Journal of Nephrology最新文献

Background: Kidney function decline is associated with cardiovascular disease and various other morbidities. Previous studies regarding polygenic risk scores of estimated glomerular filtration rate (eGFR) change were generally based on individuals of European ancestry and not validated on populations of East Asian ancestry.

Methods: We conducted a genome-wide association study for eGFR slope among 26,755 non-diabetic individuals from the Taiwan Biobank. We developed an eGFR slope polygenic risk score and validated its prediction power on chronic kidney disease (CKD) in another sample with 58,777 non-diabetic individuals.

Results: Eight candidate loci associated with eGFR slope (P-value ranging from 1.56 × 10^-6 to 8.73 × 10^-6) located in the SLC9A9, SLC26A8, DEPTOR, OBP2B, PRMT8, C19orf44 genes and an intergenic locus between MTMR12-ZFR genes were identified and a polygenic risk score for eGFR slope was constructed. The polygenic risk score was validated externally to be significantly associated with CKD in another set of individuals (P-value = 0.0182; odds ratio = 0.753; 95% confidence interval: 0.5936-0.9504).

Conclusions: We constructed a genome-wide polygenic risk score for eGFR decline and externally validated its use in predicting CKD in another Taiwan population. Our eGFR slope polygenic risk score might be useful for clinical CKD risk assessment in future, especially for East Asians.

Background: The safety of sodium-glucose co-transporter 2 inhibitors (SGLT2i) during fasting in patients with chronic kidney disease (CKD) remains underexplored. This study investigates the risk of acute kidney injury (AKI) in patients with CKD who are fasting and taking SGLT2i, and also examines the long-term estimated glomerular filtration rate (eGFR) outcomes over 6 months after fasting.

Methods: In this prospective cohort study conducted at the Kidney and Urology Centre, Alexandria, Egypt, 236 Muslim patients with CKD were enrolled during Ramadan. Patients were stratified into two groups: SGLT2i users (n = 56) and non-users (n = 180). Weekly serum creatinine and eGFR were monitored during Ramadan, with monthly follow-up for 6 months post-fasting. AKI was defined as an increase in serum creatinine ≥ 0.3 mg/dL. Logistic regression was used to identify AKI predictors.

Results: The incidence of AKI was 17.8% among SGLT2i users and 23.3% among non-users (RR 0.76; 95% CI 0.41-1.42; p = 0.38), indicating no significant difference. No significant changes were observed in eGFR between the two groups at the end of Ramadan or during the 6-month follow-up. AKI incidence significantly increased with CKD severity (p = 0.036), with 37.5% of CKD stage 5 patients experiencing at least one episode. Logistic regression identified older age and lower baseline eGFR as significant predictors of developing AKI; SGLT2i use was not independently associated with the risk of developing an AKI episode.

Conclusion: SGLT2i use in CKD patients during Ramadan fasting does not increase the risk of AKI. These findings may offer valuable guidance for clinicians managing fasting patients with CKD on SGLT2i therapy.

Background: Lack of data regarding pregnancy post-kidney transplantation challenges clinicians who are faced with complex, high-risk cases. Aiming at tackling knowledge gaps and limited cross-cultural data on pregnancy in kidney transplant recipients (KTRs), we compared the methodologies and pregnancy outcomes of three registries based in three continents.

Methods: Data were gathered from reports and publications of the Pregnancy After Renal Transplantation OUTcomes registry (PARTOUT, Netherlands), the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), and the Transplant Pregnancy Registry International (TPRI, United States of America and international). We targeted the similarities and differences among the registries to understand methodological variations.

Results: The registries utilized distinct approaches regarding data collection which influence data interpretation. PARTOUT conducted a retrospective analysis of all Dutch pregnant KTRs between 1971 and 2017. ANZDATA includes annual surveys on all KTR parenthood events since 1968. TPRI offers international coverage and includes pregnant KTRs voluntarily registered since 1991. Despite methodological differences, preeclampsia, preterm birth and low birth weight were common pregnancy complications, and outcomes were mostly comparable among the registries.

Conclusions: Despite differences in case capture, the three registries reported similar pregnancy and newborn outcomes, confirming that pregnancy in KTRs can be successful with careful monitoring across varying populations. Identifying the strengths and weaknesses of each registry can contribute to improved methodologies for global data collection and lower missing data rates. Although managing large databases may be challenging, aligning data across countries could lead to meaningful data pooling, while identifying drivers of outcomes across subpopulations.

