Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.08.022
Susan Lyon , Barnaby Hole
{"title":"Disparities in Kidney Care: Empowering Patients With Data","authors":"Susan Lyon , Barnaby Hole","doi":"10.1016/j.ekir.2024.08.022","DOIUrl":"10.1016/j.ekir.2024.08.022","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.08.012
Lena Brunkhorst , Michael Terhardt , Björn Bulitta , Miriam Gutting , Nils Janzen , Dieter Haffner , Nele Kanzelmeyer
Introduction
Monitoring kidney function and immunosuppressant levels in children post–kidney transplantation or those with glomerulopathies is challenging due to frequent venipunctures and clinic visits. Capillary dried blood spot sampling (DBS) offers a potential alternative.
Methods
In this prospective single-center study, 89 children (38% female and 62% male) requiring therapeutic drug monitoring (TDM) and kidney function assessment were enrolled. Of the patients, 79% were kidney transplant recipients, and 21% had immune-mediated glomerulopathies. The mean age was 13.4 (range, 5.7–18.0) years. DBS and standard venous serum samples were collected simultaneously for tacrolimus (TAC), cyclosporine A (CsA), everolimus (EVR), and creatinine levels. Furthermore, patient feedback on pain perception and feasibility was collected via questionnaire.
Results
No significant differences in parameter values between DBS and standard methods were observed (creatinine, −1.7 ± 14.5 μmol/l; EVR, 0.1 ± 1.2 μg/l; TAC, 0.3 ± 1.1 μg/l; CsA, 2.8 ± 9.8 μg/l). DBS demonstrated sufficient accuracy compared with standard methods. Patients favored DBS and telehealth consultations, especially due to less travel and school absences. Patients preferred finger pricking over ear pricking.
Conclusion
Capillary DBS proves reliable for TDM and kidney function assessment in pediatric kidney disease. It reduces patient and family burden compared with venous blood collection and enables telehealth consultations.
{"title":"Dried Blood Spot Sampling for Monitoring Children With Immune-Mediated Glomerulopathies and After Kidney Transplantation","authors":"Lena Brunkhorst , Michael Terhardt , Björn Bulitta , Miriam Gutting , Nils Janzen , Dieter Haffner , Nele Kanzelmeyer","doi":"10.1016/j.ekir.2024.08.012","DOIUrl":"10.1016/j.ekir.2024.08.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Monitoring kidney function and immunosuppressant levels in children post–kidney transplantation or those with glomerulopathies is challenging due to frequent venipunctures and clinic visits. Capillary dried blood spot sampling (DBS) offers a potential alternative.</div></div><div><h3>Methods</h3><div>In this prospective single-center study, 89 children (38% female and 62% male) requiring therapeutic drug monitoring (TDM) and kidney function assessment were enrolled. Of the patients, 79% were kidney transplant recipients, and 21% had immune-mediated glomerulopathies. The mean age was 13.4 (range, 5.7–18.0) years. DBS and standard venous serum samples were collected simultaneously for tacrolimus (TAC), cyclosporine A (CsA), everolimus (EVR), and creatinine levels. Furthermore, patient feedback on pain perception and feasibility was collected via questionnaire.</div></div><div><h3>Results</h3><div>No significant differences in parameter values between DBS and standard methods were observed (creatinine, −1.7 ± 14.5 μmol/l; EVR, 0.1 ± 1.2 μg/l; TAC, 0.3 ± 1.1 μg/l; CsA, 2.8 ± 9.8 μg/l). DBS demonstrated sufficient accuracy compared with standard methods. Patients favored DBS and telehealth consultations, especially due to less travel and school absences. Patients preferred finger pricking over ear pricking.</div></div><div><h3>Conclusion</h3><div>Capillary DBS proves reliable for TDM and kidney function assessment in pediatric kidney disease. It reduces patient and family burden compared with venous blood collection and enables telehealth consultations.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.08.015
Stephen Brown , Juan J. Garcia Sanchez , Hannah Guiang , Stacey Priest , David C. Wheeler , Ana F. Moura , Charlotte Johnston-Webber , Jieling Chen
Introduction
The significant burden of chronic kidney disease (CKD) is not recognized as a global public health priority, although policies aimed at delaying progression to later stages are required. Therefore, there is need for a holistic disease model to inform decision making that accounts for the multidimensional impact of CKD, and the interrelated factors that modulate progression.
