Current Opinion in Nephrology and Hypertension最新文献_第2页

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

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-07-14 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":"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":"521-526"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","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

Artificial intelligence at the bedside for the prevention, detection, and management of acute kidney injury. 床边人工智能用于急性肾损伤的预防、检测和管理。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-09-03 DOI: 10.1097/MNH.0000000000001112

Benjamin Shickel, Tezcan Ozrazgat-Baslanti, Azra Bihorac

{"title":"Artificial intelligence at the bedside for the prevention, detection, and management of acute kidney injury.","authors":"Benjamin Shickel, Tezcan Ozrazgat-Baslanti, Azra Bihorac","doi":"10.1097/MNH.0000000000001112","DOIUrl":"10.1097/MNH.0000000000001112","url":null,"abstract":"Purpose of review: Artificial intelligence is continuously and rapidly evolving. Artificial intelligence has the potential to address several clinical challenges associated with the prevention, detection, and management of acute kidney injury (AKI). This review provides an overview of the state of artificial intelligence for AKI decision-making, highlighting key recent developments, trends, and innovations towards real-world bedside deployment.Recent findings: External validation of supervised artificial intelligence models for predicting AKI outcomes is now common, with numerous retrospective studies demonstrating strong performance across institutions, patient populations, and international borders. Explainability and transportability of AKI prediction models have become increasingly prioritized, and many recent models use a smaller set of the most widely collected EHR variables with tree-based classifiers. New potential applications focused on supporting bedside AKI decision-making have emerged based on reinforcement learning and causal inference algorithms.Summary: Although consistency among externally validated AKI models is promising for eventual deployment at the bedside, few have undergone prospective validation, and the real-world clinical impact of artificial intelligence systems for AKI at the bedside remains unclear. Future work should focus on recent advances in artificial intelligence techniques and implementation studies, which assess overall clinical applicability.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"483-490"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014127","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

Pathophysiology of cognitive impairment in chronic kidney disease. 慢性肾病认知功能障碍的病理生理学研究。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI: 10.1097/MNH.0000000000001117

Lino Merlino, James Tollitt, Ross A Dunne, Philip A Kalra

{"title":"Pathophysiology of cognitive impairment in chronic kidney disease.","authors":"Lino Merlino, James Tollitt, Ross A Dunne, Philip A Kalra","doi":"10.1097/MNH.0000000000001117","DOIUrl":"10.1097/MNH.0000000000001117","url":null,"abstract":"Purpose of review: Cognitive impairment (CI) is a frequent and disabling complication in individuals with chronic kidney disease (CKD). With rising CKD prevalence, especially in aging populations, there is a pressing need to understand the complex and multifactorial mechanisms linking kidney dysfunction to cognitive decline.Recent findings: Emerging evidence highlights the multifactorial pathogenesis of CKD-related CI, involving vascular dysfunction, blood-brain barrier disruption, glymphatic impairment, systemic inflammation, uremic toxin accumulation, hormonal dysregulation, and gut-brain axis alterations. Additionally, mental health comorbidities, sarcopenia, sleep disorders, and renal replacement therapies further modulate cognitive outcomes. Advances in biomarker research and the identification of neuroprotective factors like Klotho may reshape diagnostic and therapeutic strategies.Summary: CI in CKD results from a convergence of systemic and neural insults, modulated by resilience mechanisms and shaped by aging and comorbidities. Future research should explore interventions targeting modifiable contributors, such as vascular health, inflammation, and uremic toxicity, as well as enhancing neuroresilience to preserve cognitive function in this high-risk population.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"459-468"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063704","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

Building resilience in kidney care: a composite framework from conflict, climate, and catastrophe. 在肾脏护理中建立复原力：冲突、气候和灾难的复合框架。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-11-01 Epub Date: 2025-09-25 DOI: 10.1097/MNH.0000000000001113

Rümeyza Kazancioğlu

引用次数: 0

Prevention of postoperative acute kidney injury: insights from recent clinical trials. 预防术后急性肾损伤：来自近期临床试验的见解。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-09-25 DOI: 10.1097/MNH.0000000000001114

