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Normal saline (N/S) and Ringer’s-Lactate (L/R), are administered in everyday clinical practice. Despite that, N/S increases the risk of sodium overload and hyperchloremic metabolic acidosis. In contrast, L/R has lower sodium content, significantly less chloride and contains lactates. In this study we compare the efficacy of L/R versus N/S administration in patients with prerenal acute kidney injury (AKI) and pre-established chronic kidney disease (CKD).

BACKGROUND Increased aortic blood pressure (BP) and arterial stiffness are associated with higher cardiovascular risk in hemodialysis. Previous works showed that lower dialysate sodium is associated with lower brachial-BP; data on aortic-BP and arterial stiffness are limited. This study aimed to investigate the effects of different dialysate sodium concentrations on 72-hour aortic-BP and arterial stiffness parameters in hemodialysis patients. METHODS This analysis is part of a prospective, non-randomized interventional study. Twenty-five hemodialysis patients underwent a set of 3 periods of different dialysate sodium concentrations; 6 sessions with dialysate sodium of 137 mEq/l, followed consecutively by 6 sessions with 139 mEq/l and, finally, 6 sessions with 141 mEq/l. At the start of the sixth hemodialysis session on each sodium concentration, 72-hour ABPM (Mobil-O-Graph) was performed to evaluate aortic-BP and arterial stiffness indices during the overall 72-hour, different 24-hour, daytime, and nighttime periods. RESULTS Mean 72-hour aortic systolic blood pressure (SBP)/diastolic blood pressure (DBP) were higher with increasing dialysate sodium concentrations (137 mEq/l: 114.2 ± 15.3/77.0 ± 11.8 mm Hg vs. 139 mEq/l: 115.4 ± 17.3/77.9 ± 14.0 mm Hg vs. 141 mEq/l: 120.5 ± 18.4/80.5 ± 14.7 mm Hg, P  = 0.002/ P  = 0.057, respectively). Wave-reflection parameters (AIx, AIx(75), AP) were not significantly different between the 3 dialysate sodium concentrations. Ambulatory pulse wave velocity (PWV) was significantly higher with increasing dialysate sodium concentrations (137 mEq/l: 8.5 ± 1.7 m/s vs. 139 mEq/l: 8.6 ± 1.6 m/s vs. 141 mEq/l: 8.8 ± 1.6 m/s, P  < 0.001). In generalized linear mixed models including 72-hour brachial SBP as a random covariate, the adjusted marginal means of 72-hour PWV were not significantly different between groups. CONCLUSIONS This study showed that higher dialysate sodium concentrations are associated with significant increases in ambulatory aortic BP and PWV. These findings further support the need for modification of dialysate sodium concentration in hemodialysis. [ABSTRACT FROM AUTHOR]

Background/Objective: Primary Focal and Segmental glomerulosclerosis (FSGS) is one of the most common causes of idiopathic nephrotic syndrome. Our aim was to describe a large cohort of patients with primary FSGS, identify risk factors associated with worse renal survival and assess the impact of different immunosuppressive regiments on renal survival. Methods: This was a historical cohort study of adults who were diagnosed with primary FSGS from March 26, 1982, to September 16, 2020. The primary outcome was progression to ESRD. Results: We included 579 patients. The mean age was 46 (±15) years of age, with 378 (65%) males and median 24-hour proteinuria was 3.8 (2–6) g. In multivariable analysis only eGFR (HR: 0.97 per ml/min increase, 95% CIs 0.95–0.98) and remission status (complete remission (HR: 0.03, 95% CIs 0.003–0.22) and partial remission (HR: 0.28, 95% CIs 0.13–0.61) compared to no remission) were associated with renal survival. Among patients who received immunosuppression compared to those that did not, there was a higher percentage of complete remission (121 (41%) vs. 40 (24%), p<0.001), and higher percentage of relapses (135 (64%) vs. 27 (33%), p<0.001). Immunosuppression and its type (glucocorticoids vs. cyclosporine ± glucocorticoids) were not associated with renal survival. Conclusion: In primary FSGS, complete and partial remission were associated with improved renal survival. Further randomized studies are needed to assess the efficacy of different therapeutic agents and guide treatment. [ABSTRACT FROM AUTHOR]

