End-stage Chronic Kidney Disease Research Articles

Challenges in perioperative blood transfusions in kidney transplantation and the need for Patient Blood Management.

Anemia is highly prevalent in end-stage chronic kidney disease patients, increasing their risk of receiving blood transfusions during and on the days after a kidney transplant (KTx) surgery. However, there is currently a lack of data that thoroughly describes this phenomenon in this population, the associated risk factors, and how they could benefit from the application of Patient Blood Management (PBM) guidelines. Observational study. All adult patients who received a KTx between January 1st, 2020, and December 31st, 2021, were included and followed up to six months after transplantation. Those who received a multiorgan transplant, whose data was missing in the electronic health records, and who had primary non-function were excluded. We recorded donor and recipient characteristics, cold ischemia time, preoperative hemoglobin concentration, iron status deficiency biomarkers, incidence of delayed graft function and biopsy-proven graft rejections, and graft function at discharge and 6 months after transplantation. We found that a high amount (39%) of KTx recipients required at least one blood transfusion during the perioperative period. And that 1) most of these patients had anemia at the time of transplantation (85.4%), 2) iron status upon admission was associated with the transfusion of more blood units (3.9 vs 2.7, p=0.019), 3) surgical reintervention (OR 7.28, 2.35-22.54) and deceased donor donation (OR 1.99, 1.24-3.21) were associated with an increased risk of transfusion, and finally, 4) there was an association between a higher number of blood units transfused and impaired kidney graft function six months after hospital discharge (1.6 vs 1.9, p=0.02). In conclusion, PBM guidelines should be applied to patients on the KTx deceased donor waiting list and especially those scheduled to receive a transplant from a living donor. This could potentially increase the utilization efficiency of blood products and avoid transfusion-related severe adverse effects.

SGLT-2 Inhibitors: Focus on Dapagliflozin.

Dapagliflozin (trade name FARXIGA) is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor that has transcended its initial antidiabetic application to demonstrate benefits in cardiac and renal diseases. It was first approved by the food and department administration for type 2 diabetes in 2014. Since then, it has gained food and department administration approval for chronic kidney disease in 2021, heart failure with reduced ejection fraction in 2020, and heart failure with preserved ejection fraction in 2023. Thus, dapagliflozin plays a pivotal role in improving patient outcomes. By competitive binding to renal SGLT-2 cotransporters, dapagliflozin effectively prevents glucose and sodium reabsorption, leading to glucosuria. Its pharmacokinetic profile involves minimal cytochrome P450-induced metabolism, rapid absorption with an 18-hour duration of action, and stable effects. Clinical trials have revealed dapagliflozin's efficacy in glycemic control without the risk of hypoglycemia, making it an advantageous choice for patients insufficiently managed on other antidiabetic drugs. Comparative analysis with other SGLT-2 inhibitors suggests dapagliflozin's potential superiority in preventing heart failure. Compared to empagliflozin, it has more extended effects, contributing to stable sodium diuresis, reduced blood pressure fluctuations, and potentially lower cardiovascular disease risks. However, it leads to less urinary glucose excretion compared with canagliflozin. Dapagliflozin has specific contraindications, such as type 1 diabetes and end-stage chronic kidney disease. Adverse effects include an increased risk of genital infections, urinary tract infections, and Fournier's gangrene. A nuanced understanding of dapagliflozin's benefits and limitations is imperative for informed clinical decision-making in the management of diabetes and its complications.

Analysis of Graft Survival in Pediatric Patients Undergoing Kidney Transplantation

