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Xu H, Eriksdotter M, Garcia-Ptacek S, Ferreira D, Ji D, Bruchfeld A, Xu Y, Carrero JJ. Acute Kidney Injury and Its Association With Dementia and Specific Dementia Types: Findings From a Population-Based Study in Sweden. Neurology 2024; 103:e209751. [PMID: 39173107 DOI: 10.1212/wnl.0000000000209751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Preclinical studies suggest that acute kidney injury (AKI) results in biochemical and pathologic changes in the brain. We aimed to explore the association between experiencing AKI and subsequent risks of developing dementia. METHODS We conducted a study involving individuals aged 65 years and older in Stockholm from 2006 to 2019, who were free from dementia diagnosis and had data on kidney function. The exposure was an episode of AKI (time varying), ascertained by issued clinical diagnoses and transient creatinine elevations according to Kidney Disease Improving Global Outcomes criteria. The outcome was all-cause dementia and specific types of dementia, ascertained by clinically confirmed cases in the Swedish registry of cognitive/dementia disorders, the presence of 2 issued dementia diagnoses in outpatient care, or initiation of specific antidementia medications. We investigated associations with dementia through Cox proportional hazard regression by AKI, severity levels of AKI, AKI recurrence, and setting (community-acquired or hospital-acquired AKI). RESULTS We included 305,122 individuals with a median age of 75 ± 8 years (56.6% women). During a median follow-up of 12.3 (interquartile range 8.7-13.3) years, there were 79,888 individuals (26%) suffering from at least 1 episode of AKI and 47,938 incident cases (16%) of dementia. The rate of dementia cases was 37.0 per 1,000 person-years (95% CI 36.2-37.8) after developing AKI, which was approximately 2 times higher than the rate observed during the periods before AKI (17.3, 95% CI 17.2-17.5). After multivariable adjustment, developing AKI was associated with a 49% higher rate of subsequent dementia (adjusted hazard ratio hazard ratio [HR] 1.49, 95% CI 1.45-1.53). This pattern was consistent across dementia types, with HRs of 1.88 (95% CI 1.53-2.32), 1.47 (1.38-1.56), and 1.31 (1.25-1.38) for dementia with Lewy bodies and Parkinson disease with dementia, vascular dementia, and Alzheimer dementia, respectively. Risk associations were stronger in magnitude across more severe AKIs and in hospital-acquired vs community-acquired AKI. DISCUSSION Individuals who experienced an AKI were at increased risk of receiving a diagnosis of dementia.
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Affiliation(s)
- Hong Xu
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
| | - Maria Eriksdotter
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
| | - Sara Garcia-Ptacek
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
| | - Daniel Ferreira
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
| | - Dongze Ji
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
| | - Annette Bruchfeld
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
| | - Yang Xu
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
| | - Juan J Carrero
- From the Division of Clinical Geriatrics (H.X., M.E., S.G.-P., D.F.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Pharmacy Administration and Clinical Pharmacy (D.J., Y.X.), School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China; Division of Renal Medicine and Baxter Novum (A.B.), Department of Clinical Science, Intervention and Technology, and Department of Medical Epidemiology and Biostatistics (MEB) (J.J.C.), Karolinska Institutet, Solna, Sweden
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Huang J, Cui S, Chi X, Cong A, Yang X, Su H, Zhou Z, Su C, Hu Z, Huang Z, Luo J, Wang G, Jiang Y, Tang G, Cao W. Dynamically visualizing profibrotic maladaptive repair after acute kidney injury by fibroblast activation protein imaging. Kidney Int 2024:S0085-2538(24)00536-2. [PMID: 39098582 DOI: 10.1016/j.kint.2024.07.015] [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: 12/09/2023] [Revised: 06/02/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024]
Abstract
A major challenge in prevention and early treatment of organ fibrosis is the lack of valuable tools to assess the evolving profibrotic maladaptive repair after injury in vivo in a non-invasive way. Here, using acute kidney injury (AKI) as an example, we tested the utility of fibroblast activation protein (FAP) imaging for dynamic assessment of maladaptive repair after injury. The temporospatial pattern of kidney FAP expression after injury was first characterized. Single-cell RNA sequencing and immunostaining analysis of patient biopsies were combined to show that FAP was specifically upregulated in kidney fibroblasts after AKI and was associated with fibroblast activation and chronic kidney disease (CKD) progression. This was corroborated in AKI mouse models, where a sustained and exaggerated kidney FAP upregulation was coupled to persistent fibroblast activation and a fibrotic outcome, linking kidney FAP level to post-insult maladaptive repair. Furthermore, using positron emission tomography (PET)/CT scanning with FAP-inhibitor tracers ([18F]FAPI-42, [18F]FAPT) targeting FAP, demonstrated the feasibility of non-invasively tracking of maladaptive repair evolution toward kidney fibrosis. Importantly, a sustained increase in kidney [18F]FAPT (less hepatobiliary metabolized than [18F]FAPI-42) uptake reflected persistent kidney upregulation of FAP and characterized maladaptive repair after AKI. Kidney [18F]FAPT uptake at hour 2-day 7 correlated with kidney fibrosis 14 days after AKI. Similar changes in [18F]FAPI-42 PET/CT imaging were observed in patients with AKI and CKD progression. Thus, persistent kidney FAP upregulation after AKI was associated with maladaptive repair and a fibrotic outcome. Hence, FAP-specific PET/CT imaging enables dynamic visualization of maladaptive repair after AKI and prediction of kidney fibrosis within a clinically actionable window.
