Chronic Kidney Disease Factors Research Articles

Global burden and influencing factors of chronic kidney disease due to type 2 diabetes in adults aged 20–59 years, 1990–2019

Population structure and lifestyles may have contributed to the epidemiological status of Chronic Kidney Disease due to Type 2 Diabetes (CKD-T2D). This study is a secondary data analysis. Using data from the Global Burden of Disease Study, we describe the changes in CKD-T2D burden and its influencing factors in the population aged 20–59 years from 1990 to 2019. Globally, the incidence, death, and Disability Adjusted Life Years (DALYs) rate of CKD-T2D showed an upward trend and increased with age, and the burden in males was higher than that in females. Population growth and aging were important driving factors for the increase of CKD-T2D DALY burden, while high systolic blood pressure and high body-mass index were the primary attributable risk factors. High body-mass index exhibited higher contributions to high Socioeconomic Development Index (SDI) countries, whereas low SDI countries were more impacted by high systolic blood pressure. The population attributable fraction of CKD-T2D DALY caused by high body-mass index was positively correlated with SDI, while high temperature and lead exposure were negatively correlated. Therefore, strengthening disease screening for people aged 20–59 years and formulating early intervention measures based on the level of socioeconomic development may effectively alleviate the burden of CKD-T2D.

Diuretic Potential of Fenchyl Acetate with Its Mechanism of Action: Toxicity Study.

Hypertension has become a global threat and is one of the greatest risk factors for chronic kidney disease. Fenchyl acetate is a monoterpene that has been assessed for its various pharmacological activities in the past, but no study has evaluated its diuretic potential and the mechanism involved in the diuretic activity after prolonged administration in rats. Therefore, this study aimed to measure the safety and diuretic profile of fenchyl acetate in rats. For evaluating the acute toxicity, a single dose of 2000 mg/kg was administered as per the OECD guideline no. 425, and the rats were observed for 14 days. After 14 days, blood samples were assessed for biochemical, hematological, and oxidative stress parameters. For the acute diuretic study, fenchyl acetate was given in doses of 100, 200, and 400 mg/kg, and urine samples after 8 h were assessed for sodium, potassium, creatinine, uric acid excretion, and urinary output. A single dose of fenchyl acetate (F.A) was selected for prolonged diuretic activity, and furosemide was taken as the standard drug in a repeated dose administration for 7 days. Rats' urine was assessed for pH, sodium, potassium, creatinine, and uric acid excretion along with urinary volume excretion. Furthermore, blood was withdrawn by cardiac puncture, and selected organs like the heart, liver, kidney, and spleen were analyzed for oxidative stress biomarkers. Using pharmacological antagonists or inhibitors, the involvement of L-NAME, acetylcholine, or prostaglandin in F.A.-induced diuresis was determined. Mitochondrial respiratory chain enzyme complexes were also assessed in the kidney homogenates. The acute toxicity results showed F.A to be safe as its LD50 was greater than 2000 mg/kg and there were no signs of mortality or toxicity. The acute diuretic study showed that F.A resulted in a significant and dose-dependent increase in sodium, potassium, creatinine, and uric acid excretion along with urinary output, and these results were comparable to the standard drug furosemide. Prolonged administration with F.A (400 mg/kg) resulted in a comparable excretion of sodium, potassium, creatinine, uric acid, and urine output with furosemide (15 mg/kg). The oxidative stress parameters revealed that F.A (400 mg/kg) resulted in reducing the formation of free radicals. The results from the mechanism-based studies showed the involvement of NO in inducing diuresis. Furthermore, F.A (400 mg/kg) significantly increased the mitochondrial complexes I, II, III, IV, I + III, and II + III in the kidney homogenates, thus restoring the mitochondrial enzymes and improving the renal function. The current study suggests that F.A is safe with a significant diuretic potential with the involvement of NO in its mechanism of action.

