Clinical Kidney Journal最新文献

{"title":"Pathways to translation for nanomedicine in nephrology.","authors":"Zoe Schoales, Pratyusha Ghosh, Anastasiia Vasylaki, Edgar A Jaimes, Ryan Williams","doi":"10.1093/ckj/sfaf192","DOIUrl":"10.1093/ckj/sfaf192","url":null,"abstract":"<p><p>Kidney diseases are a substantial worldwide health burden, with high mortality and increasing incidence. Despite their prevalence, substantial gaps remain in the clinic in both diagnostics and therapeutics. Many novel treatments have failed in clinical trials or fallen out of use in the clinic due to side effects and poor efficacy, in large part due to poor therapeutic profiles in the kidney. Nanomedicines have begun to emerge as a potentially promising diagnostic or therapeutic delivery system. Based on their physicochemical properties, such as size, shape, surface chemistry, and so on, some nanotechnologies can target the kidneys. However, as of yet, no kidney-specific nanomedicines have reached clinical translation. While the field of renal nanomedicine is in its early stages and growing, some potential obstacles to translation include poor preclinical models, challenges in manufacturing scale-up, clinical trial design and the cost of translation. Here, we overview the current state of the kidney-targeting nanomedicine field and outline a potential framework for clinical translation. We focus on the paths of US Food and Drug Administration- approved nanomedicines and suggestions from other nanomedicine fields to inform our key considerations for translational success. We also highlight the importance of academic and clinical collaboration with industry and federal regulators. Several investigational technologies are just now at the cusp of scaling towards the clinic and we therefore aim to support this momentum for improving the lives of patients with kidney diseases.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf192"},"PeriodicalIF":4.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184739","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":"Clinical applications and limitations of large language models in nephrology: a systematic review.","authors":"Zoe Unger, Shelly Soffer, Orly Efros, Lili Chan, Eyal Klang, Girish N Nadkarni","doi":"10.1093/ckj/sfaf243","DOIUrl":"10.1093/ckj/sfaf243","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) have emerged as potential tools in healthcare. This systematic review evaluates the applications of text-generative conversational LLMs in nephrology, with particular attention to their reported advantages and limitations.</p><p><strong>Methods: </strong>A systematic search was performed in PubMed, Web of Science, Embase and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies assessed LLM applications in nephrology. PROSPERO registration number CRD42024550169.</p><p><strong>Results: </strong>Of 1070 records screened, 23 studies met inclusion criteria, addressing four clinical applications in nephrology. In patient education (<i>n</i> = 13), GPT-4 improved the readability of kidney donation information from a 10th to a 4th grade level (9.6 ± 1.9 to 4.30 ± 1.71) and Gemini provided the most accurate answers to chronic kidney disease questions (Global Quality Score 3.46 ± 0.55). Regarding workflow optimization (<i>n</i> = 7), GPT-4 achieved high accuracy (90-94%) in managing continuous renal replacement therapy alarms and improved diagnosis of diabetes insipidus using chain-of-thought and retrieval-augmented prompting. In renal dietary guidance (<i>n</i> = 2), Bard AI led in classifying phosphorus and oxalate content of foods (100% and 84%), while GPT-4 and Bing Chat were most accurate for potassium classification (81%). For laboratory data interpretation (<i>n</i> = 1), Copilot significantly outperformed ChatGPT and Gemini in simulated nephrology datasets (median scores 5/5 compared with 4/5 and 4/5; <i>P</i> < .01). TRIPOD-LLM assessment revealed frequent omissions in data handling, prompting strategies and transparency.</p><p><strong>Conclusions: </strong>While LLMs may enhance various aspects of nephrology practice, their widespread adoption remains premature. Input-quality dependence and limited external validation restrict generalizability. Further research is needed to confirm their real-world feasibility and ensure safe clinical integration.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf243"},"PeriodicalIF":4.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184795","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 analysis of the impact of finerenone on estimated glomerular filtration rate and albuminuria in patients with diabetic kidney disease.","authors":"Kiyomi Ichijo, Ryo Yamaguchi, Hiroyuki Takashima, Hiroki Kobayashi, Takashi Maruyama, Masanori Abe","doi":"10.1093/ckj/sfaf292","DOIUrl":"10.1093/ckj/sfaf292","url":null,"abstract":"<p><strong>Aims: </strong>Large-scale clinical trials have shown that finerenone reduces the urinary albumin-to-creatinine ratio (UACR) and slows estimated glomerular filtration rate (eGFR) decline, thereby inhibiting a composite cardiovascular and kidney endpoint. However, the efficacy and safety of finerenone in clinical practice remain unknown. This study evaluated eGFR decline and changes in UACR as efficacy endpoints and changes in the serum potassium level as a safety endpoint in patients with diabetic kidney disease (DKD).