BMC Nephrology最新文献

Background: Chronic kidney disease (CKD) is a prevalent global health issue affecting millions of patients worldwide, impacting quality of life, impeding physical and psychological well-being, causing financial stress, and increasing mortality rates. This study aimed to highlight the prevalence of CKD and its associated risk factors across Saudi Arabia.

Method: This is a cross-sectional study conducted from 2015 to 2022, using data from 42 branches of a major network of diagnostic laboratories in Saudi Arabia, covering the country's 13 administrative areas.

Results: The mean age was 40.35 ± 14.5 years. The highest proportion of participants resided in the Makkah region at 35.77%, followed by the Riyadh region at 25.75%. The overall prevalence of CKD was 4.76%, with most having CKD in stage 3 (3.5%). The prevalence of CKD was higher among males compared to females (5.83% vs. 3.88%) and increased significantly with age, being 0.45% among participants aged 18-29 years and reaching 50.94% among participants aged 90 years or older. Predictors of CKD included increasing age, male sex, administrative area (Makkah 1.40 [95% CI:1.26-1.55], Jazan 1.34 [95% CI:1.18-1.52], Najran 0.47 [95% CI, 0.39-0.57], Alqasim 0.73 [95% CI, 0.64-0.82]), and a high hemoglobin A1C. CKD in Saudi Arabia is influenced by various demographic and geographic determinants contributing to its prevalence and associated burden on the population.

Conclusion: These findings emphasize the need for targeted screening and prevention strategies, especially for at-risk populations. Continued surveillance, early detection, and effective management are crucial to reducing CKD's burden and improving kidney health outcomes in Saudi Arabia. Further research is essential to better understand the disease's regional and demographic drivers.

Background: Physical performance is low and physical activity declines in people with chronic kidney disease (CKD). Both factors are associated with decreased survival. Our hypothesis was that improved physical performance after 12 months of exercise training would result in better survival in patients with CKD stages 3 to 5 not on kidney replacement therapy (KRT). Our aims in this study were to investigate the survival effects of (1) baseline physical performance and (2) physical performance after 12 months of exercise training.

Methods: This is a post-hoc analysis of the RENEXC trial, a randomized controlled study comparing 12 months of strength- and balance training both in combination with aerobic training. Both groups improved physical performance with no between group differences. Patients were categorized into five groups: improved ≥ 5%, unchanged, deteriorated ≥ 5%, non-completers, missing data. Univariate and multivariate Cox regression analyses were used and adjusted for age, sex, comorbidity, time on dialysis and time with a kidney transplant.

Results: 151 patients participated, mean age 66 ± 14 years, 65% men, eGFR 22.5 ± 8.2 ml/min/1.73m², average follow-up 60 months.

Multivariate analyses: The baseline 6-minute walk test (6MWT) (HR 0.996; 95% CI [0.993-0.998]) and 30-second sit-to-stand (30s-STS) (HR 0.94 CI [0.89-1.0]) were positively associated with survival. After 12 months of exercise improved handgrip strength (HGS) right (HR 2.66; 95% CI [1.07-6.59]) was associated with better survival compared with deterioration. Improvement compared with noncompletion was associated with better survival (6MWT (HR 2.88; 95% CI [1.4-5.88]), HGS right (HR 4.44; 95% CI [1.79-10.98]), functional reach (HR 3.69; 95% CI [1.82-7.48]), isometric quadriceps strength right (HR 2.86; 95% CI [1.43-5.72]), 30s-STS (HR 3.44; 95% CI [1.66-7.11]).

Conclusion: Baseline walking distance, muscular strength and endurance in the legs were independently associated with survival in people with CKD stages 3-5 without KRT. After completing 12 months of exercise training improved walking distance, muscular strength and endurance, and balance were positively associated with survival, compared with noncompleters. Better physical performance at baseline and the ability to complete 12 months of exercise training conferred survival benefits. There are probably several factors affecting better survival. These factors require elucidation in future studies.

Trial registration: ClinicalTrials.gov NCT02041156. Registration date 20,240,107.

Background: Osteoporosis and sarcopenia frequently occur in patients with end-stage renal disease undergoing hemodialysis (HD), and depression is also a common mental health issue in this population. Despite the prevalence of these conditions, the interrelationships among them remain poorly understood in HD patients.

Methods: In this multicenter cross-sectional study, 858 HD patients from 7 dialysis centers were recruited. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated from body composition data obtained through multifrequency bioimpedance analysis (BIA), while handgrip strength (HGS) was measured with a dynamometer. Gait speed was evaluated with a 4-meter walk test, and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9).

