Pub Date : 2025-12-01Epub Date: 2025-01-16DOI: 10.1080/0886022X.2024.2449576
Eily Hayes, Erik Mai, Andre Uflacker, Natalie Freidin
Biopsy is the gold standard for diagnosing renal pathology and the procedure is required to be learned per ACGME guidelines for Nephrology Fellowship graduation. We describe the process for the planning and development of a new Nephrologist directed native renal biopsy program to increase the opportunity to train Nephrology fellows in this procedure. The article outlines the barriers, complications and lessons learned to developing the program, highlighting the key challenges and progress that has been made within a single American tertiary academic medical center.
{"title":"Challenges encountered to creating a renal biopsy program at a tertiary care academic institution in the United States.","authors":"Eily Hayes, Erik Mai, Andre Uflacker, Natalie Freidin","doi":"10.1080/0886022X.2024.2449576","DOIUrl":"10.1080/0886022X.2024.2449576","url":null,"abstract":"<p><p>Biopsy is the gold standard for diagnosing renal pathology and the procedure is required to be learned per ACGME guidelines for Nephrology Fellowship graduation. We describe the process for the planning and development of a new Nephrologist directed native renal biopsy program to increase the opportunity to train Nephrology fellows in this procedure. The article outlines the barriers, complications and lessons learned to developing the program, highlighting the key challenges and progress that has been made within a single American tertiary academic medical center.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2449576"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The triglyceride-glucose (TyG) index has emerged as a credible surrogate indicator of insulin resistance in recent years. This study aimed to investigate the relationship between the TyG index and the deterioration of kidney function in patients with cardiovascular-kidney-metabolic (CKM) syndrome.
Methods: In this retrospective cohort study from China, 27,407 hospitalized patients with stage 1-4 CKM syndrome were consecutively included. The participants were categorized into four groups according to TyG index quartiles. The study outcome was the deterioration of kidney function, defined as a decrease in estimated glomerular filtration rate (eGFR) ≥ 40% from baseline. Restricted cubic spline (RCS) curves and multivariate Cox analysis were used for analysis.
Results: 3,248 outcome events were recorded during a mean follow-up period of 34 months. The RCS plot displayed a U-shaped curve between the baseline TyG index and the deterioration of kidney function (P for non-linear < 0.001). The baseline TyG index with the lowest hazard ratio (HR) of eGFR decline ranges from 8.65 to 9.15, with an inflection point at 8.88. After fully adjusting for covariates, HRs and 95% confidence intervals (CIs) from the lowest to highest TyG index quartile were 1.00 (reference), 0.82 (0.74, 0.91), 0.78 (0.70, 0.86), and 0.93 (0.83, 1.03), respectively. According to the Kaplan-Meier survival curve, the risk of deterioration of kidney function was elevated in the lowest and highest TyG index quartiles (log-rank test, p < 0.0001).
Conclusions: In individuals with CKM syndrome, a non-linear U-shaped relationship existed between the baseline TyG index and the deterioration of kidney function.
{"title":"The impact of the triglyceride-glucose index on the deterioration of kidney function in patients with cardiovascular-kidney-metabolic syndrome: insight from a large cohort study in China.","authors":"Zhi Shang, Song-Tao Feng, Hui Qian, Zhen-Ling Deng, Yue Wang, Yue-Ming Gao","doi":"10.1080/0886022X.2024.2446656","DOIUrl":"10.1080/0886022X.2024.2446656","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index has emerged as a credible surrogate indicator of insulin resistance in recent years. This study aimed to investigate the relationship between the TyG index and the deterioration of kidney function in patients with cardiovascular-kidney-metabolic (CKM) syndrome.</p><p><strong>Methods: </strong>In this retrospective cohort study from China, 27,407 hospitalized patients with stage 1-4 CKM syndrome were consecutively included. The participants were categorized into four groups according to TyG index quartiles. The study outcome was the deterioration of kidney function, defined as a decrease in estimated glomerular filtration rate (eGFR) ≥ 40% from baseline. Restricted cubic spline (RCS) curves and multivariate Cox analysis were used for analysis.</p><p><strong>Results: </strong>3,248 outcome events were recorded during a mean follow-up period of 34 months. The RCS plot displayed a U-shaped curve between the baseline TyG index and the deterioration of kidney function (<i>P</i> for non-linear < 0.001). The baseline TyG index with the lowest hazard ratio (HR) of eGFR decline ranges from 8.65 to 9.15, with an inflection point at 8.88. After fully adjusting for covariates, HRs and 95% confidence intervals (CIs) from the lowest to highest TyG index quartile were 1.00 (reference), 0.82 (0.74, 0.91), 0.78 (0.70, 0.86), and 0.93 (0.83, 1.03), respectively. According to the Kaplan-Meier survival curve, the risk of deterioration of kidney function was elevated in the lowest and highest TyG index quartiles (log-rank test, <i>p <</i> 0.0001).</p><p><strong>Conclusions: </strong>In individuals with CKM syndrome, a non-linear U-shaped relationship existed between the baseline TyG index and the deterioration of kidney function.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2446656"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-01-13DOI: 10.1080/0886022X.2025.2449578
Jin Li, Xing-Ling Chen, Xiao-Lu Ou-Yang, Xiao-Jiao Zhang, Yue Li, Shu-Ning Sun, Ling-Jun Wang, Zhong-Qi Yang, Shi-Hao Ni, Lu Lu
