Pub Date : 2024-10-04eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S473616
Cyntia Camilo Franco Borges Zago, Bruna de Freitas Oliveira, Giovanna Uehara, Ana Laura Carvalho da Silva, Laura Penna Rocha, Fabiano Bichuette Custódio, Liliane Silvano Araújo, Crislaine Aparecida da Silva, Marlene Antônia Reis, Juliana Reis Machado
Purpose: In the kidneys, Systemic Lupus Erythematosus leads to Lupus Nephritis (LN), a form of glomerulonephritis. There is evidence that patients with LN may present activation of specific pathways for podocyte injury. This injury can occur through different mechanisms such as loss of podocyte adhesion to the glomerular basement membrane, cell death or dedifferentiation. Podocyturia with consequent podocytopenia has been described in some nephropathies such as LN, highlighting the importance of studying podocyte injuries in this condition. Evaluating in situ morphological characteristics of podocytes becomes relevant for a better understanding of the processes involved in their pathogenesis. This study investigated podocytes in different classes of LN in renal biopsies performed by the Kidney Research Center at the Federal University of Triângulo Mineiro.
Patients and methods: Twenty control cases and 29 biopsy cases diagnosed with LN were selected, divided according to the histopathological classes of the disease. Podocyte density was assessed through immunohistochemistry for Wilms tumor 1 protein and the evaluation of foot process effacement was performed by transmission electron microscopy.
Results: Podocyte density was lower in the LN and this reduction was observed in all analyzed classes when compared to the control group. More foot process effacement was observed in the LN group, with more effacement in classes I/II and class IV compared to the control group. The class IV group showed more foot process effacement than the class III group and presented higher proteinuria levels compared to the classes I/II group. A strong, positive, and significant correlation was observed between the activity index and foot process effacement in the class IV group.
Conclusion: Podocytes play an important role in the development of LN, and possibly, injuries to these cells are more closely related to the inflammatory/diffuse proliferative cellular process developed in class IV LN.
目的:在肾脏中,系统性红斑狼疮会导致狼疮性肾炎(LN),这是一种肾小球肾炎。有证据表明,狼疮肾炎患者可能会出现荚膜细胞损伤的特定途径激活。这种损伤可通过不同的机制发生,如荚膜细胞失去与肾小球基底膜的粘附力、细胞死亡或脱分化。一些肾病(如淋巴结核)中出现了荚膜细胞尿和随之而来的荚膜细胞减少症,这凸显了研究这种情况下荚膜细胞损伤的重要性。评估荚膜细胞的原位形态特征有助于更好地了解其发病过程。本研究调查了 Triângulo Mineiro 联邦大学肾脏研究中心进行的肾活检中不同类型 LN 中的荚膜细胞:研究选择了 20 例对照病例和 29 例确诊为 LN 的活检病例,并根据疾病的组织病理学分类进行了划分。通过Wilms肿瘤1蛋白的免疫组织化学方法评估荚膜细胞密度,并通过透射电子显微镜评估足突脱出情况:结果:与对照组相比,淋巴结核患者的荚膜细胞密度较低,而且在所有分析级别中都能观察到这种降低。与对照组相比,LN 组观察到更多的足突脱出,I/II 级和 IV 级脱出更多。与 I/II 级组相比,IV 级组比 III 级组有更多的足突脱出,蛋白尿水平也更高。在 IV 级组,观察到活动指数和足突脱出之间存在较强的正相关性:结论:荚膜细胞在 LN 的形成过程中起着重要作用,这些细胞的损伤可能与 IV 级 LN 的炎症/弥漫性增生细胞过程有更密切的关系。
{"title":"Influence of Podocyte Injury on the Development of Class IV Lupus Nephritis.","authors":"Cyntia Camilo Franco Borges Zago, Bruna de Freitas Oliveira, Giovanna Uehara, Ana Laura Carvalho da Silva, Laura Penna Rocha, Fabiano Bichuette Custódio, Liliane Silvano Araújo, Crislaine Aparecida da Silva, Marlene Antônia Reis, Juliana Reis Machado","doi":"10.2147/IJNRD.S473616","DOIUrl":"https://doi.org/10.2147/IJNRD.S473616","url":null,"abstract":"<p><strong>Purpose: </strong>In the kidneys, Systemic Lupus Erythematosus leads to Lupus Nephritis (LN), a form of glomerulonephritis. There is evidence that patients with LN may present activation of specific pathways for podocyte injury. This injury can occur through different mechanisms such as loss of podocyte adhesion to the glomerular basement membrane, cell death or dedifferentiation. Podocyturia with consequent podocytopenia has been described in some nephropathies such as LN, highlighting the importance of studying podocyte injuries in this condition. Evaluating in situ morphological characteristics of podocytes becomes relevant for a better understanding of the processes involved in their pathogenesis. This study investigated podocytes in different classes of LN in renal biopsies performed by the Kidney Research Center at the Federal University of Triângulo Mineiro.</p><p><strong>Patients and methods: </strong>Twenty control cases and 29 biopsy cases diagnosed with LN were selected, divided according to the histopathological classes of the disease. Podocyte density was assessed through immunohistochemistry for Wilms tumor 1 protein and the evaluation of foot process effacement was performed by transmission electron microscopy.