Nephrology (Renal)

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WCN23-0177 Acute Kidney Injury in Scleroderma – It's Not Always Renal Crisis
(Elsevier, 2023-03-20) Brown, Alastair; Singh, Arvind; Moodley, Praneshan; Cornish, Thomas; Brown, Alastair; Singh, Arvind; Moodley, Praneshan; Cornish, Thomas; Medical and Dental
Introduction: We present an interesting case of ANCA positive vasculitis in the context of systemic sclerosis (SS). This case is notable, as ANCA positive vasculitis and scleroderma renal crisis (SRC) are serious complications of SS. They can present similarly but are managed differently. We highlight the importance of considering pauci-immune glomerulonephritis (GN) in the context of SS. A 48-year-old male was referred due to rising creatinine on routine monitoring blood tests in September 2022. He had a background of limited cutaneous SS, scleroderma-associated pulmonary fibrosis and type two diabetes. Medications included mycophenolate mofetil (MMF), co-trimoxazole, losartan, omeprazole, prednisolone, nintedanib and salbutamol. He was treated for SS with rituximab and cyclophosphamide in 2009. On further questioning, he experienced symptoms of a lower respiratory tract infection, including fevers, shortness of breath and cough, two weeks previous to the blood test. On review, however, these symptoms had settled. He also complained of recurrent episodes of epistaxis a few months. His eGFR had dropped to 45 ml/min/1.73m2 from a baseline of 88 ml/min/1.73m2 in June 2022. Creatinine was 156 micromol/l from a baseline of 89 micromol/l. Method(s): We have compiled this case study by using the patient's clinical notes. Result(s): On examination, he was euvolaemic. His blood pressure was 124/83. There were non-blanching erythematous patches on the palmar aspect of his hands bilaterally. (image. 1). An ultrasound scan of his renal tract showed kidney sizes of 11.5cm on the right and 11.1cm on the left. There was no evidence of hydronephrosis. Urine dip was performed showing significant haemoproteinuria (3+blood & 3+ protein). His urinary albumin creatinine ratio was 172.2 mg/mmol, CRP was 48 mg/l, haemolytic anaemia screen was normal and his anti-neutrophil cytoplasmic antibody (ANCA) was positive with a raised myeloperoxidase (MPO) titre of 74.9 U/ml (normal range 0-9 U/ml). GBM antibody was negative. He was commenced on intravenous methylprednisolone and booked for a renal biopsy. Biopsy showed pauci-immune crescentic necrotising GN with no evidence of thrombotic microangiopathy. He was given rituximab 1gm infusions (2 doses day '0' & day '14') and by the end of October, his renal function had improved to 39 ml/min/1.73m2 from a nadir of 31 ml/min/1.73m2. [Formula presented] Conclusion(s): SS is a multisystem disorder and commonly affects the kidney. Renal impairment associated with SS includes nephritis due to the use of nonsteroidal anti-inflammatory drugs, heart failure causing cardiorenal syndrome or dehydration due to alimentary tract involvement of SS. Scleroderma renal crisis (SRC) is a severe syndrome and occurs in 5-20% of patients with diffuse systemic sclerosis. It commonly presents with hypertension, acute kidney injury (AKI) and an unremarkable urine dip. It can progress to end stage renal failure and is treated primarily with angiotensin converting enzyme inhibition. Conversely, there is an association with ANCA positive vasculitis and SS. It can also present with hypertension and AKI. Here we highlight the diagnostic uncertainty of AKI in the context of SS and the importance of investigating with biopsy for vasculitis in selected patients.