Methods
IMPACT CKD is a microsimulation model that simulates CKD progression and incorporates the effect of clinical events and comorbidities. CKD status is assigned using estimated glomerular filtration rate (eGFR) and albuminuria levels, and CKD progression is predicted by an annual eGFR decline rate. The model projects clinical, health care resource use, economic, patient, societal, and environmental burdens from 2022 to 2032. During development, face, technical, and external validity were evaluated, with calibration conducted to population data. Further, cross-validation was conducted against 2 published models. The United Kingdom (UK) was selected as the case study for validation.
Results
A 7.7% increase in the CKD population by 2032 was predicted, with increasing numbers of patients with CKD stage 3 to 5 (21.7%), dialysis (75.3%), and transplantation (58.7%). The increase of patients on renal replacement therapy (RRT) results in an increase of 75% across freshwater use, fossil fuel depletion, and CO2 emissions over the next decade, and an estimated cost of £1.95 billion in 2032. Projections reflect validated findings from other models.
Conclusion
The IMPACT CKD model is a robust simulation that delivers validated forecasts of the holistic CKD burden, which can support evaluation of diverse health policies and treatment strategies.
{"title":"IMPACT CKD: Holistic Disease Model Projecting 10-Year Population Burdens","authors":"Stephen Brown , Juan J. Garcia Sanchez , Hannah Guiang , Stacey Priest , David C. Wheeler , Ana F. Moura , Charlotte Johnston-Webber , Jieling Chen","doi":"10.1016/j.ekir.2024.08.015","DOIUrl":"10.1016/j.ekir.2024.08.015","url":null,"abstract":"<div><h3>Introduction</h3><div>The significant burden of chronic kidney disease (CKD) is not recognized as a global public health priority, although policies aimed at delaying progression to later stages are required. Therefore, there is need for a holistic disease model to inform decision making that accounts for the multidimensional impact of CKD, and the interrelated factors that modulate progression.</div></div><div><h3>Methods</h3><div>IMPACT CKD is a microsimulation model that simulates CKD progression and incorporates the effect of clinical events and comorbidities. CKD status is assigned using estimated glomerular filtration rate (eGFR) and albuminuria levels, and CKD progression is predicted by an annual eGFR decline rate. The model projects clinical, health care resource use, economic, patient, societal, and environmental burdens from 2022 to 2032. During development, face, technical, and external validity were evaluated, with calibration conducted to population data. Further, cross-validation was conducted against 2 published models. The United Kingdom (UK) was selected as the case study for validation.</div></div><div><h3>Results</h3><div>A 7.7% increase in the CKD population by 2032 was predicted, with increasing numbers of patients with CKD stage 3 to 5 (21.7%), dialysis (75.3%), and transplantation (58.7%). The increase of patients on renal replacement therapy (RRT) results in an increase of 75% across freshwater use, fossil fuel depletion, and CO<sub>2</sub> emissions over the next decade, and an estimated cost of £1.95 billion in 2032. Projections reflect validated findings from other models.</div></div><div><h3>Conclusion</h3><div>The IMPACT CKD model is a robust simulation that delivers validated forecasts of the holistic CKD burden, which can support evaluation of diverse health policies and treatment strategies.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142223891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.08.028
Margriet E. Gosselink , Robin Mooren , Rozemarijn Snoek , Neeltje M.T.H. Crombag , Paul Vos , Mandy G. Keijzer-Veen , Albertien M. van Eerde , A. Titia Lely
Introduction
Family planning and reproductive care are essential but complex aspects of lifecycle management for individuals with autosomal dominant polycystic kidney disease (ADPKD), given the potential genetic transmission and pregnancy-related complications. In this qualitative study, we studied the experiences and perspectives of patients with ADPKD and clinicians to identify areas for potential improvement in reproductive lifecycle care.
