Pub Date : 2022-06-02DOI: 10.3390/kidneydial2020028
Ken Tsuchiya
The 67th Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT) was held in Yokohama City from 1 to3 July, 2022 [...]
第67届日本透析治疗学会(JSDT)年会于2022年7月1日至3日在横滨市举行[…]
{"title":"Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022","authors":"Ken Tsuchiya","doi":"10.3390/kidneydial2020028","DOIUrl":"https://doi.org/10.3390/kidneydial2020028","url":null,"abstract":"The 67th Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT) was held in Yokohama City from 1 to3 July, 2022 [...]","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45023339","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 : 2022-06-02DOI: 10.3390/kidneydial2020027
A. King, K. Wilund
Hemodialysis patients typically have extremely low physical activity levels, which contributes to poor physical function and quality of life (QOL). Numerous studies show that exercise, intradialytic cycling in particular, may improve physical and cardiovascular function and QOL. But there are also significant inconsistencies in the literature, and the benefits in many studies are modest. This may be due in part to methodological limitations in intradialytic cycling trials, including small sample sizes, short interventions, low volume, and intensity of exercise prescriptions, and/or low retention and protocol adherence rates. The goal of this review is twofold. First, we summarize the current literature on intradialytic cycling in HD patients, highlighting benefits and concerns noted in several recently published trials that were among the most robust and clinically relevant trials conducted to date. Second, we will consider strategies for moving forward with exercise and physical activity interventions in HD, including promoting intradialytic cycling as a core component of a more patient-centric and comprehensive strategy that helps progress patients towards standard physical activity guidelines. We urge researchers and exercise professionals to consider intradialytic cycling as a valuable component of a comprehensive patient-centered, lifestyle intervention, as opposed to a stand-alone exercise prescription.
{"title":"Next Steps for Intradialytic Cycling Research","authors":"A. King, K. Wilund","doi":"10.3390/kidneydial2020027","DOIUrl":"https://doi.org/10.3390/kidneydial2020027","url":null,"abstract":"Hemodialysis patients typically have extremely low physical activity levels, which contributes to poor physical function and quality of life (QOL). Numerous studies show that exercise, intradialytic cycling in particular, may improve physical and cardiovascular function and QOL. But there are also significant inconsistencies in the literature, and the benefits in many studies are modest. This may be due in part to methodological limitations in intradialytic cycling trials, including small sample sizes, short interventions, low volume, and intensity of exercise prescriptions, and/or low retention and protocol adherence rates. The goal of this review is twofold. First, we summarize the current literature on intradialytic cycling in HD patients, highlighting benefits and concerns noted in several recently published trials that were among the most robust and clinically relevant trials conducted to date. Second, we will consider strategies for moving forward with exercise and physical activity interventions in HD, including promoting intradialytic cycling as a core component of a more patient-centric and comprehensive strategy that helps progress patients towards standard physical activity guidelines. We urge researchers and exercise professionals to consider intradialytic cycling as a valuable component of a comprehensive patient-centered, lifestyle intervention, as opposed to a stand-alone exercise prescription.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44087306","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 : 2022-06-01Epub Date: 2022-06-18DOI: 10.3390/kidneydial2020032
Yuji Oe, Volker Vallon
SGLT2 inhibitors can protect the kidneys of patients with and without type 2 diabetes mellitus and slow the progression towards end-stage kidney disease. Blocking tubular SGLT2 and spilling glucose into the urine, which triggers a metabolic counter-regulation similar to fasting, provides unique benefits, not only as an anti-hyperglycemic strategy. These include a low hypoglycemia risk and a shift from carbohydrate to lipid utilization and mild ketogenesis, thereby reducing body weight and providing an additional energy source. SGLT2 inhibitors counteract hyperreabsorption in the early proximal tubule, which acutely lowers glomerular pressure and filtration and thereby reduces the physical stress on the filtration barrier, the filtration of tubule-toxic compounds, and the oxygen demand for tubular reabsorption. This improves cortical oxygenation, which, together with lesser tubular gluco-toxicity and improved mitochondrial function and autophagy, can reduce pro-inflammatory, pro-senescence, and pro-fibrotic signaling and preserve tubular function and GFR in the long-term. By shifting transport downstream, SGLT2 inhibitors more equally distribute the transport burden along the nephron and may mimic systemic hypoxia to stimulate erythropoiesis, which improves oxygen delivery to the kidney and other organs. SGLT1 inhibition improves glucose homeostasis by delaying intestinal glucose absorption and by increasing the release of gastrointestinal incretins. Combined SGLT1 and SGLT2 inhibition has additive effects on renal glucose excretion and blood glucose control. SGLT1 in the macula densa senses luminal glucose, which affects glomerular hemodynamics and has implications for blood pressure control. More studies are needed to better define the therapeutic potential of SGLT1 inhibition to protect the kidney, alone or in combination with SGLT2 inhibition.
