Clinical and Experimental Nephrology最新文献

{"title":"Persistent metabolic acidosis and frailty trajectories after kidney transplantation: a prospective cohort study.","authors":"Lucian Siriteanu, Andreea Covic, Călin Namolovan, Simona Mihaela Hogaș, Luminița Voroneanu, Adrian Covic","doi":"10.1007/s10157-026-02920-y","DOIUrl":"10.1007/s10157-026-02920-y","url":null,"abstract":"<p><strong>Background: </strong>Metabolic acidosis is common after kidney transplantation and has been linked to adverse graft outcomes, but its potential contribution to functional decline has not been prospectively evaluated. We investigated whether persistent metabolic acidosis is associated with longitudinal frailty trajectories in kidney transplant recipients.</p><p><strong>Methods: </strong>In this prospective single-center cohort study, 239 adult kidney transplant recipients were followed for 24 months. Serum bicarbonate was measured at baseline, 6, 12, and 24 months, and acidosis persistence was defined by the number of visits with bicarbonate < 22 mmol/L (none, transient, recurrent, or persistent). Frailty was assessed using the Fried phenotype at baseline, 12 months, and 24 months. Longitudinal frailty trajectories were analyzed using mixed-effects ordinal logistic regression.</p><p><strong>Results: </strong>Frailty prevalence at 24 months increased progressively with greater acidosis persistence, from 7.4% in patients without acidosis to 27.4% among those with persistent acidosis (p for trend = 0.004). In mixed-effects models, increasing acidosis persistence was associated with higher odds of worse frailty category (unadjusted proportional OR [pOR] per category 1.91, 95% CI 1.42-2.56). This association remained significant after adjustment for demographic, transplant-related, and clinical variables (pOR 1.52, 95% CI 1.12-2.06) and after additional adjustment for time-varying kidney function (pOR 1.42, 95% CI 1.04-1.95). Persistent acidosis was also associated with higher frailty scores in linear mixed models (β 0.31 per category increase, p < 0.001).</p><p><strong>Conclusion: </strong>Persistent metabolic acidosis was associated with worsening frailty trajectories after kidney transplantation, suggesting that persistent low bicarbonate may represent a clinically relevant marker of functional decline, although causality cannot be established.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1628-1639"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-response relationship between serum uric acid and albuminuria showing a linear trend specific to the hyperuricemic range.","authors":"Young Hoon Cho, Eun Sun Lee, Joonho Ahn","doi":"10.1007/s10157-026-02907-9","DOIUrl":"10.1007/s10157-026-02907-9","url":null,"abstract":"<p><strong>Background: </strong>Serum uric acid levels have been associated with albuminuria; nonetheless, the dose-response relationship has been insufficiently explored. This study aimed to characterize the shape of the dose-response relationship between the serum uric acid level and the urinary albumin-to-creatinine ratio in a nationally representative Korean adult population.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from 15,823 adults included in the 2022-2024 Korea National Health and Nutrition Examination Survey. The dose-response curve was characterized using generalized additive models with smoothing splines. Separate analyses were conducted for normouricemic (serum uric acid level < 7.0 mg/dL) and hyperuricemic (serum uric acid level ≥ 7.0 mg/dL) groups to determine whether the association differed across clinical ranges.</p><p><strong>Results: </strong>Generalized additive models showed a nearly flat dose-response curve within the normouricemic range, followed by a marked upward trend in the hyperuricemic range. Serum uric acid levels were positively associated with the log-transformed albumin-to-creatinine ratio in the hyperuricemic group (β = 0.184; 95% confidence interval [CI]: 0.113 to 0.256). Stratified analyses revealed that this association was significantly amplified in participants with diabetes, reduced kidney function, and in non-obese individuals.</p><p><strong>Conclusion: </strong>The association between serum uric acid levels and albuminuria appeared to exhibit a threshold-like effect, characterized by a marked increase specifically within the hyperuricemic range. These findings suggest that closer monitoring of serum uric acid may be relevant in hyperuricemic individuals with diabetes or reduced kidney function, although interventional studies are needed to determine whether urate-lowering therapy is beneficial.