Burden Of Kidney Disease Research Articles

Comparison of health related quality of life between end-stage renal disease patients on haemodialysis and continuous ambulatory peritoneal dialysis

Background: Patients with end-stage renal disease (ESRD) require dialysis for their survival. Haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two different modes of dialysis which can lead to multitude of stressful physical, mental and social problems. This study was done to evaluate the health related quality of life (HRQOL) of ESRD patients undergoing HD and CAPD. Methods: This cross-sectional analytical study was conducted in the Department of Nephrology, BIRDEM General Hospital, Dhaka during January 2019 to June 2020. A total of 66 ESRD patients undergoing HD or CAPD were taken after obtaining informed written consent. Information on socio-demographic characteristics, clinical features and laboratory investigations were assessed. HRQOL was assessed by using the validated Bengali version of Kidney Disease Quality of Life Short Form Tool (KDQOL-SF-36 version1.3). A semistructured questionnaire was used for data collection and analysis was done by Statistical Package for Social Science (SPSS) version 24.0. Results: Majority of ESRD patients underwent HD (54.5%). Age was significantly associated with dialysis treatment modality (HD vs CAPD: 55.6±11.9 vs 62.9±11.9 years, p<0.05). According to SF-36 and KDQOLSF 1.3 assessment, patient undergoing CAPD had a better QOL and mental health compared to HD. Among SF- 36 domain, physical functioning had a significant positive relation with haemoglobin level (r=0.320, p=0.009). Haemoglobin level was positively correlated with symptoms, effects of kidney disease and burden of kidney disease in KDQOL-SF 1.3 scores (p<0.05). Conclusion: CAPD patients demonstrated a better QOL compared to HD patients. BIRDEM Med J 2025; 15(1): 9-15

Exploring factors associated with Kidney Disease Quality of Life in patients with advanced chronic kidney disease: the Reach-J CKD cohort study.

Although several studies have examined the Kidney Disease Quality of Life (KDQOL) in patients with chronic kidney disease (CKD), the factors associated with kidney-related symptoms have not been fully explored. This nationwide multicenter cohort study enrolled 2248 patients. To identify the factors associated with each item or the three KDQOL domains, such as burden of kidney disease, symptoms/problems of kidney disease, and impact of kidney disease on daily life, multiple regression analysis was performed using baseline data. The study population had a mean age of 69.1 ± 12.6years, comprised 64.7% men, and had mean estimated glomerular filtration rate (eGFR) of 23.2 ± 10.4mL/min/1.73m2. Mean serum creatinine levels were 1.4 ± 0.2, 2.3 ± 0.5, and 4.5 ± 1.5mg/dL for G3b, G4, and G5, respectively. The mean scores in the three KDQOL domains among CKD stages showed significantly decreasing trends. Of all the 11 symptoms assessed, 6 had scores that significantly decreased as the CKD stage progressed and 9 had scores that significantly decreased as the age category group increased. Multiple regression analysis revealed eGFR as a significantly associated factor for 5 of 11 symptoms. Age, body mass index, and comorbidities were also detected as significant factors for some symptoms. In addition to eGFR, several factors were associated with symptoms in patients with CKD. Nephrologists need to recognize renal dysfunction-specific symptoms and explore other plausible causes of nonspecific symptoms.

Targeting allograft inflammatory factor-1 reprograms kidney macrophages to enhance repair.

The role of macrophages remains incompletely understood in kidney injury and repair. Their plasticity offers an opportunity to polarize them towards mediating injury resolution in both native and transplanted kidneys undergoing ischemia and/or rejection. Here, we show that infiltrating kidney macrophages augmented their AIF-1 expression after injury. Aif1 genetic deletion led to macrophage polarization towards a reparative phenotype while halting the development of kidney fibrosis. The enhanced repair was mediated by higher levels of anti-inflammatory and pro-regenerative markers leading to a reduction in cell death and increase in proliferation of kidney tubular epithelial cells following ischemic reperfusion injury. Adoptive transfer of Aif1-/- macrophages to Aif1+/+ mice conferred protection against ischemia reperfusion injury. Conversely, depletion of macrophages reversed the tissue-reparative effects in Aif1-/- mice. We further demonstrated an increased expression of AIF-1 in human kidney biopsies from native kidneys with acute kidney injury or chronic kidney disease, as well as in biopsies from kidney allografts undergoing acute or chronic rejection. We conclude that AIF-1 is a macrophage marker of renal inflammation, and its targeting uncouples macrophage reparative functions from profibrotic functions. Thus, therapies inhibiting AIF-1 when ischemic injury is inevitable have the potential to reduce the global burden of kidney disease.

