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Xiao B, Huang J, Chen L, Lin Y, Luo J, Chen H, Fu L, Tang F, Ouyang W, Wu Y. Ultra-processed food consumption and the risk of incident chronic kidney disease: a systematic review and meta-analysis of cohort studies. Ren Fail 2024; 46:2306224. [PMID: 38345016 PMCID: PMC10863522 DOI: 10.1080/0886022x.2024.2306224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Recent individual studies have indicated that ultra-processed food (UPF) consumption may be associated with the incidence of chronic kidney disease (CKD). We conducted a systematic review and meta-analysis based on those longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD, and synthesizing the results. METHOD PubMed, Embase, The Cochrane Library, Web of Science, and Scopus were searched from inception through 22 March 2023. Any longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD were included. Two researchers independently conducted the literature screening and data extraction. RR and its 95% CI were regarded as the effect size. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of the studies included, and the effect of UPF consumption on the risk of incident CKD was analyzed with STATA version 15.1. This study's protocol was registered in PROSPERO (CRD42023411951). RESULTS Four cohort studies with a total of 219,132 participants were included after screening. The results of the meta-analysis suggested that the highest UPF intake was associated with an increased risk of incident CKD (RR = 1.25; 95% CI: 1.18-1.33). CONCLUSIONS High-dose UPF intake was associated with an increased risk of incident CKD. However, the underlying mechanisms remain unknown. Thus, more standardized clinical studies and further exploration of the mechanisms are needed in the future.
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Affiliation(s)
- Bingjie Xiao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinxian Huang
- The Fourth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Linyi Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yujie Lin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianghong Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huifen Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lizhe Fu
- Chronic Disease Management Outpatient, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Fang Tang
- Chronic Disease Management Outpatient, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Wenwei Ouyang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Yifan Wu
- Chronic Disease Management Outpatient, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
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Patel M, Hornik C, Diamantidis C, Selewski DT, Gbadegesin R. A reappraisal of risk factors for hypertension after pediatric acute kidney injury. Pediatr Nephrol 2024; 39:1599-1605. [PMID: 37987863 PMCID: PMC10947822 DOI: 10.1007/s00467-023-06222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in hospitalized children and increases the risk of chronic kidney disease (CKD) and hypertension, but little is known about the patient level risk factors for pediatric hypertension after AKI. The aims of this study are to evaluate the prevalence and risk factors for new onset hypertension in hospitalized children with AKI and to better understand the role of acute kidney disease (AKD) in the development of hypertension. METHODS This study was an observational cohort of all children ≤ 18 years old admitted to a single tertiary care children's hospital from 2015 to 2019 with a diagnosis of AKI. Hypertension was defined as blood pressure > 95th percentile for sex, age, height, diagnosis of hypertension on the problem list, or prescription of antihypertensive medication for > 90 days after AKI. RESULTS A total of 410 children were included in the cohort. Of these, 78 (19%) developed hypertension > 90 days after AKI. A multivariable logistic regression model identified AKD, need for kidney replacement therapy, congenital heart disease, and non-kidney solid organ transplantation as risk factors for hypertension after AKI. CONCLUSIONS Incident hypertension after 3 months is common among hospitalized children with AKI, and AKD, need for dialysis, congenital heart disease, and non-kidney solid organ transplant are significant risk factors for hypertension after AKI. Monitoring for hypertension development in these high-risk children is critical to mitigate long-term adverse kidney and cardiovascular outcomes.
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Affiliation(s)
- Mital Patel
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine and Brenner Children's Hospital, Winston Salem, NC, USA.
| | - Christoph Hornik
- Division of Critical Care Medicine, Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Clarissa Diamantidis
- Division of Nephrology, Department of Medicine, Duke University, Durham, NC, USA
| | - David T Selewski
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Rasheed Gbadegesin
- Division of Nephrology, Department of Pediatrics, Duke University, Durham, NC, USA
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Yang M, Chuang SYC, Kennedy SE. Sleep disturbances in children and adolescents after kidney transplantation. Pediatr Nephrol 2024; 39:1577-1585. [PMID: 38082092 DOI: 10.1007/s00467-023-06204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND Disturbances of sleep are prevalent among children with chronic kidney disease. However, the aetiology of sleep disorders in children particularly after kidney transplantation is not clear. We sought to ascertain the prevalence and type of sleep disturbances in paediatric kidney transplant recipients and to identify predictors of sleep disturbances in this population. METHODS Caregivers of kidney transplant recipients completed online questionnaires about their child's sleep. The questionnaires utilised were the Sleep Disturbance Scale for Children (SDSC), the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), questions about sleep hygiene, and questions about restless leg syndrome. Demographic and clinical details were collected from medical records. RESULTS Thirty-five children were included in the study, with a median (IQR) age of 14.1 years (9.5-16.1) and median years (IQR) since transplant of 3.7 (0.7-8.7) years, and 72.0% were identified to have at least one category of sleep disturbance according to scores on the SDSC. The most common sleep disturbances reported were disorders of initiating and maintaining sleep (DIMS) (40.0%) and disorders of excessive somnolence (DOES) (31.4%). Statistically significant predictors of sleep disturbances include low estimated glomerular filtration rate and increased age. Among children who screened positive for DIMS and DOES, the majority indicated use of electronic devices in 1 h before bed. CONCLUSIONS A high prevalence of sleep disturbances has been identified in children after kidney transplants, and some risk factors may be modifiable. Further studies are required to understand whether there are other readily modifiable predictors of sleep disturbances.
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Affiliation(s)
- Mian Yang
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia.
| | - Sandra Ya-Chu Chuang
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Sean E Kennedy
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Nephrology Department, Sydney Children's Hospital, Randwick, NSW, Australia
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Doğan ÇS, Taner S, Tiryaki BD, Alaygut D, Özkayın N, Kara A, Gençler A, Pınarbaşı AS, Nalçacıoğlu H, Yüksel S, Akacı O, Yılmaz EK, Yavuz S, Doğan K, Gülşan RYÇ, Aksoy GK, Çiçek N, Aksu B, Küçük N, Altugan FŞ, Selçuk ŞZ, Baştuğ F, Erfidan G, Atmış B, Gökçeoğlu AU, Önder ENA, Elmacı AM, Cengiz N, Gülleroğlu K, Yılmaz EB, Tayfur AÇ, Yılmaz GG, Yel Sİ, Pehlivanoğlu C, Akgün C, Kara MA, Kılıç BD, Şimşek ÖÖ, Yucal M, Ağar BE, Gürgöze MK, Yağmur İ, Madsar Ö, Karalı DT, Girişgen İ, Bodur ED, Çomak E, Gökçe İ, Kaya M, Tabel Y, Günay N, Gülmez R, Çalışkan S. Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study. Pediatr Nephrol 2024; 39:1509-1519. [PMID: 38040872 DOI: 10.1007/s00467-023-06212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5. METHODS Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group. RESULTS A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old. CONCLUSION MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country.
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Affiliation(s)
- Çağla Serpil Doğan
- Division of Pediatric Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Sevgin Taner
- Division of Pediatric Nephrology, Adana City Hospital, Adana, Turkey
| | - Betül Durucu Tiryaki
- Division of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Demet Alaygut
- Division of Pediatric Nephrology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Neşe Özkayın
- Division of Pediatric Nephrology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Aslıhan Kara
- Division of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Aylin Gençler
- Division of Pediatric Nephrology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Ayşe Seda Pınarbaşı
- Division of Pediatric Nephrology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Hülya Nalçacıoğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Selçuk Yüksel
- Division of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Okan Akacı
- Division of Pediatric Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Esra Karabağ Yılmaz
- Division of Pediatric Nephrology, Cerrahpaşa Medical Faculty, İstanbul University - Cerrahpaşa, İstanbul, Turkey
| | - Sevgi Yavuz
- Division of Pediatric Nephrology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Kenan Doğan
- Division of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Rumeysa Yasemin Çiçek Gülşan
- Division of Pediatric Nephrology, University of Health Sciences, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Gülşah Kaya Aksoy
- Division of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Neslihan Çiçek
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Bağdagül Aksu
- Division of Pediatric Nephrology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Nuran Küçük
- Division of Pediatric Nephrology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Fatma Şemsa Altugan
- Division of Pediatric Nephrology, University of Health Sciences, Bilkent City Hospital, Ankara, Turkey
| | - Şenay Zırhlı Selçuk
- Division of Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Funda Baştuğ
- Division of Pediatric Nephrology, Kayseri City Hospital, Kayseri, Turkey
| | - Gökçen Erfidan
- Division of Pediatric Nephrology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - Bahriye Atmış
- Division of Pediatric Nephrology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Arife Uslu Gökçeoğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | | | - Ahmet Mithat Elmacı
- Division of Pediatric Nephrology, Faculty of Medicine, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Nurcan Cengiz
- Division of Pediatric Nephrology, Faculty of Medicine, Sıtkı Koçman University, Muğla, Turkey
| | - Kaan Gülleroğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Ebru Bekiroğlu Yılmaz
- Division of Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Aslı Çelebi Tayfur
- Division of Pediatric Nephrology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | | | - Sİbel Yel
- Division of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Cemile Pehlivanoğlu
- Division of Pediatric Nephrology, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Cihangir Akgün
- Division of Pediatric Nephrology, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey
| | - Mehtap Akbalık Kara
- Division of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Özgür Özdemir Şimşek
- Division of Pediatric Nephrology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Melike Yucal
- Division of Pediatric Nephrology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Buket Esen Ağar
- Division of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Metin Kaya Gürgöze
- Division of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - İsmail Yağmur
- Division of Pediatric Urology, Faculty of Medicine, Harran University, Urfa, Turkey
| | - Ömer Madsar
- Department of Urology, Faculty of Medicine, Harran University, Urfa, Turkey
| | - Demet Tekcan Karalı
- Division of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - İlknur Girişgen
- Division of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ece Demirci Bodur
- Division of Pediatric Nephrology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Elif Çomak
- Division of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - İbrahim Gökçe
- Division of Pediatric Nephrology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Mehtap Kaya
- Division of Pediatric Nephrology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Yılmaz Tabel
- Division of Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Neslihan Günay
- Division of Pediatric Nephrology, Kayseri City Hospital, Kayseri, Turkey
| | - Rüveyda Gülmez
- Division of Pediatric Nephrology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - Salim Çalışkan
- Division of Pediatric Nephrology, Cerrahpaşa Medical Faculty, İstanbul University - Cerrahpaşa, İstanbul, Turkey
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Khondker A, Ahmad I, Kim K, Malik S, Kim JK, Chua M, Richter J, Chan JY, Baker LA, Lorenzo AJ, Rickard M. Kidney function and transplants in prune belly syndrome: a scoping review. Pediatr Nephrol 2024; 39:1053-1063. [PMID: 37968538 DOI: 10.1007/s00467-023-06209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Children with prune belly syndrome (PBS) are at higher risk of developing kidney dysfunction and requiring kidney replacement therapy (KRT). While studies have described surgical and survival outcomes in these populations, there has yet to be a focused synthesis of evidence regarding kidney outcomes in this population. Here, the focus of this scoping review was to highlight knowledge gaps and report standards on kidney outcomes in PBS of all ages. METHODS Following scoping review methodology, EMBASE, MEDLINE, and Scopus were searched for peer-reviewed literature that describe kidney outcomes in PBS. All studies with a broad set of kidney outcomes (such as kidney function measures, chronic kidney disease (CKD), KRT and associated outcomes) were included. Findings were summarized and qualitatively synthesized. RESULTS Of the 436 unique records identified, 25 were included for synthesis. A total of 17 studies (441 patients) reported on kidney insufficiency outcomes, with an estimated prevalence of CKD ranging from 8 to 66%. A total of 15 studies (314 patients) described KRT, primary kidney transplant, and outcomes. Of these, the age for KRT ranged from 4 to 21 years, and graft survival ranged from 22 to 87% by last follow-up (range 1.3-27 years). CONCLUSIONS There is significant variability in studies reporting kidney outcomes in PBS which limits meaningful synthesis. There is a need for future studies with comprehensive reporting of confounders and drivers for kidney insufficiency in PBS.
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Affiliation(s)
- Adree Khondker
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ihtisham Ahmad
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kellie Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shamir Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Juliane Richter
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Justin Yh Chan
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Linda A Baker
- Division of Pediatric Urology, Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Ramos LGF, Cortes DDPVR, Reis LMD, Montenegro FLDM, Arap SS, Brescia MDG, Custódio MR, Jorgetti V, Elias RM, Moysés RMA. Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism. J Bras Nefrol 2024; 46:e20230024. [PMID: 38039492 DOI: 10.1590/2175-8239-jbn-2023-0024en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/25/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world. METHODS We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS). RESULTS In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed. CONCLUSION PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.
