International Journal of Nephrology最新文献

Introduction: Acute kidney injury (AKI) and chronic kidney disease (CKD) are widely correlated. However, the risk factors associated with outcomes of AKI in CKD patients have not been widely studied to date.

Objectives: To identify factors associated with outcomes of death and need for kidney support therapy (KST) in patients with CKD who present with AKI during hospital stay.

Methods: Retrospective cohort conducted from July 2018 to June 2022 that included patients with CKD and superimposed AKI. Sociodemographic data related to CKD, AKI, and the progression of patients to outcomes as death and KST were collected. The results were discussed with a significance level of p < 0.05.

Results: A total of 327 patients were included. The patients had a mean age of 68.6 ± 11.4 years, the majority were men, and the most prevalent comorbidities were hypertension (81.7%) and cardiovascular disease (61.5%). The mean creatinine was 1.85 ± 0.74 mg/dL. The main etiology of CKD was undetermined (26.6%) and of AKI was septic (45.3%). Patients were hospitalized mainly for infectious or cardiovascular causes (22.3% each). Overall mortality was 29.1%, and the need for KST was 35.2%. In the intensive care unit (ICU), 73.2% required dialysis and 74.4% died, reaching 85.7% in those with KST. CKD staging was not associated with any of the primary outcomes. The risk factors for KST were obesity, ATN-ISS score, and creatinine elevation greater than three times the baseline. The risk factors for death were ATN-ISS score, undetermined CKD, septic AKI, ICU admission, and KST.

Conclusions: Mortality and need for KST in CKD patients admitted to the ICU and who develop AKI are high. Variables related to AKI were more relevant than those related to CKD for clinical outcomes.

Background: The goal of antiretroviral therapy will not be achieved without addressing Human Immunodeficiency Virus (HIV) comorbidities, including depression, hypertension, and nephrotoxicity among people living with HIV (PLWH). This study was conducted to assess the interaction effect of depression and hypertension on nephrotoxicity among PLWH.

Methods: The study employed a cross-sectional study design. Data were collected from May to June 2022. The main outcome was nephrotoxicity, while depression and hypertension were considered as exposure factors. Confounders were identified through the directed acyclic graph and were controlled using the propensity score matching procedure. We estimated the causal association from the interactions by using weighted logistic regression.

Results: The study involved 416 PLWH with ages ranging from 19 to 80 years (mean standard deviation was 49.32 ± 10.43 years). The majority (79.09%) of the participants involved were females. The prevalence of depression, hypertension, and nephrotoxicity was 21.87% (95% CI = 18.15-26.12), 36.30% (31.80-41.05), and 33.65% (29.26-38.35), respectively. Among participants with both depression and hypertension, analysis showed a substantial increase in the odds of nephrotoxicity. The proportion of the combined effect due to interaction was approximately 71% (63-77), and the excess risk due to interaction was positive (RERI = 1.87; 1.46-2.28). On the multiplicative scale, when both depression and hypertension are present, the risk of nephrotoxicity tripled (effect = 3.42; 2.70-4.14). Having depression raises the likelihood of nephrotoxicity by 55% (aOR = 1.55; 1.35-1.76) among PLWH with hypertension. Among PLWH with depression, the odds of nephrotoxicity increased by over twofold due to hypertension (aOR = 2.12; 1.83-2.42).

Conclusion: The presence of both depression and hypertension raises the likelihood of nephrotoxicity much more than either condition alone. The findings revealed a synergistic effect, highlighting the need for integrated care that addresses both mental health and cardiovascular risks in HIV treatment.

Background: Kidney transplant is acknowledged as the treatment of choice for end-stage renal disease (ESRD). This study reports on the outcome of pediatric renal transplant at a tertiary hospital in Abu Dhabi.

Methods: It is a retrospective study of all pediatric renal transplants performed at a single designated pediatric center between February 2010 and February 2024, including children aged 1-16 years.

