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Zhang Q, Zhang Q, Duan Z, Chen P, Chen JJ, Li MX, Zhang JJ, Huo YH, Zhang WX, Yang C, Zhang Y, Chen X, Cai G. External Validation of the International IgA Nephropathy Prediction Tool in Older Adult Patients. Clin Interv Aging 2024; 19:911-922. [PMID: 38799377 PMCID: PMC11127691 DOI: 10.2147/cia.s455115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose The International IgA Nephropathy Prediction Tool (IIgAN-PT) can predict the risk of End-stage renal disease (ESRD) or estimated glomerular filtration rate (eGFR) decline ≥ 50% for adult IgAN patients. Considering the differential progression between older adult and adult patients, this study aims to externally validate its performance in the older adult cohort. Patients and Methods We analyzed 165 IgAN patients aged 60 and above from six medical centers, categorizing them by their predicted risk. The primary outcome was a ≥50% reduction in estimated glomerular filtration rate (eGFR) or kidney failure. Evaluation of both models involved concordance statistics (C-statistics), time-dependent receiver operating characteristic (ROC) curves, Kaplan-Meier survival curves, and calibration plots. Comparative reclassification was conducted using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results The study included 165 Chinese patients (median age 64, 60% male), with a median follow-up of 5.1 years. Of these, 21% reached the primary outcome. Both models with or without race demonstrated good discrimination (C-statistics 0.788 and 0.790, respectively). Survival curves for risk groups were well-separated. The full model without race more accurately predicted 5-year risks, whereas the full model with race tended to overestimate risks after 3 years. No significant reclassification improvement was noted in the full model without race (NRI 0.09, 95% CI: -0.27 to 0.34; IDI 0.003, 95% CI: -0.009 to 0.019). Conclusion : Both models exhibited excellent discrimination among older adult IgAN patients. The full model without race demonstrated superior calibration in predicting the 5-year risk.
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Affiliation(s)
- Qiuyue Zhang
- Chinese PLA Medical School, Beijing, People’s Republic of China
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
- National Clinical Research Center for Kidney Diseases, Beijing, People’s Republic of China
- Beijing Key Laboratory of Kidney Diseases Research, Beijing, People’s Republic of China
| | - Qi Zhang
- Department of Nephrology, Capital Medical University Electric Power Teaching Hospital, Beijing, People’s Republic of China
| | - Zhiyu Duan
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
- National Clinical Research Center for Kidney Diseases, Beijing, People’s Republic of China
- Beijing Key Laboratory of Kidney Diseases Research, Beijing, People’s Republic of China
- Department of Nephrology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Pu Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
- National Clinical Research Center for Kidney Diseases, Beijing, People’s Republic of China
- Beijing Key Laboratory of Kidney Diseases Research, Beijing, People’s Republic of China
| | - Jing-jing Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
- National Clinical Research Center for Kidney Diseases, Beijing, People’s Republic of China
- Beijing Key Laboratory of Kidney Diseases Research, Beijing, People’s Republic of China
| | - Ming-xv Li
- Department of Nephrology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jing-jie Zhang
- Department of Nephrology, Third Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yan-hong Huo
- Department of Nephrology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Wu-xing Zhang
- Department of Nephrology, Eighth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Chen Yang
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
| | - Yu Zhang
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
- National Clinical Research Center for Kidney Diseases, Beijing, People’s Republic of China
- Beijing Key Laboratory of Kidney Diseases Research, Beijing, People’s Republic of China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
- National Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
- National Clinical Research Center for Kidney Diseases, Beijing, People’s Republic of China
- Beijing Key Laboratory of Kidney Diseases Research, Beijing, People’s Republic of China
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Nakamura M, Kameyama S, Tsuru I, Izumi T, Ono A, Teshima T, Inoue Y, Amakawa R, Inatsu H, Yoshimatsu T, Kusakabe M, Morikawa T, Shiga Y. Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy. PLoS One 2024; 19:e0303104. [PMID: 38739585 PMCID: PMC11090305 DOI: 10.1371/journal.pone.0303104] [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: 01/16/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Preservation of renal function is an important goal in renal cell carcinoma-related surgery. Although several case-dependent techniques for renal pedicle clamping and hemostasis have been used, their effects on long-term renal function are controversial. METHODS The clinical records of 114 patients who underwent off-clamp non-renorrhaphy open partial nephrectomy at our hospital were retrospectively reviewed. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors of eGFR decline 12 months post-surgery and overtime deterioration of renal function were identified using a multivariate regression analysis. RESULTS The median patient age was 65 years, and the median tumor size was 27 mm. The mean eGFR preservation at 1, 3, and 12 months post-surgery were 90.1%, 89.0%, and 86.9%, respectively. eGFR decline at 1 and 3 months were associated with poor eGFR preservation at 12 months with the odds ratio (95% confidence interval (CI)) of 1.97 and 3.157, respectively. Multivariate regression analyses revealed that tumor size was an independent predictor of eGFR decline at 12 months. Among 65 patients with eGFR preservation over 90% at 1 month post-surgery, eGFR value of 28 patients deteriorated below 90% at 12 months post-surgery compared with preoperative eGFR. Tumor size and eGFR preservation at 1 month were independent predictors of long-term renal function deterioration. CONCLUSION Tumor size predicted eGFR decline 12 months post-surgery. Only a mild decline in eGFR was observed between 3 and 12 months after open partial nephrectomy. Tumor size and eGFR preservation at 1 month predicted the deterioration of renal function over time.
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Affiliation(s)
- Masaki Nakamura
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Shuji Kameyama
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ibuki Tsuru
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Taro Izumi
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Akihiro Ono
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Taro Teshima
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yasushi Inoue
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ryo Amakawa
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Hiroki Inatsu
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | | | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoshiyuki Shiga
- Department of Urology, NTT Medical Center Tokyo, Tokyo, Japan
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Kim M, Han K, Joo KW, Cho JM, Lee S, Kim Y, Cho S, Huh H, Kim SG, Kang E, Kim DK, Park S. Cardiovascular and Mortality Risks in Young Health Screening Examinees With Marginal Estimated GFR. Kidney Int Rep 2023; 8:2709-2719. [PMID: 38106592 PMCID: PMC10719598 DOI: 10.1016/j.ekir.2023.09.008] [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: 01/04/2023] [Revised: 06/07/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Additional evidence is necessary to interpret kidney function parameters in young adults, particularly in those with marginal estimated glomerular filtration rate (eGFR) values. Therefore, we aimed to investigate the association between eGFR and adverse outcomes in general young adults. Methods We performed a nationwide retrospective cohort study using the health-screening database of South Korea. We included young adults aged 20-39 years without a history of major adverse cardiovascular events (MACE) or kidney failure, who underwent nationwide health screening in 2012. The study exposure was eGFR categorized into 15 ml/min per 1.73 m2 intervals. The risks of all-cause mortality and MACE were calculated using Cox regression analysis, adjusted for various clinicodemographic characteristics. Results In total, 3,132,409 young adults were included in this study. During a median follow-up of 7.3 years, marginal eGFR (60-75 ml/min per 1.73 m2) was not significantly associated with a higher risk of all-cause mortality (adjusted hazard ratio [aHR], 0.80 [0.74-0.87]). The results were similar for MACE outcomes (aHR, 0.94 [0.87-1.01]). Although the presence of dipstick albuminuria had a significant interaction with the association between eGFR categories and all-cause mortality (interaction term P = 0.028), the risks of all-cause mortality were not significantly higher (aHR, 0.98 [0.62, 1.55]) in those with albuminuria and eGFR 60-75 ml/min per 1.73 m2. Conclusion Marginal eGFR was not associated with higher risks of all-cause mortality and MACE in general young adults. Additional clinical investigations for incidentally found marginal eGFR values may be discouraged in general young adults.
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Affiliation(s)
- Minsang Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Jeong Min Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Semin Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Korea
| | - Hyuk Huh
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Seong Geun Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Sehoon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Wei L, Shen X, Zhang J, Yong Z, Zhang Q, Zhao W. Different equations for estimating age-related changes of glomerular filtration rate in the healthy population. BMC Nephrol 2023; 24:342. [PMID: 37978461 PMCID: PMC10657123 DOI: 10.1186/s12882-023-03397-7] [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: 05/15/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Identifying age-related trend of estimated glomerular filtration rate (eGFR) is necessary to assess whether kidney function is healthily aging. This study aimed to investigate the application of CKD-EPI, FAS, and Xiangya equations for the aging estimation of eGFR in the healthy Chinese individuals. METHODS A total of 36,911 healthy individuals were enrolled in this study. We grouped every ten years to observe the trend of eGFR with aging and investigated decline rate of it by general linear regression analysis in each age-groups. Agreement between equations was determined by intraclass correlation coefficient (ICC) and Bland-Altman plot. We calculated reference interval in each age-group. We further analyzed above statistical indicators in males and females. RESULTS The eGFR by CKD-EPI, and Xiangya equation started to decline from the age of 18. Whereas eGFR by FAS equation remained stable under 40 years, then decreased more rapidly. Compared with males, the females had a higher level but a faster decline rate of eGFR with aging. Agreement analysis revealed good agreement between CKD-EPI and FAS equations (ICC 0.818-0.920). Agreement between Xiangya and CKD-EPI or FAS equations was poor to moderate in most of the population under 70 years old (ICC 0.282-0.786), but good in individuals above 70 years (ICC 0.769-0.881). CONCLUSIONS The trend of eGFR with aging was different by CKD-EPI, FAS, and Xiangya equations in the healthy Chinese. It may be necessary to take these equations- or age-related differences into consideration when assessing kidney function in primary health care and clinical practice.
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Affiliation(s)
- Lu Wei
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Xue Shen
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Juan Zhang
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Zhenzhu Yong
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Qun Zhang
- Department of Health Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weihong Zhao
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Yan R, Zhang C, Wang C, Sun Z, Peng X. Evaluation of glomerular filtration rate estimation equations based on serum creatinine in healthy Chinese children and adolescents: a nationwide cross-sectional study. BMJ Paediatr Open 2023; 7:e002132. [PMID: 37827805 PMCID: PMC10582894 DOI: 10.1136/bmjpo-2023-002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Several equations for glomerular filtration rate (GFR) estimation based on serum creatinine (SCr) have been proposed for children, but most were developed among patients with kidney disease. The association between SCr and GFR may be distorted by kidney dysfunction and thus not applicable to healthy children. This study aimed to evaluate the applicability of existing SCr-based GFR estimation equations in healthy Chinese children. METHODS GFR estimation equations that developed in healthy children were mainly analysed, including the Flanders Metadata (FM), simple height-independent (Simple), full age spectrum (FAS) and FAS-height equations. The FM equation assumed that GFR is proportional to the ratio of height to SCr. The Simple, FAS and FAS-height equations assumed that the ratio of GFR to population mean is equal to the reciprocal ratio of SCr to population mean (denoted by Q). Estimated GFR were calculated using data of SCr, age, sex and height collected from 12 208 healthy Chinese children aged 3 months to <20 years. The performance of GFR estimation equations was evaluated by the sex and age distribution of the estimated GFR and the deviation from the measured GFR reported by other literatures. RESULTS The FM and Simple equations performed well in their applicable age of 1 month to 14 years, but presented undesirable sex difference after adolescence. The FAS and FAS-height equations showed reasonable development trend of estimated GFR throughout childhood, and the FAS equation had higher consistency than the FAS-height equation compared with measured GFR in healthy children. The GFR estimated by the FAS equation increased with age before 2 years, and reached the adult level thereafter without important sex difference. CONCLUSIONS The FAS equation is applicable to healthy Chinese children.
