Clinical and Experimental Nephrology最新文献

{"title":"Zinc deficiency and antihypertensive treatment intensity in patients initiating dialysis: a cross-sectional analysis from the Jikei hemodialysis and peritoneal dialysis study (JHPS).","authors":"Ayaka Hayashi, Izumi Yamamoto, Yutaro Ohki, Mayuko Kawabe, Takafumi Kuroda, Makoto Sagasaki, Akio Nakashima, Go Kanzaki, Mahiro Kurashige, Kei Matsumoto, Nanae Matsuo, Hiroyuki Ueda, Ichiro Ohkido, Nobuo Tsuboi, Takashi Yokoo","doi":"10.1007/s10157-026-02916-8","DOIUrl":"10.1007/s10157-026-02916-8","url":null,"abstract":"<p><strong>Background: </strong>Serum zinc levels decline with chronic kidney disease (CKD) progression, and zinc deficiency has been linked to impaired urinary sodium excretion and hypertension. However, its clinical impact on hypertension management in end-stage kidney disease remains unclear. This study investigated the association between serum zinc deficiency and antihypertensive treatment intensity in patients with stage 5 CKD initiating dialysis.</p><p><strong>Methods: </strong>In this single-center cross-sectional study, 175 adults initiating hemodialysis or peritoneal dialysis between November 2021 and December 2024 were included. Serum zinc levels were measured at dialysis initiation, and zinc deficiency was defined as < 60 μg/dL. Logistic and ordered logistic regression analyses adjusted for demographic and hypertension-related factors were conducted to evaluate factors associated with zinc deficiency and its relationship with the number of prescribed antihypertensive agents.</p><p><strong>Results: </strong>Zinc deficiency was present in 59.4% of patients. Patients with zinc deficiency required more antihypertensive agents than those without deficiency. Zinc deficiency was significantly associated with antihypertensive agent number in univariate analyses and remained an independent factor in multivariate logistic regression (adjusted OR 1.6, 95% CI 1.0-2.4). Ordered logistic regression further demonstrated an independent association between zinc deficiency and greater antihypertensive treatment intensity after adjustment for age, sex, and hypertension-related risk factors (adjusted OR 2.4, 95% CI 1.1-5.3).</p><p><strong>Conclusion: </strong>Zinc deficiency was independently associated with more intensive antihypertensive therapy. These findings suggest that zinc deficiency may contribute to antihypertensive treatment intensity in advanced CKD. Assessment of zinc status may offer an underrecognized opportunity to improve blood pressure control in this population.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1559-1567"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435464","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":"The effect of tolvaptan on total kidney volume and inflammatory markers in autosomal dominant polycystic kidney disease.","authors":"Merve Oruc, Mehmet Burak Ercin, Ahmet Oruc, Kultigin Turkmen, Ismail Baloglu","doi":"10.1007/s10157-026-02910-0","DOIUrl":"10.1007/s10157-026-02910-0","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst growth, kidney enlargement, and decline in renal function. Increasing evidence suggests that inflammatory processes may contribute to disease progression. This study aimed to evaluate the association between tolvaptan use, systemic inflammatory markers, and total kidney volume (TKV) progression in patients with ADPKD.</p><p><strong>Methods: </strong>This retrospective study included 67 patients with ADPKD, including 40 receiving tolvaptan and 27 untreated controls. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), estimated glomerular filtration rate (eGFR), and TKV were evaluated at baseline and after 24 months. Longitudinal changes were assessed using Wilcoxon signed-rank tests and linear mixed-effects models.</p><p><strong>Results: </strong>Patients receiving tolvaptan were younger and had higher baseline TKV values than untreated patients. During follow-up, NLR, PLR, and SII decreased in the tolvaptan group, whereas these markers increased in untreated patients. eGFR declined in both groups but appeared less pronounced in patients receiving tolvaptan. TKV increased in both groups; however, the percentage increase in TKV was lower among patients receiving tolvaptan. Significant time × treatment interactions were observed for NLR, PLR, SII, and TKV. In the non-tolvaptan group, NLR at 24 months showed a significant positive association with TKV.