US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States

Prediction of intradialytic hypotension based on heart rate variability and skin sympathetic nerve activity using LASSO-enabled feature selection: a two-center study

BACKGROUND

Intradialytic hypotension (IDH) is a prevalent complication during hemodialysis (HD). However, conventional predictive models are imperfect due to multifaceted etiologies underlying IDH.

METHODS

This study enrolled 201 patients undergoing maintenance HD across two centers. Seventy percent of the patient cohort was randomly allocated to the training cohort (n = 136), while the remaining 30% formed the validation cohort (n = 65). IDH was defined as a reduction in systolic blood pressure (SBP) ≥20 mmHg or mean arterial pressure (MAP) ≥10 mmHg. Clinical data and autonomic nervous parameters, including skin sympathetic nerve activity (SKNA) and heart rate variability (HRV) during the initial 30 min of HD, were employed to construct the model. The least absolute shrinkage and selection operator (LASSO) regression facilitated variable selection associated with IDH. Subsequently, a multivariable logistic regression model was formulated to predict the risk of IDH and establish the nomogram.

RESULTS

Sixty-six baseline features were included in the LASSO-regression model. In the final multivariable logistic regression model, 5 variables (SBP0, aSKNA0, △aSKNA0-30, SDNN0, △SDNN0-30) were incorporated into the nomogram. The AUC was 0.920 (95% CI, 0.878-0.962) in the training cohort and 0.855 (95% CI, 0.763-0.947) in the validation cohort, indicating concordance between the nomogram prediction and actual observation of IDH.

CONCLUSION

The LASSO-enabled model, based on clinical characteristics and autonomic nervous system parameters from the first 30 min of HD, shows promise in accurately predicting IDH.

The combination of left ventricular ejection fraction and end-diastolic diameter and outcomes in peritoneal dialysis patients: a multicenter retrospective study

End-stage renal disease (ESRD) is often complicated by left ventricular dysfunction, which is associated with a poor prognosis. This study aims to investigate the association between baseline left ventricular ejection fraction (LVEF) plus left ventricular end-diastolic diameter (LVEDD) with outcomes in peritoneal dialysis (PD) patients. In this multicenter retrospective study, 1,511 incident Chinese patients on PD between 1 January 2005 and 31 December 2021 were enrolled. Restricted cubic splines (RCS) were used to explore the non-linear associations between LVEF+LVEDD and the risk of mortality. Parametric models for interval-censored survival-time data (stintreg) were used to examine the association between LVEF+LVEDD quartiles and the outcomes. During 6,451.11 person-years of follow-up [median 4.81 (IQR 3.61-6.81) years], 247 (17.8%) patients died, including 88 cardiovascular deaths. RCS showed a U-shaped association between LVEF+LVEDD and the risks of all-cause and CV mortality. According to the quartiles, the optimal range of LVEF+LVEDD associated with the lowest risk of all-cause and CV mortality was 103-107, which was set as the reference range. Both higher (≥115) and lower (<103) levels of LVEF+LVEDD were associated with increased risks of all-cause mortality (hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.58-3.07; HR 1.68, 95% CI 1.19-2.36) and cardiovascular mortality (HR 2.51, 95% CI 1.33-4.75; HR 1.86, 95% CI 0.96-3.61). Low and high levels of baseline LVEF+LVEDD were associated with increased risks of all-cause and cardiovascular mortality in PD patients.

Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of studies from China

OBJECTIVES

To systematically evaluate and meta-analyze the performance, validity, and influencing factors of frailty risk prediction models specifically developed for patients undergoing maintenance hemodialysis in China.

METHODS

China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, SinoMed, PubMed, Web of Science, Cochrane Library, CINAHL and Embase were searched from inception to October 10, 2024. Two independent reviewers conducted literature screening, data extraction, and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed to pool the incidence rates and identify independent predictors.

RESULTS

Fourteen studies incorporating 16 distinct frailty risk prediction models were included. The predictive accuracy, measured by the area under the receiver operating characteristic curve (AUC), ranged from 0.819 to 0.998. Seven studies performed internal validation, one study executed external validation, and one study conducted both internal and external validation. All studies exhibited a high overall risk of bias. Pooled incidence of frailty among maintenance hemodialysis patients was 32.2% (95% CI: 26.9%-37.6%). Significant predictors of frailty included advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression (p < 0.05).

CONCLUSIONS

The pooled incidence of frailty among maintenance hemodialysis patients was notably high at 32.2%, with advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression emerging as significant predictors. Existing frailty prediction models for maintenance hemodialysis patients demonstrated robust predictive capacity but exhibited substantial methodological limitations, high bias and limited external validation. Future research should prioritize multicenter, large sample, validation studies to enhance applicability and reliability.

Cardiovascular and renal outcomes between sodium-glucose cotransporter 2 inhibitors and dipeptidyl peptidase 4 inhibitors in patients with chronic kidney disease stages 4 and 5: a population-based study

AIMS

Limited evidence exists regarding the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in cardiovascular and renal outcomes in patients with advanced chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) < 30 mL/min per 1.73 m2.

METHODS

We enrolled patients with type 2 diabetes mellitus and eGFR < 30 mL/min per 1.73 m2 who were prescribed SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i) from 2016 to 2022 (n = 117,924). The primary cardiovascular outcomes included cardiovascular death, myocardial infarction, ischemic stroke, and heart failure-related admission. Renal outcomes encompassed an eGFR decline of >50 %, a doubling of serum creatinine levels, and progression to dialysis.

RESULTS

The study included 6,730 participants [SGLT2i, n = 1,086; DPP4i, n = 5,644]. In both groups, the composite cardiovascular events developed at a rate of 13.2 events per 100 person-years (PYs) [hazard ratio (HR), 0.92; 95 % confidence interval (CI) 0.71-1.19]. The composite of renal events occurred at a rate of 18.5 and 16.2 events per 100 PYs in the SGLT2i and DPP4i groups, respectively [subdistribution HR 1.12; 95 % CI 0.91-1.38].

CONCLUSIONS

Compared to DPP4i, SGLT2i did not show superiority in the reduction of cardiovascular or renal events in CKD stage 4-5 patients.

Systemic outcomes of symptomatic peripheral artery disease patients with end-stage renal disease undergoing lower limb endovascular treatment: a propensity score-matched analysis

BACKGROUND

This study investigates the impact of end-stage renal disease (ESRD) on systemic and localized outcomes in peripheral artery disease (PAD) patients following endovascular therapy (EVT), with a focus on major adverse cardiac and cerebrovascular events (MACCEs).

METHODS

This retrospective cohort study included symptomatic PAD patients, categorized by the Rutherford classification, who underwent EVT at a single tertiary medical center from May 2018 to May 2021. Patients were divided into ESRD and non-ESRD groups. A propensity score-matched (PSM) analysis was performed to minimize confounding factors. The primary outcome was the occurrence of MACCEs, while the secondary outcome was the incidence of major adverse limb events (MALEs).

RESULTS

ESRD patients exhibited significantly worse systemic outcomes, with higher MACCE rates compared to non-ESRD patients in both the entire cohort (79.9% vs. 39.9%; HR: 2.69; 95% CI: 1.80-4.02; p < 0.001) and the matched cohort (HR: 3.88; 95% CI: 2.30-6.53; p < 0.001). They also had higher rates of all-cause mortality and myocardial infarction (MI). For localized outcomes, MALEs were more frequent in the ESRD group in the entire cohort (61.0% vs. 34.9%; HR: 1.84; 95% CI: 1.22-2.76; p < 0.001), but no significant difference was observed in the matched cohort (HR: 1.23; 95% CI: 0.76-1.99; p = 0.40). ESRD was identified as the sole independent predictor of increased MACCE risk (HR: 2.49; 95% CI: 1.65-3.75; p < 0.001).

CONCLUSIONS

PAD patients with ESRD face significantly worse systemic outcomes, particularly elevated MACCE rates, after EVT. Preventing MACCEs, especially MI, is essential in this high-risk population. Despite more severe limb conditions, ESRD alone did not significantly increase MALE risk after PSM.

CLINICAL TRIAL NUMBER

Not applicable.

Meticulous catheter care and aseptic approach reduce catheter-related bloodstream infections significantly in hemodialysis patients: A 5-year single center study

AIM

The use of central venous catheters as hemodialysis vascular access is a major contributor to high bloodstream infection rate. In our dialysis unit in Shenzhen Guangdong Province China, we have developed and used our own dialysis catheter care protocol since May 2013 with good results. In this study, we would like to share our experience with the other units.

METHODS

We have undertaken a 5-year retrospective analysis to determine our tunneled dialysis catheter-related blood stream infection rate by adding the number of infections divided by total number of catheter days × 1000. The results were compared with another study carried out in Henan Province China. Demographic data were summarized using descriptive statistics. Continuous and categorical variables were compared using t-test and χ2 test respectively.

RESULTS

Between 2017 and 2021, a total of 216 tunneled dialysis catheters were managed by following our own dialysis access pathway and catheter care protocol. The tunneled dialysis catheter-related bloodstream infection rate was 0.0229 per 1000 catheter days in the 5-year period.

CONCLUSION

Comparing with other published studies in China, our unit has achieved a very low rate of tunneled dialysis catheter-related bloodstream infection which has been sustained over time. This paper explores how our protocol and implementation might have contributed to the results.

Acquired cystic kidney disease in children with kidney failure

BACKGROUND

This study aimed to evaluate the incidence, contributing factors, and clinical outcomes of acquired cystic kidney disease (ACKD) in children undergoing kidney replacement therapy (KRT).

