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In the aftermath of the COVID-19 pandemic, the ongoing necessity for preventive measures such as mask-wearing and vaccination remains particularly critical for organ transplant recipients, a group highly susceptible to infections due to immunosuppressive therapy. Given that many individuals nowadays increasingly utilize Artificial Intelligence (AI), understanding AI perspectives is important. Thus, this study utilizes AI, specifically ChatGPT 4.0, to assess its perspectives in offering precise health recommendations for mask-wearing and COVID-19 vaccination tailored to this vulnerable population. Through a series of scenarios reflecting diverse environmental settings and health statuses in December 2023, we evaluated the AI's responses to gauge its precision, adaptability, and potential biases in advising high-risk patient groups. Our findings reveal that ChatGPT 4.0 consistently recommends mask-wearing in crowded and indoor environments for transplant recipients, underscoring their elevated risk. In contrast, for settings with fewer transmission risks, such as outdoor areas where social distancing is possible, the AI suggests that mask-wearing might be less imperative. Regarding vaccination guidance, the AI strongly advocates for the COVID-19 vaccine across most scenarios for kidney transplant recipients. However, it recommends a personalized consultation with healthcare providers in cases where patients express concerns about vaccine-related side effects, demonstrating an ability to adapt recommendations based on individual health considerations. While this study provides valuable insights into the current AI perspective on these important topics, it is crucial to note that the findings do not directly reflect or influence health policy. Nevertheless, given the increasing utilization of AI in various domains, understanding AI's viewpoints on such critical matters is essential for informed decision-making and future research.
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COVID-19 , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Receptores de Trasplantes , Inteligencia Artificial , Pandemias/prevención & control , VacunaciónRESUMEN
BACKGROUND: This study aimed to assess outcomes of delivery hospitalizations, including acute kidney injury (AKI), obstetric and foetal events and resource utilization among pregnant women with kidney transplants compared with pregnant women with no known kidney disease and those with chronic kidney disease (CKD) Stages 3-5. METHOD: Hospitalizations for delivery in the US were identified using the enhanced delivery identification method in the National Inpatient Sample dataset from the years 2009 to 2014. Diagnoses of CKD Stages 3-5, kidney transplantation, along with obstetric events, delivery methods and foetal events were identified using ICD-9-CM diagnosis and procedure codes. Patients with no known kidney disease group were identified by excluding any diagnoses of CKD, end stage kidney disease, and kidney transplant. Multivariable logistic regression accounting for the survey weights and matched regression was conducted to investigate the risk of maternal and foetal complications in women with kidney transplants, compared with women with no kidney transplants and no known kidney disease, and to women with CKD Stages 3-5. RESULT: A total of 5, 408, 215 hospitalizations resulting in deliveries were identified from 2009 to 2014, including 405 women with CKD Stages 3-5, 295 women with functioning kidney transplants, and 5, 405, 499 women with no known kidney disease. Compared with pregnant women with no known kidney disease, pregnant kidney transplant recipients were at higher odds of hypertensive disorders of pregnancy (OR = 3.11, 95% CI [2.26, 4.28]), preeclampsia/eclampsia/HELLP syndrome (OR = 3.42, 95% CI [2.54, 4.60]), preterm delivery (OR = 2.46, 95% CI [1.75, 3.45]), foetal growth restriction (OR = 1.74, 95% CI [1.01, 3.00]) and AKI (OR = 10.46, 95% CI [5.33, 20.56]). There were no significant differences in rates of gestational diabetes or caesarean section. Pregnant women with kidney transplants had 1.30-times longer lengths of stay and 1.28-times higher costs of hospitalization. However, pregnant women with CKD Stages 3-5 were at higher odds of AKI (OR = 5.29, 95% CI [2.41, 11.59]), preeclampsia/eclampsia/HELLP syndrome (OR = 1.72, 95% CI [1.07, 2.76]) and foetal deaths (OR = 3.20, 95% CI [1.06, 10.24]), and had 1.28-times longer hospital stays and 1.37-times higher costs of hospitalization compared with pregnant women with kidney transplant. CONCLUSION: Pregnant women with kidney transplant were more likely to experience adverse events during delivery and had longer lengths of stay and higher total charges when compared with women with no known kidney disease. However, pregnant women with moderate to severe CKD were more likely to experience serious complications than kidney transplant recipients.
