Clinical Kidney Journal最新文献

{"title":"Diagnostic disclosure, communication quality, and patient experience in autosomal dominant polycystic kidney disease.","authors":"Malik Djadda, Fadi Haidar, Patrick Guirchoun, Sandra Sarthou-Lawton, Sylvie Coscoy, Dominique Joly","doi":"10.1093/ckj/sfag351","DOIUrl":"10.1093/ckj/sfag351","url":null,"abstract":"<p><strong>Background: </strong>In autosomal dominant polycystic kidney disease (ADPKD), the age and circumstances of diagnosis, the quality of initial disclosure, and how patients experience it have not been systematically described.</p><p><strong>Methods: </strong>Cross-sectional web-based survey in France (2019-2024) of adults with self-reported ADPKD recruited via patient organizations. Participants reported diagnostic context, who first disclosed the diagnosis, perceived information quality, and rated tact and overall experience on 0-5 scales. Primary outcomes were poor tact and very negative diagnostic experience (scores 0-1). Multivariable models included prespecified covariates tailored to each outcome.</p><p><strong>Results: </strong>Among 1021 respondents, median age at diagnosis was 26 (IQR 18-36) years. Diagnosis followed family screening (40%), symptom-driven work-up (27%), or incidental findings (21%), and occurred earlier in women and after parent-initiated screening. Initial disclosure was most often by radiologists (49%) rather than nephrologists (22%). Poor tact, reported by 25%, was associated with radiologist versus nephrologist disclosure [adjusted odds ratios (aOR) 2.50, 95% confidence interval (CI) 1.57-3.98]. Very negative experience, reported by 29%, was associated with poor tact (aOR 4.55, 95% CI 2.90-7.12) and poor information (aOR 2.52, 95% CI 1.53-4.15). Delayed or absent nephrology follow-up was reported by 40% and was associated with reporting no post-disclosure resolution (aOR 4.34, 95% CI 3.10-6.09).</p><p><strong>Conclusions: </strong>ADPKD was often disclosed outside nephrology, and patients frequently reported poor tact, inadequate information, and very negative diagnostic experiences. These findings identify communication quality and timely nephrology follow-up as potential targets for improving the ADPKD diagnostic experience.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag351"},"PeriodicalIF":5.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263636","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":"Corticosteroids, serum proteins, and the next phase of precision medicine in IgA nephropathy.","authors":"Carmine Zoccali, Jürgen Floege","doi":"10.1093/ckj/sfag345","DOIUrl":"10.1093/ckj/sfag345","url":null,"abstract":"<p><p>Systemic glucocorticoids remain an important but problematic treatment option in high-risk IgA nephropathy, offering kidney protection at the cost of clinically relevant toxicity. Recent serum proteomic analyses embedded within the randomized TESTING trial provide a new framework for identifying patients most likely to benefit from methylprednisolone. In 241 Chinese participants with IgA nephropathy, longitudinal profiling of 479 serum samples showed that methylprednisolone significantly modulated 302 proteins involved in cytoskeletal regulation, extracellular matrix interactions, immunometabolism, coagulation, protein turnover, and related pathways. Importantly, complement- and endothelial injury-associated pathways were incompletely modified and remained linked to adverse kidney outcomes, suggesting residual disease mechanisms that may require complementary targeted therapies. Among baseline proteins, leptin and C1QTNF5 emerged as practical candidate biomarkers of glucocorticoid responsiveness, improving prediction of treatment efficacy beyond conventional clinical variables. These findings support a shift from purely prognostic risk stratification toward treatment-informed precision medicine in IgA nephropathy. However, the biomarker model requires prospective validation across diverse populations, steroid regimens, and background therapies, and future tools must integrate both predicted kidney benefit and treatment-related harm. If confirmed, serum proteomics could help clinicians move beyond population-average steroid decisions toward biologically guided selection of patients most likely to benefit while avoiding unnecessary toxicity.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag345"},"PeriodicalIF":5.