Control of dyslipidemia in chronic kidney disease (CKD) is not always guaranteed with statins and/or ezetimibe. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have opened up a new ...era in lipid control, but their effect on renal function and proteinuria in real life have not yet been evaluated. The aim of the present study was to analyze the evolution of renal function and proteinuria in a cohort of CKD patients treated with PCSK9i. This retrospective multicentric cohort study included CKD patients treated with PCSK9i. Baseline epidemiological data, comorbidities and laboratory findings (including estimated glomerular filtration rate eGFR, proteinuria and lipid profile) were collected. The evolution of renal function, proteinuria and lipid profile was analyzed during the 1-year follow-up. The cohort included 76 patients (68% male, mean age 66 ± 10 years). The mean baseline creatinine was 1.55 ± 0.77 mg/dL, and the mean eGFR was 52 ± 22 mL/min/1.73 m2. Reductions in LDL-cholesterol, total cholesterol and triglycerides during the first month were 51 ± 25%, 32 ± 25% and 11 ± 40%, respectively, levels that remained stable throughout the first year (p < 0.001 for LDL-cholesterol and total cholesterol trends and p = 0.002 for triglyceride trend). During follow-up, proteinuria improved from 57 (9–481) to 30 (7–520) mg/g (p = 0.021). In addition, eGFR remained stable, and no adverse events were reported. In our cohort, dyslipidemia treatment with PCSK9i was associated with decreased proteinuria in CKD patients, an effect that might be due to reduced lipid nephrotoxicity. Clinical trials are needed to further investigate whether this impact on proteinuria can significantly slow CKD progression in the long term.
Background
IgA nephropathy (IgAN) may recur in kidney transplant recipients. B‐cell‐activating factor (BAFF), a proliferation‐inducing ligand (APRIL), and α‐defensins are involved in the pathogenesis ...of native IgAN; however, their role on IgAN recurrence has not been previously analyzed.
Methods
Thirty‐five patients with IgAN who received a kidney transplant in our center between January 1, 1993, and December 31, 2015, were included. Recurrence was diagnosed and ruled out in 14 and 11 patients, respectively, by indication biopsies. Pre‐transplant, 6‐month, 1‐, 3‐, and 5‐year sera selected to measure BAFF, APRIL, and defensin by ELISA.
Results
Six months post‐transplantation, APRIL levels (300.1 vs 1203.8 pg/mL, P = 0.033) and the mean APRIL values from 6 months to 3 years (409.8 vs 1258.0 pg/mL, P = 0.003) were higher in recurrent patients. Both 6‐month APRIL levels (AUC‐ROC 0.753, P = 0.033) and mean APRIL values (AUC‐ROC 0.844, P = 0.004) discriminated patients with recurrence risk. By logistic regression, APRIL at 6 months (P = 0.044) and mean APRIL (P = 0.021) related to the risk of IgAN recurrence independently. Neither BAFF nor defensin related to recurrence.
Conclusions
Serum APRIL increased at 6 months and mean APRIL remained higher the first 3 years in patients in whom IgAN was going to recur.
Induction therapy with rabbit antithymocyte globulin is frequently used in kidney transplant recipients and contributes to regulating the humoral alloantibody response. However, the effect of rabbit ...antithymocyte globulin on B-cell subpopulations, including plasma cells, has not been previously studied in humans in vivo.
We prospectively studied a cohort of 39 adult kidney transplant recipients. Twenty patients received rabbit antithymocyte globulin as induction therapy. Peripheral blood samples were obtained pretransplant and at 6 and 12 months posttransplant. T and B cells were acquired by flow cytometry.
Total lymphocytes and CD3 and CD4 cells significantly decreased at 6 and 12 months only in patients who received rabbit antithymocyte globulin. In contrast, the CD19 population did not change after rabbit antithymocyte globulin induction. One-year circulating plasma cells remained significantly lower than pretransplant levels in patients who received rabbit antithymocyte globulin. We observed sig-nificant differences in plasma cell numbers at 12 months after transplant between patients who received rabbit antithymocyte globulin and those patients who did not receive it (median of 5 and interquartile range of 3-17 vs median of 25 and interquartile range of 12-35; P = .001).