Chronic antibody-mediated rejection in kidney transplantation is a common cause of graft loss in the late post-transplant period. In this process, the role of the classical complement activation pathway is crucial due to the formation of immune complexes between donor-specific antibodies (DSAs) and donor antigens and the attachment of the C1q complement fragment. This study aimed to determine the levels of circulating C1q immunocomplexes (CIC-C1q) and complement activation (CH50), in sensitized kidney transplant recipients (KTRs). In this cross-sectional study we used serum samples from KTRs with de novo or preformed DSAs (n = 14), KTRs without DSAs (n = 28), and 22 subjects with no history of chronic kidney disease (controls). C1q immunocomplexes and CH50 concentration in serum were measured with the enzyme immunoassay (EIA) kit MicroVue CIC-C1q (Quidel, Athens, OH, USA) and EIA kit MicroVue CH50 (Quidel, OH, USA), respectively. Higher concentrations of CIC-C1q was observed in KTRs with DSAs in comparison with controls and with KTRs with no DSAs (6.8 ± 2.7 and 4.8 ± 1.9 vs. 5.0 ± 1.2 μg Eq/mL, respectively, p < 0.01). We found no difference in CIC-C1q between KTRs with no DSAs and controls. CIC-C1q levels were positively correlated with DSA titer. CH50 levels were decreased in KTRs with DSAs in comparison with controls and KTRs with no DSAs (39 ± 15 vs. 68 ± 40 and 71 ± 34 U Eq/mL, respectively, p < 0.01). There was no difference in CH50 between DSA-negative KTRs and controls. Kidney transplant recipients with DSAs had increased serum levels of C1q immunocomplexes and increased classical pathway complement activation. [ABSTRACT FROM AUTHOR]

Background Hypertension is associated with increased morbidity and mortality in hemodialysis patients. Existing recommendations suggest reduction of sodium load, but the effect of dialysate sodium on blood pressure (BP) is not fully elucidated. The aim of the present study is to investigate the effect of different dialysate sodium concentrations on 72-h ambulatory BP in hemodialysis patients. Methods This prospective study included patients on standard thrice-weekly hemodialysis. All patients initially underwent six sessions with dialysate sodium concentration of 137 meq/L, followed consecutively by another six sessions with dialysate sodium of 139 meq/L and, finally, six sessions with dialysate sodium of 141 meq/L. At the start of the sixth hemodialysis session on each sodium concentration, 72-h ABPM was performed over the long interdialytic interval to evaluate ambulatory systolic and diastolic BP (SBP and DBP) during the overall 72-h, different 24-h, daytime and night-time periods. Results Twenty-five patients were included in the final analysis. A significant increase in the mean 72-h SBP was observed with higher dialysate sodium concentrations (124.8 ± 16.6 mmHg with 137 meq/L vs 126.3 ± 17.5 mmHg with 139 meq/L vs 132.3 ± 19.31 mmHg with 141 meq/L, P = 0.002). Similar differences were noted for DBP; 72-h DBP was significantly higher with increasing dialysate sodium concentrations (75.1 ± 11.3 mmHg with 137 meq/L vs 76.3 ± 13.7 mmHg with 139 meq/L vs 79.5 ± 13.9 mmHg with 141 meq/L dialysate sodium, P = 0.01). Ambulatory BP during the different 24-h intervals, daytime and night-time periods was also progressively increasing with increasing dialysate sodium concentration. Conclusion This pilot study showed a progressive increase in ambulatory BP with higher dialysate sodium concentrations. These findings support that lower dialysate sodium concentration may help towards better BP control in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Background: Membranous nephropathy (MN) is an autoimmune disease in which circulating autoantibodies bind to a podocyte antigen, causing nephrotic syndrome. Despite several treatment options, their long-term benefits are still not established. The aim of this study is to investigate the long-term efficacy of cyclosporine and methylprednisolone in MN treatment. Methods: In this retrospective study, we included adults with biopsy-proven idiopathic MN. At diagnosis, all patients received conservative treatment, and those who did not show remission after 6 months received immunosuppression with cyclosporine and methylprednisolone. Those that despite no remission chose not to receive immunosuppression served as controls. Results: Sixty patients were included in the study with a follow-up of 94.8 ± 55.5 months. Forty-nine patients had nephrotic syndrome, and 47 received immunosuppression, while 13 received no treatment. Out of those who received immunosuppression, 63.8% showed complete, 14.9% partial, and 19.1% no remission of nephrotic syndrome. End-stage kidney disease (ESKD) or doubling of serum creatinine was reached by 12. Out of those who received no immunosuppression, 23.1% showed complete, 30.8% partial, and 23.1% had no remission. Doubling of serum creatinine or ESKD was reached by 1. Kidney survival was not altered by immunosuppression and was not different among those who received immunosuppression and had no or up to 3 relapses. Either complete or partial remission was accompanied by better kidney survival. Conclusion: Treatment of idiopathic MN with cyclosporine and methylprednisolone offers a reliable option for proteinuria remission. Nevertheless, this option does not alter long-term disease progression. [ABSTRACT FROM AUTHOR]

