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Clinical Journal of the American Society of Nephrology最新文献

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Social Determinants of Health in Acute Kidney Injury: Looking Beyond the Hospital Room. 急性肾损伤的健康社会决定因素:走出病房看世界。
IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 DOI: 10.2215/CJN.0000000596
Anna E Williams, Clarissa J Diamantidis
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引用次数: 0
Association of Kidney Function with Sodium-Glucose Co-Transporter 2 Inhibitor Discontinuation among US Veterans. 肾功能与美国退伍军人停用 SGLT2 抑制剂的关系。
IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-21 DOI: 10.2215/CJN.0000000000000536
Jesse C Ikeme, Erin Madden, Julio A Lamprea-Montealegre, Chi D Chu, Michael G Shlipak, Ian E McCoy, Michelle M Estrella
{"title":"Association of Kidney Function with Sodium-Glucose Co-Transporter 2 Inhibitor Discontinuation among US Veterans.","authors":"Jesse C Ikeme, Erin Madden, Julio A Lamprea-Montealegre, Chi D Chu, Michael G Shlipak, Ian E McCoy, Michelle M Estrella","doi":"10.2215/CJN.0000000000000536","DOIUrl":"10.2215/CJN.0000000000000536","url":null,"abstract":"","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":" ","pages":"1426-1434"},"PeriodicalIF":8.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cost-Related Medication Nonadherence among Adults with Kidney Disease in the United States. 美国肾病成人中与费用相关的不坚持用药现象。
IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-06 DOI: 10.2215/CJN.0000000000000543
Kavya M Shah, Monica Taing, Anthony Zhong, Khushi Kohli, Rishi M Shah, Li-Li Hsiao
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引用次数: 0
Where Are Patients' Voices in Chronic Kidney Disease? 慢性肾病患者的声音在哪里?
IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-30 DOI: 10.2215/CJN.0000000581
Despina Rüssmann, Prabir Roy-Chaudhury, Glenn M Chertow, Patrick Gee, Cynthia Chauhan, Steven Macari, Michael Murphy, Patrick Rossignol
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引用次数: 0
Neighborhood Socioeconomic Deprivation is Associated with Worse Outcomes in Pediatric Kidney Transplant Recipients. 邻里社会经济贫困与小儿肾移植受者的不良预后有关。
IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-31 DOI: 10.2215/CJN.0000000592
Chloe E Douglas, Miranda C Bradford, Rachel M Engen, Yue-Harn Ng, Aaron Wightman, Reya Mokiao, Sharon Bartosh, André A S Dick, Jodi M Smith
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引用次数: 0
Classification of Predictors of Rapid Development of Kidney Failure and Short-Term Changes in Concentration of Circulating Proteins. 肾衰竭快速发展和循环蛋白质浓度短期变化的预测因素分类。
IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-31 DOI: 10.2215/CJN.0000000603
Hiroki Kobayashi, Helen C Looker, Katsuhito Ihara, Zaipul I Md Dom, Eiichiro Satake, Sok Cin Tye, Kevin L Duffin, Alessandro Doria, Robert G Nelson, Andrzej S Krolewski

Objective: Limited knowledge exists regarding short-term changes/increases in concentrations of circulating proteins (referred here as deltas) and rapid development of kidney failure (rapid KF) in diabetes mellitus.

Research design and methods: Concentrations of 452 circulating proteins were measured by OLINK proteomics platform at baseline and after a median interval of 3-4 years in 106 individuals with type 1 and 77 with type 2 diabetes in two case-control studies. During 10-year follow-up, 31 and 26 individuals, respectively, developed rapid KF.

Results: Deltas for 40 proteins predicted rapid KF in both studies. All were better predictors than delta urine albumin-creatinine ratio, and half were better than delta glomerular filtration rate. Comparing the delta proteins with 46 circulating proteins of which elevated baseline concentrations were predictors of rapid KF risk in our previous study, 61 unique proteins were identified. Among these proteins, 21 were good predictors of rapid KF only when measured at baseline (predictors of initiation), 15 were good predictors when measured as deltas (predictors of progression) and 25 were good predictors when both baseline and delta concentrations were used (predictors of initiation and progression). An index score, developed for the latter 25 proteins, provided superior prediction of rapid KF. A subset of these latter proteins was associated with apoptotic processes/tumor necrosis factor (TNF) receptor signaling pathways.