WCN23-0175 Improving SGLT-2 prescribing in CKD patients at a regional English hospital: A quality improvement project
(Elsevier, 2023-03-20) Brown, Alastair; Macinnes, Poppy; Wales, Emily; Ffrench, Ruby; Brown, Alastair; Medical and Dental
Introduction: A recent trial in the New England Journal of Medicine reported significantly improved cardiovascular mortality, eGFR decline rate and progression to end stage renal failure in patients with chronic kidney disease (CKD) and albuminuria taking dapagliflozin versus placebo. The improvement was reported in both diabetic and non-diabetic patients. Subsequently, the National Institute for Health and Care Excellence (NICE) updated its guidelines in March 2022 recommending SGLT-2 inhibitors for patients with CKD and either diabetes or significant albuminuria (albumin-to-creatinine ratio [ACR] of 22.6 mg/mmol or more). The aim of this quality improvement project was to identify and improve the compliance rate of SGLT-2 prescribing in appropriate patients in our hospital. Method(s): We reviewed data for patients with CKD who were discharged from 09/03/2022 to 16/03/2022 from our institution (a district general hospital in England). We assessed whether they were appropriately prescribed SGLT-2 inhibitors based on NICE guidelines. Patients with an allergy or contraindications to SGLT-2s were excluded. Our primary outcome measure was the percentage of patients correctly prescribed dapagliflozin. We then performed an intervention to increase the rate of compliance. This consisted of stakeholder education in secondary care. In selected patients, we advised colleagues to prescribe dapagliflozin or to educate primary care to initiate treatment via discharge summaries. This was achieved via presentations at a local Grand Round meeting, junior doctor teaching sessions and educational posters in clinical areas. Subsequently, we re-reviewed the appropriate prescription rate from 25/04/2022 to 01/05/2022. Result(s): The proportion of eligible patients correctly prescribed an SGLT-2 inhibitor in the pre-intervention group was 7% (1/14). This improved in the post-intervention group to 26% (5/19). There were 35 patients in total who were excluded due to an untested urinary albumin-creatinine ratio. Conclusion(s): This quality improvement project has reported low compliance rates with SGLT-2 prescriptions in eligible patients in our institution. However, there was a noticeable increase in compliance following a local education program. There is clearly significant further scope for improvement. Causes for the shortfall may include: a lack of knowledge in primary care, the relatively recent publication of guidelines and the fact that not all eligible patients are reviewed by nephrologists. These findings show the power of education in enacting evidence-based change in a healthcare setting. Extrapolating these findings, it is likely that more stakeholder education is required nationally in primary and secondary care. The involvement of diabetic specialist nurses is a potential avenue to increase prescription rates in patients with diabetic nephropathy. Further work with primary care is also needed to increase the rates of ACR measurements in CKD patients as it is crucial to guide management and prognosis. No conflict of interest
POS-020 quality control results from StatSensor Xpress™ point-of-care creatinine meter under real-world usage
(Elsevier, 2021-04) Fredlund, Martyn; Nyawo, Mncedisi; Hamilton, Alexander; Rocco, Michael; Cullis, Brett; Fredlund, Martyn; Medical and Dental
Introduction The International Society of Nephrology’s (ISN) 0 by 25 policy aims to eliminate preventable deaths from acute kidney injury (AKI) worldwide by 2025. One of the barriers to this aim is detection of AKI in a timely fashion prior to developing complications. The ISN Kidney Care Network (KCN) project is trialling the use of AKI screening and point of care (POC) creatinine testing to expedite detection of AKI. POC testing is increasingly used with glucometers and haemoglobin measurement but creatinine has remained primarily a lab based test. Recently, several POC creatinine meters have become available1. Studies these have shown appropriate detection of AKI but mixed correlation with lab results2, 3. The promise of hand-held creatinine results to allow rapid detection of AKI has led to their inclusion in the KCN study including the South African site which is described below 4 We aimed to determine if the StatSensor XpressTM POC creatinine meter quality control results remained consistent with the manufacturer’s target range, and variability was appropriate despite the extreme conditions associated with extended use in rural clinics. Methods Over a 6 month period of the Kidney Care Network project in Mseleni, South Africa investigators collected weekly quality control readings