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Nicotinamide and acute kidney injury
Miguel Fontecha-Barriuso, Ana M Lopez-Diaz, Sol Carriazo, Alberto Ortiz, Ana Belen Sanz
doi : 10.1093/ckj/sfab173
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2453–2462
In a recent issue of ckj, Piedrafita et al. reported that urine tryptophan and kynurenine are reduced in cardiac bypass surgery patients that develop acute kidney injury (AKI), suggesting reduced activity of the kynurenine pathway of nicotinamide (NAM) adenine dinucleotide (NAD+) synthesis from tryptophan. However, NAM supplementation aiming at repleting NAD+ did not replete kidney NAD+ and did not improve glomerular filtration or reduce histological injury in ischaemic–reperfusion kidney injury in mice. The lack of improvement of kidney injury is partially at odds with prior reports that did not study kidney NAD+, glomerular filtration or histology in NAM-treated wild-type mice with AKI. We now present an overview of research on therapy with vitamin B3 vitamers and derivate molecules {niacin, Nicotinamide [NAM; niacinamide], NAM riboside [Nicotinamide riboside (NR)], Reduced nicotinamide riboside [NRH] and NAM mononucleotide} in kidney injury, including an overview of ongoing clinical trials, and discuss the potential explanations for diverging reports on the impact of these therapeutic approaches on pre-clinical acute and chronic kidney disease.
Sodium–glucose cotransporter 2 inhibitors: renal outcomes according to baseline albuminuria
Pierre Delanaye, Karl Martin Wissing, Andre J Scheen
doi : 10.1093/ckj/sfab096
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2463–2471
Sodium–glucose co-transporter 2 inhibitors (SGLT2is) reduce albuminuria and hard renal outcomes (decline of renal function, renal replacement therapy and renal death) in patients with/without type 2 diabetes at high cardiovascular or renal risk. The question arises whether baseline albuminuria also influences renal outcomes with SGLT2is as reported with renin–angiotensin–aldosterone system inhibitors. Post hoc analyses focusing on albuminuria and renal outcomes of four cardiovascular outcome trials [EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), CANVAS (Canagliflozin Cardiovascular Assessment Study), DECLARE-TIMI 58 (Multicenter Trial to Evaluate the Effect of Dapagliflozin on the Incidence of Cardiovascular Events–Thrombolysis in Myocardial Infarction 58) and VERTIS CV (Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial)] and some renal data from two heart failure trials [Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) and EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction)] showed renal protection with SGLT2is without significant interaction (P?>?0.10) when comparing renal outcomes according to baseline levels (A1, A2 and A3) of urinary albumin:creatinine ratio (UACR), a finding confirmed in a dedicated meta-analysis. Two trials [CREDENCE (Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy) and DAPA-CKD (Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease)] specifically recruited patients with CKD and UACRs of 200–5000?mg/g. A post hoc analysis of CREDENCE that distinguished three subgroups according to UACR (300–1000, 1000–3000 and >3000?mg/g) showed a greater relative reduction in UACR in patients with lower baseline albuminuria levels (P for interaction?=?0.03). Patients with a UACR?>1000?mg/g showed a significantly greater reduction in absolute (P for interaction?<?0.001) and a trend in relative (P for interaction?=?0.25) risk of renal events versus those with lower UACR levels. In conclusion, baseline UACR levels do not significantly influence the nephroprotection by SGLT2is, yet the greater protection in patients with very high UACRs in CREDENCE deserves confirmation. The underlying mechanisms of renal protection with SGLT2is might be different in patients with or without (high) UACR.
Screening for occult coronary artery disease in potential kidney transplant recipients: time for reappraisal?
Charles J Ferro, Miriam Berry, William E Moody, Sudhakar George, Adnan Sharif, Jonathan N Townend
doi : 10.1093/ckj/sfab103
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2472–2482
Screening for occult coronary artery disease in potential kidney transplant recipients has become entrenched in current medical practice as the standard of care and is supported by national and international clinical guidelines. However, there is increasing and robust evidence that such an approach is out-dated, scientifically and conceptually flawed, ineffective, potentially directly harmful, discriminates against ethnic minorities and patients from more deprived socioeconomic backgrounds, and unfairly denies many patients access to potentially lifesaving and life-enhancing transplantation. Herein we review the available evidence in the light of recently published randomized controlled trials and major observational studies. We propose ways of moving the field forward to the overall benefit of patients with advanced kidney disease.
