1,721,054 research outputs found
Nonalcoholic fatty liver disease and the kidney: a review
Full text linkNonalcoholic fatty liver disease (NAFLD) is associated with several extrahepatic manifestations such as cardiovascular disease and sleep apnea. Furthermore, NAFLD is reported to be associated with an increased risk of incident chronic kidney disease (CKD). Inflammation and oxidative stress are suggested to be the key factors involved in the inflammatory mechanisms and pathways linking NAFLD to CKD and are responsible for both the pathogenesis and the progression of CKD in NAFLD patients. This review aims to provide a more comprehensive overview of the association between CKD and NAFLD, also considering the effect of increasing severity of NAFLD. A PubMed search was conducted using the terms “non-alcoholic fatty liver disease AND kidney”. In total, 537 articles were retrieved in the last five years and 12 articles were included in the qualitative analysis. Our results showed that CKD developed more frequently in NAFLD patients compared to those without NAFLD. This association persisted after adjustment for traditional risk factors and according to the severity of NAFLD. Therefore, patients with NAFLD should be considered at high risk of CKD. Intensive multidisciplinary surveillance over time is needed, where hepatologists and nephrologists must act together for better and earlier treatment of NAFLD patients
Association between non-alcoholic fatty liver disease and obstructive sleep apnea
Full text linkBackground: Non-alcoholic fatty liver disease (NAFLD) is an emerging liver disease and currently the most common cause of incidental abnormal liver tests. The pathogenesis of NAFLD is multifactorial and many mechanisms that cause fatty liver infiltration, inflammation, oxidative stress and progressive fibrosis have been proposed. Obstructive sleep apnea (OSA) may be linked with the pathogenesis and the severity of NAFLD.
Aim: To study the association between NAFLD and OSA considering also the efficacy of continuous positive airway pressure (CPAP) treatment.
Methods: A PubMed search was conducted using the terms "non-alcoholic fatty liver disease AND (obstructive sleep apnea OR obstructive sleep disorders OR sleep apnea)". Research was limited to title/abstract of articles published in English in the last 5 years; animal and child studies, case reports, commentaries, letters, editorials and meeting abstracts were not considered. Data were extracted on a standardized data collection table which included: First author, publication year, country, study design, number of patients involved, diagnosis and severity of OSA, diagnosis of NAFLD, patient characteristics, results of the study.
Results: In total, 132 articles were initially retrieved on PubMed search and 77 in the last five years. After removal of irrelevant studies, 13 articles were included in the qualitative analysis. There was a total of 2753 participants across all the studies with a mean age between 42 and 58 years. The proportion of males ranged from 21% to 87.9% and the mean body mass index ranged from 24.0 to 49.9 kg/m2. The results of this review showed an increased prevalence of NAFLD in patients with diagnosis of OSA, even in the absence of coexisting comorbidities such as obesity or metabolic syndrome. Furthermore, the severity of NAFLD is associated with the increase in OSA severity. Effective CPAP treatment, although not always decisive, may stabilize or slow NAFLD progression with benefits on metabolic and cardiovascular functions.
Conclusion: In NAFLD patients, although asymptomatic, it is recommended to systematically perform polysomnography in order to early and better treat them before the development of potentially life threatening systemic dysfunctions
Acute kidney injury in donation after circulatory death liver transplantation: UK single centre study
No full textaim: to assess the incidence and classification of acute kidney injury (AKI) after liver transplantation (LT).
methods: this is a retrospective single-centre study of 1151 patients who underwent LT at the university hospital Birmingham from 2007 to 2014. Exclusion criteria included: urgent (=66) and living donor (=7) transplantation. we considered: renal function pre-transplant and daily within one week post-transplant, characteristics of recipient, donor type (DCD vs.DBD), graft variables and indicators of initial graft function. AKI was defined and classified on the basis of KDIGO Guidelines (2012).
results: we considered 1078 LT patients (830 DBD and 248 DCD). DBD recipients had a significantly higher median MELD score (16.84 vs. 15.83, p=0.002) and serum bilirubin level (3.16 vs. 2.37, p<0.001) than DCD, whereas there were no differences in INR and serum creatinine values. furthermore, DBD had significant longer cold and recipient warm ischemia times than DCD (p<0.001 and p=0.018 respectively).
