Clinical Kidney Journal最新文献

{"title":"Correction to: Circulating miR-129-3p in combination with clinical factors predicts vascular calcification in hemodialysis patients.","authors":"","doi":"10.1093/ckj/sfaf300","DOIUrl":"https://doi.org/10.1093/ckj/sfaf300","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfae038.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf300"},"PeriodicalIF":4.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time trends in preemptive kidney transplantation in Europe: ERA Registry Figure of the month.","authors":"Vianda S Stel, Alberto Ortiz, Anneke Kramer","doi":"10.1093/ckj/sfaf304","DOIUrl":"https://doi.org/10.1093/ckj/sfaf304","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf304"},"PeriodicalIF":4.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECOSBot: a multicenter validation pilot study of a generative AI tool for OSCE-based nephrology training.","authors":"Raphaël Bentegeac, Nans Florens, Mehdi Maanaoui, Valentin Maisons, Antoine Lanot, Mickaël Bobot, Benoît Brilland, François Glowacki, Erwin Gérard, Marc Hazzan, Philippe Amouyel, Bastien Le Guellec, Aghiles Hamroun","doi":"10.1093/ckj/sfaf308","DOIUrl":"https://doi.org/10.1093/ckj/sfaf308","url":null,"abstract":"<p><strong>Background: </strong>Developing diagnostic reasoning in nephrology is particularly challenging due to its pathophysiological complexity and reliance on abstract clinical data. Objective Structured Clinical Examinations (OSCEs) are pivotal for nephrology training but remain resource-intensive and difficult to scale. Generative artificial intelligence (AI) offers a promising alternative, yet its capacity to emulate nephrology-specific OSCEs has not been formally assessed.</p><p><strong>Methods: </strong>We developed ECOSBot, a web-based tool powered by GPT-4o, to simulate both standardized patients and examiners for nephrology-focused OSCEs. In this multicenter prospective study, undergraduate medical students from five French medical schools interacted with ECOSBot across four clinical stations. All interactions were double-rated by nephrology faculty members to establish a gold standard. ECOSBot's performance was evaluated against this standard using four criteria (script coverage, authenticity, correctness and relevance) for patient simulation, and via checklists and competency-based ratings for examiner scoring. Usability was assessed using the Chatbot Usability Questionnaire (CUQ), adapted to include six items on feedback quality.</p><p><strong>Results: </strong>Ninety-one students generated 2939 prompts across 184 OSCE sessions. ECOSBot demonstrated high fidelity in patient simulation: authenticity 98.6% [95% confidence interval (CI) 98.2-99.0], correctness 98.3% (95% CI 97.9-98.7) and relevance 99.2% (95% CI 98.9-99.5), including during exchanges not explicitly covered by the pre-specified scenario. As an examiner, ECOSBot showed strong agreement with human raters on global scores [intraclass correlation coefficient (ICC) = 0.94, 95% CI 0.91-0.96], consistent across case formats, training levels and institutions. However, scoring of attitude and communication skills was less reliable (ICC = 0.44, 95% CI 0.28-0.58). Median CUQ score was 69.7/100, with 91.7% of students finding the tool highly useful for OSCE preparation in nephrology.</p><p><strong>Conclusions: </strong>ECOSBot reliably simulated both roles in nephrology OSCEs with high fidelity and strong alignment with expert rating. While challenges remain for subjective skill assessment, this tool offers a scalable and autonomous solution to enhance nephrology education.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf308"},"PeriodicalIF":4.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12541372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: A clinical score to predict recovery in end-stage kidney disease due to acute kidney injury.","authors":"","doi":"10.1093/ckj/sfaf299","DOIUrl":"https://doi.org/10.1093/ckj/sfaf299","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfae085.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf299"},"PeriodicalIF":4.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12485600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel eGFR equations and cardiovascular outcomes in a multiethnic Asian cohort.","authors":"Zhong Hong Liew, Miao Li Chee, Riswana Banu, Yulia Liem, Ching-Yu Cheng, Cynthia Ciwei Lim, Charumathi Sabanayagam","doi":"10.1093/ckj/sfaf289","DOIUrl":"10.1093/ckj/sfaf289","url":null,"abstract":"<p><strong>Background: </strong>Novel creatinine-based glomerular filtration rate (GFR) estimating equations were proposed for chronic kidney disease (CKD) evaluation but their comparative ability to predict mortality and cardiovascular events is less established. We compared four Chronic Kidney Disease Epidemiology Collaboration equations and three European Kidney Function Consortium (EKFC) equations in predicting risk for all-cause mortality and cardiovascular events in multiethnic Asians.