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Parto Obstétrico/efectos adversos , Recursos en Salud , Hospitalización , Trasplante de Riñón/efectos adversos , Complicaciones del Embarazo/epidemiología , Insuficiencia Renal Crónica/epidemiología , Lesión Renal Aguda/epidemiología , Adolescente , Adulto , Bases de Datos Factuales , Parto Obstétrico/economía , Femenino , Recursos en Salud/economía , Precios de Hospital , Costos de Hospital , Hospitalización/economía , Humanos , Pacientes Internos , Trasplante de Riñón/economía , Tiempo de Internación , Persona de Mediana Edad , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/economía , Complicaciones del Embarazo/terapia , Mujeres Embarazadas , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/economía , Insuficiencia Renal Crónica/terapia , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Receptores de Trasplantes , Estados Unidos/epidemiología , Adulto JovenRESUMEN
AIM: Previous studies have suggested a higher incidence of urologic malignancies in end-stage renal disease (ESRD) patients. However, incidence trends of urologic malignancies in ESRD patients remain unclear. The aims of the present study were: (i) to investigate the pooled incidence/incidence trends; and (ii) to assess the risk of urologic malignancies in ESRD patients. METHODS: A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through April 2017. Studies that reported incidence or odds ratios of urologic malignancies among ESRD patients were included. Pooled odds ratios (OR) and 95%CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067687). RESULTS: Nineteen observational studies with 1 931 073 ESRD patients were enrolled. The pooled estimated incidence of kidney cancer and urothelial cancers (carcinomas of the bladder, ureters, and renal pelvis) in ESRD patients were 0.3% (95%CI: 0.2-0.5%) and 0.5% (95%CI: 0.3-0.8%), respectively. Meta-regression showed significant positive correlation between incidence of urologic malignancies in ESRD patients and year of study (slopes = +0.05 and +0.07, P < 0.001 for kidney cancer and urothelial cancers, respectively). Compared to non-ESRD status, ESRD was significantly associated with both kidney cancer (pooled OR 6.04; 95% CI 4.70-7.77) and urothelial cancers (pooled OR 4.37; 95% CI 2.40-7.96). CONCLUSION: Our study demonstrates a significant association between ESRD and urologic malignancies. The overall estimated incidence rates of kidney cancer and urothelial cancers are 0.4% and 0.5%, respectively. There is a significant positive correlation between the incidence of urologic malignancies and year of study.
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Fallo Renal Crónico/epidemiología , Neoplasias Urológicas/epidemiología , Humanos , Incidencia , Fallo Renal Crónico/diagnóstico , Estudios Observacionales como Asunto , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Neoplasias Urológicas/diagnósticoRESUMEN
Pre-eclampsia is a pregnancy-specific hypertensive disorder that may lead to serious maternal and fetal complications. It is a multisystem disease that is commonly, but not always, accompanied by proteinuria. Its cause(s) remain unknown, and delivery remains the only definitive treatment. It is increasingly recognized that many pathophysiological processes contribute to this syndrome, with different signaling pathways converging at the point of systemic endothelial dysfunction, hypertension, and proteinuria. Different animal models of pre-eclampsia have proven utility for specific aspects of pre-eclampsia research, and offer insights into pathophysiology and treatment possibilities. Therapeutic interventions that specifically target these pathways may optimize pre-eclampsia management and may improve fetal and maternal outcomes. In addition, recent findings regarding placental, endothelial, and podocyte pathophysiology in pre-eclampsia provide unique and exciting possibilities for improved diagnostic accuracy. Emerging evidence suggests that testing for urinary podocytes or their markers may facilitate the prediction and diagnosis of pre-eclampsia. In this review, we explore recent research regarding placental, endothelial, and podocyte pathophysiology. We further discuss new signaling and genetic pathways that may contribute to pre-eclampsia pathophysiology, emerging screening and diagnostic strategies, and potential targeted interventions.
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Podocitos/fisiología , Preeclampsia/fisiopatología , Inmunidad Adaptativa , Animales , Monóxido de Carbono/fisiología , Proteínas Portadoras/genética , Proteínas Portadoras/fisiología , Endotelina-1/fisiología , Endotelio Vascular/fisiopatología , Epigénesis Genética , Femenino , Hemo Oxigenasa (Desciclizante)/fisiología , Humanos , Inmunidad Innata , Neovascularización Fisiológica , Óxido Nítrico/fisiología , Placenta/irrigación sanguínea , Placenta/fisiopatología , Placentación/fisiología , Preeclampsia/etiología , Preeclampsia/terapia , Embarazo , Receptores Notch/genética , Receptores Notch/fisiología , Insuficiencia Renal Crónica/etiología , Transducción de SeñalRESUMEN
BACKGROUND: Urinary podocyte excretion (podocyturia) may function as a more specific marker of ongoing glomerular damage. This study sought to analyze the relationship between proteinuria and podocyturia in cancer patients treated with antivascular endothelial growth factor (anti-VEGF) agents. METHODS: Thirty-seven patients treated with anti-VEGF medications were analyzed in a single-institution, cross-sectional study. Podocyte cultures were performed on random urine collections (50-100 ml), and podocytes were identified by positive podocin staining. The corresponding urine samples were analyzed for protein and creatinine (Cr) measurements. RESULTS: Proteinuria ≥0.5 g/g Cr was found in 30% of the patients (median, 0.12; interquartile range, 0.04-0.86), and 62% had podocyturia. There was a significant difference in the amount of podocyturia between patients with proteinuria ≥0.5 g/g Cr and those with a value <0.5 g/g Cr (median podocyturia, 1.08 cells/mg Cr, range, 0-14.55 vs. 0.03 cells/mg Cr, range, 0-1.64, respectively; p < 0.001). A statistically significant correlation was observed between the cumulative dose of bevacizumab and both proteinuria (r = 0.48, p = 0.004) and podocyturia (r = 0.34, p = 0.045) as well as between proteinuria and podocyturia (r = 0.63, p < 0.001), suggesting that these are mechanistically related. DISCUSSION: Ongoing podocyte loss may be mechanistically related to the onset and severity of proteinuria in patients treated with anti-VEGF agents.
