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Hyperphosphatemia in Chronic Kidney Disease: The Search for New Treatment Paradigms and the Role of Tenapanor. 慢性肾病中的高磷血症:寻找新的治疗范例和特纳帕诺的作用。
IF 2 Q2 Medicine Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S385826
Valeria Cernaro, Elisa Longhitano, Chiara Casuscelli, Luigi Peritore, Domenico Santoro

Hyperphosphataemia represents a significant challenge in the management of chronic kidney disease, exerting a pronounced influence on the pathogenesis of cardiovascular complications and mineral bone disorders. Traditional approaches to address hyperphosphataemia involve implementing dietary phosphate restrictions, administering phosphate binders, and, in cases of end-stage renal disease, resorting to dialysis. Unfortunately, these interventions frequently prove inadequate in maintaining phosphate levels within recommended ranges. Additionally, commonly employed pharmacological agents are not immune to eliciting adverse events, thereby limiting their prescription and therapeutic adherence. There is a growing focus on exploring novel therapeutic strategies in this context. The current discussion centres on tenapanor, a pharmacological agent predominantly acting as a selective inhibitor of sodium/hydrogen exchanger isoform 3 (NHE3). Its mechanism of action involves modulating tight junctions, resulting in reduced sodium absorption and intestinal paracellular permeability to phosphate. Furthermore, tenapanor downregulates sodium-dependent phosphate 2b transport protein (NaPi2b) expression, thereby impeding active transcellular phosphate transport. Clinical trials have elucidated the efficacy and safety profile of tenapanor. This evidence hints at a potential paradigm shift in the management of hyperphosphataemia. However, the burgeoning optimism surrounding tenapanor warrants tempered enthusiasm, as further research remains indispensable. The imperative lies in meticulously delineating its efficacy and safety contours within the crucible of clinical practice. In this review, we synthesize the intricate interplay between hyperphosphataemia and Chronic Kidney Disease-Mineral Bone Disorder, and we discuss the existing pharmacological interventions for hyperphosphataemia and explore emerging treatment paradigms that offer novel perspectives in managing elevated phosphate levels in CKD patients.

高磷血症是慢性肾脏病治疗过程中的一项重大挑战,对心血管并发症和矿物质骨骼紊乱的发病机制有明显影响。解决高磷血症的传统方法包括限制饮食中的磷酸盐、使用磷酸盐结合剂,以及在终末期肾病患者中采用透析治疗。遗憾的是,这些干预措施往往不足以将磷酸盐水平维持在推荐范围内。此外,常用的药物也难免会引起不良反应,从而限制了处方和治疗的依从性。在这种情况下,人们越来越重视探索新型治疗策略。目前的讨论集中在替那潘诺上,这是一种主要作为钠/氢交换器同工酶 3(NHE3)选择性抑制剂的药剂。其作用机制包括调节紧密连接,从而减少钠的吸收和肠道旁细胞对磷酸盐的通透性。此外,替那帕诺还会下调钠依赖性磷酸盐 2b 转运蛋白(NaPi2b)的表达,从而阻碍磷酸盐的跨细胞转运。临床试验阐明了替那帕诺的疗效和安全性。这些证据表明,高磷血症的治疗模式有可能发生转变。然而,围绕替那帕诺的乐观情绪正在迅速升温,这需要适度的热情,因为进一步的研究仍然不可或缺。当务之急是在临床实践的严苛条件下仔细界定其疗效和安全性。在这篇综述中,我们总结了高磷血症与慢性肾脏病-矿物质骨病之间错综复杂的相互作用,讨论了现有的高磷血症药物干预措施,并探讨了新出现的治疗范例,这些范例为控制慢性肾脏病患者体内磷酸盐水平升高提供了新的视角。
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引用次数: 0
Anti-SARS-CoV-2 Spike Antibody Response to the Fourth Dose of BNT162b2 mRNA COVID-19 Vaccine and Associated Factors in Japanese Hemodialysis Patients. 日本血液透析患者对第四剂 BNT162b2 mRNA COVID-19 疫苗的抗 SARS-CoV-2 尖峰抗体反应及相关因素。
IF 2 Q2 Medicine Pub Date : 2024-05-17 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S452964
Keiji Hirai, Masako Shimotashiro, Toshiaki Okumura, Susumu Ookawara, Yoshiyuki Morishita

Background: We assessed the anti-SARS-CoV-2 spike antibody response to four doses of BNT162b2 mRNA COVID-19 vaccine in Japanese hemodialysis patients and determined factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose.