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Affiliation(s)
- Ruohua Yan
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Chao Zhang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Chen Wang
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Zimo Sun
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Health, Beijing, China
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Peng W, Gu H, Cheng D, Chen K, Wu C, Jiang C, Liu J, Peng S, Fu L. Tenofovir alafenamide versus entecavir for treating hepatitis B virus-related acute-on-chronic liver failure: real-world study. Front Microbiol 2023; 14:1185492. [PMID: 37303805 PMCID: PMC10249370 DOI: 10.3389/fmicb.2023.1185492] [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: 03/13/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
Background and aims Real-world data regarding hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients receiving tenofovir alafenamide (TAF) as an antiviral drug are limited. Hence, we evaluated the efficacy and kidney safety of TAF among this population. Methods A total of 272 HBV-related ACLF patients hospitalized at Xiangya Hospital of Central South University were enrolled in this retrospective research. All patients received antiviral therapy with TAF (n = 100) or ETV (n = 172) and comprehensive medical treatments. Results Through 1:1 propensity score matching, 100 patients were finally included in each group. At week 48, the survival rates without transplantation of the TAF group and ETV group were 76.00 and 58.00%, separately (P = 0.007). After 4 weeks of treatment, the TAF treatment group exhibited a significantly decline in HBV DNA viral load (P = 0.029). The mean estimated glomerular filtration rate was apparently improved in the TAF group compared with the ETV group (TAF 5.98 ± 14.46 vs. ETV 1.18 ± 18.07 ml/min/1.73 m2) (P < 0.05). There were 6 patients in TAF group and 21 patients in ETV group with chronic kidney disease (CKD) stage progression ≥ 1. By contrast, the ETV treatment group has a greater risk of renal function progression in CKD 1 stage patients (P < 0.05). Conclusion This real-world clinical study showed that TAF is more effective than ETV in reducing viral load and improving survival rate in HBV-ACLF patients and the risk of renal function decline is lower. Clinical trial registration https://ClinicalTrials.gov, identifier NCT05453448.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lei Fu
- *Correspondence: Lei Fu, ; orcid.org/0001-7550-1254
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Shen Z, Wang R, He P, Zhang Z, Dai Y, Li M, Liu Z, Yang H, Guan S, Sun J. Association between urinary metal concentrations and abnormal estimated glomerular filtration rate in Chinese community-dwelling elderly: Exploring the mediating effect of triglycerides. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 259:114966. [PMID: 37182299 DOI: 10.1016/j.ecoenv.2023.114966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Environmental metal exposure is associated with elevated triglycerides (TG) and the development of chronic kidney disease (CKD). However, the relationship between metal exposure and glomerular filtration rate (GFR) remains uncertain, and the mediating effect of TG between the two is unclear. METHODS This study measured the concentrations of 14 metals in urine samples from 3752 elderly people in the community. The most relevant metals were screened by least absolute shrinkage and selection operator (LASSO) regression. The relationship between combined exposure to multiple metals and abnormal estimated glomerular filtration rate (eGFR) was explored using multivariate logistic regression analysis and Bayesian kernel machine regression (BKMR) analysis. Generalized linear regression models and the Karlson-Holm-Green (KHB) method were used to assess the mediating effects of TG. RESULTS In the single-metal model, calcium (Ca), iron (Fe), selenium (Se), strontium (Sr), and thallium (Tl) showed significant negative correlations with the prevalence of abnormal eGFR (all P < 0.05). In the multi-metals model, Ca, Se, and Tl continued to show significant negative correlations, while vanadium (V) and zinc (Zn) showed significant positive correlations with abnormal eGFR (all P < 0.05). The BKMR model showed a negative joint effect of the mixture of Ca, V, Zn, Se, and Tl on the prevalence of abnormal eGFR. The generalized linear regression model showed a significant positive correlation between the concentrations of Ca (β = 0.07), Zn (β = 0.07), Se (β = 0.09), and TG levels (all P < 0.05). In the mediation analysis, TG masked a 4.30% and 5.21% correlation between Ca and Se and the prevalence of eGFR abnormalities, respectively. CONCLUSIONS Urinary concentration of multiple metals is significantly associated with eGFR abnormalities, and Ca, and Se may be among the potential protective factors. TG masked some of the protective effects of Ca and Se.
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Affiliation(s)
- Zhuoheng Shen
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Rui Wang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Pei He
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Zhongyuan Zhang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Yuqing Dai
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Meiyan Li
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Zhihong Liu
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Huifang Yang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Suzhen Guan
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China.
| | - Jian Sun
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China.
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Gama RM, Griffiths K, Vincent RP, Peters AM, Bramham K. Performance and pitfalls of the tools for measuring glomerular filtration rate to guide chronic kidney disease diagnosis and assessment. J Clin Pathol 2023:jcp-2023-208887. [PMID: 37164629 DOI: 10.1136/jcp-2023-208887] [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: 03/15/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
Accurate diagnosis, classification and risk stratification for chronic kidney disease (CKD) allow for early recognition and delivering optimal care. Creatinine-based glomerular filtration rate (GFR), urinary albumin: creatinine ratio (UACR) and the kidney failure risk equation (KFRE) are important tools to achieve this, but understanding their limitations is important for optimal implementation.When accurate GFR is required (eg, chemotherapy dosing), GFR is measured using an exogenous filtration marker. In routine clinical practice, in contrast, estimated GFR (eGFR) from serum creatinine (SCr), calculated using the enzymatic method±UACR, is recommended. Limitations of SCr include non-GFR determinants such as muscle mass, diet and tubular handling. An alternative or additional endogenous filtration marker is cystatin C, which can be used alongside SCr for confirmatory testing of CKD. However, its role in the UK is more limited due to concerns regarding false positive results.The recommended creatinine-based eGFR equation in the UK is the CKD Epidemiology Collaboration 2009 equation. This was recently updated to a race-neutral 2021 version and demonstrated reduced bias in people of Black ethnicity, but has not been validated in the UK. Limitations are extremes of age, inaccuracy at greater GFRs and reduced generalisability to under-represented ethnicity groups.The KFRE (based on age, sex, SCr and UACR) has recently been developed to help determine 2-year and 5-year risk of progression to end-stage kidney disease. It has been validated in over 30 countries and provides meaningful quantitative information to patients. However, supporting evidence for their performance in ethnic minority groups and kidney diseases such as glomerulonephritis remains modest.In conclusion, early identification, risk stratification of kidney disease and timely intervention are important to impact kidney disease progression. However, clinician awareness of the limitations and variability of creatinine, cystatin C and the eGFR equations, is key to appropriate interpretation of results.
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Affiliation(s)
- Rouvick M Gama
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's Kidney Care, King's College Hospital, London, UK
| | - Kathryn Griffiths
- King's Kidney Care, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Synnovis), King's College Hospital, London, UK
- Department of Nutrition and Dietetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Adrien Michael Peters
- Department of Nuclear Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Kate Bramham
- King's Kidney Care, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Xia F, Hao W, Liang J, Zhao Z, Wu Y, Yu F, Hu W, Fang X, Liu W. Comparison of estimated glomerular filtration rate equations based on serum creatinine-, cystatin C- and creatinine-cystatin C in elderly Chinese patients. Int Urol Nephrol 2023; 55:943-952. [PMID: 36169900 DOI: 10.1007/s11255-022-03370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND This study aimed to further evaluate the accuracy of eleven GFR equations in different subgroups of an elderly Chinese hospitalized population. METHODS All participants of the study were divided into seven separate groups including age-subgroup, sex-subgroup, GFR Staging-subgroup and whether combined with diabetic, hypertensive, coronary heart disease (CHD) and cerebrovascular disease. Referring to Tc-99m-DTPA dual plasma sample clearance method, six serum creatinine (Cr)-based [Cockcroft-Gault (CG), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr), Lund-Malmö Revised (LMR), Berlin Initiative Study (BIS1), Full Age Spectrum (FASCr) and European Kidney Function Consortium (EKFC)], two serum cystatin C(Cys)-based (CKD-EPICys and FASCys), and three Cr-Cys combination based (CKD-EPICr-Cys, BIS2 and FASCr-Cys) equations were employed. Bias, interquartile range of the median difference (IQR), P30, and GFR misclassification rate were calculated to compare the performance of the selected equations. RESULTS A total of 359 elderly Chinese patients were enrolled. Overall, median mGFR was 36.91(25.26,56.32)ml/min/1.73 m2. Smaller biases (ml/min/1.73 m2) were shown in CKD-EPICr and BIS1 equations (0.75 and 0.61). IQR (ml/min/1.73m2) was least with BIS2 equation and FASCr-Cys equation (10.34 and 10.65). For accuracy (P30), performance of FASCr-Cys, BIS2, and BIS1 equation was superior (78.3%, 78.0%, and 74.7%, respectively). In terms of RMSE (ml/min/1.73 m2), BIS1 and FASCr-Cys equation performed better (12.44 and 12.51). CONCLUSIONS Overall, this study showed that the eGFR equations were less accurate in the diabetic and non-hypertension group than in the non-diabetic and hypertension group, respectively. Among all enrolled equations, the BIS2 and FASCr-Cys equations might be the best choice to evaluate glomerular filtration rate in Chinese elderly patients.
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Affiliation(s)
- Fangxiao Xia
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Wenke Hao
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Jinxiu Liang
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Zhi Zhao
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Yanhua Wu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Feng Yu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wenxue Hu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Xiaowu Fang
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wei Liu
- Department of Geriatric Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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10
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Campbell DJ, Magliano DJ, Shaw JE. Prediction of cardiovascular death and non-fatal cardiovascular events by the Kidney age-Chronological age Difference (KCD) score in men and women of different ages in a community-based cohort. BMJ Open 2023; 13:e068494. [PMID: 36882235 PMCID: PMC10008409 DOI: 10.1136/bmjopen-2022-068494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE We examined the utility of the Kidney age-Chronological age Difference (KCD) score, an age-adapted measure of kidney function, to identify increased cardiovascular (CV) death or non-fatal CV event risk in participants of the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), a community-based cohort aged 23-95 years. DESIGN Cohort study. SETTING Community. PARTICIPANTS 11205 randomly selected participants from urban and nonurban areas across Australia. OUTCOME MEASURES Mortality status and underlying and contributory causes of death obtained from the Australian National Death Index, and non-fatal CV events from adjudicated hospital records. The association of CV death or non-fatal CV event risk with KCD score was examined using penalised spline curve analysis. RESULTS Of 11 180 participants with serum creatinine measurement at baseline and 5-year outcome data, there were 308 CV deaths or non-fatal CV events after 5 years. Penalised spline curve analysis showed similar progressive increase in CV death or non-fatal CV event risk with increasing KCD score in men and women, and participants aged <50 years to ≥80 years. Receiver operating characteristic curve analysis showed optimal discrimination at a KCD score ≥20 years (KCD20) for all participants. Among 148 participants aged<70 years with CV death or non-fatal CV event, KCD20 identified 24 (16%) participants, whereas estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 identified 8 (5%) participants (p=0.0001), with specificities of 95% and 99%, respectively (p<0.0001). CONCLUSION KCD20 predicted CV death or non-fatal CV event risk similarly in men and women of different ages in this population-based cohort. The higher sensitivity for prediction of CV death or non-fatal CV event risk in participants aged <70 years by KCD20 than by eGFR <60 mL/min/1.73 m2 offers opportunity for earlier renoprotective therapy in individuals with eGFR-associated increased CV death or non-fatal CV event risk.
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Affiliation(s)
- Duncan J Campbell
- Department of Molecular Cardiology, St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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11
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Pottel H, Adebayo OC, Nkoy AB, Delanaye P. Glomerular hyperfiltration: part 1 - defining the threshold - is the sky the limit? Pediatr Nephrol 2022:10.1007/s00467-022-05827-4. [PMID: 36459244 DOI: 10.1007/s00467-022-05827-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/27/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022]
Abstract
Glomerular hyperfiltration (GHF) is an increase in single-nephron glomerular filtration rate (GFR) that occurs in both physiological states and pathological states. Whole-kidney GHF is often used as a surrogate for single-nephron hyperfiltration since determining single-nephron GFR is impossible in routine clinical care. A clear definition (read threshold) of GHF is lacking. The aim of the first part of this review was to find evidence for defining the threshold for GHF, based on literature review, including systematic reviews and meta-analysis data, with both measured and estimated GFR. The consensus pediatric threshold for GHF as obtained from reviews, measured and estimated GFR studies, can reliably be set to 135 mL/min/1.73 m2 for children aged > 2 years. Diagnosing GHF from SCr-based estimated GFR is not reliable in subjects with reduced muscle mass. In these cases, it could be of interest to confirm the state of GHF using cystatin C-based eGFR, or preferably, by measured GFR, using methods that are accurate in the high GFR-range.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium.
| | - Oyindamola C Adebayo
- Center of Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Agathe B Nkoy
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
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12
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Recommendations for living donor kidney transplantation. Nefrologia 2022; 42 Suppl 2:5-132. [PMID: 36503720 DOI: 10.1016/j.nefroe.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023] Open
Abstract
This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.
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Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain.
