Introduction:Hemodialysis patients are at increased risk for viral hepatitis due to treatment-related exposures and transmission routes, potentially worsening liver and kidney disease. However, updated regional data in Brazil are scarce. This study evaluated the seroprevalence of hepatitis B, C, and D viruses (HBV, HCV, and HDV) and analyzed risk factors associated with HBV infection among patients undergoing hemodialysis in Northeast Brazil. Methods:This study corresponds to a cross-sectional evaluation of 293 patients from two hemodialysis clinics. Serological markers (HBsAg, anti-HDV, anti-HBc, anti-HBs, and anti-HCV) were analyzed by chemiluminescence, and the quantification of viral load was measured by real-time PCR. Sociodemographic and risk-related characteristics were collected via questionnaire. Statistical analyses included chi-square and Fisher tests (p < 0.05). Results:The prevalence of hepatitis B (HBsAg+) and hepatitis C (anti-HCV+) was 2.4% and 4.1%, respectively. Regarding hepatitis B serological status, 17.2% presented markers of exposure (HBsAg and/or anti-HBc+), 35.6% were susceptible, and 47.1% had probable vaccine-induced immunity (isolated anti-HBs+). Male sex was associated with HBV exposure, whereas female sex was associated with susceptibility (p < 0.001 and p = 0.036, respectively). Younger age (≤ 50 years) was related to vaccination status (p = 0.027). A history of jaundice was associated with HBV exposure (p = 0.030) and lower vaccination rates (p = 0.034), and psychotropic substance use with incomplete vaccination status (p = 0.014). Complete vaccination coverage (anti-HBs+ and/or ≥ 3 doses on the vaccination card) was low (51.2%), particularly among drug users. No anti-HDV reactivity was detected among HBsAg-positive individuals. Conclusion:HBV and HCV prevalence was higher than the national average in hemodialysis, with gender disparities between exposed and susceptible and low vaccination coverage, especially in drug users. Although no anti-HDV reactivity was found, investigating hepatitis D in this population remains relevant to improving understanding of its geographical distribution and clinical impact. It is recommended to reinforce screening, vaccination, and safety protocols in hemodialysis clinics.
Background:Malnutrition and systemic inflammation are common and interrelated complications in patients undergoing peritoneal dialysis (PD), contributing to poor clinical outcomes. Residual kidney clearance (Kr) may play a protective role in this context, while erythropoietin resistance index (ERI) reflects anemia management challenges influenced by inflammation. This study aimed to investigate the associations of nutritional and inflammatory markers with Kr and ERI in PD patients. Methods:We conducted a cross-sectional study of 47 stable adult PD patients. Nutritional and inflammatory indicators, including Malnutrition Inflammation Score (MIS), serum albumin, and Interleukin-6 (IL-6), were assessed alongside Kr and ERI. Linear regression analysis was used to evaluate associations, and Spearman correlation with bootstrapped 95% confidence intervals determined relationships among clinical variables. Results:The mean age was 62.2 ± 15.5 years; 53.2% were male. The mean MIS was 5.7 ± 2.5, serum albumin 3.29 ± 0.5 g/dL. IL-6 was positively associated with MIS (β = 0.684, p = 0.037). Kr was significantly inversely associated with MIS (β = -0.585, p = 0.040) and positively associated with serum albumin (β = 0.152, p = 0.018). Spearman analysis confirmed significant correlations between Kr and both MIS (r = -0.358, p = 0.008) and albumin (r = 0.343, p = 0.012), and between IL-6 and MIS (r = 0.390, p = 0.004). ERI showed no significant correlations with MIS, albumin, IL-6, or Kr. Conclusion:MIS was significantly associated with IL-6, highlighting the close relationship between malnutrition and systemic inflammation in patients undergoing PD. Higher Kr was associated with a more favorable nutritional inflammatory profile, whereas no significant associations were observed for ERI.
