Kidney Outcomes Research Articles

Clinical characteristics, disease flares, infections and their impact on kidney outcomes in pediatric lupus nephritis: A cohort study.

Limited data exists on clinical predictors of kidney outcomes in children with lupus nephritis (LN). Children aged below 18years with biopsy-proven LN followed from January 2010 to February 2024 in a tertiary-care center were enrolled in order to characterize their clinical presentations, flares, infections, histology and determine Major Adverse Kidney Events (MAKE) (defined as eGFR < 60mL/min/1.73 m2 and/or death). Data was analysed to identify predictive factors of adverse outcomes. Seventy-five children (20% boys) with median (IQR) age at diagnosis 11.2 (9,13) years, were studied. Clinical presentations were nephritic syndrome, mixed nephritic-nephrotic features, rapidly progressive glomerulonephritis (RPGN), and nephrotic syndrome in 24 (32%), 15 (20%), 11 (14.7%) and 5 (6.7%) patients, respectively. Proliferative LN was the major (70.6%) histological subtype. In total, 75 kidney flares (21.3% nephritic) with incidence rate (IR) of 0.48 flares per person-year were noted in 31 (41.3%) children. Infections occurred in 32 (42.6%), with IR of 0.58 episodes per person-year. Bacterial pneumonia 14 (22.9%), sepsis 10 (16.3%) and tropical infections 6 (9.8%) were most common. At median last follow-up of 2.3 (1.3, 5.6) years with 85.4% kidney-survival rate, 41 (54.6%), and 21 (28%) were in complete-response (CR), and partial-response (PR), respectively. Proliferative LN and those in PR or NR were at significantly higher risk of kidney flares and infections, regardless of initial induction therapy. RPGN at presentation, non-responders at 6months and severe kidney flare ever predicted MAKE in 11 (14.6%) children. Multiple kidney flares and infections constitute a significant morbidity in LN. RPGN, non-responders and severe kidney flare predict adverse kidney outcomes.

WCN25-352 Impact of loop diuretic use at baseline on kidney outcomes; a post-hoc analysis in the STOP-ACEi Trial

WCN25-352 Impact of loop diuretic use at baseline on kidney outcomes; a post-hoc analysis in the STOP-ACEi Trial

The relationship between probiotics and prebiotics, kidney dysfunction and mortality - Results from a longitudinal cohort study and Mendelian randomization.

The benefits of probiotics/prebiotics consumption on chronic kidney disease (CKD) and mortality remains controversial. This study investigates the association of probiotics/prebiotics consumption with chronic kidney disease (CKD) and mortality. Clinical data were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 database. Weighted multivariable logistic and liner regression models, cox proportional hazards models and stratified analysis were used to analyse the relationships between consumption of probiotics/prebiotics, renal parameters, CKD and mortality. We also conducted a two-sample Mendelian randomization (MR) analysis of single nucleotide polymorphisms (SNPs) related to different genera of gut microbiota to assess their causal relationships with CKD and mortality. 15,291 subjects were analysed (897 with consumption of probiotics/ prebiotics and 14,394 without). The use of probiotics/prebiotics showed an inverse correlation with urinary albumin-to-creatinine ratio (UACR) (P < 0.05). Probiotics/prebiotics use was associated with lower risk of CKD in subjects with hypertension, hyperlipidaemia and diabetes mellitus. The consumption of probiotics/prebiotics was associated with a significantly lower risk of all-cause mortality in different regression models (P <0.001, for all), but the lower risk of cardiovascular mortality did not reach statistical significance (P >0.05, for all)]. MR analysis showed negative associations between the genetically predicted genus Flavonifractor and risk of CKD and diabetic kidney disease (DKD). After multivariable regression, and cox proportional hazards analysis, we found that the use of probiotics/prebiotics was associated with improved kidney and mortality outcomes in the general population from NHANES database. The two-sample MR analysis provided further genetic evidence that a distinct genus of gut microbiota was associated with reduced risk of CKD, DKD and mortality.

Kidney Biopsy-Proven Diabetic and Non-Diabetic Kidney Diseases and Outcomes in Patients With Type 2 Diabetes Receiving Dialysis: The REIN Registry.

