Treatment Of Chronic Kidney Disease Research Articles

Upcoming drug targets for kidney protective effects in chronic kidney disease.

Despite recent advancements in the treatment of chronic kidney disease (CKD), identifying novel therapies beyond guideline-directed therapies that reduce residual cardiorenal risk remains imperative. In this review, we highlight the clinical evidence supporting emerging therapies for CKD, including glucagon-like peptide-1 receptor agonists (GLP1RA) and other incretin-based therapies, aldosterone synthase inhibitors (ASI), endothelin receptor antagonists (ERA), soluble guanylate cyclase (sGC) agonists and anti-inflammatory drugs. Long-acting GLP1RA are already recommended for glycemic control in patients with CKD and type 2 diabetes and the large, dedicated kidney outcome trial FLOW was recently stopped early for efficacy. Emerging clinical trial evidence supports the concept that ASI also provide additional benefit on top of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, which remain a cornerstone of CKD treatment. Next, we consider the use of sGC agonists, which target nitric oxide bioavailability and thereby reduce albuminuria. Finally, we explore the therapeutic potential of ERA, which act through hemodynamic and anti-fibrotic mechanisms, thereby addressing a common final pathway in the development of CKD. Accordingly, our review highlights the changing therapeutic landscape for CKD with promising agents to further prevent the progression of kidney disease.

Yiqi Juanshen decoction alleviates renal interstitial fibrosis by targeting the LOXL2/PI3K/AKT pathway to suppress EMT and inflammation.

Chronic kidney disease (CKD) is a major health concern, with renal interstitial fibrosis (RIF) as a key feature. Effective management of RIF is crucial for treating CKD. Yiqi Juanshen decoction (YQJSD), as traditional Chinese medicine, has shown promising results in CKD treatment. This study evaluates YQJSD's effectiveness in ameliorating RIF and explores the underlying molecular mechanisms using the unilateral ureteral obstruction (UUO) model. YQJSD has been shown to effectively reduce serum creatinine and blood urea nitrogen levels, decrease extracellular matrix deposition, and down-regulate the expression of α-SMA, COL4α1, Fibronectin (FN). Mechanistically, YQJSD exerts its effects by modulating multiple pathways: it inhibits the NF-κB signaling pathway, inhibiting the expression of pro-inflammatory cytokines like NF-κB1, IL-1β, TNF-α, and CCR1. Simultaneously, YQJSD suppresses the epithelial-mesenchymal transition (EMT) by downregulating the expression of Snail1, Vimentin, Twist1, and FSP1, while increasing E-cadherin expression. Moreover, YQJSD can regulate the PI3K/AKT signaling pathway by decreasing the expression of LOXL2 and PIK3R1, along with p-AKT1/2/3. This modulation of the LOXL2/PI3K/AKT pathway contributes to the inhibition of both EMT and inflammation, highlighting a critical role in the therapeutic intervention against RIF. These findings suggest that YQJSD may serve as a promising therapeutic management of RIF in CKD patients.

MicroRNA biosensors for detection of chronic kidney disease.

Chronic kidney disease (CKD) is a prevalent health condition characterized by gradual kidney function loss. Early detection is crucial for the effective management and treatment of CKD. A promising biomarker for various diseases, including chronic kidney disease, is microRNAs (miRNAs), which are becoming increasingly important due to their stability and differential expression in various disease-related states, including CKD. Recent developments in microRNA biosensors have made it possible to detect miRNAs associated with CKD in a sensitive and specific manner. This review article discusses the current state of microRNA biosensors for detecting CKD and highlights their potential applications in clinical settings. Various microRNA biosensors, including electrochemical, optical, and nanomaterial-based sensors, are explored for their ability to detect specific miRNAs linked to CKD progression. The advantages and limitations of these biosensors are evaluated, focusing on factors such as sensitivity, specificity, and ease of use. Overall, microRNA biosensors are promising diagnostic tools for early detection of CKD. However, challenges such as standardizing protocols, validating in large cohorts, and translating to clinical practice remain to be addressed. Future research efforts should aim to overcome these limitations to fully realize the potential of microRNA biosensors in improving the diagnosis and management of CKD.

