Kidney International Reports最新文献_第5页

Paradigm Shift: Dialysis as a Terminal Condition 范式转变：透析是一种终结性疾病

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.08.016

Lydia S. Dugdale

引用次数: 0

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.030

Kullaya Takkavatakarn , Yang Dai , Abhinaya Sridhar , Miriam Borvick , Ricki Ehrenfeld , Cristina Liriano Cepin , Girish N. Nadkarni , Lili Chan

引用次数: 0

Extremely Long-Lasting B-cell Depletion and BAFFling Effects Following Obinutuzumab-Based Regimen in Lupus Nephritis 狼疮性肾炎患者接受奥比奴珠单抗治疗后的极持久B细胞耗竭和BAFFling效应

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.08.008

Dario Roccatello , Savino Sciascia , Emanuele De Simone , Thomas Schindler , Elsa Martins , Huiyan (Ashley) Mao , Daniela Rossi , Roberta Fenoglio

引用次数: 0

Intrafamilial Disease Heterogeneity in Primary Hyperoxaluria Type 1 原发性高草酸尿症 1 型的脐带内疾病异质性

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.026

Lisa J. Deesker , Hazal A. Karacoban , Elisabeth L. Metry , Sander F. Garrelfs , Justine Bacchetta , Olivia Boyer , Laure Collard , Arnaud Devresse , Wesley Hayes , Sally-Anne Hulton , Cristina Martin-Higueras , Shabbir H. Moochhala , Thomas J. Neuhaus , Jun Oh , Larisa Prikhodina , Przemyslaw Sikora , Michiel J.S. Oosterveld , Jaap W. Groothoff , Giorgia Mandrile , Bodo B. Beck

Introduction

Primary hyperoxaluria type 1 (PH1) is known for its variable clinical course, even within families. However, the extent of this heterogeneity has not been well-studied. We aimed to analyze intrafamilial clinical heterogeneity and disease course among siblings in a large cohort of familial PH1 cases.

Methods

A retrospective registry study was performed using data from OxalEurope. All PH1 families with 2 or more affected siblings were included. A 6-point PH1 clinical outcome scoring system was developed to grade heterogeneity within a family. Intrafamilial clinical heterogeneity was defined as a score ≥2. Kaplan-Meier analyses were used to analyze differences in kidney survival between index cases and siblings.

Results

We included 88 families, encompassing 193 patients with PH1. The median interquartile range (IQR) follow-up time was 7.8 (1.9–17) years. Intrafamilial clinical heterogeneity, as defined by our score, was found in 38 (43%) PH1 families. In 54% of the families, affected siblings had a better outcome than the index case. Clinically asymptomatic siblings at the time of their diagnosis had a significantly more favorable clinical outcome based on the authors’ scoring system than siblings with clinical signs and index cases (P < 0.001). Kaplan-Meier analyses revealed that index cases reached kidney failure at an earlier age and earlier in follow-up compared to siblings (P < 0.001).

Conclusions

Intrafamilial clinical heterogeneity was found in a substantial number of familial PH1 cases. Compared to index cases, siblings had significantly better clinical outcomes and kidney survival; thereby supporting the policy of family screening to diagnose affected siblings early to improve their prognosis.

