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Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries. 三个欧洲国家非透析依赖型慢性肾病患者的现实生活贫血管理
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S401598
Danilo Fliser, Maria Mata Lorenzo, Katherine Houghton, Claire Ainsworth, Martin Blogg, Elena González de Antona Sánchez, Jose Portoles

Background: Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe.

Methods: This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b-5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) <13.0 g/dL (males) or <12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date.

Results: Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10-12 g/dL) within 3-6 months of ESA initiation. Hb, transferrin saturation, and ferritin levels were infrequently monitored from 3 months post-ESA initiation. Rates of blood transfusion, dialysis, and diagnosis of end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively. Rates of kidney transplant and death were 4.8% and 8.8%, respectively.

Conclusion: Among ESA-treated patients, ESA initiation was in accordance with KDIGO guidelines, but subsequent monitoring of Hb and iron deficiency were suboptimal.

背景:贫血在慢性肾脏疾病(CKD)患者中很普遍,但目前的证据表明,治疗可能不符合肾脏疾病:改善全球结局(KDIGO)指南。我们旨在记录欧洲非透析依赖(NDD)-CKD患者接受促红细胞生成剂(ESA)治疗的管理情况。方法:这项回顾性观察性研究从德国、西班牙和英国的医疗记录中提取信息。符合条件的患者是2015年1月至12月期间因贫血开始ESA治疗的成人NDD-CKD 3b-5期患者。将贫血定义为血红蛋白(Hb)。结果:共提取病历848份。大约40%的患者在ESA开始前没有接受过铁治疗。在ESA开始时,平均±标准差Hb水平为9.8±1.0 g/dL。大多数患者接受达贝泊汀治疗,在esa之间切换的患者很少(8.5%的患者)。在初始ESA治疗期间,分别有36%和42%的患者同时使用静脉和口服铁治疗。在ESA开始的3-6个月内,平均Hb水平达到目标水平(10-12 g/dL)。Hb、转铁蛋白饱和度和铁蛋白水平从esa启动后3个月开始不经常监测。输血率、透析率和终末期肾病诊断率分别为16.4%、19.3%和24.6%。肾移植率和死亡率分别为4.8%和8.8%。结论:在接受ESA治疗的患者中,ESA启动符合KDIGO指南,但随后的Hb和铁缺乏监测不理想。
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引用次数: 0
Genetic Susceptibility to Chronic Kidney Disease: Links, Risks and Management. 慢性肾脏疾病的遗传易感性:联系、风险和管理。
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S363041
Hanny Sawaf, Tariku T Gudura, Sylvester Dorobisz, Dianne Sandy, Xiangling Wang, Shane A Bobart

Chronic kidney disease (CKD) is associated with significant morbidity and mortality worldwide. In recent years, our understanding of genetic causes of CKD has expanded significantly with several renal conditions having been identified. This review discusses the current landscape of genetic kidney disease and their potential treatment options. This review will focus on cystic kidney disease, glomerular disease with genetic associations, congenital anomalies of kidneys and urinary tract (CAKUT), autosomal dominant-tubulointerstitial kidney disease (ADTKD), inherited nephrolithiasis and nephrocalcinosis.

慢性肾脏疾病(CKD)在世界范围内与显著的发病率和死亡率相关。近年来,我们对CKD遗传原因的理解随着几种肾脏疾病的确定而显著扩大。这篇综述讨论了遗传性肾脏疾病的现状及其潜在的治疗方案。本文将重点综述囊性肾病、遗传相关性肾小球疾病、先天性肾脏和尿路异常(CAKUT)、常染色体显性-小管间质肾病(ADTKD)、遗传性肾结石和肾钙质沉着症。
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引用次数: 0
Survival Analysis and Its Predictors Among Hemodialysis Patients at Saint Paul Hospital Millennium Medical College and Myungsung Christian Medical Center in Addis Ababa, Ethiopia, 2021. 2021年埃塞俄比亚亚的斯亚贝巴圣保罗医院千年医学院和明成基督教医疗中心血液透析患者的生存分析及其预测因素
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S401022
Eyob Assefa Betiru, Ephrem Mamo, Dube Jara Boneya, Abebawork Adem, Dessie Abebaw