the incidence of AKI was 57.9% (624/1078 patients), of which 57.1% of
DBD (474/830) vs. 60.5% of DCD (150/248). AKI classification is reported in the table.
conclusion: we demonstrate a higher incidence of post-LT stage 3 AKI in DCD, despite a better pre-LT liver function due to patient selection, compared to DBD. compared to previous studies we note that both DBD and DCD recipients suffer a similar degree of stage 1-2 of AKI but the DCD experience more severe stage 3 AKI
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Metabolic syndrome but not fatty liver-associated genetic variants correlates with glomerular renal function decline in patients with non-alcoholic fatty liver disease
Full text linkThe association between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) has been extensively demonstrated. Recent studies have focused attention on the role of patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 polymorphism in the association between NAFLD and CKD in non-metabolic adults and children, but the genetic impact on NAFLD-CKD association is still a matter of debate. The aim of the study was to investigate the impact of PNPLA3, transmembrane 6 superfamily member 2 (TM6SF2), membrane-bound O-acyltransferase domain containing 7 (MBOAT7) and glucokinase regulatory protein (GCKR) gene variants rather than metabolic syndrome features on renal function in a large population of NAFLD patients. The present study is a post hoc analysis of the Plinio Study (ClinicalTrials.gov: NCT04036357). PNPLA3, TM6SF2, MBOAT7 and GCKR genes were analyzed by using real-time PCR with TaqMan probes. Glomerular filtration rate (GFR) was estimated with CKD-EPI. We analyzed 538 NAFLD; 47.2% had GFR < 90 mL/min/1.73 m2 while 5.9% had GFR < 60 mL/min/1.73 m2 . The distribution of geno-types was superimposable according to GFR cut-offs. Results from the multivariable regression model did not show any correlation between genotypes and renal function. Conversely, metabolic syndrome was highly associated with GFR < 90 mL/min/1.73 m2 (odds ratio (OR): 1.58 [1.10–2.28]) and arterial hypertension with GFR < 60 mL/min/1.73 m2 (OR: 1.50 [1.05–2.14]). In conclusion, the association between NAFLD and CKD might be related to the shared metabolic risk factors rather than the genetic NAFLD background
Gender disparities in vascular access and one-year mortality among incident hemodialysis patients: An epidemiological study in Lazio Region, Italy
No full text(1) Background: Interest in gender disparities in epidemiology, clinical features, prognosis and health care in chronic kidney disease patients is increasing. Aims of the study were to evaluate the association between gender and vascular access (arteriovenous fistula (AVF) or central venous catheter (CVC)) used at the start of hemodialysis (HD) and to investigate the association between gender and 1-year mortality. (2) Methods: The study includes 9068 adult chronic HD patients (64.7% males) registered in the Lazio Regional Dialysis Register (Jan 2008–Dec 2018). Multivariable logistic regression models were used to investigate the associations between gender and type of vascular access (AVF vs. CVC) and between gender and 1-year mortality. Interactions between gender and socio-demographic and clinical variables were tested adding the interaction terms in the final model. (3) Results: Females were older, had lower educational level and lower rate of self-sufficiency compared to males. Overall, CVC was used in 51.2% of patients. Females were less likely to use AVF for HD initiation than males. 1354 out of 8215 (16.5%) individuals died at the end of the follow-up period. Interaction term between gender and vascular access was significant in the adjusted model. From stratified analyses by vascular access, OR female vs. male (AVF) = 0.65; 95% CI 0.48–0.87 and OR female vs. male (CVC) = 0.88; 95% CI 0.75–1.04 were found. (4) Conclusion: This prospective population-based cohort study in a large Italian Region showed that in females starting chronic HD AVF was less common respect to men. The better 1-year survival of females is more evident among those women with AVF. Reducing gender disparity in access to AVF represents a key point in the management of HD patients
Recovery of renal function in liver transplant alone versus combined liver kidney transplantation: analysis from the NHSBT UK registry
Full text linkIntroduction and Aims: Recovery of renal function after liver transplantation is strongly influenced by pretransplant degree and duration of renal insufficiency, despite imprecise methods for measuring renal dysfunction. Indications for combined liver-kidney transplantation (CLKT) have been defined, but these are still under debate and hepatorenal syndrome (HRS) is a particularly challenging condition given the hardly predictable spontaneous improvement with liver transplant alone (LTA). Methods: We analysed data of 6035 patients (Jan 2001-Dec 2012) from NHSBT UK Transplant Registry. Renal function at 1 years after transplantation was compared between CLKT and LTA with stratification on the basis of glomerular filtration rate (eGFR) at transplant (KDIGO Guidelines) and treatment with renal replacement therapy (RRT). Renal function post-transplantation was classified as eGFR >60, between 59-30 and <30 ml/min/1.73m2, the latter identified as non recovery of renal function. Univariate and multivariable analysis were performed.