Methods
Focus group discussions (FGDs) were conducted in the Netherlands with patients with ADPKD, both men and women, who had children through varied reproductive choices; and clinicians, including (pediatric) nephrologists, obstetric gynecologists and geneticists. Thematic analysis, utilizing a grounded theory approach, was performed on verbatim transcriptions of recordings, followed by consensus discussions to finalize themes.
Results
Nine focus groups involving 31 participants (16 patients and 15 physicians) identified 6 key themes. These included the need for timely and comprehensive information dissemination from puberty on, understanding patient-specific decision-making factors, improving tailored psychosocial guidance and communication, the need for systematic efforts to take care of missed (minor) at-risk patients, addressing inequities in access to care, and improving multidisciplinary collaboration.
Conclusions
This study represents the first qualitative study of patient and physician perspectives on reproductive lifecycle care for ADPKD. We present valuable insights into factors influencing patients’ reproductive decision-making, a comprehensive comparison between the perspectives of patients and clinicians on family planning and follow-up care of minors at risk for ADPKD, and recommendations for enhancing overall care quality. Incorporating these insights into clinical care could enhance patient-centered care and foster interdisciplinary collaborations to further improve the quality of reproductive health care services for individuals with ADPKD.
{"title":"Perspectives of Patients and Clinicians on Reproductive Health Care and ADPKD","authors":"Margriet E. Gosselink , Robin Mooren , Rozemarijn Snoek , Neeltje M.T.H. Crombag , Paul Vos , Mandy G. Keijzer-Veen , Albertien M. van Eerde , A. Titia Lely","doi":"10.1016/j.ekir.2024.08.028","DOIUrl":"10.1016/j.ekir.2024.08.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Family planning and reproductive care are essential but complex aspects of lifecycle management for individuals with autosomal dominant polycystic kidney disease (ADPKD), given the potential genetic transmission and pregnancy-related complications. In this qualitative study, we studied the experiences and perspectives of patients with ADPKD and clinicians to identify areas for potential improvement in reproductive lifecycle care.</div></div><div><h3>Methods</h3><div>Focus group discussions (FGDs) were conducted in the Netherlands with patients with ADPKD, both men and women, who had children through varied reproductive choices; and clinicians, including (pediatric) nephrologists, obstetric gynecologists and geneticists. Thematic analysis, utilizing a grounded theory approach, was performed on verbatim transcriptions of recordings, followed by consensus discussions to finalize themes.</div></div><div><h3>Results</h3><div>Nine focus groups involving 31 participants (16 patients and 15 physicians) identified 6 key themes. These included the need for timely and comprehensive information dissemination from puberty on, understanding patient-specific decision-making factors, improving tailored psychosocial guidance and communication, the need for systematic efforts to take care of missed (minor) at-risk patients, addressing inequities in access to care, and improving multidisciplinary collaboration.</div></div><div><h3>Conclusions</h3><div>This study represents the first qualitative study of patient and physician perspectives on reproductive lifecycle care for ADPKD. We present valuable insights into factors influencing patients’ reproductive decision-making, a comprehensive comparison between the perspectives of patients and clinicians on family planning and follow-up care of minors at risk for ADPKD, and recommendations for enhancing overall care quality. Incorporating these insights into clinical care could enhance patient-centered care and foster interdisciplinary collaborations to further improve the quality of reproductive health care services for individuals with ADPKD.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.08.027
Jia-Jin Chen , Cheng-Chia Lee , Chieh-Li Yen , Pei-Chun Fan , Ming-Jen Chan , Tsung-Yu Tsai , Yung-Chang Chen , Chih-Wei Yang , Chih-Hsiang Chang
Introduction
Evidence suggests a survival benefit from resuming angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) post acute kidney injury (AKI) compared to nonuse; however, the optimal timing and its impact on outcomes are unclear. The risks of earlier resumption, such as recurrent AKI or hyperkalemia, remain unexplored.
