Clinical and Experimental Nephrology最新文献

{"title":"Pathophysiology, symptoms, outcomes, and evaluation of hyponatremia: comprehension and best clinical practice.","authors":"Hirofumi Sumi, Naoto Tominaga, Yoshiro Fujita, Joseph G Verbalis","doi":"10.1007/s10157-025-02624-9","DOIUrl":"10.1007/s10157-025-02624-9","url":null,"abstract":"<p><p>This review article series on water and electrolyte disorders is based on the 'Electrolyte Winter Seminar' held annually for young nephrologists in Japan. The seminar includes lively discussions based on cases, which are also partly included in this series as self-assessment questions. The first article in this series focuses on pathophysiology, symptoms, outcomes, and evaluation of hyponatremia, a common water and electrolyte disorder in clinical practice. Diagnosing the root cause(s) of hyponatremia can be challenging due to various etiologies and co-morbidities that affect water and electrolyte homeostasis, which can result in inappropriate management and worse outcomes in acute and chronic hyponatremia. This review provides an overview of pathophysiology, symptoms, outcomes, and evaluation of hyponatremia for better comprehension and improved clinical practice.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"134-148"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021583","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":"Predictors of encapsulated peritoneal sclerosis in patients undergoing peritoneal dialysis using neutral-pH dialysate.","authors":"Toshiaki Nakano, Hiromasa Kitamura, Shoji Tsuneyoshi, Akihiro Tsuchimoto, Kumiko Torisu, Hiroaki Tsujikawa, Hideki Kawanishi, Kazuhiko Tsuruya, Takanari Kitazono","doi":"10.1007/s10157-024-02565-9","DOIUrl":"10.1007/s10157-024-02565-9","url":null,"abstract":"<p><strong>Background: </strong>Encapsulated peritoneal sclerosis (EPS) is a serious complication in patients undergoing peritoneal dialysis (PD). Neutral-pH dialysate is associated with less peritoneal damage and a lower incidence of EPS than conventional PD solution. However, monitoring for peritoneal damage and predicting EPS remain important during PD therapy.</p><p><strong>Methods: </strong>We measured the mesothelial cell area, dialysate-to-plasma ratio of creatinine after 4 h, and concentrations of the potential biological markers effluent fibrin degradation products (eFDPs), cancer antigen-125, and interleukin-6 in the effluent dialysate from patients who had been undergoing PD therapy for > 5 years in our hospital. These biomarkers were obtained from the drainage fluid of the final measurement of peritoneal equilibration testing before withdrawal from PD therapy. The concentrations of these potential biomarkers were measured in 39 patients who withdrew from PD therapy and were enrolled in the study.</p><p><strong>Results: </strong>Three participants developed EPS after withdrawing PD. The dialysate-to-plasma ratio of creatinine, area of mesothelial cells, and interleukin-6 appearance rate in participants who developed EPS tended to be higher than those in patients who did not, but there were no significant differences. Significantly more eFDPs were in participants who developed EPS than in those who did not (138.5 ± 15.1 vs. 32.9 ± 7.4 µg/mL, P = 0.002). There was no difference in the cancer antigen-125 appearance rate between the groups. A cut-off value of eFDPs ≥ 119.1 µg/mL was optimal for predicting EPS (P = 0.006, specificity = 0.972, sensitivity = 1.000).</p><p><strong>Conclusion: </strong>This study shows that eFDPs may be a useful biological marker for predicting EPS in patients undergoing PD using neutral-pH dialysate.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"212-220"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371144","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":"Causality between diabetes and membranous nephropathy: Mendelian randomization.","authors":"Zhihang Su, Ziqi Luo, Di Wu, Wen Liu, Wangyang Li, Zheng Yin, Rui Xue, Liling Wu, Yuan Cheng, Qijun Wan","doi":"10.1007/s10157-024-02566-8","DOIUrl":"10.1007/s10157-024-02566-8","url":null,"abstract":"<p><strong>Background: </strong>Membranous nephropathy (MN) has not yet been fully elucidated regarding its relationship with Type I and II Diabetes. This study aims to evaluate the causal effect of multiple types of diabetes and MN by summarizing the evidence from the Mendelian randomization (MR) study.