Clinical Kidney Journal最新文献

{"title":"From pathophysiology to novel approaches for obesity-associated hypertension.","authors":"Mehmet Kanbay, Elif Yayci, Candan Genc, Sidar Copur, Ozgur Aktas, Pantelis Sarafidis, Adrian Covic, Alberto Ortiz, Luke J Laffin","doi":"10.1093/ckj/sfaf218","DOIUrl":"10.1093/ckj/sfaf218","url":null,"abstract":"<p><p>Obesity is a rapidly growing epidemic affecting >15% of the global adult population and has considerable clinical consequences and comorbidities, including hypertension, diabetes mellitus, cardiovascular and cerebrovascular diseases and chronic kidney disease. There is a strong association between obesity or body mass index and high blood pressure (BP) in epidemiological studies while the underlying pathophysiological events linking those conditions are not fully elucidated. Hypothetical mechanisms include a sedentary lifestyle and excess intake of processed foods that contribute to obesity, overactivation of the renin-angiotensin-aldosterone and sympathetic nervous systems, inflammation, altered adipokine homeostasis and the fatty kidney hypothesis involving adipose tissue accumulation in the renal sinus and perirenal space. There are multiple pharmacotherapeutic and surgical approaches for the management of obesity, including dual and triple agonist drugs targeting glucagon-like peptide-1, gastric inhibitory peptide and glucagon receptors and endoscopic bariatric procedures. Despite promising results with such therapeutic approaches in terms of body weight reduction and BP control, it is unclear whether such BP reduction may completely be attributable to weight loss. Confirmation of the adiposity dependence would lead to a major paradigm shift in our understanding of hypertension, potentially leading to a major shift in the causes of hypertension from primary hypertension to adiposity-dependent hypertension, leading to a shift from symptomatic treatment with antihypertensive medication to cause-focused treatment with weight loss medication. In this narrative review, the aim is to evaluate the potential pathophysiological mechanisms linking hypertension and obesity and the efficiency of potential therapeutic approaches on BP.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf218"},"PeriodicalIF":4.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783653","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 mortality and technique survival in peritoneal dialysis patients: a 25-year retrospective analysis in a single center.","authors":"Roberta Scarmignan, Gaetano Alfano, Niccolò Morisi, Francesco Fontana, Giacomo Mori, Marco Ferrarini, Camilla Ferri, Laura Tonelli, Giulia Ligabue, Riccardo Magistroni, Mariacristina Gregorini, Gabriele Donati","doi":"10.1093/ckj/sfaf215","DOIUrl":"10.1093/ckj/sfaf215","url":null,"abstract":"<p><strong>Background: </strong>We comprehensively assessed patient survival and the duration of peritoneal dialysis (PD) treatment over a 25-year period within our PD unit.</p><p><strong>Methods: </strong>We retrospectively evaluated 497 PD patients who initiated PD between 1996 and 2021. The cohort was divided into three distinct periods based on pivotal events, such as the introduction of more biocompatible dialysis solutions and the initiation of remote monitoring technologies. Kaplan-Meier survival assessments, Cox proportional hazards model and Gray subdistribution hazard model were employed to evaluate patient survival and PD-to-hemodialysis (HD) transfer.</p><p><strong>Results: </strong>The use of PD as the initial treatment increased significantly over the years. Mean age was 63.5 ± 15.7 years; 61% were male, and 61% had three or more comorbidities including hypertension (81%), dyslipidemia (66%), cardiovascular disease (56%) and diabetes (16%). The five-year mortality rate was 40%. Risk factors for mortality included continuous ambulatory peritoneal dialysis (CAPD) [hazard ratio (HR) = 2.63, 95% confidence interval (CI) 1.76-3.93; <i>P</i> < .001], older age (HR = 2.96, 95% CI 1.98-4.43; <i>P</i> < .001), cardiovascular disease (HR = 1.96, 95% CI 1.31-2.95; <i>P</i> = .001) and the use of renin-angiotensin-aldosterone system inhibitors (RAASi) (HR = 1.81, 95% CI 1.22-2.70; <i>P</i> = .004). At 5 years, 48% of patients remained on PD. In the Cox model, risk factors for PD-to-HD transfer included CAPD (HR = 1.62, 95% CI 1.21-2.16; <i>P</i> = .001). RAASi use (HR = 0.66, 95% CI 0.46-0.94; <i>P</i> = .02) and female sex (HR = 0.70, 95% CI 0.51-0.96; <i>P</i> = .03) were associated with longer PD duration.</p><p><strong>Conclusions: </strong>The study provides insights into the changing landscape of PD. Advances in PD solutions and remote monitoring have contributed to changes in PD outcomes and its increased adoption over the years. Given the observational nature of the study, caution is warranted in interpreting the association of both CAPD and RAASi with mortality.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf215"},"PeriodicalIF":4.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783655","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":"Outcomes of patients in a pre-dialysis clinic and implications for shared decision making.","authors":"Hannah O'Keeffe, Rosemary Donne, Philip A Kalra, Ibrahim Ali","doi":"10.1093/ckj/sfaf211","DOIUrl":"10.1093/ckj/sfaf211","url":null,"abstract":"<p><strong>Background: </strong>The association of end-stage kidney disease (ESKD) with poor outcomes is well recognized. Education and discussions with patients with advanced chronic kidney disease (CKD) are important to facilitate shared decision making regarding care.