Results: Among the 858 participants (524 men, 334 women), 39.2% had osteoporosis. The prevalence of sarcopenia and depression was 18.9% and 42.1%, respectively. Logistic regression analysis showed that SMI was significantly associated with a decreased risk of osteoporosis (OR = 0.638, 95% CI = 0.494-0.823, P = 0.001), while HGS was not(OR = 0.990, 95% CI = 0.963-1.017, P = 0.449). HD patients with sarcopenia were 1.92 times more likely to have osteoporosis than those without sarcopenia. Most notably, after adjusting for both sarcopenia and SMI, the risk of osteoporosis in HD patients with depression was 1.45 times higher than in those without depression (OR = 1.452, 95% CI = 1.060-1.989, P = 0.020).

Conclusions: In HD patients, increased muscle mass, rather than muscle strength, is linked to a lower risk of osteoporosis. Notably, depression emerges as a significant risk factor for osteoporosis in this population, highlighting the need for mental health considerations in managing bone health.

Hypertension and chronic kidney disease (CKD) are interconnected conditions that can significantly affect a person's health-related quality of life (HRQoL). In low- and middle-income countries (LMICs), this disease burden is heightened due to limited health resources and socio-economic challenges. Based on the available literature, this narrative review aims to discuss the HRQoL of hypertensive patients with CKD in LMICs by identifying the current challenges and providing insights into the strategic potential to improve patient's quality of life. This review reveals that the hypertensive population with CKD has a much lower HRQoL than the general population. Various factors, including physical limitations, comorbidities, psychological barriers, logistical challenges, and social support, can influence HRQoL. Limited access to health care, inadequate resources, and a lack of skilled personnel in LMICs further exacerbate these individual challenges. The economic impact of decreased work productivity and increased health costs adds to the disease burden. Improved health access, effective self-management strategies, and social support are needed to improve HRQoL in hypertensive patients with CKD.

Background: IgA nephropathy (IgAN) exhibits an unpredictable trajectory, creating difficulties in prognostication, monitoring, treatment, and research planning. This study provides a comprehensive depiction of the progression of kidney function throughout the disease course, from diagnosis to a span of 36 years post-diagnosis.

Methods: We utilized a cohort of 400 Norwegian IgAN patients, from diagnosis to the occurrence of death, initiation of kidney replacement therapy (KRT), or the latest follow-up. Recorded proteinuria (n = 2676) and creatinine (n = 8738) measurements were retrieved. Patients were divided into subgroups based on their specific estimated glomerular filtration rate (eGFR) slopes.

Results: Median follow-up was 16 years. During this period, 34% of patients either died or initiated KRT. Among patients who reached endpoint, the median duration from diagnosis to the initiation of KRT or death was 8 years. Notably, 34% of the cohort exhibited a stable disease course, characterized by an eGFR decline of less than 20% between two consecutive measurements. Differences in subsequent disease trajectories among two subgroups with similar eGFR levels at diagnosis could not be accounted for by variations in treatment strategies. Among patients with proteinuria < 1 g/24 h in less than half of the measurements, KRT was five times more prevalent compared to those with more than half of the measurements recording proteinuria < 1 g/24 h (p-value = 0.001).

Conclusions: While a significant proportion of IgAN patients reach kidney failure within their lifetimes, outcomes vary widely. Clinical data at diagnosis offer limited insights into long-term risks. Enhanced risk stratification necessitates data collection at multiple time points.

Background: A number of UK transplantation centres use isotope studies to estimate the relative contribution from each kidney in living kidney donor assessment. The evidence that the estimation of pre-donation split function of the non-donated kidney influences post-donation renal recovery is limited. The aim of this study was to analyse whether, in the context of other donor factors, the split function of the non-donated kidney predicts the percentage recovery of glomerular filtration rate (GFR) at one-year post-donation.

Methodology: A retrospective cohort analysis was undertaken on 291 living kidney donors in the Glasgow Renal and Transplant Unit between 1^st January 2011 and 1^st June 2022. Univariable and multivariable linear regression analysis was used to analyse the impact of donor factors on recovery of renal function at one year relative to baseline isotope GFR (iGFR) or to estimated GFR (eGFR by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula). Sub-analyses of donor outcome (% recovery of iGFR and eGFR at one year) were undertaken using single-measures ANOVA and grouping of donors by pre-donation isotope uptake of the non-donated kidney.

Results: Median recovery of pre-donation GFR at 1 year was 70.0% (IQR 64.8-75.5). On linear regression analysis there was no significant association found between split function of the non-donated kidney and the percentage recovery of iGFR, although a small significant association was found for eGFR. There was no significant difference between mean iGFR or eGFR recovery on sub-analysis of donor outcomes.

Conclusions: This study demonstrated no clinically important predictive relationship between percentage recovery of renal function at 1 year after living kidney donation and pre-donation split function within the range accepted for donation in our centre.

