Baseline eGFR Research Articles

Association of Obesity, Visceral Fat Accumulation, and Dyslipidemia with the Risk of Chronic Kidney Disease.

Objective Although chronic kidney disease (CKD) is independently associated with hypertension or hyperglycemia, there is no consensus on the thresholds of obesity, dyslipidemia, or visceral fat accumulation to predict CKD onset and progression. Methods We performed a multivariable logistic regression analysis for the association of the subsequent rate of estimated glomerular filtration rate (eGFR) decline with body mass index (BMI), blood high-density lipoprotein (HDL) cholesterol and triglycerides (TG) levels on 308,174 subjects who underwent health examinations conducted by the Public Health Research Center Foundation from 2015 to 2022. In addition, a Poisson regression analysis was used to evaluate the association between the appearance of urinary protein in participants without baseline urinary protein levels and eGFR decline. Results The median age of the subjects was 46 years old, and the median observation period was approximately 3 years. An eGFR decline rate of ≥5%/year was significantly associated with low HDL-cholesterol levels (<40 mg/dL), independent of the BMI and TG levels. A high baseline BMI (≥25 kg/m2) or waist circumference (≥85 cm for men and ≥90 cm for women), high TG levels (≥150 mg/dL), and low HDL-cholesterol levels were significantly associated with new-onset proteinuria. Furthermore, the higher the baseline BMI, the higher the incidence rate ratio of new-onset proteinuria. Conclusion Independent of hyperglycemia and hypertension, dyslipidemia according to the Japanese metabolic syndrome criteria and an elevated BMI were associated with a high risk of new-onset proteinuria, and a low HDL-cholesterol level was significantly associated with a rapid eGFR decline.

Risk factors for adverse short-term and long-term outcomes in children with severe acute kidney injury requiring continuous kidney replacement therapy.

Severe acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) is common in critically ill children. We conducted a single-center, retrospective cohort study of children with AKI requiring CKRT from 2011 to 2020 to determine the incidence of and risk factors for adverse short- and long-term outcomes using multivariable analysis. Patients with chronic kidney disease (CKD) and, for long-term analysis, the lack of post-discharge data, were excluded. Of 217 patients, 47% died in hospital. Hospital, intensive care unit (ICU), and ventilator days were 42.71, 26.88, and 21.04days, respectively. Higher baseline estimated glomerular filtration rate (eGFR), vasoactive inotropic score, transfusions, and percent fluid balance (PFB) were associated with increased in-hospital mortality. Cardiac diagnosis, higher admission eGFR, PFB, CKRT duration and instances, and decreased transfusions were associated with increased ICU days. Higher admission eGFR and CKRT duration, younger age, and CVVHDF were associated with increased hospital days for discharged patients. Higher baseline eGFR, PFB, urine output (UOP), CKRT duration and instances, CVVHD, and M60 filter were associated with increased hospital days for patients who died. Higher eGFR at CKRT initiation, PFB, CKRT duration, and instances were associated with increased ventilator time. Of 98 patients followed at 3.58years post-discharge, 16% died at 1.3years. Increased age and UOP were associated with increased mortality. Among 82 patients who survived, 23% were at-risk for CKD and 55% developed CKD. Decreased eGFR at discharge and increased ICU and CKRT days were associated with CKD development. Several modifiable risk factors correlate with adverse short-term outcomes of CKRT. Age and discharge eGFR may guide long-term prognosis and follow-up.

Clonal Hematopoiesis of Indeterminate Potential and Progression of CKD.

Clonal hematopoiesis of indeterminate potential (CHIP) is a common inflammatory condition of aging that causes myriad end-organ damage. CHIP has been associated with incident AKI and kidney function decline in the general population, particularly mutations in CHIP genes other than DNMT3A (termed non-DNMT3A CHIP). Prior studies of CHIP in individuals with CKD had limited sample sizes and conflicting findings. We examined CHIP and CKD progression in four CKD cohorts (N = 5,654): the Chronic Renal Insufficiency Cohort (CRIC), the African American Study of Kidney Disease (AASK), individuals with CKD from the BioVU biorepository, and the Canadian study of prediction of death, dialysis and interim cardiovascular events (CanPREDDICT).Primary outcomes were incident CKD progression (50% eGFR decline or kidney failure), and eGFR slope over time. In addition, kidney function and pathology were assessed in a Tet2-CHIP mouse model of CKD induced by dietary adenine. Across all cohorts the average age was 66 ± 11 years, with an average baseline eGFR of 43 ± 15 ml/min/1.73m2, and 24% had CHIP. After meta-analysis, non-DNMT3A CHIP was associated with a 64% higher relative risk of incident CKD progression (hazard ratio [HR] 1.64; 95% confidence interval [CI], 1.00-2.68), with the strongest effect observed in individuals with baseline eGFR 30-60 ml/min/1.73m2 (HR 1.85, 95% CI: 1.18-2.90). Non-DNMT3A CHIP carriers also exhibited a faster eGFR decline (β, -0.62 ± 0.28 ml/min/1.73m2 per year; P = 0.03). In a dietary adenine mouse model of CKD, Tet2-CHIP was associated with lower GFR as well as greater kidney inflammation, tubular injury, and tubulointerstitial fibrosis. Non-DNMT3A CHIP was associated with CKD progression among individuals with CKD. Further, Tet2-CHIP mouse models support a causal role in kidney injury.

