{"title":"Celebrating the life and scientific contributions of Barry Brenner in nephrology.","authors":"Giuseppe Remuzzi","doi":"10.1093/ndt/gfae206","DOIUrl":"10.1093/ndt/gfae206","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"409-411"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elena-Bianca Barbir, Arjunmohan Mohan, Priscilla Koirala, Luis E Gutierrez, Callen D Giesen, John C Lieske, Sandra M Herrmann
{"title":"Biomarker-guided infliximab therapy for immune checkpoint inhibitor-induced acute interstitial nephritis.","authors":"Elena-Bianca Barbir, Arjunmohan Mohan, Priscilla Koirala, Luis E Gutierrez, Callen D Giesen, John C Lieske, Sandra M Herrmann","doi":"10.1093/ndt/gfae257","DOIUrl":"10.1093/ndt/gfae257","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"602-604"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramón Paniagua, Alfonso Ramos, Marcela Ávila, María-de-Jesús Ventura, Armando Nevarez-Sida, Abdul Rashid Qureshi, Bengt Lindholm
Background: Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevents complications and improves treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease, fluid overload and insufficient dialysis efficiency.
Methods: In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: (i) Composite Index 1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and (ii) Composite Index 2 comprising cardiovascular mortality, first adverse event and hospitalizations related to cardiovascular disease, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing risk analysis and restricted mean survival time (RMST) analysis.
Results: While time to reach Composite Index 1 did not differ between the groups, Composite Index 2 was reached earlier (ΔRMST: -0.86 months; P = .02), and all-cause mortality [55 vs 33 deaths, P = .01; sub-hazard ratio (sHR) 1.69 (95% confidence interval 1.39-2.05), P < .001] and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths [24 vs 13 deaths, P = .05; sHR 2.44 (95% confidence interval 1.72-3.45), P < .001] and rates of adverse events and hospitalizations related to cardiovascular disease, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs 110, P = .048).
Conclusions: This randomized controlled trial shows that RM may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy.
{"title":"Remote monitoring of automated peritoneal dialysis reduces mortality, adverse events and hospitalizations: a cluster-randomized controlled trial.","authors":"Ramón Paniagua, Alfonso Ramos, Marcela Ávila, María-de-Jesús Ventura, Armando Nevarez-Sida, Abdul Rashid Qureshi, Bengt Lindholm","doi":"10.1093/ndt/gfae188","DOIUrl":"10.1093/ndt/gfae188","url":null,"abstract":"<p><strong>Background: </strong>Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevents complications and improves treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease, fluid overload and insufficient dialysis efficiency.</p><p><strong>Methods: </strong>In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: (i) Composite Index 1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and (ii) Composite Index 2 comprising cardiovascular mortality, first adverse event and hospitalizations related to cardiovascular disease, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing risk analysis and restricted mean survival time (RMST) analysis.</p><p><strong>Results: </strong>While time to reach Composite Index 1 did not differ between the groups, Composite Index 2 was reached earlier (ΔRMST: -0.86 months; P = .02), and all-cause mortality [55 vs 33 deaths, P = .01; sub-hazard ratio (sHR) 1.69 (95% confidence interval 1.39-2.05), P < .001] and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths [24 vs 13 deaths, P = .05; sHR 2.44 (95% confidence interval 1.72-3.45), P < .001] and rates of adverse events and hospitalizations related to cardiovascular disease, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs 110, P = .048).</p><p><strong>Conclusions: </strong>This randomized controlled trial shows that RM may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"588-597"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Popova, Baiba Slisere, Karlis Racenis, Viktorija Kuzema, Roberts Karklins, Mikus Saulite, Janis Seilis, Anna Jana Saulite, Aiga Vasilvolfa, Kristine Vaivode, Dace Pjanova, Juta Kroica, Harijs Cernevskis, Aivars Lejnieks, Aivars Petersons, Kristine Oleinika
Background: Immunoglobulin A nephropathy (IgAN) is characterized by the production of galactose-deficient IgA1 (GdIgA1) antibodies. As the source of pathogenic antibodies, B cells are central to IgAN pathogenesis, but the B cell activation pathways as well as the potential B cell source of dysregulated IgA secretion remain unknown.
