Evaluation Of Kidney Function Research Articles

#501 Evaluation of the accuracy of serum creatinine-based GFR calculations across the different levels of renal function among Filipinos

Abstract Background and Aims Chronic kidney disease (CKD) is a worldwide health concern which continues to increase in prevalence. Early studies have evaluated kidney function by measuring serum creatinine (sCr) and/or the estimated glomerular filtration rate (eGFR). To date, there are limited studies that correlate nuclear GFR scans and eGFR by equations that include the Cockroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) 2021 in Asians, specifically in a Filipino population. This study aims to compare the accuracy of GFR scan results and GFR estimated from the formulas across different levels of kidney functions, age groups, gender, and co-morbidities among a Filipino subset. Method A cross-sectional study was done among 2986 patients who underwent Nuclear GFR scan in a single kidney center. Results obtained were compared to estimated GFR results. Weighted Kappa and Bland-Altman Analyses were used to test for agreement between the measured and estimated GFR results. Results Absolute GFR values derived from the three equations demonstrated moderate reliability with results from nuclear scan when intraclass correlation coefficients were calculated with CKD-EPI 2021 being the highest. When further categorized into GFR levels, there was substantial level of agreement between each equation and GFR scan, with all weighted kappa coefficients being at least 0.700 with CG having the highest result (Table 1). Furthermore, when subgroup analysis was done according to age group, gender, and comorbidities, CG was found to be the most accurate per category (Table 2). Conclusion CKD-EPI 2021 was the most accurate in the actual GFR values however we cannot fully eliminate the utility of CG due to its categorical accuracy and in monitoring the deterioration of renal function.

#1483 Creatinine excretion can serve more than a marker of kidney function in patients in the late postoperative period of bariatric surgery

Abstract Background and Aims Bariatric and metabolic surgery is the treatment of choice for severe obesity aiming to improve quality of life and control comorbidities, including chronic kidney disease (CKD). Careful monitoring of metabolic components, including markers of kidney function, are needed in the late postoperative period. The 24-hour urinary creatinine excretion rate (CER) and the Creatinine-Height Index (CHI) are accepted as non-invasive methods to evaluate kidney function, which are associated with skeletal muscle mass. However, it is not known whether these markers are also associated with muscle function among patients who underwent bariatric surgery after a period of massive weight loss. Therefore, the present study aims to investigate the association between kidney function markers with muscle function in individuals in the late postoperative period of bariatric surgery . Method This is a cross-sectional study, including women who underwent bariatric surgery for more than 18 months, when weight loss trajectory tends to stabilize. Age, date of surgery, self-reported preoperative weight, current body mass index (BMI) were collected to determine nutritional status. Patients with a BMI above 25 kg/m² were considered to have excessive body weight. Total weight loss (%TWL) and excess weight loss (%EWL) after surgery were also calculated. Patients underwent a blood test to assess serum creatinine (mg/dL) and collected 24-hour urine to estimate CER and CHI. Urinary collection was checked for adequate collection and patients with inadequate collections were excluded from the analysis. Muscle function comprised the assessment of muscle strength by handgrip strength [(HGS) JAMAR®, USA], 30-second chair stand test (30-CST) and, physical performance by timed-up and go test (TUG). Pearson's correlation was performed to test the correlation between the variables of interest and independent T-test to compare differences in creatinine markers and muscle function in the groups of patients with normal and excessive body weight. Results We analyzed 89 women (mean age 39.4 ± 8.0 years; BMI 28.6 ± 4.7 kg/m²). Bariatric surgery were at a median time of 3.9 (1.7 – 6.6) years post-operative; %TWL and %EWL were 38.0 ± 8.5% and 79.1 ± 20.2 %, respectively. Mean serum creatinine, CER and CHI were 0.67 ± 0.12 mg/dL; 5.7 ± 2.7 mmol/L; and 120.1 ± 22.5%, respectively. Significantly higher muscle strength was found between patients with excessive body weight (n = 69) compared to those with normal body weight (n = 20) for the HGS (29.2 ± 5.1 vs. 26.5 ± 5.8 kgf, p = 0.037) but not for the 30-CST (15.3 ± 4.0 vs. 14.4 ± 3.7 repetitions, p = 0.181) or performance by TUG test (6.1 ± 0.90 vs 6.1 ± 0.95 seconds, p = 0.450). Considering the total sample, HGS was significantly correlated with CHI (r2 0.238, p = 0.025, ) but not with serum creatinine or CER (r2 0.180, p = 0.093; r2 -0.047, p = 0.662, respectively). No significant correlations were found between the creatinine variables with 30-CST and TUG tests, except among patients with excessive body weight, where CER showed a significant correlation with the 30-CST test (r2 0.257, p = 0.034). Conclusion In addition to the already known effects on muscle mass, creatinine variables were correlated with muscle strength and, among those who still present excessive body weight after bariatric surgery, also with muscle functionality. Further studies may clarify mechanisms involved in physical function and creatinine excretion after a massive weight loss promoted by bariatric surgery. Determination of creatinine excretion could be useful in addition to the imaging technique arsenal available for metabolic assessment in studies with this population set.

