Impact of CT-determined low kidney volume on renal function decline: a propensity score-matched analysis.

OBJECTIVES: To investigate the relationship between low kidney volume and subsequent estimated glomerular filtration rate (eGFR) decline in eGFR category G2 (60-89 mL/min/1.73 m2) population. METHODS: In this retrospective study, we evaluated 5531 individuals with eGFR category G2 who underwent medical checkups at our institution between November 2006 and October 2017. Exclusion criteria were absent for follow-up visit, missing data, prior renal surgery, current renal disease under treatment, large renal masses, and horseshoe kidney. We developed a 3D U-net-based automated system for renal volumetry on CT images. Participants were grouped by sex-specific kidney volume deviations set at mean minus one standard deviation. After 1:1 propensity score matching, we obtained 397 pairs of individuals in the low kidney volume (LKV) and control groups. The primary endpoint was progression of eGFR categories within 5 years, assessed using Cox regression analysis. RESULTS: This study included 3220 individuals (mean age, 60.0 ± 9.7 years; men, n = 2209). The kidney volume was 404.6 ± 67.1 and 376.8 ± 68.0 cm3 in men and women, respectively. The low kidney volume (LKV) cutoff was 337.5 and 308.8 cm3 for men and women, respectively. LKV was a significant risk factor for the endpoint with an adjusted hazard ratio of 1.64 (95% confidence interval: 1.09-2.45; p = 0.02). CONCLUSION: Low kidney volume may adversely affect subsequent eGFR maintenance; hence, the use of imaging metrics may help predict eGFR decline. CRITICAL RELEVANCE STATEMENT: Low kidney volume is a significant predictor of reduced kidney function over time; thus, kidney volume measurements could aid in early identification of individuals at risk for declining kidney health. KEY POINTS: • This study explores how kidney volume affects subsequent kidney function maintenance. • Low kidney volume was associated with estimated glomerular filtration rate decreases. • Low kidney volume is a prognostic indicator of estimated glomerular filtration rate decline.

Long-term toxicities after allogeneic hematopoietic stem cell transplantation with or without total body irradiation: a population-based study in Korea.

PURPOSE: To compare long-term toxicity incidences, including secondary cancer (SC) with or without total body irradiation (TBI), in Asian patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) using a nationwide database. MATERIALS AND METHODS: We identified 4,554 patients receiving HSCT for leukemic disease from 2009 to 2016 using the healthcare bigdata system of Korea. Incidence rate ratios (IRRs) for SC, cataracts, hypothyroidism, chronic kidney disease (CKD), myocardial infarction, or strokes were compared, and standardized incidence ratios (SIR) of SC was also estimated. RESULTS: TBI was conducted on 1,409 patients (30.9%). No overall survival differences based on TBI were observed. With a median follow-up duration of 58.2 months, 143 patients were diagnosed with subsequent SC (3.4%). Incidence rates per 1,000 person-year were 6.56 (95% confidence interval [CI], 4.8-8.8) and 7.23 (95% CI, 5.9-8.8) in the TBI and no-TBI groups, respectively (p = 0.594). Also, the SIR (95% CI) was not significantly increased by TBI (1.32 [0.86-1.94] vs. 1.39 [1.08-1.77] in the no-TBI group). In the young age group (0-19 years), SIRs were increased in both groups regardless of TBI (8.60 vs. 11.96). The IRRs of cataracts (1.60; 95% CI, 1.3-2.0), CKD (1.85; 95% CI, 1.3-2.6), and hypothyroidism (1.50; 95% CI, 1.1-2.1) were significantly increased after TBI. However, there were no significant differences in the occurrence of myocardial infarction and stroke according to TBI. CONCLUSION: Our results suggest that modern TBI may not additionally increase the risk of SC after allogeneic HSCT, although increased risks of other diseases were noted. Physicians should carefully consider individualized risks and benefits of TBI, with a particular focus by age group.

Prevalence and clinical characteristics of hyperuricemia among patients with chronic kidney disease under haemodialysis in a tertiary care center: a cross-sectional study.