众所周知，原发性高草酸尿症 1 型（PH1）的临床病程多变，甚至在家族中也是如此；然而，这种异质性的程度尚未得到充分研究。我们的目的是在一个庞大的家族性 PH1 病例队列中分析家族内兄弟姐妹间的临床异质性和病程。我们利用 OxalEurope 的数据进行了一项回顾性登记研究。研究纳入了所有有两个或两个以上患病兄弟姐妹的 PH1 家族。研究人员开发了一套 6 分 PH1 临床结果评分系统，用于对家族内的异质性进行分级。家族内临床异质性定义为得分≥2。Kaplan-Meier 分析用于分析指数病例与同胞兄弟姐妹之间肾脏存活率的差异。我们共纳入了 88 个家庭，包括 193 名 PH1 患者。随访时间的中位数四分位距（IQR）为 7.8（1.9-17）年。在 38 个（43%）PH1 家系中发现了根据我们的评分定义的脐带内临床异质性。在54%的家族中，受影响的兄弟姐妹的预后优于指数病例。根据作者的评分系统，确诊时无临床症状的同胞兄弟姐妹的临床结局明显优于有临床症状的同胞兄弟姐妹和指标病例（< 0.001）。卡普兰-梅耶分析显示，与同胞兄弟姐妹相比，指标病例出现肾衰竭的年龄更早，随访时间也更早（< 0.001）。在大量家族性PH1病例中发现了脐带内临床异质性。与指数病例相比，兄弟姐妹的临床结果和肾脏存活率明显更好；因此支持家族筛查政策，即尽早诊断受影响的兄弟姐妹，以改善他们的预后。

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引用次数: 0

Stepped-Wedge Trial of Decision Support for Acute Kidney Injury on Surgical Units 手术室急性肾损伤决策支持的阶梯式楔形试验

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.025

Matthew T. James , Elijah Dixon , Zhi Tan , Pamela Mathura , Indraneel Datta , Rohan N. Lall , Jennifer Landry , Evan P. Minty , Gregory A. Samis , Gerald B. Winkelaar , Neesh Pannu

Introduction

Acute kidney injury (AKI) is common in the perioperative setting and associated with poor outcomes. Whether clinical decision support improves early management and outcomes of AKI on surgical units is uncertain.

Methods

In this cluster-randomized, stepped-wedge trial, 8 surgical units in Alberta, Canada were randomized to various start dates to receive an education and clinical decision support intervention for recognition and early management of AKI. Eligible patients were aged ≥18 years, receiving care on a surgical unit, not already receiving dialysis, and with AKI.

Results

There were 2135 admissions of 2038 patients who met the inclusion criteria; mean (SD) age was 64.3 (16.2) years, and 885 (41.4%) were females. The proportion of patients who experienced the composite primary outcome of progression of AKI to a higher stage, receipt of dialysis, or death was 16.0% (178 events/1113 admissions) in the intervention group; and 17.5% (179 events/1022 admissions) in the control group (time-adjusted odds ratio, 0.76; 95% confidence interval [CI], 0.53–1.08; P = 0.12). There were no significant differences between groups in process of care outcomes within 48 hours of AKI onset, including administration of i.v. fluids, or withdrawal of medications affecting kidney function. Both groups experienced similar lengths of stay in hospital after AKI and change in estimated glomerular filtration rate (eGFR) at 3 months.

Conclusion

An education and clinical decision support intervention did not significantly improve processes of care or reduce progression of AKI, length of hospital stays, or recovery of kidney function in patients with AKI on surgical units.

急性肾损伤（AKI）是围手术期的常见病，与不良预后有关。临床决策支持是否能改善手术单位对 AKI 的早期管理和治疗效果尚不确定。在这项分组随机、阶梯式试验中，加拿大阿尔伯塔省的 8 家手术单位被随机分配到不同的起始日期，接受教育和临床决策支持干预，以识别和早期管理 AKI。符合条件的患者年龄≥18 岁，在手术室接受治疗，尚未接受透析，并患有 AKI。符合纳入标准的 2038 名患者中有 2135 人入院；平均（标清）年龄为 64.3（16.2）岁，885 人（41.4%）为女性。出现 AKI 进展到更高阶段、接受透析或死亡这一复合主要结局的患者比例在干预组为 16.0%（178 例/1113 例入院）；在对照组为 17.5%（179 例/1022 例入院）（时间调整后的几率比为 0.76；95% 置信区间 [CI]，0.53-1.08；= 0.12）。两组在 AKI 发病 48 小时内的护理结果（包括静脉输液或停用影响肾功能的药物）无明显差异。两组患者在发生 AKI 后的住院时间和 3 个月时估计肾小球滤过率（eGFR）的变化相似。教育和临床决策支持干预并未明显改善护理流程，也未减少手术室AKI患者的AKI进展、住院时间或肾功能恢复情况。

