Stage G4 Research Articles

Use of 3D-DXA in the assessment of bone structure among patients with chronic kidney disease

IntroductionPatients in later stages of chronic kidney disease (CKD) have a 2- to 14-fold increase in fracture risk. Bone mineral density (BMD) assessment is limited due to the inability to measure trabecular and cortical bone characteristics and the interference of aortic calcifications.Study objectiveThis study aimed to assess the trabecular bone score (TBS) and three-dimensional dual-energy X-ray absorptiometry (3D-DXA) in participants across all CKD stages.Patients and methodsIn total, 64 CKD patients (consisting of 28 female participants and 36 male participants, with an average age of 69.5 years) were included. There were 9, 12, 8, 9, 11, and 15 participants in stages G1, G2, G3a, G3b, G4, and G5 of CKD, respectively. BMD at the lumbar spine (LS) and proximal femur, as well as the LS TBS, were analyzed. The proximal femur parameters such as cortical and trabecular volumetric (v)BMD, cortical thickness (CTh), and surface (s)BMD at the total hip (TH) and femoral neck (FN) were analyzed using 3D-Shaper software.ResultsComparison between the earlier stages (G1-G3a) and the later CKD stages (G3b-G5) showed significant differences in carboxy terminal collagen crosslinks (CTx) (386 vs.1053 ng/L), TH areal bone mineral density (aBMD; 0.991 vs. 0.859 g/cm2), cortical TH vBMD (831 vs. 795 mg/cm3), FN (837 vs. 788 mg/cm3), TH cortical sBMD (170 mg/cm2), and TH Cth (2.03 vs. 1.92 mm; all p < 0.05). Cross-sectional comparisons between each CKD stage showed a gradual decrease in the LS BMD, TH cortical vBMD, sBMD (FN and TH), and TH Cth. Strong positive associations between the glomerular filtration rate (GFR) and cortical parameters (FN/TH vBMD and TH Cth) were observed (p < 0.01).ConclusionIn conclusion, advanced stages of CKD (G3b–G5) were associated with lower cortical bone parameters. The majority of the cortical parameters were correlated with the GFR, demonstrating a direct relationship between the kidney function and bone structure.

Short-term efficacy of rituximab in children with calcineurin inhibitor resistant steroid resistant nephrotic syndrome

Objective: To investigate the short-term efficacy and safety of rituximab (RTX) in children with calcineurin inhibitor (CNI) resistant steroid resistant nephrotic syndrome (SRNS). Methods: A retrospective case analysis was conducted. Thirteen children with CNI resistant SRNS who were regularly treated with RTX (375 mg/m2 per dose (maximum dose 500 mg), 1 dose per week, a total of 4 doses) in Department of Nephrology, Children's Hospital of Fudan University from January 2016 to December 2023 were enrolled. The general data, disease related information, urinary protein/creatinine, serum albumin, blood creatinine before RTX treatment, immunosuppressants, adverse events, and monthly urinary protein/creatinine, serum albumin, and blood creatinine indexes within 6 months after RTX treatment were collected. The changes of urinary protein/creatinine, serum albumin and estimated glomerular filtration rate (eGFR) before and after RTX at 3 and 6 months were analyzed by using paired sample t test and Wilcoxon signed-rank test. Results: Among the 13 patients, 8 were male and 5 were female. The age of disease onset was 4.0 (2.9, 6.8) years and the age of RTX treatment was 9.8 (5.9, 13.6) years. There were 8 cases of focal segmental glomerulosclerosis, 3 cases of minimal change disease and 2 cases of mesangial proliferative glomerulonephritis. No clinically significant gene variation was detected in 12 cases and the other one did not receive gene test. Before RTX treatment, 11 cases were in chronic kidney disease stage G1, and 1 case each was in stage G2 and stage G3. Ten children completed 4 doses of RTX treatment, 1 patient completed 3 doses, and 2 patients completed 2 doses. Urinary protein/creatinine in 13 children at 3 and 6 months after RTX treatment was significantly lower than baseline (0.60 (0.13, 2.04), 0.49 (0.28, 1.10) vs. 1.44 (0.76, 4.11) mg/mg, Z=-2.34, -2.34, both P<0.05), and serum albumin was significantly higher than baseline ((35±8), (34±7) vs. (30±6) g/L, t=2.30, 2.60, both P<0.05). The eGFR at 6 months after RTX treatment was not significantly different from the baseline ((110±32) vs. (113±35) ml/(min·1.73 m2),t=-0.76,P>0.05)). No serious adverse reactions occurred in this study. Conclusion: RTX could reduce urinary protein and increase serum albumin in short-term treatment in children with CNI resistant SRNS without significant side effects.

