BMC Nephrology最新文献

Background: The impact of chronic kidney disease (CKD) on healthy life expectancy and healthcare costs requires research. This study examined associations between CKD and healthy life expectancy, and its economic burden.

Methods: This study of community-dwelling adults residing in Hakui City, Ishikawa Prefecture, Japan used data from the National Health Insurance database between 2012 and 2022. Participants were grouped by baseline estimated glomerular filtration rate (eGFR) (< 45, ≥ 45 to < 60, ≥60 to < 75, ≥75 to < 90, and ≥ 90 mL/min/1.73 m²). The primary endpoint was a composite of becoming a care level ≥ 2 or death. Multivariable Cox proportional hazards models were used to calculate the risk regarding time to the primary endpoint. Secondary endpoints were the annual medical and long-term care costs.

Results: The 5,592 participants had a mean follow-up of 6.4 years. The hazard ratio was 1.86 (95% confidence interval [CI]: 1.35 to 2.55) for the eGFR < 45 group and 1.60 (95% CI: 1.13 to 2.25) for the eGFR ≥ 90 group, both compared with the eGFR ≥ 60 to < 75 group. Both annual costs were significantly higher in the lower eGFR groups than in the higher eGFR groups. For the eGFR < 45 group, the median medical care cost was 0.38 million yen/year in all participants and the median long-term care cost was 0.40 million yen/year in primary endpoint achievers. A lower eGFR was correlated with longer unhealthy years of life.

Conclusions: Higher and lower eGFRs were associated with increased risks of reduced healthy life expectancy. A lower eGFR was associated with higher medical and long-term care costs.

Background: Calcification of the radial artery is one of the main causes of anastomotic stenosis in autogenous arteriovenous fistulas in uremic patients. However, the pathogenesis of calcification is still unknown. This study attempted to screen and validate the risk factors for vascular calcification in patients with uremia.

Methods: Serum of blood were collected and tissue samples from radial artery were obtained from 60 uremia patients with or without hemodialysis. General biochemical indicators and calcification-related molecules were collected and detected via ELISA or correlation analysis. In addition, pathological changes and calcification-related molecules in the radial artery were evaluated by HE or immunohistochemical staining.

Results: There were differences in total calcium, calcium-phosphorus products, allograft inflammatory factor 1 (AIF-1), intact parathyroid hormone (iPTH), vitamin D (VD), fibroblast growth factor 23 (FGF23) and soluble klotho (sKlotho) in the blood of uremic patients with or without hemodialysis. Furthermore, these factors are related to calcification of the radial artery. The expression of AIF-1, PTHR1, VDR, FGF23 and sKlotho was also increased in the calcified radial artery.

Conclusions: The levels of AIF-1, PTH, VDR, FGF23 and sKlotho in serum were associated with calcification of the radial artery in patients with uremia. Furthermore, calcification of the radial artery was further aggravated by abnormalities in calcium and phosphorus in maintenance hemodialysis patients.

Background: Effective treatment of late antibody-mediated rejection (late AMR) is still an unmet medical need. Clearing donor-specific antibody (DSA) and preventing its rebound is the ideal goal of treatment.

Methods: We have summarized the clinical data from seven patients with late or chronic active AMR after renal transplantation who received daratumumab (Dara)-based treatment first (Phase 1) and then tocilizumab (TCZ) therapy (Phase 2). Phase 1 consisted of an intensive treatment period (Dara plus PP/IVIG) and a maintenance treatment period (Dara alone). The main clinical indicators were DSA, Banff scores and renal function.

Results: After 4 to 17 weeks of intensive treatment, the MFI values of DSA in five of the seven patients fell below 5,000. During Dara maintenance treatment, only one patient's DSA became negative, and the remaining six patients' DSAs remained relatively stable or showed rebound. However, after TCZ treatment was begun, the DSA eventually became negative in three patients and decreased to low levels (< 3,500) in the other three patients. Also, our treatment stabilized renal function in all patients. At 24-28 months after treatment, renal biopsy showed partial remission of microvascular inflammation in four of six patients. In addition, capillary C4d deposition became negative in all patients (P = 0.001), and the mean score of i-IFTA was significantly reduced (P = 0.012). Other chronic injury scores did not change significantly.