METHODS

We conducted a cross-sectional, territory-wide study at the designated pediatric nephrology center in Hong Kong. ACKD was defined as the presence of ≥ 3 cysts in the native kidneys, excluding congenital or hereditary cystic diseases. Between June to December 2023, all paediatric patients receiving KRT in Hong Kong underwent ultrasonography, non-contrast magnetic resonance imaging (MRI), or both. Contrast-enhanced computed tomography was performed for patients with complex cysts.

RESULTS

Forty-three children (56% female; median age 14.7 years; IQR, 11.7-18.7) were included in the analysis. ACKD was detected in 18 children (42%). Nine subjects had complex cysts (grade 2, n = 5; grade 2F, n = 2; grade 3, n = 2). Most patients with ACKD (89%) were asymptomatic. One patient (5.5%) developed back pain and gross haematuria 72 months after initiation of KRT. Another patient (5.5%) developed infected cyst with back pain and clinical sepsis 60 months following KRT initiation. A dialysis duration of ≥ 28 months was the only significant factor associated with ACKD development (77.8% vs. 40%; p = 0.028; ORadj 6.09, 95% CI 1.43-25.82, p = 0.014). The diagnostic yield of paired ultrasound and MRI was superior to ultrasound alone.

CONCLUSIONS

ACKD is prevalent among children and adolescents with kidney failure, with most cases being asymptomatic, however serious complications may arise. Longer duration of dialysis is significantly associated with ACKD development. Therefore, early transplantation and active ACKD surveillance are crucial for children receiving KRT.

Lipid and immunophenotypic profiles in hemodialysis patients with citrate vs. acetate dialysates

Background

Chronic kidney disease (CKD) is a significant cardiovascular (CV) risk factor, with dialysis-dependent CKD (DD-CKD) patients facing high mortality rates. Hypercholesterolemia is another crucial CV risk factor, typically managed with lipid-lowering therapy, though its efficacy in DD-CKD remains uncertain. Evidence shows mixed results regarding the benefits of statins in these patients. Citrate-based dialysates are known to reduce inflammatory biomarkers compared to acetate-based ones, potentially impacting lipid profiles and immune responses. This study aimed to determine the effects of citrate vs. acetate dialysate on lipid profiles and immunophenotypes in DD-CKD patients.

Methods

This unicentric, cross-over, prospective study included 21 hemodialysis patients (10 males, 11 females, average age 62.25 years). Each patient underwent 24 dialysis sessions (12 with each dialysate) and acted as their own control. Lipid profiles, immunological parameters, and nutritional and inflammatory markers were measured before the last session with each dialysate.

Results

After twelve dialysis sessions with citrate dialysate (CD), compared to acetate dialysate (AD), there was a statistically significant decline in TG and remnant cholesterol, with a decrease in HDL and an increase in LDL. Regarding immunology, C3 complement levels were higher, while CD3+ CD8+ and CD16+ 56+ lymphocytes were lower. Finally, total lymphocytes were lower with AD than with CD. We found no difference in predialysis nutritional nor inflammatory parameters except for ESR, which was higher when subjects used CD than AD.

Conclusion

There are significant differences in lipid and immunophenotypic profiles with CD in comparison to AD. Interestingly, there could be an advantageous profile given the reduced amount of remnant cholesterol and TG. However, further studies are needed to understand if the observed changes lead to beneficial hard clinical outcomes in DD-CKD patients.

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

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

A machine learning-based nomogram for predicting graft survival in allograft kidney transplant recipients: a 20-year follow-up study

Background

Kidney transplantation is the optimal form of renal replacement therapy, but the long-term survival rate of kidney graft has not improved significantly. Currently, no well-validated model exists for predicting long-term kidney graft survival over an extended observation period.

Methods

Recipients undergoing allograft kidney transplantation at the Organ Transplantation Center of the First Affiliated Hospital of Kunming Medical University from 1 August 2003 to 31 July 2023 were selected as study subjects. A nomogram model was constructed based on least absolute selection and shrinkage operator (LASSO) regression, random survival forest, and Cox regression analysis. Model performance was assessed by the C-index, area under the curve of the time-dependent receiver operating characteristic curve, and calibration curve. Decision curve analysis (DCA) was utilized to estimate the net clinical benefit.

Results

The machine learning-based nomogram included cardiovascular disease in recipients, delayed graft function in recipients, serum phosphorus in recipients, age of donors, serum creatinine in donors, and donation after cardiac death for kidney donation. It demonstrated excellent discrimination with a consistency index of 0.827. The calibration curves demonstrated that the model calibrated well. The DCA indicated a good clinical applicability of the model.

Conclusion

This study constructed a nomogram for predicting the 20-year survival rate of kidney graft after allograft kidney transplantation using six factors, which may help clinicians assess kidney transplant recipients individually and intervene.

Prolyl hydroxylase inhibitor desidustat improves stroke outcomes via enhancing efferocytosis in mice with chronic kidney disease

Patients with chronic kidney disease (CKD) are at a significantly increased risk of stroke and experience worse stroke outcomes and higher mortality. CKD exacerbates stroke risk and severity through a complex interplay of systemic inflammation, oxidative stress, and impaired clearance of uremic toxins, leading to neuroinflammation and microglial activation. Current acute ischemic stroke treatments, while effective in the general population, do not adequately address CKD-specific mechanisms, limiting their efficacy in this high-risk population. Prolyl hydroxylase domain (PHD) inhibitors have shown promise in treating anemia associated with CKD and may offer cerebroprotective benefits. However, the effects of PHD2 inhibition on long-term sensorimotor outcomes and the underlying mechanisms in mice with CKD remain largely unknown. Here, we investigated the impact of CKD on stroke severity and assessed the therapeutic potential of desidustat, a PHD inhibitor, in improving stroke outcomes. Using an adenine-induced CKD mouse model, we demonstrated that CKD exacerbated stroke-induced long-term sensorimotor deficits, increased neuroinflammation, and impaired microglial efferocytosis via dysregulation of the ADAM17-MerTK axis. Desidustat treatment in mice with CKD significantly improved long-term sensorimotor functional outcomes and reduced post-stroke neuroinflammation while enhancing microglial efferocytosis by reducing ADAM17 and enhancing microglial MerTK expression. In vitro studies using human-induced microglia-like cells further confirmed the ability of desidustat to enhance efferocytosis of apoptotic neurons by reducing the cleavage of MerTK. These findings suggest that desidustat may serve as a novel therapeutic strategy for improving stroke outcomes in patients with CKD, a population at high risk for stroke and poor functional recovery.

Trends and Disparities in the Burden of Chronic Kidney Disease due to Type 2 Diabetes in China From 1990 to 2021: A Population-Based Study

BACKGROUND

This study analyzes the trends in the burden of chronic kidney disease due to type 2 diabetes (CKD-T2D) in China from 1990 to 2021, evaluates variations in risk factors, and projects the disease burden through 2036.

METHOD

Estimates of prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for CKD-T2D were retrieved along with their 95% uncertainty intervals (UIs). Age-period-cohort analysis was used to assess burden trends from 1990 to 2021, identify risk factor population attributable fractions (PAFs), and project the burden through 2036.

RESULTS

In 2021, there were 20 911 520 CKD-T2D cases in China, with an age-standardized prevalence rate (ASPR) of 1053.92 per 100 000, an incidence rate (ASIR) of 23.07, an age-standardized mortality rate (ASMR) of 5.72, and an age-standardized DALY rate (ASDR) of 122.15. Although the overall burden showed a slow decline from 1990 to 2021, incidence continued to rise. The 2021 data revealed a marked age effect, with the burden rising with age. Period effects also contributed to an increased risk, with metabolic risk factors such as high fasting plasma glucose and BMI contributing the most. Projections suggest a decline in mortality and DALYs by 2036, while incidence will keep increasing.

CONCLUSION

Despite declines in ASMR and ASDR, CKD-T2D incidence and cases continue to rise, especially among males and the elderly. This increasing burden is driven by aging and metabolic risk factors. Early screening, education, and risk management are essential for addressing CKD-T2D in China.

GABP Promotes Mesangial Cell Proliferation and Renal Fibrosis Through GLI1 in Diabetic Nephropathy

Abnormal proliferation of mesangial cells is a hallmark of diabetic nephropathy (DN). However, the cellular signaling mechanisms that regulate this proliferation remain poorly understood. In this study, it is demonstrated that GA-binding protein (GABP), a member of the ETS family of transcription factors composed of GABPα and GABPβ, plays a significant role in the development of renal fibrosis by modulating mesangial cell proliferation. Notably, the deficiency of GABP in mesangial cells inhibits hyperglycemia-induced proliferation and mitigates renal fibrosis in a murine model of type 2 diabetes mellitus (T2DM). RNA sequencing analysis identifies GLI Family Zinc Finger 1 (GLI1) as the principal downstream effector of GABP in diabetic mice, serving as a crucial regulator of the G1/S transition within the cell cycle. Subsequent investigations have demonstrated that GABP interacts with the GLI1 promoter, facilitating mesangial cell proliferation via GLI1-dependent pathways. This is evidenced by the fact that GLI1 knockdown abrogates the proliferation of mesangial cells with GABP overexpression. Consequently, GABP emerges as a pivotal regulator of renal fibrosis and represents a promising therapeutic target for the treatment of diabetic nephropathy.

