Kidney Disease Research Articles

Association of LDLR Gene Polymorphism with the Risk of Cardiovascular Disease in End-Stage Kidney Disease Patients on Maintenance Hemodialysis

Background The low-density lipoprotein receptor (LDLR) is essential for regulating intracellular cholesterol levels. Mutations in the LDLR gene can cause a increase in LDL cholesterol levels in the blood, elevating the vulnerability to cardiovascular disease (CVD). This study evaluated the correlation between the LDLR rs688 polymorphism and CVD risk in chronic kidney disease (CKD). Materials and Methods Polymorphism in this case-control study was genotyped using the TaqMan real-time polymerase chain reaction in a cohort of 100 CKD patients (Group I) and 100 healthy controls (Group II). We examined the LDLR rs688 allele and genotype distribution in 50 CKD cases with CVD and 50 cases without CVD. Results There was a significantly greater frequency of CT variant of LDL SNP rs688 in Group I than in Group II (p = 0.006). CT and TT genotypes were significantly higher in CKD patients with CVD, with odds ratios (ORs) (95% CI) of 4.3 (1.6–11.8, p = 0.004) and 7.6 (2.3–24.8, p = 0.001), respectively. Conclusion SNP rs688 C>T detection in the LDLR gene showed that CT and TT genotypes are associated with elevated CVD risk in CKD.

Impact of Renin-Angiotensin System Blockade on Mortality and Allograft Loss among Renal Transplant Recipients: A Systematic Review and Meta-Analysis.

The blockade of the renin-angiotensin system (RAS) has a beneficial effect on reducing the levels of proteinuria and blood pressure in patients with chronic kidney disease (CKD) and reduces the risk of developing end-stage kidney disease (ESKD) in CKD patients. Nonetheless, a debate persists regarding the impact of RAS inhibitors on outcomes such as mortality and graft survival in renal transplant patients. To assess the effect of RAS inhibitors on graft recipients in the past decade, we conducted a systematic review and meta-analysis. We searched Embase, PubMed, and the Cochrane Central Register of Clinical Trials from January 1, 2012, to August 1, 2022. We included 14 articles, comprising 5 randomized controlled trials (RCTs) and 9 cohort studies, including 45,377 patients. These studies compared patient or graft survival between an RAS inhibitors treatment arm and a control arm. The meta-analysis revealed that RAS blockade was significantly associated with lower mortality in cohort studies (risk ratio [RR] = 0.66, 95% confidence interval [CI]: 0.55-0.79), reduced allograft loss in cohort studies (RR = 0.62, 95% CI: 0.54-0.71), and significant changes in systolic blood pressure in RCTs. Subgroup analysis of the groups of interest (interventions involving RAS blockade, follow-up period of ≥ 5 years) showed consistently reduced mortality (RR = 0.67, 95% CI: 0.56-0.81) and reduced allograft loss (RR = 0.61, 95% CI: 0.54-0.70). Our results demonstrated that the application of RAS blockade among renal transplant recipients was associated with lower mortality and allograft loss in cohort studies but not in RCTs. More powered clinical trials are needed to evaluate the effects of RAS blockade in renal transplant recipients.

Gut microbiota profiling reflects the renal dysfunction and psychological distress in patients with diabetic kidney disease

