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Lu Y, Xiao Z, Zhao X, Ye Y, Li S, Guo F, Xue H, Zhu F. Incidence, risk factors, and outcomes of the transition of HIPEC-induced acute kidney injury to acute kidney disease: a retrospective study. Ren Fail 2024; 46:2338482. [PMID: 38604946 PMCID: PMC11011229 DOI: 10.1080/0886022x.2024.2338482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is recognized as a common complication following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Characterized by prolonged renal function impairment, acute kidney disease (AKD) is associated with a higher risk of chronic kidney disease (CKD) and mortality. METHODS From January 2018 to December 2021, 158 patients undergoing CRS-HIPEC were retrospectively reviewed. Patients were separated into non-AKI, AKI, and AKD cohorts. Laboratory parameters and perioperative features were gathered to evaluate risk factors for both HIPEC-induced AKI and AKD, with the 90-day prognosis of AKD patients. RESULTS AKI developed in 21.5% of patients undergoing CRS-HIPEC, while 13.3% progressed to AKD. The multivariate analysis identified that ascites, GRAN%, estimated glomerular filtration rate (eGFR), and intraoperative (IO) hypotension duration were associated with the development of HIPEC-induced AKI. Higher uric acid, lessened eGFR, and prolonged IO hypotension duration were more predominant in patients proceeding with AKD. The AKD cohort presented a higher risk of 30 days of in-hospital mortality (14.3%) and CKD progression (42.8%). CONCLUSIONS Our study reveals a high incidence of AKI and AKI-to-AKD transition. Early identification of risk factors for HIPEC-induced AKD would assist clinicians in taking measures to mitigate the incidence.
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Affiliation(s)
- Yunwei Lu
- Department of Intensive Care Medicine, Trauma Center, Peking University People’s Hospital, Beijing, China
| | - Ziyan Xiao
- Department of Intensive Care Medicine, Trauma Center, Peking University People’s Hospital, Beijing, China
| | - Xiujuan Zhao
- Department of Intensive Care Medicine, Trauma Center, Peking University People’s Hospital, Beijing, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing, China
| | - Shu Li
- Department of Intensive Care Medicine, Trauma Center, Peking University People’s Hospital, Beijing, China
| | - Fuzheng Guo
- Department of Intensive Care Medicine, Trauma Center, Peking University People’s Hospital, Beijing, China
| | - Haiyan Xue
- Department of Intensive Care Medicine, Trauma Center, Peking University People’s Hospital, Beijing, China
| | - Fengxue Zhu
- Department of Intensive Care Medicine, Trauma Center, Peking University People’s Hospital, Beijing, China
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2
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Irusen S, Schneider A, Joannidis M. When is the optimal time to stop continuous renal replacement therapy in children? Intensive Care Med 2024; 50:922-924. [PMID: 38739276 DOI: 10.1007/s00134-024-07463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Shaegan Irusen
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Antoine Schneider
- Service de Médecine Intensive Adulte (SMIA), Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon, 46, 1011, Lausanne, Switzerland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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3
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Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, Fliser D, Roy-Chaudhury P, Fontana M, Nangaku M, Wanner C, Malik C, Hradsky A, Adu D, Bavanandan S, Cusumano A, Sola L, Ulasi I, Jha V. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol 2024:10.1038/s41581-024-00820-6. [PMID: 38570631 DOI: 10.1038/s41581-024-00820-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
Early detection is a key strategy to prevent kidney disease, its progression and related complications, but numerous studies show that awareness of kidney disease at the population level is low. Therefore, increasing knowledge and implementing sustainable solutions for early detection of kidney disease are public health priorities. Economic and epidemiological data underscore why kidney disease should be placed on the global public health agenda - kidney disease prevalence is increasing globally and it is now the seventh leading risk factor for mortality worldwide. Moreover, demographic trends, the obesity epidemic and the sequelae of climate change are all likely to increase kidney disease prevalence further, with serious implications for survival, quality of life and health care spending worldwide. Importantly, the burden of kidney disease is highest among historically disadvantaged populations that often have limited access to optimal kidney disease therapies, which greatly contributes to current socioeconomic disparities in health outcomes. This joint statement from the International Society of Nephrology, European Renal Association and American Society of Nephrology, supported by three other regional nephrology societies, advocates for the inclusion of kidney disease in the current WHO statement on major non-communicable disease drivers of premature mortality.
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Affiliation(s)
- Anna Francis
- Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Albert C M Ong
- Academic Nephrology Unit, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Division of Nephrology & Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM, RICORS2040, Madrid, Spain
| | - Agnes B Fogo
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danilo Fliser
- Department of Internal Medicine IV, Renal and Hypertensive Disease & Transplant Centre, Saarland University Medical Centre, Homburg, Germany
| | - Prabir Roy-Chaudhury
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Christoph Wanner
- Department of Clinical Research and Epidemiology, Renal Research Unit, University Hospital of Würzburg, Würzburg, Germany
| | - Charu Malik
- International Society of Nephrology, Brussels, Belgium
| | - Anne Hradsky
- International Society of Nephrology, Brussels, Belgium
| | - Dwomoa Adu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Sunita Bavanandan
- Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ana Cusumano
- Instituto de Nefrologia Pergamino, Pergamino City, Argentina
| | - Laura Sola
- Centro de Hemodiálisis Crónica CASMU-IAMPP, Montevideo, Uruguay
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Enugu State, Nigeria
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India.
- School of Public Health, Imperial College, London, UK.
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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Efejuku TA, Wolf SE, Song J, Golovko G, El Ayadi A. THE RISKS OF FIRST ONSET PRIMARY HYPERTENSION DIAGNOSIS IN THERMAL-INJURED PATIENTS. Shock 2024; 61:541-548. [PMID: 38300832 PMCID: PMC11141234 DOI: 10.1097/shk.0000000000002310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT Introduction: Hypertension is a prevalent condition in the United States and leads to an increased risk of developing various comorbidities. However, the impact of new-onset hypertension after severe burns on patient outcomes is not known. We posit that hypertension onset after severe burn is associated with increased risk of developing comorbidities and mortality. Methods: Using the TriNetX database, burned patients diagnosed with essential hypertension after injury were compared with those who did not develop hypertension; neither had prior hypertension. Each cohort was grouped by sex, percent total body surface area (TBSA) burned, and age, then propensity matched for sex, race, ethnicity, and laboratory values. Outcomes assessed were acute kidney injury (AKI), hyperglycemia, heart failure, myocardial infarction (MI), and death. Results: Those diagnosed with hypertension after severe burn were 4.9 times more likely to develop AKI, 3.6 times for hyperglycemia, 5.3 times for heart failure, 4.7 times for acute MI, and 1.5 times for mortality. Sex analysis shows that men were at greater risk for AKI (1.5 times), heart failure (1.1 times), and death (1.4 times). Women were 1.3 times more likely to develop hyperglycemia. Percent TBSA burned grouping showed increased risk for all outcomes with increasing severity. Age grouping indicated an elevated risk of developing AKI, heart failure, acute MI, and death. Conclusion: New-onset hypertension diagnosis in severely burned patients is associated with acute kidney injury, heart failure, acute MI, and death. Overall, males, older patients, and those with a higher % TBSA burned are at a higher risk of developing these comorbidities.
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Affiliation(s)
| | | | | | - Georgiy Golovko
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas
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Lau DCW, Shaw E, Farris MS, McMullen S, Brar S, Cowling T, Chatterjee S, Quansah K, Kyaw MH, Girard LP. Prevalence of Adult Type 2 Diabetes Mellitus and Related Complications in Alberta, Canada: A Retrospective, Observational Study Using Administrative Data. Can J Diabetes 2024; 48:155-162.e8. [PMID: 38135113 DOI: 10.1016/j.jcjd.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease and a leading cause of morbidity/mortality in Canada. We evaluated the burden of T2DM in Alberta, Canada, by estimating the 5-year period prevalence of T2DM and rates of comorbidities and complications/conditions after T2DM. METHODS We conducted a population-based, retrospective study linking administrative health databases. Individuals with T2DM (≥18 years of age) were identified between 2008-2009 and 2018-2019 using a published algorithm, with follow-up data to March 2020. The 5-year period prevalence was estimated for 2014-2015 to 2018-2019. Individuals with newly identified T2DM, ascertained between 2010-2011 and 2017-2018 with a lookback period between 2008-2009 and 2009-2010 and a minimum 1 year of follow-up data, were evaluated for subsequent cardiovascular, diabetic, renal, and other complication/condition frequencies (%) and rates (per 100 person-years). Complications/conditions were stratified by atherosclerotic cardiovascular disease (ASCVD) status at index and age. RESULTS The 5-year period prevalence of T2DM was 11,051 per 100,000 persons, with the highest prevalence in men 65 to <75 years of age. There were 195,102 individuals included in the cohort (mean age 56.7±14.7 years). The most frequently reported complications/conditions (rates per 100 person-years) were acute infection (23.10, 95% confidence interval [CI] 23.00 to 23.30), hypertension (17.30, 95% CI 16.80 to 17.70), and dyslipidemia (12.20, 95% CI 11.90 to 12.40). Individuals who had an ASCVD event/procedure and those ≥75 years of age had higher rates of complications/conditions. CONCLUSIONS We found that over half of the individuals had hypertension or infection after T2DM. Also, those with ASCVD had higher rates of complications/conditions. Strategies to mitigate complications/conditions after T2DM are required to reduce the burden of this disease on individuals and health-care systems.
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Affiliation(s)
- David C W Lau
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
| | - Eileen Shaw
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Megan S Farris
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | | | - Saman Brar
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Satabdi Chatterjee
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Kobina Quansah
- Boehringer Ingelheim (Canada), Ltd, Burlington, Ontario, Canada
| | - Moe H Kyaw
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Louis P Girard
- Division of Nephrology, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Wu JH, Lin KJ, Hsu YH, Chiang YJ, Chu SH, Lin CT, Pan PY, Chen SY, Wang JY, Wang HH. Festivity: The Effects of Traditional Holidays on the Graft Function Among Stable Kidney Recipients. Transplant Proc 2024; 56:546-549. [PMID: 38523012 DOI: 10.1016/j.transproceed.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE We observed transient elevations in creatinine levels among kidney recipients after three traditional holidays in Taiwan. This retrospective cohort study aimed to compare the changes in eGFR levels after Chinese New Year, Dragon Boat Festival, and Mid-Autumn Festival, all of which are associated with high-calorie and high-fat diets. MATERIALS AND METHODS We conducted a retrospective analysis of 364 kidney recipients with stable graft function who were following at Chang Gung Memorial Hospital Linkou from 2018 to 2020. The graft function before and after the festival was determined by calculating the eGFR level using the serum creatinine measured during clinic visits prior to and following the festival. The patients were then categorized into subgroups based on their sex, BMI, and co-morbidities. The eGFR levels before and after the festival were evaluated and compared within these subgroups. RESULTS A total of 301 kidney recipients have been finally included in this retrospective cohort study. The analysis showed a significant decrease in overall eGFR levels after Chinese New Year (from 56.92 ± 29.70 to 55.14 ± 24.79, P = .006), Mid-Autumn Festival (from 54.03 ± 24.61 to 53.35 ± 24.33, P = .008), and Dragon Boat Festival only in 2020 (from 50.98 ± 24.35 to 49.99 ± 23.45, P = .018). The analysis of subgroups suggested a tendency of renal function decline after all 3 traditional holidays in patient groups with DM or hypertension or nonoverweight status. CONCLUSION In this study, we observed a significant decline in renal function among kidney recipients following traditional holidays in Taiwan, particularly among recipients with hypertension or diabetes mellitus or those who were not overweight.
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Affiliation(s)
- Jen-Hsuan Wu
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Jen Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hao Hsu
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yang-Jen Chiang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Sheng-Hsien Chu
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Chih-Te Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Pai-Yen Pan
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | - Sy-Yuan Chen
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan
| | | | - Hsu-Han Wang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Transplant Institute, Taoyuan, Taiwan.
