Liquefaction of renal allograft: An unprecedented complication in transplantation medicine

Background

Renal transplantation stands as the gold standard treatment for end-stage renal disease, offering improved quality of life and increased survival compared to dialysis. However, despite its advantages, renal allograft failure can occur, necessitating careful management to mitigate associated complications. Instances of liquefaction of the transplanted kidney are exceedingly rare, posing unique challenges to clinicians in the management of allograft failure. Existing literature highlights the complexities surrounding decisions regarding dialysis reinitiation, immunosuppression management, and the potential need for transplant nephrectomy in patients with failed renal allografts.

Case presentation

A 52-year-old Caucasian female with a complex medical history including stage 5 chronic kidney disease, non-ST-segment elevation myocardial infarction, hypertrophic cardiomyopathy with mild left ventricular systolic dysfunction, atrial fibrillation, and a history of cardiac arrest resulting in hypoxic brain injury, presented with a unique complication following renal transplantation. Imaging studies revealed complete breakdown and liquefaction of the transplanted kidney in the right iliac fossa. Despite interventions such as ultrasound-guided aspiration and drainage, the patient's condition continued to deteriorate.

Conclusion

This case highlights a rare occurrence of allograft liquefaction following renal transplantation, emphasising the need for vigilance in monitoring transplant recipients for uncommon complications. The management of such cases requires a multidisciplinary approach, considering factors such as dialysis reinitiation timing, immunosuppression management, and the potential need for transplant nephrectomy. Further research is warranted to elucidate the pathophysiology and optimal management strategies for unique complications such as allograft liquefaction, underscoring the importance of individualised treatment approaches in complex clinical scenarios.

Technical and Institutional Factors Affecting Specimen Adequacy and Complications in Ultrasound-guided Kidney Biopsy: A Retrospective Cohort Study

Background

Percutaneous ultrasound-guided kidney biopsy is a critical diagnostic tool with a higher rate of complications than most other biopsies. Our prior research identified technical factors that might improve outcomes.

Objective

The objective was to measure the impact of these technical and institutional interventions on specimen adequacy and complication rates in kidney biopsies.

Design

This is a retrospective cohort study comparing outcomes before and after intervention implementation.

Setting

Two hospitals within a single health region in Saskatchewan serving a population of approximately 1 million.

Patients

All adult percutaneous ultrasound-guided kidney biopsies performed on adult patients between 2012 to 2016 (n = 242, pre-implementation) and 2017 to 2021 (n = 338, post-implementation). Both native and transplant biopsies were included, while patients under 18, open biopsies, and biopsies of kidney masses were excluded.

Measurements

Primary outcomes included specimen adequacy and biopsy complications (hematoma, hemoglobin drop, infection, and arteriovenous fistula formation).

Methods

Technical recommendations included introducing the biopsy needle at a 60° angle, targeting a pole, and avoiding the vascular medulla. Institutional recommendations included microscopic screening for all biopsies, limiting the number of radiologists performing procedures, using a checklist, and restricting computed tomography (CT)-guided biopsies to exceptional cases. Multivariate regression analysis assessed biopsy outcomes before and after the recommendations, controlling for known confounders while at the same time refining factors associated with fewer complications and greater diagnostic yield.

Results

The rate of non-diagnostic specimens decreased from 10.3% to 4.4% (P = .005), and complications decreased from 35.5% to 14.2% (P < .0001). Two or three passes yielded excellent diagnostic success, while 4 passes increased the risk of a complication. Multivariate analysis, after accounting for the collinearity of certain technical factors revealed that medulla avoidance and biopsies done after the implementation of the 2016 recommendations significantly reduced the risk of complications (odds ratio [OR] = 0.37, P < .001) and non-diagnostic biopsies (OR = 0.31, P = .002).

Limitations

Retrospective design and novelty bias may be a cause of bias in this study. Because the institutional recommendations were followed for all biopsies, it was not possible to distinguish which recommendation was most associated with the improvements. Because our study was done in a single health region, it is not clear if they are generalizable to other programs.

Conclusions

The technical and institutional interventions implemented significantly improved specimen adequacy and reduced complication rates in ultrasound-guided kidney biopsies. We have added to these recommendations in that we have refined the requirement for angling the biopsy needle for ease of use and suggest limiting the number of passes to 2 or 3 whenever possible.

Navigating strategies used to manage fatigue by patients undergoing hemodialysis: a qualitative exploratory design

BACKGROUND

Fatigue among patients with end-stage kidney disease (ESKD) undergoing hemodialysis significantly impacts quality of life and anticipated treatment results. This study explores how Omani patients undergoing hemodialysis manage their fatigue.

METHODS

A qualitative design was employed. Data were collected from 25 participants through semi-structured interviews, which were transcribed verbatim and analyzed using thematic analysis. Data management, memo creation, and annotation were completed using NVivo 11.

RESULTS

Findings highlighted one main overarching theme, Self-initiated management strategies, outlining the coping mechanisms patients used to reduce fatigue and adapt their daily activities to its ongoing presence. This overarching theme encapsulates six subthemes that describe patients' self-initiated strategies to manage fatigue, which include (1) self-regulating weight gain and negotiating accumulated fluid removal with healthcare providers (HCPs); (2) Increased appetite and desire for rest; (3) expanding self-awareness for change; (4) engaging in regular physical activity; (5) seeking deeper understanding and support from others and (6) immersing in faith and religious practices.

CONCLUSIONS

The study findings emphasize that patients used several management strategies to manage both physical and mental fatigue and improve their quality of daily living. Although these techniques used to manage fatigue by patients were helpful, healthcare professionals must provide a holistic approach to support the patient's self-initiated fatigue management strategies. Therefore, further studies would be required both within nationally and internationally to validate study findings, and find methods to promote the positive coping techniques used.

CLINICAL TRIAL NUMBER

Not applicable.

Surgical outcomes of robotic bilateral nephrectomy compared to open surgery in adult polycystic kidney disease

PURPOSE

Native nephrectomies for patients with autosomal dominant polycystic kidney disease (ADPKD) have traditionally been performed via an open approach. We have previously described our experience with robotic synchronous bilateral nephrectomies. However, little data is available comparing open nephrectomy (ONx) to robotic nephrectomy (RNx). Here we compare outcomes of ONx and RNx in patients with ADPKD undergoing synchronous bilateral nephrectomy.

METHODS

We performed a retrospective review of patients with ADPKD undergoing open or robotic synchronous bilateral nephrectomy from January 2015 to November 2023 at a single institution. Patient characteristics, perioperative factors, kidney size, and complication rates were compared.

RESULTS

Overall, seventeen patients underwent RNx and fifteen patients underwent ONx. There was no significant difference in gender, preoperative BMI, or kidney volume. Patients undergoing ONx had significantly higher estimated blood loss (EBL), length of stay (LOS), and higher rates of non-autologous blood transfusion and complications overall. Complications in the ONx group included 10 patients who required blood transfusions and 2 patients who sustained visceral injuries. Time from nephrectomy to transplant was significantly shorter in the RNx arm.

CONCLUSION

Robotic synchronous bilateral nephrectomies for ADPKD may have advantages over the traditional open approach, including lower EBL, shorter LOS, decreased overall complication rates, less severe complications and potentially faster time from nephrectomy to transplant.

The Influence of Anti-PAR 1 and Anti-ACE 2 Antibody Levels on the Course of Specific Glomerulonephritis Types

Background: Anti-PAR 1 (protease-activated receptor 1) and anti-ACE 2 (angiotensin 2-converting enzyme 2) antibodies are a kind of non-HLA (human leukocyte antigens) antibodies postulated to be of significance in autoimmunological diseases and organ transplantation. Methods: We assessed anti-PAR 1 and anti-ACE 2 antibody levels in patients with membranous nephropathy n= 18, focal and segmental glomerulosclerosis (FSGS) n = 25, lupus nephritis (LN) n = 17, IgA nephropathy n = 14, mesangial proliferative (non-IgA) glomerulonephritis n = 6, c-ANCA (cytoplasmic anti-neutrophil cytoplasmic antibodies) vasculitis n = 40, p (perinuclear)-ANCA vasculitis n = 16, and compared them with a healthy control group n = 22. Next, we observed the clinical course of the patients (creatinine, total protein, and albumin) up to 2 years and correlated the results with the level of antibodies. Results: The anti-PAR 1 antibody level was lower in membranous nephropathy and FSGS compared to the control group. Anti-PAR 1 antibody levels were higher in secondary compared to primary glomerulonephritis. Both anti-PAR 1 and anti-ACE 2 antibody levels correlated positively (in focal and segmental glomerulosclerosis) or negatively (in lupus nephritis) with total protein and albumin at different time points of observation. Anti-PAR 1 and anti-ACE 2 antibody levels correlated also with creatinine level at one time point of observation in IgA nephropathy. Anti-PAR 1 and anti-ACE 2 antibodies correlated with each other in membranous nephropathy, FSGS, and p- and c-ANCA vasculitis (p < 0.05). Conclusions: The anti-PAR 1 antibody level was lower in membranous nephropathy and focal and segmental glomerulosclerosis compared to the control group. Anti-PAR 1 antibody levels tend to be higher in secondary compared to primary glomerulonephritis.

Detection and measurement of urinary stones on virtual monoenergetic images derived from rapid tube voltage switching dual-energy CT

INTRODUCTION

We aimed to assess urinary stone detection and measurement, which are important indicators for treatment, using virtual monoenergetic (VM) images derived from rapid tube voltage switching dual-energy CT (rsDECT).

