Pub Date : 2024-08-12eCollection Date: 2024-08-01DOI: 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.
{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 8","pages":"sfae240"},"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}
Pub Date : 2024-08-12eCollection Date: 2024-08-01DOI: 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.
{"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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 8","pages":"sfae239"},"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}
Pub Date : 2024-08-12eCollection Date: 2024-09-01DOI: 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.
{"title":"Sodium glucose co-transporter 2 inhibitors in the treatment of glomerular diseases: a <i>CKJ</i> controversy.","authors":"Fernando Caravaca-Fontán, Lucia Del Vecchio, Manuel Praga, Jürgen Floege, Carmine Zoccali","doi":"10.1093/ckj/sfae237","DOIUrl":"10.1093/ckj/sfae237","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 9","pages":"sfae237"},"PeriodicalIF":3.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125049","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}
[This corrects the article DOI: 10.1093/ckj/sfae150.].
[此处更正了文章 DOI：10.1093/ckj/sfae150]。
{"title":"Correction to: Using artificial intelligence to predict mortality in AKI patients: a systematic review/meta-analysis.","authors":"","doi":"10.1093/ckj/sfae223","DOIUrl":"https://doi.org/10.1093/ckj/sfae223","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfae150.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 8","pages":"sfae223"},"PeriodicalIF":3.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888606","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}
Diego López Fazlic, Samuel Abrante García, Micaela Gerard, Edduin Martín Izquierdo, Alejandro Alonso Bethancourt, Luca Vannini, Celestino Hernández García, Manuel Macía Heras
Cardiac amyloidosis is a cardiomyopathy resulting from the extracellular deposition of proteins such as transthyretin (TTR). We present the case of a 72-year-old male with hereditary cardiac amyloidosis (ATTRh). After confirming the diagnosis, Tafamidis, a TTR stabilizer, was administered. Remarkably, Tafamidis, when coupled with peritoneal dialysis for chronic kidney disease, maintained stability in both cardiac and renal functions. Previous studies have demonstrated Tafamidis’ efficacy in reducing all-cause mortality and cardiovascular hospitalizations, although its use in severe renal failure lacks specific evaluation. This case suggests a potential application of Tafamidis in moderate-severe kidney disease, emphasizing the need for further research in this population.
{"title":"Experience with Tafamidis in peritoneal dialysis for a patient diagnosed with transthyretin cardiac amyloidosis","authors":"Diego López Fazlic, Samuel Abrante García, Micaela Gerard, Edduin Martín Izquierdo, Alejandro Alonso Bethancourt, Luca Vannini, Celestino Hernández García, Manuel Macía Heras","doi":"10.1093/ckj/sfae233","DOIUrl":"https://doi.org/10.1093/ckj/sfae233","url":null,"abstract":"Cardiac amyloidosis is a cardiomyopathy resulting from the extracellular deposition of proteins such as transthyretin (TTR). We present the case of a 72-year-old male with hereditary cardiac amyloidosis (ATTRh). After confirming the diagnosis, Tafamidis, a TTR stabilizer, was administered. Remarkably, Tafamidis, when coupled with peritoneal dialysis for chronic kidney disease, maintained stability in both cardiac and renal functions. Previous studies have demonstrated Tafamidis’ efficacy in reducing all-cause mortality and cardiovascular hospitalizations, although its use in severe renal failure lacks specific evaluation. This case suggests a potential application of Tafamidis in moderate-severe kidney disease, emphasizing the need for further research in this population.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"212 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867998","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 This study aimed to assess the prognosis of people with chronic kidney disease (CKD) in Japan using the Kidney Disease Improving Global Outcomes (KDIGO) heatmap. Methods The prognoses of individuals with estimated glomerular filtration rates (eGFR) < 90 ml/min/1.73 m2 were evaluated based on the KDIGO heatmap using an electronic medical record database in Japan. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction (MI), stroke, heart failure (HF) hospitalization, and in-hospital death (referred to as MACE1). Additionally, ad hoc MACE2 (MI hospitalization, stroke hospitalization, HF hospitalization, and in-hospital death) was examined. The secondary outcome was the renal outcome. Results Of the 543 606 individuals included, the mean age was 61.6 ± 15.3 years, 50.1% were male, and 40.9% lacked urine protein results. The risk of MACEs increased independently with both eGFR decline and increasing proteinuria from the early KDIGO stages: Hazard ratios (with 95% confidence interval) of MACE1 and MACE2, compared to G2A1 were 1.16 (1.12–1.20) and 1.17 (1.11–1.23), respectively, for G3aA1, and 1.17 (1.12–1.21) and 1.35 (1.28–1.43), respectively, for G2A2. This increased up to 2.83 (2.54–3.15) and 3.43 (3.00–3.93), respectively, for G5A3. Risks of renal outcomes also increased with CKD progression. Conclusions This study is the first to demonstrate the applicability of the KDIGO heatmap in assessing cardiovascular and renal risk in Japan. The risk increased from the early stages of CKD, indicating the importance of early diagnosis and intervention through appropriate testing.
