Current Opinion in Nephrology and Hypertension最新文献

{"title":"Citrate in autosomal dominant polycystic kidney disease: biomarker or therapeutic agent?","authors":"Daniel Ribeiro Rocha, Ana Cristina Carvalho Matos, Ita Pfeferman Heilberg","doi":"10.1097/MNH.0000000000001047","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001047","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review highlights the latest findings regarding hypocitraturia in autosomal dominant polycystic kidney disease (ADPKD), from both experimental and clinical studies, exploring the underlying pathophysiology and potential therapeutic approach.</p><p><strong>Recent findings: </strong>Experimental studies have shown that the lodging of microcrystals in the tubules can trigger cyst formation and growth in polycystic kidney disease (PKD). ADPKD patients are prone to developing hypocitraturia in early stages, which could predispose to calcium microcrystal formation. Low urinary citrate excretion has been associated with a more rapid decline in eGFR and poorer renal survival in ADPKD patients. Animal studies employing citrate supplementation have shown promising effects on preserving the decline in estimated glomerular filtration rate (eGFR) and cyst growth.</p><p><strong>Summary: </strong>Current knowledge suggests that urinary citrate could be incorporated into existing prognostic markers for disease progression and potential adjuvant therapy in ADPKD, but further clinical studies to support such hypothesis must be undertaken.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"34 2","pages":"138-142"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058349","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}

{"title":"Built environment and chronic kidney disease: current state and future directions.","authors":"Byoungjun Kim, Rania Kanchi, Andrea R Titus, Morgan E Grams, Mara A McAdams-DeMarco, Lorna E Thorpe","doi":"10.1097/MNH.0000000000001048","DOIUrl":"10.1097/MNH.0000000000001048","url":null,"abstract":"<p><strong>Purpose of review: </strong>Despite emerging studies on neighborhood-level risk factors for chronic kidney disease (CKD), our understanding of the causal links between neighborhood characteristics and CKD is limited. In particular, there is a gap in identifying modifiable neighborhood factors, such as the built environment, in preventing CKD, that could be targets for feasible place-based interventions.</p><p><strong>Recent findings: </strong>Most published studies on neighborhood factors and CKD have focused on a single social attribute, such as neighborhood disadvantage, while research on the role of the built environment is more nascent. Early studies on this topic have yielded inconsistent results, particularly regarding whether food deserts are an environmental risk factor for CKD onset. International studies have shown that walkable neighborhoods - characterized by features such as urban design, park access, and green spaces - can be protective against both the onset and progression of CKD. However, these findings are inconclusive and understudied in the context of United States, where neighborhood environments differ from those in other countries.</p><p><strong>Summary: </strong>Future research on modifiable neighborhood factors and CKD using advanced study designs and population-representative datasets can yield stronger evidence on potential causal associations and suggest feasible place-based interventions as strategies for preventing CKD. As an example, we demonstrated the potential of electronic health record-based studies to advance research in this area.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"143-150"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11779582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680116","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}

{"title":"Dual organ transplantation: Pancreas and Liver in the kidney axis.","authors":"Manal E Alotaibi, Sam Kant","doi":"10.1097/MNH.0000000000001049","DOIUrl":"10.1097/MNH.0000000000001049","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article explores the benefits and challenges of dual organ transplants.</p><p><strong>Recent findings: </strong>Simultaneous liver-kidney transplant has become a valuable option for patients with both liver and kidney failure, especially since the introduction of clearer eligibility guidelines in 2017. When done for the appropriate candidate, it can significantly improve survival and quality of life. Similarly, simultaneous pancreas-kidney transplantation provides significant advantages for patients with diabetes-related kidney failure by addressing both glycemic control and kidney function, with significant improvement in diabetes associated complications and survival.</p><p><strong>Summary: </strong>While these procedures are complex, they offer promising solutions for managing difficult multiorgan conditions. Ongoing research and personalized patient care will be key to maximizing their benefits.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"164-169"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784436","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}

