Anna Pisano, Carmine Zoccali, Davide Bolignano, Graziella D'Arrigo, Francesca Mallamaci
Abstract Background Several studies have examined the frequency of sleep apnea (SA) in patients with chronic kidney disease (CKD), reporting different prevalence rates. Our systematic review and meta-analysis aimed to define the clinical penetrance of SA in CKD and end-stage kidney disease (ESKD) patients. Methods Ovid-MEDLINE and PubMed databases were explored up to 5th June, 2023 to identify studies providing SA prevalence in CKD and ESKD patients assessed by different diagnostic methods, either sleep questionnaires or respiration monitoring equipment (such as PSG, type III portable monitors or other diagnostic tools). Single-study data were pooled using the random-effects model. The Chi2 and Cochrane-I2 tests were used to assess the presence of heterogeneity, that was explored performing sensitivity and/or subgroup analyses. Results A cumulative analysis from 32 single study data revealed a prevalence of SA of 57% (95% CI 42–71%) in the CKD population, whereas a prevalence of 49% (95% CI 47–52%) was found pooling data from 91 studies in ESKD individuals. The prevalence of SA using instrumental sleep monitoring devices, including classical PSG and type III portable sleep monitors, was 62% (95% CI 52–72) and 56% (95% CI 42–69%) in CKD and ESKD populations, respectively. Sleep questionnaires revealed a prevalence of 33% (95% CI 16–49%) and 39% (95% CI 30–49%). Conclusions SA is commonly seen in both non-dialysis CKD and ESKD patients. Sleep-related questionnaires underestimated the presence of SA in this population. This emphasises the need for using objective diagnostic tools to identify such a syndrome in kidney disease.
背景一些研究调查了慢性肾脏疾病(CKD)患者睡眠呼吸暂停(SA)的频率，报告了不同的患病率。我们的系统回顾和荟萃分析旨在确定SA在CKD和终末期肾病(ESKD)患者中的临床外显率。方法检索截至2023年6月5日的Ovid-MEDLINE和PubMed数据库，以确定通过不同诊断方法评估CKD和ESKD患者SA患病率的研究，这些诊断方法包括睡眠问卷或呼吸监测设备(如PSG、III型便携式监测仪或其他诊断工具)。使用随机效应模型对单个研究数据进行汇总。使用Chi2和Cochrane-I2检验来评估异质性的存在，并进行敏感性和/或亚组分析。结果一项来自32项单一研究数据的累积分析显示，慢性肾病人群中SA的患病率为57% (95% CI 42-71%)，而ESKD患者中91项研究的汇总数据显示SA的患病率为49% (95% CI 47-52%)。使用仪器睡眠监测设备(包括经典PSG和III型便携式睡眠监测仪)的SA患病率在CKD和ESKD人群中分别为62% (95% CI 52-72)和56% (95% CI 42-69%)。睡眠问卷显示患病率为33% (95% CI 16-49%)和39% (95% CI 30-49%)。结论SA常见于非透析性CKD和ESKD患者。与睡眠相关的问卷低估了这一人群中SA的存在。这强调需要使用客观的诊断工具来识别肾脏疾病中的这种综合征。
{"title":"Sleep apnea syndrome prevalence in chronic kidney disease and end stage kidney disease patients: a systematic review and meta-analysis","authors":"Anna Pisano, Carmine Zoccali, Davide Bolignano, Graziella D'Arrigo, Francesca Mallamaci","doi":"10.1093/ckj/sfad179","DOIUrl":"https://doi.org/10.1093/ckj/sfad179","url":null,"abstract":"Abstract Background Several studies have examined the frequency of sleep apnea (SA) in patients with chronic kidney disease (CKD), reporting different prevalence rates. Our systematic review and meta-analysis aimed to define the clinical penetrance of SA in CKD and end-stage kidney disease (ESKD) patients. Methods Ovid-MEDLINE and PubMed databases were explored up to 5th June, 2023 to identify studies providing SA prevalence in CKD and ESKD patients assessed by different diagnostic methods, either sleep questionnaires or respiration monitoring equipment (such as PSG, type III portable monitors or other diagnostic tools). Single-study data were pooled using the random-effects model. The Chi2 and Cochrane-I2 tests were used to assess the presence of heterogeneity, that was explored performing sensitivity and/or subgroup analyses. Results A cumulative analysis from 32 single study data revealed a prevalence of SA of 57% (95% CI 42–71%) in the CKD population, whereas a prevalence of 49% (95% CI 47–52%) was found pooling data from 91 studies in ESKD individuals. The prevalence of SA using instrumental sleep monitoring devices, including classical PSG and type III portable sleep monitors, was 62% (95% CI 52–72) and 56% (95% CI 42–69%) in CKD and ESKD populations, respectively. Sleep questionnaires revealed a prevalence of 33% (95% CI 16–49%) and 39% (95% CI 30–49%). Conclusions SA is commonly seen in both non-dialysis CKD and ESKD patients. Sleep-related questionnaires underestimated the presence of SA in this population. This emphasises the need for using objective diagnostic tools to identify such a syndrome in kidney disease.