Kidney Research and Clinical Practice最新文献

Background: While hypoalbuminemia is a marker of poor prognosis in patients with end-stage kidney disease, its association with cancer risk remains unclear. This study evaluated the relationship of serum albumin levels with cancer risk and mortality after cancer diagnosis in patients undergoing maintenance hemodialysis (HD).

Methods: This retrospective cohort study analyzed HD quality assessment program data from the Korean Health Insurance Review and Assessment Service, encompassing 64,728 adult patients who received maintenance HD between 2013 and 2021. The patients were stratified into quintiles based on their serum albumin levels. Propensity score weighting and Cox regression analyses were used to estimate the hazard ratios (HRs) of incident cancer and mortality.

Results: During a median follow-up of approximately 5 years, patients in the lowest albumin quintile (1Q, 3.12-3.72 g/dL) had the highest risk of incident cancer and the lowest survival rates following cancer diagnosis. Compared with the middle quintile (3Q, 3.93-4.06 g/dL), the lowest quintile was associated with increased risks of cancer (adjusted HR, 1.12; 95% confidence interval [CI], 1.08-1.16) and all-cause mortality after cancer diagnosis (adjusted HR, 1.16; 95% CI, 1.11-1.22). Subgroup analyses revealed stronger associations among younger patients (age <60 years) and females.

Conclusion: Lower serum albumin levels are associated with increased risks of cancer and subsequent mortality following cancer diagnosis in patients undergoing HD. These results suggest a potential role for serum albumin in risk assessment, but further prospective studies are warranted to evaluate its clinical implications.

Background: Protein-energy wasting (PEW) is a strong indicator of adverse outcomes such as all-cause death and cardiovascular events. Although this association has been established in dialysis patients, it has not been clearly demonstrated in those with non-dialysis-dependent chronic kidney disease (NDD-CKD). This study aimed to evaluate the association between PEW and all-cause death or cardiovascular events in patients with NDD-CKD.

Methods: We investigated the association between PEW and adverse outcomes in patients with NDD-CKD through a prospective cohort study of 1,847 patients (median follow-up: 6.94 years). The definition of PEW followed the International Society of Renal Nutrition and Metabolism criteria: serum albumin <3.8 g/dL, body mass index <23.0 kg/m2, skeletal muscle mass <19.7 kg in women, <26.9 kg in men, and protein intake <0.6 g/kg/day.

Results: During follow-up, 129 deaths and 264 composite outcomes (all-cause death or cardiovascular events) occurred. In Cox regression analysis, all-cause death and composite outcomes were significantly increased in patients with two or more PEW parameters. All-cause death was significantly increased in patients with two PEW parameters (hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.61-4.08; p < 0.001) or ≥3 PEW parameters (HR, 3.78; 95% CI, 1.81-7.89; p < 0.001). Composite outcomes were also significantly increased in patients with two PEW parameters (HR, 2.16; 95% CI, 1.51-3.11; p < 0.001) or ≥3 PEW parameters (HR, 2.30; 95% CI, 1.30-4.07; p = 0.004).

Conclusion: PEW was a strong indicator of all-cause death and composite outcomes among NDD-CKD patients.

Background: Patient satisfaction is crucial in achieving better health outcomes, particularly for individuals undergoing hemodialysis. Although many patient satisfaction scales exist, few are culturally tailored to patients undergoing hemodialysis in Korea. This study aimed to develop and validate this population's Hemodialysis Management Satisfaction Scale.

Methods: A formative research approach involving qualitative and quantitative phases was used. In-depth interviews with 12 hemodialysis patients from four institutions identified culturally relevant satisfaction dimensions. These findings, combined with a literature review, informed the development of a draft questionnaire. The draft was administered to 121 hemodialysis patients to evaluate reliability and validity. Exploratory and confirmatory factor analyses validated the scale, and structural equation modeling tested nomological validity.

Results: Five key factors emerged: nephrologist care, medical staff, facility, environment, and proficiency. The overall Cronbach's alpha was 0.82, indicating high reliability. Factor analyses supported the scale's construct validity, while structural equation modeling demonstrated that satisfaction positively influenced health self-efficacy, which improved perceived health status and daily life satisfaction. Model fit indices showed an adequate fit (chi-square, 215.389; degrees of freedom, 64; p = < 0.001; incremental fit index, 0.838; comparative fit index, 0.836; and root mean square residual, 0.053).

Conclusion: The Hemodialysis Management Satisfaction Scale is a valid and reliable tool for assessing the satisfaction of hemodialysis patients within a culturally specific context. Findings highlight the importance of patient-centered care and the role of health self-efficacy in enhancing outcomes. This culturally adapted tool enhances patient-provider understanding, paving the way for better-tailored, patient-centered care in Korea.