#2459 Matching-adjusted indirect comparison of eGFR in patients with immunoglobulin A nephropathy treated with Nefecon (TRF budesonide) or sparsentan

Abstract Background and Aims Primary immunoglobulin A nephropathy (IgAN) is an immune-mediated disease that can lead to kidney failure, need for dialysis and kidney transplantation, and early death. IgAN is the most common type of primary glomerulonephritis globally, with an estimated worldwide incidence of 2.5 per 100 000 individuals per year. Estimated glomerular filtration rate (eGFR) is a measure of renal function and is accepted as a surrogate endpoint for clinical trials evaluating kidney function deterioration. In December 2023, the US Food and Drug Administration (FDA) granted full approval to Nefecon (marketed as Tarpeyo® by Calliditas Therapeutics), a targeted-release formulation of budesonide, to reduce the loss of kidney function in adults with IgAN at risk of disease progression, based on the Phase 3 NefIgArd clinical trial. In February 2023, sparsentan (marketed as Filspari™ by Travere Therapeutics) was granted accelerated approval by the FDA to reduce proteinuria in adults with primary IgAN at risk of rapid disease progression, generally a urine protein–creatinine ratio (UPCR) ≥1.5 g/g, based on the Phase 3 PROTECT study. Matching-adjusted indirect comparison (MAIC) is a widely accepted and relevant methodology for comparing treatments across trials in the absence of head-to-head comparisons. In this analysis, we aimed to compare the effects of Nefecon and sparsentan on kidney function deterioration in patients with IgAN, as assessed by eGFR. Method An anchored MAIC was performed to estimate the relative effect of Nefecon and sparsentan on the absolute eGFR change from baseline at 9, 12 and 24 months, with common comparators of optimized renin–angiotensin system inhibition for NefIgArd and irbesartan for PROTECT. Patient-level data from NefIgArd were used to select a population matched to PROTECT, and the following baseline characteristics were used to determine the weights: mean age (years), sex (% male), race (% white), mean eGFR (mL/min/1.73 m2), mean UPCR (g/g), urine albumin–creatinine ratio (UACR) (% with UACR >1.1 g/g), and urinary protein excretion (% with urinary protein excretion >1.8 g/day). Absolute change in eGFR was analyzed using a mixed model for repeated measures (MMRM) method, including baseline, 3-, 6-, 9-, 12-, 18- and 24-month data, baseline eGFR, baseline eGFR-by-time interaction, treatment, and treatment-by-time interaction. The MAIC weights were incorporated into the MMRM. A Bayesian fixed-effects network meta-analysis was performed on the relative effect from PROTECT and the weighted relative effect from NefIgArd, measured by the estimated absolute change from baseline in eGFR. Results The matching-adjustment of the NefIgArd patient population to the PROTECT population is shown in Table 1. The weighted NefIgArd population exhibits very similar baseline characteristics to the PROTECT population. The effective sample size of the weighted NefIgArd population is 208. Results from the anchored MAIC showed statistically and clinically significant favorable effects of Nefecon versus sparsentan on eGFR for all time points analyzed (Fig. 1). Mean differences in the absolute change in eGFR of 5.68 mL/min/1.73 m2 (95% credible interval [Crl] 3.14, 8.20; p < 0.001), 3.48 mL/min/1.73 m2 (95% Crl 0.97, 5.97; p = 0.006) and 3.28 mL/min/1.73 m2 (95% Crl 0.02, 6.51; p = 0.048) were observed when comparing Nefecon with sparsentan at 9 months vs 36 weeks, 12 months vs 48 weeks, and 24 months vs 106 weeks, respectively. Conclusion After accounting for differences in the patient populations from the NefIgArd and PROTECT trials, the anchored MAIC showed that treatment with Nefecon 16 mg/day for 9 months was associated with greater eGFR benefit compared with continuous treatment with sparsentan 400 mg/day over 2 years, with significant differences observed as early as 9 months after treatment initiation and sustained up to 2-years of follow-up.

