Current Opinion in Nephrology and Hypertension最新文献

Continuous glucose monitoring and automated insulin delivery systems in the management of diabetes among individuals with chronic kidney disease on dialysis. 连续血糖监测和自动胰岛素输送系统在慢性肾病透析患者糖尿病管理中的应用

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-15 DOI: 10.1097/MNH.0000000000001106

Alexandros L Liarakos, Ashveer Randhay, Emma G Wilmot

{"title":"Continuous glucose monitoring and automated insulin delivery systems in the management of diabetes among individuals with chronic kidney disease on dialysis.","authors":"Alexandros L Liarakos, Ashveer Randhay, Emma G Wilmot","doi":"10.1097/MNH.0000000000001106","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001106","url":null,"abstract":"Purpose of review: To describe the current evidence and emerging role of continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems in the management of diabetes among individuals with advanced chronic kidney disease (CKD) undergoing dialysis.Recent findings: Recent studies have shown that CGM provides accurate and clinically useful glucose data in people with advanced CKD requiring dialysis. CGM enables the detection of glycaemic variability and hypoglycaemia patterns that are often missed by traditional monitoring methods, such as capillary blood glucose testing and haemoglobin A1c. While observational studies show benefits, randomised controlled trial data are limited. Early trials and case series suggest that AID, especially fully closed-loop systems, may improve glycaemia in dialysis-dependent individuals with diabetes, though evidence is currently sparse and primarily focused on type 2 diabetes. Several ongoing and planned studies aim to address these knowledge gaps.Summary: CGM represents a valuable tool for improving glucose management and safety in people with diabetes and advanced CKD, but barriers to widespread use, such as cost, access, and healthcare provider familiarity, remain significant. AID technologies show promise but require further evaluation in this population. Future research should prioritise long-term outcomes, cost-effectiveness, and patient-reported outcomes to support the integration of these technologies into routine care for this high-risk group.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IgA nephropathy: a paradigm shift in treatment strategies. IgA肾病：治疗策略的范式转变。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-15 DOI: 10.1097/MNH.0000000000001105

Lydia Roberts, Max Jones, Jonathan Barratt, Haresh Selvaskandan

{"title":"IgA nephropathy: a paradigm shift in treatment strategies.","authors":"Lydia Roberts, Max Jones, Jonathan Barratt, Haresh Selvaskandan","doi":"10.1097/MNH.0000000000001105","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001105","url":null,"abstract":"Purpose of review: This review will provide an overview of the current understanding of mechanisms which drive IgA nephropathy (IgAN), and explore new therapies (those approved or being evaluated in phase 3 studies) which modulate these mechanisms to improve outcomes.Recent findings: IgAN remains the most reported primary glomerular disease worldwide. It is now clear that the majority of those diagnosed with IgAN are likely to progress to kidney failure over their lifetime, unless stringent disease control is achieved early. For decades, therapeutic options have been limited to interventions generic to chronic kidney disease (CKD), which could not alone rescue patients with IgAN from the risk of kidney failure. Recent advances in our understanding of the mechanisms driving IgAN, coupled with regulatory shifts in approvable clinical trial endpoints, have led to a surge in the development and evaluation of targeted therapies.Summary: As of early 2025, four agents have already received regulatory approval, and many more are expected. New treatments act on IgAN-specific disease pathways and modify disease pathways generic to CKD. For the first time, it is now possible to initiate well tolerated, effective, truly disease-modifying interventions early to meaningfully reduce the lifetime risk of kidney failure among those living with IgAN.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The impact of conflicts on patients with chronic kidney disease. 冲突对慢性肾病患者的影响。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-15 DOI: 10.1097/MNH.0000000000001107

Andrej Škoberne

{"title":"The impact of conflicts on patients with chronic kidney disease.","authors":"Andrej Škoberne","doi":"10.1097/MNH.0000000000001107","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001107","url":null,"abstract":"Purpose of review: Patients with kidney disease, especially patients with kidney failure, are disproportionately affected in settings of active conflict, as they rely on near constant medical care for survival. Recent increases in violent conflicts are endangering increasing numbers of patients, requiring immediate attention, a revision of current knowledge and constructive actions.Recent findings: Recent violent conflicts have revealed the profound vulnerability of patients with chronic kidney disease (CKD). In war-torn regions such as Ethiopia, Sudan, Gaza, and Ukraine, availability of essential services has been disrupted. Patients with CKD often lose access to antihypertensive and antidiabetic medications. Dialysis-dependent patients face high mortality when centres are damaged, or supply chains are cut. In Sudan, over 65% of patients on haemodialysis developed complications due to missed treatments. Sources from the wars in Bosnia, Ethiopia, and Gaza have reported mortality rates of patients with kidney failure reaching close to 50% or even exceeding it. In contrast, reports from Ukraine have shown that with intact infrastructure and sustained international support, dialysis services can be maintained and even expanded. These experiences underline the critical role of logistics, preparation, and humanitarian coordination in sustaining kidney care during conflict.Summary: Conflicts severely compromise kidney care by disrupting continuity of treatment, dialysis infrastructure, and supply chains. Outcomes vary widely depending on external support and blockade status. Preventable deaths among dialysis patients are common in besieged regions. Preparedness, coordination, and open supply lines are essential to mitigate humanitarian catastrophe among vulnerable kidney patients.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial introductions. 编辑介绍。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-01 Epub Date: 2025-05-29 DOI: 10.1097/MNH.0000000000001092