{"title":"Home dialysis: there's no place like home.","authors":"Jeffrey D Wallach, Juan A Medaura, Leonard Stern","doi":"10.1097/MNH.0000000000001056","DOIUrl":"10.1097/MNH.0000000000001056","url":null,"abstract":"<p><strong>Purpose of review: </strong>The rapid rise in incidence and prevalence of end-stage kidney disease (ESKD) over the past 50 years was matched by a drop-off in use of home dialysis and a proliferation of in-center hemodialysis across the United States. There is renewed interest in improving access to home dialysis modalities for patients with ESKD. The aim of this review is to update kidney care providers with clinical outcome data and new guidelines that promote patient-centered choices, and to address barriers to home dialysis uptake and continued use.</p><p><strong>Recent findings: </strong>Recent literature, including changing practice guidelines for prescribing home dialysis and examining the goals of treatment from the patient and caregiver perspectives will be reviewed. We will examine the impact of newer care models to promote home dialysis for incident ESKD patients. Assisted home dialysis, home dialysis in a nursing home and the impact of new payment models rewarding home dialysis providers will be examined.</p><p><strong>Summary: </strong>This concise review of recent pertinent literature should give the dialysis provider confidence in advising their patients on the benefits of home dialysis, a glimpse into the future landscape for home dialysis, and hopefully transform kidney care providers into unbiased patient advocates.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"131-137"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834064","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}

{"title":"Effect of the allelic background on the phenotype of primary hyperoxaluria type I.","authors":"Giorgia Mandrile, Barbara Cellini, Pietro Manuel Ferraro","doi":"10.1097/MNH.0000000000001057","DOIUrl":"10.1097/MNH.0000000000001057","url":null,"abstract":"<p><strong>Purpose of review: </strong>Primary hyperoxaluria type 1 (PH1) is an autosomal recessive disorder of hepatic glyoxylate metabolism leading to nephrolithiasis and kidney failure. PH1 is caused by mutations on the AGXT gene encoding alanine:glyoxylate aminotransferase (AGT). The AGXT gene has two haplotypes, the major (Ma) and the minor (mi) alleles. This review summarizes the role of the minor allele on the molecular pathogenesis and the clinical manifestations of PH1.</p><p><strong>Recent findings: </strong>PH1 shows high genetic variability and significant interindividual variability. Although the minor haplotype is not pathogenic on its own, it may be crucial for the pathogenicity of some mutations or amplify the effect of others, thus affecting both symptoms and responsiveness to Vitamin B6, the only pharmacological treatment effective in a selected group of PH1 patients.</p><p><strong>Summary: </strong>In the last years, new drugs based on RNA-interference are available for patients nonresponsive to Vitamin B6, but no specific biomarkers are available to predict disease course and severity. Therefore, a clinical assessment of PH1 taking into account molecular analysis of the mutations and the allelic background and the possible synergism among polymorphic and pathogenic variants should be encouraged to promote approaches of personalized medicine that improve the management of available resources.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"177-183"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784438","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}

{"title":"The hemodialysis unit: the place where everybody knows your name.","authors":"David S Goldfarb","doi":"10.1097/MNH.0000000000001046","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001046","url":null,"abstract":"","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"34 2","pages":"129-130"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058352","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}

{"title":"Staying home when peritoneal dialysis ends: the integrated home dialysis approach.","authors":"Alex Pecce, Léa Belhumeur, Annie-Claire Nadeau-Fredette","doi":"10.1097/MNH.0000000000001034","DOIUrl":"10.1097/MNH.0000000000001034","url":null,"abstract":"<p><strong>Purpose of review: </strong>Home dialysis has been promoted for several years for patients starting dialysis. Although incident use of peritoneal dialysis (PD) and home hemodialysis (HHD) is increasing in several regions, patients on home dialysis remain at high risk of transfer to facility-hemodialysis (HD). The integrated home dialysis model, where patient start dialysis on PD and eventually transition to HHD when PD cannot be optimally continued has gain interest from dialysis stakeholders.</p><p><strong>Recent findings: </strong>Transfers from PD to HHD are infrequently used among patients ending PD, representing between 2% and 6% of transfers to HD in registry studies. Nonetheless, this approach is associated with several clinical benefits as well as favorable cost-effectiveness.</p><p><strong>Summary: </strong>In this review, we will present data pertaining to home dialysis and the integrated home dialysis model, with broad discussion of the implementation challenges, including identifying patients who could most benefit from this approach, timely planning of the transitions and challenges relating to unexpected PD endings.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"104-111"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567494","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}

