International Journal of Nephrology最新文献

{"title":"Effect of Glucocorticoid Use in Patients With Biopsy-Proven Acute Interstitial Nephritis: Insights From a Colombian Cohort.","authors":"Joaquín Rodelo-Ceballos, Camilo García-Prada, Mauricio Restrepo-Escobar, Laura Lopera-Restrepo, Angie Pinto-Diaz, Luis Fernando Arias-Restrepo","doi":"10.1155/ijne/9980649","DOIUrl":"https://doi.org/10.1155/ijne/9980649","url":null,"abstract":"<p><p><b>Introduction:</b> Acute interstitial nephritis (AIN) is a major cause of acute kidney injury, commonly triggered by medications or infections. Although glucocorticoid (GC) therapy is recommended for patients who do not improve after removing the suspected cause, the evidence supporting its use remains limited. <b>Materials and Methods:</b> This retrospective cohort study was conducted at the Pathology Unit of the University of Antioquia-San Vicente Fundación Hospital in Medellín, Colombia, reviewing patients aged 14 and older with biopsy-proven AIN over an 11-year period. Two groups were formed based on whether or not they received GC treatment. Key outcomes included changes in delta creatinine (serum creatinine change from peak to 6-month follow-up) and the need for permanent kidney replacement therapy. Linear regression analyses assessed factors influencing delta creatinine at 6 months, adjusting for age, clinical severity, time to GC initiation, and histological findings. <b>Results:</b> Of 139 eligible patients, 101 received GC therapy. The GC-treated group showed a significantly greater reduction in delta creatinine compared to the nontreated group (-2.3 mg/dL; 95% CI, -3.6 to -1.1, <i>p</i> < 0.001). Multivariate analysis identified GC therapy as an independent predictor of improved kidney function (delta creatinine reduction: -1.47 mg/dL; 95% CI, -2.68 to -0.27, <i>p</i>=0.017), particularly when initiated within 7 days of diagnosis. The GC-treated group also had a lower incidence of permanent dialysis dependence (54% at admission vs. 11% at 6 months). Adverse events occurred in 20.1% of the cohort, with a higher frequency in the GC group (<i>p</i>=0.076). <b>Conclusion:</b> GC therapy may improve kidney outcomes in patients with biopsy-proven AIN, especially when initiated early. These results support the need for prospective studies to further evaluate its efficacy in AIN management.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"9980649"},"PeriodicalIF":1.7,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of Association Between Intraoperative Hypotension and Postoperative Acute Kidney Injury in Patients Undergoing Pancreaticoduodenectomy: A Retrospective Cohort Study.","authors":"Yue Gu, Wenwen Zhang, Jing Zhou, Xiaoge Niu, Yanliang Wang, Limeng Wang, Lei Yan, Yang Xu, Fengmin Shao","doi":"10.1155/ijne/5568151","DOIUrl":"https://doi.org/10.1155/ijne/5568151","url":null,"abstract":"<p><p><b>Background:</b> Acute kidney injury (AKI) is a common postoperative event. Previous research suggests that intraoperative hypotension (IOH) is associated with postoperative AKI. This connection, however, has not been studied in patients undergoing pancreaticoduodenectomy. <b>Methods:</b> Based on a retrospective cohort study, we analyzed 844 adult patients who had pancreaticoduodenectomy between December 2016 and June 2020 in Henan Provincial People's Hospital. We graphically modeled the associations between the lowest intraoperative systolic and diastolic pressure and AKI using a restricted cubic spline with all covariates adjusted. The association between time under the above-specified systolic blood pressure (SPB) and diastolic blood pressure (DBP) thresholds and AKI, respectively, was investigated using logistic regression models. We further tested the robustness of our findings with a sensitivity analysis. <b>Results:</b> AKI occurred in 98 (11.6%) of the 844 patients in this cohort. Blood pressure components below the thresholds of 100 mmHg for systolic and 60 mmHg for diastolic were visual change points associated with increasing odds of AKI. The median (IQR) time under SBP < 100 mmHg was 15.0 (0, 40) min and 65.0 (18.8, 105.4) min for DBP < 60 mmHg. Time spent under the threshold of SBP less than 100 mmHg and DBP less than 60 mmHg was not significantly associated with AKI. <b>Conclusions:</b> We found no relationship between IOH and postoperative AKI after pancreaticoduodenectomy. More research is needed to investigate the complex aspects influencing intraoperative blood management in order to lessen the occurrence of AKI.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"5568151"},"PeriodicalIF":1.