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Fracture Risk in Patients on Hemodialysis: the Lower the Parathyroid Hormone the Better? 血液透析患者的骨折风险:甲状旁腺激素越低越好?
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.08.023
Michel Y. Jadoul , Laura Labriola
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引用次数: 0
Erratum to “Features of Postpartum Hemorrhage-Associated Thrombotic Microangiopathy and Role of Short-Term Complement Inhibition” [Kidney International Reports Volume 9, Issue 4, April 2024, Pages 919-928] 对《产后出血相关血栓性微血管病的特征及短期补体抑制的作用》的勘误 [《国际肾脏报告》第 9 卷第 4 期,2024 年 4 月,第 919-928 页]
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.08.001
Jessica K. Kaufeld , Lucas Kühne , Ulf Schönermarck , Jan Hinrich Bräsen , Constantin von Kaisenberg , Bodo B. Beck , Florian Erger , Carsten Bergmann , Anke von Bergwelt-Baildon , Paul T. Brinkkötter , Linus A. Völker , Jan Menne
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引用次数: 0
Canagliflozin Pharmacokinetics at Steady State in Patients on Maintenance Hemodialysis 维持性血液透析患者稳定状态下的卡格列净药代动力学
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.038
Thomas A. Mavrakanas , Amélie Marsot , Efrosyne Tsirella , Norka Rios , Ari Gritsas , Rita S. Suri
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引用次数: 0
Statin Use and the Progression of Coronary Artery Calcification in CKD: Findings From the KNOW-CKD Study 他汀类药物的使用与慢性肾脏病患者冠状动脉钙化的进展:KNOW-CKD 研究的发现
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.033
Jihyun Yang , Kyu-Beck Lee , Hyang Kim , Soo Wan Kim , Yeong Hoon Kim , Su Ah Sung , Jayoun Kim , Kook-Hwan Oh , Ji Yong Jung , Young Youl Hyun

Introduction

Statin treatment can reduce the risk of cardiovascular disease (CVD). Paradoxically, previous studies have shown that the use of statin is associated with the progression coronary artery calcification (CAC), a well-known predictor of CVD, in individuals with preserved renal function or in patients on dialysis. However, little is known about the association in patients with predialysis chronic kidney disease (CKD). The aim of this study was to characterize the relationship between statin use and progression of CAC in a CKD cohort of Korean adults.

Methods

We analyzed 1177 participants registered in the Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD) cohort. Coronary artery calcium score (CACS) was assessed using cardiac computed tomography at baseline and 4 years after enrollment. CAC progression was defined using the Sevrukov method. Statin users were defined as those who used statins for 50% or more of the follow-up period.

Results

The median (interquartile range) of CACS was 0 (0–30.33), and 318 (44.2%) participants had CACS above 0 at baseline. There were 447 (38.0%) statin users and 730 (62.0%) statin nonusers. After 4 years, 374 patients (52.0%) demonstrated CAC progression, which was significantly more frequent in statin users than in statin nonusers (218 [58.3%] vs. 156 [41.7%], P < 0.001). The multivariate-adjusted odds ratio for CAC progression in statin users compared to statin nonusers was 1.78 (1.26–2.50).