Chronic kidney disease (CKD) in patients with diabetes does not always equate to diabetic kidney disease (DKD). This study aims to delineate and compare the clinical characteristics, survival rates, and access to kidney transplantation among patients with type 2 diabetes commencing dialysis, who were classified by kidney biopsy as having either DKD or non-diabetic kidney disease (non-DKD). We used the comprehensive French Renal Epidemiology and Information Network registry to analyze baseline clinical characteristics at dialysis inception and outcomes defined as death and access to kidney transplantation. We employed a multivariate Cox proportional hazards model and the Fine-Gray competing risk model to assess the probabilities of mortality and transplantation. Adults in the Renal Epidemiology and Information Network registry in France with a diagnosis of type 2 diabetes who initiated kidney replacement therapy from January 2009 to December 2015 and had a previous native kidney biopsy. We analyzed data from 2,869 patients with diabetes, 45% of whom had a biopsy-confirmed diagnosis of DKD. Among these patients, half presented additional histopathological findings indicative of nephroangiosclerosis and focal segmental glomerulosclerosis. The clinical profiles of patients with DKD and non-DKD were largely comparable. There were no significant differences in dialysis survival rates or kidney transplantation access between the groups, even after adjusting for confounding variables and considering competing risks. At the 6-year mark, the mortality rate was 60.3% (95% CI: 55.5-64.5) for the DKD group and 60.3% (95%CI: 55.9-64.3) for the non-DKD group. Multivariable Cox analysis revealed no significant difference in mortality risk between the DKD and non-DKD groups. The study limitations include potential residual confounders, lack of predialysis data, kidney biopsies possibly outdated, nonrandom biopsy indications, and survival bias because of analysis at dialysis inception. In patients with diabetes initiating dialysis, clinical characteristics and outcomes following dialysis initiation were similar in biopsy-proven DKD versus non-DKD. Our results suggest that the diabetic milieu has a more significant impact on outcomes in patients with diabetes treated with dialysis than the underlying pathological kidney diagnosis.

Acute kidney injury in critically ill COVID-19 patients in a tertiary hospital: short and long-term kidney and patient outcomes.

Acute kidney injury (AKI) in the setting of COVID-19 is associated with worse clinical and renal outcomes, with limited long-term data. To evaluate critically ill COVID-19 patients with AKI that required nephrologist consultation (NC-AKI) in a tertiary hospital. Prospective single-center cohort of critically ill COVID-19 adult patients with NC-AKI from May 1st, 2020, to April 30th, 2021. Kidney replacement therapy (KRT), recovery of kidney function, and death at 90-day and 1-year follow-up were evaluated. 360 patients were included, 60.6% were male, median age was 66.0 (57.0-72.0) years, 38.1% had diabetes, and 68.6% had hypertension. AKI stages 1, 2, and 3 were detected in 3.6%, 5.6%, and 90.8% of patients, respectively. KRT was indicated in 90% of patients. At the 90-day follow-up, 88.1% of patients died and 10.0% had recovered kidney function. Female gender (p = 0.047), older age (p = 0.047), AKI stage 3 (p = 0.005), requirement of KRT (p < 0.0001), mechanical ventilation (p < 0.0001), and superimposed bacterial infection (p < 0.0001) were significantly associated death within 90 days. At 1 year, mortality was 89.3%. Amongst surviving patients, 72% recovered kidney function, although with significantly lower eGFR compared to baseline (85.5 ± 23.6 vs. 65.9 ± 24.8 mL/min, p = 0.003). Critically ill COVID-19 patients with NC-AKI presented a high frequency of AKI stage 3 and KRT requirement, with a high 90-day mortality. Surviving patients had high rates of recovery of kidney function, with a lower eGFR at one-year follow-up compared to baseline.

Kidney growth progression patterns in autosomal dominant polycystic kidney disease

BackgroundPrognosis for autosomal dominant polycystic kidney disease (ADPKD), the main inherited cause of kidney failure, relies on estimating cystic growth using linear formulas derived from height-adjusted total kidney volume (Ht-TKV). However, nonlinear renal growth patterns may occur in typical ADPKD. AimsTo determine kidney outcomes of subjects diagnosed with typical ADPKD exhibiting nonlinear, and unpredictable cystic growth during follow-up. MethodsRetrospective cohort study. We categorized TKV changes in individuals with typical ADPKD according to observed kidney growth trajectories. Ht-TKV was calculated from consecutive CT or MRI using the ellipsoid method. We compared estimated glomerular filtration rate (eGFR) trajectories with linear mixed models. ResultsWe included 83 individuals with ADPKD (67% women; age 47 ± 12 years; follow-up 5.2 years [IQR 2.8–9.0]). Three kidney growth patterns were observed: slow progression (24%, <3%/year linear increase), fast progression (39%, ≥3%/year linear increase), and atypical progression (37%, nonlinear growth). Adjusted ht-TKV change in mL/m/year was +1.4 (IQR –4.5 to +10.0), +40.3 (+16.9 to +89.3), and +32.8 (+15.9 to +85.9) for slow, fast, and atypical progressors, respectively (p <0.001). Atypical progressors exhibited a significantly greater decline in eGFR in mL/min/m²/year (–7.9, 95% CI –6.5, –3.9) compared to slow (–0.5, 95% CI –3.1 to +0.5) and fast progressors (–3.4, 95% CI –7.9, –2.0; between-group p <0.001). Atypical progressors had a higher proportion of acute complications, including hemorrhages, infections, and urolithiasis (84%), compared to slow (20%) and fast progressors (31%) (p <0.001). ConclusionIn typical ADPKD, nonlinear, abrupt, and unpredictable cyst growth occurs frequently, leading to a higher risk of acute complications and kidney function decline.

