Kidney Research and Clinical Practice最新文献

Background: The patients receiving hemodialysis (HD) are especially vulnerable during disasters since disasters can destroy the infrastructure necessary for proper HD treatment. This study aimed to investigate disaster experience, disaster preparedness, and cognition among medical staff in Korean HD units.

Methods: The survey instrument was adapted and modified from a validated questionnaire developed by the Japanese Association of Dialysis Physicians and distributed among members of the Korean Society of Nephrology using a Google Form. Disaster preparedness was evaluated across four key domains: patient management, administrative readiness, interinstitutional networking, and facility safety measures. Disaster awareness was measured using four separate scales: risk perception, outcome expectancy, self-efficacy, and self-responsibility.

Results: Among the 170 respondents, more than half (n = 98, 57.6%) have experienced more than one type of disaster in HD units. The power outage (41.2%) and water supply disruption (37.1%) were the most common disaster situations among Korean HD units. Implementation rates of disaster preparedness varied by domains, with the highest rates (90.6%) in the facility safety domain and the lowest rates (71.2%) in the patient management domain. Overall, the respondents showed a high sense of crisis regarding disaster (7 out of 10). Risk perception was positively correlated with administrative readiness, while outcome expectancy was positively correlated with facility safety.

Conclusion: There were high levels of disaster preparedness among medical staff in HD units. Cooperation between each HD unit, the Korean Society of Nephrology, and the national government should be warranted to deal with future disasters in HD units.

Background: Chronic kidney disease (CKD) is a growing global health challenge, with smoking identified as a significant risk factor. This study investigates the long-term impact of adolescent smoking initiation on end-stage kidney disease (ESKD) development.

Methods: A retrospective cohort study was conducted using data from the Korean National Health Insurance Service claims database. The cohort included 201,678 CKD patients aged ≥40 years with a documented smoking history. Patients were stratified by smoking initiation age (<20 years vs. ≥20 years) and cumulative smoking exposure (pack-year, PY). The primary outcome was ESKD incidence, defined as kidney replacement therapy initiation. Cox proportional hazards models assessed the relationship between smoking initiation age, smoking burden, and ESKD risk.

Results: During a median 6.8-year follow-up period, 6,334 patients progressed to ESKD (incidence rate, 3.63 per 1,000 PYs). Those with higher PYs were older and had more comorbidities, such as hypertension and diabetes mellitus. Patients who began smoking before age 20 years and accumulated ≥20 PYs had a significantly higher risk of ESKD (hazard ratio, 1.26; 95% confidence interval, 1.16-1.38) compared to those with the same exposure but later smoking initiation. Increased cumulative smoking exposure further elevated the risk. When PYs were divided according to initiation age, a higher ratio was associated with an increased risk of ESKD.

Conclusion: Early smoking initiation during adolescence was associated with a significantly higher risk of progression to ESKD in patients with CKD, especially in those with higher cumulative smoking exposure. Public health interventions focusing on preventing adolescent smoking can mitigate the long-term burden of CKD progression.

Background: This study was performed to investigate whether continuous kidney replacement therapy is more beneficial than intermittent hemodialysis in patients with acute intracerebral hemorrhage undergoing chronic dialysis, while adjusting for more clinically important variables.

Methods: Dialysis-dependent patients diagnosed with acute intracerebral hemorrhage were identified using the Japanese Diagnosis Procedure Combination database. We compared the in-hospital mortality rates and improvement in modified Rankin Scale scores before intracerebral hemorrhage development to discharge among patients who received continuous kidney replacement therapy or intermittent hemodialysis within 2 days of hospitalization. Overlap weighting based on propensity scores was performed to adjust for potential confounders.

Results: Among 922 eligible patients, 204 received continuous kidney replacement therapy and 718 received intermittent hemodialysis within 2 days of hospitalization. Propensity score overlap weighting analyses showed no significant difference between the continuous kidney replacement therapy and the intermittent hemodialysis groups in terms of in-hospital mortality (45.8% vs. 46.1%; risk difference, -0.3%; 95% confidence interval, -8.8 to 8.2%; p = 0.94) or decline in modified Rankin Scale (-3.1 vs. -3.2; difference 0.1; 95% confidence interval, -0.3 to 0.5; p = 0.64).