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"101 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134957615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The prevalence of obesity has tripled over the past five decades. Obesity, especially visceral obesity, is closely related to hypertension, increasing the risk of primary (essential) hypertension by 65–75%. Hypertension is a major risk factor for cardiovascular disease, the leading cause of death worldwide, and its prevalence is rapidly increasing following the pandemic rise in obesity. Although the causal relationship between obesity and high blood pressure (BP) is well established, the detailed mechanisms for such association are still under research. For more than thirty years sympathetic nervous system (SNS) and kidney sodium reabsorption activation, secondary to insulin resistance and compensatory hyperinsulinemia, have been considered as primary mediators of elevated BP in obesity. However, experimental and clinical data show that severe insulin resistance and hyperinsulinemia can occur in the absence of elevated BP, challenging the causal relationship between insulin resistance and hyperinsulinemia as the key factor linking obesity to hypertension. The purpose of Part 1 of this review is to summarize the available data on recently emerging mechanisms believed to contribute to obesity-related hypertension through increased sodium reabsorption and volume expansion, such as: physical compression of the kidney by perirenal/intrarenal fat and overactivation of the systemic/renal SNS and the renin-angiotensin-aldosterone system (RAAS). The role of hyperleptinemia, impaired chemoreceptor and baroreceptor reflexes, and increased perivascular fat is also discussed. Specifically targeting these mechanisms may pave the way for a new therapeutic intervention in the treatment of obesity-related hypertension in the context of ‘precision medicine’ principles, which will be discussed in Part 2.
{"title":"Mechanisms and treatment of Obesity-Related Hypertension: <i>Part 1. Mechanisms</i>","authors":"Aneliya Parvanova, Elia Reseghetti, Manuela Abbate, Piero Ruggenenti","doi":"10.1093/ckj/sfad282","DOIUrl":"https://doi.org/10.1093/ckj/sfad282","url":null,"abstract":"Abstract The prevalence of obesity has tripled over the past five decades. Obesity, especially visceral obesity, is closely related to hypertension, increasing the risk of primary (essential) hypertension by 65–75%. Hypertension is a major risk factor for cardiovascular disease, the leading cause of death worldwide, and its prevalence is rapidly increasing following the pandemic rise in obesity. Although the causal relationship between obesity and high blood pressure (BP) is well established, the detailed mechanisms for such association are still under research. For more than thirty years sympathetic nervous system (SNS) and kidney sodium reabsorption activation, secondary to insulin resistance and compensatory hyperinsulinemia, have been considered as primary mediators of elevated BP in obesity. However, experimental and clinical data show that severe insulin resistance and hyperinsulinemia can occur in the absence of elevated BP, challenging the causal relationship between insulin resistance and hyperinsulinemia as the key factor linking obesity to hypertension. The purpose of Part 1 of this review is to summarize the available data on recently emerging mechanisms believed to contribute to obesity-related hypertension through increased sodium reabsorption and volume expansion, such as: physical compression of the kidney by perirenal/intrarenal fat and overactivation of the systemic/renal SNS and the renin-angiotensin-aldosterone system (RAAS). The role of hyperleptinemia, impaired chemoreceptor and baroreceptor reflexes, and increased perivascular fat is also discussed. Specifically targeting these mechanisms may pave the way for a new therapeutic intervention in the treatment of obesity-related hypertension in the context of ‘precision medicine’ principles, which will be discussed in Part 2.