Rayane Benyahia, Julie Klein, Stanislas Faguer

{"title":"Prevention of postoperative acute kidney injury: insights from recent clinical trials.","authors":"Rayane Benyahia, Julie Klein, Stanislas Faguer","doi":"10.1097/MNH.0000000000001114","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001114","url":null,"abstract":"Purpose of review: Postoperative acute kidney injury (PO-AKI) is a common complication associated with increased morbidity and mortality. Despite its frequency, guidelines for the prevention of PO-AKI are relatively recent and still based on weak or contradictory evidence. This review aims to summarize large recent studies published in the past 2 years that have attempted to address these gaps.Recent findings: While the POST-CABGDM and Stop-or-Not trials have provided additional evidence on the preoperative prescription of RAAS and SGLT2 inhibitors in selected surgical settings, future research must integrate preoperative risk profiling to personalize therapy. Likewise, although the POISE-3 trial seems to suggest that maintaining a mean arterial pressure of at least 60 mmHg is crucial in noncardiac surgery, it does not explore how targets might be personalized. In cardiac surgery, both the SIRAKI02 trial (i.e., extracorporeal blood purification membrane connected to the cardiopulmonary bypass) and the PROTECTION trial (i.e., intraoperative amino-acid infusion) demonstrated benefit only for mild AKI, raising questions about their mechanistic basis and clinical significance.Summary: \"Prevention is better than cure,\" a principle that holds particularly true for PO-AKI, a common complication that still lacks effective curative treatments. Although the recent abovementioned trials have yielded important findings, they concurrently underscore the significant obstacles in conducting clinical trials on PO-AKI and in formulating robust recommendations based on their outcomes.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130237","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

Novel approaches in antihypertensive pharmacotherapeutics. 抗高血压药物治疗的新途径。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-09-01 Epub Date: 2025-04-23 DOI: 10.1097/MNH.0000000000001081

Sidar Copur, Alexandru Burlacu, Mehmet Kanbay

{"title":"Novel approaches in antihypertensive pharmacotherapeutics.","authors":"Sidar Copur, Alexandru Burlacu, Mehmet Kanbay","doi":"10.1097/MNH.0000000000001081","DOIUrl":"10.1097/MNH.0000000000001081","url":null,"abstract":"Purpose of review: The management of hypertension remains suboptimal despite the widespread use of multiple antihypertensive medication groups. We hereby aim to evaluate the novel therapeutic approaches for the management of hypertension.Recent findings: As the decline in SBP and/or DBP is associated with a significant decline in major adverse cardiovascular events and all-cause mortality, the optimal management of hypertension is at most importance. The high prevalence of resistant hypertension, approximately 10% of hypertensive population, remains a major concern associated with high morbidity and mortality. Recently, multiple novel pharmacotherapeutic approaches have been implicated in the management of hypertension on various pathophysiological mechanisms, including aldosterone synthetase inhibitors, RNA-based therapies such as antisense oligonucleotides and small-interfering RNA, atrial natriuretic peptide analogs, dual endothelin antagonists, intestinal sodium-hydrogen exchanger-3 inhibitors, compound 17b and nonsteroidal mineralocorticoid receptor antagonists.Summary: Pharmacotherapeutic management options for hypertension is a growing field of research with potential clinical implications for multiple agents in upcoming years. Such novel approaches have the potential to improve clinical outcomes of hypertension management.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"350-359"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968795","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

Aldosterone synthase inhibition in chronic kidney disease. 慢性肾病醛固酮合成酶抑制。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-09-01 Epub Date: 2025-05-02 DOI: 10.1097/MNH.0000000000001089

Marieta P Theodorakopoulou, Fotini Iatridi, Pantelis A Sarafidis

{"title":"Aldosterone synthase inhibition in chronic kidney disease.","authors":"Marieta P Theodorakopoulou, Fotini Iatridi, Pantelis A Sarafidis","doi":"10.1097/MNH.0000000000001089","DOIUrl":"10.1097/MNH.0000000000001089","url":null,"abstract":"Purpose of review: Chronic kidney disease (CKD) is associated with elevated cardiovascular risk and progression to kidney failure, despite advances in therapy with renin-angiotensin system inhibitors and sodium-glucose-co-transporter-2 inhibitors. Overactivation of the aldosterone pathway contributes to residual cardiorenal risk. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) have shown efficacy in reducing cardiorenal outcomes in patients with albuminuric diabetic kidney disease, providing a rationale to explore broader aldosterone pathway inhibition in CKD.Recent findings: While steroidal MRAs are effective, their use is often limited by hormonal side effects and risk of hyperkalemia. Finerenone, a selective nonsteroidal MRA, showed cardiovascular and renal benefit in CKD patients with diabetes, although with only modest BP-lowering effects. Its role in nondiabetic populations and in those with lower levels of albuminuria remains to be determined. More recently, aldosterone synthase inhibitors (ASIs) have emerged as promising agents that directly suppress aldosterone production. Early-phase studies in patients with CKD, with or without diabetes, have shown reductions in albuminuria and BP, with a favorable safety profile.Summary: Direct inhibition of aldosterone synthesis may provide a novel and complementary strategy to reduce residual cardiorenal risk in CKD. Ongoing phase 3 trials will be key to defining the clinical utility of ASIs and their integration into future treatment paradigms.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"360-367"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989365","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

A current update of the development of Chimeric Antigen Receptor T-cell therapy and kidney disease. 嵌合抗原受体t细胞治疗和肾脏疾病的最新进展。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-09-01 Epub Date: 2025-06-23 DOI: 10.1097/MNH.0000000000001096

