Clinical nephrology最新文献

{"title":"Safety and efficacy of nirmatrelvir and ritonavir in kidney transplant recipients with COVID-19.","authors":"Yadi Wang, Keqin Zhang, Ling Liu, Maozhi Tang, Ming Tang, Linguo Shen, Qiongyao Peng, Bangqin Hu, Zhengsheng Rao","doi":"10.5414/CN111815","DOIUrl":"10.5414/CN111815","url":null,"abstract":"<p><p>Kidney transplant recipients (KTRs) are at an elevated risks for severe COVID-19 due to immunosuppression and comorbidities. This study retrospectively evaluated the safety and efficacy of nirmatrelvir-ritonavir (NR) in 42 KTRs with COVID-19, adjusting dosages based on estimated glomerular filtration rates. Over a 1-year follow-up, renal and hepatic functions, inflammatory markers, and acute respiratory distress syndrome (ARDS) incidence were monitored. Within the studied cohort, oxygen therapy was required in 64% of patients, with 19% necessitating mechanical ventilation; 21% developed ARDS. Multivariate analysis identified higher albumin levels (odds ratio (OR) = 0.696, 95% confidence interval (CI) 0.515 - 0.940) and CD4⁺ T-cell counts (OR = 0.982, 95% CI 0.968 - 0.998) as protective against ARDS, with an AUC of 0.859. Significant reductions in serum creatinine (p < 0.001) and aspartate aminotransferase (p = 0.01) were observed from admission to discharge, while alanine aminotransferase and estimated glomerular filtration rate (eGFR) remained stable. Complications were rare, occurring in only 2 patients. NR therapy demonstrated safety and effectiveness in KTRs, evidenced by improvements in renal and hepatic function as well as stable graft outcomes. CD4+ T-cell counts and albumin levels were identified as potential predictors of ARDS. These findings underscore the significance of early antiviral intervention and meticulous optimization of immunosuppressive management. However, further validation through larger multicenter prospective studies is necessary.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764606","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":"Effectiveness of tacrolimus in patients with lupus nephritis: A randomized controlled trials meta-analysis.","authors":"Dongming Wu, Jinli Dong, Ping Tan, Cuiqing Zeng","doi":"10.5414/CN111685","DOIUrl":"10.5414/CN111685","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the efficacy and safety of tacrolimus in the treatment of lupus nephritis (LN) by synthesizing data from randomized controlled trials (RCTs).</p><p><strong>Materials and methods: </strong>A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science for RCTs involving tacrolimus in patients with LN, published up to October 31, 2024. Eligible studies compared tacrolimus-either as monotherapy or in combination with agents such as prednisolone or mycophenolate mofetil (MMF) to control treatments like placebo or cyclophosphamide. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Statistical analyses were performed using Review Manager 5.3 and Stata 15. Standardized mean differences (SMDs) were used for continuous outcomes, and relative risks (RRs) for dichotomous outcomes.</p><p><strong>Results: </strong>Of the 484 records screened, 9 RCTs involving 1,187 patients met the inclusion criteria. Tacrolimus significantly reduced urine protein compared to MMF, placebo, and intravenous cyclophosphamide (SMD: -0.33, 95% CI: -0.48, -0.19, p < 0.0001). It also led to modest improvements in serum creatinine (SMD: 0.17, 95% CI: 0.03, 0.30, p = 0.01) and serum albumin (SMD: 0.19, 95% CI: 0.06, 0.31, p = 0.005). However, no significant differences were observed in SLE Disease Activity Index, proteinuria, or serum C3 levels (p > 0.05). Tacrolimus was associated with a slightly lower risk of adverse events, although the differences was not statistically significant (RR: 0.96, 95% CI: 0.86 - 1.07, p = 0.46). Sensitivity analyses indicated some instability in the results for urine protein and serum creatinine.