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Abd ElHafeez S, Kramer A, Arici M, Arnol M, Åsberg A, Bell S, Belliere J, Corte CD, Fresnedo GF, Hemmelder M, Heylen L, Hommel K, Kerschbaum J, Naumović R, Nitsch D, Santamaria R, Finne P, Palsson R, Pippias M, Resic H, Rosenberg M, de Pablos CS, Segelmark M, Sørensen SS, Soler MJ, Vidal E, Jager KJ, Ortiz A, Stel VS. Incidence and outcomes of kidney replacement therapy for end-stage kidney disease due to primary glomerular disease in Europe: findings from the ERA Registry. Nephrol Dial Transplant 2024; 39:1449-1460. [PMID: 38327216 DOI: 10.1093/ndt/gfae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Primary glomerular disease (PGD) is a major cause of end-stage kidney disease (ESKD) leading to kidney replacement therapy (KRT). We aimed to describe incidence (trends) in individuals starting KRT for ESKD due to PGD and to examine their survival and causes of death. METHODS We used data from the European Renal Association (ERA) Registry on 69 854 patients who started KRT for ESKD due to PGD between 2000 and 2019. ERA primary renal disease codes were used to define six PGD subgroups. We examined age and sex standardized incidence, trend of the incidence and survival. RESULTS The standardized incidence of KRT for ESKD due to PGD was 16.6 per million population (pmp), ranging from 8.6 pmp in Serbia to 20.0 pmp in France. Immunoglobulin A nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) had the highest incidences, of 4.6 pmp and 2.6 pmp, respectively. Histologically non-examined PGDs represented over 50% of cases in Serbia, Bosnia and Herzegovina, and Romania and were also common in Greece, Estonia, Belgium and Sweden. The incidence declined from 18.6 pmp in 2000 to 14.5 pmp in 2013, after which it stabilized. All PGD subgroups had 5-year survival probabilities above 50%, with crescentic glomerulonephritis having the highest risk of death [adjusted hazard ratio 1.8 (95% confidence interval 1.6-1.9)] compared with IgAN. Cardiovascular disease was the most common cause of death (33.9%). CONCLUSION The incidence of KRT for ESKD due to PGD showed large differences between countries and was highest and increasing for IgAN and FSGS. Lack of kidney biopsy facilities in some countries may have affected accurate assignment of the cause of ESKD. The recognition of the incidence and outcomes of KRT among different PGD subgroups may contribute to a more individualized patient care approach.
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Affiliation(s)
- Samar Abd ElHafeez
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Anneke Kramer
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Anders Åsberg
- The Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Glasgow, UK
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Julie Belliere
- Department of Nephrology and Organ Transplantation, Referral Centre for Rare Kidney Diseases, University Hospital of Toulouse, Toulouse, France
| | - Carmen Díaz Corte
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo University, Oviedo, Spain
| | | | - Marc Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands
| | - Line Heylen
- Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
- Dienst Nefrologie, Ziekenhuis Oost-Limburg, Genk, Belgium
- University Hasselt, Hasselt, Belgium
| | | | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | | | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, UK
- UK Renal Registry, Bristol, UK
| | - Rafael Santamaria
- Andalusian Autonomous Transplant Coordination Information System, Seville, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Patrik Finne
- Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland
| | - Runolfur Palsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Maria Pippias
- University of Bristol, Department of Health Care Evaluation, Population Health Sciences, Bristol, UK
- Bright Renal Unit, North Bristol NHS Trust, Bristol, UK
| | - Halima Resic
- Renal Registry of Society of Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina, Clinic for Hemodialysis Sarajevo, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Mai Rosenberg
- Competence Centre for Rare Diseases, Tartu University Hospital, Tartu, Estonia
| | - Carmen Santiuste de Pablos
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden
| | - Søren Schwartz Sørensen
- Department of Nephrology Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Jose Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Enrico Vidal
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Pediatric Nephrology Unit, University-Hospital of Padova, Padova, Italy
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Vianda S Stel
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
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Ueki K, Tsuchimoto A, Matsukuma Y, Kitazono T, Nakano T. A case of end-stage kidney disease due to Alport syndrome diagnosed by skin biopsy after review of a renal biopsy 12 years ago. CEN Case Rep 2024:10.1007/s13730-024-00887-x. [PMID: 38714628 DOI: 10.1007/s13730-024-00887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/02/2024] [Indexed: 05/10/2024] Open
Affiliation(s)
- Kenji Ueki
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Akihiro Tsuchimoto
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Yuta Matsukuma
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Takanari Kitazono
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Toshiaki Nakano
- Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka, 8128582, Japan.
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Tuttle KR, Abner CW, Walker PD, Wang K, Rava A, Heo J, Bunke M. Clinical Characteristics and Histopathology in Adults With Focal Segmental Glomerulosclerosis. Kidney Med 2024; 6:100748. [PMID: 38196777 PMCID: PMC10772385 DOI: 10.1016/j.xkme.2023.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Rationale & Objective Few data are available regarding histological features at the time of focal segmental glomerulosclerosis (FSGS) diagnosis among diverse real-world populations. This study describes clinical and histological characteristics and correlates of histological disease severity in adults with FSGS who underwent a clinical kidney biopsy. Study Design Real-world cohort study with data derived from health records. Setting & Participants Adults with FSGS by kidney biopsies from Arkana Laboratories from January 1, 2016 to May 31, 2020. Exposure Race, chronic kidney disease stage, nephrotic proteinuria, age, sex, and hypertension. Outcomes Severe histological disease, defined as global glomerulosclerosis in >50% of glomeruli and >25% interstitial fibrosis and tubular atrophy (IFTA). Analytical Approach Demographic, clinical, and histological characteristics were compared between race groups. Correlates of severe disease were analyzed using multiple logistic regression. Results Among 2,011 patients with FSGS, 40.6% were White, and 23.6% Black. White patients were older (52.8 vs 45.5 years, P < 0.001) with a higher estimated glomerular filtration rate (eGFR) than Black patients (53.5 vs 43.1 mL/min/1.73 m2, P < 0.001). A higher proportion of Black patients had global glomerulosclerosis ≥50% (32.1% vs 14.6%, P < 0.001) or IFTA >50% (34.6% vs 14.7%, P < 0.001). Severe histological disease was more likely in Black patients (OR, 2.46; 95% CI, 1.59-3.79; P < 0.001). A higher proportion of patients with nephrotic than nonnephrotic proteinuria exhibited diffuse foot process effacement. Limitations Unequal representation across United States regions, missing demographic and clinical data, and lack of data on primary versus secondary FSGS, treatments, or outcomes. Conclusions Black patients were more frequently diagnosed at younger age with lower eGFR and more severe histological disease compared with White patients. Timelier identification of FSGS could increase the opportunity for therapeutic intervention, especially for high-risk patients, to mitigate disease progression and complications. Plain-Language Summary Focal segmental glomerulosclerosis (FSGS) accounts for around one-quarter of diagnoses derived from clinical kidney biopsies in the United States. Limited data are available regarding the classes and distribution of histological features at FSGS diagnosis among diverse real-world populations. Analyzing data from US patients who underwent kidney biopsy and were diagnosed with FSGS, we showed that up to half of patients had features of severe histological disease. Of this overall population, Black patients were more frequently diagnosed at a younger age but with more severe histological disease than White patients. The work highlights the need for timelier diagnosis of FSGS to enable intervention at an earlier disease stage.
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Janphram C, Worawichawong S, Assanatham M, Nongnuch A, Thotsiri S, Udomsubpayakul U, Wimolluck S, Poomjun N, Ingsathit A, Disthabanchong S, Sumethkul V, Aekplakorn W, Chalermsanyakorn P, Kitiyakara C. Years of life lost and long-term outcomes due to glomerular disease in a Southeast Asian Cohort. Sci Rep 2023; 13:19119. [PMID: 37926743 PMCID: PMC10625977 DOI: 10.1038/s41598-023-46268-9] [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: 04/21/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023] Open
Abstract
Death and end-stage kidney disease (ESKD) are major outcomes of glomerular disease. (GD) The years of potential life lost (YLL) may provide additional insight into the disease burden beyond death rates. There is limited data on premature mortality in GD. In this retrospective observational cohort study, we evaluated the mortality, ESKD rates, and YLL in Thais with biopsy-proven GD. The mortality and combined outcome rates were determined by log-rank test and ESKD by using a competing risk model. YLL and premature life lost before age 60 were calculated for different GD based on the life expectancy of the Thai population. Patients with GD (n = 949) were followed for 5237 patient years. The death rate and ESKD rates (95%CI) were 4.2 (3.7-4.9) and 3.3 (2.9-3.9) per 100 patient-years, respectively. Paraprotein-related kidney disease had the highest death rate, and diabetic nephropathy had the highest ESKD rate. Despite not having the highest death rate, lupus nephritis (LN) had the highest YLL (41% of all GD) and premature loss of life before age 60. In conclusion, YLL provided a different disease burden assessment compared to mortality rates and identified LN as the major cause of premature death due to GD in a Southeast Asian cohort.
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Affiliation(s)
- Chitimaporn Janphram
- Somdech Phra Debaratana Medical Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montira Assanatham
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand
| | - Arkom Nongnuch
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand
| | - Sansanee Thotsiri
- Somdech Phra Debaratana Medical Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Umaporn Udomsubpayakul
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surangkana Wimolluck
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand
| | - Naparada Poomjun
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand
| | - Atiporn Ingsathit
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sinee Disthabanchong
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand
| | - Vasant Sumethkul
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand
| | - Wichai Aekplakorn
- Department of Community Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panas Chalermsanyakorn
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chagriya Kitiyakara
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand.