Conclusions: This new therapy combining Dara and TCZ achieved a good desensitization effect, providing an important reference point for designing better-optimized treatment of late or chronic active AMR in the future.

Trial registration: This retrospectively study was approved by the Ethics Committee of Tongji Hospital, Wuhan, China (TJ-IRB20230729).

Background: The management of depression in patients undergoing hemodialysis remains challenging and affects quality of life; however, there is a possibility that breathing exercises may be effective in this context. Thus, the purpose of this study was to evaluate the effectiveness of a breathing training program on quality of life and depression among patients on hemodialysis.

Methods: A one-group pretest-posttest quasi-experimental design was used. Data were collected from hemodialysis patients at three dialysis centers. Initial baseline data were collected, and a breathing training program was implemented. The program included three types of breathing exercises. A total of 41 participants completed the study. The participants were asked to perform the breathing training program three times a day for 30 days. The impact of the intervention on patients' quality of life and depression was measured using both the Kidney Disease Quality of Life Short Version and the Beck Depression Inventory-Second Edition.

Results: A significant decrease in the overall depression score was observed after implementing the breathing training program (BDI-II mean difference =-3.9, 95% CI:0.35-7.45, p = 0.03). The intervention has also had significant improvements on overall quality of life (KDQOL mean difference = 6.09, 95% CI: 0.48-11.70, p = 0.03) and a reduction in the symptoms and problems domain (domain mean difference = 6.71, 95% CI: 0.01-13.40, p = 0.05). There were some improvements on other quality of life domains but did not reach the statistical differences after program implementation.

Conclusions: Breathing exercises are associated with improved quality of life and reduced depression among HD patients, providing a simple and cost-effective intervention.

Background: Cardiac surgery is a major contributor to acute kidney injury (AKI); approximately 22% of patients who undergo cardiac surgery develop AKI, and among them, 2% will require renal replacement therapy (RRT). AKI is also associated with heightened risks of mortality and morbidity, longer intensive care stays, and increased treatment costs. Due to the challenges of treating AKI, prevention through the use of care bundles is suggested as an effective approach. This review aimed to assess the impact of care bundles on kidney outcomes, mortality, and hospital stay for cardiac patients in critical care.

Methods: PubMed, Scopus, Web of Science, and EMBASE were searched up to November 2024. Inclusion criteria were studies on individuals with cardiac diseases receiving critical care, that used AKI care bundle as the intervention, and reported outcomes related to AKI, mortality, and other kidney-related events. We used the Cochrane Collaboration's risk of bias tool 2 and the Newcastle-Ottawa scale for quality assessment. Pooled odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

Results: Seven studies on total 5045 subjects, including five observational and two randomized controlled trials (RCTs) were included. The implementation of care bundles significantly reduced the incidence of all-stage AKI (OR: 0.78; 95%CI: 0.61-0.99) and moderate-severe AKI (OR: 0.56; 95%CI: 0.43-0.72). Also, the implementation of care bundle increased the incidence of persistent renal dysfunction after 30 days by 2.39 times. However, there were no significant changes in RRT, major adverse kidney events, or mortality between the groups. The mean quality assessment score for observational studies was 7.2 out of ten, while there were noted concerns in the risk of bias assessment of the RCTs.

Conclusions: The application of care bundles in patients, including those undergoing cardiac surgeries as well as non-cardiac critical illness, appears to be effective in reducing AKI, particularly in moderate and severe stages. However, given the inclusion of non-cardiac patients in some studies, the observed effect may not be solely attributable to cardiac surgery cases. Future large-scale RCTs focusing specifically on cardiac surgery patients are recommended to clarify the impact of care bundles within this subgroup.

Registration id in prospero: CRD42024498972.