<p><strong>Background: </strong>While there are numerous benefits to tea consumption, its long-term impact on patients with chronic kidney disease (CKD) remains unclear.</p><p><strong>Method: </strong>Our analysis included 17,575 individuals with CKD from an initial 45,019 participants in the National Health and Nutrition Examination Survey (NHANES) (1999-2018). Individuals with extreme dietary habits, pregnancy, or non-CKD conditions were excluded. Key cohort demographics revealed a mean age of 62.3 years, with 52.1% female participants, and 57.3% identified as non-Hispanic White. A total of 5,835 deaths were recorded during follow-up, including 1,823 cardiovascular-related deaths. Cox and restricted cubic spline regression was used to examine the linear or nonlinear association of tea consumption with mortality. The substitution analysis explored the effects of replacing a specific type of tea with another type of tea. Subgroup analysis stratified by sex, age, body mass index (BMI), diabetes, cancer, cardiovascular disease (CVD), and urinary albumin. Sensitivity analysis was performed to ensure the reliability of our findings.</p><p><strong>Results: </strong>After adjusting for age, sex, race, education level, marital, annual household income, energy intake, total water intake, protein intake, carbohydrate intake, dietary fiber, sugar beverages, milk whole, total monounsaturated fatty acids, total polyunsaturated fatty acids, total saturated fatty acids, smoking, metabolic equivalent of task for physical activity level (MET-PA), BMI, diabetes, hypertension, urinary albumin, estimated glomerular filtration rate (eGFR), CVD, cancer, serum sodium, serum potassium, and serum phosphorus, setting the individuals without tea consumption record as reference. Consuming up to 4 cups of tea per day was significantly associated with lower all-cause mortality compared with that never drinking tea, among CKD patients at 1-2 stages [Hazard Ratio (HR) = 0.89; 95% Confidence Interval (CI) = 0.79, 0.99; <i>p</i> = 0.04], while the association between tea consumption and CVD mortality didn't reach statistical significance. Dose-response effect was observed, showing that consuming up to three to five cups of tea per day was associated with mitigated risks of all-cause mortality, particularly in early CKD stages (non-linear <i>p</i> > 0.05). A 1 cup per day higher intake of oxidized tea was associated with a 10% lower risk of all-cause mortality in CKD stage 1-2 [HR = 0.90; 95%CI = 0.82, 0.99; <i>p</i> = 0.03]. Replacing 1 cup of green tea with 1 cup of oxidized tea per day was associated with an 8% and 11% lower risk of all-cause mortality [HR = 0.92; 95%CI = 0.86, 0.98; <i>p</i> = 0.01] and CVD mortality [HR = 0.89; 95%CI = 0.80, 1.00; <i>p</i> < 0.05], respectively, in individuals with CKD stages 1-2.</p><p><strong>Conclusion: </strong>Tea consumption showed protective effects on all-cause mortality in CKD population, with potential benefits observed in terms of
{"title":"Association of tea consumption with all-cause/cardiovascular disease mortality in the chronic kidney disease population: an assessment of participation in the national cohort.","authors":"Jin Li, Xing-Ling Chen, Xiao-Lu Ou-Yang, Xiao-Jiao Zhang, Yue Li, Shu-Ning Sun, Ling-Jun Wang, Zhong-Qi Yang, Shi-Hao Ni, Lu Lu","doi":"10.1080/0886022X.2025.2449578","DOIUrl":"10.1080/0886022X.2025.2449578","url":null,"abstract":"<p><strong>Background: </strong>While there are numerous benefits to tea consumption, its long-term impact on patients with chronic kidney disease (CKD) remains unclear.</p><p><strong>Method: </strong>Our analysis included 17,575 individuals with CKD from an initial 45,019 participants in the National Health and Nutrition Examination Survey (NHANES) (1999-2018). Individuals with extreme dietary habits, pregnancy, or non-CKD conditions were excluded. Key cohort demographics revealed a mean age of 62.3 years, with 52.1% female participants, and 57.3% identified as non-Hispanic White. A total of 5,835 deaths were recorded during follow-up, including 1,823 cardiovascular-related deaths. Cox and restricted cubic spline regression was used to examine the linear or nonlinear association of tea consumption with mortality. The substitution analysis explored the effects of replacing a specific type of tea with another type of tea. Subgroup analysis stratified by sex, age, body mass index (BMI), diabetes, cancer, cardiovascular disease (CVD), and urinary albumin. Sensitivity analysis was performed to ensure the reliability of our findings.</p><p><strong>Results: </strong>After adjusting for age, sex, race, education level, marital, annual household income, energy intake, total water intake, protein intake, carbohydrate intake, dietary fiber, sugar beverages, milk whole, total monounsaturated fatty acids, total polyunsaturated fatty acids, total saturated fatty acids, smoking, metabolic equivalent of task for physical activity level (MET-PA), BMI, diabetes, hypertension, urinary albumin, estimated glomerular filtration rate (eGFR), CVD, cancer, serum sodium, serum potassium, and serum phosphorus, setting the individuals without tea consumption record as reference. Consuming up to 4 cups of tea per day was significantly associated with lower all-cause mortality compared with that never drinking tea, among CKD patients at 1-2 stages [Hazard Ratio (HR) = 0.89; 95% Confidence Interval (CI) = 0.79, 0.99; <i>p</i> = 0.04], while the association between tea consumption and CVD mortality didn't reach statistical significance. Dose-response effect was observed, showing that consuming up to three to five cups of tea per day was associated with mitigated risks of all-cause mortality, particularly in early CKD stages (non-linear <i>p</i> > 0.05). A 1 cup per day higher intake of oxidized tea was associated with a 10% lower risk of all-cause mortality in CKD stage 1-2 [HR = 0.90; 95%CI = 0.82, 0.99; <i>p</i> = 0.03]. Replacing 1 cup of green tea with 1 cup of oxidized tea per day was associated with an 8% and 11% lower risk of all-cause mortality [HR = 0.92; 95%CI = 0.86, 0.98; <i>p</i> = 0.01] and CVD mortality [HR = 0.89; 95%CI = 0.80, 1.00; <i>p</i> < 0.05], respectively, in individuals with CKD stages 1-2.</p><p><strong>Conclusion: </strong>Tea consumption showed protective effects on all-cause mortality in CKD population, with potential benefits observed in terms of","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2449578"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-01-22DOI: 10.1080/0886022X.2025.2454968