</p><p><strong>Conclusion: </strong>Tacrolimus appears effective in improving select renal biomarkers in patients with LN, particularly in reducing urine protein and improving serum creatinine and serum albumin levels. However, it showed no significant benefit in other clinical disease activity markers when compared to standard therapies. Although associated with a sightly lower incidence of adverse events, the overall quality of evidence was moderate to low. Further high-quality studies are warranted to confirm these findings.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764517","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 recipient age with deceased donor kidney transplant outcomes in a single-center cohort.","authors":"Paul E Schindler, Dave B Patel, Camille R Ylagan, Adam P Bregman, Didier Mandelbrot, Brad C Astor, Sandesh Parajuli","doi":"10.5414/CN112010","DOIUrl":"https://doi.org/10.5414/CN112010","url":null,"abstract":"<p><strong>Introduction: </strong>As the number of elderly patients with end-stage kidney disease (ESKD) increases, the importance of understanding how age affects post-transplant success grows. We sought to quantify the association of age with key outcomes in deceased donor kidney transplant (DDKT) recipients.</p><p><strong>Materials and methods: </strong>We did a single-center retrospective cohort analysis of all DDKT recipients who received kidneys between January 2001 and June 2021, stratified by age into 4 groups (18 - 49, 50 - 59, 60 - 69, ≥ 70). Outcomes of interest included uncensored graft failure (UCGF), death-censored graft failure (DCGF), and death with a functioning graft (DWFG) within 5 years of transplant and acute rejection (AR) within 1 year of transplant.</p><p><strong>Results: </strong>Of 3,119 recipients, 1,192 (38.2%) were 18 - 49 years old (reference group), 947 (30.4%) were 50 - 59, 795 (25.5%) were 60 - 69, and 185 (5.9%) were ≥ 70. The adjusted hazard ratio (aHR) for UCGF was 1.22 (95% CI: 1.01 - 1.48) for 50 - 59 years; 1.78 (95% CI: 1.47 - 2.17) for 60 - 69; and 2.83 (95% CI: 2.13 - 3.76) for ≥ 70. The aHR for DCGF was only statistically significant for the ≥ 70 age group at 1.73 (95% CI: 1.16 - 2.96). The aHR for DWFG was 2.00 (95% CI: 1.47 - 2.73) for 50 - 59 years; 3.36 (95% CI: 2.47 - 4.58) for 60 - 69; and 5.45 (95% CI: 3.95 - 8.26) for ≥ 70. The aHR for AR was 0.73 (95% CI: 0.61 - 0.88) for 50 - 59 years; 0.69 (95% CI: 0.56 - 0.84) for 60 - 69; and 0.47 (95% CI: 0.31 - 0.72) for ≥ 70.</p><p><strong>Conclusion: </strong>DDKT recipients over the age of 70 are at a higher risk of UCGF, DCGF, and DWFG but have a lower risk of AR than their younger counterparts.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764507","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":"Evaluation of epicardial adipose tissue in children with chronic kidney disease.","authors":"Mehmet Baha Aytac, Mustafa Dogan, Sule Ayas Ergul, Mahmud Cirakoglu, Kenan Dogan, Evic Zeynep Akgun, Neslihan Dincer Malkoc, Kadir Babaoglu, Kenan Bek","doi":"10.5414/CN111925","DOIUrl":"https://doi.org/10.5414/CN111925","url":null,"abstract":"<p><strong>Aims: </strong>Previous studies in adults have demonstrated that epicardial adipose tissue could be used to predict the risk of the development of cardiovascular disease in patients with diabetes mellitus, obesity, and chronic kidney disease. Herein, we aimed to evaluate epicardial adipose tissue, carotid intima-media thickness and left ventricular mass index in children with chronic kidney disease and compare the results with healthy subjects.</p><p><strong>Materials and methods: </strong>23 children who were diagnosed with chronic kidney disease or received kidney replacement therapy constituted the patient group; 21 age- and sex-matched healthy subjects served as the control group. Epicardial adipose tissue, carotid intima-media thickness, and left ventricular mass index obtained by using transthoracic echocardiography, demographic and biochemical parameters were compared.</p><p><strong>Results: </strong>No significant difference was detected between patients and healthy controls in terms of age, weight, height, body mass index, systolic and diastolic blood pressures. Serum glucose, calcium, phosphorus, and lipid levels were also similar. Although echocardiographic examination revealed lower epicardial adipose tissue thickness and higher mass index in patients with chronic kidney disease compared to healthy subjects (6.45 ± 1.61 vs. 7.70 ± 1.69 mm, p < 0.05), no difference was observed in carotid intima-media thickness measurement (0.40 (0.37 - 0.44) vs. 0.42 (0.35 - 0.50) mm, p = 0.29).