<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":"Tetsuo Shoji , Daijiro Kabata , Seiichi Kimura , Yuki Nagata , Katsuhito Mori , Shinya Nakatani , Hisako Fujii , Tomoaki Morioka , Masanori Emoto","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":"6 12","pages":"Article 100914"},"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 : 2024-10-11DOI: 10.1016/j.xkme.2024.100913
Dilaram Acharya , Fanar Ghanim , Tyrone G. Harrison , Tayler Dawn Scory , Nusrat Shommu , Paul E. Ronksley , Meghan J. Elliott , David Collister , Neesh Pannu , Matthew T. James
<div><h3>Rationale & Objective</h3><div>Cilastatin is an inhibitor of drug metabolism in the proximal tubule that demonstrates nephroprotective effects in animals. It has been used in humans in combination with the antibiotic imipenem to block imipenem’s renal metabolism. This systematic review and meta-analysis evaluated the nephroprotective effects of cilastatin in humans.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis of observational (comparative effectiveness) studies or randomized clinical trials (RCTs).</div></div><div><h3>Setting & Study Populations</h3><div>People of any age at risk of acute kidney injury (AKI).</div></div><div><h3>Selection Criteria for Studies</h3><div>We systematically searched MEDLINE, Embase, Web of Science, and the Cochrane Controlled Trials registry from database inception to November 2023 for observational studies or RCTs that compared kidney outcomes among groups treated with cilastatin, either alone or as combination imipenem-cilastatin, versus an inactive or active control group not treated with cilastatin.</div></div><div><h3>Data Extraction</h3><div>Two reviewers independently evaluated studies for inclusion and risk of bias.</div></div><div><h3>Analytical Approach</h3><div>Treatment effects were estimated using random-effects models, and heterogeneity was quantified using the <em>I</em><sup>2</sup> statistic.</div></div><div><h3>Results</h3><div>We identified 10 studies (5 RCTs, n<!--> <!-->=<!--> <!-->531<!--> <!-->patients; 5 observational studies, n<!--> <!-->=<!--> <!-->6,321 participants) that met the inclusion criteria, including 4 studies with comparisons to inactive controls and 6 studies with comparisons to alternate antibiotics. Based on pooled results from 7 studies, the risk of AKI was lower with imipenem-cilastatin (risk ratio [RR], 0.52; 95% confidence intervals [CI], 0.40-0.67; <em>I</em><sup>2</sup> <!-->=<!--> <!-->26.5%), with consistent results observed in RCTs (3 RCTs, RR, 0.26; 95% CI, 0.09-0.77; <em>I</em><sup>2</sup> <!-->=<!--> <!-->44.4%) and observational studies (4 studies, RR, 0.54; 95% CI, 0.41-0.72; <em>I</em><sup>2</sup> <!-->=<!--> <!-->44.4%). Based on results from 6 studies, serum creatinine concentration was lower following treatment with imipenem-cilastatin than comparators (weighted mean difference in serum creatinine<!--> <!-->−0.14 mg/dL (95% CI, −0.21 to<!--> <!-->−0.07; <em>I</em><sup>2</sup> <!-->=<!--> <!-->0%). The overall certainty of the evidence was low due to heterogeneity of the results, high risk of bias, and indirectness among the identified studies.</div></div><div><h3>Limitations</h3><div>Clinical and statistical heterogeneity could not be fully explained due to a limited number of studies.</div></div><div><h3>Conclusions</h3><div>Patients treated with imipenem-cilastatin developed AKI less frequently and had lower serum creatinine concentration following treatment than control groups or those who had received compar
理由与amp; 目的西司他丁是一种近端肾小管药物代谢抑制剂，在动物体内具有保护肾脏的作用。在人体中，它与抗生素亚胺培南联合使用，可阻断亚胺培南的肾脏代谢。本系统综述和荟萃分析评估了西司他丁对人类肾脏的保护作用。研究设计系统综述和荟萃分析观察性（比较效应）研究或随机临床试验（RCT）。研究的筛选标准我们系统地检索了MEDLINE、Embase、Web of Science和Cochrane对照试验登记系统中从数据库开始到2023年11月的所有研究，以寻找对单用西司他丁或亚胺培南-西司他丁联合治疗组与未用西司他丁治疗的非活性或活性对照组的肾脏结果进行比较的观察性研究或RCT。结果我们确定了10项符合纳入标准的研究（5项RCT，n=531名患者；5项观察性研究，n=6321名参与者），其中包括4项与非活性对照组进行比较的研究和6项与替代抗生素进行比较的研究。根据 7 项研究的汇总结果，亚胺培南-西司他丁的 AKI 风险较低（风险比 [RR]，0.52；95% 置信区间 [CI]，0.40-0.67；I2 = 26.5%），在 RCT（3 项 RCT，RR，0.26；95% CI，0.09-0.77；I2 = 44.4%）和观察性研究（4 项研究，RR，0.54；95% CI，0.41-0.72；I2 = 44.4%）中观察到的结果一致。根据6项研究的结果，使用亚胺培南-西司他丁治疗后，血清肌酐浓度低于对照组（血清肌酐的加权平均差异为-0.14 mg/dL (95% CI, -0.21 to -0.07；I2 = 0%)。结论与对照组或接受了对比抗生素治疗的患者相比，接受亚胺培南-西司他丁治疗的患者发生AKI的频率较低，治疗后血清肌酐浓度也较低。为确定西司他丁预防 AKI 的疗效，需要进行更大规模的临床试验，以降低因缺乏分配隐藏和盲法而导致的检测偏倚风险。本系统综述和荟萃分析确定了 10 项亚胺培南-西司他丁研究（5 项随机对照试验和 5 项观察性研究），涉及有 AKI 风险的人群。对治疗效果的汇总估计表明，与对比组相比，接受亚胺培南-西司他丁治疗的患者的 AKI 发生率较低，治疗后血清肌酐浓度也较低。尽管这些研究结果很有希望，但由于研究之间存在异质性、高偏倚风险以及数据的间接性，证据的总体确定性较低。尽管西司他丁似乎是一种很有前景的预防 AKI 的药物，但还需要更大规模、设计合理的试验来确定其有效性。