Background: Managing acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) or end-stage renal disease on dialysis (renal replacement therapy, RRT) presents challenges due to elevated complication risks. Concerns about contrast-related kidney damage may lead to the omission of guideline-directed therapies like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in this population.

Methods: We analysed German-DRG data of 2016 provided by the German Federal Bureau of Statistics (DESTATIS). We included cases with a primary diagnosis of AMI (ST-Elevation Myocardial Infarction (STEMI) or Non-ST-Elevation Myocardial Infarction (NSTEMI) ICD-10: I21 or I22) with and without CKD or RRT. We calculated crude- and age-standardized hospitalization rates (ASR, per 100,000 person years). Furthermore, we calculated log-binominal regression models adjusting for sex, CKD, RRT, comorbidities, and place of residence to estimate adjusted relative-risks (aRR) for receiving treatments of interest in AMI, such as PCI or CABG.

Results: We identified 217,514 AMI-cases (69,728 STEMI-cases and 147,786 NSTEMI-cases). AMI-cases without CKD had percutaneous coronary intervention (PCI) in 60.8%. In contrast, AMI-cases with CKD or RRT had PCI in 46.6% and 54.5%, respectively. The ASR for AMI-cases amounted to 184.7 (95%CI 183.5-185.8) per 100,000 person years. In regression analysis AMI-cases with CKD were less likely treated with PCI (aRR: 0.89 (95%CI 0.88-0.90)), compared to cases without CKD. AMI-Cases with RRT showed no difference in PCI rates (aRR: 1.0 (95%CI 0.97-1.03)) but were more frequently treated with CABG (aRR: 2.20 (95%CI 2.03-2.39)). Conversely, CKD was negatively associated with CABG (aRR: 0.71, 95%CI 0.67-0.75) when non-CKD cases were used as the reference group.

Conclusion: We show that AMI-cases with CKD underwent PCI less frequently, while RRT has no discernible impact on PCI utilization in AMI. Furthermore, AMI-cases with RRT exhibited a higher CABG rate.

Background: Accurate assessment of fluid volume and hydration status is essential in many disease states, including patients with chronic kidney disease. The aim of this study was to investigate the ability of a wearable continuous bioimpedance sensor to detect changes in fluid volume in patients undergoing regular hemodialysis (HD).

Methods: 31 patients with end-stage renal disease were enrolled and monitored with a sensor patch (Re:Balans^®) on the upper back through two consecutive HD sessions and the interdialytic period between. The extracellular resistance R_E was calculated from multi-frequency bioimpedance measurements and was hypothesized to correlate with the amount of extracted fluid during dialysis.

Results: Only HD sessions with a positive net fluid extraction were included in the primary analysis. Participants had an increase of 7.5 ± 4.3 Ω (Ohm) in R_E during the first HD and 6.2 ± 2.3 Ω during the second HD, and a fluid extraction (ultrafiltration (UF) volume) of 1.5 ± 0.8 L and 1.2 ± 0.6 L, respectively. The relative change in R_E during HD correlated strongly with UF volume (r = 0.82, p < 0.001). During the interdialytic period, the patients had a mean decrease in R_E of 6.0 ± 3.5 Ω. Longitudinal changes in R_E (%) and body weight (kg) over the entire study period was negatively correlated (r = -0.61 p < 0.001). Longitudinal changes in blood samples and cardiovascular changes were also in agreement with changes in weight and R_E.

Conclusions: The results of this clinical investigation indicate that the investigational device is capable of tracking both rapid and gradual changes in hydration status in patients undergoing regular HD.

Background: Dialysis recovery time (DRT) refers to the period during which fatigue and weakness subside following hemodialysis treatment, allowing patients to resume their daily routines. This study aimed to identify the factors influencing DRT in hemodialysis patients in Turkey and Portugal, where the prevalence of chronic kidney disease is notably high.