Results: 5912 patients (98.0%) underwent liver transplant alone (LTA) and 123 (2.0%) patients received a CLKT. 305 (5.2%) of the LTA group were on RRT at time of transplantation, compared to 72 (58.5%) of the CKLT group. No patient with a MELD score <20 received RRT before transplant. No patients with eGFR ≥60 mL/min/1.73m2 received CLKT. 27% of patients receiving CLKT were diagnosed with pre-transplant glomerular/tubular kidney disease, 39% with polycystic disease and 34% were not specified. LTA patients on RRT were more frequently presenting ascites ( p<0.001), variceal bleeding ( p=0.002), higher MELD score ( p<0.001), higher INR ( p<0.001) and bilirubin at transplant ( p<0.001), suggesting the occurrence of HRS (data not available). Patients on RRT experience a significant difference of renal function recovery at 1 year post-transplant when receiving LTA versus CLKT, with the latter group experiencing a higher percentage of non-recovery ( p=0.001; table 1). This difference was not detected for other eGFR stratifications.The univariate analysis identified recipient age >50 years, female gender, RRT in patients with MELD >20, polycystic disease and diabetes as predictive factors for non-recovery of renal function in patients undergoing LTA. In a multivariable model including all clinically relevant variables simultaneously, the independent predictors of renal function non-recovery were female gender (HR 2.76; 95% CI 1.52-4.99, p=0.001), RRT in patients with MELD >20 (HR 3.62; 95% CI 1.44-9.08, p=0.006) and diabetes (HR 2.55; 95% CI 1.38-4.73, p=0.003).
Conclusions: Recovery of renal function post-LTA is acceptable for patients with different stratifications of eGFR pre-transplant. RRT, female gender and diabetes may suggest to perform CLKT
Acute kidney injury and chronic kidney disease in donation after circulatory death liver transplantation: UK single centre study
No full textAim of the study is to assess the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD) after liver transplantation (LT) in DCD vs. DBD recipients. Methods: this is a retrospective single-centre study of 1151 patients who underwent LT from 2007 to 2014. Exclusion criteria: urgent (=66) and living donor (=7) LT. We considered: renal function pre-LT, daily within one week post-operatively, at 1, 3, 4, 6, 9 months and 1, 3, 5 years post-LT, characteristics of recipient, donor type, graft variables and indicators of initial graft function. AKI and CKD defined and classified on the basis of KDIGO Guidelines (2012).
Results: we considered 1078 LT patients (830 DBD and 248 DCD). DBD recipients had a higher MELD (p=0.002) and pre-LT serum bilirubin level (p<0.001) than DCD but there were no differences in INR and serum creatinine values. DBD recipients had longer cold and recipient warm ischemia times than DCD (p<0.001 and p=0.018 respectively). The incidence of AKI was 57.9% (624/1078), of which 57.1% of DBD (474/830) vs. 60.5% of DCD (150/248). DCD recipients had a higher incidence of stage 3 AKI than DBD (20.6% vs. 12.7%, p=0.0197). Among patients with stage
3 AKI DCD had a higher cumulative incidence of CKD compared to DBD (SHR 1.6 (1.0-2.7), p=0.051).
Conclusion: For the first time we showed that both DBD and DCD recipients suffer a similar degree of stage 1-2 of AKI, but the DCD experience more severe stage 3 AKI, which is associated with a higher incidence of CKD in the long-term follow-up
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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