首页 > 最新文献

Canadian Journal of Kidney Health and Disease最新文献

英文 中文
Prediction of Acute Kidney Injury After Cardiac Surgery With Combined Arterial and Venous Intrarenal Doppler. 动脉、静脉联合肾内多普勒预测心脏手术后急性肾损伤。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-23 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241309976
Cameron Giles, Karel Huard, André Denault, William Beaubien-Souligny
<p><strong>Background: </strong>Acute kidney injury (AKI) occurs in up to 50% of cardiac surgical patients and is often hemodynamically mediated. Point-of-care ultrasound is a non-invasive tool that has the potential to characterize intrarenal hemodynamics and predict the risk of AKI.</p><p><strong>Objectives: </strong>We aimed to determine the predictive characteristics of intrarenal arterial and venous Doppler markers for postoperative AKI in cardiac surgical patients.</p><p><strong>Design: </strong>This study is the secondary analysis of a prospective cohort study.</p><p><strong>Setting: </strong>This study is carried out in a care academic cardiac surgical center in Montreal, Quebec, Canada.</p><p><strong>Patients: </strong>Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.</p><p><strong>Measurements: </strong>Point-of-care ultrasound assessments were performed preoperatively and at intensive care unit admission. Arterial measurements included the renal resistive index (RRI) and intrarenal artery velocity-time integral normalized to peak systolic velocity (VTI/PSV). Venous measurements included intrarenal venous flow (IRVF) pattern and renal venous stasis index (RVSI).</p><p><strong>Methods: </strong>We used area under the receiving operating characteristic curves (AUCs) with net reclassification index (NRI) and multivariable logistic regression to determine predictive characteristics for postoperative AKI. Furthermore, we used hierarchical clustering to identify potential groups with similar Doppler parameters and performed comparisons of patients' characteristics and outcomes between groups.</p><p><strong>Results: </strong>We included 136 patients with 47 (34.6%) developing postoperative AKI. At intensive care unit admission, arterial indices showed similar discrimination for the prediction of AKI (RRI: AUC = 0.64; 95% confidence interval (CI) = 0.55 to 0.74; and VTI/PSV: AUC = 0.67; 95% CI = 0.57 to 0.77). Venous Doppler indices including IRVF patterns (AUC = 0.64; 95% CI = 0.53 to 0.74) and RVSI (AUC = 0.60; 95% CI = 0.50 to 0.71) also showed similar performance. The combined model of RRI and IRVF pattern (AUC = 0.69; 95% CI = 0.59 to 0.78) improved the prediction of AKI compared to either RRI (NRI = 0.50; 95% CI = 0.17 to 0.84) or IRVF pattern (NRI = 0.38; 95% CI = 0.04 to 0.70) alone. Through hierarchical clustering, we identified 3 groups (1: low RRI, 2: high RRI/low RVSI, and 3: high RRI/high RVSI) with different patient characteristics and outcomes. The patient in group 3 had a higher risk of AKI and worse clinical outcomes compared with other groups.</p><p><strong>Limitations: </strong>Single-center design in cardiac surgical patients limits generalizability.</p><p><strong>Conclusions: </strong>Although more complex indices of intrarenal Doppler indices including the VTI/PSV and RVSI did not improve prediction of postoperative AKI, combining RRI and IRVF pattern improved risk prediction for AKI. Intrar
背景:多达50%的心脏手术患者会出现急性肾损伤(AKI),通常是由血流动力学介导的。护理点超声是一种无创工具,有可能描述肾内血流动力学特征并预测 AKI 风险:我们旨在确定肾内动脉和静脉多普勒标记物对心脏手术患者术后 AKI 的预测特性:本研究是一项前瞻性队列研究的二次分析:本研究在加拿大魁北克省蒙特利尔市的一家心脏外科护理学术中心进行:使用心肺旁路进行心脏手术的成人患者:术前和入重症监护室时进行护理点超声评估。动脉测量包括肾脏阻力指数(RRI)和肾内动脉速度-时间积分归一于收缩峰值速度(VTI/PSV)。静脉测量包括肾内静脉流量(IRVF)模式和肾静脉淤血指数(RVSI):我们使用接受操作特征曲线下面积(AUC)和净再分类指数(NRI)以及多变量逻辑回归来确定术后 AKI 的预测特征。此外,我们还采用分层聚类法确定了具有相似多普勒参数的潜在组别,并对各组患者的特征和预后进行了比较:我们共纳入了 136 例患者,其中 47 例(34.6%)发生了术后 AKI。在重症监护室入院时,动脉指数对 AKI 的预测显示出相似的区分度(RRI:AUC = 0.64;95% 置信区间 (CI) = 0.55 至 0.74;VTI/PSV:AUC = 0.67;95% CI = 0.57 至 0.77)。包括 IRVF 模式(AUC = 0.64;95% CI = 0.53 至 0.74)和 RVSI(AUC = 0.60;95% CI = 0.50 至 0.71)在内的静脉多普勒指数也显示出相似的性能。与单独使用 RRI(NRI = 0.50;95% CI = 0.17 至 0.84)或 IRVF 模式(NRI = 0.38;95% CI = 0.04 至 0.70)相比,RRI 和 IRVF 模式的组合模型(AUC = 0.69;95% CI = 0.59 至 0.78)提高了对 AKI 的预测能力。通过分层聚类,我们确定了三组(1:低 RRI;2:高 RRI/低 RVSI;3:高 RRI/高 RVSI),这三组患者的特征和预后各不相同。与其他组别相比,第 3 组患者发生 AKI 的风险更高,临床预后更差:局限性:心脏手术患者的单中心设计限制了推广性:尽管包括 VTI/PSV 和 RVSI 在内的更复杂的肾内多普勒指数并不能改善术后 AKI 的预测,但结合 RRI 和 IRVF 模式可改善 AKI 的风险预测。肾内动静脉多普勒亚型确定了术后 AKI 的高风险患者群体。
{"title":"Prediction of Acute Kidney Injury After Cardiac Surgery With Combined Arterial and Venous Intrarenal Doppler.","authors":"Cameron Giles, Karel Huard, André Denault, William Beaubien-Souligny","doi":"10.1177/20543581241309976","DOIUrl":"10.1177/20543581241309976","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute kidney injury (AKI) occurs in up to 50% of cardiac surgical patients and is often hemodynamically mediated. Point-of-care ultrasound is a non-invasive tool that has the potential to characterize intrarenal hemodynamics and predict the risk of AKI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to determine the predictive characteristics of intrarenal arterial and venous Doppler markers for postoperative AKI in cardiac surgical patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This study is the secondary analysis of a prospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study is carried out in a care academic cardiac surgical center in Montreal, Quebec, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Point-of-care ultrasound assessments were performed preoperatively and at intensive care unit admission. Arterial measurements included the renal resistive index (RRI) and intrarenal artery velocity-time integral normalized to peak systolic velocity (VTI/PSV). Venous measurements included intrarenal venous flow (IRVF) pattern and renal venous stasis index (RVSI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used area under the receiving operating characteristic curves (AUCs) with net reclassification index (NRI) and multivariable logistic regression to determine predictive characteristics for postoperative AKI. Furthermore, we used hierarchical clustering to identify potential groups with similar Doppler parameters and performed comparisons of patients' characteristics and outcomes between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 136 patients with 47 (34.6%) developing postoperative AKI. At intensive care unit admission, arterial indices showed similar discrimination for the prediction of AKI (RRI: AUC = 0.64; 95% confidence interval (CI) = 0.55 to 0.74; and VTI/PSV: AUC = 0.67; 95% CI = 0.57 to 0.77). Venous Doppler indices including IRVF patterns (AUC = 0.64; 95% CI = 0.53 to 0.74) and RVSI (AUC = 0.60; 95% CI = 0.50 to 0.71) also showed similar performance. The combined model of RRI and IRVF pattern (AUC = 0.69; 95% CI = 0.59 to 0.78) improved the prediction of AKI compared to either RRI (NRI = 0.50; 95% CI = 0.17 to 0.84) or IRVF pattern (NRI = 0.38; 95% CI = 0.04 to 0.70) alone. Through hierarchical clustering, we identified 3 groups (1: low RRI, 2: high RRI/low RVSI, and 3: high RRI/high RVSI) with different patient characteristics and outcomes. The patient in group 3 had a higher risk of AKI and worse clinical outcomes compared with other groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Single-center design in cardiac surgical patients limits generalizability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although more complex indices of intrarenal Doppler indices including the VTI/PSV and RVSI did not improve prediction of postoperative AKI, combining RRI and IRVF pattern improved risk prediction for AKI. Intrar","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241309976"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unused Hemodialysis Acid Concentrate is Dollars and Dialysate Down the Drain: An Opinion Piece. 未使用的血液透析酸浓缩物是美元和透析液的流失:一篇观点文章。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-20 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241308631
Anukul Ghimire, Karthik K Tennankore, George Vitale
{"title":"Unused Hemodialysis Acid Concentrate is Dollars and Dialysate Down the Drain: An Opinion Piece.","authors":"Anukul Ghimire, Karthik K Tennankore, George Vitale","doi":"10.1177/20543581241308631","DOIUrl":"10.1177/20543581241308631","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241308631"},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physical Frailty and Functional Status in Kidney Transplantation: A Systematic Review. 肾移植中的身体虚弱和功能状态:系统综述。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-16 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241300777
Priscilla Karnabi, David Massicotte-Azarniouch, Shawn Marshall, Greg A Knoll

