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Clinical Advances in Kidney Failure
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Clinical Advances in Kidney Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (20 February 2023) | Viewed by 10781

Special Issue Editors

Prof. Dr. Emaad M. Abdel‐Rahman

E-Mail Website
Guest Editor
Division of Nephrology, University of Virginia, Charlottesville, VA, USA
Interests: acute kidney failure; in-center hemodialysis; home dialysis; kidney; geriatric nephrology; palliative care
Prof. Dr. Alaa S. Awad

E-Mail Website
Guest Editor
Department of Medicine, University of Florida, Jacksonville, FL, USA
Interests: chronic kidney disease; diabetic nephropathy; immune cells in kidney disease; arginase; nitric oxide

Special Issue Information

Dear Colleagues,

Kidney failure poses an enormous burden on patients, caregivers, healthcare providers, and society as a whole. While the etiology and management of kidney failure differ between low- and high-income countries, epidemiological studies point to the continued increase in the numbers of patients with kidney failure worldwide.  

A plethora of studies have been published to delineate the etiology, pathophysiology, pattern of diseases, diagnoses, and management of acute kidney disease; however, a big gap remains in the understanding and clinical practices in each of these fields.

The diagnosis of acute kidney injury (AKI) relies on assessing the serum creatinine and urine output. Both are neither sensitive nor timely in reporting the state of kidney damage. There is a pathogenesis of newer etiology for AKI as the COVID-19 virus warrants further studies. The timing of initiating dialysis in the intensive-care unit remains controversial. Predictors of outcomes after AKI are not precise, the definition of recovery of AKI is controversial, and there is a lack of standardized protocol on how to manage patients post-AKI; the timing of outpatient follow-up, coordination of care among different providers, as well as the dialysis protocol for patients with AKI still requiring dialysis (AKI-D) also remain controversial.

Novel biomarkers have been developed to diagnose and monitor AKI. More recently, the role of nano-sized membrane-bound extracellular vesicles (EV) in body fluid and using proteomic technology to identify novel urinary biomarkers were studied as diagnostic markers and therapeutic tools for AKI. Furthermore, the emergence of artificial intelligence (AI) has led to the evolution of risk prediction models of AKI. AKI alert using AI has led to less overlooked AKI. Similarly, the decision-support AI tools have led to improvement in the AKI stage.

The aim of this Special Issue is to highlight the recent advances pertaining to earlier diagnosis, predicting outcomes, better management of AKI in the hospital setting, and post-hospital discharge.

Prof. Dr. Emaad M. Abdel‐Rahman
Prof. Dr. Alaa S. Awad
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute kidney injury
  • biomarkers
  • dialysis
  • AKI-D
  • artificial intelligence

Published Papers (6 papers)

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Editorial

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3 pages, 176 KiB  
Editorial
Clinical Advances in Kidney Failure: AKI
by Alaa S. Awad and Emaad M. Abdel-Rahman
J. Clin. Med. 2023, 12(5), 1873; https://doi.org/10.3390/jcm12051873 - 27 Feb 2023
Viewed by 829
Abstract
Kidney failure poses an enormous burden on patients, caregivers, healthcare providers, and society as a whole [...] Full article
(This article belongs to the Special Issue Clinical Advances in Kidney Failure)

