BMC Nephrology最新文献

Background: Frailty is a state of vulnerability to poor homeostatic resolution of after a stressful event. The prevalence of frailty in patients with chronic kidney disease (CKD) is more common than in the general population. Frailty is associated with a poor clinical prognosis, malnutrition, and cognitive impairment; however, studies on these factors in patients with CKD are lacking. Therefore, we aimed to evaluate the relationship between CKD and frailty, nutritional status, and cognitive impairment and their influence on clinical outcomes.

Methods: We prospectively enrolled participants from June 2019 to December 2020 and divided them into three CKD groups according to kidney function (CKD G1-2, CKD G3-4, and CKD G5D). Clinical outcomes were defined as the composite outcomes of all-cause death, hospitalization, and cardiovascular outcomes, including nonfatal myocardial infarction, revascularization, or stroke. To calculate the relative risk of frailty, cognitive impairment, nutritional status, and clinical outcome, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression analysis.

Result: A total of 83 patients were included, of whom 31.3% had frailty and 18.1% had cognitive impairment. In the CKD G5D group, the prevalence of frailty (56.7%, n = 17) was significantly higher, and the nutritional quotient score was lower in the other groups. The Korean-Montreal Cognitive Assessment score was significantly lower in the CKD G5D group; however, cognitive impairment did not differ among the three groups. Frailty was significantly associated with cognitive impairment and CKD G5D group. Cognitive impairment was significantly associated with older age and higher BMI. Well-nourished status was significantly associated with BMI and CKD G5D group. Patients in the CKD G5D group were significantly more likely to have adverse clinical outcomes.

Conclusions: The prevalence of frailty increased significantly as the CKD stage progressed. Particularly, CKD G5D group correlated with frailty and nutritional status, leading to poor clinical outcomes.

People with type 2 diabetes are at risk of developing progressive diabetic kidney disease (DKD) and end stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Slowing progression of kidney disease and reducing cardiovascular events can be achieved by a number of means including the targeting of blood pressure and the use of specific classes of drugs The use of Renin Angiotensin Aldosterone System (RAAS) blockade is effective in preventing or slowing progression of DKD and reducing cardiovascular events in people with type 2 diabetes, albeit differently according to the stage of DKD. However, emerging therapy such as non-steroidal selective mineralocorticoid antagonists (finerenone) is proven to lower blood pressure and further reduce the risk of progression of DKD and cardiovascular disease in people with type 2 diabetes. This consensus reviews current evidence and make recommendations for the use of finerenone in the management of diabetes kidney disease in the UK.

Future investigations on the association between insulin resistance in people without diabetes and chronic kidney disease (CKD) should consider the following aspects to facilitate causal inference and provide more robust findings. The study design should have an adequate follow-up period to rule out reverse causation and pre-existing diabetes, as well as to confirm the diagnosis of CKD. Known causes of CKD and relevant covariates should be identified where possible. Homeostasis model assessment of insulin resistance (HOMA-IR), being an indirect measure of insulin resistance, has limited sensitivity and specificity compared to direct methods like the hyperinsulinaemic-euglycaemic clamp. Regression modelling with HOMA-IR quartiles instead of continuous form may have masked more nuanced relationships. Sensitivity analyses, such as spline regression, could provide more insights about the association and mechanism. Propensity score methods could help address the inadequate overlap in covariate distributions, if present, by ensuring covariate balance. When investigating the CKD diagnostic performance of HOMA-IR, its cut-off for clinically meaningful insulin resistance should be well justified or comprehensively explored to improve the reliability of the results.

Background: Despite advances in kidney transplant surgery and immunosuppression, lymphoceles remain a frequent complication in the early postoperative period following kidney transplantation, often requiring reintervention. While long-term outcomes such as patient and allograft survival are well studied, the impact of lymphocele formation on mid-term allograft function remains unclear.

Methods: This multicentric study included 711 recipients of living donor kidney transplants to investigate the impact of lymphocele formation on mid-term graft function. Outcomes assessed included estimated glomerular filtration rate (eGFR) at 12 months, eGFR slope, and both patient and allograft survival.

Results: Lymphoceles were detected in 17.4% of the recipients, with a median volume of 129 ml, and 71.8% of these patients required intervention. Patients without lymphocele formation had a significantly higher median eGFR at 12 months (52.1 ml/min/1.73 m²) compared to those with lymphoceles (48.7 ml/min/1.73 m²). Additionally, patients with lymphocele formation demonstrated a steeper median eGFR slope (-2.3 ml/min/1.73 m²/year) than those without (-0.3 ml/min/1.73 m²/year). No significant difference was observed in the composite outcome of allograft survival and patient death between the two groups.