BackgroundThe gut microbiota plays a pivotal role in the development of diabetes and kidney disease. However, it is not clear how the intestinal microecological imbalance is involved in the context of diabetic kidney disease (DKD), the leading cause of renal failure.ObjectivesTo elucidate the gut microbial signatures associated with DKD progression towards end-stage renal disease (ESRD) and explore whether they could reflect renal dysfunction and psychological distress.MethodsA cross-sectional study was conducted to explore the gut microbial signatures of 29 DKD non-ESRD patients and 19 DKD ESRD patients compared to 20 healthy controls. Differential analysis was performed to detect distinct gut microbial alterations in diversities and taxon abundance of DKD with and without ESRD. Renal dysfunction was estimated by urea, creatinine, and estimated glomerular filtration rate. Psychological distress was assessed using the Self-Rating Anxiety Scale, Self-Rating Depression Scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale.ResultsAlpha diversity indexes were reduced in DKD patients, particularly those with ESRD. Beta diversity analysis revealed that the gut microbial compositions of DKD patients were different with healthy individuals whereas similar compositions were observed in DKD patients. Taxon differential analysis showed that when compared with the controls, DKD patients exhibit distinct microbial profiles including reduced abundances of butyrate-produced, anti-inflammatory bacteria Faecalibacterium, Lachnospira, Roseburia Lachnoclostridium, and increased abundances of pro-inflammatory bacteria Collinsella, Streptococcus etc. These distinctive genera presented consistent associations with renal dysfunction, as well as psychological distress, especially in DKD patients.ConclusionsDKD patients, especially those who have progressed to ESRD, exhibit unique characteristics in their gut microbiota that are associated with both renal dysfunction and psychological distress. The gut microbiota may be a significant factor in the deterioration of DKD and its eventual progression to ESRD.

DEEP LEARNING BASED KIDNEY DISEASE CLASSIFICATION SYSTEM

Kidney disease is a significant global health issue that requires timely and accurate diagnosis to improve patient outcomes. This project presents a deep learning-based kidney classification system designed to assist in the early detection and classification of various kidney conditions using medical imaging data. The proposed system leverages advanced convolutional neural networks (CNNs) to analyze and classify kidney ultrasound and MRI images, distinguishing between healthy kidneys and those affected by diseases such as kidney stones, cysts, and tumors. This methodology enhances the model's ability to learn intricate patterns and features associated with different kidney conditions, ensuring high classification accuracy and robustness. Keywords: Deep Learning, Kidney Classification, Medical Imaging, Convolutional Neural Networks (CNNs)

Highly Biocompatible Graphite Electrodes by Using Interface‐Stable Coating and the Application to Hemodialysis

AbstractIn the treatment of kidney diseases such as chronic kidney disease (CKD) and acute tubular necrosis (ATN), prolonged contact between conductivity sensors and patients' bodily fluids is required, necessitating high biocompatibility for the electrodes. However, the widely used graphite electrodes exhibit limited biocompatibility, showing a cell survival rate of only 88% under indirect contact conditions, and <56% under direct contact conditions. Here, the surface detachment of graphite electrodes in liquid environments leading to cell death upon contact is observed and a solution is proposed to enhance biocompatibility and ensure conductivity, by forming a layer of interface‐stable coating (ISC) as a conductive isolation membrane on their surface. For applications with contact requirements, graphite‐like carbon (GLC) coated graphite electrodes are investigated and developed, resulting in an exceptional cell survival rate exceeding 96% under indirect contact conditions, and a relatively high survival rate exceeding 91% under direct contact conditions, both accompanied by significant proliferation. GLC‐coated graphite electrodes are successfully to monitor the dialysate conductivity in a hemodialysis machine and achieve stable monitoring with temperature compensation. The results demonstrate ISC graphite electrodes' potential in biomedical fluid monitoring, with the developed process applicable to other fields.

Adiposity in Chinese people with type 1 diabetes

Adiposity, synonymous with obesity, is prevalent among both children and adults with type 1 diabetes in China. Recent literature underscored the patho-physiological and socioeconomic factors associated with adiposity, and consistently highlighted its impact on cardiovascular, kidney, and metabolic diseases among Chinese individuals with type 1 diabetes. Addressing and managing adiposity in individuals with type 1 diabetes are complicated and entail comprehensive approaches including lifestyle modifications, cognitive-behavioral therapy, insulin dose titration, and other diabetes treatment medications. The condition calls for coordination among policymakers, researchers, clinicians, and patients.