Methods
Using multiinstitutional electronic health records, we analyzed the relationship between 3 ACEI or ARB (ACEI/ARB) resumption timelines post-AKI (prior to discharge, 0–3 months, and 4–6 months postdischarge) and outcomes including all-cause mortality, major adverse cardiac and cerebrovascular events (MACCEs), dialysis initiation or end-stage renal disease (ESRD), severe hyperkalemia, and recurrent AKI with hospitalization. Cox proportional models estimated hazard ratios (HRs) for outcomes across different resumption timings, following a target trial design.
Results
Among 5392 AKI survivors resuming ACEI/ARB within 6 months post-AKI, earlier resumption was associated with lower mortality, MACCE, MACCE-related mortality, new dialysis initiation or ESRD (P < 0.001 in trend tests), without increased risks of severe hyperkalemia and re-AKI admissions. Early resumption has a lower mortality compared to 4 to 6 months postdischarge (before discharge, HR: 0.88, 95% confidence interval [CI]: 0.83–0.93; 0–3 months, HR: 0.89, 95% CI: 0.85–0.94). Subgroup analysis showed a lower mortality HR from earlier resumption among AKI survivors with prior ACEI/ARB comorbidity indications (P < 0.001 in trend tests; before discharge, HR: 0.85, 95% CI: 0.80–0.90; 0–3 months, HR: 0.88, 95% CI: 0.83–0.93).
Conclusion
Our cohort demonstrates lower risks for mortality, cardiovascular events, and ESRD with early ACEI/ARB resumption, without heightened risks of severe hyperkalemia or rehospitalization for AKI. Early resumption should be considered for patients with indications for ACEI/ARB.
有证据表明，与不使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）相比，急性肾损伤（AKI）后恢复使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）对患者的生存有益；然而，最佳时机及其对预后的影响尚不清楚。提前恢复用药的风险（如复发性 AKI 或高钾血症）仍未得到探讨。利用多机构电子健康记录，我们分析了 AKI 后 3 个 ACEI 或 ARB（ACEI/ARB）恢复时间（出院前、出院后 0-3 个月和出院后 4-6 个月）与全因死亡率、主要不良心脑血管事件 (MACCE)、开始透析或终末期肾病 (ESRD)、严重高钾血症和复发性 AKI 与住院之间的关系。根据目标试验设计，Cox 比例模型估算了不同恢复时间的结果危险比 (HR)。在 AKI 后 6 个月内恢复 ACEI/ARB 的 5392 名 AKI 幸存者中，较早恢复与较低的死亡率、MACCE、MACCE 相关死亡率、新的透析启动或 ESRD 相关（趋势检验 <0.001），但不会增加严重高钾血症和再次 AKI 住院的风险。与出院后 4-6 个月相比，早期恢复透析的死亡率较低（出院前，HR：0.88，95% 置信区间 [CI]：0.83-0.93；出院后，HR：0.88-0.93，95% 置信区间 [CI]：0.83-0.93）：0.83-0.93；0-3 个月，HR：0.89，95% 置信区间 [CI]：0.85-0.94）。亚组分析表明，在既往有 ACEI/ARB 并发症指征的 AKI 幸存者中，较早恢复治疗的死亡率 HR 更低（趋势检验 <0.001；出院前，HR：0.85，95% CI：0.80-0.90；0-3 个月，HR：0.88，95% CI：0.83-0.93）。我们的队列显示，早期恢复 ACEI/ARB 可降低死亡率、心血管事件和 ESRD 风险，但不会增加严重高钾血症或因 AKI 再次住院的风险。有 ACEI/ARB 适应症的患者应考虑尽早恢复治疗。
{"title":"Impact of Different Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blocker Resumption Timing on Post Acute Kidney Injury Outcomes","authors":"Jia-Jin Chen , Cheng-Chia Lee , Chieh-Li Yen , Pei-Chun Fan , Ming-Jen Chan , Tsung-Yu Tsai , Yung-Chang Chen , Chih-Wei Yang , Chih-Hsiang Chang","doi":"10.1016/j.ekir.2024.08.027","DOIUrl":"10.1016/j.ekir.2024.08.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Evidence suggests a survival benefit from resuming angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) post acute kidney injury (AKI) compared to nonuse; however, the optimal timing and its impact on outcomes are unclear. The risks of earlier resumption, such as recurrent AKI or hyperkalemia, remain unexplored.