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Affiliation(s)
- Jiawen Huang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Guangzhou, China
| | - Shuang Cui
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaohua Chi
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Guangzhou, China
| | - Ansheng Cong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - XiaoQiang Yang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Guangzhou, China
| | - Huanjuan Su
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Zhanmei Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Cailing Su
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Zuoyu Hu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Zhijie Huang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Jiao Luo
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Guobao Wang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Ying Jiang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Guangzhou, China
| | - Ganghua Tang
- Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Guangzhou, China.
| | - Wei Cao
- Division of Nephrology, Nanfang Hospital, Southern Medical University, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Nephrology, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China.
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Guo L, Wu X, Cui X, Li M, Yang L, Feng Y, Zhan Q, Huang L. Clinical Characteristics and the Prognostic Impact of Acute Kidney Injury in Critically Ill Patients with Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Retrospective, Single-Center Study. KIDNEY DISEASES (BASEL, SWITZERLAND) 2024; 10:262-273. [PMID: 39131885 PMCID: PMC11309762 DOI: 10.1159/000539139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/23/2024] [Indexed: 08/13/2024]
Abstract
Introduction The incidence and impact of acute kidney injury (AKI) in patients with invasive pulmonary aspergillosis (IPA) admitted to the intensive care unit (ICU) are unknown. Methods This retrospective study included 140 patients who were diagnosed with IPA and admitted to the medical ICU of China-Japan Friendship Hospital in Beijing, China. AKI was defined according to the Kidney Disease: Improving Global Outcomes guidelines. Data on demographic characteristics, comorbidities, laboratory tests, treatments, and prognosis at ICU admission were collected. Results The rate of AKI was 71.4% (n = 100), and approximately 30% of the patients had preadmission acute kidney dysfunction. Of the 100 patients with AKI, 19, 8, and 73 patients had stage I, II, and III AKI, respectively, and 64 (87.6%) patients required continuous renal replacement therapy. Overall ICU mortality rate was 52.1%. Irreversible AKI was a strong independent risk factor for ICU mortality (odds ratio 13.36, 95% confidence interval 4.52-39.48, p < 0.001), followed by chronic lung disease, use of intermittent positive-pressure ventilation, and long-term corticosteroid treatment within 1 year prior to ICU admission. Higher cardiac troponin I levels at admission and worse volume control during the first 7 days of ICU stay were potential predictive factors of irreversible kidney dysfunction. Patients with irreversible AKI and those who died during the ICU stay had greater volume overload during the first 14 days of ICU stay. Patients who survived received earlier renal replacement therapy support after ICU admission compared to those who died (median, 2 vs. 5 days; p = 0.026). Conclusion Compared to the patients with IPA in the absence of AKI, those with AKI presented with more volume overload, worse disease burden, and required stronger respiratory support, while experiencing worse prognosis. Irreversible AKI was a strong predictor of mortality in patients with critical IPA. Better volume control and earlier CRRT initiation should be considered key points in AKI management and prognostic improvement.