Baroreflex Sensitivity and Hemodynamic Parameters at Rest and in Response to Physical and Mental Stress: A Comparative Study of Patients Undergoing Different Dialysis Modalities

Introduction Cardiac arrhythmias are the leading mortal cause of end-stage kidney disease (ESKD), and autonomic dysfunction plays a predominant role. This is the first study to compare baroreflex sensitivity (BRS) and hemodynamic responses at rest and after mental and physical stimulation maneuvers between hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods A total of 68 ESKD patients (34 HD and 34 PD, matched for age, sex, and dialysis vintage) were included. Continuous recordings from Finometer-PRO at rest and during mental arithmetic, orthostatic, and handgrip exercise tests were used for the calculation of BRS and hemodynamic responses in each individual. Results The two groups were similar in terms of age, sex, dialysis vintage, and major comorbidities. BRS during mental (HD: 3.59±2.62 vs. PD: 5.50±9.40 ms/mmHg, p=0.280) and physical stress tests (orthostatic: HD: 3.23±2.42 vs. PD: 2.07±2.69 ms/mmHg, p=0.777) was similar between HD and PD patients. During the mental test, both groups presented increases in systolic (SBP) and diastolic blood pressure (DBP) levels compared to rest (SBP HD: 156.3±27.7 vs. 142.7±20.0 mmHg, p<0.05; PD: 158.0±25.6 vs. 143.1±23.6 mmHg, p<0.05), but without significant between-group differences (p=0.853/p=0.611). Similarly, no significant between-group differences were noted in the other hemodynamic parameters. Mean SBP levels during the orthostatic test were significantly decreased compared to rest in both groups (HD: 135.4±26.8 vs. 142.2 ±20.1 mmHg; p<0.05; PD 135.3±21.9 vs. 143.1±23.6 mmHg; p<0.05), but the overall response was not different between groups (p=0.937). Finally, the hemodynamic responses during handgrip exercise and recovery did not differ between HD and PD. Conclusions BRS and hemodynamic responses to mental and physical stress tests were similar between HD and PD patients, suggesting that the function of the autonomic nervous system (ANS) in ESKD is not affected by dialysis modality.

Epidemiology and disparities of gender-affirming surgery in the United States

BACKGROUND

Several advances have been made to increase access to gender-affirming procedures across the country, yet it remains unknown whether these benefits are experienced disproportionately across demographics. The purpose of this study was to investigate the epidemiologic trends of gender-affirming surgery across the country over the past six years, as well as to analyze the racial and ethnic disparities in immediate postoperative complications for patients undergoing gender-affirming surgery nationwide.

METHODS

Retrospective cohort study was conducted of gender-affirming procedures performed in the United States between 2015 and 2020 across 719 hospitals participating in the National Surgical Quality Improvement Program. Age at surgery, type of reconstruction, and postoperative complications were compared across demographic groups.

RESULTS

During the study interval, 4491 patients underwent gender-affirming surgery, including 71.1% (n=3221) masculinizing procedures and 28.3% (n=1270) feminizing procedures. Over the last five years, there has been a fourfold increase in gender-affirming surgery, from 299 per million to 1029 per million cases performed in the United States (p<.001). Transmasculine patients were ten years younger than transfeminine patients (p<.001). While masculinizing procedures were the most common across all demographics, Black and Hispanic patients were significantly more likely to undergo feminizing procedures than White patients (p<.001). Black patients were significantly older than White patients at the time of surgery. Black patients were significantly more likely than White patients to experience postoperative surgical complications (p=.039).

CONCLUSIONS

Racial and ethnic disparities exist in gender-affirming surgery preference, timing, and postoperative outcomes.

The Association Between Lifestyle and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis: A 3-year Prospective, Observational Study

Purpose

Lifestyle is one of the important factors affecting health. There are few studies that comprehensively analyze the impact of a combination of lifestyle factors on mortality in patients undergoing maintenance hemodialysis. So, to measure the association between lifestyle factors and mortality for patients undergoing maintenance hemodialysis.

Patients and Methods

A prospective, observational study design was employed. Through convenience sampling, the patients who are over 18 years old and have undergone dialysis for at least 3 months, from the hemodialysis center outpatient in two hospitals of Xi'an were selected. The questionnaires of this study include sociodemographic characteristics and lifestyle-related scales, such as nutrition, sleep and self-management scales. The differences between the deceased group and the surviving group were analyzed using the t-test or Mann-Whitney tests and chi-square tests. Logistic regression analysis was applied to identify the association between lifestyle factors and mortality.

Results

In this study, 286 patients who completed the questionnaire were screened. During the follow-up of this 3 years, patients who transferred to another hospital (n=31), kidney transplantation (n=6) and termination of dialysis (n=13) were excluded. Finally, 236 participants were tracked to the final outcome. Of these 236 patients, 66.95% were men. The proportion of patients under 60 years old is slightly higher than that of patients over 60 years old. More than half (64.83%) of the patients have a lower education level. And the main primary disease of ESRD was diabetic nephropathy (39.83%). Through a 3-year follow-up study, 73 patients died, accounting for 30.93%. The results showed that compared with surviving patients, deceased patients had significantly lower scores of self-management (Z=-2.09, P=0.036) and higher scores of malnutrition-inflammation score (Z=-2.31, P=0.021). Moreover, deceased patients had a significantly higher proportion of poor sleepers (χ2=4.38, P=0.036) and No exercise (χ2=5.16, P=0.023). However, there were no statistically significant differences in BMI, smoking history and drinking history between the two groups. In logistic analyses, age (χ2=19.63, P<0.001, OR=0.26, 95% CI=0.14~0.47) and self-management score (χ2=3.82, P=0.051, OR=1.03, 95% CI=1.00~1.06) were major factors related to mortality.

Conclusion

Self-management and age are closely related to the mortality rate of patients. And our study showed that the relationship between self-management and mortality is strongest, so doctors and nurses at dialysis centers should pay more attention to and actively improve self-management level of patients undergoing maintenance hemodialysis.

Frequent In-Center Hemodialysis: Who Can Benefit From a Frequent Dialysis Approach?

Frequent (a.k.a daily hemodialysis) has continued to spark interest in the nephrology community as a way to possibly improve outcomes for the end-stage renal disease population. This is a patient population with a very high disease burden and mortality rate. The concept of dialysis adequacy in its current form has consolidated mainly around three times weekly dialysis, which has become the worldwide accepted standard. The current drive to encourage more home hemodialysis (which is a frequent dialysis regimen) has made the lessons from daily in-center hemodialysis more relevant. Frequent hemodialysis has been shown in both observational and randomized controlled studies to have some cardiovascular, mineral metabolism, and quality of life benefits. Some of what is learned from this body of literature is applicable today with increasing emphasis on home hemodialysis. This review will focus on the benefits and potential harms of daily hemodialysis to assist the practitioner in shared decision making with patients about the expected benefits and drawbacks of frequent in-center dialysis and what the expected goals should be for a frequent dialysis regimen.

Higher Dietary Inflammatory Index and Systemic Immune-Inflammation Index Score are Associated With Higher Risk of Chronic Kidney Disease: Analysis of the National Health and Nutrition Examination Survey From 1999 to 2018

OBJECTIVE

Chronic kidney disease (CKD) is characterized by a gradual decline in kidney function over time. The role of dietary inflammatory index (DII) and systemic immune-inflammation index (SII) in individuals with CKD remains uncertain. We aimed to explore the potential correlation between DII and SII with the prevalence of CKD in adult Americans.

METHODS

This cross-sectional study used data from the National Health and Nutrition Examination Study between 1999 and 2018. The DII was calculated based on the 24-hour dietary history interview, while the SII was calculated as the product of platelet count multiplied by neutrophil count and divided by lymphocyte count. CKD was diagnosed based on impaired glomerular filtration rate (<60 mL/min per 1.73 m2) or urinary albumin-creatinine ratio ≥30 mg/g. Multivariable logistic regression analyses and subgroup analyses were performed to examine the association between DII/SII and CKD.

RESULTS

In total, this study included 40,388 participants, of whom 7443 (18.4%) had CKD. The prevalence of CKD changed from 14.84% (95% confidence interval (CI): 13.20-16.48%) in 1999-2000 to 12.76% (95% CI: 11.10-14.43%) in 2017-2018. According to adjusted multivariate logistic regression models, individuals with higher DII scores had a higher likelihood of having CKD (odds ratio = 1.24; 95% CI: 1.12-1.37). Similarly, higher SII scores were associated with a higher risk of CKD (odds ratio = 1.37; 95% CI: 1.25-1.50). Subgroup analyses further demonstrated relatively stronger associations between DII/SII and CKD among individuals with other factors such as sex, age, body mass index, smoking status, drinking status, hypertension, and diabetes.

CONCLUSIONS

The DII and SII scores were significantly positively associated with higher risks of CKD. Anti-inflammatory diet might have the potential to prevent CKD. The SII may serve as a cost-effective and straightforward approach for detecting CKD. Further prospective longitudinal studies are needed to verify the causality.

Baseline renal function modified the association between total, plant or animal protein intake and the risk of developing renal composite outcome in people with type 2 diabetes: a prospective cohort study [diabetes distress and care registry at Tenri (DDCRT25)]

AIMS

This study aimed to identify the longitudinal associations between protein intake, and composite renal outcomes in people with type 2 diabetes.

METHODS

To examine the association between baseline total, animal, and plant protein intake and the risk of developing a composite renal outcome in 3,109 Japanese people with type 2 diabetes who participated in a cohort study at a tertiary care hospital, we used a Cox proportional hazards model.

RESULTS

During a median follow-up of 6.0 years, we observed 185 renal outcomes. Compared with the 1st quintile, the multivariable-adjusted HRs for outcome were 1.13 (p = 0.440), 1.04 (pp= 0.874), 1.40 (p = 0.215), and 2.16 (p = 0.001), respectively for the 2nd to 5th quintile of total protein intake, and 0.93 (p = 0.681), 1.1 (p= 0.596), 1.1 (p = 0.607), and 2.02 (p < 0.001), respectively for the 2nd to 5th quintile of animal protein intake. However, a significant association of total plant intake was not observed. In the analysis evaluating the joint association between protein intake and composite renal outcome with baseline estimated glomerular filtration ratio (eGFR), total protein and animal protein intake were substantially associated with a higher risk of composite renal outcome when the baseline eGFR was below approximately 60 mL/min/1.732.

