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Prabhahar A, Vijaykumar NA, Selvam S, Ramchandran R, Sethi J, Pannu AK, Sharma N. Characteristics and Prognosis of Infectious Disease Emergencies in Patients with Chronic Kidney Disease in India. Indian J Crit Care Med 2024; 28:601-606. [PMID: 39130395 PMCID: PMC11310683 DOI: 10.5005/jp-journals-10071-24731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 08/13/2024] Open
Abstract
Objectives Chronic kidney disease (CKD) significantly increases the risk of infectious diseases (IDs), leading to heightened morbidity and mortality. However, there remains a lack of detailed, region-specific studies. This study investigates the clinical spectrum, etiologies, outcomes, and baseline predictors of mortality of ID emergencies in CKD patients in North India. Methods This retrospective study was conducted at the Postgraduate Institute of Medical Education and Research, Chandigarh, from January 2021 to December 2022. It included patients aged ≥13 years with CKD and IDs admitted to the Acute Care and Emergency Medicine Unit. Results We enrolled 248 patients (mean age 50 years, 58.1% males). About 60% had CKD stage 5, and 46% were on maintenance hemodialysis. Diabetic kidney disease was the predominant etiology (38.7%). The principal IDs were pneumonia (27.4%), urinary tract infection (UTI) (21.4%), sepsis of unknown primary focus (15.7%), tuberculosis (8.1%), and multisite infections (7.7%). Patients commonly have atypical clinical presentation, e.g., absence of fever and nonspecific symptoms such as shortness of breath and altered mental status. An emergence of multidrug-resistant organisms, e.g., Enterococcus faecium for UTI and Stenotrophomonas maltophilia for catheter-related bloodstream infections, was noted.In-hospital mortality rate was 33.5%, higher with multisite infections (58%) and pneumonia (47%). A low baseline Glasgow coma scale (GCS) was an independent predictor of mortality [odds ratio (OR) 0.786, 95% confidence interval (CI) 0.693-0.891, p-value <0.001]. Conclusion Effective management and early intervention are needed to improve outcomes in CKD patients with ID emergencies, given the high mortality and atypical clinical presentations. How to cite this article Prabhahar A, Vijaykumar NA, Selvam S, Ramchandran R, Sethi J, Pannu AK, et al. Characteristics and Prognosis of Infectious Disease Emergencies in Patients with Chronic Kidney Disease in India. Indian J Crit Care Med 2024;28(6):601-606.
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Affiliation(s)
- Arun Prabhahar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Niranjan A Vijaykumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Suresh Selvam
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Raja Ramchandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Jasmine Sethi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Ashok K Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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Lee TH, Chen JJ, Wu CY, Lin TY, Hung SC, Yang HY. Immunosenescence, gut dysbiosis, and chronic kidney disease: Interplay and implications for clinical management. Biomed J 2024; 47:100638. [PMID: 37524304 PMCID: PMC10979181 DOI: 10.1016/j.bj.2023.100638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
Immunosenescence refers to the immune system changes observed in individuals over 50 years old, characterized by diminished immune response and chronic inflammation. Recent investigations have highlighted similar immune alterations in patients with reduced kidney function. The immune system and kidney function have been found to be closely interconnected. Studies have shown that as kidney function declines, both innate and adaptive immunity are affected. Chronic kidney disease (CKD) patients exhibit decreased levels of naive and regular T cells, as well as naive and memory B cells, while memory T cell counts increase. Furthermore, research suggests that CKD and end-stage kidney disease (ESKD) patients experience early thymic dysfunction and heightened homeostatic proliferation of naive T cells. In addition to reduced thymic T cell production, CKD patients display shorter telomeres in both CD4+ and CD8+ T cells. Declining kidney function induces uremic conditions, which alter the intestinal metabolic environment and promote pathogen overgrowth while reducing diversity. This dysbiosis-driven imbalance in the gut microbiota can result in elevated production of uremic toxins, which, in turn, enter the systemic circulation due to compromised gut barrier function under uremic conditions. The accumulation of gut-derived uremic toxins exacerbates local and systemic kidney inflammation. Immune-mediated kidney damage occurs due to the activation of immune cells in the intestine as a consequence of dysbiosis, leading to the production of cytokines and soluble urokinase-type plasminogen activator receptor (suPAR), thereby contributing to kidney inflammation. In this review, we delve into the fundamental mechanisms of immunosenescence in CKD, encompassing alterations in adaptive immunity, gut dysbiosis, and an overview of the clinical findings pertaining to immunosenescence.
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Affiliation(s)
- Tao Han Lee
- Nephrology Department, Chansn Hospital, Taoyuan, Taiwan
| | - Jia-Jin Chen
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, And Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yun Lin
- Division of Nephrology, Taipei Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Taipei, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Taipei, Taiwan.
| | - Huang-Yu Yang
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Tuoheti K, Bai X, Yang L, Wang X, Cao Y, Yisha Z, Guo L, Zhan S, Wu Z, Liu T. Forsythiaside A suppresses renal fibrosis and partial epithelial-mesenchymal transition by targeting THBS1 through the PI3K/AKT signaling pathway. Int Immunopharmacol 2024; 129:111650. [PMID: 38342062 DOI: 10.1016/j.intimp.2024.111650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
Renal fibrosis is a key feature of chronic kidney disease (CKD) progression, whereas no proven effective anti-fibrotic treatments. Forsythiaside A (FTA), derived from Forsythia suspense, has been found to possess nephroprotective properties. However, there is limited research on its anti-fibrotic effects, and its mechanism of action remains unknown. This study aimed to investigate the suppressive effects of FTA on renal fibrosis and explore the underlying mechanisms. In vitro, we established a HK2 cell model induced by transforming growth factor β1 (TGF-β1), and in vivo, we used a mice model induced by unilateral ureteral obstruction (UUO). CCK-8 assay, qRT-PCR, Western blotting, immunofluorescence, flow cytometry, histological staining, immunohistochemistry, TUNEL assay, RNA transcriptome sequencing, and molecular docking were performed. The results showed that FTA (40 μM or 80 μM) treatment improved cell viability and suppressed TGF-β1-induced fibrotic changes and partial epithelial-mesenchymal transition (EMT). Furthermore, FTA treatment reversed the activation of the PI3K/AKT signaling pathway, and THBS1 was identified as the target gene. We found that THBS1 knockdown suppressed the activation of the PI3K/AKT signaling pathway and reduced the fibrosis and partial EMT-related protein level. Conversely, THBS1 overexpression activated the PI3K/AKT signaling pathway and exacerbated renal fibrosis and partial EMT. In vivo, mice were administered FTA (30 or 60 mg/kg) for 2 weeks, and the results demonstrated that FTA administration significantly mitigated tubular injury, tubulointerstitial fibrosis, partial EMT, and apoptosis. In conclusion, FTA inhibited renal fibrosis and partial EMT by targeting THBS1 and inhibiting activation of the PI3K/AKT pathway.
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Affiliation(s)
- Kuerban Tuoheti
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaojie Bai
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lijie Yang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaolong Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuanfei Cao
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zuhaer Yisha
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Linfa Guo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shanzhi Zhan
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhonghua Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China; Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Wuhan, China; Hubei Province Key Laboratory of Urinary System Diseases, Wuhan, China.
| | - Tongzu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China; Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Wuhan, China; Hubei Province Key Laboratory of Urinary System Diseases, Wuhan, China.
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Nasci VL, Liu P, Marks AM, Williams AC, Kriegel AJ. Transcriptomic analysis identifies novel candidates in cardiorenal pathology mediated by chronic peritoneal dialysis. Sci Rep 2023; 13:10051. [PMID: 37344499 DOI: 10.1038/s41598-023-36647-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Peritoneal dialysis (PD) is associated with increased cardiovascular (CV) risk. Studies of PD-related CV pathology in animal models are lacking despite the clinical importance. Here we introduce the phenotypic evaluation of a rat model of cardiorenal syndrome in response to chronic PD, complemented by a rich transcriptomic dataset detailing chronic PD-induced changes in left ventricle (LV) and kidney tissues. This study aims to determine how PD alters CV parameters and risk factors while identifying pathways for potential therapeutic targets. Sprague Dawley rats underwent Sham or 5/6 nephrectomy (5/6Nx) at 10 weeks of age. Six weeks later an abdominal dialysis catheter was placed in all rats before random assignment to Control or PD (3 daily 1-h exchanges) groups for 8 days. Renal and LV pathology and transcriptomic analysis was performed. The PD regimen reduced circulating levels of BUN in 5/6Nx, indicating dialysis efficacy. PD did not alter blood pressure or cardiovascular function in Sham or 5/6Nx rats, though it attenuated cardiac hypertrophy. Importantly PD increased serum triglycerides in 5/6Nx rats. Furthermore, transcriptomic analysis revealed that PD induced numerous changed transcripts involved with inflammatory pathways, including neutrophil activation and atherosclerosis signaling. We have adapted a uremic rat model of chronic PD. Chronic PD induced transcriptomic changes related to inflammatory signaling that occur independent of 5/6Nx and augmented circulating triglycerides and predicted atherosclerosis signaling in 5/6Nx LV tissues. The changes are indicative of increased CV risk due to PD and highlight several pathways for potential therapeutic targets.
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Affiliation(s)
- Victoria L Nasci
- Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pengyuan Liu
- Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Amanda M Marks
- Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Adaysha C Williams
- Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Alison J Kriegel
- Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center of Systems Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Gut microbiome studies in CKD: opportunities, pitfalls and therapeutic potential. Nat Rev Nephrol 2023; 19:87-101. [PMID: 36357577 DOI: 10.1038/s41581-022-00647-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/12/2022]
Abstract
Interest in gut microbiome dysbiosis and its potential association with the development and progression of chronic kidney disease (CKD) has increased substantially in the past 6 years. In parallel, the microbiome field has matured considerably as the importance of host-related and environmental factors is increasingly recognized. Past research output in the context of CKD insufficiently considered the myriad confounding factors that are characteristic of the disease. Gut microbiota-derived metabolites remain an interesting therapeutic target to decrease uraemic (cardio)toxicity. However, future studies on the effect of dietary and biotic interventions will require harmonization of relevant readouts to enable an in-depth understanding of the underlying beneficial mechanisms. High-quality standards throughout the entire microbiome analysis workflow are also of utmost importance to obtain reliable and reproducible results. Importantly, investigating the relative composition and abundance of gut bacteria, and their potential association with plasma uraemic toxins levels is not sufficient. As in other fields, the time has come to move towards in-depth quantitative and functional exploration of the patient's gut microbiome by relying on confounder-controlled quantitative microbial profiling, shotgun metagenomics and in vitro simulations of microorganism-microorganism and host-microorganism interactions. This step is crucial to enable the rational selection and monitoring of dietary and biotic intervention strategies that can be deployed as a personalized intervention in CKD.
