Clinical and Experimental Nephrology最新文献

{"title":"Prognostic significance of reduced eGFR for kidney outcomes and all-cause mortality in older Japanese individuals with type 2 diabetes and normoalbuminuria: a single-center cohort study.","authors":"Yui Yamamoto, Kaya Ishizawa, Tetsuya Babazono","doi":"10.1007/s10157-026-02899-6","DOIUrl":"10.1007/s10157-026-02899-6","url":null,"abstract":"<p><strong>Background: </strong>Because glomerular filtration rate (GFR) physiologically declines with age, a fixed estimated GFR (eGFR) threshold of < 60 mL/min/1.73 m² to define chronic kidney disease may overestimate risk in older adults. We examined whether lower eGFR was associated with adverse outcomes in older Japanese adults with type 2 diabetes (T2D) and normoalbuminuria.</p><p><strong>Methods: </strong>We studied 901 Japanese adults aged ≥ 65 years with T2D and normoalbuminuria who underwent baseline assessment between 2012 and 2017. Participants were categorized by Japanese Society of Nephrology (JSN) eGFR as ≥ 90 (n = 41), 60-89 (n = 538), 45-59 (n = 251), and 15-44 mL/min/1.73 m² (n = 71). Outcomes were a composite kidney outcome (≥ 30% eGFR decline, kidney replacement therapy, or kidney-related death), all-cause mortality, and eGFR slope. Analyses included Poisson regression, competing risk models, and restricted mean survival time. A sensitivity analysis recalculated eGFR using the 2021 CKD-EPI equation with a Japanese coefficient (CKD-EPI_J).</p><p><strong>Results: </strong>The mean age was 72.6 ± 5.5 years (SD) and 41.3% were women. Over median follow-up periods of 6.8 and 7.8 years, 245 kidney events and 48 deaths occurred, respectively. Baseline eGFR by the JSN equation was not independently associated with the composite kidney outcome, mortality, or eGFR slope. In contrast, the CKD-EPI_J equation reclassified 65.7% of participants with a JSN eGFR of 45-59 mL/min/1.73 m² into a higher category, yielding a clearer gradient in the risk of kidney outcomes, whereas mortality risk estimates remained similar across categories.</p><p><strong>Conclusions: </strong>In this population, the association between lower eGFR and kidney outcomes differed by the equation used.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1441-1450"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197548","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":"Rituximab vs. cyclophosphamide in treatment-naive IMN: efficacy and renal protection in early renal impairment.","authors":"Qi Yu, Qin Yang, Shan Wu, Wenjing Wang, Yangyang Zhang, Yan Liu, Yanlang Yang","doi":"10.1007/s10157-026-02895-w","DOIUrl":"10.1007/s10157-026-02895-w","url":null,"abstract":"<p><strong>Background: </strong>Cyclophosphamide (CTX) combined with glucocorticoids and rituximab (RTX) are widely used for idiopathic membranous nephropathy (IMN), but clinical data comparing them in newly diagnosed patients with impaired renal function (eGFR < 60 mL/min/1.73 m²) remain scarce. This study aimed to compare their efficacy, safety, and effects on renal function in this specific population.</p><p><strong>Methods: </strong>A retrospective study was conducted at the First Affiliated Hospital of Wannan Medical University from November 2019 to July 2024, including 113 newly diagnosed IMN patients (55 in the CTX group, 58 in the RTX group) diagnosed by renal biopsy or positive PLA2R antibodies. All patients were treatment-naive and followed for ≥ 6 months.</p><p><strong>Results: </strong>At 6 months, composite remission rates were 69.09% in the CTX group and 62.07% in the RTX group (P > 0.05). At 12 months, the RTX group showed a numerically higher composite remission rate (83.87% vs. 70.83% in CTX group) without statistical significance (P = 0.186). By 18 months, both groups reached 73.68% composite remission (P = 1.000). In the subgroup with eGFR < 60 mL/min/1.73 m², RTX significantly improved renal function at 6 months (P = 0.008), while CTX showed no significant improvement (P = 0.113); however, no intergroup difference in eGFR was observed (P = 0.793). The CTX group had a higher incidence of non-serious adverse events, including leukopenia and mild infections (P < 0.05). HypoIgGemia was documented in 5 patients (8.62%) in the RTX group, all mild and asymptomatic.</p><p><strong>Conclusion: </strong>RTX shows comparable efficacy and better safety relative to CTX in this cohort, and may be a preferred option for newly diagnosed untreated IMN, especially in those with early renal impairment. RTX demonstrated comparable efficacy to CTX in newly diagnosed IMN but with superior safety. Notably, RTX showed greater short-term (6-month) renal function improvement in patients with early renal impairment, though long-term effects need further verification in larger-sample prospective studies.