Pub Date : 2022-11-03DOI: 10.3390/kidneydial2040052
H. Swa, B. Fernando, Shakila Premarathna, Asfa Alli-Shaik, Z. Badurdeen, Jayantha Gunarathna, N. Nanayakkara
Background: A chronic interstitial disease, chronic kidney disease of uncertain etiology (CKDu), has emerged as a notable contributor to the CKD burden in rural Sri Lanka. Most therapeutic and diagnostic approaches to CKD focus on glomerular diseases, and thus are not fully applicable to CKDu. Serum proteins, specifically those with the profile of markers representing different facets of a disease, are beneficial for a comprehensive evaluation of diseases, and hence in CKD. Our aim was to identify the role of serum-retinol-binding protein 4 (RBP4), a marker of the proximal tubule, in the diagnosis of CKDu. Methods: Definite CKDu cases were recruited from the renal clinic in Girandurukotte and Wilgamuwa (endemic regions). Healthy controls were recruited from Mandaramnuwara (nonendemic area). The levels of RBP4 and creatinine in serum were measured. An immunoassay (ELISA) was performed on the serum samples. The stages of CKD/ CKDu were classified according to eGFR. Results: Serum RBP4 was significantly increased in CKDu patients compared to CKD patients and healthy controls. The results show that the ratio of normalized serum RBP4 to serum creatine (S.cr) acts as a better competitive marker for CKDu (AUC 0.762, sensitivity 0.733) than CKD (AUC 0.584, sensitivity 0.733) when compared against healthy controls. Furthermore, the RBP4:S.cr ratio showed higher discriminating power (AUC 0.743) between CKDu and CKD, suggesting that the RBP4: S.cr ratio has potential as a serum marker to differentiate CKDu from CKDu. Conclusion: The RBP4: S.cr ratio was identified as a plausible indicator for differentiating CKDu from CKD with >70% sensitivity and specificity. Therefore, it could be used in the evaluation of the tubular interstitial involvement of CKD.
{"title":"Evaluating Serum RBP4 as an Auxiliary Biomarker for CKDu Diagnosis","authors":"H. Swa, B. Fernando, Shakila Premarathna, Asfa Alli-Shaik, Z. Badurdeen, Jayantha Gunarathna, N. Nanayakkara","doi":"10.3390/kidneydial2040052","DOIUrl":"https://doi.org/10.3390/kidneydial2040052","url":null,"abstract":"Background: A chronic interstitial disease, chronic kidney disease of uncertain etiology (CKDu), has emerged as a notable contributor to the CKD burden in rural Sri Lanka. Most therapeutic and diagnostic approaches to CKD focus on glomerular diseases, and thus are not fully applicable to CKDu. Serum proteins, specifically those with the profile of markers representing different facets of a disease, are beneficial for a comprehensive evaluation of diseases, and hence in CKD. Our aim was to identify the role of serum-retinol-binding protein 4 (RBP4), a marker of the proximal tubule, in the diagnosis of CKDu. Methods: Definite CKDu cases were recruited from the renal clinic in Girandurukotte and Wilgamuwa (endemic regions). Healthy controls were recruited from Mandaramnuwara (nonendemic area). The levels of RBP4 and creatinine in serum were measured. An immunoassay (ELISA) was performed on the serum samples. The stages of CKD/ CKDu were classified according to eGFR. Results: Serum RBP4 was significantly increased in CKDu patients compared to CKD patients and healthy controls. The results show that the ratio of normalized serum RBP4 to serum creatine (S.cr) acts as a better competitive marker for CKDu (AUC 0.762, sensitivity 0.733) than CKD (AUC 0.584, sensitivity 0.733) when compared against healthy controls. Furthermore, the RBP4:S.cr ratio showed higher discriminating power (AUC 0.743) between CKDu and CKD, suggesting that the RBP4: S.cr ratio has potential as a serum marker to differentiate CKDu from CKDu. Conclusion: The RBP4: S.cr ratio was identified as a plausible indicator for differentiating CKDu from CKD with >70% sensitivity and specificity. Therefore, it could be used in the evaluation of the tubular interstitial involvement of CKD.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43646592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.3390/kidneydial2040050
M. Eldehni, Lisa E. Crowley, N. Selby
Diabetes mellitus is the leading cause of end-stage kidney disease in many countries. The management of diabetic patients who receive dialysis can be challenging. Diabetic dialysis patients have higher rates of cardiovascular events and mortality due to metabolic factors and accelerated vascular calcification. Diabetic haemodialysis patients have high rates of haemodynamic instability which leads to organ ischaemia and end organ damage; autonomic dysfunction seems to play an important role in haemodynamic instability and abnormal organ perfusion during haemodialysis. Poor glycaemic control contributes to fluid overload and worse cardiovascular outcome. Xerostomia and thirst are the main drivers for fluid overload in haemodialysis patients and in peritoneal dialysis a chronic state of hyperhydration that is related to absorption of glucose from the PD fluids, protein loss and malnutrition contributes to fluid overload. Glycaemic control is of great importance and adjustments to diabetic agents are required. In haemodialysis, a reduction in insulin dose is recommended to avoid hypoglycaemia whereas in peritoneal dialysis an increase in insulin dose is often required. Foot ulcers and infection are more common in diabetic dialysis patients compared to non-diabetic dialysis patients or diabetic patients with normal renal function and regular surveillance for early identification is important. Ultimately, a multi-disciplinary approach which includes diabetologist, nephrologist, dietitians, microbiologist, vascular surgeon, interventional radiologist is required to address the complicated aspects of diabetic patient care on dialysis.