METHODS

Forty-eight urinary stones placed in a 32-cm diameter phantom filled with saline and 38 patients with 95 urinary stones underwent rsDECT scans with CTDIvol of 5 mGy for phantoms and 8.1 ± 2.5 mGy for patients. VM images at energies from 40 to 100 keV were generated. Stone detection rate, detection confidence level (1-4 points), and size measurement deviation (digital caliper as gold standards) on VM images were recorded and compared.

RESULTS

All stones could be detected in phantoms on VM images of all energies with one urinary stone missed in patients on VM images above 70 keV. Stones with size equal to or greater than 2 mm were detectable with highest confidence (4 points) on all VM images, while the detection confidence for stones with size smaller than 2 mm was higher on the low-energy images (40-60 keV). In addition, stone length and width measurement values decreased with the increased energy level, and high-energy VM images provided better agreements with digital caliper.

CONCLUSION

VM images in low-dose rsDECT can be used to detect urinary stones with high efficacy. Low-energy VM images provide higher detection confidence for small stones, while higher-energy images are more accurate in size measurements.

IMPLICATIONS FOR PRACTICE

Low-dose DECT should be used for detecting and characterizing small urinary stones in clinical practice to ensure high efficacy, and the low-energy and high-energy VM images in DECT should be optimized for stone detection and size measurement, respectively.

Occurrence of papillary renal cell carcinoma and clear cell renal carcinoma in a patient: A unique case report

RATIONALE

Renal cancer is one of the most common neoplasms in both males and females. Precise diagnosis, grading, and staging are very important for the outcome and the prognosis of the malignant process. Renal carcinoma disorders are presented by kidney tumors usually of the same histological type. The presence of various tumor histological types is an extremely rare event.

PATIENT CONCERNS

Two different histological types of tumors were found in the left kidney of a 74-year-old man.

DIAGNOSES

The diagnosis obtained was papillary renal cell carcinoma type 1 and clear cell renal carcinoma with pathologic stage T2N0M1.

INTERVENTIONS AND OUTCOMES

After abdominal ultrasound and computer tomography, consultation with an anesthesiologist, and a cardiologist, the patient underwent radical left nephrectomy.

LESSONS

Pathologists must be aware of the possibility of the presence of more than one histological type of renal carcinoma due to genomic alterations. Further genetic investigations must be conducted to identify the specific type and thus the treatment will be most precise.

Dialysis-Imposed Patterns of Nocturnal Sleep Duration: A Multicenter Prospective Study in Patients Using a Wearable Activity Tracker

Key Points

Background

In patients on hemodialysis, the effects of determinants of sleep duration are not widely studied. Using wearable activity trackers, we aimed to characterize natural and hemodialysis-imposed temporal patterns of nocturnal sleep.

Methods

In this yearlong prospective observational study, patients on in-center hemodialysis were equipped with activity trackers (Fitbit Charge 2). Nocturnal sleep duration was assessed according to dialysis start time (early starters: before 8 AM; late starters: others), dialysis versus interdialytic days (postdialysis day and second interdialytic day), weekdays, and seasons. Clinical, laboratory, and hemodialysis treatment data were extracted from electronic medical records. Linear mixed-effects models were constructed to determine the effect of various time patterns and predictors of nocturnal sleep duration.

Results

One hundred nine patients contributed data (age 54±12 years, 73% male, 23% diabetic). Sleep duration was 276±91 minutes; 102 (94%) patients slept on average less than the recommended 420 minutes per night. On dialysis days, participants slept 55 (95% confidence interval [CI], 51 to 59) and 48 (95% CI, 43 to 54) minutes less compared with postdialysis and second interdialytic days, respectively. Early starters slept on average 40 (95% CI, 6 to 74) minutes less compared with late starters. On dialysis days, early starters slept 86 (95% CI, 55 to 118) minutes less compared with late starters. We observed greater sleep–wake disturbance in early starters. Irrespective of dialysis schedule, patients slept on average 26 (95% CI, 19 to 33) to 32 (95% CI, 24 to 40) minutes longer on Sundays. In winter, sleep was 7 (95% CI, 1 to 13) to 10 (95% CI, 5 to 16) minutes shorter. In multivariate analysis, higher BP and higher serum creatinine were significantly associated with shorter sleep duration.

Conclusions

On average, patients on hemodialysis slept less than the recommended amount of time. The timing of hemodialysis treatment has pronounced effects on sleep duration and could be considered in patient care.

Podcast

This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2025_05_29_KID0000000761.mp3

CKD Knowledge and CKD Report Card Use During a Nephrology Encounter: A Randomized Trial

Rationale & Objective

Higher chronic kidney disease (CKD) knowledge and health literacy (HL) are associated with improved CKD outcomes. We sought to determine if the CKD Report Card intervention increased CKD knowledge in patients regardless of HL level.

Study Design

A block-randomized trial by clinic session.

Setting & Participants

Patients with CKD 3 or above in an urban academic nephrology clinic.

Intervention

The intervention group received the CKD Report Card, a 2-sided information sheet, before the clinic visit.

Outcomes

Kidney Knowledge Survey pre-post-visit score change.

Results

Of 91 participants, the average age was 66.2 years, 64.8% identified as African American, 41.8% were male, and 11.0% had inadequate HL. The control group's (n = 53) mean pre-visit knowledge score was 55.8% with a post-pre-score change of 0.9 (95% confidence intervals [CI], -1.3 to 3.2). The intervention group's (n = 38) mean pre-visit score was 60.2% with a score change of 19.2 (95% CI, 15.2-23.3). The difference in score change between the control group and intervention group was -18.4 (95% CI, -22.6 to -14.1). In addition, there was no significant difference in knowledge gained by adequate and inadequate HL for the control group (P = 0.6) or the intervention group (P = 0.6). In the fully adjusted multivariable model, the HL × group interaction term was not significant (β = -6.1; P = 0.4). Pre-visit score (β = -0.2; P < 0.01) and intervention group (β = 19.0; P < 0.001) were significant.

Limitations

Limited generalizability because the study took place at 1 academic medical center and there were only a small proportion of patients with inadequate HL.

Conclusions

The CKD Report Card is a low-touch, low-cost intervention that improved CKD knowledge for all patients in our urban nephrology clinic regardless of HL level.

Real-World Insights From Türkiye: Biologic DMARDs Usage in Spondyloarthritis Patients With Chronic Kidney Disease

AIM

The objective was to evaluate biologic disease-modifying antirheumatic drugs (DMARDs) and their side effects that hindered the continuation of treatment in a patient population diagnosed with spondyloarthritis (SpA) with a glomerular filtration rate (GFR) ≤ 60 mL/min, and to compare these side effects between patients with chronic kidney disease (CKD) and those without.

METHODS

This multicenter, observational cohort study utilized data from the TReasure database, which records SpA patients in a web-based system across Türkiye. A total of 6052 patients being included. SpA patients were categorized into two main groups: non-CKD patients and CKD patients. The clinical characteristics, disease activity, treatment options, drug retention rates, reasons for drug discontinuation, and types of adverse effects were compared between the groups.

RESULTS

Biologics prescription pattern varied between CKD and non-CKD patients. Etanercept was prescribed more frequently (53.1%) in CKD patients. Regarding the number of side effects and drug discontinuations in CKD patients, no statistically significant differences were found between the non-CKD and CKD groups for any of the bDMARDs (adalimumab, etanercept, golimumab, infliximab, ustekinumab, secukinumab, and certolizumab). No statistically significant differences were observed in the duration of drug retention based on CKD status for bDMARDs.

CONCLUSION

This study offers preliminary evidence supporting the effective and safe use of bDMARDs in patients with SpA and CKD.

Urinary V-Set Ig Domain-Containing Protein 4 and Immune Complexes for Tracking Lupus Nephritis and Renal Pathology

OBJECTIVE

This study aims to investigate whether V-set Ig domain-containing protein 4 (VSIG4; also known as complement receptor of the Ig superfamily [CRIg]) forms immune complexes (ICxs) with IgG and complement component 3 (C3) in the kidneys of patients with lupus nephritis (LN) and to assess the potential of urinary VSIG4 and VSIG4-ICx as noninvasive biomarkers of LN.

METHODS

Immunofluorescent staining was employed to detect the deposition of VSIG4 (CRIg), IgG, and C3 in kidney tissue. Urine samples from 102 patients with LN, 51 healthy controls (HCs), and 13 patients with chronic kidney disease (CKD) were analyzed via enzyme-linked immunosorbent assay for VSIG4-ICx and free-form VSIG4.

RESULTS

Immunofluorescence costaining demonstrated the colocalization of VSIG4, IgG, and C3 in the kidneys of those with LN and elevated VSIG4 protein expression in the glomeruli regions in LN. Compared with HCs and those with CKD, patients with LN exhibited significantly elevated levels of urinary VSIG4 in both free form and ICx. Urinary VSIG4-ICx correlated with clinical parameters, including the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (R = 0.55, P < 0.0001), renal SLEDAI (R = 0.52, P < 0.0001), estimated glomerular filtration rate (-0.5, P < 0.001), activity index (R = 0.25, P < 0.05), chronicity index (R = 0.32, P < 0.05), complement C3 (R = -0.33, P < 0.05), and complement C4 (R = -0.31, P < 0.05). The strong association of the urinary VSIG4-ICx with disease activity metrics and histopathologic evidence underscores its potential for clinical utility in diagnosing and monitoring LN.