Profile of miRNAs expression on serum of hypertensive patients with chronic kidney disease

Abstract Background/Introduction Arterial hypertension is a major risk factor for chronic kidney disease (CKD). MicroRNAs (miRNAs) are a group of small non-coding RNA molecules that pair with messenger RNA sequences of target genes, causing transcriptional repression for protein synthesis. Several studies suggest that the aberrant expression of miRNAs may be involved in the development of cardiovascular diseases, however little is known about the role of miRNA expression in the development of CKD in hypertensive patients. Purpose The present study evaluated the differential expression of miRNAs in the serum of hypertensive patients comparing individuals with CKD with those without CKD. Methods We evaluated the clinical and laboratory characteristics of 42 hypertensive patients followed at a tertiary university hospital and determined the serum expression of 754 miRNAs using an Array system. Patients were divided into two groups based on estimated glomerular filtration rate (eGFR): group 1 (normal eGFR [≥60 mL/min/m2]) and group 2 (altered eGFR [<60 mL/min/m2]). Differences in miRNAs expression between individuals with and without CKD were assessed by Student's t test and adjusted logistic regression analysis. P value<0.05 was considered statistically significant. Results There were 33 patients in group 1and 9 patients in group 2. The groups had statistically similar prevalence of women and mean values of age and body mass index (BMI) (age=57±10 years, 66% women, BMI=27.1±4.1 kg/m2 in group 1; age=58±8 years, 42% Women, BMI=30.1±4.6 kg/m2). Among the studied miRNAs, 9 showed differential expression (Figure 1), 8 of which were upregulated (miR-125a, miR-215, miR-146b, miR-127, miR-339-5p, miR-18a, miR-30b and miR-199a) and one was downregulated (miR-451) in hypertensive patients with low eGFR when compared to hypertensive patients with normal eGFR. Logistic regression analysis adjusted for systolic blood pressure, diabetes mellitus and antihypertensive medications use showed that miR-125a, miR-146b and miR-451 remained differently expressed between the studied groups. Conclusions Our analysis showed that CKD is accompanied by distinct expression of circulating miRNAs in individuals with hypertension, especially miR-125a, miR-146b and miR-451, suggesting that these miRNAs might play a role in CKD and could be potential biomarkers of development of this disease in hypertensive patients.Figure 1

Promoting kidney health in people with type 2 diabetes: part 2.

The incidence of chronic kidney disease is increasing internationally with many risk factors for chronic kidney disease also being risk factors for type 2 diabetes. Nurses should use primary, secondary and tertiary prevention to minimise the incidence of chronic kidney disease when caring for individuals with type 2 diabetes. This article is the second in a two-part series on the interrelationship between these long-term conditions. Part 1 addressed the significance of using primary prevention to promote kidney health in adults living with type 2 diabetes; part 2 will discuss the use of secondary and tertiary prevention relevant to these long-term conditions.

Obstructive sleep apnea risk factor for chronic kidney disease: A systematic review and meta-analysis

<b>Introduction: </b>Obstructive sleep apnea (OSA) is related to chronic kidney disease (CKD), but its association is not fully understood.<br /> <b>Objective</b>: To realize a systematic review with meta-analysis to determine the association between OSA and CKD.<br /> <b>Methods:</b> Systematic review with meta-analysis of observational studies. The search was carried out in Embase, PubMed/Medline, Scopus, and Web of Science. The data were calculated by the hazard ratio (HR). The heterogeneity was identified by I squared.<br /> <b>Results:</b> Five studies were included (n=6,710). The meta-analysis found an association between OSA and CKD (HR=2.00; confidence interval 95%=1.68-2.38).<br /> <b>Conclusions:</b> We found an association between OSA and CKD.

