International Journal of Nephrology最新文献

Aim: Anaemia is a prevalent complication in patients with end-stage kidney disease (ESKD), significantly impacting morbidity and mortality. Desidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, offers an alternative to erythropoiesis-stimulating agents for managing anaemia. This study aims to assess the response of haemoglobin and safety and efficacy of desidustat in ESKD patients.

Methods: This prospective observational study evaluated the efficacy and safety of desidustat in 50 ESKD patients on maintenance haemodialysis. Patients received 100 mg oral desidustat thrice weekly for 6 months, with regular monitoring of haemoglobin, iron profiles, lipid profiles, and adverse effects.

Results: This study demonstrated a 76% response rate to desidustat, with a mean haemoglobin rise of 0.82 g/dL (9.56% increase) over 6 months. Notably, higher baseline serum iron and ferritin levels predicted greater responses. Additionally, desidustat reduced serum ferritin, TSAT, LDL, and total cholesterol levels without impacting blood pressure.

Conclusion: Desidustat demonstrated efficacy and safety in ESKD patients on haemodialysis, offering effective haemoglobin management and a favourable safety profile. These findings support desidustat as a viable treatment option for patients with anaemia, providing a valuable alternative to existing therapies.

Sarcopenia, characterized by the progressive decline in muscle mass and function, is an important complication among patients undergoing peritoneal dialysis (PD). Despite its prevalence, there is a notable lack of comprehensive research focused on early diagnosis or treatment target for sarcopenia in PD patients. This review explores the pathophysiology of sarcopenia and examines the potential role of various biomarkers related to muscle mass and function. These markers include myokines (cytokines produced by skeletal muscle) such as myostatin, follistatin, activin A, growth differentiation factor 15 (GDF-15), and irisin, as well as adiponectin, leptin, insulin-like growth factor-1 (IGF-1), vitamin D, myoglobin, and cortisol. These markers hold promise for early diagnosis and as therapeutic targets for managing sarcopenia. By reviewing the current literature in this area, we aim to identify directions for further research on diagnostic strategies and therapeutic options for sarcopenic PD patients.

Background and objective: Cisplatin-induced acute kidney injury (C-AKI) is detrimental to adequate cancer treatment. While scoring systems to predict C-AKI are available, they do not account for the impact of concomitant medications. This study aimed to enhance the predictive model by incorporating concomitant medications as a new predictor.

Methods: We included data from 1785 patients who received cisplatin at Iwate Medical University Hospital between April 2014 and March 2023. Initially, we assessed the performance of the existing model in our cohort. We then explored additional predictors to improve their discriminatory ability guided by the Akaike information criterion. Candidates for new predictors were concomitant anticancer and supportive care medications that were previously unexamined. Finally, we assessed the statistical usefulness of the updated model using the C-statistic and its clinical usefulness using net reclassification improvement (NRI) and decision curve analysis (DCA).

Results: The discriminatory power of the existing model was poor, with a C-statistics of 0.621 (95% confidence interval [CI]: 0.582-0.660). Incorporating magnesium supplementation as a novel predictor significantly improved the model's performance, increasing the C-statistic to 0.695 (95% CI: 0.660-0.731). The updated model demonstrated a superior NRI of 0.143 (95% CI: 0.043-0.243). In the DCA, the updated model yielded higher net benefits for most threshold probabilities.

Conclusion: The existing model did not demonstrate satisfactory clinical performance in our cohort. While incorporating magnesium supplementation significantly improved model discrimination, its status as standard care limits its utility as a predictive variable. These findings underscore the necessity of developing C-AKI prediction models within cohorts receiving uniform, contemporary supportive care regimens.

