Nephroprotective effects of Amomum kravanh essential oil by inhibition of ferroptosis regulated by Nrf2/HO-1 signaling pathway

BACKGROUND

Amomum kravanh Pierre ex Gagnep. (BDK) is a Zingiberaceae plant traditionally widely used as a sweet fragrance, and commonly also utilized in minority medicine for various kidney diseases, especially chronic kidney disease (CKD) in Tibetan and Mongolian medicine. However, the underlying mechanisms by which it confers renal protection remain to be fully clarified.

PURPOSE

To investigate the renal protective mechanism of which BDK's essential oil exerts in rats with CKD induced by adenine and 5/6 nephrectomy.

METHODS

Rat models of adenine and 5/6 nephrectomy chronic nephropathy were established, and the therapeutic effects were evaluated by detecting the blood biochemical levels and H&E-/Masson staining and fiber-related factors. Then, the chemical composition of BDK's essential oil and blood components were analyzed using GC-MS. The efficacy of eucalyptol was evaluated by adenine and 5/6 nephrectomy CKD model, with mechanistic studies conducted using RNA-seq, western blot, and metabolomic approaches.

RESULTS

The blood biochemical levels and histopathological analyses (H&E-/Masson's staining) revealed that the BDK's essential oil significantly enhanced renal function and ameliorated kidney tissue fibrosis. Furthermore, GC-MS analysis identified 33 components in the essential oil of BDK, with eucalyptol being the predominant chemical component at 74.07 %. Eucalyptol is capable of entering the bloodstream in its prototypical form. Then, the efficacy and mechanism of eucalyptol were confirmed by adenine/5/6 nephrectomy CKD models, and based on RNA-seq analysis, we found that eucalyptol could significantly improve kidney function and fibrosis of kidney tissues by blocking TGF-β/smad and NF-κB pathways and inhibit ferroptosis through the Nrf2/HO-1 signaling pathway.

CONCLUSION

Both BDK's essential oil and its main constituent, eucalyptol, exhibited protective effects against CKD. They both ameliorated oxidative stress, inflammation, and fibrosis in adenine/5/6 nephrectomy rats. Eucalyptol is implicated in ferroptosis and regulation of renal fibrosis via the Nrf2/HO-1 pathway.

Efficiency of the Viabahn® Covered Stent-Graft as Salvage Treatment for Failing Hemodialysis Accesses

OBJECTIVE

To evaluate the safety and efficacy of covered stent grafts (CSG) and in particular the Viabahn® CSG for arteriovenous access (AVA) salvage.

METHODS

A retrospective data review of all patients treated with Viabahn® CSG placement for dysfunctional access between September 2018 and October 2024 in two hospital centers was performed. The primary outcome measured was the functional patency at three months. Secondary outcomes included technical success, mid-term patency rates, major complications, need and type for reinterventions and overall patient mortality.

RESULTS

We included 73 patients (53% males) in this study with a mean age of 65 ±14 years. Access salvage and functional patency after placement of a Viabahn® CSG was achieved for 94% of patients at three months. During the median follow-up of 28 months (range: 3-80 months), the primary patency rates were 76%, 51% and 48%, and the secondary patency rates were 100%, 100% and 95% at 6 months, 12 months and 18 months respectively. A total of 15 patients developed clinically significant stent restenosis requiring at least one additional procedure, 14 patients had acute access thrombosis requiring thrombectomy and PTA, with involvement of the Viabahn® CSG in 6 cases. Overall access patency rate and access loss were overall survival rate were respectively Access loss occurred in 5 patients, and 7 patients died from other causes.

CONCLUSION

The use of the Viabahn® stent-graft was associated with excellent technical success and a favorable long-term profile in terms of assisted-secondary patency. The device demonstrated sustained effectiveness over time, with no major adverse events such as stent migration, infection, or death, underscoring its high safety and reliability. These findings support the Viabahn® as a highly effective and safe therapeutic option. However, larger prospective multicenter studies with extended follow-up are warranted to further validate these outcomes.

Obesity-related glomerulopathy: How it happens and future perspectives

Obesity-related glomerulopathy (ORG) is an emerging complication of excess adiposity. Its incidence rises alongside the obesity pandemic. Up to 40% of individuals can be affected by ORG, irrespective of the status of glomerular filtration rate and albuminuria. ORG is a distinct histological diagnosis based on kidney biopsy, showing classical features of an enlarged glomerulus with and without focal segmental glomerulosclerosis in the perihilar region seen with all categories of obesity. About 10% of individuals with ORG may progress to end-stage kidney disease. The invasive nature of kidney biopsy highlights the need for non-invasive biomarkers for improved screening, diagnosis and risk prediction of ORG. These biomarkers may narrow the gaps in the management of ORG by improving: (1) screening, diagnosis and differentiation of ORG from non-ORG conditions; (2) risk prediction and stratification of individuals at risk of progression to end-stage kidney disease including the detection of trajectories of progression; (3) monitoring of treatment safety and effectiveness and (4) development of novel therapeutic targets. In the present review, we discussed the pathophysiology, emerging biomarkers (such as kidney injury molecule-1 [KIM-1], uromodulin, klotho, circulating microRNA-21 [miR-21]) and future treatment strategies (metabolic surgery, sodium-glucose cotransporter-2 inhibitors, incretin-based therapy and non-steroidal mineralocorticoid antagonists) of ORG.

Association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and chronic kidney disease in elderly insights from NHANES

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid index. Prior research has established a connection between lipid irregularities and chronic kidney disease (CKD). This study aims to establish a possible link between NHHR and CKD. Data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2003 to 2016 was used to examine the relationship between NHHR and CKD among the elderly population. This research utilized weighted logistic regression, smoothed curve fitting and subgroup analyses along with interaction tests to evaluate the association between NHHR and CKD. The findings reveal a positive correlation between NHHR and CKD in fully adjusted Model 3. Besides, NHHR had a J-curve relationship with CKD. Subgroup analysis indicated that compared with those with lower body mass index (BMI), individuals with higher BMI are more prone to CKD. Research has shown that increased NHHR levels are associated with a higher likelihood of developing CKD in individuals aged above 60 in the United States. NHHR's role in lipid metabolism suggests it might be an effective marker for tracking CKD's progression.

Association between aging phenotypes and chronic kidney disease: evidence from the NHANES and Mendelian randomization

PURPOSE

Biological aging was found to be associated with the higher prevalence of several diseases, but it is unclear in the prevalence of chronic kidney disease (CKD). This study investigated the effect of aging phenotypes, characterized by PhenoAge (PA), Klemera-Doubal Method (KDM), allostatic load (AL), homeostatic dysregulation (HD), and telomere length (TL) on CKD from the perspective of both clinical relevance and genetic susceptibility.

METHOD

From the clinical perspective, the study analyzed data from 7482 participants in the National Health and Nutrition Examination Survey 2006-2015. Logistic regression and restricted cubic spline (RCS) models were employed to evaluate both linear and nonlinear associations between aging phenotypes and the prevalence of CKD. From the genetic susceptibility perspective, Mendelian randomization analyses were conducted to establish causality between telomere length and CKD outcomes.

RESULT

Multivariate logistic regression revealed that PA, KDM, AL, and HD were associated with an increased prevalence of CKD, with PA remaining a significant risk factor after adjusting for covariates (OR = 1.0714, 95% CI = 1.0558-1.0872). RCS curves further indicated a nonlinear relationship between PA, AL, HD, and CKD prevalence (P < 0.001). Besides, inflammation indicators were found to mediate this association. Mendelian randomization analysis demonstrated a significant causal relationship between telomere length and CKD risk across multiple datasets. The results were as follows: Discovery Group (OR = 0.892, 95% CI = 0.832-0.956, P = 0.001) and (OR = 0.896, 95% CI = 0.836-0.961, P = 0.002); Replication Group (OR = 0.872, 95% CI = 0.808-0.940, P < 0.001) and (OR = 0.909, 95% CI = 0.854-0.967, P = 0.003).

CONCLUSION

These findings underscore the strong connection between aging phenotypes and CKD risk, with the mediated effect of inflammatory markers, contributing to the early disease prevention and therapeutic strategy development.

Syndemic approach to chronic kidney disease, cardiovascular disease and educational level: a longitudinal cohort study in northwest Italy

INTRODUCTION

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) represent significant public health challenges, linked to an elevated risk of cardiovascular disease (CVD) and influenced by socioeconomic disparities. This longitudinal study investigates the interplay between socioeconomic position (SEP), measured as educational level, CKD/ESRD and CVD using the syndemic framework.

METHODS

We used data from the Piedmont Longitudinal Study to establish CKD and ESRD cohorts and to identify incident CVD between January 2013 and December 2017. The educational level was retrieved from census data. We applied an accelerated failure time model to explore the relationships between CKD/ESRD, CVD and educational level with all-cause mortality and emergency room (ER) acuity.

RESULTS

The CKD cohort included 44 220 individuals, with 12 341 deaths and 15 440 ER admissions. The ESRD cohort included 4021 subjects, experiencing 1303 deaths and 1640 ER admissions. After adjusting for confounders, the combination of CKD, low educational level and incident CVD was associated with increased all-cause mortality (time ratios (TR) 0.07, 95% CI 0.05 to 0.08) and ER acuity (TR 0.16, 95% CI 0.14 to 0.17) compared with those with higher education. Instead, patients with ESRD with incident CVD and high educational level had the highest increase in mortality (TR 0.08, 95% CI 0.05 to 0.14) and ER acuity (TR 0.20, 95% CI 0.1 to 0.30).

CONCLUSIONS

Patients with CKD with low educational levels and incident CVD may represent a 'syndemic', associated with higher mortality and ER acuity. Our study highlights a potential link between these conditions and socioeconomic disparities, suggesting the need for multifaceted approaches.

hs-CRP/HDL-C can predict the risk of all cause mortality in cardiovascular-kidney-metabolic syndrome stage 1-4 patients

Background

The precise function of the hs-CRP/HDL-C ratio in forecasting the long-term mortality risk of patients with stages 1-4 of Cardiovascular-Kidney-Metabolic (CKM) syndrome remains inadequately delineated. This study investigates the potential correlation between the hs-CRP/HDL-C ratio and long-term mortality risk in individuals with CKM syndrome stages 1-4.