#1326 Impairment of ACSS2 aggravates renal fibrosis and cell senescence during aging

Abstract Background and Aims Age-related changes in kidney function, structure, and their relationships have been extensively recognized recently. Here, we report that acyl-CoA synthetase short chain family member 2 (Acss2) as a regulator of lipid metabolism, play an important role in age-associated renal fibrosis. Method 21-month-old Acss2 knockout (Acss2−/−) mice were used as the renal aging models, and H2O2 also was used to induced renal tubular epithelial cells (TCMK-1) senescence. Serum creatinine (Cr) and urinary protein creatinine ratio (UACR) were measured to evaluate kidney function, and renal tissue lesions were observed by HE staining and Masson staining. The expression of gene/protein in relation to inflammation, fibrosis and cell senescence were measured by qPCR, western blot. SA-β-gal staining also used to assess cell senescence. Results The results indicate that Acss2 was decreased in aging mice, Acss2 knockout impaired renal function as detected by increased UACR. Additionally, HE and Masson staining showed that Acss2 deficiency was associated with more glomerular sclerosis and fibrosis (Fig. 1). RT-qPCR and Western blotting also revealed that Acss2 enhanced kidney fibrosis and cell senescence, accompanied by an increase in SA-β-gal-positive senescent cells (Fig. 2). These phenomena were most apparent in the TCMK cells treated with Acss2 siRNA and H2O2 (Fig. 3). What's more, KEGG analysis showed that fatty acid metabolism changes significantly during aging in kidney, and Acss2 knockout could impact the expression of lipid metabolism genes (Fig. 4) Conclusion Acss2 is associated with renal aging, and it may played a role in renal fibrosis and cell senescence by regulating fatty acid metabolism.

Association between plasma aldosterone concentration and intraglomerular hemodynamics in primary aldosteronism.

In primary aldosteronism (PA), aldosterone could affect glomerular hemodynamics by elevating renal vascular resistance and glomerular capillary pressure. However, the relationship between plasma aldosterone concentrations (PAC) and glomerular hemodynamics including efferent arteriolar resistance (Re), afferent arteriolar resistance (Ra) in humans is still unclear. The aim of this study was to investigate the relationships of PAC with intraglomerular hemodynamic parameters in patients with PA. An observational study of glomerular hemodynamics was performed using simultaneous measurements of plasma clearance of para-aminohippurate and inulin (Cin; glomerular filtration rate (GFR)) in 17 patients with PA. Kidney function was evaluated by Cin, estimated GFR based on serum creatine (eGFRcre) and serum cystatin C (eGFRcys) and creatine clearance (Ccr). Intraglomerular hemodynamic parameters, including Re, Ra, and intraglomerular hydrostatic pressure (Pglo) were calculated using Gomez's formulae. In the 17 PA cases, PAC was significantly correlated with Cin (rho=0.752, p=0.001) and eGFRcys (rho=0.567, p=0.018), but was not correlated witheGFRcreand Ccr. PAC was also significantly correlated with Pglo, Re, and urinary protein/day (rho=0.775, p=0.0004, rho=0.625, p=0.009, and rho=0.625, p=0.007, respectively). Multivariable regression analysis showed that PAC was significantly associated with Cin and Re. In comparing aldosterone producing adenoma (APA) and non-APA cases, Cin was significantly elevated in APA (p=0.037), whereas eGFRcre, eGFRcys, and Ccr were not. Re tended to be higher in APA (p=0.064). These results suggest high aldosterone cause glomerular hyperfiltration by constricting Re. Cin, but not eGFRcre and Ccr, may be useful for evaluating kidney function in PA.

Mediterranean diet as a strategy for preserving kidney function in patients with coronary heart disease with type 2 diabetes and obesity: a secondary analysis of CORDIOPREV randomized controlled trial.

Type 2 diabetes mellitus (T2DM) is recognized an independent risk factor for chronic kidney disease (CKD). The precise contribution and differential response to treatment strategies to reduce kidney dysfunction, depending on whether obesity is present alongside T2DM or not, remain to be fully clarified. Our objective was to improve our understanding of how obesity contributes to kidney function in patients with T2DM and coronary heart disease (CHD), who are highly predisposed to CKD, to assign the most effective dietary approach to preserve kidney function. 1002 patients with CHD and estimated glomerular filtration rate (eGFR)≥30 ml/min/1.73m2, were randomized to consume a Mediterranean diet (35% fat, 22% MUFA, < 50% carbohydrates) or a low-fat diet (28% fat, 12% MUFA, > 55% carbohydrates). Patients were classified into four groups according to the presence of T2DM and/or obesity at baseline: Non-Obesity/Non-T2DM, Obesity/Non-T2DM, Non-Obesity/T2DM and Obesity/T2DM. We evaluated kidney function using serum creatinine-based estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) before and after 5-years of dietary intervention. Patients with Obesity/T2DM had the lowest baseline eGFR and the highest baseline uACR compared to non-diabetics (p < 0.05). After dietary intervention, the Mediterranean diet induced a lower eGFR decline in patients with Obesity/T2DM, compared to a low-fat diet but not in the other groups (p = 0.014). The Mediterranean diet, but not the low-fat diet, also reduced uACR only in patients with Obesity/T2DM (p = 0.024). Obesity provided an additive effect to T2DM resulting in a more pronounced decline in kidney function compared to T2DM alone when compared to non-diabetics. In patients with concomitant presence of T2DM and obesity, with more metabolic complications, consumption of a Mediterranean diet seemed more beneficial than a low-fat diet in terms of preserving kidney function. These findings provide valuable insights for tailoring personalized lifestyle modifications in secondary prevention of cardiovascular disease. URL, http://www.cordioprev.es/index.php/en . gov number, NCT00924937.