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Bose B, Milanzi E, Pascoe EM, Johnson DW, Badve SV. The outcomes of patients with kidney failure due to focal segmental glomerulosclerosis (FSGS) in Australia and New Zealand: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). PLoS One 2023; 18:e0293721. [PMID: 37917639 PMCID: PMC10621846 DOI: 10.1371/journal.pone.0293721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The outcomes of patients with focal segmental glomerulosclerosis (FSGS) on kidney replacement therapy (KRT) have not been well described. This study evaluated the outcomes of patients with kidney failure due to FSGS on KRT including dialysis and kidney transplantation. METHOD AND MATERIALS All adult patients with kidney failure who commenced KRT in Australia and New Zealand from 15th of May 1963 to 31st of December 2018 were retrospectively extracted from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Outcomes of patients with FSGS were compared to those with other causes of kidney failure (non-FSGS). RESULTS 85,052 patients commenced KRT during the study period, of whom 2991 (3.5%) were patients with FSGS. Compared to patients with non-FSGS, patients with FSGS experienced similar mortality on dialysis (adjusted hazard ratio [aHR] 0.98, 95% CI 0.90-1.06, p = 0.55) and following kidney transplantation (aHR 0.92, 95% CI 0.73-1.15, p = 0.47). The risk of first kidney allograft loss was higher in patients with FSGS (aHR 1.20, 95% CI 1.04-1.37, p = 0.01). However, when death was analysed as a competing risk, the survival in both groups was similar (sub-hazard ratio [SHR] 1.09, 95% CI 0.94-1.28, p = 0.26). Patients with FSGS had a longer waiting time for kidney transplantation (aHR 0.92, 95% CI 0.86-0.98, p = 0.02) and experienced an increased risk of disease recurrence in the allograft (aHR 1.73, 95% CI 1.35-2.21, p<0.001). Compared to patients with other forms of glomerular disease, patients with FSGS experienced similar dialysis and transplant patient survival and death-censored rate of kidney transplantation and allograft loss but higher rates of primary kidney disease recurrence. CONCLUSION FSGS was associated with similar dialysis and transplant patient survival and death-censored first allograft loss compared to non-FSGS and other forms of glomerular disease.
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Affiliation(s)
- Bhadran Bose
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Department of Nephrology, Nepean Hospital, Kingswood, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
| | - Elasma Milanzi
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
| | - Elaine M. Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
- Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
- Division of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Sunil V. Badve
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
- Department of Nephrology, St George Hospital, Sydney, Australia
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Russwurm M, Kortus-Goetze B, Maier-Giebing T, Groene HJ, Hoyer J. General prognostic models may neglect vulnerable subgroups in ANCA-associated vasculitis. J Nephrol 2023; 36:2269-2280. [PMID: 37768548 PMCID: PMC10638135 DOI: 10.1007/s40620-023-01726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/30/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND ANCA-associated vasculitis is an organ and life-threatening disease with the highest incidence in elderly patients. However, few studies have focussed on characteristics and treatment outcomes in a direct comparison of elderly and younger patients. METHODS In a retrospective, single-centre, renal biopsy-cohort, patients were dichotomized by age ≥ 65 years to analyse baseline clinical, histological, laboratory and immunological characteristics and outcome differences in elderly and younger patients as regard to mortality, renal recovery from dialysis and eGFR after two years. RESULTS In the biopsy registry, n = 774 patients were identified, of whom 268 were ≥ 65 years old. Among them, ANCA-associated vasculitis was the most prevalent kidney disease (n = 54 ≈ 20%). After a follow-up of 2 years, overall mortality was 13.4%, with 19% and 4% in patients ≥ and < 65 years of age, respectively. While 41% of elderly and 25% of younger patients were dialysis-dependent at the time of biopsy, renal recovery was achieved in 41% and 57% of patients, respectively. The accuracy of prediction differed significantly between the whole cohort and elderly patients as regard to mortality (sensitivity 46% vs. 90%, respectively) and between younger and elderly patients as regard to eGFR (r2 = 0.7 vs. 0.46, respectively). Age-group-wise analysis revealed patients above 80 years of age to have particularly dismal renal outcome and survival. CONCLUSION In our cohort, ANCA-associated vasculitis is the single most frequent histopathological diagnosis among the elderly patients in our cohort. Elderly and younger patients have comparable chances of recovering from dialysis-dependent renal failure, with comparable residual independent kidney function after two years. This study suggests (1) relevant predictors differ between age groups and hence (2) models involving all patients with ANCA-associated vasculitis neglect important features of vulnerable subgroups, i.e., patients above 80 years old.
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Affiliation(s)
- Martin Russwurm
- Centre for Internal Medicine, Renal Division, University Hospital Marburg, Marburg, Germany.
- Institute of Pharmacology, Philipps-University, Marburg, Germany.
| | - Birgit Kortus-Goetze
- Centre for Internal Medicine, Renal Division, University Hospital Marburg, Marburg, Germany
| | - Tanja Maier-Giebing
- Centre for Internal Medicine, Renal Division, University Hospital Marburg, Marburg, Germany
| | - Hermann-Josef Groene
- Institute of Pharmacology, Philipps-University, Marburg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Joachim Hoyer
- Centre for Internal Medicine, Renal Division, University Hospital Marburg, Marburg, Germany
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Yu F, He G, Hao WK, Hu W. The Long-Term Survival Outcome in Older Patients with Different Pathological Types of Chronic Kidney Disease. Kidney Blood Press Res 2023; 48:338-346. [PMID: 37040725 PMCID: PMC10308525 DOI: 10.1159/000530507] [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: 11/19/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Chronic kidney diseases (CKDs) are prevalent in older people, and renal pathological manifestations are important for diagnosis, treatment, and prognosis. However, the long-term survival outcome and risk factors for older CKD patients with different pathological types are not fully understood and need to be further investigated. METHODS Medical data were recorded and all-cause mortality was followed up in patients who underwent renal biopsy diagnosed in Guangdong Provincial People's Hospital from 2005 to 2015. Kaplan-Meier analysis was used to identify the incidence of survival outcomes. Multivariate Cox regression models and nomograms were applied to analyze pathological types and other factors for overall survival outcomes. RESULTS 368 cases were included and the median follow-up was 85 (46.5, 111) months. Overall mortality was 35.6%. The highest mortality was in the mesangioproliferative glomerulonephritis (MPGN) group (88.9%), followed by amyloidosis (AMY) group (84.6%), and the lowest mortality was in the minimal change disease (MCD) group (21.9%). Moreover, multivariate Cox regression model showed that survival times of MPGN {hazard ratio (HR) = 8.215 (95% confidence interval [CI]: 2.735-24.674), p < 0.001} and AMY (HR = 6.130 [95% CI: 2.219-16.94], p < 0.001) were significantly shorter than MCD. In addition, age, lower baseline estimated glomerular filtration rate (eGFR), history of chronic obstructive pulmonary disease (COPD) and cerebrovascular accidents (CVA)/transient ischemic attack (TIA), MPGN, and AMY were independent risk factors for the mortality of older patients with CKD. CONCLUSION The long-term survival outcome of older CKD patients showed differences among different pathological types, and MPGN, AMY, age, baseline eGFR, CVA/TIA, and COPD were independent predictors for mortality.
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Affiliation(s)
- Feng Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Ganyuan He
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Wen-Ke Hao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Wenxue Hu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
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Zhao J, Liu H, Xia M, Chen Q, Wan L, Leng B, Tang C, Chen G, Liu Y, Zhang L, Liu H. Network Pharmacology and Experimental Validation to Explore That Celastrol Targeting PTEN is the Potential Mechanism of Tripterygium wilfordii (Lév.) Hutch Against IgA Nephropathy. Drug Des Devel Ther 2023; 17:887-900. [PMID: 36992900 PMCID: PMC10042171 DOI: 10.2147/dddt.s402503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose Accumulating clinical evidence showed that Tripterygium hypoglaucum (Lév.) Hutch (THH) is effective against IgA nephropathy (IgAN), but the mechanism is still unclear. This study is to evaluate the renal protective effect and molecular mechanism of THH against IgAN via network pharmacology, molecular docking strategy and experimental validation. Methods Several databases were used for obtaining the active ingredients of THH, the corresponding targets, as well as the IgAN-related genes. The critical active ingredients, functional pathways, and potential for the combination of the hub genes and their corresponding active components were determined through bioinformatics analysis and molecular docking. The IgAN mouse model was treated with celastrol (1 mg/kg/d) for 21 days, and the aggregated IgA1-induced human mesangial cell (HMC) was treated with various concentrations of celastrol (25, 50 or 75 nM) for 48 h. The immunohistochemistry and Western blot techniques were applied to evaluate the protein expression of the predicted target. The cell counting kit 8 (CCK8) was used to detect HMC proliferation. Results A total of 17 active ingredients from THH were screened, covering 165 IgAN-related targets. The PPI network identified ten hub targets, including PTEN. The binding affinity between the celastrol and PTEN was the highest (-8.69 kJ/mol). The immunohistochemistry showed that celastrol promoted the expression of PTEN in the glomerulus of IgAN mice. Furthermore, the Western blot techniques showed that celastrol significantly elevated the expression of PTEN and inhibited PCNA and Cyclin D1 in vitro and in vivo. The CCK8 assay determined that celastrol decreased HMC proliferation in a concentration-dependent manner. Conclusion This study suggests that activating PTEN by celastrol may play a pivotal role in THH alleviating IgAN renal injury.
