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Chronic Kidney Disease and Its Complications: Mechanisms and Treatments
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Chronic Kidney Disease and Its Complications: Mechanisms and Treatments

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

Deadline for manuscript submissions: closed (31 October 2023) | Viewed by 8209

Special Issue Editor

Dr. Liang Ma

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Guest Editor
Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 332001, China
Interests: fibrotic kidney diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) affects approximately 10–14% of the global population. Kidney fibrosis, characterized by excessive extracellular matrix (ECM) deposition leading to tissue scarring, is a hallmark and common manifestation in all types of progressive CKD; however, there are currently no antifibrotic therapies used to treat CKD. Kidney fibrosis can be identified based on morphological features such as tubule atrophy, interstitial chronic inflammation and fibrogenesis, glomerulosclerosis, and vascular rarefaction. Although it takes a long time to develop effective drugs based on newly discovered mechanisms, the increasing number of treatments on the market, including RAS blockage, SGLT2 inhibitors, vasopressin receptor 2 antagonist, and non-steroidal anti-mineralocorticoid, can delay the progression of CKD. Furthermore, a better understanding of kidney fibrosis will also aid the discovery of promising blood and urinary biomarkers related to tubulointerstitial injury.

Dr. Liang Ma
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
  • kidney fibrosis
  • myofibroblast activation
  • tubulointerstitial injury
  • fibrotic biomarker
  • antifibrotic therapy

Published Papers (6 papers)

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Editorial

Jump to: Research, Review

3 pages, 185 KiB  
Editorial
Size Matters: How to Characterize ADPKD Severity by Measuring Total Kidney Volume
by Martin R. Prince, Erin Weiss and Jon D. Blumenfeld
J. Clin. Med. 2023, 12(18), 6068; https://doi.org/10.3390/jcm12186068 - 20 Sep 2023
Viewed by 682
Abstract
Following patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) has been challenging because serum biomarkers such as creatinine often remain normal until relatively late in the disease [...] Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Its Complications: Mechanisms and Treatments)