from 7 StatSensor XpressTM creatinine meters tested against two control serums (Nova Linearity solutions C1 and C3) provided by the manufacturer. C1 has a creatinine of 84 μmol/L with an acceptable range of 44 to 120 and C3 has a creatinine of 530 μmol/L with an acceptable range of 398 to 630. Results Accuracy: We calculated the difference for each sample compared to the reference mean and then worked out the bias and the limits of agreement (1.96 times SD) C1 bias is 4.3 +/- 24.4 and C3 bias is -35.5 +/- 136.4. Results outside reference range: C1 151/156 results were within reference range of 44 to 120 (96.79%), limits 39-132. C3 147/156 results were within the reference range of 398 to 630 (94.23%), limits 338-638. Change over time: The C1 difference is normally distributed and a regression model of the c1 difference against time is significant (coefficient -0.05, 95% CI -0.09, -0.01), p=0.01), implying the mean difference fell over time (by -0.05/day over the study period). The C3 difference is not normally distributed. Modelling data as linear showed significant association with time (coefficient -0.61, 95% CI -0.82, -0.41, p<0.0001). Conclusions The results overall showed reasonable accuracy consistent with previous studies on this meter, these meet some but not all of the rigorous standards set for laboratory based testing. During the study on several occasions the solution and or the test strips were left outside of fridges for extended periods due to human error, and on two occasions there were powercuts leading to loss of the cold chain. Variability over time could be expected due to degradation of the strips, the control solution, or the machine itself, especially when subjected to harsh environments of the study field. Results are encouraging that despite time exposed to these conditions there was decreased variation from the target value, thought this could be explained by regression to the mean. Reassuringly, in none of our cases did the meter provide a normal result from C3, in keeping with its current use as a screening tool for detection of severe AKI.
A woman with acute dyspnoea
(BMJ Publishing Group, 2020-01-30) Zhou, Qiaoling; Potluri, Madhu; Zhou, Qiaoling; Potluri, Madhu; Medical and Dental
No abstract available
The ASK trial: a randomised controlled feasibility trial and process evaluation of a complex multicomponent intervention to improve AccesS to living-donor Kidney transplantation
(Taylor and Francis, 2024-10-29) Bailey, Pippa; Caskey, Fergus; Babu, Adarsh; Ashford, Rachel; Pryce, Lindsay; Selman, Lucy; Kayler, Liise; Ben-Shlomo, Yoav; Babu, Adarsh; Medical and Dental
Background: Following identification of barriers to living-donor kidney transplantation, and subsequent development of a multicomponent intervention, we undertook a feasibility trial of the intervention. Trial design: Two-arm, parallel group, pragmatic, individually-randomised, controlled, feasibility trial, comparing the new intervention with usual care, with a mixed-methods parallel process evaluation. Based at two UK hospitals. Participants: Individuals were eligible if ≥18 years old, active on the kidney transplant waiting list or had been referred for transplant listing without a contraindication to transplantation. Individuals with a living-donor undergoing surgical assessment were excluded. Intervention: i) A meeting between a home educator for a dedicated discussion about living-donor kidney transplantation, living kidney donation and potential donors;ii) A standardized letter from a healthcare professional to a candidate's potential donors;iii) A home-based education and family engagement session undertaken by a living kidney donor and a nurse specialist. Objective: To establish the acceptability and feasibility i) of delivering the developed intervention in existing care pathways, and ii) of undertaking a randomised controlled trial of the intervention. Primary outcomes: Recruitment and retention. Randomisation: Participants were randomly allocated 1:1 to i) the intervention or ii) usual care, stratified by site. Minimisation was used to ensure balance in sex, age group, and socioeconomic strata, with probability weighting of 0.8. Results: 183 people were invited to participate. 62 people (34% recruitment) were randomised. 62/62 (100%) completed nurse assessed follow-up at 6 weeks. 51/62 (82%) completed follow-up questionnaires. 3/30 (10%) in the usual care arm and 9/32 (28%) in the intervention arm had individuals ask to be tested for living kidney donation following recruitment to the trial. Conclusions: Intervention and trial delivery are feasible and acceptable. Findings have informed the design of an effectiveness and cost-effectiveness trial. Trial registration: ISRCTN Registry ISRCTN10989132 https://doi.org/10.1186/ISRCTN10989132. The trial was registered on 6/11/2020.
