Pub Date : 2024-11-01DOI: 10.1016/j.xkme.2024.100909
<div><h3>Rationale & Objective</h3><div>Given the organ shortage in the United States, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors’ perceived health and its association with the likelihood of completing the donor evaluation process.</div></div><div><h3>Study Design</h3><div>Potential donors’ self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware Health Perceptions surveys.</div></div><div><h3>Setting & Participants</h3><div>Potential living donors who expressed interest in donation at a single medical center were recruited prospectively between 2017 and 2022.</div></div><div><h3>Exposure</h3><div>Donors' self-reported health and health perceptions.</div></div><div><h3>Outcomes</h3><div>Completion of the donor evaluation.</div></div><div><h3>Analytical Approach</h3><div>Adjusted linear and logistic regression models were used to examine the association between self-reported health and health perceptions with outcomes.</div></div><div><h3>Results</h3><div>A total of 1,347 individuals were included for study; 46% (N<!--> <!-->=<!--> <!-->613) were<!--> <!--><<!--> <!-->40 years of age, 71% (n<!--> <!-->=<!--> <!-->951) were female, 22% (n<!--> <!-->=<!--> <!-->294) were of Hispanic ethnicity, and 16% (n<!--> <!-->=<!--> <!-->215) completed the donor evaluation. The mean PROMIS global physical health (17.0<!--> <!-->±<!--> <!-->1.9) and mental health (15.5<!--> <!-->±<!--> <!-->2.7) raw scores were higher among donor candidates proceeding to completion of the donor evaluation when compared with those who withdrew early in the process (16.3<!--> <!-->±<!--> <!-->2.2 for physical health and 14.9<!--> <!-->±<!--> <!-->3.1 for mental health). Every z-score change in the PROMIS physical health score was associated with 1.48-fold higher odds of completing the donor evaluation (95% CI, 1.19-1.85). Fully adjusted models incorporating the PROMIS scores for predicting the completion of donor evaluations had a c-statistic of 0.70. Potential donors’ Davies and Wares health perceptions did not predict the likelihood of completing the donor evaluation in fully adjusted models.</div></div><div><h3>Limitations</h3><div>Data are derived from a single center and may not generalize to the donor evaluation process at other transplant centers.</div></div><div><h3>Conclusions</h3><div>Donor candidates’ self-reported physical health may serve as a predictor of the likelihood of completing the donor evaluation process and a potential avenue for future interventions.</div></div><div><h3>Plain Language Summary</h3><div>This study was designed to understand the health perceptions of living donor candidates. We found that donor candidates’ self-reported physical health strongly predicted their lik
{"title":"Living Donor Candidates’ Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study","authors":"","doi":"10.1016/j.xkme.2024.100909","DOIUrl":"10.1016/j.xkme.2024.100909","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Given the organ shortage in the United States, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors’ perceived health and its association with the likelihood of completing the donor evaluation process.</div></div><div><h3>Study Design</h3><div>Potential donors’ self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware Health Perceptions surveys.</div></div><div><h3>Setting & Participants</h3><div>Potential living donors who expressed interest in donation at a single medical center were recruited prospectively between 2017 and 2022.</div></div><div><h3>Exposure</h3><div>Donors' self-reported health and health perceptions.</div></div><div><h3>Outcomes</h3><div>Completion of the donor evaluation.</div></div><div><h3>Analytical Approach</h3><div>Adjusted linear and logistic regression models were used to examine the association between self-reported health and health perceptions with outcomes.</div></div><div><h3>Results</h3><div>A total of 1,347 individuals were included for study; 46% (N<!--> <!-->=<!--> <!-->613) were<!--> <!--><<!--> <!-->40 years of age, 71% (n<!--> <!-->=<!--> <!-->951) were female, 22% (n<!--> <!-->=<!--> <!-->294) were of Hispanic ethnicity, and 16% (n<!--> <!-->=<!--> <!-->215) completed the donor evaluation. The mean PROMIS global physical health (17.0<!--> <!-->±<!--> <!