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterisation of IgA Nephropathy in an Australian Cohort.","authors":"Shriram Swaminathan, Nithya Neelakantan, Henry Bryant, Pimvara Rattanamastip, Gagandeep Sandhu, Bobby Chacko","doi":"10.1155/ijne/9976879","DOIUrl":"10.1155/ijne/9976879","url":null,"abstract":"<p><p><b>Aim:</b> This retrospective cohort study aims to evaluate the prognostic factors for progression of immunoglobulin A nephropathy (IgAN) to kidney failure (defined as the initiation of kidney replacement therapy or death) and all-cause mortality in an Australian population. <b>Methods:</b> We conducted a retrospective analysis of 363 individual patients with biopsy-proven IgAN over a 21-year period (2000-2020) in the Hunter Region of New South Wales. Demographic data, comorbidities, biopsy features and biochemical markers were collected for a minimum of 12 months following biopsy diagnosis. A multivariable analysis using Cox regression was performed to examine their association with renal progression. <b>Results:</b> A total of 104 patients met the inclusion criteria and were followed for a median of 72 months. The cohort had a mean age at presentation of 45 years, with a predominantly male population. Most patients presented with haematuria and non-nephrotic range proteinuria. We stratified patients into three risk categories: low risk, intermediate risk, and high risk. Twenty-eight patients (26.92%) developed kidney failure and 15 patients (14.4%) experienced a > 20 mL/min eGFR decline within the first 12 months. The multivariable analysis revealed the following key factors associated with kidney failure: additional renal pathology on biopsy (HR 3.90, 95% CI 1.63-9.29), proteinuria (HR 1.15, 95% CI 1.02-1.29) and moderate-severe interstitial fibrosis/tubular atrophy (T2) (HR 7.00, 95% CI 2.32-21.05). There were 17 deaths (16.3%) in the cohort, with a mean survival time of 167.8 months (95% CI 152.6-183.1). <b>Conclusion:</b> In contrast to earlier reports from Australia, our findings emphasise that the progression to kidney failure is not uncommon in IgAN. We identified several predictors of the renal progression that are consistent with the previous studies. This highlights the need for a change in clinical management, as IgAN should no longer be considered a benign condition.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"9976879"},"PeriodicalIF":1.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial Expansion of the Nephrogenic Zone in the Fetal Human Kidney During Advanced Pregnancy: A Microanatomical Look at a Little Noticed Process.","authors":"Will W Minuth","doi":"10.1155/ijne/7571982","DOIUrl":"10.1155/ijne/7571982","url":null,"abstract":"<p><p><b>Introduction:</b> The experiences with preterm and low birth weight babies indicate a special vulnerability of their kidneys, since different kinds of noxae can evoke the termination of nephron formation. This leads to oligonephropathy, which is associated with serious consequences for health in the later stages of life. While the clinical aspects have been intensely investigated, only few pathological data point to the initial traces left by the noxae. Up to this date, only the reduction in the width of the nephrogenic zone (NZ) and the lack of here occurring basophilic S-shaped bodies were reported. <b>Methods and Materials:</b> The relationship between the arising nephron and its structural neighbors changes throughout the developmental progress. Locally, this determines the vertical width of the NZ reflected by the radial expansion of both the parenchyma and the interstitium. Since information about the origin, the site, and the involved structures is not available, the related microanatomical features were recorded. <b>Results:</b> The data reveal that the renal vesicles, comma-shaped bodies, and S-shaped bodies are unequally distributed in the NZ. Due to their progressive sizes, it has an influence on the local vertical width of the NZ. This parameter is registered as the distance between the inner side of the renal capsule and the proximal pole of the respective stage of the nephron anlage. The vertical width can be further subdivided: the constant height of the district of progenitor cell recruitment and the variable height of the area of nephron shaping. Exclusively here, the radial expansion of the shaping nephron stages can be noticed. It starts at the section border between the head and the conus of the related collecting duct ampulla by positioning the primitive renal vesicle. While the respective proximal pole stays mounted next to the connecting tubule of a previously developed nephron, the distal pole sticks between the head and the conus at the CD ampulla for linking the future connecting tubule. This causes that henceforth the medial aspect of the extending renal vesicle, comma-shaped body, or S-shaped body stages radially expands in close proximity to the elongating conus of the CD ampulla. <b>Conclusion:</b> Between the arising nephron stages and the elongating conus of the CD ampulla, a linked radial expansion occurs. This new finding is essential to identify the extent of targeting of noxae that subsequently leads to a reduction in the width of the NZ.