Background: Anemia is a frequent complication in patients with chronic kidney disease (CKD), with the incidence rising in stages 3-5. Iron deficiency and defective erythropoiesis are the major causes. Still, the role of iron status and the stimulating capability of ESAs on the progression of CKD have hardly been evaluated. Objective: To assess the effect of iron deficiency and ESA therapy with respect to the correction of anemia and preservation of kidney function in patients with CKD stages 3-5. Methods: A follow-up observational study was carried out in 120 CKD patients at nephrology department in a tertiary institution, from January 2023 to December 2024. The patients were classified into three groups: Group 1 and Group 3 considered iron-deficient, with no ESA and ESA therapy, respectively, while Group 2 was non-iron-deficient with no ESA. The parameters tested were hemoglobin levels, serum ferritin, transferrin saturation (TSAT), and estimated glomerular filtration rate (eGFR) at baseline and at 6 months after treatment. The ESA treatment given consisted of epoetin alfa or darbepoetin alfa, with iron supplementation given according to iron-deficiency status. Results: Baseline hemoglobin levels were significantly lower in Group 1 (9.5 ± 1.2 g/dL), and these subjects were associated with a faster decline of eGFR by value per year (annual decline in eGFR: 3.5 ± 2.3 mL/min/1.73 m²) compared to Groups 2 and 3 (p < 0.01). The ESA-treated group (Group 3) exhibited relatively the greatest improvement in hemoglobin level (to 12.3 ± 1.5 g/dL) and the slowest decline in kidney function (1.7 ± 1.2 mL/min/1.73 m²). Iron supplementation produced greater changes in ferritin and TSAT. Conclusion: Iron deficiency is a paramount modifiable driver of anemia and CKD progression. ESA treatment improves anemia and retards renal deterioration, especially when coupled with iron supplementation. Early detection and correction of anemia might merit interplay in pursuit of optimized CKD outcomes.

Objective: The relationship between different types of vascular access in maintenance hemodialysis (MHD) patients and patient prognosis is controversial. The vascular access of patients from various dialysis centers in Wuhan was summarized, and its relationship with prognosis was analyzed. Methods: The characteristics of MHD patients treated at 70 dialysis centers in the Wuhan Hemodialysis Quality Control System from 2017 to 2023 were collected. The demographic characteristics, laboratory indicators, compliance rates with laboratory indicators, annual mortality changes, survival time, and risk of death were compared in patients with various types of vascular access. Results: A total of 45,830 MHD patients were included in the study. Overall, arteriovenous fistulas (AVFs) and tunneled and cuffed catheters (TCCs) remain the most common types of vascular access. Non-tunneled and cuffed catheters (NCC) use decreases annually, whereas arteriovenous graft (AVG) use increases annually. Male patients mostly had AVFs. The vascular access types of patients with diabetic nephropathy were mainly TCCs (28.6%) and AVGs (29.4%). AVG patients had the highest average hemoglobin level. NCC patients had the lowest average hemoglobin, albumin, and potassium levels. AVF patients had the highest average albumin, potassium, calcium, phosphorus, and parathyroid hormone levels. TCC patients had the lowest calcium and phosphorus levels. From 2017 to 2023, the mortality rates of AVF, TCC, and AVG patients were significantly higher in 2022 (11%, 19.9%, and 11.7%, respectively). The median survival time of AVF patients was 4.92 (2.75, 7.75) years, which was significantly longer than that of TCC patients (2.83 [1.42, 4.92]) and NCC patients (1.00 [0.25, 2.25]). After multivariate adjustment, the risk of death in patients with internal fistulas was 50.6% lower than that in patients with catheters, according to the Cox regression analysis model (hazard ratio = 0.494, 95% CI: 0.439-0.556, p < 0.001). Conclusions: Among MHD patients with different vascular access types who were treated in Wuhan from 2017 to 2023, the numbers of AVF, AVG, and TCC patients increased with increasing overall number of MHD patients, whereas the number of NCC patients decreased. The overall condition and survival time of AVF patients were significantly better than those of MHD patients with other vascular access types, and the risk of death was lower.

