Background: The relationship between physical activity levels and overall health among survivors of moderate to severe COVID-19 remains underexplored in target organs, such as lungs and kidneys. We examined the association between physical activity levels and lung-kidney abnormalities in survivors of COVID-19 hospitalization. Methods: A cross-sectional analysis was performed within a prospective cohort of survivors of COVID-19 hospitalization. Physical activity levels were assessed with the International Physical Activity Questionnaire (short form), and physical inactivity was classified according to the WHO guidelines (<150 min/week of physical activity). Abnormal kidney function was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m 2 , whereas pulmonary involvement was defined as chest X-ray pulmonary lesion, and/or forced vital capacity < the lower limit of normal, and/or altered oximetry. Results: 653 survivors (46% female and 28% ≥65 years) were assessed 8±2 months post-hospital discharge. Physical inactivity was found in 53% of the cohort. Lung and kidney abnormalities were observed in 36% and 20% of survivors, respectively, whereas coexistence in 7%. Physically active survivors had lower odds of lung abnormality (32% vs . 41%; adjusted odds ratio [aOR]=0.67, 95%CI:0.47 to 0.97), but not of kidney (17% vs . 23%; aOR=0.81, 95%CI:0.52 to 1.26) nor lung-kidney abnormality (6% vs . 9%; aOR=0.58, 95%CI:0.29 to 1.20), compared to those physically inactive. Subgroup and sensitivity analyses showed distinct associations for lung abnormalities by age and among survivors without severe oxygen desaturation or very low kidney function. The restricted cubic spline curve for lung-kidney abnormalities showed a non-linear dose-response relationship, with higher odds below and lower odds above 150 min/week. Conclusions: Among survivors of COVID-19 hospitalization, being physically active was associated with better lung function outcomes, but not kidney or composite outcomes. This association was modified by age and baseline clinical status and followed a non-linear dose-response pattern.

Abstract Background Brain-derived neurotrophic factor (BDNF) has emerged as a key regulator of neuronal plasticity in the central nervous system. Successful biological interventions upregulate the expression of BDNF in generalized anxiety disorder (GAD) patients, but no study of psychological treatments has been found. The present study aimed to evaluate changes in plasma BDNF levels following two psychological treatments with established clinical efficacy in patients with GAD. Methods: Participants were recruited for a 14-week, 10-session clinical trial of either group acceptance-based behavior therapy (ABBT) or supportive therapy (ST). Eligible patients were GAD patients aged 18–65 years. Plasma BDNF was measured in 82 patients before and after the intervention (ABBT = 41, ST = 41). Correlation with anxiety symptom severity was also assessed using the Hamilton Anxiety Scale at pre- and post-treatment. Results: BDNF increased in both groups over time (ST: difference = 2042.6, t = 4.81, p < 0.001 vs. ABBT: difference = 1947.8, t = 4.46, p < 0.001). Although anxiety symptoms decreased in both groups, no correlation between BDNF and anxiety severity was found. Conclusions: The present study suggests that a short-term trial of two clinically effective psychotherapeutic interventions was associated with increases in plasma BDNF levels in GAD patients. Given the absence of associations between BDNF changes and symptom severity, these findings should be interpreted cautiously and not as evidence of treatment-specific or mechanistic effects. Trial registration NCT03930095|| https://www.clinicaltrials.gov / retrospectively registered on 15 April 2019.