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Affiliation(s)
- Juanyong Zhao
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Haiyang Liu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Ming Xia
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Qian Chen
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Lili Wan
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Bin Leng
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Chengyuan Tang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Guochun Chen
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Yu Liu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Lei Zhang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Hong Liu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Correspondence: Hong Liu; Lei Zhang, Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China, Tel +86-13973116951; +86-18673174522, Email ;
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9
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Chen Y, Zhang L, Xue Q, Wang N. Infection profile and risk factors for mortality in patients with end-stage renal disease attributable to systemic lupus erythematosus: a two-center integrated study. J Int Med Res 2022; 50:3000605221118702. [PMID: 35983672 PMCID: PMC9393687 DOI: 10.1177/03000605221118702] [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] [Indexed: 11/24/2022] Open
Abstract
Objective Renal impairment is a significant complication of systemic lupus
erythematosus (SLE). Additionally, infection in patients with end-stage
renal disease (ESRD) attributable to SLE is common, and it increases the
risk of mortality. This study explored the infection profile and risk
factors for mortality in patients with ESRD attributable to SLE. Methods In this retrospective, observational study of 125 hospitalized patients,
demographic, clinical, laboratory, treatment, and prognosis data were
retrieved and analyzed. Results The 125 cases included 98 pulmonary infections (78.4%), 14 urinary infections
(11.2%), and 13 intestinal infections (10.4%). Twenty-six patients died
within 1 month after enrollment. Univariate Cox regression and Kaplan–Meier
analyses revealed several possible indicators potentially influencing
patient survival. Furthermore, multivariate Cox regression analysis
identified a higher SLE Disease Activity Index-2000 score, recent
higher-dose glucocorticoid use, hypertension, and catheter indwelling as
risk factors for higher mortality. Conclusions Infections were common in patients with advanced SLE and ESRD, and several
risk factors might increase the risk of mortality. Once infection is
identified, empiric antibiotics should be initiated immediately, and
subsequent antibiotics should be applied per the results of drug sensitivity
testing to clear the infection.
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Affiliation(s)
- Yuqiang Chen
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, YISHAN 600, Shanghai, China
| | - Lisha Zhang
- Department of Emergency, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Qin Xue
- Department of Emergency, Shanghai Punan Hospital of Pudong New District, Shanghai, China
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, YISHAN 600, Shanghai, China
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10
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Abstract
Cardiovascular disease remains a leading cause of death and morbidity in kidney transplant recipients and a common reason for post-transplant hospitalization. Several traditional and nontraditional cardiovascular risk factors exist, and many of them present pretransplant and worsened, in part, due to the addition of immunosuppression post-transplant. We discuss optimal strategies for identification and treatment of these risk factors, including the emerging role of sodium-glucose cotransporter 2 inhibitors in post-transplant diabetes and cardiovascular disease. We present common types of cardiovascular disease observed after kidney transplant, including coronary artery disease, heart failure, pulmonary hypertension, arrhythmia, and valvular disease. We also discuss screening, treatment, and prevention of post-transplant cardiac disease. We highlight areas of future research, including the need for goals and best medications for risk factors, the role of biomarkers, and the role of screening and intervention.
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Affiliation(s)
- Kelly A. Birdwell
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Meyeon Park
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California
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11
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Kalantar-Zadeh K, Baker CL, Copley JB, Levy DI, Berasi S, Tamimi N, Alvir J, Udani SM. A Retrospective Study of Clinical and Economic Burden of Focal Segmental Glomerulosclerosis (FSGS) in the United States. Kidney Int Rep 2021; 6:2679-2688. [PMID: 34622107 PMCID: PMC8484118 DOI: 10.1016/j.ekir.2021.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Information on the economic burden of focal segmental glomerulosclerosis (FSGS) is sparse. This study characterized health care resource utilization (HCRU) and costs in patients with FSGS, and evaluated the impact of nephrotic range proteinuria on these outcomes. Methods This retrospective, observational cohort study used administrative claims data from the Optum Clinformatics Data Mart Database from October 2015 to December 2019. Patients with FSGS (n = 844; first claim = index event) between April 2016 and December 2018 were matched on index date, age, sex, and race to non-FSGS controls (n = 1688). FSGS nephrotic range (urine protein/creatinine ratio >3000 mg/g or albumin/creatinine ratio >2000 mg/g) and non-nephrotic subpopulations were identified. Baseline comorbidities, 12-month post-index all-cause HCRU and costs (per patient per year [PPPY]), and immunosuppressant prescriptions were compared between matched cohorts and between FSGS subpopulations. Results Comorbidity burden was higher in FSGS. Of 308 patients with available urine protein/creatinine ratio/albumin/creatinine ratio results, 36.4% were in nephrotic range. All-cause HCRU was higher in FSGS across resource categories (all P < 0.0001); 50.6% of FSGS and 23.3% of controls were prescribed glucocorticoids (P < 0.0001). Mean total medical costs were higher in FSGS ($59,753 vs. $8431 PPPY; P < 0.0001), driven by outpatient costs. Nephrotic range proteinuria was associated with higher all-cause inpatient, outpatient, and prescription costs versus nonnephrotic patients (all P < 0.0001), resulting in higher total costs ($70,481 vs. $36,099 PPPY; P < 0.0001). Conclusions FSGS is associated with significant clinical and economic burdens; the presence of nephrotic range proteinuria increased the economic burden. New treatment modalities are needed to reduce proteinuria, help improve patient outcomes, and reduce HCRU and associated costs.
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Affiliation(s)
| | | | | | | | | | - Nihad Tamimi
- Medicopharma Solutions Ltd. Canterbury, Kent, UK
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12
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Díaz Cuevas M, Limón Ramírez R, Pérez Contreras FJ, Gómez Roldán C. Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study. Nefrologia 2021; 41:53-61. [PMID: 36165362 DOI: 10.1016/j.nefroe.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/04/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. METHODS This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). RESULTS The study included 2243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, p = .004), and they were on average younger (48 years vs 55 years, p < .001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, p < .001). Patients with PGN also had more transplants (48,9%, p < .001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, p < .001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0-169,9] vs 110,3 months [95% CI: 100,8-119,7], p < .001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (p = .018). Factors with a negative influence on mortality were being older (p < .001) and having any comorbidity, mainly diabetes and liver disease (p < .001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (p = .001). CONCLUSIONS PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.
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Affiliation(s)
- María Díaz Cuevas
- Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, Spain.
| | - Ramón Limón Ramírez
- Subdirección General de Evaluación de la Gestión Asistencial, Dirección General de Asistencia Sanitaria, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
| | | | - Carmen Gómez Roldán
- Servicio de Nefrología, Hospital General Universitario de Albacete, Albacete, Spain
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13
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Infante B, Rossini M, Leo S, Troise D, Netti GS, Ranieri E, Gesualdo L, Castellano G, Stallone G. Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem. Int J Mol Sci 2020; 21:ijms21175954. [PMID: 32824988 PMCID: PMC7504691 DOI: 10.3390/ijms21175954] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022] Open
Abstract
Glomerulonephritis (GN) continues to be one of the main causes of end-stage kidney disease (ESKD) with an incidence rating from 10.5% to 38.2%. Therefore, recurrent GN, previously considered to be a minor contributor to graft loss, is the third most common cause of graft failure 10 years after renal transplantation. However, the incidence, pathogenesis, and natural course of recurrences are still not completely understood. This review focuses on the most frequent diseases that recur after renal transplantation, analyzing rate of recurrence, epidemiology and risk factors, pathogenesis and bimolecular mechanisms, clinical presentation, diagnosis, and therapy, taking into consideration the limited data available in the literature. First of all, the risk for recurrence depends on the type of glomerulonephritis. For example, recipient patients with anti-glomerular basement membrane (GBM) disease present recurrence rarely, but often exhibit rapid graft loss. On the other hand, recipient patients with C3 glomerulonephritis present recurrence in more than 50% of cases, although the disease is generally slowly progressive. It should not be forgotten that every condition that can lead to chronic graft dysfunction should be considered in the differential diagnosis of recurrence. Therefore, a complete workup of renal biopsy, including light, immunofluorescence and electron microscopy study, is essential to provide the diagnosis, excluding alternative diagnosis that may require different treatment. We will examine in detail the biomolecular mechanisms of both native and transplanted kidney diseases, monitoring the risk of recurrence and optimizing the available treatment options.
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Affiliation(s)
- Barbara Infante
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi 251, 71122 Foggia, Italy; (B.I.); (S.L.); (D.T.); (G.S.)
| | - Michele Rossini
- Clinical Pathology Unit and Center of Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto, 71122 Foggia, Italy; (M.R.); (G.S.N.); (E.R.)
| | - Serena Leo
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi 251, 71122 Foggia, Italy; (B.I.); (S.L.); (D.T.); (G.S.)
| | - Dario Troise
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi 251, 71122 Foggia, Italy; (B.I.); (S.L.); (D.T.); (G.S.)
| | - Giuseppe Stefano Netti
- Clinical Pathology Unit and Center of Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto, 71122 Foggia, Italy; (M.R.); (G.S.N.); (E.R.)
| | - Elena Ranieri
- Clinical Pathology Unit and Center of Molecular Medicine, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto, 71122 Foggia, Italy; (M.R.); (G.S.N.); (E.R.)
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi 251, 71122 Foggia, Italy; (B.I.); (S.L.); (D.T.); (G.S.)
- Correspondence: ; Tel.: +39-0881732610; Fax: +39-0881736001
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi 251, 71122 Foggia, Italy; (B.I.); (S.L.); (D.T.); (G.S.)
