BMC Nephrology最新文献

Background: Alterations in electrolytes are associated with a number of clinical problems and prompt diagnosis of electrolyte disorder and treatment are crucial in the management of patients with chronic illness. Even though, major electrolyte disorders are common among patients with chronic diseases, the problem were not received enough attention. Thus, the aim of this review was to determine the pooled prevalence and associated factors of major electrolyte disorder among patients with chronic diseases.

Methods: The PubMed, Cochrane Library, Science Direct, African Journals Online, and Google Scholar databases were searched by two authors (WCT and YAF) from January 15/2024 to January 22/2024 to identify articles reporting the prevalence of electrolyte disorders in patients with chronic disease in Ethiopia. A random-effects model was used to estimate the pooled prevalence of electrolyte disorder. Important data were extracted with Microsoft Excel and then exported to STATA software version 11 (STATA Corp LLC, TX, USA) for analysis. Cochran's Q test at a significance level of less than 0.05 and the I² index were used to examine the statistical heterogeneity among the included studies. A random-effects model was used to estimate the pooled prevalence of major electrolyte disorder due to the presence of heterogeneity.

Results: The finding of this review showed that, the pooled estimate of electrolyte disorder among patients with chronic diseases in Ethiopia was found to be 56.66% (95% CI: 44.54, 68.79, P < 0.001). Having no formal education (POR = 7.06, 95% CI = 1.35, 36.98), taking diuretic (POR = 4.41, 95% CI = 1.78, 10.91), patients with anti-diabetic medication (POR = 10.11, 95% CI = 3.45, 29.66), having a body mass index ≥ 30 kg/m² (POR = 6.99, 95% CI = 2.01, 5.93) and having uncontrolled blood glucose [POR: 7.09, 95% CI = 5.10-9.80) were factors associated with electrolyte disorders among patients with chronic diseases.

Conclusion: This systematic review and meta-analysis revealed that the pooled electrolyte disorders among patients with chronic disease was significant in Ethiopia. Patients who had no formal education, taking diuretic, taking anti-diabetic medication, body mass index ≥ 30 kg/m², alcohol consumption and having high uncontrolled blood glucose were significantly associated with electrolyte disorders. Special emphasis on the status of serum electrolytes should be given for patients with chronic disease in those taking diuretic and anti-diabetic treatments and who are overweight.

Trial registration: Prospero registration: CRD42024579411.

Background: Cognitive impairment and cognitive complaints are highly prevalent in haemodialysis patients and are associated with adverse health outcomes. Currently, there is no established guideline on cognitive screening in this population. Although neuropsychological tests are the gold standard measure of cognition, they are time-consuming and require trained personnel. The Kidney Disease Quality of Life Cognitive Function subscale (KDQOL-CF), a self-administered questionnaire with only three items, may be a feasible alternative for busy renal settings. In this study, we validated an extended version of KDQOL-CF by including an additional memory item (i.e., "How much of the time during the past four weeks did you have memory difficulties?") to improve its ability to capture memory impairments that are common in dialysis patients but missing in the original scale.

Methods: A total of 268 haemodialysis patients treated in 10 dialysis centres in Singapore completed the extended KDQOL-CF and gold standard measures of objective cognition (Montreal Cognitive Assessment) and subjective cognition (Patient's Assessment of Own Functioning Inventory). Patients also self-reported their functional impairment and treatment nonadherence. Statistical analyses were performed to determine the factor structure and psychometric properties of the extended KDQOL-CF. Receiver operating characteristic curve analyses were conducted to determine the diagnostic ability of the extended KDQOL-CF in identifying objective cognitive impairments and subjective cognitive complaints. Additionally, we examined associations between the extended KDQOL-CF and patients' self-reported functional impairment and treatment nonadherence.

