International Journal of Nephrology and Renovascular Disease最新文献

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.

Introduction: Limited data exist regarding treatment patterns and symptom burden of patients with anemia of chronic kidney disease (CKD) in the Middle East, South Africa, and Türkiye.

Methods: This real-world study explored clinical characteristics, symptom burden, and treatment patterns of patients with anemia of CKD living in the Middle East, South Africa, and Türkiye. Physician and patient perceptions of treatment were captured via cross-sectional surveys; patients' clinical characteristics were recorded by retrospective review of medical records.

Results: Data were collected from 1788 patients and 217 physicians. A high proportion of patients had never received treatment for their anemia (n = 701, 39.2%); the most common treatment was erythropoietin-stimulating agents (ESAs) + intravenous iron (n = 457, 50.3%). High symptom burden was reported, with lack of energy being the most common symptom (n = 394, 75.6% treated and n = 133, 59.9% non-treated patients). Patients' self-reported symptom burden was higher than physician-reported burden; less agreement was seen for non-dialysis-dependent (NDD) patients (kappa = 0.193, standard deviation [SD]: 0.081) than dialysis-dependent (DD) patients (kappa = 0.442, SD: 0.103). Median hemoglobin thresholds that physicians reported using for initiating treatment (NDD: <10.5 [interquartile range, 9.5-12.0] g/dL; DD: <9.3 [9.0-10.0] g/dL) were higher than actual test levels at treatment initiation (NDD: 9.2 [8.7-10.0] g/dL; DD: 9.0 [8.1-10.0] g/dL).

Conclusion: Treatment inertia is apparent despite high symptom burden in the Middle East, South Africa, and Türkiye, and disagreement was seen in physician and patient perspectives on symptomology. Improved awareness of this disagreement may help facilitate physician-patient dialogue to improve patient experience.

Background: Acute kidney injury (AKI) is common in critically ill children in the PICU, with incidence rates from 2.5% to 58%, impacting mortality and hospital duration. Early AKI detection is vital, but conventional hemodynamic monitoring often lacks specificity. This study investigates the relationship between the inferior vena cava/aortic (IVC/Ao) ratio and serum lactate levels as non-invasive indicators of renal hemodynamics and tissue perfusion in children. Understanding these parameters could improve early diagnosis, aid clinical decisions, and enhance outcomes for pediatric AKI patients, offering an accessible monitoring method for clinicians.

Methods: This cross-sectional study involved 48 pediatric patients aged 5-18 years showing Pediatric Early Warning Score (PEWS) ≥3 and diagnosed with renal disorders. Patients were admitted to the emergency department, high care unit, PICU, and pediatric ward at Dr. Hasan Sadikin Hospital, Bandung, between May and August 2023. AKI was diagnosed using pRIFLE or KDIGO criteria. The IVC/Ao ratio was assessed via transabdominal USG, and serum lactate levels were measured. Spearman correlation analysis was conducted to assess their relationship.

Results: The median (IQR) IVC/Ao ratio was 0.91 (0.70-1.10), and serum lactate levels were 1.5 (1.1-2.4) mmol/L. Spearman correlation analysis revealed a negative correlation between the IVC/Ao ratio and serum lactate (rho = -0.65, p < 0.001).

Conclusion: A decrease in the IVC/Ao ratio correlates with an increase in serum lactate levels in children with AKI.

Purpose: Social determinants of health have been related with kidney diseases and their outcomes. Financial toxicity (FT) refers to the negative impact of health care costs on clinical conditions. This scoping review aimed to evaluate the literature linking FT with renal diseases.

Patients and methods: We Included all studies analyzing FT and renal disease recorded in PubMed, Embase and Google Scholar between 2013 and 2023. The research question was formulated with reference to the acronym PCC (Problem, Concept and Contest). For each included study, we considered the study design, the population and main results from different populations with distinct renal conditions and the results were summarized in four tables.

