Defining Kidney Health Dimensions and their Associations with Adverse Outcomes in Persons with Diabetes and Chronic Kidney Disease.

Background: Individual kidney tubule biomarkers are associated with risks for chronic kidney disease (CKD) progression and mortality in persons with diabetes. Integrating multiple kidney biomarkers using a latent variable method of exploratory factor analysis could define distinct dimensions of kidney health, and their associations with adverse outcomes.

Methods: We conducted a factor analysis of 17 candidate urine and plasma biomarkers in 1,256 participants with diabetes and estimated glomerular filtration rate (eGFR) <60ml/min/1.

The p.K56M variant and risk of heart failure in chronic kidney disease: the Chronic Renal Insufficiency Cohort study.

Background: Intercellular adhesion molecule-1 (ICAM-1) is a cell-surface protein that facilitates inflammation through leucocyte adhesion. Approximately 35% of Black individuals carry at least one copy of an missense variant (rs5491; p.K56M), which has been associated with increased risk of heart failure (HF) with preserved ejection fraction (HFpEF).

Sarcopenia may increase cisplatin toxicity in bladder cancer patients with borderline renal function.

Objectives: To assess whether the effect of sarcopenia on neoadjuvant chemotherapy (NAC) toxicity is modified by borderline renal function (estimated glomerular filtration rate [eGFR] 40-65 mL/min) and whether sarcopenia and borderline renal function are independently associated with NAC toxicity risk.

Patients And Methods: All patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy (RC) between 2010 and 2022, with available cross-sectional imaging prior to NAC initiation, were included. Skeletal mass was measured from axial computed tomography images obtained at the level of the L3 vertebral body, using Aquarius Intuition software.

Surrogate End Points in Apolipoprotein L1 - Associated Kidney Disease : Evaluation in Three Cohorts.

Key Points: Apolipoprotein L1 (APOL1) high-risk genotype had higher risk of 3-year GFR-related surrogate end points and long-term kidney failure than those with the low-risk genotype. No consistent difference in surrogate–clinical outcome associations by APOL1 genotype, supporting the use of surrogates in APOL1 kidney disease.

Background: Surrogate end points for the clinical outcome of kidney failure have been accepted by the US Food and Drug Administration.

Virtual Nephron: Evaluation of a Novel Virtual Reality Educational Tool.

Introduction: Recent technological advancements allowed the development of engaging technological tools. Using ASN funding from the ASN, we developed a 3D Virtual Reality (VR) physiology course entitled DiAL-Neph (Diuretic Action and eLectrolyte transport in the Nephron). We hereby present its evaluation.

Clonal hematopoiesis of indeterminate potential is associated with reduced risk of cognitive impairment in patients with chronic kidney disease.

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) and dementia disproportionately burden patients with chronic kidney disease (CKD). The association between CHIP and cognitive impairment in CKD patients is unknown.

Methods: We conducted time-to-event analyses in up to 1452 older adults with CKD from the Chronic Renal Insufficiency Cohort who underwent CHIP gene sequencing.

Renoprotective Effects of Metabolic Surgery Versus GLP1 Receptor Agonists on Progression of Kidney Impairment in Patients with Established Kidney Disease.

Objective: To examine the renoprotective effects of metabolic surgery in patients with established chronic kidney disease (CKD).

Background: The impact of metabolic surgery compared with glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with established CKD has not been fully characterized.

Methods: Patients with obesity (body mass index ≥30 kg/m 2 ), type 2 diabetes, and baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.

Cardiac Surgery Outcomes in Patients Receiving Hemodialysis Versus Peritoneal Dialysis.

Rationale & Objective: We sought to compare outcomes of patients receiving dialysis after cardiothoracic surgery on the basis of dialysis modality (intermittent hemodialysis [HD] vs peritoneal dialysis [PD]).

Study Design: This was a retrospective analysis.

Setting & Participants: In total, 590 patients with kidney failure receiving intermittent HD or PD undergoing coronary artery bypass graft and/or valvular cardiac surgery at Cleveland Clinic were included.

Factors Associated With Non-vaccination for Influenza Among Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.

Rationale & Objective: Vaccination for influenza is strongly recommended for people with chronic kidney disease (CKD) due to their immunocompromised state. Identifying risk factors for not receiving an influenza vaccine (non-vaccination) could inform strategies for improving vaccine uptake in this high-risk population.

Study Design: Longitudinal observational study.

Risk for Chronic Kidney Disease Progression After Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort Study.

Background: Prior studies associating acute kidney injury (AKI) with more rapid subsequent loss of kidney function had methodological limitations, including inadequate control for differences between patients who had AKI and those who did not.

Objective: To determine whether AKI is independently associated with subsequent kidney function trajectory among patients with chronic kidney disease (CKD).

Design: Multicenter prospective cohort study.

IgA nephropathy.

Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis in the world. The etiology is unknown but a dysregulated T-cell immune response to viral, bacterial, and food antigens activating mucosal plasma cells to produce polymeric IgA has been proposed. No serological test exists to diagnosis IgAN.

C3 glomerulopathy.