Introduction: Kidney transplantation is the gold standard therapy for end-stage chronic kidney disease (CKD). However, aspects related to the characteristics of the donor and the recipient, the surgical technique, the immunosuppression protocol and comorbidities can impact graft survival. Objectives: To evaluate factors associated with graft survival in pediatric patients undergoing kidney transplantation. Methods: Descriptive, retrospective cohort study, which included all patients aged 1 to 18 years who underwent kidney transplantation at Unidade Renal Pediátrica of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil, from January 2017 to December 2021, with a minimum follow-up time of 10 months, totaling 51 patients. The IMIP ethics and research committee approved the study under CAAE: 52023921.1.0000.5201. Results: The median age of patients undergoing kidney transplantation was 12 years(9-13); 27 (52.9%) were male and eight (15.6%) were younger than 5 years of age. The main etiologies of CKD were congenital anomalies of the kidney and urinary tract (n = 25; 49%). As for kidney transplants, 49 (96.1%) were from a deceased donor and the median follow-up time was 32 (14-42) months. After transplantation, 58% of the population were hypertensive, while 80.4% had dyslipidemia. The 5-year graft and patient survival rates, assessed using the Kaplan Meier curve, were 86.3 and 90.2%, respectively. Seven (n = 5) patients lost the graft, the most common cause being renal vein thrombosis. Nonglomerular causes of CKD showed lower graft survival when compared to glomerular causes (log rank p = 0.035). Conclusion: Our sample’s graft and patient survival rates are similar to national and global data. The most frequent causes of graft loss were thromboembolic events. Furthermore, we observed a high prevalence of hypertension and dyslipidemia. These results direct us to establish strategies to improve survival in pediatric kidney transplants.

Multidisciplinary management of penile calciphylaxis in a patient undergoing hemodialysis

Penile necrosis in end-stage chronic kidney disease patients on hemodialysis presents complex pathophysiology involving vascular, metabolic, and dialysis-related factors. This clinical case emphasizes the significance of prompt multidisciplinary management. Surgical interventions like penectomy with scrotal pedicled flaps offer effective reconstruction, preventing complications. Long-term success mandates diligent oversight of metabolic and vascular issues. A comprehensive approach integrating urology, vascular surgery, and nephrology specialists is essential for optimal patient outcomes and quality of life.

Profile of Anemia and the Relationship between Hemoglobin Levels and Quality of Life in End-Stage Chronic Kidney Disease Patients undergoing Chronic Hemodialysis at Hasan Sadikin Hospital 2021-2022

Background: Anemia is a common complication of Chronic Kidney Disease (CKD). The severity of anemia has implications for patients' quality of life. Objective: This study aims to determine the profile of Anemia and the relationship between Hemoglobin (Hb) levels and the quality of life of end-stage CKD patients undergoing chronic Hemodialysis. Methods: This study is analytical observational research with a cross-sectional design approach to explore the correlation between Hb levels and the quality of life of routine Hemodialysis patients at Hasan Sadikin Hospital, Bandung, throughout 2021-2022. Hb levels were continuous data. The quality of life of CKD patients was measured using the Indonesian version of the KDQOL questionnaire based on eight components. The obtained data were statistically analyzed using Spearman's Rank correlation. Results: This study had 150 subjects, 75 male (50.0%) and an average age of 45. The most common etiology of CKD was hypertensive nephrosclerosis (52.7%). The average Hb level was 9 g/dL. The highest quality of life score was 68, and the lowest was 41.28, with a median of 50.99. The correlation analysis results showed an r of -0.157 and p of 0.057, indicating a very weak negative correlation that is not statistically significant. Conclusion: The study's conclusion indicates no relationship between Hb levels and the quality of life of end-stage CKD patients undergoing chronic Hemodialysis.

Fragility Fractures in End-Stage Chronic Kidney Disease (CKD) Population: Patient-Related and CKD-Related Factor Analysis-A Single-Center Experience.

Background: Chronic kidney disease (CKD) stands as a prevalent global health concern, and mineral and bone disease are among the most impactful consequences. A severe complication arising from mineral and bone disease is the occurrence of fragility fractures, which disproportionately affect individuals with CKD compared to the general population. The prevalence of these fractures impacts both survival rates and quality of life. The aims of this study are analyzing and identifying (i) patient-related risk factors and (ii) CKD-related risk factors to contribute to the development of preventive measures for fragility fractures for this population. Methods: A retrospective, single-center observational study was conducted, encompassing patient data from the years 2021 to 2023. Registry data were recorded, including patient-related and CKD-related data. Patients were interviewed about traumatological history, and their answers were recorded. Logistic regression analysis was employed to investigate the association between independent variables and dependent variables. Results: Eighty-four patients, with a mean age of 64.3 ± 15.2 years and a male percentage of 58.3%, were included in this study. Among them, 19.5% exhibited smoking habits. The mean Charlson Comorbidity Index was 3.06 ± 1.21. All patients were diagnosed with end-stage chronic kidney disease, with mean durations of 208 months from the diagnosis and 84.5 months from the beginning of dialysis. The logistic regression analysis, adjusted for age, sex, and CCI, revealed that smoking habits play a significant role as a risk factor for fragility fractures in lower limbs (p: 0.011 *). The incidence of fragility fractures increases directly proportionally to the time since diagnosis (p-value: 0.021 *) and the beginning of dialysis treatment (p-value: 0.001 *). Conclusions: Among patient-related factors, smoking habits seem to significantly affect lower-limb fracture rates (p < 0.05), whereas among CKD-related factors, time since CKD diagnosis and time since the beginning of dialysis treatment are directly related to higher risks of fragility fractures. No relevant correlations emerged in the studied treatments, except for a reduction in proximal femur fracture occurrence when patients underwent a combined treatment of a calcimimetic and a vitamin D analog.

