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Chronic Kidney Disease: Diagnosis and Treatment

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A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Biomedical Engineering and Biomaterials".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 12114

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Special Issue Editors

Dr. Po-Jen Hsiao

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Guest Editor

Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
Interests: chronic kidney disease; kidney bioengineering; proteinuria; albuminuria; hematuria; glomerular filtration rate; end-stage renal disease; kidney replacement therapy; dialysis; hemodialysis; peritoneal dialysis; kidney transplantation
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Chi-Ming Chu

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Guest Editor

Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114201, Taiwan
Interests: mHealth; wearable device; personal health record; eGFR correction; SNPs; GWAS; gene annotation; gene expression profile; natural language processing; artificial intelligence; biomedical informatics; biostatistics; epidemiology; public health
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Prof. Dr. Chi-Wen Chang

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Guest Editor

School of Nursing, College of Medicine, Chang-Gung University, Taoyuan 333323, Taiwan
Interests: pediatrics nursing; pediatrics case management; chronic child care, e.g., asthma; diabetes type I; mHealth; health informatics; telematics; healthcare resource utilization
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Prof. Dr. Hao-Yun Kao

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Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
Interests: health informatics; telematics; healthcare resource utilization
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Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is defined as decreased kidney function shown by glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m², or the presence of one or more markers of kidney damage (e.g., albuminuria, proteinuria, hematuria, urine sediment abnormalities, electrolyte abnormalities due to tubular disorders, abnormalities on histology, structural abnormalities detected by imaging, or history of kidney transplantation), and at least 3 months of duration. CKD can arise from many different disease pathways that deteriorate renal function irreversibly over months or years, while diabetes mellitus and hypertension are the main causes of CKD worldwide.

Treatment strategies for CKD patients usually consist of the management of diabetes mellitus and hypertension, avoiding nephrotoxins, adjustment in drug dosing, reducing risk of cardiovascular disease, diet adjustment, and treating complications. When the GFR is less than 15 mL/min/1.73m², the patient has reached end-stage renal disease (ESRD). Kidney function is no longer able to cope with waste and fluid clearance. Options for patients with ESRD are kidney replacement therapy (dialysis or kidney transplantation) or conservative care, that is, palliation or non-dialytic care.

This Special Issue of Bioengineering on "Chronic Kidney Disease: Diagnosis and Treatment" is dedicated to original papers, brief reports and reviews that provide further understanding or novel opinions in the diagnosis and treatment of CKD. For scholars, the traditional cell-culture models may not be adequate for studying the functional intricacies of the kidney. Recent experiments have offered improvements in our understanding of these systems, including organoid modeling, 3D bioprinting, decellularization, microfluidics and other potential applications of kidney bioengineering. We look forward to your valued research to make this Special Issue a reference resource.

Dr. Po-Jen Hsiao
Prof. Dr. Chi-Ming Chu
Prof. Dr. Chi-Wen Chang
Prof. Dr. Hao-Yun Kao
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

kidney bioengineering
chronic kidney disease (CKD)
glomerular filtration rate (GFR)
end-stage renal disease (ESRD)
kidney injury
nephrotoxins
kidney replacement therapy
kidney transplantation

Published Papers (4 papers)

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Research

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13 pages, 1781 KiB

Open AccessArticle

Performance of Nuclear Magnetic Resonance-Based Estimated Glomerular Filtration Rate in a Real-World Setting

by Amauri Schwäble Santamaria, Marcello Grassi, Jeffrey W. Meeusen, John C. Lieske, Renee Scott, Andrew Robertson and Eric Schiffer

Bioengineering 2023, 10(6), 717; https://doi.org/10.3390/bioengineering10060717 - 13 Jun 2023

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Abstract

An accurate estimate of glomerular filtration rate (eGFR) is essential for proper clinical management, especially in patients with kidney dysfunction. This prospective observational study evaluated the real-world performance of the nuclear magnetic resonance (NMR)-based GFR_NMR equation, which combines creatinine, cystatin C, valine, and myo-inositol with age and sex. We compared GFR_NMR performance to that of the 2021 CKD-EPI creatinine and creatinine-cystatin C equations (CKD-EPI_2021Cr and CKD-EPI_2021CrCys), using 115 fresh routine samples of patients scheduled for urinary iothalamate clearance measurement (mGFR). Median bias to mGFR of the three eGFR equations was comparably low, ranging from 0.4 to 2.0 mL/min/1.73 m². GFR_NMR outperformed the 2021 CKD-EPI equations in terms of precision (interquartile range to mGFR of 10.5 vs. 17.9 mL/min/1.73 m² for GFR_NMR vs. CKD-EPI_2021CrCys; p = 0.01) and accuracy (P15, P20, and P30 of 66.1% vs. 48.7% [p = 0.007], 80.0% vs. 60.0% [p < 0.001] and 95.7% vs. 86.1% [p = 0.006], respectively, for GFR_NMR vs. CKD-EPI_2021CrCys). Clinical parameters such as etiology, comorbidities, or medications did not significantly alter the performance of the three eGFR equations. Altogether, this study confirmed the utility of GFR_NMR for accurate GFR estimation, and its potential value in routine clinical practice for improved medical care. Full article

(This article belongs to the Special Issue Chronic Kidney Disease: Diagnosis and Treatment)

