Kidney function and cognitive impairment: a systematic review and meta-analysis

BACKGROUND

A worldwide evaluation exploring the link between a broad-spectrum kidney function and cognitive impairment (CI) prevalence, and related risk factors has yet to be conducted.

METHODS

Studies published before November 2024 were retrieved from PubMed and Web of Science. R software (R Foundation for Statistical Computing, Vienna, Austria) and Review Manager (Cochrane Collaboration, London, UK) were used to analyze the relationship of CI with various estimated glomerular filtration rate (eGFR) level and the associated risk factors. A random model effect was adopted for a heterogeneity (I2) of more than 50%.

RESULTS

Seventeen (involving 32,141 participants) out of 5892 studies were included. The MMSE and MoCA were the most commonly used tests to assess cognitive function. The prevalence of CI raised significantly with declining kidney function: 10% for eGFR ≥60 mL/min/1.73 m2, 47.3% for 60-30 mL/min/1.73 m2, and 60.6% for <30 mL/min/1.73 m2, totaling 16.7% overall. Thirteen potential risk factors were ascertained and analyzed. In the forest-plot analysis, T2DM, cardiovascular diseases, cerebrovascular diseases, and lower education emerged as strong predictors of risk, with odds ratios of 1.55, 1.63, 1.95, and 2.59, respectively. A mean meta-analysis of the continuous variable indicators revealed that advanced age and elevated parathyroid hormone (PTH) levels were statistically significant in the occurrence of CI.

CONCLUSIONS

The poorer the renal function, the higher the prevalence rate of CI. Patients with chronic kidney disease (CKD) have multiple risk factors that lead to CI.

Comparative efficacy and safety of febuxostat and allopurinol in chronic kidney disease stage 3-5 patients with asymptomatic hyperuricemia: a network meta-analysis

OBJECTIVE

This study evaluates and compares the effectiveness and safety of febuxostat and allopurinol in chronic kidney disease (CKD) stages 3-5 patients with asymptomatic hyperuricemia using a network meta-analysis.

METHODS

A systematic review and network meta-analysis were conducted, adhering to PRISMA-NMA guidelines. Searches included PubMed, Embase, Cochrane Library, and Chinese databases up to June 2024. Randomized controlled trials (RCTs) and cohort studies were assessed for methodological rigor using GRADE.

RESULTS

A total of 12 RCTs and 4 cohort studies (n = 2,423 participants) were included. Febuxostat was associated with greater improvements in estimated glomerular filtration rate compared to allopurinol (MD, 4.99 mL/min/1.73 m2; 95%CI -0.65 to 10.78; certainty: low) and placebo (MD, 4.72 mL/min/1.73 m2; 95%CI 0.67 to 8.82; low). Serum uric acid reduction was also more pronounced with febuxostat (MD, -0.61 mg/dL; 95%CI -1.15 to -0.05; moderate). Safety outcomes, including major cardiovascular events and adverse events, showed no significant differences between febuxostat and allopurinol. Subgroup analyses revealed enhanced effectiveness of febuxostat at six months of treatment.

CONCLUSIONS

This analysis provides robust evidence that febuxostat might offers greater improvements in kidney function and uric acid levels compared to allopurinol or placebo in asymptomatic hyperuricemia with CKD stage 3-5 patients, without compromising safety. These findings can guide clinical decision-making and treatment optimization.

Seraph 100 Microbind Affinity Blood Filter for Persistent Pediatric BK Virus Nephropathy

BACKGROUND

Resolution of BK viremia is almost universally required before kidney transplant. Unfortunately, proven anti-BK viral therapies are limited. The Seraph 100 mimics the action of the natural glycocalyx, which binds pathogens via heparin sulfate proteoglycans. In this case report, we describe the use of this filter to facilitate the clearance of BK viremia.

METHODS

Our patient was a 14-year-old cardiac transplant recipient secondary to familial dilated cardiomyopathy. She developed BK nephropathy resulting in end stage kidney disease (ESKD). After failed medical management and immunoreduction over 4 years, the Seraph 100 Microbind Affinity Blood Filter was utilized extracorporeally in line with continuous renal replacement therapy (CRRT) for 48 h to eliminate detectable BK viral replication.

RESULTS

The patient's BK titers initially increased negligibly but cleared within 2 months of Seraph 100 treatment, and she successfully underwent kidney transplantation without recurrence of BK viremia. There were no adverse events other than one episode of emesis at the initiation of CRRT.

CONCLUSION

Our case provides proof of concept and feasibility for studying the Seraph 100 as a potential therapeutic option for the clearance of BK viral titers, especially in ESKD patients who already have dialysis access.

Expanding the horizons of bicyclol in multiple diseases: Mechanisms, therapeutic implications and challenges

Bicyclol, a drug stemmed from the traditional Chinese medicine Schisandra chinensis, has been widely utilized in clinical practice due to its efficacy and safety to manage hepatopathy. Its diverse biological properties-including antiviral, anti-inflammatory, antifibrotic, immunomodulatory, antioxidative, antisteatotic, and antitumor effects-underscore its significant medicinal effects in versatile hepatic disorders, incorporating viral hepatitis, non-alcoholic fatty liver disease, hepatocellular carcinoma, acute hepatic failure, hepatic fibrosis as well as drug-induced liver injury. Furthermore, ongoing researches into the molecular mechanisms, biological activities and mode of actions concerning bicyclol have uncovered its potential therapeutic implications in other multiple diseases/conditions. Studies have indicated promising efficacy pertaining to bicyclol to treat idiopathic pulmonary fibrosis, acute lung injury, cerebral ischemia/reperfusion injury, renal dysfunction, renal cell carcinoma, and cardiovascular diseases. Accordingly, this narrative review article summarizes the current understanding of diverse biological activities and underpinning mechanisms of bicyclol across a range of diseases, as well as its pharmacokinetics, toxicity profile and shed light on future perspectives.

Secondary hyperparathyroidism due to chronic kidney disease and access to clinical treatment and parathyroidectomy in Brazil: a nationwide survey

INTRODUCTION

Chronic kidney disease (CKD) may lead to secondary hyperparathyroidism (SHP) and its treatment is based on the control of hyperphosphatemia, hypocalcemia, and serum parathormone hormone levels (PTH) levels. Despite the advances in SHP treatment, therapeutic failure is frequent and CKD patients on dialysis require parathyroidectomy (PTx).

AIM

To update the 2011 survey, estimate the current prevalence of SHP in Brazilian dialysis centers, verify access to drugs, and identify obstacles to performing PTx.

METHODS

A questionnaire was sent to active dialysis facilities. The results were compiled and statistically compared (p < 0.05).

RESULTS

A total of 114 facilities successfully responded to the questionnaire, most of them in the Southeast region. Approximately 9% of the individuals (23,535) had serum PTH levels measurements above 1,000 pg/mL (10.7% were reported in the 2011 survey). A considerable number of the reported difficulties indicated limited availability of pivotal medications for SHP management and the associated complications. Of note, only 2.7% of the individuals were submitted to PTx. For those with PTx indication, the waiting time for the procedure was over two years in 28% of the cases. The main barriers to performing PTx were reported to be the long waiting time for PTx, the shortage of head and neck surgeons, and the lack of ward beds for hospital admissions.

CONCLUSION

Some aspects have improved since 2011. However, SHP remains highly prevalent in Brazil, and a significant number of individuals do not have access to PTx or experience long waiting times for this surgical procedure while facing substantial difficulties in obtaining clinical treatment.

The functions of immune system-derived miRNAs in cardiovascular diseases

Cardiovascular diseases (CVD) are the foremost cause of mortality worldwide, with recent advances in immunology underscoring the critical roles of immune cells in their onset and progression. MicroRNAs (miRNAs), particularly those derived from the immune system, have emerged as vital regulators of cellular functions within the cardiovascular landscape. This review focuses on "immuno-miRs," a class of miRNAs that are highly expressed in immune cells, including T cells, B cells, NK cells, neutrophils, and monocytes/macrophages, and their significant role in controlling immune signaling pathways. Highlighting recent studies in human and animal models, this review examines how miRNAs influence both innate and adaptive immune responses and explores their potential as therapeutic targets for CVD. Special emphasis is placed on miRNAs that regulate T cells, suggesting that targeted manipulation of these miRNA pathways could offer new strategies for CVD treatment. As research in cardiovascular immunology advances, this review aims to provide a thorough overview of the potential of immune system-derived miRNAs to revolutionize CVD management and therapy, addressing a major global health challenge.

Association of hypoalbuminemia with hospitalization and mortality in hemodialysis patients with COVID-19

INTRODUCTION

Hypoalbuminemia is associated with poor nutritional status and inflammatory response in infectious diseases. It is commonly observed in COVID-19 patients. The aim of this study is to assess the association of serum albumin with hospitalization and mortality in dialysis patients with COVID-19.

METHODS

We retrospectively collected 250 dialysis patients, with and without COVID-19. Demographic characteristics, clinical symptoms, and laboratory tests on admission or the confirmation of COVID-19 were collected. Univariate logistic regression model was used to evaluate the association of various factors with hospitalization and death in these patients.