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Affiliation(s)
| | | | - Luciene Machado Dos Reis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil
| | - Fabio Luiz de Menezes Montenegro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Sérgio Samir Arap
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Marília D'Elboux Guimarães Brescia
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Melani Ribeiro Custódio
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil
| | - Vanda Jorgetti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil
| | - Rosilene Motta Elias
- Universidade Nove de Julho, São Paulo, SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil
| | - Rosa Maria Affonso Moysés
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil
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Taha K, Catapang M, Becknell B, Matsell DG. Hypertension in children with congenital anomalies of the kidney and urinary tract. Pediatr Nephrol 2024; 39:1185-1192. [PMID: 37910243 PMCID: PMC10922869 DOI: 10.1007/s00467-023-06207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of childhood chronic kidney disease (CKD). We hypothesized that hypertension varies across CAKUT categories and increases the risk of CKD. METHODS This was a retrospective cohort study and included cases with a multicystic dysplastic kidney (MCDK, n = 81), unilateral kidney agenesis (UKA, n = 47), kidney hypoplasia (KH, n = 130), and posterior urethral valves (PUV, n = 75). Hypertension was defined as systolic or diastolic blood pressure ≥ 95th percentile for age, sex and height, and CKD as an estimated glomerular filtration rate < 60 ml/min/1.73 m2, both at 2 consecutive clinic visits at least 3 months apart. RESULTS Sixty-two (19%) out of 333 cases developed hypertension, with significant difference according to CAKUT type. Patients with smaller kidney size (7.7 vs. 8.3, p = 0.045), kidney anomalies in addition to the primary diagnosis (aCAKUT) (53 vs. 38%, p = 0.03), proteinuria (46 vs. 12%, p < 0.001), and CKD (51 vs. 23%, p < 0.001) were more likely to develop hypertension. When adjusted for kidney size, the diagnoses of PUV (OR 10.9, 95%CI 3.0, 40.5), UKA (OR 6.4, 95%CI 1.6, 24.9) and KH (OR 4.2, 95%CI 1.1, 16.1), and aCAKUT (OR 2.1, 95%CI 1.2, 3.9) were independent risk factors for hypertension. Hypertension increased the risk of developing CKD by twofold (HR 1.9, 95%CI 1.19, 2.94). CONCLUSION Hypertension is common in children with CAKUT and increases the risk of CKD. These findings will aid in the development of a standardized clinical pathway for the care of hypertensive children with CAKUT.
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Affiliation(s)
- Khalid Taha
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Marisa Catapang
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Brian Becknell
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Douglas G Matsell
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
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8
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Sattar N, Presslie C, Rutter MK, McGuire DK. Cardiovascular and Kidney Risks in Individuals With Type 2 Diabetes: Contemporary Understanding With Greater Emphasis on Excess Adiposity. Diabetes Care 2024; 47:531-543. [PMID: 38412040 DOI: 10.2337/dci23-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024]
Abstract
In high-income countries, rates of atherosclerotic complications in type 2 diabetes have declined markedly over time due to better management of traditional risk factors including lipids, blood pressure, and glycemia levels. Population-wide reductions in smoking have also helped lower atherosclerotic complications and so reduce premature mortality in type 2 diabetes. However, as excess adiposity is a stronger driver for heart failure (HF), and obesity levels have remained largely unchanged, HF risks have not declined as much and may even be rising in the increasing number of people developing type 2 diabetes at younger ages. Excess weight is also an underrecognized risk factor for chronic kidney disease (CKD). Based on evidence from a range of sources, we explain how excess adiposity must be influencing most risks well before diabetes develops, particularly in younger-onset diabetes, which is linked to greater excess adiposity. We also review potential mechanisms linking excess adiposity to HF and CKD and speculate on how some of the responsible pathways-e.g., hemodynamic, cellular overnutrition, and inflammatory-could be favorably influenced by intentional weight loss (via lifestyle or drugs). On the basis of available evidence, we suggest that the cardiorenal outcome benefits seen with sodium-glucose cotransporter 2 inhibitors may partially derive from their interference of some of these same pathways. We also note that many other complications common in diabetes (e.g., hepatic, joint disease, perhaps mental health) are also variably linked to excess adiposity, the aggregated exposure to which has now increased in type 2 diabetes. All such observations suggest a greater need to tackle excess adiposity earlier in type 2 diabetes.
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Affiliation(s)
- Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - Calum Presslie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, U.K
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, U.K
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center and Parkland Health, Dallas, TX
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9
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Fiseha T, Ekong NE, Osborne NJ. Chronic kidney disease of unknown aetiology in Africa: A review of the literature. Nephrology (Carlton) 2024; 29:177-187. [PMID: 38122827 DOI: 10.1111/nep.14264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
During the last two decades, an epidemic of a severe form of chronic kidney disease (CKD) unrelated to traditional risk factors (diabetes and hypertension) has been recognized in low- to middle-income countries. CKD of unknown aetiology (CKDu) mainly affects young working-age adults, and has become as an important and devastating public health issue. CKDu is a multifactorial disease with associated genetic and environmental risk factors. This review summarizes the current epidemiological evidence on the burden of CKDu and its probable environmental risk factors contributing to CKD in Africa. PubMed/Medline and the African Journals Online databases were searched to identify relevant population-based studies published in the last two decades. In the general population, the burden of CKD attributable to CKDu varied from 19.4% to 79%. Epidemiologic studies have established that environmental factors, including genetics, infectious agents, rural residence, low socioeconomic status, malnutrition, agricultural practise and exposure to agrochemicals, heavy metals, use of traditional herbs, and contaminated water sources or food contribute to the burden of CKD in the region. There is a great need for epidemiological studies exploring the true burden of CKDu and unique geographical distribution, and the role of environmental factors in the development of CKD/CKDu.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Nicholas J Osborne
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
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10
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Oh SW, Byun SS, Kim JK, Jeong CW, Kwak C, Hwang EC, Kang SH, Chung J, Kim YJ, Ha YS, Hong SH. Machine learning models for predicting the onset of chronic kidney disease after surgery in patients with renal cell carcinoma. BMC Med Inform Decis Mak 2024; 24:85. [PMID: 38519947 PMCID: PMC10960396 DOI: 10.1186/s12911-024-02473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Patients with renal cell carcinoma (RCC) have an elevated risk of chronic kidney disease (CKD) following nephrectomy. Therefore, continuous monitoring and subsequent interventions are necessary. It is recommended to evaluate renal function postoperatively. Therefore, a tool to predict CKD onset is essential for postoperative follow-up and management. METHODS We constructed a cohort using data from eight tertiary hospitals from the Korean Renal Cell Carcinoma (KORCC) database. A dataset of 4389 patients with RCC was constructed for analysis from the collected data. Nine machine learning (ML) models were used to classify the occurrence and nonoccurrence of CKD after surgery. The final model was selected based on the area under the receiver operating characteristic (AUROC), and the importance of the variables constituting the model was confirmed using the shapley additive explanation (SHAP) value and Kaplan-Meier survival analyses. RESULTS The gradient boost algorithm was the most effective among the various ML models tested. The gradient boost model demonstrated superior performance with an AUROC of 0.826. The SHAP value confirmed that preoperative eGFR, albumin level, and tumor size had a significant impact on the occurrence of CKD after surgery. CONCLUSIONS We developed a model to predict CKD onset after surgery in patients with RCC. This predictive model is a quantitative approach to evaluate post-surgical CKD risk in patients with RCC, facilitating improved prognosis through personalized postoperative care.
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Affiliation(s)
- Seol Whan Oh
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 06591, Seoul, Korea
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, 06591, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 13620, Seongnam, Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 13620, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 03080, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, 03080, Seoul, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, 61469, Gwangju, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, 02841, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, 10408, Goyang, Korea
| | - Yong-June Kim
- Department of Urology, Chungbuk National University College of Medicine, 28644, Cheongju, Korea
- Department of Urology, College of Medicine, Chungbuk National University, 28644, Cheongju, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, 41404, Daegu, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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11
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Zaky A, Younan DS, Meers B, Miller D, Melvin RL, Benz D, Davies J, Kidd B, Mathru M, Tolwani A. A pilot study to explore patterns and predictors of delayed kidney decline after cardiopulmonary bypass. Sci Rep 2024; 14:6739. [PMID: 38509206 PMCID: PMC10954642 DOI: 10.1038/s41598-024-57079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
There is no current consensus on the follow up of kidney function in patients undergoing cardiopulmonary bypass (CPB). The main objectives of this pilot study is to collect preliminary data on kidney function decline encountered on the first postoperative visit of patients who have had CPB and to identify predictors of kidney function decline post hospital discharge. Design: Retrospective chart review. Adult patients undergoing open heart procedures utilizing CPB. Patient demographics, type of procedure, pre-, intra-, and postoperative clinical, hemodynamic echocardiographic, and laboratory data were abstracted from electronic medical records. Acute kidney disease (AKD), and chronic kidney disease (CKD) were diagnosed based on standardized criteria. Interval change in medications, hospital admissions, and exposure to contrast, from hospital discharge till first postoperative visit were collected. AKD, and CKD as defined by standardized criteria on first postoperative visit. 83 patients were available for analysis. AKD occurred in 27 (54%) of 50 patients and CKD developed in 12 (42%) out of 28 patients. Older age was associated with the development of both AKD and CKD. Reduction in right ventricular cardiac output at baseline was associated with AKD (OR: 0.5, 95% CI: 0.3, 0.79, P = 0.01). Prolongation of transmitral early diastolic filling wave deceleration time was associated with CKD (OR: 1.02, 95% CI: 1.01, 1.05, P = 0.03). In-hospital acute kidney injury (AKI) was a predictor of neither AKD nor CKD. AKD and CKD occur after CPB and may not be predicted by in-hospital AKI. Older age, right ventricular dysfunction and diastolic dysfunction are important disease predictors. An adequately powered longitudinal study is underway to study more sensitive predictors of delayed forms of kidney decline after CPB.
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Affiliation(s)
- Ahmed Zaky
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA.
| | - Duraid S Younan
- Department of Surgery, Staten Island University, Staten Island, USA
| | - Bradley Meers
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - David Miller
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Ryan L Melvin
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - David Benz
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - James Davies
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Brent Kidd
- Division of Critical Care, Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA
| | - Mali Mathru
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Ashita Tolwani
- Department of Nephrology, University of Alabama at Birmingham, Birmingham, USA
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12
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Jia PP, Li Y, Zhang LC, Wu MF, Li TY, Pei DS. Metabolome evidence of CKDu risks after chronic exposure to simulated Sri Lanka drinking water in zebrafish. Ecotoxicol Environ Saf 2024; 273:116149. [PMID: 38412632 DOI: 10.1016/j.ecoenv.2024.116149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024]
Abstract
It is still a serious public health issue that chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka poses challenges in identification, prevention, and treatment. What environmental factors in drinking water cause kidney damage remains unclear. This study aimed to investigate the risks of various environmental factors that may induce CKDu, including water hardness, fluoride (HF), heavy metals (HM), microcystin-LR (MC-LR), and their combined exposure (HFMM). The research focused on comprehensive metabolome analysis, and correlation with transcriptomic and gut microbiota changes. Results revealed that chronic exposure led to kidney damage and pancreatic toxicity in adult zebrafish. Metabolomics profiling showed significant alterations in biochemical processes, with enriched metabolic pathways of oxidative phosphorylation, folate biosynthesis, arachidonic acid metabolism, FoxO signaling pathway, lysosome, pyruvate metabolism, and purine metabolism. The network analysis revealed significant changes in metabolites associated with renal function and diseases, including 20-Hydroxy-LTE4, PS(18:0/22:2(13Z,16Z)), Neuromedin N, 20-Oxo-Leukotriene E4, and phenol sulfate, which are involved in the fatty acyls and glycerophospholipids class. These metabolites were closely associated with the disrupted gut bacteria of g_ZOR0006, g_Pseudomonas, g_Tsukamurella, g_Cetobacterium, g_Flavobacterium, which belonged to dominant phyla of Firmicutes and Proteobacteria, etc., and differentially expressed genes (DEGs) such as egln3, ca2, jun, slc2a1b, and gls2b in zebrafish. Exploratory omics analyses revealed the shared significantly changed pathways in transcriptome and metabolome like calcium signaling and necroptosis, suggesting potential biomarkers for assessing kidney disease.
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Affiliation(s)
- Pan-Pan Jia
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yan Li
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Lan-Chen Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Ming-Fei Wu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Tian-Yun Li
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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13
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Ranasinghe AV, Somatunga LC, Kumara GWGP, Karunarathna RH, De Silva AP, Gunawardena JMCN, Kumari SKCR, Sarjana MSF, De Silva MVC. Decreasing incidence of hospital diagnosed CKD/CKDu in North Central Province of Sri Lanka: is it related to provision of drinking water reverse osmosis plants? BMC Nephrol 2024; 25:91. [PMID: 38468233 PMCID: PMC10926649 DOI: 10.1186/s12882-024-03534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND We assessed the possible impact of provision of reverse osmosis (RO) water on the incidence of hospital diagnosed CKD/CKDu in North Central Province (NCP) of Sri Lanka. METHODS An ecological study was conducted on data from 2010-2020 on the incidence of hospital diagnosed CKD/CKDu, CKD/CKDu screening and provision of drinking water RO plants in NCP. Analysis was conducted using descriptive statistics, ANOVA and chi-square test. RESULTS The annual incidence of hospital diagnosed CKD/CKDu (per 100 000 population) in 2010-2013, 2014-2016 and 2017-2020 periods in Anuradhapura district were 129.07, 331.06 and 185.57 (p = 0.002) while in Polonnaruwa district these were 149.29, 326.12 and 296.73 (p = 0.04) respectively. In NCP provision of RO plants commenced after 2011 and the decline in the incidence of hospital diagnosed CKD/CKDu was seen in 25 of the 29 Divisional Secretary Divisions when more than 20% of the families received access to drinking RO water projects. CONCLUSIONS The annual incidence of hospital diagnosed CKD/CKDu increased in NCP from 2010 to 2016 and continuously decreased thereafter. Continuous declining of CKD/CKDu incidence was seen after more than 20% of the families received access to drinking water RO plants.