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19 pages, 877 KiB

Open AccessArticle

From Bench to Bedside: Clinical and Biomedical Investigations on Hepatitis C Virus (HCV) Genotypes and Risk Factors for Albuminuria

by Po-Jen Hsiao, Chia-Jen Hsiao, Fu-Ru Tsai, Yen-Lin Hou, Chih-Chien Chiu, Wen-Fang Chiang, Kun-Lin Wu, Yuan-Kuei Li, Chen Lin, Jenq-Shyong Chan, Chi-Wen Chang and Chi-Ming Chu

Bioengineering 2022, 9(10), 509; https://doi.org/10.3390/bioengineering9100509 - 27 Sep 2022

Cited by 2 | Viewed by 1777

Abstract

An extrahepatic manifestation of nephropathies can be a feature of the chronic hepatitis C virus (HCV) infection. Albuminuria is a major risk factor for nephropathies and chronic kidney disease (CKD). The correlation between HCV genotypes and albuminuria is still unclear. In this study, investigations have been done for the biomedical tools and methodologies used in the National Health and Nutrition Examination Survey (NHANES) public database. We searched the 2007–2016 NHANES public database to retrieve data regarding the different HCV genotypes and clinical scenarios. This study attempted to investigate the impacts of HCV genetic diversity, associated comorbidities, and racial differences on albuminuria. The urine albumin/creatinine ratio (ACR) was the primary endpoint. Among 40,856 participants, 336 participants with positive and 237 with negative HCV RNA tests were analyzed, excluding 14,454 participants with negative HCV antibodies and 25,828 which were missed. After controlling for sex, race, education level, smoking, diabetes mellitus, hepatitis B, alcohol use, and body mass index (BMI) with a generalized linear equation, HCV genotype 2 was more likely than any other genotype to cause albuminuria based on the urine ACR (p < 0.001). The generalized linear equation also demonstrated a significantly higher urine ACR, including hepatitis B (p < 0.001), diabetes mellitus (p < 0.001), and smoking (p = 0.026). In summary, the patients with HCV genotype 2 presented with increased albuminuria in comparison with other HCV genotypes in this 10-year retrospective analysis. HCV infection could be a risk factor of CKD; early diagnosis and appropriate treatment may improve clinical outcomes. Full article

(This article belongs to the Special Issue Chronic Kidney Disease: Diagnosis and Treatment)

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Review

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14 pages, 900 KiB

Open AccessReview

Revisiting the Role of NAG across the Continuum of Kidney Disease

by Ruder Novak, Grgur Salai, Stela Hrkac, Ivana Kovacevic Vojtusek and Lovorka Grgurevic

Bioengineering 2023, 10(4), 444; https://doi.org/10.3390/bioengineering10040444 - 4 Apr 2023

Cited by 2 | Viewed by 2043

Abstract

Acute and chronic kidney diseases are an evolving continuum for which reliable biomarkers of early disease are lacking. The potential use of glycosidases, enzymes involved in carbohydrate metabolism, in kidney disease detection has been under investigation since the 1960s. N-acetyl-beta-D-glucosaminidase (NAG) is a glycosidase commonly found in proximal tubule epithelial cells (PTECs). Due to its large molecular weight, plasma-soluble NAG cannot pass the glomerular filtration barrier; thus, increased urinary concentration of NAG (uNAG) may suggest injury to the proximal tubule. As the PTECs are the workhorses of the kidney that perform much of the filtration and reabsorption, they are a common starting point in acute and chronic kidney disease. NAG has previously been researched, and it is widely used as a valuable biomarker in both acute and chronic kidney disease, as well as in patients suffering from diabetes mellitus, heart failure, and other chronic diseases leading to kidney failure. Here, we present an overview of the research pertaining to uNAG’s biomarker potential across the spectrum of kidney disease, with an additional emphasis on environmental nephrotoxic substance exposure. In spite of a large body of evidence strongly suggesting connections between uNAG levels and multiple kidney pathologies, focused clinical validation tests and knowledge on underlining molecular mechanisms are largely lacking. Full article

(This article belongs to the Special Issue Chronic Kidney Disease: Diagnosis and Treatment)

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22 pages, 1559 KiB

Open AccessReview

Hemodiafiltration: Technical and Medical Insights

by Thomas Lang, Adam M. Zawada, Lukas Theis, Jennifer Braun, Bertram Ottillinger, Pascal Kopperschmidt, Alfred Gagel, Peter Kotanko, Manuela Stauss-Grabo, James P. Kennedy and Bernard Canaud

Bioengineering 2023, 10(2), 145; https://doi.org/10.3390/bioengineering10020145 - 21 Jan 2023

Cited by 11 | Viewed by 5330

Abstract

Despite the significant medical and technical improvements in the field of dialytic renal replacement modalities, morbidity and mortality are excessively high among patients with end-stage kidney disease, and most interventional studies yielded disappointing results. Hemodiafiltration, a dialysis method that was implemented in clinics many years ago and that combines the two main principles of hemodialysis and hemofiltration—diffusion and convection—has had a positive impact on mortality rates, especially when delivered in a high-volume mode as a surrogate for a high convective dose. The achievement of high substitution volumes during dialysis treatments does not only depend on patient characteristics but also on the dialyzer (membrane) and the adequately equipped hemodiafiltration machine. The present review article summarizes the technical aspects of online hemodiafiltration and discusses present and ongoing clinical studies with regards to hard clinical and patient-reported outcomes. Full article

(This article belongs to the Special Issue Chronic Kidney Disease: Diagnosis and Treatment)

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