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Improving the diagnostic of absorptive hypercalciuria: a comparative analysis of calcium load tests at 2-hour and 4-hour intervals.
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-09 eCollection Date: 2025-02-01 DOI: 10.1093/ckj/sfae399
Lara Cabezas, Pierre Letourneau, Aurélie De Mul, Justine Bacchetta, Laurence Chardon, Laurence Derain Dubourg, Sandrine Lemoine

Introduction: The calcium load test (CLT) was developed by Pak et al. in 1974 to better discriminate hypercalciuria. Absorptive hypercalciuria (AH) is defined by an increase of the difference between urinary calcium/creatinine ratio (ΔUCa/Cr) of more than 0.5 mmol/mmol with a 4-hour CLT. In clinical practice and more recent studies, CLT is a 2-hour test. We hypothesized that the 4 h timepoint is more efficient in AH diagnosis.

Methods: We report a single-centre retrospective study including all patients who underwent CLT because of hypercalciuria or hyperparathyroidism. After a 3-day low-calcium diet and a 12-hour fast, 24-hour urines were collected. Blood and urinary samples were done at arrival and after 2 h and 4 h of oral ingestion of 1 g of calcium. AH was diagnosed by ΔUCa/Cr between baseline and 2 h or 4 h of more than 0.05 mmol/mmol.

Results: We included 328 patients. Baseline UCa/Cr ratio was 0.3 ± 0.2 mmol/mmol and increased significantly after 2 h and 4 h (0.6 ± 0.3 and 0.8 ± 0.4 mmol/mmol, P < 0.001). ΔUCa/Cr was significantly different between baseline and 2 h or 4 h (0.2 ± 0.2 versus 0.5 ± 0.4, P < 0.001). AH was diagnosed in 35 (10.7%) patients after 2 h, 84 (25.6%) more were diagnosed at 4 h (P < 0.001).

Conclusions: The 4 h CLT improves the diagnosis of AH with more than 50% of AH diagnosed within 4 h of calcium ingestion. It seems that there are cases of AH of later diagnosis with a similar clinical and biological profile depending on enteral absorption.

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引用次数: 0
Push toward pre-emptive kidney transplantation - for sure? 推进先发制人的肾移植——确定吗?
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-09 eCollection Date: 2024-12-01 DOI: 10.1093/ckj/sfae335
Orsolya Cseprekal, Christian Jacquelinet, Ziad Massy

Pre-emptive kidney transplantation (PKT) has long been considered the optimal treatment for patients with end-stage chronic kidney disease (CKD) seeking the most favourable long-term outcomes. However, the significant growth in transplant procedures over recent decades has led to a notable increase in wait-listed patients and a disproportionate demand for donor organs. This situation necessitates a re-evaluation of transplantation timing and the establishment of rational indications from both societal and clinical perspectives. An increasing number of retrospective analyses have challenged the universal benefit of PKT, suggesting that premature indications for living or deceased donor PKT may not always yield superior hard outcomes compared with non-PKT approaches. Conventional predictive models have shown limitations in accurately assessing risks for certain subpopulations, potentially leading to significant disparities among wait-listed patients. To address these challenges, we propose the following considerations. Prediction models should not only optimize the distribution of our limited donor resources, but should also illuminate foreseeable risks associated with a potentially 'unsuccessful' PKT. Therefore, this article seeks to underscore the necessity for further discourse on the smouldering concept of when and for whom living or deceased donor PKT should be considered. Is it universally beneficial, or should the clinical paradigm be re-evaluated? In the endeavour to attain superior post-PKT survival outcomes compared with non-PKT or conservative treatment, it seems critical to acknowledge that other treatments may provide more favourable results for certain individuals. This introduces the intricate task of effectively navigating the complexities associated with 'too early' or 'unsuccessful' PKT.