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Hoontrakul T, Leenanupunth C, Siantong M, Sirisreetreerux P, Phongkitkarn S, Kongchareonsombat W, Kijvikai K. Residual renal volume as a long-term independent predictive factor of developing chronic kidney disease after donor nephrectomy. Sci Rep 2024; 14:5341. [PMID: 38438514 PMCID: PMC10912707 DOI: 10.1038/s41598-024-55499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/24/2024] [Indexed: 03/06/2024] Open
Abstract
To assess the long-term association between the residual renal volume and the progression of chronic kidney disease (CKD) in kidney donors following open or laparoscopic donor nephrectomy. A retrospective observational study involving 452 individuals who underwent open or laparoscopic donor nephrectomy at Ramathibodi Hospital, Bangkok, Thailand. The study spanned over a comprehensive 60-month monitoring period. Residual renal volume was determined through Computer Tomography. Patient characteristics, surgical techniques, donated kidney side, and estimated glomerular filtration rate (eGFR) were collected and analysed. In a multivariate analysis, a residual renal volume exceeding 50% of original volume is associated with an increased likelihood of developing CKD, with a hazard ratio (HR) of 1.675 (P < 0.05), and male gender has a hazard ratio (HR) of 4.013 (P < 0.001). Additionally, age is identified as a minor risk factor for developing CKD, with hazard ratio (HR) of 1.107 (P < 0.001). Higher residual renal volume, male gender, and older age were identified as independent risk factors for the development of CKD following open or laparoscopic donor nephrectomy during long-term follow-up.
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Affiliation(s)
| | - Charoen Leenanupunth
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mookdarat Siantong
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pokket Sirisreetreerux
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sith Phongkitkarn
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wisoot Kongchareonsombat
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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15
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Khalili S, Safavi-Naini SAA, Zarand P, Masoumi S, Farsi Y, Hosseinpanah F, Azizi F. Metabolic health's central role in chronic kidney disease progression: a 20-year study of obesity-metabolic phenotype transitions. Sci Rep 2024; 14:5244. [PMID: 38438600 PMCID: PMC10912755 DOI: 10.1038/s41598-024-56061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/01/2024] [Indexed: 03/06/2024] Open
Abstract
This study investigates the risk of chronic kidney disease (CKD) across four metabolic phenotypes: Metabolically Healthy-No Obesity (MH-NO), Metabolically Unhealthy-No obesity (MU-NO), Metabolically Healthy-Obesity (MH-O), and Metabolically Unhealthy-Obesity (MU-O). Data from the Tehran Lipid and Glucose Study, collected from 1999 to 2020, were used to categorize participants based on a BMI ≥ 30 kg/m2 and metabolic health status, defined by the presence of three or four of the following components: high blood pressure, elevated triglycerides, low high-density lipoprotein, and high fasting blood sugar. CKD, characterized by a glomerular filtration rate < 60 ml/min/1.72 m2. The hazard ratio (HR) of CKD risk was evaluated using Cox proportional hazard models. The study included 8731 participants, with an average age of 39.93 years, and identified 734 incidents of CKD. After adjusting for covariates, the MU-O group demonstrated the highest risk of CKD progression (HR 1.42-1.87), followed by the MU-NO group (HR 1.33-1.67), and the MH-O group (HR 1.18-1.54). Persistent MU-NO and MU-O posed the highest CKD risk compared to transitional states, highlighting the significance of exposure during early adulthood. These findings emphasize the independent contributions of excess weight and metabolic health, along with its components, to CKD risk. Therefore, preventive strategies should prioritize interventions during early-adulthood.
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Affiliation(s)
- Shayesteh Khalili
- Department of Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Ahmad Safavi-Naini
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paniz Zarand
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safdar Masoumi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yeganeh Farsi
- Department of Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 23, Parvaneh StreetVelenjak, P.O. Box: 19395-4763, Tehran, 19395-4763, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Christensen MH, Bistrup C, Rubin KH, Nohr EA, Vinter CA, Andersen MS, Möller S, Jensen DM. Kidney Disease in Women With Previous Gestational Diabetes Mellitus: A Nationwide Register-Based Cohort Study. Diabetes Care 2024; 47:401-408. [PMID: 38100751 DOI: 10.2337/dc23-1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The association between gestational diabetes mellitus (GDM) and incident kidney disease, the mediating effects of diabetes and hypertension, and the impact of severity of metabolic dysfunction during pregnancy on the risk of incident kidney disease were investigated in this study. RESEARCH DESIGN AND METHODS This Danish, nationwide, register-based cohort study included all women giving birth between 1997 and 2018. Outcomes included chronic kidney disease (CKD) and acute kidney disease, based on diagnosis codes. Cox regression analyses explored the association between GDM and kidney disease. A proxy for severity of metabolic dysfunction during pregnancy was based on GDM diagnosis and insulin treatment during GDM in pregnancy and was included in the models as an interaction term. The mediating effects of subsequent diabetes and hypertension prior to kidney disease were quantified using mediation analyses. RESULTS Data from 697,622 women were used. Median follow-up was 11.9 years. GDM was associated with higher risk of CKD (adjusted hazard ratio [aHR] 1.92; 95% CI 1.67-2.21), whereas acute kidney disease was unrelated to GDM. The proportions of indirect effects of diabetes and hypertension on the association between GDM and CKD were 75.7% (95% CI 61.8-89.6) and 30.3% (95% CI 25.2-35.4), respectively, as assessed by mediation analyses. The CKD risk was significantly increased in women with insulin-treated GDM and no subsequent diabetes compared with women without GDM (aHR 2.35; 95% CI 1.39-3.97). CONCLUSIONS The risk of CKD was significantly elevated after GDM irrespective of subsequent development of diabetes and hypertension. Furthermore, women with severe metabolic dysfunction during pregnancy had the highest CKD risk.
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Affiliation(s)
- Maria Hornstrup Christensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Claus Bistrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit Open Patient data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense University Hospital, Odense, Denmark
| | - Ellen Aagaard Nohr
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina Anne Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Skovsager Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Research Unit Open Patient data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense University Hospital, Odense, Denmark
| | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Permyakova A, Hamad S, Hinden L, Baraghithy S, Kogot-Levin A, Yosef O, Shalev O, Tripathi MK, Amal H, Basu A, Arif M, Cinar R, Kunos G, Berger M, Leibowitz G, Tam J. Renal Mitochondrial ATP Transporter Ablation Ameliorates Obesity-Induced CKD. J Am Soc Nephrol 2024; 35:281-298. [PMID: 38200648 PMCID: PMC10914206 DOI: 10.1681/asn.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
SIGNIFICANCE STATEMENT This study sheds light on the central role of adenine nucleotide translocase 2 (ANT2) in the pathogenesis of obesity-induced CKD. Our data demonstrate that ANT2 depletion in renal proximal tubule cells (RPTCs) leads to a shift in their primary metabolic program from fatty acid oxidation to aerobic glycolysis, resulting in mitochondrial protection, cellular survival, and preservation of renal function. These findings provide new insights into the underlying mechanisms of obesity-induced CKD and have the potential to be translated toward the development of targeted therapeutic strategies for this debilitating condition. BACKGROUND The impairment in ATP production and transport in RPTCs has been linked to the pathogenesis of obesity-induced CKD. This condition is characterized by kidney dysfunction, inflammation, lipotoxicity, and fibrosis. In this study, we investigated the role of ANT2, which serves as the primary regulator of cellular ATP content in RPTCs, in the development of obesity-induced CKD. METHODS We generated RPTC-specific ANT2 knockout ( RPTC-ANT2-/- ) mice, which were then subjected to a 24-week high-fat diet-feeding regimen. We conducted comprehensive assessment of renal morphology, function, and metabolic alterations of these mice. In addition, we used large-scale transcriptomics, proteomics, and metabolomics analyses to gain insights into the role of ANT2 in regulating mitochondrial function, RPTC physiology, and overall renal health. RESULTS Our findings revealed that obese RPTC-ANT2-/- mice displayed preserved renal morphology and function, along with a notable absence of kidney lipotoxicity and fibrosis. The depletion of Ant2 in RPTCs led to a fundamental rewiring of their primary metabolic program. Specifically, these cells shifted from oxidizing fatty acids as their primary energy source to favoring aerobic glycolysis, a phenomenon mediated by the testis-selective Ant4. CONCLUSIONS We propose a significant role for RPTC-Ant2 in the development of obesity-induced CKD. The nullification of RPTC-Ant2 triggers a cascade of cellular mechanisms, including mitochondrial protection, enhanced RPTC survival, and ultimately the preservation of kidney function. These findings shed new light on the complex metabolic pathways contributing to CKD development and suggest potential therapeutic targets for this condition.
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Affiliation(s)
- Anna Permyakova
- Obesity and Metabolism Laboratory, Faculty of Medicine, School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharleen Hamad
- Obesity and Metabolism Laboratory, Faculty of Medicine, School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liad Hinden
- Obesity and Metabolism Laboratory, Faculty of Medicine, School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Saja Baraghithy
- Obesity and Metabolism Laboratory, Faculty of Medicine, School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviram Kogot-Levin
- Diabetes Unit and Endocrine Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Omri Yosef
- The Lautenberg Center for Immunology and Cancer Research, Faculty of Medicine, Israel-Canada Medical Research Institute, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ori Shalev
- Metabolomics Center, Core Research Facility, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Manish Kumar Tripathi
- The Laboratory of Neuromics, Cell Signaling and Translational Medicine, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Haitham Amal
- The Laboratory of Neuromics, Cell Signaling and Translational Medicine, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abhishek Basu
- Section on Fibrotic Disorders, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Muhammad Arif
- Section on Fibrotic Disorders, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
- Laboratory of Cardiovascular Physiology and Tissue Injury, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Resat Cinar
- Section on Fibrotic Disorders, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - George Kunos
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Michael Berger
- The Lautenberg Center for Immunology and Cancer Research, Faculty of Medicine, Israel-Canada Medical Research Institute, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gil Leibowitz
- Diabetes Unit and Endocrine Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joseph Tam
- Obesity and Metabolism Laboratory, Faculty of Medicine, School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
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Gulcicek S, Seyahi N. Comparison of chronic kidney disease progression and associated complications between geriatric and non-geriatric groups. Medicine (Baltimore) 2024; 103:e37422. [PMID: 38428881 PMCID: PMC10906592 DOI: 10.1097/md.0000000000037422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
There is no consensus on the physiologic decline in estimated glomerular filtration rate (GFR) due to geriatric conditions related with the aging or chronic kidney disease (CKD) itself. In this study, we aimed to compare the CKD progression and associated complications in a large sample of geriatric and non-geriatric patients. The data of in 506 patients at age between 30 to 90 years and diagnosed with CKD at stage 2 and above (15 mL/min/1.73 m2 ≤ eGFR < 90 mL/min/1.73 m2) were collected retrospectively and compared among geriatric (>65 years old) and non-geriatric individuals. The rate of hypertension was higher in geriatrics compared to non-geriatrics (96.6% vs 91.9%, P = .04). Among laboratory findings, only PTH level was significantly lower and HCO3 concentration was higher in geriatrics compared to non-geriatrics (P = .02, P < .001, respectively). There was no significant difference in last measured eGFR (P = .99) while that measured 4 years ago was lower in geriatrics compared to that of non-geriatrics (P < .001). eGFR change was smaller in geriatrics compared to non-geriatrics (P < .001), and rate of progressive renal disease among non-geriatric group (39%) was found to be significantly higher than in the geriatrics (17.2%) (P < .001). The prevalence of hyperkalemia was lower in geriatrics at stage 3a (P = .02); prevalence of hyperparathyroidism was lower in those at stage 3b (P = .02) and lastly the acidosis was observed significantly lower in geriatric patients at stage 3a, 3b, and 4 compared to the non-geriatrics at corresponding stages (P < .001, P = .03, and P = .04, respectively). The eGFR change was significantly smaller in geriatrics at stage 3b and 4 (P < .001 and P = .04, respectively) while the rate of progressed renal disease was lower in geriatrics at stage 3a and 3b (21.1% vs 9.9%, P = .03 and 41.2% vs 11.1%, P < .001, respectively). eGFR change in 4-year period and the rates of progressive renal disease are higher in the non-geriatrics and also the prevalence of secondary complications of CKD, such as hyperparathyroidism, acidosis, and hyperkalemia, are higher in non-geriatrics. This may reflect that decline of GFR in geriatric individuals is at least partially related to physiological aging rather than kidney disease. Therefore, devising age related CKD definitions might be appropriate.
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Affiliation(s)
- Sibel Gulcicek
- Department of Nephrology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ferrara F, Siligato R, Di Maria A, Scichilone L, Di Simone E, Bondanelli M, Storari A, De Giorgi A, Di Muzio M, Fabbian F. Food insecurity and kidney disease: a systematic review. Int Urol Nephrol 2024; 56:1035-1044. [PMID: 37679580 PMCID: PMC10853316 DOI: 10.1007/s11255-023-03777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The risk of developing and worsening chronic kidney disease (CKD) is associated with unhealthy dietary patterns. Food insecurity is defined by a limited or uncertain availability of nutritionally adequate and safe food; it is also associated with several chronic medical conditions. The aim of this systematic review is to investigate the current knowledge about the relationship between food insecurity and renal disease. METHODS We selected the pertinent publications by searching on the PubMed, Scopus, and the Web of Science databases, without any temporal limitations being imposed. The searching and selecting processes were carried out through pinpointed inclusion and exclusion criteria and in accordance with the Prisma statement. RESULTS Out of the 26,548 items that were first identified, only 9 studies were included in the systemic review. Eight out of the nine investigations were conducted in the US, and one was conducted in Iran. The studies evaluated the relationship between food insecurity and (i) kidney disease in children, (ii) kidney stones, (iii) CKD, (iv) cardiorenal syndrome, and (v) end stage renal disease (ESRD). In total, the different research groups enrolled 49,533 subjects, and food insecurity was reported to be a risk factor for hospitalization, kidney stones, CKD, ESRD, and mortality. CONCLUSIONS The relationship between food insecurity and renal disease has been underestimated. Food insecurity is a serious risk factor for health problems in both wealthy and poor populations; however, the true prevalence of the condition is unknown. Healthcare professionals need to take action to prevent the dramatic effect of food insecurity on CKD and on other chronic clinical conditions.