Kidney and pregnancy outcomes in pregnancy-associated atypical hemolytic uremic syndrome: A systematic review and meta-analysis.

Pregnancy-associated atypical hemolytic uremic syndrome (p-aHUS) is a rare, life-threatening condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, elevated liver enzymes, and acute kidney injury. Prompt diagnosis and therapy are crucial due to the high risk of progression to chronic kidney disease (CKD), end-stage kidney disease (ESKD), and dialysis dependency, as well as significant maternal and fetal morbidity and mortality. A comprehensive literature search was conducted across EMBASE, MEDLINE, and the Cochrane CENTRAL from January 2000 to March 2024. Studies reporting on pregnancy and kidney outcomes in women diagnosed with p-aHUS were included. Ten studies involving 386 pregnancies in 380 patients met the inclusion criteria for the final analysis. Renal outcomes varied, with mean creatinine levels ranging from 0.72 to 8.734 mg/dL. Dialysis was required in 66.6% of patients, and 25% developed ESKD. Maternal complications included preeclampsia (36.4%) and hemolysis, elevated liver enzymes, and low platelets syndrome (29.7%), with a 5% maternal mortality rate. Fetal complications included intrauterine fetal demise (n = 25), intrauterine growth restriction, low birth weight, and prematurity. Treatment with eculizumab significantly reduced the risk of CKD and ESKD, with a pooled risk ratio of 0.20 (95% confidence interval: 0.09-0.44) and low heterogeneity (I² = 0%, P = .43). This analysis highlights the severe kidney and pregnancy outcomes associated with p-aHUS. Eculizumab treatment is significantly beneficial in reducing the risk of CKD and ESKD.

The Association of Niacin Use with Kidney Outcomes and Mortality.

Niacin is a non-statin lipid-lowering therapy that has been shown to lower triglycerides and improve other risk factors for renal outcomes. Despite these favorable data, the effect of niacin on long-term kidney outcomes remains unclear. The aim of this study is to examine the associations of niacin therapies with incident chronic kidney disease (CKD), end-stage renal disease (ESRD), and death in patients with estimated glomerular filtration (eGFR) of at least 60 mL/min/1.73 m2. In a nationwide historic cohort of 1,139,630 US Veterans with normal baseline eGFR, we examined the association of de novo prescription of niacin with incident CKD (defined as eGFR <60 ml/min/1.73m2 on two occasions, separated by ≥90 days), ESRD (defined as the initiation of kidney replacement therapy), and death. Associations were examined in Cox proportional hazard models adjusted for demographics, major comorbidities, laboratory measurements, and medications. Prescription time-distribution matching was used to control for survival bias. We identified 133,450 new users of niacin. Overall, patients (n=1,139,630) had a mean (standard deviation; SD) age of 60 (13) years, with 6% female, 78% White, 16% Black, and 6% Hispanic. Niacin users were more likely to be male, White, current, or former smokers, with higher frequencies of comorbidities and statin use. Niacin use (vs. non-use) was associated with a higher risk of CKD (HR: 1.08, 95% confidential interval [CI]:1.07-1.10) but a lower risk of ESRD (0.82, 0.76-0.88) and death (0.90, 0.89-0.91). In a large national cohort of US Veterans with normal kidney function, niacin use was associated with a lower risk of ESRD and death but with a higher risk of incident CKD, which is potentially explained by acute effects on eGFR. Further studies are needed to corroborate the potential benefits of niacin on kidney function and survival.

Kidney Replacement Therapies and Outcomes in Children With Crush Syndrome–Associated Kidney Injury

