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Novelty in the Management of Progression and Complications of CKD
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Novelty in the Management of Progression and Complications of CKD

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

Deadline for manuscript submissions: 30 May 2024 | Viewed by 6681

Special Issue Editor

Prof. Dr. Francesco Locatelli

E-Mail Website
Guest Editor
Department of Nephrology and Dialysis, Alessando Manzoni Hospital, Lecco, Italy
Interests: CKD; proteinuria; hypertension; anemia; ESAS; iron
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) progression is an increasing worldwide clinical and economic burden for patients and society and, thus, novel therapeutic approaches to its prevention and treatment will be welcomed.

Proteinuria and elevated blood pressure (BP) are still the most significant risk factors determining the progression of CKD; thus, their treatment are of paramount importance in CKD management. It has been well accepted that a stricter control of blood pressure (≤130/80 mmHg) is required in patients with proteinuria; however, increasing evidence suggests that the same target holds true in CKD non-proteinuric patients. Blockers of the renin–angiotensin system (RAS) are still recommended as the first-line treatment in all CKD hypertensive patients; however, their nephroprotective efficacy is less relevant in non-proteinuric patients. Given that RAS blockers can cause acute derangements in kidney function and hyperkalemia, caution is needed regarding their use, especially in frail, elderly nephroangiosclerotic patients or in the presence of advanced CKD. Dietetic–nutritional therapy (DNT) is an important component in conservative CKD management and should precede and be integrated in pharmacological treatment. The objectives of DNT include the maintenance of an optimal nutritional status as well as the prevention and/or correction of signs, symptoms, and complications of CKD and, possibly, the delay in starting dialysis. As part of the DNT, the modulation of protein, the adequacy of caloric intake, and the control of cholesterol, sodium, potassium, and phosphorus intake is included. Erythropoietin-stimulating agents, including the very recent availability of the hypoxia-inducible factor prolyl hydroxylase inhibitor, and iron should be used to prevent severe anemia and associated symptoms. Gliflozin is a very promising drug which has recently been approved not only for the treatment of diabetic nephropathy but for other causes of CKD and heart failure as well. The association of angiotensin II receptor antagonist with anti-endothelin I could be an interesting therapeutic approach for the near future.

Prof. Dr. Francesco Locatelli
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.

Prof. Dr. Francesco Locatelli
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

  • CKD
  • proteinuria
  • hypertension
  • anemia
  • ESAS
  • iron
  • HIF-PHIs
  • SGLT2
  • anti-endothelin

Published Papers (3 papers)