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Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos/efectos adversos , Neoplasias Gastrointestinales/tratamiento farmacológico , Podocitos/patología , Proteinuria/patología , Adulto , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos/uso terapéutico , Bevacizumab , Femenino , Neoplasias Gastrointestinales/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Podocitos/efectos de los fármacos , Proteinuria/inducido químicamente , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidoresRESUMEN
BACKGROUND: The integration of ChatGPT into nephrology presents opportunities for enhanced decision-making and patient care. However, refining its performance to meet the specific needs of nephrologists remains a challenge. This guide offers a strategic roadmap for advancing ChatGPT's effectiveness in nephrological applications. METHODS: Utilizing the advanced capabilities of GPT-4, we customized user profiles to optimize the model's response quality for nephrological inquiries. We assessed the efficacy of chain-of-thought prompting versus standard prompting in delineating the diagnostic pathway for nephrogenic diabetes insipidus-associated hypernatremia and polyuria. Additionally, we explored the influence of integrating retrieval-augmented generation on the model's proficiency in detailing pharmacological interventions to decelerate the progression from chronic kidney disease (CKD) G3 to end-stage kidney disease (ESKD), comparing it to responses without retrieval-augmented generation. RESULTS: In contrast to the standard prompting, the chain-of-thought method offers a step-by-step diagnostic process that mirrors the intricate thought processes needed for diagnosing nephrogenic diabetes insipidus-related hypernatremia and polyuria. This begins with an initial assessment, notably including a water deprivation test. After evaluating the outcomes of this test, the approach continues by identifying potential causes. Furthermore, if a patient's history suggests lithium usage, the chain-of-thought model adjusts by proposing a more customized course of action. In response to "List medication treatment to help slow progression of CKD G3 to ESKD?", GPT-4 only provides a general summary of medication options. Nevertheless, a specialized GPT-4 model equipped with a retrieval-augmented generation system delivers more precise responses, including renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, and mineralocorticoid receptor antagonists. This aligns well with the 2024 KDIGO guidelines. CONCLUSIONS: GPT-4, when integrated with chain-of-thought prompting and retrieval-augmented generation techniques, demonstrates enhanced performance in the nephrology domain. This guide underscores the transformative potential of chain-of-thought and retrieval-augmented generation techniques in optimizing ChatGPT for nephrology, and highlights the ongoing need for innovative, tailored AI solutions in specialized medical fields.
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Introduction: Patients with end-stage kidney disease (ESKD) frequently develop heart failure, contributing to high mortality. Limited data exist on cardiovascular benefits and safety of sacubitril-valsartan in this population. Our systematic review aims to evaluate the efficacy and safety of sacubitril-valsartan versus standard care in patients with ESKD who are on dialysis. Methods: We conducted a search in Embase, MEDLINE, and Cochrane databases to identify relevant studies and assessed outcomes using random-effect model and generic inverse variance approach. Results: Analysis of 12 studies involving 799 eligible patients with ESKD revealed improvement in left ventricular ejection fraction (LVEF) with sacubitril-valsartan compared to a control group with pooled mean difference (MD) 6.58% (95% confidence interval [CI]: 1.86, 11.29). LVEF significantly improved in patients with LVEF <50% (heart failure with reduced ejection fraction [HFrEF] and heart failure with moderately reduced ejection fraction [HFmrEF]) with MD 12.42% (95% CI: 9.39, 15.45). However, patients with LVEF >50% (heart failure with preserved ejection fraction [HFpEF]) did not exhibit statistically significant effect, MD 2.6% (95% CI: 1.15, 6.35). Sacubitril-valsartan significantly enhanced LVEF in patients with HFrEF, with MD 13.8% (95% CI: 12.04, 15.82). Safety analysis indicated no differences in incidence of hyperkalemia (pooled odds ratio [OR] 0.72; 95% CI: 0.38, 1.36) or hypotension (pooled risk ratio [RR] 1.03; 95% CI: 0.36, 2.98). No cases of angioedema were reported. However, safety analysis relies on evidence of limited robustness due to the observational nature of the studies. Conclusion: Our systematic review suggests that sacubitril-valsartan benefits patients with ESKD with HFrEF and HFmrEF by improving LVEF without increasing the risk of hyperkalemia, hypotension, or angioedema compared to standard care. However, safety analysis based on observational studies inherently has limitations for establishing causal relationships.