Community Knowledge and Self-Awareness on Risk Factors for Chronic Kidney Disease (CKD) in Bali, Indonesia

Introduction: In Indonesia, CKD is among the top 10 most prevalent diseases, with the prevalence increasing sharply from 2013 to 2018. Therefore, prevention should focus on reducing risk factors for people who have not yet suffered from CKD. Based on the above, researchers are interested in examining the relationship between knowledge and community self-awareness of CKD risk factors in Bali.
 Methods: This study used descriptive analysis with a cross-sectional approach. The population in the study was all Balinese people, with a sample size of 209 respondents who met the inclusion criteria. The research was conducted by means of an online survey consisting of demographic data, Self-Awareness Questionnaire and CKD Knowledge Questionnaire through Google Forms. The collected data were analyzed with univariate and bivariate analyses.
 Results: Most of the respondents were from adolescence to early adulthood (17–35 years old)—as many as 78.2%, dominated by women (64.8%). Judging from the level of knowledge, more than half of the respondents fell into the sufficient category, namely 67%. While the level of community self-awareness tends to be high, with a result of 45%, Thus, there was a significant relationship between knowledge and self-awareness of the Balinese community towards CKD risk factors (p<0.01).
 Conclusion: Balinese people have a good level of knowledge and awareness of CKD risk factors. However, preventive measures are still needed to prevent an increase in these cases. It is hoped that health services would continue to provide information.

Study to Assess the Prevalence of Risk Factor of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Client at Karambakkam

Aim: The present study aims to assess the prevalence of risk factor of chronic kidney disease among diabetes mellitus and hypertensive client at karambakkam. Methods and Materials: A Non-experimental descriptive research design was used for the present study. A total 200 samples were collected using purposive sampling technique. The demographic of diabetes mellitus and level of knowledge of risk factor of chronic kidney diseases was assessed using structured questioner and, followed by that data was gathered and analyzed. Results: The results the study revealed that there is a significant association with the level of knowledge on risk factor of chronic kidney diseases among diabetes mellitus and hypertensive client at p<0.001. Conclusion: Thus, the present study concluded that majority of the clients with diabetes mellitus and hypertension had inadequate knowledge and it is recommended that they should be educated on the risk factors of CKD.

Deletion of NuRD component Mta2 in nephron progenitor cells causes developmentally programmed FSGS.

Low nephron endowment at birth is a risk factor for chronic kidney disease. The prevalence of this condition is increasing due to higher survival rates of preterm infants and children with multi- organ birth defect syndromes that affect the kidney and urinary tract. We created a mouse model of congenital low nephron number due to deletion of Mta2 in nephron progenitor cells. Mta2 is a core component of the Nucleosome Remodeling and Deacetylase (NuRD) chromatin remodeling complex. These mice developed albuminuria at 4 weeks of age followed by focal segmental glomerulosclerosis (FSGS) at 8 weeks, with progressive kidney injury and fibrosis. Our studies reveal that altered mitochondrial metabolism in the post-natal period leads to accumulation of neutral lipids in glomeruli at 4 weeks of age followed by reduced mitochondrial oxygen consumption. We found that NuRD cooperated with Zbtb7a/7b to regulate a large number of metabolic genes required for fatty acid oxidation and oxidative phosphorylation. Analysis of human kidney tissue also supported a role for reduced mitochondrial lipid metabolism and ZBTB7A/7B in FSGS and CKD. We propose that an inability to meet the physiological and metabolic demands of post-natal somatic growth of the kidney promotes the transition to CKD in the setting of glomerular hypertrophy due to low nephron endowment.

Smokeless tobacco consumption and its association with risk factors of chronic kidney disease in rural and peri-urban Bangladesh.