-->1.9) and mental health (15.5<!--> <!-->±<!--> <!-->2.7) raw scores were higher among donor candidates proceeding to completion of the donor evaluation when compared with those who withdrew early in the process (16.3<!--> <!-->±<!--> <!-->2.2 for physical health and 14.9<!--> <!-->±<!--> <!-->3.1 for mental health). Every z-score change in the PROMIS physical health score was associated with 1.48-fold higher odds of completing the donor evaluation (95% CI, 1.19-1.85). Fully adjusted models incorporating the PROMIS scores for predicting the completion of donor evaluations had a c-statistic of 0.70. Potential donors’ Davies and Wares health perceptions did not predict the likelihood of completing the donor evaluation in fully adjusted models.</div></div><div><h3>Limitations</h3><div>Data are derived from a single center and may not generalize to the donor evaluation process at other transplant centers.</div></div><div><h3>Conclusions</h3><div>Donor candidates’ self-reported physical health may serve as a predictor of the likelihood of completing the donor evaluation process and a potential avenue for future interventions.</div></div><div><h3>Plain Language Summary</h3><div>This study was designed to understand the health perceptions of living donor candidates. We found that donor candidates’ self-reported physical health strongly predicted their lik","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.xkme.2024.100915
{"title":"Undetected Air Embolism During Hemodialysis from a Defective Central Venous Catheter Causing Intradialytic Cardiac Arrest: An Imaging Teaching Case","authors":"","doi":"10.1016/j.xkme.2024.100915","DOIUrl":"10.1016/j.xkme.2024.100915","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-11DOI: 10.1016/j.xkme.2024.100914
<div><h3>Rationale & Objective</h3><div>A response “no” (SQ-No) to the surprise question (SQ) of whether a clinician would be surprised if a dialysis patient died in the next 6 months is associated with a higher risk of all-cause death. It is uncertain what domains are intuitively assessed with the SQ. We hypothesized that the SQ would assess the patient’s frailty, malnutrition, or patient-perceived health-related quality of life in a cohort of patients on maintenance hemodialysis.</div></div><div><h3>Study Design</h3><div>Cohort study.</div></div><div><h3>Setting & Participants</h3><div>A multicenter study including 994 patients on maintenance hemodialysis in Japan.</div></div><div><h3>Predictors</h3><div>(1) SQ answered by nurses; (2) frailty by modified Cardiovascular Health Study criteria; (3) malnutrition as evaluated by Geriatric Nutritional Risk Index (GNRI); and (4) patient-perceived health-related quality of life examined by the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS).</div></div><div><h3>Outcomes</h3><div>All-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard models.</div></div><div><h3>Results</h3><div>Median age and dialysis vintage were 66 and 5.9 years, respectively, 35.8% were women, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 45.9%. Median GNRI and SF-36 PCS scores were 96.3 and 36.9, respectively. During the 5-year follow-up, 247 patients died. SQ-No, being frail, low GNRI, and low SF-36 PCS were each significant predictors of a higher risk for mortality independent of potential confounders. SQ-No remained a significant predictor after further adjustment for frailty or GNRI, but SQ-No was no longer significant when adjusted for SF-36 PCS.</div></div><div><h3>Limitations</h3><div>We did not assess the agreement of responses to the SQ between different raters.</div></div><div><h3>Conclusions</h3><div>The predictive ability of the SQ was closely related to SF-36 PCS in hemodialysis patients. Nurses’ answer to the SQ appears to assess the physical domain of patient-perceived health-related quality of life rather than objectively assessed frailty or malnutrition.</div></div><div><h3>Plain Language Summary</h3><div>“Would I be surprised if this patient died in the next 6 months?” This question posed to a clinician is called the “surprise question” (SQ) and the answer “no” (SQ-No) has been shown to predict a higher risk of mortality in patients undergoing hemodialysis. We examined which domains are intuitively assessed with the SQ, such as frailty, malnutrition, and patient-perceived quality of life in a cohort of hemodialysis patients. We found that the association between the SQ response and mortality was independent of frailty and malnutrition but was closely related to the physical domain of patient-perceived quality of life. The results suggest that the SQ appears to assess the physical domain of patient-per