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Infection in Living Donor Liver Transplantation Leads to Increased Risk of Adverse Renal Outcomes. Nutrients 2022; 14:nu14173660. [PMID: 36079917 PMCID: PMC9460461 DOI: 10.3390/nu14173660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Background: Little is known about the subsequent renal function change following incident infectious diseases in living-donor liver transplant (LT) recipients. (2) Methods: We studied patients who underwent living-donor LT from January 2003 to January 2019 to evaluate the association of incident hospitalization with major infections or pneumonia with adverse renal outcomes, including a sustained 40% reduction in estimated glomerular filtration rate (eGFR) and renal composite outcome (a 40% decline in eGFR, end-stage renal disease, or death.). Multivariable-adjusted time-dependent Cox models with infection as a time-varying exposure were used to estimate hazard ratio (HR) with 95% confidence interval (CI) for study outcomes. (3) Results: We identified 435 patients (mean age 54.6 ± 8.4 years and 76.3% men), of whom 102 had hospitalization with major infections during follow-up; the most common cause of infection was pneumonia (38.2%). In multiple Cox models, hospitalization with a major infection was associated with an increased risk of eGFR decline > 40% (HR, 3.32; 95% CI 2.13−5.16) and renal composite outcome (HR, 3.41; 95% CI 2.40−5.24). Likewise, pneumonia was also associated with an increased risk of eGFR decline > 40% (HR, 2.47; 95% CI 1.10−5.56) and renal composite outcome (HR, 4.37; 95% CI 2.39−8.02). (4) Conclusions: Our results illustrated the impact of a single infection episode on the future risk of adverse renal events in LT recipients. Whether preventive and prophylactic care bundles against infection and judicious modification of the immunosuppressive regimen benefit renal outcomes may deserve further study.
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Association of Peritonitis with Cardiovascular Mortality Over Time in the Peritoneal Dialysis Population, an ANZDATA Registry Study. Kidney Int Rep 2022; 7:2388-2396. [DOI: 10.1016/j.ekir.2022.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/25/2022] [Accepted: 08/15/2022] [Indexed: 02/07/2023] Open
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Cho NY, Mabeza RM, Lee C, Verma A, Madrigal J, Hadaya J, de Virgilio C, Benharash P. Association of Chronic Kidney Disease with perioperative outcomes following acute lower limb revascularization. Surg Open Sci 2022; 9:94-100. [PMID: 35755163 PMCID: PMC9213817 DOI: 10.1016/j.sopen.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background There is a paucity of data examining the impact of advancing chronic kidney disease stages on outcomes following revascularization for acute limb ischemia. The present study examined the association of chronic kidney disease with in-hospital mortality, amputation, and resource utilization following revascularization for acute limb ischemia using a nationally representative cohort. Methods The 2016–2018 National Inpatient Sample was queried to identify all adult hospitalizations with lower extremity acute limb ischemia requiring surgical and/or endovascular interventions. Patients were grouped according to the presence of chronic kidney disease and its severity: no chronic kidney disease, chronic kidney disease 1–3 (chronic kidney disease stages 1 through 3), chronic kidney disease 4–5 (chronic kidney disease stages 4 through 5), and end-stage renal disease. Multivariable logistic and linear models were used to evaluate association of chronic kidney disease stage with outcomes of interest. Results Of an estimated 82,610 patients meeting study criteria, 14.8% had chronic kidney disease (chronic kidney disease 1–3: 63.4%, chronic kidney disease 4–5: 12.1%, end-stage renal disease: 24.5%). Compared to those with chronic kidney disease, chronic kidney disease patients were on average older, were more frequently female, and had a higher median Elixhauser Comorbidity Index. Increasing severity of chronic kidney disease was associated with a stepwise increase in unadjusted mortality rates (4.7% in no chronic kidney disease to 12.6% in end-stage renal disease, P < .001). Following risk adjustment, only end-stage renal disease was associated with increased odds of mortality (adjusted odds ratio 3.10, 95% confidence interval 2.28–4.22) and limb amputation (adjusted odds ratio 1.99, 95% confidence interval 1.59–2.48) compared to patients with no chronic kidney disease. Similarly, advancing chronic kidney disease stage conferred increased odds of prolonged length of stay and greater hospitalization costs. Conclusion Advanced renal dysfunction demonstrated inferior perioperative outcomes and greater health care expenditures in the study population. These findings imply that quality improvement efforts in acute limb ischemia revascularization should target patients with chronic kidney disease 4–5 and end-stage renal disease.
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Lu YA, Chen CY, Kuo G, Yen CL, Tian YC, Hsu HH. In-Hospital Outcomes and Recurrence of Infectious Spondylitis in Patients with and without Chronic Hemodialysis: A Nationwide Cohort Study. Int J Gen Med 2022; 15:2991-3001. [PMID: 35308570 PMCID: PMC8932927 DOI: 10.2147/ijgm.s348431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yueh-An Lu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chieh-Li Yen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Correspondence: Hsiang-Hao Hsu, Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, Tel +886-3-328-1200 ext. 8181, Fax +886-3-3282173, Email
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Steiger S, Rossaint J, Zarbock A, Anders HJ. Secondary Immunodeficiency Related to Kidney Disease (SIDKD)-Definition, Unmet Need, and Mechanisms. J Am Soc Nephrol 2022; 33:259-278. [PMID: 34907031 PMCID: PMC8819985 DOI: 10.1681/asn.2021091257] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kidney disease is a known risk factor for poor outcomes of COVID-19 and many other serious infections. Conversely, infection is the second most common cause of death in patients with kidney disease. However, little is known about the underlying secondary immunodeficiency related to kidney disease (SIDKD). In contrast to cardiovascular disease related to kidney disease, which has triggered countless epidemiologic, clinical, and experimental research activities or interventional trials, investments in tracing, understanding, and therapeutically targeting SIDKD have been sparse. As a call for more awareness of SIDKD as an imminent unmet medical need that requires rigorous research activities at all levels, we review the epidemiology of SIDKD and the numerous aspects of the abnormal immunophenotype of patients with kidney disease. We propose a definition of SIDKD and discuss the pathogenic mechanisms of SIDKD known thus far, including more recent insights into the unexpected immunoregulatory roles of elevated levels of FGF23 and hyperuricemia and shifts in the secretome of the intestinal microbiota in kidney disease. As an ultimate goal, we should aim to develop therapeutics that can reduce mortality due to infections in patients with kidney disease by normalizing host defense to pathogens and immune responses to vaccines.
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Affiliation(s)
- Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
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Liao CC, Tai YH, Yeh CC, Hsu YH, Chen TL, Cherng YG. Effect of influenza vaccination on the outcomes of hospitalization for kidney disease in a geriatric population: A propensity-score matched study. PLoS One 2022; 17:e0262420. [PMID: 35077480 PMCID: PMC8789174 DOI: 10.1371/journal.pone.0262420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background and aims The effects of influenza vaccination (IV) on the outcomes of patients with kidney disease (KD) are not completely understood. We aimed to evaluate and compare the outcomes during admission of KD between elderly patients who did or did not receive an IV within the previous 12 months. Methods We used health insurance research data in Taiwan and conducted a population-based cohort study that included 22,590 older people aged ≥ 65 years who were hospitalized for KD in 2008–2013. We performed propensity score matching (case-control ratio 1:1) to select 4386 eligible IV recipients and 4386 nonrecipient controls for comparison. The adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of IV associated with complications and mortality during KD admission were calculated using multivariable logistic regression analyses. Results During hospitalization for KD, IV was significantly associated with lower risks of 30-day in-hospital mortality (OR 0.56, 95% CI 0.39–0.82), septicemia (OR 0.77, 95% CI 0.68–0.87), and intensive care (OR 0.85, 95% CI 0.75–0.96). Additionally, IV recipients had a shorter length of hospital stay and lower medical expenditure than nonrecipients. Subgroup analyses further showed that the association of IV with reduced adverse events was confined to patients aged ≥ 75 years. Conclusions Previous IV was associated with reduced risks of complications and mortality and in elderly patients hospitalized for KD. We raised the possibility and suggested the need to promote IV for this susceptible population of patients with KD.
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Affiliation(s)
- Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, Illinois, United States of America
| | - Yung-Ho Hsu
- Department of Nephrology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ta-Liang Chen
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- * E-mail:
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Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis - epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS INFECTIOUS DISEASES 2021; 9:Doc07. [PMID: 35106269 PMCID: PMC8777485 DOI: 10.3205/id000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Epidemiological studies show an increasing number of patients worldwide suffering from chronic kidney diseases (CKD), which are associated with a risk for progression to end-stage kidney disease (ESKD). CKD patients stage 2-5, patients with regular chronic dialysis treatment (hemo- or peritoneal dialysis), and patients suffering from kidney allograft dysfunction are at high risk to develop infections, e.g. urinary tract infections (UTI) and/or sepsis (urosepsis). These groups show metabolic disturbance, chronic inflammation, and impaired immunocompetence. Escherichia coli is still the most common pathogen in UTI. A wide variety of other pathogens may be involved in UTI. Urological interventions, catheterization, as well as repeated courses of antibiotics contribute to an increased challenge of antimicrobial resistance. The diagnosis of UTI in CKD is based on standard clinical and laboratory criteria. Pyuria (≥10 leucocytes/µl) is more often observed in patients with oligoanuria and low bacterial colony counts. The treatment strategies for this population are based on the same principles as in patients with normal renal function. However, drugs cleared by the kidney or by dialysis membranes need dose adjustment. Antimicrobials with potential systemic toxicity and nephrotoxicity should be administered with caution.