Les défis de la transplantation rénale avec artères multiples

Renal transplantation is a crucial procedure for treating end-stage chronic kidney disease, but the shortage of grafts has led to the utilization of kidneys with more complex anatomical features, such as multiple arteries. This article aims to provide surgeons with various surgical strategies based on the number of arteries, their topography, as well as the presence or absence of an associated patch. It also offers guidance on adapting organ retrieval techniques and perfusion machine setup in this type of complex anatomy.

WCN24-1268 End-Stage Kidney Disease (ESKD) and Chronic Kidney Disease (CKD) Progression among a Hispanic/Latino Population with Primary Immunoglobulin A Nephropathy (IgAN)

WCN24-1268 End-Stage Kidney Disease (ESKD) and Chronic Kidney Disease (CKD) Progression among a Hispanic/Latino Population with Primary Immunoglobulin A Nephropathy (IgAN)

Recurrence of Idiopathic Membranous Nephropathy in the Kidney Allograft: A Systematic Review.

The recurrence of idiopathic membranous nephropathy (iMN) after kidney transplantation is common, although its exact clinical significance remains unclear. This systematic review aims to elucidate the effects of iMN recurrence on graft survival. A literature search was performed by systematically searching Medline, Scopus, Web of Science, and Google Scholar from inception. Cohort studies examining iMN recurrence after kidney transplantation were deemed eligible. Meta-analysis was performed by fitting random-effects models. Twelve (12) articles published from 1995 to 2016 reporting on 139 transplant patients with recurrent iMN were included. The median time of the diagnosis of recurrent iMN was 18 months during follow-up from 35 to 120 months. Risk factors for iMN recurrence in the renal allograft are a positive serum test for anti-PLA2R antibodies pretransplant, female sex, younger age, high proteinuria pretransplant, the longest interval from initial disease to end-stage chronic kidney disease, and the combination of alleles HLA DQA1 05:01 and HLA DQB1 02:01. In the pretransplant period, 37 (26.61%) patients had a positive serum test and 18 (12.94%) patients had a positive biopsy stain for anti-PLA2R antibodies. The sensitivity of the pretransplant positive serum test for these antibodies ranges from 57% to 85.30% and the specificity is 85.10-100%. A total of 81.80% of patients who received rituximab as treatment for iMN recurrence achieved complete and partial remission, while 18.20% had no response to treatment. iMN recurrence was not associated with significantly different rates of graft loss (odds ratio = 1.03, 95% CI: 0.52-2.04, p = 0.524, I2 = 0.00%). Recurrence of iMN was not associated with increased risk of graft loss independently of whether patients were treated with rituximab (OR: 0.98, 95% CI: 0.39-2.50, I2: 0%) or not (OR: 1.22, 95% CI: 0.58-2.59, I2: 3.8%). Patients with iMN recurrence who achieved remission had significantly reduced risk of graft loss (OR: 0.14, 95% CI: 0.03 to 0.73). The main outcome from this systematic review is that there is no statistically significant difference in graft survival in patients with iMN recurrence compared to those without recurrence in long-term follow-up. The achievement of remission is associated with significantly reduced risk of graft loss.

EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN UKRAINE

The article reports on the prevalence of chronic kidney disease (CKD) in Ukrainian diabetic patients. A total of 194 patients who seeking an appointment with an endocrinologist underwent CKD screening. Materials and methods. The mean age of the patients was 64.82±0.88 years, and the duration of diabetes mellitus amounted to 9.29±0.60 years. Of these, 53.1% were female and 46.9% were male. Out of the screened patients, 79.4% had type 2 diabetes mellitus, 3.6% had type 1 diabetes mellitus, 9.3% had prediabetes, and 7.7% had other types of diabetes. We diagnosed CKD by calculating the estimated glomerular filtration rate (GFR) based on the creatinine level using the CKD-EPI Creatinine formula and determining albuminuria as the albumin-to-creatinine ratio. Results. Among diabetic patients, 26.8% had stage 1 CKD, 42.3% had stage 2, 21.6% had stage 3a, 8.2% had stage 3с, and 0.5% had each of stage 4 and 5. 70.6% of patients were found to have albumin-to-creatinine ratio (ACR) A1, 21.6% – A2, and 7.7% – A3. Of these, 30.0% were at high and very high risk of developing end-stage CKD. The regression analysis revealed a negative correlation between the duration of diabetes mellitus and the level of GFR, B (95% CI) = -0.102 (-0.179/-0.26), p = 0.009, and a positive correlation with ACR, B (95% CI) = 2.87 (0.089/5.605), p = 0.043. Conclusions. Among the examined patients with diabetes mellitus, 73.2% had stage 2-5 chronic kidney disease, and 29.3% had stage A2 and A3 albuminuria. Of these, 30% belong to the high- and very high-risk group for developing end-stage chronic kidney disease, requiring regular monitoring of glomerular filtration rate and albuminuria at least 3-4 times a year and conservative treatment. The duration of diabetes is a negative risk factor for chronic kidney disease. Hence, chronic kidney disease screening should be performed in all patients with diabetes with no exception.

Exploring Risk Factors Involved in The Progression of Chronic Kidney Disease: A Prospective Study in A Quaternary Care Hospital - Chennai.

Purpose: The study investigates the rising prevalence of chronic kidney disease (CKD) and its associated challenges, including co-morbidities and uncertain prognosis. Patients often face disease progression without clear identification of those at high risk for rapid advancement to end-stage renal disease. Conducted in a hospital setting, the research examines a cohort of adults with CKD to determine the rate of progression from early to advanced stages and identify predictors of rapid advancement. Methods: Patients meeting inclusion/exclusion criteria provided written consent before screening. The Modification of Diet in Renal Disease (MDRD-4) equation determined eGFR, and staging was based on admission results. Data were categorized into early and advanced stages according to eGFR values. Demographic details, clinical features, risk factors, comorbidities, laboratory results, and other supportive care information were extracted from hospital records. The collected data were analyzed to identify risk factors influencing CKD progression. Results: A comparative analysis of baseline characteristics revealed that age, gender, and BMI significantly contributed to the development of end-stage kidney disease. Key factors such as serum creatinine, serum uric acid, eGFR, random blood sugar, and fluid intake showed statistical significance in the progression of kidney disease. The risk of end-stage CKD was notably elevated with smoking, alcohol consumption, and increased fluid intake. Conclusion: The study demonstrated a significant association between CKD progression and parameters such as age, BMI, habits like alcohol intake and smoking, as well as clinical factors including serum creatinine, serum uric acid, eGFR, and random blood sugar. Patients with diabetes, coronary artery disease (CAD), and anemia exhibited a more accelerated decline in renal function. These factors can be modified through appropriate treatment.

Microbial Analysis in Chronic Rhinosinusitis Patients with Chronic Kidney Disease and End-Stage Renal Disease.

This study aimed to elucidate the bacterial profile of chronic rhinosinusitis (CRS) in patients with end-stage renal disease (ESRD) and chronic kidney disease (CKD) compared with nonrenal patients, guiding antibiotic selection for clinicians. We retrospectively analyzed 13,906 inpatients from the Chang Gung Research Database who underwent sinus surgery (2004-2018). Patients were categorized into ESRD-CRS, CKD-CRS, and non-CKD-CRS based on the estimated glomerular filtration rate. Bacterial cultures from surgical samples were classified as facultative anaerobes or aerobes (e.g., Klebsiella pneumoniae [KP], Pseudomonas aeruginosa [Ps.a]), anaerobes, and fungi and ranked by prevalence. Data from 47 ESRD-CRS, 230 CKD-CRS, and 13,123 non-CKD-CRS patients were analyzed. In ESRD-CRS, the predominant species were KP (31.6%), Ps.a (21.1%), and Coagulase-negative Staphylococcus (CoNS, 15.8%). CKD-CRS showed Staphylococcus epidermidis (27.7%), CoNS (20.5%), and Ps.a (20.5%). Non-CKD-CRS had Staphylococcus epidermidis (29.8%), CoNS (25.0%), and Staphylococcus aureus (15.5%). For anaerobes, ESRD-CRS was dominated by Fusobacterium nucleatum (10.5%) and Peptostreptococcus micros (10.5%), whereas CKD-CRS and non-CKD-CRS showed Propionibacterium acnes as a primary strain (14.5% and 28.7%, respectively). For CRS in ESRD, antibiotics targeting KP and Fusobacterium nucleatum are recommended. In CKD-CRS, a focus on Staphylococcus epidermidis and Propionibacterium acnes is suggested. 4 Laryngoscope, 134:3499-3507, 2024.