Treating chronic kidney disease in Danish primary care: results from the observational ATLAS study

ObjectivesTo describe the clinical characteristics, comorbidity, and medical treatment in a primary care population with chronic kidney disease (CKD). Additionally, to investigate how primary care physicians (PCPs) diagnose, manage and treat impaired kidney function, including uptake of cardio-renoprotective renin–angiotensin–aldosterone system inhibitors (RAASis) and sodium glucose co-transporter 2 inhibitors (SGLT2is).DesignAn observational study of CKD prevalence, treatment patterns and comorbidities in primary care based on patient record data combined with a questionnaire on diagnosis, management and treatment of impaired kidney function in a real-world, primary care setting.SettingIn all 128 primary care clinics in Denmark of 211 randomly invited and a quetionnaire completed by 125/128 participating PCPs.MethodsA computerized selection identified 12 random individuals with CKD per clinic with ≥ 2 measurements of eGFR < 60 mL/min/1.73 m2 or UACR > 30 mg/g within two years (N = 1 497). Pre-specified data collected from individual electronic health records included demographics, clinical variables, comorbidities, and relevant prescribed medications.ResultsOf the CKD study population (N = 1 497), 80% had hypertension, 32% diabetes (DM), 13% heart failure (HF), 59% no DM/HF. ACEis/ARBs were prescribed to 65%, statins to 56%, SGTL2is to 14%, and MRAs to 8% of all individuals. Treatment patterns differed between individuals with varying comorbidities, e.g., ACEis/ARBs usage was higher in DM (76%) or HF (74%) vs. no DM/HF (58%), as was statin usage (76% in DM vs. 45% in no DM/HF). SGTL2i usage in no DM/HF was low. Most PCPs identified CKD using eGFR < 60 mL/min/1.73 m2 (62%) or UACR > 30 mg/g (58%) and 62% reported initiating treatment to retard kidney function decline.ConclusionsDespite good PCP awareness and wish to use relevant guidelines, a gap exists in implementation of cardio-renoprotective treatment, especially in individuals without DM/HF. This offers an opportunity for clear recommendations to PCPs to optimize early cardio-renal protection in individuals with CKD.

Comprehensive treatment with dapagliflozin in elderly chronic kidney disease patients: Clinical efficacy and impact on body composition.

Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is widely used for treating heart failure and chronic kidney disease (CKD). While its renoprotective effects are well established, concerns remain regarding its impact on muscle mass and function, especially in elderly patients. To assess the effects of dapagliflozin on renal function, body composition, and muscle strength in elderly CKD patients. Twelve elderly CKD patients (75.6±1.4years) were treated with dapagliflozin for 12months. Body composition, serum parameters, and muscle function were evaluated at baseline, 6months, and 12months. Measurements included changes in eGFR, liver function, HbA1c, and muscle strength. Dapagliflozin treatment stabilized eGFR without significant improvement, but proteinuria was notably reduced in most patients, indicating a positive renal effect. AST and ALT levels showed significant reduction after 12months, suggesting improved liver function. No significant changes were observed in body weight, BMI, or muscle mass. Muscle function, as measured by the 5-sit-to-stand test, improved significantly, while grip strength remained stable. No serious adverse events were reported. Dapagliflozin is a safe and effective treatment for CKD in elderly patients, demonstrating renal protection and improved liver function without adversely affecting muscle mass or strength. The study supports the use of dapagliflozin as part of a comprehensive approach, combining pharmacotherapy, lifestyle modification, and exercise to optimize patient outcomes in CKD management.

Tackling chronic kidney disease in Nepal: from evidence to action.

Chronic kidney disease (CKD) poses a significant burden in Nepal. We reviewed the epidemiology of CKD in Nepal and proposed strategies to mitigate its burden. A nationwide survey of non-communicable diseases in 2019 reported CKD prevalence of 6.2% (95% Confidence Interval [CI]: 5.7-6.6%). Further, we found that the age-standardized prevalence of chronic kidney disease in Nepal grew by 0.11% (95% uncertainty interval, [UI]: 0.10-0.11%) per annum between 1990 and 2021. Despite the high burden (10,887.7 prevalent CKD per 100,000 population), the country only has 56 nephrologists and 60 hemodialysis centers, the majority of which are located in the country's capital, serving only 15% of the population. CKD requires multi-component interventions that address the diverse causes and pathological expressions of the disease. Integrating interventions across the care continuum, such as health educationand literacy, screening, lifestyle modifications, and improved access to renal replacement therapies, can enhance effective coverage and scalability of care. Additionally, it is crucial to explore and address disparities in access to CKD treatment, including gender and socioeconomic disparities.