The utility of remote patient management in peritoneal dialysis
Haci Hasan Yeter, Sabrina Milan Manani, Claudio Ronco
doi : 10.1093/ckj/sfab111
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2483–2489
Remote patient management (RPM) programs are one of the most crucial innovations in the peritoneal dialysis (PD) field that have been developed in the last decade. RPM programs are associated with favourable clinical outcomes by increasing the adherence of the patients to PD prescription. The literature supports that RPM is associated with increased blood pressure control and technique survival, and decreased hospitalization rate, length of hospital stay and health costs. RPM programs also facilitate patient follow-up during the coronavirus disease 2019 pandemic, increase treatment adherence and lead to better clinical outcomes. However, published data remain scarce and mainly consist of observational or retrospective studies with relatively low numbers of patients. Therefore, randomized controlled trial results will be more informative to demonstrate the effect of RPM programs on clinical outcomes.
The tryptophan pathway and nicotinamide supplementation in ischaemic acute kidney injury
Alexis Piedrafita, Stéphane Balayssac, Nicolas Mayeur, Stéphane Gazut, Julia Grossac, Marie Buleon, Melinda Alves, Julie Klein, Vincent Minville, Bertrand Marcheix, Joost P Schanstra, Stanislas Faguer
doi : 10.1093/ckj/sfab050
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2490–2496
Down-regulation of the enzymes involved in tryptophan-derived nicotinamide (NAM) adenine dinucleotide (NAD+) production was identified after acute kidney injury (AKI), leading to the hypothesis that supplementation with NAM may increase the kidney NAD+ content, rescuing tryptophan pathways and subsequently improving kidney outcomes.
Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls
Manon J M van Oosten, Susan J J Logtenberg, Marc H Hemmelder, Martijn J H Leegte, Henk J G Bilo, Kitty J Jager, Vianda S Stel
doi : 10.1093/ckj/sfab120
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2497–2523
This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications.
Integrating electronic health data records to develop and validate a predictive model of hospital-acquired acute kidney injury in non-critically ill patients
Alfons Segarra, Jacqueline Del Carpio, Maria Paz Marco, Elias Jatem, Jorge Gonzalez, Pamela Chang, Natalia Ramos, Judith de la Torre, Joana Prat, Maria J Torres, Bruno Montoro, Mercedes Ibarz, Silvia Pico, Gloria Falcon, Marina Canales, Elisard Huertas, Iñaki Romero, Nacho Nieto
doi : 10.1093/ckj/sfab094
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2524–2533
Models developed to predict hospital-acquired acute kidney injury (HA-AKI) in non-critically ill patients have a low sensitivity, do not include dynamic changes of risk factors and do not allow the establishment of a time relationship between exposure to risk factors and AKI. We developed and externally validated a predictive model of HA-AKI integrating electronic health databases and recording the exposure to risk factors prior to the detection of AKI.
Heparin-free regional anticoagulation of haemodialysis filters with calcium-free dialysate: is citrate mandatory?
Chloé Medrano, Olivier Cointault, Laurence Lavayssiere, Marie-Béatrice Nogier, Eloïse Colliou, Nicolas Setbon, Nassim Kamar, Stanislas Faguer
doi : 10.1093/ckj/sfab087
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2534–2538
There is an unmet need to develop safe and successful heparin-free regional anticoagulation modalities in haemodialysed patients at risk of bleeding. Whether the addition of citrate as a prefilter injection or in the dialysate itself is required to reach anticoagulation objectives when calcium-free dialysate is used as regional anticoagulation remains unclear.