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1521-1529"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictions of cisplatin-induced hyponatremia in patients with malignancy: a retrospective cohort survey of all cisplatin administration in clinical practice.","authors":"Yuki Nagashima, Satoru Muto, Yosuke Shimada, Shigeo Horie","doi":"10.1007/s10157-026-02922-w","DOIUrl":"10.1007/s10157-026-02922-w","url":null,"abstract":"<p><strong>Background: </strong>Despite the rise of cancer immunotherapy, cisplatin remains a cornerstone in chemotherapy. Hyponatremia is a common but under-recognized adverse event of cisplatin. Previous studies on cisplatin-induced hyponatremia (CIH) are limited and mostly focus on the initial administration. This study aimed to assess the overall incidence of CIH and identify significant predictive factors.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective cohort study of patients who received intravenous cisplatin at Juntendo University Hospital between 2018 and 2020. The occurrence and severity of CIH were assessed across all administrations. Predictive factors were analyzed using multiple logistic regression and generalized linear mixed models.</p><p><strong>Results: </strong>Among 706 patients, 340 (48.2%) experienced CIH during the study period, with 103 (14.6%) developing Grade 3 or higher severity. Across 1939 total cisplatin administrations, CIH occurred in 585 (30.2%) cases, including 135 (7.0%) with Grade ≥ 3 severity. CIH was most common at first administration (38.8%), with severe cases occurring in 11.9%. Generalized linear mixed models results that the significant prognostic factors for cisplatin-induced Hyponatremia were age (OR: 1.41, p < 0.001), last cisplatin dose (OR: 1.74, p < 0.001), serum albumin (OR: 0.65, p < 0.001), serum sodium (OR: 0.35, p < 0.001), WBC (OR: 1.26, p = 0.01), and concomitant 5-FU administration (OR: 3.91, p < 0.001).</p><p><strong>Conclusions: </strong>CIH is a frequent and potentially serious complication of cisplatin therapy. Older age, high-dose cisplatin, hypoalbuminemia, hyponatremia, leukocytosis, and 5-FU co-administration significantly increase the risk. These findings highlight the importance of proactive monitoring and management strategies to mitigate CIH risk.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1577-1583"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An index of left ventricular diastolic dysfunction in patients starting peritoneal dialysis might indicate mortality and peritoneal dialysis discontinuation.","authors":"Yoshifumi Hamasaki, Marie Morota, Masaomi Nangaku","doi":"10.1007/s10157-026-02913-x","DOIUrl":"10.1007/s10157-026-02913-x","url":null,"abstract":"<p><strong>Background: </strong>The E/e' ratio is recognized as a reliable and sensitive echocardiographic marker of left ventricular diastolic dysfunction (LVDD). Increased E/e' is known to be associated with mortality and cardiovascular events in kidney failure patients undergoing maintenance replacement therapy. To elucidate the prognostic significance of E/e' in patients starting peritoneal dialysis (PD), we investigated the relations between baseline E/e' after PD initiation and death or PD discontinuation.</p><p><strong>Methods: </strong>Data were collected retrospectively from patients with the E/e' ratio evaluated early after PD initiation during August 2008 through December 2023. We investigated the association between the average of septal and lateral E/e' (E/e' Avg) and a composite outcome comprising mortality and PD discontinuation within 8 years after PD initiation.</p><p><strong>Results: </strong>This study included 74 incident PD patients with median age of 64 years (74% male). The median value of E/e' Avg was 9.4 at the median time of 3.3 months after PD initiation. Based on the cut-off value inferred from receiver operating characteristic analysis, patients were divided into two groups: patients with E/e' Avg ≤ 9.0 and with E/e' Avg > 9.0. Kaplan-Meier analysis indicated the 8-year survival and PD continuation rates as significantly lower for the E/e' Avg > 9.0 group than for the E/e' Avg ≤ 9.0 group (p = .0019). Cox proportional hazards analyses showed E/e' Avg as independently associated with the composite outcome (hazard ratio 1.17, 95% confidence interval 1.07-1.28).</p><p><strong>Conclusion: </strong>Increased E/e' Avg early after PD initiation is associated positively with 8-year mortality and PD discontinuation.