Background:Kidney biopsy is the gold standard for diagnosing renal parenchymal diseases, guiding treatment and assessing prognosis. Real-time ultrasound-guided biopsy is widely regarded as the preferred technique. However, the implementation may be affected by equipment availability, trained personnel and workflow constraints in resource-limited settings worldwide. Objective:This study compared the safety and effectiveness of real-time ultrasound-guided and blind kidney biopsy techniques in a paediatric tertiary referral hospital in Vietnam and examined the practical implications of transitioning to real-time ultrasound guidance. Methods:A retrospective cohort study was conducted at the Nephro-Endocrinology Department, City Children's Hospital, Ho Chi Minh City, Vietnam, from May 2018 to April 2025. All native kidney biopsies performed during the study period were included. A standardised questionnaire was used to extract data from medical records, including demographics, biopsy techniques, glomerular yield, samples containing ≥ 10 and ≥ 25 glomeruli, and inadequate yield and complications, including macroscopic haematuria and major complications. Results:Among 221 participants (median age: 11 [IQR 7-13] years), 173 underwent real-time ultrasound-guided biopsy and 48 used the blind technique. The ultrasound-guided group had a significantly higher median glomerular count (p = 0.01) and greater proportion of samples with ≥ 10 (p < 0.001) and ≥ 25 glomeruli (p = 0.04). There were no significant differences in inadequate sample rates (p = 0.06), macroscopic haematuria (p = 0.63) or major complications (p = 0.60). Lower eGFR was independently associated with post-biopsy bleeding events, mainly macroscopic haematuria (AOR = 0.809 per 10 mL/min/1.73 m2 increase, 95% CI 0.671-0.975, p = 0.03). Conclusion:In this Vietnamese paediatric tertiary referral setting, real-time ultrasound-guided biopsy provided superior tissue adequacy compared with the blind technique, without a detectable increase in macroscopic haematuria or major complications. Lower estimated glomerular filtration rate was associated with post-biopsy bleeding events in this cohort, mostly macroscopic haematuria rather than major bleeding.
Aim:South Africa has one of the highest prevalences of human immunodeficiency virus (HIV) infection worldwide. Kidney disease is a common and important complication of HIV. This study describes biopsy-proven kidney pathology in people living with HIV (PLHIV) over 29 years at a South African centre, comparing patterns before and after antiretroviral therapy (ART) rollout. Methods:This retrospective descriptive study included PLHIV who underwent native kidney biopsy at Tygerberg Hospital during the period of 1 January 1992 to 31 December 2020. Patients were categorised by biopsy year into a pre-ART rollout period (before 2004) and a post-ART rollout period (2004 or later). Results:The cohort included 554 PLHIV, mostly biopsied post-ART rollout (90.1%). Mean age was 36.5 years, with a balanced sex distribution. During the post-ART period, 54.8% were on ART at biopsy. HIVAN was diagnosed in 45.7%, of which one-third had an additional histopathological pattern of injury. In the pre-ART rollout period, HIVAN was the most prevalent diagnosis (60.0%), whereas a lower prevalence was observed post-ART rollout (44.1%). During the post-ART rollout period, more than half of patients (55.9%) exhibited only non-HIVAN kidney pathology, with immune-complex-mediated glomerulonephritis (52.7%) and tubulointerstitial disease (39.7%) the most common. Conclusion:This study describes the spectrum of kidney pathology in PLHIV at a South African tertiary centre over nearly three decades, highlighting a significant HIVAN burden overall. We observed a lower proportion of patients with HIVAN following ART rollout, coinciding with an increase in non-HIVAN pathologies like immune complex glomerulonephritis and tubulointerstitial disease.
Point-of-care ultrasonography (POCUS) has revolutionized pediatric healthcare by offering immediate, bedside diagnostic capabilities that enhance clinical decision-making and patient management. This comprehensive review examines the impact and necessity of POCUS in assessing renal conditions in children. By synthesizing current literature, clinical applications, diagnostic accuracy, and patient outcomes associated with POCUS, this paper highlights its essential role in pediatric nephrology. Additionally, the integration of POCUS into clinical practice, requisite training protocols, and future technological advancements are discussed. The review concludes that POCUS is an indispensable tool in pediatric kidney assessment, improving diagnostic precision, reducing the need for more invasive procedures, and enhancing overall patient outcomes.
