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Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges
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Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 25 October 2024 | Viewed by 4693

Special Issue Editor

Dr. Botond Csiky

E-Mail Website
Guest Editor
2nd. Department of Internal Medicine and Nephrology, Diabetes Center, Clinical Center, Medical School, University of Pécs, 7624 Pécs, Hungary
Interests: chronic kidney disease progression; cardiovascular risk factors; diabetes mellitus; obesity; kidney transplantation; survival; pathophysiology of CKD; hemodialysis; peritoneal dialysis; metabolic and mineral bone disease

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is a devastating condition that has reached epidemic levels due to the aging of the population and the increasing prevalence of diabetes mellitus, hypertension and obesity. The global estimated prevalence of CKD is 13.4%. It has a substantial impact on morbidity and mortality: the Global Burden of Diseases study estimated that 1.2 million deaths were due to kidney failure and 18 million years of life lost from cardiovascular diseases were directly attributable to CKD. Even in early stages, CKD is associated with increased cardiovascular morbidity and mortality. Managing CKD-associated cardiovascular risk and the preservation of kidney function can improve outcomes and can be achieved through non-pharmacologic strategies and CKD-targeted pharmacological interventions. Despite different management strategies, the progression of CKD to end-stage kidney disease (ESKD) currenty remains inevitable.

In this Special Edition, we aim to focus on novel strategies that delay CKD progression and improve the life expectany of CKD patients by reducing cardiovascular morbidity and mortality and by better management of ESKD in dialysed and transplanted patients.

The Editor of this Special Edition invites you to submit relevant papers for consideration and expeditious publication after a vigorous peer review. We particularly welcome papers discussing novel concepts in the era of fighting ESKD. All original investigations, including both clinical and basic science studies, as well as meta-analyses and review papers will be considered.

Dr. Botond Csiky
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic kidney disease progression
  • cardiovascular risk factors
  • diabetes mellitus
  • obesity
  • kidney transplantation
  • survival
  • pathophysiology of CKD
  • hemodialysis
  • peritoneal dialysis
  • metabolic and mineral bone disease

Published Papers (6 papers)

