Kidney Disease Improving Global Outcomes Research Articles

Diagnostic Accuracy of Furosemide Stress Test and Cystatin-C for Predicting Acute Kidney Injury Progression in Children: A Prospective Cohort Study.

To evaluate the predictive ability of furosemide stress test (FST), serum and urine cystatin-C in identifying progressive acute kidney injury (AKI) and the need for kidney replacement therapy (KRT). Children aged one month to 18 y admitted in the pediatric intensive care unit (PICU) with Kidney Diseases Improving Global Outcomes (KDIGO) stage-1/2 AKI were enrolled. FST and serum and urine cystatin-C levels were performed and analyzed. The primary outcome was progression to stage-3 AKI. Secondary outcomes included comparing predictive ability of FST vs. cystatin-C for stage-3 AKI and need for KRT, adverse effects, length of hospital stay and mortality. Of the 41 children enrolled, seven (17.07%) progressed to KDIGO stage-3 AKI. Four children were furosemide non-responders at 2h and five at 6h post-FST. The sensitivity, specificity and area under the receiver operating characteristic curve (AUROC) of FST at 2h were 57.14%, 100% and 0.84 (p = 0.01), and at 6h were 71.43%, 100% and 0.87 (p < 0.001), respectively. Urine cystatin-C was positive in 20 (48.78%) children, of which seven progressed to stage-3 AKI [sensitivity- 100%, specificity- 61.76%, AUROC- 0.91 (p = 0.003)]. Five of nine children with positive serum cystatin-C progressed to stage-3 AKI [sensitivity- 71.43%, specificity- 88.24%, AUROC- 0.75 (p = 0.08)]. All FST non-responders progressed to undergo KRT showing sensitivity and specificity of 66.67% and 100% at 2h (AUROC- 0.87) and 85% and 100% at 6h (AUROC- 0.89) respectively. FST is a simple bedside tool with robust predictive value in detecting kidney impairment progression in children and can be utilized in PICU for assessing tubular dysfunction. The diagnostic accuracy of FST was comparable to that of urine and serum cystatin-C. Further studies can be done on a larger cohort for better generalizability.

Evaluating Renal Disease in Pediatric-Onset Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Disease Course, Outcomes, and Predictors of Outcome.

We aimed to study the disease course, outcomes, and predictors of outcome in pediatric-onset antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) affecting the kidneys. Patients eligible for this study had a diagnosis of granulomatosis with polyangiitis (GPA), microscopic polyangiitis, or ANCA-positive pauci-immune glomerulonephritis, were 18 years or younger at diagnosis, had renal disease defined by biopsy or dialysis dependence, and had clinical data at diagnosis and at either 12 or 24 months. Ambispective data from A Registry for Children with Vasculitis/Pediatric Vasculitis Initiative Registry was used. The primary outcome was inactive renal disease (pediatric vasculitis activity score = 0 or 1) at 12 months. Secondary outcomes included rates of improved renal function and damage within 24 months. Renal function, defined by estimated glomerular filtration rate, was categorized into Kidney Disease Improving Global Outcomes (KDIGO) stages at diagnosis and tested as a predictor of outcome using a proportional-odds logistic regression model. A total of 145 patients were included: 68% were female, and 78% had GPA. At 12 months, 83% of patients achieved inactive renal disease; however, 42% had evidence of permanent renal damage. Compared with patients with normal renal function at diagnosis, patients with moderate to severely reduced renal function, or kidney failure at diagnosis, had an odds ratio of 8.62 (P = 0.002; 95% confidence interval [CI] 2.31-32.1) and 26.3 (P < 0.001; 95% CI 6.32-109), respectively, for being in a non-normal KDIGO category at 12 months. The majority of patients with pediatric AAV achieve inactive renal disease by 12 months; however, almost half have evidence of damage. Renal function at diagnosis is a strong predictor of renal function at 12 months.

Acute kidney injury: a post-COVID-19 complication in children and adolescents.