Methods

This prospective cohort study utilises data from the China Health and Retirement Longitudinal Study (CHARLS) project, encompassing 6,719 people who satisfied stringent criteria. We developed three Cox proportional hazards regression models to investigate the potential relationship between the hs-CRP/HDL-C ratio and long-term mortality risk in patients with CKM stages 1-4. We employed Restricted Cubic Spline (RCS) curves for analysis to identify any potential nonlinear correlations. Furthermore, we performed Receiver Operating Characteristic (ROC) curve analysis to evaluate predictive performance and identify the appropriate cut-off value. To enhance the research findings, we conducted a stratified analysis to investigate the influence of various sociodemographic factors on this association.

Results

In individuals with CKM syndrome stages 1-4, the 10-year incidence of all-cause mortality was 14.1%. Upon controlling for additional potential confounding variables, the outcomes of the Cox proportional hazards regression model distinctly demonstrated a statistically significant linear positive association between the hs-CRP/HDL-C ratio and the long-term mortality risk in patients. For each quartile increase in the hs-CRP/HDL-C ratio, the probability of poor outcomes (i.e., mortality) escalated by 15% (Hazard Ratio, HR = 1.15, 95% Confidence Interval, CI: 1.09-1.22, p-value < 0.001). Moreover, the integration of the hs-CRP/HDL-C ratio into the baseline risk prediction model, with all pertinent factors thoroughly adjusted, markedly enhanced the model's predictive capacity, facilitating a more precise assessment of long-term mortality risk in patients with CKM syndrome stages 1-4.

Conclusion

This study identified a positive linear association between the hs-CRP/HDL-C ratio and long-term mortality risk in patients with stages 1 to 4 of CKM syndrome. This remarkable discovery not only offers a crucial reference for enhancing early individualised treatment options but also greatly aids in the early identification of patients with poor prognoses, hence presenting a novel perspective for improving clinical management pathways for these individuals.

Straightforward Approach Toward Thermo-Sensitive Hydrogel Coating on Polyethersulfone Membranes with Controlled Drug Delivery for Significant Inhibition of Thrombocytopenia During Hemodialysis

Thrombocytopenia is a potential complication associated with hemodialysis due to the unsatisfactory hemocompatibility of current dialysis membranes, which leads to excessive platelet destruction, accelerates organ failure, and threatens the patients' life safety in severe cases. In the clinical application of hemodialysis, there are a proportion of patients suffer thrombocytopenia. For these patients, heparin combined with tirofiban can be used during dialysis to suppress the occurrence of thrombocytopenia, but the medication requires intravenous injection and continuous infusion. To optimize the application of hemodialysis membranes, a dialysis membrane composed of polyethersulfone (PES) base membrane and a temperature-sensitive hydrogel coating poly (N-acryloyl glycinamide) (PNAGA) is designed, and prepared that can continuously release tirofiban through temperature control to reduce the burden of medication on patients and significantly inhibit the occurrence of thrombocytopenia. The resulting membrane exhibits an encapsulation efficiency of 36.2% (72.4 µg mL-1) for tirofiban, with drug release rates of 54.83% at 37 °C and 31.4% at 4 °C after 1 h. Additionally, the membrane shows excellent hydrophilicity and dialysis performance. It also effectively inhibits platelet adhesion (reduced by 92.3%), activation (reduced by 92.8%) and aggregation, and albumin adsorption (reduced by 84.7%). In summary, the work provides a new solution for the preparation of dialysis membranes that can prevent thrombocytopenia, which has potential applications in the safer hemodialysis membrane manufacturing sector.

Cardiovascular disease in chronic kidney disease

Individuals with chronic kidney disease (CKD) exhibit an increased risk for the development of cardiovascular disease (CVD) with its manifestations coronary artery disease, stroke, heart failure, arrhythmias, and sudden cardiac death. The presence of both, CVD and CKD has a major impact on the prognosis of patients. This association likely reflects the involvement of several pathophysiological mechanisms, including shared risk factors (e.g. diabetes and hypertension), as well as other factors such as inflammation, anaemia, volume overload, and the presence of uraemic toxins. Identifying and characterizing CKD is crucial for appropriate CVD risk prediction. Mitigating CVD risk in patients with CKD mandates a multidisciplinary approach involving cardiologists, nephrologists, and other health care professionals. The present State-of-the-Art Review addresses the current understanding on the pathophysiological link between CVD and CKD, clinical implications and challenges in the treatment of these patients.

Association of intra-individual differences in estimated GFR by creatinine versus cystatin C with incident cardiovascular disease

BACKGROUND AND AIMS

This study investigates the association between intra-individual differences in estimated glomerular filtration rate based on serum creatinine (eGFRscr) and cystatin C (ΔeGFRcysc-scr) and incident CVD.

METHODS AND RESULTS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020. ΔeGFRcysc-scr were determined by subtracting eGFRscr from eGFRcysc. The outcome was the incidence of CVD, including heart diseases, and stroke, obtained through self-reports. Cox proportional hazard regression models were employed to examine the association between ΔeGFRcysc-scr and CVD risks. Restricted cubic spline with three knots at the 10th, 50th, and 90th centiles was conducted to flexibly model the association. During this period, 1187 incident CVD events were documented. After adjusting for covariates, the risk of CVD was reduced by 13.2 % (Hazard ratio [HR] = 0.868; 95 % confidence interval [95 % CI]: 0.818-0.921) for every 15 mL/min/1.73 m2 increase in baseline ΔeGFRcysc-scr. Specifically, individuals in negative-ΔeGFRcysc-scr group (<-15 mL/min/1.73 m2) had a 33.6 % increased risk of CVD events (HR = 1.336; 95 % CI: 1.151-1.551), and positive-ΔeGFRcysc-scr group (≥15 mL/min/1.73 m2) had a 34.5 % decrease risk of CVD events (HR = 0.655; 95 % CI: 0.541-0.794), compared with those in reference group (-15 to 15 mL/min/1.73 m2). These associations remained robust after adjusting for potential confounders or sensitivity analysis.

CONCLUSIONS

Our findings suggest that intra-individual differences in eGFR estimates based on creatinine versus cystatin C are associated with CVD risk in the Chinese population. This highlights the potential value of using both markers for more accurate CVD risk stratification in clinical practice.

Twice against thrice-weekly hemodialysis (TATH): a multicenter nonrandomized trial

BACKGROUND

The optimal frequency of maintenance hemodialysis remains a subject of debate. In many countries, twice-weekly hemodialysis is still commonly practiced. This trial aimed to compare the outcomes of patients undergoing twice-weekly versus thrice-weekly hemodialysis.

METHODS

This prospective, multicenter, nonrandomized trial included incident adult patients, with chronic kidney disease stage 5, initiating hemodialysis between January 2018 and August 2021. Patients were allocated to either a twice-weekly or thrice-weekly regimen, and monitored at 1, 3, 6, 12 and 24 months. This trial was terminated before reaching the required sample size due to the COVID-19 pandemic and economic factors. Recruitment achieved 25% of the projected number. Missing baseline factors were imputed using multiple imputation algorithms, then entered in a logistic regression model to estimate propensity scores. The primary outcome was two-year survival analyzed using a Cox regression survival model adjusted for propensity scores and baseline residual urine output. Secondary outcomes included hospitalization rates, uncontrolled hypertension and cumulative erythropoietin dose at two years, analyzed using regression models adjusted for propensity scores and baseline residual urine output. All analyses were conducted on an intention-to-treat basis.

RESULTS

A total of 132 patients on thrice-weekly hemodialysis and 71 on twice-weekly hemodialysis were included. The mean age was 67 ± 15 years and the median eGFR at dialysis initiation was 6 (4,8) mL/min/1.73 m2. At one year, patients in the twice-weekly group had greater residual urine output. At two years, there was no significant difference in survival (HR = 0.84; 95% CI: 0.37, 1.90), hospitalization rates (P = 0.515) or uncontrolled hypertension (P = 0.442). The twice-weekly group showed a trend toward higher erythropoietin requirements (P = 0.08). Serum potassium levels and the number of antihypertensive medications were greater in the twice-weekly group.

CONCLUSIONS

Patients on twice-weekly hemodialysis showed comparable overall survival at two years to those on thrice-weekly hemodialysis. While a twice-weekly regimen may be a viable option during the first year of dialysis, especially in low-resource settings, it carries potential risks that necessitate careful monitoring after the first year.

TRIAL REGISTRATION

The trial was registered on ClinicalTrials.gov on January 16, 2018 (Identifier NCT03415776).

From Liver to Kidney: The Overlooked Burden of Nonalcoholic Fatty Liver Disease in Chronic Kidney Disease

Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as a contributor to chronic kidney disease (CKD), yet its impact remains underappreciated in clinical practice. Recent studies reveal a strong association between NAFLD and CKD progression, with evidence linking hepatic dysfunction to renal impairment through metabolic and inflammatory pathways. NAFLD not only increases the risk of CKD but also accelerates its progression, leading to worse cardiovascular outcomes and higher mortality, particularly in patients with advanced fibrosis. Despite this growing evidence, NAFLD often goes undiagnosed in CKD patients and routine hepatic evaluation is rarely integrated into nephrology care. Emerging diagnostic tools, including noninvasive biomarkers and imaging techniques, offer potential for earlier detection, yet their clinical implementation remains inconsistent. Although lifestyle modifications remain the foundation of treatment, pharmacotherapeutic strategies, including SGLT2 inhibitors and GLP-1 receptor agonists, have demonstrated potential in mitigating both hepatic and renal impairment. Recognizing the interplay between NAFLD and CKD is essential for improving patient outcomes. A multidisciplinary approach, integrating hepatology and nephrology expertise, is crucial to refining screening strategies, optimizing treatment, and reducing the long-term burden of these coexisting conditions.