</p><p><strong>Conclusions: </strong>Tolvaptan use was associated with differences in longitudinal changes in systemic inflammatory markers and kidney volume progression in ADPKD. Further prospective studies are needed to clarify the clinical relevance of these associations.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1539-1546"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316261","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-dependent association of depression with incidence of end-stage kidney disease and all-cause mortality, CKD-JAC study: a retrospective cohort study.","authors":"Maki Shinzawa, Kenta Murotani, Takahiro Imaizumi, Ryohei Yamamoto, Yoshitaka Isaka, Takashi Wada, Shoichi Maruyama","doi":"10.1007/s10157-026-02908-8","DOIUrl":"10.1007/s10157-026-02908-8","url":null,"abstract":"<p><strong>Background: </strong>Although depression is common among patients with chronic kidney disease (CKD), its impact on the incidence of end-stage kidney disease (ESKD) and all-cause mortality remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study used Cox proportional hazards (CPH) models and CPH models with penalized splines to assess the association between depression severity and the incidence of ESKD and mortality in patients with CKD, drawing on data from the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study.</p><p><strong>Results: </strong>This study included 1,694 patients with CKD (median age 61 years; mean eGFR 29.0 ± 12.2 mL/min/1.73 m²; median Beck Depression Inventory-II (BDI-II) score 8). Depression severity was classified into four categories: normal (0-13), mild (14-19), moderate (20-28), and severe (≥ 29). In Multivariable CPH models, ESKD risk showed a stepwise elevation in hazard ratios (HRs) without reaching statistical significance, whereas, mortality risk increased significantly in the moderate and severe group: HR 3.11 (95%CI 1.61-6.03) and 3.51 (1.40-8.80). Additionally, CPH models demonstrated a dose-dependent association between BDI-II categories and the incidence of both ESKD and mortality. CPH Models with penalized splines further revealed a gradual increase in ESKD risk, and a J-shaped association in mortality risk.</p><p><strong>Conclusion: </strong>Depression severity showed dose-dependent associations with increased the incidence of ESKD and mortality in patients with CKD. Although mortality risk was significantly higher in the moderate and severe groups (BDI-II score ≥ 20), the stepwise elevation in ESKD risk did not reach statistical significance, and an optimal threshold for ESKD risk could not be identified.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1530-1538"},"PeriodicalIF":2.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668686","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":"Dietary energy and protein intake assessed based on meal intake rate at dialysis initiation might be associated with 2-year mortality and hospitalization.","authors":"Yoshifumi Hamasaki, Mai Fujiwara, Mikie Imafuku, Kana Suzuki, Marie Morota, Teruhiko Yoshida, Yohei Komaru, Masaomi Nangaku","doi":"10.1007/s10157-026-02958-y","DOIUrl":"https://doi.org/10.1007/s10157-026-02958-y","url":null,"abstract":"<p><strong>Background: </strong>Dietary intake assessment is necessary for developing appropriate nutritional management aimed at improving patient outcomes. We investigated the association of dietary intake at dialysis initiation, as calculated using data of meal intake rates, with adverse outcomes.</p><p><strong>Methods: </strong>Data were collected retrospectively from patients starting hemodialysis (HD) or peritoneal dialysis (PD) during 2016-2018. Dietary energy intake (DEI) and dietary protein intake (DPI) were calculated based on data of nutritional contents of meals provided for patients and meal intake rates recorded by nurses during three days from dialysis initiation. We assessed the association between each of DEI and DPI and primary outcomes: death and hospitalization within 2 years.</p><p><strong>Results: </strong>This study examined 114 patients starting HD or PD, with median age of 72 (72% male). Cox proportional hazards analyses showed DEI and DPI as associated independently with the primary outcome. Hazard ratios and 95% confidence intervals were 0.94 and 0.91-0.98 for DEI, and 0.22 and 0.09-0.53 for DPI. The relation between each of DEI and DPI and outcomes held true in each subgroup with unplanned dialysis initiation and with pre-frail or frail condition. Receiver operating characteristic analysis results suggest cut-off values of 24.0 kcal/kg/day of DEI and 0.9 g/kg/day of DPI to predict the primary outcome.