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Affiliation(s)
| | | | - Alessio Di Maria
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Laura Scichilone
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185, Rome , Italy
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Alda Storari
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - Alfredo De Giorgi
- Clinica Medica Unit, University Hospital of Ferrara, 44124, Ferrara, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185, Rome , Italy
| | - Fabio Fabbian
- Renal Unit, University Hospital of Ferrara, 44124, Ferrara, Italy.
- Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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20
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Grimm W, Erdmann B, Grimm K, Kreutz J, Parahuleva M. Prognosis of pacing-dependent patients with cardiovascular implantable electronic devices. Herzschrittmacherther Elektrophysiol 2024; 35:39-45. [PMID: 38294518 PMCID: PMC10879369 DOI: 10.1007/s00399-024-00996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Data on the prognostic significance of pacing dependency in patients with cardiovascular implantable electronic devices (CIEDs) are sparse. METHODS The prognostic significance of pacing dependency defined as absence of an intrinsic rhythm ≥ 30 bpm was determined in 786 patients with CIEDs at the authors' institution using univariate and multivariate regression analysis to identify predictors of all-cause mortality. RESULTS During 49 months median follow-up, death occurred in 63 of 130 patients with pacing dependency compared to 241 of 656 patients without pacing dependency (48% versus 37%, hazard ratio [HR] 1.34; 95% confidence interval [CI]: 1.02-1.78, P = 0.04). Using multivariate regression analysis, predictors of all-cause mortality included age (HR 1.07; 95% CI: 1.05-1.08, P < 0.01), history of atrial fibrillation (HR 1.32, 95% CI: 1.03-1.69, P < 0.01), chronic kidney disease (HR 1.28; 95% CI: 1.00-1.63, P = 0.048) and New York Heart Association (NYHA) class ≥ III (HR 2.00; 95% CI: 1.52-2.62, P < 0.01), but not pacing dependency (HR 1.15; 95% CI: 0.86-1.54, P = 0.35). CONCLUSIONS In contrast to age, atrial fibrillation, chronic kidney disease and heart failure severity as indexed by NYHA functional class III or IV, pacing dependency does not appear to be an independent predictor of all-cause mortality in patients with CIEDs.
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Affiliation(s)
- Wolfram Grimm
- Department of Cardiology, University Hospital of Marburg and Gießen, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany.
| | - Barbara Erdmann
- Department of Cardiology, University Hospital of Marburg and Gießen, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Kathrin Grimm
- Department of Neurology, University Hospital of Erlangen, Erlangen, Germany
| | - Julian Kreutz
- Department of Cardiology, University Hospital of Marburg and Gießen, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
| | - Mariana Parahuleva
- Department of Cardiology, University Hospital of Marburg and Gießen, Philipps-University Marburg, Baldingerstraße, 35033, Marburg, Germany
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Flammia RS, Anceschi U, Tuderti G, Di Maida F, Grosso AA, Lambertini L, Mari A, Mastroianni R, Bove A, Capitanio U, Amparore D, Lee J, Pandolfo SD, Fiori C, Minervini A, Porpiglia F, Eun D, Autorino R, Leonardo C, Simone G. Development and internal validation of a nomogram predicting 3-year chronic kidney disease upstaging following robot-assisted partial nephrectomy. Int Urol Nephrol 2024; 56:913-921. [PMID: 37848745 DOI: 10.1007/s11255-023-03832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Aim of the present study was to develop and validate a nomogram to accurately predict the risk of chronic kidney disease (CKD) upstaging at 3 years in patients undergoing robot-assisted partial nephrectomy (RAPN). METHODS A multi-institutional database was queried to identify patients treated with RAPN for localized renal tumor (cT1-cT2, cN0, cM0). Significant CKD upstaging (sCKD-upstaging) was defined as development of newly onset CKD stage 3a, 3b, and 4/5. Model accuracy was calculated according to Harrell C-index. Subsequently, internal validation using bootstrapping and calibration was performed. Then nomogram was depicted to graphically calculate the 3-year sCKD-upstaging risk. Finally, regression tree analysis identified potential cut-offs in nomogram-derived probability. Based on this cut-off, four risk classes were derived with Kaplan-Meier analysis tested this classification. RESULTS Overall, 965 patients were identified. At Kaplan-Meier analysis, 3-year sCKD-upstaging rate was 21.4%. The model included baseline (estimated glomerular filtration rate) eGFR, solitary kidney status, multiple lesions, R.E.N.A.L. nephrometry score, clamping technique, and postoperative acute kidney injury (AKI). The model accurately predicted 3-year sCKD-upstaging (C-index 84%). Based on identified nomogram cut-offs (7 vs 16 vs 26%), a statistically significant increase in sCKD-upstaging rates between low vs intermediate favorable vs intermediate unfavorable vs high-risk patients (1.3 vs 9.2 vs 22 vs 54.2%, respectively, p < 0.001) was observed. CONCLUSION Herein we introduce a novel nomogram that can accurately predict the risk of sCKD-upstaging at 3 years. Based on this nomogram, it is possible to identify four risk categories. If externally validated, this nomogram may represent a useful tool to improve patient counseling and management.
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Affiliation(s)
- Rocco Simone Flammia
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Luca Lambertini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Jennifer Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Costantino Leonardo
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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Matsukawa A, Morizane S, Shimizu R, Teraoka S, Nishikawa R, Yamaguchi N, Iwamoto H, Hikita K, Honda M, Nonomura N, Takenaka A. Chronic kidney disease and Charlson comorbidity index predict complications after robot-assisted radical cystectomy: A single-center study in Japan. Int J Urol 2024; 31:231-237. [PMID: 37950530 DOI: 10.1111/iju.15337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To investigate preoperative patient factors that may predict the occurrence of perioperative complications following robot-assisted radical cystectomy at a single center in Japan. METHODS From 2013 to 2022, 103 patients underwent RARC at our institution. Complications within 90 days after surgery were assessed using the Clavien-Dindo classification. Preoperative characteristics and surgical outcomes were compared between cohorts with and without complications ≥grade 3. Logistic regression analysis was used to identify the risk factors associated with perioperative complications. RESULTS Overall, 27% of patients (27/103) experienced grade 3 or higher complications. The cohort that developed complications ≥grade 3 exhibited significantly higher Charlson comorbidity index (p = 0.046) and significantly lower estimated glomerular filtration rate (p = 0.048). Charlson comorbidity index ≥2 (p = 0.037) and estimated glomerular filtration rate <53 (p = 0.008) were independent predictors for the occurrence of complications ≥grade 3. The incidence of complications ≥grade 3 was 61.5% in the group possessing both factors, which was significantly higher than those in the groups possessing neither factor nor only one of the two factors. CONCLUSIONS Our results suggest that the Charlson comorbidity index and preoperative estimated glomerular filtration rate may be predictors of perioperative complications. It is important to evaluate the patient's preoperative characteristics and choose the surgical procedure accordingly.
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Affiliation(s)
- Atsuki Matsukawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Noriya Yamaguchi
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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Huang VW, Behairy M, Abelson B, Crane A, Liu W, Wang L, Dell KM, Rhee A. Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients. Pediatr Nephrol 2024; 39:829-835. [PMID: 37658873 DOI: 10.1007/s00467-023-06128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Posterior urethral valves (PUV) is the most common cause of obstructive uropathy in boys; approximately 15% develop kidney failure by early adulthood. However, rates of kidney function decline are poorly defined in PUV children and adults, as is the impact of potentially modifiable chronic kidney disease (CKD) progression risk factors. METHODS We conducted a retrospective review of all PUV patients followed at our institution from 1995 to 2018. Inclusion criteria were estimated glomerular filtration rate (eGFR) > 20 ml/min/1.73 m2 after 1 year of age, no dialysis or kidney transplant history, and ≥ 2 yearly serum creatinine values after age 1 year. eGFRs were calculated using creatinine-based estimating formulas for children (CKID U25) or adults (CKD-EPI). The primary outcome was annualized change in eGFR, assessed with linear mixed effects models. We also examined the association of acute kidney injury (AKI), proteinuria, hypertension (HTN), and recurrent febrile urinary tract infections (UTIs) with eGFR decline. RESULTS Fifty-two PUV patients met the inclusion criteria. Median (interquartile range) eGFR decline was 2.6 (2.1, 3.1) ml/min/1.73 m2/year. Children (n = 35) and adults (n = 17) demonstrated progressive decline. Proteinuria and recurrent UTIs were significantly associated with faster progression; AKI and HTN were also associated but did not reach significance. CONCLUSION PUV patients show progressive loss of kidney function well into adulthood. Proteinuria and recurrent UTIs are associated with faster progression, suggesting potential modifiable risk factors. This is the first study to report annualized eGFR decline rates in PUV patients, which could help inform the design of clinical trials of CKD therapies.
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Affiliation(s)
- Victoria W Huang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mohga Behairy
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | | | - Alice Crane
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Lu Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine M Dell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
- Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
| | - Audrey Rhee
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
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Nayak-Rao S. Profile of chronic kidney disease from a nephrology underserviced region in North Eastern India: a preliminary report from a single center in Assam. Int Urol Nephrol 2024; 56:1103-1108. [PMID: 37642796 DOI: 10.1007/s11255-023-03736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
Chronic kidney disease (CKD) is a worldwide health problem affecting at least 10% of the world's population. CKD represents especially a large burden in low- to middle-income countries that are ill equipped to deal with its consequences. The burden of CKD is increasing in India as well. Although diabetes and hypertension account for much of this burden of CKD, there are regions where a surprisingly high rate of CKD of undetermined etiology (CKD-U) has been described in certain areas of the country. In our observational cross-sectional study, we attempted to look at burden and etiology of CKD in a predominantly rural referral center. Out of 334 patients with diagnosed CKD, of whom 70% were male, included from Oct 2021 to July 2022, CKD-U was the single largest cause of CKD in 154 (46.1%) followed by diabetic nephropathy in 148 (44.3%). 80% of CKD patients presented initially with advanced CKD (stages 4 and 5). Approximately, 2/3rd of CKD patients reported a family income of less than 10,000 Rs/month (< 130USD). Hypertension was seen in 89% of patients in total (73% in CKD-U vs. 100% in other cause CKD). Our initial study brings to focus another new and as yet unrecognized hotspot for CKD-U in the Indian subcontinent. Given the vast diversity in the population in this region and variable delivery health care resources, we believe that concerted efforts should be made by governmental and other agencies to better understand the nature of this undiagnosed CKD epidemic so that adequate preventative strategies can be envisaged.
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Fountoglou A, Deltas C, Siomou E, Dounousi E. Genome-wide association studies reconstructing chronic kidney disease. Nephrol Dial Transplant 2024; 39:395-402. [PMID: 38124660 PMCID: PMC10899781 DOI: 10.1093/ndt/gfad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Indexed: 12/23/2023] Open
Abstract
Chronic kidney disease (CKD) is a major health problem with an increasing epidemiological burden, and is the 16th leading cause of years of life lost worldwide. It is estimated that more than 10% of the population have a variable stage of CKD, while about 850 million people worldwide are affected. Nevertheless, public awareness remains low, clinical access is inappropriate in many circumstances and medication is still ineffective due to the lack of clear therapeutic targets. One of the main issues that drives these problems is the fact that CKD remains a clinical entity with significant causal ambiguity. Beyond diabetes mellitus and hypertension, which are the two major causes of kidney disease, there are still many gray areas in the diagnostic context of CKD. Genetics nowadays emerges as a promising field in nephrology. The role of genetic factors in CKD's causes and predisposition is well documented and thousands of genetic variants are well established to contribute to the high burden of disease. Next-generation sequencing is increasingly revealing old and new rare variants that cause Mendelian forms of chronic nephropathy while genome-wide association studies (GWAS) uncover common variants associated with CKD-defining traits in the general population. In this article we review how GWAS has revolutionized-and continues to revolutionize-the old concept of CKD. Furthermore, we present how the investigation of common genetic variants with previously unknown kidney significance has begun to expand our knowledge on disease understanding, providing valuable insights into disease mechanisms and perhaps paving the way for novel therapeutic targets.
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Affiliation(s)
- Anastasios Fountoglou
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Constantinos Deltas
- School of Medicine and biobank.cy Center of Excellence in Biobanking and Biomedical Research, University of Cyprus, Nicosia 2109, Cyprus
| | - Ekaterini Siomou
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Groen in ‘t Woud S, van Gelder MMHJ, van Rooij IALM, Feitz WFJ, Roeleveld N, Schreuder MF, van der Zanden LFM. Genetic and environmental factors driving congenital solitary functioning kidney. Nephrol Dial Transplant 2024; 39:463-472. [PMID: 37738450 PMCID: PMC10899751 DOI: 10.1093/ndt/gfad202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Congenital solitary functioning kidney (CSFK) is an anomaly predisposing to hypertension, albuminuria and chronic kidney disease. Its aetiology is complex and includes genetic and environmental factors. The role of gene-environment interactions (G×E), although relevant for other congenital anomalies, has not yet been investigated. Therefore, we performed a genome-wide G×E analysis with six preselected environmental factors to explore the role of these interactions in the aetiology of CSFK. METHODS In the AGORA (Aetiologic research into Genetic and Occupational/environmental Risk factors for Anomalies in children) data- and biobank, genome-wide single-nucleotide variant (SNV) data and questionnaire data on prenatal exposure to environmental risk factors were available for 381 CSFK patients and 598 healthy controls. Using a two-step strategy, we first selected independent significant SNVs associated with one of the six environmental risk factors. These SNVs were subsequently tested in G×E analyses using logistic regression models, with Bonferroni-corrected P-value thresholds based on the number of SNVs selected in step one. RESULTS In step one, 7-40 SNVs were selected per environmental factor, of which only rs3098698 reached statistical significance (P = .0016, Bonferroni-corrected threshold 0.0045) for interaction in step two. The interaction between maternal overweight and this SNV, which results in lower expression of the Arylsulfatase B (ARSB) gene, could be explained by lower insulin receptor activity in children heterozygous for rs3098698. Eight other G×E interactions had a P-value <.05, of which two were biologically plausible and warrant further study. CONCLUSIONS Interactions between genetic and environmental factors may contribute to the aetiology of CSFK. To better determine their role, large studies combining data on genetic and environmental risk factors are warranted.