Background Malnutrition in patients with cancer is linked to worse clinical outcomes, including reduced treatment tolerance, prolonged hospital stays, diminished quality of life, and increased mortality. Although outpatient cancer treatments are prevalent (90%), comprehensive nutritional screening is often inadequate in these settings. The Patient-Generated Subjective Global Assessment (PG-SGA) is an effective tool for evaluating nutritional status. The Global Leadership Initiative on Malnutrition (GLIM) offers new diagnostic criteria, yet it is less explored in outpatient settings. This study aims to compare the diagnostic agreement of GLIM and PG-SGA for identifying malnutrition in outpatients with solid tumors. Methods This cross-sectional study was conducted at the Instituto do Cancer do Estado de São Paulo (ICESP). We included adults with histologically confirmed solid tumors, an ECOG Performance Status (ECOG-PS) of ≤ 3, and no recent treatment who began cancer treatment and underwent nutritional assessment within 14 days. Patients already in follow-up were excluded. The collected data included clinical information and laboratory tests (albumin, C-reactive protein). Nutritional assessments comprised anthropometry, multifrequency electrical bioimpedance (BIA), PG-SGA (gold standard), and GLIM criteria. Cachexia was diagnosed using Fearon’s criteria. Statistical analyses included medians, interquartile ranges, Wilcoxon, Kruskal-Wallis, chi-square, Fisher’s exact tests, and kappa statistics to evaluate the agreement between GLIM and PG-SGA, with significance set at p<0.05. Results From April 22, 2015, to September 15, 2017, 13,386 patients were screened, 1,200 completed the study, and 689 underwent comprehensive nutritional. The cohort had a median age of 60 years (IQR: 51-67), with 50.4% of the participants being male. Common cancer types included breast (26.6%), male genital (21.6%), gastrointestinal (18.7%), and head and neck (10.2%). Most patients (53.7%) were in stages I or II, and 94.9% had ECOG scores of 0 or 1. Nutritional assessments indicated that 58.4% were at nutritional risk (PG-SGA score ≥ 4), with malnutrition detected in 56.2% by PG-SGA and 35.6% by GLIM. Malnourished patients by GLIM and PG-SGA exhibited more advanced disease stages, poorer clinical performance, lower albumin levels, and higher CRP levels. There was moderate agreement between GLIM and PG-SGA (kappa 0.439). GLIM showed low sensitivity, 55.8 (50.7-60.8), but high specificity, 90.4 (86.5-93.5) for diagnosing malnutrition. Patients identified as malnourished by GLIM had higher ECOG status and weight loss, while those identified by PG-SGA had higher body mass index (BMI). Conclusion PG-SGA and GLIM criteria presented moderate agreement in this cohort of adult outpatients with cancer initiating anticancer treatment. PG-SGA had greater sensitivity for detecting early nutritional impairment among outpatients with cancer, highlighting the need to refine GLIM applications to improve early malnutrition detection.

Introdução: Physical activity levels may benefit overall health. However, its association with outcomes in critically ill COVID-19 survivors remains underexplored, especially for COVID-19's main affected organs, the lungs and kidneys. Thus, we investigated the association between physical activity levels and lung-kidney abnormalities in survivors of COVID-19 hospitalization. Métodos: A cross-sectional analysis was performed within a prospective cohort of survivors of COVID-19 hospitalization (HCFMUSP COVID-19 Study). Physical activity levels were assessed with the International Physical Activity Questionnaire (short form) and physical inactivity was classified according to the WHO guidelines (<150 min/week of moderate-to-vigorous intensity). Abnormal kidney function was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2, whereas pulmonary involvement was defined as chest X-ray pulmonary lesion, and/or forced vital capacity < the lower limit of normal, and/or altered oximetry. Resultados: A total of 653 survivors (46% female and 28% ≥65 years) were assessed 8±2 months post-hospital discharge. Physical inactivity was found in 70% of the cohort. Lung and kidney abnormalities were observed in 36% and 20%, respectively. Coexistence of lung-kidney abnormality was found in 7%. Survivors classified as physically active had a lower prevalence of lung (40% vs. 28%; p = 0.003), kidney (23% vs. 14%; p = 0.009), and lung-kidney abnormalities (9% vs. 4%; p = 0.018) compared to those physically inactive. Being physically active was associated with lower odds of lung (OR = 0.58, 95% CI: 0.40 to 0.83) and kidney abnormalities (OR = 0.59, 95% CI: 0.37 to 0.94) (OR=1.84, 95% CI: 1.16–2.92), but borderline associated with lung-kidney abnormality (OR = 0.44, 95% CI: 0.19 to 1.00). Discussão e Conclusões: In survivors of COVID-19 hospitalization, being physically active was associated with better kidney and lung functional outcomes. These findings underscore the importance of physical activity in long COVID-19 outcomes, particularly in the primary target organs of acute COVID-19, the lungs and kidneys.

Acute Kidney Disease (AKD) commonly affects disadvantaged populations in low-resourced areas with poor access to kidney care. Here, barriers to management include a lack of AKD education alongside an inability to measure serum creatinine (SCr) to identify kidney disease. The Kidney Care Network (KCN) is a service improvement initiative which aims to implement a novel strategy for the management of AKD into routine clinical care in low- and low-middle income countries (LLMICs). The strategy includes the development of a scoring system to screen patients for risk of AKD and the use of a device to measure SCr at the point-of-care (POC). This approach is underpinned by dedicated AKD training activities for healthcare workers providing front line clinical care. We report feasibility in the implementation of the KCN approach in adults in 4 LLMICs. Between 2018-2020, 4311 patients at project sites in Bolivia, Brazil, Nepal, and South Africa were deemed at risk of kidney disease and underwent SCr testing, predominantly with the POC device. AKD was identified in 2922 (67.8%) patients. AKD was most commonly due to infections and hypovolemia, and as such was treatable by relatively simple means. Most patients with AKD were treated at the site of patient presentation, including rural primary healthcare facilities, and with early AKD identification the need for kidney replacement therapy was low. In-hospital mortality was only 2.9% and follow-up occurred at 3 months in 1865 (62.3%) patients discharged post AKD diagnosis. Hence, we show the KCN approach is a feasible and effective mechanism for improving AKD management in LLMICs.