{"title":"The Surprise Question in Hemodialysis, Frailty, Nutrition, Patient-reported Quality of Life, and All-Cause Mortality: The Osaka Dialysis Complication Study (ODCS)","authors":"","doi":"10.1016/j.xkme.2024.100914","DOIUrl":"10.1016/j.xkme.2024.100914","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>A response “no” (SQ-No) to the surprise question (SQ) of whether a clinician would be surprised if a dialysis patient died in the next 6 months is associated with a higher risk of all-cause death. It is uncertain what domains are intuitively assessed with the SQ. We hypothesized that the SQ would assess the patient’s frailty, malnutrition, or patient-perceived health-related quality of life in a cohort of patients on maintenance hemodialysis.</div></div><div><h3>Study Design</h3><div>Cohort study.</div></div><div><h3>Setting & Participants</h3><div>A multicenter study including 994 patients on maintenance hemodialysis in Japan.</div></div><div><h3>Predictors</h3><div>(1) SQ answered by nurses; (2) frailty by modified Cardiovascular Health Study criteria; (3) malnutrition as evaluated by Geriatric Nutritional Risk Index (GNRI); and (4) patient-perceived health-related quality of life examined by the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS).</div></div><div><h3>Outcomes</h3><div>All-cause mortality.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazard models.</div></div><div><h3>Results</h3><div>Median age and dialysis vintage were 66 and 5.9 years, respectively, 35.8% were women, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 45.9%. Median GNRI and SF-36 PCS scores were 96.3 and 36.9, respectively. During the 5-year follow-up, 247 patients died. SQ-No, being frail, low GNRI, and low SF-36 PCS were each significant predictors of a higher risk for mortality independent of potential confounders. SQ-No remained a significant predictor after further adjustment for frailty or GNRI, but SQ-No was no longer significant when adjusted for SF-36 PCS.</div></div><div><h3>Limitations</h3><div>We did not assess the agreement of responses to the SQ between different raters.</div></div><div><h3>Conclusions</h3><div>The predictive ability of the SQ was closely related to SF-36 PCS in hemodialysis patients. Nurses’ answer to the SQ appears to assess the physical domain of patient-perceived health-related quality of life rather than objectively assessed frailty or malnutrition.</div></div><div><h3>Plain Language Summary</h3><div>“Would I be surprised if this patient died in the next 6 months?” This question posed to a clinician is called the “surprise question” (SQ) and the answer “no” (SQ-No) has been shown to predict a higher risk of mortality in patients undergoing hemodialysis. We examined which domains are intuitively assessed with the SQ, such as frailty, malnutrition, and patient-perceived quality of life in a cohort of hemodialysis patients. We found that the association between the SQ response and mortality was independent of frailty and malnutrition but was closely related to the physical domain of patient-perceived quality of life. The results suggest that the SQ appears to assess the physical domain of patient-per","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.xkme.2024.100910
{"title":"Advanced CKD of Uncertain Etiology Among Children in Guatemala: Genetic and Clinical Characteristics","authors":"","doi":"10.1016/j.xkme.2024.100910","DOIUrl":"10.1016/j.xkme.2024.100910","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.xkme.2024.100911
{"title":"Pegloticase-Induced Rapid Uric Acid Lowering and Kidney and Cardiac Health Markers in Youth-Onset Type 2 Diabetes: A Pilot Clinical Trial","authors":"","doi":"10.1016/j.xkme.2024.100911","DOIUrl":"10.1016/j.xkme.2024.100911","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.xkme.2024.100912