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223464","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":"Serum T50 is not independently associated with coronary artery calcification in early chronic kidney disease.","authors":"Guido de La Roij, Kevin Ocran, Marc Vervloet, Andreas Pasch, Rozemarijn Vliegenthart, Gerjan Navis, Martin H de Borst, Joost G J Hoenderop, Jeroen H F de Baaij","doi":"10.1093/ckj/sfag339","DOIUrl":"https://doi.org/10.1093/ckj/sfag339","url":null,"abstract":"<p><strong>Background: </strong>The serum T50 test quantifies calcification propensity, with lower values indicating a higher propensity for calcification. Lower T50 values have been associated with adverse cardiovascular outcomes, particularly in advanced chronic kidney disease. Whether serum T50 is associated with coronary artery calcification (CAC) in individuals with mildly to moderately reduced kidney function remains unclear. We examined this association in a population-based cross-sectional study.</p><p><strong>Methods: </strong>We analysed 1945 participants from the population-based Lifelines ImaLife cohort with mildly to moderately reduced kidney function (estimated glomerular filtration rate, 37.5-87.6 ml/min/1.73 m²). Serum T50 was measured using a standardized nephelometric assay. CAC was assessed by electrocardiographically triggered non-contrast computed tomography and categorized into 0, 1-99, 100-399, and ≥400 Agatston units. Associations between continuous T50 (per 10-min increase) and CAC categories were examined using multinomial logistic regression.</p><p><strong>Results: </strong>Of the 1945 participants, 56.5% had detectable CAC (CAC 1-99: 30.9%, 100-399: 14.4%, ≥400: 11.2%). In crude analyses, higher T50 values were associated with the presence of CAC [odds ratio (OR) 1.02, 95% confidence interval 1.01-1.03] and with CAC categories 1-99, 100-399, and ≥400 versus 0 (ORs 1.01, 1.02, and 1.03, respectively). These associations were no longer significant after adjustment for age, body mass index, and sex. Subgroup analyses did not identify risk groups in which T50 was significantly associated with the presence or severity of CAC.</p><p><strong>Conclusion: </strong>In this cohort with mildly to moderately reduced kidney function, T50 was not independently associated with prevalent CAC after multi-variable adjustment.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag339"},"PeriodicalIF":5.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179778","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":"Risk factors for subsequent recurrent, relapsing, and repeat peritonitis in peritoneal dialysis.","authors":"Hong-Mou Shih, Cheng-Jui Lin, Yi-Zhen Lu, Yu-Wen Hsueh, Chih-Jen Wu, Chi-Feng Pan","doi":"10.1093/ckj/sfag352","DOIUrl":"10.1093/ckj/sfag352","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD)-associated peritonitis may be followed by recurrent, relapsing, or repeat episodes, but factors associated with these subsequent phenotypes remain incompletely defined.</p><p><strong>Methods: </strong>We conducted a 16-year episode-based study of PD-associated peritonitis. Episodes after which PD was not continued were excluded, and outcomes were defined by the next peritonitis episode. The broader outcome was subsequent recurrent/relapsing/repeat peritonitis, and the narrower outcome was subsequent relapsing/repeat peritonitis. Patient-level and PD prescription-related factors were evaluated for the broader outcome, whereas acute microbiology, antibiotic-management, and severity factors were evaluated for the narrower outcome using logistic generalized estimating equation models. Cross-outcome analyses evaluated both predictor domains against both outcomes.</p><p><strong>Results: </strong>Among 385 PD-associated peritonitis episodes from 216 patients, 275 episodes from 152 patients were included. Subsequent recurrent/relapsing/repeat peritonitis occurred after 63 episodes. Male sex was associated with lower odds of this outcome, whereas diabetes mellitus, current recurrent/relapsing/repeat phenotype, fewer automated PD treatment days, and greater manual exchange burden were associated with higher odds. However, the two prescription measures were strongly inversely correlated, and neither remained significant when mutually adjusted. Subsequent relapsing/repeat peritonitis occurred after 57 episodes. Ineffective initial antibiotic therapy and delayed adequate antibiotic therapy were associated with higher odds. Organism group and acute severity markers were not significantly associated with this outcome after adjustment. Cross-outcome analyses were broadly compatible with the main findings.