</p><p><strong>Methods: </strong>The statistical data for MN was obtained from a GWAS study encompassing 7979 individuals. Regarding diabetes, fasting glucose, fasting insulin, and HbA1C data, we accessed the UK-Biobank, within family GWAS consortium, MAGIC, FinnGen database, MRC-IEU, and Neale Lab, which provided sample sizes ranging from 17,724 to 298,957. As a primary method in this MR analysis, we employed the Inverse Variance Weighted (IVW), Weighted Median, Weighted mode, MR-Egger, Mendelian randomization pleiotropy residual sum, and outlier (MR-PRESSO) and Leave-one-out sensitivity test. Reverse MR analysis was utilized to investigate whether MN affects Diabetes. Meta-analysis was applied to combine study-specific estimates.</p><p><strong>Results: </strong>It has been determined that type 2 diabetes, gestational diabetes, type 1 diabetes with or without complications, maternal diabetes, and insulin use pose a risk to MN. Based on the genetic prediction, fasting insulin, fasting blood glucose, and HbA1c levels were not associated with the risk of MN. No heterogeneity, horizontal pleiotropy, or reverse causal relationships were found. The meta-analysis results further validated the accuracy.</p><p><strong>Conclusions: </strong>The MR analysis revealed the association between MN and various subtypes of diabetes. This study has provided a deeper understanding of the pathogenic mechanisms connecting MN and diabetes.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"227-235"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388531","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":"Risk factors for surgery in children with ureteropelvic junction obstruction due to antenatally detected ınfantil hydronephrosis.","authors":"Mehmet Baha Aytac, Sule Ayas Ergul, Kenan Dogan, Neslihan Dincer Malkoc, Merve Aktas Ozgur, Cuneyd Ozkurkcugil, Kerem Teke, Busra Yaprak Bayrak, Zelal Ekinci, Kenan Bek","doi":"10.1007/s10157-025-02631-w","DOIUrl":"https://doi.org/10.1007/s10157-025-02631-w","url":null,"abstract":"<p><strong>Background: </strong>Although the majority of cases with antenatally detected hydronephrosis (ANH) resolve during postnatal period; patients should be monitored for the risk of developing ureteropelvic junction obstruction (UPJO) which requires surgical intervention. We aimed to define independent risk factors for operation in whom diagnosis of UPJO was precisely proven with histopathological evidence.</p><p><strong>Methods: </strong>Medical files of 155 children (186 renal units) with anteroposterior pelvic diameter (APPD) ≥ 7 mm or ≥ 1SFU (Society of Fetal Urology) grade of pelvicalyceal dilatation were retrospectively investigated. Patients who underwent pyeloplasty and whose pathological examinations of resected ureteral samples confirmed obstruction, were compared to non-interventional group in terms of demographics, serum creatinine, APPD, SFU grade, cortical thickness and diuretic renogram. Multiple regression models were used to predict independent risk factors for pyeloplasty.</p><p><strong>Results: </strong>155 patients (186 renal units) were recruited for the study. Pyeloplasty was performed in 50(32.2%) patients. Increased APPD, T1/2 and Tmax values with low parenchymal thickness and DRF were demonstrated in operated patients compared to those who did not. Significant decrease in APPD and T1/2 values and also significant improvement in parenchymal thickness were observed in conservatively managed group. Multivariate analysis revealed high APPD measurements and time activity curve patterns to be associated with significantly increased likelihood of surgical intervention.</p><p><strong>Conclusions: </strong>There is still an ongoing debate on which screening method should be used for the accurate diagnosis of UPJO or the indications for surgical intervention. Baseline APPD and diuretic renogram curve were found to be significant in predicting surgery for UPJO.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074035","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":"Comparison of the incidence of proteinuria and changes in eGFR among febuxostat and topiroxostat users.","authors":"Shingo Nakayama, Michihiro Satoh, Maya Toyama, Hideaki Hashimoto, Takahisa Murakami, Takuo Hirose, Taku Obara, Takefumi Mori, Hirohito Metoki","doi":"10.1007/s10157-025-02630-x","DOIUrl":"https://doi.org/10.1007/s10157-025-02630-x","url":null,"abstract":"<p><strong>Background: </strong>Febuxostat and topiroxostat are non-purine selective xanthine oxidoreductase inhibitors commonly used for hyperuricaemia treatment in Japan. However, comparative data on the effects of febuxostat and topiroxostat on renal function and proteinuria are limited. This study compared proteinuria incidence and changes in the estimated glomerular filtration rate (eGFR) among prevalent febuxostat and topiroxostat users.