This study addresses the characteristics, kidney replacement therapy (KRT) modalities, and outcomes in children diagnosed with crush syndrome following an earthquake in Turkey. To analyze the associations of different KRT modalities with long-term dialysis dependency and length of stay (LOS) in the pediatric intensive care unit (PICU). This multicenter, prospective, and retrospective cohort study was conducted across 20 PICUs in Turkey. Participants included children diagnosed with crush syndrome after the 2023 Kahramanmaraş earthquake, and eligibility criteria included age, diagnosis, and need for KRT. Data were analyzed from August to October 2024. Children diagnosed with crush syndrome who underwent KRT. The primary outcome was dialysis dependency at discharge. Secondary outcomes included LOS in the PICU. The study included 183 pediatric patients (median [IQR] age, 158 (108-192) months; 49 [54.4%] males) with earthquake-related injury, of whom 90 required KRT. The median (IQR) time under the rubble was 25.7 (1-137) hours. At admission, 51 patients (56.6%) had stage 3 acute kidney injury, and the median (IQR) serum creatinine phosphokinase level was 15 555 (9386-59 274) IU/L. There was a significant association between the Kidney Disease-Improving Global Outcomes (KDIGO) stage at admission and serum creatinine phosphokinase level (area under the curve, 0.750; 95% CI, 0.621-0.879; P < .001). Among patients undergoing KRT, 33 (36.7%) received continuous venovenous hemodiafiltration, and 23 (25.6%) underwent intermittent hemodialysis (IHD). IHD treatment was the only independent factor associated with shorter PICU LOS (odds ratio [OR], 6.87; 95% CI, 1.54-30.67; P = .01). The dialysis dependency at discharge was higher in children who were transferred late to the PICU (β = 0.003; 95% CI, 0.001-0.005; P < .001) and those with a high Pediatric Trauma Score (β = 0.022; 95% CI, 0.003-0.041; P = 02). IHD was not statistically significantly associated with remaining dialysis-dependent at discharge (OR, 2.18; 95% CI, 0.53-8.98; P = .28). The overall mortality rate in the cohort was 6 patients (6.6%). This cohort study found that children who were transferred late to intensive care and those with a high trauma score after earthquake-related crush injury were more likely to remain dialysis-dependent at discharge. Furthermore, KDIGO stage at admission was associated with elevated serum creatinine phosphokinase levels. These findings highlight the critical importance of early intervention and appropriate treatment in children with AKI following prolonged entrapment.

Metabolic and Bariatric Operation and the Path to Kidney Transplantation.

Obesity is a significant barrier to kidney transplantation for patients with end-stage renal disease (ESRD). We aimed to evaluate the long-term impact of metabolic and bariatric surgery (MBS) on kidney transplantation access and outcomes in individuals with obesity and ESRD patients. A retrospective cohort study using data from 64 US healthcare organizations included 132,989 individuals with obesity (BMI ≥30kg/m²) and ESRD requiring dialysis, of whom 6,263 (4.6%) underwent MBS. Propensity score matching produced 1:1 matched groups of 6,238 patients each, analyzed over 10 years. Primary outcomes included rates of kidney transplant waitlist placement, transplantation, and overall mortality. Secondary outcomes focused on 22,979 transplant recipients, including 1,701 (7.4%) MBS patients, to evaluate post-transplant adverse events. Over a median follow-up of 33.3 months (MBS) and 28.5 months (controls), MBS patients demonstrated higher rates of waitlist placement (19.12% vs 10.53%, HR=1.800, 95%CI=1.636-1.980, p<0.001) and transplantation (27.06% vs 16.09%, HR=1.712, 95%CI=1.584-1.852, p<0.001) at 10 years, with benefits evident within 1-month postoperation. Mortality was lower in the MBS group (30.55% vs 36.44%, HR=0.768, 95%CI=0.723-0.817, p<0.001). In transplant recipients, MBS patients had lower cardiovascular complications (37.3% vs 40.6%, RR=0.92, p=0.007) and all-cause mortality (16.70% vs 20.88%, HR=0.82, p<0.001), with no significant differences in graft rejection or failure. MBS significantly improves access to kidney transplantation and long-term survival for obese ESRD patients. Patients who underwent MBS demonstrated notable improvements in cardiovascular health, potentially leading to a better quality of life and survival.These findings suggest that MBS should be considered as part of the comprehensive care for this high-risk population.

Case-control study on long-term kidney outcomes in very low birth weight infants: impact of growth restriction and maternal preeclampsia.

To identify factors, particularly neonatal acute kidney injury, associated with an increased risk of developing chronic kidney disease (CKD) within the first 10 years of life in children with a history of prematurity and very low birth weight (VLBW). This nested case-control study was conducted on VLBW infants (> 500 g and < 1.500 g) born between 2012 and 2022. The population (n = 119) included children who developed CKD (n = 55) and controls with normal findings (n = 64). CKD was defined by abnormal blood pressure, reduced glomerular filtration rate, or elevated urinary albumin excretion. Data on neonatal and maternal factors were analyzed using logistic regression to identify predictors of CKD. Of the 267 eligible children 119 were included, with a median age of 32 months, and median gestational age and birth weight of 30 weeks and 1170 g, respectively. Children with CKD had lower birth weight Z-scores (-1.06 vs. -0.89), a higher occurrence of extrauterine growth restriction (EUGR) (72 % vs. 51 %), and an increased likelihood of maternal preeclampsia exposure. Maternal preeclampsia was identified as an independent predictor of CKD, associated with a 5 % increase in the odds of developing the condition (OR 1.05, 95 % CI 1.01-1.66). Maternal preeclampsia was associated with CKD in children with a history of VLBW. This finding highlights the importance of long-term follow-up and early identification of at-risk individuals.