</p><p><strong>Conclusions: </strong>Patient vulnerability, recent episode history, PD prescription-related patterns, and antibiotic-management factors were associated with subsequent peritonitis phenotypes among patients who continued PD. These findings may inform post-peritonitis risk assessment.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag352"},"PeriodicalIF":5.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263651","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":"Short-term effects of an SGLT2 inhibitor on divalent ions in autosomal dominant polycystic kidney disease: a randomized crossover trial.","authors":"Lorena Roth, Dusan Harmacek, Thomas Schachtner, Britta George, Cornelia Hofmann, Argyrios D Georgalis, Reto M Venzin, Patrick Hofmann, Thomas H Fehr","doi":"10.1093/ckj/sfag349","DOIUrl":"10.1093/ckj/sfag349","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a cornerstone of chronic kidney disease therapy, reducing disease progression, cardiovascular events, and mortality. Autosomal dominant polycystic kidney disease (ADPKD) patients were excluded from major trials, and data on electrolyte handling with SGLT2 inhibitors, in combination with tolvaptan, are lacking.</p><p><strong>Methods: </strong>SIDIA was a randomized, double-blind, placebo-controlled, two-period crossover trial in 15 adults with ADPKD (mean estimated glomerular filtration rate (eGFR) 68 ml/min/1.73 m²; median age 43 years). Participants received empagliflozin 10 mg or placebo for 14 days, separated by a 2-week washout. The primary endpoint was 24 h urinary and fractional excretion of phosphate, calcium, and magnesium. Exploratory secondary endpoints included markers of kidney stone propensity, inflammation, vitamin D metabolism, and tolerability. Treatment effects were estimated using generalized linear mixed models. Given the small sample size, analyses were exploratory and focused on effect estimation.</p><p><strong>Results: </strong>For the primary endpoint, neither 24 h urinary nor fractional excretion of phosphate, calcium, or magnesium differed between empagliflozin and placebo. Empagliflozin lowered serum uric acid (-26%), increased serum magnesium (+5.7%) and urinary citrate (+78.6%), and reduced blood pressure (-4/-7 mmHg). An expected decline in eGFR (-7.1%) was observed, with no major short-term safety signals observed. Copeptin levels increased with empagliflozin (+26%).</p><p><strong>Conclusions: </strong>In this exploratory mechanistic trial, no substantial short-term difference in urinary or fractional excretion of divalent ions were detected with empagliflozin. The observed changes in serum magnesium, urinary citrate, uric acid, and copeptin are hypothesis-generating and require confirmation in larger, longer-term studies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag349"},"PeriodicalIF":5.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263566","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: Molecular mechanisms in podocytopathies: finding suitable targets for a new era of glomerular gene therapy.","authors":"","doi":"10.1093/ckj/sfag314","DOIUrl":"https://doi.org/10.1093/ckj/sfag314","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfaf332.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag314"},"PeriodicalIF":5.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105209","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":"Combined statin and fenofibrate therapy and cardiorenal outcomes in patients with CKD, dyslipidemia, and ischemic heart disease.","authors":"Yen-Chih Chang, Ming-Hsien Tsai, Yu-Wei Fang, Meng-Ting Chen, Ya-Hui Tseng, Cheng-Chun Wei","doi":"10.1093/ckj/sfag343","DOIUrl":"https://doi.org/10.1093/ckj/sfag343","url":null,"abstract":"<p><strong>Background: </strong>Adults with non-dialysis-dependent chronic kidney disease (CKD), ischemic heart disease (IHD), and hypertriglyceridemia are at high cardiorenal risk; whether starting fenofibrate together with statin therapy is effective and safe in this population is uncertain.</p><p><strong>Methods: </strong>In a multicenter retrospective cohort study emulating a target trial in the TriNetX Global Collaborative Network (2018-2024), 112 003 (28.5%) of 392 969 statin initiators with CKD and hypertriglyceridemia had IHD. Those without dialysis dependence were assigned to statin-fenofibrate combination therapy or statin monotherapy according to fenofibrate initiation within 3 months of the first statin prescription. The main outcomes were expanded major adverse cardiovascular events (MACEs) (acute myocardial infarction, stroke, heart failure, cardiac arrest, or all-cause death) and end-stage kidney disease (ESKD) necessitating dialysis. Propensity score matching yielded 3191 pairs. Cox models estimated hazard ratios (HRs).