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14
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Díaz Cuevas M, Limón Ramírez R, Pérez Contreras FJ, Gómez Roldán C. Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study. Nefrologia 2020; 41:53-61. [PMID: 32800597 DOI: 10.1016/j.nefro.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. METHODS This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). RESULTS The study included 2,243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, P=.004), and they were on average younger (48 years vs 55 years, P<.001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, P<.001). Patients with PGN also had more transplants (48,9%, P<.001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, P<.001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0 to 169,9] vs 110,3 months [95% CI: 100,8 to 119,7], P<.001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (P=.018). Factors with a negative influence on mortality were being older (P <.001) and having any comorbidity, mainly diabetes and liver disease (P <.001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (P=.001). CONCLUSIONS PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.
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Affiliation(s)
- María Díaz Cuevas
- Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, España.
| | - Ramón Limón Ramírez
- Subdirección General de Evaluación de la Gestión Asistencial, Dirección General de Asistencia Sanitaria, Conselleria de Sanitat Universal i Salut Pública, Valencia, España
| | | | - Carmen Gómez Roldán
- Servicio de Nefrología, Hospital General Universitario de Albacete, Albacete, España
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15
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Kwong YD, Liu KD, Hsu RK, Johansen KL, McCulloch CE, Seth D, Fallahzadeh MK, Grimes BA, Ku E. Recovery of Kidney Function Among Patients With Glomerular Disease Starting Maintenance Dialysis. Am J Kidney Dis 2020; 77:303-305. [PMID: 32771649 DOI: 10.1053/j.ajkd.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Y Diana Kwong
- Division of Nephrology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA.
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA; Division of Critical Care Medicine, Department of Anesthesia, University of California at San Francisco School of Medicine, San Francisco, CA
| | - Raymond K Hsu
- Division of Nephrology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin Healthcare, University of Minnesota Minneapolis, MN; Department of Medicine, University of Minnesota Minneapolis, MN
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California at San Francisco School of Medicine, San Francisco, CA
| | - Divya Seth
- Division of Nephrology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA
| | - Mohammad Kazem Fallahzadeh
- Division of Nephrology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California at San Francisco School of Medicine, San Francisco, CA
| | - Elaine Ku
- Division of Nephrology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California at San Francisco School of Medicine, San Francisco, CA; Division of Pediatric Nephrology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA
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16
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Swai J, Zhao X, Noube JR, Ming G. Systematic review and meta-analysis of clinical outcomes comparison between different initial dialysis modalities in end-stage renal disease patients due to lupus nephritis prior to renal transplantation. BMC Nephrol 2020; 21:156. [PMID: 32357924 PMCID: PMC7195760 DOI: 10.1186/s12882-020-01811-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regarding lupus disease activity, morbidity and survival, limited literature concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial renal replacement therapies (RRT) prior to transplantation, in lupus nephritis end-stage renal disease (LN-ESRD) patients. This study was aimed to compare the risks of lupus flares, all-cause infections, all-cause cardiovascular events, and mortality, between hemodialysis versus peritoneal dialysis as initial RRT - modality before renal-transplant in LN-ESRD patients, by systematic review and meta-analysis. METHODS PubMed, EMBASE, and SCOPUS were searched for observational-studies comparing LN-ESRD -patients undergoing hemodialysis (Group1) versus peritoneal-dialysis (Group 2) prior to renal-transplantation, by their risks of lupus flare, all-cause infections, all-cause cardiovascular events, and mortality as outcome measures. Relative-Risks of outcomes between the groups measured overall effects at a 95% significance level. RevMan 5.3 computer software was used for analysis. RESULTS From search, 16 eligible studies reported 15,636 LN-ESRD -patients prior to renal transplantation with 4616 patients on hemodialysis, 2089 on peritoneal dialysis, 280 directly underwent kidney transplantation, 8319 were eliminated with reasons and 332 participants' details were not reported. Hemodialysis group had higher risk of all-cause cardiovascular events, Relative-Risk = 1.44 (Confidence Interval:1.02, 2.04), p-Value< 0.05. With regards to risks for mortality, flare and all-cause infections, there were trends that were not statistically significant (p-Value> 0.05). CONCLUSION Except for all-cause cardiovascular events in which peritoneal dialysis is superior to hemodialysis offering better outcomes, both treatment modalities offer more or less similar clinical outcomes as effective initial choices of RRT in LN-ESRD patients prior to renal transplant. THE PROTOCOL REGISTRATION PROSPERO 2019 CRD42019131600.
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Affiliation(s)
- Joel Swai
- Department of Nephrology and Rheumatology, Xiangya Third Hospital, Central South University, Changsha City, Hunan Province People’s Republic of China
- Department of Nephrology, Benjamin Mkapa Hospital, Dodoma City, Dodoma Region United Republic of Tanzania
| | - Xiexiong Zhao
- Department of Cardiology, Xiangya Third Hospital, Central South University, Changsha City, Hunan Province People’s Republic of China
| | - Julie-Raisa Noube
- Department of Gastroenterology, Xiangya Third Hospital, Central South University, Changsha City, Hunan Province People’s Republic of China
| | - Gui Ming
- Department of Nephrology and Rheumatology, Xiangya Third Hospital, Central South University, Changsha City, Hunan Province People’s Republic of China
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17
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Robert T, Jantzen R, Cambier A, Jamme M, Couchoud C, Brunet P, Gentile S, Rondeau E, Mesnard L, Lapidus N. Spatiotemporal trends and prognosis of end-stage renal disease patients with biopsy-proven immunoglobulin A nephropathy in France from 2010 to 2014. Clin Kidney J 2020; 14:898-908. [PMID: 33777373 PMCID: PMC7986328 DOI: 10.1093/ckj/sfaa029] [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: 10/22/2019] [Accepted: 01/28/2020] [Indexed: 12/01/2022] Open
Abstract
Background Although end-stage renal disease (ESRD) is frequently used as an outcome marker for primary immunoglobulin A nephropathy (IgAN), the clinical course after reaching ESRD is not well documented. This study examined patients’ characteristics and survival in ESRD-related biopsy-proven IgAN in France. Methods French Renal Epidemiology and Information Network Registry data from 2010 to 2014 were used to analyse patients’ survival and outcome in incident ESRD patients >16 years of age with biopsy-proven primary IgAN, in comparison with other primary and secondary glomerulonephritis (GN), adult polycystic kidney disease (ADPKD) or diabetes. Multivariable survival analysis was adjusted for age, sex, time on dialysis and comorbidities. Results Among 17 138 incident dialysis patients with ESRD, IgAN (242.8/10 000 dialysis initiation) represents the most common GN related to ESRD during 2010. IgAN patients were the youngest, and had the fewest comorbidities and the highest use of peritoneal dialysis (PD) (17%). In comparison with the haemodialysis group, hazard ratios for death were not different in the preemptive transplantation group [0.46, 95% confidence interval (CI) 0.17–1.28] and in the PD group (0.77, 95% CI 0.44–1.33). Mortality rates in IgAN patients with preemptive transplantation and in those receiving dialysis waiting for transplantation were 2.9% (95% CI 0.0–5.6) and 6.7% (95% CI 0.9–12.3). Mortality rates of ADPKD patients receiving dialysis waiting for transplantation were higher (18%, 95% CI 3.1–30.6). Conclusion IgAN has the best prognosis among primary and secondary GN. IgAN patients receiving dialysis waiting transplantation seem to have a more favourable prognosis than ADPKD patients, who usually comprise the reference population. The underlying reasons for the difference in access treatment modalities should be investigated to improve survival with respect to renal disease.
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Affiliation(s)
- Thomas Robert
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
| | - Rodolphe Jantzen
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Alexandra Cambier
- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - Matthieu Jamme
- Department of Intensive Care Nephrology, Transplantation Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université Paris, Paris, France
| | - Cecile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint-Denis la Plaine, France
| | - Philippe Brunet
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France.,REIN Registry, Agence de la Biomédecine, Saint-Denis la Plaine, France
| | - Stéphanie Gentile
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France.,REIN Registry, Agence de la Biomédecine, Saint-Denis la Plaine, France
| | - Eric Rondeau
- Department of Intensive Care Nephrology, Transplantation Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université Paris, Paris, France.,Université Pierre et Marie Curie, INSERM, IMR 1155, Hôpital Tenon, Paris, France
| | - Laurent Mesnard
- Department of Intensive Care Nephrology, Transplantation Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université Paris, Paris, France.,Université Pierre et Marie Curie, INSERM, IMR 1155, Hôpital Tenon, Paris, France
| | - Nathanael Lapidus
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Saint-Antoine Hospital, Paris, France
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18
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Xiao C, Xiao P, Li X, Huang G, Li H, Chen Y. Streptococcus may aggravate inflammatory damage in chronic nephritis via the chemotaxis of Th22 cells. Am J Transl Res 2019; 11:7432-7440. [PMID: 31934290 PMCID: PMC6943466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Infection can induce and aggravate chronic kidney disease (CKD), and the chemotaxis of Th22 cells may aggravate CKD. However, the mechanism underlying group A Streptococcus (GAS) infections in CKD through the chemotaxis of Th22 cells remains unknown. METHODS The experiment was divided into a normal control group, an IgAN model group, a GAS-treated normal group, a GAS-treated IgAN group and an anti-CCL intervention group. An IgA nephropathy model was established, and after the success of the IgA nephropathy model was confirmed, Streptococcus haemolyticus A was inoculated intranasally and compared with treatment with anti-CCL to detect changes in Th22 cells, related chemotaxis factors and kidney pathology before and after intervention. RESULTS An immunoglobulin A nephropathy model was successfully established. Streptococcus was successfully inoculated into the nasal cavity of the normal group and the IgA nephropathy infection control group. After intervention, pulmonary inflammatory cell infiltration was more obvious in the IgA nephropathy group than in the normal control group after Streptococcus infection. Th22 cells were detected more frequently in IgA nephropathy; after streptococcal infection, the percentage of Th22 cells in the IgAN group was higher than that in the normal group but decreased significantly when chemotaxis was blocked, the expression of CCL27, CCR10 and IL-22 declined simultaneously, and improvements in pathological changes were observed. CONCLUSION Streptococcus may cause the chemotaxis of Th22 cells to kidney tissue, leading to or aggravating nephritis injury.
