Kidney and Dialysis

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9 pages, 639 KiB

Open AccessArticle

The Utilization of Body Composition to Predict Cardiorespiratory Fitness and Determine Association with CKD Stage in Individuals with Mid-Spectrum CKD: A Pilot Study

by Jeffrey S. Forsse, Kathleen A. Richardson, Tomas J. Chapman-Lopez, Ricardo Torres, Jeffery L. Heileson, Ahmed Ismaeel, LesLee Funderburk, Andrew R. Gallucci, Dale C. Allison and Panagiotis Koutakis

Kidney Dial. 2023, 3(3), 265-273; https://doi.org/10.3390/kidneydial3030024 - 3 Aug 2023

Cited by 2 | Viewed by 1705

Abstract

Body composition (BC), a measure of body fat mass (FM), lean body mass (LBM), and bone mineral content (BMC), can be used as a predictor of cardiorespiratory fitness (CRF). Prior studies have established a relationship between BC and VO_2max in healthy individuals [...] Read more.

Body composition (BC), a measure of body fat mass (FM), lean body mass (LBM), and bone mineral content (BMC), can be used as a predictor of cardiorespiratory fitness (CRF). Prior studies have established a relationship between BC and VO_2max in healthy individuals over 35 years of age. However, this relationship is poorly understood in chronic disease populations. The focus of the study was to assess the relationship between BC, cardiorespiratory fitness, and chronic kidney disease (CKD). A cross-sectional analysis was conducted among 24 (9 males and 15 females) individuals diagnosed with mid-spectrum CKD (stages G2–G3b) who completed a health screening, dual-energy X-ray absorptiometry (DEXA) scan, and underwent a VO_2max exercise test. Normality tests, descriptive statistics, Pearson’s correlations, t-tests, and ANOVAs were conducted in SAS v.9.4. The average percent body fat (%BF) was 36.28 ± 8.47%, LBM was 109.4 ± 29.1 lb, BMC was 2308.7 ± 735.1 g, and VO_2max was 20.13 ± 5.04 mL/kg/min⁻¹. BC was able to predict CRF via VO_2max (R2 = 0.721, p < 0.001) and CKD stage (R2 = 0.390, p < 0.017). Positive correlations were observed in LBM (r = 0.750, p < 0.0018) and BMC (r = 0.647, p < 0.001), and negative correlations were observed with FM (r = −0.384, p < 0.032) and %BF (r = −0.802, p < 0.0001). BC was able to predict both CRF and CKD stages, with significant associations observed between BC, VO_2max, and CKD stage. The progression of the CKD stage was associated with lower LBM, BMC, and VO_2max values, indicating a graded effect of BC on CRF and CKD stage. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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13 pages, 1329 KiB

Open AccessArticle

Salt Reduction Using a Smartphone Application Based on an Artificial Intelligence System for Dietary Assessment in Patients with Chronic Kidney Disease: A Single-Center Retrospective Cohort Study

by Akane Yanai, Kiyotaka Uchiyama and Shinya Suganuma

Kidney Dial. 2023, 3(1), 139-151; https://doi.org/10.3390/kidneydial3010012 - 16 Mar 2023

Viewed by 2294

Abstract

This study evaluated the clinical usefulness of an artificial intelligence-powered smartphone application in reducing the daily salt intake of patients with chronic kidney disease (CKD). This study included 35 patients with CKD who were classified into app users (i.e., 13 outpatients who used [...] Read more.

This study evaluated the clinical usefulness of an artificial intelligence-powered smartphone application in reducing the daily salt intake of patients with chronic kidney disease (CKD). This study included 35 patients with CKD who were classified into app users (i.e., 13 outpatients who used the app for 3 months and whose salt intake was evaluated before and after using the app) and app nonusers (i.e., 22 outpatients not using the application; their salt intake was similarly evaluated). The primary outcome was estimated as salt intake after 3 months of using the application and at a 6-month follow-up. Linear mixed model analysis revealed that app users had a significant decrease in estimated salt intake after 3 months (−2.12 g/day; 95% CI, −4.05 to −0.19; p = 0.03) compared with app nonusers but not after 6 months (−0.96 g/day; 95% CI, −3.13 to 1.20; p = 0.38). App users showed a significant decrease in body mass index at 3 months (−0.42 kg/m² [95% CI, −0.78 to −0.049; p = 0.03]) and 6 months (−0.65 kg/m² [95% CI, −1.06 to −0.24; p = 0.002]). The application promoted short-term reduction in salt intake. These results provide a strong rationale for future trials. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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11 pages, 1622 KiB

