International Journal of Nephrology and Renovascular Disease最新文献

{"title":"Preoperative Doppler Ultrasound Parameters as Predictors of Arteriovenous Fistula Maturation in End-Stage Renal Disease: A Prospective Cohort Study.","authors":"Somayeh Haji Ahmadi, Shokouh Sadeghi Zadeh, Morteza Shahbandari, Mohammadreza Elhaie","doi":"10.2147/IJNRD.S604523","DOIUrl":"https://doi.org/10.2147/IJNRD.S604523","url":null,"abstract":"<p><strong>Background: </strong>Preoperative Doppler ultrasound (DUS) is routinely used to map upper-limb vessels before arteriovenous fistula (AVF) creation, yet the predictive value of individual morphologic and hemodynamic parameters remains inconsistent. This study evaluated whether preoperative vessel diameters and flow velocities predict functional AVF maturation in end-stage renal disease (ESRD).</p><p><strong>Methods: </strong>In a prospective cohort (January 2023-June 2025), adults with ESRD undergoing first-time upper-limb AVF creation received standardized DUS within 2 weeks preoperatively. Arterial and venous internal diameters and peak systolic velocities were measured at planned access sites; measurements were obtained in triplicate and averaged. Functional maturation was defined as sustained two-needle cannulation for hemodialysis at ≥300 mL/min for ≥3 consecutive sessions within 6 months, without endovascular or surgical intervention.</p><p><strong>Results: </strong>Ninety patients were enrolled; one patient was lost to follow-up before the primary outcome assessment, leaving 89 patients for analysis. Radiocephalic (Type 1) AVFs accounted for 32/90 (35.6%) and brachiocephalic (Type 2) AVFs for 58/90 (64.4%). Overall, 66/89 (74.2%) fistulas matured and 23/89 (25.8%) failed (12 early, 11 late). Maturation was not associated with fistula type, diabetes, or hypertension. Our study suggests that Larger distal radial artery diameter was paradoxically associated with failure (2.27±0.54 mm vs 1.98±0.52 mm; p=0.037) and remained significant after multivariable adjustment (coefficient=-1.892; p=0.006). No other assessed arterial or venous diameter or peak systolic velocity predicted outcome.</p><p><strong>Conclusion: </strong>Most preoperative DUS measurements did not predict AVF maturation; however, larger distal radial artery diameter paradoxically correlated with failure. Larger multicenter studies incorporating arterial wall pathology, venous outflow resistance, and detailed hemodynamics are warranted to refine preoperative decision-making. Arterial quality may be as important as size alone.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"604523"},"PeriodicalIF":2.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837743","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":"Trauma Preconditioning of Cytokine Response: Comparison of Perioperative Cytokine Profiles in Elective Cardiac versus Orthopaedic Trauma Surgery Patients.","authors":"William T McBride, Allister Irvine, Mary Jo Kurth, Joanne Watt, Gavin W McLean, John V Lamont, Peter Fitzgerald, Mark W Ruddock","doi":"10.2147/IJNRD.S580859","DOIUrl":"https://doi.org/10.2147/IJNRD.S580859","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a sudden decline in kidney function that poses a significant risk to patients undergoing surgery. Those who develop AKI face higher morbidity and mortality rates, extended hospital stays, and an increased risk of progressing to chronic kidney disease. Previously, we recruited two distinct patient cohorts, one undergoing elective cardiac surgery and one undergoing orthopaedic fracture surgery, to investigate biomarkers involved in the pathophysiology of AKI. This study is a retrospective analysis of data from the two surgical cohorts to examine if there are any similarities between cytokine responses.</p><p><strong>Methods: </strong>Pre- and post-operative blood and urine biomarker data from elective cardiac surgery patients (n=401) and orthopaedic fracture surgery patients (n=237) were analysed to compare baseline, ratio, and delta change differences.</p><p><strong>Results: </strong>Pre-operatively, baseline levels of most biomarkers were significantly higher in orthopaedic fracture patients compared to elective cardiac surgery patients. Post-operatively, most biomarker levels remained significantly higher in orthopaedic fracture surgery patients with the exception of urinary anti-inflammatory biomarkers which were higher in cardiac patients. Pre-operatively, renally favourable biomarker ratios were significantly higher in orthopaedic fracture surgery patients compared to elective cardiac surgery patients. In contrast, post-operatively, renally favourable biomarker ratios were significantly higher in elective cardiac surgery patients. The delta differences between pre- and post-operative biomarker levels were generally higher in the elective cardiac surgery patients compared with orthopaedic fracture surgery patients.