Methods: Fifty-one patients were enrolled in this single-center, prospective, longitudinal study. Change in anti-SARS-CoV-2 spike antibody titers between after the second and fourth doses were evaluated. Multiple linear regression analysis was used to identify factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose.

Results: The anti-SARS-CoV-2 spike antibody titer was higher 4 weeks after the fourth dose compared with 4 weeks after the third dose (30,000 [interquartile range (IQR), 14,000-56,000] vs 18,000 [IQR, 11,000-32,500] AU/mL, p<0.001) and 4 weeks after the second dose (vs 2896 [IQR, 1110-4358] AU/mL, p<0.001). Hypoxia-inducible factor prolyl hydroxylase inhibitor use (standard coefficient [β]=0.217, p=0.011), and the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.810, p<0.001) were correlated with the log-anti-SARS-CoV-2 spike antibody titer 4 weeks after the fourth dose, whereas only the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.677, p<0.001) was correlated with the log-anti-SARS-CoV-2 spike antibody titer 12 weeks after the fourth dose.

Conclusion: Hypoxia-inducible factor prolyl hydroxylase inhibitor use and the anti-SARS-CoV-2 spike antibody titer before the fourth dose were associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose in Japanese hemodialysis patients.

背景:我们评估了日本血液透析患者接种四剂 BNT162b2 mRNA COVID-19 疫苗后的抗 SARS-CoV-2 尖峰抗体反应,并确定了与第四剂后抗 SARS-CoV-2 尖峰抗体滴度相关的因素:这项单中心前瞻性纵向研究共纳入了 51 名患者。评估了第二次和第四次用药后抗 SARS-CoV-2 尖峰抗体滴度的变化。采用多元线性回归分析确定与第四剂后抗SARS-CoV-2尖峰抗体滴度相关的因素:结果:与第三剂后 4 周相比,第四剂后 4 周的抗 SARS-CoV-2 棘峰抗体滴度更高(30,000 [四分位数间距(IQR),14,000-56,000] vs 18,000 [四分位数间距(IQR),11,000-32,500] AU/mL,pConclusion):日本血液透析患者使用低氧诱导因子脯氨酰羟化酶抑制剂和第四次用药前的抗 SARS-CoV-2 棘峰抗体滴度与第四次用药后的抗 SARS-CoV-2 棘峰抗体滴度有关。
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引用次数: 0
Hospital-Acquired Acute Kidney Injury in Non-Critical Medical Patients in a Developing Country Tertiary Hospital: Incidence and Predictors. 发展中国家三级医院非危重内科病人的医院获得性急性肾损伤:发病率和预测因素。
IF 2 Q2 Medicine Pub Date : 2024-04-25 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S454987
Nahom Dessalegn Mekonnen, Tigist Workneh Leulseged, Buure Ayderuss Hassen, Kidus Haile Yemaneberhan, Helen Surafeal Berhe, Nebiat Adane Mera, Anteneh Abera Beyene, Lidiya Zenebe Getachew, Birukti Gebreyohannes Habtezgi, Feven Negasi Abriha

Background: Acute kidney injury (AKI) is a frequent complication in critical patients, leading to a worse prognosis. Although its consequences are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Therefore, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia.