Background:This study aimed to evaluate the diagnostic performance of renal resistive index (RRI) for predicting acute kidney injury (AKI) and glomerular filtration rate (GFR) in patients with severe preeclampsia. Methods:This observational study included 22 patients admitted with severe preeclampsia. RRI was measured at admission. AKI was defined and staged according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Receiver operating characteristic (ROC) curve analysis was used to assess RRI's ability to predict AKI and measured creatinine clearance. Results:Of the 22 patients, 9 (40.9%) developed AKI. Patients who developed AKI had significantly higher admission RRI values compared to those who did not (mean 0.75 ± 0.19 vs. 0.45 ± 0.13, respectively; p < 0.001). The area under the ROC curve for RRI predicting AKI was 0.87 (95% CI, 0.65-0.97). In the multivariate linear regression analysis, RRI showed a borderline significant negative association with adjusted GFR (β = -112.67; p = 0.095), though the overall model was not statistically significant (p = 0.23). Conclusion:The RRI measured at ICU admission is a promising, noninvasive predictor of AKI in patients with severe preeclampsia, demonstrating good diagnostic accuracy with high specificity at an optimal cutoff.
Background: Chronic kidney disease (CKD) affects approximately 850 million adults worldwide, with its prevalence rising due to increasing rates of diabetes and hypertension in aging populations. This study aims to assess the prevalence and associated factors of CKD in an urban adult cohort in Sri Lanka, where such data are limited. Methods: We conducted a stratified random sampling of participants from Ragama, Sri Lanka, initially in 2007 (ages 35-64) and reassessed them in 2014. Data collection involved structured interviews, anthropometric measurements, and biochemical tests. CKD was evaluated in 2014 using the estimated glomerular filtration rate (eGFR) calculated via the CKD-EPI formula, defining CKD as eGFR < 60 mL/min/1.72 m(2) according to KDIGO/KDOQI guidelines. A follow-up in 2017 assessed all-cause and cardiovascular mortality and morbidity. Results: Of 2985 individuals recruited in 2007, 2148 (71.6%) participated in the 2014 follow-up; 2032 (94.6%) had complete data to assess CKD status in 2014. Mean age of the participants was 52.3 (SD 7.7) years; 57% were women. Age-adjusted prevalence of CKD was 3.03 (1.98-4.11) per 100 population in 2014; most were Stage 3A (67.2%), followed by Stage 3B (23%) and Stage 4 (9.8%). Older age (p < 0.001), male gender (p < 0.05), diabetes (p < 0.001), and hypertension (p < 0.001) at baseline were associated with CKD in 2014. No association was observed between CKD and all-cause or cardiovascular mortality or morbidity by 2017 (p > 0.05). Conclusions: Diabetes and hypertension are significant contributors to CKD prevalence, with most patients at Stage 3, where early detection and management can slow disease progression. CKD remains underrecognized in Sri Lanka, highlighting the need for extensive population-based studies to better understand this growing health issue better.
Background:The human leucocyte antigen (HLA) complex has been associated with the susceptibility of several hundred human diseases, increasingly so with kidney disease. HLA data are under-represented in South Africa, and thus, their contribution to disease characterisation remains poorly understood. Therefore, there is a need for HLA typing studies among high-risk disease populations in our region. Methods:We recruited a total of 100 participants with biopsy-proven chronic kidney disease (CKD) attending a nephrology clinic in central South Africa. Exploratory analyses of demographic, clinical and serological characteristics were performed. High-resolution HLA typing was conducted using DNA microarray technology. Results:Among 100 participants, a large proportion had early-stage CKD based on glomerular filtration rate (GFR) category (CKD stage 1 and 2: 64%), yet many were classified as being at high or very high risk of disease progression to end-stage kidney disease (ESKD) according to the 'Kidney Disease: Improving Global Outcomes' (KDIGO) criteria. This risk was predominantly driven by severely increased proteinuria (proteinuria category A3: 41.8%) rather than reduced estimated GFR (eGFR). Hypertension was the most common comorbidity/complication, and roughly a fifth of the cohort were HIV positive. The most prevalent autoimmune serology was antinuclear antibody (ANA) positivity, occurring in the context of a high frequency of lupus nephritis (LN) in this cohort. We observed the following recurring set of HLA alleles in this CKD cohort, alongside specific clinical and/or serological features: HLA-A∗23:01; HLA-A∗68:02; HLA-B∗15:10; HLA-B∗44:03; HLA-DRB1∗03:01; HLADQB1∗02:01; HLA-DQB1∗02:02 and/or HLA-DPB1∗04:01. Conclusion:Our findings suggest that specific HLA alleles may be associated with CKD susceptibility and/or the increased risk of disease progression in this regional cohort, warranting further investigation into specific CKD-related immunological and molecular mechanisms to establish causality in larger studies. Furthermore, by increasing our global representation in population-specific reference panels, we can improve our understanding of South Africa's extensive genetic diversity.