Mingchuan Huang, Shenghui Wu, Pengfei Gao, Li Zhou, Qian Fu, Chenglin Wu, Huanxi Zhang, Yitao Zheng, Xiaojun Su, Wenrui Wu, Jinghong Tan, Qiang Zhang, Pei Xia, Zhe Xu, Longshan Liu, Jun Li, Changxi Wang
Background: Dual kidney transplantation (DKT) from small pediatric donors, either en-bloc or split dual kidney transplantation, contributes to mitigating organ scarcity. This study investigates the prognosis of DKT from pediatric deceased donors, and influencing factors.
Method: A retrospective study included recipients who underwent DKT from pediatric donors between 2012 and 2022. Recipients were categorized into low mismatch (BWLM, n = 30) and high mismatch (BWHM, n = 10) groups based on donor-recipient weight ratio of 1:10. Outcome encompassed recipient and graft survival, renal function, and adverse events.
Result: Forty recipients were included. The average follow-up period was 54.6 months. The 1, 3, and 5-year patient survival were 97.4%, with no significant differences between en-bloc and split dual kidney transplantation or between BWLM and BWHM groups. The graft survival at 1, 3, and 5 years were 89.9%, the graft survival of BWHM group was lower than BWLM group (70% vs 96.7%, p = 0.039). The average eGFR at 1, 3, and 5 years postoperatively were (78.93 ± 25.23), (83.82 ± 32.4), and (85.92 ± 37.08) mL/min/1.73 m2, respectively. The BWHM group also experienced higher rates of graft-related surgical complications (p = 0.006) and urinary tract surgical complications (p = 0.042).
Conclusion: DKT from pediatric donors yields favorable outcomes, with similar graft survival and complication rates across surgical subgroups. However, significant donor-recipient weight mismatch, particularly when the ratio is less than 1:10, may contribute to increased surgical complications and poorer graft survival. Efforts to minimize extreme weight mismatch are recommended to optimize outcomes.
{"title":"The effect of low donor-to-recipient body weight ratio on graft survival after dual kidney transplantation from pediatric deceased donors.","authors":"Mingchuan Huang, Shenghui Wu, Pengfei Gao, Li Zhou, Qian Fu, Chenglin Wu, Huanxi Zhang, Yitao Zheng, Xiaojun Su, Wenrui Wu, Jinghong Tan, Qiang Zhang, Pei Xia, Zhe Xu, Longshan Liu, Jun Li, Changxi Wang","doi":"10.1080/0886022X.2025.2454968","DOIUrl":"10.1080/0886022X.2025.2454968","url":null,"abstract":"<p><strong>Background: </strong>Dual kidney transplantation (DKT) from small pediatric donors, either en-bloc or split dual kidney transplantation, contributes to mitigating organ scarcity. This study investigates the prognosis of DKT from pediatric deceased donors, and influencing factors.</p><p><strong>Method: </strong>A retrospective study included recipients who underwent DKT from pediatric donors between 2012 and 2022. Recipients were categorized into low mismatch (BWLM, <i>n</i> = 30) and high mismatch (BWHM, <i>n</i> = 10) groups based on donor-recipient weight ratio of 1:10. Outcome encompassed recipient and graft survival, renal function, and adverse events.</p><p><strong>Result: </strong>Forty recipients were included. The average follow-up period was 54.6 months. The 1, 3, and 5-year patient survival were 97.4%, with no significant differences between en-bloc and split dual kidney transplantation or between BWLM and BWHM groups. The graft survival at 1, 3, and 5 years were 89.9%, the graft survival of BWHM group was lower than BWLM group (70% vs 96.7%, <i>p</i> = 0.039). The average eGFR at 1, 3, and 5 years postoperatively were (78.93 ± 25.23), (83.82 ± 32.4), and (85.92 ± 37.08) mL/min/1.73 m<sup>2</sup>, respectively. The BWHM group also experienced higher rates of graft-related surgical complications (<i>p</i> = 0.006) and urinary tract surgical complications (<i>p</i> = 0.042).</p><p><strong>Conclusion: </strong>DKT from pediatric donors yields favorable outcomes, with similar graft survival and complication rates across surgical subgroups. However, significant donor-recipient weight mismatch, particularly when the ratio is less than 1:10, may contribute to increased surgical complications and poorer graft survival. Efforts to minimize extreme weight mismatch are recommended to optimize outcomes.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2454968"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-02-17DOI: 10.1080/0886022X.2025.2459349
Lucas Yessayan, Chris J Pino, H David Humes
Sepsis, a dysregulated host response to infection, is a leading cause of morbidity and mortality in critically ill patients, despite advancements in antimicrobial therapies. Recent innovations in extracorporeal blood purification therapies, such as the Selective Cytopheretic Device (SCD), Polymyxin B Hemoperfusion Cartridge (PMX-HP), and Seraph 100 Microbind Affinity Blood Filter (Seraph), have demonstrated promising potential as adjuncts to conventional therapies. The SCD targets activated white blood cells, while PMX-HP binds endotoxins in Gram-negative sepsis. The Seraph targets a broad range of pathogens, including viruses, bacteria and fungi. Evidence from several clinical trials and observational studies indicate that these therapies can improve organ function, and potentially improve survival in patients with sepsis. Despite the strong pathophysiological rationale for using these devices in sepsis, conclusive evidence of their effectiveness remains limited. Multicenter randomized controlled trials are currently underway with each of these devices to establish their role in improving patient outcomes. Further research is needed to establish optimal protocols for their initiation, duration, and integration into standard sepsis management.