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Affiliation(s)
- Chenggen Xiao
- Department of Emergency Medicine, Xiangya Hospital, Central South UniversityChangsha 410008, Hunan, China
| | - Ping Xiao
- Department of Emergency Medicine, Xiangya Hospital, Central South UniversityChangsha 410008, Hunan, China
| | - Xiaogang Li
- Department of Emergency Medicine, Xiangya Hospital, Central South UniversityChangsha 410008, Hunan, China
| | - Guoqing Huang
- Department of Emergency Medicine, Xiangya Hospital, Central South UniversityChangsha 410008, Hunan, China
| | - Hui Li
- Department of Respiratory Medicine, The First Hospital of ChangshaChangsha 410005, Hunan, China
| | - Yusa Chen
- Department of Emergency Medicine, Xiangya Hospital, Central South UniversityChangsha 410008, Hunan, China
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19
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Grossmann M, Tzschätzsch H, Lang ST, Guo J, Bruns A, Dürr M, Hoyer BF, Grittner U, Lerchbaumer M, Nguyen Trong M, Schultz M, Hamm B, Braun J, Sack I, Marticorena Garcia SR. US Time-Harmonic Elastography for the Early Detection of Glomerulonephritis. Radiology 2019; 292:676-684. [DOI: 10.1148/radiol.2019182574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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20
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Long-term outcomes of patients with end-stage kidney disease due to membranous nephropathy: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry. PLoS One 2019; 14:e0221531. [PMID: 31442267 PMCID: PMC6707602 DOI: 10.1371/journal.pone.0221531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/08/2019] [Indexed: 01/17/2023] Open
Abstract
Background Clinical outcomes of patients with end-stage kidney disease (ESKD) secondary to membranous nephropathy (MN) have not been well described. This study aimed to evaluate patient and/or allograft outcomes of dialysis or kidney transplantation in patients with ESKD secondary to MN. Material and methods All adult patients with ESKD commencing renal replacement therapy in Australia and New Zealand from January 1998 to December 2010 were extracted retrospectively from ANZDATA registry on 31st December 2013. Outcomes of MN were compared to other causes of ESKD. In a secondary analysis, outcomes of MN were compared to all patients with ESKD due to other forms of glomerulonephritis. Results Of 32,788 included patients, 417 (1.3%) had MN. Compared to other causes of ESKD, MN experienced lower mortality on dialysis (adjusted hazard ratio [aHR] 0.79, 95% CI 0.68–0.92, p = 0.002) and following kidney transplantation (aHR 0.57, 95% CI 0.33–0.97, p = 0.04), had a higher risk of death-censored kidney allograft failure (aHR 1.55, 95% CI: 1.00–2.41, p = 0.05) but comparable risk of overall kidney allograft failure (aHR 1.35, 95% CI 0.91–2.01, p = 0.13). Similar results were obtained using competing-risk regression analyses. MN patients were significantly more likely to receive a kidney transplant (aHR 1.38, 95% CI 1.16–1.63, p<0.001) and to experience primary kidney disease recurrence in the allograft (aHR 4.92, 95% CI 3.02–8.01, p<0.001). Compared to other forms of glomerulonephritis, MN experienced comparable dialysis and transplant patient survival, but higher rates of kidney transplantation, primary renal disease recurrence and death-censored allograft failure. Conclusion MN was associated with superior survival on dialysis and following kidney transplantation compared to patients with other causes of ESKD, and comparable patient survival compared to patients with other forms of glomerulonephritis. However, patients with MN exhibited a higher rate of death-censored allograft loss as a result of primary kidney disease recurrence.
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21
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Lim WH, Shingde M, Wong G. Recurrent and de novo Glomerulonephritis After Kidney Transplantation. Front Immunol 2019; 10:1944. [PMID: 31475005 PMCID: PMC6702954 DOI: 10.3389/fimmu.2019.01944] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
The prevalence, pathogenesis, predictors, and natural course of patients with recurrent glomerulonephritis (GN) occurring after kidney transplantation remains incompletely understood, including whether there are differences in the outcomes and advances in the treatment options of specific GN subtypes, including those with de novo GN. Consequently, the treatment options and approaches to recurrent disease are largely extrapolated from the general population, with responses to these treatments in those with recurrent or de novo GN post-transplantation poorly described. Given a greater understanding of the pathogenesis of GN and the development of novel treatment options, it is conceivable that these advances will result in an improved structure in the future management of patients with recurrent or de novo GN. This review focuses on the incidence, genetics, characteristics, clinical course, and risk of allograft failure of patients with recurrent or de novo GN after kidney transplantation, ascertaining potential disparities between “high risk” disease subtypes of IgA nephropathy, idiopathic membranous glomerulonephritis, focal segmental glomerulosclerosis, and membranoproliferative glomerulonephritis. We will examine in detail the management of patients with high risk GN, including the pre-transplant assessment, post-transplant monitoring, and the available treatment options for disease recurrence. Given the relative paucity of data of patients with recurrent and de novo GN after kidney transplantation, a global effort in collecting comprehensive in-depth data of patients with recurrent and de novo GN as well as novel trial design to test the efficacy of specific treatment strategy in large scale multicenter randomized controlled trials are essential to address the knowledge deficiency in this disease.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Meena Shingde
- NSW Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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22
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Giugliano D, De Nicola L, Maiorino MI, Bellastella G, Esposito K. Type 2 diabetes and the kidney: Insights from cardiovascular outcome trials. Diabetes Obes Metab 2019; 21:1790-1800. [PMID: 30969018 DOI: 10.1111/dom.13743] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/25/2019] [Accepted: 04/07/2019] [Indexed: 12/24/2022]
Abstract
Diabetic kidney disease (DKD) still remains a progressive condition that is associated with higher risk of end-stage kidney disease and significant cardiovascular morbidity and mortality. Twelve cardiovascular outcome trials in type 2 diabetes (T2D) have been published to date. Most trials with dipeptidyl-peptidase inhibitors (SAVOR-TIMI 53 with saxagliptin, EXAMINE with alogliptin, TECOS with sitagliptin, and CARMELINA with linagliptin) and with glucagon-like peptide-1 receptor agonists (GLP-1RAs) (ELIXA with lixisenatide, LEADER with liraglutide, SUSTAIN-6 with semaglutide, EXCSEL with exenatide once-weekly, and HARMONY with albiglutide) pointed towards reduced albuminuria, which is a surrogate endpoint possibly heralding renal function preservation. The three trials with sodium-glucose co-transporter-2 inhibitors (SGLT-2is) (empagliflozin, canagliflozin and dapagliflozin) also showed a salutary effect on long-term estimated glomerular filtration rate, suggesting that SGLT-2is are more effective at mitigating loss of kidney function than incretin-based therapies; moreover, SGLT-2is also have the advantage of plausible haemodynamic mechanisms for improved renal outcomes. Despite some residual limitations linked to differences in study populations and patient characteristics, the cardiorenal protective actions of SGLT-2is, and to a lesser extent some GLP-1RAs, make them favourable medications for patients with T2D at increased cardiorenal risk. There is room for optimism that their use may change the paradigm of the ineluctable progression of DKD.
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Affiliation(s)
- Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Luca De Nicola
- Division of Nephrology, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Maria Ida Maiorino
- Diabetes Division, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Diabetes Division, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
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23
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SGLT2 Inhibitors: Nephroprotective Efficacy and Side Effects. ACTA ACUST UNITED AC 2019; 55:medicina55060268. [PMID: 31212638 PMCID: PMC6630922 DOI: 10.3390/medicina55060268] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023]
Abstract
The burden of diabetic kidney disease (DKD) has increased worldwide in the last two decades. Besides the growth of diabetic population, the main contributors to this phenomenon are the absence of novel nephroprotective drugs and the limited efficacy of those currently available, that is, the inhibitors of renin-angiotensin system. Nephroprotection in DKD therefore remains a major unmet need. Three recent trials testing effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2-i) have produced great expectations on this therapy by consistently evidencing positive effects on hyperglycemia control, and more importantly, on the cardiovascular outcome of type 2 diabetes mellitus. Notably, these trials also disclosed nephroprotective effects when renal outcomes (glomerular filtration rate and albuminuria) were analyzed as secondary endpoints. On the other hand, the use of SGLT2-i can be potentially associated with some adverse effects. However, the balance between positive and negative effects is in favor of the former. The recent results of Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation Study and of other trials specifically testing these drugs in the population with chronic kidney disease, either diabetic or non-diabetic, do contribute to further improving our knowledge of these antihyperglycemic drugs. Here, we review the current state of the art of SGLT2-i by addressing all aspects of therapy, from the pathophysiological basis to clinical effectiveness.