{"title":"Nephroprotective Effects of Cilastatin in People at Risk of Acute Kidney Injury: A Systematic Review and Meta-analysis","authors":"Dilaram Acharya , Fanar Ghanim , Tyrone G. Harrison , Tayler Dawn Scory , Nusrat Shommu , Paul E. Ronksley , Meghan J. Elliott , David Collister , Neesh Pannu , Matthew T. James","doi":"10.1016/j.xkme.2024.100913","DOIUrl":"10.1016/j.xkme.2024.100913","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Cilastatin is an inhibitor of drug metabolism in the proximal tubule that demonstrates nephroprotective effects in animals. It has been used in humans in combination with the antibiotic imipenem to block imipenem’s renal metabolism. This systematic review and meta-analysis evaluated the nephroprotective effects of cilastatin in humans.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis of observational (comparative effectiveness) studies or randomized clinical trials (RCTs).</div></div><div><h3>Setting & Study Populations</h3><div>People of any age at risk of acute kidney injury (AKI).</div></div><div><h3>Selection Criteria for Studies</h3><div>We systematically searched MEDLINE, Embase, Web of Science, and the Cochrane Controlled Trials registry from database inception to November 2023 for observational studies or RCTs that compared kidney outcomes among groups treated with cilastatin, either alone or as combination imipenem-cilastatin, versus an inactive or active control group not treated with cilastatin.</div></div><div><h3>Data Extraction</h3><div>Two reviewers independently evaluated studies for inclusion and risk of bias.</div></div><div><h3>Analytical Approach</h3><div>Treatment effects were estimated using random-effects models, and heterogeneity was quantified using the <em>I</em><sup>2</sup> statistic.</div></div><div><h3>Results</h3><div>We identified 10 studies (5 RCTs, n<!--> <!-->=<!--> <!-->531<!--> <!-->patients; 5 observational studies, n<!--> <!-->=<!--> <!-->6,321 participants) that met the inclusion criteria, including 4 studies with comparisons to inactive controls and 6 studies with comparisons to alternate antibiotics. Based on pooled results from 7 studies, the risk of AKI was lower with imipenem-cilastatin (risk ratio [RR], 0.52; 95% confidence intervals [CI], 0.40-0.67; <em>I</em><sup>2</sup> <!-->=<!--> <!-->26.5%), with consistent results observed in RCTs (3 RCTs, RR, 0.26; 95% CI, 0.09-0.77; <em>I</em><sup>2</sup> <!-->=<!--> <!-->44.4%) and observational studies (4 studies, RR, 0.54; 95% CI, 0.41-0.72; <em>I</em><sup>2</sup> <!-->=<!--> <!-->44.4%). Based on results from 6 studies, serum creatinine concentration was lower following treatment with imipenem-cilastatin than comparators (weighted mean difference in serum creatinine<!--> <!-->−0.14 mg/dL (95% CI, −0.21 to<!--> <!-->−0.07; <em>I</em><sup>2</sup> <!-->=<!--> <!-->0%). The overall certainty of the evidence was low due to heterogeneity of the results, high risk of bias, and indirectness among the identified studies.</div></div><div><h3>Limitations</h3><div>Clinical and statistical heterogeneity could not be fully explained due to a limited number of studies.</div></div><div><h3>Conclusions</h3><div>Patients treated with imipenem-cilastatin developed AKI less frequently and had lower serum creatinine concentration following treatment than control groups or those who had received compar","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100913"},"PeriodicalIF":3.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654935","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
Phoom Narongkiatikhun MD , Sungho Park PhD , Amy Rydin MD , Callie Rountree-Jablin , Ye Ji Choi MPH , Jo Ann Antenor PhD, MPH , Laura Pyle PhD , Lynette Driscoll PA-C, MA , Daniel van Raalte MD , Maureen Pushea CCLS , Alyssa Caldwell-McGee MS , Vuddhidej Ophascharoensuk MD , Kristen Nadeau MD , Kalie Tommerdahl MD , Richard J. Johnson MD , Lorna Browne MD , Alex J. Barker MD , Petter Bjornstad MD