RESULTS

A total of 250 patients were included between December 1, 2022, and February 1, 2023, in our dialysis center. Among them, 218 were dialysis patients with COVID-19, and 32 were without COVID-19. Ten patients died due to COVID-19, and 8 patients had clinical data. In dialysis patients with COVID-19, a significant difference in serum albumin levels was observed between outpatients (37.28 ± 4.01 g/L) and hospitalized patients (33.42 ± 3.82 g/L), as well as between survivors (37.12 ± 4.07 g/L) and non-survivors (31.92 ± 2.52 g/L). Univariate logistic regression showed that the reduced albumin levels were associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19.

CONCLUSIONS

Our study revealed that reduced serum albumin is associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19. Low serum albumin levels suggest a poor prognosis and nutritional support may improve clinical outcomes.

Epidemiological profile of kidney transplant patients with lupus nephritis

INTRODUCTION

Lupus nephritis (LN) affects up to 50% of patients with systemic lupus erythematosus (SLE) and may lead to kidney failure and require kidney transplantation (KT). Results compared to KT from other causes are controversial, and we aimed to assess the clinical course, complications, and survival of LN patients undergoing KT.

METHODOLOGY

Retrospective cohort of 99 KT due to LN from 1977 to 2023 at a single center, divided into two groups according to the immunosuppression period: G1 (before 2009) and G2 (from 2009 onwards). Clinical and demographic characteristics, as well as clinical evolution, were compared.

RESULTS

Patients were predominantly white (65.9%), female (86.9%), in their first KT (83.8%). The median age was 20.0 (11.5-25.0) years at SLE diagnosis, and 30.0 (23.0-40.0) years at KT. Renal graft biopsy was indicated in 46% of patients, with rejection observed in 23%, and LN recurrence in 5%. When assessing the two distinct periods of standard immunosuppression, there was no difference in median glomerular filtration rate and proteinuria at 1 and 5 years, nor in 5-year survival. Throughout follow-up, 37.4% of patients lost their graft, and 13% died with a functioning graft. No graft loss was attributed to LN recurrence.

CONCLUSION

KT is a successful treatment for LN, with graft survival rates similar to those of transplants from other causes. LN recurrence was not associated with renal graft loss.

Homemade formulas for nutrition support in chronic kidney disease: A narrative review of the opportunity for education, research, and innovation

Protein-energy wasting is common in people with chronic kidney disease (CKD), especially in those undergoing kidney replacement therapy. Oral nutrition supplements and enteral nutrition are strategies that have been shown to improve nutrition status, and potentially outcomes. However, access to specialized commercial products for people with CKD is limited by factors including cost and regional availability. Homemade formulas represent a potentially cheaper, accessible, and more flexible option than commercial products, but they come with their own unique set of challenges. Furthermore, some aspects of homemade products, including consistency of nutrients, physical properties, and food safety, may pose challenges in the context of physiological changes that occur in CKD. Despite evidence of their use in CKD clinics, there have been few studies using homemade formulas in this population. This narrative review article summarizes the available literature on the potential usage, benefits, and concerns related to homemade formulas, emphasizing the unique challenges in people with CKD. Given the potential usage and limited research on homemade formulas in people with CKD, additional education and research are warranted to optimize the use of these tools in this clinical population.

The usefulness of the updated bioelectrical impedance vector analysis references for assessing malnutrition, sarcopenia and predicting mortality in hospitalized patients

BACKGROUND & AIMS

The application of validated pre-screening tools is crucial in clinical practice to identify patients at risk for disease. Bioelectrical Impedance Vector Analysis (BIVA) has gained recognition as a qualitative method for monitoring body composition and assessing the health status of hospitalized patients. This study investigates the utility of updated BIVA reference standards in evaluating malnutrition, sarcopenia, and mortality among hospitalized individuals.

MATERIAL AND METHOD

This retrospective observational study included 2.872 patients admitted to Quironsalud Málaga Hospital between January 2019 and January 2024. Malnutrition and sarcopenia were diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines. Mortality was defined as death within one year of their initial discharge or later admissions. BIVA was performed using the former and the new 50th, 75th, and 95th reference tolerance ellipses of general population.

RESULTS

BIVA revealed significant differences in bioimpedance vectors between malnourished (n = 1187, 544 women) and non-malnourished patients, sarcopenic (n = 136, 51 women) and non-sarcopenic patients, and non-survivors (n = 317, 160 women) compared to survivors. When previous BIVA references (Piccoli 1995) were applied, the bioimpedance vectors for malnourished, sarcopenic, and non-surviving patients fell within the 75th tolerance ellipses. However, with updated references, these vectors shifted rightward, moving outside the 75th and 95th tolerance ellipses. Univariate Cox analysis showed that participants with vectors outside the new 95th tolerance ellipses faced significantly higher mortality risk (HR = 6.22 [95 % CI 4.40-8.80], p < 0.001) and lower survival rates (log-rank test p < 0.001) compared to those within the 75th ellipses. These trends persisted even after adjusting for age, sex, and BMI (HR = 4.79 [95 % CI 3.29-6.97], p < 0.001). The new reference ellipses demonstrated greater prognostic accuracy compared to the older ones, emphasizing their value in identifying high-risk patients.

CONCLUSION

The implementation of BIVA with newly established reference tolerance ellipses significantly enhances the evaluation of body composition and overall health in hospitalized patients. These updated tolerance ellipses are instrumental in accurately identifying malnutrition, sarcopenia, and heightened mortality risks. The delineation of specific mortality risk zones underscores the potential of incorporating these advanced BIVA ellipses into routine pre-screening protocols, thereby optimizing clinical nutritional assessments and interventions.

Endothelin-converting Enzyme-1b Genetic Variants Increase the Risk of Coronary Artery Ectasia

Coronary artery ectasia (CAE), defined as a 1.5-fold or greater enlargement of a coronary artery segment compared to the adjacent normal coronary artery, is frequently associated with atherosclerotic coronary artery disease (CAD). Membrane-bound endothelin converting enzyme-1 (ECE-1) is involved in the maturation process of the most potent vasoconstrictor ET-1. Polymorphisms in the endothelin (ET) gene family have been shown associated with the development of atherosclerosis. This study aims to investigate the effects of rs213045 and rs2038089 polymorphisms in the ECE-1 gene which have been previously shown to be associated with atherosclerosis and hypertension (HT), in CAE patients. Ninety-six CAE and 175 patients with normal coronary arteries were included in the study. ECE-1b gene variations rs213045 and rs2038089 were determined by real-time PCR. The frequencies of rs213045 C > A (C338A) CC genotype (60.4% vs. 35.4%, p < 0.001) and rs2038089 T > C T allele (64.58% vs. 35.42%, p = 0.017) were higher in the CAE group compared to the control group. The multivariate regression analysis showed that the ECE-1b rs213045 CC genotype (p = 0.001), rs2038089 T allele (p = 0.017), and hypercholesterolemia (HC) (p = 0.001) are risk factors for CAE. Moreover, in nondiabetic individuals of the CAE and control groups, it was observed that the rs213045 CC genotype (p < 0.001), and rs2038089 T allele (p = 0.003) were a risk factor for CAE, but this relationship was not found in the diabetic subgroups of the study groups (p > 0.05). These results show that ECE-1b polymorphisms may be associated with the risk of CAE and this relationship may change according to the presence of type II diabetes.

Brazilian Guidelines on evaluation and clinical management of Nephrolithiasis: Brazilian Society of Nephrology

The prevalence of nephrolithiasis has been increasing in recent years, affecting appro-ximately 10% and 15% of the population. Kidney stone disease is associated with syste-mic comorbidities such as cardiovascular dis-ease, diabetes mellitus, and obesity. The first Nephrolithiasis Guideline by the Brazilian Society of Nephrology was published in 2002, and since then, the accumulation of new clinical studies and guidelines has justified a review of the subject. This updated document, prepared by the Nephrolithiasis Committee of the Brazilian Society of Nephrology, reflects the advances in the management of patients with kidney stones. The guideline aims to provide recommendations for the diagnosis, prevention, and treatment of nephrolithiasis, based on the best available evidence. Topics covered include clinical evaluation, laboratory and imaging tests, as well as dietary and pharmacological interventions, and follow-up strategies.

Perceptions related to the layout of Visual Abstracts among physicians and medical students

INTRODUCTION

Visual Abstract is a visual summary of the most relevant information from a scientific article, presented as an infographic. Despite the growing use of Visual Abstracts by journals around the world, studies evaluating their components to guide their development remain scarce.

OBJECTIVE

The primary objective of this study is to identify the aesthetic perceptions of Visual Abstracts components by physicians and medical students.

METHODS

Cross-sectional study, using a virtual questionnaire sent via email to a convenience sample comprising physicians and medical students. Data were analyzed using descriptive statistics, with means and standard deviation or median and interquartile range, depending on the type of the variable distribution. Categorical variables are presented in absolute and relative numbers.