{"title":"Cardiovascular, renal and mortality risk by the KDIGO heatmap in japan","authors":"Shoichi Maruyama, Tetsuhiro Tanaka, Hiroki Akiyama, Mitsuru Hoshino, Shoichiro Inokuchi, Shuji Kaneko, Koji Shimamoto, Asuka Ozaki","doi":"10.1093/ckj/sfae228","DOIUrl":"https://doi.org/10.1093/ckj/sfae228","url":null,"abstract":"Background This study aimed to assess the prognosis of people with chronic kidney disease (CKD) in Japan using the Kidney Disease Improving Global Outcomes (KDIGO) heatmap. Methods The prognoses of individuals with estimated glomerular filtration rates (eGFR) &lt; 90 ml/min/1.73 m2 were evaluated based on the KDIGO heatmap using an electronic medical record database in Japan. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction (MI), stroke, heart failure (HF) hospitalization, and in-hospital death (referred to as MACE1). Additionally, ad hoc MACE2 (MI hospitalization, stroke hospitalization, HF hospitalization, and in-hospital death) was examined. The secondary outcome was the renal outcome. Results Of the 543 606 individuals included, the mean age was 61.6 ± 15.3 years, 50.1% were male, and 40.9% lacked urine protein results. The risk of MACEs increased independently with both eGFR decline and increasing proteinuria from the early KDIGO stages: Hazard ratios (with 95% confidence interval) of MACE1 and MACE2, compared to G2A1 were 1.16 (1.12–1.20) and 1.17 (1.11–1.23), respectively, for G3aA1, and 1.17 (1.12–1.21) and 1.35 (1.28–1.43), respectively, for G2A2. This increased up to 2.83 (2.54–3.15) and 3.43 (3.00–3.93), respectively, for G5A3. Risks of renal outcomes also increased with CKD progression. Conclusions This study is the first to demonstrate the applicability of the KDIGO heatmap in assessing cardiovascular and renal risk in Japan. The risk increased from the early stages of CKD, indicating the importance of early diagnosis and intervention through appropriate testing.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"9 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141881260","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}
Yukun Tang, Jipin Jiang, Yuanyuan Zhao, Dunfeng Du
Chronic kidney disease (CKD) is now an unquestionable progressive condition that affects more than 10% of the general population worldwide, and has emerged as one of the most important causes of global mortality. It is clear that the prevalence of CKD among aging population is significantly elevated. It involves a board range of complex and poorly understood concerns in older adults such as frailty, malnutrition, sarcopenia, and even cognitive and mental dysfunction. In kidneys, renal function such as glomerular filtration, urine concentration and dilution, and homeostasis of sodium and potassium, can be influenced by the aging process. In addition, it's worth noting that CKD and end stage of kidney disease (ESRD) patients are often accompanied by an activation of immune system and inflammation. It involves both the innate and adaptive immune system. Based on these backgrounds, in this review article, we attempt to summarize the epidemiological characteristics of CKD in aging population, discuss the immunological mechanisms in aging-related CKD, and furnish the reader with the process in therapy and management for elderly patients with CKD.