</p><p><strong>Conclusion: </strong>Larger and long-term studies in children are needed to use epicardial adipose tissue thickness as an effective method to estimate the development of cardiovascular disease in patients with chronic kidney disease.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764523","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":"A case of lupus nephritis combined with fibrillary glomerulonephritis diagnosed using mass spectrometry and immunohistochemistry of DNAJB9.","authors":"Jian-Yu Lin, Su-Xian Lin, Shao-Shao Dong, Mu-Dan Wang","doi":"10.5414/CN111923","DOIUrl":"https://doi.org/10.5414/CN111923","url":null,"abstract":"<p><strong>Background: </strong>Fibrillary glomerulonephritis (FGN) is a rare glomerular disease characterized by proteinuria, hematuria, renal insufficiency, and hypertension and was first described in 1977. Rare cases of lupus nephritis (LN) have been reported to show fibril formation similar to that observed in FGN. To date, only 6 cases of FGN associated with systemic lupus erythematosus have been reported.</p><p><strong>Case presentation: </strong>We report a case of LN combined with FGN in a 27-year-old Chinese woman presenting with World Health Organization class III LN (full-house immunofluorescence staining, strong C1q staining, high-density electron-dense immune complex deposits). At higher magnification, electron microscopy revealed randomly oriented, non-branching fibrils averaging 20 nm in the mesangial, subepithelial, and endothelial regions. Immunohistochemical staining of DnaJ homologous subfamily B member 9 (DNAJB9) is a recently discovered marker of FGN, featuring high sensitivity (98%) and specificity (> 99%), and is now widely regarded as a pathological feature of FGN. Mass spectrometry, an analytical technique that ionizes chemicals and ranks them according to their mass-to-charge ratio, is a promising approach for studying extremely rare and unknown causes of kidney disease. We used immunohistochemistry and mass spectrometry to confirm the high sensitivity and specificity of DNAJB9 in this case, thereby establishing the diagnosis of LN combined with FGN. The patient was treated with prednisone, hydroxychloroquine, and mycophenolate mofetil. Two years after treatment, kidney function remained normal.</p><p><strong>Conclusion: </strong>Rare cases of LN show fibrogenesis similar to that of FGN. It remains uncertain whether fibril formation in such cases represents a unique manifestation of LN or LN with superimposed FGN. This case highlights the importance of mass spectrometry and DNAJB9 immunostaining in confirming rare glomerular disease patterns.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764541","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":"Impact of different A1c targets on cardiovascular outcomes in diabetic kidney transplant recipients: A global cohort analysis.","authors":"Sindhura Bobba, Gaurav Gupta, Dhiren Kumar, Amber B Paulus, Akshay Athreya, Rushi Patel, Nilang G Patel","doi":"10.5414/CN111994","DOIUrl":"https://doi.org/10.5414/CN111994","url":null,"abstract":"<p><strong>Background: </strong>Optimal glycemic targets for diabetic kidney transplant recipients (KTRs) remain uncertain, particularly regarding cardiovascular outcomes.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including adult KTRs with type 2 diabetes transplanted from 2010 - 2021. Patients with simultaneous kidney-pancreas or pancreas-alone transplants were excluded. HbA1c measured 1 - 2 years post transplant was categorized as ≤ 7.5% or > 7.5%. Propensity score matching (1 : 1) balanced demographics, comorbidities, laboratory values, immunosuppression, and medications. The primary outcome was major adverse cardiovascular events (MACE: myocardial infarction, stroke, heart failure, cardiac arrest, or death); secondary outcomes included individual components of MACE and graft failure.