Concerning the related factors for kidney disease and high chronic kidney disease (CKD) progression risk, there is still a lack of study in the adult-onset type 1 diabetes mellitus (T1DM) patients from China.

Four hundred and eighty-one adult-onset T1DM patients from the Guangdong T1DM translational medicine study were included. Logistic regression analysis (Forward: LR) was utilized to identify glycemic- and nonglycemic-related factors associated with moderate albuminuria, severe albuminuria, mildly reduced estimated glomerular filtration rate (eGFR), decreased eGFR, and high CKD progression risk, and to calculate the odds ratio (OR) and 95% confidence interval (CI).

High CKD progression risk was positively associated with males (OR = 3.13, 95% CI:1.20 - 8.14, p = 0.019), duration of T1DM (OR =1.13, 95% CI:1.05 - 1.21, p < 0.001), triglyceride (OR =1.52, 95% CI:1.11 - 2.08, p = 0.008), and systolic blood pressure (SBP) (OR =1.04, 95% CI:1.02 - 1.07, p = 0.001), and negatively correlated with BMI (OR = 0.80, 95% CI:0.68 - 0.95, p = 0.011). Meanwhile, moderate albuminuria, severe albuminuria, mildly reduced eGFR and decreased eGFR had different each of glycemic- and nonglycemic-related factors.

Hyperglycemia, hypertension, hyperuricemia, and BMI may be associated with different stages of kidney disease in adult-onset T1DM patients. Early-stage adult-onset T1DM patients with male, low BMI, prolonged diabetes duration, and comorbid hypertension and dyslipidemia should undergo a thorough evaluation of albuminuria and renal function to detect those at high CKD progression risk, who should be timely transferred to the nephrology specialty to receive professional treatment for kidney disease.

This review highlights studies published in the last 18 months focusing on sex dimorphism in clinical and preclinical areas related to chronic kidney disease (CKD).

Hypertension, cardiorenal disease, hormone exposure, heat stress and dietary intake are all risk factors with sexually dimorphic effects thus contributing differentially to the development of chronic kidney disease. In CKD, GFR decline and cardiovascular mortality are more pronounced in males. Females have higher STEMI related in hospital mortality. When on dialysis, females have higher cardiovascular events rate. Males develop anemia and hyperparathyroidism earlier. Hyperphosphatemia is more prevalent in males. Vitamin D deficiency is associated with CKD in males only. Males are more likely to develop severe sarcopenia. The renoprotective effects of estrogen or estrogen agonists are mediated in part through GPER. ET-1 dual antagonism offset the action of GPER. ET-1 dual antagonism abolished the sex differences in acclimation to high salt. Sodium transport and oxygen consumption across the different renal segments is sexually dimorphic. Sexually dimorphic gene expression is mostly seen in the proximal tubules and is under androgen control.

The above findings emphasize the need to systematically include female models in preclinical and clinical research which will improve clinical management and allow for development and implementation of precision medicine tailored to sex.

Studies concerning the effect of co-exposure to melamine and phthalates on kidney function in children are rare. Thus, this study examines the above-mentioned relationship and their sex-different effect. Whether the exposure of the two chemicals from their mothers, when children were in the womb during the third trimester, affected renal injury markers in children afterwards is also examined. This study was from Taiwan Maternal and Infant Cohort Study cohort established in October 2012 to enroll third-trimester pregnant mothers up to May 2015. Their offspring were subsequently recruited between 2016 and 2020 as our study children. One-spot urine specimens were collected from both pregnant mothers (2012-2015) and study children (2016-2020) for the simultaneous measurement of melamine and 11 phthalate metabolites. Daily intakes of melamine and five phthalates, including DEHP (di-2-ethylhexylphthalate), DiBP (Dibutyl phthalate), DnBP (Di-n-butyl phthalate), BBzP (Butyl benzyl phthalate), and DEP (Diethyl phthalate), were estimated using a creatinine excretion-based model in both study children and their mothers. Two early markers of renal injury, microalbumin and N-acetyl-beta-D-glucosaminidas (NAG), were measured in urine samples of study children (2016-2020). A total of 552 eligible children were studied, with a mean age of 4 years. We found that boys in the highest quartile of estimated melamine intake (≥0.68 μg/kg/day) had significantly higher urine ACR levels and in the highest quartile of estimated phthalate intake of DEHP (≥5.36 μg/kg/day), DEP (≥0.89 μg/kg/day), and DiBP (≥1.19 μg/kg/day) had significantly higher urine NAG levels when compared to the combined three lowest quartile ones as comparison groups. No significant associations were found between their mothers' phthalates and melamine intake during the third trimester and urine ACR and NAG in children. We conclude that children (particularly boys) with high co-exposure of melamine and certain phthalate chemicals among children have increased early markers of kidney injury.

The triglyceride-glucose (TyG) index has emerged as a surrogate marker for insulin resistance and is associated with the incidence and progression of chronic kidney disease (CKD) in patients with type 2 diabetes.

Data from the ACCORD trial were used. The Cox proportional hazards model was employed to calculate hazard ratios (HRs), while generalized additive mixed models were used to capture the non-linear eGFR slope in each group. The primary outcome was CKD.

9360 participants were included in this study, divided into tertiles based on their TyG index, with 3 119, 3 121, and 3 120 individuals in T1 (low), T2 (medium), and T3 (high), respectively. After a median follow-up of 4 years, 1 229 cases of CKD (13.30 %) occurred. Among women rather than men, CKD risk increased across ascending TyG index groups (adjusted HR for T3, Model 3, 1.46 [95 % CI, 1.13-1.88]) (p for interaction = 0.03). Additionally, longitudinal analysis revealed a rapid eGFR decline in women in the T3 group (-4.79 mL/min/1.73 m2) than the T1 group (-3.07 mL/min/1.73 m2, p < 0.05), but not in men.

A higher TyG index was associated with elevated CKD risk and accelerated eGFR decline, particularly in women.

Patients with chronic kidney disease are at high and very high risk of cardiovascular disease. As estimated glomerular filtration rate declines, the incidence and severity of risk factors, complications, and atherosclerotic cardiovascular events increase. In this scenario, tailored assessment is the key to evaluate the severity of chronic kidney disease and estimate cardiovascular disease risk. Personalized stratification differentiates patients with chronic kidney disease without diabetes mellitus or established atherosclerotic cardiovascular disease in their management and beneficial treatment. Exercise intensity assessment and prescription is suggested to propose specific and safe recommendations for physical activity, training, and cardiac rehabilitation. Programs are based on a combination of endurance and resistance exercise and should be adapted to very high risk chronic kidney disease and haemodialysis patients and after kidney transplantation. Appropriate management of cardiovascular complications in these patients, such as risk factors, heart failure, arrhythmias, and coronary artery disease, is essential to ensure the best treatment and improve the prognosis. Therefore, we propose a critical and comprehensive review to suggest how to manage patients with chronic kidney disease in clinical practice and, specifically, with regard to cardiovascular risk assessment, exercise training prescription, and management of complications.