Incidence and predictors of clinically significant renal function decline among Asian non-valvular atrial fibrillation patients on warfarin

BackgroundLiterature has reported more significant deterioration of renal function in non-valvular atrial fibrillation (NVAF) patients treated with warfarin. This study aimed to assess the incidence of clinically significant renal function decline (≥ 30% decline in estimated glomerular filtration rate) following warfarin initiation in Asian NVAF patients and identify its predictors.ResultsWe analyzed 481 patients with a mean age of 68.7 ± 10.2 years. Most (n = 312, 64.9%) patients have underlying chronic kidney disease during warfarin initiation. The duration of warfarin treatment ranged from 1 to 9 years, with a mean of 3.2 ± 1.7 years. Clinically significant eGFR decline occurred in 88 (18.3%) patients and was not associated with ischemic stroke/transient ischemic attack (p = 0.245); however, it was positively associated with major bleeding (p = 0.012). Overall, female sex (aOR 2.146, 95%CI 1.272–3.623, p = 0.004), diabetes mellitus (aOR 1.784, 95%CI 1.072–2.970, p = 0.026), heart failure (aOR 2.161, 95%CI 1.267–3.687, p = 0.005), alpha-blocker use (aOR 2.566, 95%CI 1.097–6.002, p = 0.030), time in therapeutic range (TTR) < 60% (aOR 2.833, 95%CI 1.675–4.785, p < 0.001) and warfarin treatment duration in year (aOR 1.244, 95%CI 1.081–1.431, p = 0.002) were the predictors of clinically significant eGFR decline.ConclusionClinically significant renal function decline is common among Malaysian NVAF patients on warfarin treatment and was associated with an increased risk of major bleeding, highlighting the crucial need for periodic renal function monitoring in these patients. The identified predictors can help identify NVAF patients at high risk of renal function decline with warfarin and guide OAC selection to avoid adverse kidney outcomes.

Kidney and Cardiovascular Outcomes Among Patients With CKD Receiving GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of Randomized Trials.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve cardiac and kidney outcomes in patients with diabetes; however their efficacy in individuals with reduced estimated glomerular filtration rate (eGFR) is uncertain. This study evaluated the effects of GLP-1RAs on kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD). Systematic review and meta-analysis of randomized controlled trials (RCTs) reported through May 25, 2024. Adult participants in RCTs with baseline eGFR <60 mL/min/1.73 m2. RCTs including adults (≥18 years old) with varying degrees of kidney function, including individuals with CKD characterized by a baseline eGFR of less than 60 mL/min/1.73 m2, that compared GLP-1RAs with control treatments with respect to a composite kidney outcome, all-cause mortality, or a composite CV disease outcome. From among 212 screened studies, 12 trials involving that included participants with baseline eGFR <60 mL/min/1.73 m2 were included. Two independent investigators extracted the data. Pooled odds ratios (ORs) for composite kidney outcome, all-cause mortality, and composite CV outcome were estimated using random-effects models. Evidence certainty was assessed using the GRADE system. 17,996 RCT participants with baseline eGFR <60 mL/min/1.73 m2 were included in analyses. GLP-1RAs were significantly associated with a reduced risk of the composite kidney outcome (OR: 0.85 [95% CI 0.77-0.94]; p=0.001) with low heterogeneity (I2<0.01%). GLP-1RAs were also associated with a reduced the risk of a >30% eGFR decline (OR: 0.78, p=0.004), a >40% decline (OR: 0.76, p=0.01), and a >50% decline (OR: 0.72, p<0.001). Risk of all-cause mortality was also lower in the GLP-1RA group (OR: 0.77 [95% CI 0.60-0.98]; p=0.03), though there was high heterogeneity (I2=71.6%). Composite CV outcomes were also lower with the use of GLP-1R (OR: 0.86 [95% CI 0.74-0.99]; p=0.03; I2=40.3%). Sensitivity analyses restricted to human GLP-1 backbone agents showed enhanced benefits. Inconsistent kidney outcome definitions, focus on diabetic populations in most studies, and potential publication bias. GLP-1RAs improved kidney and cardiovascular outcomes, and survival in patients with CKD enrolled in an array of clinical trials.