</p><p><strong>Conclusion: </strong>DEI and DPI, as calculated using data of meal intake rates, are associated independently with 2-year mortality and hospitalization in patients starting dialysis. Patients with unplanned dialysis initiation and with pre-frail or frail condition should be prioritized for nutritional assessment.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215090","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":"Long-term changes in kidney function and urinary protein following inpatient multidisciplinary care in patients with chronic kidney disease: a 5-year follow-up study.","authors":"Yoko Kusumoto, Tsutomu Sakurada, Yugo Shibagaki, Tomoya Nishino","doi":"10.1007/s10157-026-02966-y","DOIUrl":"https://doi.org/10.1007/s10157-026-02966-y","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215097","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":"Authors' reply to the Letter to the Editor by Dotis J: Pediatric IgA vasculitis nephritis: Japanese guidance in the context of IPNA and KDIGO recommendations.","authors":"Masaki Shimizu, Kandai Nozu, Koichi Kamei, Kazunari Kaneko","doi":"10.1007/s10157-026-02963-1","DOIUrl":"https://doi.org/10.1007/s10157-026-02963-1","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215100","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":"Circadian rhythms and sleep disturbances: a conceptual perspective with implications for autosomal dominant polycystic kidney disease.","authors":"Niloufar Ebrahim, Amir Abdipour, Frederic F Rahbari-Oskoui","doi":"10.1007/s10157-026-02970-2","DOIUrl":"https://doi.org/10.1007/s10157-026-02970-2","url":null,"abstract":"<p><p>Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by cyst formation, kidney enlargement, and extrarenal complications. While the role of genetic mutations in PKD1, PKD2, and other minor genes is well established, the influence of circadian rhythms and sleep disturbances on disease progression remains underexplored. The circadian timing system, coordinated by the central clock in the suprachiasmatic nucleus and synchronized with peripheral clocks in the kidneys, regulates key physiological processes, including glomerular filtration rate (GFR), sodium handling, blood pressure, and hormone secretion. In ADPKD, circadian disruption driven by intrinsic molecular alterations and exacerbated by sleep disorders contributes to sympathetic nervous system activation, renin-angiotensin-aldosterone system (RAAS) dysregulation, and elevated vasopressin levels, all of which accelerate cyst growth and hypertension. Mechanistic links also involve the activation of the mTOR pathway, impaired fatty acid oxidation, and altered gut microbiota composition. These disturbances impair kidney function and increase the risk of cardiovascular disease. Chronotherapy and targeted sleep hygiene interventions offer promising adjunctive strategies for mitigating circadian misalignment in ADPKD. Timed administration of antihypertensives, diuretics, and disease-modifying agents, such as tolvaptan, along with melatonin supplementation, structured light exposure, and optimized physical activity patterns, may enhance therapeutic efficacy and improve quality of life (QoL). Future research should prioritize longitudinal and interventional studies incorporating circadian biomarkers to evaluate the impact of aligning therapeutic interventions with biological rhythms on kidney and cardiovascular outcomes in ADPKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215121","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":"Cisplatin-associated hyponatremia: an outcome-definition and denominator problem.","authors":"Meryem Keleş, Emre Cankaya","doi":"10.1007/s10157-026-02968-w","DOIUrl":"https://doi.org/10.1007/s10157-026-02968-w","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215069","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":"The coexistence of constipation and diarrhea is associated with the development of chronic kidney disease: a 10-year cohort study.","authors":"Kazuma Mori, Marenao Tanaka, Yukinori Akiyama, Koki Abe, Keitaro Nishizawa, Hiroki Aida, Yutaka Kawano, Yutaka Okagawa, Rie Matsumori, Kei Nakata, Itaru Hosaka, Hidemichi Kouzu, Nagisa Hanawa, Tatsuya Sato, Masato Furuhashi","doi":"10.1007/s10157-026-02959-x","DOIUrl":"https://doi.org/10.1007/s10157-026-02959-x","url":null,"abstract":"<p><strong>Background: </strong>The gut-kidney axis is a potential mechanism underlying kidney dysfunction. However, the relationship between chronic kidney disease (CKD) and bowel habit subtypes, especially the coexistence of constipation and diarrhea, remains unknown.