Kidney Disease Patients Research Articles

Relation of Serum Homocysteine Levels and Chronic Kidney Disease in Patients with Systemic Lupus Erythematosus

Abstract Background SLE is an autoimmune disease characterized by the production of autoantibodies to components of the cell nucleus in association with diverse clinical manifestations affecting almost all organ systems. It is a complex disease with variable presentations, course, and prognosis characterized by remissions and flares. The etiology of SLE remains unknown and is clearly multifactorial. Many observations suggest a role for genetic, hormonal, immunologic, and environmental factors. Objective To evaluate the relation between serum homocysteine levels and occurrence of chronic renal disease, renal functions, severity of proteinuria and progression to end stage renal disease in patients with systemic lupus erythematosus. Patients and Methods This study include 70 SLE patients with biopsy proven lupus nephritis who fulfill four or more of 2012 American College of Rheumatology (ACR) criteria for SLE. They were recruited from Rheumatology Outpatient Clinic and Rheumatology Inpatient Department of Ain Shams University Hospitals. Twenty healthy individuals were included as controls. Written consents were obtained from all patients participating in the study. Results In this study there was highly statistically significant difference between patients and controls as regards serum homocysteine levels, 17 patients had mild, 8 moderate and 5 severe hyperhomocysteinaemia, with (p- <0.001). Hypertension was recorded in 32 SLE patients (45.7%) and no one of controls was hypertensive. Carotid examination showed an overall increased intimal thickness (CIMT) in the 8 (11.4 %) SLE patients (3 of them have hypertension). There was highly statistically significant relation between levels of homocysteine with carotid intimal thickness imaging in patients group p-value <0.001. The current study proved that there statistically a significant correlation between serum homocysteine levels and class of CKD, 40 had normal and 30 had subnormal HC levels, mild HHC was observed in 17, moderate HHC in 8 cases, while sever HHC was 5 of cases with p- <0.001. Conclusion This study demonstrates that homocysteine is modifiable marker in SLE patients; hyperhomocysteinemia was significantly correlated with renal function and progression to end stage renal disease. The current study shows statistically significant relation between serum homocysteine levels and patients age, disease duration, diabetes mellitus, and hypertension. There were significant positive correlation between homocysteine levels and both blood urea nitrogen (BUN) and 24 hr urinary protein. Also, there statistically significant relation between homocysteine and CKD classes in SLE patients, 40% of patients with class IV LN had hyperhomocysteinamia.

A J-shaped relationship between ketones and the risk of diabetic kidney disease in patients with type 2 diabetes: New insights from a cross-sectional study.

To investigate the association between circulating β-hydroxybutyric acid (βOHB) and diabetic kidney disease (DKD) risk in patients with type 2 diabetes (T2D). A total of 1388 patients with T2D were recruited. Participants were divided into high and normal βOHB groups. Participants in the normal βOHB group were divided into four subgroups according to βOHB quartile (Q). The relationships of βOHB with DKD and DKD subtype were analysed using chi-square and binary logistic regression. Restricted cubic splines were used to explore the non-linear correlation between βOHB concentration and DKD risk in the total population. A higher prevalence of DKD was detected in the high compared with the normal βOHB group (43.3% vs. 33.3%, P = .041). Participants in the Q4 group (βOHB, 0.12-0.30 mM) had the lowest prevalence of DKD (P = .001). In the binary logistic regression model, the multivariable-adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for DKD risk were 2.30 (1.62-3.26) for Q1, 1.80 (1.23-2.62) for Q2 and 1.63 (1.10-2.41) for Q3 relative to Q4 (P < .001). Restricted cubic spline analyses suggested a J-shaped association of circulating βOHB concentration with DKD risk. DKD risk was lowest at a serum βOHB concentration of 0.183 mM (OR, 0.63; 95% CI, 0.52-0.77). A J-shaped relationship between circulating ketone level and DKD risk in patients with T2D was determined. Circulating βOHB in the range of 0.12-0.30 mM was associated with a lower risk of DKD. Further studies are warranted to verify the causality and to elucidate the underlying mechanisms.

Home blood pressure-centered approach - from digital health to medical practice: HOPE Asia Network consensusstatement 2023.

