eGFR Score Research Articles

Improvement of endorgan function following tricuspid edge-to-edge repair

Abstract Background/Introduction Subjects with severe tricuspid regurgitation (TR) often suffer from impaired endorgan function. The potential to improve endorgan function is an important goal of treatment. Purpose To assess baseline endorgan function and changes in organ function following transcatheter edge-to-edge repair with the TriClip device in subjects with severe TR from the TRILUMINATE Pivotal randomized controlled trial. Methods Right heart catheterization was required prior to enrollment; medication history was collected. Changes in biomarkers, including MELD-XI, GGT, eGFR, BUN, and TR and KCCQ overall summary score were assessed at baseline and 12-month follow-up for all enrolled subjects. A 15% improvement in biomarker levels was considered clinically relevant. The odds of achieving a 15% improvement in biomarkers between baseline and 12-month follow-up was compared between the Device and Control groups (presented as OR [95% CI]). Results A total of 572 subjects were enrolled and randomized. At baseline, subjects had elevated levels of GGT (83.0±87.7 U/L) and MELD-XI score (10.3±5.2), low eGFR (56.7±21.0 mL/min/1.73m2), and elevated BUN (29.5±16.7 mg/dL). Nearly 90% of subjects were on loop diuretics, with approximately 50% taking these in combination with a thiazide or potassium-sparing diuretic. The average diuretic dosage was 71 mg (furosemide equivalent). Most subjects had normal left ventricle ejection fraction (only 5% with LVEF <40%). Subjects had well-managed blood pressure (systolic: 122±13 mmHg, diastolic: 69±10), slightly elevated central venous pressures (12±6 mmHg), systolic pulmonary artery pressures (40±10 mmHg) and pulmonary capillary wedge pressures (15±4 mmHg), and normal transpulmonary gradients (11±4 mmHg). The odds of achieving a 15% improvement in liver and renal function was higher in TriClip patients compared to control: MELD-XI score (1.79 [1.22, 2.63]), GGT (1.83 [1.21, 2.77]), and eGFR (1.81 [1.18, 2.77]) - Fig 1. The favorable changes in organ function observed were also reflected when stratifying subjects by residual TR severity: The odds of a 15% biomarker improvement favored subjects with moderate or less residual TR for MELD-XI score (2.05 [1.39, 3.00]), GGT (1.91 [1.26, 2.90]), and eGFR (1.83 [1.20, 2.80]) compared with subjects who had severe or worse residual TR. Lastly, improvement in these biomarkers also favored subjects with a 15-point or greater improvement in KCCQ compared with subjects with less than a 15-point KCCQ improvement. Conclusions Use of TriClip in subjects with severe tricuspid regurgitation was associated with improvement in kidney and liver function, and this improvement was associated with reduction in the severity of TR. These data provide the first objective evidence of the physiologic impact of TR reduction obtained in a randomized clinical trial.

Estimated Glomerular Filtration Rate and Sleep Quality in Stage 3-5 Non-Dialysis Chronic Kidney Disease Patients: Is There a Correlation?

Background: Chronic kidney disease (CKD) is a growing health issue that significantly affects patients' quality of life. CKD patients are prone to sleep disturbances, which can lead to chronic fatigue and a decrease in their quality of life. The Pittsburgh Sleep Quality Index (PSQI) is a parameter that can be used to assess the sleep quality of CKD patients. Objective: This study aims to determine the relationship between estimated glomerular filtration rate (eGFR) and sleep quality in non-dialysis CKD patients. Methods: The research design is an observational analytic study with a cross-sectional approach. The research subjects were stage 3-5 non-dialysis CKD patients aged 18 to 60 years at Prof. Dr. R. D. Kandou Hospital Manado from March to May 2022. The sleep quality of CKD patients was assessed using the PSQI score. Data analysis was performed with a significance level of p < 0.05. Results: A total of 30 patients with stage 3-5 non-dialysis CKD were found. They consisted of 20 males and 10 females, aged 38-59 years, with an average of 59.80 ± 9.86 years. In the normality test using Shapiro-Wilk, the patient samples were not normally distributed (p = .000). For statistical analysis using the Spearman test, a negative correlation was found between eGFR and PSQI scores (r = -0.554), which was statistically significant (p = 0.002). Conclusion: This study found a significant relationship between eGFR and PSQI scores, which shows that a decrease in eGFR worsens the sleep quality of non-dialysis CKD patients.

The mediating role of nutritional indicators in the association between estimated glomerular filtration rate and cognitive impairment in older adults.