Methods: A retrospective chart review study was conducted from September 25, 2022 to January 20, 2023 among 232 hospitalized non-critical medical patients admitted to St. Paul's Hospital Millennium Medical College between January 2020 and January 2022. The incidence of HAAKI was estimated using incidence density per total person day (PD) observation of the study participants. To identify predictors of HAAKI, a log binomial regression model was fitted at a p value of ≤0.05. The magnitude of association was measured using adjusted relative risk (ARR) with its 95% CI.

Results: During the median follow-up duration of 11 days (IQR, 6-19 days), the incidence of HAAKI was estimated to be 6.0 per 100 PD (95% CI = 5.5 to 7.2). Significant predictors of HAAKI were found to be having type 2 diabetes mellitus (ARR = 2.36, 95% CI = 1.03, 5.39, p-value=0.042), and taking vancomycin (ARR = 3.04, 95% CI = 1.38, 6.72, p-value=0.006) and proton pump inhibitors (ARR = 3.80, 95% CI = 1.34,10.82, p-value=0.012).

Conclusion: HAAKI is a common complication in hospitalized non-critical medical patients, and is associated with a common medical condition and commonly prescribed medications. Therefore, it is important to remain vigilant in the prevention and timely identification of these cases and to establish a system of rational prescribing habits.

背景:急性肾损伤(AKI)是危重病人的常见并发症,会导致预后恶化。虽然危重病人的后果更严重,但急性肾损伤也与非危重病人的不良预后有关。因此,了解这些患者的问题严重程度至关重要,但在非危重症环境中,尤其是在资源有限的国家,这方面的证据还很匮乏。因此,本研究旨在确定埃塞俄比亚一家大型三甲医院收治的非危重内科病人医院获得性急性肾损伤(HAAKI)的发病率和预测因素:2022 年 9 月 25 日至 2023 年 1 月 20 日,对圣保罗医院千禧医学院在 2020 年 1 月至 2022 年 1 月期间收治的 232 名住院非危重内科病人进行了回顾性病历研究。HAAKI 的发病率是根据对研究参与者的总人日(PD)观察的发病密度进行估算的。为确定 HAAKI 的预测因素,在 p 值≤0.05 时拟合了对数二项式回归模型。相关性的大小用调整后相对风险(ARR)及其 95% CI 来衡量:结果:在中位 11 天(IQR,6-19 天)的随访时间内,HAAKI 的发生率估计为每 100 个 PD 6.0 例(95% CI = 5.5-7.2 例)。HAKI的重要预测因素包括:2型糖尿病(ARR = 2.36,95% CI = 1.03,5.39,P值=0.042)、服用万古霉素(ARR = 3.04,95% CI = 1.38,6.72,P值=0.006)和质子泵抑制剂(ARR = 3.80,95% CI = 1.34,10.82,P值=0.012):HAAKI 是住院非危重病人的常见并发症,与常见的病情和常用药物有关。因此,必须保持警惕,预防和及时发现这些病例,并建立合理用药习惯制度。
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引用次数: 0
Acute Kidney Injury Prediction Model Using Cystatin-C, Beta-2 Microglobulin, and Neutrophil Gelatinase-Associated Lipocalin Biomarker in Sepsis Patients. 利用胱抑素-C、β-2 微球蛋白和中性粒细胞明胶酶相关脂质体生物标记物的脓毒症患者急性肾损伤预测模型
IF 2 Q2 Medicine Pub Date : 2024-03-28 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S450901
Hani Susianti, Aswoco Andyk Asmoro, Sujarwoto, Wiwi Jaya, Heri Sutanto, Amanda Yuanita Kusdijanto, Kevin Putro Kuwoyo, Kristian Hananto, Matthew Brian Khrisna

Introduction: AKI is a frequent complication in sepsis patients and is estimated to occur in almost half of patients with severe sepsis. However, there is currently no effective therapy for AKI in sepsis. Therefore, the therapeutic approach is focused on prevention. Based on this, there is an opportunity to examine a panel of biomarker models for predicting AKI.