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1495-1503"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197508","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":"Beyond urinalysis: a review of life-course chronic kidney disease screening across health examination systems in Japan.","authors":"Kimiko Honda, Yoko Fujita, Yugo Shibagaki, Rei Goto, Yoshimitsu Gotoh, Yutaka Harita","doi":"10.1007/s10157-026-02918-6","DOIUrl":"10.1007/s10157-026-02918-6","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a major public health problem. Most international guidelines recommend targeted testing of individuals at high risk rather than population-wide screening. In Japan, urinalysis is embedded in health examination systems across the life course. However, the existence of repeated urinalysis opportunities has not necessarily meant that these programs functioned as a coherent CKD screening pathway. Repeated urinalyses were introduced under different legal mandates and for different public health purposes, with substantial variation in target conditions, test components, and follow-up arrangements. In this context, the 2025 policy decision to add serum creatinine to workplace-based health examinations, following sustained advocacy by the Japanese Society of Nephrology and growing recognition of non-proteinuric CKD, marks an important policy turning point. This review provides an overview of Japan's current health examination systems from the perspective of CKD screening throughout the life course. Specifically, this review describes the 3-year-old health examination, school urinary screening, workplace-based health examinations, the Specific Health Checkup, and late-stage elderly medical examinations by focusing on their institutional basis, structure, follow-up pathways, and current limitations. Taken together, Japan's health examination systems provide repeated urinalyses; however, these opportunities do not automatically amount to a coherent CKD screening strategy. This overview highlights the need to clarify target conditions, downstream interventions, outcome measures, and continuity across programs.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1383-1391"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419217","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":"Association between extracellular-to-total body water ratio and eGFR decline in diabetic kidney disease: a longitudinal cohort study.","authors":"Shotaro Miyamoto, Nao Imaishi, Machiko Morita, Hiroki Uchida, Yuko Yamazaki, Miyoko Osue, Yuko Hirota, Mitsuhiro Okamoto, Satoshi Nagai, Kentaro Sada, Naoki Matsuda, Takaaki Noguchi, Yoshinori Ozeki, Takeshi Nakata, Yuichi Yoshida, Akihiro Fukuda, Koro Gotoh, Takayuki Masaki, Hirotaka Shibata","doi":"10.1007/s10157-026-02905-x","DOIUrl":"10.1007/s10157-026-02905-x","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) can progress even in the absence of overt albuminuria, highlighting the need for markers for evaluating nonglomerular pathways. The extracellular-to-total body water ratio (ECW/TBW), measured via bioelectrical impedance analysis (BIA), reflects systemic fluid status; however, its longitudinal relevance to DKD progression remains unclear to date.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study using longitudinal outpatient data from October 2020 to April 2025 at the Diabetic Kidney Disease Prevention Clinic, Oita University Hospital. A total of 40 adults with type 2 diabetes and clinically diagnosed DKD contributed 355 outpatient visits. The primary outcome was the annual rate of decline in estimated glomerular filtration rate (eGFR slope, mL/min/1.73 m²/year).</p><p><strong>Results: </strong>Both baseline and time-averaged ECW/TBW values were negatively correlated with eGFR slope in the univariate analysis (p = 0.014 and 0.025, respectively) and remained significant in the multivariate models. Log-transformed urinary albumin-to-creatinine ratio (UACR) was also significantly associated with faster eGFR decline. Treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2is) was associated with lower ECW/TBW values, whereas other renoprotective medications exerted more modest individual effects, with greater reductions observed with the concurrent use of multiple agents.</p><p><strong>Conclusions: </strong>Higher ECW/TBW values were associated with faster eGFR decline in DKD, suggesting that subclinical volume overload may represent a potential nonglomerular mechanism of disease progression. This volume-related burden may be attenuated by SGLT2is therapy.