Broad antifibrotic activities of AK3280 in pulmonary, hepatic, cardiac, and skin fibrosis animal models

Fibrosis is the pathological outcome of many chronic inflammatory diseases, affecting various human organs. It is a significant contributor to global morbidity and mortality that affects nearly half of the elderly population. Pirfenidone (PFD) and nintedanib are approved by the FDA for treating pulmonary fibrosis, but these treatments are associated with poor tolerability and limited efficacy. Moreover, no antifibrotic drugs are approved for other fibrosis-related diseases, highlighting an urgent unmet medical need for more effective therapies. Here we report the in vivo pharmacological activities of AK3280, a novel, orally bioavailable small molecule designed to enhance pharmacokinetics, antifibrotic activity, and tolerability over PFD. AK3280 demonstrated antifibrotic effects across multiple organs, including the lungs, liver, heart, and skin, in various animal models. These results suggest that AK3280 holds promise as a clinically beneficial antifibrotic therapy for a range of fibrotic diseases, especially pulmonary, hepatic, cardiac, and skin fibrosis.

High triglyceride-to-high-density lipoprotein cholesterol ratio predicts poor prognosis in new-onset heart failure: a retrospective study

BACKGROUND

There is limited research on the relationship between the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and outcomes in new-onset heart failure (HF). Therefore, this study aimed to explore the association between TG/HDL-C ratio and clinical outcomes in these patients.

METHODS

A retrospective cohort of 614 adults with new-onset HF hospitalized at The First Affiliated Hospital of Nanchang University between July 2021 and December 2022 was analyzed. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular (CV) death and HF rehospitalizations within 12 months after discharge. Kaplan-Meier (K-M) curves, restricted cubic spline (RCS) analysis, and Cox regression evaluated the association between TG/HDL-C ratio and MACE risk.

RESULTS

Patients were divided into four quartiles (Quartile 1, 2,3 and 4) based on their TG/HDL-C ratios. The mean age was 68.94 ± 14.34 years, with 59.12% male. The mean left ventricular ejection fraction (LVEF) was 46.59 ± 10.89%, with 45.11% having an LVEF ≤ 40%. During the 12-month follow-up, 156 patients experienced MACE, comprising 18 CV deaths and 138 HF rehospitalizations. The Quartile 4 group had the highest MACE risk incidence compared to other groups (P < 0.001). K-M analysis confirmed that the Quartile 4 group was associated with an increased cumulative incidence of MACE, HF rehospitalization, and CV death (all P < 0.001). RCS analysis revealed a positive nonlinear relationship between the TG/HDL-C ratio and MACE risk (P for nonlinear = 0.026), with a sharp risk increase above a ratio of 1.08. After adjustment, TG/HDL-C ratio was independently associated with MACE (HR: 1.44, 95% CI: 1.29-1.60). Compared to Quartile 1, adjusted HRs were significantly higher in Quartiles 2, 3, and 4 (all P < 0.005).

CONCLUSIONS

The TG/HDL-C ratio is independently associated with 12-month MACE risk in new-onset HF patients. It may serve as a simple, cost-effective marker to improve early risk stratification and guide closer monitoring and tailored management in this high-risk population.

Prognostic value of nighttime blood pressure in patients with chronic kidney disease

The optimal blood pressure (BP) in patients with chronic kidney disease (CKD) remains uncertain. Therefore, this cohort study aimed to investigate the prognostic value of ambulatory blood pressure (ABP) in patients with CKD and to determine the optimal range for ABP. In total, 1051 hospitalized patients with CKD were enrolled. The prognosis of patients with CKD was evaluated in terms of all-cause death, cardiovascular death, cardiovascular events, and renal events. Our results showed that systolic blood pressure (SBP) had a higher predictive value than diastolic blood pressure in the multivariate-adjusted models. Additionally, nighttime SBP was found to be the best predictor of prognosis in patients with CKD. Furthermore, when dividing the nighttime SBP into quartiles (quartile 1: <110 mmHg, quartile 2: 110-124 mmHg, quartile 3:124-139 mmHg, and quartile 4: ≥139 mmHg). Nighttime SBP ≥ 124 mmHg had an impact on prognosis in patients with CKD, nighttime SBP 124-139 mmHg: total mortality (hazard ratio [HR], 3.017 [95% confidence interval (CI): 1.367-6.660]), cardiovascular death (HR, 2.570 [95% CI, 1.744-6.151]), all cardiovascular events (HR, 2.401 [95% CI, 1.288-4.475]), and 110-124 mmHg had an impact on the renal prognosis (HR, 1.975 [95% CI, 1.311-2.976]). Therefore, nighttime SBP is an independent risk factor for CKD and a significant predictor of prognosis in patients with CKD. Furthermore, the prognosis of patients with CKD improved when the nighttime SBP was maintained below 124 mmHg; however, maintaining it below 110 mmHg can further lower the incidence of renal disease.

Differences in Microorganism Profile in Periprosthetic Joint Infections of the Knee in Patients Affected by Chronic Kidney Disease

BACKGROUND

Periprosthetic joint infections (PJIs) are one of the most devastating complications of total knee arthroplasty (TKA). Patients who have chronic kidney disease (CKD) are more vulnerable to PJI. We aimed to answer the following questions: 1) What are the commonly observed pathogens in PJI after TKA in CKD patients, and do they differ from those in non-CKD patients? and 2) What are the risk factors for PJI after TKA in CKD patients?

METHODS

Patients who underwent surgery due to a chronic PJI of the TKA were retrospectively enrolled. The patients were divided into two groups as follows: patients those who had and those who did not have CKD. Demographic data and comorbidities of the patients were recorded. The microorganisms responsible for PJI were identified based on the biopsy results, and comparisons were made between the two groups. There were 331 patients in the CKD group and 2,238 in the control group. Patients who had CKD were significantly older (P < 0.001) and had higher Charlson Comorbidity Index scores (P < 0.001).

RESULTS

Binary logistic regression identified multiple microorganisms within the CKD group. The most common microorganisms in PJI were as follows: Staphylococcus epidermidis (odds ratio [OR] 1.38; P = 0.030; 95% confidence intervals (CI) 1.03 to 1.86), Staphylococcus aureus (OR 1.88; P < 0.001; 95% CI 1.36 to 2.61), Enterococcus faecalis (OR 2.39; P < 0.001; 95% CI 1.44 to 3.94), Escherichia coli (OR 1.76; P = 0.028; 95% CI 1.06 to 2.94), methicillin-resistant Staphylococcus aureus (OR 3.04; P = 0.024; 95% CI 1.15 to 8.02), polymicrobial infections (OR 1.52; P < 0.001; 95% CI 1.12 to 2.06).

CONCLUSION

Patients who had PJI and CKD demonstrated a higher incidence of infections with specific microorganisms, including Staphylococci, enterococci, gram-negative bacteria, and methicillin-resistant Staphylococcus aureus. To mitigate the high PJI risk in CKD patients, a treatment plan based on this microbial profile and a multidisciplinary assessment of CKD comorbidities before TKA is recommended.

The Kidney-Immune-Brain Axis: The Role of Inflammation in the Pathogenesis and Treatment of Stroke in Chronic Kidney Disease

Cardiovascular diseases such as stroke are a major cause of morbidity and mortality for patients with chronic kidney disease (CKD). The underlying mechanisms connecting CKD and cardiovascular disease are yet to be fully elucidated, but inflammation is proposed to play an important role based on genetic association studies, studies of inflammatory biomarkers, and clinical trials of anti-inflammatory drug targets. There are multiple sources of both endogenous and exogenous inflammation in CKD, including increased production and decreased clearance of proinflammatory cytokines, oxidative stress, metabolic acidosis, chronic and recurrent infections, dialysis access, changes in adipose tissue metabolism, and disruptions in intestinal microbiota. This review focuses on the mechanisms of inflammation in CKD, dialysis and associated therapies, its proposed impact on stroke pathogenesis and prognosis, and the potential role of anti-inflammatory agents in the prevention and treatment of stroke in patients with CKD.

Birthweight and risk of chronic kidney disease after a type 2 diabetes diagnosis in the DD2 cohort

AIMS/HYPOTHESIS

Low birthweight (LBW) is associated with younger age, less obesity and more hypertension among people recently diagnosed with type 2 diabetes, as well as increased cardiovascular morbidity and mortality risk. It is not known whether LBW is associated with an increased risk of incident chronic kidney disease (CKD) among people with a type 2 diabetes diagnosis.

METHODS

Original midwife records were retrieved for 5982 participants with recently diagnosed type 2 diabetes enrolled in the Danish Center for Strategic Research in Type 2 Diabetes (DD2) cohort between 2010 and 2024. They were followed until first incident CKD diagnosis, defined as either two eGFR measurements <60 ml/min per 1.73m2 or two urine albumin/creatinine ratio (UACR) measurements >3 mg/mmol, each 90-365 days apart. Confounder-standardised 10 year risks of CKD were estimated, with death considered as a competing risk. Adjusted hazard ratios (aHRs) for CKD were computed using Cox and spline regression analyses. All analyses were controlled for differences in sex, age at enrolment, calendar year at birth, family history of diabetes and born-at-term status. Mixed-effects models were used to examine the trajectories of eGFR and UACR following enrolment.

RESULTS

A total of 1501 incident CKD endpoints occurred, corresponding to an incidence rate of 42.4 per 1000 person-years over a median follow-up time of 8.3 years. Spline models with birthweight as a continuous measure showed progressively increasing aHRs for CKD with decreasing birthweight. The 10-year standardised risk of CKD was 36.0% in people with LBW (<2500 g) and 30.6% in people with a normal birthweight (2500-4000 g), yielding a risk difference (RD) of 5.5% (95% CI -0.5%, 11.8%) and an aHR of 1.23 (95% CI 0.98, 1.55). People with type 2 diabetes and high birthweight (>4000 g) had a similar 10-year standardised CKD risk compared with normal birthweight (33.1% and 30.6%, respectively). This yielded an RD of 2.5% (95% CI -1.6%, 6.7%) and an aHR of 1.10 (95% CI 0.93, 1.29). In mixed-effects models examining eGFR and UACR trajectories, each 1 kg decrease in birthweight was associated with a 6.6% (95% CI 1.9, 11.1) increase in UACR, whereas no association was found for eGFR.