Background: Frailty and functional decline are being recognized as important conditions in kidney transplant candidates. However, the ideal measures of functional status and frailty remain unknown as there is not a complete understanding of the relationship between these conditions and important post-transplant outcomes.

Objective: The objective was to examine the association between different measures of frailty and functional status evaluated before or at the time of transplant with adverse clinical outcomes post-transplantation.

Design: This study is a systematic review.

Setting: Observational studies including cohort, case-control, or cross-sectional studies examining the effect of frailty and functional status on clinical outcomes. There were no restrictions on type of setting or country of origin.

Patients: Adults who were waitlisted for kidney transplant or had received a kidney transplant.

Measurements: Data including demographic information (eg, sample size, age, country), assessments of frailty or functional status and their domains, and outcomes including mortality, transplantation, graft loss, delayed graft function and hospital readmission were extracted.

Methods: A search was performed in Medline, Embase, and Cochrane Central Register for Controlled Trials. Studies were included from inception to February 7, 2023. The eligibility of studies was screened by 2 independent reviewers. Data were presented by frailty/functional status instrument and clinical outcome. Point estimates and 95% confidence intervals from fully adjusted statistical models were reported or calculated from the raw data.

Results: A total of 50 studies were identified, among which 36 unique instruments were found. Measurements of these instruments occurred mostly at time of kidney transplant, transplant evaluation, and waitlisting. The median sample size of studies was 457 patients (interquartile range = 183-1760). Frailty and lower functional status were associated with an increased risk for mortality. Similar trends were observed among other clinical outcomes such as graft loss and rehospitalization.

Limitations: The heterogeneity in measurement instruments, study designs, and outcome definitions prevents pooling of the data. Selection bias and the validity of data collection could not be ascertained for some studies.

Conclusion: Frailty and functional status measures are important predictors of post-kidney transplant outcomes. Further studies are needed to evaluate the best instruments to assess frailty and functional status, and importantly, interventional studies are needed to determine whether prehabilitation strategies can improve post-transplant outcomes.

Registration prospero: CRD42016045251.

背景:虚弱和功能下降被认为是肾移植候选人的重要条件。然而,功能状态和虚弱的理想测量仍然未知,因为这些条件与重要的移植后结果之间的关系尚未完全了解。目的:目的是检查移植前或移植时评估的不同虚弱程度和功能状态与移植后不良临床结果之间的关系。设计:本研究为系统综述。背景:观察性研究,包括队列、病例对照或横断面研究,检查虚弱和功能状态对临床结果的影响。对环境类型或原产国没有限制。患者:正在等待肾移植或已经接受肾移植的成年人。测量方法:提取的数据包括人口统计信息(如样本量、年龄、国家)、衰弱或功能状态及其域的评估,以及包括死亡率、移植、移植物损失、移植物功能延迟和再入院在内的结果。方法:在Medline、Embase和Cochrane中央对照试验登记处进行检索。研究包括从开始到2023年2月7日。研究的合格性由2名独立审稿人进行筛选。数据由衰弱/功能状态仪和临床结果提供。从完全调整的统计模型中报告或从原始数据中计算点估计和95%置信区间。结果:共鉴定了50个研究,其中发现了36个独特的仪器。这些仪器的测量大多发生在肾移植、移植评估和等待名单的时候。研究的中位样本量为457例患者(四分位数间距= 183-1760)。虚弱和较低的功能状态与死亡风险增加有关。在其他临床结果如移植物丢失和再住院中也观察到类似的趋势。局限性:测量工具、研究设计和结果定义的异质性阻碍了数据的汇集。一些研究无法确定选择偏差和数据收集的有效性。结论:虚弱和功能状态指标是肾移植后预后的重要预测指标。需要进一步的研究来评估评估虚弱和功能状态的最佳工具,重要的是,需要进行介入性研究来确定康复策略是否可以改善移植后的预后。注册地址:CRD42016045251。
{"title":"Physical Frailty and Functional Status in Kidney Transplantation: A Systematic Review.","authors":"Priscilla Karnabi, David Massicotte-Azarniouch, Shawn Marshall, Greg A Knoll","doi":"10.1177/20543581241300777","DOIUrl":"10.1177/20543581241300777","url":null,"abstract":"<p><strong>Background: </strong>Frailty and functional decline are being recognized as important conditions in kidney transplant candidates. However, the ideal measures of functional status and frailty remain unknown as there is not a complete understanding of the relationship between these conditions and important post-transplant outcomes.</p><p><strong>Objective: </strong>The objective was to examine the association between different measures of frailty and functional status evaluated before or at the time of transplant with adverse clinical outcomes post-transplantation.</p><p><strong>Design: </strong>This study is a systematic review.</p><p><strong>Setting: </strong>Observational studies including cohort, case-control, or cross-sectional studies examining the effect of frailty and functional status on clinical outcomes. There were no restrictions on type of setting or country of origin.</p><p><strong>Patients: </strong>Adults who were waitlisted for kidney transplant or had received a kidney transplant.</p><p><strong>Measurements: </strong>Data including demographic information (eg, sample size, age, country), assessments of frailty or functional status and their domains, and outcomes including mortality, transplantation, graft loss, delayed graft function and hospital readmission were extracted.</p><p><strong>Methods: </strong>A search was performed in Medline, Embase, and Cochrane Central Register for Controlled Trials. Studies were included from inception to February 7, 2023. The eligibility of studies was screened by 2 independent reviewers. Data were presented by frailty/functional status instrument and clinical outcome. Point estimates and 95% confidence intervals from fully adjusted statistical models were reported or calculated from the raw data.</p><p><strong>Results: </strong>A total of 50 studies were identified, among which 36 unique instruments were found. Measurements of these instruments occurred mostly at time of kidney transplant, transplant evaluation, and waitlisting. The median sample size of studies was 457 patients (interquartile range = 183-1760). Frailty and lower functional status were associated with an increased risk for mortality. Similar trends were observed among other clinical outcomes such as graft loss and rehospitalization.</p><p><strong>Limitations: </strong>The heterogeneity in measurement instruments, study designs, and outcome definitions prevents pooling of the data. Selection bias and the validity of data collection could not be ascertained for some studies.</p><p><strong>Conclusion: </strong>Frailty and functional status measures are important predictors of post-kidney transplant outcomes. Further studies are needed to evaluate the best instruments to assess frailty and functional status, and importantly, interventional studies are needed to determine whether prehabilitation strategies can improve post-transplant outcomes.</p><p><strong>Registration prospero: </strong>CRD42016045251.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241300777"},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Primary Care Providers Barriers, Comfort and Awareness in Follow-up Care of Acute Kidney Injury Patients: A Comprehensive Survey on Current Practices. 初级保健提供者在急性肾损伤患者随访护理中的障碍、舒适度和意识:当前做法综合调查。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241304517
Jean-Maxime Côté, William Beaubien-Souligny, Lauriane Hamel, Josée Bouchard

Background: Patients who experienced acute kidney injury (AKI) may benefit from dedicated care following hospital discharge. Most of these patients will be followed by primary care providers. There is a lack of data on current practices and comfort for these care providers when offering post-AKI care.

