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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 April 2023) | Viewed by 9648

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Special Issue Editor

Prof. Dr. Shih-Hua Lin

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Guest Editor

Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center Taiwan, Taipei, Taiwan
Interests: Chronic kidney disease; nephrology; clinical acid-base electrolyte imbalance; genetic diagnosis; artificial intelligence-enabled electrocardiography for dyskalemia

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is ever-expanding and plagues tens of millions of patients worldwide. There are a variety of CKD etiologies, ranging from glomerulopathy, immune deposition damages, diabetic nephropathy, ischemic or toxic nephropathy, to secondary insults, such as cardiorenal and hepatorenal syndromes. The involved molecular pathologies include oxidative stress, advanced glycation endproducts, mitochondrial dynamic perturbations (involving tubular epithelia, podocytes, and mesangial cells), and also endothelial components, leading to a maladaptive response to injuries and, subsequently, the downward spiraling of renal functions. Owing to the complexity of CKD pathogenesis, available therapeutic options remain limited. Renin-angiotensin-aldosterone system blockers are the prototypical class of medications that demonstrate unrivaled benefits in amelioorating renal deterioration; however, subsequent pharmacological attempts at retarding renal progression frequently fail. This implies that we need more pathophysiologically directed therapeutics that cover some or even most of the CKD core pathologies in order to achieve this ambitious aim. Cumulative knowledge exists with regard to the understanding about how CKD develops and worsens over time. Therefore, in this Special Issue, we aim to recruit prospective researchers that describe and share their approaches, i.e., clinical or translational ones, that try to tackle CKD, whether in the forms of case series, reviews, original investigations, and opinion pieces.

Prof. Dr. Shih-Hua Lin
Guest Editor

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Keywords

chronic kidney disease
decline rate
epigenetics
etiology
genetics
progression
pathophysiology
therapy
translation
uremic toxins

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Published Papers (5 papers)

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11 pages, 553 KiB

Open AccessArticle

Risk Factors for Lower Extremity Amputation in Patients with End-Stage Kidney Disease: A Nationwide Cohort Study

by Min Jun Seo, Dong Geon Lee, Se Yun Ko, Ga Yeong Song, Geon Yeong Lee, Sung Hwa Kim, Dae Ryong Kang, Jiye Kim and Jun Young Lee

J. Clin. Med. 2023, 12(17), 5641; https://doi.org/10.3390/jcm12175641 - 30 Aug 2023

Cited by 1 | Viewed by 1764

Abstract

Individuals with end-stage kidney disease (ESKD) on dialysis are at a high risk of developing foot ulcerations and undergoing subsequent lower extremity amputation (LEA), which can exert significant impacts on their quality of life and contribute to rising healthcare costs. We aimed to identify risk factors associated with LEA in patients with ESKD to predict LEA progression and eventually prevent it. We used 18 years (2002–2019) of data from the Korean National Health Insurance Service (KNHIS). Data were collected from patients with ESKD who underwent renal replacement therapy (RRT) and had no history of amputation caused by trauma or toxins. The risk factors were compared between patients with or without LEA. We collected data from 220,838 patients newly diagnosed with ESKD, including 6348 in the LEA group and 214,490 in the non-LEA group. The total incidence of LEA was 2.9%. Older age, male gender, lower income, non-metropolitan residence, diabetes mellitus, dialysis treatment (compared to kidney transplantation), microvascular disease, peripheral vascular disease, endovascular procedure, and endovascular operation were associated with an increased risk of LEA. Thus, individuals with ESKD who are at a higher risk for LEA should be closely monitored, and kidney transplantation should be considered as a preventative measure. Full article

(This article belongs to the Special Issue Clinical Management on Chronic Kidney Disease)