Research

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19 pages, 2440 KiB  
Article
Acute Changes in Serum Creatinine and Kinetic Glomerular Filtration Rate Estimation in Early Phase of Acute Pancreatitis
by Paulina Dumnicka, Małgorzata Mazur-Laskowska, Piotr Ceranowicz, Mateusz Sporek, Witold Kolber, Joanna Tisończyk, Marek Kuźniewski, Barbara Maziarz and Beata Kuśnierz-Cabala
J. Clin. Med. 2022, 11(20), 6159; https://doi.org/10.3390/jcm11206159 - 19 Oct 2022
Cited by 2 | Viewed by 1965
Abstract
In patients with acutely changing kidney function, equations used to estimate glomerular filtration rate (eGFR) must be adjusted for dynamic changes in the concentrations of filtration markers (kinetic eGFR, KeGFR). The aim of our study was to evaluate serum creatinine-based KeGFR in patients [...] Read more.
In patients with acutely changing kidney function, equations used to estimate glomerular filtration rate (eGFR) must be adjusted for dynamic changes in the concentrations of filtration markers (kinetic eGFR, KeGFR). The aim of our study was to evaluate serum creatinine-based KeGFR in patients in the early phase of acute pancreatitis (AP) as a marker of changing renal function and as a predictor of AP severity. We retrospectively calculated KeGFR on day 2 and 3 of the hospital stay in a group of 147 adult patients admitted within 24 h from the onset of AP symptoms and treated in two secondary-care hospitals. In 34 (23%) patients, changes in serum creatinine during days 1–3 of the hospital stay exceeded 26.5 µmol/L; KeGFR values almost completely differentiated those with increasing and decreasing serum creatinine (area under receiver operating characteristic curve, AUROC: 0.990 on day 3). In twelve (8%) patients, renal failure was diagnosed during the first three days of the hospital stay according to the modified Marshall scoring system, which was associated with significantly lower KeGFR values. KeGFR offered good diagnostic accuracy for renal failure (area under receiver operating characteristic—AUROC: 0.942 and 0.950 on days 2 and 3). Fourteen (10%) patients developed severe AP. KeGFR enabled prediction of severe AP with moderate diagnostic accuracy (AUROC: 0.788 and 0.769 on days 2 and 3), independently of age, sex, comorbidities and study center. Lower KeGFR values were significantly associated with mortality. Significant dynamic changes in renal function are common in the early phase of AP. KeGFR may be useful in the assessment of kidney function in AP and the prediction of AP severity. Full article
(This article belongs to the Special Issue Clinical Advances in Kidney Failure)
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15 pages, 1276 KiB  
Article
Renoprotective Effect of Agalsidase Alfa: A Long-Term Follow-Up of Patients with Fabry Disease
by Markus Cybulla, Kathleen Nicholls, Sandro Feriozzi, Aleš Linhart, Joan Torras, Bojan Vujkovac, Jaco Botha, Christina Anagnostopoulou and Michael L. West
J. Clin. Med. 2022, 11(16), 4810; https://doi.org/10.3390/jcm11164810 - 17 Aug 2022
Cited by 3 | Viewed by 2164
Abstract
Fabry disease is a rare lysosomal storage disorder caused by mutations in the GLA gene, which, without treatment, can cause significant renal dysfunction. We evaluated the effects of enzyme replacement therapy with agalsidase alfa on renal decline in patients with Fabry disease using [...] Read more.
Fabry disease is a rare lysosomal storage disorder caused by mutations in the GLA gene, which, without treatment, can cause significant renal dysfunction. We evaluated the effects of enzyme replacement therapy with agalsidase alfa on renal decline in patients with Fabry disease using data from the Fabry Outcome Survey (FOS) registry. Male patients with Fabry disease aged >16 years at agalsidase alfa start were stratified by low (≤0.5 g/24 h) or high (>0.5 g/24 h) baseline proteinuria and by ‘classic’ or ‘non-classic’ phenotype. Overall, 193 male patients with low (n = 135) or high (n = 58) baseline proteinuria were evaluated. Compared with patients with low baseline proteinuria, those with high baseline proteinuria had a lower mean ± standard deviation baseline eGFR (89.1 ± 26.2 vs. 106.6 ± 21.8 mL/min/1.73 m2) and faster mean ± standard error eGFR decline (−3.62 ± 0.42 vs. −1.61 ± 0.28 mL/min/1.73 m2 per year; p < 0.0001). Patients with classic Fabry disease had similar rates of eGFR decline irrespective of baseline proteinuria; only one patient with non-classic Fabry disease had high baseline proteinuria, preventing meaningful comparisons between groups. In this analysis, baseline proteinuria significantly impacted the rate of eGFR decline in the overall population, suggesting that early treatment with good proteinuria control may be associated with renoprotective effects. Full article
(This article belongs to the Special Issue Clinical Advances in Kidney Failure)
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10 pages, 818 KiB  
Article
Association of Intradialytic Hypotension and Ultrafiltration with AKI-D Outcomes in the Outpatient Dialysis Setting
by Emaad M. Abdel-Rahman, Ernst Casimir, Genevieve R. Lyons, Jennie Z. Ma and Jitendra K. Gautam
J. Clin. Med. 2022, 11(11), 3147; https://doi.org/10.3390/jcm11113147 - 01 Jun 2022
Cited by 2 | Viewed by 1441
Abstract
Identifying modifiable predictors of outcomes for cases of acute kidney injury requiring hemodialysis (AKI-D) will allow better care of patients with AKI-D. All patients with AKI-D discharged to University of Virginia (UVA) outpatient HD units between 1 January 2017 to 31 December 2019 [...] Read more.
Identifying modifiable predictors of outcomes for cases of acute kidney injury requiring hemodialysis (AKI-D) will allow better care of patients with AKI-D. All patients with AKI-D discharged to University of Virginia (UVA) outpatient HD units between 1 January 2017 to 31 December 2019 (n = 273) were followed- for up to six months. Dialysis-related parameters were measured during the first 4 weeks of outpatient HD to test the hypothesis that modifiable factors during dialysis are associated with AKI-D outcomes of recovery, End Stage Kidney Disease (ESKD), or death. Patients were 42% female, 67% Caucasian, with mean age 62.8 ± 15.4 years. Median number of dialysis sessions was 11 (6–15), lasting 3.6 ± 0.6 h. At 90 days after starting outpatient HD, 45% recovered, 45% were declared ESKD and 9.9% died, with no significant changes noted between three and six months. Patients who recovered, died or were declared ESKD experienced an average of 9, 10 and 16 intradialytic hypotensive (IDH) episodes, respectively. More frequent IDH episodes were associated with increased risk of ESKD (p = 0.01). A one liter increment in net ultrafiltration was associated with 54% increased ratio of ESKD (p = 0.048). Optimizing dialysis prescription to decrease frequency of IDH episodes and minimize UF, and close monitoring of outpatient dialysis for patients with AKI-D, are crucial and may improve outcomes for these patients. Full article
(This article belongs to the Special Issue Clinical Advances in Kidney Failure)
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Review

