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atients with end-stage kidney disease. Kidney transplant is associated with the same degree of survival benefit among those with pretransplant prostate cancer as those without.
Although kidney biopsy is a useful tool, nephrologists' approach toward biopsies is inconsistent for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists to perform native kidney biopsy.
Qualitative study using semistructured interviews.
Purposive sampling was used to select nephrologists from different regions in the United States. Semistructured interviews were continued until thematic saturation.
A modified grounded theory was used to identify dominant themes reflecting the nephrologists' decision-making styles about kidney biopsy.
Twenty nephrologists were interviewed 16 (80%) were from academic centers, 3 (15%) performed their own biopsies, and 7 (35%) had been in practice for less than 10 years. The median time of practice was 14 years. We found substantial variability among the nephrologists in their attitude toward using kidney biopsy, which reflected individual differences in weighi to make biopsy practice more standardized.
Glomerular deposition of C4d is a widely used biomarker for activation of the lectin pathway in the complement system and is reported to be associated with kidney progression in immunoglobulin A nephropathy (IgAN). The aim of this study was to evaluate whether glomerular C4d deposition, as a new biomarker, improves the prediction of kidney prognosis in IgAN.
Systematic review and meta-analysis.
Patients with biopsy-proven primary IgAN without age limitations.Selection Criteria for Studies Cross-sectional or cohort studies reporting the prevalence of glomerular C4d deposition or evaluating its association with IgAN progression.
Glomerular C4d deposition.
Composite progression event of a>30% decline in estimated glomerular filtration rate or end-stage kidney disease.
12 studies with 1,251 patients were included. The prevalence of glomerular C4d deposition was 34% (95% CI, 27%-41%), with large heterogeneity (
=86%;
<0.001). Patients with C4d deposition had lower estimated glomerular filtrr C4d deposition is associated with an adverse prognosis and may be a useful biomarker of disease prediction in IgAN.
Glomerular C4d deposition is associated with an adverse prognosis and may be a useful biomarker of disease prediction in IgAN.
Immunoglobulin A nephropathy (IgAN) is a common glomerular disease, with mesangial cell proliferation as a major feature. There is no disease-specific treatment. Platelet-derived growth factor (PDGF) contributes to the pathogenesis of IgAN. To better understand its pathogenic mechanisms, we assessed PDGF-mediated AXL phosphorylation in human mesangial cells and kidney tissue biopsy specimens.
Immunostaining using human kidney biopsy specimens and
studies using primary human mesangial cells.
Phosphorylation of AXL was assessed in cultured mesangial cells and 10 kidney-biopsy specimens from 5 patients withIgAN, 3 with minimal change disease, 1 with membranous nephropathy, and 1 with mesangioproliferative glomerulonephritis (GN).
Glomerular staining for phospho-AXL in kidney biopsy specimens of patients with mesangioproliferative diseases.
Phosphorylated AXL detected in biopsy tissues of patients with IgAN and mesangioproliferative GN and in cultured mesangial cells stimulated with PDGF.
test, Maation of AXL. Finding appropriate inhibitors to block PDGF-mediated transactivation of AXL may provide new therapeutic options for mesangioproliferative kidney diseases such as IgAN.
PDGF-mediated signaling in mesangial cells involves transactivation of AXL. Finding appropriate inhibitors to block PDGF-mediated transactivation of AXL may provide new therapeutic options for mesangioproliferative kidney diseases such as IgAN.
Current hemodialysis (HD) treatments have limited ability to clear larger-molecular-weight uremic toxins. Retention is associated with increased symptom burden, low health-related quality of life (HRQoL), and high mortality. Improved clearance, using novel medium cut-off dialyzers, termed expanded HD (HDx), may be associated with improved subjective experience. We have previously developed a dynamic patient-reported outcome measure (PROM) instrument to allow iterative recording to better appreciate the overall burden of disease and assess the impact of therapy changes.
Single-center interventional pilot study.
28 patients established on maintenance HD, London, Ontario, Canada.
Initial study consisting of 2-week observation (baseline-conventional high-flux HD) followed by 12 weeks of HDx. HRQoL was assessed using the dynamic PROM instrument thrice weekly (enabled in a dedicated app as the London Evaluation of Illness [LEVIL]). Extension phase; 2-week baseline with 24 weeks of HDx and 8-week washout.
allow optimal design of further definitive randomized controlled trials of this newly introduced technology.
Baxter Healthcare Canada.
ClinicalTrials.gov ID NCT03640858.
ClinicalTrials.gov ID NCT03640858.
We aimed to explore the associated factors of endothelial injury in chronic kidney disease (CKD) and the relationship between endothelial dysfunction and CKD prognosis.
A prospective observational cohort study.
77 adults with CKD stages 1-5 were enrolled January 2010 to December 2010 and followed up until December2015.
Serum asymmetric dimethylarginine (ADMA) level at baseline, α-klotho, sodium-phosphorus synergistic transporter, and dimethylarginine-dimethylamine hydrolase expression in kidney biopsy samples.
Initiation of kidney replacement therapy (KRT).
Kaplan-Meier analysis was used for evaluation of the incidence rate of KRT. All tests were 2 tailed, and statistical significance was defined as
<0.05.