CONCLUSION

VSIG4-ICx shows promise as a novel urine biomarker for LN, with potential utility for diagnosis and disease monitoring.

Investigating the resilience of kidneys in rats exposed to chronic partial sleep deprivation and circadian rhythm disruption as disruptive interventions

Sleep is a vital biological function that significantly influences overall health. While sleep deprivation (SD) and circadian rhythm disruption are known to negatively impact various organs, their specific effects on kidney function remain understudied. This study aimed to investigate the impact of chronic partial sleep deprivation and circadian rhythm disruption on renal function in rats, providing insights into the relationship between sleep disturbances and kidney health. A total of 40 male Wistar rats were divided into five groups: a control group, a group with circadian rhythm disruption (CIR), a group with sleep deprivation during the light phase (SD-AM), a group with sleep deprivation during the dark phase (SD-PM), and a group with combined sleep deprivation and circadian rhythm disruption (SD-CIR). Sleep deprivation was induced using a specialized machine, depriving rats of sleep for 4 h daily, while circadian rhythm disruption was achieved through a 3.5-h light/dark cycle. After four weeks, kidney tissues and blood samples were collected for histological and biochemical analyses. The results showed that all experimental groups exhibited reduced water intake, with the CIR and SD-CIR groups also showing significantly lower food intake and reduced weight gain compared to controls. Oxidative stress markers revealed increased serum malondialdehyde (MDA) levels in the SD-PM and SD-CIR groups. Despite these metabolic and oxidative changes, histological examination of the kidneys revealed no significant alterations in renal structure or function across the groups. This study highlights the negative effects of chronic partial sleep deprivation and circadian rhythm disruption on feeding behavior, weight gain, and oxidative stress in rats. However, these interventions did not significantly alter renal structure or function. Further research is needed to explore the physiological mechanisms underlying these findings and the potential long-term effects of sleep disturbances on kidney health.

The health-economic impact of urine albumin-to-creatinine ratio testing for chronic kidney disease in Japanese non-diabetic patients

BACKGROUND

The objective of this analysis was to estimate the clinical and economic impact of undertaking urine albumin-to-creatinine ratio (UACR) testing alongside regular estimated glomerular filtration rate testing for chronic kidney disease in non-diabetic Japanese patients versus no testing and versus urine protein-creatinine ratio (UPCR) testing.

METHODS

An economic model, taking a Japanese healthcare perspective, estimated the health-economic impact of UACR testing over a lifetime time horizon. Outcomes reported were additional costs, clinical benefits measured, such as prevented dialyses and cardiovascular events, quality-adjusted life years gained, and incremental cost-effectiveness ratios. Health states were derived from risk levels reported in the Kidney Disease: Improving Global Outcomes heatmap. Results were derived assuming that after testing, treatment was available in the form of current standard-of-care or emerging chronic kidney disease therapies.

RESULTS

Repeated UACR testing was found to be cost-effective compared to both no urine testing and UPCR testing, with incremental cost-effectiveness ratios of ¥1,953,958 and ¥1,966,433, respectively.

CONCLUSION

Overall, this model demonstrates the health-economic value of undertaking UACR testing within the non-diabetic Japanese population.

Urinary peptide signature distinguishes autosomal recessive polycystic kidney disease from other causes of chronic kidney disease

Background

The diagnosis of autosomal recessive polycystic kidney disease (ARPKD) can be hampered by its pronounced phenotypic variability and ARPKD-mimicking phenocopies. Here, for the first time we specifically studied the urinary peptidome of patients with ARPKD with the aim of distinguishing ARPKD from other causes of chronic kidney disease (CKD).

Methods

Fifty-eight urine samples from patients with ARPKD, 662 urine samples from paediatric patients with CKD with various other CKD aetiologies and 45 samples from healthy children were included. The urinary peptidome was analysed by capillary electrophoresis/mass spectrometry.

Results

A 77-peptide signature specific for ARPKD was identified. Application of this signature in a matched random validation set of 19 samples of patients with ARPKD, 23 samples from patients with other CKD and 21 samples from healthy individuals led to a sensitivity of 84.2% [95% confidence interval (CI) 60.4-96.6], a specificity of 100% (95% CI 92.0-100%) and an area under the receiver operating characteristics curve (AUC) of 0.994 (95% CI 0.93-1.00). The 77-peptide signature displayed a specificity of 76.1% (95% CI 72.4-79.5) and an AUC of 0.88 (95% CI 0.85-0.90) in 591 samples from non-matched children with various CKD aetiologies. The signature was primarily (83%) composed of collagen fragments indicating structural damage. Of the remaining peptides, five originated from proteins known to bind to calcium potentially linking the current work to defaults in calcium signalling in polycystic disease.

Conclusions

We determined a urinary peptide signature that identifies paediatric patients with ARPKD with high precision among a population of children with CKD. Knowledge of the identity of the underlying peptides offers a novel starting point for discussion of possible pathophysiological processes involved in ARPKD.

Impact of urinary tract infection requiring hospital admission on short-term, mid-term and long-term renal outcomes in adult CKD patients - A potentially modifiable factor for CKD progression

BACKGROUND

Urinary tract infection (UTI) or acute pyelonephritis can lead to renal scarring and impact the subsequent renal function progression. The aims of this study were to investigate the changes in renal function related to UTI requiring hospital admission (UTI/HA) and the association between UTI/HA and long-term renal outcomes in patients with chronic kidney disease (CKD).

METHODS

This was a multicenter, retrospective observational study. Renal events and renal function before and after UTI/HA in CKD patients were analyzed for short-term and mid-term renal outcomes. A case-control study with multivariate logistic regression analysis was used to investigate the association between clinical characteristics and risk of long-term renal outcomes (kidney replacement therapy or death, KRT/death) in adult CKD patients.

RESULTS

This study included 1062 adult CKD patients, with 340 KRT and 76 deaths identified during a median follow-up of 105 months. Among 174 patients with UTI/HA, 59 (33.9 %) had bacteremia, 90 (51.7 %) acute kidney injury (AKI), and one in-hospital mortality. There was a faster decline rate of estimated glomerular filtration rate (eGFR) after UTI/HA compared to the pre-UTI/HA period [median (IQR) 0.37 (0.17-0.72) versus 0.19 (0.06-0.36) ml/min/1.73 m2 per month, P < 0.0001]. The incidence of UTI/HA was similar between the KRT/death and the CKD non-dialysis groups. Multivariate logistic regression analysis showed that baseline eGFR, baseline eGFR decline rate and number of hospital admission were significantly associated with an increased risk of KRT/death.

CONCLUSIONS

This study highlights the impact of UTI/HA on renal function and renal outcomes in adult CKD patients. It demonstrates a high incidence of in-hospital AKI but low mortality, and accelerated deterioration of renal function following UTI/HA. Long-term renal outcomes were influenced by the baseline renal function and progression rate, and the frequency of hospital admission. UTI/HA may be regarded as a potentially modifiable factor for CKD progression. However, there is a need for further analysis to isolate the impact of UTI/HA from pre-existing renal function decline on long-term renal outcomes.

The burden of hyperkalaemia in chronic kidney disease: a systematic literature review

Background

The global epidemiology and burden of hyperkalaemia in patients with chronic kidney disease (CKD) are unclear due to the inconsistent definitions of hyperkalaemia. The combination of adverse effects and interaction between comorbidity and pharmacotherapies, such as renin-angiotensin-aldosterone system inhibitors (RAASi), justify a systematic understanding of this common complication of CKD.

Methods

This systematic literature review aimed to identify and descriptively summarize the evidence on hyperkalaemia risk factors and associated characteristics in adult CKD patients, including the effects of sub-optimal RAASi. Medline® and Embase® databases were searched from January 2000 to April 2024, with additional hand searching. Publications were screened by two independent reviewers. Data were extracted by one reviewer and verified by another reviewer; study quality assessment was also conducted.

Results

A total of 138 studies described in 145 publications met the eligibility criteria. The published literature revealed varying prevalence of hyperkalaemia amongst inconsistent definitions and a significant increase in the prevalence and incidence of hyperkalaemia among patients with CKD, regardless of RAASi treatment. Hyperkalaemia was associated with adverse outcomes and increased hospital resource use. Additionally, studies pointed to negative health and economic outcomes due to sub-optimal RAASi dosing in CKD patients with hyperkalaemia, as well as in those with CKD and comorbid heart failure.

Conclusions

This review expands on current research, offering a new perspective specifically focused on CKD patients and wider clinical and economic outcomes. Identification of wider clinical and economic consequences of hyperkalaemia in CKD patients, and the interplay between these risks and the risks of sub-optimal RAASi dosing, justify the need for future research. Clinicians should exercise caution when managing this condition in this complex patient group.

A bioprinted and scalable model of human tubulo-interstitial kidney fibrosis

Chronic kidney disease (CKD) affects more than 10% of the global population. As kidney function negatively correlates with the presence of interstitial fibrosis, the development of new anti-fibrotic therapies holds promise to stabilize functional decline in CKD patients. The goal of the study was to generate a scalable bioprinted 3-dimensional kidney tubulo-interstitial disease model of kidney fibrosis. We have generated novel human PDGFRβ+ pericytes, CD10+ epithelial and CD31+ endothelial cell lines and compared their transcriptomic signature to their in vivo counterpart using bulk RNA sequencing in comparison to human kidney single cell RNA-sequencing datasets. This comparison indicated that the novel cell lines still expressed kidney cell specific genes and shared many features with their native cell-state. PDGFRβ+ pericytes showed three-lineage differentiation capacity and differentiated towards myofibroblasts following TGFβ treatment. We utilized a fibrinogen/gelatin-based hydrogel as bioink and confirmed a good survival rate of all cell types within the bioink after printing. We then combined all three cells in a bioprinted model using separately printed compartments for tubule epithelium, and interstitial endothelium and pericytes. We confirmed that this 3D printed model allows to recapitulate key disease driving epithelial-mesenchymal crosstalk mechanisms of kidney fibrosis since injury of epithelial cells prior to bioprinting resulted in myofibroblast differentiation and fibrosis driven by pericytes after bioprinting. The bioprinted model was also scalable up to a 96-well format.