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"7571982"},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Calcimimetic R568 Reduces Vascular Smooth Muscle Cell Calcification in Vitro Via ERK 1/2 Phosphorylation.","authors":"Jonas Engeßer, Philipp Gregor Albert, Matthias Scheuch, Norina Loth, Sylvia Stracke","doi":"10.1155/ijne/2492846","DOIUrl":"10.1155/ijne/2492846","url":null,"abstract":"<p><p><b>Background:</b> Vascular calcification (VC) is a common complication of chronic kidney disease, ultimately leading to high morbidity and cardiovascular mortality. In this study, we investigated the effects of the calcimimetic R568 in an in vitro model of human vascular smooth muscle cell (VSMC) calcification. <b>Methods:</b> Human VSMCs were cultured under elevated calcium (2.4 mmol/L) and phosphate (2.7 mmol/L) concentrations. Calcification was analyzed using von Kossa staining and colorimetric calcium measurement. Intracellular signaling was examined via Western blot, and apoptosis was assessed by the TUNEL assay. <b>Results:</b> Treatment with R568 significantly reduced VC over the 9-day treatment period. R568 treatment led to increased phosphorylation of extracellular signal-regulated kinase (ERK 1/2) compared to the control group. Calcimimetic treatment was also associated with a reduction in apoptosis. Blocking ERK 1/2 phosphorylation completely abolished the inhibitory effects of R568 on VC. <b>Conclusion:</b> Our study provides new insights into the mechanism of action of calcimimetics during VC and highlights the importance of ERK 1/2 signaling in this process.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"2492846"},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Renal Replacement Therapy Versus Intermittent Hemodialysis for Renal Prognosis in Elderly Patients With Acute Kidney Injury.","authors":"Enhui Li, Linlin Zhang, Yikai He, Huipeng Ge, Rong Tang, Jinbiao Chen, Yong Zhong, Xiangning Yuan, Weiwei Zhang, Yizi Gong, Xiangcheng Xiao","doi":"10.1155/ijne/8899604","DOIUrl":"https://doi.org/10.1155/ijne/8899604","url":null,"abstract":"<p><p><b>Background:</b> Continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) represent two common modes of renal replacement therapy (RRT) for elderly patients with acute kidney injury (AKI), but their clinical effectiveness is debated. This study aimed to compare the impact of CRRT and IHD on renal prognosis in elderly patients with AKI by analyzing their clinical data. <b>Methods:</b> The retrospective study population included elderly patients admitted to Xiangya Hospital between 2018 and 2022, who required RRT for AKI. Patients were separated into two cohorts based on the original RRT modes (CRRT or IHD). In our study, the primary outcome was recovery of renal function at discharge and the secondary outcome was RRT dependency rate at 90 days. A multivariate logistic regression model was constructed for the purpose of comparing the impact of CRRT and IHD on renal prognosis. <b>Results:</b> The mortality rate at the time of patient discharge was significantly elevated in the CRRT cohort relative to the IHD cohort (49.6% vs. 2.1%, <i>p</i> < 0.001). However, for the 155 patients who survived at discharge, the analysis revealed no statistically significant discrepancy in renal recovery across the two groups (40.3% vs. 59.7%, <i>p</i> = 0.694). Multivariate logistic regression analysis showed no statistically meaningful distinction among the CRRT and IHD groups concerning renal function recovery at discharge. Nevertheless, in comparison with IHD, CRRT reduced the risk of RRT dependence at 90 days. <b>Conclusions:</b> Our study indicated that CRRT and IHD have comparable effects on renal recovery at discharge in elderly patients with AKI who require RRT. However, in comparison with IHD, CRRT was linked to a diminished likelihood of requiring RRT at 90 days.