{"title":"The Pathophysiological Basis of Diabetic Kidney Protection by Inhibition of SGLT2 and SGLT1.","authors":"Yuji Oe, Volker Vallon","doi":"10.3390/kidneydial2020032","DOIUrl":"https://doi.org/10.3390/kidneydial2020032","url":null,"abstract":"<p><p>SGLT2 inhibitors can protect the kidneys of patients with and without type 2 diabetes mellitus and slow the progression towards end-stage kidney disease. Blocking tubular SGLT2 and spilling glucose into the urine, which triggers a metabolic counter-regulation similar to fasting, provides unique benefits, not only as an anti-hyperglycemic strategy. These include a low hypoglycemia risk and a shift from carbohydrate to lipid utilization and mild ketogenesis, thereby reducing body weight and providing an additional energy source. SGLT2 inhibitors counteract hyperreabsorption in the early proximal tubule, which acutely lowers glomerular pressure and filtration and thereby reduces the physical stress on the filtration barrier, the filtration of tubule-toxic compounds, and the oxygen demand for tubular reabsorption. This improves cortical oxygenation, which, together with lesser tubular gluco-toxicity and improved mitochondrial function and autophagy, can reduce pro-inflammatory, pro-senescence, and pro-fibrotic signaling and preserve tubular function and GFR in the long-term. By shifting transport downstream, SGLT2 inhibitors more equally distribute the transport burden along the nephron and may mimic systemic hypoxia to stimulate erythropoiesis, which improves oxygen delivery to the kidney and other organs. SGLT1 inhibition improves glucose homeostasis by delaying intestinal glucose absorption and by increasing the release of gastrointestinal incretins. Combined SGLT1 and SGLT2 inhibition has additive effects on renal glucose excretion and blood glucose control. SGLT1 in the macula densa senses luminal glucose, which affects glomerular hemodynamics and has implications for blood pressure control. More studies are needed to better define the therapeutic potential of SGLT1 inhibition to protect the kidney, alone or in combination with SGLT2 inhibition.</p>","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9648862/pdf/nihms-1822153.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40489031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-25DOI: 10.3390/kidneydial2020026
M. Davies, A. Sandoo, J. Macdonald
Chronic Kidney Disease (CKD) is a progressive condition characterised by declining eGFR and associated, particularly in advanced stages, with increased morbidity and cardiovascular mortality. Current treatment options for delaying disease progression are limited to a small number of pharmacological agents. Considering that rates of kidney function decline are greater in patients with lower levels of habitual physical activity, there is interest in the potential benefits of structured exercise training in delaying CKD progression. This discursive review summarises the current state-of-play in this field of research by critically analysing the published systematic reviews of randomised controlled trials of structured exercise training in the non-dialysis CKD population. Several issues are highlighted that hamper definite conclusions as to the therapeutic effectiveness of exercise training for this purpose. However, following an overview of the pathophysiology and risk factors for kidney function decline, several potential mechanisms explaining how exercise training may benefit CKD progression are offered. Finally, suggestions for future research in this area are made. The review concludes that there is a need for further research on the effectiveness of exercise before it can be recommended as part of routine care for the purpose of delaying CKD progression. Exercise can be recommended, however, to individual patients because of a potential benefit to kidney function, and definite benefits to other outcomes such as quality of life, with no apparent evidence of harm.
