International Journal of Nephrology and Renovascular Disease最新文献

Purpose: Adherence to treatment regimens is crucial to enhance the clinical outcomes of patients with End-Stage Renal Disease (ESRD). In Yemen, there is a gap in information about this issue. Hence, this study aimed to assess the adherence and associated factors of ESRD patients to the four adherence domains, including HD session attendance, medication, dietary modification, and fluid management.

Patients and methods: A descriptive cross-sectional study of ESRD patients was conducted. End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was used to collect data through face-to-face interviews. The scoring system was used. The mean of the gained scores was calculated and divided by expected maximum scores and the resulting percentage was used to rank the level of adherence as good ≥ 83%, moderate ≥58- <83% and poor <58%). Non-parametric tests to assess the mean differences with selected variables at p-value <0.005.

Results: The overall (mean ±SD) scores of 393 patients for the four adherence domains (HD, medication, fluid restrictions, and dietary recommendations) were 933.5+210 indicating an overall moderate level of adherence. Good adherence to HD and moderate adherence to medication, diet and fluids were observed (88.5%, 76.7%, 61.9%, and 61.6%, respectively). Significantly higher mean scores among patients with urban residency (941.8 vs 869.4, p=0.03), HD duration < 5 years (949.2 vs 908.0, p=0.02), the overall perception of treatment (956.7 vs 653.3, p=<0.001), patients who had a perception of medication (942.0 vs 734.3, p=0.002), fluid restriction (958.9 vs 727.3, p=<0.001), and diet recommendations (969.8 vs 715.2, p=<0.001). Significantly lower mean scores were observed among patients who had not received counseling regarding the importance of dietary and fluid restriction (962.8 vs 920.5, p=0.02) and (965.6 vs 919.0, p=0.02, respectively).

Discussion: This study is the first in our country to provide baseline information on adherence toward different treatment domains and their associated factors among patients with ESRD. The adherence level among patients with ESRD was moderate in general and good for HD. There was a significant association between adherence and residency, HD duration, overall perception of treatment, perception of medication, fluid and dietary restrictions, and poor counseling. Regular counseling should be provided to enhance adherence levels. A multicenter study is recommended to assess the causal relationship between adherence and the factors affecting adherence.

Introduction: Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a rare plasma cell dyscrasia. Growth differentiation factor-15 (GDF-15) is related with renal function, but few studies have focused on it in renal impairment of POEMS syndrome.

Objective: To evaluate the potential of circulating GDF-15 concentration as a biomarker for renal function in POEMS syndrome.

Methods: 150 Chinese patients, diagnosed with POMES syndrome, were enrolled and divided into three subgroups according to their chemotherapy stage. All the patients' medical records were retrospectively analyzed and plasma VEGF and GDF-15 were measured using ELISA kits. Treatment-naïve patients were followed up for 13±6 months.

Results: Plasma GDF-15 concentration positively correlated with serum creatinine (r=0.4048; P<0.0001), blood urea nitrogen (r=0.3302; P<0.0001), risk stratification (r=0.3949; P<0.0001), while negatively correlating with eGFR (r=-0.5057; P<0.0001) and albumin (r=-0.3800; P=0.0014). GDF-15>547.8 pg/mL provided an AUC of 0.8541 in diagnosing renal impairment (eGFR<60mL/min/1.73m²) in POEMS syndrome. With a prevalence of renal impairment of 16.7%, GDF-15>547.8 pg/mL showed a prominent NPV (94.9%) for the diagnosis of renal impairment in POEMS syndrome. Moreover, treatment-naïve patients with serous effusion had higher plasma GDF-15 concentration (P=0.0004) and lower eGFR (P=0.0001) than those without serous effusion. Noteworthy, baseline GDF-15 was positively correlated with ΔeGFR (r=0.4694, P=0.0044).

Conclusion: Circulating GDF-15 concentration is associated with serous effusion, renal function and risk stratification, while a plasma GDF-15 < 547.8 pg /mL can help rule out renal impairment in POEMS syndrome. Baseline plasma GDF-15 is associated with renal remission after chemotherapy.