Incidence, pathophysiology, risk factors, histopathology, and outcomes of COVID-19-induced acute kidney injury: A narrative review

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to a significant burden on global healthcare systems. COVID-19-induced acute kidney injury (AKI) is among one of the complications, that has emerged as a critical and frequent condition in COVID-19 patients. This AKI among COVID-19 patients is associated with poor outcomes, and high mortality rates, especially in those with severe AKI or requiring renal replacement therapy. COVID-19-induced AKI represents a significant complication with complex pathophysiology and multifactorial risk factors. Indeed, several pathophysiological mechanisms, including direct viral invasion of renal cells, systemic inflammation, endothelial and thrombotic abnormalities as well as nephrotoxic drugs and rhabdomyolysis are believed to underlie this condition. Moreover, histopathological and immunohistopathological findings commonly observed in postmortem studies include acute tubular necrosis, glomerular injury, and the presence of viral particles within renal tissue and urine. Identified risk factors for developing AKI vary among studies, depending on regions, underlying conditions, and the severity of the disease. Moreover, histopathological and immunohistopathological findings commonly observed in postmortem studies include show acute tubular necrosis, glomerular injury, and viral particles within renal tissue and urine. While, identified risk factors for developing AKI vary among studies, according to regions, underlying conditions, and the gravity of the disease. This narrative review aims to synthesize current knowledge on the incidence, pathophysiology, risk factors, histopathology, and outcomes of AKI induced by COVID-19.

Optimization of Cone Beam Computed Tomography Scan Protocols for the Intraoperative Detection of Residual Stones in Percutaneous Nephrolithotomy

Purpose: The primary surgical treatment modality for large or complex renal stones is percutaneous nephrolithotomy (PCNL). Cone beam computed tomography (CBCT) allows for intraoperative imaging and can be used to enhance intraoperative assessment of a stone-free status during a PCNL procedure. However, scanning protocols have not yet been optimized for this purpose. The high degree of stone and patient characteristics require a tailored approach. This study aimed to select the most suitable CBCT protocols for imaging stone fragments intraoperatively during PCNL. Methods: A phantom insert with 100 calcifications varying in size and density was placed in an anthropomorphic abdominal phantom. Nine different CBCT protocols were used with varying dose and copper filter settings, and each scan was repeated five times with a small translation between each scan. Detectability of the calcifications was scored by visual assessment and visibility curves were generated for each protocol, depicting the minimum size and density at which calcifications were still detectable. Image noise and contrast-to-noise ratios (CNRs) were calculated for each protocol, as well as estimated effective patient doses per CBCT scan. Results: Calcification detectability and CNRs decreased with a decrease in radiation dose, whereas noise ratios increased. Three suitable scanning protocols were selected, a high-dose or soft-stone CBCT protocol resulting in an effective dose of 10.7 millisievert (mSv) per CBCT scan, a medium-dose CBCT protocol resulting in an effective dose of 4.6 mSv and a low-dose or hard-stone CBCT protocol resulting in an effective dose of 2.2 mSv. Conclusion: Radiation dose for intraoperative CBCT for imaging calcifications can effectively be lowered while maintaining calcification visibility, by implementing low-dose CT protocols with lowered dose settings and the application of a copper filter. The three proposed scanning protocols provide options to select a scan protocol based on stone type and patient characteristics.

Fine-Needle Aspiration Biopsy of Adrenal Gland Lesions: The Roles of Image Guidance, Rapid On-Site Evaluation and Additional Tissue Sampling

OBJECTIVE

An accurate fine-needle aspiration (FNA) diagnosis of adrenal lesions may be challenging. This study was to investigate roles of imaging guidance, rapid on-site evaluation (ROSE) and additional tissue sampling in FNA diagnosis of adrenal lesions.

METHODS

Adrenal FNA cases were retrieved from pathology archive. Patients' demographics, lesion size and location, imaging guidance methods, cytologic diagnoses and histopathologic diagnoses were reviewed and analysed.

RESULTS

The study cohort included 72 cases of left (86%) and right (14%) adrenal lesions. Endoscopic ultrasound (EUS) and computed tomography (CT) were used in 47 (65%) and 25 (35%) cases, respectively. Left adrenal lesions were sampled mostly by EUS-FNA (73%), whereas right adrenal lesions by CT-guided FNA (80%). There were no differences between the EUS-FNA and CT-FNA groups in terms of non-diagnostic rate and cytologic diagnostic categories. The non-diagnostic rate and cytologic diagnostic categories were the same between ROSE and non-ROSE groups. In a subset of 18 cases with concurrent core tissue biopsy, a definite diagnosis was rendered in all biopsy cases including three cases with a non-diagnostic or indeterminate cytology diagnosis.

CONCLUSION

Our study demonstrates that FNA has great efficacy for evaluation of adrenal lesions, either via EUS or CT guidance. Incorporation of ROSE evaluation into FNA procedure does not directly affect the performance of FNA biopsy but may help direct additional tissue sampling to salvage the cases with a non-diagnostic or indeterminate cytology diagnosis, increasing diagnostic yield.

Utility of POCUS (Point of Care Ultrasound) in Renal Transplantation

Point of care ultrasound (POCUS) is gaining wide recognition in its bedside applications. The day-to-day practice of nephrology requires several ultrasonographic parameters for diagnosis. Hence, familiarity with basics of renal ultrasound imaging is becoming a necessary skill for every nephrologist. This review provides an overview of the normal and abnormal findings in a graft kidney and its environment throughout graft survival and after its failure. The correlative understanding of the clinical features with image findings provides the greatest advantage in applying POCUS at the bedside.

The inhibitory effects of proteins secreted from trigonelline-treated renal cells on calcium oxalate crystals in vitro: Implications for kidney stone prevention

Trigonelline is a bioactive alkaloid with therapeutic effects on various kidney diseases. Although previous studies have implicated its potential to prevent kidney stone disease (KSD), its anti-lithiatic mechanisms were poorly understood and thus addressed herein. Secretome (a set of secreted proteins) was collected and purified from MDCK renal cells treated with 100 µM trigonelline (termed "trigonelline-treated secretome") to examine its effects on calcium oxalate (CaOx) crystals compared with that derived from untreated cells (termed "control secretome"). Trigonelline-treated secretome significantly reduced CaOx crystal size, number and abundance during initial crystallization, and also inhibited crystal growth, aggregation and adhesion to renal cells. Quantitative proteomics using nanoLC-ESI-Qq-TOF tandem mass spectrometry revealed 46 differentially secreted (11 decreased and 35 increased) proteins, mainly from extracellular compartments, in the trigonelline-treated secretome. While most of the identified proteins were acidic, significantly increased secreted proteins had an increased proportion of basic proteins, resulting in a slightly greater isoelectric point. In concordance, significantly increased secreted proteins had a greater proportion of positively charged amino acids as compared with significantly decreased secreted proteins. However, proportions of aromatic, polar, non-polar, and negatively charged amino acids were comparable. In summary, we report herein direct evidence of the inhibitory effects of trigonelline against CaOx crystallization, growth, aggregation and adhesion to renal cells via the altered secreted proteins that show some unique physicochemical properties when the increased secreted proteins were compared with the decreased compartments. These data may lead to a better understanding of mechanisms underlying the anti-lithiatic effects of trigonelline to prevent KSD.

Fermented Strawberry (Fragaria x Ananassa Duch.) Mitigates Renal Fibrosis in a Unilateral Ureteral Obstruction Model by Reducing Inflammation, Oxidative Stress, and Regulating Smad Signaling

Renal fibrosis is a common outcome in many progressive renal diseases. Unilateral ureteral obstruction (UUO) is known to induce oxidative stress and inflammation in the kidneys, leading to the development of renal fibrosis. Fermented strawberry (Fragaria x ananassa Duch.) possesses antioxidant properties; however, its effect on renal fibrosis remains unclear. This study aimed to evaluate the impact of fermented strawberry dry powder (FSP) on renal fibrosis by assessing proinflammatory cytokines, oxidative stress markers, and underlying mechanisms. Male Sprague-Dawley rats were subjected to UUO surgery to induce tubulointerstitial fibrosis and obstructive nephropathy. Ten days postsurgery, the rats were randomly divided into four groups (n = 6), including a sham-operated control group. FSP was administered orally at doses of 0.05 or 0.5 g kg-1 body weight daily for 21 days. FSP treatment significantly improved renal function, reduced tubular dilation, and decreased interstitial volume in UUO rats. FSP decreased levels of tumor necrosis factor-α and interleukin-6, while enhancing the activities of antioxidant enzymes such as superoxide dismutase and catalase. Treatment with 0.05 and 0.5 g kg-1 FSP resulted in a reduction of collagen deposition in the kidneys by 49% and 69%, respectively, compared with UUO group. FSP increased E-cadherin expression and decreased α-smooth muscle actin level in the kidneys of UUO rats. Furthermore, FSP reduced transforming growth factor-β and Smad2/3 levels while upregulating Smad7 expression. These findings suggest that FSP mitigates renal tubulointerstitial fibrosis, likely through modulation of Smad signaling and attenuation of oxidative stress and inflammation.