</p><p><strong>Discussion: </strong>In this study, in patients which have experienced a fracture, the trauma of the initial injury activated their pro- and anti-inflammatory cytokine responses such that renally favourable ratios prevailed pre-operatively. The further pro-inflammatory response from fracture repair (during surgery) was compensated for by an already established anti-inflammatory perioperative response, suggesting that post-operative compensatory anti-inflammatory responses do not need to be of the same magnitude compared to a non-preconditioned (eg, elective cardiac) response. Cytokine profiling perioperatively could inform clinical decision making and improve patient outcomes by reducing the likelihood of an AKI event.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"580859"},"PeriodicalIF":2.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770859","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":"Effectiveness and Safety of Telmisartan Plus Amlodipine Compared to Telmisartan Plus Cilnidipine in Indian Patients with Hypertension and Renal Impairment: A Randomized, Open Label, Post Marketing Study (START Renal).","authors":"Uday Jadhav, Santanu Guha, Harsh Mittal, Chinmoy Barik, Chandrashekhar S Gillurkar, Sandeep Kumar Gupta, Mukulesh Gupta, Santosh Saklecha, Mayur Jadhav, Sanjay Y Choudhari, Saiprasad Patil, Sumit Bhushan, Divakar A, Hanmant Barkate","doi":"10.2147/IJNRD.S555573","DOIUrl":"https://doi.org/10.2147/IJNRD.S555573","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the effectiveness and safety of telmisartan-amlodipine (TA) versus telmisartan-cilnidipine (TC) fixed-dose combinations (FDCs) in patients with hypertension and renal impairment.</p><p><strong>Patients and methods: </strong>This open label, randomized, multicentric, post-marketing study was conducted in India. Adult patients with hypertension and renal impairment, receiving a stable dose of telmisartan and not on calcium channel blockers, were enrolled. Participants were randomized (1:1) to receive the TA or TC FDC for 12 months. The primary endpoint was change in the urine albumin-creatinine ratio (UACR) from baseline to 12 months. Secondary endpoints included changes in estimated glomerular filtration rate (eGFR), serum creatinine, and serum uric acid at 6 and 12 months, and office systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 3, 6, 9, and 12 months. Similar parameters were assessed in the diabetic subpopulation. Adverse events were recorded and classified using system organ classification.</p><p><strong>Results: </strong>At 12 months, the TA and TC groups showed significant reductions in UACR by 119±157.7 mg/g and 97.5±128.6 mg/g, respectively (p<0.0001 for both). Improvements in eGFR and serum creatinine were comparable between groups (p>0.05). SBP reduction was significantly greater with TA at both 9 months (20.74±12.75 vs. 16.9±13.66) mmHg, (p=0.0430)] and 12 months (25.4±14.25 vs. 20.6±10.94) mmHg, (p=0.0397)], while DBP reductions were similar. The diabetic subgroup showed a superior SBP reduction favoring the TA group -24.5 (±13.75) mmHg (p≤.0001) Vs -18.9 (±10.68) mmHg (p≤.0001) while the renal parameters were similar between the two groups. A total of 17 mild drug-related adverse events were reported (TA: 8; TC: 9), with no serious events.</p><p><strong>Conclusion: </strong>Both the TA and TC FDCs were effective and well tolerated when treating hypertension with renal impairment. The TA FDC may provide better BP reduction with similar reno-protective benefits than the TC FDC.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"555573"},"PeriodicalIF":2.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770933","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 Association of Pre-Transplant Mixed Lymphocyte Reaction (MLR) with the Function of the Kidney Allograft and Antibody Response.","authors":"Farahnoosh Farnood, Alireza Mardomi, Yalda Rahbar Saadat, Amir Vahedi, Kowsar Fathalizadeh, Mohammadreza Ardalan, Sepideh Zununi Vahed","doi":"10.2147/IJNRD.S580439","DOIUrl":"https://doi.org/10.2147/IJNRD.S580439","url":null,"abstract":"<p><strong>Aim: </strong>The mixed lymphocyte reaction (MLR) is a critical assay for evaluating immunological compatibility between donors and recipients prior to transplantation.