引用次数: 0

Impact of the choice of biomarkers and equations to estimate kidney function on the epidemiology of chronic kidney disease. 选择生物标志物和方程来评估肾功能对慢性肾脏疾病流行病学的影响。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-01 Epub Date: 2025-05-16 DOI: 10.1097/MNH.0000000000001085

Pierre Delanaye, Rouvick Mariano Gama, Thomas Stehlé

{"title":"Impact of the choice of biomarkers and equations to estimate kidney function on the epidemiology of chronic kidney disease.","authors":"Pierre Delanaye, Rouvick Mariano Gama, Thomas Stehlé","doi":"10.1097/MNH.0000000000001085","DOIUrl":"10.1097/MNH.0000000000001085","url":null,"abstract":"Purpose of review: The CKD-EPI equations were updated in 2021 to remove the race variable from eGFR estimation. In the same year, the creatinine-based EKFC equation was published, subsequently supplemented by the cystatin C-based EKFC equation. Recent findings suggest that the prevalence of chronic kidney disease (CKD) can vary depending on the equation, the biomarker, and the population studied.Recent findings: Using the CKD-EPI 2021 equation instead of the CKD-EPI 2009 equation results in an increased prevalence of CKD among Black individuals in the U.S. and a decreased prevalence among non-Blacks. The CKD-EPI equations may underestimate the prevalence of CKD in India and in some sub-Saharan African populations. This is corrected by using the EKFC equation and dedicated Q-values. In general, the prevalence of CKD is slightly higher with EKFC than with the CKD-EPI equations. The CKD-EPI cys equation generally leads to a higher CKD prevalence than the CKD-EPIcrea equations. Few epidemiological data are available for EKFC cys .Summary: The choice of biomarkers and equations has an impact on the prevalence of CKD, with implications that also depend on the characteristics of the population being studied.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"336-345"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Momentum toward patient outcome trials in chronic kidney disease-mineral bone disorder. 慢性肾脏疾病-矿物质骨紊乱患者结局试验的势头。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-01 Epub Date: 2025-05-19 DOI: 10.1097/MNH.0000000000001087

Varsha Pothula Venkata, Julia J Scialla

{"title":"Momentum toward patient outcome trials in chronic kidney disease-mineral bone disorder.","authors":"Varsha Pothula Venkata, Julia J Scialla","doi":"10.1097/MNH.0000000000001087","DOIUrl":"10.1097/MNH.0000000000001087","url":null,"abstract":"Purpose of review: The purpose of this review is to: evaluate the clinical trial evidence base for the treatment of chronic kidney disease mineral and bone disorder (CKD-MBD) in patients with kidney failure as it relates to highly prioritized clinical outcomes; and discuss approaches and principles to develop needed trials in CKD-MBD.Recent finding: Most clinical trials in CKD-MBD focus on biochemical outcomes, with few trials of surrogate outcomes (e.g., vascular calcification, left ventricular hypertrophy, bone mineral density), and even fewer of highly prioritized clinically important outcomes, such as mortality, cardiovascular disease events, or hospitalization. Within phosphate management, the recent LANDMARK trial did not detect a difference in a cardiovascular composite outcome between patients randomized to lanthanum carbonate vs. a calcium-based phosphate binder strategy over 3 years. The ongoing PHOSPHATE trial will provide needed evidence on phosphate treatment targets. There are no comparable, large trials of parathyroid hormone (PTH) targets. Observational approaches using clinical trial emulation suggest the potential for reduced cardiovascular disease and mortality with an 'emulated' low PTH target, but trials must be designed to confirm this. To ensure success, these trials must focus on practical treatment approaches, leveraging areas of practice variation and recognizing the dynamic nature of longitudinal CKD-MBD care.Summary: More intensive treatment of CKD-MBD remains a promising approach to improve clinical outcomes in patients with kidney failure and should prompt ongoing efforts to obtain needed trials.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"304-313"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial: One size does not fit all: moving toward individualized therapy. 社论：一种方式不适合所有人：转向个性化治疗。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-01 Epub Date: 2025-05-29 DOI: 10.1097/MNH.0000000000001088

Aline Martin, Rosa Moyses

引用次数: 0

Glomerular filtration rate and sexual dimorphism: lessons from animal and human studies. 肾小球滤过率和两性异形：来自动物和人类研究的经验教训。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-01 Epub Date: 2025-04-23 DOI: 10.1097/MNH.0000000000001079