Material and methods: This prospective cohort study analysed the differences in Cystatin C, Beta-2 Microglobulin, and NGAL levels in sepsis patients with AKI and sepsis patients without AKI. The biomarker modelling of AKI prediction was done using machine learning, namely Orange Data Mining. In this study, 130 samples were analysed by machine learning. The parameters used to obtain the biomarker panel were 23 laboratory examination parameters.

Results: This study used SVM and the Naïve Bayes model of machine learning. The SVM model's sensitivity, specificity, NPV, and PPV were 50%, 94.4%, 71.4%, and 87.5%, respectively. For the Naïve Bayes model, the sensitivity, specificity, NPV, and PPV were 83.3%, 77.8%, 87.5%, and 71.4%, respectively.

Discussion: This study's SVM machine learning model has higher AUC and specificity but lower sensitivity. The Naïve Bayes model had better sensitivity; it can be used to predict AKI in sepsis patients.

Conclusion: The Naïve Bayes machine learning model in this study is useful for predicting AKI in sepsis patients.

导言:AKI 是败血症患者经常出现的一种并发症,据估计,几乎一半的严重败血症患者都会出现 AKI。然而,目前还没有治疗脓毒症急性肾损伤的有效方法。因此,治疗方法的重点在于预防。在此基础上,我们有机会研究一组用于预测 AKI 的生物标志物模型:这项前瞻性队列研究分析了有 AKI 的脓毒症患者和无 AKI 的脓毒症患者胱抑素 C、β-2 微球蛋白和 NGAL 水平的差异。预测 AKI 的生物标志物建模是通过机器学习(即 Orange 数据挖掘)完成的。在这项研究中,机器学习分析了 130 个样本。用于获得生物标志物面板的参数是 23 项实验室检查参数:本研究使用了 SVM 和奈夫贝叶斯机器学习模型。SVM 模型的灵敏度、特异性、NPV 和 PPV 分别为 50%、94.4%、71.4% 和 87.5%。Naïve Bayes 模型的灵敏度、特异性、NPV 和 PPV 分别为 83.3%、77.8%、87.5% 和 71.4%:本研究的 SVM 机器学习模型具有较高的 AUC 和特异性,但灵敏度较低。讨论:本研究的 SVM 机器学习模型具有较高的 AUC 和特异性,但灵敏度较低,而 Naïve Bayes 模型的灵敏度较高,可用于预测脓毒症患者的 AKI:结论:本研究中的奈伊夫贝叶斯机器学习模型可用于预测脓毒症患者的 AKI。
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引用次数: 0
Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis. 推进以人为本的护理,满足当代慢性透析未满足的需求。
IF 2 Q2 Medicine Pub Date : 2024-03-20 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S387598
Sumedh Jayanti, Gopala K Rangan

Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.

过去三十年来,慢性透析治疗肾衰竭的进展停滞不前,50% 以上的患者仍在接受传统的院内血液透析治疗。与此同时,慢性透析医疗护理的需求也在不断变化和发展,这是因为越来越多的人体弱多病。因此,肾衰竭患者的需求与提供有效整体管理的医疗保健能力之间的差距越来越大。为解决这一问题,医疗保健政策越来越倾向于以人为本的方法。以人为本的模式转变将患者置于决策过程的最前沿,确保患者的具体需求得到理解并被优先考虑。事实证明,将以人为本的方法与患者护理相结合,可以提高满意度和生活质量。本叙述旨在评估透析服务提供者目前在管理肾衰竭方面所面临的临床挑战;总结慢性透析患者目前的经验和未满足的需求;最后强调以人为本的护理是如何推进慢性透析护理的。具体的渐进式进展包括肾脏支持护理的实施、家庭辅助透析、混合透析、透析方法的改进;而新兴进展包括便携式和可穿戴透析设备以及将人工智能融入临床实践的潜力。
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引用次数: 0
Post-Transplant Glomerulonephritis: Challenges and Solutions. 移植后肾小球肾炎:挑战与解决方案。
IF 2 Q2 Medicine Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S391779
Marcos Vinicius de Sousa