Recent innovations in digital technology have enabled the simultaneous accumulation, and the linking and analysis of time-series big data relating to several factors that influence blood pressure (BP), including biological indicators, physical activity, and environmental information. Various approaches can be used to monitor BP: in the office/clinic; at home; 24-h ambulatory recording; or with wearable and cuffless devices. Of these, home BP monitoring is a reliable and convenient method, and is recommended for hypertension management by current national and international guidelines. This recommendation is based on evidence showing that home BP is an important predictor of cardiovascular, cerebrovascular and kidney disease in patients with hypertension. In addition, lifetime personalized health record (PHR)-based home BP with telemonitoring combined with co-interventions has been shown to lower BP more effectively than the traditional approach based on office BP. Thus, home BP represents a key metric for personalized anticipation medicine, from digital healthcare to digital medicine. This paper summarizes the latest evidence on home BP monitoring and proposes a Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network consensus on a home BP-centered approach to the management of hypertension.

Diagnostic and prognostic value of galactose-deficient IgA1 in patients with IgA nephropathy: an updated systematic review with meta-analysis.

Galactose-deficient IgA1 (Gd-IgA1) is a critical effector molecule in the pathogenesis of IgA nephropathy (IgAN), a leading renal disease without noninvasive assessment options. This updated systematic review aimed to determine the diagnostic and prognostic value of Gd-IgA1 assessment in biological fluids in patients with IgAN. PRISMA guidelines were followed in this review. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, VIP Information/China Science and Technology Journal Database, and WANFANG for studies published between database inception and January 31, 2023. Eligible studies that evaluated aberrant IgA1 glycosylation in IgAN patients relative to controls were identified, and random effects meta-analyses were used to compare Gd-IgA1 levels in different groups. The quality of the evidence was assessed using the Newcastle-Ottawa Scale. This study was registered on PROSPERO (CRD42022375246). Of the 2727 records identified, 50 were eligible and had available data. The mean Newcastle-Ottawa Scale score was 7.1 (range, 6-8). Data synthesis suggested that IgAN patients had higher levels of blood and/or urine Gd-IgA1 compared with healthy controls (standard mean difference [SMD]=1.43, 95% confidence interval [CI]=1.19-1.68, P<0.00001), IgA vasculitis patients (SMD=0.58, 95% CI=0.22-0.94, P=0.002), and other kidney disease patients (SMD=1.06, 95% CI=0.79-1.33, P<0.00001). Moreover, patients with IgAN had similar levels of serum Gd-IgA1 compared to first-degree relatives (SMD=0.38, 95% CI= -0.04-0.81, P=0.08) and IgA vasculitis with nephritis patients (SMD=0.12, 95% CI= -0.04-0.29, P=0.14). In addition, ten studies demonstrated significant differences in serum Gd-IgA1 levels in patients with mild and severe IgAN (SMD= -0.37, 95% CI= -0.64--0.09, P=0.009). High serum and urine Gd-IgA1 levels suggest a diagnosis of IgAN and a poor prognosis for patients with this immunological disorder. Future studies should use more reliable and reproducible methods to determine Gd-IgA1 levels. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022375246, identifier CRD42022375246.

Prevalence, age and gender features of chronic kidney disease in patients with diabetes mellitus

To study the prevalence, age and gender characteristics of chronic kidney disease (CKD) in patients with diabetes mellitus (DM). In a case-control study, clinical and laboratory data were analyzed in 683 patients with DM (4.6% of patients with type 1 DM and 95.4% with type 2 DM) and kidney damage. The indicators of anthropometry, hemodynamics and biochemistry were studied. The glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. The proportion of middle-aged and elderly patients with CKD was the most numerous, amounting to 39 and 38%, respectively. At the same time, anemia was more common in young people, and hypercholesterolemia (35.0%), proteinuria (47.5%) and signs of renal failure (45.0%) - in middle-aged patients with CKD. 47.0% study participants had C1 and C2 categories of changes in renal function. Mean levels of systolic blood pressure (BP), the prevalence of proteinuria were statistically significantly higher in women. When evaluating the correlations, we found statistically significant relationships between the calculated GFR and the level of body mass index, systolic BP, venous blood glucose and Hb in the subgroup of men. Among females, a significant relationship between the calculated GFR value was revealed with indicators of systolic and diastolic BP, venous blood glucose and Hb concentration. Our data indicate the existence of differences in the prevalence of CKD and associated risk factors for the progression of renal failure, depending on gender differences and living conditions of patients. In urban residents, CKD was most often associated with arterial hypertension and renal failure, while overweight, obesity, and proteinuria were significantly more common in rural areas. The incidence of proteinuria and mean levels of systolic BP were significantly higher in females. Further study of the issue under discussion seems promising from the standpoint of a personalized approach and the search for a new preventive strategy to combat both end-stage renal failure and its complications.