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Carey LI, Kaimba S, Nyirenda S, Chetcuti K, Joekes E, Henrion MYR, Rylance J. Prospective cohort study to identify prevalence, risk factors and outcomes of infection associated kidney disease in a regional hospital in Malawi. BMJ Open 2022; 12:e065649. [PMID: 36442901 PMCID: PMC9710333 DOI: 10.1136/bmjopen-2022-065649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Acute kidney injury (AKI) is a common and severe complication of community acquired infection, but data on impact in sub-Saharan Africa (SSA) are lacking. We determined prevalence, risk factors and outcomes of infection associated kidney disease in adults in Malawi. DESIGN A prospective cohort study of adults admitted to hospital with infection, from February 2021 to June 2021, collecting demographic, clinical, laboratory and ultrasonography data. SETTING Adults admitted to a regional hospital in Southern Region, Malawi. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were prevalence of kidney disease and mortality by Cox proportional hazard model. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Secondary outcomes were risk factors for AKI identified by logistic regression and prevalence of chronic kidney disease at 3 months. RESULTS We recruited 101 patients presenting to hospital with infection. Median age was 38 years (IQR: 29-48 years), 88 had known HIV status of which 53 (60%) were living with HIV, and of these 42 (79%) were receiving antiretroviral therapy. AKI was present in 33/101 at baseline, of which 18/33 (55%) cases were severe (KDIGO stage 3). At 3 months, 28/94 (30%) participants had died, while 7/61 (11%) of survivors had chronic kidney disease. AKI was associated with older age (age: 60 years vs 40 years, OR: 3.88, 95% CI 1.82 to 16.64), and HIV positivity (OR: 4.08, 95% CI 1.28 to 15.67). Living with HIV was independently associated with death (HR: 3.97, 95% CI 1.07 to 14.69). CONCLUSIONS Kidney disease is common among hospitalised adults with infection in Malawi, with significant kidney impairment identified at 3 months. Our study highlights the difficulty in diagnosing acute and chronic kidney disease, and the need for more accurate methods than creatinine based estimated glomerular filtration rate (eGFR) equations for populations in Africa. Patients with kidney impairment identified in hospital should be prioritised for follow-up.
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Affiliation(s)
- Laura Isobel Carey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Bristol Renal, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sylvester Kaimba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Saulos Nyirenda
- Department of Medicine, Zomba Central Hospital, Zomba, Malawi
| | - Karen Chetcuti
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Worldwide Radiology, Liverpool, UK
| | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Worldwide Radiology, Liverpool, UK
| | - Marc Yves Romain Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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14
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Oliva-Damaso N, Delanaye P, Oliva-Damaso E, Payan J, Glassock RJ. Risk-based versus GFR threshold criteria for nephrology referral in chronic kidney disease. Clin Kidney J 2022; 15:1996-2005. [PMID: 36325015 PMCID: PMC9613424 DOI: 10.1093/ckj/sfac104] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 02/22/2024] Open
Abstract
Chronic kidney disease (CKD) and kidney failure are global health problems associated with morbidity, mortality and healthcare costs, with unequal access to kidney replacement therapy between countries. The diversity of guidelines concerning referral from primary care to a specialist nephrologist determines different outcomes around the world among patients with CKD where several guidelines recommend referral when the glomerular filtration rate (GFR) is <30 mL/min/1.73 m2 regardless of age. Additionally, fixed non-age-adapted diagnostic criteria for CKD that do not distinguish correctly between normal kidney senescence and true kidney disease can lead to overdiagnosis of CKD in the elderly and underdiagnosis of CKD in young patients and contributes to the unfair referral of CKD patients to a kidney specialist. Non-age-adapted recommendations contribute to unnecessary referral in the very elderly with a mild disease where the risk of death consistently exceeds the risk of progression to kidney failure and ignore the possibility of effective interventions of a young patient with long life expectancy. The opportunity of mitigating CKD progression and cardiovascular complications in young patients with early stages of CKD is a task entrusted to primary care providers who are possibly unable to optimally accomplish guideline-directed medical therapy for this purpose. The shortage in the nephrology workforce has classically led to focused referral on advanced CKD stages preparing for kidney replacement, but the need for hasty referral to a nephrologist because of the urgent requirement for kidney replacement therapy in advanced CKD is still observed and changes are required to move toward reducing the kidney failure burden. The Kidney Failure Risk Equation (KFRE) is a novel tool that can guide wiser nephrology referrals and impact patients.
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Affiliation(s)
- Nestor Oliva-Damaso
- Department of Medicine, Division of Nephrology, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liege, Centre Hospitalier Universitaire Sart Tilman, ULgCHU, Liege, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Elena Oliva-Damaso
- Department of Medicine, Division of Nephrology, Hospital Universitario Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | - Juan Payan
- Department of Medicine, Division of Nephrology, Hospital Costa del Sol, Marbella, Malaga, Spain
| | - Richard J Glassock
- Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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15
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Melsom T, Norvik JV, Enoksen IT, Stefansson V, Mathisen UD, Fuskevåg OM, Jenssen TG, Solbu MD, Eriksen BO. Sex Differences in Age-Related Loss of Kidney Function. J Am Soc Nephrol 2022; 33:1891-1902. [PMID: 35977806 PMCID: PMC9528336 DOI: 10.1681/asn.2022030323] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND CKD is more prevalent in women, but more men receive kidney replacement therapy for kidney failure. This apparent contradiction is not well understood. METHODS We investigated sex differences in the loss of kidney function and whether any sex disparities could be explained by comorbidity or CKD risk factors. In the Renal Iohexol Clearance Survey (RENIS) in northern Europe, we recruited 1837 persons (53% women, aged 50-62 years) representative of the general population and without self-reported diabetes, CKD, or cardiovascular disease. Participants' GFR was measured by plasma iohexol clearance in 2007-2009 (n=1627), 2013-2015 (n=1324), and 2018-2020 (n=1384). At each study visit, healthy persons were defined as having no major chronic diseases or risk factors for CKD. We used generalized additive mixed models to assess age- and sex-specific GFR decline rates. RESULTS Women had a lower GFR than men at baseline (mean [SD], 90.0 [14.0] versus 98.0 [13.7] ml/min per 1.73 m2; P<0.001). The mean GFR change rate was -0.96 (95% confidence interval [CI], -0.88 to -1.04) ml/min per 1.73 m2 per year in women and -1.20 (95% confidence interval [CI], -1.12 to -1.28) in men. Although the relationship between age and GFR was very close to linear in women, it was curvilinear in men, with steeper GFR slopes at older ages (nonlinear effect; P<0.001). Healthy persons had a slower GFR decline, but health status did not explain the sex difference in the GFR decline. CONCLUSION Among middle-aged and elderly individuals in the general population, decline in the mean GFR in women was slower than in men, independent of health status.
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Affiliation(s)
- Toralf Melsom
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Jon Viljar Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Vidar Stefansson
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | | | - Ole Martin Fuskevåg
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Trond G. Jenssen
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
- Department of Transplant Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marit D. Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
| | - Bjørn O. Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT Arctic University of Norway, Tromsø, Norway
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16
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Noronha IL, Santa-Catharina GP, Andrade L, Coelho VA, Jacob-Filho W, Elias RM. Glomerular filtration in the aging population. Front Med (Lausanne) 2022; 9:769329. [PMID: 36186775 PMCID: PMC9519889 DOI: 10.3389/fmed.2022.769329] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/24/2022] [Indexed: 12/11/2022] Open
Abstract
In the last decades, improvements in the average life expectancy in the world population have been associated with a significant increase in the proportion of elderly people, in parallel with a higher prevalence of non-communicable diseases, such as hypertension and diabetes. As the kidney is a common target organ of a variety of diseases, an adequate evaluation of renal function in the approach of this population is of special relevance. It is also known that the kidneys undergo aging-related changes expressed by a decline in the glomerular filtration rate (GFR), reflecting the loss of kidney function, either by a natural senescence process associated with healthy aging or by the length of exposure to diseases with potential kidney damage. Accurate assessment of renal function in the older population is of particular importance to evaluate the degree of kidney function loss, enabling tailored therapeutic interventions. The present review addresses a relevant topic, which is the effects of aging on renal function. In order to do that, we analyze and discuss age-related structural and functional changes. The text also examines the different options for evaluating GFR, from the use of direct methods to the implementation of several estimating equations. Finally, this manuscript supports clinicians in the interpretation of GFR changes associated with age and the management of the older patients with decreased kidney function.
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Affiliation(s)
- Irene L. Noronha
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Cellular, Genetic and Molecular Nephrology, University of São Paulo Medical School, São Paulo, Brazil
- *Correspondence: Irene L. Noronha
| | | | - Lucia Andrade
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Venceslau A. Coelho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rosilene M. Elias
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
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Zafarnejad R, Dumbauld S, Dumbauld D, Adibuzzaman M, Griffin P, Rutsky E. Using CUSUM in real time to signal clinically relevant decreases in estimated glomerular filtration rate. BMC Nephrol 2022; 23:287. [PMID: 35982411 PMCID: PMC9389810 DOI: 10.1186/s12882-022-02910-8] [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: 04/05/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background The electronic health record (EHR), utilized to apply statistical methodology, assists provider decision-making, including during the care of chronic kidney disease (CKD) patients. When estimated glomerular filtration (eGFR) decreases, the rate of that change adds meaning to a patient’s single eGFR and may represent severity of renal injury. Since the cumulative sum chart technique (CUSUM), often used in quality control and surveillance, continuously checks for change in a series of measurements, we selected this statistical tool to detect clinically relevant eGFR decreases and developed CUSUMGFR. Methods In a retrospective analysis we applied an age adjusted CUSUMGFR, to signal identification of eventual ESKD patients prior to diagnosis date. When the patient signaled by reaching a specified threshold value, days from CUSUM signal date to ESKD diagnosis date (earliness days) were measured, along with the corresponding eGFR measurement at the signal. Results Signaling occurred by CUSUMGFR on average 791 days (se = 12 days) prior to ESKD diagnosis date with sensitivity = 0.897, specificity = 0.877, and accuracy = .878. Mean days prior to ESKD diagnosis were significantly greater in Black patients (905 days) and patients with hypertension (852 days), diabetes (940 days), cardiovascular disease (1027 days), and hypercholesterolemia (971 days). Sensitivity and specificity did not vary by sociodemographic and clinical risk factors. Conclusions CUSUMGFR correctly identified 30.6% of CKD patients destined for ESKD when eGFR was > 60 ml/min/1.73 m2 and signaled 12.3% of patients that did not go on to ESKD (though almost all went on to later-stage CKD). If utilized in an EHR, signaling patients could focus providers’ efforts to slow or prevent progression to later stage CKD and ESKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02910-8.
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Affiliation(s)
- Reyhaneh Zafarnejad
- Department of Industrial Engineering, Penn State University, 310 Leonhard Bldg., University Park, PA, 16803, USA
| | - Steven Dumbauld
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
| | | | - Mohammad Adibuzzaman
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, OR, USA
| | - Paul Griffin
- Department of Industrial Engineering, Penn State University, 310 Leonhard Bldg., University Park, PA, 16803, USA.
| | - Edwin Rutsky
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Ali A. Living Kidney Donation: Glomerular Filtration Rate-Based Donor Selection Criteria. EXP CLIN TRANSPLANT 2022; 20:65-69. [DOI: 10.6002/ect.donorsymp.2022.o5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Denic A, Rule AD, Glassock RJ. Healthy and unhealthy aging on kidney structure and function: human studies. Curr Opin Nephrol Hypertens 2022; 31:228-234. [PMID: 35067600 PMCID: PMC9035051 DOI: 10.1097/mnh.0000000000000780] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review is intended to provide an up-to-date analysis of the structural and functional alterations of the kidneys that accompany healthy and unhealthy aging in humans. Macro- and micro- structural changes and glomerular filtration rate (whole kidney and single nephron) accompanying aging will be stressed. RECENT FINDINGS Comparative findings concerning distribution of anatomic changes of the kidney healthy and unhealthy aging are reviewed. Challenges concerning definition of chronic kidney disease (CKD) in otherwise healthy aging patients are discussed. The complex interactions of CKD and aging are discussed. The role of podocyte dysbiosis in kidney aging is reviewed. SUMMARY Kidney aging is a complex phenomenon often difficult to distinguish from CKD. Nonetheless, phenotypes of healthy and unhealthy aging are evident. Much more information concerning the molecular characteristics of normal kidney aging and its relevance to chronic kidney disease is needed.
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Affiliation(s)
- Aleksandar Denic
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Andrew D. Rule
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Richard J. Glassock
- Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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20
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Adler J, Taneva E, Ansorge T, Mertens PR. CKD prevalence based on real-world data: continuous age-dependent lower reference limits of eGFR with CKD-EPI, FAS and EKFC algorithms. Int Urol Nephrol 2022; 54:2929-2937. [PMID: 35482140 PMCID: PMC9534803 DOI: 10.1007/s11255-022-03210-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/09/2022] [Indexed: 12/01/2022]
Abstract
Purpose Several recent articles discuss the need for a definition of chronic kidney disease (CKD) that embarks age-dependency and its impact on the prevalence of CKD. The relevance is derived from the common knowledge that renal function declines with age. The aim of this study was to calculate age-dependent eGFR lower reference limits and to consider their impact on the prevalence of CKD. Methods A real-world data set from patients with inconspicuous urinalysis was used to establish two quantile regression models which were used to calculate continuous age-dependent lower reference limits of CKD–EPI, FAS and EKFC–eGFR based on either single eGFR determinations or eGFR values that are stable over a period of at least 3 months (± 10% eGFR). The derived lower reference limits were used to calculate the prevalence of CKD in a validation data set. Prevalence calculation was done once without and once with application of the chronicity criterion. Results Both models yielded age-dependent lower reference limits of eGFR that are comparable to previously published data. The model using patients with stable eGFR resulted in higher eGFR reference limits. By applying the chronicity criterion, a lower prevalence of CKD was calculated when compared to one-time eGFR measurements (CKD–EPI: 9.8% vs. 8.3%, FAS: 8.0% vs. 7.2%, EKFC: 9.0% vs. 7.1%). Conclusion The application of age-dependent lower reference intervals of eGFR together with the chronicity criterion result in a lower prevalence of CKD which supports the estimates of recently published work and the idea of introducing age-dependency into the definition of CKD.