Objective: We surveyed nurse practitioners and family physicians to assess their awareness, perceptions, practice patterns and comfort regarding post-AKI care.

Design/setting: We distributed a web-based self-administered survey among clinicians from the Province of Quebec. We asked about their awareness and perceptions on how AKI should be disclosed and followed, the barriers encountered regarding the process of care following hospital discharge, and their level of comfort and expertise in offering dedicated post-AKI care. The survey integrated direct and scenario-based questions and was conducted from December 2022 to April 2023.

Participants: We distributed the survey to practicing family physicians and nurse practitioners through the mailing list of the Fédération des Médecins Omnipraticiens du Québec, and the Association des infirmières praticiennes spécialisées du Québec, respectively. No incentives were provided.

Methods: We conducted descriptive analyses and used chi-squared analysis to compare responses between family physicians and nurse practitioners and between hospital-based and cabinet-based practice.

Results: The survey was opened by 779 potential participants. Of these, the response rate was 9% (70/779). Most participants were family physicians (79%) and dedicated 70% (±32) of their time in community outpatient clinics. Participants reported that 59% (±20) of all patients seen daily had at least 1 risk factor for AKI, whereas they estimated that 21% (±12) of recently discharged patients suffered from an AKI episode. The lack of awareness by the patient and lack of details on the discharge summary were the barriers most frequently reported impacting the overall process of care at follow-up. Most nurse practitioners (60%) and 33% of family physicians reported at least some levels of discomfort and lack of expertise when offering post-AKI.

Limitations: The generalizability of our study is limited by its response rate. However, this is comparable with typical response rates seen in electronic surveys. The distribution was limited to a single province of Canada.

Conclusions: We reported significant barriers regarding the hospital-to-community transition of care in patients who experienced AKI and the suboptimal comfort and expertise of primary care providers when offering dedicated post-AKI care. This reflects the need to improve communication, collaboration, and AKI training with primary care providers.

背景:急性肾损伤(AKI)患者出院后可能会受益于专门的护理。这些患者中的大多数将由初级保健提供者随访。目前还缺乏有关这些医疗服务提供者在提供 AKI 后护理时的做法和舒适度的数据:我们对执业护士和家庭医生进行了调查,以评估他们对 AKI 后护理的认识、看法、实践模式和舒适度:我们向魁北克省的临床医生发放了一份基于网络的自填式调查问卷。我们询问了他们对如何披露和跟踪 AKI 的认识和看法、出院后护理过程中遇到的障碍,以及他们在提供 AKI 后专门护理方面的舒适度和专业知识水平。调查综合了直接问题和情景问题,调查时间为 2022 年 12 月至 2023 年 4 月:我们分别通过魁北克全科医师联合会和魁北克专科护士协会的邮件列表向执业家庭医生和执业护士发放了调查问卷。没有提供任何奖励:我们进行了描述性分析,并使用卡方分析比较了家庭医生和执业护士之间以及医院执业和内阁执业之间的回复情况:779 名潜在参与者打开了调查问卷。其中,回复率为 9%(70/779)。大多数参与者是家庭医生(79%),70%(±32)的时间在社区门诊工作。参与者报告说,在每天接诊的所有患者中,59%(±20)的患者至少有一个导致 AKI 的危险因素,而他们估计最近出院的患者中有 21%(±12)的患者曾发生过 AKI。患者缺乏意识和出院摘要缺乏细节是影响随访护理整体流程的最常见障碍。大多数执业护士(60%)和 33% 的家庭医生表示,在提供 AKI 后护理时至少会有一定程度的不适和缺乏专业知识:我们研究的推广性受到了回复率的限制。然而,这与电子调查中的典型回复率相当。调查范围仅限于加拿大的一个省:我们报告了经历过 AKI 的患者在从医院到社区的护理过渡中遇到的重大障碍,以及初级医疗服务提供者在提供专门的 AKI 后护理时的舒适度和专业知识不够理想。这反映出需要加强与初级医疗服务提供者的沟通、合作和 AKI 培训。
{"title":"Primary Care Providers Barriers, Comfort and Awareness in Follow-up Care of Acute Kidney Injury Patients: A Comprehensive Survey on Current Practices.","authors":"Jean-Maxime Côté, William Beaubien-Souligny, Lauriane Hamel, Josée Bouchard","doi":"10.1177/20543581241304517","DOIUrl":"10.1177/20543581241304517","url":null,"abstract":"<p><strong>Background: </strong>Patients who experienced acute kidney injury (AKI) may benefit from dedicated care following hospital discharge. Most of these patients will be followed by primary care providers. There is a lack of data on current practices and comfort for these care providers when offering post-AKI care.</p><p><strong>Objective: </strong>We surveyed nurse practitioners and family physicians to assess their awareness, perceptions, practice patterns and comfort regarding post-AKI care.</p><p><strong>Design/setting: </strong>We distributed a web-based self-administered survey among clinicians from the Province of Quebec. We asked about their awareness and perceptions on how AKI should be disclosed and followed, the barriers encountered regarding the process of care following hospital discharge, and their level of comfort and expertise in offering dedicated post-AKI care. The survey integrated direct and scenario-based questions and was conducted from December 2022 to April 2023.</p><p><strong>Participants: </strong>We distributed the survey to practicing family physicians and nurse practitioners through the mailing list of the <i>Fédération des Médecins Omnipraticiens du Québec</i>, and the <i>Association des infirmières praticiennes spécialisées du Québec</i>, respectively. No incentives were provided.</p><p><strong>Methods: </strong>We conducted descriptive analyses and used chi-squared analysis to compare responses between family physicians and nurse practitioners and between hospital-based and cabinet-based practice.</p><p><strong>Results: </strong>The survey was opened by 779 potential participants. Of these, the response rate was 9% (70/779). Most participants were family physicians (79%) and dedicated 70% (±32) of their time in community outpatient clinics. Participants reported that 59% (±20) of all patients seen daily had at least 1 risk factor for AKI, whereas they estimated that 21% (±12) of recently discharged patients suffered from an AKI episode. The lack of awareness by the patient and lack of details on the discharge summary were the barriers most frequently reported impacting the overall process of care at follow-up. Most nurse practitioners (60%) and 33% of family physicians reported at least some levels of discomfort and lack of expertise when offering post-AKI.</p><p><strong>Limitations: </strong>The generalizability of our study is limited by its response rate. However, this is comparable with typical response rates seen in electronic surveys. The distribution was limited to a single province of Canada.</p><p><strong>Conclusions: </strong>We reported significant barriers regarding the hospital-to-community transition of care in patients who experienced AKI and the suboptimal comfort and expertise of primary care providers when offering dedicated post-AKI care. This reflects the need to improve communication, collaboration, and AKI training with primary care providers.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241304517"},"PeriodicalIF":1.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Randomized Trials Using Provincial Health Numbers for Group Assignment. 使用省健康号码进行分组分配的随机试验。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-06 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241304510
Amit X Garg, Stephanie N Dixon, Charlotte Ma, Erika Basile, Bin Luo, Magda Nunes De Melo, Amber O Molnar, Naveen Poonai, Michael J Schull, Samuel A Silver, Jessica M Sontrop, Merrick Zwarenstein, Pavel Roshanov

Purpose: Using data from Ontario, Canada, this report shows how provincial government-assigned health card numbers can be used for individual-level randomization in large pragmatic trials. We describe how health card numbers are assigned and analyze the distribution of health card digits in a trial setting. We then provide an example of how they can be used for randomization and discuss the methodological and practical considerations of the approach.

Key findings: In Ontario, Canada, health card numbers are randomly generated and assigned without regard to the applicant's characteristics. The number is a 10-digit string connected with hyphens followed by a version code (ie, 1234-567-890-XX). The number is unique to each individual and assigned for life. Before assignment, some numbers within the 10 digits are altered using proprietary business rules. We demonstrate how to use certain digits for individual-level randomization and provide an example of how we will use the tenth digit for randomization in a large new trial of different dialysate bicarbonate concentrations. While this approach has many practical and methodological advantages, it does not allow for stratification. Before using this approach, teams should consider if it will affect the integrity of the randomization and the trial, which will be influenced by the setting and the type of intervention tested.