Open AccessArticle

miR-148b as a Potential Biomarker for IgA Nephropathy

by Santosh Kumar, C. Priscilla, Sreejith Parameswaran, Deepak Gopal Shewade, Pragasam Viswanathan and Rajesh Nachiappa Ganesh

Kidney Dial. 2023, 3(1), 84-94; https://doi.org/10.3390/kidneydial3010008 - 13 Feb 2023

Viewed by 2215

Abstract

Background: IgA nephropathy (IgAN) is one of the most common glomerular diseases worldwide. Approximately 25 percent of IgAN patients reach the kidney failure stage within twenty years of diagnosis. The histopathological examination of kidney biopsy is needed to confirm the diagnosis of IgAN. [...] Read more.

Background: IgA nephropathy (IgAN) is one of the most common glomerular diseases worldwide. Approximately 25 percent of IgAN patients reach the kidney failure stage within twenty years of diagnosis. The histopathological examination of kidney biopsy is needed to confirm the diagnosis of IgAN. microRNA (miRNA) is a small RNA that plays an important role at the post-transcriptional level by downregulating mRNAs (messenger RNA). We tried to establish a miRNA-based biomarker for IgAN. Methods: We recruited 30 IgAN patients and 15 healthy controls as study participants after taking their informed written consent. A real-time PCR-based method was used for the absolute quantification of miRNAs. A logistic regression method and receiver operating characteristic analysis were performed to find the diagnostic and prognostic accuracy of miR-148b and let-7b for IgAN in histopathological MEST-C scores. Results: miR-148b and let-7b levels were higher in IgAN patients compared to the healthy controls. miR-148b was positively correlated with glomerular filtration rate (GFR) and negatively correlated with segmental glomerulosclerosis, tubular atrophy/interstitial fibrosis (T), and blood pressure (BP). The sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic (ROC) for miR-148b against T were 0.87, 0.77, and 0.85, respectively. The threshold value of the miR-148b copy number was 8479 to differentiate the severe condition of IgAN. Conclusion: miR-148b can be used as a potential biomarker for IgAN. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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12 pages, 1022 KiB

Open AccessArticle

Evaluating Serum RBP4 as an Auxiliary Biomarker for CKDu Diagnosis

by Hannah L. F. Swa, Buddhi N. T. Fernando, Shakila Premarathna, Asfa Alli-Shaik, Zeid Badurdeen, Jayantha Gunarathna and Nishantha Nanayakkara

Kidney Dial. 2022, 2(4), 576-587; https://doi.org/10.3390/kidneydial2040052 - 3 Nov 2022

Cited by 3 | Viewed by 2118

Abstract

Background: A chronic interstitial disease, chronic kidney disease of uncertain etiology (CKDu), has emerged as a notable contributor to the CKD burden in rural Sri Lanka. Most therapeutic and diagnostic approaches to CKD focus on glomerular diseases, and thus are not fully applicable [...] Read more.