Compared to smoking, which has major consequences in chronic kidney disease (CKD) initiation and progression, smokeless tobacco (SLT) consumption is considered to have fewer health consequences. We investigated the prevalence of SLT consumption and its association with risk factors of CKD in a rural and peri-urban Bangladeshi population. Using random sampling we recruited 872 adults in 2020, from the Mirzapur Demographic Surveillance System of Bangladesh, who had resided in the area for at least five years. Interviews using a semi-structured questionnaire, physical examination and anthropometric measurements were done, followed by blood and urine testing. The blood and urine tests were repeated in selected participants after three months as per the CKD Epidemiology Collaboration equation. The prevalence of SLT consumption was 29%. Being aged ≥46 years (OR=7.10; 95% CI: 4.79-10.94), female (OR=1.64; 95% CI: 1.21-2.22), housewife (OR=1.82; 95% CI: 1.35-2.45), farmer (OR=1.71; 95% CI: 1.06-2.76), widow (OR=3.40; 95% CI: 2.24-5.17), and having no formal schooling (OR=4.91; 95% CI: 3.59-6.72), family income of <$100/month (OR=1.66; 95% CI: 1.13-2.43), sleeping duration <7 hours per day (OR=2.33; 95% CI: 1.70-3.19), were associated with a significantly higher odds of SLT consumption. However, being aged 31-45 years (OR=0.25; 95% CI: 0.16-0.38) had significantly lower odds of being an SLT consumer. Among the diseases investigated, undernutrition (OR=1.63; 95% CI: 1.15-2.33), hypertension (OR=1.52; 95% CI: 1.13-2.05), anemia (OR=1.94; 95% CI: 1.39-2.71) and CKD (OR=1.62; 95% CI: 1.15-2.27) were significantly associated with SLT consumption. In the multivariable analysis, being aged 31-45 years (AOR=3.06; 95% CI: 1.91-4.90), ≥46 years (AOR=15.69; 95% CI: 4.64-53.09) and having no formal schooling (AOR=2.47; 95% CI: 1.72-3.55) were found to have a significant association with being an SLT consumer. SLT consumption is associated with most of the established risk factors of CKD within the studied population.

Prevalence and associated risk factors for chronic kidney disease in the elderly physically disabled population in Shanghai, China: a cross-sectional study

BackgroundThe global prevalence of chronic kidney disease (CKD) in the general population is relatively clear. Our previous study showed that elderly individuals who are physically disabled are more likely to experience kidney function impairment, and the main purpose of this study was to determine the prevalence and risk factors associated with CKD in elderly patients with physical disabilities.MethodsA total of 2679 elderly individuals with physical disabilities from the 2018 Shanghai Disability Health Survey were screened to calculate the prevalence of CKD. Multiple logistic regression was performed to identify the factors associated with CKD. Detailed subgroup analyses of disability level were also conducted.ResultsWe confirmed CKD in 287 of 2679 (10.7%) participants. Female sex, age, history of hypertension, red blood cell count, albumin, urea, and uric acid (UA) were independently correlated with CKD. Age and UA abnormalities were common risk factors for different levels of disabilities.ConclusionThe prevalence of CKD is higher in the mild level of older physically handicapped individuals. Age and the level of UA should also be considered in this population. The preventive strategies for patients with two levels of elderly disability should have different focuses.

Obesity as a risk factor for chronic kidney disease: a contemporary view on the problem. Review

The review article is devoted to an actual clinical problem of participation of obesity in development and progression of chronic kidney disease (CKD). Some pathogenic links due to which a negative renal effect of obesity is mediated including in particular, dyslipidemia (DLP), endothelial dysfunction (ED) of renal vessels, activation of renin‑angiotensin‑aldosterone system (RAAS), arterial hypertension (AH), a production of adipose tissue mediators with renal injuring properties such as leptin, tumor necrosis factor‑α, interleukines 1,6,8 are discussed. The data about the main factors of progression of renal damage associated with obesity included insulin resistance (IR), hyperinsulinemia, DLP, systemic and renal hemodynamic disorders caused by activation of RAAS (AH, intraglomerular hypertension) are given. The role of metabolic syndrome and its components in pathogenesis of CKD as well as a role of diabetes mellitus (DM) frequently combined with obesity in development of diabetic kidney disease (diabetic nephropathy) is generalized. Among adipokines a special attention in the present review is paid for pathogenic role of leptin and adiponektin in obesity with its conditions promoted renal damage. The participation of resistance to leptin in the pathogenesis of CKD through such links as IR, ED, oxidative stress and inflammation is discussed. The role of ED and glomerular hyperfiltration in pathogenesis of microalbuminuria is elucidated. The significance of injury of kidney tubular cell structures so called podocytes in pathogenesis of CKD in obesity is uncovered. The clinical significance of early revealing of renal pathology as well as body weight, glycemia level, arterial blood pressure control and following of healthy mode of life in reduction of risk development of CKD associated with obesity, DM and other metabolic disorders is generalized. It’s emphasized that evaluation of lipid and carbohydrate exchange parameters, serum leptin level, IR indices is considered to be perspective for diagnostics of renal damage in obesity.