Previous research has established associations between polycyclic aromatic hydrocarbons (PAHs), heavy metals (HMs), and kidney damage. However, the impact of PAHs and HMs mixtures on chronic kidney disease (CKD), particularly gender differences, remains unclear.

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) data spanning 2003-2016 to investigate the association between PAHs and HMs with CKD, employing weighted logistic regression analyses. This exploration was complemented by gender-stratified restricted cubic spline (RCS) methods. Multiple mixture analysis models were applied to evaluate the combined effects of PAHs and HMs on kidney damage. Mediation analyses were conducted to explore the mediating effects of inflammation, oxidative stress, and aging biomarkers.

The results of the mixture analysis indicated a significant positive correlation between PAHs and HMs with the CKD risk in the general population, with cadmium (Cd), lead (Pb), and 2-naphthalene (2-NAP) contributing prominently to this relationship. These findings were consistent in the female subgroup. However, no effect of co-exposure to PAHs and HMs on CKD and urine albumin-to-creatinine ratio (UACR) was observed in the male subgroup. PAHs and HMs mixtures with CKD risk mediated by the biological age (BA) and phenotypic age (PA), with mediation proportions of 44.1 % and 61.4 %, respectively.

The study reveals a significant association between PAHs and HMs mixtures and CKD in the US population, with females being particularly susceptible. Biological aging emerges as a primary mediator in this relationship. Further prospective cohort studies are required to validate these findings.

Background/Objectives: Individuals with chronic kidney disease often face significant physical and clinical challenges, such as muscle weakness, fatigue, and reduced cardiorespiratory capacity, that impact their quality of life. Physical activity has emerged as an effective intervention to counteract these effects, with clinical guidelines recommending exercise as a standard treatment for kidney transplant recipients. The aim of this study was to assess pretransplant physical activity levels in a cohort of transplant patients and analyze their relationships with cardiovascular risk factors. Methods: A cross-sectional, analytical, and correlational study was conducted from September 2020 to June 2022 with a sample of 122 kidney transplant recipients assessed before kidney transplantation. Sociodemographic data, anthropometric data, comorbidities, renal replacement therapy types, and clinical and analytical data were collected from the patients' clinical records. Physical activity was assessed via the International Physical Activity Questionnaire. Results: The average time spent waiting for transplantation was 423 ± 405 days, which was longer (387 ± 524) in the group of those under 65 years than in those over 65 years (194 ± 256) (p = 0.010). The median energy expenditure was 1742 (IQR = 1719) METs. In addition, 15.6% of the participants reported inactivity. Men reported higher physical activity levels (median: 2076 METs/week; IQR: 2037) than women did (median: 1386 METs/week; IQR: 1238). A higher level of physical activity was found in non-dialysis patients, overweight patients, and those with a history of stroke. A significant positive correlation was found between physical activity levels and serum urea. Conclusions: Increased physical activity levels were observed in men and in participants under 65 years of age. Patients with cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, overweight and obesity, reported lower activity levels, whereas those with a prior history of cerebrovascular accidents engaged in more physical activity. This study highlights the importance of assessing physical activity and promoting exercise for chronic kidney disease patients awaiting kidney transplantation. Further research is needed to explore the evolution of physical activity in this population and its impact post-transplantation.

Sex differences have a significant role on epidemiology of cardiovascular complications in chronic kidney disease. Among hemodialysis patients, central blood pressure (BP) levels and increased arterial stiffness parameters are independent predictors of cardiovascular and all-cause- mortality.

To examine the potential differences in ambulatory central BP and arterial stiffness parameters between male and female hemodialysis patients.

A total of 129 male and 91 female hemodialysis patients were included in this analysis. All participants underwent 48-h ambulatory BP monitoring with Mobil-O-Graph-NG; indices of central hemodynamics (SBP, DBP and pulse pressure), wave reflection (augmentation pressure (AP) and augmentation index (AIx)) and pulse wave velocity (PWV) were estimated.

Age, dialysis vintage and history of major comorbidities did not differ between men and women. Male patients had higher 48-h cSBP (124.7±15.7 vs. 119.8±16.7 mmHg, p=0.027) and 48-h DBP (83.7±12.2 vs. 77.5±11.9 mmHg, p<0.001) compared to female patients; relevant differences were also evident during the 44-h (excluding hemodialysis), 1st 24-h and 2nd 24-h periods and the corresponding daytime and nighttime periods of the recording. Central pulse pressure did not differ between groups. Regarding wave reflection parameters, AP, AIx, and AIx(75) were significantly lower in males versus females during the 48-h (AIx, 25.6±8.2 vs. 32.3±8.6 mmHg, p<0.001), 44-h, 1st and 2nd 24-h and also during respective daytime and nighttime periods. The two groups displayed similar PWV during all studied intervals (48-h PWV, 9.6±1.9 vs 9.7±2.1 m/s, p=0.612).

Male hemodialysis patients present with higher levels of ambulatory central BP but significantly lower levels of AP, AIx and AIx(75) than females. PWV does not differ between sexes.