RESULT

The research sample consisted mainly of medical students (65%), who were female (57.2%), with a median age of 23.5 years (IQR 21-42.25). The majority of respondents declared no prior knowledge on Visual Abstracts (61.7%). Of the analyzed variables, preferences included icons (56.7%), in a monochrome style (36.7%), second-dimensional (81.1%), and moderately detailed layout (56.7%), using the "original" color (91.7%), and structured in IMRaD format (73.9%).

CONCLUSION

Several visual components influence the aesthetic perception of physicians and medical students regarding Visual Abstracts, with particular emphasis on textual objectivity, clarity of colors, and the use of icons.

Analyzing research trends in the relationship between immunosuppressants and cancer following organ transplantation: a bibliometric study from 2001 to 2023

BACKGROUND

Recently, there has been an increasing interest in investigating the potential benefits or risks associated with using immunosuppressants for treating specific tumors post organ transplantation, with a focus on selecting appropriate drugs, doses, and treatment protocols. This study used bibliometric analysis to evaluate research trends and hotspots in this field.

MATERIALS AND METHODS

A systematic search was conducted on the Web of Science to identify studies focusing immunosuppressants and cancer following organ transplantation from 2001 to 2023. The search strategy utilized a variety of the keywords including "immunosuppressants", "cancer" and "transplant". Data extraction involved recording various parameters such as title, author, institution, country, publication, citation, H-index, immunosuppressant, and type of transplantation.

RESULTS

The analysis encompassed a total of 94 studies. The findings revealed that the period from 2005 to 2010 emerged as the most influential timeframe within this research. The United States ranked highest in the number of publications, with Vivarelli M identified as the most productive author, and the University of Bologna recognized as the most productive institute. "Immunosuppression", "rapamycin" and "kidney" were identified as the key hotspots within this field. Notably, rapamycin was identified as the predominant immunosuppressant and kidney transplantation emerged as the most prominent type of transplantation.

CONCLUSIONS

While immunosuppressants have been extensively utilized in organ transplant procedures, certain associated cancer risks have not been well addressed. Further long-term monitoring studies are required for numerous immunosuppressants to elucidate precise applications and potential implications for solid-organ transplant recipients.

Treatment Strategies for Refractory Catheter-Related Central Venous Occlusive Disorders: Review

BACKGROUND

Catheter-related central vein occlusive disease (CVOD) is a frequent complication in hemodialysis patients and significantly affects their prognosis. Current treatment options for catheter-related CVOD include standard guidewire and catheter techniques, radiofrequency ablation, and sharp recanalization. However, large-scale clinical trials evaluating these techniques are lacking, making CVOD management challenging. This article reviews current treatment strategies for catheter-related CVOD.

METHODS

A comprehensive literature review was conducted via PubMed, focusing on studies evaluating the effectiveness and safety of various treatment modalities for CVOD. The following keywords were used in PubMed: "hemodialysis", "central vein occlusion", "central vein stenosis", and "catheter".

RESULTS

The treatment methods for refractory CVOD in hemodialysis patients are diverse, including sharp recanalization, radiofrequency ablation, and percutaneous superior vena cava puncture. Complications and success rates vary widely across treatments, and evidence is generally limited to small studies or case series. However, a standardized treatment protocol is still lacking.

CONCLUSIONS

While several techniques show promise in treating catheter-related CVOD, high-quality clinical studies are necessary to identify the more effective and safe procedure. The choice of treatment should be based on individual patient characteristics, extent of the occlusion, and available resources. Percutaneous SVC puncture may be a feasible alternative after failed sharp recanalization for refractory CVOD.

Association of Metabolic Score for Visceral Fat (METS-VF) with Gout Risk in Patients with Hypertension and Hyperuricemia: A Multicenter Study Based on the Chinese Population

Background

Gout, a rheumatic disease precipitated by hyperuricemia, has become a global health concern due to its increasing prevalence, especially in China. Hyperuricemia and hypertension are significant risk factors for gout, and their coexistence amplifies this risk. Visceral adipose tissue (VAT) plays a crucial role in cardiometabolic diseases, and the metabolic score for visceral fat (METS-VF) is a non-invasive tool for estimating VAT and predicting cardiometabolic risk.

Methods

We conducted a multicenter cross-sectional study involving 8877 patients with hypertension and hyperuricemia from three Chinese medical centers between March 2021 and September 2024. We calculated the METS-VF and other obesity indices and analyzed their associations with gout risk using logistic regression models. The predictive performance of these indices was evaluated using receiver operating characteristic (ROC) curve analysis and clinical decision curve analysis (DCA).

Results

The METS-VF demonstrated a significant positive association with gout risk, independent of traditional risk factors. Each 1-standard deviation increase in the METS-VF was associated with an 82% higher odds of gout (OR=1.82, 95% CI: 1.62 to 2.03). The METS-VF outperformed other obesity indices in predicting gout risk, with a higher area under the ROC curve (AUC) value. DCA indicated that the METS-VF provided a significant net benefit across a wide range of threshold probabilities for predicting gout risk in both genders.

Conclusion

The METS-VF's robust association with gout risk in our multicenter study, independent of conventional risk factors, positions it as a potent predictor for gout. Further investigation is warranted to clarify the underlying mechanisms and the long-term predictive validity of the METS-VF across diverse populations.

Study on HIF-PHI combined with iron supplement in treatment of renal anemia in rats

BACKGROUND

Roxadustat is a novel hypoxia- inducible factor-prolyl hydroxylase inhibitor(HIF-PHI) used to treat anemia in chronic kidney disease (CKD) patients. It has been reported that roxadustat can slow down kidney damage and delay the development of kidney fibrosis. Anemia and iron deficiency are often associated with the vast majority CKD patients, and insufficient available iron or total iron storage is often the most common cause of anemia and ESAs resistance in CKD patients. The role of iron availability in the pathogenesis of anemia in chronic kidney disease has received increasing attention.

OBJECTIVES

To explore whether combined roxadustat and polysaccharide-iron complex (PIC) is more successful than standalone roxadustat, the appropriate iron supplement dosage and mechanism of roxadustat in the treatment of CKD.

MATERIALS AND METHODS

Healthy male Sprague Dawley rats were randomly divided into two groups: the control (NC) group which were sham-operated and the CKD group. The CKD group was given an adenine diet for three weeks after right unilateral nephrectomy and further divided into 6 groups: the CKD only, CKD + PIC, CKD + Roxa, CKD + PIC (25 mg/kg) + Roxa, CKD + PIC (50 mg/kg) + Roxa, and CKD + PIC (75 mg/kg) + Roxa groups. The sham-operated rats receiving only standard diet served as the control group. Roxadustat were administrated intragastrically at 10 mg/kg thrice per week in groups with Roxa. The hemoglobin (Hb), reticulocyte hemoglobin equivalent (RET-He), reticulocyte % (RET%), plasma urea nitrogen (BUN), plasma creatinine (Cr), serum iron (SI), Total iron binding capacity (TIBC), serum hepcidin-25, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL- 1β), and High mobility group protein B1 (HMGB1) levels of each group of rats were assessed. Masson staining was used to evaluate renal fibrosis, and quantitative real-time Polymerase Chain Reaction (RT-PCR) was used to detect the mRNA expression of alpha-smooth muscle actin (α-SMA) and Fibronectin (Fn) in rat renal tissues to further evaluate renal fibrosis.

RESULTS

Level of Hb in the CKD + PIC (75 mg/kg) + Roxa group increased the fastest, roxadustat combined with PIC in the treatment of renal anemia was significantly more effective than Roxadustat or PIC alone. On day 105, in the CKD + PIC (75 mg/kg) + Roxa group, there was a significant decrease in BUN and Cr levels compared to the CKD only group (p < 0.05). Roxadustat reduces the level of hepcidin, IL-6, TNF-α, IL-1β and HMGB1in CKD rats. (p < 0.05). Roxadustat alleviates renal fibrosis in CKD rats (p < 0.05).

CONCLUSIONS

HIF-PHI combined with iron supplement (Roxadustat combined with PIC) has an improved effect on the treatment of renal anemia, and early administration of sufficient iron enables the Hb to rise rapidly. Early administration of adequate dose of PIC is necessary for renal anemia. HIF-PHI can improve iron metabolism, alleviate the microinflammatory state, alleviate renal fibrosis and plays a beneficial role in the treatment of renal fibrosis in CKD rats.

Nutritional Intervention and Musculoskeletal Health in Chronic Kidney Disease

Chronic kidney disease (CKD) is a leading condition in terms of prevalence and overall health impact. With the increased life expectancy of the CKD population and the improvement in medical care, controlling musculoskeletal complications remains a tough challenge. Patients with CKD are prone to falls, fractures and sarcopenia, enhancing the risk of death. A multitude of mechanisms contribute to fractures, and treatment is suboptimal; therefore, prevention must stand out as a key step. This review aims to provide an overview of the most relevant data regarding the impact of nutrition on bone disorders and sarcopenia in CKD. The newest relevant studies emphasize that plant protein intake is associated with a lower production of uremic toxins, lower serum phosphorus levels, and stronger bones. We conclude that patients with CKD should adopt specific diets tailored to the presence of osteoporosis, renal osteodystrophy, and muscle wasting. Low-protein diets or plant-dominant diets containing an adequate amount of protein could be better choices for predialysis patients with CKD in order to protect their bones and muscles, whereas in the dialysis population, a higher protein intake could be essential to prevent osteoporosis and sarcopenia. In all patients with CKD, focusing on antioxidant food intake could provide a strong antiaging benefit through ensuring good musculoskeletal health.