Implications: Using provincial government-assigned health card numbers for pragmatic randomized trials appears viable, but the merits must be carefully considered on a trial-by-trial basis. The approach can streamline and reduce the cost of conducting such trials.

目的:使用来自加拿大安大略省的数据,本报告展示了省政府分配的健康卡号如何在大型实用试验中用于个人水平的随机化。我们描述了健康卡号是如何分配的,并分析了健康卡号在试验设置中的分布。然后,我们提供了一个如何将它们用于随机化的例子,并讨论了该方法的方法学和实际考虑。主要发现:在加拿大安大略省,健康卡号码是随机生成和分配的,而不考虑申请人的特征。该号码是一个由连字符连接的10位字符串,后跟一个版本代码(例如,1234-567-890-XX)。这个号码对每个人来说都是独一无二的,并且是终身分配的。在分配之前,使用专有业务规则更改10位数内的一些数字。我们演示了如何使用某些数字进行个体水平的随机化,并提供了一个例子,说明我们将如何在不同碳酸氢盐透析液浓度的大型新试验中使用第十位数进行随机化。虽然这种方法有许多实际和方法上的优点,但它不允许分层。在使用这种方法之前,团队应该考虑它是否会影响随机化和试验的完整性,这将受到环境和干预测试类型的影响。启示:在实用的随机试验中使用省政府指定的健康卡号似乎是可行的,但必须在逐个试验的基础上仔细考虑其优点。这种方法可以简化并降低进行此类试验的成本。
{"title":"Randomized Trials Using Provincial Health Numbers for Group Assignment.","authors":"Amit X Garg, Stephanie N Dixon, Charlotte Ma, Erika Basile, Bin Luo, Magda Nunes De Melo, Amber O Molnar, Naveen Poonai, Michael J Schull, Samuel A Silver, Jessica M Sontrop, Merrick Zwarenstein, Pavel Roshanov","doi":"10.1177/20543581241304510","DOIUrl":"10.1177/20543581241304510","url":null,"abstract":"<p><strong>Purpose: </strong>Using data from Ontario, Canada, this report shows how provincial government-assigned health card numbers can be used for individual-level randomization in large pragmatic trials. We describe how health card numbers are assigned and analyze the distribution of health card digits in a trial setting. We then provide an example of how they can be used for randomization and discuss the methodological and practical considerations of the approach.</p><p><strong>Key findings: </strong>In Ontario, Canada, health card numbers are randomly generated and assigned without regard to the applicant's characteristics. The number is a 10-digit string connected with hyphens followed by a version code (ie, 1234-567-890-XX). The number is unique to each individual and assigned for life. Before assignment, some numbers within the 10 digits are altered using proprietary business rules. We demonstrate how to use certain digits for individual-level randomization and provide an example of how we will use the tenth digit for randomization in a large new trial of different dialysate bicarbonate concentrations. While this approach has many practical and methodological advantages, it does not allow for stratification. Before using this approach, teams should consider if it will affect the integrity of the randomization and the trial, which will be influenced by the setting and the type of intervention tested.</p><p><strong>Implications: </strong>Using provincial government-assigned health card numbers for pragmatic randomized trials appears viable, but the merits must be carefully considered on a trial-by-trial basis. The approach can streamline and reduce the cost of conducting such trials.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241304510"},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Use of Autologous Omentum Transposition as a Therapeutic Intervention to Reduce the Complication of Ischemia/Reperfusion Injuries in a Rat Model. 自体大网膜转位治疗大鼠缺血/再灌注损伤并发症的研究
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-28 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241300773
Amirreza Shamshirgaran, Abdolreza Mohamamdi, Parisa Zahmatkesh, Gholamreza Mesbah, Fateme Guitynavard, Zahra Saffarian, Alireza Khajavi, Leonardo Oliveira Reis, Seyed Mohammad Kazem Aghamir

Background: Ischemia/reperfusion injury (IRI) causes cellular dysfunction and death in organs like the kidney, heart, and brain. It involves energy depletion during ischemia and oxidative stress, inflammation, and apoptosis during reperfusion. Kidney IRI often leads to acute kidney injury (AKI) in various clinical scenarios. The omentum, an adipose tissue with healing properties, has been used to treat injuries in different organs.

Objective: This study aimed to assess the omentum's healing effects on reducing IRI's adverse effects after renal ischemia in Wistar rats.

Method: A total number of 36 male Wistar rats were used in a study on IRI-induced AKI. Rats were divided into 6 groups of normal kidneys wrapped with omentum "Sham-1" and "Sham-2," ischemic kidney wrapped with omentum as "OMT-1" and "OMT-2," and ischemic kidney without omentum as "Control-1" and "Control-2." Ischemia was induced by clamping the left renal artery for 45 minutes. The omentum was transposed onto the injured kidney in "OMT" group. After sacrifice at weeks 4 and 8, kidney histology and blood samples were analyzed for kidney function markers.

Results: On the first day after surgery, there was an immediate increase in creatinine and blood urea nitrogen (BUN) levels, which then decreased by day 28. Both OMT groups showed significantly lower levels of creatinine and BUN compared to Control groups on day 1, but after 28 days differences were not statistically significant. Histological analysis using H&E and Masson's trichrome staining revealed significantly higher levels of inflammatory cell infiltration and hyperemia in the OMT groups. However, fibrosis and glomerular shrinkage were higher in the Control groups.

Conclusion: Using an omental flap significantly prevented fibrosis within the renal parenchyma, slow down the AKI progression, and potentially serving as a promising therapeutic strategy for kidney dysfunction.

背景:缺血/再灌注损伤(IRI)可引起肾、心、脑等器官的细胞功能障碍和死亡。它包括缺血和氧化应激时的能量消耗、再灌注时的炎症和细胞凋亡。在各种临床情况下,肾IRI常导致急性肾损伤(AKI)。网膜是一种具有愈合特性的脂肪组织,已被用于治疗不同器官的损伤。目的:探讨大网膜对Wistar大鼠肾缺血后IRI不良反应的修复作用。方法:采用雄性Wistar大鼠36只,对急性脑损伤(AKI)进行研究。将大鼠分为6组,正常肾包网膜“Sham-1”和“Sham-2”组,缺血肾包网膜“OMT-1”和“OMT-2”组,缺血肾不包网膜“Control-1”和“Control-2”组。左肾动脉夹持缺血45分钟。“OMT”组将大网膜转置到损伤肾上。在第4周和第8周献祭后,分析肾脏组织学和血液样本的肾功能标志物。结果:术后第1天肌酐和血尿素氮(BUN)水平立即升高,第28天下降。与对照组相比,OMT组在第1天的肌酐和BUN水平均显著降低,但28天后差异无统计学意义。H&E和Masson三色染色的组织学分析显示,OMT组炎症细胞浸润和充血水平明显升高。然而,对照组的纤维化和肾小球收缩更大。结论:使用大网膜皮瓣可显著防止肾实质纤维化,减缓AKI的进展,并可能作为肾功能障碍的一种有前景的治疗策略。
{"title":"The Use of Autologous Omentum Transposition as a Therapeutic Intervention to Reduce the Complication of Ischemia/Reperfusion Injuries in a Rat Model.","authors":"Amirreza Shamshirgaran, Abdolreza Mohamamdi, Parisa Zahmatkesh, Gholamreza Mesbah, Fateme Guitynavard, Zahra Saffarian, Alireza Khajavi, Leonardo Oliveira Reis, Seyed Mohammad Kazem Aghamir","doi":"10.1177/20543581241300773","DOIUrl":"10.1177/20543581241300773","url":null,"abstract":"<p><strong>Background: </strong>Ischemia/reperfusion injury (IRI) causes cellular dysfunction and death in organs like the kidney, heart, and brain. It involves energy depletion during ischemia and oxidative stress, inflammation, and apoptosis during reperfusion. Kidney IRI often leads to acute kidney injury (AKI) in various clinical scenarios. The omentum, an adipose tissue with healing properties, has been used to treat injuries in different organs.</p><p><strong>Objective: </strong>This study aimed to assess the omentum's healing effects on reducing IRI's adverse effects after renal ischemia in Wistar rats.</p><p><strong>Method: </strong>A total number of 36 male Wistar rats were used in a study on IRI-induced AKI. Rats were divided into 6 groups of normal kidneys wrapped with omentum \"Sham-1\" and \"Sham-2,\" ischemic kidney wrapped with omentum as \"OMT-1\" and \"OMT-2,\" and ischemic kidney without omentum as \"Control-1\" and \"Control-2.\" Ischemia was induced by clamping the left renal artery for 45 minutes. The omentum was transposed onto the injured kidney in \"OMT\" group. After sacrifice at weeks 4 and 8, kidney histology and blood samples were analyzed for kidney function markers.</p><p><strong>Results: </strong>On the first day after surgery, there was an immediate increase in creatinine and blood urea nitrogen (BUN) levels, which then decreased by day 28. Both OMT groups showed significantly lower levels of creatinine and BUN compared to Control groups on day 1, but after 28 days differences were not statistically significant. Histological analysis using H&E and Masson's trichrome staining revealed significantly higher levels of inflammatory cell infiltration and hyperemia in the OMT groups. However, fibrosis and glomerular shrinkage were higher in the Control groups.</p><p><strong>Conclusion: </strong>Using an omental flap significantly prevented fibrosis within the renal parenchyma, slow down the AKI progression, and potentially serving as a promising therapeutic strategy for kidney dysfunction.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241300773"},"PeriodicalIF":1.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Brentuximab-Induced Acute Interstitial Nephritis: A Case Report. 布托昔单抗诱发急性间质性肾炎:病例报告。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-25 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241300766
Matthew Patterson, Pouneh Dokouhaki, Chance S Dumaine, Rebecca MacKay, Davina J Tai