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"132 47","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136351679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The French REIN is 20 years old. It is not ‘just’ a national data registry but rather an epidemiological and informational network serving patients with chronic kidney disease, nephrology teams and health services. Methods The past 10-year trends of the incidence and prevalence of renal replacement therapy by dialysis or kidney transplantation and waitlist activity are presented. To detect potential significant changes in trends from 2012 and 2021, a Joinpoint regression model was used. Results The overall incidence of treated end-stage kidney disease (ESKD) was 169 per million population (pmp) in 2021. It was stable despite the increase in incidence of diabetes. We found a decreasing trend in the proportion of patients starting dialysis in an emergency but an increase in those starting haemodialysis (HD) with a temporary catheter. Peritoneal dialysis decreased by 1.7% each year, whereas home HD, although involving only 1% of dialysis patients, increased by 10% each year. For patients not treated at home, the median time to drive from the patient's home to the dialysis unit was 17 min. The proportion of patients on the transplantation waitlist at the start of dialysis increased from 7% to 12%. Among the 111 263 new ESKD patients from 2012 to 2021, 8% received a first transplant at 1 year and 20% at 5 years. Among kidney transplant recipients, the mean time on the waitlist increased from 13.8 months to 22.6 months. Living donor transplants increased in frequency, representing 15% of kidney transplants. Conclusions Data from the REIN registry allow for evaluating needs and provide a planning tool for French authorities. The progressive implementation of automatic data retrievals from dialysis informatics charts might alleviate the burden of data collection. Furthermore, the research activity REIN engenders, resulting in renewed confidence by health authorities in the dynamism of French nephrology, allows for an optimistic outlook for REIN.
{"title":"Twenty years of the French Renal Epidemiology and Information Network","authors":"Isabelle Kazes, Justine Solignac, Mathilde Lassalle, Lucile Mercadal, Cécile Couchoud","doi":"10.1093/ckj/sfad240","DOIUrl":"https://doi.org/10.1093/ckj/sfad240","url":null,"abstract":"Abstract Background The French REIN is 20 years old. It is not ‘just’ a national data registry but rather an epidemiological and informational network serving patients with chronic kidney disease, nephrology teams and health services. Methods The past 10-year trends of the incidence and prevalence of renal replacement therapy by dialysis or kidney transplantation and waitlist activity are presented. To detect potential significant changes in trends from 2012 and 2021, a Joinpoint regression model was used. Results The overall incidence of treated end-stage kidney disease (ESKD) was 169 per million population (pmp) in 2021. It was stable despite the increase in incidence of diabetes. We found a decreasing trend in the proportion of patients starting dialysis in an emergency but an increase in those starting haemodialysis (HD) with a temporary catheter. Peritoneal dialysis decreased by 1.7% each year, whereas home HD, although involving only 1% of dialysis patients, increased by 10% each year. For patients not treated at home, the median time to drive from the patient's home to the dialysis unit was 17 min. The proportion of patients on the transplantation waitlist at the start of dialysis increased from 7% to 12%. Among the 111 263 new ESKD patients from 2012 to 2021, 8% received a first transplant at 1 year and 20% at 5 years. Among kidney transplant recipients, the mean time on the waitlist increased from 13.8 months to 22.6 months. Living donor transplants increased in frequency, representing 15% of kidney transplants. Conclusions Data from the REIN registry allow for evaluating needs and provide a planning tool for French authorities. The progressive implementation of automatic data retrievals from dialysis informatics charts might alleviate the burden of data collection. Furthermore, the research activity REIN engenders, resulting in renewed confidence by health authorities in the dynamism of French nephrology, allows for an optimistic outlook for REIN.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"132 39","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136351683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Podocyte puzzle: ANCA vasculitis","authors":"Kate Stevens, David Kipgen, Kenar D Jhaveri","doi":"10.1093/ckj/sfad278","DOIUrl":"https://doi.org/10.1093/ckj/sfad278","url":null,"abstract":"","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":" 34","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135292058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco P Schena, Samantha Chiurlia, Daniela I Abbrescia, Sharon N Cox