Rationale and ObjectiveSleep is an important outcome for people with chronic kidney disease (CKD) undergoing hemodialysis. However, the applicability of commonly used instruments for assessing sleep quality in this population remains unclear. We evaluated the validity and reliability of the Pittsburgh Sleep Quality Index (PSQI) in a cohort of hemodialysis patients.Study DesignObservational cross-sectional study. Survey data were collected using QuestionPro online survey software or paper forms from a convenience sample of individuals receiving hemodialysis.Setting and PopulationAdults aged 18 or older with CKD who were receiving hemodialysis in health facilities across three states in Australia during the study period from August 2024 to March 2025 were included.ExposuresTesting of 7 components of the PSQI.OutcomesReliability and validity of PSQI.Analytical ApproachExploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess validity, and Cronbach's alpha (alpha) to assess internal consistency.ResultsOf 107 participants, the mean age was 61 years, 72% males, and the majority received dialysis three times a week (84%). Reliability data indicated good internal consistency (alpha = 0.72). EFA revealed the multidimensionality of the PSQI: sleep disruptions, sleep medication, and sleep regulation, collectively accounting for 72% variance. CFA confirmed the two-factor model, with sleep disruption and sleep regulation as the best-fitting model.LimitationsSmall sample size, lack of international representation, and test-retest reliability data.ConclusionsThis study demonstrated the PSQI's strong psychometric properties and reliability as a screening tool for sleep disturbances in the hemodialysis population. While the overall scale is robust, the sleep medication component may be less applicable in this population. Additional research is needed to establish the appropriateness of the short version of PSQI excluding sleep medication questions. Future studies should also validate the test-retest reliability of the PSQI to determine its consistency over time.
Background:Snakebite is a neglected tropical disease with a high burden in South Asia, particularly India. Acute kidney injury (AKI) is one of the most serious complications of snake envenomation, which has significant morbidity, mortality, and risk of chronic kidney disease (CKD). The present study aimed to evaluate the incidence, predictors, and outcomes of snakebite-associated AKI (SBE-AKI) in a tertiary care center. Methods:We retrospectively analyzed 325 patients with snakebite envenomation, admitted to our institution. Demographic, clinical, laboratory, and treatment variables were compared between patients with and without AKI. AKI was staged according to KDIGO criteria. Renal biopsy was performed selectively in patients with prolonged renal failure, dialysis dependence, delayed renal recovery, or suspicion of irreversible renal injury. Outcomes assessed included recovery, progression to CKD, and mortality. Results:Of the 325 patients, 79 (32.1%) developed AKI. Patients with AKI were significantly younger (mean age 34 vs. 45 years, p = 0.001). Delay in antisnake venom (ASV) administration (5 vs. 9 h, p = 0.001), need for inotropes (41.8% vs. 14.2%, p = 0.001), and mechanical ventilation (36.7% vs. 6.9%, p = 0.001) were strong predictors. Proteinuria was more frequent in AKI (80% vs. 32.5%). Among AKI patients, 57% had Stage 3 AKI; 39.2% required dialysis. Biopsy (n = 8) showed acute tubular necrosis in 37.5% and cortical necrosis in 25%. Outcomes included 77.2% recovery, 6.3% progression to CKD, and 16.5% mortality. Conclusion:SBE-AKI is a common and serious complication of snakebite. Delay in ASV administration, hemodynamic instability, proteinuria, advanced AKI stage, and cortical necrosis predict poor outcomes. Early ASV, timely dialysis, and long-term nephrology follow-up are essential to improve survival and reduce CKD progression.