{"title":"Challenges in Management of Diabetic Patient on Dialysis","authors":"M. Eldehni, Lisa E. Crowley, N. Selby","doi":"10.3390/kidneydial2040050","DOIUrl":"https://doi.org/10.3390/kidneydial2040050","url":null,"abstract":"Diabetes mellitus is the leading cause of end-stage kidney disease in many countries. The management of diabetic patients who receive dialysis can be challenging. Diabetic dialysis patients have higher rates of cardiovascular events and mortality due to metabolic factors and accelerated vascular calcification. Diabetic haemodialysis patients have high rates of haemodynamic instability which leads to organ ischaemia and end organ damage; autonomic dysfunction seems to play an important role in haemodynamic instability and abnormal organ perfusion during haemodialysis. Poor glycaemic control contributes to fluid overload and worse cardiovascular outcome. Xerostomia and thirst are the main drivers for fluid overload in haemodialysis patients and in peritoneal dialysis a chronic state of hyperhydration that is related to absorption of glucose from the PD fluids, protein loss and malnutrition contributes to fluid overload. Glycaemic control is of great importance and adjustments to diabetic agents are required. In haemodialysis, a reduction in insulin dose is recommended to avoid hypoglycaemia whereas in peritoneal dialysis an increase in insulin dose is often required. Foot ulcers and infection are more common in diabetic dialysis patients compared to non-diabetic dialysis patients or diabetic patients with normal renal function and regular surveillance for early identification is important. Ultimately, a multi-disciplinary approach which includes diabetologist, nephrologist, dietitians, microbiologist, vascular surgeon, interventional radiologist is required to address the complicated aspects of diabetic patient care on dialysis.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48851546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-20DOI: 10.3390/kidneydial2040049
J. C. De La Flor Merino, Jacqueline Apaza Chávez, Francisco Valga Amado, Francisco Díaz Crespo, P. Justo Avila, A. Marschall, Michael Cieza Terrones, Patricia Núñez Ramos, E. Ruiz Cícero
Crescentic IgA nephropathy (IgAN) with rapidly progressive glomerulonephritis (RPGN) is often associated with rapidly declining kidney function. Up to this date, specific therapy for crescentic IgAN is still unknown. Accumulating evidence suggests that sodium-glucose co-transporter-2 inhibitors (SGLT-2i) may have a role in standard therapy of glomerular diseases. However, it is unclear at what point in the natural history of specific glomerular diseases SGLT-2i can be beneficial. We report the clinical and histological features of a patient with crescentic IgAN that presented as an RPGN, who received intensive immunosuppression and renal replacement therapeutic (RRT). At the third month, the patient presented with significant improvement in his kidney function. At that point, we decided to start dapagliflozin in addition to his renin-angiotensin system (RAS) blocker, basing our decision on its proven renal benefits such as slowing the rate of decline in kidney function and reducing albuminuria. At the eighth month, the patient’s renal function gradually improved from serum Cr of 6.07 to 2.1 mg/dL; and urine albumin to creatinine ratio (UACR) declined from 5655 mg/g to 200 mg/g. The use of SGLT-2i in primary and secondary nondiabetic glomerular disease appears promising. It is crucial and necessary to accumulate more evidence for a more complete understanding of the mechanisms of the actions of SGLT-2i in non-diabetic glomerular disease.