Background: Diabetes mellitus and hypertension are the most prominent conditions causing chronic kidney disease and eventually end-stage renal disease. Renal replacement therapy, particularly hemodialysis (HD), is the mainstay of treatment. The aim of this study is to assess the overall survival status of HD patients and potential survival predictors at Saint Paul hospital millennium medical college (SPHMMC) and Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia.

Methods: A retrospective cohort study was conducted on HD patients at SPHMMC and MCM general hospital from January 1, 2013 to December 30, 2020. Kaplan Meier, Log-rank, and Cox proportional regression models were used for the analysis. Estimated risks were reported as hazard ratios with 95% confidence intervals and P<0.05 was considered as having a significant association.

Results: A total of 128 patients were included in the study. Median survival time was 65 months. The predominant co-morbid condition was found to be diabetes mellitus with hypertension (42%). The total risk time for these patients was 143,617 person years. The overall incidence rate of death was 2.9 per 10,000 person years (95% CI=2.2-4). Patients who developed blood stream infection were 2.98-times more likely to die than those without infection. Those using an arteriovenous fistula were 66% less likely to die than those using a central venous catheter. Additionally, patients treated in a government-owned facility were 79% less likely to die.

Conclusion: The study identified that the median survival time of 65 months was comparable with developed nations. Significant predictors of death were found to be blood stream infection and type of vascular access. Government-owned treatment facilities showed better patient survival.

背景:糖尿病和高血压是引起慢性肾脏疾病和终末期肾脏疾病的最主要疾病。肾脏替代疗法,特别是血液透析(HD),是主要的治疗方法。本研究的目的是评估圣保罗医院千禧医学院(SPHMMC)和埃塞俄比亚亚的斯亚贝巴Myungsung基督教医疗中心(MCM) HD患者的总体生存状况和潜在的生存预测因素。方法:对2013年1月1日至2020年12月30日在SPHMMC和MCM总医院就诊的HD患者进行回顾性队列研究。采用Kaplan Meier、Log-rank和Cox比例回归模型进行分析。估计风险以95%置信区间的风险比报告。结果:研究共纳入128例患者。中位生存期为65个月。主要的合并症是糖尿病合并高血压(42%)。这些患者的总风险时间为143,617人年。总死亡率为2.9 / 10000人年(95% CI=2.2-4)。发生血流感染的患者的死亡率是没有感染的患者的2.98倍。使用动静脉瘘的患者比使用中心静脉导管的患者死亡率低66%。此外,在政府拥有的机构接受治疗的患者死亡率降低了79%。结论:该研究确定65个月的中位生存时间与发达国家相当。发现血流感染和血管通路类型是死亡的重要预测因子。政府拥有的治疗设施显示患者存活率更高。
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引用次数: 0
Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial. 经皮肾活检的颅侧与尾侧技术:一项随机对照试验。
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S400639
Solos Jaturapisanukul, Chutima Chavanisakun, Nontawat Benjakul, Tanun Ngamvichchukorn, Punnawit Laungchuaychok, Sathit Kurathong, Wanjak Pongsittisak

Background: Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance.

Methods: This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle.

Results: A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, p = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, p = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥10% after kidney biopsy, perinephric hematoma size ≥1 cm, hematuria, and the need for blood transfusion, than the CD group.

Conclusion: The CD technique of the percutaneous kidney biopsy in the native kidney has fewer complications and was possibly more effective than the CN technique.