CONCLUSIONS/INTERPRETATION

A history of LBW was associated with elevated risk of CKD among people with a recent type 2 diabetes diagnosis, although the precision of risk estimates was limited.

Economic burden of inpatient hospitalizations for pediatric chronic kidney disease in the US

BACKGROUND

Children with chronic kidney disease (CKD) face extensive healthcare needs, leading to substantial financial strain on both families and healthcare systems due to costly kidney replacement therapies and associated comorbidities. Limited research on inpatient healthcare utilization is available for the individual stages of pediatric CKD.

METHODS

This retrospective cohort study included inpatient encounters for pediatric patients (≤ 18 years) using the Pediatric Health Information System Database (PHIS) between January 2016 and December 2022, with an ICD-10 code for any CKD stage (1-5). Hospitalization cost, length of stay (LOS), morbidity, and mortality data were collected.

RESULTS

We identified 23,980 pediatric CKD cases [stage 1: 5,059, stage 2: 6,763, stage 3: 7,012, stage 4: 3,102, and stage 5: 2,044] across 49 different children's hospitals in the United States. Mortality rates were observed to increase with increasing CKD severity, but no clear trend was observed for surgical, medical, and infection rates by CKD stage. The LOS for patients with CKD stage 4 and CKD stage 5 was 56% and 71% longer relative to the LOS of a typical hospitalization for a patient without CKD, and the billed charges for these hospitalizations were 92% and 147% higher than those of a typical hospitalization.

CONCLUSIONS

LOS and hospitalization costs were significantly higher for patients with CKD than for patients without CKD. Furthermore, pediatric patients with stage 5 CKD had significantly higher in-patient costs and all-cause hospitalization LOS compared to those with CKD stages 1-4.

Elevated Serum and Urinary Secreted Protein Acidic and Rich in Cysteine Levels are Novel Biomarkers of Kidney Fibrosis Severity

BACKGROUND

Interstitial fibrosis is the primary determinant of the progression of chronic kidney disease (CKD), and noninvasive identification of interstitial fibrosis is a major challenge. We aimed to explore the diagnostic value of secreted protein acidic and rich in cysteine (SPARC) in serum and urine in kidney fibrosis.

METHODS

Single-cell transcriptome analysis was used to measure SPARC expression in healthy reference kidneys and those of patients with CKD. A total of 674 patients with CKD who underwent renal biopsy served as the training cohort (n = 322) and the validation cohort (n = 352). Serum and urinary SPARC levels were measured at the time of kidney biopsy. In vivo and in vitro models of kidney fibrosis were also used to confirm the role of SPARC.

RESULTS

Increased SPARC expression was detected in kidney fibrosis tissues. Higher serum SPARC levels were associated with increased severity of kidney fibrosis. Moreover, the area under the receiver operating characteristic curve (AUC-ROC) (AUC 0.86) was greater for the serum SPARC level than for the urinary SPARC level and estimated glomerular filtration rate (eGFR). The combination of the serum and urinary SPARC levels and eGFR increased the AUC-ROC for predicting kidney fibrosis from 0.86 to 0.90. The diagnostic performance of serum or urinary SPARC levels was consistent in the validation cohort. In vivo and in vitro models of kidney fibrosis also confirmed the upregulation of SPARC expression.

CONCLUSIONS

Serum and urinary SPARC levels may be potential biomarkers for kidney fibrosis and may be useful for noninvasive diagnosis.

Performance of Five Estimated Glomerular Filtration Rate Equations in Vietnamese Kidney Transplant Recipients: A Cross-Sectional Study

BACKGROUND

Despite the critical role of glomerular filtration rate (GFR) assessment in monitoring kidney transplants, the most accurate estimate remains uncertain. This study aimed to evaluate the performance of established estimated GFR (eGFR) equations in the Vietnamese population.

METHODS

This cross-sectional study involving 299 Vietnamese kidney transplant recipients (KTRs) compared measured GFR (mGFR), determined using technetium-99m-diethylenetriaminepentaacetate (99mTc-DTPA) renal dynamic scintigraphy, with five eGFR equations (Modification of Diet in Renal Disease [MDRD], Asian modified Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI], CKD-EPI SCysC 2012, CKD-EPI SCr 2021, and CKD-EPI SCr-SCysC 2021). The performances of the five eGFR equations were compared based on bias, P30 accuracy, absolute accuracy, precision, root mean square error (RMSE), concordance correlation coefficient (CCC), and Pearson's correlation coefficient (r), along with their 95% confidence intervals (CIs).

RESULTS

CKD-EPI SCr-SCysC 2021 showed the best performance. The values for median bias, P30 accuracy, absolute accuracy, precision, RMSE, CCC, and r were: 2.57 [1.22; 3.55] mL/min/1.73 m2, 87.6% [83.3; 90.6], 10.0% [8.3; 11.7], 11.29 [9.57; 13.40] mL/min/1.73 m2, 11.54 [10.42; 12.92], 0.787 [0.737; 0.828], and 0.810 [0.759; 0.850], respectively. The MDRD equation did not show significantly lower precision and accuracy than the CKD-EPI SCr-SCysC 2021 equation. All five equations demonstrated improved accuracy in the mGFR ≥ 60 mL/min/1.73 m2 subgroup compared to the mGFR < 60 mL/min/1.73 m2 subgroup.

CONCLUSIONS

CKD-EPI SCr-SCysC 2021 is the most accurate eGFR equation for Vietnamese KTRs. Further studies with larger cohorts and comparisons with gold-standard methods are needed to confirm these findings.

Salivary attenuated total reflectance-fourier transform infrared spectroscopy combined with chemometric analysis: A potential point-of-care approach for chronic kidney disease screening

BACKGROUND

The increasing prevalence of chronic kidney disease (CKD) and its terminal stage, end-stage renal disease (ESRD), raises the importance of an accurate, early, and point-of-care method to diagnose and monitor patients. Saliva is a potential point-of-care diagnostic biofluid for its simple collection and ability to reflect systemic health status. This study investigated salivary spectral signatures in ESRD patients and their diagnostic potential compared to healthy controls.

METHODS

Saliva samples were collected from 24 ESRD patients undergoing hemodialysis and 24 age/sex-matched healthy controls. The dried saliva samples were analyzed using Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) spectroscopy in the 4000-400 cm⁻¹ range. Chemometric analyses, including Principal Component Analysis (PCA) and Partial Least Squares Discriminant Analysis (PLS-DA), were applied to preprocessed spectra to identify discriminatory spectral features and establish classification models.

RESULTS

Second derivative spectroscopic analysis of ATR-FTIR spectra revealed distinctive spectral patterns in dried ESRD saliva samples, including characteristic peak shifts observed in both the amide I secondary structures (from 1636 cm-1 in controls to 1629 cm-1 in ESRD) and carbohydrate (from 1037 cm-1 in controls to 1042 cm-1 in ESRD) regions. PCA demonstrated clear clustering patterns across key biological spectral regions, including the lipid CH stretching region (3000-2800 cm-1), the fingerprint region (1800-900 cm-1), and their combination (3000-2800 cm-1 + 1800-900 cm-1). PLS models based on the fingerprint region achieved optimal diagnostic performance (87.5-100 % accuracy, 75-100 % sensitivity, and 100 % specificity). Biochemical markers associated with ESRD revealed variations in lipids, protein, sugar moieties, carbohydrates, and nucleic acids, reflecting the underlying pathological changes in CKD, with the most prominent band at ∼1405 cm-1.

CONCLUSION

ATR-FTIR analysis of dried saliva demonstrated potential as a non-invasive diagnostic tool for ESRD. This approach could complement existing diagnostic methods, particularly in resource-limited settings or for frequent monitoring requirements.

Rising Obesity-Associated Mortality in Men: Exploration of Gender Disparity from the Global Burden of Disease Study, 1990-2019

OBJECTIVES

The global rise in overweight, obesity, and related diseases is undeniable; however, the pathogenesis of obesity and obesity-associated diseases is heterogeneous, with varied complications and a discordant response to treatment. Intriguingly, men have a shorter lifespan than women, despite being half as likely to be obese. This paradox suggests a potential gender disparity in the impact of obesity on mortality, with men potentially being more vulnerable to obesity-associated health risks.

METHODS

This retrospective study utilized Global Burden of Diseases data from 204 countries/territories to bridge the knowledge gap in understanding gender disparities in obesity-related mortality. Outcomes were obesity-associated mortality, years of life lost, years lived with disability, and disability-adjusted life years (DALYs).

RESULTS

In 2019, the global overweight/obesity-related disease burden reached 160.2 million DALYs, with 5.02 million associated deaths. From 1990 to 2019, the age-standardized death rates increased in males (from 58.19 to 66.55 per 100,000 person-years, APC = 0.36%, 95% CI: 0.30 to 0.42%, P < 0.001), while females experienced a decrease in age-standardized death rates (from 59.31 to 58.14 per 100,000 person-years, APC = -0.22%, 95% CI: -0.29% to -0.14%, P < 0.001). Age-standardized DALYs increased more in males (1632.5 to 2070.34 per 100,000 years, APC = 0.74%, 95% CI: 0.70% to 0.78%, P < .001) compared to females (1618.26 to 1789.67 per 100,000 years, APC = 0.24%, 95% CI: 0.19% to 0.29%, P < 0.001). Disparities were more pronounced in countries with a higher socioeconomic status and predominantly affected younger populations.

CONCLUSIONS

Overweight/obesity-related morbidity and mortality are higher among male sex. Identifying differences in pathogenesis, complications and treatment response is crucial to develop targeted interventions and equitable public health policies to combat this global burden.

Timing of meal replacement on body weight: a multicenter open-labeled randomized trial

PURPOSE

We aim to evaluate the effects of partial meal replacement (MR) with different timing of MR on body weight in Chinese adults.

