Gender and Renal Insufficiency: Opportunities for Their Therapeutic Management?

Urban-Rural Differences in Acute Kidney Injury Mortality in the United States

INTRODUCTION

Acute kidney injury (AKI) is associated with increased mortality. AKI-related mortality trends by U.S. urban and rural counties were assessed.

METHODS

In the cross-sectional study, based on the Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) Multiple Cause of Death data, age-standardized mortality with AKI as the multiple cause was obtained among adults aged ≥25 years from 2001-2020, by age, sex, race and ethnicity, stratified by urban-rural counties. Joinpoint regressions were used to assess trends from 2001-2019 in AKI-related mortality rate. Pairwise comparison was used to compare mean differences in mortality between urban and rural counties from 2001-2019.

RESULTS

From 2001-2020, age-standardized AKI-related mortality was consistently higher in rural than urban counties. AKI-related mortality (per 100,000 population) increased from 18.95 in 2001 to 29.46 in 2020 in urban counties and from 20.10 in 2001 to 38.24 in 2020 in rural counties. In urban counties, AKI-related mortality increased annually by 4.6% during 2001-2009 and decreased annually by 1.8% until 2019 (p<0.001). In rural counties, AKI-related mortality increased annually by 5.0% during 2001-2011 and decreased by 1.2% until 2019 (p<0.01). The overall urban-rural difference in AKI-related mortality was greater after 2009-2011. AKI-related mortality was significantly higher among older adults, men, and non-Hispanic Black adults than their counterparts in both urban and rural counties. Higher mortality was concentrated in rural counties in the Southern United States.

CONCLUSIONS

Multidisciplinary efforts are needed to increase AKI awareness and implement strategies to reduce AKI-related mortality in rural and high-risk populations.

An early warning model for predicting major adverse kidney events within 30 days in acute pancreatitis patients

BACKGROUND

Renal impairment is a common outcome of acute pancreatitis. Nevertheless, research on predictive models for major adverse kidney events within 30 days (MAKE30) in acute pancreatitis (AP) has been scarce.

METHODS

A retrospective study was conducted at Gansu Provincial Hospital, involving 391 patients with acute pancreatitis who were categorized into non-MAKE30 (320 cases) and MAKE30 (71 cases) groups. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for MAKE30 in the aforementioned patient cohort. The nomogram was developed utilizing findings from a multivariate logistic regression analysis. Subsequent evaluation of the nomogram involved the use of receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. Additionally, subgroup analyses were performed to different AP etiology and assess secondary outcomes.

RESULTS

Gender, respiratory rate (RR), creatinine (Cr), interleukin 6 (IL-6), prothrombin time (PT), and cardiovascular disease (CVD) were identified as associated predictors of Major Adverse Kidney Events within 30 days (MAKE30) in patients with acute pancreatitis. A nomogram model was developed based on these predictors. Evaluation using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses (DCA) demonstrated that the nomogram model exhibited significant discrimination (AUC = 0.842) > the SOFA score (AUC = 0.809), excellent calibration, and substantial clinical utility. Subgroup analysis showed the nomogram model provided good predictive value for both secondary outcomes and various etiologies.

CONCLUSION

This model shows promise in efficiently and accurately evaluating the risk of developing MAKE30 in acute pancreatitis patients within the first 24 h of hospitalization.

Oxindole derivatives alleviate paracetamol-induced nephrotoxicity and hepatotoxicity: biochemical, histological, and computational expressions

