Explore the vast range of titles available.

Fluid overload is common among asymptomatic peritoneal dialysis (PD) patients. We aim to determine the prevalence and prognostic significance of fluid overload, as measured by bioimpedance spectroscopy, in asymptomatic incident PD patients. We performed a single-center study on 311 incident PD patients. Volume status was represented by the volume of overhydration (OH), OH/extracellular water (ECW) ratio, ECW/total body water (TBW) ratio, and ECW to intracellular water (ICW) ratio (E:I ratio). Patient survival, technique survival and cardiovascular event-free survival were determined. The median period of follow up was 27.3 months. Fluid overload was present in 272 patients (87.5%) when defined as OH volume over 1.1L. All hydration parameters significantly correlated with Charlson Comorbidity Index, and inversely with total Kt/V, and serum albumin. Multivariate cause-specific Cox analysis showed that volume status independently predicted patient survival; every 0.1 unit increase in E:I ratio was associated with 24.5% increase in all-cause mortality (adjusted cause-specific hazard ratio [ACSHR] 1.245, p = 0.002). Hydration status was also an independent predictor of cardiovascular event-free survival after excluding hospital admission for congestive heart failure; each 0.1 unit increase in E:I ratio was associated with 18.7% decrease in cardiovascular event-free survival (ACSHR 1.187, p = 0.011). In contrast, hydration parameters were not associated with technique survival. Fluid overload is common in asymptomatic incident PD patients and is a strong predictor of patient survival and cardiovascular event. The impact of bioimpedance spectroscopy-guided fluid management on the outcome of PD patients deserves further study.

Iron deficiency and overload are common in kidney disease. Although the relation between iron status and clinical outcome is well reported in hemodialysis, there are few publications in peritoneal dialysis (PD). We investigated the association between iron status and outcomes of new PD patients. We reviewed 1,804 new adult PD patients between 2011 and 2020. Their baseline status was classified into reference iron status (RIS), absolute iron deficiency (AID), low iron storage (LIS), functional iron deficiency (FID), and high iron status (HIS) according to the transferrin saturation and serum ferritin level. After a median follow-up of 35.2 months, outcome measures, including patient survival, technique survival, peritonitis-free survival, number of hospital admission, and length of hospitalization, were analyzed. FID and HIS were found in 18.8% and 57.5% patients, respectively. The 2-year patient survival for RIS, AID, LIS, FID, and HIS groups were 87.4%, 90.2%, 94.7%, 82.0%, and 83.5%, respectively (log-rank test,  < 0.001). However, all-cause mortality rate was not significantly different between iron status groups after adjusting for clinical confounders. The FID group was associated with more hospital admission than the other groups, but the difference became insignificant after adjusting for clinical confounders. In conclusion, FID and HIS are common in incident PD patients. FID was associated with a trend of lower patient survival and higher hospitalization rate, but the differenced were not significant with multi-variable analysis. Further studies are required to determine the desirable iron saturation or ferritin level to guide iron replacement therapy.

Hereditary glomerular basement membrane disease is a group of conditions caused by genetic mutations in the development and maintenance of the glomerular basement membrane. Alport syndrome is a classic example caused by variants in the genes COL4A3 , COL4A4 , or COL4A5 . Less common example includes nail-patella syndrome ( LMX1B -associated nephropathy), which is caused by variants in the LMX1B gene. The manifestations of LMX1B -associated nephropathy and Alport syndrome can overlap because they share abnormalities in type IV collagen, and this can sometimes cause diagnostic challenges. We describe a case of focal segmental glomerulosclerosis with the genetic test revealing concurrent variants of both Alport syndrome and nail-patella syndrome after noting features of nail-patella syndrome on clinical examination, although the kidney biopsy showed features compatible with Alport syndrome. Our case highlighted the importance of astute clinical examination backed up by genetic testing, which aids in diagnosis and subsequent management.