</p><p><strong>Purpose: </strong>This prospective study aimed to evaluate the association of the renal allograft function with outcomes of the pre-transplant carboxyfluorescein diacetate succinimidyl ester (CFSE)-MLR assay and the levels of donor-specific antibodies (DSAs).</p><p><strong>Patients and methods: </strong>The study included 14 live donors and non-sensitized recipient pairs. Peripheral blood samples were collected from donor and recipient pairs, and then peripheral blood mononuclear cells (PBMCs) were isolated. Donor cells were treated with Mitomycin-C as inactivated stimulators, and recipient PBMCs were labeled with CFSE as responder cells for flow cytometric analysis of the responder cell proliferation. Post-transplant renal function was monitored by serial measurements of serum creatinine levels, which were then correlated with MLR proliferation rates. Additionally, the relationship between pre-transplant MLR proliferation and DSA titers was examined. Correlative analyses were also performed between MLR outcomes and DSA levels, as well as the panel reactive antibody (PRA) outcomes.</p><p><strong>Results: </strong>Significant increases in the percentage of proliferating responder cells were observed at days 3 and 5 relative to baseline (day 0). A positive correlation was identified between day 5 proliferation rates and PRA Class II levels. Pre-transplant cellular proliferation did not significantly correlate with serum DSA titers measured at six months post-transplant. Conversely, a statistically significant positive correlation was detected between day 5 MLR proliferation and serum creatinine levels at six months post-transplantation.</p><p><strong>Conclusion: </strong>The CFSE-MLR assay represents a reliable association with post-transplant immunological status and allograft function. Nevertheless, further evidence-based research with larger cohorts is warranted to validate these findings and strengthen their clinical applicability.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"580439"},"PeriodicalIF":2.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673396","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":"Malaria-Associated Acute Kidney Injury: A Key Driver of Mortality in Endemic Regions.","authors":"Gerald Olwit, Timothy Bakka Gutanamuka, Hans Chinomso Chris-Uchendu, Aime Ishimwe Mugisha","doi":"10.2147/IJNRD.S600266","DOIUrl":"https://doi.org/10.2147/IJNRD.S600266","url":null,"abstract":"<p><strong>Background: </strong>Malaria remains a major global health challenge, particularly in endemic regions where severe disease contributes substantially to morbidity and mortality. Among its systemic complications, malaria-associated acute kidney injury (MAKI) is increasingly recognized as a significant yet underappreciated contributor to poor clinical outcomes. Despite advances in antimalarial therapy, MAKI continues to be associated with high mortality and growing evidence suggests a link to long-term renal sequelae, including chronic kidney disease (CKD). This review synthesizes current evidence on the epidemiology, pathophysiology, clinical presentation, diagnosis, management, and long-term outcomes of MAKI.</p><p><strong>Methods: </strong>A focused PubMed/MEDLINE search (2015-2025) was conducted to identify relevant studies across different age groups and Plasmodium species. Emphasis was placed on epidemiology, mechanisms of kidney injury, clinical features, management strategies, and renal outcomes. Studies were selected based on relevance to the review objectives.</p><p><strong>Results: </strong>MAKI is a serious complication of severe malaria, resulting from a multifactorial process involving intravascular hemolysis, microvascular obstruction, inflammation, endothelial dysfunction, and volume depletion. Plasmodium falciparum remains the most commonly implicated species, although Plasmodium vivax and Plasmodium knowlesi are increasingly recognized causes. Clinically, MAKI is associated with prolonged hospitalization, increased need for renal replacement therapy, and higher mortality. Emerging evidence also indicates that survivors are at risk of incomplete renal recovery and progression to CKD.</p><p><strong>Conclusion: </strong>MAKI is a critical driver of both acute mortality and long-term kidney disease in malaria. Early recognition, prompt management, and post-recovery renal monitoring are essential to improve outcomes. Greater awareness and further research are needed to define preventive strategies and long-term renal implications, particularly in resource-limited endemic regions.