Tangpanithandee, Supawit

Background/Objectives: The study aimed to investigate whether malnutrition influences the obesity paradox and to explore the relationship between obesity with/without malnutrition and in-hospital outcomes among hospitalized ESKD patients. Methods: The study used the National Inpatient Sample database from 2016 to 2021. Hospitalized ESKD patients were included and categorized into three groups: non-obese, obese without malnutrition, and obese with malnutrition. The association between obesity with/without malnutrition and in-hospital outcomes, compared to non-obese patients, were analyzed. Results: Of 674,367 hospitalized ESKD patients included, 125,978 (18.7%) had obesity. Obese ESKD patients without malnutrition were associated with a decreased risk of mortality (odd ratio [OR] 0.87, 95% CI 0.84–0.91), whereas obese patients with malnutrition were associated with an increased risk of mortality (OR 2.08, 95% CI 1.90–2.27), compared to non-obese patients. Furthermore, obesity, with or without malnutrition, was linked to higher infection-related complications and resource utilization, especially when malnutrition was present. Conclusions: Our findings show that obesity is significantly associated with lower in-hospital mortality among ESKD patients without malnutrition. However, when malnutrition coexists, this survival advantage is reversed, underscoring the importance of detecting malnutrition in obese ESKD patients.

Background Sex-based differences may influence the clinical management, complication risks, and healthcare resource utilization of hospitalized end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Understanding these disparities is essential for optimizing patient care and informing healthcare policy. Methods This study was conducted using the National Inpatient Sample to identify hospitalized adult ESKD patients receiving PD from the year 2003 to 2018. The outcomes included 1) PD-related outcomes, defined as a composite of peritonitis, mechanical complications, catheter removal or revision, and adequacy issues, 2) non-PD-related outcomes, defined as a composite of sepsis, cardiac arrest, and need for mechanical ventilation 3) transfer to hemodialysis, and 4) in-hospital mortality. The associations between sex and in-hospital outcomes were analyzed using multivariable logistic regression and were adjusted for demographic factors, comorbidities, primary diagnoses, admission types, and hospital characteristics. Discharge weights were applied to generate nationally representative estimates. Results Of 97,036 hospitalized ESKD patients receiving PD analyzed, 48,906 (50.4%) were females. In adjusted analyses, there were no overall sex differences in PD-related outcomes, non-PD-related outcomes, or in-hospital mortality. However, age- and comorbidity-based variations were observed in PD-related outcomes. Female sex was associated with lower odds of transfer to hemodialysis, particularly among younger patients and those without heart failure or peripheral vascular disease. Notably, sex differences in in-hospital mortality were observed only among patients with elective admissions. Conclusion There were sex-based disparities in the outcomes and healthcare utilization of hospitalized ESKD patients receiving PD. These findings underscore the need for sex-specific, individualized strategies to improve PD care and inform clinical and policy decisions.

Background/Objectives: Malnutrition is a prevalent yet under-recognized condition in patients with advanced chronic kidney disease (CKD), contributing to increased morbidity, mortality, and healthcare burden. The aim of this study is to determine the prevalence and trends of malnutrition and investigate the impact of malnutrition on in-hospital outcomes, treatments, and resource utilization in hospitalized patients with advanced CKD. Methods: This study utilized the National Inpatient Sample (NIS) database to identify hospitalized patients with advanced CKD from 2016 to 2021. This study investigated temporal trends in the prevalence and in-hospital mortality across different degrees of malnutrition in advanced CKD patients. Multivariable regression models were used to assess the association between malnutrition and in-hospital outcomes. Results: Out of 1,244,415 advanced CKD patients, 67,587 (5.4%) had mild to moderate malnutrition, and 63,785 (5.1%) had severe malnutrition. Malnourished patients exhibited significantly higher in-hospital mortality, with adjusted odds ratios of 1.70 (95% confidence interval (CI), 1.64–1.75) for mild to moderate cases and 2.67 (95% CI, 2.60–2.75) for severe cases. Severely malnourished patients were associated with longer mean hospital stay by 7.0 days and higher hospitalization costs by $97,767 compared with non-malnourished patients. The prevalence of severe malnutrition showed a significant uptrend from 4.2% in 2016 to 5.5% in 2021 (p for trend < 0.001). Conclusions: Malnutrition in advanced CKD is an increasingly prevalent condition linked to worsened in-hospital outcomes and heightened healthcare resource utilization. The rising trend of severe malnutrition underscores the need for early nutritional screening and the need for future interventional studies to mitigate adverse clinical outcomes in this high-risk population.

Background/Objectives: With the growing population of kidney transplant recipients (KTRs) in intensive care units (ICUs), understanding their prognostic outcomes is critical. As conflicting findings exist, we aim to systematically evaluate and meta-analyze ICU outcomes in kidney transplant recipients compared to non-recipients. Methods: We conducted a comprehensive search of the PubMed, Embase, and Cochrane databases, from inception through 23 December 2024, to identify relevant studies comparing the outcomes of KTRs and non-transplant ICU patients. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and weighted mean differences (WMDs) were calculated for continuous outcomes. The risk of bias was assessed using the ROBINS-I V2 tool. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024595104). Results: Seven studies, including 12,062 patients, were analyzed. Demographics, including age and sex, were comparable across groups. No statistically significant associations were found for overall mortality (OR: 1.82, 95% CI: 0.79 to 4.16), ICU mortality (OR: 1.06, 95% CI: 0.45 to 2.48), or 28/30-day mortality (OR: 2.06, 95% CI: 0.30 to 14.10) in KTRs, though there was a trend suggesting a potential increase in the odds of overall mortality. KTRs tended to have longer ICU stays (WMD: +1.96 days, 95% CI: 0.81–3.11) and higher Sequential Organ Failure Assessment (SOFA) scores (WMD: +0.79, 95% CI: −0.78–2.36), but these findings did not reach statistical significance. One study reported higher 1-year and 5-year mortality for KTRs. Sensitivity analyses revealed one influential study. Begg’s test for overall mortality suggested non-significant publication bias (p = 1.0). Conclusions: KTRs in ICUs are at significantly higher risk for long-term mortality, emphasizing the need for tailored critical care strategies and long-term management. Future research should focus on standardizing methodologies, reducing heterogeneity, and addressing gaps in data to improve evidence-based care for this vulnerable population.

ABSTRACTBackgroundDespite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach.MethodsUsing Organ Procurement and Transplantation Network–United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12 356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5 mg/dL. Significant cluster characteristics were determined, and outcomes were compared.ResultsThe median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7–3.3) mg/dL. Cluster analysis was performed on 12 356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re‐transplant patients characterized Cluster 1. Cluster 2 was characterized by first‐time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3‐year patient death, and graft failure. Cluster 3 had a higher risk of death‐censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient‐, graft‐, and death‐censored graft survival at 1 and 3 years. Compared to non‐AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non‐AKI: 25.5%); however, there were comparable long‐term outcomes specific to death‐censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non‐AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non‐AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non‐AKI: 86.0%).ConclusionsIn this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.