Individualised Predictions of the Survival Benefit Due to Adjuvant Therapy in a Randomised Trial of Sorafenib after Nephrectomy for Localised Renal Cell Carcinoma
(SAGE Publications, 2020-12-12) Lawrence, Nicola; Martin, Andrew; Davis, Ian; Troon, Simon; Sengupta, Shomik; Hovey, Elizabeth; Coskinas, Xanthi; Kaplan, Richard; Smith, Benjamin; Ritchie, Alastair; Meade, Angela; Ritchie, Alastair; Medical and Dental
BACKGROUND: Little has been published regarding how doctors think and talk about prognosis and the potential benefits of adjuvant therapy. OBJECTIVE: We sought predictions of survival rates and survival times, for patients with and without adjuvant therapy, from the clinicians of patients participating in a randomised trial of adjuvant sorafenib after nephrectomy for renal cell carcinoma. METHODS: A subset of medical oncologists and urologists in the SORCE trial completed questionnaires eliciting their predictions of survival rates and survival times, with and without adjuvant sorafenib, for each of their participating patients. To compare predictions elicited as survival times versus survival rates, we transformed survival times to survival rates. To compare predicted benefits elicited as absolute improvements in rates and times, we transformed them into hazard ratios (HR), a measure of relative benefit. We postulated that a plausible benefit in overall survival (OS) should be smaller than that hypothesized for disease–free survival (DFS) in the trials original sample size justification (i.e. HR for OS should be ≥ 0.75). RESULTS: Sixty–one medical oncologists and 17 urologists completed questionnaires on 216 patients between 2007 and 2013. Predictions of survival without adjuvant sorafenib were similar whether elicited as survival rates or survival times (median 5–year survival rate of 61% vs 60%, p = 0.6). Predicted benefits of sorafenib were larger when elicited as improvements in survival rates than survival times (median HR 0.76 vs 0.83, p < 0.0001). The proportion of HR for predicted OS with sorafenib that reflected a plausible benefit (smaller effect of sorafenib on OS than hypothesized on DFS, i.e. HR ≥ 0.75) was 51% for survival rates, and 65% for survival times. CONCLUSIONS: The predicted benefits of adjuvant sorafenib were larger when elicited as improvements in survival rates than as survival times, and were often larger than the sample size justification for the trial. These potential biases should be considered when thinking and talking about individual patients in clinical practice, and when designing clinical trials.
Expectations of a new opt-out system of consent for deceased organ donation in England: A qualitative interview study
(Wiley, 2021-12-24) Bailey, Pippa; Lyons, Hannah; Caskey, Fergus; Ben-Shlomo, Yoav; Al-Talib, Mohammed; Babu, Adarsh; Selman, Lucy; Babu, Adarsh; Medical and Dental
Introduction: In 2020 England moved to an opt-out deceased donation law. We aimed to investigate the views of a mixed stakeholder group comprising people with kidney disease, family members and healthcare practitioners towards the change in legislation. We investigated the expected impacts of the new legislation on deceased-donor and living-donor transplantation, and views on media campaigns regarding the law change. Methods: We undertook in-depth qualitative interviews with people with kidney disease (n = 13), their family members (n = 4) and healthcare practitioners (n = 15). Purposive sampling was used to ensure diversity for patients and healthcare practitioners. Family members were recruited through snowball sampling and posters. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results: Three themes with six subthemes were identified: (i) Expectations of impact (Hopeful patients; Cautious healthcare professionals), (ii) Living-donor transplantation (Divergent views; Unchanged clinical recommendations), (iii) Media campaigns (Single message; Highlighting recipient benefits). Patients expected the law change would result in more deceased-donor transplant opportunities. Conclusions: Clinicians should ensure patients and families are aware of the current evidence regarding the impact of opt-out consent: expectations of an increased likelihood of receiving a deceased-donor transplant are not currently supported by the evidence. This may help to prevent a decline in living-donor transplantation seen in other countries with similar legislation. Media campaigns should include a focus on the impact of organ receipt.