{"title":"The Role of Exercise Training in Delaying Kidney Function Decline in Non-Dialysis-Dependent Chronic Kidney Disease","authors":"M. Davies, A. Sandoo, J. Macdonald","doi":"10.3390/kidneydial2020026","DOIUrl":"https://doi.org/10.3390/kidneydial2020026","url":null,"abstract":"Chronic Kidney Disease (CKD) is a progressive condition characterised by declining eGFR and associated, particularly in advanced stages, with increased morbidity and cardiovascular mortality. Current treatment options for delaying disease progression are limited to a small number of pharmacological agents. Considering that rates of kidney function decline are greater in patients with lower levels of habitual physical activity, there is interest in the potential benefits of structured exercise training in delaying CKD progression. This discursive review summarises the current state-of-play in this field of research by critically analysing the published systematic reviews of randomised controlled trials of structured exercise training in the non-dialysis CKD population. Several issues are highlighted that hamper definite conclusions as to the therapeutic effectiveness of exercise training for this purpose. However, following an overview of the pathophysiology and risk factors for kidney function decline, several potential mechanisms explaining how exercise training may benefit CKD progression are offered. Finally, suggestions for future research in this area are made. The review concludes that there is a need for further research on the effectiveness of exercise before it can be recommended as part of routine care for the purpose of delaying CKD progression. Exercise can be recommended, however, to individual patients because of a potential benefit to kidney function, and definite benefits to other outcomes such as quality of life, with no apparent evidence of harm.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48199792","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 : 2022-05-20DOI: 10.3390/kidneydial2020025
J. Mayes, H. Young, R. Blacklock, C. Lightfoot, J. Chilcot, A. Nixon
Frailty is highly prevalent within people living with chronic kidney disease (CKD) and is associated with the increased risk of falls, hospitalisation, and mortality. Alongside this, individuals with CKD report a high incidence of depression and reduced quality of life. The identification of frailty within nephrology clinics is needed to establish comprehensive management plans to improve clinical outcomes and quality of life for people with CKD. Current research exploring the role of non-pharmacological management has primarily focussed on exercise and physical activity interventions in the frail CKD population. However, there is a growing evidence base and interest in this area. This review provides an up-to-date overview of the literature into frailty assessment in CKD and subsequent non-pharmacological treatment approaches.
{"title":"Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease","authors":"J. Mayes, H. Young, R. Blacklock, C. Lightfoot, J. Chilcot, A. Nixon","doi":"10.3390/kidneydial2020025","DOIUrl":"https://doi.org/10.3390/kidneydial2020025","url":null,"abstract":"Frailty is highly prevalent within people living with chronic kidney disease (CKD) and is associated with the increased risk of falls, hospitalisation, and mortality. Alongside this, individuals with CKD report a high incidence of depression and reduced quality of life. The identification of frailty within nephrology clinics is needed to establish comprehensive management plans to improve clinical outcomes and quality of life for people with CKD. Current research exploring the role of non-pharmacological management has primarily focussed on exercise and physical activity interventions in the frail CKD population. However, there is a growing evidence base and interest in this area. This review provides an up-to-date overview of the literature into frailty assessment in CKD and subsequent non-pharmacological treatment approaches.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48510561","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 : 2022-05-04DOI: 10.3390/kidneydial2020024
P. Koufaki
Chronic Kidney Disease (CKD) is a global health problem and a significant contributor to mortality, morbidity and disability from non-communicable diseases (NCD). The current consensus amongst researchers in the field of renal rehabilitation and healthcare practitioners involved in the management of people with CKD, is that physical dysfunction and inactivity are severe and prevalent in all ages and CKD stages compared to normative data. The negative impact of CKD on independence is cumulative, and health interventions and policies should target prevention of deterioration of kidney function and its consequences for physical frailty, disability and ultimately, quality of life. Accurate and feasible assessment of physical function is key for supporting the clinical implementation of current clinical care management guidelines. This overview, therefore, presents the rationale and some key scientific evidence to support the recommendation of physical function measurement tools that reflect function limitations for immediate implementation in clinical practice. Measurement property characteristics of the proposed measurement tools are also summarised in order to support health and exercise professionals in selecting the right tool and in interpreting and evaluating the measured outcomes.