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7
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Schumacher C, Chorpash A, Bolch C, Eagan K, Nimer S, Van Dril E. Identification of risk factors associated with acute kidney injury in patients taking sodium-glucose cotransporter-2 inhibitors. Pharmacotherapy 2024; 44:249-257. [PMID: 38131129 DOI: 10.1002/phar.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
STUDY OBJECTIVE Studies have demonstrated sodium-glucose cotransporter-2 (SGLT2) inhibitors are kidney protective; however, their ability to cause hemodynamic changes may predispose patients to acute kidney injury (AKI). An FDA warning recommends evaluating for factors that predispose patients to AKI before initiating a SGLT2 inhibitor. The primary objective of this study is to identify risk factors that may predispose persons with diabetes to AKI when initiating SGLT2 inhibitor therapy. DESIGN Multicenter retrospective cohort chart review. DATA SOURCE Study patients were identified through an electronic medical record generated report if they had type 2 diabetes and were prescribed a SGLT2 inhibitor from January 2013 to September 2019. PATIENTS Patients were included if they were receiving care at Advocate Medical Group and were confirmed to have taken one of the four SGLT2 inhibitors available at the time of study approval, canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin, for at least 7 days. Patients were excluded if they did not have a basic metabolic panel or comprehensive metabolic panel recorded 1 year prior to or 6 months after SGLT2 inhibitor therapy initiation. RESULTS Data extraction from the electronic medical record identified 6425 patients receiving a SGLT2 inhibitor, of which 1962 met inclusion criteria and were included for analysis. Thirty-five (1.8%) patients experienced an AKI after SGLT2 inhibitor therapy initiation. There was no statistically significant difference between groups based on background medication use (p = 0.325). At baseline, patients experiencing an AKI after SGLT2 inhibitor initiation were more likely to be older in age (p = 0.010), have a higher serum potassium (p < 0.001), blood glucose (p = 0.018), SCr (p = 0.009) and UACR (p < 0.001), and a lower eGFR (p = 0.028) compared to those who did not experience AKI. CONCLUSIONS The transient eGFR decline with SGLT2 inhibitor initiation should be expected and is generally not an indication to discontinue therapy. Future initiatives should be directed at increasing knowledge of monitoring recommendations for these agents.
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Affiliation(s)
- Christie Schumacher
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, Illinois, USA
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Amanda Chorpash
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Charlotte Bolch
- Office of Research and Sponsored Programs, Midwestern University, Glendale, Arizona, USA
| | - Kellye Eagan
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Sara Nimer
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Elizabeth Van Dril
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, Illinois, USA
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8
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Romero-González G, Rodríguez-Chitiva N, Cañameras C, Paúl-Martínez J, Urrutia-Jou M, Troya M, Soler-Majoral J, Graterol Torres F, Sánchez-Bayá M, Calabia J, Bover J. Albuminuria, Forgotten No More: Underlining the Emerging Role in CardioRenal Crosstalk. J Clin Med 2024; 13:777. [PMID: 38337471 PMCID: PMC10856688 DOI: 10.3390/jcm13030777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Kidneys have an amazing ability to adapt to adverse situations, both acute and chronic. In the presence of injury, the kidney is able to activate mechanisms such as autoregulation or glomerular hyperfiltration to maintain the glomerular filtration rate (GFR). While these adaptive mechanisms can occur in physiological situations such as pregnancy or high protein intake, they can also occur as an early manifestation of diseases such as diabetes mellitus or as an adaptive response to nephron loss. Although over-activation of these mechanisms can lead to intraglomerular hypertension and albuminuria, other associated mechanisms related to the activation of inflammasome pathways, including endothelial and tubular damage, and the hemodynamic effects of increased activity of the renin-angiotensin-aldosterone system, among others, are recognized pathways for the development of albuminuria. While the role of albuminuria in the progression of chronic kidney disease (CKD) is well known, there is increasing evidence of its negative association with cardiovascular events. For example, the presence of albuminuria is associated with an increased likelihood of developing heart failure (HF), even in patients with normal GFR, and the role of albuminuria in atherosclerosis has recently been described. Albuminuria is associated with adverse outcomes such as mortality and HF hospitalization. On the other hand, it is increasingly known that the systemic effects of congestion are mainly preceded by increased central venous pressure and transmitted retrogradely to organs such as the liver or kidney. With regard to the latter, a new entity called congestive nephropathy is emerging, in which increased renal venous pressure can lead to albuminuria. Fortunately, the presence of albuminuria is modifiable and new treatments are now available to reverse this common risk factor in the cardiorenal interaction.
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Affiliation(s)
- Gregorio Romero-González
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- International Renal Research Institute of Vicenza, 36100 Vicenza, Italy
| | - Néstor Rodríguez-Chitiva
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Carles Cañameras
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
| | - Javier Paúl-Martínez
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Marina Urrutia-Jou
- Nephrology Department, University Hospital Joan XXIII, 43005 Tarragona, Spain;
| | - Maribel Troya
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Jordi Soler-Majoral
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Fredzzia Graterol Torres
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Maya Sánchez-Bayá
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Jordi Calabia
- Nephrology Department, University Hospital Josep Trueta, IdIBGi Research Institute, Universitat de Girona, 17007 Girona, Spain;
| | - Jordi Bover
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
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9
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Das SR, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Kosiborod MN, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S179-S218. [PMID: 38078592 PMCID: PMC10725811 DOI: 10.2337/dc24-s010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S219-S230. [PMID: 38078574 PMCID: PMC10725805 DOI: 10.2337/dc24-s011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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11
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Lu R, Ren J, Zhou X, Zheng B, Peng F. Risk factors for acute kidney injury associated with intravenous vancomycin in neurosurgical inpatients: a retrospective study. Eur J Clin Pharmacol 2024; 80:65-73. [PMID: 37889297 PMCID: PMC10781849 DOI: 10.1007/s00228-023-03581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Vancomycin (VAN) is widely used in neurosurgical patients for intracranial infections. We aimed to assess the incidence and risk factors for VAN-associated acute kidney injury (VA-AKI) in this population. METHODS A case-control study of patients who treated with vancomycin in neurosurgery from January 2020 to December 2022 was conducted. Demographics and potential risk factors were collected. Multivariate logistic regression analyses were performed to identify risk factors for VA-AKI. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO). RESULTS A total of 345 patients participated with a VA-AKI incidence of 17.1% (59 cases). Among them, 15 patients had renal impairment (Stage 2 or higher), and 2 required dialysis. With univariate analysis and binary logistic regression analysis, we found that the use of mannitol (OR: 4.164; 95% CI: 1.606-10.792; P = 0.003), loop diuretics (OR: 3.371; 95% CI: 1.633-6.958; P = 0.001), three or more antimicrobial applications (OR: 3.623; 95% CI: 1.600-8.206; P = 0.002), diastolic blood pressure 80-89 mm Hg (OR: 5.532; 95% CI: 1.677-18.250; P = 0.005) and diastolic blood pressure ≥ 90 mm Hg (OR: 6.845; 95% CI: 1.518-30.866; P = 0.012) were independent risk factors for VA-AKI. In addition, according to the Youden Index, the trough concentration of vancomycin should not exceed 15.845 mg/L. CONCLUSION The incidence of VA-AKI in neurosurgical patients was 17.1%. The concomitant use of mannitol and loop diuretics, along with higher diastolic blood pressure and the combined use of more than three antimicrobial agents, were associated with an increased risk of neurosurgical VA-AKI.
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Affiliation(s)
- Ruqi Lu
- School of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Junli Ren
- School of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Xuanping Zhou
- School of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Bin Zheng
- Department of Pharmacy, Shanxi Provincial People's Hospital, Shuangtasi Street 29#, Taiyuan, Shanxi, 030012, China
| | - Fangchen Peng
- Department of Pharmacy, Shanxi Provincial People's Hospital, Shuangtasi Street 29#, Taiyuan, Shanxi, 030012, China.
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12
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Ramos M, Gerlier L, Uster A, Muttram L, Frankel AH, Lamotte M. Cost-effectiveness of empagliflozin as add-on to standard of care for chronic kidney disease management in the United Kingdom. J Med Econ 2024; 27:777-785. [PMID: 38758099 DOI: 10.1080/13696998.2024.2357041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The sodium-glucose co-transporter-2 inhibitor empagliflozin was approved for treatment of adults with chronic kidney disease (CKD) on the basis of its demonstrated ability to slow CKD progression and reduce the risk of cardiovascular death. This analysis was performed to assess the cost-effectiveness of empagliflozin plus standard of care (SoC) vs SoC alone in the treatment of CKD in the UK. METHODS A comprehensive, patient-level CKD progression model that simulates the evolution of risk factors for disease progression based on CKD-specific equations and clinical data was used to project a broad range of CKD-related complications. Patient baseline characteristics, distribution across Kidney Disease Improving Global Outcomes (KDIGO) health states, and changes in estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (uACR), and other parameters while on treatment were derived from the EMPA-KIDNEY trial. UK cost and utilities/disutilities were sourced from the literature. Univariate and probabilistic sensitivity analyses were conducted. Annual discounting of 3.5% was applied on costs and outcomes. RESULTS Over a 50-year horizon, SoC resulted in per-patient costs, life years, and QALYs of £95,930, 8.55, and 6.28, respectively. Empagliflozin plus SoC resulted in an incremental gain in life years (+1.04) and QALYs (+0.84), while decreasing per-patient costs by £6,019. Empagliflozin was more effective and less costly (dominant) with a net monetary benefit of £22,849 at the willingness-to-pay threshold of £20,000. Although treatment cost was higher for empagliflozin, this was more than offset by savings in kidney replacement therapy. Empagliflozin remained highly cost-effective in patients with and without diabetes, and across scenario and sensitivity analyses. LIMITATIONS This analysis is limited by reliance on short-term clinical trial data and by uncertainties in modelling CKD progression. CONCLUSIONS Empagliflozin as an add-on to SoC for treatment of adults with CKD represents cost-effective use of UK National Health Service (NHS) resources.
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Ye Q, Xu G, Yuan H, Mi J, Xie Y, Li H, Li Z, Huang G, Chen X, Li W, Yang R. Urinary PART1 and PLA2R1 Could Potentially Serve as Diagnostic Markers for Diabetic Kidney Disease Patients. Diabetes Metab Syndr Obes 2023; 16:4215-4231. [PMID: 38162802 PMCID: PMC10757812 DOI: 10.2147/dmso.s445341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
Background Diabetic kidney disease (DKD) is a chronic renal disease which could eventually develop into renal failure. Though albuminuria and estimated glomerular filtration rate (eGFR) are helpful for the diagnosis of DKD, the lack of specific biomarkers reduces the efficiency of therapeutic interventions. Methods Based on bulk-seq of 56 urine samples collected at different time points (including 11 acquired from DKD patients and 11 from healthy controls), in corporation of scRNA-seq data of urine samples and snRNA-seq data of renal punctures from DKD patients (retrieved from NCBI GEO Omnibus), urine-kidney specific genes were identified by Multiple Biological Information methods. Results Forty urine-kidney specific genes/differentially expressed genes (DEGs) were identified to be highly related to kidney injury and proteinuria for the DKD patients. Most of these genes participate in regulating glucagon and apoptosis, among which, urinary PART1 (mainly derived from distal tubular cells) and PLA2R1 (podocyte cell surface marker) could be used together for the early diagnosis of DKD. Moreover, urinary PART1 was significantly associated with multiple clinical indicators, and remained stable over time in urine. Conclusion Urinary PART1 and PLA2R1 could be shed lights on the discovery and development of non-invasive diagnostic method for DKD, especially in early stages.