The gut–kidney axis is regulated by astragaloside IV to inhibit cyclosporine A-induced nephrotoxicity

IntroductionChronic nephrotoxicity caused by CNIs (CICN) manifests clinically as chronic kidney disease (CKD). Astragaloside IV (AS-IV) plays a certain role in the treatment of CKD. This study aimed to verify the ameliorative effects of AS-IV on CICN and further explore the mechanisms underlying the modulation of the “gut–transcriptome–metabolome coexpression network” by AS-IV within the context of the “gut–kidney axis” to improve CICN.MethodsFive groups of 40 mice were studied: a normal group (N, olive oil), a model group (M, CsA, 30 mg kg-−1 d−1), a low-dose AS-IV group (CsA + AS-IV, 30 mg kg−1 d−1 + 10 mg kg−1 d−1), a high-dose AS-IV group (CsA + AS-IV, 30 mg kg−1 d−1 + 20 mg kg−1 d−1), and a valsartan group (CsA + Val, 30 mg kg−1 d−1 + 10 mg kg−1 d−1). The gut microbiota, renal transcriptome, and urine metabolome were separately detected to construct a gut–transcriptome–metabolome coexpression network. The target species, target genes, and target metabolites of AS-IV were evaluated.ResultsCsA led to increased proteinuria and a deterioration of kidney function, accompanied by increased inflammation and oxidative stress, whereas AS-IV improved kidney damage. AS-IV inhibited intestinal permeability and disrupted the microbiota structure, increasing the abundance of Lactobacillus reuteri, Bifidobacterium animalis, Ignatzschineria indica, and Blautia glucerasea. Six coexpression pathways related to transcription and metabolism, including the citrate cycle, ascorbate and aldarate metabolism, proximal tubule bicarbonate reclamation, glycolysis/gluconeogenesis, ferroptosis, and drug metabolism–cytochrome P450, were identified. Seven target metabolites of AS-IV were identified in the 6 pathways, including UDP-D-galacturonic acid, 2-phenylethanol glucuronide, dehydroascorbic acid, isopentenyl pyrophosphate, alpha-D-glucose, 3-carboxy-1-hydroxypropylthiamine diphosphate and citalopram aldehyde. Five target genes of AS-IV, Ugt1a2, Ugt1a9, Ugt1a5, Pck1, and Slc7a11, were also identified and predicted by NONMMUT144584.1, MSTRG.30357.1 and ENSMUST00000174821. Lactobacillus reuteri was highly correlated with renal function and the target genes and metabolites of AS-IV. The target genes and metabolites of AS-IV were further validated. AS-IV inhibited intestinal-derived urinary toxins and improved renal tissue apoptosis, lipid accumulation, collagen deposition, and mitochondrial damage.ConclusionAS-IV improved CICN through the coexpression of the gut–transcriptome–metabolome network. The six pathways related to energy metabolism driven by L. reuteri, including the citrate cycle, ascorbate and alderate metabolism, proximal tube bicarbonate metabolism, glycolysis/gluconeogenesis, ferroptosis, drug metabolism–cytochrome P450, are important mechanisms.

High-density lipoprotein nanoparticles spontaneously target to damaged renal tubules and alleviate renal fibrosis by remodeling the fibrotic niches

Chronic kidney disease (CKD) ultimately causes renal fibrosis and end-stage renal disease, thus seriously threatens human health. However, current medications for CKD and fibrosis are inefficient, which is often due to poor targeting capability to renal tubule. In this study, we discover that biomimetic high-density lipoprotein (bHDL) lipid nanoparticles possess excellent targeting ability to injured tubular epithelial cells by kidney injury molecule-1(KIM-1) mediated internalization. Thus, we co-load anti-inflammatory drug triptolide (TP) and anti-fibrotic drug nintedanib (BIBF) on bHDL nanoparticles to treat CKD. Based on the targeted delivery and mutual enhancement of the efficacy of co-delivered drugs, the bHDL-based system effectively reduces kidney injury and alleviates renal fibrosis in different CKD mouse models. The mechanistic study shows that BIBF and TP synergistically remodel the fibrotic niches by decreasing inflammatory cytokines, limiting immune cell infiltration and inhibiting the activation of myofibroblasts. The bHDL vehicle also possesses high manufacturability, good safety and adequately reduces the toxicity of TP. Thus, this system is promising for the treatment of CKD and bHDL has good potential for delivering agents to damaged renal tubular epithelial cells.