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Affiliation(s)
- Lingxi Guo
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Xiaojing Wu
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Xiaoyang Cui
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Meiyuan Li
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Lu Yang
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Yiming Feng
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Qingyuan Zhan
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
| | - Linna Huang
- National Center for Respiratory Medicine, Beijing, PR China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, PR China
- National Clinical Research Center for Respiratory Diseases, Beijing, PR China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, PR China
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Din MAU, Wan A, Chu Y, Zhou J, Yan Y, Xu Z. Therapeutic role of extracellular vesicles from human umbilical cord mesenchymal stem cells and their wide therapeutic implications in inflammatory bowel disease and other inflammatory disorder. Front Med (Lausanne) 2024; 11:1406547. [PMID: 39139783 PMCID: PMC11319305 DOI: 10.3389/fmed.2024.1406547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
The chronic immune-mediated inflammatory condition known as inflammatory bowel disease (IBD) significantly affects the gastrointestinal system. While the precise etiology of IBD remains elusive, extensive research suggests that a range of pathophysiological pathways and immunopathological mechanisms may significantly contribute as potential factors. Mesenchymal stem cells (MSCs) have shown significant potential in the development of novel therapeutic approaches for various medical conditions. However, some MSCs have been found to exhibit tumorigenic characteristics, which limit their potential for medical treatments. The extracellular vesicles (EVs), paracrine factors play a crucial role in the therapeutic benefits conferred by MSCs. The EVs consist of proteins, microRNAs, and lipids, and are instrumental in facilitating intercellular communication. Due to the ease of maintenance, and decreased immunogenicity, tumorigenicity the EVs have become a new and exciting option for whole cell treatment. This review comprehensively assesses recent preclinical research on human umbilical cord mesenchymal stem cell (hUC-MSC)-derived EVs as a potential IBD therapy. It comprehensively addresses key aspects of various conditions, including diabetes, cancer, dermal injuries, neurological disorders, cardiovascular issues, liver and kidney diseases, and bone-related afflictions.
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Affiliation(s)
- Muhammad Azhar Ud Din
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine Jiangsu University, Zhenjiang, China
- Changzhou Key Laboratory of Molecular Diagnostics and Precision Cancer Medicine, Wujin Hospital Affiliated with Jiangsu University (The Wujin Clinical College of Xuzhou Medical University), Changzhou, China
| | | | - Ying Chu
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine Jiangsu University, Zhenjiang, China
| | - Jing Zhou
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine Jiangsu University, Zhenjiang, China
| | - Yongmin Yan
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine Jiangsu University, Zhenjiang, China
| | - Zhiliang Xu
- Key Laboratory of Medical Science and Laboratory Medicine of Jiangsu Province, School of Medicine Jiangsu University, Zhenjiang, China
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Berezin AE, Berezina TA, Hoppe UC, Lichtenauer M, Berezin AA. An overview of circulating and urinary biomarkers capable of predicting the transition of acute kidney injury to chronic kidney disease. Expert Rev Mol Diagn 2024; 24:627-647. [PMID: 39007888 DOI: 10.1080/14737159.2024.2379355] [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: 04/15/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) defined by a substantial decrease in kidney function within hours to days and is often irreversible with higher risk to chronic kidney disease (CKD) transition. AREAS COVERED The authors discuss the diagnostic and predictive utilities of serum and urinary biomarkers on AKI and on the risk of AKI-to-CKD progression. The authors focus on the relevant literature covering evidence of circulating and urinary biomarkers' capability to predict the transition of AKI to CKD. EXPERT OPINION Based on the different modalities of serum and urinary biomarkers, multiple biomarker panel seems to be potentially useful to distinguish between various types of AKI, to detect the severity and the risk of AKI progression, to predict the clinical outcome and evaluate response to the therapy. Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary uromodulin, serum extracellular high mobility group box-1 (HMGB-1), serum cystatin C and urinary liver-type fatty acid-binding protein (L-FABP) were the most effective in the prediction of AKI-to-CKD transition regardless of etiology and the presence of critical state in patients. The current clinical evidence on the risk assessments of AKI progression is mainly based on the utility of combination of functional, injury and stress biomarkers, mainly NGAL, L-FABP, HMGB-1 and cystatin C.
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Affiliation(s)
- Alexander E Berezin
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tetiana A Berezina
- Department of Internal Medicine & Nephrology, VitaCenter, Zaporozhye, Ukraine
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
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Tamargo CL, Parikh CR. The Use of Kidney Disease Improving Global Outcomes AKI Definitions in Retrospective AKI Research: CON. KIDNEY360 2024; 5:944-947. [PMID: 38833306 PMCID: PMC11296551 DOI: 10.34067/kid.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/04/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Christina L Tamargo
- Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Knowler WC, Chen H, Bahnson JL, Kahn SE, Lewis CE, Nathan DM, Nelson RG, Pilla SJ, Bantle JP. Within and post-trial effects of an intensive lifestyle intervention on kidney disease in adults with overweight or obesity and type 2 diabetes mellitus: a secondary analysis of the Look AHEAD clinical trial. BMJ Open Diabetes Res Care 2024; 12:e004079. [PMID: 38816203 PMCID: PMC11141171 DOI: 10.1136/bmjdrc-2024-004079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION The Look AHEAD randomized clinical trial reported that an 8-year intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) in adults aged 45-76 years with type 2 diabetes and overweight/obesity delayed kidney disease progression. Here, we report long-term post-intervention follow-up for the trial's secondary outcome of kidney disease. RESEARCH DESIGN AND METHODS We examined effects of ILI (n=2570) versus DSE (n=2575) on decline in estimated glomerular filtration rate (eGFR) to <45 mL/min/1.73 m2 or need for kidney replacement therapy (KRT: dialysis or kidney transplant) during intervention and post-intervention follow-up (median 15.6 years overall). RESULTS Incidence of eGFR <45 mL/min/1.73 m2 was lower in ILI during the intervention (HR=0.80, 95% CI=0.66 to 0.98) but not post-intervention (HR=1.03, 0.86 to 1.23) or overall (HR=0.92, 0.80 to 1.04). There were no significant treatment group differences in KRT. In prespecified subgroup analyses, age×treatment interactions were significant over total follow-up: p=0.001 for eGFR <45 mL/min/1.73 m2 and p=0.01 for KRT. The 2205 participants aged >60 years at baseline had benefit in both kidney outcomes during intervention and overall (HR=0.75, 0.62 to 0.90 for eGFR <45 mL/min/1.73 m2; HR=0.62, 0.43 to 0.91 for KRT). The absolute treatment effects were greater post-intervention: ILI reduced the rate of eGFR <45 mL/min/1.73 m2 by 0.46 and 0.76 cases/100 person-years during and post-intervention, respectively; and reduced KRT by 0.15 and 0.21 cases/100 person-years. The younger participants experienced no such post-intervention benefits. CONCLUSIONS ILI reduced kidney disease progression during and following the active intervention in persons aged ≥60 years. ILI should be considered for reducing kidney disease incidence in older persons with type 2 diabetes.
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Affiliation(s)
- William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Judy L Bahnson
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David M Nathan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
- Current: Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Scott J Pilla
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - John P Bantle
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Meersch M, Weiss R, Strauß C, Albert F, Booke H, Forni L, Pittet JF, Kellum JA, Rosner M, Mehta R, Bellomo R, Rosenberger P, Zarbock A. Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial. Intensive Care Med 2024; 50:247-257. [PMID: 38285051 PMCID: PMC10907445 DOI: 10.1007/s00134-023-07314-2] [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: 09/04/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. METHODS We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. RESULTS We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. CONCLUSION One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors.
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Affiliation(s)
- Melanie Meersch
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Raphael Weiss
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Christian Strauß
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Felix Albert
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Hendrik Booke
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Lui Forni
- School of Medicine, University of Surrey, Kate Granger Building, Guildford, UK
- Intensive Care Unit, Royal Surrey Hospital, Guildford, UK
| | - Jean-Francois Pittet
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mitchell Rosner
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Ravindra Mehta
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Rinaldo Bellomo
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Intensive Care, Austin Health, Heidelberg, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
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Li S, Luo Q, Fan Y, Zhao C, Huang F, Xia X, Chen W. Clinicopathological Characteristics and Prognosis of Lupus Nephritis Patients with Acute Kidney Injury. Am J Nephrol 2023; 54:536-545. [PMID: 37708856 DOI: 10.1159/000533847] [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: 07/01/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Acute kidney injury (AKI) is common in lupus nephritis (LN) and a risk factor for chronic kidney failure. Here, we aimed to assess the characteristics and prognosis of LN patients with AKI. METHODS AKI and AKI severity stages in LN patients were defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification. Long-term renal outcomes and patient mortality between different stages of AKI were compared by Cox regression analysis. RESULTS Of 1272 LN patients, 225 (17.69%) had AKI and 72 (5.66%) were AKI stage 3. Compared with the non-AKI group, the proportion of male patients was significantly higher in the AKI group (p = 0.002). In addition, there were markedly higher proportions of hematologic system damage, more severe renal manifestations, and higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores in the AKI group than in the non-AKI group. The active and chronic lesions in renal biopsy were significantly higher in LN patients with AKI than those without AKI. During a median follow-up of 53 months, Kaplan-Meier curve showed that LN patients with AKI stage 3 had significantly poorer long-term renal outcomes (p = 0.002) and patient survival (p < 0.001) than those without AKI. Furthermore, AKI stage 3, but not stage 1 or 2 was significantly associated with adverse renal outcomes (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.01-6.28, p = 0.048) and all-cause mortality (HR = 2.80, 95% CI: 1.18-6.61, p = 0.019) in LN patients. In patients with AKI, increased baseline serum creatinine and severe glomerular sclerosis were independent risk factors for worse renal outcomes, while higher blood pressure, increased baseline serum creatinine, and anti-Sjogren's syndrome A positivity could indicate poor survival. DISCUSSION LN patients with AKI stage 3, but not stages 1 and 2, have poorer long-term renal outcomes and patient survival. Our study demonstrates the importance of early identification and management of AKI in LN patients.
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Affiliation(s)
- Suchun Li
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Qimei Luo
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yuting Fan
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Chen Zhao
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xi Xia
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
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