Conclusion: Development of rapid KF in diabetes was preceded by elevated concentrations of multiple circulating proteins both at baseline and during short follow-up. Comparing baseline and short-term changes in concentrations of circulating proteins classified predictors of rapid KF risk into those associated with initiation, progression, or both. Predictors of both initiation & progression flagged apoptosis processes and TNF receptor signaling pathways. Multi-protein prognostic algorithms using proteins associated with both initiation and progression improved prediction of rapid KF risk beyond clinical variables.

研究目的:关于糖尿病患者循环蛋白浓度的短期变化/增加(此处称为deltas)和肾衰竭的快速发展(快速KF)的知识有限:在两项病例对照研究中,使用 OLINK 蛋白质组学平台测量了 106 名 1 型糖尿病患者和 77 名 2 型糖尿病患者在基线和中位间隔 3-4 年后的 452 种循环蛋白质浓度。在 10 年的随访中,分别有 31 人和 26 人发展为快速 KF:结果:在这两项研究中,有 40 种蛋白质的δ可预测快速 KF。所有预测指标均优于δ尿白蛋白-肌酐比值,半数优于δ肾小球滤过率。在我们之前的研究中,有 46 种循环蛋白的基线浓度升高可预测快速 KF 风险,将δ蛋白与这 46 种循环蛋白进行比较,发现了 61 种独特的蛋白。在这些蛋白质中,有 21 种蛋白质仅在基线浓度测量时才是快速 KF 的良好预测因子(起始预测因子),15 种蛋白质在测量三角浓度时是良好预测因子(进展预测因子),25 种蛋白质在使用基线浓度和三角浓度时都是良好预测因子(起始预测因子和进展预测因子)。为后 25 种蛋白质制定的指数评分能更好地预测快速 KF。这些蛋白质中的一部分与细胞凋亡过程/肿瘤坏死因子(TNF)受体信号通路有关:结论:在糖尿病患者出现快速 KF 之前,多种循环蛋白质的浓度在基线和短期随访期间都会升高。比较循环蛋白浓度的基线和短期变化,可将快速KF风险的预测因素分为与起病、进展或两者相关的因素。与凋亡过程和 TNF 受体信号通路相关的起始和进展预测因子。多蛋白预后算法使用了与起始和进展都相关的蛋白质,超越了临床变量,提高了对快速 KF 风险的预测能力。
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引用次数: 0
Reliability of Glomerular Filtration Rate Estimated by Creatinine-Based Formulas in Moderate to Severe Proteinuria. 中度至重度蛋白尿患者以肌酐为基础的公式估算的肾小球滤过率的可靠性。
IF 9.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-24 DOI: 10.2215/cjn.0000000602
Carmine Zoccali,Fabio Pasquale Provenzano,Giovanni Tripepi,Fabiola Carrara,Francesca Mallamaci,Annalisa Perna,Pierre Delanaye,Pietro Ruggenenti,Giuseppe Remuzzi
BACKGROUNDCreatinine-based Glomerular Filtration rate (GFR) formulas introduce a substantial bias in GFR estimations in patients with frank nephrotic syndrome. The bias and accuracy of creatinine-based GFR estimates (eGFR) in patients with non-nephrotic proteinuria need better characterization.METHODSWe utilized data from the Ramipril in non-diabetic renal failure (REIN 1) and REIN 2 trials involving non-diabetic chronic kidney disease (CKD) patients with proteinuria to compare eGFRs derived from the CKD Epidemiology Consortium (CKD-EPI)formulas (with and without race), and the European Kidney Function Consortium (EKFC) equations with iohexol clearance (a gold-standard GFR measure, measured glomerular filtration rate [mGFR]). Bias was defined as the median difference between eGFR and mGFR, while accuracy was assessed using P30 and P15 metrics, which represent the percentage of eGFR values within ±30% and ±15% of mGFR, respectively.RESULTSThe median bias of the three formulas being compared did not differ, being minimal and in a strict range (0.04 to 0.05 ml/ml/min/1.73m2) in the REIN 1 study and (-0.04 to -0.03 ml/min/1.73 m2) in the REIN 2 study. These findings were confirmed in analyses stratified by age and mGFR. The global accuracy of the three formulas regarding P30% showed sufficient accuracy (P30 >75%) in REIN 1 and all strata in REIN 2, but the mGFR stratum <15 ml/min/1.73m2.CONCLUSIONThe CKD-EPI (with and without race), and EKFC equations show no significant bias and sufficient accuracy in patients with proteinuria. These formulas can be safely applied to non-diabetic CKD patients with moderate to severe proteinuria.
