Frontiers in Chronic Kidney Disease

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Mechanisms of Diseases".

Deadline for manuscript submissions: closed (25 September 2022) | Viewed by 27057

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Guest Editor
Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Interests: chronic kidney disease; hypertension; diabetes mellitus
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Special Issue Information

Dear Colleagues,

Chronic kidney disease is one of the most important risk factors for end-stage kidney disease. The number of chronic kidney disease patients is increasing, especially with age. The optimal strategy to prevent the progression of chronic kidney disease is an urgent question worldwide that remains unanswered. This Special Issue of the Journal of Personalized Medicine aims to highlight the current state of the science and showcase some of the latest findings in the field of chronic kidney disease. We seek studies, including those that explore any conditions related to chronic kidney disease, using basic science, clinical and population-based approaches, as well as all kinds of behaviors for public awareness. Scientific advances in the field of chronic kidney disease will provide the promise of a more optimistic future for patients.

Prof. Dr. Haruhito A. Uchida
Guest Editor

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Keywords

  • chronic kidney disease
  • clinical research
  • basic research
  • epidemiology
  • prevention
  • public awareness (e.g., publicity and education campaigns aimed at improving health, the environment, etc.)

Published Papers (12 papers)

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11 pages, 1607 KiB  
Article
The Effect of Medical Cooperation in the CKD Patients: 10-Year Multicenter Cohort Study
by Yasuhiro Onishi, Haruhito A. Uchida, Yohei Maeshima, Yuka Okuyama, Nozomu Otaka, Haruyo Ujike, Keiko Tanaka, Hidemi Takeuchi, Kenji Tsuji, Masashi Kitagawa, Katsuyuki Tanabe, Hiroshi Morinaga, Masaru Kinomura, Shinji Kitamura, Hitoshi Sugiyama, Kosuke Ota, Keisuke Maruyama, Makoto Hiramatsu, Yoshiyuki Oshiro, Shigeru Morioka, Keiichi Takiue, Kazuyoshi Omori, Masaki Fukushima, Naoyuki Gamou, Hiroshi Hirata, Ryosuke Sato, Hirofumi Makino and Jun Wadaadd Show full author list remove Hide full author list
J. Pers. Med. 2023, 13(4), 582; https://doi.org/10.3390/jpm13040582 - 26 Mar 2023
Cited by 1 | Viewed by 1547
Abstract
Introduction: While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and [...] Read more.
Introduction: While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system. Methods: We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine–Gray subdistribution hazard model. Results: The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 ± 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105–0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225–7.687, p = 0.017). Conclusion: We evaluated mortality and ESRD using a CKD cohort with a long-term observation period and concluded that medical cooperation might be expected to influence the quality of medical care in the patients with CKD. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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8 pages, 2926 KiB  
Article
Knowledge of Chronic Kidney Disease among the General Population: A Questionnaire Survey in Hokkaido Prefecture, Japan
by Naoki Nakagawa and Saori Nishio
J. Pers. Med. 2022, 12(11), 1837; https://doi.org/10.3390/jpm12111837 - 3 Nov 2022
Cited by 1 | Viewed by 2191
Abstract
Public education programs about chronic kidney disease (CKD) are important activities worldwide. The present study investigated the knowledge of CKD in the general population of 58 out of 179 cities or towns in Hokkaido between 1 April and 30 September 2019. A total [...] Read more.