Background: Hyperuricemia is common in chronic kidney disease patients. This study aimed to investigate the prevalence and clinical characteristics of hyperuricemia in patients with chronic kidney disease undergoing haemodialysis. Materials and methods: This cross-sectional study was conducted among 104 patients with chronic kidney disease who visited the haemodialysis unit of a tertiary centre hospital from 11 September 2022, to 11 November 2022. A convenience sampling technique was used. The data were collected using a proforma form, entered into, and analyzed using the Statistical Package for Social Sciences version 21. Results: The mean age group of the study participants was 54.02 ± 14.03 years, and around two-thirds were male (n=70, 67.3%). Almost half of the participants (50, 48.07%) had hyperuricemia with a mean uric acid level of 6.76 ± 2.62 mg/dl. The majority of the participants had associated hypertension (n=100, 96.2%). More than three-fourths of the respondents (83, 79.8%) had haemoglobin levels below the target range. Conclusion: Nearly half of the study participants had hyperuricemia.

CO2 is the contrast media to choose in patients with initial Chronic Kidney Disease undergoing endovascular aneurysm repair to prevent further renal function deterioration.

OBJECTIVE: Even low quantities of iodine contrast media (ICM) could be responsible for exacerbation of a chronic kidney disease (CKD). Aim of this study was to determine whether it is more reasonable to perform endovascular aneurysm repair (EVAR) procedures in patients with initial CKD using CO2 rather than ICM to prevent further kidney deterioration. METHODS: A retrospective analysis was performed at our institution to identify patients with preoperative CKD at initial stage (class G3a-G3b according to KDOQI-KDIGO classification) who underwent either CO2-EVAR or ICM-EVAR. Primary endpoint was renal function evaluation; secondary endpoints were technical success, perioperative complications, hospital stay, and reinterventions and overall mortality at follow-up. RESULTS: Both CO2-EVAR and ICM-EVAR groups were composed of 21 patients. There were no differences in demographics, anatomy, and comorbidities, apart from worse ASA score in CO2-EVAR group (100% vs 57.1%, p = .001). Preoperative serum creatinine and glomerular filtration rates (GFR) were comparable (1.73 vs 1.6 mg/dl, p = .082 and 39.71 vs 43.04 mL/min/1.73 m2, p = .935). At follow-up (16.7 ± 18.1 months), CO2-EVAR was not associated with significant changes in creatinine and GFR, whereas ICM-EVAR determined a significant increase in creatinine (1.6 mg/dl vs 1.91 mg/dl, p = .04) and decrease in GFR values (43 vs 37.9 mL/min/1.73 m2, p = .04), determining the need for dialysis in one patient. CONCLUSIONS: ICM seems to be a determining factor in worsening renal function; therefore, an effort should be made to standardize the use of CO2 as the contrast medium of choice in patients with initial renal insufficiency undergoing EVAR.

Chronic Lithium Intoxication: A Challenging Diagnosis.

Lithium has been used in clinical practice since the 1970s. This medication is commonly used to treat and prevent bipolar disorder, but it has a narrow therapeutic index, making toxicity a frequent occurrence. Chronic lithium intoxication can arise due to progressive accumulation, particularly in contexts of dehydration. The effects of chronic lithium intoxication on the nervous, renal, and cardiac systems, as well as on the thyroid and parathyroid glands, are well documented in the literature. The authors present the case of a 66-year-old woman with schizoaffective psychosis and chronic kidney disease, admitted due to altered mental status and dysarthria. Notwithstanding an earlier clinical recommendation to cease lithium administration more than a year ago, the patient continued its usage, culminating in neurological, cardiac, renal, and endocrine manifestations. Although the diagnosis was delayed, her clinical progression was favorable, obviating the need for renal replacement therapy. This case highlights the importance of a detailed medical history and the diagnostic challenges in clinical practice. The use of this drug without proper monitoring can lead to multisystem dysfunction.

Performance evaluation of Chronic Kidney Disease Epidemiology Collaboration equations for estimated glomerular filtration rate compared to inulin clearance in Koreans.