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1598-1606"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological subtypes and clinicopathological features of podocyte infolding glomerulopathy: retrospective nationwide Japanese cohort study of 93 cases.","authors":"Kazuhiro Takeuchi, Akiko Mii, Ritsuko Katafuchi, Yoshihide Fujigaki, Shiko Honma, Takamasa Iwakura, Mineaki Kitamura, Yuta Matsukuma, Makoto Abe, Ryoko Sakaguchi, Hiroshi Morinaga, Mizuko Tanaka, Shinichi Nishi, Nobuhiko Ohno, Noritaka Mamorita, Akira Shimizu, Kensuke Joh","doi":"10.1007/s10157-026-02924-8","DOIUrl":"10.1007/s10157-026-02924-8","url":null,"abstract":"<p><strong>Background: </strong>Podocyte infolding glomerulopathy (PIG) is a rare glomerular disease, with case reports and cohort studies lacking clear morphological diagnostic criteria. We aimed to establish transmission electron microscopy (TEM)-based diagnostic criteria for PIG and classify its morphological subtypes.</p><p><strong>Methods: </strong>This retrospective nationwide cohort study was conducted by the PIG Working Group of the Japanese Society of Nephrology. Clinical data and TEM findings were collected from patients diagnosed with or suspected of PIG at 69 institutions across Japan between 1991-2025. PIG was defined by TEM as podocyte infolding exceeding half the glomerular basement membrane (GBM) thickness at two or more sites within a single capillary loop or the presence of microspheres or microtubules within the GBM. Cases were classified into morphological subtypes, and their clinical characteristics were analyzed.</p><p><strong>Results: </strong>Among 103 registered cases, 93 met diagnostic criteria. Four morphological subtypes were identified: Type A, primary podocyte infolding without prominent microspheres or microtubules (n = 21); Type B, predominant microspheres (n = 34); Type C, microtubules with or without microspheres (n = 38); and Type D, dense clusters of microspheres (n = 10). Types B and C were more common in younger females and frequently associated with systemic lupus erythematosus (58% and 71%, respectively), whereas Types A and D occurred mainly in older males and were not associated with SLE.</p><p><strong>Conclusions: </strong>We established TEM-based diagnostic criteria for PIG and identified four morphological subtypes, suggesting two clinicopathological phenotypes: SLE-associated (B and C) and non-SLE-associated (A and D).</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1584-1597"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renin-related changes after sequential switching from aliskiren to valsartan and sacubitril/valsartan in patients with a high-renin phenotype: a prospective pilot study.","authors":"Hirofumi Makino, Mariko Kobayashi, Yuta Takagaki, Masakazu Notsu, Keizo Kanasaki","doi":"10.1007/s10157-026-02915-9","DOIUrl":"10.1007/s10157-026-02915-9","url":null,"abstract":"<p><strong>Background: </strong>A high-renin phenotype suggests renin-dependent activation of the renin-angiotensin-aldosterone system (RAAS), for which direct renin inhibition may be a mechanistically relevant approach. After discontinuation of aliskiren in Japan, aliskiren-treated patients required transition to alternative RAAS inhibitors. We evaluated renin-related changes during sequential switching from aliskiren to valsartan and sacubitril/valsartan.</p><p><strong>Methods: </strong>This single-center, prospective, open-label pilot study included aliskiren-treated patients with a high-renin phenotype. Patients were switched to valsartan for 8 weeks and then to sacubitril/valsartan for 16 weeks. Plasma renin activity (PRA), active renin concentration (ARC), and plasma aldosterone concentration (PAC) were assessed with blood pressure, estimated glomerular filtration rate (eGFR), and echocardiographic parameters. Hormonal variables are shown as medians [25th-75th percentiles].</p><p><strong>Trial registration: </strong>UMIN000057149.</p><p><strong>Results: </strong>Eight patients (median age, 47.5 years; 50% male) were analyzed. After switching to valsartan, PRA increased from 0.6 [0.1-2.5] to 5.5 [3.2-15.8] ng/mL/h, and ARC increased from 2.5 [0.8-7.7] to 20.2 [16.9-45.6] pg/mL, whereas no further marked increase was observed during sacubitril/valsartan treatment. PAC did not change significantly. Systolic blood pressure increased during the valsartan phase and decreased after sacubitril/valsartan initiation. eGFR showed no progressive deterioration. Left atrial volume index increased at 24 weeks, whereas other filling pressure indices did not change.