Kidney Function Status Research Articles

Proteinuria and Significant Dehydration in a Short-Steep Triathlon: Preliminary Observational Report

Background/Objectives: Endurance triathlons impose substantial physiological stress, yet the effects of short-course formats remain relatively unexplored. This preliminary study presents novel findings on proteinuria and hydration levels in well-trained triathletes. Methods: 27 participants (41.9 ± 7.4 years) who completed a sprint triathlon consisting of a 1500 m swim, 26 km cycle, and 8 km run. Urine samples were collected before and after the race. Results: Our results revealed a significant increase in post-race proteinuria cases from four to nine (p = 0.03) and the first reported case of post-race urobilinuria and ketoacidosis in this context. Additionally, pre-race glucosuria, present in nine cases, decreased to three post-race. Hematuria cases decreased from six to two (p = 0.13) and pre-race leukocyturia resolved post-race. There was a significant increase in urine specific gravity (from 1.018 to 1.023, p = 0.03), indicating dehydration. Conclusions: Short-course triathlons significantly induced post-race proteinuria, urobilinuria, and dehydration, highlighting the substantial physiological stress on kidney function and hydration status despite the shorter distances. These findings underscore the importance of monitoring urinary biomarkers and hydration levels in athletes before and after competition.

Relationship Between Serum Uromodulin as a Marker of Kidney Damage and Metabolic Status in Patients with Chronic Kidney Disease of Non-Diabetic Etiology.

Chronic kidney disease (CKD) is often associated with dyslipidemia, marked by lipid abnormalities that can worsen kidney function and increase cardiovascular risk. A promising biomarker for evaluating kidney function and metabolic status in chronic kidney disease (CKD) is serum uromodulin (sUmod). This study sought to further investigate the relationship between sUmod levels and metabolic status in non-diabetic CKD patients. A sensitive ELISA method was used to determine sUmod levels in 90 adults with obstructive nephropathy and 30 healthy controls. Kidney function was assessed using the measured glomerular filtration rate (mGFR) through renal clearance of 99mTc-diethylenetriamine penta-acetic acid, along with cystatin C levels. Additionally, glycemic and lipid statuses were evaluated. sUmod concentrations showed a significant association with High-density lipoprotein (HDL) levels. Furthermore, CKD patients with lower sUmod levels had significantly lower Apolipoprotein A-I (Apo A-I) values compared to the control group. Significant predictors of lower sUmod concentrations identified in this study were higher glycemia (B = -15.939; p = 0.003) and lower HDL cholesterol levels (B = 20.588; p = 0.019). We conclude that, in addition to being significantly reduced in CKD patients, sUmod is a potential predictor of metabolic syndrome (MS) in this population. Lower sUmod concentrations, independent of mGFR, predict lower HDL cholesterol levels and higher glycemia values.

Clustering Based on Laboratory Data in Patients With Heart Failure Admitted to the Intensive Care Unit.

Heart failure (HF) is a common condition that imposes a significant burden on healthcare systems. We aimed to identify subgroups of patients with heart failure admitted to the ICU using routinely measured laboratory biomarkers. A large dataset (N = 1176) of patients with heart failure admitted to the ICU at the Beth Israel Deaconess Medical Center in Boston, USA, between June 1, 2001, and October 31, 2012, was analyzed. We clustered patients to identify laboratory phenotypes. Cluster profiling was then performed to characterize each cluster, using a binary logistic model. Two distinct clusters of patients were identified (N = 679 and 497). There was a significant difference in the mortality rate between Clusters 1 and 2 (50 [7.4%] vs. 109 [21.9%], respectively, p < 0.001). Patients in the Cluster 2 were significantly older (mean [SD] age = 72.35 [14.40] and 76.37 [11.61] years, p < 0.001) with a higher percentage of chronic kidney disease (167 [24.6%] vs. 262 [52.7%], respectively, p < 0.001). The logistic model was significant (Log-likelihood ratio p < 0.001, pseudo R2 = 0.746) with an area under the curve of 0.905. The odds ratio for leucocyte count, mean corpuscular volume (MCV), red blood cell (RBC) distribution width, hematocrit (HcT), lactic acid, blood urea nitrogen (BUN), serum potassium, magnesium, and sodium were significant (all p < 0.05). Laboratory data revealed two phenotypes of ICU-admitted patients with heart failure. The two phenotypes are of prognostic importance in terms of mortality rate. They can be differentiated using blood cell count, kidney function status, and serum electrolyte concentrations.