Association of Clonal Hematopoiesis of Indeterminate Potential with Cardiovascular Events in Patients with CKD.

Patients with CKD are at higher risk of cardiovascular disease. Clonal hematopoiesis of indeterminate potential (CHIP) has been associated with cardiovascular disease in the general population, with a causal role observed in animal models. In the general population, the effect of CHIP is greater for somatic mutations in pre-defined CHIP driver genes other than DNMT3A (referred to as non-DNMT3A CHIP). We sought to assess the prospective association between CHIP and cardiovascular events in patients with CKD. CHIP was measured by high-depth targeted sequencing. The primary analysis tested the association of somatic mutations in non-DNMT3A CHIP driver genes with a composite cardiovascular disease endpoint of myocardial infarction, stroke, congestive heart failure, and peripheral artery disease in 5,043 patients with CKD in four prospective cohorts. Sensitivity analyses examined the effect of CHIP subtypes, race, baseline comorbidities, APOL1 risk alleles, and IL6R p.Asp358Ala genotype. At baseline, patients had a mean age of 66 ± 12 years and eGFR of 43 ± 18 ml/min/1.73m2. CHIP was present in 24% of patients, with 13% of all patients carrying acquired non-DNMT3A mutations. Non-DNMT3A CHIP was associated with a 36% higher risk of the composite cardiovascular endpoint [95% confidence interval (CI), 6% - 76%]. Among composite components, non-DNMT3A CHIP was associated with a higher risk of stroke (HR 1.65; 95% CI 1.10 - 2.47). Baseline eGFR, diabetes status, or race did not alter the association of non-DNMT3A CHIP with cardiovascular risk. Those without genetically reduced interleukin-6 signaling (non-carriers of IL6R p.Asp358Ala) had worse disease (HR 1.46; 95% CI 1.17- 1.83, Psubgroup difference = 0.05). In patients with CKD, non-DNMT3A CHIP was associated with cardiovascular disease with an effect size similar to that reported in the general population.

Preoperatory Flot Regimen for Gastroesophageal Cancer and Renal Function: A New Onco-Nephrological Perspective.

(1) Background: The FLOT regimen, a combination of fluorouracil, leucovorin, oxaliplatin, and docetaxel, is a standard treatment for gastric and esophagogastric junction cancers, but concerns exist about its potential renal toxicity. The exact prevalence and severity of renal toxicity need to be well-documented, and this knowledge gap could impact the optimal use of the FLOT regimen in clinical practice. We aimed to evaluate the renal toxicity profile of the FLOT regimen with a specific focus on Acute Kidney Disease onset in a real-life setting and explore associated risk factors. (2) Methods: We conducted a multicenter retrospective study involving 96 patients treated with preoperatory FLOT. The incidence of acute kidney disease (AKD) and potential risk factors were identified. (3) Results: AKD occurred in three patients (incidence rate of 0.0122 cases/month of follow-up). Oral antidiabetic agents and prostate hypertrophy emerged as significant predictors of AKD. (4) Conclusion: Acute Kidney Disease is uncommon in patients treated with the preoperatory FLOT regimen. Our findings highlight the importance of diligent renal function monitoring and appropriate preventive strategies in patients undergoing FLOT treatment. These results encourage the conduction of further studies and clinical experiences in larger populations and patients with lower baseline eGFR.

Effect of Initial eGFR and Albuminuria Changes on Clinical Outcomes in People With Diabetes Receiving SGLT2 Inhibitors.