Results: Socioeconomic deprivation was the main cause of FT, and the majority of studies on the relationship between FT and chronic kidney disease (CKD) were conducted in the USA (4 studies evaluated the pediatric population and 6 studies included adults). Three studies reported the impact of FT on nephrolithiasis, and 3 studies analyzed the link between FT and renal tumors. The methods used for detecting FT differed and were based on consultations, questionnaires, expenditures and database records analysis. The COmprehensive Score for financial Toxicity (COST) questionnaire was used in 7 studies (43%), and the prevalence of FT was reported to be high in children and adults.

Conclusion: Although the quality of the selected study is limited, due to different populations investigated and heterogeneity in detecting FT, the latter seems to be a frequent finding in people with renal disease. Health care professionals should recognize socioeconomic deprivation as the major cause of FT. Detecting FT could help in prioritizing patient-centered care in populations with renal diseases through the development of strategies aimed at improving care for people with kidney diseases.

Approximately one in five patients with systemic lupus erythematosus (SLE) has disease-onset during childhood (cSLE). Lupus nephritis is more common in cSLE than adult-onset SLE and is associated with significant and increased morbidity and mortality. In this article, we review lupus nephritis in cSLE, including pathogenesis, diagnosis, biomarkers, and management through PUBMED search between July and December 2024. Diagnosis of lupus nephritis is made in 93% of cSLE patients during the first 2 years of disease. The majority of patients have active disease in other organs, and nephrotic range proteinuria and hypertension is frequently observed at diagnosis. Class III and IV are observed in over 50% of renal biopsies and progression to end-stage renal disease varies across cohorts. Major progress made in recent years includes adjustment of the proportion of fibrous crescents when scoring nephritis in cSLE to better discriminate kidney disease outcomes, and development of non-invasive biomarkers to identify renal disease activity and damage. It is anticipated that accurate non-invasive biomarkers will foster multicenter studies and help identify new treatment approaches to improve outcomes in cSLE nephritis.

Chronic kidney disease-associated pruritus (CKD-aP) is a frequent and distressing problem for individuals with chronic kidney disease (CKD) and end-stage renal disease. It affects around 20% of those with CKD and 40% of those with end-stage renal disease. Despite its clear association with poorer psychosocial and medical outcomes, it is often underreported by patients and frequently remains unnoticed by healthcare providers. This is likely due to uncertainty regarding its diagnosis and treatment. Most commonly, CKD-aP could be screened with questionnaires like the KDQoL-36 and WI-NRS, chosen for their simplicity and ease of use. Prior treatment studies of CKD-aP were mostly limited by noncontrolled design and small sample size. First CKD-aP medication - difelikefalin a powerful, new therapeutic option was approved by Federal Drug Administration (FDA) in 2021 and European Medicines Agency (EMA) in 2022. Recent expert opinions, clinical trials and metanalysis identified difelikefalin and gabapentinoids as medications of choice in treatment of CKD-aP. All these findings improved current understanding and management of this condition.

Introduction: Acute lobar nephronia (ALN) is a focal renal infection without liquefaction, historically regarded as rare in the pediatric population, yet recent literature suggests it may be under-diagnosed, which may result in the formation of renal abscess and future renal scarring.

Methods: The clinical presentation, investigations, treatment and long-term outcomes of 5 patients diagnosed with ALN was described and literature review was conducted by reviewing publications in PubMed using the keywords "acute lobar nephronia" and "pediatric".

Results: Three patients were males, aged 1 to 11 years. The primary complaint in all cases was fever, accompanied by significantly elevated inflammatory markers. Upon presentation, none of the patients exhibited pyuria on urinalysis, and all had sterile blood and urine cultures. Diagnosis was based on CT scans for three patients and renal sonography for two. Main findings included hyperechogenic renal parenchyma, and hypodense localized parenchyma. Treatment consisted of broad-spectrum intravenous antibiotics, administered for 7 to 12 days and additional 1 week course with amoxicillin-clavulanate, resulting in similar defervescence times across all patients. None of the patients demonstrated recurrence and none had renal pathology upon repeated renal sonography and upon DMSA scintigraphy.

Discussion: Clinical suspicion for ALN should arise in cases of abdominal pain and markedly increased inflammatory markers. It"s crucial to note that the absence of pyuria and negative culture results should not exclude ALN diagnosis, underscoring the need for a high index of suspicion in the pediatric population.