Methods: We carried out flow cytometry analysis of peripheral blood B cells in patients with IgAN and control subjects with a focus on IgA-expressing B cells to uncover the pathways of B cell activation in IgAN and how these could give rise to pathogenic GdIgA1 antibodies.
Results: In addition to global changes in the B cell landscape-expansion of naïve and reduction in memory B cells-IgAN patients present with an increased frequency of IgA-expressing B cells that lack the classical memory marker CD27, but are CD21+. IgAN patients furthermore have an expanded population of IgA+ antibody-secreting cells, which correlate with serum IgA levels. Both IgA+ plasmabalsts and CD27- B cells co-express GdIgA1. Implicating dysregulation at mucosal surfaces as the driver of such B cell differentiation, we found a correlation between lipopolysaccharide in the serum and IgA+CD27- B cell frequency.
Conclusion: We propose that dysregulated immunity in the mucosa may drive de novo B cell activation within germinal centres, giving rise to IgA+CD27- B cells and subsequently IgA-producing plasmablasts. These data integrate B cells into the paradigm of IgAN pathogenesis and allow further investigation of this pathway to uncover biomarkers and develop therapeutic interventions.
背景:IgA肾病(IgAN)的特征是产生半乳糖缺乏性IgA1(GdIgA1)抗体。作为致病抗体的来源,B 细胞是 IgAN 发病机制的核心,但 B 细胞活化途径以及 IgA 分泌失调的潜在 B 细胞来源仍不清楚:我们对 IgA 肾病患者和对照组的外周血 B 细胞进行了流式细胞术分析,重点研究表达 IgA 的 B 细胞,以揭示 IgAN 中 B 细胞活化的途径以及这些途径如何导致致病性 GdIgA1 抗体的产生:IgAN患者的B细胞结构发生了全面变化--幼稚B细胞增多,记忆B细胞减少--此外,IgA表达的B细胞频率增加,这些B细胞缺乏经典的记忆标记CD27,但具有CD21pos。IgAN 患者的 IgApos 抗体分泌细胞群进一步扩大,这与血清 IgA 水平相关。IgApos 浆细胞和 CD27neg B 细胞共同表达 GdIgA1。我们发现血清中的脂多糖(LPS)与 IgAposCD27neg B 细胞频率之间存在相关性,这意味着粘膜表面的失调是这种 B 细胞分化的驱动因素:我们认为,粘膜免疫功能失调可能会驱动生殖中心内的 B 细胞从头活化,产生 IgAposCD27neg B 细胞,进而产生产生 IgA 的浆细胞。这些数据将 B 细胞纳入了 IgAN 发病机制的范式,有助于进一步研究这一途径,以发现生物标志物并开发治疗干预措施。
{"title":"IgA class-switched CD27-CD21+ B cells in IgA nephropathy.","authors":"Anna Popova, Baiba Slisere, Karlis Racenis, Viktorija Kuzema, Roberts Karklins, Mikus Saulite, Janis Seilis, Anna Jana Saulite, Aiga Vasilvolfa, Kristine Vaivode, Dace Pjanova, Juta Kroica, Harijs Cernevskis, Aivars Lejnieks, Aivars Petersons, Kristine Oleinika","doi":"10.1093/ndt/gfae173","DOIUrl":"10.1093/ndt/gfae173","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin A nephropathy (IgAN) is characterized by the production of galactose-deficient IgA1 (GdIgA1) antibodies. As the source of pathogenic antibodies, B cells are central to IgAN pathogenesis, but the B cell activation pathways as well as the potential B cell source of dysregulated IgA secretion remain unknown.</p><p><strong>Methods: </strong>We carried out flow cytometry analysis of peripheral blood B cells in patients with IgAN and control subjects with a focus on IgA-expressing B cells to uncover the pathways of B cell activation in IgAN and how these could give rise to pathogenic GdIgA1 antibodies.