Identifying Research Priorities for Cognition in CKD: A Delphi Study.

Cognition is a research priority for people living with chronic kidney disease (CKD), but identification of critical research questions is lacking. This study aimed to determine which cognition-related research questions are most important to CKD stakeholders. A modified Delphi technique with 3 survey rounds was used. The study sample included 3 panels (People with lived CKD experience, Researchers, and Clinicians) recruited through international patient and kidney research networks, kidney societies, and snowball sampling with email invitations. Survey rounds were distributed electronically through REDCap. In Round 1 (October 2021-May 2022), respondents contributed three important research questions regarding cognition in CKD (free text). After deduplication and qualitative synthesis, respondents ranked the importance of these questions on a nine-point Likert scale in Round 2 (Feb-April 2023). Questions with mean and median ratings of >7 by at least two respondent panels or rated critically important by the 'lived experience' panel were re-ranked in Round 3 ( Aug-Sept 2023) and assessed for consensus to identify the final list of priority research questions. Respondents (n=152) identified 125 and 44 discrete questions after Rounds 1 and 2, respectively. The final shortlist included 27 questions in 8 categories. The most critical research question identified was "What factors prevent cognitive impairment in people receiving dialysis?" Overall, respondents prioritized questions focusing on prevention and treatment of cognitive impairment. Scores between the panels were significantly different for 16 questions. Those with lived CKD experience prioritized quality of life, researchers emphasized developing interventions to mitigate cognitive impairment, and clinicians prioritized the effect of CKD treatment on cognitive impairment. Through an established consensus methodology involving key stakeholder groups, we identified 27 critical research questions about cognition in CKD. These questions should guide future study design and outcome selection.

Chronic Kidney Disease in Balkan Countries—A Call for Optimal Multidisciplinary Management

The treatment of chronic kidney disease (CKD) has been considerably transformed in the last couple of years. However, effective management of patients with CKD is still not achieved, despite clear guidelines promoting active screening of high-risk patients, immediate diagnosis based on laboratory markers, and early initiation or intensification of pharmacotherapy like sodium/glucose cotransporter 2 (SGLT2) inhibitors, which showed reliable results in preventing disease progression, complications, and mortality. Following a recent initiative on early diagnosis, nephrology experts from Bulgaria, Croatia, Serbia, and Slovenia discussed the challenges and opportunities related to CKD treatment in the Balkan countries, also reflecting on the heterogenous socio-economic context of the region. The ongoing education of all stakeholders involved in kidney care, structured support for primary care providers, and the improvement of multidisciplinary networks were consistently recognized as key success factors. Optimal CKD management is based on continuity of care and the timely transition of coordination from primary care to nephrology-specialized services.

High prevalence of unrecognized chronic kidney disease in the Lolland-Falster Health Study: a population-based study in a rural provincial area of Denmark.

Chronic kidney disease (CKD) affects 10-15% globally and is a marked independent risk factor for cardiovascular disease. Prevalence estimations are essential for public health planning and implementation of CKD treatment strategies. This study aimed to estimate the prevalence and stages of CKD in the population-based Lolland-Falster Health Study, set in a rural provincial area with the lowest socioeconomic status in Denmark. Additionally, the study characterized participants with CKD, evaluated the overall disease recognition, including the awareness of CKD and compared it with other common conditions. Cross-sectional data were obtained from clinical examinations, biochemical analyses, and questionnaires. CKD was defined as albuminuria (urine albumin-creatinine ratio ≥30 mg/g), estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m², or by a diagnosis in the National Patient Register. Patient awareness was assessed by self-reported CKD, and overall disease recognition by either a registered hospital diagnosis or self-reported CKD. Among 16 097 adults (median age 58.6 years), CKD prevalence was 18.0% (n = 2903), with 70.1% identified by albuminuria, 28.4% by reduced eGFR, and 1.5% by a registered diagnosis alone. Of those with CKD, 98.8% had stages 1-3 (eGFR ≥30 ml/min/1.73 m²), and 1.2% had stages 4-5 (eGFR <30 ml/min/1.73 m²). Female sex, comorbidities, smoking, and low socioeconomic parameters were independently associated with CKD. Patient awareness of CKD was 4.4%, compared to >50% for hypertension and >80% for diabetes, and the overall CKD recognition (self-reported or registered diagnosis) was 7.1%. Thus, in this population-based study, CKD was highly prevalent but poorly recognized, indicating great potential for preventing CKD progression and related complications.