Introduction:Acute kidney injury (AKI) and chronic kidney disease (CKD) are widely correlated. However, the risk factors associated with outcomes of AKI in CKD patients have not been widely studied to date. Objectives:To identify factors associated with outcomes of death and need for kidney support therapy (KST) in patients with CKD who present with AKI during hospital stay. Methods:Retrospective cohort conducted from July 2018 to June 2022 that included patients with CKD and superimposed AKI. Sociodemographic data related to CKD, AKI, and the progression of patients to outcomes as death and KST were collected. The results were discussed with a significance level of p < 0.05. Results:A total of 327 patients were included. The patients had a mean age of 68.6 ± 11.4 years, the majority were men, and the most prevalent comorbidities were hypertension (81.7%) and cardiovascular disease (61.5%). The mean creatinine was 1.85 ± 0.74 mg/dL. The main etiology of CKD was undetermined (26.6%) and of AKI was septic (45.3%). Patients were hospitalized mainly for infectious or cardiovascular causes (22.3% each). Overall mortality was 29.1%, and the need for KST was 35.2%. In the intensive care unit (ICU), 73.2% required dialysis and 74.4% died, reaching 85.7% in those with KST. CKD staging was not associated with any of the primary outcomes. The risk factors for KST were obesity, ATN-ISS score, and creatinine elevation greater than three times the baseline. The risk factors for death were ATN-ISS score, undetermined CKD, septic AKI, ICU admission, and KST. Conclusions:Mortality and need for KST in CKD patients admitted to the ICU and who develop AKI are high. Variables related to AKI were more relevant than those related to CKD for clinical outcomes.
Background:The goal of antiretroviral therapy will not be achieved without addressing Human Immunodeficiency Virus (HIV) comorbidities, including depression, hypertension, and nephrotoxicity among people living with HIV (PLWH). This study was conducted to assess the interaction effect of depression and hypertension on nephrotoxicity among PLWH. Methods:The study employed a cross-sectional study design. Data were collected from May to June 2022. The main outcome was nephrotoxicity, while depression and hypertension were considered as exposure factors. Confounders were identified through the directed acyclic graph and were controlled using the propensity score matching procedure. We estimated the causal association from the interactions by using weighted logistic regression. Results:The study involved 416 PLWH with ages ranging from 19 to 80 years (mean standard deviation was 49.32 ± 10.43 years). The majority (79.09%) of the participants involved were females. The prevalence of depression, hypertension, and nephrotoxicity was 21.87% (95% CI = 18.15-26.12), 36.30% (31.80-41.05), and 33.65% (29.26-38.35), respectively. Among participants with both depression and hypertension, analysis showed a substantial increase in the odds of nephrotoxicity. The proportion of the combined effect due to interaction was approximately 71% (63-77), and the excess risk due to interaction was positive (RERI = 1.87; 1.46-2.28). On the multiplicative scale, when both depression and hypertension are present, the risk of nephrotoxicity tripled (effect = 3.42; 2.70-4.14). Having depression raises the likelihood of nephrotoxicity by 55% (aOR = 1.55; 1.35-1.76) among PLWH with hypertension. Among PLWH with depression, the odds of nephrotoxicity increased by over twofold due to hypertension (aOR = 2.12; 1.83-2.42). Conclusion:The presence of both depression and hypertension raises the likelihood of nephrotoxicity much more than either condition alone. The findings revealed a synergistic effect, highlighting the need for integrated care that addresses both mental health and cardiovascular risks in HIV treatment.