</p><p><strong>Results: </strong>In addition to global changes in the B cell landscape-expansion of naïve and reduction in memory B cells-IgAN patients present with an increased frequency of IgA-expressing B cells that lack the classical memory marker CD27, but are CD21+. IgAN patients furthermore have an expanded population of IgA+ antibody-secreting cells, which correlate with serum IgA levels. Both IgA+ plasmabalsts and CD27- B cells co-express GdIgA1. Implicating dysregulation at mucosal surfaces as the driver of such B cell differentiation, we found a correlation between lipopolysaccharide in the serum and IgA+CD27- B cell frequency.</p><p><strong>Conclusion: </strong>We propose that dysregulated immunity in the mucosa may drive de novo B cell activation within germinal centres, giving rise to IgA+CD27- B cells and subsequently IgA-producing plasmablasts. These data integrate B cells into the paradigm of IgAN pathogenesis and allow further investigation of this pathway to uncover biomarkers and develop therapeutic interventions.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"505-515"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bartholomeus T van den Berge, Martijn van den Broek, Gianluca Di Giovanni, Hanna Debiec, Sharon Gloudemans, Quinty Leusink, Dirk den Braanker, Jack F M Wetzels, Pierre Ronco, Bart Smeets, Jitske Jansen, Rutger J Maas
Background and hypothesis: Primary focal segmental glomerulosclerosis (FSGS) is characterized by podocyte injury and treatment-resistant nephrotic syndrome. Recurrence of the original disease after kidney transplantation (rFSGS) occurs in 10-50% of patients. Unidentified circulating permeability factors (CPF) are likely involved in FSGS pathogenesis. We hypothesized that donor podocyte susceptibility to CPF is also relevant. We developed a personalized model for (r)FSGS using induced pluripotent stem cell (iPSC)-derived podocytes from patients and kidney donors.
Methods: Five patients and their respective living kidney donors were included. Three patients had developed rFSGS, and two patients manifested no symptoms of rFSGS. One patient (P5) had heterozygous mutations in NPHS2. Peripheral blood mononuclear cells were reprogrammed to iPSC, and differentiated to podocytes. iPSC-derived podocytes from either patients or donors were exposed to presumed CPF-containing plasma/serum of corresponding patients. Three assays to detect podocyte injury were performed: (1) reactive oxygen species (ROS) formation, (2) cellular granularity induction, and (3) quantitative assessment of F-actin redistribution (FAR), a new quantitative method. Crossmatch experiments with donor iPSC-derived podocytes and patients samples assessed individual susceptibility to CPF-induced injury.
Results: Successful podocyte differentiation was confirmed by morphology and protein expression. Only FAR differentiated consistently between patient and healthy donor samples. All pre-transplant patient samples except P5 caused significant FAR in corresponding patient podocytes. Significant FAR was observed in donor podocytes exposed to corresponding patient samples in the setting of rFSGS, and not in donor podocytes exposed to samples of patients who did not develop rFSGS. Effects of FSGS patient samples on non-corresponding donor podocytes were variable.
Conclusions: In vitro assays using iPSC-derived donor podocytes may allow individualized assessment of rFSGS. Prospective studies in a larger cohort are required to validate our findings.