背景:经皮肾活检(PKB)是诊断各种肾脏疾病的金标准,但它可能导致潜在的并发症。本研究旨在比较实时超声引导下两种肾组织活检技术(颅向活检(CN)和尾向活检(CD))的充分性和安全性。方法:这项单中心、前瞻性、单盲、随机试验纳入了2017年7月5日至2019年6月30日接受原生PKB治疗的患者。患者随机分为CN组和CD组。分析两组间的充分性及并发症。所有PKBs均在实时超声引导下用16号肾活检针进行。结果:共纳入107名参与者(CD组53名,CN组54名)。CD组肾小球多于CN组,但差异无统计学意义(16 vs 11, p = 0.0865)。CD组比CN组获得更多的肾组织样本(69.8%比59.3%,p = 0.348)。两组肾小球组织取样不足的数量相似(分别为14例和15例)。此外,与CD组相比,CN组有更多的不良事件,包括肾活检后Hb下降≥10%,肾周血肿大小≥1 cm,血尿和需要输血。结论:原肾经皮肾活检的CD技术并发症少,可能比CN技术更有效。
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引用次数: 0
Chronic Kidney Disease Management in the Middle East and Africa: Concerns, Challenges, and Novel Approaches. 中东和非洲的慢性肾脏疾病管理:关注、挑战和新方法。
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S363133
Saeed Al-Ghamdi, Ali Abu-Alfa, Turki Alotaibi, Ali AlSaaidi, Abdulkareem AlSuwaida, Mustafa Arici, Tevfik Ecder, Ahmed F El Koraie, Mohamed Ghnaimat, Mohamed H Hafez, Mohamed Hassan, Tarik Sqalli

The burden of chronic kidney disease (CKD) and other comorbidities, such as hypertension and diabetes, which increase the risk of developing CKD, is on the rise in the Middle East and Africa. The Middle East and Africa CKD (MEA-CKD) steering committee, comprising eminent healthcare specialists from the Middle East and Africa, was formed to identify and propose steps to address the gaps in the management of CKD in these regions. The current article lists the MEA-CKD steering committee meeting outcomes and evaluates the available evidence supporting the role of novel therapeutic options for patients with CKD. The need of the hour is to address the gaps in awareness and screening, early diagnosis, along with referral and management of patients at risk. Measures to bring about appropriate changes in healthcare policies to ensure access to all benefit-proven protective therapies, including novel ones, at community levels are also vital for reducing the overall burden of CKD on the healthcare system as well as governing bodies, especially in developing countries of the Middle East and Africa.

在中东和非洲,慢性肾脏疾病(CKD)和其他合并症(如高血压和糖尿病)的负担正在上升,这些合并症会增加患CKD的风险。中东和非洲CKD (MEA-CKD)指导委员会由来自中东和非洲的知名医疗保健专家组成,旨在确定并提出解决这些地区CKD管理差距的步骤。目前的文章列出了MEA-CKD指导委员会会议的结果,并评估了支持CKD患者新治疗方案作用的现有证据。当务之急是解决认识和筛查、早期诊断以及高危患者转诊和管理方面的差距。采取措施适当改变医疗保健政策,以确保在社区层面上获得所有经证实有益的保护性疗法,包括新疗法,对于减轻CKD对医疗保健系统和管理机构的总体负担也至关重要,特别是在中东和非洲的发展中国家。
{"title":"Chronic Kidney Disease Management in the Middle East and Africa: Concerns, Challenges, and Novel Approaches.","authors":"Saeed Al-Ghamdi,&nbsp;Ali Abu-Alfa,&nbsp;Turki Alotaibi,&nbsp;Ali AlSaaidi,&nbsp;Abdulkareem AlSuwaida,&nbsp;Mustafa Arici,&nbsp;Tevfik Ecder,&nbsp;Ahmed F El Koraie,&nbsp;Mohamed Ghnaimat,&nbsp;Mohamed H Hafez,&nbsp;Mohamed Hassan,&nbsp;Tarik Sqalli","doi":"10.2147/IJNRD.S363133","DOIUrl":"https://doi.org/10.2147/IJNRD.S363133","url":null,"abstract":"<p><p>The burden of chronic kidney disease (CKD) and other comorbidities, such as hypertension and diabetes, which increase the risk of developing CKD, is on the rise in the Middle East and Africa. The Middle East and Africa CKD (MEA-CKD) steering committee, comprising eminent healthcare specialists from the Middle East and Africa, was formed to identify and propose steps to address the gaps in the management of CKD in these regions. The current article lists the MEA-CKD steering committee meeting outcomes and evaluates the available evidence supporting the role of novel therapeutic options for patients with CKD. The need of the hour is to address the gaps in awareness and screening, early diagnosis, along with referral and management of patients at risk. Measures to bring about appropriate changes in healthcare policies to ensure access to all benefit-proven protective therapies, including novel ones, at community levels are also vital for reducing the overall burden of CKD on the healthcare system as well as governing bodies, especially in developing countries of the Middle East and Africa.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/16/ijnrd-16-103.PMC10084934.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9673820","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}
引用次数: 2
Erratum: Hyperkalemia and the Use of New Potassium Binders a Single Center Experience from Vestfold Norway (The PotBind Study) [Corrigendum]. 勘误:高钾血症和新钾结合剂的使用:来自挪威Vestfold的单中心经验(PotBind研究)[勘误]。
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S416069