Public education programs about chronic kidney disease (CKD) are important activities worldwide. The present study investigated the knowledge of CKD in the general population of 58 out of 179 cities or towns in Hokkaido between 1 April and 30 September 2019. A total of 15,012 respondents who underwent specific health checkups at these centers answered the questionnaire. In response to a questionnaire item asking about the respondent’s familiarity with the term “CKD”, only 6% of the respondents answered “know it well” and 13% answered “heard of it”. In contrast, in response to a questionnaire item asking about the respondent’s familiarity with “chronic kidney disease”, 31% answered “know it well” and 33% answered “heard of it”. The leading avenue by which the respondents learned about CKD was television, followed by newspapers, magazines, and a family doctor or nurse. The leading component that the respondents considered essential for the diagnosis of CKD was proteinuria. These results indicated that the knowledge of CKD in Hokkaido prefecture is still inadequate. Many people did not appear to realize that the term “CKD” represents “chronic kidney disease”. Further continuous public education efforts are required to enlighten people about CKD. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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10 pages, 282 KiB  
Article
Microalbuminuria and Hypertension among Immigrants with Type 2 Diabetes: A Community-Based Cross-Sectional Study
by Shiryn D. Sukhram, Gustavo G. Zarini, Lemia H. Shaban, Joan A. Vaccaro and Fatma G. Huffman
J. Pers. Med. 2022, 12(11), 1777; https://doi.org/10.3390/jpm12111777 - 28 Oct 2022
Cited by 1 | Viewed by 1389
Abstract
Purpose: This study examined the association of microalbuminuria (MAU), as determined by albumin-to-creatinine ratio (ACR), with hypertension (HTN) among Turkish immigrants with type 2 diabetes (T2D) living in deprived neighborhoods of The Hague, Netherlands. Methods: A total of 110 participants, physician-diagnosed with T2D, [...] Read more.
Purpose: This study examined the association of microalbuminuria (MAU), as determined by albumin-to-creatinine ratio (ACR), with hypertension (HTN) among Turkish immigrants with type 2 diabetes (T2D) living in deprived neighborhoods of The Hague, Netherlands. Methods: A total of 110 participants, physician-diagnosed with T2D, aged ≥ 30 years were recruited from multiple sources from The Hague, Netherlands in a cross-sectional design. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated office blood pressure equipment. Urine albumin was measured by immunoturbidimetric assay. Urine creatinine was determined using the Jaffe method. MAU was defined as ACR ≥ 3.5 mg/mmol for females and/or ACR ≥ 2.5 mg/mmol for males. Results: MAU was present in 21% of Turkish immigrants with T2D. Adjusted logistic regression analysis indicated that the odds of having MAU were 6.6 times higher in hypertensive than those that were normotensive (p = 0.007; 95% confidence interval [CI]: 1.19, 36.4). Conclusion: These findings suggest that HTN and MAU may be assessed as a standard of care for T2D management for this population. Prospective studies of diabetes outcomes are recommended to further verify these findings. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
7 pages, 466 KiB  
Article
Prevalence of Chronic Kidney Disease and Variation of Its Risk Factors by the Regions in Okayama Prefecture
by Ryoko Umebayashi, Haruhito Adam Uchida, Natsumi Matsuoka-Uchiyama, Hitoshi Sugiyama and Jun Wada
J. Pers. Med. 2022, 12(1), 97; https://doi.org/10.3390/jpm12010097 - 12 Jan 2022
Cited by 7 | Viewed by 2103
Abstract
Objective: The prevention of chronic kidney disease (CKD) progression is an important issue from health and financial perspectives. We conducted a single-year cross-sectional study to clarify the prevalence of CKD and its risk factors along with variations in these factors among five medical [...] Read more.
Objective: The prevention of chronic kidney disease (CKD) progression is an important issue from health and financial perspectives. We conducted a single-year cross-sectional study to clarify the prevalence of CKD and its risk factors along with variations in these factors among five medical regions in Okayama Prefecture, Japan. Methods and Results: Data concerning the renal function and proteinuria as well as other CKD risk factors were obtained from the database of the Japanese National Health Insurance. The proportion of CKD patients at an increased risk of progression to end-stage renal disease (ESRD), classified as orange and red on the CKD heatmap, ranged from 6–9% and did not vary significantly by the regions. However, the causes of the increased severity differed between regions where renal dysfunction was predominant and regions where there were many patients with proteinuria. CKD risk factors, such as diabetes mellitus, hypertension, hyper low-density lipoprotein-cholesterolemia, obesity, smoking and lack of exercise, also differed among these regions, suggesting that different regions need tailored interventions that suit the characteristics of the region, such as an increased health checkup ratio, dietary guidance and promotion of exercise opportunities. Conclusions: Approximately 6–9% of people are at an increased risk of developing ESRD (orange or red on a CKD heatmap) among the population with National Health Insurance in Okayama Prefecture. The underlying health problems that cause CKD may differ among the regions. Thus, it is necessary to consider intervention methods for preventing CKD progression that are tailored to each region’s health problems. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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9 pages, 250 KiB  
Article
Chronic Kidney Disease Patients Visiting Various Hospital Departments: An Analysis in a Hospital in Central Tokyo, Japan
by Akira Fukui, Kohei Takeshita, Akio Nakashima, Yukio Maruyama and Takashi Yokoo
J. Pers. Med. 2022, 12(1), 39; https://doi.org/10.3390/jpm12010039 - 4 Jan 2022
Cited by 3 | Viewed by 1788
Abstract
To further improve care for chronic kidney disease (CKD) patients, healthcare providers’ awareness of CKD must be raised. Proteinuria testing is essential for CKD care, and collaboration with specialists is recommended for advanced cases. We reviewed data from the electronic medical records of [...] Read more.