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Affiliation(s)
- Sander Groen in ‘t Woud
- Radboud University Medical Center, Department for Health Evidence, Nijmegen, The Netherlands
- Radboudumc Amalia Children's Hospital, Department of Paediatric Nephrology, Nijmegen, The Netherlands
| | | | - Iris A L M van Rooij
- Radboud University Medical Center, Department for Health Evidence, Nijmegen, The Netherlands
| | - Wout F J Feitz
- Radboudumc Amalia Children's Hospital, Division of Pediatric Urology, Department of Urology, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Radboud University Medical Center, Department for Health Evidence, Nijmegen, The Netherlands
| | - Michiel F Schreuder
- Radboudumc Amalia Children's Hospital, Department of Paediatric Nephrology, Nijmegen, The Netherlands
| | - Loes F M van der Zanden
- Radboud University Medical Center, Department for Health Evidence, Nijmegen, The Netherlands
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Zhang H, Zhang Y, Gao W, Mu Y. Identification of risk factors and development of a predictive model for chronic kidney disease in patients with obesity: a four-year cohort study. Lipids Health Dis 2024; 23:57. [PMID: 38389088 PMCID: PMC10882765 DOI: 10.1186/s12944-024-02048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The sneaky onset and dismal prognosis of chronic kidney disease (CKD) make it an important public health issue. Obesity-related kidney illness has garnered more attention in recent times. Establishing and validating a risk prediction model for chronic renal illness in overweight or obese adults was the goal of this investigation. METHODS Data from the China Health and Retirement Longitudinal Study were used for analysis. The definition of CKD was reduced renal function (eGFR < 60 mL/min/1.73 m²), while overweight and obesity were characterized through a body mass index exceeding 24 kg/m². The dataset was divided into derivation and validation cohorts using a 7:3 ratio. With respect to the derivation cohort, we constructed a prediction model using LASSO analysis and multivariate logistic regression. The model's performance was evaluated using Hosmer-Lemeshow tests, calibration curves, decision curve analysis, and receiver operating characteristic (ROC) curves. The validation cohort's model was subjected to additional assessment. RESULTS The study was based on survey data from 2011 to 2015 and comprised 3246 individuals who were overweight or obese, with 2274 being part of the derivation cohort and 972 being part of the validation cohort. The research constructed a prediction model that included age, sex, fasting blood glucose, glycated hemoglobin, triglyceride, hypertension, and BMI. The validation cohort's area under the ROC curve was 0.812 (95% CI = 0.763, 0.859) while the derivation cohort's was 0.789 (95% CI = 0.754, 0.831). Hosmer-Lemeshow tests were utilized to evaluate the model's accuracy in the validation and derivation cohorts (P = 0.681 and 0.547, respectively). The calibration curve showed a high level of consistency between the actual observations and the projected outcomes. According to decision curve analysis, the model offered significant net advantages. CONCLUSIONS The forecasting model established in this research has predictive value for CKD in patients with overweight or obesity. These findings could help doctors conduct early detection and intervention in clinical practice and further improve patient prognosis.
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Affiliation(s)
- Haixia Zhang
- PLA Medical school, Beijing, China
- Department of Endocrinology, the First Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - Yue Zhang
- PLA Medical school, Beijing, China
- Department of Endocrinology, the First Medical Center of People's Liberation Army General Hospital, Beijing, China
| | | | - Yiming Mu
- Department of Endocrinology, the First Medical Center of People's Liberation Army General Hospital, Beijing, China.
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
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Ali M, Koo K, Chang D, Chan P, Oon SF, Moon D, Murphy DG, Eapen R, Goad J, Lawrentschuk N, Azad AA, Chander S, Shaw M, Hardcastle N, Siva S. Low rate of severe-end-stage kidney disease after SABR for localised primary kidney cancer. Radiat Oncol 2024; 19:23. [PMID: 38355495 PMCID: PMC10868020 DOI: 10.1186/s13014-024-02413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is an emerging treatment for patients with primary renal cell carcinoma (RCC). However, its impact on renal function is unclear. This study aimed to evaluate incidence and clinical factors predictive of severe to end-stage chronic kidney disease (CKD) after SABR for RCC. METHODS AND MATERIALS This was a Single institutional retrospective analysis of patients with diagnosed primary RCC receiving SABR between 2012-2020. Adult patients with no metastatic disease, baseline estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min/1.73 m2, and at least one post-SABR eGFR at six months or later were included in this analysis. Patients with upper tract urothelial carcinoma were excluded. Primary outcome was freedom from severe to end-stage CKD, determined using the Kaplan-Meier estimator. The impact of baseline CKD, age, hypertension, diabetes, tumor size and fractionation schedule were assessed by Cox proportional hazard models. RESULTS Seventy-eight consecutive patients were included, with median age of 77.8 years (IQR 70-83), tumor size of 4.5 cm (IQR 3.9-5.8) and follow-up of 42.2 months (IQR 23-60). Baseline median eGFR was 58 mls/min; 55% (n = 43) of patients had baseline CKD stage 3 and the remainder stage 1-2. By last follow-up, 1/35 (2.8%) of baseline CKD 1-2, 7/27 (25.9%) CKD 3a and 11/16 (68.8%) CKD 3b had developed CKD stage 4-5. The estimated probability of freedom from CKD stage 4-5 at 1 and 5 years was 89.6% (CI 83.0-97.6) and 65% (CI 51.4-81.7) respectively. On univariable analysis, worse baseline CKD (p < 0.0001) and multi-fraction SABR (p = 0.005) were predictive for development of stage 4-5 CKD though only the former remained significant in multivariable model. CONCLUSION In this elderly cohort with pre-existing renal dysfunction, SABR achieved satisfactory nephron sparing with acceptable rates of severe to end-stage CKD. It can be an attractive option in patients who are medically inoperable.
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Affiliation(s)
- Muhammad Ali
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Kendrick Koo
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Chang
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Phil Chan
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sheng F Oon
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Renu Eapen
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jeremy Goad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Arun A Azad
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sarat Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Clinical Pathology, University of Melbourne, Melbourne, Australia
| | - Mark Shaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Heo GY, Koh HB, Park JT, Han SH, Yoo TH, Kang SW, Kim HW. Sweetened Beverage Intake and Incident Chronic Kidney Disease in the UK Biobank Study. JAMA Netw Open 2024; 7:e2356885. [PMID: 38416492 PMCID: PMC10902724 DOI: 10.1001/jamanetworkopen.2023.56885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/27/2023] [Indexed: 02/29/2024] Open
Abstract
Importance An increasing body of evidence indicates an association between consuming sugar or its alternatives and cardiometabolic diseases. However, the effects of the consumption of sugar-sweetened beverages, artificially sweetened beverages, and natural juices on kidney health remain unclear. Objective To investigate the association of the intake of sugar-sweetened beverages, artificially sweetened beverages, and natural juices with the risk of chronic kidney disease (CKD), and the effect of substituting these beverage types for one another on this association. Design, Setting, and Participants This prospective, population-based cohort study analyzed data from the UK Biobank. Participants without a history of CKD who completed at least 1 dietary questionnaire were included. The follow-up period was from the date of the last dietary questionnaire until October 31, 2022, in England; July 31, 2021, in Scotland; and February 28, 2018, in Wales. Data were analyzed from May 1 to August 1, 2023. Exposures Consumption of sugar-sweetened beverages, artificially sweetened beverages, and natural juices. Main Outcomes and Measures The primary outcome was incident CKD. Multivariable Cox proportional hazards models were used to estimate the associations between the 3 beverage types and incident CKD. A substitution analysis was used to evaluate the effect on the associations of substituting one beverage type for another. Results A total of 127 830 participants (mean [SD] age, 55.2 [8.0] years; 66 180 female [51.8%]) were included in the primary analysis. During a median (IQR) follow-up of 10.5 (10.4-11.2) years, 4459 (3.5%) cases of incident CKD occurred. The consumption of more than 1 serving per day of sugar-sweetened beverages was associated with higher risk of incident CKD (adjusted hazard ratio [AHR], 1.19 [95% CI, 1.05-1.34]) compared with not consuming sugar-sweetened beverages. The AHR for participants consuming more than 0 to 1 serving per day of artificially sweetened beverages was 1.10 (95% CI, 1.01-1.20) and for consuming more than 1 serving per day was 1.26 (95% CI, 1.12-1.43) compared with consuming no artificially sweetened beverages. By contrast, there was no significant association between natural juice intake and incident CKD (eg, for >1 serving per day: HR, 0.99 [95% CI, 0.87-1.11]; P = .10). Substituting sugar-sweetened beverages with artificially sweetened beverages did not show any significant difference in the risk of CKD (HR, 1.03 [95% CI, 0.96-1.10]). Conversely, replacing 1 serving per day of sugar-sweetened beverage with natural juice (HR, 0.93 [95% CI, 0.87-0.97]) or water (HR, 0.93 [95% CI, 0.88-0.99]) or replacing 1 serving per day of artificially sweetened beverage with natural juice (HR, 0.90 [95% CI, 0.84-0.96]) or water (HR, 0.91 [95% CI, 0.86-0.96]) was associated with a reduced risk of incident CKD. Conclusions and Relevance Findings from this cohort study suggest that lower consumption of sugar-sweetened beverages or artificially sweetened beverages may reduce the risk of developing CKD.
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Affiliation(s)
- Ga Young Heo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Byung Koh
- Division of Nephrology, International Saint Mary’s Hospital, Catholic Kwandong University, Incheon, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
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Wang J, Zhu H, Miao J, Lin W, Han F. Bilateral Renal Ischemia-Reperfusion Model for Acute Kidney Injury in Mice. J Vis Exp 2024. [PMID: 38372356 DOI: 10.3791/65838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Acute kidney injury (AKI) is defined as a rapid decline in renal function, in which persistent kidney dysfunction gradually progresses to chronic kidney disease (CKD) due to the irreversible loss of nephrons and their maladaptive repair. In recent years, the incidence of AKI has been increasing concerning diverse etiologies, including volume depletion, sepsis, nephrotoxicity, muscle injury, and major trauma, in which ischemia-reperfusion injury (IRI) accounts for most episodes. Development of the IRI model in mice is induced by surgical clamping of the renal pedicles, which provides powerful and controllable tools for preclinical models of AKI. Importantly, the IRI model is deployed at different stages of the AKI development, especially in the processes of AKI to CKD. Despite the IRI model being widely practiced in many laboratories, a series of variables still influence the results of this model. Here, we describe the procedure of IRI model development to provide a repeatable and reliable method for researchers to explore the underlying pathogenesis in the development of AKI and the progression of AKI to CKD.
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Affiliation(s)
- Junni Wang
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine
| | - Huanhuan Zhu
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine
| | - Jin Miao
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine
| | - Weiqiang Lin
- International Institute of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine;
| | - Fei Han
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine;
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Liu W, Zhang D, Wang R, Chen J, Zhang J, Tao D, Liu C. Global trends in the burden of chronic kidney disease attributable to type 2 diabetes: An age-period-cohort analysis. Diabetes Obes Metab 2024; 26:602-610. [PMID: 37936340 DOI: 10.1111/dom.15349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023]
Abstract
AIM To assess temporal trends of chronic kidney disease (CKD) attributable to type 2 diabetes (T2D) globally and in five sociodemographic index (SDI) regions. MATERIALS AND METHODS We extracted the population data and CKD burden attributable to T2D from the Global Burden of Disease Study 2019. We evaluated the trends of disability-adjusted life years (DALYs), mortality, prevalence and incidence through age-period-cohort modelling, and calculated net drifts (overall annual percentage changes), local drifts (annual percentage changes in each age group), longitudinal age curves (fitted longitudinal age-specific rates), period relative risks (RRs) and cohort RRs. RESULTS From 1990 to 2019, the global burden of CKD attributable to T2D showed increasing trends in general. The burden of CKD attributable to T2D was highest in the middle SDI region and lowest in the low SDI region. Age effects increased with age, and peaked at the ages of 75-79 and 80-84 years for incidence and prevalence, respectively. Period RRs in the burden of CKD attributable to T2D increased, with the high SDI being the most remarkable in DALYs and mortality, and the middle SDI being the most notable in incidence. Cohort RRs showed unfavourable trends in incidence and prevalence among recent cohorts. CONCLUSIONS After a lengthy period of multi-initiative diabetes management, the high-middle SDI region exhibited improvement. However, unresolved issues and improvement gaps were still remarkable. Future efforts to reduce the burden of CKD attributable to T2D in the population should prioritize addressing the unfavourable patterns identified.