[This corrects the article DOI: 10.2147/IJNRD.S401623.].

[更正文章DOI: 10.2147/IJNRD.S401623.]。
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引用次数: 0
The Sphingosine Kinase 2 Inhibitor Opaganib Protects Against Acute Kidney Injury in Mice. 鞘氨醇激酶2抑制剂Opaganib对小鼠急性肾损伤的保护作用。
IF 2 Q2 Medicine Pub Date : 2022-11-17 eCollection Date: 2022-01-01 DOI: 10.2147/IJNRD.S386396
Lynn W Maines, Cecelia L Green, Staci N Keller, Leo R Fitzpatrick, Charles D Smith

Introduction: Acute kidney injury (AKI) is a common multifactorial adverse effect of surgery, circulatory obstruction, sepsis or drug/toxin exposure that often results in morbidity and mortality. Sphingolipid metabolism is a critical regulator of cell survival and pathologic inflammation processes involved in AKI. Opaganib (also known as ABC294640) is a first-in-class experimental drug targeting sphingolipid metabolism that reduces the production and activity of inflammatory cytokines and, therefore, may be effective to prevent and treat AKI.

Methods: Murine models of AKI were used to assess the in vivo efficacy of opaganib including ischemia-reperfusion (IR) injury induced by either transient bilateral occlusion of renal blood flow (a moderate model) or nephrectomy followed immediately by occlusion of the contralateral kidney (a severe model) and lipopolysaccharide (LPS)-induced sepsis. Biochemical and histologic assays were used to quantify the effects of oral opaganib treatment on renal damage in these models.

Results: Opaganib suppressed the elevations of creatinine and blood urea nitrogen (BUN), as well as granulocyte infiltration into the kidneys, of mice that experienced moderate IR from transient bilateral ligation. Opaganib also markedly decreased these parameters and completely prevented mortality in the severe renal IR model. Additionally, opaganib blunted the elevations of BUN, creatinine and inflammatory cytokines following exposure to LPS.

Conclusion: The data support the hypotheses that sphingolipid metabolism is a key mediator of renal inflammatory damage following IR injury and sepsis, and that this can be suppressed by opaganib. Because opaganib has already undergone clinical testing in other diseases (cancer and Covid-19), the present studies support conducting clinical trials with this drug with surgical or septic patients at risk for AKI.