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Health equity and accessing Spanish kidney transplant information continues being a substantial challenge facing the Hispanic community. This study evaluated ChatGPT's capabilities in translating 54 English kidney transplant frequently asked questions (FAQs) into Spanish using two versions of the AI model, GPT-3.5 and GPT-4.0. The FAQs included 19 from Organ Procurement and Transplantation Network (OPTN), 15 from National Health Service (NHS), and 20 from National Kidney Foundation (NKF). Two native Spanish-speaking nephrologists, both of whom are of Mexican heritage, scored the translations for linguistic accuracy and cultural sensitivity tailored to Hispanics using a 1-5 rubric. The inter-rater reliability of the evaluators, measured by Cohen's Kappa, was 0.85. Overall linguistic accuracy was 4.89 ± 0.31 for GPT-3.5 versus 4.94 ± 0.23 for GPT-4.0 (non-significant p = 0.23). Both versions scored 4.96 ± 0.19 in cultural sensitivity (p = 1.00). By source, GPT-3.5 linguistic accuracy was 4.84 ± 0.37 (OPTN), 4.93 ± 0.26 (NHS), 4.90 ± 0.31 (NKF). GPT-4.0 scored 4.95 ± 0.23 (OPTN), 4.93 ± 0.26 (NHS), 4.95 ± 0.22 (NKF). For cultural sensitivity, GPT-3.5 scored 4.95 ± 0.23 (OPTN), 4.93 ± 0.26 (NHS), 5.00 ± 0.00 (NKF), while GPT-4.0 scored 5.00 ± 0.00 (OPTN), 5.00 ± 0.00 (NHS), 4.90 ± 0.31 (NKF). These high linguistic and cultural sensitivity scores demonstrate Chat GPT effectively translated the English FAQs into Spanish across systems. The findings suggest Chat GPT's potential to promote health equity by improving Spanish access to essential kidney transplant information. Additional research should evaluate its medical translation capabilities across diverse contexts/languages. These English-to-Spanish translations may increase access to vital transplant information for underserved Spanish-speaking Hispanic patients.
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Trasplante de Riñón , Humanos , Alanina Transaminasa , Inteligencia Artificial , Colina O-Acetiltransferasa , Promoción de la Salud , Hispánicos o Latinos , Reproducibilidad de los Resultados , Medicina Estatal , Americanos MexicanosRESUMEN
Background and Objectives: Limited evidence exists regarding the safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients with advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Thus, we conducted a systematic review and meta-analysis to assess the safety and efficacy of GLP-1RAs in T2DM patients with advanced CKD and ESKD. Materials and Methods: We performed a systematic literature search in MEDLINE, EMBASE, and Cochrane database until 25 October 2023. Included were clinical trials and cohort studies reporting outcomes of GLP-1RAs in adult patients with T2DM and advanced CKD. Outcome measures encompassed mortality, cardiovascular parameters, blood glucose, and weight. Safety was assessed for adverse events. The differences in effects were expressed as odds ratios with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference or standardized mean difference (SMD) with 95% confidence intervals for continuous outcomes. The Risk of Bias In Non-randomized Studies-of Interventions (ROBIN-I) tool was used in cohort and non-randomized controlled studies, and the Cochrane Risk of Bias (RoB 2) tool was used in randomized controlled trials (RCTs). The review protocol was registered in the International Prospective Register of Systematic Reviews (CRD 42023398452) and received no external funding. Results: Eight studies (five trials and three cohort studies) consisting of 27,639 patients were included in this meta-analysis. No difference was observed in one-year mortality. However, GLP-1RAs significantly reduced cardiothoracic ratio (SMD of -1.2%; 95% CI -2.0, -0.4) and pro-BNP (SMD -335.9 pmol/L; 95% CI -438.9, -232.8). There was no significant decrease in systolic blood pressure. Moreover, GLP-1RAs significantly reduced mean blood glucose (SMD -1.1 mg/dL; 95% CI -1.8, -0.3) and increased weight loss (SMD -2.2 kg; 95% CI -2.9, -1.5). In terms of safety, GLP-1RAs were associated with a 3.8- and 35.7-time higher risk of nausea and vomiting, respectively, but were not significantly associated with a higher risk of hypoglycemia. Conclusions: Despite the limited number of studies in each analysis, our study provides evidence supporting the safety and efficacy of GLP-1RAs among T2DM patients with advanced CKD and ESKD. While gastrointestinal side effects may occur, GLP-1RAs demonstrate significant improvements in blood glucose control, weight reduction, and potential benefit in cardiovascular outcomes.