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13 pages, 448 KiB  
Review
The Effects of Race on Acute Kidney Injury
by Muzamil Olamide Hassan and Rasheed Abiodun Balogun
J. Clin. Med. 2022, 11(19), 5822; https://doi.org/10.3390/jcm11195822 - 30 Sep 2022
Cited by 7 | Viewed by 1494
Abstract
Racial disparities in incidence and outcomes of acute kidney injury (AKI) are pervasive and are driven in part by social inequities and other factors. It is well-documented that Black patients face higher risk of AKI and seemingly have a survival advantage compared to [...] Read more.
Racial disparities in incidence and outcomes of acute kidney injury (AKI) are pervasive and are driven in part by social inequities and other factors. It is well-documented that Black patients face higher risk of AKI and seemingly have a survival advantage compared to White counterparts. Various explanations have been advanced and suggested to account for this, including differences in susceptibility to kidney injury, severity of illness, and socioeconomic factors. In this review, we try to understand and further explore the link between race and AKI using the incidence, diagnosis, and management of AKI to illustrate how race is directly related to AKI outcomes, with a focus on Black and White individuals with AKI. In particular, we explore the effect of race-adjusted estimated glomerular filtration rate (eGFR) equation on AKI prediction and discuss racial disparities in the management of AKI and how this might contribute to racial differences in AKI-related mortality among Blacks with AKI. We also identify some opportunities for future research and advocacy. Full article
(This article belongs to the Special Issue Clinical Advances in Kidney Failure)
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7 pages, 494 KiB  
Review
Peritoneal Dialysis as a Renal Replacement Therapy Modality for Patients with Acute Kidney Injury
by Sana Farooq Khan
J. Clin. Med. 2022, 11(12), 3270; https://doi.org/10.3390/jcm11123270 - 08 Jun 2022
Cited by 4 | Viewed by 2070
Abstract
Since the advent and predominant use of extracorporeal therapies for renal replacement therapies for acute kidney injury, the use of peritoneal dialysis has largely been limited to specific resource-limited settings. This review highlights the current data available for the utilization of peritoneal dialysis [...] Read more.
Since the advent and predominant use of extracorporeal therapies for renal replacement therapies for acute kidney injury, the use of peritoneal dialysis has largely been limited to specific resource-limited settings. This review highlights the current data available for the utilization of peritoneal dialysis for acute kidney injury. Though the current randomized controlled trials have small patient numbers, they have demonstrated peritoneal dialysis to be an appropriate modality for dialysis therapy in acute kidney injury. Current outcomes do not show a difference in mortality, renal recovery rates, or infectious complications when compared to extracorporeal treatments. However, there is a marked heterogeneity in these trials, and more standardized reporting of trial design, techniques, complications, and outcomes is needed. Full article
(This article belongs to the Special Issue Clinical Advances in Kidney Failure)
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