{"title":"Personalized disease recurrence modeling using iPSC-derived podocytes in patients with idiopathic nephrotic syndrome.","authors":"Bartholomeus T van den Berge, Martijn van den Broek, Gianluca Di Giovanni, Hanna Debiec, Sharon Gloudemans, Quinty Leusink, Dirk den Braanker, Jack F M Wetzels, Pierre Ronco, Bart Smeets, Jitske Jansen, Rutger J Maas","doi":"10.1093/ndt/gfaf045","DOIUrl":"https://doi.org/10.1093/ndt/gfaf045","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Primary focal segmental glomerulosclerosis (FSGS) is characterized by podocyte injury and treatment-resistant nephrotic syndrome. Recurrence of the original disease after kidney transplantation (rFSGS) occurs in 10-50% of patients. Unidentified circulating permeability factors (CPF) are likely involved in FSGS pathogenesis. We hypothesized that donor podocyte susceptibility to CPF is also relevant. We developed a personalized model for (r)FSGS using induced pluripotent stem cell (iPSC)-derived podocytes from patients and kidney donors.</p><p><strong>Methods: </strong>Five patients and their respective living kidney donors were included. Three patients had developed rFSGS, and two patients manifested no symptoms of rFSGS. One patient (P5) had heterozygous mutations in NPHS2. Peripheral blood mononuclear cells were reprogrammed to iPSC, and differentiated to podocytes. iPSC-derived podocytes from either patients or donors were exposed to presumed CPF-containing plasma/serum of corresponding patients. Three assays to detect podocyte injury were performed: (1) reactive oxygen species (ROS) formation, (2) cellular granularity induction, and (3) quantitative assessment of F-actin redistribution (FAR), a new quantitative method. Crossmatch experiments with donor iPSC-derived podocytes and patients samples assessed individual susceptibility to CPF-induced injury.</p><p><strong>Results: </strong>Successful podocyte differentiation was confirmed by morphology and protein expression. Only FAR differentiated consistently between patient and healthy donor samples. All pre-transplant patient samples except P5 caused significant FAR in corresponding patient podocytes. Significant FAR was observed in donor podocytes exposed to corresponding patient samples in the setting of rFSGS, and not in donor podocytes exposed to samples of patients who did not develop rFSGS. Effects of FSGS patient samples on non-corresponding donor podocytes were variable.</p><p><strong>Conclusions: </strong>In vitro assays using iPSC-derived donor podocytes may allow individualized assessment of rFSGS. Prospective studies in a larger cohort are required to validate our findings.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to: Associations of neutral pH, low-GDP peritoneal dialysis solutions with patient survival, transfer to haemodialysis and peritonitis.","authors":"","doi":"10.1093/ndt/gfae073","DOIUrl":"10.1093/ndt/gfae073","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"606"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: While the kidney-protective effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors have attracted much attention, there are limited real-world clinical data examining the effects of SGLT2 inhibitors on kidney function in older individuals. We aimed to compare the kidney outcomes between SGLT2 inhibitor and dipeptidyl peptidase 4 (DPP4) inhibitor use in older adults with diabetes.
Methods: Using a nationwide claims database, we studied 6354 older adults (≥60 years of age) who had diabetes and were newly initiated on SGLT2 inhibitors or DPP4 inhibitors. A 1:4 propensity score matching algorithm was used to compare changes in estimated glomerular filtration rate (eGFR) between SGLT2 inhibitor and DPP4 inhibitor users. The primary outcome was a decrease in the rate of eGFR, which was obtained using a linear mixed-effects model with an unstructured covariance.
Results: Following propensity score matching, 6354 individuals including 1271 SGLT2 inhibitor users and 5083 DPP4 inhibitor users {median age 68 years [interquartile range (IQR) 65-70], male 60.4%, median eGFR 69.0 ml/min/1.73 m2 [IQR 59.1-79.0], median haemoglobin A1c [HbA1c] 6.9% [IQR 6.5-7.4]} were analysed. SGLT2 inhibitor users had a slower eGFR decline than did DPP4 inhibitor users [-0.97 ml/min/1.73 m2/year (95% CI -1.24 to -0.70) versus -1.83 ml/min/1.73 m2/year (95% CI -1.97 to -1.69); P for interaction <.001]. This finding remained consistent across subgroups based on age, sex, body mass index, HbA1c level, renin-angiotensin system inhibitor use and baseline eGFR. Additionally, the risk of a ≥20%, ≥30% and ≥40% decrease in eGFR from baseline was significantly lower in SGLT2 inhibitor users than in DPP4 inhibitor users.