背景基于肌酐的肾小球滤过率(GFR)计算公式会对肾病综合征患者的肾小球滤过率估算产生很大偏差。非肾病性蛋白尿患者基于肌酐的肾小球滤过率估算(eGFR)的偏差和准确性需要更好的鉴定。方法:我们利用雷米普利治疗非糖尿病肾衰竭(REIN 1)和 REIN 2 试验的数据(涉及蛋白尿的非糖尿病慢性肾病 (CKD) 患者),比较了由 CKD 流行病学联盟 (CKD-EPI) 公式(含种族和不含种族)和欧洲肾功能联盟 (EKFC) 公式得出的 eGFR 与碘海醇清除率(黄金标准 GFR 测量方法,即测定的肾小球滤过率 [mGFR])。偏差被定义为 eGFR 与 mGFR 之间的中位数差异,而准确性则使用 P30 和 P15 指标进行评估,这两个指标分别代表 eGFR 值在 mGFR ±30% 和 ±15% 范围内的百分比。结果比较的三种公式的中位数偏差没有差异,在 REIN 1 研究中偏差最小且范围严格(0.04 至 0.05 ml/ml/min/1.73m2),在 REIN 2 研究中偏差最小且范围严格(-0.04 至 -0.03 ml/min/1.73 m2)。这些结果在按年龄和 mGFR 进行的分层分析中得到了证实。在 REIN 1 和 REIN 2 的所有分层中,这三个公式关于 P30% 的总体准确性显示出足够的准确性(P30 >75%),但 mGFR 分层 <15 ml/min/1.73 m2。这些公式可安全地应用于中度至重度蛋白尿的非糖尿病 CKD 患者。
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引用次数: 0
Risk of Surgical Site Infections after Tooth Extraction in Chronic Kidney Disease: A Retrospective Real-World Study in Japan 慢性肾病患者拔牙后手术部位感染的风险:日本的一项回顾性真实世界研究
IF 9.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-23 DOI: 10.2215/cjn.0000000599
Miho Ishimaru, Sachiko Ono, Masao Iwagami, Yoshihisa Miyamoto, Risako Mikami, Jun Aida
An abstract is unavailable. This article is available as a PDF only.