Cognitive impairment (CI) is common in older adults, especially those with renal dysfunction. We aimed to investigate the complex relationships among renal function, nutritional status, and CI in older people free from late chronic kidney disease (CKD) and severe CI. A study of older people (≥60 years old) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 and Montreal Cognitive Assessment (MoCA) scores of >10 (n = 237) was conducted at Beijing Tongren Hospital. Their eGFR was determined using the CKD-EPI-cr-Cysc equation. Cognitive function was evaluated with the MoCA. We tested the relationship between eGFR and MoCA scores using Spearman correlation analysis and multivariate logistic regression analysis. We then conducted a mediation analysis to figure out the mediating roles of nutritional indicators (Mini Nutritional Assessment-Short Form (MNA-SF) scores, albumin (ALB), and haemoglobin (HGB)) between the eGFR and MoCA scores. The incidence of CI was 48.5% (115/237) in older people. Spearman correlation analysis revealed that the better the kidney function, the better the cognitive function (R = 0.297, P < 0.001). Multivariate logistic regression analysis revealed that eGFR decrease per 15 mL/min/1.73 m2 (OR: 1.415, 95% confidence interval: 1.055-1.896, P = 0.020) was related to CI after adjusting for age and sex. However, the eGFR was not associated with cognitive decline after adjusting for nutritional indicators, behavioural risk factors, other biomarkers, and chronic conditions, suggesting that eGFR is not independently associated with CI. Mediation analysis revealed that the MNA-SF scores (a*b = 0.006 (0.0002-0.012)) and HGB (a*b = 0.008 (0.001-0.017)) were mediating factors between the eGFR and MoCA scores. A decline in renal function can directly lead to CI and can also exacerbate cognitive deficits through intermediary factors such as MNA-SF scores and HGB. Therefore, correcting anaemia and improving nutritional status are significantly important for enhancing cognitive function in older patients, especially those with renal dysfunction.

Impact of Renal and Liver Function on Clinical Outcomes Following Tricuspid Valve Transcatheter Edge-to-Edge Repair

BackgroundThe TRILUMINATE Pivotal trial is a prospective, randomized, controlled study of patients with severe tricuspid regurgitation (TR). Venous congestion due to TR may lead to end-organ dysfunction and failure. The potential to reverse or stop further deterioration in end-organ function is an important goal of treatment. ObjectivesThis study sought to examine changes in end-organ function after tricuspid transcatheter edge-to-edge repair (TEER) and assess the association of baseline end-organ function with heart failure (HF) hospitalizations and mortality. MethodsSubjects were randomized 1:1 to either the TEER group (TriClip System + medical therapy) or control group (medical therapy alone). Laboratory assessments and TR grading were performed at baseline and at all follow-up visits (discharge, 30 days, 6 months, and 12 months). An independent echocardiography core laboratory assessed TR severity and an independent clinical events committee adjudicated adverse events. ResultsA total of 572 subjects were enrolled and randomized (285 TEER, 287 control patients). Patients with moderate-to-severe end-organ impairment (estimated glomerular ejection fraction [eGFR] <45 mL/min/1.73 m2 or Model for End-Stage Liver Disease excluding INR [MELD-XI] >15) at baseline had increased incidence of HF hospitalization and death through 12 months, regardless of treatment. There were no statistically significant differences between TEER and control patients in eGFR or MELD-XI at 12 months. In subgroup analyses examining only successful TEER patients (moderate or less TR at discharge) compared with control patients, as well as when censoring patients with normal baseline values, both eGFR (+3.55 ± 1.04 mL/min/1.73 m2 vs 0.07 ± 1.10 mL/min/1.73 m2; P = 0.022) and MELD-XI (−0.52 ± 0.18 vs 0.34 ± 0.18; P = 0.0007) improved. ConclusionsBaseline end-organ function was associated with HF hospitalization and death in patients with severe TR. At 12 months, eGFR and MELD-XI scores were not statistically significantly different between the overall TEER and control groups. In patients who had successful TEER, statistically significant, yet small, favorable changes occurred for both eGFR and MELD-XI. Further investigation is needed to assess whether these changes in end-organ function after successful TEER are clinically meaningful and reduce HF hospitalization or death. (Clinical Trial to Evaluate Cardiovascular Outcomes In Patients Treated With the Tricuspid Valve Repair System Pivotal [TRILUMINATE Pivotal]; NCT03904147)

Therapeutic drug monitoring of linezolid and exploring optimal regimens and a toxicity-related nomogram in elderly patients: a multicentre, prospective, non-interventional study.

The concentrations of linezolid, its optimal regimen and the associated side effects in elderly patients remain unclear. In this multicentre, prospective study, elderly patients receiving linezolid at four tertiary hospitals in Beijing between May 2021 and December 2022 were included. Linezolid concentrations and haematological toxicity were monitored dynamically. Risk factors for linezolid overexposure and moderate-to-severe linezolid-induced thrombocytopenia (M/S LIT) were analysed, and a predictive model of M/S LIT was developed. A total of 860 linezolid concentrations were measured in 313 patients. The median trough concentrations of linezolid were 24.4 (15.3, 35.8) mg/L at 36-72 h and 26.1 (17.0, 38.1) mg/L at 5-10 days (P = 0.132). Severe linezolid exposure was independently associated with age, estimated glomerular filtration rate (eGFR) and the worst SOFA score (SOFA1), and we further recommended dose regimens for elderly patients based on these findings. The incidences of linezolid-induced thrombocytopenia(LIT) and M/S LIT were 73.5% and 47.6%, respectively. M/S LIT was independently correlated with treatment duration, average trough concentration (TDMa), baseline platelet count, eGFR and baseline SOFA score (SOFA0). The developed nomogram predicted M/S LIT with an area under the curve of 0.767 (95% CI 0.715-0.820), a sensitivity of 71.1% and a specificity of 73.2%. Linezolid trough concentrations increased dramatically in the elderly, by about 10 mg/L in patients aged 65-80 years, followed by a further increase of 10 mg/L for every 10 years of age. Therapeutic drug monitoring is recommended in elderly patients receiving linezolid. The developed nomogram may predict M/S LIT and guide dosage adjustments of linezolid. Clinical trial registration number: ChiCTR2100045707.

