Clinical Kidney Journal最新文献

{"title":"Urinary microvesicles: a window into the kidney.","authors":"Luisa Schnobrich, Hayo Castrop","doi":"10.1093/ckj/sfaf189","DOIUrl":"10.1093/ckj/sfaf189","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a growing concern in aging populations. CKD is characterized by two hallmark symptoms: a decline in the glomerular filtration rate (GFR) and albuminuria. Early changes in kidney function are notoriously underdiagnosed, suggesting the need for new noninvasive diagnostic and prognostic biomarkers of CKD. Thus, analysis of urinary extracellular vesicles (uEVs) may broaden the diagnostic options for CKD. EVs are a heterogeneous group of particles, enclosed by a lipid bilayer, which differ in size, biogenesis, and function. EVs can be readily recovered from the urine (urinary EVs, uEVs), where they are derived from various cells of the kidney, bladder, prostate, and utero-vaginal tract. Within the kidney, EVs are released by almost all cell types, including but not limited to podocytes, cells of the proximal and distal tubules, the collecting duct, and the loop of Henle. In addition to specific markers of parental cells, uEVs carry mRNAs, miRNAs, and proteins. Thus, analysis of uEVs may provide insights into the content and composition of the specific cells from which they are released, leading to the identification of new diagnostic and prognostic biomarkers for kidney diseases of different etiologies. This review provides an overview of kidney disease-related changes in uEV size and concentration and covers the potential of uEVs as new biomarkers for various types of kidney disease.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf189"},"PeriodicalIF":4.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944922","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":"Effect of erythropoiesis-stimulating agent types on malignancy in hemodialysis patients.","authors":"Seok Hui Kang, Yu Jeong Lim, Bo Yeon Kim, Ji Young Choi, Jun Young Do","doi":"10.1093/ckj/sfaf148","DOIUrl":"10.1093/ckj/sfaf148","url":null,"abstract":"<p><strong>Background: </strong>Since erythropoiesis-stimulating agent (ESA) types vary in their affinity for receptors, investigating their association with malignancies could offer valuable insights. This study aims to evaluate the effect of ESA types on malignancy incidence in hemodialysis (HD) patients.</p><p><strong>Methods: </strong>The Health Insurance Review and Assessment Service has operated a nationwide HD quality assessment program to address the high medical costs and mortality rates among HD patients. This retrospective study analyzed data from 33 960 HD patients, who underwent fourth and fifth HD quality assessments. Participants were divided into three groups: short-, intermediate- and long-acting groups. The onset of any malignancy was defined as the date of the first diagnosis based on International Classification of Diseases, Tenth Revision codes for the 12 most common malignancies. Patient survival was assessed for those with a first diagnosis of any malignancy during follow-up.</p><p><strong>Results: </strong>The short-, intermediate- and long-acting groups comprised 26 006, 6448 and 1506 patients, respectively (over ∼75 months of follow-up). The 5-year malignancy-free rates were 88.4%, 88.2% and 87.0% for short-, intermediate- and long-acting groups, respectively (<i>P</i> = .024 for short/intermediate-acting vs long-acting group). Univariable and multivariable analyses showed higher malignancy risk in the long-acting group, especially in males, older individuals and those on higher ESA doses. We performed analyses using a balanced cohort after propensity score weighting. The balanced cohort also confirmed higher malignancy risk in the long-acting group, while survival rates remained unaffected by ESA type.</p><p><strong>Conclusion: </strong>Our population-based cohort study reveals an association between long-acting ESAs use and the incidence of any malignancy, with a particularly strong influence on high-dose users. This suggests that avoiding long-acting ESAs may be advisable for patients at high risk of malignancy.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 6","pages":"sfaf148"},"PeriodicalIF":3.