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.

Association between frailty and bone health in early-stage chronic kidney disease: a study from the population-based CARTaGENE cohort

Abstract Frailty is a clinical syndrome that is particularly prevalent in patients with chronic kidney disease (CKD). We aimed to assess the associations between renal function and the presence of frailty criteria and to assess the association between frailty and bone outcomes. We have conducted a retrospective study from a population-based cohort, which represents 1% of people aged 40 to 69 years in a Canadian province, excluding individuals with an estimated glomerular filtration rate (eGFR) lower than 30 ml/min/1,73m2. Frailty was defined with Fried's criteria. Bone density was estimated with Quantitative Ultrasound (QUS) at the calcaneus measuring Speed of Sound (SOS) and Broadband Ultrasound Attenuation (BUA). Time to first fracture event was assessed and analyses were conducted using logistic regressions, multiple linear regressions and Cox models. Overall, 19 973 individuals were included (mean age 54.2 ±7.8, women 51.6%, 47.0% CKD stage G2, 3.9% CKD stage G3, 34.8% with at least one frailty criterion. We observed a U-shaped association between eGFR and the Odds Ratio (OR) of presenting at least one frailty criterion, with a minimum OR around 77 ml/min/1.73m2 (per a 10 mL/min/1.73m2 increase, respectively for an eGFR&amp;lt;77 and &amp;gt;77, OR=0.93, 95%Confidence Interval (CI):0.86-1.01 and OR 1.09, 95%CI:1.06-1.13). After a median follow-up of 5.8 years, there were 837 fracture events. Having at least one frailty criterion was negatively associated with SOS (β=-3.97, p&amp;lt;0.0001) and BUA (β=-1.82, p&amp;lt;0.0001). Having at least one frailty criterion was associated with a higher fracture risk (Hazard Ratio=1.23, 95%CI: 1.07-1.42). In conclusion, having at least one frailty criterion was associated with a higher risk of fracture and a lower bone mineral density.

Prevalence of chronic kidney disease and risk factors in adults with hypertension in China

Objective: To understand the prevalence of chronic kidney disease (CKD) and influencing factors in adults with hypertension in China and provide evidence for the management of CKD in hypertension patients. Methods: The prevalence data of CKD in hypertension patients in China were collected from China Chronic Disease and Risk Factor Surveillance in 2018, the data of 68 829 hypertension patients were analyzed. After complex weighting, the prevalence of CKD in the study population was compared. A multivariate logistic regression model was used to explore the influencing factors of CKD in adults with hypertension. Results: The prevalence of CKD in the hypertension patients was 18.2% (95%CI: 17.4%-19.0%) and increased with age, and the prevalence was 16.4% in men and 20.6% in women (P<0.001). In different age groups, CKD at stage G1 mainly occurred in those aged 18-44 and 45-59 years, with the prevalence of 10.8% and 7.8%, respectively, while CKD at stages G2 and G3a mainly occurred in those aged >60 years, with the prevalence of 9.4% and 9.7%. Multivariate logistic regression results showed that in the hypertension patients, being aged ≥60 years, being women, smoking (including current and ever smoking), physical inactivity, being underweight or obese, and suffering from diabetes, dyslipidemia and hyperuricemia were the potential risk factors for CKD (all P<0.05). Conclusion: The prevalence of CKD was higher in people with hypertension than in general population in China, and age, gender, smoking status, physical activity level, and suffering from diabetes, dyslipidemia, and hyperuricemia or not were significant influencing factors. It is necessary to strengthen health education and kidney function testing in adults with hypertension and develop comprehensive CKD prevention and control measures targeting high-risk population.