Association between changes of frailty status/frailty components status and rapid loss of kidney function in middle- aged and older populations

BackgroundFrailty and its components are proposed to associate with kidney function, but little attention is paid to the significance of changes in their status on rapid loss of kidney function. This study aimed to investigate the association between changes in frailty and its components status with rapid loss of renal function.MethodsThis study used data from China Health and Retirement Longitudinal Study (CHARLS). Frailty status was measured using the Fried frailty phenotype (FP) scale, including five components: slowness, weakness, exhaustion, inactivity, and shrinking. Frailty status was further classified into three levels: robust (0 component), prefrail (1–2 components) and frail (3–5 components). Changes in frailty status were assessed by frailty status at baseline and 4- year follow-up. Rapid loss of kidney function was defined as a rate of estimate glomerular filtration rate(eGFR) decline ≥ 4 ml/min per 1.73 m2per year. Logistic regression models were performed to assess the association between changes in frailty status and its components status with rapid eGFR decline.ResultsA total of 2705 participants were included with 316 (11.68%) participants categorized as rapid eGFR decline during the 4-year follow-up. Compared with baseline prefrail participants who progressed to frail, prefrail participants who maintained prefrail or recovered to robust status had decreased risks of rapid eGFR decline (stable prefrail status, OR = 0.608, 95% CI: 0.396–0.953; recover to robust, OR = 0.476, 95% CI: 0.266–0.846). In contrast, among baseline robust or frail participants, we did not find changes in frailty status significantly affect the risks of rapid loss of kidney function. Moreover, participants who experienced incident weakness showed the significant relationship with an increased risk of rapid eGFR decline (OR = 1.531, 95% CI: 1.051–2.198) compared to stable non-weakness participants. Other changes of frailty components status did not significantly affect the risks of rapid eGFR decline.ConclusionsThe progression of frailty status increases the risks of rapid eGFR decline among prefrail populations. Preventing weakness, may benefit kidney function.

Impact of intra-patient variability of tacrolimus on allograft function and CD4 + /CD8 + ratio in kidney transplant recipients: a retrospective single-center study.

Tacrolimus is a critical component of immunosuppressive therapy for kidney transplant recipients. Intra-patient variation (IPV) of tacrolimus levels affects the function of transplanted kidney. This study aimed to investigate the impact of tacrolimus IPV on kidney function, examine its association with post-transplant duration, and assess its effect on the immune status of transplant recipients. This retrospective study was conducted from January 2016 to February 2022. IPV was evaluated using the coefficient of variation (CV) of tacrolimus trough levels from 6 to 48months after transplantation. Patients were divided into low- and high-IPV groups based on the median CV. Significant differences in kidney function, CD4 + /CD8 + ratio, and post-transplant duration between these groups were analyzed. Among 189 patients, tacrolimus IPV showed a strong correlation with serum creatinine clearance rate (Ccr) and estimated glomerular filtration rate (eGFR) (p < 0.05). Tacrolimus IPV was significantly correlated with post-transplant duration in only two patients (p < 0.05). Using a median CV of 15.4% to categorize patients, the high IPV group, compared to the low IPV group, exhibited significantly higher eGFR at 6-9months (p < 0.05), lower Ccr at 9-12months (p < 0.05), and reduced Ccr and eGFR at 15-18months (p < 0.05). Six months after transplantation, the high IPV group had a significantly lower CD4 + /CD8 + ratio than the low IPV group (p < 0.05). This study highlights the significant impact of tacrolimus IPV on transplant kidney function and immune status in transplant patients at various post-transplantation intervals.

Biochemical Markers in the Prediction of Pregnancy Outcome in Gestational Diabetes Mellitus.