The relationship between initial changes in estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR), and their independent association with clinical outcomes in type 2 diabetes (T2D) patients receiving sodium-glucose cotransporter 2 inhibitors (SGLT2is), remains unclear. This study aimed to investigate the association between initial changes in eGFR and UACR with consequent cardiovascular and kidney outcomes in an Asian population with T2D following SGLT2i treatment in a real-world setting. Using a large multicenter medical database in Taiwan, we analyzed 8222 T2D patients with baseline and 3-month follow-up eGFR and UACR measurements, receiving SGLT2is between June 1, 2016, and December 31, 2021. We assessed risks of major adverse renal events (MARE), major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), and all-cause mortality using a Cox proportional hazards model. After 3 months of SGLT2i treatment, patients were categorized based on early changes in eGFR (no decline, 0%-10% decline, > 10% decline) and UACR (no reduction, 0%-30% reduction, > 30% reduction). Among those with no initial eGFR decline (40.9%), 19.8% had no initial UACR reduction, 8.4% had 0% to 30% reduction, and 12.7% had greater than 30% reduction. For those with greater than 10% initial eGFR decline (21.5%), 6.5% had no UACR reduction, 4.3% had 0% to 30% reduction, and 10.7% had greater than 30% reduction. Patients with greater than 10% initial eGFR decline but no UACR reduction showed higher risks of MARE (adjusted HR [aHR]: 2.34; 95% CI, 1.32-4.15), MACE (aHR: 1.83; 95% CI, 1.01-3.29), and HHF/cardiovascular death (aHR: 1.93; 95% CI, 1.05-3.55) compared to those with modest early eGFR decline and UACR reduction. T2D patients experiencing profound early eGFR decline without concordant UACR reduction while on SGLT2is represent a high-risk subgroup with worse clinical outcomes. These findings suggest the need for closer monitoring and potentially more aggressive therapeutic strategies for this patient population.

Renal function decline in Asian patients with atrial fibrillation with warfarin and non-vitamin K antagonist oral anticoagulants: A report from the COOL-AF registry.

The objective of this study was to compare the risk of estimated glomerular filtration rate (eGFR) decline between atrial fibrillation (AF) patients with direct oral anticoagulants (DOACs) and warfarin. We studied patients with nonvalvular AF from a prospective multicenter national AF registry in Thailand. Patients with missing eGFR data or eGFR less than 30 mL/min/1.73 m2 were excluded. Follow-up data including eGFR were collected every 6 months until 3 years. eGFR decline was assessed by eGFR slope. We compared eGFR slope between patients who received DOACs and warfarin at baseline. In the warfarin group, we assessed the impact of good anticoagulation control by time in the therapeutic range (TTR). A total of 1708 patients were studied (mean age 68.1 years; 42.6% female). Patients with DOACs had a significantly slower rate of eGFR decline compared to warfarin. The eGFR slope was 2.32 mL/min/1.73 m2 per year in the warfarin group (95% CI: 3.09 to 1.55), and 1.31 mL/min/1.73 m2 per year in the DOAC group (95% CI: 1.97 to 0.64). The effect of OAC type on the eGFR slope remained significant even after the adjustment of baseline variables including baseline eGFR. There was no difference in GFR decline as reflected by eGFR slope when comparing warfarin patients with TTR <65% and ≥65%. In this prospective cohort of Asian patients with AF, DOACs were associated with a slower rate of eGFR decline when compared with warfarin. In the latter group, this was irrespective of the quality of anticoagulation control.

Efficacy and Safety of SGLT-2 Inhibitors in Patients With and Without Advanced CKD: A Systematic Review and Meta-Analysis.

The efficacy and safety of sodium-glucose co-transporter-2 (SGLT-2) inhibitors in patients with advanced chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2, has not been adequately studied. We conducted a systematic review and meta-analysis of phase 3 randomized controlled trials (RCTs) of SGLT-2 inhibitors in adults. We searched the MEDLINE and Embase databases from inception to April 2024. The primary outcomes were a composite kidney (worsening kidney function, kidney failure, kidney or cardiovascular death) and cardiovascular (cardiovascular death or hospitalization for heart failure) outcome. Secondary outcomes included other reported cardiovascular and kidney outcomes, eGFR slopes, mechanistic and safety outcomes. The relative risks (RR) were estimated using a random effects model. Interaction effects were estimated for treatment effect modification by baseline eGFR (<30 and ≥30 ml/min/1.73m2). A total of 10 RCTs were included (total of 4800 patients with eGFR <30 ml/min/1.73m2). Participants were randomized to receive either placebo or an SGLT-2 inhibitor. Use of SGLT-2 inhibitors was associated with a lower incidence of the primary composite kidney outcome in patients with eGFR <30 ml/min/1.73m2 [RR 0.79, 95% confidence interval (CI) 0.70-0.89] and ≥30 ml/min/1.73m2 (RR 0.71, 95% CI 0.64-0.79). The incidence of the primary cardiovascular outcome was numerically lower in the SGLT-2 inhibitor arm in patients with eGFR <30 ml/min/1.73m2 (RR 0.88, 95% CI 0.71-1.10). In patients with eGFR ≥30 ml/min/1.73m2, SGLT-2 inhibitor use was associated with a lower incidence of the composite cardiovascular outcome (RR 0.77, 95% CI 0.71-0.83). However, there was no interaction between advanced CKD status and the effect of SGLT-2 inhibitors on any of the primary or secondary outcomes. The incidence of adverse events was similar in both arms. SGLT-2 inhibitors retain their kidney and cardiovascular protective effect in patients with advanced CKD, with no added safety concerns.