Oxindole is a nature-derived heteroaromatic nucleus with a history of preclinical uses in various conditions. In this study, oxindole derivatives, 6-chloro-3-(3-hydroxybenzylidene) indolin-2-one (3OH) and 6-chloro-3-(4-hydroxybenzylidene) indolin-2-one (4OH) were evaluated for nephroprotective and hepatoprotective effects. Paracetamol-induced nephrotoxicity and hepatotoxicity model was used in mice. Tissue histology and serum biochemistry were carried out to further support in vivo activity. Compound 3OH reduced serum urea and creatinine levels by 51.8% and 64.6%, respectively (p < 0.0001). Excretion of creatinine by 3OH 10 mg was 52.8% as compared to silymarin. In case of urinary excretion of urea, the significant rise in excretion was observed in 4OH 15 mg (30.4%; p < 0.05) and 3OH 10 mg group (29.24%; p < 0.05). The compound 3OH exhibited restorative pattern of the renal tissues with slight inflammatory infiltrations. In case of hepatoprotective activity, 3OH reduced (59.9%; p < 0.0001) serum ALT at 5 mg even more than silymarin and all other doses of oxindole derivatives. In case of serum AST, all treatment groups produced significant (p < 0.0001) reduction except 3OH 15 mg. Computational studies supported the results as both derivatives were found to have promising interactions with enzymes at lower binding energies. Compound 3OH which possesses a hydroxyl group based on aromatic ring at meta position was the most successful drug candidate throughout this study. In a nutshell, the selected compounds elicited significant nephroprotective and hepatoprotective-like effects in mice.

Ramadan fasting and exercise combination therapy: A novel approach for osteoporosis prevention in ovariectomized rats

Background

Osteoporosis is a chronic bone metabolic disease that affects millions of people worldwide, particularly the elderly and postmenopausal women. It is characterized by weakened bones, increasing the risk of fractures and leading to significant morbidity and mortality. The goal of the current study is to examine the reported osteo-preservative effects of exercise and/or fasting in the Ramadan fasting model (RFM) in ovariectomized (OVX) rats.

Methods

The experimental intervention started 1 month following the ovariectomy procedure and consisted of five 15-min exercise sessions per week at 18-25 m/min and/or an approximately 13-h fast from sunrise to sunset (6:00 AM-19:00 PM). Serum bone metabolism biomarker levels were measured, and mineral concentrations in femoral ashed bones and digested serum were determined. Additionally, serum bone alkaline phosphatase (b-ALP), parathyroid hormone, osteocalcin, calcitonin, and vitamin D3 concentrations were measured using the competitive enzyme immunoassay technique.

Results

Calcium, magnesium, and phosphorus showed a notable decrease in mineral concentration among OVX rat femurs compared with the combination group (OVX + RFM + E) and control groups. In addition, homeostasis of serum concentrations of calcium, magnesium, and phosphorus was observed to increase in the OVX + RFM + E group rather than in the OVX group without intervention when compared with a control group. Furthermore, fasting and exercise, either alone or concurrently with ovariectomy, induced a non-significant elevation in osteocalcin, parathyroid hormone, and vitamin D3, whereas b-ALP and calcitonin increased significantly compared with those in control rats.

Conclusion

The combination of the Ramadan fasting model and moderate intensity exercises among OVX rats manifested advantageous effects in bone biomarkers compared with OVX rats without intervention. This could be recommended as a lifestyle modification that is protective against osteoporosis, especially in the context of depleted estrogen hormone after menopause.

Sex-related differences in SIRT3-mediated mitochondrial dynamics in renal ischemia/reperfusion injury

The prevalence of renal ischemia/reperfusion injury (IRI) in premenopausal women is considerably lower than that in age-matched men. This suggests that sex-related differences in mitochondrial function and homeostasis may contribute to sexual dimorphism in renal injury, though the mechanism remains unclear. Mouse model of unilateral left renal IRI with contralateral kidney enucleation, Ovariectomy in female mice, and a human embryonic kidney (HEK) cell model of hypoxia-reoxygenation were used to study how estrogen affects the sexual dimorphism of renal IRI through SIRT3 in vitro and in vivo, respectively. Here, we demonstrate differential expression of renal SIRT3 may induce sexual dimorphism in IRI using the renal IRI model. Higher SIRT3 level in female mice was associated with E2-induced protection of renal tubular epithelium, reduced mitochondrial reactive oxygen species (ROS), and IRI resistance. In hypoxia-reoxygenated HEK cells, SIRT3 knockdown increased oxidative stress, shifted the interconnected mitochondrial network toward fission, exacerbated hypoxia/reoxygenation-induced endoplasmic reticulum stress (ERS), and abolished the protective effects of E2 on IRI. Mechanistically, the SIRT3 level is E2-dependent and that E2 increases the SIRT3 protein level via estrogen receptor. SIRT3 targeted an i-AAA protease, yeast mitochondrial AAA metalloprotease (YME1L1), and hydrolyzed long optic atrophy 1 (L-OPA) to short-OPA1 (S-OPA1) by deacetylating YME1L1, regulating mitochondrial dynamics toward fusion to reduce oxidative stress and ERS. These findings explored the mechanism by how estrogen alleviates renal IRI and providing a basis for potential therapeutic interventions targeting SIRT3.

