Clinical Kidney Journal最新文献

{"title":"Recurrence of preeclampsia is common, even during rigorously controlled multidisciplinary follow-up: a pilot experience.","authors":"Oriana De Marco, Chiara Ruotolo, Linda Njanjo, Chiara Mariani, Béatrice Mazé, Giulia Santagati, Antioco Fois, Marie Therese Chevé, Antoine Chatrenet, Mario Salomone, Massimo Torreggiani, Giorgina Barbara Piccoli","doi":"10.1093/ckj/sfaf070","DOIUrl":"https://doi.org/10.1093/ckj/sfaf070","url":null,"abstract":"<p><strong>Background: </strong>The risk of kidney failure increases after preeclampsia (PE), further increasing after two or more episodes. Recurrence is variably estimated. The aim of this study was to assess the recurrence rate and its predictors in the setting of obstetric-nephrology follow-up of pregnancies after PE.</p><p><strong>Methods: </strong>In a prospective study (2018-24), from 108 pregnancies with prior hypertensive disorders of pregnancy we selected 77 singleton deliveries after excluding twins, miscarriages, terminations, ongoing pregnancies, and drop-outs. PE recurrence and potential associated factors were tested in univariable and multivariable logistic regression models. Gestational age at time of delivery was analyzed using Kaplan-Meier curves and Cox regression. The diagnostic potential of angiogenic placental biomarkers (soluble FMS-like tyrosine kinase-1 and placental growth factor) was likewise tested.</p><p><strong>Results: </strong>In the context of a high prevalence of previous preterm delivery (53.6%), PE recurrence was 42.9%. Furthermore, 19.5% of the women experienced other complications and only 37.7% had an uneventful pregnancy; 60.6% of recurrences occurred after the 37th gestational week (GW), making later delivery possible (median: 38 GW in the index pregnancy versus 35 GW in the previous pregnancy). The covariates associated with PE recurrence were chronic hypertension (OR 7.662, 95% CI 2.122-33.379) and having had a baby with a centile <10th (OR 7.049, 95% CI 1.56-41.027), while those associated with time to delivery were hypertension and maternal age. Being diagnosed with chronic kidney disease after a previous PE episode was not associated with a significantly increased risk of recurrent PE.</p><p><strong>Conclusions: </strong>Risk of PE recurrence was high but delayed in this cohort on multidisciplinary follow-up. The question of whether a proactive approach to delivery can help to preserve long-term maternal kidney health is open.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf070"},"PeriodicalIF":3.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985626","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":"Pathophysiology of chronic kidney disease-mineral bone disorder (CKD-MBD): from adaptive to maladaptive mineral homeostasis.","authors":"Davide Salera, Nathalie Merkel, Antonio Bellasi, Martin H de Borst","doi":"10.1093/ckj/sfae431","DOIUrl":"10.1093/ckj/sfae431","url":null,"abstract":"<p><p>Chronic kidney disease-mineral bone disorder (CKD-MBD) is a multifaceted condition commonly seen in people with reduced kidney function. It involves a range of interconnected issues in mineral metabolism, bone health and cardiovascular calcification, which are linked to a lower quality of life and shorter life expectancy. Although various epidemiological studies show that the laboratory changes defining CKD-MBD become more common as the glomerular filtration rate declines, the pathophysiology of CKD-MBD is still largely unexplained. We herein review the current understanding of CKD-MBD, provide a conceptual framework to understand this syndrome, and review the genetic and environmental factors that may influence the clinical manifestation of CKD-MBD. However, a deeper understanding of the pathophysiology of CKD-MBD is needed to understand the phenotype variability and the relative contribution to organ damage of factors involved in CKD-MBD to develop more effective interventions to improve outcomes in patients with CKD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 Suppl 1","pages":"i3-i14"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623751","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":"Pathophysiology and therapies of CKD-associated secondary hyperparathyroidism.","authors":"Sandro Mazzaferro, Lida Tartaglione, Martine Cohen-Solal, Minh Hoang Tran, Marzia Pasquali, Silverio Rotondi, Pablo Ureña Torres","doi":"10.1093/ckj/sfae423","DOIUrl":"10.1093/ckj/sfae423","url":null,"abstract":"<p><p>Uremic secondary hyperparathyroidism (SHP) refers to the biochemical abnormalities that characterize CKD-MBD. However, historically parathyroid hormone (PTH) is identified as the key culprit hormone and the essential biomarker of secondary hyperparathyroidism. SHP represents the adaptive response to several mineral abnormalities that initiate and maintain increased PTH