Assessment of glycemic susceptibility across multiple urological and reproductive disorders

ObjectiveTo test the glycemic susceptibility in three urological cancers and eight urological/reproductive diseases using the Mendelian randomization (MR) method.Materials and methodsTwo-sample MR was applied to investigate the causal role of three glycemic traits (type II diabetes, fasting glucose and glycated hemoglobin (HbA1c)) in eleven urological/reproductive diseases (kidney cancer, bladder cancer, prostate cancer, kidney/ureter stone, urinary incontinence, benign prostatic hyperplasia, erectile dysfunction, female infertility, male infertility, abnormal spermatozoa and polycystic ovary syndrome). Further multivariate MR (MVMR) and mediating analysis were performed to investigate the associations.ResultsAmong all the 11 diseases, type II diabetes was positively associated with erectile dysfunction, which was stable across both cohorts [odds ratio (OR): 1.59, 95% confidence interval (CI): 1.15–2.20, P = 0.005 for FinnGen Biobank and OR: 1.14, 95% CI: 1.08–1.21, P < 0.001 for the other cohort]. Also, type II diabetes was negatively associated with male infertility (OR: 0.57, 95% CI: 0.39–0.84, P = 0.005). In addition, all three glycemic traits were observed to be positively associated with polycystic ovary syndrome (OR: 2.36, 95% CI: 1.16–4.76, P = 0.017 for fasting glucose per mmol/L; OR: 3.04, 95% CI: 1.10–8.39, P = 0.032 for HbA1c per percentage; and OR: 1.21, 95% CI: 1.00-1.46, P = 0.046 for type II diabetes). Mediating analysis confirmed the effect of type II diabetes on these diseases.ConclusionsThere existed glycemic susceptibility in erectile dysfunction, male infertility and polycystic ovary syndrome. We could not conclude stable glycemic susceptibility in other urological/reproductive diseases.

Accuracy of Shorter Iohexol Glomerular Filtration Rate Measurement Protocols in Individuals with Preserved Kidney Function.

Measuring glomerular filtration rate (mGFR) using exogenous tracers is recommended in a number of settings. Plasma one-compartment multi-sample protocols (MSP) are the most commonly used with iohexol being the dominant tracer. The accuracy of MSP protocols has mostly been evaluated in the setting of reduced GFR where delayed initial and final samples are recommended. Much less is known about MSPs when GFR is not decreased, and the default protocol tends to include initial sampling at 120 minutes (min) and final sampling at 240 min post iohexol injection. The recent KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease includes research recommendations for the development of shorter more efficient mGFR protocols. The objective of this study was to assess the performance of shorter MSPs with earlier initial (60 and 90 min) and final (150, 180, and 210 min) sampling times in individuals with preserved GFR. Reference mGFR was calculated using 5 samples collected between 120-240 min. Four different combinations of shorter sampling strategies were investigated. Performance was evaluated using measurements of bias, precision, and accuracy (P2, P5, and mean absolute error). The mean reference mGFR of the 43 participants was 102.3 ± 13.7 ml/min/1.73m2. All shorter mGFRs had biases less than 1 ml/min/1.73m2 and mean absolute error less than 1.6 ml/min/1.73m2. All shorter mGFRs were within 5% of the reference mGFR, and the majority were within 2%. These results demonstrate that shortening the mGFR procedure in individuals with preserved GFR provides similar results to the current standard while significantly decreasing procedure time.

Elucidating the causal nexus and immune mediation between frailty and chronic kidney disease: integrative multi-omics analysis