Kidney Function Tests and Continuous eGFR Decrease at Six Months after SARS-CoV-2 Infection in Patients Clinically Diagnosed with Post-COVID Syndrome.

The long-term sequelae of SARS-CoV-2 infection are still under research, since extensive studies showed plenty of systemic effects of the viral infection, extending even after the acute phase of the infection. This study evaluated kidney function tests six months after SARS-CoV-2 infection in patients clinically diagnosed with Post-COVID Syndrome, hypothesizing persistent renal dysfunction evidenced by altered kidney function tests compared to baseline levels. Continuous eGFR decrease <30 at six months post-infection was considered the main study outcome. Conducted at the "Victor Babes" Hospital, this retrospective observational study involved adults with laboratory-confirmed SARS-CoV-2 infection and clinically-diagnosed Post-COVID Syndrome, excluding those with prior chronic kidney disease or significant renal impairment. Kidney function tests, including serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), alongside markers of kidney damage such as proteinuria and hematuria, were analyzed. Among 206 participants, significant differences were observed between the control (n = 114) and the Post-COVID group (n = 92). The Post-COVID group exhibited higher serum creatinine (109.7 μmol/L vs. 84.5 μmol/L, p < 0.001), lower eGFR (65.3mL/min/1.73 m2 vs. 91.2 mL/min/1.73 m2, p < 0.001), and elevated BUN levels (23.7 mg/dL vs. 15.2 mg/dL, p < 0.001) compared to the control group. Regression analysis highlighted significant predictors of continuous eGFR decrease <30 at six months post-infection. The development of acute kidney injury (AKI) during the initial COVID-19 illness emerged as a strong predictor of reduced eGFR (β = 3.47, p < 0.001). Additional factors, including a creatinine increase (23 μmol/L above the normal range) and an elevated Albumin to Creatinine Ratio (ACR) (>11 mg/g above the normal range), were significantly associated with eGFR reduction. Patients with Post-COVID Syndrome demonstrate significant renal impairment six months post-SARS-CoV-2 infection. The study's findings stress the need for ongoing monitoring and intervention strategies for renal health in affected individuals, underscoring the persistent impact of COVID-19 on renal function.

Impaired Kidney Function, Cerebral Small Vessel Disease and Cognitive Disorders: The Framingham Heart Study.

It remains unclear if the relation of chronic kidney disease (CKD) with cognitive dysfunction is independent of blood pressure (BP). We evaluated kidney function in relation to premorbid BP measurements, cerebral small vessel disease (CSVD) and incident mild cognitive impairment (MCI) and dementia in Framingham Offspring Cohort participants. We included Framingham Offspring participants free of dementia, attending an examination during midlife (exam cycle 6, baseline) for ascertainment of kidney function status, with brain MRI late in life (exam cycles 7-9), cognitive outcome data and available interim hypertension and blood pressure assessments. We related CKD (estimated glomerular filtration rate<60ml/min/1.73m2) and albuminuria (urine albumin-to-creatinine ratio≥30mg/g) to CSVD markers and cognitive outcomes using multivariable regression analyses. Among 2604 participants (mean age 67.4±9.2, 64% women, 7% had CKD and 9% albuminuria), albuminuria was independently associated with covert infarcts (adjusted OR, 1.55 [1.00-2.38]; P=0.049) and incident MCI and dementia (adjusted HR, 1.68 [1.18-2.41]; P=0.005 and 1.71, [1.11-2.64]; P=0.015, respectively). CKD was not associated with CSVD markers but was associated with higher risk of incident dementia (HR, 1.53 [1.02-2.29]; P=0.041), While albuminuria was predictive of the Alzheimer's disease subtype (Adjusted HR=1.68, [1.03-2.74]; P=0.04), CKD was predictive of vascular dementia (Adjusted HR, 2.78, [1.16-6.68]; P=0.023). Kidney disease was associated with CSVD and cognitive disorders in asymptomatic community dwelling participants. The relation was independent of premorbid BP, suggesting that the link between kidney and brain disease may involve additional mechanisms beyond blood pressure related injury.