Mean serum ADMA level of 77 patients was 64.3±34.6ng/mL. ADMA level increased with CKD stages (
=0.06) and declining kidney function (
=-0.267;
=0.02). The expression of α-klotho in kidney biopsy specimens also decreased. selleck inhibitor Median follow-up time was 56 (interquartile range, 50.5-62) monciated with higher circulating ADMA levels, suggesting that they may be involved in the pathogenesis of endothelial dysfunction in patients with CKD.
Serum ADMA levels increased as kidney function declined, and high serum ADMA level was associated with incident kidney failure. Low tissue α-klotho and high levels of plasma phosphorus or tissue expression of type II sodium/phosphate cotransporter in the kidney are associated with higher circulating ADMA levels, suggesting that they may be involved in the pathogenesis of endothelial dysfunction in patients with CKD.
Assessing the optimal therapy for older patients (aged≥65 years) with end-stage kidney disease requires knowledge of longevity and health-related quality of life (HRQoL) outcomes. Kidney transplantation prolongs survival but its long-term impact on HRQoL in older recipients is not well defined. We aimed to prospectively evaluate HRQoL changes from enlisting until 3 years posttransplantation and examine pretransplantation predictors of posttransplantation outcomes.
Prospective cohort study.
Patients 65 years and older enlisted at the Norwegian National Transplant Center between January 2013 and November2016.
Kidney transplantation, dialysis vintage, and pretransplantation comorbidity assessed using the Liu Comorbidity Index.
HRQoL, assessed using the Kidney Disease Quality of Life Short Form, version 1.3.
HRQoL scores obtained at 3 years posttransplantation were compared with those obtained pretransplantation and after 1 year using a paired-sample
test. Multivariable linear mixed-effect models wolder patients. The value of a pretransplant comorbidity score to predict posttransplantation outcomes warrants further evaluation and may improve the selection process.
Transplantation is associated with a sustained HRQoL improvement and should be the preferred treatment for selected older patients. The value of a pretransplant comorbidity score to predict posttransplantation outcomes warrants further evaluation and may improve the selection process.
Apolipoprotein L1 (
) high-risk variants are associated with an increased risk for chronic kidney disease (CKD) among African Americans. Less is known regarding the risk for the development of CKD and kidney failure (end-stage kidney disease [ESKD]) among African Americans with only 1
risk variant or whether the risk is modified by sickle cell trait.
The Jackson Heart Study is a community-based longitudinal cohort study.
Self-reported African Americans in the Jackson Heart Study (n= 5,306).
G1 and G2 genotypes and sickle cell trait.
Incident CKD (estimated glomerular filtration rate< 60 mL/min/1.73 m
), albuminuria (urinary albumin-creatinine ratio≥ 30 mg/g), continuous and rapid kidney function decline (≥30% decline), and incident ESKD.
Multivariable linear and logistic regression, and Cox proportional hazards models adjusted for age, sex, hypertension, diabetes, ancestry informative markers, and sickle cell trait.
Of 2,300 participants, 41.3% had zero, 45.1% had 1, and 13.6% had 2
s that might alter the risk for adverse kidney outcomes among individuals with high-risk
genotypes.
The presence of 1 APOL1 risk allele was not associated with increased risk for CKD outcomes, whereas 2 risk alleles were associated with incident albuminuria, CKD, ESKD, and rapid and continuous kidney function decline. Additional studies are needed to determine factors that might alter the risk for adverse kidney outcomes among individuals with high-risk APOL1 genotypes.
We aimed to test interventions to improve physical activity in persons with advanced chronic kidney disease not yet receiving dialysis.
Randomized controlled trial with parallel-group design.
We embedded a pragmatic referral to exercise programming in high-volume kidney clinics servicing diverse populations in San Jose, CA, and Atlanta, GA. We recruited 56 participants with estimated glomerular filtration rates< 45 mL/min/1.73 m
.
We randomly assigned participants to a mobile health (mHealth) group-wearable activity trackers and fitness professional counseling, or an Exercise is Medicine intervention framework (EIM) group-mHealth components plus twice-weekly small-group directed exercise sessions customized to persons with kidney disease. We performed assessments at baseline, 8 weeks at the end of active intervention, and 16 weeks after passive follow-up and used multilevel mixed models to assess between-group differences.
Activity tracker total daily step count.
Of 56 participants, 86% belong effective in improving physical activity in an underserved population with high comorbid conditions.
Normon S Coplon Applied Pragmatic Clinical Research program.
NCT03311763.
NCT03311763.
The prevalence of kidney failure is increasing globally. Most of these patients will require life-sustaining dialysis at a substantial cost to the health care system. Assisted peritoneal dialysis (PD) and assisted home hemodialysis (HD) are potential alternatives to in-center HD and have demonstrated equivalent outcomes with respect to mortality and morbidity. We aim to describe the costs associated with assisted continuous cycling PD (CCPD) and assisted home HD.
Cost minimization model.
Adult incident maintenance dialysis patients in Manitoba, Canada.
Full- and partial-assist home HD and CCPD. Full-assist modalities were defined as nurse-assisted dialysis setup and takedown performed by a health care aide, whereas partial-assist modalities only included nurse-assisted setup. Additionally, full-assist home HD was evaluated under a complete care scenario with the inclusion of a health care aide remaining with the patient throughout the duration of treatment.
Annual per-patient maintenance and training costs related to assisted and self-care home HD and CCPD, presented in 2019 Canadian dollars.