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引用次数: 0

Elevated Ambient Temperature Associated With Increased Cardiovascular Disease–Risk Among Patients on Hemodialysis 环境温度升高与血液透析患者心血管疾病风险增加有关

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.015

Yuzhi Xi , Zachary S. Wettstein , Abhijit V. Kshirsagar , Yang Liu , Danlu Zhang , Yun Hang , Ana G. Rappold

Introduction

In many parts of the world, ambient temperatures have increased due to climate change. Due to loss of renal function, which impacts the regulation of thermoregulatory mechanisms, the ability to adapt and to be resilient to changing conditions is particularly concerning among individuals with kidney failure. The aim of this study was to assess the effect of heat on mortality and health care utilization among US patients on hemodialysis.

Methods

We conducted a retrospective analysis from 2011 to 2016 in the contiguous United States during warmer months among eligible patients on dialysis who were identified in the United States Renal Data System (USRDS). Daily ambient temperature was estimated on a 1 km grid and assigned to ZIP-code. Case-crossover design with conditional Poisson models were used to assess the risk of developing adverse health outcomes associated with temperature exposure.

Results

Overall, exposure to high temperature is associated with elevated risk for both mortality and health care utilization among hemodialysis patients. The risk ratios for all-cause mortality and daily temperature were 1.07 (95% confidence interval [CI]: 1.03–1.11), 1.17 (1.14–1.21) for fluid disorder-related hospital admissions, and 1.19 (1.16–1.22) for cardiovascular event-related emergency department (ED) visits, comparing 99th percentile versus 50th percentile daily temperatures. Larger effects were observed for cumulative lagged exposure 3 days prior to the outcome and for Southwest and Northwest climate regions.

Conclusion

Heat exposure is associated with elevated risk for cardiovascular disease (CVD)–related mortality and health care utilization among this vulnerable population. Furthermore, the effect appears to be potentially cumulative in the short-term and varies geographically.

导言：在世界许多地区，环境温度因气候变化而升高。由于肾功能丧失会影响体温调节机制，因此肾衰竭患者的适应能力和对不断变化的环境的复原能力尤其令人担忧。本研究旨在评估高温对美国血液透析患者的死亡率和医疗保健利用率的影响。方法我们对美国肾脏数据系统（USRDS）中确认的符合条件的透析患者进行了一项回顾性分析，分析时间为 2011 年至 2016 年美国毗连地区较热月份。每日环境温度按 1 公里网格估算，并分配给邮政编码。结果总体而言，暴露于高温环境与血液透析患者死亡率和医疗保健使用率的风险升高有关。比较第 99 百分位数和第 50 百分位数的日温度，全因死亡率和日温度的风险比分别为 1.07（95% 置信区间 [CI]：1.03-1.11）、1.17（1.14-1.21）、1.19（1.16-1.22）和 1.19（1.16-1.22）。对于结果发生前 3 天的累积滞后暴露以及西南和西北气候区，观察到的影响更大。此外，这种影响在短期内似乎具有潜在的累积性，并且因地域而异。

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引用次数: 0

Peak Tricuspid Regurgitation Jet Velocity and Kidney Outcomes in Patients With Heart Failure With Preserved Ejection Fraction 射血分数保留型心力衰竭患者的三尖瓣反流射流速度峰值与肾脏预后

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.009

Tatsufumi Oka , Hocine Tighiouart , Wendy McCallum , Marcelle Tuttle , Jeffrey M. Testani , Mark J. Sarnak

Introduction

Although venous congestion secondary to elevated pulmonary artery pressure (PAP) has been hypothesized to worsen kidney function, the association of peak tricuspid regurgitation jet velocity (pTRV), a surrogate of PAP, with kidney outcomes remains uncertain in heart failure (HF) with preserved ejection fraction (HFpEF).