<div><h3>Rationale & Objective</h3><div>Blood pressure (BP) control is essential for preventing cardiorenal complications in chronic kidney disease (CKD), but most patients fail to reach BP target. We assessed longitudinal patterns of antihypertensive drug prescription and systolic BP.</div></div><div><h3>Study Design</h3><div>Prospective observational cohort study.</div></div><div><h3>Setting & Population</h3><div>In total, 2,755 hypertensive patients with CKD stages 3-4, receiving care from a nephrologist, from the French CKD–Renal Epidemiology and Information Network (CKD-REIN cohort study).</div></div><div><h3>Exposure</h3><div>Patient factors, including sociodemographic characteristics, medical history, and laboratory data, and provider factors, including number of primary care physician and specialist encounters.</div></div><div><h3>Outcomes</h3><div>Changes in antihypertensive drug-class prescription during follow-up: add-on or withdrawal.</div></div><div><h3>Analytical Approach</h3><div>Hierarchical shared-frailty models to estimate hazard ratios (HR) to deal with clustering at the nephrologist level and linear mixed models to describe systolic BP trajectory.</div></div><div><h3>Results</h3><div>At baseline, median age was 69 years, and mean estimated glomerular filtration rate was 33<!--> <!-->mL/min/1.73 m². In total, 66% of patients were men, 81% had BP<!--> <!-->≥<!--> <!-->130/80<!--> <!-->mm Hg, and 75% were prescribed<!--> <!-->≥2 antihypertensive drugs. During a median 5-year follow-up, the rate of changes of antihypertensive prescription was 50 per 100 person-years, 23 per 100 for add-ons, and 25 per 100 for withdrawals. After adjusting for risk factors, systolic BP, and the number of antihypertensive drugs, poor medication adherence was associated with increased HR for add-on (1.35, 95% confidence interval [CI], 1.01-1.80), whereas a lower education level was associated with increased HR for withdrawal (1.23, 95% CI, 1.02-1.49) for 9-11 years versus<!--> <!-->≥12 years. More frequent nephrologist visits (≥4 vs none) were associated with higher HRs of add-on and withdrawal (1.52, 95% CI, 1.06-2.18; 1.57, 95% CI, 1.12-2.19, respectively), whereas associations with visit frequency to other physicians varied with their specialty. Mean systolic BP decreased by 4<!--> <!-->mm Hg following drug add-on but tended to increase thereafter.</div></div><div><h3>Limitations</h3><div>Lack of information on prescriber and drug dosing.</div></div><div><h3>Conclusions</h3><div>In patients with CKD and poor BP control, changes in antihypertensive drug prescriptions are common and relate to clinician preferences and patients’ tolerability. Sustainable reduction in systolic BP after add-on of a drug class is infrequently achieved.</div></div><div><h3>Plain-Language Summary</h3><div>Blood pressure (BP) control remains unattained in most patients with chronic kidney disease (CKD), raising questions about how antihypertensive treatment is manag
{"title":"Antihypertensive Treatment Patterns in CKD Stages 3 and 4: The CKD-REIN Cohort Study","authors":"","doi":"10.1016/j.xkme.2024.100912","DOIUrl":"10.1016/j.xkme.2024.100912","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Blood pressure (BP) control is essential for preventing cardiorenal complications in chronic kidney disease (CKD), but most patients fail to reach BP target. We assessed longitudinal patterns of antihypertensive drug prescription and systolic BP.</div></div><div><h3>Study Design</h3><div>Prospective observational cohort study.</div></div><div><h3>Setting & Population</h3><div>In total, 2,755 hypertensive patients with CKD stages 3-4, receiving care from a nephrologist, from the French CKD–Renal Epidemiology and Information Network (CKD-REIN cohort study).</div></div><div><h3>Exposure</h3><div>Patient factors, including sociodemographic characteristics, medical history, and laboratory data, and provider factors, including number of primary care physician and specialist encounters.</div></div><div><h3>Outcomes</h3><div>Changes in antihypertensive drug-class prescription during follow-up: add-on or withdrawal.</div></div><div><h3>Analytical Approach</h3><div>Hierarchical shared-frailty models to estimate hazard ratios (HR) to deal with clustering at the nephrologist level and linear mixed models to describe systolic BP trajectory.</div></div><div><h3>Results</h3><div>At baseline, median age was 69 years, and mean estimated glomerular filtration rate was 33<!