Understanding the Role of Sex Hormones in Cardiovascular Kidney Metabolic Syndrome: Toward Personalized Therapeutic Approaches

Cardiovascular kidney metabolic (CKM) syndrome represents a complex interplay of cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic comorbidities, posing a significant public health challenge. Gender exerts a critical influence on CKM syndrome, affecting the disease severity and onset through intricate interactions involving sex hormones and key physiological pathways such as the renin-angiotensin system, oxidative stress, inflammation, vascular disease and insulin resistance. It is widely known that beyond the contribution of traditional risk factors, men and women exhibit significant differences in CKM syndrome and its components, with distinct patterns observed in premenopausal women and postmenopausal women compared to men. Despite women generally experiencing a lower incidence of CVD, their outcomes following cardiovascular events are often worse compared to men. The disparities also extend to the treatment approaches for kidney failure, with a higher prevalence of dialysis among men despite women exhibiting higher rates of CKD. The impact of endogenous sex hormones, the correlations between CKM and its components, as well as the long-term effects of treatment modalities using sex hormones, including hormone replacement therapies and gender-affirming therapies, have drawn attention to this topic. Current research on CKM syndrome is hindered by the scarcity of large-scale studies and insufficient integration of gender-specific considerations into treatment strategies. The underlying mechanisms driving the gender disparities in the pathogenesis of CKM syndrome, including the roles of estrogen, progesterone and testosterone derivatives, remain poorly understood, thus limiting their application in personalized therapeutic interventions. This review synthesizes existing knowledge to clarify the intricate relationship between sex hormones, gender disparities, and the progression of CVD within CKM syndrome. By addressing these knowledge gaps, this study aims to guide future research efforts and promote tailored approaches for effectively managing CKD syndrome.

Analysis of eplerenone in the FDA adverse event reporting system (FAERS) database: a focus on overall patient population and gender-specific subgroups

Introduction: Eplerenone is approved for the treatment of hypertension as well as symptomatic heart failure with reduced ejection fraction (HFrEF) following an acute myocardial infarction. However, the adverse events (AEs) have not been systematically analyzed. The aim of this study was to identify adverse drug reactions (ADRs) related to eplerenone using the FDA Adverse Event Reporting System (FAERS) database. By identifying previously unreported AEs, the study could potentially contribute to updating the drug's label. Methods: In order to find significant AEs, four algorithms, including Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN) and Empirical Bayesian Geometric Mean (EBGM), were used to analyze the signal strength of the ADRs connected to eplerenone that were gathered from the FAERS database over the previous 20 years. Results: From 2004Q1 to 2023Q4, a total of 20, 629, 811 reported cases were gathered from the FAERS database for this study. After processing the data and filtering, 1,874 case reports were analyzed. Of these cases, 1,070 AEs were identified, 128 of which were eplerenone-related ADRs. We investigated the occurrence of ADRs induced by eplerenone in 27 organ systems. Our study showed that the AEs listed in the medication's package insert correspond with those listed in the literature, including hyperkalemia and increased creatinine. Additionally, the prescription label for eplerenone does not include all system organ class (SOC) terms, like Vascular disorders, hepatobiliary Disorders, etc. Discussion: The study used multiple algorithms to quantify the signal strength and then identified any previously unrecognized ADRs, further studies are needed to confirm the association of ADRs with eplerenone. The findings of this study may provide important insights into the safety profile of eplerenone, ensure that healthcare providers have up-to-date information about their potential risks and help guide them in the correct use of the drug.