Repurposing the familiar: Future treatment options against chronic kidney disease.

Chronic kidney disease (CKD) is a serious health issue with rising morbidity and mortality rates. Despite advances in understanding its pathophysiology, effective therapeutic options are limited, necessitating innovative treatment approaches. Also, current frontline treatments that are available against CKD are not uniformly effective and often come with significant side effects. Therefore, identifying new therapeutic targets or improving existing treatments for CKD is crucial. Drug repurposing is a promising strategy in the drug discovery process that involves screening existing approved drugs for new therapeutic applications. This review discusses the pharmacological mechanisms and clinical evidence that support the efficacy of these repurposed drugs. Various drugs classes such as inodilators, endothelin-1 type A (ET-1A) receptor antagonists, bisphosphonates, mineralocorticoid receptor (MR) antagonists, DNA demethylating agents, nuclear factor erythroid 2-related factor 2 (NRF2) activators, P2X7 inhibitors, autophagy modulators, hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHI) are discussed that could remarkably contribute against CKD. The review critically examines the potential for repurposing well-established drugs to slow the progression of CKD and enhance patient outcomes. This review emphasizes the importance of a multidisciplinary approach in advancing the field of drug repurposing, ultimately paving the way for innovative and effective therapies for patients suffering from CKD.

Global research progress and trends in traditional Chinese medicine for chronic kidney disease since the 21st century: a bibliometric analysis.

This study analyzed literature on traditional Chinese medicine (TCM) in treating chronic kidney disease (CKD) to identify research trends and provide guidance for future studies and clinical practice. The study used data from Web of Science from 2000 to 2024 to analyze English-language literature on CKD and TCM. Bibliometric analysis was done using R software and the bibliometric package, with scientific mapping and visualization analysis conducted using tools like Citespace, VOSviewer, and ScimagoGraphica to explore research trends and connections. This study revealed that a total of 1,153 relevant documents were retrieved, and the number of published articles showed an increasing trend, reaching a peak in 2022. In terms of article publication, China ranked first with 760 articles, closely followed by the United States with 132 articles. Guangzhou University of Traditional Chinese Medicine published 60 papers, the most among academic institutions, followed by Shanghai University of Traditional Chinese Medicine with 54 papers. In terms of individual authors, Liu Xinhui holds the record for the highest number of published articles, totaling 17, followed by Li Ping and Li Shunmin. The prevalent keywords include "chronic kidney disease," "TCM," and "oxidative stress." Currently, the prominent areas of research interest include network pharmacology, gut microbiota, oxidative stress, and related topics. The current research trend in this field is towards the adoption of novel methodologies such as network pharmacology and the emphasis on exploring the relationship between gut microbiota and CKD. Global research on TCM in the treatment of CKD is showing a positive development trend, but further research on safety, efficacy evaluation, and international cooperation is still needed. The development trend is to adopt new scientific research methods and focus on exploring the mechanism of TCM in treating CKD.

The relationship between C-reactive protein to lymphocyte ratio and the prevalence of chronic kidney disease in US adults: a cross-sectional study.

The C-reactive protein/Lymphocyte Ratio (CLR) is a novel biomarker whose role in the development of chronic kidney disease (CKD) is not well understood. This study aimed to investigate the correlation between CLR and the prevalence of CKD. This cross-sectional study included participants from the US National Health and Nutrition Examination Survey conducted between 1999 and 2010. Multivariate regression analyses and subgroup analyses were performed, controlling for socio-demographic variables, lifestyle behaviors, chronic diseases associated with kidney disease, and biochemical markers of bone metabolism. The associations between CLR and CKD prevalence, as well as indicators of renal damage, were explored. Non-linear relationships were analyzed using weighted restricted cubic splines. The predictive ability of CLR for CKD was assessed by the receiver operating characteristic curve and the area under the curve was calculated. Subgroup and sensitivity analyses were conducted to validate the robustness of the model. A total of 13,862 respondents were included, comprising 2,449 CKD patients and 11,413 non-CKD patients. Weighted logistic regression modeling revealed a positive correlation between CLR levels and CKD prevalence (Odds ratio [OR] = 1.54, 95% Confidence interval [CI] = 1.30 to 1.83, P < 0.001). Additionally, CLR levels were negatively correlated with the glomerular filtration rate, a marker of renal injury, and positively correlated with the urinary albumin/creatinine ratio. The receiver operating characteristic curve demonstrated that the area under the curve for CLR in predicting CKD was 0.653 (95% CI, 0.641-0.665). The optimal cutoff value was 0.856, with a sensitivity of 0.703, specificity of 0.526, positive predictive value of 0.874, and negative predictive value of 0.275. The robustness of the model was confirmed through subgroup and sensitivity analyses. Analysis of a large cross-sectional dataset demonstrated a positive correlation between CLR levels and CKD prevalence, suggesting that CLR may serve as a novel marker for the development and treatment of CKD.