Results: The extended KDQOL-CF can be explained by a one-factor model and has good internal consistency and convergent validity. Receiver operating characteristic curve analysis provided support for the diagnostic accuracy of the extended KDQOL-CF in identifying objective cognitive impairments (area under curve = 60.9%) and subjective cognitive complaints (area under curve = 76.2%). The extended KDQOL-CF also performed better than the original KDQOL-CF in predicting functional impairment and treatment nonadherence in the recruited patients.

Conclusions: The extended KDQOL-CF may be used as a first-step cognitive screening tool in dialysis settings to offer a gateway for further diagnostic evaluation and preventive or rehabilitative programs.

Background: The outcome of kidney transplant recipients with a history of complement-mediated thrombotic microangiopathy (cTMA) and those who develop post-transplant de novo TMA (dnTMA) is largely unknown.

Methods: We retrospectively studied all kidney transplant recipients with end-stage kidney disease secondary to cTMA and those who developed dnTMA, between Jan 2000 and Dec 2020 in our center.

Results: We identified 134 patients, 22 with cTMA and 112 had dnTMA. Patients with cTMA were younger at the time of TMA diagnosis (age at diagnosis, 28.9 ± 16.3. vs 46.5 ± 16.0 years; P < 0.001). T-cell mediated rejection, borderline rejection, and calcineurin inhibitor toxicity were more prevalent in the first kidney transplant biopsy (P < 0.05) in the dnTMA group, and antibody-mediated rejection was more prevalent in anytime-biopsy (P = 0.027). After adjusting for potential confounders, cTMA was associated with a sixfold increase in the hazard of transplant failure during the first-year post-transplant (adjusted hazard ratio (aHR): 6.37 [95%CI: 2.17 to18.68; P = 0.001]; the aHR decreased by 0.87 (95% CI: 0.76 to 0.99: P = 0.033) per year elapsed since transplantation. Long-term allograft survival was similar in both groups.

Conclusion: Post kidney transplant TMA is an important cause of poor allograft survival. More studies are needed to enhance our understanding and management of this disorder.

Background: Renal disease is associated with Charcot-Marie-Tooth disease (CMT), a common inherited neurological disorder. Three forms of CMT have been identified: CMT1 of the demyelinating type, CMT2 of the axonal defect type, and intermediate type (Int-CMT). INF2 is an important target for variants that cause the complex symptoms of focal segmental glomerulosclerosis (FSGS) and CMT.

Case presentation: We report the case of a 13-year-old female Chinese patient (born in 2011) with a rare co-occurrence of CMT1 and glomerulosclerosis (GS) (CMT1-GS). The patient presented with slowly progressive gait disorder with unsteadiness during walking, pes cavus, and kyphoscoliosis since the age of 1 year. Electrophysiological studies and brain magnetic resonance imaging revealed demyelinating features consistent with CMT1. At 12 years of age, she was hospitalised for hypertension and dizziness; her serum albumin was 27.9 g/L, serum creatinine was 87 μmol/L, estimated glomerular filtration rate was 88.6 mL/min, and 24-h urine protein was 4.95 g. A renal biopsy showed glomerulosclerosis. Renal function deteriorated further during the follow-up period, and she received a kidney transplant at the age of 13. Whole-exome sequencing identified a de novo heterozygous c.326T > G (p.Met109Arg) variant in exon 2 of INF2. The variant was classified as "pathogenic" according to the American College of Medical Genetics and Genomics criteria.

Conclusions: We describe a rare clinical phenotype of CMT1-GS associated with a de novo variant of INF2. Our findings expand the phenotypic and genotypic spectrums of INF2-associated disorders.