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32 pages, 2911 KiB

Open AccessArticle

Underdiagnosed CKD in Geriatric Trauma Patients and Potent Prevention of Renal Impairment from Polypharmacy Risks through Individual Pharmacotherapy Management (IPM-III)

by Ursula Wolf, Hassan Ghadir, Luise Drewas and Rüdiger Neef

J. Clin. Med. 2023, 12(13), 4545; https://doi.org/10.3390/jcm12134545 - 7 Jul 2023

Cited by 3 | Viewed by 1915

Abstract

The aging global patient population with multimorbidity and concomitant polypharmacy is at increased risk for acute and chronic kidney disease, particularly with severe additional disease states or invasive surgical procedures. Because from the expertise of more than 58,600 self-reviewed medications, adverse drug reactions, drug interactions, inadequate dosing, and contraindications all proved to cause or exacerbate the worsening of renal function, we analyzed the association of an electronic patient record- and Summaries of Product Characteristics (SmPCs)-based comprehensive individual pharmacotherapy management (IPM) in the setting of 14 daily interdisciplinary patient visits with the outcome: further renal impairment with reduction of eGFR ≥ 20 mL/min (redGFR) in hospitalized trauma patients ≥ 70 years of age. The retrospective clinical study of 404 trauma patients comparing the historical control group (CG) before IPM with the IPM intervention group (IG) revealed a group-match in terms of potential confounders such as age, sex, BMI, arterial hypertension, diabetes mellitus, and injury patterns. Preexisting chronic kidney disease (CKD) > stage 2 diagnosed as eGFR < 60 mL/min/1.73 m² on hospital admission was 42% in the CG versus 50% in the IG, although in each group only less than 50% of this was coded as an ICD diagnosis in the patients’ discharge letters (19% in CG and 21% in IG). IPM revealed an absolute risk reduction in redGFR of 5.5% (11 of 199 CG patients) to 0% in the IPM visit IG, a relative risk reduction of 100%, NNT 18, indicating high efficacy of IPM and benefit in improving outcomes. There even remained an additive superimposed significant association that included patients in the IPM group before/beyond the 14 daily IPM interventions, with a relative redGFR risk reduction of 0.55 (55%) to 2.5% (5 of 204 patients), OR 0.48 [95% CI 0.438–0.538] (p < 0.001). Bacteriuria, loop diuretics, allopurinol, eGFR ≥ 60 mL/min/1.73 m², eGFR < 60 mL/min/1.73 m², and CKD 3b were significantly associated with redGFR; of the latter, 10.5% developed redGFR. Further multivariable regression analysis adjusting for these and established risk factors revealed an additive, superimposed IPM effect on redGFR with an OR 0.238 [95% CI 0.06–0.91], relative risk reduction of 76.2%, regression coefficient −1.437 including patients not yet visited in the IPM period. As consequences of the IPM procedure, the IG differed from the CG by a significant reduction of NSAIDs (p < 0.001), HCT (p = 0.028) and Würzburger pain drip (p < 0.001), and significantly increased prescription rate of antibiotics (p = 0.004). In conclusion, (1) more than 50% of CKD in geriatric patients was not pre-recognized and underdiagnosed, and (2) the electronic patient records-based IPM interdisciplinary networking strategy was associated with effective prevention of further periinterventional renal impairment and requires obligatory implementation in all elderly patients to urgently improve patient and drug safety. Full article

(This article belongs to the Special Issue Clinical Management on Chronic Kidney Disease)

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13 pages, 1143 KiB

Open AccessArticle

Impact of Acid Suppression Therapy on Renal and Survival Outcomes in Patients with Chronic Kidney Disease: A Taiwanese Nationwide Cohort Study