Although previous data demonstrate that total kidney volume (TKV) correlates with measured glomerular filtration rate (mGFR), evidence is however scarce in the oncology setting. The aim of this is study is to evaluate whether adding TKV to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimating equations improves the prediction of measured glomerular filtration rate (mGFR) in patients with cancer. We evaluated patients with solid tumors between April 2015 and September 2017 who had undergone contrast computed tomography and GFR measurement through the plasma clearance of 51Cr-EDTA. Estimated GFR (eGFR) was determined through CKD-EPI equations based on serum creatinine (eGFRcr) and combined with serum cystatin C (eGFRcr-cys). We used the 2009 eGFRcr and 2012 eGFRcr-cys equations and the race-free 2021 eGFRcr, and eGFRcr-cys. TKV was measured using a semi-automatic segmentation program, excluding non-functional tissues. Linear regression models were built, with TKV and eGFR equations as predictors and mGFR as the outcome. We included 189 patients (median age 58.0 [48.0–65.0] years, 49.2

Kidney diseases are a global health problem, and their frequency is continuously increasing. Available treatments provide limited kidney protection. The protective effect of the green tea polyphenol epigallocatechin-3-gallate (EGCG) in several diseases have been extensively investigated. Experimental and clinical studies have shown that the antioxidant, anti-inflammatory, and anti-apoptotic properties of EGCG are promising for the treatment and/or prevention of kidney diseases. This review analyzes the available evidence on the effects, and the likely protective mechanisms of action, of EGCG in a broad spectrum of kidney diseases, including acute kidney injury, drug-induced nephrotoxicity, kidney stone disease, diabetic nephropathy, chronic kidney disease, and kidney fibrosis.

INTRODUCTION:Endothelin-1 (ET-1) is a potent vasoconstrictor and is implicated in the pathogenesis of proteinuria and progressive chronic kidney disease (CKD). With the development of ET-1 receptor antagonists, there is interest in whether higher ET-1 concentrations are associated with a greater risk of adverse cardio-kidney events among high-risk patients, e.g., those with established CKD and type 2 diabetes mellitus (T2DM). METHODS:ET-1 concentrations were measured in a random subset of TREAT (n = 997 [25%] of the original 4,038 patients with CKD, T2DM, and anemia) using an automated ELISA assay on the Ella analyzer (ProteinSimple). We used unadjusted and adjusted Cox regression models to explore the association of baseline serum ET-1 (log-transformed and quartiles) with kidney events (composite of kidney failure or doubling of serum creatinine), heart failure (HF), and cardiovascular and all-cause death. RESULTS:At baseline, mean age was 67 ± 10 years and 56% were female. The mean eGFR was 34 ± 11 mL/min/1.73 m2; median urine protein/creatinine ratio was 0.4 (0.1, 1.7) g/g; median ET-1 was 2.4 (1.9, 3.0) pg/mL. During a median follow-up of 2.4 years, there were 225 kidney events, 99 HF events, 124 cardiovascular deaths, and 188 all-cause deaths. Each log-unit higher ET-1 was associated with a higher adjusted risk of the kidney composite (HR: 1.61; 95% CI: 1.08, 2.39), HF (HR: 2.61; 95% CI: 1.42, 4.81), but not with cardiovascular death (HR: 1.06; 95% CI: 0.65, 1.75) or all-cause death (HR: 1.33; 95% CI: 0.86, 2.04). Compared with the lowest quartile, categorical analyses suggested a higher risk of kidney events (HR 1.69; 95% CI 1.08, 2.64), HF events (HR: 2.35; 95% CI: 1.16, 4.80), and all-cause death (HR: 1.81; 95% CI: 1.09, 3.00) for the highest quartile of ET-1. CONCLUSIONS:Among patients with established CKD, T2DM, and anemia, higher baseline ET-1 was associated with a higher subsequent risk of kidney outcomes, HF events, and all-cause death. Whether higher ET-1 predicts responsiveness to ET receptor antagonism warrants further investigation.

