Management of autosomal dominant polycystic kidney disease in the era of disease-modifying treatment options

Autosomal dominant polycystic kidney disease (ADPKD) is the reported etiology in 10% of end-stage kidney disease (ESKD) patients and has an estimated prevalence of 12.5 million cases worldwide across all ethnicities. There have been major advancements over the last two decades in understanding the pathogenesis and development of disease-modifying treatment options for ADPKD, culminating in regulatory approval of tolvaptan for ADPKD patients at risk of rapid progression to kidney failure. This review highlights the genetic mutations associated with ADPKD, defines patients at risk of rapid progression to ESKD, and focuses on the management of ADPKD in the era of disease-modifying agents

Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy

Background: There is limited evidence on the association of serum phosphate with mortality in patients receiving continuous renal replacement therapy (CRRT). Objective: To assess the association of serum phosphate with mortality in critically ill patients requiring CRRT for acute kidney injury (AKI). Design: A cohort study. Setting: A tertiary referral hospital in the United States. Patients: Acute kidney injury patients receiving CRRT from 2006 through 2015 in intensive care units. Measurements: (1) Serum phosphate before CRRT and (2) mean serum phosphate during CRRT were categorized into 3 groups; ≤2.4 (hypophosphatemia), 2.5 to 4.5 (normal serum phosphate group), and ≥4.6 (hyperphosphatemia) mg/dL. Methods: Multivariable logistic regression was used to assess the association between serum phosphate and 90-day mortality. Results: A total of 1108 patients were included in this study. Of these, 55% died within 90 days after CRRT initiation. Before CRRT, 3%, 30%, and 66% had hypophosphatemia, normophosphatemia, and hyperphosphatemia, respectively. Before CRRT, both hypophosphatemia and hyperphosphatemia were significantly associated with higher 90-day mortality with the adjusted odds ratio (OR) of 2.22 (95% confidence interval [CI]: [1.03, 4.78]) and 1.62 (95% CI: [1.21, 2.18]), respectively. During CRRT, 3%, 85%, and 12% had mean serum phosphate in hypophosphatemia, normophosphatemia, and hyperphosphatemia range. During CRRT, hyperphosphatemia was significantly associated with higher 90-day mortality with adjusted OR of 2.22 (95% CI: [1.45, 3.38]). Limitations: Single center, observational design, lack of information regarding causes of serum phosphate derangement. Conclusion: Most CRRT patients had hyperphosphatemia before CRRT initiation but maintain normal serum phosphate during CRRT. Before CRRT, hypo- and hyperphosphatemia, and during CRRT, hyperphosphatemia predicted higher mortality. Trial registration: Not registered

HER2 and Helicobacter pylori Status in Resected Gastric Cancers: A Pathological Study of a Gastroenterological Issue

Introduction: Human epidermal growth factor receptor 2 (HER2)/neu is a critical target for gastric carcinoma treatment utilizing trastuzumab. Helicobacter pylori is a well known causative agent of gastric carcinoma. Aim: To study association of HER2/neu expression with the presence of H. pylori infection in resected carcinoma stomach patients. Materials and Methods: A cross-sectional study of 85 gastrectomies received in the department from January 2010 to September 2014 was done. HER2/neu was studied using Immunohistochemistry (IHC) and Giemsa stain was used to detect presence of H. pylori. Chi-square test and Fisher’s exact test were used, to test the correlation between the various parameters. A p-value <0.05 was considered significant. Results: Our study population included 67 (78.8%) males, and 18 (21.2%) females, ranging from 22 to 84 years, mean 57.68±12.12 years. HER-2 expression, graded from 0 to 3± was correlated with location, histologic type, grade, local invasion, metastasis to lymph nodes, TNM tumour staging and H. pylori infection, graded from 0 to 3+ using Giemsa stain. HER2/neu 3+ was observed in intestinal type of gastric cancer (5/55, 9%) only. Scores 2+ and 3+ were more common in H. pylori-negative patients (5/26, 19.2%) than H. pylori-positive patients (4/59, 6.8%) (p=0.02). TNM stage, extent of local invasion and lymph node metastasis in intestinal gastric carcinomas correlated significantly with HER2/neu expression. H. pylori was present in 59 (69.4%) and absent in 26 (30.6%). Conclusion: H. pylori-negative gastric cancer showed significant immunophenotypic HER2/neu overexpression i.e., H. pylori might protect against HER2 overexpression that correlated significantly with higher TNM stages of intestinal-type gastric cancer. In contrast, H. pylori infection correlated significantly with Lymph-Vascular Invasion (LVI) but was pN1/2+, thereby diminishing prognostic importance. H. pylori induced intestinal metaplasia was not significantly associated with intestinal-type gastric cancer

sj-pdf-1-jva-10.1177_11297298231159251 – Supplemental material for Global hemodialysis vascular access care: Three decades of evolution*

Supplemental material, sj-pdf-1-jva-10.1177_11297298231159251 for Global hemodialysis vascular access care: Three decades of evolution* by Mohamed Hassanein, Yeshwanter Radhakrishnan, Nora Hernandez Garcilazo, Si Yuan Khor, Sayna Norouzi, Evamaria Anvari, Roman Shingarev and Tushar J Vachharajani in The Journal of Vascular Access</p

sj-docx-1-jva-10.1177_11297298231159251 – Supplemental material for Global hemodialysis vascular access care: Three decades of evolution*

Supplemental material, sj-docx-1-jva-10.1177_11297298231159251 for Global hemodialysis vascular access care: Three decades of evolution* by Mohamed Hassanein, Yeshwanter Radhakrishnan, Nora Hernandez Garcilazo, Si Yuan Khor, Sayna Norouzi, Evamaria Anvari, Roman Shingarev and Tushar J Vachharajani in The Journal of Vascular Access</p

Characteristics of Kidney Recipients of High Kidney Donor Profile Index Kidneys as Identified by Machine Learning Consensus Clustering

Background:&nbsp;Our study aimed to characterize kidney transplant recipients who received high kidney donor profile index (KDPI) kidneys using unsupervised machine learning approach. Methods:&nbsp;We used the OPTN/UNOS database from 2010 to 2019 to perform consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 8935 kidney transplant recipients from deceased donors with KDPI &ge; 85%. We identified each cluster&rsquo;s key characteristics using the standardized mean difference of &gt;0.3. We compared the posttransplant outcomes among the assigned clusters. Results:&nbsp;Consensus cluster analysis identified 6 clinically distinct clusters of kidney transplant recipients from donors with high KDPI. Cluster 1 was characterized by young, black, hypertensive, non-diabetic patients who were on dialysis for more than 3 years before receiving kidney transplant from black donors; cluster 2 by elderly, white, non-diabetic patients who had preemptive kidney transplant or were on dialysis less than 3 years before receiving kidney transplant from older white donors; cluster 3 by young, non-diabetic, retransplant patients; cluster 4 by young, non-obese, non-diabetic patients who received dual kidney transplant from pediatric, black, non-hypertensive non-ECD deceased donors; cluster 5 by low number of HLA mismatch; cluster 6 by diabetes mellitus. Cluster 4 had the best patient survival, whereas cluster 3 had the worst patient survival. Cluster 2 had the best death-censored graft survival, whereas cluster 4 and cluster 3 had the worst death-censored graft survival at 1 and 5 years, respectively. Cluster 2 and cluster 4 had the best overall graft survival at 1 and 5 years, respectively, whereas cluster 3 had the worst overall graft survival. Conclusions:&nbsp;Unsupervised machine learning approach kidney transplant recipients from donors with high KDPI based on their pattern of clinical characteristics into 6 clinically distinct clusters