Clinical Kidney Journal最新文献

{"title":"High level of infection-related hospitalizations in the 2019-2020 French national dialysis cohort.","authors":"Nasser Al Hawajeri, Charles Chazot, Cécile Vigneau, Cécile Couchoud","doi":"10.1093/ckj/sfaf225","DOIUrl":"10.1093/ckj/sfaf225","url":null,"abstract":"<p><strong>Background: </strong>Dialysis patients experience a high rate of hospitalizations for infection. This work aimed to study the frequency of hospitalizations for infections and the associated risk factors in a nationwide dialysis cohort during 2019-2020.</p><p><strong>Methods: </strong>This was an observational, retrospective study using two national databases. We included 59 585 patients undergoing dialysis from 1 January 2019 to 31 December 2020. Hospitalization rates (per 1000 patient-years) were calculated from all hospital discharges with a principal or related diagnosis of infection. Infections were classified into 14 categories. The association between individual risk factors and incidence of infection-related hospitalizations was estimated with multilevel Poisson models with patients as random effects.</p><p><strong>Results: </strong>The incidence rate was 245 (95% confidence intervals (CI) 242-249) hospitalizations per 1000 patient-years, 241 (236-246) and 249 (244-254) in 2019 and 2020. After excluding COVID-19-related hospitalizations, the 2020 incidence was 197 (192-201). The main source of infection-related hospitalizations was pulmonary [93 (91-96)] followed by sepsis [33 (32-34)], digestive excluding peritonitis [25 (24-26)], cutaneous [24 (23-26)], urinary [18 (17-19)], and osteoarticular [9 (8-9)]. Except for pulmonary infection lower in 2020, attributed to barrier measures and lockdowns, there were no major discrepancies in incidence between 2019 and 2020. The main factors associated with risk of infection were male gender; low albumin level; presence of diabetes, chronic respiratory failure, heart failure, and lower-limb arteritis; cirrhosis stage; walking disability; and presence of active cancer. The risk of infection-related hospitalization was increased for patients with tunneled catheters and arteriovenous grafts and those under peritoneal dialysis compared with patients with arteriovenous fistula [1.63 (95% CI 1.52-1.76), 1.30 (1.11-1.53) and 1.73 (1.53-1.96); all <i>P</i> < .001].</p><p><strong>Conclusion: </strong>The risk of hospitalization for infection is high in dialysis patients, which calls for intensified prevention measures. Lockdown and shielding barriers were efficient to decrease the incidence of pulmonary infections but not other infections.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf225"},"PeriodicalIF":4.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945177","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":"Dialysis-imposed, weekly and seasonal patterns of physical activity: a multi-center prospective study in patients using a wearable activity tracker.","authors":"Maggie Han, Frank M van der Sande, Jeroen P Kooman, Xia Tao, Priscila Preciado, Lela Tisdale, Ohnmar Thwin, Peter Kotanko","doi":"10.1093/ckj/sfaf217","DOIUrl":"10.1093/ckj/sfaf217","url":null,"abstract":"<p><strong>Background: </strong>Hemodialysis patients are often sedentary, and their life is structured around the dialysis schedule. Wearable activity trackers present an opportunity for long-term continuous monitoring of physical activity. We aimed to characterize dialysis-imposed, weekly and seasonal patterns of physical activity in hemodialysis patients.</p><p><strong>Methods: </strong>In this prospective observational study, patients on in-center hemodialysis in New York City wore the Fitbit^® Charge 2™ for 1 year. Physical activity was assessed by weekday, dialysis versus interdialytic days (post-hemodialysis day and second interdialytic day), dialysis start time and season. Linear mixed-effects models with random intercepts between patient were constructed to determine the effect of time-patterns and determinants of physical activity levels.</p><p><strong>Results: </strong>A total of 109 patients on hemodialysis were included (mean age 54 ± 11.6 years, 72% male, 23% diabetic). The observed number of steps was 6590 ± 4014 (mean ± standard deviation) per day; 44 (40%) participants walked <5000 steps/day. Participants walked 912 (95% confidence interval 768, 1057) fewer steps on Sundays and 284 (129, 440) fewer on the second interdialytic day vs dialysis day. Winter activity was reduced by 321 (162, 478) to 455 (312, 598) steps compared with other seasons. Older age, diabetes and higher equilibrated Kt/V were associated with lower physical activity levels; higher albumin was associated with increased physical activity levels.</p><p><strong>Conclusion: </strong>Most hemodialysis patients walked less than recommended level of 10 000 steps/day and physical activity levels vary greatly between and within patients. Dialysis-imposed, weekly and seasonal patterns affect physical activity. Lower physical activity levels on second interdialytic days and Sundays could provide opportunities for improvements of physical activity in shared the decision-making process.