Autophagy impairment has been demonstrated in the pathogenesis of autosomal dominant polycystic kidney disease (ADPKD) and could be a new target of treatment. Trehalose is a natural, nonreducing disaccharide that has been shown to enhance autophagy. Therefore, we investigated whether trehalose treatment reduces renal cyst formation in a Pkd1-hypomorphic mouse model. Pkd1 miRNA transgenic (Pkd1 miR Tg) mice and wild-type littermates were given drinking water supplemented with 2% trehalose from postnatal day 35 to postnatal day 91. The control groups received pure water or 2% sucrose for the control of hyperosmolarity. The effect on kidney weights, cystic indices, renal function, cell proliferation, and autophagic activities was determined. We found that Pkd1 miR Tg mice had a significantly lower renal mRNA expression of autophagy-related genes, including atg5, atg12, ulk1, beclin1, and p62, compared with wild-type control mice. Furthermore, immunohistochemical analysis showed that cystic lining cells had strong positive staining for the p62 protein, indicating impaired degradation of the protein by the autophagy-lysosome pathway. However, trehalose treatment did not improve reduced autophagy activities, nor did it reduce relative kidney weights, plasma blood urea nitrogen levels, or cystatin C levels in Pkd1 miR Tg mice. Histomorphological analysis revealed no significant differences in the renal cyst index, fibrosis score, or proliferative score among trehalose-, sucrose-, and water-treated groups. Our results demonstrate that adding trehalose to drinking water does not modulate autophagy activities and renal cystogenesis in Pkd1-deficient mice, suggesting that an oral supplement of trehalose may not affect the progression of ADPKD.

Acute kidney injury (AKI) is associated with increased morbidity and mortality and is frequently encountered in cardiovascular surgical intensive care units (CVS-ICU). In this study, we aimed at investigating the utility of cyclophilin A (CypA) for the early detection of postoperative AKI in patients undergoing cardiac surgery. This was a prospective observational study conducted in a CVS-ICU of a tertiary care university hospital. All prospective clinical and laboratory data were evaluated as predictors of AKI. Serum and urine CypA, as well as urine neutrophil gelatinase-associated lipocalin (uNGAL), were examined within 6 h after cardiac surgery. The discriminative power for the prediction of AKI was evaluated using the area under the receiver operator characteristic curve (AUROC). We found that both serum CypA and urine CypA were significantly higher in the AKI group than in the non-AKI group. For discriminating AKI and dialysis-requiring AKI, serum CypA demonstrated acceptable AUROC values (0.689 and 0.738, respectively). The discrimination ability of urine CypA for predicting AKI was modest, but it was acceptable for predicting dialysis-requiring AKI (AUROC = 0.762). uNGAL best predicted the development of AKI, but its sensitivity was not good. A combination of serum CypA and uNGAL enhanced the overall performance for predicting the future development of AKI and dialysis-requiring AKI. Our results suggest that CypA is suitable as a biomarker for the early detection of postoperative AKI in CVS–ICU. However, it has better discriminating ability when combined with uNGAL for predicting AKI in CVS-ICU patients.

Among hemodialysis patients aged more than 40 years old, previous large-scale studies showed statin treatment had no effect on reducing cardiovascular adverse events. However, young-adult-onset end-stage renal disease (ESRD) patients have different physicosocial factors compared to older ESRD patients. The benefit of statins in such a specific group has not been well evaluated. Through the use of Taiwan’s National Health Insurance Research Database (NHIRD), young adult patients aged 20–40 with incident ESRD requiring permanent dialysis between 1 January 2003 and 31 December 2015 were identified. The enrollees were further divided into two groups depending on whether they received statin therapy for more than 90 days (statin group) or never received any statin (nonstatin group) in the first year after initiation of dialysis. Propensity score weighting (PSW) was used to balance the baseline characteristics between the two groups. After PSW, the statin group (n = 771) exhibited a higher rate of major adverse cardiac and cerebrovascular events (MACCEs) (2.65% vs. 1.44%, hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.43–2.45), and acute myocardial infarction (1.51% vs. 0.30%, HR: 5.34, 95% CI: 3.40–8.39) compared to the nonstatin group (n = 1709). The risk of all-cause mortality, cardiovascular (CV) death. and stroke did not significantly differ between the two groups. Similar to older patients, this study demonstrated that statin therapy cannot offer any protective effects in reducing CV outcomes among young adult ESRD patients undergoing dialysis.

Background: Although several studies suggest the benefit of a low-protein diet supplemented with amino acids and keto acids (sLPD) in delaying the initiation of hemodialysis, evidence on whether these nutritional approaches could delay the timing of preemptive transplantation is lacking. Methods: Retrospective nationwide cohort study, from Taiwan’s National Health Insurance Research Database. Patients having undergone a first preemptive kidney transplantation between 2001 and 2017 were identified and divided into two groups according to the presence of sLPD treatment or not. The primary outcome was the time between the diagnosis of advanced CKD and transplantation. Secondary outcomes were post-transplantation adverse events. Results: A total of 245 patients who received their first preemptive kidney transplantation were identified from the nationwide database; 63 of them had been on an sLPD prior to transplantation (sLPD group). The duration between the day of advanced CKD diagnosis and the day of transplantation was significantly longer in the sLPD group compared with the non-sLPD group (median duration: 345 vs. 220 days, p = 0.001). The risk of post-transplantation adverse events did not differ between the two groups. Conclusions: Within the limits of its observational, retrospective design, this is the first study to suggest that nutritional management with sLPDs can safely delay the timing of preemptive kidney transplantation.

Introduction Acute kidney injury (AKI) is a common medical condition for patients during hospitalization and is associated with long-term sequelae. The incidence of AKI is increasing, whereas in-hospital mortality from the condition is decreasing. We compared outcomes following discharge in patients with AKI between those who received follow-up with nephrologists and those who only received routine follow-up (i.e., follow-up not at the nephrology department). Materials and Methods This retrospective cohort study identified 66,859 AKI survivors with discharge eGFR values of less than 60 mL/min from January 1, 2004, to June 30, 2019. Patients were categorized by follow-up department after discharge into nephrology and non-nephrology groups. The clinical outcomes included all-cause death, cardiovascular death, heart failure, readmission with AKI, and new-onset dialysis. Results AKI survivors who received 3 years of follow-up at a nephrology department had significantly lower rates of all-cause death (hazard ratio [HR]: 0.91; 95% CI: 0.87 to 0.96), cardiovascular death (HR: 0.82; 95% CI: 0.75 to 0.90), and readmission with AKI (HR: 0.82; 95% CI: 0.77 to 0.87) but higher rates of heart failure (HR: 1.13; 95% CI: 1.05 to 1.21) and new-onset dialysis (HR: 1.67; 95% CI: 1.43 to 1.95) than did those who received routine follow-up at non-nephrology department. Conclusions Following discharge, patients with AKI during hospitalization, especially severe AKI, are at significantly lower risk of all-cause death, cardiovascular death, and readmission with AKI if they receive follow-up at a nephrology department compared with non-nephrology follow-up.