Kidney Research and Clinical Practice最新文献

Background: Patients with end-stage kidney disease (ESKD) frequently visit the emergency department (ED) due to complications from comorbidities and dialysis. This study aimed to investigate the clinical outcomes and patterns of ED visits, hospitalizations, and in-hospital mortality among ED visits by ESKD patients in South Korea.

Methods: This study utilized data from the National Emergency Department Information System from 2019 to 2021. ED visits were analyzed for ESKD patients and compared with non-chronic kidney disease (non-CKD) patients. Logistic regression analyses were conducted to assess factors associated with hospitalization and mortality, adjusting for demographics, insurance, and clinical characteristics, including the Korean Triage and Acuity Scale (KTAS).

Results: The study included 125,392 ED visits from ESKD patients and 19,287,972 from non-CKD patients. ED visits by ESKD patients had significantly higher hospitalization (66.7%) and in-hospital mortality (9.4%) rates compared to those by non-CKD patients (21.0% and 5.1%, respectively). ESKD patients were older, more frequently female, and more likely to receive medical aid. Factors strongly associated with higher hospitalization and mortality rates included advanced age, male sex, transfer from another facility, higher KTAS scores, and prolonged ED stays. Common causes of ED visits in ESKD patients included vascular device complications, digestive system disorders, pneumonia, pulmonary edema, and fluid or electrolyte imbalances.

Conclusion: ED visits by patients with ESKD were characterized by high severity, hospitalization rates, and in-hospital mortality. Further research on factors affecting clinical outcomes may improve mortality and morbidity in this population.

The impact of age on the relationship between body mass index (BMI) and all-cause mortality in hemodialysis (HD) patients is not clearly understood. We analyzed the association between BMI and all-cause mortality, stratified by age, in patients undergoing HD using data from the Korean Renal Data System (KORDS). We analyzed 66,129 HD patients from the 2023 KORDS database, with data collected between 2001 and 2022. Patients were grouped by age: <65 years ("young" group, n = 24,589), 65-74 years ("younger-old" group, n = 17,732), and ≥75 years ("older-old" group, n = 23,808). Patients were further stratified into BMI quartiles. Kaplan-Meier curves and event time ratio for the relative change in the survival time were calculated. During the follow-up period, 14,360 (21.7%) of the patients died, with a median follow-up of 3.4 years. Kaplan-Meier curves revealed poorer outcomes in lower BMI quartiles across all age groups. The lowest BMI quartile was significantly associated with a shorter survival time compared to the highest BMI quartile, with a 15% reduction in the young group (p = 0.001) and a 12% reduction in the older-old group (p = 0.002). Predicted survival time increases with rising BMI in the young group, but the rate of increase slows in the younger-old group and plateaus in the older-old group after around a BMI of 25 kg/m2. The decline in survival time with age was more pronounced in the 7-year survival than the 2-year survival. Lower BMI is associated with higher all-cause mortality in HD patients, with a more pronounced impact in younger patients.

Background: Acute kidney injury (AKI) is a critical clinical condition that requires immediate intervention. We developed an artificial intelligence (AI) model called PRIME Solution to predict AKI and evaluated its ability to enhance clinicians' predictions.

Methods: The PRIME Solution was developed using convolutional neural networks with residual blocks on 183,221 inpatient admissions from a tertiary hospital (2013-2017) and externally validated with 4,501 admissions at another tertiary hospital (2020-2021). To assess its application, we conducted a prospective evaluation using retrospectively collected data from 100 patients at the latter hospital, including 15 AKI cases. AKI prediction performance was compared among specialists, physicians, and medical students, both with and without AI assistance.

Results: Without assistance, specialists demonstrated the highest accuracy (0.797), followed by medical students (0.619) and the PRIME Solution (0.568). AI assistance improved overall recall (61.0% to 74.0%) and F1 scores (38.7% to 42.0%), while reducing average review time (73.8 to 65.4 seconds, p < 0.001). However, the impact varied across expertise levels. Specialists showed the greatest improvement (recall, 32.1% to 64.3%; F1, 36.4% to 48.6%), whereas medical students' performance improved but aligned more closely with the AI model. Additionally, the effect of AI assistance varied by prediction outcome, showing greater improvement in recall for cases predicted as AKI, and better precision, F1 score, and review time reduction (73.4 to 62.1 seconds, p < 0.001) for cases predicted as non-AKI.

Conclusion: AKI predictions were enhanced by AI assistance, but the improvements varied according to the expertise of the user.

Background: Cisplatin is widely used in clinical practice, but its nephrotoxicity severely limits its use. Previous studies have shown that cisplatin-induced acute kidney injury (AKI) is closely related to mitochondrial damage and that alleviating mitochondrial dysfunction can alleviate cisplatin-induced AKI. Methylcrotonyl‑CoA carboxylase 2 (MCCC2) is mainly located in mitochondria, where it catalyzes the catabolism of leucine and maintains mitochondrial function; however, the role of MCCC2 in cisplatin-induced renal injury has not yet been studied.