Background: A race-free glomerular filtration rate (GFR) estimation equation has recently been developed. However, the performance of the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations needs to be evaluated in Asian populations. Methods: We performed a cross-sectional study at a single center in South Korea. The measured GFR (mGFR) was determined based on systemic inulin clearance. The GFR was estimated using the five CKD-EPI equations: 2009 CKD-EPIcr, 2012 CKD-EPIcr-cys, 2012 CKD-EPIcys, 2021 CKD-EPIcr, and 2021 CKD-EPIcr-cys. The performances of five estimated GFR (eGFR) equations were assessed by bias, precision, and accuracy (percentage of estimates within 30% of mGFR). Results: The median mGFR and interquartile range (IQR) was 53.5 (32.4-80.0) mL/min/1.73 m2. The mGFR better correlated with 2009 CKD-EPIcr (ρ = 0.628) and 2021 CKD-EPIcr-cys (ρ = 0.806) than with 2021 CKD-EPIcr (ρ = 0.623) and 2012 CKD-EPIcr-cys (ρ = 0.801). The median bias of 2009 CKD-EPIcr and 2012 CKD-EPIcr-cys were lower than those of 2021 CKD-EPI equations (2009 CKD-EPIcr, 2.24 [IQR, -8.83 to 17.39] vs. 2021 CKD-EPIcr, 5.40 [IQR, -6.04 to 20.40]; 2012 CKD-EPIcr-cys, 6.74 [IQR, -2.81 to 20.80] vs. 2021 CKD-EPIcr-cys, 10.54 [IQR, 0.30-24.37]; all in mL/min/1.73 m2). The percentage of eGFR values within 30% of mGFR was higher in 2009 CKD-EPIcr and 2012 CKD-EPIcr-cys equations than 2021 CKD-EPI equations. The CKD prevalence in 2009 CKD-EPIcr, 2021 CKD-EPIcr, 2012 CKD-EPIcr-cys, and 2021 CKD-EPIcr-cys was 54.8%, 51.0%, 47.7%, and 44.8%, respectively. Conclusion: Our study demonstrated better performance of the original CKD-EPIcr and CKD-EPIcr-cys equations than the 2021 new CKD-EPI equations. We do not recommend the adoption of the new CKD-EPI equations in Korea.

Access to kidney transplantation for patients with end-stage renal failure in Maghreb countries: state of art and recommendations / Accès à la transplantation rénale des patients en insuffisance rénale chronique terminale dans les pays du Maghreb : état des lieux et recommandations

We present an overview of kidney transplantation activity in the Maghreb countries, based on data from the 9th Colloque France-Maghreb (Paris, May 20 and 21, 2022). For Algeria, Morocco and Tunisia, the incidence of end stage renal failure is respectively 120, 130 and 130 per million inhabitants, its prevalence 626, 900 and 833 per million inhabitants and the part of patients with a functional graft of 10.3, 1.8 et 8.5% with an annual number of transplants of 6.5, 0.8 and 8.7 per million inhabitants. Living donor transplants account for 99% of transplants in Algeria, 93% in Morocco and 80% in Tunisia. In conclusion, access to transplantation remains low in the Maghreb countries. All the modalities (living donor with enlargement of the circle of donors, deceased donors) must be further developed. Recommendations were issued to support activity.

Nous présentons un état des lieux de l'activité de transplantation rénale dans les pays du Maghreb à partir des données du 9e Colloque France-Maghreb (Paris, 20 et 21 mai 2022). Pour l'Algérie, le Maroc et la Tunisie, l'incidence de l'insuffisance rénale chronique terminale est respectivement de 120, 130 et 130 par million d'habitants, sa prévalence de 626, 900 et 833 par million d'habitants et la part des patients porteurs d'un greffon fonctionnel est de 10,3, 1,8 et 8,5 % avec un nombre annuel de transplantations de 6,5, 0,9 et 7,7 par million d'habitants. La transplantation avec donneur vivant représente 99 % des transplantations en Algérie, 93 % au Maroc et 80 % en Tunisie. En conclusion, l'accès à la transplantation reste faible dans les pays du Maghreb. Toutes les modalités (donneur vivant avec élargissement du cercle des donneurs, donneurs décédés) doivent être développées. Des recommandations ont été émises pour soutenir cette activité.

Factores que influyen en la supervivencia de pacientes con diálisis en El Salvador / Influencing Factors in the Survival of Dialysis Patients in El Salvador

