An approach using autologous natural regulatory T cells (nTregs) appears safe and feasible for minimizing immune suppression after kidney transplantation, according to a phase I/IIa clinical trial in The British Medical Journal.
The researchers report an initial experience with their “in-house” autologous CD4+CD25+FoxP3+ nTreg product in 11 living kidney donor transplant recipients. The nTreg product was administered 7 days posttransplant in a single intravenous dose of 0.5, 1.0, or 2.5 to 3.0 × 106 cells/kg. After treatment, the investigators attempted stepwise tapering of standard triple immunosuppression to low-dose tacrolimus monotherapy up to week 48.
More than one-fourth of patients with COVID-19 admitted to a New York City hospital in the early weeks of the pandemic had acute kidney injury (AKI), reports a study in the American Journal of Nephrology.
The retrospective analysis included 469 patients with COVID-19 admitted to the study hospital over a five-week period in March–April 2020. The hospital, which served a high-poverty area of Brooklyn, was among the centers with the most COVID-19 admissions. The study focused on the incidence of in-hospital AKI among COVID-19 patients, defined by The Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline characteristics and
An intensive urate-lowering strategy consisting of verinurad and febuxostat reduces albuminuria in patients with type 2 diabetes and hyperuricemia, reports a phase 2 trial in the American Journal of Kidney Diseases.
The multicenter trial enrolled 60 adult patients with type 2 diabetes; albuminuria, urine albumin-to-creatinine ratio (UACR) 30 to 3500 mg/g; and hyperuricemia, serum urate (sUA) concentration 6.0 mg/dL or greater. Mean age was 61.5 years, 70% of patients were men, and about one-half had an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. The study excluded patients with stage 4 or 5 chronic
Recent years have brought little progress toward reducing disparities in access to predialysis nephrology care among racial/ethnic minority patients in the United States, concludes a study in JAMA Network Open.
The study included data on more than 1 million adults who initiated maintenance dialysis between 2005 and 2015, drawn from the US Renal Data System. The patients were 57.2% male; mean age was 62.4 years. Race/ethnicity was white in 54.6% of patients, Black in 27.8%, Hispanic in 14.0%, and Asian in 3.6%. Multivariable logistic regression analyses were performed to analyze trends in racial/ethnic disparities in receipt of at
Some groups of patients with clinically localized kidney tumors and severe chronic kidney disease (CKD) are at high risk of adverse outcomes after partial nephrectomy (PN), according to a study in The Journal of Urology.
The retrospective study included 62 patients with clinically localized kidney tumors (T1-T2/N0M0) and stage 4 CKD who underwent PN at the Cleveland Clinic between 1999 and 2015. The patients were 44 men and 18 women, median age 67 years. Comorbid diseases were common, including hypertension in 94% of patients, cardiovascular disease in 53%, and diabetes in 32%. Median estimated glomerular filtration rate (eGFR)
When more than one potential living kidney donor comes forward, it is more cost-effective to evaluate them all at once, rather than one at a time, reports a study in Kidney International.
The researchers created a simple decision tree to assess the economic impact of simultaneous versus sequential evaluation of multiple potential living kidney donors. In many transplant programs, donors are evaluated one at a time, to avoid the costs of performing unnecessary evaluations.
The costs of evaluation were indeed higher when two candidates were evaluated simultaneously: $1266 (Canadian dollars) higher than sequential evaluation. However, simultaneous evaluation was
Primary aldosteronism is more common than previously recognized, and prevalence rises with severity of hypertension, reports a study in the Annals of Internal Medicine.
The cross-sectional study included participants from studies at four US medical centers: 298 with normotension, 115 with stage 1 hypertension, 203 with stage 2 hypertension, and 408 with resistant hypertension. All underwent an oral sodium suppression test, regarded as a gold-standard confirmatory test for primary aldosteronism. The study definition of “biochemically overt” primary aldosteronism was a urinary aldosterone level greater than 12 µg/24 h.
In all four blood pressure categories, participants with higher renin-independent
Higher consumption of fruit and vegetables and whole-grain foods is associated with a lower risk of type 2 diabetes, according to a pair of studies in the British Medical Journal.
A prospective study of fruit and vegetable intake included 9754 individuals with incident type 2 diabetes, as well as a subcohort of 13,662 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study. The study included measurement of plasma biomarkers—vitamin C and carotenoids—of fruit and vegetable intake.
In a multivariable adjusted model, participants with higher plasma vitamin C had a lower risk of type 2 diabetes:
Rates of peritonitis related to peritoneal dialysis (PD) vary significantly between countries, and between facilities within countries, reports a study in the American Journal of Kidney Diseases.
The researchers analyzed data on 7051 adult PD patients at 209 facilities in seven countries, drawn from the prospective, observational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Peritonitis rates were assessed at the country and facility levels, and associations with selected facility practices were assessed.
The data included 2272 episodes of peritonitis: crude rate 0.28 episodes per patient-year. Peritonitis rates varied within countries, exceeding 0.50 per patient-year at 10% of
Disparities in waitlisting for kidney transplantation among African American patients are independent of medical factors, and even of social determinants of health, reports a study in Transplantation.
The prospective cohort study included 1055 white or African American patients referred for kidney transplant evaluation in 2013 and followed up to 2018. At baseline, a wide range of potential predictors of transplant outcomes were assessed: demographic, medical/health, culturally related, and psychosocial factors, along with transplant-related knowledge, concerns, and preferences. All of these factors were evaluated for association with waitlisting for kidney transplantation.
At initial evaluation, African American patients were younger,