Renal Failure最新文献

Muscle dysfunction symptoms such as weakness and cramps are common in people with chronic kidney disease (CKD), but their impact on activities of daily living (ADLs) is not well understood. This study explored the association between muscle symptoms and patient-reported ADL impact in individuals with and without CKD. This cross-sectional secondary analysis of the I-RACE study (ISRCTN11596292) included adults (≥18 years) across the CKD spectrum and adults without CKD. Participants completed a bespoke Muscle Symptoms Scale assessing muscle-related symptoms and their impact on ADLs (daily activities, socializing, working, exercising). Group differences were tested using univariate general linear models; associations were examined via linear regression. Among 1048 participants (304 non-CKD, 345 non-dialysis CKD, 281 dialysis, 118 transplant), mean age was 57 ± 17 years and 51% were female. Muscle symptoms (weakness, tiredness, aches/pains, cramps/tightness, reduced muscle size, restless legs) were significantly worse in CKD groups (all p < 0.05). Dialysis and transplant recipients reported more severe symptoms than non-dialysis CKD, with dialysis patients reporting the worst weakness and muscle size reduction. ADL impact followed a similar pattern, with dialysis patients most affected. All muscle symptoms were significantly associated with ADL impact in CKD, particularly weakness and reduced muscle size (all p < 0.05). Muscle dysfunction symptoms are more severe in CKD, especially in kidney failure. These symptoms are strongly associated with impaired ADLs, highlighting muscle size and strength as potential targets for intervention through exercise.

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.

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 retrospective study analyzed hemodialysis (HD) and peritoneal dialysis (PD) impacts on diastolic blood pressure variability (DBPV) in Stage 5 chronic kidney disease (CKD-G5D) patients, explored volume-related indicator associations with DBPV, and provided clinical volume management evidence. Patients with CKD-G5D on maintenance dialysis (January 2019-December 2023) were included (n = 426; 298 HD, 128 PD), with median follow-up of 32.5 months. DBPV was assessed via 24-hour ambulatory blood pressure monitoring (ABPM), and volume indicators included interdialytic weight gain percentage (IDWG%), ultrafiltration volume (UFV), extracellular volume/body surface area (ECV/BSA), and N-terminal pro-B-type natriuretic peptide (NT-proBNP). HD patients had significantly higher 24h DBP SD (16.1 ± 5.3 vs 13.5 ± 4.5 mmHg), 24h DBP CV (21.3 ± 5.7% vs 17.9 ± 4.9%), and non-dipping DBPV prevalence compared with PD patients (70.1% vs 53.9%, all p < 0.01). IDWG% (r = 0.45) correlated strongest with 24h DBP SD, and dialysis modality (β = 2.31) and IDWG% (β = 1.95) were main DBPV influencers (both p < 0.001). 24h DBP SD ≥16 mmHg (dichotomous variable, HR = 1.15, 95% CI:1.08-1.23, p < 0.001) and HD modality independently predicted cardiovascular events. Targeted volume management improved DBPV in HD patients with IDWG% >5%. These results suggest that monitoring DBPV and IDWG% should be incorporated into routine dialysis care to mitigate cardiovascular risk.

Increased intestinal permeability resulting from gut dysbiosis, cardiovascular disease (CVD), and graft failure is common among kidney transplant (KT) recipients. This study was designed to investigate the effects of synbiotics on intestinal permeability, systemic and vascular inflammation markers, oxidative stress, and fibrosis in KT recipients. In this randomized controlled trial, 46 KT recipients were randomly assigned to either the synbiotic or the placebo group. Participants in the synbiotic group received two synbiotic capsules for 12 weeks, while the placebo group received a corresponding placebo. Serum lipopolysaccharide binding protein (LBP), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule type 1 (sICAM-1), malondial-dehyde (MDA), galectin-3, urea, and creatinine were measured. Serum LBP (p = 0.03), hs-CRP (p = 0.02), ICAM-1 (p = 0.04), and IL-6 (p = 0.02) showed significant reductions in the synbiotic group compared to the placebo group. Serum MDA, galectin-3, urea, and creatinine did not show significant changes within each group. This study indicates that synbiotics reduce LBP, a marker of intestinal permeability, as well as hs-CRP, IL-6, and sICAM-1, which are risk factors for CVD and graft failure, in KT recipients.

Pulmonary hypertension (PH) is a frequent yet underrecognized complication in end-stage renal disease on dialysis. Earlier echocardiographic definitions based on pulmonary artery systolic pressure (PASP) >35 mmHg derived from right atrial pressure estimation were prone to inaccuracy and volume overload bias. In 2022, the European Society of Cardiology/European Respiratory Society introduced tricuspid regurgitation velocity (TRV)-based criteria incorporating structural and functional markers to improve diagnostic specificity.

We aimed to determine the prevalence of PH in dialysis patients using TRV-based echocardiographic criteria and to identify independent predictors. This retrospective cross-sectional study was conducted at Burapha University Hospital, Chonburi Province, Thailand, from October 1, 2023, to October 30, 2024, and included 117 dialysis patients who underwent echocardiography. PH was defined as TRV >2.8 m/s plus ≥1 additional echocardiographic sign. The prevalence of PH was 43.6% (51/117). Compared with non-PH patients, those with PH had greater left ventricular diastolic dimensions, higher left atrial volume index, more diastolic dysfunction, and more frequent mitral regurgitation (MR). In multivariable analysis, longer dialysis vintage (adjusted relative risk [ARR] 1.50 per year, p = 0.009), larger LV diastolic dimension (ARR 1.06 per mmHg, p = 0.036), and the presence of MR (ARR 2.00, p = 0.020) were independent predictors.

PH was common in dialysis patients even when applying stricter TRV-based criteria that reduce misclassification related to volume status. The observed associations with dialysis vintage, left ventricular remodeling, and MR suggest a predominance of post-capillary mechanisms and support a heart-kidney-lung interaction.

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.