Results: Sixty-nine (44% female) pediatric renal transplants were performed, 36 from living-related donors and 33 from deceased donors. The mean age at transplant and last follow-up were 9.8 ± 3.6 years and 13.8 ± 4.7 years, respectively. ESRD etiologies included congenital anomalies of the kidney and urinary tract (39%), nephronophthisis (19%), glomerulonephritis (13%), and other causes (29%). Thirteen (19%) children underwent a preemptive transplant, whereas 56 (81%) were on dialysis at transplant. Thirty-one (45%) children had graft rejection: 16 (23%) in the first year, 9 (13%) in years 2-5, and 6 (9%) thereafter. Donor-specific antibodies (DSAs) were detected in 19 (28%) children; 17 (25%) of those had graft rejection with anti-DR or anti-DQ alloantibodies. Fourteen children had DSA-negative graft rejection. Of those, eight had cell-mediated rejection, and six had mixed rejection. Predictors of rejection were positive DSA (p = < 0.0001) and two DR mismatches (p = 0.029); three graft losses occurred. The prevalence of EBV, CMV, and BKV infection in the first year was 43%, 39%, and 33%, respectively, falling to 38%, 18%, and 12% in the subsequent years. Thirty-four (49%) children had at least one episode of culture-positive urinary tract infection. The 1-year and 5-year patient survival rates were 100% and 96.6%, and the corresponding graft survival rates were 98.1% and 89.7%, respectively.

Conclusion: The outcome of pediatric kidney transplants in Abu Dhabi over 14 years shows patient and graft survival comparable to published data. Acute graft rejection remains a major challenge with the presence of DSA and biallelic HLA-DR mismatch as independent predictors for rejection. Optimizing donor selection, immunosuppression, and closer surveillance are vital.

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) encompasses a group of rare systemic autoimmune diseases characterized by inflammation of small- and medium-sized blood vessels. Despite the efficacy of immunosuppressive therapy in achieving disease remission, a significant proportion of patients experience relapses, underscoring the need for reliable biomarkers to monitor disease activity. This systematic literature review evaluates the potential of urinary and serum biomarkers (CD163, CD206, CD25, and MCP-1) to detect active AAV in adult patients.

Method: A comprehensive search on PubMed, Embase, and Cochrane databases identified relevant studies, which were screened and assessed for inclusion based on predefined criteria. Data extraction and quality appraisal were independently conducted using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2).

Results: A total of 20 studies evaluated biomarkers for their diagnostic accuracy in detecting AAV activity. Most articles were scored as moderate risk of bias, with low concerns regarding applicability. Urinary soluble CD163 shows promising diagnostic accuracy for active renal vasculitis, with sensitivity and specificity values ranging from 0.72 to 1 and 0.67 to 0.98, respectively. Serum soluble CD163 and CD206 demonstrated variable accuracy. Serum MCP-1 did not differ between patients in remission and patients with active disease, while urinary MCP-1 showed potential but with inconsistent results across studies. Serum soluble CD25 was significantly elevated in active disease. Some combinations of biomarkers improved diagnostic performance (usCD163 + usCD25 + ssCD25 and usCD163 + serum Calprotectin + hematuria).

Conclusion: In conclusion, while usCD163 individually appears to be the most reliable single biomarker for detecting active renal vasculitis in these studies, the heterogeneity of study designs and cutoff values across studies precludes definitive conclusions. Further research is necessary to standardize biomarker use, evaluate promising biomarker combinations, and improve the accuracy of activity monitoring both in renal and extrarenal AAV.

Background: Chronic kidney disease (CKD) is a significant global health concern. Patients in the last stage of CKD, also known as end stage kidney disease (ESKD), need to use one of the methods of renal replacement therapy including hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT). ESKD adversely affects physical and mental health, as well as overall quality of life. However, limited research has explored the association between these health burdens and treatment modalities in Iran.

Methods and materials: This cross-sectional study included 215 patients with ESKD undergoing HD (n = 66), PD (n = 70), and KT (n = 79) at treatment centers in Mashhad, Iran. A checklist of demographic information, quality of life questionnaire specific for kidney disease patients (Kidney Disease Quality of Life Short Form [KDQOL-SF], version 1.3), Hamilton depression and anxiety inventories, and the Cassidy inventory for problem-solving and social support were distributed among patients. A regression model was employed to adjust for potential confounders, and statistical analysis was conducted using SPSS 11.5.

Results: Kidney transplant recipients were younger than patients in the HD and PD groups and exhibited significantly higher mean scores in most domains of the KDQOL, both in general and specific domains. After adjusting for confounding variables such as age, transplant patients were found to have the highest quality of life scores in specific domains. Depression prevalence was high, ranging from 60% to 65% across all groups, with no significant intergroup differences. Anxiety prevalence ranged from 21% to 26%, also without significant differences. Social support was reported as high among ESKD patients (70%-82%) with no variation between treatment modalities.