Conclusion

Statin use, significantly and independently, is associated with CAC progression in Korean patients with predialysis CKD. Further research is warranted to verify the prognosis of statin-related CAC progression.
他汀类药物治疗可降低罹患心血管疾病(CVD)的风险。矛盾的是,先前的研究表明,在肾功能保留或透析患者中,他汀类药物的使用与冠状动脉钙化(CAC)的进展有关,而CAC是众所周知的心血管疾病的预测指标。然而,人们对透析前慢性肾脏病(CKD)患者的相关性知之甚少。本研究旨在描述他汀类药物的使用与韩国成年人 CKD 队列中 CAC 进展之间的关系。我们分析了在韩国慢性肾病患者结局队列研究(KNOW-CKD)队列中登记的 1177 名参与者。在基线和入组 4 年后,使用心脏计算机断层扫描评估冠状动脉钙化评分(CACS)。CAC进展采用Sevrukov法进行定义。他汀类药物使用者被定义为在随访期间使用他汀类药物达50%或以上者。CACS的中位数(四分位数间距)为0(0-30.33),318名参与者(44.2%)在基线时CACS高于0。他汀类药物使用者为 447 人(38.0%),非使用者为 730 人(62.0%)。4 年后,374 名患者(52.0%)出现了 CAC 进展,他汀类药物使用者的 CAC 进展频率明显高于他汀类药物非使用者(218 [58.3%] 对 156 [41.7%],< 0.001)。与他汀类药物非使用者相比,他汀类药物使用者CAC进展的多变量调整赔率为1.78(1.26-2.50)。他汀类药物的使用与韩国透析前慢性肾脏病患者的 CAC 进展密切相关。需要进一步研究来验证他汀类药物相关 CAC 进展的预后。
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引用次数: 0
Prospective Trial on the Pharmacokinetics of Clopidogrel in Hemodialysis Patients 血液透析患者氯吡格雷药代动力学前瞻性试验
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.029
Juergen Grafeneder , Wisse van Os , Iris K. Minichmayr , Katarina D. Kovacevic Miljevic , Birgit Reiter , Marcus D. Säemann , Veronika Machold-Fabrizii , Amro Ahmed , Paul Spechtl , Haris Omic , Raute Sunder-Plaßmann , Bernd Jilma , Christian Schoergenhofer , Farsad Eskandary

Introduction

Hemodialysis patients (HDPs) exhibit extensive cardiovascular risk. The widely prescribed anti-platelet agent clopidogrel is metabolically activated by cytochrome enzymes, which may be impaired by uremia and chronic low-grade inflammation, typically present in HDPs. We conducted a prospective multicenter study to investigate the pharmacokinetics and pharmacodynamics of clopidogrel in HDPs and healthy volunteers (HVs).

Methods

We enrolled HDPs receiving long-term clopidogrel (75 mg) and pantoprazole treatment (40 mg). Healthy volunteers received a loading dose of 300 mg clopidogrel, followed by 75 mg once daily. Pantoprazole, a substrate and probe drug of CYP2C19, was administered intravenously (40 mg). Plasma concentrations were quantified by mass spectrometry. Pharmacokinetics were calculated, and a population pharmacokinetic model was developed. The primary endpoint was the maximum concentration of clopidogrel’s active metabolite. Platelet aggregation was measured using adenosine diphosphate-induced whole-blood aggregometry.

Results

Seventeen HDPs and 16 HVs were included. The maximum concentration of clopidogrel’s active metabolite was significantly lower in HDPs compared to HVs (median [interquartile range] 12.2 [4.6–23.4] vs. 24.7 [17.8–36.5] ng/ml, P = 0.02). The maximum concentration ratio of clopidogrel’s active metabolite to prodrug was 8.5-fold lower in HDPs, and an 82.7% reduced clopidogrel clearance, including clopidogrel’s active metabolite formation, was found using population pharmacokinetic modeling. From previous studies, adenosine diphosphate-induced platelet aggregation at 120 minutes was significantly higher in HDPs than in HVs (median [interquartile range]: 26 U [14 U–43 U] vs. 12 U [11 U–18 U], P = 0.004. Pantoprazole terminal half-life was ∼1.7-fold higher in HDPs compared to HVs.