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Affiliation(s)
| | | | - Kurt G. Naber
- Department of Urology, Technical University Munich, Germany
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Liu P, Zhang S, Jiang L, Ma J, Shao X. A negative association between low-density lipoprotein cholesterol level and infection risk in elderly stage 5 chronic kidney disease patients. Clin Exp Nephrol 2021; 26:113-121. [PMID: 34519901 DOI: 10.1007/s10157-021-02134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To explore the relationship between low-density lipoprotein cholesterol (LDL-C) level and infection risk in elderly stage 5 kidney disease (CKD) patients. METHODS This study retrospectively analyzed all 378 patients with grade 5 CKD over 60 years old treated in the Nephrology Department of our hospital from February 2014 to July 2019, including 286 cases with infection and 92 cases without. According to LDL-C levels, the patients were divided into three groups (Tertile 1-Tertile 3). Basic patient data and laboratory test results were collected for all three groups for analysis. RESULTS The incidence of infection showed a gradually decreasing trend in the three groups (from 80.2, 78.6 to 68.3%), along with increasing LDL-C levels from Tertile 1 to Tertile 3, although the differences were not statistically significant (p = 0.075). After fully adjusting for confounding factors, the risk of infection was significantly reduced (OR = 0.646, 95% CI 0.420-0.993, p = 0.046) with increasing LDL-C levels. For the LDL-C levels of the three groups, the rising trend of LDL-C was significantly associated with the reduction in infection risk (OR = 0.545, 95% CI 0.317-0.937, p = 0.028). Curve fitting revealed that LDL-C levels were linearly negatively associated with the risk of infection, and the relationship between the two was not affected by the other factors (p for interaction: 0.567-1.000). CONCLUSIONS LDL-C level is linearly negatively associated with the risk of infection in elderly patients with stage 5 CKD.
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Affiliation(s)
- Ping Liu
- Department of Geriatrics, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Shuying Zhang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Lijuan Jiang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
| | - Jinhong Ma
- Department of Clinical Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
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14
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Lee MJ, Park I, Kim H, Shin GT, Jeong JC. Preexisting comorbidities are associated with the mortality rate as well as the predialysis adverse events in incident dialysis patients. Kidney Res Clin Pract 2021; 40:419-431. [PMID: 34510861 PMCID: PMC8476300 DOI: 10.23876/j.krcp.20.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Optimal estimated glomerular filtration rate (eGFR) to start maintenance dialysis is controversial. Observational studies have reported that initiation of dialysis at high eGFRs is associated with worse postdialysis survival. Methods We retrospectively investigated 1,038 incident dialysis patients who started maintenance dialysis during 2010–2015. Patients were assessed for comorbidities and adverse events during the transitional period of dialysis initiation. Patients were classified as planned dialysis (PD) vs. unplanned dialysis (UD) according to indications for dialysis initiation. Results UD group comprised 352 patients (33.9%). Mean eGFR at dialysis initiation was higher in UD patients than PD patients (7.9 ± 5.1 vs. 5.9 ± 3.4 mL/min/1.73 m2, p < 0.001). Mean Davies comorbidity index in the UD group was higher (vs. PD group, 1.3 ± 1.0 vs. 0.9 ± 1.0, p < 0.001). Patients with more comorbidities experienced more ischemic heart disease (hazard ratio [HR], 4.36; 95% confidence interval [CI], 1.71–11.14) in the medium-risk group and HR of 8.84 (95% CI, 3.06–25.55) in the high-risk group (vs. low-risk group, p < 0.001)) during the predialysis period. High-risk group had increased postdialysis mortality (HR, 2.48; 95% CI, 1.46–4.20; p = 0.001). Adjusted HR of mortality was higher in the medium-risk group of UD patients (HR, 1.72; 95% CI, 1.16–2.56; p = 0.007). Conclusion Patients with more comorbidities were at increased risk of predialysis ischemic heart disease and postdialysis mortality. UD patients in the medium-risk population had increased risk of postdialysis mortality. Dialysis start should be individualized by considering comorbidities.
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Affiliation(s)
- Min-Jeong Lee
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Inwhee Park
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Heungsoo Kim
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Gyu-Tae Shin
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jong Cheol Jeong
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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15
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Risk Factors for Herpes Zoster in Patients with Chronic Kidney Disease: A Case-Control Study. Vaccines (Basel) 2021; 9:vaccines9090963. [PMID: 34579200 PMCID: PMC8473266 DOI: 10.3390/vaccines9090963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Chronic kidney disease (CKD) increases the susceptibility to the presence of herpes zoster (HZ). Little is known about the risk factors of HZ in CKD patients; (2) Methods: This is a case-control study. CKD patients diagnosed with HZ between January 2015 and June 2021 in a tertiary hospital were identified. One age- and gender- matched control was paired for each case, matched to the date of initial HZ diagnosis. Conditional multiple logistic regression was used to evaluate the risk factors associated with the presence of HZ; (3) Results: Forty-seven HZ patients and controls were identified. In general, about 73.40% (69 out of 94) patients were classified at IV to V stages of CKD. Immunosuppressive agents (p = 0.0012) and dialysis therapy (p = 0.021) were reported more frequently in the HZ cohort. Compared with the control group, the total white cell count and lymphocyte count were significantly lower in the HZ group (p value of 0.032 and 0.003, respectively). The conditional logistics regression model revealed that previous immunosuppressants administration (odds ratio: 10.861, 95% CI: 2.092~56.392, p = 0.005) and dialysis therapy (odds ratio: 3.293, 95% CI: 1.047~10.355, p = 0.041) were independent risk factors of HZ in the CKD population; (4) Conclusions: Dialysis and immunosuppressants therapy were associated with greater risk of HZ disease in CKD patients. Further guideline may highlight the necessity of zoster vaccine for patients with CKD, who undertake associated treatment.
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16
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Systematic Review and Meta-analysis of Herpes Zoster Vaccine in Patients With CKD. Kidney Int Rep 2021; 6:1254-1264. [PMID: 34013103 PMCID: PMC8116755 DOI: 10.1016/j.ekir.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) is a risk factor for herpes zoster (HZ) infection. Few studies have examined HZ vaccine (HZV) in this population. We conducted a systematic review and meta-analysis investigating the efficacy and safety of HZV in patients with renal disease (CKD, dialysis, and transplant). Methods MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases (up to May 2020) were searched for randomized controlled trials and nonrandomized controlled studies evaluating HZV in patients with CKD for effectiveness and adverse event risks. Studies without a control group (placebo or no vaccine) were excluded. Extraction of prespecified data and risk of bias assessments using the Newcastle-Ottawa scale for cohort studies and the Cochrane Risk of Bias Tool for randomized controlled trials were done by 3 authors. Random-effects meta-analysis was used to generate pooled treatment effects and 95% confidence intervals. Results Included were 404,561 individuals from 8 studies (3 randomized controlled trials and 5 nonrandomized). All 8 studies examined HZ as an outcome, with 3 reporting adverse events. Risk of HZ was lower in patients who received HZV compared with controls (hazard ratio, 0.55; 95% confidence interval, 0.37–0.82; P < 0.01); however, heterogeneity was high (I2 = 88%, P < 0.01). There was no significant difference in adverse events associated with HZV (hazard ratio, 1.03; 95% confidence interval, 0.54–1.28; P = 0.8). Conclusions HZV compared with control significantly lowers the risk of HZ without an increase in adverse events in CKD patients. However, significant heterogeneity was present. HZV should be actively considered in CKD patients because the prevalence of HZ is higher in this population.
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17
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Giroux M, Bouchard N, Henderson A, Lam L, Tran VAS, Projean D, Tessier JF, Lepage L, Gavra P, Ouellet G, Vallée M, Lafrance JP. Pharmacokinetics of Tobramycin Administered at the Beginning of Intermittent Hemodialysis Session (ESRD Study). Can J Kidney Health Dis 2021; 8:2054358120987061. [PMID: 33680482 PMCID: PMC7897820 DOI: 10.1177/2054358120987061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: There is a renewed interest in the successful use of aminoglycosides due to increasing resistance in gram-negative infections. Few studies to date have examined the pharmacokinetics (PK) of intradialytic infusions of tobramycin. This study sought to characterize the pharmacokinetic profile of intradialytically administered tobramycin in infected patients receiving chronic intermittent hemodialysis and to determine whether it is possible to achieve favorable PK targets. Design, Setting, Participants, and Measurements: In this prospective pharmacokinetic study, a single dose (5 mg/kg) of tobramycin was administered intradialytically to 11 noncritically ill patients undergoing chronic intermittent hemodialysis. Blood samples were collected at selected time to determine tobramycin serum concentrations. The PK analysis was performed using Phoenix™ NLME. The efficacy exposure outcome for nonsevere gram-negative infections sensitive to tobramycin with a minimum inhibitory concentration ≤1 were maximum concentration (Cmax ≥ 10 mg/L) and area under the curve (AUC24 h > 30 mg⋅h/L). For toxicity, the goal was to identify plasma trough concentrations <2 mg/L. Results: Tobramycin disposition was best described by a one-compartment model using a total clearance composed of the systemic clearance and a transitory hemodialysis clearance. Tobramycin mean (SD) Cmax, trough levels, and AUC24h were 13.1 (1.3) mg/L, 1.32 (0.47) mg/L, and 61 (23) mg⋅h/L, respectively. Monte Carlo simulation run with 1000 virtual patients showed that a 5 mg/kg dose of tobramycin administered intradialytically can outperformed the usual low-dose postdialysis dosing (80% meeting all targets versus <1%, respectively). Conclusions: A single high dose of tobramycin can achieve favorable PK outcome when administered using intradialytic infusions in hemodialysis patients. This practical dosing regimen may represent an effective and safer alternative to the usual dosing in the treatment of nonsevere gram-negative infections.