{"title":"Extracorporeal therapies in sepsis: a comprehensive review of the Selective Cytopheretic Device, Polymyxin B and Seraph cartridges.","authors":"Lucas Yessayan, Chris J Pino, H David Humes","doi":"10.1080/0886022X.2025.2459349","DOIUrl":"https://doi.org/10.1080/0886022X.2025.2459349","url":null,"abstract":"<p><p>Sepsis, a dysregulated host response to infection, is a leading cause of morbidity and mortality in critically ill patients, despite advancements in antimicrobial therapies. Recent innovations in extracorporeal blood purification therapies, such as the Selective Cytopheretic Device (SCD), Polymyxin B Hemoperfusion Cartridge (PMX-HP), and Seraph 100 Microbind Affinity Blood Filter (Seraph), have demonstrated promising potential as adjuncts to conventional therapies. The SCD targets activated white blood cells, while PMX-HP binds endotoxins in Gram-negative sepsis. The Seraph targets a broad range of pathogens, including viruses, bacteria and fungi. Evidence from several clinical trials and observational studies indicate that these therapies can improve organ function, and potentially improve survival in patients with sepsis. Despite the strong pathophysiological rationale for using these devices in sepsis, conclusive evidence of their effectiveness remains limited. Multicenter randomized controlled trials are currently underway with each of these devices to establish their role in improving patient outcomes. Further research is needed to establish optimal protocols for their initiation, duration, and integration into standard sepsis management.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2459349"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2024-12-17DOI: 10.1080/0886022X.2024.2441394
Zitao Wang, Ling Jiang, Fang Lu, Li Qian, Ying Pan, Chengning Zhang, Zhimin Huang, Ming Zeng, Bin Sun, Bo Zhang, Huijuan Mao, Yudong Zhang, Suyan Duan, Changying Xing, Yanggang Yuan
<p><strong>Objectives: </strong>To explore the association of the cortico-medullary difference in apparent diffusion coefficient (ΔADC) with clinicopathological parameters of disease activity at the time of biopsy, and with the prognositic risk stratification in IgA nephropathy (IgAN) patients.</p><p><strong>Methods: </strong>We included 112 patients with biopsy-proven IgAN who measured ΔADC. Patients underwent a kidney biopsy and diffusion-weighted magnetic resonance imaging within one week of the biopsy. Clinicopathological characteristics were compared according to different ΔADC levels. The effect of ΔADC on eGFR and kidney fibrosis was explored using multivariate regression and ROC analysis. An individual's 5-year risk probability of progressing to ESKD or decreasing of eGFR > 50% was calculated by the guidelines-recommended international risk-prediction tool in IgAN. The effect of ΔADC on prognostic risk stratification was assessed. Net reclassification improvement (NRI) was used to evaluate the model performance.</p><p><strong>Results: </strong>The average ΔADC was 168.89 ± 85.1 x10<sup>-6</sup> mm<sup>2</sup>/s. ΔADC levels decreased significantly with increasing chronic kidney disease (CKD) stages (<i>p</i> = 0.0038). Spearman correlation analysis revealed that ΔADC was positively correlated with eGFR, hemoglobin, serum albumin, while negatively correlated with levels of serum creatine (Scr), blood urea nitrogen (BUN), T score of Oxford classification and Lee grades (<i>p</i> < 0.05). Moreover, we showed that ΔADC was independently associated with eGFR (β = 0.04, 95% CI = [0.003, 0.077], <i>p</i> = 0.033) demonstrated by a backward stepwise multivariate linear regression analysis. Besides, ΔADC, a combination of ΔADC and eGFR showed an AUC of 0.776 (60% sensitivity and 85.3% specificity) and an AUC of 0.875 (100% sensitivity and 69.6% specificity) respectively for evaluating kidney interstitial fibrosis (IF) severity. Furthermore, ΔADC showed an AUC of 0.792 (95% CI 0.677-0.906) for differentiating higher progression risk categories from lower categories (specificity = 91.6%, sensitivity = 58.8%). The low-ΔADC group (≤ median value 167.1 × 10<sup>-6</sup> mm<sup>2</sup>/s) was associated with 7.509-fold higher likelihood of higher progression risk compared to the high-ΔADC group (>167.1 × 10<sup>-6</sup> mm<sup>2</sup>/s) in a fully-adjusted model. And reclassification analyses confirmed that the final adjusted model improved NRI.</p><p><strong>Conclusions: </strong>ΔADC was significantly associated with kidney function and enabled a reliable evaluation of kidney IF severity in IgAN patients. Low ΔADC can predict a high 5-year kidney progression risk in IgAN, independent of important clinical factors. Moreover, the predictive ability to identify patients at high risk of severe kidney fibrosis and adverse progression estimates with satisfactory accuracy, facilitating ΔADC a promising and noninvasive tool in complementarily evaluating dise