Temporal trends and attributable risk factors of chronic kidney disease burden in Fujian Province, 1990-2019

Objective: To understand the burden of chronic kidney disease (CKD) and its risk factors in Fujian Province during 1990-2019. Methods: Based on the Global Burden of Disease Study 2019, the incidence rate, mortality rate and disability-adjusted life years (DALYs) of CKD in Fujian from 1990 to 2019 were calculated. An age-period-cohort model was used to estimate the effects of age, period, and cohort on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of CKD. Comparative risk assessment theory was used to calculate the potential attributable DALYs due to risk factors. Results: In 2019, the ASIR of CKD in Fujian exceeded the national average. The ASIR of CKD showed an increasing trend from 1990 to 2019, but the ASMR and ASDR of CKD exhibited decreasing trends during the same period. In 2019, the ASIR of CKD was higher in women than in men, while the ASMR and ASDR were higher in men than in women. Age-period-cohort analysis indicated that ASIR, ASMR, and ASDR of CKD increased with age. The period effect for ASIR decreased first before increase, while the period effect for ASMR and ASDR displayed fluctuating trends. The cohort effect showed an upward trajectory for ASIR, but a stable status before downward trajectories for ASMR and ASDR. Compared with 1990, except the increase in the ASDR of CKD attributed to high BMI and high temperatures, the ASDR of CKD attributed to other risk factors all showed decreases in 2019. However, the ASDR attributed to high sodium intake remained higher compared with the global average. Conclusion: The burden of CKD remains heavy in Fujian, and it is necessary to reduce the attributable risk factors, such as high sodium intake and high BMI, to address this problem.

Nativity, Racial/Ethnic, and Length of US Residence Differences in Chronic Kidney Disease: National Health and Nutrition Examination Survey 2011-March 2020.

Rationale : The chronic kidney disease (CKD) burden in the US varies by race/ethnicity. It was unclear whether nativity status influences these disparities. This study compared CKD prevalence by nativity status, race and ethnicity, and length of US residence. Study Design: Cross-sectional analysis. Setting/Participants: We drew a weighted sample of 13,636 adults representing 155,147,141 Hispanic, White, Black, and Asian adults from the pooled 2011-March 2020 National Health and Nutrition Examination Survey (NHANES), which included 155,147,141 US-and foreign-born adults. Exposures : Nativity (US-or foreign-born), race/ethnicity, and length of US residence. Outcome : We defined CKD as eGFR <60mL/min/1.73m 2 or a urinary albumin-to-creatinine ratio ≥30 mg/g. Analytical Approach : Survey-weighted multivariable Poisson models estimated associations among nativity status, race, and ethnicity, length of US residence, and CKD, adjusting for covariates. Results : The prevalence of CKD among US-born adults was 14.0%, vs. 11.5% of foreign-born. Foreign-born adults were less likely to have CKD (prevalence rate ratio [PRR]: 0.75, 95% CI 0.60-0.93) than US-born adults, adjusting for age, sex, and socioeconomic factors. Black adults were more likely to have CKD than White adults (PRR: 1.44, 95% CI 1.23-1.68); this difference was greater among US-born adults (PRR: 1.48, 95% CI 1.25-1.76). Among Hispanic and Asian adults, age-and sex-adjusted prevalence of CKD increased with longer length of residence in the US. Conclusions : There are clear CKD disparities related to nativity location and length of US residence, and these vary by race/ethnicity. Interventions addressing the unique challenges faced by populations most at risk for CKD, such as access to healthcare barriers and socioeconomic disparities, may help mitigate the burden of CKD and promote health equity.