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Affiliation(s)
- Qinglin Ye
- Department of Nephrology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, People’s Republic of China
| | - Guiling Xu
- Department of Nephrology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, People’s Republic of China
| | - Hao Yuan
- Centre for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, People’s Republic of China
- Department of Immunology, School of Basic Medical Sciences, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Junhao Mi
- Centre for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, People’s Republic of China
- Department of Immunology, School of Basic Medical Sciences, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Yuli Xie
- Centre for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, People’s Republic of China
- Department of Immunology, School of Basic Medical Sciences, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Haoyu Li
- Department of Nephrology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, People’s Republic of China
| | - Zhejun Li
- Department of Nephrology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, People’s Republic of China
| | - Guanwen Huang
- Department of Nephrology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, People’s Republic of China
| | - Xuesong Chen
- Department of Nephrology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, People’s Republic of China
| | - Wei Li
- Department of Nephrology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, People’s Republic of China
| | - Rirong Yang
- Centre for Genomic and Personalized Medicine, Guangxi key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, People’s Republic of China
- Department of Immunology, School of Basic Medical Sciences, Guangxi Medical University, Nanning, 530021, People’s Republic of China
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Oh D, Lee D, Heo J, Kweon J, Yong U, Jang J, Ahn YJ, Kim C. Contrast Agent-Free 3D Renal Ultrafast Doppler Imaging Reveals Vascular Dysfunction in Acute and Diabetic Kidney Diseases. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2303966. [PMID: 37847902 PMCID: PMC10754092 DOI: 10.1002/advs.202303966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/19/2023] [Indexed: 10/19/2023]
Abstract
To combat the irreversible decline in renal function associated with kidney disease, it is essential to establish non-invasive biomarkers for assessing renal microcirculation. However, the limited resolution and/or vascular sensitivity of existing diagnostic imaging techniques hinders the visualization of complex cortical vessels. Here, a 3D renal ultrafast Doppler (UFD) imaging system that uses a high ultrasound frequency (18 MHz) and ultrahigh frame rate (1 KHz per slice) to scan the entire volume of a rat's kidney in vivo is demonstrated. The system, which can visualize the full 3D renal vascular branching pyramid at a resolution of 167 µm without any contrast agent, is used to chronically and noninvasively monitor kidneys with acute kidney injury (AKI, 3 days) and diabetic kidney disease (DKD, 8 weeks). Multiparametric UFD analyses (e.g., vessel volume occupancy (VVO), fractional moving blood volume (FMBV), vessel number density (VND), and vessel tortuosity (VT)) describe rapid vascular rarefaction from AKI and long-term vascular degeneration from DKD, while the renal pathogeneses are validated by in vitro blood serum testing and stained histopathology. This work demonstrates the potential of 3D renal UFD to offer valuable insights into assessing kidney perfusion levels for future research in diabetes and kidney transplantation.
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Affiliation(s)
- Donghyeon Oh
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Donghyun Lee
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Jinseok Heo
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Jooyoung Kweon
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Uijung Yong
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Jinah Jang
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Yong Joo Ahn
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Chulhong Kim
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
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Perschinka F, Boyer N, Forni LG, Joannidis M. Renal function in very old critically ill patients. Curr Opin Crit Care 2023; 29:534-541. [PMID: 37861208 DOI: 10.1097/mcc.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Current demographic change leads to higher number of elderly patients admitted to an ICU. Among other organs also the kidneys show age-related changes, which are associated with a decline in various aspects of renal function. The purpose of this review is to provide an overview of structural and functional changes in elderly and also to specifically address the increased risk of acute kidney injury (AKI) in this population. RECENT FINDINGS Ageing in the kidneys is affected by many different factors, such as low grade chronic inflammation, called inflammageing, and various comorbidities. Nevertheless, a decrease of glomerular filtration rate (GFR) occurs independent of the presence of comorbidities and a steady decline of GFR has been reported in both healthy men and women. Pharmacodynamic of many drugs is altered by these changes. Additionally the rate of diuretic resistance appears to be increased. The cause of AKI occurrence in older age is, multifactorial and includes preventable triggers (hypovolemia, hypotension, nephrotoxins) as well as changes associated with aging. SUMMARY Age-related alterations of the kidneys were found at microscopic and macroscopic levels of the cell. These changes lead to a reduced renal reserve and subsequently to an increased vulnerability of aged kidneys when an additional stressor is added. Age is an independent risk factor for developing AKI. Physicians should take into account the altered renal function in elderly patients and take renal protective measures at an early stage.
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Affiliation(s)
- Fabian Perschinka
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Naomi Boyer
- Department of Critical Care, Royal Surrey Foundation Trust
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Foundation Trust
- School of Medicine, Faculty of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
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Wu H, Zhou P, Hu L, Xu M, Tian D. Risk prediction of the progression of chronic kidney disease stage 1 based on peripheral blood samples: construction and internal validation of a nomogram. Ren Fail 2023; 45:2278298. [PMID: 37994438 PMCID: PMC11001344 DOI: 10.1080/0886022x.2023.2278298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/29/2023] [Indexed: 11/24/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have high morbidity and mortality, and the disease progression has a significant impact on their survival and living standards. This research aims to analyze risk factors for CKD stage 1 and provide a reference for clinical decision making. The clinical data and peripheral blood samples of 300 patients with CKD stage 1 were collected retrospectively. Patients were randomly assigned into a training set (n = 210) and a validation set (n = 90). Patients' baseline characteristic levels were subjected to statistical tests for difference. Univariate and multivariate Cox regression analyses were utilized to identify risk factors influencing disease progression. Subsequently, a prediction model for disease progression was developed using a nomogram, and the model's accuracy was assessed using the C-index and calibration curve. The results revealed that hypertension, diabetes, and urinary albumin were essential factors in the progression of CKD stage 1. The nomogram was constructed and then the C-index was calculated. The calibration curve was utilized to assess the risk model. The C-index of the training set was 0.75, and the C-index of the validation set was 0.73, suggesting a good predictive ability of the model. The risk model accurately predicted the progression of CKD stage 1, which is of great significance to developing personalized treatment for patients in clinical practice.
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Affiliation(s)
- Han Wu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Pengfei Zhou
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Liang Hu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Min Xu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Daxue Tian
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Chen HL, Peng K, Zeng DM, Yan J, Huang YQ, Jiang PY, Du YF, Ling X, Wu J. High-Salt Diet Aggravates Endothelial-to-Mesenchymal Transition in Glomerular Fibrosis in Dahl Salt-Sensitive Rats. Am J Hypertens 2023; 36:660-666. [PMID: 37179466 DOI: 10.1093/ajh/hpad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Both diabetic and hypertensive nephropathy eventually progress to glomerulosclerosis. Previous studies revealed a potential role of endothelial-to-mesenchymal transition (EndMT) in the pathophysiology of glomerulosclerosis in diabetic rats. Therefore, we hypothesized that EndMT was also involved in the development of glomerulosclerosis in salt-sensitive hypertension. We aimed to explore the effects of high-salt diet on endothelial-to-mesenchymal transition (EndMT) in glomerulosclerosis in Dahl salt-sensitive (Dahl-SS) rats. METHODS Eight-week-old male rats were fed high-salt (8%NaCl; DSH group) or normal salt (0.3%NaCl; DSN group) for eight weeks, with systolic blood pressure (SBP), serum creatinine, urea, 24-hour urinary protein/sodium, renal interlobar artery blood flow, and pathological examination measured. We also examined endothelial-(CD31) and fibrosis-related protein(α-SMA) expressions in glomeruli. RESULTS High-salt diet increased SBP (DSH vs. DSN, 205.2 ± 8.9 vs. 135.4 ± 7.9 mm Hg, P < 0.01), 24-hour urinary protein (132.55 ± 11.75 vs. 23.52 ± 5.94 mg/day, P < 0.05), urine sodium excretions (14.09 ± 1.49 vs. 0.47 ± 0.06 mmol/day, P < 0.05), and renal interlobar artery resistance. Glomerulosclerosis increased (26.1 ± 4.6 vs. 7.3 ± 1.6%, P < 0.05), glomerular CD31 expressions decreased while α-SMA expression increased in DSH group. Immunofluorescence staining showed that CD31 and α-SMA co-expressed in glomeruli of the DSH group. The degree of glomerulosclerosis negatively correlated with CD31 expressions (r = -0.823, P < 0.01) but positively correlated with α-SMA expressions (r = 0.936, P < 0.01). CONCLUSIONS We demonstrated that a high-salt diet led to glomerulosclerosis involving the EndMT process, which played an essential role in glomerulosclerosis in hypertensive Dahl-SS rats.
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Affiliation(s)
- Hui-Lin Chen
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Kuang Peng
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Dian-Mei Zeng
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Jun Yan
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Ya-Qi Huang
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Pei-Yong Jiang
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Ya-Fang Du
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Xiang Ling
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
| | - Jie Wu
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, PR China
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Du S, Zhai L, Ye S, Wang L, Liu M, Tan M. In-depth urinary and exosome proteome profiling analysis identifies novel biomarkers for diabetic kidney disease. SCIENCE CHINA. LIFE SCIENCES 2023; 66:2587-2603. [PMID: 37405567 DOI: 10.1007/s11427-022-2348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/17/2023] [Indexed: 07/06/2023]
Abstract
Diabetic kidney disease (DKD) is a major microvascular complication of type 2 diabetes mellitus (T2DM). Monitoring the early diagnostic period and disease progression plays a crucial role in treating DKD. In this study, to comprehensively elucidate the molecular characteristics of urinary proteins and urinary exosome proteins in type 2 DKD, we performed large-scale urinary proteomics (n=144) and urinary exosome proteomics (n=44) analyses on T2DM patients with albuminuria in varying degrees. The dynamics analysis of the urinary and exosome proteomes in our study provides a valuable resource for discovering potential urinary biomarkers in patients with DKD. A series of potential biomarkers, such as SERPINA1 and transferrin (TF), were detected and validated to be used for DKD diagnosis or disease monitoring. The results of our study comprehensively elucidated the changes in the urinary proteome and revealed several potential biomarkers reflecting the progression of DKD, which provide a reference for DKD biomarker screening.
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Affiliation(s)
- Shichun Du
- Department of Endocrinology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Linhui Zhai
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Guangdong, 528400, China
| | - Shu Ye
- Department of Endocrinology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Le Wang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Muyin Liu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Minjia Tan
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Guangdong, 528400, China.
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19
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Kim TM, Lee KW, Kim HD, Hong SO, Cho HJ, Yang JH, Kim SJ, Park JB. Evaluation of Selected Markers in Kidneys of Cynomolgus Monkey ( Macaca fascicularis) with Induced Diabetes during Renal Ischemia-reperfusion Injury. Comp Med 2023; 73:357-372. [PMID: 38087409 PMCID: PMC10702167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/26/2023] [Accepted: 05/04/2023] [Indexed: 12/18/2023]
Abstract
We previously reported that induced type 1 diabetes mellitus (DM) increases the susceptibility of acute kidney injury in- duced by ischemia-reperfusion injury (IRI) in cynomolgus monkeys. In this follow-up study, we compared the expression of selected markers in the renal tissues of monkeys subjected to bilateral renal IRI with and without diabetes. All tissues were obtained from the original study. Renal biopsies were obtained before and 24 and 48 h after ischemia and were examined for expression of KI-67 (tubular proliferation), Na+ /K+ ATPase (sodium-potassium pump), TNF-α(tumor necrosis factor-α, inflammation), CD31 (microvessels), CD3 (T-cells), 2 fibrotic markers (fibroblast specific protein-1, FSP-1;α-smooth muscle actin,α -SMA), and cleaved caspase 3 (apoptosis). Generally, the expression of these markers differed in monkeys with and without DM. As compared with non-DM monkeys, DM monkeys had more cells that expressed KI-67 during progression of acute kidney injury (AKI). Na+ /K+ ATPase expression was clearly present at baseline in the basolateral tubular areas only in the non-DM monkeys. At 48 h, its expression in the basolateral area was not visible in DM monkeys, but was still present in intercellular junctions of non-DM monkeys. The expression of TNF-αwas higher in DM before and 48 h after ischemia. Before and 24 h after ischemia, the number of CD31-positive capillaries was not different between 2 groups, although more collapsed vessels were found at in DM at 24 h. At 48 h, the number of capillaries was less in DM compared with those from non-DM animals. DM monkeys had more interstitial CD3-positive cells than did non-DM monkeys at 24 and 48 h after ischemia. Finally, FSP-1-stained cells were more abundant in DM than non-DM at 24 and 48 h. Our results show that DM aggravates the recovery of renal ischemia/reperfusion injury by affecting tubular proliferation, capillary density, T cell infil- tration and by altering protein and mRNA expression of various genes involved in ion channel, inflammation, and fibrotic change. The results from this observational study demonstrate that DM aggravates the recovery of renal ischemia/reperfusion injury by affecting multiple events including tubular necrosis, proliferation, function, inflammation and by inducing capillary rarefaction in cynomolgus monkeys.