CONCLUSIONS

Baseline total protein intake is associated with a higher risk of developing a composite renal outcome during follow-up in people with type 2 diabetes and low baseline eGFR, and this association may be elucidated by a higher animal protein intake. Plant protein was not associated with renal outcome.

Remote monitoring of automated peritoneal dialysis reduces mortality, adverse events and hospitalizations: a cluster-randomized controlled trial

BACKGROUND

Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevents complications and improves treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease, fluid overload and insufficient dialysis efficiency.

METHODS

In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: (i) Composite Index 1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and (ii) Composite Index 2 comprising cardiovascular mortality, first adverse event and hospitalizations related to cardiovascular disease, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing risk analysis and restricted mean survival time (RMST) analysis.

RESULTS

While time to reach Composite Index 1 did not differ between the groups, Composite Index 2 was reached earlier (ΔRMST: -0.86 months; P = .02), and all-cause mortality [55 vs 33 deaths, P = .01; sub-hazard ratio (sHR) 1.69 (95% confidence interval 1.39-2.05), P < .001] and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths [24 vs 13 deaths, P = .05; sHR 2.44 (95% confidence interval 1.72-3.45), P < .001] and rates of adverse events and hospitalizations related to cardiovascular disease, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs 110, P = .048).

CONCLUSIONS

This randomized controlled trial shows that RM may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy.

Cost-Effectiveness Analysis of a Novel Fetal Vesicoamniotic Shunt-The Vortex Shunt

OBJECTIVE

We estimated the potential outcomes, costs, and cost-effectiveness of the Vortex shunt, a novel fetal vesicoamniotic shunt (VAS), compared to standard shunts for treating fetal lower urinary tract obstruction (LUTO).

METHOD

We designed a decision-analytic model comparing the Vortex shunt to current shunts using a theoretical cohort of 1000 pregnancies equivalent to the annual U.S. LUTO cases. Current literature indicates a 50% dislodgement risk and a 36% end-stage renal disease (ESRD) probability for current shunts versus the Vortex shunt's expected 10% dislodgement risk and 18% ESRD rate from pre-clinical studies. Outcomes included preterm delivery, preterm premature rupture of membrane (PPROM), ESRD, neurodevelopmental delay (NDD), neonatal death, costs, and quality-adjusted life years (QALYs). We derived model inputs from the literature and conducted sensitivity analyses.

RESULTS

Of 1000 theoretical LUTO pregnancies, the Vortex shunt resulted in 70 fewer cases of ESRD, 110 fewer preterm deliveries, 50 fewer episodes of PPROM, and 10 fewer children with NDD. The Vortex shunt was the dominant strategy with higher QALYs and estimated lifetime savings of $168,520 for each fetus undergoing VAS. The Vortex shunt was cost-effective 98% of the time.

CONCLUSION

Our theoretical model suggests that the Vortex shunt is cost-effective compared to current shunts.

The association between systolic and diastolic dysfunction and autonomic nervous system function in children receiving chronic hemodialysis

BACKGROUND

Changes in cardiac function and structure as well as their association with the cardiac autonomic nervous system remain incompletely characterized in children with stage 5 chronic kidney disease (CKD) receiving hemodialysis (HD).

METHODS

A prospective observational cohort study was conducted on 40 Egyptian children with CKD on regular HD compared to 40 age- and sex-matched healthy children. All participants underwent thorough clinical examination, laboratory investigations, 24-h Holter monitoring, and 2D/4D echocardiographic study (conventional and advanced modalities). Participants were followed for mortality and morbidity over 36 months.

RESULTS

Following HD sessions, CKD children showed significant reductions of left and right ventricular (LV/RV) systolic function by 2D and 4D echocardiography compared to controls. HD children had significant impairment of heart rate variability parameters (evaluated by time and frequency domains). LV/RV global longitudinal shortening (GLS) as well as tricuspid annular plane systolic excursion were closely correlated with different Holter parameters, including frequency domain parameters (including low frequency, high frequency, and LF/HF ratio), time domain parameters including percentage of differences > 50 ms between consecutive normal RR intervals (pNN50), and root-mean-square of the difference between successive normal intervals (rMSSD). Over a follow-up of 34.5 ± 16.8 months, 10 (25%) patients died. Reduced LV/RV-GLS and decreased rMSSD values were independently associated with higher mortality among HD children.

CONCLUSIONS

LV and RV myocardial deformation (either 2D or 4D) primarily decreased in HD children. Altered time and frequency domain indices revealed cardiac autonomic dysfunction, evidenced by increased sympathetic activity and decreased vagal activity. Reduced LV/RV-GLS and decreased rMSSD values were independently associated with higher mortality among HD children.

Chronic kidney disease progression in patients with previous type 2 diabetes and/or hypertension: a population-based cohort study from primary care in Spain

OBJECTIVES

To evaluate whether between hypertension and type 2 diabetes (T2D)-established drivers of chronic kidney disease (CKD) progression-one might be more strongly associated with CKD progression than the other.

DESIGN

Cohort study using a primary care database (electronic health records).

SETTING

Primary care in Catalonia, Spain.

PARTICIPANTS

438 273 patients with CKD identified from the Information System for Research in Primary Care database in Catalonia (2007-2017) and stratified into four mutually exclusive groups based on the presence/absence of hypertension and/or T2D. Distribution of the CKD study cohort was as follows: CKD with hypertension (51.1%), CKD with T2D (3.9%), CKD with hypertension and T2D (32.8%), CKD without hypertension and T2D (12.2%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Patients were followed up to identify the occurrence of severe kidney impairment (SKI) and kidney failure (kidney replacement therapy/estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2). Subdistributional hazard ratios (sHRs) were estimated using Cox regression adjusted for confounders.

RESULTS

Compared with the CKD without hypertension and T2D group, adjusted sHRs (95% CIs) for SKI/kidney failure were 1.77 (1.65 to 1.89) for CKD with hypertension and T2D, 1.50 (1.41 to 1.59) for CKD with hypertension and 1.21 (1.09 to 1.34) for CKD with T2D, and for kidney failure were 1.24 (1.10 to 1.39) for CKD with hypertension, 0.74 (0.61 to 0.90) for CKD with T2D and 1.09 (0.96 to 1.24) for CKD with hypertension and T2D. The strongest risk factors for CKD progression were low eGFR and albuminuria, even at mild-moderate levels.

CONCLUSIONS

Hypertension could be associated with an equal/greater risk of CKD progression as T2D. Efforts to slow CKD progression should target both patients with hypertension and T2D, focusing on the identification, close monitoring and effective management of albuminuria and reduced eGFR.

Type of arrhythmias and the risk of sudden cardiac death in dialysis patients: a systematic review and meta-analysis

BACKGROUND

Patients on long-term dialysis for end-stage kidney disease have a high mortality rate, predominantly due to sudden cardiac death (SCD), which is associated with an increased risk of arrhythmias compared to the general population. Thus, the current systematic review and meta-analysis aimed to investigate the incidence of SCD among dialysis patients at risk of arrhythmia.

METHODS

This systematic review and meta-analysis followed the PRISMA guidelines. PubMed, Cochrane Library, Google Scholar, Medline, and Europe PMC were searched for articles meeting our inclusion criteria. Studies with risk assessment of arrhythmias and the incidence of SCD in dialysis patients were considered for inclusion. Effect size from eligible studies was pooled using a random effects model and restricted maximum likelihood estimation. Heterogeneity was quantified using the I2 statistic, and the risk of publication bias was evaluated by visually inspecting funnel plots.

RESULTS

Our search strategy yielded 5861 studies, of which 1960 duplicate entries were removed in the prescreening stage, 3326 were excluded after title/abstract screening, and 519 after full-text screening for not meeting our inclusion criteria. Finally, 11 studies were included in the analysis, and two more were selected from the bibliography list of previous reviews. Eight included studies were randomized controlled trials, and five were cohort studies, which provided a pooled population size of 12,611 dialysis patients for the meta-analysis, which indicated a significantly larger effect size of arrhythmia [Cohen's d = 110.38 (95%CI 42.72-178.05), p = 0.0]. Visual assessment of the funnel plot indicated no publication bias.

CONCLUSION

SCD remains a significant public health concern, particularly in patients undergoing dialysis. Meta-analysis results show that bradyarrhythmia is a common arrhythmic condition leading to SCD; however, other arrhythmias should also be considered.

A novel nomogram for predicting mortality risk in young and middle-aged patients undergoing maintenance hemodialysis: a retrospective study

Objectives

The annual growth in the population of maintenance hemodialysis (MHD) patients is accompanied by a trend towards younger age groups among new cases. Despite the escalating mortality risk observed in MHD patients, there remains a dearth of research focused on young and middle-aged individuals in this cohort, leading to a deficiency in specialized predictive instruments for this demographic. This research seeks to explore the critical determinants impacting mortality risk in young and middle-aged MHD patients and to construct a prediction model accordingly.

Methods

This study involved 127 young and middle-aged patients undergoing MHD in the Blood Purification Center of Chaohu Hospital of Anhui Medical University from January 2019 to January 2022. The follow-up period for each patient ended either at the time of death or on January 31, 2024. Participants were monitored to determine their survival status and categorized into two groups: those who survived (98 patients) and those who deceased (29 patients). Clinical data were gathered for analysis. Logistic regression was utilized to pinpoint independent risk factors for mortality among these patients. Subsequently, a nomogram was established to predict mortality risk. The efficacy of this model was assessed through the area under the receiver operating characteristic curve (AUC-ROC), alongside a calibration curve and the Hosmer-Lemeshow test to examine its fit. Additionally, decision curve analysis (DCA) was conducted to ascertain the clinical relevance of the predictive model.