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Affiliation(s)
- Jakob Adler
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues", Schwiesaustr. 11, 39124, Magdeburg, Germany
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-Von-Guericke-University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Elina Taneva
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues", Schwiesaustr. 11, 39124, Magdeburg, Germany
| | - Thomas Ansorge
- Medical Laboratory for Clinical Chemistry, Microbiology, Infectious Diseases and Genetics "Prof. Schenk/Dr. Ansorge & Colleagues", Schwiesaustr. 11, 39124, Magdeburg, Germany
| | - Peter R Mertens
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-Von-Guericke-University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany.
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21
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Recomendaciones para el trasplante renal de donante vivo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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22
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Bjornstad EC, Cutter G, Guru P, Menon S, Aldana I, House S, M Tofil N, St Hill CA, Tarabichi Y, Banner-Goodspeed VM, Christie AB, Mohan SK, Sanghavi D, Mosier JM, Vadgaonkar G, Walkey AJ, Kashyap R, Kumar VK, Bansal V, Boman K, Sharma M, Bogojevic M, Deo N, Retford L, Gajic O, Gist KM. SARS-CoV-2 infection increases risk of acute kidney injury in a bimodal age distribution. BMC Nephrol 2022; 23:63. [PMID: 35144572 PMCID: PMC8831033 DOI: 10.1186/s12882-022-02681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/18/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hospitalized patients with SARS-CoV2 develop acute kidney injury (AKI) frequently, yet gaps remain in understanding why adults seem to have higher rates compared to children. Our objectives were to evaluate the epidemiology of SARS-CoV2-related AKI across the age spectrum and determine if known risk factors such as illness severity contribute to its pattern. METHODS Secondary analysis of ongoing prospective international cohort registry. AKI was defined by KDIGO-creatinine only criteria. Log-linear, logistic and generalized estimating equations assessed odds ratios (OR), risk differences (RD), and 95% confidence intervals (CIs) for AKI and mortality adjusting for sex, pre-existing comorbidities, race/ethnicity, illness severity, and clustering within centers. Sensitivity analyses assessed different baseline creatinine estimators. RESULTS Overall, among 6874 hospitalized patients, 39.6% (n = 2719) developed AKI. There was a bimodal distribution of AKI by age with peaks in older age (≥60 years) and middle childhood (5-15 years), which persisted despite controlling for illness severity, pre-existing comorbidities, or different baseline creatinine estimators. For example, the adjusted OR of developing AKI among hospitalized patients with SARS-CoV2 was 2.74 (95% CI 1.66-4.56) for 10-15-year-olds compared to 30-35-year-olds and similarly was 2.31 (95% CI 1.71-3.12) for 70-75-year-olds, while adjusted OR dropped to 1.39 (95% CI 0.97-2.00) for 40-45-year-olds compared to 30-35-year-olds. CONCLUSIONS SARS-CoV2-related AKI is common with a bimodal age distribution that is not fully explained by known risk factors or confounders. As the pandemic turns to disproportionately impacting younger individuals, this deserves further investigation as the presence of AKI and SARS-CoV2 infection increases hospital mortality risk.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 516, Birmingham, AL, 35233, USA.
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Shina Menon
- Seattle Children's Hospital, Seattle, WA, USA
| | - Isabella Aldana
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 516, Birmingham, AL, 35233, USA
| | - Scott House
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 516, Birmingham, AL, 35233, USA
| | - Nancy M Tofil
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine A St Hill
- Allina Health (Abbott Northwestern Hospital, United Hospital, Mercy Hospital), Minneapolis, MN, USA
| | | | | | | | | | | | - Jarrod M Mosier
- University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | | | | | | | | | | | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, IL, USA
| | | | | | | | - Lynn Retford
- Society of Critical Care Medicine, Mount Prospect, IL, USA
| | | | - Katja M Gist
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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23
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Georas SN, Wright RJ, Ivanova A, Israel E, LaVange LM, Akuthota P, Carr TF, Denlinger LC, Fajt ML, Kumar R, O'Neal WK, Phipatanakul W, Szefler SJ, Aronica MA, Bacharier LB, Burbank AJ, Castro M, Crotty Alexander L, Bamdad J, Cardet JC, Comhair SAA, Covar RA, DiMango EA, Erwin K, Erzurum SC, Fahy JV, Gaffin JM, Gaston B, Gerald LB, Hoffman EA, Holguin F, Jackson DJ, James J, Jarjour NN, Kenyon NJ, Khatri S, Kirwan JP, Kraft M, Krishnan JA, Liu AH, Liu MC, Marquis MA, Martinez F, Mey J, Moore WC, Moy JN, Ortega VE, Peden DB, Pennington E, Peters MC, Ross K, Sanchez M, Smith LJ, Sorkness RL, Wechsler ME, Wenzel SE, White SR, Zein J, Zeki AA, Noel P. The Precision Interventions for Severe and/or Exacerbation-Prone (PrecISE) Asthma Network: An overview of Network organization, procedures, and interventions. J Allergy Clin Immunol 2022; 149:488-516.e9. [PMID: 34848210 PMCID: PMC8821377 DOI: 10.1016/j.jaci.2021.10.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022]
Abstract
Asthma is a heterogeneous disease, with multiple underlying inflammatory pathways and structural airway abnormalities that impact disease persistence and severity. Recent progress has been made in developing targeted asthma therapeutics, especially for subjects with eosinophilic asthma. However, there is an unmet need for new approaches to treat patients with severe and exacerbation-prone asthma, who contribute disproportionately to disease burden. Extensive deep phenotyping has revealed the heterogeneous nature of severe asthma and identified distinct disease subtypes. A current challenge in the field is to translate new and emerging knowledge about different pathobiologic mechanisms in asthma into patient-specific therapies, with the ultimate goal of modifying the natural history of disease. Here, we describe the Precision Interventions for Severe and/or Exacerbation-Prone Asthma (PrecISE) Network, a groundbreaking collaborative effort of asthma researchers and biostatisticians from around the United States. The PrecISE Network was designed to conduct phase II/proof-of-concept clinical trials of precision interventions in the population with severe asthma, and is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Using an innovative adaptive platform trial design, the PrecISE Network will evaluate up to 6 interventions simultaneously in biomarker-defined subgroups of subjects. We review the development and organizational structure of the PrecISE Network, and choice of interventions being studied. We hope that the PrecISE Network will enhance our understanding of asthma subtypes and accelerate the development of therapeutics for severe asthma.
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Affiliation(s)
- Steve N Georas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY.
| | | | - Anastasia Ivanova
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Elliot Israel
- Department of Medicine, Divisions of Pulmonary & Critical Care Medicine & Allergy & Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, Mass
| | - Lisa M LaVange
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Praveen Akuthota
- Pulmonary Division, Department of Medicine, University of California-San Diego, La Jolla, Calif
| | - Tara F Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Loren C Denlinger
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Merritt L Fajt
- University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh, Pa
| | | | - Wanda K O'Neal
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, NC
| | | | - Stanley J Szefler
- Children's Hospital Colorado, Aurora, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Mark A Aronica
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Allison J Burbank
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Mario Castro
- University of Kansas School of Medicine, Kansas City, Mo
| | - Laura Crotty Alexander
- Pulmonary Division, Department of Medicine, University of California-San Diego, La Jolla, Calif
| | - Julie Bamdad
- Division of Lung Diseases, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Md
| | | | | | | | | | - Kim Erwin
- Institute for Healthcare Delivery Design, University of Illinois at Chicago, Chicago, Ill
| | | | - John V Fahy
- University of California, San Francisco School of Medicine, San Francisco, Calif
| | | | - Benjamin Gaston
- Wells Center for Pediatric Research, Indiana University, Indianapolis, Ind
| | - Lynn B Gerald
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | | | - Daniel J Jackson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - John James
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Nicholas J Kenyon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Davis, Calif
| | - Sumita Khatri
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - John P Kirwan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, La
| | - Monica Kraft
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Ill
| | - Andrew H Liu
- Children's Hospital Colorado, Aurora, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Mark C Liu
- Pulmonary and Critical Care Medicine, Department of Medicine, the Johns Hopkins University, Baltimore, Md
| | - M Alison Marquis
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Fernando Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Jacob Mey
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, La
| | - Wendy C Moore
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - James N Moy
- Rush University Medical Center, Chicago, Ill
| | - Victor E Ortega
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - David B Peden
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, NC
| | | | - Michael C Peters
- University of California, San Francisco School of Medicine, San Francisco, Calif
| | - Kristie Ross
- The Cleveland Clinic, Cleveland, Ohio; UH Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Maria Sanchez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | | | - Ronald L Sorkness
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Michael E Wechsler
- Children's Hospital Colorado, Aurora, Colo; University of Colorado School of Medicine, Aurora, Colo
| | - Sally E Wenzel
- University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh, Pa
| | - Steven R White
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill
| | - Joe Zein
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amir A Zeki
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Davis, Calif
| | - Patricia Noel
- Division of Lung Diseases, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Md
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Abstract
The year 2021 was the last full year of Alberto Ortiz’s editorship at Clinical Kidney Journal (CKJ). On May 2022, Maria José Soler will start her term as the Editor-in-Chief. Over these years, CKJ obtained its first journal impact factor and has consolidated its position among the top journals in the field, consistently ranking among the top 25% (first quartile) journals in Urology and Nephrology. The 2020 journal impact factor rose to 4.45, becoming the top open access journal in Nephrology and the ninth ranked Nephrology journal overall. We now review the recent history of the journal and the most highly cited topics which include the epidemiology of kidney disease, chronic kidney disease topics, such as the assessment and treatment of chronic kidney disease, onconephrology, cardionephrology, glomerular disease, transplantation and coronavirus disease 2019 (COVID-19).
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25
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Delanaye P, Gaillard F, van der Weijden J, Mjøen G, Ferhman-Ekholm I, Dubourg L, Ebert N, Schaeffner E, Åkerfeldt T, Goffin K, Couzi L, Garrouste C, Rostaing L, Courbebaisse M, Legendre C, Hourmant M, Kamar N, Cavalier E, Weekers L, Bouquegneau A, de Borst MH, Mariat C, Pottel H, van Londen M. Age-adapted percentiles of measured glomerular filtration in healthy individuals: extrapolation to living kidney donors over 65 years. Clin Chem Lab Med 2021; 60:401-407. [PMID: 34670031 DOI: 10.1515/cclm-2021-1011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Most data on glomerular filtration rate (GFR) originate from subjects <65 years old, complicating decision-making in elderly living kidney donors. In this retrospective multi-center study, we calculated percentiles of measured GFR (mGFR) in donors <65 years old and extrapolated these to donors ≥65 years old. METHODS mGFR percentiles were calculated from a development cohort of French/Belgian living kidney donors <65 years (n=1,983), using quantiles modeled as cubic splines (two linear parts joining at 40 years). Percentiles were extrapolated and validated in an internal cohort of donors ≥65 years (n=147, France) and external cohort of donors and healthy subjects ≥65 years (n=329, Germany, Sweden, Norway, France, The Netherlands) by calculating percentages within the extrapolated 5th-95th percentile (P5-P95). RESULTS Individuals in the development cohort had a higher mGFR (99.9 ± 16.4 vs. 86.4 ± 14 and 82.7 ± 15.5 mL/min/1.73 m2) compared to the individuals in the validation cohorts. In the internal validation cohort, none (0%) had mGFR below the extrapolated P5, 12 (8.2%) above P95 and 135 (91.8%) between P5-P95. In the external validation cohort, five subjects had mGFR below the extrapolated P5 (1.5%), 25 above P95 (7.6%) and 299 (90.9%) between P5-P95. CONCLUSIONS We demonstrate that extrapolation of mGFR from younger donors is possible and might aid with decision-making in elderly donors.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium.,Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - François Gaillard
- Department of Nephrology, Bichat Hospital and University of Paris, Paris, France
| | - Jessica van der Weijden
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Geir Mjøen
- Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ingela Ferhman-Ekholm
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Laurence Dubourg
- Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Torbjörn Åkerfeldt
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospital Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Cyril Garrouste
- Nephrology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation Department, CHU Grenoble-Alpes, Grenoble, France
| | - Marie Courbebaisse
- Physiology Department and INSERM, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Christophe Legendre
- Nephrolgy and Renal Transplantation Department, Necker Hospital and University of Paris, Paris, France
| | - Maryvonne Hourmant
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Nassim Kamar
- Departments of Clinical Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
| | - Laurent Weekers
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
| | - Antoine Bouquegneau
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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Mariat C, Mjøen G, Watschinger B, Sever MS, Crespo M, Peruzzi L, Oniscu GC, Abramowicz D, Hilbrands L, Maggiore U. Assessment of Pre-Donation Glomerular Filtration Rate: Going Back To Basics A Position Paper from the DESCARTES Working Group of the ERA-EDTA. Nephrol Dial Transplant 2021; 37:430-437. [PMID: 34519827 DOI: 10.1093/ndt/gfab259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 12/24/2022] Open
Abstract
The 2017 version of the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines is the most recent international framework for the evaluation and care of living kidneys donors. Along with the call for an integrative approach evaluating the long-term end-stage kidney disease risk for the future potential donor, several recommendations are formulated regarding the predonation glomerular filtration rate (GFR) adequacy with no or little consideration for the donor candidate's age and for the importance of using reference methods of GFR measurements. Herein, we question the position of the KDIGO guidelines and discuss the rationale and modalities for a more basic, but not less demanding GFR evaluation susceptible to enable a more efficient selection of the potential kidney donor.