Adherence to healthy lifestyle was associated with an attenuation of the risk of chronic kidney disease from metabolic dysfunction–associated fatty liver disease: Results from two prospective cohorts

AimsNon-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD) are important risk factors of chronic kidney disease (CKD). Whether adherence to a healthy lifestyle can modify these effects remain unknown. This study aimed to evaluate the modification effects of healthy lifestyle on the associations among NAFLD, MAFLD, and the risk of CKD, with taking into the effect of genetic risk. MethodsThe Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH), the UK Biobank Study (UKB). The outcome was incident CKD. The exposures including NAFLD, MAFLD, healthy lifestyle, and a genetic risk score (GRS) for CKD. ResultsAfter 1,135,334 person–year follow-up, we documented 2975 incident CKD cases in the two cohorts. MAFLD and NAFLD were associated with a higher risk of CKD, particularly in patients with MAFLD. In the TCLSIH and UKB, the hazard ratios (95% confidence intervals) of incident CKD for MAFLD were 1.47 (1.30, 1.66) and 1.73 (1.57, 1.91), respectively. Adherence to a healthier lifestyle decreased the risk of CKD from MAFLD with significant interaction effects (TCLSIH: Pinteraction = 0.02; UKB: Pinteraction = 0.04). Participants with a lower CKD–GRS experienced a higher risk of CKD from MAFLD, but achieved two healthy lifestyles can significantly decreased the risk of CKD in patients with MAFLD. ConclusionsMAFLD and NAFLD are associated with a higher CKD risk, particularly MAFLD. Adherence to a healthier lifestyle was associated with a lower risk of CKD from MAFLD. These results highlight the important role of following a healthy lifestyle to prevent CKD.

Risk factors for chronic kidney disease among adults in a tertiary hospital community in north-central, Nigeria.

Background: The prevalence of chronic kidney disease (CKD) is on the increase globally with an attendant heavy disease burden and high morbidity and mortality from end-stage renal disease (ESRD). Data on the prevalence of risk factors for chronic kidney disease from sub-Saharan Africa are scanty, more so in the northern part of Nigeria. There are several risk factors for CKD which include, obesity, hypertension, diabetes mellitus and some nephrotoxic agents. Preventive strategy through early detection and treatment has been advocated for CKD especially in our own setting where majority of patients present late and cannot afford the cost of renal replacement therapy which again is not readily available.&#x0D; Method: This study was conducted among the staff of Bingham University Teaching Hospital (BHUTH), Jos, as part of a screening exercise during the World Kidney Day (WKD) program of 2021, to determine the prevalence of modifiable risk factors for CKD. Adult subjects of 18 years and above, who consented to the study were mobilized after a sensitization talk. The parameters assessed were demographics, body mass index, blood pressures, proteinuria, fasting plasma glucose and plasma creatinine. Glomerular filtration rate (GFR) was estimated using CKD-EPI Creatinine Equation 2021. Data were analyzed using SPSS version 25. The level of statistical significance was set at a p-value of &lt; 0.05.&#x0D; Results: 150 adult volunteers participated in the study. The mean age of the participants was 43.3±11.32 years (18-71 years), with 61.3% being females and 38.7% were males. The frequency of the risk factors of CKD observed were obesity in 45 (30.0%) of the participants and diabetes mellitus found in 44 (29.3%) of the participants, Proteinuria and glycosuria were found in 49 (32.7%) and 9 (6.0%) of the participants respectively while a whopping 37 (24.7%) of the participants had haematuria. The number of participants found with estimated glomerular filtration rate (eGFR) of &lt;60ml/min/1.73m2 were 55 (36.7%). There was an independent association between older age (p = 0.010), being widowed/divorced (p = 0.041), and having diabetes (p = 0.006) with an eGFR &lt;60ml/min/1.73m2.&#x0D; Conclusion The prevalence of CKD risk factors in this study population was high. Therefore, there is the need for adequate and continuous sensitization and routine screening in our various clinics for early detection and early management by lifestyle and risk factor modification to halt or reduce the growing burden of CKD with its attendant morbidity and mortality in Nigeria.