{"title":"Remission of Proteinuria in a Patient Affected by Crescentic IgA Nephropathy with Rapidly Progressive Glomerulonephritis Treated by Sodium-Glucose Cotransporter-2 Inhibitors: Casual or Causal Relationship?","authors":"J. C. De La Flor Merino, Jacqueline Apaza Chávez, Francisco Valga Amado, Francisco Díaz Crespo, P. Justo Avila, A. Marschall, Michael Cieza Terrones, Patricia Núñez Ramos, E. Ruiz Cícero","doi":"10.3390/kidneydial2040049","DOIUrl":"https://doi.org/10.3390/kidneydial2040049","url":null,"abstract":"Crescentic IgA nephropathy (IgAN) with rapidly progressive glomerulonephritis (RPGN) is often associated with rapidly declining kidney function. Up to this date, specific therapy for crescentic IgAN is still unknown. Accumulating evidence suggests that sodium-glucose co-transporter-2 inhibitors (SGLT-2i) may have a role in standard therapy of glomerular diseases. However, it is unclear at what point in the natural history of specific glomerular diseases SGLT-2i can be beneficial. We report the clinical and histological features of a patient with crescentic IgAN that presented as an RPGN, who received intensive immunosuppression and renal replacement therapeutic (RRT). At the third month, the patient presented with significant improvement in his kidney function. At that point, we decided to start dapagliflozin in addition to his renin-angiotensin system (RAS) blocker, basing our decision on its proven renal benefits such as slowing the rate of decline in kidney function and reducing albuminuria. At the eighth month, the patient’s renal function gradually improved from serum Cr of 6.07 to 2.1 mg/dL; and urine albumin to creatinine ratio (UACR) declined from 5655 mg/g to 200 mg/g. The use of SGLT-2i in primary and secondary nondiabetic glomerular disease appears promising. It is crucial and necessary to accumulate more evidence for a more complete understanding of the mechanisms of the actions of SGLT-2i in non-diabetic glomerular disease.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47407088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-17DOI: 10.3390/kidneydial2040048
Preeti Chandra, A. Haririan, C. Drachenberg
Acute kidney injury (AKI) in the setting of hypothyroidism has been documented in the literature. However, hypothyroidism is not generally considered a cause during investigation of an acute kidney injury. Most of the cases described have been reported in setting of rhabdomyolysis, while fewer cases describe AKI occurring in the absence of rhabdomyolysis. Only rarely have case reports been supplemented by renal biopsy findings to ensure other etiologies of acute kidney injury were ruled out, and none of these reports have documented changes in the kidney that could be associated with the hypothyroid state. We report a case of AKI in chronic kidney disease in the absence of rhabdomyolysis, occurring during severe hypothyroidism, that resolved completely after achievement of a euthyroid state. In addition, we provide renal biopsy findings likely associated with the hypothyroid state. We propose that evaluation of the thyroid function should be considered in any patient during evaluation of an acute kidney injury.
{"title":"Acute Kidney Injury and Hypothyroidism in a Patient with CKD","authors":"Preeti Chandra, A. Haririan, C. Drachenberg","doi":"10.3390/kidneydial2040048","DOIUrl":"https://doi.org/10.3390/kidneydial2040048","url":null,"abstract":"Acute kidney injury (AKI) in the setting of hypothyroidism has been documented in the literature. However, hypothyroidism is not generally considered a cause during investigation of an acute kidney injury. Most of the cases described have been reported in setting of rhabdomyolysis, while fewer cases describe AKI occurring in the absence of rhabdomyolysis. Only rarely have case reports been supplemented by renal biopsy findings to ensure other etiologies of acute kidney injury were ruled out, and none of these reports have documented changes in the kidney that could be associated with the hypothyroid state. We report a case of AKI in chronic kidney disease in the absence of rhabdomyolysis, occurring during severe hypothyroidism, that resolved completely after achievement of a euthyroid state. In addition, we provide renal biopsy findings likely associated with the hypothyroid state. We propose that evaluation of the thyroid function should be considered in any patient during evaluation of an acute kidney injury.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43303959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-13DOI: 10.3390/kidneydial2040047
C. McIntyre
The choice of dialysate sodium concentration remains amongst the most crucial and difficult to address challenges, in the care of hemodialysis (HD) patients. Our understanding of the determinants of sodium transport, as well as the consequences of getting the decisions wrong, remains both imperfect and evolving. This question has been subject to far less study than it deserves. In this short piece we consider what we are trying to achieve with dialysate sodium choices and how best to individualize those choices to address the symptomatic and survival-based needs of our patients.