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1457-1467"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276322","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":"Impact of frailty on prognosis in elderly patients with organ-threatening ANCA-associated vasculitis.","authors":"Kenta Taito, Seiji Hashimoto, Kaoruko Fukushima, Keitaro Ogawa, Kanako Yatabe, Ayano Izawa, Yui Ohta, Shiho Matsuno, Masatoshi Oka, Noriyuki Suzuki, Takashi Takei, Mitsuyo Itabashi","doi":"10.1007/s10157-026-02900-2","DOIUrl":"10.1007/s10157-026-02900-2","url":null,"abstract":"<p><strong>Background: </strong>Frailty has gained attention as an important prognostic factor in autoimmune diseases, but its clinical impact in organ-threatening ANCA-associated vasculitis (AAV) remains poorly understood. While recent advances in treatment have improved survival outcomes in AAV, maintaining quality of life (QOL) remains a challenge. This study investigated the impact of frailty on prognosis in elderly patients with severe AAV.</p><p><strong>Methods: </strong>We retrospectively analyzed 23 newly diagnosed AAV patients with renal involvement. Frailty was assessed using the Clinical Frailty Scale (CFS). Patients were divided into robust and frail groups based on pre-AAV onset CFS scores. We compared clinical characteristics, treatment, outcomes, and CFS progression between groups. We also investigated predictors of serious adverse events (SAEs).</p><p><strong>Results: </strong>No significant difference in age was observed between the robust and frail groups. The frequency of rituximab, intravenous cyclophosphamide, and avacopan use was comparable between groups. Two deaths occurred during the 6-month follow-up period, both in the frail group. Serious adverse events (SAEs) occurred significantly more frequently in frail patients (66.7% vs. 9.1%, p < 0.01). Survival time analysis demonstrated a markedly higher SAE risk in the frail group (log-rank: p < 0.01, HR: 6.07). Patients who developed SAEs experienced progressive deterioration of frailty, whereas those who did not developed stable or improved frailty.</p><p><strong>Conclusion: </strong>In organ‑threatening AAV, frailty may be associated with an increased risk of severe adverse events and functional decline. These exploratory findings suggest a potential role for frailty assessment in initial risk stratification.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1468-1474"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276311","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":"5-hydroxy-1-methylhydantoin (NZ-419), an endogenous antioxidant, attenuates mycotoxin-induced oxidative stress in human kidney proximal tubular epithelial cells.","authors":"Ebenezer Ofori-Attah, Mai Hashimoto, Mayu Oki, Hisao Kansui, Hitoshi Maeda, Shoko Okazaki, Keizo Takeshita, Daisuke Kadowaki","doi":"10.1007/s10157-026-02925-7","DOIUrl":"10.1007/s10157-026-02925-7","url":null,"abstract":"<p><strong>Background: </strong>Exposure to foodborne mycotoxins such as ochratoxin A (OTA) and citrinin (CIT) causes severe oxidative stress-mediated nephropathy. This study investigated the protective potential of 5-hydroxy-1-methylhydantoin (NZ-419), an endogenous creatinine metabolite, against OTA- and CIT-induced toxicity in human proximal tubular epithelial (HK-2) cells.</p><p><strong>Methods: </strong>We evaluated the radical-scavenging activity of NZ-419 using cell-free assays, including electron spin resonance. In HK-2 cells, its effects on mycotoxin-induced cytotoxicity, reactive oxygen species (ROS) generation, mitochondrial membrane potential (MMP), and related signaling pathways were assessed using biochemical assays, Western blotting, and qPCR. The effects of NZ-419 on hypoxia-reoxygenation-induced cellular stress were also examined.</p><p><strong>Results: </strong>NZ-419 selectively scavenged hydroxyl radicals and peroxynitrite. In HK-2 cells, it significantly attenuated OTA-induced cytotoxicity. While not fully restoring viability in CIT-treated cells, it effectively mitigated oxidative stress induced by both mycotoxins. NZ-419 prevented MMP depolarization and upregulated Bcl-2, indicating anti-apoptotic potential. It suppressed ROS overproduction and NADPH oxidase 4 (NOX4) expression while activating the Keap1-Nrf2 pathway, upregulating antioxidant genes (SOD1, CAT, and GPx). Furthermore, NZ-419 reduced HIF-1α and CTGF expression under both mycotoxin-induced and hypoxia-reoxygenation conditions.</p><p><strong>Conclusion: </strong>NZ-419 selectively scavenges toxic radicals and attenuates mycotoxin-induced oxidative stress and mitochondrial dysfunction in HK-2 cells. These findings provide mechanistic evidence for the protective effects of NZ-419 and support its potential as a renoprotective agent against oxidative stress-related kidney injury.