Quality of life and kidney function in CKD patients: a longitudinal study.

In chronic kidney disease (CKD), a declining glomerular filtration rate (GFR) leads to physiological and psychosocial burdens that impair quality of life (QoL). However, this relationship has been mainly investigated in cross-sectional studies and a limited number of longitudinal studies that reported contrasting results. This longitudinal study included 582 patients with Stages 2-5 CKD. QoL was assessed using the Kidney Disease Quality of Life (KDQOL™) instrument at baseline and annually for 3 years. GFR was estimated using the MDRD equation, the equation recommended by guidelines that were contemporary to the study cohort. We analysed the relationship between repeated measures of QoL and GFR using unadjusted and adjusted mixed linear models (MLMs). The cohort had a mean age of 61±12 years, with 60% males and 33% diabetics. Baseline eGFR was 36±13ml/min/1.73 m². Physical and mental component summary scores of QoL were 43.5 and 45.1, respectively. In MLM analyses adjusted for potential confounders, a 10ml/min/1.73 m² decrease in eGFR was significantly associated with reductions in physical (β=-0.60, P=.016) and mental (β=-0.52, P=.045) component summary scores over the follow-up period. The physical functioning and role limitation physical health subcomponents of QoL were primarily responsible for these associations. This longitudinal study shows that declining kidney function is associated with deteriorating QoL in CKD patients independently of other factors. These findings support the current KDIGO recommendation that regular monitoring of QoL should be incorporated into clinical practice to improve patient outcomes.

Acute kidney disease after radical cystectomy for bladder cancer: a new onco-nephrological view.

To assess the incidence of acute kidney injury (AKI) and acute kidney disease (AKD) following radical cystectomy (RC) in patients with muscle-invasive bladder cancer (BCa). A consecutive cohort of 840 patients undergoing RC for muscle-invasive BCa at a tertiary institution (2010-2022) was analysed. Clinical variables, comorbidities, surgical techniques and oncological regimens were recorded pre- and post-surgery. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed at baseline, at 24, 48 and 72 h, and 6 days post-surgery for AKI, and at multiple intervals up to 60 days for AKD. Chronic kidney disease (CKD) stages G1 G2 and ≥G3 were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. A multivariable logistic regression model was used to predict postoperative AKI or AKD risk. Of the patients included in the study, 33% developed AKI and 54% developed AKD. Independent predictors included advanced age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), chronic hypertension (OR 1.43, 95% CI 1.03-2.00) and Charlson Comorbidity Index ≥2 (OR 1.59, 95% CI 1.09-2.33). Surgical factors, including use of a robot-assisted approach (OR 2.28, 95% CI 1.50-3.49) and ileal neobladder diversion (OR 1.84, 95% CI 1.05-3.24) were significant, possibly due to the associated prolonged operating times and metabolic challenges. Baseline renal function (CKD ≥G3, OR 2.17, 95% CI 1.28-3.68) and lower preoperative eGFR strongly correlated with AKD risk; a baseline eGFR below 20 mL/min was associated with an AKD risk ≥80%. Our results showed that AKI and AKD are frequent complications of RC for muscle-invasive BCa. Personalised nephrological counselling pre- and post-surgery is essential to minimise morbidity and mortality.

Effects of Dulaglutide on Ectopic Fat Deposition in Chronic Kidney Disease (CKD): A Pilot and Feasibility Study (GLIMP).