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"8899604"},"PeriodicalIF":1.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Utility of the MEST-C Score Combined With Clinical Parameters in Hispanic Patients With IgA Nephropathy.","authors":"Lyzinhawer Alza-Arcila, Esteban Echeverri-Fernández, Mauricio Restrepo-Escobar, Ligia Lorena Calderón, José Manuel Ustáriz, Luis Fernando Arias-Restrepo, Joaquín Roberto Rodelo-Ceballos","doi":"10.1155/ijne/6974280","DOIUrl":"https://doi.org/10.1155/ijne/6974280","url":null,"abstract":"<p><p><b>Introduction:</b> The Oxford/MEST-C classification is a histopathological scoring system for patients with IgA nephropathy (IgAN) that has demonstrated prognostic utility. The aim of this study was to evaluate the prognostic utility of the combination of clinical characteristics and MEST-C in Hispanic ethnicity patients. <b>Methods:</b> Retrospective cohort study. Clinical, laboratory, and kidney biopsy information with MEST-C classification was obtained. The primary outcome was the development of end-stage kidney disease (ESKD). Cox regression analysis was performed for factors associated with ESKD, and Kaplan-Meier survival analysis for kidney survival. <b>Results:</b> A total of 397 patients were included, 51% were male, median age was 38 years with an interquartile range (IQR) of 28-53. The main comorbidity was hypertension present in 60.5%. At the time of biopsy, estimated glomerular filtration rate (eGFR) was 54 mL/min (IQR 33-94) and 24 h proteinuria was 1680 mg (IQR 594-3500). 30.7% of patients developed ESKD over a median follow-up of 1702 days (IQR 808-2858). Multivariate analysis of M, E, S, T, and C lesions showed that only S and T lesions correlated with the development of ESKD. The combination of S and T items of the MEST-C score with variables such as age, eGFR, proteinuria, and hypertension were significantly associated with the outcome. Explored prognostic models showed a high Harrel's C concordance index of 0.89. <b>Conclusion:</b> Performing the MEST score, especially the presence of sclerosing (S) and tubular fibrosis/atrophy (T) lesions combined with clinical variables are prognostic variables in the Hispanic population.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"6974280"},"PeriodicalIF":1.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Obstructive Sleep Apnea Among Lebanese Patients With Chronic Kidney Disease: Its Repercussion on Disease Trajectory and Its Effect on Patients' Quality of Life.","authors":"Salim Yakdan, Nazih Rahhal, Soltan Al Chaar, Juliano Alhaddad, Monifa Al Akoum, Yaacoub Chahine, Robert Najem, Mirna N Chahine","doi":"10.1155/ijne/1427467","DOIUrl":"10.1155/ijne/1427467","url":null,"abstract":"<p><p><b>Background and Objectives:</b> Chronic kidney disease (CKD) remains a public health threat and a major cause of morbidity and mortality worldwide. A bidirectional relationship is found between sleep disorders and CKD worldwide. However, to our knowledge, this study is the first to assess the prevalence of obstructive sleep apnea (OSA) and to evaluate its impact on the progression of other comorbidities among Lebanese patients with CKD. <b>Materials and Methods:</b> The study is an observational cross-sectional study, carried out between September and November 2021. Lebanese patients with any stage of CKD were included. Patients' characteristics were collected via electronic health record and baseline questionnaires. We screened for obstructive sleep apnea using the STOP-Bang questionnaire. <b>Results:</b> We included 168 patients. The prevalence of OSA among our patients was 47.6%. The prevalence of OSA is higher in males compared with females (81.2% vs. 18.8%, <i>p</i>=0.002). Obesity was more prevalent in patients with OSA compared with patients without OSA (42.5% vs. 19.3%, <i>p</i>=0.002). Among the 168 patients, 69.6% had hypertension, with a significantly higher prevalence among those with OSA compared with those without OSA (81.2% vs. 59.1%, <i>p</i>=0.003). Patients with OSA reported significantly lower scores compared with those without OSA in several domains of physical and emotional health, including physical functioning (54.06 vs. 66.88, <i>p</i>=0.002), role limitations due to physical health (42.19 vs. 63.07, <i>p</i>=0.001), role limitations due to emotional problems (49.17 vs. 69.32, <i>p</i>=0.004), pain (61.31 vs. 70.45, <i>p</i>=0.019), and physical component score (52.53 vs. 69.53, <i>p</i>=0.002). All the abovementioned parameters were also examined in two subpopulations: patients with CKD and ESRD. Similarly, some comorbidities and a lower physical QOL score were observed more in patients with OSA in these two subpopulations. <b>Conclusion:</b> Patients with OSA in our study have higher probability of being male, obese, and hypertensive as well as poorer QOL compared with their counterparts without OSA. Implementing more effective screening and treatment of OSA in CKD patients is necessary.