Forgotten ureteral stents: a systematic review of literature

BackgroundThe forgotten ureteral stents (FUS) is one of the late complications of stent placement. This systematic review summarized different aspects of FUS and focused on the problems and solutions related to FUS.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. PubMed® and Embase® were searched from inception until October 1st, 2022. Eligible studies were those defining FUS as a stent unintentionally left in situ longer than at least 2 months.ResultsTotal 147 studies with 1292 patients were finally included. The mean indwelling time of FUS was 33.5 months (range from 3 months to 32 years). The most common initial cause for stent placement was adjunct treatment to urolithiasis (79.2%). The major forgetting reasons were patient-related (83.9%), which included poor compliance, lapse in memory, and misconceptions about the necessity of timely removal. Primary presenting complaints were flank pain (37.3%), lower urinary tract symptoms (33.3%), and hematuria (22.8%). Encrustation (80.8%) and urinary tract infections (40.2%) were the most common complications detected in patients with FUS. Computed tomography evolving as a preferred imaging test (76.1%) was indispensable for evaluating encrustation, migration, fracture and other complicated situations in patients with FUS. Besides, evaluation of kidney function and infection status was also of great importance. Multiple and multimodal procedures (59.0%) were often necessitated to achieve the stent-free status, and were mostly endoscopic procedures. Cystoscope was most commonly used (64.8%). Retrograde ureteroscopy (43.4%) and antegrade stent removal (31.6%) were often used when dealing with more complicated situations. Extracorporeal shockwave lithotripsy (30.4%) was often used as adjunctive to other endoscopic procedures, but it sometimes failed. The decision regarding the choice of treatment is based on the volume and site of encrustation, the direction of migration, the site of fracture, kidney function and other urinary comorbidities.ConclusionsFUS not only pose hazard to patients’ health, but also impose a huge economic burden on medical care. Thorough preoperative evaluation is fundamental to developing the treatment strategy. The management of FUS should be individualized using different treatment modalities with their advantages to minimize patients’ morbidities. Prevention is better than cure. Strengthening health education and setting a tracking program are of great importance to the prevention of FUS.

A Holistic Framework for the Evaluation of Kidney Function in a Gender-Diverse Landscape

The most commonly used equations to estimate glomerular filtration rate incorporate a binary male-female sex coefficient, which has important implications for the care of transgender, gender-diverse, and nonbinary (TGD) people. Whether "sex assigned at birth" or a binary "gender identity" is most appropriate for the computation of estimated glomerular filtration rate (eGFR) is unknown. Furthermore, the use of gender-affirming hormone therapy (GAHT) for the development of physical changes to align TGD people with their affirmed gender is increasingly common, and may result in changes in serum creatinine and cystatin C, the biomarkers commonly used to estimate glomerular filtration rate. The paucity of current literature evaluating chronic kidney disease (CKD) prevalence and outcomes in TGD individuals on GAHT makes it difficult to assess any effects of GAHT on kidney function. Whether alterations in serum creatinine reflect changes in glomerular filtration rate or simply changes in muscle mass is unknown. Therefore, we propose a holistic framework to evaluate kidney function in TGD people. The framework focuses on kidney disease prevalence, risk factors, sex hormones, eGFR, other kidney function assessment tools, and the mitigation of health inequities in TGD people.

Prevalence and factors associated with masked hypertension in chronic kidney disease.

Optimal blood pressure (BP) control is key to prevent cardiovascular complications in patients with chronic kidney disease (CKD). We described the prevalence and factors associated with masked hypertension in CKD. We analyzed 1113 ambulatory 24-h BP monitoring (ABPM) records of 632 patients referred for kidney function evaluation. Masked hypertension was defined as office BP less than 140/90 mmHg but daytime BP at least 135/85 mmHg or nighttime BP at least 120/70 mmHg. Factors associated with masked hypertension were assessed with mixed logistic regression models. At inclusion, 424 patients (67%) had controlled office BP, of whom 56% had masked hypertension. In multivariable analysis conducted in all visits with controlled office BP ( n = 782), masked hypertension was positively associated with male sex [adjusted OR (95% confidence interval) 1.91 (1.16-3.27)], sub-Saharan African origin [2.51 (1.32-4.63)], BMI [1.11 (1.01-1.17) per 1 kg/m 2 ], and albuminuria [1.29 [1.12 - 1.47] per 1 log unit), and was negatively associated with plasma potassium (0.42 [0.29 - 0.71] per 1 mmol/L) and 24-h urinary potassium excretion (0.91 [0.82 - 0.99] per 10 mmol/24 h) as well as the use of renin-angiotensin-aldosterone (RAAS) blockers (0.56 [0.31 - 0.97]) and diuretics (0.41 [0.27 - 0.72]). Our findings support the routine use of ABPM in CKD, as more than half of the patients with controlled office BP had masked hypertension. Weight control, higher potassium intake (with caution in advanced CKD), correction of hypokalemia, and larger use of diuretics and RAAS blockers could be potential levers for better out-of-office BP control.