</div></div><div><h3>Methods</h3><div>Using multiinstitutional electronic health records, we analyzed the relationship between 3 ACEI or ARB (ACEI/ARB) resumption timelines post-AKI (prior to discharge, 0–3 months, and 4–6 months postdischarge) and outcomes including all-cause mortality, major adverse cardiac and cerebrovascular events (MACCEs), dialysis initiation or end-stage renal disease (ESRD), severe hyperkalemia, and recurrent AKI with hospitalization. Cox proportional models estimated hazard ratios (HRs) for outcomes across different resumption timings, following a target trial design.</div></div><div><h3>Results</h3><div>Among 5392 AKI survivors resuming ACEI/ARB within 6 months post-AKI, earlier resumption was associated with lower mortality, MACCE, MACCE-related mortality, new dialysis initiation or ESRD (<em>P</em> < 0.001 in trend tests), without increased risks of severe hyperkalemia and re-AKI admissions. Early resumption has a lower mortality compared to 4 to 6 months postdischarge (before discharge, HR: 0.88, 95% confidence interval [CI]: 0.83–0.93; 0–3 months, HR: 0.89, 95% CI: 0.85–0.94). Subgroup analysis showed a lower mortality HR from earlier resumption among AKI survivors with prior ACEI/ARB comorbidity indications (<em>P</em> < 0.001 in trend tests; before discharge, HR: 0.85, 95% CI: 0.80–0.90; 0–3 months, HR: 0.88, 95% CI: 0.83–0.93).</div></div><div><h3>Conclusion</h3><div>Our cohort demonstrates lower risks for mortality, cardiovascular events, and ESRD with early ACEI/ARB resumption, without heightened risks of severe hyperkalemia or rehospitalization for AKI. Early resumption should be considered for patients with indications for ACEI/ARB.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.08.030
Sharlene A. Greenwood , Juliet Briggs , Christy Walklin , Emmanuel Mangahis , Hannah M.L. Young , Ellen M. Castle , Roseanne E. Billany , Elham Asgari , Sunil Bhandari , Nicolette Bishop , Kate Bramham , James O. Burton , Jackie Campbell , Joseph Chilcot , Nicola Cooper , Vashist Deelchand , Matthew P.M. Graham-Brown , Lynda Haggis , Alexander Hamilton , Mark Jesky , Jamie Macdonald
Introduction
There is inequity in the provision of physical rehabilitation services for people living with chronic kidney disease (CKD). The Kidney BEAM trial evaluated the clinical value and cost effectiveness of a physical activity digital health intervention (DHI) in CKD.
Methods
In a single-blind, 11 center, randomized controlled trial, 340 adult participants with CKD were randomly assigned to either the Kidney BEAM physical activity DHI or a waitlist control. This study assessed the difference in the Kidney Disease Quality of Life Short Form 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between intervention and control groups at 6-months, and cost-effectiveness of the intervention.
Results
At 6-months, there was a significant difference in mean adjusted change in KDQoL MCS score between Kidney BEAM and waitlist control (intention-to-treat adjusted mean: 5.9 [95% confidence interval, CI: 4.4–7.5] arbitrary units [AU], P < 0.0001), and a 93% and 98% chance of the intervention being cost-effective at a willingness-to-pay threshold of £20,000 and £30,000 per quality-adjusted life year gained.
Conclusion
The Kidney BEAM physical activity DHI is a clinically valuable and cost-effective means to improve mental health-related quality of life (HRQoL) in people with CKD (trial registration no. NCT04872933).