</p><p><strong>Conclusion: </strong>In this small prospective pilot study, sequential transition from aliskiren to valsartan and sacubitril/valsartan was associated with renin-related changes without progressive renal deterioration. These preliminary findings may help characterize RAAS-related responses during treatment transition in selected patients with a high-renin phenotype.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1568-1576"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroxidasin expression patterns predict fibrosis and kidney function decline in IgA nephropathy.","authors":"Roberto Silva, Isabel Brandão, Tony J Chen, Hans-Peter Marti, Bárbara Gomes, Bernardo Faria, Manuel Pestana, Jorge R Almeida, Inês S Alencastre, João Paulo Oliveira","doi":"10.1007/s10157-026-02912-y","DOIUrl":"10.1007/s10157-026-02912-y","url":null,"abstract":"<p><p>Peroxidasin (PXDN), a heme-containing peroxidase involved in basement membrane assembly, has been increasingly implicated in fibrotic processes, yet its role in kidney disease remains unclear. We therefore characterized PXDN expression in kidney biopsies from patients with IgA nephropathy (IgAN), a leading cause of CKD, and assessed its association with fibrosis. Immunofluorescence demonstrated widespread PXDN expression across renal compartments, with predominant localization in distal tubules, consistent with healthy tissue. In contrast, PXDN expression was reduced in proximal tubules, including non-atrophic segments, and markedly increased in the fibrotic interstitium. PXDN strongly correlated with collagen III deposition in sclerotic glomeruli and fibrotic interstitium, but not with collagen IV. Clinically, patients with impaired kidney function (eGFR < 60 ml/min/1.73 m²) exhibited higher PXDN expression in glomeruli, proximal tubules, and fibrotic interstitium, with glomerular PXDN inversely correlating with eGFR. These findings reveal compartment-specific alterations in PXDN expression in IgAN, associated with interstitial fibrosis, collagen III deposition, and declining kidney function. PXDN may participate in fibrotic remodeling processes and represents a potential therapeutic target, warranting further investigation in CKD progression.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1547-1558"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A brief fall-risk screening tool to support early rehabilitation referral in hemodialysis patients: multicenter prospective cohort study.","authors":"Nobuyuki Shirai, Naoto Usui, Sho Kojima, Daisuke Okamura, Yoichi Sato, Kenta Mikami, Yu Shimano, Nobuhito Shinozaki, Syun Hirukawa, Toshimasa Kasai, Akihiro Sakuyama, Yoji Yamada, Masakazu Saitoh","doi":"10.1007/s10157-026-02914-w","DOIUrl":"10.1007/s10157-026-02914-w","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a brief screening tool to identify hemodialysis (HD) patients at risk of falls who may benefit from early rehabilitation and prevention strategies.</p><p><strong>Methods: </strong>A prospective cohort study was conducted across nine centers. Falls were recorded prospectively for 1 year following baseline assessment using the Kihon Checklist (KCL). Participants were categorized into development and validation cohorts. Logistic regression was used to identify KCL items associated with falls, and a short version was constructed by summing odds ratios (OR). Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) and compared with the standard KCL. The cutoff value was determined using the Youden index.</p><p><strong>Results: </strong>A total of 403 patients (median age 70.0 years, 42.1% female) were included, of whom 117 (29.0%) experienced a fall during 1 year. Five items were significantly associated with falls, including climbing stairs without a handrail (OR 2.3), history of falls (OR 3.1), fear of falling while walking (OR 2.3), inability to recognize dates (OR 2.1), and feelings of uselessness (OR 2.2). Based on these, a 0-12 point short version was developed. In the validation cohort (n = 100), the AUC was 0.75, comparable to the standard KCL (0.70, p = 0.39). A cutoff of 4.6 yielded a sensitivity of 77.8% and a specificity of 38.4%.</p><p><strong>Conclusions: </strong>The short KCL showed similar predictive accuracy to the standard version with less burden. Despite modest specificity, it may be a practical tool to identify high-risk HD patients and support early intervention.