Brentuximab vedotin is a combination monoclonal antibody to anti-CD30 conjugated to the anti-tubulin agent monomethyl auristatin E. It is approved for the treatment of mycosis fungoides, Hodgkin's lymphoma, and systemic anaplastic large cell lymphoma. Brentuximab has been associated with a number of potential adverse reactions; however, reports of renal complications are rare. A 73-year-old male with mycosis fungoides was admitted to hospital with acute kidney injury following his third cycle of brentuximab. The patient's serum creatinine (SCr) was 122 µmol/L with an estimated glomerular filtration rate (eGFR) of 58 mL/min/1.73 m2 at baseline. Following brentuximab, his SCr peaked at 1073 µmol/L over a 4-week period. Acute interstitial nephritis (AIN) was diagnosed after other causes of acute kidney injury were ruled out and subsequently confirmed on kidney biopsy. The patient was started on prednisone 50 mg daily. This was continued for 3 weeks, followed by a 5-week taper. The patient's SCr decreased to 156 µmol/L by completion of the prednisone taper. He was not rechallenged with brentuximab. A kidney biopsy confirmed AIN in keeping with injury from an immune checkpoint inhibitor (ICI). However, brentuximab is not an ICI. The AIN from ICIs typically has tubulointerstitial inflammatory infiltrate comprised of T lymphocytes such as the case presented here. Therefore, this represents both a novel histopathologic finding in AIN from a non-ICI medication and a rare complication of brentuximab, previously only presented in abstract form.