Effectiveness of Empagliflozin vs Dapagliflozin for Kidney Outcomes in Type 2 Diabetes

No large randomized clinical trial has directly compared empagliflozin with dapagliflozin, leaving their comparative effectiveness regarding kidney outcomes unknown. To compare kidney outcomes between initiation of empagliflozin vs dapagliflozin in adults with type 2 diabetes who were receiving antihyperglycemic treatment. This target trial emulation used nationwide, population-based routinely collected Danish health care data to compare initiation of empagliflozin vs dapagliflozin in adults with type 2 diabetes who received antihyperglycemic treatment between June 1, 2014, and October 31, 2020. Data were analyzed from October 2023 to August 2024. Persons were followed up until an outcome, emigration, death, 6 years, or December 31, 2021, whichever occurred first. Initiation of empagliflozin vs dapagliflozin. Outcomes included acute kidney injury, incident chronic kidney disease (stages G3 to G5 or stage A2 or A3), and progression of chronic kidney disease (≥40% decrease in estimated glomerular filtration rate from baseline). Risks of kidney outcomes were estimated in intention-to-treat and per-protocol analyses using an Aalen-Johansen estimator that adjusted for 56 potential confounders and considered death as a competing event. A total of 32 819 individuals who initiated treatment with empagliflozin and 17 464 with dapagliflozin were included (median [IQR] age, 63 [54-71] years; 18 872 female individuals [37.5%]; median [IQR] estimated glomerular filtration rate, 88 [73-104] mL/min/1.73 m2). After weighting, all measured covariates were well balanced between the groups. In intention-to-treat analyses, people who initiated treatment with empagliflozin and dapagliflozin exhibited comparable 6-year risks of acute kidney injury (18.2% vs 18.5%; risk ratio, 0.98; 95% CI, 0.91-1.06), chronic kidney disease stages G3 to G5 (11.8% vs 12.1%; risk ratio, 0.97; 95% CI, 0.89-1.05), chronic kidney disease stage A2 or A3 (14.8% vs 14.3%; risk ratio, 1.04; 95% CI, 0.93-1.15), and progression of chronic kidney disease (5.3% vs 5.7%; risk ratio, 0.94; 95% CI, 0.56-1.58). The primary analyses were supported by corresponding per-protocol analyses. The results of this cohort study suggest that people with type 2 diabetes who initiated treatment with empagliflozin and dapagliflozin had comparable long-term kidney outcomes.

Effects of sarcopenic obesity on incident chronic kidney disease and rapid kidney function decline: evidence from the China health and retirement longitudinal study.

Evidence on the effects of sarcopenic obesity (SO) on incident chronic kidney disease (CKD) and rapid kidney function decline (RKFD) in the Chinese population is limited. This study aimed to prospectively examine the associations of SO with incident CKD and RKFD among middle-aged and older Chinese adults. This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative longitudinal study of Chinese adults aged 45 and older. The analysis included 4201 individuals from the 2011 wave, with renal outcomes ascertained from the 2015 wave. The effects of SO on incident CKD and RKFD were assessed using logistic regression models. Robustness was tested through subgroup and sensitivity analyses. Over four years of follow-up, 228 cases of incident CKD and 213 cases of RKFD were observed. After multivariable adjustment, participants in the "sarcopenic obesity" group showed a 78% increased risk of incident CKD (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.09-2.90) and a 79% increased risk of RKFD (OR 1.79, 95% CI 1.03-3.13), compared to the "nonsarcopenia without obesity" group. Consistent results were observed across subgroups stratified by gender, education level, marital status, geographic area, lifestyle factors, and comorbidities, with no significant interactions detected. In a population-based cohort of middle-aged and older Chinese adults, SO was independently associated with elevated risks of incident CKD and RKFD, without interaction effects. These findings underscore the importance of timely intervention for SO to prevent adverse kidney outcomes. Key message What is already known on this topic? The relationship between sarcopenic obesity (SO) and the risk of chronic kidney disease (CKD) and renal function decline has been established in Korean and Japanese individuals with type 2 diabetes mellitus. However, it is uncertain if these findings apply to other populations, particularly those without diabetes. Additionally, the influence of diabetes on these associations needs further exploration, and the link between SO and rapid kidney function decline (RKFD) remains unestablished. Evidence regarding the effects of SO on incident CKD and RKFD in the Chinese population is limited, highlighting the necessity for this study to fill these gaps in knowledge. What this study adds This study is the first to prospectively explore the association of SO with incident CKD and RKFD in middle-aged and older Chinese adults. We identified SO as a significant risk factor for increased incidence of both CKD and RKFD. These findings expand the understanding of the impact of SO beyond individuals with diabetes mellitus, indicating that SO is a universal risk factor for adverse kidney outcomes in aging populations, irrespective of demographic and health characteristics. How this study might affect research, practice, or policy This study identifies SO as an independent risk factor for incident CKD and RKFD in middle-aged and older Chinese adults. The findings suggest that SO is a modifiable risk factor for kidney health, underscoring the necessity for timely interventions to prevent adverse kidney outcomes. Given the rising prevalence of SO and kidney disease in aging populations worldwide, these results highlight the importance of incorporating SO management into public health and clinical strategies. Questions pending answer What role do specific lifestyle factors (e.g. diet, physical activity) play in mitigating or exacerbating kidney function decline in individuals with SO? Are there genetic markers that predispose individuals with SO to a higher risk of incident CKD and RKFD? What are the underlying molecular mechanisms linking SO to incident CKD and RKFD?

