BMC Nephrology最新文献

Background and hypothesis: Transition onto kidney replacement therapy (KRT) is a complex, intensive phase for patients with advanced chronic kidney disease (CKD), characterised by high healthcare utilisation. Frequent outpatient visits, surgical and radiological procedures, hospitalisations and haemodialysis (HD) sessions impose a significant time burden on patients. The concept of time toxicity is widely described in oncology, and captures the disruption to patients' lives due to treatment-related demands. We aimed to quantify time- based healthcare workload during the transition onto KRT and identify patient characteristics associated with increased workload.

Methods: We conducted a retrospective cohort study including all consecutive adults initiating KRT (haemodialysis (HD), peritoneal dialysis (PD), or pre-emptive transplantation (KTx)) in the Glasgow Renal and Transplant Unit between January 2015 and December 2019. Routinely collected electronic health record data were used to estimate time spent per month on healthcare-related activities (outpatient appointments, radiology, inpatient admissions, HD sessions, and travel) from 6 months pre- to 36 months post-KRT initiation. Workload was analysed as a time-based outcome (hours/month). Univariate analysis used Kruskal-Wallis testing; multivariate modelling employed negative binomial regression.

Results: A total of 1,022 patients (58.6% male; median age 61 years) contributed over 1.1 million patient-days. Median healthcare workload peaked around KRT initiation and was highest in HD patients. Kidney transplantation was associated with markedly lower workload post-initiation (IRR 0.04). Increased workload was associated with female sex, polypharmacy (> 15 medications), late referral, older age (in maintenance phase), and modality change or failed transplant. Socioeconomic deprivation and primary renal disease were not significantly associated with higher workload.

Conclusion: Healthcare workload during KRT transition is substantial and varies widely. Transplantation is associated with significantly lower workload. These findings support timely transplant planning and underscore the importance of considering the time burden of healthcare experienced by patients when discussing treatment options.

Clinical trial number: Not applicable.

Background: Sarcopenia can severely affect patients undergoing maintenance hemodialysis. A high-quality prediction model could facilitate early identification and prevention. Despite the growing number of risk prediction models for sarcopenia in these patients, their quality and clinical utility remain uncertain.

Objective: This study aims to systematically review existing studies on risk prediction models for sarcopenia in maintenance hemodialysis patients.

Methods: A comprehensive literature search was conducted across PubMed, Web of Science, Embase, The Cochrane Library, CINAHL, CNKI, VIP, CBM, Wanfang databases, and Clinical Trials.gov from their inception until May 12, 2024. Studies on sarcopenia risk prediction models for maintenance hemodialysis patients were included. Two independent reviewers screened studies using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and the CHARMS checklist, applying predefined inclusion and exclusion criteria. Relevant data were extracted, and the risk of bias in the included studies was assessed.

Results: Eighteen studies, encompassing 21 prediction models, were included. Sample sizes ranged from 60 to 805 participants, with outcome event incidence rates varying between 6.6% and 70.0%. The reported risk factors were age, gender, body mass index, grip strength and so on. The area under the receiver operating characteristic curve (AUC) for the models ranged from 0.73 to 0.955. Most studies had a high risk of bias, primarily due to issues related to study population selection and data analysis, including inappropriate data sources, insufficient outcome events, and poor management of missing data. Only two studies raised concerns regarding applicability.

Conclusion: Current models for predicting sarcopenia in maintenance hemodialysis patients exhibit a high risk of bias, as determined by PROBAST criteria. Future research should focus on improving existing models or developing new ones using rigorous methodologies.

Registration: This study is registered with PROSPERO (registration number: CRD42024544944).

Clinical trial number: Not applicable.

Background: Home-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been suggested to reduce SARS-CoV-2 infection rates and improve outcomes compared to in-center dialysis, yet evidence from China remains scarce.

Objective: To investigate the risk and prognosis of Omicron infection among patients receiving home-based dialysis versus in-center dialysis during the Omicron surge in Shanghai, China.