Background: Kidney disease is a chronic health burden that considerably impairs patients' quality of life, necessitating a systematic evaluation of their holistic needs. This study employed the Taiwanese version of the Sheffield Profile for Assessment and Referral for Care (SPARC-T) questionnaire to identify unmet needs among patients with kidney disease.

Methods: In this prospective, cross-sectional study, the patients completed the SPARC-T questionnaire upon admission to the nephrology ward. Scores exceeding predefined thresholds in the psychological, depression, religious and spiritual, or social domains triggered referral to a psychiatry department, social works, or a discharge planning team. Demographic information and SPARC-T scores were analyzed using logistic regression.

Results: A total of 490 patients completed the questionnaire between January 2023 and June 2024. Of these, 47 patients (9.59%) had scores exceeding the threshold in at least one SPARC-T domain. The most frequently reported concerns were depression (6.94%) and spiritual distress (5.51%). Multivariate logistic regression revealed that female patients (odds ratio = 2.21, 95% confidence interval: 1.09 to 4.47) and individuals from low-income groups (odds ratio = 5.56, 95% confidence interval: 1.48 to 20.95) were significantly more likely to report higher distress scores.

Conclusions: Many patients with kidney disease, particularly women and those belonging to low-income groups, experienced unmet needs that extended beyond physical symptoms. Routine use of the SPARC-T is recommended to support patient-centered care by addressing psychological, spiritual, and social concerns alongside clinical management.

IgA nephropathy (IgAN) is the most prevalent glomerulonephritis globally, significantly contributing to kidney failure. B cells are central to its pathogenesis through IgA production. While rituximab is commonly used to deplete B cells, obinutuzumab, a type II anti-CD20 antibody, may provide more effective and sustained depletion. This report regards the efficacy and safety of obinutuzumab in patients with progressive IgAN refractory to other immunosuppressive therapies. We discuss three patients with progressive IgAN aged 21, 35, and 57 years. All patients exhibited significant proteinuria and hematuria, with kidney biopsies confirming IgAN. In addition to supportive care, they all showed favorable responses to initial immunosuppressive therapy but developed kidney function impairment and nephrotic-range proteinuria 2-4 years after discontinuing initial treatments. Following intolerance and/or poor response to a new round of immunosuppressive medications, one patient was switched from rituximab to obinutuzumab (1000 mg), while 2 patients received obinutuzumab (1000 mg, 2 doses). After 12 months of follow-up, all patients achieved sustained B-cell depletion, with a reduction in IgA/C3, proteinuria, and hematuria, and improvement in kidney function. Mild infusion reactions were noted, but no severe adverse events occurred. These findings provide preliminary, hypothesis-generating insights into the efficacy of obinutuzumab in progressive IgAN and highlight the need for further studies on these issues.

Background: Although single-daily cyclosporine may offer an effective therapeutic option with increased compliance and reduced nephrotoxicity, response predictors and long-term outcomes following this regimen remain unclear in children with steroid-dependent nephrotic syndrome.

Methods: A retrospective study was conducted between October 2005 and December 2021 on children with steroid-dependent nephrotic syndrome caused by minimal change disease (MCD) who were treated with preprandial single-daily cyclosporine to maintain 2-h post-dose levels of 500-700 ng/mL. The primary endpoint was the time to treatment failure after single-daily cyclosporine initiation. The secondary endpoint was the long-term outcome at last visit.

Results: After initiating single-daily cyclosporine therapy in 48 children, 31 patients, including 18 who did not experience relapse during treatment, were able to discontinue steroids (response group), while 17 patients experienced treatment failure. The median time to the first relapse after nephrotic syndrome diagnosis was significantly shorter in the treatment failure group than in the response group (2.1 vs. 4.3 months, p = 0.014). Multivariable Cox proportional hazard regression analysis identified two independent risk factors for treatment failure: early first relapse < 2.2 months after nephrotic syndrome diagnosis (hazard ratio: 7.79, 95% confidence interval: 2.29-26.48, p = 0.001) and higher prior relapse rate (hazard ratio: 1.41 per episode increase, 95% confidence interval: 1.07-1.86, p = 0.016). None of the patients progressed to chronic kidney disease Stage 3 or higher.

Conclusions: Single-daily cyclosporine may offer a promising treatment option for children with steroid-dependent nephrotic syndrome caused by MCD, particularly for those who do not experience early relapse following nephrotic syndrome diagnosis and have lower prior relapse rate.