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Affiliation(s)
- Marjolaine Giroux
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Nicolas Bouchard
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Anik Henderson
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Lesly Lam
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Van Anh Sylvie Tran
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Denis Projean
- Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Jean-François Tessier
- Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Laurence Lepage
- Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Paul Gavra
- Université de Montréal, QC, Canada.,Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Georges Ouellet
- Université de Montréal, QC, Canada.,Service de Néphrologie, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Michel Vallée
- Université de Montréal, QC, Canada.,Service de Néphrologie, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada
| | - Jean-Philippe Lafrance
- Service de Néphrologie, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, QC, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département de pharmacologie et physiologie, Université de Montréal, QC, Canada
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18
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Su G, Iwagami M, Qin X, McDonald H, Liu X, Carrero JJ, Stålsby Lundborg C, Nitsch D. Kidney disease and mortality in patients with respiratory tract infections: a systematic review and meta-analysis. Clin Kidney J 2021; 14:602-611. [PMID: 33623685 PMCID: PMC7886553 DOI: 10.1093/ckj/sfz188] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are a common reason for people to seek medical care. RTIs are associated with high short-term mortality. Inconsistent evidence exists in the association between the presence of kidney disease and the risk of death in patient with RTIs. METHODS We searched the PubMed, Cochrane Library and Embase databases from inception through April 2019 for cohort and case-control studies investigating the presence of kidney disease (defined as medical diagnosis of kidney disease, reduced estimated glomerular filtration rate or creatinine clearance, elevated serum creatinine and proteinuria) on mortality in adults with RTIs in different settings including community, inpatient and intensive care units. We assessed the quality of the included studies using Cochrane Collaboration's tool and conducted a meta-analysis on the relative risk (RR) of death. RESULTS Of 5362 records identified, 18 studies involving 16 676 participants met the inclusion criteria, with 15 studies investigating pneumonia and 3 studies exploring influenza. The risk of bias in the available evidence was moderate. Most [17/18 (94.5%)] of studies reported positive associations of underlying chronic kidney disease with mortality. The pooled adjusted risk for all-cause mortality in patients with RTIs almost doubled [RR 1.96 (95% confidence interval 1.48-2.59)] in patients with kidney disease. Associations were consistent across different timings of kidney disease assessment and provenances of RTIs (community-acquired or healthcare-associated). CONCLUSIONS The presence of kidney disease is associated with higher mortality among people with RTIs, especially in those with pneumonia. The presence of kidney disease might be taken into account when considering admission for patients who present with RTIs.
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Affiliation(s)
- Guobin Su
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, China
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Xindong Qin
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, China
| | - Helen McDonald
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Xusheng Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, China
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Stålsby Lundborg
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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19
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Nicotinamide Attenuates the Progression of Renal Failure in a Mouse Model of Adenine-Induced Chronic Kidney Disease. Toxins (Basel) 2021; 13:toxins13010050. [PMID: 33440677 PMCID: PMC7827863 DOI: 10.3390/toxins13010050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Nicotinamide adenine dinucleotide (NAD+) supplies energy for deoxidation and anti-inflammatory reactions fostering the production of adenosine triphosphate (ATP). The kidney is an essential regulator of body fluids through the excretion of numerous metabolites. Chronic kidney disease (CKD) leads to the accumulation of uremic toxins, which induces chronic inflammation. In this study, the role of NAD+ in kidney disease was investigated through the supplementation of nicotinamide (Nam), a precursor of NAD+, to an adenine-induced CKD mouse model. Nam supplementation reduced kidney inflammation and fibrosis and, therefore, prevented the progression of kidney disease. Notably, Nam supplementation also attenuated the accumulation of glycolysis and Krebs cycle metabolites that occurs in renal failure. These effects were due to increased NAD+ supply, which accelerated NAD+-consuming metabolic pathways. Our study suggests that Nam administration may be a novel therapeutic approach for CKD prevention.
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20
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Han Y, Huang Z, Zhang H, He L, Sun L, Liu Y, Liu F, Xiao L. Nocardiosis in glomerular disease patients with immunosuppressive therapy. BMC Nephrol 2020; 21:516. [PMID: 33243202 PMCID: PMC7690096 DOI: 10.1186/s12882-020-02179-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/19/2020] [Indexed: 01/14/2023] Open
Abstract
Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.
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Affiliation(s)
- Yuzhang Han
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zineng Huang
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huifang Zhang
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liyu He
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Sun
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu Liu
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fuyou Liu
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Xiao
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China.
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21
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Natale P, Gutman T, Howell M, Dansie K, Hawley CM, Cho Y, Viecelli AK, Craig JC, Jesudason S, Chapman JR, Johnson DW, Murphy L, Reidlinger D, Crowe S, Duncanson E, Muthuramalingam S, Scholes-Robertson N, Williamson A, McDonald S, Wong G, Teixeira-Pinto A, Strippoli GFM, Tong A. Recruitment and retention in clinical trials in chronic kidney disease: report from national workshops with patients, caregivers and health professionals. Nephrol Dial Transplant 2020; 35:755-764. [PMID: 32240311 DOI: 10.1093/ndt/gfaa044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Slow recruitment and poor retention jeopardize the reliability and statistical power of clinical trials, delaying access to effective interventions and increasing costs, as commonly observed in nephrology trials. Involving patients in trial design, recruitment and retention is infrequent but potentially transformational. METHODS We conducted three workshops involving 105 patients/caregivers and 43 health professionals discussing patient recruitment and retention in clinical trials in chronic kidney disease. RESULTS We identified four themes. 'Navigating the unknown'-patients described being unaware of the research question, confused by technical terms, sceptical about findings and feared the risk of harm. 'Wary of added burden'-patients voiced reluctance to attend additional appointments, were unsure of the commitment required or at times felt too unwell and without capacity to participate. 'Disillusioned and disconnected'-some patients felt they were taken for granted, particularly if they did not receive trial results. Participants believed there was no culture of trial participation in kidney disease and an overall lack of awareness about opportunities to participate. To improve recruitment and retention, participants addressed 'Building motivation and interest'. CONCLUSIONS Investigators should establish research consciousness from the time of diagnosis, consider optimal timing for approaching patients, provide comprehensive information in an accessible manner, emphasize current and future relevance to them and their illness, involve trusted clinicians in recruitment and minimize the burden of trial participation. Participation in clinical trials was seen as an opportunity for people to give back to the health system and for future people in their predicament.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Talia Gutman
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrea K Viecelli
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Kidney Health Australia, Victoria, Melbourne, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy R Chapman
- Westmead Clinical School, Westmead Institute for Medical Research, New South Wales, Westmead, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Lisa Murphy
- Kidney Health Australia, Victoria, Melbourne, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | | | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Shyamsundar Muthuramalingam
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Amber Williamson
- BEAT-CKD Consumer Advisory Board, Sydney, New South Wales, Australia.,Kidney Health Australia, Queensland Consumer Consultative Committee, Brisbane, Queensland, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,Westmead Clinical School, Westmead Institute for Medical Research, New South Wales, Westmead, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Cochrane Kidney and Transplant, Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
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22
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Su G, Trevisan M, Ishigami J, Matsushita K, Stålsby Lundborg C, Carrero JJ. Short- and long-term outcomes after incident pneumonia in adults with chronic kidney disease: a time-dependent analysis from the Stockholm CREAtinine Measurement project. Nephrol Dial Transplant 2020; 35:1894-1900. [PMID: 31219575 PMCID: PMC7643674 DOI: 10.1093/ndt/gfz119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Little is known about the health sequelae of pneumonia in persons with chronic kidney disease (CKD). METHODS We studied adults with CKD in Stockholm during 2006-11, who not previously been diagnosed with lower respiratory tract infections. We used multivariable-adjusted Cox regression with pneumonia as a time-varying exposure to estimate hazard ratios (HRs) [95% confidence intervals (CIs)] for the events of death, major adverse cardiovascular events (MACEs), acute kidney injury (AKI), CKD progression or hospitalization for urinary tract infections (UTIs)/sepsis. Cataract and knee/joint replacement served as negative control outcomes. RESULTS We identified 71 931 adults (mean age 79 years, 59% women), of whom 8379 (12%) were diagnosed with pneumonia during follow-up; incident pneumonia was associated with 10 times higher adjusted mortality risk during the first 90 days [HR = 10.0, 95% confidence interval (CI) 9.5-10.5] and double the mortality beyond 90 days from pneumonia diagnosis (HR = 2.0; 95% CI 1.9-2.1). Incident pneumonia was similarly associated with higher adjusted risk of MACE (<90 days: HR = 12.6; 95% CI 12.0-13.3; ≥90 days: HR = 1.5; 95% CI 1.4-1.6). The adjusted risk of CKD progression and UTI/sepsis hospitalization was highest within 90 days from pneumonia but remained elevated thereafter. For AKI, the association with incident pneumonia was only seen within 90 days. Neither cataract nor knee/joint replacement was related to pneumonia. CONCLUSIONS Incident pneumonia was associated with increased risks of MACE, CKD progression, severe UTI/sepsis and death, with risks highest soon after pneumonia diagnosis but extending beyond 90 days. Our findings highlight the susceptibility for adverse outcomes of CKD patients following pneumonia diagnosis, and may inform clinical decisions regarding vaccination strategies.
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Affiliation(s)
- Guobin Su
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China
- Global Health—Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Marco Trevisan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cecilia Stålsby Lundborg
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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23
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Yen CL, Fan PC, Lee CC, Kuo G, Tu KH, Chen JJ, Lee TH, Hsu HH, Tian YC, Chang CH. Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis? Nutrients 2020; 12:nu12113358. [PMID: 33142717 PMCID: PMC7694025 DOI: 10.3390/nu12113358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that dietary therapy can delay the initiation of dialysis, but little research has investigated whether patients with very poor renal function would benefit from a dietary therapy. METHODS This study was performed by using the Chang Gung Research Database (CGRD), which is based on the largest medical system in Taiwan. Patients with estimated glomerular filtration rates (eGFR) < 15 mL/min/1.73 m2 between 2001 and 2015 with more than 3 months of low-protein diet supplemented with ketoanalogues (sLPD) were extracted (Ketosteril group). We then assigned five patients without any sLPD to match one patient of the Ketosteril group (comparison group). Both groups were followed up for 1 year for the initiation of dialysis and rates of major adverse cardiac and cerebrovascular events (MACCEs). RESULTS The Ketosteril group (n = 547), compared with the comparison group (n = 2735), exhibited a lower incidence of new-onset dialysis (40.2% vs. 44.4%, subdistribution hazard ratio (SHR): 0.80, 95% confidence interval (CI): 0.70-0.91) and MACCEs (3.7% vs. 5.9%, HR: 0.61, 95% CI: 0.38-0.97). The beneficial effect of an sLPD did not differ in patients with a baseline eGFR < 5 mL/min/1.73 m2. CONCLUSION Even among patients with extremely low eGFR, sLPD treatment can safely delay the need for dialysis.