Colonoscopy Finding: Pseudomembranous Colitis in Chronic Kidney Disease Patient

Background: Gastrointestinal symptoms are common among patients with chronic kidney disease, reported in up to 70%–80% of patients with end-stage kidney disease. Several factors are involved in the pathogenesis, including the accumulation of uremic toxins and intestinal flora changes. Pseudomembranous colitis is a manifestation of severe colonic disease that is usually associated with Clostridium difficile infection but can be caused by a number of different etiologies. Pseudomembranous colitis occurs when changes in the fecal flora allow Clostridium difficile overgrowth. Gut dysbiosis, an alteration of the composition and function of gut microorganisms, is commonly seen in patients with chronic kidney disease.&#x0D; Case presentation: This scientific report presents a case study of a 31-year-old woman diagnosed with pseudomembranous colitis and end-stage chronic kidney disease on hemodialysis. The colonoscopy showed yellow-white nodules that formed pseudomembranes, which were scattered between the edematous mucosa. The patient had been treated with metronidazole for 4 days, but there were side effects. The antibiotic was switched to meropenem for 6 days based on feces culture. The evaluation of colonoscopy result was normal.&#x0D; Conclusion: Pseudomembranous colitis is an inflammatory bowel condition most commonly caused by Clostridium difficile infection. The presence of pseudomembranous visualization in colonoscopy can significantly establish the diagnosis.

Assessment of the Influence of Postdilution Online Hemodiafiltration on the Rate of Removal of Middle Molecular Weight Uremic Toxins

Abstract Hemodiafiltration is a method of treatment used to replace kidney function, which effectively removes uremic toxins of middle molecular weight from the blood of patients with the end-stage of chronic kidney disease. The aim of this study was to examine the effect of postdilution online hemodiafiltration on the degree of β2- microglobulin removal. Thirty patients treated with postdilution online hemodiafiltration were examined. The main parameter for assessing the removal efficiency of uremic toxins of middle molecular weight was the concentration of β2-microglobulin in the serum before and after a single session of postdilution online hemodiafiltration. The following tests were used for statistical analysis: Shapiro-Wilk test, Student’s T test for bound samples and Wilcoxon test. The average total convective volume is 21.38 ± 2.97 liters per session. The reduction index of β2-microglobulin during a single session of postdilution online hemodiafiltration is 70.86 ± 6.87%. The average loss of albumin during a single postdilution online hemodiafiltration is 2.50 ± 0.92 g/4h, and the albumin reduction index is 6.20 ± 2.12%. Postdilution online hemodiafiltration effectively removes β2-microglobulin from the blood of patients with end-stage chronic kidney disease. The reduction index of β2-microglobulin is ˜ 71.00% and the loss of albumin is less than 4.0 g/4h. This dialysis modality prevents the development of dialysis-related amyloidosis and atherosclerotic cardiovascular diseases in the population of patients treated with regular hemodiafiltration.

Fat tissue quantity, waist circumference or waist-to-hip ratio in patients with chronic kidney disease: A systematic review and meta-analysis