Association between a high triglyceride–glucose index and chronic kidney disease in adult patients with latent autoimmune diabetes

BackgroundInsulin resistance (IR) is one of the risk factors for chronic kidney disease (CKD) and diabetes. The triglyceride–glucose (TyG) index is considered a reliable alternative marker of IR. We investigated the correlation between the TyG index and the severity of CKD in patients with latent autoimmune diabetes in adults (LADA).MethodsThis cross-sectional study included 288 patients with LADA in the department of endocrinology at our hospital between January 2018 and January 2022. The TyG index was calculated as Ln [TG (mg/dl) × fasting blood glucose (FBG) (mg/dl) / 2]. All individuals were divided into either a LADA + CKD group or a LADA + non-CKD group according to the presence or absence of CKD. A correlation analysis, logistic regression analysis and receiver operating characteristics curve analysis were performed.ResultsA total of 130 (45.1%) participants were identified as having CKD. Compared with the non-CKD group, the CKD group had a longer disease duration and a higher proportion of smokers; patients were more likely to have hypertension and higher serum creatinine, triglyceride, cholesterol, low-density lipoprotein cholesterol, FBG, uric acid estimated glomerular filtration rates (eGFR) and TyG levels as well as lower high-density lipoprotein cholesterol levels (all P < 0.05). The positive relationship between the TyG index and the urinary albumin/creatinine ratio was significant (r = 0.249, P = 0.010). There was also a significant correlation between the TyG index and the eGFR (r = − 0.211, P = 0.034) after adjusting for confounding factors. The area-under-the-curve value of the TyG index was 0.708 (95% confidence interval: 0.61–0.81, P < 0.001).ConclusionsThe TyG index is significantly associated with the severity of CKD in patients with LADA. This conclusion supports the clinical application of the TyG index for the assessment of kidney disease in patients with LADA.

Acceptability, Adherence, Safety and Experiences of Low Energy Diets in People With Obesity and Chronic Kidney Disease: A Mixed Methods Study

Obesity is a modifiable risk factor for chronic kidney disease (CKD) progression. Low energy diets (LEDs) have not been adequately studied in people with CKD. This study aimed to explore acceptability, adherence, safety, and experiences of two LED prescriptions in adults living with obesity and CKD. In a mixed-methods study, obese adults with CKD were prescribed two LEDs (∼800 to 1000kcal/day each), in a randomised order for 2weeks each. One diet consisted of four meal replacement products daily (Optifast®, Nestlé Health Science) and the other two pre-prepared frozen meals (Lite n' Easy®, Mitchell's Quality Foods). Participants received weekly dietitian support, completed daily adherence checklists (converted to % of provided meals/replacements consumed) and participated in post-intervention semi-structured interviews to capture their experience. Nine participants were included (mean age 46.5±14.3years, estimated glomerular filtration rate 64±26mL/min/1.73m2, 4/9 male). Mean self-reported adherence was 88±11% and mean 4-week weight change was -7.3±5.6kg. Two participants withdrew at week two. Most frequently reported side effects were hunger and headaches. Adverse events of interest included one episode each of hyperkalaemia and hypoglycaemia. No serious adverse events occurred. Four overarching themes of patient experiences were identified: strategies used to adapt, disruption to the norm, individual preferences, and influences on acceptability. LEDs were found to be acceptable and safe with high self-reported adherence rates. Future LED trials should include specialist diabetes management, close monitoring for hyperkalaemia and adequate support to assist with managing side effects and dietary and social adjustments.