Glomeruli can be damaged in several conditions after kidney transplantation, with a potential impact on the graft function and survival. Primary glomerulonephritis, a group of glomerular immunological damage that results in variable histological patterns and clinical phenotypes, can occur in kidney transplant recipients as a recurrent or de novo condition. Specific immunologic conditions associated with kidney transplantation, such as acute rejection episodes, can act as an additional trigger after transplantation, impacting the incidence of these glomerulopathies. The post-transplant GN recurrence ranges from 3% to 15%, varying according to the GN subtype and post-transplant time, mainly occurring after 3-5 years of kidney transplantation. Advances in the knowledge of glomerulonephritis pathophysiology have provided new approaches to pre-transplant risk evaluation and post-transplant monitoring. Glomeruli can be affected by several systemic viral infections, such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), cytomegalovirus (CMV), and BK virus. The diagnosis of these infections, as well as the identification of possible complications associated with them, are important to minimize the negative impacts of these conditions on kidney transplant recipients' outcomes.

肾移植后,肾小球可能会在多种情况下受损,从而对移植肾的功能和存活造成潜在影响。原发性肾小球肾炎是一组肾小球免疫损伤,可导致不同的组织学模式和临床表型,可作为复发性或新发病症出现在肾移植受者身上。与肾移植相关的特定免疫条件,如急性排斥反应,可作为肾移植后的额外诱因,影响这些肾小球疾病的发病率。移植后 GN 复发率为 3% 至 15%,因 GN 亚型和移植后时间而异,主要发生在肾移植 3-5 年后。肾小球肾炎病理生理学知识的进步为移植前风险评估和移植后监测提供了新方法。肾小球可能受到多种全身性病毒感染的影响,如人类免疫缺陷病毒(HIV)、丙型肝炎病毒(HCV)、乙型肝炎病毒(HBV)、严重急性呼吸系统综合征冠状病毒 2(SARS-COV-2)、巨细胞病毒(CMV)和 BK 病毒。这些感染的诊断以及与之相关的可能并发症的识别对于最大限度地减少这些疾病对肾移植受者预后的负面影响非常重要。
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引用次数: 0
The Associations Between Abdominal Obesity and Coronary Artery Calcification in Chronic Kidney Disease Population. 慢性肾脏病人群腹部肥胖与冠状动脉钙化之间的关系
IF 2 Q2 Medicine Pub Date : 2024-02-01 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S446445
Peng-Tzu Liu, Jong-Dar Chen

Background: Cardiovascular disease (CVD) is the primary cause of mortality in chronic kidney disease (CKD) patients, with metabolic disorders exacerbating this risk. Compared with body mass index, waist circumference (WC) has been proposed as a more effective indicator of abnormal visceral fat. However, the associations among CKD, abnormal WC, and CVD remain understudied.

Material and methods: A cross-sectional study in Taiwan (July 2006 to May 2016) involved 10,342 participants undergoing self-paid health checkups at a single medical center. Physical examinations and blood samples were taken to assess metabolic parameters, and renal function was evaluated using the Chronic Kidney Disease Epidemiology Collaboration formula. Coronary artery calcification (CAC) scores were determined through coronary 256-slice multidetector computed tomography angiography, with a CAC score of >0 Agatston unit (AU) and ≥ 400 AU denoting positive CAC and severe CAC, respectively.

Results: Sex-based comparisons were conducted between individuals with CKD and those without CKD. In the CKD group, both sexes exhibited significantly elevated levels for systolic blood pressure, serum fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) as well as reduced serum high-density lipoprotein cholesterol. Examination of the associations of abnormal WC revealed that for both sexes, individuals with abdominal obesity (AO) were significantly older and had higher systolic/diastolic blood pressure, serum FBG, HbA1c, and lipid profiles compared with those without AO. Multiple logistic regression analysis revealed that CKD patients exhibited a more pronounced association with severe CAC scores compared with AO patients (odds ratios [ORs]: 2.7 and 1.4, respectively). Furthermore, the combined effects of AO and CKD (AO[+]/CKD[+]) resulted in increased risks of positive CAC (OR: 2.4, 95% confidence interval [CI]: 1.6-3.5) and severe CAC (OR: 4.4, 95% CI: 1.4-14.2).