Multi-omic and spatial analysis of mouse kidneys highlights sex-specific differences in gene regulation across the lifespan

There is a sex bias in the incidence and progression of many kidney diseases. To better understand such sexual dimorphism, we integrated data from six platforms, characterizing 76 kidney samples from 68 mice at six developmental and adult time points, creating a molecular atlas of the mouse kidney across the lifespan for both sexes. We show that proximal tubules have the most sex-biased differentially expressed genes emerging after 3 weeks of age and are associated with hormonal regulations. We reveal potential mechanisms involving both direct and indirect regulation by androgens and estrogens. Spatial profiling identifies distinct sex-biased spatial patterns in the cortex and outer stripe of the outer medulla. Additionally, older mice exhibit more aging-related gene alterations in loops of Henle, proximal tubules and collecting ducts in a sex-dependent manner. Our results enhance the understanding of spatially resolved gene expression and hormone regulation underlying kidney sexual dimorphism across the lifespan.

Exploring the effect of patient characteristics on the association between warm ischemia time and the risk of postoperative acute kidney injury after partial nephrectomy

BACKGROUND

The impact of warm ischemia time (WIT) on renal function after partial nephrectomy (PN) remains debated. This study investigates the effect of WIT on the relationship between preoperative comorbidities and postoperative renal function impairment in renal cell carcinoma (RCC) patients.

METHODS

Patients undergoing PN for T1 RCC at a European high-volume center (2000-2023) were analyzed. Logistic regressions assessed the association between patient comorbidities and acute kidney injury (AKI). Patients were stratified into low (LR), intermediate (IR), and high-risk (HR) groups based on a weighted comorbidity score derived from odds-ratio obtained from the logistic regression analysis. Interaction terms and a weighted local polynomial smoother function assessed the impact of WIT on AKI. Cox regressions and cumulative incidence were used to assess the chronic kidney disease (CKD) upstage ≥IIIB risk according to AKI and risk groups.

RESULTS

Of 1,048 patients, 802 underwent PN with warm ischemia. Among these, 339(42%), 208(26%), 255(32%) were classified as LR, IR and HR. IR (OR:1.82, P = 0.018) and HR (OR:3.01, P < 0.001) patients had a higher AKI risk compared to LR. The increase in WIT had little impact on the LR AKI probability compared to IR (OR:1.06, P = 0.001) and HR (OR:1.08, P < 0.001). The 10-year risk of CKD-upstage ≥IIIB was higher (36% vs. 12%, HR:2.40, P = 0.004) after AKI, and in the HR group (HR:2.42, P = 0.008) CONCLUSIONS: WIT predominantly affected the risk of AKI in HR patients for renal function impairment after surgery. Preoperative counseling is essential for comorbid patients, especially when planning complex surgeries with prolonged ischemia, to mitigate AKI and long-term renal impairment.

Role of glucuronoxylomannan and steryl glucosides in protecting against cryptococcosis

The development of vaccines for fungal diseases, including cryptococcosis, is an emergent line of research and development. In previous studies, we showed that a Cryptococcus mutant lacking the SGL1 gene (∆sgl1) accumulates certain glycolipids called steryl glucosides (SGs) on the fungal capsule, promoting an effective immunostimulation that totally protects the host from a secondary cryptococcal infection. However, this protection is lost when the cryptococcal capsule is absent in the ∆sgl1 background. The cryptococcal capsule is mainly composed of glucuronoxylomannan (GXM), a polysaccharide microfiber consisting of glucuronic acid, xylose, and mannose linked by glycosidic bonds forming specific triads. In this study, we engineered cells to lack each of the GXM components and tested the effect of these deletions on protection under the condition of SG accumulation. We found that glucuronic acid and xylose are required for protection, and their absence abrogates the production of IFNγ and IL-17A by γδ T cells, which are necessary stimulants for the protective phenotype of the ∆sgl1. We analyzed the structure of the GXM microfibers and found that although the deletion of SGL1 only slightly affects the size and distribution of these microfibers, it significantly changes the ratio of mannose to other components. In conclusion, this study identifies the structural modifications that the deletion of SGL1 and the consequent accumulation of SGs impart to the GXM structure of C. neoformans. This provides significant insights into the protective mechanisms mediated by SG accumulation on the capsule, with important implications for the future development of an efficacious cryptococcal vaccine.IMPORTANCECryptococcus neoformans is an encapsulated fungus that causes invasive fungal infections with high morbidity and mortality in susceptible patients. With increasing drug resistance and high toxicity of current antifungal drugs, there is a need for alternative therapeutic strategies, such as a cryptococcal vaccine. In this study, we identify the necessary capsular components and their structural organization required for a cryptococcal vaccine to protect the host against challenge with a virulent strain. These capsular components are glucuronic acid, xylose, and mannose, and they work together with certain glycolipids called steryl glucosides (SGs) to stimulate host immunity. Interestingly, SGs on the capsule may favor the formation of small capsular microfibers organized in specific mannose triads. Thus, the results of this paper are important because they identify a mechanism by which SGs affect the structure of the cryptococcal capsule, with important implications for the future development of a cryptococcal vaccine using capsular components and SGs.

Vasoconstriction-inhibiting factor: an endogenous inhibitor of vascular calcification as a calcimimetic of calcium-sensing receptor

AIMS

Patients with chronic kidney disease (CKD) show a high risk of cardiovascular diseases, predominantly caused by accelerated vascular calcification. Vascular calcification is a highly regulated process with no current treatment. The vasoconstriction-inhibiting factor (VIF) peptide was recently discovered with vasoregulatory properties, but no information regarding calcification has been described.

METHODS AND RESULTS

In the present work, the inhibitory calcification effect of the VIF peptide was analysed in vitro in vascular smooth muscle cells (VSMCs), ex vivo in rat aortic rings, as well as in vivo in rats treated with vitamin D and nicotine (VDN). The VIF peptide inhibits vascular calcification by acting as a calcimimetic for the calcium-sensing receptor, increasing carboxylated matrix Gla protein production and blocking the activation of calcification pathways. The VIF peptide decreased calcium influx, the production of reactive oxygen species, and the activation of multiple kinases in VSMCs. Furthermore, calcium deposition in the aortas of patients with CKD negatively correlates with the VIF peptide concentration. Moreover, we show the cleavage of the VIF peptide from chromogranin-A by 'proprotein convertase subtilisin/kexin type 2' and 'carboxypeptidase E' enzymes. In addition, 'cathepsin K' degrades the VIF peptide. The active site of the native 35 amino acid-sequence long VIF peptide was identified with seven amino acids, constituting a promising drug candidate with promise for clinical translation.

CONCLUSION

The elucidation of the underlying mechanism by which the VIF peptide inhibits vascular calcification, as well as the active sequence and the cleavage and degradation enzymes, forms the basis for developing preventive and therapeutic measures to counteract vascular calcification.

The features and risk factors of thrombotic thrombocytopenic purpura in systemic lupus erythematosus

OBJECTIVE

This study aimed to investigate clinical features and risk factors for the development of thrombotic thrombocytopenic purpura (TTP) in systemic lupus erythematosus (SLE) patients.

METHODS

A cohort of 32 SLE-TTP patients in the first affiliated hospital of Zhengzhou University from 2017 to 2023 were included, and 128 SLE patients without TTP admitted to the hospital during the same period were randomly selected as the control group. The demographic data, clinical and laboratory findings of these patients were statistically analyzed. Stepwise regression and logistic regression were used to identify the risk factors related to TTP development. The SLE-TTP patients were divided into two groups based on treatment outcomes, and the differences between the clinical data were compared between the two groups. Independent risks of short-term death in SLE-TTP patients were determined by logistic regression analysis.

RESULTS

Our study demonstrated that independent risk factors associated with the occurrence of TTP in patients with SLE included higher SLEDAI-2K score (OR = 1.96; 95%CI: 1.197-3.211; P = 0.007), high baseline total cholesterol (T-CHO) levels (OR = 8.19; 95%CI: 0.98-68.48; P = 0.048), and renal involvement (OR = 14.73; 95%CI: 1.250-173.64; P = 0.033). Multivariate logistic regression analysis showed that older age (OR = 1.02;95%CI: 0.94-1.119; P = 0.05) and non-nulliparous female (OR = 8.12; 95%CI: 0.484-136; P = 0.017) were independent risks factor for short-term death for SLE-TTP patients.

CONCLUSION

SLE patients with higher SLEDAI-2K score, high baseline T-CHO levels, and renal involvement were predisposed to TTP development. The short-term mortality is increased for SLE-TTP patients of advanced age and in non-nulliparous females. Close monitoring and active treatments of these patients are needed for this life-threatening situation.