To describe cases of acute kidney injury (AKI) in children diagnosed with COVID-19, associated risk factors, clinical aspects and outcome of cases. Retrospective study, carried out in a pediatric hospital between March 2020 and September 2021, with patients with COVID-19 who were diagnosed with AKI, studying information present in medical records such as comorbidities, age, gender and use of nephrotoxic medications. We studied 40 cases, and male individuals were significantly more affected (62.5%; p=0.025). AKI was a severe complication of COVID-19 infection, with 100% of the sample requiring admission to the Intensive Care Unit and 22.5% dying. The most prevalent comorbidities analyzed in this study were epilepsy, cerebral palsy and heart disease. Most patients were classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria as KDIGO 1 (42.5%), and required orotracheal intubation (67.5%). The frequency of use of nephrotoxic medications and need for dialysis was low, with percentages of 35 and 17.5%, respectively. Among the children who died, 70.4% had some comorbidity and 88.8% received invasive ventilation. AKI in children with COVID-19 infection is associated with severe conditions. Despite the severity, most patients were discharged alive from the hospital.

Acute kidney injury recovery status predicts mortality and cardiorenal outcomes in patients admitted with acute decompensated heart failure

BackgroundAcute kidney injury (AKI) in the context of acute decompensated heart failure (ADHF) encompasses a broad spectrum of phenotypes with associated disparate outcomes. We evaluate the impact of ‘ongoing AKI’...

Genetic Assessment of Living Kidney Transplant Donors: A Survey of Canadian Practices.

Kidney failure is a prevalent condition with tendency for familial clustering in up to 27% of the affected individuals. Living kidney donor (LKD) transplantation is the optimal treatment option; however, in Canada, more than 45% of LKDs are biologically related to their recipients which subjects recipients to worse graft survival and donors to higher future risk of kidney failure. Although not fully understood, this observation could be partially explained by genetic predisposition to kidney diseases. Genetic testing of potential LKDs may improve risk assessment and inform the safety of donation. The strategies to evaluate these donors are still evolving. In Canada, little is known about the practice of assessing for genetic conditions among LKDs. The aim was to examine the Canadian practices regarding LKDs genetic assessment. Questionnaires were sent to 23 Canadian adult transplant centers to examine their protocols for LKDs genetic assessment. The questionnaire comprised of 10 sections and 21 questions including case scenarios of different LKD encounters. Major domains of the survey addressed general demographics, information sharing practices, effect of mode of inheritance on candidacy decision, having a policy for LKD genetic evaluation, and case scenarios covering the following conditions: autosomal dominant polycystic kidney disease (ADPKD), Alport syndrome, Fabry disease, familial focal and segmental glomerulosclerosis (FSGS), atypical hemolytic uremic syndrome (aHUS), autosomal dominant tubulointerstitial kidney disease (ADTKD), sickle cell, and apolipoprotein L1 mutation (APOL1). The questionnaire was sent to the living-donor assessment committee representative (nephrologist) in adult and pediatric kidney transplant centers across Canada. In total, 16 of 23 Canadian centers responded to the survey. Of the 8 surveyed genetic conditions, ADPKD, Alport syndrome, and aHUS were the most frequently encountered. More centers have specific policies for donor evaluation for ADPKD (25%) and aHUS (21.4%) vs none to very few for other genetic conditions. The most cited guidelines are Kidney Disease Improving Global Outcomes (KDIGO), Canadian Society of Nephrology/Canadian Society of Transplantation (CSN/CST), and the Canadian Blood Services' Kidney Paired Donation Protocol. Canadian transplant centers follow a case-by-case approach rather than a standard protocol for genetic assessment of LKDs given that current guideline recommendations are based on expert opinion due to a lack of a reliable body of evidence. With the expected rise in utilization of the increasingly available genetic testing, early multidisciplinary assessment including medical geneticists has the potential to improve personalized management. Studies examining long-term donor and graft outcomes are needed to construct the basis for evidence-based recommendations and inform the safety of donations.

Non-pharmacologic nephroprotective strategies combined with nitric oxide delivery in cardiac surgical patients with chronic kidney disease