{"title":"Assessment of Function Limitations in People with Chronic Kidney Disease for Implementation in Clinical Practice","authors":"P. Koufaki","doi":"10.3390/kidneydial2020024","DOIUrl":"https://doi.org/10.3390/kidneydial2020024","url":null,"abstract":"Chronic Kidney Disease (CKD) is a global health problem and a significant contributor to mortality, morbidity and disability from non-communicable diseases (NCD). The current consensus amongst researchers in the field of renal rehabilitation and healthcare practitioners involved in the management of people with CKD, is that physical dysfunction and inactivity are severe and prevalent in all ages and CKD stages compared to normative data. The negative impact of CKD on independence is cumulative, and health interventions and policies should target prevention of deterioration of kidney function and its consequences for physical frailty, disability and ultimately, quality of life. Accurate and feasible assessment of physical function is key for supporting the clinical implementation of current clinical care management guidelines. This overview, therefore, presents the rationale and some key scientific evidence to support the recommendation of physical function measurement tools that reflect function limitations for immediate implementation in clinical practice. Measurement property characteristics of the proposed measurement tools are also summarised in order to support health and exercise professionals in selecting the right tool and in interpreting and evaluating the measured outcomes.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42195461","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 : 2022-05-03DOI: 10.3390/kidneydial2020023
C. I. Ramos, F. Nerbass, L. Cuppari
In this narrative review, we briefly describe the general features of constipation, our understanding of its physiopathology, and its diagnosis and treatment, focusing on chronic kidney disease (CKD). Considering that constipation is poorly characterized in CKD, we referred to studies that used the Rome criteria to diagnose constipation in patients to describe a more realistic prevalence based on a standardized tool. A highly variable prevalence of the condition was reported, ranging from 4.5% to 71.7%. The main risk factors associated with constipation reported in these studies were advanced age, low fruit intake, presence of diabetes, and medication use, and the main consequence of constipation in CKD was a worse quality of life. We found a paucity of interventional studies for constipation treatment in CKD; however, in the general population, meta-analyses published in the last decade have reported the beneficial effects of non-pharmacological strategies, which may guide the management of constipated patients with CKD. These strategies include the consumption of fiber, prebiotics, and probiotics, as well as physical exercise and acupuncture. In conclusion, although constipation is a frequent complaint among patients with CKD, there remains a considerable knowledge gap regarding its epidemiology, prognosis, and treatment.
{"title":"Constipation in Chronic Kidney Disease: It Is Time to Bridge the Gap","authors":"C. I. Ramos, F. Nerbass, L. Cuppari","doi":"10.3390/kidneydial2020023","DOIUrl":"https://doi.org/10.3390/kidneydial2020023","url":null,"abstract":"In this narrative review, we briefly describe the general features of constipation, our understanding of its physiopathology, and its diagnosis and treatment, focusing on chronic kidney disease (CKD). Considering that constipation is poorly characterized in CKD, we referred to studies that used the Rome criteria to diagnose constipation in patients to describe a more realistic prevalence based on a standardized tool. A highly variable prevalence of the condition was reported, ranging from 4.5% to 71.7%. The main risk factors associated with constipation reported in these studies were advanced age, low fruit intake, presence of diabetes, and medication use, and the main consequence of constipation in CKD was a worse quality of life. We found a paucity of interventional studies for constipation treatment in CKD; however, in the general population, meta-analyses published in the last decade have reported the beneficial effects of non-pharmacological strategies, which may guide the management of constipated patients with CKD. These strategies include the consumption of fiber, prebiotics, and probiotics, as well as physical exercise and acupuncture. In conclusion, although constipation is a frequent complaint among patients with CKD, there remains a considerable knowledge gap regarding its epidemiology, prognosis, and treatment.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41497293","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 : 2022-05-03DOI: 10.3390/kidneydial2020021
T. Harris
Lifestyle interventions can play an important role in improving patients’ health outcomes and helping them to live well with chronic kidney disease (CKD). The key to living well is ‘life participation’, defined as ‘the ability to do meaningful activities of life including, but not limited to, work, study, family responsibilities, travel, sport, social, and recreational activities’. Pharmaceutical, clinical, and surgical interventions such as dialysis and transplantation can deliver beneficial health outcomes for patients. Yet CKD patients say that the focus of renal appointments is ‘bloods, urine, blood pressure and kidney function’ and their treatment. Little time is provided to discuss non-clinical symptoms or concerns and recommend other treatments, such as lifestyle interventions. There are no highly ranked evidence-based guidelines for lifestyle interventions in CKD due to a historic lack of evidence. Diet advice, for example, is widely requested by patients on the internet and online forums but access to reliable information is highly variable. The lack of patient reported outcome measures (PROMs) is a barrier to monitoring and gathering evidence, but regulatory changes and the efforts of international organisations should soon deliver validated tools for research and guidelines which can be implemented in holistic care pathways. A global call to action to focus on lifestyle interventions is proposed.