Treatment practices and outcomes in incident peritoneal dialysis patients: the Swedish Renal Registry 2006–2015
Hong Xu, Bengt Lindholm, Ulrika Hahn Lundström, Olof Heimbürger, Maria Stendahl, Helena Rydell, Mårten Segelmark, Juan-Jesus Carrero, Marie Evans
doi : 10.1093/ckj/sfab130
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2539–2547
Therapeutic developments have contributed to markedly improved clinical outcomes in peritoneal dialysis (PD) during the 1990s and 2000s. We investigated whether recent advances in PD treatment are implemented in routine Swedish care and whether their implementation parallels improved patient outcomes.
Depression screening and clinical outcomes among adults initiating maintenance hemodialysis
Michael J Fischer, Elani Streja, Jui-Ting Hsiung, Susan T Crowley, Csaba P Kovesdy, Kamyar Kalantar-Zadeh, Wissam M Kourany
doi : 10.1093/ckj/sfab097
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2548–2555
Transitioning to maintenance hemodialysis (HD) is a vulnerable period for persons with end-stage renal disease (ESRD), punctuated by high rates of depression, hospitalizations and death. Screening for depression during this time may help to improve patient outcomes but formal inquiry has yet to be conducted. Among a national Veteran cohort, we examined whether depression screening in the year prior to HD initiation led to improved outcomes in the year thereafter.
Monitoring anti-PLA2R antibody titres to predict the likelihood of spontaneous remission of membranous nephropathy
Elias Jatem-Escalante, María Luisa Martín-Conde, Esther Gràcia-Lavedan, Ivan D Benítez, Jorge Gonzalez, Laura Colás, Alicia Garcia-Carrasco, Cristina Martínez, Alfons Segarra-Medrano
doi : 10.1093/ckj/sfab116
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2556–2562
In anti-phospholipase A2 receptor (PLA2R) membranous nephropathy (MN) there is controversy whether spontaneous remission (SR) can be predicted using a single titre or by assessing the dynamic changes in anti-PLA2R antibody (ab) titres. The study objective was to identify the optimal dynamics of anti-PLA2Rab titres to predict SR in MN.
Renal diseases secondary to interferon-? treatment: a multicentre clinico-pathological study and systematic literature review
Maxime Dauvergne, David Buob, Cédric Rafat, Marie-Flore Hennino, Mathilde Lemoine, Vincent Audard, Dominique Chauveau, David Ribes, Emilie Cornec-Le Gall, Eric Daugas, Evangéline Pillebout, Vincent Vuiblet, Jean-Jacques Boffa, French Nephropathology Group
doi : 10.1093/ckj/sfab114
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2563–2572
The spectrum of interferon-? (IFN-?)-associated nephropathy remains poorly described and the potential features of this uncommon association remain to be determined.
Outcomes of patients with COVID-19 on kidney replacement therapy: a comparison among modalities in England
Manuela Savino, Shalini Santhakumaran, Katharine M Evans, Retha Steenkamp, Fran Benoy-Deeney, James F Medcalf, Dorothea Nitsch
doi : 10.1093/ckj/sfab160
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2573–2581
Chronic kidney disease is a recognized risk factor of poor outcomes from coronavirus disease 2019 (COVID-19).
The association of glucagon with disease severity and progression in patients with autosomal dominant polycystic kidney disease: an observational cohort study
Martine G E Knol, Bart J Kramers, Ron T Gansevoort, Maatje D A van Gastel on behalf of the DIPAK consortium
doi : 10.1093/ckj/sfab112
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2582–2590
Mammalian target of rapamycin (mTOR) inhibitors and ketogenesis have been shown to ameliorate disease progression in experimental autosomal dominant polycystic kidney disease (ADPKD). Glucagon is known to lower mTOR activity and stimulate ketogenesis. We hypothesized that in ADPKD patients, higher endogenous glucagon is associated with less disease severity and progression.
Advanced lipoprotein parameters could better explain atheromatosis in non-diabetic chronic kidney disease patients
Marcelino Bermudez-Lopez, Hector Perpiñan, Nuria Amigo, Eva Castro, Nuria Alonso, Didac Mauricio, Elvira Fernandez, Jose M Valdivielso on behalf of the NEFRONA Investigators
doi : 10.1093/ckj/sfab113
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2591–2599
Chronic kidney disease (CKD) patients have a high burden of atheromatous cardiovascular disease (ASCVD) not fully explained by traditional lipid parameters. Lipoprotein composition and subclass particle number information could improve ASCVD risk assessment. The objective of this study is to investigate the association of advanced lipoprotein parameters with the risk of atheromatosis in a subpopulation of the NEFRONA study.