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Affiliation(s)
- Chieh-Li Yen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - George Kuo
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Tao-Han Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Hsiang-Hao Hsu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Ya-Chun Tian
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
- Correspondence: or ; Tel.: +886-3-3281200 (ext. 8181) or +0033669733371
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24
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Banshodani M, Kawanishi H, Moriishi M, Shintaku S, Tsuchiya S. Association between Dialysis Modality and Infectious Diseases: Peritoneal Dialysis versus Hemodialysis. Blood Purif 2020; 50:370-379. [PMID: 33120394 DOI: 10.1159/000511041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION For dialysis patients with end-stage kidney disease, infectious diseases (IDs) are the most common causes of hospitalization and death. However, the association between dialysis modality and IDs remains unclear. We aimed to determine the association between the dialysis modality and IDs. METHODS This retrospective observational cohort study compared the emergency hospitalization and mortality for IDs between peritoneal dialysis (PD) and hemodialysis (HD) patients. After propensity score matching, the risk factors were evaluated by the Cox proportional hazard regression models. RESULTS A total of 260 patients were compared - 130 of 135 PD and 130 of 706 HD patients. When the modality-specific ID (PD-catheter ID/peritonitis- and vascular access-related ID) was excluded, no significant differences in emergency hospitalization and mortality rates for overall IDs were observed between the PD and HD groups. Serum ferritin (HR, 2.17; CI, 1.06-4.43; p = 0.03) and Charlson Comorbidity Index (CCI) (HR, 1.24; CI, 1.01-1.52; p = 0.04) were significant predictors of emergency hospitalization for IDs, whereas age (HR, 1.12; CI, 1.05-1.19; p < 0.001), male (HR, 3.38; CI, 1.01-11.3; p = 0.048), serum alkaline phosphatase (ALP) (HR, 6.87; CI, 2.18-21.7; p = 0.001), C-reactive protein (CRP) (HR, 10.7; CI, 3.55-32.1; p < 0.001), and CCI (HR, 1.79; CI, 1.27-2.52; p < 0.001) were significant predictors of ID mortality. When modality-specific ID was included, the emergency hospitalization rate for overall IDs was higher in the PD groups, and PD was a significant predictor of emergency hospitalization for IDs, whereas no significant difference in mortality rate for overall IDs was found between the PD and HD groups. CONCLUSIONS ID events were not associated with dialysis modality when modality-specific ID was excluded, whereas the risk of modality-specific IDs was higher in PD than HD. Serum ferritin and ALP as well as age, male sex, CRP, and CCI were the risk factors for ID events.
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Affiliation(s)
- Masataka Banshodani
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan,
| | - Hideki Kawanishi
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Misaki Moriishi
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Sadanori Shintaku
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Shinichiro Tsuchiya
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
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25
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Ishigami J, Cowan LT, Demmer RT, Grams ME, Lutsey PL, Coresh J, Matsushita K. Hospitalization With Major Infection and Incidence of End-Stage Renal Disease: The Atherosclerosis Risk in Communities (ARIC) Study. Mayo Clin Proc 2020; 95:1928-1939. [PMID: 32771237 PMCID: PMC10184867 DOI: 10.1016/j.mayocp.2020.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate whether the incidence of infectious diseases increases the long-term risk for incident end-stage renal disease (ESRD) in the general population. PATIENTS AND METHODS In 10,290 participants of the Atherosclerosis Risk in Communities Study who attended visit 4 (1996-1998), we evaluated the association of incident hospitalization with major infections (pneumonia, urinary tract infection, bloodstream infection, and cellulitis and osteomyelitis) with subsequent risk for ESRD through September 30, 2015. Hospitalization with major infection was entered into multivariable Cox models as a time-varying exposure to estimate the hazard ratios. RESULTS Mean age was 63 years, and of 10,290 individuals, 56% (n=5781) were women, 22% (n=2252) were black, and 7% (n=666) had an estimated glomerular filtration rate less than 60 mL/min/1.73 m2. During a median follow-up of 17.4 years, there were 2642 incident hospitalizations with major infection and 281 cases of ESRD (132 cases after hospitalization with major infection). The risk for ESRD was higher following major infection compared with while free of major infection (crude incidence rate, 10.9 vs 1.0 per 1000 person-years). In multivariable time-varying Cox analysis, hospitalization with major infection was associated with a 3.3-fold increased risk for ESRD (hazard ratio, 3.34; 95% CI, 2.56-4.37). The association was similar across pneumonia, urinary tract infection, bloodstream infection, and cellulitis and osteomyelitis, and remained significant across subgroups of age, sex, race, diabetes, history of cardiovascular disease, and chronic kidney disease. CONCLUSION Hospitalization with major infection was independently and robustly associated with subsequent risk for ESRD. Whether preventive approaches against infection have beneficial effects on kidney outcomes may deserve future investigations.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Logan T Cowan
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins University, Baltimore, MD
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26
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Chang YL, Wang JS, Yeh HC, Ting IW, Huang HC, Chiang HY, Hsiao CT, Chu PL, Kuo CC. Dialysis timing may be deferred toward very late initiation: An observational study. PLoS One 2020; 15:e0233124. [PMID: 32401817 PMCID: PMC7219782 DOI: 10.1371/journal.pone.0233124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/28/2020] [Indexed: 01/20/2023] Open
Abstract
The optimal timing to initiate dialysis among patients with an estimated glomerular filtration rate (eGFR) of <5 mL/min/1.73 m2 is unknown. We hypothesized that dialysis initiation time can be deferred in this population even with high uremic burden. A case-crossover study with case (0-30 days before dialysis initiation [DI]) and control (90-120 days before DI) periods was conducted in 1,079 hemodialysis patients aged 18-90 years at China Medical University Hospital between 2006 and 2015. The uremic burden was quantified based on 7 uremic indicators that reached the predefined threshold in case period, namely hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate. Dialysis timing was classified as standard (met 0-2 uremic indicators), late (3-5 indicators), and very late (6-7 indicators). Median eGFR-DI of the 1,079 patients was 3.4 mL/min/1.73 m2 and was 2.7 mL/min/1.73 m2 in patients with very late initiation. The median follow-up duration was 2.42 years. Antibiotics, diuretics, antihypertensive medications, and non-steroidal anti-inflammatory drugs (NSAIDs) were more prevalently used during the case period. The fully adjusted hazards ratios of all-cause mortality for the late and very late groups were 0.97 (95% confidence interval 0.76-1.24) and 0.83 (0.61-1.15) compared with the standard group. It is safe to defer dialysis initiation among patients with chronic kidney disease (CKD) having an eGFR of <5 mL/min/1.73 m2 even when patients having multiple biochemical uremic burdens. Coordinated efforts in acute infection prevention, optimal fluid management, and prevention of accidental exposure to NSAIDs are crucial to prolong the dialysis-free survival.
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Affiliation(s)
- Yun-Lun Chang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Jie-Sian Wang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Yeh
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Han-Chun Huang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiung-Tzu Hsiao
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Pei-Lun Chu
- Division of Nephrology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chin-Chi Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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27
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Macdougall IC, Bhandari S, White C, Anker SD, Farrington K, Kalra PA, Mark PB, McMurray JJV, Reid C, Robertson M, Tomson CRV, Wheeler DC, Winearls CG, Ford I. Intravenous Iron Dosing and Infection Risk in Patients on Hemodialysis: A Prespecified Secondary Analysis of the PIVOTAL Trial. J Am Soc Nephrol 2020; 31:1118-1127. [PMID: 32253271 DOI: 10.1681/asn.2019090972] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/19/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Experimental and observational studies have raised concerns that giving intravenous (IV) iron to patients, such as individuals receiving maintenance hemodialysis, might increase the risk of infections. The Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial randomized 2141 patients undergoing maintenance hemodialysis for ESKD to a high-dose or a low-dose IV iron regimen, with a primary composite outcome of all-cause death, heart attack, stroke, or hospitalization for heart failure. Comparison of infection rates between the two groups was a prespecified secondary analysis. METHODS Secondary end points included any infection, hospitalization for infection, and death from infection; we calculated cumulative event rates for these end points. We also interrogated the interaction between iron dose and vascular access (fistula versus catheter). RESULTS We found no significant difference between the high-dose IV iron group compared with the lose-dose group in event rates for all infections (46.5% versus 45.5%, respectively, which represented incidences of 63.3 versus 69.4 per 100 patient years, respectively); rates of hospitalization for infection (29.6% versus 29.3%, respectively) also did not differ. We did find a significant association between risk of a first cardiovascular event and any infection in the previous 30 days. Compared with patients undergoing dialysis with an arteriovenous fistula, those doing so via a catheter had a higher incidence of having any infection, hospitalization for infection, or fatal infection, but IV iron dosing had no effect on these outcomes. CONCLUSIONS The high-dose and low-dose IV iron groups exhibited identical infection rates. Risk of a first cardiovascular event strongly associated with a recent infection.