Background Empirical research has consistently documented the concurrent manifestation of frailty and chronic kidney disease (CKD). However, the existence of a reverse causal association or the influence of confounding variables on these correlations remains ambiguous. Methods Our analysis of 7,078 participants from National Health and Nutrition Examination Survey(NHANES) (1999–2018) applied weighted logistic regression and Mendelian Randomization (MR) to investigate the correlation between the frailty index (FI) and renal function. The multivariate MR analysis was specifically adjusted for type 2 diabetes and hypertension. Further analysis explored 3282 plasma proteins to link FI to CKD. A two-step network MR highlighted immune cells’ mediating roles in the FI-CKD relationship Result Genetically inferred FI and various renal function markers are significantly correlated, as supported by NHANES analyses. Multivariate MR analysis revealed a direct causal association between the FI and CKD. Additionally, our investigation into plasma proteins identified Tmprss11D and MICB correlated with FI and CKD, respectively. A two-step network MR to reveal 15 immune cell types, notably Central Memory CD4+ T cells and Lymphocytes, as crucial mediators between FI and CKD. Conclusion Our work establishes a causal connection between frailty and CKD, mediated by specific immune cell profiles. These findings highlight the importance of immune mechanisms in the frailty-CKD interplay and suggest that targeting shared risk factors and immune pathways could improve management strategies for these conditions. Our research contributes to a more nuanced understanding of frailty and CKD, offering new avenues for intervention and patient care in an aging population.

Ventricular arrhythmias in the context of chronic kidney disease and electrolyte imbalance.

Patients with chronic kidney disease face ahigh risk of sudden cardiac death, particularly in more advanced stages of renal dysfunction. Ventricular arrhythmias are prevalent and contribute to the heightened cardiovascular mortality. This review aims to explore the intricate interplay of disease-specific risk factors, arrhythmic triggers, and electrolyte disorders that amplify susceptibility to ventricular arrhythmias and sudden cardiac death in this population and influence the efficacy of available treatments.

Clinical signifi cance of various variants of euthyroid pathology syndrome in patients with end-stage chronic kidney disease on programmed hemodialysis

The number of patients with end-stage renal disease (ESRD) is growing every year. Due to the high comorbidity of such patients, the search for factors that influence the course of the disease and outcome is of particular importance. Indications for studying the functional state of the thyroid gland, as well as recommendations for the treatment of thyroid dysfunction in patients with ESRD have not been developed.THE AIM: to study indicators of thyroid status and identify clinically significant variants of the euthyroid pathology syndrome in patients with ESRD on program hemodialysis (PHD).PATIENTS AND METHODS. The study included 123 patients with ESRD undergoing PHD. A cross-sectional study was conducted to examine thyroid function parameters in patients with ESCKD undergoing PHD. All patients were assessed for the levels of thyroidstimulating hormone (TSH), free triiodothyronine (free T3) and free thyroxine (free T4), the comorbidity index, which was calculated using the Charlson scale, the effectiveness of program hemodialysis using Kt/V, and the urea reduction coefficient (URR).RESULTS. Increased TSH levels were associated with higher body mass index in the studied patients. “Low T3” syndrome is associated with older age and high comorbidity. The high level of T4 in the examined patients is also associated with old age, high comorbidity and a KT/V index below the target values.CONCLUSION. The TSH level in patients with endstage renal insufficiency on programmed hemodialysis does not reflect the true functional state of the thyroid gland.

Features of the course of the new coronavirus infection COVID-19 in patients with chronic kidney disease

BACKGROUND: CKD is one of the main comorbidities in those who die from COVID-19. Renal injury is the most common nonpulmonary infection of SARS-CoV-2 and has a wide range of manifestations, ranging from mild proteinuria and hematuria to progressive acute kidney injury (AKI) requiring renal replacement therapy (RRT).THE AIM: to study the features of the course of the new coronavirus infection COVID-19 in patients with chronic kidney disease.PATIENTS AND METHODS: The study included 79 patients with confirmed new coronavirus infection COVID-19 who hospitalized. The first group consisted of people with a history of CKD (44 people), the second group included people without a history of CKD (35 people). The diagnosis of CKD established based on the calculation of glomerular filtration rate using the CKD-EPI formula. The comorbidity index calculated using two scales: Charlson and CIRS-G. Statistical data analysis carried out using the Statistica 12.0 application package (StatSoft Inc., USA).RESULTS: Patients with COVID-19 and CKD had a higher comorbidity index: according to the Charlson index in one group of patients the indicator was 7 [5.0-9.0], and in group 2 it was 5 [4.0-6.0] (p&lt;0.001). According to the CIRS-G index, in one group the indicator was 9 [7-11.5], in two group it was 4 [2-6] (p &lt;0.001). Patients in one group had a greater degree of damage to the lung tissue according to MSCT of the OGK; in laboratory tests, the levels of CRP, ferritin, LDH, and d-dimer were higher; leukocytosis with a neutrophil shift in the leukocyte count observed.CONCLUSION: Patients with a history of chronic kidney disease (CKD) had more severe COVID-19 and higher mortality.