To further improve care for chronic kidney disease (CKD) patients, healthcare providers’ awareness of CKD must be raised. Proteinuria testing is essential for CKD care, and collaboration with specialists is recommended for advanced cases. We reviewed data from the electronic medical records of outpatients at our hospital to analyze the clinical departments visited by CKD patients, and the frequency of proteinuria testing and referrals to nephrologists. We defined CKD as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or a urine protein concentration (U-pro) ≥ +1. We found that 31.1% of the CKD tests in September 2021 were performed in clinical departments other than internal medicine. Furthermore, within 1 year, 68.0% of CKD patients identified in September 2020 underwent a urine dipstick test, and 33.7% underwent a quantitative test for urinary protein or albumin. Additionally, 27.5% of individuals with an eGFR < 30 mL/min/1.73 m2 or U-pro ≥ +1 identified by non-nephrology departments in September 2020 visited the nephrology department within 1 year. Repeated assessments of these quality indicators may be useful for progress management in improving CKD care. Because CKD patients visited various departments in our hospital, campaigns to raise CKD awareness must reach a wide range of healthcare providers in hospitals. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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9 pages, 1274 KiB  
Article
Chronic Kidney Disease and Its Relationship with Mental Health: Allostatic Load Perspective for Integrated Care
by Federica Guerra, Dina Di Giacomo, Jessica Ranieri, Marilena Tunno, Luca Piscitani and Claudio Ferri
J. Pers. Med. 2021, 11(12), 1367; https://doi.org/10.3390/jpm11121367 - 14 Dec 2021
Cited by 13 | Viewed by 3909
Abstract
Background: Chronic renal failure is a chronic medical condition characterized by a progressive and irreversible loss of kidney function. Up to 50% of patients undergoing dialysis experience symptoms of depression and anxiety: what is the impact of individual factors and medical conditions on [...] Read more.
Background: Chronic renal failure is a chronic medical condition characterized by a progressive and irreversible loss of kidney function. Up to 50% of patients undergoing dialysis experience symptoms of depression and anxiety: what is the impact of individual factors and medical conditions on the mental health issue? The present study was carried out to investigate the individual factors (biomarkers and psychological dimensions) of end-stage renal disease patients dealing with dialysis, analyzing their predictor values for developing negative disease adaptations by an allostatic paradigm. Methods: We conducted an observational study on 35 patients affected by end-stage renal disease; biological and psychological markers have been detected. We conducted descriptive statistical analyses (t-tests) and performed a hierarchical regression analysis to investigate the relationship between pathological medical conditions and psychological dimensions. Results: The findings showed a positive correlation between creatinine levels and psychological distress as well as stress index. No significant effect of “time of dialysis”, “time from diagnosis”, “age” and “personality traits” was found. Conclusion: Our findings showed that personality traits did not represent a protective factor by moderating positive emotional adaptations; conversely, creatinine levels appeared predictive for negative emotional adaptations. High levels of creatinine were found to be positively associated with high stress levels as well psychological distress. According to the allostatic paradigm, end-stage renal disease patients could experience an allostatic load and more overload towards poor health outcomes; integrated biological and psychological measurements could prevent increased negative mental health through a patient-centered approach. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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9 pages, 594 KiB  
Article
Transplant Prognosis in Kidney Transplant Recipients with Diabetes under Mycophenolic Acid-Focused Therapeutic Drug Monitoring
by Eisuke Nakamura, Tadashi Sofue, Yasushi Kunisho, Keisuke Onishi, Kazunori Yamaguchi, Emi Ibuki, Rikiya Taoka, Nobufumi Ueda, Mikio Sugimoto and Tetsuo Minamino
J. Pers. Med. 2021, 11(11), 1224; https://doi.org/10.3390/jpm11111224 - 18 Nov 2021
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Abstract
Mycophenolate mofetil is a key immunosuppressant that is metabolized into mycophenolic acid (MPA). The prognostic impact of MPA-focused therapeutic drug monitoring on allograft prognosis has not been determined in kidney transplant recipients with diabetes. In this study, we assessed the pharmacokinetics of MPA [...] Read more.