Quality of life of patients with chronic kidney disease on hemodialysis Nuble, Chile, 2023

Introduction: chronic kidney disease involves a gradual and irreversible loss of renal function, impacting nephrons and quality of life due to dialytic treatment on physical, psychological, and independence levels. The objective was to determine the quality of life of users with chronic kidney disease undergoing hemodialysis in Nuble, Chile. Methods: a quantitative, descriptive study with 153 users was conducted. The Kidney Disease and Quality of Life – 36 questionnaire was administered, assessing quality of life across four subscales. Results: the majority (59,5 %) were male, with 51,6 % aged over 61. The average quality of life score was 47,7, with notable emphasis on "Perception of physical and mental health" (71,9 %) and "Burden of kidney disease" (77,1 %).Conclusions: the quality of life of users with chronic kidney disease in this study was characterized by an average below 50 %, indicating a generally low evaluation

The association Malnutrition-Inflammation Score with chronic kidney disease-associated pruritus and quality of life in hemodialysis patients: a multicenter cross-sectional study

Malnutrition is prevalent among hemodialysis patients, negatively impacting their quality of life (QoL) and chronic kidney disease-associated pruritus (CKD-aP). This study investigates the association between the Malnutrition-Inflammation Score (MIS) and CKD-aP, as well as QoL, in hemodialysis patients. This cross-sectional study was conducted on 479 HD patients (279 males and 200 females) referred to eight dialysis centers. A food frequency questionnaire (FFQ), Kidney Disease Quality of Life Short Form (KDQOL-SF™), and Yosipovitch Itch Questionnaire (YIQ) were used to assess nutritional status, QoL, and CKD-aP, respectively. Anthropometric indices, body mass index (BMI), biochemical parameters, and adequacy of dialysis (Kt/V) were also measured in all patients. Significant differences were observed across MIS quartiles in terms of age, dialysis vintage, dialysis time, and urine volume (p < 0.05 for all). QoL scores showed significant differences, with the physical component score and symptoms/problems score being lower in higher MIS quartiles (p < 0.05 for all). Multivariate analyses revealed that higher MIS quartiles were significantly associated with worse QoL scores, including symptoms/problems and physical component scores, even after adjusting for confounders (p < 0.05 for all). Moreover, the pruritus VAS score, as well as the burden of kidney disease and mental component, had a significant negative association with MIS after adjusting for confounders (p < 0.05 for all). This study demonstrates that higher MIS, indicating poorer nutritional status, is associated with impaired QoL, particularly in the symptoms/problems, physical, and mental components among hemodialysis patients. However, no significant association was found between MIS and CKD-aP.

Renal Insufficiency in Cancer Patients and Associated Demographic, Clinical and Treatment Characteristics at Kenyatta National Hospital, Nairobi, Kenya

Renal insufficiency is sub-optimal kidney function, affecting approximately 10% of the world population. In sub-Saharan Africa, it is approximated at 14% of the population whereas the kidney disease burden in Kenya is estimated to be at 4%. Studies show that at least 27.1% of cancer patients are suffering from renal insufficiency and need some chemotherapeutic drug adjustment. The objective of this study was to establish the prevalence of renal insufficiency and the associated clinical, demographic and treatment factors among cancer patients at KNH. A cross-sectional study where data was collected using a structured interviewer-administered questionnaire and hospital records. Systematic random sampling without replacement was used to select eligible 330 participants (patients) from Oncology wards and clinics at KNH. The information from the questionnaires was entered into a computer, cleaned, coded and loaded into R version 4.1.2 statistical software for analysis. Calculation of estimated GFR was done by CKD-Epi in micromole/l using a medical calculator to diagnose renal insufficiency and classify accordingly. The data was analyzed using both descriptive and bivariate/ multivariate regression analysis. All p-values were two-sided and the results were considered statistically significant at p &lt; 0.05. A total of 56.1% were females and others were male. Of the 330 study participants, 42.7% were aged between 41-60, 41.5% above 60 years and the rest below 41 years. The prevalence of renal insufficiency was 38% (95% CI 33, 44%). Age above 60 years and the use of taxanes were significantly associated with renal insufficiency before and after adjustment (p-values &lt;0.05). In conclusion, the prevalence of renal insufficiency among patients with cancer was high in this study of which the majority had stage 2 renal failures. Patients aged above 60 years had significantly higher odds of renal insufficiency while patients on taxanes had significantly lower odds of renal insufficiency