BACKGROUNDMen with chronic kidney disease (CKD) experience faster kidney function decline than women. Studies in individuals undergoing sex hormone therapy suggest a role for sex hormones, as estimated glomerular filtration rate (eGFR) increases with feminizing therapy and decreases with masculinizing therapy. However, effects on measured GFR (mGFR), glomerular and tubular function, and involved molecular mechanisms remain unexplored.METHODSThis prospective, observational study included individuals initiating feminizing (estradiol and antiandrogens; n = 23) or masculinizing (testosterone; n = 21) therapy. Baseline and 3-month assessments included mGFR (iohexol clearance), kidney perfusion (para-aminohippuric acid clearance), tubular injury biomarkers, and plasma proteomics.RESULTSDuring feminizing therapy, mGFR and kidney perfusion increased (+3.6% and +9.1%, respectively; P < 0.05) without increased glomerular pressure. Tubular injury biomarkers, including urine neutrophil gelatinase-associated lipocalin, epidermal growth factor (EGF), monocyte chemoattractant protein-1, and chitinase 3-like protein 1 (YKL-40), decreased significantly (-53%, -42%, -45%, and -58%, respectively). During masculinizing therapy, mGFR and kidney perfusion remained unchanged, but urine YKL-40 and plasma tumor necrosis factor receptor 1 (TNFR-1) increased (+134% and +8%, respectively; P < 0.05). Proteomic analysis revealed differential expression of 49 proteins during feminizing and 356 proteins during masculinizing therapy. Many kidney-protective proteins were positively associated with estradiol and negatively associated with testosterone, including proteins involved in endothelial function (SFRP4, SOD3), inflammation reduction (TSG-6), and maintaining kidney tissue structure (agrin).CONCLUSIONSex hormones influence kidney physiology, with estradiol showing protective effects on glomerular and tubular function, while testosterone predominantly exerts opposing effects. These findings emphasize the role of sex hormones in sexual dimorphism observed in kidney function and physiology and suggest new approaches for sex-specific precision medicine.TRIAL REGISTRATIONDutch Trial Register (ID: NL9517); ClinicalTrials.gov (ID: NCT04482920).

Cystinuria is the most common inheritable cause of kidney stone disease, with males exhibiting a higher susceptibility than females. However, the cellular origin and underlying mechanisms of sex differences in cystinuria remain elusive. This study aims to investigate the mechanism using Slc3a1 knockout mice. We found that male mice lacking the Slc3a1 gene exhibited more severe stone formation and renal injuries, unaffected by double knockout of another sex-dependent-expressed cystine transporter Slc7a13 or orchidectomy procedure. Further investigations revealed aberrant mitochondrial functions as the primary factor contributing to the severity of cystinuria in Slc3a1 knockout male mice. Mechanistically, higher SLC3A1 levels in male kidneys could enhance mitochondrial functions through modulation of mitochondrial NAD+ uptake primarily in proximal tubule cells. Supplementation with an NAD+ precursor rescued the sex differences caused by Slc3a1 knockout. Our studies uncover the crucial role of Slc3a1 in mitochondrial functions and provide novel insights into potential interventions for sexual dimorphism of cystinuria.

Why more males than females start kidney replacement therapy (KRT) is incompletely understood. Acute kidney injury (AKI) is a possible factor underlying sex differences in chronic kidney disease (CKD) progression, but previous studies regarding this have been inconclusive. We investigated sex differences in the association between AKI and CKD progression in UK nephrology care.

This cohort study uses UK Renal Registry data. Adults with CKD stages 4/5 in 14 nephrology centres in England were followed from January 2018 to December 2021. We compared their baseline characteristics by sex and calculated cause specific hazard ratio (HR) for outcomes: time to AKI stage 2/3 (AKI2/3), initiation of chronic KRT and death by all causes.

A total of 15 547 patients were included. Fewer females (43.8%) were seen in renal centres than males (56.2%). During follow-up, 3909 (25.1%) AKI2/3 episodes, 3510 (22.6%) KRT initiations, and 7293 (46.9%) deaths were observed. Males were more likely than females to experience each outcome: AKI2/3 [adjusted HR 1.39, 95% confidence interval (CI) 1.31-1.49], KRT initiation (adjusted HR 1.51, 95% CI 1.39-1.65) and death (adjusted HR 1.11, 95% CI 1.05-1.16). Adjustment for AKI2/3 did not change the association between being male and the higher risk of KRT initiation.

Being male was associated with a higher risk of AKI2/3, KRT initiation and death. Fewer females appeared in nephrology care data than expected from population CKD prevalence. However, no evidence was found to support the hypothesis that AKI2/3 explains the higher KRT initiation rates seen amongst males.

According to the WHO and domestic statistics, chronic diseases are one of the most common causes of disability in the Polish society, as well as in the world. The presence of the disease significantly reduces the quality of life (QoL), and gender is a factor determining the level of perceived health-related quality of life (HR-QoL), but there are no cross-sectional studies considering several disease entities. Ranking of diseases determining HR-QoL of patients in 13 different groups of disease entities by gender, assessed using the standardized tool for assessing the quality of life SF-36. A cross-sectional study was carried out in a group of 7620 patients. The criterion for inclusion in the study was a chronic disease and the lack of other comorbidities. 13 groups of disease entities were included in the study. The SF-36 questionnaire was used to assess HR-QoL. The analysis used hierarchical cluster analysis to identify disease groups that similarly impact HR-QoL levels. Logistic regression was used to assess the odds of experiencing better quality of life (OR) in the SF-36 dimensions, taking into account gender and Cohen's d was used as a measure of effect size. In the group of people burdened with chronic diseases, a better average quality of life is more often recorded in the group of men. The most significant differences in QoL are noted in thyroid (TD), renal and urinary (UD), gastrointestinal (DS) diseases. More often, the poorer quality of life of women is recorded in TD and DS (p < 0.05), in UD, the poorer quality of life is declared by men (p < 0.05). Gender significantly determines the level of perceived HR-QoL. Planning of the treatment and convalescence process in patients should consider gender differences and factors affecting HR-QoL. The ranking of diseases that most strongly reduce HR-QoL in Index Life Quality indicated that among women, diseases in the following order reduce HR-QoL most strongly: diseases of the nervous system (NS), cardiovascular disease (CVD) and cancers (CD). In the men's group, the order was as follows: the most HR-QoL-lowering diseases were CD, NS and CVD.

Previous studies have established a correlation between the microbiome-derived metabolite trimethylamine N-oxide (TMAO) and decreased renal function, but with great heterogeneity. Moreover, population-based evidence remains scarce, particularly in Chinese populations. We designed a meta-analysis and a population-based cross-sectional study in China to examine the associations between TMAO and chronic kidney disease (CKD). In meta-analysis, among 2125 pooled subjects with 1240 controls and 885 CKD patients, a significant association was observed between TMAO and CKD, with a standardized mean difference of - 0.93 (95% confidence interval: - 1.11, - 0.75). Meta-regression analysis identified gender, age, and body mass index (BMI) as significant heterogeneity factors. In our population-based study of 5584 subjects with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 from Sijing community, 100 developed CKD in 2 years. We matched 195 controls by age and gender from the 5484 non-CKD subjects. Male subjects and alcohol consumers exhibited a lower risk of CKD with adjusted odds ratio (OR) of 0.471 (P < 0.05) and 0.320 (P < 0.05), respectively. When comparing subjects in the lowest tertile of TMAO, adjusted OR reached to 1.243 (P > 0.05) for those in the middle and 2.123 (P < 0.05) in the highest tertile (P for trend < 0.05). TMAO demonstrated a moderate capacity to distinguish CKD from non-CKD subjects (AUC = 0.614, P < 0.01). Our findings indicate TMAO is significantly associated with the risk of CKD, and suggest age, gender, and BMI may confound the relationship between TMAO and CKD. KEY POINTS: • Subjects with elevated TMAO levels have an increased risk of CKD. • TMAO demonstrates a moderate capacity to distinguish CKD from non-CKD cases. • Age, gender and BMI may confound the relationship between TMAO and CKD.

