Kidney Research and Clinical Practice最新文献

Background: Several studies have reported that dementia has a high prevalence in end-stage kidney disease (ESKD) patients. However, the relationship between physical activity (PA) and the risk of dementia has not been elucidated for hemodialysis patients.

Methods: A total of 11,724 patients aged ≥40 years who started hemodialysis between 2012 and 2017 were identified from the Korean National Health Insurance Service database. Individuals with PA were defined as meeting the following criteria: 1) 1 or more days per week of vigorous activity of at least 20 minutes per day or 2) 1 or more days per week of moderate-intensity activity of at least 30 minutes per day. The occurrence of dementia was monitored until the end of 2018 based on specific codes of International Classification of Diseases, 10th Revision.

Results: During the 1.9-year follow-up, 489 hemodialysis patients developed dementia. PA was associated with a lower risk of any dementia (hazard ratio, 0.686; 95% confidence interval, 0.553-0.85) even after adjusting for confounding factors. The risk of dementia was lower in hemodialysis patients with PA when the risk of Alzheimer disease was analyzed separately, but vascular dementia was not. PA was associated with a lower risk of dementia in a dose-dependent manner when stratified by the energy expenditure level. In subgroup analyses stratified by age, sex, income level, smoking, drinking, diabetes mellitus, hypertension, dyslipidemia, and cerebrovascular accident, the risk of dementia tended to be lower in hemodialysis patients with PA than in those without PA.

Conclusion: PA was associated with a lower risk of dementia development in ESKD patients undergoing hemodialysis.

Background: Intradialytic cardiac arrest is a serious complication of hemodialysis (HD) in patients with end-stage kidney disease. Therefore, appropriate emergency equipment should be prepared before the initiation of HD. However, little is known about the effects of preparedness of emergency equipment on the outcomes of patients undergoing HD. We aimed to evaluate the effects of preparedness of emergency equipment on mortality in Korean patients undergoing maintenance HD.

Methods: Data from HD quality assessment and National Health Service claims between October and December 2015 were used. In total, 34,950 patients were categorized into two groups based on the availability of emergency equipment in the HD facilities. Cox proportional hazards models were used to assess the impact of preparedness of emergency equipment on patient mortality over a mean follow-up period of 53.7 ± 23.0 months.

Results: The proportions of patients in the groups with and without emergency equipment were 95.2% (n = 33,267) and 4.8% (n = 1,683), respectively. Serum calcium and phosphorus levels, as well as systolic and diastolic blood pressures, were lower, whereas single-pool Kt/V was higher, in the group with emergency equipment than in the group without. After adjustment for demographic and clinical parameters, preparedness of emergency equipment was observed to be an independent risk factor for patient mortality (hazard ratio, 0.87; 95% confidence interval, 0.79-0.96; p = 0.004).

Conclusion: Preparedness of emergency equipment was associated with decreased mortality among patients undergoing HD. A well-equipped HD unit can help increase patient survival.

Background: Chronic kidney disease prognosis is determined based on glomerular filtration rate and albuminuria categories. However, the albumin-to-creatinine ratio (ACR) test is not performed on all patients as a screening test. The purpose of this study was to identify risk factors for patients with albuminuria confirmed by a urine dipstick negative and develop a model to predict underestimated patients.

Methods: We analyzed data from 19,034 adult patients with a urine dipstick negative from the 2019- 2022 Korea National Health and Nutrition Examination Survey. The risk factor of albuminuria was analyzed by comparing patients with albuminuria with a urine dipstick negative with patients without albuminuria.

Results: A total of 753 patients were identified as having albuminuria with a negative urine dipstick. The results of examinations that can be evaluated at the primary care site, such as sex, age, height, weight, body mass index, abdominal circumference, and blood pressure, were significant. Chronic diseases such as hypertension, diabetes mellitus, and dyslipidemia also showed significant differences. A prediction model was built using the additive score system for factors that showed significant differences, and it was confirmed that the logistic regression and score models had high agreement.