{"title":"Aging and Chronic Kidney Disease: Epidemiology, Therapy, Management, and the Role of immunity","authors":"Yukun Tang, Jipin Jiang, Yuanyuan Zhao, Dunfeng Du","doi":"10.1093/ckj/sfae235","DOIUrl":"https://doi.org/10.1093/ckj/sfae235","url":null,"abstract":"Chronic kidney disease (CKD) is now an unquestionable progressive condition that affects more than 10% of the general population worldwide, and has emerged as one of the most important causes of global mortality. It is clear that the prevalence of CKD among aging population is significantly elevated. It involves a board range of complex and poorly understood concerns in older adults such as frailty, malnutrition, sarcopenia, and even cognitive and mental dysfunction. In kidneys, renal function such as glomerular filtration, urine concentration and dilution, and homeostasis of sodium and potassium, can be influenced by the aging process. In addition, it's worth noting that CKD and end stage of kidney disease (ESRD) patients are often accompanied by an activation of immune system and inflammation. It involves both the innate and adaptive immune system. Based on these backgrounds, in this review article, we attempt to summarize the epidemiological characteristics of CKD in aging population, discuss the immunological mechanisms in aging-related CKD, and furnish the reader with the process in therapy and management for elderly patients with CKD.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"42 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141778855","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}
Pasquale Esposito, Francesca Cappadona, Marita Marengo, Marco Fiorentino, Paolo Fabbrini, Alessandro Domenico Quercia, Francesco Garzotto, Giuseppe Castellano, Vincenzo Cantaluppi, Francesca Viazzi
Background and Objectives Acute Kidney Injury (AKI) during hospitalization is associated with increased complications and mortality. Despite efforts to standardize AKI management, its recognition in clinical practice is limited. Methods To assess and characterize different patterns of AKI diagnosis, we collected clinical data, serum creatinine (sCr) levels, comorbidities, and outcomes from adult patients using the Hospital Discharge Form (HDF). AKI diagnosis was based on administrative data and according to KDIGO criteria by evaluating sCr variations during hospitalization. Additionally, patients were also categorized based on the timing of AKI onset. Results Among 56 820 patients, 42 900 (75.5%) had no AKI, 1 893 (3.3%) had AKI diagnosed by sCr changes and coded in HDF (Full-AKI), 2 529 (4.4%) had AKI reported on HDF but not meeting sCr-based criteria (HDF-AKI), and 9 498 (16.7%) had undetected AKI diagnosed by sCr changes but not coded in HDF (KDIGO-AKI). Overall, AKI incidence was 24.5%, with a 68% undetection rate. Patients with KDIGO-AKI were younger, had a higher proportion of females, lower comorbidity burden, milder AKI stages, more frequent admissions to surgical wards, and lower mortality compared to Full-AKI. All AKI groups had worse outcomes than those without AKI, and AKI, even if undetected, was independently associated with mortality risk. Patients with AKI at admission had different profiles and better outcomes than those developing AKI later. Conclusions AKI recognition in hospitalized patients is highly heterogeneous, with a significant prevalence of undetection. This variability may be affected by patients ‘characteristics, AKI-related factors, diagnostic approaches, and in-hospital patient management. AKI remains a major risk factor, emphasizing the importance of ensuring proper diagnosis for all patients.