{"title":"Choice of the Optimal Dialysate Sodium Concentration","authors":"C. McIntyre","doi":"10.3390/kidneydial2040047","DOIUrl":"https://doi.org/10.3390/kidneydial2040047","url":null,"abstract":"The choice of dialysate sodium concentration remains amongst the most crucial and difficult to address challenges, in the care of hemodialysis (HD) patients. Our understanding of the determinants of sodium transport, as well as the consequences of getting the decisions wrong, remains both imperfect and evolving. This question has been subject to far less study than it deserves. In this short piece we consider what we are trying to achieve with dialysate sodium choices and how best to individualize those choices to address the symptomatic and survival-based needs of our patients.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49324185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-11DOI: 10.3390/kidneydial2040046
J. Kopple, M. Ekramzadeh
This paper is a synopsis of an invited lecture entitled, The Future of Renal Nutrition, that was presented at the Japanese Society of Dialysis Therapy, July 2022. The purpose of this presentation is to suggest some of the advances in the field of renal nutrition that the authors think are likely to occur during the next several years. There will be continued development of methods for precisely diagnosing and classifying protein-energy wasting and developing methods to treat this disorder. Why weight loss commonly occurs when the GFR decreases to about 30–35 mL/min/1.73 m2 and why substantial weight loss (>5%/year) is associated with increased mortality will be investigated. Clinical consequences of the interactions between gut microbiota, nutrient intake and other environmental influences will continue to be examined. The clinical value of diets high in fruits and vegetables or other plants for chronic kidney disease (CKD) patients will continue to be studied. Our knowledge of how different diets and medicines affect intestinal absorption, metabolism and excretion of nutrients will expand. Precision medicine will be extended to precision nutrition. There will be more focus on the effects of nutritional disorders and dietary treatment on the emotional status and quality of life of people with kidney disease and their families. Nutritional centers that provide centralized nutritional assessment and dietary counselling for CKD patients may develop in more urban centers. More clinical trials will be conducted to test whether nutritional management improves clinical outcomes in people with kidney disease. It is hoped that the foregoing comments will encourage more research on these topics.
{"title":"Renal Nutrition—Where It Has Been and Where It Is Going","authors":"J. Kopple, M. Ekramzadeh","doi":"10.3390/kidneydial2040046","DOIUrl":"https://doi.org/10.3390/kidneydial2040046","url":null,"abstract":"This paper is a synopsis of an invited lecture entitled, The Future of Renal Nutrition, that was presented at the Japanese Society of Dialysis Therapy, July 2022. The purpose of this presentation is to suggest some of the advances in the field of renal nutrition that the authors think are likely to occur during the next several years. There will be continued development of methods for precisely diagnosing and classifying protein-energy wasting and developing methods to treat this disorder. Why weight loss commonly occurs when the GFR decreases to about 30–35 mL/min/1.73 m2 and why substantial weight loss (>5%/year) is associated with increased mortality will be investigated. Clinical consequences of the interactions between gut microbiota, nutrient intake and other environmental influences will continue to be examined. The clinical value of diets high in fruits and vegetables or other plants for chronic kidney disease (CKD) patients will continue to be studied. Our knowledge of how different diets and medicines affect intestinal absorption, metabolism