简介:急性肾损伤(AKI)是一种常见的多因素不良反应,包括手术、循环梗阻、败血症或药物/毒素暴露,通常导致发病率和死亡率。鞘脂代谢是AKI中细胞存活和病理性炎症过程的关键调节因子。Opaganib(也被称为ABC294640)是一种一流的靶向鞘脂代谢的实验性药物,可降低炎症细胞因子的产生和活性,因此可能有效预防和治疗AKI。方法:使用小鼠AKI模型来评估opaganib的体内疗效,包括由短暂的双侧肾血流阻塞(中度模型)或肾切除术后立即闭塞对侧肾(严重模型)和脂多糖(LPS)诱导的脓毒症引起的缺血再灌注(IR)损伤。采用生化和组织学分析来量化口服奥帕格尼治疗对这些模型肾损害的影响。结果:Opaganib抑制了短暂性双侧结扎引起的中度IR小鼠肌酐和血尿素氮(BUN)的升高,以及粒细胞向肾脏的浸润。Opaganib也显著降低了这些参数,并完全预防了严重肾IR模型的死亡率。此外,opaganib降低了暴露于LPS后BUN、肌酐和炎症细胞因子的升高。结论:这些数据支持鞘脂代谢是IR损伤和脓毒症后肾脏炎症损伤的关键介质的假设,并且可以被opaganib抑制。由于opaganib已经在其他疾病(癌症和Covid-19)中进行了临床试验,因此目前的研究支持对有AKI风险的手术或败血症患者进行该药物的临床试验。
{"title":"The Sphingosine Kinase 2 Inhibitor Opaganib Protects Against Acute Kidney Injury in Mice.","authors":"Lynn W Maines,&nbsp;Cecelia L Green,&nbsp;Staci N Keller,&nbsp;Leo R Fitzpatrick,&nbsp;Charles D Smith","doi":"10.2147/IJNRD.S386396","DOIUrl":"https://doi.org/10.2147/IJNRD.S386396","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is a common multifactorial adverse effect of surgery, circulatory obstruction, sepsis or drug/toxin exposure that often results in morbidity and mortality. Sphingolipid metabolism is a critical regulator of cell survival and pathologic inflammation processes involved in AKI. Opaganib (also known as ABC294640) is a first-in-class experimental drug targeting sphingolipid metabolism that reduces the production and activity of inflammatory cytokines and, therefore, may be effective to prevent and treat AKI.</p><p><strong>Methods: </strong>Murine models of AKI were used to assess the in vivo efficacy of opaganib including ischemia-reperfusion (IR) injury induced by either transient bilateral occlusion of renal blood flow (a moderate model) or nephrectomy followed immediately by occlusion of the contralateral kidney (a severe model) and lipopolysaccharide (LPS)-induced sepsis. Biochemical and histologic assays were used to quantify the effects of oral opaganib treatment on renal damage in these models.</p><p><strong>Results: </strong>Opaganib suppressed the elevations of creatinine and blood urea nitrogen (BUN), as well as granulocyte infiltration into the kidneys, of mice that experienced moderate IR from transient bilateral ligation. Opaganib also markedly decreased these parameters and completely prevented mortality in the severe renal IR model. Additionally, opaganib blunted the elevations of BUN, creatinine and inflammatory cytokines following exposure to LPS.</p><p><strong>Conclusion: </strong>The data support the hypotheses that sphingolipid metabolism is a key mediator of renal inflammatory damage following IR injury and sepsis, and that this can be suppressed by opaganib. Because opaganib has already undergone clinical testing in other diseases (cancer and Covid-19), the present studies support conducting clinical trials with this drug with surgical or septic patients at risk for AKI.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/d1/ijnrd-15-323.PMC9677921.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40703892","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}
引用次数: 0
Full and Booster Doses of SARS-CoV-2 mRNA-1273 Vaccine Increase Waning Antibody Levels After Completed Vaccination Among Dialysis Patients at a Large Dialysis Organization. 在一家大型透析机构的透析患者中,全剂量和加强剂量的SARS-CoV-2 mRNA-1273疫苗可提高完成疫苗接种后的抗体水平。
IF 2 Q2 Medicine Pub Date : 2022-11-16 eCollection Date: 2022-01-01 DOI: 10.2147/IJNRD.S383215
Linda H Ficociello, Joanna Willetts, Claudy Mullon, Curtis Johnson, Michael S Anger, Jeffrey L Hymes
{"title":"Full and Booster Doses of SARS-CoV-2 mRNA-1273 Vaccine Increase Waning Antibody Levels After Completed Vaccination Among Dialysis Patients at a Large Dialysis Organization.","authors":"Linda H Ficociello,&nbsp;Joanna Willetts,&nbsp;Claudy Mullon,&nbsp;Curtis Johnson,&nbsp;Michael S Anger,&nbsp;Jeffrey L Hymes","doi":"10.2147/IJNRD.S383215","DOIUrl":"https://doi.org/10.2147/IJNRD.S383215","url":null,"abstract":"","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3d/f4/ijnrd-15-319.PMC9675998.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40481891","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}
引用次数: 0
Kinetics of Plasma Cytokines During Two Different Modalities of Extracorporeal Blood Purification in the Critically Ill Covid 19 Patients: A Cohort Study. 危重患者两种不同方式体外血液净化过程中血浆细胞因子动力学:一项队列研究
IF 2 Q2 Medicine Pub Date : 2022-11-02 eCollection Date: 2022-01-01 DOI: 10.2147/IJNRD.S382776
Daniela Ponce, Welder Zamoner, Luis Eduardo Magalhães, Paula Gabriela Sousa de Oliveira, Patricia Polla, Alexandre Naime Barbosa, Marjorie de Assis Golim, André Luís Balbi Snr