Abstract This narrative review shed light on the use of transcriptomics in the analysis of kidney biopsies and urinary cell samples from patients with immunoglobulin A nephropathy (IgAN) or lupus nephritis (LN). The conventional methods of examining kidney biopsy through light microscopy, immunofluorescence and electron microscopy provide valuable clinical information for diagnosis and prognosis but have some limitations that transcriptomics can address. Some recent studies have reported that kidney transcriptomics has uncovered new molecular biomarkers implicated in the inflammatory process induced by the deposition of circulating immune complexes in the investigated kidney diseases. In addition, transcriptomics applied to urinary cells mirrors the inflammatory process that occurs in the kidney. This means that we can study urinary cell transcriptomics in clinical practice to diagnose the stage of the inflammatory process. Furthermore, the transcriptomics of urinary cells can be used to make therapy decisions during patient follow-up to avoid the stress of a second kidney biopsy. The studies analyzed in this review have a significant limitation. Biomarkers have been identified in small cohorts of patients but none of them have been validated in independent external cohorts. Further prospective studies in large cohorts of patients are necessary for accurate and complete validation. Only after that these biomarkers can be widely used in clinical practice.
{"title":"Kidney and urine cell transcriptomics in IgA nephropathy and lupus nephritis: a narrative review","authors":"Francesco P Schena, Samantha Chiurlia, Daniela I Abbrescia, Sharon N Cox","doi":"10.1093/ckj/sfad121","DOIUrl":"https://doi.org/10.1093/ckj/sfad121","url":null,"abstract":"Abstract This narrative review shed light on the use of transcriptomics in the analysis of kidney biopsies and urinary cell samples from patients with immunoglobulin A nephropathy (IgAN) or lupus nephritis (LN). The conventional methods of examining kidney biopsy through light microscopy, immunofluorescence and electron microscopy provide valuable clinical information for diagnosis and prognosis but have some limitations that transcriptomics can address. Some recent studies have reported that kidney transcriptomics has uncovered new molecular biomarkers implicated in the inflammatory process induced by the deposition of circulating immune complexes in the investigated kidney diseases. In addition, transcriptomics applied to urinary cells mirrors the inflammatory process that occurs in the kidney. This means that we can study urinary cell transcriptomics in clinical practice to diagnose the stage of the inflammatory process. Furthermore, the transcriptomics of urinary cells can be used to make therapy decisions during patient follow-up to avoid the stress of a second kidney biopsy. The studies analyzed in this review have a significant limitation. Biomarkers have been identified in small cohorts of patients but none of them have been validated in independent external cohorts. Further prospective studies in large cohorts of patients are necessary for accurate and complete validation. Only after that these biomarkers can be widely used in clinical practice.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":" 41","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135292052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roser Torra, Andreas Kronbichler, Ingeborg M Bajema