Background:Kidney transplant is acknowledged as the treatment of choice for end-stage renal disease (ESRD). This study reports on the outcome of pediatric renal transplant at a tertiary hospital in Abu Dhabi. Methods:It is a retrospective study of all pediatric renal transplants performed at a single designated pediatric center between February 2010 and February 2024, including children aged 1-16 years. Results:Sixty-nine (44% female) pediatric renal transplants were performed, 36 from living-related donors and 33 from deceased donors. The mean age at transplant and last follow-up were 9.8 ± 3.6 years and 13.8 ± 4.7 years, respectively. ESRD etiologies included congenital anomalies of the kidney and urinary tract (39%), nephronophthisis (19%), glomerulonephritis (13%), and other causes (29%). Thirteen (19%) children underwent a preemptive transplant, whereas 56 (81%) were on dialysis at transplant. Thirty-one (45%) children had graft rejection: 16 (23%) in the first year, 9 (13%) in years 2-5, and 6 (9%) thereafter. Donor-specific antibodies (DSAs) were detected in 19 (28%) children; 17 (25%) of those had graft rejection with anti-DR or anti-DQ alloantibodies. Fourteen children had DSA-negative graft rejection. Of those, eight had cell-mediated rejection, and six had mixed rejection. Predictors of rejection were positive DSA (p = < 0.0001) and two DR mismatches (p = 0.029); three graft losses occurred. The prevalence of EBV, CMV, and BKV infection in the first year was 43%, 39%, and 33%, respectively, falling to 38%, 18%, and 12% in the subsequent years. Thirty-four (49%) children had at least one episode of culture-positive urinary tract infection. The 1-year and 5-year patient survival rates were 100% and 96.6%, and the corresponding graft survival rates were 98.1% and 89.7%, respectively. Conclusion:The outcome of pediatric kidney transplants in Abu Dhabi over 14 years shows patient and graft survival comparable to published data. Acute graft rejection remains a major challenge with the presence of DSA and biallelic HLA-DR mismatch as independent predictors for rejection. Optimizing donor selection, immunosuppression, and closer surveillance are vital.
Background:Chronic kidney disease (CKD) is a significant global health concern. Patients in the last stage of CKD, also known as end stage kidney disease (ESKD), need to use one of the methods of renal replacement therapy including hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT). ESKD adversely affects physical and mental health, as well as overall quality of life. However, limited research has explored the association between these health burdens and treatment modalities in Iran. Methods and Materials:This cross-sectional study included 215 patients with ESKD undergoing HD (n = 66), PD (n = 70), and KT (n = 79) at treatment centers in Mashhad, Iran. A checklist of demographic information, quality of life questionnaire specific for kidney disease patients (Kidney Disease Quality of Life Short Form [KDQOL-SF], version 1.3), Hamilton depression and anxiety inventories, and the Cassidy inventory for problem-solving and social support were distributed among patients. A regression model was employed to adjust for potential confounders, and statistical analysis was conducted using SPSS 11.5. Results:Kidney transplant recipients were younger than patients in the HD and PD groups and exhibited significantly higher mean scores in most domains of the KDQOL, both in general and specific domains. After adjusting for confounding variables such as age, transplant patients were found to have the highest quality of life scores in specific domains. Depression prevalence was high, ranging from 60% to 65% across all groups, with no significant intergroup differences. Anxiety prevalence ranged from 21% to 26%, also without significant differences. Social support was reported as high among ESKD patients (70%-82%) with no variation between treatment modalities. Conclusion:KT was associated with better quality-of-life outcomes compared to HD and PD, highlighting the potential benefits of organ donation programs. Given the substantial burden of mental health issues among ESKD patients, early detection and intervention for depression and anxiety should be prioritized in both dialysis and transplant populations.