Clinicopathological characteristics and prognosis of lupus nephritis patients with positive anti-ribonucleoprotein antibodies.

Positive anti-ribonucleoprotein antibodies may characterizea subgroup of patients affected bylupus nephritis with mild kidney damage, but little is known about their clinical features and long-term prognosis. Patients were retrospectively selected from the lupus nephritis database ( http://ln.medidata.cn ) of the First Affiliated Hospital of Sun Yat-sen University between 2006 and 2011. Logistic regression analysis identified the clinicopathological indicators related to positive anti-ribonucleoprotein antibodies. Additionally, the Cox proportional hazard regression model was used to assess the association of baseline variables with clinical outcomes. Of the 485 enrolled patients, 184 (37.9%) tested positive for anti-ribonucleoprotein antibodies. The group with positive anti-ribonucleoprotein antibodies exhibited a higher prevalence of rash, photosensitivity, and Raynaud's phenomenon, and lower scores on the systemic lupus erythematosus disease activity index (SLEDAI) and the Activity Index scores in kidney biopsies. It is important to note that, although proteinuria did not differ, patients with anti-ribonucleoprotein positivity had a lower prevalence of hematuria and cylindruria, and a higher estimated glomerular filtration rate than patients without anti-ribonucleoprotein antibodies. After a median follow-up of approximately 170months, no significant differences were observed in kidney or patient survival between groups. Lupus nephritis patients with anti-ribonucleoprotein antibodies present milder kidney damage and more dermatological manifestations. Despite the negative correlation between anti-ribonucleoprotein antibodies and both SLEDAI and activity index scores, these antibodies may not be predictive of better kidney outcomes.

The relationship between elevated serum levels of soluble interleukin-2 receptor and renal outcomes in hemophagocytic lymphohistiocytosis

BACKGROUND: Hemophagocytic lymphohistiocytosis is an uncommon disease with a high mortality rate due to ineffective overactivation of the immune system. THE AIM: to assess the effect and prediction of elevated serum soluble interleukin-2 alpha level on kidney outcomes in hemophagocytic lymphohistiocytosis.PATIENTS AND METHODS: In this analytic (experimental) clinical studies type with randomized clinical trials design in meta-analysis article, two-hundred eighty-three patients with hemophagocytosis lymphohistiocytosis diagnosis and kidney impairment were investigated.RESULTS: Relative risk and Odds ratio of elevated serum soluble interleukin-2 receptor alpha level on kidney failure progression to kidney replacement therapy was assessed 1.04 and 1.12 during 28 days and interquartile range of 35.5 days in hemophagocytic lymphohistiocytosis in this research. In prediction probability of death and chronic kidney disease progression to end-stage kidney disease led to kidney replacement therapy as outcome using high serum soluble interleukin-2 receptor alpha level was not significant statistically (p-value of 0.91 and p=0.56, respectively). There was strong negative correlation between soluble interleukin-2 receptor alpha levels and cumulative incidence of renal outcomes such as hyponatremia, proteinuria, acute kidney disease, elevated serum blood urea nitrogen and serum creatinine levels with rs of -0.7 and p-value of o.18. There was relationship between serum soluble interleukin-2 receptor alpha level and past medical history (p-value: 0.01) but overall this analysis did not show significant level statistically (p-value: 0.1).CONCLUSION: There was a strong negative correlation between serum soluble interleukin-2 receptor alpha levels and cumulative incidence of renal outcomes. There wasn't a relationship between serum soluble interleukin-2 receptor alpha level and renal outcome after adjustment of confounding factors for renal function except for past medical history.Sujpplement files (Tables) are located at: https://figshare.com/authors/Fateme_Shamekhi_Amiri/9040742

New Index Demonstrates Association between Social Vulnerability, Environmental Burden, and Kidney Failure Risk among Individuals with Glomerular Disease.