Introducción. La enfermedad renal crónica es responsable de aproximadamente 2,4 millones de defunciones a nivel mundial. La supervivencia a los cinco años después de iniciar diálisis se encuentra entre un 39 a 60 % dependiendo del país. Objetivo. Describir la situación epidemiológica de los pacientes con diálisis y analizar los factores que influyen en la supervivencia de pacientes a cinco años de iniciar tratamiento sustitutivo renal en El Salvador. Metodología. Estudio de cohorte retrospectivo de los pacientes incluidos en el Registro Nacional de Diálisis y Trasplante Renal desde enero de 2016 hasta febrero de 2023. El seguimiento se comenzó al inicio de la diálisis, el evento de interés fue la muerte del paciente. Se utilizó el método de Kaplan-Meier para determinar la supervivencia al año y a los cinco años y la regresión de Cox con el modelo de Royston-Parmar para analizar los factores que influyen sobre la supervivencia a los cinco años. Resultados. El estudio incluyó 7088 pacientes, la supervivencia a uno y cinco años fue del 79,5 % (IC 95 %: 78,6-80,5) y 50,6 % (IC 95 %: 49,1-52,1) respectivamente. La regresión de Cox para la edad de inicio de tratamiento resultó en un hazard ratio de 1,02 (IC 95 %: 1,01-1,02), mientras que para el oficio de ser agricultor el hazard ratio fue 1,1 (IC 95 %: 1,01-1,18) y para la etiología hipertensiva el hazard ratio fue de 0,7 (IC 95 %: 0,64-0,78). Conclusión. La edad de inicio de tratamiento y el ser agricultor están asociados con una menor supervivencia a cinco años en pacientes con diálisis

Introduction. The chronic kidney disease is responsible for approximately 2.4 million deaths worldwide, in El Salvador during 2019 death rate was 72.9 for 100 000 habitants, five year survival in patients after starting dialysis was between 39 and 60 % depending on the country. Objective. Analyze the factors that influence the five years survival in patients after starting renal replacement therapy in El Salvador. Methodology. It is a retrospective cohort study from patients included in dialysis and renal replacement therapy national registry from January 2016 to February 2023, the start point for the following was the initiation of dialysis, the event of interest was patient ́s death, the Kaplan-Meier method was used to determine one year and five year survival; and Cox regression with Royston-Parmar model was used to analyze the factors that influence survival. Results. The study included 7088 patients, one and five-years survival was 79.5 % (CI 95 %: 78.6-80.5) and 50.6 % (CI 95 %: 49.1-52.1) respectively. The Cox regression for age of treatment initiation resulted in a hazard ratio of 1.02 (CI 95 %: 1.01-1.02), while for farmers, the hazard ratio was 1.09 (CI 95 %: 1.00-1.18), for hypertensive etiology the hazard ratio was 0.7 (CI 95 %: 0.64-0.78). Conclusion. Data suggest that age of treatment initiation, and jobs related to agriculture were associated with less five year survival in dialysis patients.

Metabolites Associated With Uremic Symptoms in Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.

RATIONALE & OBJECTIVE: The toxins that contribute to uremic symptoms in patients with chronic kidney disease (CKD) are unknown. We sought to apply complementary statistical modeling approaches to data from untargeted plasma metabolomic profiling to identify solutes associated with uremic symptoms in patients with CKD. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: 1,761 Chronic Renal Insufficiency Cohort (CRIC) participants with CKD not treated with dialysis. PREDICTORS: Measurement of 448 known plasma metabolites. OUTCOMES: The uremic symptoms of fatigue, anorexia, pruritus, nausea, paresthesia, and pain were assessed by single items on the Kidney Disease Quality of Life-36 instrument. ANALYTICAL APPROACH: Multivariable adjusted linear regression, least absolute shrinkage and selection operator linear regression, and random forest models were used to identify metabolites associated with symptom severity. After adjustment for multiple comparisons, metabolites selected in at least 2 of the 3 modeling approaches were deemed "overall significant." RESULTS: Participant mean estimated glomerular filtration rate was 43mL/min/1.73m2, with 44% self-identifying as female and 41% as non-Hispanic Black. The prevalence of uremic symptoms ranged from 22% to 55%. We identified 17 metabolites for which a higher level was associated with greater severity of at least one uremic symptom and 9 metabolites inversely associated with uremic symptom severity. Many of these metabolites exhibited at least a moderate correlation with estimated glomerular filtration rate (Pearson's r≥0.5), and some were also associated with the risk of developing kidney failure or death in multivariable adjusted Cox regression models. LIMITATIONS: Lack of a second independent cohort for external validation of our findings. CONCLUSIONS: Metabolomic profiling was used to identify multiple solutes associated with uremic symptoms in adults with CKD, but future validation and mechanistic studies are needed. PLAIN-LANGUAGE SUMMARY: Individuals living with chronic kidney disease (CKD) often experience symptoms related to CKD, traditionally called uremic symptoms. It is likely that CKD results in alterations in the levels of numerous circulating substances that, in turn, cause uremic symptoms; however, the identity of these solutes is not known. In this study, we used metabolomic profiling in patients with CKD to gain insights into the pathophysiology of uremic symptoms. We identified 26 metabolites whose levels were significantly associated with at least one of the symptoms of fatigue, anorexia, itchiness, nausea, paresthesia, and pain. The results of this study lay the groundwork for future research into the biological causes of symptoms in patients with CKD.