Conclusion

Our data demonstrate an altered metabolism of clopidogrel in HDPs in the context of lower CYP2C19 activity, with potential implications for other substances metabolized by this enzyme.
血液透析患者(HDPs)具有广泛的心血管风险。被广泛使用的抗血小板药物氯吡格雷通过细胞色素酶进行代谢活化,而尿毒症和慢性低度炎症可能会损害细胞色素酶的活性,而尿毒症和慢性低度炎症正是血液透析患者的典型症状。我们进行了一项前瞻性多中心研究,调查氯吡格雷在 HDPs 和健康志愿者(HVs)中的药代动力学和药效学。我们招募了长期接受氯吡格雷(75 毫克)和泮托拉唑(40 毫克)治疗的 HDP 患者。健康志愿者接受 300 毫克氯吡格雷的负荷剂量,然后每天一次,每次 75 毫克。静脉注射泮托拉唑(40 毫克),泮托拉唑是氯吡格雷的底物和探针药物。通过质谱法对血浆浓度进行量化。计算了药代动力学,并建立了群体药代动力学模型。主要终点是氯吡格雷活性代谢物的最大浓度。使用二磷酸腺苷诱导的全血聚集测定法测量血小板聚集。其中包括 17 种 HDP 和 16 种 HV。与 HV 相比,HDPs 中氯吡格雷活性代谢物的最大浓度明显较低(中位数 [四分位间范围] 12.2 [4.6-23.4] 与 24.7 [17.8-36.5] 纳克/毫升,0.02)。在 HDPs 中,氯吡格雷活性代谢物与原药的最大浓度比降低了 8.5 倍,通过群体药代动力学模型发现,氯吡格雷清除率(包括氯吡格雷活性代谢物的形成)降低了 82.7%。根据先前的研究,120 分钟时二磷酸腺苷诱导的血小板聚集在 HDPs 中明显高于 HVs(中位数[四分位间范围]:26 U [14 U-43 U] vs. 12 U [11 U-18 U],0.004)。泮托拉唑的终末半衰期在 HDPs 中比在 HVs 中高 1.7 倍。我们的数据表明,在活性较低的情况下,HDPs 中氯吡格雷的代谢发生了改变,这可能对该酶代谢的其他物质产生影响。
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引用次数: 0
A Pilot Study on Protective Effect of Ambrisentan on Proteinuria in Patients With Alport Syndrome 安利生坦对阿尔波特综合征患者蛋白尿保护作用的试点研究
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.027
Zhuo-ran Song , Yang Li , Hong Zhang , Xu-jie Zhou
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引用次数: 0
Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK) 晚期肾病新型多学科护理计划(PEAK)的临床效果
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.018
Daniil Shimonov , Sri Lekha Tummalapalli , Stephanie Donahue , Vidya Narayana , Sylvia Wu , Lisa S. Walters , Roberta Billman , Barbara Desiderio , Sandra Pressman , Oliver Fielding , Kariel Sweeney , Daniel Cukor , Daniel M. Levine , Thomas S. Parker , Vesh Srivatana , Jeffrey Silberzweig , Frank Liu , Andrew Bohmart

Introduction

Multidisciplinary care (MDC) for late-stage chronic kidney disease (CKD) has been associated with improved patient outcomes compared with traditional nephrology care; however, the optimal MDC model is unknown. In 2015, we implemented a novel MDC model for patients with late-stage CKD informed by the Chronic Care Model conceptual framework, including an expanded MDC team, care plan meetings, clinical risk prediction, and a patient dashboard.

Methods

We conducted a single-center, retrospective cohort study of adults with late-stage CKD (estimated glomerular filtration rate [eGFR] < 30 ml/min per 1.73 m2) enrolled from May 2015 to February 2020 in the Program for Education in Advanced Kidney Disease (PEAK). Our primary composite outcome was an optimal transition to end-stage kidney disease (ESKD) defined as starting in-center hemodialysis (ICHD) as an outpatient with an arteriovenous fistula (AVF) or graft (AVG), or receiving home dialysis, or a preemptive kidney transplant. Secondary outcomes included home dialysis initiation, preemptive transplantation, vascular access at dialysis initiation, and location of ICHD initiation. We used logistic regression to examine trends in outcomes. Results were stratified by race, ethnicity, and insurance payor, and compared with national and regional averages from the United States Renal Data System (USRDS) averaged from 2015 to 2019.

Results

Among 489 patients in the PEAK program, 37 (8%) died prior to ESKD and 151 (31%) never progressed to ESKD. Of the 301 patients (62%) who progressed to ESKD, 175 (58%) achieved an optimal transition to ESKD, including 54 (18%) on peritoneal dialysis, 16 (5%) on home hemodialysis, and 36 (12%) to preemptive transplant. Of the 195 patients (65%) starting ICHD, 51% started with an AVF or AVG and 52% started as an outpatient. The likelihood of starting home dialysis increased by 1.34 times per year from 2015 to 2020 (95% confidence interval [CI]: 1.05–1.71, P = 0.018) in multivariable adjusted results. Optimal transitions to ESKD and home dialysis rates were higher than the national USRDS data (58% vs. 30%; 23% vs. 11%) across patient race, ethnicity, and payor.