Chronic Kidney Disease (CKD) classification for low-resource settings: Taking into account patients’ social vulnerability

Introduction: Chronic kidney disease (CKD) has increasingly become a significant public health problem and economic burden for health systems worldwide. In addition, social vulnerability (SV) can also contribute to the high burden of chronic kidney disease. Contents: Social vulnerability can be explored by evaluating five dimensions: household composition, income, unstable housing, segregation, and immigration status, proposed by Jimenez-Garcia et al. Conclusions: Based on these variables a social vulnerability index score (SOVI) was described. This article proposes integrating the social vulnerability index score into the CKD-KDIGO classification in order to provide a more comprehensive approach to the problem of chronic kidney disease burden, with the goal of promoting kidney health an improving current kidney prevention programs.

Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021.

Long-term kidney outcomes after extracorporeal membrane oxygenation (ECMO) are little quantified and understood. We aimed to describe the frequency of kidney dysfunction screening during follow-up and the prevalence of long-term kidney disease. Retrospective cohort of pediatric ECMO patients with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) using all post-discharge serum creatinine values to define three kidney outcomes: 1) acute kidney injury (AKI), with eGFR of less than 60 mL/min/1.73 m2, which subsequently improved to normal (≥ 90 mL/min/1.73 m2); 2) abnormal eGFR of less than 90 mL/min/1.73 m2 at last follow-up; and 3) chronic kidney disease (CKD) with eGFR of less than 90 mL/min/1.73 m2 on at least two occasions separated by greater than or equal to 90 days, without an intervening or subsequently normal eGFR. Single-center tertiary care children's hospital system. All pediatric patients surviving ECMO from 2009 to 2019. None. In the 10-year cohort of 666 patients, 399 (60%) survived at least 3 months post-discharge. Of these, 382 of 399 (96%) were followed at our institution for a median of 5 years (interquartile range, 3-8 yr). Two hundred sixty-four of 382 (69%) had at least one creatinine value post-discharge, and 209 of 382 (55%) had at least two values three months apart. Of the 264 with at least one creatinine value, 61 (23%) had an abnormal eGFR; of the 209 with at least two values greater than or equal to 90 days apart, 18 (9%) met criteria for CKD. Of those with CKD, 12 of 18 had AKI during ECMO, and seven of 18 had AKI events post-discharge (range, 1-6 episodes). This 2009-2019 pediatric ECMO cohort of survivors, followed for a median of 5 years, shows the subsequent high burden of kidney disease. We found that monitoring and following kidney function was not complete in this population, which is a concern since the rate of later AKI events and CKD is significant. Further study is needed to mitigate this post-ECMO vulnerability.

Dallas Nephrology Associates' journey to value-based care.

In 2016, Dallas Nephrology Associates recognized that the economic, humanistic, and societal burden of end-stage kidney disease was unsustainable and the fee-for-service model of reimbursement did not support a value-based care approach. We decided to be proactive by creating new workflows, education, and disease management so that patients could make well-informed choices, ultimately resulting in better outcomes. Our shift toward value-based care focused on patient engagement, education, integrated infrastructure, collaboration, and monitoring of metrics associated with improved outcomes. Our practice invested millions of dollars in a population health division, which includes nurse navigators and data analysts focused on managing chronic kidney disease (CKD), delaying progression, and promoting transplantation and home-based dialysis. This retrospective review demonstrates improved outcomes, lower costs, and increased quality of care. Performance metrics have consistently met or exceeded targets. Seventy-three percent of patients now experience an optimal planned start to dialysis. Preemptive transplantation referrals have increased from 7% in 2017 to 61% through June 2023. Referral of patients with stage 4 CKD to educational workshops increased from 38% to 68%, and medical nutrition therapy referrals increased from 23% to 67%. Although reimbursement challenges persist, our commitment to improving care and slowing CKD progression remains steadfast. We emphasize teamwork, robust analytics, and continuous improvement. Future initiatives include encouraging patients receiving in-center hemodialysis to convert to home-based dialysis, addressing behavioral health, and focusing on preventable complications in high-risk patients. By embracing value-based models, we have demonstrated that a patient-centered approach can lead to improved outcomes and value for payers.