</p><p><strong>Methods: </strong>We performed analysis of Singapore Epidemiology of Eye Diseases population-based cohort that recruited Chinese and Indian aged 40-80 years between 2007 and 2011. The outcomes of death and incident cardiovascular events were ascertained by data linkage with National Registry of Diseases Office until 31 March 2021. Using Cox proportional hazards model, we conducted multivariable regression analyses to evaluate the association of CKD and outcomes. C-statistic was performed to compare prediction performance of these equations.</p><p><strong>Results: </strong>During a mean follow-up of 11.3 ± 2.2 years, the all-cause mortality rate was 12.9% (743 of 5738 participants). When using Creat-ASR 2009, Creat-AS 2021, Cys 2012, Creat-cys 2021, EKFCcreat, EKFCcys and EKFCcreat-cys, mortality rates among those with CKD (eGFR <60 mL/min/1.73 m²) were 41.3%, 45.3%, 39.7%, 47.9%, 41.4%, 43.1% and 45.8%, respectively. After excluding those with existing cardiovascular disease (CVD), incident cardiovascular event rate was 9.9% (508 of 5120 participants). For all-cause mortality, Creat-cys 2021 (C-index 0.809) had better predictive ability than Creat-ASR 2009 (0.806, <i>P</i> = .001), Creat-AS 2021 (0.807, <i>P</i> = .016) and EKFCcreat (0.806, <i>P</i> = .001). For incident CVD, there was no difference in CVD prediction between Creat-cys 2021 (C-index 0.794) and EKFCcreat (0.792, <i>P</i> = .263) or Creat-AS 2021 (0.790, <i>P</i> = .050).</p><p><strong>Conclusion: </strong>Creat-cys 2021 outperformed creatinine-based GFR equations and demonstrated comparable performance to Cys 2012, EKFCcys and EKFCcreat-cys in predicting all-cause mortality. For incident CVD, Creat-AS 2021 and EKFCcreat demonstrated performance comparable to that of Cys 2012, Creat-cys 2021, EKFCcys and EKFCcreat-cys, providing cost-effective and equally reliable alternatives in this multiethnic Asian population.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf289"},"PeriodicalIF":4.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world safety of difelikefalin for chronic kidney disease-associated pruritus: initial insights from a European managed access programme.","authors":"Joerg Latus, Gert Mayer, Carlos Narvaez, Marius Manu, Sara Jesus, Despina Ruessmann, Lucio Manenti","doi":"10.1093/ckj/sfaf297","DOIUrl":"https://doi.org/10.1093/ckj/sfaf297","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease-associated pruritus (CKD-aP) is a debilitating condition with limited treatment options. A managed access programme (MAP) began in October 2021 to provide early, controlled access to the novel antipruritic difelikefalin to European and Australian patients with CKD-aP with no local access to commercially available treatments. Here, we describe the safety data collected up to 31 October 2024.</p><p><strong>Methods: </strong>Eligible adults with moderate-to-severe CKD-aP receiving in-centre haemodialysis (HD) were provided with difelikefalin (0.5 µg/kg) intravenously after each HD session. All adverse events (AEs) were recorded; a Global Drug Safety team assessed seriousness and causality. AE details, including outcomes, were also recorded.</p><p><strong>Results: </strong>A total of 438 patients were provided with a median of 115 (min-max: 30-1035) days of difelikefalin treatment. Of these, 167 (38.1%) patients experienced 458 AEs. Of 246 serious AEs (SAEs), 10.2% were considered possibly related to difelikefalin. Of those with a known outcome, 88.0% were resolved during the MAP. There were 63 fatal SAEs, none considered related to difelikefalin. There were 152 non-serious AEs, of which 63.8% were deemed possibly/probably related to difelikefalin. Of the 59 difelikefalin-related non-serious AEs with a known outcome, 86.4% were resolved during the MAP. Most AEs and SAEs were consistent with conditions typical of patients with CKD requiring HD and/or the known safety profile of difelikefalin.</p><p><strong>Conclusions: </strong>No new safety signals were detected in this MAP analysis over a 3-year period. The overall safety results were consistent with the known safety profile for difelikefalin patients with moderate-to-severe CKD-aP receiving HD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf297"},"PeriodicalIF":4.