Current Opinion in Nephrology and Hypertension最新文献_第4页

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

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub 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":"https://doi.org/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":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-23","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

Sodium-glucose cotransporter 2 inhibitors: a novel approach to prevent the transition from acute kidney injury to chronic kidney disease. 钠-葡萄糖共转运蛋白2抑制剂：防止急性肾损伤向慢性肾病转变的新途径

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-04-23 DOI: 10.1097/MNH.0000000000001080

Miguel Ángel Martínez-Rojas, Norma A Bobadilla

{"title":"Sodium-glucose cotransporter 2 inhibitors: a novel approach to prevent the transition from acute kidney injury to chronic kidney disease.","authors":"Miguel Ángel Martínez-Rojas, Norma A Bobadilla","doi":"10.1097/MNH.0000000000001080","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001080","url":null,"abstract":"Purpose of review: Acute kidney injury (AKI) often progresses to chronic kidney disease (CKD), yet standardized clinical guidelines for managing this transition remain lacking. Recent studies suggest that sodium-glucose cotransporter 2 inhibitors (SGLT2i) or flozins improve AKI outcomes. Studies on patients living with diabetes post-AKI show flozins reduce mortality, CKD progression, and recurrent AKI, highlighting their potential in mitigating maladaptive kidney repair. We discuss recent preclinical evidence supporting a role of SGLT2i during AKI repair and subsequent CKD.Recent findings: AKI is characterized by endothelial and tubular injury, hypoperfusion, metabolic dysfunction, inflammation, and cell death. SGLT2i restore renal hemodynamics, mitochondrial dysfunction, and reduce oxidative stress, improving recovery following AKI. Additionally, SGLT2i mitigate cell death by counteracting apoptosis and ferroptosis while reducing inflammation through suppression of pro-inflammatory cytokines and inflammasome activation. Beyond AKI, flozins exhibit long-term antifibrotic effects, reducing extracellular matrix deposition even after treatment discontinuation. Preclinical studies demonstrate a sustained protective effect on kidney integrity months after short-term treatment.Summary: These inhibitors hold promise for broad nephroprotection, with robust biological rationale in maladaptive repair. Further research is needed to optimize their use and establish clinical guidelines for AKI management in both diabetic and nondiabetic populations.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958371","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

Optimizing renin-angiotensin-aldosterone inhibition in advanced chronic kidney disease: balancing benefits and risks. 优化肾素-血管紧张素-醛固酮抑制在晚期慢性肾病：平衡利益和风险。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-04-08 DOI: 10.1097/MNH.0000000000001076

Sebastian Spencer, Sunil Bhandari

{"title":"Optimizing renin-angiotensin-aldosterone inhibition in advanced chronic kidney disease: balancing benefits and risks.","authors":"Sebastian Spencer, Sunil Bhandari","doi":"10.1097/MNH.0000000000001076","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001076","url":null,"abstract":"Purpose of review: Renin-angiotensin-aldosterone system inhibitors (RAASi), including angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs), are fundamental in chronic kidney disease (CKD) management, particularly in proteinuric conditions. However, their use in advanced CKD (eGFR <30 ml/min/1.73 m 2 ) remains debated because of risks of hyperkalaemia, acute kidney injury (AKI), and hypotension. This review evaluates the latest evidence, including the STOP-ACEi trial, to inform the risks and benefits of RAASi in advanced CKD.Recent findings: The STOP-ACEi trial, a multicentre randomized controlled trial (RCT), investigated RAASi discontinuation in 411 patients with advanced CKD. After 3 years, discontinuation did not slow eGFR decline or reduce mortality, while continuation was associated with a numerical trend towards lower end-stage kidney disease (ESKD) rates. Meta-analyses also indicate that ACEi may offer superior kidney protection compared to ARBs, though both lower cardiovascular risk and this difference may not be clinically significant. Combination ACEi/ARB therapy provides no additional benefits and increases adverse events, such as hyperkalaemia and hypotension. Adjunct therapies like potassium binders and sodium-glucose cotransporter-2 (SGLT2) inhibitors may enable safer RAASi use in high-risk patients.Summary: Current evidence supports RAASi continuation in most CKD patients, including those with advanced disease, unless contraindicated. Future studies should refine patient selection criteria and optimize adjunctive strategies to mitigate adverse effects.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987307","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 kidney under heat stress: a vulnerable state. 热应激下的肾脏：一种脆弱的状态。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2024-12-13 DOI: 10.1097/MNH.0000000000001050

