Journal of Nephrology最新文献

Background: Depression and anxiety are commonly experienced by people with chronic kidney disease (CKD). This study aimed to evaluate person- and service-level factors associated with depression and anxiety symptoms. We sought to also understand utilisation of mental health treatments and preferences for future psychological support.

Methods: An online survey recruited participants from six UK kidney services with varying levels of psychosocial provision. The survey was also advertised on social media. Participants completed screening questionnaires for depression and anxiety, alongside questions about mental health history, self-efficacy, treatment and support. The study included adults (18 years or older) living with CKD (stages 3b and above) or those receiving any form of Kidney Replacement Therapy (KRT), including individuals with a functioning kidney transplant. Eligible participants had to complete study measures and be proficient in reading and writing in either English or Welsh, as the survey was administered in these languages. This survey was developed with our Patient and Public Involvement group and was administered from January 2023 until 31st January, 2024 using Qualtrics and RedCap.

Results: Four hundred fifty-eight people completed the survey. Moderate-severe symptoms of depression and anxiety were 37.7% and 26.5%, respectively. Over 50% reported a history of diagnosed depression. In addition to depression, sleep problems and fatigue were identified as future support needs, with over a third indicating a preference for in-centre provision. In case-mix adjusted analysis, there was no variability in depression and anxiety symptoms across centres. Centre location and size were unrelated to symptoms. Age, female gender, current mental health treatments, self-efficacy and perceptions regarding opportunity for support, were associated with symptoms of depression and anxiety. In sub-analysis, there was a negative association between psychosocial staffing levels and depression symptoms.

Conclusion: Patient-related factors and behavioural characteristics were related to variation of these symptoms. There was little evidence of symptom variability across centres, although in a small sub-analysis, psychosocial provision showed a weak negative correlation with depression symptoms. Our findings highlight preferences of future needs which could be helpful for designing future research and service provision.

Background: The present community-based study assessed the prevalence of chronic kidney disease (CKD)/chronic kidney disease of unknown origin (CKDu) as well as anemia in some intense agricultural zones under Hirakud Command Area and evaluated their association with pesticides and heavy metal exposure.

Methods: Random cluster sampling method was used to assess the prevalence of CKD and anemia. Hematological analysis was carried out using autoanalyzer. Pesticide residues in soil, water, rice grains, blood and urine samples were analyzed using LCMSMS and GCMS, while heavy metal levels were assessed using ICP-MS. Risks associated with exposure to pesticides and to heavy metals through dietary and non-dietary sources were assessed using the United States Environmental Protection Agency (USEPA) method.

Results: CKDu was predominant among the farming community in "blocks" i.e. administrative units in rural governance, functioning as subdivisions of districts in India with intense agricultural activities. Blocks reporting higher prevalence of CKDu showed greater concentrations of nephrotoxic pesticide residues in the soil, water and rice grain. Heavy metals in water, such as cadmium, chromium, lead and arsenic, were found to be above permissible limits in all the hotspot blocks. Dietary exposure to pesticide residues was presumed to contribute significantly to non-carcinogenic risk among the exposed population. Analysis of blood and urine samples collected from patients with CKD/CKDu indicated the presence of nephrotoxic pesticide residues and heavy metals among the directly exposed group. Anemia was found to be prevalent among CKDu patients.

Conclusion: The present study indicated a strong association between environmental toxicants, like pesticides and heavy metals, and the onset and progression of CKD, as well as anemia in a high intensity agricultural zone. Dietary exposure to pesticides and heavy metals may pose high risks for kidney diseases.

Background: The estimation of glomerular filtration rate (eGFR) is essential in the early detection of diabetic nephropathy. We herein compare the performance of common eGFR formulas against a gold standard measurement of GFR in patients with diabetes mellitus.

Methods: GFR was measured in 93 patients with diabetes mellitus using iohexol clearance as the reference standard. The performance of the creatinine- and cystatin C-based EKFC formulas (2021, 2023) and the CKD-EPI formulas (2009, 2012) was compared against measured GFR.

Results: Sixty patients with type 2 diabetes mellitus and 33 patients with type 1 diabetes mellitus were included. The creatinine-based EKFC formula showed lower bias and higher accuracy than the CKD-EPI formula. No significant difference was observed between the cystatin C-based formulas. The combined creatinine- and cystatin C-based formulas had the highest accuracy and lowest bias. Body fat or diabetes type did not significantly influence the accuracy of the cystatin C-based formulas.

