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- Laboyrie, Suzanne L., et al.
(författare)
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Vascular Access Outcomes in Patients with Autosomal Dominant Polycystic Kidney Disease
- 2024
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Ingår i: KIDNEY360. - : Wolters Kluwer. - 2641-7650. ; 5:6, s. 877-885
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Tidskriftsartikel (refereegranskat)abstract
- Key Points More patients with autosomal dominant polycystic kidney disease received their first intervention to re-establish vascular access patency.Patients with autosomal dominant polycystic kidney disease do not require differential monitoring and treatment of hemodialysis vascular access.Background Autosomal dominant polycystic kidney disease (ADPKD) is a leading hereditary cause of ESKD, often using hemodialysis as a form of RRT. Patients with ADPKD may also present with extrarenal manifestations, including arterial aneurysms. The gold standard for hemodialysis access is an arteriovenous vascular access (VA), such as arteriovenous fistulas (AVFs) or arteriovenous grafts (AVGs). However, limitations, such as low VA flow and inadequate AVF outward remodeling, affect VA utilization. This study aimed to explore whether ADPKD affects patency rates of AVFs/AVGs in comparison with other underlying ESKD causes.Methods We conducted a retrospective cohort study using data from the Swedish Renal Registry from 2011 to 2020, with follow-up until 2022. We included 496 patients with ADPKD and 4321 propensity score–matched controls. VA patency rates of patients with ADPKD were compared with those of non-ADPKD patients using Kaplan–Meier survival curves and Mantel–Cox log-rank test. Interventions to maintain or restore patency were also analyzed.Results Patients with ADPKD constituted 8.0% of all patients, with a higher proportion in the pre-ESKD phase during VA creation (51.6% versus 40.6%). No significant differences were observed in primary, postcannulation primary, secondary, or functional patency between patients with ADPKD and non-ADPKD patients. However, more VAs were ligated in patients with ADPKD (10.5% versus 7.7%, P = 0.03), and they underwent more first interventions to re-establish flow (49.4% versus 41.9%, P = 0.02).Conclusions These findings suggest that AVF/AVG patency remains comparable in patients with ESKD with or without ADPKD, and VA monitoring and treatment strategies for patients with ADPKD should align with those for individuals with other ESKD causes.
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| 2. |
- Tangri, Navdeep, et al.
(författare)
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Mortality, Health Care Burden, and Treatment of CKD : A Multinational, Observational Study (OPTIMISE-CKD)
- 2024
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Ingår i: KIDNEY360. - : Wolters Kluwer. - 2641-7650. ; 5:3, s. 352-362
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Tidskriftsartikel (refereegranskat)abstract
- Background Kidney-protective treatments (renin-angiotensin system inhibitors and sodium-glucose cotransporter-2 inhibitors [SGLT-2is]) can delay CKD progression, cardiovascular events, and death. Methods This observational cohort study used electronic health records and claims data from Japan, Sweden, and the United States to assess 1-year mortality/hospitalization event rates per 100 patient-years (PYs), cumulative hospital health care costs per patient, and kidney-protective treatment use before/after SGLT-2i (dapagliflozin) approval for CKD (2021) for patients with CKD stage 3-4 with/without type 2 diabetes (T2D). Results Among 449,232 patients (across-country median age range 74-81 years), 79% did not have T2D. Prevalence ranges for atherosclerotic cardiovascular disease and heart failure were 20%-36% and 17%-31%, respectively. Baseline kidney-protective treatment (renin-angiotensin system inhibitor and/or SGLT-2i) use was limited, especially among patients without T2D. Event rates were high for CKD (11.4-44.4/100 PYs) and heart failure (7.4-22.3/100 PYs). Up to 14.6% of patients had died within 1 year. Hospital costs were higher for CKD and heart failure than for atherosclerotic cardiovascular disease. After incident CKD, kidney-protective treatment initiation was low (8%-20%) and discontinuation was high (16%-27%), especially among patients without T2D. Conclusions Incident CKD was associated with substantial morbidity, mortality, costs, and undertreatment, especially in patients without T2D, who represented the majority of patients. This highlights an urgent need for early CKD detection and better kidney-protective treatment use in moderate CKD.