The Centers for Disease Control and Prevention (CDC) Environmental Justice Index Social-Environmental Ranking (EJI-SER) combines a Social Vulnerability Module (SV) with an Environmental Burden Module (EB) to characterize cumulative environmental and social burden at the census tract level. This analysis evaluates the association between EJI-SER and kidney outcomes in glomerular disease (GD) patients. Cure Glomerulopathy (CureGN) is an observational cohort study of adults and children with biopsy-proven GD. EJI-SER is a percentile ranking by census tract, with a higher score indicating a more severe burden. Associations between EJI-SER and its components with kidney failure (initiation of kidney replacement therapy, transplant, or two estimated glomerular filtration rates [eGFRs] <15ml/min/1.73m2) and longitudinal eGFR were tested using multivariable Cox regression and linear mixed models, respectively, adjusted for demographics, histologic diagnosis, eGFR and urine protein to creatinine ratio at enrollment, and time from biopsy to enrollment. Among 1,149 participants with census tract data, the median (IQR) follow-up was 5.4 (3.0-7.0) years, the median (IQR) age at biopsy was 24 (10-48), and self-identified racial distribution was 5% Asian, 18% Black, and 70% White. Median (IQR) EJI-SER was 0.49 (0.26-0.75). EJI-SER scores in the lowest two quartiles were associated with a lower hazard of kidney failure compared to the highest quartile (adjusted HR [95% CI] 0.62 [0.36-1.08] and 0.43 [0.25-0.76] for EJI-SER 0-25% and >25-50% vs. >75%, respectively) and higher eGFR at enrolllment (adjusted mean 90.1 vs. 87.1 ml/min/1.73m2 for 0-25% vs. >75%, p=0.08). As captured by EJI-SER, higher environmental and social burdens are associated with lower eGFR and a higher risk of kidney failure in the CureGN cohort. This first use of the EJI-SER in GD demonstrates the need for additional investigation into social drivers of disparities in GD and policies and resources that address these structural inequities.

Efficacy and safety of finerenone in patients with chronic kidney disease and type 2 diabetes by diuretic use: A FIDELITY analysis.

This post hoc analysis aimed to assess the efficacy and safety of the non-steroidal mineralocorticoid receptor antagonist finerenone by baseline diuretic use in FIDELITY, a pre-specified pooled analysis of the phase III trials FIDELIO-DKD and FIGARO-DKD. Eligible patients with type 2 diabetes (T2D) and chronic kidney disease (CKD; urine albumin-to-creatinine ratio [UACR] ≥30-<300 mg/g and estimated glomerular filtration rate [eGFR] ≥25-≤90 ml/min/1.73 m2, or UACR ≥300-≤5000 mg/g and eGFR ≥25 ml/min/1.73 m2) were randomized 1:1 to finerenone or placebo. Patients were analysed by baseline diuretic use (yes/no) and type of diuretic (loop or thiazide). Key efficacy outcomes included a cardiovascular composite (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure) and a kidney composite (kidney failure, sustained ≥57% decrease in eGFR, or kidney-related death). Out of 12 990 patients, 51.6% were taking diuretics at baseline (21.6% loop; 24.2% thiazide diuretics). Finerenone reduced the risk of cardiovascular and kidney composite outcomes versus placebo; diuretic use did not modify this effect on the cardiovascular (p-interaction = 0.94) or kidney outcomes (p-interaction = 0.55). Hyperkalaemia incidences were similar between finerenone subgroups irrespective of diuretic use and lower with placebo versus finerenone (with diuretics: finerenone 13.7% vs. placebo 5.7%; without diuretics: 14.3% vs. 8.3%). The incidence of hyperkalaemia leading to hospitalization or study drug discontinuation was low across treatment groups irrespective of diuretic use. This analysis showed that the efficacy and safety of finerenone in patients with CKD and T2D was not modified by baseline diuretic use.

Severe sepsis-associated acute kidney injury and outcomes: a longitudinal cohort study.

Sepsis-associated acute kidney injury (SA-AKI) is common among patients admitted to the intensive care unit (ICU) with sepsis. This study aimed to demonstrate an association between an episode of SA-AKI and progression to dialysis dependence, with a view to identifying a cohort who may be suitable for intensive nephrology follow-up. Design: Retrospective data-linkage cohort study. Alice Springs Hospital ICU, 10-bed regional facility, housed in a 200-bed regional hospital, located in Central Australia. All patients admitted with a diagnosis code associated with sepsis between 2015 and 2017. Primary outcome was a composite measure comprising death or initiation of maintenance dialysis within 5 years of the index case of sepsis leading to ICU admission. The unadjusted risk of the composite outcome was significantly higher in the SA-AKI group (odds ratio (OR) 3.22, 95% confidence interval (CI) 1.81-5.74, P < 0.01). This effect remains after adjustment for age, illness severity and co-morbidities (adjusted OR (aOR) 2.64, 95% CI 1.22-5.68, P = 0.01). Progression to maintenance dialysis was the primary driver of this effect (OR 7.56, 95% CI 2.23-25.65, P = 0.02), although it was modified by the effect of confounders (aOR 7.3, 95% CI 0.7-75.94, P = 0.10). These results demonstrate an association between an index episode involving SA-AKI and the composite outcome in a defined population. Identification of this group may allow intensive nephrology follow-up and secondary prevention with the goal of mitigating the risk of progression of disease with significant economic and personal benefits.