Conclusion: KT was associated with better quality-of-life outcomes compared to HD and PD, highlighting the potential benefits of organ donation programs. Given the substantial burden of mental health issues among ESKD patients, early detection and intervention for depression and anxiety should be prioritized in both dialysis and transplant populations.

Background: Despite their fundamental role in managing volume overload, diuretic use in hemodialysis patients is inconsistent. This study aims to examine diuretic use, compare clinical outcomes between diuretic users and nonusers, and identify predictive factors among hemodialysis patients in Lebanon.

Method: This was a multicenter retrospective observational study. Patients' data were retrieved from eight large dialysis centers in Lebanon. Descriptive and bivariate analyses were performed, followed by multivariable logistic regression to examine the association of diuretic use with the sociodemographic, hemodialysis parameters, and clinical outcomes of patients.

Results: A total of 250 patients were included in the study. Diuretics were utilized among 38.4% of the patients, all of whom were on loop diuretics, primarily furosemide (71.3%). The mean furosemide equivalent dose was 153.56 ± 122.57 mg per day (range 20-500 mg). Only 28.7% and 16.1% were on furosemide equivalent doses of at least 250 mg and 320 mg per day, respectively. Diuretic users were more likely to have a residual kidney function (ORa = 23.189, 95% CI: 5.129-104.831, p < 0.001), a shorter dialysis vintage (ORa = 0.892, 95% CI: 0.472-0.958, p = 0.046), and a higher postdialysis systolic blood pressure (ORa = 13.760, 95% CI: 10.381-18.232, p = 0.026) compared to nonusers. Other hemodialysis parameters and clinical outcomes did not differ between diuretic users and nonusers. Furosemide equivalent doses of at least 250 mg per day were significantly associated with lower predialysis systolic blood pressure and dry weight, while doses of 320 mg and more per day were significantly associated with fewer intradialytic hypotension episodes, lower predialysis systolic blood pressure, dry weight, and interdialytic weight gain (all p < 0.05).

Conclusion: This study reveals suboptimal dosing despite a relatively high prevalence of utilization of diuretics among hemodialysis patients. Most hemodialysis parameters and clinical outcomes do not differ between diuretic users and nonusers. Higher diuretic doses are associated with improved clinical outcomes, emphasizing the need for further research to optimize dosing practices in this population.

Introduction: Chronic kidney disease (CKD) poses a major health burden globally and affects nearly 17% of the Indian population. Despite established risk factors such as diabetes and hypertension, significant interindividual variability suggests a genetic contribution to CKD susceptibility. This study explores genetic variants predisposing to CKD in the Indian population using a genomewide association approach.

Methods: A total of 90 patients with CKD and 90 healthy controls were genotyped using the Illumina Infinium Global Screening Array (640,000 markers). After stringent quality control, 5.7 million genetic markers were retained for analysis. Single-nucleotide polymorphisms (SNPs) were assessed using logistic regression including age, sex, and ten principal components as covariates. Variants meeting standard genomewide significance thresholds (p ≤ 5 × 10^-8) were considered significant.

Results: The study identified 87 SNP loci associated with CKD, of which two genes, MPP7 and MAD1L1, reached genomewide significance. Variants with extremely high odds ratios (e.g., MAD1L1 OR > 1000) were interpreted as possible methodological artifacts. SNPs in PDZK1IP1, ANO3, C3AR1, FTO, and CD70 demonstrated suggestive biomarker potential (OR < 10, p < 10^-4), warranting replication in larger cohorts. These findings provide new insights into genes involved in tubular integrity, immune activation, and metabolic regulation in CKD.

Conclusion: This genomewide analysis represents one of the first studies on CKD genetics in the Indian population. While the MPP7 variant emerges as a credible susceptibility locus, several other SNPs show promising biomarker potential. Larger, multiethnic studies and functional validation are needed to confirm their roles in CKD pathogenesis and therapeutic targeting.

Introduction: Chronic kidney disease (CKD) increasingly affects young adults in low-and middle-income countries, with significant social and economic consequences. In Tanzania, many patients begin dialysis during their most productive years, often disrupting employment and financial stability. This study aimed to examine employment patterns and dialysis-related work challenges among young adults on maintenance hemodialysis at Muhimbili National Hospital.