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf217"},"PeriodicalIF":4.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844777","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":"Association between air pollution and transplant outcomes in kidney transplant recipients: a systematic review and meta-analysis.","authors":"Mustafa Guldan, Lasin Ozbek, Derya Goksu Fidan, Ibrahim Gulmaliyev, Aladin Rustamov, Mehmet Kanbay","doi":"10.1093/ckj/sfaf222","DOIUrl":"10.1093/ckj/sfaf222","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence suggests that ambient air pollution may adversely affect long-term outcomes in kidney transplant recipients; however, quantitative estimates across clinical endpoints remain limited. This meta-analysis aimed to systematically evaluate the association between air pollution exposure and mortality, graft failure, and rejection risk in kidney transplant populations.</p><p><strong>Methods: </strong>A systematic database search was carried out across the databases of the Cochrane Library, Web of Science, Scopus, and PubMed until the 1 May 2025. Research that evaluated the impact of air pollution, particularly PM₂.₅, PM₁₀, NO₂, O₃, and other ambient pollutants, on graft survival in kidney transplant recipients were evaluated. Hazard ratios (HR) were extracted or recalculated for all-cause mortality, death-censored graft failure, and graft rejection per 10 µg/m³ increase in particulate matter concentration.</p><p><strong>Results: </strong>After screening 6209 records, a total of six studies involving populations of adult kidney transplant recipients from the USA, UK, South Korea, and Taiwan were included in the meta-analysis. Exposure to ambient air pollution was significantly associated with increased all-cause mortality among kidney transplant recipients [pooled HR 1.61; 95% confidence intervals (CI) 1.01-2.58], as well as higher risks of death-censored graft failure (HR 1.25; 95% CI 1.04-1.50) and graft rejection (HR 1.35; 95% CI 1.09-1.69) per 10 µg/m³ increment in particulate matter concentration. Substantial heterogeneity was observed across studies, particularly for mortality (<i>I</i>² = 99%) and graft rejection (<i>I</i>² = 91%). No significant associations were found between air pollution exposure and cardiovascular disease or coronary heart disease mortality.</p><p><strong>Conclusion: </strong>Ambient air pollution exposure is associated with increased risks of mortality, graft failure, and rejection in kidney transplant recipients, highlighting air pollution as a modifiable environmental risk factor that may have important implications for long-term transplant outcomes.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf222"},"PeriodicalIF":4.6,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12451696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130084","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 algorithm and management protocol aimed at ensuring blood calcium stability: a prospective single-arm study.","authors":"Ruanmei Sheng, Yimeng Liu, Shaolin Li, Jianqin Chen, Fangying Xue, Zhenjuan Dai, Ruiping Wang, Xuemin Wang","doi":"10.1093/ckj/sfaf230","DOIUrl":"10.1093/ckj/sfaf230","url":null,"abstract":"<p><strong>Background: </strong>Although several regional citrate anticoagulation (RCA) algorithms have been reported, clinical data confirming their effectiveness and safety are limited. We have developed a novel RCA algorithm applicable to extensive continuous renal replacement therapy (CRRT) settings. The aims of this study were to evaluate the incidence of calcium and citrate abnormalities that necessitated human intervention when using this algorithm during RCA and to identify the optimal values of the coefficients <i>k_cit</i> and <i>k_dis</i> in the equations.</p><p><strong>Methods: </strong>We conducted a prospective, single-arm study in patients who underwent RCA using various CRRT modes and parameters, calcium-containing replacement fluids, and presession blood calcium abnormalities. The primary outcome was the incidence of citrate and calcium overdose and deficiency in the absence of human intervention. Secondary outcomes included the values of <i>k_dis</i> and <i>k_cit</i> and the occurrence of elevated or decreased blood calcium concentrations during RCA.</p><p><strong>Results: </strong>A total of 282 RCA sessions in 110 patients were investigated. The incidence of citrate and calcium abnormalities was 19.5% (55/282). In the low-dose citrate sessions, citrate overdose occurred in one session (1/148), while the incidence of citrate deficiency was 22.3% (33/148). In the high-dose citrate sessions, citrate deficiency occurred in two sessions (2/134) and citrate overdose occurred in 18/134 (13.4%) sessions. One session (1/282) of calcium overdose was also observed, whereas no calcium deficiency occurred during RCA.