#1644 Prognostic significance of hematuria on kidney survival in podocytopathies

Abstract Background and Aims Hematuria is common in podocytopathies, but its prognostic impact on kidney survival in these proteinuric diseases is not well-established. Our study examines the prevalence of hematuria at podocytopathy diagnosis and its association with renal survival. Method In our retrospective study, we analyzed 236 patients (median age 50 years, 60% male, median eGFR 65.5 mL/min/1.73 m2, median proteinuria 3.9g/g) with biopsy proven podocytopathies—48% membranous nephropathy (MN), 32% minimal change disease (MCD), 20% focal and segmental glomerulosclerosis (FSGS)—diagnosed at a tertiary center from 2010 to 2015. Hematuria was defined as the presence of 5 or more red blood cells (RBCs) per high-power field in 3 of 3 consecutive centrifuged urine specimens obtained at least 1 week apart. The follow-up period extended until the onset of end-stage kidney disease (ESKD: start of kidney replacement therapy or renal transplantation), death, or January 2022, with a median duration of 8.5 (95% CI: 8.1, 8.8) years. Results In our patient cohort, 31% (n = 73) presented with hematuria, having a median of 120 (IQR: 40-220) red blood cells (RBCs). Those with hematuria more frequently exhibited arterial hypertension (55% vs 36%, p 0.007) and had higher levels of proteinuria (5.3 vs 3.2g/g, p 0.01). However, no significant differences were noted in terms of age (53 vs 48 years, p 0.08), Charlson comorbidity score (2 vs 2, p 0.9), type of podocytopathy (MN 52 vs 47%, MCD 27 vs 34%, FSGS 21 vs 19%, p 0.5), eGFR (62.1 vs 68.8 mL/min, p 0.08), serum albumin levels (3.3 vs 3.4g/dL, p 0.6), total renal chronicity score on histology (0 vs 0, p 0.6), and treatment with ACE inhibitors/angiotensin receptor blockers (43% vs 50%, p 0.4) or immunosuppression (81% vs 74%, p 0.4). Thirty-two percent of the patients with hematuria reached ESKD versus 9% in the group without hematuria (p 0.001); there were no differences regarding mortality between the two groups. Mean kidney survival time for the entire cohort was 10.3 (95% CI: 9.9, 10.8) years; renal survival at 1, 3, 5 and 10 years were 97%, 92%, 88% and 82%, respectively. Patients with hematuria at diagnosis had a significant shorter kidney survival time (9.0 (95% CI: 8.0, 10.0) vs 11.0 (95% CI: 10.6, 11.4) years, p 0.001). In a multivariate Cox proportional hazard model (backward Wald), presence of hematuria at diagnosis (HR 3.64, 95% CI: 1.87, 7.07), lower eGFR (HR 0.96, 95% CI: 0.94, 0.97) and higher total renal chronicity score on histology (HR 1.10, 95% CI: 1.00, 1.22) were independent predictors of reduced kidney survival. Conclusion Hematuria is prevalent in the three podocytopathies and independently correlates with poorer kidney survival outcomes. This underscores the possible need for personalized treatment strategies in patients with podocytopathies presenting with hematuria.

Chronic kidney disease and cognitive performance: NHANES 2011–2014

PurposePrevious studies suggest an association between chronic kidney disease (CKD) and cognitive impairment. The purpose of this study was to explore the association between the diverse stages of CKD and the cognitive performance of elderly American adults.MethodsData from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were used. Multivariate adjusted logistic regression, subgroup analysis, and the restricted cubic spline model were used to assess the associations of CKD stage and estimated glomerular filtration rate (eGFR) with cognitive performance. The measures used to evaluate cognitive function included the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) test, the Animal Fluency test, and the Digit Symbol Substitution test (DSST).ResultsThis study included 2234 participants aged ≥ 60 years. According to the fully adjusted model, stages 3–5 CKD were significantly associated with the CERAD test score (OR = 0.70, 95% CI [0.51, 0.97], p = 0.033), the Animal Fluency test score (OR = 0.64, 95% CI [0.48, 0.85], p = 0.005), and the DSST score (OR = 0.60, 95% CI [0.41, 0.88], p = 0.013). In addition, the incidence of poor cognitive function increased with decreasing eGFR, especially for individuals with low and moderate eGFRs. Both the DSST score (p nonlinearity < 0.0001) and the Animal Fluency test score (p nonlinearity = 0.0001) had nonlinear dose–response relationships with the eGFR. However, a linear relationship was shown between the eGFR and CERAD test score (p nonlinearity = 0.073).ConclusionsCKD, especially stages3–5 CKD, was significantly associated with poor cognitive performance in terms of executive function, learning, processing speed, concentration, and working memory ability. All adults with CKD should be screened for cognitive impairment.