Genetic association analysis of lipid-lowering drug target genes in chronic kidney disease.

The impact of lipid-lowering medications on chronic kidney disease (CKD) remains a subject of debate. This Mendelian randomization (MR) study aims to elucidate the potential effects of lipid-lowering drug targets on CKD development. We extracted 11 genetic variants encoding targets of lipid-lowering drugs from published genome-wide association study (GWAS) summary statistics, encompassing LDLR, HMGCR, PCSK9, NPC1L1, APOB, ABCG5/ABCG8, LPL, APOC3, ANGPTL3, and PPARA. A Mendelian randomization analysis was conducted targeting these drug-related genes. CKD risk was designated as the primary outcome, while estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) were assessed as secondary outcomes. Additionally, mediation analysis was performed utilizing 731 immune cell phenotypes to identify potential mediators. The meta-analysis revealed a significant association between ANGPTL3 inhibitors and a reduced risk of CKD (OR [95% CI] = 0.85 [0.75-0.96]). Conversely, LDLR agonists were significantly linked to an increased risk of CKD (OR [95% CI] = 1.11 [1.02-1.22]). Regarding secondary outcomes, lipid-lowering drugs did not significantly affect eGFR and BUN levels. Mediation analysis indicated that the reduction in CKD risk by ANGPTL3 inhibitors was mediated through modulation of the immune cell phenotype, specifically HLA-DR on CD14+ CD16+ monocytes (Mediated proportion: 4.69%; Mediated effect: -0.00899). Through drug-targeted MR analysis, we identified a causal relationship between lipid-lowering drug targets and CKD. ANGPTL3 and LDLR may represent promising candidate drug targets for CKD treatment.

Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown efficacy in clinical trials for slowing chronic kidney disease (CKD) progression, but real-world data in diverse populations are limited. This retrospective study evaluated the effectiveness and safety of SGLT2i versus renin-angiotensin-aldosterone system (RAAS) blockade in CKD patients. Data from Ramathibodi Hospital (2010–2022) were analyzed, including 6,946 adults with CKD stages 2–4, with and without diabetes, who received SGLT2i (n = 1,405) or RAAS blockade (n = 5,541) for at least three months. Patients were matched 1:4 by CKD stage and treatment initiation date. A weighted Cox proportional hazards model with inverse probability weighting assessed the effect on composite major adverse kidney events (MAKEs), including eGFR decline ≥ 40%, progression to CKD stage 5, dialysis initiation, and cardiovascular or kidney death. SGLT2i therapy was associated with a lower risk of composite MAKEs (HR: 0.59; 95% CI: 0.36–0.98; P = 0.041) and less frequent progression to CKD stage 5 (HR: 0.52; 95% CI: 0.34–0.80; P < 0.003). Adverse event rates were similar between groups, with lower urinary tract infection incidence in the SGLT2i group. These findings suggest SGLT2i therapy might reduce adverse kidney outcomes in CKD patients, regardless of diabetic status, with a favorable safety profile.