The BMI predicts mortality and cardiovascular disease (CVD) in the general population, while in patients with end-stage chronic kidney disease (CKD) a high BMI is associated with improved survival, a phenomenon referred to as the “obesity paradox”. While BMI is easy to determine and helps to categorize patients, it does not differentiate between fat tissue, lean tissue and bone mass. As the BMI may be altered in CKD, e.g. by muscle wasting, we determined in this meta-analysis (i) the association of mortality with fat tissue quantity in CKD and (ii) the association of mortality with abdominal obesity (as measured by waist circumference (WC) or waist-to-hip ratio (WHR)) in CKD. We systematically reviewed databases for prospective or retrospective cohort studies. In eleven studies with 23,523 patients the association between mortality and high fat tissue quantity in CKD was calculated. The pooled hazard ratio (HR) for this association in the CKD group in the dialysis group 0.91 (CI 0.84- 0.98, p = 0.01) which is comparable to the HR for the association with BMI. The HR in patients without dialysis was 0.7 (95% CI 0.53- 0.93, p = 0.01), suggesting a better risk prediction of high fat tissue content with mortality as compared to higher BMI with mortality in patients with CKD without dialysis. Importantly, both BMI and fat tissue quantity in CKD are described by the “obesity paradox”: the higher the fat tissue content or BMI, the lower the mortality risk. In thirteen studies with 55,175 patients the association between mortality and high WC or WHR in CKD (with or without dialysis) was calculated. We observed, that the HR in the WHR group was 1.31 (CI 1.08–1.58, p = 0.007), whereas the overall hazard ratio of both groups was 1.09 (CI 1.01–1.18, p = 0.03), indicating that a higher abdominal obesity as measured by WHR is associated with higher mortality in CKD. Our analysis suggests gender-specific differences, which need larger study numbers for validation. This meta-analysis confirms the obesity paradox in CKD using fat tissue quantity as measure and further shows that using abdominal obesity measurements in the routine in obese CKD patients might allow better risk assessment than using BMI or fat tissue quantity. Comparable to the overall population, here, the higher the WHR, the higher the mortality risk.

The Influence of the Time Factor and Marital Status on the Quality of Life of Patients After Kidney Transplantation in Uzbekistan

Background: Currently, compared to program hemodialysis and peritoneal dialysis, kidney transplantation is considered to be the preferred method of renal replacement therapy in patients with end-stage chronic kidney disease (CKD) in terms of patient survival and improvement in their quality of life (QOL). This study aimed to investigate the influence of the post-transplantation period and marital status on the health-related QOL of patients with CKD who underwent kidney transplantation.Methods and Results: A cross-sectional study was conducted among 78 patients who had received a kidney transplant from living related donors in the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation between January and April 2022. Kidney transplant recipients (KTRs) were divided into four groups depending on the time after kidney transplantation: 3, 6, 12 months, and 2 years or more after surgery. The study used 2 questionnaires. The first included questions about the sociodemographic data of patients; the second was the standardized health-related QOL questionnaire SF-36. This study of the QOL of KTRs, residents of the Republic of Uzbekistan, showed an improvement in most scales of physical and mental health components 12 months and 2 years or more after kidney transplantation. On the scales of physical and mental health components, unmarried KTRs had a higher self-assessment of QOL than married KTRs, and among married KTRs, those with children had higher QOL indicators.Conclusion: Clarifying how the time after kidney transplantation and individual sociodemographic and medical factors influence QOL indicators requires further research (including longitudinal studies) in a wider КTR population.

Exploring the Impact of Optimized Probiotic Supplementation Techniques on Diabetic Nephropathy: Mechanisms and Therapeutic Potential.

Worldwide, diabetic nephropathy (DN) is a significant contributor to end-stage renal failure and chronic kidney disease. Probiotic supplementation has recently gained popularity as a potential nutritional therapy in several clinical trials aimed at improving renal function, inflammation, oxidative stress, dyslipidemia, glycemic control, and inflammation. However, they still need to undergo a thorough assessment of DN. It is crucial that the optimal dosage, duration, and combination of probiotic strains administered for the purpose of slowing down the advancement of DN be assessed. Based on the available publications, including relevant randomized controlled trials, systematic reviews, and meta-analysisfrom 2013-2023 from search engines like MEDLINE (PubMed), Scopus, and Web of Science, a literature review was generated using the keywords "gut microbiota," "gut microbiome," "diabetic kidney disease," "diabetic nephropathy," "probiotic," and "prebiotic." Multiple clinical trials focusing on probiotic administration techniques revealed changes in renal, glucose, and lipid biomarkers. Probiotic supplementation using Bifidobacterium bifidum, Lactobacillus acidophilus, and Streptococcus thermophilus for 12 weeks indicated a reduction in glycosylated hemoglobin, fasting blood glucose, and the microalbuminuria/creatinine ratio. Multispecies as well as single-species probiotic administration containing Lactobacillus, Bifidobacterium, and Streptococcus thermophilus spp. greater than 4*109colony forming units (CFU)/day for 8-12 weeks in DN patients improves renal metabolic markers and reduces the progression of disease patterns. Optimal supplementation techniques of probiotics in conjunction with prebiotics and synbiotics in DN benefit glycaemic control, renal function, blood lipid profile, inflammation, and oxidative stress. Future randomized controlled trials supplementing specific probiotics coupled with prebiotics and synbiotics, with larger sample sizes and longer follow-up times, will generate more reliable findings for the impact of probiotic supplementation on DN.