Effectiveness and Safety of Sodium-Glucose Cotransporter-2 Inhibitor Continuation in Patients With Type 2 Diabetes and Late-Stage Chronic Kidney Disease.

Background: Expansion of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use in chronic kidney disease (CKD) prompted a pragmatic study of their safety and effectiveness in patients with type 2 diabetes mellitus (T2DM) and late-stage CKD. Objective: The primary clinical endpoint was change in HbA1c. Secondary clinical endpoints included change in body weight and blood pressure. Safety endpoints included kidney function indices, mycotic or urinary tract infection, acute kidney injury, dehydration, and ketoacidosis. Methods: Adult patients with T2DM and late-stage CKD prescribed an SGLT2i between June 1, 2018 and June 1, 2023 were included in this retrospective cohort study. Late-stage CKD was defined as CKD stage G3b, G4, or G5, including requiring dialysis or kidney transplantation. Endpoints were compared between patients who continued an SGLT2i versus those who discontinued. Results: Fifty-nine patients were included. Short-term follow-up over 4.2 ± 1.7 months revealed no difference in HbA1c between groups. Extended follow-up in a truncated sample over 10.4 ± 2.6 months showed modest, yet significantly lower HbA1c with continuation (median: -0.3 vs 0.1%; P = 0.04). Weight loss was greater when treatment continued (median: -1.8 vs 0.2 kg; P = 0.01), whereas blood pressure did not differ. No differences in safety endpoints were observed. Kidney function mildly, but significantly worsened with continuation (median estimated glomerular filtration rate [eGFR]: -2.7 vs 0 mL/min/1.73 m2; P = 0.03). Conclusions: Patients with T2DM and late-stage CKD had similar glucose control and safety profiles irrespective of SGLT2i continuation or discontinuation. This may favor clinical decision-making toward benefits of SGLT2i reduction in weight, cardiovascular events, CKD progression, and hospitalizations over potential safety concerns in these patients.

Elevated concentrations of cardiac troponin T are associated with thoracic aortic calcification in non-dialysis chronic kidney disease patients of stage G3 to G5

Background Vascular calcification (VC), especially coronary artery calcification (CAC), serves as a robust predictor of cardiovascular mortality in chronic kidney disease (CKD) patients. Recent studies have revealed that the presence of extra-coronary calcifications (ECCs) contributes to cardiovascular disease (CVD). Elevated myocardial injury markers predict mortality risk in CKD patients and are associated with CVD. Nevertheless, the relationship between VC, including CAC and ECCs, and myocardial injury markers remain unexplored in non-dialysis CKD patients. Methods In 278 non-dialysis CKD patients of stage G3 to G5, we assessed calcified scores in CAC (Agatston score) and ECCs including thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. We analyzed the relationships between VC and myocardial injury markers of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB). Results A total of 278 non-dialysis CKD patients (median age 52.4 ± 13.2; male 65.1%; diabetes 33.5%) were enrolled. A total of 71.8% (227) of patients had cTnT levels above the upper limit of normal (> 0.014 ng/mL). Moderate to severe (calcified score ≥100 vs. <100), CAC (OR 6.39; 95% CI 1.03–39.61) and TAC (OR 6.16; 95% CI 1.76–21.55) were significantly associated with higher cTnT concentrations after adjustment for confounders. Additionally, male sex and a lower eGFR were also associated with cTnT elevation. However, when we included CAC and TAC in one model, only moderate to severe TAC (OR 4.85; 95% CI 1.38–16.96) was a risk factor for cTnT elevation, but not CAC. Furthermore, patients with severer TAC presented lower diastolic blood pressure (DBP), wider pulse pressure (p < 0.001) and higher prevalence of left ventricular hypertrophy (LVH). Conclusion Moderate to severe thoracic aortic calcification (TAC score ≥ 100) is significantly associated with elevated cTnT concentrations in non-dialysis CKD patients of stage G3 to G5. The linkage may result from decreased coronary perfusion and relative myocardial ischemia.