Background: Mitsugumin 53 (MG53) plays a protective role against kidney diseases and cardiovascular diseases, but its mechanism of action is unclear. We speculate that the prevention of cardiovascular disease by MG53 may be associated with the inhibition of vascular calcification. This study was performed with the aim of investigating the potential association between the MG53 level and abdominal aortic calcification (AAC) in patients undergoing hemodialysis (HD).

Methods: A total of 263 patients undergoing HD and 65 age- and sex-matched healthy individuals were included. The patient serum MG53 level was measured by enzyme-linked immunosorbent assay (ELISA), and the abdominal aortic calcification score (ACCs) was calculated using lateral abdominal radiography parameters. The laboratory and demographic data were collected at baseline.

Results: The serum MG53 levels in HD patients were significantly lower than those in healthy individuals [24.9 (IQR: 16.1-40.1) vs 43.5 (IQR: 23.7-74.4) pg/mL, P < 0.001]. In addition, HD patients with AAC presented markedly lower serum MG53 levels than those without AAC [22.0 (IQR: 15.3-32.6) vs 26.9 (IQR: 16.8-44.2) pg/mL, p=0.024]. Furthermore, multiple logistic regression analysis indicated that lower serum MG53 levels, an older age, a longer dialysis vintage, a higher serum total carbon dioxide (TCO₂), and a higher serum phosphorus were independent risk factors for AAC in HD patients.

Conclusion: Our results demonstrate for the first time a correlation between lower serum MG53 levels and an increased risk of AAC in patients undergoing HD. In addition, an older age, a longer dialysis vintage, the presence of metabolic acidosis and higher serum phosphorus levels are independent risk factors for AAC in HD patients.

Objective: Patients with chronic kidney disease (CKD) and coronary artery disease (CAD) had a poor prognosis. Indicators derived from complete blood count (CBC), like neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), Systematic Inflammation Response Index (SIRI), systemic immune-inflammation index (SII) and Pan-Immune-Inflammation Value (PIV) had prognostic significance. But which one performed best in patients with CKD and CAD was still unclear.

Methods: CKD Patients with CAD admitted to ICU were retrospectively included. Patients with sepsis, connective tissue disease, tumor and receiving glucocorticoids were excluded. The primary endpoints encompassed in-hospital mortality and 30-day mortality.

Results: The study comprised 694 participants, with 60 patients died during hospitalization, and another 15 died in 30-day follow-up period. Both the admission level and maximal level of CBC-derived indicators were higher in the deceased group. ROC curve analysis demonstrated that maximal NLR had the highest AUCs - 0.795 for in-hospital mortality and 0.754 for 30-day mortality prediction. Furthermore, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) analyses further confirmed that adding maximal NLR to the base model, which included traditional risk factors, significantly improved both NRI and IDI (p < 0.05 for both).

Conclusion: The maximum of NLR was with the best predictive value for in-hospital mortality and 30-day mortality in ICU patients with CAD and CKD. Predicting prognosis based on dynamic changes of NLR is more worthy of attention.

[This corrects the article DOI: 10.2147/IJNRD.S485409.].

Background: IgA nephropathy (IgAN) is the leading primary glomerulonephritis globally, with many patients advancing to end-stage renal disease. Proteinuria is a key predictor of renal function decline in IgAN, yet the best method for long-term assessment is unclear. This study explores the relationship between time-weighted average proteinuria (TWAP), a novel metric of cumulative proteinuria exposure, and renal function decline in IgAN patients.

Methods: This single-center retrospective cohort study encompassed 549 patients with biopsy-confirmed primary IgAN from Shenzhen Second People's Hospital from 2011 to 2023. TWAP served as the primary exposure variable, calculated using the protein-creatinine ratio values, while changes in estimated glomerular filtration rate (eGFR) constituted the primary outcome. Covariates included age, sex, blood pressure, and mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T), and crescents (C) (known as the Oxford Classification MEST-C score system). The associations between TWAP and eGFR trajectories were analyzed using Generalized Additive Mixed Models.