{"title":"Delta corticomedullary apparent diffusion coefficient on MRI as a biomarker for prognosis in IgA nephropathy.","authors":"Zitao Wang, Ling Jiang, Fang Lu, Li Qian, Ying Pan, Chengning Zhang, Zhimin Huang, Ming Zeng, Bin Sun, Bo Zhang, Huijuan Mao, Yudong Zhang, Suyan Duan, Changying Xing, Yanggang Yuan","doi":"10.1080/0886022X.2024.2441394","DOIUrl":"10.1080/0886022X.2024.2441394","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the association of the cortico-medullary difference in apparent diffusion coefficient (ΔADC) with clinicopathological parameters of disease activity at the time of biopsy, and with the prognositic risk stratification in IgA nephropathy (IgAN) patients.</p><p><strong>Methods: </strong>We included 112 patients with biopsy-proven IgAN who measured ΔADC. Patients underwent a kidney biopsy and diffusion-weighted magnetic resonance imaging within one week of the biopsy. Clinicopathological characteristics were compared according to different ΔADC levels. The effect of ΔADC on eGFR and kidney fibrosis was explored using multivariate regression and ROC analysis. An individual's 5-year risk probability of progressing to ESKD or decreasing of eGFR > 50% was calculated by the guidelines-recommended international risk-prediction tool in IgAN. The effect of ΔADC on prognostic risk stratification was assessed. Net reclassification improvement (NRI) was used to evaluate the model performance.</p><p><strong>Results: </strong>The average ΔADC was 168.89 ± 85.1 x10<sup>-6</sup> mm<sup>2</sup>/s. ΔADC levels decreased significantly with increasing chronic kidney disease (CKD) stages (<i>p</i> = 0.0038). Spearman correlation analysis revealed that ΔADC was positively correlated with eGFR, hemoglobin, serum albumin, while negatively correlated with levels of serum creatine (Scr), blood urea nitrogen (BUN), T score of Oxford classification and Lee grades (<i>p</i> < 0.05). Moreover, we showed that ΔADC was independently associated with eGFR (β = 0.04, 95% CI = [0.003, 0.077], <i>p</i> = 0.033) demonstrated by a backward stepwise multivariate linear regression analysis. Besides, ΔADC, a combination of ΔADC and eGFR showed an AUC of 0.776 (60% sensitivity and 85.3% specificity) and an AUC of 0.875 (100% sensitivity and 69.6% specificity) respectively for evaluating kidney interstitial fibrosis (IF) severity. Furthermore, ΔADC showed an AUC of 0.792 (95% CI 0.677-0.906) for differentiating higher progression risk categories from lower categories (specificity = 91.6%, sensitivity = 58.8%). The low-ΔADC group (≤ median value 167.1 × 10<sup>-6</sup> mm<sup>2</sup>/s) was associated with 7.509-fold higher likelihood of higher progression risk compared to the high-ΔADC group (>167.1 × 10<sup>-6</sup> mm<sup>2</sup>/s) in a fully-adjusted model. And reclassification analyses confirmed that the final adjusted model improved NRI.</p><p><strong>Conclusions: </strong>ΔADC was significantly associated with kidney function and enabled a reliable evaluation of kidney IF severity in IgAN patients. Low ΔADC can predict a high 5-year kidney progression risk in IgAN, independent of important clinical factors. Moreover, the predictive ability to identify patients at high risk of severe kidney fibrosis and adverse progression estimates with satisfactory accuracy, facilitating ΔADC a promising and noninvasive tool in complementarily evaluating dise","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2441394"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-01-02DOI: 10.1080/0886022X.2024.2444389
Zhihong Zhang, Tingting Zhou, Man Zhang, Shuiqin Cheng
Objectives: Both serum creatinine and cystatin C serve as dependable markers of renal function and have demonstrated a correlation with clinical outcomes in diverse conditions, particularly through the ratio of creatinine to cystatin C (Cr/CysC). Anuric patients undergoing peritoneal dialysis (PD) depend entirely on the clearance of peritoneal solutes. This research posits that the Cr/CysC ratio may predict all-cause mortality and technique failure in anuric PD patients.
Methods: A cohort of 224 anuric PD patients was recruited from January 1, 2014, to December 31, 2019, with follow-up extending until December 31, 2023. The Cr/CysC ratio was computed by dividing the serum creatinine concentration by the cystatin C concentration obtained on the same day. We evaluated the relationship between the Cr/CysC ratio and patient survival, as well as technique failure, utilizing Cox regression and competing risk analyses.