{"title":"Kidney Beam-A Cost-Effective Digital Intervention to Improve Mental Health","authors":"Sharlene A. Greenwood , Juliet Briggs , Christy Walklin , Emmanuel Mangahis , Hannah M.L. Young , Ellen M. Castle , Roseanne E. Billany , Elham Asgari , Sunil Bhandari , Nicolette Bishop , Kate Bramham , James O. Burton , Jackie Campbell , Joseph Chilcot , Nicola Cooper , Vashist Deelchand , Matthew P.M. Graham-Brown , Lynda Haggis , Alexander Hamilton , Mark Jesky , Jamie Macdonald","doi":"10.1016/j.ekir.2024.08.030","DOIUrl":"10.1016/j.ekir.2024.08.030","url":null,"abstract":"<div><h3>Introduction</h3><div>There is inequity in the provision of physical rehabilitation services for people living with chronic kidney disease (CKD). The Kidney BEAM trial evaluated the clinical value and cost effectiveness of a physical activity digital health intervention (DHI) in CKD.</div></div><div><h3>Methods</h3><div>In a single-blind, 11 center, randomized controlled trial, 340 adult participants with CKD were randomly assigned to either the Kidney BEAM physical activity DHI or a waitlist control. This study assessed the difference in the Kidney Disease Quality of Life Short Form 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between intervention and control groups at 6-months, and cost-effectiveness of the intervention.</div></div><div><h3>Results</h3><div>At 6-months, there was a significant difference in mean adjusted change in KDQoL MCS score between Kidney BEAM and waitlist control (intention-to-treat adjusted mean: 5.9 [95% confidence interval, CI: 4.4–7.5] arbitrary units [AU], <em>P</em> < 0.0001), and a 93% and 98% chance of the intervention being cost-effective at a willingness-to-pay threshold of £20,000 and £30,000 per quality-adjusted life year gained.</div></div><div><h3>Conclusion</h3><div>The Kidney BEAM physical activity DHI is a clinically valuable and cost-effective means to improve mental health-related quality of life (HRQoL) in people with CKD (trial registration no. NCT04872933).</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Urinary sC5b-9 is Better Linked to Albuminuria Than to Intrarenal Inflammation in Common Kidney Disease","authors":"Sébastien Kissling , Nora Schwotzer , Mireille Moser , Marc Froissart , Fadi Fakhouri","doi":"10.1016/j.ekir.2024.08.009","DOIUrl":"10.1016/j.ekir.2024.08.009","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.07.032
Christopher M.T. Hayden , Gwénaëlle Begue , Jorge L. Gamboa , Keith Baar , Baback Roshanravan
Exercise interventions in chronic kidney disease (CKD) have received growing interest, with over 30 meta-analyses published in the past 5 years. The potential benefits of exercise training in CKD range from slowing disease progression to improving comorbidities and quality of life. Nevertheless, there is a lack of large, randomized control trials in diverse populations, particularly regarding exercise in nondialysis-dependent CKD (NDD). When exercise interventions are implemented, they often lack fundamental features of exercise training such as progressive overload, personalization, and specificity. Furthermore, the physiology of exercise and CKD-specific barriers appear poorly understood. This review explores the potential benefits of exercise training in NDD, draws lessons from previous interventions and other fields, and provides several basic tools that may help improve interventions in research and practice.
{"title":"Review of Exercise Interventions to Improve Clinical Outcomes in Nondialysis CKD","authors":"Christopher M.T. Hayden , Gwénaëlle Begue , Jorge L. Gamboa , Keith Baar , Baback Roshanravan","doi":"10.1016/j.ekir.2024.07.032","DOIUrl":"10.1016/j.ekir.2024.07.032","url":null,"abstract":"<div><div>Exercise interventions in chronic kidney disease (CKD) have received growing interest, with over 30 meta-analyses published in the past 5 years. The potential benefits of exercise training in CKD range from slowing disease progression to improving comorbidities and quality of life. Nevertheless, there is a lack of large, randomized control trials in diverse populations, particularly regarding exercise in nondialysis-dependent CKD (NDD). When exercise interventions are implemented, they often lack fundamental features of exercise training such as progressive overload, personalization, and specificity. Furthermore, the physiology of exercise and CKD-specific barriers appear poorly understood. This review explores the potential benefits of exercise training in NDD, draws lessons from previous interventions and other fields, and provides several basic tools that may help improve interventions in research and practice.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.08.006
Guoqin Wang , Lei Yang , Xiaoyi Xu , Weiyi Guo , Lijun Sun , Yanyan Wang , Wenrong Cheng , Nan Ye , Lingqiang Kong , Xiaoyi Zhao , Hong Cheng
Introduction
COVID-19 has been reported to be associated with the occurrence and recurrence of membranous nephropathy (MN). The clinicopathological characteristics and complement system activation of MN after COVID-19 are unclear.