Results: In patients with baseline eGFR 15-60 mL/min/1.73m², higher TWAP levels correlated with accelerated eGFR decline. Compared to TWAP < 0.3 g/g, TWAP 0.3-0.5 g/g, 0.5-1 g/g, and ≥1 g/g were associated with additional annual eGFR declines of 2.04 (95% CI: -3.72 to -0.35), 3.38 (95% CI: -5.12 to -1.65), and 4.04 (95% CI: -6.61 to -1.47) mL/min/1.73m²/year, respectively. For eGFR ≥60 mL/min/1.73m², only TWAP ≥1 g/g significantly accelerated eGFR decline 5.70 (95% CI: -6.84 to -4.55) mL/min/1.73m²/year.

Conclusion: TWAP significantly predicts renal function decline in IgAN, especially in patients with pre-existing renal dysfunction. Maintaining TWAP below 0.3 g/g may significantly slow disease progression, emphasizing the importance of stringent proteinuria control in IgAN management.

Background: Chronic Kidney Disease (CKD) represents a significant global health challenge, with Indonesia experiencing the highest surge in End-Stage Kidney Disease (ESKD) prevalence over the past decade. Kidney registries are essential for reporting health outcomes, evaluating healthcare services, advocating for policy change, and informing health infrastructure development. Survival rates in ESKD patients undergoing hemodialysis (HD) are a critical outcome measure. However, there is a lack of survival analysis data for ESKD patients receiving HD in Indonesia.

Objective: This study aims to assess the one-year survival rate of ESKD patients undergoing HD in Indonesia, while examining risk factors associated with survival, including age, gender, CKD etiology, and dialysis adequacy.

Methods: This analytical observational study employed a retrospective cohort design, utilizing patient data from Indonesia Renal Registry between 2016 and 2019. Kaplan-Meier survival curves were generated, and Log rank test was applied to assess the significance of survival differences across subgroups based on age, gender, CKD etiology, and dialysis adequacy.

Results: A total of 122,449 ESKD patients on HD were analyzed, with a mean age of 52 years; majority (55.5%) were male, and hypertensive kidney disease was the leading cause of CKD (43.7%). The overall one-year survival rate was 91.5% (95% CI: 91.3-91.6). Survival decreased significantly with advancing age (p < 0.01), and female patients exhibited lower survival rates compared to males (p < 0.01). Patients with diabetic nephropathy had the lowest survival rate among CKD etiologies (p < 0.01). Dialysis adequacy, assessed in 11,633 patients, revealed that 69.2% had a Kt/V below 1.8. Those with inadequate dialysis had significantly lower survival rates (p=0.00015).

Conclusion: The one-year survival rate for ESKD patients undergoing HD in Indonesia is 91.5%. Increased age, female, diabetic nephropathy as the underlying CKD etiology, and inadequate dialysis adequacy are associated with reduced survival rates.

Background: The occurrence of urinary tract or kidney infection is correlated with intelligence, noncognitive education and cognition, but the causal relationship between them remains uncertain, and which risk factors mediate this causal relationship remains unknown.

Methods: The intelligence (n=269,867), noncognitive education (n=510,795) and cognition data (n=257,700) were obtained from genome-wide association studies (GWAS) conducted in individuals of European ethnicities. The genetic associations between these factors and urinary tract or kidney infection (UK Biobank, n=397,867) were analyzed using linkage disequilibrium score regression. We employed a two-sample univariate and multivariate Mendelian randomization to evaluate the causal relationship, and utilized a two-step Mendelian randomization to examine the involvement of 28 potential mediators and their respective mediating proportions.