</p><p><strong>Conclusions: </strong>The application of this innovative RCA algorithm to sessions involving various CRRT conditions markedly decreased the incidence of citrate and calcium abnormalities. As a consequence, this reduction minimized the necessity for modifications to the rate of calcium and citrate supplementation during RCA.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf230"},"PeriodicalIF":4.6,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834348","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":"Comparative renal effects of angiotensin receptor neprilysin inhibitors and ACEi/ARB: a systematic review and meta-analysis.","authors":"Adrian Covic, Luminita Voroneanu, Anca-Elena Stefan, Crischentian Brinza, Alexandra Covic, Mehmet Kanbay, Viorel Scripcariu, Stefan Iliescu, Alexandru Burlacu","doi":"10.1093/ckj/sfaf224","DOIUrl":"10.1093/ckj/sfaf224","url":null,"abstract":"<p><strong>Background: </strong>Classical renin-angiotensin system inhibitors (RASI), such as angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB), have long been the foundation of treatment for patients with cardiovascular disease (CVD) and chronic kidney disease (CKD). The development of angiotensin receptor neprilysin inhibitors (ARNI) has introduced a valuable therapeutic option for patients with heart failure with reduced ejection fraction (HFrEF), reducing the risk of major cardiovascular events and becoming an essential component of treatment for this population. However, their effects on renal outcomes remain uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis to compare the renal effects of ARNI and RASI. Relevant studies were searched in the following databases from inception to 30 December 2024: MEDLINE (PubMed), Embase and Scopus. The primary outcomes assessed were: a ≥50% reduction in estimated glomerular filtration rate (eGFR) or progression to end-stage renal disease (ESRD), a composite measure of worsening renal function (serum creatinine increase of ≥0.5 mg/dL from baseline and a 25% decline in eGFR) and renal impairment (an increase of at least 0.3 mg/dL in creatinine levels). Additionally, a subgroup analysis of renal impairment in patients with HFrEF was performed. Secondary outcomes included hyperkalemia.</p><p><strong>Results: </strong>Our results suggested a 31% reduction in renal impairment with ARNI treatment compared with RASI and a 37% reduction in the odds of ≥50% decline in eGFR or ESRD. However, the pooled analysis for worsening renal function and hyperkalemia showed no apparent difference between ARNI and RASI. A subgroup analysis on a population with a reduced ejection fraction suggested a 37% lower odds of renal impairment with ARNI when compared with RASI. This study represents the largest and first systematic review and meta-analysis with clearly defined renal outcomes.</p><p><strong>Conclusion: </strong>Given that ARNI has been explored for indications beyond heart failure, further randomized controlled trials are needed to understand its renal effects better. Future research should determine whether ARNI provides a benefit in a purely CKD population or in a cardio-renal population, given that CVD is the leading cause of mortality in CKD patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf224"},"PeriodicalIF":4.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774796","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":"RNA therapeutics in kidney diseases: prospects and current status.","authors":"Francesco Paolo Schena, Emanuela Pasculli","doi":"10.1093/ckj/sfaf214","DOIUrl":"10.1093/ckj/sfaf214","url":null,"abstract":"<p><p>In this narrative review, we summarize the current knowledge on RNA-based therapies used in rare and ultrarare disorders and congenital diseases in which the kidneys may be involved. In these therapies, RNA molecules are packaged into delivery vehicles to reach the desired target. We describe only drugs that have been approved or are under review for approval by the US Food and Drug Administration and/or the European Medicines Agency. We describe the potential therapeutic role of microRNA (miRNA) in Alport syndrome, polycystic kidney disease and renal cell carcinoma. Notably, large randomized clinical studies are required before these drugs can be introduced into clinical practice. The therapeutic effects of short interfering RNA molecules have been tested and evaluated in patients with various congenital or acquired diseases, such as primary hyperoxaluria, hereditary transthyretin amyloidosis, acute kidney injury after cardiovascular intervention or kidney transplantation (i.e. delayed graft function), and in individuals affected by hypercholesterolemia. In addition, synthetic antisense oligonucleotides have proven effective in patients with moderate or severe hypercholesterolemia who developed statin side effects, such as myalgia or rhabdomyolysis, and in individuals with amyloidosis. These new therapeutic approaches need to be validated through global clinical trials in which large patient samples can be enrolled. Nonetheless, some of these promising new approaches are currently undergoing evaluation for the treatment of common diseases, such as hypertension and diabetes, which are the main causes of chronic kidney disease.