--> <!-->mL/min/1.73 m². In total, 66% of patients were men, 81% had BP<!--> <!-->≥<!--> <!-->130/80<!--> <!-->mm Hg, and 75% were prescribed<!--> <!-->≥2 antihypertensive drugs. During a median 5-year follow-up, the rate of changes of antihypertensive prescription was 50 per 100 person-years, 23 per 100 for add-ons, and 25 per 100 for withdrawals. After adjusting for risk factors, systolic BP, and the number of antihypertensive drugs, poor medication adherence was associated with increased HR for add-on (1.35, 95% confidence interval [CI], 1.01-1.80), whereas a lower education level was associated with increased HR for withdrawal (1.23, 95% CI, 1.02-1.49) for 9-11 years versus<!--> <!-->≥12 years. More frequent nephrologist visits (≥4 vs none) were associated with higher HRs of add-on and withdrawal (1.52, 95% CI, 1.06-2.18; 1.57, 95% CI, 1.12-2.19, respectively), whereas associations with visit frequency to other physicians varied with their specialty. Mean systolic BP decreased by 4<!--> <!-->mm Hg following drug add-on but tended to increase thereafter.</div></div><div><h3>Limitations</h3><div>Lack of information on prescriber and drug dosing.</div></div><div><h3>Conclusions</h3><div>In patients with CKD and poor BP control, changes in antihypertensive drug prescriptions are common and relate to clinician preferences and patients’ tolerability. Sustainable reduction in systolic BP after add-on of a drug class is infrequently achieved.</div></div><div><h3>Plain-Language Summary</h3><div>Blood pressure (BP) control remains unattained in most patients with chronic kidney disease (CKD), raising questions about how antihypertensive treatment is manag","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100905
Rationale & Objective
Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.
Study Design
A cohort study matched 1:3 to historical controls.
Setting & Participants
Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.
Exposure
Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.
Outcomes
Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.
Analytic Approach
Endpoints were assessed using Cox proportional hazards models.
Results
Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n = 34) and matched controls (n = 102) (HR 1.33 [95% CI, 0.81-2.18]; P = 0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; P = 0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR < 45 mL/min/1.73 m2 exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; P = 0.012) when compared with those with baseline eGFR ≥45 mL/min/1.73 m2 (HR 0.69 [95% CI, 0.29-1.67]; P = 0.41) (test of interaction P = 0.04).
Limitations
Small sample size that may have been underpowered for the effectiveness endpoints.
Conclusions
AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.
理论依据& 目标远程患者监护（RPM）可提高急性肾损伤（AKI）幸存者护理的质量和效率。本研究介绍了我们在 AKI RPM 方面的经验，并描述了其有效性。研究设计一项队列研究，与历史对照组进行 1:3 匹配。结果6个月内发生意外再入院或急诊科就诊的风险。分析方法采用Cox比例危险模型评估终点。结果49名参加AKI RPM的患者中有40人（82%）在出院后参加了该项目。73%的患者经历过一次 AKI RPM 警报，最常见的警报与液体状态有关。在 3 期 AKI 患者中，AKI RPM 患者（34 人）与匹配对照组（102 人）在出院后 6 个月内发生意外再入院或急诊就诊的风险没有差异（HR 1.33 [95% CI, 0.81-2.18]；P = 0.27）。AKI RPM 组未住院的急诊就诊发生率明显更高（HR 1.95 [95% CI, 1.05-3.62]；P = 0.035）。与基线 eGFR ≥45 mL/min/1.73 m2 的患者相比（HR 0.69 [95% CI, 0.29-1.67]; P = 0.41），接受 AKI RPM 治疗的基线 eGFR ≥45 mL/min/1.73 m2 患者发生意外再入院或急诊就诊的风险更高（HR 2.24 [95% CI, 1.19-4.20]; P = 0.012）（交互作用检验 P = 0.04）。结论出院后使用AKI RPM可发出警报并采取干预措施，以优化肾脏健康和AKI并发症，但并不能降低再次住院的风险。
{"title":"Acute Kidney Injury Survivor Remote Patient Monitoring: A Single Center’s Experience and an Effectiveness Evaluation","authors":"","doi":"10.1016/j.xkme.2024.100905","DOIUrl":"10.1016/j.xkme.2024.100905","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.</div></div><div><h3>Study Design</h3><div>A cohort study matched 1:3 to historical controls.</div></div><div><h3>Setting & Participants</h3><div>Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.</div></div><div><h3>Exposure</h3><div>Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.</div></div><div><h3>Outcomes</h3><div>Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.</div></div><div><h3>Analytic Approach</h3><div>Endpoints were assessed using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n<!--> <!-->=<!--> <!-->34) and matched controls (n<!--> <!-->=<!--> <!