Experience with placing peritoneal dialysis catheters in the iliac fossa in cases of frozen pelvis
(Sage, 2021-08-06) Fredlund, Martyn; Van Niekerk, Henry; Cullis, Brett; Fredlund, Martyn; Medical and Dental
Peritoneal dialysis (PD) is a modality frequently preferred by patients for the management of their end-stage kidney disease; however, a major factor in its success is PD catheter placement and subsequent function. Optimal placement of PD catheters is generally accepted to be in the true pelvis, for this reason, many patients who are found to have a pelvic cavity obliterated by adhesions are often denied the opportunity to do PD. We report on four cases of an alternative advanced laparoscopic technique used in patients with inaccessible pelvic cavities, with three catheter placements in the intraperitoneal left iliac fossa/paracolic gutter and one case in the right paracolic gutter with subsequent good outcomes. This report suggests that a 'frozen pelvis' is not a contraindication to successful PD, with alternative catheter tip placement in the iliac fossa.
Development of an intervention to improve access to living-donor kidney transplantation (the ASK study)
(Public Library of Science, 2021-06-25) Bailey, Pippa; Ben-Shlomo, Yoav; Caskey, Fergus; Al-Talib, Mohammed; Lyons, Hannah; Babu, Adarsh; Kayler, Liise; Selman, Lucy; Babu, Adarsh; Medical and Dental
A living-donor kidney transplant (LDKT) is one of the best treatments for kidney failure. The UK’s LDKT activity falls behind that of many other countries, and there is evidence of socioeconomic inequity in access. We aimed to develop a UK-specific multicomponent intervention to support eligible individuals to access a LDKT. The intervention was designed to support those who are socioeconomically-deprived and currently disadvantaged, by targeting mediators of inequity identified in earlier work. We identified three existing interventions in the literature which target these mediators: a) the Norway model (healthcare practitioners contact patients’ family with information about kidney donation), b) a home education model, and c) a Transplant candidate advocate model. We undertook intervention development using the Person-Based Approach (PBA). We performed in-depth qualitative interviews with people with advanced kidney disease (n = 13), their family members (n = 4), and renal and transplant healthcare practitioners (n = 15), analysed using thematic analysis. We investigated participant views on each proposed intervention component. We drafted intervention resources and revised these in light of comments from qualitative ‘think-aloud’ interviews. Four general themes were identified: i) Perceived cultural and societal norms; ii) Influence of family on decision-making; iii) Resource limitation, and iv) Evidence of effectiveness. For each intervention discussed, we identified three themes: for the Norway model: i) Overcoming communication barriers and assumptions; ii) Request from an official third party, and iii) Risk of coercion; for the home education model: i) Intragroup dynamics; ii) Avoidance of hospital, and iii) Burdens on participants; and for the transplant candidate advocates model: i) Vested interest of advocates; ii) Time commitment, and iii) Risk of misinformation. We used these results to develop a multicomponent intervention which comprises components from existing interventions that have been adapted to increase acceptability and engagement in a UK population. This will be evaluated in a future randomised controlled trial.
Urinary tract obstruction
(Sage, 2022-03-02) Wilson, Jacob; Farrow, Emily; Holden, Charles; Farrow, Emily; Medical and Dental
An obstruction may occur anywhere along the urinary tract from the kidney to the urethral meatus. There is a wide range of causes, from benign to malignant, and the ensuing obstruction may develop acutely or more insidiously over weeks to months. Given this variability, symptoms and signs alter depending on the underlying disease process. Knowledge of the anatomy and pathophysiology of the disease process enables prompt recognition and management of common conditions that result in urinary tract obstruction.