Network pharmacology and molecular dynamics study of the effect of the Astragalus-Coptis drug pair on diabetic kidney disease

BACKGROUND Diabetic kidney disease (DKD) is the primary cause of end-stage renal disease. The Astragalus -Coptis drug pair is frequently employed in the management of DKD. However, the precise molecular mechanism underlying its therapeutic effect remains elusive. AIM To investigate the synergistic effects of multiple active ingredients in the Astragalus-Coptis drug pair on DKD through multiple targets and pathways. METHODS The ingredients of the Astragalus -Coptis drug pair were collected and screened using the TCMSP database and the SwissADME platform. The targets were predicted using the SwissTargetPrediction database, while the DKD differential gene expression analysis was obtained from the Gene Expression Omnibus database. DKD targets were acquired from the GeneCards, Online Mendelian Inheritance in Man database, and DisGeNET databases, with common targets identified through the Venny platform. The protein-protein interaction network and the “disease-active ingredient-target” network of the common targets were constructed utilizing the STRING database and Cytoscape software, followed by the analysis of the interaction relationships and further screening of key targets and core active ingredients. Gene Ontology (GO) function and Kyoto Ency-clopedia of Genes and Genomes (KEGG) pathway enrichments were performed using the DAVID database. The tissue and organ distributions of key targets were evaluated. PyMOL and AutoDock software validate the molecular docking between the core ingredients and key targets. Finally, molecular dynamics (MD) simulations were conducted to simulate the optimal complex formed by interactions between core ingredients and key target proteins. RESULTS A total of 27 active ingredients and 512 potential targets of the Astragalus -Coptis drug pair were identified. There were 273 common targets between DKD and the Astragalus -Coptis drug pair. Through protein-protein interaction network topology analysis, we identified 9 core active ingredients and 10 key targets. GO and KEGG pathway enrichment analyses revealed that Astragalus -Coptis drug pair treatment for DKD involves various biological processes, including protein phosphorylation, negative regulation of apoptosis, inflammatory response, and endoplasmic reticulum unfolded protein response. These pathways are mainly associated with the advanced glycation end products (AGE)-receptor for AGE products signaling pathway in diabetic complications, as well as the Lipid and atherosclerosis. Molecular docking and MD simulations demonstrated high affinity and stability between the core active ingredients and key targets. Notably, the quercetin-AKT serine/threonine kinase 1 (AKT1) and quercetin-tumor necrosis factor (TNF) protein complexes exhibited exceptional stability. CONCLUSION This study demonstrated that DKD treatment with the Astragalus -Coptis drug pair involves multiple ingredients, targets, and signaling pathways. We propose a novel approach for investigating the molecular mechanism underlying the therapeutic effects of the Astragalus -Coptis drug pair on DKD. Furthermore, we suggest that quercetin is the most potent active ingredient and specifically targets AKT1 and TNF, providing a theoretical foundation for further exploration of pharmacologically active ingredients and elucidating their molecular mechanisms in DKD treatment.