The diagnosis of kidney diseases traditionally relies on clinical features, laboratory tests and imaging. In many cases, a kidney biopsy is necessary to determine the underlying pathology. However, kidney biopsies are invasive and carry a risk of complications such as bleeding. In some cases, a renal biopsy may not yield a definitive diagnosis. Undetermined kidney disease ( UKD ) is a relatively new term for which KDIGO has already indicated the need for further clarification, but it unequivocally refers to a group of patients that are lacking a final diagnosis in spite of various efforts to obtain one. UKD forms a challenge for nephrologists but recent studies have shown that monogenic disease-causing variants may explain around 25% of these nephropathies [ 1 ]. This editorial discusses a study published in this issue of Clinical Kidney Journal [ 2 ] that investigated the effectiveness of exome sequencing ( ES ) in getting closer to a diagnosis of patients with UKD, and the implications of this approach for routine nephrological healthcare. Inherited kidney diseases assumably account for around 10%–15% of
{"title":"Replacing a kidney biopsy by exome sequencing in undetermined kidney diseases – not yet ready for prime time!","authors":"Roser Torra, Andreas Kronbichler, Ingeborg M Bajema","doi":"10.1093/ckj/sfad250","DOIUrl":"https://doi.org/10.1093/ckj/sfad250","url":null,"abstract":"The diagnosis of kidney diseases traditionally relies on clinical features, laboratory tests and imaging. In many cases, a kidney biopsy is necessary to determine the underlying pathology. However, kidney biopsies are invasive and carry a risk of complications such as bleeding. In some cases, a renal biopsy may not yield a definitive diagnosis. Undetermined kidney disease ( UKD ) is a relatively new term for which KDIGO has already indicated the need for further clarification, but it unequivocally refers to a group of patients that are lacking a final diagnosis in spite of various efforts to obtain one. UKD forms a challenge for nephrologists but recent studies have shown that monogenic disease-causing variants may explain around 25% of these nephropathies [ 1 ]. This editorial discusses a study published in this issue of Clinical Kidney Journal [ 2 ] that investigated the effectiveness of exome sequencing ( ES ) in getting closer to a diagnosis of patients with UKD, and the implications of this approach for routine nephrological healthcare. Inherited kidney diseases assumably account for around 10%–15% of","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":" 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135291789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Denys-Drash syndrome (DDS) is a rare disease characterized with pseudohermaphroditism, nephroblastoma (also known as Wilms tumor), and diffuse mesangial sclerosis. The therapy for DDS is largely supportive, i.e. surgery and chemotherapy for Wilms tumor and renal replacement therapy. Due to the limited understanding of the pathogenesis, precision therapy for DDS is yet to be explored. We sought to explore the cellular components and interactions in kidney tissues from an infant with DDS. Methods Whole exome sequencing was performed to examine the mutations associated with DDS. Single-cell RNA sequencing (scRNA-seq) was performed to explore the heterogenicity of kidney tissue samples. Results A 6-month-old infant with bilateral Wilms tumors and genital ambiguity was diagnosed as having DDS. Whole exome sequencing revealed a novel de novo mutation (p.F185fs*118) in exon 1 of WT1. scRNA-seq was performed in tissue samples from bilateral Wilms tumors and the normal kidney from this infant. Fibroblasts, myocytes, epithelial cells, endothelial cells and mononuclear phagocytes (MPs) ranked at the top of the 31 135 total cells. Fibroblasts and myocytes were dominant in the Wilms tumor samples. In contrast, most epithelial cells and endothelial cells were found in normal kidney tissues. CD44 and TUBA1A were significantly changed in myocyte subclusters, which may contribute to chemotherapy drug resistance. Macrophages intensively interacted with cancerous cells, including fibroblasts, epithelial cells, and myocytes. Conclusions A novel mutation (p.F185fs*118) in exon 1 of WT1 was identified in an infant with DDS. scRNA-Seq revealed the heterogenicity of cellular components in Wilms tumors and kidney tissues, shedding light on the pathogenesis of DDS.