secretion through classical mineral derangements and more recently elucidated hormonal dysregulations. Among classic factors involved in the pathogenesis of SHP, phosphate, calcium, and calcitriol have a prominent role. The discovery of new pathogenetic factors involved in the development of SHP (and the eventual CKD-MBD) including fibroblast growth factor-23 (FGF23) and klotho provides new hypothesis and perspectives to our understanding of this complex metabolic disturbance. Recently more than serum phosphate a critical role in regulating FGF23 synthesis and the progression of CKD is ascribed to phosphate pool, reflected by production of glycerol-3-phosphate and the formation of excessive CPP-2. Finally, also skeletal resistance to PTH action, due to dysregulation of the Wnt-β-catenin system and intestinal dysbiosis, affecting the PTH actions on bone are causal factor of SHP. Identifying all the actors at play is mandatory to allow the most precise therapeutic prescription in the individual patient. This paper aims to review, in particular, the pathophysiology of SHP, which is essential to envisage the eventual therapeutic options for the associated MBD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 Suppl 1","pages":"i15-i26"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623748","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 perspectives on chronic kidney disease-mineral bone disorder.","authors":"Mario Cozzolino, Jordi Bover","doi":"10.1093/ckj/sfae432","DOIUrl":"10.1093/ckj/sfae432","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 Suppl 1","pages":"i1-i2"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623744","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":"Perspectives on social health among patients from Arab backgrounds receiving kidney replacement therapy: an interview study.","authors":"Nibras Jasim, Amanda Sluiter, Mary Ann Nicdao, Chandana Guha, Allison Jaure, Nicole Scholes-Robertson, Ben J Smith, Germaine Wong, Karine Manera","doi":"10.1093/ckj/sfaf081","DOIUrl":"https://doi.org/10.1093/ckj/sfaf081","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease receiving kidney replacement therapy have an increased risk of having poor social participation and connections, which are associated with poor health outcomes. This may be exacerbated in people from minority or disadvantaged groups, including culturally and linguistically diverse populations, who face multiple social disadvantages. We aimed to describe the perspectives on social health and connections among patients from Arab backgrounds receiving kidney replacement therapy.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted in Arabic or English language with Arab Australians receiving kidney replacement therapy across four renal units within the Western Renal Service, Australia. Transcripts were thematically analysed.</p><p><strong>Results: </strong>Twenty-five participants were interviewed, including 13 (52%) male and 22 (88%) born overseas. Four themes were identified: treatment impeding social participation (missing out on family time, limited opportunity for close friendships, symptoms interfering with relationships, reluctant to socialize to avoid infection); diminishing community and cultural ties (stigmatized and ostracized, geographic and cultural separation, emotional disconnect, avoiding additional distress); struggling with loss of normality within the family (inability to fulfil gender roles, hiding pain to protect children); and deriving comfort from connection (cultural norms preventing loneliness, easing the burden with support from family and friends, kinship and companionship during in-centre dialysis, using technology to connect with others).</p><p><strong>Conclusions: </strong>Patients from Arab backgrounds face substantial barriers to social participation, leading to loss of connection with people and culture. Strategies to improve social connections through culturally tailored peer and family support are needed.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf081"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969372","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":"Vitamin D: are all compounds equal?","authors":"Lorenza Magagnoli, Matthias Cassia, Andrea Galassi, Paola Ciceri, Elisabet Massó, Rosana Gelpi, Jordi Bover, Mario Cozzolino","doi":"10.1093/ckj/sfae417","DOIUrl":"10.1093/ckj/sfae417","url":null,"abstract":"<p><p>Vitamin D is a pre-hormone essential for maintaining mineral homeostasis and also plays significant roles in bone, cardiovascular and renal health. Vitamin D deficiency is prevalent in the general population, and even more so in chronic kidney disease (CKD) patients, in which it contributes to the development and progression of mineral and bone disorder. The landscape of vitamin D treatment has evolved, with several analogues now available, each possessing distinct pharmacokinetic and pharmacodynamic properties, efficacies and safety profiles. This diversity allows for tailored, personalized approaches to treatment in CKD patients. This review aims to provide a comprehensive overview of vitamin D, including its natural sources and metabolism, and examines the main available pharmacological vitamin D products. Particular emphasis is placed on their application in CKD management, highlighting how these compounds can be strategically used to address both vitamin D deficiency and secondary hyperparathyroidism, while also acknowledging the ongoing debate about their impact on bone health and other clinical outcomes.