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Research

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14 pages, 1190 KiB  
Article
Short-Term Dapagliflozin Administration in Autosomal Dominant Polycystic Kidney Disease—A Retrospective Single-Arm Case Series Study
by Fumiyuki Morioka, Shinya Nakatani, Hideki Uedono, Akihiro Tsuda, Katsuhito Mori and Masanori Emoto
J. Clin. Med. 2023, 12(19), 6341; https://doi.org/10.3390/jcm12196341 - 03 Oct 2023
Cited by 4 | Viewed by 2742
Abstract
Treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors may have pleiotropic and beneficial effects in terms of ameliorating of risk factors for the progression of autosomal dominant polycystic kidney disease (ADPKD). However, there is insufficient evidence regarding the use of these drugs in patients with [...] Read more.
Treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors may have pleiotropic and beneficial effects in terms of ameliorating of risk factors for the progression of autosomal dominant polycystic kidney disease (ADPKD). However, there is insufficient evidence regarding the use of these drugs in patients with ADPKD, as they were excluded from several clinical trials conducted to explore kidney protection provided by SGLT2 inhibitors. This retrospective single-arm case series study was performed to investigate the effects of dapagliflozin, a selective SGLT2 inhibitor administered at 10 mg/day, on changes in height-adjusted kidney volume (htTKV) and estimated glomerular filtration rate (eGFR) in ADPKD patients. During a period of 102 ± 20 days (range 70–156 days), eGFR was decreased from 47.9 (39.7–56.9) to 40.8 (33.7–44.5) mL/min/1.73 m2 (p < 0.001), while htTKV was increased from 599 (423–707) to 617 (446–827) mL/m (p = 0.002) (n = 20). The annual increase in htTKV rate was significantly promoted, and urinary phosphate change was found to be correlated with the change in htTKV (rs = 0.575, p = 0.020). In the examined patients, eGFR was decreased and htTKV increased during short-term administration of dapagliflozin. To confirm the possibility of the effects of dapagliflozin on ADPKD, additional interventional studies are required. Full article
(This article belongs to the Special Issue Novelty in the Management of Progression and Complications of CKD)
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13 pages, 1478 KiB  
Article
Association of Red Blood Cell Life Span with Abnormal Changes in Cardiac Structure and Function in Non-Dialysis Patients with Chronic Kidney Disease Stages 3–5
by Siyi Rao, Jing Zhang, Jiaqun Lin, Jianxin Wan and Yi Chen
J. Clin. Med. 2022, 11(24), 7373; https://doi.org/10.3390/jcm11247373 - 12 Dec 2022
Viewed by 1380
Abstract
Introduction: With the invention and improvement of the carbon monoxide (CO) breath test, the role of shortened red blood cell life span (RBCLS) in renal anemia, an independent risk factor for cardiovascular events in patients with chronic kidney disease (CKD), is gradually attracting [...] Read more.
Introduction: With the invention and improvement of the carbon monoxide (CO) breath test, the role of shortened red blood cell life span (RBCLS) in renal anemia, an independent risk factor for cardiovascular events in patients with chronic kidney disease (CKD), is gradually attracting attention. Considering that heart failure is the leading cause of morbidity and mortality in patients with CKD, this study investigated the correlation between the RBCLS and the cardiac structure and function in non-dialysis patients with CKD stages 3–5, aiming to provide new ideas to improve the long-term prognosis of CKD patients. Methods: One hundred thirty-three non-dialysis patients with CKD stages 3–5 were tested for RBCLS. We compared the serological data, cardiac ultrasound results, and follow-up prognosis of patients with different RBCLS. Results: As the RBCLS shortened, the patients’ blood pressure, BNP, and CRP gradually increased, most significantly in patients with an RBCLS < 50 d. Patients with an RBCLS < 50 d had substantially lower hemoglobin (Hb), hematocrit, and albumin levels than those with an RBCLS ≥ 50 d. The cardiac ultrasound results show that patients with an RBCLS < 50 d had significantly larger atrial diameters than those with an RBCLS ≥ 50 d and were associated with more severe diastolic dysfunction. Patients with an RBCLS < 50 d had a 3.06 times greater risk of combined heart failure at baseline than those with an RBCLS ≥ 70 d and a higher risk of heart failure at follow-up. CKD stage 5 patients with an RBCLS < 50 d were more likely to develop heart failure and require renal replacement therapy earlier than patients with an RBCLS ≥ 50 d. Conclusions: In non-dialysis patients with CKD stages 3–5, there is a correlation between the red blood cell life span and cardiac structure and function. The RBCLS may also impact the renal prognosis of CKD patients. Full article
(This article belongs to the Special Issue Novelty in the Management of Progression and Complications of CKD)
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Review

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13 pages, 491 KiB  
Review
Iron Parameters in Patients Treated with Roxadustat for Anemia of Chronic Kidney Disease
by Tomas Ganz, Francesco Locatelli, Mustafa Arici, Tadao Akizawa and Michael Reusch
J. Clin. Med. 2023, 12(13), 4217; https://doi.org/10.3390/jcm12134217 - 22 Jun 2023
Viewed by 1870
Abstract
Roxadustat is a novel agent with a distinct mechanism of action compared to erythropoiesis-stimulating agents (ESAs) and a potentially different combination of effects on iron parameters. This narrative review describes the effects of roxadustat on iron parameters and on hemoglobin levels in the [...] Read more.
Roxadustat is a novel agent with a distinct mechanism of action compared to erythropoiesis-stimulating agents (ESAs) and a potentially different combination of effects on iron parameters. This narrative review describes the effects of roxadustat on iron parameters and on hemoglobin levels in the context of iron supplementation in patients with anemia of non-dialysis-dependent (NDD) or dialysis-dependent (DD) chronic kidney disease (CKD). Roxadustat use was associated with a greater reduction in serum ferritin levels than seen with ESAs and an increase in serum iron levels compared to a decrease with ESAs. Decreases in transferrin saturation in patients treated with roxadustat were relatively small and, in the case of patients with NDD CKD, not observed by Week 52. These changes reflect the concomitant increases in both serum iron and total iron-binding capacity. Compared to placebo and an ESA, roxadustat improved iron availability and increased erythropoiesis while requiring less intravenous iron use. Hepcidin levels generally decreased in patients who received roxadustat compared to baseline values in all CKD populations; these decreases appear to be more robust with roxadustat than with an ESA or placebo. The mechanisms behind the effects of roxadustat and ESAs on iron availability and stores and erythropoiesis appear to differ and should be considered holistically when treating anemia of CKD. Full article
(This article belongs to the Special Issue Novelty in the Management of Progression and Complications of CKD)
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