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Affiliation(s)
- Iain C Macdougall
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Sunil Bhandari
- Hull University Teaching Hospitals NHS Trust and Hull York Medical School, Hull, United Kingdom
| | - Claire White
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kenneth Farrington
- Lister Hospital, Stevenage, United Kingdom.,University of Hertfordshire, Hertfordshire, United Kingdom
| | | | - Patrick B Mark
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Chante Reid
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | | | - David C Wheeler
- University College London, London, United Kingdom.,George Institute for Global Health, Sydney, New South Wales, Australia
| | - Christopher G Winearls
- Oxford Kidney Unit, The Churchill, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
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28
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Ganz T, Aronoff GR, Gaillard CAJM, Goodnough LT, Macdougall IC, Mayer G, Porto G, Winkelmayer WC, Wish JB. Iron Administration, Infection, and Anemia Management in CKD: Untangling the Effects of Intravenous Iron Therapy on Immunity and Infection Risk. Kidney Med 2020; 2:341-353. [PMID: 32734254 PMCID: PMC7380433 DOI: 10.1016/j.xkme.2020.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are at increased risk for infection, attributable to immune dysfunction, increased exposure to infectious agents, loss of cutaneous barriers, comorbid conditions, and treatment-related factors (eg, hemodialysis and immunosuppressant therapy). Because iron plays a vital role in pathogen reproduction and host immunity, it is biologically plausible that intravenous iron therapy and/or iron deficiency influence infection risk in CKD. Available data from preclinical experiments, observational studies, and randomized controlled trials are summarized to explore the interplay between intravenous iron and infection risk among patients with CKD, particularly those receiving maintenance hemodialysis. The current evidence base, including data from a recent randomized controlled trial, suggests that proactive judicious use of intravenous iron (in a manner that minimizes the accumulation of non-transferrin-bound iron) beneficially replaces iron stores while avoiding a clinically relevant effect on infection risk. In the absence of an urgent clinical need, intravenous iron therapy should be avoided in patients with active infection. Although serum ferritin concentration and transferrin saturation can help guide clinical decision making about intravenous iron therapy, definition of an optimal iron status and its precise determination in individual patients remain clinically challenging in CKD and warrant additional study.
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Affiliation(s)
- Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | | | - Lawrence T Goodnough
- Department of Pathology, Stanford University, Stanford, CA.,Department of Medicine (Hematology), Stanford University, Stanford, CA
| | - Iain C Macdougall
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Graça Porto
- Pathology and Molecular Immunology Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,i3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Wolfgang C Winkelmayer
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX
| | - Jay B Wish
- Division of Nephrology, Indiana University Health, Indianapolis, IN
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29
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Boyer-Suavet S, Cremoni M, Dupeyrat T, Zorzi K, Brglez V, Benzaken S, Esnault V, Seitz-Polski B. Functional immune assay using interferon-gamma could predict infectious events in end-stage kidney disease. Clin Chim Acta 2020; 502:287-292. [DOI: 10.1016/j.cca.2019.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
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30
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Infection in Advanced Chronic Kidney Disease and Subsequent Adverse Outcomes after Dialysis Initiation: A Nationwide Cohort Study. Sci Rep 2020; 10:2938. [PMID: 32076027 PMCID: PMC7031239 DOI: 10.1038/s41598-020-59794-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/03/2020] [Indexed: 11/21/2022] Open
Abstract
It remains unclear whether infection events before entering end stage renal disease (ESRD) have a long-term negative impact on patients with advanced chronic kidney disease (CKD) who survive to permanent dialysis. We enrolled 62,872 patients with advanced CKD who transitioned to maintenance dialysis between January 1, 2004 and December 31, 2013. We used multivariable Cox as well as Fine and Gray models to determine the association of pre-dialysis infection exposure with all-cause mortality after starting dialysis. Compared with no infection during advanced CKD, the presence of infection exposure during that period was independently associated with a higher risk of all-cause mortality in the first year of dialysis (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.27–1.42) and also during the entire follow-up period (HR 1.19, 95% CI 1.16–1.22). The increased risks of all-cause mortality increased incrementally with higher annual number of infections during advanced CKD. Similar results were found for all other adverse outcomes, e.g. post-ESRD infection-related hospitalization and major cardiac and cerebrovascular events. In conclusion, infection events during advanced CKD was associated with increased risks of adverse outcomes after dialysis has been started. Timely interventions in such a vulnerable group may help attenuate these risks.
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Hepburn KS, Lambert K, Mullan J, McAlister B, Lonergan M, Cheikh Hassan HI. Peritoneal dialysis-related peritonitis as a risk factor for cardiovascular events. Intern Med J 2020; 51:404-410. [PMID: 32034855 DOI: 10.1111/imj.14769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/11/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality in peritoneal dialysis (PD) patients. Infection is known to increase the risk of cardiovascular events (CVE); however, no studies have examined the association between PD peritonitis and CVE. AIM To examine peritonitis as a risk factor for CVE in PD patients. METHODS This retrospective cohort study included all adults undertaking PD for ≥3 months in one Australian health district from 2001 to 2015. Baseline characteristics and peritonitis event information was obtained from the Australian and New Zealand Dialysis and Transplant registry. The Centre for Health Research Illawarra Shoalhaven Population facilitated data linkage using ICD10 coding to capture CVE information. RESULTS A total of 211 patients was included, with median age of 66 years (interquartile range 54.49-74.45); 64% were male. Peritonitis occurred in 114 (54%) patients and 65 (30.8%) patients experienced a CVE. Identified risk factors for CVE included: cerebrovascular disease (hazard ratio (HR) 2.72, 95% confidence interval (CI) 1.36-5.47), diabetes (HR 2.41, 95% CI 1.47-3.96), coronary artery disease (HR 1.67, 95% CI 1.01-2.77) and age (HR 1.03, 95% CI 1.01-1.06). There was no significant increase in risk of CVE following peritonitis (HR 1.37, 95% CI 0.81-2.32, P = 0.24), even when accounting for age, cerebrovascular disease, diabetes and existing coronary artery disease (HR 1.32, 95% CI 0.78-2.23, P = 0.30). CONCLUSIONS We did not find an increase in the risk of CVE following a peritonitis episode in PD patients. This result may be due to small sample size or rapid peritonitis treatment mitigating cardiovascular risk.
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Affiliation(s)
- Kirsten S Hepburn
- Department or Renal Medicine, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kelly Lambert
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, New South Wales, Australia
| | - Brendan McAlister
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra and Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Maureen Lonergan
- Department or Renal Medicine, Wollongong Hospital, Wollongong, New South Wales, Australia.,Graduate School of Medicine University of Wollongong, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hicham I Cheikh Hassan
- Department or Renal Medicine, Wollongong Hospital, Wollongong, New South Wales, Australia.,Graduate School of Medicine University of Wollongong, University of Wollongong, Wollongong, New South Wales, Australia
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Zhang Y, Shao Y, Liu H, He F, Bou E, Yang H, Pi B. Influence of Chronic Kidney Disease on Patients Undergoing Elective Hip and Knee Orthopedic Surgery: A Systematic Review and Meta-Analysis. J INVEST SURG 2019; 34:346-356. [PMID: 31500490 DOI: 10.1080/08941939.2019.1631412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Yijian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Yijie Shao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Hao Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Fan He
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Emily Bou
- Biochemistry Department, University of Waterloo, Waterloo, Canada
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Bin Pi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
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Cherng YG, Chang CC, Yeh CC, Hsu YH, Chen TL, Liao CC. Adverse outcomes after non urological surgeries in patients with chronic kidney disease: a propensity-score-matched study. Clin Epidemiol 2019; 11:707-719. [PMID: 31496825 PMCID: PMC6690593 DOI: 10.2147/clep.s219140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/21/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD). Methods Using claims data of Taiwan’s National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008–2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD. Results The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95% CI: 1.68–1.89), pneumonia (OR: 1.60, 95% CI: 1.48–1.73), stroke (OR: 1.34, 95% CI: 1.24–1.44), and in-hospital mortality (OR: 2.17, 95% CI: 1.90–2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events. Conclusion Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.
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Affiliation(s)
- Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, University of Illinois, Chicago, USA
| | - Yung-Ho Hsu
- Department of Nephrology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Ma CM, Yin FZ. The mortality in infectious inpatients with type 2 diabetes compared with non-diabetic population: Infection in type 2 diabetes. Medicine (Baltimore) 2019; 98:e16025. [PMID: 31192954 PMCID: PMC6587657 DOI: 10.1097/md.0000000000016025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to determine the mortality in infectious inpatients with type 2 diabetes mellitus (T2DM) compared with non-diabetic population.A retrospective study was conducted on 13,916 infectious inpatients in The First Hospital of Qinhuangdao. Diabetic types were classified using International classification of Diseases-10. Mortality records were collected.The mortality was higher in patients with T2DM than patients without T2DM (T2DM 4.3% vs non-diabetes 1.7%, χ = 59.560, P < .001). In multiple logistic regression analysis, T2DM was an independent risk factor of death in infectious inpatients (OR = 1.539, 95% CI: 1.181∼2.006, P = .001). The mortalities between those with T2DM and those without T2DM were stratified by age. The mortalities of patients with T2DM were 0.0% in ∼39 years, 0.0% in 40 to 49 years, 2.7% in 50 to 59 years, 3.1% in 60 to 69 years, 4.1% in 70 to 79 years and 8.7% in 80∼ years groups. The mortalities of patients without T2DM were 0.2% in ∼39 years, 0.1% in 40 to 49 years, 0.6% in 50 to 59 years, 1.0% in 60 to 69 years, 3.1% in 70 to 79 years and 5.9% in 80∼ years groups. T2DM was an independent risk factor of death only in 60 to 69 years groups (OR = 2.323, 95% CI: 1.234∼4.372, P = .009).The increase of mortality appears earlier in patients with T2DM. Infectious inpatients with T2DM are at increased risk of death and brings heavy economic burden to patients, society and government.