Juan León-Román, Alexandra Esteves, Gloria Iacoboni, María José Soler

{"title":"A current update of the development of Chimeric Antigen Receptor T-cell therapy and kidney disease.","authors":"Juan León-Román, Alexandra Esteves, Gloria Iacoboni, María José Soler","doi":"10.1097/MNH.0000000000001096","DOIUrl":"10.1097/MNH.0000000000001096","url":null,"abstract":"Purpose of review: Chimeric antigen receptor (CAR) T-cell therapy has marked a historic milestone for its remission rates in relapsed/refractory hematological neoplasms. Despite favorable efficacy outcomes, CAR T-cells are associated with potentially severe early and late complications, such as cytokine release syndrome (CRS), neurotoxicity, acute kidney injury (AKI), cytopenias and infections.Recent findings: AKI is a common complication that normally manifests during the first week following infusion and typically shows recovery within the first month. The risk factors for AKI development include a prior history of chronic kidney disease (CKD), development of CRS or neurotoxicity, antibiotic therapy and the use of intravenous contrast, amongst others.Summary: AKI a frequent but mild complication, with fast recovery. Future multicentric prospective studies are required to investigate the pathophysiology of AKI following CAR T-cell therapy and the potential preventive treatments. Furthermore, the impact of AKI secondary to CAR T-cell treatment in patients with prior CKD has not been analyzed in long-term follow-up studies.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"389-396"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474199","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

Therapies in autosomal dominant polycystic kidney disease: beyond tolvaptan. 常染色体显性多囊肾病的治疗：超越托伐普坦。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-09-01 Epub Date: 2025-07-04 DOI: 10.1097/MNH.0000000000001101

Christina Fang, Sayna Norouzi, Pranav S Garimella

{"title":"Therapies in autosomal dominant polycystic kidney disease: beyond tolvaptan.","authors":"Christina Fang, Sayna Norouzi, Pranav S Garimella","doi":"10.1097/MNH.0000000000001101","DOIUrl":"10.1097/MNH.0000000000001101","url":null,"abstract":"Purpose of review: Autosomal dominant polycystic kidney disease (ADPKD) is a progressive genetic disorder characterized by cyst formation, kidney enlargement, and eventual kidney failure. While tolvaptan remains the only FDA-approved therapy targeting disease progression, there is a growing pipeline of novel therapies. This review explores emerging interventions aimed at modifying cystogenesis, metabolic reprogramming, and kidney function decline.Recent findings: Recent preclinical and early clinical studies have identified promising therapeutic avenues including AMPK activators (e.g., metformin), SGLT2 inhibitors, GLP-1 receptor agonists, and bempedoic acid. Dietary interventions such as ketogenic diets and caloric restriction show potential for reducing cyst burden and preserving kidney function. RNA-based therapies targeting miR-17 and PC1-correcting agents like VX-407 offer genetically targeted treatment approaches. Several of these interventions are in ongoing phase 2 or 3 clinical trials evaluating their safety and efficacy and are discussed in this review.Summary: The treatment landscape for ADPKD is rapidly evolving, with multiple innovative therapies advancing toward clinical implementation. Integration of pharmacologic, dietary, and genetic strategies represents a comprehensive approach to modifying disease trajectory. Further large-scale, long-term studies are essential to validate these approaches and optimize individualized patient care.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"34 5","pages":"368-374"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728519","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

Transport and thiazide-inhibition mechanisms of the Na-Cl cotransporter: a structural perspective. Na-Cl共转运体的转运和噻嗪类药物抑制机制：结构视角。

IF 2.4 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-09-01 Epub Date: 2025-07-03 DOI: 10.1097/MNH.0000000000001099

Chien-Ling Lee, Liang Feng

{"title":"Transport and thiazide-inhibition mechanisms of the Na-Cl cotransporter: a structural perspective.","authors":"Chien-Ling Lee, Liang Feng","doi":"10.1097/MNH.0000000000001099","DOIUrl":"10.1097/MNH.0000000000001099","url":null,"abstract":"Purpose of review: The structures of the human sodium-chloride cotransporter (hNCC) and its complex with thiazide diuretics have been determined recently. This review summarizes key structural insights into NCC's transport and inhibition mechanisms.Recent findings: Recent studies revealed the structures of hNCC and its complex with thiazide diuretics, in inward-facing and outward-facing conformations, respectively. The structures of hNCC in two major conformational states provided important insights into the transport and regulatory mechanisms. Thiazide-bound hNCC structures illuminated the molecular mechanisms of thiazide-mediated NCC inhibition and explained the structure-activity relationship of thiazide diuretics.Summary: Structures of hNCC provide mechanistic insights into molecular mechanisms of loss-of-function NCC variants that cause Gitelman syndrome. The thiazide-bound hNCC structures provide a blueprint for further optimizing thiazide diuretics to reduce side effects. The novel interdomain interaction-mediated hNCC regulatory mechanisms revealed by structural studies lay the foundation for developing next-generation NCC modulators and NCC-rescuing therapeutics for treating NCC dysfunction.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"440-449"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505068","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