</p><p><strong>Results: </strong>Median follow-up was 881 days with combination therapy and 925 days with statin monotherapy. Combination therapy was associated with lower risks of MACE [1472 [46.1%] vs 1576 [49.4%] events; HR, 0.93; 95% confidence interval (CI), 0.86-0.99] and ESKD necessitating dialysis (264 [8.3%] vs 335 [10.5%]; HR, 0.79; 95% CI, 0.67-0.92). Risks of all-cause mortality (377 vs. 375), acute myocardial infarction (537 vs. 570), heart failure (1059 vs. 1134), stroke (310 vs. 312), acute kidney injury (825 vs. 840), and coded safety events were not significantly different between groups.</p><p><strong>Conclusions: </strong>Among selected adults with non-dialysis-dependent CKD, hypertriglyceridemia, and IHD, statin-fenofibrate combination therapy was associated with lower risks of MACE and of ESKD necessitating dialysis, without a significant increase in coded safety events.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag343"},"PeriodicalIF":5.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179634","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":"Preoperative parathyroid imaging in CKD-related secondary hyperparathyroidism: a systematic review and diagnostic test accuracy network meta-analysis.","authors":"Daniele Vetrano, Simona Barbuto, Anna Mistretta, Guido Zavatta, Francesco Aguanno, Paolo Mastromauro, Giorgia Comai, Giulia Molinari, Guido Marzocchi, Giuseppe Mercante, Uberto Pagotto, Carla Serra, Stefano Fanti, Luigi Lovato, Gaetano La Manna, Giuseppe Cianciolo","doi":"10.1093/ckj/sfag344","DOIUrl":"https://doi.org/10.1093/ckj/sfag344","url":null,"abstract":"<p><strong>Background and aims: </strong>In secondary hyperparathyroidism (SHPT), imaging must characterize multifocal disease and identify ectopic or supernumerary tissue before surgery, but the comparative accuracy and optimal hierarchy of available modalities remain uncertain. We compared the main preoperative imaging techniques used for parathyroid localization in patients with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>MEDLINE, Embase, and Web of Science were searched from inception through 31 May 2026 for gland-, lesion-, or site-level diagnostic accuracy studies in adults with CKD, kidney failure, or kidney transplantation, using surgical and/or histopathological confirmation. An arm-based Bayesian bivariate network meta-analysis jointly estimated sensitivity and specificity for ultrasonography (US), non-subtraction technetium-99m methoxyisobutylisonitrile (⁹⁹ᵐTc-MIBI) planar scintigraphy, ⁹⁹ᵐTc-MIBI single-photon emission computed tomography/computed tomography (SPECT/CT), and ¹⁸F-fluorocholine (¹⁸F-FCH) positron emission tomography/computed tomography (PET/CT). Balanced accuracy and comparative effects versus US were also estimated. Risk of bias was assessed using QUADAS-3.</p><p><strong>Results: </strong>Ten studies including 479 participants contributed 24 test arms. Estimated sensitivity was 89.6% [95% credible interval (CrI) 81.9-94.5] for ¹⁸F-FCH PET/CT, 68.8% (56.0-79.2) for MIBI SPECT/CT, 64.2% (51.0-75.6) for US, and 45.9% (32.8-59.4) for planar MIBI. Specificity estimates ranged from 76.4% to 83.8% and were imprecise. Compared with US, ¹⁸F-FCH PET/CT showed higher sensitivity (odds ratio 4.83, 95% CrI 3.20-7.48) and balanced accuracy (+11.9 percentage points, 95% CrI 0.1-20.6), with no clear specificity difference. Findings were directionally consistent in sensitivity analyses.</p><p><strong>Conclusions: </strong>¹⁸F-FCH PET/CT had the highest estimated sensitivity and balanced accuracy, although evidence was limited and specificity remained uncertain. A clinically guided hierarchy beginning with US and progressing to ¹⁸F-FCH PET/CT may improve comprehensive glandular mapping and support multidisciplinary operative planning in SHPT. 4D-CT and dual-isotope scintigraphic techniques also appear promising as alternative or complementary strategies, although SHPT-specific evidence remains limited and requires further dedicated comparative studies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag344"},"PeriodicalIF":5.