Abstract
Hypertension is associated with significant cardiovascular morbidity. Blood pressure (BP) control on maintenance hemodialysis (HD) is strongly impacted by volume status. The objective of ...this study was to assess whether machine learning (ML) is effective in predicting post-HD BP in children and young adults on HD. We collected data on BP, IDWG, pulse, and weights for patients on maintenance HD (> 3 months). Input features included DW, pre-post weight difference, IDWG and pre-HD BP. Seven models were trained and tuned using open-source libraries. Model performance was evaluated using time-series cross-validation on a rolling basis (3–12 month training, 1-day testing). Various regression scores were compared between models. Data for 35 patients (14,375 HD sessions) were analyzed. Extreme gradient boosting (XGB) and vector autoregression with exogenous regressors (VARX) achieved better accuracy in predicting post-dialysis systolic BP than K-nearest neighbor, support vector regression (SVR) with radial basis function kernel and random forest (p < 0.001 for each). The differences in accuracy between XGB, VARX, SVR with linear kernel, random forest and linear regression were not significant. Using clinical parameters, ML models may be useful in predicting post-HD BP, which may help guide DW adjustment and optimizing BP control for maintenance HD patients.
The finding of a simple kidney cyst in a child can pose a diagnostic and management challenge for pediatric nephrologists, urologists, and primary care providers. The reported prevalence varies from ...0.22 to 1% in large ultrasonography-based series of more than 10,000 children each. The true prevalence, however, may be higher or lower, as factors such as variations in referral patterns, indications for ultrasonography, or technical considerations could impact prevalence rates. For many patients, simple kidney cysts may be found incidentally when imaging is performed for another indication. Although simple cysts can occur in children, they may also represent the first sign of autosomal dominant polycystic kidney disease (ADPKD) or other less common cystic kidney diseases. Definitive guidelines regarding the evaluation and monitoring of children with simple kidney cysts have not been established. The desire on the part of the practitioner and/or parents to establish a definitive diagnosis should be balanced with the cost and inconvenience of repeated imaging and visits with specialists. The goals of this review are to (1) outline the definition, epidemiology, clinical presentation, and natural history of simple kidney cysts in childhood; (2) describe clinical features that could suggest a diagnosis other than a simple kidney cyst; and (3) present a suggested framework for evaluating and monitoring of children with one or more simple kidney cysts.
Autosomal recessive polycystic kidney disease (ARPKD; MIM 263200) is a severe, typically early onset form of cystic disease that primarily involves the kidneys and biliary tract. Phenotypic ...expression and age at presentation can be quite variable
1
. The incidence of ARPKD is 1 in 20,000 live births
2
, and its pleotropic manifestations are potentially life-threatening. Optimal care requires proper surveillance to limit morbidity and mortality, knowledgeable approaches to diagnosis and treatment, and informed strategies to optimize quality of life. Clinical management therefore is ideally directed by multidisciplinary care teams consisting of perinatologists, neonatologists, nephrologists, hepatologists, geneticists, and behavioral specialists to coordinate patient care from the perinatal period to adulthood. In May 2013, an international team of 25 multidisciplinary specialists from the US, Canada, Germany, and the United Kingdom convened in Washington, DC, to review the literature published from 1990 to 2013 and to develop recommendations for diagnosis, surveillance, and clinical management. Identification of the gene
PKHD1,
and the significant advances in perinatal care, imaging, medical management, and behavioral therapies over the past decade, provide the foundational elements to define diagnostic criteria and establish clinical management guidelines as the first steps towards standardizing the clinical care for ARPKD patients. The key issues discussed included recommendations regarding perinatal interventions, diagnostic criteria, genetic testing, management of renal and biliary-associated morbidities, and behavioral assessment. The meeting was funded by the National Institutes of Health and an educational grant from the Polycystic Kidney Disease Foundation. Here we summarize the discussions and provide an updated set of diagnostic, surveillance, and management recommendations for optimizing the pediatric care of patients with ARPKD. Specialist care of ARPKD-related complications including dialysis, transplantation, and management of severe portal hypertension will be addressed in a subsequent report. Given the paucity of information regarding targeted therapies in ARPKD, this topic was not addressed in this conference.”
Primary (immotile) cilia are specialized organelles present on most cell types. Almost all of proteins associated with a broad spectrum of human cystic kidney diseases have been localized to the ...region in or around the cilia. Abnormal cilia structure and function have both been reported in animal models and human cystic kidneys. The goal of this review is to discuss current understanding of the mechanisms by which abnormal genes/proteins and cilia interact to potentially influence renal cystogenesis.