{"title":"Single-cell transcriptomes of kidneys in a 6-month-old boy with Denys-Drash syndrome reveal stromal cell heterogeneity in the tumor microenvironment","authors":"Tao Li, Jiangfeng Zhou, Haiyan Wu, Xiucheng Gao, Qiyang Shen, Rui Cheng, Mingshun Zhang","doi":"10.1093/ckj/sfad277","DOIUrl":"https://doi.org/10.1093/ckj/sfad277","url":null,"abstract":"Abstract Background Denys-Drash syndrome (DDS) is a rare disease characterized with pseudohermaphroditism, nephroblastoma (also known as Wilms tumor), and diffuse mesangial sclerosis. The therapy for DDS is largely supportive, i.e. surgery and chemotherapy for Wilms tumor and renal replacement therapy. Due to the limited understanding of the pathogenesis, precision therapy for DDS is yet to be explored. We sought to explore the cellular components and interactions in kidney tissues from an infant with DDS. Methods Whole exome sequencing was performed to examine the mutations associated with DDS. Single-cell RNA sequencing (scRNA-seq) was performed to explore the heterogenicity of kidney tissue samples. Results A 6-month-old infant with bilateral Wilms tumors and genital ambiguity was diagnosed as having DDS. Whole exome sequencing revealed a novel de novo mutation (p.F185fs*118) in exon 1 of WT1. scRNA-seq was performed in tissue samples from bilateral Wilms tumors and the normal kidney from this infant. Fibroblasts, myocytes, epithelial cells, endothelial cells and mononuclear phagocytes (MPs) ranked at the top of the 31 135 total cells. Fibroblasts and myocytes were dominant in the Wilms tumor samples. In contrast, most epithelial cells and endothelial cells were found in normal kidney tissues. CD44 and TUBA1A were significantly changed in myocyte subclusters, which may contribute to chemotherapy drug resistance. Macrophages intensively interacted with cancerous cells, including fibroblasts, epithelial cells, and myocytes. Conclusions A novel mutation (p.F185fs*118) in exon 1 of WT1 was identified in an infant with DDS. scRNA-Seq revealed the heterogenicity of cellular components in Wilms tumors and kidney tissues, shedding light on the pathogenesis of DDS.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"35 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135430308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Appropriate dialysis prescription in the transitional setting from chronic kidney disease to end-stage kidney disease is still challenging. Conventional thrice weekly hemodialysis (HD) might be associated with rapid loss of residual kidney function (RKF) and high mortality. The benefits and risks of incremental HD, compared with conventional HD were explored in this systematic review and meta-analysis. Methods We searched MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials up to April 2023 for studies that compared the impacts of incremental (once- or twice-weekly HD) and conventional thrice-weekly HD on cardiovascular events, RKF, vascular access complications, quality of life, hospitalization, and mortality. Results A total of 36 articles (138,939 participants) were included in this meta-analysis. The mortality rate and cardiovascular events were similar between incremental and conventional HD (OR 0.87; 95% CI 0.72-1.04 and OR 0.67; 95% CI 0.43-1.05, respectively). However, hospitalization and loss of RKF were significantly lower in patients treated with incremental HD (OR 0.54; 95% CI 0.32-0.89 and OR 0.31; 95% CI 0.25-0.39, respectively). In a sensitivity analysis that included studies restricted to those with RKF or urine output criteria, incremental HD had significantly lower cardiovascular events (OR 0.22; 95% CI 0.08-0.63) and mortality (OR 0.54; 95% CI 0.37-0.79). Vascular access complications, hyperkalemia, and volume overload were not statistically different between groups. Conclusions Incremental HD has been shown to be safe and may provide superior benefits in clinical outcomes, particularly in appropriately selected patients. Large-scale randomized controlled trials are required to confirm these potential advantages.