Background and Objectives: Gestational diabetes mellitus (GDM) may impact both maternal and fetal/neonatal health. The identification of prognostic indicators for GDM may improve risk assessment and selection of patient for intensive monitoring. The aim of this study was to find potential predictors of adverse pregnancy outcome in GDM and normoglycemic patients by comparing the levels of different biochemical parameters and the values of blood cell count (BCC) between GDM and normoglycemic patients and between patients with adverse and good outcome. Materials and Methods: Prospective clinical study included 49 patients with GDM (study group) and 44 healthy pregnant women (control group) who underwent oral glucose tolerance test (OGTT) at gestational age of 24-28 weeks. At the time of OGTT peripheral blood was taken for the determination of glucose levels, insulin, glycated hemoglobin, lipid status, homeostatic model assessment, BCC, iron and zinc metabolism, liver function, kidney function and inflammatory status. Each group was divided into two subgroups-normal and poor pregnancy outcome. Results: Higher RBC, hemoglobin concentration, hematocrit value, fasting glucose, uric acid and fibrinogen were found in GDM patients compared to control group. In GDM patients with poor pregnancy outcome values of fibrinogen, ALT, sedimentation rate, granulocyte and total leukocyte counts were elevated, while the serum level of zinc was significantly lower. Higher level of fibrinogen was found in normoglycemic patients with adverse pregnancy outcomes. ROC curve was constructed in order to assess fibrinogen's biomarker potential. The established AUC value for diagnostic ROC was 0.816 (p < 0.001, 95% CI 0.691-0.941), while the AUC value for assessing fibrinogen's potential to predict poor pregnancy outcome in GDM was 0.751 (p = 0.0096, 95% CI 0.561-0.941). Conclusions: The results of our study demonstrated that the best prognostic potential in GDM showed inflammation related parameters, identifying fibrinogen as a parameter with both diagnostic and prognostic ability.

Challenges in the development of novel methodologies for measuring glomerular filtration rate

Measurement of glomerular filtration rate (GFR) is crucial in assessing kidney function status. Estimating GFR using clearance methodologies is cumbersome, as plasma and urinary concentrations and timed urine collections are required. Recently, a transcutaneous sensor has been developed whereby the rate of renal washout of a fluorescent marker administered intravenously allows calculation of GFR. The challenge is to ensure that the values of GFR obtained using the washout approach are in accord with those obtained conventionally.

The association between overactive bladder and systemic immunity-inflammation index: a cross-sectional study of NHANES 2005 to 2018

Current research indicate that inflammation is linked to the development of overactive bladder (OAB). The aim of this study was to examine the correlation between OAB and the systemic immunity-inflammation index (SII) in the USA. We analyzed data from 31,881 participants in the National Health and Nutrition Examination Survey 2005–2018. SII, calculated as platelet count × neutrophil count/lymphocyte count, was categorized into quartiles. OAB was defined by the presence of urge urinary incontinence and nocturia. Weighted logistic regression models were used to examine the independent relationship between SII and OAB, adjusting for demographic factors, kidney function, and diabetes status. The results showed that each tenfold increase in log-transformed SII was associated with an 18% higher odds of OAB (OR 1.18, 95% CI 1.08–1.28) in the fully adjusted model. Compared to the lowest SII quartile, the highest quartile had a 28% increased OAB risk (OR 1.28, 95% CI 1.12–1.47). The positive association between SII and OAB risk was consistently observed across subgroups stratified by age, sex, race, marital status, education, and poverty level. Our study reveals a positive correlation between SII levels and OAB, indicating that higher SII levels are associated with an increased likelihood of developing OAB.