Myocardial remodeling in wistar rats with renal dysfunction fed a high-salt diet

BACKGROUND. Dietary adjustment is an important point in the treatment of chronic kidney disease (CKD). However, at present, the effect of a diet with a high NaCl content on the state of the cardiovascular system in patients with early stages of CKD has not been sufficiently studied.The AIM: to evaluate blood pressure levels and changes in the myocardium of Wistar rats with early stage renal dysfunction fed a high-salt diet for a long time.MATERIALS AND METHODS: The study was performed on male Wistar rats. The control group consisted of sham-operated animals (LO-group), receiving a standard diet (0.34 % NaCl), the second – rats subjected to resection of ¾ of the kidney parenchyma, receiving a standard diet (NE-group), the third – rats, subjected to ¾ NE, receiving high sodium diet (4 % NaCl, NE+HSD). After 4 months, the rats were assessed for blood pressure (BP), levels of urea, creatinine, sodium in the blood serum, daily diuresis, albumin content in the urine, myocardial mass index (IMM) and left ventricular myocardial mass index (IMLV), and a histological examination of the myocardium was performed.RESULTS: In rats with kidney dysfunction, an increase in blood pressure was detected, most pronounced in the NE+HSD group. In rats of this group, albumin excretion, connective tissue volume, arterial diameter, thickness of the adventitia and media of myocardial vessels increased relative to the indicators of rats with NE receiving a standard diet. IMLV in NE+HSD rats was higher by 16.4 %, and IMM by 10.9 % than in animals with NE on a standard diet. The groups with NE did not differ from each other in the content of urea and creatinine in the blood serum, although these indicators were higher than in LO animals. There were no differences between groups in serum sodium levels.CONCLUSION: Prolonged consumption of a diet with a high content of table salt contributes to the development of the initial stages of CKD in Wistar rats, promotes blood pressure growth and myocardial remodeling, manifested primarily in the progression of cardiomyocyte hypertrophy and myocardial fibrosis.

Progressive Kidney Failure by Angiotensinogen Inactivation in the Germline.

Autosomal recessive renal tubular dysgenesis is a rare, usually fatal inherited disorder of the REN (renin)-angiotensin system. Herein, we report an adolescent individual experiencing an unknown chronic kidney disease and aim to provide novel insights into disease mechanisms. Exome sequencing for a gene panel associated with renal disease was performed. The REN-angiotensin system was assessed by comprehensive biochemical analysis in blood. REN expression was determined in primary tubular cells by quantitative polymerase chain reaction and in situ hybridization on kidney biopsy samples. Allele frequencies of heterozygous and biallelic deleterious variants were determined by analysis of the Genomics England 100,000 Genomes Project. The patient was delivered prematurely after oligohydramnios was detected during pregnancy. Postnatally, he recovered from third-degree acute kidney injury but developed chronic kidney disease stage G3b over time. Exome sequencing revealed a previously reported pathogenic homozygous missense variant, p.(Arg375Gln), in the AGT (angiotensinogen) gene. Blood AGT concentrations were low, but plasma REN concentration and gene expression in kidney biopsy, vascular, and tubular cells revealed strong upregulation of REN. Angiotensin II and aldosterone in blood were not abnormally elevated. Renal tubular dysgenesis may present as chronic kidney disease with a variable phenotype, necessitating broad genetic analysis for diagnosis. Functional analysis of the renin-angiotensin system in a patient with AGT mutation revealed novel insights regarding compensatory upregulation of REN in vascular and tubular cells of the kidney and in plasma in response to depletion of AGT substrate as a source of Ang II (similarly observed with hepatic AGT silencing for the treatment of hypertension).

Association between vitamin A intake and depression among patients with heart failure.

We aim to investigate the association between vitamin A intake and depression among patients with heart failure (HF). In this cross-sectional study, data of HF patients were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007-2020. The independent variable was vitamin A intake, and the dependent variable was depression. Weighted univariate and multivariate logistic regression models were performed to explore the association of vitamin A intake with depression in HF patients. A total of 999 HF patients were included, with a mean age of 66.19 (0.51) years, and 566 (52.49%) were male. And 197 patients have depression. Vitamin A intake ≥731.38mcg was associated with lower incidence of depression [odds ratio (OR)=0.37; 95% confidence interval (CI): 0.18-0.76] in HF patients. Similarly, the relationship between high vitamin A intake and lower odds of depression were also observed in subgroups of those aged >65years (OR=0.16; 95% CI: 0.04-0.55), males (OR=0.35; 95% CI: 0.14-0.86), without hypertension (OR=0.25; 95% CI: 0.11-0.58), without diabetes (OR=0.30; 95% CI: 0.11-0.78), with hyperlipidaemia (OR=0.23; 95% CI: 0.09-0.64), and with chronic kidney disease (CKD) (OR=0.32; 95% CI: 0.13-0.80). High vitamin A intake was associated with lower odds of depression in HF patients. Appropriate vitamin A supplementation may have potential benefit to the prevention of depression in HF patients. Additional prospective large-scale studies are required to confirm whether or not vitamin A could lead to decrease in depression symptoms.