Mycophenolate mofetil is a key immunosuppressant that is metabolized into mycophenolic acid (MPA). The prognostic impact of MPA-focused therapeutic drug monitoring on allograft prognosis has not been determined in kidney transplant recipients with diabetes. In this study, we assessed the pharmacokinetics of MPA and allograft prognosis in recipients with diabetes. This study retrospectively analyzed 64 adult kidney transplant recipients. MPA blood concentration data (e.g., the time to the maximum concentration (Tmax), and the area under the concentration–time curve from 0 to 12 h (AUC0–12)) were collected at 3 weeks and 3 months after kidney transplantation. Of the 64 recipients, 15 had pre-existing diabetes. At 3 months after kidney transplantation, the Tmax of MPA was significantly longer in recipients with diabetes (mean (standard deviation): 2.8 (2.1) h) than in recipients without diabetes (1.9 (1.1) h, p = 0.02). However, the allograft estimated glomerular filtration rate and acute rejection rate, including borderline change, did not differ according to the diabetes status in patients with adjusted AUC0–12 of MPA within the target range. In conclusion, a longer Tmax of MPA was observed in recipients with diabetes; however, acceptable allograft prognosis was observed in kidney transplant recipients with diabetes and a sufficient AUC0–12 of MPA. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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12 pages, 2553 KiB  
Article
Changes in Prevalence and Health Checkup Coverage Rate of Chronic Kidney Disease (CKD) after Introduction of Prefecture-Wide CKD Initiative: Results of the Kagawa Association of CKD Initiatives
by Tadashi Sofue, Taiga Hara, Yoko Nishijima, Satoshi Nishioka, Hiroyuki Watatani, Masahito Yamanaka, Norihiro Takahashi, Akira Nishiyama, Tetsuo Minamino and Kagawa Association of Chronic Kidney Disease Initiatives
J. Pers. Med. 2021, 11(11), 1121; https://doi.org/10.3390/jpm11111121 - 30 Oct 2021
Cited by 1 | Viewed by 2700
Abstract
The National Health Insurance (NHI) special health checkup system in Japan targets the NHI population aged 40–74 years. Since 2015, the Kagawa NHI special health checkup was initiated in a prefecture-wide chronic kidney disease (CKD) initiative, including renal examination as an essential item [...] Read more.
The National Health Insurance (NHI) special health checkup system in Japan targets the NHI population aged 40–74 years. Since 2015, the Kagawa NHI special health checkup was initiated in a prefecture-wide chronic kidney disease (CKD) initiative, including renal examination as an essential item in NHI health checkups. Here, we aimed to investigate the effects of the prefecture-wide CKD initiative. We conducted a retrospective cohort survey using the Kagawa National Health Insurance database created by the Kagawa National Health Insurance Organization. Results of the NHI health checkup (2015–2019) and prefecture-wide outcomes (2013–2019) were analyzed. The prevalence of CKD among examinees who underwent the NHI health checkup increased from 17.7% in 2015 to 23.2% in 2019. The percentage of examinees who completed a medical visit was 29.4% in 2015. After initiation of the initiative, the NHI health checkup coverage rate increased significantly, from a mean (standard deviation) of 40.8% (0.4%) to 43.2% (1.1%) (p = 0.04). After the start of the CKD initiative, we found an increase in the prevalence of CKD and the NHI health checkup coverage rate. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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9 pages, 1657 KiB  
Article
Effectiveness of CKD Exacerbation Countermeasures in Izumo City
by Takafumi Ito, Fumika Kamei, Hirotaka Sonoda, Masafumi Oba, Miharu Kawanishi, Ryuichi Yoshimura, Shohei Fukunaga and Masahiro Egawa
J. Pers. Med. 2021, 11(11), 1104; https://doi.org/10.3390/jpm11111104 - 28 Oct 2021
Cited by 2 | Viewed by 1401
Abstract
To diagnose chronic kidney disease (CKD) at an early stage, it is important to promote appropriate health guidance and consultation recommendations through regular medical examinations and implementation of continuous high-quality and appropriate treatment. From fiscal year (FY) 2018, Izumo City has initiated the [...] Read more.