</p><p><strong>Methods: </strong>This study reports longitudinal follow-up of all patients who attended the Advanced Kidney Care Service (AKCS) in a tertiary renal centre in the UK. Patients are routinely referred to AKCS once their estimated glomerular filtration rate (eGFR) drops below 20 mL/min/1.73 m². A total of 1957 patients who first attended between September 2011 and September 2018 were included, with a minimum of 5 years follow-up to 30 September 2023.</p><p><strong>Results: </strong>During follow-up, 55.7% of the cohort commenced renal replacement therapy (RRT), the initial modality was haemodialysis in 57.2%, peritoneal dialysis in 27.3% and a pre-emptive transplant in 15.5%, of which 42.6% were from live donors. Conservative management was chosen by 17.9% of patients. Of those who had opted for RRT, 26.7% died before reaching it. The 5-year survival was 49.6% from first attendance at AKCS. The 5-year survival rates by age group were: <50 years, 84.2%; 50-64 years, 66.1%; 65-79 years, 40.1%; and ≥80 years, 22.3% (<i>P </i>< .001). The 5-year survival on haemodialysis was 49.6%, peritoneal dialysis 54.7% and 92.3% for pre-emptive transplant 92.3%. For those over 80 years of age a modest survival benefit was seen with RRT, with a median survival of 17.4 months from RRT commencement, compared with 11.8 months once the eGFR declined below 10 mL/min/1.73 m² in the conservative group.</p><p><strong>Conclusion: </strong>This study highlights the high competing mortality in an advanced CKD cohort. The high rates of pre-emptive transplantation and peritoneal dialysis initiation demonstrate the benefits of a structured AKCS strategy. Older patients with ESKD, particularly those aged over 80 years, have poor outcomes, regardless of whether they choose RRT or conservative management.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf211"},"PeriodicalIF":4.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774801","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":"Initial change in fractional excretion of total protein after SGLT2 inhibitors predicts renal prognosis in patients with chronic kidney disease.","authors":"Hideaki Kuno, Go Kanzaki, Rina Oba, Hirokazu Marumoto, Saeko Hatanaka, Takaya Sasaki, Kotaro Haruhara, Kei Matsumoto, Kentaro Koike, Hiroyuki Ueda, Yudo Tanno, Keita Hirano, Masato Ikeda, Nobuo Tsuboi, Takashi Yokoo","doi":"10.1093/ckj/sfaf209","DOIUrl":"10.1093/ckj/sfaf209","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter 2 inhibitors (SGLT2i) reduce glomerular hyperfiltration, resulting in an initial estimated glomerular filtration rate (eGFR) dip in chronic kidney disease (CKD). The association between the initial eGFR dip after SGLT2i and proteinuria reduction has not been explored. Fractional excretion of total protein (FETP) is an index of protein leakage corrected for GFR and may be useful in addressing this issue.</p><p><strong>Methods: </strong>FETP was calculated as (serum creatinine × urine protein)/(serum protein × urine creatinine) (in %) and the initial FETP dip was defined as 3 months/baseline FETP. The patients were divided into three groups according to the initial FETP dip tertile: FETP acute dipper, moderate dipper and riser. The association between initial FETP dip after SGLT2i and the eGFR slope over the subsequent 2 years was retrospectively investigated.</p><p><strong>Results: </strong>The study involved 238 patients, including 105 with diabetes mellitus. The patients' median age was 57.0 years and eGFR was 43.0 ml/min/1.73 m². The initial FETP dip was associated with the baseline eGFR, protein:creatinine ratio and FETP. The eGFR slope in the FETP acute dipper was -0.2 ml/min/1.73 m²/year, which was less than those of the moderate dipper and riser (-1.0 and -1.3 ml/min/1.73 m²/year; <i>P</i> < .001). Multivariate regression analyses revealed that the initial FETP dip was associated with the eGFR slope independent of potential confounders (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>An FETP acute dip after SGLT2i is associated with a favourable renal prognosis in CKD, indicating that FETP is a useful index for assessing the efficacy of SGLT2i.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf209"},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783654","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":"Adult prognosis of childhood kidney replacement therapy: ERA Registry Figure of the Month.","authors":"Vianda S Stel, Alberto Ortiz, Anneke Kramer","doi":"10.1093/ckj/sfaf204","DOIUrl":"https://doi.org/10.1093/ckj/sfaf204","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 6","pages":"sfaf204"},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12230547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583256","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":"Understanding and targeting senescence in kidney disease.","authors":"Lucie Chanvillard, Tilly Mason, David A Ferenbach","doi":"10.1093/ckj/sfaf190","DOIUrl":"10.1093/ckj/sfaf190","url":null,"abstract":"<p><p>Kidney disease affects >850 million people worldwide and remains a major contributor to patient morbidity, mortality, and healthcare burden. Despite advances in renoprotective therapies, current treatments are largely focused on managing risk factors such as hypertension, hyperfiltration, and hyperglycaemia, with limited options to modify disease progression at the cellular level. Emerging evidence suggests that cellular senescence, a state of irreversible cell-cycle arrest accompanied by chronic pro-inflammatory signalling, plays a significant role in chronic kidney disease (CKD) pathogenesis, particularly