Association between Body Mass Index and Early Renal Function after Kidney Transplantation: Observational and Mendelian Randomization Study

INTRODUCTION

The relationship between BMI and early renal function recovery after kidney transplantation is important due to the rising global obesity rates.

METHODS

A retrospective study on 320 patients who received allograft kidney transplantation at Guangxi Medical University Hospital explored the BMI-kidney function relationship using various statistical methods. Mendelian randomization (MR) was also employed to investigate causality.

RESULTS

Based on the univariate analysis, multivariate linear regression models, and trend analysis, it was found that there were significant positive correlations between BMI and creatinine, urea, and cystatin C on the 7th day after kidney transplantation (p < 0.05). The sensitivity analysis further confirmed these correlations in different gender stratification, adolescents, and adults. However, the positive correlation with cystatin C was only significant in males. Additionally, after conducting smooth curve fitting analysis and threshold saturation analysis, it was revealed that the negative correlation between early renal function recovery was most significant when BMI was between 22.0 and 25.5 kg/m2, and early postoperative renal function may be optimal when BMI was at 22.2 kg/m2. Finally, the MR analysis confirmed a causal relationship between BMI and renal failure, as indicated by the IVW method (p = 0.003), as well as the weighted median estimator (p = 0.004).

CONCLUSION

This study on kidney transplant patients found that maintaining a BMI within the range of 22.0-25.5 kg/m2, with an optimal BMI of 22.2 kg/m2, improves early renal function recovery. This correlation holds true for different age-groups and genders. Monitoring and controlling BMI in high-risk patients can enhance post-transplantation renal function.

Reno-protective effect of protocatechuic acid is independent of sex-related differences in murine model of UUO-induced kidney injury

BACKGROUND

Obstructive nephropathy is a condition often caused by urinary tract obstruction either anatomical (e.g., tumors), mechanical (e.g., urolithiasis), or compression (e.g., pregnancy) and can progress to chronic kidney disease (CKD). Studies have shown sexual dimorphism in CKD, where males were found to have a more rapid decline in kidney function following kidney injury compared to age-matched females. Protocatechuic acid (PCA), an anti-oxidant and anti-inflammatory polyphenolic compound, has demonstrated promising effects in mitigating drug-induced kidney injuries. The current study aims to explore sexual dimorphism in kidney injury after unilateral ureteral obstruction (UUO) and assess whether PCA treatment can mitigate kidney injury in both sexes.

METHODS

UUO was induced in 10-12 weeks old male and female C57BL/6J mice. Mice were categorized into four groups (n = 6-8/group); Sham, Sham plus PCA (100 mg/kg, I.P daily), UUO, and UUO plus PCA.

RESULTS

After 2 weeks of induction of UUO, markers of kidney oxidative stress (TBARs), inflammation (IL-1α and IL-6), tubular injury (neutrophil gelatinase-associated lipocalin, NGAL and urinary kidney injury molecule-1, KIM-1), fibrosis (Masson's trichrome staining, collagen IV expression, MMP-2 and MMP-9) and apoptosis (TUNEL+ cells, active caspase-1 and caspase-3) were significantly elevated in both males and females relative to their sham counterparts. Males exhibited significantly greater kidney oxidative stress, inflammation, fibrosis, and apoptosis after induction of UUO when compared to females. PCA treatment significantly attenuated UUO-induced kidney injury, inflammation, fibrosis, and apoptosis in both sexes.

CONCLUSION

Our findings suggest a differential gender response to UUO-induced kidney injury with males being more sensitive to UUO-induced kidney inflammation, fibrosis, and apoptosis than age-matched females. Importantly, PCA treatment reduced UUO-induced kidney injury in a sex-independent manner which might be attributed to its anti-oxidant, anti-inflammatory, anti-fibrotic, and anti-apoptotic properties.