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Affiliation(s)
- Tae M Kim
- Graduate School of International Agricultural Technology, Seoul National University, Pyeongchang, Gangwon-do 25354, South Korea
- Institutes of Green-Bio Science and Technology, Seoul National University, Pyeongchang, Gangwon-do 25354, South Korea
| | - Kyo W Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
| | - Hong D Kim
- Institutes of Green-Bio Science and Technology, Seoul National University, Pyeongchang, Gangwon-do 25354, South Korea
| | - Sung O Hong
- Institutes of Green-Bio Science and Technology, Seoul National University, Pyeongchang, Gangwon-do 25354, South Korea
| | - Hye J Cho
- Graduate School of International Agricultural Technology, Seoul National University, Pyeongchang, Gangwon-do 25354, South Korea
| | - Je H Yang
- Laboratory Animal Research Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
| | - Sung J Kim
- GenNBio Inc., 80 Deurimsandan 2-ro, Cheongbuk-myeon, Pyeongtaek-si, Gyeonggi-do 17796, South Korea
| | - Jae B Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
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20
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Huynh Thanh L, Dao Bui Quy Q, Nguyen Manh K, Nguyen Huu D, Nguyen Trung K, Le Viet T. Preoperative urine neutrophil gelatinase-associated lipocalin predicts mortality in colorectal cancer patients after laparoscopic surgery: A single-center study. Health Sci Rep 2023; 6:e1612. [PMID: 37808929 PMCID: PMC10556407 DOI: 10.1002/hsr2.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose To determine the rate of acute kidney injury (AKI) after laparoscopic colorectal cancer (CRC) surgery and the predictive value of urine neutrophil gelatinase-associated lipocalin (uNGAL) for postoperative AKI and mortality during 3 years of follow-up. Methods A total of 216 CRC patients who had undergone laparoscopic surgery were included in our study. We divided all patients into two groups, including group 1 (n = 31) with postoperative AKI and group 2 (n = 185) without postoperative AKI. Urine NGAL was measured using the ELISA technique. Clinical and laboratory data were collected the day before surgery. Postoperative AKI included events occurring within 7 days of the index operation, and mortality was obtained during 3 years of follow-up. Results The ratio of postoperative AKI was 14.35% (31/216 patients). The urine NGAL level in group 1 was significantly higher than in group 2, p < 0.001. At cut-off value = 14.94 ng/mL, uNGAL has a predictive value for AKI (area under the curve [AUC] = 0.858, p < 0.001). After 3 years of follow-up, the total mortality rate was 7.9%. The mortality rate in group 1 (45.2%) was significantly higher than in group 2 (1.6%) with p < 0.001). At cut-off value = 19.85 ng/mL, uNGAL has a predictive value for mortality (AUC = 0.941, p < 0.001). Conclusions The rate of acute kidney injury after laparoscopic CRC surgery was 14.35%. Preoperative urine NGAL has a good predictive value for postoperative acute kidney injury and mortality during 3 years of follow-up.
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Affiliation(s)
- Long Huynh Thanh
- Nguyen Tri Phuong HospitalHo Chi MinhVietnam
- Nguyen Tat Thanh UniversityHo Chi MinhVietnam
| | | | | | | | - Kien Nguyen Trung
- Military Hospital 103Ha NoiVietnam
- Vietnam Military Medical UniversityHa NoiVietnam
| | - Thang Le Viet
- Military Hospital 103Ha NoiVietnam
- Vietnam Military Medical UniversityHa NoiVietnam
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21
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Patoulias D, Papadopoulos C, Siskos F, Doumas M. Acute kidney injury with sodium-glucose co-transporter-2 inhibitors across the cardiovascular and renal outcome trials: Foe or friend? Nefrologia 2023; 43:643-645. [PMID: 36437198 DOI: 10.1016/j.nefroe.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/15/2021] [Indexed: 06/16/2023] Open
Affiliation(s)
- Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Greece.
| | - Christodoulos Papadopoulos
- Third Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Greece
| | - Fotios Siskos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Greece; Veterans Affairs Medical Center, George Washington University, Washington, District of Columbia, United States
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22
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Xu Y, Dong S, Fu EL, Sjölander A, Grams ME, Selvin E, Carrero JJ. Long-term Visit-to-Visit Variability in Hemoglobin A 1c and Kidney-Related Outcomes in Persons With Diabetes. Am J Kidney Dis 2023; 82:267-278. [PMID: 37182597 PMCID: PMC10524363 DOI: 10.1053/j.ajkd.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/08/2023] [Indexed: 05/16/2023]
Abstract
RATIONALE & OBJECTIVE To characterize associations between long-term visit-to-visit variability of hemoglobin A1c (HbA1c) and risk of adverse kidney outcomes in patients with diabetes. STUDY DESIGN Observational study. SETTING & PARTICIPANTS 93,598 adults with diabetes undergoing routine care in Stockholm, Sweden. EXPOSURES AND PREDICTORS Categories of baseline and time-varying HbA1c variability score (HVS, the percentage of total HbA1c measures that vary by>0.5% [5.5mmol/mol] during a 3-year window): 0-20%, 21%-40%, 41%-60%, 61%-80%, and 81%-100%, with 0-20% as the reference group. OUTCOME Chronic kidney disease (CKD) progression (composite of>50% estimated glomerular filtration rate [eGFR] decline and kidney failure), acute kidney disease (AKI by clinical diagnosis or transient creatinine elevations according to KDIGO criteria), and worsening of albuminuria. ANALYTICAL APPROACH Multivariable Cox proportional hazards regression. RESULTS Compared with persons showing low HbA1c variability (HVS 0-20%), any increase in variability was associated with a higher risk of adverse kidney outcomes beyond mean HbA1c. For example, for patients with a baseline HbA1c variability of 81%-100%, the adjusted HR was 1.6 (95% CI, 1.47-1.74) for CKD progression, 1.23 [1.16-1.3] for AKI, and 1.28 [1.21-1.36] for worsening of albuminuria. The results were consistent across subgroups (diabetes subtypes, baseline eGFR, or albuminuria categories), in time-varying analyses and in sensitivity analyses including time-weighted average HbA1c or alternative metrics of variability. LIMITATIONS Observational study, limitations of claims data, lack of information on diet, body mass index, medication changes, and diabetes duration. CONCLUSIONS Higher long-term visit-to-visit HbA1c variability is consistently associated with the risks of CKD progression, AKI, and worsening of albuminuria. PLAIN-LANGUAGE SUMMARY The evidence for current guideline recommendations derives from clinical trials that focus on a single HbA1c as the definitive measure of efficacy of an intervention. However, long-term visit-to-visit fluctuations of HbA1c may provide additional value in the prediction of future kidney complications. We evaluated the long-term fluctuations in glycemic control in almost 100,000 persons with diabetes undergoing routine care in Stockholm, Sweden. We observed that higher long-term HbA1c fluctuation is consistently associated with the risks of chronic kidney disease progression, worsening of albuminuria and acute kidney injury. This finding supports a role for long-term glycemic variability in the development of kidney complications and illustrates the potential usefulness of this metric for risk stratification at the bedside beyond a single HbA1c test.
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Affiliation(s)
- Yang Xu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, People's Republic of China; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Shujie Dong
- Department of Pharmacy, Peking University Third Hospital, Beijing, People's Republic of China
| | - Edouard L Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Morgan E Grams
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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23
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Zhan R, Zhang J, Chen X, Liu T, He Y, Zhang S, Liao X, Zhuang X, Tian T, Feng L. Targeting the Efficacy of Intensive Blood Pressure Treatment in Hypertensive Patients - An Exploratory Analysis of SPRINT. Circ J 2023; 87:1212-1218. [PMID: 37100596 DOI: 10.1253/circj.cj-23-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Hypertensive patients show highly heterogeneous treatment effects (HTEs) and cardiovascular prognosis, and not all benefit from intensive blood pressure treatment.Methods and Results: We used the causal forest model to identify potential HTEs of patients in the Systolic Blood Pressure Intervention Trial (SPRINT). Cox regression was performed to assess hazard ratios (HRs) for cardiovascular disease (CVD) outcomes and to compare the effects of intensive treatment among groups. The model revealed 3 representative covariates and patients were partitioned into 4 subgroups: Group 1 (baseline body mass index [BMI] ≤28.32 kg/m2and estimated glomerular filtration rate [eGFR] ≤69.53 mL/min/1.73 m2); Group 2 (baseline BMI ≤28.32 kg/m2and eGFR >69.53 mL/min/1.73 m2); Group 3 (baseline BMI >28.32 kg/m2and 10-year CVD risk ≤15.8%); Group 4 (baseline BMI >28.32 kg/m2and 10-year CVD risk >15.8%). Intensive treatment was shown to be beneficial only in Group 2 (HR 0.54, 95% confidence interval [CI] 0.35-0.82; P=0.004) and Group 4 (HR 0.69, 95% CI 0.52-0.91; P=0.009). CONCLUSIONS Intensive treatment was effective for patients with high BMI and 10-year CVD risk, or low BMI and normal eGFR, but not for those with low BMI and eGFR, or high BMI and low 10-year CVD risk. Our study could facilitate the categorization of hypertensive patients, ensuring individualized therapy.
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Affiliation(s)
- Rongjian Zhan
- Cardiology Department, The First Affiliated Hospital of Sun Yat-Sen University
- Zhongshan School of Medicine, Sun Yat-sen University
| | - Jing Zhang
- Department of Cardiology, Zhongshan People's Hospital
| | - Xuanyu Chen
- School of Mathematics, Sun Yat-sen University
| | - Tong Liu
- Department of Cardiology, Zhongshan People's Hospital
| | - Yangsheng He
- Department of Cardiology, Zhongshan People's Hospital
| | - Shaozhao Zhang
- Cardiology Department, The First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University
| | - Xinxue Liao
- Cardiology Department, The First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University
| | - Xiaodong Zhuang
- Cardiology Department, The First Affiliated Hospital of Sun Yat-Sen University
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University
| | - Ting Tian
- School of Mathematics, Sun Yat-sen University
| | - Li Feng
- Department of Cardiology, Zhongshan People's Hospital
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24
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Lin Z, Liang Y, Wang R, Hu B, He W, Li J, Ding Z, Lin Z, Zhang S. Dietary magnesium is able to influence the relationship between vitamin C and estimated glomerular filtration rate: A cross-sectional study. Food Sci Nutr 2023; 11:4773-4780. [PMID: 37576036 PMCID: PMC10420853 DOI: 10.1002/fsn3.3456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 08/15/2023] Open
Abstract
The estimated glomerular filtration rate (eGFR) is a comprehensive index that is widely used to assess renal function. Although studies have confirmed a correlation between eGFR and dietary vitamin C, the impact of varying levels of vitamin C on eGFR remains unclear. Additionally, the interaction between dietary magnesium intake and vitamin C concentration on eGFR is not well understood. As such, the objective of this study was to investigate the relationship between dietary magnesium intake and vitamin C in relation to eGFR. This study analyzed the data of consecutive NHANES from 2005 to 2018. We included 17,633 participants aged 20 or older and used multiple linear regression analysis to evaluate the relationship between dietary vitamin C and eGFR. Dietary Mg intake from experimental data was dichotomized into a low dietary Mg intake group (≤254 mg/day) and a normal dietary Mg intake group (>254 mg/day). To evaluate the impact of dietary magnesium intake on eGFR, a multivariable linear regression was conducted utilizing an interaction test between dietary vitamin C and eGFR. We discovered a positive association between dietary vitamin C content and eGFR. The relationship between dietary vitamin C levels and eGFR differed between individuals with low Mg intake and those with normal Mg intake (β: 2.96 95% CI:1.63 ~ 4.29 vs. β: 1.05 95% CI: -0.15 to 2.25), and the positive association of high dietary vitamin C content with eGFR was stronger in the low Mg intake group. Furthermore, we observed that dietary magnesium intake significantly altered the positive association between dietary vitamin C and eGFR (interaction value of 0.020). Our experimental study revealed that the interaction between dietary magnesium and dietary vitamin C can significantly impact eGFR. This finding carries significant implications for the treatment of diseases resulting from abnormal eGFR, as well as the selection of clinically relevant drugs.