EVALUATION OF COGNITIVE CONSTRUCTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON HEMODIALYSIS

Patients with chronic kidney disease often present cognitive impairment, therefore, the objective was to characterize and evaluate the presence of cognitive and executive dysfunctions in patients undergoing hemodialysis. The study is quantitative, exploratory, and cross-sectional, where the following instruments were used: sociodemographic questionnaire, Montreal Cognitive Assessment Basic, Five-Digit Test, Barkley Executive Dysfunction Assessment Scale and the Kidney Disease Quality of Life Short Form. Twenty-five individuals participated in the study, 52% of whom were female, with a mean age of ± 52 years, married, with more than 8 years of education and more than 02 years on dialysis. Regarding dysfunctions, 28% of general cognitive dysfunction and more than 24% prominent deficits in language, working memory, decision-making control and choices were identified. Regarding quality of life, the domains with the lowest scores were general health, emotional limitations, work and burden of kidney disease. The research indicates significant cognitive changes, more specifically in language, executive functions, orientation, language, abstraction, calculation, memory, attention, visual perception and concentration. The results may indicate important factors that interfere with the understanding of the treatment and consequently with adherence.

Enhanced renoprotective effects of combined glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus: Real-world evidence.

Developing a more effective treatment for the global impact of diabetic kidney disease is crucial. This study examined the renoprotective effects of combining glucagon-like peptide-1 receptor agonists (GLP-1 RA) with sodium-glucose cotransporter 2 inhibitors (SGLT2i) compared to SGLT2is alone in type 2 diabetes (DM). This retrospective cohort study used data from the TriNetX Global Collaborative Network. Type 2 DM patients with estimated glomerular filtration rates ≥60 mL/min/1.73 m2 who used GLP-1 RA or SGLT2i between January 1, 2013, and December 31, 2023. Propensity score matching balanced baseline characteristics, resulting in 71,186 patients in each group (combined GLP-1 RA and SGLT2i therapy vs SGLT2i alone). Cox regression model was adopted to compare outcomes over a 5-year period, including major adverse kidney events (MAKE), acute kidney injury (AKI), end-stage kidney disease (ESKD), and all-cause mortality. After matching, the average age was 57.1 ± 10.8 years for the GLP-1 RA plus SGLT2i group and 57.2 ± 11.7 years for the SGLT2i-only group. The GLP-1 RA plus SGLT2i group had significantly lower risk of MAKE (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.69-0.77), AKI (HR: 0.82, 95% C0I: 0.77-0.87), ESKD (HR: 0.61, 95% CI: 0.47-0.78), and all-cause mortality (HR: 0.54, 95% CI: 0.50-0.58) compared to the SGLT2i-only group. Moreover, subgroup analyses showed consistent benefits across different subgroups. Dual therapy with GLP-1 RA and SGLT2i is supported to enhance renal outcomes and address the growing burden of diabetic kidney disease.

Burden of Kidney Disease in an Aging Population Living with HIV in the United States.

Antiretroviral therapy (ART) has significantly improved mortality rates for individuals living with HIV, but kidney disease remains prevalent, especially among older adults. Our study analyzed the burden of kidney disease in individuals aged 65 and older at The Miriam Hospital Immunology Center in Rhode Island. We calculated estimated glomerular filtration rates using the last creatinine values from 2019 and identified chronic kidney disease (CKD) stages. Results showed a 19% prevalence of moderate or severe CKD among adults living with HIV, rising to 39% for those aged 75 and older. Particularly striking was the increased prevalence among African American adults aged 65+, at 30.4%, rising to 50% for those over 75. In comparison, the National Institute of Diabetes and Digestive and Kidney Diseases reports that CKD stage 3 affects 20.1% of adults aged 65+, compared with just 1.2% in those younger than 65. Gender and racial disparities are evident; CKD stage 3 is more prevalent in females (5.8%) than males (4.4%). Our findings indicate that 32% of HIV-positive females have moderate-to-severe kidney disease, compared with 14% of males. Importantly, we did not account for hypertension, diabetes, and hepatitis C virus infection, which may influence renal outcomes. Our study shows that ART has reduced mortality, as more people with HIV now live longer, while also revealing the disproportionate burden of kidney disease among older adults and racial minorities, as well as a concerning trend among women; therefore, emphasizing the need for targeted health care strategies for high-risk groups.