Frailty and obesity contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients, but the interaction between frailty and obesity remains uncertain. To examine the interaction between frailty and obesity on the clinical outcome of PD patients. Single centre prospective observational cohort study. 267 prevalent Chinese PD patients were recruited. Frailty was identified by a standard score. General and central obesity were determined by body mass index (BMI) and waist-hip ratio (WHR), respectively. Body composition was assessed by bioimpedance spectroscopy. All patients were followed for two years. Outcome measures included all-cause as well as cardiovascular mortality and hospitalization. Of the 267 patients, 120 (44.9%) were frail. Frail individuals were more likely to have central obesity (p < 0.001) but not general obesity. Although WHR did not predict patient survival, there was a significant interaction between WHR and frailty on patient survival and cardiovascular survival (p = 0.002 and p = 0.038, respectively). For patients without frailty, the two-year cardiovascular survival was 91.3% and 74.4% for those with and without central obesity, respectively (p = 0.002). For patients with frailty, however, the two-year cardiovascular survival was 64.6% and 66.7% for those with and without central obesity, respectively (p = 0.6). For patients without frailty, the number of hospital admission for cardiovascular disease over 2 years were 0.12 ± 0.37 and 0.34 ± 0.72 for those with and without central obesity, respectively (p = 0.03). For frail patients, however, the number of hospital admission was similar between those with and without central obesity. There is a significant interaction between frailty and central obesity on the outcome of PD patients. The protective role of central obesity is only apparent in PD patients without frailty but not the frail ones, and there is a little prognostic value of general (non-central) obesity.

Background Muscle wasting has been linked to negative clinical outcomes in patients undergoing peritoneal dialysis (PD). However, it remains unclear how early changes in muscle mass after the initiation of PD affects the clinical outcome. This study aimed to identify factors influencing changes in lean tissue mass (LTM) over six months in new PD patients and to assess their prognostic significance. Methods We conducted a study of 90 new PD patients. Over a six-month period, we recorded changes in LTM and adipose tissue mass (ATM) using bioimpedance spectrometry. Outcome measures included patient and technique survival rates. Results After 6 months of PD, body weight and body mass index remained unchanged, but 42 patients (46.7%) had decrease in LTM for ≥ 1 kg. The percentage of LTM (LTMp) also dropped from 63.4 ± 13.6% to 61.5 ± 13.4% ( p  = 0.006), accompanied by an increase in ATM. Multiple linear regression models showed a strong correlation between changes in LTM and ATM; for every 1 kg increase in ATM, there was a 1.01 kg decrease in LTM (95% confidence interval: 0.797 to 0.855, p  < 0.0001). However, the change in LTM during the first six months of PD was not associated with patient or technique survival rates. Conclusion Although the overall body weight was static, there was a trend of reduction in LTM and a concommitant increase in ATM during the first 6 months of PD. However, these changes were not associated with adverse clinical outcome.

Background Hyperkalemia is a common complication of chronic kidney disease (CKD) that often requires urgent dialysis and increases healthcare costs. Daily sodium zirconium cyclosilicate (SZC) is a safe and effective treatment for the control of serum potassium levels in CKD patients. We studied the efficacy and safety of intermittent SZC therapy for the prevention of hyperkalemia in CKD patients. Methods In a retrospective study, we analyzed patients in the Hospital Authority Clinical Data Analysis and Reporting System (CDARS) receiving sodium zirconium cyclosilicate (Lokelma ® ) therapy once to thrice weekly for at least 3 months from January 2021 to June 2023. Outcome measures included plasma potassium levels, hyperkalemia episodes, hospital admissions, and renal function changes, which were compared to the 6 months period before the initiation of SZC treatment. Results We studied 36 adult CKD patients. SZC treatment significantly reduced plasma potassium levels from 5.10 (inter-quartile range [IQR] 4.91–5.40) to 4.73 (IQR 4.50–5.10) mmol/l ( p  = 0.0003). The median incidence of any hyperkalemia reduced from 5.0 (IQR 2.0–8.0) to 1.9 (IQR 0.0–4.7) episode per patient-year ( p  = 0.0001), and the incidence of urgent treatment for hyperkalemia decreased from 2.0 (IQR 0.0–4.0) to 0.0 (IQR 0.0–1.5) episode per patient-year ( p  = 0.007). The number of emergency room attendance and hospitalization were not significantly reduced. Conclusion Intermittent SZC treatment may help prevent hyperkalemia in CKD patients. Further research is necessary to ascertain if this benefit translates into improvements in hard clinical outcomes. Clinical trial number Not applicable.