Safranal Ameliorates Renal Damage, Inflammation, and Podocyte Injury in Membranous Nephropathy via SIRT/NF-κB Signalling

OBJECTIVE

Safranal is a natural product from saffron (Crocus sativus L.) with anti-inflammatory and nephroprotective potential. This study aimed to explore the role of safranal in a cationic bovine serum albumin (C-BSA)-induced rat model of membranous glomerulonephritis (MGN).

METHODS

After model establishment, Sprague-Dawley rats were administered 100 or 200 mg/kg safranal by gavage. A biochemical analyser was used to measure the urine protein levels and serum levels of renal function parameters. Hematoxylin-eosin and immunofluorescence staining of kidney tissues were performed to examine histopathological changes and assess the expression of IgG, C3, and Sirt1. Western blotting was performed to measure the protein levels of podocin, nephrin, Sirt1, and factors involved in the NF-κB/p65 pathway. Inflammatory cytokine levels in renal homogenates were determined by ELISA.

RESULTS

Safranal at 100 or 200 mg/kg reduced kidney weight (2.07 ± 0.15 g and 2.05 ± 0.15 g) and the kidney somatic index (0.83 ± 0.08% and 0.81 ± 0.08%) in MGN rats compared with those in the model group without drug administration (2.62 ± 0.17 g and 1.05 ± 0.1%). C-BSA increased the urine protein level to 117.68 ± 10.52 mg/day (compared with the sham group, 5.03 ± 0.45 mg/day), caused dysregulation of renal function indicators, and induced glomerular expansion and inflammatory cell infiltration in the rat kidney samples. All the biochemical and histological changes were improved by safranal administration. Safranal at two doses also increased the fluorescence intensities of IgG (0.1 ± 0.009 and 0.088 ± 0.008) and C3 (0.065 ± 0.006 and 0.048 ± 0.004) compared with those in the MGN group (0.15 ± 0.013 and 0.086 ± 0.008). Additionally, safranal reversed the downregulation of podocin, nephrin, and Wilms tumor protein-1 (WT1) levels and reversed the high inflammatory cytokine levels in MGN rats. Mechanistically, safranal activated Sirt1 signalling to interfere with NF-κB signalling in the kidney tissues of MGN rats.

CONCLUSIONS

Safranal ameliorates renal damage, inflammation, and podocyte injury in MGN by upregulating SIRT1 and inhibiting NF-κB signalling.

The role of AGEs in muscle ageing and sarcopenia

Sarcopenia is an ageing-related disease featured by the loss of skeletal muscle quality and function. Advanced glycation end-products (AGEs) are a complex set of modified proteins or lipids by non-enzymatic glycosylation and oxidation. The formation of AGEs is irreversible, and they accumulate in tissues with increasing age. Currently, AGEs, as a biomarker of ageing, are viewed as a risk factor for sarcopenia. AGE accumulation could cause harmful effects in the human body such as elevated inflammation levels, enhanced oxidative stress, and targeted glycosylation of proteins inside and outside the cells. Several studies have illustrated the pathogenic role of AGEs in sarcopenia, which includes promoting skeletal muscle atrophy, impairing muscle regeneration, disrupting the normal structure of skeletal muscle extracellular matrix, and contributing to neuromuscular junction lesion and vascular disorders. This article reviews studies focused on the pathogenic role of AGEs in sarcopenia and the potential mechanisms of the detrimental effects, aiming to provide new insights into the pathogenesis of sarcopenia and develop novel methods for the prevention and therapy of sarcopenia.

Prevalence and predictors of stunting in children and adolescents aged 1-18 years with nephrotic syndrome attending Mulago Hospital, Uganda

BACKGROUND

Nephrotic syndrome is the predominant glomerulopathy in children worldwide, particularly in low-income countries. One of the key complications of nephrotic syndrome is stunting. Stunting is the most prevalent form of undernutrition globally; which leads to early and long-term consequences. In this study, we determined the prevalence and predictors of stunting among children and adolescents with nephrotic syndrome at a tertiary nephrology clinic in Uganda.

METHODS

Between February and August 2022, we conducted a cross-sectional study that enrolled children and adolescents aged 1 to 18 years with nephrotic syndrome. Participants had been undergoing steroid treatment for a minimum of three months and were registered at the paediatric renal clinic of Mulago National Referral Hospital in Kampala, Uganda. Medical history, physical examination and anthropometric assessment were conducted on the enrolled children. The World Health Organisation (WHO) growth reference standards were used to evaluate stunting in the enrolled children. Multivariable logistic regression analysis was performed to determine independent predictors of stunting and a p-value < 0.05 was considered statistically significant.

RESULTS

Ninety-four participants were enrolled, with a median age (IQR) at diagnosis of six years (IQR 3-9). Among the participants, 48 (51.1%) were male. The prevalence of stunting was observed in 15 (15.9%) participants (95% confidence interval [CI]: 15.88 - 16.04). Regarding severity, 12 (12.8%) participants were moderately stunted, and 3 (3.2%) were severely stunted. Participants with persistent proteinuria exhibited higher odds of stunting than those without. (OR: 4.11, 95% CI: 1.05 - 15.98, p < 0.041).

CONCLUSIONS

There is a high prevalence of stunting among children with nephrotic syndrome, particularly among those with on-going proteinuria. This underscores the importance of regular growth monitoring and screening for early identification and eventual management of stunting among children receiving care for nephrotic syndrome. Providing nutritional counselling and other interventions is thus crucial in addressing stunting among this specific group of children and adolescents.

Environmental determinants in the development of kidney stone

The increase with years of kidney stone prevalence has become a serious public health problem worldwide. The geographical distribution pattern of kidney stone (known as "stone belt") clearly indicates the critical role of environmental exposure in its formation, which has long been an underestimated risk factor in studying the development of kidney stone. Based on our previous studies and bibliometric analysis, we discerned four environmental determinants and elaborated their impacts on human internal exposure related to kidney stone formation. The importance of climatic factor lies in that the relatively high temperature and low humidity environment may contribute greater prevalence of kidney stone, since it promotes elevating the concentration of relatively insoluble stone-forming salts. Geological factors including water quality, hydrogeology, and soil environment is involved in kidney stone formation via the food chain. Additionally, air pollution and heavy metal pollutants also act as potential risk factors by directly or indirectly affecting the normal renal function and urinary metabolism. This review thus provides insights into the specific mechanisms affecting metabolic changes in the human body which result in kidney stone formation under environmental exposure, and shed light on the pathogenesis of nephrolithiasis from an interdisciplinary perspective.

Reporting of nutritional screening, status, and intake in trials of nutritional and physical rehabilitation following critical illness: a systematic review

BACKGROUND

Surviving critical illness leads to prolonged physical and functional recovery with both nutritional and physical rehabilitation interventions for prevention and treatment being investigated. Nutritional status and adequacy may influence outcome, but no consensus on which nutritional-related variables should be measured and reported in clinical trials exists.

OBJECTIVES

This study aimed to undertake a systematic review investigating the reporting of nutritional screening, nutritional status, and nutritional intake/delivery in randomized controlled trials (RCTs) evaluating nutritional and/or physical rehabilitation on physical and functional recovery during and following critical illness.

METHODS

Five electronic databases (MEDLINE, Web of Science, EMBASE, CINAHL, and Cochrane) were searched (last update 9 August, 2023). Search terms included both free text and standardized indexed terms. Studies included were RCTs assessing nutritional and/or physical interventions either during or following intensive care unit (ICU) admission in adults (18 y or older) with critical illness, and who required invasive mechanical ventilation for any duration during ICU admission. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool for RCTs and descriptive data synthesis was performed and presented as counts (%). n t RESULTS: In total, 123 RCTs (30 nutritional, 87 physical function, and 6 combined) were included. Further, ≥1 nutritional variable was measured and/or reported in 99 (80%) of the studies including BMI (n = 69), body weight (n = 57), nutritional status (n = 11), nutritional risk (n = 10), energy delivery (n = 41), protein delivery (n = 35), handgrip strength (n = 40), and other nutritional-related muscle variables (n = 41). Only 3 studies were considered to have low risk of bias in all categories.

CONCLUSIONS

Few RCTs of physical rehabilitation measure and report nutritional or related variables. Future studies should measure and report specific nutritional factors that could impact physical and functional recovery to support interpretation where studies do not show benefit. This protocol was preregistered at PROSPERO as CRD42022315122.

Analysis of survival among biopsy-determined categories of kidney disease in dogs

BACKGROUND

There are many causes of kidney disease in dogs. The association of the diagnostic category with survival is unknown.

OBJECTIVE

Determine survival outcomes for biopsy-determined diagnostic categories of kidney disease in dogs.