and excretion of nutrients will expand. Precision medicine will be extended to precision nutrition. There will be more focus on the effects of nutritional disorders and dietary treatment on the emotional status and quality of life of people with kidney disease and their families. Nutritional centers that provide centralized nutritional assessment and dietary counselling for CKD patients may develop in more urban centers. More clinical trials will be conducted to test whether nutritional management improves clinical outcomes in people with kidney disease. It is hoped that the foregoing comments will encourage more research on these topics.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44786878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-13DOI: 10.3390/kidneydial2030044
P. Monciino, L. Magagnoli, E. Fasulo, Michela Frittoli, Chiara Leotta, Hoang Nhat Pham, A. Stucchi, P. Ciceri, A. Galassi, M. Cozzolino
Background. Secondary hyperparathyroidism (SHPT) is a major risk factor for cardiovascular events and all-cause mortality in hemodialysis (HD) patients. The purpose of our study was to evaluate the effects and tolerability of etelcalcetide in HD patients with SHPT. Methods. An observational study was conducted on 16 hemodialysis patients with SHPT treated with etelcalcetide. All patients were followed up for a duration of 6 months. The primary endpoints were the reduction in mean PTH ≥ 30% and ≥40% from baseline after 6 months of etelcalcetide. All patients were divided into two groups (group A versus group B) based on baseline serum PTH level prior to etelcalcetide: above and below the median serum PTH (1300 pg/mL), respectively. Results. After 6 months, a significant decrease in PTH levels was achieved by all patients receiving etelcalcetide (p = 0.015). Both primary endpoint of reduction in PTH ≥ 40% at 6 months (p = 0.01), and the secondary endpoint of reduction in median PTH values (p = 0.0001) and median percentage reduction in PTH values (p = 0.009) were significantly achieved in group A. In contrast, a greater decline of calcium (p = 0.028) and phosphorus was reached in group B than group A. Dialysis vintage ≥ 36 months, arteriovenous fistula (AVF)-based hemodialysis, post-diluition hemodiafiltration (HDF) method, and baseline values of PTH < 1300 pg/mL can positively influence the achievement of the endpoints. Furthermore, the baseline PTH < 1300 pg/mL, among these variables, was the only one showing statistically significant relevance (OR 2.28, 95% CI 1.32–3.96, p = 0.015). The history of cinacalcet use negatively correlated with the possibility to reach therapeutic targets with etelcalcetide (OR 0.47, 95% CI 0.26–0.85, p = 0.031). Treatment with etelcalcetide was well tolerated and no adverse effects were observed. Conclusions. In our study, patients with low baseline PTH levels showed a better response to etelcalcetide than patients with higher PTH levels. Consequently, the possibility to reach desirable therapeutic targets could depend on SHPT severity at the time of initiation of therapy.
背景。继发性甲状旁腺功能亢进(SHPT)是血液透析(HD)患者心血管事件和全因死亡率的主要危险因素。本研究的目的是评估依替卡肽对伴有SHPT的HD患者的疗效和耐受性。方法。对16例血液透析合并SHPT患者应用依替卡肽进行观察性研究。所有患者随访6个月。主要终点是使用依替卡肽6个月后平均PTH较基线降低≥30%和≥40%。所有患者根据使用替替卡肽前的基线血清PTH水平分为两组(A组和B组):分别高于和低于血清PTH中位数(1300 pg/mL)。结果。6个月后，所有接受依替卡肽治疗的患者PTH水平均显著下降(p = 0.015)。a组6个月时PTH降低≥40%的主要终点(p = 0.01)，以及PTH中位值降低(p = 0.0001)和PTH中位值降低百分比(p = 0.009)的次要终点均显著达到。相比而言，B组钙和磷的下降幅度更大(p = 0.028)，透析时间≥36个月，基于动静脉瘘(AVF)的血液透析，稀释后血液滤过(HDF)方法，PTH基线值< 1300 pg/mL对终点的实现有正向影响。此外，基线PTH < 1300 pg/mL是这些变量中唯一具有统计学意义的相关性(OR 2.28, 95% CI 1.32-3.96, p = 0.015)。依替卡肽的使用史与依替卡肽达到治疗目标的可能性呈负相关(OR 0.47, 95% CI 0.26-0.85, p = 0.031)。依替卡肽治疗耐受性良好，无不良反应。结论。在我们的研究中，基线PTH水平较低的患者比PTH水平较高的患者对依替卡肽的反应更好。因此，达到理想治疗目标的可能性取决于治疗开始时SHPT的严重程度。