Eucommia ulmoides (Tochu) has been shown to possess a variety of beneficial effects on profiles affecting the onset of lifestyle- or aging-related diseases, such as hypertension, diabetes, dyslipidemia, or obesity. This exploratory single-arm clinical study was conducted on a total of 17 participants including those with mild chronic kidney disease (CKD) (n = 9), who were administered a tablet product containing Tochu leaf extract for a short period (median: 33 days), to investigate its effects on blood pressure or related clinical markers. Mean systolic blood pressure (SBP) of all the participants significantly decreased from 128.3 ± 12.3 mmHg at the start to 123.8 ± 10.2 mmHg at the end of the administration (p < 0.05). Analysis of CKD patients alone, however, revealed that SBP, to a greater extent, decreased from 130.7 ± 12.9 mmHg to 121.2 ± 10.7 mmHg (p < 0.01), while the change in non-CKD patients was not significant. Furthermore, SBP decrease in CKD patients with hypertension (n = 7) alone was also significant and comparable. Mean blood oxidative stress index of all participants was decreased from 300.2 ± 76.7 U.CARR to 285.9 ± 63.0 U.CARR (p < 0.05), while median atrial natriuretic peptide (ANP) of all the participants was increased from 8.1 (5.0-9.6) pg/mL to 8.8 (5.8-12.1) pg/mL (p < 0.05). Our findings suggested that Tochu-derived components may have potential therapeutic benefit at earlier stages in CKD, which could fill the gaps in currently underserved opportunities for prevention or intervention. Trial Registration: UMIN Clinical Trials Registry: UMIN000050727.

Introduction: Acute interstitial nephritis (AIN) is a major cause of acute kidney injury, commonly triggered by medications or infections. Although glucocorticoid (GC) therapy is recommended for patients who do not improve after removing the suspected cause, the evidence supporting its use remains limited. Materials and Methods: This retrospective cohort study was conducted at the Pathology Unit of the University of Antioquia-San Vicente Fundación Hospital in Medellín, Colombia, reviewing patients aged 14 and older with biopsy-proven AIN over an 11-year period. Two groups were formed based on whether or not they received GC treatment. Key outcomes included changes in delta creatinine (serum creatinine change from peak to 6-month follow-up) and the need for permanent kidney replacement therapy. Linear regression analyses assessed factors influencing delta creatinine at 6 months, adjusting for age, clinical severity, time to GC initiation, and histological findings. Results: Of 139 eligible patients, 101 received GC therapy. The GC-treated group showed a significantly greater reduction in delta creatinine compared to the nontreated group (-2.3 mg/dL; 95% CI, -3.6 to -1.1, p < 0.001). Multivariate analysis identified GC therapy as an independent predictor of improved kidney function (delta creatinine reduction: -1.47 mg/dL; 95% CI, -2.68 to -0.27, p=0.017), particularly when initiated within 7 days of diagnosis. The GC-treated group also had a lower incidence of permanent dialysis dependence (54% at admission vs. 11% at 6 months). Adverse events occurred in 20.1% of the cohort, with a higher frequency in the GC group (p=0.076). Conclusion: GC therapy may improve kidney outcomes in patients with biopsy-proven AIN, especially when initiated early. These results support the need for prospective studies to further evaluate its efficacy in AIN management.

Background: Acute kidney injury (AKI) is a common postoperative event. Previous research suggests that intraoperative hypotension (IOH) is associated with postoperative AKI. This connection, however, has not been studied in patients undergoing pancreaticoduodenectomy. Methods: Based on a retrospective cohort study, we analyzed 844 adult patients who had pancreaticoduodenectomy between December 2016 and June 2020 in Henan Provincial People's Hospital. We graphically modeled the associations between the lowest intraoperative systolic and diastolic pressure and AKI using a restricted cubic spline with all covariates adjusted. The association between time under the above-specified systolic blood pressure (SPB) and diastolic blood pressure (DBP) thresholds and AKI, respectively, was investigated using logistic regression models. We further tested the robustness of our findings with a sensitivity analysis. Results: AKI occurred in 98 (11.6%) of the 844 patients in this cohort. Blood pressure components below the thresholds of 100 mmHg for systolic and 60 mmHg for diastolic were visual change points associated with increasing odds of AKI. The median (IQR) time under SBP < 100 mmHg was 15.0 (0, 40) min and 65.0 (18.8, 105.4) min for DBP < 60 mmHg. Time spent under the threshold of SBP less than 100 mmHg and DBP less than 60 mmHg was not significantly associated with AKI. Conclusions: We found no relationship between IOH and postoperative AKI after pancreaticoduodenectomy. More research is needed to investigate the complex aspects influencing intraoperative blood management in order to lessen the occurrence of AKI.