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Affiliation(s)
- Zheng‐yang Lin
- Department of Clinical MedicineThe Second Clinical School of Guangzhou Medical UniversityGuangzhouChina
| | - Yong‐yi Liang
- Department of Preventive MedicineSchool of Public Health, Guangzhou Medical UniversityGuangzhouChina
| | - Ru Wang
- Department of Medical ImagingThe Second Clinical School of Guangzhou Medical UniversityGuangzhouChina
| | - Biao Hu
- Department of Clinical MedicineThe Second Clinical School of Guangzhou Medical UniversityGuangzhouChina
| | - Wen‐ju He
- Department of Clinical MedicineThe Second Clinical School of Guangzhou Medical UniversityGuangzhouChina
| | - Jun‐kui Li
- Department of Clinical MedicineThe Second Clinical School of Guangzhou Medical UniversityGuangzhouChina
| | - Zi‐ang Ding
- Department of Clinical MedicineThe First Clinical School of Guangzhou Medical UniversityGuangzhouChina
| | - Zhuo‐yuan Lin
- Department of UrologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Medical UniversityGuangzhouChina
| | - Shi Zhang
- Department of Gastrointestinal SurgeryThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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25
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Chou LF, Yang HY, Hung CC, Tian YC, Hsu SH, Yang CW. Leptospirosis kidney disease: Evolution from acute to chronic kidney disease. Biomed J 2023; 46:100595. [PMID: 37142093 PMCID: PMC10345244 DOI: 10.1016/j.bj.2023.100595] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
Leptospirosis is a neglected bacterial disease caused by leptospiral infection that carries a substantial mortality risk in severe cases. Research has shown that acute, chronic, and asymptomatic leptospiral infections are closely linked to acute and chronic kidney disease (CKD) and renal fibrosis. Leptospires affect renal function by infiltrating kidney cells via the renal tubules and interstitium and surviving in the kidney by circumventing the immune system. The most well-known pathogenic molecular mechanism of renal tubular damage caused by leptospiral infection is the direct binding of the bacterial outer membrane protein LipL32 to toll-like receptor-2 expressed in renal tubular epithelial cells (TECs) to induce intracellular inflammatory signaling pathways. These pathways include the production of tumor necrosis factor (TNF)-α and nuclear factor kappa activation, resulting in acute and chronic leptospirosis-related kidney injury. Few studies have investigated the relationship between acute and chronic renal diseases and leptospirosis and further evidence is necessary. In this review, we intend to discuss the roles of acute kidney injury (AKI) to/on CKD in leptospirosis. This study reviews the molecular pathways underlying the pathogenesis of leptospirosis kidney disease, which will assist in concentrating on potential future research directions.
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Affiliation(s)
- Li-Fang Chou
- Kidney Research Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; Graduate Institute of Biomedical Sciences, Department of Microbiology and Immunology, Department of Biochemistry, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Yu Yang
- Kidney Research Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shen-Hsing Hsu
- Kidney Research Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital at Linkou, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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26
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Rodrigues N, Fragão-Marques M, Costa C, Branco C, Marques F, Vasconcelos P, Martins C, Leite-Moreira A, Lopes JA. Predictive Risk Score for Acute Kidney Injury in Hematopoietic Stem Cell Transplant. Cancers (Basel) 2023; 15:3720. [PMID: 37509381 PMCID: PMC10377961 DOI: 10.3390/cancers15143720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Hematopoietic stem cell transplant (HSCT) is an important treatment option for hematologic malignancies. Acute kidney injury (AKI) is a common complication in HSCTs and is related to worse outcomes. We aimed to create a predictive risk score for AKI in HSCT considering variables available at the time of the transplant. We performed a retrospective cohort study. AKI was defined by the KDIGO classification using creatinine and urinary output criteria. We used survival analysis with competing events. Continuous variables were dichotomized according to the Liu index. A multivariable analysis was performed with a backward stepwise regression. Harrel's C-Statistic was used to evaluate the performance of the model. Points were attributed considering the nearest integer of two times each covariate's hazard ratio. The Liu index was used to establish the optimal cut-off. We included 422 patients undergoing autologous (61.1%) or allogeneic (38.9%) HSCTs for multiple myeloma (33.9%), lymphoma (27.3%), and leukemia (38.8%). AKI cumulative incidence was 59.1%. Variables eligible for the final score were: hematopoietic cell transplant comorbidity index ≥2 (HR: 1.47, 95% CI: 1.08-2.006; p = 0.013), chronic kidney disease (HR: 2.10, 95% CI: 1.31-3.36; p = 0.002), lymphoma or leukemia (HR: 1.69, 95% CI: 1.26-2.25; p < 0.001) and platelet-to-lymphocyte ratio > 171.9 (HR: 1.43, 95% CI: 1.10-1.86; p = 0.008). This is the first predictive risk score for AKI in patients undergoing HSCTs and the first study where the platelet-to-lymphocyte ratio is independently associated with AKI.
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Affiliation(s)
- Natacha Rodrigues
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Mariana Fragão-Marques
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
| | - Cláudia Costa
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Carolina Branco
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Filipe Marques
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Pedro Vasconcelos
- Division of Hematology, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Carlos Martins
- Division of Hematology, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
| | - Adelino Leite-Moreira
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
| | - José António Lopes
- Division of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, EPE, 1649-028 Lisboa, Portugal
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Kaur A, Sharma GS, Kumbala DR. Acute kidney injury in diabetic patients: A narrative review. Medicine (Baltimore) 2023; 102:e33888. [PMID: 37233407 PMCID: PMC10219694 DOI: 10.1097/md.0000000000033888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
Diabetes mellitus (DM) is the most common cause of chronic kidney disease, which leads to end-stage renal failure worldwide. Glomerular damage, renal arteriosclerosis, and atherosclerosis are the contributing factors in diabetic patients, leading to the progression of kidney damage. Diabetes is a distinct risk factor for acute kidney injury (AKI) and AKI is associated with faster advancement of renal disease in patients with diabetes. The long-term consequences of AKI include the development of end-stage renal disease, higher cardiovascular and cerebral events, poor quality of life, and high morbidity and mortality. In general, not many studies discussed extensively "AKI in DM." Moreover, articles addressing this topic are scarce. It is also important to know the cause of AKI in diabetic patients so that timely intervention and preventive strategies can be implemented to decrease kidney injury. Aim of this review article is to address the epidemiology of AKI, its risk factors, different pathophysiological mechanisms, how AKI differs between diabetic and nondiabetic patients and its preventive and therapeutic implications in diabetics. The increasing occurrence and prevalence of AKI and DM, as well as other pertinent issues, motivated us to address this topic.
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Affiliation(s)
- Amninder Kaur
- Senior Resident, Department of Nephrology, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Gaurav Shekhar Sharma
- Assistant Professor, Department of Nephrology, All India Institute of Medical Sciences Rishikesh, Uttrakhand, India
| | - Damodar R Kumbala
- Diagnostic and Interventional Nephrologist, Renal Associates of Baton Rogue, Baton Rogue, LA
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28
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Gui Y, Palanza Z, Fu H, Zhou D. Acute kidney injury in diabetes mellitus: Epidemiology, diagnostic, and therapeutic concepts. FASEB J 2023; 37:e22884. [PMID: 36943403 PMCID: PMC10602403 DOI: 10.1096/fj.202201340rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Acute kidney injury (AKI) and diabetes mellitus (DM) are public health problems that cause a high socioeconomic burden worldwide. In recent years, the landscape of AKI etiology has shifted: Emerging evidence has demonstrated that DM is an independent risk factor for the onset of AKI, while an alternative perspective considers AKI as a bona fide complication of DM. Therefore, it is necessary to systematically characterize the features of AKI in DM. In this review, we summarized the epidemiology of AKI in DM. While focusing on circulation- and tissue-specific microenvironment changes after DM, we described the active cellular and molecular mechanisms of increased kidney susceptibility to AKI under DM stress. We also reviewed the current diagnostic and therapeutic strategies for AKI in DM recommended in the clinic. Updated recognition of the epidemiology, pathophysiology, diagnosis, and medications of AKI in DM is believed to reveal a path to mitigate the frequency of AKI and DM comorbidity that will ultimately improve the quality of life in DM patients.
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Affiliation(s)
- Yuan Gui
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Zachary Palanza
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Haiyan Fu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Dong Zhou
- Division of Nephrology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
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29
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Fanaei SM, Mehran L, Amouzegar A, Masoumi S, Amouzegar A, Azizi F. The impact of metabolic syndrome on chronic kidney disease development. Insights from a big prospective study. Eur J Clin Invest 2023; 53:e13945. [PMID: 36576367 DOI: 10.1111/eci.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) can progress over time and cause renal replacement therapy. Studies showed the association between metabolic syndrome (MetS) and CKD. Current evidence is from cross-sectional studies. There is a need for the robust data from big prospective cohort studies with long-term follow-up. This study investigated the association between CKD and MetS after 18 years of follow-up. MATERIAL AND METHOD Among 15,255 participants aged ≥20 years at baseline (1999-2005), after exclusion of CKD, cancer, and use of corticosteroids, 8987 participants entered the study and followed at a three-year cycle up to 2018. All participants were divided into five subgroups: (1) MetS-free, (2) MetS (DM+, HTN-), (3) MetS+ (DM-, HTN+), (4) MetS+ (DM+, HTN+) and (5) MetS+ (DM-, HTN-). RESULT At baseline, the mean age of the participants was 39.8 ± 13.3 years; 4996 (55.6%) were females. CKD was developed in 2038 (22.7%) subjects during 18 years of follow-up, of whom 1107 had MetS. After adjusting for the confounding variables, MetS (DM+, HTN+) subgroup had the highest risk of CKD (HR = 1.51, 95% CI = 1.32-1.71). MetS subjects with five components had a higher incidence rate of CKD (HR = 1.43, 95% CI = 1.22-1.68). There was no association between high waist circumference (WC) (HR = 1.08, 95% CI = 0.99-1.19) and high-density lipoprotein (HDL) (HR = 1.07, 95% CI = 0.98-1.18) with CKD. CONCLUSION CKD significantly develops in patients with MetS. Metabolic syndrome was associated with the development of chronic kidney disease incidence. Hypertension, diabetes, and age were strong indicators, while abdominal obesity and reduced HDL were not associated with the incidence of CKD.