Significant Changes in Low-Abundance Protein Content Detected by Proteomic Analysis of Urine from Patients with Renal Stones After Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL), although a highly effective method for the treatment of kidney stones, can cause significant kidney damage. Since urinary protein composition directly reflects kidney function, proteomic analysis of this fluid may be useful to identify changes in protein levels induced by patient exposure to ESWL as a sign of kidney damage. To this end, we collected urine samples from 80 patients with nephrolithiasis 2 h before and 24 h after exposure to ESWL, which were concentrated and subsequently processed with a commercially available enrichment method to extract low-abundance urinary proteins. These were then separated by 2D electrophoresis and subsequently analyzed by a proteomic approach. A large number of proteins were identified as being related to inflammatory, fibrotic, and antioxidant processes and changes in the levels of some of them were confirmed by Western blot analysis. Therefore, although further experimental confirmation is needed, our results demonstrate that ESWL significantly influences the low urinary protein profile of patients with nephrolithiasis. Notably, among the identified proteins, matrix metalloproteinase 7, alpha1-antitrypsin, and clusterin, as well as dimethyl arginine dimethyl amino hydrolase 2 and ab-hydrolase, may play an important role as putative biomarkers in the monitoring and management of ESWL-induced renal damage.

Drivers and mechanisms of cognitive decline in chronic kidney disease

Cognitive impairment is highly prevalent among individuals with chronic kidney disease (CKD). Despite its high prevalence, the contributing factors and mechanisms underlying brain-kidney dysfunction in CKD remain poorly understood. However, advances in neuroscience, including novel imaging techniques and cognitive assessment methods, have begun to clarify this complex relationship. Several factors contribute directly to cognitive decline in people with CKD, including accumulation of uraemic toxins, microvascular damage, malnutrition, chronic inflammation and disruptions in key neuroprotective pathways, such as those involving Klotho and the glymphatic system. These factors are also linked to the accelerated ageing observed in people with CKD, a key contributor to cognitive decline. However, most studies on cognition in people with CKD have been cross-sectional and associative, offering limited insight into causation. Research advances, such as studies on the effect of uraemic toxins on the blood-brain barrier and the role of the endothelial glycocalyx in vascular damage, offer promising new directions. Emerging data from longitudinal cohort studies are also enhancing our understanding of these processes, with potential implications for both the treatment of CKD-related cognitive decline and the broader issue of cognitive dysfunction in ageing populations. Here, we examine key mechanisms linking CKD to cognitive decline and consider potential therapeutic interventions.

Post-ESWL urinary osteopontin level and ion-activity product of calcium oxalate are associated with stone recurrence after 5-year follow-up

BACKGROUND

Calcium oxalate (CaOx) is the predominant component in over 80% of kidney stones. The formation and retention of kidney stones involve multiple mechanisms, including overgrowth on Randall's plaques-subepithelial calcium phosphate deposits in the renal papillae-and interactions between urinary crystals and renal tubular epithelial cells. Previous studies have shown that specific urinary proteins can either promote or inhibit CaOx crystal nucleation, growth, and retention. This study investigates changes in the urinary excretion of CaOx-related proteins before and after extracorporeal shock wave lithotripsy (ESWL), aiming to identify protein markers associated with stone formation and recurrence over a 5-year follow-up.

METHODS

This study enrolled 54 patients with renal or ureteral stones treated with ESWL and 13 healthy controls. 24-hour urine samples were collected preoperatively and at 2 and 4 weeks post-ESWL for biochemical analysis. CaOx-related proteins were measured semi-quantitatively in urine samples before and after ESWL, including nucleolin-related protein (NRP), nuclear pore complex p62 (NPC), hyaluronic acid (HA), SLC26A6, CXCR4, osteopontin (OPN), Tamm-Horsfall protein (THP) and Matrix Metalloproteinase (MMPs). Statistical analyses, including Pearson correlation and logistic regression, were performed to identify factors related to 5-year stone recurrence. Statistical significance was set at p < 0.05.

RESULTS

Before ESWL, stone patients exhibited significantly higher levels of NPC, HA, and CXCR4. All examined markers, except for Tamm-Horsfall protein, increased significantly at two weeks after ESWL. At four weeks post-EWSL, OPN and SLC26A6 remained higher. Correlations were observed between CXCR4, MMPs, stone size and ion-activity product of calcium oxalate (APCaOX), a measure of urinary calcium oxalate supersaturation. Logistic regression identified urinary OPN and APCaOX at 4 weeks post-ESWL as significant factors influencing 5-year stone recurrence, with a recurrence rate of 48.4%.

CONCLUSIONS

The persistence of certain urinary proteins after ESWL implied the risk of stone recurrence despite stone removal. The stone recurrence at 5 years was significantly associated with higher urinary OPN and higher APCaOX levels at four weeks post-ESWL, suggesting the potential predictive value of these markers.

TRIAL REGISTRATION

Approval was obtained from the ethics committee of National Taiwan University Hospital (National Taiwan University Hospital Ethics Committee approval: 200706054M).

Qualitative changes in clinical records after implementation of pharmacist-led antimicrobial stewardship program: a text mining analysis

BACKGROUND

Antimicrobial stewardship programs (ASPs) are essential for optimizing antimicrobial use, but many medium-sized hospitals lack infectious disease (ID) specialists. Ward pharmacists can contribute to ASPs, but the qualitative changes in their practice patterns after ASP implementation remains unclear. We aimed to explore the potential of text mining as a novel methodology to evaluate changes in ward pharmacist antimicrobial management practices after ASP implementation in a medium-sized hospital without ID physicians.

METHODS

We conducted a retrospective observational analysis of data documented in clinical records by ward pharmacists in a 313-bed community hospital from April 2014 to March 2022. The ASP team conducted weekly reviews of targeted patients, provided feedback to physicians, and shared recommendations with ward pharmacists who then collaborated to optimize antimicrobial therapy. Using Python-based text mining with standardized technical terms and compound word extraction, we performed morphological analysis, co-occurrence network analysis, and hierarchical clustering to evaluate documentation patterns before and after ASP implementation in April 2018. Co-occurrence relationships were assessed using Dice coefficients (threshold, ≥ 0.3), and communities were detected using the Louvain algorithm. Changes in documentation patterns were compared using Fisher's exact test.

RESULTS

The analysis included 1,353 pre-ASP and 5,155 post-ASP clinical records containing antimicrobial-related terms, which increased from 3.12 to 7.81% of the total pharmacy records. New strong co-occurrence relationships emerged in the post-ASP period for several laboratory parameters (c-reactive protein, 0.646; estimated glomerular filtration rate, 0.594; and white blood cell count, 0.582). Network analysis revealed a shift from medication-focused communities (Medication Review, Prescription Verification, and Patient Education) to infection-focused communities (Infection Assessment, Microbiological Review, and Severe Infection Management). Although Antimicrobial Management was consistently used in both periods (odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.38-1.20), cross-tabulation analysis increased significantly in Laboratory Monitoring (OR: 1.58, 95% CI: 1.39-1.78) and Infection Assessment (OR: 2.09, 95% CI: 1.85-2.36).

CONCLUSIONS

This pilot application of text mining demonstrated potential as a novel methodology for objectively evaluating qualitative changes in clinical practice patterns following ASP implementation, successfully identifying shifts in pharmacists' documentation focus and providing a foundation for future multi-center validation studies across diverse healthcare settings.

Acupoint massage: a comprehensive descriptive review of its forms, applications, and underlying mechanisms

Acupoint massage is a non-invasive traditional therapy that has demonstrated reliable clinical outcomes in pain management, mental health relief, sleep disorder regulation, gastrointestinal treatment, and as an adjunct therapy for cancer. Its convenience and cost-effectiveness further enhance its appeal. However, the existing English literature lacks a systematic review that encompasses the various forms of acupoint massage. The acupoint massage forms adaptability is particularly notable when considering the diverse conditions, it addresses, as well as its applicability across different age groups and gender differences. Providing a comprehensive understanding, it is crucial to outline common practices and explore specific applications in key areas. The comprehensive understanding can create opportunities for effective collaboration between preclinical and clinical studies. Defining and categorizing different forms of acupoint massage is essential, alongside investigating the neural circuits involved in touch sensation. Future efforts should enhance collaboration with modern biology, facilitating the transition from empirical to evidence-based practice. This review summarizes forms, applications, and mechanisms of mainstream acupoint massage and provides insights for future research and applications, promoting deeper integration into healthcare.

Novel insights and an updated review of metabolic syndrome in immune-mediated organ transplant rejection

Metabolic syndrome (MetS) is a group of symptoms that are characterized by abnormal changes in metabolic substances such as glucose, lipids, proteins, and bile acids. MetS is a common complication after organ transplantation and can further affect the survival and physiological function of the graft by reprograming the patient's immune environment. Additionally, MetS can influence the occurrence of post-transplant complications, such as infections. In recent years, research into the epidemiology and mechanisms of MetS has grown significantly. In this review, we summarize the mechanisms of MetS after transplantation and the mechanisms of hyperglycemia, insulin resistance, hyperlipidemia, abnormal bile acids, and abnormal amino acids on the body's immune cells as related to the effect of metabolic disorders on immune rejection after liver, kidney, heart, skin and other organ transplantation. Finally, we provide an overview of current treatment strategies and offer insights into potential future therapies for managing MetS in transplant recipients.

KIF26B promotes bladder cancer progression via activating Wnt/β-catenin signaling in a TRAF2-dependent pathway

In this study, we report that KIF26B is upregulated in bladder cancer and acts as an independent prognostic factor. Knockdown of kif26b blocks the proliferation, metastasis, and cisplatin resistance of bladder cancer cells. Mechanistically, TCF4 potently stimulates kif26b transcription by directly binding to its promoter. KIF26B activates the Wnt/β-catenin signaling pathway through association with TRAF2 and thus promotes the formation of the TCF4/β-catenin complex. KIF26B promotes the protein stability of TRAF2 by facilitating the OTUB2-mediated de-ubiquitination of TRAF2. Importantly, KIF26B promotes the nuclear translocation of TRAF2 through enhancing its association with IPO11, a process that is dependent on the C-terminal domain of β-catenin. Additionally, phosphorylation of tyrosine 78 in TRAF2 is essential for its binding to KIF26B in response to Wnt3a signaling. Furthermore, a KIF26B/TRAF2/PD-L1 axis is identified in bladder cancer, and combined therapy of anti-B7-H3 antibody with kif26b knockdown yields superior anti-tumor effects.