Computational analysis of bevacizumab binding with protein receptors for its potential anticancer activity

Breast cancer poses a significant global challenge, prompting researchers to explore novel approaches for potential treatments. In this study, we investigated the binding free energy (ΔG) of bevacizumab, an anti-cancer therapy targeting angiogenesis through the inhibition of vascular endothelial growth factor (VEGF), with various proto-oncogenes including CDK4, EGFR, frizzled, IGFR, OmoMYC, and KIT. Our in-silico investigation revealed that hydrogen bonding is pivotal in inducing conformational changes within the DNA structure, impeding its replication and preventing cell death. Molecular docking results revealed the presence of crucial hydrogen bonds and supported the formation of stable bevacizumab complexes. The molecular docking scores for the tested complexes were CDK4 (Score = −7.2 kcal/mol), EGFR (Score = −8.5 kcal/mol), frizzled (Score = −6.9 kcal/mol), IGFR (Score = −7.8 kcal/mol), KIT (Score = −6.5 kcal/mol), and MYC (Score = −8.3 kcal/mol). The binding mode demonstrated vital hydrogen bonds correlated with the observed energy gap. Notably, the calculated binding free energies of the tested compounds are as follows: CDK4 (ΔG = 24275.195 ± 6411.293 kJ/mol), EGFR (ΔG = 363273.625 ± 8731.466 kJ/mol), frizzled (ΔG = 181751.990 ± 28438.515 kJ/mol), IGFR (ΔG = 162414.725 ± 10728.367 kJ/mol), KIT (ΔG = 40162.585 ± 4331.017 kJ/mol), and MYC (ΔG = 434783.463 ± 53989.676 kJ/mol). Furthermore, through extensive 100 ns MD simulations, we observed the formation of a stable bevacizumab complex structure. The simulations confirmed the stability of the bevacizumab complex with the proto-oncogenes. The results of this study highlight the potential of bevacizumab complex as a promising candidate for anticancer treatment. The identification of hydrogen bonding, along with the calculated binding free energies and molecular docking scores, provides valuable insights into the molecular interactions and stability of the bevacizumab complexes. These findings and the extensive MD simulations open new avenues for future research and development of bevacizumab as a targeted therapy for breast cancer and other related malignancies. Communicated by Ramaswamy H. Sarma

The estimated glomerular filtration rate was U-shaped associated with abdominal aortic calcification in US adults: findings from NHANES 2013-2014.

The high incidence of abdominal aortic calcification (AAC) is well-documented in individuals with severe renal function decline. However, there is limited research on the historical relationship between estimated glomerular filtration rate (eGFR) and the risk of AAC occurrence in the general population undergoing routine medical examinations. The main objective of this study was to investigate the historical relationship between eGFR and AAC in the general population of the United States. We performed a cross-sectional study using the National Health and Nutrition Examination Survey 2013-2014 database. Weighted multivariate linear regression models were used to estimate the associations of eGFR with AAC score. Smooth curve fitting and two-piecewise linear regression were employed to explore the potential non-linear relationship. A total of 2,978 participant (48.22% were male) aged 40-80 years were included in this study. The fully-adjusted model demonstrated a negative correlation between eGFR and AAC score (β = -0.015, 95% CI: -0.023 to -0.006). However, when applying the smooth curve fitting method, a U-shaped relationship was identified, and the inflection point was calculated at 76.43 ml/min/1.73 m2 using the two-piecewise linear regression model. There was a U-shaped association between eGFR and AAC score in general US adults, with an inflection point at about 76.43 ml/min/1.73 m2.

Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome

ObjectiveTo determine the impact of CKD on the completeness of revascularization and major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS). Patients and methodsThe study enrolled 400 CCS patients who underwent revascularization by PCI. They were separated into two categories according to their eGFR levels: the control group: 200 patients with eGFR ≥60mL/min/1.73m2, and the CKD Group: 200 patients with eGFR< 60ml/min/1.73m.2 Patients were reclassified according to revascularization into complete and incomplete revascularization groups with one-year follow-up to assess the MACE. ResultsCKD patients were significantly older (65.78 ± 6.41 vs. 56.70 ± 9.20 years, P=<0.001). They had higher syntax scores (P = 0.005), CIN (P = 0.001), all-cause mortality (P = 0.02), MACE (P = 0.037), and heart failure (P = 0.014). After reclassification according to revascularization. GFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 vs. 65.67 ± 26.62, respectively, P =<0.001). Repeated revascularization (P < 0.001), STEMI (P = 0.003), stent thrombosis (P = 0.015), MACE (P < 0.001), stroke (P < 0.001), and all-cause mortality (P < 0.001) were more prevalent among patients with incomplete revascularization. Multivariate regression analysis revealed eGFR (P = 0.001) and Syntax score (SS) (P=<0.001) as independent predictors of incomplete revascularization. The optimal eGFR cutoff value for predicting partial revascularization is 49.50mL/min/1.73m2, with 58.8% sensitivity and 69.3 % specificity. ConclusionChronic kidney disease is associated with a higher syntax score and incomplete revascularization prevalence in CCS patients. Additionally, incomplete revascularization is associated with an increased incidence of major adverse cardiac events. In patients with CCS, CKD predicts partial revascularization and subsequent MACE.