Aim: This retrospective cohort study aims to evaluate the prognostic factors for progression of immunoglobulin A nephropathy (IgAN) to kidney failure (defined as the initiation of kidney replacement therapy or death) and all-cause mortality in an Australian population. Methods: We conducted a retrospective analysis of 363 individual patients with biopsy-proven IgAN over a 21-year period (2000-2020) in the Hunter Region of New South Wales. Demographic data, comorbidities, biopsy features and biochemical markers were collected for a minimum of 12 months following biopsy diagnosis. A multivariable analysis using Cox regression was performed to examine their association with renal progression. Results: A total of 104 patients met the inclusion criteria and were followed for a median of 72 months. The cohort had a mean age at presentation of 45 years, with a predominantly male population. Most patients presented with haematuria and non-nephrotic range proteinuria. We stratified patients into three risk categories: low risk, intermediate risk, and high risk. Twenty-eight patients (26.92%) developed kidney failure and 15 patients (14.4%) experienced a > 20 mL/min eGFR decline within the first 12 months. The multivariable analysis revealed the following key factors associated with kidney failure: additional renal pathology on biopsy (HR 3.90, 95% CI 1.63-9.29), proteinuria (HR 1.15, 95% CI 1.02-1.29) and moderate-severe interstitial fibrosis/tubular atrophy (T2) (HR 7.00, 95% CI 2.32-21.05). There were 17 deaths (16.3%) in the cohort, with a mean survival time of 167.8 months (95% CI 152.6-183.1). Conclusion: In contrast to earlier reports from Australia, our findings emphasise that the progression to kidney failure is not uncommon in IgAN. We identified several predictors of the renal progression that are consistent with the previous studies. This highlights the need for a change in clinical management, as IgAN should no longer be considered a benign condition.

Introduction: The experiences with preterm and low birth weight babies indicate a special vulnerability of their kidneys, since different kinds of noxae can evoke the termination of nephron formation. This leads to oligonephropathy, which is associated with serious consequences for health in the later stages of life. While the clinical aspects have been intensely investigated, only few pathological data point to the initial traces left by the noxae. Up to this date, only the reduction in the width of the nephrogenic zone (NZ) and the lack of here occurring basophilic S-shaped bodies were reported. Methods and Materials: The relationship between the arising nephron and its structural neighbors changes throughout the developmental progress. Locally, this determines the vertical width of the NZ reflected by the radial expansion of both the parenchyma and the interstitium. Since information about the origin, the site, and the involved structures is not available, the related microanatomical features were recorded. Results: The data reveal that the renal vesicles, comma-shaped bodies, and S-shaped bodies are unequally distributed in the NZ. Due to their progressive sizes, it has an influence on the local vertical width of the NZ. This parameter is registered as the distance between the inner side of the renal capsule and the proximal pole of the respective stage of the nephron anlage. The vertical width can be further subdivided: the constant height of the district of progenitor cell recruitment and the variable height of the area of nephron shaping. Exclusively here, the radial expansion of the shaping nephron stages can be noticed. It starts at the section border between the head and the conus of the related collecting duct ampulla by positioning the primitive renal vesicle. While the respective proximal pole stays mounted next to the connecting tubule of a previously developed nephron, the distal pole sticks between the head and the conus at the CD ampulla for linking the future connecting tubule. This causes that henceforth the medial aspect of the extending renal vesicle, comma-shaped body, or S-shaped body stages radially expands in close proximity to the elongating conus of the CD ampulla. Conclusion: Between the arising nephron stages and the elongating conus of the CD ampulla, a linked radial expansion occurs. This new finding is essential to identify the extent of targeting of noxae that subsequently leads to a reduction in the width of the NZ.