C3 glomerulopathy (C3G) is a rare kidney disease that causes kidney dysfunction as a result of dysregulation of the complement system alternate pathway (AP). C3G encompasses 2 separate disorders, C3 glomerulonephritis and dense deposit disease. The presentation and natural history is variable and kidney biopsy is needed to confirm the diagnosis.

Probing the Association between Acute Kidney Injury and Cardiovascular Outcomes.

Background: Patients hospitalized with AKI have higher subsequent risks of heart failure, atherosclerotic cardiovascular events, and mortality than their counterparts without AKI, but these higher risks may be due to differences in prehospitalization patient characteristics, including the baseline level of estimated glomerular filtration rate (eGFR), the rate of prior eGFR decline, and the proteinuria level, rather than AKI itself.

Methods: Among 2177 adult participants in the Chronic Renal Insufficiency Cohort study who were hospitalized in 2013-2019, we compared subsequent risks of heart failure, atherosclerotic cardiovascular events, and mortality between those with serum creatinine-based AKI (495 patients) and those without AKI (1682 patients). We report both crude associations and associations sequentially adjusted for prehospitalization characteristics including eGFR, eGFR slope, and urine protein-creatinine ratio (UPCR).

Urine Sediment Examination: Comparison Between Laboratory-Performed Versus Nephrologist-Performed Microscopy and Accuracy in Predicting Pathologic Diagnosis in Patients with Acute Kidney Injury.

Key Points: A nephrologist is more likely to recognize the presence of pathologic casts and dysmorphic red blood cells. Nephrologist-performed urine sediment analysis is also highly accurate in diagnosing acute tubular injury or glomerulonephritis when compared with kidney biopsy.

Introduction: Automated urine technology is becoming the standard for urinalysis microscopy.

Excess risk of cardiovascular events in patients in the United States vs. Japan with chronic kidney disease is mediated mainly by left ventricular structure and function.

While patients receiving dialysis therapy in the United States are more likely to develop cardiovascular disease (CVD) than those in Japan, direct comparisons of patients with predialysis chronic kidney disease (CKD) are rare. To study this, we compared various outcomes in patients with predialysis CKD using data from the Chronic Renal Insufficiency Cohort (CRIC) and CKD Japan Cohort (CKD-JAC) studies and determined mediators of any differences. Candidate mediators included left ventricular (LV) indices assessed by echocardiography.

Resistant hypertension: A stepwise approach.

Resistant hypertension can be challenging to manage, but a stepwise approach to diagnosis, evaluation, and treatment can lead to better blood pressure control. In this article, we review the definition and prevalence of resistant hypertension and its diagnostic workup and management, including lifestyle modifications, drugs, and experimental interventional therapies.

Renal Genetics Clinic: 3-Year Experience in the Cleveland Clinic.

Rationale & Objective: There has been an increasing demand for the expertise provided by a renal genetics clinic. Such programs are limited in the United States and typically operate in a genomics research setting. Here we report a 3-year, real-world, single-center renal genetics clinic experience.

Dysnatremias, Mortality, and Kidney Failure in CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.

Rationale & Objective: Dysnatremias have been associated with an increased risk of mortality in the chronic kidney disease (CKD) population. Our objective is to identify the prevalence of and risk factors associated with dysnatremias in a CKD population and assess the association of dysnatremias with kidney failure and mortality among patients with CKD enrolled in the Chronic Renal Insufficiency Cohort Study.

Study Design: Analysis of prospective cohort study.

Comparison of CT acquired cardiac valvular calcification scores in hemodialysis and peritoneal dialysis patients undergoing open heart surgery.

Study Objective: Data is scarce regarding which dialysis modality portends more severe cardiac valvular calcification (CVC). Our aim was to compare the degree of CVC in hemodialysis (HD) and peritoneal dialysis (PD) patient cohorts prior to open heart surgery (OHS) using a CT calcium score.

Design Setting And Participants: Dialysis patients who underwent OHS at our institution from 2009 to 2019 and who had pre-surgical cardiac CT were included in our study.

Estimated Glomerular Filtration Rate Using Cystatin C is a More Sensitive Marker for Kidney Dysfunction in Nonweight-bearing Individuals.

Purpose: Individuals with neuromuscular disorders and neurogenic lower urinary tract dysfunction are commonly nonweight-bearing with lower lean muscle mass than the general population. We sought to compare estimated glomerular filtration rate equations that include creatinine, cystatin C, or both, in nonweight-bearing individuals and matched ambulatory controls.

Materials And Methods: Records were reviewed for individuals with serum creatinine (Cr) and cystatin C (Cys) and diagnosis consistent with nonweight-bearing status, and matched ambulatory controls.

Aspirin for Primary and Secondary Prevention of Mortality, Cardiovascular Disease, and Kidney Failure in the Chronic Renal Insufficiency Cohort (CRIC) Study.

Rationale And Objective: Chronic kidney disease is a risk enhancing factor for cardiovascular disease (CVD) and mortality, and the role of aspirin use is unclear in this population. We investigated the risk and benefits of aspirin use in primary and secondary prevention of CVD in the Chronic Renal Insufficiency Cohort Study.

Study Design: Prospective observational cohort.