Conclusion: We classified the ACR high-risk group by checking the medical history and physical measurement values that can be performed in the primary examination and applied the blood pressure value to the score model along with self-diagnosis items. In the long term, this model is expected to aid in the cost-effective management of CKD through selective ACR testing.

Background: Although treatment guidelines exist, referrals and discussions among clinicians about the disease can lead to more appropriate treatment for the patient. This study evaluated the effects of referrals from diabetes clinics to nephrologists on kidney function in type 2 diabetic patients through causal inference analysis.

Methods: This study included patients with type 2 diabetes who initially visited the diabetes clinic between 2004 and 2023. Patients were either referred to nephrologists (named the referral group) or continued under the care of diabetologists in the diabetes clinic (named the non-referral group). The slope of the estimated glomerular filtration rate (eGFR) per year was calculated based on the annual median difference in yearly eGFRs, and cases were censored when the values dropped below 10 mL/min/1.73 m2. We applied a difference-in-differences model to this time-series dataset with an inverse propensity weighting estimator to evaluate the effect of referral to nephrologists.

Results: Among the 30,160 patients who initially visited the diabetes clinic, 3,885 (12.9%) were referred to nephrologists during follow-up. At the time of referral, the median (interquartile range) values of the eGFR and random urine albumin-to-creatinine ratio were 55.0 mL/min/1.73 m2 (40.3-76.8 mL/min/1.73 m2) and 107 mg/g (20-846 mg/g), respectively. The average treatment effect of referral to nephrologists was an improvement in the eGFR slope, with an increase of 5.8 mL/min/1.73 m2 (95% confidence interval, 4.8-6.8 mL/min/1.73 m2) per year. The effect of referral was greater in patients with a high risk of progression than in those with a low risk.

Conclusion: Referral to nephrologists is associated with slow progression of kidney dysfunction in patients with type 2 diabetes, supporting the need to evaluate how to facilitate timely referral for each patient as a next step.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common form of polycystic kidney disease (PKD) and is a typical adult-onset multisystem disorder. It is a progressive disease characterized by the disruption of renal tubular integrity, involving the modulation of cellular proliferation and apoptosis. Most ADPKD results from a mutation in either the PKD1 or PKD2 gene encoding polycystin-1 and polycystin-2, respectively. With the inconsistent disease course of ADPKD, biomarkers that can predict the treatment efficacy and rapid progression of the disease are needed. Studies have identified neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for predicting the progression of ADPKD patients. The NGAL protein is expressed at a low level in the kidneys, which helps to regulate iron transport and participates in epithelial differentiation, inflammation, and cell proliferation. NGAL level also increases in serum and urine during renal detrimental conditions such as ischemia and acute and chronic kidney diseases. On the other hand, some studies have also demonstrated that NGAL may act as a tubulogenic factor controlling cell growth and that the upregulation of the Ngal gene hinders tubular cell proliferation, resulting in significantly reduced cyst growth in cellular and murine models of ADPKD. This review attempts to correlate ADPKD and NGAL based on available research findings to evaluate the therapeutic potential of NGAL in ADPKD.

Renal fibrosis (RF) is a prevalent clinical symptom of numerous chronic kidney illnesses and a significant pathological alteration in end-stage renal disease resulting from various mechanisms, such as abnormally activated signaling pathways, microRNAs, aging, autophagy disorders, and fibrotic ecological niches, all of which contribute to RF development. Inhibiting, blocking, or delaying the aforementioned mechanisms may yield novel approaches for treating RF. This article explores advancements in the comprehension of the mechanisms and therapeutic approaches for RF.

Background: South Korea stands out as a prominent nation relying heavily on living-donor transplants, with a high incidence of living-donor kidney transplants. This study aimed to obtain objective data on the psychological, social, and mental health status of living kidney donors in South Korea.

Methods: A questionnaire was administered to living kidney donors at two tertiary hospitals between June 2020 and November 2020. The survey covered demographic information, motives for donation, concerns during donation, medical and socioeconomic evaluation, pain assessment, quality of life using the 36-Item Short Form Health Survey measurement, and depression screening using the nine-item Patient Health Questionnaire.