Exome sequencing (ES) and genome sequencing (GS) are essential for diagnosing rare genetic disorders, yet a significant number of patients remain without a definitive diagnosis after the initial analysis. Reanalysis of existing ES and GS data has emerged as a clinically indispensable practice, offering the potential to solve previously unresolved cases by leveraging rapid advances in genomic knowledge and technology. This review comprehensively addresses the growing importance, clinical utility, methodologies, and challenges of ES and GS data reanalysis. The increase in diagnostic yield from reanalysis is driven by several key factors: the continuous discovery of new gene-disease associations, ongoing updates to clinical and population genetic databases like ClinVar and gnomAD, the refinement of bioinformatic pipelines, and the application of advanced analytical techniques. Reanalysis has been shown to provide an additional diagnostic yield ranging from 3% to 15% across various disease cohorts, including neurodevelopmental, renal, and cardiovascular disorders. A significant portion of these new diagnoses stems from the reclassification of variants of uncertain significance, which often leads to direct and meaningful changes in clinical management, including targeted surveillance and tailored therapies. The reanalysis of ES and GS data is no longer a supplementary activity but a fundamental component of modern genomic medicine, transforming genomic testing from a one-time event into a continuous diagnostic process. To fully realize its potential, the development of standardized guidelines is crucial to address financial, logistical, and ethical barriers and to facilitate the equitable integration of reanalysis into routine clinical care.

Background: Chronic kidney disease (CKD) is a global health burden, with vitamin D deficiency being a prevalent and modifiable risk factor. Vitamin D is involved in calcium-phosphate homeostasis, immune regulation, and anti-inflammatory pathways. However, its causal role in CKD progression remains uncertain.

Methods: This study employed Mendelian randomization (MR) using genome-wide association study data to assess the causal effects of genetically predicted 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels on CKD progression in a KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) cohort. CKD progression was defined as the estimated glomerular filtration rate (eGFR) slope, calculated using a linear mixed model to represent the rate of kidney function decline. Six MR methods were applied to ensure robust causal inference.

Results: Genetic variants associated with higher 25(OH)D levels were linked to a significantly slower decline in eGFR, suggesting a protective effect on kidney function. Inverse variance weighted (IVW) analysis showed a negative association between genetically predicted 25(OH)D levels and eGFR slope (β = -0.246, SE = 0.093, p = 8.54E-03). A similar association was observed for 1,25(OH)2D using the radial IVW method (β = -0.256, SE = 0.057, p = 8.84E-06), with consistent findings from IVW and weighted median methods (p = 5.50E-04 and p = 1.13E-02, respectively). Sensitivity analyses using MR-Egger and MR-PRESSO showed no evidence of directional pleiotropy.

Conclusion: This study provides evidence for a protective role of vitamin D in CKD progression, emphasizing the importance of maintaining adequate vitamin D levels. These findings highlight the potential for vitamin D-targeted therapeutic strategies in CKD management.

Background: Historically, human leukocyte antigen (HLA) matching has been a cornerstone of kidney transplantation (KT), with favorable outcomes. However, the survival benefit of KT with zero HLA mismatches appears to have decreased with the accumulation of transplantation experience and advancements in immunosuppressive therapies.

Methods: This was a prospective observational cohort study based on data from the Korean Organ Transplantation Registry, including patients who underwent deceased donor KT from May 2014 to December 2022. A total of 3,350 KT patients were propensity score-matched at a 1:1 ratio and compared according to zero HLA mismatching (zero group) vs. non-zero HLA mismatching (non-zero group).

Results: After matching, 276 patients in the zero group were compared to 276 patients in the non-zero group. Over a follow-up period of 38.4 ± 28.8 months, the use of immunosuppressants was similar between the two groups. Multivariable-adjusted hazard ratios of non-zero group vs. zero group were 1.63 (95% confidence interval [CI], 0.72-3.69; p = 0.24) for death censored graft failure, 1.62 (95% CI, 0.96-2.76; p = 0.07) for biopsy-proven rejection, 2.09 (95% CI, 0.87-5.00; p = 0.10) for death, 1.38 (95% CI, 1.02-1.86; p = 0.03) for posttransplant infection and 4.48 (95% CI, 1.52-13.25; p = 0.001) for antibody mediated rejection.

Conclusion: This study suggests that rigid adherence to HLA matching may be less critical than previously thought, particularly due to advancements in immunosuppressive therapies.