Epidemiology, treatment and outcomes of gastroenteropancreatic neuroendocrine neoplasms

To investigate incidence, treatment patterns and outcomes of gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) in the United States. The 2019 National Cancer Database was searched for adult GEP-NEN patients. Main outcomes included overall and site-specific incidence, treatment patterns, and overall survival (OS). Overall survival was evaluated using averaged Cox regression. 86,324 GEP-NEN patients were included (6.33% of all GEP malignancies). From 2004 to 2016, annual GEP-NEN cases increased (n = 4,010 to n = 9,379), largely driven by low-stage, low-grade disease. Most patients received surgery, either alone (72.9%) or in combination with systemic therapy (4.9%). Longest overall survival (OS) was evident in patients with low stage and low grade GEP-NEN of the small intestine and rectum (p < 0.001). Patients undergoing surgical resection demonstrated longest OS. The addition of systemic therapy was most effective in high stage G3 NEN. Having higher income (≥$63,333) and private insurance or Medicare, but not Medicaid, was associated with improved survival. GEP-NEN incidence increases, likely due to improved detection and diagnosis. Treatment patterns have evolved to follow the latest international guidelines and site-specific improvement in survival is noted. In addition to disease specific factors, insurance access and socioeconomic factors emerged as potential targets for improving outcomes.

Pharmacokinetics and safety of pirfenidone in individuals with chronic kidney disease (CKD) stage G2 and G3a: a single-dose, Phase I, Bridging study.

Pirfenidone is an inhibitor of transforming growth factor-beta 1 (TGF-β1) and is being developed for the treatment of diabetic kidney disease (DKD). We assessed the pharmacokinetics (PK) and safety of a single dose of pirfenidone in individuals with CKD stages G2/G3a. In this phase I bridging study, patients with CKD stages G2 or G3a, aged 18-70 years, with a body mass index of 18-26 kg/m2, and glomerular filtration rate (eGFR) ranging from 45 to 89 ml/min/1.73m2, received a single oral dose of 400 mg pirfenidone capsules 30 minutes after a standard breakfast. The pharmacokinetic parameters of the two groups were measured and compared after blood and urine collection. The co-primary endpoints were the area under the plasma concentration-time curve from time zero to 36 hours (AUC0-36) and the maximum observed plasma concentration (Cmax) of pirfenidone. Safety was a secondary endpoint. The trial has been registered on ClinicalTrials.gov (ChiCTR2300077297). A total of 20 subjects participated in this study. There were no significant differences between the control group and the patient group (CKD stages G2/G3a) in terms of plasma Cmax, the time to reach the maximum observed concentration (Tmax), and elimination half-life(t1/2). However, the Vz/F of the patient group (CKD G2 stage) was significantly higher than that of the control group. Renal accumulation rate, renal clearance rate (CLr), and urine drug concentration also showed no significant differences. No severe adverse events occurred during the trial. These results indicate that the PK and safety of pirfenidone are not influenced by renal function. Individuals with renal impairment may not require dose adjustments.

Use of Aspirin and Initial Cardiovascular and Bleeding Risk in Patients with Chronic Kidney Disease.

Background: Despite the high cardiovascular risk in patients with chronic kidney disease (CKD), the role of aspirin in primary prevention remains unclear. This study aimed to investigate the association between aspirin initiation in adults with CKD without prior cardiovascular disease (CVD) and the first cardiovascular and bleeding events using Korean nationwide cohort data. Methods: Among individuals aged 40–79 years with an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m2 who underwent routine health examinations between 2011 and 2016, 15,861 individuals who were newly prescribed aspirin at a dose of 100 mg/day were matched with 79,305 aspirin non-users by propensity score matching. The primary efficacy outcome was a composite of nonfatal atherosclerotic CVD or cardiovascular death. The primary safety outcome was hospitalization due to intracranial or gastrointestinal bleeding. Results: During a mean follow-up of 6.9±2.9 years, the incidence rates for the primary efficacy outcome in aspirin users and non-users were 8.0 and 9.0 per 1,000 person-years, respectively. Aspirin therapy initiation was not associated with the primary efficacy outcome (hazard ratio [HR], 0.93; 95% confidence intervals [CI], 0.86-1.04). However, the primary safety outcome of major bleeding was more frequent in aspirin users than in non-users (6.7 versus 4.7 per 1,000 person-years). The HR for this outcome in aspirin users versus non-users was 1.45 (95% CI, 1.32-1.59). Conclusions: No association was observed between aspirin use and the risk of nonfatal atherosclerotic CVD or cardiovascular death in patients with CKD stages G3 and G4 without prior CVD. Aspirin use was associated with higher risk of major bleeding.

