Chronic kidney disease (CKD) is a highly prevalent and potential progressive condition with life-threatening consequences. Glomerular diseases (glomerulopathies) are causes of CKD that are potentially amenable by specific therapies. Significant resources have been invested in the identification of novel biomarkers of CKD progression and new targets for treatment. By using experimental models of kidney diseases, periostin has been identified amongst the most represented matricellular proteins that are commonly involved in the inflammation and fibrosis that characterize progressive kidney diseases. Periostin is highly expressed during organogenesis, with scarce expression in mature healthy tissues, but it is upregulated in multiple disease settings characterized by tissue injury and remodeling. Periostin was the most highly expressed matriceal protein in both animal models and in patients with glomerulopathies. Given that periostin is readily secreted from injury sites, and the variations in its humoral levels compared to the normal state were easily detectable, its potential role as a biomarker is suggested. Moreover, periostin expression was correlated with the degree of histological damage and with kidney function decline in patients with CKD secondary to both inflammatory (IgA nephropathy) and non-inflammatory (membranous nephropathy) glomerulopathies, while also displaying variability secondary to treatment response. The scope of this review is to summarize the existing evidence that supports the role of periostin as a novel biomarker in glomerulopathies.
Background and Aims Early referral to nephrological care associates with improved long-term survival and lower hospitalization rates after dialysis initiation. Despite the strong evidence for this beneficial effect of early referral to pre-dialysis nephrological care in dialysis patients, the effect on COVID-19 incidence and outcome has not yet been investigated. Method Patients in the current study were recruited from a cohort of 349 consecutive patients who initiated dialysis between 2015 and 2018 at a dialysis network in Romania. All patients alive at the start of the pandemic (March 2020 = baseline) were included in this retrospective cohort study. Follow-up ended July 2021. At each visit, patients were screened for 2019 Coronavirus Disease (COVID-19) symptoms and symptomatic patients underwent PCR testing. We studied the effect of pre-dialysis nephrological care on COVID-19 incidence. Independent predictors of COVID-19 incidence were identified by multivariable logistic regression analysis. Results In total, 224 patients were included. Of these, 89 were early referral patients. At dialysis initiation, they had higher hemoglobin (median (25-75%), 10.0 (9.4-10.8) g/dL vs. 8.5 (7.6-9.4) g/dL, p<0.001), transferrin saturation (21.5 (16.8-25.3)% vs. 18.1 (13.4-23.5)%, p = 0.01), calcium (8.8 (8.3-9.1) mg/dL vs. 8.3 (7.8-8.8) mg/dL, p<0.001), phosphate (5.9 (5.0-6.8) mg/dL vs. 4.8 (3.9-5.8) mg/dL, p<0.001), and albumin (3.5 (3.2-4.2) g/dL vs. 3.5 (3.2-3.8) g/dL, p = 0.04), lower PTH (220 (136-357) pg/mL vs. 289 (148-510) pg/mL, p = 0.03), and initiated dialysis less often via a central dialysis catheter (40 (44.9%) vs. 132 (97.8%), p<0.001). Age, sex, diabetes, and Charlson Comorbidity Index did not differ between groups. During the 16 months of follow-up, 82 patients (36.6%) developed COVID-19. Incidence of COVID-19 was higher in patients with diabetes (32 (46.4%) vs. 50 (32.4%), p = 0.04), while early referral was weakly associated with a lower COVID-19 incidence (26 (29.2%) vs. 56 (41.5%), p = 0.06). Logistic regression, correcting for differences between early and late referral and differences between patients with and without COVID-19, identified a lower risk for COVID-19 among early referral patients (Table 1). No difference in mortality was detected between patients with and without COVID-19 during follow-up (19 (23.2%) vs. 36 (25.4%), p = 0.7). Conclusion Among prevalent dialysis patients, early referral to nephrological care before dialysis initiation was an independent predictor of lower COVID-19 incidence during a follow-up period of 16 month from the beginning of the pandemic.
De novo AKI patients had higher mortality as compared to CKD patients (p <0.005).3. Patients who required de novo initiation of RRT had a worse outcome. Mortality in patients who were initiated on RRT was 93 % as compared to 19.5 % in MHD patients (p <0.0001). 4.Post kidney transplant patients had a better outcome in terms of mortality and complete GFR recovery as compared to other CKD Groups (p < 0.05).
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