长期以来,预防性肾移植(PKT)一直被认为是寻求最有利长期预后的终末期慢性肾病(CKD)患者的最佳治疗方法。然而,近几十年来,移植手术的显著增长导致了等待名单患者的显着增加和对捐赠器官的不成比例的需求。这种情况需要从社会和临床的角度重新评估移植时机和建立合理的适应症。越来越多的回顾性分析对PKT的普遍益处提出了质疑,表明与非PKT方法相比,活体或已故供体PKT的过早适应症可能并不总是产生更好的硬结果。传统的预测模型在准确评估某些亚群的风险方面显示出局限性,这可能导致候诊患者之间的显著差异。为应对这些挑战,我们提出以下几点建议。预测模型不仅应该优化我们有限的捐助者资源的分配,而且应该阐明与可能“不成功”的PKT相关的可预见风险。因此,本文试图强调有必要进一步讨论何时以及为谁考虑在世或已故捐助者PKT这一悬而未决的概念。它是普遍有益的,还是应该重新评估临床模式?与非pkt或保守治疗相比,在努力获得更好的pkt后生存结果时,认识到其他治疗可能对某些个体提供更有利的结果似乎至关重要。这就引入了有效导航与“过早”或“不成功”PKT相关的复杂性的复杂任务。
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引用次数: 0
Multiethnic prevalence of the APOL1 G1 and G2 variants among the Israeli dialysis population.
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-06 eCollection Date: 2025-02-01 DOI: 10.1093/ckj/sfae397
Dror Ben-Ruby, Danit Atias-Varon, Maayan Kagan, Guy Chowers, Omer Shlomovitz, Keren Slabodnik-Kaner, Neta Mano, Shany Avayou, Yariv Atsmony, Dana Levin, Edo Dotan, Ronit Calderon-Margalit, Alla Shnaider, Yosef S Haviv, Ohad S Birk, Noam Hadar, Yair Anikster, Noa Berar Yanay, Gil Chernin, Etty Kruzel-Davila, Pazit Beckerman, Benaya Rozen-Zvi, Gabriel T Doctor, Horia C Stanescu, Revital Shemer, Elon Pras, Haike Reznik-Wolf, Ayelet Hashahar Nahum, Dan Dominissini, Karl Skorecki, Asaf Vivante

Background and hypothesis: The two apolipoprotein L1 (APOL1) variants, G1 and G2, are common in populations of sub-Saharan African ancestry. Individuals with two of these alleles (G1 or G2) have an increased risk for a spectrum of non-diabetic chronic kidney diseases. However, these variants are typically not observed outside of populations that self-identify as current continental Africans or having clear recent African ancestry such as, most notably, African Americans, and other large population groups in the Americas and several European countries. We hypothesized that the diverse ethnic groups within the Israeli population may exhibit varying levels of recent African ancestry. Therefore, it is plausible that APOL1 risk alleles might be present even in individuals who do not self-identify as being of sub-Saharan African descent.

Methods: We non-selectively screened people with kidney failure across Israel for APOL1 risk variants using restriction fragment length polymorphism.

Results: We recruited 1744 individuals from 38 dialysis units in Israel. We identified eight patients of Moroccan Jewish, Bedouin, or Muslim Arab ancestry, who carry at least one G1 or G2 allele. None of the eight patients carried the protective APOL1 p.N264K variant. Furthermore, despite all Bedouin individuals being G2 heterozygous, the G2 minor allele frequency was significantly enriched in kidney failure cases compared to ethnically matched controls (P = .006).

Conclusions: These findings show that APOL1 G1 and G2 allelic variants are present in populations previously not appreciated to possess recent sub-Saharan ancestry and suggest that a single G2 risk variant may confer increased risk for chronic kidney disease in certain population contexts.

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引用次数: 0
First real-world evidence of sparsentan efficacy in patients with IgA nephropathy treated with SGLT2 inhibitors. 首次在现实世界中证明斯帕生坦对接受 SGLT2 抑制剂治疗的 IgA 肾病患者具有疗效。
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-03 eCollection Date: 2025-01-01 DOI: 10.1093/ckj/sfae394
Moritz Schanz, Claudia Seikrit, Bernd Hohenstein, Aline Zimmermann, Leonie Kraft, Severin Schricker, Susann Berger, Andrea Schwab, Tina Oberacker, Joerg Latus

Background: Sparsentan, a dual-acting antagonist for both the angiotensin II receptor type 1 and the endothelin receptor type A, has emerged as a promising therapeutic agent for the treatment of IgA nephropathy (IgAN). Following the publication of the PROTECT trial, sparsentan recently received approval for the treatment of IgAN in Europe. However, it remains uncertain whether an additive effect can be observed in the context of existing treatment with sodium-glucose co-transporter 2 (SGLT2) inhibitors, given that the PROTECT study did not investigate this dual therapy approach.