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12541368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 a bioethics and humanities program on the educational training of nephrology residents.","authors":"Guillermo Cantú Quintanilla, Irma Gómez Guerrero, Gloria Garcia-Villalobos, Geovana Martin Alemañy, Nuria Aguiñaga Chiñas, Rafael Valdez-Ortiz","doi":"10.1093/ckj/sfaf298","DOIUrl":"10.1093/ckj/sfaf298","url":null,"abstract":"<p><strong>Background: </strong>Modern medical training must integrate not only clinical skills but also ethical and humanistic competencies. In 2013, a structured program in bioethics and humanism was implemented as part of a nephrology residency curriculum. The objective of this study was to evaluate the impact of a 3-year humanism and bioethics program for nephrology residents that focused on improving clinical communication, reducing complaint and lawsuit numbers, increasing patient satisfaction, and supporting decision-making centered on quality of life.</p><p><strong>Methods: </strong>A longitudinal, ambispective cohort (2010-19), our 3-year curriculum delivered weekly 1-h sessions for 6 months/year to 45 residents and was facilitated by three faculty instructors across six core themes. To relate outcomes to the intervention, analyses were anchored to the 2013 launch and compared pre-program (2010-13) versus post-program (2014-19) rates of formal complaints, legal claims, patient satisfaction and maximum benefit discharges.</p><p><strong>Results: </strong>Formal complaints decreased from 47.8 to 26.0 per year [incidence rate ratio (IRR) 0.54, 95% confidence interval (CI) 0.44-0.67; <i>P</i> < .001; Holm <0.001]. Legal claims were reduced from 4.25 to 0.17 per year (IRR 0.039, 95% CI 0.005-0.295; <i>P</i> = .0016; Holm = 0.0016). Maximum benefit discharges increased from 4.25 to 76.5 per year (IRR 18.0, 95% CI 11.09-29.21; <i>P</i> < .001; Holm <0.001). For satisfaction, the ordinal logistic model showed an odds ratio (OR) of 3.53 (95% CI 1.96-6.38; <i>P</i> < .001; Holm = 0.0001), consistent with the dichotomous sensitivity analysis (≥4 vs ≤3) (OR 4.08, 95% CI 2.16-7.71; <i>P</i> < .000).</p><p><strong>Conclusions: </strong>The humanism and bioethics program was proven to be an effective and transformative educational tool that promoted ethical, empathetic and patient-centered nephrology practices. The positive impact of this program was evident in both clinical indicators and strengthened medical professionalism.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf298"},"PeriodicalIF":4.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of radioactive and non-radioactive iothalamate and hippuran to assess kidney function.","authors":"Abdulfataah A A Mohamed, Ron T Gansevoort, Nico C van de Merbel, Marco van Londen, Martin H de Borst, Rolf Zijlma, Lenneke A T Junier, Hiddo J L Heerspink, Jasper Stevens","doi":"10.1093/ckj/sfaf293","DOIUrl":"10.1093/ckj/sfaf293","url":null,"abstract":"<p><strong>Background: </strong>Kidney function can be assessed by the measured glomerular filtration rate (mGFR) and effective renal plasma flow (ERPF) using the exogenous filtration markers ¹²⁵I-iothalamate and ¹³¹I-hippuran. These markers are unfavourable due to the radioactive burden for patients, personnel and the environment. We studied whether we could replace the measurement of these radiolabelled compounds ('warm method') with the measurement of their non-radioactive isotopologues ('cold method').</p><p><strong>Methods: </strong>We determined mGFR and ERPF in 220 participants by both the warm (gamma counting) and cold (liquid chromatography-tandem mass spectrometry) methods on the same serum, urine and infusion solution samples. Agreement between the methods was evaluated using Passing-Bablok regression and Bland-Altman analysis. Accuracy criteria were that ≥80% of the warm and cold mGFR measurements were within ±30% (P₃₀) and ≥50% within ±10% (P₁₀). Precision of mGFR was assessed by the standard deviation (SD) of the bias and the intratest coefficient of variation (CV%) of the measurement methods were determined.</p><p><strong>Results: </strong>mGFR measurements showed a mean difference of 1.97% and no clinically relevant bias when comparing the warm and cold methods. mGFR was accurate with a P₃₀ of 100% and a P₁₀ of 76%. The cold method was precise; the SD was 8.04 ml/min and the intratest CV% was 3.01 ± 3.15%. The ERPF values showed a mean difference of 19.2% and a large constant and proportional bias. Radiochemical impurities, which influence the warm method, were found in the ¹³¹I-hippuran formulation, and these were the cause of the discrepancy between the two methods.</p><p><strong>Conclusions: </strong>The cold method provides equivalent mGFR results compared with the warm method. The ERPF determined using the cold method is unaffected by radiochemical impurities that significantly affect the warm method.