Methods

This post hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial analyzed participants with a left ventricular ejection fraction (LVEF) of ≥45% who had pTRV measured by echocardiography at baseline. For the cross-sectional analysis, the association of baseline pTRV with baseline estimated glomerular filtration rate (eGFR) was assessed using linear regression. For the longitudinal analysis, the association of baseline pTRV with decline in eGFR of ≥30% and doubling of serum creatinine was assessed using Cox proportional hazards models.

Results

Among 450 participants, the mean (SD) baseline age, LVEF, pTRV, and eGFR were 72.3 (9.6) years, 58.2% (7.4%), 2.8 (0.5) m/s, and 62.1 (18.7) ml/min per 1.73 m², respectively. Each 1 SD higher pTRV was associated with a lower baseline eGFR (coefficient, −1.79; 95% confidence interval [CI], −3.48 to −0.10 ml/min per 1.73 m²). Over a median (interquartile range) follow-up of 3.0 (2.0–4.4) years, 203 (45%) patients experienced ≥30% eGFR decline, and 48 (11%) experienced creatinine doubling. Each 1 SD higher pTRV was associated with a 20% higher risk of ≥30% eGFR decline (hazard ratio [HR], 1.20; 95% CI, 1.04–1.39) and a 45% higher risk of creatinine doubling (HR, 1.45; 95% CI, 1.09–1.94).

Conclusions

Higher pTRV was associated with lower eGFR at baseline, and higher risk of ≥30% eGFR decline and creatinine doubling among patients with HFpEF.

导言尽管肺动脉压（PAP）升高引起的静脉充血被认为会恶化肾功能，但在射血分数保留型心力衰竭（HFpEF）患者中，三尖瓣反流喷射速度峰值（pTRV）（PAP的替代指标）与肾脏预后的关系仍不确定。方法这项醛固酮拮抗剂治疗保留心功能心衰（TOPCAT）试验的事后分析分析了左室射血分数（LVEF）≥45%、基线时通过超声心动图测量 pTRV 的参与者。在横断面分析中，使用线性回归评估了基线 pTRV 与基线肾小球滤过率（eGFR）的关系。结果 450 名参与者的平均（标度）基线年龄、LVEF、pTRV 和 eGFR 分别为 72.3 (9.6) 岁、58.2% (7.4%)、2.8 (0.5) m/s 和 62.1 (18.7) ml/min per 1.73 m2。pTRV 每升高 1 SD，基线 eGFR 就降低（系数，-1.79；95% 置信区间 [CI]，-3.48 至-0.10 ml/min per 1.73 m2）。在 3.0 (2.0-4.4) 年的中位（四分位数间距）随访期间，203 名（45%）患者的 eGFR 下降了≥30%，48 名（11%）患者的肌酐翻了一番。pTRV 每增加 1 SD，eGFR 下降≥30% 的风险就增加 20%（危险比 [HR]，1.20；95% CI，1.04-1.39），肌酐翻倍的风险增加 45%（HR，1.45；95% CI，1.09-1.94）。