Introduction: One of the promising areas of nephroprotection in cardiac surgery is perioperative nitric oxide donation. The combined using of Goal-Directed Perfusion (GDP), Kidney Disease Improving Global Outcomes (KDIGO) and nitric oxide delivery strategies can reduce the incidence of acute kidney injury by targeting different links in the pathogenesis of kidney injury. Objective: To assess the nephroprotective properties of nitric oxide delivery in combination with KDIGO and GDP strategies during cardiac surgery with cardiopulmonary bypass in patients with chronic kidney disease.Methods: The study included 136 cardiac surgery patients with chronic kidney disease. The patients were randomized into 2 groups of 68 individuals each. The complex of non-pharmacological nephroprotection methods KDIGO and GDP was used in the control group. In the main group, perioperative delivery of nitric oxide was performed along with a set of KDIGO and GDP measures.Results: In the main group, the incidence of acute kidney injury was significantly lower compared to the control: 23.5% versus 39.7% (p = 0.043), respectively. Both groups did not differ in the concentration of renal injury biomarkers. In the control group, the concentration of exhaled nitric oxide significantly decreased 2 hours after surgery (p &lt; 0.001), while in the main group no changes were recorded (p = 0.966). Conclusion: During cardiac surgery in patients with chronic kidney disease, delivery of nitric oxide in combination with the KDIGO and GDP measures reduced the incidence of acute kidney injury compared with the isolated using of non-pharmacological nephroprotective methods via leveling the perioperative deficiency of endogenous nitric oxide but did not affect the expression of kidney injury biomarkers. ClinicalTrials.gov ID NCT05757557 Received 31 October 2024. Revised 21 November 2024. Accepted 22 November 2024. FundingThe study was performed within the framework of the state assignment (topic No. 122123000017-3). Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: M.A. Tyo, N.O. Kamenshchikov, Yu.K. Podoksenov, B.N. KozlovData collection and analysis: M.A. Tyo, I.V. Kravchenko, E.A. Churilina, Yu.S. SvirkoStatistical analysis: M.A. Tyo, I.V. KravchenkoDrafting the article: M.A. TyoCritical revision of the article: N.O. Kamenshchikov, Yu.K. Podoksenov, B.N. KozlovFinal approval of the version to be published: M.A. Tyo, Yu.K. Podoksenov, I.V. Kravchenko, E.A. Churilina, Yu.S. Svirko, B.N. Kozlov, N.O. Kamenshchikov

The course of plasma alpha-1-microglobulin and haemolysis during cardiac surgery and the relationship to acute kidney injury, a pilot study

Haemolysis occurring during cardiac surgery with cardiopulmonary bypass (CPB) is assumed to be a risk factor for postoperative acute kidney injury (AKI). Plasma alpha-1 microglobulin (A1M) may have a protective role as haem scavenger. The aim of this study was to evaluate the association between AKI and the degree of haemolysis and the course of A1M concentrations during cardiac surgery, respectively. We analysed plasma concentrations of free haemoglobin (pfHb) and A1M in 25 patients undergoing cardiac surgery: before CPB; during CPB in 15 min intervals; after CPB; and at four additional time points until 24 h after surgery. Markers of kidney function were followed until 4 days after surgery. Detection of AKI was based on the KDIGO (Kidney Disease, Improving Global Outcome) criteria. The plasma concentration of free haemoglobin during CPB was found to be significantly higher in patients with postoperative AKI at 60 min after start of CPB [mean 1379 µg/mL (95% CI: 1037–1721)]; compared to [820 µg/mL (622–1018)]; p = 0.034, in patients without AKI, and at one hour post-CPB [2600 µg/mL (969–4230)] vs [1037 µg/mL (722–1353)]; p = 0.044]. There was no significant difference found for pA1M levels between the groups with and without postoperative AKI development. Haemolysis during cardiac surgery with CPB increases the risk of postoperative AKI. Levels of pA1M did not differ for patients who developed postoperative AKI compared with those who did not. The data did not allow conclusions regarding the hypothesis that pA1M has a reno-protective effect.

The nadir platelet count in the first 48 h after ICU admission is a potential predictor of acute kidney injury in hemorrhagic shock patients

BackgroundThe relationship between the nadir platelet count within the first 48 h after intensive care unit (ICU) admission and the occurrence of acute kidney injury (AKI) in hemorrhagic shock patients remains unclear. This study investigated this association in adult patients admitted to the surgical ICU for hemorrhagic shock.MethodsWe included 124 hemorrhagic shock patients, excluding those with pre-existing AKI or chronic kidney disease (CKD), admitted to two affiliated hospitals between January 2019 and May 2022. The nadir platelet count was defined as the lowest value within the first 48 h after ICU admission. AKI was diagnosed based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. We used multivariate logistic regression to identify independent risk factors for AKI and analyzed the area under the receiver operating characteristic curve (AUC) for diagnostic accuracy.ResultsPatients with AKI (n = 72) had significantly lower nadir platelet counts compared to those without AKI. The nadir platelet count was identified as an independent risk factor for AKI (OR = 0.988, 95% CI: 0.978–0.999, P = 0.035). The AUC for predicting AKI was 0.862 (95% CI: 0.795–0.929). Combining the nadir platelet count with serum cystatin C levels enhanced the predictive accuracy (AUC = 0.922, 95% CI: 0.870–0.973, P < 0.001).ConclusionsThe nadir platelet count in the first 48 h after ICU admission is independently associated with the risk of AKI in hemorrhagic shock patients and could serve as a potential predictor when combined with serum cystatin C levels.