Introducing the general management of glomerular disease from a pediatric perspective based on the updated KDIGO guidelines

In 2021, a new chapter on the general management of glomerulonephritis (GN) was added to the Kidney Disease: Improving Global Outcomes (KDIGO). It emphasizes the importance of early general management of GN for improving long-term kidney outcomes and prognosis. The chapter introduces the management of glomerular diseases in 18 subchapters. Here, kidney biopsy for the diagnosis and evaluation of kidney function and the management of complications, such as hypertension, infection, and thrombosis, are presented. Moreover, the adverse effects of glucocorticoids and immunosuppressive therapy, which are commonly used drugs for glomerular disease, are mentioned, and a guideline for drug selection is presented. Each subtheme focused on items reflecting the interpretation of the “practice points” of the expert working group are introduced. In this review of the general treatment for GN in the KDIGO guidelines, excluding pregnancy and reproductive health, we focused on and compared various references pertaining to pediatric GN management.

Association between kidney function and biological age: a China Health and Retirement Longitudinal Study.

The chronological age (CA) cannot precisely reflect the health status. Our study aimed to establish a model of kidney biological age to evaluate kidney function more elaborately. The modeling group was used to establish the model, consisting of 1,303 respondents of the China Health and Retirement Longitudinal Study (CHARLS). The biological age of the kidney (BA) was constructed by principal component analysis (PCA) and Klemera and Doubal's method (KDM) with the 1,303 health respondents. PCA was chosen as the best method for our research step by step. The test group was used to apply the model. (a) BA of the kidney can distinguish respondents with from without kidney disease. (b) BA of the kidney was significantly different in various levels of kidney function. The BA of the eGFR <60 group and 60 ≤ eGFR <90 group were older than GFR ≥90 group. (c) The group with younger BA of kidney at baseline had a lower risk of kidney function decreased. (d) The risk of decreased kidney function caused by increasing BA every additional year is higher than CA. The BA of the kidney is a parameter negatively correlated with decreased kidney function and fills the blank of evaluation among people in the middle of heathy and kidney diseases.

Experience in applying the strategy of simultaneous selective perfusion of the brain, heart and lower body in reconstruction of the aortic arch in infants

Relevance. The choice of perfusion strategy is vital for the protection of internal organs during surgery. In several studies of recent years, as well as by us, a strategy of sustained total all region (STAR) perfusion (selective brain, heart and lower body perfusion) has been proposed, allowing to avoid ischemic and reperfusion injuries of internal organs.The objective was to evaluate the benefits of STAR perfusion during reconstruction of the aortic arch in children.Materials and methods. The prospective study included 15 patients who underwent aortic arch reconstruction using a strategy of simultaneous selective brain, heart and lower body perfusion (STAR perfusion) in the period from June 2022 to May 2023. The average age at the time of surgery was 1.3 months (95 % CI (confidence interval) 6.0–16.0), the average body weight was 3.4 kg (95 % CI 2.7–4.1).Results. Сhanges of the tissue oximetry index, measured at two points, did not fall below reference ranges at any stage of the operation. The greatest mean value of lactate concentration during the operation was 2.8 ± 1.0 mmol/l, recovery of the indicator was noted after 6 hours – 1.9 ± 0.9 mmol/l. Kidney function evaluation – the rate of diuresis and creatinine levels did not exceed reference levels. The average treatment time in the intensive care unit was 7.7 ± 4.3 days (95 % CI 4.5 10.9), in the hospital – 15.4 ± 5.8 days (95 % CI 11.4–19.4). There were no deaths among those operated using the new perfusion strategy.Conclusion. The use of the strategy of Sustained Total All Region (STAR) perfusion in case of reconstruction of the aortic arch in newborn, infants and young children is safe and advanced, since it avoids ischemia of internal organs and reduces the risk of post-ischemic complications.

Assessing the Reliability of Creatinine-Estimated Glomerular Filtration Rate in Living Kidney Donor Candidates: Does it Measure up to the Measured Rate?