Elise Bouderlique, Romain Pszczolinski, Caroline Prot-Bertoye, Marie Courbebaisse

{"title":"Glomerular filtration rate and sexual dimorphism: lessons from animal and human studies.","authors":"Elise Bouderlique, Romain Pszczolinski, Caroline Prot-Bertoye, Marie Courbebaisse","doi":"10.1097/MNH.0000000000001079","DOIUrl":"10.1097/MNH.0000000000001079","url":null,"abstract":"Purpose of review: Integrating sex-based analyses is becoming a key point in the new recommendations, particularly in nephrology.Recent findings: Whereas single nephron glomerular filtration rate (GFR) is not different between men and women, male sex is associated, after multiple adjustments, with a higher number of nephrons. However, after indexation to body surface area, measured GFR (mGFR) in healthy potential kidney donors is not different between men and women between 20 and 50 years of age. After 50 years, mGFR decline seems faster in women than in men, which is concordant with the protective role of estrogens on renal function, as demonstrated in animal and some human studies. Conversely, testosterone has a detrimental effect on renal function. Of note, although testosterone has been shown to increase the kidney volume of the remnant kidney after a unilateral nephrectomy in animal models, this may generate deleterious hyperfiltration in the longer term.Summary: Taken together, these data highlight the impact of sex on GFR, notably through sexual hormones whose receptors are expressed in glomerular cells.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"330-335"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The impact of sex on blood pressure. 性生活对血压的影响。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-01 Epub Date: 2025-04-07 DOI: 10.1097/MNH.0000000000001077

Fanny Bourdon, Belen Ponte, Anne Dufey Teso

{"title":"The impact of sex on blood pressure.","authors":"Fanny Bourdon, Belen Ponte, Anne Dufey Teso","doi":"10.1097/MNH.0000000000001077","DOIUrl":"10.1097/MNH.0000000000001077","url":null,"abstract":"Purpose of review: Hypertension is the most prevalent cardiovascular disease worldwide and the leading cause of mortality in both men and women. Despite well documented sex differences in prevalence, risk factors, and treatment responses, current guidelines still fail to take these specificities into account. A more tailored approach, accounting for sex-specific pathophysiological mechanisms and risk factors, is essential.Recent findings: Studies show that hypertension is more prevalent in men than in women until menopause. After menopause, the prevalence increases in women, likely due to hormonal changes. Additionally, genetic, metabolic, and social risk factors differ between the sexes, as do cardiovascular risks and associated comorbidities. Pharmacokinetic and pharmacodynamic variations also impact antihypertensive treatment efficacy and side effects, highlighting the need for a more individualized therapeutic strategy. This review explores the pathophysiology of hypertension by sex, global risk factors with a focus on female-specific aspects, and sex-related cardiovascular risks. We also discuss antihypertensive treatments and their effectiveness based on gender-specific characteristics.Summary: Incorporating sex differences into hypertension management could enhance treatment efficacy and reduce cardiovascular mortality. Further research is needed to refine guidelines and develop personalized therapeutic strategies, optimizing hypertension care and improving patient outcomes.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"322-329"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fibroblast growth factor 23 as a risk factor for incident diabetes. 成纤维细胞生长因子23作为发生糖尿病的危险因素。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-07-01 Epub Date: 2025-04-15 DOI: 10.1097/MNH.0000000000001078

Martin H de Borst

{"title":"Fibroblast growth factor 23 as a risk factor for incident diabetes.","authors":"Martin H de Borst","doi":"10.1097/MNH.0000000000001078","DOIUrl":"10.1097/MNH.0000000000001078","url":null,"abstract":"Purpose of review: Diabetes is a major global health concern, affecting millions and increasing morbidity and mortality. Recent research highlights fibroblast growth factor 23 (FGF23) as a potential contributor to type 2 diabetes and its cardiovascular complications. This review explores the role of FGF23 in metabolic and cardiovascular dysfunction and discusses possible therapeutic interventions.Recent findings: Deregulated FGF23 is linked to insulin resistance, pancreatic β-cell dysfunction, and systemic inflammation. Studies suggest FGF23 influences glucose metabolism via insulin signaling, oxidative stress, and inflammation. Epidemiological data indicate that elevated FGF23 levels are associated with an increased risk of type 2 diabetes and posttransplant diabetes, independent of traditional risk factors. Higher FGF23 levels have also been linked with an increased cardiovascular risk in patients with diabetes, even without chronic kidney disease.Summary: FGF23 is emerging as a key factor in the cardiovascular-kidney-metabolic syndrome, connecting diabetes and cardiovascular disease. While studies suggest consistent associations, causal mechanisms remain unclear. No therapies specifically target FGF23 to lower diabetes risk, but fibroblast growth factor receptor 4 (FGFR4) inhibitors show promise. Future research should examine the role of FGF23 in individuals with normal kidney function and explore whether modifying its levels could reduce diabetes and cardiovascular risk.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"284-290"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0