Patients with chronic kidney disease (CKD) often exhibit ectopic fat accumulation, including intermuscular adipose tissue (IMAT), which is associated with metabolic and muscular dysfunctions. This study aimed to evaluate the effects of dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), on reducing IMAT and improving metabolic and physical functions in patients with CKD stage 3-4. Seven patients were recruited between April 2022 and November 2023. A 12-week dulaglutide (1.5 mg/wk) intervention was conducted with pre-and post-treatment assessments, including magnetic resonance imaging (MRI) for the IMAT evaluation and systemic physical performance battery test (SPPB) for physical performance evaluation. Their body mass indexes (BMI) were calculated and blood samples were analyzed for inflammatory and metabolic markers, including high sensitive C-reactive protein (Hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), glucose, insulin resistance (IR), total cholesterol, triglyceride, adiponectin, leptin, and leptin-adiponectin ratio (LAR) before and after treatment. Paired t-tests and Mann-Whitney U tests were used for statistical analysis, with significance set at p < 0.05. Out of 58 assessed patients with CKD stage 3-4, 7 were enrolled, with 5 completing the full 12-week dulaglutide treatment. The total 7 people had a mean age of 59 years, mean BMI of 31.4 kg/m², and baseline eGFR of 31.7 mL/min/1.73m². IMAT decreased in 4 patients and increased in 3 patients, with no statistically significant changes overall (p = 0.69). The quadriceps muscle cross-sectional area (CSA) also showed no significant difference (p = 0.73). BMI and serum leptin levels significantly decreased after treatment (p < 0.05), while other inflammatory and metabolic markers, and physical performance scores showed no significant changes. No serious adverse events were reported. This study examined the effects of a 12-week dulaglutide treatment on IMAT accumulation in patients with CKD stage 3-4. While BMI significantly decreased, changes in IMAT were modest and not statistically significant, with potential but unproven clinical and metabolic benefits. Many metabolic and inflammatory markers improved, though not statistically significantly, and physical performance remained unchanged. Muscle CSA and function were maintained, which may alleviate concerns about potential GLP-1RA-induced muscle loss. Dulaglutide was well-tolerated, with minimal side effects. The small sample size and short duration highlight the need for further research. Name of the Registry : ClinicalTrials.gov Trial Registration Number : NCT05254418 Date of Registration : 2022-02-01.

Cardiometabolic protein expression levels and pathways associated with kidney function decline in older European adults with advanced kidney disease

Abstract Background Cardiovascular disease and chronic kidney disease progression pathophysiology are similar. We investigated associations of cardiometabolic protein expression and pathways with kidney function decline in older adults with advanced chronic kidney disease (CKD) referred for nephrology assessment. Methods Two plasma proteomic panels analysed at baseline (Olink® cardiometabolic T96 and cardiovascular II T96, Uppsala, Sweden) and longitudinal estimated glomerular filtration rate (eGFR) data from European adults aged &amp;gt; 65 years with a single eGFR of &amp;lt;20 mL/min/1.73m2 (The EQUAL Study) were used to explore mechanisms of CKD progression. Protein-slope associations were estimated using generalised linear mixed-effects models and with a false discovery rate P &amp;lt; 0.05 taken to validation to verify the effect size of the association. Proteins were further modularised into biological pathways using pathway enrichment analysis. Results A discovery sub-cohort of 238 complete-case participants from Germany, United Kingdom and Poland (median age 76 years, 41% female sex, median baseline eGFR 17.8 mL/min/1.73m2) were included and 246 participants from Sweden formed the validation sub-cohort (median age 75 years, 28% female, median baseline eGFR 17.5 mL/min/1.73m2). Of the 175 analysed proteins, higher expression levels of Receptor-type tyrosine-protein phosphatase S (-15.4% change in eGFR per year per doubling of protein expression; 95%CI -23.5%, -7.6%), Insulin-like growth factor binding protein 6 (-7.9%; 95%CI -12.3%, -3.5%) and Ficolin 2 (-7.4%; 95%CI -12.0%, -2.8%) showed a validated association with eGFR decline. Conclusions Higher expression levels of proteins and biological pathways involving fibrogenesis and the complement cascade were found to be associated with kidney function loss. However, study limitations and unavailability of concurrent kidney cellular proteomic signatures necessitate further study.

Low Contrast Strategies in TAVR: Feasibility and Outcomes to Prevent Renal Injury in Chronic Kidney Disease.

