International Journal of Nephrology and Renovascular Disease最新文献

{"title":"Mitochondrial Oxidative Stress and Vascular Remodeling in Uric Acid Nephropathy: Mechanistic Insights and Therapeutic Implications.","authors":"Jiahao Liang, Yanzhi Qiu, Tong Fu, Jianing Li, Fei Xiao, Guoli Xing, Hongbo Cai, Ying Tong","doi":"10.2147/IJNRD.S549209","DOIUrl":"10.2147/IJNRD.S549209","url":null,"abstract":"<p><p>Uric acid nephropathy (UAN), driven by sustained hyperuricemia, is an underrecognized but increasingly prevalent contributor to chronic kidney disease (CKD) progression. Mitochondrial oxidative stress and vascular remodeling are central to its pathogenesis. Excess mitochondrial reactive oxygen species (ROS) cause renal tubular injury, impair mitophagy, and activate pro-apoptotic signaling pathways. In parallel, ROS disrupt endothelial homeostasis, promote phenotypic switching of vascular smooth muscle cells, and induce pathological structural changes in the renal microvasculature. These processes are mutually reinforcing, thereby exacerbating inflammation, hypoxia, and fibrosis. This review synthesizes emerging mechanistic insights into the mitochondrial-vascular axis in UAN and discusses therapeutic strategies targeting mitochondrial dysfunction and vascular pathology. Particular emphasis is placed on mitochondria-targeted antioxidants and inhibitors of key signaling pathways as potential interventions to interrupt the ROS-remodeling cycle. We also highlight the need for biomarker development and clinical translation. A more comprehensive understanding of mitochondrial-vascular crosstalk may ultimately enable the development of effective strategies to slow or halt UAN progression.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"281-301"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232554","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":"Improvement in Unhealthy Behaviors Among Patients with Chronic Kidney Disease Receiving Integrated Care at Community Hospitals in Thailand.","authors":"Teerawat Thanachayanont, Methee Chanpitakkul, Salyaveth Lekagul, Kriang Tungsanga","doi":"10.2147/IJNRD.S546137","DOIUrl":"10.2147/IJNRD.S546137","url":null,"abstract":"<p><strong>Purpose: </strong>Unhealthy behaviors can accelerate the progression of chronic kidney disease (CKD). This study aimed to evaluate the effectiveness of a community-based integrated care program in modifying key unhealthy behaviors among CKD patients in rural Thailand and to assess the impact of these behaviors on the rate of kidney function decline.</p><p><strong>Patients and methods: </strong>This is a post-hoc analysis of the ESCORT-2 trial, which is a 3-year prospective cohort study that enrolled 914 patients with CKD stages 3-4 in rural Thailand. Participants received an integrated care program involving hospital-based multidisciplinary teams and home-based community care networks. Seven unhealthy behaviors were assessed annually: usage of herbal medicines, analgesics, and non-steroidal anti-inflammatory drugs (NSAIDs); being overweight; lack of regular exercise; moderate-to-high salt intake; and high protein intake. Data were collected through patient interviews and standardized questionnaires. Changes in the prevalence of these behaviors were analyzed over three years, and the association between persistent unhealthy behaviors and the rate of eGFR decline was examined.</p><p><strong>Results: </strong>Over the 3-year study period, the integrated care program led to significant and sustained reductions in the use of herbal medicines (23.3% to 5.0%), analgesics (34.9% to 7.8%), and NSAIDs (4.3% to 1.3%) (all p<0.0001). Moderate-to-high salt intake also significantly decreased (22.1% to 14.1%, p<0.0001). However, no significant improvement was observed in the prevalence of overweight or high protein intake. While individual persistent unhealthy behaviors did not significantly correlate with the rate of estimated glomerular filtration rate (eGFR) decline, patients with a baseline accumulation of three or more unhealthy behaviors exhibited a significantly faster eGFR decline compared to those with fewer unhealthy behaviors (-2.04 vs -1.02 mL/min/1.73 m², p<0.001).</p><p><strong>Conclusion: </strong>An integrated care model implemented in a primary care setting can effectively reduce medication- and dietary-related unhealthy behaviors in CKD patients. However, fostering sustained improvements in complex lifestyle behaviors such as weight control and regular exercise remains a significant challenge.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"269-279"},"PeriodicalIF":2.