</p><p><strong>Results: </strong>The final matched cohort included 5,850 patients (2,925 per group). Over median follow-up of 4.2 years, MACE occurred in 33.4% of patients with HbA1c ≤ 7.5 vs. 39.1% with > 7.5% (adjusted hazard ratio (aHR) 0.88, 95% CI 0.78 - 0.98). Mortality was lower in the ≤ 7.5% group (19.6 vs. 23.7%; aHR 0.85, 95% CI 0.76 - 0.95). No significant differences were observed in graft failure, myocardial infarction, heart failure, or stroke. Sensitivity analyses demonstrated lowest MACE and mortality risk at HbA1c 7.0 - 8.0%, with attenuation at ≤ 7.0% and loss of significance at ≤ 6.5%. Cardiovascular benefit was most pronounced in patients < 65 years and those with favorable lipid profiles.</p><p><strong>Conclusion: </strong>In this global retrospective observational study, moderate glycemic control (HbA1c ~ 7 - 8% measured 1 - 2 years post transplant) was associated with lower cardiovascular events and mortality in type 2 diabetic KTRs. These findings support individualized targets aimed at avoiding both poor control and overly intensive lowering.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764487","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":"Clinical perspective on renal artery stenosis: A single-center experience\u2029.","authors":"Simal Koksal Cevher, Ender Ornek, Ezgi Coskun Yenıgun, Duygu Guzel Ozkan, Emre Cankaya, Meryem Keles, Muge Uzerk Kıbar, Fatih Dede","doi":"10.5414/CN111926","DOIUrl":"10.5414/CN111926","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this paper is to evaluate the effectiveness of percutaneous angiographic stenting in carefully selected, symptomatic patients diagnosed with hemodynamically significant atherosclerotic renal artery stenosis (ARAS) followed in our clinic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This retrospective study included 69 patients who underwent renal artery stenting due to renal artery stenosis between 2011 and 2023 in our clinic. Demographic, clinical, and laboratory data were retrospectively retrieved from the hospital's electronic health records. Duplex ultrasonography (DU) was used as the primary screening tool; however, the decision to stent was made only after confirmatory catheter angiography demonstrated ≥ 60% stenosis with an anatomically treatable lesion in a clinically high-risk context (resistant hypertension, acute kidney injury/acute-on-chronic kidney disease, or flash pulmonary edema). Laboratory parameters, blood pressure levels, and antihypertensive medication requirements were compared at baseline and 1 month following the procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over the 12-year study period, 69 patients underwent renal artery stenting involving a total of 86 renal arteries. Of these patients, 31 (44.9%) were female, and the mean age was 65.75 years (SD = 10.75; range = 41 - 87 years). Conventional angiography was performed in 51 patients (73.9%), while carbon dioxide angiography was utilized in 18 patients (26.1%). All 69 patients underwent simultaneous stent placement during angiography. One month post procedure, urea and creatinine levels decreased in these patients; notably, among 20 patients who presented with acute kidney injury, creatinine levels returned to normal in 11 patients (55%) at 1-month follow-up. Additionally, in 6 out of 12 patients (50%) with acute exacerbations of chronic kidney disease, creatinine levels reverted to baseline. Pulmonary edema, observed in 16 patients (23.2%) at presentation, resolved completely in all affected patients 1 month after the intervention. The reduction rates in systolic blood pressure (SBP) and diastolic blood pressure (DBP) 1 month post procedure were 23.28 ± 11.67% and 20.48 ± 12.49%, respectively, both statistically significant (for SBP: p = 7 × 10&lt;sup&gt;-13&lt;/sup&gt;, effect size r = 0.868, matched-pairs rank-biserial correlation r&lt;sub&gt;rb&lt;/sub&gt; = -1; for DBP: p = 5.4 × 10&lt;sup&gt;-12&lt;/sup&gt;, effect size r = 0.869, matched-pairs rank-biserial correlation r&lt;sub&gt;rb&lt;/sub&gt; = -1). The mean number of antihypertensive medications significantly decreased from baseline to 1 month after renal artery stenting (mean ± SD: 3.36 ± 1.37 vs. 2.10 ± 1.12; Wilcoxon signed-rank test, V = 1.693, p &lt; 0.001, effect size r = 0.85 &gt; 0.50).