Comparison of intradialytic blood pressure metrics as predictors of all-cause mortality
Ka Young Kim, Hae Sang Park, Jin Sun Kim, Shin Young Ahn, Gang Jee Ko, Young Joo Kwon, Ji Eun Kim
doi : 10.1093/ckj/sfab124
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2600–2605
Intradialytic hypotension (IDH) has been reported to be an important prognostic factor in hemodialysis patients. However, a standard definition of IDH has not yet been determined.
Minimal change disease soon after Pfizer-BioNTech COVID-19 vaccination
Seiji Kobayashi, Kazunori Fugo, Kazuto Yamazaki, Hiroyuki Terawaki
doi : 10.1093/ckj/sfab156
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2606–2607
We report on the onset of minimal change disease (MCD) presenting with anasarca after a second dose of the messenger RNA (mRNA)-based Pfizer-BioNTech vaccine against coronavirus disease 2019 (COVID-19). A 75-year-old previously healthy male was admitted with rapidly progressive anasarca and proteinuria of 7.7 g/day following the second dose. A kidney biopsy revealed MCD with nephrotic syndrome. He was treated with intravenous methylprednisolone followed by prednisolone, leading to complete remission after 35 days in the hospital. Since definite causality between the vaccine and MCD remains unclear, awareness of this potential adverse effect of mRNA vaccines is important to determine its true incidence and frequency.
Nephrotic syndrome and acute kidney injury following CoronaVac anti-SARS-CoV-2 vaccine
Suat Unver, Aptullah Haholu, Sukru Yildirim
doi : 10.1093/ckj/sfab155
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2608–2611
A 67-year-old female with Type 2 diabetes mellitus developed nephrotic syndrome within 1 week of receiving the first dose of severe acute respiratory syndrome coronavirus 2 CoronaVac vaccine. A kidney biopsy was consistent with minimal change nephrotic syndrome and treatment was symptomatic with antiproteinuric therapy and improvement in proteinuria. Oedema returned within 1 week of the second dose of CoronaVac. On this occasion, acute kidney injury and massive proteinuria were noted. In kidney biopsy, glomeruli were normal, but tubulointerstitial inflammation consistent with acute tubulointerstitial nephritis was noted. Pulse followed by oral steroids was followed by recovery of kidney function. Proteinuria decreased after initiation of cyclosporine A.
Clinical impact, reactogenicity and immunogenicity after the first CoronaVac dose in dialysis patients: a Phase IV prospective study
José Medina-Pestana, Cinthia Montenegro Teixeira, Marina Pontello Cristelli, Adriano Luiz Amiratti, Silvia Regina Manfredi, Helio Tedesco-Silva, Dimas Tadeu Covas
doi : 10.1093/ckj/sfab146
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2612–2615
Heterogeneous neutralizing antibodies production after SARS-CoV-2 vaccination in haemodialysis patients
Gaspard Lamy, Christelle Vauloup Fellous, Lina Mouna, Mathilde Dargelos, Eve Vilaine, Aymeric Couturier, Panha Chhom, Marie Essig, Ziad A Massy
doi : 10.1093/ckj/sfab171
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2616–2617
Does kidney transplantation influence a form of discrimination for antihypertensive drugs prescriptions?
Lynda Cheddani, Ziad Massy, Sophie Liabeuf
doi : 10.1093/ckj/sfab154
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2618–2619
Complement-activating conditions as potential triggers of pregnancy-related atypical haemolytic uraemic syndrome
Yulia Korotchaeva, Natalia Kozlovskaya, Efim Shifman, Elena Kamyshova, Larisa Bobrova, Kseniya Demyanova, Sergey Moiseev
doi : 10.1093/ckj/sfab163
Clinical Kidney Journal, Volume 14, Issue 12, December 2021, Pages 2620–2622