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf214"},"PeriodicalIF":4.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774803","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 oral semaglutide on kidney outcomes in people with type 2 diabetes: a nationwide, multicentre, retrospective, observational study (Renal_ENDO2S-RWD substudy).","authors":"Oscar Moreno-Pérez, Rebeca Reyes-Garcia, Cristina Guillen-Morote, Viyey Kishore Doulatram-Gamgaram, Carlos Casado Cases, Nieves Arias Mendoza, Cristina Tejera-Pérez, Jersy Cárdenas-Salas, Sandra Martínez-Fuster, Beatriz Lardiés-Sánchez, Rosa Márquez-Pardo, Pedro Pinés, Antonio Tejera-Muñoz, José Carlos Fernández-García, Inés Modrego-Pardo","doi":"10.1093/ckj/sfaf227","DOIUrl":"10.1093/ckj/sfaf227","url":null,"abstract":"<p><strong>Background: </strong>Subcutaneous semaglutide has shown kidney-protective effects in people with type 2 diabetes (PWT2D), but data on oral semaglutide remain limited. This multicentre real-world study evaluates the clinical effectiveness of oral semaglutide on kidney outcomes in PWT2D.</p><p><strong>Methods: </strong>We included PW2TD ≥18 years of age who initiated oral semaglutide in routine practice between 2021 and 2022 in the Spanish National Health System, with at least one report of clinical follow-up (FU) data at 3 months. Co-primary endpoints were changes in urine albumin:creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) slope at 6-12 months. We also assessed baseline predictors of response, drug persistence and safety by CKD severity.</p><p><strong>Results: </strong>Data were available for 819 PWT2D (median age 63 years, eGFR 88.1 ml/min/1.73 m², UACR 12 mg/g, 45.8% female, median FU 8.96 months). Oral semaglutide decreased UACR by 30.3% and 40.0% in the overall cohort, by 40.2% and 50.7% in those with a UACR ≥30 mg/g and by 40.6% and 49.9% in those with a UACR ≥300 mg/g at 6 and 12 months of FU, respectively. PWT2D with a low age-adjusted risk of liver fibrosis by the Fibrosis-4 index had increased odds of achieving a >30% reduction in UACR [adjusted odds ratio 5.50 (95% confidence interval 1.6-18.7)] regardless of baseline background. Metabolic and weight loss effectiveness, safety and persistence of oral semaglutide were consistent across CKD severities.</p><p><strong>Conclusions: </strong>In a real-world setting, oral semaglutide treatment for up to 52 weeks resulted in clinically meaningful reductions in albuminuria without changes in the eGFR slope in PWT2D. Effectiveness, safety and tolerability were not influenced by CKD severity.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf227"},"PeriodicalIF":4.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834345","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":"New biomarkers of inflammation associated with haemodialysis.","authors":"Fátima Guerrero, Andrés Carmona, Maria Jose Jiménez, Francisco Ariza, Teresa Obrero, Isabel Berdud, Carolina Carrillo-Carrión, Mariano Rodríguez, Sagrario Soriano, Juan R Muñoz-Castañeda, Alejandro Martín-Malo","doi":"10.1093/ckj/sfaf223","DOIUrl":"10.1093/ckj/sfaf223","url":null,"abstract":"<p><strong>Background: </strong>The first year of haemodialysis (HD) carries the highest risk of mortality, which to a large extent is attributed to the aggravation of inflammation. However, traditional markers such as C-reactive protein and interleukin-6 show only minor changes during the first year, suggesting that there are other factors involved. The present study evaluates the effect of HD on microinflammation and oxidative stress of uremic patients.</p><p><strong>Methods: </strong>We conducted a prospective observational longitudinal study including 30 incident HD patients. Blood samples were collected at baseline and 6 and 12 months. Pro-inflammatory monocytes were quantified using flow cytometry. Proteomic analysis (Olink) was performed on serum. Concentrations of indoxyl sulphate (IS), growth differentiation factor 15 (GDF-15), oxidative status and circulating microRNA (miRNA) expression were also determined.</p><p><strong>Results: </strong>A new population of activated monocytes was identified that progressively increased at 1 year of HD. In addition, an increase in the serum concentration of up to 29 inflammation-related proteins was detected, including interleukins, chemokines, tumour necrosis factor family molecules, cell activation molecules and apoptosis-related proteins. Conversely, leukaemia inhibitory factor receptor was downregulated. The concentration of IS was positively correlated with GDF-15 levels. Furthermore, patients exhibited decreased expression of miRNA-126-3p, -130a-3p, -146a-5p, 223-3p, -let7a-5p and -let7b-5p.</p><p><strong>Conclusion: </strong>This study highlights the impact of HD on inflammation and oxidative stress, manifested by an increase in activated monocytes and inflammatory markers. The observed subclinical inflammation associated to HD treatment may help in understanding the mechanisms of cardiovascular damage in patients on HD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf223"},"PeriodicalIF":4.