External validation of the SYNTAX score II 2020 in patients with chronic renal insufficiency.

BACKGROUND: The SYNTAX score Ⅱ 2020 (SSⅡ-2020) was created as a customized decision-making tool for individuals diagnosed with complex coronary artery disease (CAD). Nevertheless, there has been a scarcity of research investigating the long-term predictive significance of SSⅡ-2020 for patients with both CAD and chronic renal insufficiency (CRI) who undergo percutaneous coronary intervention (PCI). AIMS: We sought to showcase the prognostic capacity of SSII-2020 in evaluating long-term all-cause mortality (ACM) within this high-risk patient cohort. METHODS: A retrospective cohort comprising 1156 individuals diagnosed with CRI and exhibiting left main CAD, three-vessel CAD or both was included in this investigation. We categorized participants into three groups based on the optimal SSII-2020 threshold for predicting long-term ACM, determined using the X-tile software. RESULTS: At the median follow-up duration of 6.3 years, the ACM rates were determined to be 10% in the low, 17% in the moderate, and 28% in the high SSII-2020 groups (p < 0.001). Employing multivariate Cox regression analysis, it was observed that the high SSII-2020 group exhibited a 3.289-fold increased risk of ACM (95% confidence interval [CI]: 2.229-4.856, p < 0.001) compared with the low SSII-2020 group, whereas the high SSII-2020 group displayed a 1.757-fold (95% CI: 1.190-2.597, p = 0.005) in comparison to the median SSII-2020 groups. Compared with SSII, the SSII-2020 had an incremental value for predicting 7-year ACM (C-index: 0.662 vs. 0.534, p = 0.007; IDI: 0.016, p < 0.001). CONCLUSIONS: SSII-2020 enhances long-term ACM prediction, facilitates improved risk stratification, and improves clinical utility for PCI patients with complex CAD and CRI.

Frequency of Fabry disease in chronic kidney disease patients including patients on renal replacement therapy in Korea.

BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by the deficient activity of α-galactosidase (α-Gal A), affecting multiple organs including kidney. In this study, we aimed to determine the prevalence of FD in patients with chronic kidney disease (CKD) including those on renal replacement therapy in Korea. METHODS: This is a national, multicenter, observational study performed between August 24, 2017 and February 28, 2020. Patients with the presence of proteinuria or treated on dialysis were screened by measuring the α-Gal A enzyme activity using either dried blood spot or whole blood, and plasma globotriaosylsphingosine (lyso-GL3) concentration. A GLA gene analysis was performed in patients with low α-Gal A enzyme activity or increased plasma lyso-GL3 concentration. RESULTS: Of 897 screened patients, 405 (45.2%) were male and 279 (31.1%) were on dialysis. The α-Gal A enzyme activity was measured in 891 patients (99.3%), and plasma lyso-GL3 concentration was measured in all patients. Ten patients were eligible for a GLA gene analysis: eight with low α-Gal A enzyme activity and two with increased plasma lyso-GL3 concentration. The GLA mutations were analyzed in nine patients and one patient was found with a pathogenic mutation. Therefore, one patient was identified with FD, giving a prevalence of 0.1% (1 of 897) in this CKD population. CONCLUSION: Although the prevalence of FD in the CKD population was low (0.1%), screening tests are crucial to detect potential diseases in patients with relatives who can benefit from early treatment.

Status and trends in epidemiologic characteristics of diabetic end-stage renal disease: an analysis of the 2021 Korean Renal Data System.