within tubular epithelial cells (TECs). Senescent TECs accumulate in injured kidneys, driving inflammation, fibrosis, and loss of regenerative capacity. This process is triggered by diverse stressors, including ischaemia-reperfusion injury, metabolic stress, and uremic toxin exposure. The recognition of senescence as a pathological and potentially modifiable process has opened new therapeutic avenues in nephrology. Preclinical studies demonstrate that senolytics, which selectively eliminate senescent cells, and senomorphics, which suppress the harmful senescence-associated secretory phenotype (SASP), can reduce renal fibrosis and preserve kidney function in experimental models of fibrosis in the kidney and other organs. Translating these approaches into clinical practice requires overcoming key challenges, including the lack of validated non-invasive biomarkers to monitor renal senescence and the heterogeneity of senescent cells across different disease stages. This review discusses the contribution of cellular senescence to kidney ageing and disease progression and outlines the underlying molecular mechanisms and biomarkers of renal senescence. It also highlights recent advances in senotherapeutic strategies, emphasizing future directions for integrating senescence-targeted therapies into comprehensive CKD management.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf190"},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783656","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":"Induction therapy for class I/II lupus nephritis with glucocorticoid monotherapy associates with higher relapse and poorer kidney outcomes.","authors":"Xiuzhi Jia, Wang Xiang, Huajing Peng, Jianwen Yu, Xin Wang, Hongjian Ye, Haishan Wu, Ruihan Tang, Xi Xia, Wei Chen","doi":"10.1093/ckj/sfaf171","DOIUrl":"10.1093/ckj/sfaf171","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of glucocorticoid (GC) in combination with other immunosuppressive therapy for class I/II lupus nephritis (LN) remains controversial.</p><p><strong>Methods: </strong>We retrospectively analysed 107 biopsy-proven class I/II LN patients who had survival follow-up data from January 1996 to March 2023 and further assessed 96 patients with available treatment response data. These patients received GC alone (GC monotherapy) or GC in combination with another immunosuppressant (combination therapy) as induction therapy. The primary outcome was renal relapse and the secondary outcome was end-stage renal disease (ESRD) or all-cause mortality. Kaplan-Meier analysis was used to compare the cumulative renal relapse rate and long-term renal outcomes between the two treatment groups. Cox regression analysis was performed to identify the risk factors for renal relapse.</p><p><strong>Results: </strong>During a median follow-up of 112 months [interquartile range (IQR) 35.5-189.0], 96 patients had available treatment response data. All patients had complete or partial remission, with 78 (81.3%) achieving complete remission (CR). No significant difference in CR rate was observed between the GC monotherapy and combination therapy groups (82.1% versus 80.7%, <i>P</i> = .868). However, the cumulative renal relapse rate was significantly higher in the GC monotherapy group (logrank <i>P</i> = .004). GC monotherapy {hazard ratio [HR] 2.71 [95% confidence interval (CI) 1.28-5.75], <i>P</i> = .009} and partial remission after induction therapy [HR 4.17 (95% CI 1.78-9.80), <i>P</i> = .001] were independent risk factors for renal relapse. After a median follow-up time of 156 months (IQR 76.0-199.0), four patients (3.7%) developed ESRD, all in the GC monotherapy group. Long-term renal outcome in the GC monotherapy group was significantly poorer, with 5-, 10-, 15- and 20-year renal survival rates of 100.0%, 93.9%, 90.4% and 90.4%, respectively (<i>P</i> = .025).</p><p><strong>Conclusion: </strong>Class I/II LN patients treated with GC monotherapy have higher renal relapse rates and poorer long-term renal outcomes compared with those receiving GC in combination with other immunosuppressants as induction therapy.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf171"},"PeriodicalIF":3.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648758","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":"Reinforcing the role of magnesium in preventing cisplatin-induced nephrotoxicity: real-world evidence and clinical implications.","authors":"Luca Nardelli, Arjunmohan Mohan, Sandra M Herrmann","doi":"10.1093/ckj/sfaf212","DOIUrl":"10.1093/ckj/sfaf212","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 8","pages":"sfaf212"},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774802","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: Time-averaged concentration estimation of uraemic toxins with different removal kinetics: a novel approach based on intradialytic spent dialysate measurements.","authors":"","doi":"10.1093/ckj/sfaf207","DOIUrl":"https://doi.org/10.1093/ckj/sfaf207","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ckj/sfac273.].</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf207"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559414","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":"Prolonged normothermic perfusion: a promising approach to kidney transplantation.","authors":"Michele F Eisenga, Rainer Oberbauer","doi":"10.1093/ckj/sfaf210","DOIUrl":"10.1093/ckj/sfaf210","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf210"},"PeriodicalIF":3.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682156","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}