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24
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Willey C, Kamat S, Stellhorn R, Blais J. Analysis of Nationwide Data to Determine the Incidence and Diagnosed Prevalence of Autosomal Dominant Polycystic Kidney Disease in the USA: 2013-2015. KIDNEY DISEASES (BASEL, SWITZERLAND) 2019; 5:107-117. [PMID: 31019924 PMCID: PMC6465773 DOI: 10.1159/000494923] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/29/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study addresses an important gap, as it is the first US nationwide, epidemiologic study of ADPKD incidence and prevalence. SUMMARY This 3-year, observational study utilized data from Truven Health MarketScan® administrative claims, as well as cross-sectional data from the National Ambulatory Medical Care Survey (NAMCS). We estimated the annual incidence and diagnosed prevalence using population-based data on over 170 million de-identified patients to provide the most current epidemiologic estimates available. The ADPKD-diagnosed prevalence was 4.3 per 10,000 in the NAMCS, which closely corresponded with age-adjusted rates from patients with either commercial insurance or employer-sponsored Medicare supplemental insurance. The annual incidence was 0.62 per 10,000. Both nationwide data sets indicate that approximately 140,000 patients are currently diagnosed in the USA. We also found significant differences by gender and age. Females are nearly twice as likely as males to be diagnosed in early adulthood, while the incidence in males was highest in those aged 65 years or older. ADPKD appears more likely to be diagnosed in men after disease progression or the development of chronic kidney disease. KEY MESSAGES Our results revealed striking age and gender differences in the incidence of ADPKD. Young women are diagnosed with ADPKD at nearly twice the rate of young men, perhaps due to the use of ultrasound in women during child-bearing years. This points to a need for increased recognition of ADPKD, with an emphasis on younger men in particular. ADPKD has been inaccurately perceived as a common condition based on misinterpretation of early epidemiologic data (1957) confirmed by our data and recent European data. ADPKD affects approximately 140,000 patients in the USA and meets the criterion for a rare disease. Our results indicate a need for further study of gender and ADPKD diagnosis, progression, management, and outcomes.
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Affiliation(s)
- Cynthia Willey
- Division of Health Outcomes, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Siddhesh Kamat
- Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey, USA
| | - Robert Stellhorn
- Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey, USA
| | - Jaime Blais
- Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey, USA
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25
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Bowman B, Abdel-Rahman EM. Cardiovascular outcomes in dialysis patients: one size does not fit all. Eur Heart J 2018; 40:899-901. [DOI: 10.1093/eurheartj/ehy544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brendan Bowman
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA
| | - Emaad M Abdel-Rahman
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA
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26
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Whatmough S, Fernandez S, Sweeney N, Howell L, Dhaygude A. Comparing outcomes of biopsy-proven anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis patients treated with cyclophosphamide in the 20th and 21st centuries: a 23-year study. Clin Kidney J 2018; 12:42-48. [PMID: 30746129 PMCID: PMC6366142 DOI: 10.1093/ckj/sfy084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/31/2018] [Indexed: 11/17/2022] Open
Abstract
Background Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is a multisystem autoimmune disorder associated with significant morbidity and mortality. Approximately 80–90% of patients have circulating ANCAs. Long-term outcomes appear to be improving. This retrospective study analyses the incidence and patient outcomes over a period of 23 years at a single tertiary centre. Methods Outcomes of patients diagnosed with AAV between 1 January 1988 and 31 December 2010 were collected retrospectively. Data including patient demographics, age of diagnosis, dates of starting renal replacement therapy, death and biochemistry results were collected. Patients were divided into two cohorts (1988–99 and 2000–10) and analysed using Stata software (StataCorp, College Station, TX, USA). Results A complete dataset was obtained for 273 patients. Of these patients, 101 were diagnosed between 1988 and 1999 while 172 were diagnosed between 2000 and 2010. The number of patients diagnosed with AAV increased from 2.2/million in 1988 to 10.3/million in 2010. A higher proportion of patients (56.4%) in the earlier cohort presented with creatinine >500 μmol/L compared with the later cohort (30.2%; P < 0.001). Overall patient survival improved significantly between the two cohorts. Cohort 1 had a median survival of 59 months compared with 125 months for Cohort 2 (P = 0.003). Conclusions This study shows that AAV is being diagnosed at an earlier stage, resulting in improved outcomes. This may be because of improvements in the management of AAV and chronic kidney disease.
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Affiliation(s)
| | | | - Niamh Sweeney
- Renal Department, Royal Preston Hospital, Preston, UK
| | - Laura Howell
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Ajay Dhaygude
- Renal Department, Royal Preston Hospital, Preston, UK
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27
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Chávez-Mendoza CA, Niño-Cruz JA, Correa-Rotter R, Uribe-Uribe NO, Mejía-Vilet JM. Calcineurin Inhibitors With Reduced-Dose Steroids as First-Line Therapy for Focal Segmental Glomerulosclerosis. Kidney Int Rep 2018; 4:40-47. [PMID: 30596167 PMCID: PMC6308907 DOI: 10.1016/j.ekir.2018.08.010] [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: 05/19/2018] [Revised: 08/10/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction High-dose corticosteroids remain the first-line therapy for focal and segmental glomerulosclerosis (FSGS), whereas calcineurin inhibitors (CNIs) are reserved for those patients resistant to corticosteroid therapy. Methods This is a retrospective cohort analysis in patients with primary FSGS diagnosed between 2007 and 2014. According to the administered treatment, patients were segregated into 3 groups: high-dose prednisone, first-line CNIs plus low-dose prednisone, and rescue CNIs. Cumulative corticosteroid doses were compared as well as response to therapy and long-term renal survival by Cox regression analysis. Results A total of 66 patients were included (39 treated with high-dose prednisone, 11 treated with first-line CNI, 16 treated with high-dose prednisone followed by rescue CNI). Cumulative doses of prednisone in the high-dose group were 9.3 g (interquartile range [IQR] = 7.5−12.5 g), compared to 2.5 g (IQR = 1.82−3.12 g) in the first-line CNI plus low-dose corticosteroid group and 13.8 g (IQR = 9.2−15.8 g) rescue CNI groups, respectively (P < 0.001). Time under corticosteroid management was also higher in the high-dose prednisone group compared to the first-line CNI group. There was a response to treatment in 76.9%, 72.7%, and 87.5% of high-dose prednisone, first-line CNI and rescue CNI groups, with complete remission in 48.7%, 36.4%, and 31.3% respectively. There was no difference in relapse incidence after treatment (48.4%, 44.4%, and 46.7%) or in 5-year renal survival (87.2%, 81.8%, and 87.5%). Baseline proteinuria, biopsy chronicity score, and response to therapy were independent predictors of renal survival. Conclusion An initial CNI plus low-dose corticosteroid approach in primary FSGS reduces corticosteroid exposure with a response-to-therapy rate similar to that of the currently recommended high-dose corticosteroid regimen. These findings justify a randomized trial to formally test this hypothesis.
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Affiliation(s)
- Carlos Adrián Chávez-Mendoza
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Antonio Niño-Cruz
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Norma Ofelia Uribe-Uribe
- Department of Pathology and Pathologic Anatomy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Manuel Mejía-Vilet
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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28
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O’Shaughnessy MM, Liu S, Montez-Rath ME, Lafayette RA, Winkelmayer WC. Cause of kidney disease and cardiovascular events in a national cohort of US patients with end-stage renal disease on dialysis: a retrospective analysis. Eur Heart J 2018; 40:887-898. [DOI: 10.1093/eurheartj/ehy422] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michelle M O’Shaughnessy
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Sai Liu
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Richard A Lafayette
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA, USA
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, One Baylor Plaza, ABBR R705, Houston, TX, USA
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Huang J, Lin L, Xie J, Li X, Shen P, Pan X, Ren H, Chen N. Glucocorticoids in the treatment of patients with primary focal segmental glomerulosclerosis and moderate proteinuria. Clin Exp Nephrol 2018; 22:1315-1323. [PMID: 29761241 DOI: 10.1007/s10157-018-1585-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/26/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND To compare the efficacy of glucocorticoids in primary focal segmental glomerulosclerosis (pFSGS) patients with moderate proteinuria. Registered at http://www.chictr.org.cn/ , study No. ChiCTR-OPN-17012789. METHODS pFSGS patients with urine protein between 1.0 and 3.5 g/24 h were recruited from 2006 to 2016. No decline in urine protein > 50% was observed after 2 months of run-in angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARB) treatment. Patients were assigned to study group (glucocorticoids with ACEI/ARB) or control group (ACEI/ARB without glucocorticoids). Variables including 24-h urinary protein, serum albumin and serum creatinine during the trial were recorded. Remission was defined as proteinuria < 0.3 g/24 h or declined > 50%, and our composite end point as > 30% decrease of eGFR or eGFR < 30 ml/min. RESULTS A total of 102 patients were enrolled (study group N = 52, control group N = 50), and the median follow-up time was 36 (12-117) months without significant difference between groups. During the 12-month follow-up, the remission rate was significantly higher in study group [73.1 vs 50.0% (P = 0.01)], and the initial median response time was 3 months in the study group while 6 in the control group. The end point was reached by 22.2% cases in study group, and 42.0% in control. The medium survival times were study group 72 months and control 57 (P = 0.03). Minor adverse reactions were observed in 10 patients (study group N = 8, control group N = 2). CONCLUSIONS Additional glucocorticoids therapy is more efficacious compared to ACEI/ARB alone in the treatment of patients with pFSGS and moderate proteinuria.