</p><p><strong>Results: </strong>Podocyte density was lower in the LN and this reduction was observed in all analyzed classes when compared to the control group. More foot process effacement was observed in the LN group, with more effacement in classes I/II and class IV compared to the control group. The class IV group showed more foot process effacement than the class III group and presented higher proteinuria levels compared to the classes I/II group. A strong, positive, and significant correlation was observed between the activity index and foot process effacement in the class IV group.</p><p><strong>Conclusion: </strong>Podocytes play an important role in the development of LN, and possibly, injuries to these cells are more closely related to the inflammatory/diffuse proliferative cellular process developed in class IV LN.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"215-225"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Malnutrition inflammation score (MIS) is an instrument for assessing the nutritional status of stage 5 CKD patients, while simplified creatinine index (SCI) is used to assess muscle mass indirectly.
Purpose: This study aims to analyse the correlation between SCI and MIS, as well as determine the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients on maintenance HD.
Methods: This research was an analytical observational study with a cross-sectional study approach. The 132 research subjects were stage 5 CKD patients at the HD Unit of RSUP Dr. Hasan Sadikin Bandung. The research used the Rank-Spearman test with SPSS for correlative bivariate analysis. The area under the curve (AUC) on the receiver operating characteristic (ROC) curve was analysed to find the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients.
Results: Sixty-three subjects (47.7%) were classified as good nutrition and 69 subjects (52.3%) as poor nutrition. The average SCI value in this study was 24.5 mg/kg/day ± SD 3.2 mg/kg/day, with a median MIS value was 6. This study showed a significant negative correlation between SCI and MIS (r = -0.586, p < 0.001). The optimal SCI cut-off from the ROC curve analysis value was ≤ 24.53 mg/kg/day (sensitivity = 76.8%; specificity = 79.4%).
Conclusion: A negative correlation existed between SCI and MIS, with an SCI value ≤ 24.53 indicating poor nutritional status in stage 5 CKD patients on maintenance HD. SCI can be used as a predictor of malnutrition at a lower cost and easier.
{"title":"Simplified Creatinine Index as Predictor of Malnutrition in Stage 5 Chronic Kidney Disease Patients on Maintenance Haemodialysis.","authors":"Ria Bandiara, Davin Takaryanto, Rizky Andhika, Afiatin Makmun, Rudi Supriyadi, Lilik Sukesi","doi":"10.2147/IJNRD.S465294","DOIUrl":"10.2147/IJNRD.S465294","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition inflammation score (MIS) is an instrument for assessing the nutritional status of stage 5 CKD patients, while simplified creatinine index (SCI) is used to assess muscle mass indirectly.</p><p><strong>Purpose: </strong>This study aims to analyse the correlation between SCI and MIS, as well as determine the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients on maintenance HD.</p><p><strong>Methods: </strong>This research was an analytical observational study with a cross-sectional study approach. The 132 research subjects were stage 5 CKD patients at the HD Unit of RSUP Dr. Hasan Sadikin Bandung. The research used the Rank-Spearman test with SPSS for correlative bivariate analysis. The area under the curve (AUC) on the receiver operating characteristic (ROC) curve was analysed to find the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients.</p><p><strong>Results: </strong>Sixty-three subjects (47.7%) were classified as good nutrition and 69 subjects (52.3%) as poor nutrition. The average SCI value in this study was 24.5 mg/kg/day ± SD 3.2 mg/kg/day, with a median MIS value was 6. This study showed a significant negative correlation between SCI and MIS (r = -0.586, p < 0.001). The optimal SCI cut-off from the ROC curve analysis value was ≤ 24.53 mg/kg/day (sensitivity = 76.8%; specificity = 79.4%).</p><p><strong>Conclusion: </strong>A negative correlation existed between SCI and MIS, with an SCI value ≤ 24.53 indicating poor nutritional status in stage 5 CKD patients on maintenance HD. SCI can be used as a predictor of malnutrition at a lower cost and easier.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"205-213"},"PeriodicalIF":2.1,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11296508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-24eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S461028
Evi Diana Omar, Hasnah Mat, Ainil Zafirah Abd Karim, Ridwan Sanaudi, Fairol H Ibrahim, Mohd Azahadi Omar, Muhd Zulfadli Hafiz Ismail, Vivek Jason Jayaraj, Bak Leong Goh
Purpose: This study aimed to identify the best-performing algorithm for predicting Acute Kidney Injury (AKI) necessitating dialysis following cardiac surgery.