Methods: A total of 23 patients with IgAN were treated with sparsentan via the Managed Access Programme between December 2023 and August 2024. The patients were stable on maximum tolerated doses of renin-angiotensin system (RAS) and SGLT2 inhibitors, with an estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m² and a urine protein/creatinine ratio (UPCR) >0.75 g/g.

Results: In the 23 patients, median (IQR) baseline eGFR (CKD-EPI) was 42 mL/min/1.73 m2 (32-63) and median baseline UPCR was 1.5 g/g (0.9-1.8). After initiation of sparsentan, UPCR significantly decreased (P < 0.0001) to a median of 0.85 g/g (0.42-1.15) in the 2-week follow-up and further declined (P = 0.001) to a median of 0.60 g/g (0.32-0.82) after 14 weeks, equivalent to a relative reduction in proteinuria up to 62% (45-74). A similar significant reduction was observed for the urine albumin/creatinine ratio. No drug-related serious adverse events were reported.

Conclusions: In this real-world setting, sparsentan shows a significant impact on proteinuria, leading to a relative reduction of 62% in UPCR after 14 weeks and beyond, even in patients already receiving SGLT2 inhibitors.

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引用次数: 0
Urine complement-related proteins in IgA nephropathy and IgA vasculitis nephritis, possible biomarkers of disease activity.
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-03 eCollection Date: 2025-01-01 DOI: 10.1093/ckj/sfae395
Mazdak Sanaei Nurmi, Laura Pérez-Alós, Peter Garred, Bengt Fellström, Katja Gabrysch, Sigrid Lundberg

Introduction: The activation of the complement system plays an important role in the pathogenesis of IgA nephropathy (IgAN). Our primary aim was to evaluate a range of complement-related proteins, including pentraxin-3 (PTX-3), in blood and urine at diagnosis and their association with disease activity in the kidney biopsy, eGFR, albuminuria, and outcome. Our secondary aim was to compare the same biomarkers between patients with IgAN and IgA vasculitis with renal involvement (IgAVN).

Methods: In a longitudinal Swedish cohort of 96 patients with IgAN (n = 65) or IgAVN (n = 31), with a median follow-up time of 10.8 years, we analysed mainly lectin-pathway-related proteins and PTX-3 in plasma and urine (u) samples stored at the time of kidney biopsy. Outcome was defined by the GFR slope or by the combined outcome of 50% loss of eGFR or end-stage kidney disease (ESKD).

Results: Patients with detectable vs undetectable u-PTX-3 and u-mannose-binding lectin (MBL) more frequently had mesangial hypercellularity, endocapillary proliferation, and crescents in their kidney biopsy. u-C4c levels were higher in patients with advanced tubulointerstitial fibrosis, and u-C4c was also an independent predictor of a more severe eGFR slope. There were no differences in the levels of biomarkers between patients with IgAN and IgAVN.

Conclusion: u-PTX-3 and u-MBL might be biomarkers of an active proliferative stage of the disease, while higher u-C4c levels indicate more chronic lesions in both IgAN and IgAVN. These results must, however, be confirmed in larger and multiethnic cohorts.

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引用次数: 0
Efficacy and safety of dapagliflozin in patients with CKD: real-world experience in 93 Italian renal clinics. 达格列净对慢性肾病患者的疗效和安全性:93家意大利肾脏诊所的真实世界经验
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-03 eCollection Date: 2025-01-01 DOI: 10.1093/ckj/sfae396
Roberto Minutolo, Silvio Borrelli, Andrea Ambrosini, Luigi Amoroso, Filippo Aucella, Valentina Batini, Yuri Battaglia, Laura Bregoli, Vincenzo Cantaluppi, Giuseppe Cianciolo, Paolo Conti, Paolo Fabbrini, Carlo Giammarresi, Egidio Imbalzano, Sandra La Rosa, Marita Marengo, Vincenzo Montinaro, Dario Musone, Marcello Napoli, Felice Nappi, Corrado Pluvio, Domenico Santoro, Roberto Scarpioni, Franco Sopranzi, Tiziana Tullio, Luca De Nicola

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are recommended for reducing the renal and cardiovascular risk in patients with chronic kidney disease (CKD) based on the positive results reported by clinical trials. However, real-world data on the efficacy and the safety of these drugs in CKD population followed in nephrology setting are lacking.