Contrast volume is a major risk factor for acute kidney injury (AKI) in patients with chronic kidney disease (CKD) after TAVR. Use of a low-contrast (LC) protocol in TAVR may reduce AKI without impacting other clinical outcomes. TAVR patients with Stage 3b or worse CKD between 2015 and 2020 were grouped into LC and normal-contrast (NC). LC was defined as TAVR procedure contrast use (mL) less than estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). The primary outcome was AKI, defined as creatinine elevation > 200% or ≥ 0.3 mg/dL from baseline. Secondary outcomes were 30-day mortality, length of stay, paravalvular leak at 30 days, new dialysis requirement, major vascular complication, re-admission, bleeding, and a composite primary endpoint of secondary outcomes. We performed a propensity-matched analysis, compared cohort outcomes, and stratified outcomes by AKI severity. Four hundred thirty-seven patients were analyzed. The LC group (n = 173) were more commonly male and had a lower baseline eGFR (31 vs. 33, p = 0.03) than the NC group (n = 264). After propensity-matching, AKI occurred less frequently in LC patients than in the NC patients (17.9 vs. 28.3%, p = 0.0217). There were no inter-group differences in mortality, new dialysis requirement, major vascular complications, bleeding, or re-admissions. In TAVR patients with CKD, LC volume was associated with reduced risk of AKI, supporting a LC approach for TAVR in CKD patients. We sought to evaluate the outcomes of a LC versus normal-contrast dose strategy in TAVR amongst patients with CKD.

Defining Kidney Health Dimensions and their Associations with Adverse Outcomes in Persons with Diabetes and Chronic Kidney Disease.

Individual kidney tubule biomarkers are associated with risks for chronic kidney disease (CKD) progression and mortality in persons with diabetes. Integrating multiple kidney biomarkers using a latent variable method of exploratory factor analysis could define distinct dimensions of kidney health, and their associations with adverse outcomes. We conducted a factor analysis of 17 candidate urine and plasma biomarkers in 1,256 participants with diabetes and estimated glomerular filtration rate (eGFR) <60ml/min/1.73 m2 from the Chronic Renal Insufficiency Cohort (CRIC; N=701) and the Reasons for Geographic and Racial Differences in Stroke (REGARDS; N=555) studies. We used Cox proportional hazards models to evaluate the associations of identified factors with CKD progression and mortality, adjusting for baseline clinical risk factors, eGFR and albuminuria. Three factor scores comprising 10 biomarkers were identified: systemic inflammation and filtration (plasma tumor necrosis factor receptor-1 [TNFR-1] and -2 [TNFR-2], plasma soluble urokinase plasminogen activator receptor (suPAR), plasma symmetric dimethylarginine [pSDMA]) ), tubular function (Urine epidermal growth factor [uEGF], Urine asymmetric dimethylarginine [uADMA], Urine symmetric dimethylarginine [uSDMA]), and tubular damage (Urine α-1 microglobulin [α1m], Urine kidney injury molecule-1 [uKIM-1], Urine monocyte chemoattractant protein-1 [uMCP-1]). In CRIC, there were 244 incident end stage kidney disease (ESKD) events, 102 with ≥40% eGFR decline from baseline, and 259 deaths; in REGARDS, there were 121 incident ESKD events and 462 deaths. In CRIC, lower tubular function (hazard ratio per 1-standard deviation, 0.36; 95% confidence interval, 0.25-0.52) and higher tubular damage scores (1.45; 1.18-1.78) were independently associated with higher CKD progression risk. Associations in REGARDS were weaker but directionally consistent (tubular function [0.81; 0.47-1.39] and tubular damage scores [1.12; 0.73-1.72]). Higher tubular damage (1.47; 1.15-1.87) scores were associated with higher mortality risk in CRIC, but not REGARDS ( [1.15; 0.96-1.38]. Higher systemic inflammation and filtration factor scores were associated with higher mortality risk in both cohorts [CRIC: 1.35; 1.07-1.71; REGARDS: 1.41; 1.20-1.65]. Three distinct kidney health dimensions were identified, and each associated with CKD progression and/or all-cause mortality in persons with diabetes and CKD.

Robotic ileal ureter replacement vs kidney autotransplantation for long ureteric strictures.

To compare functional and surgical outcomes of robot-assisted ileal ureter replacement (RAIUR) vs robot-assisted kidney autotransplantation (RAKAT). This was a retrospective analysis of patients who underwent RAIUR or RAKAT for long ureteric strictures at eight European tertiary centres (2017-2024). Primary endpoints were maintenance of estimated glomerular filtration rate (eGFR) and postoperative complications within 30 days of surgery, described using the Clavien-Dindo classification. Secondary outcomes included infections, need for lifelong drainage, stricture persistence, and re-intervention for the stricture during follow-up. A total of 15 and 39 patients underwent RAIUR and RAKAT, respectively. The patients who underwent RAIUR were older (61 vs 45 years, P = 0.03), with more comorbidities (Charlson Comorbidity Index ≥3: 67% vs 28%, P = 0.03) and had a lower baseline eGFR (60 vs 87 mL/min/1.73m2, P = 0.007). The median stricture length was 9.6 cm for RAIUR vs 7 cm for RAKAT. Patients who underwent RAIUR had a shorter surgical time (290 vs 355 min, P = 0.008), whereas those who underwent RAKAT had a shorter hospitalisation (5 vs 8 days, P = 0.001). Overall complications were higher after RAIUR (73% vs 31%, P = 0.01), but Clavien-Dindo Grade ≥III complications were similar (13% vs 10%). During follow-up, both groups showed slightly improved renal function, low infection rates (13% for RAIUR vs 10% for RAKAT), low stricture persistence (13% for RAIUR vs 7.7% for RAKAT), and minimal need for drainage or re-intervention. The main limitation was the modest sample size. In the first comparative analysis of RAIUR and RAKAT, we provide evidence that both techniques provide similar improvements in renal function and similar rates of postoperative high-grade complications. Both approaches represent definitive solutions for ureteric strictures in most patients. The choice of the technique should be based on patients' factors, patients' expectations and the surgeon's experience.