#741 Gender differences in vascular access for prevalent dialysis patients

Abstract Background Gender disparities of some aspects of vascular access (VA) for hemodialysis (HD) have been reported. Aim To analyze the VA profile of prevalent HD patients (pts) according to gender in Catalonia Method Data from the Catalan Renal Registry of end-stage kidney disease (ESKD) pts over 18 years of age treated by HD on 31 December were examined from 1997 to 2021. Results The total cumulative number of follow-ups registered for prevalent ESKD pts treated by HD was 95 575 out of 25 130 pts; we have VA information for most of the follow-ups (93.1%, 88 980/95 575). The number of prevalent HD pts increased from 3104 in 1997 to 4270 in 2021. The characteristics of prevalent HD pts in 2021 (n = 4270) were different for male (n = 2731) vs female (n = 1539) regarding mean age (69.1 ± 14.6 vs 70.9 ± 14.3 years), age bracket &amp;gt;74 years (42.4% vs 48.3%), median time on HD [24.0 (9.8−48.2) vs 27.6 (10.5−59.1) ], aetiology of ESKD as polycystic kidney disease (4.4% vs 7.2%), normal functional status (38.0% vs 28.4%), cardiovascular disease (76.3% vs 71.1%) and obesity rate (body mass index BMI&amp;gt;30 kg/m2: 17.4% vs 27.2%) (for all comparisons, p &amp;lt; 0.001). The distribution of the VA used for performing HD in 2021 was also different in men vs women: fistula AVF (58.1%, n = 1465 vs 45.6%, n = 657), graft (1.8%, n = 45 vs 3.5%, n = 51) and tunnelled catheter (35.8%, n = 903 vs 45.8%, n = 660) (for all comparisons, p &amp;lt; 0.001) ; there were no differences for non-tunnelled catheter (4.3%, n = 107 vs 5.0%, n = 72) (p = 0.15). In addition, the type of AVF was different in men vs women: radiocephalic AVF (53.9% vs 40.9%) and brachial artery-based AVF (46.1% vs 59.1%) (p &amp;lt; 0.001). The percentage of pts who required at least one hospital admission or outpatient procedure for any VA pathology in 2021 was similar when comparing men [7.3% (n = 180) and 19.6% (n = 456), respectively] and women [8.6% (n = 122) and 19.3% (260), respectively] (p = 0.34 and p = 0.38, respectively). Regarding the total cumulative number of VA used for HD, the percentage of pts who used only one VA was higher for men (50.4%, n = 1265) than women (47.1%, n = 663); however, this difference is reversed when the percentage of pts who used ≥4 VA was calculated: 11.5% (n = 289) vs 14.4% (n = 203) (for all comparisons, p = 0.001). The percentage of pts who have been dialyzed through AVF at some point over time was higher for men (69.2%, n = 1889) than women (62.6%, n = 964) (p &amp;lt; 0.001) The probability of performing HD through AVF in 2021was independently associated with male gender (odds ratio 1.58 [95% confidence interval: 1.36–1.82], p &amp;lt; 0.001) after adjusting for age, time on HD, primary kidney disease, cardiovascular disease, functional status and BMI (multivariate logistic regression analysis). The percentage of both men and women on HD through AVF decreased progressively from 1997 (89.1% and 81.3%, respectively) to 2021 (58.1% and 45.6%, respectively) (for both comparisons, p &amp;lt; 0.001). The percentage of prevalent men on HD with AVF was always higher over time than that of women from 1997 (89.1% vs 58.1%) to 2021 (81.3% vs 45.6%) (for both comparisons, p &amp;lt; 0.001). Conclusions 1) AVF was the main type of VA used for prevalent men on HD, but AVF and tunnelled catheter shared this ranking in women. 2) Male gender was an independent factor associated with a 58% greater probability of performing HD through AVF than female. 3) The percentage of prevalent HD pts dialyzed through AVF progressively decreased over time in both sexes but it was always higher in men than women. 4) The type of AVF mainly used was different depending on gender: radiocephalic AVF for men and brachial artery-based AVF for women.

#2831 A randomised controlled study of a Combined Home-based ExERcISe and Nutritional ApproacH to improve frailty in kidney transplant recipients (CHERISH)