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"600266"},"PeriodicalIF":2.5,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13049373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622886","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":"Discharge-Based Recovery After Dialysis-Requiring Acute Kidney Injury: A National U.S. Analysis of Sociodemographic and Hospital Factors.","authors":"Brent Tai, Thomson Tai","doi":"10.2147/IJNRD.S593458","DOIUrl":"https://doi.org/10.2147/IJNRD.S593458","url":null,"abstract":"<p><strong>Background: </strong>Dialysis-requiring acute kidney injury (AKI-D) represents the most severe form of AKI and is associated with substantial morbidity. As survival after AKI-D improves, recovery following hospitalization has emerged as a critical but understudied phase of care. Whether recovery trajectories differ across sociodemographic groups and hospital contexts remains poorly understood. Dialysis-requiring AKI affects approximately 2-3% of hospitalized adults nationally and carries high post-acute morbidity, underscoring the importance of understanding recovery trajectories beyond survival.</p><p><strong>Methods: </strong>We conducted a retrospective, nationally representative study using the 2022 Healthcare Cost and Utilization Project National Inpatient Sample. Adult hospitalizations complicated by AKI-D among patients without pre-existing end-stage kidney disease who survived to discharge were included. The primary outcome was dialysis dependence or non-recovery at discharge, operationalized using discharge disposition as a pragmatic surrogate for post-acute recovery following receipt of acute dialysis. Survey-weighted logistic regression models adjusted for demographics, illness severity, and hospital characteristics were used to estimate adjusted odds ratios. Marginal standardization was applied to derive adjusted probabilities and absolute risk differences. Effect modification by hospital context was examined.</p><p><strong>Results: </strong>Among survivors of dialysis-requiring AKI, approximately 40% were discharged to non-home settings, indicating a substantial burden of incomplete recovery at hospital discharge. After adjustment, adults aged ≥85 years had more than two-fold higher odds of non-recovery compared with those aged 50-64 years (adjusted OR 2.19), while self-pay patients had substantially lower odds compared with Medicare beneficiaries (adjusted OR 0.45). Patients with Medicaid or no-charge encounters-and several racial and ethnic minority groups-also exhibited lower adjusted probabilities of non-recovery. Hospital characteristics modified these associations, with payer-related differences in non-recovery varying by teaching status, bed size, and geographic region. Certain hospital settings exhibited both higher overall non-recovery burden and larger disparities. Sensitivity analyses using alternative outcome definitions and excluding patients with chronic kidney disease yielded consistent findings.</p><p><strong>Conclusion: </strong>Incomplete recovery at hospital discharge is common among survivors of dialysis-requiring AKI and is shaped by both patient-level vulnerability and hospital context. Institutional environments appear to modify recovery disparities, highlighting hospitals as potential leverage points for improving equitable post-AKI outcomes. Efforts to enhance recovery after AKI-D should extend beyond the acute hospitalization to address post-discharge transitions and system-level factors.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"593458"},"PeriodicalIF":2.5,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622880","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":"Current Insights and Future Directions on the Role of GLP-1 Receptor Agonists in Chronic Kidney Disease.","authors":"Kavya Rajan, Arjun Krishen Jutley, Michael W Holliday, Sankar D Navaneethan","doi":"10.2147/IJNRD.S522424","DOIUrl":"10.2147/IJNRD.S522424","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) incidence continues to rise along with obesity and diabetes, driving substantial medical, psychosocial, and economic burdens for patients. Beyond glycemic control and the recommended therapies of ACEI/ARB, SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a cornerstone therapy to benefit mortality, heart and kidney outcomes. The following review will discuss recent