Clinical Kidney Journal最新文献

{"title":"Concordance of symptoms perceived by patients receiving haemodialysis and those reported by nurses and nephrologists: a cross-sectional, multicentre, observational study using the REIN registry.","authors":"Abdallah Guerraoui, Julie Haesebaert, Fabien Subtil, William Hanf, Caroline Pelletier, Perrine Jullien, Emmanuel Villar, Sarah Mezaache, Anna Filancia, Jean-Pierre Fauvel, Christophe Mariat, Maelys Granal, Fitsum Guebre-Egziabher, Cecile Couchoud, Agnès Caillette-Beaudoin, Denis Fouque","doi":"10.1093/ckj/sfaf239","DOIUrl":"10.1093/ckj/sfaf239","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving haemodialysis (HD) experience symptoms that impact quality of life. This study assessed the concordance of symptoms and symptom severity of HD patients and their perception by nurses and nephrologists.</p><p><strong>Methods: </strong>A cross-sectional, observational study using the 30-item Dialysis Symptom Index (DSI) questionnaire was conducted in six dialysis centres in France from 1 March 2022 to 30 June 2023. Patients were interviewed during dialysis sessions. Nurses and nephrologists were asked to complete the DSI questionnaire thereafter, to report patient symptoms they considered present. Responses were compared using sensitivity and the Cohen's κ estimate for an interrater agreement involving presence (yes/no) and intensity (5-point Likert scale).</p><p><strong>Results: </strong>A total of 256 patients, 123 nurses and 27 nephrologists participated. Patients reported four symptoms as most severe (score >3): restless legs or difficulty keeping still, feeling tired or lack of energy, bone or joint pain and trouble falling asleep. Comparisons showed a sensitivity ≥50% for 1/30 symptoms by nurses and 3/30 by nephrologists. Concordance for the presence of symptoms between nurses-patients and nephrologists-patients was low (κ >0.21-<0.40). Patient-nurse agreement was very low for 14 symptoms (46.6%), low for 15 (50.0%) and moderate for 1 (3.4%). Patient-nephrologist agreement was very low for 21 symptoms (70.0%) and low for 9 (30.0%). Nurse-nephrologist disagreement occurred for three symptoms (10.0%), very low agreement for 25 symptoms (83.3%) and low for 2 symptoms (6.7%).</p><p><strong>Conclusions: </strong>Nurses and nephrologists underestimate the presence and severity of symptoms perceived by patients. Future systematic assessment of symptoms by patient-reported outcome measures should be considered.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf239"},"PeriodicalIF":4.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029011","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 Portuguese Albuminuria Study: national insights into prevalence and risk factors.","authors":"Ana Carina Ferreira, Ana Farinha, Edgar Almeida","doi":"10.1093/ckj/sfaf240","DOIUrl":"10.1093/ckj/sfaf240","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a global health concern associated with increased cardiovascular risks. In Portugal, the high burden of CKD highlights the urgent need for early detection strategies. The primary aim of this study was to assess the presence of albuminuria in the Portuguese general population while raising awareness of CKD.</p><p><strong>Methods: </strong>An epidemiological, cross-sectional study screened 601 individuals for albuminuria using urine test strips, employing a door-to-door approach across the five regions of mainland Portugal (screening study), with 592 valid results included in the final analysis. In parallel, an awareness campaign distributed 17 000 urine test strips, with 704 participants submitting their results through an online platform (awareness study).</p><p><strong>Results: </strong>The screening occurred in a healthy population, with >70% (screening study) and >87% (awareness study) of the individuals reporting no known personal health history. The presence of albuminuria was detected in 5.1% of the screening study population and 3.4% of the awareness study participants. In both studies, significant associations were found between albuminuria and risk factors, such as age, education level, CKD and non-steroidal anti-inflammatory drug use. Regional disparities were also observed. In the screening study, multivariate analysis identified education level (<i>P</i> = .011), CKD (<i>P</i> < .0001) and autoimmune diseases (<i>P</i> = .009) as independent predictors of albuminuria.</p><p><strong>Conclusions: </strong>These findings highlight albuminuria as a critical early marker for CKD and cardiovascular risks. The results support the need for targeted screening and public health initiatives, particularly in high-risk and younger populations.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf240"},"PeriodicalIF":4.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112108","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":"Varying mortality risks among patients with primary glomerular disease starting kidney replacement therapy: ERA Registry Figure of the month.","authors":"Vianda S Stel, Alberto Ortiz, Anneke Kramer","doi":"10.1093/ckj/sfaf237","DOIUrl":"10.1093/ckj/sfaf237","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf237"},"PeriodicalIF":4.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945110","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":"Effects of hemodialysis on hemoglobin oxygen affinity and cardiac function.","authors":"Shilpa Sharma, Kim-Lien Nguyen, Isidro B Salusky, Tomas Ganz, Joachim H Ix","doi":"10.1093/ckj/sfaf233","DOIUrl":"10.1093/ckj/sfaf233","url":null,"abstract":"<p><strong>Background: </strong>Hemoglobin affinity for oxygen is modulated by ambient oxygen tension, acid/base status, 2,3 diphosphoglycerate (2,3DPG) concentrations and other factors, facilitating tissue oxygenation under changing conditions. 