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505042","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":"Terlipressin for sinusoidal obstruction syndrome-associated acute kidney injury: a novel application.","authors":"Callie J Meath, Bindu Simon, Rohtesh S Mehta, Partow Kebriaei, Jamie S Lin","doi":"10.1093/ckj/sfaf188","DOIUrl":"10.1093/ckj/sfaf188","url":null,"abstract":"<p><p>Sinusoidal obstruction syndrome (SOS) is a life-threatening complication of hematopoietic cell transplantation that can lead to multiorgan failure, including acute kidney injury (AKI) due to hepatorenal syndrome (HRS)-like physiology. Current supportive measures often fail in preserving renal function, and dialysis is associated with high mortality risk. Terlipressin, a vasopressin analog approved for HRS in cirrhosis, has not been previously described for SOS-AKI. We report the first detailed case of terlipressin improving renal function, restoring diuretic responsiveness, and preventing dialysis in a patient with SOS, highlighting its potential as a therapeutic option for SOS-related renal failure.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf188"},"PeriodicalIF":3.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636432","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":"Loop diuretics in anuric hemodialysis patients for the clearance of protein-bound uremic toxins.","authors":"Didier Sánchez-Ospina, Maria Romero-Cote, Lucia Criado-Bellido, Maria Isabel Saez-Calero, Badawi Hijazi-Prieto, Sandra Delgado-Cuesta, Francisco Herrera-Gómez, Maddalen Mujika-Marticorena, Emilio Gonzalez-Parra, Maria Jesus Izquierdo-Ortiz, Sebastián Mas-Fontao","doi":"10.1093/ckj/sfaf195","DOIUrl":"10.1093/ckj/sfaf195","url":null,"abstract":"<p><strong>Background: </strong>In chronic kidney disease, the accumulation of protein-bound uremic toxins (PBUTs), such as hippuric acid (HA), p-cresyl sulfate (PCS) and indoxyl sulfate (IS), contributes to systemic toxicity and organ dysfunction. These toxins bind to plasma proteins, primarily albumin, rendering them resistant to clearance by conventional dialysis. This study hypothesizes that loop diuretics, particularly torasemide and furosemide, can displace PBUTs from their albumin-binding sites, increasing their free fraction and enhancing their removal during hemodialysis.</p><p><strong>Methods: </strong>This pilot multicenter crossover study included 17 anuric hemodialysis patients recruited from two hospitals. Participants underwent sequential treatment with furosemide and torasemide, each phase separated by a 1-week washout period. Plasma concentrations of HA, PCS and IS were measured pre- and post-dialysis during baseline (no diuretics) and diuretic treatment phases using high-performance liquid chromatography coupled with tandem mass spectrometry. Changes in pre- and post-dialysis toxin levels were evaluated across treatment phases. Repeated measures analysis of variance assessed the effect of each diuretic treatment on toxin levels and clearance rates.</p><p><strong>Results: </strong>Both loop diuretics increased the free fraction and clearance of PBUTs compared with baseline. Torasemide demonstrated higher efficacy in enhancing the clearance of HA (76.8%) compared with furosemide (63.2%) and baseline (57.3%). For PCS, furosemide achieved greater reductions (66.3%) than torasemide (61.8%) and baseline (24%). Indoxyl sulfate clearance increased significantly with both diuretics (59.1% for furosemide and 58.8% for torasemide) compared with baseline (26.2%).</p><p><strong>Conclusion: </strong>This study demonstrates that loop diuretics, especially torasemide, can enhance the clearance of PBUTs during hemodialysis. Their use mobilizes PBUTs from tissue stores and increases their dialyzability. These findings warrant further investigation in larger, long-term studies to validate the efficacy and clinical benefits of this approach.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf195"},"PeriodicalIF":3.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648759","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":"C-terminal <i>TREX1</i> c.914A>G variant in a patient with IgA nephropathy and thrombotic microangiopathy: expanding the clinical and genetic spectrum of IgA nephropathy with microangiopathic lesions.","authors":"Ahmet Burak Dirim, Elif Yilmaz Gulec, Ozge Hurdogan, Yasemin Ozluk, Safak Mirioglu, Ayse Serra Artan, Ozgur Akin Oto, Halil Yazici","doi":"10.1093/ckj/sfaf191","DOIUrl":"10.1093/ckj/sfaf191","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf191"},"PeriodicalIF":3.