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029616","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":"Knowledge and Practice of Nurses on Prevention and Management of Intradialytic Hypotension at Kiruddu and Mulago National Referral Hospitals.","authors":"Shamia Nakabugo, Jacob Twinamatsiko, Loyce Kyarikunda, Philis Chelimo, Daphne Asaasira, Vallence Niyonzima","doi":"10.2147/IJNRD.S528836","DOIUrl":"10.2147/IJNRD.S528836","url":null,"abstract":"<p><strong>Background: </strong>Intradialytic hypotension (IDH) remains a significant and distressing complication of hemodialysis, often reducing the efficiency of the dialysis procedure and leading to adverse clinical outcomes. IDH is strongly associated with increased morbidity and mortality rates among hemodialysis patients. This study aimed to evaluate the impact of an educational intervention on nurses' knowledge and practices regarding the prevention and management of IDH at Kiruddu National Referral Hospital (KNRH) and Mulago National Referral Hospital (MNRH).</p><p><strong>Methodology: </strong>A quasi-experimental study was conducted in the dialysis units of KNRH and MNRH between May and July 2024, involving 25 dialysis nurses. Data were collected using semi-structured questionnaires to assess knowledge and an observation checklist to evaluate practices, both administered pre- and post-intervention.</p><p><strong>Results: </strong>The study recruited 25 nurses with a mean age of 33.1 years, including 13 males. The majority had 1-4 years of dialysis experience. The mean knowledge score significantly increased from 5.3 before the intervention to 13.1 after the intervention (p < 0.05). Similarly, the mean practice score improved from 12 to 20, with the difference also being statistically significant (p < 0.05).</p><p><strong>Conclusion: </strong>The baseline knowledge of nurses was generally low. The educational intervention significantly enhanced nurses' knowledge and practices in the prevention and management of IDH, highlighting the importance of continuous training to improve patient outcomes in hemodialysis care.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"255-268"},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000585","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":"Association Between Residual Kidney Function and Frailty in End-Stage Renal Disease Patients Undergoing Hemodialysis: A Cross-Sectional Study.","authors":"Piboon Showtanapanich, Chadawan Pathonsmith, Jiraporn Sri-On, Appasornsawan Jatutain, Tanun Ngamvichchukorn","doi":"10.2147/IJNRD.S532499","DOIUrl":"10.2147/IJNRD.S532499","url":null,"abstract":"<p><strong>Background: </strong>Residual kidney function (RKF) plays a crucial role in maintaining biochemical balance in hemodialysis patients. Frailty, commonly observed in end-stage renal disease (ESRD) patients, is associated with metabolic derangements, inflammation, and fluid overload. However, the relationship between RKF and frailty in this population remains unclear.</p><p><strong>Purpose: </strong>This study aimed to investigate the association between RKF and frailty in ESRD patients undergoing hemodialysis. Secondary objectives included assessing the prevalence of frailty and sarcopenia, and identifying clinical correlates.</p><p><strong>Patients and methods: </strong>A cross-sectional study was conducted involving 110 adult ESRD patients undergoing maintenance hemodialysis for ≥6 months at an urban teaching hospital in Bangkok, Thailand between October 2023 and February 2024. RKF was assessed by 24-hour urine volume, with <100 mL defined as absent RKF. Frailty was evaluated using the Thai version of the FRAIL scale, and sarcopenia was diagnosed based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Demographic, clinical, and laboratory data were analyzed using chi-squared tests, logistic regression, and multivariable models.</p><p><strong>Results: </strong>Among 110 participants, 78 (70.91%) had no RKF. Frailty prevalence was 13.64%, and sarcopenia prevalence was 65.45%. Frailty was associated with a history of cerebrovascular accident [adjusted odds ratio (OR) 10.303; P = 0.036] and lower total iron-binding capacity (TIBC) (adjusted OR 0.972; P = 0.047). Sarcopenia was linked to advanced age (adjusted OR 1.054; P = 0.020) and lower Kt/V values (adjusted OR 0.417; P = 0.002). RKF was not significantly associated with frailty.</p><p><strong>Conclusion: </strong>While RKF was not directly associated with frailty, this study highlights other significant factors, such as cerebrovascular accidents and low TIBC, contributing to frailty and advanced age associated with sarcopenia. These findings emphasize the need for comprehensive frailty screening and tailored interventions to improve outcomes in ESRD patients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"229-242"},"PeriodicalIF":2.