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Affiliation(s)
- Wenli Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Duo Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruobing Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junhui Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiaqi Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Di Tao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chaonan Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Iqbal J, Wu HX, Nawaz MA, Jiang HL, Xu SN, Huang BL, Li L, Cai JM, Zhou HD. Risk of incident chronic kidney disease in metabolically healthy obesity and metabolically unhealthy normal weight: A systematic review and meta-analysis. Obes Rev 2024; 25:e13656. [PMID: 37904643 DOI: 10.1111/obr.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Abstract
Studies have reported inconsistent results about the risk of incident chronic kidney disease (CKD) in people with metabolically healthy obesity (MHO). We designed this systematic review and meta-analysis to evaluate the risk of developing CKD in people with MHO and metabolically unhealthy normal weight (MUNW). We used a predefined search strategy to retrieve eligible studies from multiple databases up to June 20, 2022. Random-effects model meta-analyses were implied to estimate the overall hazard ratio (HR) of incident CKD in obesity phenotypes. Eight prospective cohort studies, including approximately 5 million participants with a median follow-up ranging between 3 and 14 years, were included in this meta-analysis. Compared to the metabolically healthy normal weight (MHNW), the mean differences in cardiometabolic and renal risk factors in MHO, MUNW, and metabolically unhealthy obesity (MUO) were evaluated with overall HR of 1.42, 1.49, and 1.84, respectively. Compared to MHNW, the mean estimated glomerular filtration rate (eGFR) and high-density lipoprotein (HDL) were significantly lower, and low-density lipoprotein (LDL), blood pressure, blood glucose, and triglycerides were higher in MHO and MUNW. In conclusion, MHO and MUNW are not benign conditions and pose a higher risk for incident CKD. Obesity, whether in the presence or absence of metabolic health, is a risk factor for CKD.
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Affiliation(s)
- Junaid Iqbal
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui-Xuan Wu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Hong-Li Jiang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Na Xu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bi-Ling Huang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Long Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun-Min Cai
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hou-De Zhou
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
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Vandewiele S, Herman J, van den Heuvel L, Knops N. A longitudinal study of long-term renal outcome after pediatric liver transplantation in relation to CNI exposure. Pediatr Transplant 2024; 28:e14677. [PMID: 38149466 DOI: 10.1111/petr.14677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/08/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is reported in 20%-30% of children after liver transplantation (LT). One of the proposed underlying causes is the long-term exposure to tacrolimus, a calcineurin inhibitor (CNI), which is the main immunosuppressive drug used after LT. Variation in tacrolimus absolute exposure and relative dose requirements are believed to be important risk factors for developing CNI-associated nephrotoxicity. AIM To describe the long-term renal outcome of pediatric LT recipients and determine the effects of tacrolimus exposure on renal outcome parameters. METHODS Retrospective single center study of renal function (GFR, proteinuria) and pharmacokinetic parameters (C0 , AUC0-12h ) obtained during annual follow-up in children after liver transplantation, between 1998 and 2019. Relevant pharmacogenetic variants for tacrolimus disposition (CYP3A5 and ABCB1) were determined in recipients and donors. The evolution of individual renal function and tacrolimus exposure was evaluated using linear mixed models for repeated measurements. RESULTS Twenty-six children were included (mean follow-up: 10.4 years (range 2-18.9)). Mean estimated GFR was 109.3 (SE: 7.4), vs. measured: 91.3 mL/min/1.73 m2 (SE: 6.3), which remained stable during follow-up. CKD stage ≥2 was observed in 32.8% of the visits based on eGFR versus 50.0% on mGFR. CKD stage ≥3 was uncommon (4.1% and 6.2% resp.). Mean tacrolimus C0 was 5.3 ng/mL (SE: 2.5) with a AUC0-12h of 72.7 ng*h/mL (SE: 30.3), which demonstrated a small decrease during follow-up. There was a negative correlation between C0 and mGFR (rS = -0.3; p < .001). We found no correlation between GFR and tacrolimus dose requirements ((ng/mL)/(mg/kg)) or pharmacogenetic background. CONCLUSION Renal function during long-term follow-up after pediatric LT remained stable for the majority of our cohort. However, mild CKD was relatively common, warranting follow-up into adulthood. Although absolute tacrolimus exposure has a small depressing effect on concurrent GFR, there is no progressive deterioration of GFR due to long-term exposure, dose requirements or genetic background under the current target levels. These findings should be confirmed in a larger sample set, ideally including data from multiple centers.
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Affiliation(s)
- Simon Vandewiele
- Department of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Jean Herman
- Department of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Catholic University Leuven, Leuven, Belgium
| | - Lambert van den Heuvel
- Department of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Catholic University Leuven, Leuven, Belgium
| | - Noël Knops
- Department of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Groene Hart Ziekenhuis, Gouda, The Netherlands
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Chen S, Chen J, Zhang J, Wang K, Wei J, Weng M, Zhu L. Comparison of RLP and PCNL for large pelvis calculi with CKD. MINIM INVASIV THER 2024; 33:51-57. [PMID: 38147882 DOI: 10.1080/13645706.2023.2286241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/23/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To compare the effect and safety of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for large pelvis calculi with chronic kidney disease (CKD). MATERIAL AND METHODS Between June 2017 and July 2021, 62 patients with CKD and large renal pelvis calculi (>4 cm2) were treated with RLP. Another 62 patients receiving PCNL served as controls. The perioperative parameters were compared. All patients were followed up for at least 6 months with the stone-free rate and the recovery of renal function evaluated. RESULTS Significantly longer operation time (101.47 ± 9.25 vs 62.55 ± 7.54 min), less drop in hemoglobin level (0.90 ± 0.38 vs 2.13 ± 0.80 g/dl), staged operations (0% vs 12.9%), postoperative fever (3.23% vs 16.13%) and delayed bowel movement (3.23% vs 14.52), and shorter hospitalization time (3.90 ± 1.66 vs 4.72 ± 1.80 days) were observed in the RLP group (p < 0.05). The stone-free rates were 100% in the RLP group and 88.7% in the PCNL group at the 3-months follow-up (p < 0.05). The serum creatinine level was significantly lower in the RLP group at 24 h (2.81 ± 1.18 vs 3.00 ± 1.15 mg/dl) and 1 week (2.08 ± 1.13 vs 2.34 ± 1.01 mg/dl) postoperatively (p < 0.05). CONCLUSIONS Although associated with a longer operation time, RLP is a safer and more efficient surgical option for CKD patients with large pelvic stones than PCNL.
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Affiliation(s)
- Shushang Chen
- Department of Urology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Jin Chen
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Institute of Transplantation Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jianping Zhang
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, Affiliated Haixia Hospital of Huaqiao University, Quanzhou, China
| | - Kuanyin Wang
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Junjie Wei
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Mingfang Weng
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Lingfeng Zhu
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
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Gonzalez-Quiroz M, Heggeseth B, Camacho A, Oomatia A, Al-Rashed AM, Zhang Y, McCreight A, Jewell N, Aragon A, Nitsch D, Pearce N, Caplin B. Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy. Int J Epidemiol 2024; 53:dyad151. [PMID: 37930052 PMCID: PMC10859140 DOI: 10.1093/ije/dyad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Mesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population. METHODS Two community-based cohorts (adults aged 18-30 years, n = 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model. RESULTS CKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy) occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy) in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use. CONCLUSIONS CKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Department of Renal Medicine, University College London, London, UK
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Brianna Heggeseth
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Armando Camacho
- Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua, León (UNAN-Leon), León, Nicaragua
| | - Amin Oomatia
- Department of Renal Medicine, University College London, London, UK
| | - Ali M Al-Rashed
- Department of Renal Medicine, University College London, London, UK
| | - Yixuan Zhang
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Alexander McCreight
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Nicholas Jewell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurora Aragon
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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Beamish JA, Telang AC, McElliott MC, Al-Suraimi A, Chowdhury M, Ference-Salo JT, Otto EA, Menon R, Soofi A, Weinberg JM, Patel SR, Dressler GR. Pax protein depletion in proximal tubules triggers conserved mechanisms of resistance to acute ischemic kidney injury preventing transition to chronic kidney disease. Kidney Int 2024; 105:312-327. [PMID: 37977366 PMCID: PMC10958455 DOI: 10.1016/j.kint.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Acute kidney injury (AKI) is a common condition that lacks effective treatments. In part, this shortcoming is due to an incomplete understanding of the genetic mechanisms that control pathogenesis and recovery. Identifying the molecular and genetic regulators unique to nephron segments that dictate vulnerability to injury and regenerative potential could lead to new therapeutic targets to treat ischemic kidney injury. Pax2 and Pax8 are homologous transcription factors with overlapping functions that are critical for kidney development and are re-activated in AKI. Here, we examined the role of Pax2 and Pax8 in recovery from ischemic AKI and found them upregulated after severe AKI and correlated with chronic injury. Surprisingly, proximal-tubule-selective deletion of Pax2 and Pax8 resulted in a less severe chronic injury phenotype. This effect was mediated by protection against the acute insult, similar to pre-conditioning. Prior to injury, Pax2 and Pax8 mutant mice develop a unique subpopulation of proximal tubule cells in the S3 segment that displayed features usually seen only in acute or chronic injury. The expression signature of these cells was strongly enriched with genes associated with other mechanisms of protection against ischemic AKI including caloric restriction, hypoxic pre-conditioning, and female sex. Thus, our results identified a novel role for Pax2 and Pax8 in mature proximal tubules that regulates critical genes and pathways involved in both the injury response and protection from ischemic AKI.
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Affiliation(s)
- Jeffrey A Beamish
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Asha C Telang
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Madison C McElliott
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anas Al-Suraimi
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mahboob Chowdhury
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenna T Ference-Salo
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Edgar A Otto
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rajasree Menon
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Abdul Soofi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joel M Weinberg
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjeevkumar R Patel
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gregory R Dressler
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
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Li J, Guan Y, Xu Y, Cao Y, Xie Q, Harris RC, Breyer MD, Lu L, Hao CM. Prostacyclin Mitigates Renal Fibrosis by Activating Fibroblast Prostaglandin I 2 Receptor. J Am Soc Nephrol 2024; 35:149-165. [PMID: 38062563 PMCID: PMC10843231 DOI: 10.1681/asn.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/21/2023] [Indexed: 01/06/2024] Open
Abstract
SIGNIFICANCE STATEMENT Renal fibrosis is a common pathologic process of progressive CKD. We have provided strong evidence that PGI 2 is an important component in the kidney injury/repairing process by reducing fibrosis and protecting renal function from declining. In our study, administration of a PGI 2 analog or selective PTGIR agonist after the acute injury ameliorated renal fibrosis. Our findings provide new insights into the role of PGI 2 in kidney biology and suggest that targeting PGI 2 /PTGIR may be a potential therapeutic strategy for CKD. BACKGROUND Prostanoids have been demonstrated to be important modulators to maintain tissue homeostasis in response to physiologic or pathophysiologic stress. Prostacyclin (PGI 2 ) is a member of prostanoids. While limited studies have shown that PGI 2 is involved in the tissue injury/repairing process, its role in renal fibrosis and CKD progression requires further investigation. METHODS Prostacyclin synthase ( Ptgis )-deficient mice, prostaglandin I 2 receptor ( Ptgir )-deficient mice, and an oral PGI 2 analog and selective PTGIR agonist were used to examine the role of PGI 2 in renal fibrosis in mouse models. We also analyzed the single-cell RNA-Seq data to examine the PTGIR -expressing cells in the kidneys of patients with CKD. RESULTS Increased PTGIS expression has been observed in fibrotic kidneys in both humans and mice. Deletion of the PTGIS gene aggravated renal fibrosis and decline of renal function in murine models. A PGI 2 analog or PTGIR agonist that was administered after the acute injury ameliorated renal fibrosis. PTGIR, the PGI 2 receptor, deficiency blunted the protective effect of the PGI 2 analog. Fibroblasts and myofibroblasts were the major cell types expressing PTGIR in the kidneys of patients with CKD. Deletion of PTGIR in collagen-producing fibroblastic cells aggravated renal fibrosis. The protective effect of PGI 2 was associated with the inhibition of fibroblast activation through PTGIR-mediated signaling. CONCLUSIONS PGI 2 is an important component in the kidney injury/repairing process by preventing the overactivation of fibroblasts during the repairing process and protecting the kidney from fibrosis and decline of renal function. Our findings suggest that PGI 2 /PTGIR is a potential therapeutic target for CKD.