Introduction:Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) encompasses a group of rare systemic autoimmune diseases characterized by inflammation of small- and medium-sized blood vessels. Despite the efficacy of immunosuppressive therapy in achieving disease remission, a significant proportion of patients experience relapses, underscoring the need for reliable biomarkers to monitor disease activity. This systematic literature review evaluates the potential of urinary and serum biomarkers (CD163, CD206, CD25, and MCP-1) to detect active AAV in adult patients. Method:A comprehensive search on PubMed, Embase, and Cochrane databases identified relevant studies, which were screened and assessed for inclusion based on predefined criteria. Data extraction and quality appraisal were independently conducted using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Results:A total of 20 studies evaluated biomarkers for their diagnostic accuracy in detecting AAV activity. Most articles were scored as moderate risk of bias, with low concerns regarding applicability. Urinary soluble CD163 shows promising diagnostic accuracy for active renal vasculitis, with sensitivity and specificity values ranging from 0.72 to 1 and 0.67 to 0.98, respectively. Serum soluble CD163 and CD206 demonstrated variable accuracy. Serum MCP-1 did not differ between patients in remission and patients with active disease, while urinary MCP-1 showed potential but with inconsistent results across studies. Serum soluble CD25 was significantly elevated in active disease. Some combinations of biomarkers improved diagnostic performance (usCD163 + usCD25 + ssCD25 and usCD163 + serum Calprotectin + hematuria). Conclusion:In conclusion, while usCD163 individually appears to be the most reliable single biomarker for detecting active renal vasculitis in these studies, the heterogeneity of study designs and cutoff values across studies precludes definitive conclusions. Further research is necessary to standardize biomarker use, evaluate promising biomarker combinations, and improve the accuracy of activity monitoring both in renal and extrarenal AAV.
Background:Despite their fundamental role in managing volume overload, diuretic use in hemodialysis patients is inconsistent. This study aims to examine diuretic use, compare clinical outcomes between diuretic users and nonusers, and identify predictive factors among hemodialysis patients in Lebanon. Method:This was a multicenter retrospective observational study. Patients' data were retrieved from eight large dialysis centers in Lebanon. Descriptive and bivariate analyses were performed, followed by multivariable logistic regression to examine the association of diuretic use with the sociodemographic, hemodialysis parameters, and clinical outcomes of patients. Results:A total of 250 patients were included in the study. Diuretics were utilized among 38.4% of the patients, all of whom were on loop diuretics, primarily furosemide (71.3%). The mean furosemide equivalent dose was 153.56 ± 122.57 mg per day (range 20-500 mg). Only 28.7% and 16.1% were on furosemide equivalent doses of at least 250 mg and 320 mg per day, respectively. Diuretic users were more likely to have a residual kidney function (ORa = 23.189, 95% CI: 5.129-104.831, p < 0.001), a shorter dialysis vintage (ORa = 0.892, 95% CI: 0.472-0.958, p = 0.046), and a higher postdialysis systolic blood pressure (ORa = 13.760, 95% CI: 10.381-18.232, p = 0.026) compared to nonusers. Other hemodialysis parameters and clinical outcomes did not differ between diuretic users and nonusers. Furosemide equivalent doses of at least 250 mg per day were significantly associated with lower predialysis systolic blood pressure and dry weight, while doses of 320 mg and more per day were significantly associated with fewer intradialytic hypotension episodes, lower predialysis systolic blood pressure, dry weight, and interdialytic weight gain (all p < 0.05). Conclusion:This study reveals suboptimal dosing despite a relatively high prevalence of utilization of diuretics among hemodialysis patients. Most hemodialysis parameters and clinical outcomes do not differ between diuretic users and nonusers. Higher diuretic doses are associated with improved clinical outcomes, emphasizing the need for further research to optimize dosing practices in this population.