ANIMALS

Six hundred forty-nine dogs were biopsied for evaluation of kidney disease.

METHODS

Retrospective study. Survival information was obtained for dogs whose kidney biopsy was submitted to the International Veterinary Renal Pathology Service between 2008 and 2018. Signalment, serum creatinine (sCr), urine protein : creatinine ratio (UPCR), and serum albumin (sAlb) were reported at the time of biopsy. Cox proportional hazards analysis was performed for the 14 categories with >10 cases having follow-up to determine hazard ratios (HR), using focal segmental glomerulosclerosis (FSGS) as baseline.

RESULTS

The median survival time (MST) for all dogs with follow-up (n = 649) was 608 days (interquartile range [IQR]: 109-1475 days). The most follow-up was obtained for FSGS (n = 138, MST 536 days). Dogs with renal amyloidosis (n = 80) had the shortest survival (MST 76 days, IQR 8-299 days) and, in the multivariate analysis including age, sCr, sAlb, and UPCR, an increased risk of death (HR 1.79 [95% CI: 1.22-2.65], P < .01). Dogs with podocytopathy, membranous glomerulonephritis (MGN), mixed MGN, membranoproliferative GN (MPGN), and mixed MPGN had decreased risk of death. Regardless of category, increasing age, sCr, and UPCR and decreased sAlb were associated with a greater risk of death.

CONCLUSIONS

The diagnostic category is associated with survival in dogs with kidney disease. Survival of individual dogs within each category was highly variable.

Hyponatremia Correction and Osmotic Demyelination Syndrome Risk: A Systematic Review and Meta-Analysis

Rationale & Objective

Osmotic demyelination syndrome (ODS) is a rare but severe condition often attributed to the rate of sodium collection. We evaluated the association between the overly rapid sodium correction in adult hospitalized patients with ODS.

Study Design

Systematic review and meta-analysis.

Setting & Study Populations

Adults hospitalized hyponatremia patients.

Selection Criteria for Studies

The studies comparing the incidence of ODS with and without rapid sodium correction inception to January 2024.

Data Extraction

Two reviewers independently extracted data and assessed the risk of bias and the certainty of evidence.

Analytic Approach

The incidence of ODS following a rapid and nonrapid sodium correction was pooled using the random effects model. Subgroup and meta-regression analyses were performed for the robustness and the source of heterogeneity.

Results

Eleven cohort studies were included with 26,710 hospitalized hyponatremia patients. The definition of hyponatremia varied from <116 to <130 mmol/L, and overly rapid sodium correction was defined as >8 to 12 mmol/L within 24 hours. The overall incidence of ODS was 0.23%. The incidence of ODS in rapid and nonrapid sodium correction was 0.73% and 0.10%, respectively. Meta-analysis demonstrated that a rapid rate of sodium correction was associated with a higher incidence of ODS (odds ratio 3.16, 95% CI, 1.54-6.49, I2 = 27%), whereas some patients with hyponatremia developed ODS without rapid sodium level correction. The sensitivity analysis based on the quality of the studies was consistent with the main result.

Limitation

Various definition criteria for ODS diagnosis across studies, lack of potential electrolyte and treatment data that may affect the incidence of ODS.

Conclusions

The rapid rate of sodium correction had a statistical correlation with a higher incidence of ODS. Among ODS without rapid correction, further studies are recommended to evaluate and comprehend the relationship for better and proper management of hospitalized patients with hyponatremia.

Factors Associated with the Initial Vascular Access Choice and Median Utilization Time in Hemodialysis Patients

The aim of the study was to elucidate predictors associated with the initial choice of vascular access (VA) type. The secondary aim was to determine the initial VA's median utilization time and the factors governing it. This prospective cohort study included 387 hemodialysis (HD) patients admitted to the Clinic for Hemodialysis, Clinical Center University of Sarajevo, in consecutive order between January 2006 and December 2016. We selected the primary predictors for the initial VA type using a random forest algorithm. We further quantified factors governing the initial choice of VA: temporary catheters (TCs), compared to arteriovenous fistula (AVF), using multivariate logistic regression. Finally, we used log-rank and Cox regression models to estimate the median time on each initial VA and find predictors governing it. Of the 387 patients, 265 (68.5%) used TC at dialysis initiation and 122 (31.5%) AVF. Predictors of the TC's versus AVF's initial use were older age (odds ratio = 1.02; confidence interval [CI] = 1.0, 1.03; P = 0.03) and primary cause of chronic kidney disease, particularly diabetes, compared to all other causes of kidney disease. Median time on initial AVF was 57.0 months (95% CI = 36.9, 64.1), and on initial TC 4.99 months (95% CI = 2.69, 8.48). Younger age (hazard ratio [HR] = 0.98; 95% CI = 0.97, 0.99; P = 0.01), male sex (HR = 1.51; 95% CI = 1.05, 2.19; P = 0.03), and hypertension (HR = 1.63; 95% CI = 1.13, 2.36; P = 0.01) predicted median time on initial TC, while older age (HR for patients aged > 70 years = 1.86; 95% CI = 1.09, 3.17; P = 0.02), and diabetes (HR = 1.97; 95% CI = 1.19, 3.24; P = 0.01), predicted median time on initial AVF. These results point to late VA referrals and delays in transitioning to permanent VA.

Empyema associated with peritoneal dialysis peritonitis

A 65-year-old woman on peritoneal dialysis (PD) was admitted due to abdominal pain with cloudy PD effluent. The white blood cell count in PD effluent was 5860/µL with 85% polymorphonuclear neutrophils. Therefore, she was clinically diagnosed with peritonitis. The cultures of PD effluent were negative. Initial abdominal computed tomography did not find suggest any intraabdominal pathology. The patient was treated with empirical intraperitoneal antibiotics. Because abdominal pain with cloudy PD effluent persisted, the PD catheter was removed eventually. The culture of the removed PD catheter grew Klebsiella pneumoniae. However, intermittent fever was noted over the following days and empyema developed approximately 2 weeks after PD catheter removal. The culture of pleural fluid also grew K. pneumoniae. Another computed tomography revealed multiple intraabdominal abscesses that was assumed to come from a complication of PD-associated peritonitis. We postulate that the empyema might be caused by transdiaphragmatic extension of the intraabdominal abscesses into the pleural space.

Livedoid vasculopathy, calciphylaxis, and Martorell's hypertensive ulcer: update on ischemic ulcers due to impaired microcirculation of the lower limbs

Ischemic ulcers due to compromised microcirculation of the lower limbs cause painful ulcers that represent a challenge for the correct diagnosis and treatment. Livedoid vasculopathy, calciphylaxis, and Martorell's hypertensive ischemic ulcer are part of this group and present some similarities due to microvascular occlusive impairment. They are often misdiagnosed as inflammatory ulcers such as pyoderma gangrenosum and vasculitis. This review discusses the pathophysiology, risk factors, clinical aspects, differential diagnoses, histopathology, and presents a therapeutic update of livedoid vasculopathy, calciphylaxis, and Martorell's ulcer. Although they are less frequent causes of chronic ulcers, a correct diagnosis is essential to reduce the chance of erroneous therapies that may impact morbidity and mortality related to these conditions.

Outcomes and prognostic factors in childhood-onset steroid-resistant nephrotic syndrome: a retrospective single-center study

BACKGROUND

Steroid-resistant nephrotic syndrome (SRNS) is the second leading cause of chronic kidney disease (CKD) in childhood. It represents a heterogeneous group of diseases with variable kidney outcomes that are still challenging to predict. In this study, our main objective is to describe predictive factors of remission states and kidney survival comparing genetic and non-genetic SRNS.

METHODS

We conducted a retrospective analysis of 65 pediatric patients with SRNS treated at the pediatric outpatient clinic in Berlin between 2000 and 2023. Clinical characteristics, laboratory findings, and treatment strategies were systematically collected at multiple time points. Outcomes were defined by remission status, kidney survival (CKD stage I-IV), or progression to CKD stage V. Statistical analyses included univariate and multivariate logistic and Cox regression models adjusted for monogenic SRNS to identify predictors of remission and kidney survival.

RESULTS

The median age of onset was 4.0 years, with a male predominance of 57%. Patients were followed for a median of 5.9 years. At the last follow-up, 26 patients achieved complete remission, 12 achieved partial remission, and 27 showed no remission. Kidney survival rates at 5 and 10 years were 71% and 56%, respectively. High initial nephrotic-range proteinuria, confirmed genetic diagnoses, reduced eGFR, and hypoalbuminemia at 3-month and 1-year follow-ups were identified as negative predictive factors for complete or partial remission. These factors also correlated strongly with an elevated risk of progression to CKD stage V.

CONCLUSION

Our findings highlight additional prognostic factors influencing remission status and long-term kidney survival in pediatric SRNS, emphasizing the value of detailed early time-point analyses.

Infection control Surveillance of dialysis events at outpatient hemodialysis centers in Saudi Arabia: A 3-year national data

Background

Monitoring dialysis events is very important in evaluating the risk of infection and antimicrobial use among this group of vulnerable patients. The objective was to calculate rates of dialysis events at outpatient hemodialysis centers in Saudi Arabia.