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Intervention with stent placement in symptomatic/high-risk ARAS patients presenting with resistant hypertension, acute kidney injury, or flash pulmonary edema associated with significant renal artery","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698023","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":"From shelter to stroke: A mediation-proxy analysis of homelessness-associated stroke risk in dialysis patients.","authors":"Sanat Subhash, Haziq Rabbani, Nanak Dhillon, Noah Glass, Flora Gallegos, Shyam Bihari Bansal, Prakash Gudsoorkar, Rupesh Raina","doi":"10.5414/CN111835","DOIUrl":"10.5414/CN111835","url":null,"abstract":"<p><strong>Background: </strong>Dialysis patients face high ischemic stroke risk, only partly explained by cardiometabolic and genetic factors. Homelessness, race, and other social determinants may further elevate risk, but the pathways affecting outcomes in dialysis patients remain uncharacterized.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study using the TriNetX electronic health record network, identifying 8,821 adults with at least one homelessness code and 320,432 housed adults who initiated dialysis between 2014 - 2024 with ≥ 5 years of prior data. The primary outcome was time to first ischemic stroke within 5 years. A multivariable Cox model adjusted for age, sex, race/ethnicity, and dialysis modality estimated the total homelessness effect (HR₀). We then ran 3 hazard-attenuation models, each adding 1 composite mediator block, clinical (hypertension, diabetes, hyperlipidemia, obesity), psychosocial (nicotine dependence, depression), and social-adversity (ICD-10 Z56-Z65 codes), to calculate the percent reduction in the homelessness log-hazard. Sensitivity analyses used a composite stroke-or-death endpoint and a landmark survivor cohort excluding early deaths.</p><p><strong>Results: </strong>Homelessness conferred a 4.61-fold higher 5-year stroke hazard. The clinical block attenuated this hazard by 12.1%, and the psychosocial block by 15.2%. In contrast, the social-adversity block amplified the effect by 27.4%, reflecting a suppressor phenomenon from under-documented social determinants of health codes. Sensitivity checks confirmed robustness, with a stroke-or-death HR 1.35 and death-free cohort HR 4.50.</p><p><strong>Conclusion: </strong>Pre-dialysis homelessness and Black race independently predict stroke risk in dialysis patients. This reaffirms the need for standardized social-needs screening, area-level deprivation measures, and advanced data-extraction methods to accurately capture social adversity and guide targeted interventions.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698056","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":"Simplified nutritional and inflammatory indicators for long-term survival from all-cause mortality in maintenance hemodialysis.","authors":"Qiaoming Jiang, Jiangkai Yu, Yutao Zhao, Yingchun Xiao","doi":"10.5414/CN111855","DOIUrl":"10.5414/CN111855","url":null,"abstract":"<p><strong>Objective: </strong>To investigate superior prognostic accuracy for long-term survival from all-cause mortality in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD).</p><p><strong>Materials and methods: </strong>Reviews of 2,859 ESRD patients on MHD were retrieved. The Geriatric Nutritional Risk Index (GNRI) and systemic immune inflammation index (SII) was utilized to develop a composite score of nutritional-systemic immune inflammation (N-SII). Primary endpoint was prognostic capability for long-term survival from all-cause mortality including cardiovascular events, cerebrovascular events, and infection episodes through an area under curve (AUC) using receiver operating characteristic analysis. Secondary outcomes included optimal cut-off value and hazard ratio.