Abstract Background and Aims Post-transplantation frailty is common, with a prevalence of up to 52% in kidney transplant recipients (KTRs), and is associated with increased mortality, recurrent hospitalisation and inferior quality of life (QoL). Resistance exercise training (RET) was found to improve frailty in this patient group. Both high and low protein intakes were associated with potential risk of graft failure. To date, no studies have evaluated the safety and efficacy of RET combined with protein supplementation (RETPS) in KTRs. The objectives of this study were to investigate the effect of RETPS on kidney function and frailty status in KTRs, and assess its impact on QoL. Method Forty clinically stable KTRs ≥1 year post-transplantation [mean age = 54 ± 14 years; 50% male, median time post-transplantation = 7 years] were enrolled and randomised to either RET (n = 20) or RETPS (n = 20). All participants completed a 30-minute home-based progressive RET regimen 2-3 times weekly for 12 weeks, guided by an exercise worksheet and a study-specific video link. Participants received weekly telephone call to ensure safety and compliance of the interventions. The RETPS group received additional body-weight adjusted whey protein supplementation 1-hour post exercise. Total daily dietary protein intake did not exceed 1.40 g/kg/day to confine to a safe level of protein consumption in KTRs. Kidney function was measured by estimated glomerular filtration rate (eGFR), creatinine, and albumin-creatinine ratio (ACR). Frailty was evaluated using Fried Frailty Phenotype (FFP), Short Performance Physical Battery (SPPB), 60-second Sit-to-Stand test (60s-STST), handgrip- (HG) and back-leg-chest- (BLC) derived muscle strength, bioimpedance-derived lean tissue index (LTI), and ultrasound-derived thigh muscle thickness (TMT). QoL was assessed using Short Form (SF) -36 questionnaire. All measurements were performed at baseline and at week 12. Results Kidney function did not differ significantly between baseline and week 12 in both RET [eGFR: 62.1 vs 59.7 ml/min; creatinine: 107.3 vs 111.5 μmol/L; ACR: 12.8 vs 10.4 mg/mmol] and RETPS [eGFR: 61.2 vs 60.7 ml/min; creatinine: 101.1 vs 102.2 μmol/L; ACR: 17.6 vs 20.9 mg/mmol] groups. Frailty status assessed by FFP and SPPB improved in both RET [FFP: 2.5 vs 1.3, P &amp;lt; .001; SPPB: 7.2 vs 11.6, P &amp;lt; .001] and RETPS [FFP: 2.8 vs 1.1, P &amp;lt; .001; SPPB: 6.4 vs 10.9, P &amp;lt; .001] groups, but the improvements did not differ significantly between groups (P &amp;gt; 0.23). Improvements in 60s-STST, HG-derived muscle strength, BLC-derived muscle strength, and ultrasound-derived TMT were observed in both RET [60s-STST: 23 vs 27, P &amp;lt; .001; HG-derived muscle strength: 24 vs 30 kg, P &amp;lt; .001; BLC-derived muscle strength: 62 vs 71 kg, P &amp;lt; .001; ultrasound-derived TMT: 15 vs 19 mm, P &amp;lt; .001] and RETPS [60s-STST: 20 vs 29, P &amp;lt; .001; HG-derived muscle strength: 24 vs 32 kg, P &amp;lt; .001; BLC-derived muscle strength: 57 vs 80 kg, P &amp;lt; .001; ultrasound-derived TMT: 14 vs 21 mm, P &amp;lt; .001] groups, with greater improvements in RETPS group for 60s-STST (P &amp;lt; .01), HG-derived muscle strength (P &amp;lt; .05), BLC-derived muscle strength (P &amp;lt; .05), and ultrasound-derived TMT (P &amp;lt; .001). For bioimpedance-derived LTI, improvement was observed only in RETPS group [12.8 vs 14.8 kg/m2, P &amp;lt; .05]. SF-36-derived overall-, physical- and mental- related QoL improved in both groups (P &amp;lt; .05 for all), with RETPS group reporting a greater improvement in physical-related QoL (P &amp;lt; .05). Conclusion This represents the first study demonstrating RET combined with protein supplementation is safe and effective in improving frailty and QoL in KTRs. Protein supplementation augments increased muscle mass and strength beyond RET effect, further enhancing improvement in physical-related QoL.

#1620 Association of dietary live microbe intake with chronic kidney disease based on baseline characteristics of national population: NHANES 2011-2018

