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Nephrology.
Blackwell Science,
Nephrology.

Blackwell Science,

1320-5358

Nephrology./Journal Nephrology.
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    4页

    Personalized immunosuppression after kidney transplantation

    Chi Yuen CheungSydney Chi Wai Tang
    9页
    查看更多>>摘要:Abstract With advances in immunosuppressive therapy, there have been significant improvements in acute rejection rates and short‐term allograft survival in kidney transplant recipients. However, this success has not been translated into long‐term benefits by the same magnitude. Optimization of immunosuppression is important to improve the clinical outcome of transplant recipients. It is important to note that each patient has unique attributes and immunosuppression management should not be a one‐size‐fits‐all approach. Elderly transplant patients are less likely to develop acute rejection but more likely to die from infectious and cardiovascular causes than younger patients. For those with post‐transplant cancers and BK polyomavirus‐associated nephropathy, reduction of immunosuppression can increase the risk of rejection. Therapeutic drug monitoring (TDM) is routinely used for dosage adjustment of several immunosuppressive drugs. It has been hoped that pharmacogenetics can be used to complement TDM in optimizing drug exposure. Among the various drug‐genotype pairs being investigated, tacrolimus and CYP3A5 gives the most promising results. Different studies have consistently shown that CYP3A5 expressers require a higher tacrolimus dose and take longer time to achieve target blood tacrolimus levels than nonexpressers. However, for pharmacogenetics to be widely used clinically, further trials are necessary to demonstrate the clinical benefits of genotype‐guided dosing such as reduction of rejection and drug‐related toxicities. The development of different biomarkers in recent years may help to achieve true personalized therapy in transplant patients.

    Profile of urinary exosomal microRNAs and their contribution to diabetic kidney disease through a predictive classification model

    Ana K. González‐PalomoFrancisco J. Pérez‐VázquezKaren B. Méndez‐RodríguezCesar A. Ilizaliturri‐Hernández...
    10页
    查看更多>>摘要:Abstract Aim Evaluate the expression of exomiRs‐126, ‐146, and ‐155 in urinary exosomes of patients with T2DM and diabetic kidney disease to establish a predictive classification model with exomiRs and clinical variables in order to determine their contribution to DKD. Methods The study group included 92 subjects: 64 patients diagnosed with T2DM subclassified into two groups with albuminuria (T2DM with albuminuria, n?=?30) and without albuminuria (TD2M, n?=?34) as well as 28 healthy, non‐diabetic participants. Exosomes were isolated from urine and identified by TEM and flow cytometry. Profile expression of exomiRs‐126, ‐146 and ‐155 was evaluated by RT‐qPCR. Data were analysed by permutational multivariate analysis of variance (PERMANOVA), similarity percentage (SIMPER), principal coordinate analysis (PCO), and canonical analysis of principal coordinates (CAP). Results T2DM patients with and without albuminuria showed higher levels of miR‐155 and miR‐146 compared with controls. In addition, T2DM patients with albuminuria presented a significant increase in miR‐126 contrasted to controls and patients without albuminuria. PCO analysis explained 34.6% of the total variability of the data (PERMANOVA; p?<?.0001). Subsequently, SIMPER analysis showed that miR‐146, miR‐155, and miR‐126 together, with some clinical parameters, contributed to 50% of the between‐group significance. Finally, the CAP analysis developed showed a correct classification of 89.01% with the analysed parameters. Conclusion A platform using a combination of clinical variables and exomiRs could be used to classify individuals with T2D as risk for developing DKD.

    A pilot study comparing the efficiency of a novel asymmetric cellulose triacetate (ATA) dialyser membrane (Solacea‐190H) to a standard high flux polysulfone dialyser membrane (FX‐80) in the setting of extended hours haemodialysis