Conclusion: Abdominal obesity significantly raised the odds of CAC and was associated to a 4.4-fold increased risk of severe CAC in CKD patients.

背景:心血管疾病(CVD)是慢性肾脏病(CKD)患者死亡的主要原因,而代谢紊乱会加剧这一风险。与体重指数相比,腰围(WC)被认为是内脏脂肪异常的更有效指标。然而,对慢性肾脏病、异常腰围和心血管疾病之间的关联研究仍然不足:一项在台湾进行的横断面研究(2006 年 7 月至 2016 年 5 月)涉及在一家医疗中心进行自费健康检查的 10342 名参与者。研究人员进行了体格检查和血液样本采集,以评估代谢参数,并使用慢性肾脏病流行病学协作公式评估了肾功能。冠状动脉钙化(CAC)评分是通过冠状动脉256切片多载体计算机断层扫描血管造影术确定的,CAC评分大于0阿加斯顿单位(AU)和≥400 AU分别表示阳性CAC和严重CAC:对患有慢性肾脏病和未患有慢性肾脏病的人进行了基于性别的比较。在 CKD 组中,男女收缩压、血清空腹血糖 (FBG) 和血红蛋白 A1c (HbA1c) 水平均显著升高,血清高密度脂蛋白胆固醇水平降低。对异常腹围相关性的研究显示,与无腹围异常的人相比,男女腹型肥胖(AO)者的年龄明显偏大,收缩压/舒张压、血清 FBG、HbA1c 和血脂谱也更高。多元逻辑回归分析显示,与 AO 患者相比,CKD 患者与严重 CAC 评分的关系更为明显(几率比 [ORs] 分别为 2.7 和 1.4)。此外,腹部肥胖和慢性肾脏病(腹部肥胖[+]/慢性肾脏病[+])的综合影响导致 CAC 阳性(OR:2.4,95% 置信区间[CI]:1.6-3.5)和严重 CAC(OR:4.4,95% 置信区间:1.4-14.2)的风险增加:结论:腹部肥胖明显增加了 CKD 患者罹患 CAC 的几率,并且与严重 CAC 风险增加 4.4 倍有关。
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引用次数: 0
Association of Mitochondrial Pyruvate Carrier with the Clinical and Histological Features in Lupus Nephritis. 线粒体丙酮酸载体与狼疮性肾炎临床和组织学特征的关系
IF 2.1 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-01-19 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S443519
Huanhuan Zhu, Chen Chen, Luhan Geng, Qing Li, Chengning Zhang, Lin Wu, Bo Zhang, Suyan Duan, Changying Xing, Yanggang Yuan

Background: Mounting evidence suggests that mitochondrial dysfunction contributes to lupus nephritis (LN) pathogenesis. Mitochondrial pyruvate carrier 1 (MPC1) and mitochondrial pyruvate carrier 2 (MPC2) mediating pyruvate transport from the cytoplasm to the mitochondrial matrix, determines the cell survival and cellular energy supply. Here, we aimed to investigate the association of mitochondrial pyruvate carrier expression with the clinical and histological features in LN.

Methods: Patients with biopsy-proven proliferative LN (class III and class IV, n=18) and membranous LN (class V, n=18) were included. Expression of MPC1 and MPC2 were examined by immunohistochemistry. MPC protein levels in the two groups were evaluated by the Student's t-test. Correlation analysis between MPC levels and clinicopathological features was performed by Spearman's rank correlation.