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263583","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":"The investigational non-steroidal MRA balcinrenone in cardiorenal medicine: current evidence and future perspectives.","authors":"Panagiotis I Georgianos, Sokratis Stoumpos, Christodoula Kourtidou, Evangelia Dounousi, Vassilios Liakopoulos, Patrick B Mark","doi":"10.1093/ckj/sfag347","DOIUrl":"10.1093/ckj/sfag347","url":null,"abstract":"<p><p>For almost two decades, renin-angiotensin-system (RAS) blockade was the basic pillar of therapy for cardiorenal protection in patients with chronic kidney disease (CKD) and albuminuria. Novel therapies, such as sodium-glucose co-transporter type 2 inhibitors (SGLT2is) and the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone, have been added to our therapeutic armamentarium in the last few years. Despite this substantial progress, there is still an unmet need for the development of additional therapies to mitigate the substantial residual risk of CKD patients. Balcinrenone is a novel, non-steroidal MRA that is currently under investigation for potential cardiorenal protective effects. In preclinical studies, balcinrenone was similarly effective with eplerenone in improving albuminuria and in reversing renal histopathology. Animal studies have shown a beneficial effect of balcinrenone on urinary sodium/potassium ratio that contrasts with the typical increase seen with traditional steroidal MRAs. The MIRO-CKD was a phase 2b trial showing that among 324 patients with albuminuric CKD, combination therapy with dapagliflozin and balcinrenone was safe and more effective than monotherapy with dapagliflozin in improving albuminuria over 3 months of follow-up. A large phase 3 clinical program is ongoing to investigate the long-term safety and efficacy of balcinrenone in a broad spectrum of patients with symptomatic heart failure and moderate-to-advanced CKD. In this article, we explore the tolerability, safety, and efficacy of the investigational non-steroidal MRA balcinrenone. We critically evaluate the design and key findings of the MIRO-CKD trial and provide directions for future research in this important area.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag347"},"PeriodicalIF":5.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215135","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":"Albuminuria is associated with higher turnover-related bone histomorphometric indices in chronic kidney disease stages 3-4.","authors":"Ricardo Neto, Bernardo Fernandes, Juliana Magalhães, Inês Alencastre, João Frazão","doi":"10.1093/ckj/sfag346","DOIUrl":"10.1093/ckj/sfag346","url":null,"abstract":"<p><strong>Background: </strong>Biological determinants of bone turnover in chronic kidney disease (CKD) remain incompletely understood. Although albuminuria is an established marker of kidney damage and predictor of renal and cardiovascular outcomes, its relationship with bone remodeling, as assessed by quantitative bone histomorphometry, has not previously been investigated.</p><p><strong>Methods: </strong>We performed a cross-sectional study of 56 adults with CKD stages 3-4 who underwent transiliac bone biopsy with quantitative histomorphometry following double tetracycline labeling. Associations between 24-h urinary albumin excretion and individual bone histomorphometric parameters were evaluated using multivariable linear regression. Models were adjusted for age, sex, estimated glomerular filtration rate (eGFR), intact parathyroid hormone (iPTH), and fibroblast growth factor 23 (FGF23).</p><p><strong>Results: </strong>In multivariable analyses, higher 24-h urinary albumin excretion was associated with a histomorphometric pattern consistent with increased bone turnover, reflected by greater bone formation and cell surface indices. Specifically, log₁₀-transformed urinary albumin excretion was associated with higher bone formation rate (<i>B</i> = 0.295, 95% CI 0.088 to 0.501; <i>P</i> = 0.008), osteoblast surface (<i>B</i> = 0.588, 95% CI 0.187 to 0.988; <i>P</i> = 0.005) and osteoclast surface (<i>B</i> = 0.464, 95% CI 0.041 to 0.887; <i>P</i> = 0.033). Associations with mineralization-related parameters and bone volume were not statistically significant.</p><p><strong>Conclusions: </strong>In patients with CKD stages 3-4, higher urinary albumin excretion was independently associated with quantitative histomorphometric indices of higher bone turnover. These findings suggest that albuminuria may mark a bone remodeling phenotype not fully captured by eGFR, iPTH, and FGF23. Larger prospective studies are needed to define the biological basis and clinical implications of this association.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"19 10","pages":"sfag346"},"PeriodicalIF":5.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172085","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}