从慢性肾脏疾病到终末期肾脏疾病的过渡时期，适当的透析处方仍然是一个挑战。传统的每周三次血液透析(HD)可能与残留肾功能(RKF)的快速丧失和高死亡率有关。本系统综述和荟萃分析探讨了与传统HD相比，增量HD的益处和风险。方法:我们检索MEDLINE、Scopus和Cochrane中央对照试验注册库，以比较增量(每周一次或两次HD)和常规每周一次HD对心血管事件、RKF、血管通路并发症、生活质量、住院和死亡率的影响。结果本meta分析共纳入36篇文献(138,939名受试者)。渐进式和常规HD患者的死亡率和心血管事件相似(OR 0.87;95% CI 0.72-1.04, OR 0.67;95% CI分别为0.43-1.05)。然而，渐进式HD患者的住院率和RKF损失显著降低(OR 0.54;95% CI 0.32-0.89, OR 0.31;95% CI分别为0.25-0.39)。在一项敏感性分析中，包括限制有RKF或尿输出标准的研究，渐进式HD显著降低心血管事件(or 0.22;95% CI 0.08-0.63)和死亡率(OR 0.54;95% ci 0.37-0.79)。血管通路并发症、高钾血症和容量超载在两组间无统计学差异。结论:渐进式HD已被证明是安全的，并可能在临床结果中提供优越的益处，特别是在适当选择的患者中。需要大规模的随机对照试验来证实这些潜在的优势。
{"title":"Incremental versus conventional hemodialysis in end-stage kidney disease: a systematic review and meta-analysis","authors":"Kullaya Takkavatakarn, Kavita Jintanapramote, Jeerath Phannajit, Kearkiat Praditpornsilpa, Somchai Eiam-Ong, Paweena Susantitaphong","doi":"10.1093/ckj/sfad280","DOIUrl":"https://doi.org/10.1093/ckj/sfad280","url":null,"abstract":"Abstract Introduction Appropriate dialysis prescription in the transitional setting from chronic kidney disease to end-stage kidney disease is still challenging. Conventional thrice weekly hemodialysis (HD) might be associated with rapid loss of residual kidney function (RKF) and high mortality. The benefits and risks of incremental HD, compared with conventional HD were explored in this systematic review and meta-analysis. Methods We searched MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials up to April 2023 for studies that compared the impacts of incremental (once- or twice-weekly HD) and conventional thrice-weekly HD on cardiovascular events, RKF, vascular access complications, quality of life, hospitalization, and mortality. Results A total of 36 articles (138,939 participants) were included in this meta-analysis. The mortality rate and cardiovascular events were similar between incremental and conventional HD (OR 0.87; 95% CI 0.72-1.04 and OR 0.67; 95% CI 0.43-1.05, respectively). However, hospitalization and loss of RKF were significantly lower in patients treated with incremental HD (OR 0.54; 95% CI 0.32-0.89 and OR 0.31; 95% CI 0.25-0.39, respectively). In a sensitivity analysis that included studies restricted to those with RKF or urine output criteria, incremental HD had significantly lower cardiovascular events (OR 0.22; 95% CI 0.08-0.63) and mortality (OR 0.54; 95% CI 0.37-0.79). Vascular access complications, hyperkalemia, and volume overload were not statistically different between groups. Conclusions Incremental HD has been shown to be safe and may provide superior benefits in clinical outcomes, particularly in appropriately selected patients. Large-scale randomized controlled trials are required to confirm these potential advantages.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"31 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135430181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas Weimbs, Jessianna Saville, Kamyar Kalantar-Zadeh
ABSTRACT Ketogenic Metabolic Therapy (KMT) is a medical nutrition therapy to address certain health and disease conditions. It is increasingly used for many non-communicable diseases that are rooted in abnormal metabolic health. Since chronic kidney disease (CKD) is commonly caused by overnutrition leading to hyperglycemia, insulin resistance and diabetes mellitus, the carbohydrate restriction inherent in KMT may offer a therapeutic option. Numerous studies have found that various forms of KMT are safe for individuals with CKD and may lead to improvement of renal function. This is in contrast to the current standard pharmacological approach to CKD which only slows the relentless progression towards renal failure. Kidney care providers including physicians and dietitians are usually not aware of non-standard dietary interventions, including KMT, and often antagonize KMT due to common misconceptions and uncertainty about the underlying science including the common misconception that KMT must involve high protein or meat consumption. This review article discusses the rationales for using KMT, including plant-dominant KMT, for treatment of CKD, clarifies common misconceptions, summarizes the results of clinical studies, and discusses why KMT can emerge as an effective Medical Nutrition Therapy (MNT) to consider for patients with kidney disease. KMT, including its plant-dominant versions, can expand a practitioner's kidney health toolbox, and will likely become a first-line therapy for CKD in certain CKD associated conditions such as obesity, metabolic syndrome and polycystic kidney disease.