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953964","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":"Insomnia Among Patients with End-Stage Kidney Disease on Hemodialysis: Prevalence and Associated Factors - A Cross-Sectional Study in Vietnam.","authors":"Nhu Minh Hang Tran, Vu Ngoc Ninh Dinh, Tran Khang Dang, Bui Bao Hoang","doi":"10.2147/IJNRD.S538153","DOIUrl":"10.2147/IJNRD.S538153","url":null,"abstract":"<p><strong>Background and aims: </strong>The prevalence of insomnia among patients with end-stage kidney disease undergoing hemodialysis is high. Insomnia in patients undergoing hemodialysis may reduce their quality of life. The purpose of this study was to estimate the prevalence of insomnia and to examine the risk factors associated with insomnia among patients with end-stage kidney disease undergoing hemodialysis.</p><p><strong>Subject and methods: </strong>This cross-sectional study included 216 patients with end-stage kidney disease undergoing hemodialysis at 175 Military Hospital, Ho Chi Minh City, Vietnam. Psychiatrists evaluated insomnia using clinical criteria of The Diagnostic and Statistical Mental Disorders, 5th Edition (DSM5). Participants were recruited using convenience sampling at 175 Military Hospital in Vietnam, with all eligible patients invited. Descriptive statistics (counts, percentages, means, standard deviations) were used to describe population characteristics and insomnia prevalence. Data were collected on patients' sociodemographic factors such as sex, age, marital and economic status; clinical factors including duration of end-stage kidney diseases, duration of hemodialysis, number of hemodialysis sessions per week, co-morbidities (diabetes, hypertension…) and environmental factors (eg, excessive noisy or light bedrooms). Logistic regression analysis model was used to analyze the factors associated with insomnia disorders in patients with end-stage kidney disease undergoing hemodialysis.</p><p><strong>Results: </strong>The prevalence of insomnia among patients with end-stage kidney disease was 48.1%. Multivariate logistic regression showed diabetes (OR=0.331 for no diabetes, 95% CI: 0.148-0.738, p<0.01), daytime napping (OR=2.122, 95% CI: 1.159-3.885, p=0.02, excessive noisy or light bedrooms (OR=0.251 for no exposure, 95% CI: 0.074-0.854, p=0.03) were significantly associated with insomnia.</p><p><strong>Conclusion: </strong>The prevalence of insomnia in patients with end-stage kidney disease was high. These results may help clinicians in the dialysis department pay more attention to insomnia symptoms in patients with end-stage kidney disease on dialysis and consider collaboration with psychiatrists to explore treatment strategies is also recommended.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"243-253"},"PeriodicalIF":2.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953946","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 Needle-Directed Thrombolysis in Thrombosed Arteriovenous Fistulas on Angioplasty Efficacy and the Prognostic Factors Associated with Success.","authors":"Yu Zhou, Qiong Lyu, Qiquan Lai, Xuejing Gao, Ling Chen, Xi Zhang, Ziming Wan","doi":"10.2147/IJNRD.S527885","DOIUrl":"10.2147/IJNRD.S527885","url":null,"abstract":"<p><strong>Purpose: </strong>Urokinase thrombolysis is a feasible method for salvage of thrombosed arteriovenous fistulas (AVFs). The impact of optimizing thrombolysis outcomes on improving the efficacy of subsequent angioplasty remains unclear. This study is aimed to investigate the impact of thrombolysis outcomes and to identify the prognostic factors of thrombolysis.</p><p><strong>Patients and methods: </strong>The patients were divided into a complete lysis (CL) group of 336 treatments, an incomplete lysis (IL) group of 83 treatments, and a lysis failure (LF) group of 206 treatments. The efficacy data of the subsequent angioplasty and the patency before the next intervention were compared. Demographics, fistula characteristics, and baseline serum parameters were compared to screen for prognostic factors of thrombolysis outcomes.</p><p><strong>Results: </strong>As the degree of thrombolytic therapy decreased, the complication rate significantly increased (CL, 14.6%; IL, 21.7%; LF, 30.6%; trend P < 0.001), whereas the clinical success rate of angioplasty decreased (CL, 97.0%; IL, 94.0%; LF, 82.3%; trend P < 0.001). However, no difference was noted in the patency interval before the next intervention among the three groups (log-rank P = 0.562). Elbow AVF and hemoglobin < 115 g/L were risk factors of poor lysis outcomes. The complete lysis rate of patients with both factors was 24.2%, whereas the rates of patients with one or neither factor were significantly higher (all > 50% and P = 0.001).</p><p><strong>Conclusion: </strong>Complete thrombolysis is beneficial for improving the efficacy of recanalization procedures for thrombosed AVFs. Non-elbow AVFs and hemoglobin ≥115 g/L are predictors of an increased complete lysis rate.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"215-227"},"PeriodicalIF":2.