{"title":"Efficacy and Safety of Etelcalcetide in Hemodialysis Patients with Moderate to Severe Secondary Hyperparathyroidism","authors":"P. Monciino, L. Magagnoli, E. Fasulo, Michela Frittoli, Chiara Leotta, Hoang Nhat Pham, A. Stucchi, P. Ciceri, A. Galassi, M. Cozzolino","doi":"10.3390/kidneydial2030044","DOIUrl":"https://doi.org/10.3390/kidneydial2030044","url":null,"abstract":"Background. Secondary hyperparathyroidism (SHPT) is a major risk factor for cardiovascular events and all-cause mortality in hemodialysis (HD) patients. The purpose of our study was to evaluate the effects and tolerability of etelcalcetide in HD patients with SHPT. Methods. An observational study was conducted on 16 hemodialysis patients with SHPT treated with etelcalcetide. All patients were followed up for a duration of 6 months. The primary endpoints were the reduction in mean PTH ≥ 30% and ≥40% from baseline after 6 months of etelcalcetide. All patients were divided into two groups (group A versus group B) based on baseline serum PTH level prior to etelcalcetide: above and below the median serum PTH (1300 pg/mL), respectively. Results. After 6 months, a significant decrease in PTH levels was achieved by all patients receiving etelcalcetide (p = 0.015). Both primary endpoint of reduction in PTH ≥ 40% at 6 months (p = 0.01), and the secondary endpoint of reduction in median PTH values (p = 0.0001) and median percentage reduction in PTH values (p = 0.009) were significantly achieved in group A. In contrast, a greater decline of calcium (p = 0.028) and phosphorus was reached in group B than group A. Dialysis vintage ≥ 36 months, arteriovenous fistula (AVF)-based hemodialysis, post-diluition hemodiafiltration (HDF) method, and baseline values of PTH < 1300 pg/mL can positively influence the achievement of the endpoints. Furthermore, the baseline PTH < 1300 pg/mL, among these variables, was the only one showing statistically significant relevance (OR 2.28, 95% CI 1.32–3.96, p = 0.015). The history of cinacalcet use negatively correlated with the possibility to reach therapeutic targets with etelcalcetide (OR 0.47, 95% CI 0.26–0.85, p = 0.031). Treatment with etelcalcetide was well tolerated and no adverse effects were observed. Conclusions. In our study, patients with low baseline PTH levels showed a better response to etelcalcetide than patients with higher PTH levels. Consequently, the possibility to reach desirable therapeutic targets could depend on SHPT severity at the time of initiation of therapy.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47208272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-09DOI: 10.3390/kidneydial2030043
Kunihiro Nakai, H. Segawa, M. Yashiro, Kengo Yoshii, T. Kusaba, S. Matoba, K. Tamagaki, T. Hatta, Hiroshi Kado
A discrepancy between serum concentrations of cystatin C (CysC) and creatinine (sCr) has been reported in patients with acute obstructive nephropathy. However, the usefulness of CysC for predicting the recovery of kidney function in patients with severe obstructive nephropathy remains unclear. We examined the predictability of the estimated glomerular filtration rate calculated with CysC or sCr (eGFRcys or eGFRcreat) for the post-treatment recovery of kidney function. We retrospectively collected patients with severe obstructive nephropathy (eGFRcreat < 30 mL/min/1.73 m2) whose baseline sCr and CysC were measured between 48 h before and 24 h after the release of urinary tract obstruction (UTO). The primary outcome was recovery from severe eGFRcreat depression (i.e., eGFRcreat ≥ 30 mL/min/1.73 m2) 7 days after the release of UTO. We calculated the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the relationship between eGFRcys or eGFRcreat and recovery. Thirty-four patients (20 males) with a median age of 76 years were eligible. We identified 20 recovery cases. The AUCs of the ROC curves (95% confidence interval) for eGFRcys and eGFRcreat were 0.81 (0.66–0.96) and 0.53 (0.32–0.73), respectively. These results imply cystatin C-based eGFR may help predict kidney prognosis in patients with severe obstructive nephropathy.