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Affiliation(s)
- Seyedeh Melika Fanaei
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safdar Masoumi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Atefeh Amouzegar
- Firoozgar Clinical Research Development Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Freidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rosiello G, Larcher A, Fallara G, Cignoli D, Re C, Martini A, Tian Z, Karakiewicz PI, Mottrie A, Boarin M, Villa G, Trevisani F, Marandino L, Raggi D, Necchi A, Bertini R, Salonia A, Briganti A, Montorsi F, Capitanio U. A comprehensive assessment of frailty status on surgical, functional and oncologic outcomes in patients treated with partial nephrectomy-A large, retrospective, single-center study. Urol Oncol 2023; 41:149.e17-149.e25. [PMID: 36369233 DOI: 10.1016/j.urolonc.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Partial nephrectomy (PN) is a challenging procedure, which can be associated with severe complications. In consequence, the search for accurate and independent indicators of unfavorable surgical outcomes appears warranted. We aimed at evaluating the impact of frailty status on surgical, functional and oncologic outcomes in patients undergoing PN for renal cell carcinoma (RCC). METHODS A retrospective, single-center study including 1,282 patients treated with PN for clinically localized cT1 RCC was performed. The modified Frailty Index (mFI) was used to assess preoperative frailty. Multivariable logistic, Poisson and linear regression analyses(MVA) tested the effect of frailty on complications, acute kidney injury(AKI), renal function decline after PN. Cumulative incidence and competing-risk analyses investigated survival outcomes. RESULTS Of 1,282 patients, 220 (17%) were frail. Overall, 982 (76%) vs. 123 (9.6%) vs. 171 (13%) patients underwent open vs. laparoscopic vs. robot-assisted PN. Median follow-up was 66 (IQR: 35-107) months. At MVA, frailty status predicted increased risk of complications [Odds ratio (OR): 1.46, 95%CI 1.17-1.84; P < 0.001]. Moreover, frail patients were at higher risk of postoperative AKI (OR: 1.95, 95%CI 1.13-3.35; P = 0.01). In frail patients, renal function permanently decreased over time (P = 0.01) without any renal function plateau or improvement during the follow-up, which were instead observed in the nonfrail cohort. At competing-risks analyses, frailty status predicted higher risk of other-cause mortality [Hazard ratio (HR): 1.67, 95%CI 1.05-2.66; P = 0.02], but not of cancer-specific mortality (P = 0.3). CONCLUSIONS Frailty status predicts higher risk of adverse surgical outcomes after PN. Moreover, greater renal function decline was observed in frail patients, compared with nonfrail patients. Finally, the risk of OCM significantly overcomes the risk of dying due to RCC in frail patients.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Cignoli
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Martini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Mattia Boarin
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Trevisani
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Marandino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Raggi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Bertini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Fu EL, D'Andrea E, Wexler DJ, Patorno E, Paik JM. Safety of Sodium-Glucose Cotransporter-2 Inhibitors in Patients with CKD and Type 2 Diabetes: Population-Based US Cohort Study. Clin J Am Soc Nephrol 2023; 18:01277230-990000000-00094. [PMID: 36827225 PMCID: PMC10278835 DOI: 10.2215/cjn.0000000000000115] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Limited information exists regarding the safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with CKD treated in routine care. We evaluated the safety of SGLT2i in patients with CKD and type 2 diabetes treated in US routine practice. METHODS Using claims data from Medicare and two large US commercial databases (April 2013-December 2021), we included 96,128 adults with CKD stages 3-4 and type 2 diabetes who newly filled prescriptions for SGLT2i versus glucagon-like peptide-1 receptor agonists (GLP-1RA). Safety outcomes included diabetic ketoacidosis (DKA), lower limb amputations, nonvertebral fractures, genital infections, hypovolemia, AKI, hypoglycemia, and severe urinary tract infections (UTIs). Hazard ratios (HRs) and incidence rate differences per 1000 person-years were estimated after 1:1 propensity score matching, adjusted for >120 baseline characteristics. RESULTS Compared with GLP-1RA, SGLT2i initiators had a higher risk of nonvertebral fractures (HR, 1.30; 95% confidence interval [CI], 1.03 to 1.65]; incidence rate difference, 2.13 [95% CI, 0.28 to 3.97]), lower limb amputations (HR, 1.65 [95% CI, 1.22 to 2.23]; incidence rate difference, 2.46 [95% CI, 1.00 to 3.92]), and genital infections (HR, 3.08 [95% CI, 2.73 to 3.48]; incidence rate difference, 41.26 [95% CI, 37.06 to 45.46]). Similar risks of DKA (HR, 1.07 [95% CI, 0.74 to 1.54]; incidence rate difference, 0.29 [95% CI, -0.89 to 1.46]), hypovolemia (HR, 0.99 [95% CI, 0.86 to 1.14]; incidence rate difference, 0.20 [95% CI, -2.85 to 3.25]), hypoglycemia (HR, 1.08 [95% CI, 0.92 to 1.26]; incidence rate difference, 1.46 [95% CI, -1.31 to 4.23]), and severe UTI (HR, 1.02 [95% CI, 0.87 to 1.19]; incidence rate difference, 0.35 [95% CI, -2.51 to 3.21]) were observed. SGLT2i had lower risk for AKI (HR, 0.93 [95% CI, 0.87 to 0.99]; incidence rate difference, -6.75 [95% CI, -13.69 to 0.20]). CONCLUSIONS In US patients with CKD and type 2 diabetes receiving routine care, SGLT2i use was associated with higher risks of genital infections and potentially lower limb amputations and nonvertebral fractures.
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Affiliation(s)
- Edouard L. Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elvira D'Andrea
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Deborah J. Wexler
- Diabetes Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie M. Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
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Palmer BF. Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes. Diabetes Obes Metab 2023; 25:1434-1443. [PMID: 36809555 DOI: 10.1111/dom.15030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/10/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023]
Abstract
For the purpose of predicting clinical outcomes in patients with diabetes and chronic kidney disease, change in albuminuria is a good candidate to be a surrogate marker for future cardiovascular events and progression of kidney disease. Spot urine albumin/creatinine ratio is convenient and recognized as a viable alternative to 24-h albumin, with some limitations. Although there is sufficient evidence to validate its use in clinical trials as a surrogate endpoint for renal outcomes, this is not yet the case for cardiovascular outcomes. While change in albuminuria as a primary or secondary endpoint is trial-specific, its use should be encouraged, nonetheless.
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Affiliation(s)
- Biff F Palmer
- Department of Internal Medicine, Divison of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Deng J, Li L, Feng Y, Yang J. Comprehensive Management of Blood Pressure in Patients with Septic AKI. J Clin Med 2023; 12:jcm12031018. [PMID: 36769666 PMCID: PMC9917880 DOI: 10.3390/jcm12031018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Acute kidney injury (AKI) is one of the serious complications of sepsis in clinical practice, and is an important cause of prolonged hospitalization, death, increased medical costs, and a huge medical burden to society. The pathogenesis of AKI associated with sepsis is relatively complex and includes hemodynamic abnormalities due to inflammatory response, oxidative stress, and shock, which subsequently cause a decrease in renal perfusion pressure and eventually lead to ischemia and hypoxia in renal tissue. Active clinical correction of hypotension can effectively improve renal microcirculatory disorders and promote the recovery of renal function. Furthermore, it has been found that in patients with a previous history of hypertension, small changes in blood pressure may be even more deleterious for kidney function. Therefore, the management of blood pressure in patients with sepsis-related AKI will directly affect the short-term and long-term renal function prognosis. This review summarizes the pathophysiological mechanisms of microcirculatory disorders affecting renal function, fluid management, vasopressor, the clinical blood pressure target, and kidney replacement therapy to provide a reference for the clinical management of sepsis-related AKI, thereby promoting the recovery of renal function for the purpose of improving patient prognosis.
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Affiliation(s)
- Junhui Deng
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 400120, China
| | - Lina Li
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 400120, China
| | - Yuanjun Feng
- Department of Renal Rheumatology, Space Hospital Affiliated to Zunyi Medical University, Zunyi 563002, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 400120, China
- Correspondence: or
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Infante B, Conserva F, Pontrelli P, Leo S, Stasi A, Fiorentino M, Troise D, dello Strologo A, Alfieri C, Gesualdo L, Castellano G, Stallone G. Recent advances in molecular mechanisms of acute kidney injury in patients with diabetes mellitus. Front Endocrinol (Lausanne) 2023; 13:903970. [PMID: 36686462 PMCID: PMC9849571 DOI: 10.3389/fendo.2022.903970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
Several insults can lead to acute kidney injury (AKI) in native kidney and transplant patients, with diabetes critically contributing as pivotal risk factor. High glucose per se can disrupt several signaling pathways within the kidney that, if not restored, can favor the instauration of mechanisms of maladaptive repair, altering kidney homeostasis and proper function. Diabetic kidneys frequently show reduced oxygenation, vascular damage and enhanced inflammatory response, features that increase the kidney vulnerability to hypoxia. Importantly, epidemiologic data shows that previous episodes of AKI increase susceptibility to diabetic kidney disease (DKD), and that patients with DKD and history of AKI have a generally worse prognosis compared to DKD patients without AKI; it is therefore crucial to monitor diabetic patients for AKI. In the present review, we will describe the causes that contribute to increased susceptibility to AKI in diabetes, with focus on the molecular mechanisms that occur during hyperglycemia and how these mechanisms expose the different types of resident renal cells to be more vulnerable to maladaptive repair during AKI (contrast- and drug-induced AKI). Finally, we will review the list of the existing candidate biomarkers of diagnosis and prognosis of AKI in patients with diabetes.
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Affiliation(s)
- Barbara Infante
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Conserva
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Paola Pontrelli
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Serena Leo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandra Stasi
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Dario Troise
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Carlo Alfieri
- Nephrology, Dialysis and Renal Transplant Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Castellano
- Nephrology, Dialysis and Renal Transplant Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Stallone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Liu S, Qiu C, Li X, Yu Z, Liu F, Hu G. A nomogram for predicting the mortality of patients with type 2 diabetes mellitus complicated with acute kidney injury in the intensive care unit. BMC Anesthesiol 2023; 23:4. [PMID: 36600212 PMCID: PMC9811712 DOI: 10.1186/s12871-022-01961-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is no predictive tool for type 2 diabetes mellitus (T2DM) patients with acute kidney injury (AKI). Our study aimed to establish an effective nomogram model for predicting mortality in T2DM patients with AKI. METHOD Data on T2DM patients with AKI were obtained from the Medical Information Mart for Intensive Care III. 70% and 30% of the patients were randomly selected as the training and validation cohorts, respectively. Univariate and multivariate logistic regression analyses were used to identify factors associated with death in T2DM patients with AKI. Factors significantly associated with survival outcomes were used to construct a nomogram predicting 90-day mortality. The nomogram effect was evaluated by receiver operating characteristic curve analysis, Hosmer‒Lemeshow test, calibration curve, and decision curve analysis (DCA). RESULTS There were 4375 patients in the training cohort and 1879 in the validation cohort. Multivariate logistic regression analysis showed that age, BMI, chronic heart failure, coronary artery disease, malignancy, stages of AKI, white blood cell count, blood urea nitrogen, arterial partial pressure of oxygen and partial thromboplastin time were independent predictors of patient survival. The results showed that the nomogram had a higher area under the curve value than the sequential organ failure assessment score and simplified acute physiology score II. The Hosmer‒Lemeshow test and calibration curve suggested that the nomogram had a good calibration effect. The DCA curve showed that the nomogram model had good clinical application value. CONCLUSION The nomogram model accurately predicted 90-day mortality in T2DM patients with AKI. It may provide assistance for clinical decision-making and treatment, thereby reducing the medical burden.
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Affiliation(s)
- Shizhen Liu
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
| | - Chuangye Qiu
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
| | - Xingai Li
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
| | - Zongchao Yu
- grid.412601.00000 0004 1760 3828Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630 China
| | - Fanna Liu
- grid.412601.00000 0004 1760 3828Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630 China
| | - Guoqiang Hu
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S191-S202. [PMID: 36507634 PMCID: PMC9810467 DOI: 10.2337/dc23-s011] [Citation(s) in RCA: 95] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Das SR, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Kosiborod M, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S158-S190. [PMID: 36507632 PMCID: PMC9810475 DOI: 10.2337/dc23-s010] [Citation(s) in RCA: 160] [Impact Index Per Article: 160.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Mo M, Huang Z, Gao T, Luo Y, Pan X, Yang Z, Xia N, Liao Y, Pan L. Development and validation of short-term renal prognosis prediction model in diabetic patients with acute kidney injury. Diabetol Metab Syndr 2022; 14:197. [PMID: 36575456 PMCID: PMC9793591 DOI: 10.1186/s13098-022-00971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Diabetes is a major cause of the progression of acute kidney injury (AKI). Few prediction models have been developed to predict the renal prognosis in diabetic patients with AKI so far. The aim of this study was to develop and validate a predictive model to identify high-risk individuals with non-recovery of renal function at 90 days in diabetic patients with AKI. METHODS Demographic data and related laboratory indicators of diabetic patients with AKI in the First Affiliated Hospital of Guangxi Medical University from January 31, 2012 to January 31, 2022 were retrospectively analysed, and patients were followed up to 90 days after AKI diagnosis. Based on the results of Logistic regression, a model predicting the risk of non-recovery of renal function at 90 days in diabetic patients with AKI was developed and internal validated. Consistency index (C-index), calibration curve, and decision curve analysis were used to evaluate the differentiation, accuracy, and clinical utility of the prediction model, respectively. RESULTS A total of 916 diabetic patients with AKI were enrolled, with a male to female ratio of 2.14:1. The rate of non-recovery of renal function at 90 days was 66.8% (612/916). There were 641 in development cohort and 275 in validation cohort (ration of 7:3). In the development cohort, a prediction model was developed based on the results of Logistic regression analysis. The variables included in the model were: diabetes duration (OR = 1.022, 95% CI 1.012-1.032), hypertension (OR = 1.574, 95% CI 1.043-2.377), chronic kidney disease (OR = 2.241, 95% CI 1.399-3.591), platelet (OR = 0.997, 95% CI 0.995-1.000), 25-hydroxyvitamin D3 (OR = 0.966, 95% CI 0.956-0.976), postprandial blood glucose (OR = 1.104, 95% CI 1.032-1.181), discharged serum creatinine (OR = 1.003, 95% CI 1.001-1.005). The C-indices of the prediction model were 0.807 (95% CI 0.738-0.875) and 0.803 (95% CI 0.713-0.893) in the development and validation cohorts, respectively. The calibration curves were all close to the straight line with slope 1. The decision curve analysis showed that in a wide range of threshold probabilities. CONCLUSION A prediction model was developed to help predict short-term renal prognosis of diabetic patients with AKI, which has been verified to have good differentiation, calibration degree and clinical practicability.