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The accurate interpretation of CRRT machine alarms is crucial in the intensive care setting. ChatGPT, with its advanced natural language processing capabilities, has emerged as a tool that is evolving and advancing in its ability to assist with healthcare information. This study is designed to evaluate the accuracy of the ChatGPT-3.5 and ChatGPT-4 models in addressing queries related to CRRT alarm troubleshooting. This study consisted of two rounds of ChatGPT-3.5 and ChatGPT-4 responses to address 50 CRRT machine alarm questions that were carefully selected by two nephrologists in intensive care. Accuracy was determined by comparing the model responses to predetermined answer keys provided by critical care nephrologists, and consistency was determined by comparing outcomes across the two rounds. The accuracy rate of ChatGPT-3.5 was 86% and 84%, while the accuracy rate of ChatGPT-4 was 90% and 94% in the first and second rounds, respectively. The agreement between the first and second rounds of ChatGPT-3.5 was 84% with a Kappa statistic of 0.78, while the agreement of ChatGPT-4 was 92% with a Kappa statistic of 0.88. Although ChatGPT-4 tended to provide more accurate and consistent responses than ChatGPT-3.5, there was no statistically significant difference between the accuracy and agreement rate between ChatGPT-3.5 and -4. ChatGPT-4 had higher accuracy and consistency but did not achieve statistical significance. While these findings are encouraging, there is still potential for further development to achieve even greater reliability. This advancement is essential for ensuring the highest-quality patient care and safety standards in managing CRRT machine-related issues.
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Background: This study investigated the efficacy of ChatGPT-3.5 and ChatGPT-4 in assessing drug safety for patients with kidney diseases, comparing their performance to Micromedex, a well-established drug information source. Despite the perception of non-prescription medications and supplements as safe, risks exist, especially for those with kidney issues. The study's goal was to evaluate ChatGPT's versions for their potential in clinical decision-making regarding kidney disease patients. Method: The research involved analyzing 124 common non-prescription medications and supplements using ChatGPT-3.5 and ChatGPT-4 with queries about their safety for people with kidney disease. The AI responses were categorized as "generally safe," "potentially harmful," or "unknown toxicity." Simultaneously, these medications and supplements were assessed in Micromedex using similar categories, allowing for a comparison of the concordance between the two resources. Results: Micromedex identified 85 (68.5%) medications as generally safe, 35 (28.2%) as potentially harmful, and 4 (3.2%) of unknown toxicity. ChatGPT-3.5 identified 89 (71.8%) as generally safe, 11 (8.9%) as potentially harmful, and 24 (19.3%) of unknown toxicity. GPT-4 identified 82 (66.1%) as generally safe, 29 (23.4%) as potentially harmful, and 13 (10.5%) of unknown toxicity. The overall agreement between Micromedex and ChatGPT-3.5 was 64.5% and ChatGPT-4 demonstrated a higher agreement at 81.4%. Notably, ChatGPT-3.5's suboptimal performance was primarily influenced by a lower concordance rate among supplements, standing at 60.3%. This discrepancy could be attributed to the limited data on supplements within ChatGPT-3.5, with supplements constituting 80% of medications identified as unknown. Conclusion: ChatGPT's capabilities in evaluating the safety of non-prescription drugs and supplements for kidney disease patients are modest compared to established drug information resources. Neither ChatGPT-3.5 nor ChatGPT-4 can be currently recommended as reliable drug information sources for this demographic. The results highlight the need for further improvements in the model's accuracy and reliability in the medical domain.
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BACKGROUND: Cirrhosis and end-stage kidney disease (ESKD) are significant global health concerns, contributing to high mortality and morbidity. Haemodialysis (HD) is frequently used to treat ESKD in patients with cirrhosis. However, it often presents challenges such as haemodynamic instability during dialysis sessions, leading to less than optimal outcomes. Peritoneal dialysis (PD), while less commonly used in cirrhotic patients, raises concerns about the risks of peritonitis and mortality. Our systematic review and meta-analysis aimed to assess outcomes in PD patients with cirrhosis. METHODS: We executed a comprehensive search in Ovid MEDLINE, EMBASE and Cochrane databases up to 25 September 2023. The search focused on identifying studies examining mortality and other clinical outcomes in ESKD patients with cirrhosis receiving PD or HD. In addition, we sought studies comparing PD outcomes in cirrhosis patients to those without cirrhosis. Data from each study were aggregated using a random-effects model and the inverse-variance method. RESULTS: Our meta-analysis included a total of 13 studies with 15,089 patients. Seven studies compared ESKD patients on PD with liver cirrhosis (2753 patients) against non-cirrhosis patients (9579 patients). The other six studies provided data on PD (824 patients) versus HD (1943 patients) in patients with cirrhosis and ESKD. The analysis revealed no significant difference in mortality between PD and HD in ESKD patients with cirrhosis (pooled odds ratio (OR) of 0.77; 95% confidence interval (CI), 0.53-1.14). In PD patients with cirrhosis, the pooled OR for peritonitis compared to non-cirrhosis patients was 1.10 (95% CI: 1.03-1.18). The pooled ORs for hernia and chronic hypotension in cirrhosis patients compared to non-cirrhosis controls were 2.48 (95% CI: 0.08-73.04) and 17.50 (95% CI: 1.90-161.11), respectively. The pooled OR for transitioning from PD to HD among cirrhotic patients was 1.71 (95% CI: 0.76-3.85). Mortality in cirrhosis patients on PD was comparable to non-cirrhosis controls, with a pooled OR of 1.05 (95% CI: 0.53-2.10). CONCLUSIONS: Our meta-analysis demonstrates that PD provides comparable mortality outcomes to HD in ESKD patients with cirrhosis. In addition, the presence of cirrhosis does not significantly elevate the risk of mortality among patients undergoing PD. While there is a higher incidence of chronic hypotension and a slightly increased risk of peritonitis in cirrhosis patients on PD compared to those without cirrhosis, the risks of hernia and the need to transition from PD to HD are comparable between both groups. These findings suggest PD as a viable and effective treatment option for ESKD patients with cirrhosis.
