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27.06.2020 | Original article

Estimated plasma osmolarity and risk of end-stage kidney disease in patients with IgA nephropathy

verfasst von: Shigeru Tanaka, Toshiaki Nakano, Masanori Tokumoto, Kosuke Masutani, Akihiro Tsuchimoto, Hiroaki Ooboshi, Takanari Kitazono

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 10/2020

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Abstract

Background

Several experimental studies have indicated that increased plasma osmolarity caused by recurrent dehydration is involved in kidney injury via a mechanism, mediated by vasopressin secretion and activation of the aldose reductase pathway. Epidemiologic evidence linking increased plasma osmolarity and the onset of end-stage kidney disease (ESKD), in patients with primary glomerulonephritis, is lacking.

Methods

We retrospectively examined 663 patients with IgA nephropathy (IgAN) diagnosed by kidney biopsy and evaluated the association between estimated plasma osmolarity and ESKD prevalence, using a Cox proportional hazards model.

Results

During follow-up (median 80.4 months; interquartile range 22.2–120.1), 73 patients developed ESKD. In a baseline survey, plasma osmolarity was correlated negatively with the mean value of the estimated glomerular filtration rate, but correlated positively with the mean value of urinary protein excretion, systolic blood pressure, and pathologic severity of extracapillary proliferation, in addition to tissue fibrosis and sclerosis. The incidence rate of ESKD increased linearly with increase in plasma osmolarity (P < 0.05 for trend). In multivariate analyses, plasma osmolarity was an independent risk factor for ESKD (hazard ratio for each increment of 5 mOsm/kg in plasma osmolarity 1.56; 95% confidence interval 1.18–2.07) even after adjustment for potential confounders.

Conclusions

Increased plasma osmolarity was associated significantly with an increased risk of ESKD in patients with IgAN. Maintenance of plasma osmolarity by appropriate control of the balance between salt and water may contribute to kidney protection.

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Titel: Estimated plasma osmolarity and risk of end-stage kidney disease in patients with IgA nephropathy
verfasst von: Shigeru Tanaka
Toshiaki Nakano
Masanori Tokumoto
Kosuke Masutani
Akihiro Tsuchimoto
Hiroaki Ooboshi
Takanari Kitazono
Publikationsdatum: 27.06.2020
Verlag: Springer Singapore
Erschienen in: Clinical and Experimental Nephrology / Ausgabe 10/2020
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI: https://doi.org/10.1007/s10157-020-01919-3

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Estimated plasma osmolarity and risk of end-stage kidney disease in patients with IgA nephropathy

Abstract

Background

Methods

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Conclusions

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Abstract

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