Conclusion: In this nationwide retrospective cohort study, continuous kidney replacement therapy and intermittent hemodialysis initiated within 2 days of admission showed no significant difference in in-hospital mortality or changes in modified Rankin Scale scores among dialysis-dependent patients with acute intracerebral hemorrhage.

Background: In maintenance hemodialysis (MHD) patients, vascular calcification can be detected not only in coronary vessels but also in ocular areas. However, ophthalmic examinations are not sufficiently validated to measure the degree of vascular calcification.

Methods: This study was performed prospectively, involving 32 MHD patients. Calcium deposition in the cornea and conjunctiva was checked using a slit lamp and anterior photography. Conjunctival and corneal calcification (CCC) score was calculated and the severity of CCC was graded. Extent of invasion in the corneal limbus and center was identified. Coronary artery calcium (CAC) deposit was scored using computer tomography, and cardiac function was investigated by echocardiogram. We divided patients into two groups: mild and moderate/severe groups according to the CCC scores.

Results: Mean CAC scores were 354.6 and 1,494.2 in the mild and moderate/severe groups. Mean extent of invasion in the corneal limbus and center was significantly higher in the moderate/severe groups than in the mild group. Parathyroid hormone was significantly higher in the moderate/severe groups than in the mild group and ejection fraction was significantly lower in the moderate/severe groups than in the mild group. The CCC score was positively associated with the CAC score, the extent of invasion in the corneal limbus and center, and the parathyroid hormone level. The extent of invasion in the corneal limbus and center was positively associated with the CAC score. The CCC score was negatively associated with ejection fraction.

Conclusion: The CCC score and the extent of invasion in the corneal limbus and center can predict vascular calcification in MHD patients.

Background: Fabry disease (FD) is an X-linked lysosomal disorder caused by α-galactosidase A enzyme activity deficiency. Although glycosphingolipid analogs have been identified in the plasma or urine of patients with FD, there is a limited understanding of altered metabolomics profiles beyond the globotriaosylceramide accumulation in FD.

Methods: Metabolomics study was performed for monitoring of biomarker and altered metabolism related with disease progression in serum and urine from male α-galactosidase A knockout mice and age-matched wild-type mice at 20 and 40 weeks. Profiling analysis for metabolites, including organic acids, amino acids, fatty acids, kynurenine pathway metabolites, and nucleosides in the serum and urine was performed using gas chromatography-tandem mass spectrometry and liquid chromatography-tandem mass spectrometry combined with star symbol patterns and partial least squares discriminant analysis (PLS-DA).

Results: A total of 27 and 23 metabolites from the serum and urine of FD mice were distinguished from those of wild-type mice, respectively, based on p-value (<0.05) and variable importance in projection scores (>1.0) of PLS-DA. In the serum, metabolites of the glutathione, glutathione disulfide, citrulline, and kynurenine pathways that are related to oxidative stress, nitric oxide biosynthesis, and inflammation were increased, whereas those involved in pyruvate and tyrosine metabolism and the tricarboxylic acid cycle were altered in the 20- and 40-week-old urine of FD model mice.

Conclusion: Altered metabolic signatures associated with disease progression by oxidative stress, inflammation, nitric oxide biosynthesis, and immune regulation in the early and late stages of FD.

Donor-derived cell-free DNA (dd-cfDNA) based liquid kidney biopsies have the potential to detect the chances of kidney transplant rejection. Several studies have found that dd-cfDNA can be used to determine the risk of kidney transplant rejection and may correlate with antibody-mediated rejection (ABMR), T cell-mediated rejection (TCMR), and estimated glomerular filtration rate (eGFR). A high concentration of dd-cfDNA in the body fluids may indicate possible transplant rejection since dd-cfDNA is released as a result of apoptotic and necrotic processes initiated by the recipient's immune system. dd-cfDNA assays have advantages over conventional biopsies since they are noninvasive, and therefore, have the potential to provide a safe and reliable biomarker. Different dd-cfDNA levels have been reported above a number of cutoff thresholds: ABMR at 2.45% and TCMR at 1.3%, compared with 0.44% in healthy patients; and eGFR at 2.5%, a decrease of 25% compared with healthy patients. These results indicate the levels of dd-cfDNA that may be used to signal possible kidney rejection. dd-cfDNA assay is a rapid technique, making it particularly useful in emergencies, and further research into its use in the study of kidney rejection should prove beneficial.