Methods: In vitro, the expression of MCCC2 was manipulated by transfecting HK-2 cells with lentiviruses, and changes in the acetoacetate content, cell viability, apoptosis, oxidative stress, mitochondrial function, and mitochondrial biogenesis were evaluated. In vivo, MCCC2 overexpression was manipulated by adeno-associated viruses, and serum and kidneys were collected for subsequent experiments to detect changes in renal function, tissue damage, apoptosis, oxidative stress, mitochondrial damage, and mitochondrial biogenesis.

Results: We found that MCCC2 was downregulated in cisplatin-induced AKI models. In vitro, leucine catabolism was inhibited by cisplatin, while overexpression of MCCC2 supported leucine catabolism, upregulated peroxisome proliferator-activated receptor gamma coactivator 1-alpha expression, promoted mitochondrial biogenesis, improved mitochondrial function, and alleviated cisplatin-induced apoptosis and oxidative stress in HK-2 cells. In contrast, the knockdown of MCCC2 exacerbated these effects, while leucine deprivation reversed the effects of MCCC2 overexpression on mitochondrial function and biogenesis. In vivo, the overexpression of MCCC2 promoted mitochondrial biogenesis, maintained the integrity of the mitochondrial structure and function, and alleviated cisplatin-induced AKI.

Conclusion: MCCC2 supported leucine catabolism and promoted mitochondrial biogenesis, providing a new therapeutic strategy for cisplatin-induced AKI.

Background: Limited data exist regarding the safety of direct oral anticoagulants in hemodialysis patients with venous thromboembolic disease. This study aims to investigate the safety of direct oral anticoagulants in hemodialysis patients using national data.

Methods: The National Health Insurance Service database was retrospectively queried to identify chronic kidney disease patients who took direct oral anticoagulants for venous thromboembolism from 2008 to 2019. Bleeding complications and all-cause mortality were compared between 118 hemodialysis patients (HD group) and 227 matched chronic kidney disease patients not undergoing hemodialysis (CKD group).

Results: The use of direct oral anticoagulants among chronic kidney disease patients, with or without dialysis, increased over time. The incidence rate of all-cause mortality per 100 person-years was 38.1 in the HD group and 10.5 in the CKD group (adjusted hazard ratio [HR], 3.28; 95% confidence interval [CI], 2.27-4.75; p < 0.001). When considering death as a competing risk, there was no significant difference in gastrointestinal bleeding (adjusted HR, 1.61; 95% CI, 0.91-2.88; p = 0.115) and intracranial bleeding (adjusted HR, 1.86; 95% CI, 0.73-4.74; p = 0.193) between the HD and CKD groups.

Conclusion: In comparison to chronic kidney disease patients not on hemodialysis, the major bleeding risk, including gastrointestinal and intracranial bleeding, was comparable in hemodialysis patients using direct oral anticoagulants for venous thromboembolism.

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

Chronic kidney disease (CKD) has been increasing over the last years, with a rate between 0.49% to 0.87% new cases per year. Currently, the number of affected people is around 850 million worldwide. CKD is a slowly progressive disease that leads to irreversible loss of kidney function, end-stage kidney disease, and premature death. Therefore, CKD is considered a global health problem, and this sets the alarm for necessary efficient prediction, management, and disease prevention. At present, modern computer analysis, such as in silico medicine (ISM), denotes an emergent data science that offers interesting promise in the nephrology field. ISM offers reliable computer predictions to suggest optimal treatments in a case-specific manner. In addition, ISM offers the potential to gain a better understanding of the kidney physiology and/or pathophysiology of many complex diseases, together with a multiscale disease modeling. Similarly, -omics platforms (including genomics, transcriptomics, metabolomics, and proteomics), can generate biological data to obtain information on gene expression and regulation, protein turnover, and biological pathway connections in renal diseases. In this sense, the novel patient-centered approach in CKD research is built upon the combination of ISM analysis of human data, the use of in vitro models, and in vivo validation. Thus, one of the main objectives of CKD research is to manage the disease by the identification of new disease drivers, which could be prevented and monitored. This review explores the wide-ranging application of computational medicine and the application of -omics strategies in evaluating and managing kidney diseases.

The renoprotective effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors in both diabetic and nondiabetic nephropathy are widely recognized due to results from randomized controlled trials notably the DAPA-CKD and EMPA-KIDNEY trials. Research exploring the mechanisms of renoprotection indicates that SGLT2 inhibitors exert protective effects on podocytes by enhancing autophagy and stabilizing the structure of podocytes and basement membranes. Furthermore, reductions in lipotoxicity, oxidative stress, and inflammation have been confirmed with SGLT2 inhibitor treatment. Recent clinical studies have also begun to explore the effects of SGLT2 inhibitors on nondiabetic podocytopathies, such as focal segmental glomerulosclerosis. In this review, we summarize clinical and laboratory studies that focus on the podocyte-protective effects of SGLT2 inhibitors, exploring the potential for broader applications of this novel therapeutic agent in kidney disease.