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using databases provided by DeSC Healthcare, Inc. (Tokyo, Japan). We identified 17,446 individuals (11.8% women; mean age 67.4 years) with eGFR ≥ 30 mL/min/1.73 m² and no history of cardiovascular disease or proteinuria at baseline. Separate analyses were performed for individuals with eGFR < 60 mL/min/1.73 m² and those with eGFR ≥ 60 mL/min/1.73 m². The adjusted hazard ratio (HR) for proteinuria incidence in topiroxostat users compared with febuxostat users was assessed using the Cox model. Changes in eGFR were compared between the two groups using multiple regression analysis.</p><p><strong>Results: </strong>During the mean follow-up period of 1.79 years, 1,433 participants developed proteinuria. In non-diabetic individuals with eGFR ≥ 60 mL/min/1.73 m², the adjusted HR for proteinuria incidence in topiroxostat users compared with febuxostat users was 0.60 (95% confidence interval, 0.40-0.91; p = 0.016). No significant differences were observed in eGFR changes between the two groups with eGFR < 60 and ≥ 60 mL/min/1.73 m².</p><p><strong>Conclusion: </strong>Topiroxostat prevalent users had a lower risk of proteinuria than febuxostat prevalent users in non-diabetic individuals with eGFR ≥ 60 mL/min/1.73 m². Our findings suggest that topiroxostat might be more effective than febuxostat in preventing proteinuria in non-diabetic individuals with eGFR ≥ 60 mL/min/1.73 m².</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064300","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":"Longitudinal impact of extended-hours hemodialysis with a liberalized diet on nutritional status and survival outcomes: findings from the LIBERTY cohort.","authors":"Takahiro Imaizumi, Masaki Okazaki, Manabu Hishida, Shimon Kurasawa, Nobuhiro Nishibori, Yoshihiro Nakamura, Shigefumi Ishikawa, Katsuhiko Suzuki, Yuki Takeda, Yuhei Otobe, Toru Kondo, Fumika Kaneda, Hiroshi Kaneda, Shoichi Maruyama","doi":"10.1007/s10157-024-02602-7","DOIUrl":"https://doi.org/10.1007/s10157-024-02602-7","url":null,"abstract":"<p><strong>Background: </strong>Protein-energy wasting (PEW), a unique weight loss linked to nutritional and metabolic abnormalities, is common in patients undergoing hemodialysis (HD) and associated with adverse outcomes. This study investigated whether extended-hours HD combined with a liberalized diet could overcome PEW and improve survival.</p><p><strong>Methods: </strong>The body mass index (BMI) and survival outcomes in patients undergoing extended-hours HD were evaluated for up to 8 years using data from the LIBeralized diet Extended-houRs hemodialysis Therapy (LIBERTY) cohort. Extended-hours HD was defined as weekly dialysis length ≥ 18 h.</p><p><strong>Results: </strong>The LIBERTY cohort included 402 patients who initiated extended-hours HD. An increase in the length and frequency of HD sessions was observed over time, with approximately 70% and 20% of patients undergoing extended-hours HD for > 21 h/week and > 3 sessions/week at 5 years, respectively. The BMI and percentage creatinine generation rate were maintained over time, with no substantial increase in the phosphorus and potassium levels. The estimated BMI initially increased, and thereafter plateaued over time in patients with a baseline BMI < 25 kg/m², whereas it decreased gradually in patients with a baseline BMI ≥ 25 kg/m² after several years from baseline. Ninety-one patients died, and 108 discontinued extended-hours HD during the median follow-up period of 6.2 years (interquartile range, 3.5-8.0), yielding a 5-year survival rate of 85%.</p><p><strong>Conclusions: </strong>Extended-hours HD with a liberalized diet may help achieve favorable survival outcomes and maintain nutritional status. Thus, it is a promising treatment option for managing PEW in patients undergoing HD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051877","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":"Exploring factors associated with Kidney Disease Quality of Life in patients with advanced chronic kidney disease: the Reach-J CKD cohort study.","authors":"Hironori Nakamura, Reiko Okubo, Michiko Kumagai, Mariko Anayama, Yasushi Makino, Katsuhiko Tamura, Masaki Nagasawa, Hirokazu Okada, Shoichi Maruyama, Junichi Hoshino, Takashi Wada, Ichiei Narita, Kunihiro Yamagata","doi":"10.1007/s10157-025-02628-5","DOIUrl":"https://doi.org/10.1007/s10157-025-02628-5","url":null,"abstract":"<p><strong>Background: </strong>Although several studies have examined the Kidney Disease Quality of Life (KDQOL) in patients with chronic kidney disease (CKD), the factors associated with kidney-related symptoms have not been fully explored.