The number of peritoneal dialysis (PD) catheter-related infections and peritonitis caused by nontuberculous mycobacteria (NTM) has been increasing. Nonetheless, the optimal timing for the relocation of the exit site, removal and reinsertion of the PD catheter, prognosis, and duration of antibiotic treatment remain unclear. This literature review aimed to investigate the epidemiology of patient characteristics and evaluate the most effective diagnostic and treatment strategies for PD catheter-related infections and peritonitis caused by NTM. The systematic literature review was conducted on published cases of PD catheter-related infection and peritonitis caused by NTM in PubMed, Embase, and Ichushi databases up to August 2022. A total of 335 cases (64.1%, male; mean age, 53.4 years; mean dialysis duration, 25.4 months) were analyzed. The most common causative agent of infection was Mycobacterium abscessus (40.1%), followed by Mycobacterium fortuitum (24.8%) and Mycobacterium chelonae (16.6%). With respect to diagnosis, 42.9%, 28.1%, and 29.0% of cases were diagnosed as PD catheter-related infection only, peritonitis only, and both, respectively. The initial cultures were positive for NTM only, positive for any other bacteria, and negative for NTM only in 56.5%, 19.8%, and 23.7% of cases, respectively. Ultimately, more than 80% of cases were treated with multiple antibiotics. PD catheter removal was performed in 55.4% of patients with PD catheter-related infections only and 85.5% of those with PD peritonitis. PD continuation or resumption was possible in 62.2% and 16.0% of patients, respectively. In conclusion, our findings indicate that it is advisable to perform acid-fast bacilli stain and culture in order to promptly identify NTM. PD catheter removal may be an essential management strategy during the early stages of NTM infection.

Background: The primary aim of this study is to explore the relationship between serum levels of LOX-1, hs-cTnT, and NGAL, and renal function in patients with CKD, as well as to evaluate their diagnostic value for early detection and monitoring of disease progression in CKD patients.

Methods: A retrospective study was conducted on 108 patients with chronic kidney disease admitted to our hospital from January 2023 to December 2023. The patients were divided into the mild renal insufficiency group (51 cases) and the severe renal insufficiency group (57 cases). The differences in serum levels of LOX-1, hs-cTnT, and NGAL between the two groups were compared, and Pearson correlation analysis was used to explore the relationship between the three levels and renal function. ROC analysis was used to evaluate the predictive value of the three markers for the diagnosis of CKD.

Results: The levels of LOX-1, hs-cTnT, and NGAL in the mild renal insufficiency group were lower than those in the severe renal insufficiency group (P < 0.05). Correlation analysis showed that serum levels of LOX-1, hs-cTnT, and NGAL were positively correlated with the deterioration of renal function (P < 0.001), indicating a significant correlation between LOX-1, hs-cTnT, NGAL levels, and the deterioration of renal function. ROC analysis showed that the AUC of serum levels of LOX-1, hs-cTnT, and NGAL were 0.859, 0.882, and 0.841, indicating a significant predictive value for the diagnosis of chronic kidney disease.

Conclusion: Serum levels of LOX-1, hs-cTnT, NGAL, and related markers demonstrate a direct association with the extent of renal impairment, offering predictive capabilities for diagnosing CKD.

Background: Osteoporosis is a significant concern among individuals with lupus nephritis (LN), with reported prevalence rates exhibiting considerable variation. This study investigates the prevalence and identifies risk factors contributing to osteoporosis in premenopausal and postmenopausal LN patients, addressing the paucity of data specific to the Chinese population.

Methods: This cross-sectional study enrolled patients with renal biopsy-proven LN, who underwent bone mineral density (BMD) measurements using dual X-ray absorptiometry at the lumbar spine, total hip, and femoral neck. The study was conducted at Tongji hospital from May 2011 to June 2018.

Results: A total of 130 patients were evaluated, with a mean age of 46.2 ± 12.9 years, including 2 males and 128 females. A significant majority, 52.3% (n = 67) of the female patients, were identified as postmenopausal. BMD measurements revealed that 40.0% of patients had osteoporosis in at least one site. The spearman rank correlation of BMD with clinical characteristics indicated that age at menopause, weight, height, and body mass index were positively correlated with BMD, while age, age at diagnosis of LN, and menopause duration were negatively correlated with BMD in lumbar spine, total hip, and/or femoral neck. Multivariable linear regression analysis demonstrated that body mass index was positively associated with BMD, whereas disease duration and menopause duration were negatively associated with BMD in all and postmenopausal patients. Postmenopausal patients consistently had a higher prevalence of osteoporosis across all measured sites. Factors such as older age, lower weight, and the absence of bisphosphonates therapy were independently associated with an increased risk of osteoporosis in LN patients.