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Chronic kidney disease (CKD) patients can benefit from personalized education on lifestyle and nutrition management strategies to enhance healthcare outcomes. The potential use of chatbots, introduced in 2022, as a tool for educating CKD patients has been explored. A set of 15 questions on lifestyle modification and nutrition, derived from a thorough review of three specific KDIGO guidelines, were developed and posed in various formats, including original, paraphrased with different adverbs, incomplete sentences, and misspellings. Four versions of AI were used to answer these questions: ChatGPT 3.5 (March and September 2023 versions), ChatGPT 4, and Bard AI. Additionally, 20 questions on lifestyle modification and nutrition were derived from the NKF KDOQI guidelines for nutrition in CKD (2020 Update) and answered by four versions of chatbots. Nephrologists reviewed all answers for accuracy. ChatGPT 3.5 produced largely accurate responses across the different question complexities, with occasional misleading statements from the March version. The September 2023 version frequently cited its last update as September 2021 and did not provide specific references, while the November 2023 version did not provide any misleading information. ChatGPT 4 presented answers similar to 3.5 but with improved reference citations, though not always directly relevant. Bard AI, while largely accurate with pictorial representation at times, occasionally produced misleading statements and had inconsistent reference quality, although an improvement was noted over time. Bing AI from November 2023 had short answers without detailed elaboration and sometimes just answered "YES". Chatbots demonstrate potential as personalized educational tools for CKD that utilize layman's terms, deliver timely and rapid responses in multiple languages, and offer a conversational pattern advantageous for patient engagement. Despite improvements observed from March to November 2023, some answers remained potentially misleading. ChatGPT 4 offers some advantages over 3.5, although the differences are limited. Collaboration between healthcare professionals and AI developers is essential to improve healthcare delivery and ensure the safe incorporation of chatbots into patient care.
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Background: Addressing disparities in living kidney donation requires making information accessible across literacy levels, especially important given that the average American adult reads at an 8th-grade level. This study evaluated the effectiveness of ChatGPT, an advanced AI language model, in simplifying living kidney donation information to an 8th-grade reading level or below. Methods: We used ChatGPT versions 3.5 and 4.0 to modify 27 questions and answers from Donate Life America, a key resource on living kidney donation. We measured the readability of both original and modified texts using the Flesch-Kincaid formula. A paired t-test was conducted to assess changes in readability levels, and a statistical comparison between the two ChatGPT versions was performed. Results: Originally, the FAQs had an average reading level of 9.6 ± 1.9. Post-modification, ChatGPT 3.5 achieved an average readability level of 7.72 ± 1.85, while ChatGPT 4.0 reached 4.30 ± 1.71, both with a p-value <0.001 indicating significant reduction. ChatGPT 3.5 made 59.26% of answers readable below 8th-grade level, whereas ChatGPT 4.0 did so for 96.30% of the texts. The grade level range for modified answers was 3.4-11.3 for ChatGPT 3.5 and 1-8.1 for ChatGPT 4.0. Conclusion: Both ChatGPT 3.5 and 4.0 effectively lowered the readability grade levels of complex medical information, with ChatGPT 4.0 being more effective. This suggests ChatGPT's potential role in promoting diversity and equity in living kidney donation, indicating scope for further refinement in making medical information more accessible.