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12230548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583257","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":"Chronic kidney disease in older adults: trends in prevalence and healthcare service quality from 2012 to 2018.","authors":"Tim Bothe, Elke Schaeffner, Anna Pöhlmann, Anne-Katrin Fietz, Julia Freitag, Nina Mielke, Jean-François Chenot, Muhammad Helmi Barghouth, Elizabeth Mathias, Simone Kiel, Natalie Ebert","doi":"10.1093/ckj/sfaf180","DOIUrl":"10.1093/ckj/sfaf180","url":null,"abstract":"<p><strong>Background: </strong>Data on the healthcare service quality for patients with chronic kidney disease (CKD) are vital for guiding practitioners, patients and healthcare policy makers. We examined new quality indicators for outpatient diagnostics and treatments in older patients with CKD, focusing on trends between 2012 and 2018.</p><p><strong>Methods: </strong>The study included cross-sectional German statutory health insurance claims data from four independent random samples (2012, 2014, 2016, 2018), each with 62 200 individuals aged ≥70 years. We analyzed coded CKD prevalence and incidence, non-recommended drug prescriptions (dual prescriptions of angiotensin-converting enzyme inhibitors with angiotensin II receptor blockers; non-steroidal anti-inflammatory drugs in CKD stage 4-5), as well as albumin/creatinine ratio (ACR) and dipstick testing in incident CKD cases.</p><p><strong>Results: </strong>After standardization, the samples included 58.4%-59.3% females, and mean ages ranging from 77.4 to 78.9 years. CKD prevalence increased from 17.8% [95% confidence interval (CI) 17.5; 18.1] in 2012 to 25.7% (95% CI 25.4; 26.1) in 2018. CKD incidence rose slightly from 6.4% (95% CI 6.2; 6.6) to 7.6% (95% CI 7.4; 7.9). Non-recommended drug prescriptions, which were below 5% in 2012, decreased by more than half by 2018. ACR and dipstick testing varied inconsistently over time, ranging from 11.4% to 13.5% and 55.4% to 57.2%, respectively.</p><p><strong>Conclusions: </strong>CKD prevalence in older adults in Germany rose by eight percentage points from 2012 to 2018 while prescriptions of non-recommended drugs decreased in patients with CKD, indicating better diagnosis and guideline adherence. However, ACR and dipstick diagnostic was alarmingly low, and remained below recommended levels outside kidney specialist care, showing areas for improvement.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf180"},"PeriodicalIF":3.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12223366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559412","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 diagnostic accuracy of ultrasound and genomic tests for the diagnosis of autosomal-dominant polycystic kidney disease: a systematic mapping review.","authors":"Sue Harnan, Matthew Gittus, Louise Falzon, Miranda Durkie, Olena Mandrik, Albert C Ong, James Fotheringham","doi":"10.1093/ckj/sfaf187","DOIUrl":"10.1093/ckj/sfaf187","url":null,"abstract":"<p><strong>Background: </strong>Genomic and ultrasound tests can provide diagnostic and prognostic information on autosomal-dominant polycystic kidney disease (ADPKD), and can screen first-degree relatives in whom early diagnosis can be advantageous. We conducted a systematic mapping review on test accuracy and characteristics over time.</p><p><strong>Methods: </strong>Medline, Embase, and Cochrane were searched (August 2023) for studies in first<b>-</b>degree relatives/individuals clinically diagnosed with ADPKD receiving genomic or ultrasound tests. Acceptable reference standards for sensitivity/detection rate and specificity were definitive imaging or genomic confirmation. Genomic studies were categorized by technology and read length. Relationships between sensitivity, specificity, genomic technology, diagnostic criteria/reference standard, and genes tested were compared.</p><p><strong>Results: </strong>From 1029 non-duplicate titles retrieved, 51 genomic and 7 ultrasound studies were included. There were no genomic studies in first-degree relatives. Among studies in patients with clinical diagnoses, genomic sequencing methodologies were highly heterogeneous [next generation (short read (<i>n</i> = 20), long read (<i>n</i> = 1)), targeted Sanger (<i>n</i> = 19), whole exome (<i>n</i> = 1) with additional multi-ligation probe analysis (<i>n</i> = 13)]. Median sensitivity was 78% (Interquartile range 65% to 88%). Ultrasound sensitivity and specificity generally improved with age and were worse in <i>PKD2</i> patients compared to <i>PKD1</i> (lowest reported 31% and 88%, respectively, in polycystic kidney disease (<i>PKD</i>) 2 patients aged 5-14; highest 100% and 100%, respectively, in multiple gene/age categories).