Conclusion

Patients enrolled in a novel comprehensive MDC model coupled with risk prediction and health information technology were nearly twice as likely to achieve an optimal transition to ESKD and start dialysis at home, compared with national averages.
导言与传统肾脏病护理相比,晚期慢性肾脏病(CKD)的多学科护理(MDC)可改善患者的预后;然而,最佳的 MDC 模式尚不清楚。2015 年,我们根据慢性病护理模式概念框架,为晚期 CKD 患者实施了一种新型 MDC 模式,包括扩大的 MDC 团队、护理计划会议、临床风险预测和患者仪表板。方法我们对 2015 年 5 月至 2020 年 2 月参加晚期肾病教育项目(PEAK)的晚期 CKD 成人患者(估计肾小球滤过率 [eGFR] < 30 ml/min 每 1.73 m2)进行了单中心回顾性队列研究。我们的主要综合结果是向终末期肾病(ESKD)的最佳过渡,即作为门诊病人开始中心内血液透析(ICHD),并伴有动静脉瘘(AVF)或移植物(AVG),或接受家庭透析,或进行先期肾移植。次要结果包括开始家庭透析、抢先移植、开始透析时的血管通路以及开始 ICHD 的地点。我们采用逻辑回归法检测结果的变化趋势。结果按种族、民族和保险支付方进行了分层,并与美国肾脏数据系统(USRDS)2015 年至 2019 年的全国和地区平均值进行了比较。结果在 PEAK 项目的 489 名患者中,37 人(8%)在 ESKD 之前死亡,151 人(31%)从未进展为 ESKD。在进展为 ESKD 的 301 名患者(62%)中,175 名(58%)实现了向 ESKD 的最佳过渡,其中 54 名(18%)接受腹膜透析,16 名(5%)接受家庭血液透析,36 名(12%)接受先期移植。在 195 名(65%)开始接受 ICHD 的患者中,51% 开始接受 AVF 或 AVG,52% 开始接受门诊治疗。多变量调整结果显示,从 2015 年到 2020 年,开始家庭透析的可能性每年增加 1.34 倍(95% 置信区间 [CI]:1.05-1.71,P = 0.018)。结论与全国平均水平相比,加入新型综合 MDC 模型并结合风险预测和健康信息技术的患者实现最佳 ESKD 过渡和开始家庭透析的几率几乎是全国平均水平的两倍。
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引用次数: 0
Climate Change, Heat Stress, and Kidney Disease–Associated Mortality and Health Care Utilization 气候变化、热应激与肾病相关死亡率和医疗服务利用率
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.08.018
Naresh Kumar , Venkata Madhavi Latha Telagarapu , Alessia Fornoni
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引用次数: 0
Urinary Soluble CD163: A Novel Biomarker Suggests Who Should Receive Glucocorticoids in IgA Nephropathy 尿可溶性CD163:一种新的生物标志物:提示 IgA 肾病患者哪些人应接受糖皮质激素治疗
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.08.011
Guisen Li , Susan J. Thanabalasingam
{"title":"Urinary Soluble CD163: A Novel Biomarker Suggests Who Should Receive Glucocorticoids in IgA Nephropathy","authors":"Guisen Li ,&nbsp;Susan J. Thanabalasingam","doi":"10.1016/j.ekir.2024.08.011","DOIUrl":"10.1016/j.ekir.2024.08.011","url":null,"abstract":"","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":"142181695","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
Pilot Study of Valganciclovir-Induced Leukopenia in Kidney Transplant Recipients With NUDT15 Genetic Variation 对NUDT15基因变异的肾移植受者缬更昔洛韦诱导的白细胞减少症的试点研究
IF 5.7 2区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.ekir.2024.07.010
Madan M. Bahadur , Nikhil Dhope , Rejitha R. Kaimal , Ashay Shingare
{"title":"Pilot Study of Valganciclovir-Induced Leukopenia in Kidney Transplant Recipients With NUDT15 Genetic Variation","authors":"Madan M. Bahadur ,&nbsp;Nikhil Dhope ,&nbsp;Rejitha R. Kaimal ,&nbsp;Ashay Shingare","doi":"10.1016/j.ekir.2024.07.010","DOIUrl":"10.1016/j.ekir.2024.07.010","url":null,"abstract":"","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":"141839194","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
期刊
Kidney International Reports
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