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BACKGROUND: Podocyturia, i.e. urinary loss of viable podocytes, may serve as a diagnostic tool for pre-eclampsia and as a marker of active renal disease. The current method to detect podocyturia is technically complex, lengthy and requires a high level of expertise for interpretation. The aim of this study was to develop a new technique for the identification of urinary podocytes, based on the detection of podocyte-specific tryptic peptides by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), which will provide an operator-independent and highly reproducible method. METHODS AND RESULTS: The diagnosis of pre-eclampsia was confirmed in the presence of hypertension (>140/90 mmHg) and proteinuria >0.3 g/24 h urine. The diagnosis of HELLP was confirmed based on the accepted clinical criteria of hemolysis, elevated liver enzymes and low platelet count. Random urine samples within 24 h prior to delivery were collected and centrifuged. One half of the sediment was cultured for 24 h to select for viable cells and then stained with a podocin antibody, followed by a secondary fluorescein isothiocyanate-labeled antibody to identify podocytes. The second half of the pellet was solubilized, digested and analyzed by LC-MS/MS using an internal standard. We have recruited 13 patients with pre-eclampsia and 6 patients with pre-eclampsia/HELLP syndrome. The presence of podocytes was confirmed in all patients by the podocyte culture method. In the respective samples, the presence of a podocin-specific tryptic peptide was confirmed with LC-MS/MS technology. CONCLUSION: The LC-MS/MS method is a reliable technology for the identification of urinary podocytes, based on the presence of podocyte-specific proteins in the urine.
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Biomarcadores/orina , Síndrome HELLP/diagnóstico , Podocitos/patología , Preeclampsia/diagnóstico , Proteinuria/diagnóstico , Espectrometría de Masas en Tándem , Adulto , Cromatografía Liquida , Femenino , Síndrome HELLP/orina , Humanos , Podocitos/química , Preeclampsia/orina , Embarazo , Pronóstico , Proteinuria/orinaRESUMEN
This comprehensive critical review critically examines the ethical implications associated with integrating chatbots into nephrology, aiming to identify concerns, propose policies, and offer potential solutions. Acknowledging the transformative potential of chatbots in healthcare, responsible implementation guided by ethical considerations is of the utmost importance. The review underscores the significance of establishing robust guidelines for data collection, storage, and sharing to safeguard privacy and ensure data security. Future research should prioritize defining appropriate levels of data access, exploring anonymization techniques, and implementing encryption methods. Transparent data usage practices and obtaining informed consent are fundamental ethical considerations. Effective security measures, including encryption technologies and secure data transmission protocols, are indispensable for maintaining the confidentiality and integrity of patient data. To address potential biases and discrimination, the review suggests regular algorithm reviews, diversity strategies, and ongoing monitoring. Enhancing the clarity of chatbot capabilities, developing user-friendly interfaces, and establishing explicit consent procedures are essential for informed consent. Striking a balance between automation and human intervention is vital to preserve the doctor-patient relationship. Cultural sensitivity and multilingual support should be considered through chatbot training. To ensure ethical chatbot utilization in nephrology, it is imperative to prioritize the development of comprehensive ethical frameworks encompassing data handling, security, bias mitigation, informed consent, and collaboration. Continuous research and innovation in this field are crucial for maximizing the potential of chatbot technology and ultimately improving patient outcomes.
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Background: Contrast-induced encephalopathy (CIE) is an infrequent but serious neurological condition that occurs shortly after the administration of contrast during endovascular and angiography procedures. Patients suffering from chronic kidney disease (CKD) or end-stage kidney disease (ESKD) are considered to be at a higher risk of contrast medium neurotoxicity, due to the delayed elimination of the contrast medium. However, the occurrence and characteristics of CIE in CKD/ESKD patients have not been extensively investigated. Methods: We conducted a comprehensive literature search, utilizing databases such as MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, up to September 2022. The purpose was to identify documented cases of CIE among patients with CKD or ESKD. Employing a random-effects model, we calculated the pooled incidence and odds ratio (OR) of CIE in CKD/ESKD patients. Results: Our search yielded a total of eleven articles, comprising nine case reports and two observational studies. Among these studies, 2 CKD patients and 12 ESKD patients with CIE were identified. The majority of the CKD/ESKD patients with CIE (93%) had undergone intra-arterial contrast media and/or endovascular procedures to diagnose acute cerebrovascular disease, coronary artery disease, and peripheral artery disease. The male-to-female ratio was 64%, and the median age was 63 years (with an interquartile range of 55 to 68 years). In the two observational studies, the incidence of CIE was found to be 6.8% in CKD patients and 37.5% in ESKD patients, resulting in a pooled incidence of 16.4% (95% CI, 2.4%-60.7%) among the CKD/ESKD patients. Notably, CKD and ESKD were significantly associated with an increased risk of CIE, with ORs of 5.77 (95% CI, 1.37-24.3) and 223.5 (95% CI, 30.44-1641.01), respectively. The overall pooled OR for CIE in CKD/ESKD patients was 32.9 (95% CI, 0.89-1226.44). Although dialysis prior to contrast exposure did not prevent CIE, approximately 92% of CIE cases experienced recovery after undergoing dialysis following contrast exposure. However, the effectiveness of dialysis on CIE recovery remained uncertain, as there was no control group for comparison. Conclusions: In summary, our study indicates an association between CIE and CKD/ESKD. While patients with CIE showed signs of recovery after dialysis, further investigations are necessary, especially considering the lack of a control group, which made the effects of dialysis on CIE recovery uncertain.