布伦妥昔单抗(Brentuximab vedotin)是一种抗CD30单克隆抗体与抗微管蛋白制剂单甲基奥司他丁E结合的复方制剂,已被批准用于治疗真菌病、霍奇金淋巴瘤和全身性无性大细胞淋巴瘤。布伦妥昔单抗与许多潜在的不良反应有关,但肾脏并发症的报道很少见。一名患有真菌病的 73 岁男性患者在使用布伦妥昔单抗第三个周期后因急性肾损伤入院。患者的血清肌酐(SCr)为 122 µmol/L,基线估计肾小球滤过率(eGFR)为 58 mL/min/1.73 m2。使用布伦妥昔单抗后,他的血肌酐(SCr)在四周内达到峰值 1073 µmol/L。在排除了导致急性肾损伤的其他原因后,他被诊断为急性间质性肾炎(AIN),随后肾活检证实了这一诊断。患者开始服用泼尼松,每天 50 毫克。持续用药 3 周,然后减量 5 周。泼尼松减量结束后,患者的 SCr 降至 156 µmol/L。他没有再接受布伦妥昔单抗治疗。肾活检证实,AIN 与免疫检查点抑制剂(ICI)的损伤一致。然而,布伦妥昔单抗并不是一种 ICI。ICI 引起的 AIN 通常会出现由 T 淋巴细胞组成的肾小管间质炎症浸润,本病例就是如此。因此,这既是非 ICI 药物所致 AIN 的一种新的组织病理学发现,也是布伦妥昔单抗的一种罕见并发症,以前仅以摘要形式出现过。
{"title":"Brentuximab-Induced Acute Interstitial Nephritis: A Case Report.","authors":"Matthew Patterson, Pouneh Dokouhaki, Chance S Dumaine, Rebecca MacKay, Davina J Tai","doi":"10.1177/20543581241300766","DOIUrl":"10.1177/20543581241300766","url":null,"abstract":"<p><p>Brentuximab vedotin is a combination monoclonal antibody to anti-CD30 conjugated to the anti-tubulin agent monomethyl auristatin E. It is approved for the treatment of mycosis fungoides, Hodgkin's lymphoma, and systemic anaplastic large cell lymphoma. Brentuximab has been associated with a number of potential adverse reactions; however, reports of renal complications are rare. A 73-year-old male with mycosis fungoides was admitted to hospital with acute kidney injury following his third cycle of brentuximab. The patient's serum creatinine (SCr) was 122 µmol/L with an estimated glomerular filtration rate (eGFR) of 58 mL/min/1.73 m<sup>2</sup> at baseline. Following brentuximab, his SCr peaked at 1073 µmol/L over a 4-week period. Acute interstitial nephritis (AIN) was diagnosed after other causes of acute kidney injury were ruled out and subsequently confirmed on kidney biopsy. The patient was started on prednisone 50 mg daily. This was continued for 3 weeks, followed by a 5-week taper. The patient's SCr decreased to 156 µmol/L by completion of the prednisone taper. He was not rechallenged with brentuximab. A kidney biopsy confirmed AIN in keeping with injury from an immune checkpoint inhibitor (ICI). However, brentuximab is not an ICI. The AIN from ICIs typically has tubulointerstitial inflammatory infiltrate comprised of T lymphocytes such as the case presented here. Therefore, this represents both a novel histopathologic finding in AIN from a non-ICI medication and a rare complication of brentuximab, previously only presented in abstract form.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241300766"},"PeriodicalIF":1.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes. 糖尿病肾移植受者使用钠-葡萄糖协同转运体-2 抑制剂 (SGLT2i) 的单中心经验。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241293202
Albi Angjeli, Tess Montada-Atin, Rosane Nisenbaum, Niki Dacouris, Michelle Nash, G V Ramesh Prasad, Jeffrey Zaltzman
<p><strong>Background: </strong>Sodium-glucose co-tranporter-2 inhibitors have been shown to be safe and effective in patients with type 2 diabetes for improving glycemia. Furthermore large, randomized control trials have shown cardiovascular and renal benefits. However, limited safety and efficacy data is available in kidney transplant patients with diabetes.</p><p><strong>Objective: </strong>To investigate the safety and efficacy of SGLT2i use on stability of renal function in adult kidney transplant recipients (KTR) with type 2 diabetes mellitus (DM2) or New Onset Diabetes After Transplantation (NODAT).</p><p><strong>Design: </strong>We performed a single center, retrospective cohort study pre- and post-SGLT2i exposure.</p><p><strong>Patients: </strong>Adults with DM2 or NODAT who received a living or deceased kidney transplant (Tx) and started on an SGLT2i post-Tx were reviewed. Patients who had type 1 diabetes were excluded.</p><p><strong>Measurements and methods: </strong>The baseline was the SGLT2i start date. We reviewed available data from 24 months (M) before and after SGLT2i initiation. The primary endpoints were the effects of SGLT2i use on stability of renal function using serum creatinine and eGFR, change in urine albumin excretion(uACR), and glycosylated hemoglobin (A1C). Secondary endpoints compared blood pressure, body mass index and adverse reactions at baseline and quarterly after SGLT2i initiation.</p><p><strong>Results: </strong>125 KTRs were included in cohort: NODAT (52, 42%), DM2 (73, 58%); female (33, 27%); mean age at Tx 55 years (25-75); LD (56, 45%), DD (69, 55%); mean duration of Tx (6.8 years, 0.1-42.5); study follow-up (1.8 years, 0.3-4.9).The mean eGFR remained stable pre-SGLT2i at 64.6 mL/min/1.73m<sup>2</sup>, vs post at 64.3 mL/min/1.73m<sup>2</sup>. There was no difference in mean A1C after SGLT2i initiation. The slope of uACR using natural log transformation pre-SGLT2i compared with post-SGLT2i slope reduced from +0.7 (0.03, 0.11) to -0.04 (-0.01, -0.35) mg/mmol/3mths (<i>P</i> = .002). The risk of developing new genital mycotic infections among all patients was 4% (95% CI 1.3%-9.1%) While there was no significant difference in UTI before (13.6%) and after (12%) SGLT2i use (<i>P</i> = .68), there was a higher risk of UTI seen in patients with a previous history of UTI (23.5%) vs no previous history (10.2%) post initiation. There was no significant increase in AKI pre 8%, post 10.4%, <i>P</i> = .51. There was a single DKA event pre- and post-SGLT2.</p><p><strong>Limitations: </strong>The limitations of this study include its retrospective nonrandomized nature.</p><p><strong>Conclusion: </strong>In this retrospective analysis, SGLT2i use in KTR appears to be safe and efficacious with stable renal function and glycemic control, alongside improvements in uACR. There was a low risk of new genital yeast infections after SGLT2i start. UTI occurrence was higher in patients with a previous history of UTI compared with
背景:钠-葡萄糖共转运体-2 抑制剂已被证明对改善 2 型糖尿病患者的血糖安全有效。此外,大型随机对照试验也显示了对心血管和肾脏的益处。然而,肾移植糖尿病患者使用该药的安全性和疗效数据有限:研究 SGLT2i 对患有 2 型糖尿病(DM2)或移植后新发糖尿病(NODAT)的成年肾移植受者(KTR)肾功能稳定性的安全性和有效性:我们在SGLT2i暴露前后进行了一项单中心回顾性队列研究:我们对接受活体或死体肾移植(Tx)并在移植后开始服用 SGLT2i 的 DM2 或 NODAT 成人患者进行了回顾性研究。不包括1型糖尿病患者:基线为开始使用 SGLT2i 的日期。我们回顾了开始使用 SGLT2i 之前和之后 24 个月(M)的可用数据。主要终点是使用 SGLT2i 对血清肌酐和 eGFR 肾功能稳定性的影响、尿白蛋白排泄量(uACR)的变化以及糖化血红蛋白(A1C)。次要终点比较了基线和开始使用 SGLT2i 后每季度的血压、体重指数和不良反应:结果:125 名 KTR 纳入队列:NODAT(52,42%),DM2(73,58%);女性(33,27%);平均治疗年龄 55 岁(25-75);LD(56,45%),DD(69,55%);平均治疗时间(6.SGLT2i治疗前的平均eGFR稳定在64.6 mL/min/1.73m2,治疗后为64.3 mL/min/1.73m2。使用 SGLT2i 后,平均 A1C 没有差异。SGLT2i前与SGLT2i后相比,采用自然对数转换的uACR斜率从+0.7 (0.03, 0.11) mg/mmol/3月降至-0.04 (-0.01, -0.35)mg/mmol/3月(P = .002)。虽然使用 SGLT2i 之前(13.6%)和之后(12%)的 UTI 没有显著差异(P = .68),但在开始使用后,有 UTI 既往史(23.5%)和无 UTI 既往史(10.2%)的患者发生 UTI 的风险更高。AKI 在启动前为 8%,启动后为 10.4%,P = 0.51。SGLT前后均发生过一次DKA事件2:本研究的局限性包括其回顾性非随机性质:在这项回顾性分析中,SGLT2i 用于 KTR 似乎安全有效,肾功能和血糖控制稳定,uACR 也有所改善。开始使用 SGLT2i 后,发生新的生殖器酵母感染的风险较低。与无尿毒症病史的患者相比,有尿毒症病史的患者发生尿毒症的几率更高。
{"title":"Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes.","authors":"Albi Angjeli, Tess Montada-Atin, Rosane Nisenbaum, Niki Dacouris, Michelle Nash, G V Ramesh Prasad, Jeffrey Zaltzman","doi":"10.1177/20543581241293202","DOIUrl":"https://doi.org/10.1177/20543581241293202","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sodium-glucose co-tranporter-2 inhibitors have been shown to be safe and effective in patients with type 2 diabetes for improving glycemia. Furthermore large, randomized control trials have shown cardiovascular and renal benefits. However, limited safety and efficacy data is available in kidney transplant patients with diabetes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the safety and efficacy of SGLT2i use on stability of renal function in adult kidney transplant recipients (KTR) with type 2 diabetes mellitus (DM2) or New Onset Diabetes After Transplantation (NODAT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;We performed a single center, retrospective cohort study pre- and post-SGLT2i exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults with DM2 or NODAT who received a living or deceased kidney transplant (Tx) and started on an SGLT2i post-Tx were reviewed. Patients who had type 1 diabetes were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements and methods: &lt;/strong&gt;The baseline was the SGLT2i start date. We reviewed available data from 24 months (M) before and after SGLT2i initiation. The primary endpoints were the effects of SGLT2i use on stability of renal function using serum creatinine and eGFR, change in urine albumin excretion(uACR), and glycosylated hemoglobin (A1C). Secondary endpoints compared blood pressure, body mass index and adverse reactions at baseline and quarterly after SGLT2i initiation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;125 KTRs were included in cohort: NODAT (52, 42%), DM2 (73, 58%); female (33, 27%); mean age at Tx 55 years (25-75); LD (56, 45%), DD (69, 55%); mean duration of Tx (6.8 years, 0.1-42.5); study follow-up (1.8 years, 0.3-4.9).The mean eGFR remained stable pre-SGLT2i at 64.6 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;, vs post at 64.3 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;. There was no difference in mean A1C after SGLT2i initiation. The slope of uACR using natural log transformation pre-SGLT2i compared with post-SGLT2i slope reduced from +0.7 (0.03, 0.11) to -0.04 (-0.01, -0.35) mg/mmol/3mths (&lt;i&gt;P&lt;/i&gt; = .002). The risk of developing new genital mycotic infections among all patients was 4% (95% CI 1.3%-9.1%) While there was no significant difference in UTI before (13.6%) and after (12%) SGLT2i use (&lt;i&gt;P&lt;/i&gt; = .68), there was a higher risk of UTI seen in patients with a previous history of UTI (23.5%) vs no previous history (10.2%) post initiation. There was no significant increase in AKI pre 8%, post 10.4%, &lt;i&gt;P&lt;/i&gt; = .51. There was a single DKA event pre- and post-SGLT2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The limitations of this study include its retrospective nonrandomized nature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this retrospective analysis, SGLT2i use in KTR appears to be safe and efficacious with stable renal function and glycemic control, alongside improvements in uACR. There was a low risk of new genital yeast infections after SGLT2i start. UTI occurrence was higher in patients with a previous history of UTI compared with ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241293202"},"PeriodicalIF":1.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
COVID-19 and Acute Kidney Injury Outcomes in Hospitalized Patients Following SARS-CoV-2 Vaccination: A Case-Control Study. COVID-19 与接种 SARS-CoV-2 疫苗后住院患者的急性肾损伤结果:病例对照研究
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241297369
Froylan D Martínez-Sánchez, Luis A Bastida-Castro, José L Torres-Cuevas, Julio A Vasquez-Vasquez, Alejandra Diaz-Jarquin, Rafael Moreno-Novales, Joana Balderas-Juarez, Mauricio A Salinas-Ramírez, Jose L Hernández-Castillo, Erika K Tenorio-Aguirre

Background: Acute kidney injury (AKI) is a frequent complication associated with severe COVID-19 and has been linked to increased mortality. While vaccination against SARS-CoV-2 has shown effectiveness in reducing severe COVID-19 outcomes, its impact on the development of AKI among hospitalized patients remains unclear.