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674713","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":"Incidence and Predictors of Acute Kidney Injury Among Critically Ill Adult Patients Admitted at Mbarara Regional Referral Hospital.","authors":"Rose Muhindo, Joshua Kiptoo, Christine Tumuhimbise, Caroline Nakyanzi, Francis Gonzaga Ssentongo, Michael Kavubu, Ernest Ssewanyana, John Isiiko, Julius Kyomya, Andrew Mutekanga, Alum Rachel Aguma, Judith Owokuhaisa, Tadele Mekuriya Yadesa","doi":"10.2147/IJNRD.S524082","DOIUrl":"10.2147/IJNRD.S524082","url":null,"abstract":"<p><strong>Background: </strong>Severely ill patients are vulnerable to developing Acute Kidney Injury (AKI), with variable incidence, but limited data from LMICs. We evaluated the incidence, predictors, treatment, and outcomes of AKI among very ill adult patients at a public tertiary hospital in southwestern Uganda.</p><p><strong>Methods: </strong>This prospective cohort study categorized patients who had a NEWS-2 above 5 as critically ill. We used the \"Kidney Disease Improving Global Outcomes (KDIGO)\" definition of AKI as a 0.3 mg/dl increase in serum creatinine within 48 hours. Participants were followed up until day 7 of admission, death or discharge, whichever occurred first. STATA version 13 was used for data analysis. Predictors of AKI were determined by logistic regression.</p><p><strong>Results: </strong>Of 161 critically ill patients, the median age was 48 years (IQR: 31-65). The incidence of AKI was 70 (95% CI 55-90) per 1000 person days of observation. About, 39.1% (127) drugs used during hospitalization were deemed potentially nephrotoxic, and 60% (96) of participants were exposed to at least one nephrotoxic drug. Penicillins and loop diuretics were the most commonly used nephrotoxic drugs. Predictors of AKI included: previous hospitalization in the last 3 months (aOR 2.56, 95% CI: 1.08-6.06, P=0.032), admission to the surgical ward (aOR 4.32, 95% CI: 1.22-15.24, P=0.023), elevated baseline creatinine (>1.2 mg/dl) (aOR 2.44, 95% CI: 1.13-5.27, P=0.023) and elevated baseline WBC count (>12 × 10⁹/µL) (aOR 2.57, 95% CI: 1.21-5.46, P=0.014). Most AKI patients were managed conservatively; 25% of patients with stage 3 received hemodialysis, and 25% of those with incident AKI died in the hospital.</p><p><strong>Conclusion: </strong>We found a high prevalence of AKI among critically ill patients (70 per 1000 person days). Previous hospitalization in the past 3 months, high baseline creatinine, high baseline WBC count and admission to the surgical ward were independently associated with AKI.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"201-213"},"PeriodicalIF":2.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600304","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":"Combining Super-Resolution Imaging and Shear Wave Elastography for Enhanced Risk Assessment of Moderate-to-Severe Renal Fibrosis in Chronic Kidney Disease Patients.","authors":"Xingyue Huang, Yao Zhang, Yugang Hu, Juhong Pan, Xin Huang, Jun Zhang, Huan Pu, Yueying Chen, Qing Deng, Qing Zhou","doi":"10.2147/IJNRD.S528614","DOIUrl":"10.2147/IJNRD.S528614","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the diagnostic efficacy of shear wave elastography (SWE) and super-resolution imaging (SRI) in detecting moderate-to-severe renal fibrosis (MSRF) among patients with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>In this prospective study, 202 CKD patients who underwent SWE and SRI prior to renal biopsy were enrolled. Based on pathological findings, patients were categorized into a mild renal fibrosis group (n=107) and an MSRF group (n=95). LASSO logistic regression was employed to identify independent risk factors for MSRF. Four diagnostic models-isolated, series, parallel, and integrated-were developed by combining elasticity values from SWE and vascular density values from SRI. Additionally, a nomogram incorporating clinical parameters and ultrasound composite parameters was constructed to assess MSRF in CKD patients.</p><p><strong>Results: </strong>LASSO and subsequent logistic regression analysis revealed that age, diabetes history, estimated glomerular filtration rate (eGFR), elasticity, and vascular density were independently associated with MSRF. The integrated model, utilizing a logistic algorithm, demonstrated superior diagnostic performance with an area under the curve (AUC) of 0.83 (P < 0.001), sensitivity of 80.4%, and specificity of 75.8%, outperforming all other models. Furthermore, the nomogram, which integrated clinical factors and ultrasound composite parameters, exhibited excellent predictive performance (AUC = 0.878, 95% CI 0.782-0.974). Calibration and decision curve analyses confirmed the model's robust calibration and clinical utility.</p><p><strong>Conclusion: </strong>The integration of SWE-derived elasticity and SRI-derived vascular density significantly enhances the diagnostic accuracy for MSRF in CKD patients. This comprehensive approach offers a promising non-invasive strategy for assessing renal fibrosis severity.