Association of uric acid to high-density lipoprotein cholesterol ratio with the presence or absence of hypertensive kidney function: results from the China Health and Retirement Longitudinal Study (CHARLS).

Some studies have shown that uric acid (UA) to high-density lipoprotein (HDL-C) ratio (UHR), as an indicator of inflammation, is associated with metabolic syndrome and hypertension, but its relationship with decreased renal function is unclear. This study intends to analyze the relationship between UHR and decline in renal function. Data were obtained from the 2011-2015 data of the China Health and Aging Tracking Survey (CHARLS) of Peking University, and 7,198 study participants were included and followed up until 2015. The eGFR (Total glomerular filtration rate) was estimated according to the CKD-EPI [1] creatinine equation. eGFR ≥ 60mL/min/1.73m² at baseline renal function was defined as normal renal function, and eGFR < 60mL/min/1.73m² at baseline renal function was defined as chronic kidney disease; new-onset eGFR < 60mL/min/1.73m² was defined as the occurrence of decline in renal function; in the chronic kidney disease population decrease in eGFR ≥ 5mL/min/1.73m²/year or 30% from baseline or admission to dialysis was defined as rapid progression of chronic kidney disease. eGFR slope was defined as the ratio of the difference between the final eGFR and the baseline eGFR over 4 years of follow-up. Binary logistic regression was used to analyze the relationship between UHR and renal function decline or progression, as well as linear regression and non-linear regression to clarify the relationship between UHR and GFR slope in hypertensive patients, and the correlation between UHR and CRP, and to assess the relationship between UHR levels and the risk of renal function decline in hypertensive people. (1) Hypertension was a risk factor for the decline of renal function (OR: 1.34, P = 0.03); (2) UHR was a risk factor for the decline of renal function in the hypertensive population (OR: 1.32, P = 0.02), and with the increasing level of UHR, the risk of developing CKD (Chronic Kidney Disease) in hypertension was higher (P for trend = 0.03); (3) The subgroup analyses showed that there was no interaction between hypertension and age, cystatin C and hemoglobin did not interact with each other; (4), In the hypertensive population, the slope of UHR and eGFR showed a J-shaped correlation, with UHR > 7.6% as the cut-off point, and the slope of eGFR tended to increase with increasing UHR; in the non-hypertensive population UHR and eGFR showed a linear correlation, and the slope of the decline in eGFR was smaller than that of the hypertensive population; (5), After adjusting for confounders, UHR and CRP were positive correlation (t = 3.56, P < 0.05); (6) In the hypertensive population with normal CRP, the risk of decline in renal function increased accordingly with increasing UHR (P = 0.003). UHR did not show a correlation with CRP in the hypertensive population with abnormal CRP (P = 0.24). In the hypertensive population, elevated UHR is associated with an increased risk of decline in renal function; with UHR > 7.6% as the cut-off point, the slope of eGFR tended to increase with increasing UHR, and UHR can be used as an indicator for risk stratification of renal injury in the hypertensive population.

Long-term trajectory of estimated glomerular filtration rate in ambulatory patients with type 2 diabetes and heart failure: clinical insights and prognostic implications