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Research

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15 pages, 4555 KiB  
Article
Are Platelet-Related Parameters Prognostic Predictors of Renal and Cardiovascular Outcomes in IgA Nephropathy?
by Balázs Sági, Tibor Vas, Botond Csiky, Judit Nagy and Tibor József Kovács
J. Clin. Med. 2024, 13(4), 991; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13040991 - 08 Feb 2024
Viewed by 560
Abstract
Background: IgA nephropathy (IgAN) is associated with chronic inflammation. Platelet-related parameters, such as the platelet (PLT) count, platelet-to-albumin ratio (PAR), and platelet-to-lymphocyte ratio (PLR), were examined as potential prognostic indicators for renal and cardiovascular (CV) outcomes in IgAN. We were interested in whether [...] Read more.
Background: IgA nephropathy (IgAN) is associated with chronic inflammation. Platelet-related parameters, such as the platelet (PLT) count, platelet-to-albumin ratio (PAR), and platelet-to-lymphocyte ratio (PLR), were examined as potential prognostic indicators for renal and cardiovascular (CV) outcomes in IgAN. We were interested in whether platelet-related parameters are risk factors for ESKD and CV events in IgAN patients. Methods: In a monocentric retrospective study, 124 IgAN patients were divided into two groups based on the cut-off value of the PAR. All-cause mortality, major CV events, and end-stage renal disease were the primary combined endpoints. Secondary endpoints, such as CV or renal endpoints, were also analyzed separately. Results: The patients’ mean age was 43.7 ± 13.5 years, and the follow-up time was 124 ± 67 months. The K-M curve showed that the PLR, PAR, and PLT were strongly associated with primary combined (p = 0.002, p = 0.004, p = 0.001) and renal outcomes (p < 0.001, p < 0.001, p < 0.001), but not with CV outcomes in IgAN. However, when combined with left ventricular hypertrophy (LVH) or metabolic syndrome (MetS), the PAR was found to be a significant predictor of both primary (p < 0.001, p < 0.001) and secondary outcomes (p = 0.001 and p = 0.038; p = 0.001 and p = 0.015). Additionally, the PLR correlated with albuminuria (r = −0.165, p = 0.033) and LVH (r = −0.178, p = 0.025), while PLT correlated with eGFR (r = 0.158, p = 0.040). Conclusions. Elevated PARs and PLRs may predict progression to end-stage kidney disease, but in combination with LVH and MetS, they were related to CV events in IgAN. The determination of PARs and PLRs can be useful and cost-effective parameters for assessing both cardiovascular and renal risks in IgAN. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges)
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12 pages, 1748 KiB  
Article
Interpretation of LDH Values after Kidney Transplantation
by Zoltán Sándor, Dorottya Katics, Ádám Varga, Károly Kalmár Nagy and Péter Szakály
J. Clin. Med. 2024, 13(2), 485; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13020485 - 16 Jan 2024
Viewed by 727
Abstract
Kidney transplantation is the gold-standard therapy for end-stage renal disease. However, in the early postoperative period following allograft kidney transplantation, insufficient graft function presents a diagnostic challenge to clinicians. Ischemic damage to the graft and/or an early autoimmune rejection may cause a decrease [...] Read more.
Kidney transplantation is the gold-standard therapy for end-stage renal disease. However, in the early postoperative period following allograft kidney transplantation, insufficient graft function presents a diagnostic challenge to clinicians. Ischemic damage to the graft and/or an early autoimmune rejection may cause a decrease in function. Ischemic damage is a benign and transient condition, while acute immune rejection requires immediate therapy. A kidney graft ultrasound may produce a false negative result, and graft biopsy is invasive and slow to return results. Serum lactate dehydrogenase (LDH) is under examination as a possible tool for differential diagnosis between ischemic damage and immune rejection. Herein, we analyze the continuous lab results of four patients in the early post-transplantation period, showing patterns correlating with different clinical outcomes and prognoses. In our experience, a persistent elevated LDH accompanies ischemic damage. Immune rejection was, however, associated with a decrease in LDH. Hemodialysis was not a confounding factor, while packed red blood cell transfusion caused severe diagnostic problems. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges)
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12 pages, 1465 KiB  
Article
Acute Vascular Response to Hemodialysis as Measured by Serum Syndecan-1 and Endothelin-1 Levels as Well as Vascular Stiffness
by Balázs Sági, Szilárd Kun, Rita Klaudia Jakabfi-Csepregi, Endre Sulyok and Botond Csiky
J. Clin. Med. 2023, 12(23), 7384; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12237384 - 29 Nov 2023
Cited by 1 | Viewed by 680
Abstract
Background: Chronic hemodialysis (HD) patients have a very high cardiovascular risk. Acute vascular changes during dialysis mediated by factors of the endothelium may have a crucial role in this. The aim of this article is to study the acute vascular changes during HD. [...] Read more.
Background: Chronic hemodialysis (HD) patients have a very high cardiovascular risk. Acute vascular changes during dialysis mediated by factors of the endothelium may have a crucial role in this. The aim of this article is to study the acute vascular changes during HD. Methods: In 29 consecutive chronic HD patients (age: 65.6 ± 10.4 years), their pre-, mid-, and post-HD plasma syndecan-1 (SDC-1) and endothelin-1 (ET-1) levels were measured. Applanation tonometry was performed before HD. Results: Their SDC-1 levels increased during HD (p = 0.004). Males had higher ET-1 levels. The patients were divided into two groups based on their pre-HD pulse wave velocity (PWV): PWV ≥ 12 m/s and PWV < 12 m/s. The pre-HD and mid-HD SDC-1 levels were higher in the group with a PWV ≥ 12 m/s (10.174 ± 2.568 vs. 7.928 ± 1.794 ng/mL, p = 0.013, and 10.319 ± 3.482 vs. 8.248 ± 1.793 ng/mL, p = 0.044, respectively). The post-HD ET-1 levels were higher in the patient group with a PWV ≥ 12 m/s (10.88 ± 3.00 vs. 8.05 ± 3.48 pg/l, p = 0.027). Patients with a PWV ≥ 12 m/s had higher pre-HD peripheral and aortic systolic blood pressures (p < 0.05). The total cholesterol correlated with the SDC-1 decrease during HD (r = 0.539; p = 0.008). The pre-, mid-, and post-HD SDC-1 correlated with ultrafiltration (r = 0.432, p = 0.019; r = 0.377, p = 0.044; and r = 0.401, p = 0.012, respectively). Conclusion: SDC-1 and ET-1 contribute to the vascular changes observed during HD, and they have correlations with some cardiovascular risk factors. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges)
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Review