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Affiliation(s)
- Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation rénale, Centre Hospitalier Universitaire de Saint Etienne, Hôpital NORD, Université de LYON, Université Jean MONNET, Saint Etienne, France
| | | | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | | | - Marta Crespo
- Hospital del Mar, Nephrology Department, Barcelona, Spain
| | | | | | | | - Luuk Hilbrands
- Radboud university medical center, Department of Nephrology, Nijmegen, The Netherlands
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Xia F, Hao W, Liang J, Wu Y, Yu F, Hu W, Zhao Z, Liu W. Applicability of Creatinine-based equations for estimating glomerular filtration rate in elderly Chinese patients. BMC Geriatr 2021; 21:481. [PMID: 34481470 PMCID: PMC8418712 DOI: 10.1186/s12877-021-02428-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/22/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The accuracy of the estimated glomerular filter rate (eGFR) in elderly patients is debatable. In 2020, a new creatinine-based equation by European Kidney Function Consortium (EKFC) was applied to all age groups. The objective of this study was to assess the appropriateness of the new EKFC equation with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised (LMR), Berlin Initiative Study 1 (BIS1), and full age spectrum (FAS) equations based on serum creatinine (SCR) for elderly Chinese patients. METHODS A total of 612 elderly patients with a measured glomerular filtration rate (mGFR) by the dual plasma sample clearance method with Technetium-99 m-diethylenetriamine-pentaacetic acid (Tc-99 m-DTPA) were divided into four subgroups based on age, sex, mGFR, and whether combined with diabetes. The performance of GFR was assessed while considering bias, precision, accuracy, and root-mean-square error (RMSE). Bland-Altman plots, concordance correlation coefficients (CCCs), and correlation coefficients were applied to evaluate the validity of eGFR. RESULTS The median age of the 612 participants was 73 years, and 386 (63.1%) were male. Referring to mGFR (42.1 ml/min/1.73 m2), the CKD-EPI, LMR, BIS1, FAS, and EKFC equations estimated GFR at 44.4, 41.1, 43.6, 41.8 and 41.9 ml/min/1.73 m2, respectively. Overall, the smallest bias was found for the BIS1 equation (- 0.050 vs. range - 3.015 to 0.795, P<0.05, vs. the CKD-EPI equation). Regarding P30, interquartile range (IQR), RMSE, and GFR category misclassification, the BIS1 equation generally performed more accurately than the other eqs. (73.9%, 12.7, 12.9, and 35.3%, respectively). Nevertheless, no equation achieved optimal performance for the mGFR≥60 ml/min/1.73 m2 subgroup. Bland-Altman analysis showed the smallest mean difference (- 0.3 ml/min/1.73 m2) for the BIS1 equation when compared to the other equations. CONCLUSIONS This study suggested that the BIS1 equation was the most applicable for estimating GFR in Chinese elderly patients with moderate to severe renal impairment.
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Affiliation(s)
- Fangxiao Xia
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Wenke Hao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Jinxiu Liang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yanhua Wu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Feng Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wenxue Hu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Zhi Zhao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wei Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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Jung SW, Kim DJ, Kim YG, Moon JY, Jeong KH, Lee SH. Renal Aging Resembles a Continuum Between Normal and Diseased Kidneys That Potentiates Inflammatory Response to Injury. J Gerontol A Biol Sci Med Sci 2021; 76:385-392. [PMID: 33367633 DOI: 10.1093/gerona/glaa318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
Renal aging is a natural process that can lead to structural changes and functional decline in the kidneys. These age-related changes are considered irreversible physiological processes, but resemble diseased kidneys. To enhance understanding of the molecular nature of renal aging, we first compared whole-kidney RNA sequencing between naturally aging mice (24-month-old) and adenine-induced nephropathy in young mice (2-month-old). Young mice (2-month-old) without intervention were used as the control group to investigate transcription alteration with aging or by adenine-enriched diet. Next, we compared the functional and structural renal consequences of aging and adenine-induced nephropathy between young (2-month-old) and old mice (18- to 22-month-old). C57BL/6 male mice were used in all experimental studies. Both aging kidneys and adenine-induced nephropathy showed similar transcriptional profiles characterized by upregulation in innate and adaptive immune system activation and inflammation, although these alterations were generally less significant in the aging kidneys. In contrast to aging kidneys, adenine-induced nephropathy showed prominent expression of the genes related to cytokines, T-cell activation, and fibrosis and decreased expression of the genes implicated in transporter activity and metabolism. The subclinical immunological micromilieu in aging kidneys potentially causes augmented kidney damage in response to injurious stimulus. When mice were fed with adenine-enriched diet, aging kidneys showed more extensive tubular injury and fibrosis with stronger inflammatory response than young kidneys. Taken together, our results suggest that renal aging may lie on a continuum between normal kidneys and diseased kidneys in the context of immune system upregulation that can worsen kidney damage upon injury.
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Affiliation(s)
- Su Woong Jung
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Dong Jin Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Ju-Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Gaillard F, Jacquemont L, Roberts V, Albano L, Allard J, Bouvier N, Buchler M, Titeca-Beauport D, Couzi L, Delahousse M, Ducloux D, Durrbach A, Etienne I, Frimat L, Garrouste C, Grimbert P, Hazzan M, Hertig A, Kamar N, Quintrec ML, Mariat C, Moal V, Moulin B, Mousson C, Pouteil-Noble C, Rieu P, Rostaing L, Thierry A, Vigneau C, Macher MA, Hourmant M, Legendre C. Temporal trends in living kidney donation in France between 2007 and 2017. Nephrol Dial Transplant 2021; 36:730-738. [PMID: 31778191 DOI: 10.1093/ndt/gfz229] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long-term studies have demonstrated a slight increased risk for end-stage renal disease (ESRD) for living kidney donors (LKD). In France, living kidney donation doubled within the past 10 years. We investigated the change in characteristics of LKD between 2007 and 2017 and the adequacy of follow-up. METHODS Data were obtained from the national registry for LKD. We compared characteristics of LKD between two study periods: 2007-11 and 2012-17, and stratified donors by age and relation to recipient. We aggregated four characteristics associated with higher ESRD risk [young age, first-degree relation to recipient, obesity, low glomerular filtration rate (GFR) for age] in a single risk indicator ranging from 0 to 4. RESULTS We included 3483 donors. The proportion of unrelated donors >56 years of age increased significantly. The proportion of related donors <56 years of age decreased significantly. The body mass index and proportion of obese donors did not change significantly. The proportion of donors with low estimated GFR for age decreased significantly from 5% to 2.2% (P < 0.001). The proportion of donors with adequate follow-up after donation increased from 19.6% to 42.5% (P < 0.001). No donor had a risk indicator equal to 4, and the proportion of donors with a risk indicator equal to 0 increased significantly from 19.2% to 24.9% (P < 0.001). CONCLUSIONS An increase in living kidney donation in France does not seem to be associated with the selection of donors at higher risk of ESRD and the proportion of donors with adequate annual follow-up significantly increased.
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Affiliation(s)
- François Gaillard
- Nephrology and Renal Transplantation Department, Necker Hospital, Paris, France
| | - Lola Jacquemont
- Nephrology and Renal Transplantation Department, CHU Nantes, Nantes, France
| | - Veena Roberts
- Department of Nephrology, St Vincent's Hospital, Melbourne, Australia
| | - Laetitia Albano
- Nephrology and Renal Transplantation Department, Pasteur Hospital, Nice, France
| | - Julien Allard
- Nephrology, Dialysis and Renal Transplantation Department, CHU Limoges, Limoges, France
| | - Nicolas Bouvier
- Nephrology, Dialysis, Transplantation Department, CHU Cote de Nacre, Caen University, Caen, France
| | - Mathias Buchler
- Service de Néphrologie et Immunologie Clinique, CHU Tours, Université de Tours, Tours, France
| | | | - Lionel Couzi
- Nephrology, Transplantation and Dialysis, CHU Bordeaux, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| | - Michel Delahousse
- Nephrology, Dialysis and Renal Transplantation Department, Hospital Foch, Suresnes, France
| | - Didier Ducloux
- Nephrology, Dialysis and Transplantation Department, CHU Besançon, Besançon, France
| | - Antoine Durrbach
- Nephrology and Renal Transplantation Department, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | | | - Luc Frimat
- Nephrology, Dialysis and Transplantation Department, CHU Nancy, Nancy, France
| | - Cyril Garrouste
- Nephrology, Dialysis and Transplantation Department, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Philippe Grimbert
- Nephrology and Transplantation Department, UPEC University, Créteil, France
| | - Marc Hazzan
- Nephrology Department, University Hospital, Lille, France
| | | | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, University Paul Sabatier, Toulouse, France
| | - Moglie Le Quintrec
- Nephrology, Transplantation and Dialysis Department, CHU Lapeyronie, and IRMB, INSERM U1183, Montpellier, France
| | - Christophe Mariat
- Nephrology, Dialysis and Transplantation Department, CHU Saint Etienne, Saint Etienne, France
| | - Valérie Moal
- Nephrology and Renal Transplantation, APHM, Marseille, France
| | - Bruno Moulin
- Nephrology and Transplantation Department, University Hospital, Strasbourg, France
| | | | - Claire Pouteil-Noble
- Renal Transplantation Department, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Philippe Rieu
- Nephrology and Renal Transplantation Department, University Hospital, Reims, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Transplantation Department, University Hospital, Grenoble, France
| | - Antoine Thierry
- Nephrology Department, University Hospital and Poitiers University, INSERM U1082, Poitiers, France
| | - Cécile Vigneau
- Nephrology, Dialysis and Transplantation Department, University Hospital, Rennes, France
| | | | - Maryvonne Hourmant
- Nephrology and Renal Transplantation Department, CHU Nantes, Nantes, France
| | - Christophe Legendre
- Nephrology and Renal Transplantation Department, Necker Hospital, Paris, France
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Pesenti G, Foppoli M, Manca D. A minimal physiologically based pharmacokinetic model for high-dose methotrexate. Cancer Chemother Pharmacol 2021; 88:595-606. [PMID: 34120234 PMCID: PMC8367929 DOI: 10.1007/s00280-021-04305-2] [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: 12/31/2020] [Accepted: 05/30/2021] [Indexed: 11/18/2022]
Abstract
Purpose High-dose methotrexate (HDMTX) is administered for the treatment of a variety of malignant tumors. Wide intra- and inter-individual variabilities characterize the pharmacokinetics of MTX, which is mostly excreted renally. HDMTX dosages are prescribed as a function of body surface area whereas dose adjustments depending on renal function are not well defined. We develop a population pharmacokinetic model with a physiological description of renal excretion as the basis for clinical tools able to suggest model-informed dosages and support therapeutic monitoring. Methods This article presents a minimal physiologically based pharmacokinetic (PBPK) model for HDMTX, which specifically accounts for individual characteristics such as body weight, height, gender, age, hematocrit, and serum creatinine to provide individualized predictions. The model supplies a detailed and mechanistic description of capillary and cellular exchanges between plasma, interstitial fluid, and intracellular fluid compartments, and focuses on an individualized description of renal excretion. Results The minimal PBPK model is identified and validated with a literature dataset based on Chinese patients suffering from primary central nervous system lymphoma. A comparison with a pharmacokinetic model from the literature suggests that the proposed model provides improved predictions. Remarkably, the model does not present any significant bias in a wide range of degrees of renal function. Conclusion Results show that model predictions can capture the wide intra- and inter-individual variability of HDMTX, and highlight the role played by the individual degree of renal function. The proposed model can be the basis for the development of clinical decision-support systems for individualized dosages and therapeutic monitoring.