Research

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12 pages, 1343 KiB  
Article
The Performance of Flash Replenishment Contrast-Enhanced Ultrasound for the Qualitative Assessment of Kidney Lesions in Patients with Chronic Kidney Disease
by Rachel W. Walmer, Victor S. Ritter, Anush Sridharan, Sandeep K. Kasoji, Ersan Altun, Ellie Lee, Kristen Olinger, Sean Wagner, Roshni Radhakrishna, Kennita A. Johnson, W. Kimryn Rathmell, Bahjat Qaqish, Paul A. Dayton and Emily H. Chang
J. Clin. Med. 2023, 12(20), 6494; https://doi.org/10.3390/jcm12206494 - 12 Oct 2023
Viewed by 1036
Abstract
We investigated the accuracy of CEUS for characterizing cystic and solid kidney lesions in patients with chronic kidney disease (CKD). Cystic lesions are assessed using Bosniak criteria for computed tomography (CT) and magnetic resonance imaging (MRI); however, in patients with moderate to severe [...] Read more.
We investigated the accuracy of CEUS for characterizing cystic and solid kidney lesions in patients with chronic kidney disease (CKD). Cystic lesions are assessed using Bosniak criteria for computed tomography (CT) and magnetic resonance imaging (MRI); however, in patients with moderate to severe kidney disease, CT and MRI contrast agents may be contraindicated. Contrast-enhanced ultrasound (CEUS) is a safe alternative for characterizing these lesions, but data on its performance among CKD patients are limited. We performed flash replenishment CEUS in 60 CKD patients (73 lesions). Final analysis included 53 patients (63 lesions). Four readers, blinded to true diagnosis, interpreted each lesion. Reader evaluations were compared to true lesion classifications. Performance metrics were calculated to assess malignant and benign diagnoses. Reader agreement was evaluated using Bowker’s symmetry test. Combined reader sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant lesions were 71%, 75%, 45%, and 90%, respectively. Sensitivity (81%) and specificity (83%) were highest in CKD IV/V patients when grouped by CKD stage. Combined reader sensitivity, specificity, PPV, and NPV for diagnosing benign lesions were 70%, 86%, 91%, and 61%, respectively. Again, in CKD IV/V patients, sensitivity (81%), specificity (95%), and PPV (98%) were highest. Inter-reader diagnostic agreement varied from 72% to 90%. In CKD patients, CEUS is a potential low-risk option for screening kidney lesions. CEUS may be particularly beneficial for CKD IV/V patients, where kidney preservation techniques are highly relevant. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Its Complications: Mechanisms and Treatments)
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16 pages, 2344 KiB  
Article
Comparative Clinical Performances of Tunneled Central Venous Catheters versus Arterio-Venous Accesses in Patients Receiving High-Volume Hemodiafiltration: The Case for High-Flow DualCath, a Tunneled Two-Single-Lumen Silicone Catheter
by Bernard Canaud, H. Leray-Moragues, Leila Chenine, Marion Morena, George Miller, Ludovic Canaud and Jean Paul Cristol
J. Clin. Med. 2023, 12(14), 4732; https://doi.org/10.3390/jcm12144732 - 17 Jul 2023
Viewed by 823
Abstract
Tunneled central venous catheters (CVC) are mainly considered as a rescue vascular access option in dialysis but are still used on approximately one quarter of prevalent patients worldwide even though they are associated with poor performances and higher risks. Study design: in this [...] Read more.
Tunneled central venous catheters (CVC) are mainly considered as a rescue vascular access option in dialysis but are still used on approximately one quarter of prevalent patients worldwide even though they are associated with poor performances and higher risks. Study design: in this retrospective single-center study, we aimed to report on the clinical performances achieved with high-flow tunneled CVCs (DualCath or DCath) and compared them with arteriovenous accesses (AVAs, e.g., AV fistula, AV graft, and Thomas Shunt) in a hospital-based dialysis unit. Methods: Sixty-eight stage 5 chronic kidney disease dialysis-dependent patients (CKD5D) receiving high volume hemodiafiltration were followed-up with for 30 months. The study consisted of two phases: baseline cross-sectional and longitudinal follow-ups of key performance indicators. Clinical performances consisting of effective blood flow and blood volume, recirculation, urea and ionic Kt/V, total Kt, ultrafiltration volume, and percent reduction in β2-M were measured monthly as part of quality control in our unit. Results: At baseline, the effective blood flow using a DCath was close to 400 mL/min, similar to an AVA. Recirculation with a DCath (7%, 6–13%) was higher than with an AVA. The diffusive dialysis dose delivered with a DCath (spKt and eKt/V) and convective dialysis dose achieved with a DCath were slightly lower than those achieved with AVAs, but they were still much higher than is recommended by guidelines. The percent reduction in β2-M achieved with a DCath was also 4 to 10% lower than that achieved with an AVA. On longitudinal follow-up, the main clinical performance indicators of DCaths (total Kt and total ultrafiltration volume, L/session) were maintained as very stable over time and close to those achieved with AVAs. Conclusions: As shown in this study, high-flow DualCath tunneled two-single-lumen silicone catheters may be used to deliver high volume hemodiafiltration in a reliable and consistent manner without compromising clinical performance. These results relied on the specific design of the two silicone cannulas and the strict adherence to best catheter practices. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Its Complications: Mechanisms and Treatments)
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9 pages, 1023 KiB  
Article
Patterns of Dickkopf-3 Serum and Urine Levels at Different Stages of Chronic Kidney Disease
by Paulina Dziamałek-Macioszczyk, Agata Winiarska, Anna Pawłowska, Paweł Wojtacha and Tomasz Stompór
J. Clin. Med. 2023, 12(14), 4705; https://doi.org/10.3390/jcm12144705 - 15 Jul 2023
Cited by 1 | Viewed by 929
Abstract
Dickkopf 3 (Dkk3) is a WNT/β-catenin signaling pathway regulator secreted by tubular epithelial cells upon the influence of different stressors. Recently Dkk3 was described as a biomarker of tubular cell injury and a tool that may estimate the risk of chronic kidney disease [...] Read more.
Dickkopf 3 (Dkk3) is a WNT/β-catenin signaling pathway regulator secreted by tubular epithelial cells upon the influence of different stressors. Recently Dkk3 was described as a biomarker of tubular cell injury and a tool that may estimate the risk of chronic kidney disease (CKD) progression. The data about Dkk3 concentrations at particular stages of CKD are lacking. The aim of this study was to measure serum and urine Dkk3 levels in patients with different ‘renal status’ and evaluate its role as a biomarker of renal damage. One hundred individuals, aged between 24 and 85 years (mean 53.1 ± 17.1), were enrolled in the study. Five groups of 20 subjects each were recruited based on their kidney function. Serum and urine Dkk3 levels were measured by ELISA. The highest median urinary Dkk3 normalized to urinary creatinine was found in patients with established CKD (7051 pg/mg). It was two times higher in renal transplant patients (5705 pg/mg) than in healthy individuals (2654 pg/mg) and the glomerulonephritis group (2470 pg/mg). Urinary Dkk3 was associated with serum creatinine in participants with established CKD and following transplantation. Our results confirm the potential role of Dkk3 as a biomarker of an ongoing renal injury. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Its Complications: Mechanisms and Treatments)
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23 pages, 1040 KiB  
Article
Associations of Traditionally Determined Left Ventricular Mass Indices and Hemodynamic and Non-Hemodynamic Components of Cardiac Remodeling with Diastolic and Systolic Function in Patients with Chronic Kidney Disease
by Hon-Chun Hsu, Grace Tade, Chanel Robinson, Noluntu Dlongolo, Gloria Teckie, Ahmed Solomon, Angela Jill Woodiwiss and Patrick Hector Dessein
J. Clin. Med. 2023, 12(13), 4211; https://doi.org/10.3390/jcm12134211 - 22 Jun 2023
Cited by 1 | Viewed by 778
Abstract
We aimed to evaluate the extent to which different left ventricular mass parameters are associated with left ventricular function in chronic kidney disease (CKD) patients. We compared the associations between traditionally determined left ventricular mass indices (LVMIs) and hemodynamic (predicted LVMIs) and non-hemodynamic [...] Read more.
We aimed to evaluate the extent to which different left ventricular mass parameters are associated with left ventricular function in chronic kidney disease (CKD) patients. We compared the associations between traditionally determined left ventricular mass indices (LVMIs) and hemodynamic (predicted LVMIs) and non-hemodynamic remodeling parameters with left ventricular function in patients with CKD; non-hemodynamic remodeling was represented by inappropriate left ventricular mass and inappropriate excess LVMIs (traditionally determined LVMIs-predicted LVMIs). Non-hemodynamic left ventricular remodeling parameters were strongly associated with impaired left ventricular systolic function (p < 0.001), whereas hemodynamic left ventricular remodeling was also related strongly (p < 0.001) but directly to left ventricular systolic function. Independent of one another, hemodynamic and non-hemodynamic left ventricular remodeling had associations in opposite directions to left ventricular systolic function and was associated directly with traditionally determined left ventricular mas indices (p < 0.001 for all relationships). Non-hemodynamic cardiac remodeling parameters discriminated more effectively than traditionally determined LVMIs between patients with and without reduced ejection fraction (p < 0.04 for comparison). Left ventricular mass parameters were unrelated to impaired diastolic function in patients with CKD. Traditionally determined LVMIs are less strongly associated with impaired systolic function than non-hemodynamic remodeling parameters (p < 0.04–0.01 for comparisons) because they represent both adaptive or compensatory and non-hemodynamic cardiac remodeling. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Its Complications: Mechanisms and Treatments)
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Review