Methods

A retrospective cohort study of dialysis events collected from 152 outpatient hemodialysis centers in 20 Saudi regions between January 2019 and December 2021. The Saudi Health Electronic System Network (HESN) was used to report data from participating centers. Dialysis events included in-unit intravenous antimicrobial start, positive blood culture, and infection (pus, redness, and swelling) at the vascular access site.

Results

A total of 125,761 patient months of surveillance were monitored. The most frequent type of dialysis event was the in-unit intravenous antimicrobial start at 0.75 per 100 patient months, followed by positive blood culture at 0.41, and finally, local access of the infection site at 0.34. The rates of dialysis events were highest, with temporary central lines at 4.36, permanent central lines at 1.87, arteriovenous graft at 0.35, and finally, arteriovenous fistula at 0.17. After adjusting for the differences in the type of vascular access, the rates of dialysis events in the Saudi HESN were lower, 54%-83%, than those of the American National Healthcare Safety Network (NHSN, P<0.001 for each) and a less extent 27%-55% lower when compared with the published results from Chinese people.

Conclusions

The current findings provide benchmarking data for different dialysis events that can promote fair comparisons and interest in dialysis event surveillance.

Chronic kidney disease-mineral and bone disorder: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

In 2017, Kidney Disease: Improving Global Outcomes (KDIGO) published a Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Since then, new lines of evidence have been published related to evaluating disordered mineral metabolism and bone quality and turnover, identifying and inhibiting vascular calcification, targeting vitamin D levels, and regulating parathyroid hormone. For an in-depth consideration of the new insights, in October 2023, KDIGO held a Controversies Conference on CKD-MBD: Progress and Knowledge Gaps Toward Personalizing Care. Participants concluded that the recommendations in the 2017 CKD-MBD guideline remained largely consistent with the available evidence. However, the framework of the 2017 Guideline, with 3 major sections-biochemical abnormalities in mineral metabolism; bone disease; and vascular calcification-may no longer best reflect currently available evidence related to diagnosis and treatment. Instead, future guideline efforts could consider mineral homeostasis and deranged endocrine systems in adults within a context of 2 clinical syndromes: CKD-associated osteoporosis, encompassing increased fracture risk in patients with CKD; and CKD-associated cardiovascular disease, including vascular calcification and structural abnormalities, such as valvular calcification and left ventricular hypertrophy. Participants emphasized that the complexity of bone and cardiovascular manifestations of CKD-MBD necessitates personalized approaches to management.

Leontiasis ossea in the setting of chronic kidney disease and limited dialysis access: A case report with discussion of therapeutic implications

Leontiasis ossea, also known as craniofacial fibrous dysplasia, is a rare form of osseous hypertrophy of the facial bones associated with chronic kidney disease and secondary hyperparathyroidism. As the condition progresses, changes in bone structure can lead to severe facial disfigurement, respiratory difficulties, dysarthria, and dysphagia. We describe the case of an approximately 30-year-old male with a long-standing history of end-stage renal disease who experienced rapidly progressing facial swelling and underlying bone changes following a period of poor access to dialysis. Despite brief symptomatic improvement following parathyroidectomy, the patient's hyperparathyroidism ultimately persisted. Subsequent immunomodulator therapy again offered subjective improvements but was discontinued in the setting of adverse effects. We provide a brief overview of the pathophysiology of leontiasis ossea, review imaging findings pertinent to the case presentation, and discuss relevant implications in the diagnosis and management of this disease.

Metformin and vitamin D combination therapy ameliorates type 2 diabetes mellitus-induced renal injury in male Wistar rats

Diabetic kidney disease is a major microvascular diabetes mellitus (DM) complication clinically associated with a gradual renal function decline. Although metformin is a common drug for managing DM, however, monotherapy treatment with any antidiabetic drug will necessitate dosage increment since type 2 DM (T2DM) deteriorates over time due to the increasing pancreatic β-cell dysfunction and will eventually require a combination therapy approach with another antidiabetic medication. Vitamin D is a food supplement that has been proven to have antidiabetic and reno-protective activities. Hence, we explore the combination of vitamin D and metformin on T2DM-induced renal dysfunction. Thirty male Wistar rats were randomized into five (5) groups: control, diabetes untreated, diabetics treated with metformin, vitamin D, and vitamin D + metformin. Vitamin D and metformin significantly reversed DM-induced hyperglycemia, electrolyte imbalance, and dyslipidemia. Also, vitamin D and metformin reversed T2DM-induced increase in serum creatinine and urea and renal lactate, LDH, and oxido-inflammatory response. These observed alterations were accompanied by an increase in proton pump activities and modulation of Nrf2/Nf-κB and XO/UA signaling. This study revealed that vitamin D and/or metformin ameliorated T2DM-induced renal injury.

Perspectives and Experiences of Patients with AKI: A Systematic Review

Key Points

Background

AKI is associated with higher risk of mortality and progression to CKD. The challenges and uncertainty in the diagnosis, self-management, and prevention of AKI can be distressing for patients. We aimed to perform a systematic review of qualitative studies/surveys that reported the perspectives and experiences of adults with AKI.

Methods

We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to January 17, 2024. Thematic textual analysis was used to synthesize the findings.

Results

We included 20 studies (ten qualitative studies, ten surveys) involving 867 participants. We identified six themes: navigating the unknown (an unexpected and unfamiliar diagnosis, tossed about in a fragmented system, and dismissed and vulnerable at discharge); impaired life participation, relationships, and well-being (limiting ability to do daily activities and straining relationships); unbearable and unsustainable treatment burden (adding strain on family members, financial pressure because of medical expenses, and cumulative stress of ongoing monitoring); uncertain whether recovery is attainable (possible permanence of kidney damage, fear about nephrotoxic medications, and terrified about the need for dialysis); less consequential than other health priorities (short term and reversible and prioritizing other comorbidities and conditions); and empowered in managing own health (focusing on optimizing kidney health, gaining confidence in self-management, and reassured with social and clinical support).

Conclusions

Patients may be unaware of their AKI diagnosis and prognosis, feel that care is fragmented, and be burdened by treatment. Providing education, alleviating treatment burden, and implementing a comprehensive model of care may help to address the needs of patients with AKI leading to better outcomes.

The Association Between Ambient Particulate Matter Exposure and Anemia in HIV/AIDS Patients

BACKGROUND

Anemia is common among HIV/AIDS patients, impacting prognosis. Particulate matter (PM) exposure is an understudied, potentially modifiable risk factor in this group.

METHODS

We gathered 36,266 hemoglobin (Hb) measurements from 6808 HIV/AIDS patients from the HIV/AIDS Comprehensive Response Information Management System from 1 January 2004 to 31 December 2021. We evaluated the relationship between Hb levels and short-term PM exposure using linear mixed-effects models. We used logistic regression to estimate the association of long-term PM exposure with baseline anemia prevalence and time-varying Cox models to estimate the association of long-term PM exposure with follow-up incidence of anemia. Mediation analysis explored the role of chronic kidney disease (CKD) in the association between PM exposure and anemia.

RESULTS

For every 5 µg/m³ increase in 28-day average PM 1 , Hb levels decreased by 0.43 g/l. For a 10 µg/m³ increase in PM 2.5 , Hb decreased by 0.55 g/l; for the same increase in PM 10, Hb decreased by 0.35 g/l. A 5 µg/m³ increase in 1-year average PM 1 corresponded to a 7% higher prevalence of anemia at baseline, a 10 µg/m³ increase in PM 2.5 to 8% higher prevalence, and a 10 µg/m³ increase in PM 10 to 6% higher prevalence. These rises in average PM concentrations during follow-up were associated with increased incident anemia by 54% (PM 1 ), 72% (PM 2.5 ), and 51% (PM 10 ). CKD partially mediated the positive associations between PM exposure and the incidence of anemia.

CONCLUSION

PM exposure was associated with lower Hb levels and higher incidence of anemia in HIV/AIDS patients and CKD with mediating estimated effects in PM-induced anemia.

Intradialytic Hypotension Pathophysiology and Therapy Update: Review and Update

BackgroundIntradialytic hypotension (IDH) is the most prevalent complication during hemodialysis (HD) sessions, affecting 10% to 12% of patients. It is linked with temporary ischemic stress in vital organs, increasing patient mortality. Various definitions of IDH have been proposed, and a strong correlation has been found between patient outcomes and the absolute lowest systolic blood pressure. The most probable underlying pathophysiology of IDH involves a reduced effective blood volume and decreased plasma tonicity. Optimizing the dialysis prescription and interventions during and after the dialysis session is sometimes effective for reducing IDH risk.Aim and MethodThis review discusses the pathophysiology, prevention, and therapy of IDH updates. To achieve this aim, Scopus, EMBASE, PubMed, Google, and Google Scholar were searched for articles published in the last two decades using phrases and keywords.ConclusionIntradialytic pathophysiology is ambiguous and unclear. The evidence for the effectiveness of the known therapies and maneuvers is limited. Ideally, IDH prevention should be the target; however, IDH management is sometimes needed. Different obstacles require further clinical research.