Patients and methods: The dataset encompassed patient data from a tertiary cardiothoracic center in Malaysia between 2011 and 2015, sourced from electronic health records. Extensive preprocessing and feature selection ensured data quality and relevance. Four machine learning algorithms were applied: Logistic Regression, Gradient Boosted Trees, Support Vector Machine, and Random Forest. The dataset was split into training and validation sets and the hyperparameters were tuned. Accuracy, Area Under the ROC Curve (AUC), precision, F-measure, sensitivity, and specificity were some of the evaluation criteria. Ethical guidelines for data use and patient privacy were rigorously followed throughout the study.
Results: With the highest accuracy (88.66%), AUC (94.61%), and sensitivity (91.30%), Gradient Boosted Trees emerged as the top performance. Random Forest displayed strong AUC (94.78%) and accuracy (87.39%). In contrast, the Support Vector Machine showed higher sensitivity (98.57%) with lower specificity (59.55%), but lower accuracy (79.02%) and precision (70.81%). Sensitivity (87.70%) and specificity (87.05%) were maintained in balance via Logistic Regression.
Conclusion: These findings imply that Gradient Boosted Trees and Random Forest might be an effective method for identifying patients who would develop AKI following heart surgery. However specific goals, sensitivity/specificity trade-offs, and consideration of the practical ramifications should all be considered when choosing an algorithm.
目的:本研究旨在确定预测心脏手术后需要透析的急性肾损伤(AKI)的最佳算法:数据集包括马来西亚一家三级心胸中心 2011 年至 2015 年间的患者数据,数据来源于电子健康记录。广泛的预处理和特征选择确保了数据的质量和相关性。应用了四种机器学习算法:逻辑回归、梯度提升树、支持向量机和随机森林。数据集被分成训练集和验证集,并对超参数进行了调整。评估标准包括准确度、ROC 曲线下面积(AUC)、精确度、F 值、灵敏度和特异性。整个研究过程严格遵守了数据使用和患者隐私的伦理准则:梯度提升树的准确率(88.66%)、AUC(94.61%)和灵敏度(91.30%)最高,表现最佳。随机森林的 AUC(94.78%)和准确率(87.39%)都很高。相比之下,支持向量机的灵敏度(98.57%)较高,特异度(59.55%)较低,但准确度(79.02%)和精确度(70.81%)较低。通过逻辑回归,灵敏度(87.70%)和特异度(87.05%)保持平衡:这些研究结果表明,梯度提升树和随机森林可能是识别心脏手术后发生 AKI 患者的有效方法。不过,在选择算法时应考虑具体目标、灵敏度/特异性权衡以及实际影响。
{"title":"Comparative Analysis of Logistic Regression, Gradient Boosted Trees, SVM, and Random Forest Algorithms for Prediction of Acute Kidney Injury Requiring Dialysis After Cardiac Surgery.","authors":"Evi Diana Omar, Hasnah Mat, Ainil Zafirah Abd Karim, Ridwan Sanaudi, Fairol H Ibrahim, Mohd Azahadi Omar, Muhd Zulfadli Hafiz Ismail, Vivek Jason Jayaraj, Bak Leong Goh","doi":"10.2147/IJNRD.S461028","DOIUrl":"10.2147/IJNRD.S461028","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify the best-performing algorithm for predicting Acute Kidney Injury (AKI) necessitating dialysis following cardiac surgery.</p><p><strong>Patients and methods: </strong>The dataset encompassed patient data from a tertiary cardiothoracic center in Malaysia between 2011 and 2015, sourced from electronic health records. Extensive preprocessing and feature selection ensured data quality and relevance. Four machine learning algorithms were applied: Logistic Regression, Gradient Boosted Trees, Support Vector Machine, and Random Forest. The dataset was split into training and validation sets and the hyperparameters were tuned. Accuracy, Area Under the ROC Curve (AUC), precision, F-measure, sensitivity, and specificity were some of the evaluation criteria. Ethical guidelines for data use and patient privacy were rigorously followed throughout the study.