Introduction:Chronic kidney disease (CKD) poses a major health burden globally and affects nearly 17% of the Indian population. Despite established risk factors such as diabetes and hypertension, significant interindividual variability suggests a genetic contribution to CKD susceptibility. This study explores genetic variants predisposing to CKD in the Indian population using a genomewide association approach. Methods:A total of 90 patients with CKD and 90 healthy controls were genotyped using the Illumina Infinium Global Screening Array (640,000 markers). After stringent quality control, 5.7 million genetic markers were retained for analysis. Single-nucleotide polymorphisms (SNPs) were assessed using logistic regression including age, sex, and ten principal components as covariates. Variants meeting standard genomewide significance thresholds (p ≤ 5 × 10-8) were considered significant. Results:The study identified 87 SNP loci associated with CKD, of which two genes, MPP7 and MAD1L1, reached genomewide significance. Variants with extremely high odds ratios (e.g., MAD1L1 OR > 1000) were interpreted as possible methodological artifacts. SNPs in PDZK1IP1, ANO3, C3AR1, FTO, and CD70 demonstrated suggestive biomarker potential (OR < 10, p < 10-4), warranting replication in larger cohorts. These findings provide new insights into genes involved in tubular integrity, immune activation, and metabolic regulation in CKD. Conclusion:This genomewide analysis represents one of the first studies on CKD genetics in the Indian population. While the MPP7 variant emerges as a credible susceptibility locus, several other SNPs show promising biomarker potential. Larger, multiethnic studies and functional validation are needed to confirm their roles in CKD pathogenesis and therapeutic targeting.
Introduction:Chronic kidney disease (CKD) increasingly affects young adults in low-and middle-income countries, with significant social and economic consequences. In Tanzania, many patients begin dialysis during their most productive years, often disrupting employment and financial stability. This study aimed to examine employment patterns and dialysis-related work challenges among young adults on maintenance hemodialysis at Muhimbili National Hospital. Methods:We conducted a hospital-based cross-sectional study at Muhimbili National Hospital from October to December 2024, involving adults aged 18-49 years on maintenance hemodialysis for at least three months. Data were collected using a structured questionnaire and supplemented with clinical records to assess sociodemographic, dialysis-related, employment, and transplant-related factors. Descriptive statistics were used to summarize the findings. Results:We included 134 patients aged between 18 and 49 years, with a mean age of 35.8 years (SD: 8.9). A total of 58.3% were either employed or self-employed, with 44.9% reporting that they did not work on dialysis days. Among those working, 65.4% experienced changes in their work patterns due to treatment demands, and 42.4% worked fewer than 4 days per week. Among the unemployed participants (24.6%), more than half (57.6%) reported resigning from work due to dialysis-related challenges. Out-of-pocket payment for dialysis was common, reported by 52.3% of participants. Although awareness of kidney transplantation was high (92.5%), only 27.6% had previously pursued or were actively pursuing it, primarily hindered by the absence of a donor (48.3%), high cost (23.0%), or both (28.7%). Conclusion:Young adults on maintenance hemodialysis in Tanzania face significant employment disruptions and limited access to kidney transplantation, highlighting the need for integrated interventions to support their social and economic well-being.
Introduction:Aortic calcification may be a vascular marker of health risk. Loss of elastic recoil due to arterial calcification results in hemodynamic changes that, in turn, can lead to damage to target organs, such as the kidneys. There are few studies analyzing the association between the presence of calcification in the thoracic aorta and chronic kidney disease (CKD). Objective:To investigate the association between calcification of transthoracic aortic (TAC) and its segments and CKD in individuals living in the community without established cardiovascular disease and to verify whether arterial stiffness is a confounder of this relationship. Methods:Cross-sectional study with 2427 participants from visit 2 of ELSA-Brasil, in Minas Gerais (2012-2015). TAC and its ascending (ATAC), aortic arch (AAC), and descending (DTAC) segments were categorized by the degree of calcification (0; greater than 0 and less than 100 HU; and greater than 100 HU). The presence of CKD was verified by glomerular filtration rate (eGFR CKDEPI) < 60 mL/min/1.73 m2 and/or albumin/creatinine ratio ≥ 30 mg/g. The adjustment covariates were age, sex, race/color, schooling, smoking, cholesterol/HDL ratio, BMI, diabetes, hypertension, and pulse wave velocity (PWV). Logistic regression models were performed to analyze the associations. Statistical significance was defined as p < 0.05. Results:After all adjustments, there was an association between DTAC and CKD in the group with the highest degree of calcification (OR: 2.66-1.05; 6.71). The inclusion of PWV in the final model slightly increased the magnitude of the association with DTAC (OR: 2.75; 1.07-7.05). No statistical association was found for TAC, ATAC, and AAC. Conclusion:Greater degree of DTAC is positively associated with CKD, regardless of the level of arterial stiffening.