Abstract A living donor kidney transplant is the best therapy option for patients with end stage renal disease (ESRD); however, it is associated with an increased risk of ESRD development in the donor. Thorough evaluation of the donor candidate’s kidney function status is essential for the appropriate selection of candidates with minimal risk of post-donation kidney dysfunction. In this study, glomerular filtration rate (GFR) values measured by iohexol plasma clearance (mGFR) and estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) creatinine equations (eGFR), with and without the race factor (2009 and 2021 CKD-Epi equations, respectively), were compared in a cohort of 303 kidney donor candidates. GFR values were analyzed using Bland-Altman plots, linear regression, Mann-Whitney U tests, and p10 and p30 values. Bland-Altman analysis revealed a lack of agreement between the 2009 and 2021 CKD-Epi eGFR and corresponding mGFR values, with both equations showing a negative bias of 10 – 11 mL/min/1.73m2 and indicating an underestimation of creatinine-eGFR. eGFR underestimation was confirmed by Mann-Whitney U analysis; median GFR values were significantly lower for both CKD-Epi equations as compared to corresponding iohexol-measured values (2009: 85.86; 2021: 87.29; mGFR: 96.58). Despite the overall underestimation, over 14% of donor candidates with eGFR &amp;gt;90 mL/min/1.73m2 had an mGFR value &amp;lt;90 mL/min/1.73m2. Conversely, 36% - 38% of donors with normal kidney function of &amp;gt;90 mL/min/1.73m2 as determined by iohexol-mGFR had corresponding eGFR values &amp;lt;90 mL/min/1.73m2. eGFR showed a significant but poor correlation with mGFR, with R2 values of 0.2775 and 0.2803, respectively. While the 2021 eGFR equation had better accuracy as compared to the 2009 equation (p30 of 81% versus 76%), it displayed low overall accuracy with a p10 of &amp;lt;43%. Separate analysis of Black donor candidates’ eGFR and mGFR values revealed similar trends as observed for the total cohort. While exclusion of the race factor in the 2021 CKD-Epi equation slightly improved accuracy (p30 of 77% versus 72%), the correlation with mGFR remained poor for both equations (R2: 0.1455 and 0.1377 for the 2009 and 2021 equations, respectively). The results of this study confirmed that creatinine-eGFR values, regardless of the race factor, differ significantly from iohexol-mGFR. Our data shows that even potential kidney donors with eGFR &amp;gt;90 mL/min/1.73m2 cannot be presumed to have normal kidney function, while eGFR &amp;lt;90 mL/min/1.73m2 cannot accurately exclude donor candidates. We conclude that creatinine-eGFR cannot reliably serve as a substitute for mGFR in the context of living donor kidney function evaluation.

IMPACT OF ACUTE EXPERIMENTAL BLOOD LOSS ON DIURESIS AND FILTERING CAPACITY OF KIDNEYS AND EFFICACY OF CORRECTION WITH RINGER’S LACTATE SOLUTION IN COMBINATION WITH 2-ETHYL-6-METHYL-3-HYDROXYPYRIDINE SUCCINATE

Introduction: The kidneys remain one of target organs in acute blood loss of various genesis. Reduced perfusion leads to an increase in renal insufficiency, primarily characterized by decreased urine production and glomerular filtration rate. Timely restoration of lost blood volume deficit stands as a critical objective in addressing hypovolemic shock. Among the first-line therapeutic approaches, the administration of balanced crystalloids in a 1:1 ratio relative to the lost blood volume has demonstrated efficacy; the combined use of antioxidants is regarded as promising. This study aims to investigate the impact of acute experimental blood loss on diuresis and kidney filtration capacity, assess the effectiveness of correction with Ringer's lactate solution in combination with 2-ethyl-6-methyl-3-hydroxypyridine succinate.&#x0D; Materials and Methods: In our experiments, we induced acute blood loss equivalent to 2% of the body mass in rats and evaluated kidney function using a water stress method after 1, 3, and 7 days. We measured diuresis, creatinine levels in blood serum and urine, and glomerular filtration rate. To address the effects of blood loss, we administered Ringer's lactate solution separately and in combination with 2-ethyl-6-methyl-3-hydroxypyridine succinate.&#x0D; Results: Following the induction of acute blood loss, there was a significant reduction in diuresis and glomerular filtration rate, accompanied by an increase in creatinine levels in both blood serum and urine. These impairments worsened over the course of 1 to 7 days. Comparing the efficacy of infusion therapy with Ringer's lactate solution alone and in combination with 2-ethyl-6-methyl-3-hydroxypyridine succinate after 7 days revealed a significantly more pronounced increase in diuresis, glomerular filtration rate, and a reduction in urine creatinine levels in the combined therapy group. These findings suggest the promising potential of combined therapy in preventing renal dysfunction in the context of acute blood loss.&#x0D; Conclusions: Acute blood loss equivalent to 2% of body mass leads to disturbances in diuresis and renal filtration capacity. The administration of Ringer's lactate solution in conjunction with 2-ethyl-6-methyl-3-hydroxypyridine succinate mitigates the effects of acute blood loss and yields a more substantial improvement compared to rats treated with Ringer's lactate solution alone.

Mitochondrial DNA copy number is associated with incident chronic kidney disease and proteinuria in the AIDS linked to the intravenous experience cohort

We evaluated the prospective association of mitochondrial DNA copy number (mtDNA CN) with markers of kidney function among a cohort of persons who inject drugs (PWID). This is a Prospective cohort study nested in the AIDS linked to the intravenous experience cohort (community-based cohort of PWID in Baltimore, MD). mtDNA CN was measured at two time-points 5 years apart using a real-time polymerase chain reaction. Kidney function (estimated glomerular filtration rate [eGFR], serum creatinine, urine protein) was measured annually. We used linear mixed effects models to evaluate kidney function trajectories (N = 946) and Cox regression models to assess hazard of incident CKD (eGFR < 60 at two consecutive visits, N = 739) and proteinuria (urine protein:creatinine ratio > 200, N = 573) by level of mtDNA CN (Low [lowest quartile], vs high [other three quartiles]. Models were adjusted for demographic and behavioral characteristics, HIV and/or HCV infection, and comorbidity burden. Low mtDNA CN was independently associated with higher hazard of incident CKD (aHR: 2.33, 95% CI 1.42, 3.80) and proteinuria (aHR: 1.42, 95% CI 1.04, 1.96). Participants with low mtDNA CN had greater declines in eGFR and greater increases in serum creatinine over time. Low mtDNA CN is associated with more rapid kidney function decline and risk of incident CKD and proteinuria.