To diagnose chronic kidney disease (CKD) at an early stage, it is important to promote appropriate health guidance and consultation recommendations through regular medical examinations and implementation of continuous high-quality and appropriate treatment. From fiscal year (FY) 2018, Izumo City has initiated the “Izumo City CKD Exacerbation Countermeasures” program. In this study, we aimed to report on the methods undertaken and the effects of this program. Residents aged 40–74 years who underwent specific health checkups from the Izumo City National Health Insurance in FY2018 and FY2019 were included. The rates of CKD re-examination candidates, re-examinations implementation, nephrologist referrals, and health guidance referrals between FY2018 and FY2019 were compared. The rate of CKD re-examination candidates in both years remained unchanged at approximately 7%. The rate of re-examination implementation in FY2019 significantly increased relative to that in FY2018 (p < 0.001). Subsequent re-examination candidate trends showed that the rate of nephrologist referrals did not increase. However, the rate of city health guidance referrals significantly increased (p < 0.001). Increase in the re-examination and health guidance examination rates indicate improved awareness of CKD among the public and family doctors, and it is expected to prevent CKD exacerbation in the future. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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17 pages, 13467 KiB  
Article
Impacts of Interaction of Mental Condition and Quality of Life between Donors and Recipients at Decision-Making of Preemptive and Post-Dialysis Living-Donor Kidney Transplantation
by Toshiki Hasegawa, Kouhei Nishikawa, Yuko Tamura, Tomoka Oka, Aiko Urawa, Saori Watanabe, Shugo Mizuno and Motohiro Okada
J. Pers. Med. 2021, 11(5), 414; https://doi.org/10.3390/jpm11050414 - 14 May 2021
Cited by 3 | Viewed by 2561 | Correction
Abstract
Pre-emptive kidney transplantation (PEKT) is considered one of the most effective types of kidney replacement therapies to improve the quality of life (QOL) and physical prognosis of patients with end-stage renal disease (ESRD). In Japan, living-donor kidney transplantation is a common therapeutic option [...] Read more.