Results

The study incorporated 127 young and middle-aged patients undergoing MHD, with a mortality rate recorded at 22.83% (29 cases). A logistic regression analysis revealed that age, hemoglobin (HB), serum magnesium (Mg), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-albumin ratio (PAR) were significant independent predictors of mortality among these patients. Utilizing these variables, a nomogram was developed to predict mortality risk, achieving an AUC of 0.899 (95% CI: 0.833-0.966). The model exhibited a specificity of 83.67% and a sensitivity of 82.76%, demonstrating substantial discriminative ability. The model's robustness was confirmed through internal validation with 1,000 bootstrap samples, yielding an AUC of 0.894 (95% CI: 0.806-0.949). The calibration curve closely aligned with the ideal curve, and the Hosmer-Lemeshow goodness-of-fit test yielded a χ 2 value of 6.312 with a p-value of 0.612, verifying the model's high calibration accuracy. Additionally, the DCA indicated that the model provides a net benefit across a wide range of decision thresholds from 0 to 0.99, underscoring its clinical utility.

Conclusion

The nomogram developed from variables including age, HB levels, serum Mg, NLR, and PAR exhibits high levels of discrimination and calibration. This model effectively predicts mortality risk among young and middle-aged patients undergoing MHD, proving its clinical relevance.

Marital status and risk of type 2 diabetes among middle-aged and elderly population: a systematic review and meta-analysis

Background

Marital status is among the factors influencing type 2 diabetes mellitus (T2DM). However, the precise relationship remains incompletely understood. This meta-analysis aims to evaluate the association between marital status and the incidence of T2DM.

Methods

A review and meta-analysis of observational studies were conducted to investigate the relationship between marital status and diabetes incidence. We searched three databases, including PubMed, Google Scholar, and Scopus, for relevant studies published up to August 16th, 2023. In our initial search, we identified a total of 358 articles. After a demanding screening process involving evaluating titles, abstracts, and full-text content, we ultimately included six studies for our meta-analysis.

Result

Comprising a total of 1,440,904 participants, our study found that in comparison to married individuals, unmarried participants exhibited a higher likelihood of developing diabetes [odds ratio (OR): 1.47, 95% confidence interval (CI): 0.88-2.45, I 2: 91%, p-value = 0.14]. Divorced participants had a reduced likelihood of developing diabetes compared to married participants (OR: 0.84, 95% CI: 0.77-0.91, I 2: 17%, p < 0.001). Similarly, widowed participants showed a lower risk of developing diabetes compared to divorced participants (OR: 0.35, 95% CI: 0.26-0.46, I 2: 83%, p < 0.00001).

Conclusion

This study provides strong evidence of links between marital status and type 2 diabetes risk. Unmarried individuals are more susceptible to T2DM, divorced individuals have a lower risk, and widowed individuals exhibit reduced T2DM risk. Further research should investigate underlying mechanisms and confounding factors.

Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Hemodialysis: An International, Multicentric Registry

BACKGROUND

The net benefit of oral anticoagulation in patients with end-stage renal disease on hemodialysis (HD) is uncertain. In recent years, left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation; however, there is scant evidence of LAAC in patients on HD.

OBJECTIVES

This study aimed to assess the feasibility and safety of LAAC in patients on HD.

METHODS

In an international multicenter registry, patients' baseline characteristics and procedural and follow-up data were recorded from all patients on HD with atrial fibrillation who underwent LAAC.

RESULTS

A total of 147 patients from 9 centers were included. The mean age was 72.6 ± 10.4 years; the mean CHA2DS2-VASc-score was 4.6 ± 1.5, and the mean HAS-BLED-score was 4.7 ± 1.1. Antithrombotic treatment regimens prior to implantation were notably diverse, encompassing more than 12 distinct combinations. Technical successful LAA at first procedure was achieved in 144 of 147 (98%) patients and major complications were observed in 4.7% (7 of 149 procedures). The median follow-up was 427 days (Q1-Q3: 184-797 days), no device-related thrombi were detected, and peridevice leaks ≥5 mm were 1.7% at first imaging control. The most common post-implantation antithrombotic therapy was single antiplatelet therapy with 165.9 patient-years (py). During follow-up of 222.9 py, the annual stroke rate was 0.9%, reflecting an 88% relative risk reduction (P < 0.001) compared to historical data. Similarly, the annual rate of major bleeding was 4.5%, signifying a 55% relative risk reduction (P = 0.023). Throughout follow-up, 29 deaths (19.9%) were recorded.

CONCLUSIONS

LAAC in end-stage renal disease patients on HD demonstrated an acceptable safety profile, coupled with a notably low incidence of strokes. This was paralleled by low bleeding rates.

A Novel Approach to Repositioning Peritoneal Dialysis Catheters

Introduction

Peritoneal dialysis (PD) is a crucial kidney replacement therapy for patients with end-stage kidney disease. Despite its advantages over hemodialysis (HD), long-term success can be hindered by catheter dysfunction, which often necessitates revision. Currently, surgical treatment methods for PD catheter malfunction include fluoroscopy-guided procedures and laparoscopic or open surgery to salvage or replace the catheter. Here, we introduce the first novel, minimally invasive surgery for repositioning PD catheters.

Methods

From November 2021 to May 2024, 8 patients with PD catheter dysfunction underwent this innovative procedure at the Department of Nephrology, Sichuan Provincial People's Hospital. Surgical Procedure: On the side of the original abdominal incision, blunt separation was used to find the PD catheter tunnel segment. The anterior rectus abdominal muscle sheath was incised, followed by separation of the deep polyester sleeve. The original catheter was exposed in the abdominal port or purse-string suture, and the intra-abdominal segment of the dialysis catheter was pulled out. Blunt cleaning around the periphery was performed to ensure that the PD catheter was smooth, and a rigid guidewire was placed through the intra-abdominal segment of the proximal end of the catheter of the first lateral hole. The intra-abdominal segment of the PD catheter was placed into the pelvis via the original catheter in the abdominal port. Clinical data were retrospectively collected, and patients were followed up for safety and efficacy assessment.

Results

In a study involving 8 patients, no significant complications were observed, with an immediate imaging success rate of 100% and a clinical PD catheter reset success rate of 75%. The catheter remained patent until the end of the study, with a mean follow-up time of 17.25 ± 9.25 months.

Conclusion

This new method for resetting dysfunctional PD catheters demonstrates technical feasibility, simplicity, cost-effectiveness, and safety. It has the potential to emerge as an alternative, particularly suitable for resource-limited settings.

Network for Pancreatic Organ donors with Diabetes-Kidney: A Heterogenous Donor Cohort for the Investigation of Diabetic Kidney Disease Pathogenesis and Progression

Key Points

Lack of human kidney tissue availability and access has hindered molecular understanding of human diabetic kidney disease processes and disease heterogeneity. Preclinical validation of diabetic kidney disease targets using data from large, human kidney samples should reduce poor translatability to clinical trials. The Network for Pancreatic Organ donors with Diabetes-Kidney cohort is validated and available for use by the research community.

Background

The Network for Pancreatic Organ Donors with Diabetes-Kidney (nPOD-K) project was initiated to assess the feasibility of using kidneys from organ donors to enhance understanding of diabetic kidney disease (DKD) progression.

Methods

Traditional and digital pathology approaches were used to characterize the nPOD-K cohort. Periodic acid–Schiff- and hematoxylin and eosin-stained sections were used to manually examine and score each nPOD-K case. Brightfield and fluorescently labeled whole slide images of nPOD-K sections were used to train, validate, and test deep learning compartment segmentation and machine learning image analysis tools within Visiopharm software. These digital pathology tools were subsequently used to evaluate kidney cell-specific markers and pathological indicators.

Results

Digital quantitation of mesangial expansion, tubular atrophy, kidney injury molecule-1 expression, cellular infiltration, and fibrosis index aligned with histological DKD classification, as defined by pathologists' review. Histological quantification confirmed loss of podocyte, endothelial, and tubular markers, correlating with DKD progression. Altered expression patterns of prominin-1, protein-tyrosine phosphatase receptor type O, and coronin 2B were validated, in agreement with reported literature.

Conclusions

The nPOD-K cohort provides a unique open resource opportunity to not only validate putative drug targets, but also better understand DKD pathophysiology. A broad range of pathogenesis can be visualized in each case, providing a simulated timeline of DKD progression. We conclude that organ donor-derived tissues serve as high-quality samples, provide a comprehensive view of tissue pathology, and address the need for human kidney tissues available for research.

Mitochondrial-Targeting Mesoporous Polydopamine Nanoparticles for Reducing Kidney Injury Caused by Depleted Uranium

Depleted uranium (DU), when accidentally released from the nuclear industry, can enter the human body and cause kidney damage, as DU induces oxidative damage and apoptosis through mitochondrial pathways and inflammatory reactions. The existing nanoparticles used to treat DU injury have low bioavailability and poor targeting. In this study, mesoporous polydopamine (MPDA), poly-(ethylene glycol) (PEG), and triphenylphosphonium (TPP) are combined to develop a novel mitochondrion-targeting bifunctional nanoparticle, MPDA-PEG-TPP, and confirm that it can protect the kidneys from DU. This study demonstrates the high selectivity of MPDA-PEG-TPP for uranyl in uranyl chelate assays and its promising efficiency in uranyl sequestration from the kidneys, lungs, and femurs, following immediate or delayed administration of MPDA-PEG-TPP nanoparticles. In vitro assays confirm its efficiency in removing reactive oxygen species and targeting the mitochondria. In addition, in vitro and in vivo assays confirm that MPDA-PEG-TPP can reduce mitochondrial dysfunction and ameliorate kidney injury. These results suggest that MPDA-PEG-TPP is a valuable agent for ameliorating the DU-induced kidney injury.