-->102) (HR 1.33 [95% CI, 0.81-2.18]; <em>P</em> <!-->=<!--> <!-->0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; <em>P</em> <!-->=<!--> <!-->0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR<!--> <!--><<!--> <!-->45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; <em>P</em> <!-->=<!--> <!-->0.012) when compared with those with baseline eGFR<!--> <!-->≥45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> (HR 0.69 [95% CI, 0.29-1.67]; <em>P</em> <!-->=<!--> <!-->0.41) (test of interaction <em>P</em> <!-->=<!--> <!-->0.04).</div></div><div><h3>Limitations</h3><div>Small sample size that may have been underpowered for the effectiveness endpoints.</div></div><div><h3>Conclusions</h3><div>AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100908
Numerous health concerns, primarily kidney injury, have been reported with the use of Beni-kōji CholesteHelp, a functional food containing red yeast rice. Here, we describe 2 cases of kidney injury caused by beni-kōji. The first case had normal kidney function before consuming the product. After several months of use, she developed hypertension. After 6 months of supplement consumption, her estimated glomerular filtration rate (eGFR) dropped to 22.5 mL/min/1.73 m2. A spot urine sample showed a urinary protein-to-creatinine ratio of 2.03 g/g, leading to the diagnosis of Fanconi syndrome. Kidney biopsy showed tubular degeneration. Thirty-five days after discontinuing the supplement, proteinuria resolved and the eGFR returned to baseline level. The second case, who had diabetes and normal kidney function, experienced severe kidney injury (eGFR, 3.5 mL/min/1.73 m2) after 4 months of Beni-kōji CholesteHelp use. He required hemodialysis for >2 weeks but recovered kidney function after the product was discontinued. Kidney biopsy showed tubular injury similar to the first case and glomeruli changes consistent with diabetic nephropathy. These cases indicate that beni-kōji use is associated with tubular toxicity. Further studies are required to identify the precise etiology and mechanism of kidney injury.
{"title":"Acute Kidney Injury Associated With Red Yeast Rice (Beni-kōji) Supplement: A Report of Two Cases","authors":"","doi":"10.1016/j.xkme.2024.100908","DOIUrl":"10.1016/j.xkme.2024.100908","url":null,"abstract":"<div><div>Numerous health concerns, primarily kidney injury, have been reported with the use of Beni-kōji CholesteHelp, a functional food containing red yeast rice. Here, we describe 2 cases of kidney injury caused by beni-kōji. The first case had normal kidney function before consuming the product. After several months of use, she developed hypertension. After 6 months of supplement consumption, her estimated glomerular filtration rate (eGFR) dropped to 22.5<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>. A spot urine sample showed a urinary protein-to-creatinine ratio of 2.03<!--> <!-->g/g, leading to the diagnosis of Fanconi syndrome. Kidney biopsy showed tubular degeneration. Thirty-five days after discontinuing the supplement, proteinuria resolved and the eGFR returned to baseline level. The second case, who had diabetes and normal kidney function, experienced severe kidney injury (eGFR, 3.5<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>) after 4 months of Beni-kōji CholesteHelp use. He required hemodialysis for<!--> <!-->>2 weeks but recovered kidney function after the product was discontinued. Kidney biopsy showed tubular injury similar to the first case and glomeruli changes consistent with diabetic nephropathy. These cases indicate that beni-kōji use is associated with tubular toxicity. Further studies are required to identify the precise etiology and mechanism of kidney injury.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100903
Renal physiology is considered one of the most challenging medical disciplines to understand and to teach. Eight academic nephrologists have come together to produce a podcast devoted to helping learners at any level improve their understanding of this difficult topic. Using Dr Burton D. Rose’s classic textbook: Clinical Physiology of Acid-Base and Electrolyte Disorders, the podcast faculty systematically attack each chapter of the book in a didactic yet fun-flowing interactive discussion. This education model is unique and helps demystify complex topics.