Methods: A cross-sectional observational study was conducted in a private dialysis center in Turkey and three dialysis centers in Portugal. The study included hemodialysis patients aged 18 years or older who had been undergoing four-hour hemodialysis sessions three times a week for at least six months. Participants had no communication barriers and voluntarily agreed to take part in the study. Data were collected using a semi-structured questionnaire to gather descriptive characteristics and the Hospital Anxiety and Depression Scale. Logistic regression analysis was employed to identify independent variables influencing DRT.

Results: A total of 294 patients participated in the study, including 187 from Turkey and 107 from Portugal. In Turkey, increased interdialytic weight gain (P = 0.043) was associated with prolonged recovery time, while the use of high-flux dialyzers (P = 0.026) was linked to shorter recovery times. In Portugal, older age (P = 0.020) was found to extend recovery time.

Conclusion: Recovery time after dialysis is influenced by varying factors across different countries. Further research with larger sample sizes is needed to deepen understanding of these factors and their implications.

Clinical trial number: NCT04667741.

Background: Urinalysis is a commonly performed test for the diagnosis and prognosis of kidney disease in hospitalized patients. It involves examining the chemical composition of the urine and microscopy to examine the cells and casts. In clinical settings, urinalysis is frequently delayed by several hours after sample collection and held at room temperature. The purpose of this study is to investigate the changes in urine composition over set time intervals to confirm the reliability of urinalysis when there are delays in performing the tests.

Methods: We obtained 15 mL of urine from the Foley catheters of five patients in the intensive care unit. We utilized the state-of-the-art IDEXX SediVue Dx ® machine to perform urine microscopy and the Siemens CLINITEK Status + Urine Analyzer to perform the dipstick tests. We performed microscopy and dipstick tests at 0, 1, 2, 4, and 6 h. Between the two testing methods, 30 individual components were tested in the urine. We calculated the %CV for each component by taking four repeated measurements at one time period for multiple samples.

Results: After calculating the %CV for each component, we analyzed the trend for each constituent over the 6 h. If the percent change over the six-hour interval was ± twofold than the %CV, we determined time to influence the results. Significant changes were seen in bacteria as the levels increased, red blood cells and pathological casts where the level decreased, and crystal levels were determined inconclusive due to fluctuations in the results. All other components were found to remain unchanged.

Conclusions: Timely urine analysis is necessary for accurate results as delayed analysis can considerably change the makeup of urine, which can affect clinical decisions and patient management.

Background: The effects of acute kidney injury (AKI) on liver-related outcomes in patients with hepatitis B virus (HBV) infection remain unclear. The study aimed to evaluate the association between AKI with liver-related mortality and complications in patients with HBV infection.

Methods: The multicenter, retrospective cohort study included Chinese adults with HBV infection from 24 regional central hospitals between January 2000 and December 2022. AKI was defined as a ≥ 26.5 μmol/l increase in serum creatinine concentration within 48 h, or a ≥ 50% increase over the baseline within 7 days. The primary outcome was post-discharge liver-related mortality, while the secondary outcome was a composite of new-onset liver cirrhosis and hepatocellular carcinoma. Cox proportional hazard model was employed for analyses.

Results: Of the 86,204 inpatients with HBV infection and without liver cancer or cirrhosis at baseline, 4407(5.1%) patients experienced AKI. During a mean follow-up of 4.6 ± 2.4 years, 334 (0.4%) patients died of liver-related events. After adjustment, AKI during hospitalization was significantly associated with a higher risk of liver-related mortality after discharge (adjusted hazard ratio (HR), 1.78; 95% confidence intervals (CI), 1.26-2.51, P = 0.001), especially in those with severe AKI. Similarly, AKI was associated with a higher risk of cirrhosis or new-onset hepatocellular carcinoma (adjusted HR, 1.33; 95%CI, 1.10-1.60, P = 0.004). The association between AKI and liver-related outcomes remained consistent across different subgroups.

Conclusions: AKI during hospitalization was associated with substantial increased risk of liver-related mortality and incident liver-related complication. Our findings highlight the importance of monitoring AKI in patients with HBV infection for tailoring personalized treatments.