Association between proteinuria and mineral metabolism disorders in chronic kidney disease: the Japan chronic kidney disease database extension (J-CKD-DB-Ex)

Chronic kidney disease-mineral and bone disorder (CKD-MBD) are recognized as a systemic disease affecting the prognosis of patients with CKD. Proper management of CKD-MBD is important to improve the prognosis of patients with CKD. Although proteinuria is recognized as a poor prognostic factor in these patients, few reports have examined its association with CKD-MBD. We examined the association between proteinuria and CKD-MBD using data from the Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex). Among the patients registered in the J-CKD-DB-Ex, 30,977 with CKD stages G2–G5 who had serum creatinine, albumin, calcium, and phosphate concentrations measured at least once and urinalysis performed were included. The patients were divided into four groups (negative, 1+, 2+, and 3+) according to the degree of proteinuria. The association between proteinuria and CKD-MBD was examined by a logistic regression analysis. In a model adjusted for age, sex, diabetes, and the estimated glomerular filtration rate (eGFR), the odds ratio of the 3 + group compared with the negative group significantly increased to 2.67 (95% confidence interval, 2.29–3.13) for hyperphosphatemia, 2.68 (1.94–3.71) for hypocalcemia, and 1.56 (1.24–1.98) for hypomagnesemia. Proteinuria is associated with hyperphosphatemia, hypocalcemia, and hypomagnesemia in patients with CKD independently of eGFR.

Physical activity and renal outcome in diabetic and non-diabetic patients with chronic kidney disease stage G3b to G5

The association of physical activity with renal outcome and mortality in advanced chronic kidney disease (CKD; i.e., estimated glomerular filtration rate [eGFR] < 45 ml/min/1.73m2) is poorly studied. We examined this association in patients with advanced CKD in Japan. We used the Rapid Assessment of Physical Activity to assess baseline physical activity and classify patients as active or inactive. CKD progression was defined as 40% decline in eGFR, eGFR < 10, or requiring dialysis or transplantation. Among the 1,808 eligible patients, after adjusting for possible confounders, hazard ratios (HRs) for poor renal outcome in the active group were 0.68 (95% CI, 0.44–1.04), 1.09 (0.86–1.38), and 1.01 (0.82–1.25) in CKD stage G3b, G4, and G5, respectively, suggesting a renal benefit of exercise in CKD stage G3b. Adjusted HRs for death were 0.79 (0.40–1.57), 0.55 (0.38–0.80), and 0.75 (0.44–1.26) in stage G3b, G4, and G5, respectively. While the adjusted HRs of death were 0.84 (0.52–1.38) and 0.60 (0.43–0.83) in diabetic and non-diabetic patients, suggesting that exercise may reduce mortality in non-diabetic patients. Our study suggests that exercise is associated with better survival in non-diabetic patients with CKD stage G3b-5, and better renal outcome in diabetic and non-diabetic CKD stage G3b.

Associated Factors for Chronic Kidney Disease in Patients with Diabetes Mellitus 2: Retrospective Study.