Novel direct recording of cilia calcium levels/channel activity suggests that cilia form a calcium-mediated signaling microenvironment separate from the cytoplasm, which could provide a mechanism for cilia-specific downstream signaling. Genetic-based studies confirm that cilia are not required for cystogenesis, but modulate cystic kidney disease severity through a novel, undefined mechanism. Mechanisms by which both cilia-associated and noncilia-associated proteins can alter cilia structure/function have also been identified.
Considerable progress has been made in defining the mechanisms by which abnormal genes and proteins affect cilia structure and function. However, the exact mechanisms by which these interactions cause renal cyst formation and progression of cystic kidney disease are still unknown.
Research has shown links between interpersonal conflict and problematic drinking behaviors as a way to cope. The present research examined the effects of a brief interpersonal conflict cognitive ...reappraisal intervention on short-term reductions in alcohol-related problems in a sample of college student drinkers. Undergraduates who were regular drinkers (N = 190) participated in a randomized control online study, completing self-reported measures of alcohol consumption and alcohol-related problems at baseline and 2 weeks later. After completing the baseline survey, participants completed a brief writing intervention during which they were asked to reflect on a recent interpersonal conflict and write about it from 1 of 3 possible perspectives, 2 of which were targeting cognitive reappraisal (i.e., a neutral, third-party perspective and the other party's perspective), their own perspective, or to reflect on their activities that day (control). Results from negative binomial regression models supported both reappraisal conditions: Compared with control, those who thought about the conflict from a neutral third-party perspective and those who thought about the conflict from the other party's perspective reported significantly fewer drinking problems at follow-up. Results from this study suggest preliminary efficacy of a single-session writing intervention aimed at reappraising interpersonal conflict.
Background
Posterior urethral valves (PUV) is the most common cause of obstructive uropathy in boys; approximately 15% develop kidney failure by early adulthood. However, rates of kidney function ...decline are poorly defined in PUV children and adults, as is the impact of potentially modifiable chronic kidney disease (CKD) progression risk factors.
Methods
We conducted a retrospective review of all PUV patients followed at our institution from 1995 to 2018. Inclusion criteria were estimated glomerular filtration rate (eGFR) > 20 ml/min/1.73 m
2
after 1 year of age, no dialysis or kidney transplant history, and ≥ 2 yearly serum creatinine values after age 1 year. eGFRs were calculated using creatinine-based estimating formulas for children (CKID U25) or adults (CKD-EPI). The primary outcome was annualized change in eGFR, assessed with linear mixed effects models. We also examined the association of acute kidney injury (AKI), proteinuria, hypertension (HTN), and recurrent febrile urinary tract infections (UTIs) with eGFR decline.
Results
Fifty-two PUV patients met the inclusion criteria. Median (interquartile range) eGFR decline was 2.6 (2.1, 3.1) ml/min/1.73 m
2
/year. Children (
n
= 35) and adults (
n
= 17) demonstrated progressive decline. Proteinuria and recurrent UTIs were significantly associated with faster progression; AKI and HTN were also associated but did not reach significance.
Conclusion
PUV patients show progressive loss of kidney function well into adulthood. Proteinuria and recurrent UTIs are associated with faster progression, suggesting potential modifiable risk factors. This is the first study to report annualized eGFR decline rates in PUV patients, which could help inform the design of clinical trials of CKD therapies.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information
Background
Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial.
Objective
Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 ...infection, hospitalization, and intensive care unit (ICU) admission.
Design
Retrospective cohort study with overlap propensity score weighting.
Participants
Individuals tested for SARS-CoV-2 infection in a large academic healthcare system (
N
= 72,909) from March 8–June 9, 2020, stratified by HCW and patient-facing status.
Main Measures
SARS-CoV-2 test result, hospitalization, and ICU admission for COVID-19 infection.