The Incidence, Risk Factors, and Outcomes of Acute Kidney Injury in Pediatric Hematopoietic Stem Cell Transplant Recipients.

Acute kidney injury (AKI) is a frequent complication after hematopoietic stem cell transplantation (HSCT), with reported incidences ranging from 20-70% within the first 100 days post-transplant. AKI can adversely impact outcomes and survival in this patient population. This retrospective study evaluated 110 pediatric patients who underwent HSCT at Mofid Children's Hospital, affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran, between 2016-2021. AKI was defined and staged according to the criteria for Kidney Disease Improving Global Outcomes (KDIGO). The cohort comprised 68 (61.8%) males and 42 (38.2%) females, with a mean age of 6.4 ± 4.1 years. Underlying disorders were malignant in 64 (58.1%) and non-malignant in 46 (41.9%) patients. Among the cohort, 84 (76.3%) patients underwent allogeneic HSCT, while 26 (23.7%) received autologous HSCT. Myeloablative and reduced-intensity conditioning regimens were used in 77 (70%) and 33 (30%) patients, respectively. AKI developed in 53 (48%) patients within 100 days post-transplant, with incidences of 38%, 40%, and 22% for stages 1, 2, and 3 AKI, respectively. AKI incidence was higher in allogeneic HSCT (52%) compared to autologous HSCT (17%; P = 0.023). Younger age (P = 0.033) and non-malignant disorders (P = 0.033) were associated with increased AKI risk. At the end of the study, 77 (70%) patients were alive, and 33 (30%) had deceased, with a significant positive correlation between AKI stage and mortality (P = 0.004). This study highlights the high prevalence of AKI among pediatric HSCT recipients, particularly those undergoing allogeneic HSCT, at a younger age, and with non-malignant disorders. Regular post-transplant renal monitoring may improve survival in this population.

NephroCheck as a Predictor of Acute Kidney Injury Following Coronary Artery Bypass Graft Surgery.

Background Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a significant complication following coronary artery bypass grafting (CABG), affecting 22%-30% of patients. This study evaluates the efficacy of NephroCheck, a biomarker-based test measuring insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP2), in predicting postoperative AKI. Methods In this retrospective observational cohort study, 21 patients undergoing isolated CABG were analyzed. NephroCheck values were measured preoperatively, upon ICU admission, and at 24 hours post-admission. Patients with chronic kidney disease (CKD), heart failure, or preoperative serum creatinine of ≥2 mg/dL were excluded. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria through postoperative day 7. Results Seven patients developed postoperative AKI. Preoperative NephroCheck values were significantly elevated in the AKI group compared to controls (1.34 (ng/ml)2/1000 ± 1.33 vs 0.54 (ng/ml)2/1000 ± 0.43, p = 0.009), while traditional renal function parameters showed no significant differences. Regression analysis identified preoperative NephroCheck as the only significant predictor of postoperative AKI (OR: 17.85, p = 0.047). Traditional risk factors, including preoperative renal function, Society of Thoracic Surgeons (STS) score, and operative times, showed no significant predictive value. Conclusions Preoperative NephroCheck testing demonstrates significant utility in predicting CSA-AKI following CABG, outperforming traditional risk assessment methods. These findings suggest that incorporating NephroCheck into routine preoperative assessments could enable more targeted preventive interventions, potentially reducing CSA-AKI incidence and its associated complications.

Can Broadening the Kidney Biopsy Criteria Reduce Misleading Diagnoses in Young Patients with End-Stage Renal Diseases? A Survey on the Sicilian Registry of Nephrology, Dialysis, and Transplantation.