advances to our understanding of the kidney benefits of GLP1 agonism in high-risk populations, including patients with type 2 diabetes mellitus, obesity, those with established cardiovascular disease. Renal signals from cardiovascular outcomes trials disclosed less albuminuria and slower estimated glomerular filtration rate (eGFR) decline with GLP1RA therapy, often additive to sodium-glucose cotransporter-2 inhibition. Dedicated kidney studies now show semaglutide slows CKD progression and lowers mortality in diabetics with CKD, underscoring the relevance of new guidelines that recommend GLP1RA therapy for specific populations. Future priorities should include trials of GLP-1RA in non-diabetic patients with CKD, as well as further evaluation of dual or triple agonists (GLP-1/GIP/glucagon) and clarification of oral GLP1RA efficacy. Overall, GLP-1-based therapies represent a transformative strategy to improve weight, cardiovascular health, and kidney outcomes in diabetic CKD patients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"522424"},"PeriodicalIF":2.5,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147573978","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 Impact of Pharmaceutical Care on Infection Control Measures Among Hemodialysis Patients. A Randomized Interventional Study.","authors":"Raghad Saad Hussien, Kawa Ahmad Obeid","doi":"10.2147/IJNRD.S585790","DOIUrl":"10.2147/IJNRD.S585790","url":null,"abstract":"<p><strong>Purpose: </strong>This study seeks to highlight the impact of clinical pharmacists in protecting hemodialysis patients from catheter-related infections. By ensuring appropriate antimicrobial use, guiding patients on prevention practices, and collaborating with the healthcare team. This study also examines how pharmacists improve safety, treatment adherence, and quality of life.</p><p><strong>Patients and methods: </strong>This randomized interventional study was conducted between November 2024-April 2025. Patients were divided into intervention and non-intervention groups. The care bundle comprised culture-guided antibiotic locks (except gentamicin-heparin), in-hospital exit-site dressing with 3M Tegaderm by trained staff, and safety medication checks (e.g, blood-pressure monitoring before the use of erythropoiesis-stimulating agents) were used. The primary endpoint was the incidence of catheter-related bloodstream infections (CRBSIs); secondary endpoints were length of stay, admissions, ICU admissions, catheter replacements, and death. Monthly averages of vitals, drug therapy problems (DTPs), and laboratory parameters were obtained for both groups.</p><p><strong>Results: </strong>A total of ninety patients included in this study. The patients were randomly assigned to either the intervention or non-intervention group and a total 81 out of 90 patients successfully completed the study. After four visits and six months of implementing infection control measures within the context of pharmaceutical care, the infection rate showed a significant reduction in the intervention group (from 0.64±0.48 to 0.20±0.4, p =0.0001) compared with the non-intervention group (0.66±0.48 to 0.71±0.45, p =0.9731). The mean differences increased over time, reaching 0.26 (95% CI of diff.= 0.09 to 0.43) at visit 1, 0.41 (95% CI of diff.= 0.24 to 0.58) at visit 3, and 0.51 (95% CI of diff.= 0.34 to 0.68) at visit 4.</p><p><strong>Conclusion: </strong>Clinical pharmacist intervention via implementing infection control within the context of a pharmaceutical-care process can improve infection rates among hemodialysis patients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"585790"},"PeriodicalIF":2.5,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147498989","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":"Effects of Chronic Intermittent Hypoxia and Subsequent Normoxic Recovery on Renal Senescence and the PI3K/Akt/P21 Pathway in Rats.","authors":"HaiBo Li, MingZhi Chen, Fang Han, HaoNan Zhang, MeiNa Jin, Wei Bai, ChuXuan Jia, Ying Han, Cuiying Wei","doi":"10.2147/IJNRD.S575874","DOIUrl":"https://doi.org/10.2147/IJNRD.S575874","url":null,"abstract":"<p><strong>Background: </strong>CIH, the hallmark of OSA, is a recognized driver of multi-organ injury. While its contribution to renal dysfunction is acknowledged, the specific roles of key senescence-regulating pathways-particularly the PI3K/Akt/p21 axis and the anti-aging protein Klotho-in CIH-induced renal senescence remain largely unexplored.