Fabiano Amorim, Zachary Schlader

{"title":"The kidney under heat stress: a vulnerable state.","authors":"Fabiano Amorim, Zachary Schlader","doi":"10.1097/MNH.0000000000001050","DOIUrl":"10.1097/MNH.0000000000001050","url":null,"abstract":"Purpose of review: This review examines the effects of occupational heat stress on kidney health. It focuses on the role of hyperthermia in the development of acute kidney injury (AKI) and its potential progression to chronic kidney disease of nontraditional etiology (CKDnt). We highlight the physiological mechanisms by which hyperthermia affects kidney function and discuss emerging preventive strategies.Recent findings: Hyperthermia places the kidneys in a vulnerable state. As body temperature increases, blood flow is directed toward the skin to aid in cooling, diverting it away from internal organs like the kidneys to support blood pressure regulation. At the same time, hyperthermia and dehydration increases energetic demand to promote fluid and electrolyte conservation. Collectively, this can create a localized supply-demand mismatch, resulting in tissue hypoxia that can damage kidney tissues. These findings highlight that heat hyperthermia can lead to subclinical kidney damage, with potential long-term implications for kidney health.Summary: Heat-induced AKI is a growing public health concern. Individuals engaged in manual labor with prolonged exposure are at risk of CKDnt. Interventions aimed to prevent hyperthermia show promise in mitigating the risk of AKI. Further research is necessary to refine these strategies and establish evidence-based guidelines for reducing heat-related kidney injuries.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"170-176"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834065","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 introduction. 编辑介绍。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2025-01-30 DOI: 10.1097/MNH.0000000000001059

引用次数: 0

Preparing for stormy weather: building VA health system resilience for dialysis emergency preparedness in the era of climate change. 为暴风雨天气做准备：在气候变化时代建立VA卫生系统透析应急准备的复原力。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2024-12-17 DOI: 10.1097/MNH.0000000000001054

DeAndra Martin, Peter Brewster, Susan T Crowley

{"title":"Preparing for stormy weather: building VA health system resilience for dialysis emergency preparedness in the era of climate change.","authors":"DeAndra Martin, Peter Brewster, Susan T Crowley","doi":"10.1097/MNH.0000000000001054","DOIUrl":"10.1097/MNH.0000000000001054","url":null,"abstract":"Purpose of review: Climate change has been implicated as the driver for the increasing number, intensity, duration, and consequences of catastrophic weather events. As a result of extreme weather events, climate change has also been implicated as an important mediator of adverse kidney health outcomes, not only increasing the risk for the development of acute and chronic kidney diseases, but also disrupting the delivery of critical kidney health services. In particular, the delivery of dialysis services during major emergencies remains an ongoing and increasing problem, with a recognized need for improved emergency preparedness and disaster management (EP-DM) strategies to mitigate the increased risk of morbidity and mortality associated with missed dialysis treatment.Recent findings: There are increasing reports detailing the challenges of kidney dialysis care in times of crisis, to include those resulting from both man-made and natural disasters. Optimized management of the high-risk vulnerable dialysis patient population must include both facility-facing comprehensive continuity of operations and emergency response plans, and ongoing patient-facing emergency preparedness education.Summary: This review discusses the adverse impact of climate change-related natural disasters on the delivery of dialysis services, and the evolving EP-DM strategies developed and implemented by the Veterans Health Administration (VA) to optimize the care and well being of the vulnerable end stage kidney disease (ESKD) patient population.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"156-163"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853355","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

Use of water in dialysis and its impact on the environment. 透析用水及其对环境的影响。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2024-12-17 DOI: 10.1097/MNH.0000000000001058

Suzanne Watnick

引用次数: 0

Citrate in autosomal dominant polycystic kidney disease: biomarker or therapeutic agent? 常染色体显性多囊肾病的柠檬酸盐：生物标志物还是治疗剂？

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2024-11-13 DOI: 10.1097/MNH.0000000000001047

Daniel Ribeiro Rocha, Ana Cristina Carvalho Matos, Ita Pfeferman Heilberg

{"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":"10.1097/MNH.0000000000001047","url":null,"abstract":"Purpose of review: 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.Recent findings: 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.Summary: 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.","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}

引用次数: 0

Built environment and chronic kidney disease: current state and future directions. 建筑环境与慢性肾病：现状与未来方向。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2024-11-21 DOI: 10.1097/MNH.0000000000001048

Byoungjun Kim, Rania Kanchi, Andrea R Titus, Morgan E Grams, Mara A McAdams-DeMarco, Lorna E Thorpe

{"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":"Purpose of review: 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.Recent findings: 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.Summary: 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.","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}

引用次数: 0

Dual organ transplantation: Pancreas and Liver in the kidney axis. 双器官移植：胰腺和肝脏在肾轴。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-03-01 Epub Date: 2024-12-06 DOI: 10.1097/MNH.0000000000001049

Manal E Alotaibi, Sam Kant

引用次数: 0