    Kamya KameshwarMatthew J. DamasiewiczKevan R. PolkinghornePeter G. Kerr...
    7页
    查看更多>>摘要:Abstract Aim To compare small, middle and large‐middle molecule clearance; and expression of markers of inflammation, between Solacea‐190H (asymmetric cellulose triacetate [ATA]) and FX‐80 dialysers in long‐hour haemodialysis patients. Methods This pilot, randomized cross‐over trial recruited 10 home haemodialysis patients. The total study duration was 8?weeks, using each dialyser for 4?weeks. Removal of small (urea, phosphate, creatinine and indoxyl sulfate [IS]), middle and large‐middle molecules (beta‐2 microglobulin [β2M], albumin), markers of inflammation (interleukin‐6 [IL‐6], malondialdehyde‐modified low density lipoprotein [MDA‐LDL] and alpha‐1 microglobulin [α1M]), was evaluated in serum and dialysate samples. Results Reduction ratios [RR] were calculated for variables at the fourth week of each dialyzer sequence and results expressed as difference in mean RR between dialyzers. There was no difference in clearance of small molecules, with difference in mean RR for urea ?2.43 (95% CI ‐6.44, 1.57; p?=?.19), creatinine ?1.82 (95% CI ‐5.50, 1.85; p?=?.28) and phosphate ?2.61 (95% CI ?12.45, 7.23; p?=?.55); clearance of middle and large‐middle molecules with difference in mean RR (range) for β2M 2.2 (95% CI ?3.2, 7.7; p?=?.35), IS 1.8 (95% CI ?9.5, 13; p?=?.72) and albumin ?0.6 (95% CI ?5.5, 4.2; p?=?.77). There was lack of induction of markers of inflammation, including IL‐6 15.2 (95% CI ?31.9, 62.2; p?=?.47), MDA‐LDL ?8.1 (95% CI ‐22.1, 5.8; p?=?.21) and α1M ?3.50 (95% CI ?29.2, 22.2; p?=?.76). Dialysate removal results were concurrent. Conclusion This study showed no difference in clearance of small, middle and large‐middle molecules, nor expression of markers of inflammation between dialysers.

    Self‐assessment sheet submission rate predicts technique survival in patients initiating peritoneal dialysis

    Ei KusahanaKiyotaka UchiyamaNobuko YamaguchiMaiko Hirashima...
    9页
    查看更多>>摘要:Abstract Aim Patients play a crucial role in preventing peritoneal dialysis (PD)‐related events, including peritonitis and fluid overload, as PD procedures are mainly carried out at home. We asked patients to submit a PD self‐assessment sheet at each outpatient visit in our daily clinical practice and evaluated its usefulness for outcomes in patients initiating PD. Methods This retrospective cohort study included patients who underwent PD catheter insertion between January 2008 and October 2018. The submission rate of a PD self‐assessment sheet was calculated from medical records until PD cessation or study completion (October 2020). The association between the submission rate and technique survival was analysed. Results Among the 105 recruited patients (78 men, 60.4?±?12.2?years), 44 discontinued PD and transferred to haemodialysis during the study period. The follow‐up was 52.3 (28.7–79.3) months, and the median submission rate was 78%. The log‐rank test showed that technique survival was significantly better in patients with a submission rate?≥?78% than those with a submission rate?<78% (p?=?.006). The submission rate remained significantly associated with less technique failure (hazard ratio 0.88 per 10%, p?=?.002) by the Cox regression analysis adjusted for age, sex, Charlson comorbidity index, estimated glomerular filtration rate and geriatric nutritional risk index. Conclusion The submission rate of a PD self‐assessment sheet is useful as a predictor of technique survival in patients initiating PD. Instruction that increases submission may improve technique survival in PD patients.

    Comorbidity is not associated with dialysis modality choice in patients with end‐stage kidney disease

    Anna A. BonenkampSanne VonkAlferso C. AbrahamsYolande M. Vermeeren...
    9页
    查看更多>>摘要:Abstract Aim Over the past years the proportion of home dialysis patients has decreased in the Netherlands. In addition, the home dialysis use varies significantly among centres. It is unclear whether this is the result of differences in comorbidity, or other factors. Our aim was to investigate the association between comorbidity and dialysis modality choice. Methods The multi‐centre DOMESTICO cohort study collected comorbidity data of patients who started dialysis in 35 Dutch centres from 2012 to 2016. Comorbidity was assessed by the Charlson comorbidity index. Home dialysis was defined as any peritoneal dialysis or home haemodialysis treatment during follow‐up. Multivariable logistic regression analysis was used to assess the association between comorbidity and dialysis modality, with a mixed model approach to adjust for clustering of patients within dialysis centres. Results A total of 1358 patients were included, of whom 628 were treated with home dialysis. In crude mixed model analyses, the probability of receiving home dialysis was lower when comorbidity score was higher: having a high comorbidity score resulted in an odds ratio of 0.74 (95% CI 0.54–1.00) when compared with patients without comorbidities. After adjustments for age, sex, ethnic background, body mass index and dialysis vintage, there was no association between comorbidity and home dialysis. Conclusion Comorbidity was not significantly associated with home dialysis choice, after adjustment for several confounding factors including age and body mass index. Future studies should aim at unravelling the centre‐specific characteristics that probably play a role in dialysis modality choice.