Nonlinear relationship between serum Klotho and chronic kidney disease in US adults with metabolic syndrome

Background

Current evidence regarding the effects of serum Klotho among patients with metabolic syndrome (MetS) is scarce. This study explored the relationship between serum Klotho levels and the odds of chronic kidney disease (CKD) in middle-aged and older populations with MetS.

Materials and methods

This cross-sectional study analyzed data from 4870 adults aged 40-79 years who participated in the National Health and Nutrition Survey (NHANES) from 2007 to 2016. CKD was identified at urinary albumin to creatinine ratio (UACR) of 30 mg/g or higher and/or an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. Measurement of serum Klotho concentration was determined via enzyme-linked immunosorbent assay (ELISA) and subsequently divided into four quartiles (Q1-Q4). The NHANES criteria were followed in calculating the sampling weights. Multivariable logistic regression models were employed to assess the correlation between Klotho and CKD, while generalized linear models with cubic spline functions and smooth curve fitting were utilized to detect any nonlinear relationship. Additionally, subgroup analysis and a range of sensitivity analyzes were conducted.

Results

Results showed that a nonlinear L-shaped relationship existed between serum Klotho levels and CKD risk, with the lowest prevalence observed at 9.63-9.94 pg/mL Klotho concentrations. With a two-segment linear regression model, an inflection point of 9.88 pg/mL was noted. Hypertension status was identified as an interaction mediator (P interaction = 0.006). Sensitivity analysis showed stable results.

Conclusions

A nonlinear L-shaped relationship exists between serum Klotho levels and risks of CKD among middle-aged and older adults with MetS, with the lowest prevalence observed at 9.63 to 9.94 pg/mL Klotho concentrations. Our findings, if replicated, underscore the need to estimate the optimal serum Klotho concentrations and the consequential inverse relationship, thus implying the potential of Klotho as both a serum biomarker and a possible preventive or therapeutic intervention.

Chronic Kidney Disease-Epidemiology Collaboration (CKD - EPI) classification of kidney function and predictors of kidney dysfunction among type 2 diabetes mellitus patients in a tertiary hospital in Ghana

Introduction

Type 2 Diabetes Mellitus (T2DM) is a major global health concern frequently associated with Kidney Dysfunction (KD). Globally, approximately one in eleven adults have diabetes mellitus, with 90% of these cases being type 2 diabetes mellitus. About two-thirds of T2DM patients experience KD, which may progress to chronic kidney disease and end-stage renal disease. In Ghana, the burden of T2DM is substantial and continues to rise, with kidney failure accounting for approximately 10% of all deaths among individuals with T2DM. This study sought to investigate the predictors of KD among T2DM patients in Ghana and approximately 10% of deaths in people with T2DM are attributable to kidney failure.

Methods

a hospital-based retrospective study design was employed. It involved the medical records of 141 T2DM patients. The data extracted was entered into Microsoft Excel version 16.0 and analyzed using STATA version 16.0. Chi-square test was used to establish associations between categorical variables and KD. Independent t-test was employed to analyze associations between parametric (normally distributed) variables and KD, while the Mann-Whitney U test was used for non-parametric (not normally distributed) variables. The strengths of the identified associations were evaluated using binary logistic regression analysis, with the results reported as odds ratios (OR) along with their 95% confidence intervals.

Results

among the 141 patients, 99 (70.2%) had KD. Formal employment was associated with a 95% reduced odds of kidney dysfunction (aOR = 0.05 (95%CI: 0.004-0.645); p-value = 0.021), while every unit increase in creatinine level was linked to a 10% increased odds of KD (aOR = 1.10 (95%CI: 1.06-1.14); p-value = <0.001).

Conclusion

the study revealed a significant proportion of T2DM patients experiencing kidney dysfunction. Crucially, both occupation and creatinine levels were found to be independent predictors of diabetic KD. This highlights an urgent need to educate T2DM patients, particularly those who are unemployed or informally employed, about preventive measures and the importance of regular monitoring of creatinine levels to safeguard kidney health. This emphasis is vital, as managing kidney disease in the region is notably costly, making early intervention and education key strategies in reducing the burden of KD among T2DM patients.

Dialysate Sodium Levels, Ambulatory Aortic Blood Pressure, and Arterial Stiffness in Hemodialysis Patients

BACKGROUND

Increased aortic blood pressure (BP) and arterial stiffness are associated with higher cardiovascular risk in hemodialysis. Previous works showed that lower dialysate sodium is associated with lower brachial-BP; data on aortic-BP and arterial stiffness are limited. This study aimed to investigate the effects of different dialysate sodium concentrations on 72-hour aortic-BP and arterial stiffness parameters in hemodialysis patients.

METHODS

This analysis is part of a prospective, non-randomized interventional study. Twenty-five hemodialysis patients underwent a set of 3 periods of different dialysate sodium concentrations; 6 sessions with dialysate sodium of 137 mEq/l, followed consecutively by 6 sessions with 139 mEq/l and, finally, 6 sessions with 141 mEq/l. At the start of the sixth hemodialysis session on each sodium concentration, 72-hour ABPM (Mobil-O-Graph) was performed to evaluate aortic-BP and arterial stiffness indices during the overall 72-hour, different 24-hour, daytime, and nighttime periods.

RESULTS

Mean 72-hour aortic systolic blood pressure (SBP)/diastolic blood pressure (DBP) were higher with increasing dialysate sodium concentrations (137 mEq/l: 114.2 ± 15.3/77.0 ± 11.8 mm Hg vs. 139 mEq/l: 115.4 ± 17.3/77.9 ± 14.0 mm Hg vs. 141 mEq/l: 120.5 ± 18.4/80.5 ± 14.7 mm Hg, P = 0.002/P = 0.057, respectively). Wave-reflection parameters (AIx, AIx(75), AP) were not significantly different between the 3 dialysate sodium concentrations. Ambulatory pulse wave velocity (PWV) was significantly higher with increasing dialysate sodium concentrations (137 mEq/l: 8.5 ± 1.7 m/s vs. 139 mEq/l: 8.6 ± 1.6 m/s vs. 141 mEq/l: 8.8 ± 1.6 m/s, P < 0.001). In generalized linear mixed models including 72-hour brachial SBP as a random covariate, the adjusted marginal means of 72-hour PWV were not significantly different between groups.

CONCLUSIONS

This study showed that higher dialysate sodium concentrations are associated with significant increases in ambulatory aortic BP and PWV. These findings further support the need for modification of dialysate sodium concentration in hemodialysis.

Association of frequent intradialytic hypotension with the clinical outcomes of patients on hemodialysis: a prospective cohort study

Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD), but there is no consensus on its definition. In 2015, Flythe proposed a definition of IDH (Definition 1 in this study): nadir systolic blood pressure (SBP) <90 mmHg during hemodialysis for patients with pre-dialysis SBP <159 mmHg, and nadir SBP <100 mmHg during hemodialysis for patients with pre-dialysis SBP ≥160 mmHg. This prospective observational cohort study investigated the association of frequent IDH based on Definition 1 with clinical outcomes and compared Definition 1 with a commonly used definition (nadir SBP <90 mmHg during hemodialysis, Definition 2). The incidence of IDH was observed over a 3-month exposure assessment period. Patients with IDH events ≥30% were classified as 'frequent IDH'; the others were 'infrequent IDH'. All-cause mortality, cardiovascular mortality, and all-cause hospitalization events were followed up for 36 months. This study enrolled 163 HD patients. The incidence of IDH was 11.1% according to Definition 1 and 10.5% according to Definition 2. The Kaplan-Meier curves showed that frequent IDH patients had higher risks of all-cause mortality (p = 0.009, Definition 1; p = 0.002, Definition 2) and cardiovascular mortality (p = 0.021, Definition 1). Multivariable Cox regression analysis indicated that frequent IDH was independently associated with a higher risk of all-cause mortality (Model 1: HR = 2.553, 95%CI 1.334-4.886, p = 0.005; Model 2: HR = 2.406, 95%CI 1.253-4.621, p = 0.008). In conclusion, HD patients classified as frequent IDH are at a greater risk of all-cause mortality. This highlights the significance of acknowledging and proactively managing frequent IDH within the HD patients.

Lost dwell time and cycler alarms in inpatient automated peritoneal dialysis at a tertiary care hospital

BACKGROUND AND AIMS

Dwell time is a critical component of automated peritoneal dialysis (APD) prescription, the stage at which transmembrane mass and fluid transfer occur. Loss of prescribed dwell time (LDT) can negatively influence the efficiency of APD. We investigated the incidence of LDT and related causes using APD in the acute care setting at a tertiary care center.

METHODS

Retrospective analysis was conducted of all inpatients receiving APD treatments from 1 December 2021 to 1 June 2023. Patient demographics, comorbidities, laboratory, and treatment data were extracted from electronic medical records and a propriety database.

RESULTS

N = 235 cycler treatments completed by 32 patients were included for analysis. The total LDT per treatment exceeding 30 minutes and 60 minutes occurred in 27% and 20% of all treatments. LDT of more than 10 minutes per each cycle exchange occurred in 26%. Session disruptions were caused by slow out-flow (55%), inadequate drain volumes (32%), patient line occlusions (20%), and priming errors (23%). The slow flow alarm requiring user intervention was reported to occur in about one-third of all treatments (31%).

CONCLUSION

There was significant LDT and inadequate drain volume seen in about one-quarter and one-third of all inpatient APD treatments respectively. This can impact solute clearance and ultrafiltration.  Slow flow alarms were the most prevalent and the leading cause of LDT followed by inadequate drain volume. Future studies are required to investigate measures to reduce slow drain and improve drain volume in the hospital setting.   .

