Current drug development challenges in chronic kidney disease (CKD)--identification of individualized determinants of renal progression and premature cardiovascular disease (CVD)

Healthcare Data for Achieving a More Personalized Treatment of Chronic Kidney Disease

The current concept of healthcare incites a more personalized treatment of diseases. To this aim, biomarkers are needed to improve decision-making facing chronic kidney disease (CKD) patients. Prognostic markers provided by real-world (observational) evidence are proposed in this Special Issue entitled "Biomarkers in Chronic Kidney Disease", with the intention to identify high-risk patients. These markers do not target measurable parameters in patients but clinical endpoints that may be in turn transformed to benefits under the effect of future interventions.

Naturally-Derived Biomaterials for Tissue Engineering Applications

Naturally-derived biomaterials have been used for decades in multiple regenerative medicine applications. From the simplest cell microcarriers made of collagen or alginate, to highly complex decellularized whole-organ scaffolds, these biomaterials represent a class of substances that is usually first in choice at the time of electing a functional and useful biomaterial. Hence, in this chapter we describe the several naturally-derived biomaterials used in tissue engineering applications and their classification, based on composition. We will also describe some of the present uses of the generated tissues like drug discovery, developmental biology, bioprinting and transplantation.

Cholesterol-Lowering Treatment in Chronic Kidney Disease: Multistage Pairwise and Network Meta-Analyses

Pairwise and network meta-analyses on the relationship between the efficacy of the use of statins with or without ezetimibe and reductions in low-density lipoprotein cholesterol (LDLc) and C-reactive protein (CRP) in patients with chronic kidney disease (CKD) are presented. In the pairwise meta-analysis, statins with or without ezetimibe were shown to be efficacious in reducing major adverse cardiovascular events (MACE) in patients with CKD and an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m², in the context of both primary prevention [odds ratio (OR)/95% confidence interval (95% CI)/I²/number of studies (n): 0.50/0.40–0.64/0%/6] and primary/secondary prevention (0.66/0.57–0.76/57%/18). However, in the Bayesian network meta-analysis, compared to the placebo, only atorvastatin 80 mg daily and atorvastatin and rosuvastatin at doses equivalent to simvastatin 20 mg daily reduced the odds of MACEs in this patient population. The network meta-analysis for LDLc and CRP treatment objectives also showed that, regardless of eGFR and excluding dialysis patients, the number of MACEs decreased in patients with CKD, with reductions in both LDLc and CRP of less than 50% (surface under the cumulative ranking (SUCRA)/heterogeneity (vague)/n: 0.77/0.14/3). The evaluation of the benefits of drugs may lead to individualized therapy for CKD patients: Cholesterol-lowering treatment for CKD patients with high levels of both LDLc and CRP is suggested.

High Baseline Levels of Tumor Necrosis Factor Receptor 1 Are Associated With Progression of Kidney Disease in Indigenous Australians With Diabetes: The eGFR Follow-up Study

OBJECTIVE

To examine the association between soluble tumor necrosis factor receptor 1 (sTNFR1) levels and kidney disease progression in Indigenous Australians at high risk of kidney disease.

RESEARCH DESIGN AND METHODS

This longitudinal observational study examined participants aged ≥18 years recruited from >20 sites across diabetes and/or kidney function strata. Baseline measures included sTNFR1, serum creatinine, urine albumin-to-creatinine ratio (uACR), HbA_1c, C-reactive protein (CRP), waist-to-hip ratio, systolic blood pressure, and medical history. Linear regression was used to estimate annual change in estimated glomerular filtration rate (eGFR) for increasing sTNFR1, and Cox proportional hazards were used to estimate the hazard ratio (HR) and 95% CI for developing a combined renal outcome (first of a ≥30% decline in eGFR with a follow-up eGFR <60 mL/min/1.73 m², progression to renal replacement therapy, or renal death) for increasing sTNFR1.

RESULTS

Over a median of 3 years, participants with diabetes (n = 194) in the highest compared with the lowest quartile of sTNFR1 experienced significantly greater eGFR decline (-4.22 mL/min/1.73 m²/year [95% CI -7.06 to -1.38]; P = 0.004), independent of baseline age, sex, eGFR, and uACR. The adjusted HR (95% CI) for participants with diabetes per doubling of sTNFR1 for the combined renal outcome (n = 32) was 3.8 (1.1-12.8; P = 0.03). No association between sTNFR1 and either renal outcome was observed for those without diabetes (n = 259).

CONCLUSIONS

sTNFR1 is associated with greater kidney disease progression independent of albuminuria and eGFR in Indigenous Australians with diabetes. Further research is required to assess whether TNFR1 operates independently of other metabolic factors associated with kidney disease progression.

The influence of low calcium dialysate on left ventricular diastolic function in peritoneal dialysis patients

Left ventricular (LV) diastolic function was found to be a significant predictor of cardiovascular events and general mortality in dialysis. Studies have indicated that dialysate calcium concentrations were significantly associated with cardiac function. However, the relationship between low calcium dialysate and LV diastolic function has not been clear. The aim of this study was to investigate the influence of low calcium dialysate on cardiac function in peritoneal dialysis (PD) patients. A total of 60 PD patients were enrolled in this study, with a calcium content of the PD solution of 1.25 mmol/L in 30 patients (low-calcium group) and 1.75 mmol/L in 30 patients (standard-calcium group). Standard M-mode and two-dimensional ultrasound measurements were applied to detect the cardiac function. After 12-month follow-up, we found no significant difference in blood pressure, calcium, phosphorus, parathyroid hormone (PTH), etc., between the two groups. Residual renal function (RRF), which is associated with LV cardiac function, was significantly decreased in the standard-calcium group compared with the low-calcium group (5.64 ± 3.23 vs. 9.38 ± 3.17, p = .001). Compared with the low-calcium group, E_max (peak early diastolic velocity) and A_max (peak late diastolic velocity) were significantly decreased (p < .05), whereas myocardial performance index (MPI) was obviously increased in standard-calcium group (9.69 ± 2.71 vs. 7.75 ± 0.93, p < .05). In conclusion, our data suggest that low calcium dialysate treatment is significantly associated with better LV diastolic function.

Asiatic acid ameliorates tubulointerstitial fibrosis in mice with ureteral obstruction

Asiatic acid (AA) is one of the triterpenoid compounds present in Centella asiatica and it has been shown to be capable of attenuating liver fibrosis. In the present study, we investigated the effects of AA on renal tubulointerstitial fibrosis in mice with unilateral ureteral obstruction (UUO). Mice were divided randomly into five groups (n=5 per group): the sham-surgery (Sh), UUO plus vehicle treatment (UUO+V), UUO plus 1 mg/kg body weight AA treatment (UUO+A1), UUO plus 4 mg/kg body weight AA treatment (UUO+A2) and UUO plus 16 mg/kg body weight AA treatment (UUO+A3) groups. The mice were treated with AA daily by oral gavage from the day subsequent to surgery for six days. On the seventh day, the mice were sacrificed for examination. Tubular injury was observed in the renal cortex of the mice administered the vehicle, while high doses of AA were observed to exert a significant suppressive effect on tubular injury. Interstitial fibrosis, increased expression of α-smooth muscle actin (SMA) and transforming growth factor (TGF)-β1 and phosphorylation of Smad2/3 were induced by ureteral ligation; however these effects were abrogated by intermediate and high doses of AA. These results suggest that AA may ameliorate tubulointerstitial fibrosis by reducing tubular injury, fibroblast activation and extracellular matrix (ECM) accumulation mediated by Smad-dependent TGF-β1 signaling.