清钙或磷酸盐水平与三维参数或估计骨强度指数的变化均无明显关联。相反，血清碱性磷酸酶水平与 aBMD 和 CSA 呈显著的反向相关性。完整甲状旁腺激素（i-PTH）与 aBMD、整体 vBMD、骨小梁 vBMD、皮质厚度、皮质 vBMD、CSA、CSMI 和 SM 呈显著反相关。在应用 KDIGO 标准进行敏感性分析时，PTH 较高组与 aBMD、整体 vBMD、皮质 vBMD、皮质厚度和皮质 sBMD 呈显著负相关。值得注意的是，PTH 值较低的一组与整体 vBMD 和骨小梁 vBMD 呈正相关：结论：PTH 升高而非 PTH 降低与髋骨微结构的恶化有关。更好地控制 PTH 水平可能会对透析患者的髋骨微结构起到至关重要的作用。

{"title":"Association between CKD-MBD and hip-bone microstructures in dialysis patients.","authors":"Ken Iseri, Masahide Mizobuchi, Kanji Shishido, Noriko Hida","doi":"10.1093/ckj/sfae240","DOIUrl":"10.1093/ckj/sfae240","url":null,"abstract":"Background: The longitudinal changes in hip-bone microstructures and estimated bone strength in dialysis patients, and the impact of chronic kidney disease-mineral and bone disorder (CKD-MBD) biomarkers on these changes, remain insufficiently explored.Methods: This retrospective study examined changes in cortical and trabecular bone compartments and estimated bone-strength indices, obtained by using 3D-SHAPER software, in the hip regions of 276 dialysis patients over up to 2.5 years. We used multivariate mixed models to investigate the associations between time-dependent CKD-MBD biomarkers and bone health metrics.Results: There was a significant decrease in areal bone mineral density (aBMD), integral volumetric BMD (vBMD), trabecular vBMD, cortical thickness and cortical surface BMD (sBMD). Similar deteriorations were found in estimated bone-strength indices [cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (SM) and buckling ratio]. Neither serum calcium nor phosphate levels were significantly associated with changes in three-dimensional parameters or estimated bone-strength indices. In contrast, serum alkaline phosphatase levels showed a significant inverse correlation with aBMD and CSA. The intact-parathyroid hormone (i-PTH) was significantly inversely correlated with aBMD, integral vBMD, trabecular vBMD, cortical thickness, cortical vBMD, CSA, CSMI and SM. When applying the KDIGO criteria as a sensitivity analysis, the higher PTH group had significant negative associations with aBMD, integral vBMD, cortical vBMD, cortical thickness and cortical sBMD. Notably, the lower PTH group showed a positive significant correlation with integral vBMD and trabecular vBMD.Conclusions: Elevated PTH, not low PTH, was associated with deterioration of hip-bone microstructures. Better management of PTH levels may play a crucial role in the hip-bone microstructure in dialysis patients.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072196","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}

引用次数: 0

Prognostic and therapeutic monitoring value of plasma and urinary cytokine profile in primary membranous nephropathy: the STARMEN trial cohort. 原发性膜性肾病血浆和尿液细胞因子谱的预后和治疗监测价值：STARMEN 试验队列。

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-12 eCollection Date: 2024-08-01 DOI: 10.1093/ckj/sfae239

Jorge Enrique Rojas-Rivera, Takehiro Hasegawa, Gema Fernandez-Juarez, Manuel Praga, Yuko Saruta, Beatriz Fernandez-Fernandez, Alberto Ortiz

Background: Primary membranous nephropathy (PMN) is usually caused by anti-phospholipase A2 receptor (PLA2R) autoantibodies. There are different therapeutic options according to baseline risk. Novel biomarkers are needed to optimize risk stratification and predict and monitor the response to therapy, as proteinuria responses may be delayed. We hypothesized that plasma or urinary cytokines may provide insights into the course and response to therapy in PMN.

Methods: Overall, 192 data points from 34 participants in the STARMEN trial (NCT01955187), randomized to tacrolimus-rituximab (TAC-RTX) or corticosteroids-cyclophosphamide (GC-CYC), were analysed for plasma and urine cytokines using a highly sensitive chemiluminescence immunoassay providing a high-throughput multiplex analysis.

Results: Baseline (pretreatment) urinary C-X-C motif chemokine ligand 13 (CXCL13) predicted the therapeutic response to TAC-RTX. Cytokine levels evolved over the course of therapy. The levels of nine plasma and six urinary cytokines correlated with analytical parameters of kidney damage and disease activity, such as proteinuria, estimated glomerular filtration rate and circulating anti-PLA2R levels. The correlation with these parameters was most consistent for plasma and urinary growth differentiation factor 15 (GDF15), plasma tumour necrosis factor α and urinary TNF-like weak inducer of apoptosis. Decreasing plasma GDF15 levels were associated with response to GC-CYC. Four clusters of cytokines were associated with different stages of response to therapy in the full cohort, with the less inflammatory cluster associated with remission.

Conclusion: PMN displayed characteristic plasma and urine cytokine patterns that evolved over time as patients responded to therapy. Baseline urinary CXCL13 concentration could be a prognostic marker of response to TAC-RTX.