BackgroundAlthough previous studies have evaluated renal function decline in patients with heart failure (HF), there is limited evidence on long-term renal trajectories, especially in patients with concomitant HF and type 2 diabetes (T2D). This study aims to provide a detailed analysis of renal function decline over an extended follow-up period in a well-characterized cohort of patients with HF and T2D.MethodsThis is a post hoc subanalysis of a prospective registry involving ambulatory patients with HF and T2D referred to a specialized HF clinic. The estimated glomerular filtration rate (eGFR) was assessed at baseline and during scheduled follow-up visits every three months using the Chronic Kidney Disease Epidemiology Collaboration formula. Loess curves were plotted for predefined subgroups, and multivariable longitudinal Cox regression analyses were performed to evaluate the associations between eGFR trajectories and all-cause mortality.ResultsA total of 1,114 patients with HF and T2D were included, with a mean age of 69.3 ± 10.3 years, and 68.2% were men. In total, 10,830 scheduled creatinine measurements were analysed, with a mean of 15.8 ± 9.4 measurements per patient. A significant progressive decline in the eGFR was observed, with an average annual rate of − 2.05 (95% CI − 2.11 to − 1.95, p < 0.001) ml/min/1.73 m2. Subgroup analysis indicated that older age, nonischaemic HF aetiology, HFpEF or HFmrEF, poor glycaemic control, and higher baseline eGFRs were associated with a more pronounced decline in renal function. Furthermore, a decrease in the eGFR was independently associated with an increased risk of all-cause mortality.ConclusionsThis study offers novel insights into long-term renal function trajectories in patients with HF and T2D and identifies key clinical factors associated with accelerated renal decline. Future research is warranted to validate these results in larger, more diverse cohorts and to explore potential therapeutic interventions.Graphical

Association of plasma angiogenin with risk of incident end-stage kidney disease in individuals with type 2 diabetes.

We aim to investigate the association between plasma angiogenin and the risk of progression to end-stage kidney disease (ESKD) in Type 2 Diabetes (T2D) patients and attempted to infer the causal relationship between plasma angiogenin and chronic kidney disease. A total of 1863 outpatients with T2D were included in this prospective cohort study. ESKD was defined as a composite of progression to sustained eGFR below 15 ml/min/1.73m2, maintenance dialysis or death due to renal causes. The secondary outcome was rapid kidney function decline defined as eGFR decline of 5 ml/min/1.73m2 or greater per year. Over a median follow-up of 9.3 years, 125 incident ESKD events were identified. Elevated plasma angiogenin levels were associated with an increased risk of incident ESKD (adjusted HR 1.25, 95% CI 1.01-1.55, per one SD) independent of cardio-renal risk factors including baseline eGFR and albuminuria. A high level of plasma angiogenin was also associated with an increased risk for rapid kidney function decline (adjusted OR 1.31 [1.07-1.61] per 1-SD). A two-sample Mendelian randomization approach suggested a potential causal relationship between plasma angiogenin and chronic kidney disease. Plasma angiogenin may be a novel biomarker and potential therapeutic target for progressive kidney disease in patients with T2D.

Kidney status and events preceding death in heart failure: A real-world nationwide study.

Chronic kidney disease is a frequent comorbidity in heart failure (HF) patients, affecting prognosis and mortality. This study investigates the relationship between kidney function and adverse kidney events preceding death in HF patients. We analysed registry data of HF patients who died between 2014 and 2021, with at least 1 year of HF diagnosis. Adverse kidney events, including acute kidney injury (AKI) and end-stage kidney disease (ESKD), were assessed. Patients were grouped by estimated glomerular filtration rate (eGFR) 1 year before death: eGFR ≥60, eGFR 30-59, and eGFR<30 ml/min/1.73 m2. Among 36 435 HF patients who died, 37% had eGFR ≥60 ml/min/1.73 m2, 46% had eGFR 30-59 ml/min/1.73 m2, and 17% had eGFR <30 ml/min/1.73 m2 1 year before death. Median age was 81 years, and 61.2% were men. Adverse kidney events occurred in 13.1% of patients. AKI was inversely related to kidney function, affecting 6.5% (95% confidence interval 6.1-6.9) of those with eGFR ≥60 ml/min/1.73 m2, 7.0% (6.6-7.4) with eGFR 30-59 ml/min/1.73 m2, and 21.9% (20.9-22.9) with eGFR <30 ml/min/1.73 m2. ESKD occurred in 0.7% (0.6-0.9), 2.6% (2.4-2.8), and 35.5% (34.3-36.7) of patients in the respective eGFR categories. In the last 3 months before death, kidney function notably declined, with increased chronic kidney replacement therapy. Factors associated with higher adverse kidney events included younger age, male sex, in-hospital death, and greater frailty. In HF patients, AKI and ESKD are common in the last year of life, particularly in those with lower baseline eGFR, with kidney decline accelerating in the final months.

The effects of plasma exchange and glucocorticoids on early kidney function among patients with ANCA-associated vasculitis in the PEXIVAS trial.

The effects of plasma exchange and glucocorticoids on early kidney function among patients with ANCA-associated vasculitis in the PEXIVAS trial.