Korean Renal Data System (KORDS) is a nationwide end-stage renal disease (ESRD) registry database operated by the Korean Society of Nephrology (KSN). Diabetes mellitus is currently the leading cause of ESRD in Korea; this article provides an update on the trends and characteristics of diabetic ESRD patients. The KORDS Committee of KSN collects data on dialysis centers and patients through an online registry program. Here, we analyzed the status and trends in characteristics of diabetic chronic kidney disease stage 5D (CKD 5D) patients using data from 2001 to 2021. In 2021, the dialysis adequacy of hemodialysis (HD) was lower in diabetic CKD 5D patients than in nondiabetic CKD 5D patients, while that of peritoneal dialysis (PD) was similar. Diabetic CKD 5D patients had a higher proportion of cardiac and vascular diseases and were more frequently admitted to hospitals than nondiabetic CKD 5D patients, and the leading cause of death was cardiac disease. From 2001 to 2020, diabetic CKD 5D patients had a higher mortality rate than nondiabetic CKD 5D patients, but in 2021 this trend was reversed. Diabetic PD patients had the highest mortality rate over 20 years. The mortality rate of diabetic HD patients was higher than that of nondiabetic HD patients until 2019 but became lower starting in 2020. There was a decreasing trend in mortality rate in diabetic CKD 5D patients, but cardiac and vascular diseases were still prevalent in diabetic CKD 5D patients with frequent admissions to hospitals. More specialized care is needed to improve the clinical outcomes of diabetic CKD 5D patients.

Mediation effect of antithrombin III between chronic renal insufficiency and chronic coronary artery disease in T2DM patients.

PURPOSE: The study aimed to investigate the potential effect of Antithrombin III (ATIII) between chronic renal insufficiency and chronic coronary artery disease (chronic CAD) in type 2 diabetes mellitus (T2DM) patients. METHODS: T2DM patients hospitalized in ZhongDa Hospital from 2013 to 2018 were enrolled. Relationships between renal function, ATIII, and chronic CAD risk were explored using multivariate regression models. Multiplicative and additive interactions were investigated between ATIII and renal function for CAD risk, and the role of ATIII was determined by bootstrap mediation analysis in patients with chronic renal dysfunction. RESULTS: A total of 4197 patients were included in the study, with a chronic CAD prevalence of 23.02%. Low ATIII level was statistically associated with chronic renal insufficiency and elevated CAD risk even after adjustments (P < 0.05). A positive correlation between renal function and ATIII was demonstrated, and each 1 SD increase in renal function, ATIII increased by 2.947% (2.406-3.488%, P < 0.001) and 0.969% (0.297-1.642%, P < 0.001) in crude and adjusted models respectively. Patients with decreased renal function and ATIII were at the highest chronic CAD risk (OR = 1.51, 95%CI:1.15-1.98, P < 0.05), while no multiplicative and additive interaction effects were significant. Bootstrap mediation analysis estimated that ATIII mediated approximately 4.27% of the effect of chronic renal insufficiency on chronic CAD risk. CONCLUSION: ATIII may serve as a mediator between chronic renal insufficiency and chronic CAD, providing mechanistic clues for renal-heart association and new insight into clinical therapies.

[Management of cardiovascular diseases in patients with diabetes : ESC guidelines 2023]. / Management kardiovaskulärer Erkrankungen bei Patienten mit Diabetes : ESC-Leitlinie 2023.

Patients with diabetes mellitus have an increased risk for the development of cardiovascular diseases. The presence of both comorbidities has a major impact not only on the prognosis of the patients but is also decisive for the implementation of evidence-based treatment strategies for reduction of the cardiovascular risk. The new guidelines of the European Society of Cardiology (ESC) were published in 2023 and provide clear recommendations for the management of cardiovascular diseases in patients with diabetes. The most relevant aspects of these guidelines are summarized in the following overview article.

Frequency of skin diseases in renal transplant recipients and patients with chronic kidney disease in a tertiary center: a cross-sectional study

ABSTRACT BACKGROUND: The prevalence of chronic kidney disease (CKD) has increased in the recent decades, along with the number of patients in the terminal stages of this disease, requiring transplantation. Some skin disorders are more frequent in patients with CKD and in renal transplant recipients (RTR). OBJECTIVES: To evaluate the frequency of skin diseases in RTR and patients with CKD receiving conservative treatment. DESIGN AND SETTING: This observational cross-sectional study recruited consecutive patients with CKD and RTR from a nephrology clinic at a teaching hospital in Brazil between 2015 and 2020. METHODS: Quantitative, descriptive, and analytical approaches were used. The sample was selected based on convenience sampling. Data were collected from dermatological visits and participants' medical records. RESULTS: Overall, 308 participants were included: 206 RTR (66.9%, median age: 48 years, interquartile range [IQR] 38.0-56.0, 63.6% men) and 102 patients with CKD (33.1%, median age: 61.0 years, IQR 50.0-71.2, 48% men). The frequency of infectious skin diseases (39.3% vs. 21.6% P = 0.002) were higher in RTR than in patients with CKD. Neoplastic skin lesions were present in nine (4.4%) RTR and in only one (1.0%) patient with CKD. Among the RTR, the ratio of basal cell carcinoma to squamous cell carcinoma was 2:1. CONCLUSIONS: This study revealed that an increased frequency of infectious skin diseases may be expected in patients who have undergone kidney transplantation. Among skin cancers, BCC is more frequently observed in RTR, especially in those using azathioprine.