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Affiliation(s)
- Jianni Huang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Li Lin
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jingyuan Xie
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Xiao Li
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Pingyan Shen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Xiaoxia Pan
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hong Ren
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
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30
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Wallace ZS, Wallwork R, Zhang Y, Lu N, Cortazar F, Niles JL, Heher E, Stone JH, Choi HK. Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System. Ann Rheum Dis 2018; 77:1333-1338. [PMID: 29760156 DOI: 10.1136/annrheumdis-2018-213452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Renal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown. METHODS We identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure. RESULTS During the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06-0.16). DISCUSSION Renal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.
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Affiliation(s)
- Zachary S Wallace
- Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Wallwork
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yuqing Zhang
- Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Na Lu
- Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Frank Cortazar
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Renal Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - John L Niles
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Renal Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eliot Heher
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - John H Stone
- Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hyon K Choi
- Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Sim JJ, Bhandari SK, Batech M, Hever A, Harrison TN, Shu YH, Kujubu DA, Jonelis TY, Kanter MH, Jacobsen SJ. End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population. Mayo Clin Proc 2018; 93:167-178. [PMID: 29395351 DOI: 10.1016/j.mayocp.2017.10.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population. PATIENTS AND METHODS A retrospective cohort study (between January 1, 2000, and December 31, 2011) of patients with glomerulonephropathy using the electronic health record of an integrated health system was performed. Estimated glomerular filtration rate (eGFR) change, incident ESRD, and mortality were compared among patients with biopsy-proven focal segmental glomerulosclerosis (FSGS), membranous glomerulonephritis (MN), minimal change disease (MCD), immunoglobulin A nephropathy (IgAN), and lupus nephritis (LN). Competing risk models were used to estimate hazard ratios for different glomerulonephropathies for incident ESRD, with mortality as a competing outcome after adjusting for potential confounders. RESULTS Of the 2350 patients with glomerulonephropathy (208 patients [9%] younger than 18 years) with a mean follow-up of 4.5±3.6 years, 497 (21%) progressed to ESRD and 195 (8%) died before ESRD. The median eGFR decline was 1.0 mL/min per 1.73 m2 per year but varied across different glomerulonephropathies (P<.001). The highest ESRD incidence (per 100 person-years) was observed in FSGS 8.72 (95% CI, 3.93-16.72) followed by IgAN (4.54; 95% CI, 1.37-11.02), LN (2.38; 95% CI, 0.37-7.82), MN (2.15; 95% CI, 0.29-7.46), and MCD (1.67; 95% CI, 0.15-6.69). Compared with MCD, hazard ratios (95% CIs) for incident ESRD were 3.43 (2.32-5.08) and 2.35 (1.46-3.81), 1.28 (0.79-2.07), and 1.02 (0.62-1.68) for FSGS, IgAN, LN, and MN, respectively. No significant association between glomerulonephropathy types and mortality was detected (P=.24). CONCLUSION Our findings from a real-world clinical environment revealed significant differences in eGFR decline and ESRD risk among patients with 5 glomerulonephropathies. These variations in presentation and outcomes warrant different management strategies and expectations.
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Affiliation(s)
- John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
| | - Simran K Bhandari
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Michael Batech
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Aviv Hever
- Department of Renal Pathology, Kaiser Permanente Southern California, Pasadena, CA
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Yu-Hsiang Shu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Dean A Kujubu
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Tracy Y Jonelis
- Division of Nephrology and Hypertension, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Michael H Kanter
- Regional Quality and Clinical Analysis, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Pasadena, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Gipson DS, Selewski DT, Massengill SF, Modes MM, Desmond H, Lee L, Kamil E, Elliott MR, Adler SG, Oh G, Lafayette RA, Gipson PE, Sinha A, Bagga A, Pesenson A, Courtlandt C, Spino C, Eikstadt R, Pitter R, Attalla S, Waldo A, Winneker R, Carlozzi NE, Troost JP, Smokler I, Stone M. NephCure Accelerating Cures Institute: A Multidisciplinary Consortium to Improve Care for Nephrotic Syndrome. Kidney Int Rep 2017; 3:439-446. [PMID: 29725648 PMCID: PMC5932133 DOI: 10.1016/j.ekir.2017.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction NephCure Accelerating Cures Institute (NACI) is a collaborative organization sponsored by NephCure Kidney International and the University of Michigan. The Institute is composed of 7 cores designed to improve treatment options and outcomes for patients with glomerular disease: Clinical Trials Network, Data Warehouse, Patient-Reported Outcomes (PRO) and Endpoints Consortium, Clinical Trials Consulting Team, Quality Initiatives, Education and Engagement, and Data Coordinating Center. Methods The Trials Network includes 22 community- and hospital-based nephrology practices, 14 of which are trial-only sites. Eight sites participate in the NACI Registry, and as of October 2017, 1054 patients are enrolled with diagnoses including but not limited to focal segmental glomerulosclerosis, minimal change disease, membranous nephropathy, IgA nephropathy, and childhood-onset nephrotic syndrome. By using electronic health record data extraction, robust and efficient clinical data are captured while minimizing the burden to site-based network staff. Results The Data Warehouse includes her-extracted data from registry patients, PRO development data, and data from completed observational studies and clinical trials. The Clinical Trial Consulting Team provides support for trial design in rare diseases leveraging these data. The PRO and Endpoints Consortium develops shorter-term endpoints while capturing the patient-reported significance of interventions under study. The Quality Initiatives and Education/Engagement cores elevate the level of care for patients. The Data Coordinating Center manages the analysis and operations of the Institute. Conclusion By engaging with patients, academia, industry, and patient advocate community representatives, including our Patient Advisory Board, NACI strives for better outcomes and treatments using evidence-based support for clinical trial design.
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Affiliation(s)
- Debbie S Gipson
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - David T Selewski
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan F Massengill
- Division of Pediatric Nephrology, Levine Children's Hospital, Charlotte, North Carolina, USA
| | | | - Hailey Desmond
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren Lee
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
| | - Elaine Kamil
- Division of Pediatric Nephrology, Department of Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at The University of California, Los Angeles, Los Angeles, California, USA
| | | | - Sharon G Adler
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - Gia Oh
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Richard A Lafayette
- Division of Nephrology and Hypertension, Stanford University, Stanford, California, USA
| | - Patrick E Gipson
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | - Cheryl Courtlandt
- Division of Pediatric Nephrology, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Cathie Spino
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Eikstadt
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Renée Pitter
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Samara Attalla
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne Waldo
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Winneker
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan P Troost
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Irving Smokler
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
| | - Mark Stone
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
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Breyer MD, Kretzler M. Novel avenues for drug discovery in diabetic kidney disease. Expert Opin Drug Discov 2017; 13:65-74. [DOI: 10.1080/17460441.2018.1398731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Matthew D. Breyer
- Lead Generation, Biotechnology Discovery Research, Eli Lilly and Company, Indianapolis, IN, USA
| | - Matthias Kretzler
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin Sci (Lond) 2017; 130:1147-63. [PMID: 27252402 DOI: 10.1042/cs20160047] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/29/2016] [Indexed: 01/04/2023]
Abstract
Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care. In each case we critically consider whether apparent discrepancies are likely to be explained by biological or psycho-socioeconomic factors. In some cases (a few), these findings have resulted in the discovery of disease pathways and/or therapeutic opportunities for improvement. In most cases, they have been reported as merely anecdotal findings. The aim of the present review is to expose some of the stimulating hypotheses arising from these observations as a preamble for stricter approaches using gender for the prevention and treatment of CKD and its complications.
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Abstract
SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients. This review highlights recent updates in our understanding of disease epidemiology, genetics, pathogenesis, and treatment in an effort to establish a framework for lupus nephritis management that is patient-specific and oriented toward maintaining long-term kidney function in patients with lupus.
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Affiliation(s)
- Salem Almaani
- Department of Internal Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
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Avasare RS, Rosenstiel PE, Zaky ZS, Tsapepas DS, Appel GB, Markowitz GS, Bomback AS, Canetta PA. Predicting Post-Transplant Recurrence of IgA Nephropathy: The Importance of Crescents. Am J Nephrol 2017; 45:99-106. [PMID: 28056461 DOI: 10.1159/000453081] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Most studies that have assessed the predictors of recurrent IgA nephropathy (IgAN) in the renal allograft have focused on post-transplant features. Identifying high-risk pre-transplant features of IgAN is useful for counseling patients and may help in tailoring post-transplant immunosuppression. METHODS We investigated the pre-transplant clinical and biopsy features of 62 patients with IgAN who received transplants at Columbia University Medical Center from 2001 to 2012 and compared the characteristics and outcomes of patients with IgAN recurrence to those without recurrence. The primary outcome was time to recurrent IgAN. Secondary outcomes were a composite of doubling of creatinine or allograft failure, and recurrent IgAN as a cause of allograft dysfunction. RESULTS Of the 62 patients, 14 had recurrent IgAN in the allograft. Mean time to recurrence was 2.75 years. Those with recurrent disease were younger at the time of native kidney biopsy (29 vs. 41 years, p < 0.0009). Black race and Hispanic ethnicity composed a higher proportion of the recurrent disease group. On multivariable analysis, significant predictors of recurrent IgAN included age at diagnosis (hazards ratio (HR) 0.911, 95% CI 0.85-0.98), burden of crescents on native biopsy (HR 1.21 per 10% increase in crescents, 95% CI 1.00-1.47) and allograft rejection (HR 3.59, 95% CI 1.10-11.7). CONCLUSIONS Features of native IgAN can help predict the risk of recurrent disease in the renal allograft. In particular, immunologically active disease represented by earlier age of onset and greater burden of crescents on native biopsy is more likely to recur after transplant.