POS-718 Case of Kocuria spp. induced peritoneal dialysis related peritonitis
(Elsevier, 2022-02-18) Tuck, Alexander; Singh, Arvind; Ryder, Sarah; Polturi, Madhu; Fredlund, Martyn; Tuck, Alexander; Singh, Arvind; Ryder, Sarah; Polturi, Madhu; Fredlund, Martyn; Medical and Dental; Nursing and Midwifery Registered
Introduction Peritonitis is a serious complication of peritoneal dialysis (PD) and is commonly caused by coagulase negative staphylococcal species and staphylococcus aureus. PD related peritonitis contributes to death in up to 8.6% of patients and often results in transition to haemodialysis. In this case we illustrate a rare presentation of Kocuria causing recurrent, treatment resistant peritonitis that resulted in eventual cessation of PD and switch to haemodialysis. Kocuria species are commonly found as skin commensals on human and other mammal skin and rarely cause systemic infections in humans. Despite only 12 case reports of Kocuria induced peritonitis in patients undergoing PD having been reported, Kocuria is increasingly being recognised as an important pathogen in humans. Methods We describe an 84 year old woman with end stage renal failure of an unknown aetiology who was commenced on PD in 2016. Results The patient was maintained on PD until November 2019 where she was admitted with Acinetobacter induced peritonitis that was treated with oral quinolones. In March 2021 she was admitted again with Kocuria Spp. induced peritonitis where she was treated with intraperitoneal vancomycin and oral ciprofloxacin. Despite displaying adequate sensitivities to these antibiotics, Kocuria Spp. continued to be cultured from her peritoneal fluid. As medical management of her peritonitis failed her PD line was removed in April 2021 and she was commenced on haemodialysis. Conclusions This case is a good example of a rare microbe causing PD related peritonitis that, despite displaying wide ranging sensitives during laboratory testing, was resistant to intraperitoneal antibiotics. This case adds to the growing literature suggesting that Kocuria Spp. are important causative organisms of human disease and should be considered when designing treatment pathways for peritoneal dialysis related peritonitis.
Trends in systematic reviews of kidney transplantation: A 10-year analysis of the evidence base
(Elsevier, 2023-04-05) Salih, Sarah; O'Callaghan, John; Salih, Marwah; Walker, James; Magar, Reshma; Knight, Simon; Pengel, Liset; Walker, James; Medical and Dental
Background Systematic reviews (SRs) are the highest form of evidence for all types of clinical questions in evidence-based practice. For the first time in 2018, the number of SRs in transplantation outstripped those from randomised controlled trials (RCTs). This raises concerns of duplication or increased use of non-RCT evidence. We aimed to analyse the trends, strength and quality of SRs in kidney transplantation over a 10-year period. Methods SRs in kidney transplantation were identified from the Transplant Library, without language restriction. All full-text citations were exported to a custom Research Electronic Data Capture (REDCap) database prior to evaluation. Quality of evidence in all included SRs was assessed using AMSTAR-2. Results We included 454 SRs, of which, only three were scored as ‘high quality’. We found that 96.70% of SRs were identified as ‘critically low quality’, which increased in number over time. We also found that inclusion of non-RCT data increased in the most recent 5 years. Only 14.12% of SRs had made a clear recommendation for practice. Conclusions This review highlights several concerning statistics that need to be addressed. In the last 10 years, only three SRs in kidney transplantation were ‘high-quality’. The weaknesses identified in critical domains, alongside the increased use of non-RCT data and lack of conclusive recommendations undermines the confidence in the results of the SRs and purpose of publication. As these SRs are instrumental to clinical decision-making and patient care in kidney transplantation, we advocate for improved reporting quality among SRs in kidney transplantation.
The in vitro C3d generating attribute of HLA-specific antibodies can be used to stratify immune risk in HLA incompatible transplantation by predicting the clinical efficacy of desensitisation
(Wiley, 2023-08-21) Daga, Sunil; Khovanova, Natasha; Babu, Adarsh; Krishnan, Nithya; Briggs, David; Babu, Adarsh; Medical and Dental
No abstract available
Developing a Renal Starter Club Program to Promote a Career in Nephrology
(Elsevier, 2023-10-04) Brazell, Madeline; Maidwell, Tom; Nimmo, Ailish; Scott, Jemima; Maidwell, Tom; Medical and Dental
No abstract available
WCN25-539 Case report: Tattoo giving the diagnosis of renal sarcoidosis