背景：原发性膜性肾病（PMN）通常由抗磷脂酶 A2 受体（PLA2R）自身抗体引起。根据基线风险的不同，有不同的治疗方案。由于蛋白尿反应可能会延迟，因此需要新的生物标志物来优化风险分层并预测和监测治疗反应。我们假设血浆或尿液中的细胞因子可能有助于了解 PMN 的治疗过程和反应：采用高灵敏度化学发光免疫分析法进行血浆和尿液细胞因子分析，该方法可提供高通量的多重分析：结果：基线（治疗前）尿液中的 C-X-C motif趋化因子配体 13 (CXCL13) 预测了对 TAC-RTX 的治疗反应。细胞因子水平在治疗过程中不断变化。九种血浆细胞因子和六种尿液细胞因子的水平与肾损伤和疾病活动的分析参数相关，如蛋白尿、估计肾小球滤过率和循环抗PLA2R水平。血浆和尿液中的生长分化因子 15（GDF15）、血浆中的肿瘤坏死因子 α 和尿液中的 TNF 样细胞凋亡弱诱导因子与这些参数的相关性最为一致。血浆 GDF15 水平的降低与对 GC-CYC 的反应有关。在整个队列中，四组细胞因子与不同阶段的治疗反应有关，炎症较轻的一组细胞因子与缓解有关：PMN显示出特征性的血浆和尿液细胞因子模式，并随着患者对治疗的反应而不断变化。基线尿液CXCL13浓度可作为TAC-RTX反应的预后标志。

{"title":"Prognostic and therapeutic monitoring value of plasma and urinary cytokine profile in primary membranous nephropathy: the STARMEN trial cohort.","authors":"Jorge Enrique Rojas-Rivera, Takehiro Hasegawa, Gema Fernandez-Juarez, Manuel Praga, Yuko Saruta, Beatriz Fernandez-Fernandez, Alberto Ortiz","doi":"10.1093/ckj/sfae239","DOIUrl":"10.1093/ckj/sfae239","url":null,"abstract":"Background: Primary membranous nephropathy (PMN) is usually caused by anti-phospholipase A2 receptor (PLA2R) autoantibodies. There are different therapeutic options according to baseline risk. Novel biomarkers are needed to optimize risk stratification and predict and monitor the response to therapy, as proteinuria responses may be delayed. We hypothesized that plasma or urinary cytokines may provide insights into the course and response to therapy in PMN.Methods: Overall, 192 data points from 34 participants in the STARMEN trial (NCT01955187), randomized to tacrolimus-rituximab (TAC-RTX) or corticosteroids-cyclophosphamide (GC-CYC), were analysed for plasma and urine cytokines using a highly sensitive chemiluminescence immunoassay providing a high-throughput multiplex analysis.Results: Baseline (pretreatment) urinary C-X-C motif chemokine ligand 13 (CXCL13) predicted the therapeutic response to TAC-RTX. Cytokine levels evolved over the course of therapy. The levels of nine plasma and six urinary cytokines correlated with analytical parameters of kidney damage and disease activity, such as proteinuria, estimated glomerular filtration rate and circulating anti-PLA2R levels. The correlation with these parameters was most consistent for plasma and urinary growth differentiation factor 15 (GDF15), plasma tumour necrosis factor α and urinary TNF-like weak inducer of apoptosis. Decreasing plasma GDF15 levels were associated with response to GC-CYC. Four clusters of cytokines were associated with different stages of response to therapy in the full cohort, with the less inflammatory cluster associated with remission.Conclusion: PMN displayed characteristic plasma and urine cytokine patterns that evolved over time as patients responded to therapy. Baseline urinary CXCL13 concentration could be a prognostic marker of response to TAC-RTX.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072197","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}

引用次数: 0

Sodium glucose co-transporter 2 inhibitors in the treatment of glomerular diseases: a CKJ controversy. 治疗肾小球疾病的葡萄糖钠协同转运体 2 抑制剂：CKJ 争议。

IF 3.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal

Pub Date : 2024-08-12 eCollection Date: 2024-09-01 DOI: 10.1093/ckj/sfae237

Fernando Caravaca-Fontán, Lucia Del Vecchio, Manuel Praga, Jürgen Floege, Carmine Zoccali

Integrating sodium-glucose co-transporter 2 inhibitors (SGLT2i) into the treatment for chronic kidney disease (CKD) has marked a significant therapeutic advance in nephrology. Clinical trials such as DAPA-CKD and EMPA-KIDNEY have demonstrated the beneficial effects of SGLT2i in slowing CKD progression and reducing proteinuria. However, the applicability of these results to patients with glomerulonephritis is still unresolved due to various limitations. This manuscript combines the evidence supporting the use of SGLT2i in glomerular diseases, highlights the limitations and strikes a conclusive balance on their role in clinical practice.

将钠-葡萄糖协同转运体 2 抑制剂（SGLT2i）纳入慢性肾脏病（CKD）的治疗中，标志着肾脏病学在治疗方面取得了重大进展。DAPA-CKD 和 EMPA-KIDNEY 等临床试验证明，SGLT2i 在延缓 CKD 病程进展和减少蛋白尿方面具有良好效果。然而，由于各种局限性，这些结果是否适用于肾小球肾炎患者的问题仍未得到解决。本手稿综合了支持在肾小球疾病中使用 SGLT2i 的证据，强调了其局限性，并就其在临床实践中的作用达成了结论性的平衡。

引用次数: 0