Conclusions: Our study demonstrated a slight advantage of the creatinine-based EKFC formula over the CKD-EPI formula in patients with diabetes. However, both for the CKD-EPI and the EKFC formula, the best performance was achieved by the combined creatinine- and cystatin C-based formulas.

Background: Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy prescription and the progression of kidney disease in patients with CKD.

Methods: CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with CKD (eGFR < 60 mL/min/1.73 m²). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient's kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways).

Results: At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (n = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HR_KRT 0.89, 95% CI 0.67-1.20).

Conclusions: Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.

Background: One of the most common secondary glomerular diseases in children is IgA vasculitis-associated nephritis (IgAVN). Determining the best treatment for IgAVN based on current guidelines is controversial. The purpose of this study was to evaluate the efficacy of methylprednisolone pulse therapy in Chinese children with moderate and severe IgAVN.

Methods: We compared outcomes between 86 children with IgAVN who received methylprednisolone pulse therapy (40 patients) and those who did not (46 patients). Both groups of patients were monitored for a minimum of one year. Laboratory results including 24-h proteinuria, serum albumin, serum creatinine, and clinical symptoms including edema and adverse reactions were compared.

Results: The average age of the children in the group receiving methylprednisolone pulse therapy was 8.71 ± 2.71 years, while the average age in those who did not receive pulse therapy was 8.48 ± 3.02 years. Methylprednisolone pulse treatment resulted in a longer-lasting reduction in urinary protein levels and in reduced recurrence rates and increased remission rates at 3 and 6 months (methylprednisolone: 65% and 85% versus no methylprednisolone: 43.48% and 67.39%, respectively). The recurrence rate within one year also differed significantly between the two groups. Within one year, 25% of children receiving methylprednisolone pulse therapy relapsed, whereas 43.5% of children not receiving methylprednisolone pulse therapy relapsed.

Conclusions: In Chinese children with moderate to severe IgAVN, methylprednisolone pulse therapy achieved a significantly higher remission rate and a more rapid eGFR improvement than non-methylprednisolone pulse therapy. Prompt initiation of methylprednisolone pulse therapy for children diagnosed with moderate to severe IgAVN may therefore be recommended.

Background: Renal functional reserve (RFR) measures the difference between the stimulated glomerular filtration rate (GFR) and the baseline GFR to detect early signs of renal functional decline. The protein load test (RFR-T) is the gold standard for RFR assessment but is a complicated procedure. Renal intraparenchymal resistance index (RRI) variation test (DRRI-T) is a non-invasive method to measure renal function reserve using ultrasound. A saline bag is used to induce renal vasodilation, and the DRRI is found by calculating the difference between baseline (without weight) and stress RRI (with weight). Normal DRRI-T is greater than 0.05.

Methods: Our study compared RFR-T and DRRI-T in 50 patients with normal kidney function. We evaluated anthropometric parameters, cardiovascular risk factors, and performed blood and urine tests. Patients were over 18 years old with an estimated GFR (eGFR) CKD-EPI > 60 mL/min/1.73 m². We excluded pregnant patients, those intolerant to milk protein, those with abnormal kidney ultrasound, or taking medication affecting intrarenal hemodynamics. We used Gwet's AC1 statistic to assess concordance between tests.

Results: Our study found moderate concordance (0.545 coefficient value, p-value < 0.001) between preserved RFR-T (≥ 15 mL/min/1.73 m²) and DRRI (VN > 0.05). Preserved RFR had a significant association with baseline eGFR. Age and sex have an impact on RFR. RFR deteriorates with age, leading to a significant decrease (p = 0.0220), which is more pronounced in women than men (p = 0.0350).

Conclusions: The Ultrasound test (DRRI-T) can measure RFR in just 10 min. This contrasts the gold standard method for estimating RFR, which involves a protein load test, takes a long time to execute, and requires numerous blood and urine samples, making it challenging for large-scale use. While the DRRI-T demonstrated moderate concordance with the protein load test, it did not meet the criteria to be considered a new gold standard test. We posit that it could serve as a valuable initial screening test, warranting further exploration alongside the more elaborate protein load test. Our study suggests that there may be differences between men and women in RFR changes and with regard to age, warranting further investigation on larger populations through ad hoc studies. Our work is among the first to offer original real-life experience in this field.