Kidney360最新文献

Background: Patient-reported outcomes, such as satisfaction with care, are essential for assessing and improving healthcare quality, especially in populations with chronic conditions like hemodialysis patients. In diverse societies, understanding how ethnic background influences patient satisfaction and clinical outcomes is crucial for addressing health disparities. However, the relationship between ethnic background, patient satisfaction, and clinical outcomes has not been thoroughly investigated in Israeli hemodialysis patients. This study aimed evaluate patient satisfaction among the Israeli population of maintenance hemodialysis patients and its correlation with clinical and demographic variables, including a potential association with ethnicity. In addition to assessing patient satisfaction, we also evaluated the association between ethnicity and clinical outcomes.

Methods: A prospective cross-sectional cohort study of maintenance hemodialysis patients from 3 Israeli centers with similar practice patterns. Patients were recruited between April-December 2022 and followed through February 2024. Patient satisfaction was assessed via a validated self-administered questionnaire (on a Likert scale of 1-7). Clinical outcomes included all-cause mortality and kidney-transplantation rates.

Results: The study included 127 hemodialysis patients, 74 of them were Israeli Jews and the remaining 53 included patients were Israeli of Arab origin. Israeli Jews were older, more often males, and had a lower prevalence of diabetes compared to Israeli Arabs (71.03±12.9 vs 60.86±13.7 years, p<0.001; 71.6% vs 52.8% male, p=0.030; 44.6% vs 79.2% with diabetes, p<0.001, respectively). Overall patient satisfaction was 6.47±1.08 among Israeli Jewish vs 6.83±0.68 among Israeli Arab patients (p=0.017) from dialysis clinic, whereas the mean patients' satisfaction survey was 5.58±1.08 vs 5.79±0.79 respectively, p=0.226. Ethnicity was not associated with mortality and transplantation. Dialysis vintage and patient age were the strongest predictors of patient satisfaction and mortality.

Conclusions: In Israeli dialysis centers, patient ethnicity was not associated with patient-reported satisfaction or objective clinical outcomes including mortality and transplantation rates. Larger cohort studies to assess levels of satisfaction longitudinally are indicated.

Background: The end of peritoneal dialysis (PD) can be marked by kidney transplantation, death, or transfer to hemodialysis (HD). We compared the risks of the different reasons for transfer to HD in PD patients according to the use of assistance for PD care, PD modality, and the suboptimal starter status.

Methods: This was a retrospective study using data from the French Language Peritoneal Dialysis Registry from patients who started PD between January 1, 2002, and December 31, 2018. We used Cox and Fine Gray survival models to evaluate the risks of transfer to HD due to PD inadequacy, infection, mechanical issue, psychosocial issue, others PD-related and others non-PD-related causes. Models were evaluated for three periods of PD vintage: 0 to 6 months, 6 to 18 months, and after 18 months.

Results: The study included 15,974 incident PD patients treated in 170 French PD units. There were 6,835 deaths, 5,108 transfers to HD and 3,092 renal transplantations. Nurse-assisted PD was associated with a lower risk of transfer to HD for infection in the first 18 months (cs-HR 0.51, 95%CI 0.31-0.83 before 6 months) and for adequacy issues after 6 months (cs-HR 0.59, 95%CI 0.51-0.70 after 18 months). The risk of transfer for mechanical issue was higher in CAPD compared to APD during the first eighteen months (cs-HR 1.41, 95%CI 1.00-1.99 before 6 months), but CAPD was associated with a lower risk for adequacy, infectious or mechanical issue after 18 months. Finally, suboptimal starters have a higher risk of transfer due to psychosocial challenges in the first 6 months (cs-HR 1.70, 95%CI 1.03-2.81).

Conclusions: Distinct factors are associated with the risk of transfer from PD to in-center HD, according to the cause of the transfer. Some preventive measures targeting these risk factors may help to maintain patients in PD.

Background: Emerging data suggest sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) may lower stone risk.