Methods: We report the effects of dapagliflozin in CKD patients by using data collected during a learning program in which 105 nephrologists added dapagliflozin (10 mg/day) to consecutive patients referred to their renal clinics. Efficacy endpoints were the albuminuria change and the determinants of an albuminuria decline ≥30%. Adverse events were also collected.

Results: A total of 1724 patients with CKD (age 67.4 ± 13.2 years, 72.8% males, diabetes 59.9%, eGFR 43.5 ± 17.4 ml/min/1.73 m2, severe albuminuria 70.1%) received dapagliflozin for 4 ± 1 months. Dapagliflozin significantly reduced body weight (-1.3 kg), eGFR (-0.27 ml/min/month), and blood pressure (-3.6/-1.7 mmHg). Albuminuria declined by 25.1% (95%CI 23.0-27.2) from 500 mg/day [IQR 225-1425] to 320 mg/day [IQR 100-900]. Albuminuria reduction was ≥30% in 48.3% of patients, 0-29% in 37.6% while it increased in 14.1% of patients. At logistic regression analysis, older age, female sex, use of mineralocorticoid receptor antagonist, higher eGFR, and higher albuminuria were all significant predictors of albuminuria decline ≥30%. We collected 46 side effects leading to drug discontinuation in 36 patients (2%), with acute kidney injury and urinary tract infection being the most frequent adverse events.

Conclusions: We provide evidence of the anti-proteinuric efficacy of short-term dapagliflozin in the presence of good safety profile in patients with CKD followed in nephrology.