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Affiliation(s)
- Giuseppe Pesenti
- PSE-Lab, Process Systems Engineering Laboratory, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Marco Foppoli
- Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy
| | - Davide Manca
- PSE-Lab, Process Systems Engineering Laboratory, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy.
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Gaillard F, Jacquemont L, Lazareth H, Albano L, Barrou B, Bouvier N, Buchler M, Titeca-Beauport D, Couzi L, Delahousse M, Ducloux D, Etienne I, Frimat L, Garrouste C, Glotz D, Grimbert P, Hazzan M, Hertig A, Hourmant M, Kamar N, Le Meur Y, Le Quintrec M, Legendre C, Moal V, Moulin B, Mousson C, Pouteil-Noble C, Rieu P, Ouali N, Rostaing L, Thierry A, Toure F, Chemouny J, Delanaye P, Courbebaisse M, Mariat C. Living kidney donor evaluation for all candidates with normal estimated GFR for age. Transpl Int 2021; 34:1123-1133. [PMID: 33774875 DOI: 10.1111/tri.13870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 12/01/2022]
Abstract
Multiple days assessments are frequent for the evaluation of candidates to living kidney donation, combined with an early GFR estimation (eGFR). Living kidney donation is questionable when eGFR is <90 ml/min/1.73 m2 (KDIGO guidelines) or 80 ml/min/1.73 m2 (most US centres). However, age-related GFR decline results in a lower eGFR for older candidates. That may limit the number of older kidney donors. Yet, continuing the screening with a GFR measure increases the number of eligible donors. We hypothesized that in-depth screening should be proposed to all candidates with a normal eGFR for age. We compared the evolution of eGFR after donation between three groups of predonation eGFR: normal for age (Sage ) higher than 90 or 80 ml/min/1.73 m2 (S90 and S80, respectively); across three age groups (<45, 45-55, >55 years) in a population of 1825 French living kidney donors with a median follow-up of 5.9 years. In donors younger than 45, postdonation eGFR, absolute- and relative-eGFR variation were not different between the three groups. For older donors, postdonation eGFR was higher in S90 than in S80 or Sage but other comparators were identical. Postdonation eGFR slope was comparable between all groups. Our results are in favour of in-depth screening for all candidates to donation with a normal eGFR for age.
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Affiliation(s)
- François Gaillard
- Department of Nephrology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Centre de recherche sur l'inflammation, INSERM UMR1149, CNRS EL8252, Laboratoire d'Excellence Inflamex, Université de Paris, Paris, France
| | - Lola Jacquemont
- Nephrology and Renal Transplantation Department, CHU Nantes, Nantes, France
| | - Hélène Lazareth
- Nephrology Department, Hopital Européen Georges Pompidou, Paris, France
| | - Laetitia Albano
- Nephrology and Renal Transplantation Department, Pasteur Hospital, Nice, France
| | - Benoit Barrou
- Urology Department, Pitié-Salpêtrière, Paris, France
| | - Nicolas Bouvier
- Nephrology, Dialysis, Transplantation Department, CHU Cote de Nacre, Caen University, Caen, France
| | - Mathias Buchler
- Service de Néphrologie et Immunologie Clinique, CHU Tours, Université de Tours, Tours, France
| | | | - Lionel Couzi
- Nephrology, Transplantation and Dialysis, CHU Bordeaux, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| | - Michel Delahousse
- Nephrology, Dialysis and Renal Transplantation Department, Foch Hospital, Suresnes, France
| | - Didier Ducloux
- Nephrology, Dialysis and Transplantation Department, CHU Besançon, Besançon, France
| | | | - Luc Frimat
- Nephrology, Dialysis and Transplantation Department, CHU, Nancy, France
| | - Cyril Garrouste
- Nephrology, Dialysis and Transplantation Department, CHU, Clermont Ferrand, France
| | - Denis Glotz
- Department of Nephrology and Renal Transplantation, Hopital Saint Louis, Paris, France
| | - Philippe Grimbert
- Nephrology and Transplantation Department, UPEC University, Créteil, France
| | - Marc Hazzan
- Nephrology Department, University Hospital, Lille, France
| | - Alexandre Hertig
- Nephrology and Transplantation, Hopital Pitié Salpétrière, Paris, France
| | - Maryvonne Hourmant
- Nephrology and Renal Transplantation Department, CHU Nantes, Nantes, France
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, University Paul Sabatier, Toulouse, France
| | - Yann Le Meur
- Department of Nephrology and Renal Transplantation, CHU Brest, Brest, France
| | - Moglie Le Quintrec
- Nephrology, Transplantation and Dialysis Department, CHU Lapeyronie, and IRMB, INSERM U1183, Montpellier, France
| | - Christophe Legendre
- Nephrology and Renal Transplantation Department, Hopital Necker, Paris, France
| | - Valérie Moal
- Nephrology and Renal Transplantation, APHM, Marseille, France
| | - Bruno Moulin
- Nephrology and Transplantation Department, University Hospital, Strasbourg, France
| | | | - Claire Pouteil-Noble
- Renal Transplantation Department, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - Philippe Rieu
- Nephrology and Renal Transplantation Department, University Hospital, Reims, France
| | - Nacera Ouali
- Nephrology and Renal Transplantation, Hopital Tenon, Paris, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Transplantation Department, University Hospital, Grenoble, France
| | - Antoine Thierry
- Nephrology Department, University Hospital and Poitiers University, INSERM U1082, Poitiers, France
| | - Fatouma Toure
- Nephrology, Dialysis and Renal Transplantation Department, CHU, Limoges, France
| | - Jonathan Chemouny
- Nephrology, Dialysis and Transplantation Department, University Hospital, Rennes, France
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), Liège, Belgium.,Department of Nephrology-Dialysis-Apheresis, Hopital Universitaire Caremeau, Nimes, France
| | - Marie Courbebaisse
- Department of Physiology, European Georges Pompidou Hospital, APHP, INSERM U1151, Paris University, Paris, France
| | - Christophe Mariat
- Nephrology, Dialysis and Renal Transplantation Department, Hôpital Nord, CHU de Saint-Etienne, Jean Monnet University, COMUE Université de Lyon, Lyon, France
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Campbell DJ, Coller JM, Gong FF, McGrady M, Boffa U, Shiel L, Liew D, Stewart S, Owen AJ, Krum H, Reid CM, Prior DL. Kidney age - chronological age difference (KCD) score provides an age-adapted measure of kidney function. BMC Nephrol 2021; 22:152. [PMID: 33902478 PMCID: PMC8077774 DOI: 10.1186/s12882-021-02324-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Given the age-related decline in glomerular filtration rate (GFR) in healthy individuals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an individual's kidney age is estimated from their estimated GFR (eGFR) and the age-dependent eGFR decline reported for healthy living potential kidney donors. METHODS We examined the association between death or cardiovascular event and KCD score, age-dependent stepped eGFR criteria (eGFRstep), and eGFR < 60 ml/min/1.73 m2 (eGFR60) in a community-based high cardiovascular risk cohort of 3837 individuals aged ≥60 (median 70, interquartile range 65, 75) years, followed for a median of 5.6 years. RESULTS In proportional hazards analysis, KCD score ≥ 20 years (KCD20) was associated with increased risk of death or cardiovascular event in unadjusted analysis and after adjustment for age, sex and cardiovascular risk factors. Addition of KCD20, eGFRstep or eGFR60 to a cardiovascular risk factor model did not improve area under the curve for identification of individuals who experienced death or cardiovascular event in receiver operating characteristic curve analysis. However, addition of KCD20 or eGFR60, but not eGFRstep, to a cardiovascular risk factor model improved net reclassification and integrated discrimination. KCD20 identified individuals who experienced death or cardiovascular event with greater sensitivity than eGFRstep for all participants, and with greater sensitivity than eGFR60 for participants aged 60-69 years, with similar sensitivities for men and women. CONCLUSIONS In this high cardiovascular risk cohort aged ≥60 years, the KCD score provided an age-adapted measure of kidney function that may assist patient education, and KCD20 provided an age-adapted criterion of eGFR-related increased risk of death or cardiovascular event. Further studies that include the full age spectrum are required to examine the optimal KCD score cut point that identifies increased risk of death or cardiovascular event, and kidney events, associated with impaired kidney function, and whether the optimal KCD score cut point is similar for men and women. TRIAL REGISTRATION ClinicalTrials.gov NCT00400257 , NCT00604006 , and NCT01581827 .
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Affiliation(s)
- Duncan J Campbell
- St. Vincent's Institute of Medical Research, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
- University of Melbourne, Parkville, Victoria, Australia.
- St. Vincent's Hospital, Melbourne, Victoria, Australia.
| | | | - Fei Fei Gong
- St. Vincent's Institute of Medical Research, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
- University of Melbourne, Parkville, Victoria, Australia
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michele McGrady
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Umberto Boffa
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Louise Shiel
- Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Danny Liew
- Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Simon Stewart
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Alice J Owen
- Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Henry Krum
- Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Christopher M Reid
- Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - David L Prior
- University of Melbourne, Parkville, Victoria, Australia
- St. Vincent's Hospital, Melbourne, Victoria, Australia
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Whitney DG, Wolgat EM, Ellenberg EC, Hurvitz EA, Schmidt M. The paradoxical relationship between severity of cerebral palsy and renal function in middle-aged adults: better renal function or inappropriate clinical assessment? Disabil Rehabil 2021; 44:3853-3859. [PMID: 33635734 DOI: 10.1080/09638288.2021.1890841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the association between severity of cerebral palsy with serum creatinine (sCr) and sCr-based equations to estimate glomerular filtration rate (eGFR), a marker of renal function. METHODS A clinic-based sample of 30-64 year-olds with cerebral palsy was examined and stratified by motor impairment: gross motor function classification system (GMFCS) I/II (n = 79), GMFCS III (n = 78), and GMFCS IV/V (n = 137). sCr, which is influenced by muscle mass, was obtained and sCr-based eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. RESULTS sCr was lower with increasing GMFCS. The opposite pattern was observed for eGFR: GMFCS IV/V had significantly higher eGFR derived from MDRD compared to other GMFCS groups; GMFCS III had significantly higher eGFR compared to GMFCS I/II. The pattern was similar for CKD-EPI derived eGFR. CONCLUSIONS According to widely used clinical assessment methods for renal function, higher severity of cerebral palsy among adults is associated with better renal function, which is incongruent with their other biological systems. This paradoxical relationship is likely driven by lower muscle rather than true renal function, and thus, sCr-based eGFR may overestimate renal function, especially for GMFCS IV/V. Further prospective studies are needed.Implications for rehabilitationCommon methods of clinical assessment may over-estimate renal function for adults with cerebral palsy (CP), potentially giving a false positive for normal renal health due to their reliance on muscle mass.This study of a clinic-based sample of middle-aged adults with CP highlights the paradoxical relationship between severity of CP and renal function, which is likely driven by methodological limitations in the presence of low muscle mass rather than actual better renal function.It is recommended that clinicians have a high suspicion of abnormal renal function and the need for a nephrology consultation, especially with changes in creatinine levels, even within the normal range.Rehabilitation for adults with CP must have a strong focus on muscle and kidney health, especially for patients with more severe forms of CP.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ellen M Wolgat
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Elie C Ellenberg
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mary Schmidt
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Lengnan X, Aiqun C, Ying S, Chuanbao L, Yonghui M. The effects of aging on the renal function of a healthy population in Beijing and an evaluation of a range of estimation equations for glomerular filtration rate. Aging (Albany NY) 2021; 13:6904-6917. [PMID: 33639617 PMCID: PMC7993673 DOI: 10.18632/aging.202548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
We investigated how age affected renal function in healthy subjects in Beijing and compared different estimated glomerular filtration rate (eGFR) equations. Kidney function was evaluated by five equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI); Modification of Diet in Renal Disease Study (MDRD); the Chinese version of the MDRD (MDRDc); Full Age Spectrum (FAS); and Berlin Initiative Study (BIS). A total of 46,708 subjects were enrolled and followed-up for 3 years. All showed an increase in sCr and a reduction in eGFR with increasing age. Over the 3 years, the eGFR and serum creatinine (sCr) remained unchanged in most subjects. Different equations showed good consistency; the intraclass correlation coefficients (ICC) was 0.849 for males, and 0.817 for females. The CKD-EPI equation yielded higher GFR values than the other equations (according to sCr levels). For subjects aged over 70 years, the BIS equation produced the lowest eGFR values. In summary, we observed that the renal function of individuals was relatively stable with increasing age, although different eGFR equations yielded data that varied across different populations of subjects and sCr levels.