Critical Review of the Benefit from Early Pharmacological and Dietary Support for Patients with Moderate-to-Severe (Non-Terminal) Chronic Kidney Disease

Moderate-to-severe chronic kidney disease (CKD) is a public health problem affecting hundreds of millions of people around the world. Started early, nephroprotection measures are able to prevent the degradation of renal function and are a major issue in CKD management. This approach consists of a combination of pharmacological and non-pharmacological treatments aimed at slowing down the decline in renal filtration capacity and improving patient well-being. Drugs such as angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and sodium-glucose cotransport type 2 inhibitors play a crucial role in reducing intraglomerular pressure and renal inflammation. Their beneficial effects are potentiated when they are combined with non-pharmacological approaches, such as salt and protein restriction. This present review provides a critical overview of the current pharmacological and nutritional therapies that may slow down the progression of CKD. Recently, many pharmacological treatments have opened up new perspectives for managing this condition. Nevertheless, prevention remains the cornerstone of effective disease management. Actually, very few studies include both pharmacists and dietitians in their interdisciplinary team mainly represented by nephrologists, nurses, and social workers. However, their specific collaboration may significantly improve the knowledge and skills to help patients in their own CKD management. Future research is required to assess the benefit of collaboration in supporting patients with moderate-to-severe CKD before any concern of renal replacement therapy (RRT).

Influence of Genetic Polymorphisms and Biochemical Biomarkers on Response to Nutritional Iron Supplementation and Performance in a Professional Football Team: A Pilot Longitudinal Study

BACKGROUND

Iron deficiency is a prevalent issue among elite athletes, particularly in endurance-based sports like football, where optimal iron status is crucial for aerobic capacity and performance. Despite the well-documented role of iron in oxygen transport and energy metabolism, the interplay between genetic polymorphisms, biochemical markers, and iron supplementation remains poorly understood. This study aimed to investigate the relationship between genetic polymorphisms and iron status in professional football players, assess the impact of iron supplementation on athletic performance, and develop a predictive model for iron supplementation based on genetic and biochemical profiles.

METHODS

A longitudinal study was conducted over three seasons (2021-2024) with 48 male professional football players. Participants underwent genotyping for polymorphisms in ACE (rs4646994), ACTN3 (rs1815739), AMPD1 (rs17602729), CKM (rs8111989), HFE (rs1799945), and MLCK (rs2700352, rs28497577). Biochemical markers (ferritin, haemoglobin, haematocrit, serum iron) and performance metrics (GPS-derived data) were monitored. Iron supplementation (105 mg/day ferrous sulphate) was administered to players with ferritin <30 ng/mL. A Total Genotype Score (TGS) was calculated to evaluate genetic predisposition.

RESULTS

Players with "optimal" genotypes (ACE DD, ACTN3 CC, AMPD1 CC, HFE GC) required less iron supplementation (TGS = 51.25 vs. 41.32 a.u.; p = 0.013) and exhibited better performance metrics. Iron supplementation significantly improved haemoglobin and haematocrit in deficient players (p < 0.05). The TGS predicted supplementation need (AUC = 0.711; p = 0.023), with a threshold of 46.42 a.u. (OR = 5.23, 95% CI: 1.336-14.362; p = 0.017 for non-supplemented players). Furthermore, performance data revealed that iron-supplemented players had significantly lower competition time (1128.40 vs. 1972.84 min; p = 0.003), total distance covered (128,129.42 vs. 218,556.64 m; p = 0.005), and high-speed running in the 18-21 km/h (7.58 vs. 10.36 m/min; p = 0.007) and 21-24 km/h (4.43 vs. 6.13 m/min; p = 0.010) speed zones. They also started fewer matches (11.50 vs. 21.59; p < 0.001).

CONCLUSIONS

Genetic profile combined with biochemical monitoring effectively predicts iron supplementation needs in athletes. Personalized nutrition strategies, guided by TGS, can optimize iron status and enhance performance in elite football players. This approach bridges a critical gap in sports science, offering a framework for precision nutrition in athletics.

Intradialytic Exercise: Effects on Arterial Stiffness and Gait Speed in Patients Undergoing Hemodialysis

BACKGROUND The benefits of exercise for vascular and physical health in patients on chronic hemodialysis (CHD) are controversial. This study evaluated the outcomes of an intradialytic aerobic exercise program on carotid-femoral pulse wave velocity (cfPWV, an index of arterial stiffness), gait speed, and a sit-to-stand test in patients with CHD. MATERIAL AND METHODS A total of 114 CHD patients were randomly assigned to the exercise or the control (regular care) group. Patients performed intradialytic cycling exercises (3 sessions/week for 12 months) for 20 minutes in a supine position and the exercise protocol was set at a low-to-moderate intensity, defined as activities eliciting 3 to 5.9 metabolic equivalents. Data on cfPWV, gait speed, and the 5-times sit-to-stand test were collected. cfPWV was determined from the time taken for the arterial pulse to propagate from the carotid to the femoral artery and were compared between the 2 groups. RESULTS Arterial stiffness was improved, as evidenced by a significant decrease in cfPWV, in the exercise group compared to the control group (p<0.001). Generalized estimating equations analysis revealed a reduction in cfPWV at 6 and 12 months after the exercise intervention (p<0.001). Gait speed was significantly faster in the exercise group than in the control group (p=0.019). No exercise-related adverse events were reported. Results of 5-times sit-to-stand and body composition did not differ significantly between the 2 study groups. CONCLUSIONS Intradialytic cycling exercise significantly improved cfPWV and gait speed in CHD patients during the 12-month study period.

Renalase, dopamine, and norepinephrine as markers for the development of hypertension in CKD patients

INTRODUCTION

Chronic kidney disease (CKD) leads to irreversible changes in kidney function and structure, with over 90% of patients developing arterial hypertension (HT). Renalase, dopamine, and norepinephrine are believed to influence HT development and CKD progression.

AIM OF THE STUDY

This study aims to measure renalase, dopamine, and norepinephrine levels in CKD patients to evaluate their potential as markers for CKD progression, HT development, and cardiovascular event risk.

MATERIALS AND METHODS

The study involved 117 CKD patients divided into four groups: 32 hemodialysis patients (before and after treatment), 31 peritoneal dialysis patients, 24 kidney transplant recipients (pre- and post-transplant), and 30 conservatively treated patients (CKD stages 2-5). A control group included 31 healthy volunteers. Levels of renalase, dopamine, and norepinephrine were measured using the ELISA method.

RESULTS

The study found that CKD significantly affected renalase, dopamine, and norepinephrine levels (p = 0.046; p = 0.035; p = 0.023). The lowest renalase levels were in patients with ADPKD and HT, while the highest dopamine levels were in those with CKD due to glomerulonephritis. The lowest norepinephrine levels were observed in patients with HT and diabetes.

CONCLUSIONS

Levels of renalase, dopamine, and norepinephrine may indicate CKD progression, cardiovascular event risk, and patient prognosis.

Immune response against antibiotic-resistant and antibiotic-sensitive staphylococcus aureus in a rat model of implant infection

Little is known about the in-vivo dynamics of biofilms associated with medical-device infections and their interplay with systemic inflammation, local immune responses, and tissue healing processes. There may be an opportunity to tailor therapeutic strategies to target these dynamics to improve treatment outcomes. We investigated immune responses to a methicillin-susceptible (ATCC 12600) and a multi-drug resistant (L1101) S. aureus strain using a rat subcutaneous implant model, analyzing local and systemic inflammation through 19 gene expressions over 21 days. Our goals were to identify differences in the immune response due to infection and also with respect to the two strains. We observed that systemic inflammation, indicated by α-2-macroglobulin, was elevated in the initial stages (up to day 7). Local inflammatory cytokine levels (IL-6, TNF-α, IL-6, TNF-α, IL-1β, IL10, IL-17, IL12a, IL12b, IFNG) varied by strain, typically higher against the clinical strain. Infections generally hindered early macrophage (MCSF1) and T-cell (CD4, CD5, CD6, CD8A) recruitment, particularly in cases involving the clinical strain. Conversely, a better healing response was observed in the infection of the more susceptible ATCC 12600 strain (VEGF, CXCR1, CXCR2, MMP-1, MMP-3, MMP-13). These results are crucial for understanding immune responses to such infections, guiding therapeutic strategies.