背景和目的 住院期间的急性肾损伤（AKI）与并发症和死亡率的增加有关。尽管已在努力实现 AKI 管理的标准化，但临床实践中对 AKI 的认识仍然有限。方法 为了评估 AKI 诊断的不同模式并确定其特征，我们使用出院表（HDF）收集了成年患者的临床数据、血清肌酐（sCr）水平、合并症和预后。AKI 诊断基于管理数据，并根据 KDIGO 标准评估住院期间的 sCr 变化。此外，还根据 AKI 发病时间对患者进行了分类。结果 在 56 820 例患者中，42 900 例（75.5%）无 AKI，1 893 例（3.3%）通过 sCr 变化诊断出 AKI 并在 HDF 中进行了编码（Full-AKI），2 529 例（4.4%）在 HDF 中报告了 AKI，但不符合基于 sCr 的标准（HDF-AKI），9 498 例（16.7%）通过 sCr 变化诊断出未发现的 AKI，但未在 HDF 中进行编码（KDIGO-AKI）。总体而言，AKI 发生率为 24.5%，未检出率为 68%。与Full-AKI相比，KDIGO-AKI患者更年轻，女性比例更高，合并症负担更轻，AKI分期更轻，更常入住外科病房，死亡率更低。与无 AKI 患者相比，所有 AKI 组患者的预后都更差，而且 AKI 即使未被发现，也与死亡风险独立相关。入院时发生 AKI 的患者与后来发生 AKI 的患者相比，情况不同，预后更好。结论 住院患者对 AKI 的识别存在很大差异，未被发现的情况非常普遍。这种差异性可能受到患者特征、AKI 相关因素、诊断方法和院内患者管理的影响。AKI 仍然是一个主要的风险因素，这就强调了确保对所有患者进行正确诊断的重要性。
{"title":"Recognition patterns of acute kidney injury in hospitalized patients","authors":"Pasquale Esposito, Francesca Cappadona, Marita Marengo, Marco Fiorentino, Paolo Fabbrini, Alessandro Domenico Quercia, Francesco Garzotto, Giuseppe Castellano, Vincenzo Cantaluppi, Francesca Viazzi","doi":"10.1093/ckj/sfae231","DOIUrl":"https://doi.org/10.1093/ckj/sfae231","url":null,"abstract":"Background and Objectives Acute Kidney Injury (AKI) during hospitalization is associated with increased complications and mortality. Despite efforts to standardize AKI management, its recognition in clinical practice is limited. Methods To assess and characterize different patterns of AKI diagnosis, we collected clinical data, serum creatinine (sCr) levels, comorbidities, and outcomes from adult patients using the Hospital Discharge Form (HDF). AKI diagnosis was based on administrative data and according to KDIGO criteria by evaluating sCr variations during hospitalization. Additionally, patients were also categorized based on the timing of AKI onset. Results Among 56 820 patients, 42 900 (75.5%) had no AKI, 1 893 (3.3%) had AKI diagnosed by sCr changes and coded in HDF (Full-AKI), 2 529 (4.4%) had AKI reported on HDF but not meeting sCr-based criteria (HDF-AKI), and 9 498 (16.7%) had undetected AKI diagnosed by sCr changes but not coded in HDF (KDIGO-AKI). Overall, AKI incidence was 24.5%, with a 68% undetection rate. Patients with KDIGO-AKI were younger, had a higher proportion of females, lower comorbidity burden, milder AKI stages, more frequent admissions to surgical wards, and lower mortality compared to Full-AKI. All AKI groups had worse outcomes than those without AKI, and AKI, even if undetected, was independently associated with mortality risk. Patients with AKI at admission had different profiles and better outcomes than those developing AKI later. Conclusions AKI recognition in hospitalized patients is highly heterogeneous, with a significant prevalence of undetection. This variability may be affected by patients ‘characteristics, AKI-related factors, diagnostic approaches, and in-hospital patient management. AKI remains a major risk factor, emphasizing the importance of ensuring proper diagnosis for all patients.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"43 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141778769","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}
Armando Coca, Elena Bustamante-Munguira, Verónica Fidalgo, Manuel Fernández, Cristina Abad, Marta Franco, Ángel González-Pinto, Daniel Pereda, Sergio Cánovas, Juan Bustamante-Munguira
Background Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious complication in patients undergoing cardiac surgery with extracorporeal circulation (ECC) that increases postoperative complications and mortality. CSA-AKI develops due to a combination of patient- and surgery-related risk factors that enhance renal ischemia-reperfusion injury. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) such as empagliflozin reduce renal glucose reabsorption, improving tubulo-glomerular feedback, reducing inflammation, and decreasing intraglomerular pressure. Preclinical studies have observed that SGLT2i may provide significant protection against renal ischemia-reperfusion injury due to its effects over inadequate mitochondrial function, reactive oxygen species activity, or renal peritubular capillary congestion, all hallmarks of CSA-AKI. The VERTIGO trial is a Phase 3, investigator-initiated, randomized, double-blind, placebo-controlled, multicenter study that aims to explore if empagliflozin can reduce the incidence of adverse renal outcomes in cardiac surgery patients. Methods The VERTIGO study (EudraCT: 2021–004938-11) will enroll 608 patients that require elective cardiac surgery with ECC. Patients will be randomly assigned in a 1:1 ratio to receive either empagliflozin 10 mg orally daily or placebo. Study treatment will start five days before surgery and will continue during the first seven postoperative days. All participants will receive standard care according to local practice guidelines. The primary endpoint of the study will be the proportion of patients that develop major adverse kidney events during the first 90 days after surgery, defined as 25% or greater renal function decline, renal replacement therapy initiation, or death. Secondary, tertiary, and safety endpoints will include rates of acute kidney injury during index hospitalization, postoperative complications, and observed adverse events. Conclusions The VERTIGO trial will describe the efficacy and safety of empagliflozin in preventing CSA-AKI. Patient recruitment is expected to start in May 2024.
