Renal Failure最新文献

The presence of pretransplant anti-human leukocyte antigen (HLA) donor-specific antibodies (DSAs) is still a significant barrier to successful kidney transplantation, as it increases the risk of rejection and graft failure. Rituximab (anti-CD20 antibody) has been administered in hopes of suppressing DSA production and rejection in those with preformed DSAs. However, existing studies report conflicting outcomes, underscoring the need for more data to guide clinical practice. Thus, we evaluated the efficacy of early posttransplant rituximab administration in a cohort of kidney transplant recipients with pretransplant anti-HLA DSAs. In this retrospective study of 77 patients, we compared 1-year transplant outcomes between patients treated with and without rituximab for pretransplant anti-HLA DSAs. Infectious complications tended to occur more often in the rituximab group (BK polyomavirus DNAemia >10,000 copies/mL, 3 [19%] vs. 8 [13%]; quantifiable cytomegalovirus DNAemia, 8 [50%] vs. 19 [31%]; infection requiring hospitalization, 5 [31%] vs. 11 [18%]), but none of these differences reached statistical significance. The incidence of biopsy-proven rejection (2 [13%] vs. 12 [20%]) and high plasma donor-derived cell-free DNA (2 [18%] vs. 12 [27%]) tended to be more frequent in the no-rituximab group, but none of these reached statistical significance. Preexisting DSA persisted or recurred in 44% of the patients that received rituximab, and in 46% of patients who did not receive rituximab. Similarly, de novo DSA occurred in 31% of those who received rituximab versus in 25% of those who did not. Rituximab administration did not result difference in graft and patient survival or rejection rates or recurrence of preexisting DSA.

Acute kidney injury requiring continuous kidney replacement therapy (AKI-CKRT) in the setting of coronavirus disease 2019 (COVID-19) carries a high mortality. In this two-center retrospective cohort study, we analyzed whether a simplified Sequential Organ Failure Assessment (SOFA) score, the 4-organ SOFA score with renal and neurologic sub-scores removed, would perform as well as the full SOFA score in predicting mortality. In our primary cohort, we identified 63 patients with COVID-19 hospitalized in April 2020 to July 2021 with AKI-CKRT and determined their 4-organ and full SOFA scores at CKRT initiation. Thirty-day and in-hospital mortality were 73.0% and 82.5%, respectively. The median 4-organ SOFA score at CKRT initiation among 30-day survivors was 7 (interquartile range 5.5-8.5) versus 8 (7-10) among 30-day non-survivors (p = 0.017). Four-organ SOFA scores for those who survived versus died before discharge were similar (p = 0.071). The full SOFA scores in survivors versus non-survivors were similar (p > 0.05). When comparing receiver operating characteristic curves, the 4-organ SOFA score to predict 30-day mortality performed best (area under curve 0.67). For external validation, we repeated our analysis in 88 patients with COVID-19 and AKI-CKRT from the MIMIC-IV database, and again the 4-organ score performed as well as the full SOFA score to predict 30-day and in-hospital mortality. Though hypothesis-generating and requiring additional validation, these findings suggest that 4-organ SOFA score performs as well as full SOFA score in predicting mortality in patients with COVID-19 and AKI-CKRT. However, these results reinforce prior data that SOFA score has limited prognostic value in COVID-19.

Optimal regional citrate anticoagulation (RCA) for hemodialysis (HD) in high-bleeding-risk patients remains undefined. This prospective observational cohort study included 195 high-bleeding-risk patients (481 HD sessions) allocated to three RCA groups: RCA-one (prefilter citrate only, 141 patients/337 sessions), RCA-two (pre- and post-filter citrate, 51 patients/133 sessions), and RCA+saline (prefilter citrate + post-filter saline, 3 patients/11 sessions). Primary outcome: circuit survival time; secondary outcomes: complete dialysis rate, clotting scores, and adverse events. RCA-two had the highest complete dialysis rate (99.7% vs. 97.0% [RCA-one], 97.7% [RCA+saline]; p = .037) and lowest venous expansion chamber serious clotting (score = 3: 5.4% vs. 16.9%, 30.0%; p < .001). Non-severe venous clotting (score < 3) was highest in RCA-two (94.6% vs. 83.1%, 70%; p < .001), with no intergroup differences in dialyzer clotting (score < 3: 96.1% vs. 95.3%, 90%; p = .83). RCA-two had the lowest adverse event rate (1.8% vs. 10.8%, 11.1%; p = .001), including less hypotension (0.9% vs. 7.6%, 2.0%; p = .023) and no muscle cramps. Venous pretreatment calcium in RCA-two decreased at 2 h (p = .03) without serious electrolyte/acid-base imbalances. Circuit survival time did not differ among groups (p > .05). RCA is safe and effective for high-bleeding-risk HD patients. RCA-two (pre- and post-filter citrate) offers advantages in venous anticoagulation and safety but requires confirmation in large randomized trials.

