BMC Nephrology最新文献

Background: Nephrotic syndrome (NS) is a clinical condition that results from the renal loss of protein exceeding the body's compensatory abilities. Dysproteinemia in the acute phase of the disease inevitably affects the nutritional status of children. It is unclear whether the situation will fully normalize in remission. The aim of the study was to assess the serum concentrations of retinol binding protein 4 (RBP4) and prealbumin (PA), as well as the body composition parameters in children with NS in remission in comparison to healthy counterparts.

Methods: Thirty nephrotic children at the age of 11.9 ± 4.6 years were enrolled and compared to healthy counterparts. RBP4 and PA serum concentrations together with selected basic biochemical parameters, were determined. Body composition parameters were determined based on the bioimpedance method using the Tanita MC-980MA device.

Results: In NS children the mean RBP4 concentration was 42.6 ± 11.6 mg/l, and mean PA concentration was 540.1 ± 442.1 µg/ml, and those values did not differ significantly from those in the control group (42.0 ± 10.9 mg/l and 372.8 ± 107.9 µg/ml, respectively). RBP4 concentration correlated positively with the age of the studied patients, while PA was not associated with age. Both studied markers did not show significant differences depending on the remission status - maintained with immunosuppressive therapy vs. without active treatment, as well as on the categorization according to the clinical course - steroid-sensitive NS vs. frequently relapsing or steroid-dependent NS. Based on bioimpedance measurements, the parameters characterizing body composition did not differ between NS group and controls.

Conclusions: RBP4 and PA, which can be considered as selected biochemical markers of nutritional status, as well as body composition measures based on the bioimpedance, do not indicate differences between children with remission of idiopathic NS and their healthy peers. Successful induction and maintenance of NS remission restores the assessed aspects of nutritional status of these children.

Background: Chronic kidney disease (CKD) has detrimental effects on health through multiple pathophysiological mechanisms, significantly reducing life expectancy and contributing to a substantial disease burden. Therefore, this study aims to explore the association of metabolic syndrome (MetS) and hyperuricemia (HUA) with all-cause and cardiovascular mortality in patients with chronic kidney disease (CKD).

Methods: Overall, 28,278 patients with CKD, defined by estimated glomerular filtration rate < 60 mL/min/1.73 m² or urine albumin creatinine ratio > 3 mg/mmol, MetS (≥ 3 of 5 criteria), and HUA (> 7.0 mg/dL in males, > 6.0 mg/dL in females) were assessed. The outcomes included all-cause and cardiovascular mortality. Associations were assessed using multivariate-adjusted Cox proportional hazards models and Kaplan-Meier survival analysis, supplemented by subgroup analyses and sensitivity tests.

Results: During a median follow-up of 13.21 years, 3564 all-cause deaths (17.28%) were recorded, including 1025 (4.97%) attributable to cardiovascular causes. After multiple adjustments, both HUA and MetS were strongly associated with all-cause and cardiovascular mortality. Patients with CKD and coexisting HUA or MetS exhibited a significantly higher risk of all-cause mortality (adjusted hazard ratio [aHR] = 1.45, 95% confidence interval [CI]: 1.30-1.62) and cardiovascular mortality (aHR = 2.09, 95% CI: 1.70-2.58) than those without HUA or MetS. Kaplan-Meier curves demonstrated that elevated uric acid levels and a high number of MetS components significantly reduced survival probability (P < 0.001), with an increasing trend as the uric acid levels and the number of MetS components increased. Subgroup and sensitivity analyses confirmed the robustness and consistency of our findings.

Conclusion: MetS and HUA significantly increased all-cause and cardiovascular mortality in patients with CKD, particularly in those with high uric acid levels and a high number of MetS components.

Clinical trial number: Not applicable.

Purpose: Chronic kidney disease (CKD) is a global health issue, and hemodialysis (HD) is the most commonly used dialysis method. Incremental HD has been proposed as an alternative, but evidence on its safety and benefits is limited. This study compared residual kidney function (RKF) preservation in patients undergoing incremental versus standard HD, also evaluating quality of life, hospitalizations and mortality.

Methods: This retrospective, longitudinal, observational case-control study included stage 5 CKD patients who started either incremental or standard HD between January 2021 and January 2023. The case group included patients who began incremental HD (2 weekly sessions lasting 4 h or 3 weekly sessions lasting < 3.5 h), and the control group included patients who started standard HD schedule (thrice-weekly, minimum 4-hour sessions). The groups were matched by age, sex, underlying disease, comorbidities, and baseline lab values.

Results: 80 patients were included (50% male; mean age 63.8 ± 11.9 years). Diabetes (32.5%) and hypertension (22.5%) were the main underlying conditions. Over two years, 3.8% had kidney transplants, 6.2% died, and 2.5% recovered kidney function. 45% of incremental HD patients retained RKF; none did in the standard HD schedule group. Incremental group had fewer infections, longer time free from loss of RKF than control group and better quality of life. No differences were found in cardiovascular events, mortality, or transplantation. RKF preservation was associated with incremental HD, higher albumin, and absence of bloodstream infections.

Conclusion: Starting HD with an incremental may better preserve RKF without compromising survival, while improving quality of life. Further clinical trials are needed to evaluate the safety and effectiveness of incremental HD and support its broader, patient-centered use.

Clinical trial number: Not applicable.

Background: There is a need for a user-led, evidence-based digital application (app.) that meets the identified information and support needs and preferences of young people and young adults aged 12-35 years (YP/YA) with Nephrotic Syndrome (NS) in the United Kingdom (UK). The password protected novel Nephrotic Syndrome Trust (NeST) app was therefore co-designed with YP/YA with NS to empower them to: access news of NS related events, take more control of their treatment and feel confident in sharing and accessing their data. The app allows YP/YA with NS to record regular urine dipstick readings, blood pressure, weight, temperature, medications, immunisations, symptoms (e.g. swollen feet), relapse or remission episodes, and the name of their renal unit. Additional features include an appointment diary to record feedback from their renal multidisciplinary team, treatment information and hospital admission episodes. The software was approved for release on iOS & Android app stores and the NHS Digital verification programme, meaning that users can be identified against their NHS records. The aim of the survey was to evaluate the NeST App from the perspective of YP/YA with NS.

Methods: Through a consultative process, an online survey involving a combination of closed and open-ended questions was created and circulated via social media and email to target users of the app.

Results: Twenty YP/YA with NS aged 12 years and older tested the app, completed the survey and provided quantitative and qualitative data. All found this app helpful, and easy to use and all would use it in future as part of standard practice.

Conclusions: These data provide important feedback and suggestions for further app refinement and will integrate it with current national data collection via the UK Renal Registry (UKRR). To build on this collaborative project the developers will continue to collaborate with patients and health care professionals to ensure the app is a continually evolving and relevant resource, providing a voice for those living with NS. The app technology could potentially be rebooted and relaunched at minimal cost to support patients with other kidney conditions.

Clinical trial number: Not applicable.