Low rate of severe-end-stage kidney disease after SABR for localised primary kidney cancer

BackgroundStereotactic ablative body radiotherapy (SABR) is an emerging treatment for patients with primary renal cell carcinoma (RCC). However, its impact on renal function is unclear. This study aimed to evaluate incidence and clinical factors predictive of severe to end-stage chronic kidney disease (CKD) after SABR for RCC.Methods and materialsThis was a Single institutional retrospective analysis of patients with diagnosed primary RCC receiving SABR between 2012–2020. Adult patients with no metastatic disease, baseline estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min/1.73 m2, and at least one post-SABR eGFR at six months or later were included in this analysis. Patients with upper tract urothelial carcinoma were excluded. Primary outcome was freedom from severe to end-stage CKD, determined using the Kaplan–Meier estimator. The impact of baseline CKD, age, hypertension, diabetes, tumor size and fractionation schedule were assessed by Cox proportional hazard models.ResultsSeventy-eight consecutive patients were included, with median age of 77.8 years (IQR 70–83), tumor size of 4.5 cm (IQR 3.9–5.8) and follow-up of 42.2 months (IQR 23–60). Baseline median eGFR was 58 mls/min; 55% (n = 43) of patients had baseline CKD stage 3 and the remainder stage 1–2. By last follow-up, 1/35 (2.8%) of baseline CKD 1–2, 7/27 (25.9%) CKD 3a and 11/16 (68.8%) CKD 3b had developed CKD stage 4–5. The estimated probability of freedom from CKD stage 4–5 at 1 and 5 years was 89.6% (CI 83.0–97.6) and 65% (CI 51.4–81.7) respectively. On univariable analysis, worse baseline CKD (p < 0.0001) and multi-fraction SABR (p = 0.005) were predictive for development of stage 4–5 CKD though only the former remained significant in multivariable model.ConclusionIn this elderly cohort with pre-existing renal dysfunction, SABR achieved satisfactory nephron sparing with acceptable rates of severe to end-stage CKD. It can be an attractive option in patients who are medically inoperable.

Metabolome profiling by widely-targeted metabolomics and biomarker panel selection using machine-learning for patients in different stages of chronic kidney disease

Chronic kidney disease (CKD) is an increasingly prevalent medical condition associated with high mortality and cardiovascular complications. The intricate interplay between kidney dysfunction and subsequent metabolic disturbances may provide insights into the underlying mechanisms driving CKD onset and progression. Herein, we proposed a large-scale plasma metabolite identification and quantification system that combines the strengths of targeted and untargeted metabolomics technologies, i.e., widely-targeted metabolomics (WT-Met) approach. WT-Met method enables large-scale identification and accurate quantification of thousands of metabolites. We collected plasma samples from 21 healthy controls and 62 CKD patients, categorized into different stages (22 in stages 1–3, 20 in stage 4, and 20 in stage 5). Using LC-MS-based WT-Met approach, we were able to effectively annotate and quantify a total of 1431 metabolites from the plasma samples. Focusing on the 539 endogenous metabolites, we identified 399 significantly altered metabolites and depicted their changing patterns from healthy controls to end-stage CKD. Furthermore, we employed machine-learning to identify the optimal combination of metabolites for predicting different stages of CKD. We generated a multiclass classifier consisting of 7 metabolites by machine-learning, which exhibited an average AUC of 0.99 for the test set. In general, amino acids, nucleotides, organic acids, and their metabolites emerged as the most significantly altered metabolites. However, their patterns of change varied across different stages of CKD. The 7-metabolite panel demonstrates promising potential as biomarker candidates for CKD. Further exploration of these metabolites can provide valuable insights into their roles in the etiology and progression of CKD.

Bacteremia and Mortality among Patients with Nontunneled and Tunneled Catheters for Hemodialysis.

Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion. Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (p < 0.0001). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; p < 0.0001). We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.