背景:基于临床试验报告的阳性结果,钠-葡萄糖共转运蛋白-2抑制剂(SGLT2i)被推荐用于降低慢性肾脏疾病(CKD)患者的肾脏和心血管风险。然而,这些药物在CKD人群中的疗效和安全性的实际数据缺乏。方法:我们报告了达格列净在CKD患者中的作用,通过使用在一个学习项目中收集的数据,105名肾病学家将达格列净(10mg /天)添加到他们肾脏诊所的连续患者中。疗效终点为蛋白尿改变和蛋白尿下降≥30%的决定因素。不良事件也被收集。结果:1724例CKD患者(年龄67.4±13.2岁,男性72.8%,糖尿病59.9%,eGFR 43.5±17.4 ml/min/1.73 m2,重度蛋白尿70.1%)接受达格列净治疗4±1个月。达格列净显著降低体重(-1.3 kg)、eGFR (-0.27 ml/min/month)和血压(-3.6/-1.7 mmHg)。蛋白尿从500 mg/天[IQR 225-1425]下降到320 mg/天[IQR 100-900],下降了25.1% (95%CI 23.0-27.2)。蛋白尿减少≥30%的患者占48.3%,0-29%的患者占37.6%,而增加的患者占14.1%。在logistic回归分析中,年龄较大、女性、使用矿物皮质激素受体拮抗剂、较高的eGFR和较高的蛋白尿都是蛋白尿下降≥30%的显著预测因素。我们收集了36例(2%)患者46种导致停药的副作用,其中急性肾损伤和尿路感染是最常见的不良事件。结论:我们提供了短期达格列净抗蛋白尿疗效的证据,在CKD患者肾内科随访中具有良好的安全性。
{"title":"Efficacy and safety of dapagliflozin in patients with CKD: real-world experience in 93 Italian renal clinics.","authors":"Roberto Minutolo, Silvio Borrelli, Andrea Ambrosini, Luigi Amoroso, Filippo Aucella, Valentina Batini, Yuri Battaglia, Laura Bregoli, Vincenzo Cantaluppi, Giuseppe Cianciolo, Paolo Conti, Paolo Fabbrini, Carlo Giammarresi, Egidio Imbalzano, Sandra La Rosa, Marita Marengo, Vincenzo Montinaro, Dario Musone, Marcello Napoli, Felice Nappi, Corrado Pluvio, Domenico Santoro, Roberto Scarpioni, Franco Sopranzi, Tiziana Tullio, Luca De Nicola","doi":"10.1093/ckj/sfae396","DOIUrl":"10.1093/ckj/sfae396","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are recommended for reducing the renal and cardiovascular risk in patients with chronic kidney disease (CKD) based on the positive results reported by clinical trials. However, real-world data on the efficacy and the safety of these drugs in CKD population followed in nephrology setting are lacking.</p><p><strong>Methods: </strong>We report the effects of dapagliflozin in CKD patients by using data collected during a learning program in which 105 nephrologists added dapagliflozin (10 mg/day) to consecutive patients referred to their renal clinics. Efficacy endpoints were the albuminuria change and the determinants of an albuminuria decline ≥30%. Adverse events were also collected.</p><p><strong>Results: </strong>A total of 1724 patients with CKD (age 67.4 ± 13.2 years, 72.8% males, diabetes 59.9%, eGFR 43.5 ± 17.4 ml/min/1.73 m<sup>2</sup>, severe albuminuria 70.1%) received dapagliflozin for 4 ± 1 months. Dapagliflozin significantly reduced body weight (-1.3 kg), eGFR (-0.27 ml/min/month), and blood pressure (-3.6/-1.7 mmHg). Albuminuria declined by 25.1% (95%CI 23.0-27.2) from 500 mg/day [IQR 225-1425] to 320 mg/day [IQR 100-900]. Albuminuria reduction was ≥30% in 48.3% of patients, 0-29% in 37.6% while it increased in 14.1% of patients. At logistic regression analysis, older age, female sex, use of mineralocorticoid receptor antagonist, higher eGFR, and higher albuminuria were all significant predictors of albuminuria decline ≥30%. We collected 46 side effects leading to drug discontinuation in 36 patients (2%), with acute kidney injury and urinary tract infection being the most frequent adverse events.</p><p><strong>Conclusions: </strong>We provide evidence of the anti-proteinuric efficacy of short-term dapagliflozin in the presence of good safety profile in patients with CKD followed in nephrology.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 1","pages":"sfae396"},"PeriodicalIF":3.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001287","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
Dipeptidyl peptidase 4 inhibitors reduce the risk of adverse outcomes after acute kidney injury in diabetic patients.
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-03 eCollection Date: 2025-02-01 DOI: 10.1093/ckj/sfae385
Hung-Wei Liao, Chung-Yi Cheng, Hsing-Yu Chen, Jui-Yi Chen, Heng-Chih Pan, Tao-Min Huang, Vin-Cent Wu

Background: Dipeptidyl peptidase 4 inhibitors (DPP4is) are considered safe for use in patients with diabetes mellitus and kidney dysfunction. We explored whether usage of DPP4is in patients who recovered from dialysis-requiring acute kidney injury (AKI) could reduce the risk of future cardiac and kidney events.

Methods: We used the TriNetX platform to investigate whether the use of DPP4is in diabetes mellitus patients within 90 days of discharge from acute kidney disease could reduce the risk of all-cause mortality, major adverse kidney events (MAKEs), major adverse cardiovascular events (MACEs), and re-dialysis. The patients were followed for 5 years or until the occurrence of significant outcomes, with cohort data collected from 1 January 2016 to 30 September 2022.

Results: The cohort utilizing DPP4is comprised 7348 patients with acute kidney disease, while the control group encompassed 229 417 individuals. After applying propensity score matching, 7343 patients (age 66.2 ± 13.4 years; male, 49.9%) who used DPP4is showed a significant reduction in the risk of all-cause mortality [adjusted hazard ratio (aHR) 0.89; E-value 1.50 , MAKEs (aHR 0.86; E-value 1.59), MACEs (aHR 0.91; E-value 1.44), and re-dialysis (aHR 0.73; E-value 2.10) after a median follow-up of 2.4 years.

Conclusions: We demonstrated that in diabetes mellitus patients concurrently experiencing acute kidney disease, DPP4i usage could decrease the risk of mortality, MAKEs, MACEs, and re-dialysis. These findings emphasize the pivotal role of tailored treatment strategies involving DPP4i for acute kidney disease patients.

