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Review Article
Claudins in kidney health and disease
Chor ho Jo, Gheun-Ho Kim et al.
Hanyang Biomedical Research Institute, Hanyang University College of Medicine, Seoul, Republic of Korea
Study Summary: Renal tubular transport occurs through transcellular and paracellular pathway. Traditionally, renal regulatory function for fluid and electrolyte balance is exerted by changes in transcellular transport across the renal tubular epithelial cells. However, the regulatory roles of paracellular transport in the kidney are recently emerging, particularly focusing on tight junctions. Claudins are one of the major components of tight junction proteins, and different claudins are located along the nephron segments to act as paracellular barriers or pores. In this paper, we briefly review physiologic actions of respective claudins located in glomerulus, proximal tubule, thick ascending limb of Henle’s loop, and collecting duct. Finally, we summarize the concept of claudinopathy to stress the pathophysiological roles of claudins in kidney disease.
Suggestion for future study: As the ion permeability and selectivity of different claudins are being defined, further studies are required to show regulatory and pathogenic roles of claudins in various electrolyte disorders. Interactions between paracellular and transcellular transport pathways will provide us with a deeper insight into integrative renal physiology.
Original Articles
System of integrating biosignals during hemodialysis: the CONTINUAL (Continuous mOnitoriNg viTal sIgN dUring hemodiALysis) registry
Seonmi Kim, Seung Seok Han et al.
Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Study Summary: Appropriate monitoring of intradialytic biosignals is essential to prevent worse outcomes because intradialytic hypotension and arrhythmia are associated with cardiovascular risk in hemodialysis patients. The cloud system produced a prospective, open-source registry with monitoring and collecting of intradialytic biosignals, which was named the CONTINUAL (Continuous mOnitoriNg viTal sIgN dUring hemodialysis) registry. This registry was based on a real-time multimodal data acquisition, such as blood pressure, heart rate, electrocardiogram, and photoplethysmogram. This biosignal registry will help conduct epidemiological surveys on hemodynamic complications during hemodialysis, develop artificial intelligence models predicting biosignal changes, and thus improve patient outcomes.
Clinical significance: Based on the CONTINUAL registry, we are collecting the real-time biosignals on hemodialysis, and this realizes prediction of intradialytic complications.
A multicenter, randomized, open-label, comparative, phase IV study to evaluate the efficacy and safety of combined treatment with mycophenolate mofetil and corticosteroids in advanced immunoglobulin A nephropathy
Sang Youb Han, Bum Soon Choi, Beom Seok Kim et al.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Study Summary: We conducted a multicenter, randomized, placebo-controlled, parallel-group study of 48 weeks administration of MMF and corticosteroids in biopsy-proven advanced IgAN patients with estimated glomerular filtration rate (eGFR) of 20-50 mL/min/1.73 m2 and urine protein-to-creatinine ratio (UPCR) of >0.75 g/day. At 48 weeks, the percentage that achieved complete (UPCR < 0.3 g/day) or partial remission (>50% reduction of UPCR compared to baseline) was greater in the combination therapy group than in the control group. Compared with the combination therapy group, eGFR in the control group decreased significantly from week 36 onward. The UPCR was significantly lower in the treatment group than in the control group. Overall adverse events did not differ between the groups.
Clinical significance: In advanced IgAN patients with a high risk for disease progression, combined MMF and corticosteroid therapy could be considered to preserve renal function and reduce proteinuria.
An intradialytic aerobic exercise program ameliorates frailty and improves dialysis adequacy and quality of life among hemodialysis patients: a randomized controlled trial
Sunki Kim, Hye-Ja Park, Dong-Ho Yang
College of Nursing, CHA University, Pocheon, Republic of Korea
Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
Study Summary: This study evaluated the effects of an intradialytic aerobic exercise program on frailty, dialysis adequacy, and quality of life among hemodialysis patients. Patients were randomly assigned to an exercise group (n=18) or a control group (n=21).

The 12-week aerobic exercise program comprised 40-70 min of ergometer cycling 3 times/week and a single education session. Outcomes were assessed using Fried’s frailty phenotype, the short physical performance battery, Kt/V urea, and the Short Form-36 questionnaire.

The intention-to-treat and per-protocol analyses revealed that the exercise group exhibited significant improvements in frailty score, gait speed, grip strength, exhaustion, SPPB, dialysis adequacy, and physical quality of life.
Clinical significance: An intradialytic aerobic exercise program could be a safe, feasible, and appropriate addition to routinecare among hemodialysis patients for improvements in frailty, dialysis adequacy, and quality of life.

Kidney Research
and
Clinical Practice

Print ISSN: 2211-9132
Online ISSN: 2211-9140



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