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1607-1618"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between kidney function and risk of hyponatremia: a single-center, cross-sectional study in the outpatient setting.","authors":"Masahiko Nagahama, Takehiko Kawaguchi, Takuya Fujimaru, Yugo Ito, Fumika Taki, Masaaki Nakayama, Takashi Yokoo","doi":"10.1007/s10157-026-02901-1","DOIUrl":"10.1007/s10157-026-02901-1","url":null,"abstract":"<p><strong>Background: </strong>The relationship between kidney function and hyponatremia risk remains poorly defined, particularly in patients with well-preserved kidney function. We aimed to clarify this association in an outpatient population across the full spectrum of kidney function.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 130,194 outpatients in Japan between 2010 and 2020. Multivariable logistic regression assessed the association between estimated glomerular filtration rate (eGFR) and hyponatremia (serum sodium ≤ 135 mEq/L), adjusting for demographic, clinical, medication-related, and laboratory covariates. The relationship between eGFR and urine concentration in hyponatremic patients was also assessed using the urine-to-plasma osmolality ratio.</p><p><strong>Results: </strong>The prevalence of hyponatremia was 4.3%. Patients with hyponatremia were older and had more comorbidities. Hyponatremia was least common in the intermediate eGFR range (70-80 mL/min/1.73 m²) and increased toward lower and higher eGFR levels. This association persisted after adjustment for comorbidities and medications. Compared with the intermediate eGFR range, the association in the lower eGFR range was markedly attenuated after further adjustment for variables potentially related to vasopressin-mediated water regulation, whereas elevated odds persisted in the higher eGFR range. In the fully adjusted model, odds ratios (95% CI) were 4.63 (3.73-5.75) for eGFR ≥ 150 and 1.56 (1.02-2.39) for eGFR < 10 mL/min/1.73 m². Urine concentration was higher at higher eGFR levels than at lower eGFR levels.</p><p><strong>Conclusions: </strong>Both lower and higher eGFR levels were associated with increased hyponatremia risk. Distinct patterns after covariate adjustment and differences in urine concentration suggest that the mechanisms underlying hyponatremia differ between lower and higher levels of kidney function.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1511-1520"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roxadustat and incidence of peritoneal dialysis-associated peritonitis: a propensity score-matched cohort study.","authors":"Ya-Hui Yang, Yang Zhao, Wen Tang","doi":"10.1007/s10157-026-02926-6","DOIUrl":"10.1007/s10157-026-02926-6","url":null,"abstract":"<p><strong>Background: </strong>Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), exerts pleiotropic effects beyond erythropoiesis, including modulation of inflammation and immune responses. Preliminary studies suggest Roxadustat may modulate inflammation to reduce peritoneal dialysis-associated peritonitis (PDAP) risk, but this requires further proof.</p><p><strong>Methods: </strong>Patients treated with Roxadustat or recombinant human erythropoietin (rhuEPO) at least three months from September 2014 and September 2024 were respectively enrolled. 1:1 propensity score matching (PSM) was performed based on age, sex, albumin, hemoglobin, lipid profiles, and initial urine volume. The primary outcome was PDAP incidence rate, expressed as episodes per person-year. Incidence rate ratios (IRRs) were estimated using Poisson regression models.</p><p><strong>Results: </strong>Among 296 eligible patients, PSM yielded 136 well-balanced individuals (68 per group). Over 225.85 patient-years of follow-up, 41 peritonitis episodes were recorded. The Roxadustat group exhibited a significantly lower PDAP incidence rate than the rhuEPO group (0.131 vs. 0.212 episodes per patient-year). Multivariable Poisson regression, adjusted for age, potassium, and albumin, confirmed that Roxadustat was associated with lower PDAP risk (adjusted IRR 0.494, 95% CI 0.252-0.970; p = 0.041). The trend persisted after multivariate adjustment.</p><p><strong>Conclusions: </strong>Roxadustat was associated with a reduced incidence of PDAP compared to rhuEPO, suggesting that HIF stabilization may offer protective benefits beyond anemia correction. Prospective validation is warranted.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1619-1627"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}