Abstract Background and Aims The gut microbiota plays a crucial role in a variety of diseases, including chronic kidney disease (CKD). The gut-kidney axis is mediated through metabolism dependent pathways. The relationship between CKD and the dietary consumption of live microbes has not been explicitly studied. Probiotic food intake may play a beneficial role in human health including the gut microbiota. However, in addition to probiotic foods, live micro-organisms are also found in other food products, such as raw vegetables and fruits. In this study, we adjusted for the potential association between dietary live microbiome intake and chronic kidney disease (CKD) in different baseline characteristics, including kidney function status. Method A total of 22,039 subjects were included in the study. We used data from the US National Health and Nutrition Examination Survey 2011-2018. Based on a 2-day 24-hour dietary recall, the dietary intake of the live microbiome was adjusted and the participants were categorized into three groups: low (&amp;lt;104 CFU/g), medium (104–107 CFU/g), or high (&amp;gt;107 CFU/g) dietary intake of live microbes, according to the classification system for the dietary intake of live microbes and participants’ 24-hour dietary recall data. Low intake was used as a reference. Stage 3 CKD with high risk of progression was defined by a combination of estimated glomerular filtration rate (GFR-EPI &amp;lt;60 mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (uACR &amp;gt;30 mg/g was defined as microalbuminuria). CKD was defined by a combination of GFR-EPI &amp;lt;60 mL/min/1.73 m2 or uACR, &amp;gt;30 mg/g. Albuminuria was defined as uACR &amp;gt;300 mg/g. The analyses used weighted logistic regression models (crude model and first, adjusted for age, gender, race, education and second, adjusted for hypertension, diabetes, total cholesterol level, BMI, hemoglobin level, total calorie intake, GFR and serum creatinine level). Results After model adjustment (Model 2, p&amp;lt; 0.0001), women in the medium dietary live microbe intake group had a low prevalence of stage 3 CKD with high risk of progression in contrast to those in the low dietary live microbiome intake group (OR: 0.913, 95% Cl: 0.63-1.32, p&amp;lt; 0.01), between high and low group (OR: 0.333, 95% Cl: 0.13-0.86, p&amp;lt; 0.01). However there was no significant association in men. In model 2, patients in the medium dietary live microbiome intake group had a low prevalence of microalbuminuria in contrast to those in the low dietary live microbiome intake group (OR: 0.789, 95% Cl: 0.63-0.98, p&amp;lt; 0.05). In model 2, we also found the significant association with albuminuria between high and low (OR 0.784, 95% Cl: 0.63-0.98, p&amp;lt; 0.05), medium and low (OR: 0.572, 95% Cl: 0.33-0.98, p&amp;lt; 0.05) dietary live microbiome intake patient groups. In model 2, those in the medium dietary live microbe intake group had a low prevalence of CKD in contrast to those in the low dietary live microbiome intake group (OR: 0.896, 95% Cl: 0.82-0.98) p&amp;lt; 0.01), but there was no significant association between the high and low dietary live microbiome intake groups. Conclusion In this study, a medium or high dietary live microbiome intake was associated with a low prevalence of stage 3 CKD with ahigh risk of progression in women. A medium dietary live microbiome intake was associated with a low prevalence of chronic kidney disease or microalbuminuria in the population. A medium or high dietary live microbiome intake was associated with a low prevalence of albuminuria. A medium dietary live microbiome intake was associated with a low prevalence of microalbuminuria.

#676 Correlation between dietary live microbe intake and all-cause mortality based on baseline characteristics: results from NHANES 2011-2018

Abstract Background and Aims The gut microbiome plays a beneficial role in human health, including kidney function and chronic kidney disease progression. Potential therapeutic strategies for CKD and hypertension that target the gut microbiota include dietary interventions, mainly probiotic, prebiotic, synbiotic modulation. In addition to probiotic foods, live micro-organisms are also found in other food products, such as raw vegetables and fruits. In this study, we evaluated the potential impact of dietary live microbiome intake on all-cause mortality in different baseline characteristics, including kidney function status. Method A total of 20 627 subjects were included in the study. We used data from the US National Health and Nutrition Examination Survey 2011-2018. Based on a 2-day 24-hour dietary recall, the dietary intake of the live microbiome was adjusted and the participants were categorized into three groups: low (&amp;lt;104 CFU/g), medium (104–107 CFU/g), or high (&amp;gt;107 CFU/g) dietary intake of live microbes, according to the classification system for the dietary intake of live microbes and participants’ 24-hour dietary recall data. Low intake was used as a reference. Baseline characteristics included kidney function by estimated glomerular filtration rate (GFR-EPI &amp;lt;60 mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (uACR &amp;gt;30 mg/g). We used a multivariate Cox proportional hazards model to identify the impact of dietary live microbiome intake on all-cause mortality. In subgroups, we adjusted the Hazard Ratio (aHR) of the additional factors in the models. Results The risk for all-cause mortality was significantly decreased in subjects included in the medium dietary live microbiome intake (HR: 0.82, 95% Cl: 0.73-0.93, p &amp;lt; 0.004). In subgroup analysis (N = 3302), medium dietary intake of the live microbiome decreased mortality in subjects with eGFR &amp;lt;60 mL/min/1.73 m2 or uACR &amp;gt;30 mg/g and BMI &amp;gt;25 (aHR: 0.86, 95% CI: 0.75-0.99, p&amp;lt;0.05) as compared to low dietary intake of the live microbiome group after adjustment for hypertension, diabetes, BMI, total calorie intake, laboratory results (hemoglobin, creatinine, total cholesterol, estimated glomerular filtration rate). However, there was no significance to the risk for all-cause mortality in the subgroup with CKD between the high and low dietary live microbiome intake groups. Conclusion In this study, low dietary live microbial intake significantly increased all-cause mortality in the population. The medium dietary intake of live microbiome significantly decreased all-cause mortality in overweight or obese patients with CKD or microalbuminuria.

