Clinical and patient reported outcomes in chronic kidney disease: Optimizing kidney care in an aging population

Abstract

Part 1 investigates urinary kidney injury markers using kidney transplantation as ischemia-induced acute kidney injury (AKI) model. In living donor-recipient pairs, urinary TIMP-2 and IGFBP7 excretion patterns seem indicative of glomerular filtration, while B2M and NGAL may reflect proximal tubular reabsorption. Among recipients of kidney donation after circulatory death, urinary NGAL may offer an alternative for 99mTcMAG3 renography to follow delayed graft function resolution. These results encourage research into the full potential of urinary biomarkers to pinpoint AKI. Part 2 examines serum potassium in advanced chronic kidney disease (CKD) and hemodialysis patients. A U-shaped relation was found between serum potassium and mortality, with a nadir in the upper normal potassium levels. These findings suggest cautious use of strict potassium-lowering treatment in advanced CKD. Part 3 assess health-related quality of life (HRQOL) and symptom burden in the year before and after dialysis initiation among older (≥65 years) patients. Both HRQOL and symptom burden worsened in the year before dialysis initiation, and stabilized but not fully recovered in the year thereafter. “Fatigue”, “decreased interest in sex” and “difficulty becoming sexually aroused” were most burdensome. This research helps set expectations for older patients starting dialysis and emphasizes the importance of monitoring patient-reported outcomes.