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 Suppl 1","pages":"i61-i96"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623784","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":"Valvular calcification in chronic kidney disease: new insights from recent clinical and preclinical studies.","authors":"Lucie Hénaut, Alexandre Candellier, Sharon Huish, Nervana Issa, Smeeta Sinha, Ziad A Massy","doi":"10.1093/ckj/sfae421","DOIUrl":"10.1093/ckj/sfae421","url":null,"abstract":"<p><p>Valvular calcification, developing either in the mitral or the aortic valve, is highly prevalent in patients suffering from chronic kidney disease (CKD), in whom their presence correlates with higher cardiovascular and all-cause mortality risk. To date, the exact mechanisms that promote heart valve calcification remain unclear, and none of the treatments tested so far have shown efficacy in preventing valvular fibrocalcific remodelling. It is therefore essential to improve our understanding of the mechanisms involved in the pathological process if we are to find new, effective therapies. The purpose of this review is to (i) summarize our current knowledge of the mechanisms by which CKD and related therapies affect valvular cell activity, (ii) present the latest therapeutic targets identified in preclinical studies, and (iii) discuss the most recent clinical trials evaluating the efficacy of therapies aimed at preventing valvular calcification in CKD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 Suppl 1","pages":"i27-i45"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623776","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 true cost of phosphate control in chronic kidney disease.","authors":"Cristian Rodelo-Haad, María E Rodríguez-Ortiz, Raquel Garcia-Sáez, Antonio Rivas-Domínguez, Daniel Jurado-Montoya, Alejandro Martín-Malo, Mariano Rodríguez, M Victoria Pendón-Ruiz de Mier, Juan Rafael Muñoz-Castañeda","doi":"10.1093/ckj/sfae434","DOIUrl":"10.1093/ckj/sfae434","url":null,"abstract":"<p><p>The loss of kidney function entails the development of a positive phosphate balance. The burden of addressing elevated phosphate levels is high. Both parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) are increased to promote phosphaturia, thereby preventing the rise in serum phosphate. However, if the phosphate load is excessive, the corresponding phosphaturia is maximal, kidney function deteriorates and hyperphosphataemia becomes clinically evident in advanced stages of chronic kidney disease (CKD). In addition to its role in CKD progression, hyperphosphataemia has been linked to a multitude of adverse outcomes, including overt inflammation, vascular calcifications, endothelial dysfunction, cardiovascular disease, renal osteodystrophy and secondary hyperparathyroidism. Collectively, these factors contribute to the markedly elevated mortality rates observed among individuals with CKD. Furthermore, hyperphosphataemia has been identified as a significant contributor to the development of inflammatory processes, oxidative stress and fibrosis, which underlie the aetiology of numerous comorbidities. Additionally, elevated levels of PTH and FGF23 have been demonstrated to independently induce organ and tissue injury, which is associated with poor outcomes in CKD. This article provides a concise overview of the current understanding of phosphate handling by the kidney in the context of CKD. It outlines the detrimental effects of phosphate on various organs and the mechanisms through which it contributes to CKD progression. Additionally, we discuss the tools available for clinicians to identify patients at risk of an excessive phosphate load.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 Suppl 1","pages":"i46-i60"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623762","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":"Construction and validation of prognostic models for acute kidney disease and mortality in patients at risk of malnutrition: an interpretable machine learning approach.","authors":"Xinyuan Wang, Chenyu Li, Lingyu Xu, Siqi Jiang, Chen Guan, Lin Che, Yanfei Wang, Xiaofei Man, Yan Xu","doi":"10.1093/ckj/sfaf080","DOIUrl":"https://doi.org/10.1093/ckj/sfaf080","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a prevalent complication in patients at risk of malnutrition, elevating the risks of acute kidney disease (AKD) and mortality. AKD reflects the adverse events developing after AKI. This study aimed to develop and validate machine learning (ML) models for predicting the occurrence of AKD, AKI and mortality in patients at risk of malnutrition.