by Yi-Chun Chen, Yen-Chun Chen, Wen-Yen Chiou and Ben-Hui Yu

J. Clin. Med. 2022, 11(19), 5612; https://doi.org/10.3390/jcm11195612 - 23 Sep 2022

Cited by 7 | Viewed by 2027

Abstract

Histamine-2-receptor antagonist (H2RA) has shown beneficial effects on the kidney, heart, and sepsis in animal models and on the heart and COVID-19 infection in clinical studies. However, H2RAshave been used as a reference in most epidemiological studies examining the association of proton pump inhibitors (PPI) with outcomes. Therefore, we aimed to evaluate the effect of H2RA on renal and survival outcomes in chronic kidney disease (CKD) patients. We used a Taiwanese nationalhealth insurance database from 2001 to 2016 to screen 45,767 CKD patients for eligibility. We identified new users of PPI (n = 7121), H2RA (n = 48,609), and users of neither PPI nor H2RA (as controls) (n = 47,072) during follow-up, and finally created 1:1:1 propensityscore-matchedcohorts; each cohort contained 4361 patients. Participants were followed up after receivingacid-suppression agents or on the corresponding date until the occurrence of end-stage renal disease (ESRD) in the presence of competing mortality, death, or through the end of 2016. Compared toneither users, H2RAand PPI users demonstrated adjusted hazard ratios of 0.40 (95% confidence interval, 0.30–0.53) for ESRDand 0.64 (0.57–0.72) for death and 1.15 (0.91–1.45) for ESRD and 1.83 (1.65–2.03) for death, respectively. A dose-response relationship betweenH2RA use with ESRD and overall, cardiovascular, and non-cardiovascular mortality was detected. H2RA consistently provided renal and survival benefits on multivariable stratified analyses and multiple sensitivity analyses. In conclusion, dose-dependent H2RA use was associated with a reduced risk of ESRD and overall mortality in CKD patients, whereas PPI use was associated with an increased risk of overall mortality, not in a dose-dependent manner. Full article

(This article belongs to the Special Issue Clinical Management on Chronic Kidney Disease)

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11 pages, 628 KiB

Open AccessArticle

Clinicopathological Patterns and Outcomes in Patients with Lupus Nephritis and Hyperuricemia

by Qiong Wen, Xueqing Tang, Qian Zhou, Wei Chen and Xueqing Yu

J. Clin. Med. 2022, 11(11), 3075; https://doi.org/10.3390/jcm11113075 - 30 May 2022

Cited by 1 | Viewed by 1845

Abstract

A limited number of large cohort studies have reported the clinicopathological characteristics and prognosis of patients with lupus nephritis (LN) and hyperuricemia (HUA). In this retrospective cohort study, 1297 LN patients were enrolled from January 1996 to December 2011 in the First Affiliated Hospital of Sun Yat-Sen University, and HUA occurred in 649 (50.04%) of these 1297 LN patients. Compared to patients without HUA, those with HUA presented with higher blood pressure and triglyceride levels, lower hemoglobin and serum albumin levels, worse renal function, more severe hematuria and proteinuria, higher lupus activity, and more positive antiphospholipid antibody. Pathologically, HUA cases presented more crescents, a higher degree of mesangial matrix, endothelial cell proliferation, and inflammatory cell infiltration. During the 52-month follow-up, the 5-year and 10-year incidence rates of renal endpoint events were 11.1% and 19.5% in the HUA group, and 8.3% and 13.8% in the non-HUA group, respectively (p = 0.073). In addition, the 5-year and 10-year mortality rates did not differ significantly between the HUA (12.0% and 18.2%) and non-HUA (12.2% and 17.5%) groups, respectively. This study verified that HUA was not an independent risk for poor clinical outcomes, and steroids that delay the deterioration of renal function did not affect the survival of these patients. Full article

(This article belongs to the Special Issue Clinical Management on Chronic Kidney Disease)

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2 pages, 166 KiB

Open AccessComment

Drug–Drug Interactions, Medication Adherence, and Stroke Should Be Considered When Approaching the Impact of Acid Suppression Therapy on Chronic Kidney Disease Patients. Comment on Chen et al. Impact of Acid Suppression Therapy on Renal and Survival Outcomes in Patients with Chronic Kidney Disease: A Taiwanese Nationwide Cohort Study. J. Clin. Med. 2022, 11, 5612

by Ai-Hsien Li and Yen-Ling Chiu

J. Clin. Med. 2023, 12(1), 72; https://doi.org/10.3390/jcm12010072 - 22 Dec 2022

Cited by 1 | Viewed by 1169

Abstract

Chen et al. have published a report in this journal comparing the prognostic impact of a Histamine-2-receptor antagonist (H2RA) and a proton pump inhibitor (PPI) in patients with chronic renal disease. Based on Taiwan’s National Insurance Database, they concluded that those patients treated with the H2RA demonstrated a dose–response relationship of H2RA to reduced risk of ESRD and overall cardiovascular and non-cardiovascular mortality. In contrast, the CKD patients treated with the PPI were associated with an increased risk of overall mortality. However, from our point of view, there are some methodological and research concerns that need to be clarified by the authors. Otherwise, it would be too early to make a convincing conclusion. Full article

(This article belongs to the Special Issue Clinical Management on Chronic Kidney Disease)

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