{"title":"Lifestyle Interventions in Improving Health Outcomes and Enabling People to Live Well with Kidney Disease","authors":"T. Harris","doi":"10.3390/kidneydial2020021","DOIUrl":"https://doi.org/10.3390/kidneydial2020021","url":null,"abstract":"Lifestyle interventions can play an important role in improving patients’ health outcomes and helping them to live well with chronic kidney disease (CKD). The key to living well is ‘life participation’, defined as ‘the ability to do meaningful activities of life including, but not limited to, work, study, family responsibilities, travel, sport, social, and recreational activities’. Pharmaceutical, clinical, and surgical interventions such as dialysis and transplantation can deliver beneficial health outcomes for patients. Yet CKD patients say that the focus of renal appointments is ‘bloods, urine, blood pressure and kidney function’ and their treatment. Little time is provided to discuss non-clinical symptoms or concerns and recommend other treatments, such as lifestyle interventions. There are no highly ranked evidence-based guidelines for lifestyle interventions in CKD due to a historic lack of evidence. Diet advice, for example, is widely requested by patients on the internet and online forums but access to reliable information is highly variable. The lack of patient reported outcome measures (PROMs) is a barrier to monitoring and gathering evidence, but regulatory changes and the efforts of international organisations should soon deliver validated tools for research and guidelines which can be implemented in holistic care pathways. A global call to action to focus on lifestyle interventions is proposed.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43783838","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 : 2022-05-03DOI: 10.3390/kidneydial2020022
Luis A. Valderrama, L. Barrera, E. Cantor, J. Muñoz, Javier Arango, Carlos Tobon, B. Canaud
Background: The aim was to compare the effects of high-flux hemodialysis (HF-HD) versus high-volume post-dilution hemodiafiltration (HV-HDF) on mortality risk. Methods: Retrospective observational study of prevalent patients on hemodialysis who were followed for two years and treated in 28 kidney centers in Colombia. In this study, we included all adult patients who had been on dialysis for at least 90 days treated with an arteriovenous fistula. They were classified as HF-HD if they underwent this treatment exclusively (100% of time). For HV-HDF, if they received this treatment in more than 90% of the observation period. The primary outcome variable was mortality, and the type of hemodialysis therapy was considered as the exposure variable. Propensity score matching (PSM) and Cox regression models were used to evaluate the effect of dialysis modality on the mortality risk. Results: A total of 2933 patients were analyzed, 2361 patients with HF-HD and 572 with HV-HDF. After PSM, 1010 prevalent patients remained; mortality rate was 14.2% (95% Confidence Interval—CI: 11.3–17.6%) and 5.9% (95%CI: 4.0–8.4%) in HF-HD and HV-HDF group, respectively. HV-HDF therapy was associated with a 55% reduction in mortality compared with the HF-HD group (Hazards ratio-HR: 0.45 [95%CI 0.32–0.64] p < 0.001). Cardiovascular mortality rate was not statistically different between groups (HF-HD: 7.1% (36), HV-HDF: 3.4% (17), HR: 0.51 (95%CI: 0.21–1.28), p: 0.152). However, in patients younger than 60 years, a beneficial effect was observed in favor to HV-HDF therapy with a 79% reduction in cardiovascular mortality risk (HR: 0.21, (95%CI: 0.05–0.79), p: 0.021). Conclusion: After adjustment for different confounders, this study suggests that HV-HDF could reduce all-cause mortality compared to HF-HD therapy in prevalent patients on hemodialysis.