Results: Both MPC1 and MPC2 were exclusively expressed in renal tubules of enrolled LN. Significantly lower MPC1 and MPC2 were observed in patients with proliferative LN compared to membranous LN. In addition, the MPC1 and MPC2 were negatively correlated with SLEDAI-2K score, renal function, and renal pathology activity index.

Conclusion: Both MPC1 and MPC2 were localized in renal tubules, and decreased MPC content was more pronounced in proliferative LN than membranous LN. MPC levels were significantly correlated with renal functions and renal pathology activity.

背景:越来越多的证据表明,线粒体功能障碍是狼疮性肾炎(LN)的发病机制之一。线粒体丙酮酸载体 1(MPC1)和线粒体丙酮酸载体 2(MPC2)介导丙酮酸从细胞质向线粒体基质的转运,决定着细胞的存活和能量供应。在此,我们旨在研究线粒体丙酮酸载体的表达与 LN 的临床和组织学特征之间的关联:方法:纳入活检证实的增生性 LN(III 级和 IV 级,18 人)和膜性 LN(V 级,18 人)患者。通过免疫组化检查MPC1和MPC2的表达。两组的 MPC 蛋白水平采用学生 t 检验。MPC水平与临床病理特征之间的相关性分析采用Spearman秩相关法进行:结果:MPC1和MPC2均只在入组LN的肾小管中表达。与膜状 LN 相比,增生性 LN 患者的 MPC1 和 MPC2 水平明显较低。此外,MPC1和MPC2与SLEDAI-2K评分、肾功能和肾脏病理活动指数呈负相关:结论:MPC1和MPC2都定位于肾小管,增殖性LN的MPC含量下降比膜性LN更明显。MPC水平与肾功能和肾病变活动度有明显相关性。
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引用次数: 0
Impact of Sodium-Glucose Cotransporter-2 Inhibitors in the Management of Chronic Kidney Disease: A Middle East and Africa Perspective. 钠-葡萄糖共转运体-2 抑制剂在慢性肾病治疗中的影响:中东和非洲视角》。
IF 2 Q2 Medicine Pub Date : 2024-01-03 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S430532
Ahmed Fathi Elkeraie, Saeed Al-Ghamdi, Ali K Abu-Alfa, Torki Alotaibi, Ali Jasim AlSaedi, Abdulkareem AlSuwaida, Mustafa Arici, Tevfik Ecder, Mohammad Ghnaimat, Mohamed Hany Hafez, Mohamed H Hassan, Tarik Sqalli

Chronic kidney disease (CKD) is a major public health concern in the Middle East and Africa (MEA) region and a leading cause of death in patients with type 2 diabetes mellitus (T2DM) and hypertension. Early initiation of sodium-glucose cotransporter - 2 inhibitors (SGLT-2i) and proper sequencing with renin-angiotensin-aldosterone system inhibitors (RAASi) in these patients may result in better clinical outcomes due to their cardioprotective properties and complementary mechanisms of action. In this review, we present guideline-based consensus recommendations by experts from the MEA region, as practical algorithms for screening, early detection, nephrology referral, and treatment pathways for CKD management in patients with hypertension and diabetes mellitus. This study will help physicians take timely and appropriate actions to provide better care to patients with CKD or those at high risk of CKD.