Methods: We conducted a hospital-based cross-sectional study at Muhimbili National Hospital from October to December 2024, involving adults aged 18-49 years on maintenance hemodialysis for at least three months. Data were collected using a structured questionnaire and supplemented with clinical records to assess sociodemographic, dialysis-related, employment, and transplant-related factors. Descriptive statistics were used to summarize the findings.

Results: We included 134 patients aged between 18 and 49 years, with a mean age of 35.8 years (SD: 8.9). A total of 58.3% were either employed or self-employed, with 44.9% reporting that they did not work on dialysis days. Among those working, 65.4% experienced changes in their work patterns due to treatment demands, and 42.4% worked fewer than 4 days per week. Among the unemployed participants (24.6%), more than half (57.6%) reported resigning from work due to dialysis-related challenges. Out-of-pocket payment for dialysis was common, reported by 52.3% of participants. Although awareness of kidney transplantation was high (92.5%), only 27.6% had previously pursued or were actively pursuing it, primarily hindered by the absence of a donor (48.3%), high cost (23.0%), or both (28.7%).

Conclusion: Young adults on maintenance hemodialysis in Tanzania face significant employment disruptions and limited access to kidney transplantation, highlighting the need for integrated interventions to support their social and economic well-being.

Introduction: Aortic calcification may be a vascular marker of health risk. Loss of elastic recoil due to arterial calcification results in hemodynamic changes that, in turn, can lead to damage to target organs, such as the kidneys. There are few studies analyzing the association between the presence of calcification in the thoracic aorta and chronic kidney disease (CKD).

Objective: To investigate the association between calcification of transthoracic aortic (TAC) and its segments and CKD in individuals living in the community without established cardiovascular disease and to verify whether arterial stiffness is a confounder of this relationship.

Methods: Cross-sectional study with 2427 participants from visit 2 of ELSA-Brasil, in Minas Gerais (2012-2015). TAC and its ascending (ATAC), aortic arch (AAC), and descending (DTAC) segments were categorized by the degree of calcification (0; greater than 0 and less than 100 HU; and greater than 100 HU). The presence of CKD was verified by glomerular filtration rate (eGFR CKDEPI) < 60 mL/min/1.73 m² and/or albumin/creatinine ratio ≥ 30 mg/g. The adjustment covariates were age, sex, race/color, schooling, smoking, cholesterol/HDL ratio, BMI, diabetes, hypertension, and pulse wave velocity (PWV). Logistic regression models were performed to analyze the associations. Statistical significance was defined as p < 0.05.

Results: After all adjustments, there was an association between DTAC and CKD in the group with the highest degree of calcification (OR: 2.66-1.05; 6.71). The inclusion of PWV in the final model slightly increased the magnitude of the association with DTAC (OR: 2.75; 1.07-7.05). No statistical association was found for TAC, ATAC, and AAC.

Conclusion: Greater degree of DTAC is positively associated with CKD, regardless of the level of arterial stiffening.

Tribulus terrestris has a long-standing historical legacy, having been used for centuries in the treatment of various kidney disorders and other health issues. This research aimed to evaluate the kidney-protective and antioxidant effects of different Tribulus terrestris extracts in ameliorating gentamicin-induced nephrotoxicity in Wistar albino rats. The study included nine rat groups of Wistar rats (n = 6 per group) treated for 14 days. The control group was given intraperitoneal injections of normal saline and dimethyl sulfoxide (DMSO). Group 2 received subcutaneous gentamicin injections at a dose of 100 mg/kg for eight days. Groups 3-5 were given an intraperitoneal ethanol extract of Tribulus terrestris (EETT) at 150, 300, and 450 mg/kg, respectively. Groups 6-8 received an intraperitoneal acetonitrile extract of Tribulus terrestris (AETT) at 150, 300, and 450 mg/kg, respectively. Group 9 was administered 200 mg/kg of intraperitoneal N-acetylcysteine. The results revealed that the EETT exhibited a protective effect against gentamicin-induced renal damage in Wistar albino rats. This protection was shown by reduced kidney tissue damage, lower MDA levels, and increased antioxidant enzyme levels, CAT, and GSH. Moreover, EETT administration dose-dependently improved renal histology, with full recovery observed at 450 mg/kg, whereas AETT showed no protective effect suggesting a potential dose-dependent effect. Additional studies are necessary to investigate how EETT's dose-response curve affects its ability to treat kidney damage induced by gentamicin in rats. Conversely, various doses of AETT failed to show a protective effect against gentamicin-induced nephrotoxicity.