Results: The average age of the participants was 50.46 ± 12.63 years, with 99 individuals (44.2%) being male. Among all subjects, the Cr/CysC ratio was found to be 1.85 ± 0.56. After controlling for potential confounders, Cox proportional hazards models revealed that the Cr/CysC ratio was significantly linked to the risk of all-cause mortality and technique failure (HR = 0.330, 95% CI 0.124-0.881, p = 0.027; HR = 0.440, 95% CI 0.267-0.726, p = 0.002). Importantly, the significant associations observed in the Cox regression analysis persisted even after accounting for competing risks.
Conclusion: The Cr/CysC ratio at baseline was recognized as an independent predictor of all-cause mortality and technique failure in anuric PD patients.
目的：血清肌酐和胱抑素C都是肾功能的可靠指标，并且在不同情况下与临床结果相关，特别是通过肌酐与胱抑素C的比值（Cr/CysC）。无尿患者接受腹膜透析（PD）完全依赖于清除腹膜溶质。本研究认为，Cr/CysC比值可以预测无尿PD患者的全因死亡率和技术失败。方法：从2014年1月1日至2019年12月31日招募224例无尿PD患者，随访至2023年12月31日。用当日血清肌酐浓度除以胱抑素C浓度计算Cr/CysC比值。我们利用Cox回归和竞争风险分析评估了Cr/CysC比率与患者生存以及技术失败之间的关系。结果：参与者平均年龄为50.46±12.63岁，男性99例，占44.2%。所有受试者的Cr/CysC比值为1.85±0.56。在控制了潜在混杂因素后，Cox比例风险模型显示，Cr/CysC比值与全因死亡率和技术失败风险显著相关(HR = 0.330, 95% CI 0.124-0.881, p = 0.027；HR = 0.440, 95% CI 0.267-0.726, p = 0.002)。重要的是，在Cox回归分析中观察到的显著关联即使在考虑了竞争风险之后仍然存在。结论：基线时的Cr/CysC比值被认为是无尿PD患者全因死亡率和技术失败的独立预测因子。
{"title":"Predictive value of creatinine-cystatin C ratio for mortality and technique failure in anuric peritoneal dialysis patients.","authors":"Zhihong Zhang, Tingting Zhou, Man Zhang, Shuiqin Cheng","doi":"10.1080/0886022X.2024.2444389","DOIUrl":"https://doi.org/10.1080/0886022X.2024.2444389","url":null,"abstract":"<p><strong>Objectives: </strong>Both serum creatinine and cystatin C serve as dependable markers of renal function and have demonstrated a correlation with clinical outcomes in diverse conditions, particularly through the ratio of creatinine to cystatin C (Cr/CysC). Anuric patients undergoing peritoneal dialysis (PD) depend entirely on the clearance of peritoneal solutes. This research posits that the Cr/CysC ratio may predict all-cause mortality and technique failure in anuric PD patients.</p><p><strong>Methods: </strong>A cohort of 224 anuric PD patients was recruited from January 1, 2014, to December 31, 2019, with follow-up extending until December 31, 2023. The Cr/CysC ratio was computed by dividing the serum creatinine concentration by the cystatin C concentration obtained on the same day. We evaluated the relationship between the Cr/CysC ratio and patient survival, as well as technique failure, utilizing Cox regression and competing risk analyses.</p><p><strong>Results: </strong>The average age of the participants was 50.46 ± 12.63 years, with 99 individuals (44.2%) being male. Among all subjects, the Cr/CysC ratio was found to be 1.85 ± 0.56. After controlling for potential confounders, Cox proportional hazards models revealed that the Cr/CysC ratio was significantly linked to the risk of all-cause mortality and technique failure (HR = 0.330, 95% CI 0.124-0.881, <i>p</i> = 0.027; HR = 0.440, 95% CI 0.267-0.726, <i>p</i> = 0.002). Importantly, the significant associations observed in the Cox regression analysis persisted even after accounting for competing risks.</p><p><strong>Conclusion: </strong>The Cr/CysC ratio at baseline was recognized as an independent predictor of all-cause mortality and technique failure in anuric PD patients.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2444389"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-01-13DOI: 10.1080/0886022X.2025.2449720
Lei Chen, Mengyao Yan, Jie Li, Xue Zhao, Lu Zeng, Zhumei Gao, Hongli Jiang, Limin Wei
Objectives: The aim of the study was to assess the association between the geriatric nutritional risk index (GNRI) and incidence of CKD progression, all-cause mortality, and cardiovascular events in the elderly patients with chronic kidney disease (CKD) before dialysis initiation.
Methods: We performed a post hoc analysis of the CKD-ROUTE database, which included 538 pre-dialysis CKD patients aged ≥65 years in this prospective cohort study. Associations between GNRI and clinical outcomes were estimated using Cox proportional hazards model analysis. Multivariable linear mixed regression models with random intercepts were used to assess the association between GNRI and estimated glomerular filtration rate (eGFR) decline per year.
Results: During the median follow-up period of 2.92 years, there were 123 (22.86%) CKD progression events, 44 (8.18%) deaths, and 76 (14.13%) cardiovascular events. After adjusting for multiple confounding factors, the hazard ratios (HRs) for CKD progression in patients with GNRI <92 were 1.99 (95% CI, 1.34-2.97; p < 0.001), when compared with a GNRI of ≥92. Patients with a lower GNRI also had a significantly greater rate of eGFR decline over time than well-nourished patients (mean annual difference, -1.69; 95% CI, -2.62 to -0.77; p < 0.001). In the secondary outcomes, this association was consistent for all-cause mortality. Moreover, the associations were generally consistent across several subgroup and sensitivity analyses.