Young adults starting kidney replacement therapy (KRT) during childhood and reaching their 18th birthday (i.e. adult survivors of childhood KRT) form a challenging population of interest to nephrologists treating adults, as during this period there will be a transition to adult renal centres. Nonetheless, few studies have focused on the epidemiology of KRT in this group. We aimed to provide an update on these patients' characteristics, treatment history, and graft and patient survival, to report their 5-year prognosis and expected remaining lifetime.

Data on KRT patients reaching their 18th birthday in 2008-19 were collected from 21 European countries/regions providing individual patient data to the European Renal Association (ERA) Registry. Patient characteristics and treatment trajectories were examined before and after turning 18 years old. Kaplan-Meier and Cox proportional hazards regression were used for patient and graft survival analyses.

In total, 2944 patients were included. The proportion of adult survivors initiating KRT at a very young age (0-4 years) and undergoing pre-emptive kidney transplantation increased. Unadjusted 5-year patient survival was 96.9% [95% confidence interval (CI) 96.2-97.5]. Dialysis patients had a higher risk of death than kidney transplant recipients [adjusted hazard ratio 5.44 (95% CI 3.34-8.86)]. Between ages 18 and 23 years, about 21% of the adult survivors lost their kidney transplant and 34% of the dialysis patients continued this treatment. Compared with the general population, life expectancy for 18-year-old kidney transplant and dialysis patients was 17 and 40 years shorter, respectively.

Life expectancy of 18-year-old kidney transplant recipients was lower compared with the general population, yet having a functioning kidney graft at age 18 years resulted in better outcomes than being on dialysis. Nevertheless, between ages 18 and 23 years, about one-fifth of the kidney grafts failed and one-third of the patients remained on dialysis.

Data regarding uninterrupted oral anticoagulation in patients with chronic kidney disease (CKD) during catheter ablation for left atrial arrhythmias is limited. This study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulants (DOAC) compared with uninterrupted phenprocoumon in patients with CKD undergoing left atrial catheter ablation.

We conducted a retrospective single-center study of patients who underwent left atrial catheter ablation between 2016 and 2019 with underlying chronic kidney disease (glomerular filtration rate (GFR) between 15 and 45 ml/min). The primary objective of this study was to investigate whether direct oral anticoagulant (DOAC) therapy or warfarin presents a superior safety profile in patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation. We compared periprocedural complications (arteriovenous fistula, aneurysm, significant hematoma (> 5 cm)) and/or bleeding (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, other bleeding, stroke) between patients receiving either uninterrupted DOAC or warfarin therapy. Secondary analysis included patient baseline characteristics as well as procedural data. A total of 188 patients (female n = 108 (57%), mean age 75.3 ± 8.1 years, mean GFR 36.8 ± 6 ml/min) were included in this study. Underlying arrhythmias were atrial fibrillation (n = 104, 55.3%) and atypical atrial flutter (n = 84, 44.7%). Of these, n = 132 patients (70%) were under a DOAC medication, and n = 56 (30%) were under phenprocoumon. Major groin complications including pseudoaneurysm and/or AV fistula occurred in 8.9% of patients in the phenprocoumon group vs. 11.3% of patients in the DOAC group, which was not statistically significant (p = 0.62). Incidence of cardiac tamponade (2.3% vs. 0%; p = 0.55) and stroke (0% vs. 0%) were low in both DOAC and phenprocoumon groups with similar post-procedural drops in hemoglobin levels (1.1±1 g/dl vs 1.1±0.9 g/dl; p = 0.71).

The type of anticoagulation had no significant influence on bleeding or thromboembolic events as well as groin complications in this retrospective study. Despite observing an increased rate of groin complications, the uninterrupted use of DOAC or phenprocoumon during left atrial catheter ablation in patients with CKD appears to be feasible and effective.

Chronic kidney disease (CKD) monitoring and cardiovascular risk management are essential in reducing disease progression and cardiovascular events. This study aimed to understand CKD monitoring and management practices in Australian primary care.

We conducted a retrospective, population-based cohort study of adults who attended general practices participating in MedicineInsight between 1 January 2011 and 30 June 2020 and met diagnostic criteria for CKD. Care quality was assessed in the 18-months following identification of CKD. Core monitoring was defined as at least one assessment of all the following measurements: blood pressure, estimated glomerular filtration rate (eGFR), urine albumin creatinine ratio (UACR), lipid profile, and HbA1c in patients with diabetes. Cardiovascular risk management comprised medication prescription (ACEi/ARB and statin), blood pressure target achievement and LDL cholesterol <2 mmol/L. Modified Poisson regression models adjusted for socio-demographic and clinical characteristics were used to identify patient factors associated with completion of monitoring and medication prescription.

CKD was identified in 140,780 patients, of which 34.2% received core monitoring within 18 months of CKD identification. Measurement of the individual components of the core monitoring outcome varied: blood pressure (88.7%), eGFR (86.0%), UACR (41.1%), lipids (70.9%) and HbA1c (85.5%). ACEi/ARB were prescribed in 65.2% of the cohort and 54.4% were prescribed a statin. Blood pressure targets of <140/90 mmHg and <130/80 mmHg were achieved in 57.9% and 29.3% of patients, respectively. LDL target of <2 mmol/L was achieved in 38.8% of patients. Older age, comorbid diabetes and hypertension were associated with a greater likelihood of monitoring and medication prescription.

In this large, population-based study, we observed substantial variation in CKD risk monitoring and the management of cardiovascular risk in patients with CKD. We identified several priority areas for CKD management in primary care including need for improvement in albuminuria monitoring.

University of New South Wales Scientia Program and Boehringer Ingelheim Eli Lilly Alliance.

This study analyzes the trends in the burden of chronic kidney disease due to type 2 diabetes (CKD-T2D) in China from 1990 to 2021, evaluates variations in risk factors, and projects the disease burden through 2036.

Estimates of prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for CKD-T2D were retrieved along with their 95% uncertainty intervals (UIs). Age-period-cohort analysis was used to assess burden trends from 1990 to 2021, identify risk factor population attributable fractions (PAFs), and project the burden through 2036.