Epidemiology of glomerular diseases in a Colombian population

BACKGROUND

Glomerular diseases are a diverse group of conditions with variations in clinical presentation, pathophysiology, diagnosis, and treatment. Renal biopsy is essential for determining their aetiology and prognosis.

OBJECTIVE

To describe the epidemiology of glomerular diseases based on histopathological studies conducted in the Department of Pathology at the School of Medicine, University of Antioquia, Colombia, between 1988 and 2023.

MATERIALS AND METHODS

A retrospective, descriptive, cross-sectional study was conducted on patients with glomerular disease who underwent renal biopsy between 1988 and 2023. A descriptive analysis was performed on their sociodemographic, clinical, laboratory, and pharmacological characteristics.

RESULTS

A total of 4567 histopathology reports were analysed. Of these, 56.6% were from women, with an average age of 32 years. Nephrotic syndrome was the most common indication for renal biopsy (35.0%). Lupus nephritis was the most prevalent diagnosis (28.2%), followed by focal segmental glomerulosclerosis (16.6%). In adults, lupus nephritis and focal segmental glomerulosclerosis were the most frequent diagnoses, while in children, minimal change disease and focal segmental glomerulosclerosis were the most common.

CONCLUSIONS

The type of glomerular disease varies according to sociodemographic factors such as age and sex. Lupus nephritis and focal segmental glomerulosclerosis were the most common glomerular diseases. The main indications for biopsy were nephrotic syndrome and abnormal urinary sediment.

Biomarker states and risk of death among individuals hospitalized with SARS-CoV-2 infection

BACKGROUND

Identifying individuals hospitalized for SARS-CoV-2 infection at increased risk of death is crucial for clinical decision making. Analyses must consider simultaneously the multitude of biomarkers across several domains and how these biomarker profiles change over time.

METHODS

This electronic health records-based study included individuals hospitalized at a Massachusetts General Brigham hospital for at least 24 h within 5 days prior and 30 days after diagnosis of COVID-19. K-means clustering was used to identify profiles among 20 eligible biomarkers and proportional hazards models were used to model 30-day mortality at hospitalization and 7 days after hospitalization (i.e., landmark models).

RESULTS

Twelve thousand, nine hundred forty-two individuals were included, among whom 1,198 died within 30 days. Six states were identified, characterized by the following abnormalities: (1) normal/reference, (2) hematologic, (3) inflammatory and hematological, (4) metabolic, (5) kidney, hematologic, and metabolic, and (6) cardio-thrombotic, liver, and metabolic. Risk of death within 30 days was higher in States 3, 4, 5, and 6 (adjusted hazard ratios ranging from 3.6 to 7.8) compared to individuals in State 1 at hospitalization. Landmark model findings were similar.

CONCLUSIONS

Distinct sub-phenotypes based on biomarker profiles were identified among patients hospitalized with SARS-CoV-2 infection, and certain phenotypes are associated with greater risk of 30-day mortality.

Effect of oral nutritional supplements on inflammation and oxidative stress in hemodialysis patients: a meta-analysis

OBJECTIVE

This study aims to elucidate the effects of oral nutritional supplements on inflammatory factors and antioxidant status in patients undergoing hemodialysis through a meta-analysis of previous research.

METHODS

This study conducted literature databases from inception to November 2024, including PubMed, Embase, Cochrane, Wanfang, and China National Knowledge Infrastructure (CNKI), to identify all published randomized controlled trials assessing the impact of oral nutritional supplementation on inflammation and oxidative stress in patients on maintenance hemodialysis. Heterogeneity was assessed using the Chi-square test. Subgroup analyses and sensitivity analyses were performed to explore the sources of heterogeneity. Publication bias was evaluated using funnel plots and the Egger test.

RESULTS

Supplementation with unsaturated fatty acids did not significantly affect serum CRP levels in patients undergoing hemodialysis (MD = - 0.93, 95% CI [- 2.53, 0.68], Z = 1.13, P = 0.26). The total antioxidant capacity in the antioxidant group was higher than that in the control group (MD = 0.09, 95% CI [0.05, 0.14], Z = 4.41, P < 0.0001). The MDA levels in the antioxidant group were lower than those in the control group (MD = - 2.28, 95% CI [- 2.75, - 1.80], Z = 9.42, P < 0.0001), while the difference in IL-6 levels between the antioxidant group and the control group was not statistically significant (MD = - 0.10, 95% CI [- 0.56, 0.36], Z = 0.41, P = 0.68).

CONCLUSION

Unsaturated fatty acids do not have a significant effect on serum CRP levels in patients undergoing hemodialysis. The antioxidants (vitamin E and polyphenols) can enhance the antioxidant capacity and reduce MDA levels in these patients; however, their impact on IL-6 levels is not significant. Further high-quality randomized controlled trials are needed to validate these conclusions.

Renal organic anion transporter 1: clinical relevance and the underlying mechanisms in chronic kidney disease

Organic anion transporter 1 (OAT1), primarily found in the renal proximal tubule, is essential for the excretion of various uremic toxins that contribute to the onset and progression of chronic kidney disease (CKD). OAT1 also plays a vital role in the remote sensing and signaling network, facilitating the removal of metabolites through the kidneys. The function of OAT1 is impaired under conditions such as renal ischemia/reperfusion injury, oxidative stress, and fibrosis. Several transcription factors, post-translational modifications, and endocrine hormones control the activity and expression of OAT1. This review explores the unique contribution of OAT1 to the excretion of CKD-related UTs and the mechanisms involved.

Application of an Electronic Frailty Index to Identify High-Risk Older Adults Using Electronic Health Record Data

BACKGROUND

Measurement of frailty is limited in clinical practice. Existing electronic frailty indices (eFIs) are derived from routine primary care encounters, with near-complete health condition capture. We aimed to develop an eFI from routinely collected clinical data and evaluate its performance in older adults without complete health condition capture.

METHODS

Using Electronic Health Record (EHR) data from an integrated regional health system, we created a cohort of patients who were ≥ 60 years on January 1, 2017 with two outpatient encounters in 3 years prior or one outpatient encounter in 2 years prior. We developed an eFI based on 31 age-related deficits identified using diagnostic and procedure codes. Frailty status was categorized as robust (eFI < 0.1), prefrail (0.1-0.2), frail (0.2-0.3), and very frail (> 0.3). We estimated cumulative incidence of mortality, acute care visits and readmissions by frailty, and fit Cox proportional hazards models. We repeated analyses in a sub-cohort of patients who receive primary care in the system.

RESULTS

Among 518,449 patients, 43% were male with a mean age of 72 years; 73% were robust, 16% were pre-frail, 7% were frail, and 4% were very frail. Very frail older adults had a significantly higher risk for mortality (HR: 4.1, 95% CI: 4.0-4.3), acute care visits (HR: 5.5, 95% CI: 5.4-5.6), and 90-day readmissions (HR: 2.1, 95% CI: 2.1-2.2) than robust older adults. In a primary care sub-cohort, while prevalence of deficits was higher, associations with outcomes were similar.

CONCLUSIONS

This eFI identified older adults at increased risk for adverse health outcomes even when data from routine primary care visits were not available. This tool can be integrated into EHRs for frailty assessment at scale.

Adenine phosphoribosyltransferase (APRT) deficiency: an increasingly recognized disease

Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder which causes high urinary 2,8-dihydroxyadenine (2,8-DHA) excretion, resulting in urolithiasis and crystal nephropathy. It is caused by mutations in the APRT gene. Even though it is an inherited kidney stone disease, the varied clinical presentations, even within a family with the same underlying genetic variants, can lead to delayed diagnosis with some only being recognized in adulthood and even, following a kidney transplant. First presentations include symptoms of reddish-brown diaper stains, urinary tract infections, urolithiasis, acute kidney injury from obstructive uropathy and/or intratubular 2,8-DHA crystallization or kidney failure. Siblings of index cases should be screened for APRT deficiency. An early diagnosis and treatment with xanthine oxidoreductase inhibitors (XORi) can preserve kidney function and/or prevent progressive kidney injury and kidney failure. In this review, we will discuss the pathophysiology, clinical presentations, investigations, and management of APRT deficiency.

Diagnosis and Management of Tuberous Sclerosis Complex in a Resource-Limited Setting-A Case Report of a 14-Year-Old Female Zambian Adolescent

Tuberous sclerosis complex (TSC) is a rare multisystemic neurocutaneous syndrome with a wide spectrum of clinical manifestations. We present a case of a 14-year-old adolescent female who presented with a history of facial angiofibromas since the age of 8 months. Physical examination was remarkable for multiple angiofibromas on the face, and other multiple cutaneous manifestations of TSC. MRI of the head, and abdomen revealed cortical tubers, multiple bilateral periventricular and subependymal nodular lesions, calcifications, and bilateral kidney enlargement with multiple bilateral renal angiomyolipomas of varying sizes in a background of bilateral polycystic kidneys, MRI of the chest was unremarkable. A diagnosis of TSC was made using the clinical diagnostic criteria which consist of major and minor features. A diagnosis using genetic studies could not be made due to a lack of resources. Management was multidisciplinary and regular monitoring every 6 months will be required to monitor disease progression and manage complications as they arise. This case illustrates the multidisciplinary approach needed to address the diverse clinical manifestations of TSC and the diagnostic challenges, treatment limitations, and psychological impact of TSC in low-resource settings like Zambia where access to advanced therapies is limited.