{"title":"Ketogenic metabolic therapy for chronic kidney disease – the pro part","authors":"Thomas Weimbs, Jessianna Saville, Kamyar Kalantar-Zadeh","doi":"10.1093/ckj/sfad273","DOIUrl":"https://doi.org/10.1093/ckj/sfad273","url":null,"abstract":"ABSTRACT Ketogenic Metabolic Therapy (KMT) is a medical nutrition therapy to address certain health and disease conditions. It is increasingly used for many non-communicable diseases that are rooted in abnormal metabolic health. Since chronic kidney disease (CKD) is commonly caused by overnutrition leading to hyperglycemia, insulin resistance and diabetes mellitus, the carbohydrate restriction inherent in KMT may offer a therapeutic option. Numerous studies have found that various forms of KMT are safe for individuals with CKD and may lead to improvement of renal function. This is in contrast to the current standard pharmacological approach to CKD which only slows the relentless progression towards renal failure. Kidney care providers including physicians and dietitians are usually not aware of non-standard dietary interventions, including KMT, and often antagonize KMT due to common misconceptions and uncertainty about the underlying science including the common misconception that KMT must involve high protein or meat consumption. This review article discusses the rationales for using KMT, including plant-dominant KMT, for treatment of CKD, clarifies common misconceptions, summarizes the results of clinical studies, and discusses why KMT can emerge as an effective Medical Nutrition Therapy (MNT) to consider for patients with kidney disease. KMT, including its plant-dominant versions, can expand a practitioner's kidney health toolbox, and will likely become a first-line therapy for CKD in certain CKD associated conditions such as obesity, metabolic syndrome and polycystic kidney disease.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"124 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135541991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT The ketogenic diet is a very-low-carbohydrate diet that has received a lot of attention for its role in the treatment of type 2 diabetes and obesity. For patients with chronic kidney disease, there is limited evidence on the risks or benefits of this diet. However, from the limited evidence that does exist, there are several inferences that can be drawn regarding this diet for patients with kidney disease. The ketogenic diet may not be better than comparator, higher carbohydrate diets over the long-term. The diet also has low adherence levels in studies lasting 12 months or longer. The diet's emphasis on fat, which often comes from animal fat, increases the consumption of saturated fat, which may increase the risk of heart disease. It has the potential to worsen metabolic acidosis by increasing dietary acid load and endogenous acid production through the oxidation of fatty acids. In addition, the diet has been associated with an increased risk of kidney stones in patients using it for the treatment of refractory epilepsy. For these reasons, and for the lack of safety data on it, it is reasonable for patients with kidney disease to avoid utilizing the ketogenic diet as a first-line option given alternative dietary patterns (like the PLADO diet) with less theoretical risk for harm. For those adopting the ketogenic diet in kidney disease, a plant-based version of the ketogenic diet may mitigate some of the concerns with animal-based versions of the ketogenic diet.
{"title":"Risks of the ketogenic diet in CKD – the con part","authors":"Shivam Joshi, Rachel Shi, Jason Patel","doi":"10.1093/ckj/sfad274","DOIUrl":"https://doi.org/10.1093/ckj/sfad274","url":null,"abstract":"ABSTRACT The ketogenic diet is a very-low-carbohydrate diet that has received a lot of attention for its role in the treatment of type 2 diabetes and obesity. For patients with chronic kidney disease, there is limited evidence on the risks or benefits of this diet. However, from the limited evidence that does exist, there are several inferences that can be drawn regarding this diet for patients with kidney disease. The ketogenic diet may not be better than comparator, higher carbohydrate diets over the long-term. The diet also has low adherence levels in studies lasting 12 months or longer. The diet's emphasis on fat, which often comes from animal fat, increases the consumption of saturated fat, which may increase the risk of heart disease. It has the potential to worsen metabolic acidosis by increasing dietary acid load and endogenous acid production through the oxidation of fatty acids. In addition, the diet has been associated with an increased risk of kidney stones in patients using it for the treatment of refractory epilepsy. For these reasons, and for the lack of safety data on it, it is reasonable for patients with kidney disease to avoid utilizing the ketogenic diet as a first-line option given alternative dietary patterns (like the PLADO diet) with less theoretical risk for harm. For those adopting the ketogenic diet in kidney disease, a plant-based version of the ketogenic diet may mitigate some of the concerns with animal-based versions of the ketogenic diet.","PeriodicalId":18987,"journal":{"name":"NDT Plus","volume":"124 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135541989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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