Conclusion: Lymphocele formation after living donor kidney transplantation is associated with a steeper decline in graft function. They may reflect a disturbed microvasculature and warrant closer control of cardiovascular risk factors and allograft monitoring of affected patients.

Clinical trial details: Not applicable, the study is not a clinical trial.

Purpose: To identify the relationship of triglyceride-glucose (TyG) index with clinical outcomes in chronic kidney disease (CKD) patients based on current available evidence.

Methods: PubMed, EMBASE, Web of Science and CNKI databases were searched up to August 31, 2024. Primary outcome was the all-cause mortality. Secondary outcomes included the coronary artery disease (CAD) mortality, CKD progression, risk of severe coronary artery stenosis (SCAS), major adverse cardiovascular event (MACE), coronary artery calcification (CAC) progression, end-stage renal disease (ESRD), and nonalcoholic fatty liver disease (NAFLD). The hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were combined to assess the predictive role of TyG index for above clinical outcomes among CKD patients. All statistical analysis was performed by STATA 15.0 version.

Results: Twelve studies with 26,530 cases were included. Pooled results indicated that elevated TyG index was significantly related to increased risk for all-cause mortality (HR = 1.22, 95% CI: 1.13-1.31, P<0.001). Besides, high TyG index was also associated with the CAD mortality (HR = 1.19, 95% CI: 1.04-1.36, P = 0.011), occurrence of CKD progression (HR = 1.52, 95% CI: 1.36-1.70, P<0.001), SCAS (OR = 1.79, 95% CI: 1.13-2.83, P = 0.013), MACE (OR = 1.68, 95% CI: 1.11-2.54, P = 0.014), CAC progression (OR = 1.55, 95% CI: 1.06-1.76, P = 0.02), CAD (OR = 2.865, 95% CI: 1.681-4.885, P<0.001), ESRD (OR = 1.49, 95% CI: 1.12-1.99, P = 0.006) and NAFLD (OR = 4.903, 95% CI: 3.046-7.893, P<0.001).

Conclusion: High TyG index predicts poor clinical outcomes and might serve as a novel prognostic indicator among CKD patients. However, more studies are still needed to verify above findings.

Background: Volume overload is a major mortality risk in hemodialysis (HD) patients. Drug therapy and conventional dialysis limitations underscore the importance of managing volume load through effective lifestyle interventions. In this regard, WeChat, along with its built-in self-monitoring function, has demonstrated considerable potential for application. WeChat, a versatile social media platform in China, integrating Facebook, WhatsApp, Twitter, and PayPal functionalities, shows potential in managing volume load, especially when paired with home monitoring. This method may also reduce adverse events and improve patient outcomes.

Method: The study will be conducted at the Hemodialysis Center of the Hospital of Chengdu University of Traditional Chinese Medicine, recruiting 135 participants. All patients will be cluster randomly assigned to three group according to their HD schedules. The control group will receive standard care. The WeChat group will receive volume load management via WeChat message in addition to standard care. The home monitoring-feedback group will be required to monitor their blood pressure and weight at home, and upload the number to WeChat subscription account "Health Dialysis" in addition to standard care and volume load management via WeChat message. Data will be collected during the baseline period, one, two, and three months after the intervention starts, and three months after the intervention ends to evaluate the effectiveness of this intervention measure.

Discussion: This study aims to effectively manage the volume load of HD patients and enhance their quality of life through a combination of intervention methods utilizing the WeChat platform and home monitoring. If this intervention measure proves effective, it will not only provide empirical evidence for managing HD patients through the WeChat platform but also serve as a reference model for other HD centers in addressing patient volume load issues. What's more, if significant differences are observed between the results of the WeChat groups and the home monitoring-feedback group, this will further substantiate the importance and impact of home monitoring in volume load management.

Trial registration: ClinicalTrials.gov (NCT06333574). Registered 13 March 2024.

Background: Lithium is extensively used for mood stabilization in bipolar disorder, but its long-term use can lead to nephrotoxicity, characterized by a reduction in glomerular filtration rate (GFR) and potential progression to end-stage renal disease (ESRD). Exercise has been shown to have protective effects on renal function, yet the impact of varying exercise intensities on lithium-induced nephropathy is not well understood.

Aim: This study aimed to investigate the effects of different intensities of endurance training on kidney function and inflammation in a rat model of lithium-induced nephropathy, focusing on the expression of aquaporin 2 (AQP2), glycogen synthase kinase 3-beta (GSK-3β), and SIRT1.