A Comparative Analysis of Supervised Classification Algorithms and Missing Data Handling for Enhancing Chronic Kidney Disease Prediction

Chronic kidney disease (CKD), which is becoming a more significant public health concern, is characterized by a gradual but concerning increase in morbidity and death, particularly in its early, asymptomatic stages. Risk factors for chronic kidney disease (CKD), including genetic predisposition, obesity, diabetes, and hypertension, affect the illness's prevalence. When there are no outward signs of an illness, it is challenging to diagnose and treat it in its early stages. To tackle this pressing issue, our research does a comprehensive investigation through a comparative comparison of supervised classification techniques. In particular, we examine the prediction performance of CKD using the Random Forest, Decision Tree, and Support Vector Machine (SVM) techniques. We also look into a number of approaches to handling missing data. Our research presents a thorough evaluation of these algorithms' performance under different data cleaning methods, pointing out both their benefits and drawbacks. Ultimately, our research aims to clarify the early detection and treatment of chronic kidney disease (CKD) and pave the way for larger-scale public health initiatives to tackle this quickly escalating health emergency.

Single-cell transcriptomic analysis reveals transcript enrichment in oxidative phosphorylation, fluid sheer stress, and inflammatory pathways in obesity-related glomerulopathy

Obesity-related glomerulopathy (ORG) is an independent risk factor for chronic kidney disease and even progression to end-stage renal disease. Efforts have been undertaken to elucidate the mechanisms underlying the development of ORG and substantial advances have been made in the treatment of ORG, but relatively little is known about cell-specific changes in gene expression. To define the transcriptomic landscape at single-cell resolution, we analyzed kidney samples from four patients with ORG and three obese control subjects without kidney disease using single-cell RNA sequencing. We report for the first time that immune cells, including T cells and B cells, are decreased in ORG patients. Further analysis indicated that SPP1 was significantly up-regulated in T cells and B cells. This gene is related to inflammation and cell proliferation. Analysis of differential gene expression in glomerular cells (endothelial cells, mesangial cells, and podocytes) showed that these cell types were mainly enriched in genes related to oxidative phosphorylation, cell adhesion, thermogenesis, and inflammatory pathways (PI3K-Akt signaling, MAPK signaling). Furthermore, we found that the podocytes of ORG patients were enriched in genes related to the fluid shear stress pathway. Moreover, an evaluation of cell-cell communications revealed that there were interactions between glomerular parietal epithelial cells and other cells in ORG patients, with major interactions between parietal epithelial cells and podocytes. Altogether, our identification of molecular events, cell types, and differentially expressed genes may facilitate the development of new preventive or therapeutic approaches for ORG.

The Triglyceride-Glucose Index is Independently Associated with Chronic Kidney Disease in the Geriatric Population, Regardless of Obesity and Sex.

Insulin resistance (IR) negatively affects several risk factors of chronic kidney disease (CKD). This cross-sectional study investigated whether the triglyceride-glucose (TyG) index, which reflects IR, was independently associated with CKD in a geriatric population, regardless of obesity and sex. The analysis included 7,326 individuals (2,864 males and 4,462 females) aged ≥60 years. Non-obesity or obesity was evaluated using a body mass index cutoff of 25 kg/m2. The TyG index was calculated as ln [triglyceride concentration (mg/dL)×fasting plasma glucose concentration (mg/dL)]/2. All participants were categorized into three groups according to TyG tertiles. Moderate-to-severe CKD (MSCKD) was defined as an estimated glomerular filtration rate (eGFR) of <45.0 mL/min/1.73 m2. In males and females with or without obesity, a trend test showed a decreasing tendency in the eGFR from the lowest to highest TyG tertiles. Males without obesity and females with obesity in the middle and highest tertiles of the TyG index were 2.342 and 2.393, and were 2.313 and 3.516 times more likely to have MSCKD, respectively. Those with or without obesity in the highest tertile of the TyG index were 1.736 and 2.374 times more likely to have MSCKD, respectively. Geriatric populations with an increased TyG index have a high risk of MSCKD regardless of obesity and sex. Our findings suggest that increased IR is associated with CKD in the geriatric population independent of obesity and sex.