Association between remnant cholesterol level and severity of chronic kidney disease in patients with type 2 diabetes

BackgroundStudies on whether remnant cholesterol (RC) affects the progression of chronic kidney disease (CKD) remain insufficient. This study aimed to determine whether RC level was associated with the severity of CKD in patients with type 2 diabetes mellitus (T2DM). MethodsIn total, 3383 individuals diagnosed with T2DM were enrolled in this cross-sectional study from China. The severity of CKD was defined as no, moderate, severe, and very severe CKD based on the urinary albumin-to-creatinine ratio and estimated glomerular filtration rate. Because RC was non-normally distributed, it was log-transformed and categorized into quantiles. Multivariate logistic regression and multivariate ordinal logistic regression analysis were performed to investigate whether RC was independently associated with CKD and its severity. ResultsThe median RC level was 25.9 mg/dL. The number of patients with no, moderate, severe, and very severe CKD was 2587 (76.5 %), 520 (15.4 %), 189 (5.6 %), and 87 (2.5 %), respectively. After adjusting for confounding factors, the prevalence of CKD increased 1.67-fold when the log-transformed RC level was elevated by one unit (OR [95 % CI], 1.67 [1.43–1.95]). The likelihood of CKD severity increasing by one degree was 1.76-fold for each one-unit increase in log-transformed RC level (OR [95 % CI], 1.76 [1.52–2.05]). When RC was incorporated as a categorical variable, it still correlated with CKD severity compared with quantile 1 (Q1) (Q2, 1.30 [1.01–1.68]; Q3, 1.60 [1.23–2.07]; Q4, 2.39 [1.86–3.09]). The association remained regardless of whether the patient's traditional lipid profiles achieved the target range. ConclusionRC level was associated with CKD severity even when traditional lipid profiles were within the target range in patients with T2DM.

Factors Associated with Accelerated Progression of Chronic Kidney Disease in Patients from the Colombian Caribbean Coast

Background: Chronic Kidney Disease (CKD) is a global public health problem with increasing prevalence and a substantial burden on healthcare systems. The characteristics of rapid progressors and factors that may predict accelerated CKD progression require further exploration, especially since there are no published studies about this topic in Colombia. Purpose: To identify the clinical and sociodemographic factors associated with the rapid progression of CKD in a large cohort of Colombian patients. Methods: This retrospective observational study included two cohorts of G1 to G4 stage CKD patients without dialysis from the Colombian North Coast. Follow-up was conducted for 18 months (n=14,420) and 24 months (n=10,042). Patients were divided into rapid progressors and stable progressors based on the glomerular filtration rate (GFR) slope &lt;?5 mL/min/1.73m2/year or ?-5 mL/min/1.73 m2/year, respectively. Results: 37.68% of the cohort was classified as rapid progressors at 24 months and 28.41% at 18 months. An R2=0.77 was found in both cohorts for GFR measurements, indicating a linear trend toward loss. Furthermore, accelerated progression was observed in younger patients and those with higher diastolic blood pressure values. Conclusion: In two large cohorts of renal patients, approximately 4 out of 10 patients were classified as rapid progressors at 24 months of follow-up and 3 out of 10 at 18 months of follow-up. It is important to identify patients at higher risk of accelerated CKD progression in the short term to provide them with personalized and effective care.

Interrelation between the lipid accumulation product index and diabetic kidney disease in patients with type 2 diabetes mellitus.