{"title":"Mortality in High-Flux Hemodialysis vs. High-Volume Hemodiafiltration in Colombian Clinical Practice: A Propensity Score Matching Study","authors":"Luis A. Valderrama, L. Barrera, E. Cantor, J. Muñoz, Javier Arango, Carlos Tobon, B. Canaud","doi":"10.3390/kidneydial2020022","DOIUrl":"https://doi.org/10.3390/kidneydial2020022","url":null,"abstract":"Background: The aim was to compare the effects of high-flux hemodialysis (HF-HD) versus high-volume post-dilution hemodiafiltration (HV-HDF) on mortality risk. Methods: Retrospective observational study of prevalent patients on hemodialysis who were followed for two years and treated in 28 kidney centers in Colombia. In this study, we included all adult patients who had been on dialysis for at least 90 days treated with an arteriovenous fistula. They were classified as HF-HD if they underwent this treatment exclusively (100% of time). For HV-HDF, if they received this treatment in more than 90% of the observation period. The primary outcome variable was mortality, and the type of hemodialysis therapy was considered as the exposure variable. Propensity score matching (PSM) and Cox regression models were used to evaluate the effect of dialysis modality on the mortality risk. Results: A total of 2933 patients were analyzed, 2361 patients with HF-HD and 572 with HV-HDF. After PSM, 1010 prevalent patients remained; mortality rate was 14.2% (95% Confidence Interval—CI: 11.3–17.6%) and 5.9% (95%CI: 4.0–8.4%) in HF-HD and HV-HDF group, respectively. HV-HDF therapy was associated with a 55% reduction in mortality compared with the HF-HD group (Hazards ratio-HR: 0.45 [95%CI 0.32–0.64] p < 0.001). Cardiovascular mortality rate was not statistically different between groups (HF-HD: 7.1% (36), HV-HDF: 3.4% (17), HR: 0.51 (95%CI: 0.21–1.28), p: 0.152). However, in patients younger than 60 years, a beneficial effect was observed in favor to HV-HDF therapy with a 79% reduction in cardiovascular mortality risk (HR: 0.21, (95%CI: 0.05–0.79), p: 0.021). Conclusion: After adjustment for different confounders, this study suggests that HV-HDF could reduce all-cause mortality compared to HF-HD therapy in prevalent patients on hemodialysis.","PeriodicalId":74038,"journal":{"name":"Kidney and dialysis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45615327","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 : 2022-04-13DOI: 10.3390/kidneydial2020020
Diana Bruen, Jacob J. Kingaard, Meg Munits, Clarissa S. Paimanta, Jacob A Torres, Jessianna Saville, T. Weimbs
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of renal failure and has limited pharmacological treatment options. Disease progression is relentless, and regression is not a known feature of ADPKD even with pharmacological intervention. Recent research has uncovered underlying pathogenic mechanisms that may be amenable to dietary interventions. Cyst cells in ADPKD are thought to depend on glucose for energy and are unable to metabolize fatty acids and ketones. High-carbohydrate diets and lifestyles leading to hyperglycemia appear to worsen progression of ADPKD. Additionally, renal stressors such as oxalate, phosphate and uric acid, that lead to renal tubular micro-crystal burden appear to accelerate disease progression. Based on these research findings, we have created a remote, dietitian-supervised training program to teach individuals with ADPKD the implementation of dietary and lifestyle changes to avoid factors that may worsen disease progression. Using web-based platforms, digital tools, one-on-one remote meetings, and video group meetings, participants learn to implement a plant-focused ketogenic diet that avoids renal stressors, the science behind these changes, how to self-measure health parameters, and track nutrient intake. Dietary changes are supplemented with a medical food containing the ketone beta-hydroxybutyrate and alkaline citrate, and mindfulness exercises. Here, we report the first experience with this program from a beta test with approximately 24 participants. Most participants completed the program and reported improvements in their health and well-being including pain levels, weight loss, hypertension, and eGFR. Adherence to the program was very high and the feasibility of the dietary and lifestyle changes was rated highly. The Ren.Nu program is now publicly available to individuals with ADPKD.
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