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Affiliation(s)
- Jing Li
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Guan
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunyu Xu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yingxue Cao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Raymond C. Harris
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew D. Breyer
- Cardiovascular and Metabolic Research, Janssen Research and Development LLC, Boston, Massachusetts
| | - Limin Lu
- Department of Physiology and Pathophysiology, Fudan University School of Basic Medical Sciences, Shanghai, China
| | - Chuan-Ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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Tsur AM, Akavian I, Landau R, Derazne E, Tzur D, Vivante A, Grossman E, Rotem RS, Fishman B, Pinhas-Hamiel O, Afek A, Coresh J, Chodick G, Twig G. Adolescent Body Mass Index and Early Chronic Kidney Disease in Young Adulthood. JAMA Pediatr 2024; 178:142-150. [PMID: 38079159 PMCID: PMC10714283 DOI: 10.1001/jamapediatrics.2023.5420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/03/2023] [Indexed: 02/06/2024]
Abstract
Importance Despite increasing obesity rates in adolescents, data regarding early kidney sequelae are lacking. Objective To assess the association between adolescent body mass index (BMI) and early chronic kidney disease (CKD) in young adulthood (<45 years of age). Design, Setting, and Participants This cohort study linked screening data of mandatory medical assessments of Israeli adolescents to data from a CKD registry of a national health care system. Adolescents who were aged 16 to 20 years; born since January 1, 1975; medically evaluated for mandatory military service through December 31, 2019; and insured by Maccabi Healthcare Services were assessed. Individuals with kidney pathology, albuminuria, hypertension, dysglycemia, or missing blood pressure or BMI data were excluded. Body mass index was calculated as weight in kilograms divided by height in meters squared and categorized by age- and sex-matched percentiles according to the US Centers for Disease Control and Prevention. Follow-up started at the time of medical evaluation or January 1, 2000 (whichever came last), and ended at early CKD onset, death, the last day insured, or August 23, 2020 (whichever came first). Data analysis was performed from December 19, 2021, to September 11, 2023. Main Outcomes and Measures Early CKD, defined as stage 1 to 2 CKD by moderately or severely increased albuminuria, with an estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher. Results Of 629 168 adolescents evaluated, 593 660 (mean [SD] age at study entry, 17.2 [0.5] years; 323 293 [54.5%] male, 270 367 [45.5%] female) were included in the analysis. During a mean (SD) follow-up of 13.4 (5.5) years for males and 13.4 (5.6) years for females, 1963 adolescents (0.3%) developed early CKD. Among males, the adjusted hazard ratios were 1.8 (95% CI, 1.5-2.2) for adolescents with high-normal BMI, 4.0 (95% CI, 3.3-5.0) for those with overweight, 6.7 (95% CI, 5.4-8.4) for those with mild obesity, and 9.4 (95% CI, 6.6-13.5) for those with severe obesity. Among females, the hazard ratios were 1.4 (95% CI, 1.2-1.6) for those with high-normal BMI, 2.3 (95% CI, 1.9-2.8) for those with overweight, 2.7 (95% CI, 2.1-3.6) for those with mild obesity, and 4.3 (95% CI, 2.8-6.5) for those with severe obesity. The results were similar when the cohort was limited to individuals who were seemingly healthy as adolescents, individuals surveyed up to 30 years of age, or those free of diabetes and hypertension at the end of the follow-up. Conclusions and Relevance In this cohort study, high BMI in late adolescence was associated with early CKD in young adulthood. The risk was also present in seemingly healthy individuals with high-normal BMI and before 30 years of age, and a greater risk was seen among those with severe obesity. These findings underscore the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI.
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Affiliation(s)
- Avishai M. Tsur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Tel HaShomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Akavian
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Regev Landau
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Tel HaShomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Estela Derazne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Tzur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Asaf Vivante
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Ehud Grossman
- Department of Medicine, Sheba Medical Center, Tel HaShomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran S. Rotem
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Boris Fishman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Cardiology, Sheba Medical Center, Tel HaShomer, Israel
| | - Orit Pinhas-Hamiel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Arnon Afek
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gabriel Chodick
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gilad Twig
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
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Rashidi MM, Saeedi Moghaddam S, Azadnajafabad S, Heidari-Foroozan M, Haddadi M, Sharifnejad Tehrani Y, Keykhaei M, Ghasemi E, Mohammadi E, Ahmadi N, Malekpour MR, Mohammadi Fateh S, Rezaei N, Mehrazma M, Larijani B, Farzadfar F. Burden and quality of care index of chronic kidney disease: Global Burden of Disease analysis for 1990-2019. Nephrol Dial Transplant 2024; 39:317-327. [PMID: 37587021 DOI: 10.1093/ndt/gfad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) imposes a heavy obscure burden on individuals and health systems. Besides its burden, the quality of care of CKD is less well investigated. In this study, we aimed to explore the global, regional and national trends of CKD burden and quality of care. METHODS The Global Burden of Disease Study 2019 data were used. Trends of incidence, prevalence, deaths and disability-adjusted life years were studied for the 1990-2019 period in the global aspect. By generating four secondary indices to assess different aspects of quality of care the quality of care index (QCI) was developed to explore the care provided for CKD. Inequities and disparities between various geographic, socio-demographic and age stratifications, and sex were studied using the QCI values. RESULTS In 2019, there were 18 986 903 (95% uncertainty interval 17 556 535 to 20 518 156) incident cases of CKD, globally. The overall global QCI score had increased slightly from 78.4 in 1990 to 81.6 in 2019, and it was marginally better in males (QCI score 83.5) than in females (80.3). The highest QCI score was observed in the European region with a score of 92.5, while the African region displayed the lowest QCI with 61.7. Among the age groups, the highest QCI was for children aged between 5 and 9 years old (92.0), and the lowest was in the age group of 20-24 year olds (65.5). CONCLUSIONS This study revealed that significant disparities remain regarding the quality of care of CKD, and to reach better care for CKD, attention to and care of minorities should be reconsidered. The evidence presented in this study would benefit health policymakers toward better and more efficient control of CKD burden alongside improving the care of this condition.
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Affiliation(s)
- Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Heidari-Foroozan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Center Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Sharifnejad Tehrani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL, USA
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Mehrazma
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Tain YL, Hou CY, Chang-Chien GP, Lin S, Hsu CN. Perinatal Use of Citrulline Rescues Hypertension in Adult Male Offspring Born to Pregnant Uremic Rats. Int J Mol Sci 2024; 25:1612. [PMID: 38338891 PMCID: PMC10855562 DOI: 10.3390/ijms25031612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
The growing recognition of the association between maternal chronic kidney disease (CKD) and fetal programming highlights the increased vulnerability of hypertension in offspring. Potential mechanisms involve oxidative stress, dysbiosis in gut microbiota, and activation of the renin-angiotensin system (RAS). Our prior investigation showed that the administration of adenine to pregnant rats resulted in the development of CKD, ultimately causing hypertension in their adult offspring. Citrulline, known for enhancing nitric oxide (NO) production and possessing antioxidant and antihypertensive properties, was explored for its potential to reverse high blood pressure (BP) in offspring born to CKD dams. Male rat offspring, both from normal and adenine-induced CKD models, were randomly assigned to four groups (8 animals each): (1) control, (2) CKD, (3) citrulline-treated control rats, and (4) citrulline-treated CKD rats. Citrulline supplementation successfully reversed elevated BP in male progeny born to uremic mothers. The protective effects of perinatal citrulline supplementation were linked to an enhanced NO pathway, decreased expression of renal (pro)renin receptor, and changes in gut microbiota composition. Citrulline supplementation led to a reduction in the abundance of Monoglobus and Streptococcus genera and an increase in Agothobacterium Butyriciproducens. Citrulline's ability to influence taxa associated with hypertension may be linked to its protective effects against maternal CKD-induced offspring hypertension. In conclusion, perinatal citrulline treatment increased NO availability and mitigated elevated BP in rat offspring from uremic mother rats.
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Affiliation(s)
- You-Lin Tain
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330, Taiwan
| | - Chih-Yao Hou
- Department of Seafood Science, National Kaohsiung University of Science and Technology, Kaohsiung 811, Taiwan;
| | - Guo-Ping Chang-Chien
- Institute of Environmental Toxin and Emerging-Contaminant, Cheng Shiu University, Kaohsiung 833, Taiwan; (G.-P.C.-C.); (S.L.)
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Sufan Lin
- Institute of Environmental Toxin and Emerging-Contaminant, Cheng Shiu University, Kaohsiung 833, Taiwan; (G.-P.C.-C.); (S.L.)
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Chien-Ning Hsu
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
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Wang X, Chen L, Shi K, Lv J, Sun D, Pei P, Yang L, Chen Y, Du H, Liu J, Yang X, Barnard M, Chen J, Chen Z, Li L, Yu C. Diabetes and chronic kidney disease in Chinese adults: a population-based cohort study. BMJ Open Diabetes Res Care 2024; 12:e003721. [PMID: 38267203 PMCID: PMC10823934 DOI: 10.1136/bmjdrc-2023-003721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Cohort evidence of the association of diabetes mellitus (DM) with chronic kidney disease (CKD) is limited. Previous studies often describe patients with kidney disease and diabetes as diabetic kidney disease (DKD) or CKD, ignoring other subtypes. The present study aimed to assess the prospective association of diabetes status (no diabetes, pre-diabetes, screened diabetes, previously diagnosed controlled/uncontrolled diabetes with/without antidiabetic treatment) and random plasma glucose (RPG) with CKD risk (including CKD subtypes) among Chinese adults. RESEARCH DESIGN AND METHODS The present study included 472 545 participants from the China Kadoorie Biobank, using baseline information on diabetes and RPG. The incident CKD and its subtypes were collected through linkage with the national health insurance system during follow-up. Cox regression models were used to calculate the HR and 95% CI. RESULTS During 11.8 years of mean follow-up, 5417 adults developed CKD. Screened plus previously diagnosed diabetes was positively associated with CKD (HR=4.52, 95% CI 4.23 to 4.83), DKD (HR=33.85, 95% CI 29.56 to 38.76), and glomerulonephritis (HR=1.66, 95% CI 1.40 to 1.97). In those with previously diagnosed diabetes, participants with uncontrolled diabetes represented higher risks of CKD, DKD, and glomerulonephritis compared with those with controlled RPG. The risk of DKD was found to rise in participants with pre-diabetes and increased with the elevated RPG level, even in those without diabetes. CONCLUSIONS Among Chinese adults, diabetes was positively associated with CKD, DKD, and glomerulonephritis. Screen-detected and uncontrolled DM had a high risk of CKD, and pre-diabetes was associated with a greater risk of DKD, highlighting the significance of lifelong glycemic management.
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Affiliation(s)
- Xue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Kexiang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jiaqiu Liu
- NCDs Prevention and Control Department, Pengzhou CDC, Pengzhou, China
| | - Xiaoming Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maxim Barnard
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Khan MAH, Nolan B, Stavniichuk A, Merk D, Imig JD. Dual soluble epoxide hydrolase inhibitor - farnesoid X receptor agonist interventional treatment attenuates renal inflammation and fibrosis. Front Immunol 2024; 14:1269261. [PMID: 38235144 PMCID: PMC10791967 DOI: 10.3389/fimmu.2023.1269261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Renal fibrosis associated with inflammation is a critical pathophysiological event in chronic kidney disease (CKD). We have developed DM509 which acts concurrently as a farnesoid X receptor agonist and a soluble epoxide hydrolase inhibitor and investigated DM509 efficacy as an interventional treatment using the unilateral ureteral obstruction (UUO) mouse model. Methods Male mice went through either UUO or sham surgery. Interventional DM509 treatment (10mg/kg/d) was started three days after UUO induction and continued for 7 days. Plasma and kidney tissue were collected at the end of the experimental protocol. Results UUO mice demonstrated marked renal fibrosis with higher kidney hydroxyproline content and collagen positive area. Interventional DM509 treatment reduced hydroxyproline content by 41% and collagen positive area by 65%. Renal inflammation was evident in UUO mice with elevated MCP-1, CD45-positive immune cell positive infiltration, and profibrotic inflammatory gene expression. DM509 treatment reduced renal inflammation in UUO mice. Renal fibrosis in UUO was associated with epithelial-to-mesenchymal transition (EMT) and DM509 treatment reduced EMT. UUO mice also had tubular epithelial barrier injury with increased renal KIM-1, NGAL expression. DM509 reduced tubular injury markers by 25-50% and maintained tubular epithelial integrity in UUO mice. Vascular inflammation was evident in UUO mice with 9 to 20-fold higher ICAM and VCAM gene expression which was reduced by 40-50% with DM509 treatment. Peritubular vascular density was reduced by 35% in UUO mice and DM509 prevented vascular loss. Discussion Interventional treatment with DM509 reduced renal fibrosis and inflammation in UUO mice demonstrating that DM509 is a promising drug that combats renal epithelial and vascular pathological events associated with progression of CKD.
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Affiliation(s)
- Md. Abdul Hye Khan
- Drug Discovery Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Benjamin Nolan
- Drug Discovery Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Anna Stavniichuk
- Drug Discovery Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Integrative Biology and Pharmacology, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Daniel Merk
- Department of Pharmacy, Ludwig-Maximilians Universität München, Munich, Germany
| | - John D. Imig
- Drug Discovery Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Tang R, Chen J, Zhou Q, Deng J, Zhan X, Wang X, Wen Y, Su N, Feng X, Xu Q. Association between systemic immune inflammation Index and all-cause mortality in incident peritoneal dialysis-treated CKD patients: a multi-center retrospective cohort study. BMC Nephrol 2024; 25:8. [PMID: 38172773 PMCID: PMC10765751 DOI: 10.1186/s12882-023-03451-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic inflammatory disorders in peritoneal dialysis (PD) contribute to the adverse clinical outcome. Systemic immune inflammation index (SII) is the novel and convenient measurement that is positively associated with various diseases. However, scarce is known regarding the association between SII with all-cause mortality among PD patients. METHODS In this multi-center retrospective cohort study, 1,677 incident patients with PD were enrolled. Eligible patients were stratified into groups based on SII level: tertile 1(< 456.76), tertile 2(456.76 to 819.03), and tertile 3(> 819.03). The primary endpoint was the all-cause mortality. Both Cox regression analysis and competing risk models were used to examine the association between SII and all-cause mortality. Subgroup analysis was performed to assess the influence of the SII tertiles on all-cause mortality in different subgroups. RESULTS During the follow-up period of 30.5 ± 20.0 months, 26.0% (437/1,677) patients died, of whom the SII tertile 3 group accounted for 39.1% (171/437) of the deaths. Patients in the SII tertile 3 group had a higher all-cause mortality rate than patients in the SII tertile 1 and 2 groups (log-rank = 13.037, P < 0.001). The SII tertile 3 group was significantly associated with 80% greater risk (95% confidence interval:1.13 to 2.85; P = 0.013) compared with the SII tertile 1 group in multivariable Cox regression analysis. The competing risk model also indicated that the relationship between SII tertiles and all-cause mortality remains (subdistribution hazard ratio: 1.86; 95% confidence interval: 1.15 to 2.02, P = 0.011). Furthermore, the relationship between the log-transformed SII and all-cause mortality in patients with PD was nearly linear (P = 0.124). CONCLUSION A close relationship was observed between the SII and all-cause mortality in patients undergoing PD, suggesting that more attention should be paid to the SII, which is a convenient and effective measurement in clinical practice.