</p><p><strong>Results: </strong>With the highest accuracy (88.66%), AUC (94.61%), and sensitivity (91.30%), Gradient Boosted Trees emerged as the top performance. Random Forest displayed strong AUC (94.78%) and accuracy (87.39%). In contrast, the Support Vector Machine showed higher sensitivity (98.57%) with lower specificity (59.55%), but lower accuracy (79.02%) and precision (70.81%). Sensitivity (87.70%) and specificity (87.05%) were maintained in balance via Logistic Regression.</p><p><strong>Conclusion: </strong>These findings imply that Gradient Boosted Trees and Random Forest might be an effective method for identifying patients who would develop AKI following heart surgery. However specific goals, sensitivity/specificity trade-offs, and consideration of the practical ramifications should all be considered when choosing an algorithm.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"197-204"},"PeriodicalIF":2.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-12eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S463751
Nkosingiphile Matthew Sandile Twala, Grace Tade, Patrick Hector Dessein, Gloria Teckie
Introduction: The causes of chronic kidney disease (CKD) in people living in Sub-Saharan Africa await identification. Also, whether cardiovascular risk and disease extent differ among patients with different CKD etiologies is uncertain.
Methods: In this prospective cross-sectional study, we examined the presumed causes of chronic kidney disease (CKD) and their relationships with cardiovascular risk and disease in 743 consecutive patients from a sub-Saharan low-income population.
Results: Hypertensive nephropathy (HNP) (60.2%), diabetic nephropathy (DNP) (24.4%), HIV associated CKD (20.0%) and glomerular disease (13.6%) comprised the major CKD etiologies upon enrolment at the hospital nephrology clinic. Pulse pressure was larger in patients with concurrent HNP and DNP than in those with HNP only (p<0.001). Pulse pressure and systolic blood pressure were larger in HNP or/and DNP patients than those with HIV associated CKD and glomerular disease (p=0.04 to <0.001). Cardiovascular disease was more prevalent in patients with HNP and concurrent HNP and DNP than those from other etiologic categories (p<0.05). HNP and DNP were associated with pulsatile pressures (pulse pressure and systolic blood pressure) independent of one another (p<0.01). In adjusted product of coefficient mediation analysis, mean arterial or distending pressure accounted fully for the potential impact of HNP on pulsatile pressures (103.9-115.7%) but not for that of DNP on the respective pressures (-2.0%-(-)7.5%).
Conclusion: HNP is by far the most prevalent presumed cause of CKD in this African population. Cardiovascular risk and disease differ markedly across CKD etiological categories.