Peritoneal dialysis (PD) transforms the peritoneum into a dynamic therapeutic interface, with each exchange offering direct access to molecular and cellular signals from the peritoneal cavity. Among these, extracellular vesicles (EVs) have emerged as stable, information-rich messengers reflecting peritoneal health, inflammation, and fibrosis. The review explores the peritoneum as a living therapeutic interface, summarizing current evidence on EV biology, their molecular cargo, and potential roles in monitoring inflammation, fibrosis, and membrane function. It also discusses existing knowledge gaps, technological advances, and opportunities for translating EV research into clinical practice.

This observational cohort study aimed to identify factors influencing long-term renal outcomes in 170 patients with biopsy-proven malignant hypertension (MHT)-associated renal thrombotic microangiopathy (TMA) who were dialysis-independent at baseline, recruited between 2008 and 2023. Over a median follow-up of 23.5 months, 52 patients (30.6%) progressed to end-stage renal disease (ESRD). Those developing ESRD exhibited significantly higher total cholesterol levels, heavier proteinuria, a greater proportion of global glomerulosclerosis, more advanced interstitial fibrosis/tubular atrophy, and lower baseline eGFR, along with lower use of renin-angiotensin-aldosterone system (RAAS) inhibitors. In Cox regression analysis, elevated total cholesterol (HR = 1.48 per 1 mmol/L change; 95% CI: 1.24-1.77, p < 0.001) and a higher percentage of glomerulosclerosis (HR = 1.24, 95% CI: 1.15-1.33, p < 0.001; per 5% increase of glomerulosclerosis) were independent risk factors for ESRD, while RAAS inhibitor use was associated with a significantly reduced risk (HR = 0.45, 95% CI: 0.25-0.82, p = 0.009). These findings underscore the prognostic value of lipid profiles and histologic injury severity in MHT-associated TMA and support the protective role of RAAS blockade in preserving renal function, which may guide risk stratification and therapeutic decisions in this high-risk population.

Patients with end-stage renal disease often require arteriovenous fistula (AVF) creation for hemodialysis. However, nearly 40% of patients develop aneurysmal dilatation of AVF (AVFA) after surgery, which can lead to prolonged bleeding at puncture sites, increased infection risk, and even potential rupture. Despite its high incidence, research on AVFA remains remarkably limited. This study makes an innovative discovery by establishing a link between AVFA formation and alternative splicing of fibronectin (FN), a crucial extracellular matrix component. Specifically, we demonstrate that increased inclusion of the EDA exon in FN within vascular smooth muscle cells triggers phenotypic switching to a synthetic state and extracellular matrix remodeling through the ITGB1/FAK/Src/RUNX2 pathway. These changes ultimately reduce vascular mechanical strength and contribute to AVFA development. Furthermore, we identify the splicing factor SRSF5 as a key regulator of EDA inclusion and characterize its potential binding sites, providing potential therapeutic targets for AVFA prevention.

This retrospective study evaluated prognostic factors affecting outcomes in patients with acute kidney injury (AKI) treated with acute intermittent hemodialysis (IHD). Medical records of 193 patients treated between 2014 and 2024 were reviewed. Patients were categorized as recovered, deceased, chronic kidney disease without dialysis (CKD-ND), or chronic kidney disease with dialysis (CKD-D). The main indications for dialysis were hypervolemia (64.8%) and uremia (24.9%). Overall mortality was 50.8%, while 23.8% recovered, 21.2% developed CKD, and 4.1% became dialysis-dependent. Significant differences among outcome groups were found in age and serum concentration of serum creatinine, urea, sodium, phosphorus, calcium, C-reactive protein (CRP), albumin. Multivariate logistic regression analysis identified lower creatinine and calcium levels, as well as higher sodium, urea, and CRP concentrations, as independent predictors of mortality. In conclusion, our findings highlight the prognostic importance of biochemical and inflammatory markers in AKI patients undergoing IHD. Early identification and correction of electrolyte and inflammatory disturbances may improve patient outcomes.