{"title":"Peak Tricuspid Regurgitation Jet Velocity and Kidney Outcomes in Patients With Heart Failure With Preserved Ejection Fraction","authors":"Tatsufumi Oka , Hocine Tighiouart , Wendy McCallum , Marcelle Tuttle , Jeffrey M. Testani , Mark J. Sarnak","doi":"10.1016/j.ekir.2024.07.009","DOIUrl":"10.1016/j.ekir.2024.07.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Although venous congestion secondary to elevated pulmonary artery pressure (PAP) has been hypothesized to worsen kidney function, the association of peak tricuspid regurgitation jet velocity (pTRV), a surrogate of PAP, with kidney outcomes remains uncertain in heart failure (HF) with preserved ejection fraction (HFpEF).</div></div><div><h3>Methods</h3><div>This <em>post hoc</em> analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial analyzed participants with a left ventricular ejection fraction (LVEF) of ≥45% who had pTRV measured by echocardiography at baseline. For the cross-sectional analysis, the association of baseline pTRV with baseline estimated glomerular filtration rate (eGFR) was assessed using linear regression. For the longitudinal analysis, the association of baseline pTRV with decline in eGFR of ≥30% and doubling of serum creatinine was assessed using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Among 450 participants, the mean (SD) baseline age, LVEF, pTRV, and eGFR were 72.3 (9.6) years, 58.2% (7.4%), 2.8 (0.5) m/s, and 62.1 (18.7) ml/min per 1.73 m<sup>2</sup>, respectively. Each 1 SD higher pTRV was associated with a lower baseline eGFR (coefficient, −1.79; 95% confidence interval [CI], −3.48 to −0.10 ml/min per 1.73 m<sup>2</sup>). Over a median (interquartile range) follow-up of 3.0 (2.0–4.4) years, 203 (45%) patients experienced ≥30% eGFR decline, and 48 (11%) experienced creatinine doubling. Each 1 SD higher pTRV was associated with a 20% higher risk of ≥30% eGFR decline (hazard ratio [HR], 1.20; 95% CI, 1.04–1.39) and a 45% higher risk of creatinine doubling (HR, 1.45; 95% CI, 1.09–1.94).</div></div><div><h3>Conclusions</h3><div>Higher pTRV was associated with lower eGFR at baseline, and higher risk of ≥30% eGFR decline and creatinine doubling among patients with HFpEF.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845994","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}

引用次数: 0

Lower Parathyroid Hormone Levels are Associated With Reduced Fracture Risk in Japanese Patients on Hemodialysis 甲状旁腺激素水平降低与日本血液透析患者骨折风险降低有关

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.008

Hirotaka Komaba , Takahiro Imaizumi , Takayuki Hamano , Naohiko Fujii , Masanori Abe , Norio Hanafusa , Masafumi Fukagawa

Introduction

Secondary hyperparathyroidism (SHPT) affects bone metabolism and may lead to bone fragility. However, there is conflicting evidence as to whether parathyroid hormone (PTH) levels are associated with fracture risk and whether the relationship is linear or U-shaped.

Methods

We examined the association between PTH levels and the risk of any fracture and site-specific fractures in a nationwide cohort of 180,333 patients on hemodialysis. We also examined the association between the percent change in PTH levels during the preceding 1 year and subsequent fracture.

Results

At baseline, the median intact PTH level was 141 pg/ml (interquartile range, 78–226 pg/ml). During 1 year of follow-up, there were a total of 3762 fractures requiring hospitalization (1361 hip, 551 vertebral, and 1850 other). In an adjusted analysis, higher baseline PTH levels were associated with an incrementally increased risk of any fracture (odds ratio [OR] per doubling of intact PTH, 1.06; 95% confidence interval, 1.03–1.09). The association between PTH levels and fracture risk was more pronounced for hip fractures but not found for vertebral fractures. The absolute risk difference associated with higher PTH levels appeared to be more pronounced in older individuals, females, and those with lower body mass index (BMI). Change in PTH levels was also associated with fracture risk: the adjusted OR for fracture decreased linearly with decreasing PTH levels over 1 year, regardless of the preceding PTH levels.

Conclusion

Lower PTH levels are associated with a graded reduction in fracture risk. Further studies are needed to determine whether intensive PTH control reduces fracture risk.