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Affiliation(s)
- Xu Lengnan
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Chen Aiqun
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Sun Ying
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Li Chuanbao
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Mao Yonghui
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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Kim Y, Lee S, Lee Y, Park S, Park S, Paek JH, Park WY, Jin K, Han S, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Han K, Kim DK. The minimum-mortality estimated glomerular filtration rate percentile shifts upward in the aged population: a nationwide population-based study. Clin Kidney J 2020; 14:1356-1363. [PMID: 33959265 PMCID: PMC8087142 DOI: 10.1093/ckj/sfaa238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background The estimated glomerular filtration rate (eGFR) is a biomarker not only for kidney function, but also for major clinical outcomes. We aimed to evaluate the patterns of mortality across the entire eGFR percentile spectrum using a population-based dataset. Methods We retrospectively reviewed the National Health Insurance Service (NHIS) database for people who received nationwide health check-ups from 2009 to 2012. Subjects who were ≥45 years old and had one or more serum creatinine values available were included in the study. The primary outcome was all-cause mortality as a function of eGFR percentile. Results The middle-aged group (45–64 years) showed a U-shaped pattern of association between eGFR percentile and all-cause mortality. The minimum-mortality eGFR percentile was shifted upward in the elderly group (≥65 years). Specifically, the minimum-mortality eGFR percentiles were the 28th percentile (83.8 mL/min/1.73 m2) for middle-aged males, the 63rd percentile (86.2 mL/min/1.73 m2) for elderly males, the 42nd percentile (102.8 mL/min/1.73 m2) for middle-aged females and the 75th percentile (90.1 mL/min/1.73 m2) for elderly females. Diabetes and hypertension shifted the minimum-mortality eGFR percentile upward in the middle-aged group. This pattern was attenuated in the elderly group. Conclusions The eGFR percentile showing minimum mortality moves upward in the aged population as well as patients with diabetes and hypertension, which might reduce the clinical significance of hyperfiltration. Risk stratification for mortality should be approached differently according to the specific conditions of the patient group.
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Affiliation(s)
- Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea
| | - Sanghyun Park
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Woo Yeong Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyubok Jin
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seungyeup Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Wei Y, Liu Y, Li Q, Zhang Y, Wang Q, Yang Y, Liang Y, Zhao A, Yang A, Xue J. Establishment of normal reference ranges for total and separate glomerular filtration rates in living kidney donors by Gates' method after renal depth measured using single-photon emission computed tomography/computed tomography. Quant Imaging Med Surg 2020; 10:2297-2306. [PMID: 33269228 DOI: 10.21037/qims-19-772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The underestimation of renal depth by Tønnesen formula in Gates' method, which has been confirmed by many scholars, leads to the underestimation of both separate glomerular filtration rate (gSGFR) and total glomerular filtration rate (gTGFR). This study aimed to establish the normal reference ranges of renal depth-calibrated gTGFR and gSGFR in Chinese healthy adults, and to analyze the influencing factors. Methods Renal depth was measured by CT scan followed by technetium 99m-diethylene triamine pentaacetic acid (99mTc-DTPA) renal dynamic imaging by single-photon emission computed tomography/computed tomography (SPECT/CT) in 329 living kidney donors. The renal depth-calibrated gTGFR and gSGFR were calculated by Gates' method with renal depth measured by CT instead of being calculated by the Tønnesen formula. A general linear model based on age, gender, body height, body weight, and BMI was used to analyze factors influencing gSGFR (L), gSGFR (R) and gTGFR. Results The average gSGFR (L), gSGFR (R), and gTGFR for patients aged 23-64 years old were 49.3±10.1, 49.9±10.4, and 99.1±18.7 mL/min/1.73 m2, respectively. The gSGFR (L), gSGFR (R) and gTGFR for patients aged 41-50 years old were 26.9-69.3, 27.7-68.8, and 57.5-135.3 mL/min/1.73 m2, respectively, and those for patients aged 51-60 years old were 31.0-61.5, 29.5-63.3, and 64.6-120.7 mL/min/1.73 m2, respectively. gSGFR (L), gSGFR (R) and gTGFR had statistical significance with body height and age (P<0.05); however, there was no significant difference with gender, body weight, and BMI (P>0.05). For each 1 year increase in age, the gSGFR (L), gSGFR (R), and gTGFR decreased by 0.17, 0.28, and 0.44 mL/min/1.73 m2, respectively, while for every 1 cm increase in body height, the gSGFR (L), gSGFR (R), and gTGFR decreased by 0.37, 0.36, and 0.74 mL/min/1.73 m2, respectively. Conclusions Normal reference ranges for renal depth-calibrated gSGFR (L), gSGFR (R), and gTGFR were established in healthy Chinese adults aged 23-64 years, and gSGFR (L), gSGFR (R), and gTGFR decreased with age and body height.
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Affiliation(s)
- Yushan Wei
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Medical Imaging, Xi'an Chest Hospital, Xi'an, China
| | - Yan Liu
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Li
- Department of Health Statistics, School of Medicine Xi'an Jiaotong University, Xi'an, China
| | - Yuemin Zhang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Wang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiyuan Yang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiqian Liang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Aomei Zhao
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Aimin Yang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianjun Xue
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Jung SW, Cho M, Oh W, Ko GJ, Moon JY, Lee SH, Kim YG. Incremental Effect of Aging on Obesity-Related Incident Chronic Kidney Disease in the Korean General Population. J Am Med Dir Assoc 2020; 22:1751-1756.e2. [PMID: 33238141 DOI: 10.1016/j.jamda.2020.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/16/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Obesity may increase the risk of kidney function decline. However, few studies have addressed how age modifies obesity-associated risk of chronic kidney disease (CKD) in the Asian general population. DESIGN A community-based prospective cohort study. SETTING AND PARTICIPANTS 6538 Korean general population with normal kidney function from the Korean Genome and Epidemiology Study Database. METHODS Participants were stratified according to age (40-49, 50-59, and 60-69 years old) and body mass index [≥18.5-<23 (normal-weight), ≥23-<27.5 (overweight), and ≥27.5 (obese)]. We conducted Kaplan-Meier and multivariable-adjusted Cox regression analyses to investigate the association of aging and obesity with incident CKD. RESULTS During the 12-year follow-up, an overall incidence rate of CKD was 6.1 cases per 1000 person-years. Obese, but not overweight, people had an increased risk of incident CKD compared with normal-weight people in multivariable models adjusted for metabolic factors. When analyzed by 10-year increments, this association was significant only in 60-69-year-old individuals. Kaplan-Meier analysis showed that the incidence of CKD associated with overweight or obesity showed an accentuated increase with age. With reference to normal-weight individuals aged 40-49 years, the adjusted hazard ratio of CKD increased with age regardless of body mass index, and the positive association between obesity and incident CKD was more prominent with increasing age. CONCLUSIONS AND IMPLICATIONS Obesity-associated risk of incident CKD was accentuated in older people, and this association was independent of metabolic abnormalities.
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Affiliation(s)
- Su Woong Jung
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Minhae Cho
- School of Social Work, University of Memphis, Memphis, TN, USA
| | - Wonsuk Oh
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Gang Jee Ko
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ju-Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Yang Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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Ortiz A. Ckj consolidation among Q1 Urology and Nephrology journals. Clin Kidney J 2020; 13:723-727. [PMID: 33123351 PMCID: PMC7577766 DOI: 10.1093/ckj/sfaa197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022] Open
Abstract
The Clinical Kidney Journal (ckj) impact factor from Clarivate’s Web of Science for 2019 was 3.388. This consolidates ckj among journals in the top 25% (first quartile, Q1) in the Urology and Nephrology field according to the journal impact factor. The manuscripts contributing the most to the impact factor focused on chronic kidney disease (CKD) epidemiology and evaluation, CKD complications and their management, cost-efficiency of renal replacement therapy, pathogenesis of CKD, familial kidney disease and the environment–genetics interface, onconephrology, technology, SGLT2 inhibitors and outcome prediction. We provide here an overview of the hottest and most impactful topics for 2017–19.
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Affiliation(s)
- Alberto Ortiz
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, Madrid, Spain
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Lee YP, Kim SJ, Lee J, Lee JG, Huh KH, Joo DJ, Kim SI, Kim YS, Kim MS. Long-term compensation of renal function after donor nephrectomy. KOREAN JOURNAL OF TRANSPLANTATION 2020; 34:84-91. [PMID: 35769347 PMCID: PMC9188938 DOI: 10.4285/kjt.2020.34.2.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/17/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Living donors are the major source of kidneys in countries with a shortage of deceased donors. Kidney donation after careful donor selection is generally accepted as a safe procedure, but the physiologic consequences after donor nephrectomy are not fully verified. In this study we retrospectively reviewed the renal function of the residual kidney in living donors. Methods Post-nephrectomy laboratory data of 1,175 living donors (60.7%) from 1,933 living donors who received uninephrectomy from January 1999 to December 2017 at Yonsei University, Severance Hospital, Korea were retrospectively collected. Post-nephrectomy renal function was monitored by the relative ratio of estimated glomerular filtration rate (e-GFR; pre-nephrectomy e-GFR ratio vs. post-nephrectomy e-GFR) that was calculated by the Modification of Diet in Renal Disease formula. Results During 36.3±37.6 months of mean follow-up, two cases (0.17%, 2/1,175) of renal failure developed. The mean e-GFR decreased to 64.3±14.2 mL/min/1.73 m2 immediately after nephrectomy from 99.2±19.9 mL/min/1.73 m2 of the pre-nephrectomy e-GFR. Early decrement of e-GFR was prominent in male and obese donors (body mass index >25 kg/m2, P<0.05). The e-GFR ratio increased according to post-nephrectomy duration, and the mean increment degree of e-GFR ratio after nephrectomy calculated by linear regression analysis was 1.94% per year. Unlike the early decrement of e-GFR ratio after nephrectomy, donor factors such as degree of obesity and donor sex did not affect the late increment of e-GFR ratio after nephrectomy (P>0.05). Conclusions Our data showed that long-term compensation of the renal function after nephrectomy occurs independently of preoperative donor characteristics.
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Affiliation(s)
- Yong Pyo Lee
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Seun Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
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40
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Eriksen BO, Palsson R, Ebert N, Melsom T, van der Giet M, Gudnason V, Indridason OS, Inker LA, Jenssen TG, Levey AS, Solbu MD, Tighiouart H, Schaeffner E. GFR in Healthy Aging: an Individual Participant Data Meta-Analysis of Iohexol Clearance in European Population-Based Cohorts. J Am Soc Nephrol 2020; 31:1602-1615. [PMID: 32499396 DOI: 10.1681/asn.2020020151] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Population mean GFR is lower in older age, but it is unknown whether healthy aging is associated with preserved rather than lower GFR in some individuals. METHODS We investigated the cross-sectional association between measured GFR, age, and health in persons aged 50-97 years in the general population through a meta-analysis of iohexol clearance measurements in three large European population-based cohorts. We defined a healthy person as having no major chronic disease or risk factors for CKD and all others as unhealthy. We used a generalized additive model to study GFR distribution by age according to health status. RESULTS There were 935 (22%) GFR measurements in persons who were healthy and 3274 (78%) in persons who were unhealthy. The mean GFR was lower in older age by -0.72 ml/min per 1.73 m2 per year (95% confidence interval [95% CI], -0.96 to -0.48) for men who were healthy versus -1.03 ml/min per 1.73 m2 per year (95% CI, -1.25 to -0.80) for men who were unhealthy, and by -0.92 ml/min per 1.73 m2 per year (95% CI, -1.14 to -0.70) for women who were healthy versus -1.22 ml/min per 1.73 m2 per year (95% CI, -1.43 to -1.02) for women who were unhealthy. For healthy and unhealthy people of both sexes, both the 97.5th and 2.5th GFR percentiles exhibited a negative linear association with age. CONCLUSIONS Healthy aging is associated with a higher mean GFR compared with unhealthy aging. However, both the mean and 97.5 percentiles of the GFR distribution are lower in older persons who are healthy than in middle-aged persons who are healthy. This suggests that healthy aging is not associated with preserved GFR in old age.