Results: The genetic correlation coefficients of intelligence, noncognitive education, cognition, and urinary tract or kidney infection were -0.338, -0.218, and -0.330. The Mendelian randomization using the inverse variance weighted method revealed each 1-SD increase in intelligence, the risk of infection decreased by 15.9%, while after adjusting for noncognitive education, the risk decreased by 20%. For each 1-SD increase in noncognitive education, the risk of infection decreased by 8%, which further reduced to 7.1% after adjusting for intelligence and to 6.7% after adjusting for cognition. For each 1-SD increase in cognition, the risk of infection decreased by 10.8%, increasing to 11.9% after adjusting for noncognitive education. The effects of intelligence and cognition are interdependent. 2 out of 28 potential mediating factors exhibited significant mediation effects in the causal relationship between noncognitive education and urinary tract or kidney infection, with body mass index accounting for 12.1% of the mediation effect and smoking initiation accounting for 14.7%.

Conclusion: Enhancing intelligence, noncognitive education, and cognition can mitigate the susceptibility to urinary tract or kidney infection. Noncognitive education exhibited independent effect, while body mass index and smoking initiation assuming a mediating role.

Background: Nephrotoxic drugs can worsen the kidney function of patients with chronic kidney disease (CKD). There is still a limited amount of research investigating nephrotoxic drugs in Indonesia. This study aims to analyze the prevalence of potentially nephrotoxic drugs (PND) prescriptions and the association of patients' characteristics with PND prescribing.

Methods: This cross-sectional study employed retrospective data from Universitas Indonesia Hospital (RSUI), focusing on CKD outpatients treated between January 2019 and December 2022. CKD patients over the age of 18 were included, with exclusions for those suspected of having CKD, those with a history of kidney transplants, or missing critical data. The study outcome was the prevalence of patients prescribed PND, determined using reliable references to assess potential nephrotoxicity. Furthermore, compliance with clinical guidelines was evaluated at the individual drug level, with each PND within a prescription treated as a separate case. Descriptive analyses were carried out to determine prevalence, which were presented as percentages. Logistic regression analysis was performed to examine the association between patient characteristics and the prescription of PND.

Results: In total, 248 patients were evaluated. The findings revealed that 177 out of 248 patients (71.4%) were prescribed at least one PND. The categories of these drugs included antihypertensives (50.9%), antigout medications (17.8%), antiplatelets (10.5%), antibiotics (9.8%), NSAIDs (5.8%), and antiulcer agents (5.2%). Of 275 cases of PND prescriptions, 220 (80.0%) complied to treatment guidelines, while 55 (20.0%) did not. Logistic regression analysis indicated that patients taking more than four additional medications were more likely to be prescribed PNDs than those on fewer medications (aOR 2.454, 95% CI 1.399-4.305).

Conclusion: Although non-compliance cases are relatively low, PNDs are frequently prescribed to CKD patients, with the risk rising as the number of comedications increases. Measures are needed to ensure guideline compliance, including accurate dosage assessments and outcome monitoring.

Introduction and purpose: Lupus nephritis (LN) is the main cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients, therefore the discovery of new biomarkers, which are reliable for the diagnosis of NL is necessary. Various studies have reported alteration of some miRNAs expression in LN, that considered as biomarkers and/or therapeutic targets in LN. MicroRNA-203 has been associated with the development of nephritis in SLE patients, playing an important role in the initiation and progression of the disease, but research on circulating miRNA-203 expression in LN in clinical practice is still very limited. The aim of this study was to prove the role of microRNA-203 in LN.

Patients and methods: Serum was obtained from 40 participants consisting of 20 SLE patients and 20 LN patients. The diagnostic of SLE and LN was based on the ACR 1997 criteria. MicroRNA-203 expression was determined by real-time Polymerase Chain Reaction (PCR). Statistical analysis was performed with Mann-Whitney test.

Results: The expression of miRNA-203 in the SLE group was 1.66 (0.00-8.64) and in the NL group was 5.18 (0.25-49.84). There were significant differences in microRNA-203 expression between SLE and LN patients (p=0.003).

Conclusion: MicroRNA-203 expression might be associated with nephritis manifestations in SLE patients.