Vascular access type and prognosis in elderly hemodialysis patients: a propensity-score-matched study

BACKGROUND

To compare the impact of tunneled cuffed catheters (TCCs) and arteriovenous fistulas (AVFs) on outcomes in elderly hemodialysis (HD) patients.

METHODS

A retrospective matched cohort study was performed. Propensity score matching (PSM) was applied to balance the baseline conditions, and we compared all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCEs), hospitalization, and infection rates between AVF and TCC patients ≥70 years old. Cox survival analysis was used to analyze the risk factors for death.

RESULTS

There were 2119 patients from our center in the Chinese National Renal Data System (CNRDS) between 1 January 2010 and 10 October 2023. Among these patients, 77 TCC patients were matched with 77 AVF patients. There was no significant difference in all-cause mortality between the TCC and AVF groups (30.1/100 vs. 33.3/100 patient-years, p = 0.124). Among the propensity score-matched cohorts, no significant differences in Kaplan-Meier curves were observed between the two groups (log-rank p = 0.242). The TCC group had higher rates of MACCEs, hospitalization, and infection than the AVF group (33.7/100 vs. 29.5/100 patient-years, 101.2/100 vs. 79.5/100 patient-years, and 30.1/100 vs. 14.1/100 patient-years, respectively). Multivariate analysis showed that high Charlson comorbidity index (CCI) score was a risk factor for death.

CONCLUSIONS

There was no significant difference in all-cause mortality between elderly HD patients receiving TCCs and AVFs. Compared with those with a TCC, elderly HD patients with an AVF have a lower risk of MACCEs, hospitalization, and infection.

Impaired sensitivity to thyroid hormones is associated with all-cause and cause-specific mortality among chronic kidney disease patients: results from National Health and Nutrition Examination Survey (NHANES) 2007-2012

BACKGROUND

Resistance to thyroid hormone shows underlying mechanical link with chronic kidney disease (CKD) and is prevalent in CKD population. However, whether it attributes to mortality risk among CKD population is unknown. This study aimed to examine the association of thyroid hormone resistance (THR) with all-cause and cause-specific mortality among CKD individuals.

METHODS

This study extracted CKD population from the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) for mortality from all causes, cardiovascular disease (CVD).

RESULTS

A total of 1,634 adults with CKD were included in the cohort, in which 663 deaths were recorded during an average follow-up of 8.72 years. After multivariate adjustment, resistance to thyroid hormone was significantly associated with higher all-cause and CVD mortality. There was an 18% and 31% increase in risks of all-cause and CVD mortality per-standard deviation (SD) increment in Parametric Thyroid Feedback Quantile-based Index (PTFQI) respectively. When PTFQI was analyzed as categorical variable (classified according to PTFQI percentiles), after adjusted for potential confounders and taking PTFQI ≤ P5 as reference, the HRs and 95% CIs in category with PTFQI > P95 for all-cause mortality and CVD mortality were 2.12 [1.10, 4.09] (p for trend 0.026) and 5.14 [1.81, 14.60] for (p for trend 0.018), respectively.

CONCLUSIONS

Resistance to thyroid hormone, centered on variations in the typical pituitary response to thyroid hormones, may independently correlate with all-cause and CVD mortality in CKD patients.

Correlation between ultrafiltration rate and hemoglobin level and erythropoietin response in hemodialysis patients

This study aimed to investigate the correlation between ultrafiltration rate (UFR) and hemoglobin levels and erythropoietin (EPO) response in patients receiving maintenance hemodialysis (MHD). 225 MHD patients were divided into three groups according to the UFR: < 10 ml/h/kg, 10-13 ml/h/kg, and >13 ml/h/kg. Clinical parameters and prognosis were compared among the groups. Multiple linear correlation and regression analyses were conducted. SPSS 26.0 (IBM, Chicago, IL, USA) was used to analyze all statistics. The UFR < 10 ml/h/kg group was older than the other groups (p < 0.05). The UFR > 13 ml/h/kg group had the highest SpKt/V (p < 0.05), monthly EPO dose/weight (p < 0.001), and EPO resistance index (p < 0.001), as well as the lowest dry weight (p < 0.001), BMI (p < 0.001), hemoglobin (p < 0.001), hematocrit (p < 0.05), and red blood cell count (p < 0.05). Multiple linear regression analysis showed that sex, dry weight, UFR, calcium, phosphorus, albumin, and C-reactive protein levels were associated with hemoglobin levels. Multivariate logistic regression analysis revealed that a higher UFR was associated with lower hemoglobin levels, while male sex and higher levels of calcium and albumin were associated with higher hemoglobin levels. High UFR is associated with more severe anemia and EPO resistance in MHD. This study provides new insights into anemia management in patients undergoing hemodialysis.

Effectiveness of an ergonomic training with exercise program for work-related musculoskeletal disorders among hemodialysis nurses: A pilot randomized control trial

INTRODUCTION

Hemodialysis nurses suffer a high prevalence of work-related musculoskeletal disorders due to the nursing job contents and high repetition. A practical ergonomic program was expected to improve their occupational health and musculoskeletal discomfort. This study developed an ergonomic training program with exercise and examined its effectiveness for musculoskeletal discomfort and muscle strength in hemodialysis nurses.

METHOD

A cluster pilot randomized control trial was conducted. Participant nurses were from two hemodialysis units at two medical centers in Taiwan in 2019 and 2020. A 12-week ergonomic program with exercise customized by the job analysis of hemodialysis nursing tasks applied to the intervention group (n = 14). A mobile messenger application was adopted to remind, monitor, and consult the implementation of exercises. The musculoskeletal discomfort degree and muscle strength were measured before and after training as well as the follow-up after another 12 weeks. The training effect between the intervention group and the control group (n = 20), was analyzed by the generalized estimating equations model.

RESULTS

The significant improvements in muscle strength of the wrist and pinch power of the dominant hand were identified after training. The sustaining effect showed significant decreases in musculoskeletal discomfort degrees in the elbows, wrists/hands, knees, and ankles/feet. Training participants achieved an 80% adherence rate to the exercise program, facilitated by a convenient mobile messenger application. They also responded with very high satisfaction with all the ergonomic education, exercise regimen, and use of resistance devices.

CONCLUSIONS

This trial approves the effectiveness of the developed program for hemodialysis nurses and its feasibility in clinical practice.

PRACTICAL APPLICATIONS

This ergonomic training with a customized exercise program for hemodialysis nurses can serve as a valuable educational resource for hemodialysis nurses to mitigate work-related musculoskeletal disorders and improve occupational strength. Integrating the support of remote technology can enhance program adherence in hectic work environments.

Outcomes of kidney replacement therapies after kidney transplant failure: A systematic review and meta-analysis

BACKGROUND

Following kidney transplant failure, patients generally have three kidney replacement therapy (KRT) options: peritoneal dialysis (PD), haemodialysis (HD), or pre-emptive kidney re-transplantation. This review aims to explore KRT options after kidney transplant failure and compare clinical outcomes.

METHOD

This review included studies from five databases: Medline, PubMed, Embase, Cochrane, and CINAHL. The study protocol was registered at PROSPERO [CRD42024514346]. Causes of kidney transplant failure were explored. Survival and re-transplantation rates among three groups after kidney transplant failure were compared: patients starting PD (TX-PD group), patients starting HD (TX-HD group), and patients re-transplanted without bridging dialysis (TX-TX group). Causes of death were also explored. The quality of the included studies was assessed using the CASP checklist and the meta-analysis was assessed using the GRADE approach.

RESULTS

Of 6405 articles, eight articles were included in the systematic review. Chronic damage was identified as the primary cause of kidney transplant failure. The TX-TX group had a lower mortality rate than the TX-HD group and TX-PD group, though this difference was only statistically significant in comparison to the TX-HD group (OR: 2.57; 95 % CI:1.58, 4.17; I2 = 79 %; P = 0.0001). Additionally, the TX-PD group had a significantly lower mortality rate (OR: 0.83; 95 % CI:0.76, 0.90; I2 = 88 %; P < 0.0001) and higher re-transplantation rate (OR: 1.56; 95 % CI:1.41, 1.73; I2 = 0 %; P < 0.00001) compared to the TX-HD group. Cardiovascular disease, infection, and cancer were the leading causes of death.

CONCLUSION

The TX-TX group had better survival than the TX-HD group. Survival and re-transplantation rates were higher in the TX-PD group than the TX-HD group. However, age and comorbidities may impact survival and re-transplantation rates between the TX-PD and TX-HD groups, which should be explored further.

Towards accurate and efficient diagnoses in nephropathology: An AI-based approach for assessing kidney transplant rejection

The Banff classification is useful for diagnosing renal transplant rejection. However, it has limitations due to subjectivity and varying concordance in physicians' assessments. Artificial intelligence (AI) can help standardize research, increase objectivity and accurately quantify morphological characteristics, improving reproducibility in clinical practice. This study aims to develop an AI-based solutions for diagnosing acute kidney transplant rejection by introducing automated evaluation of prognostic morphological patterns. The proposed approach aims to help accurately distinguish borderline changes from rejection. We trained a deep-learning model utilizing a fine-tuned Mask R-CNN architecture which achieved a mean Average Precision value of 0.74 for the segmentation of renal tissue structures. A strong positive nonlinear correlation was found between the measured infiltration areas and fibrosis, indicating the model's potential for assessing these parameters in kidney biopsies. The ROC analysis showed a high predictive ability for distinguishing between ci and i scores based on infiltration area and fibrosis area measurements. The AI model demonstrated high precision in predicting clinical scores which makes it a promising AI assisting tool for pathologists. The application of AI in nephropathology has a potential for advancements, including automated morphometric evaluation, 3D histological models and faster processing to enhance diagnostic accuracy and efficiency.