Prevalence of chronic kidney disease and metabolic related indicators in Mianzhu, Sichuan, China

Background

Chronic kidney disease (CKD) is a major public health problem worldwide. Periodic surveys are essential for monitoring the prevalence of CKD and its risk factors. We assessed the prevalence of CKD and its risk factors in Mianzhu City in 2020.

Method

The Natural Population Cohort Study surveyed 7,770 individuals aged>20 years in Mianzhu City of Sichuan province in 2020. Our investigation encompassed the measurement of CKD prevalence, the evaluation of various renal function indicators, and comparisons based on age, gender, and hukou status. Additionally, some metabolic indices were also measured to identify the underlying causes of CKD.

Results

(1) Overall, the prevalence of reduced renal function (eGFR<60 mL/min/1.73m2), albuminuria, and CKD were 1.3, 10.0, and 10.4%, respectively, (2) the overall prevalence of CKD was higher among men than among women (14.5% vs. 8.6%). Similarly, the prevalence of CKD was higher among men than women in most age groups, (3) among urban residents, the prevalence of CKD was higher among middle-aged individuals and lower among young individuals and older adults, and (4) considering eGFR, the albuminuria and CKD for group definition, Blood pressure, triglyceride, high-density lipoprotein, blood sugar, and BMI were all statistically different among between normal groups and abnormal groups s in the albuminuria and CKD.

Conclusion

The incidence of CKD greatly varied between Mianzhu City and other regions in China and other countries. The differences in risk factors of CKD should be explored in the future. The gender difference in the prevalence of CKD in this study was markedly different from that in previous studies. More high-quality studies are needed to further explore this controversy. Based on the different prevalence of CKD and metabolism-related indices in rural and urban areas in this study, we speculated that the high incidence of CKD in Mianzhu City might be related to diet, lifestyle, and availability of healthcare services.

Gender Differences in Insulin Resistance: New Knowledge and Perspectives

Insulin resistance is the main mechanism in a whole series of pathological conditions, which are not only of metabolic interest but also of a systemic type. This phenomenon means that the body's cells become less sensitive to the hormone insulin, leading to higher levels of insulin in the blood. Insulin resistance is a phenomenon that can be found in both men and women and in particular, in the latter, it is found mainly after menopause. Premenopause, hormonal fluctuations during the menstrual cycle, and the presence of estrogen can affect insulin sensitivity. Androgens, such as testosterone, are typically higher in men and can contribute to insulin resistance. In both sexes, different human body types affect the distribution and location of body fat, also influencing the development of diabetes and cardiovascular disease. Insulin resistance is also associated with some neurological and neurogenerative disorders, polycystic ovary syndrome, atherosclerosis, and some of the main neoplastic pathologies. A healthy lifestyle, including regular physical activity, a balanced diet, and self-maintenance, can help to prevent the onset of insulin resistance, regardless of gender, although the different habits between men and women greatly affect the implementation of preventative guidelines that help in fighting the manifestations of this metabolic disorder. This review may help to shed light on gender differences in metabolic diseases by placing a necessary focus on personalized medical management and by inspiring differentiated therapeutic approaches.

Gender-based research underscores sex differences in biological processes, clinical disorders and pharmacological interventions