Estimated health benefits, costs, and cost-effectiveness of implementing WHO's sodium benchmarks for packaged foods in India: a modelling study.

Excess dietary sodium intake has been associated with death and disability. WHO has released global sodium benchmarks for packaged foods to support countries to reduce population sodium intake. This study aimed to assess the potential health effect, costs, and cost effectiveness of implementing these WHO sodium benchmarks in India. We used a multiple cohort, proportional multistate, life table (Markov) model to estimate the health gains and cost effectiveness for adults if sodium content in packaged foods complied with the WHO benchmarks compared to the status quo. We used India-specific dietary surveys, food composition tables, foods sales data, and sodium content data from packaged food labels to estimate sodium intake before and after the intervention. Data on blood pressure, cardiovascular disease, and chronic kidney disease burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors study, and the effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to estimate net costs, and calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted at 3%. In the first 10 years, compliance with the WHO sodium benchmarks was estimated to avert a mean of 0·3 (95% uncertainty interval [UI] 0·2-0·5) million deaths from cardiovascular diseases and chronic kidney disease, a mean of 1·7 (95% UI 1·0-2·4) million incident cardiovascular disease events, and 0·7 (0·4-1·0) million new chronic kidney disease cases, compared with current practice. Over 10 years, the intervention was projected to be cost saving (100·0% probability), generating 1·0 (0·6 to 1·4) billion HALYs and US$0·8 (95% UI 0·3 to 1·4) million in cost savings. Over the population lifetime, the intervention could prevent 4·2 (2·4-6·0) million deaths from cardiovascular diseases and chronic kidney disease, 14·0 (8·2-20·1) million incident cardiovascular disease events, and 4·8 (2·8-6·8) new chronic kidney disease cases, with an 84·2% probability of being cost-saving and 100·0% probability of being cost-effective. Our modelling data suggest a high potential for compliance with WHO sodium benchmarks for packaged food being associated with substantial health gains and cost savings, making a strong case for India to mandate the implementation of the WHO sodium benchmarks, particularly as packaged food consumption continues to rise. WHO Country Office India.

Genome-wide Association Studies of Diabetic Kidney Disease in East Asians With Type 2 Diabetes: Achievements and Future Perspectives.

Diabetic kidney disease is a devastating diabetic complication, affecting up to half of people suffering from diabetes. The global burden of diabetic kidney disease is steadily increasing worldwide along with the growing prevalence of type 2 diabetes. The epidemic rise of type 2 diabetes is primarily observed in Asia, including the East Asian regions. It is generally accepted that heredity is one of the main determinants in the pathogenesis of diabetic kidney disease. Since the advent of genome-wide association studies, numerous studies have been published to identify the genetic loci susceptible to diabetic kidney disease among diverse populations. Although genome-wide association studies exploring diabetic kidney disease susceptibility loci have focused primarily on populations of European descent, a number of novel genetic variants associated with diabetic kidney disease have also been successfully revealed among East Asians. A comprehensive analysis of the genetic architecture and pathophysiological pathways of diabetic kidney disease may allow the identification of new potential therapeutic targets. This review aimed to summarize genome-wide association studies examining genetic variants associated with diabetic kidney disease in the populations of East Asian ancestry with type 2 diabetes and presented our perspective on the future of this field.

Discovery and prioritization of genetic determinants of kidney function in 297,355 individuals from Taiwan and Japan

Current genome-wide association studies (GWAS) for kidney function lack ancestral diversity, limiting the applicability to broader populations. The East-Asian population is especially under-represented, despite having the highest global burden of end-stage kidney disease. We conducted a meta-analysis of multiple GWASs (n = 244,952) on estimated glomerular filtration rate and a replication dataset (n = 27,058) from Taiwan and Japan. This study identified 111 lead SNPs in 97 genomic risk loci. Functional enrichment analyses revealed that variants associated with F12 gene and a missense mutation in ABCG2 may contribute to chronic kidney disease (CKD) through influencing inflammation, coagulation, and urate metabolism pathways. In independent cohorts from Taiwan (n = 25,345) and the United Kingdom (n = 260,245), polygenic risk scores (PRSs) for CKD significantly stratified the risk of CKD (p < 0.0001). Further research is required to evaluate the clinical effectiveness of PRSCKD in the early prevention of kidney disease.