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引用次数: 0
The use of SGLT2 inhibitors and GLP-1 receptor agonists in older patients: a debate on approaches in CKD and non-CKD populations. 在老年患者中使用 SGLT2 抑制剂和 GLP-1 受体激动剂:关于慢性肾脏病和非慢性肾脏病人群使用方法的辩论。
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-02 eCollection Date: 2025-02-01 DOI: 10.1093/ckj/sfae380
Sophie Liabeuf, Roberto Minutolo, Jürgen Floege, Carmine Zoccali

The management of CKD in older patients presents a significant challenge in modern medicine. As the global population ages, the prevalence of CKD among older adults is increasing, which demands effective and safe treatment strategies. The introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists has revolutionized the treatment of CKD, offering potential benefits beyond traditional therapies. However, their use in the older population raises essential questions about safety and efficacy, given the unique physiological changes and comorbidities associated with aging. In this CKJ controversy paper, Roberto Minutolo (PRO) and Sophie Liabeuf (CON) debate on the use of SGLT2 inhibitors and GLP-1 receptor agonists in older patients with CKD. Roberto Minutolo advocates the benefits of these medications, highlighting their role in improving cardiovascular outcomes and slowing CKD progression in older patients. He emphasizes the importance of personalized treatment plans based on the patient's cardio-renal risk profile and preferences. In contrast, Sophie Liabeuf expresses concerns about the safety of these drugs in older adults, citing risks such as fractures, acute kidney injury, and urinary tract infections. She argues that treatment decisions should be guided by patient frailty rather than chronological age, as frail individuals are more vulnerable to adverse drug effects. Both contenders agree on the need for more inclusive clinical trials to better understand the impact of these treatments on older populations. While Roberto Minutolo and Sophie Liabeuf present differing perspectives on the use of SGLT2 inhibitors and GLP-1 receptor agonists in older patients with CKD, their views can be seen as complementary rather than strictly opposing. Minutolo's focus on the benefits of these drugs underscores their potential to improve outcomes. Liabeuf's emphasis on caution and the consideration of frailty highlights the need for careful patient assessment. Both agree on the importance of personalized treatment and the inclusion of older patients in future clinical trials, suggesting a shared goal of optimizing care for this vulnerable population. Their debate underscores the complexity of treatment decisions and the necessity of balancing risks and benefits in managing CKD in older adults.

{"title":"The use of SGLT2 inhibitors and GLP-1 receptor agonists in older patients: a debate on approaches in CKD and non-CKD populations.","authors":"Sophie Liabeuf, Roberto Minutolo, Jürgen Floege, Carmine Zoccali","doi":"10.1093/ckj/sfae380","DOIUrl":"10.1093/ckj/sfae380","url":null,"abstract":"<p><p>The management of CKD in older patients presents a significant challenge in modern medicine. As the global population ages, the prevalence of CKD among older adults is increasing, which demands effective and safe treatment strategies. The introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists has revolutionized the treatment of CKD, offering potential benefits beyond traditional therapies. However, their use in the older population raises essential questions about safety and efficacy, given the unique physiological changes and comorbidities associated with aging. In this CKJ controversy paper, Roberto Minutolo (PRO) and Sophie Liabeuf (CON) debate on the use of SGLT2 inhibitors and GLP-1 receptor agonists in older patients with CKD. Roberto Minutolo advocates the benefits of these medications, highlighting their role in improving cardiovascular outcomes and slowing CKD progression in older patients. He emphasizes the importance of personalized treatment plans based on the patient's cardio-renal risk profile and preferences. In contrast, Sophie Liabeuf expresses concerns about the safety of these drugs in older adults, citing risks such as fractures, acute kidney injury, and urinary tract infections. She argues that treatment decisions should be guided by patient frailty rather than chronological age, as frail individuals are more vulnerable to adverse drug effects. Both contenders agree on the need for more inclusive clinical trials to better understand the impact of these treatments on older populations. While Roberto Minutolo and Sophie Liabeuf present differing perspectives on the use of SGLT2 inhibitors and GLP-1 receptor agonists in older patients with CKD, their views can be seen as complementary rather than strictly opposing. Minutolo's focus on the benefits of these drugs underscores their potential to improve outcomes. Liabeuf's emphasis on caution and the consideration of frailty highlights the need for careful patient assessment. Both agree on the importance of personalized treatment and the inclusion of older patients in future clinical trials, suggesting a shared goal of optimizing care for this vulnerable population. Their debate underscores the complexity of treatment decisions and the necessity of balancing risks and benefits in managing CKD in older adults.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae380"},"PeriodicalIF":3.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188477","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
Upper normal serum magnesium is associated with a reduction in incident death from fatal heart failure, coronary heart disease and stroke in non-dialysis patients with CKD stages 4 and 5.
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-12-02 eCollection Date: 2025-02-01 DOI: 10.1093/ckj/sfae390
Cayetana Moyano-Peregrin, Cristian Rodelo-Haad, Alejandro Martín-Malo, Juan Rafael Muñoz-Castañeda, Raquel Ojeda, Isabel Lopez-Lopez, Mariano Rodríguez, Mª Victoria Pendon-Ruiz de Mier, Rafael Santamaría, Sagrario Soriano