Audits allow analysis of the delivery of care and the prevalence of diseases. This study investigated kidney diseases' impact on end-stage renal disease (ERSD) in patients younger than 30 years. Methods: This analysis is retrospectively conducted on young dialysis-dependent patients included in the Sicilian Registry of Nephrology, Dialysis and Transplantation Participants. It evaluated patients who started dialysis before the age of 30 retrieved in the mentioned registry. The sample was divided into two groups, according to the presence or absence of a specific diagnosis. Baseline features were reported as mean ± sd, median [IQR] and n (%). A Student T-test, Mann-Whitney test or Pearson Chi-Square test was performed. Logistic regression analysis detected the association between the variables and the unknown diagnosis, and variables with a p-value < 0.2 were added to the multivariate model. ROC curves were drawn including this multivariate prediction. Results: In total, 145 patients started dialysis before the age of 30 years. Between patients with and without a diagnosis, the intake of renin-angiotensin-aldosteron system inhibitors (RAASIs) and blood pressure differed enough to be considered as possibly confounding. Logistic regression showed that blood pressure and RAASIs seemed to be related to the unknown diagnosis. ROC curves adjusted for RAASIs and blood pressure provided an AUC = 0.689. Conclusions: Although Kidney Disease Improving Global Outcomes (KDIGO) did not include hypertension among biopsy indications, our data suggest that performing renal biopsy in young patients with hypertension and worsening renal function could improve kidney diagnosis management.

Clinical Features and Outcomes of Patients With COVID-19 Infection and Acute Kidney Injury Requiring Hemodialysis in an Intensive Care Unit: A Retrospective Study From a Tertiary Care Center in Eastern India.

During the COVID-19 pandemic, it has been observed that acute kidney injury (AKI) especially requiring intervention support of hemodialysis has notably increased mortality rates among COVID-19-positive critically ill patients;however, comprehensive data regarding this from India, especially the eastern territory, remains sparse. This study aims to outline the demographic, clinical, and biochemical characteristics, along with the outcomes, of these patients. A retrospective study was performed at the All India Institute of Medical Sciences (AIIMS), Patna, from March 1, 2020, to March 31, 2021. Included were patients diagnosed with COVID-19 and AKI necessitating hemodialysis during their intensive care unit (ICU) stay. These patients tested positive for COVID-19 and met the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI stages 1-3, requiring ICU admission and hemodialysis. Medical history, clinical features, laboratory results, comorbidities, and demographic data were collected and analyzed. Patients were tracked from admission to discharge or death. Gaussian-distributed values were compared using the unpaired t-test or Pearson's test, while non-Gaussian continuous variables were analyzed using the Mann-Whitney test or Spearman's test. The study employed the Kolmogorov-Smirnov test to assess Gaussian distribution, while categorical data were compared using the Chi-square test. Among 773 patients with positive COVID-19 tests who were admitted to the ICU, 236 patients developed AKI, andamong them, 139 patients required hemodialysis. The total mortality rate was 167 (70.7%) among people who had AKI and 102(77%) in patients with AKI who required hemodialysis. AKI was also a risk factor associated with higher mortality rates in older patients (>45 years) (n=150 (73.2%)), those needing invasive ventilation (n=163 (88.1%)), and patients with elevated total leucocyte count (TLC) (n=130 (79.3%)), lactate dehydrogenase (LDH) (n=159 (72.9%)), interleukin-6 (IL-6) (n=153 (72.2%)), and serum ferritin (n=51 (73.7%)) and hypoalbuminemia (n=152 (73.1%)). AKI requiring hemodialysis significantly increases mortality risk in COVID-19 patients. Other risk factors for mortality with AKI in COVID-19-positive patients include age, elevated leucocyte count, invasive ventilation, and deranged inflammatory markers.