There were limited data on adipose and serum zinc alpha-2-glycoprotein (ZAG) expression and its association with body composition in patients with advanced chronic kidney disease (CKD). This study aimed to quantify adipose and serum ZAG expression and evaluate their association with body composition and its longitudinal change, together with mortality in incident dialysis patients. We performed a single-center prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. ZAG levels were measured from serum sample, subcutaneous and pre-peritoneal fat tissue obtained during peritoneal dialysis catheter insertion. Body composition and functional state were evaluated by bioimpedance spectroscopy and Clinical Frailty Scale respectively at baseline and were repeated 1 year later. Primary outcome was 2-year survival. Secondary outcomes were longitudinal changes of body composition. At baseline, the average adipose and serum ZAG expression was 13.4 ± 130.0-fold and 74.7 ± 20.9 µg/ml respectively. Both adipose and serum ZAG expressions independently predicted adipose tissue mass (ATM) (p = 0.001, p = 0.008, respectively). At 1 year, ATM increased by 3.3 ± 7.4 kg (p < 0.001) while lean tissue mass (LTM) remained similar (p = 0.5). Adipose but not serum ZAG level predicted change in ATM (p = 0.007) and LTM (p = 0.01). Serum ZAG level predicted overall survival (p = 0.005) and risk of infection-related death (p = 0.045) after adjusting for confounders. In conclusion, adipose and serum ZAG levels negatively correlated with adiposity and predicted its longitudinal change of fat and lean tissue mass, whilst serum ZAG predicted survival independent of body mass in advanced CKD patient.

Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHI) have pleiotropic properties that may affect glomerular podocytes. We studied the effects of SGLT2i and HIF-PHI on cultured podocytes and human diabetic kidney disease (DKD) specimens. Methods Cultured human podocytes were treated with high glucose, Dapagliflozin, or Roxadustat. Podocyte-associated molecules levels and morphological changes were assessed. We then studied the kidney biopsy of 5 DKD patients treated with SGLT2i and 5 untreated DKD patients (control group). The distribution patterns of podocyte-associated molecules were assessed. Results In high glucose condition, cultured podocytes had reduced mRNA expression of nephrin, podocalyxin, and synaptopodin, which was restored by treatment with Dapagliflozin, Roxadustat, or both. The corresponding intracellular protein levels were similarly reduced in high glucose and partly restored by Dapagliflozin, Roxadustat, or both. In high glucose condition, podocyte cell bodies were shrunken, and the distribution of nephrin and podocin on cell surface became granular, which were restored to the normal linear pattern when treated with Dapagliflozin, Roxadustat, or both. In high glucose condition, podocalyxin distribution at podocyte apical membrane was disorganized, while the expression of synaptopodin was reduced in the cell processes, with the punctate appearance disrupted; Dapagliflozin, but not Roxadustat, partly restored their normal distribution. In human DKD, the disorganized nephrin, podocin, podocalyxin, and synaptopodin distribution was similar to cultured podocytes, and the disrupted distribution returned to the normal linear continuous pattern with SGLT2i treatment. Conclusion SGLT2i Dapagliflozin and HIF-PHI Roxadustat partly restore the podocyte morphology and intracellular mRNA and protein levels of podocyte-associated molecule in a diabetic milieu. Clinical trial number Not applicable. Key Learning Points What was known • Podocyte dysfunction plays an important role in the pathogenesis of diabetic kidney disease (DKD) • Sodium-glucose cotransporter 2 (SGLT2) inhibitors and hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHI) have pleiotropic properties on glomerular podocytes. This study adds • In cultured human podocytes, SGLT2i and HIF-PHI partly restore the podocyte morphology and intracellular mRNA and protein levels of podocyte-associated molecules in a diabetic milieu. • The same pattern of podocyte-associated molecules changes was present in kidney biopsy from DKD patients with SGLT2i treatment. Potential impact • Our study showed that SGLT2 inhibitor and HIF-PH inhibitor are protective to podocytes in vitro, but the concomitant use of these two medications does not appear to have obvious additional effects.