The tropics, a large and heavily inhabited area, are characterized by deep contrasts in sociopolitical, economic, and social development, which are reflected in the epidemiology of diseases. Common noncommunicable chronic diseases, such as diabetes and hypertension, coexist with acute infectious tropical diseases. Global warming, immigration, tourism, and commercial travel have helped spread tropical diseases to temperate zones by facilitating the spread of vectors, the infection of animal reservoirs, and the introduction of contaminated individuals into nonendemic areas. Infectious tropical diseases are currently a significant global public health concern worldwide. Their timely diagnosis and adequate treatment might be a considerable challenge to health workers from nontropical areas because most share very similar initial clinical presentations. It is essential that health care teams worldwide can recognize and treat a broad spectrum of tropical diseases. Several of these infectious tropical diseases can affect the kidneys, acutely or chronically. In this review, we explore and discuss the epidemiology, pathophysiological mechanisms, and clinical aspects of the most relevant infectious tropical diseases that can be associated with acute kidney injury. Such diseases include, but are not limited to, dengue, yellow fever, chikungunya, malaria, leptospirosis, and scrub typhus.

Background Sarcopenia and obesity are common in patients with cancer and may reduce the accuracy of eGFR equations. We evaluated the performance of recommended eGFR equations based on creatinine or cystatin C and novel GFR markers beta(2)-microglobulin (B2M) and beta-trace protein (BTP) according to body composition derived from computed tomography (CT). Methods Prospective cohort study of adult patients with solid tumors recruited between May 2015 and October 2017 who had a CT scan within 90 days of measured GFR (mGFR) using plasma clearance of Cr-51-EDTA. eGFR was calculated with the CKD-Epidemiology Collaboration equations using creatinine (eGFR(CR)); cystatin C (eGFR(CYS)); creatinine and cystatin (eGFR(CR-CYS)); creatinine and B2M (eGFR(CR-B2M)), cystatin, B2M, and BTP (eGFR(CYS-B2M-BTP)); or creatinine, cystatin, B2M, and BTP (eGFR(CR-CYS-B2M-BTP)). Bias was assessed as the median of the differences between mGFR and eGFR. Accuracy was assessed as the percentage of estimates that differed by more than 30% from the mGFR (1-P-30). 1-P-30<10%, 10%-20%, and >20% are considered optimal, acceptable, and poor accuracy, respectively. Skeletal muscle index was quantified on CT and calculated by dividing the skeletal muscle cross-sectional area by the patient's height squared. Results Of 465 patients included, 157 (34%) met criteria for sarcopenia. Bias varied by magnitude of skeletal muscle index. In patients with sarcopenia, the accuracy of eGFR(CR) and eGFR(CYS) was poor (1-P-30 42.0% [95% CI, 34.4 to 49.6] and 20.4% [95% CI, 14.0 to 26.8], respectively). eGFR(CR-CYS) had acceptable accuracy (1-P-30: 14.0 [8.3, 19.1] %), whereas eGFR(CYS-B2M-BTP) and eGFR(CR-CYS-B2M-BTP) had optimal accuracy (1-P-30: 7.0 [3.2, 10.8] % and 8.3 [3.8, 12.3] %, respectively). Obesity did not significantly affect bias or accuracy. Conclusions GFR estimates based on eGFR(CR) and eGFR(CYS) are not sufficiently accurate in patients with cancer and sarcopenia. Body composition analysis can identify patients in need of more accurate GFR assessment.