Methods
A total of 38 patients with biopsy-proven MN who developed new-onset proteinuria after COVID-19 were enrolled in this study. One hundred patients with primary MN diagnosed before the COVID-19 pandemic were the control. Renal immunohistochemical staining for SARS-CoV-2 nucleocapsid protein was performed in 38 patients with MN after COVID-19. Serum membrane attack complex (MAC) was detected by enzyme-linked immunosorbent assay. Glomerular staining for the complement proteins in different pathways were detected by immunohistochemistry.
Results
Thirteen of 38 patients had positive staining for SARS-CoV-2 nucleocapsid protein. Compared with the control patients, the clinical manifestations were more severe in patients after COVID-19. Patients with positive SARS-CoV-2 staining had a higher proportion of nephrotic syndrome, lower level of serum albumin, and greater severity of renal interstitial fibrosis than those of patients with negative SARS-CoV-2 staining. Serum MAC level and renal MAC staining intensity of MN after COVID-19 were significantly higher than those of the control patients. MAC expression in MN patients with positive SARS-CoV-2 staining was stronger than that in both control patients and MN after COVID-19 with negative SARS-CoV-2 staining. The expression trend of factor H was consistent with that of MAC.
Conclusion
Excessive activation of the complement system aggravated symptoms in MN after COVID-19. Therapeutic strategy targeting the complement system may need to be considered.
{"title":"SARS-CoV-2 Protein Deposition Enhances Renal Complement Activation and Aggravates Kidney Injury in Membranous Nephropathy After COVID-19","authors":"Guoqin Wang , Lei Yang , Xiaoyi Xu , Weiyi Guo , Lijun Sun , Yanyan Wang , Wenrong Cheng , Nan Ye , Lingqiang Kong , Xiaoyi Zhao , Hong Cheng","doi":"10.1016/j.ekir.2024.08.006","DOIUrl":"10.1016/j.ekir.2024.08.006","url":null,"abstract":"<div><h3>Introduction</h3><div>COVID-19 has been reported to be associated with the occurrence and recurrence of membranous nephropathy (MN). The clinicopathological characteristics and complement system activation of MN after COVID-19 are unclear.</div></div><div><h3>Methods</h3><div>A total of 38 patients with biopsy-proven MN who developed new-onset proteinuria after COVID-19 were enrolled in this study. One hundred patients with primary MN diagnosed before the COVID-19 pandemic were the control. Renal immunohistochemical staining for SARS-CoV-2 nucleocapsid protein was performed in 38 patients with MN after COVID-19. Serum membrane attack complex (MAC) was detected by enzyme-linked immunosorbent assay. Glomerular staining for the complement proteins in different pathways were detected by immunohistochemistry.</div></div><div><h3>Results</h3><div>Thirteen of 38 patients had positive staining for SARS-CoV-2 nucleocapsid protein. Compared with the control patients, the clinical manifestations were more severe in patients after COVID-19. Patients with positive SARS-CoV-2 staining had a higher proportion of nephrotic syndrome, lower level of serum albumin, and greater severity of renal interstitial fibrosis than those of patients with negative SARS-CoV-2 staining. Serum MAC level and renal MAC staining intensity of MN after COVID-19 were significantly higher than those of the control patients. MAC expression in MN patients with positive SARS-CoV-2 staining was stronger than that in both control patients and MN after COVID-19 with negative SARS-CoV-2 staining. The expression trend of factor H was consistent with that of MAC.</div></div><div><h3>Conclusion</h3><div>Excessive activation of the complement system aggravated symptoms in MN after COVID-19. Therapeutic strategy targeting the complement system may need to be considered.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.ekir.2024.06.041
Tuncay Sahutoglu
{"title":"Fine-Tuning Dry Weight: A Key Component in Managing Blood Pressure for Patients on Dialysis","authors":"Tuncay Sahutoglu","doi":"10.1016/j.ekir.2024.06.041","DOIUrl":"10.1016/j.ekir.2024.06.041","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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