Background: A chronic interstitial disease, chronic kidney disease of uncertain etiology (CKDu), has emerged as a notable contributor to the CKD burden in rural Sri Lanka. Most therapeutic and diagnostic approaches to CKD focus on glomerular diseases, and thus are not fully applicable to CKDu. Serum proteins, specifically those with the profile of markers representing different facets of a disease, are beneficial for a comprehensive evaluation of diseases, and hence in CKD. Our aim was to identify the role of serum-retinol-binding protein 4 (RBP4), a marker of the proximal tubule, in the diagnosis of CKDu. Methods: Definite CKDu cases were recruited from the renal clinic in Girandurukotte and Wilgamuwa (endemic regions). Healthy controls were recruited from Mandaramnuwara (nonendemic area). The levels of RBP4 and creatinine in serum were measured. An immunoassay (ELISA) was performed on the serum samples. The stages of CKD/ CKDu were classified according to eGFR. Results: Serum RBP4 was significantly increased in CKDu patients compared to CKD patients and healthy controls. The results show that the ratio of normalized serum RBP4 to serum creatine (S.cr) acts as a better competitive marker for CKDu (AUC 0.762, sensitivity 0.733) than CKD (AUC 0.584, sensitivity 0.733) when compared against healthy controls. Furthermore, the RBP4:S.cr ratio showed higher discriminating power (AUC 0.743) between CKDu and CKD, suggesting that the RBP4: S.cr ratio has potential as a serum marker to differentiate CKDu from CKDu. Conclusion: The RBP4: S.cr ratio was identified as a plausible indicator for differentiating CKDu from CKD with >70% sensitivity and specificity. Therefore, it could be used in the evaluation of the tubular interstitial involvement of CKD. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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13 pages, 1041 KiB

Open AccessArticle

Efficacy and Safety of Etelcalcetide in Hemodialysis Patients with Moderate to Severe Secondary Hyperparathyroidism

by Paola Monciino, Lorenza Magagnoli, Eliana Fasulo, Michela Frittoli, Chiara Leotta, Hoang Nhat Pham, Andrea Stucchi, Paola Ciceri, Andrea Galassi and Mario Cozzolino

Kidney Dial. 2022, 2(3), 482-494; https://doi.org/10.3390/kidneydial2030044 - 13 Sep 2022

Viewed by 2288

Abstract

Background. Secondary hyperparathyroidism (SHPT) is a major risk factor for cardiovascular events and all-cause mortality in hemodialysis (HD) patients. The purpose of our study was to evaluate the effects and tolerability of etelcalcetide in HD patients with SHPT. Methods. An observational study was [...] Read more.

Background. Secondary hyperparathyroidism (SHPT) is a major risk factor for cardiovascular events and all-cause mortality in hemodialysis (HD) patients. The purpose of our study was to evaluate the effects and tolerability of etelcalcetide in HD patients with SHPT. Methods. An observational study was conducted on 16 hemodialysis patients with SHPT treated with etelcalcetide. All patients were followed up for a duration of 6 months. The primary endpoints were the reduction in mean PTH ≥ 30% and ≥40% from baseline after 6 months of etelcalcetide. All patients were divided into two groups (group A versus group B) based on baseline serum PTH level prior to etelcalcetide: above and below the median serum PTH (1300 pg/mL), respectively. Results. After 6 months, a significant decrease in PTH levels was achieved by all patients receiving etelcalcetide (p = 0.015). Both primary endpoint of reduction in PTH ≥ 40% at 6 months (p = 0.01), and the secondary endpoint of reduction in median PTH values (p = 0.0001) and median percentage reduction in PTH values (p = 0.009) were significantly achieved in group A. In contrast, a greater decline of calcium (p = 0.028) and phosphorus was reached in group B than group A. Dialysis vintage ≥ 36 months, arteriovenous fistula (AVF)-based hemodialysis, post-diluition hemodiafiltration (HDF) method, and baseline values of PTH < 1300 pg/mL can positively influence the achievement of the endpoints. Furthermore, the baseline PTH < 1300 pg/mL, among these variables, was the only one showing statistically significant relevance (OR 2.28, 95% CI 1.32–3.96, p = 0.015). The history of cinacalcet use negatively correlated with the possibility to reach therapeutic targets with etelcalcetide (OR 0.47, 95% CI 0.26–0.85, p = 0.031). Treatment with etelcalcetide was well tolerated and no adverse effects were observed. Conclusions. In our study, patients with low baseline PTH levels showed a better response to etelcalcetide than patients with higher PTH levels. Consequently, the possibility to reach desirable therapeutic targets could depend on SHPT severity at the time of initiation of therapy. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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Review

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11 pages, 524 KiB

Open AccessReview

Pregnancy in Chronic Kidney Disease

by Larisa Shehaj and Rümeyza Kazancıoğlu

Kidney Dial. 2023, 3(2), 152-162; https://doi.org/10.3390/kidneydial3020013 - 27 Mar 2023

Cited by 2 | Viewed by 8695

Abstract

While pregnancy among end-stage kidney disease patients is rare, the number of females becoming pregnant has been increasing worldwide during the last decade. The frequency of conception in this patient group has been reported to be between 0.3% and 7% per year. The [...] Read more.