2,3DPG is a key regulator of oxygen affinity within red blood cells and its levels are affected by blood phosphate. P50, the partial pressure of oxygen at which 50% of its hemoglobin binding sites are occupied, is a marker of oxygen delivery to tissues. We measured P50 during hemodialysis and explored its relationship with mineral metabolites and left ventricular strain as a marker of cardiac function.</p><p><strong>Methods: </strong>Venous blood gas and other laboratory parameters were measured in 20 prevalent patients pre- and post-hemodialysis. To avoid arterio-venous mixing, we selected patients dialyzing through tunneled dialysis catheters. Associations of P50 with demographics, laboratory parameters and echocardiographic measurements were examined using linear regression models.</p><p><strong>Results: </strong>P50 levels decreased from 27.1 ± 0.9 mmHg to 26.2 ± 0.7 mmHg during hemodialysis (<i>P </i>< .001). Among 18 predictors evaluated, older age, and greater reductions in phosphate during hemodialysis were the strongest predictors of P50 changes in multivariate models. There was acute worsening in left ventricular global longitudinal strain (LVGLS) during hemodialysis (reduction of 1.4 ± 3.9%; <i>P </i>= .03). Greater reductions in P50 during hemodialysis and older age were significantly associated with greater reductions in LVGLS.</p><p><strong>Conclusions: </strong>Hemodialysis consistently reduces P50. The magnitude of P50 change was strongly associated with concurrent phosphate changes. P50 reductions correlated with acute lowering of LVGLS. These observations illuminate a potential cause of systemic tissue hypoxia and potential cardiac dysfunction during hemodialysis.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf233"},"PeriodicalIF":4.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12358796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882345","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: Cardiometabolic protein expression levels and pathways associated with kidney function decline in older European adults with advanced kidney disease.","authors":"","doi":"10.1093/ckj/sfaf221","DOIUrl":"https://doi.org/10.1093/ckj/sfaf221","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfaf079.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf221"},"PeriodicalIF":3.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706584","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":"Complement abnormality predisposes to the development of malignant hypertension-associated thrombotic microangiopathy disease.","authors":"Rong Lian, Wenchuan Li, Yuejiao Li, Xinji Lian, Shengyou Yu, Wanxin Shi, Jianwen Yu, Wei Chen, Jianbo Li, Feng He","doi":"10.1093/ckj/sfaf235","DOIUrl":"10.1093/ckj/sfaf235","url":null,"abstract":"<p><strong>Background: </strong>Thrombotic microangiopathy (TMA) is a major complication of malignant hypertension (mHTN). Abnormal complement activation has been recognized as a key determinant of TMA, but less is known about the prognostic significance of complement abnormality in patients with mHTN-associated TMA.</p><p><strong>Methods: </strong>A prospective cohort study was performed in patients with mHTN. All participants had concomitant TMA proven by kidney biopsy after admission between 2008 and 2023, and were divided into normal and abnormal complement groups based on serum C3 and C4 levels. Cox regression models were used to identify risk factors for renal prognosis.</p><p><strong>Results: </strong>A total of 189 mHTN patients with TMA were enrolled in the current study, including 161 (85.2%) patients with normal complement levels and 28 (14.8%) patients with abnormal complement levels. Compared to the normal complement group, patients in the abnormal complement group had lower levels of BMI, hemoglobin, and platelet counts, and more intravascular erythrocyte fragments (21.4% vs 7.5%, <i>P</i> = .02). Notably, a substantial glomerular deposition of C3c and C5b-9 was observed in the abnormal complement group, indicating complement activation <i>in vivo</i>. Importantly, abnormal complement levels were independently associated with worse renal function recovery [hazard ratio (HR), 0.368; 95% CI, 0.140-0.970; <i>P</i> = .043]. In addition, the glomerular sclerosis ratio (HR, 0.971; 95% CI, 0.953-0.989; <i>P</i> = .002) remained an independent predictor of poor renal outcomes.</p><p><strong>Conclusions: </strong>Patients with abnormal complement levels have worse renal prognosis, suggesting that complement abnormality predisposes to the progression of mHTN-associated TMA disease.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf235"},"PeriodicalIF":4.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945173","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":"Identification of a founder haplotype of <i>APOE Kyoto</i> variant in lipoprotein glomerulopathy.","authors":"Hongyan Wu, Zhaoxia He, Jing Yang, Yi Zhou, Zhi Yang, Zhangxue Hu, Yuan Yang","doi":"10.1093/ckj/sfaf234","DOIUrl":"10.1093/ckj/sfaf234","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein glomerulopathy (LPG) is a rare autosomal dominant inherited kidney disease with incomplete penetrance, characterized by nephrotic-range proteinuria, hypertriglyceridemia and progressive renal dysfunction with elevated serum apoE level. More than 15 <i>APOE</i> mutations have been associated with LPG, with <i>APOE Kyoto</i> (Arg43Cys) the leading mutation in about 200 patients. We previously observed clustering of \"<i>APOE Kyoto</i> causing LPG\" in a Han population in China. We now explore the haplotype of the <i>APOE Kyoto</i> heterozygotes and the distribution of LPG patients in China.