Objective: To evaluate the effect of SARS-CoV-2 vaccination on the incidence and severity of AKI and 28-day mortality among hospitalized patients with severe COVID-19.

Design: Retrospective case-control study.

Setting: Conducted at the Internal Medicine Department of Hospital General Dr. Manuel Gea González, Mexico, from April 2020 to December 2021.

Patients: 413 patients over 18 with confirmed severe COVID-19 were included. Patients were categorized based on their vaccination status before COVID-19 infection.

Measurements: Key outcomes included the incidence of AKI, progression to AKI stage 3, and 28-day mortality. AKI was defined according to the KDIGO criteria.

Methods: Data were analyzed using univariate and logistic regression models to assess the association between vaccination status and the studied outcomes. Covariates included age, sex, BMI, type 2 diabetes, hypertension, and inflammatory markers.

Results: Among the 413 patients, 70% developed AKI, with a median hospital stay of 10 days (range 6-17). Vaccinated patients had a significantly lower incidence of AKI compared with nonvaccinated patients (48.7% vs 74.9%; P < .001). After adjusting for confounding factors, vaccination was associated with lower odds of AKI (OR: 0.252, 95% CI: 0.140-0.452), AKI stage 3 (OR: 0.448, 95% CI: 0.205-0.981), and 28-day mortality (OR: 0.187, 95% CI: 0.064-0.544).

Limitations: As a single-center retrospective study, generalizability is limited. In addition, vaccination data were obtained from medical records, and the completeness of vaccination could not be independently verified.

Conclusions: SARS-CoV-2 vaccination was independently associated with a reduced risk of AKI, AKI stage 3, and 28-day mortality in hospitalized patients with severe COVID-19. These findings highlight the potential protective effects of vaccination against severe kidney complications in this population.