Impact of kidney disease on perioperative outcomes of endoscopic BPH surgery: a propensity score matched analysis from the NSQIP database.

To assess the impact of kidney function in patients with BPH undergoing surgery prior to Transurethral resection of prostate (TURP), Laser enucleation of the prostate (LEP), and Laser Vaporization of the prostate (LVP) on operative and post-operative outcomes using the ACS-NSQIP database. The ACS-NSQIP database was reviewed for patients that underwent TURP, LEP and LVP for treatment of patients with BPH between the years of 2008 and 2021. Demographics, comorbidities, bleeding disorders, operative time, and surgical procedure performed were collected for comparison between Kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease. The 30-day peri-operative complications were measured and a multivariate logistic regression analysis was performed while adjusting for all confounding variables. Propensity score matching was performed between the G1 and G4-G5 cohorts. A total of 83,020 patients were included. On multivariable regression, in the G2-G3 cohort, patients were at significantly increased risk for renal complications with OR = 2.43[1.56-3.79]. After propensity score matching, the G4-G5 cohort showed increased odds of pneumonia OR = 4.02[1.343-12.056], renal complications with OR = 7.62[2.283-25.411], cardiac complications OR = 4.53[1.531-13.411], and sepsis/septic shock OR = 1.76[1.091-2.834]. They also had a higher need for blood transfusion OR = 3.58[2.242-5.714], and prolonged hospital stay with OR = 1.49[1.296-1.723]. Pre-operative kidney disease may pose an increased risk of complications for patients undergoing endoscopic BPH surgery. The literature lacks information on the effect of pre-operative kidney disease on endoscopic BPH surgeries. Further studies are required to compare post-operative outcomes of LEP and LVP as compared to TURP across kidney function status.

Impaired kidney function, cerebral small vessel disease and cognitive disorders: the Framingham Heart Study.

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

Forgotten ureteral stents: a systematic review of literature

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

Impact of metformin on cardiovascular and kidney outcome based on kidney function status in type 2 diabetic patients: a multicentric, retrospective cohort study

Metformin is the primary treatment for type 2 diabetes mellitus (T2DM) due to its effectiveness in improving clinical outcomes in patients with preserved renal function, however, the evidence on the effectiveness of metformin in various renal functions is lacking. We performed a retrospective, multicenter, observational study used data of patients with T2DM obtained from three tertiary hospitals’ databases. Patients given metformin within run-in periods and with at least one additional prescription formed the metformin cohort. A control cohort comprised those prescribed oral hypoglycemic agents other than metformin and never subsequently received a metformin prescription within observation period. For patients without diabetic nephropathy (DN), the outcomes included events of DN, major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE). After 1:1 propensity matching, 1994 individuals each were selected for the metformin and control cohorts among T2DM patients without baseline DN. The incidence rate ratios (IRR) for DN, MACEs, and MAKEs between cohorts were 1.06 (95% CI 0.96–1.17), 0.76 (0.64–0.92), and 0.45 (0.33–0.62), respectively. In cohorts with renal function of CKD 3A, 3B, and 4, summarized IRRs of MACEs and MAKEs were 0.70 (0.57–0.87) and 0.39 (0.35–0.43) in CKD 3A, 0.83 (0.74–0.93) and 0.44 (0.40–0.48) in CKD 3B, and 0.71 (0.60–0.85) and 0.45 (0.39–0.51) in CKD 4. Our research indicates that metformin use in T2DM patients across various renal functions consistently correlates with a decreased risk of overt DN, MACE, and MAKE.

Several laboratory variables indicate severity and prognosis of COVID-19.