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12358798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882346","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":"Long-term impact of PM_2.5 exposure on diabetic kidney disease patients considering time-dependent medication adjustment.","authors":"Soie Kwon, Hyunman Sim, Ara Ko, Whanhee Lee, Ho Kim, Seung Hyun Han, Hyeon Seok Hwang, Dong Ki Kim, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee, Woojoo Lee","doi":"10.1093/ckj/sfaf216","DOIUrl":"10.1093/ckj/sfaf216","url":null,"abstract":"<p><strong>Background: </strong>Ambient air pollutants adversely affect renal function and increase type 2 diabetes incidence. However, the impact of air pollution on diabetic kidney disease (DKD) patients remains underexplored, with limited consideration of medication-related effects. We assessed the influence of air pollutants on DKD patients while meticulously adjusting for medication use.</p><p><strong>Methods: </strong>We retrospectively enrolled DKD patients. Primary and secondary outcomes included end-stage kidney disease (ESKD) and a composite (ESKD and mortality). Nationwide forecasted ultra-high-resolution air pollutant data [2.5-μm particulate matter (PM_2.5), 10-μm particulate matter (PM₁₀), nitrogen dioxide (NO₂), carbon monoxide (CO)] were obtained from the Ai-Machine learning Statistics Collaborative Research Ensemble for Air pollution, Temperature, and all types of Environmental exposures (AiMS-CREATE). Monthly updated ambient air pollutants and medication prescription information were considered time-varying variables in multivariable time-dependent Cox analyses.</p><p><strong>Results: </strong>Patients (<i>n</i> = 9482) were followed for a median of 9 (ESKD) and 11 (composite outcome) years; 20.6% progressed to ESKD and 46.7% experienced composite outcomes. The DKD-stage patient distribution was 12.5% (stage 1-2), 35.8% (stage 3) and 51.6% (stage 4-5). Initial renin-angiotensin system blocker use increased from 37.4% to 58.5% during year 1 then gradually decreased. During follow-up, all four air pollutant concentrations significantly decreased, with CO exhibiting the most pronounced decline. The 1-month lagged PM_2.5 exposure (Lag1_PM_2.5) was significantly associated with higher ESKD progression risk {adjusted hazard ratio [aHR] 1.28 [95% confidence interval (CI) 1.085-1.508]}, whereas PM_2.5 itself showed no significance [aHR 1.05 (95% CI 0.872-1.260)]. Both exposures increased the composite outcome risk (PM_2.5 aHR 1.16 Lag1_PM_2.5 aHR 1.15). PM₁₀ and Lag1_PM₁₀ showed no significant associations with either ESKD progression or composite outcomes. NO₂ exposure increased ESKD progression risk but was not associated with composite outcomes.</p><p><strong>Conclusion: </strong>Even after comprehensive medication use adjustment, higher PM_2.5 exposure was independently associated with an increased risk of ESKD progression and composite outcome in DKD patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf216"},"PeriodicalIF":4.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759334","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":"Desensitization in HLA-incompatible kidney transplant recipients: current strategies and emerging perspectives.","authors":"Mahmut Altindal, Mustafa Guldan, Lasin Ozbek, Sama Mahmoud Abdel-Rahman, Selen Unlu, Ahmet Murt, Nuri B Hasbal, Abdulmecit Yildiz, Charles J Ferro, Adrian Covic, Caner Süsal, Mehmet Kanbay","doi":"10.1093/ckj/sfaf219","DOIUrl":"10.1093/ckj/sfaf219","url":null,"abstract":"<p><p>Despite development of kidney paired donation programs and prioritization in kidney allocation schemes, transplantation rates are still low and waiting times remain prolonged for highly sensitized kidney transplant recipients with broad human leukocyte antigen antibody reactivity. Desensitization confers an invaluable option improving access to kidney transplantation for sensitized patients who could not benefit from kidney paired donation programs and kidney allocation schemes. Conventional desensitization strategies use intravenous immunoglobulin combined with either plasmapheresis or monoclonal anti-CD20 antibodies. Imlifidase, IL-6 targeting agents, plasma cell-directed therapies, complement inhibitors, chimeric antigen receptor T-cell therapies, and B cell-activating factor inhibitors are emerging new options in the hope of enhancing and sustaining the efficacy of desensitization to improve allograft longevity. In this review, we discuss the rationale and outcome of desensitization with various strategies alone or in combination. Our aim is also to provide some insight for decision when pursuing desensitization might be successful or futile in sensitized patients.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf219"},"PeriodicalIF":4.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774797","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}