Background: Nephrotic syndrome (NS) is the leading cause of glomerular diseases in pediatric patients, among whom corticosteroid responsiveness has been shown to be closely associated with prognosis. Circular RNAs (circRNAs) play crucial roles in various pathophysiological processes and hold significant promise as biomarkers. This study investigated circRNAs for their ability to discriminate patients with steroid-resistant nephrotic syndrome (SRNS) from steroid-sensitive nephrotic syndrome (SSNS), and to explore the pathogenesis underlying NS.

Methods: Microarray analysis was performed to detect circRNA profiles. Total RNA was purified from peripheral blood mononuclear cells obtained from three children, each with SRNS and SSNS. The seven identified candidate circRNAs were validated among 31 SRNS and 30 SSNS patients utilizing real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). The clinical diagnostic value of the circRNAs was assessed by the receiver operating characteristic curve. Bioinformatic analysis was further performed to understand the intricate biological functions of circRNAs.

Results: Overall, 209 downregulated and 65 upregulated differentially expressed circRNAs were identified in patients with SRNS vs. SSNS. Validation by qRT-PCR revealed that the expression levels of hsa_circRNA_101015 and hsa_circRNA_104310 were considerably lower in the SRNS than the SSNS group. These two circRNAs had area under the curve values of 0.90 and 0.84, respectively, which validated their diagnostic power to discriminate SRNS from SSNS. Further, bioinformatic analysis revealed enrichment of the Wnt signaling pathway.

Conclusion: Hsa_circRNA_101015 and hsa_circRNA_104310 are novel predictive biomarkers for distinguishing SRNS from SSNS, and may participate in the pathogenesis of NS.

Background: Obesity is a major worldwide health problem and can be related to cellular senescence. Along with the rise in obesity, the comorbidity of renal ischemia-reperfusion (IR) injury is increasing. Whether obesity accelerates the severity of IR injury and whether senescence contributes to these conditions remain unclear. We studied the degree of injury and cellular senescence in the IR kidneys and perirenal adipose tissues of high-fat-diet-induced obese mice.

Methods: C57BL/6 mice fed standard chow or a high-fat diet for 16 weeks were randomized to renal IR or sham group (n = 6-10 each). Renal IR was performed by unilateral clamping of the right renal pedicle for 30 minutes. Six weeks after surgery, renal function, perirenal fat/renal senescence, and histology were evaluated ex vivo.

Results: Obese mice showed more renal tubular damage and fibrosis in IR injury than control mice, even though the degree of ischemic insult was comparable. Renal expression of senescence and its secretory phenotype was upregulated in either IR injury or with a high-fat diet and was further increased in the IR kidneys of obese mice. Fat senescence and the expression of tumor necrosis factor alpha were also increased, especially in the perirenal depot of the IR kidneys, with a high-fat diet.

Conclusion: A high-fat diet aggravates IR injury in murine kidneys, which is associated, at least in part, with perirenal fat senescence and inflammation. These observations support the exploration of therapeutic targets of the adipo-renal axis in injured obese kidneys.

Background: The global prevalence of hyperuricemia is steadily increasing, and reports indicate an upward trend in children and adolescents. Using data from the Korean National Health and Nutrition Examination Survey (KNHANES), this study aimed to examine the association of dietary factors with hyperuricemia among Korean children and adolescents in addition to known other risk factors.

Methods: This cross-sectional study included 1,268 participants aged 10 to 18 years from the eighth KNHANES 2019-2021. Dietary information was collected using a single 24-hour recall method. The associations among serum uric acid and intake of total energy, protein, fat, sodium, and sugar were analyzed using multiple regression analysis adjusting for confounding variables (age, sex, blood pressure, estimated glomerular filtration rate [eGFR], body mass index, and hemoglobin A1c [HbA1c]).

Results: From the 1,268 participants (median age, 13 years; male, 56%), 150 (11.8%) had hyperuricemia. In multiple regression analysis, higher sugar intake was independently associated with hyperuricemia (odds ratio [OR], 1.79; p = 0.01) in addition to obesity (OR, 5.5; p < 0.001), age of 13 to 15 years (OR, 2.02; p = 0.002), higher HbA1c (OR, 1.6; p = 0.04), and lower eGFR (eGFR ≥75 and <90 mL/min/1.73 m2: OR, 1.63 [p = 0.01]; eGFR <75 mL/min/1.73 m2: OR, 3.42 [p = 0.002]).

Conclusion: The results revealed that the increasing prevalence of hyperuricemia in Korean children and adolescents, and pubertal age, obesity, decreased kidney function, prediabetic state, and high sugar intake are associated with the risk of hyperuricemia in Korean children and adolescents.