The purpose of this study was to determine the relation between the lipid accumulation product index (LAPI) and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Herein, 931 patients were enrolled and their data were collected. Then the interrelation between LAPI and DKD was assessed using multivariate logistic regression analyses (LRAs) and by a restricted cubic spline (RCS). In total, 931 participants (352 females and 579 males) aged 55 years on average were included in the study. After adjusting for several confounders, the odds ratio for DKD was increased evidently in the third LAPI tertile compared with that in the first LAPI tertile. In addition, the RCS revealed a positive interrelation between LAPI and DKD. In the subgroup analyses, age, sex, hyperlipidemia, hypertension, and HbA1c did not significantly interact with LAPI. LAPI was higher in the DKD group than in the no-DKD group, and LAPI is positively linked with DKD, which may have potential value to diagnose DKD in clinical practice.

Prevalence and outcomes of end-stage kidney disease in patients with systemic lupus erythematous: a population-based study.

This study aims to examine the prevalence and outcomes of end-stage kidney disease (ESKD) among systemic lupus erythematosus (SLE) patients. SLE patients identified from the national administrative datasets were linked to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) to identify the ESKD cases. Period prevalence of ESKD among SLE patients was calculated. The risk of developing ESKD by ethnicity was explored with Cox Proportional Hazards model. The adjusted hazard ratio (HR) of all-cause mortality for Māori, Pacific, Asian compared to European/others was estimated. Of the 2837 SLE patients, 210 (7.4%) developed ESKD. The average period prevalence of ESKD among SLE patients was 5.7%. Men had twice the prevalence rate of ESKD than women (10.0% vs 5.2%). Māori and Pacific had higher prevalence rate than Asian and European/others (9.4%, 9.8% vs 4.4% and 3.8%). The adjusted HR of developing ESKD for men compared to women was 3.37 (95% CI 1.62-7.02). The adjusted HR of developing ESKD for Māori and Pacific compared to European/others was 4.63 (95% CI 1.61-13.29) and 4.66 (95% CI 1.67-13.00), respectively. Compared to European/others, Māori had an HR of 2.17 (95% CI 1.18-4.00) for all-cause mortality. SLE patients had a high prevalence rate of ESKD. Men, Māori, and Pacific patients with SLE were more likely to develop ESKD. Māori patients with ESKD had poorer survival than other patients. Interventions are needed to reduce the risk of ESKD and to improve the survival of ESKD patients for the disadvantaged groups.

Dapagliflozin protects against doxorubicin-induced nephrotoxicity associated with nitric oxide pathway—A translational study

Doxorubicin (Dox) is a potent anticancer agent, but its associated organ toxicity, including nephrotoxicity, restricts clinical applications. Dapagliflozin (DAPA), a sodium–glucose cotransporter-2 inhibitor, has been shown to slow the progression of kidney disease in patients with and without diabetes. However, the effect of DAPA to counteract Dox-induced nephrotoxicity remains uncertain. Therefore, in this study, we aimed to elucidate the effects of DAPA in mitigating Dox-induced nephrotoxicity. We analyzed the Taiwan National Health Insurance Database to evaluate the incidence of renal failure among breast cancer patients receiving Dox treatment compared to those without. After adjusting for age and comorbidities, we found that the risk of renal failure was significantly higher in Dox-treated patients (incidence rate ratio, 2.45; confidence interval, 1.41–4.26; p = 0.0014). In a parallel study, we orally administered DAPA to Sprague–Dawley rats for 6 weeks, followed by Dox for 4 weeks. DAPA ameliorated Dox-induced glomerular atrophy, renal fibrosis, and dysfunction. Furthermore, DAPA effectively suppressed Dox-induced apoptosis and reactive oxygen species production. On a cellular level, DAPA in HK-2 cells mitigated Dox-mediated suppression of the endothelial NOS pathway and reduced Dox-induced activities of reactive oxygen species and apoptosis-associated proteins. DAPA improved Dox-induced apoptosis and renal dysfunction, suggesting its potential utility in preventing nephrotoxicity in patients with cancer undergoing Dox treatment.

Molecular Signatures of Glomerular Neovascularization in a Patient with Diabetic Kidney Disease.