</p><p><strong>Results: </strong>The composite scoring system of N-SII had a better prognostic accuracy for long-term survival from all-cause mortality in hemodialysis patients with a greater AUC of 0.850 (95% CI: 0.825 - 0.874) compared to either the isolated score of GNRI or SII (AUC = 0.761 (95% CI: 0.725 - 0.791) and 0.782 (95% CI: 0.767 - 0.826)) (p < 0.001). Superiority was met if the 95% CI fell within a superiority margin of 0.80. High-risk N-SII score was an independent predictor for all-cause mortality (HR = 2.049 (95% CI: 1.668 - 2.516)) with specificity and sensitivity of 0.784 and 0.899. A significantly shorter survival from all-cause death was observed in high-risk N-SII cohort as opposed to low-risk (44.14 (95% CI: 42.76 - 45.52) vs. 31.19 (95% CI: 28.50 - 33.89), p < 0.001).</p><p><strong>Conclusion: </strong>The composite index of N-SII showed a superior prognostic accuracy for long-term survival from all-cause mortality as opposed to isolated GNRI or SII, highlighting the integration of nutritional and inflammatory indexes for effective risk stratification of prognostic assessment among patients on MHD.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698026","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 association of systemic inflammation index with parathormone levels in hemodialysis patients: A cross-sectional study.","authors":"Feyza Bayrakdar Çağlayan, Mahmud Islam, Emre Çankaya, Hamad Dheir, Mehmet Emin Demir","doi":"10.5414/CN111261","DOIUrl":"10.5414/CN111261","url":null,"abstract":"<p><strong>Aim: </strong>Abnormal parathormone (PTH) levels are common in patients undergoing hemodialysis and have been linked to adverse outcomes. This study investigated the association between the systemic inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and parathyroid hormone (PTH) levels in patients undergoing maintenance hemodialysis (HD).</p><p><strong>Materials and methods: </strong>We performed a cross-sectional analysis of 225 patients undergoing HD at a single center. Demographic data, comorbidities, dialysis vintage, and laboratory values were obtained from medical records. Patients were stratified into three groups based on PTH level according to KDIGO CKD-Mineral and Bone Disorder (CKD-MBD) guideline targets: PTH1 (< 150 pg/mL), PTH2 (150 - 600 pg/mL), and PTH3 (> 600 pg/mL). The SII and NLR were calculated from complete blood counts. We compared the clinical characteristics across the PTH groups and used logistic regression to identify independent predictors of PTH levels outside the target range.</p><p><strong>Results: </strong>Of the 225 patients (mean age 61.3 ± 17.5 years; 53.3% male), 17.3% were in the PTH1 group, 55.6% in PTH2, and 27.1% in PTH3. Patients in the PTH1 (low PTH) group were older and had a higher prevalence of diabetes mellitus than those in the target PTH group (p < 0.05). Serum calcium and phosphate levels were similar among the groups (p > 0.05). C-reactive protein (CRP) and ferritin levels were significantly higher in both the PTH1 and PTH3 groups compared to the PTH2 group (p < 0.05 for both). Accordingly, the novel inflammatory indices differed by PTH category: the median SII and NLR values were lowest in the PTH2 group and significantly elevated in both the low PTH and high PTH groups (PTH1 and PTH3, p < 0.05). In multivariate logistic regression, higher SII (p = 0.002) and NLR (p = 0.045) were independently associated with PTH levels outside the 150 - 600 pg/mL target range, even after adjusting for age, diabetes, CRP, ferritin, calcium, and phosphorus. HD duration showed a significant inverse correlation with PTH in the PTH1 group (r = -0.245, p = 0.022) but was not an independent predictor of PTH category overall.</p><p><strong>Conclusion: </strong>Hemodialysis patients with PTH levels below or above the recommended target range demonstrated elevated inflammatory markers (CRP and ferritin) and higher SII/NLR values, indicating a state of increased systemic inflammation. The SII and NLR were independent predictors of out-of-range PTH levels. These easily obtained indices may be useful for assessing inflammation in HD patients with altered mineral metabolism. Further research is warranted to determine whether addressing inflammation can modulate PTH levels or improve outcomes in this population.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590354","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}