Validação das equações para estimativa da filtração glomerular ajustáveis por raça/cor em adultos de Vitória, Espírito Santo, Brasil / Validation of glomerular filtration estimation equations adjustable by race/colour in adults from Vitória, Espírito Santo, Brazil

Resumo A avaliação da função renal é feita por meio da taxa de filtração glomerular (TFG), que pode ser determinada pelo clearance de creatinina (CrCl) e é dependente da coleta urinária de 24 horas (h), o que dificulta o seu uso na atenção primária. As equações que estimam a TFG a partir da creatinina sérica tornam o exame mais acessível, contudo, os seus ajustes por raça/cor têm sido questionados em populações miscigenadas. Para verificar a concordância entre o ClCr e a TFG estimada por fórmulas (Modification of Diet in Renal Disease [MDRD-4] e Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), com ou sem ajuste por raça/cor, foram utilizados dados de subestudo da Pesquisa Nacional de Saúde (PNS) com inclusão de 272 adultos de Vitória, Espírito Santo, que fizeram coleta urinária de 24h. Adotou-se análise de variância (ANOVA) e método de Bland-Altman. Houve concordância adequada entre o ClCr e as equações, mas o ajuste por raça/cor diminui a acurácia destas últimas. No fator raça/cor, houve semelhança entre grupos para o ClCr (p=0,21) sugerindo não haver diferença no metabolismo da creatinina em função da cor da pele. Conclui-se que MDRD-4 e CKD-EPI apresentam desempenho satisfatório na avaliação da função renal, não sendo recomendado o uso de correções para raça/cor.

Abstract The assessment of renal function is performed using the glomerular filtration rate (GFR) whose measurement by creatinine clearance (ClCr) and is dependent on a 24-hour urine sample, hindering it use in primary healthcare. The equations that estimate GFR from serum creatinine make the test more accessible, however, their adjustments by race/color have been questioned in mixed populations. To test the agreement between CrCl and GFR estimated by formulas (Modification of Diet in Renal Disease [MDRD-4] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), with or without adjusting for race/color, data were used from a sub-study of the National Health Survey (NHS) including 272 adults from Vitória/Espírito Santo who underwent a 24-hour urinary sampling. Analysis of variance (ANOVA) and the Bland-Altman method were adopted. There was adequate agreement between ClCr and equations, but the adjustment by race/color decreases the accuracy of both equations. In the race/color factor, there was similarity between groups for CrCl (p=0.21), suggesting that there is no difference in creatinine metabolism induced by skin color. It is concluded that MDRD and CKD-EPI equations perform satisfactorily in the evaluation of renal function, and the use of corrections for race/color is not recommended.

Impact of peritoneal dialysis strategy on technique and patient survival.

Background: The aim of this study was to evaluate the impact of peritoneal dialysis (PD) strategy on technique and patient survival. Methods: This was a retrospective, single-center study conducted on consecutive patients with chronic kidney disease who underwent PD between January 2009 and December 2019. The study sample was stratified into four different groups according to PD technique [automated (APD) or manual (CAPD)] and icodextrin use (yes versus no). The primary endpoints were survival of both technique and patient. Results: A total of 531 patients were included in the analysis. Mean ± standard deviation age was 60.6 ± 14.6 years, 68.4% (363) were men and 34.8% (185) had diabetes. The median technique survival time was 19 (15) months. A total of 185 (34.8%), 96 (18.1%), 99 (18.7%) and 151 (28.4%) patients were included in the CAPD/No-Icodextrin, CAPD/Icodextrin, APD/No-Icodextrin and APD/Icodextrin study groups, respectively. Throughout the study, 180 (33.9%) patients underwent renal transplant, 71 (13.4%) were changed to hemodialysis and 151 (28.4%) died. Age [hazard ratio (HR) 0.975, 95% confidence interval (CI) 0.960-0.990, P = .001] and incidence of early peritoneal infection (HR 2.440, 95% CI 1.453-4.098, P = .001) were associated with technique survival, while age (HR 1.029, 95% CI 1.013-1.045, P < .001), Charlson Index (HR 1.192, 95% CI 1.097-1.295, P < 0.001), use of icodextrin (HR 0.421, 95% CI 0.247-0.710, P < .001) and APD/Icodextrin (HR 0.499, 95% CI 0.322-0.803, P = .005) were associated with patient survival. Conclusions: Icodextrin use and APD/Icodextrin had a positive impact on patient survival, while older age and higher Charlson Index had a negative one. Age and incidence of early peritoneal infection significantly impacted on technique survival.