Earlier research has presumed that the male and female biology is similar in most organs except the reproductive system, leading to major misconceptions in research interpretations and clinical implications, with serious disorders being overlooked or misdiagnosed. Careful research has now identified sex differences in the cardiovascular, renal, endocrine, gastrointestinal, immune, nervous, and musculoskeletal systems. Also, several cardiovascular, immunological, and neurological disorders have shown differences in prevalence and severity between males and females. Genetic variations in the sex chromosomes have been implicated in several disorders at young age and before puberty. The levels of the gonadal hormones estrogen, progesterone and testosterone and their receptors play a role in the sex differences between adult males and premenopausal women. Hormonal deficiencies and cell senescence have been implicated in differences between postmenopausal and premenopausal women. Specifically, cardiovascular disorders are more common in adult men vs premenopausal women, but the trend is reversed with age with the incidence being greater in postmenopausal women than age-matched men. Gender-specific disorders in females such as polycystic ovary syndrome, hypertension-in-pregnancy and gestational diabetes have attained further research recognition. Other gender-related research areas include menopausal hormone therapy, the "Estrogen Paradox" in pulmonary arterial hypertension being more predominant but less severe in young females, and how testosterone may cause deleterious effects in the kidney while having vasodilator effects in the coronary circulation. This has prompted the National Institutes of Health (NIH) initiative to consider sex as a biological variable in research. The NIH and other funding agencies have provided resources to establish state-of-the-art centers for women health and sex differences in biology and disease in several academic institutions. Scientific societies and journals have taken similar steps to organize specialized conferences and publish special issues on gender-based research. These combined efforts should promote research to enhance our understanding of the sex differences in biological systems beyond just the reproductive system, and provide better guidance and pharmacological tools for the management of various clinical disorders in a gender-specific manner.

Access to treatment in chronic kidney disease, dialysis and transplantation. Is there gender equality?

Sex and gender are often used as synonyms. However, while sex describes only a biological state, gender is a dynamic concept that takes into account psychosocial and cultural aspects of human existence that can change according to place and time. Inequality in medicine has been described in several areas. Among them, gender inequality has been disregarded for many years and is now a matter of concern. Chronic kidney disease (CKD) is a growing epidemic worldwide, affecting approximately 10% of the population. Although both men and women are affected, gender equality, especially in access to different treatments, is a matter of concern. We decided to investigate gender equality in patients with CKD. To this end, we conducted a literature narrative review to determine whether gender inequalities were found in CKD patients in general and in access to different treatment modalities in particular. A non-language restricted search was performed until November 30th 2022 in PubMed, SciELO, Trip Database, Google Scholar, MEDES y MEDLINE. We also investigated the situation in this regard in our country. We found that CKD is more prevalent in women than men, nevertheless this prevalence decreases along the CKD stages to the point that more men reach end stage kidney disease (ESKD) and dialysis. Access to transplant (ATT) is higher in men than in women although posttransplant survival shows no gender differences. Finally, most series have shown that women are more frequently Kidney transplantation (KT) living donors than men. Results in our country are similar to the published literature with the exception of a higher proportion of men as KT living donors. As in other areas, gender inequality in Nephrology has been largely overlooked. In this review we have highlighted gender differences in CKD patients. Gender inequality in Nephrology exists and needs to be looked upon in order to reach a personalized clinical approach.

Vitamin D: Can Gender Medicine Have a Role?

This narrative review aims to shed light on the role of gender differences, on the biological and molecular functions in the main pathological mechanisms that recognize the role of vitamin D. Vitamin D deficiency is widespread worldwide, but it is still very controversial whether the amount of vitamin D taken daily is actually the only problem related to its biological functions. Currently, the plasma concentration of 25-hydroxyvitamin D represents the only indicator of the circulating blood quota. The concept is that the biological function of vitamin D is not only linked to its circulating levels, but it is hypothesized that its biological functions depend, above all, on its total bioavailability. In particular, vitamin D circulates for the most part linked to albumin and vitamin D binding protein (DBP), which depend on various pathological conditions and physiologically, above all, the function of the latter is regulated by estrogens, glucocorticoids, and inflammatory cytokines. During her life, women undergo various changes in the hormonal and sexual sphere concerning menarche, possible pregnancies, and breastfeeding but also the use of contraceptives and, finally, the transition from the period of fertility to menopause. Each of these phases presents specific needs and, consequently, sometimes also specific criticalities. Studies on young women have shown that vitamin D deficiency is present in 58 to 91% of cases. Obesity, metabolic disorders, and variation in estrogen contraction may affect vitamin D deficiency due to the decreased bioavailability from dietary sources due to deposition in body fat compartments.