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf293"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary extracellular vesicle RNAs as novel <b>biomarkers</b> for diagnosis and prognosis of lupus nephritis.","authors":"Heng Zhang, Xuexue Zheng, Saisai Huang, Li Qian, Junxiang Wu, Zhongtian Shi, Meng Jia, Yang Bai, Longwei Jiang, Shaochang Jia, Ke Zen, Yanggang Yuan, Jun Liang, Hongwei Liang","doi":"10.1093/ckj/sfaf295","DOIUrl":"10.1093/ckj/sfaf295","url":null,"abstract":"<p><strong>Background: </strong>Lupus nephritis (LN) is among the most serious organ manifestations of systemic lupus erythematosus (SLE), contributing significantly to morbidity and long-term renal outcomes. The development of noninvasive biomarkers capable of distinguishing active LN from non-renal SLE is of considerable clinical importance. Although renal biopsy remains the diagnostic gold standard, its invasive nature limits its utility for serial monitoring. In recent years, urine has emerged as a promising noninvasive medium for detecting renal inflammation and assessing disease activity.</p><p><strong>Methods: </strong>This study investigated whether RNA signatures within urinary extracellular vesicles (EVs) could serve as diagnostic biomarkers for LN. Urinary EVs were isolated from 27 patients with active LN and 13 with LN in remission. RNA sequencing was conducted, and four candidate transcripts were prioritized using three independent machine learning algorithms. These candidates were subsequently validated in an independent cohort comprising 143 urine samples using TaqMan-based quantitative PCR with reverse transcription (RT-qPCR).</p><p><strong>Results: </strong>Among the identified candidates, LINC01127, RUNDC3A-AS1, and LRRN3 emerged as potential diagnostic biomarkers for LN. Notably, RUNDC3A-AS1 and LRRN3 demonstrated robust discriminatory capacity between proliferative (class III/IV) and non-proliferative (class V) forms of LN.</p><p><strong>Conclusions: </strong>Our findings identify urinary extracellular vesicle RNAs-particularly LINC01127, RUNDC3A-AS1, and LRRN3-as novel, noninvasive biomarkers with potential clinical utility for the diagnosis and subclassification of LN.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf295"},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Green teams drive sustainability: a European Rare Kidney Disease Reference Network Survey on dialysis environmental practices.","authors":"Emanuele De Simone, Marco Carmelo Morrone, Ece Izel Tatarhan, Marco Pozzato, Dario Roccatello, Roberta Fenoglio, Savino Sciascia","doi":"10.1093/ckj/sfaf276","DOIUrl":"https://doi.org/10.1093/ckj/sfaf276","url":null,"abstract":"<p><strong>Background: </strong>the environmental impact of healthcare is a growing concern, and nephrology, particularly dialysis, is a resource-intensive field. Dialysis involves high energy use, water consumption, significant waste generation, and transport-associated emissions. However, the extent to which \"green\" dialysis practices have been implemented remains largely unexplored.</p><p><strong>Methods: </strong>A comprehensive survey assessing the adoption of sustainable practices in dialysis covering water, energy, waste, transport and procurement policies was distributed through the European Rare Kidney Disease Reference Network (November 2024 to January 2025). The questionnaire covered key sustainability domains, including water and energy management, waste reduction, transport, and procurement policies. A \"Green Score\" was developed to quantify the implementation of eco-friendly initiatives. Additionally, a patient survey was conducted to evaluate perceptions of dialysis-related environmental impact and willingness to act.</p><p><strong>Results: </strong>A total of 34 nephrology centers (43% response rate) participated. The mean Green Score indicated that only 39.4% of achievable sustainability measures were in place. Despite widespread awareness, only 26.5% of centers had formal sustainability strategies, 17.6% had dedicated \"Green Teams,\" and just 12.1% utilized measurable indicators to track interventions. Water reuse systems were absent. Plastic recycling programs were present in 79.4% of centers, yet waste-saving initiatives were rare. Notably, the presence of a Green Team was significantly associated with higher Green Scores (<i>P</i> < .05). Patient responses (<i>n</i> = 45) revealed strong interest in sustainability, with 95.6% willing to take action.</p><p><strong>Conclusions: </strong>This study highlights critical gaps in sustainable dialysis practices across European nephrology centers. Despite interest, implementation remains limited. The strong association between Green Teams and sustainability scores highlights the need for formalized institutional efforts. Given the significant ecological footprint of dialysis, urgent action is required to integrate sustainable strategies into routine nephrology care.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf276"},"PeriodicalIF":4.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12541384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}