The Impact of Sedentary Behavior on Renal Function Decline in 132,123 Middle Aged and Older Adults: A Nationwide Cohort Study.

BACKGROUND Prior studies suggest that sedentary behavior is a well-known risk factor for cardiometabolic diseases. However, the longitudinal association between overall siting time and kidney function decline is not known. MATERIAL AND METHODS We performed a nationwide prospective cohort study in individuals aged more than 40 years enrolled in the China Cardiometabolic Disease and Cancer Cohort (4C) study. A total of 132 123 individuals were included in this study. Sitting time was measured with the short version of the International Physical Activity Questionnaire (IPAQ). Kidney function decline was defined as an eGFR <60 mL/min/1.73 m² or more than a 30% decrease in eGFR from baseline. Multivariate Cox proportional hazards regression analyses were conducted to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of the relation between kidney function decline and sitting time. RESULTS During a mean follow-up of 3.8 years, 3890 (2.9%) participants experienced kidney function decline. Longer sitting time was significantly associated with the risk of kidney function decline (aHR, 1.136; 95% CI, 1.036-1.247, P=0.007, comparing participants with baseline sitting time in the lowest quartile with those in the highest quartile) after adjustment for potential confounders. CONCLUSIONS Longer sitting time was independently and prospectively associated with a higher risk of kidney function decline. Sedentary behavior might represent a modifiable risk factor for chronic kidney disease (CKD) prevention.

Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio and Cardiorenal Syndrome Type 2 in the Systemic Sclerosis EUSTAR Cohort.

The aim of the study was to evaluate the association between the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio and estimated glomerular filtration rate (eGFR) and their association with mortality in the European Scleroderma Trials and Research (EUSTAR) cohort. Patients with systemic sclerosis (SSc) from the EUSTAR database with TAPSE, sPAP, and parameters required to calculate eGFR were included. Logistic regression and Cox regression analysis were performed to evaluate TAPSE/sPAP as a risk factor for chronic kidney disease (CKD) and overall survival. A total of 2,370 patients with SSc were included; 284 (12%) patients had CKD stage 3a-5. TAPSE/sPAP (odds ratio [OR] 0.479; 95% CI 0.310-0.743; P < 0.001), arterial hypertension (OR 3.118; 95% CI 2.173-4.475; P < 0.001), diastolic dysfunction (OR 1.670; 95% CI 1.148-2.428; P < 0.01), and N-terminal pro-B-type natriuretic peptide (OR 1.165; 95% CI 1.041-1.304; P < 0.01) were associated with CKD stage 3a-5. TAPSE/sPAP ≤0.32 mm/mm Hg (hazard ratio [HR] 3.589; 95% CI 2.236-5.761; P < 0.001), eGFR <60 mL/min per 1.73 m2 (HR 2.818; 95% CI 1.777-4.468; P < 0.001), and age (HR 1.782; 95% CI 1.348-2.356; P < 0.001) were the most significant predictive factors for all-cause mortality. A total of 276 patients with SSc had pulmonary hypertension (PH) confirmed by right heart catheterization, with 69 (25%) having CKD stage 3a-5. No difference was found in eGFR between patients with PH with reduced or normal cardiac index. Reduced TAPSE/sPAP ratio is independently associated with CKD. TAPSE/sPAP ratio ≤0.32 mm/mm Hg and eGFR <60 mL/min per 1.73 m2 are prognostic factors for all-cause mortality. In patients with SSc with PH, eGFR is independent by reduced cardiac output.