{"title":"Editorial introductions.","authors":"","doi":"10.1097/MNH.0000000000001041","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001041","url":null,"abstract":"","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"34 1","pages":"vii-ix"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750187","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}

{"title":"Prospects for gene therapy in polycystic kidney disease.","authors":"Anubhav Chakraborty, Alan S L Yu","doi":"10.1097/MNH.0000000000001030","DOIUrl":"10.1097/MNH.0000000000001030","url":null,"abstract":"<p><strong>Purpose of review: </strong>We aim to provide an updated perspective on the recent advancements in gene therapy for polycystic kidney disease (PKD), a genetic disorder with significant morbidity. Given the rapid evolution of gene therapy technologies and their potential for treating inherited diseases, this review explores the therapeutic prospects and challenges in applying these technologies to PKD.</p><p><strong>Recent findings: </strong>Significant progress has been made in understanding the genetic underpinnings of PKD, making it a prime candidate for gene therapy. Re-expression of the PKD genes, treatment with the C-terminal tail of polycystin 1 protein and antagomir therapy against miR-17 have shown promise in reducing cyst formation and preserving kidney function. The rapid development of gene-editing tools, antisense oligonucleotide-based strategies, programmable RNA, and advanced gene delivery systems has opened new possibilities for PKD treatment. However, challenges such as off-target effects, delivery efficiency, and long-term safety remain significant barriers to clinical application.</p><p><strong>Summary: </strong>Current research highlights the transformative potential of gene therapy for PKD. Ongoing studies are crucial to overcoming existing challenges and translating these findings into clinical practice. We highlight the need for multidisciplinary efforts to optimize gene-editing technologies and ensure their safety and efficacy in treating PKD.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"121-127"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582446","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}

{"title":"Population health strategies for health equity in chronic kidney disease management.","authors":"Christopher O Brown, Phuong-Chi Pham, Anuja Shah, Ramanath Dukkipati, Jenny Shen, Ibrahim Elali, Tiane Dai, Evan A Raff, Kamyar Kalantar-Zadeh","doi":"10.1097/01.mnh.0001095808.65804.8c","DOIUrl":"https://doi.org/10.1097/01.mnh.0001095808.65804.8c","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic kidney disease (CKD) is a widespread health issue, affecting one out of every 10 adults. This prevalence is even higher among vulnerable and underserved populations, including low-income individuals, racial and ethnic minorities, and immigrants. Urban areas such as New York City and Los Angeles County offer municipal safety-net healthcare systems for these groups.</p><p><strong>Recent findings: </strong>Safety-net providers are essential to the healthcare landscape for vulnerable populations with chronic diseases including the Los Angeles County Health Services that exemplifies how effective population health strategies can be utilized to manage CKD and at-risk persons. These approaches focus on risk assessment, integrated practices, patient and care-partner education, cost reduction, and strategic partnerships. Kidney care tailored \"Expected Practices\" ensure that management strategies are equitable and based on clinical evidence. The eConsult system allows CKD patients' primary care providers to efficiently consult nephrologists, facilitating timely specialty care appointments through \"Precision Scheduling.\" Priority goals include slowing CKD progression, equitable access to home dialysis, and preemptive kidney transplantation. As highlighted by Kalantar-Zadeh et al. in 2025 CJASN, advancing equitable kidney care through population health approaches support comprehensive and efficient CKD management, including diabetic kidney disease, in Los Angeles County's safety-net system.</p><p><strong>Summary: </strong>With a large, underserved patient population affected by CKD, urban safety-net healthcare systems like those in Los Angeles County emphasize early detection, multidisciplinary management, shared decision-making, and equitable access to CKD. They prioritize equitable access to home dialysis modality choice and kidney transplantation, aiming to improve outcomes and the quality-of-life for diverse patient groups.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"34 1","pages":"41-47"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750190","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}