Background: In the absence of direct therapy for COVID-19, extracorporeal blood treatment (EBT) could represent an option for cytokine removal.

Objective: This study aimed to describe and compare cytokine removal during intermittent haemodialysis (IHD) and continuous renal replacement therapy (CRRT) in COVID-19 patients with Acute Kidney Injury (AKI).

Methods: It was a cohort study that studied patients with COVID-19-related AKI according to KDIGO criteria and admitted at Intensive Care Unit (ICU). Blood samples were collected at the start and end of both IHD using high flux (HF) membranes (10 patients) and continuous venovenous haemodiafiltration (CVVHDF:10 patients) in two sessions for measuring 13 different plasma interleukins and calculating the cytokine removal rate.

Results: There was no difference between the two groups regarding mechanical ventilation, vasoactive drug, age or prognostic scores. Patients treated by CRRT presented higher levels of IL-2 and IL-8 than patients treated by IHD at dialysis start. Cytokine removal ranged from 9% to 78%. Patients treated by CRRT presented higher cytokine removal for IL-2, IL-6 IL-8, IP-10 and TNF. The removal rates of IL-4, IL-10, IL-17A, IFN, MCP-1 and TGF-B1 were similar in two groups. After one session of CVVHDF (24 h), IL-2 and IL-1β levels did not vary significantly, whereas IL-4, IL-6, IL-8, IL-10, IL-17A, TNF, IFN, IP-10, MCP-1, IL-12p70 and TGF-B1 decreased by 33.8-76%, and this decrease was maintained over the next 24 h. In IHD groups, IL-2, IL-6, TNF, IP-10 and IL-1β levels did not decrease significantly whereas IL-4, IL-8, IL-10, IL-17A, IFN, MCP-1, IL-12p70 and TGF-B1 decreased by 21.8-72%; however, cytokine levels returned to their initial values after 24 h.

Conclusion: Cytokine removal is lower in IHD using HF membranes than in CVVHDF, and in IHD the removal is transient and selective, which can be associated with mortality during cytokines storm-related COVID-19.