In 2021, there were 20 911 520 CKD-T2D cases in China, with an age-standardized prevalence rate (ASPR) of 1053.92 per 100 000, an incidence rate (ASIR) of 23.07, an age-standardized mortality rate (ASMR) of 5.72, and an age-standardized DALY rate (ASDR) of 122.15. Although the overall burden showed a slow decline from 1990 to 2021, incidence continued to rise. The 2021 data revealed a marked age effect, with the burden rising with age. Period effects also contributed to an increased risk, with metabolic risk factors such as high fasting plasma glucose and BMI contributing the most. Projections suggest a decline in mortality and DALYs by 2036, while incidence will keep increasing.

Despite declines in ASMR and ASDR, CKD-T2D incidence and cases continue to rise, especially among males and the elderly. This increasing burden is driven by aging and metabolic risk factors. Early screening, education, and risk management are essential for addressing CKD-T2D in China.

Dietary risks are increasingly reported as a cause of chronic kidney disease (CKD). However, the trends in the burden of CKD attributable to dietary risks have yet to be fully elucidated.

This study extracted two major indicators related to CKD caused by dietary risks from the Global Burden of Disease (GBD) database for the years 1990 to 2021, including deaths and disability-adjusted life years (DALYs). It used estimated annual percentage change (EAPC) and percentage change to assess the trends in the burden of CKD caused by dietary risks. The relationship between Socio-demographic Index (SDI) and disease burden was also further analyzed. Additionally, we utilized the contemporary age-period-cohort model from NORDPRED to project future burden of CKD attributable to dietary risks.

In 2021, globally, the number of deaths due to CKD caused by dietary risks was 317,010, and the number of DALYs was 7,971,281, approximately 2-3 times that of 1990, and it was expected to continue to rise before 2040. The global death rates and DALY rates of CKD related to dietary risks had increased, with EAPCs of 0.63 (95% CI: 0.57 to 0.69) and 0.39 (95% CI: 0.35 to 0.42), respectively. From a gender perspective, men were more likely to suffer from CKD due to dietary risks. From an age pattern perspective, in 2021, the number of deaths due to CKD caused by dietary risks peaked among men aged 70-74 and women aged 85-89. Additionally, the highest number of DALYs due to CKD caused by dietary risks was observed among men and women aged 65-69. In terms of socioeconomic factors, from 1990 to 2021, as the SDI increased, the age-standardized death rates and DALY rates due to CKD caused by dietary risks generally decreased. Among the seven dietary habits related to dietary risks, low vegetable intake, low fruit intake, and high sodium intake had the greatest impact.

In summary, over the past 32 years, the burden of CKD attributable to dietary risks has rapidly increased globally, and it is expected to continue rising until 2040. Therefore, interdisciplinary actions involving education, policy, and healthcare should be taken to mitigate this growing trend.

Younger women have a slower progressive loss of kidney function than age-matched men and the sex advantage diminishes after menopause, suggesting a role for female hormones in the development of kidney diseases.

To examine the relationships of numerous reproductive factors and exogenous hormone use with long-term risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in women.

A total of 260 108 women without prevalent CKD and ESRD were included. The relationships of various reproductive factors and exogenous hormone use with incident CKD and ESRD were assessed, with multivariable adjustment for potential confounders.

During a median of ∼12.5 years of follow-up, 8766 CKD and 554 ESRD cases were identified. Younger age at first live birth, hysterectomy or bilateral oophorectomy before age 50 years, menopausal before age 45 years, and menopausal hormone therapy initiated before age 50 years was associated with a higher risk of CKD. The relationships of these factors with ESRD were generally consistent with those for CKD. Each 5-year increment in menopausal age was associated with an 11% lower risk of CKD (hazard ratio [HR] = 0.89; 95% CI, 0.87-0.91) and a 13% lower risk of ESRD (HR = 0.87; 95% CI, 0.79-0.95). Each 5-year delay in starting menopausal hormone therapy was associated with a 13% lower risk of CKD (HR = 0.87; 95% CI, 0.84-0.90) and a 15% lower risk of ESRD (HR = 0.85; 95% CI, 0.73-0.99).

Several reproductive characteristics reflecting shorter cumulative exposure to endogenous estrogen or premature exposure to exogenous hormones are associated with a greater risk of CKD and ESRD in women, supporting a potential role of female hormones in renal pathophysiology.

Quantifying the number and proportion of people with kidney failure (KF) who receive conservative kidney management is vital for health care system benchmarking and planning. It is not easy to ascertain this value precisely at the population level, but we can approximate it using information from different data sources to estimate the proportion of patients with advanced kidney disease who die without receiving dialysis or a transplant and should receive conservative kidney management.

To approximate the proportion of people with KF in Ontario, Canada, who die without receiving kidney replacement therapy.

A review of unpublished provincial renal agency reports of 3 retrospective population-based cohorts combined with clinical interpretation.

The 3 cohorts of people were: 1. those who died between January 1, 2013 and December 31, 2017, with an estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m2 and no evidence of receiving kidney replacement therapy; 2. those who initiated outpatient maintenance dialysis or received a preemptive transplant in the same period; and 3. those with a sustained low eGFR ≤ 10 mL/min/1.73 m2 between April 1, 2015 and March 31, 2018, and were followed for 1 year to determine if they started dialysis. In this last cohort, patients whose kidney function improved (evidence of an eGFR > 10 mL/min/1.73 m2) or who received a transplant during follow-up were excluded from the analysis.

The 3 cohorts were derived at ICES and used linked health care databases for the province of Ontario, Canada. In 2016, Ontario had a population of about 14 million people. Two nephrologists reviewed the data to provide the clinical approximation.

There were 1891 individuals with KF who died without kidney replacement (the no KRT cohort). The median (25th, 75th percentile) eGFR prior to death was 7 (5, 8) mL/min/1.73 m2. During the same period, 13 511 individuals started dialysis or received a preemptive kidney transplant (the KRT cohort). There were 7259 individuals in the low eGFR cohort; over the following year, 66% started dialysis, 20% died without dialysis, and 14% were alive without starting dialysis. The clinical approximation is that between 13 and 16% of people with KF die without receiving kidney replacement therapy.

The data reports lacked certain information to inform the clinical approximation. There was no information on the conversations health professionals had with people about kidney replacement therapy, any decisions made about receiving conservative care, or the circumstances that preceded death without kidney replacement therapy.