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| 3. |
- Unnersjoe-Jess, David, et al.
(författare)
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Three-Dimensional Super-Resolved Imaging of Paraffin-Embedded Kidney Samples
- 2022
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Ingår i: KIDNEY360. - : American Society of Nephrology (ASN). - 2641-7650. ; 3:3, s. 446-454
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Tidskriftsartikel (refereegranskat)abstract
- Background Diseases of the glomeruli, the renalfiltration units, are a leading cause of progressive kidney disease. Assessment of the ultrastructure of podocytes at the glomerularfiltration barrier is essential for diagnosing diverse disease entities, providing insight into the disease pathogenesis, and monitoring treatment responses.& nbsp;Methods Here we apply previously published sample preparation methods together with stimulated emission depletion and confocal microscopy for resolving nanoscale podocyte substructure. The protocols are modified and optimized in order to be applied to formalin-fixed paraffin-embedded (FFPE) samples.& nbsp;Results We successfully modified our protocols to allow for deep three-dimensional stimulated emission depletion and confocal imaging of FFPE kidney tissue with similar staining and image quality compared with our previous approaches. We further show that quantitative analysis can be applied to extract morphometrics from healthy and diseased samples from both mice and humans.& nbsp;Conclusions The results from this study could increase the feasibility of implementing optical kidney imaging protocols in clinical routines because FFPE is the gold-standard method for storage of patient samples.& nbsp;
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| 4. |
- Waldman, Meryl, et al.
(författare)
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COVID-19 in Patients with Glomerular Disease: Follow-Up Results from the IRoc-GN International Registry
- 2022
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Ingår i: KIDNEY360. - : AMER SOC NEPHROLOGY. - 2641-7650. ; 3:2, s. 293-306
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Tidskriftsartikel (refereegranskat)abstract
- Background The acute and long-term effects of severe acute respiratory syndrome coronavirus 2 infection in individuals with GN are still unclear. To address this relevant issue, we created the International Registry of COVID-19 infection in GN.Methods We collected serial information on kidney-related and-unrelated outcomes from 125 GN patients (63 hospitalized and 62 outpatients) and 83 non-GN hospitalized patients with coronavirus disease 2019 (COVID-19) and a median follow-up period of 6.4 (interquartile range 2.3-9.6) months after diagnosis. We used logistic regression for the analyses of clinical outcomes and linear mixed models for the longitudinal analyses of eGFR. All multiple regression models were adjusted for age, sex, ethnicity, and renin-angiotensin-aldosterone system inhibitor use.Results After adjustment for pre-COVID-19 eGFR and other confounders, mortality and AKI did not differ between GN patients and controls (adjusted odds ratio for AKI=1.28; 95% confidence interval [CI], 0.46 to 3.60; P=0.64). The main predictor of AKI was pre-COVID-19 eGFR (adjusted odds ratio per 1 SD unit decrease in eGFR=3.04; 95% CI, 1.76 to 5.28; P,0.001). GN patients developing AKI were less likely to recover pre-COVID19 eGFR compared with controls (adjusted 6-month post-COVID-19 eGFR=0.41; 95% CI, 0.25 to 0.56; times preCOVID-19 eGFR). Shorter duration of GN diagnosis, higher pre-COVID-19 proteinuria, and diagnosis of focal segmental glomerulosclerosis or minimal change disease were associated with a lower post-COVID-19 eGFR.Conclusions Pre-COVID-19 eGFR is the main risk factor for AKI regardless of GN diagnosis. However, GN patients are at higher risk of impaired eGFR recovery after COVID-19-associated AKI. These patients (especially those with high baseline proteinuria or a diagnosis of focal segmental glomerulosclerosis or minimal change disease) should be closely monitored not only during the acute phases of COVID-19 but also after its resolution.
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