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Affiliation(s)
- Rupali S Avasare
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N.Y., USA
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Abstract
Chronic kidney disease (CKD) is a lethal and rapidly increasing burden on society. Despite this, there are relatively few therapies in development for the treatment of CKD. Several recent costly phase 3 trials have failed to provide improved renal outcomes, diminishing interest in pharmaceutical investment. Furthermore, poor patient, physician, and payer awareness of CKD as a diagnosis has contributed to slow trial enrollment and successful implementation of these trials. Nevertheless, several therapeutics remain in development for the treatment of CKD, including mineralocorticoid-receptor antagonists, sodium/glucose cotransporter 2 inhibitors, anti-inflammatory drugs, and drugs that mitigate oxidative injury. Success of future CKD therapeutic trials will depend not only on improved understanding of disease pathogenesis, but also on improved trial enrollment rates, through increasing awareness of this disease by the public, policy makers, and the greater medical community.
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Affiliation(s)
- Matthew D Breyer
- Biotechnology Discovery Research, Eli Lilly and Company, Indianapolis, IN.
| | - Katalin Susztak
- Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
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Bagchi S, Agarwal S, Kalaivani M, Bhowmik D, Singh G, Mahajan S, Dinda A. Primary FSGS in Nephrotic Adults: Clinical Profile, Response to Immunosuppression and Outcome. Nephron Clin Pract 2016; 132:81-5. [DOI: 10.1159/000442999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/01/2015] [Indexed: 01/10/2023] Open
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O'Shaughnessy MM, Montez-Rath ME, Zheng Y, Lafayette RA, Winkelmayer WC. Differences in Initial Hemodialysis Vascular Access Use Among Glomerulonephritis Subtypes in the United States. Am J Kidney Dis 2016; 67:638-47. [PMID: 26774466 DOI: 10.1053/j.ajkd.2015.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/19/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The type of vascular access used for hemodialysis affects patient morbidity and mortality. Whether vascular access types differ by glomerulonephritis (GN) subtype in the US hemodialysis population has not been investigated. STUDY DESIGN Cross-sectional observational study. SETTING & PARTICIPANTS We identified all adult (aged ≥ 18 years) patients within the US Renal Data System who initiated hemodialysis therapy from July 2005 through December 2011 with a diagnosis of end-stage renal disease attributed to any of 4 primary (focal segmental glomerulosclerosis, immunoglobulin A nephropathy [reference group], membranous nephropathy, and membranoproliferative GN) or 2 secondary (lupus nephritis and vasculitis) GN subtypes. PREDICTOR GN subtype. OUTCOMES ORs with 95% CIs for arteriovenous fistula versus central venous catheter (CVC) use and for arteriovenous graft versus CVC use were computed using multinomial logistic regression, with adjustment for demographic, socioeconomic, comorbidity, and duration of nephrology care covariates. RESULTS Among 29,015 patients, CVC use at initiation of hemodialysis therapy was substantially higher in patients with lupus nephritis (89.2%) or vasculitis (91.2%) compared with patients with primary GN subtypes (72.7%-79.8%). After adjustment and compared with patients with immunoglobulin A nephropathy, patients with lupus nephritis or vasculitis were as likely to have used an arteriovenous graft (ORs of 0.94 [95% CI, 0.70-1.27] and 0.80 [95% CI, 0.56-1.13], respectively) but significantly less likely to have used an arteriovenous fistula (ORs of 0.66 [95% CI, 0.57-0.76] and 0.54 [95% CI, 0.45-0.63], respectively), whereas patients with any comparator primary GN subtype were at least as likely to have used either of these 2 access types. LIMITATIONS Potential misclassification of exposure; residual confounding by unmeasured covariates; inability to determine causes of observed associations; lacking longitudinal data for vascular access use. CONCLUSIONS Significant differences in vascular access distributions at initiation of hemodialysis therapy are apparent among GN subtypes. The unacceptably high use of CVCs in patients with lupus nephritis and vasculitis is particularly concerning. Further studies are needed to identify any potentially modifiable factors underlying these findings.
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Affiliation(s)
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA
| | - Yuanchao Zheng
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA
| | - Richard A Lafayette
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX
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O'Shaughnessy MM, Montez-Rath ME, Lafayette RA, Winkelmayer WC. Differences in initial treatment modality for end-stage renal disease among glomerulonephritis subtypes in the USA. Nephrol Dial Transplant 2015; 31:290-8. [PMID: 26610594 DOI: 10.1093/ndt/gfv386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/12/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD), while peritoneal dialysis affords certain benefits over hemodialysis. Distributions and determinants of first ESRD treatment modality have not been compared across glomerulonephritis (GN) subtypes. METHODS We identified all adult (18-75 years) patients with ESRD attributed to any of six GN subtypes [focal segmental glomerulosclerosis (FSGS), IgA nephropathy (IgAN), membranous nephropathy (MN), membranoproliferative GN (MPGN), lupus nephritis (LN) and vasculitis] who were first registered in the US Renal Data System (USRDS) between 1996 and 2011. We used multinomial logistic regression--adjusting for temporal, geographic, demographic, socioeconomic and comorbid factors--to determine odds ratios (ORs) with 95% confidence intervals (CIs) for transplantation versus hemodialysis, and for peritoneal dialysis versus hemodialysis, comparing other GN subtypes to IgAN. RESULTS Among the 75 278 patients studied, patients with comparator GN subtypes were significantly less likely than those with IgAN to receive either transplantation or peritoneal dialysis. After adjusting for potentially confounding covariates, patients with comparator primary GN subtypes (FSGS, MN, MPGN) were at least as likely to receive transplantation [FSGS OR 0.98 (95% CI 0.93-1.15), MN OR 1.19 (95% CI 1.01-1.39), MPGN OR 1.08 (95% CI 0.93-1.26)] or peritoneal dialysis [FSGS OR 1.05 (95% CI 0.98-1.12), MN OR 1.30 (95% CI 1.18-1.43), MPGN OR 0.95 (95% CI 0.85-1.06)] as patients with IgAN. Conversely, patients with the secondary GN subtypes LN and vasculitis remained significantly less likely to receive either modality [transplantation OR 0.49 (95% CI 0.43-0.56) for LN and 0.27 (95% CI 0.22-0.34) for vasculitis, peritoneal dialysis OR 0.76 (95% CI 0.70-0.82) for LN and 0.54 (95% CI 0.48-0.60) for vasculitis]. CONCLUSIONS Significant differences in ESRD treatment practice patterns are apparent among GN subtypes. To ensure equitable care for all patients, regardless of GN subtype, reasons for observed disparities should be elucidated and-if appropriate-eliminated.
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Affiliation(s)
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Richard A Lafayette
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX, USA
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Garofalo C, Borrelli S, Pacilio M, Minutolo R, Chiodini P, De Nicola L, Conte G. Hypertension and Prehypertension and Prediction of Development of Decreased Estimated GFR in the General Population: A Meta-analysis of Cohort Studies. Am J Kidney Dis 2015; 67:89-97. [PMID: 26475392 DOI: 10.1053/j.ajkd.2015.08.027] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/08/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Whether blood pressure (BP) plays an independent predictive role in the onset of decreased glomerular filtration rate (GFR) remains ill-defined because existing meta-analyses have incorporated data from studies that included individuals with low GFRs at baseline. This question is critical to optimize chronic kidney disease prevention in the general population. STUDY DESIGN Systematic review and meta-analysis of longitudinal cohort studies. SETTING & POPULATION Adults from general population. SELECTION CRITERIA FOR STUDIES We identified in PubMed, EMBASE, and the Cochrane Library database all cohort studies evaluating the role of BP in the incidence of decreased estimated GFR (eGFR; defined as eGFR<60 mL/min/1.73 m2) in individuals without decreased kidney function at baseline. PREDICTORS Hypertension (BP>140/90 mmHg), prehypertension (systolic BP of 120-139 and/or diastolic BP of 80-89 mmHg), and BP as a continuous variable. OUTCOMES Risk for decreased eGFR reported as relative risk (RR) and 95% CI. Heterogeneity (I2) was also evaluated. RESULTS Data from 16 cohorts (315,321 participants) were analyzed. All studies had a Newcastle-Ottawa score in the range of 6 to 8, denoting high quality. During a mean follow-up of 6.5 years, decreased eGFR occurred in 6.6% of participants. The presence of prehypertension and hypertension increased renal risk (RRs of 1.19 [95% CI, 1.07-1.33; I2=23.8%] and 1.76 [95% CI, 1.58-1.97; I2=37.7%], respectively). Similarly, we found that every 10-mm Hg increase in systolic and diastolic BPs associated with higher risk for decreased eGFR (RRs of 1.08 [95% CI, 1.04-1.11; I2=60.0%] and 1.12 [95% CI, 1.04-1.20; I2=51.4%], respectively). Metaregression analysis showed greater risk with older age (P=0.03), whereas other covariates were not significant. LIMITATIONS No individual patient-level data. CONCLUSIONS Prehypertension and hypertension, as BP levels, are independent predictors of decreased GFR in the general population, with the effect being more pronounced in the elderly. These findings are important for improving risk stratification in the general population.
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Affiliation(s)
- Carlo Garofalo
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Silvio Borrelli
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Mario Pacilio
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Roberto Minutolo
- Division of Nephrology, Second University of Naples, Naples, Italy.
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, Naples, Italy
| | - Luca De Nicola
- Division of Nephrology, Second University of Naples, Naples, Italy
| | - Giuseppe Conte
- Division of Nephrology, Second University of Naples, Naples, Italy
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Affiliation(s)
- Eric W Young
- Division of Nephrology, Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School, Ann Arbor, Michigan
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