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"1427467"},"PeriodicalIF":1.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Constraints in Scientific Manuscript Preparation Among Nephrologists: Insights From India.","authors":"Mythri Shankar, Anaghashree Udayashankar, Sowrabha Rajanna, Urmila Anandh, Arpita Ray Chaudhury","doi":"10.1155/ijne/9008616","DOIUrl":"10.1155/ijne/9008616","url":null,"abstract":"<p><p><b>Introduction:</b> Medical research shapes public health actions, emphasising the need for greater investments in health. Despite a surge in scientific publications, disparities exist in authorship from low-income countries and among female researchers. Addressing these gaps is vital for studying real-world health outcomes and promoting universal healthcare delivery. <b>Methods:</b> A descriptive quantitative study using an online questionnaire to gather data from Indian nephrologists and nephrology fellows was conducted by members of Women in Nephrology, India, from September 2023 to December 2023. The survey collected data on demographics, publication experience and challenges in scientific paper writing. Statistical analyses were performed using SPSS Version 25.0, with significance at <i>p</i> < 0.05. <b>Results:</b> The survey included 156 participants, with a mean age of 35.55 ± 8.91 years. The majority were males (55.8%) and practicing nephrologists (69.9%). Most respondents practiced in medical institutions (45.5%) and metropolitan cities (60.3%), with an average practice duration of 12.29 ± 9.12 years. Only 44.9% published their thesis work, and 52.6% preferred writing case reports. Key challenges included time constraints (82.1%), funding (67.9%), limited access to research articles (65.4%), lack of statistical analysis knowledge (64.7%) and limited access to research software (60.2%). Younger nephrologists faced more funding (68.9%) and knowledge-related barriers (74.4%). <b>Discussion:</b> Multiple challenges exist in scientific paper writing among Indian nephrologists, emphasising the need for targeted interventions. Funding for research, burnout and article processing charges are significant barriers. Addressing these challenges is crucial for enhancing research output and improving healthcare outcomes in resource-limited countries.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"9008616"},"PeriodicalIF":1.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dialysis in the Elderly: A Practical Guide for the Clinician.","authors":"Aparna Satish, Jhalak Agrohi, Dharshan Rangaswamy, Ravindra Attur Prabhu, Shankar Prasad Nagaraju, Indu Ramachandra Rao, Mohan V Bhojaraja, Srinivas Vinayak Shenoy","doi":"10.1155/ijne/9538115","DOIUrl":"10.1155/ijne/9538115","url":null,"abstract":"<p><p>The increasing prevalence of elderly patients with end-stage kidney disease (ESKD) poses unique challenges in nephrology. These patients often present with multiple comorbidities, cognitive impairments, and frailty, which significantly impact treatment options and outcomes. Conservative kidney management (CKM) offers a viable alternative to dialysis for many elderly patients by focusing on symptom management and enhancing quality of life rather than merely prolonging life. However, clinicians face difficulties in approaching patients and deciding between CKM and dialysis. In addition, advocating for dialysis involves challenges in selecting the appropriate modality and vascular access. Nutritional management, often overlooked, is critical due to the high prevalence of protein-energy wasting and sarcopenia among elderly dialysis patients. Similar to the initiation of dialysis, there are dilemmas in determining when to withdraw from dialysis. This practical review aims to guide clinicians through the complex and challenging process of managing dialysis in the elderly, emphasizing a holistic, patient-centered approach that prioritizes quality of life. A multidisciplinary strategy, integrating clinical expertise and patient autonomy, is essential to address the complex needs of this vulnerable population.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2025 ","pages":"9538115"},"PeriodicalIF":1.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}