Prevalence of chronic kidney disease and influencing factors in adults in Hebei Province

Objective: To analyze the prevalence of chronic kidney disease (CKD) and influencing factors of adults in Hebei Province, and provide scientific evidence for the development of comprehensive CKD prevention and control strategies. Methods: In China Adult Chronic Disease and Nutrition Surveillance in Hebei in 2018, a total of 7 562 permanent residents aged ≥18 years were selected by multi-stage stratified cluster random sampling from 13 surveillance points in Hebei for questionnaire survey, medical examination and laboratory test. Results: A total of 1 067 CKD patients were detected in the adults aged ≥18 years in this survey, with a weighted prevalence rate of 12.10%. The results of multivariate analysis showed that the daily total static behavior time (OR=1.07, 95%CI: 1.04-1.09), living in rural area (OR=1.50, 95%CI: 1.14-1.97), coal use (OR=1.37, 95%CI: 1.16-1.61), coal gas/liquefied gas/natural gas/biogas use (OR=2.92, 95%CI: 2.40-3.54) and solar energy/electricity use (OR=1.75, 95%CI: 1.36-2.25), insufficient fruit intake (OR=1.39, 95%CI: 1.06-1.83), insufficient physical activity (OR=1.35, 95%CI: 1.11-1.64), suffering from hypertension (OR=1.80, 95%CI: 1.44-2.24) and suffering from diabetes (OR=1.77, 95%CI: 1.27-2.45) were risk factors for CKD in adults in Hebei. High education level (OR=0.41, 95%CI: 0.19-0.91), excessive drinking (OR=0.53, 95%CI: 0.28-0.99), central obesity (OR=0.75, 95%CI: 0.58-0.97), history of allergic diseases (OR=0.44, 95%CI: 0.27-0.72) were protective factors for CKD. Conclusions: The prevalence of CKD in adults in Hebei was relatively high, especially in those who had too long average daily static behavior, lived in rural area, used coal, gas/liquefied gas/natural gas/biogas, solar energy/electricity, had inadequate intake of fruits, lacked physical activity and suffered from hypertension and diabetes. It is necessary to pay attention to the early prevention and treatment of CKD, strengthen the health education about healthy lifestyle and improve the management of patients with chronic disease, such as hypertension and diabetes, to further reduce the risk for CKD.

Challenges and suggestions for the prevention and control of chronic kidney disease in China

Population aging, high prevalence of chronic disease, such as hypertension and diabetes, low chronic disease control rate and chronic disease related risk factors commonly observed in population are serious public health problems faced by China today, which have resulting in severe challenges in the prevention and control of chronic kidney disease (CKD) in China. Although the prevalence rate of CKD showed decrease in the past decade, the awareness of CKD in population remains low. To facilitate early detection and treatment of CKD, it is necessary to strengthen health education or promotion and opportunistic screening in high-risk populations, and improve the accessibility of testing and diagnosis. It is suggested to continue the surveillance for disease burden of CKD and related factors and strengthen the control of risk factors to further reduce the incidence and burden of CKD.

Kidney Disease and Hematopoietic Stem Cell Transplantation.

Hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for patients with hematologic malignancies and certain solid tumors and nonmalignant hematologic conditions. Both acute kidney injury (AKI) and chronic kidney disease (CKD) occur commonly after HSCT and are associated with significant morbidity and mortality. AKI and CKD in this setting may result from direct effects of the transplant or be caused by pretransplant bone marrow conditioning regimens and/or nephrotoxic agents administered in the post-transplant period. In this article, we review the epidemiology, risk factors, etiologies, pathophysiology, diagnosis, prevention, and treatment of post-HSCT AKI and CKD, with special attention to recent advances in this fast-moving and evolving field.

Predictive Modeling of Chronic Kidney Disease Progression with Ensemble Learning Techniques

The present study aims to tackle the significant issue of prompt identification of chronic kidney disease (CKD), a highly prevalent and potentially fatal medical illness. Given the crucial function of the kidneys in maintaining homeostasis, we put forth a novel ensemble learning model to forecast the onset of chronic kidney disease (CKD). Utilizing an extensive dataset, the study employs ten carefully designed stages, covering data analysis, missing data management, normalization, and training of machine learning models. The model that we have proposed exhibits superior performance compared to the existing approaches, attaining a noteworthy accuracy rate of 98.74%. Additionally, it demonstrates a sensitivity rate of 100%, a specificity rate of 96.54%, and an F1 score of 99.02%. The visual representation of the confusion matrix effectively showcases the strong performance of the model. The results of this study indicate that our ensemble technique holds promise as a valuable tool for the prompt detection of chronic kidney disease (CKD). It has the potential to improve diagnostic accuracy in clinical settings and alleviate the financial burden associated with advanced CKD treatments.