What Not to Overlook in the Management of Patients with Type 2 Diabetes Mellitus: The Nephrological and Hepatological Perspectives

Diabetes mellitus (DM) significantly impacts renal and hepatic function, necessitating comprehensive understanding and management strategies. Renal involvement, namely diabetic kidney disease (DKD), presents a global challenge, with increasing prevalence paralleling DM rates. Lifestyle modifications and pharmacotherapy targeting hypertension and glycemic control have pivotal roles in DKD management. Concurrently, hepatic involvement in DM, characterized by metabolic dysfunction-associated steatotic liver disease (MASLD), presents a bidirectional relationship. DM exacerbates MASLD progression, while MASLD predisposes to DM development and worsens glycemic control. Screening for MASLD in DM patients is of high importance, utilizing non-invasive methods like ultrasound and fibrosis scores. Lifestyle modifications, such as weight loss and a Mediterranean diet, mitigate MASLD progression. Promising pharmacotherapies, like SGLT2 inhibitors and GLP-1 agonists, demonstrate efficacy in both DM and MASLD management. Special populations, such as diabetic individuals undergoing hemodialysis or kidney transplant recipients, demand special care due to unique clinical features. Similarly, DM exacerbates complications in MASLD patients, elevating the risks of hepatic decompensation and hepatocellular carcinoma. Recognizing the interconnectedness of DM, renal, and hepatic diseases underscores the need for multidisciplinary approaches for optimal patient outcomes. The present review aims to present the main characteristics and crucial points not to be overlooked regarding the renal and hepatic involvement in DM patients focusing on the inter-relationships between the renal and the hepatic involvements.

Acknowledging acute kidney disease following ureteroscopy and laser lithotripsy: results from a tertiary care referral center.

Acute kidney disease (AKD) is a recently described syndrome consisting of kidney function abnormalities lasting less than 3 months. Little is known regarding AKD following ureteroscopy (URS) and laser lithotripsy. To evaluate the occurrence and evolution of AKD in stone patients treated with URS. Data from 284 patients treated with URS for urinary stones were retrospectively analyzed. According to the KDIGO 2020 criteria, AKD was defined as postoperative acute kidney injury (AKI) occurrence, estimated glomerular filtration rate (eGFR) decrease ≥ 35%, or serum creatinine (SCr) increase ≥ 50%. AKI was defined as SCr increase ≥ 0.3 mg/dL or ≥ 50%. AKD evolution was evaluated 60 days post-URS. Data were analyzed using descriptive statistics. Univariable (UVA) and multivariable (MVA) logistic regression analyses tested the association of patients' characteristics and perioperative data with the occurrence of AKD. Overall, postoperative AKD occurred in 32 (11.3%) patients. Recovery from AKD was found in 26 (82%) patients and persistent AKD occurred in 6 (18%) patients. At UVA, age at surgery (p = 0.05), baseline SCr (p = 0.02), baseline CKD category (p = 0.006), Charlson comorbidity index (p = 0.01), operative time (p = 0.04) and postoperative complications (< 0.001) were associated with AKD. At MVA, CKD category (OR 2.99, 95% CI = 1.4-6.3; p = 0.004), operative time (OR 1.01, 95% CI = 1.001-1.018; p = 0.023) and postoperative complications (OR 3.5, 95% CI = 1.46-8.49; p = 0.005) were independent predictors of AKD. AKD is a frequent complication in patients treated with URS. Moreover, AKD persists in a non-neglectable percentage of patients at medium-term follow-up. Therefore, nephrological assessment should be considered, especially in high-risk patients. Current findings should be considered for the peri-operative management of stone patients.