After reviewing data from the 3 cohorts, we clinically approximate that 1 in 6 people with KF in Ontario, Canada, die without receiving dialysis and should receive conservative kidney management.

Chronic Kidney Disease (CKD) represents a significant global health challenge, with Indonesia experiencing the highest surge in End-Stage Kidney Disease (ESKD) prevalence over the past decade. Kidney registries are essential for reporting health outcomes, evaluating healthcare services, advocating for policy change, and informing health infrastructure development. Survival rates in ESKD patients undergoing hemodialysis (HD) are a critical outcome measure. However, there is a lack of survival analysis data for ESKD patients receiving HD in Indonesia.

This study aims to assess the one-year survival rate of ESKD patients undergoing HD in Indonesia, while examining risk factors associated with survival, including age, gender, CKD etiology, and dialysis adequacy.

This analytical observational study employed a retrospective cohort design, utilizing patient data from Indonesia Renal Registry between 2016 and 2019. Kaplan-Meier survival curves were generated, and Log rank test was applied to assess the significance of survival differences across subgroups based on age, gender, CKD etiology, and dialysis adequacy.

A total of 122,449 ESKD patients on HD were analyzed, with a mean age of 52 years; majority (55.5%) were male, and hypertensive kidney disease was the leading cause of CKD (43.7%). The overall one-year survival rate was 91.5% (95% CI: 91.3-91.6). Survival decreased significantly with advancing age (p < 0.01), and female patients exhibited lower survival rates compared to males (p < 0.01). Patients with diabetic nephropathy had the lowest survival rate among CKD etiologies (p < 0.01). Dialysis adequacy, assessed in 11,633 patients, revealed that 69.2% had a Kt/V below 1.8. Those with inadequate dialysis had significantly lower survival rates (p=0.00015).

The one-year survival rate for ESKD patients undergoing HD in Indonesia is 91.5%. Increased age, female, diabetic nephropathy as the underlying CKD etiology, and inadequate dialysis adequacy are associated with reduced survival rates.

Chronic kidney disease (CKD) continues to represent a significant public health concern, with both prevalence and incidence rates on the rise globally. Therefore, the study employed the Global Burden of Disease (GBD) database to investigate the global burden of CKD from 1990 to 2021.

This study utilized data from the GBD 2021. Join-point regression models were developed for the estimation of the average annual percentage change (AAPC) in the prevalence and mortality rates of CKD. Subsequently, stepwise multiple linear regression analysis was conducted to examine the trends in disability adjusted life years (DALYs) and DALYs rate for CKD across diverse populations between 1990 and 2021. Moreover, the influence of age, gender, and socio-demographic index (SDI) on the burden of CKD among patients from 1990 to 2021 was examined. Furthermore, the projection of the burden of CKD from 2022 to 2032 was also conducted.

The AAPC for prevalence and mortality rates across the entire period spanning 1990 to 2021 was 0.92 and 2.66, respectively. A notable increase in the DALYs and DALYs rate for CKD was demonstrated over time, indicating a growing CKD burden on society since 1990. Furthermore, the DALYs rates for CKD were lowest in the 5-9 year age group for both genders, rising thereafter with age. Notably, the DALYs rate for CKD was higher in males than in females. Regions with higher SDI, generally exhibited a lower burden of CKD, while less developed regions, demonstrated the opposite pattern. Additionally, the age-standardized prevalence and mortality rates for CKD would be projected to increase to 8,773.85 and 21.26 per 100,000 individuals, respectively, by 2032.

The research indicated a gradual increase in the global prevalence and mortality rates of CKD over time, which might prompt the formulation of more efficient health policies to alleviate its burden.

In chronic kidney disease (CKD), prevalence differences between sexes have been reported. While biological factors have been investigated, research on sociocultural factors is scarce. We explore the extent gender-related characteristics associate with, and contribute to, CKD prevalence in women and men in a multi-ethnic population. Cross-sectional analyses were performed on data of 12,221 women and 8,930 men aged 18-70 years across six ethnic groups from the HELIUS Study. Using age-, education-, and ethnicity adjusted Poisson regression, we determined associations between time spent on housework; primary earner status; employment status; and occupational segregation, and CKD. Population attributable fractions estimated the contribution to CKD and the extent traditional CKD risk factors explained these contributions. In women, associations with CKD were found for doing little housework, part-time work, and unemployment. In men, primary-earnership and unemployment were associated. Associations aligned across ethnic groups. Estimated contributions ranged from 1.8% for women doing little housework to 26.5% for part-time employment and 12.1% for unemployment to 37.5% for primary-earnership in men, and were hardly explained by traditional risk factors. In our study, gender-related characteristics are associated with CKD in women and men across ethnic groups. Contributions to population prevalence may hardly be explained by CKD risk factors. The prevalence of chronic kidney disease (CKD) differs between women and men. We explored to what extent the risk may be associated with sociocultural expectations for women and men. We analysed data of 12,221 women and 8,930 men from six different ethnic groups. CKD was more common in all women who did little housework, worked part-time or were unemployed, and in men whose financial contribution was equal to their partners or who were unemployed. The higher risk of CKD was not explained by a higher occurrence of known risk factors. In future, specific policies or targeted interventions may be developed to reduce the risk of CKD overall and in certain population subgroups.

Studies have shown an association of chronic kidney disease with heart failure (HF); however, this association has not been adequately examined in postmenopausal women, who are at heightened risk of both chronic kidney disease and HF. Additionally, association with HF subtypes is not well characterized.

Incident HF was defined as first hospitalization for acute decompensated HF, obtained by self-reported outcomes followed by physician adjudication through review of hospital records. Chronic kidney disease was defined using estimated glomerular filtration rate (eGFR). Restricted cubic splines tested the association of eGFR with incident overall HF, and HF with reduced ejection fraction (HFrEF) and preserved EF (HFpEF). Cox proportional hazards regression models evaluated the multivariable-adjusted association of eGFR categories with incident HF and its subtypes. The primary analysis included 23 309 women with 11 814 eGFR ≥90, 10 191 eGFR between 60 and 89, 1048 eGFR between 45 and 59 and 256 eGFR <45 mL/min per 1.73 m2. For overall HF, HFrEF and HFpEF, there was a stepwise increase in risk for incident HF with declining eGFR category. Associations were stronger for HFpEF (hazard ratio [HR], 2.80 [95% CI, 2.36-3.32]) than for HFrEF (HR, 2.18 [95% CI, 1.66-2.87]) for eGFR <45 as compared with eGFR ≥90. Heterogeneity of the HF subdistributions (HFpEF versus HFrEF) was significant (P=0.017).