Rabbit antithymocyte globulin induction leads to a late reduction in the number of circulating plasma cells at 1 year after kidney transplant. This effect can contribute to down-regulation of the humoral alloantibody response.
Se ha asociado la hemodiafiltración on-line (HDF-OL) a un aumento de la supervivencia. Hasta el momento no está bien establecida la influencia del diámetro interno de las fibras capilares del ...dializador sobre la capacidad convectiva. El objetivo del estudio fue valorar el efecto del aumento del diámetro interno del dializador sobre el volumen convectivo y la capacidad depurativa.
Se incluyeron 16 pacientes en HDF-OL posdilucional con reposición automática. Cada paciente recibió 4 sesiones, en las que se varió el diámetro interno, 185μm (FX60 Cordiax y FX80 Cordiax) versus 210μm (FX600 Cordiax y FX800 Cordiax). En cada sesión se determinaron diferentes solutos al inicio y al final de la diálisis.
El incremento de diámetro interno entre FX60 vs. FX600 y FX80 vs. FX800 no reflejó diferencias en el volumen convectivo: 32,3±3,1 vs. 31,8±3,6 y 33,7±4,3 vs. 33,5±3,8L/sesión, respectivamente. Los porcentajes de reducción tampoco mostraron diferencias: urea 83,7±4,5 vs. 84,1±3,4 para FX60 y FX600 y 82,7±4,1 vs. 83,6±3,8 para FX80 vs. FX800; creatinina similar 78,2±5,6 vs. 77,8±4,6 y 77,1±5,4 vs. 78,1±4,9; β2-microglobulina 82,2±4,3 vs. 82,9±4,2 y 82,9±4,7 vs. 84,0±3,8; mioglobina 71,0±10, vs. 70,2±9 y 72,8±11 vs. 75,0±10; prolactina 70,4±9 vs. 68,1±9 y 72,2±10 vs. 73,4±8,2; y α1-microglobulina 22,9±10 vs. 21,6±10 y 26,5±12 vs. 28,8±11, respectivamente.
El incremento del diámetro interno de las fibras capilares no ha significado una mayor eficacia en el volumen convectivo ni en la capacidad depurativa.
Online haemodiafiltration (OL-HDF) has been associated with increased survival. To date, the influence of the inner diameter of the hollow fibres of the dialyser on convective volume has not been well established. The objective of the study was to evaluate the effect of increasing the inner diameter of the dialyser on the convective volume and removal capacity.
We included 16 patients in posdilutional OL-HDF with autosubstitution. Each patient was analysed in 4 sessions in which the inner diameter varied; 185μm (FX60 Cordiax and FX80 Cordiax) versus 210μm (FX600 Cordiax and FX800 Cordiax). Different solutes were measured at the beginning and end of each dialysis session.
No differences in the convective volume were found with an increased inner diameter: 32.3±3.1 vs. 31.8±3.6 l/session (FX60 vs. FX600) and 33.7±4.3 vs. 33.5±3.8 l/session (FX80 vs. FX800). The reduction percentages also did not differ: urea 83.7±4.5 vs. 84.1±3.4 for FX60 and FX600, and 82.7±4.1 vs. 83.6±3.8 for FX80 vs. FX800; creatinine similar 78.2±5.6 vs. 77.8±4.6 y 77.1±5.4 vs. 78.1±4.9; β2-microglobulin 82.2±4.3 vs. 82.9±4.2, and 82.9±4.7 vs. 84.0±3.8; myoglobin 71.0±10 vs. 70.2±9 and 72.8±11 vs. 75.0±10; prolactin 70.4±9 vs. 68.1±9, and 72.2±10 vs. 73.4±8.2; and α1-microglobulin 22.9±10 vs. 21.6±10, and 26.5±12 vs. 28.8±11, respectively.
The increase in the inner diameter of the hollow fibres did not result in improved convective volume and removal capacity.
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