The Kidney Precision Medicine Project (KPMP) aims to create a kidney tissue atlas, define disease subgroups, and identify critical cells, pathways, and targets for novel therapies through molecular investigation of human kidney biopsies obtained from participants with AKI or CKD. We present the case of a 66-year-old woman with diabetic kidney disease who underwent a protocol KPMP kidney biopsy. Her clinical history included diabetes mellitus complicated by neuropathy and eye disease, increased insulin resistance, hypertension, albuminuria, and relatively preserved glomerular filtration rate (early CKD stage 3a). The patient's histopathology was consistent with diabetic nephropathy and arterial and arteriolar sclerosis. Three-dimensional, immunofluorescence imaging of the kidney biopsy specimen revealed extensive periglomerular neovascularization that was underestimated by standard histopathologic approaches. Spatial transcriptomics was performed to obtain gene expression signatures at discrete areas of the kidney biopsy. Gene expression in the areas of glomerular neovascularization revealed increased expression of genes involved in angiogenic signaling, proliferation, and survival of endothelial cells, as well as new vessel maturation and stability. This molecular correlation provides additional insights into the development of kidney disease in patients with diabetes and spotlights how novel molecular techniques used by the KPMP can supplement and enrich the histopathologic diagnosis obtained from a kidney biopsy.

Successful Treatment of Paecilomyces variotii Pneumonia and Lupus Nephritis With Posaconazole-Cyclophosphamide Co-administration Without Drug Interaction–Induced Toxicity

Abstract Paecilomyces variotii is an opportunistic mold that causes pulmonary infections in immunosuppressed humans that are often treated with triazole therapy. Lupus nephritis is a major cause of progressive kidney disease in patients with systemic lupus erythematosus, often requiring cyclophosphamide-based therapies. Triazole-cyclophosphamide co-administration is challenging as triazoles increase cyclophosphamide concentrations, which can worsen cyclophosphamide toxicity. We describe herein a patient with Paecilomyces variotii pneumonia and concomitant lupus nephritis who was successfully treated with posaconazole and echinocandin-bridged interruptions to allow for cyclophosphamide therapy. This regimen was well-tolerated without cyclophosphamide toxicity and achieved improvements in both fungal pneumonia and renal function.

Effect of Curcumin on Oxidative Stress, Inflammatory Response and Kidney Biochemical Parameters Among Kidney Disease Patients: A Systematic Review

Background: Chronic kidney disease (CKD) and end-stage renal diseases have high global morbidity and mortality. Objective: We aimed to investigate the antioxidant and anti-inflammatory properties of curcumin and its impact on kidney biochemical parameters associated with kidney disease among CKD and hemodialysis (HD) patients. Methods: The intended keywords were used in the literature search. Clinical trial studies from the beginning to December 25th, 2021, indexed in the Institute for Scientific Information (ISI), Scopus, and PubMed databases, were included in the review. Records with no accessible full texts, non-English language articles, and studies that were not related to the study aim were excluded. The agreement for exclusion required all authors to concur. Finally, after reviewing all available literature, 27 articles were included in this systematic review. Results: Curcumin supplementation increased antioxidant capacity by improving catalase (CAT) activity, free radical scavenging activity, and nuclear factor erythroid 2–related factor 2 (Nrf2). It also reduced hs-CRP, IL-6, and TNF-a levels in patients with CKD and HD patients. Different results were reported regarding the effect of curcumin on kidney-related biochemical parameters. But mostly, the results showed that no significant changes were seen in glomerular filtration (GFR), albumin (Alb), serum creatinine (sCr), proteinuria (PRO), and blood urea nitrogen (BUN) in these patients. Conclusion: Although it seems curcumin improved antioxidant capacity and decreased inflammatory cytokines in CKD and HD patients, it did not affect renal biochemical parameters. More clinical studies with larger sample sizes appear to be needed.