{"title":"Pegloticase-Induced Rapid Uric Acid Lowering and Kidney and Cardiac Health Markers in Youth-Onset Type 2 Diabetes: A Pilot Clinical Trial","authors":"Phoom Narongkiatikhun MD , Sungho Park PhD , Amy Rydin MD , Callie Rountree-Jablin , Ye Ji Choi MPH , Jo Ann Antenor PhD, MPH , Laura Pyle PhD , Lynette Driscoll PA-C, MA , Daniel van Raalte MD , Maureen Pushea CCLS , Alyssa Caldwell-McGee MS , Vuddhidej Ophascharoensuk MD , Kristen Nadeau MD , Kalie Tommerdahl MD , Richard J. Johnson MD , Lorna Browne MD , Alex J. Barker MD , Petter Bjornstad MD","doi":"10.1016/j.xkme.2024.100911","DOIUrl":"10.1016/j.xkme.2024.100911","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100911"},"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
Margaux Costes-Albrespic , Sophie Liabeuf , Solène Laville , Christian Jacquelinet , Christian Combe , Denis Fouque , Maurice Laville , Luc Frimat , Roberto Pecoits-Filho , Oriane Lambert , Ziad A. Massy , Bénédicte Sautenet , Natalia Alencar de Pinho
<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":"Margaux Costes-Albrespic , Sophie Liabeuf , Solène Laville , Christian Jacquelinet , Christian Combe , Denis Fouque , Maurice Laville , Luc Frimat , Roberto Pecoits-Filho , Oriane Lambert , Ziad A. Massy , Bénédicte Sautenet , Natalia Alencar de Pinho","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":"6 12","pages":"Article 100912"},"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
Mariam Charkviani , Andrea G. Kattah , Andrew D. Rule , Jennifer A. Ferguson , Kristin C. Mara , Kianoush B. Kashani , Heather P. May , Jordan K. Rosedahl , Swetha Reddy , Lindsey M. Philpot , Erin F. Barreto
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":"Mariam Charkviani , Andrea G. Kattah , Andrew D. Rule , Jennifer A. Ferguson , Kristin C. Mara , Kianoush B. Kashani , Heather P. May , Jordan K. Rosedahl , Swetha Reddy , Lindsey M. Philpot , Erin F. Barreto","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":"6 11","pages":"Article 100905"},"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
Kiyotaka Uchiyama , Masako Otani , Naoki Chigusa , Kazuya Sugita , Ryosuke Matsuoka , Koji Hosoya , Mina Komuta , Jun Ito , Naoki Washida
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":"Kiyotaka Uchiyama , Masako Otani , Naoki Chigusa , Kazuya Sugita , Ryosuke Matsuoka , Koji Hosoya , Mina Komuta , Jun Ito , Naoki Washida","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":"6 11","pages":"Article 100908"},"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
Melanie P. Hoenig , Anna R. Gaddy , Priti Meena , Roger A. Rodby , Leticia Rolón , Juan Carlos Q. Velez , Joshua Waitzman , Amy A. Yau , Joel M. Topf
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":"Melanie P. Hoenig , Anna R. Gaddy , Priti Meena , Roger A. Rodby , Leticia Rolón , Juan Carlos Q. Velez , Joshua Waitzman , Amy A. Yau , Joel M. Topf","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":"6 11","pages":"Article 100903"},"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}
<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":"Hicham I. Cheikh Hassan , Pauline Byrne , Christie Harrod , Donia George , Karumathil Murali , Jenny H.C. Chen , Judy Mullan","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":"6 11","pages":"Article 100904"},"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}
Pub Date : 2024-09-19DOI: 10.1016/j.xkme.2024.100907
Billy Zeng MD , Jeanne A. Darbinian MPH , Kenneth K. Chen MD , Hasmik Arzumanyan MD , Sijie Zheng MD, PhD , Joan C. Lo MD
{"title":"Incident Albuminuria and Ethnicity Among Adults With Diabetes in an Integrated Health Care System in the United States","authors":"Billy Zeng MD , Jeanne A. Darbinian MPH , Kenneth K. Chen MD , Hasmik Arzumanyan MD , Sijie Zheng MD, PhD , Joan C. Lo MD","doi":"10.1016/j.xkme.2024.100907","DOIUrl":"10.1016/j.xkme.2024.100907","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100907"},"PeriodicalIF":3.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537385","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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