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Affiliation(s)
- Manqiu Mo
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Zichun Huang
- Department of Cardiovascular Thoracic Surgery, Nanning Second People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, 530031, China
| | - Tianyun Gao
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yuzhen Luo
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Xiaojie Pan
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Zhenhua Yang
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Ning Xia
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yunhua Liao
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
| | - Ling Pan
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
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Acute Kidney Injury after Endoscopic Retrograde Cholangiopancreatography-A Hospital-Based Prospective Observational Study. Biomedicines 2022; 10:biomedicines10123166. [PMID: 36551921 PMCID: PMC9775076 DOI: 10.3390/biomedicines10123166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) represents a major pivotal point in gastrointestinal endoscopy. Little is known about acute kidney injury (AKI) post-ERCP. This study analyses the incidence, risk factors, and prognosis of post-ERCP AKI. Methods: A total of 396 patients were prospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dL or by an increase in SCr ≥ 50% in the first 48 h post-ERCP. Logistic regression analysis was used to identify the predictors of AKI and in-hospital mortality. A two-tailed p value < 0.05 was considered significant. Results: One hundred and three patients (26%) developed post-ERCP AKI. Estimated glomerular filtration rate (adjusted odds ratio (aOR) = 0.95, 95% confidence interval (CI): 0.94−0.96, p < 0.001), nonrenal Charlson Comorbidity Index (Aor = 1.19, 95% CI: 1.05−1.35, p = 0.006), choledocholithiasis (aOR = 4.05, 95% CI: 1.98−8.29, p < 0.001), and bilirubin (aOR = 1.1, 95% CI: 1.05−1.15, p < 0.001) were associated with post-ERCP AKI. Post-ERCP AKI was associated with longer hospital stay (p < 0.001) and with increased in-hospital mortality (7.76% versus 0.36%, p < 0.001). Moderate-to-severe (stage 2 and 3) AKI was independently associated with in-hospital mortality (aOR = 6.43, 95% CI: 1.48−27.88, p < 0.013). Conclusions: Post-ERCP AKI represented an important complication associated with longer hospital stay. Moderate-to-severe post-ERCP AKI was an independent risk factor for in-hospital mortality.
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Shen X, Lv K, Hou B, Ao Q, Zhao J, Yang G, Cheng Q. Impact of Diabetes on the Recurrence and Prognosis of Acute Kidney Injury in Older Male Patients: A 10-Year Retrospective Cohort Study. Diabetes Ther 2022; 13:1907-1920. [PMID: 36044176 PMCID: PMC9663794 DOI: 10.1007/s13300-022-01309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION While patients with diabetes are at higher risk of developing acute kidney injury (AKI), there are few studies on the recurrence of AKI in older adult patients. This study therefore aimed to examine the impact of diabetes on AKI recurrence and long-term outcomes in older male patients. METHODS This retrospective cohort study included older male patients who experienced AKI during hospitalization from July 2007 to August 2011. Medical records of all patients were followed up for 10 years. Patients with AKI were classified into groups with and without diabetes. We analyzed differences in common geriatric comorbidities, AKI recurrence frequency, and severity between the two groups, identified risk factors affecting recurrence frequency, and assessed outcomes. RESULTS Of all 266 patients, 128 had diabetes and 138 did not. The AKI recurrence rate was significantly higher in the group with diabetes (80.5 vs. 66.7%; P = 0.011). There was a significantly higher proportion of AKI caused by infections in patients with diabetes (43.3 vs. 33.2%, P = 0.006). The proportion of patients with an AKI recurrence frequency ≥ 3 was significantly higher in the group with diabetes (44.7 vs. 29.4%, P = 0.027). Diabetes and coronary heart disease were independent risk factors for AKI recurrence (P < 0.05), diabetes control was associated with multiple AKI recurrences (P = 0.016), and no significant difference was found between the groups regarding the 10-year prognosis (P = 0.522). However, a subgroup analysis showed that patients with multiple AKI recurrences within 2 years had the worst survival outcome (P = 0.004). CONCLUSIONS Older male patients with diabetes are prone to AKI recurrence after initial onset of AKI. Diabetes is an independent risk factor for AKI recurrence, and active diabetes control (HbA1c < 7%) may thus reduce the recurrence of AKI and improve the very poor outcomes of patients with multiple recurrences of AKI within 2 years.
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Affiliation(s)
- Xin Shen
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China
| | - Kunming Lv
- Department of Geriatric Gastroenterology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Baicun Hou
- Department of Geriatric Gastroenterology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Qiangguo Ao
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China
| | - Jiahui Zhao
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China
| | - Guang Yang
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China.
| | - Qingli Cheng
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China.
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Specificity of severe AKI aetiology and care in the elderly. The IRACIBLE prospective cohort study. J Nephrol 2022; 35:2097-2108. [PMID: 35503200 DOI: 10.1007/s40620-022-01322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Acute Kidney Injury (AKI) is increasingly common in people over 65 years of age, but its causes and management are poorly described. The purpose of this study was to describe the causes, management and prognosis of patients over 65 hospitalised for severe acute kidney injury (AKI) in all departments of a tertiary centre. METHOD The prospective IRACIBLE (IRA: AKI in French; CIBLE: target in French) cohort included 480 patients hospitalised at a university hospital over 18 months for severe AKI or subgroup of AKIN3 (Acute Kidney Injury Network classification) defined by an acute creatinine increase > 354 μmol/L or managed with acute renal replacement therapy (RRT). The history, aetiology of AKI, management, and prognosis were compared in three age groups: < 65, 65-75, and > 75 years. RESULTS The study population included 480 subjects (73% men) with a median body mass index (BMI) of 26.6 kg/m2 [23.3, 30.9], 176 (37%) diabetic patients, 124 (26%) patients < 65 years, 150 (31%) 65-75 years and 206 (43%) > 75 years. Increasing age class was associated with more comorbidities, a significantly lower median estimated glomerular filtration rate (eGFR) 6 months before inclusion (82; 62; 46 ml/min/1.73 m2, p < 0.05) and aetiology of AKI, which was more often obstructive (12%; 15%; 23%, p = 0.03) or part of a cardio-renal syndrome (6%; 9%; /15%, p = 0.04). Older patients were less often managed in the intensive care unit (54%; 47%; 24%, p < 0.0001), were less frequently treated by RRT (52%; 43%; 31%, p < 0.001) and received fewer invasive treatments (6%; 9%; 22%, p < 0.0001). Older survivors returned home less often (80%; 73%; 62%, p = 0.05) in favour of transfers to rehabilitation services (10%; 13%; 22%) with higher mortality at 3 months (35%; 32%; 50%, p < 0.0001). CONCLUSION Older patients hospitalised for severe AKI have a specific profile with more comorbidities, lower baseline renal function, an aetiology of AKI of mainly extra-parenchymal causes and a complex pathway of care with an overall poor prognosis.
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Muiru AN, Yang J, Derebail VK, Liu KD, Feldman HI, Srivastava A, Bhat Z, Saraf SL, Chen TK, He J, Estrella MM, Go AS, Hsu CY. Black and White Adults With CKD Hospitalized With Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2022; 80:610-618.e1. [PMID: 35405207 PMCID: PMC9547036 DOI: 10.1053/j.ajkd.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Few studies have investigated racial disparities in acute kidney injury (AKI), in contrast to the extensive literature on racial differences in the risk of kidney failure. We sought to study potential differences in risk in the setting of chronic kidney disease (CKD). STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS We studied 2,720 self-identified Black or White participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study from July 1, 2013, to December 31, 2017. EXPOSURE Self-reported race (Black vs White). OUTCOME Hospitalized AKI (≥50% increase from nadir to peak serum creatinine). ANALYTICAL APPROACH Cox regression models adjusting for demographics (age and sex), prehospitalization clinical risk factors (diabetes, blood pressure, cardiovascular disease, estimated glomerular filtration rate, proteinuria, receipt of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers), and socioeconomic status (insurance status and education level). In a subset of participants with genotype data, we adjusted for apolipoprotein L1 gene (APOL1) high-risk status and sickle cell trait. RESULTS Black participants (n = 1,266) were younger but had a higher burden of prehospitalization clinical risk factors. The incidence rate of first AKI hospitalization among Black participants was 6.3 (95% CI, 5.5-7.2) per 100 person-years versus 5.3 (95% CI, 4.6-6.1) per 100 person-years among White participants. In an unadjusted Cox regression model, Black participants were at a modestly increased risk of incident AKI (HR, 1.22 [95% CI, 1.01-1.48]) compared with White participants. However, this risk was attenuated and no longer significant after adjusting for prehospitalization clinical risk factors (adjusted HR, 1.02 [95% CI, 0.83-1.25]). There were only 11 AKI hospitalizations among individuals with high-risk APOL1 risk status and 14 AKI hospitalizations among individuals with sickle cell trait. LIMITATIONS Participants were limited to research volunteers and potentially not fully representative of all CKD patients. CONCLUSIONS In this multicenter prospective cohort of CKD patients, racial disparities in AKI incidence were modest and were explained by differences in prehospitalization clinical risk factors.
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Affiliation(s)
- Anthony N Muiru
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California.
| | - Jingrong Yang
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Vimal K Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California
| | - Harold I Feldman
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Zeenat Bhat
- Department of Medicine, Wayne State University, Detroit, Michigan
| | - Santosh L Saraf
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Teresa K Chen
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jiang He
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Michelle M Estrella
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California; Division of Research, Kaiser Permanente Northern California, Oakland, California
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Cen Y, Wang P, Gao F, Jing M, Zhang Z, Yi P, Zhang G, Sun Y, Wang Y. Tetramethylpyrazine nitrone activates hypoxia-inducible factor and regulates iron homeostasis to improve renal anemia. Front Pharmacol 2022; 13:964234. [PMID: 36324690 PMCID: PMC9618660 DOI: 10.3389/fphar.2022.964234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/03/2022] [Indexed: 02/19/2024] Open
Abstract
Renal anemia is one of the most common complications of chronic kidney disease and diabetic kidney disease. Despite the progress made in recent years, there is still an urgent unmet clinical need for renal anemia treatment. In this research, we investigated the efficacy and mechanism of action of the novel tetramethylpyrazine nitrone (TBN). Animal models of anemia including the streptozotocin (STZ)-induced spontaneously hypertensive rats (SHR) and the cisplatin (CDDP)-induced C57BL/6J mice are established to study the TBN's effects on expression of hypoxia-inducible factor and erythropoietin. To explore the mechanism of TBN's therapeutic effect on renal anemia, cobalt chloride (CoCl2) is used in Hep3B/HepG2 cells to simulate a hypoxic environment. TBN is found to increase the expression of hypoxia-inducible factor HIF-1α and HIF-2α under hypoxic conditions and reverse the reduction of HIFs expression caused by saccharate ferric oxide (SFO). TBN also positively regulates the AMPK pathway. TBN stimulates nuclear transcription and translation of erythropoietin by enhancing the stability of HIF-1α expression. TBN has a significant regulatory effect on several major biomarkers of iron homeostasis, including ferritin, ferroportin (FPN), and divalent metal transporter-1 (DMT1). In conclusion, TBN regulates the AMPK/mTOR/4E-BP1/HIFs pathway, and activates the hypoxia-inducible factor and regulates iron homeostasis to improve renal anemia.