Conclusions: Our analysis, utilizing a nationwide epidemiological dataset, demonstrated that the decrease in eGFR was slower in individuals ≥60 years of age with diabetes who were prescribed SGLT2 inhibitors compared with those prescribed DPP4 inhibitors, suggesting a potential advantage of SGLT2 inhibitors for kidney outcomes even in older individuals with diabetes.
{"title":"Kidney outcomes with SGLT2 inhibitor versus DPP4 inhibitor use in older adults with diabetes.","authors":"Yuta Suzuki, Hidehiro Kaneko, Akira Okada, Jin Komuro, Toshiyuki Ko, Katsuhito Fujiu, Norifumi Takeda, Hiroyuki Morita, Akira Nishiyama, Masaki Ieda, Koichi Node, Hideo Yasunaga, Masaomi Nangaku, Issei Komuro","doi":"10.1093/ndt/gfae158","DOIUrl":"10.1093/ndt/gfae158","url":null,"abstract":"<p><strong>Background: </strong>While the kidney-protective effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors have attracted much attention, there are limited real-world clinical data examining the effects of SGLT2 inhibitors on kidney function in older individuals. We aimed to compare the kidney outcomes between SGLT2 inhibitor and dipeptidyl peptidase 4 (DPP4) inhibitor use in older adults with diabetes.</p><p><strong>Methods: </strong>Using a nationwide claims database, we studied 6354 older adults (≥60 years of age) who had diabetes and were newly initiated on SGLT2 inhibitors or DPP4 inhibitors. A 1:4 propensity score matching algorithm was used to compare changes in estimated glomerular filtration rate (eGFR) between SGLT2 inhibitor and DPP4 inhibitor users. The primary outcome was a decrease in the rate of eGFR, which was obtained using a linear mixed-effects model with an unstructured covariance.</p><p><strong>Results: </strong>Following propensity score matching, 6354 individuals including 1271 SGLT2 inhibitor users and 5083 DPP4 inhibitor users {median age 68 years [interquartile range (IQR) 65-70], male 60.4%, median eGFR 69.0 ml/min/1.73 m2 [IQR 59.1-79.0], median haemoglobin A1c [HbA1c] 6.9% [IQR 6.5-7.4]} were analysed. SGLT2 inhibitor users had a slower eGFR decline than did DPP4 inhibitor users [-0.97 ml/min/1.73 m2/year (95% CI -1.24 to -0.70) versus -1.83 ml/min/1.73 m2/year (95% CI -1.97 to -1.69); P for interaction <.001]. This finding remained consistent across subgroups based on age, sex, body mass index, HbA1c level, renin-angiotensin system inhibitor use and baseline eGFR. Additionally, the risk of a ≥20%, ≥30% and ≥40% decrease in eGFR from baseline was significantly lower in SGLT2 inhibitor users than in DPP4 inhibitor users.</p><p><strong>Conclusions: </strong>Our analysis, utilizing a nationwide epidemiological dataset, demonstrated that the decrease in eGFR was slower in individuals ≥60 years of age with diabetes who were prescribed SGLT2 inhibitors compared with those prescribed DPP4 inhibitors, suggesting a potential advantage of SGLT2 inhibitors for kidney outcomes even in older individuals with diabetes.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"495-504"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tao Sun, Xiaofang Yue, Xiao Chen, Tiancha Huang, Shaojun Gu, Yibing Chen, Yang Yu, Fang Qian, Chunmao Han, Xuanliang Pan, Xiao Lu, Libin Li, Yun Ji, Kangsong Wu, Hongfu Li, Gong Zhang, Xiang Li, Jia Luo, Man Huang, Wei Cui, Mao Zhang, Zhihua Tao
Background: A major challenge in the prevention and early treatment of acute kidney injury (AKI) is the lack of high-performance predictors in critically ill patients. Therefore, we innovatively constructed U-AKIpredTM for predicting AKI in critically ill patients within 12 h of panel measurement.