Key Results
Of 72,909 individuals tested, 9.0% (551) of 6145 HCW tested positive for SARS-CoV-2 compared to 6.5% (4353) of 66,764 non-HCW. The HCW were younger than the non-HCW (median age 39.7 vs. 57.5,
p
< 0.001) with more females (proportion of males 21.5 vs. 44.9%,
p
< 0.001), higher reporting of COVID-19 exposure (72 vs. 17%,
p
< 0.001), and fewer comorbidities. However, the overlap propensity score weighted proportions were 8.9 vs. 7.7 for HCW vs. non-HCW having a positive test with weighted odds ratio (OR) 1.17, 95% confidence interval (CI) 0.99–1.38. Among those testing positive, weighted proportions for hospitalization were 7.4 vs. 15.9 for HCW vs. non-HCW with OR of 0.42 (CI 0.26–0.66) and for ICU admission: 2.2 vs. 4.5 for HCW vs. non-HCW with OR of 0.48 (CI 0.20–1.04). Those HCW identified as patient facing compared to not had increased odds of a positive SARS-CoV-2 test (OR 1.60, CI 1.08–2.39, proportions 8.6 vs. 5.5), but no statistically significant increase in hospitalization (OR 0.88, CI 0.20–3.66, proportions 10.2 vs. 11.4) and ICU admission (OR 0.34, CI 0.01–3.97, proportions 1.8 vs. 5.2).
Conclusions
In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patient-facing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic.
Background
In the current study, longitudinal BP and lipid measurements were examined in a NEPTUNE cohort of children with newly diagnosed nephrotic syndrome (cNEPTUNE). We hypothesized that ...hypertensive BP and dyslipidemia would persist in children with nephrotic syndrome, regardless of steroid treatment response.
Methods
A multi-center longitudinal observational analysis of data obtained from children < 19 years of age with new onset nephrotic syndrome enrolled in the Nephrotic Syndrome Study Network (cNEPTUNE) was conducted. BP and lipid data were examined over time stratified by disease activity and steroid exposure. Generalized estimating equation regressions were used to find determinants of hypertensive BP and dyslipidemia.
Results
Among 122 children, the prevalence of hypertensive BP at any visit ranged from 17.4% to 57.4%, while dyslipidemia prevalence ranged from 40.0% to 96.2% over a median of 30 months of follow-up. Hypertensive BP was found in 46.2% (116/251) of study visits during active disease compared with 31.0% (84/271) of visits while in remission. Dyslipidemia was present in 88.2% (120/136) of study visits during active disease and in 66.0% (101/153) while in remission. Neither dyslipidemia nor hypertensive BP were significantly different with/without medication exposure (steroids and/or CNI). In regression analysis, male sex and urine protein:creatinine ratio (UPC) were significant determinants of hypertensive BP over time, while eGFR was found to be a determinant of dyslipidemia over time.
Conclusions
Results demonstrate persistent hypertensive BPs and unfavorable lipid profiles in the cNEPTUNE cohort regardless of remission status or concurrent steroid or calcineurin inhibitor treatment.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information
The role of albuminuria as an indicator of progression has not been investigated in children with CKD in the absence of diabetes.
Children were enrolled from 49 centers of the CKD in Children study ...between January of 2005 and March of 2014. Cross-sectional multivariable linear regression (
=647) was used to examine the relationship between urine protein-to-creatinine (UP/C milligrams per milligram) and albumin-to-creatinine (ACR milligrams per gram) with eGFR (milliliters per minute per 1.73 m
). Parametric time-to-event analysis (
=751) was used to assess the association of UP/C, ACR, and urine nonalbumin-to-creatinine (Unon-alb/cr milligrams per gram) on the time to the composite endpoint of initiation of RRT or 50% decline in eGFR.
The median follow-up time was 3.4 years and 202 individuals experienced the event. Participants with a UP/C≥0.2 mg/mg and ACR≥30 mg/g had a mean eGFR that was 16 ml/min per 1.73 m
lower than those with a UP/C<0.2 mg/mg and ACR<30 mg/g. Individuals with ACR<30 mg/g, but a UP/C≥0.2 mg/mg, had a mean eGFR that was 9.3 ml/min per 1.73 m
lower than those with a UP/C<0.2 mg/mg and ACR<30 mg/g. When categories of ACR and Unon-alb/cr were created on the basis of clinically meaningful cutoff values of UP/C with the same sample sizes for comparison, the relative times (RTs) to the composite end-point were almost identical when comparing the middle (RT=0.31 for UP/C 0.2-2.0 mg/mg, RT=0.38 for ACR 56-1333 mg/g, RT=0.31 for Unon-alb/cr 118-715 mg/g) and the highest (RT=0.08 for UP/C >2.0 mg/mg, RT=0.09 for ACR >1333 mg/g, RT=0.07 for Unon-alb/cr >715 mg/g) levels to the lowest levels. A similar trend was seen when categories were created on the basis of clinically meaningful cutoff values of ACR (<30, 30-300, >300 mg/g).
In children with CKD without diabetes, the utility of an initial UP/C, ACR, and Unon-alb/cr for characterizing progression is similar.
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