Pruritus is a frequent and distressing symptom in chronic kidney disease (CKD). This study aimed to evaluate the association between pruritus and comorbidities or survival in CKD before the approval of difelikefalin (DFK), a novel treatment for CKD-associated pruritus (CKD-aP). A systematic literature review was conducted using PubMed and Embase, including studies published between January 2000 and August 2022 that examined the link between CKD-aP and morbidity or survival in CKD. We analyzed 5,867 title/abstracts (3,541 from Pubmed, 2,313 from Embase, and nine additional articles) and excluded 5,721 references. Thirty-seven of the 146 articles that were eligible for full reading were included in the analysis. Thus, 18 identified a statistically significant association between CKD-aP and mortality. However, this association lost significance in 3 studies after adjusting for sleep. Two additional studies found no association between CKD-aP and mortality. In terms of sleep disturbance, 14 out of 15 studies reported a significant link with CKD-aP. Moreover, six studies demonstrated relationship between CKD-aP and cardiovascular events, which remained robust even after adjusting for diabetes. The connection between CKD-aP and mental health and depressive symptoms was investigated in 20 studies, with 18 confirming a significant association between the outcomes. Finally, six studies indicated that healthcare costs were higher in CKD-aP compared to those without. Pruritus appears to be associated with increased mortality, cardiovascular events, depressive symptoms, and healthcare costs in CKD patients. Early detection and treatment, particularly with new drugs like DFK, may improve patients' quality of life and reduce CKD-aP related.

The prognostic role of the stress-induced hyperglycemia ratio (SHR) in patients with acute kidney injury related to cardiac surgery has not been fully explored. This study aims to examine the association between the SHR index and mortality in patients with cardiac surgery-associated acute kidney injury (CS-AKI). Data for this research were collected from the MIMIC database. This study investigated the relationship between SHR and prognosis of CS-AKI patients by survival analysis, restricted cubic lines, and subgroup analysis. In the final analysis, 3,249 patients were categorized into four groups based on the quartiles of the SHR. Multivariable Cox proportional hazards regression analysis demonstrated that patients in the highest quartile (Q4) had a significantly increased risk of mortality compared to those in the lower three quartiles (Q1-Q3) (p < 0.005). Receiver operating characteristic (ROC) curve analysis indicated a U-shaped relationship between SHR and patient mortality, with both low and high SHR values associated with increased risk. Incorporation of SHR into existing prognostic models (SHR+SAPS II, SHR+APACHE III, and SHR+SOFA) led to improved discriminative performance, as reflected by increased area under the curve (AUC) values. Additionally, the inclusion of SHR significantly enhanced model performance as demonstrated by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) metrics (p < 0.046). The findings of this study indicate a U-shaped association between the SHR and prognosis in patients with CS-AKI. However, only elevated SHR values were independently associated with an increased risk of mortality after adjustment for confounding variables.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are novel renoprotective agents for patients with chronic kidney disease (CKD) and have diverse effects, including on the regulation of electrolyte balance. However, their effects on serum chloride concentrations remain unclear. We conducted a retrospective single-center study of 343 CKD patients without diabetes or proteinuria who were not taking diuretics, including 202 SGLT2i users and 141 non-users, and applied propensity score (PS) matching and LASSO regression analysis. The outcomes were the change in chloride concentration with adjustment for covariates, before and after PS matching. Factors associated with these changes were identified using multivariable analysis and LASSO regression. An adjusted linear mixed effects model showed that the annual changes in chloride concentration for the non-SGLT2i and SGLT2i users were -0.39 (95% CI: -0.61 to 0.17) mEq/L/year and 0.49 (95% CI: -0.02 to 1.00) mEq/L/year, respectively [difference 0.88 (95% CI: 0.58 to 1.17) mEq/L/year] (p < 0.001). After PS matching, there was also a significant difference between users and non-users of SGLT2is in the mean change in chloride concentration [difference 0.44 (95% CI: 0.03 to 0.84) mEq/L/year] (p = 0.036). Subgroup analyses confirmed these findings. Furthermore, the use of SGLT2is had the strongest influence on the 2-year change in serum chloride concentration. To our knowledge, this is the first propensity-matched study to demonstrate a sustained chloride-preserving effect of SGLT2 inhibitors in non-diabetic CKD. In conclusion, this study identifies a previously underrecognized tubular electrolyte effect of SGLT2 inhibitors-preservation of serum chloride-which may partly explain their consistent cardioprotective effects across diverse CKD populations.