Long-term renal outcomes of patients with COVID-19: a meta-analysis of observational studies.

Kidney involvement is common in hospitalized coronavirus disease 2019 (COVID-19) patients during the acute phase, little is known about the long-term impact of COVID-19 on the kidney. This is a systematic review and meta-analysis on long-term renal outcomes among COVID-19 patients. We carried out a systematic literature search in PUBMED, EMBASE, SCOPUS, and Cochrane COVID-19 study register and performed the random-effects meta-analysis of rates. The search was last updated on November 23, 2022. The study included 12 moderate to high-quality cohort studies involving 6976 patients with COVID-19-associated acute kidney injury and 5223 COVID-19 patients without acute kidney injury. The summarized long-term renal non-recovery rate, dialysis-dependent rate, and complete recovery rate among patients with COVID-19-associated AKI was 22% (12-33%), 6% (2-12%), and 63% (44-81%) during a follow-up of 90-326.5days. Heterogeneity could be explained by differences in the prevalence of chronic kidney disease and proportion of acute kidney injury requiring renal replacement therapy using meta-regression; patients with more comorbidities or higher renal replacement therapy rate had higher non-recovery rates. The summarized long-term kidney function decrease rate among patients without acute kidney injury was 22% (3-51%) in 90-199days, with heterogeneity partially explained by severity of infection. Patients with more comorbidities tend to have a higher renal non recovery rate after COVID-19-associated acute kidney injury; for COVID-19 patients without acute kidney injury, decrease in kidney function may occur during long-term follow-up. Regular evaluation of kidney function during the post-COVID-19 follow-up among high-risk patients may be necessary.

Incidence and risk factors of drug-induced kidney injury in children: a systematic review and meta-analysis.

To comprehensively summarize the incidence and risk factors of drug-induced kidney injury (DIKI) in children. We systematically searched seven databases from inception to November 2022. Two independent reviewers selected studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted to quantify the incidence and risk factors of DIKI in children. A total of 69 studies comprising 195,894 pediatric patients were included. Overall, the incidence of DIKI in children was 18.2% (95%CI: 16.4%-20.1%). The incidence of DIKI in critically ill children (19.6%, 95%CI: 15.9%-23.3%) was higher than that in non-critically ill children (16.1%, 95%CI: 12.9%-19.4%). Moreover, the risk factors for DIKI in children were intensive care unit (ICU) admission (OR = 1.59, 95% CI: 1.42-1.78, P = 0.000), treatment days (OR = 1.04, 95% CI: 1.03-1.05, P = 0.000), surgical intervention (OR = 1.43, 95% CI: 1.00-2.02, P = 0.048), infection (OR = 2.30, 95% CI: 1.44-3.66, P = 0.000), patent ductus arteriosus (OR = 4.78, 95% CI: 1.82-12.57, P = 0.002), chronic kidney disease (OR = 2.78, 95% CI: 1.92-4.02, P = 0.000), combination with antibacterial agents (OR = 1.98, 95% CI: 1.54-2.55, P = 0.000), diuretics (OR = 1.97, 95% CI: 1.51-2.56, P = 0.000), combination with antiviral agents (OR = 1.50, 95% CI: 1.11-2.04, P = 0.008), combination with non-steroidal anti-inflammatory drugs (OR = 1.79, 95% CI: 1.40-2.28, P = 0.000), and combination with immunosuppressive agents (OR = 2.84, 95% CI: 1.47-5.47, P = 0.002). The incidence of DIKI in children is high, especially in critically ill children. Identifying high-risk groups and determining safer treatments is critical to reducing the incidence of DIKI in children. In clinical practice, clinicians should adjust medication regimens for high-risk pediatric groups, such as ICU admission, some underlying diseases, combination with nephrotoxic drugs, etc., and regularly evaluate kidney function throughout treatment.

Evaluating kidney function and the associated risk factors among patients with type 2 diabetes mellitus: a cross-sectional study at a tertiary hospital in Jordan

BackgroundThe diabetes prevalence is escalating in Jordan; as a consequence, the risk of developing diabetic kidney diseases is also increasing.ObjectiveThis study evaluated the effect of risk factors and comorbidities on...