METHODS

A multicenter open-labeled, randomized, parallel study was performed. Participants were randomly assigned to receive partial MR at breakfast and lunch or breakfast and dinner for 16 weeks. The primary outcome was the absolute change in body weight between baseline and the end of the intervention. The BMI of participants is between 24.0 kg/m2 and 35.0 kg/m2, without a history of diabetes, hypertension, or gout, and whose baseline blood pressure, fasting blood glucose, serum level of glycated hemoglobin A1c, uric acid, and liver enzymes within the pre-determined range, were recruited.

RESULTS

A total number of 153 individuals were included in the analysis (106 females and 47 males; mean age 32.6 ± 6.7 years, mean BMI 28.5 ± 2.8 kg/m2 at baseline). Partial MR for 16 weeks resulted in significant body weight loss (-5.1 kg, 95% CI: -5.8, -4.5 kg), decrease of waist (-4.8 cm; 95% CI: -5.5 cm, -4.1 cm) and hip circumference (-4.3 cm; 95% CI: -4.9 cm, -3.8 cm), and loss of body fat (-4.1 kg; 95% CI: -4.7 kg, -3.6 kg). About half of the participants (51.6%) achieved the goal of losing 5% of baseline body weight or more. Timings of MR (breakfast and lunch vs. breakfast and dinner) generated similar results.

CONCLUSION

Partial MR resulted in significant improvements in anthropometric data, body fat, and most metabolic variables while different MR timing generated similar results.

TRIAL REGISTRATION

The study was registered at https://www.chictr.org.cn/showproj.html?proj=47475 (ChiCTR2100042637).

Aprocitentan for Blood Pressure Reduction in Black Patients

BACKGROUND

Black individuals frequently present with resistant hypertension and disproportionately increased cardiovascular risk. We investigated the blood pressure (BP)-lowering effect of the dual endothelin receptor antagonist aprocitentan in Black individuals enrolled in the PRECISION study (Parallel-Group, Phase 3 Study with Aprocitentan in Subjects with Resistant Hypertension).

METHODS

Patients with confirmed resistant hypertension were randomized to aprocitentan 12.5 mg, 25 mg, or placebo for 4 weeks (part 1). They subsequently received aprocitentan 25 mg for 32 weeks (part 2) before re-randomization to aprocitentan 25 mg or placebo (part 3).

RESULTS

Eighty-two patients randomized in the PRECISION study were Black individuals. At week 4, aprocitentan 12.5 and 25 mg reduced office trough systolic BP (-11.3 and -11.9 mm Hg) to a similar degree as placebo (-12.0 mm Hg). Using 24-hour ambulatory BP monitoring, the placebo effect was minimal (-0.7 mm Hg), and aprocitentan reduced systolic BP by 4.0 and 8.6 mm Hg. During part 2, office BP continued to decrease (-16.4 mm Hg at week 36). In part 3, office and ambulatory systolic BP increased on placebo (+9.9 and +8.1 mm Hg, respectively), whereas the BP-lowering effect was maintained with aprocitentan. Aprocitentan markedly reduced albuminuria during the study. The most frequent adverse event was peripheral edema, occurring in 3 patients (10%) receiving aprocitentan 25 mg versus none receiving aprocitentan 12.5 mg or placebo.

CONCLUSIONS

Aprocitentan reduced BP and albuminuria in Black individuals with resistant hypertension. The BP-lowering efficacy was similar to that of the overall PRECISION population. Aprocitentan may represent an important addition to the often difficult-to-control hypertension in Black individuals.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03541174.

The relationship between serum uric acid and homocysteine is influenced by kidney function

BACKGROUND AND AIM

Prior research has established a relationship between homocysteine (Hcy) and serum uric acid (SUA) levels; however, the precise mechanisms underlying this association remain unclear. The objective of this research was to explore the correlation between SUA and Hcy and to evaluate the possible role of kidney function as a mediator in the connection between SUA and Hcy.

METHODS AND RESULTS

Consecutive enrollment of 16870 participants aged 20-60 years was conducted at the Third Xiangya Hospital of Central South University. Self-reported health questionnaires were used to gather information on health behaviors and medical backgrounds. Trained personnel performed laboratory examinations using standard methods. A mediation analysis was performed to explore the possible effect of renal function on the association between SUA and Hcy levels. Estimated glomerular filtration rate (eGFR) was used to assess kidney function. Logistic regression analysis showed that SUA levels were positively correlated with Hcy levels and hyperhomocysteinemia (HHcy) risk (p < 0.01). Subgroup analysis showed the robustness of the results. Significant mediation effects of eGFR were found in the relationship between SUA and Hcy, as demonstrated by the subsequent mediation analysis. In the overall study group, the percentage of eGFR mediated in the association between SUA and Hcy was 63.36 %, with 41.59 % and 57.59 % in women and men, respectively.

CONCLUSIONS

SUA was positively correlated with Hcy and HHcy risks, and the effects of SUA on Hcy may be mediated by renal function indicators (eGFR).

Fear of falling and associated influencing factors in patients on maintenance hemodialysis

INTRODUCTION

This cross-sectional study analyzed the fear of falling (FOF) and associated influencing factors in patients undergoing maintenance hemodialysis (MHD).

METHODS

Patients on MHD (n = 131) were assessed using the short Falls Efficacy Scale International, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Perceived Social Support Scale, and Barthel Index questionnaires.

RESULTS

The total FOF score was positively correlated with total anxiety and depression scores but negatively correlated with the total score of activities of daily living. There were significant differences in FOF among different age groups, employment status, the use of walkers, living arrangements (living alone), and having a history of falling in the past year. Age, employment status, history of falls in the past year, and anxiety score were significant risk factors for FOF in MHD patients.

CONCLUSION

FOF in MHD patients is strongly associated with age, employment status, history of falls in the past year, and anxiety level.

Aligning kidney function assessment in patients with cancer to global practices in internal medicine

The kidney disease: Improving Global Outcomes (KDIGO) guideline recommends assessing kidney function using glomerular filtration rate (GFR) either through direct measurement or through estimation (eGFR) and describes a standardised classification of reduced kidney function. KDIGO guidelines have been adopted by most internal medicine specialities for the assessment and classification of kidney function, but not by cancer medicine. The development of the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD) aims to overcome the perceived challenges with KDIGO recommendations by describing their utility in patients with cancer. Two virtual, consensus building workshops were held consecutively, involving international, multidisciplinary participants (Part 1 of ADDIKD development). During these workshops, three consensus recommendations were agreed upon based on KDIGO's principles; to standardise kidney function assessment, classify kidney function, and determine a uniform approach to dose anticancer drugs in patients with reduced kidney function. Cancer clinicians attending the workshops identified issues regarding the adoption of KDIGO's recommendations. These issues were addressed by nephrologists, clinical pharmacologists, and other clinicians with extensive experience in the contemporary assessment of kidney function. The key concern for cancer specialists was a hesitancy to move away from the familiar and long-standing practice of using the Cockcroft-Gault equation to estimate creatinine clearance. The consensus building within the two multidisciplinary workshops allowed a thorough assessment of the evidence and clarified how directly measured GFR and eGFR, rather than creatinine clearance, could be optimally utilised in cancer care. The development of Part 1 of the ADDIKD guideline represents a standardised, contemporary approach to the assessment, classification, and utility of kidney function in the setting of cancer care and it harmonises with the approach used in other areas of medicine internationally.

Funding

Development of the ADDIKD guideline is funded by the Cancer Institute NSW as part of the NSW Government and received no funding from external commercial sources.

Interplay between periodontitis and chronic kidney disease

Periodontitis is a ubiquitous chronic inflammatory disease affecting the supporting tissues of the teeth and is a major cause of multiple tooth loss. Despite being preventable, periodontitis and dental caries are responsible for more years lost to disability than any other human condition. The most severe form of periodontitis affects 1 billion individuals, and its prevalence is increasing globally. Periodontitis arises from a dysregulated and hyperactive inflammatory response to dysbiosis in the periodontal microbiome. This response has systemic effects associated with premature mortality and elevated risk of several systemic non-communicable diseases (NCDs), including atheromatous cardiovascular disease, type 2 diabetes and chronic kidney disease (CKD). This risk association between periodontitis and NCDs is independent of their shared common risk factors, suggesting that periodontitis is a non-traditional risk factor for NCDs such as CKD. As periodontitis progresses, the immune cells and mediators underpinning its pathophysiology leak into the systemic circulation through the ulcerated oral mucosal lining, inducing in a systemic inflammatory profile that closely mirrors that observed in patients with CKD. The relationship between periodontitis and CKD seems to be bi-directional, but large-scale intervention studies are required to clarify causality and could lead to new care pathways for managing each condition as an exposure for the other.

Bridging the Gap Between CKD Management Paradigms in Transplant and Nontransplant Settings: Published Evidence, Challenges, and Perspectives

Kidney transplantation (KT) is the best treatment for patients with kidney failure, associated with improved survival and quality of life compared with maintenance dialysis. However, despite constant improvements in the assessment and management of the alloimmune response, KT patients frequently demonstrate a reduced estimated glomerular filtration rate. Therefore, the usual complications of chronic kidney disease (CKD), such as anemia, hypertension, metabolic acidosis, hyperkalemia, or persistent secondary hyperparathyroidism, are highly prevalent after KT. However, their underlying mechanisms are different in the transplant setting (compared with the nontransplanted CKD population), and management recommendations are based on relatively poor-quality data. In recent years, new therapies have emerged, significantly improving kidney and cardiovascular outcomes of non-KT patients with CKD. Whether those new drugs could improve the outcomes of KT patients has largely been under investigated so far. In this review, we will address the challenges of the management of a KT patient with a reduced estimated glomerular filtration rate, cover the published evidence, and highlight the critical knowledge gaps.

Metformin ameliorates osteoporosis by enhancing bone angiogenesis via the YAP1/TAZ-HIF1α axis

BACKGROUND

Osteoporosis, resulting from an imbalance between osteoclast-mediated bone resorption and osteoblast-mediated bone formation, affects millions globally. Recent studies have identified type H vessels (CD31hiEMCNhi) as a specialized subset of bone blood vessels that positively regulate bone formation. This study aims to investigate the effects of metformin on bone mass, strength, and angiogenesis in osteoporotic mice, and to elucidate the underlying molecular mechanisms, particularly focusing on the YAP1/TAZ-HIF1α axis.