Conclusion: Our findings underscore a substantial prevalence of osteoporosis in LN patients, especially among postmenopausal individuals. The study identifies older age, lower weight, and absence of bisphosphonates treatment as risk factors for osteoporosis in this patient population.

Purpose: Proteinuria during treatment of immune checkpoint inhibitors (ICIs) was another renal adverse event besides from acute kidney injury. We aim to investigate the incidence and associated factors of proteinuria associated with ICIs.

Method: A case-control observational study about ICIs-treated cancer patients was conducted. Clinical and laboratory data at the baseline and during the follow-up was collected. Patients developed proteinuria during ICIs-treatment were classified to the proteinuria group.

Results: Between March 2019 and August 2022, 440 patients were included in the study. Forty-eight patients (10.9%) developed proteinuria after ICIs-treatment. The occurrence of acute kidney injury between the proteinuria group and the control showed no difference[1(2.1%) vs. 9(2.3%), p = 1.000]. By multivariable logistic analysis, accumulative cycle of ICIs-administration (OR 1.079, 95% CI 1.033 to 1.127, p = 0.001) and comorbidity of liver cirrhosis (OR 2.198, 95% CI 1.082 to 4.468, p = 0.030) were associated with occurrence of proteinuria after ICIs-treatment independently.

Conclusions: Proteinuria could develop during the course of ICIs-therapy. Urinalysis should be monitored, especially for patients received multi-cycle of ICIs-administration and comorbid with liver cirrhosis.

Background: Patients with chronic kidney disease (CKD) are susceptible to vascular calcification and vitamin K deficiency. Matrix gla protein (MGP) is a potent inhibitor of calcification requiring vitamin K for activation. Inactive MGP, i.e. dephosphorylated uncarboxylated MGP (dp-ucMGP), is frequently elevated in CKD along with protein induced by vitamin K absence (PIVKA-II). We investigated whether dp-ucMGP and PIVKA-II are useful markers of aortic calcification in CKD.

Methods: Patients with normal or reduced kidney function underwent a non-contrast computed tomography scan of the entire aorta with subsequent blinded standard calcification scoring of the aortic wall ad modum Agatston. Blood samples were analyzed for plasma concentrations of dp-ucMGP and PIVKA-II.

Results: 141 patients (104 with CKD stage 3-5) were included. In patients with/without CKD median (interquartile range) were dp-ucMGP 543 (503-744)/1078 (835-1682) pmol/l (P < 0.01); PIVKA-II 19.3 (16.3-23.5)/21.8 (17.2-36.8) ng/ml (P = 0.33) and aortic Agatston scores 1644 (729-4138)/7172 (2834-15360) (P < 0.01). Agatston score was positively associated with PIVKA-II (β = 0.71, P = 0.014, r² = 0.04) and tended to be so with dp-ucMGP (β = 0.44, P = 0.08, r² = 0.02). Age, estimated glomerular filtration rate (eGFR) and smoking status were also associated with Agatston score and remained so, along with PIVKA-II, when adjusted for potential confounders. However, the association between age and aortic Agatston score was stronger than for PIVKA-II, eGFR and smoking-status.

Conclusion: Vitamin K deficiency, as estimated through PIVKA-II, but not dp-ucMGP, is weakly associated with aortic Agatston score. Yet, as markers of aortic calcification, both were outperformed substantially by age, and neither surpassed smoking nor eGFR.

Clinicaltrials:

Gov identifier: NCT04114695.