Evaluation of the index of resistance and excretion of uromodulin in patients with predialysis chronic kidney disease, taking into account the index of comorbidity

Background. The purpose of this study was to investigate urinary uromodulin (uUmod) excretion, reactivity of the autonomic nervous system and impaired renal blood circulation in patients with predialysis chronic kidney disease (CKD), and the effect of antioxidant therapy on these parameters. Materials and methods. Ninety-one patients with CKD stage 1–5 took part in the ROLUNT (UROmoduLin UbiquinoNe GlutaThione) study, their average age was 47.00 ± 12.12 years. Thirty (32.97 %) men and 61 (67.03 %) women were divided into two groups, which were representative in terms of age and gender composition: the first one (n = 46) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≤ 2, the second one (n = 45) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≥ 3. The first and second groups were divided into subgroups A and B. Subgroup A included patients with impaired vegetative status, subgroup B — without impaired vegetative status. Subgroups 1A and 2B took glutathione 100 mg twice a day with food for 3 months; subgroups 1B and 2A received ubiquinone 100 mg once a day with food for 3 months. In patients with CKD stage1–5, uUmod, albumin to creatinine ratio (ACR), glomerular filtration rate (GFR) were evaluated. Ninety-one ultrasound duplex color scans of the kidneys were performed and the index of resistance (IR) was determined in patients with CKD stage1–5. Results. The results of the paired t-test showed that there is a significant difference between the indicators at the beginning and at the end of the study, with the exception of the following: in subgroup 1A: hemoglobin (Hb) (T = –1.5863 [–2.0739, 2.0739] 95% confidence interval (CI) [–2.4077, 0.3207], p = 0.127); in subgroup 1B: Hb (T = –0.382 [–2.0739, 2.0739], 95% CI [–1.3977, 0.963], p = 0.706); ACR (T = –1.5899 [–2.0739, 2.0739], 95% CI [–16.7323, 2.2105], p = 0.126); systolic blood pressure (SBP) (T = –0.5625 [–2.0739, 2.0739], 95% CI [–2.2414, 1.2849], p = 0.579); diastolic blood pressure (DBP) (T = –1.7936 [–2.0739, 2.0739], 95% CI [–2.3437, 0.1698], p = 0.087); Chernov questionnaire (T = 1.5071 [–2.0739, 2.0739], 95% CI [–0.6083, 3.8431], p = 0.146); Kérdö index (T = 0.9392 [–2.0739, 2.0739], 95% CI [–1.1083, 2.9431], p = 0.358); in subgroup 2A: ACR (T = –2.0147 [–2.0796, 2.0796], 95% CI [–39.1946, 0.6219], p = 0.057); in subgroup 2B: ACR (T = –1.3328 [–2.0739, 2.0739], 95% CI [–17.4695, 3.7999], p = 0.196). The Pearson correlation results showed that in subgroup 1A, there is a significant average positive relationship between uUmod and eGFR (r(21) = 0.418, p = 0.047); a significant very small negative relationship between uUmod indicators and age (r(21) = 0.438, p = 0.037); in subgroup 1B, there is a significant large positive relationship between uUmod and Hb indicators (r(21) = 0.513, p = 0.012); a significant positive relationship between uUmod and Morisky Medication Adherence Scale-8 (MMAS-8) indicators (r(21) = 0.515, p = 0.012); a significant very small negative relationship between uUmod and ACR indicators (r(21) = 0.441, p = 0.035); in subgroup 2A, there is a significant very small negative relationship between uUmod indicators and Kérdö index (r(20) = 0.427, p = 0.048); in subgroup 2B, there is a significant very small negative relationship between the uUmod indicators and Chernov questionnaire score (r(21) = 0.421, p = 0.045); a significant very small negative relationship between uUmod indicators and Charlson Comorbidity Index (r(21) = 0.481, p = 0.020); a significant very small negative relationship between uUmod and age (r(21) = 0.471, p = 0.023). In subgroup 1A at the end of the study, the following independent variables are not significant as predictors for uUmod: IRd, IRs, SBP, DBP, Hb, ACR, age, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 1B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRs, SBP, DBP, Hb, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 2A at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, MMAS-8, Charlson Comorbidity Index. In subgroup 2B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, ­MMAS-8, Kérdö index. Conclusions. Antioxidant therapy with glutathione and ubiquinone significantly affects the examination parameters of patients with CKD. Considering the safety and effectiveness of antioxidant therapy, we suggest including antioxidant therapy into the treatment protocols for patients with CKD. Further research is recommended to establish a standard protocol.