Síndrome cardiorrenal tipo 4 en paciente revascularizado percutáneamente

Introducción: el síndrome cardiorrenal es una patología dada por la disfunción en la interdependencia de estos órganos por interacciones bidireccionales (agudas o crónicas), los cuales pueden afectar indistintamente la función renal o ventricular. Objetivo: presentar y justificar la enfermedad renal crónica como desencadenante de cuadros congestivos por falla cardiaca de novo. Presentación del caso: se reporta el caso de un paciente masculino de 69 años revascularizado percutáneamente hace tres años con múltiples comorbilidades que ingresa en el contexto de una falla cardiaca de novo, secundaria a su enfermedad renal crónica estadio V de base, en manejo con hemodiálisis y en quien se descartó enfermedad coronaria aguda y miocardiopatía infiltrativa. Se logró estabilizar la injuria renal y cardiaca dando egreso y continuando manejo ambulatorio de sus patologías, al llevar un control adecuado de las mismas con Nefrología y Cardiología. Discusión y conclusión: la enfermedad cardiovascular generada por antecedentes renales tiene una gran repercusión en la función ventricular izquierda, causando hipertrofia, lo que lleva a una congestión con posterior sobrecarga debido a la caída del filtrado glomerular y que resulta en la disminución de la fracción de eyección. La enfermedad renal crónica predispone a alteraciones en la función cardiaca, lo que aumenta el riesgo cardiovascular.

Background: Cardiorenal syndrome is a pathology caused by dysfunction in the interdependence of these organs due to bidirectional interactions (acute or chronic), which can affect either renal or ventricular function. Purpose: To present and justify chronic kidney disease as a trigger of congestive conditions due to de novo heart failure. Case presentation: We report the case of a 69-year-old male patient percutaneously revascularized 3 years ago with multiple comorbidities who was admitted in the context of de novo heart failure secondary to his stage V chronic kidney disease on hemodialysis, in whom acute coronary artery disease and infiltrative cardiomyopathy were ruled out. The renal and cardiac injury was stabilized and the patient was discharged and continued outpatient management of his pathologies with adequate control of the same with nephrology and cardiology. Discussion and conclusion: Cardiovascular disease generated by renal history has great repercussion in left ventricular function causing hypertrophy that leads to congestion with subsequent overload due to the fall of glomerular filtration resulting in a decrease of the ejection fraction. Chronic kidney disease predisposes to alterations in cardiac function increasing cardiovascular risk.

Long-term outcomes and associated prognostic risk factors of childhood-onset lupus nephritis.

Background: This study investigated the clinical characteristics and kidney outcomes of childhood-onset lupus nephritis (LN), and risk factors associated with prognosis. Methods: We enrolled 216 patients with histologically diagnosed LN during childhood. The Korean Society of Pediatric Nephrology organized a retrospective cohort study of childhood-onset LN in 13 major pediatric nephrology centers in South Korea. Results: The mean age at kidney biopsy was 13.2 ± 3.22 years. The main forms of presentation were nephrotic syndrome and/or hematuria in 152 patients (70.4%), and the most common histological finding was World Health Organization (WHO) class IV in 138 patients (63.9%), followed by WHO class III in 34 patients (15.7%). In the outcome analysis, the mean follow-up period of the patients was 7.8 ± 5.11 years. At last follow-up, 32 patients (14.8%) developed advanced chronic kidney disease (CKD). Male sex and failure to achieve remission at 12 months of treatment were significant risk factors for developing advanced CKD (hazard ratio of 2.57 and 2.29, respectively). Conclusion: Our study demonstrated the clinical characteristics and long-term outcomes of patients with childhood-onset LN. Male sex and failure to achieve remission in the first year of treatment were predictive of advanced CKD. Therefore, prompt awareness and close monitoring of these high-risk patients are needed, which may further improve the prognosis of children with LN.