High neutrophil-to-lymphocyte ratio as a cost-effective marker of acute kidney injury and in-hospital mortality after cardiac surgery: a case-control study

Background Inflammation is one of the important pathophysiological characteristics of acute kidney injury (AKI) after cardiac surgery. The aim was to explore the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR), a simple and cost-effective maker of inflammatory response, and AKI after cardiac surgery. Furthermore, whether the NLR affected in-hospital mortality was also investigated. Methods The electronic medical records of patients from January 1, 2006 to December 31, 2018 undergoing cardiac surgery were utilized. The interest outcome was AKI, defined as the criteria of Kidney Disease Improving Global Outcomes (KDIGO), and other outcomes were severe AKI (KDIGO stage ≥2) and in-hospital mortality. Logistic regression was utilized to assess the association of preoperative NLR with outcomes while adjust for potential confounders. Results Totally, 23,638 patients were included. The incidence of AKI was 27.6%. The NLR was significantly greater in patients with AKI compared to those without. As the nonlinear relationship between NLR and AKI indicated by restricted cubic spline, NLR was analyzed as a categorical variable with the cutoff value of five. Multivariate analysis demonstrated that NLR > 5 was significantly associated with an increased risk of AKI, with an odds ratio of 5.046 (95% confidence interval, 4.589 to 5.548), when compared to patients with NLR ≤ 5. Furthermore, high NLR was also an independent risk factor for severe AKI and in-hospital mortality. Conclusions A higher preoperative NLR was increased the risk of AKI, severe AKI, and in-hospital mortality after cardiac surgery, which may be helpful for stratifying patients to develop individualized treatment.

Risk Factors in Chronic Kidney Disease in Newly Diagnosed Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Hospital in South Tamil Nadu, India: A Cross-sectional Study

Introduction: Chronic Kidney Disease (CKD) has become a major cause of global morbidity and mortality, especially in developing countries like India. When diagnosed at the end stage, the overall average cost incurred by the health system per haemodialysis session is INR 4,148, and the mean Out-of-Pocket Expenditure (OOPE) per patient is INR 2,838, which a poor can not afford. Indian CKD registry infers that Type 2 Diabetes Mellitus (T2DM) attributes for 31.2% of CKD cases. The high cost of haemodialysis and the expenditure spent out of pocket by impoverished patients warrants the need for the present study, which was aimed to assess CKD risk among newly diagnosed diabetics. Aim: To assess CKD risk among newly diagnosed diabetics using the Kidney Disease Improving Global Outcomes (KDIGO) 2021 guidelines, which utilise estimated Glomerular Filtration Rate (eGFR) and urine microalbuminuria as assessment tools. Materials and Methods: The present cross-sectional study was conducted in the Non Communicable Disease (NCD) Outpatient Department (OPD), Madurai Medical College (attached to the Government Rajaji Hospital), Madurai, Tamil Nadu, India, from July 1st 2022 to August 30th, 2022. Study was conducted among 200 newly diagnosed T2DM patients (diagnosed for less than 6 months), selected by consecutive sampling. After the initial administration of a questionnaire, blood and random spot urine samples were collected. CKD risk was assessed based on eGFR and urine microalbuminuria using the KDIGO 2021 guidelines, with eGFR calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software 21.0, employing the Chi-square test and Pearson’s correlation tests. Results: Of the total 200 study participants, 130 (65%) were females and 70 (35%) were males with a mean age of 47.74±10.35 years. Of the study participants, 106 (53%), belonged to the low-risk category, 74 (37%) to the moderaterisk category, and 20 (10%) to the high/very high-risk category for CKD. A statistically significant association was observed between alcohol intake and CKD (p-value=0.034). A significant negative correlation (p-value &lt;0.001) was found between age and eGFR (Pearson’s coefficient=-0.400). In the present study, age and gender were not significant factors in CKD risk. While no link was found between carbonated drink consumption and CKD risk, alcohol intake did show a notable association. The study also noted a statistically significant negative correlation between age and eGFR. Conclusion: Identifying CKD risk in diabetic patients using KDIGO guidelines based on eGFR and microalbuminuria is crucial. Early detection is vital to slow progression, particularly from moderate to high-risk categories, thereby reducing personal and societal burdens. Regular monitoring with eGFR testing and follow-ups can improve outcomes and reduce the likelihood of advanced CKD. Collaborative efforts among primary care clinicians and specialists are essential for early CKD risk detection and management using these tools.

The Use of Acetazolamide to Prevent Acute Kidney Injury in Patients with Cancer on High-Dose Methotrexate Treatment: A Retrospective Pilot Analysis.