PD07-03 UNVEIL THE INTERPLAY BETWEEN BASELINE RENAL FUNCTION, WARM ISCHEMIA TIME AND TUMOR COMPLEXITY WHEN ASSESSING RENAL FUNCTIONAL OUTCOMES OF ON- VS OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD07-03 UNVEIL THE INTERPLAY BETWEEN BASELINE RENAL FUNCTION, WARM ISCHEMIA TIME AND TUMOR COMPLEXITY WHEN ASSESSING RENAL FUNCTIONAL OUTCOMES OF ON- VS OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY Rocco Simone Flammia, Umberto Anceschi, Aldo Brassetti, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Gabriele Tuderti, Antonio Tufano, Costantino Leonardo, Michele Gallucci, Porpiglia Francesco, Daniele Amparore, Andrea Minervini, Andrea Mari, Andre Antonio Grasso, Riccardo Autorino, Daniel Eun, Alessandro Larcher, Umberto Capitanio, Giuseppe Simone, and Eugenio Bologna Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Antonio TufanoAntonio Tufano More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Porpiglia FrancescoPorpiglia Francesco More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Andrea MariAndrea Mari More articles by this author , Andre Antonio GrassoAndre Antonio Grasso More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Daniel EunDaniel Eun More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , and Eugenio BolognaEugenio Bologna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Off-clamp robot-assisted partial nephrectomy (RAPN) has been introduced as an alternative to on-clamp RAPN aiming at maximally reduce warm ischemia time (WIT). However, not all studies agreed with the theoretical benefit of off- vs on-RAPN in term of postoperative and functional outcomes. It might be postulated that prolonged warm ischemia time (WIT), needed when approaching complex renal masses, as well as baseline eGFR may influence the results of such a comparison. We aimed at showing the interplay bewteen WIT, tumor complexity and baseline eGFR. METHODS: Whitin a multinstituional databases we identified patietns treated with RAPN for kidney neoplasm (cT1-2, cN0, cM0). Exclusion criteria were multiple renal masses, solitary kidney, selective clamping. LOESS curve depicted the association between WIT and RENAL score. Multivariable Cox regression model addressing any upstaging to CKD ≥ 3a (CKD-upstaging) tested the effect of WIT, baseline eGFR and RENAL score while adjusting for important confounders (age, sex, BMI, ASA, hypertension and diabetes). The “ggeffect” R package allowed to estimate the CKD-upstaging free survival probability according to WIT, RENAL score and baseline eGFR. RESULTS: Overall, 1015 patients were identified between on- vs off-RAPN (37 vs 63%, respectively). LOESS curve showed a statistically significant increase in WIT, when approaching more complex renal masses (p<0.001). Interestingly, for RENAL score ≥ 10, off-RAPN required a median WIT ≥ 25 minutes. In multivariable Cox regression model, WIT (HR 1.02, 95%CI 1.01-1.03, p<0.001), baseline eGFR (HR 0.97, 95%CI 0.96-0.98, p<0.001) and RENAL score (HR 1.14, 95%CI 1.07-1.21, p<0.001) were all independent predictors of CKD-upstaging. Estimated probability was graphically displayed (Figure 1). CONCLUSIONS: We observed that when approaching more complex RENAL masses on-clamp RAPN may results in prolonged WIT which in turn would drastically increase the risk of renal function decline especially in those patients harboring lower baseline eGFR. In this complex situation, off-RAPN would undoubtedly reduce risk of renal function deterioration by limiting to zero WIT which represents the main surgical modifiable factor. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e162 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rocco Simone Flammia More articles by this author Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Riccardo Mastroianni More articles by this author Leonardo Misuraca More articles by this author Gabriele Tuderti More articles by this author Antonio Tufano More articles by this author Costantino Leonardo More articles by this author Michele Gallucci More articles by this author Porpiglia Francesco More articles by this author Daniele Amparore More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Andre Antonio Grasso More articles by this author Riccardo Autorino More articles by this author Daniel Eun More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Giuseppe Simone More articles by this author Eugenio Bologna More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinico-pathological features of diabetic and non-diabetic renal diseases in type 2 diabetic patients: a retrospective study from a 10-year experience in a single center.

To compare clinical and pathological characteristics as well as prognosis between diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) so as to explore potential diagnostic criteria of DN and provide some guidance for the treatment of type 2 diabetes mellitus (T2DM) patients with kidney involvement. T2DM patients with renal impairment who underwent kidney biopsy were included in this study, who were classified into 3 groups (DN, NDRD, DN with NDRD) based on their renal pathological diagnosis. Baseline clinical characteristics as well as follow-up data were collected and analyzed among 3 groups. Logistic regression was performedto determine the best predictors for DN diagnosis. Additional 34 MN patients without diabetes were enrolled by propensity score matching method to compare serum PLA2R antibody titer and kidney outcomes between diabetic MN patients and MN alone. Among 365 patients with type 2 diabetes who underwent kidney biopsy, 179 (49.0%) patients were diagnosed with NDRD alone and 37 (10.1%) patients with NDRD combined DN. Risk factors for DN development in T2DM patients were longer time since diabetes diagnosis, higher level of serum creatinine, absence of hematuria and presence of diabetic retinopathy by multivariate analysis. Lower rate of proteinuria remission and higher risk of renal progression were observed in DN group compared with NDRD group. Membranous nephropathy was the most common NDRD in diabetic patients. There was no difference in serum PLA2R antibody positiveness or titer between MN patients with or without T2DM. There was lower remission rate but similar renal progression in diabetic MN when age, gender, baseline eGFR, albuminuria and IFTA score were adjusted. Non-diabetic renal disease is not uncommon in T2DM patients with renal impairment, which has better prognosis with proper treatment. Coexisting diabetic status does not exert negative impact on renal progression in MN patients, and immunosuppressive agents should be administered when necessary.

Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy in a multi-institutional cohort of Indian patients.

The literature on studies reporting trifecta or pentafecta outcomes following robot-assisted partial nephrectomy (RAPN) in Indian patients is limited. The primary aim of this study was to report and evaluate the factors predicting trifecta and pentafecta outcomes following RAPN in Indian patients using the multicentric Vattikuti collective quality initiative (VCQI) database. From the VCQI database for patients who underwent RAPN, data for Indian patients were extracted and analyzed for factors predicting the achievement of trifecta and pentafecta following RAPN. Trifecta was defined as the absence of complications, negative surgical margins, and warm ischemia period shorter than 25 min or zero ischemia. Pentafecta covers all the trifecta criteria as well as >90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease at 12 months. In this study, among 614 patients, the trifecta was achieved in 374 patients (60.9%) and pentafecta was achieved in 24.2% of the patients. Patients who achieved trifecta had significantly higher mean age (54.1 vs. 51.0 years, P = 0.005), body mass index (BMI) (26.7 vs. 26.03 kg/m2, P = 0.022), and smaller tumor size (38.6 vs. 41.4 mm, P = 0.028). The preoperative eGFR (84.2 vs. 91.9 ml/min, P = 0.012) and renal nephrometry score (RNS) (6.96 vs. 7.87, P ≤ 0.0001) were significantly lower in the trifecta group. Comparing patients who achieved pentafecta to those who did not, we noted a statistically significant difference between the two groups for tumor size (36.1 vs. 41.5 mm, P = 0.017) and RNS (6.6 vs. 7.7, P = 0.0001). On multivariate analysis, BMI and RNS were associated with trifecta outcomes. Similarly, only RNS was identified as an independent predictor of pentafecta. RNS and BMI were independent predictors of the trifecta. At the same time, RNS was identified as an independent predictor of pentafecta following RAPN.