导言二级甲状旁腺功能亢进症（SHPT）会影响骨代谢，并可能导致骨质脆弱。然而，关于甲状旁腺激素（PTH）水平是否与骨折风险相关，以及这种关系是线性关系还是U型关系，目前尚存在相互矛盾的证据。方法我们研究了全国范围内180333名血液透析患者队列中PTH水平与任何骨折风险和特定部位骨折风险之间的关系。结果基线时，完整 PTH 水平的中位数为 141 pg/ml（四分位间范围为 78-226 pg/ml）。在一年的随访期间，共有 3762 例骨折需要住院治疗（其中髋部骨折 1361 例，椎体骨折 551 例，其他骨折 1850 例）。在调整分析中，基线 PTH 水平越高，发生骨折的风险越高（完整 PTH 每增加一倍的几率比 [OR]，1.06；95% 置信区间，1.03-1.09）。PTH水平与骨折风险之间的关系在髋部骨折中更为明显，但在椎体骨折中未发现这种关系。与较高 PTH 水平相关的绝对风险差异在老年人、女性和体重指数（BMI）较低的人群中似乎更为明显。PTH水平的变化也与骨折风险相关：1年内，随着PTH水平的降低，骨折的调整OR呈线性下降，与之前的PTH水平无关。需要进一步研究来确定强化 PTH 控制是否能降低骨折风险。

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引用次数: 0

A Survey on End-of-Life Contemplation Among Patients on Dialysis 透析患者对生命终结的思考调查

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.035

Martin Russwurm , Anetta Rabaev , Joachim D. Hoyer , Christian S. Haas , Christian Volberg , Philipp Russ

Introduction

Considering that mortality among patients on dialysis is high, it would be advisable for patients, relatives, and care givers to acknowledge that after dialysis initiation for many patients, the last phase in life has begun. We sought to investigate the frequency of precautionary planning directives, contemplation about the end-of-life (EOL) and embedding of patients’ wishes in the interaction with relatives and the treating nephrologists.

Methods

In a questionnaire-based interview survey, we investigated the frequency of precautionary planning, EOL wishes, and frequency of relatives’ or medical professionals’ conversations with patients about those wishes as well as possibly associated demographic, socioeconomic and medical factors. The interviews were conducted by a single investigator in 7 dialysis centers in Germany.

Results

From 349 identified patients, 268 (77%) participated. The participants (36% female) had a median age of 70 (interquartile range [IQR]: 58–80) years and had spent a median of 3 (IQR: 1–7.5) years on dialysis. Overall, 46% of patients on dialysis contemplated their EOL wishes at least occasionally. Of those, 85% talked about EOL wishes with their relatives, whereas 19% discussed them with their nephrologists, yet another 28% would like to have such a discussion with their nephrologist.

Conclusion

Almost half of patients on dialysis contemplate their EOL and the vast majority engage in discussions about that with their relatives. Despite patients being interested, the frequency of consultation of nephrologists on EOL care is low. This study suggests that there is a substantial but unmet need for EOL care consultation for patients on dialysis.

考虑到透析患者的死亡率很高，患者、亲属和护理人员最好能认识到，许多患者在开始透析后，生命的最后阶段已经开始。我们试图调查在与亲属和主治肾科医生的互动中，患者是否经常使用预防性计划指令、思考生命末期（EOL）以及将患者的意愿融入其中。在一项基于问卷的访谈调查中，我们调查了预防性规划的频率、临终前的愿望、亲属或医务人员与患者就这些愿望进行交谈的频率以及可能相关的人口、社会经济和医疗因素。访谈由一名调查人员在德国的 7 个透析中心进行。在 349 名确定的患者中，有 268 人（77%）参加了访谈。参与者（36% 为女性）的年龄中位数为 70 岁（四分位距[IQR]：58-80），透析时间中位数为 3 年（四分位距：1-7.5）。总体而言，46% 的透析患者至少偶尔会考虑自己的临终愿望。其中 85% 的患者会与亲属讨论临终前的愿望，19% 的患者会与肾科医生讨论临终前的愿望，还有 28% 的患者希望与肾科医生讨论临终前的愿望。几乎一半的透析患者都考虑过自己的生命终结问题，而且绝大多数患者都与亲属讨论过这一问题。尽管患者对此很感兴趣，但肾科医生就临终关怀进行咨询的频率却很低。这项研究表明，透析患者对临终关怀咨询的需求很大，但尚未得到满足。

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引用次数: 0

Correlation of Urinary Soluble CD163 Levels With Disease Activity and Treatment Response in IgA Nephropathy 尿液可溶性 CD163 水平与 IgA 肾病的疾病活动性和治疗反应的相关性