Catestatin in diagnosing cardiovascular and metabolic disorders in patients with comorbid hypertension

Background. Hypertension is the major pandemic in human history, which determines the structure of cardiovascular morbidity and mortality. There is an obvious relationship between hypertension and various diseases that largely determine its development and increase the risk of cardiovascular complications. Neuropeptides appear to have a major impact on the progression of these complications. Catestatin (CST) is one of them, which deserves special scientific and practical concern, as it has a wide range of biological effects in the body. The aim of the study: to determine the place of CST in the early diagnosis of cardiovascular and metabolic complications in patients with comorbid hypertension among the Ukrainian population. Materials and methods. One hundred and eleven patients with hypertension, type 2 diabetes mellitus, obesity (men/women — 50/61) and 20 controls were examined. All patients with hypertension, type 2 diabetes mellitus, and obesity were aged 54.37 ± 1.18 years. Following a thorough examination and supervision, they were divi­ded into 2 groups depending on the median CST level of 2.45 ng/ml. The first group included 55 (49.5 %) patients who had a CST level below 2.45 ng/ml, the second one consisted of 56 patients (50.5 %) who had a CST level above 2.45 ng/ml. In all patients, we measured body weight, height, calculated body mass index, evaluated glycated hemoglobin levels, lipid metabolism (serum concentrations of total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein cholesterol); systolic and diastolic blood pressure. The content of CST, cardiotrophin 1, leptin, cystatin C, neutrophil gelatinase-associated lipocalin, N-terminal prohormone of brain natriuretic peptide, 25(OH)D, β2-microglobulin, and insulin levels in the blood serum were determined by enzyme-linked immunosorbent assay. Results. A reliable difference between the groups was found by β2-microglobulin (p = 0.008). Univariate and multivariate linear regression analysis revealed a negative correlation between CST and cardiotrophin 1, N-terminal prohormone of brain natriuretic peptide, neutrophil gelatinase-associated lipocalin, and 25(OH)D. A positive correlation was found between CST and the level of glycated hemoglobin, body mass index, and triglycerides. A statistically significant correlation was found between CST and creatinine (R = –0.21, p = 0.029), high-density lipoprotein cholesterol (R = 0.207, p = 0.029), and β2-microglobulin (R = 0.279, p = 0.0029) in the patients with hypertension. Conclusions. It has been proven that a decrease in serum catestatin concentration can be a risk factor for the development of more severe comorbidities in patients with hypertension. The detected relationships of catestatin with creatinine, urea, and β2-microglobulin suggest that CST is a predictor of chronic kidney disease in patients with comorbidities. The revealed correlation of CST with high-density lipoprotein, obesity, and body mass index suggests its importance in the prevention of atherosclerotic and metabolic complications in patients with hypertension, type 2 diabetes mellitus, and obesity.

Liver stiffness, hepatorenal index, and microRNA-130b as predictors for chronic kidney disease in patients with non-alcoholic fatty liver disease

Background and aimCurrently, nonalcoholic liver disease (NAFLD) is the most predominant chronic liver disorder. NAFLD has been linked to hepatic and extrahepatic morbidities. We aimed to investigate the role of acoustic radiation force impulse (ARFI), hepatorenal index (HRI), and serum microRNA-130b as non-invasive predictors for chronic kidney disease (CKD) in NAFLD patients.Material and methodsIn a case–control design, we included 40 NAFLD patients (20 NAFLD with CKD and 20 NAFLD without CKD) and 20 healthy controls. After clinical evaluation, laboratory assessments including liver test profile, renal function test, and quantification of microRNA-130b were done. Liver steatosis and stiffness were evaluated using HRI and ARFI.ResultsHRI and ARFI readings were significantly higher among NAFLD with CKD patients compared to other groups (P < 0.001). The median values of microRNA-130b were 32.1, 27.01, and 25.36 copies/µl in NAFLD with CKD, NAFLD without CKD, and healthy controls, respectively, with significant differences between groups (P < 0.05). ARFI values and HRI were positively correlated with microRNA-130b (P < 0.05). At a cutoff value > 28.13 copies/µl, microRNA-130b could differentiate between “NAFLD with CKD” and “NAFLD without CKD” patients with a sensitivity and specificity of 75% and 70%, respectively (AUC = 71.9%, P = 0.018).ConclusionsSerum microRNA-130b, HRI, and ARFI are valuable noninvasive markers for the assessment of NAFLD. MicroRNA-130b is suggested as a sensitive biomarker for the prediction of CKD among NAFLD patients with good sensitivity and specificity.