Kidney dysfunction is associated with incident HF in postmenopausal women. Although lower eGFR is associated with both incident HFrEF and HFpEF, the association is stronger with HFpEF.

URL: https://clinicaltrials.gov; Unique Identifier: NCT00000611.

Uremic cardiomyopathy, characterized by diastolic dysfunction, left ventricular hypertrophy (LVH), and fibrosis, is a common cardiovascular complication of chronic kidney disease (CKD). Men are at a higher risk for cardiovascular and renal diseases, compared to age-matched, pre-menopausal women. We aimed to investigate the influence of sex on the severity of uremic cardiomyopathy through the characterization of functional and molecular indices of myocardial remodeling in a rat model. CKD was induced by a 5/6 nephrectomy in 9-week-old male and female Wistar rats. Serum and urine tests, transthoracic echocardiography, left ventricular (LV) histology, and quantitative reverse transcription polymerase chain reaction (RT-qPCR) were performed at week 8 or 9. Moreover, LV alterations were also tested in permeabilized cardiomyocytes (CMs) by force measurements and Western immunoblotting. CKD resulted in the development of a more severe uremic cardiomyopathy in male rats-including LVH, LV diastolic dysfunction, and fibrosis-than in female rats, where only LVH was observed. A uremic cardiomyopathy was also associated with a decrease in maximal Ca2+-activated force (Fmax) in CMs of male rats. Additionally, increases in CM Ca2+-independent passive stiffness (Fpassive) and decreases in cardiac myosin-binding protein C (cMyBP-C) phosphorylation levels were significantly larger in male than female rats. In conclusion, a uremic cardiomyopathy involved cardiac remodeling in both sexes. Nevertheless, male rats exhibited more pronounced signs of macroscopic and microscopic alterations than their female counterparts, illustrating a sex-dependent component of uremic cardiomyopathy.

Most epidemiological studies of hidradenitis suppurativa (HS) have described homogeneous patient populations.

To characterize demographics, modifiable health behaviors, and comorbidities of HS patients within a diverse cohort.

A retrospective cross-sectional study of 13,130 HS patients within a health care system was conducted.

A female sex bias of ∼3:1 in all racial/ethnic subgroups was observed. Black/African American (AA) patients had a lower age at HS diagnosis than White patients (37.1 years vs 39.4 years, P < .001). A higher proportion of Black/AA females than White females with HS had body mass index in the obese range (69.9% vs 56.5%; P = .03). In contrast, fewer Black/AA males with HS had a body mass index in the obese range compared to White males (51.4% vs 61.0%; P < .001). More Black/AA patients than White patients with HS had congestive heart failure (odds ratio (OR) = 2.10, confidence interval (CI) = 1.19-3.78; P < .05), chronic pulmonary disease (OR = 1.34; CI = 1.02-1.78; P < .05), diabetes with chronic complication (OR = 1.73; CI = 1.16-2.60; P < .05), renal disease (OR = 2.66; CI = 1.67-4.34; P < .05), and Charlson comorbidity index score ≥4 (OR = 1.67; CI = 1.09-2.58; P < .05). Furthermore, male patients were more likely than female patients to have renal disease (OR = 2.62; CI = 1.66-4.14; P < .05).

A single-center study.

Subgroups of HS patients had significant differences in demographics, risk factors, and comorbid conditions.

Epidemiological data show that chronic kidney disease (CKD) is more prevalent among females than males but the prevalence of women in dialysis is lower, as is their representation in nephrology trials. We aimed to test whether sex distribution varies at nephrology referral, inclusion in a trial, or at the starting of dialysis.

We evaluated patients' characteristics at the time of the first consultation in the Unit for the Care of Advanced CKD (UIRAV), at the inclusion in an observational study (PRO-RE-RE-PRO) and at the beginning of dialysis. Patient and renal survival analysis was performed in the pre-dialysis phase and after dialysis start. Reasons for denying participation to the proposed study and causes of death or withdrawal from follow-up and dialysis were likewise examined.

During the period 2017-2023, 866 patients were referred to the UIRAV, 59% males and 41% females. Female patients were older, had lower comorbidity and were referred at the same eGFR than males. The same male/female proportion was observed in patients included in the PRO-RE-RE-PRO study and at dialysis start. Survival was significantly higher in females. Overall, distribution across sex remained stable over time.

Males and females are referred at similar eGFR levels, which appears to be the main reason for seeking nephrology care. Afterward, the ratio between males and females remains stable, suggesting that if a sex-selection bias exists, it should be sought before the first nephrology referral. However, further studies are needed to ensure that health equity is respected across sexes.

Obesity-related kidney disease (ORKD) has recently become a global health issue. Metformin is widely used in patients with type 2 diabetes with concomitant obesity, but its effects on ORKD are insufficiently understood. Accumulation of lipid species including sphingolipids has been reported to disrupt glomerular functions and drive progression of chronic kidney disease. The present study aimed to test the hypothesis that metformin could exert beneficial effects on ORKD, which may be associated with changes in renal lipidomics. Male Sprague-Dawley rats were divided into normal chow diet (ND) group or high-fat diet (HFD)-fed group. After 8 weeks, HFD-fed group was subdivided into metformin treatment (HFD-Met) group and control (HFD-C) group for an additional 8 weeks. Sphingolipids and phospholipids in renal cortex were measured by targeted lipidomics. Compared with ND group, HFD-C group developed histopathological features of ORKD. Metformin alleviated dyslipidemia, renal dysfunction, proteinuria, glomerular hypertrophy, podocyte damage, and renal fibrosis in HFD-fed rats. Renal sphingolipid analysis showed elevations of total ceramide, sphingosine, glucosylceramide, and galactosylceramide levels in HFD-C versus ND group. Specific species, such as ceramide d18:1/22:0, glucosylceramide d18:1/20:0, and galactosylceramide d18:1/16:0, which were positively associated with oxidative stress and insulin resistance, were reduced in HFD-Met versus HFD-C group. Renal phospholipid analysis showed increased levels of total phosphatidylcholine and lysophosphatidylcholine (LPC) in HFD-C rats versus ND rats. The ratio of saturated and monounsaturated LPCs to polyunsaturated LPCs was significantly reduced in HFD-Met rats. These results suggest that metformin alleviates sphingolipids dysregulation and improves ORKD in HFD-fed rats. SIGNIFICANCE STATEMENT: To date, this is the first report to explore effects of metformin on renal lipidomics. These findings reveal specific changes of renal lipid species, which are crucial for deeper understanding the underlying mechanisms of obesity-related kidney disease and effects of metformin on it. The associated signature sphingolipids and phospholipids in the study may have significant implications for developing targeted therapeutic strategies for obesity-related kidney disease.