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Affiliation(s)
- Ruiying Tang
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China
| | - Jiexin Chen
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen Univeristy, Guangzhou, China
| | - Jihong Deng
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Univeristy, ZhengZhou, China
| | - Yueqiang Wen
- Department of Nephrology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ning Su
- Department of Hematology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang NO.1 People's Hospital, Jiujiang, China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China.
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Takata T, Isomoto H. The Versatile Role of Uromodulin in Renal Homeostasis and Its Relevance in Chronic Kidney Disease. Intern Med 2024; 63:17-23. [PMID: 36642527 PMCID: PMC10824655 DOI: 10.2169/internalmedicine.1342-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/06/2022] [Indexed: 01/15/2023] Open
Abstract
Uromodulin, also known as the Tamm-Horsfall protein, is predominantly expressed in epithelial cells of the kidney. It is secreted mainly in the urine, although small amounts are also found in serum. Uromodulin plays an important role in maintaining renal homeostasis, particularly in salt/water transport mechanisms and is associated with salt-sensitive hypertension. It also regulates urinary tract infections, kidney stones, and the immune response in the kidneys or extrarenal organs. Uromodulin has been shown to be associated with the renal function, age, nephron volume, and metabolic abnormalities and has been proposed as a novel biomarker for the tubular function or injury. These findings suggest that uromodulin is a key molecule underlying the mechanisms or therapeutic approaches of chronic kidney disease, particularly nephrosclerosis and diabetic nephropathy, which are causes of end-stage renal disease. This review focuses on the current understanding of the role of uromodulin from a biological, physiological, and pathological standpoint.
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Affiliation(s)
- Tomoaki Takata
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Japan
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Ran J, Tao C, Zhang S, Chen Q, Yang P, Hu Y, Liao X. Circadian syndrome is associated with the development of chronic kidney disease and rapid decline in kidney function in middle-aged and elder adults: a China nationwide cohort study. J Nutr Health Aging 2024; 28:100011. [PMID: 38267153 DOI: 10.1016/j.jnha.2023.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/25/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE The correlation between circadian syndrome (CircS) and kidney outcomes is currently supported by limited empirical evidence. Thus, the objective of this study was to determine the potential relationship between CircS and the development of chronic kidney disease (CKD), as well as the rapid decline in renal function. MATERIALS AND METHODS We utilized data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), which involved 6002 Chinese adults ≥40 years of age. Among these participants, 3670 subsequently had follow-up evaluations in the 2015 survey. The primary outcome was the development of CKD, as defined by an estimated glomerular filtration rates decrease to a level <60 ml/min/1.73 m2, while the secondary outcome was rapid decline in renal function, as defined by an estimated glomerular filtration rates decrease of >5 ml/min/1.73 m2 per year. Multivariable logistic regression analysis was utilized to determine the association between CircS and kidney outcomes. RESULTS Compared to participants without CircS, those with CircS had a higher risk of CKD in the cross-sectional studies conducted in 2011 (OR, 1.292; 95% CI, 1.053-1.585) and 2015 (OR, 1.860; 95% CI, 1.469-2.355). Participants with CircS in the longitudinal cohort study had a higher risk of progressing to CKD (OR, 3.050; 95% CI, 2.052-4.534) and a rapid decline in renal function (OR, 1.959; 95% CI, 1.433-2.677) after 4 years of follow-up evaluations and adjustment for covariates. Moreover, participants who had CircS with ≥6 CirS components had the highest risk of a rapid decline in renal function (OR, 1.703; 95% CI, 1.054-2.753). CONCLUSION CirS significantly increased the risk of CKD progression and rapid decline in renal function among middle-aged and elder individuals. Our study findings highlights the importance of recognizing and managing CirC as a preventative strategy for CKD.
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Affiliation(s)
- Jingyang Ran
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Siliang Zhang
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingsong Chen
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pengfei Yang
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yudong Hu
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xiaohui Liao
- Department of Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Zhang K, Wang Y, Sun Y, Gao L, Lu Y, Wang N. Self-reported childhood adversity, unhealthy lifestyle and risk of new-onset chronic kidney disease in later life: A prospective cohort study. Soc Sci Med 2024; 341:116510. [PMID: 38159486 DOI: 10.1016/j.socscimed.2023.116510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The prospective relation of childhood adversity with the risk of chronic kidney disease (CKD) remains unclear. We aimed to investigate the association of childhood adversity with new-onset CKD and examine the potential modifications by unhealthy lifestyle on this association. METHODS A total of 115,453 adults without prior CKD at baseline were included from UK Biobank (2006-2010). Childhood adversity was retrospectively evaluated through online Childhood Trauma Screener in 2016. Six common lifestyle factors including smoking, body mass index, sleep, diet, physical activity and alcohol consumption, were combined into an unhealthy lifestyle score. New-onset CKD was the primary outcome. RESULT The average age of participants in the study was 55.3 (SD, 7.7) years, and 39.3% of them were male. During a median follow-up duration of 14.1 years, 1905 participants developed new-onset CKD. Childhood adversity was significantly positively related with the risk of new-onset CKD in dose-response pattern. Each additional type of childhood adversity was associated with a 12% increment in the risk of developing CKD (adjusted hazard ratio (HR)1.12; 95% CI 1.08, 1.16). Among participants with high unhealthy lifestyle score, those with 4-5 types of childhood adversity increased the 1.73-fold risk of incident CKD (95% CI 1.17, 2.54) compared with those free of any childhood adversity. However, no statistically significant interaction was observed between unhealthy lifestyle and childhood adversity for new-onset CKD (P interaction = 0.734). CONCLUSIONS Childhood adversity was significantly associated with an increased risk of new-onset CKD in a dose-response pattern regardless of unhealthy lifestyle.
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Affiliation(s)
- Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Ling Gao
- Scientific Center, Shandong Provincial Hospital Affiliated to Shandong University, 250021, Jinan, Shandong, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China.
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China.
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Ribeiro M, Cardozo LF, Paiva BR, Baptista BG, Fanton S, Alvarenga L, Lima LS, Britto I, Nakao LS, Fouque D, Ribeiro-Alves M, Mafra D. Sulforaphane Supplementation Did Not Modulate NRF2 and NF-kB mRNA Expressions in Hemodialysis Patients. J Ren Nutr 2024; 34:68-75. [PMID: 37619675 DOI: 10.1053/j.jrn.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have reduced expression of erythroid nuclear factor-related factor 2 (NRF2) and increased nuclear factor κB (NF-κB). "Food as medicine" has been proposed as an adjuvant therapeutic alternative in modulating these factors. No studies have investigated the effects of sulforaphane (SFN) in cruciferous vegetables on the expression of these genes in patients with CKD. OBJECTIVE The study aimed to evaluate the effects of SFN on the expression of NRF2 and NF-κB in patients on hemodialysis (HD). DESIGN AND METHODS A randomized, double-blind, crossover study was performed on 30 patients on regular HD. Fourteen patients were randomly allocated to the intervention group (1 sachet/day of 2.5 g containing 1% SFN extract with 0.5% myrosinase) and 16 patients to the placebo group (1 sachet/day of 2.5 g containing corn starch colored with chlorophyll) for 2 months. After a washout period of 2 months, the groups were switched. NRF2 and NF-κB mRNA expression was evaluated by real-time quantitative polymerase chain reaction, and tumor necrosis factor alpha and interleukin-6 levels were quantified by enzyme-linked immunosorbent assay. Malondialdehyde was evaluated as a marker of lipid peroxidation. RESULTS Twenty-five patients (17 women, 55 [interquartile range = 19] years and 55 [interquartile range = 74] months on HD) completed the study. There was no significant difference concerning the expression of mRNA NRF2 (P = .915) and mRNA NF-κB (P = .806) after supplementation with SFN. There was no difference in pro-inflammatory and oxidative stress biomarkers. CONCLUSION 150 μmol of SFN for 2 months had no antioxidant and anti-inflammatory effect in patients with CKD undergoing HD.
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Affiliation(s)
- Marcia Ribeiro
- Graduate Program in Biological Sciences, Department of Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Ludmila Fmf Cardozo
- Graduate Program in Cardiovascular Sciences, Federal University Fluminense (UFF), Niterói, RJ, Brazil
| | - Bruna R Paiva
- Graduate Program in Cardiovascular Sciences, Federal University Fluminense (UFF), Niterói, RJ, Brazil
| | - Beatriz Germer Baptista
- Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Susane Fanton
- Graduate Program in Cardiovascular Sciences, Federal University Fluminense (UFF), Niterói, RJ, Brazil
| | - Livia Alvarenga
- Graduate Program in Biological Sciences, Department of Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Ligia Soares Lima
- Graduate Program in Biological Sciences, Department of Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Isadora Britto
- Graduate Program in Biological Sciences, Department of Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Lia S Nakao
- Federal University of Parana (UFPR), Department of Basic Pathology, Curitiba, Brazil
| | - Denis Fouque
- Department of Nephrology, Centre Hopitalier Lyon Sud, INSERM 1060, CENS, Université de Lyon, France
| | - Marcelo Ribeiro-Alves
- HIV/AIDS Clinical Research Center, National Institute of Infectology Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil
| | - Denise Mafra
- Graduate Program in Biological Sciences, Department of Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
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Xu W, Jia L, Lin Y, Zhang C, Sun X, Jiang L, Yao X, Wang N, Deng H, Wang S, Yang G. Association of air pollution and risk of chronic kidney disease: A systematic review and meta-analysis. J Biochem Mol Toxicol 2024; 38:e23610. [PMID: 38091339 DOI: 10.1002/jbt.23610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
Although epidemiological studies have evaluated the association between ambient air pollution and chronic kidney disease (CKD), the results remain mixed. To clarify the nature of the association, we conducted a comprehensive systematic review and meta-analysis to assess the global relationship between air pollution and CKD. The Web of Science, PubMed, Embase and Cochrane Library databases systematically were searched for studies published up to July 2023 and included 32 studies that met specific criteria. The random effects model was used to derive overall risk estimates for each pollutant. The meta-analysis estimated odds ratio (ORs) of risk for CKD were 1.42 (95% confidence interval [CI]: 1.31-1.54) for each 10 μg/m3 increase in PM2.5 ; 1.20 (95% CI: 1.14-1.26) for each 10 μg/m3 increase in PM10 ; 1.07 (95% CI: 1.05-1.09) for each 10 μg/m3 increase in NO2 ; 1.03 (95% CI: 1.02-1.03) for each 10 μg/m3 increase in NOX ; 1.07 (95% CI: 1.01-1.12) for each 1 ppb increase in SO2 ; 1.03 (95% CI: 1.00-1.05) for each 0.1 ppm increase in CO. Subgroup analysis showed that this effect varied by gender ratio, age, study design, exposure assessment method, and income level. Furthermore, PM2.5 , PM10 , and NO2 had negative effects on CKD even within the World Health Organization-recommended acceptable concentrations. Our results further confirmed the adverse effect of air pollution on the risk of CKD. These findings can contribute to enhance the awareness of the importance of reducing air pollution among public health officials and policymakers.
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Affiliation(s)
- Wenqi Xu
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Luzhu Jia
- Department of Epidemiology, Dalian Medical University, Dalian, China
| | - Yuxuan Lin
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Cong Zhang
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Xiance Sun
- Department of Occupational & Environmental Health, Dalian Medical University, Dalian, China
| | - Liping Jiang
- Department of Occupational & Environmental Health, Dalian Medical University, Dalian, China
| | - Xiaofeng Yao
- Department of Occupational & Environmental Health, Dalian Medical University, Dalian, China
| | - Ningning Wang
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Haoyuan Deng
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Shaopeng Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guang Yang
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
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50
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Contreras Nieves M, Powers A, Anand S, Vlahos P. Kidney disease hotspots and water balance in a warming world. Curr Opin Nephrol Hypertens 2024; 33:122-129. [PMID: 37889529 DOI: 10.1097/mnh.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Geographically localized areas with a high prevalence of kidney disease exist currently in several regions of the world. Although the exact cause is unclear, environmental exposures accelerated by climate change, particularly heat exposure and ground water contamination, are hypothesized as putative risk factors. Aiming to inform investigations of water-related exposures as risk factors for kidney disease, we excavate the history of major water sources in three regions that are described as hotspots of kidney disease: the low-lying coastal regions in El Salvador and Nicaragua, the dry central region in Sri Lanka, and the Central Valley of California. RECENT FINDINGS Historic data indicate that these regions have experienced water scarcity to which several human-engineered solutions were applied; these solutions could be hypothesized to increase residents' exposure to putative kidney toxins including arsenic, fluoride, pesticides, and cyanobacteria. Combined with heat stress experienced in context of climate change, there is potential for multistressor effects on kidney function. Climate change will also amplify water scarcity, and even if regional water sources are not a direct risk factor for development of kidney disease, their scarcity will complicate the treatment of the relatively larger numbers of persons with kidney disease living in these hotspots. SUMMARY Nephrologists and kidney disease researchers need to engage in systematic considerations of environmental exposures as potential risk factors for kidney disease, including water sources, their increasing scarcity, and threats to their quality due to changing climate.
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Affiliation(s)
| | - Angelina Powers
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Penny Vlahos
- Department of Marine Sciences, University of Connecticut, Mansfield, Connecticut, USA
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