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Affiliation(s)
- Chun-Ming Ma
- Department of Internal Medicine, Hebei Medical University
| | - Fu-Zai Yin
- Department of Internal Medicine, Hebei Medical University
- Department of Endocrinology, The First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, Hebei Province, PR China
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Liu Y, Bi X, Xiong J, Han W, Xiao T, Xu X, Yang K, Liu C, Jiang W, He T, Yu Y, Li Y, Zhang J, Zhang B, Zhao J. MicroRNA-34a Promotes Renal Fibrosis by Downregulation of Klotho in Tubular Epithelial Cells. Mol Ther 2019; 27:1051-1065. [PMID: 30853453 DOI: 10.1016/j.ymthe.2019.02.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 12/28/2022] Open
Abstract
Renal fibrosis is the main pathological characteristic of chronic kidney disease (CKD), whereas the underlying mechanisms of renal fibrosis are not clear yet. Herein, we found an increased expression of microRNA-34a (miR-34a) in renal tubular epithelial cells of patients with renal fibrosis and mice undergoing unilateral ureteral obstruction (UUO). In miR-34a-/- mice, miR-34a deficiency attenuated the progression of renal fibrosis following UUO surgery. The miR-34a overexpression promoted epithelial-to-mesenchymal transition (EMT) in cultured human renal tubular epithelial HK-2 cells, which was accompanied by sharp downregulation of Klotho, an endogenous inhibitor of renal fibrosis. Luciferase reporter assay revealed that miR-34a downregulated Klotho expression though direct binding with the 3' UTR of Klotho. Conversely, overexpression of Klotho prevented miR-34a-induced EMT in HK-2 cells. Furthermore, results showed that miR-34a was induced by transforming growth factor β1 (TGF-β1) through p53 activation, whereas dihydromyricetin could inhibit TGF-β1-induced miR-34a overexpression. Accordingly, dihydromyricetin administration dramatically restored the aberrant upregulation of miR-34a and Klotho reduction in obstructed kidney, and markedly ameliorated renal fibrosis in the Adriamycin nephropathy and UUO model mice. These findings suggested that miR-34a plays an important role in the progression of renal fibrosis, which provides new insights into the pathogenesis and treatment of CKD.
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Affiliation(s)
- Yong Liu
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Xianjin Bi
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jiachuan Xiong
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Wenhao Han
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Tangli Xiao
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Xinli Xu
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Ke Yang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Chi Liu
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Wei Jiang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Ting He
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Yanlin Yu
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Yan Li
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jingbo Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Bo Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jinghong Zhao
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
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Vilay AM. Antibiotic Dosing in Chronic Kidney Disease and End-Stage Renal Disease: A Focus on Contemporary Challenges. Adv Chronic Kidney Dis 2019; 26:61-71. [PMID: 30876619 DOI: 10.1053/j.ackd.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 02/08/2023]
Abstract
Infections are an important cause of morbidity and mortality among patients with chronic kidney disease. Therefore, appropriate antibiotic dosing is imperative to achieve positive patient outcomes while minimizing antibiotic dose-related toxicity. Accurately assessing renal function and determining the influence of renal replacement therapy on antibiotic clearance makes drug dosing in this patient population challenging. Furthermore, as technological advances in hemodialysis and peritoneal dialysis occur, research incorporating newer dialysis parameters to guide drug dosing may not be readily available. Currently, there are limited data to guide drug dosing in the setting of automated peritoneal dialysis, short daily hemodialysis, and nocturnal hemodialysis. Antibiotic-dosing recommendations should be carefully evaluated considering the accuracy of the renal function assessment, the similarity of the operating characteristics of the renal replacement therapy studied compared with those being used, and whether the dosing strategy takes advantage of the pharmacodynamic profile of the antibiotic under consideration. After implementing the antibiotic-dosing regimen, therapeutic drug monitoring should occur when possible along with careful monitoring for antibiotic efficacy and safety.
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37
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Narayanan M. The Many Faces of Infection in CKD: Evolving Paradigms, Insights, and Novel Therapies. Adv Chronic Kidney Dis 2019; 26:5-7. [PMID: 30876617 DOI: 10.1053/j.ackd.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 01/28/2023]
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38
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Su G, Xu Y, Xu X, Xu H, Lu L, Marrone G, Lindholm B, Wen Z, Liu X, Johnson DW, Carrero JJ, Stålsby Lundborg C. Association between reduced renal function and cardiovascular mortality in patients hospitalized with infection: A multi-center cohort study. Eur J Intern Med 2018; 57:32-38. [PMID: 29958748 DOI: 10.1016/j.ejim.2018.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Infection is one of the main reasons for hospitalization worldwide, and is associated with an increased risk of cardiovascular mortality. It is unclear whether this association is modified by the presence of reduced renal function. The aim of this study was to analyze the relationship between estimated glomerular filtration rate (eGFR) and cardiovascular mortality in patients hospitalized with infection. METHODS This cohort study included all adult, incident patients who were hospitalized at one of four hospitals in China between 2012 and 2015, had a discharge diagnosis of infection, and had a serum creatinine measurement at admission. Patients receiving renal replacement therapy were excluded. Hospital data were linked to death registry data. All-cause and cardiovascular mortality were evaluated according to admission eGFR [≥60 (reference), 30-59 and < 30 mL/min/1.73m2] using multivariable Cox regression and competing risk analyses. RESULTS During a median follow-up period of 2.39 years, 40,524 patients were hospitalized with infection (mean age 61 years, 54.3% female 18.4% diabetic). Of these, 4781 died. Lower admission eGFR was associated with progressively increased risks of cardiovascular mortality (≥60 mL/min/1.73m2 reference; 30-59 mL/min/1.73m2 subdistribution hazard ratio [SHR] 2.15, 95% CI 1.85-2.50, P< .01; <30 mL/min/1.73m2 SHR 3.19, 95% CI 2.68-3.80, P < .01). The proportion of deaths due to cardiovascular disease increased as the eGFR decreased, predominantly due to ischemic heart disease. CONCLUSIONS Patients hospitalized with infections and reduced renal function have significantly increased risks of cardiovascular mortality. Heart status should be carefully monitored following infections, especially for those with reduced renal function.
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Affiliation(s)
- Guobin Su
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China
| | - Yanjun Xu
- Institute of chronic non-communicable disease, Center for Disease Control and Prevention of Guangdong Province, China
| | - Xiaojun Xu
- Institute of chronic non-communicable disease, Center for Disease Control and Prevention of Guangdong Province, China
| | - Hong Xu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Liming Lu
- Key Unit of Methodology in Clinical Research (KUMCR), Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China
| | - Gaetano Marrone
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Zehuai Wen
- Key Unit of Methodology in Clinical Research (KUMCR), Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China
| | - Xusheng Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou city, Guangdong Province, China.
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Stålsby Lundborg
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Wang Z, Xiao J, Zhang Z, Qiu X, Chen Y. Chronic kidney disease can increase the risk of preoperative deep vein thrombosis in middle-aged and elderly patients with hip fractures. Clin Interv Aging 2018; 13:1669-1674. [PMID: 30237703 PMCID: PMC6138966 DOI: 10.2147/cia.s174691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Preoperative deep vein thrombosis (DVT) is a common complication in patients with hip fractures. Chronic kidney disease (CKD) as a frequent comorbidity in middle-aged and elderly patients with hip fractures is known to promote a proinflammatory and prothrombotic state. We aimed to identify whether CKD can increase the risk of DVT in middle-aged and elderly patients with hip fractures, as well as identify other risk factors. Patients and methods We retrospectively studied 248 middle-aged and elderly patients with hip fractures who were admitted to our hospital from January 2016 to June 2017, meeting all the inclusion criteria. Doppler ultrasonography was used to diagnose DVT. Patients with CKD were classified into five stages according to the Kidney Diseases Outcomes Quality Initiative. We identified whether CKD could increase the occurrence of preoperative DVT in middle-aged and elderly patients with hip fractures and further investigated other independent risk factors for preoperative DVT by using univariate and multivariate analyses. Results The mean estimated glomerular filtration rate was 125.7±41.4 mL/min/1.73 m2. Briefly, 82.3% (n=204) had been diagnosed with normal kidney function, 11.7% (n=29) with mildly decreased kidney function, and 6.0% (n=15) with stage 3 and 4 CKD. In addition, of the 248 patients, 11.7% (n=29) developed DVT before surgery. Independent predictors of preoperative DVT identified by multivariate analyses were age, prolonged bedridden time, increased levels of fibrinogen, and lower estimated glomerular filtration rate. Conclusion CKD can increase the risk rate of preoperative DVT in middle-aged and elderly patients with hip fractures. Additionally, age, prolonged bedridden time, and increased levels of fibrinogen were also independent risk factors for preoperative DVT in these patients. We should take preventive measures for these patients with risk factors in order to reduce the incidence of preoperative DVT.
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Affiliation(s)
- Zhen Wang
- Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, China,
| | - Ji Xiao
- Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, China,
| | - Zitao Zhang
- Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, China,
| | - Xusheng Qiu
- Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, China,
| | - Yixin Chen
- Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, China,
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Ishigami J, Matsushita K. Clinical epidemiology of infectious disease among patients with chronic kidney disease. Clin Exp Nephrol 2018; 23:437-447. [PMID: 30178234 PMCID: PMC6435626 DOI: 10.1007/s10157-018-1641-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022]
Abstract
Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population. In addition, several mechanisms impairing immune function have been hypothesized including accumulated uremic toxins, increased oxidative stress, endothelial dysfunction, low-grade inflammation, and mineral and bone disorders. In terms of prevention strategies, influenza and pneumococcal vaccines are most feasible and important. Nevertheless, the extent of vaccine utilization in CKD has not been well documented. In addition, antibody response to vaccination may be reduced in CKD patients, and thus a vaccine delivery strategy (e.g., dose and frequency) may need to be optimized among patients with CKD. Through this review, we demonstrate that infection is a major but underrecognized complication of CKD. As CKD is recognized as a serious public health issue, dedicated research is needed to better characterize the burden of infectious disease associated with CKD, understand the pathophysiology of infection in patients with CKD, and develop effective strategies to prevent infection and its sequela in this high risk population.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA.