Methods: The prospective cohort study included 680 patients in the training set and 249 patients in the validation set. After performing inclusion and exclusion criteria, 417 patients were enrolled in the training set and 164 patients were enrolled in the validation set. AKI was diagnosed by Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
Results: Twelve urinary kidney injury biomarkers (mALB, IgG, TRF, α1MG, NAG, NGAL, KIM-1, L-FABP, TIMP2, IGFBP7, CAF22, and IL-18) exhibited good predictive performance for AKI within 12 h in critically ill patients. U-AKIpredTM, combined with three crucial biomarkers (α1MG, L-FABP, and IGFBP7) by multivariate logistic regression analysis, exhibited better predictive performance for AKI in critically ill patients within 12 h than the other 12 kidney injury biomarkers. The area under the curve (AUC) of the U-AKIpredTM, as a predictor of AKI within 12 h, was 0.802 (95% CI: 0.771-0.833, P < .001) in the training set and 0.844 (95% CI: 0.792-0.896, P < .001) in the validation cohort. A nomogram based on the results of the training and validation sets of U-AKIpredTM was developed that showed optimal predictive performance for AKI. The fitting effect and prediction accuracy of U-AKIpredTM was evaluated by multiple statistical indicators. To provide a more flexible predictive tool, the dynamic nomogram (https://www.xsmartanalysis.com/model/U-AKIpredTM) was constructed using a web calculator. Decision curve analysis and a clinical impact curve were used to reveal that U-AKIpredTM with the three crucial biomarkers had a higher net benefit than these 12 kidney injury biomarkers, respectively. The net reclassification index and integrated discrimination index were used to improve the significant risk reclassification of AKI compared with the 12 kidney injury biomarkers. The predictive efficiency of U-AKIpredTM was better than the NephroCheck® when testing for AKI and severe AKI.
Conclusion: U-AKIpredTM is an excellent predictive model of AKI in critically ill patients within 12 h and would assist clinicians in identifying those at high risk of AKI.
背景:预防和早期治疗急性肾损伤(AKI)的一个主要挑战是缺乏重症患者的高效预测指标。因此,我们创新性地构建了 U-AKIpredTM,用于预测重症患者在面板测量后 12 小时内的 AKI:前瞻性队列研究将 680 名患者纳入训练集,249 名患者纳入验证集。在执行纳入和排除标准后,417 名患者被纳入训练集,164 名患者被纳入验证集。AKI根据肾病改善全球结局(KDIGO)标准进行诊断:结果:12 个尿液肾损伤生物标志物(mALB、IgG、TRF、α1MG、NAG、NGAL、KIM-1、L-FABP、TIMP2、IGFBP7、CAF22 和 IL-18)对重症患者 12 小时内的 AKI 具有良好的预测性能。通过多变量逻辑回归分析,U-AKIpredTM 与三个关键生物标记物(α1MG、L-FABP 和 IGFBP7)相结合,对危重病人 12 小时内 AKI 的预测效果优于其他 12 个肾损伤生物标记物。作为 12 小时内 AKI 的预测指标,U-AKIpredTM 的曲线下面积(AUC)为 0.802(95% CI:0.771-0.833,P):U-AKIpredTM 是重症患者 12 小时内 AKI 的绝佳预测模型,有助于临床医生识别 AKI 高危人群。
{"title":"A novel real-time model for predicting acute kidney injury in critically ill patients within 12 hours.","authors":"Tao Sun, Xiaofang Yue, Xiao Chen, Tiancha Huang, Shaojun Gu, Yibing Chen, Yang Yu, Fang Qian, Chunmao Han, Xuanliang Pan, Xiao Lu, Libin Li, Yun Ji, Kangsong Wu, Hongfu Li, Gong Zhang, Xiang Li, Jia Luo, Man Huang, Wei Cui, Mao Zhang, Zhihua Tao","doi":"10.1093/ndt/gfae168","DOIUrl":"10.1093/ndt/gfae168","url":null,"abstract":"<p><strong>Background: </strong>A major challenge in the prevention and early treatment of acute kidney injury (AKI) is the lack of high-performance predictors in critically ill patients. Therefore, we innovatively constructed U-AKIpredTM for predicting AKI in critically ill patients within 12 h of panel measurement.