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of patients at risk of malnutrition. Eight ML algorithms were employed to predict AKD, AKI and mortality. The performance of the best model was evaluated using various metrics and interpreted using the SHapley Additive exPlanation (SHAP) method. An artificial intelligence (AI)-driven web application was also created based on the best model.</p><p><strong>Results: </strong>A total of 13 395 patients were included in our study. Among them, 1751 (13.07%) developed subacute AKD, 1253 (9.35%) were transient AKI, and 1455 (10.86%) met both AKI and AKD criteria. The incidence rate of mortality was 6.74%. The light gradient boosting machine (LGBM) outperformed other models in predicting AKD, AKI and mortality, with area under curve values of 0.763, 0.801 and 0.881, respectively. The SHAP method revealed that AKI stage, lactate dehydrogenase, albumin, aspirin usage and serum creatinine were the top five predictors of AKD. An online prediction website for AKI, AKD and mortality was developed based on the final models.</p><p><strong>Conclusions: </strong>The LGBM models provide an effective method for predicting AKD, AKI and mortality at an early stage in patients at risk of malnutrition, enabling prompt interventions. Compared with the AKD model, the models for predicting AKI and mortality perform better. The AI-driven web application can significantly aid in creating personalized preventive measures. Future work will aim to expand the application to larger, more diverse populations, incorporate additional biomarkers and refine ML algorithms to improve predictive accuracy and clinical utility.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf080"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984343","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":"Elevated urinary fatty acid-binding protein 4 level predicts future renal dysfunction and poor prognosis in Japanese patients with diabetes: a longitudinal cohort study.","authors":"Marenao Tanaka, Tatsuya Sato, Tomohito Gohda, Nozomu Kamei, Maki Murakoshi, Erika Ishiwata, Kei Nakata, Yukinori Akiyama, Keisuke Endo, Wataru Kawaharata, Hiroki Aida, Toru Suzuki, Mitsunobu Kubota, Michiyoshi Sanuki, Yusuke Suzuki, Masato Furuhashi","doi":"10.1093/ckj/sfaf056","DOIUrl":"https://doi.org/10.1093/ckj/sfaf056","url":null,"abstract":"<p><strong>Background: </strong>Fatty acid-binding protein 4 (FABP4) is an adipokine secreted from adipocytes and macrophages and is also expressed in injured, but not normal, glomerular endothelial cells. Elevated levels of urinary FABP4 (U-FABP4) have been reported to be associated with glomerular damage and increased proteinuria.</p><p><strong>Methods: </strong>The associations of levels of U-FABP4 at baseline with future events including renal dysfunction defined by a 30% decline in estimated glomerular filtration rate (eGFR) and all-cause death were investigated in 660 patients with diabetes (type 1/2, 57/603).</p><p><strong>Results: </strong>During a follow-up period (median: 62 months), 90 patients (13.6%) developed renal dysfunction, and 66 patients (10.0%) died (median follow-up period 65 months). Kaplan-Meier survival curves showed that there were significant differences in cumulative incidences for a 30% decline in eGFR and all-cause death in patients divided by the tertiles of U-FABP4 level. Furthermore, multivariable Cox proportional hazard models with a restricted cubic spline showed that hazard ratios for a 30% decline in eGFR and all-cause death increased with a higher level of logarithmically transformed (log) U-FABP4 after adjustment for age, sex, type of diabetes, body mass index, current smoking habit, duration of diabetes, comorbidities of hypertension and dyslipidemia, eGFR, and the categorical classification of urinary albumin-creatinine ratio. The addition of log U-FABP4 to traditional risk factors significantly increased the discriminatory capacities for renal dysfunction in net reclassification improvement and integrated discrimination improvement and for all-cause death in NRI.</p><p><strong>Conclusion: </strong>U-FABP4 is a predictive biomarker for future renal dysfunction and poor prognosis in patients with diabetes.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf056"},"PeriodicalIF":3.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957395","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}