This study investigates the relationship between the atherogenic index of plasma (AIP) and chronic kidney disease (CKD) occurrence in the general population, with a focus on potential gender disparities.

The study included 22,952 adults from the National Health and Nutrition Examination Survey (NHANES). Various statistical models were employed to evaluate the association between AIP and CKD occurrence and explore gender-specific differences.

Adjusted for confounding factors, higher AIP levels showed a mild association with increased CKD risk in the general population. Specifically, individuals in the highest AIP quartile had a slightly elevated odds ratio (OR) for CKD compared to the lowest quartile (OR: 1.24, 95% CI: 1.02-1.52, P for trend = 0.023). Gender-stratified analysis revealed significant differences. Among males, higher AIP levels were significantly associated with CKD risk (OR: 1.49, 95% CI: 1.15-1.94, P for trend < 0.001), whereas in females, the association was weaker and statistically non-significant (P for trend = 0.055). U-shaped relationships between AIP and CKD were observed. Mediation analysis provided insights into potential pathways underlying this association. Among males, changes in uric acid accounted for 44.50% of CKD prevalence related to AIP, while glomerular filtration rate (eGFR), BMI, and bicarbonate levels contributed 44.09%, 17.55%, and 15.36%, respectively. Among females, uric acid changes accounted for 45.53%, while eGFR, bicarbonate, C-reactive protein (CRP), sodium, and potassium levels contributed 37.96%, 12.43%, 6.37%, 5.58%, and 3.14%, respectively.

Our findings suggest that elevated AIP levels may increase CKD risk, particularly among males in the general U.S.

Hemodialysis (HD) patients often face a heavy symptom burden, low subjective well-being, and high perceived stress. Traditional nonpharmacological interventions have limited effectiveness in improving this situation. Virtual reality (VR) technology, as an emerging approach, has shown significant advantages in alleviating symptom burden and enhancing mental health.

To assess the feasibility of a single VR travel session for HD patients and to examine its impact on symptom burden, subjective well-being, and perceived stress.

This study adopted an embedded design, providing approximately 10 minutes of natural VR travel experience using VR head-mounted displays (HMD). The effectiveness of a single VR travel session for HD patients was evaluated. Quantitative data were collected through self-reported surveys using the Dialysis Frequency Severity and Symptom Burden Index (DFSSBI) to assess symptom burden, the General Well-Being Schedule (GWBS), and the Perceived Stress Scale (PSS) to evaluate well-being and stress. Postintervention, a modified single-item questionnaire assessed patient satisfaction with the VR travel experience. An open-ended question was included to capture patients' experiential feedback.

Twenty HD patients, with a mean age of 41.30 (9.82) years, completed the VR travel and subsequent assessments. The cohort comprised 35% female and 65% male participants. The VR travel significantly improved symptom burden (t = 3.64, P = 0.002), increased subjective well-being (t = -6.12, P < 0.001), and reduced perceived stress (t = 4.16, P = 0.001). The postintervention satisfaction score was 7.35 (1.35) out of 10, and participants provided positive feedback on their VR travel experience.

A single VR travel session can alleviate symptom burden, enhance subjective well-being, and reduce perceived stress in HD patients. Participants reported high satisfaction and positive emotional responses, suggesting that this experience could be integrated into care routines as a nonpharmacological intervention to improve symptom burden and mental health in HD patients.

[www.chictr.org.cn], identifier [ChiCTR2400082781].

The financial burden of kidney replacement therapy (KRT) is considerable, and detailed information on KRT costs is essential for managing these huge healthcare costs. However, cost analyses for kidney transplantation (KTx) are limited in Japan. This study aimed to report the healthcare costs of KTx recipients in Japan based on large medical receipt data.

This cost analysis of KTx recipients using the Japan Medical Data Center Claims Database between January 2005 and August 2020 identified living donor KTx (LDKT) and deceased donor KTx (DKT) recipients. The primary outcome was the total direct healthcare costs of KTx recipients. As an exploratory analysis, we examined the factors that contributed to the increase in the costs of LDKT.

In total, 84 LDKT and 17 DKT recipients were included in this study. The total healthcare costs for LDKT and DKT recipients during the first year after KTx were 6,639,982 and 6,840,450 JPY/year, respectively. However, after the second year post-KTx, total healthcare costs decreased to 1,735,931 and 1,348,642 JPY/year for LDKT and DKT recipients, respectively. During the first year, inpatient costs accounted for > 70% of the total healthcare costs, whereas pharmaceutical costs accounted for more than half after the second year post-KTx. The use of everolimus and male sex were associated with higher and lower total healthcare costs in the first and subsequent years after LDKT, respectively.

Using large-scale administrative databases, this study revealed the total healthcare costs of KTx in Japan and provided valuable information for the health technology assessment of KTx.

Diabetic kidney disease (DKD) is one of the main complications of diabetes, the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide. The etiopathogenesis of DKD is complex and multifactorial; recently, genetic susceptibility has gained relevance since certain ethnicities, such as Native Americans and Mexican Americans, have a higher risk of developing this disease. Numerous studies have described that single nucleotide polymorphisms (SNPs), including those for ELMO1 and AGTR1 genes, could be associated with DKD.

To carry out a systematic review of the scientific literature on the association of SNPs of the ELMO1 and AGTR1 gene with DKD in adult patients with type 2 diabetes mellitus (T2D).

Systematic review in PubMed, Google Scholar, Worldwide Science, and Science Direct databases. The selection of publications was carried out following the guidelines proposed by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses). Original articles that reported results in the adult population with T2D were included. Information about the allelic and genotypic frequencies of the SNPs and their association with DKD was obtained.

The polymorphisms most frequently associated with a DKD higher risk were rs741301, rs1345365, and rs10951509 for the ELMO1 gene, whereas the rs5186 and rs388915 for the AGTR1 gene.

The risk of developing DKD depends on several factors, including the genetic susceptibility conferred by the ELMO1 and AGTR1 gene polymorphisms, without ignoring the patient's lifestyle and environmental factors. The studies about these polymorphisms' association with DKD will allow a better understanding of non-modifiable risk factors for developing this disease and recognize the differences between different studied ethnicities, which would allow faster detection of patients with T2D susceptible to developing DKD, become early markers of kidney damage, as well as implementing preventive strategies on the most susceptible ethnicities.