Conclusions: The lower GNRI is significantly associated with higher risks of renal prognosis and all-cause mortality in elderly patients with CKD.
{"title":"Association of geriatric nutritional risk index with renal prognosis and all-cause mortality among older patients with chronic kidney disease: a secondary analysis of CKD-ROUTE study.","authors":"Lei Chen, Mengyao Yan, Jie Li, Xue Zhao, Lu Zeng, Zhumei Gao, Hongli Jiang, Limin Wei","doi":"10.1080/0886022X.2025.2449720","DOIUrl":"10.1080/0886022X.2025.2449720","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to assess the association between the geriatric nutritional risk index (GNRI) and incidence of CKD progression, all-cause mortality, and cardiovascular events in the elderly patients with chronic kidney disease (CKD) before dialysis initiation.</p><p><strong>Methods: </strong>We performed a post hoc analysis of the CKD-ROUTE database, which included 538 pre-dialysis CKD patients aged ≥65 years in this prospective cohort study. Associations between GNRI and clinical outcomes were estimated using Cox proportional hazards model analysis. Multivariable linear mixed regression models with random intercepts were used to assess the association between GNRI and estimated glomerular filtration rate (eGFR) decline per year.</p><p><strong>Results: </strong>During the median follow-up period of 2.92 years, there were 123 (22.86%) CKD progression events, 44 (8.18%) deaths, and 76 (14.13%) cardiovascular events. After adjusting for multiple confounding factors, the hazard ratios (HRs) for CKD progression in patients with GNRI <92 were 1.99 (95% CI, 1.34-2.97; <i>p</i> < 0.001), when compared with a GNRI of ≥92. Patients with a lower GNRI also had a significantly greater rate of eGFR decline over time than well-nourished patients (mean annual difference, -1.69; 95% CI, -2.62 to -0.77; <i>p</i> < 0.001). In the secondary outcomes, this association was consistent for all-cause mortality. Moreover, the associations were generally consistent across several subgroup and sensitivity analyses.</p><p><strong>Conclusions: </strong>The lower GNRI is significantly associated with higher risks of renal prognosis and all-cause mortality in elderly patients with CKD.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2449720"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Sepsis is an uncontrolled systemic response to infection that leads to life-threatening organ dysfunction. The in-hospital mortality rate remains significantly high in septic shock patients with malignancies. This study investigates whether early and high-volume administration of sodium bicarbonate during continuous renal replacement therapy (CRRT) can reduce 28-day mortality, increase shock reversal rates, and shorten the duration of CRRT, mechanical ventilation, and intensive care unit (ICU) stays. The goal is to provide valuable clinical data for the management of cancer patients with sepsis-associated acute kidney injury (SAKI).
Materials and methods: A retrospective study was performed on 88 patients who were admitted to the ICU and received continuous renal replacement therapy (CRRT) for acute renal failure secondary to sepsis at the Cancer Center of Sun Yat-sen University from March 2010 to October 2021. Based on the initiation time of CRRT and the volume of sodium bicarbonate infusion, patients were divided into four groups: the early high-volume group, early low-volume group, late high-volume group, and late low-volume group.
Results: The results of this study showed that in the 28-day mortality model, established using the Cox proportional hazards method, early CRRT (HR 0.473; 95% CI 0.245-0.915, p = 0.026) and high-volume sodium bicarbonate infusion (HR 0.173; 95% CI 0.078-0.383, p < 0.001) were identified as two independent protective factors. The 28-day mortality rate in the early high-volume group (15.0%) was significantly lower than that of the other three groups (60.0%, 30.0%, and 75.0%, respectively; χ2 = 23.822, p < 0.001). Additionally, the shock reversal rate in the early high-volume group (80.0%) was significantly higher compared to the other groups (35.0%, 45.0%, and 35.7%; χ2 =13.576, p = 0.004). The duration of CRRT was shorter in the early high-volume group (35.0 ± 4.45 h) than in the other groups (70.0 ± 30.19 h, 48.0 ± 5.22 h, and 72.0 ± 19.84 h; χ2 =11.278, p = 0.01). Furthermore, the duration of mechanical ventilation (7.0 ± 3.33 days) was lower in the early high-volume group compared to the other groups (8.0 ± 1.12 days,10.0 ± 1.11 days, and 8.0 ± 2.65 days; χ2 =8.064, p = 0.045), as was the length of ICU stay (7.0 ± 0.89 days) compared to the other groups (13.0 ± 3.35 days, 10.0 ± 1.49 days, and10.0 ± 3.70 days; χ2 = 9.184, p = 0.027).
Conclusion: Early and high-volume administration of sodium bicarbonate during CRRT may reduce 28-day mortality and improve shock reversal rates in patients with sepsis-associated acute kidney injury complicated by malignancy. Prospective randomized controlled large sample studies are needed to confirm this.