</p><p><strong>Methods: </strong>The prospective cohort study included 680 patients in the training set and 249 patients in the validation set. After performing inclusion and exclusion criteria, 417 patients were enrolled in the training set and 164 patients were enrolled in the validation set. AKI was diagnosed by Kidney Disease: Improving Global Outcomes (KDIGO) criteria.</p><p><strong>Results: </strong>Twelve urinary kidney injury biomarkers (mALB, IgG, TRF, α1MG, NAG, NGAL, KIM-1, L-FABP, TIMP2, IGFBP7, CAF22, and IL-18) exhibited good predictive performance for AKI within 12 h in critically ill patients. U-AKIpredTM, combined with three crucial biomarkers (α1MG, L-FABP, and IGFBP7) by multivariate logistic regression analysis, exhibited better predictive performance for AKI in critically ill patients within 12 h than the other 12 kidney injury biomarkers. The area under the curve (AUC) of the U-AKIpredTM, as a predictor of AKI within 12 h, was 0.802 (95% CI: 0.771-0.833, P < .001) in the training set and 0.844 (95% CI: 0.792-0.896, P < .001) in the validation cohort. A nomogram based on the results of the training and validation sets of U-AKIpredTM was developed that showed optimal predictive performance for AKI. The fitting effect and prediction accuracy of U-AKIpredTM was evaluated by multiple statistical indicators. To provide a more flexible predictive tool, the dynamic nomogram (https://www.xsmartanalysis.com/model/U-AKIpredTM) was constructed using a web calculator. Decision curve analysis and a clinical impact curve were used to reveal that U-AKIpredTM with the three crucial biomarkers had a higher net benefit than these 12 kidney injury biomarkers, respectively. The net reclassification index and integrated discrimination index were used to improve the significant risk reclassification of AKI compared with the 12 kidney injury biomarkers. The predictive efficiency of U-AKIpredTM was better than the NephroCheck® when testing for AKI and severe AKI.</p><p><strong>Conclusion: </strong>U-AKIpredTM is an excellent predictive model of AKI in critically ill patients within 12 h and would assist clinicians in identifying those at high risk of AKI.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"524-536"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Guohua He, Yunfei Liu, Arvind Bagga, Chinyere Ukamaka Onubogu, Franz Schaefer, Zhiyong Zou, William E Smoyer, Nianzhou Xiao, Tianxin Lin, Ali Asghar Lanewala, Hee Gyung Kang, Muhammad Zeeshan Waheed, Seungkyo Park, Xiaoyun Jiang, Yi Song, Jie Ding
Background: Although congenital abnormalities of the kidney and urinary tract (CAKUT) is the leading cause of childhood-onset chronic kidney disease and kidney failure, comprehensive information on the disease burden among children and adolescents globally is lacking. We aim to report the trends and socioeconomic inequality of CAKUT burden for people aged 0-24 years from 1990 to 2019.
Methods: We reported the prevalence, mortality and disability-adjusted life-years (DALYs) for CAKUT based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, quantified the association of disease burden and socio-demographic index (SDI), and calculated the slope index of inequality, the relative index of inequality and concentration index.