Association patterns of ketone bodies with the risk of adverse outcomes according to diabetes status.

To investigate the associations between ketone bodies (KB) and multiple adverse outcomes including cardiovascular disease (CVD), chronic kidney disease (CKD) and all-cause mortality according to diabetes status. This prospective study included 222 824 participants free from CVD and CKD at baseline from the UK Biobank. Total KB including β-hydroxybutyrate, acetoacetate and acetone were measured by nuclear magnetic resonance. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between KB and adverse outcomes among participants with normoglycaemia, prediabetes and type 2 diabetes, respectively. During a mean follow-up of 14.1 years, 24 088 incident CVD events (including 17 303 coronary heart disease events, 5172 stroke events and 5881 heart failure [HF] events), 8605 CKD events and 15 813 deaths, were documented. Higher total KB significantly increased the risk of HF among participants with normoglycaemia (HR, 1.32 [95% CI, 1.17-1.49], per 10-fold increase in total KB) and prediabetes (1.35 [1.04-1.76]), and increased the risk of CKD among those with normoglycaemia (1.20 [1.09-1.33]). Elevated KB levels were associated with an increased risk of all-cause mortality across the glycaemic spectrum (1.32 [1.23-1.42] for normoglycaemia, 1.45 [1.24-1.71] for prediabetes and 1.47 [1.11-1.94] for diabetes). Moreover, a significant additive interaction between KB and diabetes status was observed on the risk of death (P = .009), with 4.9% of deaths attributed to the interactive effects. Our study underscored the variation in association patterns between KB and adverse outcomes according to diabetes status and suggested that KB could interact with diabetes status in an additive manner to increase the risk of mortality.

Loss of Y Chromosome and Cardiovascular Events in Chronic Kidney Disease.

Chronic kidney disease represents one of the strongest risk factors for cardiovascular diseases, and particularly for heart failure. Despite improved pharmaceutical treatments, mortality remains high. Recently, experimental studies demonstrated that mosaic loss of Y chromosome (LOY) associates with cardiac fibrosis in male mice. Since diffuse cardiac fibrosis is the common denominator for progression of all forms of heart failure, we determined the association of LOY on mortality and cardiovascular disease outcomes in patients with chronic kidney disease. LOY was quantified in men with stable chronic kidney disease (CARE for HOMe study [XXX], n=279) and dialysis patients (4D study, n=544). The association between LOY and mortality, combined cardiovascular and heart failure-specific end points, and echocardiographic measures was assessed. In CARE for HOMe, the frequency of LOY increased with age. LOY >17% was associated with increased mortality (heart rate, 2.58 [95% CI, 1.33-5.03]) and risk for cardiac decompensation or death (heart rate, 2.30 [95% CI, 1.23-4.27]). Patients with LOY >17% showed a significant decline of ejection fraction and an increase of E/E' within 5 years. Consistently, in the 4D study, LOY >17% was significantly associated with increased mortality (heart rate, 2.76 [95% CI, 1.83-4.16]), higher risk of death due to heart failure and sudden cardiac death (heart rate, 4.11 [95% CI, 2.09-8.08]), but not atherosclerotic events. Patients with LOY >17% showed significantly higher plasma levels of soluble interleukin 1 receptor-like 1, a biomarker for myocardial fibrosis. Mechanistically, intermediate monocytes from patients with LOY >17% showed significantly higher C-C chemokine receptor type 2 expression and higher plasma levels of the C-C chemokine receptor type 2 chemokine (C-C motif) ligand 2, which may have contributed to increased heart failure events. LOY identifies male patients with chronic kidney disease at high risk for mortality and heart failure events.