Chronic kidney disease affects the quality of life of people with diabetes mellitus, increases cardiovascular risk, and has high social costs. To determine associated factors for chronic kidney disease in people with diabetes mellitus type 2. Retrospective cohort study with 371 patients evaluated in primary care for diabetes mellitus. Information on age, sex, disease duration, comorbidity and laboratory results was obtained. Patients of both sexes attended between 2022 and 2024 were included. Patients with other renal diseases or referrals were excluded. Logistic regression analysis was performed to identify associated factors. Males (p = 0.014), age >60 years, (p = 0.01) uncontrolled diabetes (HbA1C >7.99%±1.84) and disease duration over 20 years (p = 0.02) are associated factors for chronic kidney disease (CKD). HbA1c had significant differences between those with and those without CKD. The most frequent comorbidities are arterial hypertension (70%), dyslipidemia (43%), overweight/obesity (44%) and anemia (31%). CKD stage G2 is the most frequent (45%). One hundred percent of patients in G1 and G2 CKD stages have an elevated microalbuminuria/creatinuria rate, and 13% of patients between G3a and G4 stages have this rate within normal values. Most patients receive nephroprotection with ARA II and ACEIs. It is important to screen for kidney disease in patients with diabetes mellitus type 2 who are male, over 60 years of age, with uncontrolled HbA1c and prolonged disease duration, as well as to treat comorbidities and nephroprotection regardless of the stage of chronic kidney disease.

Surgery or Comorbidities: What Is the Primum Movens of Kidney Dysfunction After Nephrectomy? A Multicenter Study in Living Donors and Cancer Patients.

Background and Hypothesis: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are significant risks for kidney cancer (KC) patients undergoing partial (PN) or radical nephrectomy (RN) and for living kidney donors (LKD). This study compares AKI and CKD incidence in these groups with a pre-operative glomerular filtration rate (GFR) over 60 mL/min/1.73 m2. Methods: This study included 465 KC patients with cT1-2N0M0 kidney mass and 256 LKD who underwent nephrectomy at four Italian institutions from 2014 to 2021. Data on demographics, comorbidities, and therapies were analyzed. Serum creatinine and estimated GFR (eGFR) were measured before and after surgery. Outcomes were AKI (per KDIGO guidelines) and CKD stage progression. Analyses included descriptive statistics, ANOVA, logistic regression, and Kaplan-Meier survival. Results: Among 721 patients, significant age and gender differences were noted. Hypertension (41%) and diabetes (7.1%) were prevalent in RN and PN groups. Post-surgery AKI was more common in donors (84%), while CKD stage progression varied by surgery type (CKD stage G3 after 60 months: RN 48.91%, PN 18.22%, LKD 26.56%). Age, pre-surgery CKD, and surgery type predicted CKD progression. Limitations include retrospective design and bias. Conclusions: Both LKD and KC patients face similar AKI and CKD risks. Surgery type significantly influences AKI and CKD incidence, highlighting the importance of approach.

Determinants of the serum potassium concentration in chronic kidney disease.

If Ccr is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (Ks) is the sum of EK/Ccr and TRK/Ccr, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (Ks = EK/Ccr + TRK/Ccr). We investigated changes in EK/Ccr, TRK/Ccr, and Ks through the stages of chronic kidney disease (CKD). We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (Ks, Ku, crs, and cru) were used to calculate 1,007 individual values of EK/Ccr and TRK/Ccr as Ku×crs/cru and Ks - EK/Ccr, respectively. Mean values of EK/Ccr and TRK/Ccr were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (Ks > 5.1 mmol/L), normokalemia (Ks 3.8 - 5.1 mmol/L), and hypokalemia (Ks < 3.8 mmol/L). In comparison to values in CKD stages G1 - 2, EK/Ccr rose and TRK/Ccr fell in each higher stage. Decrements in TRK/Ccr equaled increments in EK/Ccr in G3a and G3b, and Ks remained stable. In G4 - 5, the ascent of EK/Ccr exceeded the decline in TRK/Ccr, and Ks rose accordingly. Within each CKD stage, EK/Ccr was remarkably similar in the three kalemic subsets; consequently, differences in TRK/Ccr were the sole source of differences in Ks. EK/Ccr rises and TRK/Ccr falls through the stages of CKD. Ks remains stable in stages G3a - 3b in association with equal and opposite changes in EK/Ccr and TRK/Ccr. In stages G4 - 5, Ks increases progressively because EK/Ccr rises more than TRK/Ccr falls. Within each CKD stage, differences in TRK/Ccr account entirely for differences in Ks among hyper-, normo-, and hypokalemic subsets. Causes of variability of TRK/Ccr require additional investigation.