| | - Kunihiro Matsushita
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA
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41
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de Chickera S, Akbari A, Levin A, Tang M, Brown P, Djurdev O, Biyani M, Clark EG, Sood MM. The Risk of Adverse Events in Patients With Polycystic Kidney Disease With Advanced Chronic Kidney Disease. Can J Kidney Health Dis 2018; 5:2054358118774537. [PMID: 30186614 PMCID: PMC6117870 DOI: 10.1177/2054358118774537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/08/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Polycystic kidney disease (PKD) leads to progressive chronic kidney disease (CKD) with a subsequent risk of adverse events such as cardiac disease, infections, end-stage kidney disease (ESKD), and mortality. Objectives: To determine the risks of CKD-related adverse outcomes in patients with PKD compared with patients without PKD. Setting: Canadian study of prediction of death, dialysis and interim cardiovascular events (CanPREDDICT) was a prospective pan-Canadian cohort study from 2008-2013 involving 28 facilities with adjudicated outcomes. Patients: Adult CKD patients (estimated glomerular filtration rate [eGFR] = 15-45 mL/min/1.73 m2) under the care of a nephrologist. Measurements: Polycystic kidney disease as identified by the treating physician. Methods: Patients with PKD (PKD) and non-PKD were propensity score (PS) matched (1:4) using demographics, comorbidities, and laboratory values. We used conditional Cox proportional hazards models to examine the risk of cardiac disease (defined as coronary artery disease or congestive heart failure), infection, ESKD, or all-cause mortality in patients with PKD compared with no PKD. Results: Among a total of 2370 patients, 105 with PKD were matched with 416 without PKD with a baseline mean age and eGFR of 62.6 years and 27.8 mL/min, respectively. During 1680 person-years of follow time (median follow-up: 3.8 years), there were a total of 43 cardiac, 83 ESKD, 117 infectious, and 39 all-cause mortality events. PKD was associated with a higher risk of cardiac events (9.5% vs 7.9%, hazard ratio [HR] = 1.46, 95% confidence interval [CI] = 1.04-2.04) and ESKD (25.7% vs 13.5%, HR = 2.00, 95% CI = 1.33-3.01), and with similar risks for infection (21.9% vs 22.6%, HR = 1.16, 95% CI = 0.75-1.82) or all-cause mortality (6.7% vs 7.7%, HR = 0.87, 95% CI = 0.40-1.91) compared with non-PKD. There were no differences in the types of infections (urinary, respiratory, hematologic, or other) between the 2 groups (P = .585). Conclusions: Patients with PKD with advanced CKD are at a potentially higher risk of ESKD and cardiac events compared with patients without PKD. These findings, if confirmed in larger cohorts, suggest that monitoring and treatment for adverse outcomes in patients with PKD, especially related to cardiac disease, may be beneficial.
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Affiliation(s)
| | - Ayub Akbari
- Department of Medicine, University of Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Adeera Levin
- BC Renal Agency, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Mila Tang
- University of British Columbia, Vancouver, Canada
| | - Pierre Brown
- Department of Medicine, University of Ottawa, Ontario, Canada
| | | | - Mohan Biyani
- Department of Medicine, University of Ottawa, Ontario, Canada
| | - Edward G Clark
- Department of Medicine, University of Ottawa, Ontario, Canada
| | - Manish M Sood
- Department of Medicine, University of Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, Ontario, Canada
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42
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Lehto M, Groop PH. The Gut-Kidney Axis: Putative Interconnections Between Gastrointestinal and Renal Disorders. Front Endocrinol (Lausanne) 2018; 9:553. [PMID: 30283404 PMCID: PMC6157406 DOI: 10.3389/fendo.2018.00553] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022] Open
Abstract
Diabetic kidney disease (DKD) is a devastating condition associated with increased morbidity and premature mortality. The etiology of DKD is still largely unknown. However, the risk of DKD development and progression is most likely modulated by a combination of genetic and environmental factors. Patients with autoimmune diseases, like type 1 diabetes, inflammatory bowel disease, and celiac disease, share some genetic background. Furthermore, gastrointestinal disorders are associated with an increased risk of kidney disease, although the true mechanisms have still to be elucidated. Therefore, the principal aim of this review is to evaluate the impact of disturbances in the gastrointestinal tract on the development of renal disorders.
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Affiliation(s)
- Markku Lehto
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Abdominal Center of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- *Correspondence: Markku Lehto
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Abdominal Center of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
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43
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Stadlbauer V, Horvath A, Ribitsch W, Schmerböck B, Schilcher G, Lemesch S, Stiegler P, Rosenkranz AR, Fickert P, Leber B. Structural and functional differences in gut microbiome composition in patients undergoing haemodialysis or peritoneal dialysis. Sci Rep 2017; 7:15601. [PMID: 29142271 PMCID: PMC5688134 DOI: 10.1038/s41598-017-15650-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/31/2017] [Indexed: 01/28/2023] Open
Abstract
Complications of end-stage renal disease (ESRD) are critically related to inflammation. The gut microbiome is a key driver of inflammation. Since dialysis modalities may differently influence the gut microbiome, we aimed to compare the effects of haemodialysis (HD) and peritoneal dialysis (PD) on patients' gut microbiome composition and function. We therefore studied faecal microbiome composition and function as well as inflammation and gut permeability in 30 patients with ESRD (15 HD, 15 PD) and compared to 21 healthy controls. We found an increase in potentially pathogenic species and a decrease in beneficial species in patients on HD and to a lesser extend in patients on PD when compared to controls. These changes in taxonomic composition also resulted in differences in predicted metagenome functions of the faecal microbiome. In HD but not in PD, changes in microbiome composition were associated with an increase in c-reactive protein (CRP) but not with intestinal inflammation or gut permeability. In conclusion microbiome composition in ESRD differs from healthy controls but also between modes of dialysis. These differences are associated with systemic inflammation and cannot completely be explained by dialysis vintage. The mode of renal replacement therapy seems to be an important driver of dysbiosis in ESRD.
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Affiliation(s)
- Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Angela Horvath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bianca Schmerböck
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Center of Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Gernot Schilcher
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sandra Lemesch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Fickert
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Center of Biomarker Research in Medicine (CBmed), Graz, Austria
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44
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Xu H, Gasparini A, Ishigami J, Mzayen K, Su G, Barany P, Ärnlöv J, Lindholm B, Elinder CG, Matsushita K, Carrero JJ. eGFR and the Risk of Community-Acquired Infections. Clin J Am Soc Nephrol 2017; 12:1399-1408. [PMID: 28818849 PMCID: PMC5586562 DOI: 10.2215/cjn.00250117] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/26/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Community-acquired infections are common, contributing to adverse outcomes and increased health care costs. We hypothesized that, with lower eGFR, the incidence of community-acquired infections increases, whereas the pattern of site-specific infections varies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 1,139,470 health care users (mean age =52±18 years old, 53% women) from the Stockholm CREAtinine Measurements Project, we quantified the associations of eGFR with the risk of infections, overall and major types, over 12 months. RESULTS A total of 106,807 counts of infections were recorded throughout 1,128,313 person-years. The incidence rate of all infections increased with lower eGFR from 74/1000 person-years for individuals with eGFR=90-104 ml/min per 1.73 m2 to 419/1000 person-years for individuals with eGFR<30 ml/min per 1.73 m2. Compared with eGFR of 90-104 ml/min per 1.73 m2, the adjusted incidence rate ratios of community-acquired infections were 1.08 (95% confidence interval, 1.01 to 1.14) for eGFR of 30-59 ml/min per 1.73 m2 and 1.53 (95% confidence interval, 1.39 to 1.69) for eGFR<30 ml/min per 1.73 m2. The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis became increasingly higher along with lower eGFR strata (e.g., low respiratory tract infection accounting for 25% versus 15% of community-acquired infections in eGFR<30 versus 90-104 ml/min per 1.73 m2, respectively). Differences in incidence associated with eGFR were in general consistent for most infection types, except for nervous system and upper respiratory tract infections, for which no association was observed. CONCLUSIONS This region-representative health care study finds an excess community-acquired infections incidence in individuals with mild to severe CKD. Lower respiratory tract infection, urinary tract infection, and sepsis are major infections in CKD.
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Affiliation(s)
- Hong Xu
- Departments of Medical Epidemiology and Biostatistics and
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Alessandro Gasparini
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Guobin Su
- Public Health Sciences and
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden; and
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Carl Gustaf Elinder
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Juan Jesús Carrero
- Departments of Medical Epidemiology and Biostatistics and
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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45
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Santos J, Fonseca I, Malheiro J, Beirao I, Lobato L, Oliveira P, Cabrita A. End-stage renal disease versus death in a Portuguese cohort of elderly patients: an approach using competing event analysis. J Investig Med 2017; 65:1041-1048. [PMID: 28729248 DOI: 10.1136/jim-2017-000480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease (CKD) is higher in elderly, but mortality outweighs the risk of end-stage renal disease (ESRD). Our aim was to identify prognostic markers for ESRD or death in elderly CKD, within a competing-risk analysis. This is a longitudinal study of consecutive newly referred patients with CKD ages 65 years, followed until the time of the first event (ESRD or death), using a competing-risk analysis. A modified Charlson Comorbidity Index (mCCI) was subdivided into subgroups (0-2, 3-4, ≥5). Patients were followed for hospitalizations that occurred prior to the outcomes. Among 416 patients, age 76±8 years, 52% male, median estimated glomerular filtration rate of 32 mL/min per 1.73 m2, 50% had diabetes, and 67% cardiovascular disease. Over a median follow-up of 3.6 years, 36 patients progressed to ESRD (8.7%) and 103 died (24.8%). Older age (subdistribution HR (sHR)=1. 06; p<0.001), creatinine≥1.6 mg/dL (sHR=2.03, p=0.004), hemoglobin <11 g/dL (sHR=1.91, p=0.003), mCCI score≥5 (sHR=3.01, p<0.001) and having one or more hospitalizations (sHR=1.73, p<0.001) were associated with death before ESRD. The independent predictors for ESRD with competing risk of death were: lower age (sHR=0.94; p=0.009), creatinine≥1.6 mg/dL (sHR=3.26, p=0.006), hemoglobin <11 g/dL (sHR=2.15, p=0.027), peripheral vascular disease (sHR=3.45, p=0.001) and having one or more hospitalizations (sHR=1.56, p=0.031). Elderly referred patients with CKD are near threefold more likely to die than progress to ESRD. A competing-risk framework based on available clinical and laboratory data may discriminate between those outcomes and could be used as a decision-making tool.
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Affiliation(s)
- Josefina Santos
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Isabel Fonseca
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal.,ISPUP5EPI Unit, Universidade do Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Idalina Beirao
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Luisa Lobato
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Pedro Oliveira
- ISPUP5EPI Unit, Universidade do Porto, Porto, Portugal.,Department of Population Studies, Instituto de Ciências Biomédicas Abel Salazar Porto, Universidade do Porto, Porto, Portugal
| | - Antonio Cabrita
- Nephrology Department, Hospital de Santo António, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
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