背景:急性肾损伤(AKI)是与严重 COVID-19 相关的常见并发症,并与死亡率增加有关。尽管接种 SARS-CoV-2 疫苗在减少严重 COVID-19 结果方面显示出了有效性,但其对住院患者发生急性肾损伤的影响仍不明确:目的:评估接种 SARS-CoV-2 疫苗对重症 COVID-19 住院患者 AKI 发生率和严重程度以及 28 天死亡率的影响:设计:回顾性病例对照研究:2020 年 4 月至 2021 年 12 月在墨西哥 Manuel Gea González 总医院内科进行:共纳入 413 名 18 岁以上确诊患有严重 COVID-19 的患者。根据感染 COVID-19 前的疫苗接种情况对患者进行分类:主要结果包括 AKI 发生率、AKI 进展至 3 期以及 28 天死亡率。AKI根据KDIGO标准定义:采用单变量和逻辑回归模型对数据进行分析,以评估疫苗接种情况与研究结果之间的关联。协变量包括年龄、性别、体重指数、2 型糖尿病、高血压和炎症指标:在413名患者中,70%发生了AKI,中位住院时间为10天(6-17天不等)。与未接种疫苗的患者相比,接种疫苗的患者发生 AKI 的比例明显较低(48.7% vs 74.9%;P < .001)。调整混杂因素后,接种疫苗与较低的 AKI(OR:0.252,95% CI:0.140-0.452)、AKI 3 期(OR:0.448,95% CI:0.205-0.981)和 28 天死亡率(OR:0.187,95% CI:0.064-0.544)相关:局限性:这是一项单中心回顾性研究,可推广性有限。此外,疫苗接种数据来自医疗记录,无法独立核实疫苗接种的完整性:结论:SARS-CoV-2 疫苗接种与严重 COVID-19 住院患者发生 AKI、AKI 3 期和 28 天死亡率的风险降低有独立关联。这些发现凸显了接种疫苗对该人群严重肾脏并发症的潜在保护作用。
{"title":"COVID-19 and Acute Kidney Injury Outcomes in Hospitalized Patients Following SARS-CoV-2 Vaccination: A Case-Control Study.","authors":"Froylan D Martínez-Sánchez, Luis A Bastida-Castro, José L Torres-Cuevas, Julio A Vasquez-Vasquez, Alejandra Diaz-Jarquin, Rafael Moreno-Novales, Joana Balderas-Juarez, Mauricio A Salinas-Ramírez, Jose L Hernández-Castillo, Erika K Tenorio-Aguirre","doi":"10.1177/20543581241297369","DOIUrl":"https://doi.org/10.1177/20543581241297369","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a frequent complication associated with severe COVID-19 and has been linked to increased mortality. While vaccination against SARS-CoV-2 has shown effectiveness in reducing severe COVID-19 outcomes, its impact on the development of AKI among hospitalized patients remains unclear.</p><p><strong>Objective: </strong>To evaluate the effect of SARS-CoV-2 vaccination on the incidence and severity of AKI and 28-day mortality among hospitalized patients with severe COVID-19.</p><p><strong>Design: </strong>Retrospective case-control study.</p><p><strong>Setting: </strong>Conducted at the Internal Medicine Department of Hospital General Dr. Manuel Gea González, Mexico, from April 2020 to December 2021.</p><p><strong>Patients: </strong>413 patients over 18 with confirmed severe COVID-19 were included. Patients were categorized based on their vaccination status before COVID-19 infection.</p><p><strong>Measurements: </strong>Key outcomes included the incidence of AKI, progression to AKI stage 3, and 28-day mortality. AKI was defined according to the KDIGO criteria.</p><p><strong>Methods: </strong>Data were analyzed using univariate and logistic regression models to assess the association between vaccination status and the studied outcomes. Covariates included age, sex, BMI, type 2 diabetes, hypertension, and inflammatory markers.</p><p><strong>Results: </strong>Among the 413 patients, 70% developed AKI, with a median hospital stay of 10 days (range 6-17). Vaccinated patients had a significantly lower incidence of AKI compared with nonvaccinated patients (48.7% vs 74.9%; <i>P</i> < .001). After adjusting for confounding factors, vaccination was associated with lower odds of AKI (OR: 0.252, 95% CI: 0.140-0.452), AKI stage 3 (OR: 0.448, 95% CI: 0.205-0.981), and 28-day mortality (OR: 0.187, 95% CI: 0.064-0.544).</p><p><strong>Limitations: </strong>As a single-center retrospective study, generalizability is limited. In addition, vaccination data were obtained from medical records, and the completeness of vaccination could not be independently verified.</p><p><strong>Conclusions: </strong>SARS-CoV-2 vaccination was independently associated with a reduced risk of AKI, AKI stage 3, and 28-day mortality in hospitalized patients with severe COVID-19. These findings highlight the potential protective effects of vaccination against severe kidney complications in this population.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241297369"},"PeriodicalIF":1.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prevalence, Characteristics, and Outcomes of People With A High Body Mass Index Across the Kidney Disease Spectrum: A Population-Based Cohort Study. 高体重指数肾病患者的患病率、特征和预后:一项基于人群的队列研究。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241293199
Gurleen Sahi, Jennifer Reid, Louise Moist, Michael Chiu, Amanda Vinson, Saverio Stranges, Kyla Naylor, Yunxu Zhu, Kristin K Clemens
<p><strong>Background: </strong>Obesity has a major impact on health and health care, particularly in those with chronic kidney disease (CKD).</p><p><strong>Objective: </strong>The objective was to describe the prevalence, characteristics, and outcomes of people living with CKD and obesity (defined by a body mass index [BMI] ≥30 kg/m<sup>2</sup>) in Canada.</p><p><strong>Design: </strong>Population-based cohort study using linked administrative health data (ICES).</p><p><strong>Patients: </strong>Adults aged 18 year and older with CKD G1-5D who had a height and weight recorded during a visit to an academic hospital in London Ontario Canada, between January 2010 and December 2019.</p><p><strong>Measures: </strong>CKD as defined by CKD 3A or higher. BMI as defined by weight kg/m<sup>2</sup>.</p><p><strong>Methods: </strong>As a primary interest, we described the percentage of patients with CKD across different BMI categories (<25 kg/m<sup>2</sup>, BMI 25-29.9 kg/m<sup>2</sup>, and BMI ≥30 kg/m<sup>2</sup>), as well as their demographic and clinical profiles. As secondary interests, we followed patients until January 1, 2022 to summarize: (1) the percentage with CKD G3 who had kidney disease progression (50% decline from baseline estimated glomerular filtration rate [eGFR]) by BMI category, (2) the percentage with CKD G3-4 who developed kidney failure (initiation of maintenance dialysis or an eGFR of <15 mL/min/1.73 m<sup>2</sup>) by BMI category, (3) the percentage with CKD G4-G5D who received a kidney transplant by BMI category, and (4) post-transplant outcomes in those transplanted over the study period, by BMI category. We performed similar analyses across CKD risk categories.</p><p><strong>Results: </strong>Of the 198 151 patients included, the percentage with obesity defined by a BMI ≥30 kg/m<sup>2</sup> increased from CKD G1 to CKD G4 (ie, 37% of those with CKD G1 had a BMI ≥30 kg/m<sup>2</sup> vs 40.9% of CKD G4). In CKD G5D and CKD T, the prevalence of high BMI appeared to drop (only ~38% had a BMI ≥30 kg/m<sup>2</sup> across groups). Across CKD categories, those with a BMI ≥30 kg/m<sup>2</sup> appeared to have more comorbidities, use more health care resources, and have more socioeconomic disparities than those with lower BMIs. Although secondary outcome events were limited, those with G3-4 with a BMI ≥30 kg/m<sup>2</sup> appeared to have a higher risk of CKD progression and those with CKD G5D with BMI ≥30 kg/m<sup>2</sup> were less likely to receive transplant over the study period. Interestingly those transplanted with a BMI ≥30 kg/m<sup>2</sup> appeared to have fewer post-transplant complications. We also observed an "obesity-paradox" in the risk of mortality, with high BMI appearing protective, particularly in the end stages of kidney disease.</p><p><strong>Limitations: </strong>We used BMI to capture obesity in this study but recognize its limitations as a measure of body composition. Secondary outcomes were descriptive and unadjusted
背景:肥胖对健康和医疗保健有重大影响,尤其是对慢性肾脏病(CKD)患者:目的:描述加拿大患有慢性肾脏病和肥胖(定义为体重指数[BMI]≥30 kg/m2)的人群的患病率、特征和结果:设计:基于人群的队列研究,使用关联的行政健康数据(ICES):患者:2010 年 1 月至 2019 年 12 月期间在加拿大安大略省伦敦市一家学术医院就诊并记录了身高和体重的 18 岁及以上 CKD G1-5D 成人:CKD 定义为 CKD 3A 或更高。体重指数以体重 kg/m2 为标准:作为主要兴趣点,我们描述了不同 BMI 类别(2、BMI 25-29.9 kg/m2 和 BMI ≥30 kg/m2)的 CKD 患者比例,以及他们的人口统计学和临床概况。作为次要兴趣,我们对患者进行了跟踪调查,直至 2022 年 1 月 1 日,以总结(1) 按 BMI 分类,CKD G3 患者中肾病进展(估计肾小球滤过率 [eGFR] 比基线下降 50%)的比例;(2) 按 BMI 分类,CKD G3-4 患者中出现肾衰竭(开始维持性透析或 eGFR 为 2)的比例;(3) 按 BMI 分类,CKD G4-G5D 患者中接受肾移植的比例;(4) 按 BMI 分类,研究期间接受移植者的移植后结果。我们对不同的 CKD 风险类别进行了类似的分析:在纳入的 198 151 例患者中,从 CKD G1 到 CKD G4,BMI ≥30 kg/m2 的肥胖患者比例有所增加(即 CKD G1 患者中 37% 的人 BMI ≥30 kg/m2 ,而 CKD G4 患者中 40.9% 的人 BMI ≥30 kg/m2)。在 CKD G5D 和 CKD T 中,高体重指数的发生率似乎有所下降(各组中只有约 38% 的人体重指数≥30 kg/m2)。在所有 CKD 类别中,BMI ≥30 kg/m2 的患者似乎比 BMI 较低的患者有更多的并发症,使用更多的医疗资源,并有更多的社会经济差异。虽然次要结果事件有限,但 BMI ≥30 kg/m2 的 G3-4 患者似乎有更高的 CKD 进展风险,而 BMI ≥30 kg/m2 的 CKD G5D 患者在研究期间接受移植的可能性较低。有趣的是,那些体重指数≥30 kg/m2的移植患者似乎有较少的移植后并发症。我们还观察到死亡率风险中的 "肥胖副作用",高体重指数似乎具有保护作用,尤其是在肾脏疾病的晚期:局限性:在本研究中,我们使用体重指数(BMI)来衡量肥胖程度,但也认识到其作为身体成分衡量标准的局限性。由于样本量较小,次要结果是描述性的,未经调整,可能会受到选择偏差和混杂因素的影响:结论:由高体重指数定义的肥胖在慢性肾脏病患者中非常普遍,患者在健康、医疗保健和社会方面存在差异。未来的研究对于了解 BMI 对 CKD 患者的影响以及如何在 CKD 的各个阶段对 BMI 和肥胖进行个体化管理仍然非常重要。
{"title":"Prevalence, Characteristics, and Outcomes of People With A High Body Mass Index Across the Kidney Disease Spectrum: A Population-Based Cohort Study.","authors":"Gurleen Sahi, Jennifer Reid, Louise Moist, Michael Chiu, Amanda Vinson, Saverio Stranges, Kyla Naylor, Yunxu Zhu, Kristin K Clemens","doi":"10.1177/20543581241293199","DOIUrl":"https://doi.org/10.1177/20543581241293199","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obesity has a major impact on health and health care, particularly in those with chronic kidney disease (CKD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to describe the prevalence, characteristics, and outcomes of people living with CKD and obesity (defined by a body mass index [BMI] ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt;) in Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Population-based cohort study using linked administrative health data (ICES).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults aged 18 year and older with CKD G1-5D who had a height and weight recorded during a visit to an academic hospital in London Ontario Canada, between January 2010 and December 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measures: &lt;/strong&gt;CKD as defined by CKD 3A or higher. BMI as defined by weight kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;As a primary interest, we described the percentage of patients with CKD across different BMI categories (&lt;25 kg/m&lt;sup&gt;2&lt;/sup&gt;, BMI 25-29.9 kg/m&lt;sup&gt;2&lt;/sup&gt;, and BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt;), as well as their demographic and clinical profiles. As secondary interests, we followed patients until January 1, 2022 to summarize: (1) the percentage with CKD G3 who had kidney disease progression (50% decline from baseline estimated glomerular filtration rate [eGFR]) by BMI category, (2) the percentage with CKD G3-4 who developed kidney failure (initiation of maintenance dialysis or an eGFR of &lt;15 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;) by BMI category, (3) the percentage with CKD G4-G5D who received a kidney transplant by BMI category, and (4) post-transplant outcomes in those transplanted over the study period, by BMI category. We performed similar analyses across CKD risk categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 198 151 patients included, the percentage with obesity defined by a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; increased from CKD G1 to CKD G4 (ie, 37% of those with CKD G1 had a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; vs 40.9% of CKD G4). In CKD G5D and CKD T, the prevalence of high BMI appeared to drop (only ~38% had a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; across groups). Across CKD categories, those with a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; appeared to have more comorbidities, use more health care resources, and have more socioeconomic disparities than those with lower BMIs. Although secondary outcome events were limited, those with G3-4 with a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; appeared to have a higher risk of CKD progression and those with CKD G5D with BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; were less likely to receive transplant over the study period. Interestingly those transplanted with a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; appeared to have fewer post-transplant complications. We also observed an \"obesity-paradox\" in the risk of mortality, with high BMI appearing protective, particularly in the end stages of kidney disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;We used BMI to capture obesity in this study but recognize its limitations as a measure of body composition. Secondary outcomes were descriptive and unadjusted","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241293199"},"PeriodicalIF":1.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Canadian Journal of Kidney Health and Disease
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1