Journal of Nephrology最新文献

Background: Anaemia is a common complication of chronic kidney disease (CKD) impacting clinical outcomes and quality of life (QoL). Despite available treatment options, unmet needs exist, especially in relation to QoL. We aimed to develop a consensus of European nephrologists' opinion on the management of anaemia of CKD.

Method: Seventy-six nephrologists from seven European countries participated in a modified Delphi panel, consisting of two survey rounds followed by an online consensus meeting. Consensus was defined as ≥ 80% agreement or disagreement. The responses were initially assessed against the KDIGO 2012 guideline and reassessed against the draft KDIGO 2025 guideline.

Results: Panellists did not reach consensus on current guidelines being easy to implement or adequately considering patient needs, noting that updates are still needed. Patients with chronic inflammation, infection, erythropoiesis-stimulating agent (ESA) resistance, or cancer were identified as populations with unmet needs. Consensus was reached that patients should be more involved in decision-making regarding therapy options. Health-related QoL (HRQoL) was acknowledged as important in the management but no consensus was reached on the use of validated HRQoL tools.

Conclusions: European nephrologists believe that existing clinical practice guidelines are not sufficient for the management of patients with anaemia of CKD, especially in those with ESA hyporesponsiveness, infection, chronic inflammation, and malignancy. Unmet needs exist in personalized care, particularly with regard to involving patients and carers in clinical management decisions and using HRQoL tools in routine care. There are no substantial changes in the draft KDIGO 2025 guideline to adequately address the unmet needs identified here.

Background: Acute kidney injury (AKI) is linked to a heightened risk of progressing to chronic kidney disease (CKD) in individuals exhibiting normal baseline kidney function. However, the extent of such association in individuals with pre-existing CKD or renal impairment has been insufficiently investigated. Hence, we performed an extensive literature review and meta-analysis of the literature.

Methods: Articles published on PubMed, Embase, and Cochrane (up to December 2, 2024) were searched for post-hoc analyses/sub-analysis of randomized controlled trials (RCTs) or observational studies that evaluated the association between AKI insult and long-term progression or overall death in individuals with pre-existing CKD or kidney dysfunction. All selected articles incorporated odds ratio (OR), hazard ratio (HR), or relative risk (RR) statistics along with data for assessing the association. Pooled RRs and 95% confidence intervals (CI) were derived utilizing random-effects models, notwithstanding the heterogeneity evaluated by I² statistic. The protocol was not registered at PROSPERO or SRDR.

Results: Ultimately, 39 studies with an aggregate of 332,198 participants were determined to be eligible for inclusion. Of them, 28 studies were included in an analysis of CKD progression risk, and 27 studies were incorporated in the analysis of all-cause mortality. Individuals who have experienced AKI were at  elevated risk for progression of CKD (HR 2.36, 95% CI 1.96-2.85) and all-cause mortality (1.58, 1.38-1.81) with significant heterogeneity. Subgroup and sensitivity analyses supported the findings. For both outcomes, gradient of risk was observed as the AKI stage increased. For all-cause mortality, the risk magnitude was modified by the clinical environment.

Conclusions: A history of AKI is correlated with heightened risks of CKD progression and overall death in patients with pre-existing CKD. Future research should be focused on the frequency of AKI episodes, the restoration of kidney function according to the different timeframe, and the impact of concomitant proteinuria on prognosis in these patients.

Background: Kidney function declines faster in patients with type 2 diabetes mellitus (T2DM) than in those without, and coronary artery calcification is a risk factor for adverse kidney outcomes. Thus, we examined whether T2DM modified the relationship between coronary artery calcification and chronic kidney disease (CKD) progression.

Methods: Among 2067 participants from the KoreaN Cohort Study for Outcome in Patients With CKD, the main exposures analyzed were T2DM and coronary artery calcification. The primary outcome was CKD progression, which was a composite of > 50% decline in estimated glomerular filtration rate (eGFR) or kidney failure requiring kidney replacement therapy. A multivariable cause-specific hazard model was used to determine the association between the main exposures and the primary outcome.

Results: During 8633 person-years of follow-up, the primary outcome occurred in 565 (27.3%) participants. After adjusting for confounding factors, T2DM and coronary artery calcification score > 0 were associated with 2.03- and 1.51-fold increased risks of CKD progression, respectively. T2DM and coronary artery calcification showed a significant interaction in terms of the primary outcome. In patients with T2DM, coronary artery calcification score > 0 was associated with a significantly higher risk of CKD progression compared with coronary artery calcification score = 0. However, the significant association of coronary artery calcification score > 0 versus coronary artery calcification score = 0 was lost in patients without T2DM. The slope of eGFR decline was steeper in patients with T2DM and coronary artery calcification score > 0 than in those with T2DM or coronary artery calcification score > 0 alone.

Conclusions: Coronary artery calcification is more strongly associated with the risk of CKD progression in patients with T2DM than in those without. Therefore, the clinical implications of coronary artery calcification vary depending on the presence of T2DM.

Background: Pauci-immune glomerulonephritis (GN) is a typical renal manifestation of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, patients positive for ANCA can present with kidney pathologies other than pauci-immune GN. This study aimed to investigate and compare the characteristics of ANCA-positive patients diagnosed with pauci-immune GN to those with non-pauci-immune kidney diseases, based on kidney biopsy findings.

Methods: We retrospectively analyzed the electronic medical records of ANCA-positive patients who underwent kidney biopsy from January 2010 to October 2023 at a single tertiary center in Seoul, Republic of Korea. Logistic regression analysis was performed to identify variables associated with the diagnosis of pauci-immune GN in this cohort.

Results: Of 268 ANCA-positive patients, 195 (72.8%) were diagnosed with pauci-immune GN, while 73 (27.2%) had other kidney diseases. The most common pathologies in the non-pauci-immune GN group were IgA nephropathy (20.5%) and lupus nephritis (16.4%). Compared to the non-pauci-immune GN group, patients with pauci-immune GN exhibited higher platelet counts and C-reactive protein (CRP) levels, along with lower estimated glomerular filtration rate (eGFR). Urine abnormalities, categorized by the presence or absence of hematuria and/or proteinuria, differed significantly between the groups. Multivariate analysis identified hematuria and pulmonary involvement as significant predictors of pauci-immune GN.

Conclusions: Approximately 70% of our ANCA-positive patients who underwent kidney biopsy were diagnosed with pauci-immune GN. Predictive factors for pauci-immune GN included platelet count, CRP levels, eGFR, hematuria, and pulmonary involvement. Identifying these clinical and laboratory markers may be valuable for improving the diagnostic approach towards AAV-related kidney manifestations.