Results: In 2019, the global prevalence, mortality and DALYs of CAKUT among individuals aged 0-24 years were 167.11 (95% confidence interval 166.97, 167.25), 0.30 (0.29, 0.30) and 32.22 (32.16, 32.29), respectively, per 100 000 population. The greatest prevalence, mortality and DALYs were recorded in the 0-4 years age group. The greatest mortality and DALYs were recorded in low SDI countries and territories. During 1990 to 2019, the prevalence, mortality and DALYs decreased globally, while in low and low-middle countries and territories the reduction was much less slower. India, Nigeria and Pakistan had the highest DALYs. Saudi Arabia and China exhibited a markedly decrease of CAKUT burden. Globally for every 0.1 increase in SDI, there was a 20.53% reduction in mortality and a 16.31% decrease in DALYs, but a 0.38% rise in prevalence.
Conclusions: Inequality for disease burden of varying SDI was increasing globally. Thus, specific preventive and health service measures are needed to reduce the global burden from CAKUT.
{"title":"Trends and socioeconomic inequality of the burden of congenital abnormalities of the kidney and urinary tract among children and adolescents.","authors":"Guohua He, Yunfei Liu, Arvind Bagga, Chinyere Ukamaka Onubogu, Franz Schaefer, Zhiyong Zou, William E Smoyer, Nianzhou Xiao, Tianxin Lin, Ali Asghar Lanewala, Hee Gyung Kang, Muhammad Zeeshan Waheed, Seungkyo Park, Xiaoyun Jiang, Yi Song, Jie Ding","doi":"10.1093/ndt/gfae115","DOIUrl":"10.1093/ndt/gfae115","url":null,"abstract":"<p><strong>Background: </strong>Although congenital abnormalities of the kidney and urinary tract (CAKUT) is the leading cause of childhood-onset chronic kidney disease and kidney failure, comprehensive information on the disease burden among children and adolescents globally is lacking. We aim to report the trends and socioeconomic inequality of CAKUT burden for people aged 0-24 years from 1990 to 2019.</p><p><strong>Methods: </strong>We reported the prevalence, mortality and disability-adjusted life-years (DALYs) for CAKUT based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, quantified the association of disease burden and socio-demographic index (SDI), and calculated the slope index of inequality, the relative index of inequality and concentration index.</p><p><strong>Results: </strong>In 2019, the global prevalence, mortality and DALYs of CAKUT among individuals aged 0-24 years were 167.11 (95% confidence interval 166.97, 167.25), 0.30 (0.29, 0.30) and 32.22 (32.16, 32.29), respectively, per 100 000 population. The greatest prevalence, mortality and DALYs were recorded in the 0-4 years age group. The greatest mortality and DALYs were recorded in low SDI countries and territories. During 1990 to 2019, the prevalence, mortality and DALYs decreased globally, while in low and low-middle countries and territories the reduction was much less slower. India, Nigeria and Pakistan had the highest DALYs. Saudi Arabia and China exhibited a markedly decrease of CAKUT burden. Globally for every 0.1 increase in SDI, there was a 20.53% reduction in mortality and a 16.31% decrease in DALYs, but a 0.38% rise in prevalence.</p><p><strong>Conclusions: </strong>Inequality for disease burden of varying SDI was increasing globally. Thus, specific preventive and health service measures are needed to reduce the global burden from CAKUT.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"484-494"},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Turgay Saritas, Vincenzo Cantaluppi, Ana Sanz Bartolome, Stanislas Faguer, Joana Gameiro, Jose Antonio Lopes, Jolanta Malyszko, Marlies Ostermann, Nicholas M Selby, Sophie De Seigneux
{"title":"Kidney expert consultation and the outcomes of in hospital acute kidney injury.","authors":"Turgay Saritas, Vincenzo Cantaluppi, Ana Sanz Bartolome, Stanislas Faguer, Joana Gameiro, Jose Antonio Lopes, Jolanta Malyszko, Marlies Ostermann, Nicholas M Selby, Sophie De Seigneux","doi":"10.1093/ndt/gfaf043","DOIUrl":"https://doi.org/10.1093/ndt/gfaf043","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}