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The utilization of vasopressin receptor antagonists, known as vaptans, in the management of hyponatremia among patients afflicted with the syndrome of inappropriate antidiuretic hormone (SIADH) remains a contentious subject. This meta-analysis aimed to evaluate the safety and efficacy of vaptans for treating chronic hyponatremia in adult SIADH patients. Clinical trials and observational studies were identified by a systematic search using MEDLINE, EMBASE, and Cochrane Database from inception through September 2022. The inclusion criteria were the studies that reported vaptans' safety or efficacy outcomes compared to placebo or standard therapies. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD 42022357307). Five studies were identified, comprising three RCTs and two cohort studies, enrolling a total of 1840 participants. Regarding short-term efficacy on days 4-5, vaptans exhibited a significant increase in serum sodium concentration from the baseline in comparison to the control group, with a weighted mean difference of 4.77 mmol/L (95% CI, 3.57, 5.96; I2 = 34%). In terms of safety outcomes, the pooled incidence rates of overcorrection were 13.1% (95% CI 4.3, 33.6; I2 = 92%) in the vaptans group and 3.3% (95% CI 1.6, 6.6; I2 = 27%) in the control group. Despite the higher correction rate linked to vaptans, with an OR of 5.72 (95% CI 3.38, 9.70; I2 = 0%), no cases of osmotic demyelination syndrome were observed. Our meta-analysis comprehensively summarizes the efficacy and effect size of vaptans in managing SIADH. While vaptans effectively raise the serum sodium concentration compared to placebo/fluid restriction, clinicians should exercise caution regarding the potential for overcorrection.
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BACKGROUND: ChatGPT is a novel tool that allows people to engage in conversations with an advanced machine learning model. ChatGPT's performance in the US Medical Licensing Examination is comparable with a successful candidate's performance. However, its performance in the nephrology field remains undetermined. This study assessed ChatGPT's capabilities in answering nephrology test questions. METHODS: Questions sourced from Nephrology Self-Assessment Program and Kidney Self-Assessment Program were used, each with multiple-choice single-answer questions. Questions containing visual elements were excluded. Each question bank was run twice using GPT-3.5 and GPT-4. Total accuracy rate, defined as the percentage of correct answers obtained by ChatGPT in either the first or second run, and the total concordance, defined as the percentage of identical answers provided by ChatGPT during both runs, regardless of their correctness, were used to assess its performance. RESULTS: A comprehensive assessment was conducted on a set of 975 questions, comprising 508 questions from Nephrology Self-Assessment Program and 467 from Kidney Self-Assessment Program. GPT-3.5 resulted in a total accuracy rate of 51%. Notably, the employment of Nephrology Self-Assessment Program yielded a higher accuracy rate compared with Kidney Self-Assessment Program (58% versus 44%; P < 0.001). The total concordance rate across all questions was 78%, with correct answers exhibiting a higher concordance rate (84%) compared with incorrect answers (73%) ( P < 0.001). When examining various nephrology subfields, the total accuracy rates were relatively lower in electrolyte and acid-base disorder, glomerular disease, and kidney-related bone and stone disorders. The total accuracy rate of GPT-4's response was 74%, higher than GPT-3.5 ( P < 0.001) but remained below the passing threshold and average scores of nephrology examinees (77%). CONCLUSIONS: ChatGPT exhibited limitations regarding accuracy and repeatability when addressing nephrology-related questions. Variations in performance were evident across various subfields.
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Longer pre-transplant dialysis duration is known to be associated with worse post-transplant outcomes. Our study aimed to cluster kidney transplant recipients with prolonged dialysis duration before transplant using an unsupervised machine learning approach to better assess heterogeneity within this cohort. We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 5092 kidney transplant recipients who had been on dialysis ≥ 10 years prior to transplant in the OPTN/UNOS database from 2010 to 2019. We characterized each assigned cluster and compared the posttransplant outcomes. Overall, the majority of patients with ≥10 years of dialysis duration were black (52%) or Hispanic (25%), with only a small number (17.6%) being moderately sensitized. Within this cohort, three clinically distinct clusters were identified. Cluster 1 patients were younger, non-diabetic and non-sensitized, had a lower body mass index (BMI) and received a kidney transplant from younger donors. Cluster 2 recipients were older, unsensitized and had a higher BMI; they received kidney transplant from older donors. Cluster 3 recipients were more likely to be female with a higher PRA. Compared to cluster 1, cluster 2 had lower 5-year death-censored graft (HR 1.40; 95% CI 1.16-1.71) and patient survival (HR 2.98; 95% CI 2.43-3.68). Clusters 1 and 3 had comparable death-censored graft and patient survival. Unsupervised machine learning was used to characterize kidney transplant recipients with prolonged pre-transplant dialysis into three clinically distinct clusters with variable but good post-transplant outcomes. Despite a dialysis duration ≥ 10 years, excellent outcomes were observed in most recipients, including those with moderate sensitization. A disproportionate number of minority recipients were observed within this cohort, suggesting multifactorial delays in accessing kidney transplantation.