Methods: We characterized 24-hour urine parameters among individuals with kidney stone disease receiving these agents using Medicare claims from beneficiaries with urine collections processed by a central laboratory between January 2010 and December 2019. We identified a cross-sectional cohort with diabetes and a prescription fill for SGLT2i or GLP-1RA within the six months preceding their urine collection and matched controls. We additionally identified a subset of patients who performed two collections and had a prescription fill for SGLT2i or GLP-1RA before the second collection, but not the first. We compared across 24-hour urinary parameters in both cohorts and adjusted for multiple comparisons.

Results: The cross-sectional cohort included 124 patients with a prescription fill for SGLT2i (and 620 matched controls), and 349 patients with a prescription fill for GLP-1RA (and 349 matched controls). Compared to controls, patients on SGLT2i had a higher mean urine citrate (838 mg vs. 636 mg; p<0.01) and volume (2.4L vs. 2.0 L; p<0.01) with improved calcium phosphate supersaturation (p<0.01). Lower urine pH and higher sulfate, and uric acid were observed in the SGLT2i group (p<0.01 for each). There were no significant differences in urine parameters with GLP-1RA. In the longitudinal analyses of SGLT2is (59 patients) and GLP-1RAs (154 patients), there were no significant differences in urinary parameters.

Conclusions: SGLT2is were associated with higher urine volume and citrate in a cross-sectional cohort. GLP-1RA were not associated with changes that would reduce stone risk.

Background: To date, very little is known about the lived experiences of families impacted by chronic kidney disease (CKD), especially regarding the adaptive coping strategies these families use to successfully cope with the chronic stress they must face due to CKD.

Methods: An exploratory qualitative descriptive study was conducted by recruiting a sub-sample of adults with advanced CKD participating in the Canadian Frailty Observation and Interventions Trial (CanFIT) study and some of their caregivers. As part of this ongoing larger study, 12 adults with advanced CKD and seven of their caregivers (N = 19) completed one focus group discussion that explored topics related to their unique lived experiences of individuals impacted by CKD. Narrative data was analyzed using a 3-step inductive thematic analysis process.

Results: Three themes that portray participants' lived experiences were identified, including 1) experiencing chronic stress due to CKD; 2) coping successfully with the stress caused by CKD; and 3) recommendations to improve family well-being.

Conclusions: Social and health services for families impacted by CKD may be more effective in promoting the health, well-being, and quality of life of both adults with CKD and their caregivers if they acknowledge the chronic stressors these families face daily and provide support strategies that help them successfully cope with such stressors.

Background: In a cohort of patients with late-stage kidney disease who completed dialysis modality education and who self-identified as racial ethnic minorities, we studied characteristics of those choosing PD, and perception of usefulness of the education session in modality selection.

Methods: In this study of individuals with kidney failure cared for by nephrologists at Montefiore Medical Center, Bronx, NY, who were referred for modality education, we: 1-tested the association of patient characteristics with modality selection in 113 patients from 2021-2023, and 2-examined patient perception of the quality of modality education from 13 semi-structured interviews. We compared sociodemographic, clinical attributes, and patient responsiveness to attempts made by staff among those who selected and initiated PD to those who a-did not select PD, or b-initiated on HD urgently . We performed qualitative analysis of interviews to reach consensus on theoretical domain framework concepts and how they fit events in the kidney failure trajectory.

Results: Compared to individuals who required urgent HD, those who selected, and were initiated on, PD were younger (54 yrs vs 66 yrs), had fewer comorbidities, and did not require as many attempts to schedule modality education. Qualitative analysis of interviews showed that experience with staff and quality of information conveyed during education was generally positive, but the following gaps were identified: lack of support for the emotional trauma of kidney failure diagnosis, inability to address structural barriers to PD specific to the patient population, and the lack of a deliberate program to lessen anxiety about the responsibility of PD.