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"187-199"},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575430","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":"Comparative Analysis of Surgical Outcomes Between Robotic-Assisted Pyelolithotomy and Mini-Percutaneous Nephrolithotomy for Renal Stones Larger Than 2 cm in Older Adults: A One-Year Follow-Up Study.","authors":"Hong-An Tu, Shu-Chuan Weng, Yu-Hsiang Lin, Chien-Lun Chen, Yu-Ting Chen, Horng-Heng Juang, Chen-Pang Hou","doi":"10.2147/IJNRD.S532866","DOIUrl":"10.2147/IJNRD.S532866","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the surgical outcomes of robotic-assisted pyelolithotomy (RAPL) and mini-percutaneous nephrolithotomy (mini-PCNL) specifically in older adults with renal stones more than 2cm. We hypothesized that robotic-assisted pyelolithotomy (RAPL) is a safe and effective approach for managing large renal stones (>2 cm) in older adults.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 605 patients aged 50-80 years who underwent either RAPL (n=31) or mini-PCNL (n=574) for renal stones >2 cm at Chang Gung Memorial Hospital, Taiwan, between December 2016 and November 2023. Patients were selected based on predefined inclusion and exclusion criteria. Key outcomes measured included stone-free rate, complication rate, hospital stay duration, and re-intervention rates. All patients were followed for at least one year postoperatively.</p><p><strong>Results: </strong>RAPL patients exhibited a longer total operative time (165.2 vs 127.4 minutes, p = 0.016) but experienced significantly shorter hospital stays (1.8 vs 4.0 days, p < 0.001), lower complication rates (6.5% vs 27.7%, p < 0.05), and higher SFRs (90.3% vs 60.8%, p < 0.001). Blood transfusion, postoperative discomfort, and re-intervention rates were also markedly lower in the RAPL group.</p><p><strong>Conclusion: </strong>For older patients with large renal stones, RAPL is a promising alternative to mini-PCNL, offering better stone clearance, fewer complications, and quicker recovery. Its minimally invasive, tissue-sparing approach benefits those at higher postoperative risk.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"177-185"},"PeriodicalIF":2.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475147","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":"Association of Beta-2 Microglobulin Concentrations with Frailty in Patients Undergoing Chronic Hemodialysis.","authors":"Pringgodigdo Nugroho, Nur Hidayat, Kuntjoro Harimurti, Ikhwan Rinaldi, Eric Daniel Tenda, Andhika Rachman, Suryo Anggoro Kusumo Wibowo","doi":"10.2147/IJNRD.S513968","DOIUrl":"10.2147/IJNRD.S513968","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with Chronic Kidney Disease (CKD) undergoing regular hemodialysis experience various metabolic changes, including premature aging marked by increased prevalence of frailty. Beta-2 microglobulin (B2M), a uremic toxin whose concentration significantly increases in hemodialysis patients, has emerged as a potential biomarker of frailty. Previous evidence suggests potential link between B2M and frailty in older adults. However, data on its relationship with frailty in hemodialysis patients remains limited.</p><p><strong>Purpose: </strong>To determine the relationship between B2M concentration and frailty in hemodialysis patients.</p><p><strong>Patients and methods: </strong>This is a cross-sectional study utilizing primary data from hemodialysis patients at Rumah Sakit Cipto Mangunkusumo (RSCM), employing a total sampling method. Beta-2 microglobulin was measured using the Enzyme-Linked Fluorescent Assay (ELFA) method. Frailty was assessed using the Frailty Index 40-item. Medical history was obtained from medical records and interviews. Chi-square tests were performed to determine the relationship between B2M and frailty. Multivariate analysis was conducted to determine variables that affect frailty.</p><p><strong>Results: </strong>A total of 79 subjects participated in the study. The median B2M concentration was 32.8 (IQR 29.8-36.77). Higher B2M concentration showed a trend toward increased frailty prevalence (PR of 4.83, 95% CI 0.69-33.81, p = 0.113). The final multivariate analysis showed that sarcopenia (PR 5.37; 95% CI 2.88-10.04) was strongly and consistently associated with frailty prevalence.</p><p><strong>Conclusion: </strong>Higher B2M showed a trend towards increased frailty prevalence; however, this association is not statistically significant. Sarcopenia is a significant factor influencing the prevalence of frailty in hemodialysis patients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"18 ","pages":"151-162"},"PeriodicalIF":2.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309846","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}