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Affiliation(s)
- Yun Cen
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University and Institute of New Drug Research, Jinan University College of Pharmacy, Guangzhou, China
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Peile Wang
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Fangfang Gao
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Mei Jing
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Zaijun Zhang
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Peng Yi
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Gaoxiao Zhang
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Yewei Sun
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
| | - Yuqiang Wang
- Institute of New Drug Research and Guangzhou Key Laboratory of Innovative Chemical Drug Research in Cardio-cerebrovascular Diseases, Jinan University College of Pharmacy, Guangzhou, China
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Kumar R, Kumar S, Gupta R, Kumar B, Rajan A, Chandra S, Gupta H, Atam V, Sonkar SK. Clinical presentation and outcomes of chronic kidney disease patients with COVID-19 admitted to the intensive care unit of a teaching hospital of Northern India during the third wave of the pandemic: A retrospective study. J Family Med Prim Care 2022; 11:6363-6368. [PMID: 36618157 PMCID: PMC9810892 DOI: 10.4103/jfmpc.jfmpc_445_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/03/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) patients have impaired immune status; that's why these patients are prone to develop infection-related complications. The current study compares non-haemodialysis chronic kidney disease and end-stage renal disease (NO-HD-CKD and ESRD, respectively) patient outcomes, the data of which is sparse. Methods Patients diagnosed with COVID-19 infection through reverse transcriptase polymerase chain reaction (RT-PCR) were retrospectively studied using electronic health records. Patients were divided into three categories: non-chronic kidney disease (NO-CKD), NO-HD-CKD, and ESRD, and the outcome was assessed. Results Out of 745 patients, 92 (12.34%) had NO-HD-CKD and 31 (4.16%) had ESRD. CKD patients who were not on haemodialysis had higher rates of comorbidities and D-dimer and C-reactive protein (CRP) values compared to ESRD patients. The overall unadjusted mortality rate was found to be 17.44%, and it was 10.45% in case of NO-CKD patients, 58.69% for NO-HD-CKD patients, and 48.39% for ESRD patients. It was observed that patients having NO-HD-CKD had greater odds ratio of overall expiry in comparison to those without CKD in univariate analysis (OR: 1.58; 95% CI: 1.31-1.91). It was not significant in fully adjusted models (OR: 1.11; 95% CI: 0.88-1.40). Conclusions During the third wave of COVID-19, we found higher mortality rates for cases with NO-HD-CKD and, to a lower extent, ESRD. However, patients with ESRD were observed to have good outcomes in comparison to those with NO-HD-CKD. Primary care physicians are the first point of contact for patients. Hence, it is critical for them to manage and to do proper referral of comorbid patients to higher centres.
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Affiliation(s)
- Rahul Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Satish Kumar
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Satish Kumar, Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India. E-mail:
| | - Rahul Gupta
- Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Bhupendra Kumar
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Aditi Rajan
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Supriya Chandra
- Department of Cardiovascular and Thoracic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Harish Gupta
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Virendra Atam
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sayendra Kumar Sonkar
- Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Wang Z, Zhang C. From AKI to CKD: Maladaptive Repair and the Underlying Mechanisms. Int J Mol Sci 2022; 23:ijms231810880. [PMID: 36142787 PMCID: PMC9504835 DOI: 10.3390/ijms231810880] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
Acute kidney injury (AKI) is defined as a pathological condition in which the glomerular filtration rate decreases rapidly over a short period of time, resulting in changes in the physiological function and tissue structure of the kidney. An increasing amount of evidence indicates that there is an inseparable relationship between acute kidney injury and chronic kidney disease (CKD). With the progress in research in this area, researchers have found that the recovery of AKI may also result in the occurrence of CKD due to its own maladaptation and other potential mechanisms, which involve endothelial cell injury, inflammatory reactions, progression to fibrosis and other pathways that promote the progress of the disease. Based on these findings, this review summarizes the occurrence and potential mechanisms of maladaptive repair in the progression of AKI to CKD and explores possible treatment strategies in this process so as to provide a reference for the inhibition of the progression of AKI to CKD.
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Merker L. Akutes Nierenversagen. DIE DIABETOLOGIE 2022. [PMCID: PMC9365206 DOI: 10.1007/s11428-022-00939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Das akute Nierenversagen oder die akute Nierenschädigung ist eine ernsthafte Erkrankung. Es gibt nur vage Zahlenangaben zum Auftreten. Im vorliegenden Beitrag wird versucht, die diabetologisch relevanten Aspekte dieser Erkrankung darzustellen. Die möglichen Ursachen werden aufgezeigt. Menschen mit Diabetes mellitus haben überwiegend ein höheres Risiko für ein akutes Nierenversagen als nicht von dieser Stoffwechselerkrankung Betroffene. Dies wird für diagnostische sowie klinisch relevante Risikokonstellationen dargestellt. Sowohl diagnostisch als auch therapeutisch ist die interdisziplinäre Kooperation insbesondere mit dem Fachgebiet Nephrologie erforderlich. Therapeutisch relevante Aspekte werden angerissen, auch medikamentöse Maßnahmen.
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Affiliation(s)
- Ludwig Merker
- Diabetologie im MVZ am Park Ville d’Eu GmbH, Königstr. 12–14, 42781 Haan, Deutschland
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Characteristics of risk factors for acute kidney injury among inpatients administered sulfamethoxazole/trimethoprim: a retrospective observational study. J Pharm Health Care Sci 2022; 8:20. [PMID: 35909129 PMCID: PMC9341082 DOI: 10.1186/s40780-022-00251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Sulfamethoxazole/trimethoprim (SMX/TMP) potentially increases the serum creatinine levels, resulting in acute kidney injury (AKI). However, the clinical characteristics of the AKI associated with SMX/TMP and the risk factors for its development have not been fully characterized. Methods A retrospective cohort observational analysis was conducted on adult inpatients who started SMX/TMP treatment at the Tokyo Women’s Medical University, Yachiyo Medical Center, from April 2018 to March 2020. The primary outcome was AKI, defined as an increase in serum creatinine level of ≥ 50% from baseline. Multivariate logistic regression analysis was used to determine the risk factors for the AKI associated with SMX/TMP. Results Of the 281 patients, 32 (11.4%) developed AKI. The multivariate logistic regression analysis identified that body mass index (BMI) (odds ratio [OR] = 0.86, 95% confidence interval [95% CI] 0.76–0.97, p < 0.01), presence of hypertension (OR = 2.69, 95% CI 1.11–6.49, p = 0.02), SMX/TMP daily dose (OR = 1.16, 95% CI 1.03–1.30, p = 0.02), and concomitant loop diuretic use (OR = 2.91, 95% CI 1.08–7.78, p = 0.04) were the associated risk factors for AKI in patients who were administered SMX/TMP. Conclusions This study showed that low BMI, hypertension, high-dose SMX/TMP, and concomitant loop diuretic use increased the risk of AKI in patients administered SMX/TMP. Clinicians should consider monitoring the renal function in patients at a high risk of AKI.
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A Single Oral Dose of Diclofenac Causes Transition of Experimental Subclinical Acute Kidney Injury to Chronic Kidney Disease. Biomedicines 2022; 10:biomedicines10051198. [PMID: 35625934 PMCID: PMC9138744 DOI: 10.3390/biomedicines10051198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Nephrotoxic drugs can cause acute kidney injury (AKI) and analgesic nephropathy. Diclofenac is potentially nephrotoxic and frequently prescribed for pain control. In this study, we investigated the effects of single and repetitive oral doses of diclofenac in the setting of pre-existing subclinical AKI on the further course of AKI and on long-term renal consequences. Unilateral renal ischemia–reperfusion injury (IRI) for 15 min was performed in male CD1 mice to induce subclinical AKI. Immediately after surgery, single oral doses (100 mg or 200 mg) of diclofenac were administered. In a separate experimental series, repetitive treatment with 100 mg diclofenac over three days was performed after IRI and sham surgery. Renal morphology and pro-fibrotic markers were investigated 24 h and two weeks after the single dose and three days after the repetitive dose of diclofenac treatment using histology, immunofluorescence, and qPCR. Renal function was studied in a bilateral renal IRI model. A single oral dose of 200 mg, but not 100 mg, of diclofenac after IRI aggravated acute tubular injury after 24 h and caused interstitial fibrosis and tubular atrophy two weeks later. Repetitive treatment with 100 mg diclofenac over three days aggravated renal injury and caused upregulation of the pro-fibrotic marker fibronectin in the setting of subclinical AKI, but not in sham control kidneys. In conclusion, diclofenac aggravated renal injury in pre-existing subclinical AKI in a dose and time-dependent manner and already a single dose can cause progression to chronic kidney disease (CKD) in this model.
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Persistent vascular congestion in male spontaneously hypertensive rats contributes to delayed recovery of renal function following ischemia-reperfusion compared to females. Clin Sci (Lond) 2022; 136:825-840. [PMID: 35535709 DOI: 10.1042/cs20220002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Acute kidney injury (AKI) is a serious and frequent clinical complication with mortality rates up to 80%. Vascular congestion in the renal outer medulla occurs early after ischemia reperfusion (IR) injury, and congestion has been linked to worsened outcomes following IR. There is evidence implicating both male sex and preexisting hypertension as risk factors for poor outcomes following IR. The present study tested the hypothesis that male spontaneously hypertensive rats (SHR) have greater vascular congestion and impaired renal recovery following renal IR vs. female SHR and normotensive male Sprague-Dawley rats (SD). 13 wk old male and female SHR and SD were subjected to sham surgery or 30 minutes of warm bilateral ischemia followed by reperfusion. Rats were euthanized 24 hours or 7 days post-IR. IR increased renal injury in all groups vs. sham controls at 24 hours. At 7 days post-IR, injury remained elevated only in male SHR. Histological examination of SD and SHR kidneys 24 hours post-IR showed vascular congestion in males and females. Vascular congestion was sustained only in male SHR 7 days post-IR. To assess the role of vascular congestion on impaired recovery following IR, additional male and female SHR were pretreated with heparin (200 U/kg) prior to IR. Heparin pre-treatment reduced IR-induced congestion and improved renal function in male SHR 7 days post-IR. Interestingly, preventing increases in BP in male SHR did not alter sustained vascular congestion. Our data demonstrate that IR-induced vascular congestion is a major driving factor for impaired renal recovery in male SHR.
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Chi PJ, Lee CJ, Hsieh YJ, Lu CW, Hsu BG. Dapagliflozin Ameliorates Lipopolysaccharide Related Acute Kidney Injury in Mice with Streptozotocin-induced Diabetes Mellitus. Int J Med Sci 2022; 19:729-739. [PMID: 35582427 PMCID: PMC9108401 DOI: 10.7150/ijms.69031] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Sepsis, which is a serious medical condition induced by infection, has been the most common cause of acute kidney injury (AKI) and is associated with high mortality and morbidity. Sodium-glucose cotransporter 2 (SGLT2) inhibitor is a new oral antidiabetic drug that has greatly improved the cardiovascular and renal outcomes in patients with type 2 diabetes independent of its sugar lowering effect, possibly by attenuation of the inflammatory process. We investigated the effect of the SGLT2 inhibitor dapagliflozin on lipopolysaccharide (LPS)-induced endotoxic shock with AKI in streptozotocin-induced diabetic mice. Endotoxin shock with AKI was induced by intravenous injection of 10 mg/kg LPS in C57BL6 mice with streptozotocin-induced diabetic mellitus with or without dapagliflozin treatment. Observation was done for 48 hours thereafter. In addition, NRK-52E cells incubated with LPS or dapagliflozin were evaluated for the possible mechanism. Treatment with dapagliflozin attenuated LPS-induced endotoxic shock associated AKI and decreased the inflammatory cytokines in diabetic mice. In the in vitro study, dapagliflozin decreased the expression of inflammatory cytokines and reactive oxygen species and increased the expressions of AMP-activated protein kinase (AMPK), nuclear factor erythroid-2-related factor, and heme oxygenase 1. These results demonstrated that dapagliflozin can attenuate LPS-induced endotoxic shock associated with AKI; this was possibly mediated by activation of the AMPK pathway.
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Affiliation(s)
- Po-Jui Chi
- Division of Nephrology, Department of Medicine, E-DA Hospital, Kaohsiung, Taiwan
- School of medicine, College of medicine, I-Shou University, Kaohsiung, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Yi-Jen Hsieh
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chia-Wen Lu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Bang-Gee Hsu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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