</p><p><strong>Methods: </strong>This retrospective observational study was conducted in a real-world clinical setting and included patients with DKD. Eligible patients were those diagnosed with chronic kidney disease stage G1 to G4 who had a UACR of ≥30 mg/gCr while taking a renin-angiotensin system inhibitor and who had initiated finerenone. Endpoints included changes in the eGFR slope, UACR, other urinary biomarkers, laboratory and vital parameters, and adverse events.</p><p><strong>Results: </strong>The analysis included 120 patients. Finerenone significantly improved the rate of eGFR decline from -4.99 (-5.75, -4.23) to -0.59 (-1.24, 0.07) mL/min/1.73 m²/year (<i>P</i> < .0001). UACR also decreased significantly after finerenone treatment from 908 to 487 mg/gCr (<i>P</i> < .0001). Finerenone improved the eGFR slope across all baseline eGFR and albuminuria categories. The rate of eGFR decline improved regardless of whether sodium-glucose cotransporter 2 inhibitor therapy was used concomitantly. Symptomatic hypotension, acute kidney injury and hyperkalemia leading to drug discontinuation were uncommon.</p><p><strong>Conclusions: </strong>This real-world analysis suggests that finerenone may improve the eGFR slope in patients with DKD without causing significant hyperkalemia, regardless of baseline eGFR and albuminuria values.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf292"},"PeriodicalIF":4.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343875","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: The burden of acute kidney disease: an epidemiological review and importance of follow-up care.","authors":"","doi":"10.1093/ckj/sfaf277","DOIUrl":"https://doi.org/10.1093/ckj/sfaf277","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfaf169.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf277"},"PeriodicalIF":4.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112053","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: Decongestion in patients with advanced chronic kidney disease coexisting with heart failure.","authors":"","doi":"10.1093/ckj/sfaf288","DOIUrl":"https://doi.org/10.1093/ckj/sfaf288","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfaf185.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf288"},"PeriodicalIF":4.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112063","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: Spatially resolved transcriptomic profiling for glomerular and tubulointerstitial gene expression in C3 glomerulopathy.","authors":"","doi":"10.1093/ckj/sfaf257","DOIUrl":"https://doi.org/10.1093/ckj/sfaf257","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfaf139.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf257"},"PeriodicalIF":4.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112055","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":"Are oval fat bodies useful diagnostic clues in kidney disease?","authors":"Eisuke Kubo, Kotaro Haruhara, Takaya Sasaki, Nobuo Tsuboi, Takashi Yokoo","doi":"10.1093/ckj/sfaf281","DOIUrl":"10.1093/ckj/sfaf281","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf281"},"PeriodicalIF":4.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243787","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":"Regional citrate anticoagulation ensures safe and effective kidney replacement therapy in metformin-associated lactic acidosis.","authors":"Francesca Di Mario, Giuseppe Regolisti, Maria Chiara Pacchiarini, Benedetta Mordà, Paolo Greco, Caterina Maccari, Tommaso Di Motta, Vincenzo Oliva, Chiara Italiano, Teresa Coccini, Elisa Roda, Enrico Fiaccadori","doi":"10.1093/ckj/sfaf286","DOIUrl":"10.1093/ckj/sfaf286","url":null,"abstract":"<p><strong>Background: </strong>Metformin-associated lactic acidosis (MALA) is a rare but potentially life-threatening complication of metformin therapy, often associated with acute kidney injury (AKI). Sustained low-efficiency dialysis (SLED) offers both haemodynamic stability and effective metformin clearance. However, during regional citrate anticoagulation (RCA), concerns may arise regarding citrate accumulation due to metformin-induced impairment of cellular metabolism. This study assesses the efficacy and safety of SLED with RCA in the management of MALA, providing direct measurements of serum metformin and citrate levels to evaluate drug clearance and potential citrate accumulation.</p><p><strong>Methods: </strong>A prospective observational study was conducted on consecutive critically ill patients with severe AKI and suspected MALA undergoing a 16-h SLED session with RCA. Demographic, clinical and laboratory data were collected. Serum metformin and citrate levels were measured via high-performance liquid chromatography and enzymatic spectrophotometric analysis, respectively. Mixed effects linear models were used to analyse serum metformin, lactate, citrate, electrolytes and acid-base parameters over time.</p><p><strong>Results: </strong>Twenty-three patients (median age 79 years; APACHE II score 29) had metformin levels at intensive care unit (ICU) admission above the therapeutic range (median 29.1 mg/l; normal: 0.5-3). ICU mortality was 22% (<i>n</i> = 5). SLED led to significant haemodynamic and acid-base improvements, with a marked reduction in serum lactate. Metformin levels decreased from 27.75 mg/l at SLED start to 3.95 mg/l, with minimal rebound. Four SLED sessions (17%) were interrupted, with one being due to impending circuit clotting. No biochemical or clinical signs of citrate accumulation were observed, with serum citrate levels consistently <0.5 mmol/l. No significant correlation was found between serum metformin and citrate levels or between lactate and citrate.