无摘要。本文仅以 PDF 格式提供。
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引用次数: 0
Albuminuria and Rapid Kidney Function Decline as Selection Criteria for Kidney Clinical Trials in Type 1 Diabetes Mellitus. 将白蛋白尿和肾功能快速下降作为 1 型糖尿病肾脏临床试验的选择标准。
IF 9.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-18 DOI: 10.2215/cjn.0000000000000567
Youngshin Keum,Maria Luiza Caramori,David Z Cherney,Jill P Crandall,Ian H de Boer,Ildiko Lingvay,Janet B McGill,Sarit Polsky,Rodica Pop-Busui,Peter Rossing,Ronald J Sigal,Michael Mauer,Alessandro Doria
BACKGROUNDThe optimal criteria to select individuals with type 1 diabetes mellitus (T1D) and albuminuric or normoalbuminuric diabetic kidney disease (DKD), who are at risk of rapid kidney function decline, for clinical trials are unclear.METHODSThis study analyzed data from the Preventing Early Renal Loss in Diabetes (PERL) clinical trial, which investigated whether allopurinol slowed kidney function decline in persons with T1D and early-to-moderate DKD. Rates of iohexol GFR (iGFR) and estimated GFR (eGFR) decline during the three-year study were compared by linear mixed effect regression between participants enrolled based on a history of moderately or severely increased albuminuria (N=394) and those enrolled based on a recent history of rapid kidney function decline (≥3 ml/min/1.73 m2/year) in the absence of a history of albuminuria (N=124). The association between baseline albuminuria and iGFR/eGFR decline during the trial was also evaluated.RESULTSRates of eGFR decline during the trial were higher in participants with a history of albuminuria than in those with a history of rapid kidney function decline (-3.56 [95% confidence intervals {CI} -3.17, -3.95] versus -2.35 [95% CI: -1.86, -2.84] ml/min/1.73 m2/year, p=0.001). Results were similar for iGFR decline, although the difference was not significant (p=0.07). Within the history of albuminuria group, the rate of eGFR decline was -5.30 (95% CI -4.52, -6.08) ml/min/1.73m2/year in participants with severely increased albuminuria as compared to -2.97 (95% CI 2.44, -3.50) and -2.32 (95% CI -1.61, -3.03) ml/min/1.73m2/year in those with moderately increased or normal/mildly increased albuminuria at baseline (p<0.001).CONCLUSIONSSeverely increased albuminuria at screening is a powerful criterion for selecting persons with T1D at high risk of kidney function decline. A history of rapid eGFR decline without a history of albuminuria is less effective for this purpose but it can still identify individuals with T1D who will lose kidney function more rapidly than expected from physiological aging.CLINICAL TRAIL REGISTRATIONClinicalTrials.gov, NCT02017171.
背景选择1型糖尿病(T1D)和白蛋白尿或正常白蛋白尿型糖尿病肾病(DKD)患者进行临床试验的最佳标准尚不清楚,因为这些患者有肾功能快速下降的风险。方法本研究分析了预防糖尿病早期肾功能丧失(PERL)临床试验的数据,该试验研究了别嘌醇是否能减缓T1D和早期至中度DKD患者的肾功能下降。通过线性混合效应回归比较了三年研究期间异嘌呤醇 GFR (iGFR) 和估计 GFR (eGFR) 下降率,比较对象为有中度或重度白蛋白尿增高病史的入选者(394 人)和近期肾功能快速下降(≥3 毫升/分钟/1.73 平方米/年)且无白蛋白尿病史的入选者(124 人)。结果试验期间,有白蛋白尿史的参与者的 eGFR 下降率高于有肾功能快速下降史的参与者(-3.56 [95% 置信区间 {CI} -3.17, -3.95]对 -2.35 [95% CI: -1.86, -2.84]毫升/分钟/1.73平方米/年,P=0.001)。iGFR 下降的结果类似,但差异不显著(P=0.07)。在白蛋白尿病史组中,白蛋白尿严重增高者的 eGFR 下降率为-5.30(95% CI -4.52,-6.08)毫升/分钟/1.73 米2/年,而白蛋白尿中度增高者的 eGFR 下降率分别为-2.97(95% CI 2.44,-3.50)毫升/分钟/1.73 米2/年和-2.32(95% CI -1.61,-3.03)毫升/分钟/1.73 米2/年。结论筛查时白蛋白尿严重增加是选择肾功能衰退高风险 T1D 患者的有力标准。没有白蛋白尿的 eGFR 快速下降史在这方面的效果较差,但仍能识别出肾功能下降速度比生理衰老预期速度更快的 T1D 患者。
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引用次数: 0
Baseline, Early Changes, and Residual Albuminuria: Post-hoc Analysis of a Clinical Trial of Dapagliflozin in Chronic Kidney Disease 基线、早期变化和残余白蛋白尿:达帕格列净治疗慢性肾病临床试验的事后分析