Ultrasound viscoelastic imaging in the noninvasive quantitative assessment of chronic kidney disease

BACKGROUND

This study aims to evaluate the clinical application value of ultrasound viscoelastic imaging in noninvasive quantitative assessment of chronic kidney disease (CKD).

METHODS

A total of 332 patients with CKD and 190 healthy adults as a control group were prospectively enrolled. Before kidney biopsy, ultrasound viscoelastic imaging was performed to measure the mean stiffness value (Emean), mean viscosity coefficient (Vmean), and mean dispersion coefficient (Dmean) of the renal. CKD patients were divided into three groups based on estimated glomerular filtration rate. The differences in clinic, pathology, ultrasound image parameters between the control and patient groups, or among different CKD groups were compared. The correlation between viscoelastic parameters and pathology were analyzed.

RESULTS

Emean, Vmean, and Dmean in the control group were less than the CKD group (p < 0.05). In the identification of CKD from control groups, the area under curve of Vmean, Dmean, Emean, and combining the three parameters is 0.90, 0.79, 0.69, 0.91, respectively. Dmean and Vmean were increased with the decline of renal function (p < 0.05). Vmean and Dmean were positively correlated with white blood cell, urea, serum creatinine, and uric acid (p < 0.05). Vmean is positively correlated with interstitial fibrosis and inflammatory cell infiltration grades (p < 0.001).

CONCLUSIONS

Ultrasound viscoelastic imaging has advantages in noninvasive quantitative identification and evaluating renal function of CKD. Emean > 6.61 kPa, Vmean > 1.86 Pa·s, or Dmean > 7.51 m/s/kHz may suggest renal dysfunction. Combining Vmean, Dmean, and Emean can improve the efficiency of identifying CKD.

The effects of hemodialysis on the cardiovascular system

Chronic kidney disease and dialysis-dependent end-stage renal disease are increasing in prevalence in the United States. The costs associated with end-stage renal disease management comprise approximately 1% of the federal government's annual budget. Chronic kidney disease and end-stage renal disease cause significant derangements of the cardiac and vascular system. Pathophysiologic hallmarks include alterations of the renin-angiotensin system, chronically increased sympathetic tone, calcium and phosphate imbalance, pro-inflammatory cytokine release, and uremic toxin accumulation. This results in several pathologies specific to the cardiac and vascular systems, which will each be reviewed separately herein.

Development and validation of a simple clinical nomogram for predicting infectious diseases in pediatric kidney transplantation recipients: a retrospective study

To construct and verify an easy-to-use nomogram for predicting the risk of infectious diseases in pediatric kidney transplant recipients. Clinical data of hospitalized pediatric kidney transplant recipients were retrospectively analyzed. Meaningful variables identified from the multivariate stepwise logistic regression analysis were used to construct the nomogram. Internal validation was performed using Bootstrap resampling 1,000 times. The nomogram was evaluated using calibration, decision and receiver operating characteristic (ROC) curves. A total of 297 pediatric kidney transplant recipients were included (164 infected, 133 non-infected). Multivariate stepwise regression analysis identified white blood cell count (WBC), lymphocyte to monocyte ratio (MLR), platelet to neutrophil ratio (PNR), red cell distribution width-standard deviation (RDW-SD), and albumin (ALB) as significant predictors of postoperative infection. The nomogram, based on the five indicators, showed strong discrimination ability (AUC = 0.756; 95% CI [0.702-0.811]), with a sensitivity of 88.0% and a specificity of 54.3%. The calibration curve and decision curve further demonstrated good consistency and clinical practicality between the predicted and actual values. WBC, MLR, PNR, RDW-SD, and ALB are effective indicators for predicting postoperative infection in pediatric kidney transplant recipients. The nomogram constructed from these indicators can effectively predict and evaluate the early risk of infection in these patients.

Performance characteristics of a prototype dialysate turbidity monitoring system to detect peritonitis in patients receiving peritoneal dialysis

BACKGROUND

The risk of peritonitis has limited wider adoption of peritoneal dialysis (PD) in the United States. We developed a prototype bedside dialysate turbidity monitoring system, aiming to improve diagnostic accuracy relative to conventional approaches which depend on visual inspection and reporting of insensitive and non-specific symptoms.

METHODS

The prototype system was tested in a single-centre, proof-of-principle clinical study in patients receiving intermittent PD. We obtained multiple effluent dialysate samples from each consenting participant. We compared turbidity measurements with diagnostic criteria endorsed by the International Society of Peritoneal Dialysis (ISPD).

RESULTS

Overall, we analysed 983 specimens from 65 patients, including 105 samples from patients with peritonitis and 878 samples from patients without peritonitis. An operating point derived from a previous in vitro study yielded an unadjusted sensitivity and specificity of 95.2% and 91.5%, respectively. The majority of samples that did not meet ISPD diagnostic criteria were either cases detected before criteria were met or were related to active peritonitis treatment and resolution.

CONCLUSION

This proof-of-principle study demonstrates the feasibility and diagnostic accuracy of a prototype dialysate turbidity monitoring system for peritonitis surveillance.

Circulating osteoprotegerin as a cardiac biomarker for left ventricular diastolic dysfunction in patients with pre-dialysis chronic kidney disease: the KNOW-CKD study

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is a major cause of mortality in patients with chronic kidney disease (CKD), and diagnosis is challenging. Moreover, no specific biomarker for HFpEF has been validated in patients with CKD. The present study aimed to investigate the association between serum osteoprotegerin (OPG) levels and the risk of left ventricular diastolic dysfunction (LVDD), a surrogate of HFpEF, in patients with pre-dialysis CKD.

METHODS

A total of 2039 patients with CKD at stage 1 to pre-dialysis 5 were categorized into quartiles (Q1 to Q4) by serum OPG levels, and were cross-sectionally analyzed. The study outcome was LVDD, which was operationally defined as the ratio of early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e') > 14.

RESULTS

In the analysis of baseline characteristics, higher serum OPG levels were clearly related to the risk factors of HFpEF. A scatter plot analysis revealed a moderate correlation between serum OPG levels and E/e' (R = 0.351, P < 0.001). Logistic regression analysis demonstrated that the risk of LVDD in Q3 (adjusted odds ratio 2.576, 95% confidence interval 1.279 to 5.188) and Q4 (adjusted odds ratio 3.536, 95% confidence interval 1.657 to 7.544) was significantly higher than that in Q1.

CONCLUSIONS

Elevated serum OPG levels are associated with the risk of LVDD in patients with pre-dialysis CKD. The measurement of serum OPG levels may help the diagnosis of LVDD, which is an important echocardiographic feature of HFpEF.

Uncovering Patient and Caregiver Goals for Goal-Concordant Care in Kidney Therapy Decisions

CONTEXT

In kidney therapy (KT) decisions, goal-concordant decision-making is recognized to be important, yet alignment with patients' goals during dialysis initiation is not always achieved.

OBJECTIVES

To explore older patients' and caregivers' hopes, goals, and fears related to KT and communication of these elements with members of their health care team.

METHODS

The study included patients aged ≥75 years with an estimated glomerular filtration rate ≤25 mL/min/1.73 m2 and their caregivers enrolled in a palliative care intervention for KT decision-making. Patients and caregivers were asked open-ended questions about their hopes, goals, and fears related to KT decisions. A survey assessed if patients shared their goals with members of their health care team. Qualitative data underwent content analysis, supplemented by demographic descriptive statistics.

RESULTS

The mean age of patients (n = 26) was 82.7 (±5.7) years, and caregivers (n = 15) had a mean age of 66.4 (±13.7) years. Among the participants, 13 patients and 11 caregivers were women, and 20 patients and 12 caregivers were White. Four themes emerged: (1) Maintaining things as good as they are by avoiding dialysis-related burdens; (2) seeking longevity while avoiding dialysis; (3) avoiding pain, symptoms, and body disfigurement; and (4) deferring decision-making. Patients rarely had shared their goals with the key members of their health care team.

CONCLUSION

Patients and caregivers prioritize maintaining quality of life, deferring decision-making regarding dialysis, and avoiding dialysis-related burdens. These goals are often unshared with their family and health care teams. Given our aging population, urgent action is needed to educate clinicians to actively explore and engage with patient goals in KT decision-making.

What every clinician needs to know about chronic kidney disease: Detection, classification and epidemiology

Chronic kidney disease (CKD) is a major healthcare challenge, affecting >800 million people worldwide. Implications for population health result from the strong associations of CKD with increased rates of cardiovascular disease, heart failure, progressive CKD leading to kidney failure, acute kidney injury (AKI), and mortality. In addition to a single disease perspective, CKD commonly coexists alongside other long-term conditions, in particular type 2 diabetes and cardiovascular disease. CKD is therefore an important component of multimorbidity that influences individual management and impacts prognosis. CKD is defined by abnormalities of kidney structure or function of any cause with implications for health that are present for longer than 3 months. The diagnosis is usually made on the basis of an abnormal glomerular filtration rate (GFR < 60 mL/min/1.73 m2) and/or the presence of proteinuria (urine albumin to creatinine ratio > 30 mg/g or >3 mg/mmol). GFR is usually estimated from serum creatinine concentration using a variety of validated equations. However, serum creatinine is closely related to muscle mass and may therefore not be an accurate marker of GFR in people with high or low muscle mass (sarcopaenia). Cystatin C is an alternative endogenous marker of GFR that is increasingly being used but also has limitations. An estimate of GFR based on both creatinine and cystatin C is the most accurate. Diagnosis should be followed by classification and risk stratification to guide the development of a risk-based, personalized care plan. Improved detection and widespread implementation of optimal CKD management has the potential to bring major benefits to population health.