Methods: This single-center retrospective cohort study included patients undergoing maintenance dialysis (home-based dialysis or in-center dialysis) at Ren Ji Hospital from December 1, 2022, to January 31, 2023. The primary endpoint was Omicron infection rate; secondary endpoints included infection timeline, all-cause mortality, and associated risk factors. Logistic regression was used to identify independent predictors.

Results: A total of 465 patients were included: 267 in the home-based dialysis group (263 PD, 4 HHD) and 198 in the in-center dialysis group. The infection rate was significantly lower in the home-based dialysis group than in the in-center dialysis group (52.1% vs. 88.4%, P < .001). Home-based dialysis was an independent protective factor against infection. No significant difference was found in all-cause mortality between home-based dialysis and in-center dialysis groups (5.2% vs. 7.6%, P = .304). Advanced age, heart failure, and low serum albumin were associated with increased risk of death following infection.

Conclusions: Home-based dialysis significantly reduced the risk of Omicron infection without adversely affecting survival outcomes. Expanding home-based dialysis may have public health implications for dialysis care during future pandemics.

Background: Hepatocyte nuclear factor 1β (HNF1B) pathogenic variants constitute a major genetic contributor to congenital anomalies of the kidney and urinary tract (CAKUT), with patients simultaneously exhibiting distinct extrarenal features. Among these clinical manifestations, renal disease progression is crucial for long-term outcomes, needing comprehensive evaluation.

Methods: Using the Chinese Children Genetic Kidney Disease Database (2017-2024), we analyzed 26 pediatric HNF1B cases to characterize renal phenotypes and genotype correlations.

Results: All patients exhibited abnormal renal phenotypes at diagnosis: renal cysts (50%) and multicystic dysplastic kidney (MCDK) (37.5%). Genetic analysis revealed 16 patients (61.5%) had a 17q12 deletion including the HNF1B gene, while the remaining carried HNF1B intragenic pathogenic variants, including a novel c.1390-1405dup. Comparing phenotypic trajectories, 17q12 deletion cases showed earlier renal phenotype onset (median age: 0 vs. 1 year 11 months, p = 0.121), while HNF1B variants showed faster renal function deterioration (latest eGFR: 85 vs. 45.6 mL/min/1.73 m², p = 0.11). Three of five CKD 5 children underwent kidney transplantation before 15; one developed reversible tacrolimus-induced hyperglycemia.

Conclusion: Our results suggest a potential trend wherein the 17q12 deletion may be associated with a higher prevalence of developmental renal anomalies, while HNF1B pathogenic variants might correlate with an increased risk of tubular dysfunction, indicating possible distinct genotype-phenotype correlations. Based on these observations, we recommend that affected families receive tailored clinical management, including prenatal counseling, genotype-specific monitoring, and regular renal function assessment.

Background: The relationship between uric acid and chronic kidney disease (CKD) progression remains unclear. To study the association between the serum uric acid-to-24-hour-urinary urate excretion ratio (SUER) and kidney events in patients experiencing chronic kidney disease (CKD) progression.

Methods: A retrospective cohort study involving 165 CKD patients with estimated glomerular filtration rates (eGFRs) between 15 and 150 mL/min/1.73 m² was conducted at Huadong Hospital, Fudan University (Shanghai, P. R. China). The exposure variable was the SUER, whereas the outcome was a renal endpoint event, defined as a 50% decrease in eGFR from baseline, initiation of renal replacement therapy, or death during follow-up. Both univariate and multivariate logistic regression analyses were performed in the entire cohort and in male subgroups with or without diabetes mellitus. Forest plots were drawn to visualize the odds ratios (ORs) derived from multivariate regression analysis, and receiver operating characteristic (ROC) curves were constructed. And we divided the male non-diabetic population into low UACR group and high UACR group based on the median UACR, and conducted a univariate analysis of the differential variables. P < 0.05 was considered to indicate statistical significance.

Results: The general population aged 56.45 ± 15.76 years, and of which 65 (39.39%) CKD patients are females. The SUER was not the risk of experiencing renal endpoint events in the overall population (OR = 1.05; 95% CI: 0.680, 1.621; P = 0.826), but was an associated factor of renal endpoint events in males without diabetes (OR = 2.196; 95%CI:1.191,4.052; P = 0.012).