背景:在COVID-19缺乏直接治疗的情况下,体外血液治疗(EBT)可能是细胞因子去除的一种选择。目的:本研究旨在描述和比较COVID-19急性肾损伤(AKI)患者间歇血液透析(IHD)和持续肾脏替代治疗(CRRT)期间细胞因子的去除情况。方法:采用队列研究方法,对符合KDIGO标准并在重症监护病房(ICU)住院的covid -19相关AKI患者进行研究。采用高通量(HF)膜(10例)和连续静脉-静脉血液滤过(CVVHDF:10例)在IHD开始和结束时采集血样,分两期测量13种不同的血浆白细胞介素并计算细胞因子去除率。结果:两组患者在机械通气、血管活性药物、年龄和预后评分方面无差异。CRRT治疗的患者在透析开始时IL-2和IL-8水平高于IHD治疗的患者。细胞因子去除率从9%到78%不等。接受CRRT治疗的患者IL-2、IL-6、IL-8、IP-10和TNF的细胞因子去除率较高。两组患者对IL-4、IL-10、IL-17A、IFN、MCP-1、TGF-B1的去除率相似。1次CVVHDF(24小时)后,IL-2和IL-1β水平无显著变化,而IL-4、IL-6、IL-8、IL-10、IL-17A、TNF、IFN、IP-10、MCP-1、IL-12p70和TGF-B1水平下降33.8-76%,并在接下来的24小时内保持这种下降。在IHD组中,IL-2、IL-6、TNF、IP-10和IL-1β水平未显著下降,而IL-4、IL-8、IL-10、IL-17A、IFN、MCP-1、IL-12p70和TGF-B1水平下降21.8-72%;结论:使用HF膜的IHD患者细胞因子的去除低于CVVHDF,并且在IHD中细胞因子的去除是短暂的和选择性的,这可能与细胞因子风暴相关的COVID-19期间的死亡率有关。
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引用次数: 0
Clinical Evaluation of Dapagliflozin in the Management of CKD: Focus on Patient Selection and Clinical Perspectives. 达帕格列净治疗慢性肾脏病的临床评估:关注患者选择和临床视角。
IF 2.1 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-11-01 eCollection Date: 2022-01-01 DOI: 10.2147/IJNRD.S234282
Khaled Nashar, Patricia Khalil

Dapagliflozin is a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor that was recently approved in the USA and the EU for the treatment of adults with chronic kidney disease (CKD) with or without diabetes mellitus (DM). The DAPA-CKD trial showed a 39% decline in the risk of worsening kidney function, onset of end-stage kidney disease, or kidney failure-related death. Patients with lower levels of eGFR and higher levels of albuminuria are among those who stand to gain the greatest absolute benefits. These benefits were similar in both patients with or without diabetes, thus undermining the hypothesis that these drugs mitigate glycemia-related nephrotoxicity. Suggested mechanisms for renal protection include hemodynamic effects; BP reduction and improving salt sensitivities and metabolic effects; and glucose, uric acid and triglycerides (TG)-lowering effects. There have been already many excellent reviews on dapagliflozin and CKD management. Most of them cover both efficacy and safety. This review will focus on clinical perspectives and patient selection for the practicing clinician.

达帕格列净是一种选择性钠-葡萄糖共转运体 2 (SGLT2) 抑制剂,最近在美国和欧盟获批用于治疗伴有或不伴有糖尿病 (DM) 的成人慢性肾病 (CKD)。DAPA-CKD 试验显示,肾功能恶化、终末期肾病发病或肾衰竭相关死亡的风险降低了 39%。eGFR 水平较低而白蛋白尿水平较高的患者绝对获益最大。无论患者是否患有糖尿病,这些益处都是相似的,因此削弱了这些药物可减轻与血糖相关的肾毒性的假设。建议的肾脏保护机制包括血液动力学效应;降低血压、改善盐敏感性和代谢效应;以及降低血糖、尿酸和甘油三酯(TG)效应。已有许多关于达帕格列净和慢性肾脏病管理的优秀综述。其中大多数都涉及疗效和安全性。本综述将侧重于临床视角和患者选择,供临床医生参考。
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引用次数: 0
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International Journal of Nephrology and Renovascular Disease
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