Results: A total of 95 donors completed the pre-donation survey, 273 completed the post-donation survey, and 68 completed both surveys. Most donors prioritized altruistic reasons for donating, with concerns primarily related to physical issues. After donation, the donors experienced a decrease in subjective health scores and quality of life and an increase in depressive symptoms. Economic and social changes were reported by 34.2% of the donors, with significant financial burdens related to surgical costs and insurance restrictions.

Conclusion: Living kidney donors in Korea face psychological, social, and economic challenges after donation. Understanding the donors' concerns and difficulties is crucial to ensure their wellbeing and provide appropriate support.

Sarcopenia, commonly found in the elderly and characterized by the loss of skeletal muscle mass, decreased muscle strength, and reduced physical performance, draws attention because it often leads to frailty, an increased risk of falls and fractures, and higher morbidity and mortality. Patients with chronic kidney disease (CKD) usually suffer from malnutrition, physical inactivity, inflammation, metabolic acidosis, insulin resistance, and other hormonal changes, which are all aggravating factors of sarcopenia. Therefore, the prevention, early detection, and adequate management for sarcopenia in patients with CKD help to improve their quality of life, prevent various complications and disabilities, as well as to reduce the risk of major morbidities and death. We reviewed the diagnosis and prevalence of sarcopenia in CKD and discussed the risk factors, etiology, pathophysiology, clinical impacts, and present treatment strategies for sarcopenia in CKD. The applications of exercises along with nutritional interventions, correction of metabolic acidosis caused by CKD, anabolic hormones, appetite stimulants, and other agents in uremic sarcopenia were discussed. Early detection and adequate management help to improve muscle strength and mass and enhance physical performance, therefore improving the quality of life and reducing mortality in CKD patients with sarcopenia.

The worldwide prevalence of chronic kidney disease (CKD) is high and growing, making CKD a leading cause of mortality. Skeletal muscle wasting, sometimes called sarcopenia or protein-energy wasting, is a frequent, serious consequence of CKD that reduces muscle strength and function, diminishes the quality of life of patients, and raises their risk of comorbidities and death. Muscle atrophy results from a disturbance in muscle protein balance that results from some combination of an increased rate of protein degradation, a decreased rate of protein synthesis, and dysfunctional muscle regeneration. Development of therapeutic strategies to ameliorate muscle loss, or maintain muscle mass, is challenging because of the multifactorial nature of the signals that alter protein homeostasis. This review discusses the cellular signals and mechanisms that negatively alter protein turnover in skeletal muscle during CKD.

Background: Traditional statistical models for estimating the impact of multiple environmental chemicals on kidney outcomes have limitations. This study aimed to evaluate the risk prediction of kidney disease in the general population using innovative methodologies.

Methods: Serum persistent organic pollutant (POP), urinary chemical, serum creatinine, and urinary albumin levels were measured in a subpopulation of adults (n = 1,266) drawn from the Korean National Environmental Health Survey Cycle 3 (n = 3,787). Various machine learning (ML) models, including bagging, ridge, lasso, and random forest, were used to predict chronic kidney disease (CKD) risk, and their results were compared with those of conventional logistic regression methods. Furthermore, the weighted quantile sum (WQS) approach, which assigns weights to mixture components, was employed to evaluate multi-pollutant effects. Presplit was attempted to incorporate existing domain knowledge.

Results: A total of 42 variables, including baseline characteristics and laboratory findings, were analyzed during the ML modeling process. The decision tree algorithm generally outperformed logistic regression in risk prediction. Based on the decision tree models, lipid-corrected polychlorinated biphenyl 153 (PCB153) emerged as the strongest predictor of CKD. PCB153 remained a significant predictor of CKD in middle-aged adults (<50 years; p = 0.01) following age stratification. Particularly among middle-aged adults with hemoglobin levels >13.25 g/dL, CKD risk was predicted to be 71.4% in the high serum PCB153 group.

Conclusion: Current observations showed that utilizing both WQS regression and ML-based predictions offers valuable insights. In the models, POPs, particularly PCB153, were identified as important risk factors for CKD in Korean adults.