</p><p><strong>Methods: </strong>This nationwide multicenter cohort study enrolled 2248 patients. To identify the factors associated with each item or the three KDQOL domains, such as burden of kidney disease, symptoms/problems of kidney disease, and impact of kidney disease on daily life, multiple regression analysis was performed using baseline data.</p><p><strong>Results: </strong>The study population had a mean age of 69.1 ± 12.6 years, comprised 64.7% men, and had mean estimated glomerular filtration rate (eGFR) of 23.2 ± 10.4 mL/min/1.73 m². Mean serum creatinine levels were 1.4 ± 0.2, 2.3 ± 0.5, and 4.5 ± 1.5 mg/dL for G3b, G4, and G5, respectively. The mean scores in the three KDQOL domains among CKD stages showed significantly decreasing trends. Of all the 11 symptoms assessed, 6 had scores that significantly decreased as the CKD stage progressed and 9 had scores that significantly decreased as the age category group increased. Multiple regression analysis revealed eGFR as a significantly associated factor for 5 of 11 symptoms. Age, body mass index, and comorbidities were also detected as significant factors for some symptoms.</p><p><strong>Conclusions: </strong>In addition to eGFR, several factors were associated with symptoms in patients with CKD. Nephrologists need to recognize renal dysfunction-specific symptoms and explore other plausible causes of nonspecific symptoms.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051876","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":"HDAC9-mediated deacetylation of CALML6 promotes excessive proliferation of glomerular mesangial cells in IgA nephropathy.","authors":"Xingxing Zhuang, Fei Xiao, Feihu Chen, Shoudong Ni","doi":"10.1007/s10157-024-02620-5","DOIUrl":"https://doi.org/10.1007/s10157-024-02620-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study seeks to investigate the fundamental molecular processes through which histone deacetylase 9 (HDAC9) governs the proliferation of glomerular mesangial cells in the context of immunoglobulin A nephropathy (IgAN) and to identify novel targets for clinical research on IgAN.</p><p><strong>Methods: </strong>Data from high-throughput RNA sequencing for IgAN were procured from the Gene Expression Omnibus database to assess the expression profiles and clinical diagnostic significance of histone deacetylase family proteins (HDACs). Blood samples from 20 IgAN patients were employed in RT-qPCR analysis, and the spearman linear regression method was utilized to analyze the clinical correlation. The proliferation of glomerular mesangial cells (GMCs) under the influence of HDAC9 was examined using the 5-ethynyl-2'-deoxyuridine (EdU) assay. Proteins interacting with HDAC9 were predicted utilizing the STRING database. Immunoprecipitation and protein immunoblotting employing anti-acetylated lysine antibodies were conducted to determine the acetylation status of calmodulin-like protein 6 (CALML6).</p><p><strong>Results: </strong>Analysis of the GSE141295 dataset revealed a significant upregulation of HDAC9 expression in IgAN and the results of RT-qPCR demonstrated a substantial increase in HDAC9 expression in IgAN patients. Receiver operating characteristic (ROC) analysis indicated that the area under the curve (AUC) value for HDAC9 were 0.845 and Spearman correlation analysis showed that HDAC9 expression was positively correlated with blood levels of blood urea nitrogen (BUN) and serum creatinine (Crea). The EdU cell proliferation assay indicated that HDAC9 facilitated the excessive proliferation of GMCs. The STRING database and recovery experiments identified CALML6 as a downstream effector of HDAC9 in controlling abnormal GMC multiplication. Co-immunoprecipitation assays demonstrated that HDAC9 modulates CALML6 expression through acetylation modification.</p><p><strong>Conclusion: </strong>HDAC9 is markedly upregulated in IgAN, and it mediates the excessive proliferation of GMCs by regulating the deacetylation of CALML6.