Background: Serum magnesium disturbances are common in patients with cardiovascular disease (CVD). However, the well-established link between low serum magnesium and nutritional or inflammatory disorders has limited its consideration as a non-traditional risk factor for mortality. This study aims to elucidate the relationship between serum magnesium concentrations and mortality due to fatal heart failure (HF), coronary heart disease (CHD) and stroke in non-dialysis patients with chronic kidney disease (CKD) stages 4 and 5.

Methods: A cohort of 1271 non-dialysis patients with CKD stages 4 and 5 was followed from 2008 to 2018. Patients with prior major adverse cardiovascular events (MACE) were excluded. Serum magnesium levels were stratified into tertiles and the primary outcomes were incidence rates of fatal HF, CHD and stroke. Secondary outcomes included composite MACE and all-cause mortality. Hazard ratios (HRs) were calculated using multivariate Cox regression, adjusting for demographics, comorbidities and biochemical parameters. E-values were used to assess the robustness of the results.

Results: Over the 10-year follow-up, 186 patients died. Higher serum magnesium levels were significantly associated with reduced mortality risk from HF [HR 0.49 (95% CI 0.27-0.89) for T2; HR 0.31 (95% CI 0.16-0.60) for T3] compared with the lowest tertile. Similar trends were observed for CHD and stroke mortality. The incidence rate of MACE per 1000 person-years was reduced from 68.2 in tertile 1 to 26.2 in tertile 2 and 16.8 in tertile 3. Secondary endpoints, including all-cause mortality and composite MACE, followed trends similar to the primary outcomes.

Conclusions: Higher serum magnesium concentrations were associated with lower risks of death from fatal HF, CHD and stroke in non-dialysis patients with CKD stages 4 and 5.

背景:血清镁紊乱在心血管疾病(CVD)患者中很常见。然而,由于低血清镁与营养或炎症性疾病之间的联系已得到证实,因此将其作为非传统的死亡风险因素的考虑受到了限制。本研究旨在阐明慢性肾脏病(CKD)4 期和 5 期非透析患者血清镁浓度与致命性心力衰竭(HF)、冠心病(CHD)和中风死亡率之间的关系:从2008年至2018年,对1271名慢性肾脏病(CKD)4期和5期的非透析患者进行了队列随访。排除了曾发生重大不良心血管事件(MACE)的患者。血清镁水平分为三等分,主要结果为致命性高血压、冠心病和中风的发病率。次要结果包括复合 MACE 和全因死亡率。采用多变量考克斯回归法计算危险比(HRs),并对人口统计学、合并症和生化参数进行调整。E值用于评估结果的稳健性:在10年的随访中,有186名患者死亡。与最低三分位数相比,血清镁水平越高,心房颤动的死亡风险越低[T2的HR为0.49(95% CI为0.27-0.89);T3的HR为0.31(95% CI为0.16-0.60)]。在冠心病和中风死亡率方面也观察到类似的趋势。每1000人年的MACE发生率从第1分层的68.2例降至第2分层的26.2例和第3分层的16.8例。次要终点(包括全因死亡率和复合 MACE)的变化趋势与主要结果相似:结论:血清镁浓度越高,慢性肾脏病 4 期和 5 期非透析患者死于致命性高血压、冠心病和中风的风险越低。
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引用次数: 0
The management of chronic kidney disease in primary care in Denmark: patient characteristics, treatment, follow-up, progression and referral. 丹麦基层医疗机构对慢性肾病的管理:患者特征、治疗、随访、进展和转诊。
IF 3.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-30 eCollection Date: 2025-02-01 DOI: 10.1093/ckj/sfae393
Henrik Birn, Karl Emil Nelveg-Kristensen, Line Elmerdahl Frederiksen, Stefan Christensen, Juha Mehtälä, Sarah Smith, Michael Bruun, Ulrik Bodholdt