{"title":"Cystatin C-Based eGFR Predicts Post-Treatment Kidney Prognosis in Patients with Severe Obstructive Nephropathy","authors":"Kunihiro Nakai, H. Segawa, M. Yashiro, Kengo Yoshii, T. Kusaba, S. Matoba, K. Tamagaki, T. Hatta, Hiroshi Kado","doi":"10.3390/kidneydial2030043","DOIUrl":"https://doi.org/10.3390/kidneydial2030043","url":null,"abstract":"A discrepancy between serum concentrations of cystatin C (CysC) and creatinine (sCr) has been reported in patients with acute obstructive nephropathy. However, the usefulness of CysC for predicting the recovery of kidney function in patients with severe obstructive nephropathy remains unclear. We examined the predictability of the estimated glomerular filtration rate calculated with CysC or sCr (eGFRcys or eGFRcreat) for the post-treatment recovery of kidney function. We retrospectively collected patients with severe obstructive nephropathy (eGFRcreat < 30 mL/min/1.73 m2) whose baseline sCr and CysC were measured between 48 h before and 24 h after the release of urinary tract obstruction (UTO). The primary outcome was recovery from severe eGFRcreat depression (i.e., eGFRcreat ≥ 30 mL/min/1.73 m2) 7 days after the release of UTO. We calculated the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the relationship between eGFRcys or eGFRcreat and recovery. Thirty-four patients (20 males) with a median age of 76 years were eligible. We identified 20 recovery cases. The AUCs of the ROC curves (95% confidence interval) for eGFRcys and eGFRcreat were 0.81 (0.66–0.96) and 0.53 (0.32–0.73), respectively. These results imply cystatin C-based eGFR may help predict kidney prognosis in patients with severe obstructive nephropathy.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45632464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-11DOI: 10.3390/kidneydial2030042
F. Lamine, M. Pruijm, Virginie Bahon, A. Zanchi
Patients with type 2 diabetes (T2D) and end-stage kidney disease (ESKD) on renal replacement therapy represent a specific population with high morbidity and mortality, an increased risk of hypoglycemic episodes and large intra- and interdialysis glycemic variability. Antidiabetic treatment adjustment is therefore challenging, especially in insulin-treated patients. Continuous glucose monitoring (CGM) is increasingly proposed to T2D patients on hemodialysis (HD), although data regarding flash monitoring systems (FMSs) and real-time CGM (rtCGM) in HD patients are limited. Small CGM pilot studies of a short duration demonstrated improvements in glycemic control and decreased hypoglycemic events, despite a lower accuracy of CGM as compared to capillary blood glucose. Moreover, CGM–drug interactions with vitamin C, mannitol and paracetamol can occur in HD diabetic patients and need further study. Despite these shortcomings, professional CGM has the potential to become an integral part of glucose monitoring of HD patients treated with insulin. Personal CGM prescriptions can especially be useful in highly selected, motivated T2D HD patients on multiple daily insulin injections or experiencing frequent hypoglycemia with preserved diabetes self-management abilities or in whom diabetes is fully managed by medical providers. A close collaboration between the clinical staff working on HD units and diabetology teams, and ongoing patient education, are mandatory for optimal use of CGM.
{"title":"What Nephrologists should Know about the Use of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus Patients on Chronic Hemodialysis","authors":"F. Lamine, M. Pruijm, Virginie Bahon, A. Zanchi","doi":"10.3390/kidneydial2030042","DOIUrl":"https://doi.org/10.3390/kidneydial2030042","url":null,"abstract":"Patients with type 2 diabetes (T2D) and end-stage kidney disease (ESKD) on renal replacement therapy represent a specific population with high morbidity and mortality, an increased risk of hypoglycemic episodes and large intra- and interdialysis glycemic variability. Antidiabetic treatment adjustment is therefore challenging, especially in insulin-treated patients. Continuous glucose monitoring (CGM) is increasingly proposed to T2D patients on hemodialysis (HD), although data regarding flash monitoring systems (FMSs) and real-time CGM (rtCGM) in HD patients are limited. Small CGM pilot studies of a short duration demonstrated improvements in glycemic control and decreased hypoglycemic events, despite a lower accuracy of CGM as compared to capillary blood glucose. Moreover, CGM–drug interactions with vitamin C, mannitol and paracetamol can occur in HD diabetic patients and need further study. Despite these shortcomings, professional CGM has the potential to become an integral part of glucose monitoring of HD patients treated with insulin. Personal CGM prescriptions can especially be useful in highly selected, motivated T2D HD patients on multiple daily insulin injections or experiencing frequent hypoglycemia with preserved diabetes self-management abilities or in whom diabetes is fully managed by medical providers. A close collaboration between the clinical staff working on HD units and diabetology teams, and ongoing patient education, are mandatory for optimal use of CGM.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43048223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-05DOI: 10.3390/kidneydial2030041
R. Vanholder
The greenhouse effect of carbon dioxide, nitrous oxide, and methane release resulted in an exponential rise of land temperatures over the last decades [...]
二氧化碳、一氧化二氮和甲烷释放的温室效应导致过去几十年陆地温度呈指数级上升〔…〕
{"title":"Green Nephrology","authors":"R. Vanholder","doi":"10.3390/kidneydial2030041","DOIUrl":"https://doi.org/10.3390/kidneydial2030041","url":null,"abstract":"The greenhouse effect of carbon dioxide, nitrous oxide, and methane release resulted in an exponential rise of land temperatures over the last decades [...]","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45642714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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