While several laboratory variables have been used to assess COVID-19 disease, to our knowledge, no attempt has previously been made to compare differences across different patient groups. We attempted to evaluate the relationship between laboratory variables and severity of the disease as well as on prognosis. We searched BioLINCC database and identified three studies which had separately included outpatients, inpatients, and ICU patients. For this re-analysis, we extracted data on general demography, laboratory variables and outcome. In total, 2454 participants (496 outpatients [Study 1], 478 inpatients [Study 2], and 1480 ICU patients [Study 3]) were included in the analysis. We found three laboratory variables (i.e., creatinine, aspartate transferase, and albumin) were not only prognostic factors for outcome of inpatients with COVID-19, but also reflected disease severity as they were significantly different between inpatients and ICU patients. These three laboratory variables are an indication of kidney function, liver function, and nutritional status. For patients with COVID-19, in addition to monitoring infectious disease indicators, we need to pay attention to liver function, renal function, and take timely measures to correct them to improve prognosis.

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

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

COMPARISON BETWEEN RENOPROTECTIVE EFFECTS OF FEBUXOSTAT AND ALLOPURINOL IN CHRONIC KIDNEY DISEASE PATIENTS WITH HYPERURICEMIA

Objective: The objective of the study was to compare the renoprotective effects of febuxostat versus allopurinol in chronic kidney disease patients with hyperuricemia. Methods: One hundred and ten patients were divided randomly into two equal groups: group F (febuxostat) and group A (allopurinol). Group F patients received tablet febuxostat 40 mg OD for 4 months and group A patients received tablet allopurinol 100 mg TDS for 4 months. Following parameters such as estimated glomerular filtration (eGFR) assessment, serum creatinine, serum uric acid (SUA), total serum protein, urine creatinine, urine protein, blood urea, and number of dialysis were carried out and repeated at the end of 1st–4th month to check for the effect of the test drugs on the status of kidney function. Observations: Febuxostat caused more rise in eGFR than allopurinol. Meanwhile, the number of patients with eGFR ≤15/mL/min/1.73 m2 showed no difference between the groups. No patient showed &gt;10% decrease in the eGFR values. Febuxostat showed more decline in SUA levels than allopurinol, although the number of patients reaching the target SUA levels was the same in both groups. Febuxostat led to a more reduction in serum creatinine levels than allopurinol. Urine creatinine and urine albumin levels decline were associated more with febuxostat. No remarkable difference in comparison of both the groups in terms of total serum protein and serum globulin, although a significant rise was seen with febuxostat in serum albumin levels. Both drugs had a similar sequel in declining blood urea nitrogen levels. No discernible difference in the number of dialysis sessions needed by patients in the previous month was seen in the study groups. Conclusion: The present study concluded that febuxostat appears to be a better alternative to allopurinol for chronic kidney disease patients with hyperuricemia. Febuxostat has a superior renoprotective effect than allopurinol.

Association of physical activity with endothelial dysfunction among adults with and without chronic kidney disease: The Maastricht Study

Background and aimsPhysical activity (PA) constitutes an established protective factor while sedentary behavior (SB) an emerging independent risk factor for cardiovascular diseases. This study evaluated the association of PA and SB with endothelial dysfunction (ED) depending on kidney function status. MethodsCross-sectional data from the prospective, population-based Maastricht Study were used. PA and SB were measured using the ActivPAL3 accelerometer 24h/day for eight consecutive days. ED was evaluated by plasma levels of soluble vascular cell adhesion protein-1, intercellular adhesion molecule-1, E-selectin and von Willebrand factor, which were combined into an ED score with higher values depicting higher ED. ResultsOverall, 2,668 participants, 323 with chronic kidney disease, were included. In normal kidney function individuals, the ED score presented a significant negative association with total, lower-intensity and moderate-to-vigorous PA duration and a positive association with total sedentary time, sedentary breaks and sedentary bout duration. In participants with chronic kidney disease, a significant negative association of ED score with total [β: -4.42, 95% confidence intervals (95% CI): -7.98; −0.87] and lower-intensity (β: -7.08, 95% CI: -13.41; −0.74) PA duration, as well as a positive association of ED score with sedentary bout duration (β: 43.72, 95% CI: 9.85; 77.59) were noted. The strength of associations did not significantly differ across kidney function subgroups (p > 0.05). ConclusionsThis analysis showed that PA duration is inversely associated with ED both among patients with normal kidney function and chronic kidney disease. In chronic kidney disease, longer sedentary bouts were associated with greater endothelial dysfunction.