P16 and EGFR analyses in cervical carcinoma on paraffin material in Egyptian females: the NCI experience

Abstract Introduction Cervical cancer is considered the fourth most prevalent malignant tumor in women worldwide. In Egypt, it ranks as the 14th most frequent cancer among women. Epidermal growth factor receptor has been an attractive target for anticancer therapy. Although EGFR mutations are less commonly seen in cervical cancer, there is a potential correlation between EGFR expression level and clinical response. Overexpression of p16INK4a is associated with increased overall and disease-free survival in cervical cancer, thus denoting a better prognosis. Aim of the work To investigate the expression of EGFR and p16 by immunohistochemistry as well as amplification of EGFR by FISH technique in cervical carcinoma among Egyptian females. Material and methods Seventy-seven cases of invasive cervical carcinomas were retrieved from paraffin blocks. EGFR and p16 expression were assessed by immunohistochemistry. EGFR gene amplification was assessed by FISH analysis. Results p 16 Positivity was detected in 62.3% of cases. Positive reaction to EGFR (score 3+) was detected in 20.8% of cases. The EGFR gene was not amplified in 77.9% of cases. Statistical significance was found between histological type, p16, and EGFR expression. A fair agreement was detected between EGFR expression and EGFR amplification. Poor agreement was detected between p16, EGFR expression, and EGFR amplification. Conclusion EGFR and p16 have an independent role in the development of cervical cancer in Egyptian females. EGFR overexpression and EGFR amplification represent two different genetic events; in other words, an increase in gene copy number does not mean that there will be an increase in the function of the gene as expressed by an increase in protein expression.

The Association between Symptoms of Depression and Anxiety, Quality of Life, and Diabetic Kidney Disease among Chinese Adults: A Cross-Sectional Study.

Depression and anxiety are common comorbid symptoms among patients with diabetic kidney disease (DKD). Little is known about the influence of poor psychological conditions on the disease progression and quality of life (QOL) in DKD patients. This study aimed to investigate the prevalence of, and risk factors for, depression and anxiety in Chinese DKD patients, and to analyze their impact on the renal function, proteinuria, and QOL. A total of 620 adult patients with Type 2 diabetes and DKD being treated at a tertiary hospital in East China were recruited. Depression and anxiety symptoms were assessed by the Zung Self-Rating Depression Scale and Anxiety Scale. Among the DKD participants, 41.3% had symptoms of depression and 45.0% had anxiety symptoms. A poor education, physical inactivity, stroke, low serum albumin, CKD stage 3-4, macroalbuminuria, and a poor QOL were independent risk factors for depression in the DKD patients. Whereas a higher education, physical inactivity, diabetic retinopathy and neuropathy, low hemoglobin, CKD stage 3-4, and a poor QOL were risk factors for anxiety. Depression and anxiety scores among the DKD patients were negatively correlated with the eGFR and QOL scores. Moreover, depression and anxiety symptoms were independent risk factors for DKD patients with CKD stage 3-4 and a poor QOL. Our findings suggest a high prevalence of depression and anxiety among Chinese DKD patients, and the severity of psychological symptoms is closely linked to the deterioration of renal function and the QOL. The early screening and intervention of psychopathological disorders is thus strongly recommended for improving the QOL and clinical outcomes among DKD patients.

Kidney concentrating capacity in children with autosomal recessive polycystic kidney disease is linked to glomerular filtration and hypertension

BackgroundImpaired kidney concentration capacity is present in half of the patients with autosomal dominant polycystic kidney disease (ADPKD). The kidney concentrating capacity was further impaired within the animal model of autosomal recessive polycystic kidney disease (ARPKD). To date, only one small study has investigated it in children having ARPKD. Therefore, we aimed to study the kidney concentrating ability in a larger cohort of children with ARPKD.MethodsEighteen children (median age 8.5 years, range 1.3–16.8) were retrospectively investigated. A standardized kidney concentrating capacity test was performed after the application of a nasal drop of desmopressin (urine osmolality > 900 mOsmol/kg). The glomerular filtration rate was estimated using the Schwartz formula (eGFR) and blood pressure (BP) was measured as office BP.ResultsKidney concentrating capacity was decreased (urine osmolality < 900 mOsmol/kg) in 100% of children with ARPKD. The median urine osmolality after desmopressin application was 389 (range 235–601) mOsmol/kg. Sixteen patients (89%) were defined as hypertensive based on their actual BP level or their use of antihypertensive drugs. The maximum amounts of urinary concentration correlated significantly with eGFR (r = 0.72, p < 0.0001) and hypertensive scores (r = 0.50, p < 0.05), but not with kidney size. Twelve patients (67%) were defined as having CKD stages 2–4. The median concentrating capacity was significantly lower in children within this group, when compared to children with CKD stage 1 possessing a normal eGFR (544 mOsmol/kg, range 413–600 mOsmol/kg vs. 327 mOsmol/kg, range 235–417 mOsmol/l, p < 0.001).ConclusionsImpaired kidney concentrating capacity is present in most children with ARPKD and is associated with decreased eGFR and hypertension.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Noninvasive assessment of renal function and fibrosis in CKD patients using histogram analysis based on diffusion kurtosis imaging