{"title":"Renal Physiology Education via Podcast: Channel Your Enthusiasm","authors":"","doi":"10.1016/j.xkme.2024.100903","DOIUrl":"10.1016/j.xkme.2024.100903","url":null,"abstract":"<div><div>Renal physiology is considered one of the most challenging medical disciplines to understand and to teach. Eight academic nephrologists have come together to produce a podcast devoted to helping learners at any level improve their understanding of this difficult topic. Using Dr Burton D. Rose’s classic textbook: <em>Clinical Physiology of Acid-Base and Electrolyte Disorders</em>, the podcast faculty systematically attack each chapter of the book in a didactic yet fun-flowing interactive discussion. This education model is unique and helps demystify complex topics.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100904
<div><h3>Rationale & Objective</h3><div>Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Study Populations</h3><div>Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used.</div></div><div><h3>Selection Criteria for Studies</h3><div>Retrospective or prospective, observational studies, non-randomized or randomized controlled trials.</div></div><div><h3>Data Extractions</h3><div>Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; <em>I</em><sup>2</sup> <!-->=<!--> <!-->86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68).</div></div><div><h3>Limitations</h3><div>Substantial heterogeneity between the studies and large number of studies with poor quality.</div></div><div><h3>Conclusions</h3><div>bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies.</div></div><div><h3>Plain-Language Summary</h3><div>Peritoneal dialysis (PD) is limited by hemodialysis transfer. The optimal vascular access in hemodialysis is the arteriovenous fistula, yet requirements for maturation often necessitate a central venous catheter (CVC) insertion in acute transfers from PD. A back-up arteriovenous fistula (bAVF) is a strategy used to avoid CVC use in such situations. However, no consensus is currently available on the best approach for bAVF in PD. By conducting a systematic review, we found that 69% of bAVFs were never used. Nevertheless, bAVFs reduced the risk of hemodialysis transfer with
{"title":"Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis","authors":"","doi":"10.1016/j.xkme.2024.100904","DOIUrl":"10.1016/j.xkme.2024.100904","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting & Study Populations</h3><div>Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used.</div></div><div><h3>Selection Criteria for Studies</h3><div>Retrospective or prospective, observational studies, non-randomized or randomized controlled trials.</div></div><div><h3>Data Extractions</h3><div>Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale.</div></div><div><h3>Results</h3><div>We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; <em>I</em><sup>2</sup> <!-->=<!--> <!-->86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68).</div></div><div><h3>Limitations</h3><div>Substantial heterogeneity between the studies and large number of studies with poor quality.</div></div><div><h3>Conclusions</h3><div>bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies.</div></div><div><h3>Plain-Language Summary</h3><div>Peritoneal dialysis (PD) is limited by hemodialysis transfer. The optimal vascular access in hemodialysis is the arteriovenous fistula, yet requirements for maturation often necessitate a central venous catheter (CVC) insertion in acute transfers from PD. A back-up arteriovenous fistula (bAVF) is a strategy used to avoid CVC use in such situations. However, no consensus is currently available on the best approach for bAVF in PD. By conducting a systematic review, we found that 69% of bAVFs were never used. Nevertheless, bAVFs reduced the risk of hemodialysis transfer with ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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