Prevalence and risk factors for kidney disease among hospitalized PLWH in China

BackgroundKidney disease is an important comorbidity in people living with HIV(PLWH), and is associated with poor outcomes. However, data on renal function of PLWH are limited in China so far. In this study we assessed the prevalence of kidney disease in patients either on antiretroviral therapy (ART) or not respectively in a single center in China and explored the possible risk factors associated.MethodsIn the cross-sectional study, we recruited hospitalized adult PLWH. Demographic characteristics, clinical information and laboratory variables were collected. Kidney disease was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, and/or isolated hematuria, proteinuria, microalbuminuria. We calculated the prevalence of kidney disease and used logistic regression to assess its associated risk factors.ResultsA total of 501 adult PLWH were enrolled, 446 (89.0%) males and 55 (11.0%) females. The median age was 39 (IQR 30–50) years old. The prevalence of kidney disease was 19.0%, 22 (4.4%) patients with eGFR < 60 mL/min/1.73 m2, 53 (10.6%) patients with hematuria, 11 (2.2%) patients with proteinuria, and 40 (8.0%) patients with microalbuminuria. 297 (59.3%) patients were receiving ART. The patients on ART had a higher prevalence of renal disease than those had not been administrated with ART (22.6% vs. 13.7%, P = 0.013). On the multivariate logistic regression analysis among patients not on ART, lower haemoglobin (OR 0.994, 95%CI: 0.902–0.988, P = 0.013) were significantly associated with kidney disease. While among those on ART, older age (OR 1.034, 95%CI: 1.003–1.066, P = 0.032), lower haemoglobin (OR 0.968, 95%CI: 0.948–0.988, P = 0.002) and lower albumin (OR 0.912, 95%CI: 0.834–0.997, P = 0.044) were significantly associated with kidney disease.ConclusionsThe prevalence of kidney disease among hospitalized PLWH in China is high, especially in patients on ART. A larger scale study on Chinese outpatient PLWH should be conducted, so as to precisely assess prevalence of kidney disease in general Chinese PLWH.

Estimated health economic impact of conducting urine albumin-to-creatinine ratio testing alongside estimated glomerular filtration rate testing in the early stages of chronic kidney disease in patients with type 2 diabetes

AimTo estimate the health economic impact of undertaking urine albumin-to-creatinine ratio (UACR) testing versus no UACR testing in early stages of chronic kidney disease (CKD) progression in patients with type 2 diabetes (T2D).MethodsAn economic model, taking a UK healthcare system perspective, estimated the impact of UACR testing on additional costs, clinical benefits measured as prevented dialyses and cardiovascular-related deaths, life years gained (LYg), LYg before kidney failure, and incremental cost-effectiveness ratio (ICER). Sixteen of the 18 Kidney Disease: Improving Global Outcomes (KDIGO) heatmap categories were considered separately, and grouped in health states according to CKD risk. Results were derived for current standard-of-care and emerging CKD therapies.ResultsThe cohort that adhered to both UACR and estimated glomerular filtration rate (eGFR) testing guidelines in early stages of CKD (n = 1000) was associated with approximately 500 LYg before kidney failure onset; costing approximately £2.5 M. ICERs across the KDIGO heatmap categories were approximately £5,000.LimitationsThis model used data from a comprehensive meta-analysis that was initiated more than 10 years ago (2009). While this was the most comprehensive source identified, recent changes in the treatment landscape, patient population and social determinants of CKD will not be captured. Furthermore, a narrow approach was taken, aligning included costs with UK NHS reference materials. This means that some direct and indirect drivers of costs in late-stage disease have been excluded.ConclusionsUACR testing in the early stages of CKD is cost effective in T2D patients. Emerging therapies with the potential to slow CKD progression, mean that optimal monitoring through UACR/eGFR testing will become increasingly important for accurate identification and timely treatment initiation, particularly for the highest-risk A3 category.