PurposeTo investigate the potential of histogram analysis based on diffusion kurtosis imaging (DKI) in evaluating renal function and fibrosis associated with chronic kidney disease (CKD).Materials and methodsThirty-six CKD patients were enrolled, and DKI was performed in all patients before the renal biopsy. The histogram parameters of diffusivity (D) and kurtosis (K) were obtained using FireVoxel. The histogram parameters between the stable [estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2] and impaired (eGFR < 60 ml/min/1.73 m2) eGFR group were compared. Besides, patients were classified into mild, moderate, and severe fibrosis group using a semi-quantitative standard. The correlations of histogram parameters with eGFR and fibrosis scores were investigated and the diagnostic performances of histogram parameters in assessing renal dysfunction and fibrosis were analyzed. The added value of combination of most significant parameter with 24 h urinary protein (24 h-UPRO) in evaluating fibrosis was also explored.ResultsSeven D histogram parameters in cortex (mean, median, 10th, 25th, 75th, 90th percentiles and entropy), two D histogram parameters in medulla (75th, 90th percentiles), seven K histogram parameters in cortex (mean, min, median, 10th, 25th, 75th, 90th percentiles) and three K histogram parameters in medulla (mean, median, 25th percentile) were significantly different between the two groups. The Dmean of cortex was the most relevant parameter to eGFR (r = 0.648, P < 0.001) and had the largest area under the curve (AUC) for differentiating the stable from impaired eGFR group [AUC = 0.889; 95% confidence interval (CI) 0.728–0.970]. The K90th of cortex presented the strongest correlation with fibrosis scores (r = 0.575, P < 0.001) and achieved the largest AUC for distinguishing the mild from moderate to severe fibrosis group (AUC = 0.849, 95% CI 0.706–0.993). Combining the K90th in cortex with 24 h-UPRO gained statistically higher AUC value (AUC = 0.880, 95% CI 0.763–0.996).ConclusionHistogram analysis based on DKI is practicable for the noninvasive assessment of renal function and fibrosis in CKD patients.

On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis.

Simple SummaryRobot-assisted partial nephrectomy is a viable option to treat tumors >7 cm. In this setting, however, the risk of postoperative renal function deterioration is higher because of the prolonged warm ischemia times (>20 min) that are required in two-thirds of cases, if an on-clamp approach is used. On the contrary, an off-clamp robotic partial nephrectomy is associated with shorter operation times and significantly improves the probabilities of achieving favorable perioperative outcomes.We compared perioperative outcomes after on-clamp versus off-clamp robot-assisted partial nephrectomy (RAPN) for >7 cm renal masses. A multicenter dataset was queried for patients who had undergone RAPN for a cT2cN0cM0 kidney tumor from July 2007 to February 2022. The Trifecta achievement (negative surgical margins, no severe complications, and ≤ 30% postoperative estimated glomerular filtration rate (eGFR) reduction) was considered a surrogate of surgical quality. Overall, 316 cases were included in the analysis, and 58% achieved the Trifecta. A propensity-score-matched analysis generated two cohorts of 89 patients homogeneous for age, ASA score, preoperative eGFR, and RENAL score (all p > 0.21). Compared to the on-clamp approach, OT was significantly shorter in the off-clamp group (80 vs. 190 min; p < 0.001), the incidence of sRFD was lower (22% vs. 40%; p = 0.01), and the Trifecta rate higher (66% vs. 46%; p = 0.01). In a crude analysis, >20 min of hilar clamping was associated with a significantly higher risk of sRFD (OR: 2.30; 95%CI: 1.13–4.64; p = 0.02) and with reduced probabilities of achieving the Trifecta (OR: 0.46; 95%CI: 0.27–0.79; p = 0.004). Purely off-clamp RAPN seems to be a safe and viable option to treat cT2 renal masses and may outperform the on-clamp approach regarding perioperative surgical outcomes.

Bio-conductivity characteristics of chronic kidney disease stages examined by portable frequency-difference electrical impedance tomography.

Chronic kidney disease (CKD) is an escalating global health concern, and non-invasive means for early CKD detection is eagerly awaited. Here, we explore the potential of using home-based frequency-difference electrical impedance tomography (fdEIT) to evaluate CKD based on bio-conductivity characteristics. We first verified the feasibility of using portable EIT capturing bio-conductivity in fresh pig kidneys ex vivo. We further performed bio-conductivity measurement in vivo paired with standard eGFR measurements on CKD patients by EIT and traditional blood test, respectively. Our results showed a significant correlation between renal bio-conductivity changes captured by fdEIT and standard eGFR scores. These results hold promise to be developed into a non-invasive and portable device for early CKD detection and longitudinal CKD treatment monitoring in clinical, community and home-based settings. Clinical Relevance - A novel non-invasive bio-conductivity approach was developed for CKD classification. The renal assessment with portable EIT device demonstrated the potential to ameliorate the detection and classification of CKD into a portable, accessible, self-administrable home-based process.