Comprehensive identification of stone-promoting proteins in the urine of kidney stone formers

Urinary proteins have crucial roles in modulating kidney stone formation. While stone-inhibiting urinary proteins are well characterized, stone-promoting urinary proteins are insufficiently explored. This knowledge gap limits our ability to fully comprehend the pathogenic mechanisms underlying nephrolithiasis and hampers the development of targeted therapeutic/preventive interventions. Therefore, we systematically identified stone-promoting proteins from the urine of 30 calcium oxalate (CaOx) nephrolithiatic patients (stone formers). Urinary proteins were fractionated by anion exchange and size-exclusion chromatography. A total of 15 protein fractions (SF1-SF15) were tested for their modulating activities on CaOx crystals by various assays compared with the control. The fractions with net CaOx-promoting activities were then identified by nanoLC-ESI-Qq-TOF MS/MS. From 15 fractions, 9 had net CaOx-promoting activities in all crystal assays. Among 3-99 proteins identified from these fractions, alpha-1acid glycoprotein 2, alpha-1-antitrypsin, apolipoprotein D, CD44 antigen, endosialin, fibrinogen alpha chain, interleukin-18-binding protein, kallikrein-1, retinol-binding protein 4, and titin have been found to increase in the urine of stone formers compared with controls, reinforcing their potential roles as CaOx stone promoters. This study offers the largest collection of CaOx stone-promoting proteins that will shed light on pathogenic mechanisms of nephrolithiasis and may allow further development of new drug targets to treat/prevent nephrolithiasis.

Renal fibrosis progression following partial unilateral ureteral obstruction: mechanisms and therapeutic insights

Ureteral obstruction, a common clinical condition, is associated with various renal disorders affecting all age groups and can lead to permanent renal damage. In Partial unilateral ureteral obstruction (PUUO), increased ureteral pressure, and decreased glomerular filtration rate (GFR) in the affected kidney cause cellular and molecular abnormalities, which ultimately lead to renal fibrosis if untreated. While removing the obstruction (RUUO) is essential to prevent long-term damage, additional therapeutic approaches may be necessary to fully restore kidney function. The PUUO model is used to induce renal fibrosis, primarily characterized by tubular injury resulting from obstructed urine flow. PUUO in rodents can simulate human chronic obstructive nephropathy at an accelerated rate. Although alleviating the obstruction can reduce immediate symptoms, it is often insufficient to reverse established fibrosis, emphasizing the need for adjunctive therapies. The renal response to RUUO depends on factors like the obstruction's duration and severity, as well as the contralateral kidney's functional state.

TET2 gene mutation status associated with poor prognosis of transition zone prostate cancer: a retrospective cohort study based on whole exome sequencing and machine learning models

Background

Prostate cancer (PCa) in the transition zone (TZ) is uncommon and often poses challenges for early diagnosis, but its genomic determinants and therapeutic vulnerabilities remain poorly characterized.

Methods

Tumor mutational landscape was characterized in nine patients with TZ PCa, identifying somatic variants through whole-exome sequencing (WES). Novel candidate variants relevant to driver gene were selected using rare-variant burden analysis. Kaplan-Meier curves with log-rank testing and Cox regression models were applied to evaluate the prognostic significance of selected mutant driver gene and clinicopathological characteristics in a cohort of 132 patients with TZ PCa. Significant prognostic determinants were integrated into a validated nomogram for individualized prediction of 3-, 4-, and 5-year biochemical recurrence-free survival (BRFS) and overall survival (OS) probabilities. Eight machine learning algorithms were employed to develop BRFS and OS prediction models in a cohort.

Results

A total of 5,036 somatic single nucleotide variants (SNVs) and 587 somatic insertion and deletion (INDELs) were discovered. Among eight driver gene mutations which were verified through Sanger sequencing, TET2 gene, with high mutation frequency and potential targeted drug relevance (bromodomain inhibitors and DOT1L inhibitors) was selected for further validation. Retrospective cohort study demonstrated that TET2 mutant status was significantly associated with Gleason score (p = 0.004) and distant metastasis (p = 0.002). Furthermore, TET2 mutant status was significantly correlated with inferior BRFS and OS and served as an independent predictor. Comparative evaluation of eight algorithms revealed the GBM model achieved superior discriminative ability for BRFS (AUC for 3-year: 0.752, 4-year: 0.786, 5-year: 0.796). The predictive model based on the GBM machine learning algorithm achieved the best predictive performance for OS (AUC for 3-year: 0.838, 4-year: 0.915, 5-year: 0.868). The constructed predictive nomogram provided evidence that TET2 mutant status integration conferred statistically significant improvements in model accuracy and clinical predictive value.

Conclusion

Our study elucidated the distinct genetic basis of prostate cancer in the transition zone and identified TET2 mutation as an independent prognostic determinant in TZ PCa. However, the limited sample size of this study necessitates cautious interpretation of these findings, and further validation in larger cohorts is warranted to confirm their generalizability.

E-cadherin as a surrogate marker of epithelial-to-mesenchymal transition for detection of diabetic nephropathy and subclinical atherosclerosis among children and adolescents with type 1 diabete

BACKGROUND

Epithelial-to-mesenchymal transition (EMT) may be involved in the pathogenesis of diabetic nephropathy (DN) among adults with type 2 diabetes. The current study aimed to evaluate the role of E-cadherin as a surrogate marker of EMT among children and adolescent with type 1 diabetes (T1D) and DN and its possible relation to carotid intima media thickness (CIMT).

RESEARCH DESIGN AND METHODS

Sixty participants with T1D were divided equally into two groups based on urinary albumin creatinine ratio (UACR) and compared with 30 healthy controls. Hemoglobin A1c (HbA1c), kidney function tests, serum E-cadherin and CIMT were assessed.

RESULTS

E-cadherin levels were significantly lower in patients with microalbuminuria (56.5 ± 15.8 ng/mL) compared with patients with normoalbuminuria (179.8 ± 45.1 ng/mL) and healthy controls (222.5 ± 39.9 ng/mL) (p < 0.001). E-cadherin correlated negatively with HbA1c (r = -0.42, p = 0.001), UACR (r = -0.89, p < 0.001) and CIMT (r = -0.716, p < 0.001). ROC curve analysis showed that the E-cadherin cutoff value 135 ng/mL could detect nephropathy with 96.67% sensitivity and 86.67% specificity. Logistic regression showed that E-cadherin was a significant independent factor for nephropathy.

CONCLUSIONS

E-cadherin is a potential biomarker reflecting EMT activity in both pathogenesis and progression of DN and subclinical atherosclerosis in pediatric patients with T1D.

Investigating the effect of icterus interference on a creatinine Roche enzymatic methodology

BackgroundIt is well established that high bilirubin concentrations can lead to erroneous creatinine results when measured by a Jaffe-based method. However, the effects of bilirubin on enzymatic methods appear less well-defined. The Roche Cobas 8000 enzymatic creatinine (CREP2) has an unconjugated bilirubin icterus limit of 20 mg/dL, equivalent to a bilirubin concentration of 342 µmol/L. Many hepatology patients have bilirubin levels much higher than this limit, and laboratories are unable to release creatinine results on these complex patients. This is particularly challenging for patient management, as creatinine is a key test and is a prerequisite for many procedures, imaging studies and treatments.MethodsTwo spiking studies were carried out, the first to define the interference effect of bilirubin on enzymatic creatinine measurement, and the second to see if this interference could be mitigated via dilution. Serum samples (n = 50) were spiked with a concentrated bilirubin solution. Indices, bilirubin and creatinine were measured using the Roche Cobas 8000 c702 automated analyser according to manufacturer instructions.ResultsThe spiking study found a negative linear relationship and as bilirubin concentrations increased, the measured creatinine concentration decreased (R2 = 0.7828, y = -0.0597x + 15.603). Samples with a bilirubin concentration over 246 µmol/L demonstrated an average 1.48% drop in creatinine concentration per 25 µmol/L increase in bilirubin.ConclusionsA service improvement was applied where creatinine results can be released on samples with a bilirubin concentration up to 550 µmol/L, with an appropriate comment, upon request by the clinician.

The association of perioperative serum albumin concentrations with outcome after deceased donor liver transplantation

BACKGROUND

Perioperative hypoalbuminemia has been associated with worse outcome after major surgery. Although hypoalbuminemia is common in patients with chronic liver disease and frequently occurs following liver transplantation (LT), data are sparse regarding perioperative hypoalbuminemia and outcome after LT.

METHODS

In this single-center retrospective study performed at the Medical University of Vienna, we evaluated adult patients undergoing orthotopic liver transplantation (OLT) between 2004 and 2019. The association between perioperative serum albumin concentrations and survival, acute kidney injury (AKI), and postoperative surgical complications was analyzed using cox and logistic regression models.

RESULTS

In total, 724 patients were analyzed. Serum albumin concentrations decreased from 32.0 ± 6.8 to 22.8 ± 4.8 g/l (nadir within 48 h following OLT). Overall survival was not associated with serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT (Day1: HR:0.988, 95%CI:0.966-1.011, P = 0.306; Day2: HR:1.021, 95%CI:0.991-1.052, P = 0.167; Nadir: HR:0.998, 95%CI:0.971-1.025, P = 0.863). Serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT were not associated with AKI (Day1: OR:0.975, 95%CI:0.949-1.002, P = 0.070; Day2: OR:1.011, 95%CI:0.971-1.053, P = 0.601; Nadir: HR:0.976, 95%CI:0.940-1.013, P = 0.20) or with postoperative complications (Day1: OR:0.997, 95%CI:0.976-1.059, P = 0.80; Day2: OR:1.002, 95%CI:0.973-1.032, P = 0.890; Nadir: HR:0.993, 95%CI:0.966-1.021, P = 0.610). However, we observed an increased risk for initiation of renal replacement therapy with lower serum albumin concentrations on the day preceding initiation (HR = 0.946; 95%CI:0.896-1.000; P = 0.049).

CONCLUSION

Hypoalbuminemia was not associated with reduced survival, the development of AKI, or postoperative surgical complications after OLT. However, postoperative hypoalbuminemia was associated with the timing of initiating renal replacement therapy after OLT.