Breath Analysis: Identification of Potential Volatile Biomarkers for Non-Invasive Diagnosis of Chronic Kidney Disease (CKD).

Recently, volatile organic compound (VOC) determination in exhaled breath has seen growing interest due to its promising potential in early diagnosis of several pathological conditions, including chronic kidney disease (CKD). Therefore, this study aimed to identify the breath VOC pattern providing an accurate, reproducible and fast CKD diagnosis at early stages of disease. A cross-sectional observational study was carried out, enrolling a total of 30 subjects matched for age and gender. More specifically, the breath samples were collected from (a) 10 patients with end-stage kidney disease (ESKD) before undergoing hemodialysis treatment (DIAL); (b) 10 patients with mild-moderate CKD (G) including 3 patients in stage G2 with mild albuminuria, and 7 patients in stage G3 and (c) 10 healthy controls (CTRL). For each volunteer, an end-tidal exhaled breath sample and an ambient air sample (AA) were collected at the same time on two sorbent tubes by an automated sampling system and analyzed by Thermal Desorption-Gas Chromatography-Mass Spectrometry. A total of 110 VOCs were detected in breath samples but only 42 showed significatively different levels with respect to AA. Nonparametric tests, such as Wilcoxon/Kruskal-Wallis tests, allowed us to identify the most weighting variables able to discriminate between AA, DIAL, G and CTRL breath samples. A promising multivariate data mining approach incorporating only selected variables (showing p-values lower than 0.05), such as nonanal, pentane, acetophenone, pentanone, undecane, butanedione, ethyl hexanol and benzene, was developed and cross-validated, providing a prediction accuracy equal to 87% and 100% in identifying patients with both mild-moderate CKD (G) and ESKD (DIAL), respectively.

Impact of Prepared Vascular Access on Mortality and Medical Expenses in Elderly and Nonelderly Japanese Patients with CKD Stage G5: A Retrospective Cohort Study

Impact of Prepared Vascular Access on Mortality and Medical Expenses in Elderly and Nonelderly Japanese Patients with CKD Stage G5: A Retrospective Cohort Study

Polypharmacy and Potentially Inappropriate Medications among Elderly Patients with Advanced Stage G5 CKD

Polypharmacy and Potentially Inappropriate Medications among Elderly Patients with Advanced Stage G5 CKD

Bioimpedance Analysis for the Assessment of Body Composition and Relation with Muscle Strength in Patients with CKD Stage G3 to G5 and Healthy Controls

Bioimpedance Analysis for the Assessment of Body Composition and Relation with Muscle Strength in Patients with CKD Stage G3 to G5 and Healthy Controls

Chemostratigraphy and mineralogical characterization of Piacenzian sapropels cluster A (2.75–2.57 Ma) in the Gelasian GSSP type-section of Monte San Nicola (Sicily, Italy): Paleoenvironmental and paleogeographic implications

Mineralogical, geochemical and stable isotope (δ18O, δ13C) data from Marine Isotope Stages (MIS) G4 to 103 are here presented. The studied interval includes the sapropelic cluster A (A2-A5) from the Gelasian GSSP type-section, outcropping at Monte San Nicola (Sicily, Italy). The studied section exhibits a good response of the δ18O measured on the bulk carbonate to the Earth's astronomical parameters. The sapropelic red/brown layers (A2- A5) are alternated to grey marls and this cyclicity is clearly evident by the difference in colour, organic matter content, redox-sensitive elements and runoff indicators, tied to the precession/insolation cycles. Further, the obliquity signal is well evident in paleoproductivity indicators and mineralogical composition, driven by glacial-interglacial cycles. The obtained dataset has allowed the reconstruction of the paleoenvironmental conditions during marls/sapropels deposition, which appears to be influenced by the precessional forcing that induced strong changes in the marine water circulation. This scenario is also integrated by an original paleogeographic model including the presence of a high topographic structure in SE Sicily that limited water exchanges between the Ionian and Central Mediterranean Seas during sea level drawdowns, caused by glacial phases, triggered by obliquity minima.