Conclusions: An increased SUER may be an indicator for kidney function decline in male CKD patients without diabetes. Further studies should focus on subgroup analyses of CKD patients particularly in male CKD patients without diabetes to evaluate whether uric acid-lowering measures are warranted.

Clinical trial number: Not applicable.

Background: Hemodialysis is a common renal replacement therapy for patients with end-stage renal disease (ESRD). The common types of vascular access mainly include arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC). However, the association between different access types and all-cause mortality remains controversial. Accordingly, this study aims to systematically assess the effect of different vascular access on mortality among hemodialysis patients with ESRD, thereby providing evidence-based recommendations for optimal vascular access strategies in clinical settings.

Methods: The systematic searches in PubMed, Embase, Cochrane Library and Web of Science were employed to determine the cohort study or randomized controlled trials comparing the effects of AVF, AVG, or CVC on mortality in patients undergoing hemodialysis. A total of 33 studies were included.

Results: Meta-analysis results showed the following: (1) All-cause mortality: Compared to AVF, CVCs significantly increased all-cause mortality. AVGs also increased all-cause mortality. (2) Cardiovascular events mortality: Compared to AVF, CVCs and AVGs showed a trend toward higher cardiovascular mortality, but the differences were not statistically significant. (3) In-hospital mortality: Compared to patients without vascular access, AVF was associated with increased in-hospital mortality. (4) Infection-related mortality: Compared to AVF, CVCs significantly increased infection-related mortality.

Conclusion: Compared with CVCs and AVGs, AVF remains the lowest mortality risk. Early planning and education regarding vascular access are essential to improve long-term outcomes in hemodialysis patients.

Introduction: Uremia and Kidney Renal Clear Cell Carcinoma (KIRC) are two significant health conditions that place a considerable burden on patients globally. This study aims to identify and validate common hub genes in uremia and KIRC, investigate their molecular roles, and explore their potential as biomarkers for diagnosis and prognosis.

Method: We retrieved two publicly available datasets (GSE37171 for uremia and GSE66272 for KIRC) from the Gene Expression Omnibus (GEO) and identified differentially expressed genes (DEGs) using the limma package in R. A Venn analysis was conducted to identify shared DEGs between the two conditions. The identified genes were subjected to protein-protein interaction (PPI) network construction using the STRING database and Cytoscape software, followed by hub gene identification with the CytoHubba plugin. Hub gene expression was validated in 9 KIRC cell lines and 5 normal control kidney cell lines using RT-qPCR. Functional assays, including gene knockdown, cell proliferation, colony formation, and wound healing assays were performed.

Results: A total of 114 shared DEGs were identified between uremia and KIRC. ALDH18A1, CALU, DERL1, and SUCLG2 were identified as hub genes with the highest connectivity in the PPI network. These genes were significantly upregulated in KIRC cell lines compared to normal controls. Validation using the KIRC TCGA dataset confirmed their upregulation in tumor samples and across different KIRC subtypes. Further analyses revealed hypomethylation of the hub genes, along with significant mutation frequencies and CNV amplifications. High expression of these hub genes was associated with poor survival in KIRC patients, and their correlation with immune cells and drug resistance was also observed. Gene knockdown of ALDH18A1 and CALU in 786-O and Uremic-786-O significantly reduced cell proliferation, colony formation, and migration, emphasizing their role in KIRC and Uremia pathogenesis. Additionally, silencing these genes decreased the expression of PDK1 and IDH1, key activators of the Citrate cycle, suggesting their involvement in metabolic dysregulation in KIRC.

Conclusion: This study identifies ALDH18A1, CALU, DERL1, and SUCLG2 as potential biomarkers for KIRC diagnosis and prognosis. Our findings suggest that these hub genes are involved in the dysregulation of key metabolic pathways, including the citrate cycle, and may serve as therapeutic targets in KIRC.

Clinical trial number: Not applicable.