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36 pages, 495 KiB  
Review
Pharmacological Nephroprotection in Non-Diabetic Chronic Kidney Disease—Clinical Practice Position Statement of the Polish Society of Nephrology
by Tomasz Stompór, Marcin Adamczak, Ilona Kurnatowska, Beata Naumnik, Michał Nowicki, Leszek Tylicki, Agata Winiarska and Magdalena Krajewska
J. Clin. Med. 2023, 12(16), 5184; https://doi.org/10.3390/jcm12165184 - 09 Aug 2023
Viewed by 3524
Abstract
Chronic kidney disease (CKD) is a modern epidemic worldwide. Introducing renin–angiotensin system (RAS) inhibitors (i.e., ACEi or ARB) not only as blood-pressure-lowering agents, but also as nephroprotective drugs with antiproteinuric potential was a milestone in the therapy of CKD. For decades, this treatment [...] Read more.
Chronic kidney disease (CKD) is a modern epidemic worldwide. Introducing renin–angiotensin system (RAS) inhibitors (i.e., ACEi or ARB) not only as blood-pressure-lowering agents, but also as nephroprotective drugs with antiproteinuric potential was a milestone in the therapy of CKD. For decades, this treatment remained the only proven strategy to slow down CKD progression. This situation changed some years ago primarily due to the introduction of drugs designed to treat diabetes that turned into nephroprotective strategies not only in diabetic kidney disease, but also in CKD unrelated to diabetes. In addition, several drugs emerged that precisely target the pathogenetic mechanisms of particular kidney diseases. Finally, the role of metabolic acidosis in CKD progression (and not only the sequelae of CKD) came to light. In this review, we aim to comprehensively discuss all relevant therapies that slow down the progression of non-diabetic kidney disease, including the lowering of blood pressure, through the nephroprotective effects of ACEi/ARB and spironolactone independent from BP lowering, as well as the role of sodium–glucose co-transporter type 2 inhibitors, acidosis correction and disease-specific treatment strategies. We also briefly address the therapies that attempt to slow down the progression of CKD, which did not confirm this effect. We are convinced that our in-depth review with practical statements on multiple aspects of treatment offered to non-diabetic CKD fills the existing gap in the available literature. We believe that it may help clinicians who take care of CKD patients in their practice. Finally, we propose the strategy that should be implemented in most non-diabetic CKD patients to prevent disease progression. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Its Complications: Mechanisms and Treatments)
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