</p><p><strong>Conclusions: </strong>Despite technological advances, sensitivity of genomic tests appeared static between 2000 and 2023. Possible explanations include clinical diagnostic criteria (and hence populations recruited) widening from <i>PKD1</i> to include <i>PKD2</i> and atypical phenotypes, and small incremental gains of testing genes other than PKD1 and PKD2. For people at risk of ADPKD in genetically unresolved families, the accuracy of ultrasound is uncertain. Unified genomic test taxonomies would facilitate future reviews. <b>Registration:</b> PROSPERO CRD42023456727.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf187"},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689069","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":"Asymmetric dimethylarginine and citrulline are risk factors for cardiovascular disease independently of both estimated and measured GFR.","authors":"Nikoline B Rinde, Toralf Melsom, Ole Martin Fuskevåg, Bjørn O Eriksen, Jon Viljar Norvik","doi":"10.1093/ckj/sfaf181","DOIUrl":"10.1093/ckj/sfaf181","url":null,"abstract":"<p><strong>Background: </strong>Nitric oxide (NO) is crucial for endothelial dysfunction and its deficiency is linked to cardiovascular disease (CVD) and impaired kidney function. While research has explored NO metabolism in individuals with kidney disease, diabetes mellitus (DM) or CVD, the relationship in healthy individuals remains unclear. Studies using estimated glomerular filtration rate (eGFR) for kidney function may introduce non-GFR-related factors, confounding the results. We investigated the association between NO-related biomarkers and CVD outcomes in a healthy population, comparing adjustments using eGFR and measured GFR (mGFR).</p><p><strong>Methods: </strong>This 14-year longitudinal study evaluated 1575 healthy, middle-aged participants without pre-existing DM, CVD or kidney disease in the Renal Iohexol Clearance Survey (RENIS). Cox regression models assessed the effects of asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), arginine, citrulline and ornithine levels on CVD incidence and all-cause mortality. Analyses were adjusted for GFR using mGFR by iohexol clearance or eGFR based on serum creatinine (eGFR_c _rea) or cystatin C (eGFR_c _ys).</p><p><strong>Results: </strong>Elevated ADMA levels were associated with incident CVD across all GFR adjustment methods, with a hazard ratio (HR) of 1.21 [95% confidence interval (CI) 1.06-1.38] for mGFR. SDMA was associated with CVD when adjusting for eGFR_c _rea [HR 1.19 (95% CI 1.03-1.38)], not with mGFR or eGFR_c _ys. Through all GFR methods, higher citrulline levels consistently correlated with CVD [HR 1.17 (95% CI 1.03-1.33) for mGFR]. No biomarkers were linked to all-cause mortality.</p><p><strong>Conclusions: </strong>In a healthy population, ADMA and citrulline were associated with incident CVD, regardless of the GFR adjustment method, while the association of SDMA depended on the method used.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf181"},"PeriodicalIF":3.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607710","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":"Reducing CKD burden in Europe: first make the elephant apparent!","authors":"Luca De Nicola, Roberto Minutolo, Giuseppe Grandaliano","doi":"10.1093/ckj/sfaf182","DOIUrl":"10.1093/ckj/sfaf182","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf182"},"PeriodicalIF":3.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12230549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583260","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":"Decongestion in patients with advanced chronic kidney disease coexisting with heart failure.","authors":"Carmine Zoccali, Adeera Levin, Francesca Mallamaci, Robert Giugliano, Raffaele De Caterina","doi":"10.1093/ckj/sfaf185","DOIUrl":"10.1093/ckj/sfaf185","url":null,"abstract":"<p><p>Heart failure (HF) and chronic kidney disease (CKD) are closely interconnected conditions. Congestion, a central element in HF and CKD pathophysiology, progresses from haemodynamic changes to pulmonary oedema, with asymptomatic pulmonary congestion and an isolated increase in brain natriuretic peptide (BNP) as an intermediate step. Management strategies include sodium restriction, diuretics and emerging technologies for fluid monitoring. Diuretics, while essential, present challenges such as resistance and side effects, necessitating combination therapies and alternatives, like SGLT-2 inhibitors and, in special cases, ultrafiltration. Personalized approaches are critical to improving clinical outcomes in HF and CKD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 7","pages":"sfaf185"},"PeriodicalIF":4.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12223367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559415","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}