IF 9.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2024-10-17 DOI: 10.2215/cjn.0000000000000550
Dominique van Mil, Priya Vart, Glenn M. Chertow, Ron T. Gansevoort, Peter Rossing, Robert D. Toto, Ricardo Correa-Rotter, Anna Maria Langkilde, C. David Sjöström, David C. Wheeler, Hiddo J.L. Heerspink
n patients with CKD and albuminuria, with and without type 2 diabetes. Methods: In this post-hoc analysis of the DAPA-CKD trial, 4304 adult patients with CKD were randomized to dapagliflozin 10mg or placebo as adjunct to maximally tolerated renin-angiotensin-system (RAAS) inhibitors. The primary endpoint was a composite of sustained ≥50% decline in estimated glomerular filtration rate, kidney failure, or death from kidney or cardiovascular cause. The kidney composite endpoint was similar but excluded cardiovascular death. We assessed associations among baseline albuminuria, early change in albuminuria, (baseline to Month 4), and residual albuminuria (Month 4) with the primary composite and kidney composite endpoints using Cox proportional hazards regression analyses. Results: Compared to placebo, dapagliflozin reduced urinary albumin-to-creatinine ratio (UACR; baseline to Month 4) by 36% (95% CI: 30.2%, 42.5%) and 21% (95% CI: 12, 30%) in participants with and without type 2 diabetes, respectively (p-interaction: 0.02). A reduction in UACR from baseline to Month 4 was associated with a lower risk for the primary and kidney composite endpoints with a similar risk gradient for participants with and without type 2 diabetes (p-interaction: 0.10 and 0.19, respectively). Residual albuminuria was associated with a similar risk for the primary and kidney composite endpoints in each treatment arm (p-interaction: 0.19 and 0.18, respectively). Conclusions: Dapagliflozin reduced albuminuria, and the magnitude of albuminuria reduction showed similar proportional reductions in risks for the primary and kidney composite endpoints in participants with and without type 2 diabetes. Patients with residual albuminuria at Month 4 – whether randomized to dapagliflozin or placebo – experienced relatively high rates of CKD progression kidney endpoints, suggesting that therapies added to RAAS inhibitors and dapagliflozin may be required to sustain kidney and cardiovascular health. Clinical trial registry name and registration number: A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients with Chronic Kidney Disease (DAPA-CKD), NCT03036150. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology...
患有或未患有 2 型糖尿病的慢性肾脏病和白蛋白尿患者。方法在这项 DAPA-CKD 试验的事后分析中,4304 名成年 CKD 患者被随机分配到达帕格列净 10 毫克或安慰剂中,作为最大耐受量肾素-血管紧张素系统 (RAAS) 抑制剂的辅助用药。主要终点是估计肾小球滤过率持续下降≥50%、肾衰竭或死于肾脏或心血管原因的复合终点。肾脏综合终点类似,但不包括心血管死亡。我们使用 Cox 比例危险回归分析评估了基线白蛋白尿、白蛋白尿早期变化(基线至第 4 个月)和残留白蛋白尿(第 4 个月)与主要复合终点和肾脏复合终点之间的关系。研究结果与安慰剂相比,达帕格列净可使2型糖尿病患者和非2型糖尿病患者的尿白蛋白与肌酐比值(UACR;基线至第4个月)分别降低36%(95% CI:30.2%,42.5%)和21%(95% CI:12%,30%)(p-交互作用:0.02)。从基线到第 4 个月,UACR 的降低与主要终点和肾脏综合终点风险的降低相关,2 型糖尿病患者和非 2 型糖尿病患者的风险梯度相似(p-交互作用:分别为 0.10 和 0.19)。在每个治疗组中,残留白蛋白尿与主要终点和肾脏综合终点的风险相似(p-交互作用:分别为0.19和0.18)。结论达帕格列净降低了白蛋白尿,而且白蛋白尿降低的幅度显示,2型糖尿病患者和非2型糖尿病患者的主要终点和肾脏综合终点的风险降低比例相似。第4个月时仍有白蛋白尿的患者,无论是随机接受达帕格列净治疗还是安慰剂治疗,其慢性肾功能衰竭进展肾脏终点的发生率都相对较高,这表明可能需要在RAAS抑制剂和达帕格列净治疗的基础上增加其他疗法,以维持肾脏和心血管健康。临床试验登记处名称和登记号:评估达帕格列净对慢性肾脏病患者肾脏预后和心血管死亡率影响的研究(DAPA-CKD),NCT03036150。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 代表美国肾脏病学会出版...
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Clinical Journal of the American Society of Nephrology
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