METHODS

Osteoporotic mice were administered metformin, and bone mass and strength were measured. In vivo and in vitro angiogenesis assays were performed under hypoxic conditions. Expression levels of YAP1/TAZ and HIF1α were assessed in femoral metaphysis and hypoxia-cultured human microvascular endothelial cells (HMECs). Small interfering RNA was used to interfere with HIF1α or YAP1/TAZ expression in hypoxia-cultured HMECs. Additionally, we employed AAV-mediated overexpression of YAP1/TAZ in vivo to determine whether elevated YAP1/TAZ levels alter metformin's effects on bone mass and angiogenesis.

RESULTS

Metformin significantly enhanced bone mass and strength in osteoporotic mice. It also promoted angiogenesis under hypoxia conditions both in vivo and in vitro. Metformin reduced YAP1/TAZ expression while increasing HIF1α expression in both the femoral metaphysis of osteoporotic mice and hypoxia-cultured HMECs. Interference with HIF1α or YAP1/TAZ confirmed that metformin enhances HIF1α and its target genes primarily by inhibiting YAP1/TAZ. Furthermore, overexpression of YAP1/TAZ partially reversed the bone-protective effect of metformin, leading to reduced HIF1α levels and diminished type H vessel formation.

CONCLUSION

Our findings suggest that metformin holds promise as a therapeutic agent for osteoporosis by enhancing type H vessel formation through the inhibition of the YAP1/TAZ-HIF1α axis.

Iguratimod modulates osteoclast differentiation in rheumatoid arthritis: Insights into AMPK/HIF-1α signaling pathway regulation

BACKGROUND

Rheumatoid arthritis (RA) leads to joint deformities and diminishes quality of life if not managed promptly. Investigating Iguratimod effects on osteoclast differentiation in RA patients could provide insights into disease management.

METHODS

Peripheral blood mononuclear cells (PBMCs) were extracted from blood samples taken from RA patients. TRAP staining confirmed the ability of these cells to differentiate into osteoclasts. Those cells were treated with Iguratimod, AMPK agonist (AICAR), and HIF-1α interference (PX-478) during osteoclast induction. CCK8, flow cytometry, ELISA, qPCR, and WB were used to detect changes after exposure in each group.

RESULTS

Iguratimod, AICAR and PX-478 reduced osteoclast formation and viability while promoting apoptosis. ELISA results showed that exposure with Iguratimod, AICAR and PX-478 significantly reduced the levels of CXCL8, CCL20, TNF-α, IL-1, IL-6, IL-17 and TPRA secreted by PBMCs from RA patients. In addition, the results demonstrate that Iguratimod, along with AICAR, PX-478, and Leflunomide, significantly suppresses the expression of osteoclast-specific markers (HIF-1α, TRAP, CTSK, CTR, MMP9, and RANK) at both mRNA and protein levels. Notably, Iguratimod, AICAR, and Leflunomide increase the expression of AMPK and p-AMPK, while PX-478 decreases their expression.

CONCLUSIONS

Iguratimod potentially modulates AMPK/HIF-1α pathway, thereby suppressing release of inflammatory factors and influencing differentiation of peripheral blood osteoclasts in RA patients. These findings suggest promising therapeutic strategies for exposure of joint deformities associated with RA.

Scalable ion concentration polarization dialyzer for peritoneal dialysate regeneration

A wearable artificial kidney (WAK) stands poised to offer dialysis treatment with maximal temporal and spatial flexibility for end-stage renal disease (ESRD) patients, while portability has not yet been achieved due to difficulties in portable purification. The ion concentration polarization (ICP), one of the nanoelectrokinetic phenomenon, has garnered substantial attention in the realm of portable purification applications, owing to its remarkable capacity for charge separation. In this work, scalable ICP dialyzer with 10,000-fold increase in throughput, was applied for peritoneal dialysate regeneration. First, the mechanism underpinning dialysate purification was corroborated based on micro-nanofluidics. Simultaneously, the electrochemical reactions utilized the complete decomposition of uncharged toxin (urea), achieving approximately 99% clearance, while the ICP phenomenon promoted the removal of positively charged toxin (creatinine), achieving approximately 30% clearance. Second, 3-D scalable ICP dialyzer was developed with a creation of micro-nanofluidic environment inside. Throughput scalability was demonstrated up to 1 mL/min with average approximately 30% toxins clearance. Ultimately, the 3-D ICP dialyzer was applied to assist peritoneal dialysis (PD) using a bilateral nephrectomy rat model. We demonstrated that regenerated dialysate successfully reduced in vivo toxicity, with average toxins removal ratio of approximately 30% per cycle. We believe that the integration of this scalable ICP dialyzer into the WAK holds tremendous potential for substantially enhancing the quality of life for individuals with ESRD.

The effect of exercise training on quality of life in people with chronic kidney disease requiring dialysis. A systematic review with meta-analysis

BACKGROUND

Chronic kidney disease (CKD) is a debilitating condition associated with poor health outcomes, including reduced quality of life (QoL), frequent hospitalisation and premature mortality.

AIM

This study aimed to determine the effect of exercise training on health-related QoL in individuals with CKD requiring dialysis, focusing on mental health scores. Secondary aims included analysing the effect of exercise modality, intensity, and delivery context to maximise exercise training benefits for QoL. Additionally, differences in mental component summary and physical component summary scores using CKD-specific generic QoL patient reported outcome measures were examined.

METHODS

A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus up to November 14th, 2024, identified randomised controlled trials (RCTs) comparing exercise training to usual care in CKD patients requiring dialysis. Twenty-five RCTs met the inclusion criteria and were pooled for meta-analyses.

RESULTS

Pooled analysis revealed significant improvements in QoL scores for mental component summary (MD 3.33 [1.24, 5.41], p = 0.002) and physical component summary (MD 3.75, [2.28, 5.23], p < 0.00001) compared to the usual care. A statistically significant improvement in the mental component summary was found for aerobic training (p = 0.02) and resistance training (p = 0.04). Moderate intensity (p = 0.003), an intervention duration of 12-26 weeks (p = 0.0004), interdialytic delivery (p = 0.003), intradialytic delivery (p = 0.03) and supervised training (p = 0.002) all demonstrated statistically significant improvements in mental component summary. The short form (SF)-36 demonstrated significant improvements in mental component summary (MD 4.15 [1.54, 6.76], p = 0.002), while the kidney disease QoL patient-reported outcome measure did not show significant improvement (p = 0.33).

CONCLUSIONS

Supervised, inter-dialytic or intra-dialytic exercise, including aerobic or resistance training at a moderate intensity for up to 26 weeks, can significantly improve mental component summary scores in individuals with stage 5 CKD on dialysis.

Unveiling drug-induced osteotoxicity: A machine learning approach and webserver

Drug-induced osteotoxicity refers to the harmful effects certain pharmaceuticals have on the skeletal system, posing significant safety risks. These toxic effects are critical concerns in clinical practice, drug development, and environmental management. However, current toxicity assessment models lack specialized datasets and algorithms specifically designed to predict osteotoxicity In this study, we compiled a dataset of osteotoxic molecules and used clustering analysis to classify them into four distinct groups Furthermore, target prediction identified key genes (IL6, TNF, ESR1, and MAPK3), while GO and KEGG analyses were employed to explore the complex underlying mechanisms Additionally, we developed prediction models based on molecular fingerprints and descriptors. We further advanced our approach by incorporating models such as Transformer, SVM, XGBoost, and molecular graphs integrated with Weave GNN, ViT, and a pre-trained KPGT model. Specifically, the descriptor-based model achieved an accuracy of 0.82 and an AUC of 0.89; the molecular graph model reached an accuracy of 0.84 and an AUC of 0.86; and the KPGT model attained both an accuracy and an AUC of 0.86. These findings led to the creation of Bonetox, the first online platform specifically designed for predicting osteotoxicity. This tool aids in assessing the impact of hazardous substances on bone health during drug development, thereby improving safety protocols, mitigating skeletal side effects, and ultimately enhancing therapeutic outcomes and public safety.

Prognostic Impact of Chronic Kidney Disease After Percutaneous Coronary Intervention with Drug-Coated Balloons

Background: A drug-coated balloon (DCB) is an emerging treatment technology for percutaneous coronary intervention (PCI). However, the prognostic factors of PCI with a DCB remain fully determined. Chronic kidney disease (CKD) is an independent predictor of adverse outcomes in patients with coronary artery disease (CAD) who underwent PCI. The aim of this present study was to clarify the impact of CKD on prognosis in CAD patients who underwent PCI with a DCB. Methods: We enrolled 252 consecutive patients with CAD who underwent PCI with a DCB from 2015 to 2023. The endpoints of this study were composite events including all-cause death, myocardial infarction, target vessel revascularization, stroke, and major bleeding. Results: The prevalence rate of CKD was 48%. Patients with CKD were older and had higher prevalence of hypertension and diabetes mellitus than those without. Kaplan-Meier analysis revealed a significantly higher composite event rate in patients with CKD (log-rank test, p = 0.003). In the multivariate Cox proportional hazards analysis, CKD was independently associated with composite events after adjusting for confounding factors (adjusted hazard ratio 1.985, 95% confidence intervals 1.157-3.406, p = 0.013), mainly driven by all-cause deaths. Conclusions: CKD was associated with unfavorable outcomes in CAD patients who underwent PCI with a DCB.

Nonleisure-time physical activity as a protective factor against sarcopenia in hemodialysis patients: a prospective cohort study

Objectives

Sarcopenia is prevalent among individuals undergoing maintenance hemodialysis (MHD) and is influenced by sedentary lifestyles. Although leisure-time physical activities have been shown to prevent sarcopenia in patients undergoing MHD, the impact of nonleisure-time physical activities on sarcopenia has not yet been examined in prospective studies.