</p><p><strong>Purpose: </strong>This study aimed to investigate the effects of CIH and subsequent normoxic reoxygenation on renal senescence in rats, and to elucidate the dynamic involvement of the PI3K/Akt/p21 pathway and the anti-aging protein Klotho in this process.</p><p><strong>Methods: </strong>Forty 5-week-old male Sprague-Dawley rats were randomly assigned to NC and CIH groups. The CIH group was exposed to IH (range 6.5-7.5%, 30 cycles/h, 8 h/day) for 8 weeks, followed by a 4-week normoxic recovery period. Renal function (SCr, BUN,CysC), histopathology (cortex-to-medulla ratio, tubular epithelial density), and the expression of senescence-related molecules (p21, Klotho, PI3K/AKT pathway components) were assessed at weeks 0, 8, and 12. Statistical significance was determined by two-way ANOVA with Tukey's post hoc test.</p><p><strong>Results: </strong>Following 8 weeks of CIH exposure, rats exhibited significant renal dysfunction, with SCr increased by 21.3%, BUN by 24.0%, and CysC by 27.9% compared to controls (all P<0.05), alongside histopathological alterations including cortical atrophy, medullary expansion, and reduced tubular epithelial density (P<0.05).These changes were associated with upregulation of p21 and downregulation of PI3K/AKT signaling and Klotho (P<0.05). After 4 weeks of normoxic recovery, renal function and PI3K/Akt/p21 signaling were largely restored (P>0.05 vs NC). However, cortical-medullary structural imbalance and suppressed Klotho expression persisted (P<0.05). Statistical significance was determined by two-way ANOVA with Tukey's post hoc test).</p><p><strong>Conclusion: </strong>CIH induces a partially reversible renal senescence phenotype in rats, which is associated with dynamic modulation of the PI3K/Akt/p21 axis. The persistent suppression of Klotho may underlie irreversible structural injury, providing novel mechanistic insights into OSA-associated kidney disease.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"575874"},"PeriodicalIF":2.5,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473749","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 and Factors Associated with Albuminuria Screening Among High-Risk Adults in Saudi Arabia: A Retrospective Cross-Sectional Study.","authors":"Mohamed A Albekery, Mohammed Alnuhait, Ibrahim S Alhomoud, Khalid Alhussain, Munirah K Alkulaib, Gharam M Alanazi, Zainab F Alshaikh, Fatimah S Alibrahim, Kawthar Y Alburayman, Ghadeer H Alhajji, Bassem A Almalki, Ibrahim F Aldossary, Lulwah Al Turki, Abdulaziz Almulhim","doi":"10.2147/IJNRD.S580140","DOIUrl":"https://doi.org/10.2147/IJNRD.S580140","url":null,"abstract":"<p><strong>Background: </strong>Albuminuria is a key marker for the early detection of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Despite guideline recommendations for albuminuria testing in these high-risk populations, adherence remains suboptimal.</p><p><strong>Methods: </strong>A retrospective study was conducted at a tertiary center in Al-Ahsa, Saudi Arabia. Data were collected from the records of 516 adults with diabetes mellitus, hypertension, or both. Patients with CKD were excluded. The primary outcome was the rate of albumin-to-creatinine ratio (ACR) testing.</p><p><strong>Results: </strong>Among 516 patients (mean age 63.7 ± 7.6 years), the overall prevalence of ACR testing was 59.1%. Testing was highest in the diabetes-only subgroup (69.5%), followed by the diabetes with hypertension subgroup (66.3%), and lowest in the hypertension-only subgroup (19.3%) (p<0.001). Testing was more likely in patients with high HbA1c, more outpatient visits, and among individuals using angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. After adjustment, hypertension-only patients were less likely to be tested (adjusted odds ratio [AOR] = 0.14; 95% CI: 0.07-0.31), whereas the use of ARBs (AOR = 3.17; 95% CI: 1.69-5.93) and SGLT2 inhibitors (AOR = 3.00; 95% CI: 1.31-6.90) was independently associated with increased testing. Of those tested, 40% had albuminuria (A2 or A3).</p><p><strong>Conclusion: </strong>Albuminuria testing is substantially underutilized among high-risk patients in Saudi Arabia. Individuals with hypertension only are the least likely to undergo screening. This suggests a gap between clinical practice and guideline recommendations. These findings highlight the need for strategies to improve early CKD detection, particularly in primary care.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"580140"},"PeriodicalIF":2.5,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432755","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}