    Association between higher variability in kidney function and long‐term mortality

    Jiwon RyuYujin ParkHye Won KimNak‐Hyun Kim...
    9页
    查看更多>>摘要:Abstract Aim We evaluated whether estimated glomerular filtration rate variability in the general population could be associated with all‐cause mortality. Methods Health examination data from 7842 individuals aged >20?years who visited for health check‐ups at least thrice at ≥6‐month intervals between May 1, 1995 and November 30, 2010 were collected. Estimated glomerular filtration rate variability was defined as the coefficient of variation of the estimated glomerular filtration rate, that is, standard deviation/mean value multiplied by 100. The study population was divided into three groups based on the coefficient of variation tertiles, and the mortality risks were compared across groups. Results The mean duration from the final visit to the outcome was 10.3?±?2.9?years. The mean coefficient of variations of estimated glomerular filtration rate variability from the lowest to the highest variability group were 5.1?±?1.8%, 9.0?±?1.0%, and 14.4?±?3.9%, respectively. There was a 1.3 times higher risk of mortality in the group with the highest variability (hazard ratio: 1.300, 95% confidence interval: 1.013–1.669) after adjustment. The findings were similar in patients with diabetes and those >60?years old (hazard ratio: 1.635, 95% confidence interval: 1.076–2.483; hazard ratio: 1.585, 95% confidence interval: 1.107–2.269). Conclusion Higher estimated glomerular filtration rate variability was associated with increased 10‐year mortality in the general population. This variability was very small, but considering the patients' long‐term prognoses, it was significant.

    Histological diagnosis from kidney transplant biopsy can contribute to prediction of graft survival

    Salmir NasicJohan M?lneBernd StegmayrBj?rn Peters...
    9页
    查看更多>>摘要:Abstract Aim The primary aim of this study was to in depth examine if the histological findings in a transplanted kidney biopsy can predict the prognosis for the graft and the patient. The secondary aim was to extend knowledge of the impact of time elapsed on biopsy findings. Methods Data from 1462 patients were merged from a kidney transplantation registry and a biopsy registry during 1 January 2007 and 30 September 2017. Kaplan–Meier analysis and multivariate Cox‐regression analysis were performed and hazard ratios (HR) with 95% confidence intervals (CI) were presented. Results Compared to normal biopsy findings, graft survival after biopsy (gsaBiopsy) was shorter for patients with glomerular diseases (HR 8.2, CI:3.2–21.1), rejections (HR 4.2, CI:1.7–10.3), chronic changes including IFTA (HR 3.2, CI:1.3–8.0), acute tubular injuries (HR 3.0, CI:1.2–7.8), and borderline changes (HR 2.9, CI:1.1–7.6). Sub‐analysis of rejections showed shorter gsaBiopsy for chronic TCMR (HR 4.7, CI:1.9–11.3), active ABMR (HR 3.6, CI:1.7–7.7) and chronic ABMR (HR 3.5, CI:2.0–6.0). Patients with TCMR Banff grade II (HR 0.35, CI:0.20–0.63) and grade I (HR 0.52, CI:0.29–0.93) had a better gsaBiopsy compared to all other types of rejections. Conclusion Shorter gsaBiopsy was noted in kidneys with glomerular diseases, rejections, acute tubular injuries and borderline changes. TCMR Banff rejections grade I and II were associated with a better prognosis.

    Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease

    Kelly LambertSu BahceciHarriet HarrisonMaria Chan...
    4页

    A medication frequency error resulting in hypermagnesemia in a patient with kidney failure

    Jerard Kneifati‐HayekJack HuebnerAnne GrauerJo R. Applebaum...
    2页