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1398-1414"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700956","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":"Effects of cilostazol on renal function, renal blood flow, and long-term prognosis in patients with chronic kidney disease.","authors":"Chie Saito, Kaori Mase, Shun Ishibashi, Takuya Harada, Ryoya Tsunoda, Toshiaki Usui, Tatsuya Simizu, Kei Nagai, Reiko Ohkubo, Naoki Morito, Masahiro Hagiwara, Hirayasu Kai, Joichi Usui, Kunihiro Yamagata","doi":"10.1007/s10157-026-02897-8","DOIUrl":"10.1007/s10157-026-02897-8","url":null,"abstract":"<p><strong>Background: </strong>Cilostazol has antiplatelet and vasodilatory properties and may provide renoprotective and cardiovascular benefits; however, its effects in patients with advanced chronic kidney disease (CKD) remain unclear.</p><p><strong>Methods: </strong>This prospective pilot study enrolled 12 patients with advanced CKD due to nephrosclerosis (7 men, 5 women; mean age 65.3 ± 11.0 years). Patients were randomly assigned to receive cilostazol 200 mg/day plus aspirin 100 mg/day (Group C, n = 6) or aspirin 100 mg/day alone (Group A, n = 6). Glomerular filtration rate (GFR) and renal plasma flow (RPF) were measured using inulin and para-aminohippuric acid clearance at baseline and after 1 year. Renal outcomes and complications were evaluated, followed by long-term observation until initiation of renal replacement therapy (RRT).</p><p><strong>Results: </strong>Baseline GFR and RPF were comparable between groups. After 1 year, GFR increased in 4 of 6 patients in Group C but declined in all patients in Group A. Mean GFR decreased significantly in Group A but not in Group C. Although estimated GFR declined in both groups, the annual rate of decline was significantly slower in Group C than in Group A (- 2.72 vs. - 3.84 mL/min/1.73 m²/year). RPF and urinary protein levels showed no significant changes in either group. Over a mean follow-up of 6.7 years, RRT was initiated in 2 patients in Group C and 4 in Group A. Two cerebral infarctions occurred in Group A, whereas no cardiovascular events occurred in Group C.</p><p><strong>Conclusion: </strong>Cilostazol may slow short-term renal function decline and offer long-term cardiovascular protection in patients with advanced CKD. Further studies are needed to determine its role in preventing long-term renal deterioration.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1426-1432"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197522","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":"The prevalence of IgA nephropathy in Japan: results from a nationwide survey.","authors":"Keiichi Matsuzaki, Ryousuke Aoki, Shinya Nakatani, Satoko Ohfuji, Satoru Muto, Wakaba Fukushima, Yoshitaka Isaka, Takashi Yokoo, Yusuke Suzuki","doi":"10.1007/s10157-026-02948-0","DOIUrl":"https://doi.org/10.1007/s10157-026-02948-0","url":null,"abstract":"<p><strong>Background: </strong>Precise epidemiological statistics regarding IgA nephropathy (IgAN) are essential for healthcare resource allocation and optimal therapeutic management. However, a nationwide epidemiological study has not been conducted in Japan over the past twenty years.</p><p><strong>Methods: </strong>We conducted a mail-based survey targeting departments at hospitals to estimate the annual numbers of patients with IgAN in 2022. Departments were selected using stratified random sampling based on specialty and hospital size, and a total of 2148 departments (nephrology, pediatrics, and urology) were included in the analysis. The overall and sex-specific annual numbers of patients with IgAN were estimated, along with the number of patients with high disease activity. The corresponding prevalence was calculated using these estimates, divided by the midyear population of Japan in 2022.</p><p><strong>Results: </strong>A total of 702 departments responded to the survey representing an overall response rate of 32.7%. The estimated numbers of patients with IgAN were 103,800 (95% confidence interval [CI] 83,431-124,170), including 50,160 men (95% CI 40,034-60,287) and 53,640 women (95% CI 42,799-64,481). The annual prevalence of IgAN was 83.1 per 100,000 population (men: 82.6 women: 83.6), with a male-to-female ratio of 0.99. The estimated numbers of IgAN patients with high disease activity were 15,646 (95% CI 12,464-18,828).</p><p><strong>Conclusions: </strong>This nationwide survey provides updated estimates of the prevalence of IgAN and the number of the IgAN patients with high disease activity in Japan. The prevalence of IgAN has risen substantially over the past twenty years.