Conclusions: Incorporation of tailored content that addresses clinical comorbidity, structural barriers to care and emotional trauma constitute aspects of modality education that can be improved to increase PD uptake among minoritized patients.

Background: Vascular calcification (VC) is prevalent among patients with end stage kidney disease (ESKD). Exosomes, small extracellular vesicles actively secreted by cells, contain proteins, nucleic acids, lipids and other bioactive substances and are considered major mediators of cell-cell interactions. Endothelial-Mesenchymal Transition (EndMT) has been observed in a variety of pathological conditions, such as abnormal shear stress, vascular damage, and chronic inflammation. The aim of this research was to assess the effects of serum-derived exosomes from ESKD patients with VC on the induction of EndMT in endothelial cells and their potential role in accelerating VC.

Methods: Twenty hemodialysis patients with VC and 10 healthy volunteers were recruited. Cardiac and brain VC were assessed among patients with ESKD treated with dialysis. Serum samples were taken at dialysis initiation for exosome isolation. Human umbilical vein endothelial cells (HUVEC) were treated with 100 µg/mL exosomes for 24-96 hours. At the end of incubation, cells were collected for mRNA and protein analysis.

Results: Exosomes isolated from dialysis patients with VC induced EndMT in HUVECs. After 24h, endothelial markers CD31 and VE-cadherin were decreased (31% and 51%, respectively; P<0.001) and the mesenchymal proteins Vimentin and N-cadherin were increased (283% and 156%, respectively; P<0.001), compared to healthy exosomes. After 96h of incubation, expression of genes essential for osteoblast differentiation, including the bone morphogenetic genes (BMP2, BMPR2, BMP4 and BMP9), and the transcription factor RUNX2 were significantly elevated.

Conclusions: Exosomes derived from the serum of dialysis patients with VC, induced EndMT and contributed to calcification. The vicious cycle highlighted the intricate interplay between exosomes, EC and VC, emphasizing the critical necessity for therapeutic strategies to disrupt this pathway and mitigate calcification advancement.

Background: Acute kidney injury (AKI) is common in SARS-CoV-2 infection and COVID-19, often leading to long-term kidney dysfunction. However, the transcriptomic features of AKI severity and its long-term effects are underexplored.

Methods: We performed bulk RNA sequencing on peripheral blood mononuclear cells (PBMCs) from hospitalized SARS-CoV-2 patients and complemented these findings with proteomic data from the same cohort. We compared the functional enrichment findings with historical sepsis-AKI data and subsequently examined the association between molecular signatures and long-term kidney function changes.

Results: In 283 patients, 57 had mild AKI (stage 1) and 49 had severe AKI (stage 2 or 3). Following adjustments for age, sex, severity of infection, and pre-existing chronic kidney disease (CKD), we identified 6,432 differentially expressed genes (DEGs) in the severe AKI vs. control comparison, 840 in the mild AKI vs. control, and 1,213 in the severe vs. mild AKI comparison (FDR<0.05). Common pathways included unfolded protein response, cellular response to stress via eIF2, and IFN-g-mediated inflammatory response. Severe AKI was linked to pathways involved in mitochondrial dysfunction and endoplasmic reticulum stress. Proteomic analysis confirmed 40 established AKI and inflammation biomarkers, while gene-set enrichment of transcription regulators revealed additional biomarkers for severe AKI. Comparison with PBMC transcriptomics from sepsis-related AKI showed significant functional overlap (30%). Analysis of post-discharge eGFR data in 115 patients identified 177 DEGs for severe vs. control, 106 for mild vs. control, and 46 for severe vs. mild AKI. Key associations included kidney function decline related to carbohydrate and mitochondrial metabolism, inflammatory-response, and cardiovascular regulation.

Conclusions: We demonstrate that severe AKI in SARS-CoV-2 infection is linked to mitochondrial dysfunction and ER stress. The functional overlap with sepsis-AKI suggests potential broader therapeutic applicability. Long-term kidney dysfunction is influenced by disruptions in cellular energy metabolism and immune response.