败血症是一种不受控制的全身感染反应，可导致危及生命的器官功能障碍。脓毒性休克合并恶性肿瘤患者的住院死亡率仍然很高。本研究探讨在持续肾替代治疗（CRRT）期间早期和大剂量给药碳酸氢钠是否可以降低28天死亡率，增加休克逆转率，缩短CRRT、机械通气和重症监护病房（ICU）住院时间。目的是为脓毒症相关急性肾损伤（SAKI）癌症患者的管理提供有价值的临床数据。材料与方法：回顾性研究2010年3月至2021年10月中山大学肿瘤中心收治的88例重症监护室接受持续肾替代治疗（CRRT）的脓毒症继发急性肾功能衰竭患者。根据CRRT起始时间和碳酸氢钠输注量将患者分为4组：早期高容量组、早期低容量组、晚期高容量组、晚期低容量组。结果：本研究结果显示，在采用Cox比例风险法建立的28天死亡率模型中，早期CRRT (HR 0.473；95% CI 0.245-0.915, p = 0.026)和大容量碳酸氢钠输注(HR 0.173；95%可信区间0.078 - -0.383,pχ2 = 23.822,pχ2 = 13.576,p = 0.004)。早期高容量组CRRT持续时间（35.0±4.45 h）短于其他组（70.0±30.19 h、48.0±5.22 h、72.0±19.84 h）；χ2 =11.278, p = 0.01)。早期高容积组机械通气持续时间（7.0±3.33 d）低于其他组（8.0±1.12 d、10.0±1.11 d、8.0±2.65 d）；χ2 =8.064, p = 0.045)， ICU住院时间（7.0±0.89 d）与其他组（13.0±3.35 d、10.0±1.49 d、10.0±3.70 d）比较差异有统计学意义；χ2 = 9.184, p = 0.027)。结论：CRRT期间早期和大量给予碳酸氢钠可降低败血症相关急性肾损伤合并恶性肿瘤患者的28天死亡率并提高休克逆转率。需要前瞻性随机对照大样本研究来证实这一点。
{"title":"Early and high-volume administration of sodium bicarbonate in sepsis-associated acute kidney injury in patients with malignancies, during continuous renal replacement therapy.","authors":"Lamei Ouyang, Yin Pan, Ya-Fei Wu, Qiang Tang, Dao-Feng Wang, Ning Lou","doi":"10.1080/0886022X.2024.2443026","DOIUrl":"10.1080/0886022X.2024.2443026","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is an uncontrolled systemic response to infection that leads to life-threatening organ dysfunction. The in-hospital mortality rate remains significantly high in septic shock patients with malignancies. This study investigates whether early and high-volume administration of sodium bicarbonate during continuous renal replacement therapy (CRRT) can reduce 28-day mortality, increase shock reversal rates, and shorten the duration of CRRT, mechanical ventilation, and intensive care unit (ICU) stays. The goal is to provide valuable clinical data for the management of cancer patients with sepsis-associated acute kidney injury (SAKI).</p><p><strong>Materials and methods: </strong>A retrospective study was performed on 88 patients who were admitted to the ICU and received continuous renal replacement therapy (CRRT) for acute renal failure secondary to sepsis at the Cancer Center of Sun Yat-sen University from March 2010 to October 2021. Based on the initiation time of CRRT and the volume of sodium bicarbonate infusion, patients were divided into four groups: the early high-volume group, early low-volume group, late high-volume group, and late low-volume group.</p><p><strong>Results: </strong>The results of this study showed that in the 28-day mortality model, established using the Cox proportional hazards method, early CRRT (HR 0.473; 95% CI 0.245-0.915, <i>p</i> = 0.026) and high-volume sodium bicarbonate infusion (HR 0.173; 95% CI 0.078-0.383, <i>p</i> < 0.001) were identified as two independent protective factors. The 28-day mortality rate in the early high-volume group (15.0%) was significantly lower than that of the other three groups (60.0%, 30.0%, and 75.0%, respectively; <i>χ</i><sup>2</sup> = 23.822, <i>p</i> < 0.001). Additionally, the shock reversal rate in the early high-volume group (80.0%) was significantly higher compared to the other groups (35.0%, 45.0%, and 35.7%; <i>χ</i><sup>2</sup> =13.576, <i>p</i> = 0.004). The duration of CRRT was shorter in the early high-volume group (35.0 ± 4.45 h) than in the other groups (70.0 ± 30.19 h, 48.0 ± 5.22 h, and 72.0 ± 19.84 h; <i>χ</i><sup>2</sup> =11.278, <i>p</i> = 0.01). Furthermore, the duration of mechanical ventilation (7.0 ± 3.33 days) was lower in the early high-volume group compared to the other groups (8.0 ± 1.12 days,10.0 ± 1.11 days, and 8.0 ± 2.65 days; <i>χ</i><sup>2</sup> =8.064, <i>p</i> = 0.045), as was the length of ICU stay (7.0 ± 0.89 days) compared to the other groups (13.0 ± 3.35 days, 10.0 ± 1.49 days, and10.0 ± 3.70 days; <i>χ</i><sup>2</sup> = 9.184, <i>p</i> = 0.027).</p><p><strong>Conclusion: </strong>Early and high-volume administration of sodium bicarbonate during CRRT may reduce 28-day mortality and improve shock reversal rates in patients with sepsis-associated acute kidney injury complicated by malignancy. Prospective randomized controlled large sample studies are needed to confirm this.</p>","PeriodicalId":20839,"journal":{"name":"Renal Failure","volume":"47 1","pages":"2443026"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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