</p><p><strong>Conclusions: </strong>SLED with RCA is safe and effective in patients with MALA, ensuring adequate KRT duration, rapid metformin clearance and acid-base status restoration. Direct citrate measurements confirmed the absence of accumulation, reinforcing RCA as a viable anticoagulation strategy in this clinical setting.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf286"},"PeriodicalIF":4.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279065","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":"Ultrafiltration rate and mortality in patients undergoing extended-hours haemodialysis.","authors":"Takahiro Imaizumi, Masaki Okazaki, Manabu Hishida, Nobuhiro Nishibori, Shimon Kurasawa, Toru Kondo, Fumika Kaneda, Hiroshi Kaneda, Shoichi Maruyama","doi":"10.1093/ckj/sfaf287","DOIUrl":"https://doi.org/10.1093/ckj/sfaf287","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend maintaining ultrafiltration rate (UFR) below 10-13 ml/h/kg for patients undergoing conventional haemodialysis to reduce adverse outcomes. However, achieving this target may compromise nutritional status, particularly in underweight patients. We aimed to explore the association of the interaction between UFR and body weight with mortality.</p><p><strong>Methods: </strong>We analysed the LIBERTY cohort data to assess the association between UFR (net ultrafiltration volume divided by session length) and mortality. We employed three multivariable Cox regression models: baseline (long-term effects), time-dependent (short-term effects), and time-averaged (cumulative effects). Contour plots examined the UFR and post-dialysis weight interactions. Dialysis and laboratory parameters were electronically collected and averaged quarterly.</p><p><strong>Results: </strong>Among 614 patients (mean age 62 years; 65% male) undergoing extended-hours haemodialysis, the median net ultrafiltration volume was 3.0 (IQR, 2.4-3.7) kg/session, with dialysis session length of 21 (18-24) hours/week. The median scaled and unscaled UFR were 7.4 (6.0-9.1) mL/h/kg and 434 (334-531) ml/h, respectively. Over a median follow-up of 6.2 (3.5-10.1) years, 225 patients died. The association between UFR and mortality was significantly modified by post-dialysis weight. Higher-weight patients showed increased mortality with higher UFR in baseline and time-averaged models, while lower-weight patients showed poorer outcomes with lower UFR in time-dependent models. These findings were particularly pronounced in older patients.</p><p><strong>Conclusion: </strong>UFR-mortality association is significantly modified by body weight in extended-hours haemodialysis patients. These findings highlight individualized UFR management needs and potential nutritional intervention benefits for underweight patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf287"},"PeriodicalIF":4.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12541367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353322","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":"Indications and recent evidence for apheresis in children and adults with kidney diseases: a comprehensive review.","authors":"Rupesh Raina, Eugene Yu-Hin Chan, Jieji Hu, Pujan Moradiya, Bryce Pember, Priyanka Khandelwal, Ruchi Mahajan, Ali Düzova, Kinnari Vala, Vivekanand Jha, Olivia Boyer, Sidharth Sethi, Pietro Canetta","doi":"10.1093/ckj/sfaf282","DOIUrl":"10.1093/ckj/sfaf282","url":null,"abstract":"<p><strong>Introduction: </strong>Plasmapheresis has been a therapeutic option in kidney diseases to eliminate disease-causing autoantibodies, circulating factors, and abnormal components involved in complement pathways. We aim to systematically review the effectiveness and adverse events associated with plasmapheresis and related apheresis therapies in treating kidney diseases in paediatric and adult populations.</p><p><strong>Methods: </strong>We searched databases including EMBASE, CINAHL, PubMed, and Cochrane Central for studies from 2010 to October 2023. The search terms included terms related to glomerulonephritis treated with plasmapheresis. Outcomes included the patient's length of hospital stay, mortality, development of kidney failure, associated comorbidities, and adverse events. Risk of bias was assessed using the Newcastle-Ottawa Scale, and meta-analyses were performed to calculate pooled adverse event rates.</p><p><strong>Results: </strong>A total of 33 studies with 1363 participants were included. The pooled proportion of kidney failure was 26.36% (95% CI 17.38%-36.47%), and the rate of dialysis requirement was 30.43% (95% CI 14.80%-48.82%). The mortality rate was 10.86% (95% CI 9.12%-12.81%). Adverse events were reported in 31.03% (95% CI 12.78%-53.05%) of cases. Heterogeneity was significant for most outcomes. We also performed a literature review due to a lack of adequate studies regarding the use of plasmapheresis in lupus nephritis, multiple myeloma, and atypical haemolytic uremic syndrome, as well as the use of low-density lipoprotein apheresis in kidney diseases.</p><p><strong>Discussion: </strong>Plasmapheresis has demonstrated remission in patients with kidney diseases, particularly in those with ANCA-associated vasculitis and FSGS. Based on the results of our systematic review, we discuss the use of plasmapheresis for treating glomerular diseases, atypical haemolytic uremic syndrome, other kidney diseases, and the usage of low-density lipoprotein apheresis. Further research is needed to improve patient outcomes and reduce complications, especially in paediatric populations.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 10","pages":"sfaf282"},"PeriodicalIF":4.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279112","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}