Background The International Society of Nephrology proposes an acute kidney disease (AKD) management strategy that includes a risk score to aid AKD identification in low- and low-middle-income countries (LLMICs). We investigated the performance of the risk score and determined kidney and patient outcomes from AKD at multiple LLMIC sites. Methods and findings Adult patients presenting to healthcare facilities in Bolivia, Brazil, South Africa, and Nepal were screened using a symptom-based risk score and clinical judgment. Those at AKD risk underwent serum creatinine testing, predominantly with a point-of-care (POC) device. Clinical data were collected prospectively between September 2018 and November 2020. We analyzed risk score performance and determined AKD outcomes at discharge and over follow-up of 90 days. A total of 4,311 patients were at increased risk of AKD, and 2,922 (67.8%) had AKD confirmed. AKD prevalence was 80.2% in patients enrolled based on the risk score and 32.5% when enrolled on clinical judgment alone (p < 0.0001). The area under the receiver operating characteristic curve was 0.73 for the risk score to detect AKD. Death during admission occurred in 84 (2.9%) patients with AKD and 3 (0.2%) patients without kidney disease (p < 0.0001). Death after discharge occurred in 206 (9.7%) AKD patients, and 1865 AKD patients underwent reassessment of kidney function after discharge; 902 (48.4%) patients had persistent kidney disease including 740 (39.7%) patients reclassified with de novo or previously undiagnosed chronic kidney disease (CKD). The study was pragmatically designed to assess outcomes as part of routine healthcare, and there was heterogeneity in clinical practice and outcomes between sites, in addition to selection bias during cohort identification. Conclusions The use of a risk score can aid AKD identification in LLMICs. High rates of persistent kidney disease and mortality after discharge highlight the importance of AKD follow-up in low-resource settings.

Rationale & Objective: beta(2)-Microglobulin (B2M) and beta-trace protein (BTP) are novel endogenous filtration markers that may improve the accuracy of estimated glomerular filtration rate (eGFR) beyond creatinine and cystatin C (eGFR(cr-cys)), but they have not been assessed in patients with cancer. Study Design: Cross-sectional analysis. Setting & Participants: Prospective cohort of 1,200 patients with active solid tumors recruited between April 2015 and September 2017. Exposure: CKD-EPI equations without race combining B2M and/or BTP with creatinine with or without cystatin C (2-, 3-, or 4-marker panel eGFR). Outcome: Performance of equations compared with eGFR(cr-cys) and non-GFR determinants of serum B2M and BTP (S-B2M, and S-BTP, respectively). Measured GFR (mGFR) was determined using the plasma clearance of chromium-51 labeled ethylenediamine tetraacetic acid (Cr-51-EDTA). Analytical Approach: Bias was defined as the median of the differences between mGFR and eGFR, and 1-P-30 was defined as the percentage of estimates that differed by more than 30% from the mGFR (1-P-30). Linear regression was used to assess association of clinical and laboratory variables with S-B2M, and S-BTP after adjustment for mGFR. Results: Mean age and mGFR were 58.8 +/- 13.2 SD years and 78.4 +/- 21.7 SD mL/min/1.73m(2), respectively. Performance of the 3-marker and 4-marker panel equations was better than eGFR(cr-cys) (lesser bias and 1-P-30). Performance of 2-marker panel equations was as good as eGFR(cr-cys) (lesser bias and similar 1-P-30). S-B2M and S-BTP were not strongly influenced by cancer site. Limitations: Participants may have had better clinical performance status than the general population of patients with solid tumors. Conclusions: B2M and BTP can improve the accuracy of eGFR and may be useful as confirmatory tests in patients with solid tumors, either by inclusion in a multimarker panel equation with creatinine and cystatin C, or by substituting for cystatin C in combination with creatinine.

OBJECTIVES:[51Cr]CrEDTA is used to measure the Glomerular Filtration Rate (GFR) in different clinical conditions. However, there is no consensus on the ideal number of blood samples to be taken and at what time points to measure its clearance. This study aimed to compare Slope Intercept (SI) and Single-Sample (SS) methods for measuring GFR in patients with solid tumors, stratified by age, GFR, and Body Mass Index (BMI). METHODS:1,174 patients with cancer were enrolled in this prospective study. GFR was calculated by the SI method using blood samples drawn 2-, 4-, and 6-hours after [51Cr]CrEDTA injection (246-GFR). GFR was also measured using the SI method with samples at 2 and 4 hours (24-GFR) and at 4 and 6 hours (46-GFR), and SS methods according to Groth (4Gr-GFR) and Fleming (4Fl-GFR). Statistical analysis was performed to assess the accuracy, precision, and bias of the methods. RESULTS:Mean 246-GFR was 79.2 ± 21.9 mL/min/1.73 m2. ANOVA indicated a significant difference between 4Gr-GFR and the reference 246-GFR. Bias was lower than 5 mL/min/1.73 m2 for all methods, except for SS methods in subgroups BMI > 40 kg/m2; GFR > 105 or < 45. Precision was adequate and accuracy of 30 % was above 98% for all methods, except for SS methods in subgroup GFR < 45. CONCLUSION:46-GFR and 246-GFR have high agreement and may be used to evaluate kidney function in patients with solid tumors. Single-sample methods can be adopted in specific situations, for non-obese patients with expected normal GFR.