Background: Chronic kidney disease (CKD) is mainly managed in primary care, but detailed information on these patients is limited. This study describes CKD patients and the disease management and referrals by general practitioners (GPs) in Denmark in order to identify opportunities for improved care.

Methods: Patients with CKD, defined by at least two abnormal estimated glomerular filtration rate (eGFR) or urinary albumin/creatinine ratio (UACR) measurements ≥90 days apart during 2019-2020, were followed until May 2023 utilizing electronic health records.

Results: Among 1316 patients with one abnormal eGFR or UACR test, 993 (75%) had a second abnormal test within a median of 10.8 months, which confirmed CKD. Most patients (62%) were G-stage 3a, 89% had cardiovascular disease and 34% had diabetes. A UACR test was performed in 52% of patients around time of index. The use of renin-angiotensin-aldosterone system inhibitors was high (67%), whereas sodium-glucose cotransporter 2 inhibitors was low at inclusion (5%), although increasing during follow-up (15%). Patients had a median of 13.5 GP contacts/year, 1-2 eGFR and 0-1 UACR tests/year, and only 2.7% were referred to a nephrologist. The median decline in eGFR was modest; however, 15% experienced a drop of >5.0 mL/min/1.73 m2 during 3-years of follow-up.

Conclusions: The findings indicate a high likelihood of CKD following one abnormal measurement. CKD patients constitute a significant burden to primary care with frequent GP contacts, yet more focus on UACR testing and new treatment adaptation to improve CKD prognosis is warranted.

{"title":"The management of chronic kidney disease in primary care in Denmark: patient characteristics, treatment, follow-up, progression and referral.","authors":"Henrik Birn, Karl Emil Nelveg-Kristensen, Line Elmerdahl Frederiksen, Stefan Christensen, Juha Mehtälä, Sarah Smith, Michael Bruun, Ulrik Bodholdt","doi":"10.1093/ckj/sfae393","DOIUrl":"10.1093/ckj/sfae393","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is mainly managed in primary care, but detailed information on these patients is limited. This study describes CKD patients and the disease management and referrals by general practitioners (GPs) in Denmark in order to identify opportunities for improved care.</p><p><strong>Methods: </strong>Patients with CKD, defined by at least two abnormal estimated glomerular filtration rate (eGFR) or urinary albumin/creatinine ratio (UACR) measurements ≥90 days apart during 2019-2020, were followed until May 2023 utilizing electronic health records.</p><p><strong>Results: </strong>Among 1316 patients with one abnormal eGFR or UACR test, 993 (75%) had a second abnormal test within a median of 10.8 months, which confirmed CKD. Most patients (62%) were G-stage 3a, 89% had cardiovascular disease and 34% had diabetes. A UACR test was performed in 52% of patients around time of index. The use of renin-angiotensin-aldosterone system inhibitors was high (67%), whereas sodium-glucose cotransporter 2 inhibitors was low at inclusion (5%), although increasing during follow-up (15%). Patients had a median of 13.5 GP contacts/year, 1-2 eGFR and 0-1 UACR tests/year, and only 2.7% were referred to a nephrologist. The median decline in eGFR was modest; however, 15% experienced a drop of >5.0 mL/min/1.73 m<sup>2</sup> during 3-years of follow-up.</p><p><strong>Conclusions: </strong>The findings indicate a high likelihood of CKD following one abnormal measurement. CKD patients constitute a significant burden to primary care with frequent GP contacts, yet more focus on UACR testing and new treatment adaptation to improve CKD prognosis is warranted.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfae393"},"PeriodicalIF":3.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188315","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}
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Clinical Kidney Journal
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