</p><p><strong>Methods: </strong>We investigated the association of bowel habit subtypes including the no-constipation/diarrhea, constipation-only, diarrhea-only and coexisting constipation/diarrhea groups with new onset of CKD during a 10-year follow-up period in 14,876 Japanese adults (men/women: 9,620/5,256, mean age: 47 years) who underwent annual health examinations.</p><p><strong>Results: </strong>During a median follow-up of 7.0 years, 2,281 participants (men/women: 1,571/710) developed CKD. Multivariable Cox proportional hazards models analysis after adjustment for age, sex and several confounders showed that hazard ratio (HR) for the development of CKD was significantly higher in the coexisting constipation/diarrhea group (HR [95% confidence interval]: 1.24 [1.06-1.46], p = 0.008), but not the constipation-only group or diarrhea-only group, than in the no-constipation/diarrhea group. Sex-stratified analyses showed that the adjusted HR in women, but not in men, was significantly higher in the constipation-only and coexisting constipation/diarrhea groups than in the no-constipation/diarrhea group, though the interaction by sex was not statistically significant (p = 0.118). In the mutually adjusted analysis using frequency of constipation/diarrhea, frequent constipation was independently associated with the development of CKD. The addition of bowel habit subtypes into traditional risk factors for CKD significantly improved the discriminatory capacity.</p><p><strong>Conclusions: </strong>The coexistence of constipation and diarrhea is independently associated with an increased risk for the development of CKD. The bowel habit subtype provides clinically relevant information regarding future risk for CKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215083","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":"Dahuang Fuzi decoction attenuates renal fibrosis via suppression of the NF-κB pathway.","authors":"Yan Liu, Zeji Niu, Mingzhen Guo, Wansen Sun, Ruiping Li","doi":"10.1007/s10157-026-02960-4","DOIUrl":"https://doi.org/10.1007/s10157-026-02960-4","url":null,"abstract":"<p><strong>Background: </strong>Renal fibrosis is a key pathological process in chronic kidney disease with limited treatment options. Dahuang Fuzi Decoction (DFT), a classic traditional Chinese medicine formula, shows therapeutic potential, but its anti-fibrotic mechanism remains unclear.</p><p><strong>Methods: </strong>The anti-fibrotic effect of DFT was assessed in a unilateral ureteral obstruction (UUO) rat model via histopathological examination and renal function tests. The underlying mechanism was investigated using an integrated strategy which included serum pharmacology with drug-containing serum from treated rats, network pharmacology to screen bioactive compounds and predict targets, and in vitro validation in angiotensin II (Ang II)-stimulated NRK-52E cells, with a focused analysis of the nuclear factor κB (NF-κB) signaling pathway.</p><p><strong>Results: </strong>DFT treatment ameliorated renal injury, reduced collagen deposition, and improved biochemical parameters in UUO rats. DFT-containing serum attenuated Ang II-induced fibrotic responses in cells. Bioinformatics and experimental validation identified the NF-κB pathway as a key target. DFT suppressed p65 nuclear translocation and downstream target gene expression in both UUO kidney tissue and Ang II-stimulated NRK-52E cells, and pharmacological activation of this pathway reversed the protective effects of DFT.</p><p><strong>Conclusion: </strong>DFT alleviates renal fibrosis, at least in part by inhibiting the NF-κB signaling pathway, as validated in both UUO kidney tissue and Ang II-stimulated tubular epithelial cells, providing a pharmacological basis for its clinical application.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215112","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}