Everolimus on cystic kidney disease burden reduction in pediatric tuberous sclerosis complex patients: a case series

BackgroundTuberous Sclerosis complex (TSC) is a multisystemic neurocutaneous genetic condition with high rates of morbidity and mortality from subependymal giant cell astrocytoma (SEGA), renal angiomyolipoma, and renal cyst complications. Everolimus is an inhibitor for mTORC1 and is currently used to treat TSC for its main role in rapidly reducing SEGA volume and seizure burden, although mainly studied in the adult population. It has also been shown to stabilize estimated glomerular filtration rate and reduce renal angiomyolipoma size in the adult population.Case presentationThis case report illustrates three pediatric patients placed on everolimus for SEGA and seizure control with incidental findings of the disappearance of or decreased burden of cystic kidney disease after everolimus therapy. In one patient, the cyst burden remained stable even after the cessation of everolimus while the SEGA resumed growth.ConclusionsThis report demonstrates the utility of everolimus in not only renal angiomyolipomas but also cystic kidney disease particularly in pediatric patients with a promising role in preserving renal function and preventing long term sequelae such as hematuria and hemorrhage from larger renal cysts especially if used early on in disease course.

"I won't ever feel normal": experience reported through photovoice by children with chronic kidney disease.

Much of the global chronic kidney disease burden is experienced in low- and middle-income countries. Children living with chronic kidney disease (CKD) face medical and social challenges, and they need support at the individual and family levels. This study aimed to explore children's experiences living with kidney replacement therapy (KRT) who attend the largest pediatric nephrology department in Guatemala. This qualitative study used photovoice and asked children to take pictures that represented what is like to live with CKD. Each child and their caregiver underwent an interview where the photos were used to elicit and facilitate discussion. The interviews were recorded, transcribed, and then analyzed using thematic analysis. Eight children and their mothers participated in the study. Three themes were identified: interactions with the health system, changing and difficult family dynamics, and strains on social interactions. Children face social challenges including self-isolation and alienation. The family dynamics and familial structures often are forced to change, inducing stress. This is all exacerbated by the difficulties that arise in navigating the Guatemalan health system. Photovoice techniques are a feasible way to understand the experiences of children and their families who face CKD. The disease affects all aspects of life and recognizing this while advising and administering care can help provide a comprehensive level of care. Health systems need to make efforts aimed at improving the quality of care as well as the multidisciplinary support available to children and their families.

Comparing health-related quality of life and utility scores of patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis in Indonesia.

Although both hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) are covered by national healthcare insurance, 98% of kidney failure disease patients are treated with hemodialysis. This study compared the health-related quality of life (HRQoL) and utility scores of patients receiving hemodialysis and CAPD in Indonesia and determined factors associated with HRQoL and utility scores. A cross-sectional study was performed using the Kidney Disease Quality of Life-36 and EQ-5D-5L instruments at six hospitals. Utility scores were presented as SF-6D and EQ-5D scores. Factors associated with the EQ-5D were evaluated using Tobit regressions due to ceiling effects, while the SF-6D and HRQoL were assessed using generalized linear models since the data were not normally distributed. Among the 613 patients, 76% were treated with hemodialysis. After adjusting for sociodemographic characteristics and clinical parameters, CAPD patients reported better HRQoL compared to hemodialysis patients in terms of the SF-6D (p = .038), mental component summary (p = .020), symptoms (p = .005), and effects of kidney disease (p<.001), but no significant differences were reported in EQ-5D (p = .083), physical component summary (p = .323), burden of kidney disease (p = .111), and kidney summary scores (p = .068). Poorer HRQoL and utility scores were likely experienced by older patients who were male, married, with diabetes, treated in Class A hospitals, and with lower education, hemoglobin, and albumin levels. In Indonesia, patients treated with CAPD had better HRQoL and utility scores compared to patients undergoing hemodialysis. Therefore, CAPD should be promoted by healthcare professionals as the first treatment option for patients who are eligible for both hemodialysis and CAPD.