Predicting the incidence of chronic kidney disease in patients with myocardial infarction and acute kidney injury

Aim. To estimate the incidence of chronic kidney disease (CKD) and develop a calculator to estimate the CKD probability in patients with myocardial infarction (MI) and acute kidney injury (AKI).Material and methods. A total of 193 patients with MI aged 34-79 years were examined: 123 patients with MI and signs of AKI, 70 patients without AKI. In all patients, the levels of C-reactive protein, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), microalbuminuria (MA), creatinine, and glomerular filtration rate (GFR) were determined. In the presence of AKI criteria on the 3rd day and at discharge, the level of kidney injury molecule-1 (KIM-1) molecule and interleukin-18 was examined in the urine. Six months after discharge, GFR was assessed over time. Patients of both groups underwent coronary angiography with stenting of infarct-related artery.Results. The GFR at admission in patients with AKI was lower than in the group without AKI with normal creatinine levels. Following correlations between AKI and markers of cardiovascular events were revealed: KIM-1 and NT-proBNP (r=0,29 p=0,031), GFR and NT-proBNP (r=-0,22 p=0,015), NT-proBNP and IL-18 (r=0,18 p=0,045), MA with troponin I and CRP (r=0,20 p=0,048 and r=0,29 p=0,001). After six months, persistent renal function decline was more frequently diagnosed in patients with acute MI and AKI on index hospitalization. An equation for a multifactorial model for CKD risk was created: P(CKD)=exp(z)/(1+exp(z)), z=-1,113092e+01 — 4,082006e-02 * troponin I + 8,553826e-04 * NT-proBNP (discharge) + 1,620188e-01 * age + 3,411724e-02 * systolic blood pressure -7,753111e-03 * MA. ROC analysis revealed the most reliable sensitivity of 83% and specificity of 88,2% for the threshold value of CKD probability of 86,1%.Conclusion. Patients with MI and AKI have a significant risk of CKD within 6 months after ACS. The created mathematical model and calculator determine the likelihood of CKD.

Metabolic disorders induced by PNPLA3 and TM6SF2 gene variants affect chronic kidney disease in patients infected with non-genotype 3 hepatitis C virus

BackgroundPatients with chronic hepatitis C virus (HCV) infections differ in their risk for metabolic disorders and chronic kidney disease (CKD). The aim of this study was to investigate the effect of metabolic disorders induced by genetic factors on CKD in HCV-infected patients.MethodsPatients with chronic non-genotype 3 HCV infection with or without CKD were examined. PNPLA3 and TM6SF2 variants were determined using high-throughput sequencing. The relationships of variants and different combinations with metabolic disorders were analyzed in CKD patients. Univariate and multivariate analyses were used to identify factors associated with CKD.ResultsThere were 1022 patients with chronic HCV infection, 226 with CKD and 796 without CKD. The CKD group had more severe metabolic disorders, and also had higher prevalences of liver steatosis, the PNPLA3 rs738409 non-CC genotype, and the TM6SF2 rs58542926 CC genotype (all P < 0.05). Relative to patients with the PNPLA3 rs738409 CC genotype, patients with the non-CC genotype had a significantly decreased eGFR and a greater prevalence of advanced CKD (CKD G4-5). Patients with the TM6SF2 rs58542926 CC genotype had a lower eGFR and a higher prevalence of CKD G4-5 than those with the non-CC genotype. Multivariable analysis indicated that multiple metabolic abnormalities, including liver steatosis and the PNPLA3 rs738409 C > G variant, increased the risk of CKD, but the TM6SF2 rs58542926 C > T variant decreased the risk of CKD.ConclusionSpecific PNPLA3 rs738409 and TM6SF2 rs58542926 variants are independent risk factors for CKD in patients with chronic HCV infections and are associated with the severity of renal injury.

New Paradigms for CKD Management in Patients With T2D.

At the end of the activity, participants will be able to: Identify the risks of kidney disease and their consequences in patients with type 2 diabetes (T2D). Appropriately screen for the presence of chronic kidney disease (CKD) in patients with T2D. Initiate evidence-based therapy to slow the progression of kidney disease in patients with T2D and CKD. Become familiar with the novel nonsteroidal mineralocorticoid receptor antagonist finerenone and its role in the treatment of patients with T2D and CKD.