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29 pages, 889 KiB  
Review
Fibrosis in Chronic Kidney Disease: Pathophysiology and Therapeutic Targets
by Allison B. Reiss, Berlin Jacob, Aarij Zubair, Ankita Srivastava, Maryann Johnson and Joshua De Leon
J. Clin. Med. 2024, 13(7), 1881; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13071881 - 25 Mar 2024
Viewed by 1036
Abstract
Chronic kidney disease (CKD) is a slowly progressive condition characterized by decreased kidney function, tubular injury, oxidative stress, and inflammation. CKD is a leading global health burden that is asymptomatic in early stages but can ultimately cause kidney failure. Its etiology is complex [...] Read more.
Chronic kidney disease (CKD) is a slowly progressive condition characterized by decreased kidney function, tubular injury, oxidative stress, and inflammation. CKD is a leading global health burden that is asymptomatic in early stages but can ultimately cause kidney failure. Its etiology is complex and involves dysregulated signaling pathways that lead to fibrosis. Transforming growth factor (TGF)-β is a central mediator in promoting transdifferentiation of polarized renal tubular epithelial cells into mesenchymal cells, resulting in irreversible kidney injury. While current therapies are limited, the search for more effective diagnostic and treatment modalities is intensive. Although biopsy with histology is the most accurate method of diagnosis and staging, imaging techniques such as diffusion-weighted magnetic resonance imaging and shear wave elastography ultrasound are less invasive ways to stage fibrosis. Current therapies such as renin-angiotensin blockers, mineralocorticoid receptor antagonists, and sodium/glucose cotransporter 2 inhibitors aim to delay progression. Newer antifibrotic agents that suppress the downstream inflammatory mediators involved in the fibrotic process are in clinical trials, and potential therapeutic targets that interfere with TGF-β signaling are being explored. Small interfering RNAs and stem cell-based therapeutics are also being evaluated. Further research and clinical studies are necessary in order to avoid dialysis and kidney transplantation. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges)
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Other

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9 pages, 784 KiB  
Brief Report
Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care
by Francesca K. Martino, Giulia Fanton, Fiammetta Zanetti, Mariarosa Carta, Federico Nalesso and Giacomo Novara
J. Clin. Med. 2024, 13(4), 1144; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13041144 - 18 Feb 2024
Viewed by 453
Abstract
Background: We conducted a retrospective epidemiological study about the prevalence of stage 5 chronic kidney disease (CKD) in a high-income district, comparing some demographic characteristics and outcomes of those patients who had nephrological consultations and those who had not. Results: In a district [...] Read more.
Background: We conducted a retrospective epidemiological study about the prevalence of stage 5 chronic kidney disease (CKD) in a high-income district, comparing some demographic characteristics and outcomes of those patients who had nephrological consultations and those who had not. Results: In a district of 400,000 adult subjects in 2020, 925 patients had an estimated glomerular filtration rate (eGFR) under 15 mL/min and CKD. In the same period, 747 (80.4%) patients were assessed by nephrologists, while 178 (19.6%) were not. Age (88 vs. 75, p < 0.0001), female gender (66.3% vs. 47%, p < 0.001), and eGFR (12 vs. 9 mL/min, p < 0.001) were significantly different in the patients assessed by a nephrologist as compared those who did not have nephrological care. Furthermore, unfollowed CKD patients had a significantly higher death rate, 83.1% versus 14.3% (p < 0.0001). Conclusions: About 20% of ESKD patients did not receive a nephrologist consultation. Older people and women were more likely not to be referred to nephrology clinics. Unfollowed patients with stage 5 CKD had a significantly higher death rate. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges)
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9 pages, 843 KiB  
Opinion
Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine
by Francesca K. Martino, Giacomo Novara, Federico Nalesso and Lorenzo A. Calò
J. Clin. Med. 2024, 13(1), 41; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13010041 (registering DOI) - 21 Dec 2023
Cited by 1 | Viewed by 890
Abstract
In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to [...] Read more.
In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice. Full article
(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges)
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