{"title":"EValuating the Effect of periopeRaTIve empaGliflOzin on cardiac surgery associated acute kidney injury: rationale and design of the VERTIGO Study","authors":"Armando Coca, Elena Bustamante-Munguira, Verónica Fidalgo, Manuel Fernández, Cristina Abad, Marta Franco, Ángel González-Pinto, Daniel Pereda, Sergio Cánovas, Juan Bustamante-Munguira","doi":"10.1093/ckj/sfae229","DOIUrl":"https://doi.org/10.1093/ckj/sfae229","url":null,"abstract":"Background Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious complication in patients undergoing cardiac surgery with extracorporeal circulation (ECC) that increases postoperative complications and mortality. CSA-AKI develops due to a combination of patient- and surgery-related risk factors that enhance renal ischemia-reperfusion injury. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) such as empagliflozin reduce renal glucose reabsorption, improving tubulo-glomerular feedback, reducing inflammation, and decreasing intraglomerular pressure. Preclinical studies have observed that SGLT2i may provide significant protection against renal ischemia-reperfusion injury due to its effects over inadequate mitochondrial function, reactive oxygen species activity, or renal peritubular capillary congestion, all hallmarks of CSA-AKI. The VERTIGO trial is a Phase 3, investigator-initiated, randomized, double-blind, placebo-controlled, multicenter study that aims to explore if empagliflozin can reduce the incidence of adverse renal outcomes in cardiac surgery patients. Methods The VERTIGO study (EudraCT: 2021–004938-11) will enroll 608 patients that require elective cardiac surgery with ECC. Patients will be randomly assigned in a 1:1 ratio to receive either empagliflozin 10 mg orally daily or placebo. Study treatment will start five days before surgery and will continue during the first seven postoperative days. All participants will receive standard care according to local practice guidelines. The primary endpoint of the study will be the proportion of patients that develop major adverse kidney events during the first 90 days after surgery, defined as 25% or greater renal function decline, renal replacement therapy initiation, or death. Secondary, tertiary, and safety endpoints will include rates of acute kidney injury during index hospitalization, postoperative complications, and observed adverse events. Conclusions The VERTIGO trial will describe the efficacy and safety of empagliflozin in preventing CSA-AKI. Patient recruitment is expected to start in May 2024.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"47 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141785459","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}
Eleni Stamellou, Jennifer Nadal, Bruce Hendry, Alex Mercer, Claudia Seikrit, Wibke Bechtel-Walz, Matthias Schmid, Marcus J Moeller, Mario Schiffer, Kai-Uwe Eckardt, Rafael Kramann, Jürgen Floege
Background and Aims The importance of albuminuria as opposed to proteinuria in predicting kidney outcomes in primary IgA nephropathy (IgAN) is not well established. Method From 2010 to 2012, 421 patients with biopsy-proven IgAN have been enrolled into the German Chronic Kidney Disease (GCKD) cohort, a prospective observational cohort study (N = 5217). Adjudicated endpoints included a Composite Kidney Endpoint (CKE) consisting of eGFR decline > 40%, eGFR < 15 ml/min/1.73 m2 and initiation of kidney replacement therapy; the individual components of the CKE; and combined major adverse cardiac events (MACE), including nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. The associations between the incidence of CKE and baseline factors, including demographics, laboratory values and comorbidities were analyzed using