Background: High-dose methotrexate (HDMTX) chemotherapy is associated with a significant risk of acute kidney injury (AKI). Acetazolamide is thought to increase methotrexate solubility via urinary alkalinisation, potentially reducing the risk of crystalline nephropathy. A tertiary hospital has included acetazolamide in its HDMTX protocols, although data on the risks and benefits are limited. This study evaluated the role of acetazolamide in managing patients receiving HDMTX and identified risk factors for AKI. Methods: The retrospective cohort pilot study included consecutive hospital patients who received HDMTX (≥500 mg/m2). Data collected from digital medical records included demographics, comorbidities, methotrexate dosages and serum concentrations, and pathology results. The development of AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Relationships between variables and AKI were initially assessed using Mann-Whitney U-tests and chi-square tests, and significant variables were further analysed using logistic regression to identify independent predictors of AKI. Results: Among 66 HDMTX treatment cycles in 31 patients, AKI occurred in 0/7 cycles with acetazolamide versus 14/59 cycles without (p = 0.33). Increasing age, the presence of hypertension, and concurrent use of beta-lactam antibiotics were associated with the development of AKI. Age was identified as the strongest independent risk factor for AKI (odds ratio 1.12, p = 0.034). Conclusions: Optimising management protocols, especially for older patients, is essential to reduce AKI risk during HDMTX therapy. While acetazolamide did not appear to reduce the risk of AKI, this pilot study was limited by a small sample size. Large randomised controlled trials are needed to assess efficacy and patient outcomes.

Recommendations for European laboratories based on the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.

The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease (CKD) evaluation and management bring important updates, particularly for European laboratories. These guidelines emphasize the need for harmonization in CKD testing, promoting the use of regional equations. In Europe, the European Kidney Function Consortium (EKFC) equation is particularly suited for European populations, particularly compared to the CKD-EPI 2021 race-free equation. A significant focus is placed on the combined use of creatinine and cystatin C to estimate glomerular filtration rate (eGFRcr-cys), improving diagnostic accuracy. In situations where eGFR may be inaccurate or clinically insufficient, the guidelines encourage the use of measured GFR (mGFR) through exogenous markers like iohexol. These guidelines emphasize the need to standardize creatinine and cystatin C measurements, ensure traceability to international reference materials, and adopt harmonized reporting practices. The recommendations also highlight the importance of incorporating risk prediction models, such as the Kidney Failure Risk Equation(KFRE), into routine clinical practice to better tailor patient care. This article provides a European perspective on how these KDIGO updates should beimplemented in clinical laboratories to enhance CKD diagnosis and management, ensuring consistency across the continent.

Acute Kidney Injury and Outcomes in Infants, Children, and Adolescents, Supported With Extracorporeal Life Support for Cardiopulmonary Failure.

In neonatal and pediatric patients who require extracorporeal life support (ECLS), 60-70% develop acute kidney injury (AKI). Acute kidney injury has been associated with increased morbidity and mortality. We sought to describe our center's experience with AKI in patients requiring ECLS and its effect on outcomes. We conducted a retrospective single-center study at an academic children's hospital. All patients 0-18 years of age who required ECLS between January 2014 and December 2019. During the study period, there were 313 ECLS runs. The majority were neonates (66.8%) and 68.7% of runs were veno-arterial. Using Kidney Disease Improving Global Outcomes (KDIGO) criteria, 227 patients (72.5%) developed stage 2 or 3 AKI. The AKI group were younger (median age: 0.9 vs. 11.7 months, p < 0.001), more likely to experience a hemorrhagic complication (46.9% vs. 31.9%, p = 0.0298), and had higher mortality rates (44.9% vs. 24.4%, p = 0.0009). Neonates who required ECLS were more likely to develop stage 2 or 3 AKI (78%) than pediatrics (63%) (p = 0.005). Adjusting for confounders, patients who developed AKI had 2.38 times higher odds of mortality (95% confidence interval [CI]: 1.34-4.25, p = 0.003). We conclude that the majority of patients requiring ECLS develop stage 2 or 3 AKI. Those with AKI were twice as likely to die when controlling for confounding variables. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.

Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Dialysis-Dependent Patients with Anaemia of Chronic Kidney Disease: A Retrospective Observational Study.

Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) in patients with anaemia of chronic kidney disease may lead to increased ESA doses to achieve target haemoglobin levels; however, elevated doses may be associated with increased mortality. Furthermore, patients with hyporesponsiveness to ESAs have poorer clinical outcomes than those who respond well to ESAs. Incidence and clinical characteristics of patients with ESA hyporesponsiveness were explored in a real-world setting. This was a retrospective study of electronic medical records of adults with stage5 chronic kidney disease receiving renal replacement therapy and ESA treatment, from 1 January 2015 to 31 December 2021. The primary objective was ESA hyporesponsiveness rate/1000days, with a hyporesponsive event defined as ESA use at an elevated dose, according to National Institute for Health and Care Excellence (NICE) criteria. Other hyporesponsiveness definitions applied were erythropoietin resistance index-defined ESA hyporesponsiveness (ERI) Kidney DiseaseImproving Global Outcomes (KDIGO) and a clinical practicality algorithm. In total, 85,259 patients were included in the analysis; 59.9% were male, median (interquartile range) ESA starting dose was 733.3 (400.0, 1200.0)IU/week and follow-up duration was 2.2 (1.0, 4.2) years. Incidence of ESA hyporesponsiveness varied when applying different definitions; NICE 0.05/1000days (5.2% of patients), ERI 0.40/1000days (40.7%), KDIGO 0.15/1000days (15.4%), and clinical practicality algorithm 0.48/1000days (47.9%). ESA doses remained higher in hyporesponsive versus responsive patients, yet haemoglobin levels were similar between groups. The results from this study, which applied multiple hyporesponsiveness definitions to a large, geographically diverse population of patients with anaemia of CKD, showed variation in ESA hyporesponsiveness incidence rates depending on definitions used and higher ESA doses in hyporesponsive versus responsive patients. These results underscore the need for individualised clinical assessment and thorough evaluation when considering ESA dose adjustments to reach haemoglobin targets. Graphical abstract available for this article. NCT05530291.

Guidelines for the management of hypertension in CKD patients: where do we stand in 2024?

Until recently, major bodies producing guidelines for the management of hypertension in patients with chronic kidney disease (CKD) disagreed in some key issues. In June 2023, the European Society of Hypertension (ESH) published the new 2023 ESH Guidelines for the management of arterial hypertension a document that was endorsed by the European Renal Association. Several novel recommendations relevant to the management of hypertension in patients with CKD appeared in these guidelines, which have been updated to reflect the latest evidence-based practices in managing hypertension in CKD patients. Most of these are in general agreement with the previous 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines-some reflect different emphasis on some topics (i.e. detailed algorithms on antihypertensive agent use) while others reflect evolution of important evidence in recent years. The aim of the present review is to summarize and comment on key points and main areas of focus in patients with CKD, as well as to compare and highlight the main differences with the 2021 KDIGO Guidelines for the management of blood pressure in CKD.

Burden and Excess Risk of Adverse Outcomes in Patients With Type 1 Diabetes Using KDIGO Classification: A National Cohort Study.

The widely adopted Kidney Disease: Improving Global Outcomes (KDIGO) classification system has been underused in assessing the burden and risk of adverse outcomes in type 1 diabetes. This observational study aimed to clarify how each KDIGO category correlates with adverse outcomes in this patient group. In a cohort of 40,199 individuals with type 1 diabetes from the Swedish National Diabetes Register, we aimed to investigate the 1) prevalence of different KDIGO categories at baseline; 2) incidence of adverse kidney and cardiovascular (CV) outcomes, including mortality, within each category; and 3) association of baseline category with excess risk of five outcomes: a 40% decline in estimated glomerular filtration rate (eGFR), kidney failure, major adverse kidney/CV events, and all-cause mortality. Cox regression analyses were conducted using three different reference categories: 1) the conventional low-risk "combined G1A1+G2A1"; 2) "G1A1" alone to assess whether G2A1 had excess risk; and 3) "G1bA1" alone to evaluate whether eGFR ≥105 mL/min/1.73 m2 had increased risk. Among 39,067 included patients, with a mean follow-up of 9.1 years, 18.5% presented with chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2 and/or albuminuria. A progressive increase in the incidence and adjusted hazard ratio for all studied outcomes was found with advancing eGFR and albuminuria categories, including in G2A1 (non-CKD). An eGFR ≥105 mL/min/1.73 m2 without albuminuria was not associated with increased risk. A progressively increasing burden of all studied adverse outcomes was observed with advancing KDIGO categories. Even individuals with preserved eGFR and normoalbuminuria (G2A1), conventionally perceived as non-CKD, had an excess risk for all outcomes.