Methods: Thirty-five male Wistar rats were divided into five groups: control, lithium-only, lithium with low-intensity exercise (LIT), lithium with medium-intensity exercise (MIT), and lithium with high-intensity exercise (HIT). The lithium-induced nephropathy model was established by administering lithium in food. Exercise groups underwent treadmill training at specified intensities for eight weeks. Fractional excretion of sodium (FENa) was measured, and GFR was evaluated by Cr clearance. ELISA and Western blotting assessed inflammatory markers (TNF-α, IL-10), SIRT1, GSK-3β, and AQP2 expressions in kidney tissues.

Results: Lithium significantly reduced Cr clearance and increased FENa compared to controls. All exercise intensities improved Cr clearance and reduced FENa, with HIT showing the most significant improvement. Exercise at all intensities reduced TNF-α levels and increased IL-10 levels, with MIT and HIT significantly enhancing SIRT1 levels. Lithium reduced the expression of GSK-3β and AQP2, whereas exercise increased their expression across all intensities.

Conclusion: Endurance training, particularly at high intensity, significantly mitigates lithium-induced renal impairment by improving GFR, reducing inflammation, and enhancing the expression of renal protective proteins. These findings suggest that tailored exercise regimens could be beneficial for patients undergoing long-term lithium therapy to prevent renal damage.

Clinical trial number: Not applicable.

Objective: To promote the application of high-quality frailty risk prediction models in the field of debilitation among Chinese patients undergoing MHD, and to provide a basis for optimisation and improvement of future studies.

Methods: A literature search was conducted in Chinese and English databases (PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, Wanfang, VIP, SinoMed) and the cutoff date for which was April 30, 2024. Literature characteristics, types of studies, predictors, model construction methods and results were analysed and compared.

Results: Ten studies met the inclusion criteria, and seven were focused on model development and validation. A total of 12 predictive models were included across these 10 studies; three of these were solely model development studies, while seven were both model development and validation. The area under the curve (AUC) for the subjects' operating characteristics was > 0.7 in all ten studies. The most frequently identified predictors in the models included age, nutritional status, the presence of multimorbidity, gender, and depression. While the overall applicability of the ten studies was deemed satisfactory, it is important to note that all studies exhibited a high risk of bias, particularly concerning the data analysis component.

Conclusion: The frailty risk prediction models for patients undergoing maintenance hemodialysis have demonstrated satisfactory applicability; however, they are all associated with a significant risk of bias and lack comprehensive external validation. To develop more accurate and practical prediction models, future studies must rely on large-sample, multicenter prospective cohort studies and adhere to a rigorous study design.

Clinical trial number: Not applicable.

Background: Monoclonal gammopathy of renal significance (MGRS) represents a range of disease processes arising from monoclonal proteins depositing in the kidney. These deposits vary and can be broadly grouped as containing a substructure or being non-organised. Their clinical phenotype can include proteinuria, haematuria, kidney injury and tubulopathies resulting in electrolyte changes.

Case presentation: Crystal storing histiocytosis (CSH) is a rare form of MGRS that typically deposits in the interstitium but rarely in the glomerulus to cause progressive kidney disease. We report a case of a male with known monoclonal protein and progressive proteinuria, whose biopsy showed glomerular histiocytosis with non-crystallizing IgG kappa inclusions.

Conclusion: This case reviews an unusual case of a glomerular histiocytosis with non-crystallizing IgG kappa inclusions.

Objective: This study aimed to analyze the associations between depressive and anxiety symptoms and risk of incident kidney failure in patients with biopsy-proven diabetic nephropathy (DN).

Methods: This retrospective study enrolled 241 type 2 diabetic patients with biopsy-proven DN. Huaxi Emotional-Distress Index (HEI) was used to evaluate the depression and anxiety status of patients on admission. According to the HEI score, DN patients were divided into HEI score ≤ 8 group (without depression and anxiety) and HEI score > 8 group (with depression and anxiety). The study endpoint was defined as progression to kidney failure. The cox proportional hazard analysis was performed to investigate the risk factors for progression to kidney failure in DN patients.

Results: Twenty-three patients had HEI score > 8, accounting for about 9.5% of all patients. Compared with HEI score ≤ 8 group, those with HEI score > 8 had more severe proteinuria, higher systolic blood pressure, and lower baseline eGFR and serum albumin levels. During a median follow-up of 28 months, the outcome event occurred in 89 (36.9%) of all the patients. After multivariable adjustment, HEI score > 8 (HR 1.825, 95% CI 1.050-3.172) was associated with an increased risk of progression to kidney failure.

Conclusion: Depressive and anxiety symptoms might be associated with an increased risk of progression to kidney failure in patients with DN, which implied psychosocial issues should be early screened, assessed and intervened to delay the progression of DN.