</p><p><strong>Methods: </strong>A total of 115 <i>APOE Kyoto</i> heterozygotes were enrolled and identified by Sanger sequencing, and in this study, the haplotypes of <i>Kyoto</i> and counterpart alleles were investigated by TA cloning and Sanger sequencing.</p><p><strong>Results: </strong>Overall, 114 out of 115 <i>APOE Kyoto</i> alleles shared an identical haplotype, likely from haplotype 1 in ε3. Among heterozygotes, the counterpart of <i>APOE Kyoto</i> allele showed haplotype diversity, and the difference in haplotype distribution of the counterpart allele was not observed between LPG patients and asymptomatic carriers.</p><p><strong>Conclusions: </strong>This study provides further evidence for the founder effect of <i>APOE Kyoto</i> may play a critical role in the progression of LPG.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf234"},"PeriodicalIF":4.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834347","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":"Height matters: re-thinking blood pressure targets through physics, physiology and evolution.","authors":"Tuncay Sahutoglu","doi":"10.1093/ckj/sfaf226","DOIUrl":"10.1093/ckj/sfaf226","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf226"},"PeriodicalIF":4.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774798","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":"Hypertension burden in CKD: is nocturnal hypertension the primary culprit?","authors":"Francesca Mallamaci, Claudia Torino, Giovanni Tripepi","doi":"10.1093/ckj/sfaf229","DOIUrl":"10.1093/ckj/sfaf229","url":null,"abstract":"<p><p>Hypertension is a pervasive and progressive complication in chronic kidney disease (CKD) patients, affecting up to 90% of those in advanced stages or on dialysis. A particularly insidious aspect of this condition is nocturnal hypertension, characterized by high blood pressure (BP) during sleep and a blunted or absent nighttime BP dipping-phenomena associated with accelerated CKD progression and increased cardiovascular risk. Despite its strong prognostic significance, nocturnal hypertension remains underdiagnosed due to limited use of ambulatory BP monitoring. This narrative review explores the pathophysiological underpinnings of nocturnal hypertension in CKD, including impaired sodium handling, volume overload, autonomic dysfunction and dysregulation of the renin-angiotensin-aldosterone system. Emerging evidence highlights its associations with left ventricular hypertrophy, proteinuria, endothelial dysfunction and poor renal outcomes, emphasizing the need for comprehensive BP profiling and targeted management strategies. Current therapeutic approaches include lifestyle modifications, diuretics and antihypertensive pharmacotherapy, with growing interest in chronotherapy-the timing of medication administration to align with circadian BP rhythms. However, robust clinical data specifically guiding the treatment of nocturnal hypertension in CKD remain scarce. This review underscores the clinical importance of diagnosing and addressing nocturnal BP abnormalities and advocates for future trials focused on optimizing management strategies for this high-risk population.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 9","pages":"sfaf229"},"PeriodicalIF":4.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029014","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":"Telitacicept treatment for recurrent IgA nephropathy after kidney transplantation.","authors":"Lichen Xu, Shukun Wu, Ping Zhang, Fang Wang, Wenjia Di, Shan Zhong, Yifu Hou, Hongji Yang, Guisen Li","doi":"10.1093/ckj/sfaf232","DOIUrl":"10.1093/ckj/sfaf232","url":null,"abstract":"<p><strong>Background: </strong>Immunoglobulin A nephropathy (IgAN) is frequently recurrent after kidney transplantation, posing significant challenges in management. Current treatments, including glucocorticoids and immunosuppressants, have shown limited effectiveness in treating recurrent IgAN. A phase 2 clinical trial indicated that telitacicept could reduce proteinuria in patients with primary IgAN. In this report, we conduct a retrospective analysis to assess the efficacy and safety of telitacicept in treating recurrent IgAN among kidney transplant recipients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted from August 2023 to April 2025. Patients with biopsy-proven recurrent IgAN following kidney transplantation who were treated with telitacicept were included. Clinical data were collected from hospitalization records and outpatient follow-ups. The primary outcome was proteinuria reduction at 6 months, with extended evaluation at 12 months. Renal function changes were also observed.</p><p><strong>Results: </strong>Ten patients with recurrent IgAN were treated with telitacicept. After a 6-month follow-up, two patients achieved complete remission (CR), and two patients reached partial remission (PR). Furthermore, six patients (60%) experienced a reduction of over 30% in proteinuria by the end of the 6-month treatment period. At 9-month follow-up, one patient reached CR, two patients reached PR and five patients (50%) showed a reduction in proteinuria. By the 12-month follow-up, serum creatinine levels and estimated glomerular filtration rate remained stable in nine patients. Furthermore, the treatment also effectively reduced urine red blood cell counts.</p><p><strong>Conclusions: </strong>Telitacicept shows promising safety and efficacy in lowering proteinuria for patients with recurrent IgAN following kidney transplantation.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf232"},"PeriodicalIF":4.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834349","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}