慢性肾脏病(CKD)是中东和非洲地区(MEA)的主要公共卫生问题,也是 2 型糖尿病(T2DM)和高血压患者的主要死因。由于钠-葡萄糖共转运体-2 抑制剂(SGLT-2i)具有保护心脏的特性和互补的作用机制,因此在这些患者中尽早开始使用钠-葡萄糖共转运体-2 抑制剂(SGLT-2i)并与肾素-血管紧张素-醛固酮系统抑制剂(RAASi)进行适当的排序可能会带来更好的临床疗效。在本综述中,我们介绍了中东欧地区专家基于指南的共识建议,作为高血压和糖尿病患者慢性肾脏病管理的筛查、早期检测、肾脏病转诊和治疗路径的实用算法。这项研究将帮助医生及时采取适当行动,为慢性肾脏病患者或慢性肾脏病高危人群提供更好的护理。
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引用次数: 0
Effect of Executive Function on Health-Related Quality of Life in Children with Chronic Kidney Disease 执行功能对慢性肾病儿童健康相关生活质量的影响
IF 2 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.2147/IJNRD.S428657
Elrika Wijaya, P. Solek, Dedi Rachmadi, Sri E Rahayuningsih, Rodman Tarigan, D. Hilmanto
Introduction As the highest function in the brain that regulates our daily activity, executive dysfunction might affect someone’s health-related quality of life (HRQoL), especially in those with chronic diseases, including chronic kidney disease (CKD). Neurocognitive functions, including intelligence quotient (IQ) and executive function can be affected through various mechanisms in CKD. However, there was still no specific study regarding how IQ and executive function might affect HRQoL in children with CKD. Purpose To assess Executive Function’s impact on HRQoL and to find association between treatment modalities and CKD stages with HRQoL in children with CKD. Methods A cross sectional study was conducted at Pediatric Nephrology Clinic at Hasan Sadikin General Hospital, Bandung, Indonesia from September 2022 to April 2023. We included 38 children whose age range were 6–16 years 11 months old with CKD stage III – V. Assessment tools used were: BRIEF questionnaire for executive function; WISC III tool for IQ; PedsQLTM questionnaire generic module for HRQoL. Data was analyzed using SPSS ver. 26.0. Results Total number of samples was 38. Complete examinations were done on 30 patients. Eight other patients did not undergo the IQ test. There was a negative correlation between executive function components scores (GEC, BRI, MI) with HRQoL scores on parents’ proxy in all domains. We found no correlation between HRQoL and IQ scores, but we found a correlation between IQ and CKD stage. There was a significant difference in HRQoL from the children’s perspective among the three modalities; children who underwent conservative treatment were having the best HRQoL scores. Conclusion Interventions to improve executive function of children with CKD should be done to improve their HRQoL in the future. Early diagnosis and treatment of CKD should be done at the earliest to improve neurocognitive function and HRQoL.
导言 作为大脑中调节日常活动的最高功能,执行功能障碍可能会影响人们与健康相关的生活质量(HRQoL),尤其是慢性疾病患者,包括慢性肾脏病(CKD)患者。慢性肾脏病患者的神经认知功能,包括智商(IQ)和执行功能,会通过各种机制受到影响。然而,关于智商和执行功能如何影响 CKD 儿童的 HRQoL,目前还没有具体的研究。目的 评估执行功能对 HRQoL 的影响,并发现治疗方式和 CKD 分期与 CKD 儿童 HRQoL 之间的关联。方法 一项横断面研究于 2022 年 9 月至 2023 年 4 月在印度尼西亚万隆 Hasan Sadikin 综合医院的小儿肾脏病诊所进行。我们纳入了 38 名年龄介于 6-16 岁 11 个月之间、患有慢性肾脏病 III - V 期的儿童:用于评估执行功能的 BRIEF 问卷;用于评估智商的 WISC III 工具;用于评估 HRQoL 的 PedsQLTM 问卷通用模块。数据分析采用 SPSS ver.26.0.结果 样本总数为 38 个。对 30 名患者进行了全面检查。另有 8 名患者未进行智商测试。在所有领域中,执行功能成分得分(GEC、BRI、MI)与父母代理的 HRQoL 分数之间均呈负相关。我们没有发现 HRQoL 与 IQ 分数之间存在相关性,但我们发现 IQ 与 CKD 分期之间存在相关性。从儿童的角度来看,三种治疗方式的 HRQoL 有明显差异;接受保守治疗的儿童 HRQoL 得分最高。结论 今后应采取干预措施改善慢性肾脏病患儿的执行功能,以提高他们的 HRQoL。应尽早诊断和治疗慢性肾脏病,以改善神经认知功能和 HRQoL。
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引用次数: 0
期刊
International Journal of Nephrology and Renovascular Disease
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