Background: MicroRNAs (miRNAs) play important roles in the progression of renal fibrosis. We studied the urinary levels of miR-21, miR-29 family and miR-93, which are downstream mediators of the transforming growth factor-β 1 (TGF-β 1 ), in patients with immunoglobulin A (IgA) nephropathy. Methods: We studied the urinary miRNA levels of 43 IgA nephropathy patients and 13 healthy controls. Results: The IgA nephropathy group had significantly lower urinary miR-29b and miR-29c, but higher miR-93 levels than controls. Proteinuria significantly correlated with urinary levels of miR-29b (r = –0.388, p = 0.003) and miR-29c (r = –0.409, p = 0.002). Glomerular filtration rate significantly correlated with urinary levels of miR-21 (r = 0.338, p = 0.028), miR-29b (r = 0.333, p = 0.031) and miR-29c (r = 0.304, p = 0.050). Urinary miR-93 level significantly correlated with glomerular scarring (r = –0.392, p = 0.010). Urinary miRNA level of SMAD3, but not TGF-β 1 , correlated with urinary miR-21 (r = 0.624, p < 0.001), miR-29b (r = 0.566, p < 0.001), miR-29c (r = 0.619, p < 0.001) and miR-93 (r = 0.332, p = 0.032). Conclusions: Urinary miR-29b and miR-29c levels correlated with proteinuria and renal function, while urinary miR-93 level correlated with glomerular scarring. More importantly, urinary levels of these miRNA targets significantly correlated with urinary SMAD3 level. Our results suggest that these miRNA targets are regulated by the TGF-β 1 /SMAD3 pathway and they may play important roles in the development of progressive renal fibrosis in IgA nephropathy.

Background Diabetic kidney diseases (DKD) is a the most common cause of end-stage kidney disease (ESKD) around the world. Previous studies suggest that urinary podocyte stress biomarker, e.g. podocin:nephrin mRNA ratio, is a surrogate marker of podocyte injury in non-diabetic kidney diseases. Method We studied 118 patients with biopsy-proved DKD and 13 non-diabetic controls. Their urinary mRNA levels of nephrin, podocin, and aquaporin-2 (AQP2) were quantified. Renal events, defined as death, dialysis, or 40% reduction in glomerular filtration rate, were determined at 12 months. Results Urinary podocin:nephrin mRNA ratio of DKD was significantly higher than the control group ( p  = 0.0019), while urinary nephrin:AQP2 or podocin:AQP2 ratios were not different between groups. In DKD, urinary podocin:nephrin mRNA ratio correlated with the severity of tubulointerstitial fibrosis ( r  = 0.254, p  = 0.006). and was associated with the renal event-free survival in 12 months (unadjusted hazard ratio [HR], 1.523; 95% confidence interval [CI] 1.157–2.006; p  = 0.003). After adjusting for clinical and pathological factors, urinary podocin:nephrin mRNA ratio have a trend to predict renal event-free survival (adjusted HR, 1.327; 95%CI 0.980–1.797; p  = 0.067), but the result did not reach statistical significance. Conclusion Urinary podocin:nephrin mRNA ratio has a marginal prognostic value in biopsy-proven DKD. Further validation is required for DKD patients without kidney biopsy.