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.031

Jingyi Li , Jicheng Lv , Muh Goet Wong , Sufang Shi , Jincan Zan , Helen Monaghan , Vlado Perkovic , Hong Zhang

Introduction

The TESTING trial demonstrated that corticosteroids reduce the risk of kidney failure in patients with IgA nephropathy (IgAN) but increase the risk of serious adverse events. Reliable noninvasive biomarkers are needed to identify patients who would benefit most from corticosteroid therapy. Previous studies suggest glomerular macrophage infiltration is associated with response to immunosuppressive therapy in IgAN and urinary soluble CD163 ([u-sCD163], a marker of alternatively activated macrophages [M2]c macrophage) is correlated with clinical remission in vasculitis. This study aims to investigate the association between u-sCD163 and response of steroids therapy in IgAN.

Methods

We measured u-sCD163 in patients from a large IgAN cohort and Chinese participants of the TESTING trial. The correlation of baseline or serial u-sCD163 and their response of corticosteroids therapy or kidney outcomes were investigated.

Results

In cross-sectional analysis, u-sCD163 levels correlated with kidney macrophage infiltration, especially in crescentic areas, and with active lesions. Subgroup analysis of the TESTING cohort showed higher levels u-sCD163 were associated with greater benefits from corticosteroids therapy in proteinuria remission (odds ratio, 35.56 [95% confidence interval, CI: 7.62–292.34] vs. 3.94 [95% CI: 1.39–12.93], P for interaction: 0.036). Corticosteroids therapy significantly reduced u-sCD163 levels at 6 months compared to placebo group (79% [interquartile range: 58%–91%] vs. 37% [−11% to 58%], P <0.001). There was no difference in the suppressive effects on u-sCD163 by either dosage of corticosteroids (full and reduced-dose). The suppression of u-sCD163 was significantly associated with a reduced risk of kidney progression events (adjusted hazard ratio: 0.52, 95% CI: 0.30–0.93, P = 0.027).

Conclusion

u-sCD163 is a reliable noninvasive biomarker associated with active pathological lesions in IgAN and can guide glucocorticoid therapy.

TESTING试验表明，皮质类固醇可降低IgA肾病（IgAN）患者发生肾衰竭的风险，但会增加发生严重不良事件的风险。需要可靠的非侵入性生物标志物来确定哪些患者最受益于皮质类固醇治疗。先前的研究表明，肾小球巨噬细胞浸润与IgAN患者对免疫抑制疗法的反应有关，尿液可溶性CD163（[u-sCD163]，一种替代活化巨噬细胞[M2]c巨噬细胞的标记物）与脉管炎的临床缓解有关。本研究旨在探讨u-sCD163与IgAN患者类固醇治疗反应之间的关系。我们测量了来自大型 IgAN 队列的患者和 TESTING 试验的中国参与者的 u-sCD163。我们研究了基线或序列u-sCD163与皮质类固醇治疗反应或肾脏预后的相关性。在横断面分析中，u-sCD163水平与肾脏巨噬细胞浸润（尤其是在新月体区域）和活动性病变相关。对 TESTING 队列进行的亚组分析显示，u-sCD163 水平越高，蛋白尿缓解时从皮质类固醇治疗中获益越多（比值比 35.56 [95% 置信区间：7.62-292.34] vs. 3.94 [95% 置信区间：1.39-12.93]，交互作用为 0.036）：0.036).与安慰剂组相比，皮质类固醇治疗可显著降低6个月时的u-sCD163水平（79% [四分位间范围：58%-91%] vs. 37% [-11% to 58%]，<0.001）。两种剂量的皮质类固醇（全量和减量）对u-sCD163的抑制作用没有差异。u-sCD163的抑制与肾脏恶化风险的降低显著相关（调整后危险比：0.52，95% CI：0.30-0.93，=0.027）。

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引用次数: 0