While pregnancy among end-stage kidney disease patients is rare, the number of females becoming pregnant has been increasing worldwide during the last decade. The frequency of conception in this patient group has been reported to be between 0.3% and 7% per year. The aim of this review is to summarize the latest guidelines and practice points for ensuring the best outcome for both the fetus and the mother. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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17 pages, 1375 KiB

Open AccessFeature PaperReview

Renal Mechanisms of Diuretic Resistance in Congestive Heart Failure

by Norbert Lameire

Kidney Dial. 2023, 3(1), 56-72; https://doi.org/10.3390/kidneydial3010005 - 5 Jan 2023

Cited by 8 | Viewed by 11733

Abstract

This study reviews the renal aspects of diuretic resistance occurring in diuretic treatment, mostly with loop diuretics of congestive heart failure. A short discussion on the different classes of diuretics, including the recently introduced sodium-glucose transporter 2 inhibitors, and their mechanism of action [...] Read more.

This study reviews the renal aspects of diuretic resistance occurring in diuretic treatment, mostly with loop diuretics of congestive heart failure. A short discussion on the different classes of diuretics, including the recently introduced sodium-glucose transporter 2 inhibitors, and their mechanism of action in the nephron is provided, followed by a summary of recent data discussing the different causes and pathophysiological mechanisms of diuretic resistance. The major cause of diuretic resistance appears to be localized within the distal tubule. Traditionally, the concept of compensatory post-diuretic sodium reabsorption (CPDSR) was considered the major cause of diuretic resistance; however, recent studies have disputed this traditional concept and demonstrated that patients with congestive heart failure are in constant sodium-avid state. Finally, the different options of therapeutic strategies, combining different classes of diuretics are summarized. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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10 pages, 2711 KiB

Open AccessReview

The Age–Stiffness Relationships of Elastic and Muscular Arteries in a Control Population and in End-Stage Renal Disease Patients

by Gerard M. London, Michel E. Safar and Bruno Pannier

Kidney Dial. 2023, 3(1), 36-45; https://doi.org/10.3390/kidneydial3010003 - 3 Jan 2023

Viewed by 1952

Abstract

Arterial dysfunction is major risk factor for cardiovascular complications, and arterial stiffness is an independent risk factor in end-stage renal disease patients. As the distance from the heart increases, arterial stiffness (pulse wave velocity) becomes progressively more marked. This generates a centrifugal stiffness [...] Read more.

Arterial dysfunction is major risk factor for cardiovascular complications, and arterial stiffness is an independent risk factor in end-stage renal disease patients. As the distance from the heart increases, arterial stiffness (pulse wave velocity) becomes progressively more marked. This generates a centrifugal stiffness gradient, which leads to partial, continuous local wave reflections, which in turn attenuate the transmission of pulsatile pressure into the microcirculation, thus limiting the potentially deleterious outcomes both upstream (on the heart: left-ventricular hypertrophy and coronary perfusion) and downstream (on the renal and cerebral microcirculation: reduced glomerular filtration and impaired cognitive functions). The impact of arterial aging is greater on the aorta and central capacitive arteries, and it is characterized by a loss or reversal of the physiological stiffness gradient between central and peripheral arteries. Recently, however, in contrast to observations on the aorta, several studies have shown less pronounced, absent, or even negative associations between muscular peripheral arteries and age–stiffness relationships, which may be associated with a decrease in or reversal of the stiffness gradient. These findings point to a potential benefit of assessing the muscular peripheral arteries to predict the risk of cardiovascular disease and suggest that reversal of the stiffness gradient may be an independent risk factor for all-cause mortality. Full article

(This article belongs to the Special Issue Feature Papers for Kidney and Dialysis: Advances in Nephrology and Dialysis)

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