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Affiliation(s)
- Bjørn O Eriksen
- Metabolic and Renal Research Group, University of Tromsø - The Arctic University of Norway, Tromsø, Norway .,Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,University of Iceland, Reykjavik, Iceland
| | - Natalie Ebert
- Institute of Public Health, Charité - Berlin University of Medicine, Berlin, Germany
| | - Toralf Melsom
- Metabolic and Renal Research Group, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Markus van der Giet
- Department of Nephrology, Charité - Berlin University of Medicine, Berlin, Germany
| | - Vilmundur Gudnason
- University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Olafur S Indridason
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Trond G Jenssen
- Metabolic and Renal Research Group, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Department of Organ Transplantation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Marit D Solbu
- Metabolic and Renal Research Group, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Elke Schaeffner
- Institute of Public Health, Charité - Berlin University of Medicine, Berlin, Germany
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Abstract
Long-term safety of living kidney donation (LKD), especially for young donors, has become a real matter of concern in the transplant community and may contribute to creating resistance to LKD. In this context, the criteria that govern living donor donations must live up to very demanding standards as well as adjust to this novel reality. In the first part, we review the existing guidelines published after 2010 and critically examine their recommendations to see how they do not necessarily lead to consistent and universal practices in the choice of specific thresholds for a parameter used to accept or reject a living donor candidate. In the second part, we present the emergence of a new paradigm for LKD developed in the 2017 Kidney Disease: Improving Global Outcomes guidelines with the introduction of an integrative risk-based approach. Finally, we focus on predonation renal function evaluation, a criteria that remain central in the selection process, and discuss several issues surrounding the donor candidate's glomerular filtration rate assessment.
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42
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Delanaye P. Too much nephrology? The CKD epidemic is real and concerning. A CON view. Nephrol Dial Transplant 2020; 34:581-584. [PMID: 30418616 DOI: 10.1093/ndt/gfy331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
The prevalence of chronic kidney disease (CKD) clearly depends on its definition, and the definition used most often is the one proposed by the Kidney Disease: Improving Global Outcomes guidelines in 2012: 'CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health.' Abnormality of kidney function is a glomerular filtration rate (GFR) <60 mL/min/1.73 m2, and the most frequently used marker of kidney damage is the presence of albuminuria [albumin excretion rate >30 mg/24 h or albumin/creatinine ratio (ACR) >30 mg/g (or 3 mg/mmol)]. However, two major aspects of this definition could explain why CKD prevalence is, in our view, overstated in most epidemiological studies. First, the fixed threshold at 60 mL/min/1.73 m2 is questionable because normal GFR decreases with age. This and the profound consequence it has on CKD epidemiology will be illustrated. The second aspect of the definition is the criterion of chronicity, which is ignored by the vast majority of epidemiological studies. In other words, confirming CKD (low GFR and/or high ACR) is mandatory. Indeed, a large proportion of subjects with a low first GFR level has a normal GFR level when tested a second time. The prevalence of CKD may hence, in fact, be considerably lower although still neither negligible nor irrelevant.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
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43
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Should the definition of CKD be changed to include age-adapted GFR criteria? YES. Kidney Int 2020; 97:34-37. [DOI: 10.1016/j.kint.2019.08.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
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44
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Quinn SM, Fernandez H, McCorkle T, Rogers R, Hussain S, Ford CA, Barg FK, Ginsburg KR, Amaral S. The role of resilience in healthcare transitions among adolescent kidney transplant recipients. Pediatr Transplant 2019; 23:e13559. [PMID: 31441191 DOI: 10.1111/petr.13559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/22/2019] [Accepted: 07/03/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE AYAs with KTs experience high rates of premature allograft loss during the HCT. There is a critical need to identify protective factors associated with stable HCT. Resilience-the ability to adapt and thrive in the setting of adversity-has known positive impact on health outcomes. This study explored the novel role of resilience constructs as protective factors in securing stable HCT among AYA with KT. METHODS We conducted semi-structured interviews of adolescents and young adults who transitioned from a single pediatric transplant center to multiple adult nephrology centers between 2010 and 2017. Interviews explored the role of key resilience constructs in participants' lives around the time of HCT. Participants were stratified into stable or unstable HCT groups based on biological markers of allograft function and clinical data from chart review. Content analyses of interview transcripts were reviewed and compared among HCT groups. RESULTS Thirty-two participants enrolled (17 stable; 15 unstable). Key resilience constructs more salient in the stable versus unstable HCT group were confidence in and connection to one's healthcare team. Reports of healthcare self-management competencies were similar across both HCT groups. CONCLUSIONS Confidence in and connection to one's healthcare team appear to be linked with a stable HCT among AYA with KT. This suggests that interdependence, the ability to foster connections with and elicit support from healthcare providers, as opposed to complete independence or autonomy, which is often advised in the HCT process, is a critical component of resilience linked to stable HCT.
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Affiliation(s)
- Sheila M Quinn
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Taylor McCorkle
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rachel Rogers
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Saarah Hussain
- Hahnemann University Hospital and Drexel College of Medicine, Philadelphia, PA
| | - Carol A Ford
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - Kenneth R Ginsburg
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sandra Amaral
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
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Delanaye P, Jager KJ, Bökenkamp A, Christensson A, Dubourg L, Eriksen BO, Gaillard F, Gambaro G, van der Giet M, Glassock RJ, Indridason OS, van Londen M, Mariat C, Melsom T, Moranne O, Nordin G, Palsson R, Pottel H, Rule AD, Schaeffner E, Taal MW, White C, Grubb A, van den Brand JAJG. CKD: A Call for an Age-Adapted Definition. J Am Soc Nephrol 2019; 30:1785-1805. [PMID: 31506289 PMCID: PMC6779354 DOI: 10.1681/asn.2019030238] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Current criteria for the diagnosis of CKD in adults include persistent signs of kidney damage, such as increased urine albumin-to-creatinine ratio or a GFR below the threshold of 60 ml/min per 1.73 m2 This threshold has important caveats because it does not separate kidney disease from kidney aging, and therefore does not hold for all ages. In an extensive review of the literature, we found that GFR declines with healthy aging without any overt signs of compensation (such as elevated single-nephron GFR) or kidney damage. Older living kidney donors, who are carefully selected based on good health, have a lower predonation GFR compared with younger donors. Furthermore, the results from the large meta-analyses conducted by the CKD Prognosis Consortium and from numerous other studies indicate that the GFR threshold above which the risk of mortality is increased is not consistent across all ages. Among younger persons, mortality is increased at GFR <75 ml/min per 1.73 m2, whereas in elderly people it is increased at levels <45 ml/min per 1.73 m2 Therefore, we suggest that amending the CKD definition to include age-specific thresholds for GFR. The implications of an updated definition are far reaching. Having fewer healthy elderly individuals diagnosed with CKD could help reduce inappropriate care and its associated adverse effects. Global prevalence estimates for CKD would be substantially reduced. Also, using an age-specific threshold for younger persons might lead to earlier identification of CKD onset for such individuals, at a point when progressive kidney damage may still be preventable.
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Affiliation(s)
- Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège, Centre Hospitalier Universitaire Sart Tilman, ULg CHU, Liège, Belgium;
| | - Kitty J Jager
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arend Bökenkamp
- Emma Children's Hospital, Amsterdam UMC, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - Anders Christensson
- Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Laurence Dubourg
- Nephrology, Dialysis, Hypertension and Functional Renal Exploration, Edouard Herriot Hospital, Hospices Civils de Lyon and Université Lyon 1, Lyon, France
| | - Bjørn Odvar Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - François Gaillard
- Renal Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France, Paris Sud University, Orsay, France
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Markus van der Giet
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Richard J Glassock
- Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Olafur S Indridason
- Division of Nephrology, National University Hospital of Iceland, Reykavik, Iceland
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Christophe Mariat
- Nephrology, Dialysis and Renal Transplantation Department, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Jean Monnet University, Communauté d'universités et Etablissements Université de Lyon, Lyon, France
| | - Toralf Melsom
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, Clinic of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Olivier Moranne
- Nephrology, Dialysis, Apheresis Unit, Centre Hospitalier Universitaire Caremeau Nimes, University of Montpellier, Montpellier, France
| | | | - Runolfur Palsson
- Division of Nephrology, National University Hospital of Iceland, Reykavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Elke Schaeffner
- Charité - Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Institute of Public Health, Berlin, Germany
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, UK
| | - Christine White
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anders Grubb
- Department of Clinical Chemistry and Pharmacology, Laboratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden; and
| | - Jan A J G van den Brand
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations. Kidney Int 2019; 95:1181-1189. [DOI: 10.1016/j.kint.2018.11.045] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/10/2018] [Accepted: 11/29/2018] [Indexed: 01/27/2023]
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Gaillard F, Courbebaisse M, Kamar N, Rostaing L, Jacquemont L, Hourmant M, Del Bello A, Couzi L, Merville P, Malvezzi P, Janbon B, Moulin B, Maillard N, Dubourg L, Lemoine S, Garrouste C, Pottel H, Legendre C, Delanaye P, Mariat C. Impact of estimation versus direct measurement of predonation glomerular filtration rate on the eligibility of potential living kidney donors. Kidney Int 2019; 95:896-904. [DOI: 10.1016/j.kint.2018.11.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Pottel H, Björk J, Bökenkamp A, Berg U, Åsling-Monemi K, Selistre L, Dubourg L, Hansson M, Littmann K, Jones I, Sjöström P, Nyman U, Delanaye P. Estimating glomerular filtration rate at the transition from pediatric to adult care. Kidney Int 2019; 95:1234-1243. [PMID: 30922665 DOI: 10.1016/j.kint.2018.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 01/11/2023]
Abstract
The current Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend the use of the bedside creatinine-based Chronic Kidney Disease in Children (CKiD) equation to estimate glomerular filtration rate (GFR) in children and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in adults. However, this approach causes implausible changes in estimated GFR (eGFR) at the transition from pediatric to adult care. We investigated the performance of the KDIGO strategy and various creatinine-based eGFR equations in a cross-sectional dataset of 5,764 subjects (age 10-30 years), using directly measured GFR (mGFR) as reference. We also evaluated longitudinal GFR slopes in 136 subjects who transitioned to adult care. Implausible changes in eGFR resulted from the large overestimation (bias=+21 mL/min/1.73m2) and poor precision of the CKD-EPI equation in the 18-20 year age group, compared to CKiD in the 16-18 year age group (bias=-2.7 mL/min/1.73m2), resulting in a mean change of 23 mL/min/1.73m2 at the transition to adult care. Averaging the CKiD and CKD-EPI estimates in young adults only partially mitigated this issue. The Full Age Spectrum equation (with and without height), the Lund-Malmö Revised equation, and an age-dependent weighted average of CKiD and CKD-EPI resulted in much smaller changes in eGFR at the transition (change of 0.6, -2.1, -0.9 and -1.8 mL/min/1.73m2, respectively). The longitudinal analysis revealed a significant difference in average GFR slope between mGFR and the KDIGO strategy (-2.2 vs. +2.9 mL/min/1.73 m2/year), which was not observed with the other approaches. These results suggest that the KDIGO recommendation for GFR estimation at the pediatric-adult care transition should be revisited.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Arend Bökenkamp
- Emma Children's Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ulla Berg
- Department of Clinical Science, Intervention, and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kajsa Åsling-Monemi
- Department of Clinical Science, Intervention, and Technology, Division of Pediatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Luciano Selistre
- Mestrado em Ciências da Saúde-Universidade Caxias do Sul Foundation, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil
| | - Laurence Dubourg
- Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Magnus Hansson
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Karin Littmann
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ian Jones
- Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Per Sjöström
- Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Ulf Nyman
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Malmö, Sweden
| | - Pierre Delanaye
- Nephrology-Dialysis-Transplantation, University of Liège, Centre Hospitalier Universitaire du Sart Tilman, Liège, Belgium
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Ortiz A, Vinck C. The new Clinical Kidney Journal, 4 years later. Clin Kidney J 2019; 12:1-5. [PMID: 30746126 PMCID: PMC6366135 DOI: 10.1093/ckj/sfy139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022] Open
Abstract
The February 2015 issue of ckj started a new era with renewed efforts to be useful to the training and practicing nephrologists and a new focus on Clinical and Translational Nephrology. Four years later, it has become a truly global journal with contributors and readers from all over the world. The increase in quality of the published material has resulted in a nearly exponential growth of citations. Since 2016, ckj is listed in the new Emerging Sources Citation Index (ESCI) database from Clarivate Analytics and from January 2019 it will be listed in the full Science Citation Index. ckj will therefore receive its first official impact factor based upon 2018 citation to 2016 and 2017 articles. While no official impact factor was awarded for 2017, the estimated impact factors calculated from data available in Clarivate's Web of Science database rose to 2.987 in 2017, which would correspond to an estimated journal impact factor percentile of 72.4% in the Urology and Nephrology field.
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Affiliation(s)
- Alberto Ortiz
- Editor-in-Chief, Clinical Kidney Journal, IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN, Madrid, Spain
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