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069337","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 of serum chloride concentration with the risk of major adverse cardiovascular events in patients undergoing peritoneal dialysis: the Fukuoka peritoneal dialysis registry (F-PDR).","authors":"Tomoya Hamashoji, Shoji Tsuneyoshi, Kazuhiro Okamura, Shunsuke Yamada, Kazuhiko Tsuruya, Toshiaki Nakano, Tetsuro Ago","doi":"10.1007/s10157-026-02952-4","DOIUrl":"https://doi.org/10.1007/s10157-026-02952-4","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is the leading cause of death among patients undergoing peritoneal dialysis (PD). Serum chloride might provide prognostic information independent of serum sodium; however, its association with cardiovascular events in patients undergoing PD remains unclear. The aim of this study was to assess the association between serum chloride concentration and major adverse cardiovascular events (MACE) in patients undergoing PD.</p><p><strong>Methods: </strong>We conducted a multicenter cohort study using data from the Fukuoka Peritoneal Dialysis Registry. A total of 1,043 PD patients were included after excluding those with a PD duration of <90 days. The primary outcome was MACE (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke). Serum chloride was analyzed in tertiles and per 1 mmol/L decrease. Associations were evaluated by multivariable-adjusted Cox proportional hazards models, further adjusting for serum sodium.</p><p><strong>Results: </strong>Over a median follow-up of 681 days, 135 patients experienced MACE. Hypochloremia (< 96 mmol/L) was present in 32.5% of the patients. In multivariable-adjusted models, patients in the lowest serum chloride tertile showed a significantly higher risk of MACE compared with those in the highest tertile (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.28-4.42). Each 1 mmol/L decrease in serum chloride was also associated with increased risk of MACE (HR, 1.08; 95% CI, 1.01-1.16).</p><p><strong>Conclusions: </strong>Lower serum chloride concentration was independently associated with a higher risk of MACE in PD patients, even after adjusting for serum sodium. Serum chloride might provide information on cardiovascular risk, which was not fully reflected by serum sodium.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069255","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 ABCG2 transporter functionality and CKD progression: a retrospective cohort study in patients with CKD stage G3.","authors":"Yuki Ohashi, Nobuo Tsuboi, Hiroyuki Ueda, Pingping Qi, Wenxiu Chang, Satoru Kuriyama, Takashi Yokoo, Shunya Uchida, Kimiyoshi Ichida","doi":"10.1007/s10157-026-02940-8","DOIUrl":"https://doi.org/10.1007/s10157-026-02940-8","url":null,"abstract":"<p><strong>Background: </strong>ATP-binding cassette subfamily G member 2 (ABCG2), an efflux transporter for urate and uremic toxins, plays a critical role in extra-renal urate elimination. Its dysfunction leads to elevated serum urate (SU) levels and may promote renal tubular urate overload and uremic toxin accumulation, potentially contributing to chronic kidney disease (CKD) progression.</p><p><strong>Methods: </strong>This retrospective cohort study included 317 patients with CKD stage G3, with 8,664 medical records (mean 6.74-year follow-up). ABCG2 function was estimated based on genotypes for p.Q126X and p.Q141K in the ABCG2 coding region: full function, mild dysfunction (approximately 75% function), and severe dysfunction (≤ 50% function). We performed generalized estimating equation analysis to assess the estimated glomerular filtration rate (eGFR) slope and Cox regression analysis to evaluate a > 30% decline in eGFR. The models were adjusted for age, sex, CKD etiology, renin-angiotensin system inhibitor use, proteinuria, and either CKD stage (G3a/G3b) or baseline eGFR, respectively.</p><p><strong>Results: </strong>Owing to ongoing therapeutic interventions, no significant differences in SU levels were observed among ABCG2 functional groups at baseline. The eGFR slopes for fully functional, mildly dysfunctional, and severely dysfunctional ABCG2 were - 0.95 ± 0.12, - 0.94 ± 0.16, and - 1.37 ± 0.14 mL/min/1.73 m²/year, respectively. In the time-to-event analysis, severely dysfunctional ABCG2 was associated with a higher hazard ratio (HR) for > 30% eGFR decline during follow-up (HR, 2.72; 95% confidence interval, 1.11-6.66) compared to fully functional ABCG2.</p><p><strong>Conclusion: </strong>ABCG2 functionality is associated with renal prognosis in CKD and could be a useful marker for risk stratification in clinical settings.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069242","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}