{"title":"Causes of Chronic Kidney Disease and Their Associations with Cardiovascular Risk and Disease in a Sub-Saharan Low-Income Population.","authors":"Nkosingiphile Matthew Sandile Twala, Grace Tade, Patrick Hector Dessein, Gloria Teckie","doi":"10.2147/IJNRD.S463751","DOIUrl":"10.2147/IJNRD.S463751","url":null,"abstract":"<p><strong>Introduction: </strong>The causes of chronic kidney disease (CKD) in people living in Sub-Saharan Africa await identification. Also, whether cardiovascular risk and disease extent differ among patients with different CKD etiologies is uncertain.</p><p><strong>Methods: </strong>In this prospective cross-sectional study, we examined the presumed causes of chronic kidney disease (CKD) and their relationships with cardiovascular risk and disease in 743 consecutive patients from a sub-Saharan low-income population.</p><p><strong>Results: </strong>Hypertensive nephropathy (HNP) (60.2%), diabetic nephropathy (DNP) (24.4%), HIV associated CKD (20.0%) and glomerular disease (13.6%) comprised the major CKD etiologies upon enrolment at the hospital nephrology clinic. Pulse pressure was larger in patients with concurrent HNP and DNP than in those with HNP only (p<0.001). Pulse pressure and systolic blood pressure were larger in HNP or/and DNP patients than those with HIV associated CKD and glomerular disease (p=0.04 to <0.001). Cardiovascular disease was more prevalent in patients with HNP and concurrent HNP and DNP than those from other etiologic categories (p<0.05). HNP and DNP were associated with pulsatile pressures (pulse pressure and systolic blood pressure) independent of one another (p<0.01). In adjusted product of coefficient mediation analysis, mean arterial or distending pressure accounted fully for the potential impact of HNP on pulsatile pressures (103.9-115.7%) but not for that of DNP on the respective pressures (-2.0%-(-)7.5%).</p><p><strong>Conclusion: </strong>HNP is by far the most prevalent presumed cause of CKD in this African population. Cardiovascular risk and disease differ markedly across CKD etiological categories.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"175-195"},"PeriodicalIF":2.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11180468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-28eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S450772
Sriya Kosaraju, Rong M Zhang
{"title":"Retrospective Study on the Efficacy and Safety of Dulaglutide in Patients with Diabetes and Moderate-Advanced Chronic Kidney Disease.","authors":"Sriya Kosaraju, Rong M Zhang","doi":"10.2147/IJNRD.S450772","DOIUrl":"10.2147/IJNRD.S450772","url":null,"abstract":"","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"163-166"},"PeriodicalIF":2.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-28eCollection Date: 2024-01-01DOI: 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.
{"title":"Hyperphosphatemia in Chronic Kidney Disease: The Search for New Treatment Paradigms and the Role of Tenapanor.","authors":"Valeria Cernaro, Elisa Longhitano, Chiara Casuscelli, Luigi Peritore, Domenico Santoro","doi":"10.2147/IJNRD.S385826","DOIUrl":"10.2147/IJNRD.S385826","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"151-161"},"PeriodicalIF":2.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11144652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Anti-SARS-CoV-2 Spike Antibody Response to the Fourth Dose of BNT162b2 mRNA COVID-19 Vaccine and Associated Factors in Japanese Hemodialysis Patients.","authors":"Keiji Hirai, Masako Shimotashiro, Toshiaki Okumura, Susumu Ookawara, Yoshiyuki Morishita","doi":"10.2147/IJNRD.S452964","DOIUrl":"10.2147/IJNRD.S452964","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"135-149"},"PeriodicalIF":2.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"Hospital-Acquired Acute Kidney Injury in Non-Critical Medical Patients in a Developing Country Tertiary Hospital: Incidence and Predictors.","authors":"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","doi":"10.2147/IJNRD.S454987","DOIUrl":"https://doi.org/10.2147/IJNRD.S454987","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"125-133"},"PeriodicalIF":2.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28eCollection Date: 2024-01-01DOI: 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.
{"title":"Acute Kidney Injury Prediction Model Using Cystatin-C, Beta-2 Microglobulin, and Neutrophil Gelatinase-Associated Lipocalin Biomarker in Sepsis Patients.","authors":"Hani Susianti, Aswoco Andyk Asmoro, Sujarwoto, Wiwi Jaya, Heri Sutanto, Amanda Yuanita Kusdijanto, Kevin Putro Kuwoyo, Kristian Hananto, Matthew Brian Khrisna","doi":"10.2147/IJNRD.S450901","DOIUrl":"10.2147/IJNRD.S450901","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Material and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Conclusion: </strong>The Naïve Bayes machine learning model in this study is useful for predicting AKI in sepsis patients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"105-112"},"PeriodicalIF":2.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20eCollection Date: 2024-01-01DOI: 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.
{"title":"Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis.","authors":"Sumedh Jayanti, Gopala K Rangan","doi":"10.2147/IJNRD.S387598","DOIUrl":"10.2147/IJNRD.S387598","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"91-104"},"PeriodicalIF":2.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}