12 Renal & Urology News
WINTER 2022
www.renalandurologynews.com
IKF Common in Adolescent Anorexia Impaired kidney function may offer a better way to judge anorexia severity, according to researchers IMPAIRED KIDNEY function (IKF) in adolescent patients with anorexia is common and transiently worsens during hospitalization, according to a recent study. In a study of 395 patients with a mean age of 14.6 years (81.6% girls) recently hospitalized with the psychiatric disorder, IKF was present in 146 (36.8%), Evgenia Gurevich, MD, of Schneider Children’s Medical Center of Israel in Petach Tikva, and colleagues reported in JAMA Network Open. The investigators defined IKF as an estimated glomerular filtration rate (eGFR, in mL/ min/1.73 m2) less than 90. Among patients with IKF, the mean eGFR decreased during hospitalization, declining from 83.0 at admission to a nadir of 79.1 during hospitalization. It rose to 97.7 at the most recent measurement.
The investigators observed no significant difference in body mass index (BMI) at admission between the patients with and without IKF. The maximal serum creatinine level during hospitalization was significantly higher in the patients with IKF (mean 83 vs 59 mg/dL).
Race Affects Role of SES In Use of PN
White patients, Black patients had significant 34% lower odds of undergoing PN. Compared with White patients in the lowest SES quartile (reference), Whites in the highest quartile had significant 1.2-fold higher odds of PN, whereas Blacks in the lowest and highest SES quartiles had significant 29% and 42% lower odds of PN, the investigators reported. Within the highest neighborhood SES quartile, Black patients had significant 56% lower odds of receiving PN compared with White patients. In the other quartiles, the races did not differ significantly in the odds of PN, according to the investigators. The authors acknowledged that their study had limitations. The New York State Cancer Registry database does not describe tumor location in the kidney or patients’ comorbid conditions. In addition, the database does not include information on the location and specific details about the treating hospitals. Dr Anderson and colleagues pointed out that guidelines support PN as the preferred treatment for small localized renal masses when technically feasible because it offers similar oncologic outcomes to RN but with a lower risk for chronic kidney disease. Despite increasing use of PN for these renal masses, however, many patients who are eligible for PN but receive RN instead are disproportionately patients of color and those with low SES, they noted. ■
A STUDY OF patients in New York City showed that higher socioeconomic status (SES) is associated with a greater likelihood of undergoing partial nephrectomy (PN) for localized renal masses, and the effect of SES varies by race. As neighborhood SES quartile increased, White patients were significantly more likely to undergo PN, whereas Black patients were not. Using the New York State Cancer Registry (NYSCAPED), a team led by Christopher B. Anderson, MD, MPH, of Columbia University Irving Medical Center in New York, New York, identified 5,633 patients who underwent PN (61%) or radical nephrectomy (RN, 39%) for localized renal masses from 2004 to 2016. They identified patients’ home neighborhoods through Public Use Microdata Areas in NYSCAPED, which uses US Census-level socioeconomic and demographic data. A significantly higher proportion of White patients than Black patients received PN (64.7% vs 57.4%), Dr Anderson and colleagues reported in Urologic Oncology. Compared with
Impaired kidney function observed in more than one third of patients. During hospitalization, serum creatinine increased in those with IKF but remained unchanged in those without IKF. “Since proper hydration could be assured during hospitalization,
this finding suggests the presence of a unique yet undefined mechanism other than dehydration,” Dr Gurevich and colleagues wrote. The patients with IKF had a significantly lower mean minimal eGFR (79.1 vs 112) and a significantly higher serum creatinine to BMI ratio (4.9% vs 3.6%). Minimal heart rate and free triiodothyronine levels, both physiologic parameters of anorexia severity, correlated with eGFR but not with admission BMI, the investigators reported. The median length of hospital stay was significantly longer in the IKF than noIKF group (13 vs 8 days). “Results of this case-control study suggest that impaired kidney function may be a better parameter of anorexia nervosa severity than body mass index,” Dr Gurevich and colleagues concluded.
The investigators compared with anorexia group with a control group of 495 age- and sex-matched patients hospitalized during the same period with other diagnoses. The median BMI percentile at hospital admission was significantly lower in the anorexia group compared with controls (12.3 vs 49). The minimal eGFR was significantly lower in the anorexia than control group (99.8 vs 124). The mean serum creatinine concentration was in the normal range for anorexia group as a whole, but was higher compared with controls (0.68 vs 0.54 mg/ dL), according to the investigators. The mean serum creatinine level increased significantly during hospitalization and then decreased to a lower than admission value in the anorexa group. The level was 0.66 mg/dL at admission and reached a maximum of 0.68 mg/dL, and was 0.60 mg/dL at hospital discharge. ■
Men Found to Be More Likely Than Women to Start Dialysis AMONG PATIENTS with chronic kidney
during the first 12 months after study
disease (CKD), men are more likely than
enrollment and first eGFR value after
women to start dialysis, a sex-related
enrollment. After adjusting for all of
difference not explained by CKD pro-
these variables, the investigators found
gression alone, a study found.
no significant difference between
“Although the causal mechanisms are
the sexes in the likelihood of kidney
uncertain, this finding helps interpret
transplantation or death prior to kidney
the preponderance of men in the dialy-
replacement therapy (KRT).
sis population,” Manfred Hecking, MD,
For the overall study population,
PhD, of the Medical University of Vienna
93% of KRT initiations among men and
in Austria, and colleagues reported in
women were dialysis. Interestingly, the
Kidney International Reports.
investigators noted, France had a mark-
Dr Hecking and colleagues studied
edly higher percentage of patients whose
8237 patients (4811 men and 3426
initial mode of KRT was kidney trans-
women) with CKD stages participating in
plantation (13% for both men and women)
the Chronic Kidney Disease Outcomes
compared with the other countries.
and Practice Patterns Study (CKDopps).
Dr Hecking’s team stressed that they
The patients were from the United
were unable to identify factors explain-
States, Brazil, France, and Germany.
ing why men and women differed in their
During a median follow-up duration
likelihood of starting KRT, “as all the
of 2.57 years, 23% of the men initiated
available variables adjusted for in the
KRT compared with 18% of women.
analysis did not explain this difference.”
Men had a significant 50% increased
They added, “Awareness that treat-
likelihood of starting dialysis compared
ment of women may differ from the
with women, after adjusting for age,
treatment of men is important for the
Black race, diabetes, cardiovascular
nephrological community and should
disease, albuminuria, and estimated
be openly discussed and further
glomerular filtration rate (eGFR) slope
investigated.” ■