the Cox proportional hazards regression model. Results The mean age at baseline of IgAN patients was 51.6 years (± 13.6) and 67% were male. Patient-reported duration of disease at baseline was 5.9 ± 8.1 years. Baseline median UACR was 0.4 g/g (0.1–0.8) and mean eGFR was 52.5 ± 22.4 mL/min/1.73m2. Over a follow-up of 6.5 years, 64 (15.2%) experienced > 40% eGFR decline, 3 (0.7%) reached eGFR < 15 ml/min and 53 (12.6%) initiated kidney replacement therapy and 28% of the patients experienced the CKE. Albuminuria, with reference to < 0.1 g/g was most associated with CKE. Hazard ratios (95% CI) at UACR 0.1–0.6 g/g, 0.6–1.4 g/g, 1.4–2.2 g/g and > 2.2 g/g were 2.03 (1.02–4.05), 3.8 (1.92–7.5), 5.64 (2.58–12.33) and 5.02 (2.29–11-03), respectively. Regarding MACE, the presence of diabetes (HR = 2.53, 95% CI 1.11–5.78) was the most strongly associated factor, whereas UACR and eGFR did not show significant associations. Conclusion In the GCKD IgAN sub-cohort more than every fourth patient experienced a CKE event within 6.5 years. Our findings support the use of albuminuria as a surrogate to assess the risk of poor kidney outcomes.
{"title":"Long term outcomes of patients with IgA nephropathy in the German CKD (GCKD) cohort","authors":"Eleni Stamellou, Jennifer Nadal, Bruce Hendry, Alex Mercer, Claudia Seikrit, Wibke Bechtel-Walz, Matthias Schmid, Marcus J Moeller, Mario Schiffer, Kai-Uwe Eckardt, Rafael Kramann, Jürgen Floege","doi":"10.1093/ckj/sfae230","DOIUrl":"https://doi.org/10.1093/ckj/sfae230","url":null,"abstract":"Background and Aims The importance of albuminuria as opposed to proteinuria in predicting kidney outcomes in primary IgA nephropathy (IgAN) is not well established. Method From 2010 to 2012, 421 patients with biopsy-proven IgAN have been enrolled into the German Chronic Kidney Disease (GCKD) cohort, a prospective observational cohort study (N = 5217). Adjudicated endpoints included a Composite Kidney Endpoint (CKE) consisting of eGFR decline &gt; 40%, eGFR &lt; 15 ml/min/1.73 m2 and initiation of kidney replacement therapy; the individual components of the CKE; and combined major adverse cardiac events (MACE), including nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. The associations between the incidence of CKE and baseline factors, including demographics, laboratory values and comorbidities were analyzed using the Cox proportional hazards regression model. Results The mean age at baseline of IgAN patients was 51.6 years (± 13.6) and 67% were male. Patient-reported duration of disease at baseline was 5.9 ± 8.1 years. Baseline median UACR was 0.4 g/g (0.1–0.8) and mean eGFR was 52.5 ± 22.4 mL/min/1.73m2. Over a follow-up of 6.5 years, 64 (15.2%) experienced &gt; 40% eGFR decline, 3 (0.7%) reached eGFR &lt; 15 ml/min and 53 (12.6%) initiated kidney replacement therapy and 28% of the patients experienced the CKE. Albuminuria, with reference to &lt; 0.1 g/g was most associated with CKE. Hazard ratios (95% CI) at UACR 0.1–0.6 g/g, 0.6–1.4 g/g, 1.4–2.2 g/g and &gt; 2.2 g/g were 2.03 (1.02–4.05), 3.8 (1.92–7.5), 5.64 (2.58–12.33) and 5.02 (2.29–11-03), respectively. Regarding MACE, the presence of diabetes (HR = 2.53, 95% CI 1.11–5.78) was the most strongly associated factor, whereas UACR and eGFR did not show significant associations. Conclusion In the GCKD IgAN sub-cohort more than every fourth patient experienced a CKE event within 6.5 years. Our findings support the use of albuminuria as a surrogate to assess the risk of poor kidney outcomes.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"54 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141778765","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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