Background: This study aimed to explore the clinical and pathological features of patients with diabetic kidney disease (DKD), with and without non-diabetic kidney disease (NDKD), through a retrospective analysis. The objective was to provide clinical insights for accurate identification.

Methods: A retrospective analysis of 235 patients admitted to the Department of Nephrology at Hangzhou Hospital of Traditional Chinese Medicine was conducted between July 2014 and December 2022. These patients underwent renal biopsy and received a pathology-based diagnosis of DKD. They were categorized into the DKD alone group (93 cases) and the DKD + NDKD group (142 cases).

Results: In the DKD alone group, gender distribution was even, with ages mainly between 50 and 59 years, and a disease duration of less than 5 years, primarily presenting nodular diabetic glomerulosclerosis. In contrast, the DKD + NDKD group had a higher male incidence, a wider age range, longer disease duration, and prevalent diffuse diabetic glomerulosclerosis. Acute and chronic tubulointerstitial lesions and IgA nephropathy were the predominant types of combined NDKD, accounting for 40.14% and 35.21%, respectively. Clinical correlation analysis revealed associations between glomerular grading, tubulointerstitial lesions, renal arteriolar vitelliform lesions, renal vascular atherosclerosis, and clinical parameters such as 24-hour urine protein, hemoglobin, and urinary specific gravity. Multifactorial logistic regression analysis identified independent factors affecting DKD + NDKD, including body mass index, blood creatinine level, microscopic erythrocyte grade, urinary immunoglobulin G/creatinine ratio, and serum immunoglobulin A.

Conclusion: The research underscores distinctions in age, gender distribution, disease duration, and renal pathology between DKD alone and DKD + NDKD groups. Additionally, significant discriminative factors including BMI, blood creatinine level, microscopic erythrocyte grade, UIgG/urine creatinine ratio, and serum IgA levels help differentiate DKD from NDKD, thereby enabling personalized treatment approaches. Furthermore, the study highlights the role of RASi as the most commonly used drug in the treatment of both DKD and NDKD, with emerging drugs such as SGLT2 inhibitors showing promising renal protective effects.

Background: The existing criteria for living kidney donors (LKDs)in Japan are controversial. We evaluated the roles of computed tomography volumetry (CTV) and 99 m Tc-diethylenetriamine penta-acetic acid (DTPA) scintigraphy in assessing preoperative and postoperative renal function and predicting early recovery of residual renal function.

Methods: We retrospectively reviewed the medical charts of 175 consecutive LKDs who underwent donor nephrectomy (DN) at our institution between 2006 and 2022. Preoperative renal volume was assessed using enhanced CTV, and screening of renal functions was performed using 99 m Tc-DTPA scintigraphy. We evaluated the estimated glomerular filtration rate (eGFR), single-kidney eGFR (skeGFR), and recovery rate three months after DN.

Results: We included 55 men and 81 women (median age, 59 years; median follow-up period, 73 months). Age > 60 years, hypertension, and total kidney volume/body surface area (TKV/BSA) < 170 mL/m² independently predicted preoperative eGFR < 80 mL/min/1.73 m², whereas total measured GFR < 80 mL/min/1.73 m² independently predicted preoperative eGFR < 70 mL/min/1.73 m². Regarding postoperative renal function, residual KV/BSA < 85 mL/m² and ΔskeGFR ≤ 9 mL/min/1.73 m² independently predicted postoperative eGFR < 60% of preoperative eGFR, and TKV/BSA < 170 mL/m² independently predicted early recovery of skeGFR.

Conclusions: CTV may be used as a reliable prognostic screening tool to select LKDs and assess their split renal functions before DN, and renal scintigraphy may help select the optimal LKD.

Background: High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reducing deaths in this group. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point-of-care dry weight (POC-DW) technique.

Methods: The present observational, prospective study was carried out at the Pafram hemodiafiltration unit in Morona Santiago, Ecuador, and the hemodialysis unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POC-DW for eight weeks. In Group 1, patients whose use of antihypertensive drugs was not required to control systolic blood pressure with a value less than 150 mmHg predialysis, less than 130 mmHg postdialysis, and a peridialytic blood pressure (defined as post-HD minus pre-HD SBP) between 0 and - 20 mmHg were analyzed. In Group 2, patients who required antihypertensive drugs for not meeting the aims of systolic blood pressure were included. The variables included clinical, demographic, mortality, description of the treatment, and routine laboratory tests in dialysis programs. The sample was nonprobabilistic. Survival analysis was performed for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons.

Results: The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125-4.158) (P = 0.0243).

Conclusion: In hemodiafiltration and hemodialysis programs, blood pressure control with active ultrafiltration measures and without using antihypertensives is essential for survival in patients with CKD.