Oral Microbiota and Inflammatory Bowel Diseases: Detection of Emerging Fungal Pathogens and Herpesvirus

Background/Objectives: Ulcerative colitis (UC) and Crohn's disease (CD) are the usual clinical forms of inflammatory bowel disease (IBD). Changes in the oral microbiota, especially the presence of emerging fungi and herpesviruses, have been shown to worsen the clinical aspects of IBD. The aim of this study was to screen for emerging pathogens in the oral yeast microbiota and the presence of herpesvirus in IBD patients. Methods: Oral swabs of seven UC or CD patients were collected. The samples were plated on Sabouraud Dextrose Agar and subcultured on CHROMagar Candida and CHROMagar Candida Plus. Polyphasic taxonomy was applied and identified using molecular tools, such as MALDI-TOF MS and ITS partial sequencing. Multiplex qPCR was used to identify the herpesvirus. Results: The mean age was 38.67 ± 14.06 years, 57.14% were female, and two had diabetes. The CD patients presented with Rhodotorula mucilaginosa, Candida orthopsilosis and Kodamaea jinghongensis, while the UC patients presented with Cutaneotrichosporon dermatis, Candida glabrata, Candida lusitanea and Candida tropicalis. Two UC individuals had at least one herpesvirus. In the first individual, a co-detection of Herpes Simplex Virus 1 (HSV-1) and C. lusitaniae was observed. The second presented with co-infections of Epstein-Barr virus (EBV), Human Herpesvirus 7 (HHV-7) and C. tropicalis. Conclusions: We identified rarely described yeasts and co-infections in IBD patients, highlighting the need to identify emerging pathogens in the oral microbiota, as they may contribute to opportunistic infections.

Perception of transplant recipients and professionals about health care following kidney transplantation

OBJECTIVE

To explore the perception of renal transplant recipients and professionals about health care following kidney transplantation.

METHOD

Exploratory, qualitative study, carried out through focus groups and questionnaire application, in 2023, with kidney transplant recipients and healthcare professionals. The analysis was performed with the support of the software IRaMuTeQ®.

RESULTS

Twenty-four transplant recipients and 18 professionals participated. From data processing, two thematic groups emerged: use of immunosuppressive medications and dietary habits after kidney transplantation, and other non-pharmacological care and health monitoring after transplantation.

CONCLUSION

The major concern of transplant recipients is related to the use of medication and eating habits; and professionals consider the use of medication and health monitoring extremely important for the proper functioning of the transplanted graft. However, there is an importance of non-pharmacological care, for both groups, in the face of adequate therapeutic follow-up.

Prevalence and determinants of poor glycemic control among diabetic chronic kidney disease patients on maintenance hemodialysis in Tanzania

BACKGROUND

Poor glycemic control in diabetic chronic kidney disease (CKD) patients on maintenance hemodialysis is of great challenge, resulting in increased risk of morbidity and mortality. This study aimed to determine the prevalence and determinants of poor glycemic control among diabetic CKD patients on maintenance hemodialysis.

METHODOLOGY

A cross-sectional study was conducted in 12 dialysis centers located in four regions of Tanzania from March to June 2023. The study population was diabetic CKD patients above 18 years on maintenance hemodialysis for three months or more. A consecutive sampling technique was used for patient recruitment, and a semi-structured questionnaire was used to collect data. The primary outcome was poor glycemic control were considered when glycated hemoglobin (HbA1c) levels were <  6% or > 8%. Statistical Package for Social Sciences (SPSS) version 23 was used for data analysis. Univariate and multivariable regression models were used to evaluate the determinants of poor glycemic control. A p-value < 0.05 was considered statistically significant.

RESULTS

Out of 233 enrolled patients, the overall prevalence of poor glycemic control was 55.4%, whereby 27.0% had HbA1c < 6% and 28.33% had HbA1c > 8%. A high risk of HbA1c > 8% was observed among patients who were on antidiabetic medication (2.16 (95% CI: 1.06-4.41) p =  0.035) and those attending dialysis sessions less than 3 times a week (1.59 (95% CI: 1.02-2.48) p =  0.040). The lower risk of HbA1c < 6% was observed in patients dialyzed using glucose-containing dialysates than those dialyzed with glucose-free dialysate (0.57 (95% CI 0.36-0.87) p =  0.020).

CONCLUSION

The high prevalence of poor glycemic control among diabetic CKD patients, as revealed by this study, has significant implications. Patients on antidiabetic medication and those with less than three dialysis sessions per week are at a high risk of HbA1c > 8%. Conversely, patients dialyzed using glucose-free dialysates are at a high risk of HbA1c < 6%. Glycemic control in diabetic chronic kidney disease (CKD) patients is a great challenge due to altered glucose homeostasis, gluconeogenesis, tubular glucose reabsorption and inaccuracy of glycemic regulation metrics [1]. Furthermore, changed renal pharmacokinetics of antihyperglycemic agents (AHA), uremic milieu, and dialysis therapy also contribute to this challenge [2]. Based on the severe risk of hyperglycemia and hypoglycemia in patients with diabetic end-stage renal disease (ESRD), glycemic control is of paramount importance.

Implementation and first report of the Brazilian Kidney Biopsy Registry

BACKGROUND

Kidney biopsy registries are valuable tools for guiding clinical practice and developing health policies. In 2021, the Brazilian Society of Nephrology (SBN) created the Brazilian Kidney Biopsy Registry (BKBR). This is the first BKBR report, presenting patient data from 2021.

METHODS

BKBR is a web-based platform hosted on the BSN website, which contains patient demographics, clinical data, frequency, and distribution of histologic diagnosis of Brazilian adult native kidney biopsies.

RESULTS

Of the 1012 cases registered in 2021, 954 cases were evaluated after excluding pediatric and kidney transplant cases. Twenty-one centers enrolled patients, with representation from all Brazilian regions. There was a slight predominance of females (52.6%), a mean age of 44.7 ± 16 years, and 13.6% of patients were >65 years old. The main indication for kidney biopsy was renal dysfunction (56%) and nephrotic syndrome (41.4%), respectively. At the time of the biopsy, 47.9% of the patients were hypertensive and 15.2% were diabetic. Although 66.2% of patients had eGFR ≤60ml/min/1.73m2 upon biopsy, the majority (60.2%) had mild interstitial fibrosis and tubular atrophy. The most frequent diagnosis in the BKBR was glomerular disease (74.8%). Lupus nephritis was the most frequent diagnosis of glomerular disease (22.6%), followed by IgA nephropathy (13%) and focal segmental glomerulosclerosis (12.2%).

CONCLUSION

This is the first report of a Nationwide registry of kidney biopsies in Brazil. This data provides pivotal information about the kidney disease profile in this country with continental dimensions.

Association between triglyceride-glucose index and clinical outcomes among patients with chronic kidney disease: a meta-analysis

PURPOSE

To identify the relationship of triglyceride-glucose (TyG) index with clinical outcomes in chronic kidney disease (CKD) patients based on current available evidence.

METHODS

PubMed, EMBASE, Web of Science and CNKI databases were searched up to August 31, 2024. Primary outcome was the all-cause mortality. Secondary outcomes included the coronary artery disease (CAD) mortality, CKD progression, risk of severe coronary artery stenosis (SCAS), major adverse cardiovascular event (MACE), coronary artery calcification (CAC) progression, end-stage renal disease (ESRD), and nonalcoholic fatty liver disease (NAFLD). The hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were combined to assess the predictive role of TyG index for above clinical outcomes among CKD patients. All statistical analysis was performed by STATA 15.0 version.

RESULTS

Twelve studies with 26,530 cases were included. Pooled results indicated that elevated TyG index was significantly related to increased risk for all-cause mortality (HR = 1.22, 95% CI: 1.13-1.31, P<0.001). Besides, high TyG index was also associated with the CAD mortality (HR = 1.19, 95% CI: 1.04-1.36, P = 0.011), occurrence of CKD progression (HR = 1.52, 95% CI: 1.36-1.70, P<0.001), SCAS (OR = 1.79, 95% CI: 1.13-2.83, P = 0.013), MACE (OR = 1.68, 95% CI: 1.11-2.54, P = 0.014), CAC progression (OR = 1.55, 95% CI: 1.06-1.76, P = 0.02), CAD (OR = 2.865, 95% CI: 1.681-4.885, P<0.001), ESRD (OR = 1.49, 95% CI: 1.12-1.99, P = 0.006) and NAFLD (OR = 4.903, 95% CI: 3.046-7.893, P<0.001).

CONCLUSION

High TyG index predicts poor clinical outcomes and might serve as a novel prognostic indicator among CKD patients. However, more studies are still needed to verify above findings.