Introduction. Circulating autoantibodies against phospholipase A2 receptor (anti-PLA2R) are recognized as key elements in the pathogenesis of idiopathic membranous nephropathy. In current clinical practice, they are increasingly gaining attention as novel tools for diagnosis and disease monitoring. We investigated the diagnostic and prognostic utility of anti-PLA2R antibody measurements in Greek patients with biopsy-proven membranous nephropathy.

Background: High aldosterone levels contribute to kidney disease progression, while spironolactone in combination with ACEi or ARBs can potentially reduce proteinuria and ameliorate kidney function deterioration. However, evidence on the impact of eplerenone in patients with glomerulonephritis is scarce. Methods: In this prospective observational study, we assessed the effects of eplerenone in patients with biopsy-proven glomerulonephritis who were already treated with ACEi or ARBs. Patients received either eplerenone (25 mg daily) on top of ACEi or ARBs or standard treatment alone. Proteinuria (24 h total protein excretion), kidney function, blood pressure and serum K+ levels were assessed at 3, 6 and 12 months after the initiation of treatment. Results: Sixty-six patients were included in the study. Eplerenone was administered in 30 patients, while 36 received only ACEi or ARB. Proteinuria decreased from 1768 to 1152 mg/24 h after 1 year of eplerenone treatment, while it remained stable in controls. Eplerenone showed significant impact on proteinuria in those with baseline proteinuria of >1000 mg/24 h. Patients who received eplerenone showed a reduction in systolic blood pressure, while eGFR and serum K+ levels remained stable. Conclusions: Addition of eplerenone has a beneficial effect on proteinuria in patients with glomerulonephritis and significant baseline proteinuria. [ABSTRACT FROM AUTHOR]

The article in the American Journal of Hypertension discusses the impact of different dialysate sodium concentrations on blood pressure and arterial stiffness in hemodialysis patients. The study found that short-term changes in dialysate sodium levels may affect peripheral blood pressure but may not reflect structural changes in the arterial wall. Long-term implications on mortality were not within the scope of the study, and more research is needed to understand the relationship between sodium intake, hypertension, and cardiovascular risk in hemodialysis patients. The authors suggest that further studies, including magnetic resonance imaging of tissue sodium stores, could provide valuable insights for individualized sodium prescription in hemodialysis. [Extracted from the article]