Methods

This prospective cohort study, conducted in 2020 with a 12-month follow-up, included stable MHD patients without baseline sarcopenia. Sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia criteria. Physical activity was assessed using the International Physical Activity Questionnaire. Additionally, demographic, dietary, nutritional, and laboratory data were collected. Modified Poisson regression analysis was employed to evaluate the impact of physical activity on the risk of developing sarcopenia.

Results

Among the 196 MHD patients who completed the 1-year follow-up, 29 (14.8%) developed sarcopenia. The average total physical activity was 1,268 METs/week, with leisure-time activity averaging 300 METs/week and nonleisure-time activity averaging 724 METs/week. Adjusted analyses indicate that leisure-time physical activities do not significantly affect the risk of sarcopenia (RR = 0.920, 95% CI = 0.477-1.951; P > 0.05), whereas nonleisure-time physical activities are significantly associated with a reduced risk of sarcopenia (RR = 0.449, 95% CI = 0.248-0.814).

Conclusion

Actively participating in physical activities (nonleisure-time physical activities) can reduce the incidence of sarcopenia in patients undergoing MHD. Promoting such activities may be an effective strategy to enhance physical fitness and mitigate sarcopenia risk among this population.

Association of iodized salt intake with the risk of physical frailty in patients with type 2 diabetes

OBJECTIVES

We aimed to investigate the association of the status of iodized salt in terms of consumption of salt type and urinary iodine concentration (UIC) in diabetes, with frailty and examine whether this association could be modified by thyroid function.

DESIGN

A population-based cohort study.

SETTING AND PARTICIPANTS

We included 850 patients with type 2 diabetes from 11 communities in Shanghai, who completed five-year follow-up.

MEASUREMENTS

The type of salt consumed was collected through a standardized questionnaire and UIC was measured by an inductively coupled plasma-mass spectrometer. Frailty was assessed by frailty phenotype. Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured by electrochemiluminescence. Modified Poisson regression model with robust variance was used to estimate the relative risks (RRs) with 95% confidence intervals (CIs) for frailty in relation to iodized salt consumption and UIC.

RESULTS

In this five-year follow-up study in patients with diabetes, 111 (12.9%) patients progressed to frailty. Patients who consumed non-iodized salt (RR: 1.09, 95% CI: 1.01-1.18) had an increased risk of frailty, compared to patients who consumed iodized salt. Lower UIC was associated with a higher risk of frailty (1.10, 1.01-1.19). In patients with high TSH and low FT4, the RRs of frailty were 1.20 (1.08-1.34) and 1.15 (1.02-1.29) for non-iodized salt, and 1.14 (1.02-1.28) and 1.12 (0.99-1.27) for low UIC.

CONCLUSIONS

Non-iodized salt consumed and low UIC were associated with an increased risk of frailty in diabetes, particularly in those with high TSH and low FT4. Maintaining adequate iodine intake is critically important for preventing frailty in diabetes, especially for individuals with potential thyroid dysfunction.

Contribution of the glomerular filtration rate slope to the kidney hierarchical composite endpoint

INTRODUCTION

A recent chronic kidney disease (CKD) progression hierarchical composite endpoint (HCE) utilizes the glomerular filtration rate (GFR) slope for participants without a dichotomous event. Here, we evaluated clinical interpretations when HCE analyses are driven by GFR slope comparisons.

METHODS

Using CKD trial data, we calculated win odds using only GFR slope; dichotomous kidney events and GFR slope; all-cause mortality, dichotomous kidney events, and GFR slope; and all-cause mortality with dichotomous kidney events.

RESULTS

Win odds (95% confidence interval) calculated from pairwise GFR slope only comparisons were 1.44 (1.34-1.55), 1.60 (1.49-1.72), 1.19 (1.10-1.28), and 0.82 (0.78-0.86) in the DAPA-CKD, CREDENCE, SONAR, and ALTITUDE trials, respectively. Win odds were similar for the GFR slope only and full kidney HCE with and without mortality.

CONCLUSIONS

These results support incorporation of GFR slope into the CKD progression HCE and help to interpret the magnitude of treatment effect on kidney HCE estimated with win odds.

Sex-Specific Multimorbidity-Multibehaviour Patterns in Primary Care Populations

BACKGROUND

A conceptual shift in healthcare emphasises multimorbidity and multibehaviours as interconnected phenomena, highlighting dose-response associations and sex-specific differences. Data-driven approaches have been suggested for overcoming methodological challenges, of multimorbidity research. By using exploratory factor analysis, this study aimed to identify sex specific lifestyle associative multimorbidity patterns, providing valuable evidence to primary care providers and informing future multimorbidity guidelines.

METHODS

A retrospective observational study examined the electronic health records of three general practices in the UK between 2015 and 2018. The participants were aged 18+ with lifestyle multimorbidity, having engaged with multiple health risk behaviours. Stratified exploratory factor analysis with oblique rotation was used to identify sex specific lifestyle associative multimorbidity patterns.

RESULTS

The study included N = 7560 patients, with females comprising 53.9%. Eight independent lifestyle associative multimorbidity patterns were identified and distributed as follows. For females, three patterns emerged: cardiometabolic-neurovascular spectrum disorders (42.97% variance), respiratory conditions (8.08%), and sensory impairment (5.63%), with 25.4% assigned to these patterns. For males, five patterns were revealed: cardiometabolic-vascular spectrum disorders (34.10%), genitourinary (9.19%), respiratory-vision (8.20%), ocular (5.70%), and neurovascular-gastro-renal syndrome (4.54%), with 43%.

CONCLUSIONS

We revealed eight different sex-specific lifestyle-associated patterns, implying the need for tailored clinical approaches. The application of exploratory factor analysis yielded clinically valuable and scientifically rigorous multimorbidity patterns. Clinically, the findings advocate for a paradigm shift towards person-centred care, integrating multimorbidity and SNAP multibehaviours to enhance the complexity of inquiry and treatment of high-risk populations.

The varied Q creatinine in multi ethnics population and impact of adopting three different estimated glomerular filtration rates based on creatinine in adult populations: a call for performance validation

Background

The determination of kidney function is commonly done by estimating the glomerular filtration rate (eGFR) using serum creatinine levels. Various eGFR formulas, including the recently developed European Kidney Function Consortium (EKFC) and the Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI), have been adopted and are commonly utilized in clinical settings. Nevertheless, the extent of acceptance among these formulations in the multi ethnics populace is still undetermined. Thus, this study aimed to evaluate the performance of these formulations across different glomerular filtration rate categories in the adult population.

Methods

The research involved a total of 9,557 individuals (median age of 40 years and 85% being male) who underwent routine medical examinations. Enzymatic or modified Jaffe techniques were employed to measure serum creatinine levels. The CKD-EPI2009 eGFR was employed as corresponding GFR in the comparisons. The Bland-Altman method was used to determine the average discrepancies and 95% confidence intervals of eGFR between each formula. Ultimately, in order to compare the equations, Lin's correlation coefficients were calculated for various eGFR categories.

Results

The median creatinine level in the different island population showed variability. The CKD-EPI 2009 as well as different equations showed categorical agreement within the range of 91.42 to 92.77%. The correlations between CKD-EPI2009 and CKD-EPI 2021 and EKFC were 0.998 and 0.79, respectively (p < 0.001).

Conclusion

A substantial variation in creatinine and eGFR assessment were observed among different eGFR analysis for the adult population. Prospective study in various clinical contexts using measured GFR is essential to validate eGFR.

New equation for estimating glomerular filtration rate in Vietnamese kidney transplant recipients

PURPOSE

Accurate assessment of kidney function is essential for post-kidney transplant management. This study aims to develop a new equation tailored to Vietnamese kidney transplant recipients and validate its performance against established equations.

METHODS

A total of 299 kidney transplant recipients underwent glomerular filtration rate (GFR) measurement using technetium-99m-diethylenetriaminepentaacetate renal dynamic scintigraphy, along with demographic, clinical, and laboratory assessments. Participants were divided into a development cohort (n = 150) to generate a new GFR-estimating equation and a validation cohort (n = 149) for internal validation against six equations.

RESULTS

The new equation, G F R = 100.430 × 1 . 080 sex × a g e - 0.097 × S c r - 0.524 × S c y s - 0.435 (sex: 0 = female; 1 = male), showed the smallest median bias (-0.11 [-1.40; 1.11]), highest P30 accuracy (94.0% [88.6; 96.6]), highest precision (interquartile range = 9.82 [7.63; 12.37]), and strongest correlation with measured GFR (r = 0.824 [0.752; 0.880]) among tested equations in the validation cohort. Among creatinine-based equations, the Modification of Diet in Renal Disease equation was the most accurate.

CONCLUSION

The new equation outperformed established equations and is recommended for Vietnamese kidney transplant recipients. The Modification of Diet in Renal Disease equation may serve as an alternative in centers lacking access to serum cystatin C. Further studies with larger cohorts, external validation, and comparisons with gold-standard GFR measurement methods are needed to confirm these results.

The influence of female sex and estrogens on drug pharmacokinetics: what is the evidence?

INTRODUCTION

Pharmacological research has traditionally been skewed toward male subjects, leading to uniform treatment guidelines for both men and women that assume similar drug pharmacokinetics across sexes. This oversight contributes to women experiencing adverse drug reactions on average twice as often as men. More recent studies have revealed significant pharmacokinetic differences between the sexes, partly due to different sex hormone levels. Additionally, intraindividual differences in women have been observed due to fluctuating estrogen levels, impacting important aspects of drug pharmacokinetics.

AREAS COVERED

This review highlights key sex differences in drug pharmacokinetics, focusing on absorption, distribution, metabolism, and excretion. A particular emphasis is placed on the role of cytochrome P450 (CYP) and uridine diphosphate-glucuronosyltransferase (UGT) enzymes in drug metabolism, and on the role of P-glycoprotein (P-gp). The impact of estrogens is reviewed by exploring how drug pharmacokinetics change over the menstrual cycle, before and after menopause, and with estrogen-containing medications.