Pre-emptive kidney transplantation (PEKT) is considered one of the most effective types of kidney replacement therapies to improve the quality of life (QOL) and physical prognosis of patients with end-stage renal disease (ESRD). In Japan, living-donor kidney transplantation is a common therapeutic option for patients undergoing dialyses (PDKT). Moreover, during shared decision-making in kidney replacement therapy, the medical staff of the multidisciplinary kidney team often provide educational consultation programmes according to the QOL and sociopsychological status of the ESRD patient. In Japan, the majority of kidney donations are provided by living family members. However, neither the psychosocial status of donors associated with the decision-making of kidney donations nor the interactions of the psychosocial status between donors and recipients have been clarified in the literature. In response to this gap, the present study determined the QOL, mood and anxiety status of donors and recipients at kidney transplantation decision-making between PEKT and PDKT. Deterioration of the recipient’s QOL associated with “role physical” shifted the decision-making to PEKT, whereas deterioration of QOL associated with “role emotional” and “social functioning” of the recipients shifted the decision-making to PDKT. Furthermore, increased tension/anxiety and depressive mood contributed to choosing PDKT, but increased confusion was dominantly observed in PEKT recipients. These direct impact factors for decision-making were secondarily regulated by the trait anxiety of the recipients. Unlike the recipients, the donors’ QOL associated with vitality contributed to choosing PDKT, whereas the physical and mental health of the donors shifted the decision-making to PEKT. Interestingly, we also detected the typical features of PEKT donors, who showed higher tolerability against the trait anxiety of reactive tension/anxiety than PDKT donors. These results suggest that choosing between either PEKT or PDKT is likely achieved through the proactive support of family members as candidate donors, rather than the recipients. Furthermore, PDKT is possibly facilitated by an enrichment of the life–work–family balance of the donors. Therefore, multidisciplinary kidney teams should be aware of the familial psychodynamics between patients with ESRD and their family members during the shared decision-making process by continuing the educational consultation programmes for the kidney-replacement-therapy decision-making process. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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3 pages, 448 KiB  
Correction
Correction: Hasegawa et al. Impacts of Interaction of Mental Condition and Quality of Life between Donors and Recipients at Decision-Making of Preemptive and Post-Dialysis Living-Donor Kidney Transplantation. J. Pers. Med. 2021, 11, 414
by Toshiki Hasegawa, Kouhei Nishikawa, Yuko Tamura, Tomoka Oka, Aiko Urawa, Saori Watanabe, Shugo Mizuno and Motohiro Okada
J. Pers. Med. 2022, 12(12), 2036; https://doi.org/10.3390/jpm12122036 - 9 Dec 2022
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The authors wish to make the following corrections to this paper [...] Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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26 pages, 555 KiB  
Systematic Review
Effect of Exercise on Inflammation in Hemodialysis Patients: A Systematic Review
by Erika Meléndez Oliva, Jorge H. Villafañe, Jose Luis Alonso Pérez, Alexandra Alonso Sal, Guillermo Molinero Carlier, Andrés Quevedo García, Silvia Turroni, Oliver Martínez-Pozas, Norberto Valcárcel Izquierdo and Eleuterio A. Sánchez Romero
J. Pers. Med. 2022, 12(7), 1188; https://doi.org/10.3390/jpm12071188 - 21 Jul 2022
Cited by 11 | Viewed by 2783
Abstract
Background: In recent years, physical exercise has been investigated for its potential as a therapeutic tool in patients with end-stage renal disease (ESRD) undergoing hemodialysis maintenance treatment (HD). It has been shown that regular practice of moderate-intensity exercise can improve certain aspects of [...] Read more.
Background: In recent years, physical exercise has been investigated for its potential as a therapeutic tool in patients with end-stage renal disease (ESRD) undergoing hemodialysis maintenance treatment (HD). It has been shown that regular practice of moderate-intensity exercise can improve certain aspects of immune function and exert anti-inflammatory effects, having been associated with low levels of pro-inflammatory cytokines and high levels of anti-inflammatory cytokines. Purpose: The aim of this review is to examine the studies carried out in this population that analyzed the effect of intradialytic exercise on the inflammatory state and evaluate which exercise modality is most effective. Methods: The search was carried out in the MEDLINE, CINAHL Web of Science and Cochrane Central Register of Controlled Trials databases from inception to June 2022. The PEDro scale was used to assess methodological quality, and the Cochrane Risk of Bias Tool and MINORS were used to evaluate the risk of bias. The quality of evidence was assessed with GRADE scale. The outcome measures were systemic inflammation biomarkers. Results: Mixed results were found in terms of improving inflammation biomarkers, such as CRP, IL-6 or TNFα, after exercise. Aerobic exercise seems to improve systemic inflammation when performed at medium intensity while resistance training produced better outcomes when performed at high intensity. However, some studies reported no differences after exercise and these results should be taken with caution. Conclusions: The low quality of the evidence suggests that aerobic and resistance exercise during HD treatment improves systemic inflammation biomarkers in patients with ESRD. In any case, interventions that increase physical activity in patients with ESRD are of vital importance as sedentary behaviors are associated with mortality. More studies are needed to affirm solid conclusions and to make intervention parameters, such as modality, dose, intensity or duration, sufficiently clear. Full article
(This article belongs to the Special Issue Frontiers in Chronic Kidney Disease)
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