(Elsevier, 2025-01-27) Zaidi, Syed; Singh, Arvind; Zaidi, Syed; Singh, Arvind; Medical and Dental
No abstract available
Cardiovascular Events in Lupus Nephritis: A Systematic Review and Meta-Analysis
(Karger Publishers, 2025-04-30) Vakshoori, Mehrbod; Heidari-Bateni, Giv; Mathew, Roy; Abdipour, Amir; Daher, Noha; Hiremath, Swapnil; Hassanein, Mohamed; Golsorkhi, Mohadese; Ebrahimi, Niloufar; Kumar Singh, Arvind; Norouzi, Sayna; Kumar Singh, Arvind; Medical and Dental
Introduction: Systemic lupus erythematous (SLE) is known to be associated with cardiovascular events (CVEs). However, the incidence of CVE has not been thoroughly investigated in lupus nephritis (LN) patients. In this meta-analysis, we aimed to assess the incidence of CVE in patients with LN. Methods: We performed a literature search in PubMed, Scopus, and Web of Science database for studies reporting CVE (myocardial infarction [MI], heart failure, cerebrovascular accident [CVA] [i.e., ischemic or hemorrhagic stroke or transient ischemic attack], any cardiovascular- or cerebrovascular-related disease or death) in patients with LN. In addition, subgroup analyses were conducted according to geographical locations and kidney disease status. We also separately reported the incidence rate of MI, CVA, and cardiovascular- or cerebrovascular-related deaths, with CVE and MI risk in patients with LN. Results: Twenty-one records, encompassing 29,489 subjects, were included. The overall CVE incidence was 9% (95% confidence interval [CI]: 6–12%). Specifically, the incidence of MI (8 studies, n = 5,735), CVA (9 studies, n = 6,053), and mortality attributed to any cardiovascular or cerebrovascular disease (10 studies, n = 26,511) were 4% (95% CI: 2–7%), 4% (95% CI: 2–7%), and 5% (95% CI: 3–7%), respectively. Geographically, patients residing in Asia exhibited a lower incidence of CVE (2.3%, 95% CI: 1.6–3.3%) compared to those residing in North America (10.1%, 95% CI: 5.7–17.2%) and Europe (13.3%, 95% CI: 7.6–22.4%). Patients with LN had higher risk of CVE compared to SLE subjects (odds ratio: 1.18, 95% CI: 1.03–1.34, p = 0.014). Conclusion: CVE occurrence among individuals with LN is significant, and this disease entity increases CVE risk, highlighting the importance of implementing early therapeutic interventions to prevent poor outcomes.
IgG4-Related Kidney Disease
(American Society of Nephrology, 2025-04-01) Ebrahimi, Niloufar; Ha, Vince; Whittier, William; Efe, Orhan; Kronbichler, Andreas; Choung, Hae Yoon Grace; Singh, Arvind; Abdipour, Amir; Norouzi, Sayna; Singh, Arvind; Medical and Dental
No abstract available
The views of UK Chinese individuals towards living and deceased-donor kidney transplantation: A qualitative interview study
(Public Library of Science, 2025-06-04) Beresford, Matthew; Wong, Katie; Al-Talib, Mohammed; Bailey, Pippa; Beresford, Matthew; Medical and Dental
The views of UK Chinese people towards transplantation and organ donation are not known. It is not known whether the perspectives of Chinese people living in the UK differ from those of Chinese people living elsewhere in the world, or whether perspectives of UK Chinese people vary according to time spent living in the UK. This qualitative interview study aimed to investigate the views of UK Chinese individuals towards kidney donation and transplantation. It formed part of a convergent parallel mixed-methods programme of research alongside a quantitative registry study which found that UK Chinese individuals experience poorer access to living-donor kidney transplantation compared to UK White individuals. We conducted in-depth semi-structured interviews with sixteen participants across three UK cities. Participants were permanently resident in the UK and self-identified as UK Chinese. Interviews were conducted between 9th April 2020 and 16th July 2020. Interviews were transcribed verbatim, coded using NVivo software, and analysed using inductive thematic analysis. Three main themes and seven sub-themes were identified: (1) Importance of kinship: biological and social (i) Familism, ii) Relationship hierarchy, iii) Matching; (2) Donor sacrifice (i) Negative impact on donors, ii) Bodily integrity after death; and (3) Patient as information gatekeeper (i) Culture of silence, ii) A perceived need for education and engagement. This study provides insights that may offer some explanation for reduced rates of living-donor transplantation amongst UK Chinese individuals. Further research is required to investigate observational research findings not explained here, and to develop effective strategies to improve treatment access for UK Chinese individuals with kidney disease.

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