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001233","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":"Glomerular diameter is associated with a reduction in urinary protein by treatment with dapagliflozin in patients with chronic kidney disease.","authors":"Arata Osanami, Hiroaki Komatsu, Yufu Gocho, Keitaro Nishizawa, Marenao Tanaka, Yuichi Nakamura, Masato Furuhashi","doi":"10.1007/s10157-025-02625-8","DOIUrl":"https://doi.org/10.1007/s10157-025-02625-8","url":null,"abstract":"<p><strong>Background: </strong>Several clinical trials showed that sodium-glucose cotransporter 2 (SGLT2) inhibitors have protective effects against chronic kidney disease (CKD) in both patients with and those without type 2 diabetes mellitus. Since one of the renoprotective mechanisms of SGLT2 inhibitors is thought to be amelioration of glomerular hyperfiltration, we hypothesized that an enlarged glomerular diameter, which suggests increased single-nephron glomerular filtration rate, is associated with a reduction in urinary protein after treatment with an SGLT2 inhibitor.</p><p><strong>Methods: </strong>This study was a retrospective multicentered study including 28 adult patients with CKD who underwent kidney biopsy and were then treated with dapagliflozin, an SGLT2 inhibitor. The association of glomerular diameter with changes in urinary protein 4-8 weeks after the initiation of treatment with dapagliflozin was investigated.</p><p><strong>Results: </strong>Maximum glomerular diameter was significantly and positively correlated with change in urinary protein-to-creatinine ratio (UPCR) (R² = 0.44; P < 0.001). Maximum glomerular diameter was significantly larger in patients who achieved ≥ 30% reduction in UPCR after the initiation of treatment with dapagliflozin than in patients who achieved < 30% reduction in UPCR (219.4 ± 23.9 vs. 188.0 ± 29.0; P = 0.005). After adjustment of age, sex and estimated glomerular filtration rate, maximum glomerular diameter was independently associated with change in UPCR (β = 0.645, P < 0.001). Furthermore, maximum glomerular diameter was independently associated with ≥ 30% reduction in UPCR (odds ratio: 1.07, 95% confidential interval: 1.01-1.14).</p><p><strong>Conclusion: </strong>Glomerular diameter is independently associated with an early change in UPCR after the initiation of treatment with dapagliflozin in patients with CKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001222","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 different timings of protein supplementation on variable outcomes in hemodialysis patients: a randomized clinical trial.","authors":"Mohamed Mamdouh Elsayed, Amr Mohamed Elkazaz","doi":"10.1007/s10157-025-02626-7","DOIUrl":"https://doi.org/10.1007/s10157-025-02626-7","url":null,"abstract":"<p><strong>Background: </strong>Oral nutritional supplements (ONS) are commonly prescribed to provide protein and energy to hemodialysis (HD) patients. There is a debate about the appropriate timing to administer ONS. We aimed to study the effect of different timings of ONS on variable outcomes in HD patients.</p><p><strong>Methods: </strong>This research is a prospective, randomized, multicentric clinical trial (RCT) that included 120 patients on regular HD. Patients were allocated to receive ONS (25 gm protein powder/HD session) for 8 weeks either predialytic (1 h before the start of the session), intradialytic (2 h after the start of the session), or interdialytic (on non-dialysis days). Laboratory parameters, blood pressure (BP), dialysis adequacy, and nutritional parameters were assessed during the study.</p><p><strong>Results: </strong>At study end, BP at the end of HD dropped significantly in the intradialytic group compared to the other groups (p < 0.001). Serum albumin improved significantly in the predialytic (p < 0.001) and intradialytic (p = 0.039) groups. The mean subjective global assessment score increased significantly in the interdialytic group (p = 0.040). The Kt/V and urea reduction ratio decreased significantly only in the intradialytic group (p value < 0.001 and 0.001). Serum sodium, potassium, phosphorus, cholesterol, triglycerides, and adverse events did not significantly differ between the different groups.</p><p><strong>Conclusions: </strong>Predialytic ONS supplementation is a favorable option due to improved serum albumin with minimal effects on hemodynamics and dialysis adequacy compared to intradialytic and interdialytic supplementation.</p><p><strong>Clinical trials registration: </strong>ClinicalTrials.gov NCT05953636. First registration date: 1/07/2023.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001237","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}