EXPERT OPINION

Personalized dosing based on sex and estrogen levels is important for improving treatment outcomes in female drug users. Clinical trials of drugs likely affected by these factors should incorporate pharmacokinetic studies that distinguish between sexes and evaluate the impact of estrogens, aiming to develop optimized dosing regimens.

Fibrosis: cross-organ biology and pathways to development of innovative drugs

Fibrosis is a pathophysiological mechanism involved in chronic and progressive diseases that results in excessive tissue scarring. Diseases associated with fibrosis include metabolic dysfunction-associated steatohepatitis (MASH), inflammatory bowel diseases (IBDs), chronic kidney disease (CKD), idiopathic pulmonary fibrosis (IPF) and systemic sclerosis (SSc), which are collectively responsible for substantial morbidity and mortality. Although a few drugs with direct antifibrotic activity are approved for pulmonary fibrosis and considerable progress has been made in the understanding of mechanisms of fibrosis, translation of this knowledge into effective therapies continues to be limited and challenging. With the aim of assisting developers of novel antifibrotic drugs, this Review integrates viewpoints of biologists and physician-scientists on core pathways involved in fibrosis across organs, as well as on specific characteristics and approaches to assess therapeutic interventions for fibrotic diseases of the lung, gut, kidney, skin and liver. This discussion is used as a basis to propose strategies to improve the translation of potential antifibrotic therapies.

Association of sarcopenia index, a surrogate marker of muscle mass, and incident chronic kidney disease

BACKGROUND

Sarcopenia, characterized by loss of muscle mass and strength, has been linked to various health outcomes, including chronic kidney disease (CKD). This study aims to investigate the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident CKD in middle-aged and older adults.

METHODS

This study extracted data from a nation cohort, including age ≥45 years adults without CKD at baseline. Sarcopenia index was calculated based on serum creatinine and cystatin C levels, and incident CKD was assessed through follow-up surveys. Cox proportional hazards regression models were used to analyze the association between sarcopenia index and incident CKD, adjusting for potential confounders, with hazard ratio (HR) with 95 % confidence interval (95 % CI) reported.

RESULTS

A total of 8618 participants were included in the analysis. The median age was 61.0 years, and 44.7 % were male. During a mean follow-up period of 5.0 years, 514 cases of incident CKD were identified. After adjusting for covariates, compared with participants in the lowest tertile, the corresponding CKD HRs (95 % CIs) for participants in the medium and highest tertile were 0.701 (95 % CI: 0.558-0.880, P = 0.002), 0.784 (95 % CI: 0.618-0.994; P = 0.045). Restricted cubic spline curves revealed that incident rate decreased with increase in sarcopenia index.

CONCLUSION

This study provides national longitudinal evidence on the association of higher sarcopenia index with lower incident CKD. Our findings suggest that sarcopenia index may be a useful biomarker for predicting the risk of CKD in this population.

Transcriptome profiling of serum exosomes by RNA-Seq reveals lipid metabolic changes as a potential biomarker for evaluation of roxadustat treatment of chronic kidney diseases

The incidence of chronic kidney disease (CKD) is increasing globally; however, effective preventive and therapeutic strategies are currently limited. Roxadustat is being clinically used to treat renal anemia in CKD patients to reduce anemia-related complications and improve patients' life quality. Exosomes are small vesicles carrying important information that contribute to cell-to-cell communication and are present in various body fluids. However, little is known about the role of serum exosomes and their association with CKD after roxadustat treatment. Next-generation sequencing approaches have revealed that exosomes are enriched in noncoding RNAs and thus exhibit great potential as sensitive nucleic acid biomarkers in various human diseases. In this study, we aimed to identify the changed mRNAs-lncRNAs after roxadustat treatment as novel biomarkers for assessing the efficiency of the treatment. Through our study using RNA-seq data, we identified 957 mRNAs (626 upregulated and 331 downregulated after roxadustat treatment) and 914 lncRNAs (444 upregulated and 470 downregulated) derived from exosomes that were significantly changed, which was highly correlated to lipid metabolism. Our analysis through whole transcriptome profiling of exosome RNAs encompasses an identified differentially expressed mRNA-lncRNA regulatory axis in a larger patient cohort for the validation of suitable biomarkers for assessing CKD after roxadustat treatment.

Molecular docking, dynamics simulations, and in vivo studies of gallic acid in adenine-induced chronic kidney disease: targeting KIM-1 and NGAL

Gallic acid (GA), a naturally occurring compound with antioxidant, anti-inflammatory, anti-apoptotic, and regenerative properties, has gained attention for its potential protective role against kidney dysfunction and diseases, though its therapeutic efficacy in this context remains underexplored. The primary objective of this study was to explore the therapeutic effects of GA in treating adenine-induced chronic kidney disease (CKD) in male Wistar rats. The study evaluated GA's therapeutic potential against CKD, along with its pharmacokinetic and drug-likeness properties through a comprehensive analysis. It also assessed GA's inhibitory effects on key kidney proteins, KIM-1 and NGAL, using gene expression analysis, molecular docking, and molecular dynamics simulations. The results demonstrated a range of positive effects, including significant improvement in adenine-induced kidney damage, as shown by changes in urine and serum markers, as well as oxidative stress biomarkers, following GA treatment. The study revealed that GA effectively suppresses the adenine-induced gene expression of KIM-1 and NGAL. Furthermore, GA adhered to Lipinski's Rule of Five, and molecular docking analysis indicated strong interactions and low binding energies between GA and the target proteins KIM-1 and NGAL, further supporting its efficacy in targeting these markers. Additionally, 100 ns molecular dynamics simulations showed that gallic acid has a stronger binding affinity for NGAL than for KIM-1, with higher binding energy, stability, and stronger hydrogen bonds, suggesting that it primarily influences NGAL interactions. This study underscores gallic acid's potential in reducing adenine-induced kidney damage and improving kidney function, with computational evidence supporting its promise as a treatment for CKD.

Association between atherogenic index of plasma and future cardiovascular disease risk in middle-aged and elderly individuals with cardiovascular-kidney-metabolic syndrome stage 0-3

Background

Cardiovascular disease (CVD) is strongly correlated with plasma atherogenic index (AIP); however, there is limited literature exploring the association between trajectories of change in AIP and the risk of CVD. This study aimed to investigate whether changes in AIP are associated with CVD in individuals with cardiovascular-kidney-metabolic (CKM) syndrome stage 0-3.

Methods

Data were sourced from the China Health and Retirement Longitudinal Study (CHARLS), aimed to compile high-quality microdata on individuals and households aged 45 and older in China. Change in AIP from 2012 to 2015 were classified employing K-means clustering analysis. Logistic regressions were employed to assess the association between different AIP change clusters and cumulative AIP and CVD incidence. Additionally, restricted cubic spline (RCS) regression was conducted to further evaluate the underlying linear relationship between cumulative AIP and CVD. Subgroup analyses were applied to verify the influence of confounding variables on the relationship between AIP and CVD. Weighted quantile sum (WGS) regressions were utilized to offer a comprehensive assessment of the overall effect.

Results

Out of 4,525 participants, 578 (12.77%) ultimately developed CVD within three years. Compared to cluster 1, which served as the best control for AIP, the odds ratio (OR) was 1.29 (1.02-1.62) for cluster 2, 1.33 (1.04-1.71) for cluster 3 and 1.35 (0.98-1.85) for cluster 4 after adjusting for several confounding variables. Categorizing the cumulative AIP into quartiles revealed an ascending trend (P for trend = 0.014). RCS regression disclosed a linear relationship between cumulative AIP and CVD. Further subgroup analyses revealed variations in these correlations modified by gender and Hukou status. WQS regression analysis highlighted the significance of triglyceride in the pathogenesis of CVD.

Conclusions

Significant changes in AIP are independently associated with the elevated risk of CVD in adults aged > 45 with CKM syndrome stage 0-3. Monitoring long-term fluctuations in AIP may aid in the early identification of individuals at high risk for CVD.

The global, regional, and national patterns of change in the burden of chronic kidney disease from 1990 to 2021

BACKGROUND

Chronic kidney disease (CKD) is a major global public health problem with increasing prevalence and a huge health and economic burden. Diabetes mellitus and hypertension are major risk factors for CKD, and CKD is associated with cardiovascular disease and end-stage renal disease. Understanding the prevalence and burden of CKD is essential for the development of prevention and control strategies.

METHODS

Using data from the Global Burden of Disease Study (GBD) 2021 study, this study analyzed the incidence, prevalence, and disability-adjusted life years (DALYs) of CKD at global, regional, and national levels between 1990 and 2021. Decomposition analysis, health inequalities and frontier analysis were used to analyse the changes.

RESULTS

This study analyzed the global regional and national burden, trends, and disparities of CKD from 1990 to 2021 and found that the global burden of CKD had increased significantly, in line with trends in population ageing and population growth, and with significant variations between regions. There were 673.7 million people with CKD worldwide in 2021, accounting for 8.54% of the global population, a 92.0% increase from 1990. Despite a slight decline in age-standardized prevalence rate (ASPR), the absolute number of CKD cases increased. Central Asia had the highest prevalence of CKD, while Central Latin America had the highest rate of DALYs and incidence for CKD. In 2021, At the national level, China had the highest number of new CKD cases. The country with the highest ASPR and age-standardized DALYs rate (ASDR) of CKD was Mauritius. Globally, age-standardized incidence rate (ASIR) and ASDR were on the rise in almost all countries/regions, suggesting that the impact of CKD on global health is increasing. Population growth and ageing were major factors contributing to the increasing burden of CKD, especially in China and low Socio-demographic Index (SDI) regions. In addition, the cross-national study of health inequalities in CKD showed that, although there have been improvements in global health over time, health inequalities continue to exist. The frontier analysis revealed a considerable degree of heterogeneity in the effective differences across the spectrum of socio-demographic indices.

CONCLUSION

CKD is a global health problem, the burden of which varies between regions and countries. A multifaceted approach is necessary to prevent and control CKD, including population-level interventions targeting risk factors, improvements in the accessibility and quality of health care, and measures to address health inequalities.